McAllen,Texas and Medicare Overspending
by Dr. Tony Magana
Does McAllen, Texas deserve notoriety as the most expensive place for Medicare recipients or is it just a convenient focal point of diversion for politicians who want to avoid the real issues?
The city of McAllen Texas has been in the unwelcome spotlight this month because of an article in the New Yorker Magazine by Atul Gawande discussing the fast rising costs of health care in the area. Dr. Gawande recently visited doctors and hospitals in the area after a review published in the New England Journal of Medicine showed McAllen area hospitals to be among the highest Medicare spenders.
Both Dr. Gawande and Dr. Eliot Fisher , the author of the NEJM article, came to the conclusion that overuse of facilities and technology by doctors is wasting money and possibly puts patients at risk for complications from unnecessary procedures.
Traditionally medical practice was seen as art supported by science. Practitioners were trained to treat diseases by apprenticeship and experience. There has been a movement in medicine away from individual thinking and more to adopting best practices. Doctors within each field of medicine would come to a consensus on guidelines how best to treat conditions rather than relying upon their own particular experience.
For health care planning the use of guidelines becomes very necessary. Estimating the cost of health care for a population requires that first a reasonable estimate of the occurrence of illness that is going to occur over time be made and then followed by a reasonable estimate of the cost of treating those maladies. If every doctor is treating the same condition that same way then costs, benefits, and complications are much easier to track.
This approach to medicine means that most of the time the patient is going to receive the right care but does not really allow for individualization. Doctors who treat patients in a manner that varies from these norms run the risk that they will be criticized. The benefit of such a program is that it potentially brings economy and a standard of care nationwide but there is also a cost.
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There is no doubt that at current spending levels the Medicare program which funds over 50% of all health care in America will go broke by 2017. Unfortunately health care expenditures do not increase directly the economic output of the nation but remain a cost. As science moves forward we will find more ways to help people live longer lives that is certain. However, technology and preventative care do not save money as advertised by some politicians. Our main defense against future higher health care costs must be and can only be a more productive economy with higher employment levels and truly higher wages by highly educated employees.
Cookbook medicine that follows strict guidelines may save money but is not without problems. Some researchers like Dr. Robert A. Berenson and Jack Hadley of the Urban Institute have shown sometimes places which have high costs for health care may be justified in doing so even if some basic outcomes measurements suggest otherwise.
Not allowing for variation in treatments runs the risk that health care will become stagnant. Also if the research done is only looking at costs or hospitalization or even complications it may miss important issues such as patient satisfaction. Some patients may be better served by straying from the norm by intangible factors.
The tone of Dr. Gawande article was critical of physicians in the Rio Grande Valley area for owning portions of hospitals or diagnostic facilities although it admitted that these situations alone would not account for the overall expenditures. It is possible that doctors who own portions of hospitals or diagnostic facilities can “overuse” them as alleged by Dr. Gawande. On the other hand there may other factors that play a role in the high cost of health care for Medicare patients in the McAllen area.
Drs. Gawande and Fischer have the luxury to practice medicine in sophisticated urban areas of high income and education in regions of the country where the majority of the population has never experienced difficulty with access to care.
The Valley population contains one of the most uneducated and poverty stricken regions in the United States which is 90% Hispanic. Medical researchers have documented that many times this ethnic group will seek treatment for conditions such as chest pain indicating heart disease much later then most Americans. Physicians who deal with patients and their families in this population must also deal with a history of mistrust of institutional medicine which just a few decades ago severely restricted access to this population.
Family members often accompany older non-English speaking elderly patients for medical visits. Telling them that abuelita(grandmother) may have a heart problem which may require future surgery or angioplasty but first can be treated with just medicine can easily be perceived as “rationing” care for the poor. Many of these patients are on both Medicaid and Medicare so they never experience any personal out of pocket costs. The good news is that this does not obstruct their access to care but the bad news is that potentially opens a flood gate for abuse.
The New York Times today reported that President Obama, himself, has specifically looked at the situation in McAllen, Texas as a problem area for overspending. The likely outcome is that there is going to be some cutbacks in payments for hospitals, medical specialists, and equipment but perhaps an increase in payments to primary care and preventative services nationwide.
Everyone agrees that the status quo cannot be continued. But putting McAllen’s doctors in the situation of having to explain to family members why abuelita cannot have the best technology, like they have in Houston, just to “save money” will not work. The politicians should take the responsibility to explain to the public the realities of health care spending and why there may have to be limits. Because in the long run, society will not get as angry at the doctors for doing too much for abuelita as they could against the politicians who they perceive wanted to to do too little.
Thanks for reading Contempo Magazine blog which discusses issues for McAllen, the Rio Grande Valley, and America from a conservative Hispanic point of view. Tony Magaña grew up in McAllen Texas, attended Texas A&M University, served as an officer in Army Reserve, and holds a doctorate from Harvard University. The co-founder of Contempo Magazine has participated in Valley business for over 20 years. He is a member of the National Association of Hispanic Journalists and also writes for the American Daily Review. Follow him on twitter http://twitter.com/contempomagazin
