United States (KaiserHealth) – Dr. Donald Berwick, who oversaw Medicare and Medicaid until earlier this month, defended the programs Monday, but said they are trapped in a U.S. health system that promotes wasteful spending and inefficient care.

“Health care is broken,” Berwick said in an interview with Kaiser Health News. “… We have set up a delivery system that is fragmented, unsafe, not patient-centered, full of waste and unreliable. Despite the best efforts of the workforce, we built it wrong. It isn’t built for modern times.”

Berwick said the 2010 federal health law is changing how doctors and hospitals are paid and deliver care though such new arrangements as accountable care organizations, which are designed to improve coordination and lower costs.

But he said it is unclear whether such efforts would produce results quickly enough to hold off critics, including most Republicans, who want to make more radical changes that would shift more of the burden to beneficiaries. “That is the central question, the nub…whether that will happen fast enough, I just don’t know.”

Despite being considered one of the foremost authorities on health quality and safety, Berwick was a controversial pick as administrator of the Centers for Medicare and Medicaid Services after Republicans accused him of supporting rationing care. Berwick denies the charge, but noted both private insurers and government programs impose limits on what they will cover.

After Republicans said they would not confirm his appointment, President Obama appointed him during a congressional recess in July 2010, which meant he could serve only for 18 months. His last day was Dec. 2.

Berwick previously led the Cambridge, Mass.-based Institute for Healthcare Improvement.

On other topics, Berwick told KHN:

• His failure to be confirmed did not affect his ability to get things done, though he would have preferred a longer term. “An agency of this size will do better with longer-term leadership commitment,” he said. Knowing his tenure could be short gave him a greater sense of urgency to achieve things, he said.
• His most challenging decisions involved state requests to cut Medicaid benefits and writing regulations to encourage doctors and hospitals to form accountable care organizations to work more closely, while not making the requirements overly burdensome.
• He criticized state efforts to limit hospital coverage for Medicaid recipients, currently under review by federal regulators. Hawaii has proposed a 10-day coverage limit on some enrollees; Arizona has proposed a 25 day limit. “It’s a nonsensical idea,” he said. “If a patient needs twenty days, the patient should get twenty days,” he said.
• Managed care done right is the best way to provide care, he said, but if states are not ready to take on the responsibility, it can lead to restrictions that prevent people from getting the care they need. Early in his career, Berwick worked for Harvard Health Plan, a nonprofit HMO based in Boston.

Berwick said he has not yet decided what to do next beyond spending more time with his family in Boston.

– Provided by Kaiser Health News.

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New York, NY, United States (KaiserHealth) – For many adults, a routine visit to a primary care physician might involve blood tests, a urinalysis, an electrocardiogram, maybe a bone density scan. Too often, however, these tests are inappropriate and they cost a bundle, according to a recent study, not only for the health care system but also for individuals, who are increasingly footing more of the bill for their care.

The study, led by physicians from the Mount Sinai Medical Center and the Weill Cornell Medical College in New York, was published online in October in the Archives of Internal Medicine. The researchers examined the cost of common primary care practices that were identified as being overused earlier this year in a study by another group of physicians, known as the Good Stewardship Working Group. .

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The working group, for example, had noted that blood and other diagnostic tests were often ordered even for patients who had no related symptoms or risk factors and said they should be discontinued in those cases. Also included on its list were imaging studies such as CT scans or MRIs for low back pain and Pap tests to screen for cervical cancer in teenagers.

Among the frequently inappropriate pediatric practices were writing prescriptions for antibiotics for children with sore throats who didn’t have a strep infection; recommending cough medicines for children with upper respiratory infections and ordering imaging tests for the heads of kids who took a spill but didn’t exhibit red-flag symptoms such as dizziness or loss of consciousness.

The newest study, using data from federal medical surveys, estimated that 12 of those unnecessary treatments and screenings accounted for $6.8 billion in medical costs in 2009. The activity most frequently performed without need was a complete blood cell count at a routine physical exam. In 56 percent of routine physicals, doctors inappropriately ordered such tests, accounting for $32.7 million in unnecessary costs. In terms of dollars, the biggest-ticket item by far was physicians ordering brand-name statins before trying patients on a generic drug first: That accounted for a whopping $5.8 billion of the $6.8 billion total.

Minal Kale, an internist at Mount Sinai School of Medicine and lead author of the study, says $6.8 billion was a conservative estimate of the cost of the inappropriate care. She notes, for example, that the study didn’t evaluate the cost of additional testing or procedures that result from an abnormal blood test reading result or imaging scan, even though in the absence of symptoms or risk factors the follow-up may be unnecessary and even cause harm. “The financial and other emotional results of that can be significant,” she says.

The original list of primary care activities upon which Kale and her colleagues based their financial analysis was developed by the Good Stewardship Working Group under a grant from the American Board of Internal Medicine Foundation and published first online in May. Working group members were composed of internists, family physicians and pediatricians who are part of the National Physicians Alliance, a group of 22,000 doctors that advocates universal, affordable health care.

