Cleveland Clinic Announces Top Ten Health Care Innovations for 2012

Patricia Salber

Posted 10/07/11 on The Doctor Weighs In

Every year the Cleveland Clinic announces the top 10 innovations that their experts think will impact healthcare the most in the following year.  Here are the winners for 2012:

#1 Catheter-based renal denervation for resistant high blood pressure

People with hypertension (HTN) are at risk for heart attacks, strokes, and kidney failure.  When high blood pressure cannot be controlled with three or more medications, it is considered resistant.  One-third of Americans have hypertension and 20-30% of these cases are considered resistant.  High blood pressure is the leading risk factor for death worldwide – worse than cigarettes.  Until the development of renal denervation, there was no effective treatment for resistant hypertension.  In a small randomized controlled trial, the Simplicity HTN study, 39% achieved target blood pressures and 50% had some measurable benefit compared to the controls, treated only with high blood pressure mediations that had no change from their baseline blood pressures.  Average decrease in systolic blood pressure was an astonishing 35 mm Hg with a 12 mm drop in diastolic blood pressures.  The procedure takes about 40 minutes and is performed in a hospital’s catheterization lab.  If the results hold up – and if there are no unintended consequences – this could be really BIG (which, of course, is why it won the #1 slot on this list).

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Reverse Innovation & The Cost Crisis of American Healthcare

Kent Bottles

First posted 9/10/11 on Kent Bottles Private Views

The realization that the American health care system must simultaneously decrease per-capita cost and increase quality has created the opportunity for the United States to learn from low and middle-income countries. “Reverse innovation” describes the process whereby an inexpensive innovation is used first in countries with limited infrastructure and resources and then spreads to industrialized nations like the United States.

The traditional model of innovation has involved the creation of high end products by companies in industrialized nations and the spread of these products to the developing world by adapting them to function in low and middle-income countries. Reverse innovation reverses the direction of spread with the United States borrowing new ideas and products designed for less wealthy countries in order to deliver health care more efficiently. (1)

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So Cheap, I’ll Take Two!

Paul Levy

WBUR/CommonHealth reporter Rachel Zimmerman went shopping recently for a pelvic ultrasound.  She summarizes the results on a great new website called Healthcare Savvy.  Here’s an excerpt:

I called each facility, and here are the prices I was quoted for a pelvic ultrasound:

–Mass. General: $2847 or $2563 (more on this later)
–Mt. Auburn: $971.96
–Diagnostic Ultrasound Associates: $516

All three quotes were for the imaging only and did not include professional services or other additional costs, I was told.

So, is it just me, or is a five-fold difference in price for the same procedure at three greater Boston facilities kind of shocking?

I called MGH back to make sure I heard right. Weirdly, on Wednesday, the ultrasound price was $2,847, but on Thursday it was $2,563. (Do I hear $2,000?) I called the hospital’s PR office for a comment on why it costs so much more. Here’s the statement they sent me from Sally Mason Boemer, Senior Vice President of Finance: “MGH typically benchmarks our gross charges with like institutions and find our charge levels to be consistent with other urban medical centers that have a significant amount of complex care, teaching and research missions, and a high uncompensated care burden.”

Paul Levy is a former large hospital CEO and now, an advocate for patient-centered, efficient care. He writes at Not Running a Hospital.

You’d Better Shop Around: MRI Pricing Variances

Jane Sarasohn-Kahn

First published 6/30/11 on Health Populi

My mama told me you’d better shop around, as Smokey Robinson also told us. We now know it pays to shop the prices for digital imaging. The price of an MRI of the brain ranges from a low of $825 to a high of $3,600 within the Southeast region of the U.S. In the Northeast, the low is $1,540 and the high, $3,500. There are similar price “spreads” in other regions of the country for the same imaging study, and across other imaging modalities such as PET and CT.

The greatest regional variances by service type are for MRI scans of the brain, varying 747% between a low price of $425 in the Southwest to a high of $3,600 in the Southeast, based on an analysis from change: healthcare‘s Q2 2011 Healthcare Transparency Index.

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Rads Are Good For You. Take Twice As Many

Paul Levy

First published 6/19/11 on Not Running A Hospital

Dear Mrs. Smith, I am writing to inform you that we exposed your body to an unnecessary level of radiation during your visit to our hospital. Oh, by the way, that was two years ago. We don’t intend to do anything about this for you. Also, we have known about this problem for a long time, and we don’t expect to change our procedures for future patients. Just wanted you to know. Yours in delivering the best health care in the world, Chief of Radiology and CEO. (Jointly signed.)

That’s the essence of this article by Walt Bogdanich and Jo Craven McGinty in the New York Times. Here are excerpts:

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Book Review: “Overdiagnosed” and the Paradox of Cancer Survivorship

Kenneth Lin

First published 4/12/11 on Common Sense Family Doctor

OverdiagnosedAccording to the National Cancer Institute and the Centers for Disease Control and Prevention, the number of cancer survivors in the U.S. has increased dramatically in my lifetime, from 3 million in 1971 to 11.7 million in 2007. From 2001 to 2007 alone, the number of persons living with a cancer diagnosis rose by nearly two million. Most people would probably see these statistics as good news: an indication that our cancer treatments are improving and allowing people to live longer, or that earlier diagnoses are giving people a better chance to survive by catching localized cancers before they spread and become impossible to cure.

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Primary Care’s “Top 5” List

Kenneth Lin

First published 5/30/11 on the AFP Community Blog

Last week, the journal Archives of Internal Medicine published “The ‘Top 5’ Lists in Primary Care,” a physician-authored consensus statement that recommended five activities each for the specialties of family medicine, internal medicine, and pediatrics to pursue to reduce waste and improve quality. Here is the top 5 list for family physicians, together with related online resources from AFP By Topic collections:

1) Don’t do imaging for low back pain within the first 6 weeks unless “red flags” are present.

AFP By Topic: Muculoskeletal Care – Neck and Back

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