Precision Medicine: Can We Afford It? Can We Afford Not To Explore It? [news release]

From the 8 March 2016 Texas A & M news release

Excerpts

Imagine that the next time your doctor orders a round of tests, in addition to cholesterol and vitamin D, she also orders a genome sequence. It sounds like science fiction, but the day might come sooner than you think.

Precision medicine—in which each patient’s prevention and treatment decisions are tailored for them—has been a buzzword in the health care industry recently. President Barack Obama launched his Precision Medicine Initiative, and other countries have similar projects underway.

With concerns about the cost of health care, though, can we afford precision medicine?

In certain instances, precision medicine can actually save money. For example, if patients can be screened for drug hypersensitivity before being prescribed certain drugs, they won’t have to be treated later, which is better for patients and cuts down on costs. A similar approach works for choosing treatments.

“When you use a therapy to target only the individuals who will benefit, you avoid wasting drugs or other resources on people who you know won’t get any benefit, and who might actually be harmed,” said David Threadgill, Ph.D., professor and holder of the Tom and Jean McMullin Chair of Genetics at the Texas A&M Health Science Center College of Medicine and director of the Texas A&M Institute for Genome Sciences and Society.

Of course, it’s not quite that simple. “Whether the economics works out in favor of precision medicine depends on two things: the difficulty and the cost of finding the best candidates who will benefit from specific, tailored treatments,” said Robert L. Ohsfeldt, Ph.D., health economist and professor in the Department of Health Policy & Management at the Texas A&M School of Public Health. “You have to know a lot about the disease process and how individual characteristics—genetics and environmental factors like diet or exposure to toxins—mediate the treatment response.”

Continue reading on Vital Record.

Beware of hype about how consumers will benefit when health insurers merge [Reblog]

From the 27 July 2015 blog of the Association of Healthcare Journalists

GraphicStock

 

Earlier this month, Thomas Greaney explained the antitrust issuescomprehensively in Health Affairs. “Because each market is local, antitrust analysis would also require an assessment of the competitive overlap in each region,” he wrote. Greaney, is the Chester A. Myers Professor of Law and director of the Center for Health Law Studies at Saint Louis University School of Law.

There is no evidence that insurance or provider monopolies are good for consumers, he wrote, citing Boston and Pittsburgh as evidence that big is not necessarily better in health care or health insurance.

For a good review of the regulatory hurdles insurers face, see this thorough analysisi*** in The New York Times by Robert Cyran. Regulators are concerned about how reduced competition may drive up prices, he explained, writing, “Insurance markets are highly concentrated, and big mergers will make them even more so.”

***Excerpt from The New York Times article
“What’s more, the argument that a big merger would create competition for an even heftier rival has already failed in other industries. In 2011, for example, Sprint, the third-largest cellphone service provider at the time, defended its plan to buy T-Mobile US, the fourth-largest, as necessary to keep its rivals Verizon and AT&T in check. The Federal Communications Commission and the Justice Department rejected the contention, making clear that shrinking the market to fewer than two nationwide carriers would harm consumers.”

Insurers could also argue that a combination would create savings and improvements in technology that would redound to consumers’ benefit. Besides, they may point out, state insurance commissioners would have to approve any rise in insurance premiums. Yet the commissioners have often been reluctant to deny insurers rate increases, and insurance company mergers typically lead to higher premiums, according to a study by Leemore Dafny, former director of health care antitrust at the Federal Trade Commission.

So what might persuade the regulators?

The Affordable Care Act could be the answer. President Obama’s health care overhaul creates online exchanges for buying coverage, allowing insurers to expand into new markets without hiring expensive agents. The companies will still need the approval of state commissioners, but the lower barriers to entry should stir more competition – and, at least in the future, appease regulatory fears. It’s unclear whether that would be enough to counterbalance concerns over the top five insurers’ currently chunky market shares.”

[Reblog] The Smoking Gun: How U.S. Health Care Came to Cost Insanely More

From the 20 May 2015 post at The Health Care Blog

Health care that costs more than it needs to is not just an annoyance; it’s a big factor in income inequality in the United States. The financial, physical and emotional burden of disease are major drivers of poverty. At the same time, the high cost of health care even after the Affordable Care Act means that many people don’t access it when they need it, and this in turn deprives large swathes of the population of their true economic potential as entrepreneurs, workers and consumers. People who are burdened by disease and mental illness don’t start businesses; don’t show up for work; and don’t spend as much money on cars, smartphones and cool apartments. Unnecessary sickness is a burden to the whole economy.

How did we get this way? What was the mechanism that differentiated U.S. health care from all other advanced countries? The usual suspects (such as “We have the most sophisticated research and teaching hospitals,” or “It’s the for-profit health insurers” or “Doctors make too much”) all fail when we compare the United States with other sophisticated national systems such as those in Germany and France. Other countries have all of these factors in varying amounts — private health insurers, world-class research, well-paid physicians — and cost a lot, but still spend a far smaller chunk of their economy on health care. Blame has been leveled in every direction, but in reality no single part of health care has been the driver. The whole system has become drastically more expensive over the last three decades.

What’s the Mechanism?

Since the difference between the United States and other countries is so large and obvious, there should be some way we can look at health care spending that would make that mechanism jump out at us. And there is a way.

…

That first big leap is between 1982 and 1983. What was different in 1983 that was not there in 1982? DRGs, diagnosis-related groups — the first attempt by the government to control health care costs by attaching a code to each item, each type of case, each test or procedure, and assigning a price it would pay in each of the hundreds of markets across the country. The rises continue across subsequent years as versions of this code-based reimbursement system expand it from Medicare and Medicaid to private payers, from inpatient to ambulatory care, from hospitals to physician groups and clinics, to devices and supplies, eventually becoming the default system for paying for nearly all of U.S. health care: code-driven fee-for-service reimbursements.

Cost Control Drives Costs Up?

How can a cost control scheme drive costs up? In a number of ways: In an attempt to control the costs of the system, the DRG rubric controlled the costs of units, from individual items like an aspirin or an arm sling to the most comprehensive items such as an operation or procedure. The system did not pay for an entire clinical case across the continuum of care from diagnosis through rehab; or for an entire patient per year on a capitated basis, which would capture the economic advantages of prevention; or for an entire population. While it is more cost-effective (as well as better medicine) to provide a diabetes patient with medical management, in-home nursing visits and nutritional counseling rather than, say, waiting until the patient needs an amputation, the coding system actually punished that efficiency and effectiveness. Under this system, we got paid for our inefficiencies, and even for our mistakes: Do-overs would often drop far more to the bottom line than the original procedure did.

The system punished, rather than rewarded, spending more time with patients, trying to help patients before their problems became acute, or maintaining a long-term, trusted relationship with patients. Under a code-driven fee-for-service system, getting serious about prevention and population health management would be a broad road to bankruptcy.

If extra items were deemed necessary (an extra test or scan, say), there were codes for that, and reimbursements awaiting. In so doing, the system rewarded doing more (“volume”) rather than whatever would be the best, most appropriate, most efficient treatment path (“value”). It provided a written, detailed catalog of reimbursements which rewarded diagnoses of greater complexity, rewarded new techniques and technologies with new and usually higher reimbursements, and especially rewarded systems that invested in a greater capability to navigate the coding system. At the same time, the reimbursements were constantly open to pressure from the industry. Each part of the industry, each region, each specialty, each part of the device industry, became fiercely focused on keeping those reimbursements up, and getting new codes for more costly procedures.

The business and strategic side of health care became a matter of making money by farming the coding system. Do more of what gets better reimbursement, less of what does not. Make sure every item gets a code and gets charged for. The codes became a manual for success, a handbook for empire.

The Smoking Gun

The smoking gun is right there in the chart, at the big split between the trajectories of the United States and other countries. And today, at this moment, the code-based fee-for-service payment system is still by far the basis of the majority of all revenue streams across health care.

The unifying factor between multiple new strategies unfolding in health care right now, including patient-centered medical homes, pay for performance, bundled prices, reference prices, accountable care organizations, direct pay primary care and others, is to find some way around the strict code-based fee-for-service system, either by avoiding it entirely or by adding epicycles and feedback loops to it to counter its most deleterious effects.

There is no perfect way to pay for health care. All payment methods have their drawbacks and unintended consequences. But the code-based fee-for-service system got us here, and any path out of the cost mess we are in has to get us off that escalator one way or another.

…

[News release] George Washington University to hold national conference on integrating health and legal care

From the 25 March 2015 EurkAlert!

he National Center for Medical-Legal Partnership, part of Milken Institute School of Public Health at the George Washington University, will host its tenth annual conference on April 9-10, 2015, in McLean, Virginia to discuss how to better address the social and legal problems negatively impacting the health of 50 million low-income Americans. Leaders from law, health care, public health and government in 38 states will present research and strategies aimed at effectively integrating health and legal care.

With featured remarks from Lauren Taylor, co-author of The American Health Care Paradox, Jeffrey Levi, executive director of Trust for America’s Health, and Phillip Alberti, senior director for health equity research & policy at the Association of American Medical Colleges, participants will explore topics including:

• The intersection of health and legal problems for veterans, children and chronically ill individuals;
• The ways that providing integrated legal care for patients can help meet community benefit requirements for public hospitals; and
• The ability of legal care to strengthen population health interventions.

A full agenda is available at: http://www.medical-legalpartnership.org/join-movement/summit/

[News release] Research aims to reduce health care disparities

From ScienceDaily

Date:March 26, 2015

Source:H. Lee Moffitt Cancer Center & Research Institute

Summary:The lesbian, gay, bisexual, transgender/transsexual, queer/questioning and intersex (LGBTQI) population has been largely understudied by the medical community. Researchers found that the LGBTQI community experience health disparities due to reduced access to health care and health insurance, coupled with being at an elevated risk for multiple types of cancer when compared to non-LGBTQI populations.

—

The study highlights that LGBTQI populations face barriers to health insurance such as when partnerships and marriages are not legally recognized; concerns about disclosure in a health care setting, discrimination, misconceptions, legal and financial barriers and the disenfranchised stress and distress of caregiving same-sex partners.

Additionally, there are higher rates of smoking and substance abuse and low screening rates resulting in poor patient outcomes and survival rates for LGBTQI populations. Her review, The Importance of disclosure: Lesbian, gay, bisexual, transgendered, queer/questioning, and intersex individuals and the cancer continuum, was published in the American Cancer Society’s journal, Cancer.

Researchers identified that the real or perceived limited access to care due to fear of discrimination and lack of sensitivity and knowledge of LGBTQI issues stood as roadblocks to patient care. In a study of family physicians only 1 in 80 reported routinely asking patients about sexual orientation, while the majority reported rarely or never asking. The National Institutes of Health and the Institute of Medicine now recognize gender identify and sexual orientation as vital aspects of a health history and the need for improved research in this population.

“For many years, physicians did not ask patients about their sexual orientation. The importance of recognizing gender identity and sexual orientation is critical to ensuring the best quality and evidence-based care is available to patients,” explained Quinn.

