Mayo, 22 other leaders encourage patient-centered reform

Feb. 23, 2010

In advance of the White House Summit on Health Reform this Thursday, Feb. 25, 2010, Mayo Clinic, along with 22 other organizations will run a full-page open letter Wednesday in Roll Call magazine to encourage Congress to come together on patient-centered reform.  Our goal is to call attention to the issues that diverse interests have [...]

Payment Reform and Coverage for All a Step in the Right Direction

Feb. 11, 2010

We have been asked about the financial impact of health care reform bills on Mayo Clinic. We reiterate that both the House and Senate bills include important steps toward creating a more equitable and higher value health care system, consistent with the cornerstones of the Mayo Clinic Health Policy Center. We believe that reform provisions, [...]

Come Together on Patient-Centered Reform

Jan. 28, 2010

In his State of the Union address, President Obama urged Congress to continue to push forward and find a way to come together on health care reform. If we don’t act now, health care costs will continue to rise and more Americans will not have access to affordable, quality health care. The urgency for the [...]

Keep Patient-Centered Reform Moving Forward

Jan. 22, 2010

Reforming health care in America will not become easier with the passage of time. The status quo is not sustainable, and Mayo Clinic remains firmly committed to moving forward with patient-centered reform. We at Mayo Clinic encourage all stakeholders – government officials, patients, insurers, providers and employers – to work together to pass reforms that provide [...]

High Value, Affordable Care Will Benefit All Patients

Jan. 6, 2010

The Mayo Clinic Health Policy Center offers the following commentary in response to a Jan. 6, 2010 article in the Washington Post, “Health bills would shift Medicare money to Mayo and other ‘high-value’ hospitals.”  We feel the primary goal of health care reform must be ensuring that all Americans have access to high quality, affordable care. Reforming [...]

AHLA Connections: Legal Implications of Health Care Social Media

March 10, 2010

The current issue of the American Health Lawyers Association's Connections magazine features an article I co-authored with fellow AHLA health lawyer, Jody Joiner, on the impact of social media use in health care.The article, Risky Business: Treating Tweeting the Symptoms of Social Media (PDF version), is featured in the March 2010 issue of AHLA Connections (Vol.14, No. 3, March 2010), a health lawyer magazine for the health and life sciences law community.We provide background context on the use of social media tools by health care providers, address why we think health lawyers need to understand social media, and explore some of the legal implications as social media and the law intersect. The article ends with practical guidance to health care providers and organizations on implementing policies emphasizing the appropriate use of social media.You can peruse the complete digital edition of the March 2010 AHLA Connections (Vol. 14, No. 3, March 2010). AHLA members should also check out the article in this issue on the recently launch Health Law Wiki. Great to see AHLA adding a wiki resource for members to share their expertise and experience in the complex and ever changing health care legal and regulatory world.Special thanks to the AHLA Connections staff for allowing Jody and I the opportunity to write the article and for their great editorial assistance.

Lesson for Hospitals and Health Care Providers: Photos of Shark Bite Victim

March 5, 2010

Martin Memorial too mum: Hospital staff violated privacy of shark victim, an article from the Palm Beach Post. The article highlights the impact ubiquitous mobile devices with cameras are having on our society and the potential liability risks associated with the use/misuse of these devices by health care employees.The article indicates that various hospital employees took photos of a shark bite victim when he arrived in the emergency room. The article discusses the action taken by the hospital in response to the incident. Another article indicates that the photos were emailed to others.This type of situation is a nightmare for hospital administration, the privacy officer and legal counsel. The effort and investigation that likely went into figuring out who took photos, where those photos went and the procedure for recapturing/removing the photos from the various sources was time consuming and expensive (both in $$ and reputation) for the hospital.As such, this incident provides a good example for training and reeducating health care employees on patient privacy issues. Health care employees and professionals must always remember to start from a framework of protecting the health and privacy of their patients. As the use of mobile devices with cameras and social media tools becomes more ingrained in our every day lives -- the ability for private information to be captured, transferred and spread in a viral fashion has become much easier. Caution must be used and this case highlights the importance of retraining staff and highlighting the importance of protecting your patient's privacy.

