The Health Care Blog – Page 459 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Government’s New Doctor Payments Website Worthy of a Recall

Oct 1, 2014• 6

CHARLES ORNSTEIN

If the federal government’s new Open Payments website were a consumer product, it would be returned to the manufacturer for a full refund.

Open Payments is the government’s site for publishing payments made to doctors and teaching hospitals by drug and medical device manufacturers. It includes 4.4 million payments, worth $3.5 billion, to more than half a million doctors and almost 1,360 teaching hospitals.

In a news release announcing the site’s launch, the Centers for Medicare and Medicaid Services said the goal is “to help consumers understand the financial relationships between the health care industry, and physicians and teaching hospitals.”

Free Medical School?

Oct 1, 2014• 3

By JACK COCHRAN, MD and CHARLES KENNEY

One of the most compelling medical stories in the country is unfolding within the sprawling landscape of inland Southern California. The story centers on the University of California, Riverside School of Medicine where G. Richard Olds, MD, the school’s dean, is taking on one of the uber challenges in health care today: How to get doctors into areas significantly underserved by health care professionals.

The UC-Riverside School of Medicine is in its infancy having welcomed its first class of 50 students just last year. But it has embarked on an innovative program fueled by a passion not only to get doctors into geographic areas where they are most urgently needed, but also to make sure these physicians practice specialties most in demand. “There are 18 new medical schools in the United States and the vast majority are just like existing medical schools,” says Dean Olds. “We are substantially different than most other new schools. We are designed around a unique mission – to try and address the health workforce needs of inland Southern California. We need to train health care professionals who come from backgrounds and communities they will be taking care of.”

The Ebola Outbreak: The CDC Director’s Guidance for Health care workers

Sep 30, 2014• 52

By Tom Frieden, MD

There has been a lot of fear about Ebola. The health care workers who care for Ebola patients are right to be concerned – and they should use that concern to increase their awareness and motivation to practice meticulous infection control measures.

Ebola virus is transmitted through direct contact with bodily fluids of an infected person who is sick with Ebola, or exposure to objects, such as needles, that have been contaminated with infected secretions.

Travel from Affected Region

There is a risk for Ebola to be introduced to the United States via an infected traveler from Africa. If that were to happen, widespread transmission in the United States is highly unlikely due to our systematic use of strict and standard infection control precautions in health care settings, although a cluster of cases is possible if patients are not quickly isolated. Community spread is unlikely due to differences in cultural practices, such as in West Africa where community and family members handle their dead.

CDC has advised all travelers arriving from Guinea, Liberia, Nigeria, and Sierra Leone to monitor their health for 21 days and watch for fever or other symptoms consistent with Ebola. If they develop symptoms, they should call ahead to their hospital or health care provider and report their symptoms and recent travel to the affected areas so appropriate precautions can be taken.

Changing My Mind on SES Risk Adjustment

Sep 29, 2014• 15

ASHISH JHA, MD

I’m sorry I haven’t had a chance to blog in a while – I took a new job as the Director of the Harvard Global Health Institute and it has completely consumed my life. I’ve decided it’s time to stop whining and start writing again, and I’m leading off with a piece about adjusting for socioeconomic status. It’s pretty controversial – and a topic where I have changed my mind. I used to be against it – but having spent some more time thinking about it, it’s the right thing to do under specific circumstances. This blog is about how I came to change my mind – and the data that got me there.

Changing my mind on SES Risk Adjustment

We recently had a readmission – a straightforward case, really. Mr. Jones, a 64 year-old homeless veteran, intermittently took his diabetes medications and would often run out. He had recently been discharged from our hospital (a VA hospital) after admission for hyperglycemia. The discharging team had been meticulous in their care. At the time of discharge, they had simplified his medication regimen, called him at his shelter to check in a few days later, and set up a primary care appointment. They had done basically everything, short of finding Mr. Jones an apartment.

Ten days later, Mr. Jones was back — readmitted with a blood glucose of 600, severely dehydrated and in kidney failure. His medications had been stolen at the shelter, he reported, and he’d never made it to his primary care appointment. And then it was too late, and he was back in the hospital.

The following afternoon, I spoke with one of the best statisticians at Harvard, Alan Zaslavsky, about the case. This is why we need to adjust quality measures for socioeconomic status (SES), he said. I’m worried, I said. Hospitals shouldn’t get credit for providing bad care to poor patients. Mr. Jones had a real readmission – and the hospital should own up to it. Adjusting for SES, I worried, might create a lower standard of care for poor patients and thus, create the “soft bigotry of low expectations” that perpetuates disparities. But Alan made me wonder: would it really?

To adjust or not to adjust?

Because of Alan’s prompting, I re-examined my assumptions about adjustment for SES. As he walked me through the data, I concluded that the issue of adjustment was far more nuanced than I had appreciated.

