On the Republican campaign trail, the healthcare debate has focused on the mandatory coverage that Mitt Romney signed into law as governor in 2006. But back in Massachusetts the conversation has moved on, and lawmakers are now confronting the problem that Mr. Romney left unaddressed: the state's spiraling healthcare costs. After three years of study, the state's legislative leaders appear close to producing bills that would make Massachusetts the first state — again — to radically revamp the way doctors, hospitals and other health providers are paid. Although important details remain to be negotiated, the legislative leaders and Gov. Deval Patrick, all Democrats, are working toward a plan that would encourage flat "global payments" to networks of providers for keeping patients well, replacing the fee-for-service system that creates incentives for excessive care by paying for each visit and procedure. "We have shown the nation how to extend care to everybody," Mr. Patrick said in an interview, "and we'll be the place to crack the code on costs."
When Illinois state Sen. Iris Martinez proposed that nonprofit hospitals should provide a minimum amount of charity healthcare in order to keep their tax-free status, she didn't win friends in the industry. Many hospital officials, she said, wouldn't discuss the idea, and once "I was told to my face (the bill) needs to go away." But with recent rulings by courts and the state that have forced some hospitals to start paying millions of dollars in property taxes, "now these hospitals are beginning to see we need to do something about this," said Martinez, a Chicago Democrat. For more than a century, nonprofit hospitals in Illinois generally have not had to pay property, income and sales taxes. In exchange, the hospitals individually grant millions of dollars in free or reduced-cost care to patients who qualify because they are poor or uninsured. Now, battle lines are being drawn between hospital officials who would like a blanket tax exemption and taxpayer and health advocates who say it's high time that medical facilities provide more charity care or pay their share of taxes.
New guidelines for diagnosing and treating attention deficit hyperactivity disorder could lead pediatricians to diagnose the condition in kids as young as four and to continue treating teens through high school on stimulant drugs like Ritalin and Adderall. The recommendations, released Monday at the American Academy of Pediatrics annual meeting in Boston, state that primary care physicians should do a diagnostic workup and initiate treatment for ADHD for any child aged 4 through 18 who has academic or behavioral problems and has trouble with inattention, hyperactivity, or impulsivity. The previous guidelines issued a decade ago only applied to children aged 6 through 12 since at that time, there a was a lack of research in preschoolers and teens, according to Dr. Mark Wolraich, chair of the guideline committee.
These days, some surgeons have four arms and are made of metal and plastic. Use of a robotic assistant called the Da Vinci Surgical System has quadrupled in the last four years, and the machine now helps with incisions and sutures in 2,000 hospitals around the world. Da Vinci is a multi-purpose robot — the only one of its kind — that can scrub in on heart bypass and valve repair operations, hysterectomies, prostate removal surgeries and other procedures. The Da Vinci robot is not actually performing operations; it only mirrors the movements of the surgeon's hands on two joystick-like controllers. Hospitals with the robot proudly proclaim its modern capabilities. Some patients insist on being treated by the mechanical surgeon. But despite the Da Vinci's popularity, its surgical talents may not surpass those of flesh-and-blood physicians. "There's never been a study showing clinical superiority," says Dr. Marty Makary, a surgeon at the Johns Hopkins University School of Medicine in Baltimore. "For the patient, there's clearly no difference."
Healthcare IT stakeholders gathered Oct. 14 in Washington for a work meeting, discussing ways IT could help improve transitions in care. The invitation-only meeting was hosted by the Office of the National Coordinator for Health Information Technology, the John A. Hartford Foundation, the Gordon and Betty Moore Foundation, and Kaiser Permanente. Attendees included federal officials, electronic health record vendors, entrepreneurs, grantees, leaders from ONC's Beacon Communities and foundation funding organizations. "We basically have all the tribes together today," said Aaron McKethan, director of ONC's Beacon Program, as he kicked off the meeting. National Coordinator Farzad Mostashari, MD, was both realistic and optimistic in his charge to attendees. "Our healthcare system is in trouble," he said. "It doesn't keep people safe and it's too costly. But I'm incredibly optimistic that this is the time when we're going make this better."
St. Joseph Medical Center is looking to partner with other hospitals as it continues to lose patients and revenue in the wake of problems with its lead cardiologist — a move that experts say might even lead to a merger. The Towson hospital has asked area hospitals to present options for forming a "strategic partnership" that its executives hope would improve the quality of care and services to patients. St. Joseph executives, who insist the hospital is not for sale, said they were prompted to enter talks with other hospitals by changes in the health care industry. Hospitals have been merging rapidly and looking for ways to operate more efficiently as they face competitors such as urgent-care centers and declines in reimbursements from Medicare and Medicaid — both trends that cut into profits. Its closest hospital neighbor, Greater Baltimore Medical Center, wouldn't confirm whether it was in talks with St. Joseph, but said "one strong system of care in Towson" would be a good idea.