The States With the Worst Healthcare Systems

Nearly a quarter of West Virginians have lost six or more teeth, and other findings from a new Commonwealth Fund report.

By Olga Khazan
The Atlantic
Originally published May 1, 2014

Here is an excerpt:

Healthcare in Mississippi and in other Southern states is unlikely to become more equitable anytime soon, however. As the study authors note, 16 of the states in the bottom half of the ranking have opted not to expand Medicaid under the Affordable Care Act to adults making up to 138 percent of the federal poverty level.

The entire article is here.

With Guns, Suicide Is the Biggest Problem

By Sarah Wickline
MedPage Today
Originally posted April 11, 2014

Every day, 88 people die from firearm-related injury; two-thirds of those deaths are suicides, a high proportion of which are committed by seniors and individuals living in rural areas, researchers reported here.

"Mass shooting episodes are obviously horrible," Molly Cooke, MD, president of the American College of Physicians (ACP), told reporters in a press briefing. "But one of the points we make in the paper is that every day there are 88 firearms-related deaths."

The entire article is here.

U.S. Prisons Becoming De Facto Home of the Mentally Ill

A new study reveals that prisons in America house ten times as many mentally ill as the state-run psychiatric wards that could actually treat them.

By Abby Haglage
The Daily Beast
Originally published April 10, 2014

Here is an excerpt:

While TAC’s study—titled The Treatment of Persons With Mental Illness in Prisons and Jails—isn’t the first of its kind, it’s notable for two reasons: it’s the first to analyze the data by state, and it’s the most recent illustration that the problem is growing more acute. One of the worst offenders is New York, where the law mandates mentally ill inmates be sent to psychiatric hospitals (which—given the lack of available beds—is mostly useless). A 2011 study estimated that of the 12,200 inmates at Riker’s Island, ⅓ of the men and ⅔ of the women are mentally ill.

The entire article is here.

The Ethics of an Ordinary Doctor

William T. Branch Jr.
Article first published online: 9 JAN 2014

DOI: 10.1002/hast.250

Here is an excerpt:

Bioethicists have proposed that an emphasis on autonomy and justice constitutes the important turn in contemporary medical ethics. As an ordinary doctor involved in the care of sick patients, I experienced a different turn: the shift from scientific hubris toward more compassionate care.

The future will likely bring an emphasis on limiting the costs of health care, related in ethics to distributive justice. But what do we learn about justice from being at the patient's bedside? We will not learn to abandon being our individual patients’ advocates. As in the case above, we witness their suffering. We participate. Our responsibility is to care for them.

The entire article is here.

Medical Start-up Invited Millions Of Patients To Write Reviews They May Not Realize Are Public

By Kashmir Hill
Forbes
Originally posted October 21, 2014

Here is an excerpt:

Much like a Facebook policy change, it seems that doctors and patients wound up having data exposed or used in a way they didn’t expect. But this is a much more serious case in that it involves sensitive health conditions. Medical privacy laws spell out explicitly what health providers and their “business associates,” a.k.a. vendors, are allowed to do with patient information. While Practice Fusion says contacting patients for reviews is a service done on behalf of doctors — as is required by HIPAA — the cynical take is that they used their access to patient records for business purposes — to build a review site to compete with ZocDoc and Yelp.

Deven McGraw, a medical privacy law expert at the Center for Democracy and Technology, was also troubled by the messaging. “Anything they want to do with patient data, they’re supposed to do on behalf of the doctor. It’s not a license or invitation to take the data you get and use it for your own business purposes,” she says.

The entire story is here.

The DSM-5: A Vehicle For High-Profit Patent Extensions?

Gregg Fields & Lisa Cosgrove | Labcast
Harvard University SoundCloud Podcast

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders affects drugs with sales in the billions of dollars. In research supported by the Edmond J. Safra Center for Ethics, Lisa Cosgrove of UMass-Boston investigated financial ties between DSM panel members and the pharmaceutical companies that have a vested interest in finding new indications for their blockbuster drugs. In this podcast, she tells journalist Gregg Fields what she found, what it means—and why we all should care.

"Tripartite Conflicts of Interest and High Stakes Patent Extensions in the DSM-5," Psychotherapy and Psychosomatics.

Terri Schiavo's family joins family of teen Jahi McMath in fight over life support

By Josh Levs, Catherine E. Shoichet and Caleb Hellerman, CNN
Originally published January 2, 2014

(CNN) -- The family of Terri Schiavo has joined the battle over Jahi McMath, a 13-year-old girl on life support who has been declared dead by doctors.

"Together with our team of experts, Terri's Network believes Jahi's case is representative of a very deep problem within the U.S. healthcare system -- particularly those issues surrounding the deaths of patients within the confines of hospital corporations, which have a vested financial interest in discontinuing life," the Terri Schiavo Life & Hope Network said in a prepared statement.

