Monday, June 30, 2008

Privacy, Electronic Health Records, and Consensus

Electronic medical records. Electronic health records. Personal health records. It doesn't matter whether you refer to them as EMRs, EHRs, or PHRs, the concept is still basically the same. Since the subject is one near and dear to us here at the Health Care Reform Now! Blog, it should come as no surprise to you that we are very excited about the best practices standards released last Wednesday by the Markle Foundation.

In an attempt to bring some of the spirit of the Health Insurance Portability and Accountability Act (HIPAA) to the digital arena, Markle has debuted their standards with some heavy hitters backing it. Google, Microsoft, Intuit, WebMD, Aetna, the AMA, and others have all stepped up to the plate on this one in an attempt to create a true set of industry standards and policies.

Research shows that more than half of modern Americans are interested in the advantages of having easily accessible online records. It also shows that one of the greatest barriers on the consumer level is fear of privacy issues. With a large segment of both the major and minor players in health care already on board at the time of announcement we could be well on our way to making it a non-issue.

Marianne Kobalsuk McGee over at Information Week took note of another vitally important aspect of this announcement:

Meanwhile, for other companies looking to jump on to the consumer personal health record bandwagon, the framework has been assembled early enough in this emerging market so they too can develop their products and services with the framework's privacy policies and practices in mind, Diamond said.
I have the distinct feeling that this is going to have repercussions across the industry. It seems that progress is being made. Now to keep an eye on the implementation of these standards...

SOURCE: "Google, Microsoft Back Online Health Records Privacy Framework" 06/26/08
photo courtesy of dominiekth, used under its Creative Commons license

Friday, June 27, 2008

Doctor's Visit? Can't Afford It

A new report by the Center for Studying Health System Change has just been released that sheds some light on American behavior patterns as the cost of care continues to escalate. Out-of-pocket expenditures are driving more and more people to opt out when it comes to the care that they need, and cost is the factor driving this trend.

Sarah Rubenstein of The Wall Street Journal reports:

About 20% of the respondents in a 2007 survey of 18,000 people said that they had put off or gone without needed medical treatment at some point in the year earlier, up from 14% in a 2003 survey. [...]

Of those who said in the 2007 survey they had scrimped, 69% cited concern about cost as a reason.
I'm sure that a moment's thought will bring to mind people that you, our reader, know on a personal level that have made decisions like this. I know I do. As a matter of fact, I have been one of those who has put off long overdue checkups and medical care simply due to the fact that even with insurance I cannot afford it. As Ms. Rubenstein notes in her article, I am not alone in this:
While the uninsured reported the highest rate -- 38% -- of delaying or going without care, the biggest rate of increase in such reports was among people who had health insurance. Seventeen percent of insured respondents said that they had scrimped, which was up from 11% in the 2003 poll.
Deductibles, co-pays, and high price tags seem to combine to make a very effective "patent repellent." And even for those of us who are acutely aware of how much more expensive a health issue can become after being neglected there is still the financial bottom line. Medical care can often put a dent on one's personal finances that is so large that it can quickly become a matter of paying the bills or paying for treatment.

To help illustrate the point here is a video that I came across on Current that will introduce you to a woman who did not forgo treatment, a decision which cost her greatly.

SOURCE: "More Americans Delay Health Care: Cost Concerns Drive Even the Insured To Forgo Treatment" 06/26/08
SOURCE: "Uninsured in America" 06/11/08

Thursday, June 26, 2008

Leveraging The Internet For Lower Blood Pressure

Information technology is an extremely important part of health care reform efforts in the modern age. The benefits of developing a wide ranging and compatible system of electronic health records has been shown in several studies to dramatically reduce the cost of administration, which accounts for a large percentage of spending.

Chronic conditions are also proven to consume a large share of medical spending, especially now that many Baby Boomers are reaching retirement age where these conditions often surface.

