MedWorm provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest medical blog items that have been tagged with 'health care quality'. Sat, 03 Sep 2011 02:49:37 +0100 http://www.medworm.com/index.php?rid=4241681&cid=t_119409_86_f&fid=36669&url=http%3A%2F%2Ffadelibrary.wordpress.com%2F2010%2F12%2F08%2Fjournal-of-the-american-medical-association-2010-vol-304-no-21%2F Contents Page Fade Fave: Toward an Outcomes-Based Health Care System: A View From the United Kingdom Fade Skinny: In a comprehensive, publicly funded system like the United Kingdom’s National Health Service (NHS) there is an overriding imperative to deliver maximum health benefit per pound spent. Quality, effectiveness, and efficiency are the goals. Following a decade of above-inflation increases in NHS funding, the urgent need to reduce the United Kingdom’s national debt means the NHS is entering a sustained period of flat or declining funding, while demand for services continues to increase (from technological progress, an aging population, increasing expectations, and population growth). Striving for value therefore becomes an ethical imp... Fade Library blogs http://www.medworm.com/rss/comments.php?id=4241681 Wed, 08 Dec 2010 12:14:42 +0100 4241681 http://www.medworm.com/index.php?rid=2999657&cid=t_119409_114_f&fid=35410&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fletstalkhealthcare%2F%7E3%2FLoMOa4XCm2I%2F I try not to toot the Harvard Pilgrim horn too much in these postings, but I can’t let the fact go by that we have been recognized for the fifth year in a row by U.S. News & World Report and the National Committee on Quality Assurance (NCQA) as the highest rated commercial health plan in the country. Everyone here is thrilled with the honor, especially in a year that has been marked by unprecedented attempts to demonize the health insurance industry. But let’s not talk Harvard Pilgrim. What I would like to point out is that the U.S. News & World Report/NCQA process is built on an assumption that private health plans deliver value to the health care system and are worth going to the trouble to rank at all. The rankings are based on a composite score made up of three elements: ... HPHC blogs http://www.medworm.com/rss/comments.php?id=2999657 Mon, 16 Nov 2009 21:49:06 +0100 2999657 http://www.medworm.com/index.php?rid=2894617&cid=t_119409_114_f&fid=35410&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fletstalkhealthcare%2F%7E3%2Fw68H2rqUvCo%2F The Health Care Blog ran a posting entitled “To Change Health Care, Change Diabetes”. The title overreaches, but the argument – that early diagnosis, prevention, and treatment of diabetes would reduce health care costs – is certainly true. The article calls for more measurement of quality, coordination of care, and aggressive treatment. It is well known that diabetes is a condition that, if undiagnosed or untreated, can lead to serious medical complications. It also well known that the right lifestyle choices and routine preventive care can help diabetics avoid complications. Health plans like Harvard Pilgrim that are accredited by the National Committee on Quality Assurance have known for many years that conditions like diabetes need to be controlled to improve quality and lower t... HPHC blogs http://www.medworm.com/rss/comments.php?id=2894617 Wed, 14 Oct 2009 17:46:17 +0100 2894617 http://www.medworm.com/index.php?rid=1943395&cid=t_119409_114_f&fid=35410&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2Fletstalkhealthcare%2F%7E3%2F445575474%2F For the past four years, the National Committee for Quality Assurance (NCQA) has teamed with U.S.News & World Report to prepare a national ranking on health plans using member satisfaction and clinical effectiveness information compiled by NCQA to build individual scorecards for each participating carrier.  This is the equivalent of the U.S.News forays into colleges, hospitals, and other elite services. For the past three years, Harvard Pilgrim has managed to secure the top spot in the U.S.News / NCQA national rankings.  Well, it happened again.  For the fourth year in a row, Harvard Pilgrim sits atop the U.S.News  & World Report  national ranking of health plans.  We didn’t win by much.  Our friends at Tufts Health Plan finished just behind us (think Michael Ph... HPHC blogs http://www.medworm.com/rss/comments.php?id=1943395 Fri, 07 Nov 2008 15:29:54 +0100 1943395 http://www.medworm.com/index.php?rid=1856090&cid=t_119409_114_f&fid=35410&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2Fletstalkhealthcare%2F%7E3%2F412905718%2F As CEO of Harvard Pilgrim, I find I do a fair amount of public speaking.  Over the past ten days or so, I’ve been on several panels with a variety of public policy, health policy and industry types.  We also represented a pretty broad collection of political philosophies - some Democrats, some Republicans, some liberals, some moderates and some conservatives. What really struck me, though, was the amount of cross-over support several policy ideas had in the “what do we need to do about health care” arena.  To listen to the media, one would conclude there is no common ground between the parties on this issue - and, frankly, a lot of the stuff the people I was with were talking about hasn’t really showed up on the national debate scene at all. So - at the risk of... HPHC blogs http://www.medworm.com/rss/comments.php?id=1856090 Mon, 06 Oct 2008 15:37:02 +0100 1856090 http://www.medworm.com/index.php?rid=1844778&cid=t_119409_114_f&fid=35410&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2Fletstalkhealthcare%2F%7E3%2F408324727%2F I wrote a blog a few weeks ago on the interplay between Emergency Room traffic and elective surgeries, in response to a story in the Boston Globe about new DPH guidelines concerning ER diversions.  