Medicaid has long been regarded as Medicare’s (ugly) stepchild, primarily because of the essentially fifty different ways the program is sustained nationwide and the myriad federal ins-and-outs of a long complicated relationship with managed care and federal financing. Not surprisingly, many states are taking the opportunity exploit the concerns of very real budgetary deficits to propose streamlining plans to cut many of its services many lawmakers — both Republican and Democrat — say are wasteful.
A major national trial is about to begin actively collecting data. It’ll track kids from pre-birth to the 21st year of life, and identify physical, biological, and social factors in their health. There will be seven locations taking part. Ramsey Co. (St. Paul), MN is one of those locations.[1] Apparently, this trial is described as “landmark” in its information- and data-gathering techniques for the sole purpose of accurately detailing the state of pediatric health in this country.
“Times have changed since the early ’60s,” said Pat McGovern, a University of Minnesota professor who will be lead researcher of the Minnesota arm of the study. “We have more single-parent families [and] more two-parent families in which both parents are working. Immigration patterns have changed. Children’s exercise and diet habits have changed. There’s a whole lot more chemicals we’re all exposed to in the air and water.”
This study aims to provide definitive data on pediatric and adolescent medical care for the 21st century. Dubbed the National Children’s Study, the federally funded venture will continue to provide data over time, gleaning information from as many diverse sources as possible over many years. Perhaps it will provide significant answers surrounding the development and optimal treatment of disorders such as asthma, ADD, and autism. | LINK
Policy wonks, regulatory agencies, legislators, and just about any interested person can usually obtain access to a physician’s relationship with pharma companies and the drugs they pitch. It wasn’t too long ago that this information was more challenging to find, let alone synthesize. Over the past twenty years, Minnesota has pioneered efforts through legislative action designed to strengthen consumer protections with regard to freedom of disclosure laws. Large state mandated databases now report routinely on physicians, pharmacists, and other providers in the state, as a result.
Increasingly, however, disclosure information reported to inquiring third parties has been lacking in accuracy — more specifically, the reports lack effective auditing mechanisms for the purpose of ensuring the most accurate disclosure data regarding provider payouts from pharma relationships. The net effect is that there are usually major discrepancies in what pharma companies are required to post versus what the state posts. Physicians, as a result, may be incorrectly characterized as to their degree of involvement. This, of course, has implications for both healthcare systems, consumers of healthcare, and state and local governments if reform — as it applies to spending on healthcare — is to make any sense of just how much waste is occurring at the hands of Pharma and its industry sponsored payouts. | LINK | LINK to ProPublica’s Dollars for Docs database (Minnesota)
Since the late 20th century, innovation in long term care (LTC) has been fueled by a desire of healthcare systems – in this case, owners of skilled nursing facilities — to achieve new quality benchmarks in healthcare delivery at a reasonable cost. Thanks to major pieces of legislation over the past 15 years emphasizing patient safety, healthful outcomes, and cheaper methods of treatment delivery; LTC as a discipline has undergone a sea change for the better. As a geriatrician, I have seen this evolution firsthand. That’s why I absolutely love seeing developments like this
Working with a psychiatrist and a pharmacist, [nurse and resident care coordinator in a Two Harbors, MN nursing home, Eva] Lanigan started a project last year to find other ways to ease the yelling, moaning, crying, spitting, biting and other disruptive behavior that sometimes accompany dementia. They wanted to replace drugs with aromatherapy, massage, games, exercise, personal attention, better pain control and other techniques. [..] Within six months, they eliminated antipsychotic drugs and cut the use of antidepressants by half.
The savings in cost due to the cessation of expensive psychotropics (even if informed consent enabled usage), the avoidance of chemical restraint and its obvious negative effect on patient safety, and the increase in patient quality of life without the need for specialized dementia care (again, at an enormous increase in care delivery cost) are at least three major reasons why innovation in geriatric care is so important in the age of reform. And it’s happening right here in Minnesota. Excellent.
Minneapolis Star Tribune columnist Lori Sturdevant pulls no punches on the prospect of publicly subsidized healthcare under a Republican governor’s administration. She takes to the Sunday paper to make the case for a swift end to the recount quagmire in the state’s undecided governor’s race that could affect when exactly the presumptive winner, Democrat Mark Dayton, will enter office. Timing, of course, is everything; because, the fate of the guarantee of $1.4B to Minnesota’s healthcare delivery hinges on when a swearing-in will take place.
Virtually the entire Minnesota health care industry is rooting for the governor’s suite to be occupied on or before Jan. 15 by someone willing to catch the Medicaid football and score with it. Only [Democrat] Mark Dayton, now leading Republican Tom Emmer by an unofficial 8,755-vote margin, wants to make that play.
The lobby AHIP spent close to $90M in an effort to rally Insurance and the GOP to fight the public option provision in President Obama’s battle for health reform. The funds were paid to the U.S. Chamber of Commerce and easily exceeded its entire budget for the previous year. According to the COC spokesman, the funds were meant to “advance a market- based health-care system and advocate for fundamental reform that would improve access to quality care while lowering costs”. Of course, this information is made public by law. Minnesota-based UnitedHealth is just one of the major players involved in the effort to dethrone the public option as a provision in the final passed legislation. | LINK
Not only was drama predicted in the Minnesota race for governor, but it delivered in droves. The big story, as expected, was the nailbiter of a governors race, which ends — or rather begins — with a recount. Never has a race truly reflected what pre-election polling had consistently shown — that the Democrat Mark Dayton would lead by only a few percentage points over GOP challenger Tom Emmer. How few? Try less than 0.5%, triggering an automatic recount. That process could take at least 2-3 weeks, some are saying.
Perhaps overshadowing this potential election law firestorm, is the news that the state flipped its balance of legislative power completely, with the GOP taking control of both the House and Senate for the first time in more than a generation. Even if Democrat Mark Dayton ascends to the governor’s office, there will certainly be a direct challenge to his campaign ideals and platform; everything from his massive budget-closing promises of increased taxation to his hopes for more government injection into the state’s healthcare delivery. | LINK
So much of what happens to safety-net healthcare delivery really does depend upon who will take the governor’s job this year in Minnesota. The state’s largest indigent acute care facility, Hennepin Co. Med. Ctr. (HCMC) — in response to a year fraught with budget cuts amid a $6B deficit backdrop — will no longer accept patients who do not reside in its county (Hennepin) for non-emergency care.
HCMC estimates that the new policy might save about $600,000 a year by denying treatment to an average of 1,000 destitute patients annually, based on 2008-09 statistics. Board Chairman Mike Opat acknowledged that’s not a huge impact on the hospital’s bottom line.
Perhaps it isn’t, but the bigger story here is the impact of care delivery. Currently, this hospital is one of a network of safety nets designed to provide ongoing care with capped state funds meant as a stopgap in spiralling costs due to the retooling of the major indigent care program, General Assistance Medical Care. With enrollment limits achieved in this network among all of the state’s safety nets, it is unclear what impact this move will have on the rates of acute, emergent, uncoordinated care provided by HCMC — and that does not bode well for future healthcare costs in Minnesota in an age of reform. | 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.
