February 9th, 2011 by KevinMD in Health Policy, Opinion
Tags: Accountable Care Organizations, ACOs, Better Patient Care, Dartmouth Atlas, Dr. Kevin Pho, Health System Consolidation, Healthcare Delivery Models, Healthcare Policy, Healthcare Politics, Healthcare reform, Improved Healthcare Cost Control, Integrated Health Systems, KevinMD, Medical Monopoly, Merrill Goozner, The End of Private Practice
No Comments »
Health reformers propose the proliferation of integrated health systems, like the Mayo Clinic or Kaiser Permanente, which, according to the Dartmouth Atlas, lead to better patient care and improved cost control.
To that end, accountable care organizations (ACOs) have been a major part of health reform, changing the way healthcare is delivered. Never mind that patients may not be receptive to the new model, but the creation of these large, integrated physician-hospital entities that progressive policy experts espouse comes with repercussions. Monopoly power.
To prepare for the new model of healthcare delivery, physician practices have been consolidating. In many cases, they’re being bought by hospitals. Last year, I wrote how this is leading to the death of the private practice physician.
But with consolidation comes a tilt in market power. Health insurers, desperate to control costs, are finding it more difficult to negotiate with hospital-physician practices that dominate a market. And patients are going to side with the hospital — insurers that leave out popular doctors and medical facilities face a backlash from patients. Witness the power that Partners Healthcare has in the Boston market that’s mostly driven by patient demand for big-reputation, high-cost Massachusetts General Hospital and Brigham and Women’s Hospital. Read more »
*This blog post was originally published at KevinMD.com*
February 9th, 2011 by IsisTheScientist in Opinion, Research
Tags: ADA, AJCN, American Dietetic Association, American Journal of Clinical Nutrition, Artificial Sweetener, Aspartame, Birth Defects, Communication Gap, Diet Soda, Doctor-Patient Communication, Dr. Isis, Fetal Exposure, Fetal Health, Food and Drink, Food Safety, Healthy Pregnancy, High Blood Pressure, Hypertension, In Moderation, Isis the Scientist, Maternal-Fetal Medicine, Methanol, NutraSweet, OB/GYN, Obstetrics And Gynecology, Patient Education, Pre-Term Delivery, Pre-Term Labor, Pregnancy and Childbirth, Premature Birth, Saccharin, Safe Diet During Pregnancy, Splenda, Sucralose, Sweet N' Low, The Brain Confounds Everything
No Comments »
I can already tell that this pregnancy is different from my first. When I was pregnant with Little Isis, I drank no caffeine and took no over-the-counter medication. I remember having a few headaches and Mr. Isis fighting with me to take a headache pill. I would then proclaim dramatically, “But I can’t! What if it hurts the baby?!”
This morning, now pregnant with my second, I washed down a Zyrtec and two Tylenol with a cup of coffee. The little bugger is going to have to grow up with Little Isis. He might as well start building up his tolerance to exogenous substances at some point. I figure, now that its got a closed neural tube and a beating heart, we might as well begin.
Still, you can’t blame a pregnant woman for being a bit neurotic. The feeling that one is solely responsible for the well-being of a developing creature, combined with often contradictory advice, is enough to make anyone nuts. Most online advice is completely and utterly useless. Take this answer from Russell Turk, M.D. on the popular pregnancy website BabyCenter in response to the common question, “Is it safe to drink diet soda during pregnancy?” He answers:
Diet sodas often contain both caffeine and an artificial sweetener. There are several types of artificial sweeteners you may see on nutrition labels:
Aspartame (NutraSweet): Seems to be okay when consumed in moderation (the amount found in one or two 12-ounce servings of soda per day).
Saccharin (Sweet’n Low): Saccharin was found to cause birth defects in laboratory rats when consumed in very high amounts. Because its safety in smaller amounts is hard to prove, I would advise avoiding it.
Sucralose (Splenda): This relatively new sweetener, a modified form of regular table sugar, appears to be safe. But because it hasn’t been extensively studied, it’s best used in moderation.
It’s generally bad advice and leaves one wondering: “What is moderation? Will one soda hurt my baby? Will two sodas hurt my baby? How about three?” The default answer when we don’t know seems to be to tell women to do things in “moderation.” This places the sole responsibility on her to know what moderation means, and allows her to feel the guilt if something goes wrong. I think that these imprecise answers leave many women feeling helpless and afraid. Read more »
*This blog post was originally published at The Brain Confounds Everything*
February 9th, 2011 by StevenWilkinsMPH in Opinion, True Stories
Tags: Authorization For Care, Cancer Treatment, Denied Coverage, Empowered Patients, Health Insurance Carrier, Health Insurance Preauthorization, Hospital Business Office, Hospital Business Services, MD Anderson Cancer Center, Medical Insurance Issues, Medical Necessity, Medically Necessary Treatment, Mind The Gap, Navigating the healthcare system, Non-Small Cell Lung Cancer, NSCLC, Oncology, Out-of-network providers, Patient Advocacy, Patient Experience, Steven Wilkins MPH
No Comments »
Let me start by saying I really like MD Anderson Cancer Center. There is a lot to like. Take their tag line for example: “Making care history.” If anyone finds a cure for this cancer or that cancer, MD Anderson will have a hand in it, I’m sure. Hospitals could also learn a thing or two about the meaning of comprehensive care, clinical integration, and customer service from MD Anderson is well.
