‘Main Street’ informed, skeptical on health reform
In her blog on CJR.org, AHCJ Immediate Past President Trudy Lieberman updates what is becoming an annual franchise: Her summer man-on-the-street column gauging popular opinion on health reform. Just like last year, Lieberman found her subjects on the streets of Columbia, Mo., a town that’s about as close to the (population) center of the United States as you can get.
The common thread? Missourians were pretty sure health care reform wasn’t all it was cracked up to be, but still weren’t willing to vote “yes” in the state’s referendum on opting out of the individual mandate.
Lieberman added a concrete dimension to her main street opinions by prying details on income and expenses from her sources, numbers and ideas which she then used to link their stories to the larger themes surrounding reform implementation.
Keep an eye out for part two of the column, which should be coming soon.
Lundberg’s list of why health care costs are rising
While people on the streets, experts and legislators debate the causes of rising health care costs, George Lundberg, M.D., editor-at-large of MedPage Today, does no such hand wringing.
He declares that a survey of the topic that was posted by his publication missed the point and did not provide the correct answers.
Lundberg, who edited the Journal of the American Medical Association for 17 years and is a member of the Institute of Medicine, lists what he sees as the “Primary Drivers of Rising Healthcare Costs.”
AP takes on medical costs of overtreatment
Filed under: Health policy, Hospitals, Hot Health Headline
The AP’s Lauran Neergaard has taken on medical overtreatment in America in the first two parts of a six-part series, both of which eschew the cost angle in favor of a more purely clinical discussion.
In the first installment, she focuses on the medical consequences of overtreatment, which include radiation exposure and complications. She looks at every stage of life, from cesarean births to unnecessary and painful cardiac tests performed on dying patients. In the second piece, she takes on one of the most notorious sectors of overtreatment: back surgery. Back pain is notoriously complicated, and surgeries are on the rise despite little evidence that they’re necessary or effective.
“The way medicine is so Star-Treky these days, they believe something can be done,” said Dr. Charles Rosen, a spine surgeon at the University of California, Irvine.
The reality is that time often is the best antidote. Most people will experience back pain at some point, but up to 90 percent will heal on their own within weeks. In fact, for run-of-the-mill cases, doctors aren’t even supposed to do an X-ray or MRI unless the pain lingers for a month to six weeks.
Related
- Understanding variations in spending (Elliot Fisher presentation)
- MedPACReport: Measuring Regional Variation in Medicare Service Use (Mark Miller presentation)
- Opportunities and Pitfalls of Spotlighting Regional Cost Differences (Patrick Romano presentation)
- Author Q&A: Shannon Brownlee on overtreatment of patients
Blame aggressive treatment, tech for rising costs
Wholesome, clean-living and thrifty, Provo, Utah, has always been a Dartmouth Atlas darling. But in recent years, health costs in Provo – like those in similarly cheap markets nationwide – have risen faster than in the rest of the country. Kaiser Health News’ Jordan Rau takes a deeper look at the Utah college town in an effort to figure out why, despite recent efforts to bring everybody else down to Provo’s cost level, Provo seems to instead be climbing up to join its costlier cousins.
Provo, Utah (Photo by jpstanley via Flickr)
In Provo, the costs seem to come down to a few interlocking factors which should already be familiar to anyone who has investigated health care costs in the past. They include advancing technology and more aggressive treatment, all driven by an increase in the number of hospitals and clinics competing in the area. It’s a combination that’s looking increasing irresistible.
To some, it’s inevitable low cost areas such as Provo will catch up to their more expensive peers as a greater proportion of medical spending goes toward expensive machines and nursing salaries, which are rising, says Greg Poulson, senior vice president at Intermountain. Aggressive marketing of the latest technology also is making it more likely that patients everywhere are demanding the same novel treatments, even ones that aren’t proven to work better, Poulson says.
Insider offers view of health innovation
Filed under: Health care reform, Health policy, Hospitals
Blogging for the Harvard Business Review, Simon Stevens (chairman of the UnitedHealth Center for Health Reform & Modernization) seeks to explain why the field of health care is so agonizingly slow to adopt innovation, whether it be 15 years and counting for e-mail communication or several generations for scurvy-preventing limes. Without spoiling Stevens well-chosen analogies and explanations, I can say he makes a case that it comes down to three factors:
- The labor intensive nature of health care
- Failure to spread organizational innovation
- Barriers to new entrants in care delivery
To Stevens’ way of thinking, there is one group positioned to overcome those barriers and push the system forward: Health plans. UnitedHealth and its competitors have the data, platforms and connections to become major change agents in the field of health care delivery, as well as the incentive to put it all to work improving outcomes and decreasing costs.
