Small-Picture Approach Flips Medical Economics
By BRUCE JAPSEN
CHICAGO — Even as she struggled to manage her Type 2 diabetes, Fannie Cline’s condition spiraled downward. It was not uncommon for Mrs. Cline, a 69-year-old retiree, to have dizzy spells, some so bad that they landed her in a hospital emergency room near her home here on the South Side.
But last May, she began to receive extra attention from Gwlie Lloyd, a registered nurse and care manager at Advocate Health Care, which operates a number of Chicago hospitals and clinics. Ms. Lloyd frequently calls to check on Mrs. Cline; she offers advice on diet and exercise, schedules appointments, orders meals for delivery and arranges appointments with a social worker.
As a result, Mrs. Cline’s health has markedly improved. She is more active, the dizzy spells have subsided and she has not been hospitalized since May. Now she spends her days visiting friends.
Hospital Groups Will Get Bigger, Moody’s Predicts
By REED ABELSON
Responding to changes in health care, big hospital groups are expected to get even bigger. And some hospitals will join forces with once-unlikely partners, health insurers and for-profit companies, a new report says.
The difficult business environment and the changes expected in how hospitals will be paid for delivering care are driving many smaller, stand-alone hospital groups into the arms of larger and better-financed organizations, said Lisa Goldstein, who follows nonprofit hospitals for Moody’s Investors Service and is one of the authors of a report expected to be released Thursday.
The report by Moody’s predicts even more consolidation. “We think the pace will accelerate,” she said.
While hospitals have always looked to mergers as a way of becoming larger, partly to demand higher payments from insurers, they are now also looking for ways to become more efficient. Hospitals are expecting to see lower reimbursements from Medicare and to find it increasingly difficult to persuade private insurers to pay more for care.
Public and private insurers also are demanding that hospitals work better with doctors both to coordinate care and to improve the quality of care so people stay out of emergency rooms and avoid hospital stays altogether.
Giving Dennis Kucinich his due
By Katrina vanden Heuvel,
A certain kind of politician is becoming a dwindling breed. I’m not thinking of the over-praised and frequently eulogized centrist, the kind who spends a career watering things down and gets lionized for having done so. I mean the bold, politically courageous people who make real the cliché, “Speak truth to power.” The ones who are, perhaps, a little too righteous, who don’t compromise easily, but who prove again and again a tendency to be correct. They are the ones who are harder to dismiss, no matter how much the pundits or corporate media try. They insert themselves into the national conversation, pushing their ideas and their vision into the debate.Dennis Kucinich is one of those politicians. At least, he was. Last week, thanks in large part to Republican gerrymandering, he lost his bid for reelection. In his loss, the country loses something too. Whatever your view of Kucinich’s politics or style, he mattered a great deal.
Kucinich was never afraid to take the positions that should have been at the core of the Democratic party. He opposed the Patriot Act when few brave Democrats would join him. He wasopposed to the Iraq war from the outset, whipping his colleagues against it, with the result that three-fifths of House Democrats voted against that immoral, illegal invasion. Once it began, he called on Congress to defund it, when few in his party were willing to go along. Despite almost no political support, he introduced articles of impeachment against Vice President Cheney, accusing him (rightly, I believe) of lying to the American people to get us into the war in Iraq.
http://www.washingtonpost.com/opinions/dennis-kucinich-drove-the-progressive-conversation/2012/03/12/gIQA7vAT9R_print.html
Antipsychotic drugs grow more popular for patients without mental illness
By Sandra G. Boodman,
Adriane Fugh-Berman was stunned by the question: Two graduate students who had no symptoms of mental illness wondered if she thought they should take a powerful schizophrenia drug each had been prescribed to treat insomnia.
“It’s a total outrage,” said Fugh-Berman, a physician who is an associate professor of pharmacology at Georgetown University. “These kids needed some basic sleep [advice], like reducing their intake of caffeine and alcohol, not a highly sedating drug.”
Those Georgetown students exemplify a trend that alarms medical experts, policymakers and patient advocates: the skyrocketing increase in the off-label use of an expensive class of drugs called atypical antipsychotics. Until the past decade these 11 drugs, most approved in the 1990s, had been reserved for the approximately 3 percent of Americans with the most disabling mental illnesses, chiefly schizophrenia and bipolar disorder; more recently a few have been approved to treat severe depression.
