In a New England Journal of Medicine piece, Perri Klass, M.D., talks of her anxiety, in looking after her now-late mother’s care in a hospital, as the weekends approach and so much of the hospital closed down, leaving patients vulnerable and family caregivers scared.
“I would start feeling tense every Thursday afternoon, every Friday morning, staving off panic by displaying a slightly frenetic need to get consults done, problems reassessed, orders written. I would waylay consultants, try to pin down residents about when they could come by and when they planned to sign out, press the nurses to page the attendings. I became one of those people I would have hated to encounter on a Friday afternoon….
….”I felt scared, as Thursday turned to Friday and the dark clouds gathered; I could feel the staff signing out, the hospital slowing down around us, and the weekend closing in.”
Will the understaffing on weekends of hospitals continue or even worsen with the Affordable Care Act and the flood of aging and ailingf Baby Boomers swells.
Medical Economics reports that the Medicare Payment Advisory Commission (MedPAC) will recommend a 1.4 payment cut in 75 percent of non-primary care services in Medicare’s Physician Fee Schedule in a bid to continue funding a 10 percent bonus payment for primary-care physicians that expires at the end of 2015.
The American Academy of Family Physicians reported that MedPAC Commissioner Kathy Buto, MPA, said “I’ve been involved with the fee schedule from the start, and there’s never been a year when primary care was funded in a way that was appropriate.” AAFP said that she suggested valuing primary care separately from specialty care covered by Medicare.
Commissioner William Hall, M.D., questioned whether the bonus payment is enough to fix the problems with primary care. “If we double the salaries of primary care physicians, we would get more people in primary care, but we would have little or no impact on the system of care that people on Medicare need,” AAFP reported.
Nonprimary-care physicians have good lobbyists in Washington, D.C., too, so it’s hard to predict that their fees will be cut.
How very, very sad today to hear of the death of Stanley M. Aronson, M.D., at age 92 after a long battle with age and illness that did not diminish his mental acuity and his love of life.
Stan was a giant of medical education, at Brown University and elsewhere, a distinguished leader in global public health, especially in developing nations, and an elegant, learned and delightfully idiosyncratic writer. He somehow combined joy, enthusiasm and even exuberance with a deep skepticism and (I think) a basically tragic view of life. And then there was his amusement in absurd situations, including involving himself.
I knew him in the various roles we each had over the years, but especially because of our editor-writer relationship.
I had been well aware of his distinguished career well before I became The Providence Journal’s editorial-page editor, in 1992.
But it was then, at the encouragement of my wife, Nancy, that we became friends after I hired him to do a weekly column for The Journal’s Commentary pages on medicine, history, science, language and a few hundred other topics. My wife had become a fan while reading Stan’s columns in Medicine/Health Rhode Island, the journal of the Rhode Island Medical Journal, where she had done some art and graphics work.
I left The Journal, except as a rarely read freelance columnist, in 2013, but my successor, Edward Achorn, also long a fan of Stan’s, has continued to run the columns, many of which have been reprinted in newspapers across America and Canada. Collections of his columns have comprised the contents of three books.
Stan continued to write these essays until his death: His work ethic was the equal of his other legendary attributes. His work has enriched the lives of multitudes and will continue to do so. Meanwhile, his many friends will mourn him as long as they live.
— Robert Whitcomb
William A. Galston writes in a very important piece in today’s Wall Street Journal that Oregon is so far succeeding with its 15 regional Coordinated Care Organizations involving Medicaid patients “designed to break down the multiple ‘silos’ of health services and provide integrated, patient-centered services with a focus on primary and preventive care.”
Oregon’s governor, John Kitzhaber, M.D., is leading the way in developing this national model of reform.
So far, the plan seems to be succeeding in saving money while improving healthcare delivery. If it goes on like this, says Mr. Galston, “the results would be revolutionary….for the country as a whole, implementation of the Oregon model could save Medicaid more than $900 billion over the next decade.”
Cambridge Management Group has been working intensely in Oregon on coordinated-care community-health projects and is very pleased that Mr. Galston is touting what we at CMG also see as potentially revolutionary improvements.
He notes that the Center for American Progress suggests expansion of the Oregon model ”to cover all healthcare spending, public and private,” in the U.S.
”The goal is to provide reliable, evidence-based, continuum-based care that is of high value,” Christine Bent, senior vice president for clinical-service lines, told H&HN. ”The idea is that, for anyone who enters our system, their outcome doesn’t vary based on geography.”
”Bent and Allina President and Chief Clinical Officer Penny Wheeler, M.D., oversee the entire service line structure as a team. Each of the service lines is managed across the system by a steering committee that reports monthly to Bent and Wheeler.”
”Within each service line are several multidisciplinary program committees chaired by doctors and organized by medical condition across all locations that offer treatment for a particular condition. …Allina uses a similar approach for hospital-based services, such as critical care and emergency medicine.”
”The service line management strategy has resulted in a number of scripted workflows that reduce variation in care and cost, ” H&HN reports.
”The insurance industry should be able to develop a more modern system of monitoring the use of resources by their patients, … maybe by monitoring these things electronically through claims data, actively informing patients each time they use up one of the benefits they have remaining.
”There’s gotta be an app for that …
”Taking the doctors out of this process could improve our quality of life and the satisfaction of our patients. And no doubt the system’s efficiency will also dramatically improve, and savings will undoubtedly follow.”
“David and Goliath (1599) oil painting by Caravaggio.
Herewith the story of Evergreen Health Cooperative, created under the federal Affordable Care Act to offer “patient-centered” care and cut healthcare-market costs. (We keep being slightly amused by term ”patient-centered” care. Isn’t that the population that healthcare was always suppose to be centered on? Well, maybe not….Follow the money?)
Evergreen has two parts: a nonprofit insurance company with a traditional network of doctors and a health system that directly employs providers.
“We’re the first new commercial insurer in 20 years in Maryland as far as we know,” Peter Beilenson, M.D., a former Baltimore health commissioner, told The Baltimore Sun. “It’s not easy to have a successful startup in a state that basically has a monopoly,” citing CareFirst BlueCross BlueShield, Maryland’s dominant insurer.
Evergreen is one of 24 such co-ops in America, officially called Consumer Operated and Oriented Plans, and, as The Sun noted, ”many of them face similar behemoths.”
And the ACA doesn’t let these co-ops do traditional marketing. Further, government rules make it hard to sign up large employers that could bring in many paying customers at once.
”That fierce competition {from big insurers} is the biggest hurdle to the co-ops’ success …. But there are a host of other potential stumbling blocks, including name recognition and funding, and the co-ops are responding by boosting their industry knowledge, aggressively marketing their services and cutting premium prices to lure customers, ” reports The Sun.
Evergreen looks to small businesses that it could attract on its own and enroll in groups. ”So far, about 1,000 small businesses employing {a total of} about 12,000 people have switched to the co-op.”
Research ”shows those insurers that follow the {co-op} model could save around 20 percent on hospitalizations alone, one of their biggest costs.”
We wonder how some of these co-ops might be integrated with Federally Qualified Health Centers.
