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12/12/2017

Clay Richards Discusses Medicare's Bundled Payments for Care Improvement (BPCI) Demonstration (December 11th)

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CMS has been experimenting with Medicare bundled payment arrangements, where the provider is reimbursed a total fee (either prospectively or reconciled retrospectively), for three decades.  Under ACA authority CMS' Center for Medicare and Medicaid Innovation (CMMI) has launched several five-year bundled payment demonstrations, most notably BPCI that began in 2013.  The BPCI demo allows providers to voluntary accept a bundled payment for any one of 48 Diagnosis Related Groups (DRGs), for example a heart attack, under three care models.  Model Two is the most popular.  It begins with an anchor acute hospital stay followed by 30 to 90 days of post acute care.  The most common Model Two bundle is for hip or knee replacement surgery.  Recently, the Lewin Group completed its third evaluation of the BPCI.  Regardless of the demonstration's performance to date, has it moreover reduced spending and/or improved care quality and outcomes, it is anticipated CMS will renew the BPCI demo in the very near future since the current demo times out this September. 

During this 25-minute discussion Mr. Clay Richards discusses naviHealth's BPCI's efforts, the company's BPCI financial and quality results to date, Lewin Group's most recent BPCI evaluation and how the demonstration can be improved under a reauthorized BPCI demonstration.  

Mr. Clay Richards is CEO of naviHealth, a post-actue care transition company and one of the nation's largest BPCI Clay richardsconvenors.  The company, founded in 2012, partners with approximately 50 hospitals in 25 states, collectively they account for over 40,000 BPCI care episodes  annually.  Prior to joining naviHealth, Mr. Richards served as Senior Vice President of Healthways, Inc.  Mr. Richards' community service includes serving on the Martha O'Bryan Center Board, the Oak Hill School Board and on the Vanderbilt Owen Graduate School of Management Board of Visitors.  Mr. Richards was graduated from Washington and Lee University and from the University of Mississippi School of Law.

Information on naviHealth is at: https://www.navihealth.com/.

Information on the BPCI demo and the Lewin Group's evaluation can be found at: https://innovation.cms.gov/initiatives/bundled-payments/.  

12/07/2017

Myra Christopher Discusses Under Treated Chronic Pain and the PAINS Project (December 6th)

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Despite the fact an estimated 100 million Americans suffer from chronic pain costing approximately $640 billion annually in medical expenses and lost productivity, the disease remains widely under treated.  This is all the more true for ethnic and racial minorities independent of age, gender, education, wealth and pain intensity.  Despite recent efforts by the Institute of Medicine, the DHHS, i.e., its 2016 "National Pain Strategy," and new payment models designed to improve care quality, for example, Accountable Care Organizations and Patient Centered Medical Homes, under treatment persists.  Addressing the problem has become all the more difficult over approximately the past decade due to the opioid epidemic that has blurred, if not erased, the line between effective treatment and drug abuse.  We face the nearly impossible situation where Americans are simultaneously under treated and over medicated.     

During this 29-minute conversation Ms. Christopher discusses why chronic pain continues to be under treated, to what extent, if any, chronic pain measurement and data collection has improved, the work of the Center for Practical Bioethics' PAINS Project and the extent to which the opioid epidemic is undermining chronic pain treatment. 

Ms. Myra Christopher is currently the Director of the PAINS Project and as well the Kathleen M. Foley Chair at the Center for ChristopherPractical Bioethics.   She served as President and CEO of the Center from its inception in 1985 through 2011.  From 1998 through 2003 she served as National Program Officer at the Robert Wood Johnson Foundation's National Program Office for State-Based Initiatives to Improve End-of-Life Care.   She has consulted with numerous organizations including the Joint Commission on the Accreditation of Healthcare Organizations, at CMS in developing the Community State Partnerships to Improve End-of-Life Care initiative, participated in drafting the IOM's 2011 "Relieving Pain in America" report discussed during this interview, as a reviewer on the IOM's 2014 report, "Dying in America" and the DHHS committee that produced the  "National Pain Strategy." She has also consulted with the CDC, AARP and other organizations to promote pain and palliative care as public health issues.  She is s a founding member of the Coalition to Transform Advanced Illness (CTAC), has served on numerous boards including the Duke University Institute for Care ad the End of Life and has received as well numerous awards including the American Society for Bioethics + Humanities Lifetime Achievement Award in Bioethics.   

