December 22nd, 2008 by Dr. Val Jones in Medblogger Shout Outs
No Comments »
Here’s my weekly round up of quotable quotes from my peers:
NHS Blog Doctor: Antibiotics do not cure snot. [Please go to the site for a fabulous illustrative photo.]
KevinMD: Since work-hours were restricted in 2003, there are no studies that have shown any marked improvements in patient safety or outcomes. Worse, errors have arisen from the so-called “patient hand-off,” the period of communication where rested doctors replaces those who are fatigued. Does increasing the frequency of patient hand-offs outweigh the benefit of better rested doctors?
Richard Reece, MD: The moral for doctors: Don’t expect as much leverage as in the past when negotiating with hospitals, even though you represent their main revenue stream.
Paul Levy: The medical community in Boston likes to boast about the medical care here, but we don’t do a very good job holding ourselves accountable.
Dr. Wes: Thanks to exorbitant costs of implementing EMRs in physician practices, the Medicare requirements for billing and prescribing electronically, and the prohibitive documentation requirements mandated by CMS in the name of “quality,” independent physician practices of all types will have no choice but capitulate to larger entities that have a fully integrated electronic medical record paired with collection software.
Heart found in a car wash (h/t Dr. Wes)
Ramona Bates, MD: I don’t think I would ever want to be part of doing a posthumous face lift or blepharoplasty or other cosmetic procedure, but I would be willing to debulk tumors if it would help families or individuals say “goodbye” more easily.
WhiteCoat Rants: For $79 you can blow into your iPod and it will play you a song if your blood alcohol is more than 0.08. You know this device wasn’t made for parents.
Just what we need. A bunch of drunk teenagers farting around with their iPods and getting into a “who can get the highest blood alcohol” contest.
The Happy Hospitalist: It frightens me to hear people say they want to work in medicine and work in a similar capacity as physicians, evaluating, diagnosing and managing disease, but not want to put in the time and sacrifice to be residency trained in depth and scope…
Science-Based Medicine: Our soldiers, grievously wounded in combat, deserve only the best science-based therapy available… If I were to propose treating our injured soldiers with bloodletting and toxic metals (both common methods in the 1700s and early 1800s) based on the concept that it would put the “imbalance of the four humors” back into balance, the Pentagon and the military medical establishment would toss me out on my ear as a dangerous quack–and rightly so. But introduce a method that claims “ancient Chinese wisdom” based on somehow magically redirecting the flow of a mysterious “life energy” by sticking small needles into parts of the body that correspond to no known anatomic structures through which “qi” flows, and suddenly the Air Force is funding a program to train medics and physicians treating our wounded soldiers how to do this method based on the same amount of convincing scientific evidence that qi exists as for the four humors (none) and in the face of no strong clinical evidence that it’s any better than a placebo.
Rural Doctoring: Hospitalists, take note: this is an example of why people go ape-sh*t crazy in the hospital:
• Her right arm is completely immobilized to protect the graft site.
• Her left arm has a heplocked IV in it.
• Half her head is shaved because the surgeon took the donor skin from the scalp.
• She’s vegetarian and the cafeteria sent her chicken for lunch.
• Dinner was vegetarian but she can’t really cut up a baked potato with only one hand.
• The hospital has double rooms and is running at capacity, so the staff is harried.
• Her roommate is an elderly, demented woman who keeps trying to get out of bed by herself and objects to the TV being on. So far, all she’s said to us is “Mind your own business!”
December 18th, 2008 by Dr. Val Jones in Audio, Expert Interviews
No Comments »
I often cringe when I see charts displaying parallel growth lines of these two variables: the number of American fast food restaurants in a given country and local obesity rates. The bad news is that our unhealthy eating habits have been exported successfully to foreign countries. The good news is that we’re going to export hospitals and health services next.
I spoke with Emme Deland, Senior Vice President of Strategy at New York Presbyterian Hospital, about the globalization of healthcare and the exportation of American health technology and expertise. You may read my summary of our discussion, or listen to the podcast here:
[Audio:http://blog.getbetterhealth.com/wp-content/uploads/2008/12/deland.mp3]
Dr. Val: Where does New York Presbyterian Hospital stand in terms of the global marketplace for medical tourism?
