Accountable Care Organizations, explained

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Question Q&ABy Jenny Gold
KHN

One of the main ways the Affordable Care Act seeks to reduce health care costs is by encouraging doctors, hospitals and other health care providers to form networks that coordinate patient care and become eligible for bonuses when they deliver that care more efficiently.

The law takes a carrot-and-stick approach by encouraging the formation of accountable care organizations (ACOs) in the Medicare program. Providers make more if they keep their patients healthy.

About 6 million Medicare beneficiaries are now in an ACO, and, combined with the private sector, at least 744 organizations have become ACOs since 2011. An estimated 23.5 million Americans are now being served by an ACO. You may even be in one and not know it. Continue reading

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California approves physician-assisted suicide; Bill heads to governor’s desk

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Flag_of_CaliforniaBy APRIL DEMBOSKY
 KQED/NPR

A controversial bill to legalize physician-assisted suicide in California is headed to the governor for consideration, after almost nine months of intense — often personal — debate in the legislature.

If Gov. Jerry Brown signs the bill, California would become the fifth state to allow doctors to prescribe lethal medication to terminally ill patients who request it, after Oregon, Washington, Vermont and Montana.

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Seattle Children’s ethics conference now online (video)

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The videos from Seattle Children’s Treuman Katz Center for Pediatric Bioethics 2015 Conference, The Delicate Triangle: Responsibilities and Challenges in the Provider-Patient-Parent Relationship, are now available on the Seattle Children’s website,

Here’s the opening talk, entitled “Must We Always Tell Children the Truth?”, by John Lantos, MD,, director of the Children’s Mercy Hospital Bioethics Center in Kansas City.

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Study supports more aggressive blood pressure treatment

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From the National Institutes of Health

NIH study shows intensive blood pressure management may save lives

EKG tracingLower blood pressure target greatly reduces cardiovascular complications and deaths in older adults

More intensive management of high blood pressure, below a commonly recommended blood pressure target, significantly reduces rates of cardiovascular disease, and lowers risk of death in a group of adults 50 years and older with high blood pressure.

This is according to the initial results of a new clinical trial sponsored by the National Institutes of Health called the Systolic Blood Pressure Intervention Trial (SPRINT). Continue reading

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New heart procedure boon to patients and hospitals

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Dr. Josh Rovin, left, and Dr. Douglas Spriggs, right, perform TAVR procedure at Morton Plant Hospital in Clearwater, Florida (Photo by Phil Galewitz/KHN)

Dr. Josh Rovin, left, and Dr. Douglas Spriggs, right, perform TAVR procedure at Morton Plant Hospital in Clearwater, Florida (Photo by Phil Galewitz/KHN)

New Hope Beats For Heart Patients And Hospitals

By Phil Galewitz
KHN

CLEARWATER, Fla. – Inch by inch, two doctors working side by side in an operating room guide a long narrow tube through a patient’s femoral artery, from his groin into his beating heart. They often look intently, not down at the 81-year-old patient, but up at a 60-inch monitor above him that’s streaming pictures of his heart made from X-rays and sound waves.

As with other new medical technology, TAVR draws concerns about possible overuse or adoption by hospitals lacking proficiency, which could harm patients and increase health care costs.

The big moment comes 40 minutes into the procedure at Morton Plant Hospital. Dr. Joshua Rovin unfurls from the catheter a metal stent containing a new aortic valve that is made partly out of a pig’s heart and expands to the width of a quarter outside the catheter. The monitor shows it fits well over the old one. Blood flow is normal again.  “This is pretty glorious,” Rovin said.

The surgeon has performed one of the fastest-growing procedures in U.S. heart care known as a transcatheter aortic valve replacement, or TAVR. The operation was approved in the U.S. in late 2011 to help patients too ill or frail for traditional “open-heart” valve surgery. The procedure has rapidly gained doctors’ acceptance, particularly for patients in their 80s and 90s. Continue reading

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Medical schools teach students to talk to patients about costs

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Isaiah Roggow, a third-year medical student at the University of California, Riverside, examines patient Becky Ketchum during the school's free clinic.

Isaiah Roggow, a third-year medical student at the University of California, Riverside, examines patient Becky Ketchum during the school’s free clinic.

By Rebecca Plevin, KPCC

Time for a pop quiz:

When it comes to health care, what’s the difference between cost, charge and payment?

“Does anyone want to take a stab at it?” Sara-Megumi Naylor asks a group of first-year residents at the David Geffen School of Medicine at UCLA.

Naylor answers her own question with a car metaphor. “Producing the car might be $10,000, but the price on the window might be $20,000, and then you might end up giving them [a deal for] $18,000, so that’s cost versus charge versus payment,” she explains.

Doctors have been taught to provide the best care possible, leaving the cost considerations aside.

It might seem natural for new doctors to learn about the cost of the care they’re providing, but, in fact, doctors have been taught to provide the best care possible, leaving the cost considerations aside.

