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The Psychology of the ObamaCare Debate

May 4, 2012• 34

By Peter Ubel, MD

“How can the government make us buy health insurance? What gives them that right?”

Sitting on my left while our airplane raced above the clouds, Elizabeth was clearly upset about Obamacare. She wondered why the bill had to be so long, and why Obama would endorse a plan that doubled her health insurance costs. But nothing vexed her more than the individual mandate.

At least that’s what I though until I spoke with her at greater length, and she revealed a profound truth to me about people’s attitudes towards the mandate and towards Obamacare more generally: she showed me that deep down she liked the idea of the mandate, once she realized its important role in accomplishing goals people on all sides of the political spectrum care about deeply.

We were flying towards North Carolina the day before the Supreme Court held its oral arguments on Obama’s healthcare plan. Elizabeth had heard a great deal about the mandate. She read The Wall Street Journal regularly, in part because it was so relevant to her work in banking. And she enjoyed watching Bill O’Reilly on Fox News, but not Hannity, who she thought was “too extreme”. She was by no means a conservative extremist. She had major concerns about the banking industry for example, and as a Christian felt strongly that income inequality is a moral problem that neither party was addressing in an effective manner. But she was solidly Republican, no doubt about that, and she agreed with most people in that political party that Obamacare was hurting the economy. And above all she believed the health insurance mandate was “un-American.”

Enabling Patients to Be Part of Their Care

May 4, 2012• 7

By David Lansky, PhD

In May 2008, when the Roper poll asked a random sample of Americans “If your medical records and personal health information, such as test results and doctor’s instructions, were available to you online, how likely do you think you would be to access those records and information?” Sixty-five percent said they were somewhat, very, or extremely likely to access their records. In the February 2009 stimulus bill, Congress asked the Health IT Policy Committee “to facilitate secure access by an individual to such individual’s protected health information” and “… to facilitate secure access to patient information by a family member, caregiver, or guardian acting on behalf of a patient…”

CMS now proposes that in 2014, hospitals receiving the billions of dollars of Stage 2 federal EHR incentive payments must provide patients with electronic access to their hospital discharge information within 36 hours of leaving the hospital. CMS is not only asking hospitals to give patients reasonable access to their own current and actionable health information, but it’s also trying to help patients and families address the wasteful and dangerous rates of hospital readmission and failures in continuity of care that haunt American healthcare. But the American Hospital Association is arguing that “Establishing a web portal or other mechanism to provide patients online access to this magnitude of data is unrealistic and premature.”

A Fork in the Road to Meaningful Use

May 4, 2012

By Adrian Gropper, MD

The deadline for comments to Stage 2 is upon us and a clear fork has emerged for federal regulators. The cats and dogs here are institutional vs. patient engagement. The institutional fork has been taken by the American Hospital Association. The patient fork is exemplified by the National Partnership for Women and Families. The primary argument is over patient access to their own information. The draft regulation suggests a 36 hour (or 4 days in other circumstances) delay. The AHA wants 30 days. Some patient advocates are seeking immediate and highly convenient access.

The fork in the road for federal regulators, with some $30 Billion dollars of incentives in hand, is whether to micromanage the institutions or to encourage patient-centered innovation. This choice is deeply entangled in the $Trillion realities of payment reform.

The micromanagement of institutions through increasingly complex regulations on EHR vendors, clerical and clinical staff seems like slow torture. We have institutions begging for relief. Large vendors are consolidating their lock-in business model as the barriers to entry into the health information market get higher and higher. Quality transparency is controversial and price transparency is almost unimaginable.

Why Do We Trust Doctors?

May 3, 2012• 4

By Richard Reece, MD

The National Journal has released a Special Report. The Report features a series of four articles: Restoration Calls – Fixing America’s Crumbling Foundation. Among these articles is: “Why Do We Trust Doctors?” It contains results of a Gallup poll, showing trust in doctors is at all-time high of 70% over the last ten years.

This is intriguing considering numerous media articles on physician personal profiteering and physician partnerships in technologies such as imaging equipment for financial gain.

The article begins, ”We’re cynics about insurance companies and critics of big health companies. So why do we still believe in physicians?”

Why indeed? The author of the April 26 piece, Margot Sanger-Katz, tells the story of 60 year old Mary Morse-Dwelley of Maine who has undergone 22 operations to close an abdominal incision and who has had her gallbladder, uterus, and 2 feet of intestine removed. She has spent two years in bed. Despite this long surgical ordeal, she implicitly trusts her surgeon. So does the American public, if you believe Gallup.

When patients are asked why they trust doctors, patients say they see doctors as someone who is trying their best to help them. They do not see them as agents of government, insurance companies, or institutions. They trust the interpersonal face-to-face relationship and the motives of their doctors.

The Testing Glut

May 3, 2012• 9

By H. Gilbert Welch

In case you missed it, a recommendation came out last month that physicians cut back on using 45 common tests and treatments. In addition, patients were advised to question doctors who recommend such things as antibiotics for mild sinusitis, CT scans for an uncomplicated headache or a repeat colonoscopy within 10 years of a normal exam.

The general idea wasn’t all that new — my colleagues and I have been questioning many of the same tests and treatments for years. What was different this time was the source of the recommendations. They came from the heart of the medical profession: the medical specialty boards and societies representing cardiologists, radiologists, gastroenterologists and other doctors. In other words, they came from the very groups that stand to benefit from doing more, not less.

Nine specialty societies contributed five recommendations each to the list (others are expected to contribute in the future). The recommendations each started with the word “don’t” — as in “don’t perform,” “don’t order,” “don’t recommend.”

Could American medicine be changing?

