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Sunday, August 31, 2014

Health Care Reform Articles - August 31, 2014


Editor's Note:

I have embarked on an experiment and have created by own website at www.philcaper.net. It contains links to my regular Bangor Daily News columns and to other articles I have written, as well as a link to a radio interview (about 30 minutes long) I did recently during a visit to Seattle and to the Maine AllCare website.

 In addition, I have devoted a page in the website to articles by others I think are especially important or well written (often both).

It is a work in progress, and other material will be added and some deleted as time goes on.

If you'd like, let me know what you think of it and please forward any suggestions you may have for improving it and making it more useful to me at pcpcaper21@gmail.com.

- SPC


A Visit with a Neighbor
By Richard Dillihunt, MD

 For decades, I have admired the Canadian health care system, first while at a remote Northern Quebec fishing camp. There, impromptu sick call was held for the Cree, local aboriginal people with rights to this remote land. Members of this tribe had various complaints that we treated with our medical chest. Despite the difference in language in the elderly, the shyness barriers were easily overcome. They seemed completely confident in our medical abilities.
We felt privileged as caregivers to be given such confidence and warm doctor-patient relationships came forth. Over the years we saw burns from campfire mishaps, an acute gallbladder, and a mangled hand injured beyond our medical capabilities. We made radio calls to regional flying services, and patients were fetched and flown to various medical centers. There were no lawyers or insurance companies involved. The only physical evidence of health care coverage was a small card that each patient guarded carefully. This card admitted them to their national health care system. It provided quality medical care covering all 35 million Canadians scattered across the second largest nation on earth.
The patient with the injured hand was emblematic of this system. A radio call summoned a floatplane, and the patient was loaded and lugged across and down the 150 km of the Peribonka River to the medical center in Chicoutimi. After treatment, he was returned by air. That little card had covered all medical care and transportation. Imagine what such a journey would cost us!
This system of universal health care came into being in 1946. It is attributed to a Canadian native son, Tommy Douglas. As premier of Saskatchewan, he established a universal single payer health care for all of Canada. After his death he was voted “Greatest Canadian” by the Canadian Broadcast Corporation viewers.
Although medical service for the Cree and Inuit have been difficult for the Canadian government to perfect, they have enjoyed great success. Given the vast territory, the nation does well to spread its resources over ten million square km, much of it being a harsh environment.
The Canadian system deserves careful scrutiny by every American who has concerns regarding our badly broken health care system. Inspection of how the Canadians have successfully developed their universal single payer form of health care uncovers features that the US needs to seriously consider. Just recently Danielle Martin, a brilliant young Canadian physician, called attention to the superior provisions of Canada’s public system in her testimony before Sen. Bernie Sanders’ committee in Washington. She showed that the Canadian system is based on need, not on the ability to pay. Her interaction with Sen. Burr (R-NC) went viral, generating over 700,000 views on YouTube across North America. Many major media outlets focused on her evidence-based, intelligent, and energetic defense of Canadian Medicare.
Canadians take great pride in their medicare-for-all system. They know that Canada’s life expectancy rates and maternal and infant mortality figures are superior to America’s, and their quality of care is equal to ours. They are aware that, traditionally, wait times have been a source of intense criticism of their system. They understand that this is largely overblown by stateside special interest groups whose propaganda has brainwashed America about horrendous waiting times for referrals and elective surgery. The facts show differently. Canada has addressed wait time issues with a Wait Time Alliance. Through this alliance there has been much improvement, and changes have been uncovered to correct this problem.
Two nations have developed, through different pathways, health care systems which are clinically similar and among the world’s best. When compared, Canada has taken the high ground, selecting a route featuring social justice and equality with a strong nationalism. Canadians are caring for one another. America’s profit- driven hard-nosed traditions and business practices have permeated the ways and means of the USA’s health care.
Lacking checks and balances, our system costs nearly twice that of Canada’s per capita, $8233 vs $4445 yearly. This accounts for 17.6% of America’s GDP while Canada’s health care expenditure is 11.4% of her GDP according to 2012 statistics. The most stunning statistic of all is this. Even with the ACA finally deployed, there are over 30 million uninsured American citizens, approximately equal to the entire population of Canada where everyone is covered by Medicare, and a simple little card replaces by comparison a vast array of paperwork that chokes our system.
The Canadian system is remarkably popular in America. Maine must pay attention to this surge. Because of our unique geographical location, we are surrounded by Canadian relatives, friends, and neighbors. Canada can provide us with more than frigid winds. We need to lead the way in acknowledging a very attractive Canadian healthcare system.
http://www.mainemed.com/sites/default/files/content/JulAugSep2014_FINAL.pdf



New Novartis Drug Shows Striking Efficacy in Treating Heart Failure

By 
An experimental drug has shown a striking efficacy in prolonging the lives of people with heart failure and could replace what has been the bedrock treatment for more than 20 years, researchers said Saturday.
The drug, which is being developed by the Swiss company Novartis, reduced both the risk of dying from cardiovascular causes and the risk of being hospitalized for worsening heart failure by about 20 percent in a large clinical trial.
“I think that when physicians see these data, they will find it compelling, and what we will see is a paradigm shift,” said Dr. Milton Packer, a professor of clinical sciences at the University of Texas Southwestern Medical Center in Dallas and one of the two principal investigators in the study.
The results are being presented at the European Society of Cardiology congress in Barcelona, Spain this weekend and were published Saturday by The New England Journal of Medicine.
Heart failure is a disease in which the heart cannot pump enough blood to the body’s organs, resulting in shortness of breath, fatigue and retention of fluids. It can be caused by a heart attack, uncontrolled hypertension or other problems.
Some five million to six million Americans, and an estimated 26 million people globally, have heart failure, and it is the leading cause of hospitalization in the United States and Europe, according to a recent paper in the Journal of the American College of Cardiology. Many patients die within a few years of diagnosis.
Some doctors not involved in the study agreed the results were compelling.

