Posts Tagged ‘Institute of Medicine’

Dying for Coverage

Tuesday, July 10th, 2012

More than 26,000 working-age adults die prematurely in the United States every year because they lack health insurance, according to a study published by Families USA.  The consumer advocacy group study, estimates that a record high of 26,100 people aged 25 to 64 died for lack of health coverage in 2010, up from 20,350 in 2005 and 18,000 in 2000.  That adds up to a rate of approximately 72 deaths per day, or three per hour.

The non-profit group based its report on data from the U.S. Census Bureau, the Centers for Disease Control and Prevention (CDC), and a 2002 Institute of Medicine (IOM) study that showed that Americans who lack insurance face a 25 percent higher risk of death than those with coverage.  The findings are in line with a study by the Urban Institute think tank that estimated 22,000 deaths nationwide in 2006.

“Lives are truly on the line,” said Ron Pollack, Executive Director of Families USA, who supports the Patient Protection and Affordable Care Act (ACA).  “If the Affordable Care Act moves forward and we expand coverage for tens of millions of people, the number of avoidable deaths due to being uninsured will decrease significantly.”  Pollack is not the only healthcare advocate to predict that the number of uninsured will continue to rise without reform as healthcare costs accelerate, employers cut benefits, and the social safety net unravels because of fiscal pressures.

The Affordable Care Act was passed by Congress to address an American tragedy and an American shame,” Pollack said.  “The fact remains that for the millions of Americans without health coverage, only the Affordable Care offers the promise of access to affordable coverage and to a longer and healthier life.”

According to the report, the reasons for being uninsured differ, but many without health insurance were denied coverage because of a pre-existing condition.  Others have been priced out of the market at a time when keeping their homes and feeding their families take priority over holding on to insurance in the face of rising premiums.  Some lost their benefits when employers stopped providing coverage.

Census Bureau data show that 50 million Americans lack healthcare coverage, and experts say that these people do without medical care, physician visits and preventive tests including cancer and blood pressure screenings.  “The uninsured get healthcare about half as often as insured Americans, on average,” said Dr. Arthur Kellermann, director of the think tank RAND Health and co-chairman of the committee that wrote the 2002 IOM study.  “There is an overwhelming body of evidence that they get less preventive care, less chronic disease care and poorer quality hospital in-patient care,” he said.

The $2.6 trillion American healthcare system, which totals nearly 18 percent of the economy, is accessible to a majority of working-age Americans only through private health insurance.  But insurance costs – premiums, deductibles, co-pays and co-insurance – are unaffordable for many.

Robert Zirkelbach, spokesman for America’s Health Insurance Plans, the national trade association that represents the insurance industry said the rising cost of care must be addressed.  “Health plans have long supported reforms to give all Americans the peace of mind and financial security that healthcare coverage provides.  The nation must also address the soaring cost of medical care that is adding a financial burden on families and employers and threatening the long-term sustainability of our vital safety net programs.”

Families USA counters that the current delivery system is stacked against Americans who lack insurance.  They pay more for care because they lack the ability to negotiate discounted prices on physician and hospital charges like insurance companies can.

Writing in Forbes, Matthew Herper points out that “This estimate is 19 years old, and this number doesn’t tell us much that’s new about what is wrong with our healthcare system.  If anything, it emphasizes how our total lack of information about what works and what doesn’t is trapping us in an economic and social death spiral around health costs.  If anything, available data seem to point to this estimate being low.  The real story is that we care so little about how much insurance matters to people’s life spans that we haven’t really bothered to find out.  It’s possible that the number is actually higher.  A 2009 article in the American Journal of Public Health actually found a 40 percent increase in the risk of death for those who lack insurance.  The IOM notes this finding, and that using it would have substantially increased the 26,000 number.  So how many people do die from lack of health insurance?  The short answer is that we don’t know, because we don’t look.  We should have data collection systems in place to answer questions about how healthcare is performing.  This should translate into more transparency, so that voters and consumers can find out how well the system is doing.  Instead, we tend not to track data about the healthcare system, and to keep it completely siloed.  And then we wonder why the system doesn’t work.”

