Health and Medical News and Resources

General interest items edited by Janice Flahiff

[Reblog] The hospital that will remain nameless

One person’s journey through an unhealthy health care system.  Definitely not patient centered. Have had similar insurance problems, mostly because of errors in the insurance company erring in my personal identifiers.

From the 19 February 2015 item  By LISA SUENNEN at The Health Care Blog

Let me start this story by telling you the end: I am just fine. For those of you who like me, there is nothing to worry about and all is well. For those of you who don’t like me, sorry to disappoint you, but you’re stuck with me for a while.

I’m telling you these things—news to make you happy or disappointed, depending on your point of view about me—because this story is about my recent trip to the hospital, an unexpected journey that I wasn’t sure I was going to talk about publicly.

And from one of the comments…

William Palmer MD says:

You sound true and authentic to me too. I am embarrassed as to how often we do screw up. The only excuse I think is that we have so much internal and external regulation that we become nervous nellies, unable to relax and enjoy what we are doing. You should go to a Pharmacy and Therapeutics meeting in a hospital and listen to the barrage of complaints from everyone to everyone. Wrong dose, wrong timing, wrong drug, wrong patient. I have walked out of these meetings because of the hostility. We would all do better if we could start some little village clinic in the Congo, without the interminable watching from a thousand eyes.

February 22, 2015 Posted by | health care | , , , , , , , , | Leave a comment

[Reblog] John A. Rich: Black men, trauma, and nonviolence

From the 21 February 2015 item by Teagan Kuruna (the MPH formerly known as Teagan Keating)

…While at Boston City Hospital, [Dr.] Rich saw a steady stream of young Black men come through the emergency room with stabbing and gunshot wounds. He also began to realize that everyone, including the other medical staff, saw these men as perpetrators rather than victims. The general consensus was that these men had done something to get themselves injured instead of what was obvious to Rich: these young Black men were truly victims.

Because of his compassionate streak, Rich began interviewing these men to learn more about their lives and what led to them returning to the ER over and over. He learned that the injuries that brought them to him were often due events outside their control–a robbery, a few wrong words to the wrong person, a simple accident that escalated to violence. After talking with them as they received treatment, Rich realized that the men were suffering from post-traumatic stress syndrome. Even worse, their injuries were stitched up and they were sent right back out to the same environment that brought them to the ER.

Rich wrote a book about these experiences called Wrong Place, Wrong Time: Trauma and Violence in the Lives of Young Black Men.

February 22, 2015 Posted by | health care | | Leave a comment

[Reblog] A problem with precision medicine: It’s not quite precise – at least not yet

From the 20 February 2015 post by Joseph Burns at Covering Health (Association of Health Care Journalist)

geneinchromosome

At a conference last year, Michael Laposata, M.D., Ph.D., one of the nation’s best known pathologists, explained how clinical laboratories could deliver more value to patients, physicians, and health insurers. To do so, pathologists and laboratory scientists need to provide more detailed explanations about lab test results because even physicians who order genetic and molecular tests are often confused about the results, said Laposata, chairman of the Department of Pathology at the University of Texas Medical Branch.

When he explains test results to ordering physicians, he frequently refers to an “allele” which is one of two or more versions of a gene, he said. When he does, physicians sometimes ask, “What’s an allele?”

His anecdote is telling following President Obama’s announcement last month that he recommended spending $215 million on the precision medicine initiative. The announcement was correctly hailed as an important and needed investment in medical technology. “Precision medicine” is described by the National Institutes of Health as “an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment, and lifestyle for each person.”

Given that there is and will continue to be a lot of hype about precision and personalized medicine, we may want to check our expectations, because the hurdles are daunting, as Tabitha M. Powledge wrote for the Genetic Literacy Project. “The plan embodies a wonderfully human let’s-climb-Everest-because-it’s-there aspiration. But you also have to wonder about the practicality of such a sweeping program,” she explained.

There is not much good, proven, scientific, medical uses for what we’re talking about as personalized or precision medicine,” Greely said. “And yet, we … sell and we hype as if there is much more.”

“Here’s the problem: because personalized medicine is in the realm of OMG-that’s-too-complicated science, the usual watchdogs don’t see it. Plus the big academic medical centers love the grants that it generates.”

Even health insurers are struggling to understand the full implications of genetic and molecular testing…

 

Related article

Precision medicine to prevent diabetes? Researchers develop personalized way to steer prevention efforts

February 22, 2015 Posted by | health care | , , , | Leave a comment

[Reblog] Could mHealth Apps Be a Reprise of the EHR? The Need For Clinician Input

From the 14 February 2014 item at The Health Care Blog

……

“…. many app developers have little or no formal medical training and do not involve clinicians in the development process and may therefore be unaware of patient safety issues raised by inappropriate app content or functioning.”

Without the insights of seasoned real-world doctors and nurses, apps could end up with the same safety issues that are plaguing electronic health records, many of which were also developed with little regard to physician or nurse input.

In other words, just because it’s a “health” app doesn’t mean its necessarily so.

February 15, 2015 Posted by | health care | , , , , , , , | Leave a comment

[Report] Incarceration’s Front Door: The Misuse of Jails in America

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Among other issues, this is definitely a mental health concern. As quoted above, Serious mental illness affects men and women in jail at rates four to six times higher in the general population.

Excerpts….

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February 15, 2015 Posted by | health care, Psychiatry | , , , , | Leave a comment

[Reblog] The high cost of free check-ups

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Bill Branson (Photographer)

http://commons.wikimedia.org/wiki/File:Doctor_consults_with_patient_(7).jpg

From the 14 February 2014 post at The Health Care Blog

 

flying cadeuciiA predictable irony of the never-ending Affordable Care Act (ACA) debate is that the one provision that the Republicans should be attacking — free “checkups” for everyone — is one of the few provisions they aren’t attacking. Why should they attack them? Simple — checkups, on balance, are worthless. Why provide a 100 percent subsidy for a worthless good? Where is the GOP when you need it?

How worthless are checkups? Dr. Ezekiel Emanuel — one of the architects of the ACA and its “free” checkup centerpiece — recently recommended not getting them. As if “free” is not cheap enough, the ACA also pushes ubiquitous corporate wellness programs, which often pay employees to get checkups — or fine them if they don’t. This policy establishes a de facto negative price for millions of workers, making checkups the only worthless service on earth that one could get paid to utilize.

Those economics of a “negative price” trump Dr. Emanuel’s advice, and have made preventive care the fastest-growing component of employer health spending. Though hard statistics on checkups themselves are elusive, Dr. Emanuel estimates about 45-millon adult checkups are conducted each year, the equivalent of roughly 8 percent of America’s PCPs doing nothing but checkups, a curious use of their time when experts say the country could soon face a shortage of PCPs.

Shortage or not, subsidies and incentives might make economic sense if checkups improved health. However, when generally healthy adults go to the doctor for no reason, just the opposite is true: the Journal of the American Medical Association (JAMA) supports Dr. Emanuel assertion that annual checkups for asymptomatic adults are at best worthless, saying that additional checkups are “not associated with lower rates of mortality” but “may be associated with more diagnoses and more drug treatment.”

The solution to this orgy of overscreening and overdoctoring is remarkably simple: remove the ACA provision that makes annual checkups automatically immune from deductibles and copays; if they are going to be free at all, it should only be every few years. The proposal could still allow employers to override this provision — and even to attach money (incentives and penalties) to checkups — if they are willing to summarize the above-cited clinical findings for their employees.

If the only way they can continue the subsidy is by summarizing the literature, corporate human resources departments would predictably and immediately curtail this expensive corporate medical campaign. That would free up PCP time to work with patients who actually need medical care, while reducing counterproductive and costly healthcare utilization by those who do not.

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February 15, 2015 Posted by | health care | , , , , , , , , , | Leave a comment

[Reblog] Will Getting More Granular Help Doctors Make Better Decisions?

Will Getting More Granular Help Doctors Make Better Decisions?

Excerpt (longish post)

But, there are many things that data will never do well.  For certain things, physician heuristics may lead to better decisions than any predictive model.

Heuristics are shortcuts, based on experience and training that allow doctors to solve problems quickly.  They are pattern maps that physicians are trained to recognize. But, heuristics have a reputation for leading to imperfect answers: Wikipedia notes that heuristics lead to solutions that “(are) not guaranteed to be optimal, but good enough for a given set of goals…. (they) ease the cognitive load of making a decision.”  Humans use them because we simply can’t process information in sequential binary fashion the way computers do.

It would be a mistake to call heuristics a sad substitute for big data.  Some cognitive scientists have made the argument, and I think they’re right, that heuristics aren’t simply a shortcut for coming to good-enough answers. For the right kinds of problems, heuristically generated answers are often better than the those generated by computers.

How can this be?

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I often think of the following cartoon in Randall Munroe’s superb recent book, What If? Serious Scientific Answers to Absurd Hypothetical Questions.  In trying to compare human and computer thinking, he rightly notes that each excels at different things.  In this cartoon, for example, humans can quickly determine what they thought happened.  Most people can tell you that the kid knocked over the vase and the cat is checking it out, without going through millions of alternate scenarios.  Monroe notes that most computers would struggle to quickly come to the same conclusion.

So, from the perspective of an emergency doctor, here are the three leading problems with the applied use of complex analytics in the clinical setting:

  • 1. The garbage in, garbage out problem.  In short, humans regularly obfuscate their medical stories and misattribute causality. You need humans to guide the patient narrative and ignore red herrings.
  • 2. If we want to be able to diagnose, screen and manage an ER full of runny-nosed kids with fevers, we simply can’t afford the time it takes for computers to sequentially process millions of data points. The challenge is at one simple and nuanced: allowing 99% of uncomplicated colds to go home while catching the one case of meningitis. It’s not something that a computer does well: it’s a question of balancing sensitivity (finding all true cases of meningitis among a sea of colds) and specificity (excluding meningitis correctly) and doctors seem to do better than computers when hundreds of cases need to be seen a day.
  • 3. There is a problem with excess information, where too much data actually opacifies the answer you’re looking for. Statisticians call this “overfitting” the data. What they mean is that as you add more and more data points to an equation or regression model, the variability of random error around each point gets factored in as well, creating “noise”. The more variables, the more noise.

The paradox is that ignoring information often leads to simpler and ultimately better decisions.

February 10, 2015 Posted by | health care | , , , , , , | Leave a comment

[News article] New ‘smart bandages’ for burn victims and others

From the February 2015 Science 360 news article

TODAY’S VIDEO New ‘smart bandages’ for burn victims and others

http://c.brightcove.com/services/viewer/federated_f9?isVid=1&isUI=1

Some bandages are embedded with medicine to treat wounds, but researchers at Harvard University and Brigham and Women’s Hospital have something much more sophisticated in mind for the future of chronic wound care. With support from the National Science Foundation, engineer Ali Khademhosseini and a multidisciplinary team are bringing together advances in sensors, biomaterials, tissue engineering, microsystems technology and microelectronics to create “smart bandages” for wounds that require ongoing care, such as burns, diabetic ulcers and bed sores. The new devices, known collectively as flexible bioelectronics, will do much more than deliver medicine. They will be able to monitor all the vital signs of the healing process, such as oxygen levels and temperature, and make adjustments when needed, as well as communicate the information to health professionals who are off-site. To fulfill the critical need for flexibility, the team is testing new materials, such as a hydrogel that would cover a wound with just the right amount of stretch to be comfortable.

Provided by the National Science Foundation
Runtime: 3:08

February 10, 2015 Posted by | health care | , , , | Leave a comment

[Reblog] False Positives and Real Dollars: Why $88 won’t effectively screen for lung cancer

 

On a related note, during Peace Corps training in Nashville (1979) I came down with a bad cough, often coughing for 5-10 minutes at a time. Don’t think the rainy weather and me going around with an umbrella or raincoat helped. Anyways, was sent to an area doctor and after a few tests, told me and the Peace Corps staff not to be concerned. Just a dormant fungus (and I do live a bit north of the Ohio River Valley). Anyways, after a few days in Monrovia, Liberia (6 am temps of about 85), I stopped coughing.

PS We were boarded in motels. One late night was awakened by a few young men  in the group coughing loudly and giggling outside my window. Chalk it up now to some late night drinking and the men still being, well, young.

On another note, my husband quit smoking back in the 80’s after about 25 years of smoking. He had a lung X-ray and a dark spot on the lungs was noticed. He had quit smoking the month before. So now I’m wondering…cancer or fungus? He has not had any firm diagnosis of cancer since.

