The Experts Were Wrong About the Best Places for Better and Cheaper Health Care - The New York Times

As part of his push for the Affordable Care Act in 2009, President Obama came to Central High School to laud this community as a model of better, cheaper health care. “You’re getting better results while wasting less money,” he told the crowd. His visit had come amid similar praise from television broadcasts, a documentary film and a much-read New Yorker article.

All of the attention stemmed from academic work showing that Grand Junction spent far less money on Medicare treatments – with no apparent detriment to people’s health. The lesson seemed obvious: If the rest of the country became more like Grand Junction, this nation’s notoriously high medical costs would fall.

But a new study casts doubt on that simple message.- Oops !

The Price Ain’t Right? Hospital Prices and Health Spending on the Privately Insured*

Moreover, whereas Medicare
hospital prices are set by a regulator (as is true for prices for health care services in most
countries), hospital prices for the privately insured are market-determined. However, this may change wth the Affordable Care Act, the transition from volume based reimbursement to new models of care, including quality of care and HEDIS scores which reflect hospital and  health care compliance with recomendations from NQAH.

Health care providers’
transaction prices – have been treated as commercially sensitive and have been largely
unavailable to researchers. As a result, there is a great deal that is unknown about how and why
health care providers’ prices vary across the nation and the extent to which providers’ negotiated
prices influence overall health spending for the privately insured. 

Add to that is the complex algorithm  upon which payments are based, including the DRG (Diagnostic Related Group). There are roughly 999 listed by CMS Future payments will be altered by a penalty for non-compliance with the standards... It is not really an incentive where hospitals would be rewarded with an increase in payments, but a penalty for not complying, another negative incentive. Do more, get paid less.

The research looked not only at Medicare but also at a huge, new database drawn from private-insurance plans – the sorts used by most Americans for health care. And it shows that places that spend less on Medicare do not necessarily spend less on health care over all. Grand Junction, as it happens, is one of the most expensive health care markets in the country for the privately insured – despite its unusually low spending on Medicare.

All of these figures were based upon 2011, prior to the Affordable Care Act. Stay tuned for more gobbledy-gook.

The Experts Were Wrong About the Best Places for Better and Cheaper Health Care - The New York Times

Dr. Jay Parkinson - Why there’s no Uber for Healthcare Back in...

Dr. Jay Parkinson - Why there’s no Uber for Healthcare Back in...

Alarming News About Your Physician(s) Burnout increasing among U.S. doctors

Burnout among U.S. doctors is getting worse, according to a study that shows physicians are worse off today than just three years earlier.  Mayo Clinic researchers, working with the American Medical Association, compared data from 2014 to measures they collected in 2011 and found higher measures on the classic signs of professional burnout. More than half of physicians felt emotionally exhausted and ineffective. More than half also said that work was less meaningful.

The data dovetail with a recent JAMA study, which found much greater prevalence of depression among doctors in training than in the general population.

Nearly a third of new docs at high risk for depression

Some new doctors are working 30-hour shifts

Doctors fear work caps for medicine may be bad idea

When doctors commit suicide, it's often hushed up

Washington Post

This should be alarming news for you as a patient. Why  ?  Is your physician worried about making payroll,overhead expenses,  saving for retirement, educating his/her children, and the immediate need for paying off astronomical student loans between $100,000 dollars and $250,000 dollars.  Shouldn't your physicians be using all their energy for caring for you and also continuing medical education.  The prospect of a medico-legal misadventure are highly probable in a physician's career.    The professional bar for performance is very high (as it  should be). The vast majority of physicians are not self-serving and have am ethical and moral interest in your health. Few enter the profession with the idea of becoming rich, only to  maintain a reasonable standard of living, educate their children and save for retirement. Their income results in a considerable tax responsibility.  If one is a small practice doctor the personal financial liabilities are immense for overhead, dues, subscription fees, professional society dues, state licensees, the cost of specialty recertification and more.

Taken together, experts say the problems require solutions that offer a systemic approach. All health care organizations have a shared responsibility to address the situation, they add.

