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
When she was diagnosed with multiple sclerosis, a Minnesota woman thought that her carefully chosen neurologist had her best interests in mind when prescribing initial treatments to modify the disease. That was before a little detective work uncovered the real motivation for her physician’s patterns of prescribing that left her even more debilitated than when she was initially showing symptoms.
It worried me that none of them ever suggested that I discontinue treatment—or switch to another treatment—even after I reported that my injection site reactions were affecting my quality of life. Despite the fact that my neurologist insisted that I begin disease-modifying therapy, I was never contacted by him, his nurse, or anyone else in the neurology clinic with questions about how my Copaxone injections were going.
The patient, a U of M philosophy graduate student, puts into her own words the ethical issue she gradually uncovered while under the specialist’s care. Just how influential are pharma companies’ financial compensations for physicians who choose to prescribe their products? Just how willing are they to prescribe knowingly untested medications without concern as to their problematic and potentially lethal adverse effects? Her answer came at her next appointment, after enduring months of increasingly debilitating pain and enfeebling function from the trial with the first drug.
[M]y neurologist informed me that I’d begun to develop lesions inside my brain stem. He explained that this was a very bad place to have lesions, occupied as it is with regulating some of the body’s basic functions, such as breathing. He strongly recommended that I go back on MS treatment, suggesting this time a drug called Tysabri (natalizumab), which had worked wonders for some of his patients but also carried some amount of risk. Worried about the new lesions, but knowing little about the drug he was advising, I told him I’d think about it. I needed to be convinced through my own investigations that this drug would be worth taking.
Her investigations were not only telling, but they are also indicative of an all-to-familiar refrain for patients of (mostly specialist) physicians who pocket major coin from pharma companies to get these ridiculously expensive agents to the marketplace, at the risk of patient harm. In Minnesota, the patient was assisted by a database which lists pharmaceutical third parties with which a prescribing physician has a financial interest. She makes little doubt of her eagerness for this requirement to spread nationally as the result of the reform law. | PDF LINK
Are the citizens of Minnesota ready to take a look at prototype models for healthcare exchanges? The marketplace stimuli as part of reform are being unveiled today. Although it may seem early for such exposure, MN must demonstrate that it can operate an exchange as part of reform much sooner — just over a year from now, in fact. Four companies have placed demo modules up for public review. Playing around with a couple of them, I get the feel of sites that are actually consumer portals into products that resemble reservation services, only instead of purchasing a flight or hotel accomodations, I am choosing a provider which can treat certain chronic conditions more cheaply, for instance, in one organization in comparison another based upon my personal situation.
States participating in this exercise which are not able to fully integrate these virtual exchanges at the outset of reform will get fed assists. Minnesota seems ahead of the curve here, as the governor has taken a seemingly personal role in getting this state’s offerings public and implementing diligent task-force support to the process early.
Political coalitions here in Minnesota have largely towed the Democratic line, having gone decidedly blue in the last presidential election in spite of reports that the state was a purple one “in play” in an ultimate result that was anything but close. The building within the democratic base also stands to reap benefits with respect to the reform law by its inception in 2014.
This, according to an MIT healthcare economist.
[Jonathon Gruber] told members of a governor’s task force Thursday that the federal health care law will reduce the health insurance racial disparities in Minnesota. [...] Gruber projects that almost 300,000 additional Minnesota residents would gain insurance coverage by 2016, and that those who currently buy health insurance on the individual market could pay 20 percent less in premiums after taxes.
Gruber was speaking in terms of the savings generated by increased access to healthcare with the advent of exchanges under reform. Dem Governor Mark Dayton has recently formed a couple of healthcare task forces — one of which will exclusively work to develop an exchange to increase access to the state’s un- and under-insured. | LINK
Just under 13 percent of skilled long term care facilities here in Minnesota are part of a project that is aimed at reducing the “supply side” of potentially unnecessary hospitalizations in the care of their elderly patients. The three year initiative is based upon data already gleaned from smaller tests and it essentially involves going back to the fundamentals of physical diagnosis — from all members of the skilled provider team.
