January 24, 2012
3:40 pm
If you’ve ever watched the movie “The Sixth Sense,” you see what a talented director and writer can accomplish by withholding critical information from the audience. In that movie (and, no, I’m not going to spoil it if you haven’t seen it), M. Night Shyamalan holds back an essential fact about Bruce Willis’s main character until the very end of the film. When that fact is revealed, it changes the entire context of what we thought we knew about the story.
What works well, though, in the cinema isn’t necessarily a sound methodology when it comes to public policy matters that affect lives. Transparency is public matters is virtually always a good thing, but when the practice of transparency reveals facts without context, it can be counterproductive.
Dr. Thomas Stossel, a professor of medicine at Harvard Medical School, discussed this issue in a Wall Street Journal op-ed this week, “Who Paid For Your Doctor’s Bagel?” In his op-ed piece, he discusses the Physicians Payment Sunshine Act, a new law that will require medical innovation companies to disclose any transfer of value to physicians. The Centers for Medicare and Medicaid Services (CMS) has recently issued draft guidelines for implementation of the new law.
Again, in principle, this type of transparency is a good thing. But when the new law results in a list of consulting fees and other payments made by pharmaceutical and medical device companies to physicians, there will be a piece of the puzzle still missing. What is the purpose of that exchange beyond a minimalist bureaucratic definition such as “consulting fee?” What was the impact for patients and for the current and future practice of healthcare? Without this context, negative inferences can be made about any exchange of value.
As Stossel wrote in the Journal, “The media already exploit disclosures….to demean physicians compensated by royalties from useful inventions that they license to companies, or who were paid consulting fees for advice concerning the optimal use of products, or for educating other physicians about products.”
The fact is that collaborations between physicians and industry have led to some of the most important medical breakthroughs of the last several decades. Physicians help guide industry on how to make new innovations beneficial for patients. Companies train physicians on the optimal use of new drugs and devices. This sharing of knowledge is essential to the advancement of healthcare.
We’ll be discussing this issue in greater detail in the months ahead. HLC launched an initiative called the National Dialogue for Healthcare Innovation and, through this effort, multiple organization representing healthcare providers, health industry sectors, academia and patients have been developing a consensus set of principles to help guide future physician-industry collaborations. More to come.
December 15, 2011
9:46 am
If there ever seemed an issue, in today’s political environment, upon which Democrats and Republicans would never meet in the middle, it is Medicare reform. This is always particularly true in the months leading up to an election. It’s just too easy to portray any new idea to make the Medicare program more affordable or sustainable as a dangerous threat to vulnerable seniors.
That’s why it’s impossible to overstate the significance of Senator Ron Wyden (D-OR) and Representative Paul Ryan (R-WI) reaching across the aisle and joining together to offer a meaningful Medicare reform plan. This development has probably caused no small amount of heartburn in some political and campaign planning circles, but for taxpayers, future Medicare beneficiaries and the program itself, this is a very positive step.
We’re not going to try to comprehensively analyze the Wyden-Ryan plan right now in this space. Both lawmakers have, in fact, said that they won’t offer legislative language until after the 2012 elections. In broad strokes, though, the concept offers a sustainable path for Medicare’s future, offering beneficiaries a fixed federal contribution that can be used to acquire coverage from either conventional fee-for-service Medicare or a selection of competing private plans. As we’ve said at the Healthcare Leadership Council, in advocating this type of approach, competition will drive greater innovation, quality and value.
The news today, though, is not the details of the plan, but the fact that Ron Wyden and Paul Ryan have opened up a crack in the previously impenetrable wall between the two parties on this issue. If this gradually moves us to a place where we have more substantive discussions about how to maintain a viable Medicare program, and fewer 30-second “Mediscare” TV ads, then these two have made an incredibly valuable contribution.
December 07, 2011
1:15 pm
There are numerous concerns these days about the nation’s supply of medical professionals to meet America’s growing elderly population as well as the millions of citizens who will gain health coverage when the Affordable Care Act is fully implemented. How will the healthcare workforce meet this rising patient demand?
We received good news this week regarding the supply of nurses. A RAND study shows that the number of young nurses – registered nurses between the ages of 23 and 26 – has grown by 62 percent between 2002 and 2009. This reverses a course projected back in 2000 by a study in the Journal of the American Medical Association, which said the U.S. would have a 20 percent shortfall in the supply of nurses by 2020.
