The good news: the media have done a reasonably good job of getting the word out to consumers of healthcare with respect to the prevention of medical and surgical mistakes in acute care settings. The bad news? Here in Minnesota, the numbers of “wrong surgeries”, a collective term meaning never-events in this care realm, topped 2010′s tally by five cases — creating a surge in such cases last year.

The figure is the highest in eight years of self-reporting by Minnesota hospitals. Officials cited many reasons for the mistakes — from doctors filling out incorrect orders to sloppy inventories that make it easy to grab the wrong joint implants for orthopedic procedures.

While the surge appears to be from the absolute numbers of incorrect procedures performed, the rate of adverse events has globally decreased, bringing into question the efforts of many healthcare systems in the processes involved in preventing completely avoidable lapses in care delivery. | LINK

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Robbing Peter to pay Paul — in terms of Medicare cost sharing, that is. A new Medicare benefit design will enable increased costs for lower utilizers of the government entitlement (relatively healthier beneficiaries). This limit on cost-sharing among beneficiaries would decrease the costs per sicker beneficiary for, say, acute visits to the hospital rather substantially, leaving those who do not use services as much shouldering the burden.

A melding of the services by hospitals (part A) and doctor visits (B) as they relate to deductibles, plus a requirement that participants pay 20 percent toward a $5500 limit would increase the payment of almost 75 percent of beneficiaries (the lower utilizers of acute care) by almost $200/month. My take? It’s potentially a mechanism for some savings by the federal government, and it may give more ammo to Republicans who are interested in tiering beneficiary eligibility — such as via so-called means-testing.

All this in an interesting study via Kaiser. | LINK

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Sign of the times: social media’s use in increasing interaction among patients with dementia. A researcher, part of a team, is busy at work on a web-based app based upon Facebook for utilization among cognitively impaired elders. She states:

“We have already carried out some practical testing of other web-based communications systems. Among other things, we have tested a “digital diary” and a “scrapbook” containing personal photos, newspaper cuttings and information found online.”

What is both curious and puzzling at the same time regarding this research is that it is being conducted in Norway, of all places. Why not here in the good ol’ U.S. of A? Innovation of this type began and germinated here. Social media’s global function of “keeping one in the loop”, including the elderly, can not be understated in its potential in non-pharmacologic dementia research. Here’s to hoping it gains ground on these shores.

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Alzheimer dementia continues to be among the most heavily researched and funded chronic diseases in medical science today. The increased awareness, brought into the spotlight and “modernized” more than 20 years ago following the high profile revelations of celebrites and politicians afflicted with the disorder, has led to increased patient education, public policy initiatives, and, of course, greater research monies in the effort to not only treat symptoms, but also to find a cure.

An international advocacy group is now asking municipalities to take awareness a notch higher with the commitment to even greater awareness of the disorder — addressing what it calls a “treatment gap”, hampering any gains on detection of the disorder at its earlier stages. Here in the U.S., the Obama admin is apparently hard at work in developing the country’s first-ever national anti-Alzheimer strategy aimed at sharply cutting the enormous healthcare costs associated with ancillary treatment .

The National Alzheimer’s Project: From Act to Action is an effort to support a committed and effective implementation of the National Alzheimer’s Project Act (NAPA). Information collected from individuals living with the disease, caregivers, providers and other stakeholders will be shared with the U.S. Department of Health and Human Services, which is responsible for creating a national strategy to address the crisis and coordinate across government agencies. This project is facilitated and supported by the Alzheimer’s Association.

Consider this effort an amalgam of citizen awareness and discussion (townhalls) and legislation (congressional passage of the National Alzheimer Project Act) garnering bipartisan^[1] support to fight a scourge that can leave heavy financial tolls on caregivers, families, and the healthcare delivery system itself.^[2] A daunting task, to be sure — but one that is sorely needed. Here’s looking forward to December — the date when the president makes his plans for these initiatives very public. | LINK

1. Just how bipartisan? In 2007, Newt Gingrich co-authored an article in Alzheimer’s and Dementia: The Journal of the Alzheimer’s Association, making the case for the creation of a federal Alzheimer strategy.
2. Alzheimer’s Association advocates sent more than 15,000 email messages to the White House asking the President to sign the National Alzheimer’s Project Act into law; on 1/4/11, he did — making this action the most significant legislative action with respect to Alzheimer funding intiatives up to this point.