Beschreibung: Konventionelles Röntgenbild des ...

Beschreibung: Konventionelles Röntgenbild des Thorax (der Lunge) mit rundlicher Verdichtung in der linken Lunge Quelle: selbst erstellt –Benutzer:Lange123 17:18, 11. Nov. 2004 (CEST) (Photo credit: Wikipedia)

From the 9 February 2015 article By MATT HAWKINS, MD at The Health Care Blog

…Histoplasma capsulatum is a fungus endemic to the Ohio and Mississippi River Valleys.  It is everywhere.  You get it by breathing.  Prior studies suggest that >80% of those living in these regions have contracted the fungus.  The majority of people with histo don’t get sick.  But – they get lung nodules.  Lots of them.  The nodules are benign but often indistinguishable on imaging from “early” lung cancer.

The entrepreneurial owners of the pictured urgent care center likely know this.  They also know that Medicare and other carriers have limited coverage (reasonably so) to patients between the ages of 55 and 74 with at least a 30 pack year history of smoking.  If patients have quit smoking, they must have quit within 15 years to be eligible for coverage.  At first glance, it may seem like offering cheap, $88 screening for Americans ineligible for lung cancer screening coverage, or those eligible citizens too busy to get a physician order for a screening exam, is a good deed.  But, $88 is just the tip of the iceberg.  Additional screening exams and subsequent procedures/biopsies will all incur additional costs.

Our collective fear of malignancy, the unfortunately high frequency of lung cancer, and the promise of low dose CT screening for this disease will drive people outside of the NLST’s strict inclusion criteria into these low-cost, high-volume CT-scanning conveyor belts to “catch the cancer early.”

And what will they find in the Ohio River Valley?

Lots and lots of lung nodules.

The markedly increased propensity of patients in this region to have pulmonary nodules is likely to lead to an increased number of image-guided and open surgical biopsies (when the image-guided biopsy provides insufficient tissue for analysis).  More invasive procedures will naturally lead to more cost-inducing complications (such as pneumothorax and pulmonary hemorrhage) and, in some instances, death.

….

 

 

 

February 10, 2015 Posted by | health care | , , , , | Leave a comment

[Report] Report Will Aid in Detecting, Diagnosing Cognitive Impairment

From the 5 February 2015 post at The Gerontological Society of America

 

For Immediate Release
February 6, 2015
Contact: Todd Kluss
tkluss@geron.org
(202) 587-2839

A new report from The Gerontological Society of America’s Workgroup on Cognitive Impairment Detection and Earlier Diagnosis outlines a course of action for increasing the use of evidence-based cognitive assessment tools as part of the Medicare Annual Wellness Visit (AWV).

The AWV was established by 2010’s Affordable Care Act to allow Medicare beneficiaries to receive preventive and assessment services during visits with their primary care providers. And although detection of cognitive impairment is among the required AWV services, no specific tools are mandated and no data are available regarding tools used for this purpose.

The new report outlines a plan for addressing this shortcoming and shows how increased detection leads to earlier and optimal diagnostic evaluation, referral to post-diagnosis support and educational services in the community, and ultimately to improved health-related outcomes and well-being for Medicare beneficiaries with diagnosed dementia and their families.

“The Medicare AWV offers a universal opportunity for primary care providers to start a conversation with older adults and their families about cognitive changes that might be worthy of further investigation,” said Richard Fortinsky, PhD, chair of the workgroup. “Our workgroup’s report provides guidance for providers so they can start this conversation and, as appropriate, employ evidence-based assessment tools to detect cognitive impairment.”

The report is available at www.geron.org/ci. The website also contains a link to a companion webinar held in January, led by workgroup members Katie Maslow, MSW, and Shari M. Ling, MD.

“Increased detection of cognitive impairment is essential for earlier diagnosis of Alzheimer’s disease and related dementia — and also earlier diagnosis leads to more timely linkage of older adults and their families with community-based services and supports,” Maslow said.

In the report, the workgroup outlines a recommended for four-step process achieving its goals.

Step 1 is to kickstart the cognition conversation. To increase detection of cognitive impairment and promote earlier diagnosis of dementia in the Medicare population, the GSA workgroup endorses that primary care providers use the AWV as an annual opportunity to kickstart — that is, to initiate and continue — a conversation with beneficiaries and their families about memory-related signs and symptoms that might develop in older adulthood.

Step 2 is to assess the patient if he or she is symptomatic. The GSA workgroup endorses use of a cognitive impairment detection tool from a menu of tools having the following properties: it can be administered in
five minutes or less; it is widely available free of charge; it is designed to assess age-related cognitive impairment; it assesses at least memory and one other cognitive domain; it is validated in primary care or community-based samples in the U.S.; it is easily administered by medical staff members who are not physicians; and it is relatively free from educational, language, and/or cultural bias. The report provides a list of tools that may be suitable for this purpose.

Step 3 is to evaluate with full diagnostic workup if cognitive impairment is detected. The GSA workgroup recommends that all Medicare beneficiaries who exceed threshold scores for cognitive impairment based on the cognitive assessment tools used in step 2 undergo a full diagnostic evaluation. Numerous published clinical practice guidelines are available to primary care providers and specialists to help them arrive at a differential diagnosis.

Step 4 involves referral to community resources and clinical trials, depending on the diagnosis. The GSA workgroup recommends that all Medicare beneficiaries who are determined to have a diagnosis of Alzheimer’s disease or related dementia be referred to all appropriate and available community services to learn more about the disease process and how to prepare for the future with a dementia diagnosis.

“The GSA workgroup views this suggested four-step process as a framework for communicating with a wide variety of stakeholders about the critical importance of incorporating cognitive impairment detection into everyday clinical practice with older adults,” Fortinsky said. “We look forward to building on this report by helping to plan additional activities intended to disseminate and implement the report’s recommendations in communities throughout the country.”

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The Gerontological Society of America (GSA), the nation’s oldest and largest interdisciplinary organization devoted to research, education, and practice in the field of aging. The principal mission of the Society — and its 5,500+ members — is to advance the study of aging and disseminate information among scientists, decision makers, and the general public. GSA’s structure also includes a policy institute, the National Academy on an Aging Society, and an educational branch, theAssociation for Gerontology in Higher Education.

 

February 7, 2015 Posted by | health care | , , , | Leave a comment

[Reblog] Glass Half Empty? Half Full? Shattered?

From the 5 February 2015 post By JACK COCHRAN, MD  and CHARLES KENNEY at The Health Care Blog

Technology occupies an unusual place in health care. Some people say that electronic health records are clumsy barriers between patients and their doctors. Others suggest that technology is a kind of secret sauce.

In many places physicians and other clinicians are stymied by awkward technology. In other organizations — Kaiser Permanente included — electronic health records enable some of the finest individual and population health care ever.

This humorous equation speaks volumes about technology and health care:

NT + OO = COO

New technology + old organization = Costly old organization. In other words, technology doesn’t change an organization. Change is about leadership and culture. It is about thinking in new ways and asking new questions.

For example, rather than ask how many patients can you see, let’s ask how many patients’ problems can you solve?

Instead of asking how can we convince patients to get required prevention, let’s ask how can we create systems that significantly increase the likelihood that patients get required prevention?

Instead of asking how often should a physician see a patient to optimally monitor a condition, let’s ask what is the best way to optimally monitor a condition?

When we begin asking these kinds of questions, we see technology as a tool — not a solution by itself, but as a powerful tool we can use to deliver better individual and population care. Technology, like data, is only useful when it enables clinicians and teams to work effectively to provide the highest quality care for patients.

Read the entire post here

February 6, 2015 Posted by | health care | , , , | Leave a comment

[Report] Rising consumerism: Winning the hearts and minds of health care consumers

From Deloitte Review 16 WRITTEN BY Sheryl Coughlin, Jeff Wordham & Ben Jonash, 26 February 2015

The intersection between rising consumerism and a growing retail orientation in the health care sector presents challenges, some unprecedented, for existing players. We explore three shifts that health industry players should respond to, and that can set the scene for greater consumer involvement.

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Matching a buyer with a seller. On Angie’s List it’s simple: Consumers search, select, and schedule the services that fit their needs.

Could it ever be that easy in health care?

The cost of health care is high and rising. For the past 10 years, health care costs have exceeded US economic growth by an average 2.5 percent annually. The anticipated average annual growth rate of health care costs is 5.7 percent per year through 2023, well above gross domestic product (GDP), average wages, and productivity gains.1 Improving economic conditions, the impact of the ACA’s insurance coverage expansions, and an aging population are expected to drive health care expenditure growth.2 Average annual growth of out-of-pocket health care expenditure is projected to rise to 5.5 percent by 2023 from 3.2 percent in 2013.3

The health care system in the United States is edging toward a recalibration. Existing business models are being challenged to find and deliver new sources of value and to develop innovative approaches to make health care less complicated, and to improve outcomes:

  • Health care is moving toward value, not volume, as a central organizing principle. That impacts how patients are cared for, how physicians and hospitals are paid, and how life sciences companies approach the market.

  • Those paying the bills—employers, government, health plans, and increasingly, individuals—are looking for better value and better outcomes.

  • Entrepreneurs, retail organizations, and communications and technology companies see opportunity in the large and growing health care market. Taking advantage of developing trends, they are slipping across the industry’s increasingly permeable boundaries.

Read the entire review here

February 6, 2015 Posted by | health care | , , , , | Leave a comment

[Reblog] Discount drug pricing: Cutting through the controversy

From the 4 February 2015 article through the Association of Health Care Journalists

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Independent journalist Lola Butcher reports that debate about the government’s 340B Drug Pricing Program continues to build as the program expands.

“Like all good controversies, this one has enthusiastic advocates and wild-eyed opponents, and it’s easy to get snagged by the passion of the partisans,” she writes in a new tip sheet.

The program, which started in 1992, requires pharmaceutical companies to sell outpatient drugs to eligible health care organizations at significantly reduced prices.

Over the years, the eligibility criteria to participate has expanded repeatedly. Currently, safety-net hospitals, children’s hospitals, critical access hospitals, federal health centers and other organizations are eligible; organizations that fall into those categories must register and enroll in the 340B program.

Butcher, as a 2014 AHCJ Reporting Fellow on Health Care Performance, wrote about the migration of cancer care from physician-owned clinics and community centers to hospital outpatient departments. She found that the 340B program helped fuel that trend.

In this tip sheet for reporters, she explains the program, including the program’s winners and losers, how much money is involved and story ideas.

 

February 5, 2015 Posted by | health care | , | Leave a comment

Surgical metrics do not provide a clear path to improvement

Surgical metrics do not provide a clear path to improvement 

From the 4 February 2015 Mayo Clinic press release

PHOENIX – While surgical outcomes have improved nationally over time, surgical outcome reporting does not necessarily lead to better outcomes, according to a Mayo Clinic study published this week in the Journal of the American Medical Association.

Systems that capture, analyze, and report surgical outcomes are an increasingly important part of the quality improvement movement in health care in the United States.  Within the U.S., the most widely used surgical outcomes reporting system is the National Surgical Quality Improvement Program (NSQIP), which is coordinated through the American College of Surgeons.

The study analyzed data regarding surgical outcomes — complications, serious complications, and mortality — in over 345,000 patients treated between 2009 and 2013 at academic hospitals throughout the United States.  Of these patients, approximately half were treated at hospitals that participated in the NSQIP.  The study showed that surgical outcomes significantly improved overall in both study groups during the period of analysis.

“In our study we weren’t interested in whether patients had better outcomes in NSQIP vs. non-NSQIP hospitals,” says David Etzioni, M.D., chair of Colorectal Surgery at Mayo Clinic in Arizona and the study author. “We wanted to know whether the outcomes experienced by patients treated at NSQIP hospitals improved, over time, in a way that was different from patients treated at non-NSQIP hospitals.”

The study found no association between hospital-based participation in the NSQIP and improvements in postoperative outcomes over time, suggesting that a surgical outcomes reporting system does not provide a clear mechanism for quality improvement.  According to the research team, the failure of these types of outcomes monitoring systems to produce measurable improvements in outcomes may be related to difficulties in identifying mechanisms that translate reports into changes in how surgical care is provided.

