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Monday, June 2, 2014

Health Care Reform Articles - June 2, 2014

Unnecessary Tests and Procedures In the Health Care System
What Physicians Say About
The Problem, the Causes, and the Solutions Results from a National Survey of Physicians
May 1, 2014
Conducted for
The ABIM Foundation
By
PerryUndem Research/Communication
Sponsored by the Robert Wood Johnson Foundation
Physicians Say Unnecessary Tests and Procedures Are a Serious Problem, and Feel a Responsibility to Address the Issue 
Introduction
May 1, 2014. Funded by the Robert Wood Johnson Foundation, the ABIM Foundation commissioned PerryUndem Research/Communication to conduct a national survey of physicians. The purpose of the survey was to gauge physicians’ attitudes toward the problem of unnecessary tests and procedures in the health care system, views on the causes of the problem, and their perspectives on various solutions. The survey also measured exposure to the Choosing Wisely® campaign and compared self-reported behaviors between those with and without exposure to the campaign.
The survey was conducted by telephone from February 12 through March 21, 2014 among n = 600 physicians (primary care and specialists) nationwide. The margin of sampling error is + 4.0 percentage points. The margin of error is larger for smaller subsamples. More information about the methodology can be found at the end of this report.
Following are detailed findings.
http://www.choosingwisely.org/wp-content/uploads/2014/04/042814_Final-Choosing-Wisely-Survey-Report.pdf


Life Beyond the Cancer Clinic

By MIKKAEL A. SEKERES, M.D.
 

Three years.
That’s the total amount of time we train to be oncologists.
It’s both a lot of time and not enough.
When we enter our oncology fellowships, most of us have spent four years in college, four or five years in medical school, and three years completing an internal medicine residency. We donate our 20s — what are supposed to be our “fabulous years” — to studying how to be doctors. Is it any wonder we emerge just a little bit socially awkward and behind the times? And then we dedicate what seems like an eternity — another
Yet, three years seems a trifle in the vast expanse of time it would take to understand all of oncology. In that time, we have to learn how to distinguish cancer from noncancerous conditions (we live in fear of administering toxic treatments to somebody whose disease doesn’t deserve them); measure the extent of cancer, and thus its stage; identify therapies most successful in containing, even eliminating, specific cancers; and escort our patients past the cabal of nasty chemotherapy toxicities, anxiety of cancer returning, and long-term cancer and treatment consequences that threaten to overthrow their return to well-being.
In the end, we really only follow our new cancer patients for a short time, and thus emerge from training unaware of how our patients’ lives play out beyond their immediate therapy.



Insurance CEO: Hawaii Needs To Shut Down State’s Obamacare Exchange

May 9, 2014 3:36 PM

HONOLULU (AP) — The chief executive of Hawaii’s largest health insurance company is calling on Hawaii to shut down its beleaguered health insurance exchange.
Michael Gold, president and CEO of Hawaii Medical Services Association, says the state shouldn’t keep spending money on a system that is financially unsustainable and does not work.
Gold says Hawaii should ask the federal government for an exception to the part of the Affordable Care Act that requires states to run their own insurance exchanges.
He proposes that businesses buy insurance plans directly from the insurance companies. Individuals would do the same, buying directly through insurers, or the federal government could take over that part of the exchange.
The Hawaii Health Connector was awarded about $200 million in federal funds and enrolled about 9,200 people in six months.

Doctor Shortage Is Cited in Delays at V.A. Hospitals

By  and 
Dr. Phyllis Hollenbeck, a primary care physician, took a job at the Veterans Affairs medical center in Jackson, Miss., in 2008 expecting fulfilling work and a lighter patient load than she had had in private practice.
What she found was quite different: 13-hour workdays fueled by large patient loads that kept growing as colleagues quit and were not replaced.
Appalled by what she saw, Dr. Hollenbeck filed a whistle-blower complaint and changed jobs. A subsequent investigation by the Department of Veterans Affairs concluded last fall that indeed the Jackson hospital did not have enough primary care doctors, resulting in nurse practitioners’ handling far too many complex cases and in numerous complaints from veterans about delayed care. “It was unethical to put us in that position,” Dr. Hollenbeck said of the overstressed primary care unit in Jackson. “Your heart gets broken.”
Her complaint is resonating across the 150-hospital Veterans Affairs medical system after the department’s inspector general released findingson Wednesday that the Phoenix medical center falsified data about long waiting times for veterans seeking doctor appointments.
http://www.nytimes.com/2014/05/30/us/doctor-shortages-cited-in-va-hospital-waits.html?_r=0

