Articles Posted in Quality outcome measures

PE-Color-240x300The Republicans haven’t waved a white flag—yet. They may never formally surrender. But the GOP’s seven-year, take-no-prisoners campaign to repeal and replace the Affordable Care Act, aka Obamacare, has foundered. For good?

Political prediction is a knucklehead’s sport. It’s never safe to predict what’s going to happen, especially when unpredictable tragedies rear up like  Sen. John McCain’s brain cancer diagnosis.

No matter. We now know painful truths about the politicians who have sway over our health care—and will continue to do so in vast ways, Trumpcare or no.

IVThree Washington, D.C.-area teaching hospitals have ranked in the lowest-scoring group nationally on preventing infections when their patients are hooked up to central lines, intravenous tubes that supply fluids, medications, and nutrients to those in dire need. Two institutions in the region rated highly.

Consumer Reports deserves credit for its continuing reporting on hospital acquired infections (HAIs), a scourge that in 2011 afflicted 650,000 already ailing Americans and which contributed to 75,000 deaths. The advocacy group says 27,000 patients were felled with central line infections in 2015, with a quarter of these especially sick and frail individuals dying of them. Treating patients for central line infections cost on average $46,000—more than for any other HAI.

The area teaching hospitals that the magazine ranked poorly, based on an analysis of federal data from 2011 to 2015, were: George Washington University Hospital, Holy Cross Hospital in Silver Spring, and Howard University Hospital. The two high-ranking institutions were: MedStar Franklin Square Medical Center in Baltimore and Sentara Norfolk (Va.) General Hospital.

vox ocareAs speculation explodes about what the GOP and the president-elect will or won’t do with the Affordable Health Care Act (aka Obamacare), Medicare, and Medicaid, skeptical citizens would be well-served to learn as much as they can about critical policy concerns. Ask tough questions and be wary of counterfactual contentions. Here are a few prime subjects:

Debunking so-called ‘tort reform’

  • A tip of the hat to the Center for Justice and Democracy at New York University for providing research that debunks what may be a component of the multi-pronged attack on Obamacare: the falsehood that one way to contain rising medical costs is to enact so-called “tort reforms,” especially those that target medical malpractice lawsuits. I’ve written about this canard. These bad policy measures: strip patients of invaluable rights to sue; impose arbitrary, cruel, and unsupported caps on what they can recover from doctors and hospitals that harm them significantly; and fail to curb rising medical costs, no matter how partisans shill to sell them. The center’s new research points out that insurers play a huge role in creating malpractice liability crises. Although they blame malpractice lawsuits for driving up coverage costs and causing physicians to practice “defensive” over-testing and other negative medical practices, insurers, the center’s research shows, actually are at the root of many cost explosions due to their own avaricious practices. That’s because insurers rely on market investments to pump up their premium and capital reserve revenues. They have sent coverage costs skyrocketing in good times and bad to ensure they have money to invest and profit more with Wall Street, or to supplement their reserves when their stock losses mount. Meantime, medical malpractice claims and premiums are at historic lows—certainly nowhere near levels to justify hype about how the health care system would benefit from so-called tort reforms.

spinal cordFederal auditors have found that 80 percent of Medicare spending in a recent year on chiropractic care−some $359 million−was medically unnecessary. The federal insurance program for senior citizens should not have thrown taxpayer dollars at chiropractors to treat strains, sprains, or joint conditions, the Department of Health and Human Services’ Office of Inspector General says.

Its auditors, reporting on 2013 claims, said Medicare should impose limits on how often seniors can receive chiropractic care, which they said became excessive after a dozen visits; after 30 sessions of treatment, the federal watchdogs said, patients were receiving unnecessary care.

The chiropractors’ association denounced the audit and the proposed curbs on their practitioners’ care. The acting director of the Centers for Medicare and Medicaid Services resisted the recommendations for caps on chiropractic treatment, noting the absence of cited evidence and differences in individual patients. The agency noted that it has tightened its rules on chiropractic claims, including requirements soon to take force that will require advance approval for certain kinds of this care.