“I think if there is one lesson that we have learned at Mayo Clinic; real quality is achieved through a system — not just a doctor, not just a nurse or other staff,” Dr. Etzioni says. “All of these elements of care have to work together closely to provide patients with the best possible outcomes.”

February 5, 2015 Posted by | health care | , , , , | Leave a comment

[Press release] Care of patients prior to making a diagnosis rarely assessed by quality measures

Care of patients prior to making a diagnosis rarely assessed by quality measures

From the 3 February 2015 press release

An examination of process measures endorsed by the National Quality Forum finds that these measures focus predominantly on management of patients with established diagnoses, and that quality measures for patient presenting symptoms often do not reflect the most common reasons patients seek care, according to a study in the February 3 issue of JAMA.

 

Health care reform efforts, such as accountable care organizations, focus on improving value partly through controlling use of services, including diagnostic tests. Publicly reported quality measures that evaluate care provided prior to arriving at a diagnosis could prevent financial incentives from producing harm. The National Quality Forum (NQF) currently serves as the consensus-based quality-measure-endorsement entity called for in the Affordable Care Act. Endorsed measures are often adopted by the Centers for Medicare & Medicaid Services in payment and public reporting programs, according to background information in the article.

 

Hemal K. Kanzaria, M.D., M.S.H.P.M., of the University of California, Los Angeles, and colleagues examined NQF-endorsed process measures that evaluate the prediagnostic (prior to making a diagnosis) care of patients presenting with signs or symptoms. There were 372 process quality measures listed on the NQF website as of June 4, 2014; from these, 385 codings were determined, by categorizing the process quality measures by a system developed by the Institute of Medicine. Approximately two-thirds (n = 267) targeted disease management and 12 percent (n = 46) targeted evaluation/diagnosis. The remaining were evenly distributed among prevention, screening, and follow-up.

 

Of 313 measures pertaining to evaluation/diagnosis or management, 211 (67 percent) began with an established diagnosis, whereas 14 (4.5 percent) started with a sign/symptom. The sign/symptom-based measures focused on geriatric care (e.g., memory loss, falls, urine leakage) or emergency department care (e.g., chest pain). In contrast, many common reasons for which patients seek care, including fever, cough, headache, shortness of breath, earache, rash, and throat symptoms, were not reflected by the quality measures. The performance of a lab test or medical imaging study was the action required by 59 of 313 (19 percent) endorsed quality measures; many others required actions related to medication prescribing.

February 5, 2015 Posted by | health care | , , , , | Leave a comment

[press release] Reducing Hospital Readmission Rates Will Require Community-Focused Effort

From the Wiley press release (February 2015)

Recent research indicates that most of the variation in hospital readmission rates in the United States is related to geography and other factors over which hospitals have little or no control. Access and quality of care outside of the hospital setting seem to be especially important.

A new editorial that addresses these findings notes that a broader focus on community health systems, not just performance of individual hospitals, may be needed to reduce hospital readmissions.

Because high readmission rates trigger reductions in Medicare reimbursements to hospitals, facilities in socioeconomically disadvantaged and underserved communities may be disproportionately penalized. The editorial is published in Health Services Research.

Access and quality outside the hospital may affect the degree to which the HRRP can achieve its intended outcome, fewer readmissions, but other factors are likely to determine whether the policy is an operational success. For the HRRP, operational success could be defined as whether hospitals respond in a manner consistent with the underlying motivations of improving quality of care and reducing costs. In terms of improving quality, a recent meta-analysis of randomized trials found that interventions designed to prevent readmissions tended be moderately effective (relative risk of 30-day readmission 0.82, 95 percent CI, 0.73–0.91). The studied interventions addressed care both during and after hospitalization, such as through case management, patient education, home visits, and patient self-management support, among other activities. Multifaceted interventions were more common and were 30–40 percent more effective than one-dimensional ones (Leppin et al. 2014), yet they may also be more challenging to implement and more costly. The degree to which hospitals nationwide are implementing quality improvement interventions that target readmissions does not appear to have been described.

February 5, 2015 Posted by | health care | , , , | Leave a comment

[News article] Hospital readmissions after surgery associated with new post-discharge complications

From  the  February 3, 2015  Science Life article (University of Chicago)  by John Easton in At the BedsideSidebar

surgery

A study including data from 346 hospitals found that readmissions during the first 30 days after surgery were associated with new complications—post-discharge problems related to the surgical procedure—and not, as previously suspected, to the worsening of medical conditions the patient already had or acquired while hospitalized for surgery.

In this study, published in the February 3 issue of JAMA, Ryan P. Merkow, MD, MS, a clinical scholar in residence at the American College of Surgeons, now chief surgery resident at the University of Chicago, and colleagues examined the reasons, timing, and factors associated with unplanned postoperative hospital readmissions within 30 days after surgery.

Financial penalties for readmissions have made them an important quality and cost-containment issue for hospitals and clinicians. Hospitals try to reduce readmissions, but until now little has been known about the reasons for readmission after surgery. Identifying these reasons could advance quality-improvement efforts and reduce surgical readmissions.

“The Hospital Readmission Reduction Program is federal law and is here to stay,” Merkow said. “Hospital administrators and quality departments must determine how to approach readmissions, and in particular readmissions after surgery.”

“Until recently, efforts were primary focused on medical conditions,” he said, “namely heart failure, myocardial infarction and pneumonia. However, a growing emphasis by policy makers now specifically targets readmissions after surgery. Yet, surprisingly, little is known about why surgical patients are being readmitted. It is completely unclear if oversight initiatives such as public reporting and pay-for-performance should be similarly applied to both medical and surgical patients.”

“Unlike patients being admitted for a medical condition, surgical patients experience a discrete, invasive event (i.e., surgery) with known risks of complications,” Merkow said. “We believe this study definitively separates medical and surgical readmissions as distinct entities that require unique reduction strategies.”

In this study, the unplanned 30-day readmission rate following 498,875 operations was 5.7 percent. Rates ranged from 3.8 percent after hysterectomy to 14.9 percent after lower-extremity vascular bypass. Only 2.3 percent of patients were readmitted for a complication they had experienced during their index hospitalization.

The researchers found that the most common reason for unplanned readmissions was surgical-site infections, followed by intestinal ileus or obstruction, bleeding or anemia, blood clots, and surgical-device issues. Surgical-site infections (SSI) ranged from 11.4 percent after bariatric surgery to 36.4 percent after lower extremity vascular bypass.

The findings have at least two significant policy implications, the authors insist. First, because most readmissions result from post-operative complications, “readmissions after surgery penalize hospitals twice.” And second, because it has been difficult to reduce the most common post-operative complications, such as surgical site infections, penalizing hospitals for problems they do not know how to prevent could be counterproductive, leading to untested solutions that may be ineffective or even counterproductive.

“Understanding the underlying reasons for readmission, the timing, and the associated factors should help hospitals undertake targeted quality-improvement initiatives to reduce readmissions,” the authors wrote. “However, surgical readmissions mostly reflect post-discharge complications, and readmission rates may be difficult to reduce until effective strategies are put forth to reduce common complications such as SSI.”

Efforts should focus on reducing complication rates overall rather than just those that occur after discharge, the authors insist. “This will subsequently reduce readmission rates as well. Readmissions after surgery may not be an appropriate measure for pay-for-performance programs but rather better suited as a measure for hospitals to track internally.”

February 4, 2015 Posted by | health care | , , , , , , , , , | Leave a comment

[Reblog] Reducing Pain of Varicose Vein Surgery

Reducing pain of varicose vein surgery has been a priority of The Whiteley Clinic.(31 January 2015)

This latest research studied how pain and anxietycan be reduced under local anaesthetic varicose vein surgery. This sort of surgery is also called “keyhole” orendovenous surgery for varicose veins.Reducing pain of varicose vein surgery - Research from The Whiteley Clinic and University of Surrey

Reducing pain of varicose vein surgery – Research from The Whiteley Clinic and University of Surrey

The research showed that both:

  • one-to-one talking with a specific nurse
  • using a stress ball

both significantly reduced the pain and anxiety of the varicose vein surgery.Interesting, watching a DVD during the surgery reduced the anxiety, but not the pain of varicose vein surgery. Listening to music had no effect.
This study is part of the continuing research program that makes treatment at The Whiteley Clinic unique.This projectwas funded by The Whiteley Clinic andwas performed at our Whiteley Clinic, Guildford.The researcher, Briony Hudson,was supervised by Prof Jane Ogden at The University of Surrey and Prof Mark Whiteley. Her workhas been submitted to the University of Surrey and shewas awarded her PhD in Autumn 2014.The workis going to be published:

  • Hudson BF, Ogden J, Whiteley MS. Randomised Controlled Trial to Compare the Effect of Simple Distraction Interventions on Pain and Anxiety Experienced During Conscious Surgery. European Journal of Pain. 2015.

See link: http://www.medicaldaily.com/how-reduce-anxiety-and-pain-during-surgery-small-talk-and-stress-balls-320176

February 3, 2015 Posted by | health care | , , , , , | Leave a comment

[Press release] Physical activity as medicine among Family Health Teams: Study

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http://www.classbrain.com/cb_pta/images/childact1.jpg

An interdisciplinary primary care model ideal setting to promote physical activity as medicine

From the 2 February 2015 Canadian Science Publishing site

To better understand the current use of physical activity as medicine among Family Health Teams (FHTs) in Ontario, researchers at the Department of Kinesiology at the University of Waterloo and the Centre for Family Medicine Family Health Team conducted an environmental scan of 102 FHTs. They published their findings today in the journalApplied Physiology, Nutrition, and Metabolism.

Family Health Teams (FHTs) are part of a shift towards a multidisciplinary primary care model that addresses the healthcare needs of a community by allowing different healthcare professionals to work collaboratively under one roof.  Currently, FHTs serve a relatively small percentage of Ontarians; however, their multi-disciplinary structure may create an ideal environment to enable physical activity promotion as most Canadians receive healthcare though the primary care system. Physical activity has well-established health benefits; however, the best way to engage Canadians in an active lifestyle remains largely unknown.

Before this environmental scan, the number and types of physical activity promotion services, and the types of professionals providing physical activity counselling in Ontario FHTs was not known .

The researchers found that almost 60% of responding FHTs in Ontario offered a physical activity service.  However, the types, durations and targeted populations of the services varied depending on the individual FHT.  Physical activity services were often restricted to people with specific conditions or needs rather than available to all individuals.

According to the study, “many different types of allied health professionals were facilitating physical activity services.  The diversity in the qualifications is concerning, as it suggests that individuals providing physical activity therapy do not always have qualifications related to physical activity prescription and counselling.”

Cameron Moore, from the Department of Kinesiology at the University of Waterloo and co-author  of the study said, “It is promising that almost 60% of responding FHTs offered a physical activity service.  However, continued efforts are needed to increase the accessibility and standardization of physical activity therapy offered though primary care.“

“In Ontario, Kinesiology is a newly accredited professional designation with a scope of practice that includes physical activity promotion and prescription. We feel that physical activity counsellors who are Registered Kinesiologists with expertise in physical activity prescription and behavior change counselling are ideally suited as primary care providers in FHTs.”

The article “Physical Activity as Medicine among Family Health Teams: An Environmental Scan of Physical Activity Services in an Interdisciplinary Primary Care Setting” was published today in Applied Physiology, Nutrition, and Metabolism.

 

February 3, 2015 Posted by | Consumer Health, health care | , , , , , | Leave a comment

[News article] Whose Numbers Determine if a Targeted Cancer Therapy is “Worth It?”

From the 2 February 2015 Newswise article

Health economics helps insurers, health care systems and providers make treatment decisions based on the cost of extra “units” of health arising from a specific treatment. By calculating the cost for each year of life or quality-adjusted year of life gained, these groups can decide whether changing treatments or adding in a new treatment beyond the existing standard of care is “worth it.”

However, while the resulting incremental cost effectiveness ratio (ICER) is often presented as an absolute measure upon which to base these decisions, an opinion published by University of Colorado Cancer Center researchers D. Ross Camidge, MD, PhD, and Adam Atherly, PhD, suggests that the consumers of these data need to be much more aware of the assumptions underlying these calculations.

“Increasingly physicians are being presented with health economic analyses in mainstream medical journals as a means of potentially influencing their prescribing. However, it is only when you understand the multiple assumptions behind these calculations that you can see that they are by no means absolute truths,” Camidge says.

…..

