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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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

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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.

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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

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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

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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

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The initial spin on the recently squared away budget deal preventing a national default relates a necessary evil that not only carries the partisan rift seen in advance of the legislation, but also becomes a harbinger for a financial outlook that, in some ways, looks as bleak as the presumptive default did. Still retaining its triple-A rating, the credit outlook for the United States will be reflected in a “negative” forecast — likely resulting in a downgraded credit status within the next couple of years. Of course, all of this big-picture wrangling really doesn’t mean much to the millions of people whose salaries are paid — in part — by the federal government. A harsh reality at the forefront of this thinking, given the current jobless rate and achingly persistent unemployment levels is the specter of the loss of unemployment insurance for those currently receiving benefits. Minnesota is just one of many states bracing for such an apocalypse which appears to be sparing future cuts in another enormous federal subsidy — Medicaid.

Department of Human Services Commissioner Lucinda Jesson said she was relieved that Medicaid, known as Medical Assistance in Minnesota, is exempted from the initial cut. That doesn’t mean the new bipartisan commission charged with driving down the deficit won’t come after it once the panel breaks out the budget knife. “We are going to track it very closely,” Jesson said Tuesday. She said her department will also keep a close watch on child protection, food support and other assistance for seniors.

What about cuts to the service side of the equation? Since Social Security and Medicaid are specifically exempted from the ravages of the debt ceiling bill, physicians could see an additional 2 percent pay cut on top of double-digit Medicare reductions already slated for 2012 under the debt ceiling deal. Perhaps more concerning is the strong likelihood for major Medicare cuts and overhauls in long term care payments as a by product of a commission^[1] created as part of the deal agreed to on Sunday. Nursing homes would be hit extremely hard in this scenario — potentially affecting care delivery to the most medically complex beneficiaries in the LTC sector. Understandably, the deal reached by a less than jubilant Hill on Sunday has many folks extremely wary about the nation’s prospects on an already shaky economy. Its effects on federally subsidized healthcare delivery ups the ante for lobbyists, providers, and most importantly — patients. | LINK

1. The deal to raise the debt ceiling would task a 12-member bipartisan committee to come up with $1.5 trillion in deficit reduction and would require a significant swath of cuts starting in 2013 if those efforts at reducing the deficit should fail.

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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

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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

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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.

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