I tend to “batch read” medical journals. I usually set aside some time on Sunday mornings, after the New York Times and before the Giants kick-off to skim the cardiology journals that I still get. This past Sunday I saw something in Circulation that caught my eye.
The title of the article was “Medication initiation burden required to comply with heart failure guideline recommendations and hospital quality measures” and it was apparently deemed important enough by the editors to have an accompanying editorial called “Rethinking the focus of heart failure quality measures.” Both were authored by luminaries in the field. The punch-line? Lots of patients admitted to the hospital with heart failure need to start one or more new medications to meet guideline recommendations and hospital heart failure quality measures. This is, of course, hard to pull off, because of the challenges associated with “managing polypharmacy” and “heart failure transitional care.”
Continue reading No Kidding
When the Affordable Care Act (ACA) was passed in 2010, the most contentious provisions – which are still the subject of challenges in federal courts – were the establishment of state-wide insurance exchanges, the “individual mandate” that compels eligible citizens to buy insurance, and the expansion of state Medicaid programs. Less well appreciated, but arguably more important, were a wide range of reforms to the Medicare program. Summarized here, they touch on almost all aspects of the program, but I want to concentrate on just one.
The law directed CMS to move Medicare from a strictly fee-for-service (FFS) payment model (“paying for volume”) to one in which the quality of care was factored into the payment received by hospitals and physicians (“paying for value”). As I have written previously I believe this is the right move. There are just too many challenges to improving care and lowering costs that derive from “straight” FFS that is disconnected from any assessment of quality. And while you may not have known that they grew out of the ACA, the payment reforms themselves have gotten a lot of attention. Penalties for readmissions, requirements for physician quality reporting, pilot programs for bundled payments and accountable care organizations are just of few of the Medicare reforms. Even though they currently influence a small percentage of overall Medicare spending, these changes may already be having a big impact on how care is delivered.
Continue reading Not Your Father’s Medicare
Steven Brill made a name for himself with an article in Time magazine back in 2013 entitled “Bitter Pill,” in which he harshly criticized how health care providers (especially hospitals) inflate the costs of their services. The piece created a lot of buzz, and some backlash from hospital groups and others. Now it seems that Mr. Brill has had a bit of a “sick-bed conversion.”
He has a new piece in the January 19th issue of Time called “What I learned from my $190,000 open-heart surgery: the surprising solution for fixing our health care system.” Since Time won’t let you read the article without subscribing or paying, I will save you the trouble. It seems that what he learned is that health care providers – the same ones he vilified in 2013 – were pretty great when they were taking care of his heart in 2015. In fact, he now believes that the way to “fix” healthcare is to “let the foxes run the henhouse” by allowing large integrated health systems become insurance companies and compete on price and “brand” and regulate their profits to assure that they are acting in the public interest. Yeah, well, no kidding.
Continue reading So What Else is New?