Tag: Uncategorized

Health Wonk Review – 4/3/08

Apr 3, 2008• 4

By Brian Klepper

HWR has clearly arrived, at least in the sense that all KINDS of
columnists are clamoring to be read here. More than thirty submissions
arrived in my inbox, a collection of the utilitarian, the thoughtful
and sometimes the downright ridiculous. Given only so much space for an anthology, I set aside more
than a few. Some were simply plugs, or not directly relevant to a blog focused on
health policy and market dynamics. Others were merely good.

But the twenty remaining posts were, I thought, exceptional
contributions from writers who continually plug away, asking themselves, “What
really matters and how can I talk about it?” As ever, you’ll find a
potpourri here of expert observation, analysis and commentary from
every part of health care. It’ll take a little effort wading through
it, but I promise you an illuminating and entertaining time.

Ah, a warning. One of these posts is for April Fools. Keep your eye out!

On to The Review! Enjoy!

Guidelines for Contributors

Apr 1, 2008

THCB welcomes contributions from readers. I often publish pieces and am happy to allow contributors to either use their own name, or use a pseudonym. If you want to use a pseudonym I need to know who you are, but I will of course keep that information in confidence. I always make clear when it’s my writing or that of a contributor both by giving a by-line in the title and by using indentation and different fonts. Regular readers will see this automatically, I hope.

There are only a few ground rules for contributors. The topic has to be on some aspect of health care that should be of interest to THCB readers, but as most contributors are readers that’s usually assumed. If you are contributing please save your piece in .txt or .rtf format. Using Word causes a lot of translation problems with its special characters, and just sending it in an email also often requires a lot of work on reformatting at this end.

Finally, although I print much of what I’m sent, THCB of course retains editorial control. I won’t publish anything without asking (or telling) you, but I assume that anything I’m emailed is fair game. Just use common sense and of course if you expressly do NOT want something published please tell me. And I’m not going into legalities about copyright, who owns what, and all that guff — but I’ll reserve the right to say more about that if in some happy future day this site ever starts adding to my bank account rather than subtracting from it!

— Matthew Holt

That being said, here’s some advice THCB editor Sarah Arnquist.

Want to improve your writing and make THCB editors happy? Follow these basic guidelines.Get to the point quickly. That means in the first or second paragraph. People are more likely to continue reading your post if you tell them what you’re writing and why early. Remember these: WHO, WHAT, WHERE, WHEN, WHY and HOW? Try to answer them early in your post.Avoid acronyms whenever possible. A good rule is that if your spouse wouldn’t know what the acronym is – spell it out on first reference. So CEO is fine, but PHR should be personal health record (PHR) on first reference. Watch out for jargon. Yes, you are writing for your peers, but it might be nice if a less informed person stumbled onto your post and learned something from it. Right? If the post is full of jargon, that won’t happen. Inevitably, some “insider terms” will slip through, but be cautious.When quoting statistics, a concept or popular entity ADD LINKS to either the original source (ideal) or a secondary source, such as Wikipedia or a newspaper article. Because we don’t put end notes in our stories, and constantly saying according to or reported in etc. is tiresome, this is a way to add credibility to your post. It also gives readers the opportunity to learn more.The nitty gritty details:Health care is two words. ALWAYS –- at least on our blog. Use ONE SPACE between sentences. This isn’t a term paper. This is Web writing.Use quotation marks to indicate quotes, and very rarely in other circumstances. Using quotes in attempts to be witty rarely is successful. Mostly, it will only confuse readers.Along those lines – punctuation ALWAYS goes within “quotation marks.” Note the period is before the quotation mark.When using the em dash -– use it judiciously. It’s really difficult to read a paragraph filled with breaks.Don’t take editing personally.If THCB sends a submission back to you with suggestions on how to improve it, don’t take it as a personal attack on your writing abilities. We ALL need editors, who provide a fresh set of eyes and offer important suggestions to make your article more concise and understandable. If you have any questions e-mail sa***@***************og.com.