These two topics come together in a study from Wednesday's Journal of the American Medical Association, involving 778 Group Health patients with uncontrolled high blood pressure who were given the opportunity to have online assistance in managing their condition.

The results?

Via Time Magazine:

Among the more than 700 patients in the study, 258 were put into a standard physician-care group, with regular office visits. The remainder were divided into two self-care groups: in the first, patients had access to their electronic medical records and were instructed to measure their own blood pressure two to three times each week; patients then sent the results to their physician, who recorded the readings in files the patients could review. In the other group, patients performed the same self-measurements, but were also provided access to a pharmacist who evaluated their readings and helped patients adjust medication dosages as necessary. At the end of a year, twice as many people in the home-care-only group lowered their blood pressure to under 140/90 mmHg (the clinical cut-off for high blood pressure), compared with the standard-care group. But the patients with access to a pharmacist saw the most dramatic decline in blood pressure — a nearly 28-point lower measurement in the top number, or systolic reading, compared with the traditionally treated group. "We were surprised that the Web-based model had such a good effect, especially in those with more difficult-to-control hypertension," says lead author Dr. Beverly Green. "These people were three times more likely to get their blood pressure under control with the help of the pharmacist than those in the standard-care group."
This is big news. Not only does the study show that this approach is a step forward as far as effectiveness goes, but it also underscores the cost reduction that Internet technology can provide by reducing the costs incurred by multiple office visits. This is far from an instant cure-all, however; the "pay per visit" baseline of our health care system does not make this a profitable venture for care providers outside of Group-Health type plans. What it does do is pave the way more more innovative approaches as we evolve our idea of what truly American universal health care should be.

SOURCE: "Lowering Your Own Blood Pressure" 06/24/08
photo courtesy of skyfaller used under its Creative Commons license

Wednesday, June 25, 2008

How Much Is Health Care Costing You In Taxes?

Cost. So much of the current national conversation about health care comes down to costs. Of course, the sheer magnitude of our system combined with the vast array of interests involved in it make the question of health care cost a veritable Gordian Knot.

It is this economic complexity that made me sit up and take notice when I ran across the recent article in Dollars and Sense: The Magazine of Economic Justice penned by Joel A. Harrison, PhD, MPH. In it, he presents a case for the "hidden costs" of American health care. Dr. Harrison takes us on a tour of where the money is generated and where it goes, as well as with what effect.

From the section titled "Paying Through The Taxman":

The U.S. health care system is typically characterized as a largely private-sector system, so it may come as a surprise that more than 60% of the $2 trillion annual U.S. health care bill is paid through taxes, according to a 2002 analysis published in Health Affairs by Harvard Medical School associate professors Steffie Woolhandler and David Himmelstein. Tax dollars pay for Medicare and Medicaid, for the Veterans Administration and the Indian Health Service. Tax dollars pay for health coverage for federal, state, and municipal government employees and their families, as well as for many employees of private companies working on government contracts. Less visible but no less important, the tax deduction for employer-paid health insurance, along with other health care-related tax deductions, also represents a form of government spending on health care. It makes little difference whether the government gives taxpayers (or their employers) a deduction for their health care spending, on the one hand, or collects their taxes then pays for their health care, either directly or via a voucher, on the other. Moreover, tax dollars also pay for critical elements of the health care system apart from direct care—Medicare funds much of the expensive equipment hospitals use, for instance, along with all medical residencies. All told, then, tax dollars already pay for at least $1.2 trillion in annual U.S. health care expenses. Since federal, state, and local governments collected approximately $3.5 trillion in taxes of all kinds—income, sales, property, corporate—in 2006, that means that more than one third of the aggregate tax revenues collected in the United States that year went to pay for health care.
While it seems that everyone is aware of the costs of care, this examination of the ebb and flow of dollar signs is quite illuminating. Even for those who find economics to be a rather dry and dusty subject, this should make for gripping reading. As we move towards redeveloping our domestic health care, an understanding of these patterns and forces is essential to making an informed decision.

