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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Sue the Patient

Dan Munro

Posted 4/27/12 on Forbes

States often confer the tax-exempt status on hospitals with the expectation that certainly some services will be extended to the less fortunate with limited capacity to pay. Two of the more litigious hospitals in North Carolina are Carolinas HealthCare and Wilkes Regional Medical Center in North Wilkesboro. They each filed over 12,000 lawsuits against patients in the same five-year period. One of the controlling entities – Carolinas HealthCare System – reported annual profits of more than $300 million over the last three years. One facility, Carolinas Medical Center-Mercy (CMC-Mercy) promotes itself as a “Planetree Designated Patient-Centered Hospital.” Planetree, Inc (itself a non-profit) offers tiered designations (Bronze, Silver and Gold) for “achievement in patient-/person-centered care based on evidence and standards.” The designation appears to be loosely based on an “application review fee” ($2,500 – $5,000) and includes a “self-assessment.” CMC-Mercy’s Gold Designation status is prominently featured on the hospital’s website:

CMC-Mercy – Planetree Gold Designation

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Why US Health Costs are Higher Than Anywhere Else in the World

Jane Sarasohn-Kahn

Health Populi

The price of physician services, proliferation of clinical technology and the cost of obesity are the key drivers of higher health spending in the U.S., according to The Commonwealth Fund‘s latest analysis in their Issues of International Health Policytitled, Explaining High Health Care Spending in the United States: An International Comparison of Supply, Utilization, Prices, and Quality, published in May 2012.

The U.S. devotes 17.4% of the national economy to health spending, amounting to about $8,000 per person. The UK devotes about 10%, Germany 11.6%, France, 11.8%, Australia 8.7%, and Japan, 8.5%.

On the physician pay front, primary care doctors in the U.S. earn about $186,000 a year, compared with Australian colleagues who bring in about $92K a year, French peers at $96K per annum, Canadian PCPs earning $125,000, Germans at $131K, and British earning $160K.

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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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A Health Affairs Study on Medicare Spending and the RUC

Chris Fleming

Posted 5/7/12 on the Health Affairs Blog

©2012 Health Affairs by Project HOPE – The People-to-People Health Foundation, Inc.

To calculate physicians’ fees under Medicare—which in turn influence private payers’ decisions on how they will pay doctors—the Centers for Medicare and Medicaid Services (CMS) relies on the recommendations of a controversial advisory panel known as the RUC (the Relative Value Update Committee), which mainly represents a broad group of national physicians’ organizations. In recent years physicians in primary care have expressed concerns that this committee has too little representation from their ranks and is partly responsible for increasing the pay gap between primary care providers and specialists. Other research has shown that increases in physician service prices brought about by committee recommendations contribute to increased costs of services used by Medicare enrollees.

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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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Will Regina Holiday Become Health Care’s Rosa Parks?

Michael Millenson

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.

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The ACP’s Cognitive Dissonance

Brian Klepper

Relative to their specialist colleagues, primary care physicians have been generally passive about the politics that shape their professional lives, and they have been big losers. It is important for them to consider whether their societies are genuinely acting in their interests. I believe the evidence overwhelmingly reflects poor judgment by the societies that has diminished primary care’s prospects and, more importantly, caused significant harm to patients and purchasers.

Over at the ACP Advocate Blog on Wednesday, ACP Senior Vice President of Governmental Affairs and Public Policy Bob Doherty took me to task for asserting that the American Academy of Family Physicians is the only “pure” primary care society. He’s right, of course, in the sense that the American College of Physicians (ACP), the American Academy of Pediatrics (AAP) and the American Osteopathic Association (AOA) have done yeoman’s work in the past few years in promoting the value of primary care. He’s also right, and I stand corrected, on my statement that AAFP is the largest society. The information on Wikipedia shows that ACP has 130,000 members while AAFP has less at around 100,000.

As though any of this matters.

Source: Medscape Physician Lifestyle Report 2012, http://www.medscape.com/sites/public/lifestyle/2012

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GOP Alternatives to ObamaCare

Joe Paduda

Posted 5/2/12 on Managed Care Matters

When it comes to health reform, perhaps the only thing Congressional Republicans agree on is they hate ObamaCare.

There’s no agreement on a basic framework much less consensus on an actual bill. Moreover, there are parts of ObamaCare that enjoy solid support amongst many Republicans, complicating the GOP’s efforts to develop an alternative without conceding political ground.

Their dilemma is certainly understandable; as anyone who followed the tortuous path of the PPACA (aka Obamacare), there was precious little consensus among the Democrats who passed the bill. While most had serious issues with various bits and pieces, they held their noses and voted “aye” when pressed.

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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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Is Sugar Carcinogenic?

Dov Michaeli

Posted 4/30/12 on The Doctor Weighs In

Last Sunday on his show on CNN, Dr. Sanjay Gupta interviewed pediatrician, Dr. Robert Lustig, who made the assertion that sugar is toxic, and probably carcinogenic. This attention-grabbing statement had earned him a wide following on UTube. But is it true? Let’s examine the evidence.

How is sugar used in the cell?

Every cell in our body needs energy in order to survive and perform its functions. Our biochemistry has evolved over billions of years to extract energy from simple sugars, like glucose and fructose. I mentioned the evolutionary ancient-ness (is this a word?) for a reason. In the beginning (relax, I am not getting into the creation debate) the atmosphere was poor in oxygen. Yet cells had to extract energy from their nutrients. The solution? Extract energy from glucose without the participation of oxygen. This process is called anaerobic glycolysis, and even today, there are anaerobic bacteria that survive solely through glycolysis. This process nets a measly 2 ATP molecules (these are the molecules that store the energy necessary to drive chemical reactions in the cell), and two 3-carbon molecules of pyruvic acid.

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More Information Is Not Always Better: Pulling Consumers Into Active Choices About Testing

Wendy Lynch

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.

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Why Do Hospitals Still Allow Preventable Adverse Events?

Michael Wong

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?

This are questions that I posed to lawyers, insurers, and healthcare professionals attending a major healthcare conference, the Crittenden Medical Conference.

According to the Institute of Medicine, each preventable adverse event costs about $8,750 — and this excludes potential litigation costs.

Can hospitals afford to give away money? So, why do preventable adverse events still occur in hospitals?

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