Category: Uncategorized

A Model for Health Care Reform:Would You Guess Medicare Part D?

Apr 4, 2013• 11

By Hank Pomeranz

Every day, over 7,600 baby boomers turn 65. By 2029, this number will rise to over 11,000. As more and more Americans approach senior citizenship, health care for seniors through Medicare becomes increasingly relevant. The question is, how will this affect you?

We all have questions about how the current budget battle and resulting spending cuts are going to impact Medicare. It seems unavoidable that Medicare costs will have to be reduced in some manner. Both Democrats and Republicans have proposed fixes to counteract these budget cuts. President Obama, in his State of the Union address, recommended adjustments to Medicare Part D that would enforce mandatory rebates–in other words, price controls–on drug companies.

But we need to ask ourselves: why would we make changes to the most successful part of Medicare by far? Polls indicate that 90 percent of seniors are happy with their current Part D coverage. Not only is Part D popular; it is also cost effective. It has cost 30 percent less than originally estimated. Premiums are an average of half the price originally estimated. Meanwhile, price controls are estimated to increase drug costs by 40 percent. Clearly, they are not the answer to cutting Medicare costs.

Healthy Community Data Summit — A Call to Action

Apr 4, 2013• 1

By Wil Yu

Do we live in times of barbarism?

While I imagine many reading this would disagree that we live as a primitive culture based on our technological progress, I contend that how we operate as a community may be vastly improved in supporting the health and well-being of everyday citizens. Furthermore, I believe that one day we’ll look back on ourselves as society and marvel at how primitive the tools were to improve the health of communities.

On a daily basis, our individual health is driven by countless decisions. Where we shop for food, how we commute, where we choose to live and spend our time outdoors are all contributors to our health and wellbeing. Each of these actions can be improved—optimized so they contribute to a maximum level of health—if adequate data is available.

So It Turns Out Inventing Your Own Business Model Is More Fun Than You Were Expecting…

Apr 3, 2013• 12

By Rob Lamberts, MD

It’s official. The road sign clearly welcomed me here. I guess all business start-ups have to go through this town (Hell).

What? No bravado? No chest pounding about how my ideas will change health care while making patients smell as springtime fresh? Nope. None of that. It’s hard to get excited about ideas when only money pays the bills.

Having now left the safe confines of my leftover earnings from my old practice, I am now supposed to be self-supporting. Two big things have caused this to not go as smoothly as I have planned:

My construction took twice as long as I expected.
I have yet to find a computer system that doesn’t make me want to pound on my desk and wantonly overuse the word “inconceivable.”

How the Best of Intentions Is Hurting Care for Americans Who Live In Rural Areas

Apr 2, 2013

By Ashish Jha, MD

Ensuring that Americans who live in rural areas have access to health care has always been a policy priority. In healthcare, where nearly every policy decision seems contentious and partisan, there has been widespread, bipartisan support for helping providers who work in rural areas. The hallmark of the policy effort has been the Critical Access Hospital (CAH) program– and new evidence from our latest paper in the Journal of the American Medical Association suggests that our approach needs rethinking. In our desire to help providers that care for Americans living in rural areas, we may have forgotten a key lesson: it’s not about access to care. It’s about access to high-quality care. And on that policy goal, we’re not doing a very good job.

A little background will be helpful. In the 1980s and 1990s, a large number of rural hospitals closed as the number of people living in rural areas declined and Medicare’s Prospective Payment System made it more difficult for some hospitals to manage their costs. A series of policy efforts culminated in Congress creating the Critical Access Hospital program as part of the Balanced Budget Act of 1997. The goals of the program were simple: provide cost-based reimbursement so that hospitals that were in isolated areas could become financially stable and provide “critical access” to the millions of Americans living in these areas. Congress created specific criteria to receive a CAH designation: hospitals had to have 25 or fewer acute-care beds and had to be at least 35 miles from the nearest facility (or 15 miles if one needed to cross mountains or rivers). By many accounts, the program was a “success” – rural hospital closures fell as many institutions joined the program. There was widespread consensus that the program had worked.

Despite this success, there were two important problems in the legislation, and the way it was executed, that laid the groundwork for the difficulties of today. Continue reading…

Can We Put the Hospital Marketing Genie Back in the Bottle?

Apr 2, 2013• 7

By Joanne Conroy, MD

I am old enough to remember when physicians did not advertise. It was considered a professional ethical issue. Hospital advertising consisted of institutional “We’re here” ads. Anything aggressive by docs or hospitals was considered bad taste… but that was before health care became as competitive as any other type of business.

I have been barraged, as have many of you, by a wave of hospital advertisements as our health care marketplaces consolidate and organizations seek to brand and differentiate themselves. We are subjected to print, radio, and TV ads extolling services, expensive technology, and that fact that each institution cares more than its competitors.

