Tag: Brian Klepper

Posts by Brian Klepper

Business As Usual: California’s Reform Proposal – Brian Klepper

Brian_klepperIn the world of health reform wonks – the writers on this blog qualify in spades – all eyes
are on California at
the moment. His Republicanism notwithstanding,
Governor Schwartzenegger has developed a generous $14 billion bill that
would extend universal coverage to all Californians by 2010.

that the plan is set, the special interests are lining up. Most of the
health care groups – the physicians, hospitals, the health plans (with
the interesting exception of Wellpoint) – are supportive, fully aware
that if more money can be found for health care, they’ll be the
recipients. Also in the mix are two prominent unions: SEIU (the Service
Workers’ International Union) and the American Federation of State,
County and Municipal Employees. They are both key supporters, each with
health care workers who would benefit from the deal.

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Policy- vs. Market-Based Reform: RHIOs as a Case Study – Brian Klepper

BrianAs Anonymouse insightfully commented, the Harvard team’s RHIO study in Health Affairs is very telling
about the barriers facing do-gooder health care projects. That said, I wanted to add two comments.

First, while RHIOs are unquestionably good public policy, what they might accomplish can be seen as counter to their interests of many organizations expected to support them. (The same can be said for EHRs, by the way)

Second, this is why health care reform will emerge not from within health care and not from policy, but from the marketplace, driven by non-health care interests.

Read the rest over at the Health 2.0 Blog

Bad Medicine: How The AMA Undermined Primary Care in America – Brian Klepper

On Tuesday’s Wall Street Journal website, Dr. Benjamin Brewer describes
physicians’ reactions
to the 10.1% cut in Medicare physician payments
that will take effect January 1. He argues that the onus will fall,
once again, disproportionately on primary care physicians, who are
already losing the struggle to keep their heads above water.

He is right, of course. There is no question that Medicare must rein in
But the cuts are approximately the same across specialties and
therefore regressive. Insensitive to its distinct role, its lower
revenues and its high operational costs, they hit primary care harder
than they do specialties. Given its already battered status, the cuts’
impact on primary care could translate to real consequences this time.

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If Grady Fails By Brian Klepper

In an extraordinary move earlier this week, the politically-appointed Fulton-DeKalb Hospital Authority, the governing body over Atlanta’s Grady Health System, unanimously and voluntary stepped aside, to be replaced by a new non-profit corporation. Projecting a $55 million deficit this year, the hospital had just three weeks of cash on hand. It needs $300 million immediately for sorely needed renovations, and must deal with $63 million in accumulated debt to its biggest creditors, Emory University Medical School and Morehouse School of Medicine. New oversight was the predicate for a hoped-for financial bailout from business, philanthropies and financial institutions.

Other Atlanta hospitals are undoubtedly concerned that Grady will fail, and will probably do everything possible to support a bailout. The last thing they want is for Grady’s patients to come to their facilities. Now would be a good time to rally business leaders and legislators, who nearly always go to fancier hospitals, which of course has been a big part of the problem.

Grady’s turmoil should be recognized as the first small shock of much larger seismic event, long in the making, a concrete sign of America’s relentlessly intensifying health care crisis. The wrath falls on our most vulnerable – those with health problems or with few financial resources – as well as on the institutions and professionals that care for them.

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Why Consumers’ Checkbook v CMS is a Sideshow – Brian Klepper

There are people who call for market solutions as the answer to every societal problem, but who then work to restrict the information that markets (and societies) must have to function effectively. Often, the truth is that these supposed market advocates need secrecy and opacity to protect their current advantages. If markets were to work as they claim they want, their actual behaviors (or pricing, or performance) would become known, and their positions compromised.

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Aspen Report 3 – Removing the Blinders: Dr. Kelman’s Wonderful Contribution, Brian Klepper

of the most fascinating and moving experiences at the Aspen Health
Forum – Given the quality of the content there, this is saying
something. The audience was rapt – was a talk by Neen Hunt, Executive
Director of the Lasker Foundation.
Each year this organization bestows a hugely prestigious prize to
individuals who have made significant contributions to scientific
medicine, clinical medicine and public service.

Dr. Hunt’s talk
focused on combating the geeky stereotypes that often are associated
with people with dedicated passions, and on conveying their broad
humanity. Her vehicle was a character portrait of Dr. Charles D.
Kelman, an ophthalmologist practicing in Manhattan during the latter
half of the 1900s, who in an incredibly bold stroke, blew past
convention, inciting the wrath of those tied to the established order,
and revolutionized the way that cataract surgeries are performed.

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We Are What We Eat: Where Is America’s Leadership? – Brian Klepper

One of the attributes of a great image is its ability to convey vast amounts of information and meaning quickly and simply. Here’s a terrific example.

In one of his typically astute comments, Barry Carol alerted us to a wonderfully clever graphic by Wellington Gray – the image needs more space to be viewed properly than this blog allows, so you’ll have to click on the link – displaying the percentage of people older than 15 in different developed countries with a Body Mass Index greater than 30. In other words, the percentage of fat adults.

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What Obesity Really Costs – Brian Klepper

lingering doubts that America’s cavalier attitude toward lousy food and
obesity is draining the nation’s health and economic vitality should
have been laid to rest a couple weeks ago. Two important studies were released
that quantified just how much our inability to resist fast food is
costing us.

In Health Affairs, the premier journal of
health care market dynamics, economics and policy, Professor Ken Thorpe
and colleagues from Emory reported on a study comparing incidences of chronic disease in the US and in 10 European countries.
They found strong evidence that Americans have much higher levels of
lifestyle-related chronic disease than do Europeans – in other words,
we’re sicker – that American medicine tends to identify and treat
disease more aggressively than does European medicine, and that our
more excessive lifestyles and aggressive treatment patterns undoubtedly
contribute significantly to our much higher per capita health care
spending, which can be twice what Europeans pay.

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Aspen Report 2 – Healing Unbound: The Promise of Advancing Computational Power, Brian Klepper

Laptop-attached ultrasound units that produce startlingly clear internal images for five dollars in the field. Organs that re-generate inside scaffolds.  Drugs tailored to an individual’s biology. Micro-images of cancerous cells lit up by bio-chemical markers. Decision support tools that scan the physiological values in electronic health records for patterns too complex to be detected by an unaided clinician.

The advances available from dramatic improvements in computational capabilities were a recurring theme at the Aspen Health Forum, with experts from each discipline describing where the technology was leading us. I attended two sessions featuring Star Trek clips that predicted realities now within at least theoretical reach. (Prescient and corny, audiences nodded nostalgically.) Sessions on biotechnology, imaging, electronic health records (EHRs) and the hospital of the future highlighted the power that is being leveraged to improve care.

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Aspen Report 1 – A Rage To Know: A Few Days At The Aspen Health Forum, Brian Klepper

At one of the opening sessions of the Aspen Health Forum, Peter Agre and Michael Bishop, both physician researchers and Nobel laureates, recounted their childhoods, their families, their likes and dislikes, their school experiences, and the barriers, successes and lucky breaks that led them into lives of discovery. Dr. Agre won the award for identifying the mechanisms that allow water to cross the cell membrane. Dr. Bishop won for discovering how certain defects in genes can lead to cancer.

Those of us in the audience were struck by the commonness and good humor of their stories, but also by these individuals’ profound humility and, most of all, their passion. What Neen Hunt, Director of the Lasker Foundation, the third speaker on that panel, in her description of Dr. Charles Kelman, an ophthalmologist who revolutionized the way cataract surgeries are performed (more on that in another post), called “a rage to know.”

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