The Health Care Blog – Page 565 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

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Why Medicare Cuts Will Quietly Kill Seniors

Apr 8, 2013• 18

By MICHAEL L. MILLENSON

The recent news that thousands of seniors with cancer are being denied treatment with expensive chemotherapy drugs as a result of sequestration-mandated budget cuts raises the question of whether other patients are being equally harmed, but less visibly.

A careful study of the impact of past federal budget cutting suggests a troubling answer. That study, in a National Bureau of Economic Research Working Paper published in 2011 and revised last year, established an eerily direct link between slashing hospital reimbursement and whether Medicare patients with a heart attack live or die.

Using data from California hospitals, researchers Vivian Y. Wu of the University of California and Yu-Chu Shen of the Naval Postgraduate School examined mortality rates for heart attack patients following the Medicare payment cuts resulting from the Balanced Budget Act (BBA) of 1997. The impact of the BBA was not as sudden or clear as the current situation, where Medicare’s two percent across-the-board cut on April 1 instantly transformed some expensive chemotherapy drugs into money losers, but it was significant and long-lasting.

The researchers examined hospitals claims data for a three-year period before the BBA, a three-year period when the BBA first took effect and, finally, a six-year period after budget cuts had either permanently changed care or failed to do so. They also tried to adjust for the severity of illness of the heart attack patients – the condition is formally known as acute myocardial infarction (AMI) – and other factors.

In the end, the researchers were able to trace a clear path from Congressional budget decisions to the patient’s bedside. Payment reductions triggered by the BBA , Wu and Shen concluded, led to “worse Medicare AMI patient outcomes, and more importantly, that the adverse effect only became measurable several years after the policy took place.”

They even quantified the effect: every thousand dollars of Medicare revenue loss from the BBA translated to a six to eight percent increase in mortality rates from heart attack.Continue reading…

Twitter Study of Vaccine Messages: Opinions Are Contagious, But In Unexpected Ways

Apr 8, 2013• 1

By Beth Skwarecki

Remember 2009? The H1N1 pandemic we were all waiting for? I do. I was pregnant; H1N1 was particularly risky for pregnant women. The vaccine wasn’t available until after I had my baby, but when they held a clinic an hour north of where I live, I brought my husband there so we could both get our shots. My infant son was too young to be vaccinated, so I wanted to protect him through herd immunity.

A study came out recently on twitter messages from that time. How did pro-vaccine sentiments spread, versus anti-vaccine ones? Which messages were more contagious?

I talked to one of the authors, Marcel Salathe, today. He’s an infectious disease researcher studying the spread and transmission, not (just) of disease, but of information. “We assume people infect each other with opinions about vaccinations,” he said, and the H1N1 scare was a good opportunity to put some of his group’s theories to the test.

They collected nearly half a million tweets about the H1N1 flu vaccine. In 2009, H1N1 wasn’t included in the regular flu shot, and became available partway through flu season as a separate dose. With a possible pandemic looming, people had plenty of motivation to get the vaccine and encourage others to get it—butanti-vaccine sentiments were in circulation too.

The result, striking but perhaps not surprising: negative opinions were more contagious than positive ones. (Specifically, someone who read a lot of anti-vaccine messages was more likely to follow up by tweeting or retweeting negative messages of their own.)

Teaching Value: Medical Educators Need to Take Charge and Help Deflate Medical Bills

Apr 7, 2013• 7

By Neel Shah, MD, Christopher Moriates, MD & Vineet Arora, MD

At a time when one in three Americans report difficulty paying medical bills, up to $750 billion is being spent on care that does not help patients become healthier. Although physicians are routinely required to manage expensive resources, traditional medical training offers few opportunities to learn how to deliver the highest quality care at the lowest possible cost. While the gap is glaring the problem is not new.

In 1975, the department of medicine at Charlotte Memorial Hospital initiated a system to monitor medical costs generated by house officers. In the Journal of Medical Education leaders of the Charlotte initiative described how simply being aware of how clinical decisions impact the costs of care could decrease inpatient length of stay by 21%. Over the last four decades there have been dozens of similar efforts to educate medical students and residents about opportunities to improve the value of care. Some interventions were simple like the one in Charlotte, and simply revealed the cost of routine tests to their trainees. Others provided more sophisticated didactics, interrogated medical records to give trainee-specific feedback on utilization, or creatively leveraged the hospital computer order-entry systems.

