The Health Care Blog – Page 618 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

ONC Launches the Reporting Safety Events Challenge

Aug 2, 2012

By Ariana Godles & Hemali Thakkar

This challenge addresses a stark reality centered on hospitals struggling to increase internal incident reporting — a major reason being the busyness of care providers. Daily, hospital workers fight to create effective systems for the quality and risk management staff to complete root cause analyses and follow-ups, which are required by both the Centers for Medicare & Medicaid Services and the Joint Commission. However, their efforts are not always effective.

On top of that, it is said that quality and risk management staff suffer from reporting fatigue in a paper-based reporting system, which affects reporting frequency and quality. All of their energy is exuded in trying to convince physicians and nurses to report incidents (not just talk about them in the halls), and asking that they do a thorough investigation to fill out the appropriate forms to fax them to the appropriate agencies.

To allow progression of our understanding of patient safety issues, it is vital to innovate beyond the existing tools so that a fresh system will collect and analyze information that characterizes patient safety events in a standardized, discrete, and measurable way.

Latest CBO Report on Health Law Adds to Business Uncertainty

Aug 1, 2012• 2

By Matt Barry

The Congressional Budget Office’s new estimates of the budgetary impact of the Affordable Care Act, made in the wake of the Supreme Court’s ruling last month, glides right by one obvious fact: the budget analysts really have no idea how the court ruling will affect their previous estimates.

The CBO report says very clearly that “what states will be able to do and what they will decide to do are both highly uncertain.” Translation? They don’t know any more than anyone else right now about how states will act, now that the high court has determined that the federal government can’t force states to participate in the expansion of Medicaid by withholding the federal share for existing activities.

CBO isn’t to blame for this uncertainty. Rather, they should be commended for their candor in acknowledging the degree of uncertainty that remains. Most news reports and commentaries on the new CBO findings have downplayed or ignored this problem.

Why Medical Management Will Re-Emerge

Aug 1, 2012• 22

By Brian Klepper

Several years ago I had dinner with a woman who had served in the late 1990s as the national Chief Medical Officer of a major health plan. At the time, she said, she had developed a strategic initiative that called for abandoning the plan’s utilization review and medical management efforts, which had produced heartburn and a backlash among both physicians and patients. Instead, the idea was to retrospectively analyze utilization to identify unnecessary care.

This was at the height of anti-managed care fervor. A popular movie at the time, As Good As It Gets, cast Helen Hunt as the mother of a sick kid. When someone mentioned an HMO, Ms. Hunt’s character let fly a flurry of expletives. America’s theater audiences exploded in applause.

Apparently, the health plan’s senior management team bought into cutting back on medical management but saw no need for retrospective review. After all, if the health plan abandoned actions against inappropriate services, utilization and cost would explode. Fully insured health plans make a percentage of total expenditures, so more services, appropriate or not, meant the plan’s profits would increase.

And that’s how it played out. Virtually all health plans followed suit, dismantling the aggressive medical management that had been managed care’s core mechanism in driving appropriateness. In the years following 1998, health plan premium inflation grew significantly, for a short period reaching 5.5 times general inflation, but averaging 4 times general inflation through today. Medical management became all but a lost, or at least a scarce, discipline in American health care, which is its status now.
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The (Great) Colonoscopy Experience

Aug 1, 2012• 17

By John Halamka, MD

Today, as Kathy finished her last radiation therapy appointment, I had my first screening colonoscopy – a rite of passage for new 50 year olds.

Although a bit of a personal issue, I’m known for my transparency and I’m happy to share the experience so that others approaching 50 know what to expect.

The preparation is the hardest part. Three days before the procedure, it’s recommended that you reduce the quantity of high fiber foods you eat – fruits, vegetables, nuts etc. For me that was particularly challenging since my entire diet as a vegan (who tends to avoid white flour, white rice, and white sugar) is high fiber. I moved to soups and brown rice. A day before the procedure (really 36 hours), you move to a clear liquid diet – apple juice, broth, and tea. In my case I drank a cup of vegetable broth and apple juice every 3 hours.

At 7pm the night before the procedure, the real challenge begins. The bottle of magnesium citrate reads “a pasteurized, sparkling, laxative”. Sounds so appealing. The first dose is 15 ounces. The bottle warns that the maximum therapeutic dose is 10 ounces in 24 hours for adults, but colonoscopy is a special case. The 15 ounces of laxative is followed by 24 ounces of clear liquids over the next 2 hours. Keep in mind that you have not eaten any solid food for 24 hours at this point. Sparkling laxative followed by broth and apple juice is not Chez Panisse.

Needle Exchange Programs Vital In Fight Against AIDS

Aug 1, 2012

By Lord Norman Fowler

In 1986, British Prime Minister Margaret Thatcher’s special cabinet committee on AIDS made a fundamentally important decision which changed the course of the emerging HIV epidemic in the UK. In spite of some vocal opposition, it decided there should be clean needle exchanges for injecting drug users (IDUs) to prevent the spread of HIV.

The opposition to that move has been echoed in the years that followed — not least in the United States. Government-financed needle exchanges would condone crime, the critics claimed. It would encourage drug use and give entirely the wrong message to the public.