$1,000 Toothbrushes and $140 Tylenols: And You’re Footing the Bill

Thursday, March 29th, 2012

As the debate about the future of Medicare heats up, the program’s chief actuary estimates that 15 percent to 30 percent of healthcare expenditures are wasteful. Cindy Holtzman, a consumer advocate with Medical Billing Advocates of America, cited several examples, such as a Florida patient who was charged $140 for a single Tylenol.  A patient in South Carolina paid $1,000 for a toothbrush.  A patient in Georgia who used one bag of IV saline solution was billed for 41 bags for a total of $4,000.  In the case of the Georgia patient, insurance paid the entire claim.  “Usually any kind of bill under $100,000, they (insurance companies) don’t look at the details.  And that’s where something like this can be paid in error,” Holtzman said.  After Holtzman investigated, the bill was fixed, and the insurance company was refunded its money.

Medicare spending exceeded $500 billion in 2010.  As much as $75 billion to $150 billion could be cut without reducing needed services.  A potential cause is that Medicare’s reimbursement procedures do not track the appropriateness of the care provided.  Medicare farms out its claims administration to private local contractors based on how quickly and cheaply they process claims.  These contractors are not given incentives to audit the taxpayer dollars they spend; even if they wanted to, they would need data that is typically not found on the claim form.

Healthcare spending is wasteful across the board, not just in Medicare.  Writing for Politico, Ralph G. Neas, CEO of the National Coalition on Health Care (NCHC), a non-profit, non-partisan organization working to improve America’s healthcare system, says that “Total expenditures on healthcare represented 17 percent of the gross national product in 2010 and are projected to reach 20 percent by the end of this decade.  The federal government already spends more for health care than for defense, Social Security or any other single spending category.  The nonpartisan Congressional Budget Office has emphatically identified rising health costs as the greatest threat to our fiscal future.  It doesn’t have to be this way.  Our current system is devastatingly inefficient.  The United States spends 141 percent more on healthcare than other economically advanced nations.  But our far higher bill is not buying us a healthier population.  Roughly 30 percent to 40 percent of medical and hospital costs can be attributed to waste and inefficiency.  That means, America is on a path to squander $10 trillion over the next decade. That hemorrhage would leave our economy — and our cities, states, small businesses and middle-class families — on life support.  Given our financial condition, preventing this kind of spending and the economic drag it represents should be the kind of urgent national problem that overrides ideological differences and encourages us to find common purpose.”

NEHI, an independent non-profit national network for health innovation, has recommended actions that would reduce wasteful healthcare spending by up to $84 billion. The plan was produced in collaboration with the National Priorities Partnership.  One major area for savings is eliminating emergency department overuse.  More than half of the 120 million annual ED visits can be avoided, representing a $38 billion opportunity for savings.  Medication errors add up to seven million inpatient admission and outpatient visits involving serious but avoidable medication errors, representing a $21 billion opportunity for savings.  Unnecessary hospital readmissions is another area where savings can be achieved.  Seven million people are readmitted to hospitals within 30 days of discharge annually but 836,000 of these cases could be avoided, representing a $25 billion opportunity.

Another study believes that healthcare spending waste is much more widespread.  As much as 50 cents of every dollar spent in healthcare is wasted, according to Pricewaterhouse Cooper’s Research Institute. The organization determined that unnecessary price gouging makes up $1.2 trillion of the $2.2 trillion spent on healthcare nationwide.  “Our best estimate is that for the country as a whole, probably half of what we’re spending on healthcare delivery today is technically waste from a patient’s perspective,” said Dr. Brent James, chief quality officer for Intermountain Healthcare in Salt Lake City.  “There are better ways of doing it.”

The Institute of Medicine (IOM), a division of the non-partisan National Academy of Sciences, reports that “excess costs” – which translates to waste — in the American healthcare system cost $810 billion every year. Their findings?  Overly-high insurance administrative costs absorbed by doctors and hospitals cost $190 billion.  Insurance company inefficiencies cost $20 billion.  Unnecessary services (brand name drugs instead of generics, repetitive tests and procedures, etc.) cost $210 billion.  Too-high prices for doctors and hospitals cost $85 billion.  High drug and device prices cost $20 billion.  Errors and avoidable complications cost $75 billion.  Inefficient delivery of services costs $ 80 billion.  Fraud costs $75 billion.  Missed disease-prevention opportunities cost $55 billion.

