Tuesday, October 2, 2012

Perils of Personalized Medicine
The entire structure of ObamaCare is designed specifically to remove important (i.e., costly) medical decisions from the purview of the individual doctor and patient. The role of the doctor is now to relay expert-guided determinations of what is best for the herd down to the level of the individual patient, and to do it in such a way that their patients do not realize that the doctor’s recommendations are population-based, and not tailored to their own needs
Richard N. Fogores, MD, author of  Open Wide and Say Moo! The Good Citizen’s Guide to the Right Thoughts and Right Actions under Obamacare . Dr. Fogores  blogs at the The Covert Rationing Blog
October 2, 2012 -  We are entering the age of personalized and individualized medicine.  It is now possible to attach or implant sensors to  track and react to a patient’s disease from a distance.  Not only that, one can assess how an individual  will respond  to treatment by studying their genetic makeup.   All of this in an era of “patient-centered care,” where a patient’s individual needs are paramount.
Or so it seems. 
The trouble is Medicare  has not seen fit to pay for attached and implanted sensors and genetic tests, except in extreme cases of kidney or bone marrow transplants.  
Another  problem is that Obamacare rests on the pillar that health care ought to be “population-based,” rather than “individualized.” 
Treatments and testing, say the Obamacare sages,  ought to be standardized, homogenized, and based on clinical trials of large populations,  rather than what an individual physician thinks ought be done for an individual patient.  Everything, to use federal jargon, ought to be “evidence-based.”
Enter Big Data, clinical algorithms, and performance protocols, which will dictate and foretell what Medicare, the $1 trillion payment gorilla which private payers assiduously follow,  will pay for.
According to John C. Goodman, in his health alert blog, “Can Personalized Care Survive Obamacare’s Assembly Line  Medicine?, Medicare, in its bureaucratic wisdom, has created these obstacles to personalized medicine.
1.    has yet to create  payment codes for sensors or genetic tests;

2.    must agree to pay for personalized tests and  procedures, something Medicare so far has been unwilling to do;

3.    will likely place price controls on individualized tests and procedures, making them unprofitable to order or perform;

4.    will regulate physician response to data, which  will differ from patient to patient, and will therefore not be standardized, which defeats the  purpose of Obamacare, i.e, standardization and homogenization;

5.    will place the doctor in an untenable position because sensor and genetic data will generate complex “data dumps, “ all the details of which the physician may miss, and which will be grist for the mill of malpractice attorneys.

Goodman’s bottom line?  “We need to bring public policy into the modern age.”

Tweet:  Because  of Obamacare’s and CMS’ bureaucratic  policies,  the era of personalized, individualism, patient-centered care may be slow to dawn.

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