Related articles

• LGBT Rights in Utah
• June is LGBT Pride Month
• Gay & LGBT Agenda – March 13, 2015
• Study: Public opinion, state law at odds on LGBT workplace protections
• Homosexual by Choice? Planned Parenthood Says Sexual Orientation Can Change Over Time
• Defeat of Charlotte anti-discrimination bill demonstrates long road ahead for equality
• Anti-bias bill supported by Mormon Church passes in Utah legislature
• Designing the Future for Equality Is Our Business in Arkansas

[Research article] High value health IT: Policy reforms for better care and lower costs

From the 16 March 2015 Brookings news release

Achieving better health outcomes at a lower cost and succeeding with payment reforms that shift from volume to value is difficult without health information technology (IT). Health IT can engage and support health care providers, patients, and consumers with access to timely and accurate clinical information from electronic health records (EHRs) and other sources. It can also provide access to cost and coverage information that avoids burdensome administrative processes and unexpected costs. Health IT can achieve these benefits through interoperability across information and data exchange platforms – avoiding duplicative parallel systems and additional data entry. Engaged patients and providers, supported by flexible, usable and useful health IT, can make informed shared decisions about testing and treatment which can lead to more timely, efficient, and higher-value health care.

 

Download the issue brief.

Related articles

• CMS publishes Stage 3 Meaningful Use proposal
• Hospital Open Patient Physician Exchange (HOPPE) Ends Interoperability
• Doctors say Obamacare’s electronic health record mandate is too costly, results in worse care

[News release] Insuring undocumented residents could help solve multiple U.S. health care challenges

From the 18 March 2015 UCLA news release

UCLA health care policy analysis finds four key problem areas for Latinos under Affordable Care Act

Latinos are the largest ethnic minority group in the United States, and it’s expected that by 2050 they will comprise almost 30 percent of the U.S. population. Yet they are also the most underserved by health care and health insurance providers.

Latinos’ low rates of insurance coverage and poor access to health care strongly suggest a need for better outreach by health care providers and an improvement in insurance coverage. Although the implementation of the Affordable Care Act of 2010 seems to have helped (approximately 25 percent of those eligible for coverage under the ACA are Latino), public health experts expect that, even with the ACA, Latinos will continue to have problems accessing high-quality health care.

Alex Ortega, a professor of public health at the UCLA Fielding School of Public Health, and colleagues conducted an extensive review of published scientific research on Latino health care. Their analysis, published in the March issue of the Annual Review of Public Health, identifies four problem areas related to health care delivery to Latinos under ACA:

• The consequences of not covering undocumented residents.
• The growth of the Latino population in states that are not participating in the ACA’s Medicaid expansion program.
• The heavier demand on public and private health care systems serving newly insured Latinos.
• The need to increase the number of Latino physicians and non-physician health care providers to address language and cultural barriers.

“As the Latino population continues to grow, it should be a national health policy priority to improve their access to care and determine the best way to deliver high-quality care to this population at the local, state and national levels,” Ortega said. “Resolving these four key issues would be an important first step.”

Insurance for the undocumented

Whether and how to provide insurance for undocumented residents is, at best, a complicated decision, said Ortega, who is also the director of the UCLA Center for Population Health and Health Disparities.

For one thing, the ACA explicitly excludes the estimated 12 million undocumented people in the U.S. from benefiting from either the state insurance exchanges established by the ACA or the ACA’s expansion of Medicaid. That rule could create a number of problems for local health care and public health systems.

For example, federal law dictates that anyone can receive treatment at emergency rooms regardless of their citizenship status, so the ACA’s exclusion of undocumented immigrants has discouraged them from using primary care providers and instead driven them to visit emergency departments. This is more costly for users and taxpayers, and it results in higher premiums for those who are insured.

In addition, previous research has shown that undocumented people often delay seeking care for medical problems.

…

As the ACA is implemented and more people become insured for the first time, local community clinics will be critical for delivering primary care to those who remain uninsured.

“These services may become increasingly politically tenuous as undocumented populations account for higher proportions of clinic users over time,” he said. “So it remains unclear how these clinics will continue to provide care for them.”

..

 

[News release] Medical expansion has led people worldwide to feel less healthy

From the 19 March 2015 Ohio State University news release

In 28 countries, more medicine has unexpected effects

COLUMBUS, Ohio – Across much of the Western world, 25 years of expansion of the medical system has actually led to people feeling less healthy over time, a new study has found.

A researcher at The Ohio State University used several large multinational datasets to examine changes in how people rated their health between 1981 and 2007 and compared that to medical expansion in 28 countries that are members of the Organization for Economic Co-operation and Development.

During that time, the medical industry expanded dramatically in many of those countries, which you might expect would lead to people who felt healthier.

But that’s not what Hui Zheng, assistant professor of sociology at Ohio State, found.

“Access to more medicine and medical care doesn’t really improve our subjective health. For example, in the United States, the percentage of Americans reporting very good health decreased from 39 percent to 28 percent from 1982 to 2006,” Zheng said.

Hui Zheng

In fact, Zheng conducted what is called a “counterfactual analysis” using the data to see what would have happened if the medical industry hadn’t expanded at all in these countries since 1982. In this analysis, other factors that are generally linked to improved health, such as economic development, were left unchanged.

Under this scenario, the analysis predicted that self-rated health would have increased in these 28 countries. For example, the percentage of Americans reporting very good health could have increased by about 10 percent.

“It seems counterintuitive, but that’s what the evidence shows. More medicine doesn’t lead to citizens feeling better about their health – it actually hurts,” Zheng said.

The study appears in the July 2015 issue of the journal Social Science Research.

The OECD is an organization of countries, including the United States and many countries in Europe, that accept the principles of representative democracy and free-market economy. This study included information from OECD Health Data, World Development Indicators, the World Values Survey and theEuropean Values Study.

Zheng measured three kinds of medical expansion. One was medical investment, which includes health care spending per capita and total health employment; medical professionalization and specialization, which includes the number of practicing physicians and specialists; and expanded pharmaceutical industry, which includes pharmaceutical sales per capita.

…

 

Zheng said there are several reasons why medical expansion may actually lead people to feel less healthy. For one, more diseases are discovered or “created,” which increases the risk of being diagnosed with “new” diseases. Three examples, he said, include the rise in diagnoses of attention deficit hyperactivity disorder (ADHD), depression and autism.

In addition, there is more aggressive screening, which turns up more diseases in people. Overdiagnosis can potentially cause harm to perfectly healthy people, he said.

As more medical care becomes more widely available, people may expect better health, perhaps to an unrealistic degree, Zheng said.

“Consumers begin demanding more medical treatment because of the declines in subjective health and the increasing expectations of good health, and medical expansion continues. It is a cycle,” Zheng said.

In a separate but related study published online in Social Science Research, Zheng found that Americans’ confidence in medicine has declined over the last three decades, again at the same time as medical expansion.

“The decline in confidence has occurred at the same rate, regardless of gender, age, income or any other factor,” Zheng said.

[Reblog] Value-Based Care

From the 11 March 2015 post by Cindy Nayer at The Health Care Blog

In recent weeks, the market has reacted to a few noteworthy headlines, all involved with or touching upon value-based discretionary actions, and many with the not-so-hidden question: What’s In It for Me or WIIFM?

• CMS announced that by 2016 30% of fees in health care should be paid for through a value-based system, moving away from fee-for-service.
• ACO results have shown ambivalent outcomes.
• Outcomes-based contracts have permeated the Hepatitis C cost-nado (that’s a cost sharknado, the kind that fiercely defies cost controls and takes over all noise about payment reform and patient preferences).
• Reference-based pricing is a good/bad troublemaker in the middle of the value-based travails.

The latest rampages have appeared on two national and highly-regarded blogs: The Health Care Blog [Value-Based Reform] and The Health Affairs Blog [Go Slow on Reference Pricing].

As one of the loudest proponents on value-based designs, I lift the curtain again to show the thinking behind the movement from fee for service to value-based designs. All of these items above discuss the message of payment reform, or system alignment, but they are intensely linked to the patient-consumer ability to make the right choices, choose the right sites for care, and pay the right amount for services rendered to achieve health security.

….

Related articles

• State is model for doctors, hospitals nationwide
• White House Launches ‘Next Generation ACO’ With High-Touch Value-Based Care
• Health Insurers Poised to Profit on Value-Based Care
• A 3-part checklist that gets you ready for the value-based world of healthcare
• The shifting center of care
• CMS Releases Physician Value Modifier Payment Data
• What’s Wrong With Obama’s Rush to Change Doctors’ Medicare Payments
• Aetna Can’t Escape Fee-For-Service Medicine ‘Fast’ Enough
• New Phase of Obamacare: Next Generation Medical Care

Poll finds US public sees ill health as resulting from a broad range of causes

Good study. However I would like to see how this compares with what researchers believe are causes/correlations of ill health and how best to address the causes/correlations.

From the 2 March 2015 Harvard School of Public Health press release

Many believe their health has been impacted by negative childhood experiences

A new NPR/Robert Wood Johnson Foundation/Harvard T.H. Chan School of Public Health poll finds that more than six in ten people living in the U.S. (62%) are concerned about their future health. Nearly four in ten (39%) said that they had one or more negative childhood experiences that they believe had a harmful impact on their adult health.

Causes of ill health

“When the public thinks about the causes of ill health, it’s not just about germs. They also see access to medical care, personal behavior, stress, andpollution as affecting health,” said Robert J. Blendon, Richard L. Menschel Professor of Health Policy and Political Analysis at Harvard T.H. Chan School of Public Health.

When given a list of 14 factors that might cause ill health, the top five causes cited by the public as extremely important are lack of access to high-quality medical care (42%), personal behavior (40%), viruses or bacteria (40%), high stress (37%), and exposure to air, water, or chemical pollution (35%).

Those rankings diverge, however, among ethnic groups.

…

Actions to improve health

Given the wide range of reasons given for why ill health occurs, it is not surprising that people in the U.S. have a very broad view of the actions that could be taken to improve people’s health. The top five things (from a list of 16) that the public believes would improve people’s health a great deal are: improving access to affordable healthy food (57%), reducing illegal drug use (54%), reducing air, water, or chemical pollution (52%), increasing access to high-quality health care (52%), and improving the economy and the availability of jobs (49%).

 

 

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• It’s official: millennials are the most stressed-out generation
• Employed white southerners are most likely to lose their health insurance in Supreme Court case
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• What Shapes Health? Join The Discussion On Harvard’s Webcast
• As Supreme Court Weighs Gutting Obamacare, Low Income Americans Say Their Health Is Suffering

[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

Related articles

• How to stay compliant with healthcare data security regulations
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[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.

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

[Press release] Carnegie Mellon, Pitt Ethicists Question Impact of Hospital Advertisi

About 20 years ago I started thinking along similar lines. Now I am at a point questioning if it is ethical to profit from health care. Two years as a Peace Corps volunteer (back in 1980/81 in Liberia, West Africa) changed my views on many topics considerably. Also I think it was the wonderful humanistic/social justice  tone of grade school religious textbooks, notably 8th grade back in 1969.

Summary (from EurkAlert!)

Ethicists question the impact of health information that is available online, specifically hospital advertisements, and argue that while the Internet offers patients valuable data and tools — including hospital quality ratings and professional treatment guidelines – that may help them when facing decisions about where to seek care or whether to undergo a medical procedure, reliable and unbiased information may be hard to identify among the growing number of medical care advertisements online.

From the 30 January 2015 Carnegie Mellon press release

In a commentary piece published in JAMA Internal Medicine, Carnegie Mellon University’s Alex John London and the University of Pittsburgh’s Yael Schenkerquestion the impact of health information that is available online, specifically hospital advertisements. London and Schenker argue that while the Internet offers patients valuable data and tools — including hospital quality ratings and professional treatment guidelines — that may help them when facing decisions about where to seek care or whether to undergo a medical procedure, reliable and unbiased information may be hard to identify among the growing number of medical care advertisements online.

