The questions and lingering concerns surrounding the overuse of antibiotics is an age-old and well-worn conundrum for physicians and patients. Even the latter group, well-informed as consumers of healthcare, can agree that most acute upper respiratory infections are most often the result of viral infestations which play themselves out in spite of antimicrobial treatment.The decision to (over)use them in standard medical practice is often the point of debate, as physicians weigh factors such as patient satisfaction and lingering medical and health policy issues surrounding resistance.

Last year, this blog reported on these issues as background for a program in which some retail pharmacy chains were giving away for free antibiotics to patients with prescriptions from their physicians as a way of helping with affordability in the wake of the debate on reform. The CDC offered a statement promoting the responsibilities providers, pharmacists, and patients should consider in taking part in such a program.

Smaller chain pharmacies are trying to compete with the big boys, and in trying to earn store-brand loyalty among their (un- and underinsured) consumers, they are throwing free antiobiotics their way. Last week, the CDC sent out letters those several chain pharmacies that offer no-cost prescription antibiotics to low-income consumers urging them to promote responsible use of antibiotics.

While the program was essentially successful in its efforts to bridge the gap between affordable, accessible healthcare and patient responsibility, no one was really prepared for the massive policy decisions that would have to be made as the June ‘09 H1N1 pandemic loomed — after its initial discovery just one month after this initial Doctor Pundit posting.

Pfizer’s current research on a potential blockbuster anti-Alzheimer drug is currently back to drawing-board status. According to the pharma company

[T]he drug, called Dimebon, had shown virtually no effect after six months in treating the cognitive decline or behavioral problems associated with Alzheimer’s when compared with a placebo.

Apparently, Wall Street has been watching the results of this Phase I study; the verdict is still out on whether Pfizer will continue to fund the research for this agent — designed to work better and longer at inhibiting some of the most distressing symptoms related to the disease. | LINK

What’s the healthiest county in the state in which you live? A new survey just published by the RWF finds what is essentially common knowledge in the healthcare policy blogosphere —  that persons in more rural counties fare worse than their urban counterparts with respect to decreases in healthcare access, increases in premature death, increases in hospital admissions for the treatment of highly preventable conditions, among other findings.

These findings should come as no surprise, because all (healthcare) politics is local, right? Here in Minnesota, research findings such as these take on an entirely prescient meaning — as our Governor is proposing enormous cuts in spending within the budget this cycle in order to balance it. The vast majority of those cuts are occurring in within the Dept. of Human Services, particularly its wholly funded General Assistance Medical Care public payer program. | LINK

• The Wellpoint saga continues…as well as the blame game for significant premium hikes.
• Study: alcohol + energy drinks (like Red Bull) = recipe for disaster.
• Has the H1N1 pandemic peaked?
• The first study of the anti-CSF prototypes for treatment/reversal of Alzheimer dementia is underway.

The trial will measure in the cerebrospinal fluid (CSF) and blood plasma of amnestic mild cognitively impaired (MCI) patients the biochemical changes that are associated with AD and correlate them with the pharmacokinetics of the drug and its metabolites.

• For California, the bleeding never ends. Today, Gov. Schwarzenegger releases his spending plan for 2010-11 which details even deeper cuts to its Dept. of Human Services.

A year ago, this blog cited a study which detailed the difficulties cancer patients faced when navigating the byzantine nature of health plans which essentially made it difficult, if not impossible, to receive life-saving treatments. The paper [PDF] went on to describe the problems these patients would still face even when eligibility requirements for government assistance via Medicare or Medicaid were at least partially met.

Either through ignorance of policyholders’ plans limitations or via the inability for their out-of-pocket costs to cover the difference, cancer patients have continued to face significant challenges in accessing crucial care. The verdict may still be out on the finer points of President Obama’s goals for reform, but Insurance does not really seem to be waiting for his signature on legislation to react.

