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Telehealth

  • Upstate New York insurer will cover telehealth
    BlueCross BlueShield in New York will cover a new telehealth service provided by the American Well Online Care platform that links patients to medical assistance via the telephone or Internet starting soon with western New York. Plans are in the works to expand the service to the northeastern part of the state later in the year, the insurer said. InformationWeek (3/10)
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March 12, 2010 Posted by | Creative disruption, Health care delivery, health information technology, healthcare, insurance | , | Leave a comment

How Emergency Rooms Are Used

Top 10 Emergency Department Diagnosis Discharges
Rank Diagnosis Category Total Number of Discharges
1 Sprains and strains 6,375,245
2 Superficial injury, contusion 6,107,869
3 Other upper respiratory infections 5,285,382
4 Abdominal pain 4,381,653
5 Open wounds of extremities 3,697,836
6 Spondylosis, intervertebral disc disorder, other back problems 3,236,278
7 Nonspecific chest pain 3,018,660
8 Headache, including migraine 2,825,233
9 Open wounds of head, neck, and trunk 2,692,292
10 Skin and subcutaneous tissue infections 2,610,735

Data Source: HCUPnet. Healthcare Cost and Utilization Project (HCUP), 2006. Agency for Healthcare Research and Quality. Rockville, MD. http://hcupnet.ahrq.gov.

March 1, 2010 Posted by | Health care delivery, healthcare | , | Leave a comment

Speeding Breakthroughs to Market

The Food and Drug Administration and the National Institutes of Health unveiled a plan to work together to speed the process of converting scientific breakthroughs into care for patients.

Read more at modernhealthcare.com

February 24, 2010 Posted by | Health care delivery, healthcare | | Leave a comment

Primary Care Physician Survey Planned

About 9,000 primary care physicians nationwide are being surveyed to examine work force matters, medical homes and other practice issues.

One goal is to help determine whether there are enough primary care physicians to tend to the nation’s needs — especially if insurance coverage is extended to more people in a reformed health system.

“There were discussions of shortages of primary care physicians, and we wanted to understand the nature of the shortage,” said Edward Salsberg, director of the Assn. of American Medical Colleges’ Center for Workforce Studies, which is reviewing the responses.

Reports of long waits to see primary care physicians in Massachusetts after the state extended health insurance coverage to nearly everyone also provided a push for the survey. Physicians in that state have been over-sampled to provide sufficient data to analyze, Salsberg said.

Questions on the four-page survey include asking whether physicians plan to work longer hours or hire more staff if they experience an influx of new patients. The survey also is assessing physicians’ readiness to establish patient-centered medical homes, asking if electronic medical records or disease registries are part of their practice.

In addition, the survey is looking at the impact of the recession on doctors by inquiring about any decrease in patient visits or decline in charity care.

Primary care physicians and subspecialists in pediatrics and internal medicine received the surveys, Salsberg said. Collaborating on the effort with the AAMC are the American Medical Association, American College of Physicians, American Academy of Family Physicians, American Academy of Pediatrics, and American Assn. of Colleges of Osteopathic Medicine.

The AAMC will prepare reports based on the results, which are expected to be analyzed by March or April, Salsberg said.

http://www.ama-assn.org/amednews/2010/02/08/prsd0210.htm

February 11, 2010 Posted by | Health care delivery, healthcare, physicians | , , , | Leave a comment

When will our Elected Officials Listen the the Electorate

Just 36 percent of Americans approve of Mr. Obama’s handling of health care, according to the poll, conducted from Jan. 6 – 10. Fifty-four percent disapprove. In December of last year, 42 percent of Americans approved of the president’s handling of health care, and 47 percent approved in October.

Yet things could be worse: With Democrats in Congress continuing to negotiate the terms of their comprehensive health care package, both Congressional Republicans and Democrats receive even lower marks than the president on the issue, the poll shows.

http://www.cbsnews.com/blogs/2010/01/11/politics/politicalhotsheet/entry6084856.shtml

January 11, 2010 Posted by | Federal Government, Health care delivery | , , | Leave a comment

Who Should Coordinate Your Medical Home

A state legislative push to create pilot programs to test the patient-centered medical home (PCMH) concept has bled over into a long-running debate about advanced practice nurses’ role in medicine.

That debate has taken on new urgency amid a statewide and national shortage of primary-care doctors.