Donald Berwick pushes single payer health plan

By David Scharfenberg

  | GLOBE STAFF   AUGUST 30, 2014
Democratic gubernatorial candidate Donald Berwick has laid out some ambitious goals, among them ending chronic homelessness and eliminating childhood poverty. But his most sweeping proposal — arguably the most sweeping proposal of the political season — is moving Massachusetts to a single-payer or “Medicare for all” health care system.
Eight years after the state became the first in the country to establish near-universal coverage, Berwick is reaching for an even bigger prize sought by liberals: shifting from privately financed care to a system funded by the government.
The candidate says replacing a welter of insurance companies with a single public payer would simplify a complex system and save hundreds of millions of dollars in administrative costs that could be redirected to other needs: job creation, education, and infrastructure.
“The opportunity is vast,” said Berwick, who ran Medicare and Medicaid for the Obama Administration for 1½ years.
But observers say the hurdles to single-payer health care are many. For one thing, it would require a tax increase. For another, it can be a complex idea that is difficult to explain in campaign soundbites. That may explain, in part, the candidate’s poor standing in the polls with just over a week to go until the Sept. 9 Democratic gubernatorial primary.
It’s also unclear that state legislators or the public have the appetite for another major health care overhaul. And powerful interests, including the insurance industry, are arrayed against a single-payer system that would sharply curtail their business.

Surgical error at Tufts prompts widespread changes

By Liz Kowalczyk

  | GLOBE STAFF   AUGUST 31, 2014
Caroline Carcerano arrived at Tufts Medical Center hoping that a brief procedure would relieve lingering symptoms from a back injury. In the operating room, the neurosurgeon requested a special dye to test the location of tubing that had been threaded into her spine. But the pharmacy didn’t have it and provided a different one.
The surgeon checked the label, hospital executives said, and then injected it, twice.
After Carcerano awoke with severe pain and seizures, caregivers zeroed in on the substitute dye, whose label clearly warned against use inside the spine, according to a report from regulators who investigated the error.
“A mistake was made,” the neurosurgeon, Dr. Steven Hwang, immediately told Carcerano’s two sons as they watched over their 74-year-old mother. “We gave her the wrong dye.’’
Carcerano died the following day last November, unleashing hospital and government inquiries that have led to widespread safety improvements in Tufts operating rooms this year and may highlight medical errors involving “cognitive bias” — an area of growing interest among researchers. The label on the dye read “not for intrathecal use,’’ meaning it should never be injected into the spine. But hospital executives said Hwang did not notice that warning, and instead saw what he anticipated the label would say — the name of a dye intended for injection into the spine.

Coverage for End-of-Life Talks Gaining Ground

By 

DUNDEE, N.Y. — Five years after it exploded into a political conflagration over “death panels,” the issue of paying doctors to talk to patients about end-of-life care is making a comeback, and such sessions may be covered for the 50 million Americans on Medicare as early as next year.
Bypassing the political process, private insurers have begun reimbursing doctors for these “advance care planning” conversations as interest in them rises along with the number of aging Americans. People are living longer with illnesses, and many want more input into how they will spend their final days, including whether they want to die at home or in the hospital, and whether they want full-fledged life-sustaining treatment, just pain relief or something in between. Some states, including Colorado and Oregon, recently began covering the sessions for Medicaid patients.
But far more significant, Medicare may begin covering end-of-life discussions next year if it approves a recent request from the American Medical Association, the country’s largest association of physicians and medical students. One of the A.M.A.’s roles is to create billing codes for medical services, codes used by doctors, hospitals and insurers. It recently created codes for end-of-life conversations and submitted them to Medicare.
The Centers for Medicare and Medicaid Services, which runs Medicare, would not discuss whether it will agree to cover end-of-life discussions; its decision is expected this fall. But the agency often adopts A.M.A. recommendations, which are developed in meetings attended by its representatives. And the political environment is less toxic than it was when the “death panel” label was coined; although there are still opponents, there are more proponents, including Republican politicians.

Doctors are shifting their business models
by Lisa Zamosky
With insurance companies often paying doctors less for their services and with paperwork increasing, Dr. Gregory Yu was putting in longer workdays to squeeze in more patients.
He figured there had to be a better way. So a few years ago he shifted a portion of his practice to a concierge model in which patients pay a monthly fee of $150 in exchange for more of his time — both in and out of the office.
"It was more for my own personal longevity," said the La Cañada Flintridge internist, explaining why he made the switch. "If I have to see patient after patient after patient, and I'm not really feeling the satisfaction of doing the best job that I possibly could for people, I was afraid I might burn out."
Being a doctor in private practice today is more complicated than it used to be, with growing financial pressures, more government regulation, greater oversight by insurers, rapid developments in medicine and pressure to keep up with technology.
"Practices are being asked to do more with less," says Dr. Susan Turney, chief executive of the Medical Group Management Assn., which represents professionals running medical practices.
In response, doctors say they are increasingly looking for new ways to practice medicine so they can spend more time with patients and less time on paperwork — while maximizing their incomes.
Many are giving up on independent practice to become employees of larger healthcare systems, Turney says.
In fact, a national survey of 13,500 doctors by the Physicians Foundation, a nonprofit organization representing the interests of physicians, shows that in 2000 more than half were practicing independently. But by 2013, that share had shrunk to a third.
In some cases, those wanting to remain independent are switching to alternate models, such as the concierge-style practice that Yu adopted. For consumers, that can mean changes in the way they get their medical care and how they pay for it.
Experts outline a few common ways doctors are shifting the way they do business and how they're likely to affect your care and your wallet.
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