A killer edition of Health Wonk Review

Boston is full of killer doctors. So, this is the Dr. Death edition of Health Wonk Review – the roving digest of health policy blog posts. 

  Start with Donald Berwick – Obama’s nominee to head the Medicare and Medicaid program. Republicans cast the Cambridge doc as a supporter of medical rationing.  Is evidence-based medicine the same thing as rationing? Do they ration care in the U.K.? Is Berwick the personification of the death panel? 

If so, he wouldn’t be Boston’s first killer doctor. In recent years, the local news brought us details of the alleged “Craig’s List killer” – a BU med student – as well as the “secret life” doctor. He was convicted of beating his wife  and slashing her throat after a walk in the suburban woods. Prosecutors said he was motivated by his appetite for prostitutes and phone sex. The “cross-dressing” dermatologist was convicted of fatally shooting his wife. While in jail, he was charged with but aquitted of hiring a hit man to kill a former country prosecutor. 

 (Note that doctors can also play a role in preventing violence against women.)  

But, in Boston’s most notorious medical murder, the victim was doctor. In 1849, Boston Brahman Dr. George Parkman tried to collect a debt from a chemist co-worker and ended up dead. The killer chemist dismembered the body and hid it behind a wall at what was then Harvard Medical School. 

Not to make light of murder –but, could any of this been driven by sleep deprivation? What if the members of the rationing panel are tired ? Maggie Mahar of  The Health Beat blog looked at a survey released this week which found most people think residents work reasonable hours. She writes: 

Most patients have no idea that the residents caring for them may be coming to the end of a 30-hour shift.  Sleep deprivation impairs a resident’s judgment and this can lead to errors that harm and even kill patients. Residents themselves have been killed after falling asleep at the wheel while attempting drive home following a 30 -hour shift.  In 2006, the Institute of Medicine recommended capping shifts at 16 hours. The Accreditation Council on Graduate Medical Education (ACGME), the group that oversees resident’ training. The ACGME has been reviewing IOM’s recommendations and is expected to release its ruling later this month. For hospitals, residents represent cheap labor. For patients, an exhausted resident represents a threat to patient safety. 

Brad Wright at Wright on Health comments as well, in a post entitled Debating the Physician Work Week. 

Dartmouth Atlas 

Gooz News – and many others — commented on The New York Times story on the limitations of the Dartmouth Atlas  in both a review and a weekly roundup. 

Regional variation in Medicare spending is one indicator of gross overutilization. Something is happening when a hospital in McAllen, Texas does twice as many knee implants per Medicare beneficiary as a hospital in Baton Rouge, Louisiana. (An earlier version of this post compared McAllen to Rochester, MN, which actually has a slightly higher rate of knee implants per 1,000 Medicare enrollees.) 

But that by itself tells us nothing about why that overutilization occurs. 

(McAllen Texas, was the subject of Atul Gawande’s much touted New Yorker piece on cost and practice pattern variations.) 

Avik Roy at The Apothecary says “…(T)he debate about the ins and outs of the Dartmouth Atlas is not merely a statistical one. It is about something more fundamental: Can government do a better job of managing medicine than doctors and hospitals can, or should the doctor-patient relationship remain sovereign? There is plenty of waste in medical care today, but the Dartmouth Atlas demonstrates that government is the problem, not the solution.” 

To catch up on the blog spew on the Dartmouth data see Kaiser Health News. 

Oil Spill 

Jon Coppelman of Workers Comp Insider looks at the BP oil spill and sees another potential disaster looming for the health of recovery workers.  

North Grove St. site of Parkman murder

Aging 

Eric Widera presents Rethinking Prisoner Release Policies from a Geriatrics Perspective posted at GeriPal – A Geriatrics and Palliative Care Blog, calling it “a short little piece on why geriatric prisoner release policies need to be reexamined and reworked.” 

Canada  

Henry Stern, LUTCF, CBC presents No More Free Lunch posted at InsureBlog, saying, “Summary: Just as ObamaCare heats up here, our Friends to the North are looking to bail on their own nationalized health care system.” 

HIT  

Shahid N. Shah presents How to commercialize your healthcare IT and media products posted at The Healthcare IT Guy, saying, “Shahid gives advice from his recent talk at The National Institutes of Health Commercialization Program (NIH-CAP) to this year’s class of SBIR/STTR grantees about how to commercialize their Healthcare IT, Media, and Training products.” 

