Summary: If hospitals pay more attention to how they discharge patients, and what happens to them after they leave, Medicare could save billions. Under the reform legislation, beginning in 2011 Medicare will refuse to pay for an excessive number of preventable readmissions. Over at the New American Foundation’s “Health Care Dialogue” Joanne Kenen reports on research that shows that we do know how to reduce “bounce-backs.”  And hospitals aren’t waiting for 2011, they are already finding creative solutions to the problem.
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In a post titled “Slowing Down that Revolving  Readmissions Door" the New America Foundation’s Joanne Kenen writes about avoidable readmissions. “I once interviewed a patient who literally could  not remember how often he had been hospitalized within just a few months,” Kenen recalls, referring to a story published in the Washington Post last year.

There, she reported that “one of five Medicare hospital patients returns to the hospital within 30 days–at a cost to Medicare of $12 billion to $15 billion a year—and by 90 days the rate rises to one of three, according to an analysis of 2007 data by Stephen Jencks.”  Within a year, two out of three are back in the hospital—or dead—says Jencks who consults on this issue for the Institute for Healthcare Improvement (IHI).

This is money that health care reformers could use as we expand care to the uninsured. It’s worth noting that what many call “Medicare cuts” are really “Medicare savings”—billions that could be reclaimed if we rescued patients from that revolving door.

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Summary-Not long ago, a New York Times editorial repeated a statistic that you may have heard before: "one in four Americans are projected to die of cancer."  Fortunately, this is a complete fabrication. For most Americans–including the vast majority of Times' readers– the risk is far lower.

A recent New York Times editorial announced that the war on cancer is reaching "a state of crisis."   Citing the Institute of Medicine (IOM), the Times called for boosting funds that support cancer trials while also raising the academic rewards to encourage researchers to run clinical trials. Appealing to readers' pre-dawn terrors, the editorial concludes by declaring that "Nearly one in four Americans are projected to die from cancer. It is vitally important to find the best treatments for them."

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Over on “Movin’ Meat,” an ER doctor living in the Pacific Northwest tells a true story titled “Where romance and medicine collide.”

 I suspect that many readers will view this tale as a welcome  respite from the details of health care legislation.  But I should warn that  some might find it in questionable taste. The opening should help you decide: 

“A patient was brought in around midnight as a ‘possible stroke.’ She was a sixty-something woman who had suddenly become unresponsive.  She and her husband had been making love at the time, and he noticed that she was no longer conscious.” [Good For Him!- mm]

Many thanks to the “Happy Hospitalist” for calling attention to this post

You can find the full post here.

Summary: In Part 3 of “Myths & Facts about the Impact of Reform on Hospitals and Patients Who Need Hospital Care,”  I addressed the fear that  cuts in Medicare spending will threaten the financial health of the nation’s hospitals. Reform’s critics argue that hospitals already lose money on Medicare patients, and that if the government tightens its belt, they will lose revenues that they sorely need if they are going to provide high quality care. The truth is that, today, more efficient hospitals make money or at least break even on Medicare beneficiaries. The Medicare “cuts” will not affect needed care; they aim only at reducing waste, infections and inefficiencies that hurt patients. I also explain how Medicaid’s expansion will help hospitals.

Here, in Part 4, I respond to rumors that because government pays less than private insurers, hospitals will continue to shift costs to insurers, and thus, insurance premiums will rise. The truth is that private insurers are over-paying some hospitals, not because Medicare pays too little, but because large brand-name hospitals have more clout in the marketplace than insurers, and can force them to accept high charges. As reform regulations put insurers under financial pressure, it’s likely that they will begin to fight back. Meanwhile, states will follow Massachusetts in taking a closer look at “marquee hospitals” that charge more for basic services, without providing better care.

