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Matthew Holt

The Healthcare MacGuffin?

Aug 4, 2008• 9

By Bob Wachter Robert_wachter

Last week’s ABIM Foundation Summer Forum focused on patient-centered care… and who could be against that? But is patient-centered care just a healthcare MacGuffin?

What’s a MacGuffin, you ask? In a spectacular talk at the Forum, Michael Richardson of Chicago’s Hines VA reminded us that the MacGuffin was one of Alfred Hitchcock’s favorite directorial strategies. Hitchcock defined the term this way:

MacGuffin:
a plot device that motivates the characters or advances the story, but
the details of which are of little or no importance otherwise.

I
loved Richardson’s analogy when I heard it, but its utter aptness
became clear only as the conference proceeded. Let’s start with the
areas of general agreement (thanks to Jim Naughton, Chair of the ABIM
Foundation, for articulating these points):

Patients’ preferences should be respected.
We should attend to patients’ emotional needs, context, comfort and meaning.
Patients should be engaged and empowered.
There should be shared decision-making that promotes patient autonomy.
Family and friends should be involved in care decisions where appropriate.
Care should be coordinated within and across systems.

Well, sure.

But then things became a bit fuzzier. The conference’s first talk was framed as an egregious example of what happens when care isn’t patient-centered. Margaret Murphy,
a soft-spoken, matronly Irish woman who now serves on the Patient
Steering Committee of the WHO’s World Alliance for Patient Safety, told
the tragic, infuriating story of her 19-year-old son Kevin’s needless
death. Somehow this young man with classic hyperparathyroidism
(“stones, moans, bones, and abdominal groans” – a constellation of
symptoms recognizable to any decent 3rd year medical student) was
misdiagnosed for the better part of a year, in a tragedy of cognitive
(he carried the presumptive diagnosis of leptospirosis for months) and
logistical (his hypercalcemia was noted on a Post-it Note that got
stuck to the back of a piece of his chart and went unseen for weeks)
errors.

This isn’t a lack of patient-centered care. This is
unconscionably bad doctoring, mixed with really awful systems, pure and
simple.

Hospital offers a window to the world

Aug 4, 2008• 1

Cover_hospital

By Sarah Arnquist

A hospital brings together the best and worst of people often in chaotic, traumatic scenarios that for some are everyday events, and for others are life changing moments.

In her latest book, Hospital, journalist Julie Salamon uses palpable descriptions and poignant anecdotes to capture those moments and personalities that make a hospital what it is.

Salamon spent a year at Maimonides Medical Center in Brooklyn to tell a story about a hospital, but it turns out to be a reflection on societal values, priorities, tolerance and politics told through the lens of doctors, nurses and patients. Salamon shows how a hospital can be far more than a building of laboratories and medical equipment but a source of community pride, consternation and certainly conversation.

Health Reform is Possible; Voters Still Hold the Power

Aug 4, 2008• 11

By MAGGIE MAHAR

In a post originally published here on The Health Care Blog and reprinted Health Care Policy and Marketplace Review health care analyst Brian Klepper asks: “Is Meaningful Health Care (Or Any Other Kind Of) Reform Possible?”

His answer: “I’d be surprised. Delighted! But surprised.”

Klepper believes that the lobbyists are just too strong. Always incisive, he pulls no punches: “In a policy-making environment that is so clearly and openly influenced by money,” it’s just not likely that “Congress will be able to achieve health care reforms that are in the public interest.”

I disagree. I believe economic pressures are pushing us toward a political turning point. (If you want to understand what is happening in history or in politics, follow the money.) The Bush administration has been thoroughly discredited. Americans are ready for change. Health care reform will not happen tomorrow; it will require a bare-knuckled political fight. But it will happen, and this is why: Although lobbyists are powerful, so are voters. And they realize that we are approaching a flashpoint: middle-class Americans are being priced out of our health care system.

Dilemma of declining revenues and patient care

Aug 4, 2008• 3

By Jane Sarasohn-Kahn

Health providers want to provide quality care and improve patient satisfaction. Really, they do. It’s just that pesky problem of declining reimbursements getting in the way of meeting those two key business objectives.

This dilemma comes to you courtesy of a survey conducted by IVANS, Inc., the company that helps providers process health transactions. IVANS found that about 50 percent of providers derive over 50 percent of their income from Medicare. As Medicare continues to be fiscally challenged, providers’ fiscal pain from this payer will increase.

CollabRX aims to make drug development faster and cheaper with power of Internet

Aug 1, 2008• 3

By Sarah Arnquist

Harnessing the collective power of patients needing new treatments and therapies to speed up and lessen the cost of the development process drives a new venture called CollabRX. Callobrx

Jay M. Tenenbaum, Collab RX founder, learned he had melanoma in 1998 and had a recurrence five years ago. He found many patient advocacy groups working to raise awareness of the deadly skin cancer and to raise money for research, but felt they lacked collaboration.

Tenenbaum saw a business opportunity in that lack of collaboration and founded CollabRX with $2 million of his own money.

The Wall Street Journal profiled Tenenbaum and his new company this week. An excerpt from the Journal:

CollabRx aims to expand patient-funded research
further by connecting individuals or small numbers of patients with the
tools and services they need. Each CollabRx client is assigned a
project manager, a specialist who works with patients to devise a
research strategy, interpret the results and later steer any promising
prospects toward development of possible treatments.

