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Quality of Care Should Be the Standard, No Matter Where One Lives

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Quality of Care Should Be the Standard, No Matter Where One Lives

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The quality of healthcare Americans receive depends largely on where they live, with insurance coverage, access to preventive medicine and disease treatment varying widely from state to state, according to a study released Thursday by the Commonwealth Foundation.

"Where you live matters," said the foundation's Vice President Cathy Schoen, who co-authored the study for the private research group, in a conference call with reporters. "And it shouldn't."

The report found that all of the states that have made healthcare reforms provide better access to medical treatment and prevention and mostly avoid costly hospital procedures.

Residents of Vermont have the best healthcare in the country, the foundation said. The small northern state, which embarked on a radical plan to provide all citizens with healthcare less than a decade ago, also leads the nation in "equity," or making sure that people of lower income groups have healthcare.

The report comes as the U.S. Congress inches closer to finalizing a plan to reshape healthcare. So far, drafts of the plan have emphasized relying on the states to operate insurance exchanges and possibly to extend more health insurance to families with lower incomes.

"The patterns indicate that public policies, plus state and local health care systems, can make a difference," according to the report, which was also conducted by Joel Cantor, director of the Center for State Health Policy at Rutgers University.

Hawaii followed Vermont, and Iowa was ranked third on the scorecard. Neither state has a plan to reform healthcare, but Minnesota, which has created public-private collaborations on healthcare, ranks fourth, followed by Maine, which has also implemented sweeping reforms. Massachusetts - the Vermont neighbor that recently began a universal health insurance program - was seventh.

At the other end of the spectrum, Mississippi has the worst healthcare, according to the scorecard. Oklahoma fares mildly better, followed by Louisiana and Arkansas.

Generally, the report found, states in the South, Southwest and lower Midwest have worse insurance rates and less access to good medical treatment.

In an example of the disparate coverage, the report found that more than 25 percent of children in the bottom five states did not receive recommended vaccinations, while in the top five states, only 10 percent went without vaccinations.

MOST ADULTS DON'T HAVE HEALTH INSURANCE

At the national level, the dearth of health insurance for adults resembles an epidemic, Schoen said.

Since the start of the decade, the number of states with high uninsured rates for adults - which the report measured as 23 percent or higher - rose to nine from two. While the number with rates of 14 percent or less dropped to 11 from 22.

From 2007 to 2009, health insurance coverage of adults aged 18 to 64 declined in 31 states.

The number of states with high rates of uninsured children, on the other hand, dropped, as the federal government expanded its support of the Childrens Health Insurance Program, which targets children of low-income families.

Many states have expressed reservations about a national healthcare plan during the longest and deepest recession in 70 years. With their revenues plummeting, they say they cannot take on additional costs that may come with a federal plan.

But the Commonwealth Foundation said a national plan would give states crucial support.

"The erosion of insurance coverage...and the high uninsured rates in many states underscores the need for national reform and federal action to extend affordable insurance and ensure access for everyone," it said.

(Reporting by Lisa Lambert; Editing by Cynthia Osterman)

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Healthcare Quality Varies Widely By State, Study Finds

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The quality of healthcare Americans receive depends largely on where they live, with insurance coverage, access to preventive medicine and disease treatment varying widely from state to state, according to a study released Thursday by the Commonwealth Foundation.

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Another example of inefficiency and missed opportunity to provide education, resources and information for facilitation of greater outcomes

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Cultural Differences Can Result in Patients Receiving Less Than Optimal Care

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Cultural Differences Can Result in Patients Receiving Less Than Optimal Care

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Another Chronic Condition Often Preventable

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Another Chronic Condition Often Preventable

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Insurance companies must increase their willingness to reimburse for education and healthy lifestyle promotion

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Not everyone is treated equally when seeking medical care

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Racism and discrimination in health care: Providers and patients - Harvard Health

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It is sadly true that people of color cannot necessarily expect to receive the same quality of medical care in this country as whites. And unfortunately, discrimination by patients toward doctors is another problem that the medical community needs to address. To overcome the racism and discrimination that lead to ...