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Summary: I’m crossing posting this piece from Dr. Len’s Cancer Blog http://www.cancer.org/aspx/blog/Comments.aspx?id=353

because it seems to me a very wise and balanced assessment of what Provenge means—and doesn’t mean—for patients, for Medicare and for society as a whole. I’ve highlighted some sentences, and inserted a few comments in italic. Many thanks to HealthBeat reader Greg Pawelski for calling attention to this piece.

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Today’s announcement by the Food and Drug Administration (FDA)   (FDA) that they approved Provenge for the treatment of advanced, hormone resistant prostate cancer is significant for several reasons, not the least of which that it offers new hope to men with advanced prostate cancer where progress in treatment has been very slow in coming.

Equally important, it closes the door on decades of unfulfilled hopes that tumor vaccines and immunotherapy would eventually play a significant role in cancer treatment.  We now have a demonstrated success, which is especially important given the many near-misses that have occurred over the years.  This reinforces for many the dream that one day we would be able turn on the body’s own defense mechanisms as one more approach to treat (or one day—perhaps—prevent) certain cancers.

As exciting as this announcement is, and with all of that hope it brings to patients, their families and the physicians who treat them, it is important that we keep this development in perspective for what it is: one small step in an otherwise complex and still difficult situation.  It is not a miracle cure, especially for men with very advanced, symptomatic disease.

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For a compendium of some of the most provocative healthcare posts of the past two weeks, see Health Wonk Review, hosted this time by Health Care Economist Jason Shafrin.  For instance:

• The Incidental Economist wonders whether the Affordable Care Act is just an excuse for income redistribution.
• Georgians for a Healthy Future analyzes the Illinois Supreme Court’s decision to strip not-for-profit Provena Covenant Medical Center of its exemption from property tax, stating that the hospital did not provide enough charity care to justify that exemption. [Note under health reform legislation non-profit hospitals will have to justify their tax-exempt status every three years–mm ]
• The Health Affairs Blog has a way to add some teeth to the health reform mandate: tying your credit score to whether or not you have health insurance [They are going to have to do something to stiffen the penalty or young, healthy people won’t join the pool and insurance will be extremely expensive.—mm]—
• HealthCare Renewal says that fining large health care companies for criminal activities will not change the firms’ behavior. An idea to convince health care executives to follow the rules is to allow for the prosecution of these corporate leaders. –
• Will the FDA begin regulating medical software? The Health Blawg says the answer may be yes as the FDA has asserted the right to “regulate software as a device, not only in the context of radiology, but also in the context of electronic health records.

These are just highlights. Click here for the full review.

 – The FDA Approves Provenge, a Prostate Cancer “Vaccine”

Summary: Today, the news broke that the FDA has approved a drug that could extend the lives of some patients suffering from late-stage prostate cancer. For Wall Street, it’s a big story. For cancer researchers, it could represent a break-through. For some of today’s patients, it may be good news—if they can afford the drug.

The headlines are everywhere:

“Dendreon Hits the Jackpot” 

“FDA approves breakthrough cancer therapy Provenge”

“Dendreon (DNDN) is trading at $53.50 after last trading at $45.50 before the halt“

“Dendreon: Provenge boosts survival 40 pct”

What does Provenge actually do? The company calls it a “vaccine,” but it doesn’t prevent prostate cancer. Nor does it cure prostate cancer. Contrary to what you may have read, it doesn’t “save lives.”

 It extends the lives of men suffering from late-stage prostate cancer by an average of 4 months. The patients in a trial of 512 men lived a median time of 25.8 months if they received Provenge, compared to 21.7 months if they got the  placebo. (I have no idea why Reuters claims that Provenge boosts survival by 40 percent.)

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Summary: Earlier this month, an FDA committee voted on whether it should tighten the rules for generics to make certain that they are exactly the same as brand-name drugs. Medical research says that they are equivalent in all of the important ways. But critics have been raising questions, stirring controversy in the media. HealthBeat’s Naomi Freundlich took a look at the problem in January. Recently, Merrill Goozner, who is a member of the FDA committee, reported on its decision. Why did the committee decide not to jack up the requirements for generics? What is it doing to ensure that generic manufacturers are meeting safety standards? Why is the FDA’s decision politically important at this point in time? A final question : Is the generic version of the anti-depressant Wellbutrin really as effective for all patients?