“The problem is the doctors,” [Dr. Robert Kane, a University of Minnesota aging expert who is helping lead the experiment, said.] “Physicians familiar with nursing homes learn quickly to trust the precise information from nurses using the Interact tools. But for the others, especially nights or weekends, the default is hospitalization.”
I like to think of this as a recognition about what physicians have always known about medicine. Nothing substitutes for a thorough physical exam, regardless of who the examiner is. Any effort to utilize the good ol’ noggin to diagnose and treat without the knee-jerk rush to the hospital ED to provide primary care is always preferred, and it saves the proverbial bean counters on the acute care side of things (hospitals) of having to deal with yet another inappropriate admission. | LINK
As a geriatrician, another reminder of the work that I do and why it is so important in today’s delivery of healthcare as it relates to chronic, complex diseases (especially with the explosion in the sheer numbers of Boomers into that hallowed 65-and-older territory):
Some 89 percent of the state’s medium and larger hospitals offer palliative care — which focuses on easing pain and discomfort while often continuing aggressive treatment. That placed Minnesota among seven states getting an A in a report released Wednesday by the Center to Advance Palliative Care at Mount Sinai School of Medicine in New York City.
The report also cites cost-of-care decreases in aspects of delivery of care to the very infirmed while noting the provisions of dignified, compassionate care characteristic of established palliative care programs. Imagine that. | PDF LINK to report
She is an extremely popular, if not equally reviled, U.S. congresswoman from Minnesota’s sixth district. Everywhere she goes, controversy, drama, and gaffes usually follow en masse. Michele Bachmann is currently relishing her role in the media spotlight, though, not all seems to be going smoothly for her. Fresh from her recent likening of herself to a serial killer, the latest public snag has less to do with poorly constructed similes and metaphors, and more to do with breaches on campaign values.
It’s no secret that Michele Bachmann condemns massive government funding for healthcare delivery, allowing her to utter dispassionately the phrase “Obamacare” at virtually every campaign stop. Her attacks on Medicare, Medicaid, and health reform in general are well known and have certainly have created for her a coveted niche at the top of the 2012 GOP heap along with top billing by the presumptive front runner Mitt Romney. But, until now, it’s the little known benefit that her husband, a licensed psychologist, apparently received at the hand of the federal government that will eclipse her more previously innocuous missteps.
The mental health clinic run by her husband has been collecting annual Medicaid payments totaling over $137,000 for the treatment of patients since 2005. Initially, Bachmann said the fed-state reimbursements were a one-time event — funds used for training staff and initial services. More importantly, however, is the fact that, in spite of her proclamations of Medicare and Medicaid enrollments increasing the “welfare rolls”, her husband’s practice was a direct beneficiary. I guess we’ll see what gaffes develop from this latest issue. | LINK
The current economic crisis that is afflicting many states, including Minnesota, renders no amount of negotiation trivial (or, even civil at times, for that matter) and is gripping many states in political gridlock. With a Democrat chief executive and a Repub controlled legislature, Minnesota is no exception. One of the state’s largest agencies — the Dept. of Human Services — is receiving the lions share of scrutiny as it is a major source of govt spending. It follows that, with the gridlock in St. Paul, a shutdown could be looming; that could have an enormous effect on state subsidized health care spending.
Not all healthcare entities in the state are bracing for the worst in the current legislative impasse amid a $5B budget deficit. Hospitals in Minnesota are proud to trumpet their contributions to a growing, if sputtering, economy.
In all, the state’s 148 hospitals generated $27.2 billion and created 214,108 jobs in 2009, according to the most recent data available from the Minnesota Department of Employment and Economic Development, which ran the numbers for the Hospital Association.
Hospitals in Minnesota, especially those in rural areas, may be huge economic drivers of activity, but the spending on healthcare — in the acute care setting — will always outpace the cost of care delivered in a strictly preventative sense. Including safety nets, which were created to attend to those with limited access to healthcare resources, many hospitals still account for heavy spending — eventually encroaching on the need for public matching funds to offset explosive growth in the cost of delivery. In troubled economic times, a balance is needed between spending in both the public and private sectors to ensure continued healthcare delivery in a fiscally sound fashion, not a reckless one. Apparently DHS leaders, reps from the MN Hosp. Assn., Governor Dayton, and lawmakers will be meeting to discuss their philosophical approaches to this glaring issue next week. | LINK
WIth Paul Ryan’s misstep, former MN governor and now declared GOP presidential candidate Tim Pawlenty sees an opening.