HHS Website Monitors Health Insurance Premium Increases

Monday, October 17th, 2011

Consumers can now select their state on a federal web page to see if any health insurers have raised rates, as well as the company’s reasoning behind the action. This information was previously unavailable, according to Steve Larsen, the Department of Health and Human Services (HHS) deputy director for oversight (only a few states include rate increases on their own websites).  Now, all insurance companies must file this information with HHS as one directive of the Patient Protection and Affordable Care Act (ACA).  “We are taking a good, hard look at why insurance companies are seeking to raise your rates, why your premiums might be going up, and making sure these decisions are public and justified,” HHS Secretary Kathleen Sebelius said.  “This is just a start, and over time we will be reporting more of these requests.”

The announcement follows a recent survey by the Kaiser Family Foundation that showed premiums for an employer-sponsored plan for a family of four climbing nine percent in 2011.  A report by Barclays Capital Equity Research showed that in the first three months of 2011, 13 of the leading 14 health insurers exceeded their earnings per share estimates; average earnings were 46 percent over estimates.  Insurers who wanted to raise rates 10 percent or more for individual or small group plans are required to provide justification.

At the same time, an advisory group urged officials to create a list of essential health benefits under President Barack Obama’s healthcare overhaul that aligns with the cost of typical small-employer plans.  The Institute of Medicine (IOM) report recommended that HHS be specific in deciding what health benefits should be required in individual and small group plans as the ACA goes into full effect in 2014.  The IOM, one of the National Academies of Science that advises U.S. policymakers, did not address any specific benefits types, in keeping with its assigned task.  “We’re in a marathon.  What we’ve just gotten today is the first leg,” said Paul Keckley, executive director of the Deloitte Center for Health Solutions.

The IOM recommendation favors business groups and insurers who have sought a narrow package of required benefits because of concerns that the plans will cost too much, said Neil Trautwein, vice president for the National Retail Federation.  Government should limit premiums to levels no higher than what small businesses pay on average and choose benefits “within the context of financial constraints,” according to the report.  The recommendation “is the appropriate tack to take since the objective is to cover everyone with at least basic benefits,” Trautwein said.

The issue has seen businesses and patient advocacy groups — such as the American Cancer Society, which argues for robust coverage — at odds with each other.  The ACA requires insurance plans to cover 10 broad categories of care, including hospitalization, mental health and pediatrics starting in 2014 and left details to Obama’s HHS secretary, who has  asked the IOM to recommend the optimal way to select the benefits that should be included in the plans.  Employer lobby groups argue that a generous package of benefits would cause workers to desert company plans, which could have the effect of compelling employers to pay fines and raise premiums as the number of people covered by their health plans decreases.

According to the IOM, Sebelius should start with a package of benefits that mirrors what small businesses offer their employees.  She should set a “premium target” for the benefits that is approximately the same as what small businesses will pay, on average, in 2014.  Next, she should select benefits that meet the target, a process the IOM compared to shopping for groceries under a budget.  “If the package of essential health benefits gets too comprehensive, it quickly becomes unaffordable,” said John Ball, chairman of the institute committee that wrote the report.

Beginning in 2014, every health plan in the new marketplaces known as “exchanges” will have to provide a minimum package of “essential health benefits.”  The IOM report provides federal officials with a framework for devising that package, but doesn’t provide specifics.  “I’m sure a lot of people were expecting to get a list,” said Elizabeth McGlynn, a member of the IOM committee and head of the Kaiser Permanente Center for Effectiveness and Safety Research.  “That was outside of our charge.”

“With this thoughtful report, the IOM is urging policymakers to strike a balance between the affordability of coverage and the comprehensiveness of coverage,” said Karen Ignagni, president and CEO of the health insurance trade group America’s Health Insurance Plans.  “We agree that this balance is critical to ensuring that individuals, working families and small employers can afford health insurance.”  Amanda Austin of the National Federation of Independent Business termed the report “encouraging,” and “pretty thoughtful,” although she believes that HHS still has to do the heavy lifting to write the plans.

Sebelius issued her own statement on the report, saying she will hold “listening sessions” to help people choose what benefits they want included in the mandatory package.  “These conversations will help us ensure that every American can access quality, affordable health coverage they can rely on,” she said.  This seems to suggests to some that a proposal from the department won’t be coming anytime soon.