For more information on the PAINS Project go to: http://painsproject.org/

The IOM's "Relieving Pain In America" is at: https://www.ncbi.nlm.nih.gov/pubmed/22553896.

The DHHS' "National Pain Strategy" is at: https://www.hhs.gov/ash/about-ash/news/2016/national-pain-strategy-outlines-actions-improving-pain-care/index.html.

11/17/2017

Dr. Jim Rickards Discusses His Recent Work, "Our Health Plan, Community Governed Healthcare That Works" (November 16th)

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This, my 125th interview, will discuss Oregon's Coordinated Care Organizations (CCOs) that have received considerable attention nation-wide for their ability to provide Medicaid beneficiaries with coordinated care, moreover primary care services integrated with mental/behavioral and oral health.  The Oregon CCO model has also demonstrated over the past five years an ability to improve care quality while keeping spending below a targeted 3.4 percent annual growth rate via a capitated payment arrangement.  Oregon's CCO success is the subject of Dr. Jim Rickards recent work, "Our Health Plan, Community Governed Healthcare That Works.  The work details the experience of one Oregon CCO, Yamhill Community Care.     

During this 29-minute discussion Dr. Rickards provides a brief description Yamhill County, how the Yamhill County's CCO, Yamhill Community Care, was formed, what initial decisions or steps it took, how it organizes or coordinates care moreover between and among primary care providers, dentists, behavioralists, community health workers and a community paramedicine program.   The role Health Information Technology (HIT), or Oregon/Washington's Health Information Exchange (HIE) or EDIE, and quality measures play, what beneficiary spill over effects have resulted from the CCO's care delivery and how might Oregon's CCO model be adopted elsewhere.  

Dr. Jim Rickards is currently the Senior Medical Director at Moda Health in Portland, Oregon.  Previously, Dr. Rickards was the Rickards Chief Medical Officer of the Oregon Health Authority, where he provided clinical and policy leadership in managing Oregon's Medicaid population.  He received his B.S. from Indiana University Bloomington, MBA from Oregon Health and Science University, M.D. from Indiana University School of Medicine.  He completed his residency and fellowship training in radiology in Chicago at Cook County Hospital and Rush University Hospital.  Dr. Rickards currently resides in Mcminnville, Oregon.

For more information on Our Health Plan go to: https://www.prnewswire.com/news-releases/new-health-care-delivery-book-asks-is-community-healthcare-the-future-300501810.html.

For information on the Oregon Health Authority go to: http://www.oregon.gov/OHA/Pages/index.aspx.

A thorough review of 2016 CCO performance results is at: http://www.oregon.gov/oha/HPA/ANALYTICS-MTX/Documents/CCO-Metrics-2016-Final-Report.pdf

11/14/2017

"As the World Burns" (November 13th)

Listener's may recall my August 3rd interview with David Wallace Wells concerning his New York magazine essay, "The Uninhabitable Earth" and my posting a link to my June 13th essay that appeared on The Health Care Blog (THCB) and titled, "Medical Associations Non-Pulsed by Trump's Withdrawal From the Paris Accord."  Both addressed the problem of unambiguous global warming. 

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

Yesterday, 3 Quarks Daily posted my essay, "As the World Burns," moreover about the professional medical community's inattention to the issue.  It is at: http://www.3quarksdaily.com/3quarksdaily/2017/11/as-the-world-burns-.html#more.  (The comments in the essay are my own.) 

 

11/10/2017

Dr. Ronald Epstein Discusses His Recent Work, "Attending: Medicine, Mindfulness and Humanity" (November 9th)

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Over the past 20 years Dr. Ronald Epstein has published on the topic he terms "mindful practice."  "Mindful practice," he argues, enables physicians and other clinicians to have heightened self-awareness that allows in turn for greater attentiveness or greater presentness in caring for patients.  It is what makes good providers, he says, great.  

During this 26-minute conversation Dr. Epstein discusses his recent work, Attending: Medicine, Mindfulness and Humanity, or moreover what mindfulness is, how it improves patient care and outcomes by, in part, better addressing patient suffering and how it improves as well physician or provider satisfaction.    

