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Tag: California

Transforming Care Through Transparency


By year’s end, the Department of Health and Human Services will announce plans for making its Physician Compare website into a consumer-friendly source of information for Medicare patients about the quality of care provided by doctors and other health care providers. In doing so, Physician Compare will take its place alongside Hospital Compare and more than 250 other websites that offer information about the quality and cost of health care. More importantly, perhaps, it will send an important signal that transparency in health care is the new normal.

To look at these 250-plus online reports is to see the good, the bad, and the ugly of the public reporting aspect of the transparency movement. Some make it easy for people to make choices among physicians and hospitals, and just as notably, let providers see where they fall short and need to improve care. But others ask too much, forcing users to sort through rows and rows of eye-glazing data and jargon that requires a medical degree to fathom.

The Affordable Care Act calls for Physician Compare to offer information about the quality of care, including what physicians and their practices did and the outcome for patients, as well as care coordination; efficiency and resource use; patient experience and engagement; and safety, effectiveness, and timeliness. That’s a lot of information, and it demonstrates the tall order facing the federal government to make the reports meaningful and accessible, so that physicians and patients will both be more apt to use them.Continue reading…

Give Big Tobacco a Kick in the Ash and Save Lives

What could be more pressing than ending suffering and death from cancer — a disease that kills 155 people every day in California?

A yes vote on Proposition 29 on June 5 to increase the tobacco tax by $1 will save lives from cancer and other lethal diseases caused by tobacco, protect kids from the tobacco industry’s predatory marketing, ease the enormous economic burden of tobacco use on the state and fund groundbreaking medical research on the leading killer diseases.

Yes on 29 is an opportunity to tell Big Tobacco that enough is enough. That we’re tired of the industry’s relentless assault on our children, our health and our economy. Proposition 29 was written by the state’s leading public health groups – the American Cancer Society, American Heart Association and American Lung Association – to empower Californians to fight back against Big Tobacco’s ongoing campaign of addiction and death. Proposition 29 will also help reverse tobacco’s debilitating drag on California’s economy, saving the state billions of dollars in health costs.

The tobacco industry spends every minute of every day surreptitiously recruiting new customers: our kids. During the past decade, Big Tobacco invested 10 times more on marketing its deadly products in California than the state spent on educating the public about its harmful effects. The tobacco industry spends more than $650 million each year targeting our state with deceptive marketing designed to recruit their next generation of customers – and has already spent nearly $40 million to distort the truth on Proposition 29.

The industry’s efforts are devastatingly proficient: California’s kids buy or smoke more than 78 million packs of cigarettes each year. Nearly 90 percent of the smokers in California started smoking before their 18th birthday.

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The Super Committee: Bracing for More Medicare Cuts

I attended a depressing forum on cost-saving ideas for Medicare to present to the Congressional “Super Committee” charged with coming up with $1.2 trillion in budget savings by the end of the year. The tone was ominous, best summed up by Mark Smith, president of the California HealthCare Foundation. “In times of crisis, meat-axes are taken to whole sectors. If you don’t believe me, ask the people who used to work for Lehman Brothers,” he said.

Here’s the backdrop. President Obama in his mid-September budget reduction plan called for coming up with an additional $320 billion in Medicare savings over the next decade, which would be on top of the half trillion dollars in Medicare cost reductions contained in the Affordable Care Act. The president would get there largely by cutting payments to hospitals and other providers, although the president also called for higher premiums on wealthier seniors for physician and drug coverage.

Will the Super Committee look for the same $320 billion in cuts to Medicare? A good case can be made that Medicare’s contribution to the $1.2 trillion recommendation should be less than what the president sought. The Congressional Budget Office’s current baseline projections for federal spending over the next decade has Medicare spending $7.4 trillion out of a total of $44 trillion. That’s 16.8% of ALL federal spending (defense, Social Security, discretionary domestic programs, you name it). Apply that 16.8% to $1.2 trillion and you get about $202 billion as Medicare’s “fair share,” not the $320 billion proposed by the president.

Still, there were precious few ideas at this morning’s forum that would come up with even a fraction of that total. Robert Berenson of the Urban Institute and Steve Phurrough of the Agency for Healthcare Research and Quality, both former top-ranking officials at the Center for Medicare and Medicaid Services, outlined a series of steps CMS could take to get better pricing, stop paying for uncalled for operations, and only pay the price of the “least costly alternative” when medical interventions are comparable. But most of those changes would require Congressional approval (fat chance), and none of the examples given (they spent a lot of time talking about implantable cardio-defibrillators, where an estimated 25% to 30% of the million operations each year are in patients who don’t really need them) raised more than a billion dollars.

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What Voters Really Think About Evidence-Based Health Care

I want to call your attention to an important survey done by the California-based Campaign for Effective Patient Care. They surveyed California voters on their understanding of evidence-based medicine.The bad news is that patients think their health care treatment is generally evidence-based even though that assumption is highly questionable. The good news is that patients want it to be evidence-based.At a time when we hear anecdotal evidence, particularly from town hall meetings, that people don't want any "interference" between them and their doctors they do seem to appreciate they need to get all of the facts when making a treatment decision.Here is the survey summary. You can access all of it here.

