Viewpoints: Ryan and Medicare; Va. ultrasound bill 'overreaches'?; NEJM on patient-centered care

Mar 1 2012

The Wall Street Journal: Ryan's Medicare Revolution
Over the past year, an entitlement revolution has taken place on Capitol Hill. ... The revolution involves Medicare, the health-care program for the elderly and the single biggest cause of America's looming debt crisis. Reform of Medicare would be achieved by a policy known as "premium support." It would bring consumer choice and spending restraint to the beleaguered program (Fred Barnes, 3/1).

USA Today: Editorial: Olympia Snowe Leaves Void At The Center
Snowe stood out. Despite great pressure, she voted for the 2009 stimulus measure and the 2010 banking reform law, and she worked to craft the health reform law (though she voted against the final version). Without people like her, the Congress, indeed the whole nation, will suffer (2/29).

Boston Globe: Warren Risks Morphing Into The 'Woman's Candidate'
Talking about sex is so much better than talking about gas prices. Democrats are thrilled that birth control is a major issue not only in the presidential election, but in Senate contests across the country. But be careful what you wish for, especially if you are a woman running for the US Senate in Massachusetts (Joan Vennochi, 3/1).

The Washington Post: Even With Watered-Down Ultrasound Bill, Virginia GOP Overreaches 
When doctors elect to do ultrasounds that early in a pregnancy, they are generally the transvaginal variety. But it's critical that they be done consensually, within the privacy of a doctor's relationship with a woman seeking an abortion -; not as the result of meddlesome state intrusion (2/29).

Chicago Sun-Times: Women, Be Aware: Access To Birth Control Coming Under Fire
The reality is that no woman wants to get an abortion. ... Yet mistakes do happen. Condoms break and the Pill doesn't always work. And, worse, horrific crimes occur against women everyday. Women are raped and pregnancies can happen as a result. Nothing could be worse than making these victims endure another rape at the hands of their doctor, especially in the name of a political agenda (Dr. Laura Berman, 2/28).

Sacramento Bee: Head to Head: Should Birth Control Be Considered An 'Essential Benefit' In Health Plans?
Ben Boychuk: No. ... there is no compelling government interest in making contraception an "essential benefit" of health insurance under the Affordable Care Act – certainly not at the expense of religious liberty. ... Pia Lopez: Yes.  
... Clearly, teens and women of childbearing age have unique health care needs – from birth control to prenatal care – that should be covered by health insurance (3/1).

Houston Chronicle: Health Care Work Force Will Be Tested By Reform
In order to address potential shortages that might be driven by the ACA, and take full advantage of the ACA's focus on preventive care and integrated care delivery, Congress and state legislatures need to focus on expanding the health work force and supporting collaboration between health workers (Joanne Spetz, 2/29).

The Dallas Morning News: Editorial: Better Reporting Of Medical Reviews Is Needed
This gap in the medical reporting process -; in which the medical board is aware of investigations but hospitals are not alerted case by case -; needs to be closed. Like anyone else, doctors should be presumed innocent until all the facts are in. But for the safety of patients, hospitals should have a better way to find out about complaints than hoping that patients, internal whistle-blowers or the doctors themselves come forward (2/29).

Minneapolis Star Tribune: Let's Not Lose The Progress We've Made For Mentally Ill
Treatment must be based on the current reality that mental illnesses, including major illnesses such as schizophrenia, can be effectively treated, managed and even cured. In order to achieve this result, however, mental health facilities, including the Security Hospital, must use best practices in treatment and care. The Department of Human Services sent an important message when it placed the Security Hospital on a conditional license (Susan Segal, 2/29).

Sacramento Bee: Medi-Cal Needs To Move On Helping Kids
Perhaps the bureaucrats who run the state's Medi-Cal dental program would move more quickly to improve dental service for Sacramento kids if it were their own children waiting for months for their cavities, broken teeth and abscessed molars to be treated (3/1).

St. Louis Post-Dispatch: The Many Ways Benefits Managers Help Pharmacies
Express Scripts, Medco and other PBMs have played an important role in helping retail pharmacies gain the benefits of modern technology. Before PBMs existed, reimbursement from insurers involved paper forms, carbon copies and long waits for payment. Today, our payment processing systems give pharmacists more time to spend counseling patients instead of filling out forms. ... Express Scripts and other PBMs partnered with independent and chain pharmacies to create the nation's largest e-prescribing network. ... The use and promotion of e-prescribing saves lives, improves quality and decreases costs for pharmacies. This type of innovation is a hallmark of what we do currently and what we expect to do more of if our merger with Medco is completed (Dr. Steve Miller, 2/29).

In addition, the New England Journal of Medicine had a number of "Perspectives" pieces in this week's issue:

New England Journal of Medicine: Supreme Court Review of the Health Care Reform Law 
If the Court upholds the ACA, the number of people with health insurance coverage will swell by as many as 32 million. This result would put pressure on providers to deliver more care. Currently, only about two thirds of physicians accept Medicaid patients, so the burden of serving the newly eligible populations would fall disproportionately on these physicians. The ACA begins to address this problem with workforce-development provisions. In addition, at least in the short run, health care costs would probably increase, though the ACA contains some cost-control measures (Dr. Gregory D. Curfman, Brendan S. Abel,  and Renée M. Landers, 2/29).

New England Journal of Medicine: Goal-Oriented Patient Care -; An Alternative Health Outcomes Paradigm 
Attention to patient-centered measures and outcomes will be particularly important as CMS moves increasingly to link health care providers' reimbursement to their performance on selected measures. ... Perhaps the most important barrier to goal-oriented care is that medicine is deeply rooted in a disease-outcome–based paradigm. ... Ultimately, good medicine is about doing right for the patient. For patients with multiple chronic diseases, severe disability, or limited life expectancy, any accounting of how well we're succeeding in providing care must above all consider patients' preferred outcomes (Drs. David B. Reuben and Mary E. Tinetti, 3/1).

New England Journal of Medicine: Shared Decision Making -; The Pinnacle of Patient-Centered Care 
Over time, advances in medical science have provided new options that, although often improving outcomes, have inadvertently distanced physicians from their patients. ... Patients should be educated about the essential role they play in decision making and be given effective tools to help them understand their options and the consequences of their decisions. ... Clinicians, in turn, need to relinquish their role as the single, paternalistic authority and train to become more effective coaches or partners -; learning, in other words, how to ask, "What matters to you?" as well as "What is the matter?" (Dr. Michael J. Barry and Susan Edgman-Levitan, 3/1).

New England Journal of Medicine: Defining "Patient-Centered Medicine" 
A patient consults an orthopedist because of knee pain. The surgeon determines that no operation is indicated and refers her to a rheumatologist, who finds no systemic inflammatory disease and refers her to a physiatrist, who sends her to a physical therapist, who administers the actual treatment. Each clinician has executed his or her craft with impeccable authority and skill, but the patient has become a shuttlecock. Probably a hassled, frustrated, and maybe bankrupt shuttlecock. ... Health relies on collaboration between the patient and the doctor, with many others serving as interested third parties. Patient and physician must therefore meet as equals (Dr. Charles L. Bardes, 3/1).