Author: cmh

At NewYork-Presbyterian Hospital, Its Ex-C.E.O. Finds Lucrative Work – NYTimes.com

 

When Dr. Herbert Pardes retired as president and chief executive of NewYork-Presbyterian Hospital in 2011, the institution honored him at its annual “Cabaret” fund-raiser. More than 1,000 guests dined on wild mushroom soup catered by the restaurateur Danny Meyer and listened to Kelli O’Hara, a star of “South Pacific,” serenade them with Rodgers and Hammerstein, Sondheim and Berlin.

But there were more thanks to come.

The next year, Dr. Pardes earned $5.6 million, which included $1 million in base salary, a $1.8 million bonus for his final year as chief executive and more than $2 million in deferred compensation, according to hospital tax records. That exceeded the amount earned by Dr. Pardes’s successor, Dr. Steven Corwin, who made $3.6 million that year.

Three years after retirement, Dr. Pardes is still employed by the hospital as the executive vice chairman of its board of trustees, a position that compensation experts say is rare in the nonprofit world, though much more common in for-profit companies

At NewYork-Presbyterian Hospital, Its Ex-C.E.O. Finds Lucrative Work – NYTimes.com

Insurers Once on the Fence Plan to Join Health Exchanges in ’15 – NYTimes.com

 

In a sign of the growing potential under the federal health care law, several insurers that have been sitting on the sidelines say they will sell policies on the new exchanges in the coming year, and others plan to expand their offerings to more states.

“Insurers continue to see this as a good business opportunity,” said Larry Levitt, a health policy expert at the Kaiser Family Foundation. “They see it as an attractive market, with enrollment expected to ramp up in the second year.” Eight million people have signed up for coverage in 2014, and estimates put next year’s enrollment around 13 million.

In New Hampshire, for example, where Anthem Blue Cross is the only insurer offering individual coverage on the state exchange, two other plans, both from Massachusetts, say they intend to offer policies next year. Harvard Pilgrim Health Care, a nonprofit insurer with 1.2 million members, said it expected to participate in the exchanges in both New Hampshire and Maine for the first time and to add Connecticut to the mix in 2016.

Insurers Once on the Fence Plan to Join Health Exchanges in ’15 – NYTimes.com

The giant problem American health care ignores – Vox

 

Adrianna McIntyre: Can you start by summarizing the core message in your book — what is the "paradox" in American health care, and how do you start to unravel it?

Lauren Taylor: The paradox that we outline is one that a lot of readers will be familiar with: that the United States has very high health-care costs, and in many cases middling — and sometimes lousy — health outcomes when you look at certain metrics. These are metrics — like infant mortality and life expectancy — where, when you look across developed nations, we’re really at or near the bottom.

People cited this paradox before our book, and tried to explain it in any number of different ways. That included rationales like, "Well, U.S. health outcomes are bad because too few people have insurance" or "because prices are just high."

What our book tries to do is offer another reason that hasn’t been talked about much in health policy: maybe "health spending" isn’t telling us the whole story. Maybe we need to look at a broader summary of what resources nation puts in to support population health.

To do this, we included social services spending in our study, which captures things like housing, food assistance, and job training. The ratio of health to social-service spending was more predictive of several outcomes than health spending alone. This led us to suggest that social-service spending — and, more broadly, attention to the social determinants of health — could be a missing piece in the health reform discourse.

The giant problem American health care ignores – Vox

BBC News – Do doctors understand test results?

Don’t cheat!

But it’s not just that doctors and dentists can’t reel off the relevant stats for every treatment option. Even when the information is placed in front of them, Gigerenzer says, they often can’t make sense of it.

In 2006 and 2007 Gigerenzer gave a series of statistics workshops to more than 1,000 practising gynaecologists, and kicked off every session with the same question:

A 50-year-old woman, no symptoms, participates in routine mammography screening. She tests positive, is alarmed, and wants to know from you whether she has breast cancer for certain or what the chances are. Apart from the screening results, you know nothing else about this woman. How many women who test positive actually have breast cancer? What is the best answer?

  • nine in 10
  • eight in 10
  • one in 10
  • one in 100

Gigerenzer then supplied the assembled doctors with some data about Western women of this age to help them answer his question. (His figures were based on US studies from the 1990s, rounded up or down for simplicity – current stats from Britain’s National Health Service are slightly different).

