Posted 5/01/12 on The Doctor Weighs In
Can Hospitals Afford to Give Away Money? If not, then why are Preventable Adverse Events Still Occur in Hospitals?
Posted 4/24/12 on Healthcare Transparency Now
Recent focus groups conducted as part of a study funded by a federal agency reported the following:
- People are loathe to make cost and resource use a consideration in choosing health care providers and treatments, even when they are in high deductible plans
- People will assume higher cost = higher quality if only given cost data
- People assume more tests and treatments are better, unless information is framed explicitly in terms of potential harms and risks
- People are interested, for the most part, on what it costs them to get care
- There are some measures that people think could be very useful that are“cost” measures that they can see are also “quality “ measures
- Example: costs/level of “avoidable complications”
Much of the data currently available will not respond to what consumers care about: (1) It doesn’t address their costs, (2) It doesn’t take into considerations variations in insurance design that affect what different individuals pay and (3) It cannot be clearly linked to quality measures.
It has been my experience that lower cost providers tend to be high quality providers. The explanation for this is that providers that end to do high volume services of a particular kind tend to have greater efficiencies.
The price variability among healthcare providers is extreme and what patients are paying for their services in many cases is not a reflection of what it costs to deliver the services. Thus pricing is all over the place. Often time’s people will go and seek services based on a doctor’s recommendation and patients are given the information and share it with their doctor. This will often influence the doctor as to where patients should receive their services.
There is no doubt that price transparency in services will change purchasing behavior of physicians and patients in seeking alternatives.
Source: Engaging consumers with a high value healthcare system, by Shoshana Sofaer (2011)
Posted 4/25/12 on The Disease Management Care Blog
The Disease Management Care Blog agrees that if you want a peek at a potential future scenario for health care reform, look at what has happened in Massachusetts since 2006. That’s when the Bay State passed a law that, just like its cousin the Affordable Care Act (ACA), emphasized insurance reforms that included exchanges, subsidies and changes in Medicaid eligibility.
According to this recent New England Journal of Medicine article, the reforms resulted in both good and bad news. The good news is that 98% of Massachusetts’ citizens have insurance coverage; the bad news is that health care now consumes a whopping 54% of the state’s total budget.
In response, the state is now pursuing cost reforms. As the DMCB understands it, Massachusetts is banking on the principle of “global payment” to incent health care providers to work within a budget. If it works out, the providers will embrace “value” by delivering needed services and cutting waste. If it doesn’t work out, the providers could end up putting savings before patients by withholding medical care.
Continue reading “Cappers vs.Skinners in the Struggle To Control Costs”
Posted 4/24/12 on Common Sense Family Doctor
A few years ago, a good friend of mine who holds bachelor’s and law degrees from Ivy League schools lost his job and became one of the estimated 50 million medically uninsured persons in the U.S. Over the course of several days, he developed increasingly severe abdominal pain, fever, and vomiting. Though reluctant to seek medical attention, he finally was persuaded to visit his local hospital’s emergency department, where he was diagnosed with acute appendicitis. Despite his critical condition and the need for immediate surgery, he refused treatment until the hospital’s billing department gave him an estimate of how much an emergency appendectomy would cost. Then, as he was being prepared for the operating room, he somehow managed to bargain with the surgeon to reduce his customary fees.
Continue reading “How Much Does It Cost To Have An Appendectomy?”
Posted 4/29/12 on The Hospitalist Leader
The press gave the Choosing Wisely initiative, unveiled several weeks ago, a great deal of attention. Briefly, the ABIM foundation collaborated with Consumer Reports to produce Top 5 lists from nine specialty societies to identify “five tests or procedures commonly used in their field, whose necessity should be questioned and discussed.” It is a first step to engage patients and physicians in the shapeless “national conversation” on (sensibly) rationing that everyone speaks of, but never hears. I write about it now, not just because this process is inevitable—which it is, but because the Society of Hospital Medicine is amongst the next group of eight to offer up recommendations.
