Kings, dogs and Burwells: The latest policy posts from the Health Wonk Review #HWR

BHN is hosting this week’s round-up. In anticipation of the King v. Burwell decision, we offer kings and Burwells. The content of the images is not meant as a BHN endorsement for either position. Same goes for the opinions in these posts. Some say the ruling may come down today, others bet on 6/29. SCOTUS Blog is the site to watch. (For actual posts on the pending decision, see the 6/3 edition.)

Finally, our thoughts are with the members of Emanuel African Methodist Episcopal Church and the staff at one more hospital that had to brace for victims of a mass shooting.

The posts:

  • 512px-BBKing07

    By Roland Godefroy

    Joseph Paduda at Managed Care Matters writes:  Health care cost drivers; or, here’s where you’re getting screwed. Two studies published in Health Affairs shed much light on hospital costs and the societal implications of physician practice consolidation.  Both are a bit scary.

  • A post from Health Affairs analyzes the major elements of the final rule recent Medicare Shared Savings Program Final Rule.Lawrence Kocot, of Ross White,

    HHS photo

    and Mark McClellan at KPMG  offer alternatives for CMS and the possible future of the program

  •   From David Willams at the Health Business Blog notes: Long term care insurance -narrow framing is not the problem. Why don’t people buy long term care insurance? Because for many it’s not a good value
  •  David Harlow at the HealthBlawg: Outsourced Chronic Care Management Service256px-King_Kong_1933_French_posters Can Help Physicians and Patients. I wrote this post with a client about Chronic Care Management, a newly-reimbursable service under Medicare as of January 2015, and a service that is specifically non-face-to-face. The federales are dedicating significant funds to this service based on the belief that it will reduce expenditures on other services for multiply-chronically-ill elders.
  • From Boston Health News, links to stories on telemedicine and hospitals as step-down units.
  • From Roy Poses at Health Care Renewal: Health Care Professional Societies Whose Leadership Betrays Their Own Members – the APA Alleged to Have Supported Torture, and Deceived its Members to Collect Money. Health care professionals need to be extremely skepticburwellneonal of the leadership and governance of all health care organizations.  True health care reform requires organizational leaders who understand the health care system, uphold its values, and are willing to be accountable.
  •  Tom Lynch of Workers Comp Insider offers “the word of the week: horrendoma. That’s a description he applies to the healthcare system after looking at billed vs paid hospital data and the concept of charges as a “starting point.” See his post: Hospital Medicare Charges: You Don’t Always Get What You Want.
    By Metro-Goldwyn-MayerReproduction Number: LC-USZ6-2067 Location: NYWTS -- BIOG [Public domain], via Wikimedia Commons

    By Metro-Goldwyn-Mayer, Inc.

  • Henry Stern at InsureBlog asks “What carrier in its right mind would cover” sex change surgery? Transjenner Insurance: In case you were wondering: Yes, ObamaPlans *do* cover sex-changes. InsureBlog has the, er, straight scoop.
  • From Health System Ed: Decrying the End of Private Physician Practice? Not so fast!  Experts have been saying that the private physician practice is no longer sustainable under managed care but then along comes ACOs and perhaps that tune is changing when the focus turns from volume to outcomes.
  • This Health Affairs post focuses specifically on the provisions of the rule dealing with benchmarkingBWburwell2 and distribution of shared savings and losses and suggests that CMS consider the possibility of graduated rates of sharing savings and loss distribution.y Carrie Colla, Scott Heiser, Emily Tierney, and Elliott Fisher at Dartmouth
  • Finally, Brad Wright asks : This Father’s Day, Give 1 For Dad
    In honor of his father, he’s donating to “Give 1 For Dad campaign to fund an important clinical trial for prostate cancer at the Duke Cancer Institute. At issue is that the treatment uses a safe generic drug, which is great because it isn’t toxic like other current treatments, but not so great because no major pharmaceutical companies are willing to fund a clinical trial of a generic drug.”

What does your king look like? king-cobra-405623_640(Click on images for credits, rights.)


