Action For Better Healthcare

A forum to identify, discuss, confront, and propose solutions to complex non-profit healthcare issues

Is Obama over promising on healthcare?

An interesting perspective written by Paul Levy

I admire the President and really hope a healthcare bill is passed by Congress, but I wonder if his overstatement of what the bill does might ultimately cause him to fail. Here’s the latest, as reported in the New York Times:

Boiling down his proposal to a few sentences, Mr. Obama asked, “How many people would like a proposal that holds insurance companies more accountable? How many people would like to give Americans the same insurance choices that members of Congress get? And how many would like a proposal that brings down costs for everyone? That’s our proposal.”

Is that really the proposal?

As for holding insurance companies more accountable, a number of state insurance commissioners have their doubts, at least with regard to federal regulation of premium rate levels.

Will we have the same insurance choices as members of Congress? Well, maybe to the extent that they can choose from a number of plans, but that is not the full set of benefits to which they are entitled.

And, as for bringing down costs, every person in the industry knows that is just not true. David Brooks explains why in his op-ed.

From the beginning, I pointed out that Mr. Obama was over-promising when he was offering (1) a reduction in healthcare costs; (2) an increase in access for people currently uninsured or under-insured; and (3) maintaining choice for people in their selection of doctors and hospitals.

Opposition to Mr. Obama’s plan is often characterized as a politically motivated attack from the Republicans. Certainly, some of that is true. But some portion of the opposition also arises from this kind of overstatement, which in turn generates mistrust or at least concern among educated members of the public.

Mr. Obama is betting, though, that his energy and passion will carry the day in motivating members of Congress in his own party to muster enough votes.

Paul Levy is president and CEO of Beth Israel Deaconess Medical Center in Boston
He blogs regularly at Running a Hospital


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Hospital executives tell patients - “Get a second opinion”

By Kester Freeman
Former CEO, Palmetto Health 

There seems to be a misconception on the part of some patients out there. These patients think if they ask for a second medical opinion, it will offend the doctor they are currently seeing who is managing a particular health condition for them.

Patients seem reluctant to ask for these second medical opinions, when they really need to be getting a second set of eyes to evaluate potential treatment options including surgery.

At a recent meeting with former hospital CEOs who contribute to the Action for Better Healthcare blog, the consensus among our team is that many patients need to feel more comfortable with seeking out second medical opinions. Patients need to be better informed about all their healthcare options.

“I tell my friends they should get a second opinion,” says Ed Howe, former president and CEO of Aurora Health Care. “If your doctor appears offended or in fact says that is the case, you should probably get another doctor,” explains Mike Stephens, former CEO of Hoag Memorial Hospital Presbyterian. Consider it a major red flag.

Getting a second opinion can offer you additional options for treating a medical condition. Maybe the first doctor does not offer this particular treatment option. Maybe it is new or maybe it is offered through a clinical trial that is only offered at a certain hospital, adds Don Ammon, former CEO of Adventist Health System West.

“Most doctors I know are really not offended when their patient seeks a second opinion,” says Howe. “Many patients just think this will automatically be the case, when in fact it is not.”

I agree. In fact, many doctors expect that their patients will get a second opinion and will help their patients do so.

Some doctors may have a conservative approach. Others may be more aggressive. A second opinion may reveal a treatment option that has not been mentioned to you before.

Here are some tips from the American Heart Association about how to get another medical opinion:

  • Your doctor may refer you to other doctors or specialists
  • Ask friends or relatives who’ve been treated for the same condition who treated them
  • Ask for a list of approved doctors from your medical insurance company or your employer’s health plan administrator
  • Call your local medical society or check the American Medical Directory

As a patient, think of a second opinion as a safeguard you give yourself. In some cases you may have to pay out of pocket, but isn’t the peace of mind worth it?

Let us know what you think. Share your comments below.


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Quality healthcare and lower hospital costs can coexist

By Jennifer Mitchell
Editor, Action for Better Healthcare

It is possible to have quality healthcare for patients and at the same time have a hospital be able to control and even cut costs. This is happening in various hospitals across the country, but you just don’t always hear about it in the news.

