As Congress prepares to return to Washington DC, health reform continues to dominate the domestic agenda.

I have gathered up a number of resources that might help cut through the rancor, fear mongering, and distractions that have become the hallmark of one of the fiestiest recesses on record.

These are only 3, but there is an incredible amount of information here and they are among the best resources, in my opinion.  If you know of others, please feel free to pass those along.

Here then are a few of my “go to” sites:

KAISER FAMILY FOUNDATION

A short paper released by the Kaiser Family Foundation explains how government subsidies—an integral part of most major health reform plans under consideration in Congress—work.

The paper is only one of  a number of resources available on the Foundation’s health reform gateway page, which serves as “a clearinghouse of key information, news and analysis about national health reform efforts. The gateway includes an interactive online tool allowing users to compare major health reform bills, the Foundation’s research and analysis on key issues in health reform, as well as Kaiser’s polling data.”

HEALTH AFFAIRS & ROBERT WOOD JOHNSON FOUNDATION

“The latest Health Policy Brief (PDF) from Health Affairs and the Robert Wood Johnson Foundation offers basic facts about the status quo and about how major pieces of reform legislation might affect the picture. In each of the areas described above, the Brief describes what’s true now, and what could change under health reform.

The briefs are geared to policymakers, congressional staffers, and others who need short, jargon-free explanations of health policy basics. The briefs include competing arguments from various sides of policy proposals and the relevant research supporting each perspective.”

NATIONAL HEALTH POLICY FORUM

I am particularly partial to The Forum as I used to work there…Here’s what you will find on their website, www.nhpf.org:

“The Forum has convened a series of small-group discussions to help senior federal staff navigate the ins and outs of the individual insurance market, as well as options for reform. To date, topics have included underwriting, rating, and regulation; insurance exchanges; risk adjustment; and actuarial equivalence. Future meetings will add to these fundamental building blocks.

As speaker slides and related materials become available, we’re posting them to a special Health Reform section of our Health Policy Essentials page. They’re also available under the entry for each meeting.”

In the midst of furious showdowns on health care reform at town hall meetings, a moment of peace surfaced in Montana when President Obama drew bipartisan applause after calling a mother heroic.  This mother of two had voiced her concern about the Medicaid program she relied on for her child who has multiple chronic conditions.  The president reassured her and went on to discuss how our disease-care system does not proactively manage chronic conditions.

Children and young adults with chronic medical conditions and disabilities (CMCD) need proactive management now and for their entire lives.  Our health care system fails to serve the young people who need it the most.

Children with CMCD are completely dependent on adults for their health care.  Poor health management negatively affects their growth and development, education, and socialization – and drags the entire family down.  As the mother of a young adult with CMCD and the founder of a non-profit created because of our experiences with poor quality health care, I cannot understand why this population is not a major focus of health care reform.

One path to start on is to build on successful programs to create a comprehensive system of care.  Take a look at the 35% of children with CMCD covered by SCHIP/Medicaid. Medicaid provides a specialized set of comprehensive services known as EPSDT, Early Periodic Screening, Diagnosis, and Treatment Program. The current model of care in favor for chronic conditions is the medical home. First conceptualized by the American Academy of Pediatrics for children with CMCD in the 1960s, the medical home has yet to become the standard of care for children with CMCD in Medicaid.  Pairing EPSDT with the medical home would be a step forward in developing a system of care for children covered by Medicaid.    Another step is to expand EPSDT and medical homes to cover the remaining publicly covered children with CMCD enrolled in SCHIP.

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One of my favorite movies is 1776, the musical.

In July 1776, Congress was working on the Declaration of Independence. A rather controversial undertaking with far reaching implications. In July 2009, Congress was tackling another controversial undertaking with far reaching implications. I am speaking of course about health reform.

The parallels, and lessons learned, are striking.

Today, health reform has its Gang of Six (Senators Max Baucus, Jeff Bingaman, Kent Conrad, Charles Grassley, Michael Enzi, and Olympia Snowe). Congress in 1776 appointed a Committee of Five (John Adams, Ben Franklin, Thomas Jefferson, Robert Livingston, and Roger Sherman) to assist with the drafting of the Declaration of Independence.