Vintage photos of cancer, genetic research from Dana-Farber, MIT and NCI

Looking for art for you health or science blog? NCI Visuals Online contains images from the collections of the Office of Communications and Public Liaison, National Cancer Institute. For more information about Visuals Online, including reuse and contact information, see About Visuals Online. Click for NCI captions and IDs.

Here are a few, including shots from MIT, Dana-Farber

Hospitals consolidation: Brill says yes, new Massachusetts AG says no

From Shirley Leung’s Monday column in the Globe:

partnersNo judge or jury delivered a verdict on the Partners HealthCare settlement Monday, but we didn’t need either after Attorney General Maura Healey’s three-page court filing.

She thinks the deal stinks, and if given the chance, she would bring an antitrust suit to block Partners’ efforts to expand. And just like that, the 43-year-old rising political star dared to rock the biggest boat in Massachusetts health care. In the wake of her threat, Healey left a list of winners and losers.

From Steven Syre’s column in today’s Globe:

Maura Healey has been on the job less than a week, but we don’t have to wonder where she stands on the biggest health care conflict in Massachusetts.

And, a Q. & A. from Steven Brill, author of “America’s Bitter Pill: Money, Politics, Backroom Deals and the Fight to Fix Our Broken Health System. That book looks at focuses on the debate over the Patient Protection and Affordable Care Act. But it also returns to Brill’s indictment of high hospitals costs that filled an entire issue Time magazine in 2013. His solution looks very much like a combination of the Kaiser Permanente insurer-plus-provider approach and the Partners’ plan.

HLM: Why will this consolidation approach work to curb costs where other reforms have failed?

Brill: The reason this idea may work is it is going to happen without my writing about it. It’s going to happen. The question is, do we seize that momentum, turn it around jujitsu- style and attach a whole bunch of regulations to it?

I really started thinking about this after my [heart] surgery. I decided: New York Presbyterian, it’s a damn good place and the guy who runs it is a good guy. [Later] I was watching a panel including Toby Cosgove [CEO of Cleveland Clinic] and someone said: You’re gobbling up Cleveland and your market share is way too high.

Cosgrove said, the FTC would never let us have too much of a market share. I’m thinking, this guy Cosgrove, he’s a celebrated surgeon, a war hero. He seems like a pretty good guy to me. The idea the he wants to control and provide healthcare all over Ohio, why is that such a bad thing?partners-logopartners-logo

Daily Dose archived, health blogger Kotz leaves “The Boston Globe”

Deborah Kotz,  the Globe’s Daily Dose health blogger for the past four years, has taken a buy-out and that Daily Dose will be archived.

We’ll miss Kotz. While often stuck fielding the barrage of journal studies coming out of Boston medical centers,  she always managed to avoid disease-of-the week reporting.  Some stories just confuse readers. But writers who skip them often have to face editors asking “Why didn’t we have this?”

Still, it’s the kind of reporting that wins health writers like Kotz kudos.

The Globe no longer shares content with, so that website produces its own health reports. Mostly aggregation, but a few stories. We’ll miss the science touch Kotz brought to that site before the Globe/ divorce.  We wish them well as they find their way.They seem to have taken over the @bewellboston twitter feed.


Check in here for your sort-of-weekly, but always insightful dose of local health blogging. Or check out WBUR’s CommonHealth for daily posts.

Don’t have a hot attack: Framingham Heart Study carries on

fhsWhat is up with the Framingham Heart Study? That long-running research project has been tracking the cardiac health of hundreds of local folk for decades.  (The algorithm used to estimate the 10-year risk of heart disease is called the “The Framingham Risk Score.”)

A story and a blog post recently reported woefully about a 40 percent sequester cut to the study’s National Institutes of Health funding.  Neither quoted anyone from NIH.

So, both pieces failed to note that the cut is to the study’s administrative grant from the National Heart Lung and Blood Institute, not its research grants.  According to BU, the study receives an estimated $5.4 million in NIH grants for research. This funding is not impacted by the 40 percent cut.

