October 26th, 2010 by Jennifer Shine Dyer, M.D. in Better Health Network, Health Policy, Health Tips, News, Opinion, Research
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When it comes to understanding medical information, even the most sophisticated patient may not be “smarter than a fifth grader.”
In one of the largest studies of the links between health literacy and poor health outcomes, involving 14,000 patients with type 2 diabetes, researchers at the University of California San Francisco and Kaiser Permanente found that more than half the patients reported problems learning about their condition and 40 percent needed help reading medical materials. The patients with limited health literacy were 30 to 40 percent more likely to experience hypoglycemia — dangerously low blood sugar that can be caused if medications are not taken as instructed — than those with an adequate understanding of medical information.
Now, federal and state officials are pushing public health professionals, doctors, and insurers to simplify the language they use to communicate with the public in patient handouts, medical forms, and health websites. More than two-thirds of the state Medicaid agencies call for health material to be written at a reading level between the fourth and sixth grades.
A new federal program called the Health Literacy Action Plan is promoting simplified language nationwide. And some health insurers, doctors’ practices, and hospitals have begun using specialized software that scans documents looking for hard-to-understand words and phrases and suggests plain-English replacements. Read more »
October 25th, 2010 by RyanDuBosar in Better Health Network, Health Policy, News, Research
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New Jersey’s state health department is considering a rule that would allow nurse anesthetists to work without a doctor’s supervision, as long as there’s a plan to reach one in case of an emergency. New Jersey would join the 30 states that allow nurse anesthetists to work without direct supervision.
On the other end of the country, a California court upheld the state’s decision to opt out of a Medicare requirement that doctors be present while a nurse anesthetist works in order to be reimbursed. The Centers for Medicare and Medicaid Services have allowed states to opt out of that requirement since 2001.
Since then, there has been no evidence of increased inpatient deaths or complications, researchers reported in the August 2010 issue of Health Affairs. Earlier this month, the Institute of Medicine reported that nurses should have a larger role in medical care, including anesthesiology.
*This blog post was originally published at ACP Internist*
August 30th, 2010 by RyanDuBosar in Better Health Network, Health Policy, News
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More than one-fifth of hospitals are government-owned, but states and counties are out of cash to keep them open. So, charitable hospitals are being sold to for-profit groups or facing closures. Rising costs and more uninsured patients run smack into falling Medicare and Medicaid reimbursement. When bonds come due, there’s little chance of states and counties paying them back. And the facilities are often standalones, and they can’t fall back on corporate backing. This year, 53 hospitals have been sold in 25 arrangements. While the deals often stipulate that care for the poor continues, no one is certain exactly how or even whether such services will continue.
That said, other charitable hospitals are making big profits. What are they doing differently? First, they’re competing for patients, so they’re increasing room sizes, offering amenities and even investing in high-end procedures such as robotic surgery. They continue to offer community care, but they’re acting more like for-profit institutions to cover their charitable missions. But this conflicts with an old-fashioned view of what charitable care is supposed to be.
Stepping into the breach is the Centers for Medicare and Medicaid Services, which is offering one solution, by increasing reimbursement for inpatient services in rural areas. The agency is expanding a pilot program by increasing reimbursement for inpatient services. Facilities are eligible if they offer care to rural areas in the 20 states with the lowest population densities, have fewer than 51 beds, provide emergency-care services and are not a critical-access hospital. (Wall Street Journal, Washington Post, Modern Healthcare)
*This blog post was originally published at ACP Internist*
July 15th, 2010 by David H. Gorski, M.D., Ph.D. in Better Health Network, Health Policy, News, Opinion, Quackery Exposed, Research, True Stories
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There’s been a bit of buzz in the health blogs over President Obama’s decision last week to use the mechanism of a recess appointment to be the director of the Centers for Medicare and Medicaid Services (CMS).
Recess appointments, for those who may not be aware, allow a President to put a nominee in place when Congress is in recess in order to have him in place without the messy process of having him approved by the Senate. True, the Senate still has to approve a recess appointment by the end of its term, or the seat goes vacant again, but it’s an excellent way to avoid having nasty confirmation fights during election years. Of course, both parties do it, and the reaction of pundits, bloggers, and politicians tend to fall strictly along partisan lines.
If you support the President, then a recess appointment is a way to get around the obstructionism of the other party. If you don’t support the President, it’s a horrific abuse of Presidential power. And so it goes. Either way, I don’t really care much about the politics of how such officials are appointed so much as who is being appointed.
The man who was appointed last week to head CMS is Donald Berwick, M.D., CEO of the Institute for Healthcare Improvement. His being placed in charge of CMS will likely have profound consequences not just for how the recent health care/insurance reform law is implemented, but for how the government applies science-based medicine to the administration of the this massive bill. Read more »
*This blog post was originally published at Science-Based Medicine*
July 14th, 2010 by John Mandrola, M.D. in Better Health Network, Health Policy, News, Opinion
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It happened. Guilty. I confess. Reading about Dr. Berwick’s recess appointment to lead the Centers for Medicare and Medicaid Services (CMS) induced me to watch a Fox news clip. Gosh, I feel bad about it. It felt good, though.
Patients — that’s you and me — should know that CMS controls doctors, nurses and especially hospital/practice managers. They are ten times more scary than the radar patrol car on the highway.
Dr. Berwick likes the British system of healthcare delivery. In Europe healthcare is free, and everyone likes free stuff. Free stuff happens all the time, doesn’t it?
In Cambridge, Mass — at Harvard — free stuff for all seems a plausible tenet. There must be a lot of coffee shops and free time in Cambridge. In the real world — on Main street, on the farm, in the factory, or really everywhere other than college — people know getting something for nothing is fantasy.
It hasn’t happened yet, so my Dad’s advice about not worrying too much about future events still holds true, but Dr Berwick’s recess appointment to lead the all-controlling CMS has the potential to make caring for patients even more challenging. Yes, more regulations, longer EMR notes with a really careful review of systems, and less pay to doctors will surely improve patient care. Scary indeed. Read more »
*This blog post was originally published at Dr John M*
