The Health Care Blog – Page 619 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

It Doesn’t Have to Be This Way …

Aug 3, 2012

By Evan Falchuk

I was struck by the recent story in the New York Times about a young boy who was misdiagnosed, and lost his life.

The boy, Rory Staunton, was a healthy, active 12-year old, until one day he ended up in the middle of our time-strapped, broken healthcare system. He was treated by good, well-intentioned doctors, at a leading medical center, but something went terribly wrong. What started out as a minor cut suffered in a basketball game turned into a major infection that took his life.

Yet nowhere along Rory’s journey, from boy with a bellyache on Thursday to gravely ill boy on Friday night, did anyone act on strong indications that he might be fighting for his life. Critical information gathered by his family doctor and during his first visit to NYU Langone was not used, was not at hand or was not viewed as important when decisions were made about his care, records show.

Story’s like Rory’s happen far too often, and in far too familiar ways. Scientific studies show that patients are misdiagnosed between 15% and 44% of the time. Researchers have found that the combination of fragmented medical information and not enough time between doctor and patient are the leading causes of this problem. And yet, much of America is still unaware how often misdiagnosis happens. Lost in all the politics of healthcare is a recognition that, at its core, healthcare must be about making sure each and every patient gets the right care.

Obesity: Global Public Health Challenge or Investment Opportunity?

Aug 3, 2012• 5

By Marion Nestle

Worried about the potential personal and economic costs of obesity? Never mind. It’s time to view obesity as a business opportunity.

As the press release for a new research report from Bank of America Merrill Lynch, Globesity—The Global Fight Against Obesity, points out:

“Increasing efforts to tackle obesity over the coming decades will form an important new investment theme for fund managers…Global obesity is a mega-investment theme for the next 25 years and beyond…The report…identifies that efforts to reduce obesity is a “megatrend” with a shelf-life of 25 to 50 years…BofA Merrill Lynch analysts across several sectors have collaborated to identify the sectors and companies developing long-term solutions.”

Given the worldwide increase in obesity, its high prospective costs, and the ever-present threat of government regulation, the report identifies more than 50 global stocks that provide investment opportunities for fighting “globesity.” These fall into four categories:

Pharmaceuticals and Health Care: companies taking advantage of the FDA’s increased support for obesity drug development; tackling related medical conditions and needs including diabetes, kidney failure, hip and knee implants; making equipment such as patient lifts, bigger beds and wider ambulance doors.
Food: companies accessing the $663 billion “health and wellness” market and reformulating portfolios to respond to increasing pressure such as “fat taxes” to reduce sugar and fat levels.

In God We Trust. All Others Must Bring Data.

Aug 3, 2012• 5

By Bob Wachter, MD

I knew it would happen sooner or later, and earlier this week it finally did.

In 2003 US News & World Report pronounced my hospital, UCSF Medical Center, the 7th best in the nation. That same year, Medicare launched its Hospital Compare website. For the first time, quality measures for patients with pneumonia, heart failure, and heart attack were now instantly available on the Internet. While we performed well on many of the Medicare measures, we were mediocre on some. And on one of them – the percent of hospitalized pneumonia patients who received pneumococcal vaccination prior to discharge – we were abysmal, getting it right only 10% of the time.

Here we were, a billion dollar university hospital, one of healthcare’s true Meccas, and we couldn’t figure out how to give patients a simple vaccine. Trying to inspire my colleagues to tackle this and other QI projects with the passion they require, I appealed to both physicians’ duty to patients and our innate competitiveness. US News & World Report might now consider us one of the top ten hospitals in the country, I said, but that was largely a reputational contest. How long do you think it’ll be before these publicly reported quality measures factor heavily into the US News rankings? Or that our reputation will actually be determined by real performance data?

Why Should You Care Whether or Not Your State Decides to Expand Medicaid Coverage?

Aug 2, 2012• 8

By Maggie Mahar

By expanding Medicaid, the state-federal partnership that offers health insurance to low-income Americans, the Affordable Care Act set out to cover some 17 million uninsured – or roughly half of the 34 million who are expected to gain coverage under reform. But when the Supreme Court ruled on the Affordable Care Act in June, it struck down a key provision which threatened that if a state refused to co-operate in extending Medicaid to more of its citizens, it could lose the federal funding it now receives for its current Medicaid enrollees.

In a 7-to-2 decision, the justices ruled that this punishment was too coercive: “withholding of ‘existing Medicaid funds’ is ‘a gun to the head’” – that would force states to acquiesce.

As a result, states can, if they choose, opt out of the Medicaid expansion, and some governors are threatening to do just that – even though the federal government has committed to pay 100 percent of the cost from 2014 to 2017. After that, the federal share would gradually decline to 90 percent in 2020, and remain there. This is a generous offer; today the federal government now picks up just 57 percent of the Medicaid tab.

Nevertheless, some states claim that the 10 percent that they would have to ante up after 2020 is more than they can afford. A few go further and admit that this isn’t just about money: by rejecting the federal funds, they are voicing their objection to “Obamacare.”

App-Happy Health Care Full of Optimism, Money

Aug 2, 2012• 2

By Michael Millenson

There is a corner of the health care industry where rancor is rare, the chance to banish illness beckons just a few mouse clicks away and talk revolves around venture deals, not voluminous budget deficits.

Welcome to the realm of Internet-enabled health apps. Politicians and profit-seeking entrepreneurs alike enthuse about the benefits of “liberating data” – the catch-phrase of U.S. Chief Technology Officer Todd Park – to enable it to move from government databases to consumer-friendly uses. The potential for better information to promote better care is clear. The question that remains unanswered, however, is what role these consumer applications can play in prompting fundamental health system change.

Michael W. Painter, a physician, attorney and senior program officer at the Robert Wood Johnson Foundation, is optimistic. “We think that by harnessing this data and getting it into the hands of developers, entrepreneurs, established businesses, consumers and academia, we will unleash tremendous creativity,” Painter said. “The result will be improved and more cost efficient care, more engaged patients and discoveries that can help drive the next generation of care.”

The foundation is backing up that belief with an open checkbook. RWJF recently awarded $100,000 to Symcat, a multi-functional symptom checker for web and mobile platforms. Developed by two Johns Hopkins University medical students, the app determines a possible diagnosis far more precisely than is possible by just typing in symptoms as a list of words to be searched by “Dr. Google.” Symcat also links to quality information on different providers and can even direct users to nearby emergency care and provide an estimate of the cost.

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.