WSJ looks at effects of Penn. outcomes database
Filed under: Health care reform, Health data, Health policy, Hospitals, Hot Health Headline
The Wall Street Journal’s Thomas Burton has taken a look at the effects of one state’s commitment to publishing hospital data. Since 1989 Pennsylvania has compiled and published data on hospital outcomes and, to a lesser extent, costs. Collecting the data isn’t cheap, estimates of the cost to the state’s 172 acute-care hospitals range from $7 million to $10 million, but Burton’s story makes it clear that the investment has paid off. Burton reinforces that impression with statistics (”An August 2008 study in the American Journal of Medical Quality reported that Pennsylvania in-hospital odds of death were 21% to 41% lower than those in other states.”) and convincing examples (by basing their health plans on outcomes data, companies were able to save millions). His profile of a now-defunct Hershey company plan is particularly interesting.
“High-quality care costs less — always,” says David B. Nash, a medical-quality expert and dean at Thomas Jefferson University’s School of Population Health in Philadelphia. “If the federal government could behave like a savvy shopper, that would change the health-cost game overnight. But the government is a bill payer, not a savvy shopper.”
Burton also reports that some stakeholders, given the success of Pennsylvania’s example, are pushing for hospital outcomes research to be part of the $1 billion stimulus investment into comparative effectiveness.
The White House is looking at publishing information possibly including medical outcomes as part of overhaul efforts, officials say. Quality data could also be used in existing programs. “There is a clear understanding from the Obama administration that both Medicare and Medicaid need to move in the direction of what’s happening in Pennsylvania,” says Jonathan Blum, director of the government’s Center for Medicare Management.
Bloomberg explains all five House, Senate plans
Filed under: Government, Health care reform, Health policy, Hot Health Headline
Bloomberg’s Kristin Jensen and Nicole Gaouette have perused all five proposed health care reform plans, each originating from a different committee in either the U.S. Senate or House of Representatives, and were kind enough to explain exactly what they have in common and what they don’t.
In case you’re wondering, they all come with an individual mandate, expanded coverage, comparative effectiveness, increased regulation of insurers and cost-cutting measures. They differ in terms of budget, funding, a public option and an employer mandate.
Reporters miss crucial detail about Lewin Group
Filed under: Conflicts of interest, Health care reform, Health data, Health policy
The Lewin Group, which refers to itself as “a leading health care policy and management consulting firm,” has launched a Center for Comparative Effectiveness Research that is expected to offer research “for use by policy makers, researchers, health care providers and others to improve patient care and optimize resources.”
Some reporters writing about this development, and other issues, are still referring to the Lewin Group as a nonpartisan organization, yet AHCJ president Trudy Lieberman pointed out in April that the group is ultimately part of United Healthcare Group, a major insurance company. Lieberman turned up evidence indicating that there may be no formal protections in place for Lewin Group’s editorial independence.
However, in recent stories, ABC News, The Washington Post, Investor’s Business Daily, KPCC, a southern California public radio station, and other news outlets continue to describe the Lewin Group as “nonpartisan.” And, while the Lewin Group does refer to itself as “objective,” it’s probably not a good idea to overlook their corporate ties entirely.
Let the comparison shopping begin
The august Institute of Medicine is out with academic medicine’s answer to the Billboard Hot 100. A panel of experts has come up with a list of the top 100 health topics that deserve a rigorous comparison of options to determine which are best.
The recommendations, part of a larger report that lays out a blueprint for research, are organized by quartile, and the top 25 would be the ones with a bullet, to stretch the pop music analogy.
Some of the high priorities:
- What are the best strategies to reduce infections spread in health-care settings?
- What’s the best way to use expensive biotech drugs – like Remicade, Enbrel and Humira – to treat inflammatory diseases, such as rheumatoid arthritis?
- How should dental care be delivered to children to most effectively prevent cavities?