With respect to one insurer, news comes of a cancer patient’s current fight to obtain treatment oncologists thought could save his life. Relapsing neuroblastoma has sidelined a five year-old’s life right now; his insurer has refused a new treatment option it deems as expiremental — in spite of covering a cheaper treatment in 2007 that was also called such, resulting in a full remission. The child’s parents are suing the carrier.

Advocates for insurance reform have taken a backseat in the reform debate, which is not surprising. Although, Obama has described his reform plans are not a referendum on reform of Insurance in a strict sense, it is apparent that sound arguments based upon solutions in the way coverage is paid and delivered need to transcend the rather simple promise of non-discrimination based upon claims denials.

A couple of weeks ago, I interviewed the CEO of the EHR/PHR tech company MediConnect, Amy Rees Anderson. What follows is the second half of that interview here on Doctor Pundit.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

DP: How important is portability of the health record for patients beginning to benefit from EHR adoption?

Ms. Anderson: The cheapest way to facilitate the portability of the records is to have the doctors adopt electronic medical records at point of care. Once this occurs the ability to retrieve and transfer records will become substantially more affordable. Again, I don’t think we will see this adoption for doctors really start to boom until we incent the current providers to do so. I do, however, believe that the rising generation of physicians who grew up with their handhelds and tablet PCs will come right out of school using these systems already. But it’s the physicians who have been practicing for years that we need to incent to switch over. Without electronic health records we can still retrieve and digitize the paper records like MediConnect has been doing since 1996, it just comes at a higher cost than if we dealt with all electronic records.

DP: Do you see any immediate barriers to adoption with respect to hospitals, vendor interface, or broadband availability in resource-poorer regions of the country?

Ms. Anderson: I don’t think broadband availability is the barrier to adoption today. The majority of records are stored in offices in the metropolitan areas of the country where the highest numbers of people live anyway, which has ample availability for high speed. In the smaller areas, where the Internet is slower, the doctors can keep records on a local server that can connect and upload to secure online storage in batch mode, so it won’t prohibit them from the changeover to electronic records. With regard to vendors, I think it’s important to let doctors choose whatever electronic records software works best for them in their own practice. Trying to force everyone on to one system is just not practical. That said, every system should allow for the transmitting secure health data to other systems as requested by the patient controlling that data.

Read the rest of this entry »

The increase is primarily for health programs in poor countries that will build on U.S.-funded efforts to combat AIDS. President Barack Obama’s budget boosts global health initiatives by almost 10 percent — expanding child and maternal health programs that coincide with AIDS relief programs in the world’s poorest countries.

The new global health initiative reiterated the administration’s pledge to put more than four million people on HIV/AIDS drug therapy and prevent more than 12 million new HIV infections by 2014.

AIDS/HIV continues to be a scourge worldwide, to say nothing of its prevalence here in the United States, as well as here in Minnesota — whose increases in incidence and prevalence should not only spur new efforts at education, but also at healthcare delivery with respect to this still-fatal virus. | LINK

You just have to hand it to Minnesota and its spirit of rugged self-determination. Its citizen individualism and desire to pioneer are just a couple of the qualities that are part of the state’s storied history as innovator and trendsetter. The concept of managed care as a healthcare delivery ideal had some of its roots in Minnesota, a concept going back over 35 years. Designed as a way to create a balance between providers and payments for services rendered, it has evolved — for better or worse — into a system upon which today’s healthcare marketplace has codified current business practices. That is, the very dynamic which has given the current President of the United States such a strong (though somewhat misguided) desire to overhaul the way healthcare is delivered in this country.

Pharma, Insurance, and the physician are the core triptych at which so much in the debate to reform healthcare is directed. Many primary care physicians feel as though they are at the epicenter of this reform morass, and many are left feeling dismayed over why they chose medicine as a profession at all. For many family docs, for example, navigating the complexities of day-to-day practice; feeling the pressure of seeing enough patients to justify employment in many manage care systems; and dealing with Insurance and public payers in order to simply get paid are essentially too much for them to deal with. Attrition from the profession usually results.