[H]is plan to secure Medicare’s finances will allow seniors to choose between the current fee-for-service program or other options. [...] He hinted at options he would provide for seniors to encourage more private insurance coverage, but he stressed that they should be allowed to choose which system to use.
In the antecedent to the Senate vote in which the Ryan proposals were soundly voted down (albeit, by a partisan vote), Ryan was pressed to consider running for president. Since the NY-26 loss and apparent referendum on the so-called Ryancare plan, that consideration has gained no traction, and, Pawlenty — sensing an urgent need for early differentiation in a relatively weak ’12 GOP field — wasted no time in doing so. Of course, his “plan” is short on details — but, in the world of constantly shifting soundbites on how to reform Medicare, that approach is all that is needed right now. Count on the Democrats to work hard on maintaining voter perception that its party is the only choice to “manage” Medicare in the age of reform.
Yesterday, CMS released a statement confirming an increase in reimbursements to Medicare Advantage plans. The uptick of 0.4 percent is not as high as the 1.6 percent planned increase the agency announced just two months ago, but reflects “economic changes” in the marketplace — not changes to Medicare policy.
This is meaningful, as a provision of the reform law was to create payment alignment with traditional FFS Medicare. Almost one-quarter of Medicare beneficiaries possess some sort of coverage through private insurers over and above traditional Medicare. Obviously, private plans will have to adjust to this reality, as the cost of MA care delivery to taxpayers is roughly 10 percent greater than the cost of traditional Medicare delivery.
Are Americans utilizing fewer healthcare resources? Certainly projections like this may bear this trend out. But, private insurers — like UnitedHealth here in Minnesota — face major cuts throughout the next decade under reform.The cost of delivering healthcare via the federal government may be greater in the long run for them. Sure, cost of delivery is important, but the ongoing specter of regulation looms large for private insurers which expect significant ROI on care delivery to those who qualify for Medicare.
Here’s a developing Minnesota health policy item: governor lauds donation from major provider of indigent care to reduce state deficit — all the while, GOP lawmakers push for bill to make cuts to funds earmarked for the state’s Department of Human Services in an effort to reduce same budget deficit.
Democratic Gov. Mark Dayton announced the donation from UCare, which provides coverage for patients on state and federal programs including MinnesotaCare, Medicaid and Medicare.
While this move is a great one, I can’t help but anticipate what the GOP-led legislature has up its sleeve in creating cost-control measures for the critical delivery of care to Minnesota’s Medicaid and dually-eligible population of patients — given that cuts to institutionalized long term care and mental healthcare services are not on the table. | LINK
Believe it or not, the very first indication of polling the citizens of Massachusetts on issues of satisfaction of that state’s universal healthcare delivery has just occurred. The results show that consumers of healthcare in Massachusetts are pleased with it. A clear majority of patients (well over 80 percent) have had at least one visit with a physicians under the state’s publicly subsidized program since its inception five years ago.
Juxtapose this with the ongoing Obama mandate for universal access to care under the ACA, and you’ve got a recipe for continued controversy as long as the GOP-dominated House makes the case for piecemeal repeal of the legislation in its entirety. Here in Minnesota, a bill will probably pass the legislature (only to be vetoed ultimately by the state’s Dem governor) that would put a hold on any state funding for universal access under reform if certain elements of the law are judged unconstitutional — a decision likely to be made by SCOTUS. | LINK
Originating from Saint Paul, Minnesota, [doctorpundit.com] is a weblog about the policy of healthcare and where it intersects with politics and public opinion; it is edited by Michael Douglas, MD, MBA. Welcome, and please consider my take on what is Healthcare 2.0, complemented by a few of my thoughts on my personal avocations and guilty pleasures: music, prose, and writing. Follow Doctor Pundit via RSS above.
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DOCTOR PUNDIT @ ONE YEAR | An occasional DP series from 2010 highlighting healthcare policy trends over the period from 2009-2010 in a compare/contrast format.
