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3 posts from August 2017

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."