WSJ: Small hospitals get little benefit from device
In The Wall Street Journal, John Carreyrou uses the problems of a small New Hampshire hospital to illustrate how difficult it is for small hospitals to attain the cost and safety savings promised by the DaVinci surgical device’s manufacturers, a fact which has not deterred 131 of them from shelling out at least $1 million (plus maintenance and replacement fees) to own one.
“There’s a medical arms race,” says Paul Levy, chief executive of Beth Israel Deaconess Medical Center in Boston. “Technologies are being adopted and becoming widespread based on the marketing prowess of equipment makers and suppliers, not necessarily on the public good.”
Smaller hospitals, which Carreyrou defines as those with fewer than 200 beds, simply don’t have the volume to gain the DaVinci cost efficiencies promised by manufacturer Intuitive Surgical.
One study published in the Journal of Urology found that a hospital needs to do at least 520 surgeries a year with the robot to bring its costs in line with traditional surgery. That’s seven times the number of robotic surgeries Wentworth-Douglass has been averaging.
And while it’s unfortunate that they don’t even use the device enough to save money, it’s far worse that they also don’t use it often enough to master its steep learning curve. Surgeons at the New Hampshire hospital got two days of training and began operating unassisted after four cases.
Jim Hu, a surgeon at Brigham and Women’s Hospital in Boston who has done more than 1,000 surgeries with the robot, says it takes a urologist anywhere from 250 to 700 cases to master it. Dr. Hu considers the da Vinci a clear benefit for experienced surgeons, saying, “You can do a better job.” But he cautions it can do more harm than good when used without adequate training.
In New Hampshire, the hospital’s four urologists were pressured to use the device, but resisted because they felt more training was needed, Carreyrou writes. Three of them eventually left the hospital.
#AHCJ2010 early coverage roundup
Filed under: Government, Health care reform, Health journalism, Health policy, Hot Health Headline, Member news
Apart from the announcement of the FDA’s infusion pump regulation push, the biggest appearances out of Health Journalism 2010 in Chicago this week have been U.S. Department of of Health and Human Services Secretary Kathleen Sebelius and Thomas Frieden, director of the Centers for Disease Control and Prevention.
Landon Hall, of The Orange County Register, covered the Sebelius and Frieden appearances for AHCJ.
At Health Journalism 2010, Kathleen Sebelius talked about implementing health care reform. (Photo: Pia Christensen)Reuters’ Debra Sherman also covered both presentations.
Sebelius focused on insurers, especially those who deny coverage to those with a legal write to it, Sherman wrote. According to Sherman, “Sebelius… said to expect ‘hand-to-hand combat’ if insurers try to ‘drive patients out of plans.’”
Working from a broader perspective, New America Foundation’s Joanne Kenen wrote about how insurance fit into Sebelius’ larger task of implementing recently passed health care reform measures.
In his presentation, Frieden focused on smoking, which he called the leading preventable cause of death. Reuter’s Sherman again:
Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, said that after years of steady declines in the nation’s smoking rates, progress has stalled over the last few years and that the agency was renewing its focus.
He said government stimulus funds would be used to increase anti-smoking efforts. He said the CDC would encourage states to implement anti-smoking strategies, such as education and media campaigns, smoke-free laws and higher cigarette prices.
In other AHCJ 2010 news, Dallas Morning News reporter Robert Garrett wrote that a “siege mentality was very much on display when a trio of hospital executives spoke this morning at an Association of Health Care Journalists conflab in Chicago.”
“We’re all scared to death by health care reform,” said Advocate Health Care president and CEO Jim Skogsbergh, who runs 13 hospitals in Illinois. “We know we’re going to get paid less.”
