Important News About Health Care Today

 

 

The Institute of Medicine of the National Academies has released several reports at the beginning of December.

• 

  For the Public’s Health: The Role of Measurement in Action and Accountability Released: December 8, 2010

  Despite having the costliest medical care delivery system in the world, Americans are not particularly healthy. While this information is alarming, the bigger problem is that we do not know how to reverse this trend. Our lack of knowledge is due in large part to significant inadequacies in the system for gathering, analyzing, and communicating health information about the population. In this report, the IOM reviews current approaches for measuring the health of individuals and communities and creates a roadmap for future development.

 

The Science of Adolescent Risk-Taking - Workshop Summary Released: December 1, 2010

Adolescence is a time when youth make decisions, both good and bad, that have consequences for the rest of their lives. Some of these decisions put them at risk of lifelong health problems, injury, or death. The IOM held three public workshops between 2008 and 2009 to provide a venue for researchers, health care providers, and community leaders to discuss strategies to improve adolescent health.

Redesigning the Clinical Effectiveness Research Paradigm: Innovation and Practice-Based Approaches - Workshop Summary Released: December 6, 2010

Currently, a substantial gap exists between the knowledge needed and that available for medical care decisions. The IOM Roundtable on Value & Science-Driven Health Care sponsored a meeting to explore the methods, data resources, tools, and techniques that are emerging in the new generation of accelerated clinical research approaches.

The Science of Adolescent Risk-Taking - Workshop Summary Released: December 1, 2010

Adolescence is a time when youth make decisions, both good and bad, that have consequences for the rest of their lives. Some of these decisions put them at risk of lifelong health problems, injury, or death. The IOM held three public workshops between 2008 and 2009 to provide a venue for researchers, health care providers, and community leaders to discuss strategies to improve adolescent health.

The Safe Use Initiative and Health Literacy: A Workshop - Workshop Summary Released: December 1, 2010

Every year at least 1.5 million people suffer adverse effects from medication. These problems occur because people misunderstand labels, are unaware of drug interactions, or otherwise use medication improperly. The Food and Drug Administration’s Safe Use Initiative seeks to identify preventable medication risks and develop solutions to them. The IOM held a workshop to discuss the FDA’s Safe Use Initiative and other efforts to improve drug labeling and safety.

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The Beginning of Rationing

 

Governor Brewer’s decision to withhold Liver Transplants for Medicaid recipients in Arizona should serve as a loud warning to the electorate regarding governmental intrusions into health care financing and health care operations.

The decision was ill advised on the basis of multiple factors.  The survival rates differ from one facility to another.

What is the liver transplant survival rate and what information needs to be considered when looking at such numbers? 

For example, the country and facility in which a liver transplant is performed can have rates that are vastly different from the overall number. Also worth considering is the type of transplant (full organ or partial, i.e. liver graft) and the status of the donor (living or deceased).

 

At the Mayo Clinic in Florida

The survival rate for liver transplant in adults (both living and deceased donors) at the Florida location is higher than the national average.

The one-month survival rate there is over 98 percent for recipients; nationally it’s almost 97 percent. The one-year rate is almost 94 percent, beating out the national average of over 88 percent. Finally, the three-year rate comes in at over 82 percent, as opposed to the over 78 percent rate nationally.

In an article published in the journal Transplantation Proceedings, the MELD/PELD system is credited with an ‘excellent’ transplant survival rate in multiple categories. The study followed 4163 adults and pediatric recipients of whole organ and liver graft transplant from deceased donors from February 2002 through December 2003. The conclusion reads, “We conclude that patient and graft survival have remained excellent since implementation of the MELD/PELD system. Although recipients with MELD scores in the highest quartile have reduced survival compared with other quartiles, their 1-year survival rate is acceptable when their extreme risk of dying without a transplant is taken into consideration.”

There are many considerations besides the availability of funding when a decision is made for or against a patient undergoing liver transplantation .   The overall chances for success or failure of a liver transplant are always considered when appraising a waiting list by those responsible for allotting available donor livers.   In the case of individuals these cannot be disclosed publicly due to privacy and/or confidentiality issues regulated by HIPAA.

