Priorities for Comparative Effectiveness + Senate and health reform

The Institute of Medicine, a Congressional research arm, released a list of  “100 health topics  (.pdf) that should get priority attention and funding from a new national research effort to identify which health care services work best.”

Among the high priority issues: atrial fibrillation, hearing loss, fall prevention for the elderly, MRSA prevention, localized prostate cancer,  lower back pain, Alzheimer’s disease, a form of breast cancer called Ductal Carcinoma In Situ, ADHD, unintended pregnancies and obesity.    

For more on effectiveness research and the conservative objections to it see my earlier post.

If you have a cold, what should you do? Take aspirin? Vitamin C? Flush your sinuses out with a little pot that looks like a lamp a kid would rub to release a genie? (I have one of those.) What about pain from gallstones? Should you let a doctor take out your gall bladder?  (I used to have one of those.)

Among those who sat on the panel: Brigham and Women’s Hospital president Dr. Gary L. Gottlieb, Dr. JoAnn E. Manson, also of the Brigham, and head of the Women’s Health Initiative and and Dr. James N. Weinstein of the Dartmouth Institute for Health Policy and Clinical Practice, which has been leading research into the area for years.

 

 

Also, Sens. Kennedy and Dodd yesterday proposed a less expensive version of the health reform plan put forward by Senate Democrats. Kaiser Health News has a good round up of stories — including some that question the senators’ math. This from CQ Politics:

Democrats have struggled with CBO to get the agency’s cost estimates of their legislation down to a less staggering price tag. Dodd alluded to the behind-the-scenes negotiations during the Thursday conference call, at a point when he thought reporters were unable to hear him.”This is great news, staff really did a wonderful job,” he told other senators who had joined him on the call. “I talked to [CBO director] Doug Elmendorf more times over the weekend, trying to get these numbers. It got to be pretty frustrating. The results are great” 

 

Health delivery lessons from the developing world?

Bruce Walker, director of the Partners AIDS Research Center at Massachusetts General Hospital, comments in today’s Wall Street Journal story on using “simpler and less expensive treatments like those used abroad” to reduce heatlh costs here.   

 Walker “worries that imported practices — and possibly lower standards — would be adopted only for disadvantaged patients in the U.S. But Dr. Walker believes it will be too costly for the U.S. to continue to rely on current practices. “You have to find a way of changing the approach slightly while still providing outstanding care,” he says.”

 Also, Susan Milligan – who knows her way around Capitol Hill — reports on Obama’s health care forum for the Globe.  

 AP reports on his rejection of single payer.

 Obama said a government-run “single-payer” health care system works well in some countries. But it is not appropriate in the United States, he said, because so many people get insurance through their employers working with private companies.

 Kaiser Health News has the transcript

 Here’s the problem, is that the way our health care system evolved in the United States, it evolved based on employers providing health insurance to their employees through private insurers.  And so that’s still the way that the vast majority of you get your insurance.  And for us to transition completely from an employer-based system of private insurance to a single-payer system could be hugely disruptive.  And my attitude has been that we should be able to find a way to create a uniquely American solution to this problem that controls costs but preserves the innovation that is introduced in part with a free market system. 

Massachusetts June 24 State House health bill testimony

The Joint Committee on Health Care Financing held a hearing Wednesday afternoon on several bills including one on health care affordability.

Health Care for All reports on the hearings on their blog.

“Dorcas Grigg-Saito, the CEO of the Lowell Community Health Center, shared the struggles many of her clients have with the costs of health care. Grigg-Saito informed the Committee that the Lowell Community Health Center serves one-third of the population of Lowell and 93% of the patients are below 200% fpl.”

(Click here for my story on how the Lowell health center works with the Khmer community’s preference for traditional medicine.)

 

More woes for Massachusetts insurance model

From the Globe:

Overseers of Massachusetts’ trailblazing healthcare program made their first cuts yesterday, trimming $115 million, or 12 percent, from Commonwealth Care, which subsidizes premiums for needy residents and is the centerpiece of the 2006 law.

WBUR’s CommonHealth also reports

The economy is hitting the state’s free and subsidized health insurance program, Commonwealth Care, from 2 angles. First, more state residents affected by the shrinking job market are signing up. Second, the state has less money to spend on this…and hundreds of other programs.

For more on the way the state casts the plan, see the Commonwealth Connector website.

The Globe has this interview as well:
State Treasurer Timothy P. Cahill has come out strongly against the $1 billion in tax increases approved by the Legislature, proposing instead deep cuts in the state’s landmark effort at universal healthcare, calling it a luxury taxpayers can no longer afford.

As the Globe points out, Cahill has no say in this except that he’s apparently toying with the idea of running for governor.

In other news, The Washington Post has an interview with Atul Gawande, the Harvard doc whose New Yorker piece put the concept of practice pattern variation into the conversation.
 

 

Non-profit hospitals behaving badly?

I was surprised by this factoid. It was buried is Scott Allen’s fine Sunday story in the Globe on the fight for outpatient business in the suburbs. 

Beth Israel set up a taxpayer group in 2006 to oppose a proposed $13 million cancer center at Newton-Wellesley Hospital, in part because it would be less than 5 miles from a Beth Israel cancer center. Beth Israel later dropped its opposition in a settlement whose terms were not disclosed.

Paul Dreyer, state director of Health Care Safety and Quality, said hospitals commonly set up independent taxpayer organizations as a way to oppose other hospitals’ building plans. That’s because a grass-roots group with as few as 10 members can force a public hearing under state law.

