May 26th, 2010 by DrWes in Better Health Network, Health Policy, Opinion, Research
Tags: Clinical Research, Clinical Trials, comparative effectiveness research, Cutting-Edge Research, Cutting-Edge Science, Evidence Based Medicine, FDA, Food and Drug Administration, Government Research, Healthcare Lab, Insync, Medical Research, Medical Researchers, Medical Scientists, Medtronic, Peter Orsag, Randomized Trials, Research Centers, Research Studies, Science Based Medicine, Science-Based Evidence
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“…I have always depended on the kindness of strangers.” — Blanche DuBois in Tennessee Williams’ play A Streetcar Named Desire
Years ago when I began my medical training, I recall enrolling patients for clinical research. In cardiology, there were a myriad of questions that needed to be answered, especially in the area of defining which medications were best to limit the damage caused by a heart attack.
Patients routinely participated in large, multi-center prospective randomized trials to answer these questions. It was routine for them not to charged for participating in the trial — the drug(s) and additional testing would be funded by the company whose drug was being studied. Patients enrolled willingly, eager to help advance science and perhaps, in some small way, their fellow man. It never dawned on me in those early days why hospitals and research centers were so eager to promote research. Read more »
*This blog post was originally published at Dr. Wes*
May 26th, 2010 by StevenWilkinsMPH in Better Health Network, Health Policy, Health Tips, Opinion
Tags: Board Certification, Care Coordination, Doctor-Patient Communication, Dr. Avedis Donabedian, Empowered Patients, Evidence-Based Questions, Expert Patients, Family Doctor, Family Medicine, General Medicine, Health Grades, Healthcare Insiders, Healthcare Providers, Informed Healthcare Consumer, Internal Medicine, Medical Specialty, New Doctor, Patient Satisfaction, Patient-Doctor Relationship, Personal Physician, Primary Care, Quality Assurance, Quality in Health Care, The Lichfield Lecture, Years In Medical Practice
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What if the average patient (person) knew what healthcare insiders, providers and expert patients know?
Take the process of looking for a new personal physician. Conventional wisdom tells people that when looking for a new physician they need to consider things like specialty, board certification, years in practice, and geographic proximity. Online services like Health Grades allow you to see and compare the satisfaction scores for prospective physician candidates.
But industry insiders know different. Consider those patient satisfaction scores for physicians. In reality, “one can assume that the quality of care is actually worse than surveys of patient satisfaction would seem to show,” according to a 1991 lecture by Avedis Donabedian, M.D.:
“Often patients are, in fact, overly patient; they put up with unnecessary discomforts and grant their doctors the benefit of every doubt, until deficiencies in care are too manifest to be overlooked.”
Given the constant drumbeat about the lack of care coordination and medical errors, it would seem that some people (patients) are beginning to reach the breaking point alluded to by Dr. Donabedian. The empowered among us are starting to compare physicians (and the hospitals that employ them) to a higher standard — a higher standard that reflects the nature and quality of the medical services physicians actually provide. Empowered patients today are “being taught to be less patient, more critical, and more assertive.” Read more »
*This blog post was originally published at Mind The Gap*
May 26th, 2010 by BobDoherty in Better Health Network, Health Policy, Humor, Opinion, Research, Uncategorized
Tags: A.A. Milne, Accountable Care Organizations, Advance Practice Nurse, Consultant Physicians, Duplicate Testing, Edward Bear, Family Caregivers, Family Medicine, Follow-Up Phone Calls, Follow-Ups, General Medicine, House At Pooh Corner, Insurance Companies, Internal Medicine, Internists, Jay Larson, Lab Studies, Medicare Payment Rate, NEJM, New England Journal of Medicine, Office Visits, Patient Satisfaction, Patient-Centered Medical Homes, Pharmacy Callbacks, Physician Assistant, Physician Satisfaction, Pre-Authorizations, Prescription Renewals, Primary Care, Qualified Non-Physician, Return Calls, Richard Baron, Team-Based Primary Care, Unnecessary Referrals, Winnie The Pooh, Worried Patients
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Here is Edward Bear, coming downstairs now, bump, bump, bump, on the back of his head, behind Christopher Robin. It is, as far as he knows, the only way of coming downstairs, but sometimes he feels that there really is another way, if only he could stop bumping for a moment and think of it.
