The nation's largest hospital associations have banded together to ask the Obama administration to resist efforts by governors to reduce maintenance-of-effort funding for Medicaid in their cash-strapped states.
"We want to reiterate our strong support for the Medicaid MOE requirement that was part of the Affordable Care Act, and urge you to continue to resist efforts to erode the important coverage protections that this provision is intended to ensure," the associations said in a joint letter Tuesday to Health and Human Services Secretary Kathleen Sebelius. "The nation's hospitals and health systems recognize the significant fiscal pressures facing many states and stand ready to work with them, as you do, to find effective solutions without compromising coverage."
The letter was sent as Republican governors urged the Obama Administration to change Medicaid from its reliance on state and federal matching funds, and into a block grant program. The GOP governors said block grants would provide them with the flexibility to manage the budget-busting program and cover gaping state revenue shortfalls. Several media outlets reported Tuesday that the Obama administration has rejected the idea.
Medicaid covers more than 50 million people, and the rolls have increased in recent years owing to the recession and sputtering recover. The hospital associations in the letter to Sebelius acknowledged the pressure that Medicaid is putting on state budgets, but they urged the federal government to resist any requests for MOE waivers, which are otherwise prohibited before Jan. 14, 2014, when the ACA's coverage expansion goes into effect.
"A relaxation of the MOE provisions will push many low-income Americans off Medicaid rolls, thereby increasing the number of uninsured – moving us backwards rather than forward towards the ACA's goal of expanded health coverage," the associations said. "Removing people from Medicaid does not keep them from getting sick and will deter them from seeking the care that they need. Further, it shifts the burden of their care from states and the federal government largely onto the nation's hospitals. Hospitals currently provide some $40 billion in uncompensated care and the loss of the Medicaid MOE will only increase this burden on providers."
The letter was signed by representatives from the American Hospital Association, Catholic Health Association of the United States, Federation of American Hospitals, National Association of Children's Hospitals, National Association of Public Hospitals and Health Systems, the Association of American Medical Colleges, and VHA Inc.
Healthcare quality continues to progress, albeit slowly—about 2.3% a year. Disparities based on race, ethnicity, socioeconomic status and other factors, however, remain unacceptably high, according to the 2010 National Healthcare Quality Report and National Healthcare Disparities Report issued this week by the Department of Health & Human Services' Agency for Healthcare Research and Quality.
The reports, mandated by Congress, are based on more than 200 healthcare measures categorized in several areas of quality: effectiveness, patient safety, timeliness, patient-centeredness, care coordination, efficiency, health system infrastructure, and access.
"All Americans should have access to high-quality, appropriate and safe healthcare that helps them achieve the best possible health, and these reports show that we are making very slow progress toward that goal," said AHRQ Director Carolyn M. Clancy, MD. "We need to ramp up our overall efforts to improve quality and focus specific attention on areas that need the greatest improvement."
Healthcare quality gains were seen in several areas, with the highest rates of improvement in measures related to treatment of acute illnesses or injuries. For example, the proportion of heart attack patients who underwent procedures to unblock heart arteries within 90 minutes improved from 42% in 2005 to 81% in 2008. Very modest gains were seen in rates of screening for preventive services and child and adult immunization.
Measures of lifestyle modifications such as reducing obesity, smoking cessation and substance abuse saw no improvement.
The reports indicate that few disparities in quality of care are getting smaller, and almost no disparities in access to care are getting smaller. Overall, blacks, American Indians and Alaska Natives received worse care than whites for about 40% of core measures. Asians received worse care than whites for about 20% of core measures. Hispanics received worse care than whites for about 60% of core measures. Poor people received worse care than high-income people for about 80% of core measures.
