The Health Care Blog – Page 949 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Engage With Grace

Nov 26, 2008• 5

By Alexandra Drane &
The Engage with Grace Team

We make choices throughout our lives — where we want to live, what types
of
activities will fill our days, with whom we spend our time.

These choices
are often a balance between our desires and our means, but at the end of the
day, they are decisions made with intent. But when it comes to how we want
to be treated at the end our lives, often we don’t express our intent or
tell our loved ones about it.

This has real consequences. 73% of Americans would prefer to die at home,
but up to 50% die in hospital. More than 80% of Californians say their loved
ones "know exactly" or have a "good idea" of what their wishes would be if
they were in a persistent coma, but only 50% say they’ve talked to them
about their preferences.But our end of life experiences are about a lot more
than statistics. They’re about all of us.

A “blog rally” to improve the end-of-life journey

Nov 26, 2008• 1

By Sarah Arnquist

At least 40 health bloggers plan to post a notice about Engage With Grace: The One Slide Project this Thanksgiving weekend. The Health Care Blog thanks them for their support.

Matthew and Alexandra Drane, CEO of Eliza Corp., came up with the idea after discovering they shared a similar interest in improving end-of-life care. Watch the video below to learn more about Alex’s sister-in-law’s end-of-life journey that inspired this campaign.

Paul Levy, CEO of Boston’s Beth Israel Deaconess Hospital and author of the Running a Hospital Blog, jumped in and has championed this mission around the blogosphere and Facebook. In the process, he coined a new term "blog rally" — blogs posting on the same topic to raise awareness.

Engage with Grace from Health 2.0 on Vimeo.

Here’s the list of participating bloggers we’d like to thank:

Rethinking compassion in medicine

Nov 26, 2008• 7

By Michael Miller

Two recent events made me think about how traditional medical care and medical education address the issue of compassion.

The first was at the annual dinner for the Kenneth B. Schwartz Center when they gave out their annual Compassionate Caregiver Award, and reviewed the accomplishments of previous awardees. These individuals have all made remarkable differences in the lives of patients and families through their empathy and personal connections.

The second event was reading about the passing of Florence Wald, the former Dean of Nursing at Yale who organized the first hospice in the United States in 1974 because of her interest in compassionate care at the end of life.

While there has been much discussion about:

Shortages of primary care clinicians
How medical school graduates are increasingly going into specialties
Medical schools are thinking of replacing the requirement that applicants have taken organic chemistry with requirements for more biochemistry or genetics
A survey of physicians finding that over the next three years 49% plan to reduce the number of patients they see or stop practicing entirely, and 60% would not recommend medicine as a career

All these relate to the structure and content of physician education and training. And I have two proposals:

First, while medical school education has progressively shifted from teaching in hospitals to more out-patient and community care, I think doing more to show medical students and residents the rewards of community primary care would be a good step for increasing the number and prestige of primary care clinicians.

And second, while medical schools require students to go through rotations in pediatrics, Ob/Gyn, medicine, surgery and psychiatry, I don’t know of any that require students to go through a hospice rotation. This may be because medicine and society try to discount death as a failure, but a hospice rotation would be a great opportunity for teaching students about empathy and compassion, and shifting the discussion of death within the context of medical education so that it is viewed more as part of the continuum of life. In addition, having medical students in a rotation where they are not reporting to (and trying to impress) senior physicians, but rather working with nurses and social workers, also might provide them with a better perspective on teamwork in healthcare delivery – as well as a dose of humility.

The value of hospice (or palliative care) rotations for students does seem to be growing. An article from 2006 reported that the University of Arizona was thinking about requiring a hospice rotation. And the American Association of Medical College’s web-site has an article from 2004 about how Mt. Sinai has integrated palliative care into their curriculum.

Does anyone know of any medical schools that require hospice rotations for medical students or have integrated these types of programs into their core curriculum? (BTW – A major focus for the Schwartz Center is grand rounds and other educational programs about compassionate care and patient-caregiver communications for both established clinicians and students.)

And lastly, it should also be recognized that expanding young physicians communications and empathy skills should help them work better with their patients, (and patients’ families), which could help reduce unnecessary and costly care.

Dr. Michael Miller started HealthPolCom Consulting in 2000 after 12 years in health policy positions in Washington, DC. He works with an extensive network of policy and communications consultants. He blogs regularly at Health Policy & Communications, where this post first appeared.

Open Wide: Here comes the change you thought would never happen

Nov 25, 2008• 22

By Jeff Goldsmith

The morning after the election, I posted a speculative blog in Health Affairs on three possible scenarios for President-elect Obama’s implementing health reform: folding it into a bold, ambitious emergency legislative package (Complete the New Deal), carving funding out of the current $2.5 trillion national health spend (Braveheart), and postponing implementation until the economy recovers but taking steps now to prepare for it (Wait/Lay the Groundwork).

At the time, the Wait/Lay the Groundwork option seemed 70 percent likely. But with economic conditions worsening, I’m now convinced Obama will probably opt instead for the Complete the New Deal option, and try to implement health reform in the first 120 days of his Presidency, before the health care industry “dragon” can even stir from its cave.

Let’s call Obama’s program The Real Deal. We can already see its contours: an economic stimulus program including highway construction and other state-directed public works, a green energy spending initiative, emergency housing assistance including a foreclosure prevention measure, an auto industry bailout, labor law reform and income supports through tax credits for low income people.

Small Business Coverage: A Report from the Trenches

Nov 25, 2008• 4

Brianklepper By Brian Klepper

John Sinibaldi, a well-respected health insurance agent in St. Petersburg, Fla., has become prominent in Florida’s broker community because he counsels and services a large book of small business clients and studiously tracks the macro trends that impact coverage for this population. And he’s active in the state’s regulatory and legislative activities.