Deland: We’ve spent the last couple of years reviewing our strategy regarding medical tourism because we want to be a part of the global healthcare economy. There is a growing market for hospital development overseas, particularly in India, the Middle East, Eastern Europe, and China. The US offers the most advanced medical care in the world, and it’s only natural that other countries want to begin importing it. Whether it’s minimally invasive surgery, infertility techniques, or prenatal diagnostics and care – America is among the global leaders in health technology and services.
Dr. Val: What do these countries want to import exactly? Providers, infrastructure, physical plants, data systems, consultants who can advise on ways of doing things to reduce errors and improve quality?
Read more »
December 17th, 2008 by Dr. Val Jones in Primary Care Wednesdays
1 Comment »
By Alan Dappen, MD
 |
|
Alan Dappen, MD
|
Believe it or not, this headline paraphrases the recent lead article from the American Medical News, covering a comprehensive, white paper published by the American College of Physicians (ACP). The article reviews the state of primary care physicians. The conclusion: since primary care doctors are essential to control the spiraling costs of health care, a bailout is necessary to shore up their rapidly shrinking ranks.
To understand why they argue a bailout is needed, we must look at what caused the crisis. Primary care doctors are drowning in red tape, as my partner Steve Simmons mentioned last week. Over the past 20 years have come bureaucracies and regulations with acronyms like OSHA, CLIA, HIPPA, CPT, ICD-9, P4P. Drops led to trickles: more complex certification and increasing malpractice risk. Then trickles formed streams of data that is required of practitioners: quality reporting, management reports, productivity measures, electronic medical record systems, billing reports. Finally, the flood of information needed to stay in compliance with Medicare, Medicaid and insurance regulations swamps primary care providers.
The creative and intellectual focus of primary care physicians has been diverted to understanding this new world order of business contracts, negotiated rates, billing details, payment denials, coding, and non-compensated services. This is no game. It means the difference between medical practices staying afloat or going under. There are now thousands of reasons a doctor can lose money by getting fined, sued, or refused reimbursement.
Family doctors and internists have grown weary. They feel underappreciated by their patients, undervalued by the specialists, underpaid by the insurance company, overworked to meet expenses, and overexposed to malpractice risk. U.S. medical graduates entering family medicine residencies dropped by 50% over 10 years and are now filled mostly by non-US trained physicians. American medical graduates now rush to specialties where they make better money, gain higher status and/or achieve better control of their work schedules. To keep primary care doctors in adequate supply, so the argument goes, system subsidies and readjustments are needed.
Outsiders easily “get” what went wrong the auto and financial industries. These industry execs standing in line for handouts make most of us angry. They refused to do so many things to avoid their plight: innovate, stand up to wrongs, worry about sustainability, take responsibility, invest in a new future, even ”bending the truth” and turning a blind eye was fine as long as there were profits. They say that Americans didn’t want “the truth.” They want us to believe that they are victims of circumstances beyond their control. What should we think of primary care doctors who put themselves on the same playing fields as these execs asking for a bailout?
Internists and family doctors are the backbone of a vibrant healthcare system that is cost-effective [see later blog post to learn why]. But, for far too long we in primary care have piggybacked on the insurance systems, relying on them to pay the bills, even when the costs of administering that is more expensive than the care provided in most cases. This has slowly weakened our doctor-patient relationships and our advocacy for patients, thus compromising our power and professionalism. By casting its lot with third party payers, primary care essentially has announced that it wants someone else to fix the problem of affordable care.
I feel that the solution to primary care is simple. We should not be looking for a bailout. Instead, primary care doctors must step up to initiate change. Personally, I stopped waiting for someone else to rescue me or tell me how to do my job, promising they could make me happy. The restructuring I’m suggesting to revitalize primary care is that patients retain control of the funds they (and their employers) have been giving to the insurance companies for their day-to-day care (which now account for about 30% of total costs), and directly purchase the services they need from doctors who serve them best. Doctors in Oregon (www.greenfieldhealth.com), New York City (www.hellohealth.com) and Northern Virginia (www.doctokr.com) already have set up such practices. These doctors have developed innovative business models that deliver better care to patients at much lower cost. But these will only spread on a large scale if patients understand the value of these new business models, and flock to support them.
More details about the changes needed can be found on our website or by listening to our story with “The Story” on National Public Radio, and in this blog in the coming weeks.