Ratings games

Mar 31, 2008• 9

By Jane Sarasohn-Kahn

Most Americans believe there are fair and reliable ways to gauge the quality of health care. 9 in 10 Americans are interested in their health plans having a website where you could rate doctors on issues like trust, communications, medical knowledge, availability and office environment – and participating on such social networks (think: The Health Care Scoop, or Zagat/WellPoint).

The latest Wall Street Journal/HarrisInteractive survey published March 25 finds that 3 in 4 consumers favor patient satisfaction surveys – once again asserting they value opinions from peers (aka “people like me”) even more than those coming from institutions, whether private sector (e.g., employers or health plans) or public (e.g., government agencies).

Nonetheless, consumers still do value other sources for ratings:

– 66% like medical boards
– 65% value assessments by third parties, such as JCAHO
– 64% of consumers like measurements on preventive screening tests
– 58% believe the use of EMRs is a proxy for quality
– 42% see malpractice suits as a useful measure of quality health care.

The timing of this poll nicely coincides with the news that Angie’s List – known for its home repair service ratings – launched a health care ratings service earlier this month. On Angie’s List, consumers will be able to rate some 50 types of health care providers – including doctors, dentists, pharmacies, hospitals and health plans.

Which way to go for health reform? From Birkenstocks to pom-poms

Mar 31, 2008• 1

By Sarah Arnquist

The methods proposed to clean up the health care mess in the United States that leading voices pitched to hundreds of journalists Friday unsurprisingly were as varied as their Birkenstocks and patriotic tie.

David Himmelstein, co-founder of Physicians for a National Health Program and Birkenstock-wearing Harvard Medical School professor of medicine, unrelentingly pushed a single-payer system. "We need a reform that helps the insured as well as the uninsured," he said, adding that the system should "get rid of the insurance companies that provide no added value."

At the other end of the spectrum, Tom Miller, resident fellow at the American Enterprise Institute conservative think tank, wants more tax credits to put consumers in the driver’s seat and deregulation of the individual market.

Between those two ideologies, were Karen Davis, president of The Commonwealth Fund, and Julie Barnes, deputy director of the New America Foundation‘s health policy program.

Medicare releases hospital patient satisfaction data

Mar 29, 2008• 8

By Sarah Arnquist

Before choosing a hospital for an elective procedure, patients can now use the Centers for Medicare and Medicaid Services’ Hospital Compare Web Site to see how former patients rated their experiences at various hospitals. Patients can compare hospitals based on how well patients felt the doctors and nurses listened to them, whether the patients felt respected by the hospital staff, and whether patients understood the instructions on what to do after leaving the hospital.

Patients can also use the Hospital Compare Web site to compare how many patients were treated for heart attacks, pneumonia, and various surgeries at nearby hospitals and see how much Medicare paid.

These are the federal government’s latest steps to promote "value-driven health care."

"Everyone ought to have a motivation to get better quality and lower costs," said Michael Leavitt, secretary of the U.S. Department of Health and Human Services.

CMS launched the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey data Friday before a group of hundreds of journalists gathering in Washington D.C. for an annual conference.

Dennis Quaid takes on hospital errors

Mar 28, 2008• 35

By Sarah Arnquist

Hospital patient safety has a new celebrity advocate in Dennis Quaid, whose twin newborns received a massive overdose of a blood thinner last year at Cedars-Sinai Medical Center while being treated for infections.

While his twins bled profusely, Quaid and his wife, Kimberly, were met by a hospital risk management team, who instead of offering an apology and explanation, provided half-truths and excuses, Quaid told hundreds of journalists Thursday at the annual Association of Healthcare Journalists Conference in Washington D.C.

The Quaids’ experience has been widely covered in the press, and he and his wife recently started The Quaid Foundation to shine a spotlight on the 100,000 people who the Institute of Medicine estimates die annually from preventable hospital errors.

"Unfortunately this tragic secret in the medical industry will continue until the medical community overwhelms a conspiracy of silence and demands public accountability,” Quaid said. "I do realize that because I’m a known person, we have an opportunity to get the word out."

Happy Birthday, Viagra!