The responsibility is not just for health care organizations, but is that of general society to protect those who sacrifice much to care for you..  When was the last time you asked your physician how he was doing ? If you like your doctor, perhaps a letter to your congressman or senator stating what you observe and not demand unreasonable bureaucracy being placed upon your caregivers.  They serve you, the patient, healthy, sick or otherwise.  They are not government employees unless they work for a state, county, or federal agency such as the Veterans Administration, military service, or public health agency. The vast majority of doctors are now seeking employment, just to  escape the endless worsening tunnels of managed care, federal regulations and mandates for automated medicine, electronic health records.  All of these factors shorten a career life add disability issues and increase the shortage of physicians..  There are few highly paid specialty groups, radiology, neurosurgery, and several interventional medical specialties, such as gastroenterology, and cardiology.  

It would be a unique experience to see how federal regulations could be designed to lower stress and cost for physicians. 

I am not holding my breath.

Some new doctors are working 30-hour shifts

Doctors fear work caps for medicine may be bad idea

When doctors commit suicide, it's often hushed up

Burnout increasing among U.S. doctors - The Washington Post


Signs of depression are 'unacceptably high' among doctors in training, study finds

Senate Votes to Repeal ACA for the First Time

Senate Votes to Repeal ACA for the First Time

ACA Sparked Spending Burst on Physician Services in 2014

The Most Common Causes of Eye Injuries in the US

In the past the most common causes of eye injuries was 4th of July fire crackers, baseball injuries or racketball injuries. Today the incidence of those causes have almost been eliminated by prevention. Most localities ban fireworks, the use of protective  eye wear in  sports, and in occupations has almost completely eliminated eye injuries from  those sources.

Falling was the No. 1 cause of eye injuries overall and accounted for more than 8,425 hospitalizations. Researchers also found that the cost to treat eye injuries at hospitals rose by 62 percent during that period and now exceeds $20,000 per injury.

Serious ocular trauma injuries include orbital fractures and being pierced by objects. These injuries can be expensive to treat, and in many cases are preventable. With that in mind, researchers at Johns Hopkins University decided to identify the most common causes of eye injuries as well as the associated hospital costs so that prevention efforts could be better targeted. Such interventions could perhaps lower eye injury rates and overall health care costs for eye trauma inpatient visits.

They identified a sample of nearly 47,000 patients ages 0 to 80 diagnosed with ocular trauma from 2002 to 2011 using a national health care database. They examined the total cost of hospitalization, cause of injury, type of injury and length of hospital stay. The researchers then grouped injured people by age. Their findings include:

•Falls are the leading cause of eye injury:

Most of the 8,425 falls recorded happened to those 60 and older. Among the types of falls, slipping caused nearly 3,000 eye injuries. Falling down stairs was cited as a cause of eye injury 900 times. 


•Fighting was second most common cause of ocular trauma:

 In total, nearly 8,000 hospitalizations for eye injuries were caused by fighting and various types of assault. 

“Unarmed fight or brawl” came in at No. 2 overall among specific causes of eye injuries requiring hospitalization, but was the top cause reported for ages 10 to 59.

•Kids injured in accidents, vehicle collisions and by sharp objects:

 For children ages 10 and under, the leading cause of eye injury was being struck by accident by a person or object. Car crashes and accidentally being pierced or cut by a sharp object (such as scissors) were second and third on the list of causes.

•The median cost of treating these eye injuries shot up from $12,430 to $20,116 between the years 2002 to 2011, an increase of 62 percent. The researchers found costs to be higher at large hospitals and for older patients. Income did not correlate with costs. However, the Johns Hopkins team says that other factors not included in the study could play a role, too.   More...

