September 16th, 2007 by Dr. Val Jones in Health Policy, News
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I was glad to to hear from Wendy from wendysbattle.com … like my friend, she is battling stage IV colon cancer. Unlike my friend, she lives in Ontario and has no assistance to pay for her chemotherapy. In a jaw dropping video from a cancer press conference in Ontario, Wendy and 2 other colon cancer patients testify about being denied coverage for standard of care colon cancer therapy. Wendy says that Ontario has valued her life at less than $18 thousand dollars.
In a recent interview with Senator Mike Kirby, I learned that one of the major problems facing the Canadian healthcare system is the cost of expensive new drugs. The universal system was designed to have patients pay out of pocket for their medicines and have the government cover almost everything else. When this health insurance strategy was created, drugs were very inexpensive. However, with all of the technological advances in medicine – diseases like HIV/AIDS and cancer have become chronic, manageable illnesses with expensive treatment price tags. And now, the lack of drug coverage is shifting unmanageable costs directly to the patient. Sadly, Wendy is one of many victims of lack of drug coverage in Canada.
All this to say that the grass is not really greener in Canada – especially for cancer patients.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
August 26th, 2007 by Dr. Val Jones in Opinion
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The Wall Street Journal’s Health Blog recently featured a heated
debate about the utility of online physician ratings. On the one hand, some physicians are worried
that their reputations will be harmed by poor ratings given by a select minority
of disgruntled patients. Some have gone
so far as to ask that their patients sign an agreement not to participate in
online physician ratings. On the other
hand, many physicians view online ratings as a welcome form of constructive feedback
– believing that the ratings will further showcase their already good work.
I believe that physician ratings are not a perfect measure of
quality care, but they can offer a legitimate and enlightening patient
perspective on bedside manner, office efficiency, and communication skills. Many patients have nothing more than a health
insurance company’s list of “in network professionals” from which to choose a
provider. Online physician ratings sites
now give them a little bit more information to guide their selection process.
The potential for inappropriate or libelous postings depends
upon how carefully the ratings company reviews the comments. Open message boards may degenerate into gripe
sessions, but closely monitored ratings like those at Revolution Health, are much less risky. Even more valuable will
be the fusion of consumer ratings, peer reviews, hospital, and health
plan ratings of an individual physician all in one place. This kind of rating system is not far off.
The bottom line is that online physician ratings are here to
stay – and the best way for the ratings to fairly reflect the average patient’s
experience is to have physicians encourage all their patients to rate them
online. In that way, the rare
disgruntled patient’s review will be seen in the context of the majority of
satisfied customers. If the majority of
comments are still cautionary, then it becomes more likely that the physician
him or herself has some work to do.
Since the American Board of Medical Specialties is now
recommending demonstration of patient satisfaction as part of the recertification
process for many specialties, online physician rating sites may actually become
a great (and cost effective) way for physicians to collect such qualitative
data. So my advice to physicians is to
embrace physician ratings and make them work for you and for the benefit of
your future patients. Give the audience
some credit – they won’t judge you on one outlier comment… unless perhaps that’s
the only comment they see.
Your views and dissenting opinions are welcome.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
August 18th, 2007 by Dr. Val Jones in Health Policy, Medblogger Shout Outs
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Emergency departments are splitting at the seams, uninsured patients fill the waiting rooms, and Emergency Medicine physicians are crying “uncle” on a national level. We assume that gaps in health insurance coverage force patients to seek treatment in the ED, but the reality is that many insured patients seek treatment there as well. Why? Because the ED is a crowded, but one-stop shop whose convenience cannot be denied. PandaBearMD explains why one well-insured patient (who has a regular PCP) still chose to see him in the ED:
“As my patient related to me, in order to see his doctor he has to
make an appointment which is often weeks to months in the future. On
the day of his appointment, even if he shows up on time he will usually
have to wait an hour or two because the doctor is always running late.
Then he will spend a brief ten to fifteen minutes with his doctor who
will order a slew of tests and imaging studies, many of which will have
to be completed at a different location. He may, for example, have to
drive across town for a CT scan and it is usually scheduled for a
different day, often weeks in the future.
Then, as my patient explained, he must wait several weeks for his
next appointment where his physician will explain the results and
finally initiate either definitive treatment or, as is often the case,
referral to another specialist who will repeat the time consuming
process…
My patient also confided to me that even getting the results of studies
and imaging was not guaranteed. Although we are all quick to relay bad
news, apparently follow-up is not that pressing to many physicians if
the results are normal…
Consider now a visit to the Emergency Department. First, my patient did
not need an appointment. While it is true that he was triaged to a low
acuity and had to wait a while, at certain times of the day the waiting
times are not that much longer than the typical wait for his delayed
primary care physician. Second, the lab tests he needed were drawn on
the spot and the results reported within an hour even though he was a
low acuity patient. Our goal, you understand, is to discharge or admit
as fast as possible. Likewise his imaging studies were obtained, read,
and reported quickly. Finally, if anything serious has been discovered
he would have been admitted within hours. More importantly to my
patient, since everything was all right he knew fairly quickly instead
of biting his nails for a couple of months.”
