Alcatatel from Health 2.0 on Vimeo.
Alcatatel from Health 2.0 on Vimeo.
John Irvine
Are Market-Oriented Economists Wrong About Health Care?
Tyler Cowen posted 10 common mistakes of market-oriented economists the other day, paired with 14 common mistakes of left-wing economists. That prompted Ezra Klein to propose his own list of mistakes and others are chiming in.
I think it’s too bad that economists are classified as right and left. After all, economics is a science and reality is reality. Why should political preferences interfere with the scientific quest for truth? Milton Friedman once said there are only two kinds of economics: good economics and bad economics. I not only agree, I think only “good economics” qualifies as “economics.” But I’ll yield to convention for the remainder of this post.
On health care, Tyler says right-of-center economists go wrong in two ways:
- I’m all for Health Savings Accounts, Tyler writes, but unless done on a Singaporean scale, and with lots of forced savings, they’re not a health care plan to significantly benefit most Americans.
- There is less of a coherent health care plan, coming from this side [the right] than one might like to think. There is already considerable health care cost control embedded in the Affordable Care Act (ACA), most of all for Medicare, and this is not admitted with sufficient frequency.Continue reading…
The Promise of Stem Cell Research: Recent Advancements and Setbacks
Few technologies spark as much fascination, hype, and controversy as stem cell technology. One of the most interesting medical applications of stem cell research is in regenerative medicine, where stem cells are being developed to regenerate tissue and repair failing organs. Perhaps the most befitting symbol for this emerging technology is the Greek god, Prometheus, whose immortal liver was feasted on day after day by Zeus’ eagle and day after day was able to regenerate. The leading minds in science and medicine today hope to make this legendary concept of regeneration into reality, but hurdles abound.
The excitement about stem cell research and its potentially transformative therapeutic applications is evidenced by the large investments into research that have been made by companies, governments, and universities around the world. Significant unmet needs associated with chronic diseases have catalyzed this investment. In contrast to the symptomatic-focused treatment offered by conventional therapeutics, stem cell therapies offer potentially curative treatments for many diseases that arise as a result of damage to terminally differentiated cells. High market potential for both embryonic and adult stem cell therapies has resulted in strategic partnerships between large pharmaceutical companies and stem cell research-based companies, such as the agreement between Athersys and Pfizer to develop and market MultiStem for the treatment of Inflammatory Bowel Disease. Pharmaceutical companies are also interested in exploring the various methods in which stem cells could be utilized in the drug discovery process to accelerate the discovery of novel and safe drugs. Illustrative of this interest, GlaxoSmithKline, AstraZeneca, and Roche teamed together to form a consortium with the UK government to develop stem cells for safety testing of new drugs.Continue reading…
THCB Live: Betty Otter-Nickerson, President, Sage Healthcare
Matthew Holt caught up with Sage Healthcare President Betty Otter-Nickerson at HIMSS to talk about the company’s plans for 2011 and beyond.
Looking For Quality In the Wrong Place
Last week I attended the first annual meeting of the Long-Term Quality Alliance and listened to Gregg Pawlson (a geriatrician and executive with NCQA) talk about quality measurement. Right now, quality measurement does too little to drive practice towards quality care because it is based only on things that are “feasible,” or easy to measure—like what gets coded on medical bills. Pawlson observed that while feasibility must be one of the watchwords of quality measurement for now, in the near future electronic medical records should allow us to move beyond billing codes to gather real clinical data for more important quality measurement, including key care processes and outcomes.
I sure hope so. Because those who have looked beyond the dim illumination of current billing-based “quality measures” and searched in the darkness where real processes of clinical care can found have found that the situation is grave. The ACOVE (Assessing Care of Vulnerable Elders) process, while laborious, looks at clinical care where it really happens – in offices and charts – rather than in bills and therefore has a better chance of driving meaningful quality improvement. Readers know that I am a big fan of this work, begun at RAND by outstanding clinician-researchers including Neil Wenger, David Solomon, David Reuben, and many others. I believe that ACOVE is an example of what we need in elder care: high quality evidence about essential clinical practices that are sensibly related to real health outcomes and show how we could (often easily) do better for older people. ACOVE is a blessing.Continue reading…
Why Berwick Matters
Two cover stories in this week’s Time magazine debate a provocative question: Is America in decline?