Four main sections make up Dr. Harrison's article:
  • Paying Through The Taxman
  • Where Does All The Money Go?
  • More Taxpayer Dollars, Less Medical Research
  • Getting What We've Already Paid For
As you can see, these are all topics that address basic underpinnings of our broken system. An understanding of the flow of revenue is data that can only help, after all in order to fix a problem the first step is identifying it. The discourse surrounding the Presidential Election has already determined that Americans are well aware of the breakdown, now it is time to move from the macro to the micro and look at the details.

Dr. Harrison's full article (with a large amount of documentation) may be found in the "sources" listed below.

SOURCE: "Paying More, Getting Less" 06/24/08
photo courtesy of Paul Keleher, used under its Creative Commons license

Tuesday, June 24, 2008

Congress Gets a Shot in the Arm

It would seem that the United States Congress is getting themselves mobilized to make an impact on health care. How much of these efforts end up being substantive and how many ephemeral is a question answerable only by the passage of time.

Ben Bernanke's recent statements about health care taking up a quarter of the federal budget were only one facet of the mobilization beginning on several fronts within those hallowed halls.

Sens. Ron Wyden (D-Ore.) and Robert F. Bennett (R-Utah) are sponsoring the first bipartisan proposal for universal coverage to come out of the Senate. The proposal would scrap employer-based health insurance replacing it with a state-run system where insurance companies are mandated to offer basic coverage to all applicants and compelling those not covered by employer-based plans to buy in.

Tom Daschle has just released a new book in which he argues in favor of a Federal Health Board similar in structure to the Federal Reserve. This probably will be one of the thrusts of the legislation he is currently working on along with fellow Democrat George Mitchell and Republicans Bob Dole and Howard Baker. The four former Senate Majority Leaders plan to introduce their legislation in November. (For an in-depth interview about the book and Sen. Daschle's stance on health care take a look at the interview that he did with Ezra Klein for the American Prospect.)

Via The Washington Post:

"We have a broad consensus that we aren't getting nearly as much as we should for the money," said Mark B. McClellan, President Bush's former director of the Centers for Medicare and Medicaid Services who now heads the new Engelberg Center for Health Care Reform at Brookings. "There's an unprecedented level of agreement that something can be done and that something must be done."
Let us keep our fingers crossed and our eyes open.

SOURCE: "Writing New Prescriptions For Change" 06/17/08
photo courtesy of yanivba, used under its Creative Commmons license

Monday, June 23, 2008

Electronic Medical Records: They Only Work If You Use Them

The positive effect of implementing electronic medical records (EMRs) is well documented through a number of studies and sources. It is a fundamental axiom of the move to reconfigure health care in the U.S. so that the system actually works.

Steve Lohr at The New York Times has done some digging around on the subject investigating why EMRs have not made more of an impact as of yet. His findings turn out to be pretty intuitive: they don't work if they are not being used.

Via The New York Times:

The national survey [by the New England Journal of Medicine] found that electronic records were used in less than 9 percent of small offices with one to three doctors, where nearly half of the country’s doctors practice medicine.
Suddenly certain aspects of our situation snap into sharper focus. If half the country's medical providers are not using EMRs, that would certainly be a large factor. Once Mr. Lohr starts digging, he finds that the bugaboo to implementation is one we have expounded upon frequently in this blog: cost. To pull another quote from The New York Times:
Bringing patient records into the computer age, experts say, is crucial to improving care, reducing errors and containing costs in the American health care system. The slow adoption of the technology is mainly economic. Most doctors in private practice, especially those in small practices, lack the financial incentive to invest in computerized records.
One doctor from a small, three physician practice in NJ is quoted as saying that he has explored making the jump to a digital system and found the expense prohibitive. According to his statements, converting their practice would take $15-20 thousand dollars per physician to implement, a level of cost that places it firmly out of reach for both him and his partners.