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To Create an Efficient System of Healthcare...

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To Create an Efficient System of Healthcare...

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We must eliminate the rampant amount of unnecessary services being provided

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It's common knowledge in medicine: Doctors routinely order tests on hospital patients that are unnecessary and wasteful.|
Sutter Health, a giant hospital chain in Northern California, thought it had found a simple solution.

The Sacramento-based health system deleted the button physicians used to order daily blood tests. "We took it out and couldn't wait to see the data," said Ann Marie Giusto, a Sutter Health executive.

Alas, the number of orders hardly changed. That's because the hospital's medical-records software "has this cool ability to let you save your favorites," Giusto said at a recent presentation to other hospital executives and physicians. "It had become a habit."

There are plenty of opportunities to trim waste in America's $3.4 trillion health care system -- but, as the Sutter example illustrates, it's often not as simple as it seems.

[Also: Poplar Healthcare will pay nearly $900,000 over allegations they improperly promoted, performed stain test]

Some experts estimate that at least $200 billion is wasted annually on excessive testing and treatment. This overly aggressive care also can harm patients, generating mistakes and injuries believed to cause 30,000 deaths each year.

"The changes that need to be made don't appear unrealistic, yet they seem to take an awful lot of time," said Dr. Jeff Rideout, chief executive of the Integrated Healthcare Association, an Oakland, Calif., nonprofit group that promotes quality improvement. "We've been patient for too long."

In California, that sense of frustration has led three of the state's biggest health care purchasers to band together to promote care that's safer and more cost-effective. The California Public Employees' Retirement System (CalPERS), the Covered California insurance exchange and the state's Medicaid program, known as Medi-Cal -- which collectively serve more than 15 million patients -- are leading the initiative.

Progress may be slow, but there have been some encouraging signs. In San Diego, for instance, the Sharp Rees-Stealy Medical Group said it cut unnecessary lab tests by more than 10 percent by educating both doctors and patients about overuse.

[Also: Hospital-based primary care clinics ordering more unnecessary tests, researchers say]

A large public hospital, Los Angeles County-University of Southern California Medical Center, eliminated preoperative testing deemed superfluous before routine cataract surgery. As a result, patients on average received the surgery six months sooner.

These efforts were sparked by the Choosing Wisely campaign, a national effort launched in 2012 by the American Board of Internal Medicine (ABIM) Foundation. The group asked medical societies to identify at least five common tests or procedures that often provide little benefit.

The campaign, also backed by Consumer Reports, encourages medical providers to hand out wallet-sized cards to patients with questions they should ask to determine whether they truly need a procedure.

Critics have knocked Choosing Wisely for playing it too safe and not going after some of the more lucrative procedures, such as certain spine operations and arthroscopic knee surgeries.

Daniel Wolfson, chief operating officer at the ABIM Foundation, said the Choosing Wisely campaign has been successful at starting a national conversation about unwarranted care. "I think we need massive change and that takes 15 years," Wolfson said.

[Also: Florida urologist to pay $3.8 million for allegedly ordering unnecessary medical tests]

The state effort, dubbed Smart Care California, is in the early stages as well.

Initially, the group has focused on cutting the number of elective cesarean sections, reducing opioid use and avoiding overtreatment for patients suffering low-back pain. In its contract with health insurers, the Covered California exchange requires that their in-network providers meet a range of quality standards, including low C-section rates.

Dr. Richard Sun, co-chairman of the Smart Care group and a medical consultant at CalPERS, said he's pursuing safer, more affordable treatments for low-back pain, a condition that cost the state agency $107 million in 2015. "One challenge is developing metrics that everyone can agree upon to measure improvement," he said.

