The Health Care Blog – Page 571 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Combat Medicine’s ‘Golden Hour’

Mar 22, 2013• 8

By J.D. Kleinke

WASHINGTON — While the news swells this week with sad and angry retrospectives on the war in Iraq, it is worth noting that the tremendous human costs of that war would have been much greater, were it not for breakthroughs in combat medicine deployed for the first time on a broad scale in Iraq.

4,486 American men and women were killed in the Iraq war. This represents approximately 14 percent of the 32,221 wounded in action — versus the 19 percent killed in Vietnam, or 27 percent killed in World War II. These statistics are cold comfort for those whose lives were derailed and families tormented in the process, and they are a clarion call to re-double all our efforts to help those who survived.

Hippocratic Hypocrisy: When It Comes to CPR, Is Less Care Actually Better Care?

Mar 21, 2013• 5

By Elizabeth Dzeng, MD

I am a doctor working both in the UK and in Baltimore. Recently I took care of a patient at a hospital in the US who was bleeding to death. Advanced cancer was consuming his body. Doctors at another hospital said there was nothing more they could do, but his family desperately wanted him to live so they brought him to our hospital.

The fistulas in his abdomen were so large, his bowels were open to the air. Blood frequently gushed out of his wounds, necessitating blood transfusions and other desperate measures. The only way to stop the bleeding was to push hard on these wounds, which inflicted excruciating pain. Despite these aggressive treatments, there was no hope of long-term survival.

His family was not ready to let him go and so they told us to take any measures possible to keep him alive. In order to do this, I would have to crack his ribs during chest compressions and electrocute him in an attempt to restart his heart. Regardless of whether we could keep the heart beating, the rest of his body would still be irreparably consumed by cancer.

THCB Shout Out

Mar 21, 2013

The Health Care Blog is produced at our offices in San Francisco with the help of a network of dedicated supporters around the country, including hundreds of journalists, med students, researchers, doctors, programmers, healthcare workers and other friends of the site.

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Follow Nuance on Twitter at @NuanceHealth. Find Nuance on Facebook at NuanceHealthcare. Learn more at ww.nuance.com/healthcare/.

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Let’s Have Dinner and Talk About Death

Mar 21, 2013• 9

By Alexandra Drane

Our family debates a lot of things over our dinner table – the best Looney Toon character, politics, whether or not (and where or when) something is appropriate… For many of these topics, there are no right answers and no wrong answers – just a whole lot of discussion and opinions.

A few months ago, on the heels of the Health 2.0 conference, a small group of us gathered in a San Francisco kitchen for one of the most powerful experiences most of us had ever had around a dinner table.

Truth At the End of Life

Mar 21, 2013• 6

By Elaine Waples

Most of us have spent some time thinking about our own deaths. We do it with a sense of dreadful curiosity, but then we push it aside with “well, we’ve all got to go sometime.”

Unlike most people, I probably know the how, the why, and maybe even the when of that event. It is profound information that turns the world upside down for us, our families, friends and caregivers.

I have cancer that is incurable, aggressive, and has negligiblesurvival odds. My chemotherapy is a long shot. I will leave a spouse, children, siblings and a life that I love and cherish. I cannot imagine existence without them.

I have read the books about stages of grief and end of life. But when all is said and done, truth is the great measure. The truth between doctor and patient when there is nothing else to be done. The truth between patient and family who want desperately to have a few more months or days and cannot. The truth between patient and friends who must accept and move on without bitterness. The truth between patient and spouse, partner, or caregiver who have waited for that moment and are helpless to change it.

Five Things Obamacare Got Right-and What Experts Would Fix

Mar 20, 2013• 83

By Dan Diamond

It was one of the most notorious quotes that emerged from the battle over the Affordable Care Act.

We have to pass the bill so you can find out what is in it. – House Speaker Nancy Pelosi, March 9, 2010.

The line was taken out-of-context, as Pelosi’s office has continued to protest. But more than three years after her quote — and nearly three years after the ACA passed Congress — Pelosi’s accidental gaffe seems pretty apropos.

The law continues to delight supporters with what they see as positive surprises; for example, some backers say Obamacare deserves credit for the unexpected slowdown in national health spending. But critics warn that the law’s perverse effects on premiums are just beginning to be felt.

And there still are “vast parts of the bill you never hear about,” notes Timothy Jost, a law professor at Washington & Lee. “I wonder if they’re [even] being implemented.”

Jost and a half-dozen other health policy experts spoke with me, ahead of Obamacare’s third birthday on Saturday, to discuss how the law’s been implemented and what lawmakers could have done better.