I won’t repeat what I said then, but thought I should highlight one of the comments I got for that post from Brad Prenney at Boston University.  It pretty much speaks for itself. Take it away Brad… “Boston Medical Center is not the only hospital that has been able to address problems of patient flow, including timely access to emergency care, using the methodology developed by Boston University’s Management of Variability Program (MVP), which Eugene Litvak heads. Cincinnati Children’s Hospital Medical Center (CCHMC) achieved comparable benefits when they separated OR res... HPHC blogs http://www.medworm.com/rss/comments.php?id=1844778 Wed, 01 Oct 2008 14:59:39 +0100 1844778 http://www.medworm.com/index.php?rid=1798192&cid=t_119409_114_f&fid=35410&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2Fletstalkhealthcare%2F%7E3%2F393359954%2F There was a story in the Boston Globe the other day about the Massachusetts Department of Public Health’s decision to order hospitals to stop temporarily closing their Emergency Rooms, effective January 1, 2009. This is good news. I first heard about the practice of temporarily turning away ambulances from the ER — commonly called “diversion” — about ten years ago. The Globe did a series of articles on temporary ER closures, and while I can’t recall for sure, I think the culprit was “managed care.” Those stories then, like this story now, focused almost exclusively on ERs, ER personnel, ER administrators and ER clinicians. I’m not sure that’s the best way to frame this issue. In fact, many people think ER overcrowding usually has... HPHC blogs http://www.medworm.com/rss/comments.php?id=1798192 Mon, 15 Sep 2008 16:46:39 +0100 1798192 http://www.medworm.com/index.php?rid=1742781&cid=t_119409_114_f&fid=35410&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2Fletstalkhealthcare%2F%7E3%2F378143772%2F There was a story in the Wall Street Journal last week-end about how “a growing number of health plans offer specially trained case managers to help patients during a major illness…”  The story goes on to say that these people “take our very fragmented health-care system and put some glue on it to ensure that a patient with a complex condition does not fall through the cracks.” Umm…Harvard Pilgrim has been providing these kinds of services to our members for about THIRTY YEARS — and I know that many other carriers have been doing it for more than ten. In fact, if I wanted to, I could post a blog on this site almost every day about a letter or an email or a phone call I’ve gotten from one of our members about how one of our case managers has lit... HPHC blogs http://www.medworm.com/rss/comments.php?id=1742781 Fri, 29 Aug 2008 14:52:41 +0100 1742781 http://www.medworm.com/index.php?rid=1739217&cid=t_119409_114_f&fid=35410&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2Fletstalkhealthcare%2F%7E3%2F376201403%2F For the past year or so, I’ve been listening to and participating in a conversation in New England and nationally about the rising cost of health care. It’s a sticky wicket, to be sure, with no obvious, simple solutions. But I must say, I’ve been surprised that at least one pretty good idea hasn’t generated more traction. Intensive Care Unit checklists — which I’ve written about before — have already demonstrated that they can save lives, money and time, reduce variation, and improve quality, but they remain the exception instead of the rule in ICU care. In June, the World Health Organization shared preliminary data on a demonstration it’s running using a “Safe Surgery Checklist” that showed reductions in deaths, complications and ... HPHC blogs http://www.medworm.com/rss/comments.php?id=1739217 Wed, 27 Aug 2008 13:44:02 +0100 1739217 http://www.medworm.com/index.php?rid=1596471&cid=t_119409_114_f&fid=35410&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2Fletstalkhealthcare%2F%7E3%2F329907798%2F For The Record — I am a member of the Board of Trustees of Beth Israel Deaconess Medical Center (BIDMC). The Board of Trustees is NOT the same as the Board of Directors. The Board of Directors is the governing body that has fundamental oversight responsibility for the hospital. The Trustees serve as an ancillary board to the main board, and serve as members on various sub-committees of the Board. That makes me, I suppose, an “interested party.” Nonetheless, I thought it worthwhile to comment on the big story in our health care marketplace these days — which is the wrong side surgery at BIDMC. The Boston Globe pretty much covered the incident, and BIDMC CEO Paul Levy has blogged on it several times in the past couple of days, so I won’t spend a lot of time re-hashing t... HPHC blogs http://www.medworm.com/rss/comments.php?id=1596471 Tue, 08 Jul 2008 15:26:01 +0100 1596471 http://www.medworm.com/index.php?rid=1531341&cid=t_119409_114_f&fid=35410&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2Fletstalkhealthcare%2F%7E3%2F315417328%2F Ten years ago, the term “medical tourism” referred to non-U.S. citizens seeking health care in the United States, because the health care systems in their own countries either couldn’t give them what they needed in a timely way, or couldn’t give it to them at all. What a difference a decade makes. Today, more often than not, medical tourism refers to people leaving the United States to access care that’s every bit as high quality as it is in the United States — but much, much cheaper — in foreign countries. According to a study by the Deloitte Center for Health Solutions — which I first saw referenced in the May 5th edition of Modern Healthcare — the number of people leaving the US to access care in other countries is now