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Medicaid: Will The Cost Of Expanding Eligibility Be Overwhelming?

Medicaid has been front and center this week as President Obama addressed the National Governors Association, and several governors testified before the House Energy and Commerce Committee. Obama told the governors that he supports the Wyden-Brown bill, which would accelerate the availability of waivers under the Affordable Care Act (ACA), so that states would not have to first create health insurance exchanges under the law, and then have the right to dismantle them and replace them with other mechanisms to achieve coverage goals of the law without additional cost to the federales. (See Wyden-Brown fact sheet.) The sponsors’ home states, Oregon and Massachusetts would otherwise have to dismantle parts of their own health reform efforts in order to align with the federal mandates. (Wyden has been a longer-term proponent of experimentation and innovation in health reform.) 

The mini-med waivers granted to states (in addition to those granted to corporations and unions) are just one example of interim steps needed to harmonize federal and state health reform. When in 2014 mini-med plans will no longer be permitted at all under the federal health reform law, there will either need to be a significant dislocation of the underinsured “Young Invincibles” in Massachusetts and underinsured employees in capped health plans elsewhere in the country, or a change in the law.

Similar difficulties await state Medicaid programs, which will be faced with expanded eligibility, and other state agencies, which will need to set up exchanges per the ACA. The cost associated with eligibility expansion will be overwhelming — or maybe it won’t. There are, of course, expert opinions across the board on the financial impact of health reform on state budgets. As the saying goes, “Where you stand depends on where you sit.” Some reports inflate state expenses by not accounting for the fact that the federal share of Medicaid expansion covers 92 percent of the total. Read more »

*This blog post was originally published at HealthBlawg :: David Harlow's Health Care Law Blog*

Measuring The Patient Experience

There’s a growing recognition within the medical-industrial complex that the patient is a key element of the enterprise, and that patient satisfaction, patient experience, patient engagement, patient activation, and patient-centeredness are very important. Some research shows that patient activation yields better patient outcomes, and that patient activation can be measured.

Patient-centeredness and patient engagement are two of the key metrics to be used by the feds in describing Accountable Care Organizations (ACOs), if the internecine battles within government are resolved soon enough to actually release draft ACO regulations in time to allow for sufficient advance planning for the January 2012 go-live date. (Wearing one of my many hats, I’ve had the opportunity to submit a response to CMS regarding the RFI on these metrics on behalf of the Society for Participatory Medicine.) These measures go into the “meaningful use” hopper as well, as meaningful use stage 2 metrics are being reviewed.  

In recent years, the federales have been measuring patient experience using the Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys, and — coming soon to a bank account near you — there will be Medicare dollars tied to the scores on these questionnaires, not just dollars tied to the act of reporting scores.

As this emphasis on patient experience is unfolding, the Leapfrog Group is adding its voice to the chorus. I spoke this week with CEO Leah Binder and hospital survey director Matt Austin about the new patient experience measures they are adding to their 2011 hospital survey. In keeping with past practice, they will be asking hospitals to report three CAHPS measures (rather than asking folks to collect and report new measures). The three were selected as being representative of a hospital’s broader performance with respect to patient experience, and also because hospital performance on these measures is all over the map. Read more »

*This blog post was originally published at HealthBlawg :: David Harlow's Health Care Law Blog*

First Report From The Society of Participatory Medicine’s Newly-Appointed Public Policy Committee Chair, David Harlow

In December, the Society for Participatory Medicine’s executive committee appointed health law attorney David Harlow to represent the Society in public policy matters. Regular readers of HealthBlawg::David Harlow’s Health Care Law Blog know what a patient-centered, participatory thinker David is. This is his first report.

David HarlowI am delighted to offer my first report as Public Policy Committee Chair for the Society of Participatory Medicine. I encourage all of you who are not yet Society members to join, and I encourage new and old members to consider volunteering to help with the wide range of public policy issues facing us today.

Over the past couple of months, the Public Policy Committee has gotten its sea legs. We are beginning to add the Society’s voice to the national discourse on patient engagement in a formal manner. As planning for health reform and related initiatives becomes more concrete, it is clear that patient engagement and patient-centeredness are key issues to be considered. For example, it was encouraging to hear Centers for Medicare and Medicaid Services (CMS) Administrator Don Berwick speak about the “Triple Aim” at the Accountable Care Organization (ACO) workshop this fall, and explicitly link the achievement of the triple aim — better care for individuals, better health for populations, and reduced per-capita costs — to patient engagement and empowerment.

There will be many opportunities for the Society to engage with policymakers, payors and provider organizations as this work continues. CMS and its many related organizations, as well as many provider and private sector payor organizations recognize that without maintaining a focus on the patient at the core, health reform and related health IT initiatives cannot be successful. We’ve kicked things off on two fronts — ACOs and Stage 2 Meaningful Use rules. Read more »

*This blog post was originally published at*

Newt Gingrich’s Take On Facebook Saving A Woman’s Life

I’ve seen at least half a dozen links to the op-ed coauthored by Newt Gingrich and neurosurgeon Kamal Thapar about how the doctor used information on Facebook to save a woman’s life. (It was published by AOL News. Really.)

In brief, a woman who had been to see a number of different health care providers without getting a clear diagnosis showed up in an emergency room, went into a coma and nearly died. She was saved by a doctor’s review of the detailed notes she kept about her symptoms, etc., which she posted on Facebook. The story is vague on the details, but apparently her son facilitated getting the doc access to her Facebook page, and the details posted there allowed him to diagnose and treat her condition. She recovered fully.

Newt and Dr. Thapar wax rhapsodic about how Facebook saved a life, and sing the praises of social media’s role in modern medicine. (I’m not sure how this really fits in with Newt’s stance on health reform, within his 12-step program to achieve the total replacement of the Left…but, hey, nobody has the patience these days for so many details anyway.)

Regular readers of HealthBlawg know that I would perhaps be the last to challenge the proposition that social media has a role to play in health care. However, I think Newt got it wrong here. Read more »

*This blog post was originally published at HealthBlawg :: David Harlow's Health Care Law Blog*

End-Of-Life Wishes: How To “Engage With Grace”

As patients, as family members, as friends, as health care providers, we have all faced end-of-life issues at one time or another, and we will face them again. And again. 

This weekend the “Engage With Grace” message is being broadcast virally, through a “blog rally,” at a time when many people are with family and friends over the long weekend. The point is: We all need to have the potentially uncomfortable conversation with people close to us about what kind of treatment we would want, and they would want, if incapable of making or communicating healthcare decisions. CNN ran a story on “Engage With Grace” yesterday.

End-of-life decision-making has long been an issue of great personal and professional interest to me, and I am proud to have played a role in having out-of-hospital DNR orders recognized in Massachusetts by EMS providers, as an example. Read more »

*This blog post was originally published at HealthBlawg :: David Harlow's Health Care Law Blog*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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