Still, some local PCMH advocates fear House Bill 198, which would create PCMH pilot projects in the Dayton area and Toledo, will stall if disagreements over the role of advanced practice nurses aren’t resolved quickly.

“I think what we have right here right now is a tipping moment,” said Dr. Ted Wymyslo of Family Medicine Dayton. Wymyslo is a key orchestrator in the local PCMH initiative.

The bill needs to “move favorably or it might get mired and lose momentum,” Wymyslo said.

The Ohio Association of Advanced Practice Nurses (OAAPN) is pushing for changes to the bill that would let not only primary-care physicians, but also advanced practice nurses, head up PCMHs.

“We would like to be recognized as leaders of the medical home model,” said Jacalyn Golden, legislative co-chair for OAAPN, which represents 8,000 advanced practice nurses statewide and is based in Centerville.

http://www.daytondailynews.com/business/medical-home-bill-ignites-debate-over-nurses-role-485647.html

January 11, 2010 Posted by | Health care delivery, healthcare, physicians | , , , , | Leave a comment

AMA Backs Health Reform

he nation’s largest physician lobby has officially endorsed the Senate’s health reform package—which cleared key hurdles over the weekend—after it won assurances from lawmakers that they would work to craft a long-term solution for Medicare payment come January 2010.

The original Senate bill included a measure that would erase a 21% pay cut in 2010 with a 0.5% increase, but an amendment, filed on Saturday, squashed the provision.

http://www.modernhealthcare.com/article/20091221/FREE/312219953

December 21, 2009 Posted by | Federal Government, Health care delivery, physicians | , , , , | Leave a comment

Health Care Expense Averages

Average expenses per event for selected event types for adults ages 18-44, 1996 and 2006
Type of visit 1996 (in 2006 dollars) 2006
Office physician visit $119 $180
Inpatient hospital average per diem $2,336 $2,470
Emergency room visit $393 $638
Dental visit $181 $247
Prescription medical purchase $79 $161

 

Data Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey, 2006.

Publication: AHRQ’s Medical Expenditure Panel Survey, Statistical Brief #254, August 2009. http://www.meps.ahrq.gov/mepsweb/data_files/publications/st254/stat254.pdf

December 15, 2009 Posted by | Cost, Health care delivery, healthcare, hospitals | , , , , , , , | Leave a comment

Growing Backlash of Health Care Reform

This from the Washington Examiner:

Two-dozen Democrats from Republican-leaning districts, who voted for the House version of President Obama’s increasingly unpopular health care reform, are beginning to feel a growing public backlash. ReversetheVote.org has already raised $123,105 that will be dedicated exclusively to defeating all 24, including Rep. Gerry Connolly, D-Va., in 2010 if they don’t reject the final conference committee version of the bill. They “voted to take away your healthcare and put it in the hands of federal bureaucrats,” the Web site says. “Democrats made a choice … next fall, voters will make a choice.”

They’re not the only ones. Twenty-nine other House Democrats who voted for the bill come from districts that John McCain carried, making them particularly vulnerable to an angry electorate that never bought into the “hope and change” hype in the first place.

Democratic senators who are up for re-election next year in nine states face the same dilemma. As support erodes for Obamacare’s massive tax increases and deep Medicare cuts, they must also consider the personal political cost. Only 38 percent of the public supports their health care plan, the lowest level of public support in more than two years. As more details of the 2,074-page behemoth — which most members of Congress concede they have not read — continue to trickle out, the more the poll numbers drop.

It’s not hard to figure out why. Obamacare was supposed to lower costs, extend coverage and improve Americans’ health care options. It does none of those things.

Despite accounting gimmicks, Obamacare will cost $4.9 trillion over the next 20 years. This enormous sum will suck the wind out of an already struggling economy. The plan includes higher premiums for younger workers, fines for those who refuse to purchase coverage, lower Medicare payments to doctors and hospitals, and job-killing taxes on employers.

Obamacare will also force an estimated five million workers to lose their employer-provided coverage.

Federal taxpayers will be forced to pay for elective abortions even though only 13 percent favor such coverage.