Dr. Peter Buerhaus of the Vanderbilt School of Nursing (Colleen Conway-Welch, the nursing school’s dean, is a Healthcare Leadership Council member) was one of the authors of the earlier JAMA study and told Nashville Public Radio that he’s no longer worried about a nursing shortage. He credited more colleges adding nursing programs and successful initiatives raising awareness about personnel shortages and job openings in the nursing field.
Certainly programs like Johnson & Johnson’s Discover Nursing initiative have been extremely helpful in both pointing out the employment opportunities, available scholarships and job satisfaction in the nursing field.
This doesn’t ease all of our concerns about healthcare workforce shortages, but at least it’s a solid and important step in the right direction.
December 06, 2011
12:53 pm
Vermont is number one. Mississippi is number 50. But, truth be told, every single state has reason for concern.
The United Health Foundation has issued its annual “America’s Health Rankings” report, showing a state-by-state ranking in overall population health. The striking news this year was not that the New England states occupied six of the top 10 positions, but that the nation as a whole is not faring well.
The United report card showed zero overall improvement in America’s health status over the past year. That’s the first time in two decades that our health has showed no upward mobility whatsoever. In fact, over the past decade, the rate of improvement in the nation’s health status is 69 percent less than it was in the 1990s.
It doesn’t take much analyzing to find out the reason. Obesity is up considerably and diabetes cases are escalating in number. This concurs with what the Centers for Disease Control and Prevention has been telling us about chronic disease trends.
As Reed Tuckson of the United Health Foundation board said, the United States is facing a “tsunami of preventable illness.”
The good news is that there are initiatives being developed throughout the country to keep communities and workforces in better health and prevent the onset of chronic disease. The Healthcare Leadership Council has chronicled a number of these in its HLC Wellness Compendium. We shared this document with key staff members on Capitol Hill at a briefing last week.
The better news will occur when we see policymakers taking these successful examples and finding ways to extrapolate them to help larger populations.
We can still hope that, in the future, when states are competing for placement on the United rankings, that the entire competition will be taking place on a higher plane of healthiness.
November 22, 2011
11:40 am
If hand-wringing and finger-pointing actually generated dollars, Washington, DC would probably be able to solve the federal deficit problem today. With ‘super committee’ negotiations collapsing and members of the Joint Select Committee on Deficit Reduction formally admitting that they won’t have recommendations to submit by the November 23 deadline, the Beltway blame game is in full swing. Kaiser Health News has a good summary of the news coverage taking place today – with links.
Worries about whether there will be meaningful spending cuts are premature. The November 23 date was an artificial deadline anyway. With the automatic sequestration cuts not taking place until 2013, Congress has an entire year to figure out $1.2 trillion in savings alternatives.
That’s not to say there aren’t serious missed opportunities in the ‘super committee’s’ failure to act. With the nation’s focus on their deliberations, this was an ideal time to launch a national debate on how to reform Medicare, make the program more cost-efficient and more sustainable for the long run. That public debate didn’t happen.
Sure, there were some ideas on the table for reforming entitlement programs. Some, like raising the Medicare eligibility age, warrant serious discussion. There were also reportedly discussions, though, focused on the tired, old approach of cutting payments to Medicare providers (and pretending this doesn’t affect beneficiaries’ access to quality care and medical innovations.)
What was lacking was a serious conversation about the issue raised by former Clinton budget director Alice Rivlin and former U.S. Senator Pete Domenici in their testimony to the Select Committee. Structural changes to the Medicare program, which the two experts said is essential in order to address the nation’s debt crisis, didn’t get off the launching pad.
It seems strange to me that there would be such political intransigence in some quarters to the concept of reforming Medicare to give beneficiaries a greater degree of choice in their health coverage. It’s a structure that has worked well with the Federal Employees Health Benefits Program and the Medicare Part D prescription drug benefit, and it’s going to be utilized in the Affordable Care Act’s state health insurance exchanges.
Yet, when it comes to Medicare, there is a greater willingness by some to simply cut dollars from the program, thus undermining both quality and access, than to create a role for the private sector in driving value and cost-efficiency.
The ‘super committee’s’ failure to take up the cause of Medicare reform was a missed opportunity. It will come back around again, though. As Dr. Rivlin and Senator Domenici accurately point out, you can’t fix America’s debt problem without it.
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