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The rise in prescription drug abuse in this country has been muted somewhat by the traditional messaging by anti-drug campaigns which advocate the overarching “just say no” philosophy … and have done so since the heady days of the Reagan administration some 25 years ago. A different kind of advocacy is needed, say the appropriate groups; that is, one of attention toward the ripple effect of the “other” illicit drug — the prescription narcotic (including, most notably, hydrocodone and oxycodone).

In scenarios in which the levels of violent crimes (pharmacy robberies and assaults) are belied by the common perceptions of acquisition of such drugs (petty theft, paper script forgeries, etc), it’s easy to see why some say the FDA has been lukewarm at efforts to control this burgeoning problem.

The 12-year delay in the federal regulators’ final decision about hydrocodone – the second most-abused pain drug – has been agonizing, to say the least — all the more so as the Drug Enforcement Administration and Food and Drug Administration are apparently still studying whether to move hydrocodone-containing medicines to Schedule II category of medicines from the less restrictive Schedule III. Advocates for tighter controls over hydrocodone opine that it is time the government took concrete action to save lives — since a study funded by the National Institutes of Health has shown that nearly 8 percent of the 12th-graders in the US have abused hydrocodone in the last year.

The agency says many factors — chief among them the logistics involved in augmenting widespread training and retraining of healthcare providers as to the merits of prescribing in this new climate of addiction — have complicated movement forward on the matter. It’s a problem that’s not going away anytime soon. Those hoping for a sweeping decision by the FDA to correct things are better off considering scenarios in which the government agency can partner with other entities to begin to address oversight in prescribing lapses, formulary monitoring, and drug utilization reviews in healthcare organizations. | LINK

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How does obtaining health coverage (insurance) compare to not getting it at all? According to a trial published via the National Bureau of Economic Research (Harvard/MIT), beneficiaries’ quality of life was enhanced and made a “big difference” in those patients’ self-health perceptions and their daily outlook — according to the study’s lead author. A quick glance at the results confirms that all encompassing statement, especially since the study employed the diagnostic “gold standard” in trial research by utilizing a randomized, controlled design.

Taking a look at approximately the first year of coverage for Medicaid beneficiaries in the state of Orgeon, the study showed that healthcare expenditures for those who got coverage increased by almost $800/year. Those who received Medicaid were around 60 percent more likely to get mammograms. Medicaid recipients were over 50 percent more likely to have a regular primary-care doctor. They were also in better shape financially and less likely to have unpaid medical bills. Those who got Medicaid were also far more likely to report themselves in good or excellent health. ED admissions did not decrease; however, the increase in ED utilization by beneficiaries was not statistically significant.

It is clear from the results that coverage, in and of itself, has a positive effect on patients’ perceptions of health and wellness. What is not documented as much at this time is how this translates into outcomes with respect to various chronic problems such as obesity, diabetes, and risk factors (such as serum cholesterol, blood pressure, etc.) for heart disease. Also, it is unclear how these results translate into real numbers once reform increases Medicaid rolls substantially by 2014. Researchers plan on following the participants for at least another year. | LINK

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Social media is taking on another meaning entirely in the world of healthcare, specifically with respect to the patient-as-consumer demographic. As we inch closer to the complete institution of the reform law (PPACA) — barring any attempt to repeal any or all of the legislation — questions about its real world implications continue to present challenges for suppliers of health care (systems, providers, insurers).

Patients with a strong interest in navigating the path of the legislation’s numerous provisions could be getting help in the form of social media mechanisms. This is apparently demonstrated in research from the University of Utah which shows social marketing tools are crucial to the success of health care providers in their efforts to help consumers navigate the PPACA.