Both the yes and no arguments are made persuasively, and I found myself on the fence after reading them, perhaps leaning ever-so-slightly toward the “no” side (optimist that I am). Sure, times are tough, but we’ve got the Right Stuff and we’ve bounced up from the mat before.
Then I considered the political fracas over Don Berwick’s appointment as director of the Centers for Medicare & Medicaid Services (CMS), and decided to change my vote, sadly. Yes, America is in decline, and this pitiful circus is Exhibit A.
Berwick, as you know, is a brilliant Harvard professor and founding head of the Institute for Healthcare Improvement. He is also the brains and vision behind most of the important healthcare initiatives of the past generation, from the IOM reports on quality and safety, to “bundles” of evidence-based practices to reduce harm, to the idea of a campaign to promote patient safety.
President Obama’s selection of Berwick to lead CMS last year was inspired. In the face of unassailable evidence of spotty quality and safety, unjustifiable variations in care, and impending insolvency, Medicare has no choice but to transform itself from a “dumb payer” into an organization that promotes excellence in quality, safety and efficiency. There is simply no other person with the deep knowledge of the system and the trust of so many key stakeholders as Don Berwick.
But Berwick’s nomination ran into the buzz saw of Red and Blue politics, with Republicans holding his nomination hostage to their larger concerns about the Affordable Care Act. In the ludicrous debate that ultimately culminated in Obama’s recess appointment of Berwick, the central argument against his nomination was that he had once – gasp – praised the UK’s National Health Service. Interestingly, without mentioning Berwick by name, Fareed Zakaria pointed to this very issue to bolster his “decline” argument in Time:
A crucial aspect of beginning to turn things around would be for the U.S. to make an honest accounting of where it stands and what it can learn from other countries. [But] any politician who dares suggest that the U.S. can learn from – let alone copy – other countries is likely to be denounced instantly. If someone points out that Europe gets better health care at half the cost, that’s dangerously socialist thinking.Continue reading…
Perspective
“I can’t sleep, doc.”
“Really?”
“Yeah. And it ain’t like I ain’t sleepy, either. I just be sitting there. Just up and bored.”
“Tell me about your evenings.”
“I get in bed at like eleven. I turn on my television and just watch some TV. You know, Leno and the news.”
“Okay.”
“My old lady falls asleep and then I just sit there. Wide awake. After while, I shut off my television and just lay there.”
“Hmmm.”
“I know . . . . I ain’t supposed to watch TV in bed, but I’m telling you, doc, it ain’t that.”
“That television can be harder on you than you think. Has it always been hard for you to sleep?”
“No, ma’am. I used to sleep fine. And as for that TV? Naw, it ain’t that. I been sleeping with my TV for years.”Continue reading…
The Urgency of Medicaid Reform
Austin Frakt has penned a reply to a recent piece I wrote on Medicaid for my health-policy blog on Forbes, The Apothecary. Austin is a guy who takes the time to address opposing points of view, to his credit, and I’ve enjoyed my back-and-forth with him over time. But while I’m grateful for Austin’s attention to an issue of high import—the degree to which Medicaid harms the poor—he didn’t respond to the core concerns I raised in my post.
For those who haven’t been following the debate on Medicaid outcomes from the beginning, let me offer a brief summary.
How Medicaid Harms the Poor: The Debate (So Far)
Last summer, on my old blog, I put up a series of posts highlighting the findings of a study published in Annals of Surgery by a group of surgeons at the University of Virginia, entitled “Primary Payer Status Affects Mortality for Major Surgical Operations.” The study evaluated 893,658 major surgical operations occurring between 2003 and 2007, stratified by primary payer status, on three outcomes endpoints: in-hospital mortality, length of stay, and total costs incurred.
