Published Online 6/27/2016 in JAMA Internal Medicine.
A couple of months before Elaine died from peritoneal cancer, we hired Anila, a cheerful, hearty Albanian house cleaner. On her first visit, Anila saw that Elaine was bedridden. “Kerosene can save her,” she said. “There is science. Look it up on the Internet.” Later, Elaine and I had a good laugh over it. She said, “Maybe that’s all they have available in Albania.” But in retrospect I’ve thought, “Could it be any worse than the treatment she got here?”
Elaine was a bright light to those who knew her, one of those rare people whose inherent grace put others at ease and made them feel special. A trained pianist, she was also a gifted and productive artist who in her last year painted and gave away more than a dozen original pieces to friends and family. Continue reading “The Gold Standard for Current Cancer Treatment”
Posted 4/07/13 on Medscape Connect’s Care & Cost Blog
Last week I visited with Gary Rost, an unassumingly knowledgeable man and the Executive Director of the Savannah Business Group (SBG), arguably one of the most effective health care coalitions in the country. Their offices are only a couple hours away from my home on the Northeast Florida coast, so it was a quick trip up.
SBG was founded in 1982 as a way of mobilizing employer buying power for better care at lower cost. Its reach now extends beyond Savannah about an hour south, north into South Carolina and west from the coast. The vision described on its site is straightforward and easy for purchasers to appreciate:
“SBG endorses and adheres to the principles of value-based purchasing: performance measurement, transparency, public reporting, pay for performance, informed consumer choice and collective employer leadership.”
Continue reading “When Employers Get Serious About Managing Health Care Risk”
This beautifully written letter was forwarded after an interview with me on health care cost appeared in a Florida newspaper.
Many of us with coverage often think in abstract terms about working families that do not have access to employer-sponsored coverage, and that must shoulder the overwhelming burden of costs on their own. As Mrs. Doss describes, health care costs dominate her family’s economic life and drive many of their most important decisions.
Continue reading “The Reality of Health Care Cost”
Complications from my cancer sent me to the hospital again recently. The news that I was in trouble came unexpectedly from my oncologist’s office Thanksgiving eve, following a routine blood test. “Your liver numbers are out of whack.” My response was “Really?” as if I’d been notified that my driver’s license had expired.
I was diagnosed with a blocked bile duct and I missed the turkey and cranberry sauce. My oncologist called in a gastroenterologist, who scheduled a procedure to open the blocked duct. But my tissues were too distorted to complete the procedure, so the next day an interventional radiologist inserted a bile drain. I met him seconds before I drifted into sedation. When it was over and I was awakening, he offered me a cheery “good luck” as I rolled out the door. I never saw him again.
Continue reading “Hospitals: Are We All Talking?”
Posted 5/10/12 on The Doctor Weighs In
For most of us, talking about death doesn’t come easily. Yet, it’s something we all experience — the loss of those we know and love, and ultimately, our own death – quote from DeathWise.org
In this wonderful age of digital empowerment, we can now take charge of many things that we used to have to depend on others to do for us. Examples include booking vacations and managing our investment portfolios. Now, there is a website, DeathWise, that can help you manage your death–well, not exactly your death, rather the planning for your death. This can mean the difference between an orderly exit or one that leaves your family and friends combing through your papers and guessing your wishes.
In my family, no one ever talked about death, let alone planned for it. One example was the death of my maternal grandmother who, at the age of 78, died in her bed in the apartment she had rented for almost 40 years. Neither her daughters, their spouses, nor the rest of her extended family had any idea about the details of her life despite the fact that we all lived within 30 miles of her house and saw her frequently. We were pretty surprised to find out that all of “her” furniture actually belonged to the landlord.
And, that her frugal habits included saving every rubber band that ever made it into her hands – all rolled up into a gigantic rubber band ball. We didn’t know where her papers were, what type of service she would like or even if she preferred cremation or burial. We muddled through, spending days in her apartment opening cupboards, poking around in drawers, and rifling through papers, bankbooks (remember them?), and check stubs. We hoped we did what she would have wanted, but we weren’t really sure.
Continue reading “DeathWise.org – DIY End of Life Planning”
Posted 5/7/12 on The Health Affairs Blog
A recent spate of commentaries on the continuing health spending moderation raise an important policy question: If the cost curve is well and truly bent, why are we investing so much of our policy energy on bending it further, when the more pressing problem is the declining percentage of Americans that can afford our health system’s astronomical costs?
