In case you missed it last week, amidst all the returning stars for one of the final episodes of the TV show ER, there was a dramatic Operating Room scene where Dr. Benton (played by Eric Lasalle) is “observing” the kidney transplant of Dr. John Carter (played by Noah Wyle), because as we see, the transplant surgeon is a very coarse and roughshod individual. The significance of the scene is that as the surgery is about to begin, Dr. Benton pulls out his pre-surgical checklist and browbeats the transplant surgeon into going through it – during which the nurses note their concern that they don’t have reperfusion solution in the OR, so they go and get some as the surgery starts. …
Transparency & Accountability for Physicians in Health Reform
Yesterday I had the opportunity to give Medical Grand Rounds at Caritas Carney Hospital in Boston on the topic of “Health Reform 2009 and Beyond.” Rather than compare and contrast various national health reform proposals, I reviewed the major forces and trends that are reforming healthcare, and explained how they would likely impact different stakeholder groups – particularly physicians.
I started by discussing the major trends in cost, access and quality – noting how the first two are easier to quantify and that the debate over access to healthcare services versus insurance coverage has been resolved in favor of health insurance coverage, because only having access to free clinics and emergency rooms doesn’t enable people to get the type of healthcare that they really need. …
Medical Case Management – Making It Work
Jeffrey Krasner had a great article in yesterday’s Boston Globe about his experience trying to manage and coordinate his Mom’s care. As a very experienced health reporter in a city dense with advanced health care delivery and health policy wonks, his story of problems getting care coordinated amongst her physicians and having her medical records transferred is very illuminating. However, for those of us who have spent time trying to help friends and relatives navigate the medical care maze, it is not surprising. (I went through a somewhat similar situation with my Aunt several years ago.)
While some people conclude that the solution to this complexity is a national health system, I believe that creating more standardization and accountability within our existing structure is a much more practical answer. …
Patient-Physician Communications: Sometimes It’s the Small Things
Wide ranging discussions are ongoing about how to systemically improve the collection and analysis of clinical information via electronic medical records and other forms of health IT. In addition there are more focused discussions about how to improve physician patient relationships. However, when a friend told me how a communication failure with her physician left her with less than optimal treatment instructions, I was reminded that at the very micro level there are additional communications issues that need to be examined.
Here’s the story: My friend had a temporary and rather minor – but certainly annoying – skin problem, and her doctor advised her that hot/moist compresses would be the best thing, and that she should wrap a potato in a paper towel and “zap it,” and then apply this to where she had the skin issue. …
Health Reform Challenges and Prospects
The prospect for Federal health reform legislation remains high because of the growing need, Democratic control of Congress, and a lower barrier to major actions because of the economic situation. However, opposing these positive factors are the apparent unraveling of broad coalitions supporting fundamental health reform, and lower expectations for bipartisanship in Congress.
Growing conflicts within health reform coalitions was reported in Tuesday’s Chicago Tribune, (and discussed on the HealthBeatBlog), but this dis-cohesion was very predictable when it came time to talk specifics. Unfortunately, the prospects for bipartisan action on health reform also seem to have faded sooner than one would have hoped. …
Controlling Health Care Costs and Improving Quality with Effective Care Coordination
A study published by in the New England Journal of Medicine last week examining the effects of 15 different Medicare care coordination demonstrations received wide coverage by the general media. Unfortunately, much of this focused on the study’s overall finding that these programs didn’t reduce hospitalizations or Medicare spending. For example, the AP story’s headline, “Study finds bid to cut Medicare costs failed,” was used by many papers such as the Washington Times.
However, the actual study had much more complex, important, and useful findings, and the paper’s authors from Mathematica, (which Medicare contracted to do the analysis from this project), deserve a lot of credit for extracting meaningful information from this project.…
Communicating Health Quality Measures
Educating patients, (a.k.a. “consumers”), to make the “best” health care choices has been a fundamental principle in some health reforms schools, including those advocating for more high-deductible health plans. While this concept makes sense in economic theories, it also requires belief that patients can and will make good use of the information available to them – particularly when they are ill.
Another fundamental necessity for making such consumer-directed healthcare work to improve quality and lower costs is that the information provided to people is meaningful and accurate. A study published in the November/December 2008 issue of Health Affairs illustrates the complexity of providing accurate information.…
Darwinian Politics of Health Reform in the U.S.
Tomorrow is Charles Darwin’s 200th birthday, and the Economist had a very interesting article about how his original theories have evolved over the past 200 years – and how a greater understanding of human evolution have revealed insights into human society and economics.
One of the most interesting observations in the Economist article is the differing levels of belief in evolution among countries. The article explains these differences as possibly arising from the country’s safety nets for vulnerable people, i.e., individuals who have less concern about being able to obtain food or housing may be less likely to believe in God and be more likely to believe in evolution. …
Osteoporosis – Increasing Rates and New Treatments
A press release from the NIH yesterday announced a new discovery about the biology of bone remodeling that may lead to a new way to treat osteoporosis. The study, (published in Nature), described how a compound found in the blood helps control the development of bone destroying cells called osteoclasts. (Osteoclasts break down bone while osteoblasts build new bone – The balance between these two cell types determines whether bone density and strength stays the same, increases or decreases.)
Lead for New Treatments for Osteoporosis
The effects of this compound, (sphingosine-1-phosphate), on osteoclasts may lead to the development of new treatments for osteoposorisis since the existing treatments have focused on the activity of more mature osteoclasts and osteoblasts. …
Chronic Wellness Promotion v. Chronic Disease Management in Medical Homes
One of the hottest health reform topics is Medical Homes: Medicare has Demonstration Project starting this year, several states have implemented, (or are implementing), medical home related initiatives, the Center for Studying Health System Change (CSHSC) released a great white paper titled “Making Medical Homes Work,” and the New York Times just had a story about how IBM is teaming up with United Healthcare to promote Medical Homes for their 11,000 employees and dependents in Arizona.
Definition of Medical Homes
One of the controversies in Medical Homes is the definition. CSHSC and many others use the definition developed by 4 national medical societies which combines aspects of preexisting primary care and chronic care models with the goal of creating a primary care “home” that can more effectively address the needs of patients with chronic conditions.…
High Costs of Cancer Treatments for Patients Not on Medicare
Last week I wrote about the challenges of people with Medicare getting the best treatments for cancer. Today, the Kaiser Family Foundation released a report examining the challenges people who get insurance through the private system, (i.e. employer based or individually purchased), have affording their cancer treatments. And how the public insurance programs, (i.e. Medicare and Medicaid), have waiting periods or other enrollment requirements that delay or prevent patients from being covered immediately – something which is of particular concern for patients with cancer.
The Kaiser Family Foundation’s report presents an excellent mix of data analysis and individual patient examples. The report’s conclusions are that our health system has a significant number of holes (or cracks) that people can slip into causing them to suffer clinicall and/or financially. …
Advancements in Understanding Head Trauma and Preventing Long-Term Problems
When I was training to become an orthopedic surgeon, one of the senior physicians said that the two best learning sources for orthopedic surgeons were football and war. Over the past year I’ve been talking with friends and colleagues about another connection between war and football – how minor repetitive head trauma has long-term serious consequences.
It has become clear with the increasing reports about the neurological, cognitive and personality problems military personnel have experiences after repeated minor concussive events, (often from being inside vehicles hit by IEDs), that this is a real and serious situation. While the VA health system has taken steps to understand the consequences of repetitive minor head trauma and work to provide appropriate diagnostic and treatment methods, I have been telling people that this new understanding of neuro-trauma will have implications for football.…