A scientific advisory panel has recommended that federal officials give top priority to comparing the effectiveness of competing medical strategies in areas that include treating prostate cancer, reducing hospital infections, and lowering the rate of unwanted pregnancies. In the report, a panel assembled by the Institute of Medicine released a list of 100 health topics that it said should get high priority as the Obama administration proceeded with a plan to spend $1.1 billion in comparing the effectiveness of competing drugs, medical devices, operations, and other treatments for specific health conditions.
An estimated three-quarters of people who are pushed into personal bankruptcy by medical problems actually had insurance when they got sick or were injured. And as the federal government tries to cover the tens of millions of Americans without medical insurance, many health policy experts say simply giving everyone an insurance card will not be enough to fix what is wrong with the system.
Milwaukee-based Aurora Health Care plans to eliminate about 90 jobs. The healthcare system, which employs about 29,000 people, also said about 220 vacant positions would not be filled. The jobs slated to be eliminated are almost entirely in administrative functions and primarily in the Milwaukee area. Employees whose positions are being eliminated will be given priority for other jobs that become available, Aurora representatives said.
A bill working its way through Congress would expand the number of Medicare-funded physician residency positions by 15% over the next 3 years. The number of physician residency openings has been capped since 1997, and if passed the measure would add approximately 15,000 new residency training positions. The increases would be targeted to states that have had high population growth in the last decade. But simply creating more residency slots in primary care will not necessarily increase the number of primary care physicians, says Sg2 Vice President Natasha Goburdhun.
All the hospitals and outpatient surgical centers in Rhode Island have agreed to follow the same process to prevent errors in surgery. In announcing the new rules, the Hospital Association of Rhode Island said the state is the first in which a uniform protocol has been voluntarily adopted by all surgical providers. The protocol was developed over 18 months of consultation with hospital and healthcare leaders and the Joint Commission.
Anthem Blue Cross wants to raise rates by as much as 32% on Connecticut health insurance policies that consumers buy on their own.
A leading seller of individual policies, Anthem Blue Cross and Blue Shield is seeking regulators' approval for increases averaging 23% this fall. Most of the company's 56,000 Connecticut members under age 65 in individual plans would see premiums rise between 22% and 30%, although some would see no change.
Our Lady of Lourdes Medical Center in Camden, NJ, closed its inpatient pediatric unit primarily because the nine-bed unit had been underused, a spokeswoman said. Pediatric admissions at Lourdes have been declining for 15 to 20 years because of improvements in medical procedures and preventive care, said Wendy Marano, director of public relations for the Lourdes Health System, which operates the 410-bed Camden center.
Democratic leaders in Pennsylvania hope to double the number of residents who receive state-sponsored health insurance, but Republicans fear the costs may be too high. The Pennsylvania House voted 104-98 in favor of HB 1 to increase the number of individuals receiving adultBasic from 45,000 to 90,000. Republican leaders in the Senate say they might oppose the effort. Carolyn Scanlan, president and CEO of the Hospital & Healthsystem Association of Pennsylvania, also expressed reservations.
The Institute of Medicine released 100 health topics today that should receive priority attention and funding under the new national research initiative to identify healthcare services and procedures that work best. IOM also specified what needs to be done to update comparative effectiveness research initiatives in the future.
IOM's recommendations follow the release on Monday of the Federal Coordinating Council for Comparative Effectiveness Research's Report to Congress and the President advising how $1.1 billion could be spent under the economic stimulus legislation to assist federal agencies in coordinating and comparing the effectiveness of health services research.
The committee's report provides independent guidance--built on public input from the past several months--to Congress and to Department of Health and Human Services Secretary Kathleen Sebelius on how HHS should spend its $400 million on research to compare health services and approaches to care under the stimulus bill.
The IOM panel recommended 29 research priority categories, which include both primary and secondary research areas. The top priority category was health delivery, followed by disparities, disabilities, cardiovascular, geriatrics, psychiatry, neurology, pediatrics, endocrinology, and musculoskeletal.
Among the list of priority topics listed are:
Compare the effectiveness of treatment strategies for atrial fibrillation, including surgery, catheter ablation, and pharmacologic treatment.