President Obama observed that during July and August “everybody in Washington gets all wee-weed up.” John Adams, equally frustrated with the pace of Congress, sputtered that all Congress did was to Piddle, Twiddle and Resolve…(and Not One Damn Thing Do We Solve.)

But perhaps the most important parallel was the challenge of one overwhelming lightning rod of an issue. In 1776, it was slavery—Jefferson, Adams and Franklin wanted to include emancipation along with Independence. Now, I want to be clear that I am by no means equating slavery with Obama’s public option in health reform. Rather, I am pointing out the parallel of how one controversial issue has (had) the power to (almost) derail an act of Congress.

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For the last 30 years, at the Lincoln Recovery Center in the Bronx, Dr. Michael O. Smith has managed a successful drug detoxification program that relies on ear acupuncture as its primary medical modality. In the 1970’s the program was geared entirely towards heroin addicts that had made their way into the Methadone maintenance clinic. Through trial and error Dr. Smith, who is both an MD and a certified acupuncturist, and his colleagues, discovered that the daily insertion of five acupuncture needles in each ear for about 45 minutes achieved results similar to what the addicts experienced in the Methadone maintenance clinic. In the past twenty years, Dr. Smith has brought the solution, known as the NADA (National Acupuncture Detoxification Association) Protocol around the world. The protocol is used on all prison inmates in Great Britain. In fact, more than 1500 clinical sites in the US, Europe, Australia and the Caribbean currently use these acupuncture protocols as an adjunctive treatment for addictions and mental disorders.

As part of my own study of integrative medicine in America, I spent the month of July learning the NADA protocol from Dr. Smith and his staff. Over 7,000 mental health and acupuncture professionals have been trained at Lincoln Recovery Center over the years. The training, which takes approximately two weeks, is streamlined, focused, and involves a peer teaching component with feedback and quality control mechanisms. During my training period, I met individuals from Denmark and England who traveled to the U.S. just to be trained in the protocol. After we completed our initial training, we treated patients who showed up, religiously each day, to receive their ear acupuncture. The clinic consists of about 80 comfortable, high backed chairs lined up, one next to the other. Patients check in, grab an alcohol pack, take an empty seat, and swab their ears clean. Once they have cleaned their ears, they raise a hand and the next available acupuncturist makes his way over to quickly insert the five needles in each ear. This process takes about 3 minutes. Then, in the quiet of the room, the patients rest their heads on the back of the chair, most close their eyes and meditate or sleep, though some read. After about 45 minutes have passed, the patient raises his hand. An acupuncturist hands the patient some gauze, removes the needles, and the patient is free to leave – until tomorrow, when the process is repeated again – all in the name of remaining drug-free.

What I experienced during my training at the Lincoln Recovery Center was not only an effective treatment for addictions, but also a process that empowered the individual to become responsible for himself and his actions – perhaps going to the true root of an addiction. Everyone of these patients showed up willingly, participated in their own care (when was the last time a nurse asked you to swab your arm before drawing blood for a test?), and took ownership of the process and of their own actions.

Here’s the kicker…..given the streamlined training, medical supervision component (at least as it is administered in New York state), and number of people that can be treated concurrently, it is estimated that the cost for this service is about one dollar per person per treatment, or about 300 dollars a year. The effectiveness of this treatment has been proven in over 30 years in over 1500 clinical sites in over 25 countries. Yet, here in the US, the country of the NADA protocol’s origin, health insurance does not pay for this service. In fact, in some states, the protocol is not permitted to be administered at all. If decreasing illegal drug use, decreasing the cost of care, increasing patients’ responsibility for their own care, and increasing the effectiveness of care all while using safe (low risk) modalities are goals of health (or health insurance) reform, shouldn’t modalities like NADA be acknowledged, used and for God’s sake paid for? For more on NADA, the non-profit association, see www.acudetox.com .

Last night I saw a sobering statistic, reporting audience numbers for Fox News, CNN, and MSNBC. It was instructive. Put in overly simplified terms, if 5 people are watching cable news, three of them are watching Fox News, one is watching MSNBC, and one is watching CNN. It seems to me that there is some embedded information here. Three people are being scared to death, while only two might be getting a somewhat more nuanced picture of the nation’s response to health care reform.

