MedPAC ’s Proposed “Reforms” Should Be Tested Before They’re Implemented: CMS’s Hospital Readmissions Reduction Program Is Exhibit A | Part II
Conclusions reached by Gupta et al. and MedPAC
In November of 2017 Ankur Gupta and 10 other experts in cardiovascular medicine published an article in JAMA Cardiology entitled, “Association of the Hospital Readmissions Reduction Program implementation with readmission and mortality outcomes in heart failure.” The authors were affiliated with well-known universities, and three of them were also editors of JAMA Cardiology [4]. Their research was financed by grants from the NIH and Get With the Guidelines-Heart Failure (GWTG-HF), a “voluntary quality improvement program” sponsored by the American Heart Association.
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Source: The Health Care Blog - December 7, 2018 Category: Consumer Health News Authors: matthew holt Tags: Medicare Politics CMS Congress hospital readmissions HRRP Kip Sullivan MedPAC P4P Pay for Performance Source Type: blogs
Part II | MedPAC ’s Proposed “Reforms” Should Be Tested Before They’re Implemented: CMS’s Hospital Readmissions Reduction Program Is Exhibit A
Conclusions reached by Gupta et al. and MedPAC
In November of 2017 Ankur Gupta and 10 other experts in cardiovascular medicine published an article in JAMA Cardiology entitled, “Association of the Hospital Readmissions Reduction Program implementation with readmission and mortality outcomes in heart failure.” The authors were affiliated with well-known universities, and three of them were also editors of JAMA Cardiology [4]. Their research was financed by grants from the NIH and Get With the Guidelines-Heart Failure (GWTG-HF), a “voluntary quality improvement program” sponsored by the American Heart Association.
...
Source: The Health Care Blog - December 7, 2018 Category: Consumer Health News Authors: matthew holt Tags: Medicare Politics CMS Congress hospital readmissions HRRP Kip Sullivan MedPAC P4P Pay for Performance Source Type: blogs
MedPAC ’s Proposed “Reforms” Should Be Tested Before They’re Implemented: CMS’s Hospital Readmissions Reduction Program Is Exhibit A
This report card is grossly inaccurate even though it relies on medical records data as well as claims data.) By the late 1990s, conventional wisdom among health policy “thought leaders” had elevated readmission rates to the same status as mortality rates – it was a legitimate quality measure that could be safely administered to thousands of hospitals and millions of patients.
However, the conventional wisdom remained unproven by the early 2000s, and remains unproven to this day. “[T]he link between early readmission and quality of care is still uncertain,” is how five experts put it in a 2004 article. “[T]he a...
Source: The Health Care Blog - December 6, 2018 Category: Consumer Health News Authors: matthew holt Tags: Medicare Politics ACA Affordable Care Act CHIP CMS Congress hospital readmissions Kip Sullivan MACRA MedPAC P4P Pay for Performance Source Type: blogs
AAP Bronchiolitis Guidelines a Mismatch with Clinical Practice
I recently met with a group from our children's hospital to standardize the hospital management of bronchiolitis according to the latest American Academy of Pediatrics guidelines. (Pediatrics 2014;134[5]:e1474; http://bit.ly/2QIGbMX.) Unfortunately, these guidelines seem to cause confusion for experienced and inexperienced emergency physicians alike.This confusion comes from the guidelines raising unaddressed issues and new questions, most importantly not tackling important aspects of frontline clinical practice. These guidelines were developed with the best evidence currently available, and their application mo...
Source: M2E Too! Mellick's Multimedia EduBlog - December 4, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Ignorance based cardiology : How common is “ myocardial congestion ” in cardiac failure ?
We learn from basic physiology lessons that human body is made up of 60 % water. What about heart ? There is no reason for the heart should behave differently from rest of the body . If my assumptions are correct when the normal heart weighs 300g , 180g of which should be be water. The same thing could be applicable for LV mass( * Reference requested)
Is there myocardial congestion in cardiac failure ?
Genesis of edema in any tissue depends on local hydrostatic pressures, tissue resistive forces, osmotic balance, and cell membrane permeability. In the myocardium individual contribution of above factors are not ...
Source: Dr.S.Venkatesan MD - November 27, 2018 Category: Cardiology Authors: dr s venkatesan Tags: cardiac failure Cardiac MRI Cardio Nephrology effect of dialysis on myocardial water content lv amss and myocardial edema myocardial edema and ckd chronic kidney failure myocardial interstitial edema myocardial water imaging water logging Source Type: blogs
Software Marks Advances at the Connected Health Conference (Part 2 of 2)
The first part of this article focused on FDA precertification of apps and the state of interoperability. This part covers other interesting topics at the Connected Health conference.
Presentation at Connected Health Conference
Patient engagement
A wonderful view upon the value of collecting patient data was provided by Steve Van, a patient champion who has used intensive examination of vital signs and behavioral data to improve his diabetic condition. He said that the doctor understands the data and the patient knows how he feels, but without laying the data out, they tend to talk past each other. Explicit data on vital s...
Source: EMR and HIPAA - October 31, 2018 Category: Information Technology Authors: Andy Oram Tags: Connected Health Digital Health Digital Therapies Health IT Startups Health Sensors Healthcare AI Healthcare Analytics Medical Devices mHealth Clinical Data Exchange Healthcare Interoperablity Patient Engagement Standards Source Type: blogs
Will The Fitbit Care Program Break New Ground?
Wearables vendor Fitbit has launched a connected health program designed to help payers, employers and health systems prevent disease, improve wellness and manage diseases. The program is based on the technology Fitbit acquired when it acquired Twine Health.
