AbbyLane2001
Membership Revoked
http://www.sightings.com/general10/seekas.htm
Cancer Hospitals Now Refusing
Patients Seeking Second Opinions http://www.msnbc.com/news/580621.asp
5-31-1
It's a wrenching and controversial change. The practice of a patient diagnosed with terminal cancer securing a second - or, as is often the case, a third, fourth or even fifth - opinion from a prestigious cancer center is a time-honored tradition in American medicine. But some of the top centers are instituting systems that limit the ability of such patients to have their cases reviewed.
It,s partly a matter of dollars and cents. The patients in question may have few available treatment options, and, for many medical centers, reviewing massive amounts of charts, X-rays, pathology slides and CAT scans for a patient with a complex and long medical history has become economically unfeasible.
The shift is taking place at a time when second opinions are increasingly in demand. Drug and treatment breakthroughs are holding out hope that cancer can be arrested or even licked. Managed-care organizations are encouraging consultations with respected specialists (before steering patients to less expensive local hospitals for treatment). Thus, Americans are fanning out aggressively in search of the most advanced care. But this rising tide of desperate patients is reaching hospitals as they struggle with soaring costs and declining income.
Consequently, major medical centers are seeking patients who will undergo full treatment, as opposed to outpatients seeking a second opinion. The hospitals are also generally cutting back on consultations for people already diagnosed or being treated for cancers that are too advanced to respond to care.
Some major cancer-treatment centers " among them, City of Hope hospital in suburban Los Angeles and the Yale Cancer Center in New Haven, Conn. " say they are resisting the trend. But those that are tightening the rules make up a roster of medical renown.
At M.D. Anderson cancer center in Houston, patients with advanced breast or gastrointestinal cancer trying to obtain a second consultation may have to stand in line, says Thomas Burke, a leading oncologist there. M.D. Anderson, which was recently named the nation,s No. 1 cancer center in an influential survey, has in recent years experienceda a surge in calls from gravely ill people seeking an opinion.
The upshot: M.D. Anderson has implemented a triage system that is simple and efficient. Cancer patients who are newly diagnosed and coming for treatment are "given a priority appointment within days or a week, Dr. Burke explains. "If you are requesting a second opinion it might take four and five weeks, particularly in busy cancer specialties. In some cases, trained nurses using specially developed criteria tell patients over the phone it may not be worth their while to make the trip to Houston.
Dr. Burke, among others, believes that limiting second-opinion consultations could turn out to be humane " that it,s actually kinder to spare a dying person another disappointment. "It is really a disservice to lead those patients on, to bring [across the country] someone who has failed four or five regimes and has metastatic cancer, he says, arguing that that it is more ethical to tell them "up front the Texas center has nothing to offer.
M.D. Anderson told the Rev. H. James Reamy that it had no "salvage therapy and "no protocol for him, says the 68-year-old retired priest from Sebastian, Fla. Father Reamy says he called M.D. Anderson recently, after his local options for fighting advanced bladder cancer ran out. He says a staffer informed him that the cancer center had nothing to offer him. "I took that as their way of saying that had I come to Anderson to begin with, they would have given me all sorts of miraculous stuff, he says.
Still, the spunky priest called back the following day and confronted the cancer center. "I need to know why are you rejecting me, he remembers asking a woman at the other end of the line. After repeating that M.D. Anderson had nothing to offer, Father Reamy recalls, the woman offered him an appointment with a specialist " at the end of June.
"I don,t want to wait this long, says the distraught priest. "I have this growing in my neck and I could tell when it was shrinking and I could tell when it is growing again.
Dr. Burke says that Father Reamy dealt with one of the triage specialists, who had his records reviewed by a physician. "What was offered to the patient is that we would be happy to speak with your oncologist at home to discuss options of conventional treatments or we could review your records as a formal second opinion at a distance or we could bring you on a nonpriority schedule, Dr. Burke explains.
Father Reamy,s oncologist, Frederick Weeks, who practices in Vero Beach, Fla., says he understands the need for a triage system. "I think that they are overwhelmed, he says of institutions such as M.D. Anderson and Memorial Sloan-Kettering in New York City. It can be a kindness, he contends, to spare patients a long trip for a useless consultation.
Medicare will pay roughly $190 for a specialist,s consult and about $265 for an in-depth visit entailing a report for the referring physician. But, considering costs, the hospital itself may not make a dime unless "ancillary services, such as new X-rays or CAT scans, have to be performed (Medicare pays for those.)