I have to admit that I was heartened to see MSNBC edge ahead of CNN. Rachel Maddow is doing the closest thing to investigative reporting I can find on cable, though I think her colleagues at MSNBC, with a few exceptions, are not noticing this, even though her rankings keep swelling. She is also the “young” and “very intelligent” player in this drama. She consistently references the successes of her colleagues, though they rarely return the favor. She understands the role of the internet as no other commentator. There is probably some embedded information in all these facts too.

One of the most bizarre aspects of watching our collective response to the potential of a real change in health care is the fixation by cable news on the political gamesmanship of the process, likening these games to games of the past in a rather nostalgic tone of voice. There is thus an overt neglect of the issues. Hence, I have an excess of information about who thinks who is doing stuff behind the scenes (reference Ronald Reagan and Bill Clinton here) and almost no factual information on the realities of the health care world. The rare exceptions are noteworthy because they are rare.

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Disruptive Women is pleased to make Dr. Steven Wartman,  President and CEO of the Association of Academic Health Centers, our August Man-of-the-Month. He sat down with Disruptive Women’s Wendy Grossman in his office to talk about the Association of Academic Health Centers’ work on Capitol Hill, health reform, his new blog, missing students and patients, and why he became a doctor.

Q: Tell me about AAHC and your work in Washington DC.

A: First, let me start by describing what constitutes an “academic health center.” It is an accredited, degree-granting university that consists of a medical school, one or more other health professions schools (such as nursing, dentistry, pharmacy, allied health, etc), and a relationship with a teaching hospital or health system. Examples in the immediate DC area include: George Washington, Georgetown, Howard, and the Uniformed Services University of the Health Sciences. In addition to their missions of health professions education, patient care, and research, academic health centers are also economic engines for their communities and often are among the largest employers in their region. And the products from their research have a lot of value in the commercial world, leading to the development of new treatments.

Q: What’s the most important thing you’ve done since you’ve been AAHC’s President?

A: Set a strategic direction for the organization.

Q: Which is what?

A: Our strategic direction is based on three founding principles: in all we do, we wish to strengthen, advocate and lead on behalf of the nation’s academic health centers. Specifically, in addition to general advocacy, we’ve prioritized three main areas: the organization and management of these highly complex enterprises (whose budgets often run into the billions), the health professions workforce (having enough of the kinds and types of health professionals that the nation needs), and the regulatory environment (trying to harmonize the numerous regulations that impact academic health centers in their mission areas of education, patient care, and research). As one example of the impact of regulation, we’re actively involved in assuring that clinical trials, which are critical for testing new therapies and procedures, can be conducted efficiently with proper protection of patients.

Q: How has your job changed since President Obama took office?

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Who is the most disruptive Member of congress in the current health care debate?

Enter Disruptive Women’s Facebook contest for your chance to win a free coffee mug!

Those who have spent their careers in the trenches of healthcare and are now reading the uncertain headlines in the news each day and fearing for the future of healthcare, fear not! There are fresh crops of enthusiastic students, eager to make a difference and keep the ball rolling in the quest to improve healthcare, sprouting up in graduate programs starting across the nation this summer.

Having started the Johns Hopkins Masters of Public Health (JHSPH) program in July, it has been a thrilling month and will no doubt be a fast year with many choices to make for classes, volunteer opportunities, and research projects. The plethora of options was described by one former student as “going to the grocery store when you’re hungry.” Not to mention, each student shopping in the “grocery store” is a Type A overachiever with diverse interests and remarkable accomplishments under their belts. It is no exaggeration that it is difficult to get a seat in the first few rows of the lecture halls—it is just that kind of crowd.

Each day has been a new adventure with exciting speakers further energizing us and spurring new thoughts and ideas, laying the groundwork for our future studies this year. Countless fliers for seminars to attend cover the bulletin boards week after week, and we each have several hundred courses for credit from which to choose during our 11-month program.