In other words, the cuts come from the money used to run the program – office staff, data collection and the management of study subjects, not the scientific research projects that fall under the program’s umbrella. The data collected from the locals helps researcher understand the mechanics and, more recently, the genetics of heart disease as it impacts the rest of us.

In total, NIH says it will spend $21 million this year contracts for the FHS study infrastructure – including a study looking for biomarkers for heart disease. In addition to funding the BU research, NIH says its grants cover 17 FHS related studies at eight different organizations and universities. In addition to the Heart Lung and Blood institute, that money comes from five other NIH institutes and centers, including the National Institute on Aging, The National Institute of Diabetes and Digestive and Kidney Diseases and the National Institute of Neurological Disorders and Stroke.

None of this was clear in this first, July 20 story from the Metro West Daily:

The Framingham Heart Study expects to lose $4 million in funding as part of the federal budget cuts known as sequestration, study officials confirmed Friday in a statement. The $4 million cut takes effect Aug. 1 and represents 40 percent of funding it receives from the National Heart, Lung and Blood Institute (NHLBI), a division of the National Institutes of Health, the statement said.

 The story quotes a spokeswoman from Boston University, which is home to the study.

The cut with “result in a reduction in workforce affecting 19 staff from a variety of clinical and administrative areas, as well as reductions in clinic exams and lab operations.”

Then it quotes from a statement about NIH cuts in general from new Sen. Ed Markey:

“Slashing critical federal investment in medical research jeopardizes the health of many Massachusetts residents, while putting at risk tens of thousands of jobs in the commonwealth’s innovation economy and the industries they support,” Markey said. 

Then it quotes from Karen LaChance, a Framingham resident and president of the Friends of the Framingham Heart Study.

“We just hate to see any cut. It delays hopefully finding whatever the magic bullet might be to prevent heart disease.

Then it doesn’t quote anyone from NIH.

In a post on the Metro West Daily story,  WBUR’s CommonHealth blog offers the headline “Famed Framingham Heart Study Faces Deep Cuts From Federal Sequester.”

It was a “Say it isn’t so” moment this morning when I saw this MetroWest Daily News headline: Framingham Heart Study Faces $4 Million Cut. “Heart disease is the country’s number 1 killer, and chances are whatever you do to prevent it or treat it was influenced by the Framingham Heart Study, a venerable epidemiological gem right here in our own Boston suburbia….”

But, you could argue that it ain’t so.

As far as the impact of the cuts, Metro West Daily quote  BU as noting that “This loss of funding will result in a reduction in workforce affecting 19 staff from a variety of clinical and administrative areas, as well as reductions in clinic exams and lab operations.”

BU tells us that approximately 80 people work at the FHS. “The affected staff will see a reduction in hours beginning Aug. 19; if alternative funding sources are not identified, a layoff would occur Nov. 1. “

The FHS site was a little clearer on all this, with note on its home page:

New Information for FHS Participants edited July 20 2013

Q. Is the FHS closing?
A. No. The current Offspring and Omni Group 1 exams are continuing to Oct. 31, 2013. Ancillary studies are continuing as planned. Medical history updates are being collected on the regular schedule. Please respond to calls for FHS participation as usual.

By Wednesday August 1, BU had posted its own story on the BU Today website with the headline: “Framingham Heart Study Carries on, Despite Budget Cuts: 65-year-old core contract loses 40 percent of funding.”

NU prof in NYTimes: Can meditation teach manners?

Update 7/18 :The folks at WGBH’s Boston Public Radio took calls after an interview with David DeSteno, the author of this meditation study. Note:  Jim Braude does not mediate: his co-host Margery Eagan does.

7/7: This piece in the NYTimes magazine, “The Morality of Meditation” is of interest for two reasons. It was written David DeSteno is a professor of psychology at Boston’s Northeastern University. And, this reporter has spent the past five weeks in a brace and on crutches with a fractured tibia plateau — top of the shin bone. Anecdotally, that 16 percent of people would give up a seat for a person on crutches seems about right.

bll-leg-pix-web Buddha: “I teach one thing and one only: that is, suffering and the end of suffering.” For Buddha, as for many modern spiritual leaders, the goal of meditation was as simple as that….

