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09/05/2017

Upcoming Podcasts: September 25th and 26th

On September 25, I'll interview Eric Weinberg, co-author with Donna Shaw, of, Blood on Their Hands: How Greedy Companies, Inept Bureaucracy and Bad Science Killed Thousands of Hemophiliacs.   The authors write, "most people with severe hemophilia who regularly infused commercial clotting drugs between 1980 and 1985 contracted the AIDS virus."  How this happened and the resulting legal battle to hold the pharmaceutical industry accountable is the subject of their work.  

On September 26, I'll interview Dr. Haider Warriach concerning his recent work, Modern Death, How Medicine Changed End of Life.  Among other topics he addresses in his work is euthanasia or physician assisted suicide (now legal in five states and DC) and terminal sedation. 

08/24/2017

Review of Elisabeth Rosenthal's "Am American Sickness" (August 24th)

Dr. Elisabeth Rosenthal's recent, "An American Sickness, How Healthcare Became Big Business and How You Can Take It Back," has received considerable attention.  Here is my review of her work titled, "Healthcare as a Moral Universe," i.e., at: http://thehealthcareblog.com/blog/2017/08/21/healthcare-as-a-moral-universal/.

If you're interested in how we find ourselves in a situation where, as Dr. Rosenthal notes, health care "attends more or less single-mindedly to its own profits," I'd recommend Stephen Metcalf's recent, "Neoliberalism, The Idea That Swallowed the World." It is at: https://www.theguardian.com/news/2017/aug/18/neoliberalism-the-idea-that-changed-the-world.

 

08/08/2017

The National Academy of Medicine's "Effective Care for High-Need Patients," A Conversation with Melinda Abrams (August 14th)

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Recently the National Academy of Medicine (NAM) (formerly the Institute of Medicine) released it's "Effective Care for High-Need Patients, Opportunities for Improving Outcomes, Value and Health."  The report attempts to address a long-standing problem in health care delivery, e.g., five percent of patients ("high-need" patients) account for, or consume, 50 percent of health care resources.  That is if these patients were identified in a more timely manner and better managed overall health care spending could be substantially reduced.   Beyond the complexities involved in managing care for these highly co-morbid patients, the US does a comparatively poor job of coordinating or blending clinical care with non-clinical social service supports these patients need to mitigate their functional status limitations.     

During this 28 minute conversation Ms. Abrams discusses among other things the NAM work group's efforts to calculate methods for identifying high-need or super utilizers, or more generally developing patient categorization schemes, the importance of accompanying clinical care with social service supports for those patients with functional status limitations, how/why the 14 profiled providers in the report are able to provide comprehensive quality care for these patients, and the need for improved reimbursement models to allow for or support such care. 

Ms. Melinda Abrams is currently Vice President at The Commonwealth Fund.  Since 1997 she has worked on, among other Abramsprojects, the Fund's Task Force on Academic Health Centers, the Child Development and Prevention Care Program and most recently has led the Patient-Centered Coordinated Care Program.  Ms. Abrams has served on numerous national boards and committees for federal agencies and private organizations and as a peer-reviewer for several health care journals.  She is the recipient of the Champion Award from the Primary Care Development Corporation and a Primary Care Community Research Leadership Award from the Patient Centered Primary Care Collaborative.  Ms. Abrams earned her undergraduate degree from Cornell and her M.S. in health policy and management from the Harvard School of Public Health. 

The NAM report is at: https://nam.edu/effective-care-for-high-need-patients/

For more on the Commonwealth Fund's work go to: http://www.commonwealthfund.org/ 

08/04/2017

The MACRA Proposed Rule: The Administration (Largely) Takes a Pass on Medicare Reform (August 4th)

In late June the administration released its 2018 proposed MACRA (Medicare Access and CHIP Reauthorization Act) rule.  The largest proposed change is to, again, exclude approximately two-thirds of Medicare (Part B) physicians and other eligible clinicians (ECs) from having to participate in MACRA's Merit-based Incentive Payment System (MIPS) that financially rewards or punishes ECs for performance based on quality measures, improvement activities and health information technology use. This performance year, 2017, over 800,000 ECs are excluded and the administration, namely CMS, is proposing to exclude over 900,000 ECs from MIPS in performance year 2018.  Why this is a problem for those excluded, for those included and for Medicare beneficiaries as well is discussed in my essay, "The Many Problems with Medicare's MIPS Exclusion Threshold," posted yesterday on the Health Affairs blog.   