Related resources

February 3, 2015 Posted by | health care | , , , , , | Leave a comment

[Reblog] Tele Taking Off (Telehealth, Telemedicine…)

From the 30 January 2015 post By CECI CONNOLLY at The Health Care Blog
telemedicine-full

http://ishcmcwiki.wikispaces.com/Telemedicine

In Washington, sometimes the most significant developments quietly creep up on you. No epic debate or triumphant bill-signing ceremony, but rather a collection of seemingly small events begin to tip the scales.

That’s what is happening today with telehealth. Almost under the radar, federal and state officials have been giving a much-needed push in support of virtual care. Though the technology has long existed, until recently the money had not followed. And sadly in our current fee-for-service healthcare system, little gets done without a payment code, even if it makes eminent medical and economic sense.

Consider some of the recent action. In November, the Department of Agriculture released more than $8.5 million in health-related grants to 31 recipients in rural communities. Many are using the money to purchase telehealth equipment such as high-quality cameras and broadband Internet.

The previous month the federal government issued rules expanding Medicare payment for a range of telehealth services. Caregivers can earn about $42 per month for chronic care management under the new regulations. Seven new procedure codes were also added, covering such services as annual wellness visits and psychotherapy.

And the end-of-year spending bill approved by Congress designates more than $26 million for telemedicine programs largely in rural communities and through the Veteran’s Administration.

Legislation filed in the new Congress would continue the trend loosening anti-kickback restrictions for the purchase of telemedicine equipment and requirements that physicians receive a separate license to practice in each state (a major barrier for doctors aiming to deliver virtual care to patients across the nation.)

Consumers can’t wait. Nearly 40% of 1,000 adults nationwide surveyed by PwC’s Health Research Institute say they would be willing to have an appointment with a physician via smartphone, representing a potential $42.1 billion market. Significant percentages of American consumers indicate they are eager for virtual care alternatives such as a device that attaches to a mobile phone, snaps an image of an ear canal or rash and transmits it to a physician for an instant reading.

Read the rest of the article (with comments) here

Related articles

  • What is Telemedicine (American Telemedicine Association)
  • Telehealth (US Department of Health and Human Services)
    The Role of Telehealth in an Evolving Health Care EnvironmentInstitute of Medicine report (11/20/2012)Telehealth professionalTelehealth is the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration. Technologies include videoconferencing, the internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications.HRSA works to increase and improve the useoftelehealth to meet the needs of underserved people by:

    • Fostering partnerships within HRSA, and with other Federal agencies, states and private sector groups to create telehealth projects.
    • Administering telehealth grant programs.
    • Providing technical assistance.
    • Evaluating the use of telehealth technologies and programs.
    • Developing telehealth policy initiatives to improve access to quality health services.
    • Promoting knowledge exchange about “best telehealth practices.” “
  • Telemedicine  (Medicaid.gov)
    “Provider and Facility GuidelinesMedicaid guidelines require all providers to practice within the scope of their State Practice Act. Some states have enacted legislation that requires providers using telemedicine technology across state lines to have a valid state license in the state where the patient is located. Any such requirements or restrictions placed by the state are binding under current Medicaid rules.”
  • Ohio Department of Rehabilitation and Correction Telemedicine
    Since itsinception, the Telemedicine program has conductedapproximately 19,000 consultations. Approximately 5000 such consults in 12 different medical specialties are now completed each year. Medical careis initiated at the local prison by the nurses and physiciansonsite. Telemedicine is then used to present the inmate and his or her medical condition to the specialty physicians at The Ohio State University Medical Center forappropriate care. In addition to the medical services provided by theOSUMC,ODRC staff conduct psychiatric and dietary consultations from a Central Office video systemlocated in the Office of Correctional Health Care. Thirty-two prisonsparticipate in the Telemedicine program.The Telemedicine network is part of a larger ODRC videoconferencing network that also includes the Division of Parole and Community Services’ eight regional offices and 3 district offices. The prison school system known as the Ohio Central School System has 6 distance learning centers included on the network as well. Thus, the videoconferencing network is used to not only to provide improved access to specialty care, but also continuing education to health care, administrative, security, and other support staff, as well as legal hearings, parole board hearings, administrative meetings, and patient transfer meetings.”
  • Telemedicine at UPMC (University of Pittsburg Medical Center)
    “The UPMC Telemedicine Program connects small or rural community hospitals and outpatient locations to specialists at UPMC, allowing patients to receive world-class care close to home.

February 1, 2015 Posted by | health care | , , | Leave a comment

[Reblog] Precision Medicine Initiative: Some quick resources

 

1.29.15_precision_medicine

From the 30 January 2015 post BY PIA CHRISTENSEN  at Covering Health – Monitoring the Pulse of Healthcare Journalism 

 White House has announced its anticipated “Precision Medicine Initiative,” which it describes as an “emerging field of medicine that takes into account individual differences in people’s genes, microbiomes, environments, and lifestyles – making possible more effective, targeted treatments for diseases like cancer and diabetes. ”

….

The practice of medicine has always been personal regarding the treatment of individual patients, but science has fostered a new era of so-called personalized medicine that takes into account each person’s specific clinical, genetic, genomic and environmental information in designing tailored treatment plans

The White House released this fact sheet today.

This interview with the director of the program in personalized health at the University of Utah offers a good explanation of what personalized care is and examples of what it could do.

For Science magazine, Jocelyn Kaiser writes that the Obama precision medicine plan would create huge U.S. genetic biobank. She follows up with more details about the price tag and budget.

The White House released this fact sheet today.

This interview with the director of the program in personalized health at the University of Utah offers a good explanation of what personalized care is and examples of what it could do.

For Science magazine, Jocelyn Kaiser writes that the Obama precision medicine plan would create huge U.S. genetic biobank. She follows up with more details about the price tag and budget.

 

Related articles

“I have been thinking lately about the cultural and business phenomena that are currently shaping and accelerating the adoption of connected health and, in that context, came up with five accelerants.  The best part of the story is that four of the five are already going on and we can see their early-stage effects.

So, at the risk of ‘dumbing down’ adoption, here is my list of five accelerants.  If we could make these go faster, the adoption of connected health would accelerate too.”

1. Increase value-based reimbursement for providers.
2. Create more mechanisms for provider reimbursement for non face-to-face care (like the new CMS CPT code that just took effect).
3. Accelerate consumer choice in the marketplace as well as ‘consumer-driven health care’ (i.e., high deductible plans, health savings accounts (HSAs), etc.).
4. Make the consumer-facing technology truly frictionless.
5. Create a universal privacy/security technology and make it a public good.

  • Integrated approach to customer relationship management and patient relationship management (From the 28 January 2015 post at Health Care Conversation)

    A comprehensive consumer and patient engagement model should help providers attract and engage individuals in the key areas they value:

    • Help in understanding and navigating the health care system
    • Personalize information and care based on an individual’s needs
    • Easy access and communication with provider and care team
    • Support in managing an acute episode or a chronic illness
    • Secure access to personal health records

 

Read the entire article here

February 1, 2015 Posted by | health care, Medical and Health Research News | , , , , , , , , , , , | Leave a comment

[Reblog] Use of Social Media Across US Hospitals: Descriptive Analysis of Adoption and Utilization

English: Infographic on how Social Media are b...

English: Infographic on how Social Media are being used, and how everything is changed by them. (Photo credit: Wikipedia)

Use of Social Media Across US Hospitals: Descriptive Analysis of Adoption and Utilization,January 29, 2015

From the post at Full Text Reports
Source: Journal of Medical Internet Research

Background:
Use of social media has become widespread across the United States. Although businesses have invested in social media to engage consumers and promote products, less is known about the extent to which hospitals are using social media to interact with patients and promote health.

Objective:
The aim was to investigate the relationship between hospital social media extent of adoption and utilization relative to hospital characteristics.

Methods:
We conducted a cross-sectional review of hospital-related activity on 4 social media platforms: Facebook, Twitter, Yelp, and Foursquare. All US hospitals were included that reported complete data for the Centers for Medicare and Medicaid Services Hospital Consumer Assessment of Healthcare Providers and Systems survey and the American Hospital Association Annual Survey. We reviewed hospital social media webpages to determine the extent of adoption relative to hospital characteristics, including geographic region, urban designation, bed size, ownership type, and teaching status. Social media utilization was estimated from user activity specific to each social media platform, including number of Facebook likes, Twitter followers, Foursquare check-ins, and Yelp reviews.

Results:
Adoption of social media varied across hospitals with 94.41% (3351/3371) having a Facebook page and 50.82% (1713/3371) having a Twitter account. A majority of hospitals had a Yelp page (99.14%, 3342/3371) and almost all hospitals had check-ins on Foursquare (99.41%, 3351/3371). Large, urban, private nonprofit, and teaching hospitals were more likely to have higher utilization of these accounts.

Conclusions:
Although most hospitals adopted at least one social media platform, utilization of social media varied according to several hospital characteristics. This preliminary investigation of social media adoption and utilization among US hospitals provides the framework for future studies investigating the effect of social media on patient outcomes, including links between social media use and the quality of hospital care and services.

January 30, 2015 Posted by | health care | , , , , , | Leave a comment

[Reblog] Medical Necessity and Unnecessary Care

Medical Necessity and Unnecessary Care

From the 29 January 2015 post at The Health Care Blog

Paul KeckleyUnnecessary care that’s not evidence-based—usually associated with excess testing, surgical procedures or over-prescribing—accounts for up to 30% of what is spent in healthcare. In recent months, enforcement actions against physicians and hospitals have gained increased attention. But unnecessary care and over-utilization is not a new story or one that’s easy to understand.

Background

Medical necessity means something slightly different in every part of the healthcare industry. Varied definitions and interpretations are used by providers, physicians, courts, pharmacy benefits managers, government insurers, private insurers, and consumers. Perhaps the two most important are from the largest and most influential payer, Medicare, and the industry’s most important clinical authority, the American Medical Association (AMA).

 

The AMA defines medical necessity as: “Healthcare services or products that a prudent physician would provide to a patient for the purpose of preventing, diagnosing or treating an illness, injury, disease or its symptoms in a manner that is: (a) in accordance with generally accepted standards of medical practice; (b) clinically appropriate in terms of type, frequency, extent, site, and duration; and (c) not primarily for the economic benefit of the health plans and purchasers or for the convenience of the patient, treating physician, or other healthcare provider.” “Statement of the American Medical Association to the Institute of Medicine’s Committee on Determination of Essential Health Benefits,” American Medical Association, January 14, 2011

So based on these definitions, the application of “medical necessity” leaves lots of room for variation in how doctors and hospitals determine what’s done, and how payers (Medicare, Medicaid, employers, individuals) assess the appropriateness of their activities and costs. Therein is the conundrum about medical necessity and unnecessary care and the need for fresh thinking about the issue.

The basic facts:

Over-utilization and unnecessary care is prevalent and costly: Several reputable studies point to systemic over-utilization costing the U.S. system up to 30% more than what’s necessary (Exhibit A). The U.S. health system is the world’s most expensive, and health costs, per the Congressional Budget Office, will continue to increase at least 2-3% faster than the overall economy for the next decade. The costs associated with unnecessary care (a.k.a. medical necessity) are significant and growing. “The 2014 Long-Term Budget Outlook,” Congressional Budget Office, July 2014.

The government is cracking down on unnecessary care: Hospitals are increasingly being held accountable for the practice patterns of the physicians on their medical staff via the False Claims Act. Enforcement actions against both are on the rise and financial penalties harsh (see Exhibit B for recent cases).

Media attention is sparking public attention to unnecessary care: The Wall Street Journal calls its series, “Secrets of the System.” National broadcast and print news organizations have increased coverage of healthcare including its tendencies around medical necessity and unnecessary care. And social media is a hotbed for anecdotal assessments of “medical necessity”—some supported with objective data, most supported by personal experience, and a few judiciously studied and reported.

So if health costs are a looming problem in U.S. healthcare, and lack of consistency around the delivery of medically-necessary care is a systemic challenge that’s increasingly transparent, why isn’t more done? Most industry insiders offer these reasons:

The body of scientific evidence about what works best is expanding and changes fast. There are 20,000 medical journals. Keeping track of the latest innovations is almost impossible without using a clinical knowledge management software program that captures and filters relevant information useful to making patient diagnostic treatment decisions.
The strength of evidence about what works best and why is often weak. As more information about a patient’s signs, symptoms, risk factors and co-morbidities are factored into a treatment determination, the less likely it is that a clear “medical necessity” directive is found. Ironically, the more information (data) a clinician has about a specific patient, the less likely it is that a “medically necessary service” is dictated through a clinical algorithm or guideline.

