Cooperating for better care.

Robert Whitcomb

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Works in progress in ACA innovation lab


Illustration by Theodor von Holst from the frontispiece of the 1831 edition of Mary Shelley’s 1818 novel, Frankenstein; or The Modern Prometheus.

Federal officials  have  submitted to Congress a progress report on the work of the  laboratory created by the Affordable Care Act to help transform how medicine is delivered and financed. There are a few successes but the lab mostly reports  that its projects are works in progress.

And “some 2.5 million patients and more than 60,000 hospitals, clinics and doctors will soon be participating in models run by {the lab called} HHS’s Center for Medicare and Medicaid Innovation, the center estimated in its biennial report,” reported Kaiser Health News.

Programs include Accountable Care Organizati0ns, efforts to end preterm births and to lower hospital readmissions for nursing-home patients, and big grants to states to improve care  (and  better control costs) for all  payers and patients, including those with private insurance.




Bad luck the biggest culprit in cancer


Bad genetic luck is mostly to blame for cancer — not  behavior — says this study,  by mathematician Cristian Tomasetti and geneticist Bert Vogelstein, both of Johns Hopkins University. We wonder what effect this will have on funding incentives for people to change bad behavior — smoking, inactivity and so on.

Bloomberg News suggested that the study would support ”focusing more resources on diagnosing the disease in early stages and on treatments to reduce mortality rates.”

The news service also noted that the researchers ”cautioned that the study isn’t a license to engage in unhealthy behavior. ‘Cancer-free longevity in people exposed to cancer-causing agents, such as tobacco, is often attributed to their ’good genes,’ but the truth is that most of them simply had good luck,’ Vogelstein said.”



Foreign patients a bonanza for Boston Children’s Hospital


Boston’s Children’s Hospital reported that it earned $113 million on operations in the fiscal year that ended Sept. 30 — a 28 percent jump from the year before.

“The growth was fueled largely by international patients: Revenue from these patients soared 47 percent from last year, nearly six times the pace of revenue growth from local patients,” The Boston Globe reported.

Children’s has increased marketing abroad   in recent years to attract new international business.”

As with Ivy League and other prestigious parts of American higher education, prestigious teaching hospitals such as Boston Children’s are in a strong position to lure affluent foreigners who can pay full freight. This business can offset some of the losses from serving American patients. But the vast majority of American hospitals, of course, lack that allure.



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