See: http://healthaffairs.org/blog/2017/08/03/the-many-problems-with-medicares-mips-exclusion-thresholds/

 

08/03/2017

David Wallace-Wells Discusses His Recent Essay, "The Uninhabitable Earth" (August 3rd)

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Approximately three weeks ago New York Magazine published David Wallace-Well's 7,500 word essay "The Uninhabitable Earth, Famine, Economic Collapse, A Sun That Cooks Us: What Climate Change Could Wreak - Sooner Than You Think."  The article has to date been downloaded over 4.5 million times.  It is the most read essay the magazine has ever published.  The essay begins with, "If your anxiety about global warming is dominated by fears of sea-level rise, you are barely scratching the surface of what terrors are possible, even within the lifetime of a teenager today."  The work goes on to discuss worst case effects by the end of this century should carbon emissions or global warming not be successfully addressed.   

During this 36 minute conversation Mr. Wallace-Wells discusses what prompted him to write the essay.  He summarizes his findings, discusses Jim Hansen's concern climate scientists may be undermining their ability to effectively communicate the threat via what Hansen terms "scientific reticence," what, if any, edits he would make after learning the scientific community's response to the essay, and how hopeful he is whether carbon tax, carbon capture and other policies will avoid atmospheric warming by four, five or more degrees Celsius over the next several decades.

David Wallace Wells is deputy editor at New York Magazine.  His 2015 cover story about the epidemic of honey bee deaths, Wallace Wellsthe first magazine story to put the blame on neonicitinoid pesticides, is now accepted science.  He joined the magazine as literary editor in 2011 and became features director in 2016.  Before joining the magazine he was deputy editor at The Paris Review where he edited and published writers including Ann Beattie, Werner Herzog and Jonathan Franzen.  Previously Mr. Wallace-Wells served as The New York Sun's books editor.  Mr. Wallace-Wells graduated from Brown University with a degree in history.    

Mr. Wallace-Wells essay is at: http://nymag.com/daily/intelligencer/2017/07/climate-change-earth-too-hot-for-humans.html.   

The noted Popovich and Pearce article, "It's Not Your Imagination Summers Are Getting Hotter," in the July 28 issue of The New York Times is at:  https://www.nytimes.com/interactive/2017/07/28/climate/more-frequent-extreme-summer-heat.html.

Listeners may recall my March 31 interview with Professor Jonathan Patz regarding this past February's "Climate and Health Conference" at the Carter Center and links to two related essays by me posted this past June 13 concerning the medical community's non-response to the the Trump administration withdrawal from the Paris climate accord and one posted May 25, 2016 reviewing the Obama's administration's, "The Impacts of Climate Change on Human Health in the US."  

07/28/2017

Dr. Fischer-Wright Discusses Her Recent Work, "Back to Balance, The Art, Science and Business of Medicine" (July 27th)

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During this 20 minute discussion Dr. Halee Fischer-Wright discusses her recently published work, "Back to Balance, The Art, Science and Business of Medicine."  As the title suggests, Dr. Wright argues the practice of medicine has become dominated by the business and science aspects of care delivery both to the detriment of both the patient and the physician.  

Dr. Halee Fischer-Wright is currently President and CEO of MGMA (the Medical Group Management Association).  Prior to, Dr. Wright Firscher-Wrightwas a practicing pediatrician and management consultant in multiple industries. Immediately prior to accepting the MGMA position,  Dr. Wright  served as a Chief Medical Officer within Centura Health.  Prior to that she was President of the 680-physician Rose Medical Group in Denver for 12 years. She is the recipient of several national awards for leadership in innovation, healthcare, business and women's leadership.  She is also co-author of the work, "Tribal Leadership."  Dr. Wright earned her bachelor's and medical degree from the University of Colorado and holds a a master's in medical management from USC.  She completed her internship/residency as president of the Pediatric Residency at Phoenix Children’s Hospital/Maricopa Medical Center Program.