This is a perfect illustration of how Americans value convenience over cost, and how health insurance can be an enabler for inappropriate ER use. The solution here is in IT. Primary Care Physicians need the tools to automate a lot of what they do, thus making care more convenient for their patients and themselves. A common, secure PHR-EMR, synched with online scheduling, radiology suites and laboratories, health news alerts, care pages and vibrant community, chronic disease management tools, and comprehensive, credible, patient education will go a long way to keeping people out of the ER. Revolution Health is working on such a system, and we have high hopes that the creation of America’s first integrated, digital medical home will improve the quality of life of patients and physicians alike. Achieving this goal will require cooperation and patience from all sectors in healthcare. I hope we’ll find a way to work together as rapidly as possible or else the PCPs and ER docs are going to crack. Hang in there, guys – help is on the way, though it might be a few years out…This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
August 15th, 2007 by Dr. Val Jones in Expert Interviews
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The Washington Post featured an article about how social networking tools like Facebook are influencing student socialization at college. Some say that the frenetic texting, online communications, and iPhone chatter are causing students to lose the ability to socialize normally in-person. Others say that technology levels the social “playing field” for introverts. I interviewed Revolution Health’s psychologist, Dr. Mark Smaller, to get his thoughts on the matter. Feel free to add your perspective in the comments section of this blog.
Dr. Val: The article
suggests that technology can become a social crutch, keeping people from making
new friends. Do you think that the
Internet can isolate students from one another?
Dr. Smaller: I think the long term impact of the Internet in
social interactions is unclear. For now
such technology does allow students to remain in touch with one another
instantly, but that’s not too different from what the telephone did for
previous generations. If anything, I’d
say that technology can interfere with isolation, especially for the new
college student away from home for the first time. If there is a propensity for isolation, any
activity in excess – reading, school work, drinking, etc. will become the means
to continue that isolation.
Dr. Val: Do you think
that social networking and Internet based methods of communication are
particularly healthy for introverts?
Dr. Smaller: Being able to communicate sincerely or
genuinely but indirectly and not in person may help the otherwise shy person. Some of our most brilliant artists and
writers have used their craft as a means to communicate to others in ways they
could not in social situations.
Dr. Val: Overall do
you think that socializing via the Internet is a good thing or a bad thing for
college students?
Dr. Smaller: One things is certain on and off the Internet:
relationships for children, adolescents, and adults can become quite intense
with this way of communicating because of fantasy and anonymity. Previous generations used the art of letter
writing to express intense feelings, followed by the telephone, and now online
communication. What they all have in
common is the essential human need to connect – including the satisfaction of
doing so and the frustration when it chronically does not occur.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
August 14th, 2007 by Dr. Val Jones in Expert Interviews
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In a recent study conducted by the Agency for Healthcare Research and Quality (AHRQ), it was argued that better primary care could prevent 4 million hospitalizations per year. This staggering potential savings – on the order of tens of billions of dollars – seems like a good place to start in reducing some of the burden on the healthcare system (and reducing unnecessary pain and suffering). I interviewed Dr. Joe Scherger, Clinical Professor of Family & Preventive Medicine at the University of California, San Diego School of Medicine (UCSD) and member of the Institute of Medicine, to get his take on the importance of prevention in reducing health costs.
Dr. Val: What do the AHRQ
statistics tell us about the role of primary care in reducing healthcare
costs?
Volumes!
Primary care works with the
patient early in the course of illness, maybe even before it has developed, such
as with prehypertension and prediabetes. Primary care focused on prevention
with patients keeps people healthier and out of the
hospital.
Dr. Val: What can individual
Americans do to reduce their likelihood of having to be admitted to the
hospital?
Prevention begins with the individual,
not the physician. 60% of disease is related to lifestyle. Bad habits such as
smoking, overeating, not being physically fit, and stress underlie most common
chronic diseases. If Americans choose to be healthy and work at it, we would
save tremendously in medical expenses.
Dr. Val: Are there other studies
to suggest that having a medical home (with a PCP) can improve
health?
The medical home concept is new and lacks
studies, but the work of Barbara Starfield and others have confirmed the
importance of primary care and having a continuity relationship with a primary
care physician. The more primary is available, the healthier the population.
The opposite is true with specialty care.
Dr. Val: Why did the
“gatekeeper” movement (promoted by HMOs) fail, and what is the current role of
the family physician in the healthcare system?
The
“gatekeeper” role failed because it restricted patient choice. Patients need to
be in control of the health care, which is what patient-centered care is all
about. HMOs put the health insurance plan in charge, something which was hated
by patients and their physicians.
Dr. Val: In your work with the
IOM (specifically in Closing the Quality Chasm) did the role of primary care and
preventive medicine come up? If so, what did the IOM think that PCPs would
contribute to quality improvement in healthcare? Did they discuss (perhaps
tangentially) the cost issue (how to reduce costs by increasing preventive
measures?)
Just before the IOM Quality Reports
came out, the IOM did a major report on the importance of primary care. The
importance of primary care and prevention are central to improved quality. In
the “Chasm Report”, the focus was more on the patients taking greater charge of
their health care, and the realization that primary care is a team effort, and
not just a role for physicians. The reduction in costs comes from making health
care more accessible (not dependent on visits) through health information
technology and the internet. Preventing disease, and treating it early when it
comes, are the keys to quality and cost reduction. Revolution Health is a
vehicle for this, consistent with the vision of the “Chasm Report.”
Dr. Val: How can patients be sure that they’re getting the best primary care?
First take charge of your
own primary care. The traditional patient-physician relationship was, “Yes
doctor”, “Whatever you say doctor”. Your care would be limited by the knowledge
and recall (on the spot) of your doctor.
Much better is a “shared care” relationship with your primary care
physician and team. After all, the care is about you. Be informed. Make your
own decisions realizing that the physician and care team are advisors, coaches
in your care. You may agree with them, or disagree and do it your way. By
having your own personal health record and being connected to resources like
Revolution Health, you are empowered to get the care you want and need.
Finally, choose your primary care wisely. Not just anybody will do. Your
primary care physician is as important a choice as your close friends. You need
to like and trust this person. Have a great primary care physician who knows
you and cares about you and your health care is in real good shape. But, no
matter how good she or he is, you still must take responsibility for your care.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