growing at a faster rate than ... HPHC blogs http://www.medworm.com/rss/comments.php?id=1531341 Wed, 11 Jun 2008 18:41:45 +0100 1531341 http://www.medworm.com/index.php?rid=1531342&cid=t_119409_114_f&fid=35410&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2Fletstalkhealthcare%2F%7E3%2F315417330%2F Boston Globe reporter Jeff Krasner does a great job covering business issues for the Globe and was kind enough to attend the seventh — and most recent — public meeting of the Coalition for Affordable Health Care. The Coalition is a group of Massachusetts businesses and health plans (including Harvard Pilgrim) who’ve joined together to promote state policies that reduce the increase in health care costs and improve quality. The Coalition is focused on several issues: 1) Leveraging the Commonwealth’s Health Care Quality and Cost Council (of which I’m a member) to collect and make public understandable information on health care cost and quality — by provider and by procedure — in Massachusetts. The group believes that to do something about health care cost and quality, the pub... HPHC blogs http://www.medworm.com/rss/comments.php?id=1531342 Mon, 09 Jun 2008 18:43:26 +0100 1531342 http://www.medworm.com/index.php?rid=1463834&cid=t_119409_114_f&fid=35410&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2Fletstalkhealthcare%2F%7E3%2F296074973%2F A few weeks ago, I wrote a post about a recent study by the folks at Dartmouth concerning variation in resource utilization at various providers in Massachusetts during the last six months and two years of life. The study showed that the variation in practice patterns and resource utilization in health care, even for fairly standard procedures, during the period of time studied was gigantic — sometimes as much as 300-500%. Practice pattern variation. It’s like a bad penny. Activists and advocates — and many others — prefer to talk about the money that’s wasted on administrative inefficiencies — and if we could just get everyone covered by one payer, everything would be fine. But then Jack Wennberg and Co. at Dartmouth keeps publishing these studies that show that the bi... HPHC blogs http://www.medworm.com/rss/comments.php?id=1463834 Wed, 21 May 2008 15:00:59 +0100 1463834 http://www.medworm.com/index.php?rid=1442933&cid=t_119409_114_f&fid=35410&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2Fletstalkhealthcare%2F%7E3%2F290384941%2F I have a book sitting on my desk at home called, “Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer,” by Shannon Brownlee, a journalist who’s been writing about health care policy issues for quite some time. I’m going to read it — soon — maybe in between my kids’ games and my day job. I don’t know her — and I’m sure in her mind, my industry — and guys like me — are a big part of the problem. I’ll take my lumps. That’s okay. Because someday, somehow, we need to get over this “more” thing that dominates the way we think about health care. Three quick examples… 1) A few years ago, Harvard Pilgrim began requiring physicians’ offices to notify us when they ordered non-emergency high end radio... HPHC blogs http://www.medworm.com/rss/comments.php?id=1442933 Wed, 14 May 2008 16:01:18 +0100 1442933 http://www.medworm.com/index.php?rid=1432535&cid=t_119409_114_f&fid=35410&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2Fletstalkhealthcare%2F%7E3%2F286896968%2F I was one of several local (aka, “Boston area”) health care participants who had a chance to hear Dr. Steve Pearson, President of the Institute for Clinical and Economic Review and Senior Fellow at America’s Health Insurance Plans in Washington, DC speak recently about “CER” (Comparative Effectiveness Research). I’m proud to say that Dr. Pearson is a member of the faculty at the Department of Ambulatory Care and Prevention at the Harvard Medical School — and is, therefore, supported in part by the folks at Harvard Pilgrim Health Care — who support the DACP at HMS as a joint venture with the medical school. Dr. Pearson is the Vice-Chair of the Medicare Evidence Development and Coverage Advisory Committee, serves as a member of the AcademyHealth Methods Co... HPHC blogs http://www.medworm.com/rss/comments.php?id=1432535 Thu, 08 May 2008 15:43:31 +0100 1432535 http://www.medworm.com/index.php?rid=1377935&cid=t_119409_117_f&fid=34612&url=http%3A%2F%2Fwww.thedoctorweighsin.com%2Fjournal%2F2008%2F4%2F17%2Fwhy-cant-we-do-it.html By Dov Michaeli MD, Ph.DI am not a health care policy wonk, or a wonk of anything, to tell the truth. But having observed the heated arguments, the indecipherable terms and acronyms, and the general sense of helplessness in breaking the political logjam, I asked a naїve question: how do others deal with the issue?  I looked at the British system, which I know quite well. I also looked at the Japanese system, which I knew from my visits to the country and contacts with Japanese doctors, professors, drug companies, and just plain folks. Finally, I looked at the Taiwanese system, which I think is an unsung hero that deserves more recognition.The British systemThe Brits are very much like us economically, politically and culturally. They have a much more cynical attitude toward governmen... The Doctor Weighs In blogs http://www.medworm.com/rss/comments.php?id=1377935 Thu, 17 Apr 2008 04:14:18 +0100 1377935 http://www.medworm.com/index.php?rid=1356163&cid=t_119409_114_f&fid=35410&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2Fletstalkhealthcare%2F%7E3%2F265962012%2F This report, like the many that have been issued before it, illustrates, in typical Wennbergian fashion, the extraordinary differences in resource use associated with health care that’s provided by health care organizations during the last