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The Five Best Things and Five Worst Things About Healthcare in 2009

Cheryl Clark, for HealthLeaders Media, December 23, 2009

The year 2009 was an eventful, some would even say historic, year in healthcare. Washington spent most of the year cobbling together healthcare reform legislation, but those in the healthcare industry didn't sit by and wait for lawmakers to develop solutions to the healthcare system.

Health leaders spent 2009 doing what they always do—trying to provide better care to their patients.

But what exactly were they doing? Here's a list of the five best and five worst developments in healthcare in 2009.

The Five Best Things

1. The very best thing about healthcare in 2009 is the new-found appreciation that there is wide geographic variation in quality and amount of care patients receive, and the cost of providing it, although the reasons remain unclear. An article in the New Yorker by surgeon Atul Gawande called "The Cost Conundrum" drew upon statistics published in the Dartmouth Atlas. Gawande went to parts of the country that varied the most to examine the differences, and he suggested that our healthcare system rewards quantity of care, not necessarily quality.

More health executives and physician leaders as well as patients are beginning to understand why it's not OK to provide more care, unless it means people will have better quality lives as a result.

2. There is a new emphasis on getting more Americans health coverage, and on holding health insurance plans accountable for the care they provide. The goal of the administration and many in Congress working for health reform is to make sure that no one is denied coverage based on a pre-existing condition. It remains unclear, however, whether insurance plans will in effect deny coverage by charging exorbitantly high premiums to those with existing disease or high risks of being diagnosed.

3. James Lott, executive vice president of the Hospital Association of Southern California, which represents 157 hospitals in six counties, named as number one on his list of the best: "The Obama Administration's reversal of the Bush-era restrictions placed on the use of embryonic stem cells to develop cures or treatments for diseases and medical conditions that cause human suffering, premature and often agonizing death, and whose treatment contributes mightily to the high cost of healthcare." This is a good thing, but it remains to be seen whether it will result in meaningful care in the near future. Fingers are crossed.

4. An increasing number of Web sites allow healthcare consumers to compare geographic- and facility-specific variations in pricing, from actual outcome measures, such as mortality, falls or rates of infection. There are also an increasing number of sites that publish process measures, such as whether procedural steps in evidence-based care were performed, for example, prescribing beta blockers to certain heart patients.

5. A growing recognition among providers, based in at least two recent research papers, that the impact of radiation exposure during imaging exams is not an abstract one. Rather, it carries a quantifiable risk of cancer and other undesirable health effects.

The National Cancer Institute estimates nearly 30,000 excess cancers occurred from the 72 million CT scans in the U.S. just in 2007. About half of those cancers may be lethal. Two-hundred and sixty patients at Cedars-Sinai Medical Center in Los Angeles gave patients undergoing brain perfusion CT scans seven or eight times their dose of radiation. Patients at three other hospitals undergoing CT scans to detect stroke similarly received overdoses of radiation.

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