The Health Care Blog – Page 933 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Is Medicare backpedalling on evidenced-based medicine?

Jan 27, 2009• 2

By Merrill Goozner

Note: This post first appeared at Gooznews.com

Both the New York Times and the Wall Street Journal
carried stories today on Medicare's expansion of the number of
drug-listing compendia that can now be used to justify reimbursement
for the off-label use of anti-cancer drugs. This expansion, which
GoozNews covered last summer (see posts here, here, and here), will sharply increase Medicare spending on anti-cancer drugs of questionable medical value.

It has also provided drug companies with an alternative system for
getting reimbursed that won't require their going to the Food and Drug
Administration to prove that the regimens listed in the compendia
actually benefit patients.

The effects of this new system were understated in the articles. The Times
estimated that the higher spending by Medicare will come on top of the
$2.4 billion the senior citizen health care program spent on cancer
drugs in 2007. But according to this 2006 testimony
by Center for Medicare and Medicaid Services official Herb Kuhn,
Medicare spent about $10 billion on "Part B" drugs in 2005 (these are
drugs administered in physicians' offices, which includes most cancer
drugs), and about half of that went to oncologists.

Heard around the Web

Jan 26, 2009• 1

Rating hospital quality
Healthgrades.com
released findings today from a national study that identified 270
hospitals, out of 5,000, where patients are on average 27 percent less
likely to die and 8 percent less likely to suffer a major complication (adjusting for hospital case mix).

Open philanthropyBill Gates writes a 10-page letter discussing progress of his health care foundation and future challenges to reducing the global burden of disease.

The future of researchObservational studies using electronic medical record databases offer significant promise for future research, according to a study published today in The British Medical Journal. The University of Pennsylvania researchers replicated randomized controlled trials using the databases and found the results were mostly similar, particularly when applying a new statistical method to control for confounding.

Major Pharma mergerPfizer's plan to buy Wyeth Pharmaceuticals for $68 billion would create the fourth largest company in the U.S. The NY Times explores the impact, management changes and golden parachutes.

OctupletsA California woman gave birth to eight babies at once. The six boys and two girls are alive and said to be doing well. Wow.

The Siren Song of Public Programs

Jan 26, 2009• 26

By Roger Collier

Although details of their 2008 health care reform plans vary, there is significant consensus among the new Washington heavyweights—Obama, Daschle, Baucus, and Clinton. Their common proposal: we should expand Medicaid and offer an under-65 version of Medicare to compete with private insurance.

It seems a seductive idea. Medicaid and its little cousin, SCHIP, provide coverage to more than forty million low-income people, most of whom would otherwise have no insurance, while Medicare is an essential part of the lives of 45 million seniors. It’s hard to imagine American health care without these programs, and understandable that there should be demands for their expansion to cover many of our forty-seven million uninsured.

Seductive it may be, but could the proposal also be the siren song that might lead to the wreck of reform?

A brief classical digression: in Homer’s Odyssey, the song of the two
sirens (who were not named Medicaid and Medicare), proved so attractive
to ancient mariners that they drove their vessels onto the rocks upon
which the sirens sat.

—So what risks could Medicaid expansion pose to the future of our health care ship?

Is Healthcare IT Ready for its Big Coming Out Party?

Jan 25, 2009• 11

By BOB WACHTER, MD

In 2001, when my colleagues and I ranked nearly 100 patient safety practices on the strength of their supporting evidence (for an AHRQ report), healthcare IT didn’t make the top 25. We took a lot of heat for, as one prominent patient safety advocate chided me, “slowing down the momentum.” Some called us Luddites.

Although we hated to be skunks at the IT party, we felt that the facts spoke for themselves. While decent computerized provider order entry (CPOE) systems did catch significant numbers of prescribing errors, we found no studies documenting improved hard outcomes (death, morbidity). More concerning, virtually all the research touting the benefits of HIT was conducted on a handful of home-grown systems (most notably, by David Bates’s superb group at Brigham and Women’s Hospital), leaving us concerned about the paucity of evidence that a vendor-developed system airlifted into a hospital would make the world a better place.