Graphic Warning Labels on Cigarettes Are Scary, but Do They Work?

Sep 27, 2014• 2

DEBORAH SHARF and WILLIAM SHADEL

Looking at cigarette packaging in some countries, you might think Big Tobacco and AMC have entered into a bizarre cross-promotion for The Walking Dead. You’ll see blood-drenched corpses, facial scars and head wounds, people dying in hospital beds, screaming children, crying women—the list goes on.

These “graphic warning labels” pair gruesome images with warnings about the dangers of smoking, covering anywhere from 30 to 80 percent of cigarette pack “faces” (the front and back). The goals of such labels are informing consumers about the risks of smoking, encouraging quitting among smokers, and preventing others from ever starting.

Research shows people exposed to these labels are understandably repulsed and disgusted. When asked, they express the belief that labels should keep people from smoking. And after viewing them, they have more negative thoughts and feelings about smoking.

But do graphic warning labels actually prevent people from starting to smoke? Do they cause current smokers to quit?

Ceci Connolly: Will Technology Replace Doctors?

Sep 26, 2014• 35

Ceci Connolly

It’s a provocative question, but it’s also the wrong one.

The question ought to be: When will healthcare fully embrace technology and all it has to offer?

It’s widely known that the $2.8 trillion US health system has significant waste and errors – between 25% and 30% of our health dollars go to services that do not improve health. Technology has the ability to put a big dent in that through standardization, real-time insights, convenient gadgets and complex data analysis the human brain simply cannot perform.

Consider some of the early innovators. There’s the heart monitor in the phone. The wristbands that count steps. And then there’s Oto, the cellphone attachment that snaps an image of the inner ear sparing frazzled parents one more trip to the doctor’s office for yet another infection.

Have Doctors Joined the Working Class?

Sep 26, 2014• 19

By Richard Gunderman, MD

On September 28, 1864, exactly 150 years ago this weekend, the first meeting of the International Workingmen’s Association (IWA) was convened at St. Martin’s Hall, London. Among the attendees was a relatively obscure German journalist by the name of Karl Marx. Though Marx did not speak during the meeting, he soon began playing a crucial role in the life of the organization, in part because he was assigned the task of drafting its founding documents.

The work of the IWA and Marx is increasingly relevant to the practice of medicine today, largely because of the rapidly shrinking percentage of US physicians who own their own practices. This moves physicians into the category of what Marx and his associates called, “working people.” According to data from the American Medical Association, in 1983 76% of physicians were self-employed, a number that had fallen in 2012 to 53%. And the trend is accelerating. It is estimated that in 2014, 3 in 4 newly hired physicians will go to work for hospitals and health systems.

To put this change in Marx’s terms, the rapid fall in physician self-employment means that a shrinking percentage of physicians own what he called the means of production. In his view, this alienates workers – in this case physicians – from other physicians, themselves, the work they do, and from patients. Whether we agree with Marx on every point, his writings on this topic provides a provocative perspective from which to survey the changing landscape of contemporary medicine.

Surviving Healthcare

Sep 26, 2014• 9

Joe Flower

Health care is fragile. It survives in a much narrower band of circumstances than most of us realize. Right now many hospitals and systems are having a second down year in a row. They’re consolidating, laying off people, working through major shifts in strategy — all because of what we must admit (if we are honest) are relatively minor economic shifts, such as small reductions in utilization and Medicare payments, a blunting of accustomed price rises, and stronger bargaining from health plans.

If minor revenue stream problems put your entire institution in jeopardy of chaotic deconstruction, it cannot be called robust.

At the same time, an increasing number of vectors outside the sealed world of health care could overwhelm and kill your institution, from climate chaos to pollution disasters to epidemics and the loss of antibiotics.

The Org Chart of the Damned

Sep 26, 2014• 1

THCBist

HAT TIP: Mr. Nosta

Ask Me Anything with CDC Director Tom Frieden

Sep 26, 2014• 13

Thomas Frieden, MD

The Ebola outbreak in West Africa is an international public health emergency. As the world responds, there is a risk that American responders working on the ground may be exposed to the virus or become ill. This summer, two American health care workers infected with Ebola while working in West Africa were successfully treated at Emory University Hospital. Their health care team used the proper infection control practices and there was no transmission of the virus to the health care team or others in the hospital and community.

Now two more American health care workers working in West Africa have become infected with Ebola virus and are being treated in the United States.

CDC has already consulted with state and local health departments on almost 100 cases where travelers had recently returned from West Africa and showed symptoms that might have been caused by Ebola. Of those cases, only eleven of were considered to be truly at risk. Specimens from all eleven patients were tested and fortunately Ebola was ruled out in all cases.

There is understandably a lot of fear surrounding Ebola. The health care workers who might need to care for Ebola patients are right to be concerned – and they should use that concern to increase their awareness and motivation to practice the meticulous infection control measures we know will prevent transmission of the virus.