The entire story is here


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E.R. Costs for Mentally Ill Soar, and Hospitals Seek Better Way

By Julie Creswell
The New York Times
Originally published December 25, 2013

Here is an excerpt:

Today, North Carolina has only eight beds in state psychiatric hospitals per 100,000 people, the lowest ratio in the country.(North Carolina, like other states, has added beds in local community facilities but, even then, its total beds are down a quarter since 2001.)

Uninsured patients rarely receive individual therapy, only group sessions. And it can take up to three months to see a psychiatrist.

“Now, we are seeing some of the most acute, the most aggressive and the most chronic mental health patients, and we’re holding them longer,” said Janice Frohman, the director of WakeMed’s emergency department.

The effects of the upheaval in care of the mentally ill is playing out vividly at WakeMed. A private, nonprofit organization with 884 beds, WakeMed is struggling to find a way to meet the needs of increasing numbers of mentally ill patients while also controlling costs.

The entire article is here.

The Healthcare Industry and the U.S.S.R.

By Jeanne Pinder
Ignite: Enlighten us, but make it quick
Uploaded December 16, 2013

Screening Newborns For Disease Can Leave Families In Limbo

By Nell Greenfieldboyce
NPR Health News
Originally posted December 23, 2013

For Matthew and Brianne Wojtesta, it all started about a week after the birth of their daughter Vera. Matthew was picking up his son from kindergarten when he got a phone call.

It was their pediatrician, with some shocking news. Vera had been flagged by New York's newborn screening program as possibly having a potentially deadly disease, and would need to go see a neurologist the next day.

Like every state, New York requires that newborns get a small heel prick so that a few drops of blood can be sent to a lab for testing. The idea is to catch health problems that could cause death or disability without early intervention.

But in recent years, patient advocacy groups have been pushing states to adopt mandatory newborn screening for more and more diseases, including ones that have no easy diagnosis or treatment.

One of those is Krabbe disease, a rare and devastating neurological disorder.

In 2006, New York became the first state to screen for Krabbe, and until recently it was the only state to do so. Screening for this disease is expanding, even though some experts say the treatment available doesn't seem to help affected children as much as was initially hoped — and testing can put some families in a kind of fearful limbo.

The entire story is here.

The cheapest form of health care is to let sick people die

By John F. Hunt
KevinMD Blog
Originally posted December 21, 2013

If you learn nothing else today, I would ask you to learn that moral hazard is the cause of medical price hyperinflation.

Moral hazard is not just two words that don’t seem to go together. Moral hazard is when the person who bears the economic burden of a decision is not the decision maker. In the health care setting, moral hazard is when the third party payer (insurance/government) bears the economic consequences of a patient’s decision.

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The cheapest form of health care is to let sick people die. And the government will always need to save money on health care so they can afford to send soldiers to foreign lands that have oil, subsidize big agribusiness to grow corn to make ethanol to destroy our engines, give huge grants to bankrupt companies whose executives support Obama, double the size of the NSA’s Utah data center, or bail out a few more Wall Street looters.

Remember that health insurance  – because of its inherent moral hazard — is the problem, not the solution.

The entire article is here.

Thanks to Ed Zuckerman for this blog post.

People with mental health problems still waiting over a year for talking treatments, UK

Medical News Today
Originally published November 28, 2013

More than one in ten (12%) people with mental health problems are stuck on waiting lists for over a year before receiving talking treatments and over half (54%) wait over three months, reveals a new report launched by the We Need to Talk coalition of which the mental health charity Mind is part of (1).

The survey (2) of over 1,600 people who have tried to access talking therapies such as counselling and Cognitive Behaviour Therapy on the NHS in England over the last two years also shows how some people are paying for private therapy to get the help they desperately need. One in ten (11%) said that they had faced costs for private treatment because the therapy they needed was not available on the NHS.

The choice of treatment on offer was also found to be limited even though CBT, the most commonly prescribed talking treatment, doesn't work for everyone. The coalition found that three in five people (58%) weren't offered a choice in the type of therapy they received.

Since 2007, the Government's increased investment in the Improving Access to Psychological Therapies (IAPT) programme has helped millions of people to access psychological therapies on the NHS who otherwise wouldn't have had this support. However, delays in accessing support and a lack of choice is having a devastating effect on people's lives and recovery.

The entire article is here.

Introducing deprescribing into culture of medication

By Catherine Cross
Canadian Medical Association
Originally published August 12, 2013

An Ontario pharmacist has received a government grant to develop clinical guidelines to help doctors determine whether patients are on medications they no longer need or that should be reduced.

