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Above the Fold
Personal genetic companies back in service
Two direct-to-consumer genetic testing firms, 23andMe and Navigenics gained approval
from California regulators this week to continue providing clients access to and interpretations of their personal DNA.
The NY Times reports this morning that, "The licenses, granted to Navigenics and 23andMe, should help defuse a
controversy that began in June when the California Department of Public
Health sent “cease and desist” letters to the two companies and 11
others that offer genetic testing directly to consumers."
The news sparked a heated summer debate over whether consumers should have unbridled access to their DNA or whether a doctor should lead the process.
On Rural Doctoring: The Landscape
This is the first part of a series that first appeared on the blog Rural Doctoring, where Theresa Chan writes about her experience working as a family physician and hospitalist in a rural Northern California community.
I’ve been reading the blogs of medical students and residents with some interest lately. Their stories about the trials and tribulations of learning to stay awake night and day and how to deal with cranky attendings and even crankier patients take me back to the bad old days of my own residency.
I’ve also had a few glimpses of the osteopathic medical students (OMS) who are rotating in rural California as they assume their new roles as clinical learners. Hearing about and witnessing these experiences makes me reflect on my own training and the steps I took to become a doctor in a rural community. This post series will examine these steps in more detail, and I hope it will be helpful to trainees who are considering a career in rural health care.
Back-to-school specials at the retail clinic
People have begun to ration themselves off of medical visits and prescription drugs, according to the National Association of Insurance Commissioners (NAIC).
One in 5 Americans said they reduced visits to the doctor due to the slowing economy. One in 10 have reduced their prescription drug intake.
The NAIC found that 85 percent of Americans have made a change to their health insurance policy.
In related news, Take Care Clinics, part of Walgreens, is offering school and sports physicals for $25 to patients 18 months of age and older. The clinics will also certify that kids’ immunizations are up-to-date. The launch of this targeted service is well-timed for back-to-school physicals when pediatricians’ offices can be very busy in the weeks leading up to school starts. Take Care’s press release has been quick to point out that, "School and sports physicals at a Take Care Clinic do not take the place of a child’s yearly routine health exam and complete developmental assessment." Take Care has about 200 clinics in 14 states.
Health IT policy: the fur is flying
Some fur is flying in the rarefied world of health IT policy geeks this morning. Health Affairs has three articles. The first from Markle’s Carol Diamond, writing with Here Comes Everybody author and Internet guru Clay Shirky, more or less says that obsessive attention to rigid standards is not helping and actually may be hindering the IT adoption process. And yes, in case you were wondering they do mean CCHIT and ONCHIT’s current policies and agenda which has been going for four years and which they’re accusing of “magical thinking.” Instead, we need new policies which target desired outcomes measured in improved patient care, instead of assuming that creating new technology standards will get us there. And by policies I think they mean money, and its redirection by current payers. After all, if putting in a RHIO costs hospitals operating revenue in reducing admissions and tests, why would they do it?
Pay Doctors For the Value They Offer Patients
When Medicare first created a fee schedule, critics suggested that it was a Marxist invention. Nevertheless, the schedule, which lists what Medicare is willing to pay for some 7,000 procedures, has become the master list for physician reimbursement in our health care system: Most private insurers peg their payments to the Medicare schedule.
The notion of deciding the precise worth of some 7,000 diagnostic and therapeutic procedures is mind-boggling. How exactly does Medicare do it?
The process began in the late 1980s when officials at the Department of Health and Human Services decided that the way Medicare paid doctors should be overhauled. At the time, Medicare was reimbursing physicians based on what was considered “customary, prevailing and reasonable” in a particular market — in other words the “market value” of the service in that region.
Instead, reformers urged Congress to begin paying doctors in a way that reflected the real cost, to the doctor, of providing the service. (This is where Marx comes in: rather than letting the local market decide what a service is worth “the system appears to be based on the Marxist ‘labor theory of value,’” sputtered Susan Mandel in a 1990 piece in the National Review.)
Health care in the YouTube era
By Bob Wachter
August 11th was the 2nd anniversary of the epic implosion of George Allen’s presidential campaign, the first defeat at the hands of YouTube. Two recent videos of unattended patients dying in ER waiting rooms leave me wondering whether health care has also entered the YouTube era.
Remember the George Allen fiasco? A 20-year-old Indian-American named S.R. Sidarth, working for Allen’s opponent Jim Webb, was filming an Allen campaign stop in Breaks, Virginia. Twice, Allen pointed to him and called him “Macaca,” a racial slur meaning “monkey.” Once the video hit YouTube, it went completely viral (this clip, one of many, has been viewed 350,000 times) and Allen’s promising political career was toast.
What does this have to do with health care? In the past 18 months, two powerful, highly troubling videos have surfaced of patients being left to die in ER waiting rooms. The first, in May 2007, involved a woman named Edith Rodriguez. Rodriguez began vomiting blood while waiting outside the King-Drew ER, and soon collapsed. Rodriguez’s husband called Los Angeles’s 911 system, but got nowhere. Then someone else in the waiting room called:
Health care in the YouTube era
Video of the woman dying in the emergency room waiting room at Kings Hospital.
Connecting the dots between gas and health costs
Rite Aid, a top retail pharmacy chain, awarded its first Fill Up & Fuel Up gasoline gift cards this week.
I’ve been writing about gas ‘n health care since the inception of the Health Populi blog; see this inaugural post.
Now comes a pharmacy connecting the dots between consumer spending categories: the interdependency of fuel and prescription drugs.
As the differences between price tiers of prescription drugs have increased over the past ten years, I’ve often asked pharma clients the question: what is the consumer’s marginal value of that $20 (or $30 or $50) co-payment compared to something else on their shopping list — say, a new electric razor for their husband, or that $95 jar of anti-aging skin cream?
Health reform for ordinary folks
When it comes time to vote in November, will Americans know what they’re voting for in terms of their health care futures? Will they understand what Barack Obama or John McCain’s health proposals mean for them?
Over at Columbia Journalism Review, Trudy Lieberman says they won’t given the current media coverage of health reform. The journalism professor critiques the mainstream media’s coverage for basically
transcribing the candidates’ pitches, and says the blogosphere is overly wonky.
"Exactly how will all these economic and political calculations and
pronouncements affect those who struggle daily to fill their
prescriptions, find a competent doctor, or pay their medical bills?"
she asks. "These are the people whose stories the media have yet to
tell."
In a series called "Health Care on the Mississippi," Lieberman examines how the presidential candidates’ health proposals will affect ordinary folks.
In Part 1, she goes to Helena, Arkansas, a town of 6,300 along the Mississippi River to talk with the working-class residents about health care. Currently, most knew "nothing of the coming health care battle being waged in their name," she wrote.
In Part 2, Lieberman examines how Helena’s head jailer and his diabetic adult son would fair under McCain and Obama’s health plans.