HITECH Law Blog

March 1, 2010

A warm welcome to fellow AHLA member and health law blogger, Kathie McDonald-McClure.I just ran across her blog, HITECH Law Blog. She focuses the blog on health information technology, privacy and security and the blog was named after the HITECH Act. Looks like a great addition to the health law blogosphere.Ms. McDonald-McClure is a member of the Health Care Services Team at Wyatt Tarrant & Combs, LLP in Louisville, KY.

AHLA Hospital's Friend or Foe: The Age of Social Media and Health 2.0

Feb. 26, 2010

Today Jody Joiner and I presented at the AHLA Hospitals and Health Systems Institute on the use of social media by hospitals and health care providers. We provided an overview of social media use by hospitals and health care providers, discussed the pros/cons of using social media in the health care environment, presented case studies of the risks and legal implications and did a short role play involving tweets in the context of a medical negligence case. We also provided those attending with recommendations on developing social media guidelines and policies.To show the speed and ease of using social media tools to spread information, news and photos we we did some live shots during the presentations using an iPhone that were then loaded up to my blog, Twitter and Facebook. We then pulled up the posts and tweets at the end of our hour presentation.Great audience with great follow up questions. Thanks go out to Mark Browne (@ConsultDoc) and Peter Leibold (@HealthLawyers) for live tweeting during the session.

Feb. 26, 2010

Insurance Companies Cancelling Health Insurance of Sick Patients

Sept. 15, 2009

With President Obama’s speech to Congress last night outlining the details of his overhaul of healthcare in the United States, one interesting point popped up - the fact that Obama would guarantee that insurers could not reject people because of preexisting conditions. Health insurance companies are increasingly citing the failure to disclose preexisting conditions as a means to cancel policies and deny benefits to people in need of care. The term for this is "Post Claims Underwriting". What this means is that the insurance companies will not investigate someone for verification of entitlement to coverage until after they are sick and need the insurance. Of course, if they then determine the person is sick but not qualified they cancel the coverage and the sick consumer is left with no insurance. Insurance companies are using the term "rescission" to refer to the cancellation of insurance coverage due to a company being misled. Rather than trying to mislead companies, omissions of preexisting conditions seem to be honest mistakes by people filing out increasingly complex forms. There have been countless stories about how people have signed up for health insurance, only to have their policies later cancelled when they need care. No one knows how often policies are cancelled because of a variety of different state laws and policies in place, however, the practice has become rampant enough to result in numerous lawsuits and new regulations put in by states throughout the country. In the past year and a half, California has fined the five largest insurers in its state almost $19 million for cancelling the policies of individuals who became sick. One insurance company even admitted offering bonuses to employees who were able to find reasons to cancel policies. President Obama has been trying to gain support for his healthcare overhaul in part tapping into consumer dissatisfaction with the insurance industry, an industry that has never been popular among the American people. His plan for healthcare overhaul includes restricting insurance companies from screening for preexisting conditions, however, this still might not save people from having their policies cancelled. With new regulations, insurance companies might not necessarily cancel the policies of those individuals with undisclosed preexisting conditions, however, a company might institute further preauthorization requirements on services for certain patients, which might discourage such patients from renewing their policies. Lawsuits continue to be instituted against insurance companies who have cancelled policies. Rather than fight fraud, rescission has devolved into a backdoor route for insurance companies to stop paying the medical bills of people in their time of greatest need.

Coverage at the county level...