— From A.A. Milne’s “Winnie the Pooh and the House at Pooh Corner.”
Internists, I expect, will identify with Edward Bear.
Richard Baron’s study in the NEJM on the amount of work he and his colleagues do outside of an office visit — the “bump, bump, bump” of a busy internal medicine (IM) practice — has resonated with many of his colleagues.
Jay Larson, who often posts comments on this blog, did a similar analysis for his general IM practice in Montana, and found that for every one patient seen in the office, tasks are done for 6 other unscheduled patients. Jay writes: “So really there [are] internists [who] are managing about 130 patients per day. Not much consolation when they only get paid for 18 per day.” Read more »
*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*
May 25th, 2010 by EvanFalchukJD in Better Health Network, Health Policy, Opinion
Tags: Commission, David Williams, Ezra Klein, Health Business Blog, Health Insurance Bloggers, Health Insurance Business, Health Insurance Industry, Healthcare Policy, Healthcare System, Loss Experience, Medical Loss Ratio, Premium, Profit, Richard Dale, Terminology, Venture Cyclist
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Like Ezra Klein, smart people keep saying foolish things about the health insurance business. This time it’s a pair of bloggers talking about the largest expense that health insurers face — their “medical loss ratio.”
According to Richard Dale at the Venture Cyclist:
[W]hy do they call it Medical Loss Ratio? Why is looking after me (or you) called “Medical Loss,” when the whole point of a healthcare system is to look after me (or you)?
(Sigh.)
Alan Katz, one of the leading health insurance bloggers, surprisingly links to this with approval, saying “words matter.” The problem? The word “loss” is probably one of the four oldest words in the insurance industry. I’d say the others are probably “premium,” “commission,” and “profit.” Should we start outlawing these words, too? Read more »
*This blog post was originally published at See First Blog*
May 25th, 2010 by Davis Liu, M.D. in Better Health Network, Health Policy, Health Tips, Opinion, Quackery Exposed, Research
Tags: Alcohol In Moderation, Bone Density Testing, Calcium, Carotid Ultrasound, Controlling Blood Pressure, Controlling Cholesterol, Dual-Energy X-Ray Absorptiometry, DXA, Family Medicine, General Medicine, Hip Fracture, Insurance Claims, Insurance Coverage, Internal Medicine, Life Line Screening, Low-Sodium Diet, Medicare, National Stroke Association, Not Covered By Insurance, Osteoporosis, PAD, Peripheral Artery Disease, Preventive Health, Preventive Health Services, Preventive Healthcare, Preventive Medicine, Preventive Screening, Primary Care, Quitting Smoking, Regular Exercise, U.S. Preventive Services Task Force, Unnecessary Medical Tests, Unnecessary Testing, USPSTF, Vascular Disease, Vitamin D
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A patient brought in a flyer for Life Line Screening, where for $129 an individual can have their carotid (neck) and peripheral (leg) arteries screened for blockage, their abdominal aorta screened for aneurysm (swelling), and be tested for osteoporosis. The advertisement claims that “we can help you avoid a stroke,” and their logo notes “Life Line Screening: The Power of Prevention.”
Are these tests worth your money? Short answer: No.
Although the flyer correctly indicates that 80 percent of stokes can be prevented, the National Stroke Assocation does not recommend ultrasound as a screening test. Preventing stroke includes quitting smoking, knowing your blood pressure and cholesterol numbers, drinking alcohol in moderation (if already doing so), exercising regularly, and eating a low-sodium diet. Their is no mention of an ultrasound test. Why? Because there is NO evidence that it helps save lives in individuals who are healthy and have no symptoms (except for the following situations). Read more »
*This blog post was originally published at Saving Money and Surviving the Healthcare Crisis*