Voluntary guidelines generally do not command attention. One envisions this list of 2500+ much the same way we view our bedroom walk in closets. The filled shoeboxes of yesteryear are there, but we will not open or utilize their contents again. Knowing they are near though allows us to sleep better, a token consolation, but alas, they are memories.
Continue reading “Choosing Wisely or Vicely”
Posted 4/12/12 on Common Sense Family Doctor
Regardless of whether or not the Supreme Court strikes down the individual mandate or the entire 2010 health reform law in June, state-based health insurance exchanges are a good idea and, if established, should benefit many working Americans who are too well-off to qualify for Medicaid but unable to otherwise afford health insurance coverage on their own. This post and two to follow over the next week are excerpts from an unpublished paper that I recently authored on this topic.
One of the key elements of the insurance coverage expansion contained in the Affordable Care Act (ACA) is the establishment of health benefits exchanges operated by individual states, groups of states, or the federal government, by January 1, 2014. These exchanges will offer competitive and/or subsidized insurance options for individuals whose employers do not provide insurance, as well as offer plans to small businesses (up to 100 employees) at reasonable rates. Prior to the ACA, Massachusetts and Utah had both operated state insurance exchanges with varying degrees of success. By outlining only basic requirements for the functions of the exchanges, the ACA left many important questions regarding their design unanswered. Some states appear to be pursuing a “wait and see” strategy, hoping that the U.S. Supreme Court will strike down the ACA prior to the January 2013 deadline for showing sufficient progress toward establishing an exchange or ceding control to the federal government. Others are at various stages of the planning process; as of January 2012, 13 states had formally established their exchanges through legislation or executive orders. Maryland and California are at the vanguard of this group.
Continue reading “My Take On State Health Insurance Exchanges – Part 1”
Here is the introduction by Jesse Gruman, host of the Prepared Patient Forum:
Posted on the Prepared Patient Forum
Andrew Robinson was a successful New York trial attorney when he was diagnosed with “an incurable form of Leukemia” and told he had “less than five years to live.” That was more than 15 years ago. Despite severe complications, including over 50 hospitalizations, Andrew was the founder and CEO of Patient2Patient, a mission based company that developed disease specific WebGuides to help patients learn how to locate and use the medical information, resources and tools available on the Internet.
Andy is a friend, a playwright, a humorist, a blogger and a veteran of many cancer diagnoses and treatments. Andy embodies the ideal participator in Participatory Medicine. He is an informed, active and curious person who has found ways of working with a wide variety of specialist physicians over the years to devise strategies that allow him to remain as healthy and functional as he can.
Continue reading “An Open Letter to a Surgeon From His Patient”
Posted 3/27/12 on The American Family Physician Community Blog
In the March 15, 2011 issue of American Family Physician, Drs. Mark Graber, Robert Dachs, and Andrea Darby-Stewart analyzed an industry-funded trial that compared the effects of two daily doses of the Alzheimer’s disease drug donepezil (Aricept): a new 23 mg version and the existing 10 mg version that would soon lose its patent protection. Despite the trial authors’ finding that the higher dose of donepezil slightly improved cognitive outcomes, AFP Journal Club commentators determined that this difference was clinically unimportant, and was greatly outweighed by the higher frequency of adverse effects in patients using the higher dose:
First, the authors did four comparisons. Three were negative and only one was positive. And the one that was positive was only two points different on a 100-point scale. So, although this is statistically significant, it is clinically meaningless. There is no discernible benefit for the patient or caregivers. … Also, the drop-out rate in this study was an astounding 30 percent in the higher-dose group and 18 percent in the lower-dose group.
Continue reading “The FDA Fails to Stop Deceptive Dementia Drug Advertising”
Published 4/10/12 in The Fiscal Times
Last week, physician groups representing nearly half of America’s doctors issued guidelines that would limit Americans’ access to allegedly unnecessary medical tests and procedures. The public reaction was noticeable for the one thing that was missing – a public outcry against rationing.
