#NEJM #Relman obit: “A master in the use of the bully pulpit” #HCR

A not entirely objective perspective on the  career of the journal’s storied editor. Here’s the last paragraph:

In the increasingly complex world of health care, Bud Relman was a prophetic figure, larger than life. He acted nejmas our conscience. In his writing and speaking, he always reminded us that the medical profession is far more than a business and that as physicians, we have the responsibility to do what is right for patients and for the community as a whole. As distinguished as he was as a researcher, clinician, editor, teacher, and administrator, Bud Relman will be most remembered for the way he fought for a fundamental reshaping of our nation’s health care system. His passionate commitment to that cause will forever secure his position in the pantheon of leaders in medicine.

 

 

Video: How to use national database to evaluate your doctor’s Medicare billing, treament patterns #hcr #doctors #costs

More from ProPublica:

Medicare recently released, for the first time, details on 2012 payments to individual doctors and other health professionals serving the 46 million seniors and disabled in its Part B program. Part B covers services as varied as office visits, ambulance mileage, lab tests, and the doctor’s fee for open-heart surgery. Use this tool to find and compare providers. | Related story »

Investigative health reporting lives: Milking Medicare

The latest in health data reporting  from ProPublica:

downloadMedicare paid for more than 200 million office visits for established patients in 2012. Overall, health professionals classified only 4 percent as complex enough to command the most expensive rates. But 1,800 providers billed at the top level at least 90 percent of the time, a ProPublica analysis found. Experts question whether the charges are legitimate.

For more: Top Billing: Meet the Docs who Charge Medicare Top Dollar for Office Visits

For a more precise look at your own doc note:

Looking at raw numbers, though, can unfairly flag some doctors who have multiple providers billing under their IDs or who justifiably use expensive services. It can be more revealing to look at which procedures doctors are performing and how frequently, and how their billings compare with those of their peers. (ProPublica has created a tool called Treatment Tracker that allows users to do just that.)

More health reporting from the ProPublica archives:

More than 1 million patients suffer harm each year while being treated in the U.S. health care system. Even more receive substandard care or costly overtreatment. Our ongoing investigation of patient safety features in-depth reporting, discussion and tools for patients.

Never-before-released government prescription records shows that some doctors and other health professionals across the country prescribe large quantities of drugs known to be potentially harmful, disorienting or addictive for their patients. And officials have done little to detect or deter these hazardous prescribing patterns.

ProPublica is tracking the financial ties between doctors and medical companies.

Hospital closures: “Survival of the fattest”

No. Grove St. Today. Note street sign.

MGH

Some say the health care system could stand to shrink a bit. Here, Alan Sager of BU uses the sudden closure of North Adams Regional Hospital to argue that the wrong hospitals are closing.  Hidden on the Globe letters page:

Over half of the Massachusetts hospitals open when John F. Kennedy was elected president have now closed. Not one that closed was a major teaching hospital. Heavy reliance on teaching hospitals helps explain our state’s extraordinarily high hospital costs. The pattern of closings may be partly responsible for that reliance.

Some might suppose that a functioning free market protects needed and well-run hospitals while closing unneeded and inefficient ones. Sadly, that pattern seldom prevails. Low-cost, efficient hospitals are not likelier to survive. But hospitals in wealthier places, with more patients insured by higher-paying insurers, rarely close. Some call this survival of the fattest.

More good work from the Globe health desk here:

 Are cardiologists refusing to follow new cholesterol recommendations?

Good morning Denver: Health writers meeting this weekend #AHCJ14

ahcj-logo-topNot much of a Boston presence at the Association of Health Care Journalists meeting this weekend, but we take note anyway.

Even if you are not a writer, the meeting offers much clear-eyed insight into the health care system. And these days, tools we use to probe quality and costs are available to anyone who knows how to sort a spread sheet. Still, journalists and consumers alike need to know how to surf the ongoing tsunami of health care data.

So, follow #ahcj14 on Twitter for tips and the occasional link.

Globe, Times on some of the the 3 million newly insured

globe-ssWith the uproar about computer glitches with the new health insurance exchanges, you would never know that millions of people were about the get coverage at a reasonable cost.

Today, The Boston Globe’s  Chelsea Conaboy offers stories on five of them. The story is  behind the pay wall. You can look at the pictures, go out and buy the Sunday paper or get a digital subscription. 

Much has gone wrong since state and federal health insurance websites created under the Affordable Care Act launched on Oct. 1. Technological glitches have frustrated customers, flustered politicians, and fueled debate about President Obama’s landmark legislation.

Lost amid all the fury, however, have been the success stories.

Many who struggled without insurance are getting it. Others with poor coverage have found better plans. Some whose policies cost a lot, yet covered little, have obtained more comprehensive coverage that — with government subsidies — often costs less.

