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Above the Fold

Friday frolicks in Nawlins

Jul 25, 2008• 4

By Matthew Holt

I’m in New Orleans taking the day off (shhh…wife is sleeping, don’t wake her yet!). Yesterday I gave a talk about Health 2.0 to a very confused looking group of state legislators at the National Conference of State Legislators.

But what was really confusing was the exhibit hall. There was a complete dogs breakfast of interest groups there. The NRA across from the Brady campaign to ban handguns; There were 4 or 5 variations of the humane society, and PETA had 2 booths, one explicitly about cruelty to elephants in circuses, and Barnum & Bailey/Ringling Bros also had a booth (presumably to try to stop legislators caring about cruelty to elephants). The oil & gas industry was next to a big booth of plug-in electric cars. All the right-wing think tanks (Cato, Heartland et al) were spread around, while the lefties (ACLU, Planned Parenthood, People for the American Way) were all sequestered in a ghetto. There were the correctional guys, the taser sellers, and about 4 booths selling ways to put alcohol breath locks on cars. Plus a bunch of companies selling micro-targeting marketing software—all used for targeting voters….not to forget the nudists—their trade association (who knew? or should that be, who nude?) was there and gave me a “naked-nation” pin. Not sure where I was supposed to pin it!

And of course the health care people were all there. Who knew that there are two different masseuse associations (with booths dead opposite each other), and of course the lab guys, the NPs, etc, etc were all there too. There was a mobile optometrists truck put on by an vision care insurer (VPS) which goes to under-served areas giving free eye exams and glasses.

Knol and web publishing challenge medical journals’ stronghold

Jul 25, 2008• 7

Robert_wachter By Bob Wachter

Yesterday, Google launched Knol, immediately branded as Google’s answer to Wikipedia. As health care adviser to the project, I’ll say a few words about Knol, but focus on how it – and other forms of electronic self-publishing – may signal the end of medical publishing as we have known it.

First, a word about Knol (the name is short for “a unit of knowledge”). Google’s vision is that providing a tool for people to write about “things that they know” will make the world a better place. Unlike Wikipedia’s anonymous, collaborative writing/editing process, Knols have authors, with names, faces, and reputations. (Authors can choose to have their identity verified, through a cross-check on their credit card or phone records.) Google provides Knolers a tool; authors enter their content and click “publish.” And poof, there it is, on the Web. Users can rate and comment on Knols, send them to friends, and suggest changes. But the author remains the sole owner of the content, able to update and modify it (or remove it) at any time.

Medicare Could Pave the Way for National Reform

Jul 25, 2008• 8

By MAGGIE MAHAR

Thanks the unbridled rise in health care prices, Medicare is going broke. As I mentioned in a recent post, four years ago the Medicare trust fund that pays for hospital stays started to run out of money. In 2004 the fund began paying out more than it takes in through payroll taxes.

Since then, the balance in the fund, combined with interest income on that balance, has kept the fund solvent. But in just 11 years, it will be exhausted,” the Medicare Payment Commission reported in its March. “Revenues from payroll taxes collected in that year will cover only 79 percent of projected benefit expenditures.” And each year after 2019, the shortfall will grow larger.

Make no mistake: this is not an example of an inefficient government program spending hand-over-fist without caring whether it is getting a bang for the taxpayer’s buck. As I discussed in that earlier post, health care prices have been climbing—without a concomitant improvement in patient outcomes or patient satisfaction—in the private sector as well.

Medicare Reform Could Pave the Way for National Reform

Before trying to roll out national health insurance, the next administration needs to address the structural problems that undermine the laissez-faire chaos that we euphemistically refer to as our health care “system.” Otherwise, we run the risk of winding up with a larger version of the dysfunctional, unsustainable system that we have today. Ideally, the administration should make Medicare reform a demonstration project for high quality, affordable universal coverage.

Century Foundation launches group to study Medicare reform

Jul 25, 2008

By THCB Staff

The Century Foundation announced this week the creation of a working group to create a blueprint for Medicare reform.

Maggie Mahar, award winning journalist, author of the HealthBeatBlog and regular THCB contributor, will direct the group of prominent physicians and health care experts.

Bob Wachter, another regular THCB contributor, UCSF physician and author of Wachter’s World, is also part of the eight-member working group.

