Wednesday, November 11, 2009

Reader Beware: Health Statistics Can Be Misleading

There was a recent article “Patients More Likely to Die While in ICU in U.S. than in England.” http:///The lead sentence of the article states that: "dying hospital patients in the U.S. are nearly five times more likely to spend their last days in the ICU than are patients in England." The article goes on to say that “the death rate among patients who received intensive care in England was nearly three times higher than in the U.S.”

There seems to be a contradiction here. Information extrapolated from a study done by Columbia University researchers who compared data from England to data from seven states in the U.S. points out the need for further investigation to evaluate why so many elderly Americans end up in the ICU and what that says about our approach to end of life care. It is a valid issue that goes right to the heart of how we spend money in healthcare. It also points out how sensational and misleading headlines can affect public perception about the real story. Reading through this article tells us that although more Americans than Brits spend their last days in the ICU, the death rate for intensive care patients in the UK is higher, (in fact three times higher).

There was a similar situation when the World Health Organization rankings of health performance in countries around the world were made public. WHO ranked the United States 37th, in health performance behind nations like Morocco, Cyprus and Costa Rica. Finishing first and second were France and Italy. U.S. citizens reading these headlines were astonished. What was not stated in the media stories is that health performance from country to country is not measured on the same yardstick. Healthcare quality is affected by many things including delivery systems, payment systems, lifestyle choices among the population - even injuries resulting from criminal acts and accidents. Additionally different countries have vastly different reporting and legislated requirements that change the statistics based on what is revealed and what is ignored. In other words the publicity promulgates an evaluation that does not consider structural, cultural and philosophical differences among countries as well as the scope of the healthcare infrastructure.

Statistics that compare the U.S. and other countries are meaningless and neglect to inform us that national health systems portion out care with restraint that the American public might not feel is an acceptable standard. Let us not be lulled into believing that our standards of care are either beyond reproach or are so low that we deserve the media dispersions. We have a lot of work to do to improve care access and quality of care. We also, in most instances, are not as bad as the media would have us believe.

Monday, September 14, 2009

Connected Health Lowers ER Visits and Healthcare Costs

One of the biggest culprits contributing to high healthcare costs is that people go to the emergency room when they cannot, for whatever reason, see their doctor, or do not have a doctor because they are among the more than 46.3 million uninsured Americans. (Latest count from the U.S. Census Bureau). President Obama so aptly described this situation in his recent address to the joint session of Congress, when he talked of the catch 22 situation experienced by those who have health insurance and who not only pay their own high premiums, but also pay a hidden tax in the high healthcare costs generated by ER use and other charitable care of the uninsured.

There are nearly 120 million visits annually to the ER for conditions that range from a simple stomach ache, the flu or a sore throat to more serious flare ups experienced by the more than 130 million Americans who suffer with chronic diseases. Nearly 50% of Americans had at least one chronic medical condition, which could include diabetes, high blood pressure, cancer and heart failure. These individuals tend to have more frequent need for emergency care than others.

Connected Health also known as telemedicine is a new way of delivering healthcare to individuals with chronic conditions and those who are homebound or to all those who live in more remote areas where there are few medical facilities. Connected health is enabled by the convergence of the Internet, high bandwidth telecommunications, video technology; the development of CT scanning and electronic scopes, the availability of sophisticated robotics and sensors, and the spread of electronic health records. The concept behind connected health is to provide the pathways and to give patients the tools, education, and responsibility to better manage their own health with the assistance of networks of medical providers who steps in when and where needed.

These empowered patients use tools including sensor devices, such as weight scales, that measure fluid retention, devices for checking, taking and recording blood sugar levels, and widgets that can detect when patients take their medication. There is also clothing that measures blood pressure, oxygen levels, and body temperature, and implantable cardiac monitors. All of these devices are tied to communication systems that send data to a healthcare provider. When something goes awry, an immediate solution is put in place so that many trips to the ER can be avoided.

The annual Connected Health Symposium, Up from Crisis: Overhauling Healthcare Information, Payment and Delivery in Extraordinary Times will take place in at Boston on October 21, 22. These two days of lively sessions include discussions on healthcare reform, patient-centered healthcare new developments in mobile health technology and chronic disease management and more. For anyone interested in healthcare reform spearheaded by the deployment of new technologies in medicine, this is a must.

The promise of the connected health movement, which represents another facet of health reform is that it provides an infrastructure and the tools to change health behaviors, adjust the way we think about resolving a health crisis and, over the long term, significantly cut the cost of caring for many people, especially those with chronic conditions. In the short term, like everything else on the road to reform, connected health will cost money to deploy. However, for those who have the vision to take the longer view, the promise to realize significant savings cannot be ignored.

