The Health Care Blog – Page 729 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

The Hospitalist Field Turns 15: What The Past Says About The Future

May 16, 2011

By BOB WACHTER, MD

I just returned from the Society of Hospital Medicine’s annual meeting in Dallas. Seeing more than 2,000 hospitalists in one place is remarkable, since I remember the days when we all fit into a mid-sized conference room at a Holiday Inn.

I have clearly assumed the mantle of elder statesman at these meetings. I find this odd, since my idea of an elder statesman is UCSF’s former chair of medicine, Lloyd Hollingsworth (“Holly”) Smith, a man of unbelievable accomplishment and grace. Holly is now in his late 80s, and every year we ask him to say a few words at our department’s annual faculty dinner. Holly is the best after-dinner speaker I know – his comments, always insightful and hilarious, are increasingly peppered with “old guy” references (my recent favorite: “I’ve now reached the age of – when I reach down to tie my shoes, I ask myself, ‘Is there anything else I need to do as long as I’m down here?’ before I get up.”)

I’m not complaining: for the past decade, I’ve had the honor of giving a closing keynote address at the annual hospital medicine meeting. In this week’s talk, I reflected on the history of the hospitalist field, in the 15 years since Lee Goldman and I coined the term in the New England Journal of Medicine.

This kind of reflection is useful because, in a world in which we’re all drinking out of a huge information hose, it’s easy to focus on the short term and lose track of the arc of history. Self-help guru Tony Robbins had it right when he said, “Most people overestimate what they can do in a year, and underestimate what they can do in a decade.” Our 15-year history proves that.Continue reading…

Does Mitt Romney Deserve the Abuse He’s Getting on Health Care? Yes, He Does.

May 16, 2011• 10

By DAVID E. WILLIAMS

Mitt Romney took a big beating on the Wall Street Journal‘s editorial page last week, the same day he laid out his health care plan in the USA Today and defended his position on the topic in a speech in Michigan. I’m not a big Romney fan but had been feeling sympathetic enough toward him on this issue to defend him. After reading what he has to say, though, I’m not prepared to offer a defense. On the other hand, Massachusetts health reform remains defensible, if incomplete.

Here’s what Mitt Romney should have said:

Health reform in Massachusetts has achieved its main goal: more than 98% of residents now have health insurance including 99.8% of children
The Massachusetts reform was achieved by bringing together all major stakeholders in the state from both parties, and focusing on addressing a serious problem rather than scoring political points against one another at the expense of the public good
Gaining consensus enabled health reform not just to get passed, but actually implemented more or less as envisioned, in contrast to earlier failed attempts at universal coverage
Massachusetts’ long history of substantial public sector investments made this kind of reform feasible. Good schools translate into an educated workforce that attracts high-wage employers who can afford to offer health insurance. That made it possible for the state to offer a safety net that was more generous than other states’ (e.g., in its eligibility criteria for Medicaid) even before the enactment of so-called Romney Care
Massachusetts, like other states, still has a cost problem. It’s no surprise that Massachusetts health reform didn’t bring costs down. First, that wasn’t its goal. Second, cost problems can’t be addressed in a serious manner without changes in the health care delivery system and reform of Medicare. Tackling the delivery system is very difficult, and states have no power to reform Medicare. That’s why health reform can’t be left purely to the states; it has to be tackled at the national level
Even a cold-blooded capitalist like me realizes that pure free-market approaches aren’t effective or fair in health careContinue reading…

Wellpoint gets aggressive on inpatient payment changes

May 16, 2011• 3

We’ve heard a lot of whining over the years from private insurers about how they have to pay more because Medicare pays less. But now Wellpoint is going to essentially use the ACA as cover to put all of its hospitals on a pay for performance plan–obviously related to the ACO ideas we’re hearing from CMS. The WSJ reports that all hospitals in Wellpoint’s networks are going to be paid future increases based on a formula for outcomes, patient safety and patient satisfaction. Thus far private insurers have been laggards in that they haven’t really mixed up payment schemes to incent better behavior by providers–even though nothing was stopping them. They always claimed they would eventually. Maybe eventually is now.

