The Health Care Blog – Page 791 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Sickening People

Sep 17, 2010• 3

ROB LAMBERTS, MD

I found the discussion around my recent post about treating colds very interesting. Sick people come to the office to find out how sick they are. Most people don’t want to be sick, and when they are sick they want doctors to make them better.

Most people.

Some people want to be sick, and some doctors want to make people sick. I am not talking about hypochondriacs – people who worry that they may have disease and become fixated on being sick. I am not talking about malingerers – people who pretend to be sick so they can get medications. I am talking about the slippery slope of defining disease.

“I lost my job and have felt depressed ever since.”

“My son won’t obey me.”

“I’m just tired and have no motivation.”

“My daughter’s having trouble in school.”

The definition of disease versus normal has become a big issue recently. A recent study found that over 50% of Americans are taking regular medications. In the eye of the hurricane of this controversy is the DSM-5, the new manual for the definition of mental illness. John Gever, of MedPage Today explained in a recent article on KevinMD that the criteria seem, in the eyes of many, to shrink the definition of a “normal” person. The motivation to put a label on normal people, he explains, has various motivating forces:

It’s true that drug companies often do little to discourage off-label use of psychiatric drugs and sometimes encourage it. It’s also true that many doctors throw medications at patients who might do better with other treatments or no treatments. (That’s true for many somatic conditions too, let’s not forget.)Continue reading…

Health 2.0 Europe: Keynote Address by Pieter Vos and Jolyn van Vuuren

Sep 16, 2010• 1

By Bianca Grogan

Pieter Vos, from the Council for Public Health and Health Care, gave a keynote address on stage at the Health 2.0 Europe Conference, April 6-7, 2010, in Paris, France. The Council for Public Health and Health Care is the independent body which advises the government on public health and care.

Human Resources and Surviving Health Reform

Sep 16, 2010• 25

By MIKE TURPIN

As the first snowflakes of change fall on the eve of health reform, HR professionals may soon wake up to an entirely transformed healthcare delivery landscape. The Patient Protection and Affordable Care Act (PPACA) clearly will impact every stakeholder that currently delivers or supplies healthcare in the United States.

While the structural, financial, behavioral and market-based consequences of this sweeping storm of legislation will occur unevenly and are not fully predictable, this first round of healthcare legislation is designed to aggressively regulate and rein in insurance market practices that have been depicted as a major factor in our “crisis of affordability” and to expand coverage to an estimated 30 million uninsured. However, fewer than 30 percent of employers polled in a recent National Business Group on Health survey believe reform will reduce administrative or claims costs.

Yet, it is unlikely that reform will be repealed. For all its imperfections, PPACA is the first in a series of storm systems that will move across the vast steppe of healthcare over the next decade resulting in a radically different system. Whether reform concludes with a single payer system or emerges as a more efficient public-private partnership characterized by clinical quality and accountability remains obscured by the low clouds and shifting winds of political will. One thing is certain during these first phases – inaction and lack of planning will cost employers dearly.Continue reading…

THCB Recommends

Sep 16, 2010

NYC Train Station Bathroom Yields Cleaner Hands than Hospitals

Sep 16, 2010• 7

By MICHAEL L. MILLENSON

Who can forget last year’s celebration of Global Handwashing Day, when it turned out that Brits wash their hands after using a gas station bathroom about as often as your doctor washes his hands before examining you? And that’s not a good thing.

OK, British researchers didn’t exactly come to that conclusion: I did, in this blog, after comparing what they found about motorists to what the academic literature says about doctors.

Now comes a survey of public bathroom hygiene in the US of A, and the good news is that even America’s worst washers are far more likely to have washed their hands than British drivers. The bad news is that the guy who just used the toilet at Grand Central Station is also way more likely to have clean hands than the guy walking up to your bed at the local hospital.

The Health Insurance Purchase Mandate: Peeking Into Pandora’s Box?

Sep 15, 2010• 25

By DAVID DRANOVE

Governors from most twenty mostly red states are suing to block the implementation of health reform. I have no idea whether they will win on the legal merits. But when it comes to the economics of the issue, they are on the wrong side. But even as my head says that the mandate is a good thing, my heart tells me otherwise.

Mandating the purchase of a good or service should be anathema to any card-carrying economist. But healthcare is unlike other goods and services in one critical way. No one will sell you food or clothing or anything else that you cannot pay for. But if you need surgery to save your life, someone will operate on you. Healthcare providers are trained to “treat now, bill later.” And while providers pursue (and sometimes harass) the uninsured for payment, the lion’s share of their costs end up as bad debt or charity write-offs. So the uninsured get their care while the rest of us pay for it. An insurance mandate is supposed to prevent such free riding. It is as if we are saying, “We can’t stop ourselves from taking care of everyone who needs medical care, so we will force everyone to pay their fair share.”

