January 15th, 2010 § 0
Profound, simple, and unknown:
It’s because we cleaned our water, developed vaccines, and invented antibiotics. We saved the children, and now modern medicine is flailing around selling relative snake oil to now try and save the old people who’ve terrorized their bodies since surviving childhood.
Full post by Jay Parkinson here.
November 3rd, 2009 § 0
The Dartmouth Atlas, relatively unknown to the general public, has been whispered about for decades in health care circles. It sees the light of day now:
A provision in the House health care bill, included over the objections of hospitals from New York and other cities, would order a neutral group, the Institute of Medicine, to conduct a two-year study of regional variations in Medicare spending. The bill requires the institute to recommend changes that would reward “quality and value,” and those changes would take effect automatically unless Congress objected by May 31, 2012.
This is certainly controversial and attacks have begun on the validity of the data showing major differences in costs across all regions of the U.S. for similar procedures. This is an effort to reign in those costs in high-spending hospitals.
The CEO of Beth Israel rationally thinks through the issues, especially that of patient noncompliance, which everyone health care facility suffers regardless of region.
“I don’t dismiss the Dartmouth study out of hand,” said Stanley Brezenoff, chief executive of Continuum Health Partners, parent company for major New York hospitals like Beth Israel Medical Center and St. Luke’s-Roosevelt Hospitals. “What I’m saying is there may be explanations that go beyond the simple explanation of overutilization.”
“I now have my people poring over readmissions,” he said. “What we’re discovering are things like individuals don’t take their medications, and you ask yourself what it is that we as a hospital could do to deal with that.”
October 26th, 2009 § 0
The NYTimes article last week talked about President Obama’s attack on the health insurance industry. Here’s why it happened:
The report, issued by America’s Health Insurance Plans, concluded that premiums would rise 18 percent more under provisions of a Senate bill than they would otherwise in the next decade, to an average of nearly $26,000 for families and $9,700 for individuals in 2019.
Obama’s charged response:
“It’s smoke and mirrors,” Mr. Obama said. “It’s bogus. And it’s all too familiar. Every time we get close to passing reform, the insurance companies produce these phony studies as a prescription and say, ‘Take one of these, and call us in a decade.’ Well, not this time.”
Rather than trying to curb costs and help patients, he said, the industry is busy “figuring out how to avoid covering people.”
“And they’re earning these profits and bonuses while enjoying a privileged exemption from our antitrust laws,” he said, “a matter that Congress is rightfully reviewing.”
More politics. The David and Goliath game continues and you’re never sure who represents which side. It’s as confusing as health care reform itself. I publish a newsletter to try to make sense of it anyhow.
Joe Paduda of Managed Care Matters clarifies the details of the exemption from anti-trust regulations here, and here is Jay Parkinson’s take on the issue.
October 19th, 2009 § 1
Richard Smith from Patients Know Best after finally getting online access to his medical record:
It was an anticlimax. My records contain almost no information about me. You’d have no idea from these records who I was, what I did, what I thought, or what I care about. You’d know more about me after two minutes on the world wide web than you would from reading everything in my medical record.
Even if the appropriate documentation were available, asymmetry of information – the gap of knowledge between patient and physician – would prevent meaningful understanding of what had been written. Perhaps wiki links, clinical translation services, or changes in the way medical students learn to document may help.
Medical records tend to be disjointed. Linkages between labs ordered, results, the reading physician’s assessment and the attending physician’s follow-up don’t flow as a stepwise event. Without sequential order it’s difficult to tell where the gaps are and who might have dropped the ball.
And some of the most important information was wrong. It said that I took no drugs, and I do: I take the five ingredients of the polypill. These were prescribed by a cardiologist not the GP, but he had written to the practice. Unsurprisingly the information hadn’t made it into my notes.
Currently, healthcare is in the adoption phase of simply getting medical records online. Data is sorely needed, though challenges still exist to make effective use of that data.
October 15th, 2009 § 0
The New England Journal of Medicine’s perspective on payment reform:
Care management, with its cost-reducing potential, will not spread widely in the health care system without substantial changes in payment policy. If hospitals profit from unnecessary readmissions, they are unlikely to adopt effective hospital-to-home care-management programs. If primary care practices are not reimbursed for the work of a registered-nurse care manager, they will not hire one unless they share in the savings generated by reducing hospital admissions and emergency department visits. Other obstacles include nursing shortages and the paucity of training programs for nurses to become effective care managers.
Current financial incentives sometimes create less revenue for better care. In a fee-for-service (FFS) system, rework (i.e. unnecessary readmissions) can be profitable because providers are paid per visit, not a cumulative clinical episode.
The first line of the article cites a stat noted often that deserves reiteration:
In the United States today, 10% of patients account for 70% of total health care expenditures. Many patients who require high-cost care are people with multiple chronic conditions, many medications, frequent hospitalizations, and limitations on their ability to perform basic daily functions due to physical, mental, or psychosocial challenges.
Chronic disease, such as congestive heart failure, diabetes, and coronary artery disease commonly occur in the elderly (though in the case of diabetes that is quickly changing). This sector of the population is also growing faster than any other.
Cost reform must be strategic and piece by piece unravel the complex knot that now represents the US health care system.