Mar 27, 2008• 3

By Jane Sarasohn-Kahn

It’s the drug that raised the profile of medicine in popular culture. It’s been hawked by a prominent politician and has been the butt of jokes on late-night TV. It’s Viagara, and it’s turning 10 today.

The FDA approved the drug on March 27, 1998. Here is the FDA’s approval page for it.

Pfizer’s Viagra reshaped pharmaceutical marketing in several ways. The company used direct-to-consumer advertising to great effect, and changed the game of DTC by advertising the drug not only in late at night broadcast outlets.

More broadly, the marketing of Viagra bolstered the trend of medicalization of everyday life. Viagra’s origin as sildenafil citrate was targeted to cardiovascular medicine. Originally conceived as a heart drug for hypertension and angina, the molecule was, serendipitously, found to be useful in erectile dysfunction.

In 1998, three scientists who studied the dynamics of nitric oxide, the secret sauce in Viagra, won the Nobel Prize.

Jane’s Hot Points: One of the most informative primers on Viagra is this book from Meika Loe of Colgate University. In it, she observes that we are Viagra nation where, "our sexual status quo has shifted dramatically." Ten years after Viagra’s entry on the health scene, the search remains for a "pink viagra," a version for women. No one can deny the game-changing role that Viagra has played in American health care and in popular culture.

Average Time of Discharge: Why a Hospital is Not a Hilton

Mar 26, 2008• 7

By Robert Wachter

Do you get as annoyed as I do about being pressured on your “Time of Discharge?” I just received my monthly report, and we’re in The Doghouse again: our average TOD – 3:28 pm – is hours after “check-out time.”

But when did we turn into the Holiday Inn?
Robert_wachter

Let’s start by appreciating where this comes from. Many hospitals, including mine, tend to run full – given the huge fixed costs of operating a modern hospital, being full is probably the only way you can be profitable, just like the airlines. Queuing theory (don’t tell me you’ve forgotten your queuing theory!) tells us that, when you’re full, you should look for fundamental choke points and do your best to relieve them. There are PhDs working for McDonald’s whose lives are dedicated to figuring out how to avoid lines at lunchtime rush hour, and others working in aviation who model the best ways to load passengers onto planes (latest answer courtesy of a Fermi Lab astrophysicist: start in the back and load every third row, back to front, sequentially).

The main stenosis in hospitals occurs in the early afternoon: the morning’s OR cases are finishing, the ED is heating up, the clinics are sending over elective and urgent admissions, the respiratory therapists have done their weaning and “liberated” a few patients from vents… and everybody needs a floor bed. Now! But they’re all taken, since nobody’s gone home yet.

Gridlock. Bad for business.

How do you fix this? About a decade ago, some smart consultant (I can’t figure out who, but he or she must have had a terrific PowerPoint slide making this point since every hospital I know of picked up on it) came up with the solution: let’s measure and report the time of discharge by service, shining the holy light of transparency on service chiefs like me to get them cracking. And since everybody likes Goals, how about we set a guideline – “The Discharge Time on 5 South is 11 am” – and post it in every room and nurse’s station. Then it won’t be a shocker to the patients when we try to hustle grandma into the wheelchair and roll her out of her room before noon.

Entering Unfamiliar Territory

Mar 24, 2008• 13

By Kristen Trusko

If universal coverage mandates that employers provide health insurance or that people secure it themselves, it is highly likely that the majority will choose the lowest cost option, or “low premium” (aka HDHP or high deductible health plan). These plans enable consumers to open an associated financial account – HSAs. In addition to helping consumers plan their spending, savings and investment for current and future health needs, HSAs provide a triple tax free opportunity to save for retiree health.

Health 2.0: Weighing In With a Reality Check

Mar 21, 2008• 5

By Michael Millenson

Maybe you saw the article: “Health 2.0 Helps, But Personal Contact Remains Top Weight Loss Strategy.”

OK. I made up the headline. But the information comes from an article that provides food for thought for those of us who speak, blog and otherwise evangelize about the good things the Internet is bringing to
health care. Here’s one question to start with: is there a different ethical obligation for those promoting the efficacy of an online health intervention than for those promoting a site to help you find a great
hotel?