So this is the part of the post where the subject of market forces comes up, as it always does when speaking of national level subjects and financial expenditure. This is the part of the article that begins to get really interesting.

"We have a broken market for electronic health record adoption because the people who gain financially are not the people who pay," said Dr. Blackford Middleton, a health technology expert at Partners Healthcare, a nonprofit medical group that includes Massachusetts General Hospital in Boston.

To fix the market, Dr. Middleton, like others, recommends that the government play a role in providing incentives or subsidies to speed the use of computerized patient records in the United States, whose adoption rate trails most developed nations.

The government took a step in that direction last week, announcing a $150 million Medicare project that will offer doctors incentives to move from paper to electronic patient records. The program is intended to help up to 1,200 small practices in 12 cities and states make the conversion.

This looks like a one-two punch straight out of George C. Halvorson's book! Two points that he stresses in Health Care Reform Now! are the need for EMRs and the perverse nature of the financial incentives utilized by our health care industry. If we can reconfigure incentives in this fashion and use them to fix the system rather than continually erode it, we will have taken a giant step towards bringing health care to all of our citizens!

SOURCE: "Most Doctors Aren’t Using Electronic Health Records" 06/19/08
photo courtesy of john norris, used under its Creative Commons license

Thursday, June 19, 2008

AMA Says $210 Billion Wasted on Admin

That's right, $210 billion dollars annually are wasted in administrative costs related to insurance claims processing. Don't trust me on this, trust the American Medical Association (AMA) who documents the amount in their newly released report. If you wish to take a look at the findings and statement of methodology, you can download a PDF of the report as well as other related info at the AMA website here.

The opening paragraph of the report is succinct in presenting the situation as it stands now:

Physicians are spending as much as 14 percent of their total collections to obtain accurate payment for their services. When physicians submit correctly coded health care claims, health insurers and other third-party payers may still inappropriately delay, deny or significantly reduce payments. The significant savings that could be realized from more efficient claims processing could be better spent on increasing the quality of patient care and reducing the burden of high premium costs to consumers.
Fourteen percent? Doesn't sound all that huge unless it is your money, and as cost of care spirals out of control in order (among other things) to cover these costs, it is your money. Every medical need that involves paperwork or billing -- i.e., all of them -- is more expensive because of the cost of processing and filing.

Seven insurers were graded, along with the government-run Medicare: Aetna, Anthem Blue Cross and Blue Shield,CIGNA Corp., Coventry Health Care, Health Net Inc., Humana Inc., and United Health care. The results are disquieting (via The Chicago Tribune):
But business leaders and health policy makers are interested in cutting an estimated annual $210 billion in wasted administrative claims processing costs, AMA leaders said.
$210 billion? In some parallel universe that might be acceptable, but here in the real world where Joe America is suffering the skyrocketing cost of food and gas along with the cost and access issues of modern health care, that number is frightening. As a matter of fact, the price of doing business with insurance companies and the erratic claims process has driven some doctors to cease dealing with them completely.

Dr. Marcy Zwelling, a physician interview for the Tribune article, got fed up with the expense and time wasted in attempting to process insurance claims for her practice that she ceased dealing with insurance companies completely. That was four years ago. She now runs a boutique practice in which her patients simply pay an annual fee.
"The best thing is, I get to be a doctor" instead of a claims processor, said Zwelling, of Los Alamitos, Calif. She says she doesn't make any more money than she did when she accepted insurance, but she has more time with patients.
Of course, like everyone else, I immediately took a look at my own health insurance to see how it rates:
UnitedHealthcare had the lowest rate of contract compliance, according to the AMA report. About 62 percent of medical services billed were paid by UnitedHealthcare at the contracted rate, compared with 71 percent for Aetna and 98 percent for Medicare.
Lovely. Sixty two percent of the contracted rate. Barely over half of the claims are fulfilled according to contract. That's a wonderful wake up call. In what other business can you get away with that?

