February 23rd, 2009 by Dr. Val Jones in Audio, Expert Interviews, Health Policy
Tags: 2009, AHLTA, Dr. Jeff Gruen, Health IT, HIT, IT, Military Health Summit, Military Healthcare, Obama, Stimulus, VISTA, World Health Care Congress
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Together the Department of Defense and the Department of Veterans Affairs have the largest and most advanced IT infrastructures in US healthcare. As the Obama administration ramps up funding for electronic medical records and other IT initiatives, one might ask what the public and private sectors can learn from the military IT systems (aka AHLTA and VISTA).
I interviewed Dr. Jeff Gruen about the upcoming Military Health Summit at the World Health Care Congress, April 14-16 in Washington, DC. Jeff is Head of the Global Healthcare Practice at PRTM, a management consulting firm and a Chairman of the Military Health Summit.
You may listen to our conversation by clicking the arrow button, or read a summary of our conversation below.
[Audio:http://blog.getbetterhealth.com/wp-content/uploads/2009/02/militaryhealthsummitjeffgruen.mp3]
Dr. Val: To set the stage, tell me a little bit about the World Health Care Congress, and what the Military Health Summit hopes to achieve.
Dr. Gruen: This is the 6th annual World Healthcare Congress (WHC), and the first year for the Military Health Summit. We expect 1500 to 2000 participants – the WHC is the premiere event for healthcare services and the healthcare system at large. It brings together people from across all sectors of healthcare and in addition to the general summit events we have this exciting Military Health Summit track.
Dr. Val: What does the healthcare system at large have to learn from the military health system?
Dr. Gruen: Three things: first, we can use the military health system as a case study for IT initiatives, since they’ve already achieved broad adoption of an EMR. It’s not perfect, but it’s used widely and is getting better. The DOD and the VA are working hard to make their systems interoperable. Second, because the military health system is both a payer and a provider, it serves as a wonderful laboratory for inventing new ways of delivering care. Realigning incentives between inpatient and outpatient care or primary and specialty care can be achieved nicely in the military system, which is like a giant, international Kaiser Permanente. Third, the military has developed very advanced battlefield techniques and devices for saving lives – including telemedicine. So it’s fun to hear about these advances.
Dr. Val: How will healthcare reform impact the Military Health System – do you have any predictions based on what you’ve heard on Capitol Hill?
Dr. Gruen: It’s impossible to know exactly, but let me offer a couple of observations. First, there’s a sense of national patriotic commitment to make sure that our service men and women (and their dependents) get the very best care possible. There’s a real desire to apply the best practices from the commercial sector to the military. PRTM feels very passionate about this, especially since one of our own is currently serving in Iraq right now.
There are a few core problems in healthcare, and they all fall under the rubric of “the right care delivered in the right environment by the right provider at the right time.” These problems may be addressed with interventions including providing point of care decision support, tools that would decrease provider practice variation, and connected convergent care – the idea that we have to move from a system that is designed for acute care to one that is very good at managing chronic care. We also need to move to a system where all the data is present in a very transparent way across environments to allow us to apply the same protocols regardless of whether someone’s in the hospital, or at home, or in a nursing home. The military health system could get these systems in place in a faster and broader way than the general healthcare system.
Dr. Val: Who should attend the Military Health Summit? How do they register?
Dr. Gruen: Those who should attend include: 1) People actively involved in the Military Health system because it offers an opportunity to interact with their luminaries. 2) Anyone on the commercial side of healthcare who’d like to do work with the military 3) Anyone who is interested in health reform 4) People with a particular interest in health IT (disease management and telemedicine in particular) 5) Anyone who wants to hear about the coolest new things coming out of battlefield medicine.
To register, one need only go to the World Health Care Congress website and follow the prompts for the Military Health Summit.
February 12th, 2009 by Dr. Val Jones in Expert Interviews, Health Policy
Tags: AMA, American Medical Association, Comparative Effectiveness, Dr. Nancy Nielsen, Medicare, Medicare Policy Summit, Sustainable Growth Rate
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I attended my very first Medicare Policy Summit conference today – and it was truly riveting (wonk alert). I took copious notes and will do my best to summarize some key points in a series of blog posts. This first post is devoted to the presentation by AMA President, Dr. Nancy Nielsen.
Dr. Nielsen began her lecture with an amusing story. She said, “congressional hearings are pure theatre” and described what she’d experienced three months ago at a meeting with Pete Stark. The conversation went something like this:
Stark: I’m sick of rich doctors driving up in their Porsches saying ‘I’m pulling out of Medicare.’
