Month: January 2012

Recession Drives Lower Health Spending

Jan 10, 2012

By Merrill Goozner

The Great Recession has achieved what 20 years of policy machinations in Washington could not. For the second straight year, the world’s most expensive health-care system did not gobble up a greater share of the nation’s economy. In fact, health care grew at a slightly slower pace.

Health spending rose just 3.9 percent to $2.59 trillion in 2010, only one-tenth of a percentage point faster than the previous year. That was slightly below the 4.2 percent nominal growth in gross domestic product (GDP), which means health care stayed at 17.9 of the total economy, no different than the prior year.

This represents the third straight year of markedly slower growth in health-care spending, compared to the prior decade. Health care was 13.8 percent of GDP in 2000 and 12.5 percent in 1990.

The lingering effects of the U.S. economic slowdown were largely responsible for a slower growth of health-care consumption, economists at the Centers for Medicare and Medicaid Services said. Cash-strapped consumers postponed elective surgeries, put off doctor visits and switched to generic drugs to hold down out-of-pocket costs, which grew just 1.8 percent in 2010.

The economic downturn “caused many people to lose employer-sponsored health insurance and people cut back on their use of care,” said Anne B. Martin, an economist at the Centers for Medicare and Medicaid Services.

What Doctors Can Learn from the New England Patriots

Jan 9, 2012• 17

By Davis Liu, MD

As the new year starts, I’m eager for a fresh start and working on improving myself both physically and emotionally. I’m also eager for the NFL playoffs and seeing how my favorite team, the New England Patriots, fares under the leadership of Coach Bill Belichick and quarterback Tom Brady. Doctors and health care can learn much from their examples.

Over the past decade, the New England Patriots have been dominant appearing in 40 percent of the Super Bowls played and winning 3 out of 4. Nothing prior to 2000, would have suggested this superior performance with playoff appearances only six times from 1985 to 2000 and two Super Bowl appearances, both losses. Their new head coach Bill Belichick hired in 2000 had a losing record in his prior stint at Cleveland. Their current quarterback Tom Brady was drafted in the second to last round.

The Essential Bargain

Jan 9, 2012• 8

By Jonathan Halvorson

The ACA has included a long series of bargains to achieve universal health care in the face of two forces: a multi-trillion dollar health care industry, and an implacable political opposition that refuses to bargain. Whatever the merits and blunders of the compromises taken, it should have come as no great surprise that the guidance released at the end of 2011 for the minimum benefit set (the “essential benefits”) was yet another compromise. It bowed to the existing authority of the states by allowing them leeway to decide the essential benefit package, despite the fact that the law itself seemed to intend a single national standard. There are limits, of course: ten categories of benefit must be covered (hospital, lab, maternity, dental, etc.) and the details on what is covered must be set by reference to one of four model plans:

• One of the three largest small group plans in the state by enrollment;
• One of the three largest state employee health plans by enrollment;
• One of the three largest federal employee health plan options by enrollment;
• The largest HMO plan offered in the state’s commercial market.

Predictably, immediate reactions were mostly negative. It was almost universally described as a “punt” by the administration, but a more accurate football metaphor is that the new guidance was a field goal. It’s certainly better than not scoring at all, and games can be decided by field goals. But it also means that your offense wasn’t good enough to close the deal on a touchdown. In that way, you can look at a field goal as one step closer to losing. For different reasons, that is exactly what some foes and supporters alike of the ACA will say about the new guidance.

What if They Had Had to Pay?

Jan 9, 2012• 44

By Paul Levy

A true story, with changes made to protect privacy. An 89-year-old man with dementia, a heart condition, and other serious medical conditions fell in his Arizona apartment and broke his hip. His children, wanting the best possible care, arranged for him to be air-lifted to New York. There, the orthopaedic surgeon advised them that the chance of their father surviving hip surgery was very low, but he would do as the family wished. The man’s three children could not agree. Two would have avoided the surgery, but a third felt very strongly that everything that could be done for the father should be done. The other siblings, out of guilt and respect for the third, acceded. The surgery took place, and the father spent three days in the ICU before his heart gave out.

Here’s the terrible and hard-hearted question I pose: If the costs of this procedure and hospitalization had not been covered by Medicare, would the man’s children have proceeded along the chosen path? I am guessing not. I don’t know the total bill incurred, but it was certainly in the range of tens of thousands of dollars.

In the US, we don’t have a good societal process for making these decisions. In the United Kingdom, though, they do, as reported by Bob Wachter in a recent blog post. Here are some excerpts:

Progress made by ONC (Really!)

Jan 6, 2012

By Matthew Holt

ONC Director Farzad Mostashari is out with his review of 2011 on a month by month basis. Good to see that Farzad & colleagues took December 2011 off (just kidding!). He calls it a year of “momentous” progress. I’m doubly biased because I’m a proponent of newer and better health technology for clinicians AND citizens. Also, (FD) Health 2.0 is the main subcontractor on the i2 Investing in Innovation challenges which were–as noted by Farzad–launched in June, have had several close already, and will continue to roll off the production line for another 18 months. But as a general and occasionally cynical observer I’m very impressed with what ONC has done. Continue reading…

Is Epidemiology Worthless?

