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Why America Needs a Patient-in-Chief

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“These are exciting and very promising times for the widespread application of information technology to improve the quality of healthcare delivery, while also reducing costs, but there is much yet to do, and in  my comments I want to note especially the importance of the resource that is most often under-utilized in our information systems – our patients.”
– Charles Safran MD, testimony to the House Ways & Means subcommittee on health [Emphasis added]

Quite current, yes? No: Dr. Safran said those words in June 2004. And not much has changed.

By ePatient DAVE DEBRONKART

My physician Dr. Danny Sands, mentored by Dr. Safran and colleague Warner Slack MD, heard similar sentiments from them decades earlier. And where are we today? Patients are still untapped, and we have the worst dysfunction in the history of healthcare. Perverse incentives and unintended outcomes are the rule, not occasional glitches, as costs spiral up and outcomes don’t.

As Consumer Reports recently said, in the ten years since the Institute of Medicine’s classic report To Err is Human documented as many as 98,000 deaths a year from preventable medical error, “not much has changed.”

These are signs of a system that’s governed without input from its customer – the patient.

Patients have the most at stake, but they’re invisible in Washington. We need to link them in; we need their passion, their commitment, their very-motivated contributions.

Continue reading…

Why health insurance reform really matters

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By CF Mother

Just occasionally we get a really heartfelt comment on THCB that is passionate and rational, and reminds us why for all the bile spewed about the topic the essential part of the health care bill—making insurance available to everyone—is really important. This comment from CF Mother was left on my post “Thinking the unthinkable” on Friday. And of course, this could happen to anyone—including you. And frankly the Democrats need to do a better job explaining this—Matthew Holt

Questions for those who do not support health care reform:

Twenty years ago our cheery toddler was diagnosed with cystic fibrosis. Afraid, we dug into the medical research to understand the disease that threatened his future. We healed through optimism, roused by the news eight days after his diagnosis that the gene that causes CF had been found, opening the door toward a cure. We knew that our heroes, the researchers and his doctors, would continue to find ways to protect his future. We were no longer afraid of CF.

The fear that woke me in the night was of losing our health insurance because our son was on every insurer’s no-fly list. While my husband’s profession was periodically roiled by layoffs, he decided against the security of opening his own firm because the cost of carrying coverage for our eldest son was too high, the thread on which his health care dangled too slight.

Continue reading…

Update: Surgeons, nurses, and other medical personnel needed to help in Haiti

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By PARTNERS IN HEALTH

We are deeply grateful for the multitude of people who have contacted us wanting to provide medical assistance. At this time, while we wish we could use all of the support so generously offered, we are unable to accommodate any volunteers without significant surgical or trauma training and experience.

We are in need of: orthopedic surgeons, trauma surgeons, anesthesiologists, nurse anesthetists, OR nurses, post-op nurses, and surgical technicians.

If your qualifications match this need, please fill out the following form ..

“FDA More Pro Industry Than Any Time in 35 Years”

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By MERRILL GOOZNER

Merrill

So says Jim Dickinson, editor of FDAWebview, an industry newsletter that closely follows enforcement issues at the agency. After reviewing the deregulatory shifts at the Food and Drug Administration since the Carter administration, he writes:

It has taken almost a generation, but by now, the pro-industry infiltration of FDA’s culture is firmly entrenched. Not only is collaboration in product reviews officially encouraged, but good relationships across the regulatory fence hold the prospect of a possible future career in a well-paid industry job – a connection that is less likely to be publicly noticed in news media that now have to line up for information that has been filtered through agency press offices. The arm’s-length relationship that formerly ruled every contact between agency and industry has become a fading memory.

He says the shift in culture accelerated after the 1992 passage of the Prescription Drug User Fee Act, which made the agency dependent on industry funding. He concludes there’s nothing that Margaret Hamburg, the new commissioner, and Joshua Sharfstein, her deputy, can do about it. Quoting a former chief of enforcement, he writes:

User fees at FDA are the primary villain, because they “allowed the industry to dictate the changes at the FDA in programs, procedures and practices. It will be impossible for the Obama administration to reverse the trend because as long as the user fees are in place the industry has the upper hand.”

Radical stuff from an unexpected source.

The Union “Cadillac” Tax Sweetheart Deal

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By ROBERT LASZEWSKI

Just when you thought you couldn’t be more cynical about the health care bill.

As I have said before, there wasn’t a lot of hope the same administration that ignored the rule of law in granting unions priority over Chrysler bondholders was going to offend them on the “Cadillac” tax.

We’ve seen the “Louisiana purchase” giving Senator Landrieu hundreds of millions for her vote, only to be upstaged by Ben Nelson’s Medicaid deal for Nebraska. Then the Democratic leadership claimed the $250 billion Medicare physician fee problem didn’t have anything to do with health care reform. Add to that a “robust” Medicare commission that can’t touch doctor or hospital costs. Or, how about six years of benefits under the bill and ten years of taxes. Or, counting $70 billion from the new long-term care program as offsetting revenue to help pay for it.