For information on "Back to Balance," go to, e.g., https://www.amazon.com/Dog-Complex-Bringing-Balance-Backwards/dp/1633310140.

06/25/2017

Will Senate Republicans Get 50 Votes to Repeal the ACA? (June 24th)

This coming week the Senate will take up their amended version of the House repeal bill, the American Health Care Act. Here is my assessment of the legislation's prospects posted yesterday on The Health Care Blog.  I conclude the essay by citing a 2014 study by Gilens and Page.  If the legislation passes it demonstrates, as Gilens and Page wrote, the "American public actually have little influence over the politics of our government adopts."  Phrased another way, "when a majority of citizens disagrees with economic elites or with organized interests," they said, "they generally lose."

My essay is at: http://thehealthcareblog.com/blog/2017/06/24/will-senate-republicans-get-50-votes-to-repeal-the-aca/

Gilens and Page's article is at: https://scholar.princeton.edu/sites/default/files/mgilens/files/gilens_and_page_2014_-testing_theories_of_american_politics.doc

06/22/2017

Improving the Use of Evidence-Based Medicine: A Conversation with Dr. Todd Feinman (June 21st)

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 A 2012 National Academy of Sciences (Institute of Medicine) study titled, "Best Care and Lower Cost," found about one quarter of all medical spending is wasted, much of this excessive spending going to pay for treatments that are of unknown effectiveness.   With medical spending now accounting  for one-sixth of the nation's GDP, or over $3 trillion annually, how do we limit spending to treatments that are proven effective or are of high value.  How do we increase the use of evidence-based medicine.  While this issue or problem has been, or is being, addressed by several federal health care agencies including the Agency for Healthcare Research and Quality (AHRQ) and the the ACA-created Patient Centered Outcomes and Research Institute (PCORI), progress has been frustratingly slow.   (For example, a day prior to this interview a Health Affairs blog post discussed the persistent use, despite clinical evidence to the contrary, of pre-cataract surgery blood analysis and EKG testing.)      

During this 23-minute conversation Dr. Feinman discusses how his background as a hospitalist led to his co-founding Doctor Evidence, what explains the variation in the use of evidence based medicine, how Doctor Evidence is working to improve the timely collection, dissemination and use of evidence-based medicine, how his work is related to the Cochrane Collaborative, and how work by Doctor Evidence can influence quality measurement and drive or improve health care value, or patient outcomes achieved relative to spending. 

Dr. Todd Feinman is the Chief Medical Officer and co-founder of Doctor Evidence where he works to create evidence Feinmantechnologies that will lead to improved care, better health care outcomes, greater patient satisfaction and reduced spending growth.  Among other partnerships, Doctor Evidence works with the USC Center of Body Computing and with several medical associations and pharmaceutical companies.  Dr. Feinman began his career as a hospitalist, developing the first such programs in Southern California.   He is a board certified internist.   Dr. Feinman earned his medical degree at UCLA's David Geffen School of Medicine and did his residency work at Cedars-Sinai Medical Center in Los Angeles and at Huntington Memorial Hospital in Pasadena. 

For information on the firm Doctor Evidence go to: http://drevidence.com.

 

 

06/15/2017

Medicare As a Neutral Payer (June 15th)

If your're interested in Medicare payment reform generally, you may be interested in my essay, "Medicare Programs Should Compete," posted today on the Health Affairs blog.  It is at:  http://healthaffairs.org/blog/2017/06/15/medicares-programs-should-compete/.

06/14/2017

The Medical Communities (Non) Response to Trump's Withdrawal From the Paris Climate Accord (June 13th)

If you're interested in learning what was the response by the trade and professional medical association communities to President Trump's June 1 announcement regarding the Paris accord please feel free to read my essay, "Medical Association's Non-Pulsed by Trump's Withdrawal From Paris Accord," posted yesterday on The Health Care Blog: http://thehealthcareblog.com/blog/2017/06/13/medical-associations-non-pulsed-by-trumps-withdrawal-from-the-paris-accord/.