Some of these considerations include the etiology of liver failure, a malignant  process may not be confined to the liver,  another comorbidity, such as alcohol or other substance dependency, Hepatitis C, heart disease,  socioeconomic living conditions (homelessness) which can impact postoperative care and follow-up, age of the recipient, co-dependency of other family members, children’s ages, and other factors.  Tissue committees usually review all of these factors prior to assigning liver disposition.  Like it or not these are realistic and time proven methods of recipient selection.

Unfortunately Governor Brewer did not publicly, or the media misrepresented the decision making process done prior to the announcement that Medicaid would not fund a liver transplant in t his case..  Has the process been politicized?  The media would like this to be the case for whatever motivates their reporting.

There was also a lack of transparency of the process.  Where was DHS, Medicare and other public agencies? Is this a last minute crisis decision or another failure of incompetent legislative planning.?

There are many alternative solutions, including cutting back public services to a four day week, furloughing some public employees, delaying of funding pension plans, re-allocating funds from other programs.  Delaying Health IT expenditures, and other non essential services of Medicaid.   Why have Health IT and EMR if patients must die to fund it??

According to the Kaiser Family Foundation,  Arizona ranks poorly in regard to Medicaid cost containment.  Arizona as not:  implemented pharmacy cuts, decreased eligibility, implemented co-pays or share of costs.

Hopefully the AMA, and the Arizona State Medical Society have lodged their protest and guidance to alter this policy immediately.

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A Disruption in the Continuum

 

Like Captain Picard I sense a disruption in the continuum. Although we have been travelling at warp 9 through the celestial span, our sensors detect a sub-space discontinuity that is causing the warp engine to overheat.  The plasma container is failing, and we can no longer maintain life support on the holohealth deck.  Health 2.0 and blogging is in grave danger. At the rate of decay of medical ethics, we may also not be able to maintain life forces as we knew it.  The discontinuity in the sub space spectrum is causing a severe disruption in our broadband speed.  We may have to resort to dial-up photon propulsion.

The Federation may no longer provide reimbursement to the outer limits of federation space.  The Romulans have promised global health care to the Federation fleet, as well as the uninsured Klingons.

 

Klingon Insignia

 

A Romulan  (in good health)

Vulcan has  made an offer through their spokesman, Spock to form an ACO(Accountable Care Organization) to provide health care to the entire galactic space. 

They are building outlying clinics for rural areas of the space-timcontinuum. These distant outposts will be eligible for federated grants to underserved, under populated federation space stations.

 

A Klingon in bad health without Federation  ACO

 

Spock ACO delivers preventive health measures as an added value to ACO.

 

The unknown expenditures for the Borg

 

may be offset by the first lady’ charm and budgeting at home.

Non disclosure and waiver of liability.

The events, pictures and portrayals  in this posting are intended as humor, without disrespect, or harmful innuendo, except that Barak Obama has an uncanny resemblance to Spock. 

We need to see his real birth certificate.

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Liberating the NHS UK

 

Equity & Excellence: Liberating the NHS

As we steam along toward centralizing health care with the Obama care Bill, we need to take a look at the corrective actions which the NHS in the UK are attempting to improve freedom of choice and patient involvement in their own care.  This has taken several decades to become important enough to take action.

Unfortunately Don Berwick, the present head of CMS totally ignores this feature of the NHS.  The NHS system has not been  self correcting due to it’s massive bureaucracy and inertial guidance system. This is typical of government.  The only way to  control this seems to be having congress not fund mandates.

del.icio.us Tags: Obamacare,Donald Berwick,UK,National Health Service,NHS,CMS

WORLD’S AIDS DAY

 

Today is AID’s day.  Let’s not forget how much progress has been made, and how we can treat those who have not yet received life saving drugs.

Please go to http://www.worldaidsday.org/  and give someone a new hope for life.

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Privacy Matters

Sometimes consumer watchdog and whistleblowers do a good thing (actually they do it a lot).

Several Consumer Advocacy Groups have filed an action before the Federal Trade Commission: “Request for Investigation, Public Disclosure, Injunction, and Other Relief” against none other than:

Google, Microsoft, Quality Health, WebMD, Yahoo, AOL, Health Central, Health line, Everyday Health, and Other web companies, including a litany of consumer oriented marketing scams.

All physicians should be pleased that someone has done this for our patients and the medical profession.