OdometerHealth care economists have a simple prescription for patients wanting better care: Drive a little farther to a better hospital.

As Austin Frakt writes in the Upshot column for the New York Times, there were measurable and significant survival gains in heart attack patients who chose superior care at hospitals a mile or two farther away. Those improvements were “half as large” as those achieved with “breakthrough technologies,” such as the increased use of stents and clot-busting drugs.

Patients saw similar benefits, albeit at a lesser degree, by going a little farther to high quality hospitals for heart failure and pneumonia, he says, quoting a new research paper still in the works by health care economists from Harvard, the University of Chicago and MIT.

nntModern medicine can get mired in a lot of mumbo jumbo, so much so that it gets daunting for patients and consumers to try to understand something simple but critical: How effective is a therapy that my doctor wants me to have?

Because I’ve written before about the virtue in a clear and decisive figure, the Number Needed to Treat (NNT), I was delighted to see that Stat, the online health news site, has published a piece headlined, “What are the odds your medication will help you get better?”

The article explains that the NNT answers the question:

Government officials typically say the flu shot is about 50-60 percent effective in preventing influenza. We’ve used that number ourselves, as recently as this month in the usual annual promo for flu vaccines. But health care researchers who count actual patients say it’s far, far less effective, more in the range of 1-3 percent.

What’s the difference between the competing numbers? And why is the difference so big? The source of the 50-60% effective number is actually shrouded in mystery; the Centers for Disease Control and Prevention, which uses the number a lot, has no specific source. The best guess is it’s a “relative risk reduction,” which means that if your risk was, say, one in 100 before vaccination, and then was one in 200 after, that’s a drop of 50% if you divide those two numbers (100/200). But in terms of what doctors call “absolute” risk, it’s a drop of only half a percent: from 1% (1 in 100) to 0.5% (1 in 200).

The point is you need to know actual numbers of human beings who are saved from a miserable bout of flu by the vaccine, not just some relative percentage comparison which sounds more impressive than it really may be.

Although the potential for using stem cells to treat various disorders is exciting, the science is in its infancy and the therapy is far from a standard response for managing and curing disease, much less using it in more questionable contexts. But that hasn’t stopped some practitioners and patients from “early adapting” this complex science as if it were the latest smartphone app.

In fact, as a story in USA Today  described, nobody knows if certain stem cell treatments work, or even if they’re legal.

Stem cells, also known as “master cells,” have the potential to develop into any cell found in the human body, and the potential to create an entire organism. That kind of power has attracted the attention of professional athletes desperate to prolong careers threatened by age or injury.

An impressive study published last week strongly suggests that when it comes to a certain kind of breast cancer, early, aggressive intervention has no effect on a patient’s survival 10 years later.

The research in JAMA Oncology reviewed the records of more than 100,000 women. After being diagnosed with ductal carcinoma in situ (DCIS), the women’s overall chances of dying were a little more than 3 in 100 over two decades. Survival rates for women who received treatment beyond a lumpectomy (to remove abnormal cells) were no different from those who had no additional interventions.

The results of the study were widely reported last week. One news source, the Washington Post, wrote, “The findings add to concerns that the ability to detect these lesions through mammograms may be leading to unnecessary mastectomies.”

Bouncebacks are patients who get readmitted to the hospital less than a month after they’ve been sent home. You want to keep the rate low, because too many bounceback admissions means the hospital is discharging patients too soon.

One element of the Affordable Care Act (ACA, or “Obamacare”) now in its fourth year is a review of hospital readmissions, and the imposition of penalties if facilities don’t meet the standards Medicare has established. As reported by KaiserHealthNews.org (KHN), the latest review shows that most U.S. hospitals aren’t measuring up.

A readmission is when a former hospital inpatient must return for care within a month of his or her discharge. Readmissions are one way to measure hospital quality, and this year, 2,592 hospitals will receive less money from Medicare reimbursements as a penalty for a readmission rate that’s too high. The total loss: $420 million government dollars.

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