Of the 22 measures of access to healthcare services tracked in the reports, about 60% did not show improvement, and 40% worsened. On average, Americans report barriers to care one-fifth of the time, ranging from 3% of people saying they were unable to get or had to delay getting prescription medications to 60% of people saying their usual provider did not have office hours on weekends or nights. Among disparities in core access measures, only one—the gap between Asians and whites in the percentage of adults who reported having a specific source of ongoing care—showed a reduction.
Ventas, Inc. will acquire Nationwide Health Properties, Inc. in an all-stock transaction valued at $7.4 billion that – when completed – will create the nation's largest publicly traded real estate investment trust, the two REITs announced jointly Monday.
The board of directors at both REITs unanimously approved the definitive agreement, under which Chicago-based Ventas will acquire all of the outstanding shares of NHP in a stock-for-stock transaction that would be the equivalent to $44.99 of Ventas stock for each NHP share, which represents a premium of about 15% over NHP's closing price on Friday.
The combined company will have more than 1,300 assets in 47 states, the District of Columbia, and two Canadian provinces, which represents approximately $17 billion in equity value, and an enterprise value of approximately $23 billion, the two REITs said.
Ventas shareholders are expected to own approximately 65% of the combined company, and NHP shareholders are expected to own approximately 35%. The transaction is expected to be immediately accretive to Ventas's normalized funds from operations and funds available for distribution after the closing, which is expected to occur in the third quarter of 2011, the REITs said.
Ventas Chairman/CEO Debra A. Cafaro will be chairman/CEO of the combined company. Douglas M. Pasquale, NHP's chairman/president/ CEO, will serve as a senior advisor during the transition. When the deal is finalized, the Ventas board will be expanded to include three directors from NHP, including Pasquale, bringing the total to 13 members. The REIT will continue to be headquartered in Chicago.
"The combination of Ventas and NHP increases the scale and diversification of the combined company, the strength and flexibility of the company's balance sheet and the quality and geography of the assets," Cafaro said. "With Ventas's successful track record of value-creating transactions and NHP's longstanding history of regional, asset-level acquisitions, taken together with one of the strongest balance sheets in the REIT industry, the combined company will have a unique opportunity for continued external growth."
Pasquale called Ventas "the right partner" for Newport Beach, CA-based NHP. "Our shareholders, property operators and tenants will all benefit from our expanded strength, diversification and capabilities," he said. "We're pleased that this all-stock transaction offers NHP shareholders a premium and also the opportunity to participate in the combined company's future prospects for dividends and growth."
Among its $5.1 Billion in healthcare real estate assets, NHP owns 667 properties in 42 states including
United Regional Health Care System has agreed to a demand from federal prosecutors that it no longer block health plans from contracting with other hospitals in the Wichita Falls, TX area, the Department of Justice has announced.
Federal prosecutors said URHCS illegally used contracts to maintain its monopoly for hospital services in violation of the Sherman Act, which meant that consumers paid more for healthcare. This is the first case brought by DOJ since 1999 that challenges a monopoly with in traditional anticompetitive unilateral conduct.
"Unfettered competition among hospitals is vital to ensuring that patients receive high-quality, low-cost healthcare," said Christine Varney, assistant Attorney General in charge of the Department of Justice's Antitrust Division. "Today's settlement prevents a dominant hospital from using its market power to harm consumers by undermining its competitors' ability to compete in the marketplace."
Phyllis Cowling, president/CEO of URHCS, said the private, nonprofit health system "was pleased with the resolution" of the investigation.
"While we disagree with the Department's interpretation of the facts and would have welcomed the opportunity to address this matter in a court of law, we believe it is in the best interest of United Regional and our patients to instead move forward with our total attention and resources focused on our passion of providing excellence in healthcare for the communities we serve," Cowling said in a statement posted on the URHCS Web site.
URHCS is the largest hospital in Wichita Falls, controlling about 90% of general acute-care inpatient hospital services, and 65% of outpatient surgical services. It is the region's only provider of cardiac surgery, obstetrics and high-level trauma care. URHCS's average per-day rate for inpatient hospital services sold to commercial health insurers is about 70% higher than its closest competitor for the services that are offered by both hospitals.
