A Simple Nudge That Will Improve Medical Care for People with Diabetes

Posted on by admin

diabetes
When patients with diabetes come to the doctor’s office, it is important for their clinicians to take a look at their feet. Many, if not most, foot amputations among people with diabetes would be prevented with this simple exam, an exam that will identify problems early enough to prevent them from progressing. But us busy clinicians often forget to do this. David Aizenberg, a physician at the University of Pennsylvania came up with a simple way to increase the proportion of patients who receive this exam: take off their shoes!

“We try to have our medical assistants tell every diabetic patient to take off their shoes before the doctor comes into the room,” he said. “That little thing triggers the reminder that the physician should look at the patient’s feet. Without that system in place, screening often falls by the wayside.”

 
Such a simple nudge, with so much potential to improve people’s lives.

On Being a Parent to Someone with Schizophrenia

Posted on by admin

I have been pulling a lot of quotes, recently, from Andrew Solomon’s Far From the Tree.  The book is wonderful, although too long. It could have used a more aggressive editor.  Nevertheless, it is chock full of great stories and great ideas.  Here is a Solomon quote I feel compelled to share, which captures how good the book can be when it is good. He has already finished writing about Down syndrome and Autism, and is now tackling Schizophrenia:

off

 “The trauma of Down syndrome is that it is present prenatally and can therefore undermine the early stages of bonding. The challenge of autism is that it sets in or is detected in the toddler years, and so transfigures the child to whom parents have already bonded. The shock of schizophrenia is that it manifests in late adolescence or early adulthood, and parents must accept that the child they have known and loved for more than a decade may be irrevocably lost, even as that child looks much the same as ever.”

Hard to imagine a situation worse for parent and child. Yet good parenting is still so important in this setting, as Solomon later acknowledges:

“Schizophrenia cannot be cured with encouragement and love alone, but it can be hugely exacerbated by neglect.”

This book is worth owning, so you can pick up a chapter at a time, and see what Solomon has to say.

(Click to view comments)

Where in the World are the ACOs?

Posted on by admin

The Affordable Care Act established several programs to promote the formation of Accountable Care Organizations. These ACOs are a relatively new way of organizing healthcare delivery, in which healthcare providers join together – perhaps across physician groups and hospitals – to care for a population of patients, and are then held accountable both for the cost and quality of the care they deliver to those patients. This accountability cuts both ways – if they spend too much money on such patients and provide low quality of care, they might face financial repercussions, but if they offer high quality at a lower than expected cost, they might be rewarded with part of those cost savings.
A recent study gives us a glimpse of where the ACOs are forming in the United States. You will see they are not being formed everywhere, but instead are heavily concentrated in the southern and eastern United States:

map mar27

The study also shows that these organizations are disproportionately made up of large, nonprofit healthcare systems, but not ones classified as public hospitals.
tab mar27
 
This is just a snapshot of what’s happening right now, which I thought I would pass along for those of you policy geeks interested in some of these rich details. Now we get to find out whether these organizations can thrive, and whether they will truly prove to be a win-win idea – lowering healthcare costs while maintaining or improving healthcare quality.

Is Medicare Being Too Generous To Rural Healthcare Providers?

Posted on by admin

 
pic1
If you live in the rural U.S., you probably face relatively limited access to the wonders of American healthcare.  There won’t be as many physicians per capita offering you their services.  This paucity of healthcare professionals will be especially stark for subspecialty care.  There are not many ENT specialists opening up shops in rural Texas when they can find jobs in Houston or San Antonio.
This undersupply of physicians has long caused medical experts to fret that rural patients receive too little medical care.  As a team of researchers pointed out in a recent article in Health Affairs, Medicare has responded by providing a financial incentive to rural healthcare providers, boosting their payment to encourage physicians to locate in such areas…(Read more and view comments at Forbes)

Medicaid Expansion/Lack of Expansion Plans: In A Map

Posted on by admin

For anyone interested in health policy, Sarah Kliff at the Washington Post has perhaps the most useful and informative blog to be found. Here’s a picture she posted recently, showing the status of state Medicaid programs, in a post exploring which states she expects to be revisiting their decisions about how, or whether, to expand in accordance with the Affordable Care Act.
medi- march 25 2014
In so many ways, The Affordable Care Act is still a work in progress. On the downside, that forces me to revise my syllabus every year, for my health policy class. On the upside, it keeps things interesting!

(Click to view comments)

Provocative Piece On Behavioral Economics And Public Policy

Posted on by admin

The Financial Times, one of the great newspapers of the world, recently published a really nice essay exploring some of the controversies about what role, if any, behavioral economics should play in public policy. I’m going to give you a “teaser” of the article here, and you can always click on the link to read more:

“The past decade has been a triumph for behavioural economics, the fashionable cross-breed of psychology and economics. First there was the award in 2002 of the Nobel Memorial Prize in economics to a psychologist, Daniel Kahneman – the man who did as much as anything to create the field of behavioural economics. Bestselling books were launched, most notably by Kahneman himself (Thinking, Fast and Slow , 2011) and by his friend Richard Thaler, co-author of Nudge (2008). Behavioural economics seems far sexier than the ordinary sort, too: when last year’s Nobel was shared three ways, it was the behavioural economist Robert Shiller who grabbed all the headlines.
Behavioural economics is one of the hottest ideas in public policy. The UK government’s Behavioural Insights Team (BIT) uses the discipline to craft better policies, and in February was part-privatised with a mission to advise governments around the world. The White House announced its own behavioural insights team last summer.
So popular is the field that behavioural economics is now often misapplied as a catch-all term to refer to almost anything that’s cool in popular social science, from the storycraft of Malcolm Gladwell, author of The Tipping Point (2000), to the empirical investigations of Steven Levitt, co-author of Freakonomics (2005).
Yet, as with any success story, the backlash has begun…”

…Read more, see original article in the Financial Times

Click to view comments

How Long Will It Take to Get a Doctor’s Appointment?

Posted on by admin

A report on the Kaiser Family Foundation website shows how long it takes to get appointments with primary care doctors and subspecialists. The most dramatic finding comes out of Boston, where you can expect to wait more than two months to see a family physician.
3.24.14_blogpic1
I expect the delay in seeing a family physician results not only from the over specialization of physicians in Massachusetts, but also the expansion of health care coverage under the Massachusetts Health Plan. I wonder if this predicts access problems that will be happening across the nation over the next few years.

Click to view comments

PeterUbel