About 3 million people have signed up for a private health plan through the online insurance exchanges, a senior US health official said Friday. More people are newly enrolled in Medicaid in states expanding that program, which provides coverage to people with low incomes.

Or, check out this story from last week’s New York Times about how the law is having an immediate impact on people who suddenly qualify for Medicaid.

WELCH, W.Va. — Sharon Mills, a disabled nurse, long depended on other people’s kindness to manage her diabetes. She scrounged free samples from doctors’ offices, signed up for drug company discounts and asked for money from her parents and friends. Her church often helped, but last month used its charitable funds to help repair other members’ furnaces.

Ms. Mills, 54, who suffered renal failure last year after having irregular access to medication, said her dependence on others left her feeling helpless and depressed. “I got to the point when I decided I just didn’t want to be here anymore,” she said.

So when a blue slip of paper arrived in the mail this month with a new Medicaid number on it — part of the expanded coverage offered under the Affordable Care Act — Ms. Mills said she felt as if she could breathe again for the first time in years. “The heavy thing that was pressing on me is gone,” she said.

 

Vertex gets clawed after sales of much-touted hepatitis C drug drop

It sounds kind of hostile, but “clawback” is an economic development term. Instead of using flat-out tax breaks to lure companies that promise new jobs, the Massachusetts Life Science Initiative now holds firms to their promises.  If they don’t generate jobs, companies have to pay back the state.

fan-ss-web

Boston Redevelopment Authority.

So, Vertex, the Cambridge biotech that just built a $800 million headquarters in the Seaport District, will have to return some of our money.

From the Globe:

With the drug’s sales dropping sharply, Vertex said it is cutting about 17 percent of its total workforce, or 370 jobs — including 175 in Massachusetts — and will return $4.4 million in state tax incentives it received for promising to create jobs.

The company may yet become an anchor of the state biotech sector. But to do so, executives will need to make good on their plans to build a multi-drug pipeline — something few in the high-risk biotech business have done. The first test will be winning approval for a portfolio of cystic fibrosis drugs.

The city of Boston also contributed to the project.

Clawbacks provide taxpayers a way of making sure their investment in development subsidies pays off in the form of real public benefits, and allow governments to recoup their money if it does not. The concept of a clawback may seem like common sense. However, with the way many subsidy deals are currently structured, companies often face no penalties if they fail to deliver on promised jobs or investment. A company’s plan to create public benefits may be regarded by both corporate executives and public officials as more of a goal than an enforceable commitment. Governments often take a “good faith” approach, assuming the company has done and will continue to do its best, and letting it off the hook if it falls short. 

Often, companies will threaten to relocate unless they win tax breaks. Vertex was considering its move at the time the state was setting up its life science subsidy program. From Nature Network Boston:

For Josh Boger, the head of Vertex Pharmaceuticals, the need for incentives from the state is real. “I’m the one who regularly gets detailed reports about how much more favorable things would be if we moved Vertex to another state,” said Boger, who is also the current chair of BIO, the national association of biotechnology companies.

As Vertex looks to expand its headquarters, Boger has been listening to pitches from other states, as well as other countries. “Am I looking at Massachusetts? Yes,” he said. “That doesn’t mean that I’m not looking elsewhere.”

Checking in with this week’s edition of the Health Wonk Review

The new Health Wonk Review is up with a collections of health policy blog posts. Image

This edition includes comments on a Harvard School of Public Health study on “how public and healthcare experts perceive very different reasons for Medicare’s always-impending insolvency.” Also, the latest on the effort to shut down the government in an effort to defund the affordable care act.

With the exchanges coming on line next week, it’s a good time of check in with this crowd.

Beyond the ACA,  local blogger David William takes on those who take on doctor rating programs.

The importance of the hospital patient survey and more policy news

Two local bloggers contribute to the new edition of  Health Wonk Review,  a bi-weekly digest of health policy posts.

masthead-hwrHealthBlawg offers a wrap-up post on the health information technology and health care policy conference in DC earlier this month. The Datapaloozers are looking at data streams from the government and beyond in an effort to manage the health and the health care costs of various populations…policy blog posts.

Why are patient experience surveys crucial to gaining clues for improving patient care and comfort? Many hospitals use them, notes David Williams at Health Business Blog, even though providers may not always be enthusiastic about being rated. They’ve become more important since Medicare began using patient experience as a criterion for reimbursement. 

Does Berwick have a fix for Massachusetts that he didn’t get to try in DC?

berwickIn addition to the rest of the state’s problems, would-be Governor Don Berwick would inherit the post-mandate struggle to contain health care costs. Does he have any solutions for  Massachusetts that he didn’t get a chance to try in DC?

Last summer, the former Medicare chief gave a talk before a film about the failures of U.S.  health care.  Instead of demonizing doctors and drug companies , he said they are just working within the system as it stands.

They’re just doing what makes sense,” he said. “We have to change what makes sense.”

Read full post here. 

For more on Dr. Berwick see:

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