Since that time, there have been lots of studies regarding the impact of HIT on safety and, while many of them are positive, many others are not. In fact, beginning about 5 years ago a literature documenting new classesof errors caused by clunky IT systems began to emerge. A study from Pittsburgh Children’s Hospital found a significant increase in mortality after implementation of the Cerner system – a study that was criticized by IT advocates on methodologic grounds, and because “they didn’t implement the system properly.” Studies by Ross Koppel of Penn and Joan Ash of Oregon (such as here and here) chronicled the unintended consequences of IT systems, and urged caution before plunging headfirst into the HIT pool. I raised similar concerns in a 2006 JAMA article, and also recounted the iconic story of Cedars-Sinai’s 2003 IT implementation disaster, where a poorly designed interface, combined with physician resistance to overly intrusive decision support, led the plug to be pulled on the $50 million CPOE system only a few weeks after it was turned on.Continue reading…

Please, do not ban reference-based pricing

Jan 25, 2009• 4

By Rick Peters, MD & Karl Luber, MD

We were stunned (yes, we're naïve and idealistic) to read in The Kaiser Family Foundation newsletter and The Wall Street Journal article last week that CMS (surprise) and the now former the Bush Administration (no surprise) were proposing a ban on reference-based prescription drug pricing under Medicare Part D.

Health and Human Services Secretary Tom Daschle has said the Obama Administration will work to see that health care “will be guided by evidence and effectiveness, not by ideology.” This proposed ban is in direct opposition to that commitment.

Reference-based pricing drives appropriate clinical decision-making, appropriately decreases health care costs, and appropriately empowers consumers in the health care decision process. It is one of the few rationally applied cost control tools we have. It should be a model – not a pariah.

Announcements: Nudging people to better health with innovation

Jan 25, 2009

Are you helping people make better health choices?

If you care about encouraging choices that promote healthy living, we want to hear from you.

Ashoka’s Changemakers is collaborating with the Pioneer Portfolio of the Robert Wood Johnson Foundation to launch a global search for “nudges” – innovative little pushes—that help people make better decisions regarding their own health and the health of others.

Do you know innovators who work to help people make choices that
improve their health? By nominating them, you will provide them the
opportunity to promote their projects on a global platform and get
connected with potential funding. To learn more visit here.

Commentology

Jan 25, 2009

Mitch came to the defense of Sanjay Gupta in the thread on Maggie Mahar’s post “Doubts About Gupta for Surgeon General.

“I guess I see this differently. One, Gupta is one of the most respected surgeons in the country in his field. Two, his work on TV makes him a natural communicator with the public, which we haven’t had for a very long time. Three, using his TV work to condemn him pretty much says that anyone who’s been in TV should be automatically disqualified for government work. Four, he talked about Anna Nicole Smith because that was his job; not everyone gets to pick and choose what they do or don’t want to do at work. Five, Moore did fudge some of the facts, and if you don’t believe me, ask people in Canada, England, and Australia that live in larger communities how long it takes them to get major procedures unless they pay for it themselves. And six, so he’s against medical marijuana; not every doctor agrees on every single thing. What’s happened to qualifications as guideposts for whether someone is qualified for a position or not? From where I sit, he’s imminently more qualified for the post of surgeon general than Leon Panetta is qualified to be the head of the CIA; true, it’s not a medical comparison, but it’s valid nonetheless. Sounds like a lot of jealousy to me from no-name, if possibly qualified, physicians, who wish it were them than Dr. Gupta.”

Richard Reece MD had this response to Roger Collier’s Sunday morning post “The Siren Song of Public Programs …”

In their frenzy for public programs to expand cover to all, wonk enthusiasts removed from reality conveniently forget the key to making expansion work: physicians. Coverage without physician access is meaningless. And the only federal progam doctors hate more than Medicare is Medicaid. Both are bureaucratic landmines, and both pay considerally less than private coverage.

Advert: The Haas Business of Healthcare Conference

Jan 25, 2009

The Haas Business of Health Care Conference provides an interdisciplinary forum where cutting-edge information and innovative approaches to health care are shared. This is the only event of its kind on the West Coast where health care industry professionals will come together with students from multiple disciplines, predominantly business, public health, and public policy, as well as engineering and science, to present and discuss ideas and learn from each other.
The 3rd Annual Haas Business of Health Care Conference promises to be a extraordinary event, attracting more than 350 attendees and speakers, and bringing together a wide range of perspectives while focusing on the theme of "The Impact of Integration" – We will explore the extent to which the trend toward integration is working to address existing fragmentation and improve the overall ‘health’ of the industry. Panel discussions will span a broad range of major health care hot topics.

We invite you to explore our website at www.haashealthcareconference.org/2009 to learn more!

Dr. George Lundberg for Surgeon General

Jan 25, 2009• 18

By Brian Klepper

The report that Mr. Obama’s Surgeon General choice might be neurosurgeon and CNN medical correspondent Dr. Sanjay Gupta produced an upwelling of strong opinion, particularly in the medical community. Some argued that Dr. Gupta has clearly demonstrated his abilities as an able communicator.

