Outrageous if true:

Lovekitties said:

Outrageous for sure

While the app itself is a dangerous tool for all patients, I am very angry that any physician would accept payment for "not treating the patient" outside of an insurers guidelines.  The $350 per patient mentioned in the article could mean the difference between life and death.  To me this smacks of medical malpractice, and in the case of a death negligent homocide.

This is not the first report, nor will it be the last, of an insurer getting between the patient and what treatment they need.

I pray that there are enough ethical doctors out there who will say "no thanks" to the app and the payments and have their patient's best interest in mind as they treat them.

As patients and caregivers we must remain vigilant and be willing to push for treatments, diagnostic testing, etc. that can mean more time.  I know for my sister, the last chemo treatment she received was only a week before she died.  The doctor would have recommended not getting it but my sister said she wanted to keep trying.  That was enough for the doctor to approve it.

My article was based on direct interaction with the principals..Dr. Resmhi Jadghi told an ASCO cost-effectiveness session, “Physicians cannot pretend that their sole duty is to the patient…Resources are finite, and allocation must occur.” Similarly, Dr. Scott Ramsey an oncologist involved in developing the app suggests denying patients “costly new technology -- even if cost-effective -- if it “results in budget pressures that may force restrictions in the use of other technologies by the poor, disabled, minority groups.” 

Nearer to the root of the current medical crisis are:

lack of implementation and competition with existing technologies for an order of magnitude cost reduction e.g. generic oral chemo, cimetidine and celecoxib. Many stage IV's spend $30-50,000/month, we spend under $1000 - such a "unicorn" exists;

barriers to entry for new types of medical providers and institutional resistance to radical improvement;

the population's knowledge level on health, nutrition and science (ditto, medical schools);

large portions of the population not taking responsibility for their own health;

parasitic financial structures or relationships.  

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Rationing schemes will fail and cause great misery. Radically improving the results through voluntary means at lower cost is the only way to succeed. Unfortunately we keep increasing the costs/price of failing medical care with so many "experts" and involuntary prescriptions, while punishing or disabling self responsibility and leaps of cost effectiveness.

What a hot potato this one is.  I need to learn more about the public health model.  What little I have heard sounds much like the earlier comments about investment in the dying.

With the cost of medical training in this country with student loans at >8% in some cases.  The doctors seemingly start out behind the eight ball.  There are some debt foregiveness programs for physcians under certain circumstances.  

My point is that there is a parasitic relationship which is fostered by financial necessity.  Running afoul of the insurerers may mean a total inability to practice at all.  Leaving these new doctors at the mercy of the predatory student loan machine.

This represents a daily ethical dilemna.  Treat the many or fall on the preverbial "sword" for the one.  I HATE THIS PART!!! Doing the right thing should not pivot on some bean counter's opinion of what is best for me.  Especially since these are often people in exceptional health with first class insurance; unlike me.  Doing the right thing should not be so seemingly tentative.

Paying physcians by the occurence not fee for service smacks of capitation.  Leaving the doctors to accept more of the financial risks for treatment decisions.  Potentially, further stretching the liability away from the administrator and onto the physician.

I would not like to be the one who has to decide what is adequate care...

Sorry for the rant. 

Art