Nielsen: [Thinking to herself: First witness please?] I drive a GEO jeep.
Then Dr. Nielsen looked out at the Medicare Policy Summit audience and asked, “are there any doctors here?” I raised my hand enthusiastically at the back of the room. Then she responded, “Oh thank God. Well, you know we’re in the lion’s den…”
[Parenthetically, I didn’t see anyone else raise their hand – which is the subject for another conversation.]
What Is The AMA’s Current Agenda?
1. To expand coverage for the uninsured
2. To reform the physician payment system
3. To improve the quality and safety of healthcare
4. To improve public health
What Is The Bee In Nielsen’s Bonnet?
Nielsen explained that the sustainable growth rate is unsustainable. She stated:
“We can’t go through the annual death dance with congress over this. There is another 21% across-the-board cut in Medicare reimbursement scheduled for January 2010. And this cut will affect a group of small business owners (aka physicians) whose reimbursement has not increased since 2001 while their costs have increased 20%.”
What Does Nielsen Propose We Do?
1. Reform the system so that it reimburses for care coordination and prevention
2. Craft solutions based around patients’ needs
3. Rebase the SGR
4. Bundle services to increase value and reduce costs
5. Invest in disease prevention and wellness
6. Use comparative effectiveness to inform clinical decision-making (but NOT as a basis for coverage decisions)
7. Bring physicians into the policy decision-making process
Closing High-Five to Nurses
Dr. Nielsen closed with an amusing anecdote about inauguration day. Apparently she was standing in the sidelines of the parade route where Biden got out of his limo to greet the crowd. He gave a big hug to some nurses standing next to her and said, “I love nurses. They’re so much better than doctors.” Dr. Nielsen then had the opportunity to introduce herself to Biden and he responded, “Doctors saved my life, but nurses gave me the will to live.”
February 6th, 2009 by Dr. Val Jones in Audio, Expert Interviews, Health Policy
Tags: Budget, Dr. Joshua Sharfstein, Dr. Val Jones, FDA, FDA Commissioner, Finance, Food and Drug Administration, Food Poisoning, Funding, Inspectors, Outbreak, Peanut Butter, Podcast, Salmonella, Tommy Thompson, Underbudget, Understaffed
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Tommy Thompson
The recent peanut butter/salmonella outbreak offers another opportunity to reflect on the underlying budget crisis and staff shortage at the Food and Drug Administration. I interviewed Tommy Thompson, former Secretary of Health and Human Services, about what the peanut butter debacle tells us about the FDA inspections of our food supply.
You may listen to our conversation by clicking on the play button, or read a summary below. Enjoy!
[Audio:http://blog.getbetterhealth.com/wp-content/uploads/2009/02/tommythompsonpeanutbutter.mp3]
Dr. Val: Has this recent outbreak influenced how the FDA tracks food ingredients?
Thompson: No it hasn’t. We have a serious food problem in America because the FDA is understaffed. There have been too many outbreaks of food poisoning – everything from listeria on cucumbers and onions to salmonella infections from ice cream and peanut butter. Approximately 82 million people experience an episode of food poisoning each year, 350,000 of them require treatment in a hospital and 8,000 die. People don’t seem to realize what a large problem food poisoning is until there is a new outbreak. The recent peanut butter contamination affected between 700-800 different food products.
Americans need to realize that the FDA is severely understaffed and cannot do the inspections necessary to protect all of our food. I’ve been harping about this for a long time. When I was Secretary of HHS I was able to increase the number of inspectors by 100%, but since I left the funding was decreased and the numbers of inspectors is back to the level when I started.
There are 64,000 venues that the FDA has to inspect, and there are only 700 inspectors. It is geographically and mathematically impossible to do all the inspections. The FDA is responsible for inspecting 80% of our food supply while the department of agriculture does the rest. The department of agriculture has 7000 employees and 6000 venues that they have to inspect. Just compare the resource differential between the FDA and the department of agriculture and you see the serious constraints under which the FDA operates.
The department of agriculture inspects every meat processing factory every day. But an FDA inspector may get to a food processing plant only once every 6 or 7 years.
Dr. Val: Wow, that’s enlightening and also terrifying at the same time.
Thompson: Yes, it really is. We inspect less than 1% of the food coming into America. The amount of imported food continues to increase as the number of inspectors decreases. We have some serious problems with our food supply and it’s about time that congress recognized this.
