AG Healey Weighs In Against Partners Acquisition Of South Shore Hospital

Attorney General Maura Healey, at WBUR (Robin Lubbock/WBUR)

Attorney General Maura Healey, at WBUR (Robin Lubbock/WBUR)

Updated 7:15 p.m.

BOSTON — On her first Monday morning as Massachusetts attorney general, Maura Healey stepped into a fight that may well continue through her first term. Healey said, in short, that Partners HealthCare should not be allowed to acquire South Shore Hospital and that she would sue to block the acquisition.

Her predecessor, Martha Coakley, had the option of suing Partners, but chose instead to negotiate concessions. In a deal filed in court by Coakley, Partners would be able to add at least three more hospitals — South Shore and two owned by Hallmark Health — but would have to keep price increases in line with inflation for six and half years and cap the size of its physician group for five years.

Healey raised several concerns about the agreement in a brief filed in court Monday. She suggests that the physician cap is too lax and that the terms of the deal are too short. When the deal expires, “Partners may wield market leverage that is greater than its current, already significant market leverage,” Healey said.

Healey said she wants proof that Partners has figured out how to use its size to save money.

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Hundreds Mourn Surgeon Fatally Shot At Boston’s Brigham And Women’s Hospital

A woman wears a button honoring Michael Davidson at his funeral service Friday. (Jesse Costa/WBUR)

A woman wears a button honoring Michael Davidson at his funeral service Friday. (Jesse Costa/WBUR)

The cardiac surgeon killed inside Brigham and Women’s Hospital in Boston this week was laid to rest on Friday.

More than a thousand people gathered at Temple Beth Elohim in Wellesley Friday to pay their respects to Dr. Michael Davidson, who was fatally shot by a patient’s son on Tuesday.

Some wore buttons with Davidson’s initials, MJD, in a heart. Six buses brought people from Brigham and Women’s, and when Rabbi Joel Sisenwine asked all the doctors and caregivers to rise, at least half the room stood.

Several colleagues and friends of Davidson’s spoke, as did Davidson’s father, Robert, a well-known cardiologist at Cedars-Sinai Medical Center in Los Angeles. He spoke of the hopeful flight he and his wife took to Boston Tuesday after they received news that their son had been shot — hopeful because Davidson’s parents thought when they boarded the plane that he would live.

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How Are We Today? Study Lets Patients Help Write Medical Notes, Google Doc Style

(Life Mental Health/Flickr via Compfight)

(Life Mental Health/Flickr via Compfight)

First, beginning about five years ago, came the OpenNotes study. Researchers found that when they gave patients access to their primary care doctors’ written notes, the patients said they got better at taking care of themselves, particularly at taking medications correctly. And contrary to some doctors’ fears, the notes did not tend to cause offense or avalanches of questions.

“OpenNotes” caught on; Some 5 million patients’ records around the country now use it.

Then came the next bold move: The researchers, centered at Beth Israel Deaconess Medical Center, launched a pilot program to open some psychiatric notes to selected patients. (The journal headline: Let’s Show Patients Their Mental Health Records. Our headline: What Your Shrink Thinks.)

And now, the open records movement is moving beyond transparent, to interactive. That is, what if you could not just see your doctor’s medical notes but actually comment on them and contribute to them? As you do, say, when you collaborate online with colleagues on a project in Google Docs?

That’s the next step, says Jan Walker, co-director of the “OpenNotes” project and a researcher at Beth Israel Deaconess and Harvard Medical School. With a new $450,000 grant from The Commonwealth Fund, researchers plan to develop and test “OurNotes,” an interface that will invite patients to contribute to their own medical notes.

Our conversation, edited:

Given the self-obsessive behavior of some people I know who use Fitbits and other health trackers, I think if I were a doctor I’d fear a huge deluge of data into my patients’ health records: “I took 6,000 steps and slept 6:27 hours…” How do you address that?