Imagine the self-determination of one Minnesota family physician — an employee of a primary care group in the Twin Cities for decades — when he simply could not “take it any more”. With actions that can at once be described as both narcissistic and noble, this doc decided to go it alone and get Insurance out of the mix altogether. Armed with $80 000 and a desire to accept only cash, he’s jumping into uncharted territory in 21st century healthcare delivery and going back to the pre-managed care days of Dr. Marcus Welby — and he’s doing it in one of the most heavily-penetrated managed care states in the country. The spirit of Minnesota innovation shines again, at least for one physician. | LINK

Pennsylvania’s Corrections Department is getting creative in the healthcare delivery to its aging prison population. With funding courtesy a grant from the National Institute of Nursing Research, the state will be bringing together the appropriate caregiving provider contingent to study the cheapest and most effective ways to deliver end of life (EOL) care. This pro-active move will likely be a point of reference as state budgets come under increasing pressure to provide this level of service to this patient population in the unique ”perfect storm” of declining state budgets devoted to healthcare delivery; exponential growth of geriatric populations/units in correctional facilities; and competition for federal healthcare dollars as the result of the Obama reform package (whenever that occurs).

The project will develop an intervention toolkit for use by staff at any prison in the country. [..] Prison workers, including health care professionals, chaplains, prison society volunteers and corrections officers, will provide information on current limitations, strengths, existing perceptions of end-of-life care among prison stakeholders and areas of care that bear improvement. Using the data collected, researchers will create a set of educational strategies for use by prison staff that they can tailor to fit individual prison’s needs.

The devotion of grant money to fund this type of research is appealing and compelling on many fronts — not the least of which is a shared national discourse which is sure to follow on such unique EOL care initiatives. | LINK

President Obama’s healthcare initiatives are, once again, upfront in the 24-hour news cycles this week — albeit for reasons he probably would prefer not experience in the one-week run-up to his second SOTU address. Before all of the current negative sentiment surrounding health reform became the norm, there was a halcyon period for the new president, and it was about a year ago when he took office. Barack Obama’s election as the 44th U.S. President arrived fresh with bold promises of a completely revamped healthcare delivery system that would revolutionize access for the vast majority of U.S. citizens like no other piece of legislation since the Medicare entitlement over 40 years ago.

The talent pool from which the new president was to draw resources to revolutionize healthcare delivery included, at its centerpiece, the drive for innovation in the age of the electronic medical record. The ability for patients-as-consumers not only to have control over their healthcare information, but also have immediate access to it holds great promise for positively influencing efficiency in health information dissemination. Lower costs and less waste are to be the results of this innovation. Obama’s penchant for tech only adds to his administration’s zeal in making this happen.

Search giant Google made headlines when it entered the hallowed space of patient information and medical record retrieval. Of course, this caught the attention of the Obama administration, as it has already implemented Google as one of four key players in a demonstration project involving Medicare beneficiaries’ health information and records retrieval. Another up-and-coming HIT company targeted by the Obama administration as part of this CMS demo project is MediConnect. This company has emerged as one of the few major players in the new and thriving electronic medical records industry after growing nearly 800 percent in the past four years and is now serving some of America’s largest health payers and life insurance carriers.

I recently had a chance to interview its CEO, Amy Rees Anderson, and gauge her thoughts on the brave new world of this patient-as-consumer driven technology and what it means in the overall plan for healthcare reform. Part II of this interview will be posted on Doctor Pundit next week.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

DP: You are the CEO of a company fresh off an acquisition and explosive growth over the past 4 years. Where do you see the impact of the electronic health record (EHR) and the patient’s utilization of it in driving healthcare delivery efficiency over the next decade?