HHS Sets New Guidelines for Women’s Health Services

Monday, August 29th, 2011

The Department of Health and Human Services (HHS) has announced new guidelines requiring health insurance plans to cover several women’s preventive services on or after August 1, 2012.  Among the inclusions are contraception and voluntary sterilization.  According to HHS Secretary Kathleen Sebelius the decision is a result of the Affordable Care Act’s (ACA) efforts to prevent problems before they start.  “These historic guidelines are based on science and existing literature and will help ensure women get the preventive health benefits they need,” she said.  The Institute of Medicine (IOM) conducted a scientific review of women’s health needs and gave recommendations on specific preventive measures; HHS has now approved those recommendations.

“Today, as part of the Affordable Care Act, we are announcing historic new guidelines that will help women get the care they need to stay healthy,” Sebelius said. “Today we are accepting the recommendations of the Institute of Medicine, so no woman in America needs to choose between paying a grocery bill and paying for the key care that can save her life.”

The new rules are one of the broadest and potentially popular provisions of the ACA. “Since birth control is the most common drug prescribed to women ages 18 to 44, insurance plans should cover it,” Sebelius said. “Not doing it would be like not covering flu shots.”  The new rules also apply to annual “well-woman” checkups; screening pregnant women for diabetes; DNA testing every three years for human papillomavirus (HPV) — which can cause certain cancers in women 30 years and older; annual screening and counseling for HIV; counseling to determine whether a woman is at risk for other sexually transmitted diseases; breast-feeding support, counseling and supplies including breast pumps; yearly screening and counseling for domestic violence; and sterilization methods.

Howard Koh, MD, HHS assistant secretary for health, estimated that by 2013, 34 million women between the ages of 18 and 64 will receive the benefits detailed in the new ruling.  Although preventive care saves money by avoiding or delaying more costly chronic disease care, Koh said the new benefits will involve a “small” increase in premium costs.

Stephanie Cutter, a deputy senior advisor to President Obama, said that, “As a result of the Affordable Care Act, the new health reform law, insurance companies have to provide preventative care with no out-of-pocket costs.  There were never any guidelines for women’s health to make sure they stay healthy throughout the course of their lives.  Today, that’s no longer the case.  We have a set of recommended preventative services for women.  Private insurance companies,” Cutter said, “have to provide the services with no out-of-pocket costs.  Many of the benefits we’re announcing today are already part of large private healthcare care, employer plans, and they’re part of federal health care benefits.  Members of Congress have the benefits. Now, they’re going to be available to all women.”

“For women’s health, this is historic — a really important turning point,” said Judy Waxman, vice president for health and reproductive rights at the National Women’s Law Center.  At present, women pay as much as $50 a month for birth control pills, even if they have insurance coverage, said Dr. Allison Cowett, director of the Center for Reproductive Health at the University of Illinois at Chicago Medical Center.  For many women, this is a financial hardship and a disincentive to practice consistent birth control.  Fully 95 percent of women who have unplanned pregnancies report using contraception only occasionally or never — often because it’s too expensive, according to the Guttmacher Institute, a nonpartisan research organization.  Birth control has been shown to improve maternal and child health, in addition to reducing unwanted pregnancies and abortions.

The guidelines, which would compel insurance companies to cover costs and eliminate co-pays and deductibles, have their critics. Birth control has been controversial since Margaret Sanger opened the United States’ first family planning clinic in 1916 — and ended up in prison for it. While many believe that contraception is the best method to prevent unwanted pregnancies, others support abstinence education. The United States Conference of Catholic Bishops opposes the new guidelines, saying, “Pregnancy is not a disease, and fertility is not a pathological condition to be suppressed by any means technically possible.”  Women’s rights advocates argue that the benefits of free birth control have uses other than preventing pregnancy. “The number of children we have determines how many we need to educate, how many we need to employ,” says Roosevelt Institute Senior Fellow Ellen Chesler.  “The social and economical outcomes of contraception are critical.”

The new guidelines will not apply to religious institutions that offer health insurance to employees.  Not surprisingly, health insurers also oppose the rules.  The Institute of Medicine counters that the “direct medical cost of unintended pregnancy in 2003 was $5 billion, with a savings from contraception that year estimated at $19.3 billion.  With nearly half of pregnancies unintended, there’s quite a bit of room to save money with free contraception.”  One estimate of the cost of birth control for women is between $3,600 and $18,000 over a lifetime, depending on insurance, the form of contraception and other factors.