DOJ said URHCS systematically demanded most commercial health insurers to sign contracts that required the insurers to pay significantly higher prices if they contracted with a nearby competing healthcare facility. Since URHCS is a must-have hospital for any insurer that wants to sell health insurance in the Wichita Falls area, and because the penalty for contracting with the health system's rivals was significant, almost all insurers offering health insurance in Wichita Falls entered into exclusionary contracts with URHCS.
The proposed settlement -- now under consideration by a U.S. District Judge in North Texas -- would be in effect for seven years. It would ban URHCS from using agreements with commercial health insurers that improperly inhibit insurers from contracting with competitors. In particular, URHCS would be banned from conditioning the prices or discounts that it offers to commercial health insurers based on exclusivity. URHCS also would be banned from taking retaliatory actions against an insurer that contracts with a rival provider.
There is something inherently commonsensical about wellness programs.
If employers entice and incentivize employees to take better care of themselves, by losing weight, quitting smoking, exercising, etc., then the healthier life style will result in lower medical costs, which will be reflected in lower health insurance premiums, and other costs associated with employer-based health plans.
It's a remarkably simple theory. Until recently, however, it's been just that: theory. It's been difficult to consistently demonstrate savings generated by wellness programs. As the wellness movement matures, however, more studies prove they are a worthy return on investment.
Highmark Inc., the Pittsburgh-based health insurers, have published the findings of a four-year study which found that healthcare costs rose at a 15% slower rate among wellness participants who were offered a consistent and comprehensive wellness program over several years, when compared with employees in a control group who did not participate in wellness programs.
The study of select Highmark employer group wellness programs showed that the savings per participant was $332 a year, when compared with the control group of nonparticipants. Actually, the savings could be considerably higher, says Jennifer Grana, a director at Highmark, because the study does not factor in the cost of lost productivity and absenteeism due to health issues.
The study was published in the March/April edition of the American Journal of Health Promotion.
Grana says the measuring ROI on wellness programs has been difficult because it often takes years to see the results. "When you start to talk about a return on investment you will want to evaluate and measure your wellness program knowing it takes time to change behavior," she says. "You have to allow for the fact that it usually takes three to five years of good participation to even begin to move the needle and demonstrate a return on investment."
"It is all about changing behavior, and that takes time," Grana says. "It could take several attempts for people to quit smoking or lose weight. It is not something you will necessarily see overnight. But if you keep at it you will be able to see that you are moving the needle, and that can equate to some dollars saved."
Highmark evaluated the impact of wellness programs on healthcare costs and utilization over time by matching approximately 10,000 wellness program participants at 47 Highmark employer groups with a risk-matched comparison group. The employers offered Web-based wellness programs from Highmark to their employees consistently for at least three or more years.
The study found that wellness program participants used services such as preventive physicals, mammograms and cancer screenings more than their comparison group counterparts, possibly as a result of self-care knowledge obtained from their worksite wellness programs. While these preventive care measures often cost employers more in the short term, they can help save on longer-term healthcare costs.
Grana says that Highmark data show that successful wellness programs almost always start with a health risk assessment that could be combined with biometric screenings. "It's important to follow up with the 'what's next?' with the data," she says. "Whether it's a digital coaching program that a worker can access that deals with topics like binge eating or weight management or insomnia, or it could be telephonic coaching, or employer-sponsored worksite programs. (Making) them aware of the resources that are readily available for them is crucial."
While worksite health promotion and wellness programs have been around for 30 years, Grana says that in the past five years employers have more readily embraced wellness as part of their organizational mission. "Some have tied incentives for participation in wellness programs to their benefit design. Those types of movements have allowed great progress in terms of getting more participation so there is more data, so we can implement more meaningful programs or interventions that address the data," she says.Grana says she is finding C-suites are becoming more receptive toward wellness programs as they demonstrate their value, and as healthcare costs continue to pile up. "It's not just in terms of healthcare dollars. It's also in terms of productivity," she says. "We know people who manage their stress or depression who are healthier are more productive employees. They miss less work and when they are at work they are functioning at a higher level."
