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Primary care crisis is HERE

Jul 21, 2008• 24

By Bob Wachter Robert_wachter

I recently heard from a UCSF physician who was flabbergasted when he sought an
appointment in our general medicine practice and was told it was “closed.” Turns out we’re not alone: there are also no new PCP slots available at Mass General. The primary care crisis has truly arrived.

I’ve written about the roots of the problem previously, and won’t restate the sad tale of woe. But I hope you’ll take the time to listen to two very powerful NPR reports on the topic – the first, a WBUR special by healthcare journalist Rachel Gotbaum called “The Doctor Can’t See You Now,” is the best reporting on this looming disaster I’ve heard (here is the MP3 and the show’s website). The piece is long (50 minutes), so I’ll summarize a few of its moments that really hit home.

First, it is true – MGH is not accepting any new primary care patients. Like UCSF, therefore, getting “a regular doctor” at MGH now takes the combination of cajoling, pleading, and knowing somebody generally referred to as “working the system.” In other words, the process of finding a primary care doc is now like getting a great table in a trendy restaurant. Obviously, this is horrible for patients, but it is also no fun for doctors. For example, in the NPR special, MGH’s director of Emergency Medicine laments:

“If you really want to give me heartburn, you can say, excuse me but I know you work at Mass General and I would like a primary care physician please.”

Determination of need rule only goes partway

Jul 21, 2008• 1

By Charlie Baker

Charlie Baker is the president and CEO of Harvard Pilgrim Health
Care, Inc., a nonprofit health plan that covers more than 1 million New
Englanders. Baker blogs regularly at Let’s Talk Health Care.

I usually spend some time throughout the year visiting with accounts, physicians, hospitals, and brokers (among others), just to hear what’s up and what’s going on. Earlier this week, I was out visiting the leadership at a community hospital in Massachusetts, and asked them if they appreciated the MA Department of Public Health’s (DPH) decision to require academic medical centers to prove they weren’t duplicating existing clinical services in the community when they opened new operations in the suburbs around Boston.

For the uninitiated, this issue has been percolating in Massachusetts for the past couple of years, as a number of well known teaching hospitals have broken ground on some pretty big outpatient facilities in the suburbs around Boston. The service suite in these places varies, but it’s basically day surgery, cancer treatment, cardiac care, high-end radiology, and assorted other high-margin outpatient services that many community hospitals in Massachusetts argue they were already doing, and may now lose to these new facilities.

Around the Web in 60 Seconds (Or Less)

Jul 21, 2008• 1

By THCB Staff

USA Today: Examines individual health policies and concludes they leave many behind.

USA Today: A record number of babies were born in the USA in 2007. Is this the next baby boom?

CNN: Teen pregnancies up for first time in 15 years.

NY TIMES: Paul Krugman predicts the doldrum economy to last many years and targets lack of universal health care as a reason.NY TIMES: David Brooks says we’re entering an era of "epic legislation" and health care is one of the areas where policy makers will redefine the landscape for future generations.

REUTERS: Family planning groups object to a Bush administration memo that
proposes to redefine abortion to include several types of
contraception, including birth control pills and intrauterine devices.

CNN: FDA lifts the safety ban on tomatoes.

WSJ Health Blog: California rulings against insurance rescissions could spread across the country.

HEALTHNEWSREVIEW: Journalistic hype of health news never stops, says Gary Schwitzer critiques as he critiques ABC’s claims about a "miracle drug" for Alzheimer’s. disease.

Marketplace: New magazine for “Amateuer Economists”

Jul 21, 2008

The online magazine Amateur Economists launched this month to explain the factors that influence how people and organizations make choices for non-economists.

The expert writers will explore current economic issues their respective fields, such as health care, law, politics, literature and art
and science and technology.

In "The Dismal Side of Health care" section, a physician and nurse discuss the latest issues affecting health care economics. In "Fictionomics," an English professor explores the subject of economics in fiction, and in "Economically Correct," a lawyer and law student look at the economics of laws.

Should a surgeon be punished for wrong-site surgery?

