Notes & Links: October 25, 2013

Raising the Medicare eligibility age is now a REALLY bad idea
Aaron Carroll and Austin Frakt at The Incidental Economist give us all the smart economic reasons why raising the eligibility age for Medicare is dumb. 

Put these two things together, and the new estimate for federal savings is much lower than it was before. But all the non-federal costs (not in the CBO report but covered by us before — see links above) remain, as does the concern about the viability of the exchanges and the fact that Medicaid hasn’t expanded in all states. So if raising the Medicare eligibility age before was a bad idea (and it was), it’s an even worse idea now.

This is a great smart clearly written read.

FDA to Regulate Gluten-Free Labeling
Jennie Bragg at Healthworks Collective shares the new FDA rule on what a product has to do to be labeled Gluten-Free.

…a food or beverage must contain fewer than 20 parts per million (20ppm) of gluten. This translates to approximately two-hundredths of a gram of gluten per kilogram (2.2 pounds) of food.

I can’t help but wonder if some of the foods currently saying Gluten-Free who have sales that show many people buying them and feeling better will end up not making the cut because they are not strickly Gluten-Free. Can you say placebo effect?

GOP’s Oddest Obamacare Objection
Michael Millenson a Contributor to Forbes shares his shock and awe at the the following:

The reason that Republicans shut down the federal government, it turns out, was to “restore patient-centered healthcare in America.”

Really? Worried about patients and patient centered care? The GOP? One quote to capture the complete and utter lucency of this. 

Obamacare opponents assert that the ACA undermines the traditional doctor-patient relationship – although I suspect that being able to pay your doctor because you have health insurance actually improves it quite a bit. Yet in calling for “patient-centered healthcare” instead of the more common “patient-centered care” or even patient-centeredmedicine, conservatives unwittingly abandoned doctor-patient language in favor of business-speak.

Go read this piece and smile.

Polio eradication: where are we now?
The Lancet editorial reminds us that it would be wrong to forget this disease still exists, still can cause suffering, and still needs world attention. 

With regard to the technical dimension of ending polio, global eradication efforts led by WHO, UNICEF, and the Rotary Foundation have made remarkable progress. Poliomyelitis cases have been reduced by more than 99% and there are only three remaining polio-endemic countries—Afghanistan, Nigeria, and Pakistan. In 2013, the number of polio cases from the three endemic countries—99 in total—is 40% lower than in 2012.

Technically we cannot do better at eradicating this disease it is now a battle of political will. 

Shine again
Jonathan Barnes writing in The Lancet reviews Stephen King’s new novel a sequel to The Shinning titled Doctor Sleep. When I saw The Lancet had a book review I was drawn to like link bait. The book follows Danny the son from The Shinning into the 21 Century where he is a physician working in a hospice in New Hampshire. 

The review is good and the fact it is in The Lancet and ties the loose ends of addiction to King and his previous work is interesting. 

Notes & Links: September 12, 2013

The Public Needs to Wise Up About Medicare Spending
Adrianna Mcintyre writing in The Incidental Economist shares data from a recent report in the NEJM “The Public and the Conflict over Future Medicare Spending“. In her opening paragraph Adrianna captures the money shot on this report. 

Robert Blendon and John Benson find, among other things, that people generally don’t understand the role Medicare plays in the federal budget deficit—which matters, since the legislators responsible for reducing that deficit tend to care about reelection.

We as a community/nation/individuals don’t get Medicare and basically driven by misinformation from those seeking reelection. What is sad is that the majority of media or experts site the following three leading causes for rising Meiicare costs are: poor management, fraud and abuse, and excessive charges by hospitals. The lowest ranked reason, new drugs and treatments being offered to seniors. There is a great chart showing just the opposite. Technology is driving costs most of all. Below is a quote pulled from the NEJM article.

This article goes further and seeks to document the underlying beliefs that may shape the public response to future efforts to substantially slow projected Medicare spending. Our thesis is that there exists today a wide gap in beliefs between experts on the financial state of Medicare and the public at large. Because of the potential electoral consequences, these differences in perception are likely to have ramifications for policymakers addressing this issue.

Take the time to read the NEJM article as well as the link to it at The Incidental Economist. It is important for both the nations finances and its health we understand what is going on with Medicare.

Death of Porn Star
Tim Lahey, MD writing on the Healthcare Blog writes about the recent announcement that Cameron Bay a porn actress tested positive for HIV. Beyond the usual self righteous offensive and nasty tweets and comments Dr. Lahey makes us stop to consider the reality of this diagnosis and what it means. 