Ms. Anderson: I believe it is critical for patients to get involved in overseeing their own health care. If you really think about it, as consumers we often spend more time researching what car to drive then we do on our healthcare decisions.

In order to get consumers involved, it will take two main components 1) help them gain access to their medical records and 2) help them understand what is in those records so it becomes more meaningful to the consumer.

As we can accomplish these two things, which we believe MediConnect now offers with the combination of our record retrieval services and now the acquisition of PassportMD, the online Personal Health Record system, we can help consumers to get involved in knowing and understanding their own healthcare. As the adoption of these types of services grow, consumers will ultimately be what forces the facilitation of transferring medical information between their own medical care providers. The patient is really the only person who can build their entire health record by keeping every record from every care provider in one central repository which they can either directly access or grant access to certain portions to the people they feel need that information in order to best guide their healthcare.

Read the rest of this entry »

As with any specialized year-end list it is only natural to speculate what all of the changes described in those recaps will mean for the year, or in this case, the decade ahead. Already, niche pundits are eagerly awaiting the arrival of high profile events in early 2010 which highlight everything from the new winter Fox TV broadcast schedule (American Idol’s 9th season) to what’s next in gadgetry (CES 2010, Las Vegas) — and let’s not forget the biggest upcoming showcase of them all, at least among Mac Heads: the Mac World Expo in San Francisco.

But what about health policy?

Although Washington gets back to business next week, the hoopla surrounding the merging of the Senate and House versions of the reform bill is rather lukewarm — for innumerable reasons spelled out in this blog and all over the healthcare blogosphere in 2009. In spite of this historic bill pending Obama’s signature making it into law, the focus of health policy — for this year at least — will be on what will happen to healthcare delivery in spite of the language expressed in the final passage of the merged bill into law. Because of this, many health policy pundits, like myself, will be closely watching forces which will continue to define the heatlhcare marketplace — the economy within the economy which drives the institutions of Pharma, Insurance, and medical tech and devices in this country in influencing our health coverage. In turn, these two-ton pachyderms in the ongoing debate of health reform will spur interest in how the processes of healthcare systems, IT, patient-centered issues (the patient safety movement, consumer directed healthcare, patient healthcare disparities), and myriad other forces will set the trends for care delivery in the coming decade of the 2010s.

The groundwork has been laid. Now, we’re off and running.

The pending shortage of physicians projected has been preached about for so long it seems as though the healthcare thought leaders and policy watchers must be wearing sandwich signs direct from their ivory podia as they make their pronouncements. This is not to deny that the country is in the midst of a looming physician shortage —  something that is not to be helped by the rapid graying of America.^[1] The most convenient answers have centered around the simple increases in medical school class size and increasing the range of residency opportunities. Ambitious as these solutions seem, the problem of physician depletion and workforce shrinkage is much too complex to simply ascribe repletion as a mechanism for change.

Read the rest of this entry »

1. The U.S. Census Bureau reports that the world’s 65-and-older population is projected to triple by midcentury, from 516 million in 2009 to 1.53 billion in 2050. [↩]

We hear a lot about IT infrastructure as a valuable element of the growth plan for many healthcare systems as part of the overall goal of healthcare reform. It’s a vision that has been championed quite vigorously by healthcare leaders and none other than President Obama himself. However, a study just out seems to question just how essential refining a sound IT framework is when it comes to perhaps the most important goal of reform — saving money in the process.

The recently released study evaluated data on 4,000 hospitals in the U.S over a four-year period and found that the immense cost of installing and running hospital IT systems is greater than any expected cost savings. And much of the software being written for use in clinics is aimed at administrators, not doctors, nurses and lab workers.

No surprise there. Even CIOs of major health systems would have to admit that sharpening IT infrastructure is geared toward management as a first step in the overall journey toward quality care. Still, one has to wonder, if finding the most efficient way to generate insurance claims data versus mining for system-wide critical clinical data continues to be a greater priority for healthcare organizations. | LINK