Now, in a stark departure from the past, the vast majority of the country’s medical schools now integrate discussions of cost, value and effectiveness into their curricula. Continue reading

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Congressional leaders ask FDA about Coumadin safety

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RedBloodCellsBy Charles Ornstein
ProPublica

The bipartisan leadership of the House Energy and Commerce Committee is asking the Food and Drug Administration how it monitors the safety of the popular blood thinner Coumadin, particularly in light of deaths and hospitalizations of nursing home residents taking the drug.

The committee’s letter, sent last week, follows a ProPublica report co-published by the Washington Post in July that focused on the harm caused by nursing homes’ failure to manage the drug.

Our analysis of government inspection reports found that, between 2011 and 2014, at least 165 nursing home residents were hospitalized or died after errors involving Coumadin or its generic version, warfarin.

In some cases, homes gave residents too much of the drug, which caused internal bleeding. In other cases, they gave residents too little, leading to blood clots and strokes. Continue reading

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When the hospital is your doctor’s boss, that’s where you go

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Sign for an emergency room.By Jay Hancock
KHN

Why did hospitals binge-buy doctor practices in recent years?

To improve care coordination, lower costs and upgrade patient experiences, say hospitals.

To raise costs, gain pricing power and steer patient referrals, say skeptics.

Ownership by a hospital “dramatically increases” odds that a doctor will admit patients there instead of another, nearby hospital.

Researchers at Stanford University tested those opposing arguments by comparing referral patterns between independent doctors and those working for hospitals.

Ownership by a hospital “dramatically increases” odds that a doctor will admit patients there instead of another, nearby hospital, they found.

Worse, from the viewpoint of reformers, it boosts chances that patients will go to higher-cost, lower-quality hospitals. Continue reading

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To make better policy, states seek better death certificates

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454px-EddieSchneider_DeathCertificateBy Michael Ollove
Stateline

Robert Anderson may know more about death than anybody else in the United States.

Anderson is chief of mortality statistics for the Centers for Disease Control and Prevention. Information about death flows into his suburban Maryland office from all over the country, detailing not only how many Americans have died—2,596,993 in 2013—but the causes of those deaths.

Researchers use the information to learn what kills Americans, and public officials use it to craft policies to improve health and safety.

Researchers use the information in death certificates to learn what kills Americans, and public officials use it to craft policies to improve health and safety.

On the best certificates, the information is accurate and complete. That would mean, for example, that the death certificate would say not only that someone had died of a drug overdose, but that the drug had been heroin.

If the departed had died of cardiac arrest, the certificate would say that death resulted from a heart attack and it would disclose that the person had been a lifelong smoker and overweight.

Unfortunately, many death certificates are incomplete or inaccurate. When multiplied across thousands and thousands of cases, such gaps can translate into a faulty understanding of mortality in the United States, and affect how money is spent on research and prevention. Continue reading

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Surgeon General wants to get us to “Step it up”

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US Surgeon General issues a “National Call to Action on Walking”

In a new report, US Surgeon General Dr. Vivek H. Murthy calls for Americans to take up walking to improve their health and reduce their risk of developing diabetes, cardiovascular disease and other common conditions.

The report, called  Step It Up! The Surgeon General’s Call to Action to Promote Walking and Walkable Communities, discusses the health benefits of walking and calls on individuals to make walking a priority in their lives. Continue reading

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Health programs face funding cuts

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United States Capitol Building

Congress faces budgetary decisions, worrying advocates for medical research, teen pregnancy prevention and other federal initiatives.

Planned Parenthood isn’t the only health program targeted for funding cuts

By Julie Rovner
KHN

Federal funding for Planned Parenthood will clearly be a flash point when Congress returns this week from its summer break.

But the fate of many other health programs, from the National Institutes of Health to efforts to reduce teen pregnancy, hang in the balance as well, as lawmakers decide whether and how to fund the government after the current fiscal year expires Sept. 30. Continue reading

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More than half of Asian Americans with diabetes are undiagnosed

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New statistics also show rising prevalence of diabetes among all groups

From the National Institutes of Health

More than half of Asian Americans and nearly half of Hispanic Americans with diabetes are undiagnosed, according to researchers from the National Institutes of Health and the Centers for Disease Control and Prevention. Their results were published Sept. 8 in JAMA, the Journal of the American Medical Association

Additionally, prevalence of diabetes for all American adults went up, from nearly 10 percent to over 12 percent between 1988 and 2012.

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The graph shows the percentage of the U.S. adult population – both as a whole and by ethnic/racial subgroup – with diabetes (blue bars) and the percentage who have diabetes that has not been diagnosed (green bars), according to findings from researchers supported by the NIH and the CDC and published in the Sept. 8 issue of JAMA.

Diabetes prevalence – how common the condition is – also went up in every age, sex, level of education, income and racial/ethnic subgroup. Continue reading

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