"We don't normally test drugs in the elderly, but they are taking many drugs. As they get older and get more chronic conditions, the number of medications increases," says Barbara Farrell, a clinical scientist with the Bruyère Research Institute in Ottawa, Ontario.

Sometimes when medications are deprescribed or reduced, "confusion will clear, or they'll stop falling, and a lot of literature supports that," says Farrell, who received the $430 000 grant from the Ontario Ministry of Health and Long-Term Care.

The entire story is here.

End-of-Life Care Improves But Costs Increase, Study Finds

by E.J. Mitchell
The Medicare News Group
Originally published July 12, 2013

Improvements in end-of-life care have occurred rapidly for Medicare patients but costs have increased, according to a new Dartmouth Institute brief that was released today. The study revealed that beneficiaries in their last six months of life spent fewer days in the hospital and that more patients received hospice services in 2010 compared to 2007.

However, Medicare spending for chronically ill patients at the end of life increased more than 15 percent during that time period, while the consumer price index rose only 5.3 percent.

The data from the brief, which is through the Dartmouth Atlas Project, also found that in 2010 compared to 2007:

• patients were less likely to die in the hospital;
• patients were as likely to spend time in intensive care units (ICUs) during the last six months of life;
• the variations in end-of-life care at some academic medical centers quickly changed;
• patients spent more days in hospice care; and
• patients were more likely to see more than 10 physicians during the last 6 months of life.
• The Dartmouth Atlas brief found that across hospitals improvement was variable, with some experiencing rapid change while others showed little improvement.

The entire article is here.

An Imperative for Change: Access to Psychological Services for Canada

Canadian Psychological Association
Press Release
May 2013

To mark the one year anniversary of Canada’s first mental health strategy next week, the Canadian Psychological Association (CPA) is releasing an independent report by a group of health economists. The report ‘An Imperative for Change’ states that the delivery of mental health services can be characterized as a silent crisis and provides a business case, and proposes models, for improved access to psychological services.

“One of the great challenges when it comes to caring for the mental health of Canadians is the significant barriers to accessing mental health services. Despite the fact that one in five Canadians will experience a mental health problem in a given year, only one-third will receive the help they need. We have psychological treatments that work, and experts trained to deliver them. Yet the services of psychologists are not funded by provincial health insurance plans, which make them inaccessible to many with modest incomes or no insurance. Publically funded services, when available, are often in short supply and wait lists are long. The cost of mental illness in Canada is estimated at 51 billion dollars annually so we need to act now and be innovative in our approach,” said Dr. Jennifer Frain, President of the CPA.

“Last year we were very pleased that Canada’s national mental health strategy called for increased access to evidence-based psychotherapies by service providers qualified to deliver them. In response, we commissioned a report to look at how this can be achieved. The report proposes and costs out four models that could be implemented and adapted here,” said Dr. Karen Cohen, Chief Executive Officer of the CPA.

“Canada has fallen behind other countries such as the United Kingdom, Australia, the Netherlands, and Finland who have launched mental health initiatives which include covering the services of psychologists through public health systems. These initiatives are proving both cost and clinically effective. Analysis of research in the United Kingdom found that substantial returns on investments could be achieved in the early detection and treatment of common mental health conditions such as depression. These models respond to the recommendations of the mental health strategy. By implementing them, we can move from conversation to action,” added Dr. Cohen.

Models for Canada

Adapt the United Kingdom’s publicly funded model for Improved Access to Psychological Therapies (IAPT) in the provinces and territories. Under this program psychologists and low intensity therapists deliver care for people with the most common mental health problems:

• depression and anxiety.
• Integrate psychologists on primary care teams so that mental health problems are addressed at the right time, in the right place, by the right provider.
• Include psychologists on specialist care teams in secondary and tertiary care facilities for health and mental health conditions.
• Expand private insurance coverage and promote employer support for psychological services
• Canadian employers could expect to recover $6 to $7 billion annually with attention to prevention, early identification and treatment of mental health problems among their workforces.

Read “An Imperative for Change: Access to Psychological Services for Canada” here

Psychiatrists waste 1 million hours getting patients admitted

United Press International
Originally published April 24, 2013

U.S. psychiatrists spend an average 38 minutes telephoning an insurance company getting authorization to admit a patient to the hospital, researchers say.

Lead author Dr. Amy Funkenstein, a child psychiatry fellow at Brown University in Providence, R.I., led the study while she was a psychiatric resident at Cambridge Health Alliance and Harvard Medical School in Boston.

Over a three-month period, the researchers tabulated how long psychiatric patients who were deemed in need of inpatient admission stayed in the emergency department prior to being hospitalized, and the amount of time the ED psychiatrists spent obtaining authorization from the patient's insurer.

Most psychiatric patients required hospitalization because they were suicidal or, in a few cases, homicidal, Funkenstein said.