Health spending the past two reported years (2009 and 2010) have grown in the high 3 percent range, the lowest growth rates since Dwight Eisenhower’s last year in office (1960), five years before Medicare.Medicare’s actuaries have pointed to the recession as a root cause. Yet even Medicare spending growth has subsided to about 5 percent in 2010, a development hard to attribute to recession since so few Medicare patients have first-dollar cost exposure. This analyst’s extensive industry contacts suggest no spending rebound in 2011 and 2012, despite an aging population and fee-for-service’s pernicious volume-increasing incentives in full force.
Continue reading “Barking Up the Wrong Tree: Affordability, Not Cost Growth, Is The Real Policy Challenge”
Posted 5/6/12 on Health Blawg
Meaningful Use Stage 2 regulations were released in March by CMS and ONC. Over the past month or so, I’ve been working with other members of the Society for Participatory Medicine (thank you, all) to prepare comments on these regulations from the patient perspective. Last Friday, we filed two comment letters on the proposed regulations. One letter to the ONC on Meaningful Use Stage 2, and one letter to CMS on Meaningful Use Stage 2. Each letter opens like this:
Continue reading “Nothing About Me Without Me: Participatory Medicine, Meaningful Use and the American Hospital Association”
If you read only one book about state and federal health care policy, it should be The Great Experiment: The States, the Feds and Your Healthcare. Published by the Boston-based Pioneer Institute, it is the most articulate and rigorous presentation of issues that I have seen, a stark contrast from many papers, articles, and speeches that slide by as “informed debate” in Massachusetts and across the country. I learned more about health care policy from this book than from anything else I have read in the last decade.
Continue reading “The Great Experiment”
Posted 5/5/12 on The Health Care Blog
The protest organized by Regina Holliday over a patient’s right to access their medical information is not quite the same magnitude as agitating for integration in 1950s-era Alabama. Yet there are intriguing similarities between the crusade Rosa Parks launched then and what Holliday is attempting today. Both involve a refusal to accept second-class status and a resolve to push back against entrenched institutions.
Continue reading “Will Regina Holiday Become Health Care’s Rosa Parks?”
Christine K. Cassel
Posted 4/5/12 on the ABIM Foundation Medical Professionalism Blog
As we all know, this is a time of great challenge and introspection in our health care system. Not just in terms of health reform – although that has been the catalyst for several critically important conversations over the last two years. I’m referring to a broader reexamination of how we deliver care in America and what physicians, working with their patients, can do to ensure the highest-quality care.
This is an important conversation for us to have, and in a polarizing political environment, it can be difficult for rational discourse. Waste, overuse, accountability – these are simple terms that belie the complex underpinnings of our health care system. While some might be tempted to pick a particular phrase as the launching point for this rhetoric, the facts driving our work speak for themselves. And what they show is that despite significant investment in our health care system, it does not deliver the quality or value we would expect, and that patients deserve.
Continue reading “Dr. Cassel Sets Out The Mission of the Choosing Wisely Initiative”
Posted 5/1/12 on Health Populi
You can now carry a doctor with you in your pocket. Two top telehealth companies that support online physician-patient visits have gone mobile. This upgrade was announced this week at the 2012 American Telemedicine Association conference, being held in San Jose, CA.
Continue reading “A Doctor’s Appointment on your Phone: Out of Beta and Into Your Pocket”
Posted 5/01/12 on the Altarum Institute’s Health Policy Forum
“I’m thinking of getting a full-body CT scan,” Jane said. “What do you think?” Here was a healthy, active 72-year-old with no specific symptoms considering an expensive screening test. When asked for a reason, she shared that strokes run in her family and a doctor told her that she might be able to see if there was a possible bulge in a blood vessel in her brain. Plus, while they were looking, the scan could see if there was some other problem.
When asked how it would affect her to know – do you think you would consider brain surgery if there was a problem? (probably not); what might you do differently if you knew? (I don’t know); do you know whether a bulge in her vessel would definitely cause a stroke? (not necessarily); she hadn’t really gone that far. She just thought she should know.
Continue reading “More Information Is Not Always Better: Pulling Consumers Into Active Choices About Testing”