  1. The probability that a woman has breast cancer is 1% ("prevalence")
  2. If a woman has breast cancer, the probability that she tests positive is 90% ("sensitivity")
  3. If a woman does not have breast cancer, the probability that she nevertheless tests positive is 9% ("false alarm rate")

In one session, almost half the group of 160 gynaecologists responded that the woman’s chance of having cancer was nine in 10. Only 21% said that the figure was one in 10 – which is the correct answer. That’s a worse result than if the doctors had been answering at random.

The fact that 90% of women with breast cancer get a positive result from a mammogram doesn’t mean that 90% of women with positive results have breast cancer. The high false alarm rate, combined with the disease’s prevalence of 1%, means that roughly nine out of 10 women with a worrying mammogram don’t actually have breast cancer.

I’ve often argued, when consumer choice and consumer driven health care are brought up as the solution for our health care woes, that doctors don’t even know how to make reasonable decisions so how can we expect lay people to do it?

 

BBC News – Do doctors understand test results?

Our unrealistic views of death, through a doctor’s eyes – The Washington Post

 

Doing something often feels better than doing nothing. Inaction feeds the sense of guilt-ridden ineptness family members already feel as they ask themselves, “Why can’t I do more for this person I love so much?”

Opting to try all forms of medical treatment and procedures to assuage this guilt is also emotional life insurance: When their loved one does die, family members can tell themselves, “We did everything we could for Mom.” In my experience, this is a stronger inclination than the equally valid (and perhaps more honest) admission that “we sure put Dad through the wringer those last few months.”

At a certain stage of life, aggressive medical treatment can become sanctioned torture. When a case such as this comes along, nurses, physicians and therapists sometimes feel conflicted and immoral. We’ve committed ourselves to relieving suffering, not causing it. A retired nurse once wrote to me: “I am so glad I don’t have to hurt old people any more.”

Our unrealistic views of death, through a doctor’s eyes – The Washington Post

The Role Of Sales Representatives In Driving Physicians’ Off-Label Prescription Habits – Health Affairs Blog

 

Off-label prescribing is widespread in Canada and the United States. One in nine prescriptions for Canadian adults are for off-label uses with the highest percentages coming from anticonvulsants (66.6 percent), antipsychotics (43.8 percent), and antidepressants (33.4 percent). Overall, 79 percent of the off-label prescriptions lacked strong scientific evidence for their use.

For 160 drugs commonly prescribed to U.S. adults and children, 21 percent were for off-label indications totaling 150 million prescriptions. In this case, 73 percent had little to no scientific backing and once again psychoactive drugs such as gabapentin had the highest level of off-label use.

Moreover, doctors do not seem to know what are and are not approved FDA use for many of the drugs that they prescribe. Now an article published in the June issue of Health Affairs by Ian Larkin and colleagues points to active promotion by sales representatives as one reason for the widespread off-label use of antipsychotics and antidepressants in children.

The Role Of Sales Representatives In Driving Physicians’ Off-Label Prescription Habits – Health Affairs Blog

JAMA Network | JAMA Internal Medicine | The Political Polarization of Physicians in the United States: An Analysis of Campaign Contributions to Federal Elections, 1991 Through 2012

 

Conclusions and Relevance Between 1991 and 2012, the political alignment of US physicians shifted from predominantly Republican toward the Democrats. The variables driving this change, including the increasing percentage of female physicians and the decreasing percentage of physicians in solo and small practices, are likely to drive further changes.

Figures in this Article

Although few systematic analyses have been conducted on the political behavior of physicians in the United States, it is often assumed that they sit to the right on the political spectrum. Generalizing from the American Medical Association’s strong opposition to the 1965 passage of Medicare, the belief is that physicians share the wariness of Republicans about government interventions, particularly in health care.1,2 Ostensibly, this outlook persists today.3

Given the scarcity of data and alert to the many changes in the composition and organization of the physician workforce, we examined physician contributions to presidential and congressional political campaigns from 1991 to 2012. Information on campaign contributions to federal elections is publicly available. The data illuminate patterns of support of physicians for Democratic and Republican candidates and how these patterns compare to those for all donors.

