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 policy'. Sat, 03 Sep 2011 01:49:44 +0100 http://www.medworm.com/index.php?rid=5182053&cid=t_99857_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002155.html Everyone seems convinced there's a ton of fraud in Medicare. And they may be right. What there wasn't, for far too long, was much emphasis on finding and prosecuting the criminals stealing from taxpayers by defrauding Medicare. Well, looks like... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=5182053 Thu, 01 Sep 2011 23:00:00 +0100 5182053 http://www.medworm.com/index.php?rid=5181798&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-features-of-a-bundled-payment-for-care-improvement-project%2F2011.09.01 Many health care provider organizations have not been overly eager to jump onto the Accountable Care Organization (ACO) bandwagon, citing high startup costs and uncertain returns on investment given the complexity of the program.  Well, recently, the CMS Center for Innovation has announced the Bundled Payment for Care Improvement initiative.  This initiative incorporates elements of earlier CMS demonstration projects — the gainsharing demos and ACE (acute care episode) bundled payments demonstrations which the HealthBlawger has helped a number of clients around the country qualify for in the past — and builds on the broad authority granted to the CMS Center for Innovation under health reform. The advantages to proceeding with a Bundled Payment for Care Improvement project inc... Better Health blogs http://www.medworm.com/rss/comments.php?id=5181798 Thu, 01 Sep 2011 21:00:08 +0100 5181798 http://www.medworm.com/index.php?rid=5182150&cid=t_99857_131_f&fid=34989&url=http%3A%2F%2Ffeeds.b5media.com%2F%7Er%2Fb5media%2FGeneticsHealth%2F%7E3%2Fy40e0ba2MBU%2F Jeanene Harlick, 37, was at 65% her ideal body weight and needed a feeding tube, but her insurance company wouldn’t cover inpatient care at an eating disorder facility. Harlick lives in California, which has one of the nation’s strongest mental health parity laws—laws that say insurance companies must provide the same coverage for mental illness as they do for physical illness). So she sued—and won, for now; the U.S. 9th Circuit Court of Appeals in San Francisco just said that her insurance company, Blue Shield of California, must pay for her residential care. The ruling could make a difference in how insurers in other states cover mental health treatment, too. Forty-nine states and D.C. have mental parity laws, but they vary in degree widely, according to the National Conf... Genetics and Health blogs http://www.medworm.com/rss/comments.php?id=5182150 Thu, 01 Sep 2011 20:51:32 +0100 5182150 http://www.medworm.com/index.php?rid=5181702&cid=t_99857_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2011%2F09%2Fsay-it-aint-so-howard-dean-runs-through.html The revolving door now accommodates the whole political spectrum.  A Salon article documented the transit of one Howard Dean, former darling of the left-wing of the Democratic party:Howard Dean has long cultivated an image as the plainspoken doctor who speaks for the left wing of the Democratic Party, a role he still plays as a pugnacious pundit on TV. But since his term as chairman of the Democratic National Committee ended in January 2009, Dr. Dean has taken on a less-noticed role: paid advocate for interest groups that would find few fans among the progressive voters once energized by Dean's 2004 presidential bid.Dean may not be the worst of the 'buckrakers,' those prototypical capital characters who exploit their name and connections without regard for principle. But his recent po... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=5181702 Thu, 01 Sep 2011 20:39:00 +0100 5181702 http://www.medworm.com/index.php?rid=5181799&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fimproving-doctor-patient-communication-to-provide-patient-centered-care%2F2011.09.01 The first experience patients are likely to have with your hospital is not in an ER visit or inpatient stay.  A patient’s first experience will most likely be in one of your primary-care physician offices.  That because a person is 10 times more likely during a year to end up in the physician’s office for a routine visit than they are to require an overnight hospital stay. As a hospital marketer or patient experience officer this should raise an interesting question. How well do your physicians–particularly your primary-care physicians–represent your brand? Take “patient-centeredness.” Lots of hospitals these days are promoting themselves as providing patient-centered care.  You know … when the hospital and its staff try where possible to be sensitive to and honor the wish... Better Health blogs http://www.medworm.com/rss/comments.php?id=5181799 Thu, 01 Sep 2011 18:00:05 +0100 5181799 http://www.medworm.com/index.php?rid=5182054&cid=t_99857_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002154.html In MCM's ongoing effort to keep our loyal readers apprised of things that will affect their businesses, it's time to remind one and all that the Super-Committee's budget cuts are due in less than three months. Yep, in 83 days... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=5182054 Wed, 31 Aug 2011 23:00:00 +0100 5182054 http://www.medworm.com/index.php?rid=5169545&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdo-physicians-have-a-role-in-controlling-healthcare-costs%2F2011.08.27 The Role of Physicians in Controlling Medical Care Costs and Reducing Waste by the RAND Corporation and David Geffen, University of California Los Angeles School of Medicine, Santa Monica was just published in the Journal of the American Medical Association (JAMA).  I do not think the JAMA should have published this article. 1.Why would the JAMA publish such an article? 2. Why are physicians blamed for all the waste in the system? 3. Why is it the physicians’ responsibility to eliminate waste when they are not the cause of the greatest percentage of the waste? “The amount of money spent on medical care is increasing faster than the gross domestic product (GDP), and the federal deficit is increasing.” The initial statement assumes that the government deficit is increasing because phy... Better Health blogs http://www.medworm.com/rss/comments.php?id=5169545 Sat, 27 Aug 2011 21:05:19 +0100 5169545 http://www.medworm.com/index.php?rid=5158999&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fare-patients-considering-the-idea-of-medical-tourism-to-receive-health-care%2F2011.08.24 I must confess that I have a weakness for medical tourism. Patients have always been ready to go on a pilgrimage to find the world’s leading expert (we call it ‘key opinon leader’ now) hoping to find a cure. As long as traditional leaders in the field of Medicine have been the Germans, the French and the English -with some occasional Austrian and Spanish name in the mix- traffic of wealthy patients across Europe is nothing new. Since we entered the antibiotics era, these leaders started to be located mainly in the United States, the cradle of modern, technology-driven Medicine. Thus hi-tech centers got ready to welcome foreign patients, building strong International Customer Support departments. A random example -by no means the only one- would be the Mayo Clinic. On their website y... Better Health blogs http://www.medworm.com/rss/comments.php?id=5158999 Wed, 24 Aug 2011 14:00:07 +0100 5158999 http://www.medworm.com/index.php?rid=5139734&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fchronic-health-needs-must-be-addressed-after-a-natural-disaster%2F2011.08.18 Sichuan earthquake rescue workers carrying an injured person. In light of the widespread media coverage of natural disasters, such as the earthquake in Haiti and the tsunami in Japan, the public and medical professionals are aware of the anticipated immediate medical needs in these kinds of emergencies. However, it is less well known that after the initial management of life- and limb-threatening injuries, there may be an enormous need to provide care to persons with chronic illnesses. This is because they are displaced from their homes, become exposed to adverse environmental and socioeconomic hardships, lose access to healthcare, are deprived of their sources of medications, and so forth. Some of my colleagues were allowed to enter Japan after the tsunami, and their observations agree wi... Better Health blogs http://www.medworm.com/rss/comments.php?id=5139734 Thu, 18 Aug 2011 14:00:00 +0100 5139734 http://www.medworm.com/index.php?rid=5130748&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-pros-and-cons-of-ipab-and-why-it-shouldnt-be-repealed%2F2011.08.15 In recent weeks, several Democrats and some health reform advocates including the AMA have joined Republicans in calling for a repeal of provisions in the new health law that create the Independent Payment Advisory Board (IPAB). For these people, IPAB represents the worst aspects of the new law–an unelected, centralized planning authority empowered by government to make decisions about the peoples’ health care. Arbitrary cuts to providers, short-sighted decisions that stifle innovation and rationing of care are sure to follow, they claim. While it’s true that the rules governing IPAB are flawed and should be fixed, eliminating IPAB altogether would be a mistake. (more…) *This blog post was originally published at Pizaazz* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=5130748 Mon, 15 Aug 2011 12:00:44 +0100 5130748 http://www.medworm.com/index.php?rid=5118641&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fbeing-a-doctor-is-a-lot-like-being-a-parent-you-cant-tap-out%2F2011.08.11 The American College of Graduate Medical Education has enacted further restrictions on resident work hours.  No more than 80 hours per week of work for resident physicians, averaged over one month.  And no more than 16 hours of continuous work for first year residents (24 after that), which includes patient care, academic lectures, etc. Whenever they do this sort of thing, everyone seems excited that it will make everyone safer.  After all, residents won’t be working as much, so they’ll be more rested and make much better decisions.  It’s all ‘win-win,’ as physicians in training and patients alike are safer. I guess.  The problem of course is that after training, work hours aren’t restricted.  There is no set limit on the amount of work a physician can be expected to do, ... Better Health blogs http://www.medworm.com/rss/comments.php?id=5118641 Thu, 11 Aug 2011 18:05:30 +0100 5118641 http://www.medworm.com/index.php?rid=5118643&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdrug-manufacturer-issues-statement-banning-drug-used-for-lethal-injections%2F2011.08.11 A friend sent me a press release a few days ago and I still find myself thinking about it. Here in the United States capital punishment is still legal in many states and is performed, frequently, by lethal injection. Prisoners sentenced to death have an IV placed in their arm which is then infused with the following three solutions: A barbiturate like Sodium Pentothal or Nembutal, used to induce anesthesia A paralytic like pancuronium bromide or succinylcholine chloride, used to stop respiration Potassium chloride used to stop electrical conduction in the heart I remember a few years ago drug manufacturer Hospira, the producer of Sodium Pentothal, issued a statement that it disapproved of its drug being used in capital punishment.  But, that was as far as their opposition went and, alth... Better Health blogs http://www.medworm.com/rss/comments.php?id=5118643 Thu, 11 Aug 2011 14:00:36 +0100 5118643 http://www.medworm.com/index.php?rid=5118801&cid=t_99857_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002146.html With nine of the twelve spots on the Super-Committee taken, it looks like energy, tax policy, and political connections (now there's a surprise!) are well-represented. What isn't is expertise in health care, Medicare, or Medicaid. With House Democrats scheduled to... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=5118801 Wed, 10 Aug 2011 23:00:00 +0100 5118801 http://www.medworm.com/index.php?rid=5118647&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fexpensive-medications-is-the-benefit-worth-the-cost%2F2011.08.10 The concept of cost-effectiveness in medicine is elastic. One’s view on this issue depends upon who is paying the cost. Of course, this is true in all spheres of life. When you’re in a fine restaurant, you order differently when the meal will be charged to someone else. Under these circumstances, the foie gras appetizer and the jumbo shrimp cocktail are no longer luxuries, but are considered as essential amino acids that are necessary to maintain life. In the marketplace, except in the medical universe, goods and services are priced according to what the market will bear. If an item is priced too high, then the seller will have fewer sales and a bloated inventory. Consumers will not pay absurd prices for common items, regardless of supernatural claims of quality. Would you pay $100 fo... Better Health blogs http://www.medworm.com/rss/comments.php?id=5118647 Wed, 10 Aug 2011 16:00:00 +0100 5118647 http://www.medworm.com/index.php?rid=5107514&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fphysician-discusses-the-confusing-aspects-of-medicare-part-d%2F2011.08.09 I have discussed Medicare Part B and Part F in recent blogs. A reader asked about Medicare Part D: Dr. Feld “Please discuss Medicare Part D, the drug benefit plan available to seniors. It is very complicated and completely confusing to me. My physician gave me a prescription for Levequin 500 mg once a day for 10 days. The pharmacist told me it would cost me $330 dollars. Medicare Part D would pay an additional $110 dollars for a total of $440 dollars. I asked the pharmacist if there was a generic equivalent. The answer was yes. It cost $10 dollars. This is unconscionable. It is highway robbery. Sincerely a.g.” Several issues are presented in this readers note. It is essential to understand these issues. The issues are an indictment against government “controlled” programs. (m... Better Health blogs http://www.medworm.com/rss/comments.php?id=5107514 Tue, 09 Aug 2011 14:00:44 +0100 5107514 http://www.medworm.com/index.php?rid=5103342&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhat-should-people-receiving-health-care-be-called-empowered-patient-vs-health-care-consumer%2F2011.08.05 “There is a better way – structural reforms that empower patients with greater choices and increase the role of competition in the health-care marketplace.” Rep. Paul Ryan (R-WI) August 3, 2011 The highly charged political debates about reforming American health care have provided tempting opportunities to rename the people who receive health services.  But because the impetus for this change has been prompted by cost and quality concerns of health care payers, researchers and policy experts rather than emanating from us out of our own needs, some odd words have been called into service.  Two phrases commonly used to describe us convey meanings that mischaracterize our experiences and undervalue our needs: “empowered patient” and “health care consumer.” As one who has done ... Better Health blogs http://www.medworm.com/rss/comments.php?id=5103342 Fri, 05 Aug 2011 21:00:35 +0100 5103342 http://www.medworm.com/index.php?rid=5096672&cid=t_99857_118_f&fid=34850&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHealthBusinessBlog%2F%7E3%2FTzkpCA8QfLU%2F The American Recovery and Reinvestment Act of 2009 (ARRA) created major incentive programs for clinicians and hospitals that adopt electronic health records and achieve certain Meaningful Use (MU) criteria. Medicare and Medicaid have similar but separate programs. All providers –except certain hospitals– have to choose one program or the other to participate in. CMS has a useful PDF, which highlights the key differences between the Medicare and Medicaid programs. Some are: Medicare providers receive payment reductions if they don’t achieve MU by 2011, while there is no such provision for Medicaid The maximum bonus for eligible professional is $44,000 for Medicare and $63,750 for Medicaid States can add elements to the MU definition for Medicaid, but Medicare’s defi... Health Business Blog blogs http://www.medworm.com/rss/comments.php?id=5096672 Thu, 04 Aug 2011 18:19:25 +0100 5096672 http://www.medworm.com/index.php?rid=5096206&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-problem-with-medical-licenses%2F2011.08.04 In one of those things I don’t really get*, Texas requires a separate license from an unrestricted medical license to prescribe narcotics. As the price of this extra license has always seemed to be more ‘cover the cost’, nobody has seriously objected. It’s $25, in case you’re interested. Since it’s a State license, it’s required if your job could even perceivably need to prescribe narcs in a hospital. (So, Radiologists and Pathologists are usually exempted). It’s never been an issue, as long as you don’t screw up. Until now. From the Austin American Statesman: (more…) *This blog post was originally published at GruntDoc* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=5096206 Thu, 04 Aug 2011 14:00:59 +0100 5096206 http://www.medworm.com/index.php?rid=5086172&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Foverwhelmed-ers-continue-to-rise-to-the-challenge%2F2011.07.31 Last night I was contacted by a physician in the local urgent-care.   I like him, and we made polite, but brief, conversation.  ‘So, are you guys busy?’ I gave him the status report.  ‘Well, yeah.  We have about 25 people waiting to be seen the waiting room is full and every patient room is full.  Also, we just received a gun-shot wound to the head by EMS.’ ‘Wow, sounds terrible!  So, here’s what I need to send you…’ What he sent was, in fact, reasonable.  A young woman with signs and symptoms of meningitis (who was treated earlier in the day for and upper respiratory virus…with Amoxicillin, of course.) She needed a lumbar puncture, which I performed and which was  negative. But I had this thought.  I could probably have said, (more…) *This blog ... Better Health blogs http://www.medworm.com/rss/comments.php?id=5086172 Sun, 31 Jul 2011 21:00:39 +0100 5086172 http://www.medworm.com/index.php?rid=5086174&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhealth-care-attorney-warns-about-hipaa-privacy-issues-in-social-media%2F2011.07.31 This is the first of a three part post addressing the legal concerns of social networking in the health care arena. Legal expert, David Harlow, Esq., Health Care Attorney and Consultant at The Harlow Group, LLC in Boston, addresses the legal issues. Q:  Barbara: What are the legal implications for doctors, nurses and hospitals engaging in social media? A:  David: Health care providers are concerned about HIPAA privacy issues – HIPAA violations may occur as a result of staff posts, or as a result of patient, family or caregiver posts – as well as potential liability for medical advice provided on line.  Physicians and nurses have been sanctioned and fired for privacy breaches via social media, so these are real concerns.  Some communications that folks think are OK may in fact be v... Better Health blogs http://www.medworm.com/rss/comments.php?id=5086174 Sun, 31 Jul 2011 16:00:39 +0100 5086174 http://www.medworm.com/index.php?rid=5077685&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Ftake-an-active-role-in-your-own-health-it-can-save-more-than-just-your-life%2F2011.07.29 Sometimes you need a published study to tell you what should be obvious in the first place. This time, researchers have discovered that: When physicians have more personalized discussions with their patients and encourage them to take a more active role in their health, both doctor and patient have more confidence that they reached a correct diagnosis and a good strategy to improve the patient’s health. Really? But wait, there’s more. (more…) *This blog post was originally published at See First Blog* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=5077685 Fri, 29 Jul 2011 18:00:07 +0100 5077685 http://www.medworm.com/index.php?rid=5077866&cid=t_99857_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002138.html There's good news and bad news in the latest projections on health care costs; last year, US health spending increased a mere 3.9 percent, due largely to the recently ended recession (people lost health insurance, and those who still had... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=5077866 Wed, 27 Jul 2011 23:00:00 +0100 5077866 http://www.medworm.com/index.php?rid=5069471&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhen-physicians-fail-to-take-responsibility-for-their-own-orders%2F2011.07.27 A physician asked me a question regarding what should be the role of hospitalists in carrying out discharge orders written by other physicians. I have been following your blog since I was a resident and recommend it to a lot of people.  Thank you so much for enlightening me on so many day to day hospital issues.  I wanted to know your opinion about something that puzzles me.  When a specialist changes a medication or requires a lab to be done as outpatient after a discharge order is written (for example you write: okay to D/C if okay with cardiology, and they change a dose or request stress test out-pt) who is required to write the new scripts and arrange that test? Is it the hospitalist’s responsibility to do it? Or is the specialist who changed the dose after you rounded require... Better Health blogs http://www.medworm.com/rss/comments.php?id=5069471 Wed, 27 Jul 2011 21:00:00 +0100 5069471 http://www.medworm.com/index.php?rid=5069475&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhat-is-the-most-costly-healthcare-expenditure%2F2011.07.27 The National Institute for Healthcare Management Foundation is a nonprofit, nonpartisan organization focused on healthcare. The foundation just published an excellent report on the distribution of  healthcare costs in the population. The results indicate that reducing healthcare cost is all about reducing and managing chronic diseases. U.S. healthcare spending has sharply increased between 2005 and 2009 by 23 percent from $2 trillion to $2.5 trillion per year. This is a result of a combination of factors. Chief among them is the increasing incidence of obesity. Who spends the money? (more…) *This blog post was originally published at Repairing the Healthcare System* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=5069475 Wed, 27 Jul 2011 12:00:54 +0100 5069475 http://www.medworm.com/index.php?rid=5069477&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Finstitute-of-medicine-suggests-8-new-preventive-services-to-improve-womens-health%2F2011.07.26 Eight preventive health services for women should be added to the services that health plans will cover at no cost to patients under the Patient Protection and Affordable Care Act of 2010, according to a report by the Institute of Medicine. The recommendations encompass diseases and conditions that are more common or more serious in women than in men. They are based on existing guidelines and an assessment of the evidence on the effectiveness of different preventive services. They include: 1) screening for gestational diabetes in pregnant women between 24 and 28 weeks and at the first prenatal visit for women at high risk for diabetes, 2) adding high-risk human papillomavirus DNA testing in addition to conventional cytology testing in women with normal cytology results starting at age 30, ... Better Health blogs http://www.medworm.com/rss/comments.php?id=5069477 Tue, 26 Jul 2011 18:00:00 +0100 5069477 http://www.medworm.com/index.php?rid=5069449&cid=t_99857_87_f&fid=36438&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCato-at-liberty%2F%7E3%2FBjcOn1sbcrE%2F By Michael F. CannonI’m a few days behind on this, but over at The Corner Yuval Levin has written an important post about how health care entitlements are the real cause of the debt crisis facing the federal government. Using Congressional Budget Office projections, Levin creates this magnificent chart, which I plan to steal over and over again: If Republicans want to conquer the federal debt, they need to embrace health policy like they embrace tax cuts. Health Care Entitlements Are the Real Debt Bomb is a post from Cato @ Liberty - Cato Institute Blog (Source: Cato-at-liberty) Cato-at-liberty blogs http://www.medworm.com/rss/comments.php?id=5069449 Tue, 26 Jul 2011 16:55:19 +0100 5069449 http://www.medworm.com/index.php?rid=5050583&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhy-doctors-should-participate-in-the-debt-ceiling-debate%2F2011.07.20 Joe Scarborough reminds us that the divisions in American government are hardly new, paraphrasing Benjamin Franklin’s observation that “When you assemble a number of men, to have the advantage of their joint wisdom, you inevitably assemble . . . all their prejudices, their passions, their errors of opinion, their local interests, and their selfish views. From such an assembly can a perfect production be expected?” (This comes from a September 17, 1787 speech by Mr. Franklin to urge ratification of the U.S. Constitution, read on his behalf because he was too ill to deliver it in person. The Constitution was ratified the same day.) I suppose we should be encouraged that Congress’s prejudices, passions, errors of opinion, local interests and selfish views are as American as apple pie,... Better Health blogs http://www.medworm.com/rss/comments.php?id=5050583 Wed, 20 Jul 2011 16:00:00 +0100 5050583 http://www.medworm.com/index.php?rid=5050812&cid=t_99857_113_f&fid=35744&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fe-CareManagement%2F%7E3%2Fjm_ArodpnyU%2F I doubt it. IMHO, the recent acquisition by Highmark Blue Cross Blue Shield of West Penn Allegheny Health System (WPAHS) for $475 M is unique to local market conditions. It was done as a last resort and should not be taken as a signal that health plans are starting a hospital buying binge. Why are hospitals unattractive investments for health plans: (more…) Tags: acquisition, hospital (Source: e-CareManagement) e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=5050812 Mon, 18 Jul 2011 19:00:17 +0100 5050812 http://www.medworm.com/index.php?rid=5036229&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-real-world-of-medicine-today%2F2011.07.17 The old joke in medicine goes, ‘don’t get sick on July 1st.’ That’s because it’s the day when new resident physicians, freshly graduated from medical schools across the land, begin their training programs. Although they have spent four years in undergraduate school and four years in medical school, it’s residency where physicians are made from the raw material of knowledge-rich, experience poor high achievers. However, even in residency physicians are seldom told the entire story of how the practice of medicine, and their lives, will look and feel as their careers evolve and they enter the medical work-force. Since our profession changes from year to year and administration to administration, it seems a good time to mention some of the things upcoming young physicians will face... Better Health blogs http://www.medworm.com/rss/comments.php?id=5036229 Sun, 17 Jul 2011 16:00:50 +0100 5036229 http://www.medworm.com/index.php?rid=5036230&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhat-can-history-tell-us-about-healthcare-in-america%2F2011.07.17 Millions of our citizens do not now have a full measure of opportunity to achieve and enjoy good health. Millions do not now have protection or security against the economic effects of sickness. The time has arrived for action to help them attain that opportunity…The poor have more sickness, but they get less medical care. People who live in rural areas do not get the same amount or quality of medical attention as those who live in our cities. The above quote wasn’t taken from an Obama administration policy proposal. These words are from a 1945 speech by President Harry Truman. It is astonishing that over 60 years later, the health care crisis is not only still with us, but is slowly smothering us. How many years of oxygen do we have left until health care in America is entirely asphy... Better Health blogs http://www.medworm.com/rss/comments.php?id=5036230 Sun, 17 Jul 2011 14:00:00 +0100 5036230 http://www.medworm.com/index.php?rid=5036234&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fbudget-cuts-and-their-potential-complications-for-family-medicine%2F2011.07.16 Every day in the news, you hear about the United States federal budget and the potential political complications if something is done or if nothing is done. And every day in the news you hear about possible cuts in Medicare. What you don’t know is that some cuts in Medicare can significantly impact the training of future Family Physicians. What do I mean by this? Well, did you know that residency programs are paid Medicare funds (called Graduate Medical Education funds) going to hospitals? Check out this great article about how residency programs are funded. So, let’s play this out with its potential complications for Family Medicine. If GME funds are cut as they are proposed, then many hospitals with only one residency program (usually a Family Medicine program), may be forced... Better Health blogs http://www.medworm.com/rss/comments.php?id=5036234 Sat, 16 Jul 2011 16:00:45 +0100 5036234 http://www.medworm.com/index.php?rid=5028695&cid=t_99857_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002131.html The Medicare drug program - Part D - was the largest expansion of entitlement programs since the Great Society. And it was - and is - a Republican program. A political masterstroke, Part D undoubtedly helped George W Bush get... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=5028695 Thu, 14 Jul 2011 23:00:00 +0100 5028695 http://www.medworm.com/index.php?rid=5028214&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fcould-our-health-system-function-without-power-in-the-digital-age%2F2011.07.14 * Bzzzzzaaaaapp * Suddenly, the light went out. There was complete and utter darkness. Then, about 3 seconds later, the lights returned. My computer with its flat screen poised before me, remained dark. I hesitated a moment, then pushed the power button. Within a few more moments, the computer restarted. All seemed intact. But what if it wasn’t? Today with our myriad of computer systems, electronic medical records, e-mail messages, paging systems, digital xray machines, blood chemistry analyzers, automated blood pressure cuffs, etc., etc., etc., what would happen if we had no power or functional electronic medical record, just for a week? Could our health system function? We have entered the era when our medical students and residents have never entered a written order and “fl... Better Health blogs http://www.medworm.com/rss/comments.php?id=5028214 Thu, 14 Jul 2011 18:00:00 +0100 5028214 http://www.medworm.com/index.php?rid=5028696&cid=t_99857_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002129.html While the news this morning is not good, I still don't think Congress will fail to raise the debt limit; the economic consequences would be catastrophic, and there's too much political risk for either party to allow it to go... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=5028696 Tue, 12 Jul 2011 23:00:00 +0100 5028696 http://www.medworm.com/index.php?rid=5008198&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fobamacare-unraveled-what-could-possibly-go-wrong%2F2011.07.07 It is hard to remember all the defects in President Obama’s Healthcare Reform Act at once. President Obama’s Healthcare Reform Act is so flawed it cannot possibly work as it was intended. It must be repealed. A serious, thoughtful, practical and common sense way to “Repair The Healthcare System” must be enacted before all the stakeholders have adjusted to President Obama’s coming changes that will create a more dysfunctional system. A reader sent me a photo of a poster hanging in his local ice cream store. It is a reminder of previous criticisms of President Obama’s Healthcare Reform Act. (more…) *This blog post was originally published at Repairing the Healthcare System* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=5008198 Thu, 07 Jul 2011 14:00:26 +0100 5008198 http://www.medworm.com/index.php?rid=5008200&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-massachusetts-experiment-analyzed-provider-payments-based-on-their-negotiating-strength-not-quality-of-care%2F2011.07.06 Massachusetts Attorney General Martha Coakley released her office’s second annual report, An Examination of Health Care Cost Trends and Drivers (PDF; see also press release), which contains a wealth of critical data analysis — and also highlights how little we know about certain things — providing some important context for the discussion of the proposed Part III of Massachusetts health reform, a bill filed by Governor Patrick which would create all-payor ACOs and a system of global payments. At this late date, few would argue against a move a way from fee-for-service reimbursement for health care, or adding quality metrics to the mix, and tying financial rewards to providers to their performance measured against these metrics.  (Consider the Massachusetts Blue Cross Blu... Better Health blogs http://www.medworm.com/rss/comments.php?id=5008200 Wed, 06 Jul 2011 23:00:08 +0100 5008200 http://www.medworm.com/index.php?rid=5008183&cid=t_99857_87_f&fid=38368&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FDisruptiveWomenInHealthCare%2F%7E3%2FbRJcm-h-R3I%2F   mHealth Summit to Highlight Groundbreaking Research Abstracts and Innovative Presentations TOPIC AREAS: RESEARCH: Ground-breaking health research using mobile technologies in clinical medicine and public health outcomes. TECHNOLOGY: Categories that examine the technologies being deployed today while also exploring new technologies currently under development.  BUSINESS: Focus on moving the debate forward by addressing the business models that impact mHealth with a focus on lessons learned, best practices, and the emergence of commercially viable models to scale mHealth globally. POLICY: Showcase of healthcare, technology and investment communities seeking regulatory clarity on wireless medical technologies to accelerate this promising engine of health care innovation The subm... Disruptive Women in Health Care blogs http://www.medworm.com/rss/comments.php?id=5008183 Wed, 06 Jul 2011 13:19:47 +0100 5008183 http://www.medworm.com/index.php?rid=4997518&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthere-are-only-four-ways-to-reduce-healthcare-spending%2F2011.07.04 Everyone agrees that national spending on healthcare is on a trajectory to bankrupt America during the lifetimes of even Old Farts like DrRich. And therefore, most folks* agree that we ought to do something to reduce our national spending on healthcare. ____ *The reason it’s only “most folks” who agree is that, apparently, some folks are still partial to the Cloward-Piven strategy, and continuing to spend on healthcare as we are doing today is the quickest and surest way to get there. ____ Unfortunately, our national “discussion” on how to achieve this reduction in healthcare spending has devolved into a spectacle of accusations and counter-accusations, vituperation, abuse, and scurrility. Accordingly, not much useful has so far been achieved. Worse, the back-and-forth contumelie... Better Health blogs http://www.medworm.com/rss/comments.php?id=4997518 Mon, 04 Jul 2011 18:00:51 +0100 4997518 http://www.medworm.com/index.php?rid=4992684&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhhs-recommends-toothless-unfunded-plans-to-reduce-health-disparities-and-promote-disease-prevention%2F2011.07.02 In the 1993 film Groundhog Day, Bill Murray plays a TV weatherman who finds himself trapped in a do-loop, covering the numbingly boring display of Punxutawney Phil, over and over again. Forgive those of us who follow news from the Department of Health and Human Services for feeling like Bill Murray in that movie. Last month, HHS released an action plan to reduce racial disparities in health care. The plan called for new care models, more service delivery sites, a beefed-up health and human services workforce, and targeted efforts to reduce cardiovascular disease, childhood obesity and other scourges of minority populations. Remarkably however, the plan came with no funding. Apparently, it was supposed to prompt agencies within HHS to assure that their own internal plans were aligned with t... Better Health blogs http://www.medworm.com/rss/comments.php?id=4992684 Sat, 02 Jul 2011 18:00:01 +0100 4992684 http://www.medworm.com/index.php?rid=4992685&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fnurse-prompts-are-key-to-successful-implementation-of-icu-safety-measures%2F2011.07.02 Over the last few years, you may have heard a lot about the value of checklists in ICU medicine and their ability to reduce mortality, reduce cost and reduce length of stay.   But a recent study took the concept one step further and suggested that checklists by themselves may not be  effective unless physicians are prompted to act on the checklist. As reported in the American Journal of Respiratory and Critical Care Journal, a single site cohort study performed at Northwestern University Feinberg School of Medicine’s medical intensive care unit compared two rounding groups of physicians.  One group was prompted to use the checklist.  The other group of physicians had access to the checklist but were not prompted to use it. What they found was shocking.  Both groups had access t... Better Health blogs http://www.medworm.com/rss/comments.php?id=4992685 Sat, 02 Jul 2011 16:10:00 +0100 4992685 http://www.medworm.com/index.php?rid=4992681&cid=t_99857_87_f&fid=38368&url=http%3A%2F%2Fwww.changehealthcare.com%2Fdownloads%2Fhcti%2FHCTI_Q42010.pdf 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. USA Today reported on this study on June 30, 2011. Christopher Park... Disruptive Women in Health Care blogs http://www.medworm.com/rss/comments.php?id=4992681 Fri, 01 Jul 2011 15:47:47 +0100 4992681 http://www.medworm.com/index.php?rid=4992692&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fsupreme-court-data-mining-ok-even-when-physician-privacy-is-compromised%2F2011.07.01 The Supreme Court has sided with Big Pharma in their challenge to the Vermont Law limiting the pharmaceutical Industry’s access to physician prescribing information. The nation’s high court handed down a verdict Thursday in the Sorrell v. IMS Health case, striking down by a 6-3 vote a 2007 Vermont law that that bans the practice of data mining — the sale and use of prescriber-identifiable information for marketing or promoting a drug, including drug detailing — unless a physician specifically gives his or her permission to use the information. Apparently, Big Pharma’s right to “free speech” trumps my right to privacy. How getting access to my prescribing information has anything to do with free speech is beyond me.  In the twisted logic of the pro-business, anti-citizen Sup... Better Health blogs http://www.medworm.com/rss/comments.php?id=4992692 Fri, 01 Jul 2011 12:00:14 +0100 4992692 http://www.medworm.com/index.php?rid=4984452&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fbending-the-cost-curve-in-cancer-care-reduce-excessive-testing-for-reassurance-purposes%2F2011.06.29 This is the second in a series of posts on Bending the Cost Curve in Cancer Care. We should consider the proposal, published in the NEJM, gradually over the course of this summer, starting with “suggested changes in oncologists’ behavior,” #1: 1. Target surveillance testing or imaging to situations in which a benefit has been shown. This point concerns the costs of doctors routinely ordering CTs, MRIs and other imaging exams, besides blood tests, for patients who’ve completed a course of cancer treatment and are thought to be in remission. The NEJM authors consider that after a cancer diagnosis many patients, understandably, seek reassurance that any recurrence will be detected early, if it happens. Doctors, for their part, may not fully appreciate the lack of benefit of detecting ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4984452 Wed, 29 Jun 2011 15:00:37 +0100 4984452 http://www.medworm.com/index.php?rid=4975867&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhy-should-you-get-an-hiv-test-national-hiv-testing-day%2F2011.06.28 jQ(document).ready(function(){jQ('.bannerad').hide();jQ('#healthy_vision').parent().parent().parent().hide();});Note: Yesterday President Obama issued a statement on National HIV Testing Day Thirty years ago, at the beginning of the HIV/AIDS epidemic, there was no test for HIV, the virus that causes AIDS. For many, there was only the long and worrisome wait for the signs of infection. Once those signs appeared, no treatment for the virus was available. I personally cared for many, many patients in this era, and I am thankful that those days are over. Today, HIV testing is accurate, widely available, and often free—and treatment can help people living with HIV enjoy long, healthy lives, especially when they get diagnosed early. The good news is that more people are being tested fo... Better Health blogs http://www.medworm.com/rss/comments.php?id=4975867 Tue, 28 Jun 2011 13:00:40 +0100 4975867 http://www.medworm.com/index.php?rid=4975869&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fmore-employers-are-dropping-healthcare-insurance-coverage%2F2011.06.26 McKinsey Quarterly has reported its survey concluding there will be a radical restructuring of employer-sponsored health benefits (ESI) as a result of President Obama’s following the 2010 passage of the Affordable Care Act. Healthcare insurance rates have already skyrocketed as a result of anticipating the conditions of Obama care. President Obama has been powerless to do anything about the increases. Thirty percent (30%) of companies providing ESI to their employees will drop healthcare insurance coverage once Obama care takes effect in 2014. The survey included 1300 employers providing ESI across industries, geographies, and employer sizes. Other surveys have found that as we get closer to 2014, President Obama’s Healthcare Reform Act will provoke a much greater number of employers t... Better Health blogs http://www.medworm.com/rss/comments.php?id=4975869 Sun, 26 Jun 2011 21:00:51 +0100 4975869 http://www.medworm.com/index.php?rid=4968486&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fprimary-care-is-undervalued-what-should-be-done%2F2011.06.26 An article by Brian Klepper and Paul Fischer at Health Affairs has me all fired up. Finally these two health experts are calling it like it is. The Wall Street Journal, New York Times and EverythingHealth have written before about the way primary care is undervalued and underpayed in this country and how it is harming the health and economics of the United States. A secretive, specialist-dominated panel within the American Medical Association called the RUC has been valuing medical services for decades. They divvy up billions of Medicare and Medicaid dollars and all insurance payers base their reimbursement on these values also. The result has been gross overpayment of procedures and medical specialists and underpayment of doctors who practice primary care in internal medicine, family medi... Better Health blogs http://www.medworm.com/rss/comments.php?id=4968486 Sun, 26 Jun 2011 16:00:00 +0100 4968486 http://www.medworm.com/index.php?rid=4968492&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fmedical-students-deterred-from-primary-care%2F2011.06.25 Primary care physicians are getting paid more, two surveys agree, while hospital employment is rising. Internists earned $205,379 in median compensation in 2010, an increase of 4.21% over the previous year, reported the Medical Group Management Association’s (MGMA’s) Physician Compensation and Production Survey: 2011 Report Based on 2010 Data. Family practitioners (without obstetrics) reported median compensation of $189,402. Pediatric/adolescent medicine physicians earned $192,148 in median compensation, an increase of 0.39% since 2009. Among specialists, anesthesiologists reported decreased compensation, as did gastroenterologists and radiologists. Psychiatrists, dermatologists, neurologists and general surgeons reported an increase in median compensation since 2009. Regional... Better Health blogs http://www.medworm.com/rss/comments.php?id=4968492 Sat, 25 Jun 2011 14:00:00 +0100 4968492 http://www.medworm.com/index.php?rid=4968493&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fcan-crime-be-linked-to-cuts-in-the-mental-health-budget%2F2011.06.25 From the New York Times today we have a story entitled, “A Schizophrenic, A Slain Worker, Troubling Questions,” a horrible story about a mentally ill man who killed a social worker in his group home. The story highlights the defendant’s longstanding history of violence with several assaults in his past. He once fractured his stepfather’s skull and his first criminal offense involved slashing and robbing a homeless man. (On another post on this blog Rob wondered why the charges were dismissed in that case; from experience I can tell you it’s probably because the victim and only witness was homeless and couldn’t be located several months later when the defendant came to trial.) The defendant, Deshawn Chappell, also used drugs while suffering from schizophr... Better Health blogs http://www.medworm.com/rss/comments.php?id=4968493 Sat, 25 Jun 2011 12:00:00 +0100 4968493 http://www.medworm.com/index.php?rid=4968494&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhen-is-it-appropriate-to-disregard-guidelines-in-medical-care%2F2011.06.24 Podcast: In an article appearing last week in the American Heart Journal, investigators concluded that if American doctors would prescribe for their patients with heart failure each of the six therapies which are most strongly recommended in current heart failure guidelines, 68,000 lives per year could be saved. The following (for the interest of the reader, and for the convenience of any attorneys who may follow DrRich’s offerings), is an ordered list of these six proven, life-saving heart failure therapies, along with the number of American lives that could be saved each year if only American doctors would stop grossly under-utilizing them in violation of published guidelines: aldosterone antagonist therapy – 21,407 lives beta blockers – 12,922 lives implantable defibrillators ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4968494 Fri, 24 Jun 2011 21:00:47 +0100 4968494 http://www.medworm.com/index.php?rid=4960066&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fsuggestions-for-minimizing-spending-in-oncology%2F2011.06.22 Recently the NEJM ran a Sounding Board piece on Bending the Cost Curve in Cancer Care. The author’s take on this problem: Annual direct costs for cancer care are projected to rise — from $104 billion in 2006 to over $173 billion in 2020 and beyond.2…Medical oncologists directly or indirectly control or influence the majority of cancer care costs, including the use and choice of drugs, the types of supportive care, the frequency of imaging, and the number and extent of hospitalizations… The article responds, in part, to Dr. Howard Brody’s 2010 proposal that each medical specialty society find five ways to reduce waste in health care. The authors, from the Divisions of Hematology-Oncology and Palliative Care at Virginia Commonwealth University in Richmond VA, offer two lists: S... Better Health blogs http://www.medworm.com/rss/comments.php?id=4960066 Wed, 22 Jun 2011 21:00:34 +0100 4960066 http://www.medworm.com/index.php?rid=4960067&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwho-is-responsible-for-the-hospital-bills-of-prisoners%2F2011.06.22 Are government entities required to pay the hospital bills of incarcerated prisoners?  This is a scenario that happens quite often.  Jailed patients are admitted onto the hospitalist service through the ER for anything from patients faking seizures in the ER to chest pain to drug overdoses.  When patients are under the custody of the city, state or federal system, those entities are required to pay for necessary acute health care services.  I don’t know, maybe it has something to do with a prisoner’s constitutional right.  You lose your right to vote, but not to get a liver transplant. So what happens? Jailed patients get admitted and guards, sometimes, one, two or three at a time, are required to be at the patient’s bedside 24 hours a day.  If the patient needs to ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4960067 Wed, 22 Jun 2011 18:00:00 +0100 4960067 http://www.medworm.com/index.php?rid=4960200&cid=t_99857_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002119.html There's been much publicity around a McKinsey survey that purported to indicate many employers would drop their employee health insurance plans, a finding markedly different from that predicted by several other studies. Were the other surveys wrong, and is McKinsey... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4960200 Tue, 21 Jun 2011 23:00:00 +0100 4960200 http://www.medworm.com/index.php?rid=4952841&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhow-the-va-can-help-our-female-veterans%2F2011.06.21 Women are the fastest growing segment in the US military, already accounting for approximately 14 percent of deployed forces. According to statistics from the Department of Veterans Affairs (VA), 20 percent of new recruits and 17 percent of Reserve and National Guard Forces are women. As the number of women continues to grow in the military, so does the need for health care specifically targeted to their unique concerns. Historically, lower rates of female veterans have used the VA system. “Research has shown that women didn’t define themselves as veterans in the past, and this is changing,” said Antonette Zeiss, PhD, a clinical psychologist and Acting Chief for Mental Health Services at the VA Central Office in Washington, DC. Now, “Women are among the fastest growing segments of ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4952841 Tue, 21 Jun 2011 18:00:00 +0100 4952841 http://www.medworm.com/index.php?rid=4952849&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fcdc-reports-that-salmonella-is-still-a-major-problem%2F2011.06.20 Salmonella food infections continue despite success reducing disease caused by other pathogens, the Centers for Disease Control and Prevention reports. Salmonella should be targeted because while infection rates have not declined significantly in more than a decade, they are one of the most common, the CDC reports in its latest Vital Signs. Contaminated food causes approximately 1,000 reported disease outbreaks and an estimated 48 million illnesses, 128,000 hospitalizations, and 3,000 deaths annually in the U.S. Salmonella causes 1 million foodborne infections annually, incurring an estimated $365 million in direct medical costs. Salmonella infections in 2010 increased 10% from 2006-2008. The same prevention measures that reduced Escherichia coli infections to less than 1 case per 100,000 ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4952849 Mon, 20 Jun 2011 12:00:00 +0100 4952849 http://www.medworm.com/index.php?rid=4921420&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fphysicians-must-do-their-part-to-reduce-unnecessary-hospital-expenses%2F2011.06.10 Hospital costs are out of control. We have an aging population living longer with more complicated presentation of disease. We have an insurance driven platform instead of a health driven accountability. The long term sustainability of that architecture is one of guaranteed insolvency. One way or another hospitals are going to find their lifeline cut off. Medicaid is bankrupt. Hospital profit margins from Medicare have been negative for almost a decade. In addition, the rapid rise in private insurance premiums and industry’s gradual but accelerating exit from the health insurance benefit market all tell me that hospitals must find a way to reduce the cost of providing care. There are many ways hospital costs can be reduced. Administrators are paid handsomely to make it happen. Either... Better Health blogs http://www.medworm.com/rss/comments.php?id=4921420 Fri, 10 Jun 2011 21:00:00 +0100 4921420 http://www.medworm.com/index.php?rid=4921609&cid=t_99857_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002116.html It's pretty simple, really. Once people gain actual real-life experience with a government program, they abandon their fear of the unknown, see its benefits more clearly, and become invested in its future. We've seen that with Medicare, which consistently pleases... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4921609 Thu, 09 Jun 2011 23:00:00 +0100 4921609 http://www.medworm.com/index.php?rid=4911481&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhealthcare-regulations-gone-wild%2F2011.06.08 We certainly have seen regulations upon regulations appear for health care over the past several years, and this letter to the editor of the Wall Street Journal (1 June 2011) from the Commissioner of the Consumer Product Safety Commission, Nancy A. Nord, should cause us all to pause: As a commissioner at the U.S. Consumer Product Safety Commission (CPSC), I can attest that no such (regulatory reform) activity is happening at this agency. We certainly have not combed through our regulations to eliminate those that are “out-of-date, unnecessary, [or] excessively burdensome,” as he suggests is being done across the government. Instead, we are regulating at an unprecedented pace and have pretty much abandoned any efforts to weigh societal benefits from regulations with the costs im... Better Health blogs http://www.medworm.com/rss/comments.php?id=4911481 Wed, 08 Jun 2011 18:00:00 +0100 4911481 http://www.medworm.com/index.php?rid=4911484&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fveterans-affairs-cio-says-ipads-need-to-be-secured-for-medical-use%2F2011.06.07 In a nod to the reality of rapid physician adoption of tablets and smartphones, the CIO of the VA system recently stated that the VA must find a way to accommodate  iPads at a  conference on federal information technology. According to Baker, the fact is that 100,000 residents rotate through the VA each year and “they’re all carrying mobile devices”. In order for them to do their jobs, they want to be able to access resources on the internet. In an article published at nextgov.com, CIO Roger Baker said: I’ve told my folks I don’t want to say ‘no’ to those devices anymore…I want to know how I say yes. The key, according to Baker, is security. While the iPad can be secured, proper protocols need to be developed. Otherwise, the device can be likened to a “huge unencrypted... Better Health blogs http://www.medworm.com/rss/comments.php?id=4911484 Tue, 07 Jun 2011 18:00:16 +0100 4911484 http://www.medworm.com/index.php?rid=4902420&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fphysician-professional-associations-are-not-ivory-tower-elites%2F2011.06.06 “We can destroy ourselves by cynicism and disillusionment, just as effectively as by bombs.” This observation, from the late, great British historian Kenneth Clark, could be a warning sign to the medical profession. Some of the more incendiary commentary in blogs, editorials, and medical publications today display the classic characteristics of cynicism, which is a profound pessimism accompanied by a deep distrust and even the disparagement of the motivations of others. Physician cynics not only direct their anger at the usual suspects – members of Congress, insurance companies, and government “bureaucrats”—but even at their own colleagues, including the leadership of their own professional societies. Now, to be clear, I am not talking about principled disagreement and deba... Better Health blogs http://www.medworm.com/rss/comments.php?id=4902420 Mon, 06 Jun 2011 11:00:00 +0100 4902420 http://www.medworm.com/index.php?rid=4893450&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fnew-york-state-wants-to-dictate-what-doctors-can-wear%2F2011.06.03 From AMA Medical News: New York physicians may have to take off their neckties, jewelry, wristwatches and long-sleeved white coats when caring for patients if a bill under consideration in the state legislature becomes law. The bill, proposed in April in the state Senate, calls for a “hygienic dress code council” within the New York Health Dept. to consider advancing a ban on neckties and requiring physicians and other health professionals to adopt a “bare below the elbow” dress code in an effort to slash hospital-acquired infections. Even though there’s no data that this does anything to reduce hospital acquired infections. But that doesn’t matter. So why stop there? I say, doctors should do the ultimate for their patients: the Full Monty. *Th... Better Health blogs http://www.medworm.com/rss/comments.php?id=4893450 Fri, 03 Jun 2011 18:00:00 +0100 4893450 http://www.medworm.com/index.php?rid=4872030&cid=t_99857_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2011%2F05%2Fmedical-societies-paid-to-do-corporate.html BackgroundLast year we posted about how two medical societies which received funding from a drug manufacturer tried to persuade the US Food and Drug Administration (FDA) to deny approval of a generic competitor to one of that company's products.  The medical societies were the Society of Hospital Medicine (SHM) and the North American Thrombosis Forum (NATF).  The company was Sanofi-Aventis and the product involved was its anti-coagulant derivative of heparin, Lovenox.  At the time, we noted that the SHM CEO denied the need to specifically disclose funding from Sanofi-Aventis in the letter to the FDA, since he asserted the letter was about "providing the best, most effective care to the hospitalized patient." If so, I wondered why the SHM ha... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=4872030 Fri, 27 May 2011 18:37:00 +0100 4872030 http://www.medworm.com/index.php?rid=4872093&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Ffrom-the-cdc-top-ten-greatest-public-health-achievements%2F2011.05.27 The Center for Disease Control published the top ten public health achievements from 2001-2010, the first decade of the 21st century.  In no order they are: Vaccine-preventable Diseases – new vaccines for herpes zoster, pneumonia, HPV and rotavirus have saved thousands of lives  When you add in the older vaccines for diptheria, pertussus, tetanus and measles/mumps millions of lives have been saved around the world.  (I saw diptheria in Haiti and it is horrible) Tobacco Control- We have been battling tobacco since 1964 but there is finally progress with more states enacting smoke-free laws and raising cigarette taxes.  By 2010, the FDA banned flavored cigarettes and established restrictions on youth access.  We have a long way to go.  Smoking costs us all about $193 billion... Better Health blogs http://www.medworm.com/rss/comments.php?id=4872093 Fri, 27 May 2011 11:00:00 +0100 4872093 http://www.medworm.com/index.php?rid=4872095&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fkudos-to-the-cdc-for-creative-health-messaging-the-zombie-project%2F2011.05.26 This is good.  I knew the CDC was socially tuned-in but this came as a surprise:  Preparedness 101: Zombie Apocalypse .  It’s every American’s guide to dealing with a zombie attack.  You come thinking zombies but take away principles for emergency preparedness.  Well done, CDC. The real take away for those of us looking under the hood: effective health messaging should be creative and fun.  While we’ll never be able to measure the true effectiveness of this approach in an emergency, expect the post’s massive traffic to convert important links on emergency preparedness.  Hopefully the CDC will release stats on the effectiveness of this campaign. I’d like to write more, but I’m goin’ to make my kit. *This blog post was originally published at 33 Charts* (Source... Better Health blogs http://www.medworm.com/rss/comments.php?id=4872095 Thu, 26 May 2011 19:00:36 +0100 4872095 http://www.medworm.com/index.php?rid=4872255&cid=t_99857_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002105.html The expansion of Medicare to include coverage for prescription drugs was a political masterstroke. In a single move, the GOP won the hearts and votes of seniors. The result was significant - larger Republican majorities in Congress, and re-election for... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4872255 Wed, 25 May 2011 23:00:00 +0100 4872255 http://www.medworm.com/index.php?rid=4862545&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhen-physicians-have-to-say-no-does-patient-satisfaction-suffer%2F2011.05.25 The short answer: No. At least not in the context of a strong physician-patient relationship. Many physicians have legitimate concerns about the prospects of having their salary or level reimbursement linked to patient satisfaction. I would too given the way most health care providers go about measuring and interpreting patient satisfaction data. A major concern of physicians is the issue of patient requests – particularly the impact of unfulfilled (and unreasonable) requests upon patient satisfaction. According to researchers, explicit patient requests for medications, diagnostic tests and specialty referrals occur in between 25% to 40% of primary care visits. This figure is much higher when requests for information are factored in. (more…) *This blog post was originall... Better Health blogs http://www.medworm.com/rss/comments.php?id=4862545 Wed, 25 May 2011 14:00:01 +0100 4862545 http://www.medworm.com/index.php?rid=4862546&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fno-single-intervention-can-cure-poor-medication-adherence%2F2011.05.25 You are sick with something-or-other and your doctor writes you a prescription for a medication.  She briefly tells you what it’s for and how to take it.  You go to the pharmacy, pick up the medication, go home and follow the instructions, right?  I mean, how hard could it be? Pretty hard, it appears.  Between 20 percent to 80 percent of us – differing by disease and drug – don’t seem to be able to do it. There are, of course, many reasons we aren’t.  Drugs are sometimes too pricey, so we don’t fill the prescription. Or we buy them and then apply our ingenuity to making them last longer by splitting pills and otherwise experimenting with the dosage. Some drugs have to be taken at specific times or under specific conditions, posing little challenge when you are taking only ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4862546 Wed, 25 May 2011 12:00:37 +0100 4862546 http://www.medworm.com/index.php?rid=4862547&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fsupporting-primary-care-has-become-a-partisan-issue%2F2011.05.25 You’d think that ensuring that there will be enough primary care doctors would not become a partisan issue. If you are a Republican congressman from Texas, or a Democratic Senator from California, you’d want your constituents to have access to a primary care doctor, right? Apparently not: in the hyper-polarized and ideological world in which we now live, even modest steps to support primary care have been caught up in the worst kind of partisanship. The Washington Post reported recently that funding for a new expert commission authorized by the Affordable Care Act (ACA), which was to examine barriers to careers in primary care, has been blocked by Republicans: “When the government set out to help 32 million more Americans gain health insurance, Congress and the Obama administration... Better Health blogs http://www.medworm.com/rss/comments.php?id=4862547 Wed, 25 May 2011 10:00:00 +0100 4862547 http://www.medworm.com/index.php?rid=4862548&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhow-to-take-back-control-of-your-google-searches%2F2011.05.24 Eli Pariser talks at TED about how we’re losing the internet to algorithmic gatekeepers at Google, Yahoo, Facebook and even our news sites, which tailor search results to what they think we want to see. Which is why I often start exploring my search results on page 10 instead of page 1. But what if some search results don’t even make it onto my queue? The side by side comparison of two different users’ internet search on the term “Egypt” during the crisis there is a stunning example of how computerized gatekeepers choose for us what we see (and don’t see) when we log on. You can’t have a functioning democracy if citizens don’t have a free flow of information. I encourage you to watch the entire video, and hope the big mahoffs of the internet sitting in the TED audience hea... Better Health blogs http://www.medworm.com/rss/comments.php?id=4862548 Tue, 24 May 2011 21:00:16 +0100 4862548 http://www.medworm.com/index.php?rid=4862550&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Forganized-medicine-is-out-of-touch-with-how-practicing-physicians-feel-about-obamacare%2F2011.05.24 There is a widespread discrepancy between the opinions of organized medical group leaders in the American Medical Association (AMA), the American Academy of Family Physicians (AAFP), the American College of Physicians (ACP), and  practicing physicians.  AMA, AAFP, and ACP are part of organized medicine. These organizations supported the healthcare reform law in 2010 and continue to support the legislation. I believe they have taken this position because they want a seat at the table as implementation of the legislation moves forward. President Obama has not paid attention to them so far and there is little evidence that he will in the future. In March of 2010, Speaker of the House Nancy Pelosi famously said, “We have to pass the [health care] bill so that you can find out what is i... Better Health blogs http://www.medworm.com/rss/comments.php?id=4862550 Tue, 24 May 2011 16:00:17 +0100 4862550 http://www.medworm.com/index.php?rid=4862551&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fpregnant-female-prisoners-must-remain-in-shackles-during-c-section-procedures%2F2011.05.24 “But for the grace of God go I.” My late aunt drilled that value into my six-year old head and it has never left. An article regarding a New York politician recently caught my attention. When New York State enacted a bill to ban the shackling of pregnant prisoners, a New York State Assemblywoman objected. The article goes on to discuss the case of Jeanna M. Graves, who, in 2002 was arrested on a drug charge and began a three year sentence. Graves was pregnant with twins and while in labor, was handcuffed during her entire C. Section. How utterly ridiculous. Before a C. Section begins, a patient is usually given either an epidural or spinal anesthesia. On rare occasions, she is put to sleep with general anesthesia if the baby must be delivered emergently. On all accounts, the patient’... Better Health blogs http://www.medworm.com/rss/comments.php?id=4862551 Tue, 24 May 2011 14:00:54 +0100 4862551 http://www.medworm.com/index.php?rid=4852855&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhy-cloud-computing-can-be-dangerous-in-healthcare%2F2011.05.23 A lot of people are intrigued with using “cloud” applications and storage for personal health data. This week we’re seeing what I think is the final nail in the coffin of “cloud only” for anything important. You gotta have offline backups: two huge cloud vendors – Amazon and now Google – have demonstrated that even they can go down, leaving their users absolutely powerless. Cloud computing (Wikipedia) is hugely attractive to software developers and businesses. As shown in this diagram from Wikipedia, the idea is that you do your computing using storage or tools that are on some computer somewhere out there “in the cloud.” You don’t know or care where, because somebody out there takes care of things. As your business or database grows, “they” take care of it. And it... Better Health blogs http://www.medworm.com/rss/comments.php?id=4852855 Mon, 23 May 2011 18:00:31 +0100 4852855 http://www.medworm.com/index.php?rid=4847955&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fsurgeons-who-refuse-to-treat-obese-women-liability-containment-or-discrimination%2F2011.05.20 In a nation with 93 million obese people, a few ob-gyn doctors in South Florida now refuse to see otherwise healthy women solely because they are overweight. Fifteen obstetrics-gynecology practices out of 105 polled by the Sun Sentinel said they have set weight cut-offs for new patients starting at 200 pounds or based on measures of obesity — and turn down women who are heavier. Some of the doctors said the main reason was their exam tables or other equipment can’t handle people over a certain weight. But at least six said they were trying to avoid obese patients because they have a higher risk of complications. Source: visiontoamerica.org/719/report-doctors-refusing-to-treat-overweight-patients/ While I have not specifically “refused to treat” obese patients, I have in a few cas... Better Health blogs http://www.medworm.com/rss/comments.php?id=4847955 Fri, 20 May 2011 22:00:14 +0100 4847955 http://www.medworm.com/index.php?rid=4847957&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhy-racial-disparities-are-alive-and-well-in-healthcare%2F2011.05.20 It was 1999 when the Federal government first acknowledged our nation had a problem with race and health care. That year, Congress tasked the Institute of Medicine to study the matter, and the resulting report was not good. Minorities were in poor health and receiving inferior care, the report said. They were less likely to receive bypass surgery, kidney transplants and dialysis. If they had diabetes, they were more likely to undergo amputations, meaning their disease had been poorly controlled. And there was a lot more where that came from. The IOM report was a call to action. In subsequent years, lawmakers crafted policies and established goals for improvement. Federal and state governments and numerous foundations set aside billions to fund projects. Health services researchers expanded... Better Health blogs http://www.medworm.com/rss/comments.php?id=4847957 Fri, 20 May 2011 16:00:50 +0100 4847957 http://www.medworm.com/index.php?rid=4841479&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fmost-americans-dont-know-what-healthy-eating-means%2F2011.05.19 Only one in 10 respondents to a national survey could estimate how many calories they should consume in a day. Seventy-nine percent make few or no attempts to pay attention to the balance between the calories they consume and expend in a day. These and other piquant findings from the online 2011 Food and Health Survey fielded by the International Food Information Council Foundation (IFIC) struck home last week as I smacked up against my own ignorance about a healthy diet and the difficulty of changing lifelong eating habits. The confluence of my failure to gain weight after cancer treatment and a blood test suggesting pre-diabetes meant that as of last Tuesday, I have been on an eat-specific-types-of-food-every-hour-and-write-it-down regimen.  And despite a lifetime of recommending that p... Better Health blogs http://www.medworm.com/rss/comments.php?id=4841479 Thu, 19 May 2011 12:00:13 +0100 4841479 http://www.medworm.com/index.php?rid=4841725&cid=t_99857_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002102.html For several years, Newt Gingrich was one of the more interesting voices in the health care policy world. He joined obscure policy entities, developed interesting ideas, promoted the use of technology as a BIG part of the solution, wrote a... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4841725 Wed, 18 May 2011 23:00:00 +0100 4841725 http://www.medworm.com/index.php?rid=4841480&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fprogressive-counter-point-the-ipab-could-be-a-good-thing%2F2011.05.18 I shouldn’t do this. It’s madness to try to delve into the minds of conspiracy theorists and try to make sense of their ravings. But I can’t help myself; I’m drawn like a moth to the flame. It never ends well. I only wind up with a horde of trolls in the comments telling me that I’m a glib supercilious idiot and should stick to medicine or go die in a fire or something. Sometimes it’s too hard to stay away. Maybe it was the personal affront I felt in the false imputation of ill motives onto progressives. Maybe it was the gross errors in fact, sitting there ripe for the plucking. I don’t know, but I just can’t resist a rebuttal to Dr Rich at Covert Rationing, who weaves a technocratic cost control body into a paranoid web of fantasy, conclud... Better Health blogs http://www.medworm.com/rss/comments.php?id=4841480 Wed, 18 May 2011 21:00:00 +0100 4841480 http://www.medworm.com/index.php?rid=4841481&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fconservative-viewpoint-the-ipab-is-the-frightening-lynchpin-of-obamacare%2F2011.05.18 In the speech President Obama gave responding to Congressman Ryan’s budget plan (the one in which he lured Ryan to sit in the front row in order to be publicly pilloried), the President did something DrRich did not think he would do before the next election. He openly invoked, and openly embraced, the Independent Payment Advisory Board (IPAB) as the chief mechanism by which Obamacare will control the cost of American healthcare. “IPAB” might be a new term to many Americans, but DrRich pointed his readers to this entity, within a few weeks of the passage of Obamacare, as the lynchpin (and a very scary lynchpin at that) of the whole enterprise. Until President Obama’s recent “outing” of IPAB, however, this new board has been almost entirely ignored by most commentators. Since the... Better Health blogs http://www.medworm.com/rss/comments.php?id=4841481 Wed, 18 May 2011 19:00:30 +0100 4841481 http://www.medworm.com/index.php?rid=4828879&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fall-attempts-to-reduce-bureaucracy-in-the-healthcare-system-will-increase-it%2F2011.05.17 “The media is the message.” It does not matter if the policy has failed previously.  All that is important is the effectiveness of the policy’s presentation and its ability to manipulate the polls. The government’s purpose is to work for the people who elected it. It does not seem to be working that way at present. Bureaucrats create rules or regulations as they interpret the laws made by congress and the president. Regulations are controlled by the administration’s ideology. Many times the regulations in one area nullify the intended effect in another area. Regulations and bureaucracy inhibit the use of common sense in policy making for the benefit of the people. The people did not have an outlet to express their opinions or frustrations until blogging came into its own seven y... Better Health blogs http://www.medworm.com/rss/comments.php?id=4828879 Tue, 17 May 2011 12:29:19 +0100 4828879 http://www.medworm.com/index.php?rid=4828884&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fcreative-semantics-used-by-health-insurance-companies-to-avoid-payments%2F2011.05.16 Insurance companies are supposed to pay for health care, although they do everything they can think of to avoid doing so. One company in particular (a small player here though a much bigger gorilla in other markets) does so by playing with words, even when another behemoth lost a lawsuit over the same issue. The topic involves paying for preventive services while a patient is in the office for care of an acute illness or management of a chronic condition. The way we communicate with insurance companies about what we do in the office is by way of codes; CPT codes, to be precise. There are separate codes to differentiate between preventive services and the so-called Evaluation and Management (E/M) services. The latter are your basic office visit codes covering all the “cognitive” service... Better Health blogs http://www.medworm.com/rss/comments.php?id=4828884 Mon, 16 May 2011 16:00:32 +0100 4828884 http://www.medworm.com/index.php?rid=4828886&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fcutting-healthcare-costs-in-spain-evidence-based-disinvestment%2F2011.05.16 In an economic downturn, two classic cost-reducing solutions come to mind in the healthcare services industry: reduce offerings (give fewer services)  or control demand (limit access to healthcare or increase copayments). There are many more but these two are the most frequently used. Actually, budget cuts in the Spanish region of Catalonia fit in the first type: they will need fewer resources (both human and material) because their services offered will shrink. It’s always controversial to cut healthcare services in Spain. Even talking about it leads to accusations of promoting total privatization, attacking the Welfare State and so on. But there is another way to cut services, drugs or technologies. It’s what Dr. Iñaki Gutierrez-Ibarluzea called ‘Evidenced-based disinvestment’ ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4828886 Mon, 16 May 2011 11:00:10 +0100 4828886 http://www.medworm.com/index.php?rid=4829077&cid=t_99857_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002099.html There's been a good deal of complaining about the future costs of health care under reform, some of it justified, some not. In particular, the release of the Medicare Trustee's report last week noted that the date when Medicare intake... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4829077 Sun, 15 May 2011 23:00:00 +0100 4829077 http://www.medworm.com/index.php?rid=4828888&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhealth-insurance-coverage-and-leaving-the-hospital-against-medical-advice%2F2011.05.15 There is a huge myth being unknowingly  perpetrated against the general public when it comes to their rights and responsibilities as a patient.  It’s a myth that I can remember hearing as far back as my first few weeks of clinicals during medical school.  It was a constant presence during my residency training and even now, as a private practice hospitalist I hear misinformation being handed down day after day, month after month. This myth is perpetrated by doctors, nurses, and therapists of all kinds.  What is this myth?  That their health insurance company will not pay for the care provided if they want to leave against the medical advice of their physician. Will my insurance company pay if I leave against medical advice (AMA)? Yes.  They will pay.  Medicare and Medicaid pa... Better Health blogs http://www.medworm.com/rss/comments.php?id=4828888 Sun, 15 May 2011 19:00:00 +0100 4828888 http://www.medworm.com/index.php?rid=4820955&cid=t_99857_113_f&fid=35744&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fe-CareManagement%2F%7E3%2F5iLWq8bfPRM%2F It’s time to call it — the Medicare Shared Savings (SS) ACO is dead-in-the-water. Ironically — at the same time — commercial payers are awakening to ACO opportunities. Please read further. (more…) Article Series - Accountable Care Organizations: Cure-du-Jour or Real Collaborative Care?The Big Idea in Understanding “Accountable Care Organizations”The Achilles Heel of ACOs? Shared Savings Payment Model Unlikely to Motivate HospitalsA Dark Horse in ACO Formation: Large Physician Groups“Does This ACO Thing Really Mean We Need to be ‘Accountable’”Will ACO IT Models Be Walled Gardens or Open Platforms?10 Reasons Why an Open IT Platform Strategy is the Right Long-Term Choice for an ACOIs Economic Credentialing A Tool for Primary Care to Lead... e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=4820955 Fri, 13 May 2011 23:12:43 +0100 4820955 http://www.medworm.com/index.php?rid=4820853&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Ftips-for-physicians-on-handling-their-online-persona%2F2011.05.13 Like everybody else, physicians are expanding their online personal identities. At the same time, they are trying to comply with codes of conduct that help consumers trust them and their profession. There’s no problem so long as the personal online activities of physicians don’t jeopardize their obligations as professionals, which means that there is a problem, unfortunately. In a recent study for example, 17% of all blogs authored by health professionals were found to include personally identifiable information about patients. Scores of physicians have been reprimanded for posting similar information on Twitter and Facebook, posting lewd pictures of themselves online, tweeting about late night escapades which ended hours before they performed surgery, and other unsavory behaviors. A... Better Health blogs http://www.medworm.com/rss/comments.php?id=4820853 Fri, 13 May 2011 12:00:59 +0100 4820853 http://www.medworm.com/index.php?rid=4820857&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhy-industry-largesse-is-a-necessary-part-of-good-healthcare%2F2011.05.12 Largesse: (Form thefreedictionary.com): 1. a. Liberality in bestowing gifts, especially in a lofty or condescending manner. b. Money or gifts bestowed. 2. Generosity of spirit or attitude. Two days into last week’s Heart Rhythm Society meeting, Propublica, an independent online investigative journalism-in-the-public-interest endeavor published a series of high profile articles as part of their Dollars for Docs series. Their marquee piece, published prominently in the USA Today, chronicled the strong financial ties (the ‘largesse’) that bind medical societies to industry. Reporters Charlie Ornstein and Tracy Weber highlighted the meeting’s ‘mansion’-sized exhibits, intense advertising, and the fact that most of the opinion leaders, officers of medical societies and guideline wri... Better Health blogs http://www.medworm.com/rss/comments.php?id=4820857 Thu, 12 May 2011 15:30:02 +0100 4820857 http://www.medworm.com/index.php?rid=4813410&cid=t_99857_113_f&fid=35744&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fe-CareManagement%2F%7E3%2Fs9XNXeZXdbs%2F Major U.S. health insurers, including Aetna Inc., Humana Inc. and WellPoint Inc., are retooling to become more than just health plans, in the wake of the federal health-care overhaul that is changing the rules for the industry’s core business. Diversification plans, touted in meetings with investors this year, include stepped up acquisitions and partnerships that will allow the companies to employ doctors directly, deliver health-information technologies, and participate in new hospital-doctor groups known as accountable-care organizations. Wall Street Journal; May 12, 2011 Does this make sense? Absolutely! (more…) No tag for this post. (Source: e-CareManagement) e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=4813410 Thu, 12 May 2011 04:14:23 +0100 4813410 http://www.medworm.com/index.php?rid=4820996&cid=t_99857_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002096.html Actuarial consulting firm Milliman reported recently that the average American family's health insurance costs are now over nineteen thousand dollars. Costs have more than doubled in the last ten years. And families are paying over $8000 towards the cost of... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4820996 Wed, 11 May 2011 23:00:00 +0100 4820996 http://www.medworm.com/index.php?rid=4813286&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhy-accountable-care-organizations-acos-will-fail-to-reduce-costs%2F2011.05.11 In an ideal world ACOs should work. There is no evidence that  untested and complex organizational structure of ACOs developed by Dr. Don Berwick (head of CMS) will improve quality of care and reduce costs. ACOs are supposed to provide financial incentives to health care organizations to reduce costs and improve quality. There are too many defects in the ACOs infrastructure to improve the financial and medical outcomes. At a conceptual level, the incentive for ACOs would be to increase efficiency and avoid overuse and duplication of services, resources, and facilities. In this model, ACO members would share the savings resulting from the increased coordination of care. I have said over and over again that excessive administrative fees and ineffective management of chronic disease is the m... Better Health blogs http://www.medworm.com/rss/comments.php?id=4813286 Wed, 11 May 2011 18:00:41 +0100 4813286 http://www.medworm.com/index.php?rid=4813280&cid=t_99857_87_f&fid=38368&url=http%3A%2F%2Fwww.allhealth.org%2Fhealth-issues-sourcebook2011%2Fcovering-health-issues-2011.pdf The completely updated 200-page Alliance sourcebook, “Covering Health Issues, 6th Edition,” is now available. Written with reporters in mind, “Covering Health Issues” is useful for anyone looking for concise information on health policy issues, and experts from across the political spectrum. Chapters contain fast facts, background, tips for reporters, story ideas and experts with contact information. The book also includes an extensive glossary, ideas and examples for TV and radio reporters, and links to polls on health issues. Supported by a grant from the Robert Wood Johnson Foundation. To see a video demonstration of the book by Julie Rovner of NPR, click here. To see individual chapters, click on any of the chapter titles below. To download the entire sourcebo... Disruptive Women in Health Care blogs http://www.medworm.com/rss/comments.php?id=4813280 Wed, 11 May 2011 13:00:06 +0100 4813280 http://www.medworm.com/index.php?rid=4813231&cid=t_99857_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2011%2F05%2F10%2Fstrengthen-restrictions-on-health-threatening-chemicals-says-study%2F With growing evidence of the link between exposure to toxic chemicals and chronic diseases, especially in children, the United States needs to step up its efforts to protect the public from hazardous chemicals, say researchers writing in the May issue of Health Affairs. The Environmental Protection Agency (EPA), stymied by the outdated Toxic Substances Control [...] (Source: Health Affairs Blog) Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=4813231 Tue, 10 May 2011 15:16:51 +0100 4813231 http://www.medworm.com/index.php?rid=4803141&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdo-most-hospitals-have-similar-performance-scores%2F2011.05.09 Quality measures. Patient satisfaction surveys. With our new health care reform law, these “performance measures” are the new black in health care. Hospitals are currently spending, conservatively, tens of millions of dollars to bolster these “performance measures” in hopes of securing a refund of a mere 1% of payments that CMS will soon withhold from them in the name of “assuring” quality improvement. But what if, nationwide, there wasn’t a big difference in these measures between hospitals? What happens then? Might payments then be made on political grounds? Performance measures have been collected for some time now in anticipation of this new payment initiative by the government, so data exist to evaluate. In fact, Kaiser Health News was nice en... Better Health blogs http://www.medworm.com/rss/comments.php?id=4803141 Mon, 09 May 2011 13:00:00 +0100 4803141 http://www.medworm.com/index.php?rid=4794858&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-nra-wants-to-prevent-physicians-from-asking-their-patients-about-guns%2F2011.05.06 Should the government be able to dictate to a doctor what he or she is allowed to discuss with a patient? Yes, says the National Rifle Association (NRA), which is pushing state legislation to prohibit physicians from asking patients about firearms in their homes. An NRA-supported bill in Florida originally would have made it a criminal offense—punishable by fines and/or jail—if physicians asked a patient about firearms. The Florida Medical Association (FMA) fiercely opposed the bill as an intrusion on the physician-patient relationship. Now, a compromise has been reached between the NRA and the FMA that “allow doctors to ask questions about gun ownership, as long as the physician doesn’t ‘harass’ the patient, and doesn’t enter the information into the patient’s record witho... Better Health blogs http://www.medworm.com/rss/comments.php?id=4794858 Fri, 06 May 2011 19:00:00 +0100 4794858 http://www.medworm.com/index.php?rid=4789245&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fnational-strategy-to-reduce-prescription-drug-abuse-is-playing-big-brother-ok-in-an-emergency%2F2011.05.05 The White House released its plan last week entitled “Epidemic: Responding to America’s Prescription Drug Abuse Crisis” [LINK to pdf of this 10-page plan]. Below are some of the elements in this plan that is part of the National Drug Control Strategy (like that has worked so well :-/). The areas of this plan involve education of prescribers and users, monitoring programs, making it easy to dispose of controlled dangerous substances (CDS for short), and enhancing enforcement. The plan establishes thirteen goals for the next five years, and also creates a coordinating body, the Federal Council on Prescription Drug Abuse, to oversee and coordinate it all. If any of our readers have comments on specific items (I’ve numbered them for ease of reference), including uninte... Better Health blogs http://www.medworm.com/rss/comments.php?id=4789245 Thu, 05 May 2011 21:00:00 +0100 4789245 http://www.medworm.com/index.php?rid=4789247&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fspanish-physicians-take-heed-social-media-influences-healthcare-decision-making%2F2011.05.05 The Spanish Twitter chapter of #hcsmeu (hashtag #hcsmeuES) held its first unconference on April 1st in Barcelona. For many it sounds like a convention of freakish fans of some cult science-fiction TV show (a group I’m also part of, by the way). But its actually a group of about 200 healthcare professionals from all over Spain who share their interest in social networks and their influence in this particular industry. Many of those present were meeting face to face for the first time but all of them had previously been gathering weekly on Twitter for a one-hour discussion about the relationship between physicians, pharma, patients and ICT, just as other groups across Europe. Nowadays even the most reactionary guy admits that both new technological advances and social networking are changi... Better Health blogs http://www.medworm.com/rss/comments.php?id=4789247 Thu, 05 May 2011 15:00:11 +0100 4789247 http://www.medworm.com/index.php?rid=4780312&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Faccountable-care-organizations-acos-hmos-with-lipstick%2F2011.05.03 Thousands of articles have been written about forming ACOs. Millions of dollars have been spent by hospital systems to try to form an ACO. Healthcare policy consultants have discovered a new cash cow. Hospitals systems are wasting their money. They think the return from owning salaried physicians’ intellectual property will be more than worth the cost. Thousands of physicians have been confused by the concept of ACO. Many have felt ACOs are an attack on their freedom to practice medicine the best they can. Many have rejected the concept because they feel they will have to be salaried by hospital systems. Many physicians do not trust President Obama or Dr. Don Berwick. The Stage 2 ACO regulations are not easy to understand. They are more ominous than the stage 1 regulations. The two cor... Better Health blogs http://www.medworm.com/rss/comments.php?id=4780312 Tue, 03 May 2011 14:00:50 +0100 4780312 http://www.medworm.com/index.php?rid=4775386&cid=t_99857_87_f&fid=38368&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FDisruptiveWomenInHealthCare%2F%7E3%2F0yXsNCDCsz4%2F By Glenna Crooks. Did you see the publication of a study on happiness and suicide made the news lately? It was based on State-level data here in the US and replicates findings from other studies comparing nations in a similar way. The investigators call the phenomenon a ‘dark paradox’ since the highest rates of suicide occurs in States with ‘happier’ people. This holds true even when adjusting for age, gender, race, income, marital status and employment status. The study answers only one question: Is there a relationship between happiness in a State and suicide? The answer is ‘yes.’ The study does not answer the question about why that appears to be true, through the authors speculate that happy people create a context for living in which those who are not happy see their own c... Disruptive Women in Health Care blogs http://www.medworm.com/rss/comments.php?id=4775386 Mon, 02 May 2011 11:42:51 +0100 4775386 http://www.medworm.com/index.php?rid=4775393&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fnew-alzheimer%25e2%2580%2599s-guidelines-emphasize-early-detection-frighten-some%2F2011.05.02 For the first time in 30 years, an expert panel has updated guidelines for the diagnosis of Alzheimer’s disease. The long overdue facelift should favorably impact care for millions and accelerate badly needed research on the disease. The guidelines were produced by representatives from the National Institute on Aging and the Alzheimer’s Association. They portray Alzheimer’s for the first time as a three-stage disease. In addition to ‘Stage 3,’—the full-blown clinical syndrome that had been described in earlier versions of the guidelines—the new guidelines describe an earlier ‘Stage 2,’ of mild cognitive impairment due to Alzheimer’s, and a ‘Stage 1, or preclinical’ phase of the disease. The latter can only be detected with biochemical marker tests and brain scans.Th... Better Health blogs http://www.medworm.com/rss/comments.php?id=4775393 Mon, 02 May 2011 11:00:06 +0100 4775393 http://www.medworm.com/index.php?rid=4775395&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fend-of-life-care-costs-does-your-doctor-know-when-youre-going-to-die%2F2011.05.01 One interesting comment I have seen come up over and over is the idea that end-of-life costs are the thing that is spiralling out of control and that if we could somehow find a way to curb the costs of futile care, then that would somehow solve the health care inflation crisis. Andrew Sullivan endorsed such an idea the other day, a “Modest Proposal,” which is not nearly as radical or amusing as Swift’s. And indeed, there is a modicum of sense in the idea. Estimates are that spending in the last six months of a person’s life account for 30-50% of their overall health care costs, and that the spending in the last year of a person’s life accounts for 25% of overall medicare spending. So — simple solution, right? cut down on the futile care, and we’re ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4775395 Sun, 01 May 2011 18:00:00 +0100 4775395 http://www.medworm.com/index.php?rid=4771226&cid=t_99857_113_f&fid=35744&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fe-CareManagement%2F%7E3%2FHV4Xl_SaRVc%2F Reprinted courtesy of MCOL. Perspectives on a Selected Key Topic |     April 2011/May 2011     |   Volume Three Issue Two Will a material number of hospitals and their core medical staffs, that are relatively independent, evolve into highly integrated delivery systems during this decade, and why? William J DeMarco MA, CMC President and CEO, Pendulum HealthCare Development Corporation The great momentum brought about by government and private payers demand for more accountability is unstoppable. Rapid consolidation of hospitals and consolidation of physicians by physician groups, hospitals and now insurers will shift referral patterns and consumer preference. 1 out of 4 hospitals will fall short of providing value and close or be absorbed within 10 years. Physicians will ... e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=4771226 Sun, 01 May 2011 01:17:30 +0100 4771226 http://www.medworm.com/index.php?rid=4771024&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhat-medical-condition-is-the-most-costly-to-employers%2F2011.04.30 Ok…here’s a brain teaser.  What medical condition is the most costly to employers?  I’ll give you a hint.  It is also a medical condition that is likely to go unrecognized and undiagnosed by primary care physicians. If you guessed depression you are correct. If you mentioned obesity you get a gold star since that comes in right behind depression for both criteria…at least in terms of cost and the undiagnosed part. Four out of every ten people at work or sitting in the doctor’s waiting room suffer from moderate to severe depression.  Prevalence rates for depression are highest among women and older patients with chronic conditions.  Yet despite its high prevalence and costly nature, depression is significantly under-diagnosed (<50%) and under-treated by physicians. For em... Better Health blogs http://www.medworm.com/rss/comments.php?id=4771024 Sat, 30 Apr 2011 19:00:08 +0100 4771024 http://www.medworm.com/index.php?rid=4767993&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fis-national-debt-as-bad-as-paul-ryan-says-it-is-lessons-from-the-past%2F2011.04.30 The last two weeks have made clear that the debate over our national debt will play a major role in the next election cycle. On one side, many Republicans, lead by Representative Ryan, insist that the rate of growth of our national debt – especially the massive projected growth of Medicare and Medicaid – promises to destroy our society within a generation or two; and that the only way to avert that catastrophe is to make substantial structural changes to our entitlement programs. The subtext of their message is: Federal debt is bad, and debt of this magnitude will be fatal. On the other side, most Democrats, led by President Obama, stress that our entitlement programs are promises that simply can’t be changed in any substantial way, insist that such entitlements are “investments in... Better Health blogs http://www.medworm.com/rss/comments.php?id=4767993 Sat, 30 Apr 2011 14:00:10 +0100 4767993 http://www.medworm.com/index.php?rid=4762766&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fshould-pharmaceutical-companies-get-involved-in-social-media%2F2011.04.28 Imagine you’re a pharmaceutical company product manager and your specific product helps people with a chronic illness, or a cancer that can be managed by taking a pill or an injectable medicine over many years. You want to be part of the dialogue patients have with each other. You want to be part of the community. Facebook users, and other social media participants, are increasingly forming groups around health conditions, big and small. You want to be there, because, after all, your company has invested hundreds of millions of dollars developing the approved drug and hopes this medicine, and perhaps a successor, will be on the market for a long time. This is an exciting time on the Internet and pharmaceutical product managers want to be part of health discussions. But it is fraught with... Better Health blogs http://www.medworm.com/rss/comments.php?id=4762766 Thu, 28 Apr 2011 21:00:44 +0100 4762766 http://www.medworm.com/index.php?rid=4762770&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fshould-the-u-s-limit-the-number-of-embryos-transfered%2F2011.04.28 Everyone knows about “Octomom” and her octuplets born after in-vitro fertilization (IVF).  That was an extreme case, but multiple births resulting from unregulated artificial reproductive technologies have skyrocketed over the last decade.  The increased rate of twins, triplets and even higher multiples are due to in-vitro treatments and those women and infants are at much higher risk of pregnancy complications, premature birth and long term health problems. New research,  published in theJournal of Pediatrics, looked at admissions at just one hospital in Montreal, Quebec and found multiple embryo transfers was responsible for a significant proportion of admissions to the neonatal intensive care unit (NICU).  These infants were born severely preterm.  Six babies died and 5... Better Health blogs http://www.medworm.com/rss/comments.php?id=4762770 Thu, 28 Apr 2011 11:00:00 +0100 4762770 http://www.medworm.com/index.php?rid=4758752&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fkilled-by-tpn-a-never-ever-hospital-event%2F2011.04.27 Recently, nine patients died in Alabama when they received intravenous nutrition that was contaminated with deadly bacteria. This type of nutrition is called total parenteral nutrition, or TPN, and is used to nourish patients by vein when their digestive systems are not functioning properly. It is a milestone achievement in medicine and saves and maintains lives every day. What went wrong? How did an instrument of healing become death by lethal injection? What is the lesson that can emerge from this unimaginable horror? This tragedy represents that most feared ‘never event’ that can ever occur – death by friendly fire. No survivors. Contrast this with many other medical ‘never events’ as defined by the Centers for Medicare and Medicaid Services, such as post-operative infections,... Better Health blogs http://www.medworm.com/rss/comments.php?id=4758752 Wed, 27 Apr 2011 22:00:00 +0100 4758752 http://www.medworm.com/index.php?rid=4758756&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fpatients-expect-the-er-to-be-unpleasant-so-why-make-it-better%2F2011.04.27 Our emergency department was very busy recently. The hospital was full and we were holding patients. Three had been in the ER many hours; one waiting for a bed for six hours, another eight hours, and still one more for eleven hours. Of course, ambulance traffic hadn’t stopped and the waiting room was full, with patients waiting too long to be seen. (And we all know that the media loves to highlight bad outcomes from the ER waiting room!) Administration set up a ‘command post’ to try to arrange beds, discharges and moves. At one point I asked one of our administrators to move those waiting the longest to hallway beds up on the patient floors. He told me that he couldn’t because each of the two floors in question already had one patient in the hall. And besides, it would violate the ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4758756 Wed, 27 Apr 2011 11:00:03 +0100 4758756 http://www.medworm.com/index.php?rid=4747612&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhat-do-clinical-guidelines-and-the-us-tax-code-have-in-common%2F2011.04.25 The above graph from the Cato Institute demonstrates the growing complexity of the U.S. tax code over the years. After doing my taxes recently and trying to track the ins and outs of the law for my wife’s private practice, I can attest to the graph’s accuracy. But then I was reading an interesting editorial in Circulation: Arrhythmia and Electrophysiology by N.A. Mark Estes III, MD and Jonathan Weinstock, MD that reviewed an article by Roos, et al in the same journal that found only 27 of 698 guideline recommendations from the European Society of Cardiology (median 1.2% per guideline [IQR 0.95% to 3.7%]) were correctly referenced as Class I or III Level of Evidence A recommendations, calling into question the accuracy of guideline recommendations. In their editorial, Estes and ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4747612 Mon, 25 Apr 2011 15:00:00 +0100 4747612 http://www.medworm.com/index.php?rid=4747616&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Ffalse-positives-and-the-dangers-of-too-much-ct-scanning%2F2011.04.24 On the US News & World report website, Dr. Kenny Lin writes as a physician and a concerned observer about “Dangers of Incidentaloma: Why To Think Twice Before Getting a CT Scan.” It’s an important issue. Give it a look. Lin’s blog, “The Common Sense Family Doctor,” is also worth visiting. Recently he cited one of my alltime favorite essays, “The Last Well Person,” by Dr. Clifton Meador, who wrote in 1994: “The demands of the public for definitive wellness are colliding with the public’s belief in a diagnostic system that can find only disease. A public in dogged pursuit of the unobtainable, combined with clinicians whose tools are powerful enough to find very small lesions, is a setup for diagnostic excess. And false positives... Better Health blogs http://www.medworm.com/rss/comments.php?id=4747616 Sun, 24 Apr 2011 17:00:46 +0100 4747616 http://www.medworm.com/index.php?rid=4742385&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fshould-you-self-insure-against-medical-malpractice%2F2011.04.22 I wrote at some length yesterday about the prerequisites for a medical group to self-insure. What I didn’t go into in detail was the why — the benefits and the risks. I’m going to tackle that a bit today. Potential Benefits to self-insurance Those who have been around a few years can testify that the medical malpractice insurance market is highly cyclic. It seems that about once a decade a crisis hits. Whether this is a rational market is another question entirely. Some have attributed these crises to macroeconomic factors, like the market crash of 2002, after which insurers had to recoup investment losses, or hurricanes and natural disasters in which insurers cost shifted onto other product lines. Other obervers cite skyrocketing medical malpractice losses as the driver... Better Health blogs http://www.medworm.com/rss/comments.php?id=4742385 Fri, 22 Apr 2011 19:00:00 +0100 4742385 http://www.medworm.com/index.php?rid=4742386&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdomestic-violence-has-become-one-of-the-top-public-health-issues-facing-us-women%2F2011.04.22 Domestic violence knows no boundaries: cultural, socio-economic, religious, level of education, gender or age. It can occur in any relationship and to anyone, but especially to women. In fact, roughly 25 percent of women will become a victim at one time or another during her lifetime. Abuse is defined as any act used to gain power and control over another person, which can take on many forms. It can include physical, sexual, emotional, economic, coercion, threats, isolation and/or intimidation. Domestic violence is abuse that occurs within interpersonal relationships and has become one of the top public health issues facing women in the United States. It is a leading cause of injury to women between the ages of 14 and 44 in this country. There are risk factors that may increase the likelih... Better Health blogs http://www.medworm.com/rss/comments.php?id=4742386 Fri, 22 Apr 2011 16:00:00 +0100 4742386 http://www.medworm.com/index.php?rid=4742387&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhow-much-does-it-cost-to-bring-one-drug-to-market%2F2011.04.22 Despite the variety of health systems across hundreds of different countries, one feature is near-universal: We all depend on private industry to commercialize and market drug products. And because drugs are such an integral part of our health care system, that industry is generally heavily regulated. Yet despite this regulation, little is publicly known about drug development costs. But aggregate research and development (R&D) data are available, and the pharmaceutical industry spends billions per year. A huge challenge facing consumers, insurers, and governments worldwide are the acquisition costs of drugs. On this point, the pharmaceutical industry makes a consistent argument: This is a risky business, and it costs a lot to bring a new drug to market. According to PhRMA, the U.S. ph... Better Health blogs http://www.medworm.com/rss/comments.php?id=4742387 Fri, 22 Apr 2011 14:00:37 +0100 4742387 http://www.medworm.com/index.php?rid=4734095&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwill-our-healthcare-system-end-up-looking-like-an-apple-or-android-product%2F2011.04.21 The future direction of American health care is unclear.  Certainly the cost trend as it exists is unsustainable with health care costs being a major concern of the private sector, the government, and individuals.  How does the nation manage costs while ensuring high quality medical care, access, and service?  Proposals include increasing competition among insurers, providers, and hospitals to drive down prices or giving more financial responsibility to patients via higher deductibles and co-pays with the belief that they will demand price transparency, shop around for the best price, and as a result slow health care costs. What if both ideas are wrong? While it is possible these plans might work, I cannot help but notice the similarities in the challenges for patients in navigating the... Better Health blogs http://www.medworm.com/rss/comments.php?id=4734095 Thu, 21 Apr 2011 17:00:00 +0100 4734095 http://www.medworm.com/index.php?rid=4734098&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fchildhood-education-may-be-the-key-to-reducing-healthcare-costs%2F2011.04.21 In a recent op-ed in the San Francisco Examiner, William Dow, a professor of health economics at UC Berkeley, commented on the importance of education as a means of enabling more people to afford health care insurance. In my view, education is important not simply because an educated population can more easily pay for health care. The main importance is that educating children will allow those children and their children to have healthier childhoods, less burden of disease as adults, access to more personal and communal resources to deal with whatever disease they have and less need for health care, and that translates into less health care spending. Let me frame this in terms of the San Francisco Bay Area. In a series of articles in the Contra Costa Times last year, Susanne Bohan and San... Better Health blogs http://www.medworm.com/rss/comments.php?id=4734098 Thu, 21 Apr 2011 11:00:01 +0100 4734098 http://www.medworm.com/index.php?rid=4734099&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhy-accountable-care-organizations-acos-will-not-solve-our-healthcare-cost-crisis%2F2011.04.20 In 2009 President Obama stated that Accountable Care Organizations (ACOs) were going to be pilot programs in real world settings. The goal was to see if they effective in reducing costs and increasing “quality of care.” The results of the pilot programs have not been published. Last week despite the lack of proof of concept HHS and CMS announced new proposed regulations for ACOs. The new delivery and payment model the agency estimates could serve up to 5 million Medicare beneficiaries through participating providers, and also potentially save the Medicare program as much as $960 million over three years. How were these estimates derived? It could be another accounting  trick by President Obama’s administration. The idea of coordinating care and developing systems of care is a great... Better Health blogs http://www.medworm.com/rss/comments.php?id=4734099 Thu, 21 Apr 2011 01:00:07 +0100 4734099 http://www.medworm.com/index.php?rid=4734103&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fare-paul-ryans-medicare-budget-cuts-going-to-harm-the-elderly%2F2011.04.20 For some time now, numerous loved ones and dear friends have been advising and occasionally urging DrRich that, perhaps, it has become a bit inappropriate, and even unseemly, for him to continue in his longtime position as President and sole member of Future Old Farts of America (FOFA). For a not unsubstantial interval DrRich ignored this advice, feigning incipient deafness. But finally, after some focused study of that which these days returns his gaze in the mirror, and reluctantly concluding that maybe his loved ones have a point (and not wishing to seem Cranky), DrRich has reluctantly decided to resign from (and therefore disband) FOFA. DrRich is pleased to announce that he has accepted a new position as President and sole member of Glorious Old Farts of America (GOFA). And it is in th... Better Health blogs http://www.medworm.com/rss/comments.php?id=4734103 Wed, 20 Apr 2011 14:00:32 +0100 4734103 http://www.medworm.com/index.php?rid=4734104&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fis-it-a-crime-to-help-illegal-immigrants-get-healthcare%2F2011.04.20 According to some state legislators, the answer is yes. Lawmakers in South Carolina are pushing legislation that would “make it illegal to transport immigrants anywhere, including a hospital” reports the New York Times. Fox News Phoenix reports that in Arizona, a bill has been introduced to “require hospitals, when admitting nonemergency cases, to confirm that a person seeking care is a U.S. citizen or in the country legally. In emergency cases where the patient isn’t here legally, the hospital would be required to call immigration authorities after the treatment is done. Hospitals in non-emergency situations would also be required to contact federal immigration authorities, but they would have more apparent discretion about whether to treat illegal immigrants.” Such ill-advi... Better Health blogs http://www.medworm.com/rss/comments.php?id=4734104 Wed, 20 Apr 2011 11:00:00 +0100 4734104 http://www.medworm.com/index.php?rid=4724042&cid=t_99857_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002081.html Last week we saw two starkly different views of how to control future costs of Medicare. President Obama is seeking to use the negotiating and regulatory power of government, while Rep Ryan wants to abandon any pretense that government can... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4724042 Sun, 17 Apr 2011 23:00:00 +0100 4724042 http://www.medworm.com/index.php?rid=4723871&cid=t_99857_99_f&fid=35342&url=http%3A%2F%2Fblog.vcu.edu%2Fcbuttery%2F2011%2F04%2Fsteps-to-preserve-privacy-may-compromise-emr-usability.html The Chicago Tribune (4/12) reported that physicians, hospitals, and the "vendors that create the systems" that store EMRs have been "working on preventing breaches and protecting privacy." However, the same safeguards that "keep the world from learning you have a history of mental illness or are at a high risk for uterine cancer might make it harder to deliver critical information about your health" to an emergency department physician. Moreover, as with paper records, "both federal law and institutional policies impose stiff penalties for spying." In clinical care, EMRs can "create a conflict between hassle and security," meaning a physician "might have to enter several commands when consulting on a case by smartphone or other mobile device." (Source: Dr. Buttery's Public Health BLOG) Dr. Buttery's Public Health BLOG blogs http://www.medworm.com/rss/comments.php?id=4723871 Sun, 17 Apr 2011 22:02:31 +0100 4723871 http://www.medworm.com/index.php?rid=4719895&cid=t_99857_87_f&fid=38368&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FDisruptiveWomenInHealthCare%2F%7E3%2FxoVcIRBN-tE%2F By Robin Strongin. When I think of the actress Catherine Zeta-Jones, my mind immediately goes to Velma Kelly, the role she played in the movie Chicago.  Brash, self-assured, confident in using both her sensuality and a tommy gun as effective weapons, Zeta-Jones owned that character and was the silver screen epitome of a powerful woman. But now we’ve learned that the woman playing Velma Kelly and other memorable roles is, in actuality, a very vulnerable individual facing significant challenges in her life.  Her publicist announced on Wednesday that Zeta-Jones had checked herself into a mental health clinic for treatment of a bipolar disorder. Juxtaposed this week with the actress’s revelation was a study released by the U.S. Centers for Disease Control and Prevention pointing out that... Disruptive Women in Health Care blogs http://www.medworm.com/rss/comments.php?id=4719895 Fri, 15 Apr 2011 14:09:17 +0100 4719895 http://www.medworm.com/index.php?rid=4714741&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhow-a-patient-who-asks-for-salt-for-his-eggs-could-cost-a-hospital-2-5-million%2F2011.04.14 This was a classic moment of comical clarity that only comes along once a week.  As you may or may not know, starting in 2013, The Medicare National Bank has promised to take back 1% of all  of a hospital’s total Medicare revenue (to increase in future years) if the hospital has a higher 30 day readmission rate for  congestive heart failure, acute myocardial infarction or pneumonia than an as yet undefined acceptable 30 day rate of readmission. What does this mean?  It means if the government decides that 20% is an acceptable rate for congestive heart failure 30 day readmission, and the hospital has a readmission rate of 25%, the hospital will be told to return 1% of all Medicare revenue for the year, not just their heart failure revenue. Let’s use some hypothetical numbers... Better Health blogs http://www.medworm.com/rss/comments.php?id=4714741 Thu, 14 Apr 2011 21:00:00 +0100 4714741 http://www.medworm.com/index.php?rid=4714693&cid=t_99857_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2011%2F04%2Fthird-rail-that-no-one-wishes-to.html DiscussionWhile the data from this case-study were limited, they do suggest that major private foundations that support global health, and by extension, health care, services, and policy research may have institutional conflicts of interest, and their leaders may have personal conflicts of interest. It is possible that these conflicts have steered global health policy to favor vested interests, particularly towards approaches that depend on drugs and devices, perhaps instead of more effective ones using less technology.Furthermore, it is possible that that these conflicts of interest have helped create the anechoic effect.  Conflicts of interest could have pushed the foundations in directions that favored specific vested interests, and away from... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=4714693 Thu, 14 Apr 2011 20:11:00 +0100 4714693 http://www.medworm.com/index.php?rid=4714746&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdo-it-yourself-health-care-a-new-form-of-outsourcing%2F2011.04.14 The outsourcing of work by businesses to the cheapest available workers has received a lot of attention in recent years.  It has largely escaped notice, however, that the new labor force isn’t necessarily located in Southeast Asia, but is often found here at home and is virtually free.  It is us, using our laptops and smart phones to perform more and more functions once carried out by knowledgeable salespeople and service reps. This was particularly salient to me this week: I spent an hour online browsing, comparing prices, reading customer reviews and filling out the required billing and shipping information to get a great deal on a new lamp.  An airline would charge me 99 cents to talk to a person but provides information for free online.  Calls to Amtrak to make train reservations... Better Health blogs http://www.medworm.com/rss/comments.php?id=4714746 Thu, 14 Apr 2011 12:00:54 +0100 4714746 http://www.medworm.com/index.php?rid=4709203&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fphysicians-wary-of-healthcare-reform-models-intended-to-save-primary-care%2F2011.04.13 When I talk to internal medicine audiences around the country about the latest health policy flavor of the day – accountable care organizations (ACOs) – a typical reaction is skepticism trending toward cynicism. Many don’t quite get what ACOs are all about and certainly don’t want to be lectured about how they need to re-invent their practices. And they don’t buy the idea that ACOs will somehow save internal medicine primary care. The same can be said, perhaps to a lesser extent, about their reactions to PCMHs (Patient-Centered Medical Homes), P4P ( pay-for-performance), HIT (health information technology), MU (meaningful use), and the whole alphabet soup of other reforms being proposed to reform health care delivery and payment systems. And who can blame them? Older inte... Better Health blogs http://www.medworm.com/rss/comments.php?id=4709203 Wed, 13 Apr 2011 23:00:00 +0100 4709203 http://www.medworm.com/index.php?rid=4704659&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fphysicians-and-hospitals-protect-their-turf-with-patient-safety-arguments%2F2011.04.12 Prototype ‘BS’ meter. So many folks express views that are obviously self-serving, but they try to masquerade them as altruistic positions that benefit some other constituency. These attempts usually fool no one, but yet these performances are common and ongoing. They are potent fertilizer for cynicism. Teachers’ unions have been performing for us for decades. Their positions on charter schools, school vouchers, merit pay and the tenure system are clear examples of professional advocacy to protect teachers’ jobs and benefits; yet the stated reasons are to protect our kids. Yeah, right. While our kids are not receiving a top flight education, the public has gotten smart in a hurry on what’s really needed to reform our public educational system. This is why these unions are... Better Health blogs http://www.medworm.com/rss/comments.php?id=4704659 Tue, 12 Apr 2011 12:00:00 +0100 4704659 http://www.medworm.com/index.php?rid=4696617&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fin-brief-new-accountable-care-organization-aco-regulations%2F2011.04.11 ACO regulations and related federal issuances hit the street last Thursday, after several months of waiting — from CMS, OIG, FTC, DOJ and IRS.  They cover the waterfront, ranging from the central regulation defining the structure and workings of the ACO, to  limited Stark self-referral ban and anti-kickback statute waivers in the fraud and abuse arena, to new frameworks for antitrust analysis, to rules governing joint ventures involving taxable and tax-exempt organizations. I had the opportunity to discuss the regs the day after they were issued on a special edition of the Blog Talk Radio show, ACO Watch, hosted by Gregg Masters (@2healthguru).  Gregg’s guests included Mark Browne (@consultdoc), Vince Kuraitis (@VinceKuraitis), Jaan Sidorov (@DisMgtCareBlog) and yours truly ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4696617 Mon, 11 Apr 2011 12:00:09 +0100 4696617 http://www.medworm.com/index.php?rid=4696618&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fare-electronic-medical-records-a-27-billion-waste-of-money%2F2011.04.10 President Obama’s has created an incentive program to encourage physicians to adopt functional Electronic Medical Records.  The program’s $27 billion dollars (funded by President Obama’s Economic Stimulus package) will turn out to be a colossal failure and a waste of money. Twenty seven billion dollars would provide $44,000 for 640,000 physicians. After the bureaucratic infrastructure is built the federal government will be lucky if one third of the money remains for bonuses to physicians. Only 21,000 of 650,000 (3%) of physicians have applied to date. Complex bureaucracies and complicated regulations never save money. These bureaucracies create bigger government, inconsistent policies, more complicated regulations and inefficiencies. The best and cheapest way to create a universall... Better Health blogs http://www.medworm.com/rss/comments.php?id=4696618 Sun, 10 Apr 2011 23:00:40 +0100 4696618 http://www.medworm.com/index.php?rid=4696623&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fbaseball-safety-should-we-ban-non-wood-bats%2F2011.04.10 Opening Day, the first day of the 2011 major league baseball season, was March 31st. The first pitch was thrown a little after 1 p.m., and sometime after that baseball fans heard the first crack of the bat of a brand-new season. Even nonfans can rejoice at this sign of spring, and a promise that summer days are ahead. But you won’t hear the crack of the bat very much these days from other diamonds—Little League, high school, and college. It has been replaced by pings and thunks as most players at those levels now use metal bats or composite ones, which that are made with a mixture of materials, including graphite. Players started using metal (usually aluminum) bats about 30 years ago. They last longer than wooden bats and send the ball farther. The composite models have come on strong ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4696623 Sun, 10 Apr 2011 12:00:17 +0100 4696623 http://www.medworm.com/index.php?rid=4693286&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Ftreatments-for-kids-with-autism-and-cerebral-palsy-on-insurance-chopping-block%2F2011.04.08 One of the great challenges facing the folks who have been tasked to implement the Big O’s health care law is defining “essential benefits,” the core medical services that insurers must cover. Despite its voluminous nature, the law is remarkably vague in this regard. It does identify 10 care categories that health plans must provide to consumers who use federally-funded health insurance exchanges to select a plan, but the categories and associated lists aren’t comprehensive or specific (the categories appear at the end of this post). The Institute of Medicine has been tasked to flesh out the lists of required services. It has begun work amid a frenzy of lobbying by private insurers and consumer groups. Habilitative services are one contentious area, and they illustrate the challe... Better Health blogs http://www.medworm.com/rss/comments.php?id=4693286 Fri, 08 Apr 2011 20:00:28 +0100 4693286 http://www.medworm.com/index.php?rid=4693385&cid=t_99857_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002072.html Rep Paul Ryan's (R WI) Plan to address the deficit relies heavily on private health insurers to solve the seemingly-intractable health care cost inflation problem. Today we'll finish the discussion of his solution for Medicare. Ryan's Medicare plan does include... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4693385 Thu, 07 Apr 2011 23:00:00 +0100 4693385 http://www.medworm.com/index.php?rid=4684315&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fcan-primary-care-physicians-keep-specialists-from-ordering-too-many-tests%2F2011.04.07 There are many tips to saving money on medical costs like asking your doctor only for generic medications, choosing an insurance plan with a high deductible and lower monthly premiums, going to an urgent care or retail clinic rather than the emergency room, and getting prescriptions mailed rather than go to a pharmacy. How about getting your old medical records and having them reviewed by a primary care doctor?  It might save you from having an unnecessary test or procedure performed. Research shows that there is tremendous variability in what doctors do.  Shannon Brownlee’s excellent book, Overtreated – Why Too Much Medicine Is Making Us Sicker and Poorer, provides great background on this as well as work done by the Dr. Jack Wennberg and colleagues on the Dartmouth Atlas. S... Better Health blogs http://www.medworm.com/rss/comments.php?id=4684315 Thu, 07 Apr 2011 17:00:00 +0100 4684315 http://www.medworm.com/index.php?rid=4684317&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-republican-healthcare-plan-the-good-the-bad-and-the-ugly%2F2011.04.07 I am all for any proposal that will improve heath care in America. Improvement means controlling costs, covering all Americans so no one has to worry about going bankrupt to pay for health care. Improvement means access to quality care without having to worry about losing your job, which means losing your coverage. Improvement means a system where all incentives are aligned to prevent disease, rather than using expensive technologies and hospitals to treat disease after the fact. Any proposal that gets us there has my vote. In the GOP “Path to Prosperity” budget for 2012, they propose a few things that are good and a few big things that are bad…really really bad. First the good. Capping the medical malpractice lawsuits for “pain and suffering” would be a huge ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4684317 Thu, 07 Apr 2011 12:00:00 +0100 4684317 http://www.medworm.com/index.php?rid=4684319&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fsurgeons-criticize-medical-tourism-you-cant-sue-if-things-go-awry%2F2011.04.06 In an earlier post, DrRich offered several potential strategies for doctors and patients to consider should healthcare reformers ultimately succeed in their efforts to make it illegal for Americans to seek medical care outside the auspices of Obamacare. To those readers who persist in thinking that DrRich is particularly paranoid in worrying about such a thing, he refers you to his prior work carefully documenting the efforts the Central Authority has already made in limiting the prerogatives of individual Americans within the healthcare system, and reminds you that in any society where social justice is the overriding concern, individual prerogatives such as these must be criminalized. Indeed, whether individuals will retain the right to spend their own money on their own healthcare is ul... Better Health blogs http://www.medworm.com/rss/comments.php?id=4684319 Wed, 06 Apr 2011 20:00:54 +0100 4684319 http://www.medworm.com/index.php?rid=4684320&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhats-fueling-technological-advances-a-free-market%2F2011.04.06 So I have a Droid.  I purchased it in July, not long after taking my old flip-phone for an oceanic bath at Hilton Head, SC.  I waffled for a long time.  In fact, I almost purchased a Casio phone that was marketed as water and impact resistant.  ‘Mil-spec,’ was the phrase used…a phrase which appeals to me as a one-time Air-Guard flight surgeon.  What it meant to me was, ‘you can’t hurt it.’ Still, I was attracted by medical applications and the assorted other cool things a Droid can do.  I mean, my old phone didn’t have a Magic 8 Ball, for crying out loud!  More to the point, my old phone didn’t have Epocrates, or the Emergency Medicine Residents Association Guide to Antibiotic Therapy.  It lacked a flashlight, an mp-3 player, a protractor and a scientific calculator... Better Health blogs http://www.medworm.com/rss/comments.php?id=4684320 Wed, 06 Apr 2011 17:00:17 +0100 4684320 http://www.medworm.com/index.php?rid=4684321&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fshould-elderly-men-be-screened-for-prostate-cancer%2F2011.04.06 A study in the Journal of Clinical Oncology found that “that men in their seventies had prostate cancer screening nearly twice as often as men in their early fifties, who are more likely to benefit from prostate cancer detection and treatment.” An American Society for Clinical Oncology news release includes this quote: “Our findings show a high rate of elderly and sometimes ill men being inappropriately screened for prostate cancer. We’re concerned these screenings may prompt cancer treatment among elderly men who ultimately have a very low likelihood of benefitting the patient and paradoxically can cause more harm than good,” said senior author Scott Eggener, MD, assistant professor of surgery at the University of Chicago. “We were also surprised to fin... Better Health blogs http://www.medworm.com/rss/comments.php?id=4684321 Wed, 06 Apr 2011 14:00:27 +0100 4684321 http://www.medworm.com/index.php?rid=4684541&cid=t_99857_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002071.html Rep Paul Ryan (R WI) has come up with an economic/philosophical/governance plan that puts our problems squarely on the table - unsustainable government spending, driven in large part by health care costs. While that's not exactly new news, it is... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4684541 Tue, 05 Apr 2011 23:00:00 +0100 4684541 http://www.medworm.com/index.php?rid=4670107&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Frules-to-ensure-a-hipaa-compliant-social-media-strategy%2F2011.04.03 Health care social media continues to be a hot-button issue for hospitals and other provider types around the country.  Health care provider organizations considering taking a first step into social media often articulate concerns about regulatory and legal barriers to the use of social media in health care.  As regular readers of HealthBlawg know, I believe that an ounce of prevention is worth a pound of cure — in the health care social media arena as elsewhere.  Careful planning up front will help you avoid the potential liabilities and pitfalls you may otherwise face in implementing a health care social media program.  I invite you to take a look at this quick compendium of rules to live by, which I compiled with Dan Hinmon of Hive Strategies, and follow the link on the last p... Better Health blogs http://www.medworm.com/rss/comments.php?id=4670107 Sun, 03 Apr 2011 12:00:56 +0100 4670107 http://www.medworm.com/index.php?rid=4670198&cid=t_99857_113_f&fid=35744&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fe-CareManagement%2F%7E3%2FFHz_zmBTpS4%2F On March 31, CMS released the long-awaited “Medicare Shared Savings Program: Accountable Care Organizations” document (ACO Rule). Read the details here (strong suggestion: unless you’re looking to get your PhD in ACOs, start with the fact sheets). There are many surprises. Here are eight first impressions on this 429 page tome: The bar has been set high…very high.  Tire kickers need not apply. Don’t expect to see many or any small ACOs. Patients will be confused by ACOs. Concerns over maintaining competition and avoiding antitrust are being taken seriously. CMS scores points for coordinating the ACO Rule across Federal agencies. CMS loses points for micromanagement and a controlling mindset. Possible losers — hospitals, ACO vendors. Possible winners — physicians, health pla... e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=4670198 Sun, 03 Apr 2011 01:19:52 +0100 4670198 http://www.medworm.com/index.php?rid=4670108&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fphysicians-pressured-not-to-order-tests-then-sued-if-they-dont%2F2011.04.02 Cardiologists in Connecticut are standing up to the lack of liability protection in the state’s new low-income health plan called SustiNet: The SustiNet program would create large pools of people, including those who can’t currently afford health insurance, that would theoretically drive down premium costs by competing with the plans of private insurers. Among other cost savings, it would designate a single doctor or practice for each patient, to reduce emergency care use, and create new “best-use” procedures for a variety of ailments to reduce the number of tests doctors order. But a key provision of the plan was that doctors, in return for following the new procedures and ordering fewer tests, would be protected from malpractice suits if the outcome of a case was ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4670108 Sat, 02 Apr 2011 21:00:00 +0100 4670108 http://www.medworm.com/index.php?rid=4670111&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fantibiotics-losing-the-battle-against-drug-resistant-bacteria%2F2011.04.02 The single most important medicine ever discovered is the antibiotic.  Prior to 1930, humans died at early ages of simple infections and even childbirth was a major killer of women because of infection.   The mortality rate from simple staph aureus was as high as 80%,  but between 1944 and 1972 the human life expectancy jumped by 8 years because of antibiotics.   By 1950 the golden age of antibiotics was already looking tarnished as organisms became resistant to the drugs.  Now many medical advances that we take for granted, including cancer treatment, surgery, transplantation and neonatal care are endangered by increasing antibiotic resistance and a decline in new medications to combat the super germs. Drug resistance is both a public health and global security threat. Resistance ha... Better Health blogs http://www.medworm.com/rss/comments.php?id=4670111 Sat, 02 Apr 2011 12:00:00 +0100 4670111 http://www.medworm.com/index.php?rid=4664175&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fcounter-point-happy-birthday-health-reform%2F2011.04.01 Who would have thought when we first looked upon you a year ago, barely formed, still somewhat embryonic, that you would have grown so much in just a year, and created so much, well, trouble? Yes, I’m talking about you, health reform. After all, aren’t you the reason for the sea change in Washington? Aren’t you behind several pending appeals that will get to the Supreme Court? Aren’t you the reason that the country is going to hell in a handbasket? But wait. Let’s look at some other major milestones of the past year. – You sent $250 checks to Medicare beneficiaries to help cover the “donut hole” in their drug coverage. – You created special insurance pools designed to provide health care NOW to people with preexisting conditions who can... Better Health blogs http://www.medworm.com/rss/comments.php?id=4664175 Fri, 01 Apr 2011 14:00:00 +0100 4664175 http://www.medworm.com/index.php?rid=4664176&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fbureaucrats-propose-to-discontinue-home-glucose-monitoring-coverage%2F2011.04.01 The larger the bureaucracy the more inefficient a system becomes. Several things can happen in the decision making process. 1. The decision making process can become opaque rather than transparent. 2. Decisions are made by a committee by consensus. 3. Consensus committee decisions might not sharply define the original goals. 4. Blame for errors gets dissipated. 5. Decisions are only as good as the information that is gathered. 6. Changing a wrong decision can be difficult and costly. President Obama’s healthcare reform law is creating 256 new agencies to gather information and recommend decisions for other agencies to write regulations. The following decision is being made by an agency in Washington state. It is not only the wrong decision, but is a decision that will set back the care o... Better Health blogs http://www.medworm.com/rss/comments.php?id=4664176 Fri, 01 Apr 2011 11:00:24 +0100 4664176 http://www.medworm.com/index.php?rid=4664298&cid=t_99857_113_f&fid=35744&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fe-CareManagement%2F%7E3%2FsjGmiz2m08s%2F On Friday April 1st, 2011 (yes, ‘April Fools day’) at 4 PM Eastern and 1 PM Pacific ACO Watch: A Mid Week Review will host a special roundtable series on the ‘hot of the press’ Notice of Proposed Rules’ pertaining to the implementation of Accountable Care Organizations. For the published rule, click here. The roundtable team will consist of Mark Browne, MD, PYA, aka @consultdoc, Vince Kuraitis, e-Care Management blog, aka @VinceKuraitis, and David Harlow, the Harlow Group, LLC,  aka @healthblawg, with Gregg Masters, aka @2healthguru, as moderator and host. To listen live, or via archived replay, click here. During the broadcast you may also listen in via (619) 393-2836, and even participate in t... e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=4664298 Thu, 31 Mar 2011 23:05:36 +0100 4664298 http://www.medworm.com/index.php?rid=4664299&cid=t_99857_113_f&fid=35744&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fe-CareManagement%2F%7E3%2Fjh9IAmR8VZs%2F 429 p. Proposed ACO Rule ACO Fact sheet from HHS Medicare Fact Sheet: What Providers Need to Know HHS press release Don Berwick’s article on ACOs in the NEJM ACO Quality Performance Standards Summary FTC/DOJ Joint Antitrust Statement on ACOs TheHill article “Leaked memo reveals Dem strategy for defending healthcare reg” The leaked memo No tag for this post. (Source: e-CareManagement) e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=4664299 Thu, 31 Mar 2011 17:32:50 +0100 4664299 http://www.medworm.com/index.php?rid=4664300&cid=t_99857_113_f&fid=35744&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fe-CareManagement%2F%7E3%2FB9uML3xGuUk%2F Let me try to get you in the right frame of mind to read one of the most remarkable white papers in a long time: Better to BEST: Value Driving Elements of the Patient Centered Medical Home and Accountable Care Organizations — released yesterday by the Commonwealth Fund, Dartmouth Institute, and PCPCC. Having been a debater in high school and then trained as a lawyer, my default mode of thinking is to be critical: “Hey, Vince, how ya doin’? Great day isn’t it?” “Well, …err…maybe, maybe not…actually, here’s 14 reasons why not.” My wife and friends kindly tell me that this personal quality can be insufferable, and if you’ve ever met a lawyer you know what I’m talking about. My internal defense mechanism against my inner-critical brain is simply to... e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=4664300 Thu, 31 Mar 2011 14:48:23 +0100 4664300 http://www.medworm.com/index.php?rid=4664181&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fcdc-brain-injury-guidelines-for-physicians-when-to-scan-a-concussion%2F2011.03.31 By Richard C. Hunt, MD, FACEP Centers for Disease Control and Prevention A 17 year-old athlete arrives on the sideline, at your office, or in the emergency department after hitting her head during a collision on the sports field and is complaining that she has a headache and “just doesn’t feel right.” Can she return to play? If not, when can she safely return to school, sports, and to her normal daily activities? Does she need immediate care, a Head CT or MRI, or just some time to rest? Do those questions sound familiar? Each year thousands of young athletes present at emergency departments and in the primary care setting with a suspected sports- and recreation-related concussion. And every day, health care professionals, like us, are challenged with identifying and appropriately man... Better Health blogs http://www.medworm.com/rss/comments.php?id=4664181 Thu, 31 Mar 2011 11:00:04 +0100 4664181 http://www.medworm.com/index.php?rid=4658383&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fcan-patients-commit-medicaid-fraud%2F2011.03.30 We hear so much about health care fraud and how much it costs us all in terms of higher Medicaid, Medicare and private insurance costs, and if we could just rein in this fraud we could make our health care system pay for itself. My trusty Mac widget dictionary defines fraud as: a person or thing intended to deceive others, typically by unjustifiably claiming or being credited with accomplishments or qualities and wrongful or criminal deception intended to result in financial or personal gain. Well, I’m wondering, what is actually considered fraud? Let me give some examples, and help me understand whether or not this is fraudulent behavior. The examples are purely hypothetical and do not represent any known individuals, living or dead, or specific situations in any known emergency de... Better Health blogs http://www.medworm.com/rss/comments.php?id=4658383 Wed, 30 Mar 2011 17:00:19 +0100 4658383 http://www.medworm.com/index.php?rid=4658385&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-salzberg-statement-patients-must-be-involved-in-healthcare-decisions%2F2011.03.30 Last Thursday at the headquarters of the British Medical Journal in London, an important announcement will be made about patients’ rights to be actively involved in decisions about their treatment. Below is the press release about it. The subject is shared decision making, which we’ve been posting about recently (series here; initial post here.) Developed by the participants in a Salzburg Global Seminar last December, the document is called the Salzburg Statement. The pivotal distinction here is the difference between informed consent, in which the physician assesses the options and selects one, and gets your consent to do it; and informed choice, in which clinicians tell you the options, with all the pros and cons, and let you choose, based on your preferences. Click the image to do... Better Health blogs http://www.medworm.com/rss/comments.php?id=4658385 Wed, 30 Mar 2011 11:00:46 +0100 4658385 http://www.medworm.com/index.php?rid=4658436&cid=t_99857_113_f&fid=35744&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fe-CareManagement%2F%7E3%2FoVM7gUfkvy0%2F Health care lobbyists and advocates are bracing for six pages of the health care reform law to explode into more than 1,000 pages of federal regulations when the Department of Health and Human Services releases its long-delayed accountable care organization rules this week. Politico What should you be looking for as you snuggle by the fireplace this weekend reading the draft ACO regs? Rob Lazerow writes a helpful article listing 5 Things to Watch in the Medicare Shared Savings Program Proposed Rule. His list of five key design issues includes: How will patients be assigned to ACOs? To what cost benchmark will ACOs be compared? How will bonuses be calculated and paid? For which quality metrics will ACOs be responsible? What is the application process? I’d like to add a sixth  ite... e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=4658436 Wed, 30 Mar 2011 07:03:33 +0100 4658436 http://www.medworm.com/index.php?rid=4653331&cid=t_99857_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fahrq-healthcare-access-and-racial-disparities-not-improving%2F2011.03.29 According to American Medical News, the U.S. health system is demonstrating better performance on most measures of health care quality, but it’s failing to improve access to care or cut racial and ethnic health disparities, according to two reports released in February by the Agency for Healthcare Research and Quality.  “Quality of care continues to improve, but at a slow rate,” said Ernest Moy, MD, leader of the team at AHRQ that produced the reports.  ”In contrast to that, focusing on issues of access to care, not much has changed.  Focusing on disparities in care, not much changed…Those are bigger problem areas than overall quality of care.”  Measures related to hospital quality are showing the most improvement.  For example, in 2005, just 42% of patients with heart att... Better Health blogs http://www.medworm.com/rss/comments.php?id=4653331 Tue, 29 Mar 2011 20:00:25 +0100 4653331