Category: Uncategorized

JAMA EHR Study: Misdiagnosis Poses Significant Potential for Harm

Apr 5, 2013• 21

By Evan Falchuk

An important study in the Journal of the American Medical Association finds that misdiagnosis is more common than you might think. According to the study, almost 40% of patients who unexpectedly returned after an initial primary care visit had been misdiagnosed. Almost 80% of the misdiagnoses were tied to problems in doctor-patient communication, and more than half of those problems had to do with things that were missed in the patient’s medical history.

The results of this study shouldn’t be surprising if you’re a regular reader here – they are another example of a system that isn’t working as well as it could for patients, and doctors. Doctors – and the medical professionals who help them in their work – are the best educated and best trained than they have ever been. They have more access to medical information and technology than at any time in our history. And yet, U.S. government data show that the typical doctor visit involves 15 minutes or less with your doctor. Medical records are kept in fragmented, uncoordinated ways.

Inside the New Data on ADHD Diagnosis Rates

Apr 5, 2013

By Brendan Saloner

The New York Times had a cover story recently reporting on the estimated prevalence of Attention-Deficit/Hyperactivity Disorder from the 2011-2012 National Survey of Children’s Health (they don’t identify the survey by name).

The story is going to get a lot of people interested in what is happening to children — every new datapoint on ADHD is noteworthy because it allows journalists to reopen the black box on childhood behavioral health disorders, and to raise the perennial alarm bells about over-diagnosis of children.

All of the issues raised in the article are valid. Many children with very mild impairments are getting a diagnosis, and enterprising drug companies are increasing demand for their product by implying that ADHD medications are a cure for generalized social impairments.

But — and this is critical – we have little systematic population-level data to compare the reported prevalence of a diagnosis with underlying data on ADHD symptoms in children. Continue reading…

Strength In Numbers

Apr 5, 2013• 1

By Doctor Girl

Data = Power. The Surviving in Numbers Project.

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?