There’s a name for this in policy circles – instead of grass roots organizations, these are astroturf orgs.

 A business tactic or a way to game the system?  I guess it depends on which side of the fight you’re on.

H.E.L.P.! Senators start swinging on health reform

Apparently it was quite a scene on Wednesday as the Senate Committee on Health, Education, Labor and Pensions tried to begin the debate on the health care bill.

Kaiser Health News has a good round up.

Sen. John McCain, R., Ariz., interrupted the opening remarks of Sen. Christopher Dodd, D., Conn., saying the proceedings were a “joke.”

Ouch.

More from the NY Times.

ONC: “Meaningful use” for HIT will evolve

 A panel deciding what kind of computerized health information systems will get stimulus money was sent back to do some more homework yesterday, according to Healthcare IT News.

 Companies that make these systems and providers who use them have been waiting for a definition of the “meaningful use” requirement  so they canplan to  get in on the $20 billion in stimulus money set aside for HIT. Looks like they may have to wait a while for a precise RFP-type definition. This HIT News story was entitled “ONC goes back to the drawing board on meaningful use“: 

After a “lively discussion [on the criteria] and considerable input on meaningful use, we decided to send the workgroup back to work on another set,” David Blumenthal, MD, national coordinator for health information technology, said during a media call…. According to Tony Trenkle, director of the CMS Office of e-Health Standards and Services, CMS expects to have a proposed final rule on payment issues – including the definition of meaningful use – by the end of the year.

But Dr. John D. Halamka, CIO of CareGroup, which includes BIDMC, says on his Geek Doctor blog that:   

 After months of anticipation, the definition of Meaningful Use has arrived. 

Sort of. As he points out, the HIT Policy Committee meeting in DC did produce a framework that will help steer docs and geeks in the right direction.

 The meaningful use matrix is organized into specific meaningful use goals to be achieved by 2011, 2013, and 2015. It also lists metrics for these goals to evaluate hospital and clinician progress in meeting them.

 You can check it out here on the Health IT Policy Committee page.

Or, you can read the story that was posted later in the same HIT news, which read: “Officials outline criteria for meaningful use“

 Beside Blumenthal, Bostonians at yesterday’s meeting include:

•  John Glaser of Partners
•  Micky Tripathy, of the Massachusetts e-Health Collaborative, which got three Mass towns started on HIT
•  David Bates of Partners

 

Massachusetts underinsurance model? Plus, weekly reviews.

Three things.

Boston health week in review: See my look back, posted weekly on the Mass Device website. Also, check out the rest of the site. Devices are a big part of the health industry but don’t get the same attention as pharma.

 Health Wonk Review: The latest collection of health policy blogs is up on Managed Care Matters. There, Joe Paduda directs us to video clips of the Senate debate, as well as his own piece about the miraculous transformation of VA health care.  His point – many government-run programs efficiently produce high quality products and services: the Centers for Disease Control, US Coast Guard, National Oceanic and Atmospheric Administration, Head Start, AmeriCorps, NIH, the GI BIll, and the National Weather Service. (Some would disagree on NIH.) Also, great postings on the public insurance plan debate, costs and the impact of reform on hospitals. Click here for a HWR archive.   

Massachusetts underinsurance model: Some employer plans “meet the letter but not the intent of the law,” according to a Kay Lazar story in today’s Globe:

Regulators yesterday said that reviews of scores of health plans show many cap the benefits insurers pay each year on prescription drug coverage, exclude maternity coverage for dependents, or place an annual overall dollar limit on benefits.

Jamie Katz, general counsel for the Connector Authority, which oversees the state’s health initiative…said that while rules created by the Connector require, for instance, health plans to include prescription coverage, they don’t address whether such coverage is allowed to have limits.

Also see WBUR’s post on enrollment and the anonymous response to it  about the failure of the Mass plan.  

Keeping up with Capitol Hill happenings

The full-pitched health reform battle is under way in DC.

To keep up,  I suggest checking out the Wall Street Journal‘s Health Blog, National Public Radio’s Health Blog, the Kaiser news page, Politico  and, of course, The Boston Globe.

 Find other good links to the right under Health Reform and Health News

Kennedy produces health care bill

You can read Kennedy’s actual bill here. If you’re not up to reading all 615 pages, find a few reports below. 

(For the conservative response, see this story in The American Spectator.)

This from the AP story on the Kennedy bill:

Americans would be able to buy long-term care insurance from the government for $65 a month under a provision tucked into sweeping health care legislation that senators will begin considering next week.

The 651-page bill, released Tuesday by Sen. Edward M. Kennedy, D-Mass., would revamp the way health insurance works. Insurance companies would face a slew of new government rules, dealing with everything from guaranteed coverage for people with health problems to possible limitations on profits. Taxpayers, employers and individuals would share in the cost of expanding coverage to nearly 50 million uninsured  Americans.

The story also notes, in fact, leads with this:

Americans would be able to buy long-term care insurance from the government for $65 a month under a provision tucked into sweeping health care legislation that senators will begin considering next week.

That’s a expensive item but in effect, Medicaid already pays for a lot of  nursing home patients who stay more than a year. It takes about that long for even middle class patients to ”spend down” to the eligible level.

Dementia units cost $4,300 month and shared nursing home rooms cost $80,000 year, according to Met Life’s 2008 report on the cost of long tem care. The average bill at an assisted living facility – which neither Medicaid nor Medicare covers– is $2,500 to $3,300 a month.  

Also see reports on the bill from the LA Times and NPR.