Nurse Burn-Out, Depression Can Be Fatal to Patients

Tuesday, July 26th, 2011

The horror began last September 14 when an experienced Seattle nurse realized she’d overdosed a fragile baby with 10 times too much medication. The stunned nurse told nearby staff at the Cardiac Intensive Care Unit at Seattle Children’s Hospital what had transpired.  “It was in the line of, ‘Oh my God, I have given too much calcium,’” recalled a fellow nurse.  In the nurse’s 24-year career, all of it spent at Seattle Children’s, dispensing 1.4 grams of calcium chloride — instead of the correct dose of 140 milligrams — was the sole serious medical mistake she’d ever made, according to the public investigation.  “She was devastated, just devastated,” said her partner and co-parent of their two children.  That mistake turned out to be the start of a life that unraveled, contributing not only to the child’s death, an eight-month-old girl, but also to Hiatt’s firing, a state nursing commission investigation — and Hiatt’s suicide at age 50.

This story highlights the twin casualties caused by serious medical errors: The patient is the first victim, the person hurt or killed by a preventable error.  The second victim is the healthcare professional who has to live with the aftermath of making it.

There is no question that patients are the primary concern in a nation where one in seven Medicare patients experience serious harm because of medical errors and hospital infections each year.  Another 180,000 patients die, according to a study by the Department of Health and Human Services’ Office of Inspector General.  That’s nearly twice the 98,000 deaths attributed to preventable errors in the important 1999 report “To Err is Human,” by the Institute of Medicine, which fired up the nation’s patient-safety movement.  In the real world, doctors, nurses and other medical workers who commit errors are often traumatized, with reactions ranging from anxiety and sleeping problems to doubt about their professional abilities – as well as thoughts of suicide, according to two recent studies.

This sad story raises the issue of healthcare provider depression and burnout.  Writing on the website, an anonymous nurse says “While visiting in the lounge one day, we discovered that every nurse there was on an anti-depressant.  I have had ‘Treatment Resistant Depression’ for about 20 years — as long as I’ve been a nurse.  Now I am totally burned out, on major meds, and am seeking disability due to depression/anxiety.  I believe years of long hours, high stress, high expectations and little appreciation (from management, not patients) has contributed to this.  How many other jobs consider you a traitor because you call in sick?  And trying to get off for a sick child is an unforgivable sin.  How many other jobs want you to work overtime on the days you are scheduled, call you at all hours of the night or day when you are off, first pleading with you to come in, then laying a guilt trip on you if you say “NO!”  And let’s not forget the mandatory in-services and CEUs (continuing education units) that take time away from your family.  If any profession should understand the importance of the individuals’ physical, mental, social and spiritual self it should be nursing — -after all we are taught in nursing school about treating the patient as a whole, not just a disease!  Why don’t we treat our staff the same way.”

According to Anthony Cirillo on the Hospital Impact website,“Two studies suggest that nurses working in hospitals are much more susceptible to depression than their counterparts in clinics, schools or other locations, especially if their hospital is high-volume.  A study in Journal of Clinical Psychiatry looked at the relationship between bed occupancy rates and absenteeism and found that those working in units that were 10 percent more crowded than the optimal rate had twice the rate of depressive illness than their counterparts in less crowded units.  The second study, appearing in Health Policy, is based on data from the 2005 National Survey of the Work and Health of Nurses in Canada. While looking at absenteeism in general, the report notes that depression is a “significant determinant” for missed work among RNs and LPNs, and that those who work in a hospital are more likely than those working in other settings to miss work.  One thing we might first observe is that with health reform, things will get much worse before they get better.  At some point, the estimated 35 million newly insured Americans will seek healthcare, potentially burdening the system.  And, of course this all impacts recruitment and retention and even further impacts whether folks choose to enter into the profession.”

