OP-ED

OP-ED

Op-Ed: Healthcare Reform Lessons From Mayo Clinic

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Mayo_MN_Gonda_3884cp Three goals underscore our nation’s ongoing healthcare reform debate:1) insurance for the uninsured, 2) improved quality, and 3) reduced cost.  Mayo Clinic serves as a model for higher quality healthcare at a lower cost.President Obama, after referencing Mayo Clinic and Cleveland Clinic, advised, “We should learn from their successes and promote the best practices, not the most expensive ones.”

Atul Gawande writes in The New Yorker, “Rochester, Minnesota, where the Mayo Clinic dominates the scene, has fantastically high levels of technological capability and quality, but its Medicare spending is in the lowest fifteen per cent of the country-$6,688 per enrollee in 2006.”Two pivotal lessons from our recent in-depth study of Mayo Clinic demonstrate cost efficiency and clinical effectiveness.

Op-Ed: Jump-Starting Health IT – Best $20 Billion You’ll Ever Spend

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An Open Letter to President Obama and the Congress

Please accept my heartfelt congratulations for recognizing health information technology (IT) as one of the most promising targets for public investment at this crucial moment.

As a (formerly practicing) doctor, I’d diagnose our economy on the verge of a Code Blue, and our healthcare system with a more chronic but equally threatening condition.  You’ve recognized how these two illnesses interrelate, with spiraling healthcare costs damaging business competitiveness and job losses threatening healthcare coverage.  If I may offer a second opinion, I concur 100% with your decision to apply the chest paddles now, charged with $20 billion of investment.

Now I would like to offer this promise: I and my fellow health IT leaders are passionately committed to ensuring that this treatment not only succeeds, but delivers a substantial positive return far exceeding the amount invested.  How can we be so confident?  Well, even a 1% improvement in the efficiency of our $2.2 trillion healthcare spend would put us in positive payback territory.  But we can do better than that, and here’s why:

OP-ED: The MRI Safety Gap

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In health care, particularly in patient safety, there is a cultural predisposition towards excellence. There’s a fundamental desire to create better, safer environments in support of care. That applies to staff qualifications, policies & procedures, medical technology, and—usually—standards for accreditation.

I say ‘usually’ because there is a glaring hole, more than two decades old, in patient safety accreditation standards: MRI (magnetic resonance imaging).

Approximately 1 in 10 Americans—or roughly 30,000,000 people—had an MRI last year. Most if not all of them went through some type of screening and passed signs with cryptic warnings as they entered locked doors to the MRI suite. The screening and warnings are intended to prevent serious accidents and injuries. Ferromagnetic materials (such as oxygen tanks, wheelchairs, cleaning equipment) must be kept outside the MRI suite lest they become magnet-homing missiles, which have killed patients in the past. Patients with contraindicated implants may experience potentially fatal adverse interactions with the MRI’s magnetic field or RF energies, and facilities must prevent MRI devices, which can cost in excess of $2 million, from accidental damage.

OP-ED: Small Business and Health Reform

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Small businesses are among the groups hit hardest and left most vulnerable in our current health insurance system.  Yet, the small business community has been almost uniformly typecast as down on reform.  So goes the conventional wisdom.  But is it true?

This is not solely an academic question.  Where small business stands on health care is critically important to the prospects for meaningful reform in 2009.  As the debate over reform heats up, a whole lot of people – from Members of Congress to the media to the public – will be looking to hear from small business owners to find out where they stand on health care.

Rather than stand around and pontificate about what small business owners are thinking about health reform, we decided to go out and ask them.  To get a beat on small business owners’ priorities, we conducted a survey project in 2008 where organizers in twelve states around the country went door to door, got face to face with local small business owners, and surveyed them about their experiences with health insurance and their perspectives on different reform proposals.

 

The Five Myths of Healthcare Reform

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The arguments that the widespread use of health information technology (HIT), improving health status, expanding outcomes research, implementing pay-for-performance systems, and covering everyone will make it possible for us to afford comprehensive health care reform are commonly cited by people on both sides of the political aisle. It’s all a myth.

Undoubtedly, these ideas will be at the core of any number of health care reform proposals as we begin the 2009 health care reform effort.There is nothing wrong with any of these things and all can make a positive contribution toward improving both the cost of and especially the quality in our health care system. All should be part of a reform proposal.The problem is that none of them would make more than a modest dent in what a reformed system would cost us and not come anywhere near close to
accomplishing the objective of stabilizing our health care costs much less reducing them.