Oregonian re-injects meaning into reform clichés
Filed under: Health care reform, Hot Health Headline
The Oregonian’s Joe Rojas-Burke clearly has a keen eye for that special place at which jargon and cliché intersect, and his nifty health care glossary cuts right through it all to explain those terms like “bending the curve” and “diagnostic yield” that we’ve all heard so many times that they’ve lost whatever meaning, if any, that they originally had. Each definition reads like a mini-column, complete with links and context, that explains why these words and phrases are actually important.
Photo by Beverly & Pack via Flickr.Rojas-Burke tackles plenty of sophisticated concepts (scroll down to surrogate endpoint), but my favorite entry is one that goes back to basics and elegantly explains a fundamental dilemma behind rising health care costs.
Healthy — Medical technology is blurring the distinction between healthy and sick, as illustrated by a study in which 1,192 healthy women and men had their entire body scanned by X-ray computed tomography, or CT. Abnormalities showed up in 1,030 of them, nearly 90 percent, and doctors advised 37 percent of the patients to get further tests. An essayist writing in the Journal of the American Medical Association hit the nail on the head: “A colleague of mine recently asked a resident how he would define a well person. With no hesitation, the resident replied that a well person was merely someone who had not been thoroughly worked up.”
Lieberman: Pollack wrong, reform coverage lacking
Filed under: Health care reform, Health journalism
Last week, Harold Pollack (bio), a University of Chicago professor who has been contributing to The New Republic’s The Treatment blog, recently referred to health care reform reporting as “the most careful, most thorough, and most effective reporting of any major story, ever.”
AHCJ Immediate Past President Trudy Lieberman took issue with that in a post on CJR.org.
Better coverage than the Vietnam War; the civil rights movement; the consumer movement? Really? In the case of the civil rights struggle, the press helped change the discourse; Americans began to view race in a new way, which led to the eventual passage of the Civil Rights Act. During the Vietnam War, the media effectively changed the public dialogue from a war we couldn’t lose to one we could not win. In the early days of the consumer movement, media coverage of Ralph Nader led Congress to enact significant consumer protections. Coverage of health reform has hardly risen to that level.
Lieberman writes that health care reform coverage failed because the public was inadequately educated on the finer points of reform efforts. Her evidence? That public opinion was roughly split on reform. Had reporting been better, Lieberman writes, public support levels would have been higher. She then brings up a number of issues she says were undercovered and uses examples to back them up.
For advice from Lieberman and three other journalists on the front lines on what needs to be covered next and how to approach this complex topic, see this special tip sheet.
Are insurers to blame for rising costs?
The San Francisco Chronicle’s Carolyn Lochhead and Victoria Colliver use the recent furor over insurer Anthem’s rate hikes to explore just how much of the blame for rising health care costs should be shouldered by insurers. The reporters find that, in the end, insurers are just another one of the cartels (others include device makers and providers) and operate inside the opaque world of medical pricing and snag hefty cuts for themselves. Lochead and Colliver put it thus:
While the Anthem case has raised a political storm, the underlying surge in costs gets far less scrutiny. But each sector of the health industry points fingers at the other for driving up prices, and all are raking in money.
Insurers blame hospitals and doctors, doctors blame insurers, and hospitals blame doctors and medical devicemakers in what academics call an inscrutable medical-industrial complex that rivals anything the defense industry ever invented. All these groups are combining into what many experts describe as cartels.
The reporters write that, despite their best efforts, they weren’t able to get many folks on the record. When they did find someone who was willing to talk, it was often a source we’ve seen before in other cost stories. It’s a tough theme to get quotes on, as nobody wants to burn bridges with their professional suppliers and everybody’s got some sort of skin in the game. They did, however, manage to find a local source who offered an original and illuminating anecdote:
Christina Bernstein, a medical-device engineer and independent sales representative based in San Francisco, sells disposable surgical tools made mostly out of plastic that she estimates are manufactured for about $40 each. These are marked up and sold to hospitals for as much as $350, she said, for a single use in a surgery on a patient.
“But if you were to get a detailed bill of what the hospital was charging the insurance company for the insured patient, those things get marked up to something like $1,200,” Bernstein said. “It’s ridiculous. There’s no open competition.”
(Hat tip to AHCJ Immediate Past President Trudy Lieberman, who wrote a column on CJR.org praising the Chronicle’s story.)
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Spend a week at the CDC studying public health, meeting sources. Apply for the AHCJ-CDC Health Journalism Fellowships today!
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