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BMJ Group — “Stop the silent misdiagnosis: patients’ preferences matter”
The BMJ Group is owned by the British medical Association, and it provides research, medical information, and resources to improve outcomes for patients and the provision of healthcare worldwide.
In recent decades, rapid advances in the biosciences have delivered an explosion of treatment options. This is good news for patients, but it makes medical decision making more complicated. Most critically, an accurate medical diagnosis is no longer sufficient to identify the proper treatment. Just as important is an accurate preference diagnosis.1 Every option for treatment (a term that we use broadly here, to include procedures, tests, and even watchful waiting) has a unique profile of risks, benefits, and side effects. Doctors, generalists as well as specialists, cannot recommend the right treatment without understanding how the patient values the trade-offs. Regrettably, patients’ preferences are often misdiagnosed.
The article’s authors provide a method for making better preference diagnoses:
- Adopt a mindset of scientific detachment
- Formulate a data based provisional diagnosis
- Engage the patient in conversation and deliberation
- Team talk
- Option talk
- Decision talk
The result should be better care, not necessarily more care, but more cost effective care and better patient satisfaction.
This study was also commented on by The Dartmouth Center for Health Care Delivery Science in a press release, in which it stated that “Standard & Poor’s has warned a number of countries, including the US and UK, could see their credit ratings downgraded within the next decade if they fail to cut health care costs.”
Continuing Confusion over Health Care Reform
Reuters ran an article on November 2, 2012, “In the Badger State, divided over and baffled by Obamacare.” In Beloit, Wisconsin, the focus of the article, the article’s author writes “Whether the sweeping 2010 law is fully implemented, as President Barack Obama intends, or repealed, as GOP nominee Mitt Romney pledges, no policy difference in next week’s election is likely to affect more Americans in their daily lives.” Unfortunately, as she goes on to say, there remains great ignorance and confusion about what Obamacare does and the benefits and savings it has already brought to people, even though many of Obamacare’s most significant programs do not go into effect until 2014.
I have struggled for a long time to try to figure out what it is about Obamacare that has resulted in such irrationally negative reactions to it.
Finally, I think I understand.
Two things – First, I believe that many have been convinced in the obfuscation and deliberate misinformation of the political campaigns that the current problems many face in their healthcare coverage and benefits has been caused by Obamacare, rather than understanding that Obamacare is part of the solution to making sure that all Americans will have access to meaningful healthcare insurance. Second, many employers have threatened to terminate their employee coverage because of the so-called additional burdens placed on them by Obamacare. Yet, that type of decision is also based on ignorance and misinformation.
An informed and spirited debate on how best to take care of sick Americans, to promote healthier Americans, and to improve healthcare for everyone is what is needed. If we cannot get our political leaders to discuss these issues in a meaningful way during an election, it seems doubtful that such a discussion will ever occur.
WSJ CIO Journal: One Stanford Doctor Wants to Focus on Real Patients, Not iPatients
Electronic medical records don’t always reflect what really happens during an examination. Physicians are so busy checking off boxes and keying in vital signs that sometimes they spend more time with the virtual patient than the real one.
“Many of us recognized that there was a gap between what the medical record claimed was done on the patient, in a sense, and the actual execution of the task,” Dr. Abraham Verghese, a professor at Stanford University’s School of Medicine and best-selling novelist, said in a Thursday Wall Street Journal article. “It reflects an increasing dependence on technology and paying lip-service to the actual examination of the patient,” he said.
Creators of electronic medical records never envisioned that the technology might actually decrease the quality of patient care. Instead, they saw a world where medical errors would drop because charts could be easily accessed and read. They also hoped that electronic records would result in fewer duplicated tests and lower costs. Yet, the difficulty of using many of these systems means that, in some cases, it’s encroaching upon the quality of patient care. It’s a lesson for CIOs — the very technology they implement to solve a problem can actually make that problem worse if they don’t think carefully about the people using it.