SOURCE: "AMA: National Health Insurer Report Card" 06/17/08
SOURCE: "AMA issues first report card on health insurers" 06/16/08
photo courtesy of Jon-A-Ross, used under its Creative Commons license

Tuesday, June 17, 2008

Bernanke Addresses Health Care Issues

On Monday, Federal Reserve Chairman Ben Bernanke addressed the Senate Finance Committee's Health Reform Summit (full transcription here). Bringing his financial acumen to the table, he reframed the question of health care cost, putting into a perspective of "What are we gaining from these expenditures?" rather than the usual absolute and simplified "What does it cost?"

From the economist's perspective, the question of whether we are spending too much on health care cannot ultimately be answered by looking at total expenditures relative to GDP or the federal budget. Rather, the question, whatever we spend, is whether we are getting our money's worth. In general, good information and appropriate incentives are necessary to allocate resources efficiently. In health care, the necessary information should include not only the clinical effectiveness of certain tests or courses of treatment but also their cost-effectiveness. As the regional comparison of health-care costs illustrates, cost-effective approaches may be at least as useful as more costly approaches in delivering good health outcomes.
His remarks were tightly focused on health care cost and its impact on the U.S. financially. Monetary policy and overall comments about U.S. economy were not addressed other than as they affect health care. He also declined to make any solid policy recommendations.

Among other issues, Bernanke pointed out that rising costs of health care are quite liable to reduce access to health care as the lower income elements of the U.S. are priced out of both care and insurance. Hardly an earth shattering observation, but one that is lent weight by his bringing it up in this particular forum.
"The best way to reduce the fiscal burdens of health care is to deliver cost-effective health care throughout the entire system"
Hopefully this will turn some attention towards the inadequacies of the "pay per procedure" methodology that has driven American health care for decades.

SOURCE: "Chairman Ben S. Bernanke At the Senate Finance Committee Health Reform Summit, Washington, D.C. Challenges for Health-Care Reform" 06/16/08
photo courtesy of Ashley Pollack, used under its Creative Commons license

Friday, June 13, 2008

"The FDA Has Become a Joke," Says Specter

A recent ruling by the U.S. Supreme Court states that once the FDA approves a medical device, the manufacturer is immune to lawsuit even if said device causes injury to the recipient. This ruling has now come under fire in the Senate Committee on the Judiciary.

Strange bedfellows keep popping up in the health care debate, probably because health concerns cut across party lines like a laser through a marshmallow. In this case we see two often opposing voices raise in ire at the testimonies presented to them: Sen. Patrick Leahy, D-Vt., and Sen. Arlen Specter, R-Pa.

Harrowing personal testimony from two women in particular brought down anger from both of these veteran legislators. First was Bridget Robb, who on December 7, 2007, suffered a defibrillator malfunction that shocked her heart 31 times in the span of a few minutes. When she arrived at the hospital, luckily still alive, she discovered the device had been recalled months earlier. ABC News recounts the details in an article by Ynuji DeNies, Sheila Evans, and Stephanie Dahl, including the details of how Robb was prevented from taking legal action by the Supreme Court ruling mentioned above.

Then came the story of Maureen Kurtek, a lupus sufferer whose story would shock just about anyone. Her full testimony is transcribed on the U.S. Senate Committee on the Judiciary website here. I would like to share with you her summation from the end of it, especially the second paragraph:

[...] all of this pain and suffering was caused by an insurance company that failed to provide me with a treatment that I had received six times prior at the same hospital under the same insurance provider with good effective results. Previously, this treatment had helped my body increase its ability to fight infection and keep my platelet count at a normal level. This treatment was prescribed for me by at least seven doctors and two specialists and was never considered to be experimental by them. This treatment, although expensive, was necessary for me. And, my insurance company delayed my treatment.

