“…a preliminary analysis of H.R. 3962, the Affordable Health Care for America Act…”

(PDF)

http://www.cbo.gov/ftpdocs/106xx/doc10688/hr3962Rangel.pdf

…and the text of the bill itself, for those of you who have plenty of time on your hands:

http://docs.house.gov/rules/health/111_ahcaa.pdf

http://www.createhealthcarevalue.com/blog/post/?bid=107

What do providers need to start preparing for?

Here is my opinion about the core elements of the 5 bills presently in the Senate and House and what it may mean for doctors and hospitals

by John S. Toussaint, MD
President and CEO, ThedaCare Center for Healthcare Value. He writes:

…I would estimate that a 2-5% productivity improvement (depending on inflation) per year is the minimum to survive financially moving forward…

Those of you who have worked in hospitals or insurance understand the magnitude of that statement and the difficulty that organizations will have realizing that sort of sustained improvement. I had the pleasure of meeting this individual both during a symposium in Iowa City in 2007 and during a site visit last year at the ThedaCare in Appleton, WI. Even more impressive than Toussaint’s dedication to performance improvement was the level of staff buy-in. World class.

Find more about his recent article in Health Affairs here:

http://www.createhealthcarevalue.com/blog/post/?bid=10

Barnes and Noble Nook. Powered by Android, so apps are a possibility in the future…plus Wal-Mart’s now pricing books at $9.99, so titles should drop in price in the future. DRM details are sketchy and Apple’s supposed to be making a tablet, so I’ll wait this one out until more details emerge–but there’s no doubt it’s a much more exciting device than the Kindle.

No tailgating for us this weekend. Instead, dehydrating habaneros and jalapenos…and pitching yeast for two 5 gallon batches of cider:

• Applecart Orchard (locally produced) with Wyeast 4766 Cider strain;
• Musselman’s “Premium, not from concentrate” (produced who knows where?) with White Labs WLP775 English Cider

Note how the filtration process (intended to improve appearance and shelf-life, I suppose) has removed particulates from the Musselman’s juice. The local juice appears lighter in color–but, in reality, the Musselman’s juice is simply much less turbid. It will be interesting to see how this treatment impacts the flavor of the finished product. In retrospect, I wish I would have controlled this experiment by using the same yeast for both batches.

If you’re interested in the impact of various yeast strains, see this post for more on the topic:

http://forum.northernbrewer.com/viewtopic.php?f=9&t=64821&hilit=experiment#p596948

This guy has WAY too much time on his hands…

…bone dry. High proof. Strong aroma. I’m more than happy with how it has turned out.

I added the following adjuncts to the (5 gallon) bottling bucket of decanted cider:

• 0.75 cups of dextrose (corn sugar) for priming, and…
• 1.75 teaspoons of dry stevia extract for sweetness. It tastes 300 times sweeter than sucrose, so not much is needed.

…I’ll try one on 10/31 and post the results. Originally, I would have been happy to settle for anything other than vinegar, but with the fantastic flavor I noticed in the sample I took pre-bottling, I’m now hoping for total excellence!

http://googleresearch.blogspot.com/2009/06/google-fusion-tables.html

Before:

After:

…plus lots of collaboration functionality. It’s apparently very slow to compute with large data sets, but I can’t wait to see where this goes. It should be great!

Bumrungrad International is one of the largest destinations for international healthcare services in the world. Bumrungrad Group CEO Curtis Schroeder has given several interviews, during which he discusses the business model, prospects for growth, and competitive advantages that exist within the field.

http://health.scribemedia.org/2008/01/17/chw-medical-tourism-bumrungrad-international/

…from HealthDot.org (scribemedia): Ruben Toral sits down with Curtis Schroeder, CEO Bumrungrad International, a Bangkok Thailand hospital that has been around for 28 years and was one of the early movers in medical tourism.

http://www.medtripinfo.com/audio/by/title/interview_with_bumrungrad_s_group_ceo_curt_schroeder

…from MedTripInfo.com: Interview with Bumrungrad’s Group CEO, Curt Schroeder (Posted December 4th, 2007 by David Williams)

Here’s a summary of public opinion polls that I’ve found online. Apparently, neither side seems to be too concerned with painting an accurate picture of the general consensus at this point in the game.

Understanding How Americans View Health Care Reform

Robert J. Blendon, Sc.D., and John M. Benson, M.A.

FREE full-text HTML online at: http://healthcarereform.nejm.org/?p=1424?query=TOC

Full-text PDF at: http://content.nejm.org/cgi/reprint/NEJMp0906392.pdf

Although most Americans are satisfied with their current arrangements, a majority say they are worried (”very” or “somewhat”) about having to pay more for their health care or insurance coverage and are concerned that the quality of care they receive will get worse. Also, a majority of insured Americans say they are worried about losing their coverage (KFF July 7). In addition, nearly half of Americans believe that their federal income taxes are already too high (Gallup April 6).