Imagine that you are taking a medication that works well for you. But the monthly co-pay is $75.  This is more than you can afford. A generic is available, and the co-pay is only $10. The FDA says that it is just as good. But when you take it, you’re not sure. It sometimes seems that the pain is worse—or that you are more tired, or more depressed than you were when you were taking the brand-name drug. How can you be certain? When you try to think about how you feel, you realize that your mind is trying to diagnose your mind.  It’s a standoff that leaves you totally flummoxed.

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Summary: An exceptional essay in the April issue of Lancet explores why even healthy, asymptomatic people are terrified when they hear the word “cancer.”  Robert Aronowitz, an internist and professor of the history and sociology of science at the University of Pennsylvania, describes “cancerphobia,” a term coined in the 1950s by a Cleveland Clinic surgeon who suggested that our “fear of cancer can cause even more suffering than cancer itself . . . public health campaigns with their constant calls for surveillance and aggressive treatments combine to increase cancer fears, which in turn has led to demands for increasingly aggressive intervention and more surveillance.”  Over-testing leads to over-diagnosis and over-treatment. A study just published in the Journal of the National Cancer Institute offers disturbing numbers on the magnitude of “over-diagnoses,”  defined as “the diagnosis of a ‘cancer’ that would otherwise not go on to cause symptoms or death.”

Even when we are told that tests are ineffective or of little benefit, testing gives many patients a false sense of control over their fears. Meanwhile, cancerphobia has spawned an enormous, lucrative industry.

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The very word “cancer” inspires a degree of fear that “heart attack,” “stroke” or even “kidney failure” do not. Any of these conditions can kill. Even worse, in rare cases, a stroke can leave a patient “locked in” — conscious and able to think, but unable to speak or move.

Yet, somehow, to many of us, the idea of cancer seems more horrifying.  Perhaps it is because the word calls up an image of something evil invading the body, and then spreading. It is a growing, living thing, crawling inside one’s own body, preying on the tissue.

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Note: The “summary” below is a HealthBeat pilot project. Some readers have noted that HealthBeat posts are, well . . . a tad long. At the same time, many seem to appreciate comprehensive, in-depth coverage of a topic. HealthBeat has a niche, and I wouldn’t want to desert those readers.   So I’ve decided to experiment with offering what a medical journal would call an “abstract” at the beginning of each post. Since HealthBeat isn’t a medical journal, I’m just calling it a “summary”. Many thanks to friend and fellow blogger Joanne Kenen  for this suggestion. Please let me know what you think about the change. mm.

Summary: Short-term, at least, hospitals are winners. When it came to negotiating with reformers, they “got into the tent early,” and the reductions in Medicare increases that they accepted will be offset by an influx of paying patients. Granted, government payments to hospitals that take a disproportionate number of uninsured low-income patients will be slashed, but because there will be many fewer uninsured patients, most hospitals will come out ahead. Those that continue to care for larger share of those who can’t pay will receive additional payments.

Fear-mongers fret that cuts in Medicare spending will threaten the financial health of the nation’s hospitals: they argue that hospitals already lose money on Medicare patients. The truth is that, today, more efficient hospitals make money or break even on Medicare beneficiaries. Hospitals that run a tight ship save money and offer better care. Unfortunately, waste remains an enormous problem in many U.S. hospitals, and waste and poor quality care go hand in hand.

Medicaid’s expansion also will help hospitals. True, Medicaid payments to hospital are low, but in the past, hospitals were treating many patients who didn’t qualify for Medicaid, but were too poor to pay their bills. Low payment beats no payment.

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