I stand before you today with a tracheotomy scar on my neck, five amputated finger tips and an amputated right foot where I still experience phantom pains. Life ceased as I had known it. I can no longer jog or dance. I can not wear stylish shoes on special occasions such as my son's graduation, and I have to wear an orthopedic shoe which I can assure you is not the dream of any woman. During my time in the hospital, I missed my son's spelling bee, piano recital, his confirmation at church and baseball games. These are events I can never get back.

Due to this law, insurance companies can get away with denying care and delaying treatment without any consequences. This is wrong. We need to change this law so no families will have to suffer the way mine has.
The ABC Article provides us with the responses of our esteemed Senators:

"The Supreme Court has ignored the intent of Congress in passing these measures, oftentimes turning these laws on their heads, and making them protections for bug business rather than for ordinary citizens," Leahy said. "I hear this buzzword of activist judges and I can't think of anything more activist than these decisions."

[...] Sen. Arlen Specter, R-Pa., put the blame on the FDA which approved the faulty device. "The FDA has become a joke," Specter said.

Whichever way this goes, it will have far reaching implications both for medical device manufacturers and the patients who rely on their devices. Specter, the ranking Republican on the committee, was harshly critical of the Bush Administration for delaying requests for FDA funding reportedly calling it "criminal negligence."

The ongoing battle for reform is taking place in courtrooms and governmental chambers across the nation with bipartisan efforts cropping up more and more frequently as cases like these shine a media spotlight on the broken aspects of the American health care system. A "perfect storm" has arrived heralding oncoming change. Becoming engaged and informed on this issue is of utmost importance for us all.

SOURCE: "Young Daughter: 'Mommy's Dying': Bridget Robb Can't Take Legal Action Because Device Was FDA-Approved" 06/11/08
SOURCE: "Testimony of Maureen Kurtek before the Senate Committee of the Judiciary" 06/11/08
photo courtesy of DBKing, used under its Creative Commons license

Thursday, June 12, 2008

Maggie Mahar Looks at an Alternate Approach: Value Added Tax

'Tis the season. Election season, that is. With health care hot on the topic list for politicians, 47 million uninsured, and voters in general, it seems only appropos to look at some of the ideas floating up from the Blogosphere.

Maggie Mahar examines a plan proposed by Dr. Ezekiel Emanuel in her most recent post on Taking Note (which is, if you are unaware, a Century Foundation website). In the spirit of George C. Halvorson's exhortation to examine foreign systems in order to inspire the development of a uniquely American one, Dr. Emanuel proposes a Value Added Tax (VAT) to consolidate health care payment. While this may or may not be the correct path to take, the arguments as framed are rather compelling:

Here is how the plan works: Every American would receive a voucher for individual or family coverage. The vouchers would be of equal value and all insurers would be required to offer the same comprehensive benefits package to anyone who applied—young or old, sick or healthy.

Insures would report to 12 Regional Health Boards. Each Board would have a Center for Patient Safety and Dispute Resolution staffed by patients, physicians and lawyers that would receive and adjudicate patient complaints, compensate patients, discipline and disqualify physicians responsible for repeatedly injuring patients, and fund and develop patient safety programs. (Patients not satisfied with the Board’s resolution of their complaint still could sue for malpractice).

The Guaranteed HealthCare Access Plan pledges to cover the 257 million Americans who are not now on Medicare at a cost of nearly $1 trillion. This number includes what we now spend on employer-based insurance, Medicaid and SCHIP –plus what it would cost if the uninsured had employer-based coverage.

People who are now enrolled in Medicaid, SCHIP or Medicare would not be forced to switch to the new Guaranteed HealthCare Access Plan, but if they chose to, they could. For the time being, probably most seniors on Medicare would stay put. But over 15 years, these three plans would be phased out.