Aug. 19, 2009

Plenty has changed since 2006, the latest year that the uninsured of California was counted by the U.S. Census. But even then, many months before the current recession hit, the percentage of people living without health insurance in our state was startling. This week, the Sacramento Bee laid out the statistics, finding quite a disparity between those with health insurance and those without. Just in the five-county region The Bee covers, Yolo County posted an uninsured rate of 22 percent of people under 65, while the more prosperous Placer County -- with more employment-based coverage -- posted a 13.7 percent rate. That's quite a disparity, and the article by Phillip Reese and Anna Tong is worth reading. But the Bee doesn't limit information to its circulation area, it also posts online a comprehensive rundown of each of California's 58 counties' uninsured rate, along with an interactive map of the state and rollover charts. Here's a sampling of what the authors wrote: "The uninsured present an immense fiscal and public health challenge: 18,000 Americans die each year because they aren't covered, according to the Institute of Medicine, a nonprofit research organization. This is because having insurance is closely tied to health outcomes: The uninsured won't see a doctor regularly, and if they seek care it is likely to be inadequate or too late. Moreover, the uninsured are a cost for society: One economist recently estimated the tab at $56 billion per year, 75 percent of which is paid by governments. In cash-strapped California, that cost is critical: 6.6 million residents went uninsured in 2007, more than in any other state, according to the California Healthcare Foundation." You can bet that, with massive layoffs and small businesses closing since that Census count, the number of those among us -- members of our communities -- who are going without health insurance is a great deal larger. Factor in the Governor and Legislature's cuts in health and insurance programs for lower-income Californians, their children and the elderly, and you get an unimaginable sum of fellow Californians without access to affordable, quality health care -- notably, preventative health care, with better outcomes. This is what the conversation about health care reform boils down to, not pumped-up talking points and hyper-emotive protests based on misinformation. This is not a partisan issue. It is a people issue. And the bottom line is that the majority of Americans have already voted -- for substantive change for a better future for our country.

California Offers Lessons on Insurance Exchanges

Aug. 6, 2009

As Congress debates creating insurance "exchanges" as part of a health-care overhaul, the failure of a similar effort in California may offer important insights, former participants in the program say. From 1993 to 2006, small businesses in California could buy health insurance through an exchange run initially by the government, and later by a nonprofit group. The plan was undermined when some businesses with relatively healthy workers bought policies more cheaply directly from insurers, bypassing the exchange. That left the exchange with a shrinking pool of less-healthy workers, forcing rates higher and prompting many insurers to withdraw. Managers chose to shut the program in 2006 when one of three remaining insurers withdrew. "There are definite lessons to be learned," said John Ramey, who as former head of the Managed Risk Medical Insurance Board helped implement California's exchange. "We learned them the hard way out here." Among those lessons, he and others said: Employers and individuals who qualify must be required to obtain health insurance through the exchange. Failing that, John Grgurina, who ran California's exchange from 2002 until it ended, said government must impose rules governing rates and eligibility to protect the exchange from attracting a disproportionate share of high-risk people. An exchange aims to get better prices for coverage by banding together businesses and individuals. Insurers would have an incentive to join an exchange because they would gain access to more potential customers. Individuals and employees of businesses that participate in an exchange would be able to chose from the available plans and pay the same rate. Exchanges, either on a regional basis or a single national one, are likely to be a part of any final health-care legislation. Late Friday, the House Energy and Commerce Committee approved its health-care bill, though a full House vote won't come until the fall. President Barack Obama on Saturday praised the House committee's action and urged lawmakers to "build upon the historic consensus." The compromise proposal agreed to in the House Friday exempted more businesses from the mandate to provide coverage to their employees and offered subsidies to fewer individuals to buy insurance through an exchange, which would shrink the number of potential participants. Each of the three major bills -- one in the House and two in the Senate -- would create one or more exchanges. The specifics vary, but most of the proposals would impose more regulations than the failed California program, which analysts say would help the exchanges compete. Despite California's struggles, insurance exchanges are still the most effective way to expand coverage, said Elliot Wicks, a health-care consultant who wrote a report on the California program. The report, released last month, was commissioned by the California HealthCare Foundation, a private independent nonprofit. Veterans of the California effort said the ultimate effectiveness of any exchange would rest on details that have yet to be worked out. They said the pool of people in an exchange should be as broad as possible, to spread both risk and administrative costs. Click here for your free California health insurance now!

