In a recent blog posting, I described Group Health’s medical home for 8,000 patients. It proved to be a boon for primary care physicians, who were able to reduce the size of their patient panels, see fewer patients per day, refer more patients to specialists, and maintain or increase their incomes.
Patients liked it, too. And Group Health was happy because expenditures per patient were 2 percent lower. But poor patients had trouble getting through the front door of the medical home, so based on demographic differences alone, expenditures should have been lower by 10 percent or more. Nonetheless, they declared victory.
Now news filters south from Ontario’s eight-year experiment with medical homes for 8,000,000 patients, and the news is similar. Participation is skewed to healthier and wealthier patients who, in the absence of risk adjustment, yield profitable capitation for primary care physicians. Incomes have soared an average of 25 percent. Read more »
The Associated Press recent article “Overtreated: More medical care isn’t always better” reiterated a commonly known fact which is not understood by the public. This problem of doing more and yet getting little in return is a common issue which plagues the U.S. healthcare system and was illustrated quite convincingly by Shannon Brownlee’s book. Americans get more procedures, interventions, imaging, and tests but aren’t any healthier.
In fact they are often worse off. Too many unnecessary back surgeries. Too many antibiotics for viral infections, which aren’t at all impacted by these anti-bacterial therapies. Too many heart stents which typically are best used when someone is actually having a heart attack. Research shows that those that are treated with medications do just as well. As all patients with cardiac stents know, they also need to be on the same medications as well.
Eliminating unnecessary treatments is a good thing, particularly when it is based on science. Read more »
We’ve been slacking in the “Medical news of the obvious” department lately. Seems like research has been either actually newsworthy or so obvious that you could spot it yourselves (for example, the continuing investigations of whether smoking and being lazy are bad for you).
But we couldn’t let this one slide by: “A new study that analyzes what would happen if a person were to eat 2,000 calories of foods that are advertised on the tube,” as HealthDay describes. As even the average Saturday morning cartoon viewer could have predicted, the food in commercials turns out to be bad for you. Read more »
*This blog post was originally published at ACP Hospitalist*
Reporting from the American Society of Clinical Oncology conference in Chicago, empowered patient Andrew Schorr discusses how long it can take before a study is presented at ASCO and the role of clinical trials in giving patients access to the medicines of tomorrow today.
The worst-kept secret in journalism circles recently was that the New York Times was planning an article critical of the Dartmouth Atlas. Among the main points in the article:
• “The mistaken belief that the Dartmouth research proves that cheaper care is better care is widespread.”
• “The atlas’s hospital rankings do not take into account care that prolongs or improves lives.”
• “Even Dartmouth’s claims about which hospitals and regions are cheapest may be suspect.”
• “Failing to make basic data adjustments undermines the geographic variations the atlas purports to show.”
The Times has also published the correspondence it had with the Dartmouth team about methodology questions.
The Dartmouth team challenges each of these criticisms. The team says the Times made at least five factual errors and several misrepresentations. They write:
“What is truly unfortunate is that the Times missed an opportunity to help educate the American public about what our research actually shows — or about the breadth of agreement about what our findings mean for health care reform.”Read more »
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