The Smarter Healthcare Consumer Myth

Mar 20, 2013• 16

By John S. Wilson

If consumers could review and shop for health care coverage as easily as they do television sets, costs would decline and we wouldn’t have as large a health care crisis. At least that’s what some folks would lead us to believe. But the picture isn’t that clear.

A recent article in The Wall Street Journal reports how companies are using private health insurance exchanges to lower costs and give employees more flexibility. The exchanges are similar in nature to those mandated by the Patient Protection and Affordable Care Act (a.k.a. Obamacare)—the difference being a private company is overseeing the exchange and not the federal government or states. Employees are able to log on to a site, review coverage plans with different benefits and a range of deductibles, and choose what works best for their budget.

A consultant running one such exchange was enthusiastic about its progress thus far. “When people are spending their own money, they tend to be more consumeristic,” Ken Sperling, national health exchange strategy leader for Aon Hewitt, a unit of AON Plc, told the Journal. (Aon itself, as well as Sears Holdings Inc. and Darden Restaurants are using a new Aon run exchange.) Benefits consultants Mercer (part of Marsh & McLennan Cos.) and Buck (part of Xerox) are rolling out similar private exchanges.

There’s no doubt that consumers are more astute, on average, regarding price for benefit when directly paying for goods and services.

RWJF Call for Proposals: Pioneering Use of Behavioral Economics

Mar 20, 2013• 2

By Lori Melichar, RWJF Pioneer

We have announced our second Call for Proposals in the field of behavioral economics. We’re actively seeking ideas that will help us to better understand how to discourage the consumption of low-value health services — those that provide more harm than benefit or which provide only marginal health benefits. In addition to improving health outcomes, this knowledge could contribute to lowering health care costs for us all.

Behavioral economics is an area of study by which I’ve personally grown increasingly intrigued and in which the Foundation has recently begun to invest. We all know, for example, that we need to exercise, eat right and be actively engaged in our own health care. But we don’t always do what we know we should do; knowing the “right” decision to make does not guarantee that we make that decision. The goal of behavioral economics is to uncover insights that could enable people to make better — more “rational” — choices for their health.

It’s not a given that the behavioral economic-driven solutions that have been shown to, for example, increase 401k savings will prove to be true when applied to the challenges of health and health care. But it’s a risk we want to take because we sincerely believe — if it does — that it could lead to the profound social impact that the Pioneer Portfolio, and the Robert Wood Johnson Foundation as a whole, is seeking.

Accountable Care Organizations Can Change Everything, But Only If We Get the Definition Right

Mar 20, 2013• 12

By Jaan Sidorov, MD

Writing in the March 20 issue of JAMA, Drs. Douglas Noble and Lawrence Casalino say that supporters of Accountable Care Organizations (ACOs) are all muddled over “population health.”

This correspondent says the article is what is muddled and that the readers of JAMA deserve better.

According to the authors, after the Affordable Care Act launched the Medicare Accountable Care Organizations (ACOs), their stated purpose has morphed from Health-System Ver. 2.0 controlling the chronic care costs of their assigned patients to Health System Ver. 3.0 collaboratively addressing “population health” for an entire geography.

Between the here of “improving chronic care” and the there of “population health,” Drs Noble and Casalino believe ACOs are going to have to confront the additional burdens of preventive care, social services, public health, housing, education, poverty and nutrition. That makes the authors wonder if the term “population health” in the context of ACOs is unclear. If so, that lack of clarity could ultimately lead naive politicians, policymakers, academics and patients to be disappointed when ACOs start reporting outcomes that are limited to chronic conditions.

The Ghost of Steve Jobs and Your Bottom Line

Mar 19, 2013• 12

By JOE FLOWER

The progeny of the iPhone and the iPad will change the shape of your institution — and your balance sheet.

One of the more striking images, to me, out of the online spew in the last few months was from the inauguration. It was a wide view of an inaugural ball. There was the president waltzing with the first lady, and a crowd of several hundred watching them. What was striking about that image was that the several hundred people held several hundred small glowing rectangles in their hands. Practically every member of the crowd was carrying a smartphone and was photographing or videotaping the moment.

The scene was commonplace in its moment, remarkable only in the perspective of history — but such a short history. We could not have imagined so many people carrying smartphones at Obama’s first inaugural only four years ago. Four years before that, we could not have imagined any. The iPhone had not been invented.

There had been attempts at smartphones before the iPhone, and devices like tablets before the iPad. But the rampant success of iOS devices did far more than establish two profitable niche. It changed our relationship with the world.