December 27th, 2011 by GruntDoc in Health Policy, Opinion
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This article and its graph (from the NEJM), and its interesting, informative but probably useless graph, was referenced today on twitter, via the Washington Post’s Wonkblog,
Recently, the Centers for Medicaid and Medicare Services announced a scheduled cut in Medicare physician fees of 27.4% for 2012. This cut stems from the sustainable growth rate (SGR) formula used by the physician-payment system. …
To illustrate the level of inequity in this system, we broke down the national spending for Medicare physician services by state and by specialty and determined which states and specialties have contributed most to the SGR deficit between 2002, when the program was last balanced, and 2009. Although SGR spending targets are set on a national level, we computed state targets by applying the SGR’s national target growth rate to each state’s per capita expenditure, using 2002 as the base year. Our analysis is an approximation, because, unlike the SGR, we do not adjust for differential fee changes. …
We compared the state targets for the years 2003 to 2009 to actual state expenditures and added the annual difference between these figures to get a cumulative difference between the state’s spending and the SGR target. This cumulative difference was Read more »
*This blog post was originally published at GruntDoc*
December 4th, 2011 by DavedeBronkart in News, Research
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Wow. Todd Park, Chief Technical Officer at HHS, ought to be jumping out of his skin with joy at this one.
This time, House, M.D. fans, it was lupus. The article “Evidence-Based Medicine in the EMR Era” published in the Nov. 10 issue of the New England Journal of Medicine might have read like a House television script, but it was a real-life glimpse of what the most optimistic health IT advocates are hoping will become commonplace in U.S. health care: Mining EHR data to arrive at treatment decisions.
In a Health IT Exchange piece (on TechTarget) EHR data spurs real-time evidence-based medicine, Don Fluckinger summarizes (and dramatizes, accurately) this early specimen of care being transformed – beyond the literature – by looking at past records. Faced with a 13 year old lupus patient with a complex problem (see article for details)…
In four hours, they did a retrospective study of similar patients in the hospital’s data warehouse…, and decided to move ahead with the treatment based on the previous results of 98 [similar patients] … The authors said they will never know if they made the “correct” decision, but they did know that — in absence of randomized trial research to support their decision — they acted on the evidence of the best data available, coupled with their experience.
“Our case is but one example of a situation in which the existing literature is insufficient to guide the clinical care of a patient,” the authors wrote. …
What are we waiting for, people?? Imagine if Read more »
*This blog post was originally published at e-Patients.net*
August 28th, 2011 by Michael Kirsch, M.D. in Opinion, Research
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Medical malpractice reform is in the news again. Of course, for the medical profession, the medical malpractice system is the wound that simply will not heal. For the plaintiffs bar, in contrast, the medical liability system is the gift that keeps on giving. I have argued that the current system fails on four important fronts.
- Efficiency
- Cost
- Fairness
- Quality Improvement
I admit readily that my profession has not been as diligent as it should be in holding ourselves accountable. We have not been forthright in admitting our medical errors, although can you blame us under the current medical liability construct? Read more »
*This blog post was originally published at MD Whistleblower*
August 20th, 2011 by Paul Auerbach, M.D. in Research
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Yellow fever is an affliction caused by a potentially lethal viral (flavivirus) hemorrhagic (causes bleeding) virus common in parts of Africa and South America. A highly effective vaccine made from live virus (known as the “17D vaccine”) is currently used to inject persons to prevent yellow fever; this vaccine is known to rarely cause serious adverse effects, namely, onset of allergic reactions, or a life-threatening or fatal infection that resembles yellow fever.
So, there is need for a safer (“nonreplicating”—in other words, not based on live virus) vaccine. In a recent article, “An Inactivated Cell-Culture Vaccine against Yellow Fever,” Thomas Monath, MD and his coauthors described their experience with a potentially safer vaccine (NEJM, 2011;364:1326-33). In their study, Read more »
This post, Advancement In Research For A Safer Yellow Fever Vaccine, was originally published on
Healthine.com by Paul Auerbach, M.D..
August 9th, 2011 by Elaine Schattner, M.D. in Opinion, Research
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We’ve reached the second half of our discussion on Bending the Cost Curve in Cancer Care. The authors of the NEJM paper, Drs. T. Smith and B. Hillner, go on to consider how doctors’ behavior influences costs in Changing Attitudes and Practice. Today’s point on the list: “Oncologists need to recognize that the costs of care are driven by what we do and what we do not do.”
In other words (theirs): “The first step is a frank acknowledgment that changes are needed.” A bit AA-ish, but fair enough -
The authors talk about needed, frank discussions between doctors and patients. They emphasize that oncologists/docs drive up costs and provide poorer care by failing to talk with patients about the possibility of death, end-of-life care, and transitions in the focus of care from curative intent to palliation.
They review published findings on the topic: Read more »
*This blog post was originally published at Medical Lessons*