Accepting the validity of the wellness movement, and building a wellness movement for your organization are not the same thing, however. "Wellness is not easy," Grana says. "You have to have a trusting culture, you have to motivate employees, and you have the have the administrative and communications support to make these things successful to get the biggest bang for the buck. When you balance it all out employers know it's the right thing to do."
Wellness programs may be the right thing to do for employees, and they may give the folks in HR a higher sense of purpose as they help colleagues enjoy the higher quality of life that comes with better health. But wellness programs will only prosper and proliferate if they're shown to be cost effective. Fortunately, the data is telling us that it's true.
Medical student and resident education has to include instruction on how healthcare systems function -- especially with the advent of complicated national healthcare reforms, University of Michigan physicians said.
Two U-M physicians and a U-M Medical School graduate called for a national curriculum in health policy for medical students and residents, in an article in the New England Journal of Medicine. “Without education in health policy and the healthcare system, physicians are missing critical tools in their professional toolbox,” said co-author Matthew M. Davis, MD, associate professor at U-M in Pediatrics and Communicable Diseases, Internal Medicine and Public Policy.
Davis said his previous research has found that fewer than half of graduating medical students in the U.S. said they received adequate training in understanding healthcare systems and the economics of practicing medicine.
“As a resident, I routinely care for patients who cannot afford their medications or don’t have access to regular medical care,” said Mitesh S. Patel, MD, a 2009 U-M Medical School graduate and lead author of the article. “These issues have a major impact on the delivery and cost of healthcare. However, they are rarely discussed in educational lectures or during teaching rounds.”
Physicians who don't understand the healthcare system or health insurance policies disserve their patients, said Monica Lypson, MD, assistant dean of Graduate Medical Education at U-M and a co-author on the article. “The healthcare system is complicated, but it’s no more complicated than the other things we expect medical students and residents to learn,” Lypson said. “Regardless of partisan persuasion or political beliefs, physician trainees and medical doctors in general should have the knowledge needed to engage in meaningful discussions regarding health policy.”
The U-M Medical School has added an elective course in healthcare policy, which Davis teaches. “It is enrolled to the maximum,” he said. “The students were hungry to learn more. We have to find the best ways to teach medical students to be the best navigators of the healthcare system for their patients.”
The three authors want a common national curriculum -- with content tailored regionally and locally. They recommend pilot projects as a precursor to a standardized national curriculum and propose a focus on four concentrations: healthcare systems, healthcare quality, value and equity, and health politics and law.
The new curriculum should not jeopardize other topics, but that policy discussions should be integrated with clinical instruction and permeate the educational training. The authors want a multidisciplinary faculty to conduct the health policy training, including experts in health economics, sociology, business, and psychology.
Lypson said patients expect physicians to be knowledgeable about healthcare reforms, health insurance, health policy, and the impact of these forces on their care. “We don't expect them to learn to practice medicine simply by saying, “Go take care of patients now,’” she said. “That doesn't work for clinical knowledge, and it doesn't work for policy knowledge, either.”
North Country Health Services in Bemidji, MN, and Dakotas-based Sanford Health have signed an affiliation agreement that will create Sanford Health of Northern Minnesota on March 1. As part of the affiliation, Sanford will invest $70 million in resources over the next ten years and will immediately make a $5 million gift to the NCHS Foundation, the two healthcare systems said Friday in a joint announcement.
NCHS and Sanford Bemidji Clinic said the affiliation is the "first step" in the integration of the two Bemidji-based organizations to provide coordinated care for patients close to home. Plans are underway to expand service lines for heart, cancer, orthopedics & sports medicine, women's health, and research and education. The affiliation is also expected to help with clinician recruiting.