More on the 5 myths of U.S. health care

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A good friend sent me a recent op-ed from the Washington Post that discussed the 5 myths of health care reform by Shannon Brownlee and Ezekiel Emanuel.

I’ve written about both of them before (here & here). Brownlee is a visiting scholar at the NIH’s Clinical
Center, and Emanuel is the chair of the Center’s Bioethics Department.
Ezekiel also happens to be the brother of incoming White House Chief of Staff Rahm
Emanuel’s. Hmmm…

Anyway, I really like most of what they have to say – which will
probably come as a surprise to them – and maybe to some of my
colleagues as well. Their five myths are, in no particular order…

1) America has the best health care in the world.

2) Somebody else is paying for your health insurance.

3) We would save a lot if we could cut the administrative waste of private insurance.

4) Health care reform is going to cost a bundle.

5) Americans aren’t ready for an overhaul of the health care system.

Ethics of the genetic testing marketplace

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Dna

Fresh on the heels of the launch of the deCODE BreastCancer genetic test last week, Dr. Arthur Caplan, renowned director of the University of Pennsylvania Center for Bioethics, said in an article for MSNBC.com that breast cancer gene tests are not worth the price.

If you are worried about your risk of getting the disease, or are thinking about getting a genetic test done for any other reason, talk with your doctor or a genetic counselor who can determine whether your family history justifies the expense. You may be surprised to find that you can make changes in lifestyle and monitoring your own health that can reduce your risk without testing.

Dr. Caplan even goes so far as to accuse genetic testing companies of corporate greed which, given the current economic environment in the U.S., is bound to send shivers down their spine.

With respect to deCODE’s breast cancer genetic test, it examines seven single nucleotide polymorphisms* (SNPs) that are purportedly involved in 60 percent of all breast cancers. Results from the test are given as personal lifetime relatively risk compared to the general population (specifically people of European descent). Other risk factors such as family history, pregnancy history, etc. are not taken into consideration when calculating a deCODE BreastCancer genetic test taker’s risk.

deCODE’s Chief Scientific Officer, Dr. Jeff Gulcher, responded to Dr. Caplan on its blog, deCODE You (a member of the DNA Network) and drew analogies between the BreastCancer genetic test and LDL-cholesterol tests. Anyone who is identified to be at higher risk of breast cancer (or in the analogy, high cholesterol leading to cardiovascular disease) would benefit from greater vigilance, more intensive screening, and possibly, preventive therapy.

Another DNA Network member, Dr. Steve Murphy at Gene Sherpas calls the deCODE BreastCancer test “hype.” Cancer Research UK also believes that “it’s too early for a test of this kind to be released to the general public.” Dr. Len Lichtenfeld of the American Cancer Society does not believe the test will “advance our cause in the fight to reduce deaths from cancer in a meaningful, evidence-based and scientifically accurate way.”

Speaking of cost, though,it seems that 23andMe customers get the better deal because six of the seven SNPs (rs4415084 was on the v1 chip but not on the v2 chip) examined in the deCODE BreastCancer genetic test are included on version 2 of the 23andMe gene chip (I checked using SNPedia) not to mention the other nearly 600,000 SNPs included in the 23andMe report. A 23andMe DNA test costs $399 while a deCODE BreastCancer genetic test costs $1,625.

deCODE’s test offers other bits and fancy algorithms for calculating risk to justify the price. But customers should be aware that there is more than one way to get the genetic data they desire. And that data’s worth can be hard to price.

*See the list of SNPs in this sample report (pdf).

Hsien-Hsien Lei (pron. shen-shen lay) is a PhD-trained epidemiologist and biotech consultant. She blogs regularly at Eye on DNA, where this post first appeared. She is a consultant to DNA Direct, a genetic testing company.

Quotable

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We asked THCB contributor Maggie Mahar for her quick take on the health care policies of each of the presidential candidates. We were pretty much expecting one of Maggie’s trademarked dissertations – a meticulously researched critique of each politician’s views on various important substantive issues. Instead this entertaining reply turned up in our email inbox.

“If Clinton wins we have real national health care reform.

If Obama wins, I’m not so sure, given that Cutler thinks we’re getting value for our dollars, and healthcare doesn’t seem to be a big priority for Obama (although his plan seems a lot like hers).

If McCain wins, we all move to Canada. Northern Canada, where will not only have healthcare, but may be able to avoid the fall-out from the nuclear war that he starts.”