What If Doctors Had Instant Access to All Medical Research?

Apr 7, 2013• 1

By Stanford Med

We are asking doctors to help us study what access to all medical research would mean for their practice. To study the value of such access, we are providing physicians who participate in this Stanford University Public Access Study with eleven (11) months of complete access to virtually all medical journals, as well as to an evidence-based clinical decision-support service.

Participating physicians will have free, one-click access to this vast body of research on their computer or tablet, whenever and wherever they are online. The study is intended to inform current discussions and legislation on the state of public and professional access to federally funded medical research.

Demands on Participant: Participants must be a physician licensed to practice in the United States. Data will be collected on participants’ use of research, with selected participants asked to participate in a 30-minute confidential interview. As a control measure, participants are given an extra month of the evidence-based clinical decision-support service, either prior or following the eleven months of access to the research literature.

To learn more and/or to begin immediate participation (after providing informed consent) in the Public Access Study, follow this link: http://nihpublic.stanford.edu/.

The principal investigator of the Public Access Study is John Willinsky, Khosla Family Professor, Stanford University, Stanford CA; jo************@******rd.edu.

ONC Holds A Key To the Structural Deficit

Apr 7, 2013• 24

By Adrian Gropper, MD

It’s called Blue Button+ and it works by giving physicians and patients the power to drive change.

The US deficit is driven primarily by healthcare pricing and unwarranted care. Social Security and Medicare cuts contemplated by the Obama administration will hurt the most vulnerable while doing little to address the fundamental issue of excessive institutional pricing and utilization leverage. Bending the cost curve requires both changing physicians incentives and providing them with the tools. This post is about technology that can actually bend the cost curve by letting the doctor refer, and the patient seek care, anywhere.

The bedrock of institutional pricing leverage is institutional control of information technology. Our lack of price and quality transparency and the frustrating lack of interoperability are not an accident. They are the carefully engineered result of a bargain between the highly consolidated electronic health records (EHR) industry and their powerful institutional customers that control regional pricing. Pricing leverage comes from vendor and institutional lock-in. Region by region, decades of institutional consolidation, tax-advantaged, employer-paid insurance and political sophistication have made the costliest providers the most powerful.

What Do mHealth Leaders Need Most From Our Government? Clarity.

Apr 7, 2013• 2

By Jonathan Spalter

My job and my life intersected in a profound way when my daughter was diagnosed with Type I diabetes. Years working in mobile innovation didn’t prepare me for how personally relevant mHealth so quickly became. Her clinical trial at Stanford University, supported by the National Institutes of Health through Congress’ Special Diabetes Program, featured a world-class endocrinologist working alongside software coders, applications developers, algorithm writers, network engineers and other mobile innovators. They were all pushing together for what could be a revolution in diabetes management—the artificial pancreas.

Recently I had the opportunity to talk about my daughter’s experience and share my thoughts on how government can help encourage the next wave of mHealth innovation, when I was invited to testify before Congress on mobile innovation and health care.

America’s leadership in the mobile economy — 40,000 apps and counting in the broad mHealth category — matches America’s leadership at the cutting edge of medical technology.

Mobile devices, wireless networks and targeted applications are enabling better, more seamless and cost-effective care that empowers and informs stakeholders on both sides of the stethoscope.

The virtuous cycle of investment in the mobile ecosystem — from networks, to handsets and tablets, to applications — provides an unparalleled foundation for dramatic advances in the nation’s health and wellness. My message to Congress was to lean in and strike a reasonable and circumspect balance that both protects patient safety and privacy and propels the dramatic, mobile-fueled advances we are seeing through American medicine today.

The True Collaborative Health Record

Apr 6, 2013• 13

By Rob Lamberts, MD

I’ve been going about this all wrong.