"A yearlong evaluation process revealed many ways for us to better serve the region together as an integrated provider," said Kelby Krabbenhoft, CEO of Sanford Health. "We will combine the resources of a strong regional healthcare institution and a multi-specialty physician clinic, together with the Sanford Health System, to offer more primary and specialty care services and new programs in research and education. Our goals were the same -- to make Bemidji a regional referral center in northern Minnesota and this merger will enable us to do so."
Sanford Bemidji will consist of Sanford Bemidji Medical Center and Sanford Bemidji Clinic and will operate under the legal name of Sanford Health of Northern Minnesota, based in Bemidji. Sanford Bemidji will serve as the regional hub for Sanford Health in northern Minnesota.
The existing board at NCHS will comprise the new Sanford Bemidji Board of Directors, using the same corporate structure as other Sanford hospitals such as Sanford USD Medical Center, and Sanford Fargo Medical Center.
"Both NCHS and Sanford Bemidji Clinic have deep roots in this region as well as a legacy of community service," said Paul Hanson, president/CEO of NCHS. "At a time of great change in healthcare, we see this affiliation as an opportunity to grow and provide quality healthcare to the people of this region now and for years to come."
NCHS has more than 900 employees with 25,000 emergency visits, 5,500 acute admissions and 1,000 births per year. NCHS opened in 1898 and is an acute care hospital serving a region of approximately 100,000 people in northern Minnesota. It has 80 acute hospital beds, 16 acute rehabilitation beds, 12 acute geriatric psychiatric beds and 78 skilled nursing home beds; 120 assisted living apartments including a distinct dementia unit; a durable medical equipment company; a Class A licensed homecare agency and Medicare certified hospice program.
Sanford Bemidji Clinic has 75 physicians, 15 mid-level providers and 550 employees.Sanford Health is an integrated health system headquartered in Fargo, ND and Sioux Falls, SD and consists of two long-standing organizations that merged in 2009. Sanford is now the largest, rural, not-for-profit healthcare system in the nation with a presence in 111 communities in eight states.
Sanford Health includes 31 hospitals, 111 clinic locations and more than 800 physicians in 70 specialty areas of medicine. With more than 19,000 employees, Sanford Health is the largest employer in North and South Dakota.
Both health organizations said the affiliation would create more healthcare-related jobs, rather than layoffs, as the full integration of the systems continues over many months.
Will Sanford Health Plan be offered in Bemidji?
The Sanford Health Plan is currently the second largest commercial health insurer in South Dakota, covering more than 65,000 lives. Recently it was introduced in North Dakota and it is currently available in southwest Minnesota. Work is being done so we can offer both group and individual policies in northern Minnesota in the future. This is subject to regulatory approvals. In the meantime, Sanford Health Plan is available to all Sanford Health employees.
How will Mr. Sanford's gift be used in this new health system?
Mr. Sanford's gift of $400 million is being used for clearly defined Sanford Health Initiatives: The Sanford Project – a quest to cure Type 1 diabetes, Sanford Children's Clinic development around the world and a multitude of other research development projects. His most recent gift of $100 million will be used for advancement of breast cancer research and treatment. These initiatives will be part of the new integrated health system (including NCHS).
BlueCross BlueShield of Illinois will pay the federal government and the state of Illinois $25 million to settle False Claims Act allegations, the Justice Department has announced.
The settlement resolves claims that BCBS IL illegally terminated coverage for private duty skilled nursing care for medically fragile, technologically dependent children, which shifted the cost of the care onto Medicaid, DOJ said in a statement.
Under the alleged scheme, children whose specialized care should have been covered by BlueCross BlueShield of Illinois were shifted to the government-funded Home and Community Based Services Medicaid program, operated by the Illinois Division of Specialized Care for Children.