The FDA is doing the best job they can, and yet they are regularly criticized by the media. When you consider their limitations, they’re doing a heck of a good job with the resources they have.
Dr. Val: So what do we need to do to improve this situation?
Thompson: The FDA needs a larger budget, we need to get more inspectors out there, we need updated testing technology, but we also need a more modern law that would require food processing plants to file an affidavit with the FDA to ensure that their food is safe. There’s very little supervision of these companies.
Dr. Val: Is there anything the public can do to petition the government to increase funding to the FDA so they can inspect our food properly?
Thompson: There’s a coalition to improve the quality of food inspections at FDA and I’m a part of that. There are people in congress who are working on introducing legislation to provide the FDA the resources necessary to hire more inspectors, and to require affidavits of safety from food processing plants.
Dr. Val: Do you think Dr. Joshua Sharfstein will become the new FDA commissioner?
Thompson: Sharfstein is being considered for a position at FDA, whether it’s commissioner, assistant commissioner, or chief of staff I don’t know.
Dr. Val: Do you have any advice for the new FDA commissioner, whoever it is?
Thompson: Yes. In addition to lobbying for increased funding to support more inspector positions, he or she should consider appointing a special commissioner of food that would report directly to the Secretary of Health and Human Services. The new FDA commissioner should focus on getting medicines and new drugs to market. In 2008 we had fewer new drugs get to market than any year since 1981. The entire FDA is overworked, the responsibilities are great, and congress meddles too much in their affairs, though that may change now that the democrats control both houses and the presidency.
The staff at FDA are becoming demoralized because every time they make a decision someone in congress criticizes them for it. Then they become reluctant to make decisions at all.
February 4th, 2009 by Dr. Val Jones in Audio, Expert Interviews, Health Policy
Tags: Department of Health and Human Services, HHS, interview, nominee, Podcast, Secretary of Health and Human Services, Tom Daschle, Tommy Thompson, withdrawal
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Many Americans have been surprised and disappointed by Senator Tom Daschle’s withdrawal as HSS Secretary nominee. I asked Tommy Thompson, former Governor of Wisconsin and the 7th U.S. Secretary of Health and Human Services, what he made of this. You may listen to our full conversation by clicking on the podcast arrow, or read a shortened summary below. Enjoy.
[Audio:http://blog.getbetterhealth.com/wp-content/uploads/2009/02/tommythompsondaschle.mp3]
Dr. Val: Tom Daschle’s withdrawal as HHS Secretary nominee has been a real shock for most people. Some are saying that without Daschle’s influence, healthcare reform will take a back seat to other economic priorities this year. What do you think?
Thompson: I don’t think that will happen because we’re in such dire need of reform that even without Tom Daschle there’s going to be a tremendous transformation of the healthcare system this year. Two healthcare bills are already undergoing the legislative process, and one is ready to be signed into law – the expansion of SCHIP, the insurance plan to cover poor children. The second bill involves the expansion of COBRA, which allows unemployed individuals to buy in to their previous employer’s health insurance plan.
But beyond this, the new stimulus package has 20 billion dollars set aside for health IT infrastructure – to create an electronic medical record for all Americans and beef up broadband access. There will also be a lot of money set aside for preventive health initiatives – to help Americans become healthier so they won’t need as many medical services.
Of course, Senator Kennedy is pushing for a “play or pay” plan modeled after Massachusetts’ law. There will be a lot of pressure to get this done quickly due to his ailing health. So you can bet your bottom dollar that the healthcare system that we know today is going to be changed so considerably that I doubt if you’ll recognize it a year from now.
Dr. Val: Do you have any idea who might replace Tom Daschle as HHS Secretary nominee?
Thompson: I’ve been hearing a lot of names. Governor Kathleen Sebelius from Kansas is very much in the running. Howard Dean’s name has also come up. Overall I do think it will be a governor or former governor who gets the position.
Dr. Val: What sort of person would have the skills for the job?
Thompson: I think a governor is the ideal person for the job because they already have experience running both state and federal programs – both initiating and managing them.
Dr. Val: Do you think that being a physician could be an advantage as well?
Thompson: There are so many physicians in the department that I don’t believe that being a physician adds or detracts from the position. Being the Secretary of HHS is an administrative position and although doctors have many skills, I’m not sure that running a large agency of over 67,000 employees with a budget of over 600 billion dollars is something that most doctors have the experience to do well.