As the summer session comes to a close and I find myself in the throes of final exams, I not only have learned the principles of epidemiology and environmental health but also have taken away several overarching lessons with widespread implications:

• Change is possible, even if the odds are against you. Dr. D.A. Henderson, former Dean at JHSPH, spoke to our class about the global campaign he led to eradicate smallpox in the 1960s when no infectious disease had ever been eliminated on such a large scale.
• Even if wide scale change is not immediately plausible, something—no matter how small—can still be done. For instance, Howard County, Maryland took it upon itself to help its own uninsured residents by launching the Healthy Howard Access Plan to provide basic health services to those unable to obtain or afford health insurance.
• The American people can successfully unite to affect healthcare change. Polio: An American Story (required reading for incoming MPH-ers) by David Oshinsky, a Pulitzer Prize-winning historian, depicts the true story of Americans coming together despite socioeconomic class or political party to find a vaccine for polio.

Needless to say, with just one term under my belt, the JHSPH motto “protecting health, saving lives—millions at a time” doesn’t seem such a far-reaching feat after all. This thinking that is shared with my classmates is proof that midterms and finals have not tarnished our raring-to-go attitudes or deflated our ideas and dreams about improving the health and lives of many. And hopefully knowing this will help some of my more seasoned colleagues out there rest assured and sleep a little easier.

Sam, a 70 year old healthy man, sat on the table in his urologist’s office for his one year follow up visit. Twelve months prior to this visit, Sam had bladder stones and an enlarged prostate. Dr. Rosenthal, his urologist, removed the stones and some prostate tissue during a hospital-based outpatient surgery. The surgery went well, and during the two-week follow up visit, Dr. Rosenthal informed Sam that he would not need to see him again for a year. One year later, as Dr. Rosenthal walked into the exam room eyeing Sam’s medical record he stopped for a moment, raised his eyebrows and then looked sheepishly at Sam. “I’m sorry,” he said, “the pathology report from your surgery showed prostate cancer. And, I am afraid I did not see the report until now.” Sam was confused as to how that could have happened. Although he had not previously requested a copy of the report, he asked for one now. After calming down, finding a new urologist, and making plans for the testing to find out how far the cancer had spread over the past year, Sam finally sat down and read the report. Typed in large, bold type across the top of the report was the following statement: “Results telephoned in to Dr. Rosenthal on 05/05/08″…..one year prior to the visit. Turns out not only did Dr. Rosenthal have a copy of the report, he also had received a verbal notification that Sam’s pathology report showed cancer of the prostate. The hospital had a strict policy of calling the surgeon, in addition to faxing and mailing a copy of the report whenever there was a finding of cancer. Sam’s story is one case – what happened here may not be common place, but it does occur. Although we may not think it’s our responsibility to read our operative report or a pathology report, incompetent physicians and medical malpractice claims aside, it could mean the difference between a good or bad result in the best case scenario, or life and death in the worst case scenario. In the end, your health information is just that…..yours. No one will care more about it, or own it, in quite the same way as you.

“I’m mad as hell, and I’m not going to take it anymore.” Howard Beale, Network.

As the fight over healthcare reform continues to heat up in the Senate and House, the mob mentality has taken hold over America.

From town hall meetings, protests and OpEds and to blogs, Tweets and Facebook postings, ‘I’m mad as hell’ is permeating the interwebs, airways, and pages of our life. Even a newly formed U.S. “religious left” has wandered into the debate. Everyone, it seems, wants a piece “of me/you/him/them.”

So what is it exactly that is fanning the flames of passion? And why is so much misinformation being strewn across America?

Interestingly, fear mongering took hold shortly after 9-11 and didn’t let go in the 7 years that followed.

Fear mongering is once again taking hold and riling up the crowds. And the arguments aren’t intelligent ones. Socialism, Nazism, Constitutional Rights being destroyed, Obamacare, death panels…where does it stop? And does the mob mentality actually interfere with our free right of expression when those of us who attend the town halls can’t hear the information because of the accusations being thrown around the room.

Frankly, I believe that the only ones who can rein in the angry mobs are the mobs themselves – that individuals need to turn a deaf ear and begin to intelligently explore the options being laid out on the table.