two years and last six months of a patient’s life. For the past forty years or so, Wennberg and his colleagues have been publishing study after study after study on the enormous differences in practice patterns and practice styles that exist across the health care system. More importantly, I think they’ve proven beyond any reasonable doubt that these differences don’t translate into better health care. To quote one of the Project’s Policy Briefs, “Regions and academic medical centers with greater overall spending rates... HPHC blogs http://www.medworm.com/rss/comments.php?id=1356163 Mon, 07 Apr 2008 23:13:27 +0100 1356163 http://www.medworm.com/index.php?rid=1344176&cid=t_119409_117_f&fid=34612&url=http%3A%2F%2Fwww.thedoctorweighsin.com%2Fjournal%2F2008%2F4%2F1%2Fpractical-advice-to-employers-on-managing-a-health-plan.html Lynn Jennings On blogs like this, people like me write analytically about issues which are often, at best, conceptual to us.Not so to the guys in the rough and tumble world of health care finance. I remember that the first time I went to dinner with Lynn Jennings, I only knew that he was CEO of Alliance Underwriters, working in reinsurance, and that he is a former President and a current Board member of the Self-Insurance Institute of America (SIIA). SIIA is the national association of third party administration firms, the organizations that administer health plans for self-funded employer health plans. As we were walking into the restaurant, he turned to me and said, "In reinsurance you make a very sizable bet and find out three years later how things turned out."Over time, thou... The Doctor Weighs In blogs http://www.medworm.com/rss/comments.php?id=1344176 Tue, 01 Apr 2008 18:14:36 +0100 1344176 http://www.medworm.com/index.php?rid=1298758&cid=t_119409_114_f&fid=35410&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2Fletstalkhealthcare%2F%7E3%2F250352409%2F Well, sometimes the federal government can surprise us all. Many of you probably know by now that the Office of Human Research Protections (OHRP) — which is part of the U.S. Department of Health and Human Services — has reversed its position prohibiting the use of health care checklists unless every patient signed a waiver permitting their use. Since the primary use of these lists to date had been in ensuring safe and effective use of C-lines in ICUs, that seemed like kind of a high standard. And more importantly, they appear to improve safety, save lives and reduce costs — a triple play that’s often hard to find in today’s health care world. I wrote about this hoo-hah in two previous blogs (part I and part II). I’m happy to report that the feds not only permit the ... HPHC blogs http://www.medworm.com/rss/comments.php?id=1298758 Wed, 12 Mar 2008 21:02:56 +0100 1298758 http://www.medworm.com/index.php?rid=1276038&cid=t_119409_114_f&fid=35410&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2Fletstalkhealthcare%2F%7E3%2F245234566%2F In case you haven’t heard, today is a big day for the health care industry in Massachusetts. MA Senate President Therese Murray unveiled a much-anticipated plan to reduce the growth rate in health care costs earlier today.  While some of what she’s proposing makes me nervous, I applaud her efforts, and look forward to the discussion her proposals will most certainly jump start.  Senator Murray talked about some of these issues in a speech before the Greater Boston Chamber of Commerce last year.  Back then, she proposed public hearings to justify premium rate increases in excess of 7 percent in any given year.  While the incrementalist in me says, “Yikes!  This road is fraught with peril!” the realist in me says, “Anyone who thinks we can change the... HPHC blogs http://www.medworm.com/rss/comments.php?id=1276038 Tue, 04 Mar 2008 03:00:55 +0100 1276038 http://www.medworm.com/index.php?rid=1225241&cid=t_119409_117_f&fid=34612&url=http%3A%2F%2Fwww.thedoctorweighsin.com%2Fjournal%2F2008%2F2%2F12%2Flets-all-ask-secretary-leavitt-to-explain-hhs-schizophrenia.html Brian Klepper Regular readers will know that, last Sunday, I posted a column that pointed to HHS' schizophrenic behavior when it comes to the release of Medicare physician data. First they fight the consumer advocacy group Checkbook.org's lawsuit demanding the release of data in 4 states and DC. (The AMA's Board Chair has admitted that they lobbied HHS to appeal the court's finding that they should make the data public.) Then, a week ago last Friday, HHS announced a new program that would identify Chartered Value Exchanges (CVEs) in 14 communities - these are coalitions of employers, payers, providers and consumers - and then hand over the same physician data they've been fighting the courts to keep secret so these groups can combine them with data available from the private sector and cre... The Doctor Weighs In blogs http://www.medworm.com/rss/comments.php?id=1225241 Tue, 12 Feb 2008 20:57:35 +0100 1225241 http://www.medworm.com/index.php?rid=1184648&cid=t_119409_117_f&fid=34612&url=http%3A%2F%2Fwww.thedoctorweighsin.com%2Fjournal%2F2008%2F1%2F28%2Ffamilies-usa-health-action-2008-an-alternative-plan.html Brian Klepper A wonderful meeting (Full disclosure: They brought me in to blog my impressions.), The Families USA conference that ended Saturday brought together some impressive Congressional politicians - Nancy Pelosi, Tom Daschle, Ken Salazar, Blanche Lincoln - and true health care experts - Don Berwick, Tony Fauci - with "consumer advocates" from around the country. I thoroughly enjoyed the people at the conference. They were, for the most part, knowledgeable about health care and committed to driving a better system. (My favorites were a group of California Gray Panthers, all of whom were