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4 posts from March 2013

03/26/2013

Dr. Bob Berenson Discusses Possible Remedies for the Infamous Medicare "Doc Fix" (March 26, 2013)

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In 1997 the Congress reformed how it pays physicians under Medicare.  The new formula was termed the "sustainable growth rate" (SGR).   The impetus for the reform was to control better Medicare cost growth.   (Medicare physician payments now exceed $100 billion annually).   Largely because of the concern physicians would limit seeing Medicare patients if their Medicare reimbursement rates were cut, the Congress has not enforced the SGR since 2002.   Despite the realization the SGR is unalterably broken, the Congress has been unable or unwilling to amend the law.  Though the upaid SGR tab is presently $138 billion this amount is substantially less than previous calculations that approached  $300 billion (due to a recent decline in Medicare utilization).  With debt and deficit reduction talks expected to re-emerge over the next few months will the Congress finally find the wherewithal to fix the docs?    

The podcast begins with Dr. Berenson addressing the genesis of the SGR and then proceeding to explain why Congress has routinely ignored enforcing the SGR since 2002.  The discussion proceeds to explain why/how doing away with the SGR would currently cost $138 billion.   What effect the SGR has (still) had and what recent MedPAC and a bipartisan House proposal (Reps. Schwartz and Heck) call for in creating a new payment method while offsetting the accumulated $138 billion.  Dr. Berenson next discusses his recent Congressional testimony where he identified ways to improve or mend Medicare fee for service payments, e.g., reducing distortions in, or improving the accuracy of, physician service relative value units (RVUs), improving payment for evaluation and management services.  He argues in sum for global payment or partial capitation.  Dr. Berenson concludes by noting current Congressional bi-partisan support for SGR reform though noting reform proposals would have to identify some mechanism/s to control for volume growth and an indication that quality and efficiency would be improved.           

Dr. Robert Berenson is currently a Fellow at the Urban Institute where his research work concerns health care policy, particularly Medicare.  From 1998-2000, Dr. Berenson was in charge of Medicare payment policy and private health plan contracting in the Centers for Medicare and Medicaid Berenson_lg[1] Services (CMS). Previously, he served as an Assistant Director of the Carter White House Domestic Policy Staff.  Dr. Berenson became a Commissioner of the Medicare Payment Advisory Commission (MedPAC) in 2009 and in 2010 became MedPAC's Vice Chair.  Dr. Berenson is a board-certified internist, for the last twelve years practicing in Washington, D.C.  He is Fellow of the American College of Physicians and the author of numerous research publications.  He is a graduate of the Mount Sinai School of Medicine and on the faculty at the George Washington University Schools of Medicine and Public Health and the Fuqua School of Business at Duke.

 

Dr. Berenson's February 2013 Energy and Commerce Committee testimony can be found at:  http://democrats.energycommerce.house.gov/sites/default/files/documents/Testimony-Berenson-Health-SGR-Medicare-Payment-2013-2-14.pdf

Dr. Berenson's (et al.) March 2013 Urban Institute paper, "Can Medicare Be Preserved While Reducing the Deficit?" is available at:http://www.rwjf.org/en/research-publications/find-rwjf-research/2013/03/can-medicare-be-preserved-while-reducing-the-deficit-.html

03/12/2013

Ms. Suzanne Mintz Discusses the Work of Family Caregivers and the Caregiver Action Network (March 12, 2013)

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Family caregivers are the most ignored providers of health care delivery despite the fact they constitute 30 percent of the adult population, or are 65 million Americans.  Caregivers are more typically women, over fifty, spending 20 hours a week (over an average of five years) providing care most frequently for a family member typically a parent with dementia.  They are literally the backbone of health care.   Professionally, caregivers, half of whom work full time, incur lost wages, promotions, health insurance, retirement savings and frequently suffer deleterious physical and mental health effects.  Nearly 80 percent of caregivers report needing more help and information with at least 14 specific topics related to caregiving. 

During this 31 minute interview Ms. Mintz discusses the varied and substantive contributions caregivers make and how their efforts can be better supported.

Ms. Suzanne Mintz is the cofounder of the nonprofit the Caregiver Action Network (formerly the National Family Caregivers Association), an organization that provides both direct support for caregivers and advocates for legislative reform  and other policy changes.  Currently Ms. Mintz also serves on the board of National Patient Safety Foundation, the advisory council of the National Transitions of Care Coalition and the advisory board of the Images[3]Partnership to Fight Chronic Disease.  She was honored for her work in 2006 as one of the first 15 winners of the Purpose Prize.  She has written several books, the latest is A Family Caregiver Speaks Up: It Doesn't Have to Be This Hard and has published numerous articles on and for family caregivers.   She holds a BA in English from Queens College, City University of New York and a MS in Human Ecology from the University of Maryland.