Now, the unions and public employees are going to be exempt from the “Cadillac” excise tax on high cost plans until 2018.It will be interesting to see how proponents, or should I say apologists, for this health care effort spin the latest. I would just ask that you please, please, please, not call this mess health care reform.

There is an important election on Tuesday in the Bay State that looks to be
focused on the Democratic health care effort. This kind of stunt may just be enough to push it over the edge.

Is it 2013 (or 2014) Yet?

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By JD KLEINKE

Nope, it’s only 2010 – a new year to be sure, as evidenced by stabilizing home prices and normalizing presidential approval ratings.  But you can stop holding your organization’s breath, slow down the conversion of that emergency room to a primary care clinic, and forget coming clean with your health insurer about your actual medical conditions.  Health “reform” won’t be here until 2014, if the Senate bill – passed just as Santa Claus was loading up his own sled with presents – prevails in the legislative horse-trading that begins this week.

Or it could be here as early as 2013, if we give way to the reckless abandon of the House bill.  In either case, fear not: full implementation of The Plan does not occur until well after the end of the world, according to the Mayan calendar.  If this is a government take-over of health care, taking their sweet time may prove to be a brilliant poker strategy.Continue reading…

PharmaSecure using SMS to detect counterfeit drugs

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By Matthew Holt

In developing countries, (and here too) counterfeit drugs are a mega-big problem. Essentially fraudulently labeled drugs in the supply chain are often not what they say they are, with potentially devastating consequences. But there’s no really easy way for companies to monitor their supply chain. We ran into PharmaSecure as they were getting off the ground last year, and yesterday I met CEO Sarah Hine who showed me how their technology allows the consumer to directly connect with the manufacturer using SMS.

A very innovative use of technology and a very interesting brief interview (complete with demo!). They’ve also just raised a $2m series A round.

MS-HUG Awards; let’s see you, Health 2.0 gang!

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By Matthew Holt

Last year I was a judge in the MS-HUG award for the HealthVault applications category. The quantity and standard of the entries was pitiful. I think that a few sales reps rounded up a few entries at the last minute

Given that many if not most Health 2.0 applications now link to HealthVault I really hope that the entries this year are way better. Here’s the blurb but if you are a cool Health 2.0 company linked to HealthVault, please enter. You have a week or so (and no Microsoft is not paying me to write this! In fact I didn’t even get paid to be a judge!)

Nominations are accepted in the following categories: 

Clinical Records – Inpatient
Clinical Records – Ambulatory
HIE and Interoperability
Microsoft HealthVault Applications
The nominations have been open since mid-December and will close on January 22 at 5:00 pm Central Standard Time. All of this year’s awards information is on the Microsoft HUG website at: www.mshug.org/awards.

Nurse Practitioners – Doctors?

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By Barbara Ficarra, RN, BSN, MPABarbara Ficarra

Doctors like to assert, maintain control and continuously patrol over their territories; at least some do. In a recent post on THCB, “Nurseanomics” by Maggie Mahar addresses the heated debate over the difference between a doctor and a nurse. Mahar takles the question that Legislators in twenty-eight states are dealing with. Should a nurse practitioner (NP) with an advanced degree provide primary care, without an M.D. being in charge? But another pressing question that needs to be addressed is: Should nurse practitioners be called doctors (DNP)? (DNP is a Doctor of Nursing Practice.) That is the question that I will address here. I reached out to the medical community to get their reaction. It’s not surprising that the immediate response of some doctors when asked if nurse practitioners should be called doctors (DNP) is “No!” evidenced by Dr. Stangl’s comment.

“NO! Nurse practitioners should NOT be called “doctors” because they are NOT! While many NPs do an excellent job of handling certain types of problems in certain settings, they do not have near the depth or length of education that physicians do and should be credited for what they Do have, which is their nursing background and expertise.” Susan Stangl, MD

Take a look at this comment that appears in THCB:

“An NP has mostly on the job training…they NEVER went to a formal hard-to-get into school like medical school,” wrote one doctor. “I have worked with NPs before, and their basic knowledge of medical science is extremely weak. They only have experiential knowledge and very little of the underpinning principles. It would be like allowing flight attendants to land an airplane because pilots are too expensive. HEY NURSIE, IF YOU WANT TO WORK LIKE A DOCTOR…THEN GET YOUR BUTT INTO MEDICAL SCHOOL AND THEN DO RESIDENCY FOR ANOTHER 3-4 YEARS. NO ONE IS PREVENTING YOU IF YOU COULD HACK IT![his emphasis]”

Continue reading…

The Cost of Mammography Screening for Women Under 50

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By MERRILL GOOZNER

Goozner The tempest that greeted the United States Preventive Services Task Force guidelines on mammography screening for women in their 40s prompted the Senate to insert a mandate in its health care reform bill that every insurer cover every mammography screening test at no cost to beneficiaries. If it passes, it will spark an upsurge in mammography screening, especially among women under 50, and raise the nation’s health care tab.

The Journal of the American Medical Association this morning provides a timely article (subscription required) reminding physicians and women about the serious health costs of adopting that policy.Continue reading…

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