The settlement also resolves claims that BCBSI denied patient claims based on internal, undisclosed guidelines that were more restrictive than the language provided to beneficiaries in plan policy materials. Additionally, the DOJ claimed that BCBSI improperly told policy holders that children were not covered for private duty nursing during the claims review process sought after denials.
Under the agreement, BlueCross BlueShield of Illinois will pay $14.25 million to Illinois and $9.5 million to the federal government. The insurer, a division of Health Care Service Corp., will also pay $1.25 million to Illinois under the state consumer fraud statute.
"It is appalling for a major insurance company to terminate medical services coverage for sick children in need just to boost their bottom line at taxpayers' expense, as we've alleged here," said Tony West, Assistant Attorney General for the Justice Department's Civil Division. "When private insurance companies improperly force patients to turn to Medicaid for medical coverage those companies should be providing, we will hold them accountable."
BCBS IL issued the following statement: "Our agreement with the state attorney general and the federal government resolves a long-standing dispute concerning certain claims involving private duty nursing benefits. While we disagree with the allegations and deny any inappropriate conduct at any time, we are pleased to put this matter behind us and focus on serving the needs of our policyholders. This dispute began many years ago when we reviewed certain claims and determined that the benefits sought were not covered by the applicable insurance plans and policies. These plans and polices determine which benefits are covered and which are not. Several years ago, in cooperation with the state attorney general, we expanded our explanation of benefits to ensure that our members understood what nursing benefits are covered under their plans. That action, coupled with today's agreement, are in the best interests of our members."
DOJ has used the False Claims Act to recover more than $5.5 billion since January 2009 in cases involving fraud against federal healthcare programs. The Justice Department's total recoveries in False Claims Act cases since January 2009 are nearly $7 billion.
The Department of Health and Human Services said Thursday it is making available nearly $200 million in grants to help states combat "unreasonable premium increases" of 10% or more.
HHS said the new money will bolster state programs to improve transparency and thoroughness in the review process for health insurance premium rate hikes, and builds on the $46 million awarded last August to help 45 states and the District of Columbia crack down on unreasonable premium hikes. The grants will help states with new federal rules under the Affordable Care Act that proposed in December to require insurance companies to publicly justify unreasonable premium rate increases, HHS said.
"For too long, families and small business owners have struggled to pay ever increasing health insurance premiums," said Steve Larsen, director of the Center for Consumer Information and Insurance Oversight, which administers the rate review grants. "The Affordable Care Act provides States new resources and tools to curb those rising costs, as well as to help make sure that consumers and businesses are getting value for their premium dollars."
Of the total funding, $149 million is available to states for baseline grants to improve transparency and effectiveness in rate hike review. Another $50 million in grant funds are available to states as either: "workload" grants totaling $22.5 million for states with larger populations and more health insurers; or "performance" incentives totaling $27.5 million for states that have – or enact – the authority to approve or disapprove rate increases.
America's Health Insurance Plans and other insurance industry advocacy groups complain that the government has focused on healthcare premium increases while ignoring the underlying costs driving the increases.
Health plan leaders polled for HealthLeaders Media's Industry Survey 2011, cited "government laws and mandates" as a top driver of healthcare costs, second only to overutilization of services.
In a letter this week to HHS, Daniel T. Durham, AHIP's executive vice president for policy and regulatory affairs, warned that "politicizing the reviews…threatens to undermine the financial health and continued viability of health plans." Durham reiterated the health plans' contention that "strong steps outside of the rate review process (emphasis theirs)are needed to address the underlying factors that are driving medical costs. The rate review process cannot serve as a substitute for meaningful health care cost containment."
However, the nonprofit Consumer Union said the grant money is welcomed and needed.
"Right now, we have a patchwork of rate review rules and practices in the states. Even states that have authority to reject rate increases often lack the resources to collect sufficient data and closely analyze rate hikes," said Sondra Roberto, a staff attorney for Consumers Union. "An insurer's rate increase is always based on future projections of revenues and costs, so it is very important that these projections are analyzed to ensure that they are reasonable, fair, and based on valid data and assumptions. We hope that states receiving this funding will use it to improve data collection, standardize filing requirements, and conduct more in-depth reviews."