Jan 6, 2012• 7

By Seth Roberts

Epidemiology has lots of critics. In this article, for example, it is called “lying on a grand scale.” Every critique I have read has ignored history. Epidemiologists have been right about two major issues: 1. Heavy smoking causes lung cancer. 2. Folate deficiency causes birth defects. In both cases, the first evidence was epidemiological. Another example is John Snow’s conclusion about the value of clean water. In my experience, epidemiologists often overstate the strength of their evidence (as do most of us) but overstatement is quite different from having nothing worth saying.

Let’s look at an example. Many people think osteoporosis is due to lack of calcium. Bones are made of calcium, right? The epidemiology of hip fractures is clear. In spite of the conventional idea, the rate of hip fracture has been highest in places where people eat a lot of calcium, such as Sweden, and lowest in places where they eat little, such as Hong Kong. (For example.) In other words, the epidemiology flatly contradicted the conventional idea. This was apparently ignored by nutrition experts (everyone knows correlation does not equal causation) who advised millions of people, especially women, to take calcium supplements to avoid osteoporosis. Millions of people followed (and follow) that advice.

The Earbud Epidemic

Jan 6, 2012• 2

By Doc Gurley

A new study shows that one in five Americans, 20%, has some form of hearing loss. That is a huge number and much larger than anyone had previously thought. According to the study, in the Annals of Internal Medicine, that means 48 million Americans hear so poorly that they cannot understand a companion in a crowded restaurant. Until this study, estimates had been that the number of Americans with this level of hearing loss was less than half the number found or under 10%.

The study looked at Americans 12 years and older who have had their hearing tested rather than previous studies that relied on self-reported data. This study used the World Health Organization’s definition for hearing loss, which is not being able to hear sounds of 25 decibels or less at the frequencies for speaking. And it found that of those 20%, 13% had hearing loss at that level in both ears. The remainder had it in just one.

The study draws no conclusions about the reasons for this – nor does it state that this is something that has changed over time. It is well known that people’s hearing deteriorates over time and it is also well-known that people can damage their hearing by listening to sounds at inappropriate volume levels for periods of time. That’s why people protect their ears when working with loud machinery, etc.

Harvard Business School Future of Healthcare Conference

Jan 5, 2012• 5

By Stephanie Bartz

Personalized medicine, iPads, insurance exchanges, non-profit/private partnerships…what will healthcare look like in 2020? The healthcare industry today is under enormous stress. Big Pharma is struggling to fill its pipeline, and the biotech industry has failed to deliver sustainable profits for its investors. Health plans operate under enormous uncertainty as reform hits one political roadblock after another. Hospitals struggle to find profitable business models, while patients struggle to find safe, affordable and high-quality care.

But the future of healthcare remains incredibly promising. Scientific discoveries and business model innovations are shaping the healthcare of tomorrow, today. But what will that future look like? On February 4th, over 600 industry leaders, professionals, and students will gather at Harvard Business School for its 9th Annual Healthcare Conference to answer that very question. Karen Ignagni, CEO of America’s Health Insurance Plans (AHIP) and one of Modern Healthcare’s “100 Most Influential People in Healthcare”, will discuss the future of the health insurance industry. Other keynote speakers include Bill Crounse, Senior Director, Worldwide Health for Microsoft and contributor to Microsoft Healthblog, and Larry Culp, CEO of Danaher, who will discuss broader trends in healthcare IT and innovation.

A variety of topics will be debated during panel sessions where moderators are encouraged to challenge panelists to envision the healthcare business models of tomorrow. In the Biotech & Pharma panel, for example, panelists will discuss the rise of tailored therapeutics―Dr. Stephen Spielberg, Deputy Commissioner of the FDA, will provide his perspective on the regulation of personalized treatments. The Payor & Provider Panel will explore the shift to an outcomes-based future―Regina Herzlinger, author of “Who Killed Health Care?” and often dubbed the “Godmother” of consumer-driven Healthcare movement, will share her viewpoint.

Winners Announced in “Using Public Data for Cancer Prevention and Control” Innovation Challenge

Jan 5, 2012• 1

By Austin Cohen

At the Hawaii International Conference on Systems Sciences (HICSS) yesterday, Wednesday January 5, the Office of the National Coordinator for Health IT (ONC) and the National Cancer Institute (NCI) announced the winners of the “Using Public Data for Cancer Prevention and Control: From Innovation to Impact” Challenge. Congratulations to the winning teams, Ask Dory! and My Cancer Genome.

The public challenge launched in July 2011 in conjunction with the National Cancer Institute and under the auspices of the ONC’s Investing in Innovation (i2) program. The Challenge asked developers to create solutions that addressed various gaps in foci across the cancer control continuum. In addition to building applications that bridge these gaps, participants were instructed to design solutions in ways that promoted and made possible healthy decision-making, early detection and adherence to treatment plans.