For patients, overtreatment can be more than a minor annoyance. Galen Gunther, a 59-year-old from Oakland, said that during treatment for colorectal cancer a decade ago he was subjected needlessly to repeated blood draws, often because the doctors couldn't get their hands on earlier results. Later, he said, he was overexposed to radiation, leaving him permanently scarred.

"Every doctor I saw wanted to run the same tests, over and over again," Gunther said. "Nobody wanted to take responsibility for that."

At Cedars-Sinai Medical Center in Los Angeles, officials said that economic incentives still drive hospitals to think that more is better.

"We have excellent patient outcomes, but it's at a very high cost," said Dr. Harry Sax, executive vice chairman for surgery at Cedars-Sinai. "There is still a continued financial incentive to do that test, do that procedure and do something more."

In addition to financial motives, Sax said, many physicians still practice defensive medicine out of fear of malpractice litigation. Also, some patients and their families expect antibiotics to be prescribed for a sore throat or a CT scan for a bump on the head.

To cut down on needless care, Cedars-Sinai arranged for doctors to be alerted electronically when they ordered tests or drugs that run contrary to 18 Choosing Wisely recommendations.

The hospital analyzed alerts from 26,424 patient encounters from 2013 to 2016. All of the guidelines were followed in 6 percent of those cases, or 1,591 encounters.

Sax said Cedars-Sinai studied the rate of complications, readmissions, length of stay and direct cost of care among the patients in whose cases the guidelines were followed and compared those outcomes with cases where adherence was less than 50 percent.

In the group that didn't follow the guidelines, patients had a 14 percent higher incidence of readmission and 29 percent higher risk of complications. Those complications and longer stays increased the cost of care by 7 percent, according to the hospital.

In 2013, the first year of implementation of Choosing Wisely guidelines, Cedars-Sinai said it avoided $6 million in medical spending.

For perspective, Cedars-Sinai is one the largest hospitals in the nation with $3.3 billion in revenue for the fiscal year ending June 30. It reported net income of $301 million.

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In Northern California, Sutter has incorporated more than 130 Choosing Wisely recommendations as part of a broader effort to reduce variation in care. In all, Sutter said, it has saved about $66 million since 2011.

That's a significant sum. However, during the same period, Sutter reported $2.7 billion in profits. Last year alone, it posted an operating profit of $554 million on revenue of nearly $12 billion.

Giusto said her team of employees tasked with changing physician behavior and eliminating these variations is separate from administrators who are focused on maximizing reimbursement. She said there can be conflicting forces within a hospital.

"We get real excited about a project with [emergency department] doctors on reducing CT scans for abdominal pain," said Giusto, director of Sutter's office of patient experience. "Then I can hear the administration say that was a fee-for-service patient. I just lost money, right?"

Giusto meets with doctors to present data on how many tests or prescriptions they order and how that compares to others. At one clinic, she shared slides showing that some doctors were ordering more than 70 opioid pills at a time while others prescribed fewer than 20. In response, Sutter set a goal of 28 tablets in hopes of reducing opioid abuse.

"Most of the physicians changed," Giusto said. "But there were still two who said, 'Screw it. I'm going to keep doing it.'"

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

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Unnecessary medical tests, treatments cost $200 billion annually, cause harm

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It's common knowledge in medicine: Doctors routinely order tests on hospital patients that are unnecessary and wasteful.| Sutter Health, a giant hospital chain in Northern California, thought it had found a simple solution. The Sacramento-based health system deleted the button physicians used to order daily blood tests.

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The U.S. spends double what other developed nations do on healthcare, yet we rank last in terms of overall health.

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Decreased time with patients identified as greatest challenge

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As healthcare shifts to value-based care, there is growing emphasis on helping patients with chronic conditions better manage their health. Patients with two or more chronic conditions - such as heart failure, diabetes and asthma - make up more than two-thirds of the entire Medicare population. And caring for these patients requires extra time - something most physicians don't have. Physicians looking to bring more personalized care to their practices report difficulties implementing the additional services needed for this group of patients.