Public Health Insurance Would Be Too Good and We'd Like It Too Much

Dec. 17, 2008

A common thread is emerging in the right wing response to healthcare reform. Its opponents aren't claiming that public healthcare will be bad. Rather, they are terrified that the new system will be so good that no citizen would buy expensive private insurance--or vote for politicians who wanted to take public insurance away. The Obama team is sending clear signals that healthcare reform is a core economic issue, and the health insurance industry is becoming increasingly anxious by the future administration's determination to bring healthcare costs under control. Some Americans are seeing their healthcare premiums rising at four times the rate of inflation, if they have insurance at all. Healthcare reform is a pocketbook issue for all of us, according to the Obama team. In tough economic times it might be tempting to postpone healthcare reforms, but Obama is adamant that delay would be a false economy. In the American Prospect, Joanne Kenen and Sarah Axeen support claims about the high cost of doing nothing: A recent report by the New America Foundation's health-policy program estimates that the cost of doing nothing about health care, including poor health and shorter lifespan of the uninsured, is well above $200 billion a year and rising. That's enough to cover the uninsured and still have some left over for other public-health needs. If healthcare costs continue to rise at their current rates, it will cost $24,000/yr to insure a family of four by 2016, an 84% increase from today. At these rates, half of American households would have to spend at least 45% percent of their income to be insured. In the Nation, Willa Thompson describes how a bicycle crash made her appreciate the connection between healthcare and politics. Thompson was 21 years old when she suffered major injuries after a collision with a truck. Luckily, she was covered by her parents' medical insurance until she turned 22. She later realized that if she had been just a few months older when the accident happened, she wouldn't have been able to pay for her medical care. We all agree that something needs to be done. Let's briefly review the options that have been proposed so far. Obama wants to provide healthcare for all by requiring private insurance companies to cover everyone and creating a public health insurance plan to compete with private insurers. The second part of his plan is the public option that Republican opponents are so scared of. Click here for your free California health care quote now!

Why is single-payer health reform not viable?

Dec. 2, 2008

When it comes to health care reform in America, there is a relatively simple solution that will cover everyone's basic health care, control costs and save businesses, most people and the country a lot of money. It's called a single-payer health plan, where the government collects taxes to finance national health insurance. The government, which is the "single payer," covers all citizens and pays the bills when they visit private (or public) doctors, hospitals and other facilities for medical care. All would have basic coverage, regardless of whether they have a job, or where they work. Nobody gets billed for basic care. No-body goes broke because of medical bills. Yet this option has been declared "off the table" by Sen. Max Baucus, D-Mont., who's among those leading the charge for health care reform in America. Top Democrats who will be deciding policy in America in 2009, including Baucus and President-elect Barack Obama, say single-payer is "not politically feasible," because the public won't strongly support it. What they really mean is that when it comes to health care reform, they don't want a political fight with some of the nation's most powerful financial interests, which have the resources and the motivation to turn public opinion against meaningful reforms. These interests include the health insurance industry, pharmaceutical drug companies, some hospitals, highly paid medical specialists, medical suppliers and others who now profit handsomely from our current system - and who could no longer command those profits under a single-payer system or an alternative form of a national health plan. Californians, click here for your free health insurance quote now!

Gregg: Use Medicare Cuts To Plug Budget Gap

March 11, 2010

Democratic proposals to cut Medicare spending are good policy, said New Hampshire Senator Judd Gregg, the senior Republican on the Senate Budget Committee, at a Health Affairs Media Breakfast this morning. The problem, according to Gregg, is that Democrats want to use the money saved to fund new benefits under health reform legislation, rather than [...]

Radiation Hazards Illustrate Need For Industry-Wide Safety Response

March 10, 2010

Editor’s Note: In addition to Peter Pronovost (photo and biography above), authors of this post include Julius Pham, Assistant Professor, Emergency Medicine, Johns Hopkins University School of Medicine; Sara Singer, Assistant Professor, Harvard School of Public Health,  Department of Health Policy and Management, Massachusetts General Hospital; Jerod Loeb, Executive Vice President for Research, The Joint [...]

Shock Me, Tube Me, Line Me: An ER Doc Reassesses DNRs

March 9, 2010

In “Shock Me, Tube Me, Line Me,” a Narrative Matters essay in the February 2010 issue of Health Affairs, emergency physician Boris Veysman sets forth his own version of an advance directive and challenges common perceptions about care at the end of life. An excerpted version of Veysman’s essay appears in today’s Washington Post Health [...]