How Should Medicare Pay for Medical Care?

May 15, 2011• 6

By JOHN GOODMAN

There are basically five possibilities. To compare them, let:

S = each unit of service, or a package of services

P = the price of each unit of service, or the price of a package of services

Then the government can:

1. Dictate every service it will pay for and the price it will pay for each of them (fix S and P), leaving providers to compete only on amenities, including waiting times.

2. Dictate S, but leave providers free to compete on P, say, through a system of competitive bidding.

3. Dictate P, but leave providers free to compete on what S they will provide for that price.

4. Initially fix S and P, but leave providers free to opt out, substituting different bundles of S & P as long as government’s cost goes down and quality of care goes up.

5. Initially fix S and P, but allow patients to opt out, managing a portion of the funds directly and making their own purchasing decisions.

Alert readers will recognize (4) and (5) as NCPA solutions, (3) as the Rivlin-Ryan plan, and (1) as the status quo. But I’m getting ahead of the story.

Under the current system (Method 1), Medicare establishes a list of about 7,500 physician tasks it will pay, and sets the price for each of them. These prices differ, however, for every city, town, and hamlet in the land. So that in fact there are millions of prices that Medicare is administering every day.

One important drawback of this system is that it’s in no one’s interest to curtail spending. Every provider maximizes profit and every patient maximizes utility by exploiting the reimbursement formulas.

Sorry, been busy!

May 12, 2011• 8

You may have noticed that I haven’t been hanging around THCB much this week so far. Well I have a great excuse. This is my wife Amanda and our new daughter Colette. She was born on Sunday at 6 am and mom and baby are doing very well!

The Quantified Self and the Future of Health Care

May 12, 2011• 5

By GARY WOLF

The Quantified Self is a global collaboration of users and tool-makers interested in the personal meaning of personal data. There are now Quantified Self groups in more than twenty cities around the world. Our inspiration is the Homebrew Computer Club. Once upon a time, computers were thought to be useful only for scientists, managers, and planners. But a few people saw things differently: they argued that computers were for all of us. That notion seemed very strange. What would an ordinary person do with a computer? But it turned out that the personal uses of computers were not just an important use, but the most important use.

We at the Quantified Self think of data the same way. Nearly every day, we hear about a new system to track human behavior. There is sensor-based tracking of sleep, activity, location, heart rate, blood glucose, metabolism, even facial expression. There are web services to track mood, diet, menstrual cycle, productivity, and cognition. (This is just a sample, to give a sense of range, and not an endorsement of any particular approach.) Often, when I talk to my friends in the health care field, they are eager to know how exploring these tools might be justified in conventional health care terms: return on investment, treatment outcomes, patient compliance, etc. This managerial view of data is part of the important conversation that happens every day on the The Health Care Blog. But for the remainder of this post, I’d like to ask you put these questions aside. Seeing something of the big culture change happening outside health care might prove useful for solving some of the seemingly intractable problems inside it.

There are three reasons people track themselves:

They have a specific goal, such as losing weight, keeping fit, sleeping better, ameliorating a chronic condition, or training for an athletic competition.
They are generally curious. Surprisingly often, people find their tracking data valuable even in the absence of narrowly-defined utility. These self-trackers see their data as a kind of mirror on the self, helpful in maintaining overall self-awareness. (Like keeping a diary.)

They want to establish a baseline with which to measure future changes. This often goes along with a belief that the data will become more powerful over time. Personal data, in this sense, is an investment that will pay off in the future, and is part of an exploratory, pioneering worldview.Continue reading…

The Lightweight Romney Health Plan

May 12, 2011• 34

By ROBERT LASZEWSKI

Mitt Romney has outlined his new health plan. He outlined five key steps in an op-ed in USAToday. Here is a summary:

Step 1: Give states the responsibility, flexibility and resources to care for citizens who are poor, uninsured or chronically ill.

