Health reform brought us a bunch of new words and phrases to learn and use. But in case you missed some of them, here's a quick pastiche of some of the most interesting.
1. BoTax. Senate Majority Leader Harry Reid's health reform package included a proposal that would impose a 5% tax on all cosmetic surgery, raising about $5 billion between now and 2020 to help pay for health reform. But the idea was quickly thrown out.
Not only did plastic surgeons vehemently object, but the tax was seen as discriminatory toward women, some of whom argue that as they age, they need a bit of work done to maintain their appearance in a competitive workplace. They saw such a tax as sexist, because in men, an older appearance is seen as dignified, but in women not so much. The current discussion has shifted toward what might be called a "Brown Tax," a similar fee on those who use tanning salons.
2. Core or Process Measures versus Outcome Measures. Core measures are increasingly used as surrogates to rate quality of care during the process of providing that care. Health plans and government payers use these measurements to reward providers for completing steps in the road to improve quality.
For example, there is evidence that giving certain drugs to patients admitted to the hospital with symptoms of heart disease is associated with quicker recoveries and lower death rates.
Outcome measures, however, are a much more direct way of evaluating quality, such as counting the number of patients who fell, developed a hospital-acquired infection or wound, or died during or shortly after a particular surgical procedure.
3. Electronic Medical Records (EMR) versus Electronic Health Records (EHR). These acronyms were around before 2009, but more Americans are now aware of the technology. EMR and EHR are sometimes used interchangeably, but they are not the same thing, although further refinements of their definitions are ongoing. EMR is the electronic replacement of a paper chart and the record of a patient's history and care generated by one particular provider. An EHR, meanwhile, is a complete, long-term computerized electronic record of a patient's care culled from any and all provider settings.
The EHR connects multiple providers, such as hospitals and clinicians, laboratories, and prescription and/or pharmacy histories, test results, and care notes collected by any provider throughout time for one particular patient.
4. Engage With Grace. If asked where they wish to die, in a hospital with tubes and strangers, or at home with family and friends, most Americans would say they want to die at home.
The health reform debate this past year frequently drew attention to the fact that an enormous amount of the nation's healthcare dollars are spent during the last two years of life, when interventions will merely prolong life by a few weeks or months.
All too often at the end of life, doctors push family members to keep patients in the hospital to manage the death process. One such incident prompted a California family to launch Engage With Grace, an effort to provoke a national familial discussion about how people want to end their lives. It sounds morbid, but all too often patients affected by terminal illness have not sufficiently explained their wishes to their loved ones.
5. Garlic Milkshake. Rep. John Boehner doesn't think a government run health plan is a suitable solution for the uninsured and said in the fall that he doesn't think the American people like it either. "I'm still trying to find the first American to talk to who is in favor of the public option," the Ohio Republican said in September. "This is about as unpopular as a garlic milkshake."
Obviously, Boehner didn't understand the political chutzpah of Gilroy, the California town south of San Francisco that claims to be the garlic capital of the country, and where garlic milkshakes, or at least garlic ice cream, are considered a must-have delicacy.
Deeply offended, Rep. Mike Honda, a San Jose Democrat whose district includes Gilroy, promptly delivered Boehner a basket of Gilroy garlic to Boehner's office. He stopped short of trying to send him an actual milkshake or ice-cream, perhaps fearing it would sour or melt along the way.
Honda included a limerick, which his staff presumably wrote:
"Two things make for a strong healthy heart.
Gilroy garlic, for one, a good start.
Public option? Also high in the American eye.
65 percent ne'er want it to part."
6. Guaranteed Issue. Increasingly popular provisions in health reform bills would prohibit health plans from rejecting an applicant based on pre-existing conditions or health risk. The bill approved by both houses of Congress would prevent carriers from setting premiums based on health status.
7. HAIs or Hospital Acquired Infections. Increasingly dreaded by care providers, hospital acquired infections, such as methicillin-resistant staphylococcus aureus or Clostridium difficile, kill 98,000 hospitalized patients. Efforts are underway to use creative efforts, such as hospital observers like secret shoppers, to make sure providers wash their hands whenever they're supposed to and that other universal precautions are taken.
There's more at stake for providers, as Medicare no longer pays for care required because of a HAI, leaving hospitals to absorb the cost of care on their own.
8. Medicare Buy-In. Now, apparently out the window, this health reform proposal would have allowed people between the ages of 55 and 64 to pay premiums in exchange for early eligibility in the Medicare program. Its fading chances are blamed on the fact that it is seen as too expensive, both for government and the would-be enrollee.
9. Nosocomial versus iatrogenic. These labels are frequently used interchangeably, but they too have a subtle difference. Nosocomial incidents originate in a hospital and are usually associated with infections when it's unclear how the incident occurred.
Iatrogenic incidents are the direct result of unintentional actions by a physician or surgeon, such as a sponge left in a surgical cavity or an infection carried by a doctor or nurse who touched two patients without washing.
10. VBP or Value-Based-Purchasing. VBP is a movement by employers and purchasers to get more for their money in improved results. One way to think of VBP is that it might eliminate coverage for procedures for which there is little evidence of efficacy.
According to the Agency for Healthcare Research and Quality, VBP is "any purchasing practices aimed at improving the value of healthcare services, where value is a function of both quality and cost. It can be helpful to think about value as the result of quality divided by cost."