It’s a familiar refrain, and one Minnesota senator is making it this time; that is, the call for certain reform of the Medicare payment reimbursement system. In an op-ed, the Democratic senator pushes quality over quantity as the sole parameter for the assignment of Medicare dollars. Although the concept is familiar, Sen. Amy Klobuchar argues, the aggressive adoption of quality claims reporting will result in streamlined payments for “standards of care” which can be applied equally in disparate care settings.

Making Medicare a purchaser of quality, rather than just an indiscriminant government guarantor of entitled healthcare to certain patient populations is a step in that direction, according to Klobuchar. The problem is — this is known already. The initial fixes must reach beyond establishing vague quality parameters to stimulate change among those on the frontlines of healthcare quality — the physicians. Adoption by this critical segment of healthcare delivery in this country will be hard to achieve without discrete, concrete goals. Unfortunately, for the providers on the front lines of healthcare (primary care), getting paid is the immediate quality concern. | LINK

Thought tuberculosis (TB) was an afterthought?  Think again. The rates of the most difficult to eradicate strains — the so-called multi drug resistant (MDR) strains — are creating concern in the epidemiological and public health spheres.  Although not a major problem in this country, the rates of MDR-TB are climbing in developing nations.  The use of what is called “directly observed therapy“, a mode in which patients must take treatment under the supervision of a public health entity, is becoming increasingly challenged practically everywhere.  That fact doesn’t bode well for keeping a key infectious disease as contained as it previously was just a few years ago. | LINK

It looks like the state of Louisiana gets it. As the discipline of primary care medicine becomes known more for cuts in Medicare and Medicaid reimbursements than for treatment and prevention of disease, the state — whose brush with hurricane Katrina in 2005 has done more for its sense of healthcare activism than in many other southern states — is being proactive in overhauling its healthcare delivery systems to its un- and underinsured. How is Louisiana approaching primary care reform? By lobbying hard for government pilot projects that emphasize parity among provider networks in the delivery of chronic disease management, while giving traditional fee-for-service Medicaid programs a run for their money. | LINK

As many are expecting the fate of a recent bill blocking cuts in Medicare reimbursements to physicians to head straight to veto, pundits from the healthcare policy sphere debate what the intended goals of its passage would have brought (or, will bring) to the overall business of healthcare.  Will shifting payments from physicians to payers give seniors more choice in their healthcare, as Republicans suggest; or, will this action limit access to care because of physician disenrollment — a concern of Democrats? | LINK

This is not as much a post related to healthcare as it is a document. Make that an historical document. In the ever-increasing Internet that is at once fluid yet static, news organizations, blogs, and multiple other Web portals are documenting one ironclad fact that no one — not even Hillary Clinton — can deny: that today marks the first time in the history of this country that a Black man is the choice of a major political party in its quest to claim the Top Job In The World.

Yesterday Sen. Barack Obama precisely claimed such in a rousing speech in my homebase of Saint Paul, MN. Obviously pouncing headfirst in a game of political one-upsmanship, the now-presumptive Democratic party nominee for POTUS drew a line in the sand for his across-the-aisle counterpart, Sen. John McCain — essentially calling the Arizona senator to take notice of his campaign for change when McCain’s party’s coronation occurs in this exact location some three months from now.

A truly historic day indeed. Now, if he can only make his future oratory on healthcare reform just as classic has his nomination kickoff speech, his speech on race relations, and his speech on the day he announced his candidacy, we will perhaps have an even better idea of the altruism we hope this man can muster for those thirsty for true change in this country.

For better or worse, habits — be they good or bad — are easy to initiate, but may be tremendously difficult to abandon.  In the case of medical students exposed to the gifts and luncheons sponsored by pharma companies, the latter notion definitely applies.  Fact is, many physicians who were exposed to extensive pharma company detailing while in undergraduate medical education usually don’t mind the practice after formal training has concluded for them.  To be sure, Pharma is hitting major roadblocks lately with respect to access to many physicians outside of academic training centers.  They are no stranger to peddling wares to unsuspecting and eagerly gullible medical students, however; and in the past few years, this inertia to decreased access has resulted in increases of Pharma detailing in medical school training centers.  Whether they admit it or not, students are in usually no position to question the proverbial free lunch and are only grateful for the attention. 

However, some medical educators are taking the philosophy of many healthcare organizations today and considering banning the practice of pharma detailing in these scenarios.  While stopping short of an outright ban, the Assn. of American Medical Colleges (the nation’s largest medical education advocacy group) is calling for schools to “strongly discourage participation by their faculty in industry-sponsored speakers’ bureaus, as well as establish centralized systems for the acceptance of medication samples from pharmaceutical companies or develop alternative ways to manage pharmaceutical sample distribution that do not carry the risks to professionalism with which current practices are associated.”  [PDF of report here.]  Further, their report calls for strict auditing of information presentation in academic programs which may be deemed as being questionable in quality. | LINK

Hospital for sale in Suburban Chicago. Although in pristine condition, it’s still a “fixer-upper”. Needs a little work in the following areas: state Medicaid reimbursements are a little low; buyer must agree to take its estimated 40,000 annual emergency room visits — no questions asked; finally, buyer must furnish a capable accountant to work with greedy insurance companies for services rendered. | LINK

Healthcare reform is at the top of most voters’ agendas this election year. Sure, all voters are in agreement that the infrastructure of healthcare is broken, and they cite the lack of affordable insurance as the only way to fix it. Revamping healthcare access and reforming managed care are priorities this election year.