Here’s how they tested that concept:

When a participant entered the waiting area for our lab, he (or she) found three chairs, two of which were already occupied. Naturally, he sat in the remaining chair. As he waited, a fourth person, using crutches and wearing a boot for a broken foot, entered the room and audibly sighed in pain as she leaned uncomfortably against a wall. The other two people in the room — who, like the woman on crutches, secretly worked for us — ignored the woman, thus confronting the participant with a moral quandary. Would he act compassionately, giving up his chair for her, or selfishly ignore her plight?

The results were striking. Although only 16 percent of the nonmeditators gave up their seats — an admittedly disheartening fact — the proportion rose to 50 percent among those who had meditated.

BHN Report: On MV, Berwick takes a break from his break to comment on Ryan Medicare plan, new film

Former Medicare chief Donald Berwick was present both on and off the screen for a Thursday Martha’s Vineyard showing of a new film on the health care system. Berwick, who spends part of his summer in Chilmark, was fresh off an interview with WBUR’s On Point call-in show. So, he was ready to comment on the Medicare voucher plan proposed by Republican Vice Presidential candidate Paul Ryan.

Berwick thinks the addition of Ryan to the ticket will be good for the debate over the Medicare budget.

“You see Romney trying to explain the Ryan plan. I think it will help clarify the difference in viewpoints,” between the two parties, he said.

At the same time, Berwick noted that issues surrounding Medicare are complicated – he admited that he had study up on some technicalities when he took over the national health plan for the elderly for a year.  So, voters are already hearing a lot of “irresponsible rhetoric” and one-liners, he said.

As it turns out Romney and Ryan were also in New England this week– talking about Medicare during yesterday’s campaign stop in New Hampshire. The Boston Globe reported that Ryan said he invites a debate on the plan. He characterized Obama’s approach this way:

            Mitt Romney and Paul Ryan, campaigning in a state with a median age higher than Florida’s, criticized President Obama on Monday morning for his health care law and said the Republican ticket would be more likely to put Medicare on sounder financial footing.

     “Medicare should not be a piggybank for Obamacare!” Ryan said.

Romney and Ryan charge that the health reform law takes $750 billion from Medicare to pay for the new health law.  Berwick said that’s “not really true.” The changes in payment are designed to promote changes in the way care is delivered, he said. “It doesn’t take a nickel away from beneficiaries. The Ryan plan is the one that takes money away from beneficiaries by putting them at risk. “

      The Ryan plan cuts Medicare by setting up a voucher system, he said. Instead of a guaranteed benefit, the approach would become a guaranteed payment in the form of a voucher. It cuts the budget, Berwick noted, by telling beneficiaries – “It’s your problem now.”

Interest in the topic drew a full house to see Escape Fire: The Fight to Rescue American Health Care in a small viewing room in Edgartown’s Harbor View Hotel. (The title refers to a method firefighters use to avoid being burned by a wildfire.) The movie offers a beginner’s overview of the problems facing the health system, as well as three engaging stories of people coping with them.   The subjects – interspersed between talking heads — include a doctor, a soldier and a victim of grossly excessive treatment for heart disease. Judging from the gasps from members of the audience, familiar facts about problems like medical errors were new to them.  “Disturbing,” one woman leaned over and whispered to her companion.

Besides Berwick and Steve Nissen of the Cleveland Clinic, those commenting in the  film did not represent the usual suspects. Most people associate Andrew Weil and Dean Ornish with healthy lifestyles, not systemic change. Still, they spoke to the need from more preventative care. The audience seemed to agree. A heart attack patient opening a can of Vienna sausages and smoking a cigarette generated the loudest groans.

Berwick also offered something different. Instead of demonizing doctors and drug companies, he notes that they just are working within the system as it stands.

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


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