VERY up on the issues). There were also bright young people relatively early in their careers, and representatives from community health advocacy organizations around the country, all f... The Doctor Weighs In blogs http://www.medworm.com/rss/comments.php?id=1184648 Mon, 28 Jan 2008 20:51:46 +0100 1184648 http://www.medworm.com/index.php?rid=1184649&cid=t_119409_117_f&fid=34612&url=http%3A%2F%2Fwww.thedoctorweighsin.com%2Fjournal%2F2008%2F1%2F28%2Ffamilies-usa-health-action-2008-berwick-on-everything-health.html Brian Klepper  One of the pleasures of the Families USA Health Action conference was that the speakers represented a nice blend of top politicians and genuine health care experts. Tony Fauci MD, the wonderful head of NIH's National Institutes for Allergies and Infectious Diseases, who talked about Global Health, was followed by the equally impressive Don Berwick MD, the Founder and leader of the Institute for Healthcare Improvement. I've heard Dr. Berwick speak several times and am always delighted by his cogent, comfortable, sensible presentations. I can think of several people who, if they gave one, deserve a health care Nobel Prize for the positive impact they've had on millions of people through their work to change the industry. Dr. Berwick is one. (Others include Jack Wenn... The Doctor Weighs In blogs http://www.medworm.com/rss/comments.php?id=1184649 Mon, 28 Jan 2008 20:48:00 +0100 1184649 http://www.medworm.com/index.php?rid=1150640&cid=t_119409_117_f&fid=34612&url=http%3A%2F%2Fwww.thedoctorweighsin.com%2Fjournal%2F2008%2F1%2F15%2Ffour-big-trends.html Brian KlepperSeveral events and trends emerged over the last year that will reverberate throughout the health care marketplace in 2008 and going forward. While none of these dominated the trade press like some other issues - electronic and personal health records, RHIOs, the evolving labor shortage, pay-for-performance reimbursement - these manifestations of change are occurring in the marketplace as well as through policy, and are moving health care forward in fundamentally positive and far-reaching ways. Health 2.0The most significant for the long term in terms of its capacity to change how health care works is the Health 2.0 movement, which Matthew Holt and Indu Sabaiya have played a central role in facilitating and explaining. In some ways, Health 2.0 is simply a continuation of what h... The Doctor Weighs In blogs http://www.medworm.com/rss/comments.php?id=1150640 Tue, 15 Jan 2008 08:15:52 +0100 1150640 http://www.medworm.com/index.php?rid=1146242&cid=t_119409_117_f&fid=34612&url=http%3A%2F%2Fwww.thedoctorweighsin.com%2Fjournal%2F2008%2F1%2F11%2Fdo-we-really-have-the-best-health-care-in-the-world.html by Pat SalberHow many times have you heard health professionals, politicians, and others say: “Here in the US, we are fortunate to have the best health care in the world.” I still occasionally hear someone say this, but certainly not as often as in the past. The proponents of this myth generally follow the “best care” statement by noting that Canadians come to the US to get procedures they have to queue for in their own country. These same people scoff at “socialized medicine” in the UK believing that we are must be getting better care than those poor Brits subjected to “government medicine.”Well, gang, it just isn’t so. The November issue of Health Affairs reports on the results of a 2007 survey of adults in seven countries, including ... The Doctor Weighs In blogs http://www.medworm.com/rss/comments.php?id=1146242 Fri, 11 Jan 2008 22:43:13 +0100 1146242 http://www.medworm.com/index.php?rid=1136803&cid=t_119409_117_f&fid=34612&url=http%3A%2F%2Fwww.thedoctorweighsin.com%2Fjournal%2F2008%2F1%2F8%2Fon-practical-reforms.html Brian Klepper Now that health care reform is once again an active, visible issue in state governments and the presidential campaigns, the ideas are flying fast and furious. Predictably, some ideas are better than others. Over at Health Care Policy and Marketplace Review, Bob Laszewski asks an important, practical but vexing question for universal coverage advocates: Can you really mandate people to buy health insurance? Mandated health insurance is a plank in the Clinton campaign's health care reform plan and is a key way that Ms. Clinton and Mr. Obama differ on that issue. (I don't know why Presidential candidates should provide this level of operational specificity at this point in the game - there are lots of different ways to skin the universal coverage cat - but they have.) Under... The Doctor Weighs In blogs http://www.medworm.com/rss/comments.php?id=1136803 Tue, 08 Jan 2008 21:53:38 +0100 1136803 http://www.medworm.com/index.php?rid=1128656&cid=t_119409_117_f&fid=34612&url=http%3A%2F%2Fwww.thedoctorweighsin.com%2Fjournal%2F2008%2F1%2F4%2Fon-medical-miracles.html Brian KlepperNow and then, amid the stories of financial conflict, medical errors and political intrigue that so often undermine health care, comes a story of the miraculous, where patients in impossible conditions not only survive, but thrive, due to the skill and resources of many dedicated clinicians, due to luck and due to who knows what extraordinary circumstances that are still beyond our understanding.The New York Times has a story like this today. On December 7th, Alcides Moreno and his brother Edgar, window washers, fell 47 stories down the side of the Upper East Side apartment building they were working on. His brotherwas killed instantly, but Alcides survived, consuming 24 units of blood and 19 units of plasma. In a coma, he went through 9 orthopedic operations, and then amazing... The Doctor Weighs In blogs http://www.medworm.com/rss/comments.php?id=1128656 Fri, 04 Jan 2008 01:36:39 +0100 1128656 