The other day I dropped him Jane Sarasohn-Kahn’s post that reported on International Foundation of Employee Benefit Plans’ survey showing that most employers still want to be involved with health care. John responded with a long description of what the small employers he works with are up against. It’s an illuminating, damning piece. I asked him whether I could post it, and he graciously agreed.

John notes that only 36 percent of Florida’s small businesses — employers with two to 50
employees – now offer coverage. This is significant because 95 percent of
Florida businesses are small. Nationally, about one-third of all employees work for firms with fewer than 100 employees.

The increasing pressure on small business may explain why, as I
pointed out the other day, even the arch-conservative National
Federation of Independent Business (NFIB) recently co-sponsored a
reprise of the Harry & Louise health care reform ads. This time
it advocated for, rather than against, universal health care. Previously,
they were part of the coalition that killed the Clinton reform effort.

Finally, Mr. Sinibaldi’s message should drive home a key point, echoed by Shannon Brownlee and Zeke Emanuel in the Washington Post over the weekend and Bob Laszewski’s post yesterday.
To be successful, the expansive health care reform discussions that
typically dominate in Washington MUST go beyond the Massachusetts and
California reform efforts. Approaches
that can address waste and cost are just as important as those relating
to universal coverage. Otherwise the resulting solutions will continue
to be out of reach to a sizable portion of the American people,
and the underlying driver of the crisis, out-of-control cost, will
remain untouched.

Often the discussions on sites like this are dominated by people who understand health care’s problems deeply but abstractly. For John and his employers, buying health care is a stark, concrete problem that boils down to cutting care arrangements that are affordable for the employers and employees. As he describes it, it’s an increasingly impossible task.

Health care costs are crippling small businesses

Nov 25, 2008• 4

By John Sinibaldi

I’ve got news for the folks doing the International Foundation of Employee Benefit Plans’ survey: Smaller businesses, especially those defined as true small businesses with two to 50 full-time employees, are strapped beyond belief when it comes to paying ever-higher premiums for health care.

The survey’s results are NOT indicative of what is happening in the small group market (much like the Kaiser Family Foundation’s (KFF) annual survey on total premium and the portions shared by employees, which always makes me laugh. The employees at my businesses would kill to have the low percentage of total premium passed on to them that is reported in the KFF survey).

Across the board, the 100+ businesses I represent, all of them two to 50 full-time employees, have received increases between 13 percent and 75 percent this year. The average has been around 20 to 24 percent. That’s on top of more than 15 percent average increases last year, the year before, and the year before.

Up in smoke

Nov 25, 2008• 1

By Sarah Arnquist

Taxing cigarettes is the single-most effective way to lower smoking rates, particularly among youth. And if we could lower smoking rates, we’d save hundreds of thousands of lives and billions of dollars each year.

Good Magazine demonstrates this strong correlation on a state-by-state basis in a fantastic interactive graphic. Go check it out.

In a related matter, I heard Matt Myers, president of Tobacco Free Kids, recently predict a federal cigarette tax increase to fund SCHIP. He said there’s strong bipartisan support, particularly to fund an expansion of children’s health coverage.

The demands for robotic surgery

Nov 24, 2008• 13

By Paul Levy

Many months ago,
I wrote about the da Vinci Robot Surgical System and expressed doubts
about whether there was evidence to support the clinical efficacy of
this equipment, as opposed to the marketing efficacy of the company
selling it. Well, the time has come to graciously say, “Uncle!”

Without
making any representations about the relative clinical value of this
robotic system versus manual laparoscopic surgery, I am writing to let
you know we have decided to buy one for our hospital.

Why? Well, in
simple terms, because virtually all the academic medical centers and
many community hospitals in the Boston area have bought one. Patients
who are otherwise loyal to our hospital and our doctors are
transferring their surgical treatments to other places.

Prospective
residents who are trying to decide where to have their surgical
training look upon our lack of the robot as a deficit in our education
program. Prospective physician recruits feel likewise. And, these
factors are now spreading beyond urology into the field of
gynecological surgery. So as a matter of good business planning,
concern for the quality of our training program, and to continue to
attract and retain the best possible doctors, the decision was made for
us.

So there you have it. This is an illustrative story of the health care system in which we operate

Paul Levy is the President and CEO of Beth Israel Deconess Medical
Center in Boston. He blogs about his
experiences at, Running a Hospital, one of the few blogs we know of maintained by a senior hospital executive.

Fostering an adult conversation about health reform

Nov 24, 2008• 8

By Robert Laszewski

Zeke Emanuel and Shannon Brownlee have an op-ed in Sunday’s Washington Post that should be required reading for anyone interested in health care reform.

The title is, “5 Myths About Our Ailing Health Care System.”

They suggest the “5 Myths” are:

America has the best health care in the world.
Somebody else is paying for your health insurance.
We would save a lot if we could cut the administrative waste of private insurance.
Health-care reform is going to cost a bundle.
Americans aren’t ready for a major overhaul of the health–care system.

At one level I can disagree with many of their points and at another I can agree with all of them — but they are right on all counts.

Hospitals hit by economic downturn

Nov 24, 2008• 2

By Jane Sarasohn-Kahn

Forty percent of American hospitals have seen drops in inpatient admissions, according to the American Hospital Association.

In the AHA’s survey, Report on the Economic Crisis: Initial Impact on Hospitals, it’s clear that hospitals are already experiencing the effects of the economic downturn.

CEOs are considering several cost-cutting tactics in dealing with this financial crisis: