Friday, November 20, 2009
QD: News Every Day--Santa's take on H1N1 influenza, part II
ACP Internist's daily digest of news and events continues with the contentious issues the senate faces for health care reform and Medicare reimbursement, as well as the pecking order for H1N1 flu prioritization
Health care reform
The Senate will vote Saturday whether to proceed with its bill. The issues are contentious: abortion, affluence and affordability, among others. According to ACP Advocate, the Senate likely won't vote on its bill until December, and even after that happens, the two versions will still need to be reconciled with each other and passed again by both chambers. (New York Times, Los Angeles Times, AP, Christian Science Monitor, ACP Advocate)
The House voted to cancel the pending 21% cut to Medicare reimbursement. Now the issue moves to the Senate, which didn't get that accomplished as a single issue when it came up in October. They'll reconsider it as part of overall health care reform legislation.
In case you missed it ...
As we reported yesterday, organizations representing mall Santas want their members added to the priority list for H1N1 influenza vaccination. Now, hog farmers are saying their proximity to pigs trumps the Santa's contact with children. They first want to protect their herd from humans carrying H1N1 influenza. The Santas respond that they should fall in the pecking order when pigs fly, not reindeer.
Labels: H1N1, health care reform, QD, reimbursement
posted by Ryan DuBosar at
11:48 AM
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Thursday, November 19, 2009
Rethink pink: breast cancer screening evidence met politics and lost
The controversy started at exactly 5 p.m. Monday, when the Annals of Internal Medicine lifted its embargo on new breast cancer screening recommendations and the rest of the medical community simultaneously released opposing positions. With lines drawn and positions taken, a furor began ultimately pitted evidence-based medicine against political machinations. So far, medicine has lost. 
The recommendations, issued by the U.S. Preventive Services Task Force, suggest that asymptomatic individuals with no family history or other risk factors could wait before starting mammograms and undergo screening every two years instead of annually. They balanced the benefits of less frequent screening against the harms of more frequent screening by reviewing the evidence and creating models.
The recommendations have since been on the pages of every newspaper in America, from the smallest locals to the biggest dailies. The American College of Physicians is tracking "impressions," as they're called, in the millions.
There's always a downside to new knowledge, and it's playing out in week following the announcement. It will take time for physicians to digest the new recommendations. It will take time to explain them to patients. In the meantime, public discourse has been messy.
Experts have told women to talk to their doctors about how evidence-based recommendations apply to individual circumstances. But other medical societies are sticking to their guns on annual screenings at earlier ages, and it's unsettling for patients to see doctors disagree and even more unsettling when shouting matches erupt on television.
But neither the government nor insurers are rushing out to make dramatic changes to existing practice of medicine. To calm fears, HHS Secretary Kathleen Sebelius clarified that the doctors who drafted the recommendations, the U.S. Preventive Services Task Force, comprise an independent body of experts who review evidence but don't set policy. To calm fears, she stated that women should still go to their doctors to discuss their individual needs. Insurers aren't going to change their policies, either.
In short, the recommendations inform the talks between doctors and patients. They give physicians something to consider during the informed consent process. Consider the words of family physician David Baron, MD, who said, "I respect [USPSTF] a great deal. They've got no horse in the race. They are independent experts." Take it from practicing physician Jan Gurley, MD, who summarized in plain language how recommendations should impact encounters between physicians and patients.
This is in contrast to internist and TV commentator Elizabeth Lee Vliet, MD, who went on the attack about a "distant and impersonal 'review of data' from published studies." In an op-ed shopped around to media outlets, she further ranted that, "I am profoundly concerned that government 'experts,' far removed from the daily care of patients, are sitting 'on high' to proclaim that women don't need to start mammograms at age 40."
And of course, Dr. Vliet decried it as a cost cutting measure and as the start of "government-mandated, guideline-based rationing of health care." Those are her poorly chosen words. But she's not alone.
U.S. Rep. Marsha Blackburn of Tennessee bemoaned that, "This is where you start getting a bureaucrat between you and your physician." Rep. Michele Bachmann of Minnesota joined the misinformation brigade, starting her press conference on the task force recommendations by blaming President Obama and Speaker of the House Nancy Pelosi. Watch for yourself.
Hijacking evidence-based recommendations to further partisan debate is a semantic trick. And it's a disgrace.
Labels: cancer, evidence-based medicine, guidelines, health care reform, health policy, patient communication, patient education, women's health
posted by Ryan DuBosar at
12:15 PM
2 Comments
QD: News Every Day--Santa's take on H1N1 influenza
ACP Internist's daily digest of news and events continues with the latest progress on health care reform measures in the Senate, and a caution that Santa is looking at who's naughty, nice and vaccinated this year.
Health care reform
After a few quiet days, Senate Majority Leader Harry Reid set up a potential Saturday vote to take the legislation to the Senate floor. According to the Congressional Budget Office:
--the bill would cost $848 billion over the next decade
--the bill would reduce the federal deficit by $127 billion over the first decade and $650 billion over the second decade,
--it would cover more than 94% of Americans, and
--it would reduce the number of uninsured Americans by 31 million.
A wrap-up digests the breaking news from multiple sources. (Washington Post, Kaiser Health News)
In case you missed it ...
The Amalgamated Order of Real Bearded Santas wants its members to be added to the priority list for H1N1 influenza vaccination, both because of their contact with children and their (likely) obesity. Meanwhile, states' attorneys general are investigating why liquid Tamiflu doses range in price from $43 to $130. That will put some retailers on the naughty list for sure. (New York Daily News, ABC News)
Labels: H1N1, health care reform, QD
posted by Ryan DuBosar at
12:01 PM
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Wednesday, November 18, 2009
QD: News Every Day--when evidence and politics collide
ACP Internist's daily digest of news and events continues with health care reform and how it intersects with the primary care shortage.
Health care reform
As far as the poll numbers are concerned, the public wants improvements to the healthcare system. (Who wouldn't want improvement, to anything?) But they don't want to pay for it themselves. (Los Angeles Times)
Primary care shortage
While waiting for the Senate to pick up the health care debate, newspapers' opinion sections are humming with analysis. ACP President Joseph Stubbs, FACP, and former ACP chapter governor for Massachusetts, Allan Goroll, MACP, say that health care reform is essentially a discussion of a primary care shortage. ACP's Tennessee chapter governor, Kenneth Olive, FACP, watches as his chapter's members struggle with the issues of cost, access to care, and inadequate numbers of primary care physicians on a daily basis. Sabitha Vasireddy, ACP Member, agrees. For the patients at her free clinic in Danbury, Pa., health care access is just as important as reform. It can't be worse than Oklahoma, which ranks 50th of the states in terms of active medical doctors per 100,000 population and last in primary care doctors. (The Hill, Kingsport Times-News, Danville News, Oklahoma City Journal Record)
H1N1 influenza
Despite an increase in deaths in Canada, official believe flu season may peak there earlier than predicted; 20% of the population has been vaccinated. (Reuters)
In case you missed it ...
Politicians are using evidence-based medicine as political fodder. Monday's announcement in the Annals of Internal Medicine stated that breast cancer screening recommendations should change. Now, opponents of health care reform are using it as evidence of government interference in health decisions--one slim step away from "death panels" and other easily disproven myths. (ACP Internist, Los Angeles Times)
Labels: health care reform, primary care shortage, QD
posted by Ryan DuBosar at
12:58 PM
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Ghostwriting haunts Congress' hallowed halls
The U.S. Chamber of Commerce and other business groups are shopping around for an economist to study the impact of current health care legislation and then distribute results that health care reform is a job killer, reports the Washington Post. Joining the U.S. Chamber are some other mighty big names, such as the National Association of Manufacturers.
The U.S. Chamber wanted to hire an economist to study the issue, then get other economists to sign onto the results, and then attack health care legislation in an ad campaign. (Oops, they assumed the economist's results would be unfavorable.) Isn't this like a drugmaker drafting a medical study and then shopping around for a doctor to put his or her name on it?
Ghostwriting is a huge problem for the credibility of peer reviewed studies, so why would this be any different? Should we hold economic research to the same standards as other scientific research?
No, because this isn't peer-reviewed. This is politics.
Medical research authors are required to disclose funding for their research. In this case, any economist who might sign onto to the project would have to disclose conflicts of interest with not only the U.S. Chamber, but from the other lobbying groups who contributed to the study (in this case, $5,000 apiece).
Medical researchers are required to report their outcomes, good or bad. But positive publication bias is a known factor in medical research. In the case of the U.S. Chamber, it was questioned whether a positive outcome would be reported. After some hemming and hawing, a spokesman later said it would educate the organization's position.
Any economist who'd sign on with the U.S. Chamber's project would skip the peer review process and enter straight into the hardscrabble world of politics and lobbying. Yes, these lobbyists are entering into the public discourse and trying to influence the outcomes of legislation that impacts every person. But there are different standards for political lobbying groups like the U.S. Chamber than for medical researchers, so it's a bit Pollyanna-ish to expect them to be above board.
Besides, the Chamber's own message boards are clobbering the organization's opposition to health care reform. Check out the responses to a recent Chamber post that chastised the House vote on its legislation. Start here and keep scrolling down as members and small businesses speak their mind.
Labels: conflict-of-interest, health care reform
posted by Ryan DuBosar at
8:00 AM
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Tuesday, November 17, 2009
QD: News Every Day--payment fix inches forward (for this year, anyway)
ACP Internist's daily digest of news and events continues with incremental progress on fixing physician payments, and a double-take on Twitter during surgery.
Health care reform
Health care reform is increasingly unlikely to fix the annual threat of Medicare reimbursement cuts. For this year, at least, the U.S. House is expected to pass its part of the fix on Thursday. (Politico, New York Times)
Instead of a legislative solution, fixing health care will require a profound shift in what patients expect from a doctor's visit. And, the patient-centered medical home has to be at the center of any future health-care system, says one doctor. (WBUR FM of Boston, Indianapolis Star)
There won't be enough doctors to handle the uninsured, said one editorial. But, without health insurance, there are more deaths, said one survey that linked lack of insurance to ED mortality. (Wall Street Journal, AP)
In case you missed it ...
One article questions whether surgeons who broadcast procedures in- step-by-step detail using social media outlets such as Twitter are going too far. When patients do it, too, then maybe it's too much. (Biz Report, ACP Internist)
Labels: health care reform, primary care shortage, QD, social media
posted by Ryan DuBosar at
12:10 PM
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Monday, November 16, 2009
QD: News Every Day--not the intended effect
ACP Internist's daily digest of news and events continues with backlash from an analysis of proposed health care reform legislation, voices from middle American and an ACP Fellow's controversial stance on just how much money is wasted in our current health care system.
Health care reform
Medicare's chief actuary reports that legislation in the U.S. House would raise health care costs by $289 billion over the next 10 years and reduce benefits and access to services. (The Hill, Washington Post)
Meanwhile, 43% of Americans oppose the health care plans underway in Congress, 41% approve, 15% are undecided, the latest poll figures show. But opponents are more strongly against it than supporters are in favor, say numbers provided in a study by Stanford University and the Robert Wood Johnson Foundation. (AP/Washington Post)
Peter Reiter, FACP of Ottumwa, Iowa, describes the need for health care in his community, while Robert Vautrain, ACP Member, of Springfield Il., asks for a public option specifically. (Ottumwa Courier of Iowa, State Journal-Register of Illinois)
H1N1 influenza
Airlines are chafing at CDC recommendations that they filter air for H1N1 influenza even while at the terminals. They say it's costly, but just 20 minutes on the ground is long enough to spread the virus. (CBS 11 of Dallas-Forth Worth)
Primary care shortage
Concierge medicine rankles some in communities already stretched by a lack of primary care providers. Read how the controversy is playing out in Waco, Texas. (Waco Tribune-Herald)
Medical education
To accommodate the arrival of the first baby boomers, the American Geriatrics Society is proposing that elder care be added to the list of medical education's six core areas. (Boston Globe)
In case you missed it ...
Richard A. Cooper, FACP, blasts the vaunted Dartmouth Atlas for its statement that one-third of the nation's health care goes toward wasted expenses. He counters that the analysis is unfair toward urban hospitals, which treat more poor who lack primary care. His critics are just as harsh. But Dr. Cooper is not afraid of taking strong, pro-primary care position. He's taken on concierge medicine (opens as 1-hour video) and The Mayo Clinic. (Kaiser Health News)
Is Medicare fraud getting worse, or are the documentation requirements just becoming more onerous? (Washington Post)
Labels: concierge medicine, geriatrics, H1N1, health care reform, medicare, primary care shortage, QD
posted by Ryan DuBosar at
11:29 AM
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Thursday, November 12, 2009
QD: News Every Day--no holidays for Congress
ACP Internist's daily digest of news and events continues with Congress' newfound work ethic and how the U.S. kept extra chickens on hand to help with H1N1 vaccine preparations.
Health care reform
Following its Veterans Day break this week, Congress may not make it home for any more holidays. The Senate may work right up until Thanksgiving to work on health care reform, said Majority Leader Harry Reid. Representatives in the House will be kept in session until Christmas, says House Majority Leader Steny Hoyer. (Roll Call, The Hill)
Having trouble keeping track of different versions of legislation in both chambers of Congress? This article breaks down the differences between bills in the House and Senate. (St. Petersburg Times of Florida)
H1N1 influenza
Special flocks of chickens were ready and waiting to prepare more eggs for flu vaccines, if needed. Seriously! Margaret Hamburg, FACP, Commissioner of the Food and Drug Administration, revealed this in a letter to America's health care professionals providing information on the safety of the 2009 H1N1 vaccines.
"Some of your patients may be asking how the FDA, the manufacturers and the scientific community can have confidence in vaccines that were available just six months after the 2009 H1N1 virus emerged," Dr. Hamburg wrote. "Understanding more about the manufacturing and approval process for these vaccines should help you to answer their questions." But why wait for the post office? The letter can be viewed at the FDA's Web site.
More than 41 million doses have been delivered for distribution, but layoffs and furloughs among public health workers have further delayed distribution, Anne Schuchat, FACP, told a Senate health subcommittee hearing. (Reuters)
Globally, China's authoritarian measures--quarantining villages or medically isolating entire planeloads of passengers--worked, officials there said. In contrast, the European Union saw its deaths doubled in three of the last four weeks. (New York Times, Washington Post)
Primary care shortage
In Davenport, Iowa local health officials are trying to encourage more doctors into rural practice, but face hurdles from physicians who fear low pay, lack of training and lack of technology at smaller hospitals. But they try to counter with low cost of living, reimbursement for education and a community lifestyle. (KWQC.com)
Labels: H1N1, health care reform, primary care shortage, QD
posted by Ryan DuBosar at
11:48 AM
0 Comments
Wednesday, November 11, 2009
QD: News Every Day--dry, boring health care reform? Think again.
ACP Internist's daily digest of news and events continues with how health care reform issues play out in real life, how the next generation of doctors view primary care careers, and how hospitalists are changing primary care.
Health care reform
Health care reform debates might at times seem esoteric, appealing only to economists and actuaries. For political wonks, the issue is about balancing what's possible vs. what's achievable. But the impact of reform plays out in real life and upon real lives, as profiles in Maine show. There, the need for health care reform has never been more acute. (New York Times, CBS News)
H1N1 influenza
Just in time for Christmas: flu vaccines. Drugmaker Sanofi-Aventis expects to ship 75 million doses to the U.S. market by late December, their CEO told reporters. (Reuters)
If a smartphone made its way onto your holiday gift list, an app in development could diagnose colds and flus by how the user sounds when coughing into it. (Daily Telegraph)
Primary care shortage
An internal medicine resident in San Francisco relates his eyewitness accounts of how a lack of primary care plays out in multiple care settings. A University of Alaska Anchorage student chooses to answer the call. (Los Angeles Times, The Northern Light)
Hospital medicine
Winneshiek Medical Center finished its first year with a hospitalist program. The results:
--$72,000 profit,
--decreased emergency room transfers to other facilities of 15%,
--decreased patient length of stays and an increase in observation stays by 65%,
--steady patient satisfaction of 88%, with better discharge timing,
--happier inpatient nurses, and
--approval from primary care doctors and emergency room staff.
But hospitalists aren't universally appreciated. Marcy Zwelling-Aamot, ACP Member in Los Angeles, calls them a "substitute" brought in when patients most need their existing primary care doctor. Her editorial decries all the barriers that create a wall between patients and doctors. (Decorah Newspapers of Winneshiek County, Iowa, Press-Telegram of Long Beach, Calif.)
In case you missed it ...
Do we need health care reform or health insurance reform? More than health care politics, doctors are fed up with insurance companies--paperwork, arguing on the phone, fights for what patients need. Some say they'd take pay cuts if there was a model that let them practice medical care differently. In Connecticut, internists discuss the issue in terms of health insurance reform, not health care reform. (Philadelphia Inquirer, Greenwich Time)
An Indiana health clinic is letting those who can't afford care pay for treatments by volunteering elsewhere in the community. (NPR)
Labels: H1N1, health care reform, health insurance, hospital medicine, primary care shortage, QD
posted by Ryan DuBosar at
10:28 AM
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Tuesday, November 10, 2009
QD: News Every Day--more time, more patients, more quality
ACP Internist's daily digest of news and events continues with a snapshot of health care reform, as well as a look at an ACP member's findings that doctors are spending more time with more patients, and still providing better care across nine quality measures.
Health care reform
The focus has now shifted to the Democrats for health care reform.
--Some Democrats don't think it slows health spending enough.
--Some Democrats think it pits young constituents against elderly ones.
--It's either pragmatic and flexible or just as good as it gets.
As the debate moves back to the Senate next week, there's five "flash points" to consider. (New York Times, Wall Street Journal, Politico, The Hill, Cristian Science Monitor)
Patient encounter
Doctors are spending more time with their patients--21 minutes in 2005 compared to 18 minutes in 1997, reports Lena Chen, ACP Member. And, primary care visits increased 10%, from about 273 million visits in 1997 to 338 million in 2005. Yet, quality is improving across nine performance measures. The population is aging, which requires more time, but also health care in general is more complex now. And, patients are better informed and more engaged. (U.S. News & World Report)
In case you missed it ...
Medical education is changing to focus on health care reform, the patient-centered medical home and patient communication, and leaving anatomy for later. Genetics, demography and the environment are being included. Students are helping design the curriculum, too. What's going on? (Washington Post)
Kaiser Health News looks back to 1977 for a familiar scenario--politicizing living wills that might lower unneeded or unwanted health care use at the end of life.
Labels: health care reform, living wills, medical education, patient communication, patient-centered medical home, QD
posted by Ryan DuBosar at
11:25 AM
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Monday, November 9, 2009
QD: News Every Day--health reform ready to reconcile
ACP Internist's daily digest of news and events continues with updates from the weekend's passage of health reform in the U.S. House, a global look at H1N1 influenza, and a look at a local hospitals attempt to make a profit by hiring an internist.
Health care reform
Health care passed in the U.S. House over the weekend, and now pressure is on to reconcile it all in the Senate and with the White House. (Kaiser Health News, New York Times, Los Angeles Times)
H1N1 influenza
It hasn't been just H1N1 influenza vaccines in short supply. Hand sanitizers are also evaporating in the face of increased demand. One manufacturer is running its plants around the clock with increased workers, and has asked customers not to stockpile. (CNN)
Globally, an Amazon tribe faces hundreds of infected members and possibly seven deaths from H1N1. Meanwhile, Saudi Arabia's health minister received the H1N1 vaccination on television to calm fears and encourage vaccination among those participating in the Hajj, the once-a-lifetime pilgrimage required of Muslims. (BBC, CNN International)
New Scientist examines H1N1's impact throughout history.
Smoking cessation
America's new "anti-smoking czar" lays out his goals as head of the FDA's new agency, the Center for Tobacco Products: reduce youth smoking rates, reduce tobacco-related disease, and inform the public about tobacco products' ingredients. (Courier-Journal, Louisville, Ky.)
In case you missed it ...
Unicoi County Memorial Hospital in Tennessee was losing money. The hospital's auditor helpfully suggested, "We'd always like to see the hospital have an income." So board members hired an internist and a surgeon to join the staff. Read about their gamble to break even. (The Erwin Record)
Labels: H1N1, health care reform, hospital medicine, QD, smoking cessation
posted by Ryan DuBosar at
12:34 PM
1 Comments
Friday, November 6, 2009
QD: News Every Day--waiting for the weekend
ACP Internist's daily digest of news and events continues with this weekend's expected vote on health care reform, H1N1 influenza's ascendance as the dominant strain, and Texas' look at doctor-owned hospitals.
Health care reform
Everyone is gearing up for the expected weekend vote in the U.S. House on health care reform. ACP President Joseph W. Stubbs, FACP, said while the legislation doesn't have every proposal the organiation wants, it "... would represent an historic step forward to achieving ACP's desired future of a U.S. health care delivery system that provides access, best quality care and health insurance coverage for 100% of its people." The American Medical Association is supporting it, with its president saying in a press release that while the legislation is not perfect, "It goes a long way toward expanding access to high-quality affordable health coverage for all Americans, and it would make the system better for patients and physicians."
While the Congressional Budget Office estimates the legislation will cost $894 billion over 10 years and reduce the national deficit by $30 billion, the actuary for the Centers for Medicare and Medicaid Services said he may not have an estimate ready by the weekend vote. While Congress is bound to budget office estimates, CMS figures may sway some votes. (The Hill)
H1N1 influenza
H1N1 influenza is now the dominant strain globally. Obesity may be a factor for complications. More on this will be reported in ACP InternistWeekly on Tuesday. (CNN, CBS News)
In case you missed it ...
This weekend's New York Times Magazine features the debate about evidence-based medicine--clinical judgment squares off against the scientific method, and what happens when doctors at Intermountain Healthcare create their own evidence base.
In Texas, legislators are debating how to treat doctor-owned hospitals. Texas has 67 physician-owned hospitals with about 50 more expected to open, state Rep. Sam Johnson told the Dallas Morning News. While pending legislation would severely curtail existing facilities and prohibit new ones, amendments may grandfather the existing ones. At is issue is whether these facilities cherry-pick the wealthiest patients.
Labels: evidence-based medicine, H1N1, health care reform, QD
posted by Ryan DuBosar at
10:47 AM
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Thursday, November 5, 2009
QD: News Every Day--health care reform's eerie repeat history
ACP Internist's daily digest of news and events continues with updates on health care reform, "swine" flu in a cat, and two views on fixing the shortage of primary care doctors.
Health care reform
Health care reform is streaking toward a vote in the U.S. House Saturday, but is it just a case of history repeating itself--specifically, the Clintons' 1994 effort? A New England Journal of Medicine paper analyzed 30 public opinion surveys and compared the shift in public opinion, both then and now. (AP, Boston Globe, NEJM)
Waiting in the wings, the Senate's legislation is facing opposition from surgeons and other specialists. (The Hill)
One aspect of health care that needs reform is the practice of defensive medicine. One doctor was profiled about why he encourages patients not to get unneeded tests, and then capitulates if the patients insist. (AP)
Primary care shortage
Op-eds in two major dailies agree that fixing the shortage of primary care doctors is an important component of health care reform. You wouldn't normally expect the Los Angeles Times and Wall Street Journal to agree on anything but the rising cost of newsprint.
H1N1 influenza
Swine flu has jumped from a cat owner to the pet, ABC News reports.
In case you missed it ...
In case the mainstream media misses something, there's always a blogger who digs a little deeper and finds it. Hats off to the person who found this outlier right in the middle of the U.S. House legislation on health care reform--a tax credit for second generation biofuels. (FireDogLake.com)
And, an economist offers "vaguely heretical" musings on the proposed legislations floating around Congress. His social conscience doesn't override his desire to balance the books. (The New Yorker)
Labels: H1N1, health care reform, primary care shortage, QD
posted by Ryan DuBosar at
11:47 AM
0 Comments
Wednesday, November 4, 2009
QD: News Every Day--health care reform's 'sunshine provision'
ACP Internist's daily digest of news and events continues with findings that N95 respirators weren't all they were cracked up to be, and a look at disclosing more about doctors' financial ties with industry.
H1N1 influenza
Authors retracted findings that N95 respirators were better than surgical masks at preventing flu, causing a stir at the Infectious Diseases Society of America meeting, where the retraction was announced. Reviewers questioned the study, and re-analysis resulted in the findings being no longer significant. The original study spurred guidance from the Centers for Disease Control and Prevention and the Institute of Medicine on using the masks.
Blogger Gerald O'Malley, DO, says that he's not getting vaccinated. Hospital administrators are pressuring him, he sees flu patients in emergency wards and his two kids have it. But he's not budging. Neither are college students. (Physicians Practice, The Washington Post)
"Presenteeism" could exacerbate flu's spread, public health leaders said, since 39% of all private-sector workers do not receive paid sick days, (Bureau of Labor Statistics figure). They also send their sick kids to school because they have to work. (New York Times)
Health care reform
Legislation in the U.S. House could get a vote as early as Friday night, But in the senate, Majority Leader Harry Reid isn't making any promises to pass legislation this year, which could frustrate the White House if it delays health care reform until 2010. (The Hill, CBS News, AP)
One aspect of health care reform legislation includes "sunshine provisions" intended to disclose the financial relationships between the medical industry and doctors and hospitals. It's been tried before, though, and bioethicist Bernard Lo, FACP, argues that sunshine provisions don't go far enough. It needs to include other health professionals, and academic research. A survey in Health Affairs found that 53% of academic research faculty in the life sciences at top schools reported financial ties to industry. (New York Times, Wall Street Journal)
Labels: ethics, H1N1, health care reform, QD
posted by Ryan DuBosar at
12:20 PM
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Tuesday, November 3, 2009
QD: News Every Day--health care reform splits urban, rural hospitals
ACP Internist's daily digest of news and events continues with the focus of health care reform shifting toward the U.S. House of Representatives. Also, urban and rural hospitals eye each other for the lion's share of reimbursement.
Health care reform
Legislation released in the House faces opposition from abortion and immigration. The $1.2 trillion price tag over 10 years made many take a second look at what Americans would get for their money. Meanwhile, the deadline for potentially passing legislation is slipping into next year. (AP, Politico)
Rural and urban hospitals would fare differently under health care reform. For example, New York City facilities are worried about losing money to Iowa; Iowa, in turn, is already worried about subsidizing urban areas. (New York Times, WQAD.com)
H1N1 influenza
Pregnant women and children ages 10-17 need only one dose to inoculate against H1N1 influenza. But children ages 6 months to nine years still need two doses for best efficacy. Anne Schuchat, FACP, reports that half of all vaccinations have gone to minors. While the World Health Organization is recommending one dose for all kids and the use of adjuvanted vaccines to stretch supplies, U.S. officials are still recommending two doses. Adjuvanted doses have not been cleared for use in the U.S. Research on them was reported in the Sept. 15 ACP InternistWeekly. (Washington Post, Washington Times, New York Times)
Scientists have used a supercomputer to predict a third wave of H1N1 coming this spring. But others want to use handheld devices to predict which individuals might get sick before they actually do. (Wall Street Journal)
Labels: flu, H1N1, health care reform, hospital medicine, QD
posted by Ryan DuBosar at
1:28 PM
0 Comments
Monday, November 2, 2009
QD: News Every Day--the public option as a Straw Man
ACP Internist's daily digest of news and events catches up with newly appointed Surgeon General Regina Benjamin, MD, fears about adverse reactions to H1N1 vaccinations, and why one ACP member says hope for recovery isn't always the best for a patient.
Surgeon General confirmed
Newly confirmed Surgeon General Regina Benjamin said preventive medicine will be her priority, following her confirmation by a unanimous Senate vote late last week. Month before, during a press conference announcing her nomination, she had spoken about losing relatives to lung cancer, diabetes and other lifestyle-related illnesses. (al.com)
Health care reform
For all the fuss over the public option, the Congressional Budget office estimates that 2% of the nation, 6 million in all, would enroll in it. (AP/The Washington Post)
Barry Izenstein, FACP, Governor of ACP's Massachusetts Chapter, writes that health care reform should cover all Americans, create more primary care doctors and reform medical liability. (The Springfield Republican)
Meanwhile, Peter Boling, ACP Member, is undertaking his own effort at health care reform by falling back on the old-fashioned house call. The House and Senate are considering such measures as part of the "Independence at Home" provision of current legislation. (AP)
H1N1 influenza
Independent experts started today tracking adverse events from the H1N1 vaccine to spot any real problems quickly, explain false alarms and separate normal disease rates from potential yet real risks. (AP/Boston Globe) There's a basis to the fear of H1N1 vaccination, and it's generational, says one psychologist. (Psychology Today)
In case you missed it ...
Sometimes, it's better to lose hope for recovery, University of Michigan researchers said.
Peter Ubel, ACP Member, teamed up on a study that noted while it's important not to lose hope, it's also important to realize that hope might make some people unhappier because they fall into a holding pattern of sorts, waiting for their condition or chronic pain to wane before moving on with their lives. They compared outlook among patients who'd just had colostomies. Some were told the procedure would be reversible, and some were told the procedures were permanent. He explains more about hope's "dark side."
Labels: H1N1, health care reform, patient communication, QD
posted by Ryan DuBosar at
12:12 PM
1 Comments
Thursday, October 29, 2009
QD: News Every Day--public option in da House!
ACP Internist's daily digest of news and events covers how health care reform is being reconciled in Congress, how the primary care shortage impacts local emergency rooms, and how community doctors in Bermuda are reacting to the introduction of hospitalists.
Health care reform
While the Senate stares down a threatened filibuster of legislation that includes a public option, the House introduced its version, which includes it. As the House and Senate reconcile their respective bills into one per each chamber,
Cecil B. Wilson, MACP, who is also the American Medical Association's president-elect, told Floridians at a union-sponsored rally that the majority of Americans, including physicians and AMA members, want reform. (Washington Post, Miami Herald)
Primary care shortage
A column in The Olympian (Olympia, Wash.) points out that the community already has universal health care. Unfortunately, it's the local emergency room. In Palm Beach, Fla., county commissioners are considering whether to build a public hospital for just that purpose. Jose Arrascue, ACP Member, representing the Palm Beach County Medical Society, told commissioners, "We believe the health care delivery system in Palm Beach County is in critical condition. We have escalating numbers of uninsured, diminished access to care, an aging physician population and a lack of specialty care." (Palm Beach Post)
University of Pennsylvania bioethicist Arthur Caplan told an audience in Bakersfield, Calif., that one way to alleviate the primary care shortage is to forgive medical school loans. (Bakersfield.com)
H1N1 influenza
Now, there's an app for that. Harvard Medical School has launched an iPhone application that includes information on the pandemic's spread, practical steps people can take to mitigate their risk of infection, key symptoms to watch for, and what to do in case of infection. The application includes text, video and links to government databases. It also provides information to businesses for managing through the pandemic. People need all the help they can get. Richard Wenzel, MACP, reports that half of all outpatient H1N1 influenza cases don't develop a fever, so the patients don't take precautions. Even among hospitalized patients, 15% don't get a fever. (Minnesota Public Radio)
In case you missed it ...
Family doctors claim that the switch to hospitalists has shut them out of their community hospital ... in Bermuda. The chief of staff at King Edward VII Memorial Hospital feared being hanged in effigy outside his office after general practitioners lost their hospital privileges and communication suffered between community and hospital doctors. But, the chief said outcomes have improved and the move is needed as his facility moves from being a rural provider to a modern metropolitan facility. (Bermuda Sun)
Labels: flu, H1N1, health care reform, hospital medicine, primary care shortage, QD
posted by Ryan DuBosar at
11:46 AM
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Wednesday, October 28, 2009
QD: News Every Day--public option unsettles Senators
ACP Internist's daily digest of news and events wraps up how the public option has shifted the balance of opinion in the Senate, how the public itself has shifted on H1N1 vaccination, and the economic impact of a rural physician.
Health care reform
The introduction of a public option has precariously shifted Senators' support. Democrats are divided. What bi-partisan support there was has evaporated. Liberals are happy, but that won't carry the day. (AP, Los Angeles Times, Boston Globe)
H1N1 influenza
Some hospitals are seeing their emergency department patient volumes double from H1N1 influenza as doctors are being recruited as the flu police, trying to prioritize who gets vaccinated. To ease the crunch, more than 22 million doses of H1N1 flu vaccine are now available now, and health officials are still saying better late than never. (USA Today, New York Times, AP/MSBNC.com)
Data produced by a supercomputer shows that there could be a third wave of the H1N1 virus in the spring. The University of Texas is using
the "Ranger" supercomputer to make its predictions. (KXAN-TV)
Handshaking was out, and now so is the simple fist bump. Here's some humorous ways to greet people. (NPR)
In case you missed it ...
Doctors' economic contributions are as important to rural communities as their medical ones. The National Center for Rural Health Works estimates that a rural hospital loses $236,565 from clinic visits and $451,169 net revenue for every half-a-physician they are short. When extrapolated to include services purchased by the physician, the clinic and employees, the shortage translates to 13.8 jobs and $533,493 in income. (Iowa Independent)
Irving Harper, ACP Member, discusses how he handles his patients with e-mail, cell phone and video chat. Ahhh, but it's good to practice in Hawaii. (U.S. News & World Report).
Labels: H1N1, health care reform, health information technology, QD, telemedicine, vaccination
posted by Ryan DuBosar at
11:32 AM
0 Comments
Tuesday, October 27, 2009
QD: News Every Day--the need for health reform
ACP Internist's daily digest of news and events continues with more on how the need for health care reform plays out across the country, as well as the uneven distribution of H1N1 vaccines.
Health care reform
Sen. Reid's announcement of a public option in Senate legislation follows statements by legislators who said they'd oppose any bill without it. He still doesn't have 60 Senators on board to prevent filibuster. (AP/The Washington Post)
ACP Fellows continue to vent about the need for health care reform. In the latest op-ed, Rod Hochman, FACP, CEO of Swedish Medical Center in Seattle, talks about how the patient-centered medical home plays out in what he calls "the other Washington." (The Seattle Times)
The largest private group practice in Kansas City, Mo. has stopped accepting walk-in Medicare patients. At Kansas City Internal Medicine, 65% of its nearly 70,000 active patients are 65 or older. Keith Jantz, ACP Member, says that it's a harbinger of things to come if Medicare reimbursement is cut by 21%. (CNN) It's a situation that one patient experienced in Grand Junction, Colo. (KJCT8.com )
A Thomson Reuters piles on the blame, finding the health care system wastes between $505 billion and $850 billion every year, about a third of the overall bill. (Reuters)
--antibiotic overuse and lab tests to protect against malpractice are 37% of the wasteful spending, or $200 to $300 billion a year,
--fraud is 22% of waste,
--administrative inefficiency and redundant paperwork are 18%, and
--mistakes are 11%.
H1N1 influenza
Despite shortages and some tales of uneven or nonsensical distribution, the vaccine is worth getting late rather than never, said Health and Human Services Secretary Kathleen Sebelius. (ABC News; Los Angeles Times; GetBetterhealth.com; AP/The Washington Times) Also, USA Today breaks down H1N1 flu incidence by region.
In case you missed it ...
One medical student prefers primary care, despite the financial shortfalls he'll face. His profile is here. (Minneapolis Star Tribune)
Labels: flu, H1N1, health care reform, primary care shortage, QD
posted by Ryan DuBosar at
12:29 PM
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Monday, October 26, 2009
QD: News Every Day--H1N1 'emergency' and vaccine shortage
ACP Internist's daily digest of news and events continues with H1N1 updates, and physicians speaking out about health care reform.
H1N1 influenza
The weekend's health news had one theme: President Obama declared a national emergency, coupled together with pictures of long lines of people waiting for vaccines. Lines formed despite the large numbers of people refusing to get inoculated. (Half of all Canadians!)
Health insurance
Health care reform may have to start at the (medical) home. Eleven percent of health care workers are uninsured. Ambulatory care workers are three times as likely as hospital employees to not have insurance; residential care workers are four times as likely; and service workers are 50% more likely to be uninsured than those involved in treatment. Meanwhile, Blue Cross Blue Shield of Florida, that state's largest insurer, is moving its 5,000 employees to a high-deductible insurance plan linked to health savings accounts.
In case you missed it ...
Internist Randy Silverstine, MD, turned his solo office into a concierge practice but only charges $600 a year, a fraction of what others have charged. He joins the ranks of the 12% of internists who no longer accept health insurance. "This was the only way I knew how to keep practicing the kind of medicine I loved," he told the Sarasota, Fla. Herald-Tribune.
ACP Fellows are sounding off about health care reform. Charles M. Fischman, FACP, spells out how the possibility of a 21% cut in Medicare reimbursement would play out in Florida--with a mass exodus, he predicts. Paul Dolinsky, FACP, says there's plenty of blame to spread around for rising costs.
Labels: flu, H1N1, health care reform, QD
posted by Ryan DuBosar at
12:01 PM
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Friday, October 23, 2009
QD: News Every Day--slow start for H1N1 vaccine
ACP Internist's daily digest of news and events continues with the answer to the age-old question: Which came in first, H1N1 influenza or its egg-based vaccine?
Twenty percent of U.S. children had a flu-like illness earlier in October, and most of them likely H1N1 flu. And 7% of the surveyed adults said they'd had a flu-like illness in the past week, according to a household survey of more than 10,000 adults done in the first 11 days of October. Now, an already slow process of using chicken eggs is now burdened by vaccine-makers trying to make diseases for seasonal and H1N1 strains. Also, the virus on which the swine flu vaccine is based reproduces very slowly in eggs, moreso than seasonal flu.
New York City is seeing fewer cases than expected, but Philadelphia's childrens' hospitals are already hunkering down from ER cases that probably could have been treated at home. Both cities had been suggested to have acquired a "herd immunity" from having been hit so hard in the spring.
Leave it to Moody's to break it down into investment advice. Hospitals usually see some positive cash flow during flu season, but H1N1 could muddle the picture.
And, don't miss the H1N1 robotic simulator.
Health care reform
Senators met with White House officials Thursday evening to discuss how to merge the two health care reform bills in the Senate. Politico reported negotiators are contemplating a national government health plan, but allowing states to opt out. But then it's not a national plan ...
Labels: flu, H1N1, health care reform, QD
posted by Ryan DuBosar at
10:00 AM
0 Comments
Thursday, October 22, 2009
QD: News Every Day--health care reform and H1N1
ACP Internist's daily digest of news and events continues with health care reform, H1N1 influenza and how primary care shortage issues play out regionally.
Health care reform
Halts to the annual cuts to physician reimbursement under Medicare died in the Senate because legislators objected to $247 billion in unfunded costs over the next decade. Enough legislators from both parties objected to an effort to freeze reimbursement for 10 years while Congress found an alternative to the sustainable growth rate formula. ACP President Joseph W. Stubbs, FACP, said, "Although many [legislators] will claim that their vote against cloture was a vote for fiscal responsibility, there is nothing fiscally responsible about pretending that Medicare will save money, from cuts that Congress has no intention to let go into effect, in order to make it seem like Medicare will spend less than it really will."
Meanwhile, some versions of health care reform legislation in the U.S. House would raise the rate of medical spending, not lower it, reports the Office of the Actuary, an independent arm of the Centers for Medicare and Medicaid Services. Spending would increase by 2.1% over 10 years, or $750 billion, because 34 million more people would have health coverage, according to the report. (Wonks can read it here.)
A lesson can be taken from Massachusetts physicians, who support their health care reform laws by a 5-to-1 margin, albeit with some desired changes, reported the Boston Globe. That's slightly higher than in the rest of the public, according to the most recent general poll by Robert Wood Johnson Foundation and Blue Cross Blue Shield of Massachusetts Foundation. Highlights include:
--Two-thirds of doctors say the law has not diminished the quality of care;
--19 percent say it has improved quality;
--62% say the law has not affected the amount of time they spend with their patients; and
--Nearly 80% say the law had no negative impact on their practice overall or had a positive impact.
The original study was published in the New England Journal of Medicine. Health care reform can expand access but not reduce costs, if lessons from Massachusetts teach us anything, reports The Christian Science Monitor.
H1N1 influenza
Production of a vaccine for swine flu virus is behind schedule, said Anne Schuchat, FACP, director of CDC's National Center for Immunization and Respiratory Diseases. Officials expect "widespread availability" by mid-November.
Meanwhile, public radio presents more on "presenteeism" and how a lack of sick days forces some sick workers to show up.
Primary care shortage
ACP's governor of its Connecticut Chapter addresses why so much money is spent on some health care items, such as prescription drugs, medical scans and durable medical equipment, and not on more important areas such as public health education and training medical students. The consequences are dire, as this profile of the Sacramento, Calif. area shows. California has 59 primary-care physicians per 100,000 citizens, whereas 60-80 considered sufficient.
Labels: flu, H1N1, health care reform, primary care shortage, QD
posted by Ryan DuBosar at
12:22 PM
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Wednesday, October 21, 2009
Is the evidence piling up everywhere or just around me?
First, there was the session advising primary care docs to start making money off MRIs. Then, there was a big TIME magazine article about the success of the Geisinger model. Now, today I attended a seminar on coordinated diabetes care, and heard over and over again--from docs and other experts--that the reason doctors don't do more care coordination is because they're not getting paid specifically for it.
One alternative to motivate coordination is to pay for outcomes, but of course, that brings up concerns about gaming the system and general fairness (as Zeke Emanuel put it, the reverse-Lake-Wobegone effect, where everyone thinks their patients are sicker than average).
It's beginning to seem more likely, to me at least, that doctors may have to be provided the same incentives that the rest of us are. Why do I write obits and answer phone calls from PR people instead of just crafting snide blog posts all day? Because it's my job and I'm paid a--here comes the dirty word--salary to do it. I know, the loss of independence and entrepreneurship and all that, but when more and more medical students are deciding that they don't want to get involved in the primary care business, maybe it's time to change the model.
Labels: health care reform, pay-for-performance
posted by Stacey Butterfield at
2:34 PM
1 Comments
QD: News Every Day--SGR cuts stalled
ACP Internist's daily digest of news and events continues with more on SGR cuts, and one physician who reformed health care in Oregon from the inside, as a legislator and later as governor.
SGR cuts
Legislation to permanently fix the annual threat of sustainable growth rate (SGR) cuts to Medicare physician payment formula has stalled. Some legislators balked on voting for it because the $247 billion price tag over 10 years wasn't offset elsewhere. Permanently ending annual SGR cuts were part of a quid pro quo deal between doctor's groups and Senate Majority Leader Harry Reid; eliminate the SGR in exchange for supporting overall health reform. The money would hold reimbursement where it is until Congress can create a better way to reimburse for Medicare.
Since political debate involves a lot of name-calling, one legislator compared the American Medical Association's position to prostitution for its support. The AMA promptly got all dolled up and released 22 "patient access hot spots" nationwide that the organization claims highlights the impact of Medicare cuts. The AMA analyzed state-level data on five access measures and declared hot spots are based on their ranking in the top 15 of at least two of five measures of access:
-- practicing physicians per 1,000 Medicare beneficiaries,
-- Medicare beneficiaries below 150% of the federal poverty level,
-- estimated underserved population living in primary care health professional shortage areas,
-- hospital emergency room visits per 1,000 population, and
-- percentage who hadn't seen a doctor in the past 12 months because of cost.
In case you missed it ...
A physician enacted health care reform in Oregon, first as president of the state's Senate and then as its Governor. The Oregon Health Plan prioritized medical services by value and the number of services covered was determined by how much money the legislature appropriated. It was radical and it worked. Kaiser Health News profiles the physician.
Meanwhile, ACP governors from Nebraska and North Dakota and a member from Green Bay, Wisc. chimed in their support for health care reform.
Labels: health care reform, medicare, QD, reimbursement
posted by Ryan DuBosar at
12:08 PM
1 Comments
Tuesday, October 20, 2009
QD: News Every Day--Senate considers SGR overhaul
ACP Internist's daily digest of news and events continues with the tantalizing prospect of permanently ending the annual SGR cuts, changing public support over health care reform, and Maine's effort to recruit medical students to its rural areas.
SGR cuts
The Senate considers today closing debate and proceeding to vote on a way to permanently end annual SGR cuts. This year, a 21% reduction is on the line, which would prompt primary care doctors to stop seeing Medicare patients. Democrats and Republicans had put off the procedural step, called a cloture vote, to allow time for consensus on the issue instead. ACP reports what doctors can do ahead of this key vote. The separation of SGR cuts from health care reform was done in exchange for physician support for both items.
Health care reform
The Robert Wood Johnson Foundation found that about one-third of Americans worry about losing health care coverage, a slight increase from last month. The number of Americans who worry about losing coverage in the next year has increased by 11% points since the spring. Young adults are the most often concerned (40%), followed by middle-aged (38%) and then seniors (29%) even though they have Medicare.
The Washington Post reports 57% of all Americans now favor some form of a public insurance option while 40% oppose it. More specifically, 45% of Americans favor current outlines in Congress, and 48% are opposed.
H1N1 influenza
H1N1 influenza--"swine flu"--has finally been confirmed in pigs. The agriculture department confirmed that a pig exhibited at the Minnesota State Fair was infected, and that the infection was unrelated to teenagers there who later became sick. But, three other piglets may have become ill after being handled by humans.
In case you missed it ...
Tufts University School of Medicine in Boston and the State of Maine will offer all Maine-based students half-tuition scholarships for those who agree to clinical practice in rural Maine. The students will spend most of the first two years in Boston studying at Tufts’ main campus, then get immediate hands-on experience traveling around rural locations in the state. Maine used Recovery Act stimulus package funds and private sources for the scholarships and hopes in return to retain 75% of students as doctors after graduation.
Also, Illinois' largest insurer is launching a patient-centered medical home pilot. The Chicago Tribune spells out how it might work.
Labels: H1N1, health care reform, medical education, QD, reimbursement
posted by Ryan DuBosar at
11:46 AM
0 Comments
Thursday, October 15, 2009
QD: News Every Day--legislative tricks, treat the underserved and banning sick kids ... from hospitals
ACP Internist's daily digest of internal medicine in the news continues with a look at legislative tricks for health legislation, a medical school that sends students into poor neighborhoods as part of their training, and hospitals that are enacting bans on minor visitors to avoid spreading H1N1.
Health care reform
Senates are seeking a bill that increases Medicare fees by $247 billion in the next decade. Because it will raise the deficit, Senators are trying a two-bill approach, a bit of legislative sleight-of-hand, to let them claim that health care reform won't cost more. At stake is a 21% reduction in Medicare reimbursement that was is scheduled to take effect in January.
In another bit of having one's cake while eating it, too, seniors will pay more for Medicare Advantage when costs increase from an average of $32 to $39 per month next year. Insurers are cutting plans that have no premiums--a federal requirement. Also being scrutinized are the free perks meant to entice traditional Medicare patients into private Medicare Advantage policies. But free to patients means paid for by the government--or sometimes hidden as higher co-pays and additional fees.
Investor's Business Daily points out a looming fight between primary care and specialty medicine. Legislation in the Senate gives primary care doctors a 10% bonus if they work in a Health Professional Shortage Area and 60% of their services are primary care. Half of the funding for the bonus comes from across-the-board cuts for specialists, who are refusing support.
Primary care shortage
Federally qualified clinics could treat more than 20 million patients this year, 2 million more than last year, the AP reports. The increase comes at a time that states are cutting their health care budgets.
To serve this need, Florida International University curriculum will send medical students to poor neighborhoods as part of their training. TIME profiles the program (and quotes ACP president Joseph W. Stubbs, FACP in the process.)
Finally, an emergency room doctor wrote an open letter to President Obama, making the points that:
--people without health care head to ER for treatment,
--medical training is expensive and causes primary care shortages, and
--legislators would discuss the space program without involving astrophysicists, so it's time to get doctors involved in health care reform.
These are all familiar points, but the letter is worth a read.
In case you missed it ...
To avoid spreading H1N1 influenza, hospitals have begun banning visitors less than 18 years old. These are children's' hospitals, too. M.D. Anderson followed suit, as well.
Labels: flu, health care reform, medical education, medicare, primary care shortage, QD
posted by Ryan DuBosar at
12:04 PM
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Wednesday, October 14, 2009
Out of the mouths of executives
They weren't the "futurists" who have been popular features of conferences lately, but I'd still put some faith in the predictions offered by the speakers I heard this morning. An MGMA panel included Toby Cosgrove, MD, Gary Kaplan, MD, and William Wright, MD, chief executives at the Cleveland Clinic, Virginia Mason and Permanente Colorado, respectively.
They had a lot of miscellaneous information to offer (strategies for improving quality, maintaining employee satisfaction, etc.) but I found a couple of points on health reform particularly interesting.
All three have electronic medical record systems, and while they think that the technology will have beneficial impact on quality, they say the government's focus on EMRs as cost savers is misguided. "I do not think we've saved a penny so far and we've shucked out hundreds of millions," said Dr. Cosgrove. Dr. Wright also made the point that EMRs will make no difference in quality, either, unless they're used to improve other aspects of care.
So how will health care reform manage to save money? Bundled payments. All of the execs think that bundled payments for episodes of care and outcomes are coming and that they will have a major impact on the way money is distributed within health care. Dr. Kaplan thinks they'll even create downward pressure on proceduralists, when various specialties have to divide the pot. They're so certain about the impending changes that one of the docs described physician-owned hospitals as an effort "to take the gains for the few remaining years left."
Another prediction that might displease physicians was the experts' certainty that minute clinics are here to stay. They advised providers to either embrace the trend or partner with it (Cleveland has a partnership with CVS).
Labels: health care reform, MGMA conference
posted by Stacey Butterfield at
12:53 PM
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QD: News Every Day--The disconnect of health reform
ACP Internist's daily digest of internal medicine in the news continues with the disconnect on health care reform, a larger analysis of who was hospitalized for H1N1, and more on the primary care shortage.
Health care reform
Americans want health care reform to change, but they don't want to pay for it.
Meanwhile, the Economic Policy Institute, a think tank focused low- and middle-income Americans, points out that Medicaid and the SCHIP held in check the number of children who would have gone without health between 2000 to 2008. Children without insurance dropped 1.7% between 2000 and 2008, while adults less than 65 without insurance rose 3.1%. By contrast, children with public coverage grew 8.8%, compared to a 3.5% increase for the adult population under 65.
H1N1 influenza
Health officials now say that 46% of 1,400 adults hospitalized with H1N1 influenza did not have a chronic underlying condition, according to the largest analysis to date. The study looked at adults and children hospitalized from April through August in 10 states at medical centers participating in a special disease surveillance network. Anne Schuchat, FACP, who heads the CDC's National Center for Immunization and Respiratory Diseases, said the larger analysis looked at underlying conditions not previously examined. Among adults, 26% had asthma, 10% had diabetes, 8% had some other chronic lung disease, 8% had weakened immune systems and 6% were pregnant.
Primary care shortage
A financial advisor chimes in with his analysis of why primary care doesn't pay, including input from his own internist. The doctor says, "The average income of a primary care doctor in Massachusetts is about $86,000. Why do I do it? Because I love it."
The medical home
Profiles of practices trying the patient-centered medical home include Greenhouse Internists in Mt. Airy, Pa. and the Adirondack Regional Medical Home Pilot, which also an effort to stop the loss of primary care practitioners in the region. And for a lighter note, don't miss ACP Internist's own Stacey Butterfield's report from the MGMA meeting in Denver.
In case you missed it ...
In Minnesota, the Vitality Project prompted one town to build sidewalks and bike trails; restaurants, groceries and schools to push healthier foods; and employers to give workers time to exercise. The experiment added an average 3.1 years to the longevity of about 2,300 residents who calculated their lifespans by answering 36 lifestyle questions.
Labels: diet, exercise, flu, H1N1, health care reform, health insurance, health policy, patient-centered medical home, primary care shortage, QD
posted by Ryan DuBosar at
11:53 AM
0 Comments
Tuesday, October 13, 2009
QD: News Every Day--Senate committee passes health care reform
ACP Internist's daily digest of internal medicine in the news continues with a key vote on health care reform, severe flu cases and an ACP Fellow honored for treating the poor.
Health care reform
[Updated from its original post] At nearly 3 p.m. today the Senate Finance Committee approved its version of the health care reform bill 14-9. Observers were atwitter (and a-Twittering) every time Republican Sen. Olympia Snowe so much as shifted in her seat. Eventually, she shifted to the left and said she would vote for the bill in committee without taking a position down the line.
Following today's vote, the bill will merge with the Senate Health Committee's version over the next few weeks and then go to the full Senate. On the House side, Rep. Nancy Pelosi will send several versions of a health care reform bill to the Congressional Budget Office, including one with a government-run public insurance option.
Even if a bill is signed into law this year, it will take three years before any tax credits begin.
H1N1 influenza
About 1 in 1,000 will develop severe illness from H1N1 influenza, and when they need hospitalization, they quickly consume limited resources such as mechanical ventilation, according to JAMA. Researchers profiled the outbreaks in Canada and Mexico, and an editorial suggested regionalizing care for patients with advanced respiratory failure. Alternatives also include telemedicine and temporary staffing changes to divert experts to the point of care.
In case you missed it ...
Pedro Jose Greer, FACP, of Miami, Fla. received the 2009 Presidential Medal of Freedom for his work treating the poor regardless of their ability to pay. His profile is here.
You know times are tough when even the Mayo Clinic, the model for health care, get criticism for limiting Medicare patients to Minnesotans and the border states of Iowa, Wisconsin and the Dakotas. But if you're wealthy, you can turn to your financial planner for Medicare advice.
Labels: H1N1, health care reform, QD
posted by Ryan DuBosar at
1:10 PM
1 Comments
Monday, October 12, 2009
QD: News Every Day on health care reform, primary care shortage and health care use
ACP Internist's daily digest of internal medicine in the news continues with the disconnect on who's supporting health care reform, the primary care shortage and who's to blame for how American consumer health care.
Health Care Reform
According to an Urban Institute study of 20 congressional districts where more than 30% of residents have no health coverage, members of congress whose constituents might gain the most from reform sometimes oppose it, while others representing voters who will likely pay more for little gain support it.
Primary care shortage
Kaiser Health News reports--surprise!--that little is being done to ramp up the number of primary care doctors to meet the needs of any beneficiaries of health care reform.
A paper in Health Affairs suggests using prepaid group practices, "highly structured, multispecialty medical groups that are reimbursed by capitation to serve the enrollees of a health maintenance organization," to achieve a physician-to-population ratio 22% to 37% below the national rate.
It's gotten so bad that one family practitioner earns more from her eBay services. In all fairness to the practice of medicine, she's a top seller.
In case you missed it ...
Last week we reported that doctors drive up health care costs, not patients. This week we note that doctors may order needless tests because of their patients, who read about diseases on the Internet and think they have them. Or, direct-to-consumer ads prompt prescription requests. NPR reports.
Labels: health care reform, primary care shortage, QD
posted by Ryan DuBosar at
12:59 PM
0 Comments
Thursday, October 8, 2009
QD: News Every Day--health care reform / Surgeon General / unlicensed providers
ACP Internist's daily digest of internal medicine in the news continues with sides blurring on health care reform, a new Surgeon General favorable to primary care and the suggestion of continuous credential monitoring for providers.
Health Care Reform
According to the Congressional Budget Office, the Senate Finance Committee's proposal will:
--slow spending growth on medical care
--lower the deficit
--cost less than President Obama's threshold
--cover 29 million uninsured Americans
--cover 94% of all Americans
The Finance Committee's bill requires a vote, possibly on Tuesday, and then will be merged with a bill in the Senate's Health, Education, Labor and Pensions Committee.
Now, Congress needs to figure out who will pay for it all, the wealthy or the insurance companies.
Meanwhile, some Republicans who carry the title of "former" are supporting some kind of reform: former Senate Majority Leaders Bob Dole and Bill Frist, and former Medicare administrator Mark McClellan. Former Health and Human Services Secretary Tommy Thompson cited the Senate Finance Committee's plan specifically.
And while Republican governors Arnold Schwarzenegger and Bobby Jindal support reforming health care in some way, two Democratic governors oppose expanding Medicare because of its impact on the states.
In case you missed it ...
Regina Benjamin, MD, took one step closer to becoming Surgeon General. The Senate Health, Education, Labor and Pensions Committee approved the nomination; she now goes to the full Senate. But there's no timetable to vote on Dr. Benjamin, a primary care physician.
Nearly one in 5 health care practitioners operate under malpractice allegations, an expired license or false credentials, and nearly 2% practice without a license. The study, done by a company that provides credentialing verification, prompted them to suggest continuous Web-based monitoring instead of reviews every two to three years.
Where one lives impacts the health care received, since insurance coverage, access to preventive medicine and disease treatment vary widely among states, according to a study released by the Commonwealth Foundation. Vermont focused on health care and its robust residents faired the best, followed by Hawaii, Iowa, Minnesota and Maine. As usual, the South trundles behind the rest of the nation's health care performance. Mississippi has the worst health care, with Oklahoma, Louisiana and Arkansas rounding out the results.
Labels: disparities, health care cost, health care reform, QD
posted by Ryan DuBosar at
12:18 PM
0 Comments
Tuesday, October 6, 2009
QD: News Every Day
Health care reform
Nothing good gets done until a committee has considered it. Now, the Senate Finance Committee put off voting on health care reform until the Congressional Budget Office chimes in with estimate of how much it will cost.
Flu vaccination
Health departments in three states began administering the first of the 7 million currently available H1N1 flu vaccine doses this week. Don't sweat it if your state wasn't one of them; 40 million doses will be available by mid-October and 10 million to 20 million will become available each week after that.
Globally, the World Health Organization has begun mass vaccination campaigns in China and Australia and will be starting soon in the U.S. and Europe. Worldwide, governments have ordered 440 million doses of GlaxoSmithKline's H1N1 vaccine Pandemrix.
In case you missed it ...
The U.S. fares worse than other industrialized countries in rates of preventable deaths--premature deaths caused by diabetes, epilepsy, stroke, influenza, ulcers and pneumonia--and has been falling further behind over the past decade, according to a Commonwealth Fund study published in the journal Health Affairs.
Labels: Diabetes, flu, H1N1, health care reform, QD, stroke
posted by Ryan DuBosar at
12:30 PM
0 Comments
Monday, October 5, 2009
QD: News Every Day
Health care reform
Five bills floating around Congress need to be combined. The report suggests a broad outline of health care reform is emerging. But two key Democrats have pledged to withhold support. Any merger will be tough, leaders say.
Republican senators are using procedural votes to block nominations at the Department of Health and Human Services, including that of Surgeon General nominee Regina Benjamin. Republican senators plan to withhold consent to move the nominations to the full Senate in a fight over a warning letter that HHS sent to an insurance company accused of misleading enrollees over health care reform. Dr. Benjamin was popular among some ACP Internist readers, who were pleased to have a primary care doctor as the nation's most visible physician.
Does San Francisco hold the key to health care reform? Its model is being hailed despite employer mandates and available coverage for any uninsured adult who lives in the city and earns as much as 500% of the federal poverty level.
But any kind of mandate isn't the answer, as 2% of people refuse health insurance, says Kaiser Health News.
In case you missed it ...
Doctors for America sent physicians from each state to Washington, D.C., to advocate for meaningful health reform. Physicians met with President Obama in the Rose Garden. Doctors for America’s Executive Director, Mandy Krauthamer, ACP Member, and other ACP members joined the cause as their states' representatives.
“The urgent need for health reform cannot be overstated," Dr. Krauthamer said in an e-mailed press release. "These physicians from around the country have taken time away from their families and their practices to come to Washington to advocate for passage of comprehensive health reform this year. As physicians, we know that this is the right thing for our patients, our profession and our nation.”
Profiles of the Doctors for America members that went to the White House are online. Meanwhile, three former American Medical Association presidents who weren't invited to the White House event aired their ideas for reform elsewhere.
Labels: health care reform, QD
posted by Ryan DuBosar at
1:18 PM
1 Comments
Friday, October 2, 2009
QD: News Every Day
ACP Internist's daily digest of primary care in the news continues with sudden coherence on Obamacare, prescription med fatalities and the trend of falling patient volume and procedures during the recession.
Health care reform
Overnight, Democrats and moderates in the Senate Finance Committee agreed to $400 billion in federal subsidies to defray premium costs for lower-income families and help small businesses offer coverage to their workers. Amendments will seek to let the states form their own public options and make health care affordable. But the compromise doesn't offer a permanent fix for the Sustainable Growth Rate. It could hurt physicians who are the biggest users and discourage them from taking on patients. And it still needs to merge with other bills.
If you're unclear which health care reform bill is which, the San Francisco Chronicle explains them.
In case you missed it:
Drug overdoses, mostly from prescription meds, overtook traffic accidents as the leading cause of death in some states.
The Robert Wood Johnson Foundation warns that not passing health care reform could hurt the states most of all.
Revenue in medical practices declined in 2008, possibly tied to smaller patient volumes and increasing bad debt due to patient financial hardship.
According to the "MGMA Cost Survey: 2009 Reports Based on 2008 Data," multispecialty group practices saw a 1.9% decrease in total medical revenue in 2008. (MGMA captures data on both multispecialty groups and single-specialty practices, but uses multispecialty data as a proxy for overall trends.)
Procedure volume fell 9.9% and patient volume shrunk 11.3% from 2006 to 2008. And bad debt in multispecialty group practices from fee-for-service charges increased 13% from 2006 to 2008, suggesting that patients may be having a harder time paying their medical bills.
In 2008, multispecialty practices cut overhead expenses 1.4%, largely by cutting support staff costs by 1.5%--the first decline in several years. Support staff make up 32% of medical practice expenses. While medical groups reduced support staff costs, their total worker count remained constant, indicating that employees may have gone without raises and bonuses or perhaps even suffered pay cuts.
Revenue by specialty:
Labels: drugs, health care reform, practice management, QD, recession
posted by Ryan DuBosar at
12:29 PM
0 Comments
Thursday, October 1, 2009
QD: News Every Day
ACP Internist's daily digest of primary care in the news continues with legislative jockeying for health care reform, public rejection of flu vaccination and primary care's dominance of mental health prescribing.
Health care reform
Legislation proceeds apace, with congressional members jockeying and pushing for the House and Senate bills to reach their respective chambers by mid-month. Abortion restrictions were defeated, as were other provisions. But there are many hurdles to clear as legislators threaten to cancel the Columbus Day break to get the legislation finished by either Thanksgiving or the end of the year.
Meanwhile, former Senate Majority Leader Tom Daschle said lawmakers were “flummoxed” when attempting to craft specific reform legislation, so Gary R. Gibson, FACP, has created an algorithm to help them understand it.
Flu prevention
Consumer Reports says only a third of Americans plan to get the H1N1 vaccine. More than half of adults with risk factors don't know what complications the flu could cause. They're worried about risks from the vaccine itself, or they're not confident of its efficacy. Or, they just don't think they'll get the flu.
In an NEJM perspective, authors say there's a pressing need for research into whether N95 masks work better or worse than surgical masks to prevent spreading the flu. So JAMA obliged with a study finding that surgical masks work just as well. An accompanying editorial notes that other preventive measures, such as vaccinating health care workers and hand washing, are critical but overlooked.
In case you missed it:
Mental health issues affect 1 in 4 Americans, 1 in 17 severely. Mostly, they go to their primary care clinicians for help, says the Agency for Healthcare Research and Quality.
Fifty-nine percent of U.S. mental health drug prescriptions are written by family doctors, reports Researchers from Thomson Reuters and the U.S. Substance Abuse and Mental Health Services Administration. They examined 472 million prescriptions written for psychotropic drugs from August 2006 and July 2007 and found general practitioners prescribed 62 percent of antidepressants and 52 percent of stimulants, mainly drugs for treating attention deficit hyperactivity disorder.
Labels: flu, H1N1, health care reform, mental health, mental illness, QD
posted by Ryan DuBosar at
12:54 PM
0 Comments
Wednesday, September 30, 2009
QD: News Every Day
ACP Internist begins a daily digest of primary care in the news, debuting with an update on health care reform's messy reconciliation in Congress, good news about Medicare access (as health care currently stands) and what a national EHR network would look like.
Most recently for health care reform:
Two Democratic proposals to create a government insurance plan to compete with private insurers failed, while members of Congress turn their attention toward paying for abortion and insurance coverage for illegal immigrants. Now, Sen. Max Baucus is looking to revise a key financing provision after an analysis showed its tax burden would fall on seniors. In the wake of voting, amendments, provisions and alternatives are being slung left and right (politically, as well as figuratively.)
Since it's not a news cycle without something on H1N1, hundreds of New York state's health care workers protested a mandate that medical professionals get seasonal and swine-flu vaccines. But state health commissioner Richard F. Daines, FACP, told Gannett News Service, "This isn't the time to pump air into a completely deflated argument about vaccine safety."
Other issues internists should also be aware of include:
The Government Accountability Office found that less than 3% of Medicare beneficiaries had major problems accessing physician services, even while more people used the benefit and the number of services per beneficiary increased. More physicians are accepting Medicare, too. Unfortunately for Medicaid, it's far too easy to fraudulently access addictive drugs--65,000 instances costing of about $65 million in 2006 and 2007.
Finally, doctors' offices and hospitals are slowly, slowly moving toward electronic health records. Another view on the issue is instead of one national database, there'd be a "network of networks."
Labels: electronic health records, electronic medical records, emr, H1N1, health care reform, medicare, QD
posted by Ryan DuBosar at
1:06 PM
1 Comments
Friday, September 25, 2009
Readers polarized about town hall meetings on health reform
About half of ACP Internist and ACP Hospitalist readers saw the summer's town hall meeting on health care reform as a failure, according to results of a survey. The reasons why were as polarized as the open-ended responses readers gave.
Some perceived the meetings as a success because they saw the meetings reflect their own points of view on health care, pro or con. Others saw the meetings as failures because of their tenor, or the outcomes of specific events.
The angry rhetoric caused respondents to express concerns not only for health care reform, but for democracy. One said, "They were a success in that people came out to speak; they were a failure in that the democratic process of debate was cast aside for emotional rhetoric."
Some called for more physician and hospital leadership on the issue, and from ACP itself. "Physicians must become leaders in this debate so that Americans get meaningful, full reform that benefits the majority of our citizens."
Eyewitness respondents provided first-hand reports on their own town hall meetings, or in one case, a lack of meeting. Rep. John Tierney (D-Mass.) instead had a telephone conference.
Another reader related opinions from Alaska, where "There were standing ovations opposing 'socialized medicine' and increased taxation. The senator's response to a young uninsured mother's plea to 'What should I do?' for her child with asthma was disappointing. It boiled down to: 'Contact my office, I may be able to get samples from the drug company, and in this country the emergency room will never turn you away.'"
Another reader complimented Rep. Charles A. Gonzalez (D-Texas) on his town hall in San Antonio at the end of August. "The opposition (some brought in on charter buses) was loud and intermittently disruptive. Rep. Gonzalez did an excellent job of explaining HR 3200 and answering questions. If there were any initially neutral persons in attendance, I think they might have had their questions answered."
But disruptions and misinformation prompted many readers to view the meetings as a failure, due to either hecklers or the congresspeople themselves. Others cited the lack of focus on solutions, as well. "Misinformation, incorrect perceptions and strangely focused ideology ruled the day rather than any real conversation."
Others saw success despite the messy process.
"While many [meetings] were devastated by hecklers and got the bulk of the media coverage, some were successful and educated people and got the issue out there. ... It is rejuvenating to see Americans participating in democracy by discussing issues relevant to the future of our nation."
Another summed up, "They gave the public a chance to express concerns and fears. Whether this helped the legislators is yet to be seen."
Labels: health care reform
posted by Ryan DuBosar at
8:00 AM
1 Comments
Monday, September 21, 2009
American values and health care
I read a good post from the New York Times about Health Care Reform and 'American Values' and it got me a thinkin' ... just what are American Values when it comes to health care? Usually I get a little anxious when I see "American Values" in a sentence, because what usually follows is something about rugged individuality, pulling oneself up by bootstraps, getting the damn government out of our lives and those damn immigrants and welfare mothers who won't work and want to live off others.
But I have listened to about ten thousand patients over the past 25 years, and I have a good idea of what these Americans want for health care. They are the silent majority ... the people who work, study, raise their kids and seldom call into a radio talk show. They don't have time to go to town hall meetings and shout slogans.
They range from age 17 to 101 and most of them are middle class. They come in all races ... Asian, black, white, Pacific Islander and mixes of all.
Some are wealthy enough to have multiple homes and private planes.
Some are uninsured and watch their health care spending very closely. Most were thrilled to get Medicare and I've never heard a complaint from a Medicare patient.
Here is my list of what these Americans think about health care:
--They do agree that everyone should be covered for basic health care and would pay higher taxes if they could believe that there would not be fraud and waste. (The recent banking meltdown has destroyed all confidence that government can regulate or be independent from special interests.)
--They want choice of physicians and hospitals.
--They are sick of insurance companies and all feel like they have been screwed in one way or another. They are shocked at how little insurance companies pay toward the doctor visit and the way those fees are discounted.
--They are technocentric and want tests, imaging, referrals and think "more is better" when it comes to health care. They think tests are cures. Because of the perverse incentives, the "more is better" philosophy benefits doctors and hospitals, but not necessarily patients.
--They fear losing insurance if they have it.
--They are confused about the current reform debate and mostly fear losing whatever coverage they now have, because they know how impossible it is to get by without any coverage at all.
There are no such thing as "American Values" because we are a diverse group of people. But we all have certain things in common. We want to be healthy. We don't want to be screwed by anyone (big business or the government).
We want to be able to manage our own health care but we don't want to have to decide between numerous health plans every year with pages of information that cannot be understood. We are tired of not knowing where all the trillions of dollars really are being spent.
We want to know the price of a service up front, and we want a trusted physician to help us decide if that is how our money should be spent. We want smart, committed physicians to know us, and not hurt us.
Sounds American to me.
Toni Brayer, FACP, is an ACP Internist editorial board member who blogs at EverythingHealth, designed to address the rapid changes in science, medicine, health and healing in the 21st Century.
Labels: health care reform, health insurance, pay-for-performance
posted by Toni Brayer MD at
8:00 AM
2 Comments
Friday, September 11, 2009
What did Obama mean?
Obama's nod to malpractice reform got Republicans on their feet the other night, but he was wisely vague about his specific intentions. A Washington Post article helpfully explains what the administration's approach to malpractice reform would likely really entail. As with the whole overall, the current plan sounds like it's along the lines of what he talked about during the campaign. Gets points for consistency, at the very least.
And, to compensate, some light reading for a gloomy (at least here in Philly) Friday afternoon--a CDC report of preschool teachers accidentally eating brownies spiked with pot. A couple of notes: First, California's medicinal marijuana laws must have made the drug awfully easy to come by that magic brownies are now selling on the street for $1.50. Second, one of the teachers went to the hospital and was treated with antibiotics. I'm no doctor but I'm pretty sure "being sky high" is an off-label use for any antibiotic.
Labels: drugs, health care reform, malpractice
posted by Stacey Butterfield at
2:23 PM
1 Comments
Friday, September 4, 2009
It takes all kinds
Two approaches to the debate over health care reform: civil and thoughtful or totally ridiculous.
Labels: health care reform
posted by Stacey Butterfield at
9:00 AM
0 Comments
Friday, August 28, 2009
A totally different vision of health reform
Often the phrase "consumer-driven health care" is a cue to hold on to your pockets because there's an unexpected bill headed your way. But in the cover story of this month's issue of the Atlantic, David Goldhill makes an interesting argument about the benefits that a truly consumer-driven system could provide. Or, at least, he's pretty convincing on the idea that it couldn't be any worse than things are now. His plan's not going to be enacted anytime soon and has some flaws (boy, does he hate hospitals), but it's definitely an interesting read.
Labels: health care reform, health insurance, health policy
posted by Stacey Butterfield at
1:14 PM
0 Comments
Wednesday, August 19, 2009
Worrisome statistics
Ever wonder what all those presidential pollsters do when it's not an election year? Based on today's health news, it looks like they spend their time asking Americans about their worries.
First, from CQ Politics, "Consumer Worry Grows on Health Care Access." The health care consumer confidence level (whatever that is) dropped more than 10 points among people 65 and older and 4 points in those 50-64 last month. The pollsters didn't bother to ask people whether they were worried that health care reform would pass or that it wouldn't, so it's a little hard to figure exactly what you could actually learn from these statistics.
On the other hand, people are not troubling themselves about swine flu, according to the Washington Post. "Only about one in eight Americans is very worried that swine flu will affect his or her family," the article reports. Six in eight are "not too worried" or "not at all worried," which we guess leaves that last guy sorta worried? The survey does teach us one thing. Despite the media's best efforts, it seems like the pandemic paranoia plan has been a failure.
Labels: health care reform, statistics, swine flu
posted by Stacey Butterfield at
2:39 PM
0 Comments
Wednesday, August 12, 2009
The government, online.
It's not exactly an impartial view of health reform, but if you want to know what the administration is thinking and saying about health care without risking a town hall meeting, check out healthreform.gov. It's a snazzy site, complete with an interactive map, blog and videos from Kathleen Sebelius.
Labels: health care reform
posted by Stacey Butterfield at
4:51 PM
2 Comments
Thursday, August 6, 2009
Making sense instead of noise
Tired of all the people yelling about health care reform? This little article from the Wall St. Journal provides a nice respite. It uses both logic and morality to explain why a totally free-market approach to health care coverage doesn't work. Even the comments section is surprisingly civil.
Labels: health care reform, health insurance
posted by Stacey Butterfield at
12:00 PM
1 Comments
Friday, July 31, 2009
President's former physician pulls for single-payer
One ACP Member with potentially unique influence is pulling for single-payer health care reform--President Obama's former private physician. Chicago-based David L. Scheiner, MD, cared for the not-yet-president for 22 years. CNN profiled him here.
Labels: health care reform
posted by Ryan DuBosar at
8:26 AM
1 Comments
Tuesday, July 21, 2009
Look that free drug in the mouth
Last winter, we (and the CDC) got riled up about pharmacies eliminating co-pays for antibiotics because it could encourage overuse of the drugs and antibiotic resistance. A new Wall St. Journal article points out that drug manufacturers are doing the same thing with medications for some chronic illnesses. And sure enough, pharma's co-pay rebates are also likely to have negative consequences for society.
Specifically, the elimination of the co-payment on a brand name drug (Lipitor was one cited by the article) pulls patients away from generic options and pushes up drug costs for the insurer. (The drug makers aren't offering the same kind of deals to third-party payers; for them, medication prices have only increased as co-pays went down.) Luring business away from generic competitors was explicitly the point of the rebates, explained one pharma exec quoted in the article.
Massachusetts is the only state that currently bans the practice, but it will probably become a hotter topic as health reform progresses. Under the current system, the complaints of insurance companies that have to pay a little more for drugs isn't going to elicit a lot of sympathy from consumers and legislators. But if a public plan option results in tax dollars paying for these brand-name medications, that'll be a different story.
Labels: drug companies, health care reform
posted by Stacey Butterfield at
9:00 AM
0 Comments
Wednesday, July 15, 2009
Pay attention! Primary care faces a shortage
NBC devoted prime time news coverage to the shortage of primary care physicians, and interviewed residents on why they're not pursuing primary care. (Apologies for the short commercial NBC posts before its online outtakes.)
Near-daily coverage of the provider shortage crosses our desks at ACP Internist, shown here, here and here to post just a few from recent days. And to post a few more, here, here and here.
It may be cold comfort, but the issue doesn't lack for attention, just a solution.
Labels: health care reform, physician shortage, primary care shortage
posted by Ryan DuBosar at
2:04 PM
0 Comments
Tuesday, June 23, 2009
The doughnut hole will need a new name
Yesterday, pharmaceutical companies agreed to shrink the Medicare doughnut hole by offering a 50% discount on meds purchased while a patient in the hole. The full price of the medicines will continue to count toward getting back out the other side. Given this development, the gap in coverage is going to need a new name to convey its smaller size--maybe the icing in the eclair or the Oreo filling?
More seriously, the most interesting thing about this change is how it benefits everyone involved. The advantages to patients are obvious. But the seemingly altruistic move by big pharma will probably benefit their bottom line, too, according to an analyst interviewed by the New York Times.
"'Because of the discounts,' he said, 'Medicare beneficiaries are likely to continue filling prescriptions in the doughnut hole, whereas in the past many stopped taking their medications because the drugs were unaffordable to them.'"
It makes you wonder why they didn't do it sooner. Was this strategy reserved until it would have the biggest possible PR impact as a contribution to health reform?
And if the talk of doughnuts and Oreos has made you desperately crave some junk food, my apologies. The NYT also has an interesting article about this psychological torment.
Labels: diet, drug companies, health care reform
posted by Stacey Butterfield at
2:30 PM
0 Comments
Wednesday, June 17, 2009
Did you miss it? Rationing already happened.
Maybe you've heard that Obama is planning some kind of health care reform. In fact, reading the health news this week you might think that all scientific research and disease spread (where did you go, swine flu?) had been halted while the country debates health insurance.
Comparisons to Canada and their "rationed" health care system are a popular conservative talking point. But a column in today's New York Times makes the point that health care in the U.S. is already rationed--against other resources, between the insured and uninsured, and perhaps most significantly to our audience, in the allocation of physicians' time. When a patient can't get an appointment, or the doc doesn't have time for one more question--that's rationing.
Might be a useful rebuttal in those cocktail party debates over health care that you're likely to run into this summer. And if that doesn't work, maybe it's time to change the subject. Have you heard about the pandemic?
Labels: health care reform
posted by Stacey Butterfield at
11:49 AM
0 Comments
Thursday, May 21, 2009
How to annoy a reporter
I spent the past two days at ACP's Leadership Day and full coverage of the event will appear in the July issue of ACP Internist. You can also read more on the ACP Advocate blog. But there will be a few things missing from the story, because the congressional staff and presidential advisors who spoke to attendees insisted on being "off the record." Of course, politicians live in fear of the press, and they know how easily blogs and youtube can shoot a misspoken word around the globe. But somehow I thought the result of that would be that they thought before they spoke, not that they would forbid the 400 people hearing their speech from repeating what they said. So, sadly, frustratingly, I can't tell you details, but take my word for it that the Democrats are really fired up about making health care reform happen now. And, if you want the inside scoop, I guess you'll just have to come to DC yourself next year.
Labels: health care reform
posted by Stacey Butterfield at
1:29 PM
0 Comments
Friday, May 15, 2009
More about the benjamins.
Yesterday's discussion at SGIM centered on health care costs, and assumed that some kind of reform is coming, but both Bob Brook and Albert Siu avoided the issue of whether the new system should be single- or multi-payer. That contentious topic was the focus of this morning's plenary session. Richard Epstein, a law professor, and Steffie Woolhandler, MD, founder of Physicians for a National Health Program, each presented their views and then responded to questions from the audience. Their conclusions were pretty stark. Dr. Woolhandler, who comes from Massachusetts argued (and presented evidence) that the mandated coverage plan that her state has enacted and Obama is considering only makes health care worse and less accessible. She sees single-payer as the only possible solution. Meanwhile, Prof. Epstein said that single-payer would be a costly, bureaucratic disaster and that the only solution is an entirely free-market health care system. The poor and uninsured can get their lower quality health care from Wal-Mart, just as they do other goods and services, he said. As you might guess, that was not a popular suggestion with the audience.
Labels: health care reform, SGIM meeting
posted by Stacey Butterfield at
12:37 PM
1 Comments
Thursday, May 14, 2009
Fixing the house of medicine from the inside
As promised, the story of how Bob Brook wants doctors to spend less, in addition to eating less. At the SGIM opening session this morning, he called on physicians to improve the quality and lower the cost of their care, before making demands for insurance and payment reform. He suggested that the Journal of General Internal Medicine only publish research that works toward lowering costs (by, for example, testing out a new, less expensive alternative to an accepted treatment). He also recommend that physicians threaten their hospital CEOs with a job action unless they start working to increase the value of care provided at their facilities.
His ideas sounded pretty revolutionary until the keynote lecturer on geriatrics, Albert Siu, MD, made some similar arguments. He also called on general internal medicine to prove its value in caring for chronically ill patients. His point was that PCMH-like models would never be fully supported until primary care proved its value. Although he also said that payment system had to be reformed in order to show the value, so it seemed like a slightly circular argument.
Both lectures included the sort of digs on more procedural specialties that you would never hear at, um, other internal medicine meetings. These SGIM folks are not afraid to say how they think health care spending should be redistributed. But they also placed some of the blame on primary care, for not providing "excellent, affordable, humane care," as Bob Brook put it. Sounds like a challenge.
Labels: health care reform, SGIM meeting
posted by Stacey Butterfield at
4:56 PM
0 Comments
Thursday, March 12, 2009
Obama should check his facts on EHRs, say Harvard docs
At last week's White House health-care summit, President Obama made electronic health records a cornerstone of his proposal for reform, a move he said could save up to $80 billion a year, among other benefits.
Unfortunately, that's wishful thinking, say Jerome Groopman, FACP, and Pamela Hartzband, FACP, in a commentary in today's Wall Street Journal. (Drs. Groopman and Hartzband, both on the Harvard Medical School faculty, write ACP Internist's Mindful Medicine column). The 2005 RAND study upon which the president based his cost savings predictions was funded by companies that stand to benefit from selling EHRs, they point out, and new information has surface over the past four years that contradicts the study's findings.
"The RAND study and the Obama proposal it spawned appear to be an elegant exercise in wishful thinking," Drs. Groopman and Hartzband write. The two note that they voted for Obama in part because of his "openness to changing his mind when those data contradict his initial approach to a problem." They call for him to apply that kind of scientific thinking to the health care conundrum.
Labels: electronic health records, health care reform
posted by Janet Colwell at
1:10 PM
1 Comments
Thursday, December 4, 2008
Is health care the new Hummer?
Rationing is in. First, we learned that we all need to cut back on our carbon output, then it was discretionary spending that had to be restricted. Now, some health care analysts are pointing out the painful truth that the only affordable, equitable way to provide health care may be to ration it.
Daniel Callahan of the Hastings Center has recently stirred controversy on the issue, with a New York Times blog post describing his rationing plan. Basically, he suggests that Medicare coverage for very expensive therapies (like open-heart surgery) be cut off once patients hit age 80. By the way, it seems important to note that Dr. Callahan himself is 78. "Our society can not, and should not, promise open-ended, progress-driven medical care that is indifferent to costs," he concluded.
Sound outlandish? Not to the Brits, who are already doing something along these lines. Another NYT article discusses NICE, the British government institute that decides whether a therapy is cost-effective enough to be covered. Their cut-point right now for life-extending cancer drugs is about $22,000 for per 6 months of life gained. The policy raises a whole heap of protest from pharma companies (who the article pretty well puts through the ringer) and patient advocates. Even so, numerous other countries are looking at the British example to deal with their ballooning health care costs, the NYT says.
"What price is life?" asks a woman in the article whose husband was denied an expensive drug. It's a tough question, but one which bureaucrats, health experts and politicians might soon have to answer. Is rationing the only solution?
Labels: drug companies, health care reform, health policy
posted by Stacey Butterfield at
11:21 AM
0 Comments
Wednesday, December 3, 2008
Obama should read the NEJM
There's no shortage of advice available to President-elect Obama on how to reform health care. If there's a health policy analyst out there who hasn't thrown her 2 cents in yet, I'd be surprised. But the experts writing in this week's New England Journal have an extra argument on their side: history. They analyze the last successful piece of federal health reform--the creation of Medicare.
In their account, the passage of the plan was in large part due to LBJ's political skills. We know Obama is talented in that department, but a couple of the authors' key suggestions may prove difficult for him to follow.
First, they say that to be successful, health care reform must be tackled immediately (if not sooner). Yet, it seems likely that dealing with the disaster that is the economy will take most of Obama's attention after inauguration. Can he really launch a huge, new spending plan when pleas for money are coming from every direction? (See governors' meeting taking place today.)
The authors also recommend letting Congress manage the specifics of reform. But Obama's already got problems with Congressional Democrats straying way off the health care reservation. (e.g., Sen. Baucus is now proposing to mess with employer-sponsored coverage--an idea that Obama campaigned hard against during the election.) Also, can what has come to be known as our do-nothing branch be trusted to get something effective passed on this issue?
There is one recommendation that it seems like it shouldn't be too hard for Obama to follow. LBJ got Medicare enacted because he didn't worry too much about the future costs, the authors say. (Explains a lot about the mess it is now.) And as AIG, Citi and the rest of the bunch can attest, if there were ever a time when it was publicly acceptable for the government to spend money it doesn't have, that time is now.
Labels: health care reform, health policy
posted by Stacey Butterfield at
8:00 AM
1 Comments
Thursday, October 30, 2008
Primary care shortage dooms universal health care
Guest blogger Toni J. Brayer, FACP, of ACP Internist's Editorial Advisory Board, offers her comments on how the primary care shortage will doom attempts to reform health care. She writes:
Senator Obama wants to provide universal health care coverage to all Americans, but the physician shortage will stop it dead in its tracts. With less than 2% of medical students choosing primary care medicine as a specialty and the aging physician population that is ready to retire within the next five years, we have a crisis looming.
It is the primary care specialties who manage 80% of all health care needs of our population and who keep costs under control by knowing the patient and providing continuity and preventive care. As they retire or close their practices to new patients, there are no young physicians to take their place.
There is already a shortage of primary care physicians and physicians in some basic specialties like general surgery, neurology and rheumatology. Even large metropolitan areas are lacking in gerontologists, general internists and family physicians. Rural communities face challenges for primary care and specialty care.
Young physicians in training are turned off by the enormous unsatisfying paperwork and difficult practice environment of primary care. Our reimbursement system has disadvantaged these physicians for years and they are at the bottom end of the income scale, despite the fact that they are the basis for a healthy population.
Primary care doctors spend more time talking with patients and managing health care without expensive procedures and tests. The reimbursement for these cognitive services are not keeping up with the costs of running a practice and young doctors are walking away from this type of practice in favor of better lifestyles and more pay.
Even in medical strongholds like Boston, Mass., where there are several academic teaching hospitals and wonderful medical care, there is such a shortage of primary care physicians that doctors and nurses can't find a doctor to care for their own family. Finding a good primary care physician requires "knowing someone" who can open the door for you to be seen as a patient.
The proposal to provide insurance for the 45 million Americans who are presently uninsured will fall flat unless we address this critical issue of primary care and who is going to take care of people. Having insurance is not the same as having access to care.
Episodic, expensive, high-tech, specialty services have created a monetary health crisis that looms larger than the banking meltdown. It is time we look at the primary care crisis and begin finding solutions that will allow health care reform to succeed. Without considering the primary care piece, it is doomed to failure.
Labels: health care reform
posted by Ryan DuBosar at
9:29 AM
0 Comments
ACP Internist hosted Grand Rounds on June 16, wrapping up the best of the medical blogosphere. Click here for the complete wrap-up.
Contact ACP Internist
Send comments to ACP Internist staff at acpinternist@acponline.org.
Previous Posts
- QD: News Every Day--Santa's take on H1N1 influenza...
- Rethink pink: breast cancer screening evidence met...
- QD: News Every Day--Santa's take on H1N1 influenza...
- QD: News Every Day--when evidence and politics col...
- Ghostwriting haunts Congress' hallowed halls
- QD: News Every Day--payment fix inches forward (fo...
- QD: News Every Day--not the intended effect
- Medical news of the obvious
- QD: News Every Day--flu's growing tally
- QD: News Every Day--no holidays for Congress
Archives
Blog log
American Journal of Medicine
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.
Clinical Correlations
A collaborative medical blog started by Neil Shapiro, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.
db's Medical Rants
Robert M. Centor, FACP, contributes short essays contemplating medicine and the health care system.
Everything Health
EverythingHealth is designed to address the rapid changes in science, medicine, health and healing in the 21st Century.
Getting Better with Dr. Val
Getting Better is the continuation of Dr. Val Jones' previous blog at Revolution Health. It is devoted to helping people understand health issues from a balanced, scientifically sound perspective.
HealthHombre
A roundup of health policy news drawn from a database of hundreds of Web sites.
Interact MD
Michael Benjamin, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.
Kevin, MD
The alter ego of Kevin Pho, ACP Member, is the closest thing to royalty in the medical blog world.
LSUHSC-S Medical Library Evidence Alert
Major guidelines, systematic reviews, meta-analyses and/or major reviews by national and international organizations.
PLoS Blog
The Public Library of Science's open access materials include a blog.
White Coat Rants
One of the most popular anonymous blogs written by a doctor.