http://www.medworm.com/index.php?rid=1111797&cid=t_119409_117_f&fid=34612&url=http%3A%2F%2Fwww.thedoctorweighsin.com%2Fjournal%2F2007%2F12%2F21%2Fhealth-care-quote-of-the-year.html Brian Klepper I was reading through some other peoples' blog posts yesterday and came across this straightforward statement by Paul Levy, the CEO of Beth Israel Deaconess Medical Center in Boston. Paul made news by establishing a blog called Running a Hospital. I think he's probably taken some good-natured ribbing by his more straightlaced colleagues. But I admire that fact that he's broken the bounds of decorum and speaks openly about the many tremendously difficult issues that face hospital executives. While many many hospitals (and doctors and health plans and...) are still doing everything possible to hold back the transparency tide, here's his take, published yesterday on Matthew Holt's Health Care Blog:The main value of transparency is not necessarily to enable easier consumer c... The Doctor Weighs In blogs http://www.medworm.com/rss/comments.php?id=1111797 Fri, 21 Dec 2007 20:49:30 +0100 1111797 http://www.medworm.com/index.php?rid=1106183&cid=t_119409_117_f&fid=34612&url=http%3A%2F%2Fwww.thedoctorweighsin.com%2Fjournal%2F2007%2F12%2F19%2Fshannon-brownlees-overtreated.html In yesterday's New York Times , the economics columnist David Leonhardt wrote a nice tribute to Shannon Brownlee's Overtreated, an explanation of how and why American health care is out of control. Ms. Brownlee, a Fellow at the New America Foundation, wrote me that she wrote this book for her mother. (Can there be a better motivation? I'm reminded here of JD Salinger's Raise High The Roof Beams, Carpenters and its tribute to the hero's librarian, Ms. Overman.) Leonhardt suggests that Overtreated should win the award for "economics book of the year."Shannon sent me her book, and it is as deeply interesting and important as Leonhardt claims it is. For those of you genuinely interested in health care, its a worthwhile expenditure of your time. Take a leap, buy it and immerse yoursel... The Doctor Weighs In blogs http://www.medworm.com/rss/comments.php?id=1106183 Wed, 19 Dec 2007 23:45:49 +0100 1106183 http://www.medworm.com/index.php?rid=1100142&cid=t_119409_114_f&fid=35410&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2Fletstalkhealthcare%2F%7E3%2F201782127%2F Sometime ago, I wrote a blog called, “One Thing…” which was about the one thing I would do — if I could do one thing — to improve the quality and reduce the cost of health care in the U.S. I talked about creating a National Institute for Health Care Delivery. But what do I know. I’m just the head of a regional non-profit health insurance plan. So imagine my surprise, and total delight, when I read a recent article in The New Yorker by world renowned surgeon and author Atul Gawande called, The Checklist. Gawande’s article is a must-read for anyone who wants to know more about what can be done to improve health care, and it focuses on a simple question — why, when there is overwhelming evidence that it works — are health care professionals so reticent to... HPHC blogs http://www.medworm.com/rss/comments.php?id=1100142 Mon, 17 Dec 2007 19:18:13 +0100 1100142 http://www.medworm.com/index.php?rid=950848&cid=t_119409_117_f&fid=34612&url=http%3A%2F%2Fwww.thedoctorweighsin.com%2Fjournal%2Fhealing-unbound-the-promise-of-advancing-computational-power.html Laptop-attached ultrasound units that produce startlingly clear internal images for five dollars in the field. Organs that re-generate inside scaffolds.  Drugs tailored to an individual’s biology. Micro-images of cancerous cells lit up by bio-chemical markers. Decision support tools that scan the physiological values in electronic health records for patterns too complex to be detected by an unaided clinician.The advances available from dramatic improvements in computational capabilities were a recurring theme at the Aspen Health Forum, with experts from each discipline describing where the technology was leading us. I attended two sessions featuring Star Trek clips that predicted realities now within at least theoretical reach. (Prescient and corny, audiences nodded nostalgicall... The Doctor Weighs In blogs http://www.medworm.com/rss/comments.php?id=950848 Mon, 15 Oct 2007 11:24:57 +0100 950848 http://www.medworm.com/index.php?rid=947940&cid=t_119409_117_f&fid=34612&url=http%3A%2F%2Fwww.thedoctorweighsin.com%2Fjournal%2F2007%2F10%2F13%2Fa-broad-vision-of-health-20.html Brian KlepperThree weeks ago Pat and I attended a fascinating conference in San Francisco on Health 2.0, an emerging industry that promises to change the ways patients manage their own health, and the ways that clinicians and purchasers of all types make clinical and management decisions. The term Health 2.0 refers to Web 2.0, the idea that, in social networking, people will use Web-based platforms to reformulate data for their own purposes.Jane Sarasohn-Kahn is a highly-respected health economist and commentator working at the intersection points of health care and technology. Jane and I worked together to describe the elements and functions we believe will be integrated to constitute Health 2.0's real value. We've posted this narrative and an accompanying image - its an animated PowerPoi... The Doctor Weighs In blogs http://www.medworm.com/rss/comments.php?id=947940 Sat, 13 Oct 2007 05:22:44 +0100 947940 http://www.medworm.com/index.php?rid=936754&cid=t_119409_117_f&fid=34612&url=http%3A%2F%2Fwww.thedoctorweighsin.com%2Fjournal%2F2007%2F10%2F9%2Fsorry-theres-no-room-at-the-inn-in-other-words-we-are-not-ta.html Margaret Cary, MD MBA MPHRecently a friend mentioned that her sister had just moved to Boston, was looking for a doctor and