The experience of the last quarter of century has disproved those fears. There is no question that needle exchanges and drug substitution have reduced HIV: only 2% of new infections in Britain now come through that route. The policy has neither encouraged drug taking nor crime. Similar reports come from other nations that have adopted this approach.   Tragically, not all nations have followed such a lead. Nearly half of the countries with epidemics concentrated among IDUs have no needle and syringe programs at all according to UNAIDS. The result is the further spread of HIV and an increasing death toll — only four of every 100 people who inject and are eligible for treatment get antiretroviral (ARV) drugs.

Things Are About to Get Interesting

Jul 31, 2012

By Dr. Wes

It was a chance encounter.

After all it’s not every day you see an internist who still frequents a hospital. We’ve known each other for years and he’s been watching the changes in health care, too.

“Boy, they’re really not happy Over There. Seems they’ve contracted with Big Boy insurance as part of their new ACO model. Everyone’s going to get their piece before the doctors: Over There hospital, their four million administrators, lawyers, grounds crews, parking staff…. Then, after everyone else is paid, the doctors might get a few scraps if there’s some left over. No guarantees. All risk, no certainty of reward. There was no way I could still go there. I joined them, but had to leave when I saw how unworkable that was.”

“Isn’t this our new way forward?” I asked.

“I guess so. Scary. But I’ve got just a few more years. Just have to get the kids through college.”

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‘Help Wanted’ For Medicaid Expansion

Jul 31, 2012• 4

By John H. Schumann, MD

Despite its complexities and its politics, I support the Affordable Care Act (aka “Obamacare”). As I’ve written elsewhere, I think it would be both morally and economically wrong for Governor Fallin and the Oklahoma legislature to opt out of the ACA’s vast Medicaid expansion – a position shared by Oklahoma Policy Institute. So if Oklahoma does the right thing and opts to expand Medicaid for adults with incomes at or below 133 percent of the federal poverty level, what will happen?

Oklahoma faces a serious shortage of primary care access. The Oklahoma Health Care Authority, the agency in charge of administering Medicaid, recently compiled county-by-county maps, color-coded to classify areas of severe physician shortage based on presumptive levels of Medicaid expansion. At a glance, these maps reveal something we already know: rural areas are hurting for physicians and populous counties seem to have more capacity. In my opinion, however, the maps don’t paint a full picture of the eventual shortfall.Continue reading…

Time For Biopharma To Jump On The “Big Data” Train?

Jul 31, 2012• 2

By David Shaywitz, MD

In a piece just posted at TheAtlantic.com, I discuss what I see as the next great quest in applied science: the assembly of a unified health database, a “big data” project that would collect in one searchable repository all the parameters that measure or could conceivably reflect human well-being.

I don’t expect the insights gained from these data will obsolete physicians, but rather empower them (as well as patients and other stakeholders) and make them better, informing their clinical judgment without supplanting their empathy.

I also discuss how many companies and academic researchers are focusing their efforts on defined subsets of the information challenge, generally at the intersection of data domains. I observe that one notable exception seems to be big pharma, as many large drug companies seem to have decided that hefty big data analytics is a service to be outsourced, rather than a core competency to be built. I then ask whether this is savvy judgment or a profound miscalculation, and suggest that if you were going to create the health solutions provider of the future, arguably your first move would be to recruit a cutting-edge analytics team.

The question of core competencies is more than just semantics – it is perhaps the most important strategic question facing biopharma companies as they peer into a frightening and uncertain future.

The Supreme Court May Have Saved Lives … by Keeping People Off Medicaid

Jul 30, 2012• 15

By John Goodman

Here’s the most underreported story of the summer. When the Supreme Court ruled on the Affordable Care Act (ObamaCare) it inadvertently liberated millions of people who were going to be forced into Medicaid. Now they will have the opportunity to have private health insurance instead. What difference does that make? It could be the difference between life and death.

A Congressional Budget Office (CBO) report this week says there are 3 million such people. The actual number could be several times that size. But first things first.

Imagine that you are the head of a family of three, struggling to get by on an income, say, of $25,000 a year. You’ve signed up for your employer’s health plan because you want your family to get good health care when they need it. But that takes a big bite out of your paycheck — $250 a month.

When you first heard about the president’s health plan, you heard him say that if you like the plan you’re in you can keep it. That was good news. You also believed the whole point of the reform was to help families like yours get health insurance if for some reason you had to seek insurance on your own.

The Olympics, Doctors, NHS, Transformation, and Heroes: Why the Difference between USA and UK?

Jul 30, 2012• 6

By Kent Bottles, MD

I was surprised when the Opening Ceremonies of the Olympics in London honored two of my favorite institutions: the National Health Service and the World Wide Web. I was not surprised when LA Times sports writer Diane Pucin posted the following tweet: “For the life of me, though, am still baffled by NHS tribute at opening ceremonies. Like a tribute to United Health Care or something in US.” @swaldman responded to the sports writer with “Well, maybe, if United Health Care were government-run and a source of national pride.”

I was not surprised when Meredith Vieira and Matt Lauer of NBC admitted they had no idea why Tim Berners-Lee was being honored by sending out a tweet. Ever since I read his book Weaving the Web: The Original Design and Ultimate Destiny of the World Wide Web by Its Inventor (HarperSanFrancisco, 1999), Berners-Lee has been one of my heroes. Finally locating my hard copy of the book in the guest bedroom where my son Colin used to sleep, I quickly located the marked passage I was looking for:

“People have sometimes asked me whether I am upset that I have not made a lot of money from the Web. In fact, I made some quite conscious decisions about which way to take my life. These I would not change…. What does distress me, though, is how important a question it seems to be to some.

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