This quick article from the times made me think of our conversation last week in class. It summarizes a study done by the Department of Economics at Harvard about the career costs of family. Not surprisingly, the corporate world posed the highest penalty in salary for women who took time off to raise kids. In contract, MDs were found to have had the best outcomes.
Though the focus of the study is on having children, I think it follows that a job with more flexibility has implications on other work-life trade-offs.
http://economix.blogs.nytimes.com/2010/12/06/m-b-a-s-have-biggest-mommy-penalty-doctors-the-smallest/
Tuesday, December 7, 2010
Monday, December 6, 2010
“Patient-Centered” Patient-Centered Medical Homes
The Affordable Care Act (ACA) places a strong emphasis on illness prevention, promoting health, and management of chronic conditions. The Patient-Centered Medical Home (PCMH) has taken a front row seat in health nomenclature. For instance, In particular, the ACA requires some Medicaid enrollees to be in a “health home,” invests in primary care and family medicine, and initiates Accountable Care Organizations for Medicare.
While many are excited by the PCMH concept, providers and policy implementers are concerned that there is not a specific PCMH definition or a common understanding of what one is. Political task forces and major provider organizations are researching and discussing the specific requirements and goals that these entities should strive to achieve. But what if the answer is in our own backyard? For instance, when reforming a community clinic, why wouldn’t one start by asking what the community wants from their clinic?
At the North American Primary Care Research Group Meeting earlier this month, I met a few community physicians doing this type of patient engagement. They reached out to the community and asked them to sit on their redesign boards and to be active participants in the discussion of how the fundamental PCMH principals could be applied to their clinic.
One physician relayed his story of working with his community. When the providers in his clinic met alone, they decided that 48 hours was an adequate goal for returning a patient’s email. A patient had a very different opinion. She thought a few hours was even too long. She said that patients mainly contact their physicians when they are in need of an urgent medicine refill or if they have symptoms that aren’t quite concerning enough for the emergency room and that both of those situations deserve a quick response.
I found this idea very powerful because it is the beginning of a paradigm shift in medicine from the historical paternalistic patient-provider relationship to a new partnership in health. As a family doctor in training, I see a future where all community delivery systems (clinics, hospitals, or other providers) reflect the needs and values of the communities in which they serve. To do this, community involvement is key. Patient-engagement not only provides the clinic with effective quality improvement strategies, but also empowers the patients to take ownership over their local health system and over their own health.
For more information on patient-engagement in healthcare, please read Lansky, D. Patient Engagement and Patient Decision-Making in US Health Care. Foundation for Accountability. July 11, 2003. Accessed from www.gih.org/usr_doc/FACCT_Paper.pdf on December 2, 2010.
And for more on PCMH generally, I recommend checking out the PCHM page at HHS (http://www.pcmh.ahrq.gov/portal/server.pt/community/pcmh__home/1483), the Patient Centered Primary Care Collaborative (http://www.pcpcc.net/content/joint-principles-patient-centered-medical-home), and this nifty little video (http://www.emmisolutions.com/medicalhome/transformed/english.html).
While many are excited by the PCMH concept, providers and policy implementers are concerned that there is not a specific PCMH definition or a common understanding of what one is. Political task forces and major provider organizations are researching and discussing the specific requirements and goals that these entities should strive to achieve. But what if the answer is in our own backyard? For instance, when reforming a community clinic, why wouldn’t one start by asking what the community wants from their clinic?
At the North American Primary Care Research Group Meeting earlier this month, I met a few community physicians doing this type of patient engagement. They reached out to the community and asked them to sit on their redesign boards and to be active participants in the discussion of how the fundamental PCMH principals could be applied to their clinic.
One physician relayed his story of working with his community. When the providers in his clinic met alone, they decided that 48 hours was an adequate goal for returning a patient’s email. A patient had a very different opinion. She thought a few hours was even too long. She said that patients mainly contact their physicians when they are in need of an urgent medicine refill or if they have symptoms that aren’t quite concerning enough for the emergency room and that both of those situations deserve a quick response.