Comparing effectiveness is suddenly an idea whose time has come. “Health care decisions too often are a matter of guesswork, because we lack good evidence to inform them,” said Harold C. Sox, editor of The Annals of Internal Medicine, and panel co-chairman, according to The New York Times.
In legislation to boost the economy, Congress set aside more than $1 billion to fund comparisons that would pick health winners and losers. It was the IOM’s job to come up with recommendations on where to start.
For a little peek into how the priorities were chosen, Consumer Reports‘ Health Blog has a Q&A with Consumer Union President Jim Guest, who was a member of the Federal Coordinating Council for Comparative Effectiveness Research that came up with the recommendations.
The New England Journal of Medicine weighed in with a “Perspective” piece on implications of the report. For more about comparative effectiveness, see this piece from AHCJ board member Andrew Holtz, M.P.H.
Dartmouth Atlas: Powerful when used right
Filed under: Health care reform, Health data, Health journalism, Health policy, Hot Health Headline, Pharmaceuticals
The Dartmouth Atlas contains detailed information on regional variations in health care spending and use and therefore has the potential to play a key role in the debate over health care cost and efficiency.
Nonetheless, it has come under fire in a few prominent publications lately. Writing for the Health Affairs blog, Amitabh Chandra defends the utility of the Atlas, pointing out that in many cases quibbles with the Atlas arise due to a lack of broad perspective or understanding of the health care system as a whole and an inability to properly interpret Dartmouth’s findings.
In addition to refuting certain attacks on the Atlas, Chandra expands his defense to include an outline of just why it can be a useful resource when trying to evaluate health care spending and effectiveness.
To learn more about the Dartmouth Atlas and how to use it to determine how medical resources are distributed and used in the United States, read AHCJ’s Covering Hospitals, a slim guide that focuses on how journalists can best use Dartmouth Atlas and Hospital Compare.
Report compares reform estimates, finds huge savings
Filed under: Government, Health care reform, Hot Health Headline, Studies
A report from the health reform-focused Commonwealth Fund compares costs over the next decade for numerous reform options, using estimates from the Office of Management and Budget (for the president’s reform proposal and stimulus), the Congressional Budget Office and a Commonwealth-commissioned Lewin Group report titled “The Path to a High Performance Health U.S. Health System.”
Estimates vary widely between the three efforts, with the Lewin Group (which has some ties to the insurance industry) generally giving the rosiest predictions. The federal reports generally focus exclusively on government savings, while the Lewin study often also lists the savings incurred by the system as a whole. The comparisons are particularly interesting, with some estimates looking remarkably divergent. For example, for a hospital pay-for-performance system, the OMB estimates a $12 billion savings, the CBO says $3 billion and the Lewin Group says the government will save $43 billion with the system as a whole saving $55 billion.
Hastings Center debuts ‘Health Care Cost Monitor’
Filed under: Health care reform, Health journalism, Health policy
The Hastings Center, an independent bioethics think tank, has launched the ‘Health Care Cost Monitor,’ a blog aimed at covering the “crisis” of rising health care costs with “care, depth, and nuance.”
Daniel Callahan, co-founder, senior research scholar and president emeritus of The Hastings Center, NAS Institute of Medicine member and author will edit the blog. According to the Center, “other regular American and international contributors to the blog will include Henry Aaron, Eric Cassell, Anthony Culyer (UK), Muriel Gillick, Hans Maarse (Netherlands), Theodore Marmor, James Morone, Jonathan Oberlander, Steven Pearson, Louise Russell, Richard Saltman, Mark Schlesinger, Peter Ubel, and Joseph White.”
Here’s a look at the blog’s posts so far. Already, it has established itself as a bit more nuanced and deliberative than most blogs, with the result that it’s also quite a bit longer in form.
Speaking Truth to Evasion
Callahan argues that cost controls invite evasion, and declares that health care cost may be a more important issue than universal coverage, primarily because costs are one of the biggest obstacles to such proposals. He writes that an effective cost control plan would probably have to include some form of rationing, a practice that invites the sort of ethical dilemmas in which his Center specializes. In that vein, Callahan makes his editorial position clear: “We think it important to get a reform plan in place that will stand the test of time, one that has built cost control into it from the start, and that the public is fully informed about that necessity.”