Most consumers assume everything recommended is “medically necessary.” The majority of consumers assume that what their physician recommends is evidence-based, and few feel confident to challenge their view. Therefore, consumers want MORE not less in the majority of cases. And social media and media coverage is complicating matters as treatments-de jour become more widely known to consumers searching the latest and best treatments. The burden to stay abreast about traditional and nontraditional methods for diagnosing and treating is daunting, especially if reimbursements are cutting into time spent with patients.

Most providers necessarily err on the side of over-treatment. The majority of physicians and the institutions that credential them to practice tend to over-treat fearing liability exposure or the possibility of an inaccurate diagnosis. It’s precautionary and a business imperative (discounting it can be lucrative at the same time).

The health information technology tools that allow for real-time, accurate matching of a patient’s signs, symptoms, risk factors and co-morbidities to the latest and best evidence don’t exist or are too expensive. The integration of smart medical record systems shared by clinically-integrated networks and with their patients is still aspirational in most communities. These systems are expensive. Clinicians doubt that these systems will pay for themselves in improved efficiency (less paperwork), nor do they trust that payers will pay them more if they make the investment. And most consumers aren’t demanding them to make the investment. Instead, basic access, convenient locations and an assuring experience with doctor are of higher importance.

These views provide a defensible rationale as to why medical necessity and unnecessary care is a systemic challenge in our system, but in coming months, they may be seen more as lame excuses. The spotlight on unnecessary care and medical necessity is likely to shine brighter because:

Unnecessary care contributes significantly to the impressive profitability in many parts of the health system.


Unnecessary care can be harmful to consumers.
The data and sophisticated analytic tools upon which determinations of medical necessity and unnecessary care are increasingly available. Defaults that “my patients are different” and “we don’t have the data” will fall on deaf ears.

What does it mean?

Documentation is key. Accurate clinical documentation across sites and systems of care is table stakes.

Transparency about medical necessity and unnecessary care is assured. Data about the performance of every practitioner, hospital, and health system will be widely accessible. And the evidence supporting coverage and denial decisions by insurers, formulary design by Pharmacy Business Managers (PBMs) and benefits managers, and the justification for narrow networks will be equally available.

 

January 30, 2015 Posted by | health care | , , , , | Leave a comment

[Reblog] Health insurers using drug coverage to discriminate

From the 28 January 2015 post at Engineering Evil – Intel Portal for Weighted Data and Information

In some US health plans, HIV drugs cost nearly $3,000 more per year than in other plans. If left unchecked, this practice could partially undermine a central feature of the Affordable Care Act.

Harvard School of Public Health

Boston, MA — Some insurers offering health plans through the new federal marketplace may be using drug coverage decisions to discourage people with HIV from selecting their plans, according to a new study from Harvard T.H. Chan School of Public Health. The researchers found that these insurers are placing all HIV drugs in the highest cost-sharing category in their formularies (lists of the plans’ covered drugs and costs), which ends up costing people with HIV several thousands more dollars per year than those enrolled in other plans.

The study appears online January 28, 2015 in the New England Journal of Medicine.

January 29, 2015 Posted by | health care | , , , , , , , , , , | Leave a comment

[Reblog] A sampling of perspectives on Brill’s take on health reform

From the 23 January 2015 post at Covering Health-Monitoring the Pulse of Health Care Journalism

I’m sure a lot of you have Steven Brill’s “America’s Bitter Pill” on your bedside table by now – I’m not going to try to recap it here.

But I did want to share a few links to some of the more thoughtful (or provocative) articles and reviews, representing critics on both the left and right. I also wanted to draw your attention to another recent book providing a conservative perspective on health reform.

The second book (and I should say that while I have a copy, I loaned it to a colleague before I read it myself…) is by the Washington Examiner‘s commentary editor,  Philip Klein, who looks at the options and thoughts on the right in “Overcoming Obamacare: Three Approaches to Reversing The Government Takeover of Health Care.” It hasn’t been as widely reviewed as Brill’s book but Aaron Carroll gives it an interesting write-up in the Incidental Economist blog.

January 27, 2015 Posted by | health care | , , , , , , , | Leave a comment

[Press release] Patients dismissing ‘trivial’ symptoms could delay cancer diagnosis

One of our neighbors died 5 years ago. She hid her symptoms from her family. Wondering if she would be alive today if she would have been proactive.

[Press release] Patients dismissing ‘trivial’ symptoms could delay cancer diagnosis

26 January 2015, Cancer Research UK

People who dismiss their symptoms as trivial or worry about wasting the doctor’s time may decide against going to their GP with red-flag cancer warning symptoms, according to a Cancer Research UK study* published in the British Journal of General Practice (link is external)today.

 “Many of the people we interviewed had red flag symptoms but felt that these were trivial and didn’t need medical attention, particularly if they were painless or intermittent.” – Dr Katriina Whitaker

Others might decide not to get possible cancer symptoms checked out because they fear a cancer diagnosis, they adopt a stiff upper lip, they lack confidence in the healthcare system, or they think their problem is down to ageing.

Researchers in London and Hull** looked at how people who experience possible cancer symptoms decide whether or not to seek medical help. They sent out a health survey that was completed by more than 1,700 people, aged 50 and over, from three London GP practices.

The survey specifically did not mention cancer, but incorporated a list of 17 symptoms including 10 cancer ‘alarm’ warning signs, such as persistent cough or hoarseness, unexplained lump, persistent change in bowel or bladder habits, and a sore that does not heal.***

More than 900 people reported having at least one alarm symptom during the past three months. Researchers carried out in-depth interviews with almost 50 of them, almost half (45 per cent) of whom had not seen their GP about their symptoms. ****

One woman with persistent abdominal pain did not go for a recommended test. She said: “At times I thought it was bad … but when it kind of fades away, you know, it doesn’t seem worth pursuing really.”  A man, who experienced a persistent change in bladder habits, said: “You’ve just got to get on with it. And if you go to the doctor too much, it’s seen as a sign of weakness or that you are not strong enough to manage things on your own.”

Dr Katriina Whitaker, a senior research fellow at University College London during the study, said: “Many of the people we interviewed had red flag symptoms but felt that these were trivial and didn’t need medical attention, particularly if they were painless or intermittent.

“Others felt that they shouldn’t make a fuss or waste valuable NHS resources. The stiff-upper-lip stoicism of some who decided not to go to their doctor was alarming because they put up with often debilitating symptoms. Some people made the decision to get symptoms checked out after seeing a cancer awareness campaign or being encouraged to do so by family or friends – this seemed to almost legitimise their symptoms as important.”

Reasons people gave for deciding to seek help included symptoms not going away, instinct that something was not right, and awareness or fear that they might have cancer. A man with an unexplained throat lump said: “But always at the back of your mind you’ve always got the fear of cancer …….. well it’s best to check just in case.”  However, fear also made some people decide not to check out symptoms, or if symptoms did persist some people began to think they were normal for them.

Some people waited for another reason to visit their GP and mentioned the cancer alarm symptom then. Others said they would rather use an emergency route, such as going straight to A and E, than wait to see a specialist after being referred by their GP.

Dr Richard Roope, Cancer Research UK’s GP expert, said: “The advice we give is: if in doubt, check it out – this would not be wasting your GP’s time. Often your symptoms won’t be caused by cancer, but if they are, the quicker the diagnosis, the better the outcome. Seeking prompt advice from your GP about symptoms, either on the phone or during an appointment, could be a life-saver, whatever your age. And the good news is that more than half of all patients diagnosed with cancer now survive for more than 10 years.”

January 26, 2015 Posted by | health care, Health News Items | , , , , | Leave a comment

[Reblog] What’s Next For Physician Compare? | The Health Care Blog

What’s Next For Physician Compare? | The Health Care Blog.

From the 22 January 2015 post

Screen Shot 2015-01-23 at 9.33.17 PMOf the many hidden gems in the Affordable Care Act, one of my favorites is Physician Compare.  This website could end up being a game changer—holding doctors accountable for their care and giving consumers a new way to compare and choose doctors.  Or it could end up a dud.

The outcome depends on how brave and resolute the Centers for Medicare and Medicaid Services (CMS) is over the next few years.  That’s because the physician lobby has been less than thrilled with Physician Compare, and, for that matter, with every other effort to publically report measures of physician performance and quality.

I’d give CMS a C+ to date.   Not bad considering it’s the tough task.  The agency has been cautious and deliberate.  But after the many problems with Hospital Compare, Nursing Home Compare, Home Health Compare, and Dialysis Facility Compare—not to mention the shadow of healthcare.gov’s initial rollout—that’s understandable.  They want, I hope, to get this one right from the get-go.  And competition from the private sector looms.

Congress mandated that CMS establish Physician Compare by Jan. 1, 2011 and that an initial content plan be submitted by Jan. 1, 2013.  CMS met those deadlines, albeit with a rudimentary site that launched in late December 2010.  The agency updated its plans in 2013 and 2014, even as it added more content and functionality to the site.

The law requires the site to have “information on physician performance that provides comparable information on quality and patient experience measures.”  That’s to include measures collected under the Medicare Physician Quality Reporting System (PQRS), Medicare’s main quality reporting vehicle, and assessments of:

  • patient health outcomes and the functional status of patients
  • continuity and coordination of care and care transitions, including episodes of care and risk-adjusted resource use
  • the efficiency of care
  • patient experience and patient, caregiver, and family engagement
  • the safety, effectiveness, and timeliness of care

Notably, Congress set no deadline for the site to meet those specifications or be fully operational.

So what’s posted so far?   The centerpiece of the site is a searchable directory of some 850,000 Medicare providers.  That includes most of the practicing doctors in the U.S. with the exception of pediatricians and other physicians who don’t treat Medicare patients.  This database predates the ACA and Physician Compare but its functionality, reliability and accuracy (a big complaint from physician groups) is being gradually enhanced.

Each doctor has his or her own profile page—a significant foundation that could accommodate quality and patient experience data in the future.

Consumers can also search three additional databases on the site.  They identify doctors and other clinicians who participate in (a) PQRS; (b) the Electronic Prescribing Incentive Program; and (c) the electronic health record (EHR) incentive program (also called the meaningful-use program).  About 350,000 physicians and other clinicians participate in the latter.

The bad news: these databases are separate and their content is not integrated.  That makes searching for information on a particular group practice or individual doctor cumbersome and time consuming.  And the databases aren’t user-friendly.  On the plus side, for researchers and health administrators, the databases are downloadable.

January 26, 2015 Posted by | health care | , , , , , , | Leave a comment

[News] Fourth Florida Insurer Agrees To Cap Cost Of HIV Drugs | Kaiser Health News

Fourth Florida Insurer Agrees To Cap Cost Of HIV Drugs | Kaiser Health News.

Excerpt

January 22, 2015

 The last of four Florida insurers blasted by AIDS activists for the high cost of their HIV drugs relented last week, saying it would cap what patients pay every month for four types of medication.

“We will voluntarily agree to set an out-of-pocket limitation of $200 per month on each of the following drugs: Atripla, Complera, Stribild, and Fuzeon,” Preferred Medical Plan CEO Tamara Meyerson wrote to Kevin McCarty, commissioner of the Florida Office of Insurance Regulation, in a Jan. 14 letter.

The other three companies — Coventry Health Care, Humana and Cigna — had earlier reached formal agreements with state regulators to lower their prices and to fill prescriptions without prior authorization for 2015.

Preferred did not violate Florida’s anti-discrimination laws, said Amy Bogner, a spokeswoman for the state’s insurance office.

An estimated 120,000 Floridians have HIV, and nearly half of them live in South Florida, according to state data.

…….

January 26, 2015 Posted by | health care | , | Leave a comment

[News] The coming revolution in much cheaper life-saving drugs | Medication Health News

The coming revolution in much cheaper life-saving drugs | Medication Health News.

From the 22 January 2015 post

ID-10057221Recently the FDA has approved the first “biosimilars” to be available in the United States.  In order for a drug to be considered biosimilar, the law requires that the copycat drug is “highly similar” to the reference drug, and does not have “clinically meaningful” differences. Biosimilar drugs will offer lower-cost competition as they tend to cost between 20 – 30 % less than the original branded drug. According to the Federal Trade Comission, Biosimilar products are estimated to take 8 to 10 years to develop and will cost the manufacturers up to $200 million to produce.With this new class of drugs, patients will be able to save thousands on their medications. Has your company/employer began exploring the budgetary effects of biosimilars? How will this new class of biosimilars affect health care spending in the US?

