The Health Care Blog – Page 953 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Nudging the value glacier

Dec 4, 2008• 2

By Sarah Arnquist Glacier

In just two years, seniors will spend a quarter of their monthly Social Security checks on Medicare out-of-pocket expenses, including premiums, co-payments and deductibles.Meanwhile, Medicare bookkeepers predict total health spending in the U.S. to increase from 2.2 trillion today to 4.3 trillion in 2017.

At that rate of growth, it won’t be long before the entire Social Security check goes toward medical care. So what’s the solution?

Barry Straube, CMS chief medical officer, said the solution is transforming Medicare into an active purchaser that seeks to get more bang — in terms of high quality care and improved health — for its buck.

In health care lingo, that’s called value-based purchasing – the topic of a two-day conference put on by the ECRI Institute that Straube,and other health care bigwigs attended this week in Washington D.C.

“Medicare should be paying for care that promotes health, prevents complications, optimizes quality and efficiency, and keeps health care costs down,” Straube said. “… We have a system that arguably is based on resource consumption and volume irrespective to the value associated with that care.”

Technology should promote patient involvement not replace it

Dec 4, 2008• 3

By THCB Reader SR

This post came as a comment by SR to Dr. Kibbe’s piece on electronic medical records. It’s a great consumer perspective and worth reprinting in full. — THCB Staff

Health Care consumers and patients have a wide range of interests,
needs and values that vary across our lifespans and circumstances and
hopefully there will be many different tools, products and services
provided to both providers and users of health care.

For example, my 70-year-old retired father is the head of a neighborhood
wellness program with over 3,000 people and maintained a family blog
during my mom’s cancer treatment but doesn’t own a cell phone and would
rarely change physicians despite differences in quality. I am rarely
ill, and yet expect SMS alerts if a lab test is done and want my
clinical records to link with my Nike tracker in my shoe as well as
apps on my Iphone.

I envision a system similar to the financial sector (bad example
right now perhaps) where you are able to move your information from
clinician to clinician (online bank statements = EMR) supplement that
with information gathered via other ancillary providers (investment
account at E-trade) take all of that information into my PHR (without
entering most of the data so it is similar to downloading into
Quicken) adding in some personal data (from my nike+ sensor and mobile
apps that track my diet and yoga classes) and generate reports (like
turbo tax) to share with some of my providers

Patients still choose docs based on word of mouth

Dec 4, 2008• 3

By Sarah Arnquist

Patients still choose where they receive care based on good old word of mouth and referrals from their doctors, despite numerous Web sites and initiatives aimed at giving them information to compare the cost and quality of doctors and hospitals.

That’s the finding of a new national study released today by the Center for Studying Health System Change (HSC) and funded by the California HealthCare Foundation.

The key findings were:

In 2007, only 11 percent of American adults looked for a new primary care physician. In doing so, half relied on recommendations from friends and relatives, 38 percent relied on physician recommendations, and another 35 percent used health plan information.
When choosing specialists, nearly all consumers relied exclusively on physician referrals.
Use of online provider information ranged from 3 percent for consumers undergoing procedures to 7 percent for consumers choosing new specialists to 11 percent for consumers choosing new primary care physicians.
Very few of the 35 million adults who underwent a medical procedure used information other than the doctor’s referral in deciding where to seek care.

The bottom line: All the hoopla about consumer shopping and seeking out the bargains and best value for themselves, may be just that – hoopla.

How do all the Health 2.0 platforms launching into this area plan to change this ingrained consumer behavior?

There’s waste in the medical system–Duh!

Dec 3, 2008• 6

By Robert Laszewski

As we begin the health care reform discussion in earnest, many are pointing out all of
the waste in the system and the need to research what works best, provide the incentives to do it, manage the big spenders’ chronic care better, make better use of heath information technology, and encourage wellness and prevention.

One of the disadvantages of being at this for more than 20 years is that I feel like I’ve seen this movie a few times before. You may recall the picture "Groundhog Day" where the guy kept living through the same thing time after time.

I am particularly taken by those that cite the statistics regarding health care waste and efficiency as if this was a new discovery they made in the last few days.

For example, the excellent groundbreaking research from Dartmouth is often cited pointing to the conclusion that as much as 30% of all medical spending does nothing to improve care.

I can’t disagree with many of these conclusions having argued much the same myself.

Addressing an epidemic of overtreatment

Dec 3, 2008• 6

By John Halamka & Rich Parker

Health care costs in the U.S. are approaching 17 percent of the GDP and may be as high as 20 percent in the next few years.

