Advancements in Understanding Head Trauma and Preventing Long-Term Problems

January 28, 2009 / Michael D. Miller MD / Delivery of Healthcare, Public Health, Quality of Care & Safety / 1 Comment

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.…

States Poaching Biotech Companies

January 28, 2009 / Michael D. Miller MD / Innovation, Politics / No Comments

In the Boston Globe there have been a couple of articles and an ad that pointed out the challenges states have in promoting and keeping productive and growing companies in their states.

In today’s paper there is an article about how the Governor of Massachusetts is going to the West Coast to “to network with executives at computer and energy companies that have large facilities here, aiming to shore up and even expand their employment and investments in Massachusetts.” While this is presumably a very good thing for Massachusetts, it raises two thoughts:

When I moved to Massachusetts in 2002 people were talking about how the state had lost its lead in the computer industry in the 1970s and 80s to California
The article doesn’t mention biotechnology, life sciences or healthcare – industries where Massachusetts still has a leadership position

This second point is particularly important because Saturday’s Globe had an article about how state regulations scheduled to take effect July 1st requiring disclosure of industry payments to physicians may cut down on medical meetings in Boston. …

Managing Expectations for Federal Health Reform

January 28, 2009 / Michael D. Miller MD / Access to Healthcare, Federal Healthcare Reform / 1 Comment

One of the challenges facing health reform legislation are the expectations of different stakeholder groups – many of whom were strong supporters of the Barack Obama’s campaign. Although the new Administration has only been in office a week and a day, a number of signs point to the fact that health reform legislation will not be quickly formed and passed – including an article in today’s Boston Globe titled, “Some fear window is narrow for healthcare overhaul.”

But not rushing health reform was both predictable and a good thing. First, the reasons why it won’t happen quickly:

It takes time for the new Administration and Congress to get organized – and they are rightly prioritizing actions to address the economic “situation”
The US system of government is designed to be deliberative and not speedily make major decisions
For reasons that are not fully apparent, the Senate is taking longer to confirm Tom Daschle as Secretary of HHS – although there are no signs that this won’t happen soon
Senator Kennedy’s health has been a question mark, but his staff has been working diligently to prepare legislative framework and language in conjunction with other Congressional offices such as the Finance Committee
Congressman Waxman’s taking over the Chairmanship of the Energy and Commerce Committee will likely mean some staff turnover in that Committee which also takes time – particularly since Congressman Waxman is known for getting some of the best and brightest staff in Congress

And second, not rushing health reform legislation through the process may be a good thing because no matter what scope and details the legislation eventually includes, getting more groups comfortable with its goals, priorities and specifics will make it more likely to succeed. …

Improving Cancer Care and Medicare’s Cancer Coverage

January 28, 2009 / Michael D. Miller MD / Access to Healthcare, Comparative Effectiveness, Innovation, Medicare / 2 Comments

The New York Times and Wall Street Journal both had articles yesterday about a new rule clarifying how Medicare would decide whether or not to pay for off-label uses of medicines to treat cancer. These articles describe controversies around Medicare relying on several compendia containing information about such off-label uses to make these coverage decisions, how some of the compendia may have industry connections, and how the new rule might increase Medicare spending.

I have a long history with this issue. As a Legislative Assistant working for Congressman Sander Levin in the early 1990s, I was very involved in writing the legislation that first changed Medicare law to require Medicare Part B to pay for off-label used of medicines to treat cancer. …

Health Reform and the Economy: 4 Spheres to Consider

January 25, 2009 / Michael D. Miller MD / Access to Healthcare, Delivery of Healthcare, Health System Reform / 2 Comments

Many people and pundits have opined on the effects that the economic downturn will have for the likelihood of health reform: On the Federal level, how much money will be available for expanding insurance coverage, and how much money will be included in the “stimulus package” – and for what? And in the States, how much will be cut from Medicaid programs and government employees’ benefits? In addition, there have been news stories about the economic downturn leading to loss of insurance coverage secondary to job-loss, as well as people forgoing direct medical care, healthy activities, and wellness behaviors.

These points illustrate how the multiple parts of our health care “system” interconnect, (particularly financing effecting delivery), and everything existing within the overall economic environment. …

Quality of Care in Medical Practices – Size Does Matter

January 19, 2009 / Michael D. Miller MD / Clinician-Patient Relationships, Delivery of Healthcare, Health System Reform, Information & Communications, Quality of Care & Safety / 6 Comments

The Journal of General Internal Medicine published a study last month that looked at primary care medical practices in Massachusetts to see how well they were able to provide the quality improving capabilities of Patient-Centered Medical Homes. These structural capabilities represent process measures that assess the quality of care in medical practices. However, these same measures could also help patients select their own primary care physicians.