But others said that Gupta lacks the experience, seriousness and focus on public health. (I can’t help thinking that anyone who has achieved working neurosurgeon and national TV commentator status is pretty capable and serious, demeanor notwithstanding.)

And so it is that on Facebook, that Dr. Richard Lippin, a longtime Preventive Medicine physician based in Pennsylvania, has posted a letter he sent to President Obama and Secretary Daschle, urging the consideration of Dr. George Lundberg for Surgeon General.

The header reads: “We need a physician with the gravitas and the moral credentials and authority to use this bully pulpit position to speak for science and values based priority public health issues for all Americans. Dr. George Lundberg fits the bill.”

The letter provides a brief bio of Dr. Lundberg, the brilliantly eclectic, progressive, Alabama-born, down-to-earth physician who has been a visible mainstay of American medicine for decades. Dr. Lippin doesn’t mention Dr. Lundberg’s landmark 2002 book on American health care and reform, Severed Trust. (The title alone provides a lot of insight into Dr. Lundberg’s view of the world.)

But Dr. Lippin does believe the Surgeon General choice is about healing both America and American medicine, He writes, “we have a genuine crisis on many levels in US Medicine. Also we need desperately for the medical profession to regain its moral and ethical foundations and furthermore we also need medical leaders who must regain the trust of the American Public which has been dangerously eroded.

I agree with Dr. Lippin that those are the tasks, and I agree that Dr. Lundberg is a terrifically suitable candidate. Over many years, I have developed a warm friendship with him. It is impossible to not be bowled over by his range and grasp of issues, and by his unswerving willingness to stand clearly and openly for approaches that are tied to evidence and reason. The ultimate critical thinker, his judgments are founded most closely to merit, possibility and an unshakable belief in the correctness of the pursuit of excellence in health.

He is also bold and politically savvy. You don’t become the longest running Editor-in-Chief of the Journal of the American Medical Association (until he got politically at odds with them) and then build Medscape into the most widely read Web resource for clinicians worldwide unless you can continuously strike the delicate balances between science, sensibility and moral imperatives among your peers.

I can’t say whether Dr. Lundberg would be the best candidate for the job ahead. He has a huge following in the medical community, nationally and worldwide, the result of many, many years of consistently high performance infused with unassailable integrity. Whether he’s the right person for this moment is another issue, though, fraught with the complexities of political consideration, a vision consistent with the larger plan of the Obama team, fluency with the bewildering array of new technologies that are changing the face of medicine and the patient-physician relationship, and so on.

But Dr. Lippin makes an important point. American medicine is demoralized in the field. Overt, rampant financial conflict has caused many to believe that the profession has lost its compass. With that loss, the trust of patients and the authority that trust conveys have also diminished.

Restoring that trust and authority isn’t simply a matter of leadership or preaching, but will depend on fundamentally changing the business of medicine, a much larger task indeed that will require an orchestrated effort by all of us, not just physicians.

But the new Surgeon General, whoever he or she is, should be grounded first in science, evidence and best practice, in tirelessly advocating and maneuvering for a care delivery system that is as advanced and nuanced as the diagnostic and treatment approaches we’ve developed, and on advancing the health of ALL our people in ways that leverage rather than squander increasingly precious resources.

While there is no question that Dr. Lundberg is worthy, I’d be surprised if the call for his consideration is heard in the din of this transition. Even so, it is deeply gratifying to see an outpouring of support by his peers, the result of successfully dedicating his life to advancing medical knowledge and its best application.

A Shout Out to Our Sponsors

Jan 24, 2009

According to ConnextionsHealth, growing losses of individual and group plan members are eroding acquisition costs, profitability and competitive advantage at all major health plans, making member retention a strategic priority for 2009. At some health insurers, member turnover is running as high as 40%. Further, McKinsey & Co. found that health plans capture less than 10% of members lost through job termination, early retirement and elimination of employer-funded coverage. This “employee transition” market segment alone is estimated at $40 billion annually. To address this emerging market need, ConnextionsHealth and World Health Care Congress are hosting a first-of-its-kind Leadership Summit on Member Retention for Health Plans scheduled for March 18-19, 2009 in Orlando, FL. Designed for health plan senior executives, the Summit will provide an insider’s look into the underlying issues and successful strategies for retaining individual and small group plan members and building brand loyalty. More information is available at www.worldcongress.com/retention.