Dr. Ronald M. Epstein is Professor of Family Medicine, Psychiatry & Oncology at the University of Rochester Medical EpsteinCenter, and board-certified in Family Medicine and Hospice and Palliative Medicine.  He is also the Director of the Center for Communication and Disparities Research and he directs the Dean's Teaching Fellowship program to promote excellence in medical education.  Among other accomplishments, he was named the first George Engel and John Romano Dean's Teaching Scholar at the University of Rochester. National honors include the Lynn Payer Award from the American Academy on Communication in Healthcare for lifetime achievement in research on communication and health and the Humanism in Medicine Award from the New York Academy of Medicine.  Dr. Epstein has been a Fulbright scholar at the Institute for Health Studies in Barcelona, Spain and a visiting scholar at the University of Sydney.  He is a frequent keynote speaker at major national and international conferences on medical education, communication, and mindfulness in health care.  He has published over 200 research articles.  Dr. Epstein graduated from Wesleyan University and Harvard Medical School.  

For information on Attending go to: http://www.ronaldepstein.com/.

For a complete list of related literature go to: https://www.urmc.rochester.edu/family-medicine/mindful-practice/publications-research.aspx.

11/03/2017

How Well Did Medicare Accountable Care Organizations Perform in 2016? (November 2nd)

For those interested in Medicare ACO performance, here is an overview of 2016 results via my essay titled, "Evaluating ACO Performance, 2016 Edition."  It is at: http://thehealthcareblog.com/blog/2017/11/02/evaluating-aco-performance-year-2016/

11/01/2017

Patient Safety Issues Associated with Electronic Health Records: A Conversation with Dr. David Troxel (October 31st)

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Electronic Health Records (EHRs) were largely adopted after 2009, or after the Congress passed the HITECH Act that appropriated $30 billion in financial incentives for hospital and physicians to migrate from paper to digital records.   In theory the policy made/makes perfect sense.  Adopting information technology/IT would over time create efficiencies, drive better care coordination and overall improve care quality and reduce unnecessary spending or reduce spending growth.  However, for numerous reasons moving to widespread use of EHRs has presented/continues to present numerous challenges and problems, some anticipated and some not, that meant putting patients at risk of medical harm, or essentially swapped out one set of problems (associated with paper records) for another set of problems (associated with EHRs).    

During this 29-minute conversation Dr. Troxel offers his view why the medical industry comparatively lagged in adopting digital records, what are the more common EHR design flaws and what kinds of medical errors they cause, how prevalent are EHR-related errors or what did his report, cited below, conclude, why EHR-related errors or harm occur, what is the current status of a proposed federal Health IT Safety Center and what can patients do to improve the safety of their EHRs. 

Dr. Troxel is Secretary of the Board of Governors and Medical Director of The Doctors Company, a physician-owned medical malpractice insurer.  Dr. Troxel is also Clinical Professor Emeritus at the School of Public Health at the  Troxel
University of California at Berkeley.  He is past president of the American Board of Pathology and the California Society of Pathologists.  He serves as Chairman of The Doctors Company Foundation and as a member of the Patient Safety and Technology Committees at The Doctors Company.

Referenced during the discussion the report, "Electronic Health Record Closed Claims Study," is at: http://www.thedoctors.com/ecm/groups/public/documents/print_pdf/con_id_013553.pdf.

The 2011 IOM report, "Health IT and Patient Safety: Building Safer Systems for Better Care," also referenced during the discussion is at:  http://www.nationalacademies.org/hmd/Reports/2011/Health-IT-and-Patient-Safety-Building-Safer-Systems-for-Better-Care.aspx.

Information on the Doctors Company is at: http://www.thedoctors.com/

10/03/2017

MACRA's Virtual Groups (October 3rd)

If you're into the weeds relative to the regulatory implementation of the Medicare Access and CHIP Reauthorization Act (MACRA), the 2015 Medicare law that replaced the SGR (Sustainable Growth Rate), here's an essay I co-wrote with Manu Uppal, an information technology expert, regarding the Merit-Based Incentive Payment System (MIPS) Virtual Group provision CMS is proposing to implement in 2018.  The Virtual Groups provision is yet another example of Medicare policy that in theory or on paper sounds correct but relative to how in practice it's actually implemented, is black box.

"CMS Should Play the Role of Virtual Group Matchmaker, " is at: http://thehealthcareblog.com/blog/2017/10/03/cms-should-play-the-role-of-virtual-group-matchmaker/.