Death Of A Sales Job (A Three Act Ploy)

March 5, 2010

With apologies to Arthur Miller … President Obama went back before the cameras again Wednesday, providing yet another recycling of fading rationales for his health reform product that more voters would rather leave on the Capitol Hill store shelves than purchase.   But “attention must be paid” whenever the president speaks.  He tried to claim that “we have now incorporated [...]

HA Blog Top Ten For February

March 5, 2010

Posts on health reform dominate the ten most-read Health Affairs Blog posts for February. Also on the list are reports on health spending and an innovative way to supplement the primary care workforce: Health Reform: The Need To Move Forward by Henry Aaron Getting Health Reform Done by Timothy Jost The Grandparents Corps: A New Primary Care Model by Arthur Garson [...]

HEALTH POLITICS: The Byrd Bath

March 11, 2010

 Democrats are moving ahead to get health care an up or down vote via reconciliation, but Republicans are preparing for a "Byrd Bath.At a Health Affairs event this morning, Sen. Judd Gregg (R-NH) gave his perspective, saying that Republicans would scrutinize every single line in the health reform reconciliation package relying on the rules laid out by Sen. Robert Byrd of West Virginia, the master of Senate procedure. Under the Byrd Rule, every provision must be relevant to the budget. As Gregg put it, every line will be submerged in a “Byrd bath.”<!--break--> Gregg warned that there was no guarantee the reconciliation package could survive the Senate intact, and Republicans would do whatever they could to change it. He echoed what House Minority Whip Eric Cantor (R-VA) and Senate Minority Whip John Kyl (R-AZ) said earlier this week -- House Democrats are nervous the Senate won’t hold up their end of the bargain if the House passes the Senate bill and then tries to fix it. Sen. Gregg thought it was unlikely Senate Democrats would want to go through the reconciliation process after they had “already…gotten what [they] want… I think it’s a reach and it should cause questions for Democrats in the House.” He also argued that the Senate bill had to be passed into law before reconciliation could be used to amend it -- an opinion supported today by the Senate parliamentarian. Gregg said the Senate parliamentarian Alan Frumin was "very fair, very good" and understood his role as an unbiased umpire in the game. More on Gregg’s remarks here and here. Health Policy Program

HEALTH REFORM: If We Were Going to Use a Mixed Metaphor.....

March 11, 2010

...We'd say the wheels are back on the train leaving the station.Lots of movement on the Hill, with the House Budget Committee likely to start work on the reconciliation package Monday or Tuesday. (You can read about the likely calendar on Congress Daily or Politico or any of the other usual suspects, but read fast, because it may all change yet again.)<!--break-->For those of you outside of Capitol Hill, here are some thoughts. Getting the votes in the House is a chicken and egg process. Speaker Pelosi can't call a floor vote if she doesn't have the 217 votes (we think that's the magic number at the moment, it's fluctuated a bit with retirements, deaths, sex scandals etc) -- but she won't get the 217 votes unless she starts the process that leads to the House floor vote. So Pelosi is probably within reach of 217 -- but not there yet. And of course the not unexpected Senate parliamentarian ruling that the House does in fact have to vote directly on the Senate bill whether they like it or not -- and they don't like it one bit -- makes it harder. To throw in some cliches to our mixed metaphors, it's not over until it's over. But even with all the parliamentarian wrangling, it's sure looking a lot better than it did.In the Senate, the timetable isn't as clear. But Harry Reid was clear in his letter to Mitch McConnell. It's reconciliation time, baby. “As you know, the vast majority of bills developed through reconciliation were passed by Republican Congresses and signed into law by Republican Presidents -- including President Bush’s massive, budget-busting tax breaks for multi-millionaires.  Given this history, one might conclude that Republicans believe a majority vote is sufficient to increase the deficit and benefit the super-rich, but not to reduce the deficit and benefit the middle class.  Alternatively, perhaps Republicans believe a majority vote is appropriate only when Republicans are in the majority.  Either way, we disagree.”“At the end of the process, the bill can pass only if it wins a democratic, up-or-down majority vote.  If Republicans want to vote against a bill that reduces health care costs, fills the prescription drug ‘donut hole’ for seniors and reduces the deficit, you will have every right to do so.”Senate moderates seem more resigned to the process. When South Carolina Republican Lindsey Graham offered to try some bipartisan bridge-building, he didn't get a warm embrace. "It's not the same as it was before," centrist Democrat Ben Nelson said. Too much troubled water flowing under that bridge. Health Policy Program