What is causing the US to have the highest cost and lowest value for the healthcare dollar? Simple – it’s overtreatment.

Overtreatment
takes many forms – from over ordering expensive diagnostic tests to the
prescribing of expensive and sometimes unneeded therapeutics.

After 12 months of recession, whither health reform?

Dec 3, 2008• 1

By Jane Sarasohn-Kahn

We’re in a recession; actually, we’ve been in one for the past year, but no official agency decided to tell us. Perhaps "they" wanted to wait until after the November ’08 Presidential election?

The declaration of recession is the official news from The National Bureau of Economic Research (NBER), whose mind-numbingly-titled press release, Determination of the December 2007 Peak in Economic Activity, provides the following important details:

* The Business Cycle Dating Committee of NBER met by conference call on 11/28 to discuss whether the U.S. economy was in recession.

* The group figured out that the U.S. economy "peaked" in December 2007.

* They calculated that the 12/07 peak ended the economic expansion that started in November 2001, lasting 73 months.

* The previous expansion in the 1990s lasted 120 months (that would include, but not be limited to, The Clinton Era).

* Other measures of a declining economy — including personal income less transfer payments, real manufacturing and wholesale-retail trade sales, industrial production, and employment estimates based on the U.S. household survey — also peaked some time in the past 13 months.

Presidential Rx for Health

Dec 2, 2008• 4

By Susan Blumenthal and Yi-An Ko

Capital_2
Past U.S. presidents have provided innovative leadership that shaped the landscape for our national health and science institutions.

President Lincoln established the National Academy of Sciences. President Truman’s foreign policies inspired the creation of the United States Agency for International Development (USAID). President Lyndon Johnson signed legislation that established Medicaid and Medicare. And President Clinton signed legislation that created the State Children’s Health Insurance Program (SCHIP).

Currently, our country faces significant health challenges including skyrocketing health-care costs, declining funding for medical and scientific research, and a lack of effective coordination and innovation in the government’s response to emerging health threats such as obesity and pandemic flu. Addressing these issues must be a top national and foreign policy priority for the next administration. With transformational leadership, President-elect Barack Obama has the opportunity to build upon his predecessors’ legacies and write a new national prescription for improving the health of Americans.

Extracting more value from the health care dollar

Dec 2, 2008• 1

By Sarah Arnquist

Americans spend more money on health care than any other nation, but get far less in return, say multiple health care executives in Sunday’s Washington Post.

That’s not news to readers of this blog, but probably is not yet common knowledge among the general American taxpayer. That might change. The news media seems to be writing about this "value gap" more frequently, particularly in citing the growing momentum behind creating a center for comparative effectiveness research to evaluate drugs, devices and treatments to find out what works best.

Defining and measuring value is not easy, but increasingly public and
private health care purchasers are using their market power to demand higher quality care. Whether the science is
ready to support this "value-based purchasing" is the topic at the ECRI Institute’s annual conference today and tomorrow. (I’m attending the conference and will report on it tomorrow.)

More on the 5 myths of U.S. health care

Dec 2, 2008• 1

By Charlie Baker Charlie_baker

A good friend sent me a recent op-ed from the Washington Post that discussed the 5 myths of health care reform by Shannon Brownlee and Ezekiel Emanuel.

I’ve written about both of them before (here & here). Brownlee is a visiting scholar at the NIH’s Clinical
Center, and Emanuel is the chair of the Center’s Bioethics Department.
Ezekiel also happens to be the brother of incoming White House Chief of Staff Rahm
Emanuel’s. Hmmm…

Anyway, I really like most of what they have to say – which will
probably come as a surprise to them – and maybe to some of my
colleagues as well. Their five myths are, in no particular order…

1) America has the best health care in the world.

2) Somebody else is paying for your health insurance.

3) We would save a lot if we could cut the administrative waste of private insurance.

4) Health care reform is going to cost a bundle.

5) Americans aren’t ready for an overhaul of the health care system.

e-patient Dave & his e-doctor describe their journey in participatory medicine

Dec 2, 2008

By Sarah Arnquist

Over at the e-patients blog, blogger e-patient Dave has posted video clips from his presentation with Dr. Danny Sands at the Connected Health Forum last month at Harvard Medical School.

Dave describes the presentation called "Illness in the Age of ‘e’ " as a "full-length case study in participatory medicine." Here’s the first video clip. To see the rest go to the e-patients blog, where presentation slides are also uploaded.