Better care with ‘Medicaring,’ cancer center ads, and physician survey results

July 14, 2016

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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Joanne Lynn, MD, believes we have our priorities wrong when it comes to caring for the frail elderly. As a leader in Medicaring Communities, an initiative of the Altarum Institute, she advocates for plans that reflect personal goals and which include services largely provided in the home setting, instead of in healthcare facilities. Now a study conducted by the Institute, where she is director for the Elder Care and Advanced Illness Center, shows Medicaring Communities also actually saves Medicare $269 to $537 per person per month. Four communities, Akron, OH; Milwaukie, OR; Queens, NY; and Williamsburg, VA served as test simulations. Findings from the study were published this week in the Milbank Quarterly and show that better care at lower cost for elderly Medicare patients is possible. Medicare, however, will need to reinvest savings to strengthen nonmedical supportive services in the community, such as home-delivered meals, transportation, and relief for family caregivers. Lynn, an authoritative voice on elder care, was recently interviewed for the Lown Institute blog, and has keynoted at the Lown Annual Conference last April. By 2030, it’s estimated that there will be 9 million Americans age 85 or older. The need for better care is clear; the only question is how to build the political will to redirect Medicare dollars.

Walk into any academic medical center and many community hospitals and you’ll find the most elegantly appointed wing is devoted to treating cancer. Cancer services are highly profitable for hospitals, many of which have turned to consumer advertising to bring in more dollars. Reuters reports on a study published this week in JAMA Internal Medicine, finding that cancer hospital advertising tripled between 2005 and 2014 in the United States reaching $173 million. Television ads alone accounted for $80 million in 2014. Just 20 of the existing 890 cancer centers led the way, claiming 86 percent of all cancer ad expenditures. A study co-author, Linda Vater, MPH, told Reuters the ads, which are long on emotion and short on facts about benefits, risks or costs, “may persuade patients to pursue high-cost treatments with a low likelihood of improving outcomes.” In a companion editorial in JAMA IM, Lisa Schwartz, MD and Steven Woloshin, MD voice concern over the false ad-hype. “The advertisements of many institutions implicitly or explicitly state that patients with cancer will live longer or better if treated at their hospital. Yet these claims cannot be substantiated because valid methods are lacking to compare cancer survival statistics (unlike cardiac surgery complications) or quality of life across hospitals.” That’s putting it politely. Hospitals are preying on vulnerable patient fears to enhance revenue. So much for being patient-centered.

In his Forbes column, Robert Pearl, MD, explains why American healthcare continues to produce poor outcomes, underscoring results from a recent survey of 30,000 patients and 600 physicians, conducted by Nielsen and commissioned by the Council of Accountable Physician Practices, which Pearl heads. The survey focused on three areas: patient access to care during evenings and weekends; information technology designed to improve care; and physician communication around preventive care. Only a third of physicians indicated they are available to patients during the off hours, and only 38 percent of patients said they are able to obtain physician advice by phone during those hours, leaving many to seek relief in more costly settings like the ER. Half of the physicians surveyed said they are not able to share medical information (EHRs) with other physicians. Regarding chronic illness prevention, only 14 percent of patients said their doctors discussed the topic, while 89 percent of the doctors said they did. Pearl, who heads the Kaiser Permanente Federation, a salaried group practice, points out that fee-for-service payment discourages doctors from investing sufficient time in prevention conversations. “If the frequency of chronic disease continues to rise,” Pearl said, “our nation will experience even lower quality and higher costs than those we see today.”


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