March 6, 2014
The growing bureaucratization of medicine presents a serious threat to physicians’ ability to provide quality patient care. Whether through big government or mega hospital systems, innovation and detailed attention to the needs of individual patients will suffer.
The pain will be especially acute for independent practices specializing in primary care. They operate with the narrowest margins and have the fewest resources to adjust to the mountain of new regulatory demands being imposed on them.
via Governmen Bureaucracy Will Stifle Hospital and Smal Practitioners – NYTimes.com.
February 26, 2014
Health-policy experts often talk up the notion of a “patient-center medical home”—in which a medical practice actively manages patients’ chronic conditions to improve their health and avoid hospitalizations—as the ideal model for transforming the U.S. health-care system.
But a study of one of the earliest and largest medical-home pilots found that after three years, patients’ health improved in only 1 of 11 measures. There was no change in hospital or emergency-room use, and no significant cost savings.
“There are folks who believe the medical home is a proven intervention that doesn’t even need to be tested or refined. Our findings will hopefully change those views,” said Mark W. Friedberg, a researcher at RAND Corp. and lead author of the study, published Tuesday in the Journal of the American Medical Association.
via Study Questions Benefits of ‘Medical Home’ Programs for Chronically Ill – WSJ.com.
February 26, 2014
Context: Massachusetts enacted health care reform in 2006 to expand insurance coverage and improve access to health care. The objective of our study was to compare trends in health status and the use of ambulatory health services before and after the implementation of health reform in Massachusetts relative to that in other New England states.
Methods: We used a quasi-experimental design with data from the Behavioral Risk Factor Surveillance System from 2001 to 2011 to compare trends associated with health reform in Massachusetts relative to that in other New England states. We compared self-reported health and the use of preventive services using multivariate logistic regression with difference-in-differences analysis to account for temporal trends. We estimated predicted probabilities and changes in these probabilities to gauge the differential effects between Massachusetts and other New England states. Finally, we conducted subgroup analysis to assess the differential changes by income and race/ethnicity.
Findings: The sample included 345,211 adults aged eighteen to sixty-four. In comparing the periods before and after health care reform relative to those in other New England states, we found that Massachusetts residents reported greater improvements in general health (1.7%), physical health (1.3%), and mental health (1.5%). Massachusetts residents also reported significant relative increases in rates of Pap screening (2.3%), colonoscopy (5.5%), and cholesterol testing (1.4%). Adults in Massachusetts households that earned up to 300% of the federal poverty level gained more in health status than did those above that level, with differential changes ranging from 0.2% to 1.3%. Relative gains in health status were comparable among white, black, and Hispanic residents in Massachusetts.
Conclusions: Health care reform in Massachusetts was associated with improved health status and the greater use of some preventive services relative to those in other New England states, particularly among low-income households. These findings may stem from expanded insurance coverage as well as innovations in health care delivery that accelerated after health reform.
February 21, 2014
According to a recent study, severely injured patients are less likely to be transferred to a trauma center if they have health insurance.
Researchers from the Stanford University of Medicine found that patients with insurance are less likely to get the best care than those who do not have insurance. They found that insured patients taken to non-trauma hospitals were 13 to 15 percent less likely to be transferred to trauma centers than uninsured ones.
via Study: Uninsured Patients Get Better Care Than Insured « CBS DC.
February 5, 2014
Dr. Held talks to Neil Cavuto about why she sent a termination letter to Aetna to protect her patients from ObamaCare
via Dr. Kris Held on ObamaCare: “I will NOT comply.” – YouTube.
January 27, 2014
The core issue in medicine remains reimbursement, and fee-for-service appears for the moment to have easily survived yet another assault on its dominance. As I’ve noted, the most likely catalyst for change may be transitioning of employees to private exchanges, coupled with a tethering of employer healthcare contributions to the consumer price index (CPI), as my Tech Tonics co-author Lisa Suennen has explained. This would rapidly make employees considerably more price (and value) sensitive, and create the sort of market conditions most likely (or at least, more likely) to motivate meaningful change.
via Learning About American Medicine From A Poignant Portrait Of A Long Island Jeep Dealership – Forbes.
December 17, 2013
Giving patients access to their own medical records is a key goal of health reformers. In an initiative known as Blue Button, the Obama administration has pressed doctors, hospitals, government agencies and businesses that hold patient data to make it available to download. And the government has sponsored contests to encourage tech entrepreneurs to design apps and other tools to make the data easier for patients to use.
via Next in Tech: App Helps Patients Track Care – WSJ.com.
October 30, 2013
During President Obama’s Boston visit to talk about the ACA and the Massachusetts experiment, it is important to remember some context. Here are a few pictures that help to illustrate the successes and failures of Mass reform.
However, caution should be used when expecting the same results under the two laws, since the laws are different, and Massachusetts is not the same as Arizona, or Texas, or Alabama, or Ohio, or etc…. For example, read five reasons why employer behavior will not be the same under the ACA as it was under RomneyCare, Part 1 and Part 2. But before we begin, let’s pause to recognize that the ACA will impact Massachusetts in some significant ways.
via In Pictures: 15 Facts Pres. Obama Needs To Know About Mass.’s Healthcare Reform | Pioneer Institute.
October 23, 2013
Critics and supporters alike have framed the Affordable Care Act as an effort primarily aimed at expanding access to health care insurance. As the refrain goes, the legislation placed much less emphasis on pursuing ways to make health care delivery more affordable. This analysis belies significant measures that the legislation pursues, in the name of cost control, which will fundamentally transform the delivery of medical care. These provisions are based on a primary belief that there is a lot of waste in the delivery of medical care. Moreover, the president and his advisers believed that this waste owes largely to the inefficient and sometimes inappropriate decisions made by providers. The legislation sets out, through a collection of policy measures, to restructure the organization and delivery of medical care. Among other things, it consolidates providers around hospitals where they will become salaried employees that are easier to regulate and supposedly less likely to overprescribe services. History shows, such measures do not produce the promised savings. Moreover, this reorganization comes at a significant cost, not only in terms of the quality of medical care, but its affordability. Provider productivity will inevitably decline. Continuity of care will suffer. Entrepreneurship in medical practice will be squelched. Obamacare will dramatically change the practice of medicine. This will perhaps be its most enduring legacy, and its most significant human cost.
via How Obamacare will reshape the practice of medicine – Health – AEI.
October 18, 2013
Obamacare could cause untold unnecessary deaths by destroying healthcare innovation. To explain, let me offer an analogy.
In 1993, almost everyone in the technology industry agreed that the next wave of innovation in computing was going to be related to some global network to which consumers and businesses could be connected and shop and converse.
via What The Internet Teaches Us About Healthcare | The Federalist.