COSTS: Uncompensated Care to Increase without Reform

March 11, 2010

What happens if reform fails? Billions and billions in uncompensated care. What happens if reform passes? A whole lot less uncompensated care. About half, according to an Urban Institute report this week. According to the study, there were 49.1 million uninsured Americans in 2009, and uncompensated care reached $62.1 billion -- or $1,264 per uninsured person. Without comprehensive health reform, which would cover more than 30 million uninsured Americans, the number of uninsured will likely grow to more than 57.0  million (at best) or 65.7 million (at worst) over the next 10 years. In this scenario, the cost of uncompensated care is estimated to reach $106.6 billion (at best) or $141.4 billion (at worst) in 2019. (See graph below.) However, with comprehensive health reform, the study shows that uncompensated care costs will fall to $54.0 billion in 2014 and $46.6 billion in 2019. That's still a lot of money -- but the trend goes in the right direction. Urban's John Holahan and Bowen Garrett explain that uncompensated care is financed through a number of sources, including: Medicaid and Medicare payments to hospitals to care for the indigent ($18.1 billion in 2008);Appropriations from state and local governments ($10.6 billion in 2008); andCost shifts onto private insurers ($6.3 billion in 2008). The authors suggest that in the absence of reform, it will be increasingly difficult for state and local governments to finance the health care expenses of the uninsured. Under budgetary constraints, federal contributions are not likely to grow significantly, so local and state governments will have the burden. The financial strain on hospitals and clinics will grow, and they may be forced to limit how much care they give uninsured people. With another 30 million or more people covered, we can redirect uncompensated care to other parts of the system (where it can be spent more efficiently). Under a system of mandates and shared responsibility, all Americans will contribute (with subsidies for those who can't). Read the full report here.Health Policy Program

COST: The Value of Value-Based Insurance

March 11, 2010

Picture this. You have two choices for insurance at your job at an Oregon steel mill. One is the traditional model we are all familiar with (those of us who get decent insurance through our jobs, at least, are familiar with it). The other one is value-based insurance. There will be no premiums and it will provide inexpensive care for chronic diseases -- asthma, congestive heart failure, diabetes, depression, heart disease, chronic bronchitis or emphysema. But if you need -- or want -- pricier and often overused procedures like heart bypasses or hysterectomies, you will pay more. Julie Appleby writes in USA Today/Kaiser Health News: The policies are among the first to apply financial incentives on both sides of one important factor driving up the nation's health care tab: The underuse of proven treatments and overuse of certain surgeries and diagnostic tests that may be less valuable. If the model works, employers save money. And patients get the right care. It may reduce costs both by cutting down on the costlier procedures and imaging, and because chronic diseases will be kept under control so there are fewer expensive acute crises and complications. Usually we condense interesting articles but Julie's excellent piece covers a lot of ground and it’s hard to boil down without losing the subtleties. So go read the whole thing yourself. (We read it three times.) Check out what our colleague Tom Emswiler has blogged about tiered pricing too, although that is often restricted to drugs, not surgeries or imaging. A few points to highlight though. For now, at least, the value-based alternative is an option, not a requirement. That of course may change. Right now it may well be a good deal for someone with chronic disease or the risk for chronic disease, but may not be the best choice for someone who may need a bypass. The pricing structure isn’t a whimsy. These procedures cost more AND there is evidence they are overused and aren't actually better for most people. That doesn’t mean that the costlier procedures aren’t necessary in some circumstances (Julie cites the obvious one of a hysterectomy for uterine cancer or stents for a heart attack) or that people might try more conservative treatments first and then decide that the knee replacement really is the way to go. People can still get those treatments. It will cost more -- but this is still insurance. The patient will have to pay hundreds of dollars more, but there are limits to their financial exposure. The policy described in the article would limit an individual exposure to hospital bill to $1,500 annually, $3,000 for a family. Health Policy Program

