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Ill health of poor imperils health of affluent

April 14, 2015by Robert Whitcomb in Uncategorized tagged ,

minnesota

Minneapolis, with some rich suburbs and many poor people, too.

Minnesota Health Commissioner Ed Ehlinger, M.D., has challenged his fellow state healthcare leaders to stop “’admiring the problem’ of health inequity — the troubling gap between the excellent health of Minnesota’s {more affluent} white majority and the poor health of {low-income} minorities” and do something about it.  And, the Minneapolis Star Tribune reports, he noted that the health of the middle-and-upper-income white majority can be jeopardized by the ill health of the poor.

He said, the paper paraphrased, ”that solutions go beyond medical treatment and health insurance coverage. Everything from affordable housing to education to workplace leave policies and fresh produce can influence a person’s well-being — so addressing gaps in health means addressing gaps in those areas as well.”

That’s what Cambridge Management has found in its community-health work, especially in the Pacific Northwest.

The paper, paraphrasing his remarks, said that “Getting the healthy white majority to care sufficiently about inequities will take work. In a system that has been described as ‘structural racism,’ the healthy people might be sympathetic, but also loathe to give up advantages that have ensured their superior health.”

Dr. Ehlinger told a state Health Department forum:  “In the societies with the biggest disparities, the people at the top are not as healthy.”

“We are affected by who serves our food, who takes care of people in the hospital, people in the nursing homes, people in our child care centers. They are increasingly people of color and people with lower incomes. Their health is going to have a direct impact on the health of the people they are working with.”

How patients should respond to physicians’ financial conflicts

April 12, 2015by Robert Whitcomb in Uncategorized tagged ,

 

James Rickert, M.D., discusses what patients can do in a time when physicians’ personal-financial conflicts of interest all too trump the best clinical decisions as medicine is seen more and more (by some) as a business more than a calling.

Health IT: ‘Bound to be disappointed’

April 10, 2015by Robert Whitcomb in Uncategorized tagged , ,

 

hairpin

MedPage Today interviews Robert Wachter, M.D., about the present and future of technology in healthcare, warts and all.

He’s associate chairman of medicine at the University of California at San Francisco and author of the much-publicized book The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age,

“In retrospect, we were bound to be disappointed,” reads the first line of his latest book, when he compares consumer technology to healthcare’s more crooked road to computerization.

He talks about ”the most encouraging and frightening aspects of technology in healthcare and who can provide guidance in navigating the changing digital landscape,” summarizes MedPage.

 

Addressing the crisis of physician burnout

April 9, 2015by Robert Whitcomb in Uncategorized tagged , , ,

 

suicide

“The Suicide,” by Edouard Manet.

Arnold R. Eiser, M.D., discusses physician burnout and that doctors have a considerably higher suicide rate does than the general population.

He ends his essay, a blog on  The Philadelphia Inquirer Web site, with:

”I think it is fair to say that there a crisis in medical practice in the United States. We need to examine the cultural and social causes of this crisis if we are to maintain high professional standards for the medical profession.  No patient wants a clinician taking care of them who is burned out, depressed, or suicidal.  However, if we just focus on individuals and their psychological shortcomings, we will miss the big picture of factors afflicting postmodern healthcare.

”As a start we need to teach physicians-in-training how to deal better with stress. Mindfulness training including meditation, case discussions of stressful practice situations, and other positive psychology practices need to be part of the curriculum of medical schools and should also be made available to practicing physicians. We also need to re-examine the current best practices in medicine to take into account their psychological impact on clinicians. Reevaluating the usual way of doing business in medicine is not just important for clinicians. It is also essential for the good of their patients and of society too.”

50 years of Medicare: Personal histories

April 3, 2015by Robert Whitcomb in Uncategorized tagged , , ,

 

Physicians, including a former CMS administrator, talk about their experiences  dealing with Medicare and look at its future in a MedPage Today series.

Here are remarks by a couple of  the physicians:

Michael Ellis,  M.D., an ENT surgeon connected with Tulane University School of Medicine: “I think Medicare has worked well overall, providing adequate access for good reimbursement. The problem comes from the Medicare allowable charge of 80% of the doctor’s fee, with the doctor having to bill the patient or supplemental insurance for the remainder, which is a lot of paperwork. And for the dually-eligible, we get nothing for Medicaid. The good side is that Medicare is less hassle to deal with than commercial insurers, now that the program here doesn’t require pre-authorization anymore.

“Now there’s talk about paying for quality, as if we have adequate quality measures, which we don’t, and with a big push toward bundled payments, with hospitals divvying up the proceeds.”

“I think more patient knowledge of costs would help, but public information right now about real costs and not just charges is difficult to come by.”

And Peter Hollmann,  M.D.,  chief medical officer of University Medicine, in Providence: “A Medicare Level 4 visit has a fair range of complexity, and this is the area where geriatricians work. So, while the law of averages sort of works out for most physicians, if you’re working at the skewed end, like most geriatricians, there is more marked inequity in reimbursement. Also, because they’re working largely for one insurer, Medicare, geriatricians can’t cost shift among insurers like some other physicians can.

“In general, it will be difficult to address everything that should be for the more complicated patients. Quality measures may prove difficult because there’s no methodology as yet for evaluating individual physicians with any accuracy, and it’s especially difficult with geriatricians, who deal with a wide variety of cases. But it’s a good thing Medicare is looking at quality initiatives; it’s been behind some private insurers moving in this direction.”