The paper highlights some of the potential challenges consumers face as a result of initiatives implemented in response to the PPACA and suggests ways health care providers, policy makers and health care marketers can best prepare consumers to meet them. After examining three consumer barriers – understanding, decision-making, and maintenance of healthy behaviors – Scammon advocates that social marketing is the best way to segment health consumers and then identify the specific challenges faced by each segment.

If the premise of this study is that breaking down information barriers to create a clear understanding of the law benefits conusmers and creates more efficient healthcare delivery overall, then its realization will only occur at the hands of an administration willing to continue to use social media as a constuctive, not divisive, force in making this brave new world of healthcare delivery work for everyone. Of course, just how well this aspect of social media is implemented into to the rollout of the ACA will depend on what 2012 brings to the White House. | PDF LINK here

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Doctor Pundit appears to be taking a step further into the physician social media space. Yes, the blog is already on Twitter. (I continue to resist Facebook, for personal reasons.) But, it looks like it has caught the eye of the marketing team behind one of the Interweb’s largest online social networks for physicians: Sermo. I must admit that I have only reluctantly ventured out into social media as a willing participant — opting mostly to occupy the “push” aspect (blogging; RSS; the very occasional off-topic tweet) instead of indulging the more complex mano a mano interactions many more psychologically intrepid docs other than myself utilize — media such as Facebook, LinkedIn, and, of course, Sermo.

So, imagine my surprise when Sermo contacted the blog to be included as one of its “selected sites”. At this point, many thoughts raced through my very constant linear judgment. Do I need to become more active in social media other than merely possessing a presence on Twitter or Facebook? Are message boards really for me? Do I really feel like I have something to offer in an alternative manner to the straight-up matter-of-fact blog? What will my patients think? Am I a social prude? Does anyone but me really care about any of this?

Then, I figured it out. The realm of physician social media is expanding into places beyond the simple message board. Perhaps the initial reticence of social media sites like Sermo in finally trekking out of its own constraints to include influential alternatives such as Doctor Pundit is representative of a changing of the guard in this space. By including voices in the medical blogosphere this relatively public migration of the completely private Sermo (the site is only open to licensed U.S. physicians) is obviously a prudent move. Why shouldn’t Doctor Pundit be meeting Sermo halfway in this endeavor? So much (social) pressure; so little time.

Well, I suppose in the time it has taken you to read this blog post, I have already decided to acknowledge Sermo with it. Guess that speaks for itself. Shhh! Hear that? That’s the sound of this blog jumping into this partnership with both feet.

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Via National Journal, the current CMS chief Don Berwick, MD, and others discuss the effect of healthcare associated infections on delivery and cost of care. Among the topics discussed in the Q&A are (jump ahead to the times listed to see): political infighting in the healthcare policy arena and role of the public and its perception of health policy @ 34:30; Berwick’s views on “systemic” improvements in care delivery based upon organizational leadership and governance @ 42:00 — and most importantly, his thoughts on the iPod and iPad @ 56:00.

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The shift to a sharp decline in the prescribing of neuroleptic (antipsychotic) medications to treat paranoid symptoms and behavioral instability in patients with dementia (no psychiatric indication/past medical history) was begun well before the unified FDA response in imposing a black box^[1] warning as to its usage, according to a VA study.

According to the principal investigator, this demographic shift in the usage of these class of medications would not have occurred if it had not been for the adjustment (taking statistical account) with respect to patients over 65 — as opposed to those with longstanding psychiatric illness. This trial^[2] just confirms what most geriatricians, including myself, have known about this class of medications all along: that since the early 2000s, the overall risks of death from all causes were specific to this class and this specific demographic of patients. It’s a far cry from the rather liberal use of these medications in the routine treatment of the non-mentally ill aged during my training.

1. FDA has determined that patients with dementia-related psychosis treated with atypical (second generation) antipsychotic medications are at an increased risk of death compared to placebo.
2. The analysis, published in the February 7 issueof the Archives of General Psychiatry, drew from data on more than 250,000 patients from national Veterans Affairs registries maintained in Ann Arbor. It’s the only study on the topic to adjust for demographic shifts.

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