For more on the Caregiver Action Network, see: http://caregiveraction.org/

 

03/07/2013

Dr. Linda Randolph Discusses the Developing Families Center's Maternal and Child Health Care Model (March 7, 2013)

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Dr. Linda Randolph, President and CEO of District of Columbia's Developing Families Center (DFC),  discusses DFC's unique maternal and child health care model that has drawn international attention for its comprehensiveness and its high quality outcomes.  

During this 23 minute interview Dr. Randolph offers her explanation for the causes of worse maternal outcomes among minority populations, including higher income African American women.  For example, she notes inter-generational factors, the effects of toxic or chronic stress and racism.  She explains the DFC's services beyond nurse midwifery, i.e., pediatric care, the DFC's breastfeeding education and peer support program (African American women are the least likely to breast feed) and the DFC's infant and todler (newborns-to-three-year-olds) child development center or early head  start.  Dr. Randolph defends this programming against criticisms that Head Start program benefits fade as children reach the first and second grades.  Finally, Dr. Randolph emphasizes the importance of a continuum of maternity to early child development care, one that is more holistic emphasizing primary prevention - that is the mission of the DFC.  

(This discussion compliments the Dr. Lubic interview.) 

Dr. Linda A. Randolph is a public health pediatrician with over thirty years of experience serving in Federal, state and local governments, academia, private philanthropy and not-for-profit Dr.-Randolph-300x271[1]organizations.  Dr. Randolph, a native Washingtonian and a 20 year resident of Harlem and Albany, NY, is known for her work to eliminate racial/ethnic disparities in health and building upon the strengths of families and communities to effect health policy.  Dr. Randolph was elected to the Institute of Medicine in 2008, she is the recipient of numerous awards in the field of maternal and child health including the American Public Health Association’s 2001 Martha May Eliot Award.  In February Dr. Randolph and Dr. Lubic co-presented the Association of Maternal and Child Health Program's John C. MacQueen Memorial Lecture.  She earned her MD from the Howard University College of Medicine and her MPH from the University of California at Berkeley.

03/05/2013

Dr. Ruth Lubic Discusses Midwifery's Contribution to Improving Healthy Births (March 5, 2013)

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For decades the US has experienced the highest infant mortality rate of high income countries.  The US also ranks poorly on other birth outcomes such as pre-term births, low birth weight and Caesarean sections.  Infant mortality rates for non-hispanic blacks is twice that of the national average.  In sum, about 25,000 infants die each year in the United States.  During this 37 minute interview Dr. Lubic explains briefly nurse midwifery and its peri-natal goals, she discusses at some length the gradual acceptance of nurse midwives from the 1930s through the 1960s, the Family Health and Birth Center's "care in a social context" and birth outcomes its achieved, i.e., a 66% reduction in both pre-term births and Caesarean sections and a 75% reduction in low birth weights.  

For more on midwifery outcomes see this recently published article in the Journal of Midwifery & Women's Health:  http://onlinelibrary.wiley.com/doi/10.1111/jmwh.12003/full

Dr. Lubic's midwifery career began in 1962 when she was graduated from the country’s first nurse-midwifery program, the Maternity Center Association in NYC.  In 1970, Dr. Lubic became General Director of the Association (now called Childbirth Connection) and opened the first state-licensed birthing center in the country in 1975.  Eventually the Morris Heights Childbearing Center opened in the South Bronx, bringing quality obstetric care to underserved, low-income women.  The moneys she received from a MacArthur Foundation genius award enabled her to replicate her NYC Ruthlubic[1]midwifery model in 2000 by opening the Developing Families Center in Washington, D.C.  Among other numerous credits and awards Dr. Lubic was elected to the National Academy of Sciences’ Institute of Medicine and is the recipient of its Lienhard Award.  The American Academy of Nursing, also in 2001, named her a Living Legend.   The American College of Nurse-Midwives honored her with the Hattie Hemschemeyer Award.   In 2006, the American Public Health Association conferred its Martha May Eliot Award and she also is the recipient of eight honorary doctorate degrees.  Dr. Lubic was awarded a nursing degree from the U. of Pennsylvania and was graduated from Columbia University with a Ph.D. in applied anthropology.