This concern about free riding is how we got health insurance in the first place. During the Great Depression, many patients couldn’t pay their bills. So hospitals and doctors encouraged individuals to prepay for their share of the community’s medical costs in exchange for guaranteed access. Even then, many remained uninsured and some had trouble getting medical care. By the 1950s, the new Hill-Burton program subsidized nonprofit hospitals in exchange for guarantees that they would take in the uninsured. A building spree of taxpayer funded county hospitals and community health centers further bolstered the safety net.Continue reading…

The Next Big Thing for Doctors

Sep 14, 2010

By RICHARD REECE, MD

The Future Just Happened,
by Michael Lewis, 2001

As a consultant to the Physician Foundation, a not-for-profit 501 C-3 Organization representing physicians in state medical societies, as a sometime futurist, and as someone who has written extensively about innovation in Innovation-Driven Health Care (Jones and Bartlett, 2007) and in 1475 blogs in Medinnovation, I have been asked: What is the next big thing for doctors, and how should they react to it?

The next big thing for physicians will be Medicare fee cuts in the neighborhood of 50% by 2020 as mandated by the Affordable Care Act, and the next big clinical innovative response for doctors will be encouraging patients enter their own data, their own chief complaint, and their own medical histories before seeing the doctor to compensate for fee reductions.

Ceding a Traditional Physician Function to Survive Economically

Doctors will have to cede a traditional function – taking a history – to patients to become more efficient to survive. Payers – including Medicare, Medicaid, and private health plans- will demand standardization and restructuring of the medical history to achieve consistency in medical records. Patient-entered information may be disruptive. Doctors will have to change practice flow patterns to adjust to reality of lower pay. The need for greater productivity will drive this change.

The Cost of Care

Sep 13, 2010• 45

By NEEL SHAH, MD

Do you have a story about a medical bill that was higher than you expected it to be? Or a time when you wanted to know how much a medical test or treatment might cost and couldn’t find out?

Costs of Care, a nonprofit group based in Boston, is offering $1000 for anecdotes like these that illustrate the importance of cost-awareness in medicine. Judges will include former U.S. Health and Human Services Secretary Michael Leavitt, Boston surgeon and New Yorker writer Atul Gawande, and former Massachusetts Governor and Democratic Presidential Candidate Michael Dukakis. According to Dr. Neel Shah, who is directing the contest, “Using everyday examples from across the country, these stories will highlight the need to make healthcare prices more transparent.”

Submissions should be no longer than 750 words and are due by November 1st. More details are available here.

EHR Mythology 101

Sep 13, 2010• 25

By MARGALIT GUR-ARIE

Healthcare IT is bustling with activity these days. There are big changes in the air and, only time will tell, but we may be witnessing a defining moment in HIT. Naturally, everybody involved has an opinion and some folks, yours truly included, have more than one.

Below are some of the more popular opinions amongst physicians and a considerable portion of industry analysts.

The current EHRs on the market are outdated legacy systems

This is the battle cry of every new entrant to the market. First the ASP, or web based, vendors referred to the existing client/server vendors as legacy systems. This is about to change once the iPhone EHR vendors start calling the web EHRs legacy systems. One common thing that new vendors tend to gloss over is the fact that the existing vendors did not stop writing software in 1995. Most incumbents are releasing updates and major new versions on a regular basis, and by now most Visual Basic code has been replaced by .NET and the latest Java technologies. True, here and there, you can still find MUMPS platforms, but even the VA’s VistA is in the process of getting a major upgrade towards generic web based capabilities, not to mention the futuristic bombshell veteran EHR vendor e-MDs is about to toss into the mix.Continue reading…

Building a Better Mousetrap

Sep 13, 2010• 23

By JOHN C. GOODMAN, PhD

The story was front page and above the fold in The New York Times. Six teachers in Newark are leaving the traditional school system to start a public school of their own.

If the product was something other than education, this would have been no news at all. I would guess that the vast majority of businesses in this country were started by people who walked away from an employer, convinced that they could make a better product on their own. Teachers rarely have the opportunity to do the same, however. They are usually trapped in a system that does not allow innovation or experimentation and is ordinarily hostile to entrepreneurship.

What does all this have to do with health care? A lot. Doctors are just as trapped as teachers. And that is the most important defect in the health care system.

This, of course, is not the conventional view. The received wisdom in the health policy community is that doctors have too much freedom, not too little. Witness the wide variation in medical practice patterns — from city to city and region to region — all seemingly unrelated to medical outcomes. How can anyone defend that? Certainly not me. Where I part company with so many of my colleagues is that they blame the doctors for this problem — I blame the third-party payers.

Were we to look into the matter, I’m sure we would find wide variations in the practice of teaching from school to school, district to district and state to state. Yet I still maintain the teachers are essentially trapped. This may appear to be an oxymoron, but it’s really not. Both in education and in health care, the practitioners have a great deal of freedom to waste resources. But they have virtually no freedom to profit by discovering innovative ways of lowering costs and raising quality.