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policy

reading list: getting real about socioeconomics and policy

Following the lead of the great Susannah Fox, I want to share a few articles which have the hamster wheel in my brain spinning in double time. We’re starting to seriously wrestle with some of the real socioeconomic and policy  challenges of health and providing healthcare. Two of these articles appear in popular press rather than journals.

Sabrina Tavernise in the New York Times writes about The Health Toll of Immigration to America.

A growing body of mortality research on immigrants has shown that the longer they live in this country, the worse their rates of heart disease, high blood pressure and diabetes. And while their American-born children may have more money, they tend to live shorter lives than the parents. “There’s something about life in the United States that is not conducive to good health across generations,” said Robert A. Hummer, a social demographer at the University of Texas at Austin.

Thanks to Dennis Boyle for sharing the article.

 

The New York times, H. Gilbert Welch writes Diagnosis: Insufficient Outrage

Consider another recent shift in health care: hospitals have been aggressively buying up physician practices. This could be desirable, a way to get doctors to use the same medical record so that your primary care practitioner knows what your cardiologist did.

But that may not be the primary motivation for these consolidations. For years Medicare has paid hospitals more than independent physician practices for outpatient care, even when they are providing the same things. The extra payment is called the facility fee, and is meant to compensate hospitals for their public service — taking on the sickest patients and providing the most complex care.

Hat tip to Doctor_V and DrNancyGlass1 for finding the article:

 

In the New England Journal of Medicine, Michael Rawlins, MD publishes: NICE: Moving Onward

There is now wide acceptance that no country seeking to provide universal health care has the resources necessary to achieve the highest possible standards of care for everyone. …

This part is important:

However, priority setting in health care must encompass more than the technical and scientific demands of health technology assessment. It must also take account of the social values of the relevant communities. NICE therefore established a Citizens Council, with members drawn from the general public, to examine, deliberate over, and report on the social principles on which the Institute’s guidance should be based.

Grateful for Pritpal Tamber, MD for the oignal quote and link:

 

HIPAA: The greatest red herring the world has ever seen

In 60s FERPA law opened up access for students to see their records. Why do we still not have same in healthcare #tedmed

Ryan Panschadsaram at TEDMED 2013

At TEDMED this year, White House advisor Ryan Panchadsaram spoke about patient rights. He spoke about how all of us have the right to view our health records and take control of the content. Specifically he called out our rights to:

  • View our records
  • Correct mistakes
  • Decide who sees them
  • Request a copy

Panchadsaram said we’re all already afforded these rights under HIPAA.

scccrrrrreeeeecccchhhhh

HIPAA? The Dread Pirate Roberts of laws? The none shall pass of policies? The Great Wall of HCSM?

Yes, that HIPAA.

The Health Insurance Portability and Accountability Act has been manifest into the greatest red herring the world has ever seen.

For years we’ve all —me included —blamed HIPAA for various reasons our eHealth, mHealth, and HCSM dreams have failed to take flight. Oh, doctors can’t engage with patients online because if HIPAA (Actually, to fairly represent most of the objections, I should probably misspell it HIPPA).

Panchadsaram’s point is spot on. HIPAA is not a limiter, it’s an empowerment tool.

And if we, as digital and social health advocates, are going to make headway, we’re going to have to reframe our arguments, or drop them all together.

If we stop thinking about HIPAA as the the barrier, what then? We might also think differently about the whole problem.

How might we reframe our thinking?

Maybe it’s not about getting your doctor to tweet with you. Maybe instead its about helping the traditional medical establishment (ah-hum, I count myself in that lot) understand that these tools exist, and patients use them to discover expertise and new connections.

Maybe we shouldn’t expect hospital Facebook pages to reply to every patient by saying: thank you, come see us again soon. Instead we should be driving them to post how someone who sees Panchadsaram’s video can get easy online access to their own records.

Wherever we do, let’s stop blaming and start solving. Action conquers fear!

You can watch Ryan Panchadsaram’s talk below or on the TEDMED site. Ryan is also on Twitter. Here is the Office of Civial Rights letter he mentions in the talk.

Health Affairs is the new shirtless dancing guy

2/13 update: Videos for the panels are now available on the Health Affairs site. Sometimes it’s about the idea, and sometimes it’s about validating existing ideas. Last week, the well-regarded health policy journal Health Affairs hosted a briefing on The New Era of PAtient Engagement. I attended and left feeling satisfied, even excited, and also frustrated and a tad disappointed.

The briefing was a forum for researchers and authors of articles in the February edition to present their work. Many of the topics focused on ways to activate patients or to get patients engaged in their care. Proponents, supported by compelling data, argued activated or engaged patients have better outcomes and reduced costs.

The presentations ranged from reports on data, to emotional appeals. Some, in particular Jessie Gruman, did a nice job of mixing both. Kristin Carman presented an amazing Framework For Understanding The Elements [of shared decision making] pictured here: Framework

I sensed frustration from some attendees. We proved the value of engagement years ago, this isn’t new… and why aren’t there actual patients represented on the panels?. Some even, appropriately, called attention to the fact that Health Affairs requires a subscription to view most of the articles (some where funded by PCORI and made publicly available).

Personally, I was disheartened by some word choices. Implying patients need to be activated suggests patients are passive and something has to be done to them in order for them to care about their health and interactions with healthcare providers. That misses the mark.

What about phyisician activation? we have an opportunity to collaborate on a new model which reduces the power-distance index between providers and patients. We should be helping health systems and providers find ways to reduce the stress and fear for patients who are already engaged.

I appreciate all the concerns, and agree with many of them. But I am, none the less, excited about what Health Affairs has done. It’s important for us to have forward-thinking visionaries who knew were focused patient centered care years ago. It’s important to recognize the importance of what Health Affairs has done.

Five years ago, would a major publication have dedicated an issue to patient engagement? I doubt it. Howard Koh, MD, Assistant Secretary for Health, US Department of Health and Human Services, opened the briefing and called attention to its significance. His presence alone suggests the patient experience and engagement is on the minds of top officials.

I’m reminded of this video of the shirtless dancing guy:

My takeaway from the Health Affairs briefing is the same as the video’s message: it’s not about being the first, it’s about validating those who dare to put forth new ideas. In this case, patient engagement, shared decision making, and participatory medicine are not new. What is new is the attention from major publications, providers, policy makers, administrative leaders and researchers. That’s something worthy of a happy dance.