Insurers pay more than Medicare " $500 for the doctor,s consult, says Michael Gutnick, chief financial officer at Memorial Sloan-Kettering. Even so, second opinions " in effect, lengthy office visits " tie up doctors, time with patients who are often incurable and who will usually be treated elsewhere. That time is best spent treating patients who perhaps can be cured " and who will use more of the hospital,s facilities, Mr. Gutnick points out.
Memorial has a twofold approach. It has an aggressive ad campaign in place, urging people to come to it early after being diagnosed. It is also trying to implement a computerized triage system aimed at sorting out those likely to survive from its applicant pool and giving their care top priority.
Even the world-renowned Mayo Clinic, where a complex second opinion could cost thousands of dollars, has tried to limit them in some overbooked specialties. In some cases, patients are offered the option of getting a second opinion by mail.
Since many of the nation,s premier cancer centers conduct clinical trials, it might be thought that patients with advanced cancer seeking second opinions would be likely subjects. But researchers are increasingly looking for younger and healthier patients, explains Samuel Kopel of Maimonides Medical Center in Brooklyn, N.Y. Defending the practice, Dr. Kopel says it,s tough to get a reading on a drug,s efficacy with patients who have failed multiple treatments.
Resisting the tide away from second opinions can be expensive for a hospital. City of Hope, where a comprehensive review of a complex case can cost the hospital $3,500, charges the patient a flat $500 fee. Gil Schwartzberg, the Los Angeles hospital,s chief executive and a former business executive, says he always worries that losses at the hospital could "spiral out of control. Still, he decided that "second opinions are non-negotiable, he says. "A cancer center exists to provide these opinions.
Vincent DeVita, who runs the Yale Cancer Center, concurs. "Cancer patients have a terrible time " they are under extraordinary stress. How can you wait for a second opinion for a month? It is not good medicine, he says.
Dr. DeVita says categorically he would not install such a system at Yale, even if the center were "jammed with patients. Besides, he says, "sometimes it is a major help, lives are saved, and I can,t imagine this process ought not to go on. (The Yale center declines to discuss its second-opinion charges.)
Noting that doctors are the first to want a second opinion when they or their loved ones are involved, Dr. DeVita says, "I have never in my entire life taken care of a doctor who didn,t get a second opinion. And you know what? They don,t want it tomorrow. They want it yesterday.
Copyright © 2001 Dow Jones & Company, Inc. All Rights Reserved.
[ 06-01-2001: Message edited by: AbbyLane2001 ]
Cancer Hospitals Now Refusing
Patients Seeking Second Opinions http://www.msnbc.com/news/580621.asp
5-31-1
It's a wrenching and controversial change. The practice of a patient diagnosed with terminal cancer securing a second - or, as is often the case, a third, fourth or even fifth - opinion from a prestigious cancer center is a time-honored tradition in American medicine. But some of the top centers are instituting systems that limit the ability of such patients to have their cases reviewed.
It,s partly a matter of dollars and cents. The patients in question may have few available treatment options, and, for many medical centers, reviewing massive amounts of charts, X-rays, pathology slides and CAT scans for a patient with a complex and long medical history has become economically unfeasible.
The shift is taking place at a time when second opinions are increasingly in demand. Drug and treatment breakthroughs are holding out hope that cancer can be arrested or even licked. Managed-care organizations are encouraging consultations with respected specialists (before steering patients to less expensive local hospitals for treatment). Thus, Americans are fanning out aggressively in search of the most advanced care. But this rising tide of desperate patients is reaching hospitals as they struggle with soaring costs and declining income.
Consequently, major medical centers are seeking patients who will undergo full treatment, as opposed to outpatients seeking a second opinion. The hospitals are also generally cutting back on consultations for people already diagnosed or being treated for cancers that are too advanced to respond to care.
Some major cancer-treatment centers " among them, City of Hope hospital in suburban Los Angeles and the Yale Cancer Center in New Haven, Conn. " say they are resisting the trend. But those that are tightening the rules make up a roster of medical renown.
At M.D. Anderson cancer center in Houston, patients with advanced breast or gastrointestinal cancer trying to obtain a second consultation may have to stand in line, says Thomas Burke, a leading oncologist there. M.D. Anderson, which was recently named the nation,s No. 1 cancer center in an influential survey, has in recent years experienceda a surge in calls from gravely ill people seeking an opinion.
The upshot: M.D. Anderson has implemented a triage system that is simple and efficient. Cancer patients who are newly diagnosed and coming for treatment are "given a priority appointment within days or a week, Dr. Burke explains. "If you are requesting a second opinion it might take four and five weeks, particularly in busy cancer specialties. In some cases, trained nurses using specially developed criteria tell patients over the phone it may not be worth their while to make the trip to Houston.