asked for a recommendation."Let me contact my friend. He is on the faculty at Harvard Medical School and at MIT. I bet he will know the best doctors."Just like old times, right? When you need medical care, you ask a local doctor you trust.His answer? "Big problem.""There are no PCPs (primary care physicians) taking new patients at either MGH (Massachusetts General Hospital) or BWH (Boston Women’s Hospital). It is virtually impossible for someone to choose his internist anymore. Everyone's practice is closed. You can go to a practice where a junior person will be building up a panel. Those practices are either institution based, e.g., Hea... The Doctor Weighs In blogs http://www.medworm.com/rss/comments.php?id=936754 Tue, 09 Oct 2007 02:00:19 +0100 936754 http://www.medworm.com/index.php?rid=886212&cid=t_119409_117_f&fid=34612&url=http%3A%2F%2Fwww.thedoctorweighsin.com%2Fjournal%2F2007%2F9%2F20%2Fhow-might-information-technology-actually-change-health-care.html Brian KlepperToday I’m in San Francisco for the Health 2.0 conference, billed as “User-Generated Health Care.” Organized by my pal Matthew Holt and his partner, Indu Subaiya, "Health 2.0" references "Web 2.0," social networking, applied to health care.  The meeting will feature top executives from high and low profile IT firms that either are already dedicated to or hope to play an important role in health care, like Google, Microsoft, Yahoo, Intel, Cisco, WebMD, Revolution Health, AthenaHealth, Sermo, and many other lesser known organizations, all discussing their strategies for leveraging data in new ways to create value for all health care constituencies.Elsewhere, I’ve referred to this as a “significant portion of market-based heal... The Doctor Weighs In blogs http://www.medworm.com/rss/comments.php?id=886212 Thu, 20 Sep 2007 04:31:08 +0100 886212 http://www.medworm.com/index.php?rid=795062&cid=t_119409_117_f&fid=34612&url=http%3A%2F%2Fwww.thedoctorweighsin.com%2Fjournal%2F2007%2F8%2F13%2Fhealth-care-reform-whither-thou-goest.html Primary season is in full swing with each candidate promising a better deal than the others.  Healthcare reform is one of the top three or four concerns, depending upon your socioeconomic group and political affiliation.  The last time this concern was front and center was in the 1992 Presidential election, extending into President Clinton’s first years in office.  I was still practicing medicine and did my best to care for my friends.  An artist friend and his wife called me around that time to tell me they were expecting their first child and had no health insurance.  They were also struggling with paying their rent and buying food.Over the years I had arranged medical care for several people who needed more care than I could provide, but this was the first... The Doctor Weighs In blogs http://www.medworm.com/rss/comments.php?id=795062 Mon, 13 Aug 2007 07:40:03 +0100 795062 http://www.medworm.com/index.php?rid=757910&cid=t_119409_117_f&fid=34612&url=http%3A%2F%2Fwww.thedoctorweighsin.com%2Fjournal%2F2007%2F7%2F24%2Fcookbook-medicine-saves-lives.html by Pat Salber, MD In the early days of the clinical practice guidelines movement, doctors used to complain that it was “cookbook medicine.” As a pretty good cook, who still uses cookbooks, I say, great – when you follow the directions of experts, instead of “winging it,” you increase the odds of getting a good outcome.So it should be not a surprise that a new study, in the July 23 issue of Archives of Internal Medicine, found that outcomes of hospitalized heart-failure patients are improved when hospital personnel follow clinical guidelines. OPTIMIZE-HF (“Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure”) is a heart failure guidelines/quality improvement program adopted by the American Heart Associ... The Doctor Weighs In blogs http://www.medworm.com/rss/comments.php?id=757910 Thu, 26 Jul 2007 00:49:41 +0100 757910 http://www.medworm.com/index.php?rid=748890&cid=t_119409_117_f&fid=34612&url=http%3A%2F%2Fwww.thedoctorweighsin.com%2Fjournal%2F2007%2F7%2F22%2Fcrabby-doctors-and-the-explosion-of-big-practices.html Brian KlepperDoctors are a cranky bunch these days, and justifiably so. Their world is changing. Its undoubtedly less fun to be the object of a paradigm shift than its driver or observer.A recent survey showing healthy 2007 income increases across specialties notwithstanding, physicians are besieged by increasing patient loads, a torrent of new information, Byzantine administrative requirements, demands for new technology investments and the very real likelihood that their incomes will plummet under Medicare and commercial coverage P4P programs. Despite the apparently rosy survey numbers, its clear that many primary care physicians are having trouble making ends meet.  Many specialists are seeing their incomes drop as well. So its striking that, unlike a decade ago, there are rel... The Doctor Weighs In blogs http://www.medworm.com/rss/comments.php?id=748890 Sun, 22 Jul 2007 00:27:45 +0100 748890 http://www.medworm.com/index.php?rid=744793&cid=t_119409_117_f&fid=34612&url=http%3A%2F%2Fwww.thedoctorweighsin.com%2Fjournal%2F2007%2F7%2F19%2Fshould-we-have-health-care-performance-transparency-by-whom-.html Brian Klepper Last week the New York Times reported that the state's Attorney General (AG) office threatened UnitedHealthcare (UHC) with a lawsuit if it proceeded with the September release of a physician profiling report. The details were fuzzy, but apparently the AG was responding to charges by different physician groups – the AMA and the St. Louis Metropolitan Medical Society were named  - that UHC's methodology is based purely on cost and does not consider quality. The Times piece includes this snippet:Linda