The Health Care Blog – Page 934 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

The New Science of Vascular Disease

Jan 28, 2009• 9

By William H. Bestermann M.D.

Vascular
disease and the conditions that produce arterial problems consume
roughly one- third to one-half of the $2 trillion annual spend in
American health care. The science and systems exist today to dramatically improve the quality and cost related to cardio-metabolic
conditions but almost nothing has been done to implement these new
tools since the Institute of Medicine (IOM) published “Crossing
the Quality Chasm” in 2001.

The most glaring
example of the failure of medical and political leadership in these
matters can be found in the treatment of chronic conditions, which
consume 70 percent of our health care dollars. “Crossing the
Quality Chasm” was a stinging indictment of American medicine,
describing a system that is in need of fundamental change, with many
professionals and patients concerned that the care delivered is not
the care that we need. The report described a system that harms too
frequently and routinely fails to deliver its potential benefits.

CEOs’ Urgent, Shared Commitment to Change

Jan 27, 2009• 32

By Gary S. Kaplan

A few weeks ago, I joined five of my peers in health care leadership throughout the country to help launch Health CEOs for Health Reform, a coalition dedicated to transforming health care and creating a more sustainable health system.

In mission, we committed to moving past policy concepts toward a detailed blueprint that would reconcile legislative goals with operational realities of the health care system. Our goals are lofty and the challenges immense. What struck me in recent months, with the current state of the economy, is the tremendous sense of urgency we all feel and the confidence we have that now is the time to truly transform health care.

I read Michael Millenson’s post The Inevitability of Health Care Reform: This Time, the Politics Have Changed with great interest and personal reflection. What is different this time around? What do I think a handful of health CEOs can really do to change a system entrenched with waste and cost that does not add value to our very customer – the patient?

The Virtual Health Home

Jan 27, 2009• 12

By Don Kemper

The virtual health home is
the “other half” of the patient-centered medical home. Some might
say it’s the better half. Though related in purpose, the two “homes”
differ dramatically in perspective. While both place the patient at
the center of care:

In the medical
home the perspective is that of health professionals who are looking
and managing in toward the patient.
In the virtual
health home the patient is looking and managing out from the center.

The difference is astounding.

The British are revolting!

Jan 27, 2009• 21

By Matthew Holt

The BBC (British Band of Communists) has created an appalling piece of propaganda suggesting that the American health care system is an unfair mess. And they’re not exactly too polite about the rest of America, including setting up some doubtless fake multi-millionaire with a spendthrift wife to look ridiculous while saying that we shouldn’t be sharing the wealth.

And if you want to watch it, luckily it won’t be shown here on TV. But those communists have now invented something call YouTube, so you can see it there. But I’m sure none of you realists will want to watch it, and instead will join my call to make sure that these tax-subsidized radical extremists are banned from these shores.

And of course, these are the fools who claimed that spaghetti grows on trees.

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.