That was reserved for the floor of the U.S. House of Representatives on a completely separate issue. The Republican majority last week cast another symbolic vote against what it calls rationing in the health care reform law better known as Obamacare.
Continue reading “Rationing Redux: The Dog That Didn’t Bark”
Posted 4/6/12 on Cracking Health Costs
So reads the headline in a Reuters story on April 4, 2011.
Let’s linger on the notion that they are exposing procedures that are “harmful” yet “routinely prescribed.” Giving harmful care to cancer patients is not rare, but “routine”. The words immoral, unethical, unscrupulous, and venal come to mind.A private task force was led by Dr. Lowell Schnipper, a cancer physician at Beth Israel Deaconess Medical Center. The task force was organized by the American Society of Clinical Oncology. The goal was to “…to identify procedures that do not help patients live longer or better or that may even be harmful, yet are routinely prescribed.” [Italics mine.]
Continue reading ““Doctors call for end to five cancer tests, treatments””
In the fall of 2010, Atul Gawande, surgeon at Brigham and Women’s Hospital in Boston and an associate professor at Harvard Medical School, delivered a touching speech at the October New Yorker Festival. My husband attended with a friend and, because he said it so profoundly impacted the audience, I watched it myself on video the next day. It was indeed amazing. Dr. Gawande, author and national health care presence, spoke unabashedly about his lack of skill in conducting end-of-life conversations with his patients.
Continue reading “Four Perfect Questions”
Posted 3/30/12 on Health Populi
It was Dr. Charles Safran who said, “Patients are the most under-utilized resource in the U.S. health system,” which he testified to Congress in 2004. Seven years later, patients are still under-utilized, not just in the U.S. but around the world.
Yet, “when patients have an active role in their own health care, the quality of their care, and of their care experience improves,” assert researchers from The Commonwealth Fund in their analysis of 2011 global health consumer survey data published in the April/June 2010 issue of the Journal of Ambulatory Care Management. This analysis is summarized inInternational Perspectives on Patient Engagement: Results from the 2011 Commonwealth Fund Survey, published on The Commonwealth Fund’s website on March 29, 2012.
Continue reading “Patient Engagement and Medical Homes – Core Drivers of a High-Performing Health System”
Paul F. Levy and W. David Stephenson
Published in the current issue of the Boston Business Journal
Massachusetts has a stunning opportunity to break open many of the mysteries surrounding delivery of health care. Doing so will help resolve important public policy issues. It will help contain rising health care expenses. And, it will even help save lives and improve the public health.
Doing this requires no new state law. The law is already on the books. It requires no addition to the state budget. The costs have already been incurred.
What could cause so dramatic an impact? Liberating data that is already in the hands of the state government.
Continue reading “Free Our Data and Improve Public Health!”
Posted 4/02/12 on Kent Bottles Private Views
“If you cannot measure it, you cannot improve it.” Lord Kelvin
“Asking science to explain life and vital matters is equivalent to asking a grammarian to explain poetry.” Nassim Nicholas Taleb
Of course the quantified self movement with its self-tracking, body hacking, and data-driven life started in San Francisco when Gary Wolf started the “Quantified Self” blog in 2007. By 2012, there were regular meetings in 50 cities and a European and American conference. Most of us do not keep track of our moods, our blood pressure, how many drinks we have, or our sleep patterns every day. Most of us probably prefer the Taleb to the Lord Kelvin quotation when it comes to living our daily lives. And yet there are an increasing number of early adopters who are dedicated members of the quantified self movement.
“They are an eclectic mix of early adopters, fitness freaks, technology evangelists, personal-development junkies, hackers, and patients suffering from a wide variety of health problems. What they share is a belief that gathering and analysing data about their everyday activities can help them improve their lives.”
Continue reading “Will the Quantified Self Movement Take Off in Health Care?”