Monday, August 3, 2009

Fighting Obesity One Pound at a Time

Just days after I wrote “Lose Weight, Get Healthier, Not So Easy!” the CDC ( that about 10 percent of medical costs in this country are linked to obesity. Expenditures of $147 billion per year or 9% of all medical dollars spent treat problems related to weight. One out of three Americans is carrying an average of 23 extra pounds. The CDC study points out that obese individuals’ health costs are approximately $1500 (@41%) more than individuals who do not have weight issues. Most of that money goes to pay for prescription drugs to control diseases such as Type II diabetes and heart conditions. These same individuals also have a higher incidence of disability and early death.

Twenty three pounds, you say, look around you! Who does not have 20 or more pounds to lose? It is easy to justify carrying extra pounds when everyone has the same problem. It is extremely difficult to follow a regiment to shed those pounds by modifying your diet. Everywhere you turn, you are tempted by high fat, high sugar, high calorie foods some of which are touted as “healthy”. Even when you think you are healthy because you exercising several times a week, if you do not shed pounds you need to pay attention.

The CDC ( looks at the bigger issues – the health of the nation and how to implement changes that impact everyone including: regulating how foods are marketed and presented to the American public; taxing those foods that offer no nutritional value and educating Americans on healthy eating habits. I suggest they also look at regulating the multi-million dollar diet industry and those diet promoters who push fad diets and quick weight loss programs, many of which encourage you to continue to eat the same foods (albeit in smaller portions) that got you to where you are. The record shows that as soon as you go off those diets, you gain back all the weight you have lost and more.

The key to reducing the overweight population is to change people’s eating habits. For starters people need to eliminate all juices and sodas and products that contain white sugars, corn starch, and white flour. There are healthy eating programs and healthy foods are on the grocery shelves alongside the bad foods.

The USDA has a website ( where individuals can go to learn about the recommended healthy foods, register and enter their name, age, weight. They can record and track their daily food intake and exercise program and the USDA site creates an individualized set of recommendations. It is an eye opener. The calories you think you have eaten are generally higher the exercise program you think you have completed to counter-act your intake of food is lower than required.

None of us are ready to give up the piece of apple pie with ice cream, chips, hot dogs, and glass of wine or beer completely. However, if we begin to understand what we are eating and how that fits in the overall nutritional scheme, it will be a start toward to a healthier nation.

Sunday, July 26, 2009

Lose Weight; Get Healthier, Not So Easy!

In my last blog ("Should we be Paying Individuals for Good Health Habits") I advocated that healthcare insurance companies reward their customers for practicing good health habits including: exercising, losing weight and quitting smoking, by reducing insurance premiums thus putting money back into their customer’s pockets. In the long term this alone will lower the number of people who suffer from chronic disease and save millions in healthcare costs.

Many applaud this idea which is embedded in the healthcare reform legislation that is currently being discussed. Several health plans now pay a percentage of a person’s health club or weight loss program fee. However, in spite of exercise and a million different diet programs, when it comes to losing weight and keeping it off, most people simply cannot win this battle. Who cannot say that they have lost 10 pounds only to gain back 15 pounds a year later? We live in a society where richer, fattier food in large portions is marketed to the American public as a way to experience the good life.

In a recent Boston Globe column: “Putting Obesity out of business” (,Ellen Goodman points out that overweight people are not where they are just because they do not have the will power to resist food but because we live in a country that makes it cheaper to buy fast food than fresh food; where portions served are bigger and where the food industry works very hard and spends a lot of money to make it attractive for us to eat more.

Accolades should be given to the Starbucks coffee shops in New York City where they are posting the outrageous number of calories in the drinks and pastries they sell, which for many are standard breakfast fare every day, (caramel macchiato grande whole milk 319 calories; white chocolate mocha venti, with skim milk 628 calories, classic blueberry muffin 422, mixed fruit scone, 335 etc.). Every Starbucks should adopt that policy.

If it became a law that every food company from MacDonald’s with its Big Mac – 540 calories, large fries – 539 calories, to the local ice cream parlor posted the calories of the foods that they sell; perhaps we would see a reduction in the pounds that people are carrying with them.

Hopefully, with more education, less marketing hype from the big food companies and posted calories people would begin to understand the real story behind what they are ingesting.

There are over 130 million Americans who suffer from chronic conditions, many caused by abusing their bodies with drinking and eating bad calories and introducing smoke and inappropriate drugs into their bodies. Millions more are on the brink of Type II diabetes, asthma, heart disease caused by over-indulging in bad eating and drinking. In discussions on healthcare reform, shaking up the food companies could go a long way toward a healthier nation.

Monday, July 20, 2009

Should We Pay Individuals for Good Health Habits, You Bet!

We have all heard about pay for performance for physicians. Now there are proposals that would, in effect, pay individuals for good performance for controlling their bad health habits by quitting smoking, changing their eating habits and losing weight.

In my book, Digital Communication in Medical Practice published by Springer for a physician audience, I propose that individuals should be compensated for recognizing the importance of good health habits and following through on programs that encourage them to make changes in the way they live.

A provision in the healthcare overhaul bill that is before the U.S. Senate right now proposes to reduce health insurance premiums by as much as half for those members who change their habits through exercise, weight loss and no smoking. This proposal has the potential to save employers thousands of dollars per year with a healthier workforce that has fewer lost days of work, more energy to perform at peak and less chronic diseases like Type 2 diabetes and hypertension.

