Cartoons Debate Profits in Health Care & MLR

A very amusing animation about medical loss ratio (MLR), otherwise known as the amount of money insurers should be required to spend on care versus administration. Likely developed by insurers -- who else would be spending time animating a debate about such esoteric issues -- nevertheless, it turns out to be quite amusing.

Journalists Know More About Dealing with Patients (Than You Doctors)

In case you didn't realize that journalists understand how to engage with patients better than physicians, just read this recent Boston Globe editorial and be educated!

Evidence mounts of problems in doctor-patient relationships

December 30, 2010

THE DOCTOR-PATIENT relationship, rightly celebrated as the beating heart of the American health care system, needs a little treatment on its own. Studies over the past year have shown that doctors often don’t level with patients about a poor prognosis, even if it means the patient will undergo unnecessary procedures. Talk about end of life decisions gets short shrift, too, partly because it’s not always billable. And now comes evidence that cancer patients don’t feel comfortable telling their doctors about the alternative treatments they’re pursuing.

There are understandable reasons why doctor-patient relationships can be difficult. A cancer diagnosis, especially if the disease is advanced, is a devastating moment in a patient’s life. Oncologists, usually the bearers of the bad news, face a major challenge in designing effective therapies. In the tireless battle against a disease that is invading the patient’s body, many oncologists become, in the eyes of their patients, the gatekeepers of treatments and the brokers of promise. Patients can begin to feel powerless.

In an effort to take control of their condition, many patients seek alternative therapies, though they don’t always tell their doctors about it. A study of Seattle prostate cancer patients published this month found that 52 percent of 379 patients surveyed used one or more alternative therapies, but only 43 percent of those patients discussed it with their primary doctor or oncologist. Common alternative treatments include mind-body therapies such as relaxation techniques but patients also report turning to acupuncture, special diets, homeopathy, and even magic. The idea to initiate alternative therapies comes from many sources — family and friends, television or magazine advertisements, online support group recommendations, and more. The main reasons for not telling doctors about these therapies, according to patients surveyed, are fear of a negative reaction, or a sense that their doctor simply does not believe in these treatments. (Really? Trained physicians don't believe alternative treatments ... like magic ... how dare they be so narrow minded?!)

While it is true that the scientific efficacy of many of these therapies has not been proven, doctors should keep in mind that benefits to cancer patients cannot exclusively be measured through regression or remission. Improved quality of life is also a benefit, and if a patient feels empowered and less stressed by seeking a harmless, if therapeutically ineffective, therapy, that’s also success. A doctor who discusses these treatments with his or her patients, offering advice on which ones may help improve quality of life, does a much better service than a doctor who dismisses anything that does not fit the Western medicine mold. An added benefit is that doctors might be able to spot troublesome therapy combinations. For example, some herbal supplements could potentially interfere with the efficacy of some treatments. A cancer patient that goes on a special diet might rapidly lose weight, which an oncologist could misinterpret as a sign of the patient advancing into late-stage cancer.

Given the relatively widespread use of these therapies among patients, doctors should make sure they engage in a constructive dialogue about this topic every time they make a diagnosis. There is much to be gained, and failing to acknowledge their patients’ use of these methods is not going to make the issue go away.

Wondering About EMR Meaningful Use and How to Get Paid?

I recently received a request to help decipher this thing called "Meaningful Use", which has the health care community all abuzz. It's an incentive program that has been laid out by the federal government to promote the transition from paper medical records to electronic medical records and will pay either $44,000 or $63,750 over a five year period to those who meet certain requirements.

EMR has long been touted as the holy grail of cost containment and was a big part of the federal health care reform debate. Now it's just being touted because going electronic is always better! And after a little research I came across this short description of how quality measures need to be reported from an EMR system (one of several requirement to meet Meaningful Use requirements and get paid). The blurb below is how the Centers for Medicare and Medicare (CMS), who is coordinating the national health IT movement, describes the endeavor. 

Good luck deciphering this one and good luck to all the future 'meaningful users' out there!

Eligible Professional Clinical Quality Measures

Instructions for Reporting Numerators, Denominators & Exclusions

Each clinical quality measure includes specifications for the numerator, denominator and also indicates if there are any exclusions for the measure as described in the measure specifications. Each measure requires reporting one or more numerators and one or more denominators. Although the denominator population may not change for a measure, when there is more than 1 numerator, it is required to report the denominator each time. Conversely, when the denominator population is stratified but there is only 1 numerator in the measure, the numerator must be repeated for each subset of the denominator population. See attached table which depicts the number of numerators and denominators required for reporting. This table also identifies if exclusions may be reported and the field type required for each numerator, denominator and exclusion, if applicable.

The following measures require reporting more than one numerator (NQF Numbers 0064, 0027, 0421, 0024, 0033, 0036, 0038, 0075, 0004, and 0105). If a measure has more than one numerator, than all numerators must be reported and there must also be a denominator reported for each numerator (even if the denominator population remains the same for the measure). Therefore the number of numerators reported will always equal the number of denominators needed for reporting regardless of whether the denominator remains the same for a measure or it changes (e.g., denominator population is stratified by age) and results in more than one denominator for the measure.

(Table not included, but not useful anyway.)