In The States: A Not-So-Healthy Picture of Health in the Nation's Capital

March 10, 2010

Here's something that makes no sense to me.Last summer, in one of my favorite posts on this blog, I wrote about an ambitious, creative attempt to reinvent and improve health care for low-income people with chronic disease in Washington DC -- which describes a lot of the residents of our nation’s unhealthy capital. The Chronic Care Initiative included rival hospitals and community clinics -- people who don’t often sit down in one room together -- in a collaborative quality initiative that included projects ranging from cell-phone apps for diabetes self-care to strategies for getting hospitals to let clinics know when their patients are admitted (which turns out to be way way way harder than it sounds). I have had the privilege of sitting in on a few of the group’s sessions, and had planned to write more about the individual projects as they come on line in the next few months.<!--break-->This month, the head of the program -- Dr. Joanne Lynn, a nationally recognized clinician, researcher and author -- was fired. The future of the program is unclear. A Department of Health spokeswoman hasn’t answered my email (and I’ll update if she does). A couple of people affiliated with the initiative that I ran into at an Institute for Healthcare Improvement conference this week were either noncommittal about its future, or confided that they had doubts it could thrive without her. I am not completely objective about this. I have known Dr. Lynn’s work for about 15 years and have gotten to know Joanne personally in the last three or four years. I respect her. She's interesting. Look back at how I introduced the project: [The Chronic Care Initiative is] taking the lessons of quality improvement and the goals of population health and applying them across an entire city with an unhealthy population and a fragmented health care system that in its current form is not conducive to managing chronic illness. The Chronic Care Initiative is, in essence, an attempt to reinvigorate primary care (and common sense) in Washington, and to apply city-wide what quality improvement wonks called the Triple Aim goals: 1) Improve the health of the population 2) Enhance the patient experience 3) Get Value That's a tall order in the best of circumstances. Here they are trying to achieve the Triple Aim for an unhealthy population that includes lots of people who are poor, sick, and members of racial or ethnic minorities. The CCI initiative is not abstract. It is highly pragmatic. Grantees had to work on something small that, if successful, could very quickly become something big. It had to spread. They also had to be open -- because it was a collaborative cross-silo, in some cases cross-status (older established academic medicine center physicians with nurses  in community settings). They had to be flexible. If something in their idea wasn’t working out, they had to be agile enough to try something different. Improvement and innovation not as an endpoint, but as an ongoing part of health care delivery. Some of the programs are about to come online -- and I still plan on writing about some of them. Washington certainly needs the help. According to data Joanne Lynn shared in an IHI presentation this week, Washingtonians have a life expectancy eight years lower than the U.S. average. The city has high rates of serious mental illness (10 percent), diagnosed diabetes (5 percent), and overweigh (half). It has the highest U.S. rate of end stage renal disease and amputation. And health care here is expensive -- 70th percentile on Dartmouth Atlas measures.Not many people, including local media, paid all that much attention to this interesting endeavor when it began. Maybe they will take note now that it could end. Health Policy Program

Pelosi Makes another Wise Decision

March 12, 2010

Late Thursday the Associated Press reported that “House Democratic leaders have abandoned a long struggle to appease the most ardent abortion opponents in their ranks, gambling that they can secure the support for President Barack Obama's sweeping health care legislation...

Advice to Hospitals in a Downturn: “Market the High-Margin Service”

March 11, 2010

One might think that hospitals would be recession-proof. After all, hospital care is a necessity. But one would be wrong. When times are tough, people put off elective surgery, and even avoid going to the hospital in an emergency. Although...

The Doctor Who Invented PSA Test Calls It “A Profit-Driven Public Health Disaster” . . . Why This Is Good News

March 11, 2010

Times are changing. Americans are beginning to acknowledge that “early detection” is not the absolute answer to cancer. And many are recognizing that what seems a simple diagnostic test can carry more risks than benefits. Tuesday, the New York Times...