But these days atypical antipsychotics — the most popular are Seroquel, Zyprexa and Abilify — are being prescribed by psychiatrists and primary-care doctors to treat a panoply of conditions for which they have not been approved, including anxiety, attention-deficit disorder, sleep difficulties, behavioral problems in toddlers and dementia. These new drugs account for more than 90 percent of the market and have eclipsed an older generation of antipsychotics. Two recent reports have found that youths in foster care, some less than a year old, are taking more psychotropic drugs than other children, including those with the severest forms of mental illness.
latimes.com
New rules aim to ease state-run health insurance exchanges
The exchanges are a key feature of President Obama's healthcare law, but questions — and criticism — have grown as the deadline approaches for setting them up.
By Noam N. Levey, Washington Bureau
6:44 PM PDT, March 12, 2012
Reporting from Washington
Portland forges trail away from obesity
Posted: 10:32 AMUpdated: 10:33 AM
New exercise stations are part of the city's two-year public health campaign.
Shane Dreibholz, left, and Nate Ellis install a rope ladder on Monday at Back Cove that is among exercise stations being built across Portland. The fitness trails and other anti-obesity efforts were funded by a federal grant to the city.PORTLAND — City workers hooked up a rope ladder along Back Cove on Monday, putting one of the finishing touches on a two-year effort aimed at preventing obesity.http://www.pressherald.com/news/forging-a-trail-away-from-obesity_2012-03-13.html
The Effect Of Physicians’ Electronic Access To Tests: A Response To Farzad Mostashari
By Danny McCormick, David Bor, Stephanie Woolhandler, and David Himmelstein
Health Affairs Blog, March 12th, 2012
Health Affairs Blog, March 12th, 2012
Our recent Health Affairs article linking increased test ordering to electronic access to results has elicited heated responses, including a blog post by Farzad Mostashari, National Coordinator for Health IT. Some of the assertions in his blog post are mistaken. Some take us to task for claims we never made, or for studying only some of the myriad issues relevant to medical computing. And many reflect wishful thinking regarding health IT; an acceptance of deeply flawed evidence of its benefit, and skepticism about solid data that leads to unwelcome conclusions.
Primary Care: Can Seeds Of Innovation Take Root?
By Thomas Bodenheimer
Health Affairs, March 2012
“Breaking Point: How The Primary Care Crisis Endangers The Lives Of Americans”
by John Geyman
Friday Harbor (WA): Copernicus Healthcare, 2011
234 pp.; $18.95
Many innovations in health care falter. New drugs, hastily approved, can disappear in a flurry of bad outcomes. Medical devices (some metal-on-metal hip replacements, for instance) turn into disasters for those who have them. Certain attempts to improve quality might be oversold and fail to live up to their initial hype; pay-for-performance comes to mind. In health policy, so-called tipping points[1]— times when new ideas spread rapidly to become the norm—are few and far between.
An innovation that “tipped” successfully into place in the recent past is the hospitalist movement, in which hospital-based general physicians handle care for hospitalized patients in place of the patients’ primary care physicians. It took the nation by storm in the 1990s and, for better or worse, changed the way both in- and outpatient care are delivered. Coming now to the innovation forefront is the patient-centered medical home—also known as “transformed primary care,” “twenty-first-century primary care,” and “the primary care of the future.”
http://www.pnhp.org/print/news/2012/march/primary-care-can-seeds-of-innovation-take-root
Health Affairs, March 2012
“Breaking Point: How The Primary Care Crisis Endangers The Lives Of Americans”
by John Geyman
Friday Harbor (WA): Copernicus Healthcare, 2011
234 pp.; $18.95
Many innovations in health care falter. New drugs, hastily approved, can disappear in a flurry of bad outcomes. Medical devices (some metal-on-metal hip replacements, for instance) turn into disasters for those who have them. Certain attempts to improve quality might be oversold and fail to live up to their initial hype; pay-for-performance comes to mind. In health policy, so-called tipping points[1]— times when new ideas spread rapidly to become the norm—are few and far between.
An innovation that “tipped” successfully into place in the recent past is the hospitalist movement, in which hospital-based general physicians handle care for hospitalized patients in place of the patients’ primary care physicians. It took the nation by storm in the 1990s and, for better or worse, changed the way both in- and outpatient care are delivered. Coming now to the innovation forefront is the patient-centered medical home—also known as “transformed primary care,” “twenty-first-century primary care,” and “the primary care of the future.”
http://www.pnhp.org/print/news/2012/march/primary-care-can-seeds-of-innovation-take-root
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