Compare the effectiveness of the different treatments (e.g., assistive listening devices; cochlear implants; electric acoustic devices; and habilitation and rehabilitation methods, such as auditory/oral, sign language, and total communication) for hearing loss in children and adults, especially individuals with diverse cultural, language, medical, and developmental backgrounds.
Compare the effectiveness of upper endoscopy utilization and frequency for patients with gastroesophageal reflux disease on morbidity, quality of life, and diagnosis of esophageal adenocarcinoma.
Compare the effectiveness of primary prevention methods, such as exercise and balance training, versus clinical treatments in preventing falls in older adults at varying degrees of risk.
Compare the effectiveness of dissemination and translation techniques to facilitate the use of CER by patients, clinicians, payers, and others.
Compare the effectiveness of comprehensive care coordination programs, such as the medical home, and usual care in managing children and adults with severe chronic disease, especially in populations with known health disparities.
"This report lays the foundation for an ongoing enterprise to provide the evidence that healthcare providers need to make better decisions and achieve better results," said IOM Committee Co chair Sheldon Greenfield, Donald Bren Professor of Medicine and executive director, Health Policy Research Institute, University of California, Irvine, in a statement.
"To make the most of this enterprise, HHS will need to ensure that the results are translated into practice and that the public is involved in priority setting to ensure that the research is relevant to everyday health care," Greenfield said.
Fairly or not, healthcare reform advocates—including President Barack Obama—have made McAllen, TX, Exhibit A for much of what is driving the high cost of healthcare in the United States.
The small Texas border town was targeted for heavy—and disputed—criticism in a June 1 issue of The New Yorker, entitled "The Cost Conundrum", for excessive healthcare costs, owing to what the magazine says are a high number of questionable medical procedures, tests, and other cost drivers.
Obama cited the report in a June 15 speech to the American Medical Association, and told the physicians that McAllen is the product of a healthcare system that incentivizes physicians to perform tests and procedures and "rewards the quantity of care rather than the quality of care; that pushes you, the doctor, to see more and more patients even if you can't spend much time with each, and gives you every incentive to order that extra MRI or EKG, even if it's not necessary. It's a model that has taken the pursuit of medicine from a profession—a calling—to a business."
It is comments like these–suggesting that "medicine" and "business" are mutually exclusive–that make healthcare economist Mark Reiboldt nervous. Reiboldt, a vice president at Coker Capital Advisors, an Atlanta investment banking firm, says the climate in Washington, DC, is making business "extremely disadvantageous for the physician entrepreneur."
"When you look at the whole picture, we are getting close to universal healthcare and single-payer, which is dangerously close to socialized medicine and that type of model you see in the UK and the EU," he says.
Reiboldt says he isn't defending or accusing the physicians of McAllen of any improprieties. But he believes the healthcare reform movement is using an extreme example as a standard for what is wrong, rather than correctly identifying an outlier.
"There are very defined and strict guidelines that prevent or forbid doctors from doing what was happening in Texas to the extent that it is not right, that it is unethical," he says. "You can't base the entire system on these outliers. They are going to take advantage of the system in any system."
"If you use the folks that are the exception to the rule, the folks who are going to break the rules and violate the structure and put that in a framework with the people who want to operate a business efficiently and be able to take advantage of all the revenue opportunities it can legally morally and ethically, I believe the market will have a way of balancing out those negative externalities or the outliers that are taking advantage of the situation," he says.
Rep. Jim Cooper, D-TN, says he's not so sure that McAllen is an outlier. "If the issue is self-referral, then the data are pretty clear that physicians are more likely to self-refer when they own the referral facility," Cooper says, citing McKinsey & Co. 2007 report that estimated that physicians make about $8 billion a year with self-referrals.
"When a doctor owns a facility, miraculously, referrals go up," he says. "It's not in the Hippocratic Oath that you should own the referral facilities. In The New Yorker article about McAllen, TX, the evidence is pretty overwhelming. Hopefully doctors would be so ethical that they would not over-refer, but it seems pretty clear that in aggregate they are over-referring."
Ted Epperly, MD, president of the American Academy of Family Physicians, says he won't tell colleagues how to run their practices. But he says a balance has to be struck between the public good and physicians' right to earn a living. "There is going to be a certain degree of experimentation that is going to on with this as we try to find the right balance," he says.