The motion requests that the Food and Drug Administration investigate these sites

The plea includes as one portion of its plea the following,

Physicians, nurses and other health professionals are also the target of powerful digital marketing practices that have a direct effect on the health and financial costs born by consumers. The growth of online “e-detailing,” “e-samples,” and other digital ad practices designed to influence health professionals to order specific pharmaceuticals and treatments raises new concerns over the role of online advertising in the healthcare arena. Data collected via e-detailing and related methods also pose privacy concerns.

 

The FDA held two days of hearings in November 2009 on the role of the Internet and marketing for regulated drugs.6 Pharmaceutical marketers purposely painted a sanitized, storybook image of social media and digital marketing. Missing were data and information related to the powerful capabilities of interactive marketing to promote relationships with specific brands, including the ability to foster what has been called consumer “micro-persuasion.” “Direct-to-Consumer Digital Marketing” of pharmaceutical and health-related products requires the FTC to develop safeguards for sensitive-data-related advertising practices, and also ensure that interactive ad techniques are truthful and non-misleading.

The pdf file is well worth the read.  This action required a good bit of research to develop a credible request for an injunction

 

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The Physick Story

 

Take a trip on Marketplace  and visit City Hall, The Print Shop, The Surgical Amphitheater, The home of George Guild, the Oculist

Philadelphia: The Birthplace of Healthcare

How did Benjamin Franklin help launch the pharmaceutical industry? How did Philip Physick, who invented dozens of early surgical instruments, also invent an economic instrument that enabled surgeons to get paid? And how did an idealistic eye doctor at the turn of the century help launch what's now a multi-billion dollar screening industry?

Early Philadelphians transformed the money side of health care. It's too fantastic a story to bring you with radio alone -- so health care reporter Gregory Warner and intern Mara Zepeda corralled Philadelphia artists, actors, historians, botanists and puppeteers to help tell the tale. More Marketplace Money Philadelphia coverage »

It is quite a story.

Hear this story how Dr. Physick influenced medicine. The first cataract operation in America, first stomach pump in America, first human blood transfusion, double mastectomies, funded indigent care by selling tickets for the public to watch surgeries.  (A new business model ). 

He offered a prepaid plan for  $20.00 a month.  He became the richest doctor in Philadelphia.

1900. Atlantic City. The American Medical Association — 50 years old at the time — meets for its annual conference. There, a Philadelphia eye doctor named George M. Gould sells doctors on a new idea: patients with no symptoms coming into the doctor's office once a year for a full-body check up. The "annual physical exam" redefines the doctor's role from one who treats the sick, to one who watches over you when well. "It is in catching sight of the earliest indications of disease, the symptom of the symptom," Gould tells the crowd. "That's where progress lies."

Start Video

Hear about the birth of the annual physical

A Moment of Silence for Tom Turkey

 

Health Train Express is almost to the TurkeyDepot.  I won’t be posting until Monday, November 29,2010.

I leave  you with this thought.

A Poem  for Thanksgiving

 

Thanksgiving Friends

Thanksgiving is a time
For reviewing what we treasure,
The people we hold dear,
Who give us so much pleasure.

Without you as my friend,
Life would be a bore;
Having you in my life
Is what I’m thankful for.

By Joanna Fuchs

Belly Stuffer

Thanksgiving brings a terrible chore,
'Cause I’m forced to eat and eat some more.
If I don’t eat it up right down to dessert,
I fear the cook’s feelings will surely be hurt,
So I do my part, even though I suffer;
To be a good guest, I’m a belly stuffer.

By Karl Fuchs

If you wish to learn more about the authors of these poems (two incredible people click on the “ A Poem for Thanksgiving

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Why We Do Need Or Do Not Need HIT Or EMR

 

Bad Fonts         Font you

Some of us may remember college, med school, and post graduate training.  I remember my handwriting deteriorating in medschool as I attempted the losing battle of taking hand written notes.

I also remember looking forward to the progression of chart notes and the time when I would write that last note, below.

There is no justice in this world!

 

EMR will have a profound negative effect on medical students, by reducing motivation to become an attending.

For those interested trainees you can obtain “bad handwriting font” for  EMR notes.