“The marketing objective of selling services by making them seem attractive to consumers can create tensions or outright conflict with the ethical imperative of respect for persons, since the latter requires that patients make medical decisions in light of balanced information about the full range of risks and benefits associated with their care,” said London, professor of philosophy in CMU’s Dietrich College of Humanities and Social Sciences and director of the Center for Ethics and Policy.

Referencing a research article in the same journal issue that found hospital websites failed to disclose risk information for transaortic valve replacement (TAVR), a recently approved procedure to treat patients whose aortic valve does not open fully, London and Schenker pinpoint four risk concerns for patients seeking medical information online:

1. Identifying Advertising — Hospital websites often have the appearance of an education portal, leaving patients to assume that the information presented is informational, not persuasive.

2. Finding Unbiased Information — Unlike FDA-regulated direct-to-consumer advertising for prescription drugs, hospital advertising is overseen by the Federal Trade Commission and subject to the same “reasonable” standards applied to advertisements for common consumer goods such as cars and cereal. While hospital advertisements may describe specific medical interventions that entail significant
risks, there is no legal requirement that these risks be disclosed.

3. Recognizing Incomplete or Imbalanced Information — Poor-quality medical information is hard to recognize unless the person reading it is a trained clinician.

4. Influence on Health Care Decisions — As patients seek out information online, the quality of their decision-making and care choices will be influenced by the accuracy or inaccuracy of the information they are likely to encounter.

To begin to fix the risk to patients seeking medical information online, London and Schenker recommend to clearly label hospital websites as advertisements; allocate resources to created balanced online informational tools; and focus future attention on not only the content of health care advertising but its impact.

For more information, visit http://www.hss.cmu.edu/philosophy/faculty-london.php.

 

Related Resource

• Evaluating Health Information (Health Resources for All, Edited by JaniceFlahiff)
  • The Penn State Medical Center Library has a great guide to evaluate health information on the Internet.

    The tips include

    • Remember, anyone can publish information on the internet!
    • If something sounds too good to be true, it probably is.
      If the Web site is primarily about selling a product, the information may be worth checking from another source.
    • Look for who is publishing the information and their education, credentials, and if they are connected with a trusted coporation, university or agency.
    • Check to see how current the information is.
    • Check for accuracy. Does the Web site refer to specific studies or organizations?
  • How to Evaluate Health Information on the Internet (US National Cancer Institute)

[Issue Brief] The Rise in Health Care Coverage and Affordability Since Health Reform Took Effect – The Commonwealth Fund

The Rise in Health Care Coverage and Affordability Since Health Reform Took Effect – The Commonwealth Fund.

From the January 2015 Issue Brief

Overview

New results from the Commonwealth Fund Biennial Health Insurance Survey, 2014, indicate that the Affordable Care Act’s subsidized insurance options and consumer protections reduced the number of uninsured working-age adults from an estimated 37 million people, or 20 percent of the population, in 2010 to 29 million, or 16 percent, by the second half of 2014. Conducted from July to December 2014, for the first time since it began in 2001, the survey finds declines in the number of people who report cost-related access problems and medical-related financial difficulties. The number of adults who did not get needed health care because of cost declined from 80 million people, or 43 percent, in 2012 to 66 million, or 36 percent, in 2014. The number of adults who reported problems paying their medical bills declined from an estimated 75 million people in 2012 to 64 million people in 2014. Read the brief.

 

 

 Publication Date:

January 15, 2015

Authors:
Sara R. Collins, Petra W. Rasmussen,Michelle M. Doty, Sophie Beutel

Contact:
Sara R. Collins, Vice President, Health Care Coverage and Access, The Commonwealth Fund

E-mail: src@cmwf.org

Citation:
S. R. Collins, P. W. Rasmussen, M. M. Doty, and S. Beutel, The Rise in Health Care Coverage and Affordability Since Health Reform Took Effect, The Commonwealth Fund, January 2015.

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January 20, 2015

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January 15, 2015

2014 Biennial Health Insurance Survey

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The Affordable Care Act Is Reversing Years of High Uninsurance Rates and Cost Barriers to Care

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[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.

• Here’s a Sunday New York Times book review by Zephyr Teachout.
• Here’s Malcolm Gladwell in the New Yorker.
• And Peter Orszag (who was in the Obama administration when the bill was being written and appears in the book) at Bloomberg View writes about what he thinks Brill got wrong.
• Avik Roy at Forbes has a conservative perspective.

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.

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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.

….

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

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[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.

 

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.

View chartpack

See the full survey results

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.

View chartpack

See the full survey results

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.

View chartpack

See the full survey results

[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

#172216716 / gettyimages.com

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

• Interim Update on 2013 Annual Hospital-Acquired Condition Rate and Estimates of Cost Savings and Deaths Averted from 2010 to 2013
• May 2014 patient safety results report
• Partnership for Patients Preliminary Evaluation Report

Hepatitis C Cure May Be Too Expensive for Prisoners – Stateline

Surely, as one of the wealthiest countries in the world, we can find a way to provide basic health care for all.
And this includes prisoners, they too are human beings.

 

Hepatitis C Cure May Be Too Expensive for Prisoners – Stateline.

If used widely, a new generation of antiviral drugs has the potential to wipe out the deadly hepatitis C virus in the United States. But the high price of the drugs might prevent their use in prisons, which house as many as one-third of those who are infected.

The drugs cost anywhere from about $65,000 to $170,000 for a single course of treatment—between three and nine times more than earlier treatments. Ronald Shansky, former medical director of the Illinois prison system and founder of the Society of Correctional Physicians, described that price as “extortionarily high, criminal.”

…

HIV Precedent
States and municipalities typically pay for prisoner health care out of their corrections budgets. When effective HIV treatments emerged in the late 1990s, those budgets grew to accommodate the cost of the drugs, said Edward Harrison, president of National Commission on Correctional Health Care, which sets standards for prisoner health care.

But the new hepatitis C medications present a much bigger challenge. “The prevalence of HCV [hepatitis C) is 10 times greater than HIV and the cost of treatment is probably 10 times greater than a year’s worth of treating HIV,” said Anne Spaulding of Emory University, one of the leading researchers on hepatitis C in prisons.

 

…

The new hepatitis C drugs and others in the pipeline could be the “straw that breaks the back of corrections” and force large-scale changes in penal systems. Already, as a result of a U.S. Supreme Court decision, California has had to reduce its prison population by tens of thousands because of inadequate health care. Spaulding said she can foresee the high costs of medicine could force cuts in prison populations across the United States.

Another possibility, she said, would be to create a different mechanism for paying for prison health care, perhaps by extending Medicaid to jail and prison populations.

One thing is clear: The goal of eradicating hepatitis C won’t be achieved unless the campaign involves prisons.

“Because of these new drugs, the conversation about eliminating hepatitis C is finally happening,” said Ninburg of the Hepatitis Education Project. “But if it’s going to be eliminated, we are going to have to address hep C in the correctional setting.”

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Order or Download Your Free Patient Packet – Tips on How to Talk with your Health Care Provider

Order or Download Your Free Patient Packet | NCCAM

From the Web page

Order or Download Your Free Patient Packet

As part of the Time To Talk campaign, NCCAM has developed a packet of helpful materials to help you begin a dialogue with your health care providers. Order your packet online or call 1-888-644-6226 and use reference code D393.

Each packet contains:

• Backgrounder: The backgrounder provides information about the importance of health care providers and their patients talking about complementary health practices.Download PDF

 

• TELL tip sheet: This sheet provides tips for talking with health care providers.Download PDF

• Patient wallet card: This card will help to keep track of all medications, including dietary supplements and other complementary health products, and will be a handy reference during visits to your health care provider.Download PDF

• Get the Facts: Are You Considering Complementary and Alternative Medicine? This fact sheet will assist you in your decision making about using CAM.Download PDF

Order your packet online or call 1-888-644-6226 and use reference code D393.

 

Related Resources

• Patient involvement (including questions to ask your doctor) from US AHRQ (Association for Healthcare Research and Quality)
• Diagnosis and Treatment (including Quick Tips When Talking with your Doctor) from US AHRQ

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US Government Program requires drug manufacturers to provide outpatient drugs to eligible health care organizations/covered entities at significantly reduced prices

New to me!

From the US Health Resources and Services Program Web page –  340B Drug Pricing Program & Pharmacy Affairs

The 340B Drug Pricing Program requires drug manufacturers to provide outpatient drugs to eligible health care organizations/covered entities at significantly reduced prices.

The 340B Program enables covered entities to stretch scarce Federal resources as far as possible, reaching more eligible patients and providing more comprehensive services.

Eligible health care organizations/covered entities are defined in statute and include HRSA-supported health centers and look-alikes, Ryan White clinics and State AIDS Drug Assistance programs, Medicare/Medicaid Disproportionate Share Hospitals, children’s hospitals, and other safety net providers. See the full list of eligible organizations/covered entities.

To participate in the 340B Program, eligible organizations/covered entities must register and be enrolled with the 340B program and comply with all 340B Program requirements. Once enrolled, covered entities are assigned a 340B identification number that vendors verify before allowing an organization to purchase 340B discounted drugs.

New registrations are accepted October 1-15, January 1-15, April 1-15 and July 1-15.

Update here, which includes..

…

HRSA is currently working to formalize existing program guidance through regulation, designed to cover a number of aspects of the 340B Program. The regulation currently under development will address the definition of an eligible patient, compliance requirements for contract pharmacy arrangements, hospital eligibility criteria, and eligibility of off-site facilities. We expect to publish this proposed regulation, which will be open for public comment, by June 2014. In order to ensure that covered entities retain flexibility based on their size, structure, and patient population, HRSA will continue to hold covered entities accountable for implementing those requirements as appropriate for their specific circumstances.

…..

Implemenation page includes

Once a covered equity is enrolled in the 340B Program and included in the covered entities database, it is the covered entity’s responsibility to inform wholesalers and manufacturers of enrollment in order to purchase drugs at the 340B discounted price.

Covered entities may continue to work directly with individual wholesalers and manufacturers and may participate in the 340B Prime Vendor Program (PVP). As the government’s awarded 340B Prime Vendor, Apexus is responsible for securing sub-ceiling discounts on outpatient drug purchases and discounts on other pharmacy related products and services for covered entities electing to join the PVP. For complete information, see the Prime Vendor Program .

Implementation Options

HRSA does not specify how participants should implement the 340B Program. As long as participants comply with all 340B Program requirements, they have flexibility in implementing the 340B Program.

Most covered entities choose one or more of the following options:

• In-House Pharmacy, in which the covered entity owns drugs, pharmacy and license; purchases drugs; is fiscally responsible for the pharmacy; and pays pharmacy staff.
• Contract Pharmacy Services, in which the covered entity owns drugs; purchases drugs; pays (or arranges for patients to pay) dispensing fees to one or more contract pharmacies; and contracts with pharmacy to provide pharmacy services.
• Provider/In-House Dispensing, in which the covered entity owns drugs; employs providers licensed in the state to dispense; holds a license for dispensing for the participating providers; and is fiscally responsible for operating and dispensing costs.
• Alternative Methods Demonstration Project, in which HRSA Office of Pharmacy Affairs approves a model proposed by the covered entity, such as a network of 340B covered entities.

