Category: Uncategorized

What Most Patients Don’t Know About the Residents Who Care For Them

Jun 4, 2010• 19

By MAGGIE MAHAR

Summary: Most hospital patients have no idea that the resident treating them could be coming to the end of a 30-hour shift. If he is exhausted, the resident’s judgment may be impaired. Yesterday, the union that represents some 13,000 residents and interns nationwide (CIRSEIU), the American Medical Student Association (AMSA) Public Citizen, the consumer advocacy organization based in Washington DC, as well as sleep scientists at the Harvard Medical School’s Division of Sleep, announced the results of survey published in BMC Medicine, revealing how little the public knows about residents’ hours.

Sleep deprivation is likely to lead to errors; residents themselves acknowledge that lack of sleep has caused them to make mistakes that harm, and sometimes even kill patients. Exhaustion also affects how they feel about their patients. In 2008, the Institute of Medicine (IOM) recommended capping shifts at 16 hours, saying that longer shifts are unsafe for patients and residents themselves. The Accreditation Council on Graduate Medical Education (ACGME), the group that oversees the training of physicians in the U.S currently allows resident physicians to work for 30 consecutive hours up to twice per week. The ACGME has been reviewing the IOM recommendations and is expected to announce its decision later this month.

The problem: residents represent cheap labor. Some say that the ACGME faces an inherent conflict of interest because its board is dominated by the trade associations for hospitals, doctors and medical schools that benefit from the residents’ long hours. Is this true?

The NY Times, dogs, sores & Dartmouth critics

Jun 3, 2010• 16

By Matthew Holt

Today’s NY Times has a confused, woffly attack on Dartmouth from Reed Abelson & Gardiner Harris. This is a dreadful article. Period.

That the NY Times printed it is remarkable given the turnaround in thinking by David Leonhart in the Economix blog on the NY Times over the years to being a thoughtful Dartmouth proponent. It’s end even more remarkable that they didn’t even quote Buzz Cooper, probably the leading thoughtful Dartmouth critic. Longtime THCB readers will expecting me to start writing about dogs licking their sores….

Dartmouth has pretty much immediately refuted their article (and I suspect it didn’t take too much research). But what they really missed was the big announcement yesterday that HHS is now releasing a whole lot of datasets that researchers can use to put these and other data together and are encouraging the private payers to add to the mix (FD The Health 2.0 Developer Challenge is helping convene tech developers to work on this). Is it really true that Sacramento is cheap according to Dartmouth but expensive to private payers. And why?

There’s lots more work to be done here, but this article doesn’t help.

If you want a deep deep dive into this problem, here’s the article Daniel Gilden wrote on my blog last year. With lots of intelligent back and forth in the comments (including one from a Nobel Prize winner!).

When a Fire Breaks Out In the Operating Room

Jun 3, 2010

By MAGGIE MAHAR

Summary: It
is hard to imagine fire engulfing a patient on the operating
table. But it does happen—even at highly respected medical
centers. An electrical device is turned on while the patient is
receiving oxygen . . . Or, electricity meet an alcohol-based solution
that was used to clean a patient’s skin before making an incision .

Rarely is a patient severely burned in an OR. Although
the Cleveland Clinic experienced six surgical fires last year, only
three patients were hurt and they suffered minor burns. Yet
it is amazing that there were six surgical fires at the widely
respected Cleveland Clinic –and that the Clinic didn’t report the fires.
In Ohio, as in many other states, hospitals are not required to tell
anyone about these adverse events. And patients who
receive compensation are often asked to sign confidentiality agreements.
(To be fair, when Medicare inspectors came in March, the Clinic
voluntarily talked about the fires that had occurred over
the previous 12 months. It is not at all clear that the Clinic was
trying to bury the information. It just didn’t have anyone to tell. That
is the problem. )

Surgical fires, like many accidents that hospitals
call “adverse advents” could be prevented. If more errors
and accidents were made public, medical professionals could analyze
causes and publish guidelines that would make patients safer, not only
at one hospital, but nationwide.

Under the new reform legislation, regulation is all
about transparency. Medicare will insist that hospitals report infection
rates. And my guess is that more and more states are going to require
that hospitals publicly disclose accidents and errors.