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California Moves Backward on Covering Uninsured Children

During tough budget times, most states have maintained their commitment to covering uninsured children. At least eighteen states have even further strengthened coverage for uninsured children, despite budget problems, as the recession has increased the need.While many states have prioritized covering uninsured children, California lawmakers voted to deny coverage to nearly 800,000 children. This decision ignores strong public support for providing affordable health coverage to children and families. This decision also undermines California’s ability to access federal funds, just when the state needs them most. The Children’s Health Insurance Program Reauthorization Act of 2009 made the federal government an even stronger partner for states that prioritize covering uninsured children. California’s $144 million children’s coverage cut will cost the state $267 million in federal funds.This is a difficult time for state budgets but an even harder time for family budgets, and many states are responding to meet the need. Alabama, Washington, North Dakota, Colorado, Iowa, Kansas, Nebraska, Arkansas, West Virginia, and Montana have all expanded coverage; Oregon and Ohio are on the verge of doing the same. Other states have instituted reforms designed to make their CHIP and Medicaid programs more family-friendly, all with the goal of increasing access to affordable health coverage for children.California faces unique public policy challenges that have contributed to this step backward for children. The state was hit particularly hard by the economic and housing crises. More importantly, California has legal restrictions that put large shares of the state’s budget out of lawmakers’ reach, as well as supermajority requirements for passage of budget legislation.While the search continues for ways to help California restore affordable health coverage options for children and families and hope remains high that national health insurance reform will be enacted soon, California’s decision should not diminish the accomplishments of the other states. It is critical that states keep working to strengthen and maintain the gains they’ve made in offering affordable health coverage options to uninsured children and that the federal government remain a strong partner in their efforts.

Illinois AG: Shady AIDS Charity’s Web Campaign Broke State Law

Four months after we first reported on a sketchy AIDS "charity" with a nationwide fundraising campaign,
authorities have begun to crack down. But the move might not have much
impact if other officials don't follow suit.

The Illinois attorney general alleged in a lawsuit Thursday that the Center for AIDS Prevention
solicited donations illegally and falsified official documents. The
group's fundraising campaign has featured ads on the Web sites of the New York Times, the Chicago Tribune, the Los Angeles Times and others for months, drawing attention to the charity's shady practices.

In March, we noted that the group promoted false health information and ineffective herbal remedies, misled potential donors with claims about its battle to "stop
AIDS," and repeatedly failed to provide a full accounting of how it
spends contributions. Its financial records show no expenses, and there
is no evidence that it has provided any services to people with AIDS,
its stated mission.

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After Nurses Investigation, Scrutiny Turns to Other California Health Boards

Earlier this month, ProPublica and the Los Angeles Times published an investigation detailing the failure of the California Board of Registered Nursing to investigate and discipline nurses accused of misconduct in a timely manner. An examination of all disciplinary cases from 2002 to 2008 found that the board took an average of more than three years to investigate and close them — while the nurses accused of wrongdoing continued to practice without restriction. The day after the story was published, Gov. Arnold Schwarzenegger replaced most members of the board, and its longtime executive officer resigned the day after that.

The fallout has continued. There have been a slew of follow-up editorials and articles in California newspapers. One, in the Los Angeles Times, said of the governor's response: "This time, he acted to protect patients, but where was the gubernatorial outrage when the state Board of Chiropractic Examiners, which included several of Schwarzenegger's friends, was accused in a state audit of similar failures to put consumers first?"

Another, in the San Francisco Chronicle, suggested that "Schwarzenegger shares a measure of blame too: his imposed work furloughs will slow investigations, and his administration should have been on the problem earlier."

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Schwarzenegger replaces most of state nursing board

Picture 2Gov. Arnold Schwarzenegger replaced most members of the California
Board of Registered Nursing on  Monday, citing the unacceptable time it takes to discipline nurses accused of egregious
misconduct.

He fired three of six sitting board members – including President
Susanne Phillips  – in two-paragraph letters curtly thanking them for
their service. Another member resigned Sunday. Late Monday, the governor's
administration released a list of replacements.

The shake-up came a day after the Los Angeles Times and ProPublica published an investigation finding that it takes the board, which oversees 350,000 licensees, an average
of three years and five months  to investigate and close complaints against
nurses.

During that time, nurses accused of wrongdoing are free to
practice – often with spotless records – and move from hospital to
hospital. Potential employers are unaware of the risks, and patients have been
harmed as a result.

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Head of Investigations Unit Resigns

Dca-logo BY TRACY WEBER

The head of investigations for California’s Department of Consumer Affairs has resigned, continuing the fallout from a Los Angeles Times – Propublica investigation into lengthy delays in disciplining nurses accused of egregious misconduct.

According to a spokeswoman for the California State and Consumer Service Agency, the decision by Lynda Swenson to quit was tied to revelations by The Los Angeles Times and ProPublica about problems at the Board of Registered Nursing. Most investigations of errant nurses are handled by the Division of Investigation, which Swenson headed.

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And in today’s scuttlebutt–Sutter pay grades

A little birdie contacted me leading me to wonder, what did the former CEO of Sutter Health Van Johnson do to get paid $5.6 million for working for a “part year” in 2006? (See page 100 of this PDF). It may go somewhat to explaining why a) Sutter is the most expensive hospital system in Northern California, and b) why the unions hate it so much! On the other hand we’re entitled to wonder when the web site says things like this :

Unlike investor-owned health care systems, Sutter Health is a not-for-profit organization. As such, any money left over after employees and bills have been paid is reinvested in health care.

On the other hand in 2005 Johnson didn’t make the top 5 list dominated by CEOs of individual Sutter hospitals all earning what typical hospital CEOs make—500K and up!) (page 59 here). Neither did current CEO Patrick Fry make the top 5 in 2007 (page 99 here). Perhaps the key is that they only pay the big boss after he quits?

Anyway, anyone who can elucidate please comment away.

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