Author Archives: Karen Weintraub

Mass. HHS Secretary Polanowicz On Cutting Health Costs, And More

Governor Patrick swearing in John Polanowicz as Secretary of Health and Human Services in the Governor’s Council Chambers at the State House on Tuesday, January 22, 2013. (Photo: Eric Haynes / Governor’s Office)

Governor Patrick swearing in John Polanowicz on Jan. 22, 2013. (Photo: Eric Haynes/Governor’s Office)

John Polanowicz, the Massachusetts Secretary of Health and Human Services, joined WBUR’s Meghna Chakrabarti on Radio Boston yesterday to discuss medical marijuana, the high cost of care in the Commonwealth, and more. Here’s a snippet on costs:

Meghna’s question, lightly distilled: Before your current posting, you were the president of St. Elizabeth’s Medical Center — the biggest hospital in the Steward Health Care System, which has been pretty aggressive in trying to reduce costs. Massachusetts has academic medical centers that are gems in terms of medical research and care, but those top-tier hospitals tend to say that their prices need to be higher to support research, or care for those who can’t pay. What do you tell them?

Polanowicz, excerpted:

We are one of the few states where we’re a little upside down in terms of where care is actually being sought. The vast majority of individuals in other states are not running to their academic medical centers for primary and secondary care. Absolutely going there for tertiary care and for some of the advances and frankly programs that we, as a Commonwealth, should be very proud of, that we have them here in Massachusetts.

I think that part of the issue is, and what I would say is, we have a lot of duplication of programs.  We have programs even within some systems, the same program almost across the street from each other…

I’ve said this to many of my former CEO colleagues: No one is going to want to pay us more for the things we are doing today, so we have to figure out ways to provide the care less expensively. Whether that’s through technologies, through reduction of testing, through reduction of waste.
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Atul Gawande, Renowned Surgeon And Writer, Launches Innovation Lab

In some ways, the name Dr. Atul Gawande chose for his new health care innovation center — Ariadne Labs – says it all.

“Ariadne is the myth of the Greek goddess who showed Theseus the way out of the labyrinth with a simple thread,” Gawande explained. “We’re in the simple-threads business to show our way out of the labyrinth of health care complexity.”

Surgeon/writer Atul Gawande is opening Ariadne Labs, a center, for health care innovation. (Photo: Fred Field)

Surgeon and writer Atul Gawande is opening Ariadne Labs, a center for health care innovation. (Courtesy Fred Field)

Gawande, a surgeon at Brigham and Women’s Hospital, has been named one of the world’s most influential thinkers. The surgical checklist he promotes has been gaining traction worldwide since 2008, when it’s use in a World Health Organization project reduced deaths during surgery by nearly 50 percent. The list is a set of questions everyone in an operating room answers, starting with: Do we have the correct patient? What operation are we performing? And is the site marked?

Now, Gawande is expanding his focus from surgery to two other big health care moments: childbirth and death.

“We think in the course of a person’s life that you will turn to the health system for a few high-risk, high-failure health care moments, and also some of the highest-cost moments in that system,” Gawande said. It starts with childbirth and surgery — the average person has seven operations in their lifetime — all the way to the end of life.

“We know that almost 90 percent of patients say they want to die at home, yet less than 50 percent do,” Dr. Rachelle Bernacki tells an audience gathered for the first research meeting on end-of-life care at Ariadne Labs’ new office.

Boston can be the Silicon Valley of health care innovations.
–Atul Gawande

Bernacki is testing a set of questions that aim to make sure doctors understand the wishes of patients who face a prognosis of death within six months. “We start all conversations with, ‘What’s your understanding of where you are with your illness now?’” Bernacki explained. She is analyzing patients’ responses to seven questions and training doctors to have these difficult conversations.

Some health care experts who’ve wrestled with the end-of-life issue for years – like Stuart Altman, who has worked on health care reform at the state and national level for 45 years —  are thrilled to hear Gawande’s lab is taking it on.

“Atul Gawande is a true find,” Altman said. “There are few people — no, as a matter of fact, I don’t know anybody who really has a better insight into how our system works and where it doesn’t work and how it could be better.”

But Gawande knows there are hurdles ahead. Continue reading

Health Care Expert But Political Novice: Berwick Runs For Governor

donald berwick

Pediatrician and health policy guru Dr. Donald Berwick officially announced his candidacy for governor of Massachusetts on Monday.