Meanwhile, groups such as the Empowered
Patient Coalition and the Consumers Union Safe
Patient Project are
providing new channels for patients to report these accidents.

~~~~~~~~~~~~~~~~~~~~~~

A Salute to the VA on Memorial Day—Part 1

Jun 3, 2010• 7

By MAGGIE MAHAR

In 2007, a book by Phillip Longman sent lasting ripples through the U.S. health care establishment. The title was audacious: Best Care Anywhere. But it was the subtitle that shocked: Why VA Healthcare is Better than Yours.

Was Longman suggesting that the Veterans’ Health Administration provides better care than the treatment that millions of well-insured Americans typically receive in the private sector? Yes.

Longman had uncovered what one reviewer called “the biggest untold story of the past decade,” the quality revolution that Dr. Ken Kizer launched when he took over the VA health system in 1994. And Longman had eye-popping evidence to back up his claims: overwhelming hard-core data from the most prestigious peer-reviewed medical journals. The research revealed that when it comes to everything from outcomes to patient satisfaction, and patient safety, the VA outperforms.

Announcing the Health 2.0 Developer Challenge

Jun 2, 2010• 1

By Indu Subaiya & Matthew Holt

Today, it was a great thrill for us to have Aneesh Chopra (CTO of the Federal Government) this morning in DC at the Community Health Data Initiative Data Forum announce the The 2010 Health 2.0 Developer Challenge, with support from the Department of Health and Human Services (HHS) and the Community Health Data Initiative (CHDI).

With newly opened government data sets and lightweight frameworks for rapid application development, we have a unique opportunity to participate in an ecosystem of data “suppliers” and “appliers” to build innovative tools to improve personal and population health.

Health 2.0 will host a series of events leading up to the final Challenge during the Health 2.0 Annual Conference October 6-9, 2010, the culminating event of Health Innovation Week, October 3-10, in San Francisco CA.

Stay tuned! This is going to be an exciting process of innovation and we’re really excited to kick it off.

You can go to Health2Challenge.org and see more and register your interest—whether you’re a developer, or you have a data set to contribute, or you want to issue a challenge, or sponsor a prize.

Show Me the Data

Jun 2, 2010• 6

By LYGEIA RICCIARDI

While much (important) discussion in healthcare is about the collection of and access to data, it’s also essential to communicate about it clearly. Good communication of health data, particularly to patients–is too often an under-funded and under-supported afterthought, if it happens at all. The Health 2.0 Show’s webinar Tuesday underscored the importance of effective visual communications.

The three speakers gave examples of very different but effective “pictures” of data. David Hale of the National Library of Medicine and the National Institutes of Health demoed PillBox, a program that lets people identify pills based on their physical characteristics. This capability could save time, money, and even lives given the more than 1.5 million adverse drug events reported each year in the US.

Next Artist and Patient Advocate Regina Holliday showed her artistic interpretation of hospital ratings data. In Regina’s case, communication to the public of the core concept—that many hospitals are performing poorly based on patient satisfaction–included both a product (a painting) and the process by which it was made. Regina stood on the sidewalk outside of a hospital to paint a child holding report card with low grades, symbolizing poor hospital performance. As she painted, she spoke to passersby, answering questions and educating them about a topic most know little if anything about.

Health 2.0 Webinar with David Hale, Ted Eytan, Regina Holliday, Marco Smit

Jun 2, 2010

By Matthew Holt

Tuesday’s Health 2.0 Show with Indu & Matthew was (IMHO) the best we’ve done so far. For those of you who missed it, we had David Hale demoing talking about Pillbox—fascinating. Then Ted Eytan and Patient activist Regina Holliday discussed and showed her murals. Finally Marco Smit tells you a little about what is coming from Health 2.0 Advisors. But don’t take my word for it. Watch it all!

Patrick Soon-Shiong – Role in a World of “Data Liberacion”

Jun 1, 2010

SUBTEXT: In the DC panel debate on the Role of “Data Liberacion” Executive Chairman of Abraxis Health, Patrick Soon-Shiong, commented on how coordination and exchange of health data can improve healthcare and have a direct impact on individuals. He also talked about how his “realizing of the American Dream” enabled him to contributes to this through the non-profit organization the Health Transformation Institute.

Pitfalls of PPACA – The Grandfathering Problem

Jun 1, 2010• 10

By ROGER COLLIER

Throughout his election campaign and his subsequent efforts to achieve passage of health care reform, President Obama assured Americans that anyone with existing coverage could keep that coverage. Consistent with the president’s promise, Democratic lawmakers worked to include language guaranteeing continuation of coverage in the reform legislation.

They may have been too successful.

Section 1251 of the Patient Protection and Affordable Care Act provides assurances that nothing in the Act requires that an individual terminate existing coverage, excludes many of the provisions of the Act from applying to existing coverage, and goes on to guarantee that existing coverage can be extended to new employees (in a group plan) and additional family members (if allowed by any plan).

On the one hand, these provisions counter some concerns about reform (at least for those who understand them). On the other hand, the grandfathering of existing coverage undermines much of the intent of other parts of PPACA. Grandfathered plans are exempt from each of the following reform requirements (and others):

Elimination of cost-sharing for preventive care
Elimination of annual limits (individual plans only)
Elimination of preexisting condition exclusions (individual plans only)
Provision to consumers of “plain language” plan information
Availability of a standard appeals process
Limitation on premium variations by age and other factors
Guaranteed availability of coverage
Guaranteed renewal of coverage
Prohibition on discrimination based on health status
Provision of comprehensive health care coverage

In other words, grandfathered plans will be able to continue most of the practices that have angered consumers—and discriminated against those most in need of coverage.

There’s another problem, too. In the small group market—and possibly also in the individual market in some states—the effect of grandfathering may be to reduce the diversity of the insurance exchange risk pools. Insurers will be eager to perpetuate their current plans and avoid most of the new regulatory requirements, while employers with younger and healthier employees will want to retain their prior lower-cost coverage, leaving older and sicker groups to migrate to the exchanges, with regulations and rates more favorable to them. The effect in states currently with high numbers of uninsured—and therefore potentially with the most exchange enrollees—may be minimal, but in others the result may be that premiums are higher for plans available through exchanges than for those outside, while many insurers may decide to focus on their present less-regulated business and simply avoid the exchanges.

Also by this author….

Roger Collier was formerly CEO of a national health care consulting firm. His experience includes the design and implementation of innovative health care programs for HMOs, health insurers, and state and federal agencies. He is editor of Health Care REFORM UPDATE [reformupdate.blogspot.com].