As you’ll see, the program overview makes it sound as the Fitbit program is the greatest thing since sliced bread for health coaching and care management, I’m not so convinced, but judge for yourself.
Fitbit Care includes a mix of standard wearable features and coaching. Perhaps the most predictable option is built on standard Fitbit functions, which allow users to...
Source: EMR and HIPAA - September 21, 2018 Category: Information Technology Authors: Anne Zieger Tags: Connected Health Digital Health EHR Electronic Health Record Electronic Medical Record EMR Fitness Trackers Health Care Healthcare HealthCare IT Medication Adherence mHealth Mobile Apps Mobile Health Care Patient Home Monitorin Source Type: blogs
Behold the power of clinical triads
A few weeks ago, I saw a patient with shortness of breath during my Saturday clinic. He had been short of breath for a few weeks, and on a couple of occasions, he had also experienced mild chest pain. He has known aortic stenosis, moderate according to his last echocardiogram two years ago.
My brain kicked into autopilot, and I asked: “Have you fainted or passed out recently?” It was a flashback to medical school, where it seemed we were inundated with lists of threes.
For aortic stenosis, the triad of surgical indications for critical degrees was: angina, synkope (remember I’m Swedish) and svikt, which is Swedish fo...
Source: Kevin, M.D. - Medical Weblog - September 18, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/a-country-doctor" rel="tag" > A Country Doctor, MD < /a > Tags: Conditions Cardiology Endocrinology Source Type: blogs
Caregivers Benefit from Hospice Education Ahead of Need
Dear Carol: My dad is in a good assisted living facility. He’s 96, and other than congestive heart failure, he’s in fair health for his age and has a good attitude for the most part. He was having physical therapy for hip and knee problems but now refuses it. I feel that at his age he can do what he wants so I haven’t pushed it. He uses a wheelchair to get around for the most part, but he can transfer himself. The nurse at the ALF said that he’d probably qualify for hospice care, though a doctor would have to make the determination. She did say that it’s a good idea for us to check into hospice because they can o...
Source: Minding Our Elders - August 12, 2018 Category: Geriatrics Authors: Carol Bradley Bursack Source Type: blogs
If Facebook knows me better than my spouse, why does my doctor know so little?
A few months ago, I was on call and admitted a 65-year-old man to the intensive care unit for a flare of his chronic obstructive pulmonary disease (COPD). Although he had only gotten to the point of being unable to speak full sentences between gasps for breath for only a few days, his story started two months earlier when he had gradually started retaining water and getting more short of breath. He became unable to cook for himself and spent most of his time in bed, propped up with pillows. To feed himself, he spent the next six or so weeks ordering pizza delivery and eating it in bed, until his shortness of breath got so ...
Source: Kevin, M.D. - Medical Weblog - July 10, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/denitza-blagev" rel="tag" > Denitza Blagev, MD < /a > Tags: Tech Hospital-Based Medicine Pulmonology Source Type: blogs
I want to go dancing.....
Managing wrote:What really sucks is that no matter how many things you do to keep yourself busy you are still kind of forced to be alone as the spouse of a chronically ill person. I want so badly to go dancing with a man. To go on little adventures together instead of just sitting in the house with a blaring TV in order be with him. . . and him dozing in and out of sleep anyway. I am very lonely. Friends just don't fill the spouse gap. I think I will always be mad at him for not caring enough about my quality of life to even TRY to take care of his health so he can do things with me. He has given up on life. And in do...
Source: Wife of a Diabetic - July 7, 2018 Category: Endocrinology Tags: congestive heart failure dancing dementia diabetes ketoacidosis Source Type: blogs
An aging physician muses on end-of-life care
As a retired physician who has written a book about end-of-life issues for elderly patients, I have placed myself in an awkward position. According to most guidelines, at age 67, I am elderly. How will I approach the end of my life?
Not only do my personal medical concerns career around in the echo chamber of my own mind, but I have the added challenge of trying to follow my own advice regarding end-of-life decision making. And, there are multiple examples of physicians who did not do that.
Witness the example of Francis Warren, Harvard’s most famous surgeon of the 20th century, renowned for heroic cancer surgeries and p...
Source: Kevin, M.D. - Medical Weblog - May 21, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/samuel-harrington" rel="tag" > Samuel Harrington, MD < /a > Tags: Physician Palliative Care Source Type: blogs
We Should Use Both Medicare Advantage for All and Medicaid As A Package to Cover Everyone And We Should Do It Now
BY GEORGE HALVORSON
A growing number of people want to set aside all of our current health care financing approaches as a country and set up Medicare For All as a Canadian like single payer system to cover every American and pay for our care.
When we spend three trillion dollars a year on health care and still have thirty million people without insurance, the possibility of covering everyone using the most direct and simple approach has some obvious appeal.
That Medicare for All approach being proposed to Congress today would be funded with a half dozen taxes that would include making income tax more progressive and inheri...
Source: The Health Care Blog - April 6, 2018 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized George Halvorson Medicaid Medicare Advantage for All Source Type: blogs
What is the perfect fee-for-service system?
It is wildly popular to say that the chief culprit in the U.S. health care system is the traditional fee-for-service payment system, which rewards physicians for volume but not quality, leading to high-cost, low-quality health care. It supposedly follows that the fix is a system of “value-based” payments.
Despite the popularity of these arguments, both aspects have been shown to be wrong. Studies show that the rising cost of American health care is due primarily to rising prices, and that value-based payment systems do not reliably lower the costs of care or improve quality. In fact, despite what the “experts” say,...
Source: Kevin, M.D. - Medical Weblog - March 29, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/matthew-hahn" rel="tag" > Matthew Hahn, MD < /a > Tags: Policy Public Health & Washington Watch Source Type: blogs