Jan Walker: One of the frontiers here is making decisions about what data is really paid attention to. As we invite patients to contribute to their records, as we invite patients to upload data from home devices into their records, there are going to be many new inputs of data into the medical records, from technologies that probably don’t even exist yet.

For clinicians, this can look like such a flood of data coming toward them that it’s impossible to pay attention to, to distill it and act on it, and be responsible for understanding everything that’s coming in. So one of the interesting parts of this research is figuring out how to highlight important things for clinicians, and let the rest just be stored.

We will face some of that with this project; perhaps we will be able to have patients flag things they think are important for doctors to see right away, versus just things that are reminders to themselves or things they want to have in the documents.

So will it be kind of like editing with someone on a Google doc, where you can see who did what?

We don’t know yet but we’re thinking about things exactly like that.

What are some examples of uses you imagine?

OpenNotes co-director Jan Walker (courtesy)

OpenNotes co-director Jan Walker (courtesy)

If you’re a patient, you might have gone to the doctor with an infection and been given antibiotics. So you might write down in this record when your symptoms abated or how you did with the antibiotics.

Similarly, you might read in your notes that the doctor reminded you to exercise, and you might keep track of your exercise regime to discuss that with your doctor at the next visit.

Or, in between visits, you may think of things that you want to talk to your doctor about on the next visit, and you would, in essence, set an agenda for yourself so that when you get to that visit, everything gets covered.

And the doctor could look at your agenda beforehand and be more informed, instead of looking things up on the fly?

Exactly. If you can set an agenda before you get to the visit, it gives the doctor a chance to prepare.

Another possibility would be to work with the clinician actually during the visit to write this note. Perhaps the clinician starts the note while you are still sitting there in the office, and you look at what’s being written, you comment, you add, and so it becomes almost a co-authored note.

Yet another use of this interactive feature would be to raise questions about things you think might possibly be in error. Continue reading

Laughing Gas For Labor Pain May Be Regaining Popularity In U.S.

ABC News reports a resurgence in the use of laughing gas for labor pain. (Not to toot our own horn, but we reported this back in 2010 here at CommonHealth and did a podcast on it in 2013.)

ABC suggests the practice may be gaining popularity since 2011, when “the U.S. Food and Drug Administration approved new nitrous oxide equipment for delivery room use.”

Quoting Dr. William Camann, director of obstetric anesthetics at Brigham and Women’s Hospital in Boston, the ABC piece continues:

labor pain

“Maybe 10 years ago, less than five or 10 hospitals used it [for women in labor],” Camann…told ABC News. “Now, probably several hundred. It’s really exploded. Many more hospitals are expressing interest.”

He added the gas popular in dentists’ offices has an “extraordinary safety record” in delivery rooms outside the U.S. But more studies are needed to confirm its safety, other doctors say. Continue reading

Trouble With State Health Connector’s Call Centers Frustrates Insurance Seekers

Update at 9:17 p.m.: Gov. Charlie Baker has extended the deadline for signing up for coverage:

Original post:

Frustration with the state’s Health Connector is mounting.

Today (Friday) is the deadline for coverage that begins Feb. 1, but an untold number of residents say they’ve hit roadblocks while trying to enroll and pay for a plan. The problem at this stage is not so much the new website — it’s the call centers. Continue reading

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Gov. Baker Names 2 Top State Health Care Officials

Gov. Charlie Baker has tapped two top health care officials.

Baker announced Thursday that Louis Gutierrez will serve as executive director of the Massachusetts Health Connector, which oversees the state’s health insurance marketplace and website.

Baker also appointed Daniel Tsai as assistant secretary for MassHealth, the state’s Medicaid program.

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CDC: Risks Loom As Many Women Of Child-Bearing Age Are Prescribed Painkillers

Source: CDC

Source: CDC

The U.S. Centers For Disease Control and Prevention reports that many women of child-bearing age (notably, women on Medicaid) are taking opioid pain medications and that these drugs taken during pregnancy can increase the risk of birth defects.