I found this idea very powerful because it is the beginning of a paradigm shift in medicine from the historical paternalistic patient-provider relationship to a new partnership in health. As a family doctor in training, I see a future where all community delivery systems (clinics, hospitals, or other providers) reflect the needs and values of the communities in which they serve. To do this, community involvement is key. Patient-engagement not only provides the clinic with effective quality improvement strategies, but also empowers the patients to take ownership over their local health system and over their own health.
For more information on patient-engagement in healthcare, please read Lansky, D. Patient Engagement and Patient Decision-Making in US Health Care. Foundation for Accountability. July 11, 2003. Accessed from www.gih.org/usr_doc/FACCT_Paper.pdf on December 2, 2010.
And for more on PCMH generally, I recommend checking out the PCHM page at HHS (http://www.pcmh.ahrq.gov/portal/server.pt/community/pcmh__home/1483), the Patient Centered Primary Care Collaborative (http://www.pcpcc.net/content/joint-principles-patient-centered-medical-home), and this nifty little video (http://www.emmisolutions.com/medicalhome/transformed/english.html).
Saturday, December 4, 2010
AZ Cuts Some Transplant Services for Medicaid Patients
The recent NY Times article on how Arizona is cutting financing for transplants patients on Medicaid, effective in October, is worth a read, even during this crazy finals week. While reading the article, I had many mixed emotions, from anger over the patients being turned away to seeing the financial constraints Arizona is facing and trying to come to terms with how to deal with providing health care in the face of economic constraints. This article provides many important takeaways to consider that reflect the horrible shape our health care system is in. The increasingly high expenditures is leading to rationing of care, leading to a real "death panel." Should Medicaid patients be turned away from having lifesaving transplant operations if they cannot afford to pay for it? Perhaps Arizona could reduce their health care costs by eliminating waste in their Medicaid operations/payments in order to keep transplant services. The article also brings up the question of how much we value an individual life, and how much extra time as a result of a treatment is worth what cost. Any thoughts on how AZ should proceed?
Wednesday, December 1, 2010
Federal Judge Rejects Health Law Challenge
http://www.nytimes.com/2010/12/01/health/policy/01lawsuit.html?_r=1&ref=health
On Tuesday a federal judge in Lynchburg, VA issued a ruling that the new health reform law is constitutional. The Liberty University (a private Christian college) had challenged the law on the grounds that requiring Americans to obtain medical coverage does not fall within Congress's authority to regulate interstate commerce.
This is the second time in two months that a federal judge has upheld the new health care reform law. However, over the next few months, Repbulican-appointed federal judges will also rule on the constituionality of the new law in Richmond, VA and Pensacola, FLA. It is anticipated that these judges may come to a different ruling. If disagreement does occur amongst lower federal courts, then the Supreme Court will get involved.
On Tuesday a federal judge in Lynchburg, VA issued a ruling that the new health reform law is constitutional. The Liberty University (a private Christian college) had challenged the law on the grounds that requiring Americans to obtain medical coverage does not fall within Congress's authority to regulate interstate commerce.
This is the second time in two months that a federal judge has upheld the new health care reform law. However, over the next few months, Repbulican-appointed federal judges will also rule on the constituionality of the new law in Richmond, VA and Pensacola, FLA. It is anticipated that these judges may come to a different ruling. If disagreement does occur amongst lower federal courts, then the Supreme Court will get involved.
How will CA handle enrollment of new Medi-Cal beneficiaries associated with health reform?
In California, Medi-Cal requires beneficiaries to enroll in person or, in limited areas, though a mail-in application. When the Medi-Cal FPL increases to 133% across all populations, there will likely be long wait times associated with enrollment. I see a comprehensive IT solution as the best way to prepare for increased eligibility and enrollment demand. Wisconsin developed a one-stop-shop web portal for beneficiaries to be screened and enroll in many public programs. This may be a viable option for California and other states if done well.
Click here to read the KFF brief about the Wisconsin IT solution.
Click here to read the KFF brief about the Wisconsin IT solution.
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