Until then, I remain yours in primary care,
Alan Dappen, MD
December 16th, 2008 by Dr. Val Jones in Audio, Expert Interviews
3 Comments »
 |
|
Dr. Joseph Heyman
|
Alright I admit it, that was a rather provocative title. The truth is that at the end of a recent interview with Dr. Joseph Heyman, the chair of the board of trustees of the AMA, I was in fact chided for having left full time clinical practice. Dr. Heyman was rather avuncular in his tone when he stated,
You are robbing patients of the opportunity to have a good clinician like you involved in their care. I guess it reflects badly on our profession that the best and brightest are making alternative career choices – practicing clinical medicine is becoming unbearable.
No amount of protest on my part (about my volunteer work at Walter Reed) would convince Dr. Heyman that I hadn’t abandoned my profession to some degree. And it touched a chord with me too – because taking care of patients is very gratifying for me in many ways. It was with a heavy heart that I chose to become a medical journalist instead.
And so back to the interview with Dr. Heyman. We had an interesting discussion about the concept of medical tourism:
You may listen to our conversation here, or read my summary below.
[Audio:http://blog.getbetterhealth.com/wp-content/uploads/2008/12/heyman.mp3]
Dr. Val: Is medical tourism about people coming to the U.S. for care, or about patients leaving the U.S. to get more affordable care elsewhere?
Dr. Heyman: Historically, medical tourism has been about patients coming to the United States to get high quality care. Nowadays, people are realizing that there are wonderful places overseas where they can seek treatment. If they don’t have a very exotic illness, or require a highly specialized procedure, they can get appropriate care overseas. Hip replacements are a good example of a standard procedure that can be performed without too much difficulty. It wouldn’t be as much of a draw for patients who need hip replacements to come to the U.S. Read more »
December 15th, 2008 by Dr. Val Jones in Opinion
No Comments »
The “Health 2.0” movement is about “consumer directed healthcare” and proposes to empower patients with online tools and technologies to help them manage their care and take control of their health. Some Health 2.0 initiatives have been quite popular – though many suffer from lack of participation on the part of consumers. Having your own personal health record sounds great – but when you’re the one who has to manually enter the majority of the data into it, only the most motivated patients will participate. Access to online physician ratings is appealing – but when everyone wants to read the ratings, but no one takes the time to complete the ratings questionnaire, the value of the tool is lost.
Over the past few years there have been a number of regularly repeating conferences created to unify key stakeholders around healthcare’s digital agenda – Health 2.0, Health Care Consumerism, The Healthcare Globalization Summit, Health 3.0, New Media Expo, Blog World Expo, Health 4.0, the AMA’s Medical Communications Conference, and more. Thankfully, these disparate groups with overlapping agendas are beginning to consolidate – offering new mega conferences that simplify the learning and relationship-building process.
My observation as an attendee of several of these conferences is that providers and patients are still not coming together as they should. Online healthcare solutions tend to be created in a lopsided manner – either by consumer/patient groups without much provider input, or by providers/health plans/governmental agencies without much patient/consumer input. The result tends to produce two types of products 1) active online groups and tools that facilitate both helpful information and misinformation or 2) products that advance good concepts, but have low participation due to lack of user-friendliness.
The current conference version “arms race” (to attract the most powerful vendors and largest audience possible) is not terribly helpful. Whether you associate with Health 2.0, 3.0 or 4.0 – the bottom line is that the Internet is a powerful force in healthcare. It can provide many different kinds of tools that make valuable contributions to health education, care management, behavior modification, emotional support, and improved quality outcomes. In the wrong hands it can also mislead patients, promote snake oil, sensationalize health news, confound research efforts, misinform, and mislead.
There is no more critical time than this for providers and patients to join forces to guide the development of new online health initiatives. The successful execution of digital health platforms requires a patient-provider partnership – I can only hope that upcoming conferences will embrace this view more fully.
In my next few blog posts, I’ll provide you with some fascinating interviews with key opinion leaders from the recent Consumer Health World mega-conference in Arlington, Virginia. The interviews are as follows, so stay tuned:
1. Skip Brickley, founder of Consumer Health World
2. Joseph Heyman, M.D., Chair, Board of Trustees, the American Medical Association
3. Emme Levin Deland, Senior Vice president, Strategy, New York Presbyterian Hospital
4. Joseph Kvedar, M.D., Director, Center For Connected Health, Partners Healthcare