According to the Nursing Center website, “Studies have also shown that nurses (the vast majority of whom are women) may be especially at risk.  This study surveyed 150 medical-surgical nurses from three hospitals to determine the prevalence and predictors of depression among female nurses.  All participants had at least a year of nursing experience and worked at least 20 hours per week.  Most (93 percent) were white; they averaged 38 years of age and 10 years’ hospital nursing experience.  Thirty-five percent of nurses had mild-to-moderate depressive symptoms; the most common included restless sleep, poor motivation, feeling bothered, and concentration problems; many reported feeling hopeful, happy, or joyful on only two days (or fewer) during the week before filling out the questionnaire.  Somatic symptoms, stressful major life events, greater occupational stress, and lower income were correlated with the presence of depressive symptoms.  Fatigue and low energy were bothersome to 43 percent of nurses; pain in extremities and joints, trouble sleeping, and back pain were also common.  Having a mortgage or loan of more than $10,000 within the previous year was the most commonly reported (43 percent) stressful major life event.  Others included changes in sleeping habits, vacation, and holidays.  The most highly ranked occupational stressors were having insufficient time to provide emotional support to a patient and to complete nursing tasks, being required to complete many non-nursing tasks (such as paperwork), and inadequate staffing.”

Donald Berwick: Healthcare’s Greatest Motivational Speaker?

Monday, March 7th, 2011

The Centers for Medicare and Medicaid Services (CMS) is planning an exhaustive patient-safety initiative that will draw from already-known strategies for safer care. “Let’s make the best the norm,” said Dr. Donald Berwick, CMS administrator, citing as evidence of the efficacy of such initiatives the unfavorable patient events that – happily — are now virtually nonexistent at some of the nation’s hospitals.  Berwick is renowned for his “100,000 Lives” and “Protecting 5 Million Lives from Harm” campaigns, which he initiated when he headed the Institute for Healthcare Improvement before moving to CMS.

Berwick praised the Patient Protection and Affordable Care Act, as well as the information technology it supports to create the best possible healthcare delivery system.  Both offer tools that will allow coordinated-care plans for patients and encourage caregiver teams to manage those plans.  One of the tools will be accountable care organizations (ACO).  Berwick said the regulations defining ACOs under Medicare as “imminent.”  According to Berwick, the regulations will be in the form of a “notice of proposed rulemaking,” with a 60-day public comment period.  “This will be our first stab at that definition.”

Quality News Today notes that “Motivational efforts and inspirational talk may seem more the bailiwick of Super Bowl coaches than government bureaucrats.  But when one considers that Berwick’s successful career as a national leader in healthcare quality improvement boiled down to fostering an internal drive on the part of individuals and organizations to do better work, the efforts perhaps are no surprise at all.”  Berwick said that CMS’ strategy will focus on building operational excellence; improving care for individuals; integrating care for populations; and improving the health of populations and communities.  “We do have tremendous knowledge about how to make care safe,” Berwick said.  Some organizations have remarkable records in patient safety, but there are only “pockets of excellence.”  Berwick wants to “bring excellence to scale” and believes that CMS is up to the task.  “We can do well with a joyous work force, we can’t without it,” Berwick said,  “I myself will be teaching the first four 90-minute classes on improving the work.”

John Rother, executive vice president for policy for AARP, the Washington-based advocacy group for people 50 and older, applauds Berwick’s emphasis on patient safety. Changes have saved “lives and money,” Rother said.

Unfortunately — and despite excellent intentions — errors still occur in hospitals, even with the new safeguards. Ten years ago, the Institute of Medicine published its landmark report “To Err Is Human:  Building a Safer Health System.”  The report estimated that 44,000 to 98,000 deaths occur every year because of preventable medical errors in American hospitals.  According to Manoj Jain, an infectious-disease specialist and an adjunct assistant professor at the Rollins School of Public Health at Emory University in Atlanta, “But, to make hospitals really safe, we need to take a leap.  We need to build a culture in which patient safety is the priority not just for the quality improvement director but also for every nurse, doctor, administrator, aide, housekeeper, dietary worker and hospital board member.”

Watson Supercomputer Could Revolutionize Medicine

Monday, February 21st, 2011

There has been significant buzz about the IBM supercomputer Watson’s recent appearances on the television quiz show “Jeopardy” and whether the machine will beat Ken Jennings and Brad Rutter, the program’s two superstars. While Watson’s celebrity may be cemented by its television appearances, the supercomputer also has the possibility to transform medicine.  Writing in USA Today, Yong Suh, a medical student at the Johns Hopkins University School of Medicine, says that “The company that revolutionized the personal computer industry in the 20th century has the potential to do the same for healthcare in the 21st century.”  Watson was the victor, winning with a commanding lead of $77,147.