Dr. Burke, among others, believes that limiting second-opinion consultations could turn out to be humane " that it,s actually kinder to spare a dying person another disappointment. "It is really a disservice to lead those patients on, to bring [across the country] someone who has failed four or five regimes and has metastatic cancer, he says, arguing that that it is more ethical to tell them "up front the Texas center has nothing to offer.
M.D. Anderson told the Rev. H. James Reamy that it had no "salvage therapy and "no protocol for him, says the 68-year-old retired priest from Sebastian, Fla. Father Reamy says he called M.D. Anderson recently, after his local options for fighting advanced bladder cancer ran out. He says a staffer informed him that the cancer center had nothing to offer him. "I took that as their way of saying that had I come to Anderson to begin with, they would have given me all sorts of miraculous stuff, he says.
Still, the spunky priest called back the following day and confronted the cancer center. "I need to know why are you rejecting me, he remembers asking a woman at the other end of the line. After repeating that M.D. Anderson had nothing to offer, Father Reamy recalls, the woman offered him an appointment with a specialist " at the end of June.
"I don,t want to wait this long, says the distraught priest. "I have this growing in my neck and I could tell when it was shrinking and I could tell when it is growing again.
Dr. Burke says that Father Reamy dealt with one of the triage specialists, who had his records reviewed by a physician. "What was offered to the patient is that we would be happy to speak with your oncologist at home to discuss options of conventional treatments or we could review your records as a formal second opinion at a distance or we could bring you on a nonpriority schedule, Dr. Burke explains.
Father Reamy,s oncologist, Frederick Weeks, who practices in Vero Beach, Fla., says he understands the need for a triage system. "I think that they are overwhelmed, he says of institutions such as M.D. Anderson and Memorial Sloan-Kettering in New York City. It can be a kindness, he contends, to spare patients a long trip for a useless consultation.
Medicare will pay roughly $190 for a specialist,s consult and about $265 for an in-depth visit entailing a report for the referring physician. But, considering costs, the hospital itself may not make a dime unless "ancillary services, such as new X-rays or CAT scans, have to be performed (Medicare pays for those.)
Insurers pay more than Medicare " $500 for the doctor,s consult, says Michael Gutnick, chief financial officer at Memorial Sloan-Kettering. Even so, second opinions " in effect, lengthy office visits " tie up doctors, time with patients who are often incurable and who will usually be treated elsewhere. That time is best spent treating patients who perhaps can be cured " and who will use more of the hospital,s facilities, Mr. Gutnick points out.
Memorial has a twofold approach. It has an aggressive ad campaign in place, urging people to come to it early after being diagnosed. It is also trying to implement a computerized triage system aimed at sorting out those likely to survive from its applicant pool and giving their care top priority.
Even the world-renowned Mayo Clinic, where a complex second opinion could cost thousands of dollars, has tried to limit them in some overbooked specialties. In some cases, patients are offered the option of getting a second opinion by mail.
Since many of the nation,s premier cancer centers conduct clinical trials, it might be thought that patients with advanced cancer seeking second opinions would be likely subjects. But researchers are increasingly looking for younger and healthier patients, explains Samuel Kopel of Maimonides Medical Center in Brooklyn, N.Y. Defending the practice, Dr. Kopel says it,s tough to get a reading on a drug,s efficacy with patients who have failed multiple treatments.
Resisting the tide away from second opinions can be expensive for a hospital. City of Hope, where a comprehensive review of a complex case can cost the hospital $3,500, charges the patient a flat $500 fee. Gil Schwartzberg, the Los Angeles hospital,s chief executive and a former business executive, says he always worries that losses at the hospital could "spiral out of control. Still, he decided that "second opinions are non-negotiable, he says. "A cancer center exists to provide these opinions.
Vincent DeVita, who runs the Yale Cancer Center, concurs. "Cancer patients have a terrible time " they are under extraordinary stress. How can you wait for a second opinion for a month? It is not good medicine, he says.
Dr. DeVita says categorically he would not install such a system at Yale, even if the center were "jammed with patients. Besides, he says, "sometimes it is a major help, lives are saved, and I can,t imagine this process ought not to go on. (The Yale center declines to discuss its second-opinion charges.)
Noting that doctors are the first to want a second opinion when they or their loved ones are involved, Dr. DeVita says, "I have never in my entire life taken care of a doctor who didn,t get a second opinion. And you know what? They don,t want it tomorrow. They want it yesterday.
Copyright © 2001 Dow Jones & Company, Inc. All Rights Reserved.
[ 06-01-2001: Message edited by: AbbyLane2001 ]
