Friday, December 7, 2018



Op-Ed: Leave it to Darwin?


Roger collierI’ve been reading some of the testimony on delivery system reforms from the House Ways and Means  Committee meeting earlier this month, in particular the lengthy statements from MedPAC Chairman Glenn Hackbarth and Urban Institute Senior Fellow Dr. Robert Berenson.  Hackbarth and Berenson are each distinguished health care figures, and their remarks are worth careful study. Together, they paint an all too familiar gloomy picture of a system whose costs are out of control, in which quality is often poor, and where there is little correlation between expenditures and outcomes. Few would disagree with the causes that they identify: payment structures that reward volume, lack of coordination among providers, an overemphasis on specialty care, and a system that seems more often driven by supply than demand. The two sets of testimony include several very important recommendations, like more emphasis on public health, dissemination of comparative effectiveness information, and higher payments for primary care (although several years will elapse before this makes a real impact on physician career choices).

Other testimony proposals, however, especially those focused on
Medicare, carry the risk of distracting us from more important changes.
Chronic care coordination (including the medical home model) has not
yet convincingly been demonstrated to cut costs. Accountable care
organizations (this year’s buzz-phrase) require more willingness to
cooperate than many providers have so far shown. Bundled
hospitalization payments make good sense but require the same kind of
willingness to cooperate. Tying payments to quality introduces
questions of data interpretation and validity of guidelines.  

Beware the Bursting of the Health Care Bubble


George Lundberg The good news is that if and when the American healthcare bubble bursts, some value will remain. The bad news is that the annual appropriate value could actually be only about 60% of the current expenditure.

The turn of the 21st Century has been marked by the creation, expansion, and im/explosion of at least 3 significant economic “bubbles”: the huge company Enron, plus the fields of dotcom and real estate/finance. A “bubble” comes to pass when a commodity of great promise and wide applicability entices many to participate and grows at a pace that reflects hope, excitement, sometimes greed, but does not have sufficient underlying  substance to support its continuing growth.

The demise of the fraudulently inflated Enron forecast much of this decade’s  financial  collapse.  A once successful oil and gas distribution company, Enron enjoyed accelerated growth in an essential field. But it came acropper by fakery, derivatives, and manipulation, out of synch with sound principles for sustaining value. When the trickery was exposed, little remained . Enron had become a “bubble” company with a top stock price of $90 in 2000 that shrunk to pennies.  This emperor had no clothes. It was a house built of Texas sand.

Op-Ed: Cost-Reduction Strategies Help Hospitals Weather Economic Uncertainty


David Markoski In today’s current economic climate, many hospitals are reducing staff to cut costs and balance their budgets. An even greater number are trying to reduce administrative costs to save money for the difficult days ahead and retain their employees.While reducing staff may help the bottom line, it may threaten a hospital’s long-term success by jeopardizing quality patient care and its reputation. Cutting non-salary costs, meanwhile, may save as much—or more—while kick-starting organizational recovery when the economy improves. Since these cost reductions do not compromise patient care or the level of support hospitals provide to their physicians, they create long-term efficiencies that will serve the hospitals into the future.Employee compensation accounts for the single largest item on a hospital’s budget, but the aggregated costs of goods and services are greater. These costs represent dozens of money-saving opportunities—from supply chain management and physician-preference items to service contracts and pharmacy—that can impact the bottom line without affecting patient care.

Op-Ed: Patients first. Doctors second.


Arun As part of the recently enacted stimulus bill the federal government is spending $19 billion to promote the adoption of electronic medical records by physicians.  Yet, with all the focus on doctors, lawmakers have forgotten the most critical piece of the puzzle — patients.

Take the case of Joe (not his real name), a patient who came to see one of us recently. Joe is a thirty-something year-old with type 1 diabetes. After a rebellious few decades that included dozens of hospitalizations, he was finally re-engaged in his care. His most recent request — to access his electronic medical record. Joe wanted to track his hemoglobin A1c, an important marker of his diabetes, follow his blood pressure and take a closer look at his cholesterol. After all, it is his information in the clinic's commercially available electronic medical record.  Sadly, his request couldn't be honored. Patient-access features simply hadn't been built in.

Health information technology offers great promise to patients. Patients can access their medical information online, communicate with doctors by email, schedule appointments through the web and take advantage of numerous tools to manage their own illnesses. They can become equal partners in their care.

Op-Ed: Seven Strategies to Address the Nation’s Health Care Crisis


Susan_Blumenthal_SOH_Photo1 America's health crisis does not have either a single cause or a silver bullet solution. Yet previous attempts at reform have often focused too narrowly on the financing and delivery of health care. In a report released last week, a Commission of national health experts convened by the Center for the Study of the Presidency and Congress (CSPC) emphasizes a wide spectrum of actions needed to become the healthiest nation in the world. The Commission on U.S. Federal Leadership in Health and Medicine: Charting Future Directions that we co-chair has identified seven strategies to mobilize all sectors of American society to help put "health" into our nation's health care system.