Ending the Cost Insanity: Some First Steps
Senior Brookings fellow Henry J. Aaron dismantles the health care industry’s much-publicized pledge to cut $2 trillion in spending in the next decade, saying that the U.S. system is constructed to be “as immune as possible to health discipline” and detailing just why that is the case. He then shows why the tax burden of a universal system would be unbearable without cost reductions, and outlines a possible solution including comparative effectiveness research and spending constraints and bargaining power for government health care entities.
Debate roils over effectiveness, ‘rationing’
Filed under: Health care reform, Health policy, Hot Health Headline
The Kansas Health Institute’s Dave Ranney attempts to illuminate and explain the fears that research into the comparative effectiveness of health care will lead to a “rationing” system that forces patients toward the cheapest options. Ranney interviewed prominent Kansas sources on all sides of the debate.
U.S. Sen. Pat Roberts, R-Kan., expressed his reservations about the possible consequences of seemingly-innocuous research into comparative effectiveness.
Roberts warned that there’s little to stop the federal government from using the research to figure out which medications or treatments achieve similar results for less cost. When that happens, he said, it won’t be long before Medicare starts cutting costs by steering doctors toward the cheaper alternatives and rationed or cookie-cutter treatments heedless of individual results.
And where Medicare goes, the nation’s health insurers will soon follow.
“This is very dangerous territory,” Roberts said.
In response to Sen. Roberts, Ranney quoted a health policy expert who said such theories are “fear mongering, it’s raising the specter of socialism, it’s telling people they’re going to have some fuzzy-headed bureaucrat telling them what to do, denying them choice.”
Ranney includes the answers that Kansas governor and HHS nominee Kathleen Sebelius gave to similar questions posed by the Senate Finance Committee.
Effectiveness debate over virtual colonscopies
Officials are considering whether or not Medicare will cover virtual colonoscopies, a technology that, while cheaper and far less invasive, may also be less reliable. Los Angeles Times reporter Noam N. Levey looked at how the debate over colorectal screening illuminates the difficulties inherent in the larger discussion about the Obama administration’s push for efficient health-care spending.
According to Levey, “Colorectal cancer is highly treatable if detected early, but it remains the nation’s second deadliest cancer, in large part because half of adults over 50 do not get screened.” Levey reported that patients avoid screening primarily because they wish to avoid the sedation or discomfort that accompany the procedure.
Doctors and researchers do not yet agree on the effectiveness of virtual scanning, and it still requires unpleasant preparations like colon-cleansing and the insertion of air into the intestine. Nonetheless, it promises to offer a relatively enticing alternative to the traditional colonoscopy.
Some studies have indicated that the procedure can detect most polyps as well as traditional colonoscopy. But others have suggested it is not be as good at detecting some smaller polyps.
Disputes over the cost-effectiveness of virtual colonoscopy further complicated the analysis.
The agency’s extensive year-long review of the efficacy of virtual colonoscopy shows just how much budgetary pressure Medicare is under during a period of increased scrutiny and reform.
Medicare, which will spend more than $500 billion this year, is under increasing pressure to contain spending that many experts say threatens the whole federal budget.
Of particular concern has been the rising cost of scans. Medicare spent more than $14 billion on imaging in 2006, double what it spent six years earlier, according to a 2008 report by the Government Accountability Office.
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Health Journalism 2010, AHCJ's annual conference, features a world-class program with story ideas, sources, stronger reporting skills, chances to meet newsmakers and network with other journalists.
- Health and education: Covering these intersecting beats
- Reporting on the business of health care
- Health reporting resources for journalists on state and local government beats
- Shortened Lives: How location, lifestyle affect health
- Covering a complex story for the long haul
- Aging in the 21st Century: Presentations and tip sheets
- AHCJ calls for better information from Joint Commission Web site
