The mission of Prognosis is to explore the nexus at which healthcare policy meets healthcare practice and how one affects the other. This blog makes readers more aware of the innovations taking place in healthcare delivery, financing and technology and the types of public policies that will encourage further progress.
Healthcare In Focus is a public education initiative of the HLC, created to promote a constructive dialogue about the state and future of American healthcare.
There’s an interesting article this week in the journal Foreign Affairs by Peter Orszag, formerly President Obama’s budget director and now a global banking executive at Citigroup. Mr. Orszag wrote an in-depth retrospective on the development and passage of the new health reform law and what he sees as its strengths and weaknesses in addressing the need to curb healthcare cost growth.
The article, “How Health Care Can Save or Sink America,” covers a panorama of issues, but one of the most striking provisions concerns medical liability reform or, more precisely, the lack of it in the Affordable Care Act. Mr. Orszag calls it the measure’s “biggest substantive shortcoming.”
To critics who say that the current liability climate does little to raise costs, he writes that you have to look beyond Congressional Budget Office estimates and current academic studies. He says, “What this literature largely misses, however, is the fundamental problem with the laws’ standard of ‘customary practice’ – the norm that protects doctors if they can be found to have treated their patients the way most other doctors in the area do. This basis for malpractice creates a strong contagion effect among doctors, because a doctor’s legal liability is minimized by doing what the doctor down the hallway is doing.” In other words, there is a huge multiplier effect found in defensive medicine practices, physicians ordering more tests and procedures than may be medically necessary, because that’s what other doctors are doing to protect themselves against possible litigation, thus becoming the ‘customary practice.’
Mr. Orszag’s remedy is “provide a safe harbor for doctors who follow evidence-based guidelines. Under this approach, a doctor would not be held liable if he or she followed the recommended course for treating a specific illness or condition under guidelines put forward by professional associations such as the American Medical Association or the Institute of Medicine.”
The Healthcare Leadership Council and other organizations concerned with the impact the current liability climate as on both costs and healthcare quality have been exploring a policy direction similar to the one Mr. Orszag outlined in his article. We have been receiving a promising reception from members of Congress intrigued by the possibility of tying liability reform to the usage of health information technology and the practice of evidence-based medicine.
I applaud Mr. Orszag’s candor on the liability issue. He also wrote, “By failing to move forcefully in this direction, the health reform act missed a major opportunity.” I would like to believe the opportunity still exists to build a bipartisan majority on Capitol Hill in favor of common sense liability reforms.
(The link above takes readers to the Foreign Affairs article. You must, however, register with Foreign Affairs in order to view the article in its entirety.)
The last several days have brought good news on multiple fronts in the war against cancer. News stories have spotlighted major strides, including:
· Dr. Vincent Tuohy, an immunologist at the Cleveland Clinic, said he believes he has discovered a vaccine that can prevent breast cancer. If tests go well, Dr. Tuohy noted in the accompanying video, he hopes that a vaccine for women over 40 can be available a decade from now.
· The drugmaker AstraZeneca has experienced good results with a medicine that can attack thyroid cancer. Patients with advanced medullary thyroid cancer who took the drug experienced a 54 percent reduction in the rate at which their disease progressed, compared to those who took a placebo. AstraZeneca said it will file for regulatory approval of the drug later this year.
· A new study from Canada shows that men with prostate cancer have a better chance of stopping the cancer from spreading, and thus increasing their odds of survival, is radiation treatments are used in conjunction with conventional hormone therapies.
Dr. Robert Waller, the former CEO of the Mayo Clinic, used to tell me that medical advances happen so rapidly, attempting to get a handle on all of the new emerging innovations is like trying to drink water from a fire hose. Good weeks like this one, with real progress in the fight against cancer, remind me exactly what Dr. Waller was talking about.
There are a couple of important facts often overlooked in the wake of congressional passage of health reform legislation. One is that, over the next few years, approximately 30 million Americans will be gaining some form of health coverage. There is a great deal of work to do in preparing our healthcare system for that change, in areas like strengthening the healthcare workforce and improving cost efficiency so that higher utilization doesn’t rapidly accelerate costs. Also, we need to keep in mind that the new health reform law is, in many respects, a blueprint on how the healthcare system should be improved. It will take a great deal of private sector innovation and ingenuity to make those improvements happen.
In this video provided by the McKinsey consulting firm, McKesson CEO John Hammergren, who chairs the Healthcare Leadership Council, addresses these issues and explains the role business needs to play in the future of American healthcare.
This morning I had the pleasure of speaking to C.E. Huffman at KTVO TV in Ottumwa, Iowa about the Medicare Part D open enrollment period. It was a good opportunity to inform seniors about Medicare’s prescription drug benefit and to let them know how to find additional information. You can access our full conversation here.
Almost four years after the Medicare Part D prescription drug program went into effect, an overwhelming majority (88 percent) of America’s seniors approve of their individual plan and coverage. In a national survey released this morning by HLC’s nonpartisan Medicare Today coalition, 95 percent of seniors who used their plan and received prescriptions over the past year also reported that their plan has worked well, while 85 percent continue to find their monthly premium to be affordable.
The survey, conducted from October 16-25 by market research firm KRC Research, offers the latest evidence that seniors continue to see the prescription drug program as a success. The annual open enrollment period, in which Americans eligible for Medicare can add, drop or change their prescription drug coverage for 2010, begins on Sunday, November 15th, 2009. Read more
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Almost four years after the Medicare Part D prescription drug program went into effect, an overwhelming majority (88 percent) of America’s seniors approve of their individual plan and coverage. In a national 