CollabRx calls such integrated projects virtual
biotechs because they aim to replicate many of the steps typically
taken as part of a pharmaceutical or biotech company’s search for a new
drug. As the number of private labs available to do sophisticated
research grows, many parts of the drug-development process can now be
contracted separately. Researchers in various locations can share
information and material by means of a Web-based network created by
CollabRx software engineers.

Creating Currency to Care For the Elderly

Aug 1, 2008• 9

By MAGGIE MAHAR

Did you know that Japan has found an ingenious way to “create” money that can be used to care for the elderly?

Bernard Lietaer, author of Access to Human Wealth: Money beyond Greed and Scarcity (Access Books, 2003) describes the system in this interview with Ravi Dykema, publisher and editor of Nexus, a leading Holistic journal.

Lietaer begins with the basics, by explaining what money is: “I define money, or currency, as an agreement within a community to use something as a medium of exchange. It’s therefore not a thing, it’s only an agreement – like a marriage, like a business deal…And most of the time, it’s done unconsciously. Nobody’s polled about whether you want to use dollars. We’re living in this money world like fish in water, taking it completely for granted.”

Lietaer, who co-designed and implemented the convergence mechanism to the single European currency system (the Euro), and served as president of the Electronic Payment System in his native Belgium, doesn’t take currencies for granted. He knows that a dollar is simply a piece of paper (which is no longer backed by gold). It has value because we have agreed that it has value.

The problems with high-risk pools

Aug 1, 2008• 5

By Robert Laszewski

What do we do with people who are uninsurable because they have a pre-existing medical condition?

That is a particularly important question as both McCain and Obama propose reforming American health care by building on the private health insurance system.

One of the solutions being discussed–by McCain among others–is to use state-based risk pools. Under McCain’s plan heavily dependent on an individual platform, people who don’t have employer-based coverage and healthy enough to qualify for individual health insurance could get a private mainstream plan and people who do not qualify for a standard individual plan could buy into a state-run high risk pool for the uninsurable.

The affordability factor must accompany discussions on health care coverage

Jul 31, 2008• 42

By Charlie Baker

Charlie Baker is the president and CEO of Harvard Pilgrim Health
Care, Inc., a nonprofit health plan that covers more than 1 million New
Englanders. Baker blogs regularly at Let’s Talk Health Care.

I was in a meeting the other day when someone said — mostly in exasperation — "Everyone’s for affordable health care for everyone, but no one cares very much about dealing with the cost of health care.”

I’m sure that truer words have been spoken, but I can’t think of any off the top of my head. It’s too bad. Somehow, we’ve divorced the coverage/affordability question from the cost question, and we pay for it – everyday.

In a recent article in the Journal of the American Medical Association (JAMA), bio-ethicist Zeke Emanuel from the National Institutes of Health, put it pretty well — “Without controlling health care cost, any attempt at universal coverage will be transient. Sustainable expansion of coverage to all Americans requires credible changes in the rate of health care inflation. In the strange calculus that is American politics, the more politically salient issue of costs may provide a better way to achieve the comprehensive reforms necessary to cover the uninsured that the hitherto futile direct moral appeal.”

Readers respond to the primary care crisis

Jul 31, 2008• 6

By Sarah Arnquist

Two recent posts by Matthew and Bob Wachter on the crisis in primary care sparked great debates in the comment sections.

Matthew’s inference that Medicare’s bankruptcy will be fast upon us if everyone with brain cancer received an experimental surgery like Sen. Ted Kennedy recently had evoked this response from Bev. M.D. Tedkennedy

Kennedy’s case is an excellent example of why evidence-based medicine
will never translate into a "cookbook" of completely standardized
practice. As a pathologist who has looked at this nasty tumor under the
microscope too many times, glioblastoma is almost uniformly fatal
within, at most, a few years. But each patient’s tumor, and each
patient’s age and medical background, and each patient’s will to fight,
is different. Also, many medical advances are made by doctors
courageous enough to defy standard opinion who achieve good results and
then over time develop a track record to make their treatment an
accepted and evidence-based one. Therefore, one cannot apply a uniform
and permanent EBM rubric of – gonna die anyway, don’t operate – to all
glioblastoma patients for MEDICAL reasons. However, one COULD apply it
for social/political/economic reasons, and therein lies the basic
conundrum before us.

Deeper in the comments, Peter wrote:

Bev, I agree to a point, but why should there be only two people
involved in the decision – the doctor, who gets paid when he/she
operates using someone else’s money, and the patient, using someone
else’s money, and therefore has nothing to loose. If we went with this
thinking then who stops all the Mickey Mantle decisions? Is every Terri
Schiavo worth keeping on life support waiting for God to perform a
miracle? Would a Medicaid patient get to go to Duke and obtain the same
try? I know this discussion goes around in circles forever but there
must be a better way if we are going to avoid bankrupting the "system."

The $2,500 question

Jul 30, 2008• 7

By Craig Stoltz

There’s some peculiar numerology going in the presidential candidates’ health reform plans. Stoltz
John McCain proposes that every American receive a $2,500 tax credit ($5,000 for families) to help them afford health insurance bought in the private market.Barack Obama says his health care plan will save the average American family $2,500 per year.I mean, what are the chances?I suspect both campaigns are shrewd enough to know that "a couple hundred bucks a month" [middle-class citizen’s translation of $2,500 per year] is likely to get a voter’s attention. The fact that both campaigns came up with an identical figure is eerie, however. It’s enough to make you wonder whether anti-trust laws should apply to political campaigns.