Step 2: Reform the tax code to promote the individual ownership of health insurance.

Step 3: Focus federal regulation of health care on making markets work…For example, individuals who are continuously covered for a specified period of time may not be denied access to insurance because of pre-existing conditions. And individuals should be allowed to purchase insurance across state lines, free from costly state benefit requirements. Finally, individuals and small businesses should be allowed to form purchasing pools to lower insurance costs and improve choice.

Step 4: Reform medical liability. We should cap non-economic damages in medical malpractice litigation.

Step 5: Make health care more like a consumer market and less like a government program. This can be done by strengthening health savings accounts that help consumers save for health expenses and choose cost-effective insurance.

It looks to me like his health care outline is more intended to make conservative Republicans happy then to really propose ways to reform America’s health care system.

There isn’t one new idea here and it all comes straight from the 2010 Republican campaign playbook.Continue reading…

The Social Life of Health Information

May 12, 2011• 2

By SUSANNAH FOX

“I don’t know, but I can try to find out” is the default setting for people with health questions.

The internet has changed people’s relationships with information. Data collected by the Pew Internet Project and the California HealthCare Foundation consistently show that doctors, nurses, and other health professionals continue to be the first choice for most people with health concerns, but online resources, including advice from peers, are a significant source of health information in the U.S.

These findings are based on a national telephone survey conducted in August and September 2010 among 3,001 adults in the U.S., with interviews conducted in either English or Spanish and including 1,000 cell phone interviews. The full report, “The Social Life of Health Information, 2011,” is available at pewinternet.org.

The survey finds that, of the 74% of adults who use the internet:

80% of internet users have looked online for information about any of 15 health topics such as a specific disease or treatment. This translates to 59% of all adults.
34% of internet users, or 25% of adults, have read someone else’s commentary or experience about health or medical issues on an online news group, website, or blog.
25% of internet users, or 19% of adults, have watched an online video about health or medical issues.
24% of internet users, or 18% of adults, have consulted online reviews of particular drugs or medical treatments.
18% of internet users, or 13% of adults, have gone online to find others who might have health concerns similar to theirs.
16% of internet users, or 12% of adults, have consulted online rankings or reviews of doctors or other providers.
15% of internet users, or 11% of adults, have consulted online rankings or reviews of hospitals or other medical facilities.Continue reading…

The Dual Online Identities of Physicians

May 12, 2011• 3

By GLENN LAFFEL, MD

Like everybody else, physicians are expanding their online personal identities. At the same time, they are trying to comply with codes of conduct that help consumers trust them and their profession.

There’s no problem so long as the personal online activities of physicians don’t jeopardize their obligations as professionals, which means that there is a problem, unfortunately.

In a recent study for example, 17% of all blogs authored by health professionals were found to include personally identifiable information about patients. Scores of physicians have been reprimanded for posting similar information on Twitter and Facebook, posting lewd pictures of themselves online, tweeting about late night escapades which ended hours before they performed surgery, and other unsavory behaviors.

As I mentioned Monday, medical students and younger physicians who grew up with the Internet have to be particularly careful, since they had established personal online identities before accepting the professional responsibilities that came with their medical degree.

Medical schools, residency programs and teaching hospitals can help young professionals manage their dual lives online. Some have implemented curricula and policies that foster appropriate use of social media, but surprisingly these programs are not widespread. In a recent study of medical schools that had experienced at least one incident in which a student used social media inappropriately, only 38% had adopted formal policies to handle future incidents. An additional 11% reported they were developing such policies. We can do better than this.

Non-teaching hospitals, CME providers and professional organizations like the American Medical Association can also help providers navigate the online world. The AMA’s recent guide to Professionalism in the Use of Social Media provides helpful guidance in this regard.