A. Lacewell, a senior lawyer in the office of Attorney General Andrew M. Cuomo, wrote in the letter that the ranking would apparently be used to steer consumers toward selected doctors. “To compound the situation,” she wrote, “we understand that em... The Doctor Weighs In blogs http://www.medworm.com/rss/comments.php?id=744793 Thu, 19 Jul 2007 23:30:07 +0100 744793 http://www.medworm.com/index.php?rid=735492&cid=t_119409_117_f&fid=34612&url=http%3A%2F%2Fwww.thedoctorweighsin.com%2Fjournal%2F2007%2F7%2F15%2Fto-fix-health-care-fix-america-first.html Brian Klepper Been to see Sicko yet? If you haven't, I'd urge you to go right out and see it. The audience in my very conservative Southern community was riveted and clapped at the end, and everyone I've traded notes with has told me their audience clapped too. While it has its flaws, its central argument – that America's health care system is clinically and financially failing a large and growing percentage of our people – is compelling and undeniable. By the way, the movie is NOT about how the system is failing the uninsured, but how it is failing those of us in the mainstream with insurance.Sicko's has several powerful themes. One is that American health care is like it is because our leaders favor their contributors rather than voters. It's true. It's unlikely we can f... The Doctor Weighs In blogs http://www.medworm.com/rss/comments.php?id=735492 Sun, 15 Jul 2007 22:23:09 +0100 735492 http://www.medworm.com/index.php?rid=719793&cid=t_119409_117_f&fid=34612&url=http%3A%2F%2Fwww.thedoctorweighsin.com%2Fjournal%2F2007%2F7%2F7%2Fmy-friend-bob.html By Maggi Cary MD, MBA, MPHBob and Lara were my landlords, in their 60s, and lived across the nearly-two-lane road in the house they built over Adobe Canyon Creek in Sonoma County, California.I was Bob and Lara’s doctor—not in the come-to-my-office sense, but in the I’m-the-only-medical-person-in-the-family sense.  Bob developed a Dupuytren’s contracture, which is where a finger, or fingers, is drawn down toward the palm.  The connective tissue thickens and shortens, so moving the affected finger(s) is difficult.  The treatment is surgery and I recommended one of the top plastic surgeons in town.  Another friend did Bob’s anesthesia, blocking the nerves leading to the hand, much as dentists block nerves in your mouth, with Bob awake during t... The Doctor Weighs In blogs http://www.medworm.com/rss/comments.php?id=719793 Sat, 07 Jul 2007 20:08:00 +0100 719793 http://www.medworm.com/index.php?rid=682486&cid=t_119409_117_f&fid=34612&url=http%3A%2F%2Fwww.thedoctorweighsin.com%2Fjournal%2F2007%2F6%2F19%2Fwise-up-when-is-comes-to-heart-disease-women-are-different-f.html This is Dr. Bill Bestermann's first post as one of the TDWI writers (A Big Welcome, Bill!).   Dr. Bestermann makes it clear that there is a long way to go, baby, before the diagnosis and treatment of heart disease in women gets to where it should be...hey! ladies, let's WISE up!  Here you go: The evidence has become irrefutable that life-style change and medications aimed at vascular risk factors outperform bypass surgery and stenting in prevention of heart attack. Not only that, but non-invasive strategies have positive benefits on the entire vasculature that prevent stroke, nerve damage, eye damage, kidney damage and amputation. Women are different These differences may be even more important for females. For some time now, there has been discussion of women being di... The Doctor Weighs In blogs http://www.medworm.com/rss/comments.php?id=682486 Tue, 19 Jun 2007 19:07:41 +0100 682486 http://www.medworm.com/index.php?rid=674822&cid=t_119409_117_f&fid=34612&url=http%3A%2F%2Fwww.thedoctorweighsin.com%2Fjournal%2F2007%2F6%2F13%2F911-my-wife-is-dyingplease-send-help-to-the-er.html Photo by Mark Boster, LA TimesThis story, from the Los Angeles Times,  is so outrageous I have to take a few deep breaths before I tell it. Edith Rodriguez died in the ER…not on a gurney surrounded by doctors and nurses desperately trying to save her life. She died on the floor of the lobby, lying in her own blood as a janitor mopped up around her.Jose Prado, her partner, tried to get the attention of Los Angeles’ King-Harbor ER staff, but he was ignored even though Edith was writhing in pain and spitting up blood as she lay on the floor. He called 911 from a pay phone only to be told “Paramedics are not going to pick…his wife up, from a hospital, because she’s already at one.”An unidentified woman, perhaps another patient, jumped in to help.... The Doctor Weighs In blogs http://www.medworm.com/rss/comments.php?id=674822 Wed, 13 Jun 2007 20:35:29 +0100 674822 http://www.medworm.com/index.php?rid=628947&cid=t_119409_117_f&fid=34612&url=http%3A%2F%2Fwww.thedoctorweighsin.com%2Fjournal%2F2007%2F5%2F21%2Fcosmetic-surgery-meets-managed-care.html Managed health plans are able to deliver lower cost services, in part, by developing networks of providers (docs and hospitals) who are willing to accept a discounted reimbursement rate in exchange for the volume of members provided by the plan. Cosmetic surgery, except for restoration of disfigurement, has not typically been a benefit covered by health insurance. So folks have had to pay out of pocket to get tucked, trimmed, augmented, or lifted. And Americans have done it in spades. There were 11.5 million surgical and non-surgical cosmetic procedures performed in the US in 2006. Now, in order to differentiate themselves, some health plans are offering access to the American Cosmetic Surgery Network. The network, owned by United Networks of America, Inc. is made-up of plastic surgeo... The Doctor Weighs In blogs http://www.medworm.com/rss/comments.php?id=628947 Mon, 21 May 2007 17:22:23 +0100 628947