The public mood today about health care is very similar to what it was at the outset of the 1993 health care reform debate. In 2009, as in 1993, health care is seen as the second-most-important issue for government action, after the economy (Harris May 11).² More than three fourths of Americans support a major change in the health care system (CBS July 24),² and more than half favor enactment of a national health insurance program (HSPH June 17).² The biggest difference is that President Barack Obama has a much higher approval rating than President Bill Clinton did (58% vs. 38%) (CBS July 24 and CBS Aug. 2), which suggests that Obama has more opportunity for leadership.

—

Health Care Reform 2009 at healthcarereform.nejm.org

Gregory D. Curfman, M.D., Stephen Morrissey, Ph.D., Debra Malina, Ph.D., and Jeffrey M. Drazen, M.D.

Editorial online at: http://healthcarereform.nejm.org/?p=1268?query=TOC

Why We Must Ration Health Care

Michael E. Porter, Ph.D.

HTML full text: http://content.nejm.org/cgi/content/full/NEJMp0904131

PDF full text: http://content.nejm.org/cgi/reprint/361/2/109.pdf

Kaiser Health Tracking Poll, June 2009

    http://www.kff.org/kaiserpolls/upload/7924.pdf

A side-by-side comparison of the leading comprehensive reform proposals from the Kaiser Family Foundation:

http://conyers.house.gov/_files/SidebySideComparisonofMajorHealthCareProposals.pdf

H.R. 676:
http://www.pnhp.org/publications/united_states_national_health_care_act_hr_676.php

National Health Insurance Act Passes

By S. Allende

Published: July 4th, 2009

http://www.nytimes-se.com/2009/07/04/national-health-insurance-act-passes/

Summary from Conyers (D-MI):

http://conyers.house.gov/_files/HR_676_Summary111th.pdf

As introduced:

http://conyers.house.gov/_files/HR676111th.pdf

THE HOUSE TRI-COMMITTEE HEALTH REFORM DISCUSSION DRAFT SUMMARY

A summary:

http://edlabor.house.gov/documents/111/pdf/publications/DraftHealthCareReform-BillSummary.pdf

Rationale:

http://edlabor.house.gov/documents/111/pdf/publications/DraftHealthCareReform-12ReformHelpFamilies.pdf

Some stats:

http://edlabor.house.gov/documents/111/pdf/publications/DraftHealthCareReform-CostofInaction.pdf

The full text (850 pages!):

http://edlabor.house.gov/documents/111/pdf/publications/DraftHealthCareReform-BillText.pdf

Hardin Library for the Health Sciences

• Institute of Medicine. (2001). Crossing the Quality Chasm. Washington D.C.: National Academy Press.
• Malcolm K. Sparrow. (2000). License to Steal–How Fraud Bleeds America’s Health Care System. Boulder: Westview Press (Perseus).
• Robert H. Blank and Viola Burau. (2007). Comparative Health Policy, 2nd ed. New York: Palgrave/Macmillan.
• Samuel Levey and N. Paul Loomba. (1984). Health Care Administration–A Managerial Perspective, 2nd ed. New York: Lippincott.
• Jacques Van Der Gaag et al. (1982). Economics of Health Care. New York: Prager.
• Andrew Green. (2007). An Introduction to Health Planning for Developing Health Systems, 3rd ed. New York: Oxford University Press.
• Milton I. Roemer. (1985). National Strategies for Health Care Organization. Ann Arbor: Health Administration Press.

    MICHAEL NIELSON: Is scientific publishing about to be disrupted?

http://michaelnielsen.org/blog/?p=629

via CShaffer (fb via twitter)

Exploring the Harmful Effects of Health Care

by Charles M. Kilo; Eric B. Larson

JAMA. 2009; 302:89-91.

http://jama.ama-assn.org/cgi/reprint/302/1/89?ct

State Licensure and Professional Monopolies in Medicine

by Rebecca A. Harris

JAMA. 2009; 302:35-a.

http://jama.ama-assn.org/cgi/reprint/302/1/35-a?ct

both via JAMA Topic Collection Alert

]]> http://hefel.wordpress.com/2009/07/01/readings-for-today/feed/ 0 hefel http://hefel.wordpress.com/2009/06/26/milliman-medical-index-2009/ http://hefel.wordpress.com/2009/06/26/milliman-medical-index-2009/#comments Fri, 26 Jun 2009 16:33:42 +0000 hefel http://hefel.wordpress.com/?p=1022 ]]>

http://www.milliman.com/expertise/healthcare/products-tools/mmi/pdfs/milliman-medical-index-2009.pdf

The fifth annual Milliman Medical Index™ (MMI™) measures average annual medical spending for a typical American family of four covered by an employer-sponsored preferred provider organization (PPO) program. The MMI provides a consistent benchmark of healthcare benefit costs by annually assessing the changes in those costs over the most recent five-year period.