See on blogs.wsj.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
GWU Face the Facts: Medicaid covers nearly half the 1.2 million Americans getting regular treatment for HIV – 47%
Nearly 1.2 million Americans get regular treatment for HIV, and Medicaid covers almost half of them – 47 percent. Only 1 percent of Medicaid clients have HIV; their care consumes 2 percent of the Medicaid budget ($5.3 billion). They represent 23 percent of all HIV-infected people in the U.S; not all those infected are receiving treatment.
African-Americans are at particular risk for HIV. Half of Medicaid HIV patients are African-American, and the CDC estimates new HIV infections run six times as high among African-Americans as for white men.
See on facethefactsusa.org
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
Alzheimer’s News 10/23/2012: Settlement ensures people with Alzheimer’s access to rehabilitative services
As one of the plaintiffs in the federal class action lawsuit Jimmo v. Sebelius, which challenged the Medicare Improvement Standard, the Alzheimer’s Association applauds the recently announced proposed settlement.
The long-practiced Medicare Improvement Standard provided that Medicare beneficiaries must achieve demonstrable improvements in order to receive rehabilitative services, such as physical, speech and occupational therapy. Without these demonstrable improvements, Medicare would not pay for these services. Now, under the settlement agreement, Medicare will pay for these services if they maintain the patient’s current condition or prevent or slow further deterioration.
The Association believes that eliminating the Improvement Standard is very important for the health and well-being of the growing number of Americans with Alzheimer’s disease. As an organization that has advocated for these changes on behalf of the millions of Americans living with Alzheimer’s and the millions more who will face the disease in the future, the Association determined it was important to join this lawsuit to secure these changes.
See on www.alz.org
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
New Yorker 6-28-12: Atul Gawande: Why the Uninsured Are Still Vulnerable — The debate rages on
Below is an excerpt from Atul Gawande’s op-ed piece that was published in The New Yorker after the Supreme Court upheld the Affordable Care Act last June. The debate rages on during the presidential campaign.
* * * * *
During the nineteenth century, for instance, most American leaders believed in a right to vote—but not in extending it to women and black people. Likewise, most American leaders, regardless of their politics, believe that people’s health-care needs should be met; they’ve sought to insure that soldiers, the elderly, the disabled, and children, not to mention themselves, have access to good care. But many draw their circle of concern narrowly; they continue to resist the idea that people without adequate insurance are anything like these deserving others.
And so the fate of the uninsured remains embattled—vulnerable, in particular, to the maneuvering for political control. The partisan desire to deny the President success remains powerful. Many levers of obstruction remain; many hands will be reaching for them.
For all that, the Court’s ruling keeps alive the prospect that our society will expand its circle of moral concern to include the millions who now lack insurance. Beneath the intricacies of the Affordable Care Act lies a simple truth. We are all born frail and mortal—and, in the course of our lives, we all need health care. Americans are on our way to recognizing this. If we actually do—now, that would be wicked.
See on www.newyorker.com
Poking Fun at My Patients to create an environment that feels at least a little normal
“I joke around with my patients to create an environment that feels at least a little normal in the craziness of their disease, so they can focus on living, not dying.”
Certain aspects of medical school, like learning the basics of normal and abnormal organ function, or rotating onto specialty services as mini-apprenticeships to recognize disease and treat it, haven’t changed much in 100 years of medical education.
What has changed is the emphasis on communicating with patients, which includes understanding how social and cultural factors and life circumstances can influence everything from disease occurrence to medication compliance. This is a good thing.
Leukemia doesn’t read a person’s tax returns, and my patients run the gamut. In the same morning recently, I saw a Russian oligarch who comes for visits in his private jet and a 20-year-old whose leukemia diagnosis kept him from serving jail time, and who catches the Regional Transit Authority bus for his appointments. I need to have insight into their lives outside my stark exam room to appreciate how their environments will affect the care plans we develop.
We also learn how patients react to illness, and how a diagnosis like cancer can dramatically alter a family’s landscape, or how a person defines herself.