Porn stars, too, are easy to oversimplify. Dressed (at least temporarily) in garish or stereotypical costumes, they have sex on camera, they say things most can’t imagine saying, and they behave on screen like simplified primal versions of the complicated people of ordinary life. We project a mixture of desire, disdain, and pity on them, and often we forget to consider the person under all that exposed skin.

Indeed the person under that skin. Take a moment to read this article and consider the person. 

Majority of Viagra Bought Online May Be Fake, and Possibly Dangerous, Research Shows
Not sure I am being incentive presenting “Death of a  Porn Star” followed by this but the article in Forbes written by Melanie Haiken addresses a larger issue, online pharmacies in general. And since I get about a dozen or more requests to by this stuff online I couldn’t not read the article. 

The reference to Viagra was in fact an abstract presented at the World Meeting on Sexual Medicine and showed that 77% of all Viagra purchased online from 22 different sites was counterfeit. (An aside: it was an abstract funded by Pfizer). 

Other data shared:

Somewhat cumbersomely titled Internet Drug Outlet Identification Program Progress Report for State and Federal Regulators, July 2013, the report revealed that only 257 of 10,275 online pharmacy sites it examined could be considered legitimate.

Not so fast:

The belief that most online pharmacies are suspect and that most Viagra sold online is fake is not universal, however. In fact, says Roger Bate, a scholar at the American Enterprise Institute and author of Phake: The Deadly World of Falsified and Substandard Medicines, his own tests of drugs sold online found the vast majority to be authentic and those sold by credentialed online pharmacies to be 100 percent authentic. Bate published a paper in 2010 finding that just 7.3 percent of Viagra samples purchased online failed spectrometry testing and proved to be fake

Who to believe? Even a small percent is fake consider what is in the fake. This is what was found. 

  • Blue printer ink
  • Speed or amphetamine
  • The antibiotic Metronidazole (Flagyl)
  • Drywall and plaster
  • Other ingredients and dyesused to mimic the texture and color of real Viagra


Fourteen Oddball Reasons You’re Not Dead Yet

Laura Helmuth in Slate shares, yes oddball, facts that have extended our life expectancy not one of them has to do with Obamacare or preventive medicine. Okay check that, there is a reason or two from government regulations. Here is the list. Hop over and take a look at the details. 

  • Satellites
  • Fluoride
  • Window screens
  • Unconscious bias
  • Botts’ Dots (Those are the raised ceramic reflectors between road lanes)
  • Morbidity and Mortality Weekly Report
  • Air-conditiong 
  • The resident of Framingham, MA
  • Pasteurization
  • Shoes
  • Cows
  • Oppressive, burdensome, over-reaching government regulations

Thanks to Liz Borkowski on ScienceBlogs for this link.

Notes & Linkes: August 8, 2013

“Validity of Web-Based Self-Reported Weight and Height: Results of the Nutrinet-Sante Study”

Lassale, Peneau, et. al. have published an article in JMIR examining the trending in healthcare of e-pidemiology and the validity and reliability of self-reported data. 

Compared with the clinical data validity was high. Intraclass correlation coefficient ranged from 0.94 for height and 0.99 for weight. They reported a slight underreporting of weight and over reporting of height which lead to underreporting of BMI (p<.05) for both men and women. I guess we all lie about our weight and height a little

Conclusions: Web-based self-reported weight and height data from the NutriNet-Santé study can be considered as valid enough to be used when studying associations of nutritional factors with anthropometrics and health outcomes. Although self-reported anthropometrics are inherently prone to biases, the magnitude of such biases can be considered comparable to face-to-face interview. Web-based self-reported data appear to be an accurate and useful tool to assess anthropometric data.

This study supports web-based self reporting and for my two cents it is another tool to aid outcomes that resides outside the office visit. But for my money it strikes me as an important step in demonstrating to providers a way to lower utilizations costs while improving physician patient engagement. 

Glad to see more studies like this every month. We need to know what is happening from a data .

“What’s CBS worth? How About Just the Programs”

If you live in NYC or LA TWC shut down CBS and Showtime (Dexter!!!!!) over money.

Doc Searls examines this issue and what may happen going forward. I know I am looking to find a way to cut the cable cord myself. Most of the tech heads I follow have done it to some degree but tend to return. There is a real opportunity for change in pricing and access to TV shows and networks. I wonder about Apple and their iTV. Networks will not roll over like the cheap suits of music due to the impeccable logic of one Steve Jobs. But with Netflicks and others producing high quality content we may just be at the cross roads. I sure hope so.

“Top 5 Reasons Hospitals Are Losing Money”

Only 5? Each one of us can identify three more. 