It is nice to run across a fresh perspective. Ms. Mahar's post goes in depth examining various permutations of this plan such as
  • Why not just raise income taxes instead?
  • How is the VAT an incentive to reduce waste?
  • How will the Guaranteed Health Access Plan reduce administrative costs?
  • How to protect the Health care system from lobbyists.
  • The creation of an impartial Institute for Technology and Outcomes Assessment to provide impartial testing and review of new drugs and technologies
The article is rather long, but chock full of information and links back to relevant source material. Another course on the banquet of "food for thought" that is laid before the American voting public. Please feel encouraged to join the conversation in the comments both here and on Taking Note.

SOURCE: "A Fresh Look at Health Care Reform: Part II" 06/05/08
photo courtesy of Phillip, used under its Creative Commons license

Wednesday, June 11, 2008

Presidential Candidates and Their Plans For Health Care

Well, the Internet and conventional media are all abuzz now that Barack Obama is officially the Democratic Party's candidate for President of the U.S. For the Health Care Reform Now! Blog, that means that it is time once more to take a look at his plan for dealing with the health care crisis. With that in mind, I would like to share part of a post I found on Joseph Padua's Managed Care Matters Blog:

The differences between the McCain and Obama plans are big – really big. Philosophically, McCain’s approach is market-based and tax policy driven, relying on individuals to make the best decisions on health care procedures and treatment. His plan would remove the favorable treatment of employer-funded health insurance, instead providing a refundable tax credit of $2500/individual or $5000 per family to help them buy insurance (note – the average individual policy now costs over $4000 and the average family policy cost exceeds $12,000). Conversely, Obama’s plan is more pragmatic, focused on fixing the problems with the current market-based system with a ban on medical underwriting, a comprehensive ‘minimum’ benefit design, financial help for small employers buying health insurance, and some sort of stop-loss insurance for high dollar claims.
Mr. Padua goes on to do a quick but telling point-by-point comparison of the approach taken by each of these Presidential contenders. What really stands out in his analysis is the fact that unlike so much of the politicized polemic being bandied about, he actually illustrates pros as well as cons on each side.

Pointing out that McCain is "dead on when he talks about the need to pay for health, not reimburse for procedures," he then provides criticism of the Arizona Senators proposed methodology. One of his huge criticisms of the McCain approach is the fact that it would cause a massive increase in the nation's budget deficit. Not only that, but these costs would be an immediate expense incurred by implementation of his programs.

The health care aspect of the run for the White House is going to get very interesting in coming months. The ongoing comparison/contrast of the two candidates is sure to be a hot topic, especially now that Sen. Obama has joined forces with Elizabeth Edwards (post and video via Crooks and Liars)

SOURCE: "Obama, McCain, and Health Care Reform" 06/10/08
SOURCE: "Obama To Team Up With Elizabeth Edwards On Health Care Reform" 06/09/08
photo courtesy of ~twon~, used under its Creative Commons license

Tuesday, June 10, 2008

Social Networking For Health

User-generated content is not the first thing you would look for when searching for health care info on the Internet -- or is it?

Kenneth Corbin of Internet News brings us an interesting perspective on the common ground between social media and health care:

"We're in the early days here of what is essentially a data experiment," Scott Mowbray, editorial director of, said of the fast growing online body of health information -- much of which is created by people who aren't doctors.

"News in health is not only something that's been discovered," he said. "It's you discovering something that might already be out there. To you, it's news as soon as you have a disease. Suddenly, it's the most important news in the world."

This rings true in my experience. Having watched a number of friends battle cancer and other chronic diseases, I have frequently been consulted to help them find info about their condition or proposed treatment online.

[...] panelists said that there is another, less structured revolution taking place where people seeking information about a health issue are looking to connect with others who have experience dealing with the same condition.

It's a form of social networking, though very different from what is found on a mass-appeal site like Facebook or MySpace. But the principles of viral distribution and user-generated content (UGC) are the same.

"It's about personalization of the information," said Benjamin Heywood, president of Patients Like Me, a site housing online communities for people dealing with specific diseases. "What you really want to know is the information that's relevant to me -- based on my situation, my condition."