As far as improving health care options is concerned, the administration wants to cut down on mammograms and slash Medicare Advantage for seniors to save money. After all this spending and upheaval, 24 million Americans will remain uninsured in 2019. Every Democrat who ignores the public will and votes for this higher-cost, lower-care monstrosity will be held accountable. Voters back home won’t let them forget it.

http://www.washingtonexaminer.com/opinion/Growing-public-backlash-over-Obamacare-8587245-73790867.html

November 29, 2009 Posted by | Health care delivery, healthcare | , , , , , , | Leave a comment

Have we Built an Infrastructure that Can Pursue Prevention Effectively

Editor’s note: How do you balance the desire to live longer, more productively (using enormous amounts of health related resources for critical care when it is likely too late) versus utilizing resources for prevention, but the evidence  to pursue this direction requires knowledge, a degree of belief,  and trust in scientific studies that in some case prove out and in others prove to be false?

Said differently, people maintain a degree of skepticism until presented with unassailable facts regarding their demise before being compelled to act. An example of this is smoking behavior.

In the NY Times article the case for engaging prevention behaviors, research and making real sustainable changes in societal structures is something that is impacted by many variables. The debates that must ensue in order to sort this out and develop a uniform direction are complex, emotional and at the very root of the competing beliefs of our society.

Giving people access to health care, enabling comparative effectiveness, funding health information exchanges, funding measurement of quality and effectiveness are puzzle pieces of the architectural structure. Arranging that structure so that it is effective and serves the dual purposes of delivering quality care that is financially responsible is the work that must be done before we build  square pieces for round holes.

So read the article here:

New York Times: http://www.nytimes.com/2009/11/13/health/research/13prevent.html?_r=1&em=&pagewanted=all

A good friend offers this view of human behavior as it relates to these choices.

“When I was a young lawyer, we defended insurance claim of varying kinds.  In particular, we defended products liability cases, many of which involved the effort to establish liability based on failure to warn, or, when there was in fact a warning, the failure to warn adequately.  Every one of these cases would involve an expert testifying about the need for warnings to permit people to identify and manage risk.  The problem was that there was a lot a research that demonstrated that people simply failed to act no mater how clear the warning.  The attached article references that tendency and even talks about focusing cancer research on drugs that treat existing cancers because the population somehow refuses to take low cost drugs proven to prevent cancer.  In perhaps one of the most classic coincidences, I was trying a failure to warn, products liability case and the fire alarm went off in the courthouse.  No one moved for a few seconds, and the Judge called to the deputy to see what was going on and whether there really was anything to worry about.  I think that it was in this case that the jury box had a swinging door that said “pull”, and every time the jury got up to leave, they wound up pushing the door to no effect.  They not only failed to read the plainly labeled door – they couldn’t remember from the morning to the afternoon, or from one day to the other, that one had to pull the swinging door inward.

As I recall the research, it demonstrated that people have a built in risk assessment program – perhaps genetically coded.  It tends to work well in a simple natural surrounding, like the African veldt where much of our evolution occurred.  It fails spectacularly in our modern setting.  The military research on the topic disclosed that certain hard wired training programs were required to reset behavior norms (there were some aircraft accidents as pilots took off from aircraft carriers in WWII that prompted this effort).

The implications for public policy are troublesome.  I hear some say that people cannot be trusted to look out for themselves and that therefore some top down direction is required.  Viewed from a macroscopic societal level, this may even be true.  It might cost less for the society to prevent cancer than it does to treat those cancers that occur.  After reading this article, you would have to say that we can achieve prevention effectively by retraining everyone in the society.  This raises that interesting philosophical question of whether we should have someone who has the authority to say “I know what’s good for you and I’m going to make you do it no matter what!”  In essence, the current health care legislation takes that position with having health care.  It mandates coverage.  It mandates coverages within policies.  In these respects, it presumes to tell individuals what they must do.  Yet, after looking at the article, and all the common health wisdoms that find no statistical support in rigorous studies, can you imagine how many mandates we might face if this philosophy finds traction?  For example, I have looked at the underlying studies on DDT and for trans fats, and those fail to correlate the substances with negative effects.  Indeed, the World Health Organization recently lobbied to reinstate the use of DDT, which provoked a firestorm of criticism.

Our political structure as framed in the Constitution was intended to make such mandates incredibly difficult to impose.  It appears that our political class has overcome the philosophical difficulties with imposing requirements at the point of a gun.  It will remain to see if the Supreme Court goes along.  There is apt to be some serious litigation on these topics in my view.”

November 15, 2009 Posted by | Accountability, Affordability, Cost, Economics of Health care, Electronic health records, Federal Government, Health care delivery, healthcare, Prevention and Wellness | , , , , , | Leave a comment