For additional information click here

Photo courtesy of [ddpavumba]  freedigitalphotos.net

January 26, 2015 Posted by | health care | , , , , , , , | Leave a comment

[News]Checklist devised to spot elderly patients most at risk of death — ScienceDaily

Checklist devised to spot elderly patients most at risk of death — ScienceDaily.

English: An elderly patient at St. Elizabeths ...

English: An elderly patient at St. Elizabeths Hospital in Washington, D.C. (Photo credit: Wikipedia)

Excerpt

Date:January 22, 2015
Source:BMJ-British Medical Journal
Summary:A checklist has been designed to spot elderly hospital patients likely to die within the next three months, a new article outlines. The researchers emphasize that the checklist is not intended to substitute healthcare for the elderly who are terminally ill. Instead, it is meant to “provide an objective assessment and definition of the dying patient as a starting point for honest communication with patients and families about recognizing that dying is part of the life cycle.”
From the journal article
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January 26, 2015 Posted by | health care, Medical and Health Research News | , , , , , | Leave a comment

Dump the Business Model | The Health Care Blog

Dump the Business Model | The Health Care Blog.

From the 22 January 2015 post

There are no winners in the fee-for-service game.

It’s time to toss the whole business-as-usual model — for your own good and the good of your customers.

The emerging Default Model of health care — the “consumer-directed” insured fee-for-service model in which health plans compete to lower premiums by bargaining providers into narrow networks — not only does not work for health care’s customers, it cannot work. This is not because we are doing it wrong or being sloppy. By its very nature the Default Model must continually fail to bring our customers what they want and desperately need. Ultimately it cannot bring you, the providers, what you want and need.

Take a dive with me into the real-world game-theory mechanics of the health care economy, and you will see why. It’s time to rebuild the fundamental business models of health care.

The Default Model Health Care Game

It’s a little easier to find our way around an economic model by picturing it as a game and asking: “What defines winning for each player? What does each player need to do to win?”

Health plans: For health plans, winning means surviving, succeeding and growing as a business. But there are a couple of rule changes now. Health plans used to be able to stay more profitable by pushing down their medical loss ratio (MLR — the percentage of premiums actually paid out for medical care), by “rescinding” the plans of people who cost too much, and by refusing to cover anyone with pre-existing conditions.

Now they have to take everybody, can’t toss them out, and their MLR has to be at least 80 percent (or 85 percent for large customers). So their administrative expenses, advertising, executive salaries (and the profits and stock price of the for-profits) are all tied to a percentage of the actual costs of health care. Hmmm. If they were confronted with a way to make health care cost half as much, would they be interested? Would they make it a top priority? No. They have no incentive to actually drop the real costs of health care.

….

While I agree with the author of the above article, the selected related articles do include other viewpoints.

January 26, 2015 Posted by | health care | , , , , | Leave a comment

[Report] Hospitalizations for Patients Aged 85 and Over in the United States, 2000–2010

Hospitalizations for Patients Aged 85 and Over in the United States, 2000–2010 

From the January 2015 NCHS Data Brief (US Centers for Disease Control and Prevention)

Key findings Data from the National Hospital Discharge Survey

  • In 2010, adults aged 85 and over accounted for only 2% of the U.S. population but 9% of hospital discharges.
  • From 2000 through 2010, the rate of hospitalizations for adults aged 85 and over declined from 605 to 553 hospitalizations per 1,000 population, a 9% decrease.
  • The rate of fractures and other injuries was higher for adults aged 85 and over (51 per 1,000 population) than for adults aged 65–74 (9 per 1,000 population) and 75–84 (23 per 1,000 population).
  • Adults aged 85 and over were less likely than those aged 65–74 and 75–84 to be discharged home and more likely to die in the hospital.

From 2000 through 2010, the number of adults aged 85 and over in the United States rose 31%, from 4.2 million to 5.5 million, and in 2010, this age group represented almost 14% of the population aged 65 and over (1). It is estimated that by 2050, more than 21% of adults over age 65 will be aged 85 and over (2). Given this increase, adults aged 85 and over are likely to account for an increasing share of hospital utilization and costs in the coming years (3). This report describes hospitalizations for adults aged 85 and over with comparisons to adults aged 65–74 and 75–84.

What percentage of hospital care was provided to adults aged 85 and over?

  • In 2000, adults aged 85 and over accounted for only 2% of the U.S. population but 8% of hospital discharges. In 2010, adults aged 85 and over still accounted for 2% of the U.S. population but accounted for 9% of hospital discharges (Figure 1).

Figure 1. Population, discharges, and days of care, by age: United States, 2000 and 2010

Figure 1 is a horizontal bar chart showing the percentage of the U.S. population, hospital discharges, and days of care by four age groups 2000 and 2010

NOTE: Population is the U.S. civilian noninstitutionalized population.
SOURCE: CDC/NCHS, National Hospital Discharge Survey, 2000–2010.

  • In 2000 and 2010, adults aged 85 and over accounted for 12% and 14%, respectively, of those aged 65 and over. However, adults aged 85 and over accounted for more than 20% of hospital discharges for those aged 65 and over for both years.
  • Adults aged 85 and over accounted for a disproportionate share of the total days of care, 10% in 2000 and 11% in 2010.

 

Figure 2. Hospitalizations, by age: United States, 2000–2010

Figure 2 is a line graph showing hospitalization rates for five age groups for 2000 through 2010

1Rate of hospitalization exceeds the rate for younger age groups for every year from 2000 through 2010 (p < 0.05).
SOURCE: CDC/NCHS, National Hospital Discharge Survey, 2000–2010.

  • From 2000 through 2010, the hospitalization rate for adults aged 85 and over remained significantly higher than the rates for adults under age 65, aged 65–74, and aged 75–84.
  • In 2010, the hospitalization rate for adults aged 85 and over (553 per 1,000 population) was more than five times higher than the rate for adults under 65 (80 per 1,000 population).

 

What were common causes of hospitalization for adults aged 85 and over?

  • In 2010, congestive heart failure (43 per 1,000 population) was the most frequent first-listed diagnosis for adults aged 85 and over, but in 2000 and 2005, pneumonia (51 and 52 per 1,000 population, respectively) was the most common first-listed diagnosis for adults aged 85 and over (Table).
  • Hospitalization rates for congestive heart failure, pneumonia, stroke, and hip fracture decreased from 2000 through 2010 for adults aged 85 and over, and the rates for urinary tract infections and septicemia increased from 2000 through 2010.

 

Table. Common causes of hospitalization for adults aged 85 and over: United States, 2010
First-listed diagnosis 2000 2005 2010 Percent change1 (2000 to 2010)
Rate of hospitalization per 1,000 population
Congestive heart failure 48 47 43 –9.5
Pneumonia 51 52 34 –32.8
Urinary tract infection 19 24 30 +55.9
Septicemia 15 18 28 +84.8
Stroke 37 27 28 –25.0
Hip fracture 28 23 21 –25.4

1Percent change for each diagnosis is significant from 2000 through 2010 (p < 0.05).
NOTE: First-listed diagnosis is considered to be the main cause or reason for the hospitalization. The diagnoses were chosen because they were the top six first-listed diagnoses in 2010.
SOURCE: CDC/NCHS, National Hospital Discharge Survey, 2000–2010.

How likely were adults aged 85 and over to be hospitalized for injury?

  • The rate of all injuries for adults aged 85 and over (51 per 1,000 population) was higher than the rates for adults aged 65–74 and 75–84 (9 and 23 per 1,000 population, respectively) (Figure 3).
  • The rate of hip fractures for adults aged 85 and over (21 per 1,000 population) was higher than the rates for adults aged 65–74 and 75–84 (2 and 8 per 1,000 population, respectively).
  • The rate of other fractures for adults aged 85 and over (18 per 1,000 population) was higher than the rates for adults aged 65–74 and 75–84 (4 and 10 per 1,000 population, respectively).
  • The rate of other injuries for adults aged 85 and over (12 per 1,000 population) was higher than the rates for adults aged 65–74 and 75–84 (3 and 6 per 1,000 population, respectively).

 

 

More at  http://www.cdc.gov/nchs/data/databriefs/db182.htm

 

January 26, 2015 Posted by | health care, Health Statistics | , , , , , , , , , | Leave a comment

[Reblog] The legacy of Dr. Michael Davidson (murdered in his office)

The comments about physicians/health care industry were overwhelmingly thought provoking and insightful.
Some excerpts from the comments…

  • What we as a profession appear to be (willfully) unaware of is that we doctors are the face of the healthcare system. To the extent that we do not speak up, protest and advocate for our patients when they are taken advantage of by hospitals and insurers, we provide a face for patients to blame.
  • This did not happen in a vacuum. It happened in a culture where there is a lot of rage, sometimes uncontrolled, and easy access to guns. And it happened in a very broken healthcare system which is driven by greedy big business profit motive that results in anyone with money or good insurance getting very overtreated and anyone without money or good insurance getting severely undertreated. And yes, our system has bred a lot of mistrust and hopelessness.
  • “Anyone who doesn’t think that corporate executives and hospital administrators take full advantage of the opportunity to hide behind us as they maximize profits at the expense of our patients, is a fool.”

The legacy of Dr. Michael Davidson.

From the 22 January 2015 post at KevinMD

In 1994, I was working at my first radiation oncology job in San Diego at Grossmont Hospital when I came into work to hear disturbing news.  One of my colleagues in medical oncology, a compassionate man known for his gentle nature, had stayed late at the cancer center the evening before to finish up paperwork.  With his back to his ever open door, he sat at his desk never once considering that he was in danger.  A disgruntled relative of a former patient surprised him from behind and beat him viciously over the head and body causing broken bones and contusions, and leaving him for dead.

Read the entire article, with comments here.

January 24, 2015 Posted by | health care | , , , , , | Leave a comment

DocuBase Article: Trading Away Access to Medicines – Revisited

DocuBase Article: Trading Away Access to Medicines – Revisited.

From the abstract

Tuesday, 13th January 2015
Trading Away Access to Medicines – Revisited
Source: Oxfam International

Screen Shot 2015-01-23 at 12.29.50 PM

From Summary:

The failure of the current pharmaceutical research and development (R&D) system is revealed by the World Health Organization (WHO) alert about the lack of effective medicines to address antimicrobial resistance, and the absence of a treatment for the deadly Ebola virus that is ravaging communities in West Africa at the time of writing.

While low- and middle-income countries (LMICs) have being suffering from a lack of access to medicines for years, European public health systems have become unable to bear the burden of expensive new medicines. The rise of non-communicable diseases (NCDs) is affecting all people, but is more acutely hitting developing countries that are still struggling with the unfinished business of communicable diseases. Meanwhile, European health systems, badly hit by austerity measures, are under pressure to deliver more with less money, against a backdrop of rising medicine prices.

The European Union (EU) could play a leading role in improving pharmaceutical innovation and access to medicines around the world. However, the European Commission (EC) has implemented a trade agenda that favours the commercial interests of the multinational pharmaceutical industry over the health of people in LMICs. Such trade policies have triggered an outcry from European citizens, experts and organizations, who are asking for the public interest to be prioritized in trade discussions.

Opening statement
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January 23, 2015 Posted by | health care | , , , , | Leave a comment

[Research journal article] Medicare Per Capita Spending By Age And Service: New Data Highlights Oldest Beneficiaries | Full Text Reports…

Medicare Per Capita Spending By Age And Service: New Data Highlights Oldest Beneficiaries 

  1. Patricia Neuman1,*,
  2. Juliette Cubanski2 and
  3. Anthony Damico3

  1. 1Patricia Neuman (tneuman@kff.org) is senior vice president and director of the Program on Medicare Policy at the Henry J. Kaiser Family Foundation, in Washington, D.C.

  2. 2Juliette Cubanski is associate director of the Program on Medicare Policy at the Henry J. Kaiser Family Foundation.

  3. 3Anthony Damico is an independent consultant in Bethesda, Maryland.

