November 12, 2015
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 healthcare system toward the right care for all patients.
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In Washington Monthly, authors Anne-Marie Slaughter and Ben Scott describe the evolution of think tanks and urge that now they need to reconnect with America. The authors propose a new model, which “blends conventional policy research with local organizing, coalition building, public education, advocacy and bottom up projects that generate and test new ideas… a heady brew of what makes America great—a deep commitment to self-government plus an insatiable spirit of private enterprise to invent solutions without waiting for permission or help.” An example of this? They cite the Lown Institute. In the Lown spirit of “inventing solutions” is a letter posted this week on BMJ, signed by dozens of clinicians and scientists and addressed to US presidential candidates, asking each for a statement on whether they “support access to clinical trial data held by federal agencies, irrespective of topic, sponsor, country in which the trial was run or results.” Shannon Brownlee, MSc, and Vikas Saini, MD, Lown Institute senior vice president and president, respectively, are among the signatories, as are David Newman, MD; John Abramson, MD, Peter Doshi, MD, and other members of RightCare Alliance Councils.
Have you ever wondered why primary care doesn’t include dental care – or why a visit to the dentist could not include a physical exam, especially for poor people who have inadequate access to either or both? An innovative program at Harvard School of Dental Medicine hopes to bridge this healthcare gap by assigning faculty from the medical school once a week to train dental students to conduct physical exams, including taking comprehensive histories, on their dental patients. Acid reflux, high blood pressure, diabetes and other chronic conditions can leave traces in the mouth, and when detected, the dental students can refer to PCPs and monitor their progress. Because some patients see their dentist more often than they see their physician, this program, featured in Stat News, aims at treating the whole patient, not merely a part of him or her—a welcome inclusion for people who think we should be treating the whole person. New York University pioneered a similar effort nine years ago. Judith Haber, executive director of New York University’s Oral Health Nursing Education and Practice Program, explains: “We’re putting the mouth back in the head, and putting the head back in the body.” Nurse practitioner students from Northeastern University are also scheduled to work with the dental students in the coming months, adding their expertise to the mix of right care.
We write often about U.S. healthcare spending because it is out of control and poses significant opportunity costs if we want to improve access to good care and improve the nation’s health. An article in the Washington Post this week underscores (even more) how unjustified costs are and how flawed our delivery system is, too. When complications or mistakes happen in the hospital and additional care is required to correct or treat the outcome, who is responsible for paying the unexpected bill? Take, for example, the case featured, a standard colonoscopy, where the patient’s colon was perforated, requiring emergency surgery. The patient argues that what happened to him was an avoidable error and that the hospital should be responsible for the added care costs. But the hospital insists the punctured colon is a known risk for the procedure. Follow up treatments totaled $600,000 and ate up the patient’s life savings. Malpractice remedies are not always an option, as noted in the article, because many attorneys will not take cases on contingency or when it’s not very clear that the provider was negligent. True medical errors cost the nation $19.5 billion in 2008, and most of that was for extra care. At times, insurers can intercede on behalf of patients. While some hospitals offer to pay for care that follows errors, a large majority do not. Leah Binder, of the Leapfrog Group, which grades hospitals on various measures, complains, “You would expect if (providers) make the mistake, they would make you whole. But that is not what happens. In health care, you pay and you pay and you pay.” One issue the article in the Post did not examine: how well was the patient informed of the risk of perforation? Multiple studies show that patients are often in the dark when they consent to procedures, including screening tests.
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