By BRIAN ANDERSON, MD

On Monday, the medical establishment and the general public were put on alert by an emergency notification from the Centers for Disease Control and Prevention: Florida’s Miami-Dade County had 14 confirmed cases of the Zika virus, the infectious disease which causes birth defects, and was at risk of continued active transmission.  In the following days, the CDC has advised pregnant women and their partners to avoid Wynwood, a small community north of downtown Miami–the first time it has ever issued a travel alert in the United States for an infectious disease. It has also issued specific Zika guidelines for the Wynwood region for patients who have traveled to the area on or after June 15th.

Moments like these test our healthcare system and reveal its weaknesses.  We’ve spoken often on this blog about healthcare’s connectivity problem: islands of information and data siloes that don’t talk to one another, sometimes to lethal effect. Public health crises demand that health information flow freely and that healthcare providers have the latest clinical guidelines at their fingertips.
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By KIP SULLIVAN

“[We are supposed to gather information from patients] prior to the physician going into the room. It doesn’t happen. I’m going to be honest – the reality … is … we also are responsible for telephone triage, walk-in emergencies, diabetic meter teaching, I mean, the list goes on and on.”

That is a quote from an interview with a “care coordinator” for a “medical home” in Minnesota. Minnesota is one of the eight states that participated in the Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration, which is one of three experiments CMS has conducted testing the “patient-centered medical home” (PCMH) concept. The quote appears in a report  published by the University of Minnesota in February 2016. (p. 75)

In this three-part series, I am addressing the question, What can we learn from the latest report from CMS about the MAPCP demo? The report in question is the second-year evaluation  of the demo which CMS released with zero publicity on May 11, 2016. That evaluation reported that PCMHs have had virtually no effect on the cost or quality of medical care given to Medicare beneficiaries (with the possible exception of Vermont, where PCMHs lowered costs not counting CMS subsidies to PCMHs, but had little effect on quality. [1] Evaluations of the other two CMS “medical home” experiments have reached the same conclusion (see Table 2 of this Kaiser Family Foundation report  and my comment here.

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By MICHAEL MILLENSON

As Hillary Clinton’s motorcade sped toward the Chicago hotel hosting the American Medical Association’s annual meeting in June 1993, the clergyman giving the invocation made a jarring request of God: that the audience not boo the speaker.

Those weren’t his exact words, of course, but the prayer pointedly included reminders about the obligation to be polite to guests, particularly when a national TV audience was watching. An AMA official made a similar plea without involving the Deity.

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By JOSHUA ELDER and GAIL D’ONOFRIO

The United States is facing an alarming rate of opioid and heroin overdoses. The recent death of Prince highlighted yet again a tragic event that is occurring 78 times everyday in the United States according to the Center for Disease Control (CDC). With more deaths from overdoses occurring annually than motor vehicle collisions, President Obama’s administration recently asked Congress for more than $1 billion to fight the opioid epidemic. Fortunately for Obama the issue has garnered strong bipartisan support and what remains is how to responsibly allocate this funding toward a variety of strategies aimed at prevention, treatment and harm reduction.

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By HOSPITAL TALK

In this Carelogistics podcast, THCB editor Sanchayeeta Mitra talks about how thinking like an engineer can eliminate breakdowns in care delivery, the eternal quest to make a trip to the doctor’s office more like the experience of using Amazon.com and why doctors and engineers (and nurses and the IT department) should all love each other. Really.

If you have a story to tell about something innovative you’re doing or a hack you’re using to change medicine or improve care delivery at your hospital or practice – drop us an email to considered for an interview.

By ANISH KOKA, MD

Like many cities, Philadelphia is a city defined by its neighborhoods.  I practice in two neighborhoods separated by a few miles but leagues apart in every other way.  One of the hospitals is a tertiary care facility in the heart of Center City – a well to do upcoming part of town – and the other is a small community hospital a few miles South.  The patients at the two locations are quite different, and the mechanism of health care delivery is also starkly different.  Medical care at the Center City campus is provided mostly by employed physicians, and care at the community hospital is provided mostly by private practice physicians.

The debate about employed physicians vs. private physicians was one that until very recently was thought to have been settled.  To the nascent Obama administration in 2008 charged with ‘fixing’ health care, it was obvious that health care delivery in the United States was of low quality and needed change.  Enamored by models like the Mayo Clinic, the Cleveland Clinic, and Geisinger the answer clearly was large clinically integrated networks.  And just like that, with little discussion, and no evidence, the Obama administration set into motion legislation in the form of the Affordable Care Act that brought private practice to its knees. Declining reimbursement and increased overhead costs from regulations meant that percentage of private practice physicians went from 57% in 2000 to 37% in 2013.
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