For years, medical organizations have been developing recommendations and guidelines focused on things doctors should do. The specialty societies have been focused on protecting the financial interests of their most profligate members and have been reluctant to acknowledge the problem of overuse. Maybe they are now owning up to the problem.

So it Turns Out that Lots and Lots of People Still Want to Be Doctors

May 3, 2012• 8

By Aaron Carroll, MD

As I noted last week, I get a little annoyed by the seemingly constant public complaints of physicians, coupled with threats to leave medicine and dire warnings that no one will want to be a doctor in the future. This is in spite of it still being one of the most trusted professions around, and one that is darn well compensated. So it’s nice to see that the general public hasn’t bought into this meme yet (from the AAMC 2011 Medical School Enrollment Survey):

First-year medical school enrollment in 2016–2017 is projected to reach 21,376. This projection represents a 29.6% increase above first-year enrollment in 2002–2003 and comes close to reaching the 30% targeted increase by 2015 the AAMC called for in 2006.

Of the projected 2002–2016 growth, 58% will be at the 125 medical schools that were accredited as of 2002. New schools since 2002 will experience 25% of the growth, and the balance (17%) will come from schools that are currently in LCME applicant- or candidate-school standing.

Continue reading…

CajunCodeFest Highlights the Silicon Bayou

May 2, 2012

By Hemali Thakkar

When you hear of ‘health tech’ or ‘health innovation,’ the first places that come to mind are usually Silicon Valley, Boston or New York City. Yet, this past weekend’s event shook that notion for everyone that attended. It is not just big cities like SF, Boston or NYC that are experiencing a surge of innovation and entrepreneurship. In fact, even the smallest towns across the nation are taking technology and the power of internet to confront our nation’s growing health problems. CajunCodeFest, in Lafayette, Louisiana, is no exception.

An incredible crew of nearly 300 entrepreneurs, health experts, students, coders, and professionals gathered in Lafayette this weekend, representing 3 countries, 15 states, and 40 cities. With Louisiana having the second highest obesity rates (after Mississippi), the code-a-thon marked an important stepping stone for the state in its battle against obesity. As obesity rates continue to rise, the epidemic is now considered one of the nation’s biggest public health problems. The Louisiana Secretary of Health and Hospitals, Bruce Greenstein, put it loud and clear during his opening remarks, stating how “we have failed to take personal responsibility” for our obesity problems and we continue to blame others for this growing issue. That’s why the CajunCodeFest taking place in Lafayette was more important than ever.

Medical Research We Never Hear About: The Problem of Unpublished Studies

May 2, 2012• 5

By Claire McCarthy, MD

Every day, there is another medical study in the news. There’s another newspaper or TV story telling us that X can cure depression or make you thinner or cause autism or whatever. And since it’s a medical study, we usually think that it’s true. Why wouldn’t it be?

But what most people don’t realize, let alone really think about, is that there might be other studies that show that X does none of those things — and that some of those studies might never have been published.

Just this week, the journal Pediatrics released an article that perfectly demonstrates this problem. There have been a number of studies that have shown that a certain type of medication, selective serotonin reuptake inhibitors (SSRIs), can help stop the repetitive behaviors of autism, like hand-flapping or head-banging. If you were to do a search of the medical literature, as doctors and parents and patients often do, you’d think that using SSRIs is a good idea. But when researchers dug deeper, they found that there were just as many unpublished studies that showed that SSRIs didn’t help. If they had all been published (they were all good enough to be published), that same search of the medical literature would have shown that using SSRIs isn’t a good idea.

This is bad. We rely on studies to guide our decisions. What is going on?

The journals that publish articles certainly play a role. After all, it’s cooler to publish a study that has a grabby headline, that promises an answer or a cure. That’s much more likely to get readers than a study that says that something doesn’t do anything at all. But it turns out that the researchers themselves play a bigger role.

Obama Supporters Put High Court on Trial

Apr 30, 2012• 44

By Betsy McCaughey

As the U.S. Supreme Court deliberates the Obama healthcare law, the court itself is on trial.

Obamacare supporters are attacking the justices as “hacks dressed up in black robes,” calling for limits on their life tenure, and claiming judicial review is undemocratic.

Worse, President Obama and his Secretary of Health and Human Services Kathleen Sebelius are shoveling money into implementing the law as fast as possible and refuse to discuss an alternative. That’s irresponsible. What’s needed now is not court bashing but contingency planning.

The Obama administration and allies in Congress have nine weeks to plan how to pick up the pieces on a vast array of health insurance issues. It’s the President’s duty to have a plan. It will signal his respect for the nation’s system of checks and balances — something he has utterly failed to show.

Heady Times for Health Care in the Cloud

Apr 30, 2012• 1

By Jonathan Bush

In 1990, when I got my first health care job driving ambulances, not a soul in the New Orleans EMS department had a cellphone. Not even the head of the service. The mayor, his chief of staff and the police chief each had one. That was about it. These phones weighed like 15 pounds and were hardwired to a car battery. And we ambulance drivers documented our care on “run sheets” found on metal clipboards but, since so few people bothered to read them, we also wrote key vital signs and other metrics on a three-inch-wide piece of white tape smacked across the patient’s abdomen.

Today, everyone in New Orleans — and everywhere else — has a cellphone. These cellphones have the computing power to find, and add to, and direct everything that anyone would need to know about a patient anywhere in the world… but they don’t do it! Today’s “do-everything” cellphones are the size of your wallet, yet most ambulance crew run sheets are still paper, found on metal clipboards. And most good patient data is still found on those three-inch-wide pieces of tape.

Why? I’ll give you one good reason and one bad one.