Dr. Val: Do you think Daschle made the right choice to withdraw?
Thompson: Tom Daschle is a friend of mine. I think he’s an honorable person and I think he would have made an outstanding Secretary of HHS. I’m sorry he’s withdrawn, but the debate about his taxes was splashy enough to be affecting the stimulus bill and diverting attention from it. So I think overall it was probably the right thing to do.
Dr. Val: What’s the most important thing for the American people to know about the Daschle case?
Thompson: They should know that there is no double standard between people in power and those not in power. All of us are equal in the eyes of the law, and we’re a country of laws, not of men. We’re all responsible for our own personal decisions, and that includes paying our taxes.
***
See KevinMD’s excellent round up of further thoughts about Tom Daschle.
January 31st, 2009 by Dr. Val Jones in Expert Interviews, Opinion, Quackery Exposed
Tags: Borneman, David J. Kroll, David Kroll, Dr. David Kroll, Dr. Val Jones, Founder's Day, Homeopathic Remedies, Homeopathy, PCP&S, Ph.D., Philadelphia College of Pharmacy and Science, Quackery, Science, Snake Oil, University of the Sciences in Philadelphia
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David Kroll, Ph.D. and I share more than an appreciation for bibs and crab legs (pictured at left during our recent “academic” rendezvous) – we are pro-science bloggers who want to understand the evidence for (or against) health treatment options, both in the natural product world and beyond. At our recent meet up at The Palm we discussed homeopathy – a bizarre pseudoscientific approach to medicine often confused with herbalism. Homeopaths believe that “like cures like” (for example, since an onion causes your eyes to water and nose to run, then it’s a good cure for a cold) and that homeopathic remedies become more potent the more dilute they are. So if you want a really strong medicine, you need to mix it with so much water that not even a molecule of it is left in the treatment elixir. Of course, homeopathy may have a placebo effect among its believers – but there is no scientific mechanism whereby tinctures of water (with or without a molecule of onion or other choice ingredient like arsenic) can have an effect beyond placebo.
David graduated with his B.S. in toxicology from one of the most prestigious schools in the country, the Philadelphia College of Pharmacy and Science (PCP&S). In the early 1900s PCP&S graduates were critical players in combating snake oil hucksters and establishing chemical standards, safety, and efficacy guidelines for therapeutic agents. So it was with utter amazement that he received recent news that PCP&S was planning to award an Honorary Doctorate of Science to a major leader in homeopathy – on Founders’ Day, no less.
“Our founders would be rolling in their graves,” David told me. And he wrote a letter of complaint to the University president which you can read here. This is a choice excerpt:
Awarding Mr. Borneman an Honorary Doctor of Science is an affront to every scientist who has ever earned a degree from the University and, I would suspect, all current faculty members who are engaged in scientific investigation. Homeopathy is a fraudulent representation of pharmacy and the pharmaceutical sciences that continues to exist in the United States due solely to political, not scientific, reasons. Indeed, homeopathic remedies are defined as drugs in the Federal Food, Drug, and Cosmetic Act [21 U.S.C. 321] Section 201(g)(1) as a result of the 1938 actions of U.S. Senator Royal Copeland (D-NY), a noted homeopath of his time. But scientifically, homeopathic remedies are nothing more than highly-purified water misrepresented as medicine based upon an archaic practice that is diametrically opposed to all pharmacological principles.
Honoring people who actively promote pseudoscience is wrong in many ways as David points out. I would also add that doing so confuses the public. If academic institutions committed to scientific integrity lend their names to cranks, then it makes it more difficult for the average person to distinguish quackery from science. I have the utmost sympathy for the patients out there who are trying to figure out fact from fiction in medicine. That is why I have a “trusted sources” tab on my blog – please click on them for guidance regarding health information you can trust.
As for PCP&S, if they value their academic principles (as no doubt many within the organization do) the president should rescind his offer to honor Mr. Borneman’s “entrepreneurial spirit” on founder’s day (February 19th, 2009). Finding a way to sell water to people as cures for their diseases is certainly entrepreneurial – but I see nothing honorable about it. I hope that President Gerbino sees the light before founder’s day.
Together the Department of Defense and the Department of Veterans Affairs have the largest and most advanced IT infrastructures in US healthcare. As the Obama administration ramps up funding for electronic medical records and other IT initiatives, one might ask what the public and private sectors can learn from the military IT systems (aka AHLTA and VISTA).