The working group focused on common activities that no physician would argue against, says Stephen Smith, a family physician and professor emeritus at Brown University’s Alpert Medical School, who co-authored that group’s paper. That’s why you don’t see more controversial practices like the PSA blood test for prostate cancer, which was recently removed from the U.S. Preventive Services Task Force’s list of recommended screenings for most men. “What we were trying to do was change [physicians'] mindset, not cause firestorms of controversy,” says Smith.

So why would physicians continue to order tests and prescribe pricey drugs when there’s clear evidence that they’re not necessary in many cases and may even cause harm by exposing people to unneeded care?

One of the main reasons is the way doctors are trained, Smith says. “I think all of us practicing in the U.S. were raised in an educational environment where we got dinged if we didn’t order certain tests,” he says.

Defensive medicine also plays a role. “Nobody ever gets sued for ordering unnecessary tests,” says Doug Campos-Outcalt, a family physician in Phoenix and a past president of the Arizona Academy of Family Physicians.

And patient expectations drive some of the spending as well, say physicians, who note that sometimes simple directives, such as drinking less alcohol or getting more exercise, aren’t what patients want to hear. “If a doctor says, ‘Let’s talk about weight control,’ patients aren’t usually too happy,” says Campos-Outcalt. “They feel like there should be some testing.”

Doctors alone can’t turn the tide. Improving patient education and communication with doctors is key to helping change practice patterns, says Smith.

Still, one expert is encouraged that doctors came up with this list of wasteful spending, rather than leaving it to government bean counters. “It’s only the doctors that can get into the clinical detail and find out what sorts of things are not producing a benefit and might cause harm,” says H. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice, whose work has questioned whether much of the preventive screening people receive is helpful.

The dollar amounts identified in the current study may be a good start, but they don’t even begin to address the country’s spending issues, he says. In 2009, health spending grew to $2.5 trillion and accounted for 17.6 percent of the gross domestic product.

Kale suggests that specialist care be the next target that physicians take aim at to identify inappropriate, overused activities. Specialist income, after all, is primarily generated through procedures, while primary care is often conversation-based. “We have more to gain by examining [specialist care] more closely,” she says.

– Provided by Kaiser Health News.

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Frustration over her physically impaired daughter’s medical care led Maryanne Godboldo to lash out at what she considered state interference, sparking a 12-hour standoff when Detroit police came to take the girl away.

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Initiative Builds on Integrated Care Model of Medicaid Health Plans WASHINGTON, May 13, 2011 /PRNewswire-USNewswire/ — Medicaid Health Plans of America (MHPA) commends Health and Human Services …

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Hospitals need to take steps to adequately prepare for an outbreak of measles, which can spread in health care settings, researchers say.

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The new Dubin Breast Center of The Tisch Cancer Institute at Mount Sinai opened today, bringing a range of multidisciplinary services under one roof and marking a great leap forward in care of breast cancer patients throughout the region. Encompassing more than 15,000 square feet at 1176 Fifth Avenue, the Dubin Breast Center represents a bold new vision for breast cancer treatment and research-one that focuses on the emotional, as well as the physical, health of individuals who have or are at risk of developing cancer…

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A new study has concluded that hospital culture and organization of care, including factors like the values and goals of the organization, and senior management involvement, may explain the wide range in mortality rates among patients treated for heart attacks in US hospitals.

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WBZ’s Jon Keller sat down with Geoffrey Beckwith of the Massachusetts Municipal Association. BOSTON (CBS) – Local cities and towns are trying to find a way to work with unions to help …

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Toronto, Ontario, Canada (AHN) – The Young Women’s Christian Association (YWCA) of Canada is pushing for a national child care program to ensure the country’s future economic prosperity.

The YWCA pointed out more women should be freed from child care duties as the Canadian workforce increasing relies on female workers who are educated and skilled.

The proposal is an alternative to men beginning to be more active in raising children, according to the YWCA report released Monday prior to the global celebration of International Women’s Day.

While many Canadian couples want to have both husband and wife working, the presence of young children forces women to either stay at home or seek only part-time employment. One alternative is to bring the children to child care facilities, which charge up to $60 a day and often have long waiting lists.

Despite the establishment of a national daycare program being one of the vital recommendations of the 1970 Royal Commission on the Status of Women, regulated child care in Canada is available for only 20 percent of children under 5 years old.

However, even with that limitation, employment of women with babies and toddlers grew to 64.4 percent in 2009 from 27.6 percent in 1976. For women with children with the ages 6 to 15, employment reached 79 percent.

Last year, Ontario introduced the full-day kindergarten with schools offering the service expected to reach 1,700 in 2012. YWCA Chief Executive Officer Paulette Senior welcomed the launch of the full-day kindergarten because it will permit the women to participate fully in the economic, social, cultural and political life of their communities.

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Patients don’t want to hear that they’re dying and doctors don’t want to tell them. But new guidance for the nation’s cancer specialists says they should be upfront and do it far sooner.

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