According to Suh, “Performing well on ‘Jeopardy’ and diagnosing sick patients have similar prerequisites: a broad fund of knowledge, ability to process subtlety and ambiguity in natural language, efficient time management, and probabilistic assessment of different possibilities.  Like ‘Jeopardy’ clues, a patient’s symptoms, medical history, physical exam findings and laboratory results present clues that must be synthesized into a differential diagnosis.  While computer systems to assist clinical decision-making have existed for decades, adoption of legacy systems has been hindered by rigid algorithms that require translation of natural language into machine language and heavy reliance on user input.”

Watson has the ability to address two serious problems in healthcare today: deaths due to medical errors and shortage of physicians.  The Institute of Medicine (IOM) has reported that as many as 98,000 deaths a year are due to medical errors – making them the fifth leading cause of death.  Misdiagnosis is frequently the result of cognitive errors physicians make.  Watson’s advanced memory and ability to process information means it can analyze all medical evidence, and minimize bias when making diagnoses.  In terms of the physician shortage, Watson could become a significant technology that forces the medical community to rethink how patients interact with healthcare providers and how the delivery system is organized.

A somewhat contrary view of Watson’s potential for enhancing healthcare is presented by Fahmida Y. Rashid on the website “Medical Center.”  According to Rashid, “Of course, the enormity of the hardware and the algorithmic advances required to make a truly ‘revolutionary’ tool such as this are obviously staggering. Considering that it takes 10 racks of multiprocessor IBM servers with 15 terabytes of memory and a team of varied domain experts writing algorithms for several years to accomplish the NLP advances and lookups to answer ‘Jeopardy’ style trivia questions, one can only imagine what a truly useful cybernetic medical assistance system would look like.  It should also be remembered that Watson does not think.  Humans do.  I believe a machine even close to passing a ‘New England Journal of Medicine Turing test’ (a measure of a machine’s ability to demonstrate intelligence will be a long time in coming.  Until then, we should be encouraging better support for human physicians struggling to use their medical expertise in a sea of bureaucracy, stress and overwork (part of which will increasingly be a struggle with mission-hostile health IT).”

More and more frequently, physicians are using hand-held devices – such as smart phones – to access information on their patients.  This way, they do not have to rely on memory to determine exactly what medications a particular patient is taking.

Johns Hopkins’ Suh also notes that “The prospect of using Watson in medicine also raises some difficult questions.  What will be the new roles for physicians, nurses, technicians and other healthcare professionals when the current hierarchy, delineated by varying levels of medical knowledge, is flattened by an intelligent machine?  What will be the impact on the practice of humanistic medicine?  How will patient outcomes be affected by patient-machine interactions? Who will be held accountable for medical errors that arise from decisions made by a machine?”  Only time will tell.

Study: U.S. Needs a Comprehensive National Health Strategy

Monday, February 7th, 2011

The United States needs to formulate a consistent national strategy to address life expectancy and overall health, according to recent report from the Institute of Medicine (IOM).  “Although the United States invests over 17 percent of its gross domestic product on medical care – far more than any nation – we lag behind other countries in several measures of health,” said Marthe Goldman, chairwoman of the committee that wrote the report.  “Our understanding of more effective and efficient strategies for improving health is hampered by inadequacies in the current system.”

The IOM report, which was sponsored by the Robert Wood Johnson Foundation,  notes that the Department of Health and Human Services (HHS) should take the lead to coordinate and provide pertinent health information and statistics to Americans.  Additionally, HHS should assist in efforts to integrate population health data collection, analysis and reporting, as well as offer guidance on how to develop health indicators and analyze the effects of these over time.  Finally, the nation should adopt a single-summary measure of the population’s health to serve as the GDP equivalent for the health sector.

Typically, the United States and other nations have used death rates as the standard measure of population health.  “However, life expectancy is a blunt tool.  It cannot capture the diminution in life experience and capacities that is associated with the chronic illnesses and injuries that are of increasing prevalence in modern society,” according to the report.