In rural Maine, dearth of doctors is a growing crisis

At a time when fewer young people are choosing to become primary care physicians, the state is poised to see a dramatic increase in need.

Jennifer Desmond stood in the middle of Vinalhaven island’s Old Harbor Road on a January day. The cold rain and fierce wind chafed her face as she helped paramedics respond to a car accident.
Desmond – a nurse practitioner and the island’s unofficial comforter-in-chief – should have been home with her feet up sipping hot chocolate on that day in 2012. She was nine months pregnant, and it was her official due date. But Desmond needed to work because the island was short on doctors, a common occurrence during her eight years on the island.
“It was crazy, but it was crazy all the time,” Desmond, 41, said last week, recalling a period when her life was filled with 16-hour workdays and weeks without a day off. “I can’t tell you how many times I would go home, take my shoes off and immediately my pager would go off.”
Vinalhaven and other rural areas of Maine often suffer shortages in primary care, and the problem is expected to worsen in the coming decades unless action is taken, authorities say. Physicians are aging and not enough young doctors are willing to locate to small towns or the countryside to pursue a career in primary care when they are laden with big medical school bills and would receive significantly less pay than their specialized peers.
The trends cut against rural medicine in Maine and elsewhere:
• Maine’s distribution of primary care physicians is wildly uneven, with a disproportionate number choosing to practice near Portland. In Cumberland County, there were 163 primary care doctors per 100,000 people in 2010, the latest numbers available, according to the federal data. In more rural counties, the per capita rate is less than half that: 45.7 in Washington, 53.6 in Oxford, 65.2 in Sagahadoc, and 65.1 in Somerset. The national average is 90.5 primary care doctors per 100,000, according to the Association of American Medical Colleges.
• Fewer medical school students are going into primary care. The number of doctors choosing primary care training programs declined nationally from 3,293 in 1998 to 2,730 in 2011, according to the University of Washington Rural Health Research Center. Specialists earn far higher salaries than family doctors.
• Many recent medical school graduates belong to a generation that increasingly shuns rural areas when choosing where to live. Nearly 90 percent of millennials, roughly those in the 18-34 age bracket, want to live in urban places, according to a 2012 survey by the Robert Charles Lesser and Co. real estate firm. Surveys also show millennials favor public transportation and express a desire to be less reliant on cars, which could spell trouble for Maine, with its rural character and weak public transportation network.

The Vanishing Cry of ‘Repeal It’

By 

It was supposed to be so easy this election year for Republican congressional candidates. All they would have to do was shout “repeal Obamacare!” and make a crack about government doctors and broken websites, and they could coast into office on a wave of public fury. The failure of the Affordable Care Act was simply assumed.
But it has not quite worked out that way. The government website was fixed, and 8.1 million people managed to sign up for insurance through the exchanges. An additional 4.8 million people received coverage through Medicaid and the Children’s Health Insurance Program. Three million people under the age of 26 were covered by their parents’ plans. Though the law itself has never been widely popular, most people say they like its component parts, and a large majority now says it wants the law improved rather than repealed.
That sentiment conflicts with the Republican playbook, which party leaders are suddenly trying to rewrite. The result has been an incoherent mishmash of positions, as candidates try to straddle a widening gap between blind hatred of health reform and the public’s growing recognition that much of it is working.
Sometimes the dissonance reaches nearly comic levels. The Senate minority leader, Mitch McConnell, recently won his party’s primary for his Kentucky Senate seat in part by saying he wanted to repeal the health law “root and branch.” Last week, though, he was asked what repeal would mean for the 413,000 people who had signed up for insurance under Kynect, Kentucky’s state-run exchange. “I think that’s unconnected to my comments about the overall question,” he said. Mr. McConnell knows full well, of course, that the popular Kynect program was created by the Affordable Care Act and could not exist without it, but he is hoping to fool his constituents into believing the health care access they like has nothing to do with the law he has fought against for so long or with President Obama.
http://www.nytimes.com/2014/06/02/opinion/the-vanishing-cry-of-repeal-it.html?hpw&rref=opinion