Or, should they be?

With the news of a major medical mistake making headlines here in Minnesota and nationally, there is a renewed focus on an overlooked area in need of reform — especially within the scope of the acute care hospital: the secretive culture of the medical error.

For years, hospitals have always kept mum on many mistakes, both minor and life-threatening, entirely out of the fear of lawsuits. The issue has even cropped up this decade in the form of Bush administration legislation targeting abuses in tort law. But hospitals here in Minnesota and nationwide are beginning to realize that fighting fire with fire is not the only way to deal with hospital medical errors. They feel that true reform in this area begins with two words: “I’m sorry”. | LINK

The concept of End of Life (EOL) care in the nursing home among severely demented patients (representing just one of many public health demographics) is a relatively broad one.  The spectrum of treatments can run the gamut of care, even with patients who are in well-defined hospice care plans.  The use of antibiotics for general, systemic infections in this period of a patient’s life is raising concerns.  Rising antibiotic resistance profiles in nursing facilities, failure of the demented patients to communicate even the most basic medical need, and the lack of effective communication between physician, family, and hospice team in the EOL scenario probably all contribute in some fashion to the results just out from a Harvard study.  In it, investigators concluded that severely demented patients were receiving antibiotics (many of them intravenously) at extremely high rates — without apparent benefit to the patient’s quality of life.  This care dilemma represents another overlooked (and underreported) arena of healthcare delivery which carries a major public health threat: antibiotic resistance.  It is something which has a relatively easy remedy.  Education. | LINK

Just who really comprises a significant chunk of the 47 million uninsured and underinsured in this country? Will their situations be helped by either the Clinton or Obama plans? A recent article in the NYT discusses one portion of that unfortunate healthcare demographic: the free rider — that is, the moderate income earning, relatively young and healthy person without any pre-existing condition barring enrollment in many comprehensive plans — who chooses not to enroll in a structured coverage plan.

To Hillary, these persons are the ones who are positioned squarely in the crosshairs of her healthcare mandate. Forcing them to contribute their fair share into the healthcare funding pot would virtually eliminate the wasteful delivery of uncompensated care in this country, care seen mostly in crowded emergency departments and acute care hospital floors. Making healthcare available to all by mandated subsidy would also eliminate, in her words, “discrimination against those with pre-existing medical problems. Only then … would it be fair for the government to require insurers to cover even those likely to require expensive care.”

Barack Obama, on the other hand, sees no value in mandating a policy which would be difficult to enforce — not to mention the cost-prohibitive nature of funding the administrative logistics to do it. To the newly anointed front-runner, insurance mandates should only be for the children. Using taxpayer subsidy and tax-cut rollbacks, he would propose a similar model to provide coverage for the nation’s uninsured children. To close the gap among uninsured adults, a central tenet of his healthcare coverage plan is to simply make it more affordable.

Two views. Two strong Democratic presidential candidates. One winner. A revamped healthcare coverage scheme sure to take years to develop. How long does one really have to wait? | LINK

Although healthcare providers continue to leave their patients with the admonition that influenza just doesn’t suddenly cease to infect by January, many continue to believe, that by mid-February, every yearly cycle of infection has essentially “run its course” and immunization by that point is painful futile.  This story should mitigate against that line of thinking.

Widespread flu activity now exists in virtually every state, and many of the infections are being caused by some strains not covered by this year’s influenza vaccine, U.S. health officials said Friday.

“After relatively low levels of influenza activity in the early part of the season, since January, influenza activity has been picking up in the nation,” Dr. Joe Bresee, chief of the branch of epidemiology and prevention at the U.S. Centers for Disease Control and Prevention’s Influenza Division, said during a teleconference.

“This season, we are seeing more disease out there and higher rates of hospitalizations and deaths than we’ve seen in the last couple of years,” Bresee added.

Although this year’s vaccine may not have prevented some of these outcomes, preventive medicine should take center stage.  In addition to vaccination, education is the key.  In a perfect world, all influenza strains would be completely eradicated and all subsequent mutations would be controlled with the “right” vaccine.  But, until that time comes, influenza outbreaks such as this should make everyone reconsider the effect of vaccination in terms of the healthful thing to do, unless you have the potential for experiencing a severe allergic reaction, of course.

The LAT has an interesting article on the similarities of the health plan proposals of the top three Democratic presidential nominees. It highlights the similarities, rather than the differences in their proposals, and the underlying idea is in how healthcare coverage is purchased and if that care should be based on a Medicare-like program, but for all adults who wish to buy into it.

But wait a minute, did you think that their plans were unique? Well, they are, but a closer look into the candidates’ proposals plays up the notion of market competition. Private insurers have nothing to fear, right? Depends on how one looks at it.

Detractors have it easy, essentially decrying the possibility of an “even bigger government” than we have now, undercutting the ability for even the most economically efficient private payer to compete for similar services. Supporters laud the chance for government run healthcare coverage that would make quality initiative measurements in reducing fraud and waste easier than it is now, additionally citing the utilization of other possible initiaitives, like pay for performance plans. (via the WSJ HealthBlog)