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.)
Reporters chronicle the death of a sugary drink tax
With a classic tale of powerful established interests, millions and millions of dollars and savvy lobbying, Chicago Tribune reporters Tom Hamburger and Kim Geiger draw our attention to the news vacuum that has formed where debate over a sugary drink tax used to be. From its optimistic beginnings to its eventual slow strangulation, Hamburger and Geiger track the rise and fall of the push to tax sugary drinks in order to discourage poor dietary choices and help fund health care reform.
The reporters do a wonderful job of chronicling every lobbying pressure point pushed by the industry, from faux grassroots to industry alliances to muli-million-dollar advertising campaigns. Here’s a small sample of their overview:
The White House has dismissed the idea, however, even after President Barack Obama had expressed interest last summer. A key congressional committee, though initially seeming receptive, ended up refusing to consider it. Several minority advocacy groups, including some committed to fighting obesity, lined up against the tax after years of receiving financial support from the industry.
…..
Meanwhile, beverage lobbyists attacked several nutrition scientists, accusing them of bias and distorting available evidence. The beverage industry also financed research that reached conclusions favorable to its position.
(Hat tip to Audrea Huff of the Orlando Sentinel’s Fitness Center blog)
Academics: Media added to reform confusion
Filed under: Health care reform, Health data, Hot Health Headline, Member news
Health News Florida’s Carol Gentry talked to journalism professors at three major Florida universities about the effect of media coverage on public perception of health care reform. The trio suggested that the media muddied the issue by focusing coverage on the political horse-race aspects while neglecting to invest the time necessary to fully explain the proposed legislation’s finer details.
In a column for AHCJ, Trudy Lieberman, the organization’s immediate past president has discussed some of the same shortcomings of health reform coverage. The academics say this is nothing new – many of the same issues surfaced during Clinton’s health reform push in the early ’90s, but say today’s fragmented media environment and 24-hour news cycle have certainly exacerbated matters.
[Kim Walsh-Childers, University of Florida journalism professor] said many Americans get their information from talk radio or blogs, “which are far less likely to provide balanced, complete information than are traditional news outlets, especially newspapers.”
“Even those who read newspapers may be getting far more information about the political strategies (of) the various stakeholders … than they are about what those proposals actually would mean for the average family,” Walsh-Childers continued.
Walsh-Childers praised NPR and The New York Times for their more thoughtful reform coverage, and said layoffs of experienced health reporters had likely weakened coverage at many outlets.
Gentry also cited surveys conducted by the Kaiser Family Foundation which found that peoples’ opinions of reform changed when they were better informed of the bills’ actual components.
Surveyors found that while a majority said they were opposed to the legislation, support grew markedly when survey participants found out the major parts of the plan.
Three-fourths became more favorable when they heard about tax credits for small businesses and two-thirds liked what they heard about health exchanges, constraints on health insurers and plugging the Medicare prescription-drug “doughnut hole.”
Related
More columns by Lieberman about coverage of health reform:
- Putting a human face on McCain, Obama health plans
- Look for opportunities to localize the debate on national health reform
- If candidates won’t focus on aging issues, journalists better
- Candidates’ health reform language needs closer scrutiny, definition
- Journalists must do better to inform, educate public
Health reform and the Supreme Court
Filed under: Government, Health care reform, Health data
Sarasota Health News‘ David Gulliver and Health News Florida’s Mary Jo Melone considered exactly how last Thursday’s Supreme Court ruling on campaign contributions by corporations would impact the health care lobby and the health reform debate. Their most interesting angle? That health care companies have already spent such gigantic sums of money on lobbying (more than $2.2 billion in 2008 and 2009) that the ruling won’t have the same impact on health as it will on other industries. In other words, the medical industry has already had the volume on the lobbying amp cranked to 10 for some time now, and it’s just not possible to ratchet it up any higher.
Gulliver and Melone on exactly what has changed in theory:
Until now, companies could not spend their own money directly on political advertising. They had to create political action committees, or a shadowy type of nonprofit known as a 527 organization. Then those groups could raise money from donors to pay for advertisements. For PACs, those donations are limited under federal law to $5000 per person per year.
In practice, the impact is less clear. Even under the previous system, those with money found ways to use it with impunity. It’ll be a more straightforward process now but, especially in health care, may not lead to huge changes in the money being spent. According to one school of thought, the biggest change will be in the use of explicit anti-candidate advertising threats as a metaphorical club during negotiations.
NOTE: It’s important to remember that, in a companion decision, the court upheld the transparency requirements that accompany these political donations. If you’re interested in tracking the changes in donations post-decision, head over to OpenSecrets.org, where they have a post explaining exactly how to use their tools to do so.
As for immediate impact, the reporters quote several experts who seem to think that unrestrained spending won’t transform the health care reform debate, partly because it’s already been so thoroughly transformed by other factors.
(Brad Ashwell of Florida Public Interest Research Group) said the legislative health-reform package pending in Congress is already “pretty moderate,” and it’s not likely to get more consumer-friendly now that business interests “can go straight to their treasuries.”
Even before the Supreme Court ruling, chances of helping Florida’s 3.8 million uninsured were looking increasingly sketchy, with a special-election loss that cost Democrats a crucial seat in the U.S. Senate this week. The only quick route to passage was for the House to accept the version of the legislative package that barely passed in the Senate on Christmas Eve, and House Speaker Nancy Pelosi announced Thursday she doesn’t have the votes to pull it off.
How health reform lost popular support
Filed under: Government, Health care reform, Health policy
Kaiser Health News staff writers, including Jordan Rau, Mary Agnes Carey, Julie Appleby and Phil Galewitz, teamed up to figure out why Americans are so disenchanted with health care reform. After talking to an analyst who admitted that politicians “can do everything right and still fail in health reform,” the reporters set out to figure out what, if anything, went wrong.
The reporters divided the administration’s missteps (and, to a lesser degree, those of lawmakers) into four categories: helping individuals understand how reform tangibly benefited them, threatening Medicare, proposing a number of confusing tax increases, and the lengthy and frustrated deal-making process that preceded the reform bills now under consideration.
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