Abstract

Medicare per capita spending for beneficiaries with traditional Medicare over age 65 peaks among beneficiaries in their mid-90s and then declines, and it varies by type of service with advancing age. Between 2000 and 2011 the peak age for Medicare per capita spending increased from 92 to 96. In contrast, among decedents, Medicare per capita spending declines with age.

As the US population ages and more people on Medicare live into their 80s, 90s, and beyond, analysts and policy makers are examining the impact of these trends on the federal budget and the Medicare program. At the same time, geriatricians and other providers who care for older patients are paying greater attention to the question of how best to meet the needs of an aging population. By 2050 the number of people on Medicare ages 80 and older will nearly triple; the number of people in their 90s and 100s will quadruple.13

To inform discussions about Medicare’s role in providing coverage for an aging population and to assess the relationship between Medicare spending and advancing age, this article presents findings from an analysis of Medicare per capita spending among beneficiaries over age 65 in traditional Medicare, by age and type of service.4Our main findings are shown in Exhibit 1 and discussed in detail below.

Screen Shot 2015-01-23 at 7.41.43 AM

Exhibit 1

Medicare Per Capita Spending For Traditional Medicare Beneficiaries Over Age 65, By Age And Survival Status, 2011

SOURCE Authors’ analysis of a 5 percent sample of Medicare claims for 2011 from the Chronic Conditions Data Warehouse of the Centers for Medicare and Medicaid Services. NOTES Average per capita spending in 2011 for all traditional Medicare beneficiaries over age 65 (“all beneficiaries”) was $9,839; for the subset of those beneficiaries who were still alive at the end of 2011 (“full-year survivors”), it was $8,647. The analysis excluded beneficiaries with Medicare Advantage. The analysis also excluded traditional Medicare beneficiaries age 65 because some of these beneficiaries are enrolled for less than a full year; therefore, a full year of Medicare spending data is not available for all people at this age.

Previous studies have reported an increase by age in Medicare per capita spending,5,6beneficiaries’ out-of-pocket spending,7 and Medicaid spending.8 However, they have not examined Medicare per capita spending in depth, categorizing it by beneficiaries’ age and type of service and including trends over time.

We examine the following questions: What is the trajectory of Medicare per capita spending by age, at what age does spending peak, and has the peak age changed over time? How does Medicare per capita spending by age vary for specific Medicare-covered services? What is the pattern of per capita spending by age among decedents?

January 23, 2015 Posted by | health care | , , , | Leave a comment

[Reblog] Do drug seekers in the ER make you burst out in song? It did here.

Do drug seekers in the ER make you burst out in song? It did here.. From the 19 January 2015 post at KevinMD.com

January 22, 2015 Posted by | health care | , , , , | Leave a comment

[Report] Medicare Hospices Have Financial Incentives To Provide Care in Assisted Living Facilities | Full Text Reports…

 

Screen Shot 2015-01-21 at 9.27.45 PM

From the executive summary of the January 2015 report by Department of Health and Human Services, OFFICE OF INSPECTOR GENERAL

WHY WE DID THIS STUDY
Medicare hospice care is intended to help terminally ill beneficiaries continue life with
minimal disruption and to support families and caregivers. Care may be provided in
various settings, including a private home or other places of residence, such as an assisted
living facility (ALF). Pursuant to the Patient Protection and Affordable Care Act, the
Centers for Medicare & Medicaid Services (CMS) must reform the hospice payment
system, collect data relevant to revising payments, and develop quality measures. This
report provides information to inform those decisions and is part of the Office of
Inspector General’s (OIG) larger body of work on hospice care. While the report focuses
on ALFs, many of the issues identified pertain to the hospice benefit more broadly.
HOW WE DID THIS STUDY
We based this study on an analysis of all Medicare hospice claims from 2007 through
2012. We used Certification and Survey Provider Enhanced Reports data and Healthcare
Cost Report Information System reports for information on hospice characteristics.
WHAT WE FOUND
Medicare payments for hospice care in ALFs more than doubled in 5 years, totaling
$2.1 billion in 2012. Hospices provided care much longer and received much higher
Medicare payments for beneficiaries in ALFs than for beneficiaries in other settings.
Hospice beneficiaries in ALFs often had diagnoses that usually require less complex care.
Hospices typically provided fewer than 5 hours of visits and were paid about $1,100 per
week for each beneficiary receiving routine home care in ALFs. Also, for-profit hospices
received much higher Medicare payments per beneficiary than nonprofit hospices. This
report raises concerns about the financial incentives created by the current payment
system and the potential for hospices to target beneficiaries in ALFs because they may
offer the hospices the greatest financial gain. Together, the findings in this and previous
OIG reports show that payment reform and more accountability are needed to reduce
incentives for hospices to focus solely on certain types of diagnoses or settings.
WHAT WE RECOMMEND
We recommend that CMS, as part of its ongoing hospice reform efforts: (1) reform
payments to reduce the incentive for hospices to target beneficiaries with certain
diagnoses and those likely to have long stays, (2) target certain hospices for review, (3)
develop and adopt claims-based measures of quality, (4) make hospice data publicly
available for beneficiaries, and (5) provide additional information to hospices to educate
them about how they compare to their peers. CMS concurred with all five
recommendations.

January 21, 2015 Posted by | health care | , , | Leave a comment

[Report] Regulation of Clinical Tests: In Vitro Diagnostic (IVD) Devices, Laboratory Developed Tests (LDTs), and Genetic Tests

From the summary of the December 2014 report by the Congressional Research Service

In vitro diagnostic (IVD) devices are used in the analysis of human samples, such as blood or
tissue, to provide information in making health care decisions. Examples of IVDs include (1)
pregnancy test kits or blood glucose tests for home use; (2) laboratory tests for infectious disease,such as HIV or hepatitis, and routine blood tests, such as cholesterol and anemia; and (3) tests forvarious genetic diseases or conditions. More recently, a specific type of diagnostic test—called acompanion diagnostic—has been developed that may be used to select the best therapy, at the right dose, at the correct time for a particular patient; this is often referred to as personalized or precision medicine.


In June 2010, FDA announced its decision to exercise its authority over all LDTs. A provision in
the Food and Drug Administration Safety and Innovation Act of 2012 stipulates that the agency
“may not issue any draft or final guidance on the regulation” of LDTs without, “at least 60 days
prior to such issuance,” first notifying Congress “of the anticipated details of such action.” On
July 31, 2014, in fulfillment of this statutory requirement, the FDA officially notified the Senate
Committee on Health, Education, Labor and Pensions and the House Committee on Energy and
Commerce that it will issue draft guidance on the regulation of LDTs, and included the
anticipated details of that regulatory framework. On October 3, 2014, the FDA formally issued
these documents as draft guidance in the Federal Register, giving 120 days for comment.
The draft guidance identifies groups of LDTs that will be (1) exempt from regulation entirely; (2)
only required to meet notification and adverse event reporting requirements; and (3) required to
meet notification, adverse event reporting, applicable premarket review, and other regulatory
requirements. FDA will use the information obtained through the notification requirement to
classify LDTs, based on risk, using a public process involving advisory panels and public
comment. Once classification has taken place, the FDA will enforce premarket review
requirements, prioritizing the highest-risk tests. The agency anticipates the entire process of
bringing all LDTs into compliance will take nine years to complete.

 

January 21, 2015 Posted by | health care | , , , , | Leave a comment

[Reblog] Imprisonment and public health

From the   post at thefeverblog

Mass incarceration in the United States goes beyond the logistical issues of overcrowded prisons. A shallow mindset wouldn’t identify the connection between mass incarceration and public health, but it’s prevalent and significance is being recognized. An article published in the New York Times briefly discusses the impact mass incarceration has on public health. It touches on a report published by the Vera Institute of Justice, which is an organization that focuses on making justice systems fairer through research and innovation. Most people in prisons come from impoverished communities, and therefore have low health-status.  Specifically, people in prisons have higher rates of chronic disease, mental illness, and substance abuse.

But that’s really the obvious part of the mass incarceration-public health relationship. Overcrowding exacerbates health problems, especially communicable diseases such as flu and other viral infections. In a previous post, I shared how social reform in Russia led to mass incarceration and in turn one of the largest outbreaks of tuberculosis in history. Mental illness  and substance abuse are major problems in jails, and the problem isn’t being addressed adequately. Although over 45% of incarcerated people have a mental illness and over 68% have substance abuse issues, only 15% receive proper treatment.

But that’s not even the  real problem. Our justice system is focused on penalizing, so vulnerable people coming out of prison are unable to receive any assistance because their actions have removed their eligibility. On first glance, the conservative argument would be that felons shouldn’t be privy to housing, medical, and financial assistance. But the whole picture has to be taken into consideration. Families can be easily torn apart by a family member being incarcerated, especially when parents are taken away from children.

Suicides and violence are also common in prisons. In the Vera Institute study it was found that 1/3 of deaths in prisons are due to suicide. Everything considered, mass incarceration is an epidemic and it’s public health ramifications are significant. The justice system in the United States needs to work with public health agencies to improve services, education, and awareness in prisons. The system needs to consider cases of penalizing on an individual by individual basis when evaluating eligibility for financial, housing, and medical assistance.

January 21, 2015 Posted by | health care, Public Health | , , , | Leave a comment

From the 13 January 2015 post at Mike the Mad Biologist

Last week, the NY Times ran story about how the Harvard University healthcare plan is raising various employee costs in an effort to lower costs–this is partly a response to various Obamacare/ACA policies (boldface mine):

The university is adopting standard features of most employer-sponsored health plans: Employees will now pay deductibles and a share of the costs, known as coinsurance, for hospitalization, surgery and certain advanced diagnostic tests. The plan has an annual deductible of $250 per individual and $750 for a family. For a doctor’s office visit, the charge is $20. For most other services, patients will pay 10 percent of the cost until they reach the out-of-pocket limit of $1,500 for an individual and $4,500 for a family.

Previously, Harvard employees paid a portion of insurance premiums and had low out-of-pocket costs when they received care.

……

Why? If you’re sick and able to pay, you will get the treatment in most cases. It’s worth the money–being able to afford medical treatment is one reason people like having money. Most people just aren’t that cheap when it comes to their health. But if you’re unable to pay, you won’t get treatment–even if you need it. The latter will lower healthcare costs–less fortunate people won’t get treatment–but so would shooting sick people in the head. And if you don’t believe me, those radicals at the Boston Federal Reserve seem to think so as well.

January 20, 2015 Posted by | health care | , , , | Leave a comment

[Reblog] The Illogic of Co-Pays and Deductibles

From the 13 January 2015 post at Mike the Mad Biologist

Last week, the NY Times ran story about how the Harvard University healthcare plan is raising various employee costs in an effort to lower costs–this is partly a response to various Obamacare/ACA policies (boldface mine):

The university is adopting standard features of most employer-sponsored health plans: Employees will now pay deductibles and a share of the costs, known as coinsurance, for hospitalization, surgery and certain advanced diagnostic tests. The plan has an annual deductible of $250 per individual and $750 for a family. For a doctor’s office visit, the charge is $20. For most other services, patients will pay 10 percent of the cost until they reach the out-of-pocket limit of $1,500 for an individual and $4,500 for a family.

Previously, Harvard employees paid a portion of insurance premiums and had low out-of-pocket costs when they received care.

……

Why? If you’re sick and able to pay, you will get the treatment in most cases. It’s worth the money–being able to afford medical treatment is one reason people like having money. Most people just aren’t that cheap when it comes to their health. But if you’re unable to pay, you won’t get treatment–even if you need it. The latter will lower healthcare costs–less fortunate people won’t get treatment–but so would shooting sick people in the head. And if you don’t believe me, those radicals at the Boston Federal Reserve seem to think so as well.

January 20, 2015 Posted by | health care | , , | Leave a comment

[Repost] Journalists’ coverage of prenatal screening uncovers big gaps in what we know about genetic testing

From the 16 January 2015 article at Covering Health

Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health insurance. He welcomes questions and suggestions on insurance resources and tip sheets at joseph@healthjournalism.org.

Photo by mahalie stackpole via Flickr

Last month, journalists from the New England Center for Investigative Reporting raised serious questions about prenatal genetic screening tests, saying physicians and patients may not fully understand the results of these tests for fetal abnormalities.

In their reporting, the journalists exposed a symptom of what may be a bigger problem: the proliferation of genetic tests without a full understanding about what such testing can and cannot do. Even health insurers have struggled to understand how to pay for new genetic tests.