As a patient, you should care about hospitals being succcessful when it comes to cutting costs. Why? Because as “the patient” the costs ultimately trickle down to you. The report below offers a simple example of a hospital that is finding ways to save millions of dollars, but is not cutting back on their quality of care. Take a look and post your comments below. Join the discussion.


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One Response to: “ Quality healthcare and lower hospital costs can coexist ”

  1. # 1 michael stephens Says:

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    The experience at Intermountain Healthcare reconfirms what has been demonstrated in other integrated health delivery systems. If ... ...

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Hospitalists and the patient experience

By Mike Stephens
Former CEO, Hoag Memorial Hospital Presbyterian 

The growing shortage of general internal medicine physicians is occurring at a time when an aging population will require more, not fewer, to provide primary care. It’s estimated that fewer than 20 percent of those physicians who complete a general internal medicine residency intend to begin an active practice as general internists.

Instead, many pursue continued training in various medical subspecialties or they become hospitalists and practice inpatient medicine at major hospitals across the country.

Those who choose to practice as “hospitalists” are either employed by a hospital or join a hospitalist group that contracts with a hospital.  Hospitalists are in the hospital at all times of the day and night. They provide overall medical management for patients who do not have a physician or for those who are admitted by other medical subspecialists who request that hospitalists assume responsibility for the overall medical management and discharge of the patient.

I know of a hospital where 90 percent of the patients have been assigned to the care of a hospitalist.

The advantages to the hospital, the nursing staff and other physicians are obvious.

Hospitalized patients needing to be seen by a physician can do so more quickly than waiting for the patient’s physician to arrive from the office.  Patients who do not have a personal physician can be admitted immediately rather than wait for an on-call physician to arrive.  And for the nursing personnel, there is always a hospitalist physician available to assist and advise a nurse with a patient problem.

For physicians, who assign their patients to the hospitalist, it means more available time to see patients in the office without the interruption of attending to a hospitalized patient.

For some patients, seeing a hospitalist for the first time in the hospital can be disconcerting and surprising. There is a concern the hospitalist will not be as familiar with all of the patient’s medical information compared to their own primary physician. In addition, the continuity of care between discharge from the hospital and the return to the primary physician may not be optimal.

If you’ve been a patient in a hospital and had your medical care handled by a hospitalist, what has been your experience? Do the advantages outweigh the disadvantages as you perceive them? Do you view this major change in hospital inpatient care positively or negatively? I’d be interested in your comments. Please post them below.

 

Other popular posts:
Former hospital CEO offers advice to Obama


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2 Responses to: “ Hospitalists and the patient experience ”

  1. # 1 Don Ammon Says:

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    This is also happening is small and medium size hospitals. I believe that hospitalists generally improve the care because of thei... ...

  2. # 2 Yvonne Stratton, MD, MMM Says:

    [+]

    I have had very negative experiences with hospitalists. The idea was not only to provide timely care in the hospital but to creat... ...

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Infection rates drop as Michigan hospitals use checklists

American Medical News has written an informative article regarding how checklists are helping to lower infection rates in a group of hospitals in Michigan.

While checklists are not the final answer when it comes to decreasing infection rates, experts such as Peter Pronovost, MD, PhD and Atul Gawande, MD, MPH, explain how checklists are certainly impacting the quality of care. You can read the entire story by clicking here.

The article takes a look at catheter-related bloodstream infections:

A group of Michigan hospitals implemented a relatively simple set of interventions, including a checklist of infection-control practices, and their average infection rate dropped 66 percent after one year. The median central-line infection rate fell to zero per 1,000 catheter days, compared with a national average of 5.2. The achievement was due to hand washing, using full-barrier precautions when inserting central venous catheters, cleaning the skin with chlorhexidine, avoiding the femoral site for insertion and removing unnecessary catheters.

What do you think about the idea of checklists? Are they helpful?


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One Response to: “ Infection rates drop as Michigan hospitals use checklists ”

  1. # 1 michael stephens Says:

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    I remember some initial reactions from physicians relative to check lists. I got the impression many believed check lists were fo... ...

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