The 340B Database includes links to

• Search contract pharmacies
• Search manufacturers
• Search covered entities (health plans, health care clearinghouses, and health care providers that transmit health information electronically)

 

 

 

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[Reblog] Measuring Quality of Care for Older Adults With Serious Illness

From he 22 January 2014 post at HealthAffairsBlog

by Laura Hanson, Anna Schenck, and Helen Burstin

Editor’s Note: This post is the third in a periodic Health Affairs Blog series on palliative care, health policy, and health reform. The series features essays adapted from and drawing on an upcoming volume, Meeting the Needs of Older Adults with Serious Illness: Challenges and Opportunities in the Age of Health Care Reform, in which clinicians, researchers and policy leaders address 16 key areas where real-world policy options to improve access to quality palliative care could have a substantial role in improving value. 

In the United States, value is the new health care imperative – improving quality while controlling costs.  We spend nearly twice the rate of comparable nations, yet have poorer health outcomes.  In 2010, President Obama signed the Patient Protection and Affordable Care Act (ACA), mandating a new emphasis on paying for value, not volume.

Our greatest opportunity to enhance value in US health care is to improve quality of care for older adults with serious illness – the group who uses the most health care services. Serious illness, in which patients are unlikely to recover, stabilize, or be cured, is life-altering for patients and family caregivers.  It includes advanced, symptomatic stages of diseases such as congestive heart failure, chronic lung disease, cancer, kidney failure, and dementia. Serious illness may also refer to the cumulative consequences of multiple conditions progressing over time, causing functional decline or frailty.

We’ve made important progress in understanding high quality care for this population of patients.  Researchers have asked patients with serious illness and their families how they define high quality care.  Especially in serious illness, patients want control over treatment through shared decision-making.   Even when there is no cure, most patients still want health care that helps them live longer – but only if they can also get help with function, physical comfort, and attention to family, emotional and spiritual needs.

We know what types of health care help patients and families cope with serious illness.  A 2012 report to the Agency for Healthcare Research and Quality finds evidence for three types of care to improve health outcomes:

1. Expert pain and symptom treatment
2. Communication to engage patient preferences for treatment decisions
3. Interdisciplinary palliative care

We’ve developed quality measures to understand how often real-world care lives up to these ideals.

……

 

Read the entire article here

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[Reblog] How Many Patients Did We Hurt Last Month? Learning (But Not Too Much) From The Best Hospitals

From the 6 November 2013 HealthCare Blog post by ASHISH JHA, MD

…

A few years ago, I was working on a strategy for improving the quality and safety of VA healthcare.  As part of this effort, I called up senior quality leaders of major healthcare organizations across the nation.  One call is particularly memorable.  Because I promised anonymity, I will not name names but this clinical leader was very clear about his responsibility: every month, he met with his CEO, who began the meetings with three simple questions: “How many patients did we hurt last month? How many patients did we fail to help? And did we do better than the month before?”

The CEO and the entire hospital took responsibility for every preventable injury and death that occurred and the culture of the place was focused on one thing: getting better.  When I looked them up on Hospital Compare, they too had excellent outcomes and they regularly get “A” ratings for patient safety from the Leapfrog Group.

 

How do the BIDMCs and these other super-high performers pull it off?  How do they build a culture of quality when so many organizations seem to struggle?  High performance is complex, of course, and I won’t try to be overly simplistic.  But a few things seem common among many high performing institutions. They seem to be focused on three things:  timely, clinically relevant outcomes data; transparency within (and usually outside) the organization; and a constant focus on getting better.

You can see the kinds of data that BIDMC posts on its website – it’s not just the standard Hospital Compare stuff (which everyone has to do) but other data on a series of outcomes which are not required.   When I hear Kevin Tabb, their current CEO talk about quality – it’s obvious that quality is not a platitude.  He is genuinely focused on getting better.

So what’s the lesson from BIDMC, Mayo and other high performing institutions? There is no substitute for great leadership.  Each of them seems to have been blessed with leaders who, despite all the wrong incentives in the healthcare system, prioritize patient care and drive their organizations to great performance.  They are internally motivated and do all the things I describe above, despite the fact that our primary payment systems incentivize them to do more, not better.  They are extraordinary leaders- with not only great vision but also the ability to execute that vision.

But here’s the risk:  too many policymakers believe that all we need to do is figure out what BIDMC or Mayo or Kaiser does and just get everyone else to do it. Such an approach, while seemingly perfectly good on paper, fails to account for the human element.  The strategies that they have used have been executed by individuals unusually focused on improving care.  Barring substantial improvements in cloning technology, we can’t expect that each hospital will have a great leader.

We don’t expect that every technology company will have a Steve Jobs.  In every industry, there are a few visionary leaders, but the rest of the organizations?  They are run by mortals – and mortals respond to incentives.  And here lies the problem:  the incentives in the system are not motivating the typical CEO to improve care.  Whatever strategy we employ around timely data, transparency, etc. won’t work until the leadership is properly motivated and focused on quality.  And while that happens in pockets, it’s not happening across the entire healthcare system.  And this is where we will pick up in my next blog: how to get the rest of the organizations to make quality a real priority.

 

Read the entire article here

 

[New Scientist Article] Data trackers monitor your life so they can nudge you

From the 7 November 2013 New Scientist article by Hal Hodson

Once you know everything about a person, you can influence their behaviour. A thousand students with tattletale phones are going to find out how easy that is

THERE’S something strange about this year’s undergraduate class at the Technical University of Denmark – they all have exactly the same kind of phone.

The phones are tracking everywhere the students go, who they meet and when, and every text they send. Around 1000 students are volunteers in the largest-ever experiment of its kind, one that could change our understanding of how we interact in groups.

Sune Lehmann and Arek Stopczynski of DTU are using the data to build a model of the social network the students live in – who talks to who, where groups gather. They plan to test whether the results can be used for purposes like boosting student achievement, or even improving mental health. “We hope to be able to figure out how to make this work in terms of academic performance,” says Lehmann.

This is sociology on a different scale, gathering detailed data about an entire group and then using that information to “nudge” them into changing their behaviour. Used ethically, the results could improve the way society works, transforming everything from healthcare and public transport to education and governance. Used for the wrong reasons, it could be extremely dangerous.

…

Used ethically, the results could improve the way society works, transforming everything from healthcare and public transport to education and governance. Used for the wrong reasons, it could be extremely dangerous.

…

Used ethically, the results could improve the way society works, transforming everything from healthcare and public transport to education and governance. Used for the wrong reasons, it could be extremely dangerous. a 2010 study, participants were encouraged to boost their activity levels either through personal rewards, or rewards given to a buddy who was supposed to keep tabs on them. Being motivated by an incentivised buddy resulted in twice the activity increase of the direct reward.

…

..nudges related to public health could be as simple as allowing doctors to ring up their patients when their activity levels start to follow patterns that correlate with, say, diabetes or depression, and asking them if they are feeling OK.

…

But we shouldn’t lose sight of the potential dark side, says Evan Selinger, a technology ethicist at the Rochester Institute of Technology in New York. “There is extraordinary power in the access to data at a personal level – even predicting future behaviour,” he says. “There’s a lot to be gained, but there’s a lot of problems that scare the living ******** out of me.”

 

 

Related articles

• It’s time to close the Government’s sinister ‘Nudge Unit’ and let the free market take over (blogs.telegraph.co.uk)
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[Reblog] Healthcare Solutions

Health care systems and single payer (Photo credit: Wikipedia)

 

I have a nagging question…is it right that health care is basically a for-profit industry?
Realize I need to clarify and expand on this in order for it to make sense.
However, in the past 20 or so years, I’ve seen the rise of medical complexes,  “battles” among hospitals for market shares,  huge increases in medical/health care advertising, and yet what seems to be a decline in the overall average health of Americans.
So, I have to ask…is this for-profit model working? And if not, what is the answer?

 

 

 

From the 5 November 2013 item at ThePeaceResource

 

The math is not complex. Instead of doling out corporate welfare to insurance firms, we pay that money to deliver actual health care. As health improves, costs go down. “Single-payer allows citizens and businesses to win twice: — less money out of our individual budgets for health insurance, and — no government bureaucracy that gives our tax money to the less efficient health insurance companies through a variety of federal and state programs”http://www.medicareforall.org/pages/Terms_and_Facts Or we stick with corporate cons running the show and 31 million continue to suffer without health care.* This will raise costs of care and lead to more suffering. *{a report from the Congressional Budget Office (CBO) predicts that in the post-Obamacare world of 2023, 31 million, non-elderly Americans will remain uninsured.http://www.cbo.gov/publication/44190}

 

 

More resources on health care options:
ThePortlandAlliance.org/healthcare
health-careresource.blogspot.com/…
writingresource.info/healthcare/
internationalpeaceresources.org/healthcare/
unionresource.blogspot.com/

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[Reblog] Forms do not keep patients out of hospitals

A patient having his blood pressure taken by a physician. (Photo credit: Wikipedia)

 

From the 21 October 2013 KevinMD.com article by Kathy Neider, Physician

 

Over one year ago my office implemented an EHR (electronic health record). I’ve not done a note on paper since.

Last week, a Transition of Care (TOC) document was placed on my desk with a sticky note stating: “Dr. Nieder please fill out this form so we can bill a 99496 for your visit with Mrs. Jones yesterday.”

 

I pick up two sheets of paper with multiple questions including:

• discharge Medications: (list)
• present Medications: (list)
• diagnostic tests reviewed/disposition (list)
• disease/illness education (discussion documentation)
• home health/community services discussion/referrals: (list)
• establishment or re-establishment of referral orders for community resources: (list)
• discussion with other health care providers: (list)
• assessment and support of treatment regimen adherence: (discussion documentation)
• appointments coordinated with: (list)
• education for self-management, independent living and activities of daily living: (discussion documentation)

Please remember, I am now on an EHR. So I am expected to document electronically first then manually fill out forms. I have no discharge summary yet from the hospital.  The medications when she left the hospital state “resume pre-admission meds.” In order for me to list what tests she had I log in to the hospital portal and look them all up. Some of them have been scanned into my EHR, some not. She had a straight forward admission for a small bowel obstruction. She declined to keep the surgeon’s appointment as she was told there was nothing he could do for her.

A TOC visit is paid at a higher rate than other visits if the patient does not return to the hospital in the following 30 days. Hence, we hold the billing until that time. My understanding of the purpose of this new code is to improve coordination of care as a patient transitions from the hospital to home. Coordination would imply that there are other individuals involved and thus there is improved communication between us.

However my staff and I bear the brunt of gathering information (which is what we normally do anyway, so I guess it’s nice because now we get paid for it).

At what point will it become incumbent upon the hospital to send me the necessary information for treating the patient now that he/she is home again? How does it follow that improving care means the primary care doctor fills out even more forms, ultimately reducing the time spent with the patient?

The form will not keep the patient out of the hospital. Communication can keep the patient out of the hospital. True coordination of care might keep the patient out of the hospital. More busy work for the patient’s primary care doctor will not. Since the order of the day is using hospitalists, it is imperative that we improve our communication systems at the time of discharge and before the patient is seen again in the primary care office. Systems must stop thinking that one more form is going to save the patient. Especially another form on my back.

Kathy Nieder is a family physician who blogs at Family Practice 2.0.

 

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Study: The Health Care Experiences and Expectations of Low-Income Californians – NPQ – Nonprofit Quarterly

Study: The Health Care Experiences and Expectations of Low-Income Californians – NPQ – Nonprofit Quarterly.