The former administrator of the Centers for Medicare and Medicaid Services for the Obama Administration, Berwick is an expert on cost and quality in health care, issues that are in the national spotlight as the federal health care law best known as Obamacare begins to come into effect.

WBUR’s Bob Oakes spoke with Berwick on today’s Morning Edition. Berwick offered this insight on how he would use his expertise in this area to bolster health care in the state as governor:

Massachusetts is being looked to by everyone around the country for success in its own health care reform. It’s very important  to have a governor who knows how to get us to health care reform in the state. We haven’t completed the job yet.
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No ‘Pot Doctors,’ Neon, Candy: Mass. Medical Pot Rules Take Shape

medical marijuana sign

(Photo: Laurie Avocado via Wikimedia Commons)

See that enticing medical marijuana sign above? Well, you won’t be seeing anything like it in Massachusetts.

As rules and guidelines and processes are developed to translate last year’s successful medical marijuana ballot measure into practice, the shape of the state’s coming “MM” order is beginning to emerge. State officials say it is a “Goldilocks” plan — (as in, just right) — balancing patients’ needs with concerns about abuse.

And that means learning from the 17 other states that have already legalized medical marijuana, they say. So, for example: The rules will emphasize that to prescribe marijuana, a doctor must be involved in a patient’s continuing care, thus avoiding the pot equivalent of “pill mills.” Signs will need to be low-key, not neon. Edible marijuana will be allowed, but cannot be marketed in candy-like forms alluring to children.

Those are a few of my takeaways from speaking to interim commissioner Cheryl Bartlett of the Department of Public Health. Our conversation is below, lightly edited, and for further details, the state has a medical marijuana FAQ here and more information here. To learn more, tune in to Radio Boston today at about 3 p.m. for a live interview with John Polanowicz, the state’s secretary of Health and Human Services — and if you have a particular question, the show will be taking call-ins at 800-423-8255.

So where are we at with medical marijuana?

The latest thing that happened is on Friday, we held a public hearing at the Department of Public health on fees. The ballot initiative requires that we develop a program of oversight, and that it be revenue-neutral to the state. So it authorized us to develop fees to cover the costs of this program. We took input and comments on that, and we’ll formulate the comments and get them up to Administration and Finance, which has the authority to establish fees.

When are they expected?  Continue reading

For State’s Health, It’s Report Card Time…

report card

(Wikimedia Commons)

Dear Massachusetts,
Your annual health report card is ready for viewing.  In this state of overachievers, you may not be pleased.  Your C+ is better than last year, but there is lots of room to improve.
Your evaluation shows progress in some areas:

School-Based BMI Reporting: A- (up from B in 2012)Promising new evidence suggests that the state’s school-based BMI program is creating positive results for students and families. Despite this, there has been pushback from legislators based on media reports and parent misunderstanding.

*Primary Care: B+ (up from B) – The new state health care law creates special incentives for developing strong, patient-centered primary care in Massachusetts. The Executive Office of Health and Human Services (EOHHS) has set the goal for all primary care practices to become patient-centered medical homes by 2015.

*Healthy School Meals: B (up from B-) – The Commonwealth is now fully implementing the most stringent requirements in the country for the sale of ‘competitive’ foods in schools. USDA regulations governing school lunch and breakfast programs were amended by the Healthy-Hunger Free Kids Act of 2010. Rules and regulations are being finalized, with state implementation ongoing.

Healthy Transportation Systems: B- (up from C) – The Legislature passed revenue measures to address the shortfall in funding for transportation and to improve the performance of state transportation agencies; it has not yet provided any long-term stability in financing. The state continues a promising start to healthy transportation planning. Continue reading

From Farm To Fridge: Should Raw Milk Be Easier To Get?

Nathan Greenwood-FreeDigitalPhotos

For Pamela and Ray Robinson, producing raw milk has been an economic lifesaver for their small, organic farm in Hardwick, Mass. Back when they used to send their milk for pasteurization, they earned less than they spent.

“Being conventional dairy farmers wasn’t paying the bills” says Pamela Robinson, a retired nurse midwife whose husband is a fourth generation farmer.

But their new source of income puts them in direct conflict with public health officials, who say raw milk is dangerous.