Despite the fact that the authors controlled for age, gender, income, geographic region, operation, and 30 comorbid conditions, Medicaid fared poorly compared to those with private insurance, Medicare, and even the uninsured. Relative to those with private insurance, Medicare, uninsured, and Medicaid patients were 45%, 74%, and 97% more likely to die in the hospital post-operatively. The average length of stay for private, Medicare, uninsured, and Medicaid patients was 7.38, 8.77, 7.01, and 10.49 days, respectively. Total costs per patient were $63,057, $69,408, $65.667, and $79,140 respectively.
Despite Austin’s initial criticism that this was merely one study, and therefore not representative, the poor performance of Medicaid beneficiaries is well-established in a very large body of medical literature. What was striking about the UVa study was its large sample size; that it controlled for a highly validated set of background health and social factors; and its finding that Medicaid beneficiaries not only underperformed those with private insurance (and dramatically so), but also those who lacked insurance.
Given that a core feature of PPACA is its large expansion of Medicaid to those with higher incomes than current beneficiaries, I argued that it was far from clear that this expansion would improve health outcomes, and in fact was likely to harm them by crowding out the more-efficacious private sector. Furthermore, I argued for the clinical benefits of migrating Medicaid over to a premium-support or cash-assistance model, which would allow Medicaid recipients to benefit from the superior quality of care delivered by private insurance. As I’ve said all along, “There is, doubtless, a level of poverty at which Medcaid is better than nothing at all. But most people can afford to take on more responsibility for their own care, and indeed would be far better off doing so.”
Health Insurance Doesn’t Necessarily Mean Better Health
By JIM MARKS, MD MPH
A new study in the influential policy journal Health Affairs gives added credence to the idea that much of what drives health falls outside of the realm of medical care. In fact, this must-read study points out what so many of us know: that simply providing someone a health insurance card is not enough to make them healthy.
What better place to test this theory than in Canada – our northern neighbor with a publicly financed universal health care system. Researchers looked at nearly 15,000 Canadians in the nation’s health system who were free of heart disease and tracked them for at least a decade. Not surprisingly, people disadvantaged by little education and low income, used the health care system more than those with higher incomes. But more importantly, this increased use of services had no discernable effect on improving their health or cutting their death rates – the ultimate bottom line – when compared with others with higher education, higher income and LESS usage of health care.
Almost all of the debate about health care here has been about how many Americans will be covered, for what care, and at what cost. The results of this Canadian study are clear. It may be helpful to have insurance to get care, but the United States cannot expect that giving people medical care will diminish differences in health outcomes or the likelihood of an early death among disadvantaged people. The authors explicitly warn against relying on universal coverage to eliminate inequalities in health.Continue reading…
Doctors Love iPads. What Does it Mean? What Does it Mean?
By VINCE KURAITIS
After attending HIMSS 11 the largest annual health IT conference of the year, John Moore reported
that “nearly every EHR vendor has an iPad App for the EHR [electronic health record], or will be releasing such this year.”
Doctors love iPads…not surprising? But, how might you explain this?
There are at least two different possibilities:
- Coincidence Theory
- Conspiracy Theory
The Coincidence Theory
So doctors want to access EHR software through the iPad…what’s the big deal?
Apple has built a great new hardware platform with the iPad. There’s nothing else like it in the marketplace. While other companies are building competing tablets, Apple’s has been the only viable option in the market for over a year.
The iPad is intuitive, easy to use, reasonably priced, easy to carry around, and has a lot of apps that have been developed for the platform. People — not just doctors — love the experience of using an iPad.
Doctors just happen to be one group of zillions buying iPads. Why wouldn’t they? Doctors are smart, affluent, and many are opinion leaders. Doctors like cool new technologies just like anyone else.
Doctors also are mobile. They want to access EHRs in different exam rooms, from the hospital, from their homes. The iPad is the perfect hardware platform to take with you as as a doctor goes about their day.
Why are nearly all EHR vendors making their software work on the iPad?
Because doctors are demanding it.
The Conspiracy Theory
The iPad is Apple’s Trojan horse to create new revenues in an industry in which the company has had minimal presence — health care.
Apple has developed a very appealing hardware platform in the iPad. Recognizing the market strength and lock-in to their walled garden they are creating with consumers, Apple is targeting key market segments to create new revenue streams and business models. Health care is the next target for Apple’s aggressive smarts.