The group’s blueprint will be based on recommendations in the Medicare Payment Advisory Commission’s 2007 and 2008 reports. Among the issues the group will review are:

Revising Medicare’s physician fee schedule to pay more for primary care, palliative care, and co-ordination and management of chronic diseases.

Rethinking Medicare’s fee-for-service system to reward doctors for quality, not volume.

Creating an independent Comparative Effectiveness Institute that reviews head-to-head testing of drugs, devices, and procedures to ensure that they are effective.

Identifying and rewarding hospitals that provide better outcomes and higher patient satisfaction at a lower cost while helping other hospitals meet benchmarks.

Around the Web in 60 Seconds (Or Less)

Jul 25, 2008

ABC: A Rhode Island man arrested this week for drunk driving had a potentially lethal blood-alcohol level at the highest ever recorded by police.

LA Times: Physicians and entrepreneurs team up to launch Medpedia — a Wikipedia for medical issues.

HC Finance News: HHS doles out $49 million to state high-risk pools.

Plain Dealer: AHIP launches astroturf campaign in Cleveland called a "Campaign for an American Solution." Members of Health Care for All protested outside.

Wash Post: Some doctors and hospitals are trying to go green.

LA Times: Medicare Part D a boon to drug companies.

Medicine meets Wiki

Jul 24, 2008• 2

By Jane Sarasohn-Kahn

There’s a new wiki in the health social media town, Medpedia.

Among the most popular online sources for health information is Wikipedia. Millions of people search Wikipedia daily for insights into medical conditions, drugs, and procedures. Medpedia estimates it will cover information on at least 30,000 conditions/diseases and 10,000 drugs.

Now comes the announcement of a sharply-focused wiki from the most credible of academic health institutions: Harvard, Michigan (my alma mater), Stanford, UC-Berkeley, and a host of other highly-branded health associations and stakeholders including the NIH, the CDC, and the FDA.

Sharing more than they intended — future doctors on Facebook

Jul 24, 2008• 7

By Sarah Arnquist

The Facebook/MySpace generation is now graduating from medical school, and their
profiles along with much embarrassing personal information has been indexed in cyberworld for many to see.

The Associated Press wrote an interesting story about how researchers from the University of Florida combed through the social web sites and found embarrassing pictures of future doctors “grabbing their breasts and crotches or posing with a dead animal. They also found many photos of students drinking heavily.”

About half of the medical students they looked at had Facebook pages but only 37 percent of those limited viewership.

Clearly, the take-home message is to refrain from putting things you wouldn’t want your mother to see on your profile and to restrict who can see your profile.

Still, the info is out there. Perhaps, doctor rating sites could incorporate this readily accessible information onto their physician profiles. That would be scary.

Communication 101: Shedding power imbalances to protect patients

Jul 24, 2008• 2

By Katie Fiebelkorn Westman

Katie Fiebelkorn Westman is a registered nurse at an acute care hospital in the Minnesota Twin Cities. She is working toward a clinical nurse specialist degree, focusing on improving patient care quality.

The Joint Commission’s recent sentinel event alert on the detrimental affects of ineffective communication between caregivers prompted me to examine the communication I see daily in the hospital.

The dearth of effective communication skills is not limited to the health care profession — we just have bigger consequences when we get things wrong. Someone in another profession may run a report incorrectly and be annoyed to have to redo it, but in health care, we can take off the wrong body part, give the wrong medicine, or send someone home with the wrong discharge instructions.

These mistakes are big deals. We need, as healthcare providers, to respect each other, our different points of view, and learn how to talk.

California kids may face triple whammy, leading to more uninsured

Jul 24, 2008• 4

By Sarah Arnquist

After years of seeing decreasing numbers of uninsured children, California is poised to go the other direction.

For years, child enrollment in private health insurance plans decreased as companies scaled back on health care costs by increasing employees’ share of the premiums or by stopping dependent coverage altogether.

But those declines were offset by increased enrollment in public programs. Recognizing that half the uninsured children already qualified for Medi-Cal (California’s version of Medicaid), and Healthy families (the
state’s SCHIP program), school districts and advocates focused efforts on finding and enrolling those children.

But now, things aren’t looking so rosy. State and county budgets constraints threaten to erode the children’s enrollment gains in
Medi-Cal, Healthy Families and Healthy
Kids programs, county-organized health plans.

"Come next spring, you could have a double or triple whammy of kids
losing health coverage," said Joel Diringer, a consultant who helped
many California counties create the local programs.