I have another reason why I like MD Anderson so well: They saved my wife’s life. You see, she was diagnosed back in November of 2004 with stage four non-small cell lung cancer (NSCLC). As anyone familiar with lung care knows, lung cancer is a very tough adversary. It’s an even tougher adversary when your insurance company insists that your local community hospital and oncologists are “just as good” as MD Anderson’s in terms of quality and outcomes.
You guessed it. In 2004, my wife and I had to fight long and hard to get our insurance carrier to authorize my wife care at MD Anderson, an out of network provider. I’m happy to say we won that fight back in 2004 and again just last week when my wife’s employer’s new insurance carrier refused to authorize her continued care at MD Anderson. You see, her new carrier wanted to rehash the whole medical necessity thing all over again.
Now you would think that a world-class organization like MD Anderson would do everything possible to help prospective patients deal with these kinds of insurance issues. After all, they seem to do everything for you once care is authorized. But you would be wrong. Read more »
*This blog post was originally published at Mind The Gap*
February 9th, 2011 by Lucy Hornstein, M.D. in Opinion, Quackery Exposed
Tags: Clinical, Clinically Proven, Direct-To-Consumer Healthcare Advertising, Dr. Lucy Hornstein, Inappropriate Use of Terminology, Irresponsible Medical Marketing, Medical Marketing Language, Medical Terms, Musings of a Dinosaur, TV and Radio Health Ads
No Comments »
I heard yet another commercial on the radio this morning for some menopausal cure-all that was “clinically proven” to reduce hot flashes, improve sleep, increase energy, help you lose weight, and probably cure bad breath to boot. Anyone who calls in the next ten minutes gets a month’s supply for free. “Hurry.” Don’t.
At least they finally stopped running the one for the colon cleansing product that helped remove the “five to ten pounds of waste some experts* believe are spackled along the inside of the large intestine.” (*Emphasis mine. “Some experts” also believe the moon landing was a hoax, the Holocaust never happened, and homeopathy is effective medicine.) Somehow this colon cleansing stuff helps you preferentially lose belly fat. Not really sure what belly fat has to do with five to ten pounds of stuff spackled inside your intestine, but they’re not selling logic. “Call right now for your free sample.” Or not.
Then there was the pediatrician hawking the natural, safe, clinically-proven effective sinus cure that sounded suspiciously like saline spray. “Hurry and call right now.” Don’t bother.
Words are my friends, and I hate to see people abuse them.
“Clinical” is an adjective referring to “that which can be observed in or involves patients.” It’s the hands-on part of medicine that can’t be replicated in a lab or taught from a book. There is virtually no such thing as “proof” in the scientific sense. Laboratory and patient-based medical research can strongly suggest things. Scientific evidence can accumulate supporting things, and the more the better, of course. Read more »
*This blog post was originally published at Musings of a Dinosaur*
February 8th, 2011 by Debra Gordon in Better Health Network, Opinion
Tags: Advance Directives, Afraid Of Dying, Death and Dying, Debra Gordon, End Of Life Care, End-Of-Life Decisions, End-Of-Life Planning, End-Of-Life Preferences, End-Of-Life Wishes, Family Planning, Fear Of Death, Healthcare Power Of Attorney, Healthcare Proxy, Prolonged Dying, Prolonged Life, Washington Post
No Comments »
The recent Washington Post article entitled, “Who decides when medicine prolongs dying, not living?” perfectly captures my earlier blog on why we’re afraid of death. An excerpt from the Post piece:
[There’s a] huge gap between Americans’ wishes about end-of-life care, as expressed in numerous public opinion polls, and what actually happens in too many instances–futile, expensive, often painful procedures performed on people too sick to leave the hospital alive–much less survive with a decent quality of life. Ninety percent of Americans say they want to die at home but only 20 percent do so. Half of Americans die in hospitals and another 25 percent in nursing homes, after a long period of suffering from chronic, incurable conditions that finally become untreatable. An astonishing one out of five die in intensive care units, often unconscious, isolated from loved ones and hooked up to machines that do nothing but prolong an inevitable death.
This happens partly because of the natural human tendency to procrastinate about addressing painful subjects with relatives and partly because doctors are often too pressed for time–and too uncomfortable with death and dying themselves–to respond when patients do bring up such issues. Just try to get a straight answer out of an oncologist, as an 89-year-old friend of mine did when her doctor advised another course of chemotherapy even though her cancer had metastasized to her brain. “Doctor,” she asked, “what chance is there that I’ll have a few months more of life that I can enjoy with my family?” He replied, “We can’t know these things.” She replied, “No, but we can use our common sense,” and declined further treatment. She died a month later in hospice, surrounded by her children, grandchildren and great-grandchildren. What if she hadn’t been clear-minded enough to to speak for herself? What if her children, out of love, guilt or a combination of the two, had subjected her to treatment that she wouldn’t have wanted? That is what advance medical directives are intended to prevent. Read more »
*This blog post was originally published at A Medical Writer's Musings on Medicine, Health Care, and the Writing Life*