The MMI looks at key components of actual medical spending and charts the changes in these components over time, including cost changes for employers and employees. In addition to national cost trends, the MMI includes results for 14 major American metropolitan areas to illustrate how widely medical costs can vary by region.

While the MMI has always had broad implications for the healthcare sector, it takes on new importance this year as the country embarks on a discussion of how best to reform the U.S. healthcare system. The MMI offers useful context that can inform this discussion by offering a cost benchmark for employer-provided coverage, which remains a primary source of healthcare insurance.

See previous years at: http://www.milliman.com/expertise/healthcare/products-tools/mmi/index.php

The Science of Health Care Reform

Author: Robert H. Brook, MD

JAMA. 2009;301(23):2486-2487 (doi:10.1001/jama.2009.866)

Available online: http://jama.ama-assn.org/cgi/content/full/301/23/2486

Robert H. Brook has published nice summary of considerations that need to be made on the part of practitioners in choosing a side in the next battle over the specifics of health care reform. See a few  key points in the excerpt below (edits, links, and emphasis are mine):

The RAND HIE (more) was a population- and community based,
controlled experiment in which families from 6 sites
across the country were randomized to 1 of 5 health insurance
plans…The HIE’s conclusions were straightforward:
(1) increased cost sharing proportionally decreased
health care use and (2) on average, individuals with
free care used about one-third more care than those in costsharing
plans, but at the end of 5 years, they were no healthier
on average than their cost-sharing counterparts….

…The findings of these population-based studies seem to support
policies that reduce service use in most geographic areas
and increase what patients pay for care. Such policies would
not affect population-based health outcomes. However, from
the perspective of an individual patient, the story is quite different.
In the HIE, the reason more care did not improve health
is that providing more care did not improve the quality of care
individuals received. Furthermore, when patients had to pay
for their own care, they reduced use of effective services in
equal proportion to use of ineffective services.

How can physicians change the health care system in ways
that both are sensitive to the needs of individual patients and
reflect population-level data? Some suggestions follow.

…First, however health care is reformed, the resulting system
must explicitly assess the appropriateness of any major
medical or surgical procedure before it is performed in
a specific patient.

…Second, the assessment of appropriateness must be based
on reliable information.

…Third, the problems identified by the HIE and the Dartmouth
Atlas need to be addressed by eliminating unnecessary
care and wasted resources. Informal discussions with
various specialists about the proportion of care they provide
that does not meet their own definition of “necessary”
suggests an amount ranging upward from 20%.

…Fourth, it appears that simple interventions involving common
clinical encounters may translate into large savings. For
instance, most physicians order certain tests once a month, see
patients once a year, and draw blood in the morning hours.What
if physicians added 15% to a monthly or yearly interval and extended
the frequency with which procedures are performed by
1 month or 1 year?

…Fifth, perhaps it is time to address the affordability question
head-on and insist that research about health care delivery
focus on eliminating unnecessary care and wasted resources.

I picked up one of these cameras at AKAR in Iowa City. It was left sitting on the shelf for a few months, waiting for a reason to allot 2+ hours for its assembly; Taiwan was found to be a suitable excuse.

More technical details on pinhole photography can be found here.

To see full size images, please click the thumbnails in attached gallery below:

Exposures varied from 3-8 seconds, given the camera’s manufacturer-declared  f/130 for the pinhole and the use of ISO100 and ISO 50 films (Velvia RVP50 (an E-6 color reversal film,  as well as some cheap Fujicolor 100 negative film, both skillfully processed and scanned at University Camera in Iowa City).

The sky above the port was the color of television, tuned to a dead channel.

-William Gibson in Neuromancer, 1984

• http://gizmodo.com/5288832/goodbye-analog-static
• The author’s blog: http://www.williamgibsonbooks.com/blog/blog.asp

Doctors’ Group Opposes Public Insurance Plan

By ROBERT PEAR

2 of udon’s tags in Taipei, Taiwan.

More:

• http://www.world-graffiti.com/2009/03/udon-world-graffiti/
• http://www.world-graffiti.com/2009/01/udon-graffiti-in-san-francisco-usa/
• http://www.flickr.com/photos/phunk/tags/udon/
• http://fiveprime.org/hivemind/Tags/graffiti,udon