From the 24 October 2013 article BY ANNE EIGEMAN at NonProfit Quarterly

As the most recent update in an ongoing research project that began in 2011, this week, the Blue Shield Foundation of California released a report on the healthcare experiences and expectations of low-income Californians. Two central goals guided the project: 1) to help healthcare facilities—particularly California’s community health centers—successfully navigate the changes brought about by the ACA, and 2) to help community health centers identify the most effective ways of encouraging patients and providers alike to embrace primary care redesign and move closer toward the goal of patient empowerment. As key findings, the study points to the “wide range of positive outcomes” that come from successful communication between patients and providers and the “broad gap” that currently exists between the information patients possess and the information they want.

The study found that only 28 percent of low-income Californians feel they have easily comprehensible health information for decisions about care. In addition, almost 40 percent rely on media sources to address concerns—“a potential problem” according to the study, because “trust in information is much higher when it comes from a medical professional than from other sources.”

A central theme is the value to patients that comes from a strong patient-provider relationship, which can lead to improvement in a patient’s overall sense of being well informed about his or her health, the level of satisfaction with the quality of care at a specific facility, and trust of the information provided by doctors. In light of upcoming structural changes to healthcare systems from the ACA, the study’s note that “alternative communication approaches also show great promise in helping to improve patients’ relationships with their providers.” is significant. Examples of these new approaches include team based care, decision aids, health coaches, and online or smartphone-accessible health sites, all of which were found to “enhance, rather than diminish, the critical connection between patients and their providers.”

The study devotes considerable attention to the effect of the digital divide on healthcare for specific groups of low-income Californians. “While four in ten low-income Californians overall lack Internet access, that soars to 67 percent of Spanish-speakers, 63 percent of non-citizens, 62 percent of Latinas and 59 percent of those in only fair or poor health,” the study reports. In addition, the fact that 59 percent of low-income residents over 50 lack Internet access and 41 percent lack a text-capable phone makes this “vulnerable population particularly hard to reach with technology-based information and communications.”

 

 

Read the entire article here

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[Repost] Is ‘Patient Capitalism’ The Answer To Poverty?

From the 18 October 2013 NPR story

Part 5 of the TED Radio Hour episode Haves And Have-Nots.

About Jacqueline Novogratz’s TEDTalk

Jacqueline Novogratz, CEO of Acumen Fund, shares stories of how “patient capitalism” can bring sustainable jobs, goods, services and dignity to the world’s poor.

About Jacqueline Novogratz

Jacqueline Novogratz is redefining the way problems of poverty can be solved around the world.

She is a leading proponent of financing enterprises that can bring affordable clean water, housing and health care to poor people so that they no longer depend on traditional charity and aid.

The Acumen Fund, which she founded in 2001, has an ambitious plan: to create a blueprint for alleviating poverty using market-oriented approaches.

Rather than handing out grants, Acumen invests in fledgling companies and organizations that bring products and services to the world’s poor.

Novogratz places a great deal of importance on identifying solutions from within communities rather than imposing them from the outside.

In her book, The Blue Sweater, she tells stories which emphasize sustainable bottom-up solutions over traditional top-down aid.

http://www.ted.com/talks/jacqueline_novogratz_on_patient_capitalism.html

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[Reblog] Need to See the Doctor? You May Have Company on Your Next Visit

From the 2 August 2013 New York Times Health article

hared medical appointments, or group visits, are becoming a popular — and possibly more satisfying — way to see the doctor.

“As soon as I mention shared medical appointments, everybody automatically pictures a room full of people in their underwear,” says Dr. Richard Kratche, a family physician at Cleveland Clinic who conducts group visits for physicals. Rest assured, he says, these shared medical appointments don’t literally involve having an audience during a physical exam.

But they do require divulging and discussing private medical information in front of strangers (albeit ones who have signed waivers not to talk about other patients’ medical histories outside of the visit). And while that makes some people understandably uncomfortable, a surprising number of patients are finding these appointments to be rewarding and effective ways of getting more out of doctor’s visits. Since 2005, the percentage of practices offering group visits has doubled, from 6% to 13% in 2010. With major provisions of the Affordable Care Act due to be implemented by next year, such group visits are also becoming attractive cost savers — patients who learn more about ways to prevent more serious disease can avoid expensive treatments.

Read more: http://healthland.time.com/2013/08/07/need-to-see-the-doctor-you-may-have-company-on-your-next-visit/#ixzz2bYyjf5Y9

 

 

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[Reblog] Are governments legally obliged to ensure adequate access to health information?

From the 3 August 2013 blog item at Soumyadeep B -Caffeinated Works & Random Musings

The Lancet Global Health published a paper yesterday titled , ”  Governments are legally obliged to ensure adequate access to health information  ” that calls  to increase the availability and use of healthcare information in low- and middle-income countries globally and recognition of access to health information as a legal right of citizen The paper has been written by Dr. Soumyadeep Bhaumik, HIFA Country Representatives for India together with his colleagues Pranab Chatterjee, and Tamoghna Biswas along with Dr Neil Pakenham Walsh , coordinator of HIFA2015 and CHILD2015 networks and codirector of Global Healthcare Information Network.

The full article may be read here

An excerpt..

A 2012 analysis12 by the New York Law School and HIFA2015 concluded that “health information is an essential component of many identified and established human rights. States party to treaties such as the International Covenant on Civil and Political Rights must provide and guarantee access to health information.”

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What is observation care? Clearing up common misperceptions

From the 4 February 2013 article at KevinMD.com

o treat observation care as simply a loophole that allows hospitals to avoid the Medicare penalties from readmissions — as Brad Wright, an assistant professor of health management and policy at the University of Iowa did earlier this month — is to take a short-sighted approach to a complex health issue.

 

Observation care in fact aims to address several of healthcare’s thorniest challenges head on. In the process, a well-run observation unit can not only help reduce hospital readmission rates, but it can reduce crowding and speed throughput in the ER, save patients an extended first hospital admission (let alone a re-admission), and perhaps most importantly, improve patient outcomes.

To see how, and to clear any misconceptions some like Wright could have about observation care, it might be helpful to do some Q&A.

…

 

Read the entire article here

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Let’s solve our most pressing healthcare problems first

From the 24 January 2013 post at KevinMD.com

“He’s dead, Jim.”

So here’s my beef. At the recent Forbes Healthcare Summit  there was a lot of focus on speakers and vendors offering very cool new tech, from future “Tricorders” that can diagnose multiple diseases, is non-invasive, and hand-held; personal genomics, where data from your own genome is cheap and easy to get and can be integrated with clinical knowledge to produce better care; targeted therapies for various diseases, using the specific biology of a patient and her disease to design a treatment.

All of these are awesome, but really have little impact on our most pressing healthcare problems.

In the U.S., we manage to deliver a triple-whammy: health care that is less effective than in other nations, is only available to limited numbers of people, and costs a ton. There are a number of factors that go into this, most of which are historico-cultural.

The article goes on to say how folks are marginalized through being unemployed, falling through cracks (as being poor and single), profit driven health care facilities, lack of data sharing, and more.

 

 

Read the entire article here

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What Does the Dartmouth Atlas Have to Say About the Politics of the ACA?

From the 27 December 2012 article at The Health Care Blog by Anubhav Kaul, MD, Peter Bhandari, and Thom Walsh, PhD

…The Dartmouth Atlas Project is an online database which collects Medicare spending and utilization data from around the country. Information gathered from the database has shown immense variation in the way medical resources are utilized by even similar regions, communities, and health care organization. Evidence has repeatedly shown that, from a population perspective, areas that spend more on medical care do not consistently benefit from increased quality of care or patient wellbeing. Variation in the type of care delivered can be attributed to diverse incidence and prevalence of disease severity or the type of care a well- informed patient chooses. Variation in health care delivery is thus omnipresent and expected, because every patient is unique and medical innovation presents a growing number of care options to choose from….

[The interactive map may be found here]

…

The top ten Republican states have higher Medicare spending than the top ten Democratic states. The rate of hospitalization and surgical procedures are also higher for Republican states. If we investigate a procedure like percutaneous coronary interventions (PCI), the Republican states are performing more PCI procedures with equal mortality benefit compared to Democratic states. The evidence of variation in cost and utilization is a strong indication of inconsistency and inefficiency in the care delivery process. Are the Republican states providing better care by providing more care? We cannot find evidence of for such an assertion. Nor do we find evidence of harm occurring from a lack of utilization to individuals residing in democratic states. Six of the ten Republican states sued the federal government over the individual mandate and Medicaid expansion earlier this year (Utah, Alabama, Louisiana, Texas, Georgia, and Nebraska), compared to only one democratic majority state (Maine). Yet the Republican states have a higher average of uninsured people, thus inhibiting a greater percentage of their citizens from accessing preventive healthcare….

Read the entire article here

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Doing the right thing when things go wrong

English: PACIFIC OCEAN (Aug. 10, 2007) – Lt. Cmdr. Angela Powell, an otolaryngologist assisted by Hospital Corpsman 3rd Class Daniel Vogel a surgical technician, performs surgery aboard the Military Sealift Command (MSC) hospital ship USNS Comfort (T-AH 20). Comfort is on a four-month humanitarian deployment to Latin America and the Caribbean providing medical treatment to patients in a dozen countries. U.S. Navy photo by Hospital Corpsman 1st Class Jean A. Wertman (RELEASED) (Photo credit: Wikipedia)

 

From the 14 December 2012 EurkAlert article

 

…UMHS approach to medical errors and malpractice suits could be used by hospitals nationwide, new study indicates

ANN ARBOR, Mich. — The University of Michigan Health System doesn’t claim to be perfect. But its response to medical errors, near-misses, unexpected clinical problems and unintended outcomes is a model for the nation that other hospitals can and should copy, according to a new paper in a prestigious health care journal.

The “Michigan Model” for handling these situations, and preventing them from happening again, has not only helped patients and medical staff alike – it has also helped UMHS go against the grain of the costly, combative “deny and defend” medical malpractice culture…

…Campbell and Boothman have led a decade-long effort to implement and measure the results of the Michigan Model. It’s based on these key principles:

 

• Compensate patients quickly and fairly when inappropriate care causes injury
• Support clinical staff when the care was reasonable
• Reduce patient injuries (and claims) by learning from patients’ experiences

In that decade, new malpractice claims per month have dropped, total liability costs have dropped, claims and potential claims are being resolved faster, and UMHS is increasingly avoiding litigation in both claims without merit and claims with merit.

 

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More information does not equal better care

 Chalmette, LA, December 16, 2005 – A patient describes his symptoms with a nurse at the Primary Care Clinic in St. Bernard Parish. The facility located in a triple-wide office trailer offers free medical care to area residents, staffed by personnel from the U.S. Public Health Agency and FEMA Disaster Medical Assistance Team (DMAT). Robert Kaufmann/FEMA

A wise, sobering post on the limits of medical/health related information.

Technology is increasingly used to collect and store personal health and medical data. While the amount of personal stored data is rising, this does not necessarily translate into better care. For example, the information stored in electronic medical records is only as good as the data entered.  Medical devices (as imaging and gene testing instruments) generate data that may or may not be useful depending on why they were ordered and how they results are interpreted.

The use of the data is also troublesome. As this post states, medical test results are often misused by the diagnostics industry in over testing.  This leads to unneeded treatments which divert money and resources.  Health care providers, especially those in primary care have less time to listen to and counsel patients.