Roberto said states have a poor history of considering the impact of rate hikes on consumers, or of making the process open for consumer advocates. "These grants will hopefully encourage more states to open up the process to allow more public involvement and use this input to balance the hardship on consumers against the company's need for an increase," she said.
Whether or not Medicare patients undergo elective surgery depends on where they live and their doctors, according to a report from the Dartmouth Atlas Project and the Foundation for Informed Medical Decision Making.
Researchers found remarkably wide regional variations in elective surgery for Medicare patients even though they had similar conditions.
For example:
Men over 65 with early-stage prostate cancer in San Luis Obispo, CA are 12 times more likely to have surgery to remove their prostate than those in Albany, GA.
Medicare patients with heart disease in Elyria, OH were 10 times more likely to have a procedure such as angioplasty or stents than those in Honolulu, HI.
Women over 65 living in Victoria, TX were seven times more likely to undergo mastectomy for early-stage breast cancer than women in Muncie, ID.
“These striking variations are the by-product of a doctor-centric medical delivery system. In highlighting the variation from community to community for elective procedures, we hope to shine a light on the fact that patients’ preferences are not always taken into account when medical decisions are made,” says Shannon Brownlee, lead report author and instructor at the Dartmouth Institute for Health Policy and Clinical Practice.
The report is the first in a series looking at individual states and regions, and highlights Minnesota in addition to presenting national trends. Researchers analyzed the rates of elective or ?preference-sensitive? procedures, including:
mastectomy for breast cancer;
coronary artery bypass surgery;
percutaneous coronary intervention;
back surgery;
knee and hip joint replacement;
carotid artery surgery;
gall bladder removal;
radical prostatectomy for prostate cancer;
The report also advocates for shared decision-making to help patients understand their choices and share treatment decisions with their clinicians. The report also describes the treatment choices available for the preference-sensitive procedures, all of which can?but do not have to be? treated with surgery, as well as steps patients can take to make sure they get the care they want and need.
?All too often, patients facing elective surgery are not given an opportunity to learn about the full range of options, and that each choice has unique risks and benefits. Many are not even aware that the decision about an elective procedure is actually a choice. Instead, they routinely delegate such important decisions to their clinicians, with the result being that patients often do not get the treatment they would prefer,? says David C. Goodman, MD, report co-author and co-principal investigator for the Dartmouth Atlas Project, and director of the Center for Health Policy Research at the Dartmouth Institute for Health Policy and Clinical Practice.
The researchers explain that differences in clinicians? personal beliefs and opinions contribute to the variation in surgical rates in observed geographic locations. For example, there is considerable disagreement among surgeons about the need for back surgery, its effectiveness, and even the best way to diagnose the cause of back pain. With no consensus about how to diagnose and treat back pain, the rate of back surgery varies widely from place to place.
As a result, Medicare patients living in Casper, WY are nearly six times more likely to undergo back surgery than patients living in the Bronx, NY.
?Some of the most important choices in medicine are not the clinician?s alone to make. Patient preference is especially important when facing a test, surgery or treatment that is elective. In order to ensure that patients get the treatment that is right for them, the choice should be a shared decision. When done right, shared decision-making results in a better decision: a personalized choice based on both the best scientific evidence and the patient?s values,? says Michael J. Barry, MD, report co-author and president of the Foundation for Informed Medical Decision Making.
The Dartmouth Atlas Project is located at the Dartmouth Institute for Health Policy and Clinical
Practice and principally funded by the Robert Wood Johnson Foundation.
Click here for the full report, Improving Patient Decision-Making in Health Care: A 2011 Dartmouth Atlas Report Highlighting Minnesota.