Sixty-three percent of primary care physicians cite lack of time to provide the extra guidance and reinforcement that chronic care patients require to understand their treatment plans as a top challenge, according to a new study released by SmartCCM, a medical services company that specializes in chronic care management.

Fielded by Medical Marketing, Inc. in July and August 2015, the survey polled 500 primary care physicians who treat Medicare patients on the challenges of caring for chronic care patients, frequency of contact with these patients and patient compliance.

The survey found that almost half (46 percent) of primary care physicians are not aware that they can be reimbursed for non-face-to-face time with Medicare patients who have two or more chronic conditions. Medicare introduced CPT code 99490 in January 2015 as a way to reimburse physicians for the extra time, staffing, and technology necessary to sustain comprehensive chronic care management. The code is intending to vastly improve outcomes for patients while providing additional income for physicians' practices.

Key findings include:

-56 percent cite the complexity of managing multiple conditions as one of the top-two challenges in caring for this population

-38 percent percent of physicians do not contact their Medicare patients with two or more chronic conditions between office visits.

- When it comes to compliance with a specific care plan, the physicians characterize three-quarters of their Medicare patients with two or more chronic conditions as only "somewhat compliant."

-Other challenges (such as patient inconsistency in following treatment plans, patient hesitation toward price of tests and prescriptions, and high frequency of calls and visits from such patients) were mentioned to a lesser degree.

To read the full results of the survey here

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Physicians Reveal Lack of Time As Greatest Challenge in Caring for Chronic Care Patients

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As healthcare shifts to value-based care, there is growing emphasis on helping patients with chronic conditions better manage their health. Patients with two or more chronic conditions - such as heart failure, diabetes and asthma - make up more than two-thirds of the entire Medicare population.

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Keys for transitioning to value-based care

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Improving the Quality and Efficiency of U.S. Health Care

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In this video, the third in a series our on health reform, former Commonwealth Fund president Karen Davis discusses how changing the way we pay for and deliver health care will improve the quality and efficiency of the health system.

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This can be seen daily in U.S. healthcare

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Patients Often Feel They Are Not Being Heard

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Patients Often Feel They Are Not Being Heard

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The continued weight increase in the youngest Americans is especially worrisome for long-term health. One in five adolescents, ages 12-19; one in five kids, ages 6-11, and and one in ten preschoolers, ages 2-5 are considered obese, not just overweight.

Obesity is medically defined as having a body-mass index of more than 30. The findings on obese kids in the U.S. comes on top of this week's World Health Organization report that childhood obesity is soaring around the world, increasing more than tenfold over the past four decades.

Overweight and obese children have a higher risk to stay obese and childhood obesity is linked to a higher chance of early death in adulthood.

Overall, 70.7 percent of Americans are either overweight or obese, meaning that an unhealthy weight has become the norm, with normal weight Americans - a BMI of less than 25 - now in the minority.
Related: Americans are getting fatter
What the CDC report doesn't reveal is why the obesity crisis continues to worsen. A recent study by epidemiologists at Georgia Southern University discovered that fewer Americans, particularly women, are trying to lose weight. Public health experts say that an unhealthy diet and the lack of exercise are still the two biggest culprits.

"There's still a huge amount of cheap, accessible, highly processed food available everywhere almost anytime," says Hu. "And despite people doing more recreational activity these days, the overall activity level, household activity and occupational activity has decreased in recent years."

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America's obesity epidemic reaches record high, new report says

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The continued weight increase in the youngest Americans is especially worrisome for long-term health. One in five adolescents, ages 12-19; one in five kids, ages 6-11, and and one in ten preschoolers, ages 2-5 are considered obese, not just overweight. Obesity is medically defined as having a body-mass index of more than 30.

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We strive to eliminate the effects of fragmented care in the United States.

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Care Coordination Improves Health Outcomes and Reduces Costs