The money spent on unnecessary treatments is a burden not only on individuals, but also health care facilities and government agencies. Health care facilities become caught in a spiral of justifying diagnostic equipment through marketing and at some point they will find it nearly impossible to recoup their investments. Medicare and Medicaid funds are not used wisely to diagnose and treat, resulting in ever more increased costs to the system.

As this post points out, health care providers would be wise to take a deep look at their role and be realistic about their expectations.
The same can be said about those who consult with health care providers.

From the 1 November 2012 article at KevinMD.com

I have found that this concept is hard for non-healthcare people to really grasp – that a less aggressive testing approach knowingly misses disease, but makes no difference in the overall prospects of the patient. It is crucial that the U.S. culture fights the prevailing scare tactics of the diagnostics industry, or we’ll never lower the rate of over testing. Any administrative tricks to lower testing rates will be subverted by both physicians and patients who assume more tests equal better care unless the underlying culture and conventional beliefs are changed.

The change required is deeper than administrative rules. It has to come from a more humble attitude on the part of doctors, patients, employers, and insurers that just because a patient could be labeled as having a disease, there is nothing to be gained by doing anything about it. More information does not equal better care.

Our American culture proclaims, “Just Do It.” To reclaim resources from the healthcare industry and return them to the general economy, we must proclaim, “Don’t just do something for the sake of doing something, stand there.”

 

Related Resources

• US Agency for Healthcare Research and Quality (AHRQ)- Consumers and Patients
  • Choosing Quality Care
  • Comparing Medical Treatments
• Evaluating Health Information (Health Resources for All Edited by Janice Flahiff)

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Why Health Care is a Civil Right

Health care systems (Photo credit: Wikipedia)

 

I rarely overtly “get political” at my  blog.
However, this seems to go beyond politics to what living in a functional democracy or republic is all about.

 
From the 31 October 2012 article at Medical News Today

 

I want to clear up a misunderstanding often voiced in the healthcare blog universe: namely, whether health care is a right or a service. Our answer to this question will affect how we approach healthcare reform in the next Congress, so let me say plainly: health care is a civil right.

Civil rights are what we call those claims necessary to secure free and equal citizenship, secondary to basic rights. For example, we don’t have a right to vote for any natural reason; we have the right to vote because society is ordered in a way that makes voting both possible and essential to our free and full participation in society. Voting is a civil right.

 

Health care is a civil right because society is ordered in such a way as to make it both possible and essential to the free and full participation of the sick, injured and disabled — i.e. ‘patients’ — in society. I’m a patient, and I can tell you: lack of health care makes it impossible for me to participate freely and fully in society. Among the reasons …

• I can’t choose my work. Because health care is tied to employment, and not all jobs have benefits, I can’t do things that might be socially useful or personally satisfying but lack benefits. I can never start a business, for example, because I wouldn’t have health insurance.
• I can’t buy the things I need. Patients are denied the free purchase of goods and services by restrictions on the healthcare market: FDA regulations, prescription requirements, doctor licensing, insurance rules. These restrictions help make health care safer and more effective, but they also sharply curb supply of medical goods and increase their price, which is paid disproportionately by patients.
• I can’t participate fully in the political process. I rarely volunteer in my community — dealing with my healthcare takes up most of my free time. I can’t give money to causes or candidates I support, because I don’t have any to spare. Moreover, a sick person is less likely to risk losing employer-provided insurance by organizing a union, whistle-blowing against fraud, or reporting discrimination in the workplace.

None of these exclusions is intrinsic to illness, but due instead to the structure of our society. And each reason is more compelling to the extent illness and injury are produced by pollution, toxic products, and other societal causes. A patient’s basic right to justice requires us to respond to the likelihood that we — as a society — had something to do with their illness.

One of the counter-claims made against this line of reasoning is that nobody is entitled to claim a health provider’s labor as a right. But there are many other professions which are subject to civil rights claims: teachers, firefighters, lawyers, to name a few. Moreover, physicians and other providers are able to do their job effectively in large part due to public investment in research and technology.

Unfortunately, the Affordable Care Act did not go far enough to guarantee patients right to health care. Access to insurance is not the same as access to care, as any patient will tell you. The ACA was a small step in the right direction, but we still need legislation recognizing patients’ right to health care. Whatever the outcome of the election, health care must be acknowledged as a civil right.

Duncan Cross blogs from the perspective of a chronic patient at his self-titled site, Duncan Cross.

 

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California to start regaining control of prison healthcare

Prison health care does seem to be improving in California.
Why I am I reporting this? Because health care (and I’m not talking non-elective procedures here) is a right. A right that does not depend on one’s socioeconomic status. I believe that because prisoners are human beings, it is our collective responsibility to make sure they do get needed health care.  Just as it is our collective responsibility for all.Being found guilty of crimes and committing crimes does not take away their humanity. It may be hard to have compassion for those who showed no compassion at some point in our lives. But as human beings, I believe we are truly capable of seeing good in all.

There are a number of factors here (see related articles). Excessive salaries for some prison health care workers. And prison overcrowding (at least partially attributable to the three strike law). So I think not only prison reform is in order, but who we criminalize and why needs to be rationally addressed.

Prison doors (Photo credit: rytc)

 

From the 25 October 2012 article at the Los Angeles Times

SACRAMENTO — Seven years after federal courts took control of California’s prison healthcare system, citing care so poor that inmates were dying needlessly, they will start the long process Friday of turning operations back over to the state.

J. Clark Kelso, the court-appointed overseer, said he could foresee a full resumption of state control in about two years. He will begin Friday with a test: handing over authority to staff and equip new care facilities, including a $1-billion project in Stockton, and the sensitive job of making sure inmates get to doctors, clinics and hospitals…

…

California lost its authority after U.S. District Judge Thelton Henderson declared in June 2005 that “extreme measures” were needed to fix a care network that killed one inmate each week through incompetence or neglect. Henderson said that despite repeated warnings from his court, sick prisoners continued to die “for no acceptable reason.”

The state had two such deaths last year, a level Kelso said is within reason: “There are limits to how perfect medicine can be.”..

 

 

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Troubled Teens Could Benefit from Online Access to Health Records, Say Researchers

 

From the 22 October 2012 article at ScienceDaily

 

 Online health records could be surprisingly useful for at-risk teenagers who cycle through the juvenile justice system. A new study from the Stanford University School of Medicine and the Santa Clara Valley Medical Center found that these young people have high rates of Internet use and an unexpectedly favorable attitude toward accessing their health records online.

Teens who get in trouble with the law could particularly benefit from online health records because they generally have worse health than other adolescents — and no one keeping track of the health care they do receive. These teens’ health problems range from spotty immunization histories to chronic diseases such as asthma, sexually transmitted infections, mental illnesses and substance abuse. And not only do poverty, difficult relationships with their parents and frequent moves make it hard for them to get consistent health care, these problems also increase the chances that doctors who are treating them will not have access to their medical histories..

…

The teens were enthusiastic about the option, with 90 percent saying it would be useful to have their health information automatically put online so they could access it later.

“I didn’t expect this level of interest because they don’t typically think of health as something that’s part of their daily lives,” Anoshiravani said, adding that these teens engage in risky behaviors that make them seem cavalier about their health.

These teens’ need for reliable and accessible health records is made even more urgent because they often do not have family members overseeing health-related chores, such as tracking immunizations and medications, checking lab results or recording their medical history. The lack of records is a problem not just in the short term but also when these teens reach adulthood, especially for those who survived serious medical events in childhood. “They may turn 18 and not know they were born with a heart defect that was surgically repaired,” Anoshiravani said.

Contrast that situation to a typical teenager. “A parent or grandparent is going with them to the doctor and keeping their health records,” Anoshiravani said, noting that troubled teens don’t have that help. And it’s not realistic to expect these teens to keep a hard copy of their medical file. “Carrying around pieces of paper that they could lose did not make sense to them, but having a place to check this information online did make a lot of sense,” he added.

The researchers were surprised to find that the teenagers would also share online health records: The vast majority of the respondents were willing to share their records with doctors and half said they would want to share the information with their parents.

The next step, Anoshiravani said, is to implement and test online health records for at-risk teens. The biggest challenge will revolve around the issue of information-sharing, since minors’ parents are entitled to see some parts of their health records, while other types of records cannot be shared with parents without the patients’ consent….

.

 

 

 

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A changing doctor-patient relationship – latimes.com

 

English: Livingston, TX, 9/25/05 — A doctor talks to a patient with a broken neck at a triage center at Livingston Hospital. Doctors and nurses on FEMA’s Disaster Medical Assistance Team from North Carolina care for patients brought to the 50 bed hospital. The hospital does not have enough staff to care for all the patients evacuated from Texas cities in the path of hurricane Rita. Photo by: Liz Roll (Photo credit: Wikipedia)

 

 

 

From the 13 September 2012 article at the LA Times

 

Until now, doctors have pretty much called the shots in the doctor-patient relationship. But change is on the way. Patients, say ahhhhh — it’s about to be all about you.

The new approach is called patient-centered care, and it’s a very good thing, according to Dr. James Rickert, the founder and president of the Society for Patient Centered Orthopedics in Bedford, Ind. “It will mean better outcomes, more satisfied patients and lower costs,” he says.

Here are just a few ways your relationship with your doctor may evolve in the not-too-distant future:

Your doctor won’t be the boss of you...

…

In a patient-centered healthcare universe, doctors will make sure their patients have all the information they need about all their options — and patients will have to tell their doctors their priorities.

“Research suggests that patients want to participate,” Barry says, “but they may be afraid to push back, afraid they’ll be labeled bad patients. Then it’s important for clinicians to draw them out.”

You may have a whole team taking care of you...

You and your doctor will spend more time on the Internet.

That’s because e-visits will replace some traditional kinds of appointments.

“It’s so easy,” says Dr. Redonda Miller, an associate professor at the Johns Hopkins University School of Medicine in Baltimore. “Patients love it — 50% of what we do in the office could by done by email.”

You may also avail yourself of the extensive medical information that can found on the Web. Your doctor should advise you about reliable sources, says Hedy Wald, a clinical associate professor of family medicine at Brown University. “We don’t want people thinking it’s a cure to put egg yolks on their heads.”

Facilities will be designed with you in mind...

 

 

 

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• The Doctor’s Hand: A Healing Touch (thoughtsofdaktari.wordpress.com)
• The Institute for Research on “Humanism in Medicine” Created by The Gold Foundation – To Better Define the Role of Compassion, Altruism, and Respect To Support the Importance of the Doctor/Patient Relationship (ducknetweb.blogspot.com)

 

Rational Rationing vs. Irrational Rationing

 

English: This image depicts the total health care services expenditure per capita, in U.S. dollars PPP-adjusted, for the nations of Australia, Canada, France, Germany, Japan, Switzerland, the United Kingdom, and the United States with the years 1995, 2000, 2005, and 2007 compared. An ‘OECD Health Data 2010’ report is used for the information, which is available here. Note that there is additional information in this list. (Photo credit: Wikipedia)

 

Rational Rationing vs. Irrational Rationing By DAVID KATZ, MD in the 13 September 2012 article at The Health Care Blog

Excerpts

n a system of universal, or nearly universal health insurance such as in Massachusetts, decisions about what benefits to include for whom are decisions about the equitable distribution of a limited resource. If that is rationing, then we need to overcome our fear of the word so we can do it rationally. By design or happenstance, every limited resource is rationed. Design is better.