Jul 20, 2008• 6

By Paul Levy Surgeon

During these couple of weeks following our wrong-side surgery, a number of people
have asked me if we intend to punish the surgeon in charge of the case, as well as other people in the operating room, who did not carry out the expected time-out procedure.

My initial and immediate reaction has always been, "No, these people have been punished enough by the searing experience of the event. They were devastated by their error and distraught to think that they could have participated in an event that unnecessarily hurt a patient. The surgeon immediately reported the error to his Chief and to me and took all appropriate actions to disclose and apologize to the patient, as well as participate openly and honestly in the case review."

This reaction was supported by one of our trustees, who likewise responded, "God has already taken care of the punishment." But another trustee said that it just didn’t feel right that this highly trained physician, "who should have known better," would not be punished. "Wouldn’t someone in another field be disciplined for an equivalent error?" this trustee asked.

Birthing turf wars

Jul 18, 2008• 7

By Vijay Goel

This spring, the American Medical Association decided to support a legislation "that
helps ensure safe deliveries and healthy babies by acknowledging that the safest setting for labor, delivery, and the immediate post-partum period is in the hospital" or accredited birth center.

So the AMA is against ANY women choosing to give birth at home. This appears to be based more on turf management than evidence.

(The issue erupted following the release of the documentary, "The Business of Being Born," by former talk show host Ricki Lake in which she haves her baby at home. The American College of Obstetricians and Gynecologists and AMA publicly criticized Lake, who wrote about the ordeal last month for the Huffington Post.)

Governors saddled with health costs

Jul 18, 2008• 7

By Jane Sarasohn-Kahn

The National Governors Association (NGA) met in Philadelphia this week, where my City of Brotherly and Sisterly Love is witnessing some sobering discussions about health care.

On the one hand, Bill Clinton called in his opening keynote speech for the states to be laboratories of democracy.

But how much health-democracy can each governor afford when balancing their budget in the face of declining revenues? According to the NGA’s 2008 Fiscal Survey of the States, not a whole lot.

Investigative journalism is good for the nation’s health

Jul 18, 2008

By Sarah Arnquist

Despite seemingly never-ending reports of layoffs in American newsrooms, a new model of investigative journalism has emerged and health care falls squarely into its areas worthy of significant scrutiny. Propublica

ProPublica is a nonprofit, investigative journalism organization that launched this year with promises to focus its efforts on "truly important stories, stories with moral force." Its Web site is up and filled with great content, including a section on health and science.

The founders/funders of ProPublica — led by the Sandler Foundation — believe "investigative journalism is at risk," and are pioneering this new model. Paul Steiger, a former managing editor of The Wall Street Journal, is at the helm.

What does this have to do with health care? ProPublica has targeted health care as an area worthy of investigation. That’s evident by the recent recruitment announcement of Charles Ornstein and Tracy Weber from the L.A. Times.

AHIP starts smoking astroturf

Jul 17, 2008• 8

By Matthew Holt

Let’s say you ran a lobbying organization that may (or may not) be staring into a political storm. And say that you’d just lost a battle with opponents within the health care industry that you thought you’d won in 2003.

Now, say you “believe” that the 47 million people — who are uninsured in part (but to be fair, only in part) due to your members’ greed, political choices and incompetence over the years — represent a market for your members.

Say your organization had some members who could possibly adapt to a new world, where tightly regulated organizations were contracted under strict terms to provide care to the whole population in a social insurance scheme — with appropriate risk-adjustment and other mechanisms in place to promote the care management you say your members do so well.

And say then it had other members, who are mere sharks and who would go out of business the minute they were banned from cherry-picking only the best customers and selling them quasi-fraudulent products.

Is Meaningful Health Care (Or Any Other Kind Of) Reform Possible?

Jul 17, 2008• 27

By Brian Klepper

Those who wait, ever hopefully, for real health reform might want to take a deep breath and take stock of a few realities.First, think about the fact that when the Democrats retook Congress, they tweaked but did not fundamentally change the lobbying rules that trade money for influence over policy. In fact, most contributors have now adjusted their contributions to favor the current, rather than the past, majority party. As it turns out, Democrats, like Republicans, are only too eager to allow special interests to trump the common interest, so long as the transactions fetch a good price.