09/29/2017

Eric Weinberg Discusses His Recent Work, "Blood On Their Hands" (September 28th)

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Mr. Eric Weinberg is co-author with College of New Jersey Journalism Professor, Donna Shaw, of the recently published work,  Blood On Their Hands, How Greedy Companies, Inept Bureaucracy, and Bad Science Killed Thousands of Hemophiliacs (Rutgers University Press).  The book details how beginning in the late 1970s through the mid-1980s tens of thousands of hemophiliacs in the US (and tens of thousands more around the world) became infected with HIV via the use of life-saving plasma-based blood clotting medicines.  Manufactures knew plasma-based products transmitted disease, for example, it was well known clotting medicines had infected countless hemophiliacs with hepatitis.  Nevertheless, neither did they cleanse or purify their blood clotting products, technology that was also well known, nor warn patients of adverse side effects.  Federal regulators, similarly, did nothing.  As a result, by the late 1980s the mean life span of a hemophiliac declined by over fifteen years.  While (civil) financial settlements were reached with approximately 6,000 victims or their families and the Congress passed in 1998 legislation, the Ricky Ray Hemophilia Relief Act, that provided additional compensation, the Justice Department chose not to criminally prosecute anyone.      

During this 35 minute conversation Mr. Weinberg discusses among other issues how blood plasma was obtained in the 1970s and 1980s, the position manufactures held on the safety of their clotting medicines, a (failed) federal class action effort to compensate hemophiliacs and their family survivors, the influential Institute Of Medicines 1995 report on HIV transmission through blood products, eventual civil settlement with the major manufacturers of these products and how his work representing hundreds of hemophiliac patients and their families over more than a decade affected him.  

Mr. Eric Weinberg is the principal of the Weinberg Law Firm, based in New Brunswick, New Jersey, since Weinberg1984.  Since founding the firm, Mr. Weinberg has tried approximately thirty jury trials and over two hundred bench trials to verdict.  He has also served as a Visiting Lecturer at Cook College, Rutgers University and has taught Ph.D. candidates at the Rutgers School of Management and Labor Relations.  Previously, Mr. Weinberg worked for the law firm Franchino, Lenahan and Cross and prior still served as Chief of Juvenile Prosecutions and Assistant County Prosecutor in Somerset County, New Jersey.   Mr. Weinberg has been an invited speaker in many forums on topics relating to the prosecution and settlement of serious injury cases, including mass torts and catastrophic injury cases.  Mr. Weinberg is the recipient of numerous awards for his years of community service. He was graduated from Rutgers College in 1977 and from Boston University School of Law in 1980. He is admitted to the Bar of the States of New Jersey and New York as well as numerous federal courts.  

09/27/2017

Dr. Haider Warraich Discusses His Recent Work, "Modern Death" (September 27th)

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Earlier this year St. Martin's Press published Dr. Haider Warraich's Modern Death, How Medicine Changed the End of Life. As the dust jacket notes, "the mechanics and understanding" of dying, "the whys, wheres, whens and hows are almost nothing like what they were mere decades ago."  Today, eight in ten Americans die at an advanced age, or under Medicare, die in a medical setting after suffering for some while from a chronic, eventually fatal disease or diseases.  If lucky, how Americans die will have been determined, or at least informed, by an advanced directive or like document.        

During this 27 minute conversation Dr. Warraich discusses what characterizes "modern death,"  how the 1970s Karen Ann Quinlan case redefined death or dying, the role family caregivers play and the unintended consequences for them in providing a family member care, the limitations of advanced directives and living wills, euthanasia, physician assisted suicide and terminal or palliative sedation and whether "how medicine changed the end of life" has made "modern death" comparatively better. 

Dr. Haider Javed Warraich is currently fellow in cardiology at Duke University Medical Center.  He was graduate from Warraichmedical school in Pakistan in 2009 and did his residency in internal medicine at the Beth Israel Deaconess Medical Center, a teaching hospital of Harvard Medical School   He is a regular opinion page contributor to The New York Times, The Atlantic, The Guardian, The Wall Street Journal, the LA Times and has contributed to several academic publications such as The New England Journal of Medicine, the Journal of the American Medical AssociationLancet and Circulation.  

During the interview mention is made of a November 28, 2016 Fresh Air (NPR) interview titled, "The Debate Across the Nation Over Death With Dignity Laws," that featured Dr. Warraich along with Dr. Ira Byock.  The interview is at: https://dianerehm.org/shows/2016-11-28/aid-in-dying