Charlie Rohlfing blogged recently about the worst in hospital advertising techniques, and you will recognize them all. They usually include a Da Vinci Robot and orthopedic surgery that will “get you back in the game.” They claim to be “state-of-the-art,” “leading edge,” or “cutting edge,” with actors playing doctors and nurses in masks.

Measuring the Quality of Hospitals and Doctors: When Is Good Good Enough?

Apr 1, 2013• 11

By Bob Wachter, MD

In the past, neither hospitals nor practicing physicians were accustomed to being measured and judged. Aside from periodic inspections by the Joint Commission (for which they had years of notice and on which failures were rare), hospitals did not publicly report their quality data, and payment was based on volume, not performance.

Physicians endured an orgy of judgment during their formative years – in high school, college, medical school, and in residency and fellowship. But then it stopped, or at least it used to. At the tender age of 29 and having passed “the boards,” I remember the feeling of relief knowing that my professional work would never again be subject to the judgment of others.

In the past few years, all of that has changed, as society has found our healthcare “product” wanting and determined that the best way to spark improvement is to measure us, to report the measures publicly, and to pay differentially based on these measures. The strategy is sound, even if the measures are often not.

Wellness Programs Aren’t Working. Three Ideas That Could Help.

Apr 1, 2013• 29

By MIKE MIESEN

You’d be forgiven if, after reading last month’s Health Affairs, you came to the conclusion that all manner of wellness programs simply will not work; in it, a spate of articles documented myriad failures to make patients healthier, save money, or both.

Which is a shame, because – let’s face it – we need wellness programs to work and, in theory, they should. So I’d rather we figure out how to make wellness work. It seems that a combination of behavioral economics, technology, and networking theory provide a framework for creating, implementing, and sustaining programs to do just that.

Let’s define what we’re talking about. “Wellness program” is an umbrella term for a wide variety of initiatives – from paying for smoking cessation, to smartphone apps to track how much you walk or how well you comply with your plan of care, and everything in between. The term is almost too broad to be useful, but let’s go with it for now.

When we say “Wellness programs don’t work,” the word work does a lot of, well, work. If a wellness program makes people healthier but doesn’t save lives, is it “working”? What if it saves money but doesn’t make people healthier?

Why Become a Doctor?

Mar 31, 2013• 65

By Vineet Arora, MD

Recently, I was having a discussion with a colleague about being a doctor. She confided in me that if someone asked her about becoming a doctor, she would tell him or her to become a nurse practitioner. After reading the emotional open letter to our policymakers in Washington DC, it may sound like a reasonable suggestion. After all, why go into this much debt and spend so much time in training if your prospects are not much better? More recently, the New York Times article points out job prospects for radiology trainees are thinning, meaning the well known “ROAD” (Radiology, Ophthalmology, Anesthesiology, and Dermatology) to success may soon become a road to nowhere if there are no jobs.

There in lies the question, why become a doctor? If the answer is to make money or to have an easy life, then you probably need to look for a new profession. With healthcare payment reform, doctors can expect lower salaries as bundled payment and cost cutting measures are instituted. Moreover, the demand for healthcare will go up as more patients have insurance, leading to higher patient volumes and the expectation to see more patients with the same amount of time.

Shoe-Leather Epidemiology Needs More, Not Less Funding

Mar 29, 2013• 3

By Andi L. Shane, MD

Infections from contaminated steroid injections, influenza outbreaks, destruction from Sandy, West Nile Virus, measles and pertussis outbreaks. These are just a few of the public health crises we faced down in 2012, thanks to the tireless efforts of local and state health departments. Each outbreak takes tremendous resources on top of day to day surveillance activities, but public health is now facing its own crisis of funding: The sequestration will cripple local and state public health departments. Analysts calculate an effective funding reduction of 9%, with the Centers for Disease Control and Prevention losing $350 million. While every federal agency will have to tighten its belt, for public health there are no more belt holes.

“Sequestration would impact every CDC program and could increase the risk of disease outbreaks,” Centers for Disease Control and Prevention Director Thomas R. Frieden recently told CQ HealthBeat. “More than two-thirds of our budget goes out to boots-on-the-ground work at the state and local level to find and stop outbreaks and other health threats.”

A National Caregiver Corps: What the Administration Could Do

Mar 29, 2013• 20

By Janice Lynch Schuster

Nearly 40 years ago, when I was in elementary school, a controlling teacher would issue edicts about what we could and could not do: We could not talk at lunch time, nor could girls wear shorts. In both cases, my lawyer-father encouraged me to launch petitions. I wrote a paragraph about the unfair practices, stapled together a pile of loose-leaf paper, which I circulated at recess, in class, and on the bus. After a week or so, I presented the document—perhaps 100 children had signed, and some parents—to the principal. He was unaware of the rules! And, upon hearing them, reversed them. It was my first attempt at community organizing and pushing back against a policy that was making my life nearly unbearable.

It’s been years, and I’ve occasionally signed petitions exhorting various government agencies to act—or not act—on one issue or another. But until recently, my own petition-bearing days had ended.