The stories also pointed out that federal regulators are wrestling with how to classify genetic tests. Many of these tests fall into the category of what pathologists call lab-developed tests or LDTs. These tests are not regulated by the FDA, as the NECIR journalists reported. In October, the FDA proposed regulating these tests as medical devices and clinical laboratories are pushing back, saying such regulations could interfere with the practice of medicine.

We’ll address these issues one at time…..

January 20, 2015 Posted by | health care | , , , , , | Leave a comment

[Reblog] Will Robots Replace Doctors?

I like the emphasis…will play a major role… instead of replace. I think that many nuances can only be detected by humans. And not sure computers can be totally programmed for such intangibles as empathy.

From the blog post by Dr. Bertalan Meskó on January 20, 2015

It is quite obvious, based on my previous posts, that I think cognitive computing will play a major role in the future of diagnostics. See these examples:

Now MobileHealthGlobal.com asked me to share my views on this:

In fact, these machines, which are also called cognitive computers, have the advantage of allowing the doctor to focus all of his or her attention on the patient, instead of having to concentrate on finding information. Thus, to combine human and artificial intelligence is key. Meskó defends that “the best potential pair is a human with technology.”

superordinadorwatsonibmeditora191251610

January 20, 2015 Posted by | health care | , , , | Leave a comment

Data for Individual Health | Agency for Healthcare Research & Quality (AHRQ)

Data for Individual Health | Agency for Healthcare Research & Quality (AHRQ).

From the press release
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Screen Shot 2015-01-20 at 5.31.01 AMScreen Shot 2015-01-20 at 5.32.09 AM

 

And that is the way it is

January 20, 2015 Posted by | health care | , | Leave a comment

[Reblog] Germs. The pseudoscience of quality improvement

hmmm…position justifications? power plays?

C-Dif

From the 7 December 2014 post by Karen Siebel, MD at the HealthCare Blog

No one wants a hospital-acquired infection—a wound infection, a central line infection, or any other kind.  But today, the level of concern in American hospitals about infection rates has reached a new peak—better termed paranoia than legitimate concern.

The fear of infection is leading to the arbitrary institution of brand new rules. These aren’t based on scientific research involving controlled studies.  As far as I can tell, these new rules are made up by people who are under pressure to create the appearance that action is being taken.

Here’s an example.  An edict just came down in one big-city hospital that all scrub tops must be tucked into scrub pants. The “Association of periOperative Registered Nurses” (AORN) apparently thinks that this is more hygienic because stray skin cells may be less likely to escape, though there is no data proving that surgical infection rates will decrease as a result.  Surgeons, anesthesiologists, and OR nurses are confused, amused, and annoyed in varying degrees.  Some are paying attention to the new rule, and many others are ignoring it.  One OR supervisor stopped an experienced nurse and told to tuck in her scrub top while she was running to get supplies for an emergency aortic repair, raising (in my mind at least) a question of misplaced priorities.

The Joint Commission, of course, loves nothing more than to make up new rules, based sometimes on real data and other times on data about as substantial as fairy dust.

A year or two ago, another new rule surfaced, mandating that physicians’ personal items such as briefcases must be placed in containers or plastic trash bags if they are brought into the operating room.  Apparently someone thinks trash bags are cleaner.

Now one anesthesiology department chairman has taken this concept a step further, decreeing that no personal items at all are to be brought into the operating room–except for cell phones and iPods.  That’s right, iPods, not iPads.  This policy (of course) probably won’t be applied uniformly to high-ranking surgeons or to people like the pacemaker technicians who routinely bring entire suitcases of equipment into the OR with them.

What’s particularly irrational about this rule is that cell phones likely are more contaminated with bacteria than briefcases or purses, even if they’re wiped off frequently.

 

Instead of creating more and more rules governing the care of all patients, perhaps we need to focus on the subsets of patients and case types that we already know are at higher risk, and examine what additional steps we need to take on their behalf.

 

 

 

December 9, 2014 Posted by | health care | , , , , , , , | Leave a comment

[Press release] Distrust of police is top reason Latinos don’t call 911 for cardiac arrest

Distrust of police is top reason Latinos don’t call 911 for cardiac arrest.

From the 4 December 2014 EurkAlert

WASHINGTON – Fear of police, language barriers, lack of knowledge of cardiac arrest symptoms and financial concerns prevent Latinos – particularly those of lower socioeconomic status – from seeking emergency medical help and performing cardiopulmonary resuscitation (CPR), according to a study published online yesterday in Annals of Emergency Medicine (“Barriers to Calling 911 and Learning and Performing Cardiopulmonary Resuscitation (CPR) for Residents of Primarily Latino, High-Risk Neighborhoods in Denver, Colorado”).

English: CPR training

English: CPR training (Photo credit: Wikipedia)

“Residents of low-income, minority neighborhoods have two strikes against them: the incidence of out-of-hospital cardiac arrest is much higher than average and rates of bystander CPR are below average,” said lead study author Comilla Sasson, MD, PhD, FACEP of the American Heart Association and the University of Colorado School of Medicine in Aurora, Colo. “We need to do a better job of overcoming the significant barriers to timely medical care for Latinos suffering cardiac arrest. Culturally sensitive public education about cardiac arrest and CPR is a key first step.”

Researchers conducted focus groups and interviews with residents of primarily lower-income Latino neighborhoods in Denver to determine why they underutilize 9-1-1 emergency services and how to increase knowledge and performance of CPR on people suffering cardiac arrest. General distrust of law enforcement, of which 9-1-1 services are bundled, was cited as a top reason for not calling 9-1-1 by most participants.

Many subjects also believed – incorrectly – that they would not be able to ride an ambulance to the hospital without first paying for it, as that is the practice in Mexico where many participants came from. Subjects also expressed a lack of understanding about the symptoms of cardiac arrest and how CPR can save a life. Strong reticence about touching a stranger for fear that it might be misconstrued was a unique cultural barrier to performing CPR. Language barriers – either with 9-1-1 dispatchers or first responders – also inhibited subjects from getting involved with someone experiencing cardiac arrest.

In the interest of educating more people on how to perform CPR, participants widely supported policy changes that would make CPR either a high school graduation requirement or a pre-requisite for receiving a driver’s license.

“Future research will need to be conducted to better understand how targeted, culturally-sensitive public education campaigns may improve the provision of bystander CPR and cardiac arrest survival rates in high-risk neighborhoods,” said Dr. Sasson.

###

Annals of Emergency Medicine is the peer-reviewed scientific journal for the American College of Emergency Physicians, the national medical society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research, and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies. For more information, visit http://www.acep.org.

December 5, 2014 Posted by | health care, Medical and Health Research News | , , , , , , | Leave a comment

[Report] Surveying Health Care Quality & Value

Surveying Health Care Quality & Value

From the 24 November 2014 Robert Woods Foundation report

Recent years have brought numerous efforts to educate and engage Americans in what “quality” health care is, how to find it and how they can get better value for their dollars. To better understand the latest trends, the Robert Wood Johnson Foundation funded the AP-NORC Center for Public Affairs Research at the University of Chicago to conduct three surveys through the summer and fall of 2014.

The surveys each individually examined how consumers and employers, as purchasers, perceive health care quality and how they use quality information and performance data on health plans and providers. Learn more about the research and access links to the full reports with accompanying materials.

 

 A medical assistant checks a patient's blood pressure and pulse.

Consumer Awareness of Provider Quality and Value

A number of initiatives in recent years have aimed at engaging consumers in making informed health care decisions, including empowering patients and their caregivers with data on provider quality, performance, cost and value. The first in the series of surveys looks at the inroads these efforts have made.

Thirty-seven percent of respondents don’t believe that higher health care costs correlate with better quality care—but 48 percent think they do. The poll also found that more than two-thirds say finding a doctor or hospital that offers the highest quality at the lowest possible cost is important to them. The survey also showed getting Americans to find quality information and use it in their health care decisions remains a challenge, with only 11 percent of Americans reporting they have done so.

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Cost- and Coverage-Based Decision-Making

As more provisions of the Affordable Care Act (ACA) are implemented over the next decade, the government projects that approximately 12 million additional people younger than 65 will enter the private insurance market. The second in the series of surveys looks at consumer opinions on health care costs and coverage, and how it impacts their decision-making.

It shows that nearly a fifth of insured Americans report skipping a trip to the doctor when they’re sick or injured to save money, and only 36 percent are confident they can pay for a major, unexpected medical expense. Those enrolled in health plans with high deductibles are greatly impacted by the out-of-pocket cost of health care—they are concerned with the uncertainty of major expenses, skip necessary medical treatment, and experience real financial burden when obtaining health care.

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Billboard Illustration for SHADAC ESI Report April 2013

Employers Use of Quality Information in Purchasing

As a group, employers represent the largest purchaser of care in the United States. Given this, it is critical that they demand good value for the money they spend, ensuring that the plans offered to employees be high quality. The third and final report in the series of surveys looks at the opinions of private sector employers, including small-, medium- and large-sized businesses.

It shows that American firms are hesitant to say they would pay more for higher quality care, and when it comes to measuring quality, 90 percent don’t know or don’t use independent quality information when deciding on what plans to offer employees. And while many employers are indeed providing wellness programs to benefit their employees’ health, relatively few are actively promoting those programs or offering incentives for participation.

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December 5, 2014 Posted by | health care | , , , , , , | Leave a comment

[Press Release] Efforts to improve patient safety result in 1.3 million fewer patient harms, 50,000 lives saved and $12 billion in health spending avoided

Efforts to improve patient safety result in 1.3 million fewer patient harms, 50,000 lives saved and $12 billion in health spending avoided

From the US Health and Human Services press release

Hospital-acquired conditions decline by 17 percent over a three-year period

A report released by the Department of Health and Human Services today shows an estimated 50,000 fewer patients died in hospitals and approximately $12 billion in health care costs were saved as a result of a reduction in hospital-acquired conditions from 2010 to 2013.  This progress toward a safer health care system occurred during a period of concerted attention by hospitals throughout the country to reduce adverse events. The efforts were due in part to provisions of the Affordable Care Act such as Medicare payment incentives to improve the quality of care and the HHS Partnership for Patients initiative.  Preliminary estimates show that in total, hospital patients experienced 1.3 million fewer hospital-acquired conditions from 2010 to 2013.  This translates to a 17 percent decline in hospital-acquired conditions over the three-year period.

“Today’s results are welcome news for patients and their families,” said HHS Secretary Sylvia M. Burwell. “These data represent significant progress in improving the quality of care that patients receive while spending our health care dollars more wisely.  HHS will work with partners across the country to continue to build on this progress.”

Today’s data represent demonstrable progress over a three-year period to improve patient safety in the hospital setting, with the most significant gains occurring in 2012 and 2013. According to preliminary estimates, in 2013 alone, almost 35,000 fewer patients died in hospitals, and approximately 800,000 fewer incidents of harm occurred, saving approximately $8 billion.

Hospital-acquired conditions include adverse drug events, catheter-associated urinary tract infections, central line associated bloodstream infections, pressure ulcers, and surgical site infections, among others.  HHS’ Agency for Healthcare Research and Quality (AHRQ) analyzed the incidence of a number of avoidable hospital-acquired conditions compared to 2010 rates and used as a baseline estimate of deaths and excess health care costs that were developed when the Partnership for Patients was launched. The results update the data showing improvement for 2012 that were released in May.

“Never before have we been able to bring so many hospitals, clinicians and experts together to share in a common goal – improving patient care,” said Rich Umbdenstock, president and CEO of the American Hospital Association. “We have built an ‘infrastructure of improvement’ that will aid hospitals and the health care field for years to come and has spurred the results you see today. We applaud HHS for having the vision to support these efforts and look forward to our continued partnership to keep patients safe and healthy.”

Additional Information

December 5, 2014 Posted by | health care | , , , , , | Leave a comment

Online Health Care Data Sources | Brookings Institution

Online Health Care Data Sources | Brookings Institution.

 

From the Web site

This is a preliminary scan of publicly available online health care datasets, transparency websites and tools, gathered from expert recommendations and intensive review. Though this list is not exhaustive, we have attempted to include the most relevant sources for the purposes of this study. Each health data source is assigned an icon representing (1) who the source is useful to i.e. consumers or researchers; (2) what information the source includes i.e. data pertaining to quality of care or cost of care; and (3) who the source provides information on i.e. providers or payers.

December 2, 2014 Posted by | health care | , , , , , | Leave a comment

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