Study Finds Larger Practices Have More Quality Related Capabilities
Not surprisingly the study found that larger practices, (and to a lesser extent those affiliated with larger networks of practices), provided more capabilities to improve the quality of patient care.…

Health Spending, Health Reform, and Physicians

January 15, 2009 / Michael D. Miller MD / Economics & Financing, Federal Healthcare Reform, Politics / 7 Comments

The Centers for Medicare and Medicaid Services released 2007 US healthcare spending data in late December. Since then several publications have come out analyzing this information. The most comprehensive is probably a Health Affairs article which highlighted a slowdown in the growth in spending for prescription drugs and government administration.

The Center for American Progress also recently issued a paper comparing the US healthcare system in 2007 to the situation in 1994. This paper concluded:

“The status quo of American health care is spending more money to cover fewer people, yielding disappointing outcomes. Effective reforms, which would invest in measures to improve the quality and delivery of care, reform payment to reward outcomes, and provide affordable, accessible, comprehensive health insurance for all Americans, are long overdue.

…

Groups Seeking Funds in Health Reform

January 12, 2009 / Michael D. Miller MD / Economics & Financing, FDA, Medicaid, Medicare, Politics / No Comments

With all the anticipation about health reform happening soon, many groups are expecting increased Federal funding for different things, e.g. electronic medical records, expansion of SCHIP and Medicaid (or at least great funding assistance to States), more emphasis on personalized medicine, more resources for FDA to help them with their expanding domestic and international responsibilities, closing the donut hole in the Medicare outpatient prescription drug benefit, fixing Medicare’s physician payment formula, etc.

Another area looking for increased emphasis and funding – both as part of health reform and economic/jobs stimulus – are biomedical researchers. The Boston Globe and Mass High Tech had articles last week describing how the Massachusetts Life Sciences Collaborative is lobbying for more NIH grant money. …

Auto Industry Retirees’ Health Benefits Squeezed Again

January 8, 2009 / Michael D. Miller MD / Economics & Financing, Politics, Private-Employer Based Health Insurance / 2 Comments

In all the discussion about the auto industry’s financial problems, health care costs for retirees are often brought up as one of the major challenges the big 3 domestic companies. This is not a new issue, and one that I actually researched in the early 1990s when I worked for a Congressman from the Detroit area. What is new is that the companies had worked out an arrangement with the United Auto Workers union to turn paying for retiree health costs over to Voluntary employees’ beneficiary associations (VEBAs). These VEBAs – one for each company – were created in the fall of 2007, and were funded by the companies as a way to relieve the them of the unpredicatbility of future costs for retiree health benefits starting in 2010.…

Health Reform – Achieving Universal Coverage

January 5, 2009 / Michael D. Miller MD / Access to Healthcare, Delivery of Healthcare, Health System Reform, Medicaid, Public Health / 5 Comments

During the holidays the Obama Health Transition Team urged people to organize discussions about health care in their homes and communities – and then to report back. Reading about these discussions – including the one that Secretary Designee Tom Daschle attended in Indiana – made me think about what things are going to be needed to make health reform actually work.

My end-of-year reflections and ruminations led me to conclude that one of the most challenging parts of health reform will be to actually get more people enrolled in whatever expanded coverage plans are developed and implemented. Enrollment barriers are not new, but they are frequently not highlighted because they may present great political and fiscal risks.…

Transparency in Non-Profit Organizations

December 22, 2008 / Michael D. Miller MD / Delivery of Healthcare, Public Health / 1 Comment

The ongoing series of financial failures and scandals have made me more interested in financial transparency for non-profit organizations – which economic theory states are really supported by everyone because their donations are tax deductible which reduces total tax revenues. My thinking about the finances of non-profits has also been piqued because of an accounting class I’ve been taking, as well as by my last post about transparency in health reform legislation.

One recent example of non-profit organizations increasing their transparency is colleges and universities issuing press releases and sending letters to alumni about how the economic downturn has effected their endowment, and what steps they are taking to be more fiscally conservative – such as freezing hiring or delaying construction projects.…

Transparency v. PAYGO in Health Reform Legislation

December 18, 2008 / Michael D. Miller MD / Economics & Financing, Federal Healthcare Reform, Health System Reform, Politics / 1 Comment

One of the looming questions for health reform legislation in the 111th Congress is how will it be paid for? Or will that be less of a concern because deficit spending in a recession is deemed to be OK?

In earlier times, (i.e., 1990s), the projected costs of legislation had to be “paid-for” under the so-called PAYGO rules – which stands for “pay-as-you-go.” However, in recent years those rules have lapsed or been waived.

Three recent nuggets of information indicate that transparency in the legislative process may be replacing PAYGO in the coming years. First was the Obama Transition Team’s extra-ordinary level of transparency, exemplified by their policy of having information from all meetings with outside groups being posted on the Change.gov…

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