Massachusetts legislators are currently considering whether to make it easier for boutique farmers to sell raw milk – a measure backed by farmers like the Robinsons and advocates who say raw milk is more nutritious than pasteurized milk, which is heated to kill off pathogens. They say proper farming techniques, including a more stringent routine of cow care, milking procedures and testing, ensure safe milk.

But health officials say that farmers’ good practices can’t guarantee safety, and the extra health benefits come at too high a cost: a 150-times higher risk of food poisoning.

“Don’t drink it!” says Dr. Barbara Mahon, a CDC epidemiologist. “It is one of the likeliest foods  there is to carry germs that can make you seriously sick.”

House bill 717 would allow Massachusetts farmers to bring their raw milk closer to customers. Right now, raw milk and soft cheeses made from it can only be purchased on the farm where they are produced.  The new bill would allow farmers to transport their own milk to their customers directly to their homes, pre-established receiving spots or through community supported agriculture (CSA) arrangements.  Before purchasing their raw milk products, customers would be required to establish a contract with the farmer they plan to buy from.
Pamela Robinson spoke in favor of the bill earlier this month at a public hearing held by the Joint Committee on Environment, Natural Resources & Agriculture at a high school gym in Spencer, MA.

Robinson says she’s frustrated by the current law.

“A lot of our customers come from urban areas,” she says.  “All the border states have looser raw milk laws, so we lose business to them.” Continue reading

Bullying At Home: Aggressive Siblings Hurt Mental Health, Study Finds

(Wikimedia Commons)

(Wikimedia Commons)

True story: My older brother tormented me quite a bit as I was growing up, and my parents would mete out frequent discipline, but when we were visiting my grandparents and I’d complain, “He hit me!” my grandfather would joke dismissively: “It was a love tap!”

Funny. Sure didn’t feel like love.

These days, laudable anti-bullying programs abound in the nation’s schools. But the anti-bullying movement seems to have an odd blind spot when it comes to bullying at home.

A new study just out in the journal “Pediatrics” addresses that gap, using findings from a national survey of children and their caregivers. It found that, just like bullying by peers, bullying by siblings causes significant mental distress and worsens the victims’ emotional health. Bottom line:

The authors concluded that parents, pediatricians and the public should treat sibling aggression as potentially harmful, and not dismiss it as normal, minor, or even beneficial, and this message should be included in parenting education.

Corinna Jenkins Tucker, associate professor of family studies at the University of New Hampshire and the paper’s lead author, suggests that it’s time for the new norms that condemn school bullying to stop making an exception for siblings.

Sibling aggression has “generally gone unrecognized and dismissed,” she said in a phone interview. “Our findings suggest that it should not be dismissed and it’s in fact not benign.” Continue reading

Patients’ Joy Over Supreme Court Decision On Gene Patents

Catherine Corman (courtesy)

Catherine Corman (courtesy)

By Cathy Corman
Guest Contributor

My inbox and voicemail were filled with gleeful messages from colleagues, friends, and family Thursday afternoon. My beloved friend Martha put it just right when she called me from Connecticut: “I’m happy for you, and me, too, and everyone else!”

In what may be the single most popular opinion of his Supreme Court career, Justice Clarence Thomas wrote the unanimous decision, released Thursday, that liberates scientists to perform research on and design tests for BRCA 1 and 2. These are the genetic mutations linked to an elevated risk of developing breast and ovarian cancer.

Some of us belong to families where grandmothers, mothers, aunts, and sisters don’t survive into middle age because they develop breast and ovarian cancer. Up until today, the only way we could find out if we’d be likely to share the fate of our doomed relatives was to give our cells to one company — Myriad Genetics.

Myriad claimed its patent prevented any other entity from providing this service, and it set the cost for testing so high that low-income, uninsured, and underinsured women weren’t able to unlock the riddle of their fate.  In addition, it made research into effective cures impossible. Continue reading

How To Divide One Fund? Should Double Amputees Get Double Money?

Should someone who lost two legs in the Boston Marathon bombings get twice as much compensation as someone who lost only one?

This is an admittedly heart-rending quandary. But it’s one that administrators of Boston’s One Fund for marathon bombing victims will have to resolve soon.

Tomorrow (Saturday) is the deadline for applications. Money will go out to victims on July 1, based on the fund total as of July 27. So between July 27 and July 31, One Fund administrator Ken Feinberg and his team will decide who gets how much. Feinberg has set the categories. The question is…how to divide the money?Picture 2

This is a tragic calculation. As Feinberg has said, there is no way to meet all the victims’ needs. But how would you do it? How much more does the family of someone who died deserve as compared to a young woman who lost most of one leg or a man who kept both legs but suffered permanent damage?