The report, New Horizons for a Healthy America: Recommendations to the New Administration, adopts a comprehensive perspective in framing its seven recommended strategies for a high-performance health care system and a healthier nation. These recommendations include:

Issue a Presidential Call to Action for a "Healthy U.S." The
Administration, working with Congress, should set a bold framework for
action for improving health in the United States (Healthy U.S.),
mobilizing all sectors of society and emphasizing comprehensive health
promotion, disease prevention, and the delivery of high quality medical
care .

Establish "Health in All Policies."  Marshal the leadership and
resources of the more than 40 federal agencies that address health into
a coordinated, synergistic effort.

Op-Ed: Health care reform is within reach


-1In recent weeks, President Obama has gotten flack for insisting that, despite the nation’s urgent economic  problems, “health care reform
cannot wait.”

On this point, though, he’s absolutely right. But that doesn’t mean we
need more government programs. What we need is a focus on chronic

Chronic diseases are among the most serious public health threats
facing the American people today. These conditions, which include
diabetes, chronic kidney disease, cardiovascular disease and cancer,
often last for years, requiring frequent treatment throughout a
person’s life. The toll they exact on American patients is appalling,
accounting for 70 percent of all deaths in the United States.

America’s exorbitant health care spending is also linked to these
destructive illnesses. In fact, 75 percent of the more than $2 trillion
spent on health care in the United States goes toward caring for those
with chronic conditions. Heart disease and strokes alone cost the
American people $448 billion in 2008.

Op-Ed: Dropping Cancer Death Rates and the Role of Radiation Therapy


Mackie_rockRadiation therapy is the most overlooked of cancer therapies. While attention has primarily been given to  chemotherapy and immunotherapy, the truth is that for every 100 people who survive cancer, about 50 can principally thank surgery, 45 are alive because of radiation therapy and perhaps 5 survive due to all other therapies. As cancer death rates continue to decline, we must recognize and support the critical role that radiation therapy plays in this trend.

Of the $2.2 trillion spent by the U.S. economy on healthcare, less than one percent (about $800 million) is spent on radiation therapy equipment—this, despite the fact that radiation therapy serves as our safest, most convenient and cost-effective method of treating cancer.

Op-Ed: Surgeon Shortage Worries Rural Doc


Now that I’ve reached my mid-50s, I sometimes think about retirement, and to be honest it worries me.
  I’m not talking about the typical things you worry about pre-retirement, such as the loss of income or lifestyle changes.  I worry about what will happen to my patients.

Why?  For the simple reason that it will be hard to replace me. This isn’t my ego talking: there simply aren’t nearly enough new surgeons coming along to replace me – or my other contemporaries, for that matter.

I work in Glasgow, Montana, a town of 3,500 in northeastern Montana that is about as rural as it gets.  I serve more than 20,000 patients in an area that runs 100 or more miles in every direction except north past the Canadian border. I’ve been on call essentially every hour of every day since I came to Montana over 20 years ago.

Op-Ed: No Need for Alarm Over Need for Foreign Nurses


Recent news coverage (“Amid Nation’s Recession,
More Than 200,000 Nursing Jobs Go Unfilled,” Reuters, March 8th) validly
and vividly calls attention to a nursing shortage in the U.S. healthcare system that
“threatens the quality of patient care even as tens of thousands of
people are turned away from nursing schools, according to experts.”

That article adds, “The shortage has drawn the
attention of President Barack Obama. During a White House meeting on Thursday
to promote his promised healthcare system overhaul, Obama expressed alarm over
the notion that the United States
might have to import trained foreign nurses because so many U.S. nursing jobs are

Importing internationally-trained nurses is no cause for
alarm.  The fact is, at least in the short term, the U.S.does have to
import these nurses, and plenty more of them, if we are to meet our rapidly
growing healthcare needs.  Don’t understand why?  Consider the

Op-Ed: Pathway for FOBs Should Balance Need for Competition and Need for Innovation


President Obama's first budget calls for the creation of a regulatory pathway for the creation of follow-on, or biosmiliar, biologics. This is obviously now the most high-profile call yet to move forward with a system that will provide the benefit of biotech drugs to patients who need them the most.

The biotech industry has done an outstanding effort in the last 10 years producing some of the most high-tech but also the most expensive drugs on the market. Some biotech medicines cost hundreds of thousands of dollars each year. Many of these products face no competition, because there is no legal way for a generic version of the product to get on the market. Individual patients as well as the healthcare system generally simply cannot absorb these continually rising costs.

To date, the debate over follow-on biologics has been mostly political posturing between the trade groups that represent the generic drug industry and the pioneering companies. The generic industry wants biotech companies to have only three to five years of market protection after bringing a new drug to market. The industry counters it needs up to 14 years of exclusivity to recapture its investment costs, which can reach over $1 billion for a single product.