It is recommended that you wear protective eye wear when fighting, sanding metal, and other objects, playing baseball, or racketball, and target practice, 

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The Most Common Causes of Eye Injuries in the US

NEW FDA COMMISSIONER > Meet Robert M. Califf, MD, Deputy Commissioner for Medical Products and Tobacco

FDA Organization > Meet Robert M. Califf, MD, Deputy Commissioner for Medical Products and Tobacco

Kaiser program brings hospital care to the patient's home

Who says primary care is dead?  It is just relocating....house-calls of the 21st Century


Audio from this story

Frequent medical visits had become a way of life earlier this year for John and Audrey Stanton of Hemet in Riverside County.  

John, 86, suffered from serious eye problems; a painful skin infection called cellulitis, and more recently, repeated shortness of breath — all of which kept landing him in the hospital."It was one thing after another. Like the doctor said, 'Somebody is after you!'" Stanton laughs. And for his 81-year-old wife Audrey, the nearly two-hour drive to-and-from Kaiser in Riverside was a tough haul."I’m not a long distance driver so I had to be real careful," she says. "It was stressful." 

But that stress dissipated last summer when John was admitted to the hospital — at home.  

"I thought, 'Wow! This is amazing. I love this!'" he says. "This is what people need!"

Pneumonia, cellulitis or congestive heart failure  Stanton is one of about 125 patients who’ve been enrolled in an experimental hospital at home program run out of Kaiser’s Permanente’s Riverside Medical Center.  Launched two years ago, the program is designed for people who need treatment - typically only given in the hospital — for one of three conditions: pneumonia, cellulitis or congestive heart failure.

"Our goals are to have patients be safe at home and to have them recover at home and to have a high-quality experience," says Dr. Earl Quijada, one of three Kaiser doctors assigned to the program. Not every patient with one of the three conditions qualifies for the program. It's restricted to those who are not at risk for complications that could require more intensive care, says Dr. Nirav Shah, senior vice president and chief operating officer for clinical operations at Kaiser Permanente Southern California. 

"We ask if that patient wants to be admitted [to the hospital] or admitted at home," Shah says. "If they choose to be admitted at home, we'll send a truck home with them with all the equipment they need."

For John Stanton, the program saved two to three days in the hospital as well as a number of return trips for follow-up visits, Quijada says.   

"Things are just so much more relaxed"

Stanton’s at-home care for a pneumonia diagnosis involved an intravenous antibiotic; a phlebotomist to check his blood and house calls from a nurse and Quijada. Hospital rounds — usually done by the patient's health care team in the hallway outside the patient's room — took place instead on the phone. 

Kaiser program brings hospital care to the patient's home 

The Affordable Care Act is it Working ?

If you are a Republican chances are very good you say  Obamacare (ACA) is a failure. If you are a Democrat you talk about its successes. The corollary is if you don't like Obamacare you are a Republican and if you like it you are a Democrat.
Which came first is like the chicken and the egg conundrum.

Obamacare is entering it's third year of transition.  Some pundits have it as entering a holding area to be monitored as some of it's vital organ systems are struggling to survive.

The ACA was passed during a political firestorm, and a majority Democratic congress. The only people who knew what was written in the statute were those who wrote the actual Bill. Some prominent Democrats overtly expressed "you won't know what is in it until we pass it".  Enough time has passed that we know that to be  true, but we also don't know what is coming next.

The health landscape has changed dramatically in the past decade as has the economy. The calculus has changed in regard to reimbursement models and organizational stability.

Several things are happening that should set off warning bells (if congress even listens or cares) in the middle of world crises.

Politics and health care have been mixed,and patients now find their health is competing with ISIS, the war on terror and everything in the national budget.  Physicians have always known and saw this several decades ago in 1963 when Medicare was added to social security entitlements..  As health expenses were met with an 80% coverage, and with  the lack of cost containment  medicare fueled health inflation. For more than two decades health expenditures grew at more than twice the rate of the gross domestic product, fueled by the black hole of the federal government and it's ability to manipulate budgets by borrowing and printing more currency.  Now it is a part of the seventeen trillion dollar national debt. Annually health contributes to 17% of the GDP.

The ACA went into effect in 2013 and beginning then there have been enormous changes in health care financing, the administration and delivery of medical care.

Health insurance companies,  health plans, and related enterprises such as pharma are adjusting to the limitations on profitability for operations.

