The Health Care Blog – Page 783 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Dear Mr. Smith…..

Oct 25, 2010• 15

By DAVID DRANOVE

John Smith of Chicago (not his real name) asked the following question in a recent letter to a local newspaper:

“Over the last several years my annual deductible has increased from $500 to $2000…With higher rates, I have had to limit key diagnostic services that my physician recommended at my physical. Does health reform cap deductibles…?”

The paper’s response mentioned that many preventive services are covered under the new law and mentioned something about risk pools – a decent enough answer I suppose. Here is what I would have written:

Dear Mr. Smith,

I understand that you are upset. No one wants to spend money on something when someone else has been buying it for them. Healthcare is no exception, and over the years we have gotten use to having our health insurance company buy everything our doctors ordered. The upside of generous health insurance coverage is that we are better able to avoid the risk of financial ruin. The downside is that we sometimes agree to receive medical services that we might not need. The latter is really true – the research evidence is overwhelming – and this has contributed mightily to the cost crisis you have been reading about.

Suing the Right to Life

Oct 25, 2010• 18

By LUCAS RESTREPO, MD

Last week, the fire department of a small town in Tennessee called South Fulton ignored the call of a man who needed help quelling a fire near his house. The firefighters declined lending a hand because the caller neglected to pay a $75 bill, the prerequisite for deserving assistance. The caller tried to put down the fire with a garden hose, but after two hours, his house caught on fire. When the property of a neighbor who had paid the $75 became threatened by the flames, the gallant firemen promptly answered the call of duty. The brave public servants prevented the flames from spreading to the property of their responsible contributor, carefully avoiding to suppress the conflagration’s source. Someone has to teach a lesson to the free-loaders in our society, explains a high-minded commentator.

Our health care system works exactly like South Fulton’s worthy fire department: we are entitled to health care only if we have money or qualify for Medicare or Medicaid. If you don’t have money, your health entirely depends on the charity of health care providers, who, as our admirable firefighters, may refuse to help.

I wish to argue that, besides being cruel and inhumane, the “South Fulton health care model” is a latent threat to society. The cost and effort of preventive medicine and basic primary care (fire prevention, putting down a small fire) is less than dealing with instances of end-organ failure (a house in flames). Moreover, having uninsured people (not aiming water to the fire source) creates a constant economic liability to responsible costumers (the neighborhood). On the other hand, why should someone become a doctor, nurse, or health insurance company founder (a firefighter) without being an altruist? Do firefighters dream of wealth and leisure?

The costs of not doing anything about a burning house are always paid in full by society ―and some costs are not immediately apparent. Who loves the sight and smell of a charred landscape? Where will the man live now that he has no house? Will he react violently to the inaction of the firemen? Will the reputation of the fire department (and the city’s) go up in smoke?

Crossing the ROAD to Real Reform

Oct 25, 2010• 3

By ALI KHAN, MD, MPP

“So, why didn’t I take the ROAD again?”

It’s a question that I regularly hear from many of my co-residents in internal medicine – and no, we’re not questioning our travel routes to the hospital.

We all know why we chose internal medicine: the intellectual challenges inherent in treating across organ systems, the excitement of primary scientific investigation and diagnosis and the like. As we struggle through the rigors of primary care training, however, it’s hard not to look wistfully at our colleagues in such lucrative, ”lifestyle” specialties as radiology, ophthalmology, anesthesia and dermatology – the “ROAD” to riches in modern medicine – and wonder exactly how green the proverbial grass on the other side might be.

In the wake of the Affordable Care Act’s [ACA] passage, conventional wisdom suggests that we’re about to find out. After all, with the ACA’s passage comes the influx of more than 30 million new customers to American primary care offices and hospitals. In a health care marketplace where just two percent of all graduating American medical students will pursue careers in general medicine (according to a 2008 JAMA study), an exponential jump in supply will mean a requisite increase in demand – with a boost in wages for primary care docs surely close behind.

Teamwork Training in Healthcare: More Than Just Kumbaya

Oct 22, 2010• 17

By BOB WACHTER, MD

One of the central tenets of the patient safety movement is that modern medicine is a team sport. Unfortunately, its players – particularly physicians – were trained and socialized to be free-spirited individualists. We need the Celtics of the 80s; what we have is a collection of young John McEnroes.

