When it comes to health care in general and primary care in particular, America is not keeping pace with the rest of the world. Shocking as it may be, America is not in the top 30 countries in infant mortality and not in the top 40 in life expectancy at birth. We have a health system organized around acute care.

Those were the opening remarks of Dr. Harvey Fineberg, president of the Institute of Medicine, at a symposium – “Shock to the System: Preparing Primary Care for the Baby Boomers” – that marked the 30th anniversary of Urban Medical, a pioneer in providing patient-centered primary care to the frail elderly and chronically ill in Boston.

Currently, primary care is geared to treat acute, episodic problems in 15 minute patient visits. Fineberg said the team approach, as developed and practiced by Urban Medical, is a system of care that thinks first about the patients’ needs. He said “these understandings are not going to arise in the acute care setting.” And what we need to help solve the crisis in primary care, is to see a “thousand more Urban Medicals around the country.”

Unfortunately, the focus on acute care, “crowds out chronic disease management and preventive care,” according to Dr. Thomas Bodenheimer, of UCSF, and an expert on primary care. Read more…

One might think that something consuming up to one-third of our nation’s $2.3 trillion in health care spending would be easy to identify. But part of the challenge of reducing waste in health care – defined as spending that could be eliminated without reducing the quality of patient care – is to find where it is, why and how much. And although many policy experts and organizations have published well-regarded, specific studies of waste, until now there has been no system-wide collection of waste evidence.

The New England Healthcare Institute (NEHI) recently tackled this issue in How Many More Studies Will It Take? A Collection of Evidence That Our Health Care System Can Do Better. Read more…

The Kaiser Family Foundation is out with a poll and a study that illustrate how the economy is affecting health care. The telephone survey of 2,003 Americans says the rising cost of health care is a top concern. It finds that a growing number of Americans are skipping recommended tests or not filling prescriptions. 7% of those surveyed say they got married to get or give their spouse health coverage. Health care has dropped (with the economy moving up) in the ranking of priority issues for the Presidential campaign. Some health care policy experts say that’s a signal that not much will happen in the next administration. What do you think?

The Kaiser report, out yesterday, projects the impact of every one point increase in the national unemployment rate:

• The number of uninsured in the country would grow by 1.1 million;
• Medicaid and SCHIP enrollment would increase by one million (600,000 children and 400,000 non-elderly adults);
• The enrollment increase in Medicaid and SCHIP would lead to $3.4 billion more in spending, of which $1.4 billion would be states’ obligation; and
• State General Fund revenue would drop by 3 to 4 percent, leading to state budget cuts with Medicaid spending a likely target since it is a substantial segment of state budgets.
(from the Kaiser press release)

Governor Deval Patrick and other State House leaders keep predicting that Massachusetts will weather this economic downturn better than many other states. But with Commonwealth Care already under financial stress, any rise in the state’s uninsured population will be difficult to handle.

Martha Bebinger

Last week, the Massachusetts Health Care Quality and Cost Council (HCQCC) issued its first Annual Report, which identifies specific strategies for providers, insurers, employers and consumers that are designed to improve health care quality while containing costs. The Council’s recommendations address a range of issues that have long been acknowledged as needing attention to improve patient safety and the quality of care while at the same time decreasing inefficiencies and unnecessary costs in the system. The Council’s recommendations are unique in that they reflect discussion and collaboration among a wide range of stakeholders and represent hundreds of hours of work by individuals Council members.

These recommendations reflect the overarching goals set by the Council last year. We are committed to reducing the annual rise of health care costs to no more than the unadjusted growth in Gross Domestic Product by 2012; Read more…

Every now and then, at some health care meeting, someone will ask whether Massachusetts can reign in health care spending without undermining a major part of the state’s economy, the health care industry. The fear is…with so many jobs tied to discovering the next (expensive) medical miracle, designing a device that hospitals will buy too many of or (over)treating Massachusetts patients…the state can not “afford” to interfere with that sector. On the other hand, legislators and regulators are talking about limiting hospital expansions, the use of brand names drugs and some patients benefits.

Will it be hard to find the balance that supports medical innovation, services and lower health care spending rates?

Is this an exaggerated concern?

Did you submit the HC-A (Health Care Appeals) form with your 2007 state tax return?

Would you mind writing a bit here about why and how the appeal process is going?

On April 17, the Senate unanimously approved a comprehensive cost containment bill designed to rein in the state’s spiraling health care costs.

The vote could not have come at a more crucial time for the Commonwealth, as several converging factors are threatening to undermine the state’s efforts to ensure that all Massachusetts residents have access to health insurance.

Consider the following:

• In the last two years, approximately 340,000 Massachusetts residents have secured health care coverage, a milestone state officials did not expect to reach until Year 5. Over 176,000 have signed up for Commonwealth Care, the state-subsidized program for low and moderate-income residents. Nearly 75 percent of these individuals make no monthly premium payments, so the state must pick up the costs. Read more…

On behalf of the 65+ organizations statewide, that have worked together for more than 2 years as the Disparities Action Network (DAN) to craft legislation that would provide for an Office of Health Equity to be located in the Executive Office of Health and Human Services, as Co-Chair I wish to express our great disappointment in the House budget released last week for its failure to support this provision as it was contained in Governor Patrick’s budget proposal.

As we get ready to “celebrate” the second anniversary of the Massachusetts health care experiment, the message in the House budget is clear; there is no political will or budgetary authority for addressing the most challenging issues for true health reform. Read more…

This study in Health Affairs uses survey responses from physicians to analyze why minorities may receive lower quality primary care. Doctors who see a large percentage of minorities report spending less time with patients (as compared with physicians who see fewer minorities), language barriers and trouble finding specialists who will accept their referrals. The reports suggests that inadequate Medicaid reimbursement rates contribute to these problems and resulting health disparities.

From the findings:

The study concludes that “racial and ethnic disparities in primary health care are in part systemic in nature, and the lower resources flowing to physicians treating more minority patients are a contributing factor. In particular…if Medicaid payments to physicians were on par with those paid by Medicare, disparities in reported difficulties between physicians whose patient panels were made up of greater versus. smaller proportions of minorities would diminish, often substantially. Low payments may be leading primary care physicians to reduce the time spent with patients and more generally diminish their ability to function effectively as their patients’ medical home.”

Afterward Jesus returned to Jerusalem for one of the Jewish holy days. Inside the city, near the Sheep Gate, was the pool of Bethesda, with five covered porches. Crowds of sick people—blind, lame, or paralyzed—lay on the porches. One of the men lying there had been sick for thirty-eight years. When Jesus saw him and knew he had been ill for a long time, he asked him, “Would you like to get well?” “I can’t, sir,” the sick man said, “for I have no one to put me into the pool when the water bubbles up. Someone else always gets there ahead of me.” Jesus told him, “Stand up, pick up your mat, and walk!”
Instantly, the man was healed! John 5:1-9 (New Living Translation)

As we celebrate the second year anniversary of health care reform in our Commonwealth, I often think about the Christian story noted above. Oh, how it summarizes the “Wonder” of Chapter 58! Read more…