The Fallen Souffle Economy and the Health Care Bubble

Jeff Goldsmith

First posted 8/10/11 on The Health Care Blog

It is increasingly clear that the United States’ economic troubles are far from over.

The stock market plunge that began in earnest last week reflects the market’s belief that we’re not going to recover fully from the recession that began in 2007. As a Wall Street Journal commentator said mid-Monday’s plunge:  “The market is pricing in a double dip recession”. In reality, the 2007 recession (caused initially by $150 a barrel oil) never really ended.

Past remedies for recession basically involved nearly free money and Keynesian pump priming to stimulate demand with either borrowed or freshly printed money. The most recent (bipartisan) stimulus effort, nearly a trillion worth of extended Bush tax cuts, unemployment extensions, payroll tax cuts, etc. which Congress and the Obama Administration negotiated in December, seems to have disappeared into thin air, producing a whopping 0.8% economic growth in the first half of 2011 and a July unemployment rate of 9.2%. This Economist analysis argues that the political system has exhausted its remedies for our economic problems.

Continue reading “The Fallen Souffle Economy and the Health Care Bubble”

Why Medical Specialists Should Want to End the Reign of the RUC

Paul M. Fischer, MD

The old doctors know.  The practice of medicine has changed in a very basic way over the last 20 years.  Physician relationships have lost their civility and have been replaced by a level of tension that takes the fun out of collegial interactions.  I remember my first year of family medicine as the only doctor in Weeping Water, Nebraska.  My personal medical community had gone from an entire medical school campus with limitless lectures and many physicians to share in “interesting cases” to an occasional phone call with a consultant in Omaha.  These contacts became my primary source for medical education and updates for Weeping Water’s health care.  The phone calls were collegial, respectful, and focused on what was best for my patients.

Continue reading “Why Medical Specialists Should Want to End the Reign of the RUC”

Alternatives To Scrapping 510(k)

Merrell Goozner

First posted 8/11/11 on Gooz News

The Institute of Medicine report on medical device regulation released two weeks ago called for scrapping the 510(k) process that allows for market entry of new devices if they’re shown to be “substantially equivalent” to already marketed devices. In a Perspective in today’s New England Journal of Medicine, committee members David R. Challoner, M.D. of the University of Florida and William W. Vodra, J.D., an attorney at Arnold & Porter, reiterated the reasoning of the report:

Today, we have a system in which a new moderate-risk device can enter the market because it is substantially equivalent to another device that may have been cleared for marketing 2 years ago because its manufacturer showed that it was substantially equivalent to yet another device cleared in 2003, and so on, all the way back to a device that was being marketed when the law was enacted in 1976. But that original device might never have been assessed for safety or effectiveness, nor perhaps would any subsequent ones in the family tree. . . We decided that the 510(k) process cannot be transformed into a premarketing evaluation of safety and effectiveness as long as the standard for clearance is substantial equivalence to a previously cleared device.

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MHA Does CLABSI Right!

Paul Levy

First posted 8/13/11 on Not Running A Hospital

Here’s a great step forward by the Massachusetts Hospital Association, a public presentation  of current data on the rate of central line associated bloodstream infections among its participating members. Here’s the current chart:

Let’s talk about what’s good about this. First, the data are quite current, just a few months old.  Next, the monthly figures, which are subject to minor variations, are smoothed out with a three-month moving average, so you can see the trend.  Third, there are no punches pulled.  When the rate goes up, they say it.

Since each hospital knows it own rate, it can easily compare its progress to others in the state.  N0t for the sake of trying to attract more patients or for other kinds of marketing, but to act as a form of creative tension within the organization to do better. Now, that’s the right kind of competition.

Paul Levy is a former large hospital CEO in Boston. He now writes as an advocate for patient centered care and efficient management of health care services.

Low Back Pain: Is Relief In Sight?

By Dov Michaeli

First posted 8/8/11 on The Doctor Weighs In

For people of a certain age low back pain is a fact of daily life. Why, of all people, should our venerable seniors suffer from this affliction? The short answer is disk degeneration. The longer answer requires a longer explanation. So bear with me and I’ll walk you through it.

The intervertebral disk

This structure is a marvel of engineering. Now don’t get me wrong, I am not implying that an all knowing intelligent engineer designed it. What is marvelous about it is that an evolutionary process of trial and error lasting many millions years made us, and all vertebrates, well…vertebrates. And probably as important, it allowed us to walk upright, although we had to pay a penalty for the privilege. More on that later.

The picture below shows the basic structure of a disk.

The center of the disk, called nucleus pulposus, is made up of cartilage material, which has the consistency of a gel; imagine a water-filled sponge. If you apply pressure on the sponge from above, what would keep the water from running off to the sides?

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Bad Language: Words One Patient Won’t Use (And Hopes You Won’t Either)

Jesse Gruman

First posted 8/03/11 on Prepared Patient Forum

“There is a better way – structural reforms that empower patients with greater choices and increase the role of competition in the health-care marketplace.” Rep. Paul Ryan (R-WI)August 3, 2011

The highly charged political debates about reforming American health care have provided tempting opportunities to rename the people who receive health services.  But because the impetus for this change has been prompted by cost and quality concerns of health care payers, researchers and policy experts rather than emanating from us out of our own needs, some odd words have been called into service.  Two phrases commonly used to describe us convey meanings that mischaracterize our experiences and undervalue our needs: “empowered patient” and “health care consumer.”

As one who has done serious time as a patient and who spends serious time listening to talks and reading the literature that use these words to describe us, I ask you to reconsider their use.

Continue reading “Bad Language: Words One Patient Won’t Use (And Hopes You Won’t Either)”