Danyell Jones posting in HealthWorks Collective presents the follow sobering data

With such a high cost of care, many assume that hospitals in America are turning a healthy profit; however this just isn’t the case.  In fact recent estimates indicate that nearly 67% of US hospitals are losing money, particularly when it comes to the treatment of Medicaid/Medicare patients. 

The five are:

  • Denials and Coding Issues
  • Service Level Discrepancies
  • Front Desk Processes
  • Look at your Patient Mix
  • Evaluate Your Contracts and Negotiate to Win

 Color me surprised a post on an industry supported site first blames Medicaid/Medicare patients. Gee that was easy. Listen to the Terry Gross on Fresh Air interviewed Elisabeth Rosenthal, MD from the New York Times about her series on cost of healthcare in the US. 

It costs $13,660 for an American to have a hip replacement in Belgium; in the U.S., it’s closer to $100,000.

Rosenthal examination of the issue from an investigative journalist does not lay the blame (i.e. reasons) on Medicare/Medicaid. Our system drives the need to price healthcare at an al la carte basis with layer upon layer of costs for each procedure. 

We may never change our system but all of us will be looking at costs going forward and that may help to put pressure on lowering prices while delivering care, not excess. To that point a friend just delivered a baby at a major NYC hospital and said for the two days she was there every time there was a service delivered (i.e. cleaning the room, coaching breast feeding, etc.) there was a survey immediately following. Gotta love a corporation humping outcomes. In fact my friend said for the breast feeding coaching session there were no less then four people in the room. It takes a village of al a carte services.

PS: Why does a class money filled operation like NPR hang its graphic hat on crappy stock art of the lowest order. Gee show me pills spilled on $20 bills. Nothing says cost in medicine like that. NOT! 

“Why Reports of the Death of Physician Participation in Medicare May be Greatly Exaggerated”

Dan Diamond writing in The Health Care Blog quotes the usual suspects on the demise of care for Medicare patients 

 “Half of primary care physicians in survey would leave medicine … if they had an alternative.” — CNN, November 2008

“Doctors are increasingly leaving the Medicare program given its unpredictable funding.” – ForbesJanuary 2013

And least we forget our favorite healthcare resource for evidence based knowledge 

The Wall Street Journal last month portrayed physician unhappiness with Medicare as a burning issue, with a cover story that detailed why many more doctors are opting out of the program.

And yes, the number of doctors saying no to Medicare has proportionately risen quite a bit — from 3,700 doctors in 2009 to 9,539 in 2012. (And in some cases, Obamacare has been a convenient scapegoat.)

Oh no Mr. Bill the WSJ didn’t report on some data? I am shocked. 

What the Journal didn’t report is that, per CMS, the number of physicians who agreed to accept Medicare patients continues to grow year-over-year, from 705,568 in 2012 to 735,041 in 2013.

And other providers aren’t turning down Medicare, either. The number of nurse practitioners participating in the program has only gone up, Jan Towers of the American Academy of Nurse Practitioners says. 

Yes there is frustration and HCP are pissed at low revenue and more work. My hope is as the system lowers cost overall dollars can be shifted to the HCP to care for the elderly who suck down a lot of dollars. Outcomes measures will do much to drive that balance. 

Notes & Links July 17, 2013

Don’t Trust Online Tests For Alzheimer’s Disease 

Color me surprised the Internet may not be the best place to find trustworthy evidence based knowledge you can take to your HCP. 

Gary Drevitch article in Forbes reminds us that reader beware is the mantra for Web based medical/healthcare knowledge. 

But a new report released today at the Alzheimer’s Association’s International Conference in Boston finds such claims to be scientifically invalid and characterizes their hosts as unethical and often predatory in their pursuit of profits through sales of sketchy prevention tools to a beleaguered, vulnerable older population.

We need to create projects where we are teaching people how to critical appraise healthcare information. Even a well written article in a fairly mass media outlet will not reach everyone. And who is letting HCPs know that this is an issue? 

Ya Gotta Love Marco Arment

There’s a new app he created while sitting around which looks like a must have. It quickly draws arrows and boxes on screen shots so you can email them and the reader can quickly find what you are referencing. 

It’s called Bugshot. Love it

Clipboard: 4 of 5 MA Groups in Medicare Experiment Save Money in the blog White Coat Notes 

Four of the five — Partners HealthCare, Steward Health Care, the Beth Israel Deaconess Physician Organization, and the Mount Auburn Cambridge Independent Practice Association — said Tuesday that they spent less on patient care than the Medicare target for 2012, in part by reducing expensive hospital stays. The groups split the savings with Medicare.

 This is not clearly a huge win since it is early but it shows we can make a difference within a system of so many moving parts and people and goals.