While this theory has been generally accepted, there is less agreement regarding how to change things. When I speak about safety culture, many of the questions I’m asked focus on how we are going to train future generations of medical students and residents to be “different” (translation: not like the prima donnas I have to deal with in my daily practice). It’s as if people are fatalistic about the ability to transform the culture of today’s practitioners; perhaps the next crop of physicians will do, and be, better.

Those of us who aren’t resigned to a biological solution to this problem have been enthusiastic about teamwork training and crew resource management programs for years. These programs are modeled on similar programs introduced in aviation in the 1980s after it was discovered that several tragic crashes had their roots in remarkably poor teamwork and communication. The programs bring together multidisciplinary groups to learn habits of clear communication and teamwork, and to be trained in the use of tools to employ when the going gets tough – such as, say, when a flock of Canadian geese flies into your jet’s engines.

Five years ago, with funding from the Moore Foundation, we implemented such a program on the medical services at UCSF and at two nearby hospitals. Unfortunately, while the program’s participants believed that it made care safer, our relatively small numbers of patients and providers left us unable to show improvements on hard outcomes like mortality. Other studies have had similarly mixed results – enough to keep the candle burning for those of us who believe that culture is critical and that teamwork training is the likeliest way to improve it, but not enough to catalyze a national movement for more. And, because it is expensive (the outlays for the trainers are only a small fraction of the costs – the real costs are the lost productivity of scores of nurses and doctors taking a day away from their regular jobs), teamwork training has mostly remained a novelty, implemented by a few cutting edge institutions and true believers.

How Reform Law Funds Itself, Strengthens Medicare, and Cuts the Deficit: Part 1

Oct 22, 2010• 58

By MAGGIE MAHAR

The Mainstream Media Rarely Tries to Explain the Congressional Budget Office’s nearly unbelievable claims that the Patient Protect and Affordable Care Act can:

1) Pay for itself

2) Provide coverage for 32 million uninsured Americans

3) Trim this nation’s deficit by some $143 billion over the next ten years

And, that’s not all. Medicare’s Trustees say that the reform legislation puts Medicare on the road to financial solvency–while limiting co-pays and beefing up benefits.

You might well ask: How can this be? How can we provide insurance for an additional 32 million people, improve Medicare, and simultaneously save money?

The media has not been a great help in answering these questions. This is, in large part, because the good news lies in the details—dozens and dozens of details. Fleshing out the myriad ways that the ACA generates new revenues while reining in health care spending would take up far too much time on a cable television show—and way too much space in most newspapers.

NCI’s Abdul Shaikh on Challenge for Enabling Community Use of Data for Cancer Prevention and Control

Oct 21, 2010• 2

Indu Subaiya, Director of the Health 2.0 Developer Challenge interviews Abdul Shaikh, Program Director for National Cancer Institute's Health Communication and Informatics Research Branch at NIH about the National Cancer Institute's inspiration in putting together the Enabling Community of Data for Cancer Prevention and Control challenge. Abdul talks about NCI's support of data mash-ups and visualizations related to cancer prevention and the need to create tools for both consumers and policy makers to utilize their data to drive behavior change, and draws inspiration from Hans Rosling's TED talk in 2006.

Interview with Abdul Shaikh

How Health Services Researchers Can Harness Data : Discussion at Health Innovation Week, SF

Oct 20, 2010• 3

By TED EYTAN, MD

Last week’s Health Innovation Week in San Francisco started for me with a day entitled “From Data to Information, to Knowledge to Application: How Health Services Research Can Harness Data to Help Support a More Rapid Learning Cycle,” at @KPGarfield in Oakland, California. I was asked to present an example from clinical practice on “Novel Means of Data Generation.”

Kind of a lot to get my head around as since I am not a health services researcher.

I knew that I would be co presenting with Gilles Frydman ( @gfry ) and as I have always learned, even if you don’t know what to do, take a good history, so I went.

The second in my slide is maybe a small reflection of my anxiety over Twitter, thanks to the audience for letting me express it.

