One of my interns was “running the list” with me last week (giving me a thumbnail update on the plans for each of our inpatients). It was standard stuff until he got to Ms. X, a 80ish-year-old woman admitted with urosepsis who was now ready for discharge. “I stopped her antibiotics, advanced her diet, called her daughter, and YoJo’ed her.”
Say whaa?
I’m pretty sure that the most valuable thing I’ve done in my 15 years running UCSF’s inpatient service has been to convince the hospital to hire a discharge scheduler, Yolanda Jones, a delightful woman with a big smile and the world’s most thankless job. When a patient is ready for discharge, the interns send Yolanda a note with a list of follow-up appointments, radiology studies, and other outpatient tests that need to be scheduled. She makes all the appointments, then calls the patient and intern with the info. Our hospital would cease to function if not for Yolanda; she is the unsung hero of the medical service.
RememberItNow! is a feisty little start-up that's aiming at the medication reminder/management space. I like the feature set and the approach, and I hope the Pam Swigley the engaging CEO gets some traction. It’s launching officially on Friday
But what I really like is their use of this cool presentation software called Prezito give their demo. So to kill 2 birdies with one stone, hereit is— click thearrow and enjoy.
I saw a patient today and looked back at a previous note, which said the following: “stressed out due to insurance.” It didn’t surprise me, and I didn’t find it funny; I see a lot of this. Too much. This kind of thing could be written on a lot of patients’ charts. I suspect the percentage of patients who are “stressed out due to insurance” is fairly high.
My very next patient started was a gentleman who has fairly good insurance who I had not seen for a long time. He was not taking his medications as directed, and when asked why he had not come in recently he replied, “I can’t afford to see you, doc. You’re expensive.”
A surprise move by ONC/HHS indicates the wheels may be falling off health IT reform at about the same rate they've fallen off Democrats' broader health reforms.
David Blumenthal and his staff have unveiled two separate plans to test and certify EHR technology products and services. We don't think this is a good idea. We've supported the purpose and spirit of the ARRA/HITECH incentive programs, and believe ONC's/HHS' re-definition of EHR technology puts it on a trajectory to improve the quality and efficiency of health care in the U.S. But this recently-announced two-stage EHR technology certification plan bears all the marks of a hastily drawn up blueprint that, if rushed into production, could easily collapse of its own bureaucratic weight.
As I noted in another post, the media seems to be turning “reconciliation” into an ugly word.
But “filibuster” is the word with a more unsavory history. (Thanks to HeathBeat reader Barry Carroll who sent me a link to the history of the word.)
“Filibuster” finds its root in the Spanish word “filibustero,” which means “pirate.” The filibuster was originally seen as an opportunity to “pirate” or “hijack” a debate. (more...)
Last week in London I met with two of the brightest lights in the UK's community of physicians looking at Health 2.0. Annabel Bentley is the medical director and head of informatics at Bupa, the UK-based non-profit health insurer, which owns Health Dialog amongst many other activities, and is also a sponsor of the upcoming Health 2.0 Europe conference. Emma Stanton is a psychiatrist, round-the-world yachtswoman, and has just spent two years on assignment working with Sir Liam Donaldson the Chief Medical Officer in the UK, and is on her way to a Harkness fellowship in the US working with Don Berwick & Eliot Fisher. Not bad company!
Dr. Lavizzo-Mourney is the President and CEO of the Robert Wood Johnson Foundation. Before joining Robert Wood Johnson she taught at the University of Pennsylvania, where she was the Sylvan Eisman Professor of medicine and health care systems and director of Penn’s Institute on Aging. In Washington, D.C., she was deputy administrator of what is now the Agency for Health Care Research and Quality.
Thanks to a new set of reports, we now know that where you live matters to your health. People who call Prince George’s County Maryland home are twice as likely to die prematurely from disease as their neighbors just across the line in Montgomery County. The data cut both ways. People who live in the healthiest counties, such as Montgomery or Howard County Maryland have a two-to-three times better chance of living longer than people who live in less healthy counties such as Prince Georges or Baltimore. (more...)
I’m viewing the latest rumblings in the US health care debate from the confines of a clear but cold Britain, where the big news is that the country is joining the PIGS in entering economic meltdown—or at least being a lot more broke than it thought it was. (PIGS are Portugal, Greece, Ireland & Spain, not farm animals). And yet it appears that health reform is making if not a comeback then at least vigorous palpitations. The reason for this seems to be the strength that the Anthem Blue Cross/Wellpoint premium rises have imbued into the Administration.
The Massachusetts health reform law Part II, enacted in 2008 - laid the groundwork for cost control and quality improvement, as a follow-on to the initial legislation's emphasis on achieving near-universal coverage. The legislation authorized several studies -- including a report published a few months back on global payment strategies -- and set the stage for hearings on health care cost containment to be held before the state Division of Health Care Finance and Policy (DHCFP), which are scheduled to begin March 16, 2010.
Twenty-seven years ago, President Ronald Reagan and a Congress split between Republican and Democratic control agreed to a radical new payment scheme for Medicare. The resulting legislation trimmed billionsof dollars from the federal budget and caused medical inflation to plummet, yet still maintained quality of care.
Although this stunning achievement led to a permanent change in how both the public and private sector pay for health care, it has gone curiously unmentioned during more than a year of rancorous health reform debate. Nor isit likely to arise at the much-ballyhooed bipartisan summit. The topic simply raises too many squirm-inducing questions. In this instance, conservatives and liberals alike can agree that political discretion is the better part of valor.