We did some back-of-the-envelope math to get the conversation started, using the best numbers we’ve been able to gather thus far.

As of today, the One Fund has just about $48 million, and 155 people have applied.

The largest awards will go to victims who died, are double amputees or those with permanent brain damage. There were four deaths (three at the bombing site and Sergeant Sean Collier) and two double amputees. We don’t know how many survivors have a permanent brain injury. To be cautious, let’s say one. So the total in Category A would be 7. Let’s say we start with $2 million a piece, for a total of $14 million.

The second-highest award will go to survivors who lost one limb. We know of 14. If they get $1 million each, for a total of $14 million, the fund has $20 million left to distribute. Continue reading

Long After Recession’s End, Deep Layoff Scars May Remain

In this June, 2010, photo, Frank Wallace, who has been unemployed since May of 2009, is seen during a rally organized by the Philadelphia Unemployment Project. (AP Photo/Matt Rourke)

(Matt Rourke/AP)

I went back to visit my old parking lot at The Boston Globe this week. For more than six years, I commuted to the Globe along the crawling traffic of the Southeast Expressway, travel mug in hand. But what I remember most about that parking lot is crying in it.

It was 2009. The Globe was in a major financial crisis, like much of the country. Brian McGrory, then the Metro editor, had just called me in to his office to warn me that I was almost certainly about to lose my job.

I held it together in his office, but then when I came out into the parking lot to call my best friend, I felt a wave of shame and insult engulf me. I knew better, but for just that moment, I felt — worthless.

Carey Goldberg stops back at The Boston Globe, where she was laid off in 2009. (George Hicks/WBUR)

Carey Goldberg stops back at The Boston Globe, where she was laid off in 2009. (George Hicks/WBUR)

Well, that’s no surprise, right? Everybody knows it hurts to lose your job. But what has caught me by surprise is that even though my family didn’t suffer much financially from my layoff, and even though I tend to be pretty upbeat and resilient, and even though I’ve landed well, it still hurts. More than four years later, I’m still not fully over it.

At work, I feel hypervigilant – as if nothing I do is ever enough, or good enough, to feel safe. At home, making life plans fills me with anxiety.

Which makes me wonder: Are these feelings normal? And if so, what does that mean for the roughly one-quarter of American workers who were laid off at some point during the recent recession?

These days, the Dow is hitting record highs. Housing is hot again in many spots. More and more, the Great Recession of 2009 is becoming just a bad memory. Except that, like other bad experiences, for many of us it may have left emotional scars that last.

So are we going to end up something like the forever frugal survivors of the Great Depression?

“One of the things you find about depression babies, as we call them — that is, people who came of age in the great depression — is that they retained a characteristic skepticism about good times. They never believed them,” said Prof. Bruce Schulman, an American historian who is chair of the Boston University history department.

“They were the people like my grandparents who always reused teabags. Even when they went out to a restaurant at a prosperous time, to celebrate a great occasion, [they] would take the teabag and drain it out and wrap it up and put it in their purse.” It is a generation, Schulman said, that tries always to be prepared for crisis.

Of course, the depression was far worse than the recent recession. But extensive research shows that whether one-third of the population is out of work or only one-tenth, layoffs at any time can have deep and long-lasting effects.

Harvard Business School professor Sandra Sucher says that though virtually everyone faces tough experiences, layoffs can be an unusually damaging kind of life event.

Harvard Business School professor Sandra Sucher

Harvard Business School professor Sandra Sucher. (Courtesy)

“It approaches my financial health, in the sense of what my income is,” she said. “It approaches and is disruptive to my physical health; it can disrupt my mental health and my sense of self; and I think for so many of us, work is a central part of our identity, and so when that is disrupted, that is actually something that layers on top of all these known effects.”

Let’s begin with the financial impact of a layoff, which Sucher says can persist indefinitely.

“One study of workers displaced in a 1981 recession found that they experienced a 30 percent decline in their income at the time of the layoff,” she said. “Twenty years later, they were still earning 20 percent less than employees who were not laid off.”

Now for health. The stress of a layoff shoots up your risk of high blood pressure and heart disease. Your risk of depression doubles; your risk of alcoholism quadruples; your risk of committing violence or suicide also rises. Continue reading