Between 1991 and 2012, campaign contributions in the United States increased substantially. Inflation-adjusted to 2012 dollars, contributions from all individuals increased from $716 million in 1991 to 1992 to $4.64 billion in 2011 to 2012, a 6.5-fold increase. Contributions from physicians increased at a greater rate, from $20 million to $189 million, or by nearly 9.5 fold.

We grouped contributions by the 2-year congressional election cycles. There are important differences in voter participation between midterm election years and presidential election years; for example, people with low incomes are less likely to vote in midterm elections.4(pp130-133) Contributions also varied between midterm and presidential years, with greater contributions in presidential years.

Over our 22-year study period, the composition of the medical profession changed—most notably, there were more female physicians and fewer solo practitioners5– 7—and politics in the United States became increasingly polarized.4 We hypothesized that the increased number of female physicians and the changes in medical practice altered the patterns of political partisanship within the profession.

JAMA Network | JAMA Internal Medicine | The Political Polarization of Physicians in the United States:  An Analysis of Campaign Contributions to Federal Elections, 1991 Through 2012

The gift of hospice – Pittsburgh Post-Gazette

An op-ed I wrote about the difficulty of navigating the hospice benefit in these days of increased scrutiny…

There are those who continue to pose the question: If hospice is meant to be end-of-life care, why do some patients get “discharged?”

The answer is two-fold. One reason is ever-changing patients and illnesses.

A growing percentage of hospice patients have illnesses with outcomes that are hard to predict. In the past, cancer was the dominant hospice diagnosis. Now, the portion of hospice patients with cancer — one of the more-predictable diseases — has declined. Today, non-cancer diagnoses (such as dementia or heart disease) account for more than 63 percent of hospice admissions, according to the National Hospice and Palliative Care Organization.

The other reason for discharge is simply that reputable hospice organizations are paying close attention to the new rules. Most hospices are more careful than ever about the patients they admit and the patients they keep in their care.

The gift of hospice – Pittsburgh Post-Gazette

What Has PAMED Done to Improve Tort Reform in Pennsylvania?

Pennsylvania has made amazing strides in medical liability reform WITHOUT CAPS! Follow the link to see the  summary of opportunities that other states can pursue without damaging victims’ rights.

What Has PAMED Done to Improve Tort Reform in Pennsylvania?

Most Pennsylvania physicians — more than 93 percent according to a 2009 study published in the Journal of the American Medical Association —report that they continue to engage in defensive medicine as a result of the state’s hostile medical liability environment.

Physicians often ask us, “What has the Pennsylvania Medical Society [PAMED] done to address this problem in the past and what are you doing now to achieve meaningful tort reform in Pennsylvania?”

What Has PAMED Done to Improve Tort Reform in Pennsylvania?

Navigating Medicare Policy on Physical Therapy and Other Services – NYTimes.com

 

For years, some people on Medicare had difficulty getting insurance coverage approved for physical therapy, occupational therapy and other treatments. The prevailing approach was that if the therapy was not helping to improve a patient’s condition, then it was not eligible for coverage.

“They’d get denied because they weren’t improving, or because they had plateaued,” said Judith Stein, executive director of the Center for Medicare Advocacy, a nonprofit consumer group. The situation was especially difficult, she said, for patients with chronic or degenerative conditions, like Parkinson’s disease or multiple sclerosis.

That is changing, as a result of a 2013 settlement of a lawsuit that the center and others brought against the secretary of the Health and Human Services Department, the parent agency of the Centers for Medicare and Medicaid Services, which oversees Medicare. The suit claimed that Medicare billing contractors were inappropriately denying coverage for “skilled” care by applying an “improvement” standard as a rule of thumb.

Because of the settlement, the agency updated its policy manuals last year. The revisions make clear that if treatment is needed to prevent or slow further deterioration in a patient’s condition, “coverage cannot be denied based on the absence of potential for improvement or restoration.” The update applies to therapy provided in nursing homes, in outpatient clinics and at home. (The agency maintains that the revision was not a change, but was made to “clarify” what had been existing Medicare policy.)

Navigating Medicare Policy on Physical Therapy and Other Services – NYTimes.com