Republican candidates in 2nd District face health care conundrum

Getting rid of some parts of the Affordable Care Act while keeping other parts could destabilize the law.

By Michael Shepherd 
Kennebec Journal
The Republicans running for Maine’s 2nd Congressional District want to repeal and replace the federal Affordable Care Act, but a health policy expert said eliminating elements they disagree with could undermine parts of the law that they like.
The candidates, Kevin Raye and Bruce Poliquin, have run a heated primary, but they agree on getting rid of the national health care reform law championed by Democratic President Barack Obama that passed Congress without Republican support in 2009.
At a May debate in Brewer, Raye said the way the law passed “doomed it from the start.”
Poliquin said the parts of the law that “kill jobs” – such as an impending mandate that will require businesses with 50 or more people to provide health care to employees – must be removed, and also noted that many new taxes were created under the law.
But that doesn’t mean the candidates want every single element of the sweeping law scrapped. Neither does the general public, even though the law is unpopular overall, with Gallup polls for most of the past year finding majorities in opposition. However, parts of the law are popular.
If Raye or Poliquin wins the seat and Republicans keep control of the U.S. House of Representatives and win the Senate from Democrats, they likely won’t get a crack at repealing the law, also known as Obamacare, because the president will be in office through 2016.

FDA cancer chief says ‘escalating’ drug prices can’t continue

By Julie Steenhuysen, Reuters
Posted June 02, 2014, at 7:25 a.m.
CHICAGO — By law, Dr. Richard Pazdur, the U.S. Food and Drug Administration’s cancer drug czar, is not allowed to consider the cost of treatments his agency reviews, only whether they are safe and effective.
But Pazdur is not blind to escalating drug prices and the growing debate over how to place an appropriate value on cancer drugs, which can cost $100,000 a year or more a year.
“It’s very difficult for me to talk about,” Pazdur said in an interview at the American Society of Clinical Oncology meeting in Chicago, where the issue of value has been a consistent theme among the world’s top cancer doctors.
Instead, he recounts a story about buying his first house in Detroit in 1982.
“I was very nervous. I asked the Realtor if I was paying the correct price. She said to me, ‘Rick, the price is what anybody is willing to pay for it.’”
In his view, the same applies to cancer drugs.
“Everybody knows that these are expensive drugs,” he said. “Obviously, we can’t just continue going on with escalating prices of drugs. That’s not a regulatory decision or anything profound from the FDA. It’s just the reality of the situation.”
Pazdur said the solution will likely take “a national dialogue” involving all stakeholders — insurers, patients, doctors, lawmakers.
At the ASCO meeting this week, that dialogue already has begun. In a forum on drug costs, Dr. Ezekiel Emanuel, architect of President Barack Obama’s health care law, said costs no longer can be ignored. Emanuel reminded his well-heeled audience that the median household income in the United States is $52,000.
“It’s not a lot of money, especially compared to almost everything we do for cancer patients,” he said. Just one costly cancer drug “wipes out the median income household.”
And while the FDA may be barred from considering cost, Dr. John Marshall of Georgetown Lombardi Comprehensive Cancer Center said the agency might reconsider its standards of deciding which drugs offer enough benefit to win approval.
“Is a $30,000-a-month drug that improves survival by 1.4 months effective? By an FDA standard, yes, if it meets the safety and efficacy data bar. But you would never swipe your Visa card for that kind of advantage,” Marshall said.


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