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More skepticism of hospitals’ role in promoting health, health care for the homeless, & concerns about quality metrics

December 18, 2014

In order to bring you more of the news you want to read, RightCare Weekly summarizes and interprets three important articles and provides headlines linking to the many other articles and editorials you’ll find interesting. As always, RightCare Weekly presents articles related to moving our health care system toward the right care for all patients.

Join the conversation: Post your comments in our new section at the bottom of this page.

 

Features:

  • We asked last week if hospitals are playing a significant role in advancing good health in our communities. Andy Lazris, MD, a Maryland primary care, geriatric physician responded, stating he doesn’t think so. Later in the week, he elaborated his position. “Hospitalization may be dangerous for patients, it may be bankrupting the system, but it is still encouraged on every level,” he wrote. “Involve practicing primary care doctors in the discussion, transfer the decision making and financial power away from hospitals and to patients, and the revolution will begin.”  As always, we welcome comments from our readers and will consider submitted guest blogs.

 

  • An innovative initiative to help treat the sickest in the homeless population was the brainchild of Mitchell Katz, MD, director of L.A. Country Department of Health Services and drew the attention of the PBS NewsHour last week. Katz advocates that federal funds from Medicaid expansion be used to purchase or build housing for the homeless. The cost of caring for such patients, who are often chronically ill and heavy users of emergency departments, range from $90,000-$150,000 a year, according to the segment. “For the homeless,” Katz said, “housing is a relevant health service.” Katz is a keynote speaker at the Lown Institute third annual conference, Road to RightCare: Engage, Organize, Transform, March 8-11, 2015, at the Omni San Diego Hotel. (More on the conference, in the announcements section below.)

 

  • Joanne Lynn, MD, of the Altarum Institute spoke at our last annual conference about her work developing more effective elder care systems for communities. Now, in her blog on medicaring.org, and also in our commentaries section, she says efforts to improve hospital quality by penalizing hospitals with high Medicare re-admission rates are, in fact, hitting hospitals that have successfully reduced overall admissions, at the same time that they keep the rate of re-admissions constant. But since the metric looks at re-admission rates, many high-quality hospitals are facing stiff financial penalties. Her point is that it’s difficult to design effective quality metrics for health care, but getting quality metrics right is essential when they’re tied to financial incentives.

 

QUESTION: Do you know of another quality metric that does not truly capture its intent? Please tell us in the comments section below.

 

Announcements:

  1. On behalf of RightCare Weekly and the Lown Institute, we wish you and your loved ones a happy and healthy holiday season. If you enjoy reading RightCare Weekly, we hope you’ll consider sharing it with your friends and colleagues! We’ll be taking a short break, but we’ll be back on January 8.

 

  1. We can’t wait to hear Dr. Harlan Krumholz’s keynote at our third annual conference, Road to RightCare: Engage, Organize, Transform, at the Omni San Diego Hotel, March 8-11 next year. Join your colleagues in advocating for health care that delivers the right care, compassionately and effectively. Register now.

 

  1. The Lown Institute, in collaboration with the Do No Harm Project, is calling for applications to the first Do No Harm Project Vignette Competition. The top two vignettes will be eligible for conference scholarships. Applications are due by January 7, 2015. To learn more, read here or apply now.

 

Headlines:

Patient safety

  1. Are Midwives Safer Than Doctors?New York Times editorial
  2. Oversold prenatal tests spur some to choose abortions – Beth Daley, Boston Globe
  3. Scientists tallied up all the advice on Dr. Oz’s show. Half of it was baseless or wrong. – Julia Belluz, Vox
  4. Doing more, expecting nothing for it – Aaron Carroll, The Incidental Economist
  5. Long Radiation Treatments Called Unnecessary in Many Breast Cancer Cases – Gina Kolata, New York Times
  6. NY Governor Must Decide Today On Shielding Doctors Who Use Unproven Lyme Disease Treatments – Steven Salzberg, Forbes

 

Regional variation

  1. How residency programs are training doctors to waste money – Sarah Kliff, Vox
  2. Physicians Trained in High-Cost Regions Spend More – John Commins, HealthLeaders Media
  3. Geographic variation and efficiency (in charts) – Austin Frakt, The Incidental Economist

 

Social determinants of health

  1. Doctors Dole Out Prescriptions for Exercise – Laura Landro, Wall Street Journal
  2. If Guns Threaten Health Like Smoking Or HIV, What Should Doctors Do? – Martha Bebinger, WBUR
  3. Doctors at St. Mike’s launch project to address root causes of poor health – Sara Mojtehedzadeh, Toronto Star
  4. Medicine’s Unrelenting Race Gap – James Hamblin, The Atlantic

 

Global health

  1. Reforms and right steps towards universal health coverage can prove transformative for India – Lawrence H. Summers, The Economic Times

 

Patient-centered care

  1. Infusionarium Aims to Take Trauma Out of Chemotherapy for Young – Jan Hoffman, New York Times Well blog

 

End-of-life care

  1. ‘Warehouses for the dying’: Are we prolonging life or prolonging death? – Peter Whoriskey, Washington Post
  2. Doctors struggle with telling patients the end is near – Stacey Burling, Philadelphia Inquirer
  3. A debate over end-of-life care – Michael Vitez, Philadelphia Inquirer

 

Health services research data access

  1. How much Medicare data are being withheld anyway? – Austin Frakt, The Incidental Economist
  2. The value of identifiable research data – Austin Frakt, The Incidental Economist
  3. Then again, maybe the rules do prohibit CMS disclosures – Nicholas Bagley, The Incidental Economist
  4. A statement from SAMHSA on withholding data – Nicholas Bagley, The Incidental Economist
  5. A new spreadsheet reveals more about what research data CMS withholds – Austin Frakt, The Incidental Economist

 

Medical training

  1. Stop Wasting Doctors’ Time – Danielle Ofri, New York Times op-ed
  2. 5 Simple Habits Can Help Doctors Connect With Patients – John Henning Schumann, NPR Shots blog

 

Costs of care

  1. Forbidden Topic in Health Policy Debate: Cost Effectiveness – Aaron Carroll, The Upshot
  2. The Odd Math of Medical Tests: One Scan, Two Prices, Both High – Elisabeth Rosenthal, New York Times
  3. Health spending — under control? – Robert Samuelson, Washington Post op-ed
  4. The Punishing Cost of Cancer Care – Mikkael A. Sekeres, MD, New York Times Well blog

 

Payment system

  1. UnitedHealthcare Tests a Flat Rate for Cancer Treatment – Anna Wilde Mathews, Wall Street Journal
  2. Obamacare paradox: Medicaid is expanding, but doctors are facing a huge pay cut – Jason Millman, Washington Post
  3. Study: Doctors Paid More for Multiple Procedures Than for Multiple Patients – Andrew Soergel, US News

 

Elder care

  1. This Nursing Home Calms Troubling Behavior Without Risky Drugs – Ina Jaffe and Robert Benincasa, NPR
  2. Death in Bronx Shows Vulnerability of State’s Nursing Home Residents – Tatiana Schlossberg and Nina Bernstein, New York Times
  3. U.S. Health Care Lags Worldwide for Those Over 65 – Paula Span, New York Times New Old Age blog

 

RightCare Weekly is made possible through the generous support of the Robert Wood Johnson Foundation