According to the agency’s latest Morbidity and Mortality Weekly Report:

During 2008–2012, more than one fourth of privately insured and more than one third of Medicaid enrolled reproductive-aged women (15–44 years) filled a prescription for an opioid from an outpatient pharmacy each year. Prescription rates were consistently higher among Medicaid-enrolled compared with privately insured women.

The most frequently prescribed opioids, says the CDC, were hydrocodone, codeine and oxycodone.

The report details why early exposure is particularly risky:

“The development of birth defects often results from exposures during the first few weeks of pregnancy, which is a critical period for organ formation. Given that many pregnancies are not recognized until well after the first few weeks and half of all U.S. pregnancies are unplanned, all women who might become pregnant are at risk.”

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Kin: Man Who Killed Brigham Doctor Had Blamed Him For Mother’s Death

Brigham and Women's Hospital staff embrace after a ceremony remembering Dr. Michael Davidson on Wednesday. (Robin Lubbock/WBUR)Brigham and Women's Hospital staff embrace after a ceremony remembering Dr. Michael Davidson on Wednesday. (Robin Lubbock/WBUR)

Brigham and Women’s Hospital staff embrace after a ceremony remembering Dr. Michael Davidson on Wednesday. (Robin Lubbock/WBUR)

A man who walked into a leading Boston hospital, asked for a cardiac surgeon by name and fatally shot him outside an examination room had been upset about his mother’s death and had blamed the doctor for it, relatives said. Continue reading

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Colleagues Mourn Surgeon Fatally Shot At The Brigham

Staff at Brigham and Women’s hospital Wednesday were mourning the surgeon who was shot and killed Tuesday by the son of a former patient. As WBUR’s Fred Bever reports, Dr. Michael Davidson was remembered both for his skills as a surgeon and his rich personal life. Listen to his full report above.

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Worcester Telegram: Alleged Brigham Shooter Had Complained About Past Medical Bills

Flowers are left outside the Brigham in honor of the slain Dr. Michael Davidson. (Robin Lubbock/WBUR)

Flowers are left outside the Brigham in honor of the slain Dr. Michael Davidson. (Robin Lubbock/WBUR)

Stephen Pasceri, the 55-year-old Millbury man who police say shot and killed Brigham and Women’s Hospital surgeon Michael Davidson and then himself, had complained in the past about medical bills, the Worcester Telegram & Gazette reports here.

It writes today:

Mr. Pasceri, in 2012, told Telegram & Gazette columnist Dianne Williamson that he was frustrated with an $8,100 bill that his mother received after his father died from a heart attack. He sent copies of the bills to then-Sen. John F. Kerry and U.S. Rep. James P. McGovern, he said, because he believed Medicare was being overcharged by hospitals. His mother, who said in 2012 that she was making payments to UMass Memorial Medical Center in Worcester, died in November.

The Boston Globe reports that Pasceri “‘had some issue’ with prior medical treatment of his mother at [Brigham and Women’s], said Superintendent Robert Merner, head of the Bureau of Investigative Services. Marguerite E. Pasceri died Nov. 15.”

The Globe also reports that Pasceri’s brother, Gregory, believes “something snapped” when Pasceri got new information recently about their mother’s death. She developed complications after surgery at the Brigham, he told the Globe.

That 2012 Telegram column by Dianne Williamson was headlined, “A Beloved Dad Passes, A Bill Lingers,” and includes this:

Some of the charges in the itemized bill from UMass include $1,928 for the emergency room; $645 for an echocardiogram; $1,462 for CPR; $454 for the doctor’s visit; and $2,149 for the ambulance ride up Belmont Street. As part of its Prompt Pay Discount Program, UMass offered to shave 20 percent from the bill if she paid it immediately, but Mrs. Pasceri lives off Social Security and was unable to take advantage of the offer. Continue reading

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