In the U.S. health care system, some can afford to get any procedure at any hospital, others need to take what they can get. Some doctors provide concierge service, and charge a premium for it. Any “you can have it if you can afford it” system imposes rationing, with socioeconomic status the filter. It is the inevitable, default filter in a capitalist society where you tend to get what you pay for.

That works pretty well for most commodities, but not so well for health care. As noted, failure to spend money you don’t have on early and preventive care may mean later expenditures that are both much larger, and no longer optional — and someone else winds up paying. If you can’t afford a car, you don’t get one; if you can’t afford care for a bullet wound — if you can’t afford CPR — you get it anyway, and worries about who pays the bill come later.

But those costs, and worries, do come later — and somewhere in the system, we pay for them.

By favoring acute care — which can’t be denied — our current system of rationing dries up the resources that might otherwise be used for both clinical preventive services and true health promotion. Fully 80 percent of all chronic disease could be eliminated if our society really rallied around effective strategies for tobacco avoidance, healthful eating, and routine physical activity for all. But when health care spending on the diseases that have already happened is running up the national debt, where are those investments to come from? The answer is, they tend not to come at all. And that’s rationing: not spending on one thing, because you have spent on another.

Nor is this limited to health care. The higher the national expenditure on health-related costs, the fewer dollars there are for other priorities, from defense, to education, to the maintenance of infrastructure. If cutting back on defense calls the patriotism of Congress into question, then classrooms get crowded and kids are left to crumble. Apparently, it is no threat to patriotism to threaten the educational status of America’s future. …

 

 

 

Related articles

• How Would You Like Your Rationing – Rational, or Irrational? (thehealthcareblog.com)
• U.S. health care system wastes $750B a year (cbc.ca)
• Waste and Promise Seen in U.S. Health Care System (nytimes.com)

 

Top Ten Myths of Medicare

 

From the Full Text Report abstract

Top Ten Myths of Medicare

August 26, 2012

Top Ten Myths of Medicare
Source: Social Science Research Network

In the context of changing demographics, the increasing cost of health care services, and continuing federal budgetary pressures, Medicare has become one of the most controversial federal programs. To facilitate an informed debate about the future of this important public initiative, this article examines and debunks the following ten myths surrounding Medicare: (1) there is one Medicare program, (2) Medicare is going bankrupt, (3) Medicare is government health care, (4) Medicare covers all medical cost for its beneficiaries, (5) Medicare pays for long-term care expenses, (6) the program is immune to budgetary reduction, (7) it wastes much of its money on futile care, (8) Medicare is less efficient than private health insurance, (9) Medicare is not means-tested, and (10) increased longevity will sink Medicare.

 

Related articles

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• Kaplan: The Top Ten Myths of Medicare (taxprof.typepad.com)
• Medicare Cuts: Will they affect you? (medicaresupplementshop.com)
• Article on the Myths Surrounding Medicare (lawprofessors.typepad.com)
• What do I do if my Medicare HMO goes out of business? (insurance.com)
• The almost-definitive guide to the Medicare debate (dailykos.com)

 

Is the Fact that I Am a Woman Considered a Pre-Existing Condition?

 

By MAGGIE MAHAR at the 8 August post at The Health Care Blog

The male body has long been considered the “standard” for health care coverage. Having a woman’s body is seen as an expensive anomaly, and women pay dearly for being different.

When they buy their own health insurance in the individual market, women must lay out an extra $1 billion a year, simply because they are women. Some argue that this is fair: after all, a woman could become pregnant, and labor and delivery are costly.

But the truth is that, even when maternity benefits are excluded, one-third of all health plans charge women at least 30 percent more, according to a report released just last month by the National Women’s Law Center.

In 36 states, “92 percent of best-selling plans charge 40-year-old women more than 40-year-old men,” the Center reports, and “only 3 percent of these plans cover maternity services … One plan in South Dakota charges a woman $1252.80 more a year than a 40-year-old man for the same coverage.”

Today, less than half of American women can obtain affordable insurance through a job, which explains why millions buy their own insurance in the individual market. In that market, just 14 states ban gender rating:  California, Colorado, Maine, Massachusetts, Minnesota, Montana, New Hampshire, New Mexico, New Jersey, New York, North Dakota, Oregon, Vermont, and Washington….

…

 

Insurers explain that women cost them more, even if policies don’t cover maternity, because “they are more likely to visit doctors, get regular check-ups, take prescription drugs, and have certain chronic illnesses.”

In other words, women are penalized for taking care of themselves, As for those “female chronic ailments,” men also are more vulnerable to certain diseases – including many caused by smoking (23 percent percent smoke vs. 17 percent of women)…

…

If a woman is raped she, too, risks being shunned. When Christina Turner was attacked by strangers, doctors advised that she take HIV medication “just in case.” Insurers then refused to cover her because the HIV drugs “raise too many health questions.” They told her they would reconsider her in three years if she could prove she did not have AIDS.

Turner went without insurance for three years. Other rape victims report being denied because they suffered from post-traumatic stress syndrome.

These are the most shocking cases. Other rules discriminate against millions of women for a long list of commonplace reasons:

• If a woman has survived breast cancer, this is a pre-existing condition.
• If she is pregnant when she applies, this also is considered a pre-existing condition, just like cancer. Most likely, she will be turned down.
• If she is of child-bearing age and has children, this may well viewed as a pre-existing condition, leading to higher premiums.
• On the other hand, if she is infertile, this too, can be labeled a pre-existing condition.

Not long ago, House Minority Speaker Nancy Pelosi summed up the hurdles: “If you’re a woman, it’s a pre-existing condition.”

“In most markets if you are a non-smoking female you will pay more than a smoking male of the same age because you possess ovaries and not testes.”..

 

.

Related articles

• Affordable Care Act a lifeline for people with pre-existing conditions (king5.com)
• 2 million N.C. adults to benefit from health care law provision, supporters say (newsobserver.com)
• Preventive Care Provisions Of Health Care Law Go Into Effect (chicago.cbslocal.com)
• U.S. health law may curb rising maternal deaths (upi.com)
• Health care reform report: Nearly 2.4 million Michiganders have pre-existing conditions (mlive.com)

 

Better medicine, brought to you by big data through new types of data analysis

 

A good overview of how improved data analysis and presentation is improving health care delivery.

I especially liked the slideshare presentation found below in Related Articles.
The 42 slides in Big data – a brief overview outlines what big data is, its sources and processes, how it is analyzed, current “players”,examples, market analysis, future, and opportunities.

From the 15 July 2012 blog post at Gigaom

Slowly but surely, health care is becoming a killer app for big data. Whether it’s Hadoop, machine learning, natural-language processing or some other technique, folks in the worlds of medicine and hospital administration understand that new types of data analysis are the key to helping them take their fields to the next level.

Here are some of the interesting use cases we’ve written about over the past year or so, and a few others I’ve just come across recently. If you have a cool one — or a suggestion for a new use of big data within the healthcare space — share it in the comments:

Genomics. This is the epitomic case for big data and health care. Genome sequencing isgetting cheaper by the day and produces mountains of data. Companies such asDNAnexus, Bina Technologies, Appistry and NextBio want to make analyzing that data to discover cures for diseases faster, easier and cheaper than ever using lots cutting-edge algorithms and lots of cloud computing cores.

BI[definition of business intelligence] for doctors. Doctors and staff at Seattle Children’s Hospital are using Tableau to analyze and visualize terabytes of data dispersed across the institution’s servers and databases. Not only does visualizing the data help reduce medical errors and help the hospital plan trials but, as of this time last year, its focus on data had saved the hospital $3 million on supply chain costs….

..Semantic search. Imagine you’re a doctor trying to learn about a new patient or figure out who among your patients might benenfit from a new technique. But patient records have been scattered throughout departments, vary in format and, perhaps worst of all, all use the ontologies of the department that created the record. A startup called Apixio is trying to fix this by centralizing records in the cloud and applying semantic analysis to uncover everything doctors need, regardless who wrote it…

..Getting ahead of disease. It’s always good if you figure out how to diagnose diseases early without expensive tests, and that’s just what Seton Healthcare was able to dothanks to its big data efforts…

and more!

Related articles

• Better medicine, brought to you by big data [GigaOM] (gigaom.com)
• Intel and NextBio seek Big Data upgrades in genomics (fiercebiotechit.com)
• Big Changes Are Ahead For The Health Care Industry, Courtesy Of Big Data (fastcompany.com)

• Big data – a brief overview (slideshare.net) [a slide presentation, 42 slides]

• Oracle adopts the popular R language for the enterprise and big data. (oracle.com)
• Presentation: Scalability Challenges in Big Data Science (architects.dzone.com)
• Salesforce intros Radian6 Insights for social big data (zdnet.com)
• Big Data Modeling – Part I – Defining “Big Data” and “Data Modeling” (infocus.emc.com)
• NextBio and Intel Announce Collaboration to Optimize Use of Hadoop Stack And Move Forward With Big Data Technologies in Genomics (ducknetweb.blogspot.com)
• A Beautiful Friendship: Big Data and Social Media (blogs.sap.com)
• Stanford rides Big Data wave in medical research (fiercebiotechit.com)
• Big Data? Big Deal! (clean-clouds.com)

AHRQ’s Health Care Innovations Exchange Focuses on Clinical-Community Linkages to Improve Chronic Disease Car

AHRQ’s Health Care Innovations Exchange Focuses on Clinical-Community Linkages to Improve Chronic Disease Care

From a recent email update rec’d from AHRQ (US Agency for Healthcare Research and Quality)

The July 3 issue of AHRQ’s Health Care Innovations Exchange features two profiles of partnerships between clinical practices and community organizations that leverage health provider teams and lay health advisors to improve the management of chronic diseases. One profile describes a public-private initiative that worked with community health teams to improve the delivery of preventive, health maintenance, and chronic care services in Vermont. The pilot program included incentive payments to providers who met National Committee for Quality Assurance-determined care standards, access to an insurer-funded team of community-based health providers, health information incorporated into a Web-based clinical tracking system, and interfaces with other State care coordination initiatives. Over a 4-year period, the pilot program experienced a 6 percent decrease in inpatient admissions and a 10 percent decrease in emergency department visits among participating practices. Select to read more profiles related to clinical-community linkages, including innovations and tools, on the Health Care Innovations Exchange Web site, which contains more than 700 searchable innovations and 1,500 QualityTools.

Related articles

• AHRQ Implementation Toolsets for E-Prescribing (medicineandtechnology.com)
• 11 Chronic Disease Technologies to Watch (thielst.typepad.com)
• Involving eHealth: How Health Care Leaders May Envelop Chronic Care Management Strategies with Health Information Exchange Directives (silverevolution.wordpress.com)
• Tools Help Foster Communication Between Patients and Clinicians (thielst.typepad.com)

Infographic: Where money is spent in health care vs. what makes us healthy

While I’m not sure if there is a one-to-one relationship between money spent on health care and what will result in healthier individuals…still this is a real eye-opener.

Between The Charts

Read full report by BPC here

Read full article here

Via WONK blog by @ezraklein

View original post

For those interested in health system indicators (statistics)

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The Health System Measurement Project tracks government data on critical U.S. health system indicators. The website presents national trend data as well as detailed views broken out by population characteristics such as age, sex, income level, and insurance coverage status.