See on well.blogs.nytimes.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
Modern Physician: Practice Makes Perfect: Preparing for shared-risk reimbursement models
In June, the MGMA-ACMPE released the results of a questionnaire that ranked members’ most-pressing practice management challenges. In this edition of “Practice Makes Perfect,” we’ll tackle No. 2 on that list: Preparing for reimbursement models that place a greater share of financial risk on the practice.
One of the many hot topics at our upcoming annual conference in San Antonio will be the changing healthcare environment and how practices can—and should—prepare for new payment methodologies. The federal government and commercial insurance companies are in the midst of changing the way they pay hospitals and doctors. Some of these changes are the result of the Patient Protection and Affordable Care Act as well as market forces. These changes will affect practices in all settings, and it’s important to prepare for reimbursement models that place a greater share of financial risk on the practice.
Physicians may soon be at financial risk as payers test and adopt new payment methods. The CMS and private insurers are proposing models to replace separate payments to hospitals, doctors and other providers with a single bundled payment, and we are seeing multiple definitions of bundling. A common type of bundled payment involves a single payment for all services furnished before, during and after a hospitalization, including outpatient diagnostic tests, inpatient facility costs, drugs, supplies and the professional services of every physician involved in the patient’s care.
In addition, the CMS and many insurers are testing variations on the capitation payment concept that was widely used in the health maintenance organization craze of the 1990s. Commonly referred to as “global payment,” this reimbursement method pays a set amount per patient (usually adjusted by demographics) and the provider accepts responsibility for a predetermined set of services regardless of the costs.
Both bundled and global payment reflects a sea change from the traditional fee-for-service payment system. Payers hope that bundled and global payments will create incentives for primary-care physicians, specialists and hospitals to better coordinate services and share accountability for the cost and quality of services. They hope the new payment systems will improve the care their beneficiaries receive while lowering the total cost of care by eliminating redundant services.
These new payment methods require doctors to think in new ways and will challenge the information systems of even the most sophisticated fee-for-service practice. Bundled and global payments change a practice’s profit calculation from emphasizing service volume to operating efficiency.
In this new payment environment, practices that gather the right information and provide high-quality, lower-cost care will be the most profitable.
See on home.modernphysician.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
Medical Homes Survey: Primary care with a personal touch – Modern Healthcare
Medical Homes Survey reveals diverse settings, but single goal: Increase quality of care.
When primary-care physicians needed to go somewhere new to revitalize their field, they found that there was no place quite like the patient-centered medical home: A practice model that emphasizes care coordination, increased access and enhanced doctor-patient communication—all with an emphasis on continuous quality improvement.
Modern Healthcare’s second annual Medical Homes Survey, conducted June 25-Sept. 28, drew responses from 29 organizations. The survey sample illustrates the wide variety of settings among the 4,870 sites that have been recognized as medical homes. One survey response came from an organization with a staff of 350 doctors, and another came from a solo practice. The largest group in the survey has an enrolled patient population of 939,000 while the smallest has 823. One thing they have in common is a desire to increase the quality of care by advancing an old-fashioned concept that is often enhanced by the newest technology.
See on home.modernhealthcare.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
The New Values Voters: People Of Faith For Health Care Reform
Faith communities have also spoken out for reforming our health care system, urging that it reflect the values of human dignity, shared responsibility, compassion, stewardship of resources, and concern for those who are vulnerable. Advocates for reform include the U.S. Conference of Catholic Bishops, the United Methodist Church, the Evangelical Lutheran Church in America, the Episcopal Church, the Union for Reform Judaism, the Central Conference of American Rabbis, and others.
Such support is also reflected in the values of people in the pews. A 2009 survey by the Pew Forum on Religion and Public Life showed 6 in 10 Americans—including 48 percent of white evangelicals, 55 percent of Catholics, 56 percent of white mainline Protestants, and 72 percent of the religiously unaffiliated—favoring a government guarantee of health insurance for all citizens, even if it would mean raising taxes.
See on thinkprogress.org
Joseph Rugg's Health Law Blog 