 

 

Narrowing networks harrowing for specialists

April 2, 2015by Robert Whitcomb in Uncategorized tagged , , , ,

 

basal

Basal-cell cancer.

Dermatologists  seem particularly up in arms about the narrowing of insurance contracts that have hit them and other specialists.

Brett Coldiron, M.D.,  president of the American Academy of Dermatology, says, reports Dermatology Times, that cuts to Medicare Advantage plans  caused insurers to eliminate their most expensive patients by eliminating the doctors who treat them from their network. ”Despite the fact their government reimbursement has declined from 114 percent to 104 percent of fee for service Medicare, the overall profit margin of insurers has increased.”

“In the long run, they will not save money,” he said. “They are de-listing physicians for treating the sickest patients. Delayed care means greater risk of mortality and more expensive care later on. What does it cost to treat someone with metastatic melanoma [compared to melanoma that has not metastasized]?”

Dermatology Times reports: “One of the distressing realities of this de-listing phenomenon is that patients who will be most affected are retirees, typically over 65 years of age, who have been making Medicare contributions throughout their working years, according to Dr. Coldiron.”

This last  remark is rather misleading. It’s common to say that since people paid into Medicare and Social Security in their working years that they have more than paid for what they get from services later in life. But because of increased longevity and the world’s most expensive medical care, most older people take out considerably more than they pay in, helping to intensify the nation’s long-term fiscal challenge.

Residencies shortage: Go Caribbean

April 2, 2015by Robert Whitcomb in Uncategorized tagged , , ,

 

martin

Sign in usually tranquil St. Martin, where medical students stand by to help in disaster.

Heidi Chumley, M.D., executive dean and chief academic officer of the American University of the Caribbean School of Medicine,  on the island of St. Martin, criticizes the “pernicious idea” that American medicine is speeding to a “residency cliff” of a “severe shortage ” of residencies.

One could guess that she says that in part because less-selective medical schools like hers would like to  be seen as a good source of young physicians to meet this challenge, though some hospitals are leery on hiring students from them.

“Having led medical education programs for a decade, I want to reassure aspiring doctors: It’s not that bad. It is certainly not a reason to abandon a dream of becoming a doctor, especially not when the country faces a growing shortage of physicians.”

“Though the number of residencies per graduate may be decreasing, it is not worsening as rapidly as the ‘cliff’ metaphor implies. Overall, the number of U.S. allopathic medical students is growing by about 2 percent. Comparing this to the 1-2 percent growth in first-year residency positions, we can see that there is a squeeze, but by no means an imminent drop-off. ”

“Schools like AUC are doing their part to address this imbalance by providing a pipeline of mainly primary care physicians to care for underserved U.S. populations.”

Fighting corruption in orthopedic surgery

March 23, 2015by Robert Whitcomb in Uncategorized tagged , ,

hip

X-ray of hip replacement. 

James Rickert, M.D., an Indiana orthopedist, says financial conflicts of interest often drive physicians to perform worthless surgeries, and he says that orthopedics “is one of the worst offenders,” reports MedPage Today.

He has launched a “moral persuasion” campaign to  get his colleagues to stop this corruption. Dr. Rickert founded the Society for Patient Centered Orthopedic Surgery to push this cause.

 

Technological ‘exuberance’s’ threat to healthcare

March 20, 2015by Robert Whitcomb in Uncategorized tagged , ,

 

Hooman Noorchashm, M.D., and Amy Reed, M.D.,  write in The Philadelphia Inquirer that “irrational exuberance” about the value of technological innovation in medicine can lead us to disaster.

They write:

“{A} very serious and insidious deficit also plagues our optimistic, ‘benefit-oriented’ outlook on innovation and progress in corporate medicine. We do not always place sufficient emphasis on the concept of ‘harm’. That is, in our quest to save lives and innovate, the cost to those who do not benefit is often disregarded or minimized.”

”We do not focus enough on whether the harm brought about by our ‘beneficial advances’ could have been avoided – nor do we evaluate the tangible and intangible costs of advancement when we construct our new standards of care.”

“{W}e may be on an ‘irrationally exuberant‘ path to financial and spiritual ruin in medicine, despite our best intentions. Our financial markets have demonstrated this phenomenon repeatedly over the past three decades in America.”

“Of course, this irrational exuberance in American medicine stands to be dramatically worsened by medicine’s corporate nature today.”

 

 

Physicians’ bias and black lives

March 20, 2015by Robert Whitcomb in Uncategorized tagged , , , ,

 

In  an essay in The New England Journal of Medicine, David A. Ansell, M.D., and Edwin K. McDonald, M.D., discuss “Bias, Black Lives, and Academic Medicine.’

Among their conclusions:

“First, there is evidence that doctors hold stereotypes based on patients’ race that can influence their clinical decisions. Implicit bias refers to unconscious racial stereotypes that grow from our personal and cultural experiences….Although explicit race bias is rare among physicians, an unconscious preference for whites as compared with blacks is commonly revealed on tests of implicit bias.

“Second, despite physicians’ and medical centers’ best intentions of being equitable, black–white disparities persist in patient outcomes, medical education, and faculty recruitment. In the 2002 report Unequal Treatment, the Institute of Medicine (IOM) reviewed hundreds of studies of age, sex, and racial differences in medical diagnoses, treatments, and healthcare outcomes.The IOM’s conclusion was that for almost every disease studied, black Americans received less effective care than white Americans. ”

 

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