It’s not my dumping of the payment system so I can focus on care over codes, my use of technology to connect better with patients, or my vision of the “collaborative record” that is wrong. It’s the fact that I am doing this without my most important resource: my patients.

I realized this while driving in to work this past week. My first patient was a tech-savvy guy I’ve known for a long time. Not only does he know me, and knows more than me about technology, he also is a regular reader of my blog (bless his heart)…and he still chose to switch to my practice! So I was looking forward to running some of my ideas by him to see if my thoughts have strayed to the land of silliness (which they often do) or if I am actually onto something. This line of thought led me to think about collaborating with him to work on my IT vision, since he does work for an IT company. My line of thought then careened into the brick wall of the obvious: why just him? I’ve been getting suggestions and offers for help from many of my patients, who are clearly intrigued by my direction and desirous to lend their expertise on the project. So why not involve any of my patients who want to be part of this project?

Doctors: We Can’t Leave It to Business to Educate Us

Apr 5, 2013• 9

By Leslie Kernisan, MD

Recently I came across yet another media article with suggestions as to how digital health products can gain more widespread adoption. The writer notes that “we can learn a lot from the pharma and healthcare industries,” and goes on to discuss the importance of engaging the doctor.

This article, like many I read, doesn’t acknowledge the downsides of using pharma’s tactics.

I have to assume that this is because from a business perspective, there aren’t a lot of downsides to pharma’s tactics. Pharma, along with many other healthcare industry players (hospitals, insurance companies, device manufacturers) has overall been extremely successful from a business standpoint.

So if the intent is to help digital health companies succeed as businesses, then by all means one should encourage them to copy pharma’s tactics.

But as we know, what works for business has often not worked well for serving the needs of individual patients, or to society from a health services and public health perspective.

Could Private Investment Be A Game Changer For Med Student Debt?

Apr 5, 2013• 7

By Shady Henien

Each year, medical students incur more than $166,750 in medical school debt, according to the AAMC. Despite the organization’s conclusion that medical student debt is not a determining factor in choosing a medical specialty, the cost of education is a major concern for the future of health care. Medical students and physicians across the US have made extensive time commitments during their 20s to mastering the foundations of medicine and completing a residency. New physicians today face an exorbitant amount of debt that takes anywhere from 10 to 30 years to repay. We must continue to attract the brightest and smartest students into medicine without deterring them by cost. All Americans and the newly insured 32 million US citizens are counting on my generation to become the future of medicine. We cannot afford to let a price tag deter us from this responsibility.

When a friend and I created our medical school’s first student state lobby day, the solution proposed by many legislators was to find a side job or take out more student loans. As any physician would know, medical students already work and study for more than 70 hours a week, which does not allow for earning a substantial side income.

I propose a unique business model, “Invest in a Medical Student’s Tuition Program,” (IMSTP) to help mitigate student loan debt. I began working on this idea three years ago, after I presented it to the AAMC’s Organization of Student Representatives. My goal is to create a new venture that would eliminate one of the two financial problems facing students: cost of tuition and interest rates. Because the cost of tuition is set by the university, I decided to tackle the 6.8 percent interest rate set by federal government Direct Loans.

Think NCAA Athletes Shouldn’t be Paid? What the Kevin Ware Story Says About the Risks of College Sports

Apr 5, 2013• 4

By Dan Diamond

In many ways, it had been an exemplary few days for the NCAA and its signature basketball tournament—a weekend that put the madness back in March.

On Friday, Michigan and star guard Trey Burke completed an epic comeback over Kansas. On Saturday, Cinderella team Wichita State crashed the Final Four.

But for many people watching the Louisville-Duke game unfold, a disturbing injury to Louisville guard Kevin Ware illustrated a different sort of madness: the continued lack of compensation for the players who make the tournament so special.

“Pray for [Ware],” columnist Dave Zirin tweeted. “There is no safety-net for the injured NCAA athlete.”

Injury worst seen on TV

Ware’s broken leg—”about the most gruesome injury I’ve seen in a basketball game,” bemoaned analyst Seth Davis—came on a routine play, as he landed awkwardly after trying to block a shot by Duke’s Tyler Thornton.