Category: Health Care Quality

Should Dissent Be Allowed In Health Care?

Confident DoctorsAn eminent physician has tentatively proposed that published treatment guidelines be accompanied by dissenting expert opinions, much like the U.S. Supreme Court does. Daniel Musher, MD, of Baylor College of Medicine, served on the Advisory Committee on Immunization Practice of the Centers for Disease Control and Prevention, which considered guidelines for a dual vaccine approach for pneumococcal vaccination for adults.

He disagreed strongly with the published recommendation, but was prevented from publishing his opinion alongside the recommendation. Dr. Musher believes the publishing of dissenting opinions is very valuable to the progress of knowledge:

As citizens of the United States, we are as much bound by a 5-4 decision of the High Court as a 9-0 vote (although closely passed decisions are more likely to be overturned in future cases).1 Similarly, as practitioners of medicine, until new guidelines are written, we are seriously constrained by, if not actually bound by, existing ones, without regard to the unanimity of opinion in the recommending committee. Nevertheless, there is much to gain from studying dissenting opinions, as was famously shown by the writings of Justices Holmes and Brandeis, many of whose minority opinions, in time, became the law of the land.2 I propose that the failure to publish differing or dissenting views in medical guidelines presents our profession with an inappropriately monolithic view—one that is studied as gospel by physicians-in-training and forced on practitioners by incorporation into a variety of performance measures.

Innovation and Self-Insured Employer Plans

About 175 million people are covered by an employee health plan through their job or the job of a loved one.  More than half of people in employee health plans work for an employer that is self-insured or partially self-insured.  Self-insured plans are ones that are subject to federal law rather than the patchwork of state regulations that insurers must follow.  When employers self-insure, they take on the risk of their employees medical needs and generally have stop loss coverage to guard against any one worker or dependent have exceptionally high medical bills. Whereas insurance is somewhat of a stodgy business, employers themselves are looking for solutions rather than premium hikes year-after-year.  Most of the innovation that occurs in health coverage are experiments being conducted by self-insured employers. These include decision-support tools to make enrollees more informed consumers of medical care. Employers are dumping a ton of money into employee Health & Wellness programs, health risk assessments and chronic disease management.  A few employer plans, like North Carolina-based like HSM Solutions, are outsourcing some medical care for high cost procedures to countries abroad.  CalPERS, the public employee union, has initiated experiments in reference pricing to provide beneficiaries an incentive to seek out lower-cost providers.  These are all examples of self-insured plans looking for solutions to the problem of high medical costs.

Americans Think Their Health Care Is Fine, But “American” Health Care Is Not

doctor-mom-and-sonNational Public Radio, the Robert Wood Johnson Foundation, and Harvard University’s T. H. Chan School of Public Health have released findings of a February survey, Patients’ Perspectives on Health Care in the United States:

Even though most (55%) Americans reflect positively on their state’s health care system, saying it is excellent or good, few give their state top marks. Just one in six (17%) say the health care system in their state is excellent, while more than two in five (42%) adults in the U.S. say it is fair or poor.

Americans are much more negative about the nation’s health care system than they are about the health care system in the state where they live. Only 38 percent of adults in the U.S. had positive things to say about the country’s health care system, and fewer than one in ten (9%) gave it top marks. In contrast, more than three in five (61%) U.S. adults say the nation’s health care system is fair or poor.

Almost half the people who believe their own state’s health care is excellent deny that it is excellent elsewhere!

Accountable Care Enrollees to Triple by 2020

David Muhlestein of Leavitt Partners predicts that the number of patients enrolled in Accountable Care Organizations (ACOs) will rise from 23.5 million today to 72 million in 2020.F9What is an ACO? I am becoming less sure that it is a meaningful term. I mean, really, are you in favor of unaccountable care?

Unconnected Medical Devices Harm Patients

The federal government’s dominance of health information Technology (HIT) has been most apparent, and most harmful, in electronic health records (EHRs). However, the hand of government must lie heavily in other parts of health care, too.

An example is medical devices hooked up to patients at the hospital. Remarkably, these devices do not talk to each other, requiring nurses to waste time transcribing data from one device to another. This infographic summarizes a survey of 500 nurses commissioned by the West Health Institute:

Copyright: West Health Institute (2015)

Copyright: West Health Institute (2015)


These are appalling figures. I don’t know about you, but I figured out how to connect my VCR to my TV sometime during the 1980s. Medical devices are heavily regulated by the FDA. The fact that devices critical to hospital patients’ health are still not connected strikes me as a likely consequence of over-regulation.

More Evidence We’re Winning the War on Cancer

This blog has previously presented evidence of America’s remarkable success in the war on cancer. The factors leading to success included lifestyle changes (especially quitting smoking) as well as improved diagnosis and treatment.

New research looks only at diagnosis and treatment, and finds stunning improvements since 1990:

Men and women ages 50 to 64, who were diagnosed in 2005 to 2009 with a variety of cancer types, were 39 to 68 percent more likely to be alive five years later, compared to people of the same age diagnosed in 1990 to 1994, researchers found.

“Pretty much all populations improved their cancer survival over time,” said Dr. Wei Zheng, the study’s senior author from Vanderbilt University in Nashville. (Andrew M. Seaman, Reuters)

Improved diagnosis and treatment result from good research and development in the medical-device and pharmaceutical industries, not government-imposed mandatory health insurance.

GAO: Medicare, Medicaid, Veterans Health Administration at High Risk for Fraud, Waste, Abuse

The Government Accountability Office (GAO) has published its annual update of federal programs “that it identifies as high risk due to their greater vulnerabilities to fraud, waste, abuse, and mismanagement…”

Healthcare programs feature high on the list. Medicare, the entitlement program for seniors, and Medicaid, the joint state federal welfare program for low-income households, are longstanding members of the list; and the GAO notes that legislation will be required to fix them:

We designated Medicare as a high-risk program in 1990 due to its size, complexity, and susceptibility to mismanagement and improper payments.

We designated Medicaid as a high-risk program in 2003 due to its size, growth, diversity of programs, and concerns about the adequacy of fiscal oversight.

Has Telehealth Gone Too Far, Too Fast?

Jerry King is the cartoonist for the Kaiser Family Foundation’s Kaiser Health News (which publishes a valuable daily briefing and is a great resource for healthcare news).

One of our issues at NCPA is digital health, especially telehealth (which we have researched since at least 2007). Things are finally moving in the right direction on telehealth adoption. King’s cartoon this morning made us wonder whether things are going too far, too quickly.


Original at Kaiser Health News.

Is the Medical-Malpractice Crisis Being Solved?

In a JAMA article published last month, Michelle Mello and colleagues review trends in medical-malpractice claims and med-mail insurance costs.

Data show a decline in the rate of paid claims against physicians: 6.3% annually for MDs and 5.3% for doctors of Osteopathy, from 1994 to 2013. Further, the average amount paid per claim has been unchanged in real (inflation-adjusted) terms for the past seven years.


Source: The Medical Liability Climate and Prospects for Reform from JAMA

83 Percent of Physician Practices Say Medicare’s Quality Reporting Does Not Improve Quality

The Medical Group Management Association (MGMA) has produced another painful report about the experience of being a physician or physician executive:

More than 83% of physician practices stated they did not believe current Medicare physician quality reporting programs enhanced their physicians’ ability to provide high-quality patient care. In addition to the lack of effectiveness, physician practices reported significant challenges in complying with Medicare quality reporting requirements. More than 70% rated Medicare’s quality reporting requirements as “very” or “extremely” complex. In addition, a significant majority of respondents indicated these programs negatively affected practice efficiency, support staff time, and clinician morale.