VA Care     

Jason Shafrin presents Non-VA VA Care posted at Healthcare Economist, saying, “The VA is held up as a model of integrated, government-run medical care. Even the VA, however, sometimes has to purchase medical services from outside vendors. The Healthcare Economist explores why this is the case.” 

Today, No. Grove St. leads to Mass General. Note street sign.

Jason Shafrin The New America Foundation’s New Health Dialogue blog offers three posts on the revised and updated edition of Phil Longman’s “Best Care Anywhere” book on the VA. This one looks at “Longman’s ideas on how the rest of the health care system may be able to adapt some of the VA’s innovations and create a version of accountable care.” 

 “Patient engagement”  

Chris Langston presents Sailing the Ship of Health Care posted at The John A. Hartford Foundation blog, Health AGEnda, on “patient engagement in health care, focusing on a team-based approach to care management and the respective roles of each ‘team member.’” 

Insurance and Payment Reform  

David Williams writes about Mental health parity: a three-stage path to equality posted at Health Business Blog. “Implementation of mental health parity may lead to the increased use of evidence based medicine for utilization management. But it’s a 3-step process” 

The Colorado Health Insurance Insider says: Continuous Coverage Does Not Eliminate Underwriting  

 If the co-director for health policy at the Center on Budget and Policy Prioritieisn’t clear about how medical underwriting and the individual health insurance market work, it’s no wonder that people in general find the subject a bit confusing. 

National Center for Policy Analysis president  John Goodman  blogs “Do We need an Individual Mandate?”  Goodman explains why he thinks mandating health insurance coverage creates more problems than it solves. 

Dr. Parkman's remains

California Health Line wonders why small businesses aren’t embracing reform.

Austin Frakt  writes about  The Decline Of Employer-Sponsored Coverage Under Health Reform: Good, Bad Or Ugly? at The Incidental Economist, saying, “One of the latest criticisms of the new health overhaul law is that it will encourage employers to stop offering health insurance. In fact, it will. And that’s not a bad thing.” 

Anthony Wright, Health Access California presents Real choices… posted at Health Access WeBlog: California is moving forward on state legislation to implement reform, not just to set up exchanges, but on standardizing benefits in the whole individual market to allow for real apples-to-apples comparison and choice.” 

The Disease Management Care blog looks at “some recent developments involving that darling of health reformists everywhere, the “Patient Centered Medical Home”  and concludes” The issue remains unsettled. “ 

 In contrast to the Obama Administration’s confidence that the PCMH is a bedrock of “bending the curve” there is a report from the American Academy of Family Physicians that shows how difficult it can be to install it and how little impact it has on clinical outcomes and patient satisfaction.  On the other hand, Blue Cross Blue Shield of Michigan is making it look easy and they have a press release saying they saved beaucoup money.  Which is it?  Stay tuned…….. 

 

Current site of HMS

Bradley Flansbaum comments on physician salary and workforce issues in a post entitled  The Spend We Don’t Have, Part II at The Hospitalist Leader. 

Drug Channels explains the dispute between Walgreens and CVS/Caremark  in “The WAG-CVS Brouhaha: What’s Really Going On” 

From Health Care Renewal : RUC Off – the New England Journal Once Again Fails to Mention the Unmentionable:“A major article in the most prestigious US medical journal noted how Medicare’s payments to physicians have tilted in favor of procedures and against cognitive medicine, including primary care.  Yet the article failed to mention the key role of the RUC (RBRVS Update Committee), the obscure, opaque AMA committee that de facto controls the payment system, without public input from any other group or individuals.”

 Etc. 

Boston Health News promises to move away from the macabre next time. (The last edition featured East Cambridge’s famous Halloween decorations.) 

Violence is a serious issue. And surprisingly, the health care system doesn’t always deal very well with death and dying. 

But we’ve spared you the obvious sports theme of choking Bruins, trailing Celtics and sort-of surging Sox. 

Finally, for local science news, check out the revived Nature Network Boston. We’re still updating the home page. Your BHN  host, Tinker Ready,  is now in charge of bringing the briefly dormant blog there back to life. Today’s edition: The stem cell rap.

You’ll find similar sites for local scientists in London and NY. 

  Wonk on.