Commonality of experience is a huge part of the draw. Being able to read about what experiences someone else had during their gall bladder surgery, chemotherapy, new diabetes treatment, etc., not only helps to personalize the situation but also gives those just starting treatments such as these to get an idea of what they are in for.

The image of a physician leaning over you saying "this won't hurt a bit," is an image everyone knows. Everyone is also familiar with the pain that is usually expected to follow that statement. With health care oriented social networking you would go into such a procedure knowing that it might cause you to become painfully light sensitive, or so nauseous that you cannot eat. Just like other strata of the social networking world it is the personal narrative that people seem to find magnetic.

As a social media consultant myself, I am well aware of some of the issues faced by projects like these. For one thing (Sanjay Gupta of CNN also comments on this in the article) people are always much more likely to actually leave a comment or write a post when they are angry. Rarely do they seem so disposed when it comes to positive or complimentary information.

This natural tendency skews the efforts of sites like these, but the question is does it skew too far to be effective?

SOURCE: "Health Care: Social Networking Gone Serious?" 06/09/08
photo courtesy of M. Keefe, used under its Creative Commons license

Monday, June 2, 2008

More Does Not Equal Better

The Seattle Post Intelligencer's Cherie Black brings us today's reality check by sharing a recent study from Dartmouth that points to an overabundance of care being a problem in and of itself:

Too much medical care could be harmful to your health.

That's what researchers concluded after examining the nations' hospitals and the care patients receive. Some hospitals and some areas of the country give patients more aggressive care -- meaning more tests, longer hospital stays and more procedures -- than others. And the extra treatment doesn't always translate to longer or better lives.

This brings us firmly back to the issue of our medical system charging per procedure rather than charging for overall results. Billing codes abound, although as we often point out here on the blog, there is not one code for a cure.

The 2008 Dartmouth Atlas of Health Care study, released Thursday, studied more than 4 million Medicare patients at nearly 3,000 hospitals across the country from 2001 through 2005 during the last two years of life.

The patients were 65 years and older and were treated for the top nine leading causes of death, including congestive heart failure, chronic pulmonary disease, cancer, dementia, coronary artery disease, chronic kidney failure, peripheral vascular disease, diabetes with organ damage and severe chronic liver disease.

Since all of these are chronic conditions, they fall into that segment of health care that produces a vast majority of costs incurred in the United States. When you add in the number of Baby Boomers who are hitting this age bracket, the equation becomes more and more worrisome.

The study found that depending on where patients lived and what hospital they went to, there were big discrepancies in how they were treated.

Researchers reasoned all medical care carries some risk, so the longer a patient is hospitalized and the more procedures and tests performed, the greater the risks, in addition to greater costs.

Costs. It seems to always come full circle back to costs, no matter what angle of the health care discussion you approach. Costs keep people from seeing a doctor until it is unavoidable. Costs keep providers from adding more Medicare patients to their rolls. Costs directly affect who can afford insurance. On that note one tool that is immediately useful came online along with the report:

Launched in conjunction with the Dartmouth study, the online tool at lets consumers compare treatment approaches among hospitals for the nine serious chronic conditions in the study on a scale from 0 percent to 100 percent (the higher the percentage the more aggressive the treatment).

The percentile rank is based on the total number of hospital days and inpatient physician visits over the last two years of life. Next to each of the nearly 3,000 hospitals, there also are the patient out-of-pocket costs over the last two years of life.

While aggressive treatment is not always a bad thing, in some cases, it is the only correct path. There are far too many cases where it is counterproductive and exists simply due to the perverse nature of financial incentives within the health care industry. Ms. Black's examination of the Dartmouth report provides some interesting and unfortunate new statistics to add to the ongoing discussion.

SOURCE: "More health care may not always be better: Study finds extra treatment can mean extra risks, costs" 05/30/08
photo courtesy of Jeff Kubina, used under its Creative Commons license