The entire story is here.

A Health Provider Strives to Keep Hospital Beds Empty

By Annie Lowrey
The New York Times
Originally published April 23, 2013

On a stormy evening this spring, nurses at Dr. Gary Stuck’s family practice were on the phone with patients with heart ailments, asking them not to shovel snow. The idea was to keep them out of the hospital, and that effort — combined with dozens more like it — is starting to make a difference: across the city, doctors are providing less, but not worse, health care.

For most health care providers, that would be cause for alarm. But not for Advocate Health Care, based in Oak Brook, Ill., a pioneer in an approach known as “accountable care” that offers financial incentives for doctors and hospitals to cut costs rather than funnel patients through an ever-greater volume of costly medical services. Under the agreement, hospital admissions are down 6 percent. Days spent in the hospital are down nearly 9 percent. The average length of a stay has declined, and many other measures show doctors providing less care, too.

This approach is one small part of a growing effort by providers to hold down costs without restricting needed care. Nationwide, health care spending has grown over the last three years at the slowest rate since the federal government started keeping data more than 50 years ago. While the bulk of that is related to the poor economy, changes among insurers and health care providers have contributed as well. If the trend continues, even at a reduced pace, it could help alleviate Washington’s long-term deficit problems and ease the strain on family budgets.

The entire story is here.

Nevada buses hundreds of mentally ill patients to cities around country

By Cynthia Hubert, Phillip Reese, & Jim Sanders
The Sacramento Bee
Originally published April 14, 2013

Over the past five years, Nevada's primary state psychiatric hospital has put hundreds of mentally ill patients on Greyhound buses and sent them to cities and towns across America.

Since July 2008, Rawson-Neal Psychiatric Hospital in Las Vegas has transported more than 1,500 patients to other cities via Greyhound bus, sending at least one person to every state in the continental United States, according to a Bee review of bus receipts kept by Nevada's mental health division.

About a third of those patients were dispatched to California, including more than 200 to Los Angeles County, about 70 to San Diego County and 19 to the city of Sacramento.

In recent years, as Nevada has slashed funding for mental health services, the number of mentally ill patients being bused out of southern Nevada has steadily risen, growing 66 percent from 2009 to 2012. During that same period, the hospital has dispersed those patients to an ever-increasing number of states.

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It also is cheaper, he noted. Southern Nevada Adult Mental Health Services spent a total of $205,000 putting patients on Greyhound buses during the past five years, according to The Bee analysis. The state hospital admits about 4,000 patients a year to its inpatient unit, and inpatient care runs around $500 per day per client, Ghertner said.

The entire story is here.

Patients should decide what the end of life is like, study says

By Mary VacVean
The Los Angeles Times
Originally published March 20, 2013

Finding out what dying patients want and treating them accordingly leads to happier patients who are in less pain and who use fewer healthcare dollars, UCLA researchers said Tuesday.

“You can improve care while reducing costs by making sure that everything you do is centered on what the patients want, what his or her specific goals are and tailor a treatment plan to ensure we provide the specific care he or she wants,” Dr. Jonathan Bergman, a Robert Wood Johnson clinical scholar at UCLA, said in a statement.

Bergman and colleagues wrote an article advocating for patient-centered care at the end of life in the journal JAMA Surgery.

People who are dying often receive care that is poorly coordinated and not in line with the patient’s values or goals, the journal authors said. That should change, they said.

The entire article is here.

Proof That Obamacare 'Rate Shock' Is An Ugly Insurance Company Deception

By Rick Unger
Forbes - Op Ed
Originally published on March 26, 2013

Over the past few months, the nation’s largest health insurance companies have been hard at work selling a narrative claiming that the Affordable Care Act is about to result in dramatically larger premium costs for a significant number of Americans. Indeed, the warnings have become so worrisome that the massive increases they are predicting have taken on a frightening descriptor all its own—rate shock.

At the heart of the health insurers’ retelling of the Chicken Little story is a regulation promulgated by the Department of Health and Human Services a few months back limiting what a health insurer can charge a 64 year old to three times what they charge a 21 year old. Currently, the average bump for older participants is typically five times that of the younger customers—although there are examples where the increase can reach ten times what is paid by the young immortals buying coverage.

As a result of the lower premium prices that will be paid by older participant, the expectation—one created by the large insurance companies—is that the youngest participants will have to pay significantly more to make up the difference.

Now, The Urban Institute—an organization so clearly bi-partisan that even the most suspicious partisan would encounter extreme difficulty making a case for bias—is out with a study that states that the ‘rate shock’ argument is “unfounded”, particularly when applied to the millions of Americans in the individual market.

The entire Op Ed is here.

The study debunking the "rate shock" rumor is here.