In a recent Boston Globe article, writer Michael Kranish reported that some companies such as Safeway and EMC Corporation have already adopted such programs and provide positive feedback on their success. EMC offers its employees a 12 percent reduction in their insurance payments – approximately $300 savings annually on a family plan – for employees who take a health risk assessment and engage in sessions with a “life style coach” that the company offers. According to Delia Vetter who is in charge of the EMC project, about 90 percent of the company’s US workers participate in this program.

The Safeway grocery chain also provides reduced health insurance to its nonunion employees who demonstrate that they can meet certain health measures or take definitive steps to make themselves healthier, including quitting smoking and weight loss. About 74 percent of their workers participate and their savings can be as much as $1,560 per year for workers who have a family plan.

Politics as usual is rearing its ugly head in these discussions as some Congressmen and Senators try to ban provisions in legislation that would pay individuals to get healthier. We can only hope that enough members of Congress have the foresight to take the long view and understand that giving employers a model that encourages employees to work at becoming healthier will lower healthcare costs and elevate the quality of health for all of this nation’s citizens.

Thursday, February 26, 2009

Digital Diagnosis: A New Dimension

A New York Times Magazine story “The Medical Detectives” by Robin Marantz Henig (Sunday, February 22, 2009) described the efforts of a unique medical team at the National Institutes of Health that takes on very sick patients with complex multiple problems and tries to figure out the mystery of what happened to these individuals. The unique approach of these doctors at NIH who are part of the Undiagnosed Diseases Program is to look at the entire litany of issues that the patient presents and not one problem at a time. Although their efforts may not cure the individual patients they are reviewing, they promise to provide new insights that could impact future generations.

This exciting work coupled with the research coming out of work on the human genome that has unveiled unimaginable insights about the functioning of the human body in relation to genetic mutations, has the potential to revolutionize the way that healthcare professionals approach disease. A key enabling technology to accomplish such intense data analysis and problem solving is the digitization of patient information, using an electronic health record. At the most basic level, the wide-spread use of the EHR for data analysis purposes enables healthcare professionals to aggregate baseline information on disease across populations. From this information they make assumptions that apply to a wide spectrum of health issues. Digital diagnosis is being used in little pockets throughout the medical world. The expansion of electronic health records throughout the population and the sophistication of these intelligent digital databases promise a new way of looking at health problems that astute diagnosticians such as the team at NIH will deploy to understand and ultimately cure many of the diseases that plague the citizens of the world.

Friday, January 16, 2009

Sick Economy, Sicker Patients

The Commonwealth of Massachusetts recently announced that its senior citizens are going to experience significant increases in their copayments for prescription drugs as a result of an $11 million cut in the state-funded Prescription Advantage program that was set up to defray pharmacy costs for eligible seniors. The cut is part of the $1 billion in funds slashed by the Governor Duval Patrick in October 2008 due to the economic recession.

Many other states facing similar huge deficits are also reducing services to the most vulnerable citizens. At least 19 states have proposed or implemented cuts that will affect low-income children’s or families’ eligibility for health insurance or reduce their access to health care services. For example, Rhode Island eliminated health coverage for 1,000 low-income parents; South Carolina is limiting coverage for many services, such as psychological counseling, physician's visits, and routine physicals; and California and Utah are reducing the types of services covered by their Medicaid programs.: At least 17 states plus the District of Columbia are cutting medical, rehabilitative, home care, or other services needed by low-income people who are elderly or have disabilities.

Almost 90 percent of individuals, age 65 and older, take an average of five or more prescription drugs daily. Many of these same individuals are retired and on a fixed income; 25% report that they do not fill one or more of the prescriptions their doctors write for them because of the cost. Others skip days or cut their dosage to make the prescriptions last longer.

In 2005, The New England Journal of Medicine reported that 33 - 69 percent of medication-related hospital admissions in the U.S. were due to poor medication adherence with a resultant cost to the American public of over $100 billion a year, because non-adherence results in more hospitalizations and more emergency room visits. This was part of the reason why Medicare instituted the drug benefit program, hoping Medicare Part D would make prescriptions more accessible and affordable.

In spite of the economic glitches that we face, as a society we have a responsibility to provide basic and essential health services to all individuals. What is going on with prescription drug co-payments and its impact on medication adherence should be concerning to payers, physicians and patients. When we accept short term solutions, such as cutting the budget for health reimbursement, we create longer term costly problems. When we force bands of citizens to seek care in emergency departments or end up as in-patients, the costs mound at a much steeper rate than if we foot the bills that keep co-payments at an affordable level. Doctors and patents need to work together to look at all possible options for addressing immediate and chronic health medication needs, including greater use of generics, and cooperative arrangements with pharma companies, associations and public agencies that might help fund some of the medical requirements of citizens who cannot afford to pay the full tab that is being asked of them. A sicker society is not an answer for anyone!!