October 2012 – Page 8 – The Health Care Blog

Can Personalized Care Survive ObamaCare’s Assembly Line Medicine?

Oct 1, 2012• 7

By John Goodman

Previously, I wrote about some wondrous developments that are taking place in medical science. Implantable or attachable devices already exist — or soon will exist — that can monitor the conditions of diabetics, asthmatics, heart patients and patients with numerous other chronic conditions. These devices will allow patients and doctors to modify therapeutic regimes and tailor treatments to individual needs and responses. Genetic testing is reaching the point where patients can be directed to take certain drugs or avoid other drugs, based solely on the patient’s own genes.

Almost all HIV treatment these days involves therapy cocktails tailored for each individual patient. The FDA has approved a breast cancer drug only for women with a particular genetic makeup. Patients are being advised to steer clear of an ADHD drug and certain blood thinners if they have particular genetic variations.

We are entering the age of personalized medicine, where the therapy that’s best for you will be based on your physiology and genetic makeup — and may not be right for any other patient.

Yet standing in the way of this boundless potential is an Obama administration whose entire approach to health reform revolves around the idea that patients are not unique and that bureaucrats can develop standardized treatments that will apply to almost everybody with a given condition. When former White House health adviser Ezekiel Emanuel told CNN recently that “personalized medicine is a myth,” he was fully reflecting the worldview of the authors of health reform.

Medical Malpractice – What Obamacare Misses

Oct 1, 2012• 37

By JOHN LYNCH

Medical malpractice in America remains a thorny and contentious issue, made no less so by its virtual exclusion from the Affordable Care Act (ACA, or Obamacare) governing healthcare reform in America.

Which is why I was glad to see the former head of President Obama’s Office of Management and Budget, Peter Orszag, now with the liberal Center for American Progress, cite it as his second top priority for gaining control of our out-sized medical spending – an implicit criticism of its omission from Obamacare.

Although speaking in the context of criticizing Rep. Paul Ryan’s (R-WI) plan to offer vouchers so Medicare enrollees could purchase private health insurance, his comments about the need to address malpractice reform are a departure from the liberal talking points on Obamacare. Here’s what he had to say…

Former Obama Budget Head Challenges Paul Ryan To Demonstrate How His Budget Would Lower Health Costs

“Rep. Paul Ryan’s (R-WI) proposals to control health care spending by slashing the federal government’s contribution to Medicare and Medicaid and shifting that spending on to future retirees or the states, has dominated Washington’s conversation about entitlement reform. But…a group of health care economists and former Obama administration officials laid out an alternative approach that could achieve health savings by encouraging providers to deliver care more efficiently…

“‘Mr. Ryan has had too much running room to go out with proposals that neither will reduce overall health care costs nor will help individual beneficiaries simply because there has not been enough of an alternative put forward by those who believe that we really need to focus on the incentives and information for providers…If I had to pick out two or three things to do immediately, I would pick the accelerated (trend) towards bundled payments and non fee-for-service payment…

Continue reading…

Destination Unknown

Oct 1, 2012• 2

By Rob Lamberts, MD

I cleaned out my office yesterday. I gathered up the outdated pictures of my family, handwritten notes from my children when they were much younger, pictures of patients, notes from patients, and the knick knacks that accumulate over 18 years of being in one place. Most of them were dusty or worn with the tarnish of time; things that sit in the office unnoticed until a moment like this.

I also went through the files of old information – information I seldom if ever used – detailing the financial struggles it took to build a successful practice. Here’s what we collected in 1998. Here are the notes from an office administration meeting in 2002. Here are handwritten flow diagrams I made to figure out a way to improve workflow. Here’s a list of patients from 2000 who were eligible flu shots with a sticky note affixed to the folder saying: “give to Angie.” I’m not sure I ever gave it to her.

The majority of paper, however, was spent on spreadsheets. There are spreadsheets of productivity, of income, of expenses, projected income, effects of adding new partners, of quality measures and of the ever ominous accounts receivable. These are numbers my distractible brain always had difficulty wrapping around, yet they stand as a testament to the myriad of details that work in the background of life. They mean even less to me now than they once did, like the dates on gravestones for people long forgotten, yet their existence reminds me that these days were not the dusty pictures sitting on the shelves of my memory; they were days of many small details and struggles. Life looks like a movie from the outside, but its reality is found in the spreadsheets it leaves behind.