Mergers and acquisitions have long been part and parcel of the health business scene. However the rate and size of the shifting health space has increased in numbers and size.

Health care business will survive in this hostile environment, as a necessity of life, the demand for services is infinite. The balance between restricting necessary health care and it's availability is precarious


Aetna, Anthem reassure investors on forecast, exchanges   
Pfizer, Allergan announce $160 billion merger, 'inversion' deal would shift HQ overseas

LAO Finds Rapid Medi-Cal Enrollment

Health care mergers and acquisitions in 2015: Running list (89)

Some insurers are treading lightly and reassessing their involvement in health insurance exchanges

LAO Finds Rapid Medi-Cal Enrollment - capradio.org

LAO Finds Rapid Medi-Cal Enrollment - capradio.org

How Do Oncologists Use Social Media, and What Information Are They Seeking? | ASCO Connection

A new study in the Journal of Oncology Practice (JOP), explores how oncologists use social media. The study, “Social Media Use Among Physicians and Trainees: Results of a National Medical Oncology Physician Survey,” sheds light on the kind of professional knowledge clinicians seek when visiting sites such as Twitter and Facebook and identifies barriers to using social media. 

The study, published online, ahead of print, October 6, was carried out by a team of researchers from cancer centers across Canada and was designed to address a gap in the research: nearly all previous studies on the nexus of social media and medicine have focus on the challenges social media presents in terms of privacy and maintaining professionalism.

”The existing literature on social media was really just cautioning doctors, and wasn’t focusing on the opportunities social media was presenting,” said Rachel Adilman, BSc, first author of the study. “We wanted to highlight the fact that social media actually has opportunities for us. We can share knowledge, we can collaborate, and we can harness these opportunities to further our knowledge and cooperation.”

How are oncologists using social media?

The researchers sent surveys to 680 medical, radiation, and surgical oncologists; hematologists; and oncology trainees, asking about different aspects of social media use; Trainees were defined as pre-medical students, medical students, and residents. Two hundred and seven study participants sent back the surveys (a response rate of 30%). Analysis of the responses revealed these findings:

• Frequency of social media use: 72% of respondents use social media
   
• Differences in use of social media by age of oncologist: The study used age as an indicator of respondent’s career phase, whether trainees, fellows, or early-, mid-, or late-career oncologists. Among those age 18-24 (trainees) and 25-34 (fellows), 89% and 93%, respectively, use social media. However, among those age 35-44 (early-career), the percentage goes down to 72%. And among those age 45-54 (mid-career), the percentage of oncologists who use social media dips down to 39%, a rate that is significantly lower than the 89% and 93% seen among trainees and fellows. Interestingly, late-career oncologists (age 55 and over) have a higher rate of social media use (59%) compared to mid-career oncologists.
   

• What are oncologists’ goals in visiting social media sites for professional development?

Fifty five percent of respondents said their goal in visiting social media sites was to network with colleagues or professionals, 17% said their goal was to share research, and 13% said their goal was leadership development.

When separated by age group, differences emerged between users’ goals in visiting social media sites. Among the trainees and early-career cohorts, more than 53% of respondents reported a desire for professional networking, whereas among mid-career oncologists, the rate was 36%.

• What kind of professional information are oncologists seeking on social media sites?

Fifty three percent of respondents said they are seeking journal articles, 52% said they are seeking information about upcoming conferences and courses, and 51% are looking for updates on current oncology research.

 Search features on  all social media platforms allow users to search using a # hashtag. In essence this turns twiiter into a search engine for diseases, conferences, and specialty or other term of interest.





How Do Oncologists Use Social Media, and What Information Are They Seeking? | ASCO Connection

The Future of Work: Quantified Employees, Pop-Up Workplaces, And More Telepresence

The Future of Work: Quantified Employees, Pop-Up Workplaces, And More Telepresence

The 10 Most Important Work Skills in 2020

The 10 Most Important Work Skills in 2020

CDC’s Health IQ App | Mobile Activities | CDC