Libel Laws Stifle Scientific Debate

March 10, 2010

The editor of the British Medical Journal, Fiona Godlee, writes that “organized sceptism,” or the “requirement that scientific claims be exposed to critical scrutiny before they are accepted” is one of the basic tenets of good science.Yet in the UK,...

Sarah Palin Admits Going to Canada for Health Care-- Why?

March 8, 2010

How rich is this? Over at “Think Progress,” Igor Volksy reports that, while speaking to a crowd in Calgary, Canada last weekend Sarah Palin revealed a tidbit about her life growing up not far from Whitehorse: “We used to hustle...

Do You Know What Biologics Are?

March 11, 2010

In 2008, 28 percent of sales from the pharmaceutical industry’s top 100 products came from biologics; by 2014, that share is expected to rise to 50 percent. Biologic drugs can be more expensive to manufacture; they are grown inside living cells rather than put together chemically, as conventional drugs are. But this does not fully account [...]

What People Outside the Beltway Think

March 11, 2010

Source: Rasmussen Reports, March 2010.

The Truly Bizarre Structure of ObamaCare Health Care Subsidies

March 11, 2010

These tables were the basis for Steve Entin’s latest NCPA Brief Analysis.

The Callahan Solution for Spiraling Health Costs: Put Seniors on the Ice

March 11, 2010

This is from David Henderson’s review of Daniel Callahan’s Taming the Beloved Beast: In reaching his major conclusion—that people beyond about age 80 should just accept death—he seems unaware of how elastic the concept of “old age” has been across the centuries. But this does not stop him from advocating that the government step in and [...]

Maybe Sen. Bunning is Right about Unemployment Benefits

March 10, 2010

Here’s what Obama advisor Larry Summers wrote in The Concise Encyclopedia of Economics: Unemployment insurance also extends the time a person stays off the job. [Kim] Clark and I estimated that the existence of unemployment insurance almost doubles the number of unemployment spells lasting more than three months. If unemployment insurance were eliminated, the unemployment rate [...]

Community Programming, the Final Frontier: Going Where No World Bank Evaluation Has Gone Before

March 4, 2010

On February 8th, the World Bank released a two-page summary of an evaluation underway to identify the effectiveness of the Community Initiatives component of the World Bank MAP, and how, if at all, it adds value to the national response. The evaluation—conducted in collaboration with DFID and the UK NGO AIDS Consortium—hopes to garner enough [...]

Death Toll from Haiti’s Earthquake in Perspective

Feb. 19, 2010

This is a joint post with Owen McCarthy. The January 12th earthquake in Haiti is the most lethal natural disaster of the past 20 years. On February 12th, the Associated Press reported that official Haitian government estimates of the dead had been revised upwards, now reaching 230,000 dead. Furthermore, the number could be much higher, since the [...]

FDA Goes Global: A New Approach to Food and Drug Import Safety

Feb. 12, 2010

Last week, I participated in an event at the Center for Strategic and International Studies (CSIS) in which U.S. Food and Drug Administration (FDA) Commissioner Margaret Hamburg announced a remarkable shift in the FDA’s thinking on food and drug import safety. If adequately supported by Congress and translated into concrete action, this change in strategy [...]

Daddy Healthbucks: How Will the Gates Foundation Leverage the New $10 Billion for Vaccines and Immunization?

Feb. 9, 2010

In announcing a $10 billion, decade-long commitment for vaccine development and immunization in poor countries, Bill Gates made no claims that the vaccine financing challenges are solved. Quite the contrary. He and many others have highlighted the need for other donors, industry and developing country governments to up their own ante to immunization. [...]

U.S. Global Health Initiative: An Opportunity to Provide Short (and Useful) Comments on a Tall Order

Feb. 3, 2010

More on the FY11 Budget Development and Obama’s Budget; Interview with CGD’s Sarah Jane Staats Obama’s First Budget Request: Modest Increases but Strong Signaling for Development MCC Slated for $1.28 Billion in FY2011 Budget Request Todd Moss’ Expert Commentary on President Obama’s 2011 Budget Request Yesterday’s release from the White House of the FY2011 budget  and a simultaneous release of [...]