Health Train Express LTE 4G

G et what you pay for

G et better quality

G et government out of health care

G et more primary care physicians

Next will be:

G et EMR

This is what Health Train needs.  Perhaps this will cure what ails health care in America

The Christmas Gift we all Wish for.

 

Don’t we all wish it could be this simple?

Important News Today Top Stories

 

FDA Approves New Stem Cell Line

Advanced Cell Technology (ACT), of Marlborough, Mass., announced that it has received FDA approval to begin treating children with Stargardt's macular dystrophy using retinal cells derived from ESCs.

(Photo: A fluorescent microscope image shows human embryonic stem cells at Stanford University  March 9, 2009/California Institute for Regenerative Medicine)

 

Eat Your Fruits and Veggies

HHS Releases New Insurance Rule

 

HHS Releases Final Medical Loss Ratio Regulations

 

So Long, Darvon and Darvocet: FDA Requests Pain Meds Be Pulled

 

 

Non invasive Fat Removal

 

Has The Obama Administration Created a Monster

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Accountable Care, or Count the Care?

 

            

 

The consolidations have started. Humana announced it will purchase Concentra. Humana has been a health insurance carrier. Concentra, a privately held health care company based in Addison, Texas, delivers occupational medicine, urgent care, physical therapy and wellness services from more than 300 medical centers in 42 states. The transaction involved a cash price of 790 million dollars.Concentra earns about $800 million in annual revenue. Humana projects that the acquisition will add slightly to its earnings for the year ending Dec. 31, 2011. For Humana, the deal signals that the health insurer is branching back into its origins as a health care provider, but the new business would still amount to just a fraction of its overall revenue.

Humana entered the health insurance segment in 1984, and was a combination managed care and hospital company until 1993, when the company split in half - resulting in a hospital company and today's Humana. The hospital company was later sold.

"This builds on our caregiving heritage and offers new opportunity in a growing part of health care," Noland said in an interview. "The demand for primary care services will increase partly as a result of demographic trends, notably the aging of baby boomers, and also because of some of the incentives in the new health reform law."

Concentra, a privately held health care company based in Addison, Texas, delivers occupational medicine, urgent care, physical therapy and wellness services from more than 300 medical centers in 42 states.    Besides its medical center locations, Concentra also serves employer customers by operating more than 240 worksite medical facilities.

Humana spokesman Tom Noland said the deal announced Monday moves the company "into promising new territory." Humana already operates a few clinics in south Florida.

More than netting immediate financial gain this may signal the first major merger  stimulated by forecasts of  “Accountable Care Organizations”.

Humana’s previous experience with HMOs and managed care gives it previous experience in regulating health costs.  Then again this may fail just as HMOs failed to develop into what was  projected, and rejected by physicians. 

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ACOs Junk-it

 

The latest round of junkets for hospital administrators, management consultants, is regarding ACOs or Accountable Care Organizations. Like managed care which became renamed “mangled care”  ACOs will earn a new moniker soon as well.  I will rename it, “Anonymous Care Organization” for want of a better term. 

Who is going to run this ‘entity’ designed for who knows what? Some say it will control cost, improve outcomes, and balance the federal budget.   Some say our country will not survive without reducing the percentage of GDP utilized  by Health Care.   Health care expenditures have increasedd to somewhere between 16.0% and 17.9% of GDP according to  Market Watch, Time Magazine, and the Center for Medicare Services (CMS)  and other  bean counters. How about fixing health care expense and increasing GDP?  Much of our  problem revolves around poor productivity, lack of manufacturing capacity,  and lack of diversity in the U.S. economy.

Many features of the robust pluralistic features of American economics have gone by the wayside, the milkman, the paperboy, the corner grocery store, bakery, delicatessen, gardener’s (in the form of after-school teenagers, handymen, bookeepers, #2 pencils, yellow legal pads,   Oldsmobile's, Pontiacs, vinyl records, tubes in radios.  Much of our workforce has been moved offshore, outsourced and/or replaced by computers, software, automation,  and technology resulting in fewer productive jobs, and increased unemployment requiring increased entitlement programs and burgeoning governmental morass.

The present situation in health care is not the fault nor cause of economic stress in America.  This dysfunctional and chaotic representation by the body-politic of America diverts us all from finding the ‘cure’.

 

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