Looking Beyond the Money: Crucial Steps to Getting Vaccines to Children

Lois Privor-Dumm

Posted 5/8/12 on Disruptive Women in Health Care

looking-beyond-the-money-crucial-steps-to-getting-vaccines-to-childrenWithout money, many nations can’t afford to tackle health care issues and introduce the life-saving vaccines that are critical to child survival in the developing world.  But even after a vaccine is introduced and money has been spent, some children never see even the first dose.  With so much investment and effort, you wonder — how can that be?

Take Nigeria, the country with the second largest number of child deaths globally.  Over the past few years, they’ve raised vaccine coverage in many parts of the country to nearly 70%.  But progress is fragile, and results uneven.  Some areas have coverage rates above 80%; others are barely providing any vaccine.  Economic status and presence or absence of donor funding don’t fully explain the disparities. It’s not just the money – there must be something more.

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Whatever It Is, It’s Not Insurance

Tom Emerick

Posted 5/9/12 on Cracking Health Costs

Discussions about covering “pre-existing” health conditions occur frequently among health policy people. One frequent thread is that health insurers should not be allowed to deny coverage to people with pre-existing health condition. After all, aren’t those the people who need health insurance the most?  Sounds reasonable, doesn’t it?  Problem is that proposition is really not reasonable.

Let me explain.  For any kind of insurance to work right, the “contingent event” can not have already happened before you buy it.  In life insurance, the contingent event is the death of the policyholder.  You can’t buy life “insurance” on someone who has already died.  For homeowners insurance, you can’t buy fire insurance after the home has burned.

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Barking Up the Wrong Tree: Affordability, Not Cost Growth, Is The Real Policy Challenge

Jeff Goldsmith

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.

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You Can Unleash This Horsepower!

Paul Levy

Posted 5/6/12 on Not Running a Hospital

Among the great hospital leaders in America, Jeffrey Thompson, CEO of the Gundersen Lutheran Health System in Wisconsin, stands out for going beyond achieving marvelous results in patient quality and safety.  Jeff’s commitment that his system will not accept mediocrity shows up in other arenas as well.  He and his board have adopted a corporate strategic plan that sets a goal of being “the best regionally and nationally on environmental stewardship and accountability.”

This is outlined in a recent keynote speech he gave at CleanMed 2012 in Denver.  Jeff pointed that hospitals have a large impact on the environment and on public health because of their use of electricity.  Noting that his system alone produces 500,000 pounds annually of airborne particulates tied to its electricity consumption, he concluded that reducing that impact can and should be tied into the culture of a health care institution.  He asserted, “We are going to be responsible to members of the community.  We are going to be transparent, and we are going to act to fix things.”

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Nothing About Me Without Me: Participatory Medicine, Meaningful Use and the American Hospital Association

David Harlow

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:

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The Great Experiment

Paul Levy

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.

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How About Team-Based Care AND Experts

Jaan Sidorov

Posted 5/2/12 on the Disease Management Care Blog

Disease Management Care Blog readers may recall this snarky “It’s Team Based Care, Not More Experts” speechifying that challenged aJohn A Hartford Foundation report on the growing need for expert geriatric care.  The Foundation’s Program Director Christopher Langston responded and, rather than let it languish as a bottom-of-the-page-comment, the DMCB thought it warranted its own separate posting. Dr. Langston makes some good points:

The John A. Hartford Foundation has long recognized (here’s an example) that there are only 24 hours in the day and that teams are critical to delivering quality care in a cost-effective way.

So when we reported the results of our recent poll showing that despite the existence of the new Medicare Annual Wellness Visit benefit, older adults still aren’t getting important assessments (like fall risk, mood screening, or medication review) at adequate rates, we weren’t trying to doctor bash or even suggest that MDs should work harder. They just need to be sure that the work gets done by someone.

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Dr. Cassel Sets Out The Mission of the Choosing Wisely Initiative

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.

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Women and Cardiovascular Disease: Disparities in Care

Kevin R. Campbell

Posted 4/29/12 on The Doctor Weighs In

Sudden Cardiac Death and cardiovascular disease is the number one killer of women in the US second only to ALL cancers COMBINED.  The prevalence of coronary artery disease in women is similar to that in age-matched cohorts of men– yet women tend to be under-served and under-treated.  When we look at specific interventions such as Percutaneous Coronary Interventions (PCI or coronary stenting) and Implantation of Implantable Cardioverter-Defibrillators (ICDs), and advanced devices for Congestive Heart Failure, we find that men tend to have more access to advanced therapies and are undergoing procedures at two to three times the rate of women.

Why is this?  Let me offer my two cents:

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A Doctor’s Appointment on your Phone: Out of Beta and Into Your Pocket

Jane Sarasohn-Kahn

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.

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The Decline and Potential Renaissance of Employer-Sponsored Health Benefits: EBRI and MetLife Reports Tell the Story

Two reports this week suggest countervailing trends for employer-sponsored health benefits: the erosion of the health benefit among companies, and opportunities for those progressive employers who choose to stay in the health benefit game.

In 2010, nearly 50% of workers under 65 years of age worked for firms that did not offer health benefits. The uber-trend, first, is that the percentage of workers covered by employer-sponsored health insurance has declined since 2002. Workers offered the option of buying into a health benefit, as well as the percent covered by a health plan, have both fallen, according to the Employee Benefits Research Institute (EBRI), an organization that has long-tracked this trend. EBRI’s report on Employment-Based Health Benefits: Trends in Access and Coverage, 1997-2010, provides the details behind this declining picture.

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Cappers vs.Skinners in the Struggle To Control Costs

Jaan Sidorov

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.

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Choosing Wisely or Vicely

Bradley Flansbaum

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.

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iMedicine: The Influence of Social Media on Medicine

Kent Bottles

Posted 4/25/12 on Kent Bottles’ Private Views

iMedicine:  The Influence of Social Media on Medicine was the topic of the day-long 27th Annual Physician Student Awareness Day (SPAD) held on April 24, 2012 on the campus of New York Medical College in Valhalla, New York.  The entire conference was run by medical students from the Class of 2015.

Karl Adler, MD, CEO, welcomed the 200 attendees by recalling his own medical school education in the 1960s. Dr. Adler relied on textbooks, mimeographed handouts, and lecture notes to master both the art and science of medicine.  In his day, students were taught to rely on the history, the physical examination, laboratory tests, radiology studies, and the EKG; his teachers stressed that the history and physical obtained in a face-to-face encounter between the physician and the patient were the keys to successfully caring for the patient.

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TedMed 2012: Day 1

Patricia Salber

Posted 4/10/12 on The Doctor Weighs In

TedMed 2012 has begun.  And how!  The opening event was “Traces-Urban Acrobats.”  Urban Acrobats?  It was mouth-droppingly over-the-top athleticism.  One long sequence consisted of the members of the troup jumping, gliding, and soaring through hoops at varying heights–always landing on their feet and making it look easy.  This was not circus stuff, this was, as our program book described it, “the human body…pushed to its limits.”  Great way to start an long anticipated event.  Take a look:

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