Not only can one view data, but one can customize graphs and tables

From the About Page

The Project focuses on ten critical dimensions of our health care system covering the availability, quality, and cost of care, the overall health of Americans, and the dynamism of the system. The Project examines the evolution of these aspects of our system over time. It also assesses the status of these dimensions of the system with respect to subgroups of the population, with a particular emphasis on vulnerable populations.

About the Topical Areas

The measures are divided into the following ten topical areas:

• Access to Care
• Cost and Affordability
• Coverage
• Health Information Technology
• Innovation
• Population Health
• Prevention
• Quality
• Vulnerable Populations
• Workforce

About the Functionality

With this web tool you can:

• Quickly view data on a given topic from multiple sources
• Compare national metrics with the same metrics measured at the regional and state level
• See time trends for up to 10 years
• Compare data across variables such as income, race, age, and insurance coverage type
• View data in both graphical and table format

Related articles

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New AHRQ Report Finds Teamwork and Follow-Up as Strengths of Medical Offices but Work Pressure and Pace are Problemat

From a recent email from AHRQ (US Agency for Healthcare Research and Quality)

Teamwork and patient care tracking/follow-up are strengths for medical offices, but work pressure and pace are areas for improvement, according to new results from the AHRQ Medical Office Survey on Patient Safety Culture. Most (84 percent) medical office staff feel they have good teamwork among staff and providers and that the office follows up with patients appropriately (82 percent). But only 46 percent of staff rated the work pressure and pace in their office positively. The first edition of the Medical Office Survey on Patient Safety Culture: 2012 User Comparative Database Report provides results from 23,679 staff from 934 U.S. medical offices. The report helps medical offices compare their patient safety culture scores with other medical offices. It contains detailed comparative data on the survey by number of providers, specialty, ownership, region, and by staff position. Select to access the survey that can be used by medical offices, health systems and researchers to assess the opinions of medical office staff about patient safety issues and overall quality of care. It measures 10 areas of patient safety culture as well as overall ratings on quality and patient safety.

Am thinking that maybe the amount of “paperwork” would be factor in the ratings.
And that more providers could potentially affect ratings.
Maybe so..an excerpt from the summary

Number of Providers

• Medical offices with one or two providers had the highest average percent positive on all 10 patient safety culture composites.
• Percent positive scores (those responding “Excellent” or “Very Good”) for all five Overall Ratings on Quality were higher for medical offices with fewer providers.
• Medical offices with two providers had the highest (74 percent) percentage of respondents who gave their medical office an Average Overall Rating on Quality and Patient Safety of “Excellent” or “Very good.” Medical offices with 14 to 19 providers had the lowest (57 percent).

Diagnostic Codes & Misleading Clinical Assumptions (Explains Why Pneumonia Cases Were Underreported Nationwide)

Bottom line…an author had used codes which underreported pneumonia cases by not taking into account diagnoses where pneumonia was a secondary diagnosis

 

From NLM Director’s Comments Transcript
Diagnostic Codes & Misleading Clinical Assumptions: 05/29/2012

Purported declines in pneumonia hospitalization and mortality rates were misleading because a standardized clinical diagnostic coding system was interpreted one-dimensionally, find an illuminatingstudy and an accompanying editorial recently published in the Journal of the American Medical Association.

Both the study and the editorial suggest subtle revisions in the use of diagnostic codes and related reimbursement procedures can impact hospital data and alter inferences about patient results as well as the quality of health care provided by U.S. hospitals, clinics, and health care providers….

…

n the study, five authors initially found a 27 percent decline in hospitalization and a 28 percent decline in mortality rates from pneumonia during 2003-2009 by using a patient results database that is undergirded by a nationally used diagnostic code system. The coding system is called the International Classification of Diseases, Ninth Revision, Clinical Modification, which is often referred to as ICD-9-CM. ICD-9-CM is used by hospitals, clinics, and health care providers nationwide to code patient diagnoses and is a foundation for administrative and patient records as well as insurance billing.

The study’s authors explain the Nationwide Input Sample (grounded in ICD-9-CM diagnostic codes) suggested there were significant improvements in hospitals and clinics across the U.S. in the treatment of pneumonia, which also were reported in other, smaller studies.

However, the study’s authors checked the identical dataset for hospitalization rates by using a more multidimensional definition of pneumonia within ICD-9-CM codes. The authors asked how many patients were diagnosed with sepsis and respiratory failure with a secondary diagnosis of pneumonia during the same time period? The authors found the hospitalization and respiratory rates increased by 178 percent and nine percent respectively for patients diagnosed with sepsis and respiratory failure with a secondary diagnosis of pneumonia.

When the study’s authors then combined a primary and secondary pneumonia diagnoses from the same dataset, they found an overall 12 percent decline in pneumonia-related admissions and a six percent increase in mortality occurred from 2003-2009. In other words, the addition of two other codes for pneumonia diagnoses partially refuted the initial reports of highly reduced hospitalization and mortality from pneumonia.

The study’s authors write (and we quote) ‘the results suggest that secular trends in documentation and coding, rather than improvements in actual outcomes, may explain much of the observed change in this and other studies’ (end of quote).

The study’s authors explain the current research is the first to assess hospitalization and mortality rates using a multidimensional diagnostic definition of pneumonia.

Similarly, the editorial’s authors write and we quote): ‘nuances in the assignment of principal and secondary diagnoses (in ICD-9-CM codes) can also affect assessment of hospital performance’ (end of quote).

Among other examples, the editorial’s authors add the use of sepsis as a diagnosis among patients with pneumonia may have increased significantly from 2003-2009 because the reimbursement potential for sepsis (based on diagnosis related groups) was higher than pneumonia during this period. The editorial’s authors write (and we quote): ‘Under prospective payment, there is a wide variation in reimbursement for different diagnosis related groups (DRGs), creating incentives to identify principal diagnoses associated with higher reimbursing DRGs’ (end of quote).

While the editorial’s authors acknowledge ICD-9-CM codes and DRGs (as well as other, related information) make it easier to use administrative data to assess health care delivery and quality of care, they underscore it is important to judiciously interpret the methods and findings. The editorial’s authors conclude (and we quote): ‘the potential for misleading interpretation of findings based on naïve analysis of administrative data and a lack of appreciation of the nuances in diagnostic coding will continue to be a problem’ (end of quote).

Meanwhile, MedlinePlus.gov’s health insurance health topic page provides insights into the bottom line byproduct of diagnostic codes that impactpatients and health consumers — how to pay for a provider’s or health organization’s charges.

MedlinePlus.gov’s health insurance health topic page provides two overviews of health insurance from the American Academy of Family Physicians in the ‘start here’ section. A helpful guide to 10 ways to make health benefits work for you (from the U.S. Department of Labor) also is available in the ‘start here’ section.

A website from the American College of Physicians and the American Association of Retired Persons (available in the ‘related issues’ section) helps you understand some of the pending changes in health insurance associated with the comprehensive health care law the U.S. Congress passed in 2010.

MedlinePlus.gov’s health insurance health topic page additionally contains updated research summaries, which are available within the ‘research’ section. Links to the latest pertinent journal research articles are available in the ‘journal articles’ section. From the health insurance health topic page, you can sign up to receive email updates with links to new information as it becomes available on MedlinePlus.

To find MedlinePlus.gov’s health insurance health topic page, type ‘health insurance’ in the search box on MedlinePlus.gov’s home page, then, click on ‘health insurance (National Library of Medicine).’

MedlinePlus.gov also contains related health topic pages on: Financial Assistance, Managed Care, Medicaid, Medicare, and Medicare Prescription Drug Coverage.

Before I go, this reminder……. MedlinePlus.gov is authoritative. It’s free. We do not accept advertising …and is written to help you.

 

 

Related articles

• So What Was Wrong With ICD-9? (informationweek.com)
• ICD-9 codes underestimate statin-linked rhabdomyolysis (medicalxpress.com)
• Why the Fragility of Health Outcomes Research May Be a Good Outcome for Health (thehealthcareblog.com)
• Reported Decline in U.S. Pneumonia Deaths May Be False: Study (news.health.com)
• Pneumonia Patients With High Glucose Levels At Greater Risk Of Death (medicalnewstoday.com)
• You: Health agency says hospital staff must be trained to combat pneumonia (guardian.co.uk)

A healthy look at social media

From the 10 May 2012 Medical News Today article

Can social media solve the US healthcare crisis?

The creation of a social media videoconferencing platform geared towards healthcare might pave the way for enhanced use of social media in the world of healthcare according to a study published this month in the International Journal of Electronic Finance.

Peter DeVries of the Department of Finance, Accounting, and CIS, at the University of Houston – Downtown, explains that despite the advent of social media tools and accessible mobile communications devices, the patient-doctor relationship has changed little. DeVries suggests that innovative use of social media might improve that relationship as well as the healthcare industry as a whole not only by reducing inefficiencies but by making healthcare provision and advice more immediate and engaging at lower cost. DeVries suggests that from the perspective of healthcare providers social media might also open up new revenue streams that could bolster an industry currently in economic turmoil.

DeVries points out that many industries are using social media to improve the customer and user experience and to provide social interaction among like-minded individuals. The popularity of Twitter and Facebook, which is fast approaching 1 billion worldwide users, is testament to the power social media might wield and the opportunities it could bring. “We are seeing companies linking to social media sites from their corporate websites to form closer relationships with their customers,” says DeVries. In his paper, he offers healthcare providers several pointers as to how they might engage their customers, the patients, through social media with a view to not only improving medical provision but improving the company finances too.

Two aspects of social media that might revolutionize healthcare provision lie in the relationships between patients, the relationships between physicians and perhaps most importantly the relationships between the two. If social media can enable patients to share information with other patients and to gain knowledge and at the same time give physicians the ability to share and learn from their peers more readily, then the meshing of these two threads could make for better informed connections between patients and their physicians too.

DeVries cites the Association of American Medical Colleges on how there is likely to be a 124,000 shortfall of full-time physicians in the USA by 2025, while there will be a need for almost 140,000 family physicians by 2020 if Americans are to have adequate access to primary healthcare.

The projected shortage of physicians demands innovation in the healthcare industry, says DeVries. “Doctors and hospitals must find ways to provide healthcare in more productive and efficient ways,” he adds. “If a growing number of patients are finding themselves as users of Web 2.0, then Web 2.0 might be the answer to alleviate the forecasted overcrowding.”

Related articles

• Can Social Media Solve The US Healthcare Crisis? (medicalnewstoday.com)
• Physicians Leveraging Social Media to Educate Patients (bjconquest.com)
• Healthcare Social Media: Healing or Hurting? (tedkolota.com)

Repairing the tear in health care’s safety net with social media

Excerpt from the post at KevinMD.com (May 5, 2012)

…And while social media is by no means a replacement for in-person care, it should be a viable means for consumers to get safe, trusted health information from medical professionals online that provides enough orientation and preventative guidance that they do not need to visit the ER for routine care.

America needs to reverse the role of the safety net system back to its designated place of original design – with safety net care serving critical need patients without insurance or other economic means who require both proactive and reactive medical care.  We remain optimistic that healthcare reform will address some of these critical issues – and help to deploy more efficient protocols.  In the interim, we are hopeful that consumers and physicians will recognize the role that “information sharing” can play in empowering both patients and doctors to collectively embrace better, more accessible solutions…

Related articles

• What Makes Better Care? The Series. Part 2: Protect Vulnerable People (hcfama.org)
• James V. Pagano M.D. on Affordable Care Act (clarespark.com)
• When It Comes To Healthcare, We Are Not The Customers (vistage.com)