The International Health Partnership, which is dedicated to improving health services and health outcomes, issued a white paper in July, 2009, assessing national health strategies and plans.  According to the paper, “The way a joint assessment is done will be unique to each country, but based on some key principles:  it will be country demand driven; be country led and build on existing processes; be as light as possible without being superficial; include an independent element; and engage civil society and other relevant stakeholders.”

Australia has taken the lead in setting a comprehensive national healthcare strategy.  With the goal of being the world’s healthiest country by 2020, the strategy set in April, 2008, by the National Preventative Health Task Force for the Minister for Health and Ageing focuses on eating healthier foods; reducing obesity; smoking cessation; and addressing the health and social issues associated with heavy drinking.

Expectant Parents Beware! Not All Health Plans Cover NICU

Wednesday, January 19th, 2011

The majority of expectant parents know that their obstetrician and the hospital where their baby will be born participate in their health insurance network.  If the baby is born prematurely or needs special care in the neonatal intensive-care unit (NICU), however, the new parents may get a nasty surprise — this level of care may be out of their network.  “Some hospitals do contract with other clinical provider groups to run their NICUs,” said Marie Watteau, the American Hospital Association’s (AHA) director of media relations.  “When selecting a hospital, pregnant women should…verify that all hospital care, including NICU care and physician services, are in network.”

Three quarters of babies who require costly NICU care are born prematurely; the remaining 25 percent have other medical problems.  In 2009, one baby in eight was born prematurely, defined as before 37 weeks of gestation, according to the Centers for Disease Control and Prevention’s National Center for Health Statistics.  Although premature birth rates have fallen recently, they are still 30 percent higher than in 1981.  The Institute of Medicine reports that medical bills and other premature-related costs totaled $26.2 billion in 2005.  That’s $51,600 per premature baby.

Depending on weight and other medical criteria, some premature babies needing NICU care could be declared disabled under the Supplemental Security Insurance program.  That would make the baby eligible for Medicaid.  Although families typically must meet income guidelines to be eligible for Medicaid, “while the child is in the institution, the child’s income alone is what’s looked at for Medicaid purposes,” according to Mary Kahn, a spokeswoman for the Centers for Medicare and Medicaid Services.  After the baby is discharged, however, it is no longer eligible for Medicaid unless the parents meet the income guidelines.

It’s Time to Shed Light on Healthcare Spending

Tuesday, November 16th, 2010

As much as 40 percent of American healthcare spending brings no benefit.  The healthcare system in the United States significantly under performs every other industrialized nation, with the result that too many Americans either die or are harmed every year.  This is the opinion of Louise Probst, Executive Director of the St. Louis Area Business Health Coalition.  Writing for the Commonwealth Fund, Probst says that “Since the Institute of Medicine’s (IOM) executive summary to its landmark report To Err is Human was published in the Journal of the American Medical Association, the IOM estimate that up to 30 percent of all healthcare expenditures pay for care with little or no health benefit fails to shock.  Experts now predict that 40 percent or more of all spending has little or no benefit.  Meanwhile, the average cost of health insurance for a family of four has grown to more than $14,000 annually.”  The Commonwealth Fund promotes a high-performing healthcare system that achieves better access, improved quality, and greater efficiency, particularly for society’s most vulnerable — low-income people, the uninsured, minority Americans, young children and the elderly.

According to Probst, “High healthcare costs create significant suffering for American families, businesses and governments.  Other leading nations spend half of what we do on healthcare, making it increasingly difficult for families to retain their standard of living and for American businesses to compete in a global economy.”  Each and every American pays the nation’s healthcare tab indirectly through smaller paychecks, higher taxes and health benefit costs hidden in the price of non-healthcare goods.  Compounding the situation is the fact that the jobs that the nation needs to make up for these costs are being outsourced to nations where healthcare is cheaper.  “The outcome is soberly clear:  In 2009, one of even seven Americans lived in poverty and 50 million Americans were uninsured, according to the U.S. Census,” Probst said.

Why is it that healthcare consumers know so little about spending and the waste associated with it?  Probst says that “Despite consistent calls for price and quality transparency from the business community since the ‘buy-right’ movement of the early 1980s, the IOM’s call for action more than a decade ago, and the sustained effort of many labor and consumer groups, our nation has yet to achieve meaningful transparency.  As long as price differences remain opaque to patients and their physicians, there is little hope for improving the affordability and efficiency of American healthcare.”