Speaking of social media, I really liked the stated approach for the day, “share whatever you like, just don’t attribute it to people.” For me that sets a great tone, so kudos to the organizers for discussing this proactively rather than waiting for someone to ask. With that in mind, I will attribute things to myself only, since they’re my things to attribute…

The Politics of Health Reform

Oct 19, 2010• 44

By JOHN GOODMAN, PhD

There will be two national elections before the new health overhaul is substantially implemented (in 2014) and a third election the year it is supposed to be implemented.

Question: Will the voters reward office holders who supported the Affordable Care Act (ACA), or will they vote for their opponents? In thinking about this question, forget all the public opinion polls. Can you predict the outcome based on what you know about political science alone?

My prediction: Supporters of the new law are going to get creamed. As I explained at my own blog the other day, there are four reasons: The law violates two bedrock principles of coalition politics that have been successful for the past 80 years; it abandons core Democratic constituencies; and it ignores the fundamentals of the politics of the health care sector.

Franklin Roosevelt’s First Principle of Successful Coalition Politics: Create benefits for people who are concentrated and organized, paid for by people who are disbursed and disorganized.

The ACA violates this principle in spades. The main beneficiaries are many (but not all) of the new law are 32 million to 34 million newly insured people who otherwise would have been uninsured. Far from being organized and focused, most people in this group do not even know who they are. Indeed, it is probably fair to say that never in American history have so many benefits been conferred on so many people who never even asked for them!

Medicare Costs Rise, Health Outcomes Suffer When Seniors Are Over-Medicated

Oct 19, 2010• 6

By NAOMI FREUNDLICH

The problem of elderly people taking too many medications is not new, but continues to pose a serious risk to health as well as contribute significantly to rising Medicare costs. The fact is that nearly 20% of adults aged 65 years and older who are not hospitalized take 10 or more medications daily. This number is not the result of shoddy care, but rather achieved when doctors simply follow practice guidelines for several common, co-existing conditions like diabetes, high blood pressure and depression, for example. If you look at all seniors (those both in and out of the hospital) the American Society of Consultant Pharmacists reports that the average 65-69 year old takes nearly 14 prescriptions per year; by ages 80-84 that number averages an astounding 18 prescription drugs per year.

What’s troubling is that instead of improving the health of seniors, evidence is growing that the more medications an elderly person takes, the more likely he is to experience falls, cognitive decline, loss of mobility, depression and even cardiac problems. These adverse drug effects may be mistaken for Alzheimer’s disease or other dementias too. The bottom line: Experts estimate that up to one-third of the elderly in our communities may be over-medicated and some 20% of their hospital admissions are due to adverse drug events. The costs related to over-medication in the elderly are thought to exceed $80 billion each year.

Although the problem of so-called “polypharmacy” among seniors results in significant economic and public health costs, little has been done to remedy the problem. In fact, in a recent commentary in the Journal of the American Medical Association, Jerry Avorn, associate professor of medicine at Harvard Medical School and author of the book “Powerful Medicines,” says that “many aspects of the US health care system act to discourage optimal prescribing” for the elderly.

For example, elderly Americans are highly underrepresented in the clinical trials for many of the drugs that doctors commonly prescribe for them. Seniors may metabolize these medications differently and they are often more sensitive to side effects and counter-indications with other drugs than younger people. They also take many more drugs (often all at the same time) than any subjects who take part in controlled clinical trials. Disturbingly, doctors sometimes end up prescribing a new medication to treat the adverse effects of a pill the elderly patient has been taking for years.

San Francisco 2010: Qpid.me Demonstration

Oct 19, 2010• 1

By Bianca Grogan

At the Health 2.0 Fall Conference, October 7-8, 2010, in San Francisco, Ca, during the much talked about Behavior Change, Health 2.0 & The Unmentionables session, Ramin Bastani, Founder of Qpid.me spoke about one of the most difficult, but important, conversations you should have with your partner. Ramin drew from his past experiences while introducing a service which he called "a mordern, flirtatious, I'll show you mine, if you show me yours." Take a look at this demonstration and discover a new and easy way to mention one of the biggest unmentionables of them all.