The Kaiser Family Foundation has developed a side-by-side, interactive comparison of the proposals being laid on the table. Do yourself a favor: visit the site, read through the proposals, and learn the truth. Then if you still feel angry, put down your dukes and express it intelligently and passionately, not angrily and ignorantly.

Education is power. Anger only serves to dilute it.

As the nation focuses on how to cut the cost of so-called health care reform, maybe it’s time to pay attention to demonstrated methods for improving care while reducing costs that are not yet supported by Medicare and other payers. We cannot afford the system we have and changing it should be on the top of the agenda for anyone who wants to extend coverage of health care to all and improve health outcomes.

For example, many readers of this blog will have had the experience of being a patient or family caregiver for someone who is older and has multiple chronic health problems that periodic become acute and require hospitalization. Once discharged from the hospital, the patient and caregiver often feel at a loss for how to manage some of the problems that can arise even within hours of discharge. A study published in the New England Journal of Medicine in April of this year reported that one in five Medicare patients who are discharged from a hospital will be readmitted within 30 days. That number keeps increasing with time, so that by the end of one year, about half of these patients will have been readmitted. This is costing the nation an estimated $17 billion.

Mary Naylor is a nurse researcher at the University of Pennsylvania who has spent more than 20 years developing and studying what she calls a Transitional Care Model (PDF). Under this model of care, an advanced practice registered nurse (APRN) goes into the hospital when high risk (for readmission) patients are admitted. The APRN assesses the patient and family caregiver, clarifies the plan of care and coordinates the input of sometimes multiple health care providers, prepares the patient and family caregiver for discharge, then makes a home visit within the first 24 hours after discharge and continues to work with the patient and family caregiver for up to 90 days post-discharge. Naylor says this is more than “care coordination.” She sees it as an opportunity to help patients and families rethink how they approach and manage their care. The APRN will even go with the patient and family caregiver on a follow up visit to the physician’s office to model how to make the best use of this time.

Naylor isn’t the only one doing this work. Eric Coleman of the University of Colorado at Denver Medical Center and Chad Boult of the John Hopkins University Health Institute have developed variations on the Naylor model. All show that hospital readmission rates decrease, money is saved and health outcomes improve in some way.

Now AARP has worked with Congress to develop a Medicare Transitional Care Act (H.R. 2773/S. 1295) that has been introduced into both houses of Congress. The Act calls for Medicare to pay for a transitional care benefit, first for high-risk patients and then, if the outcomes of this first phase are satisfactory, for low- and moderate-risk patients. It’s long overdue. I now believe it to be unethical for hospitals to discharge patients knowing that they don’t have the knowledge and resources to help them through this difficult transition to home. To read about the details of the bill, go to http://www.govtrack.us/congress/billtext.xpd?bill=s111-1295. The bill needs advocates who will urge Senators and Representatives to sign on as co-sponsors or, at the very least, support this important legislation.

The day before my daughter Elise’s 15th birthday, the new iPhone went on sale.  My birthday was 4 days later.  So Elise figured out we should buy each other an iPhone to mark our big days.  She planned (and saved) for months.  She spent weeks talking to friends, researching apps on line, planning for such accessories as protective covers, and educating herself on how to maximize her minutes.

When the big day came, we made our way to the Apple store and stood shoulder to shoulder with hundreds of others waiting on a very long line.  Two and a half hours later we were invited, actually escorted, in to the store by an extremely friendly, knowledgeable young man who stayed with us during the entire purchase transaction.

He answered tons of questions (mine, not Elise’s…she already knew everything), politely reviewed various functions with me (Elise was extremely patient during this process), and made great suggestions about which plan was best for us.

While we were waiting on line, I looked around at the people waiting with us–we were an extremely diverse group–and wondered (a) Why in the world were we all willing to wait hours to buy a telephone, a very expensive telephone?  (b) How did the folks at Apple get us to this point? and (c) What lessons could we take away and apply to health care?

Here’s what I came up with:

Cool. The iPhone is not your mother’s rotary dial wall phone.  The engineers and creative types figured out how to make a very uncool, but necessary, object not only aesthetically pleasing, edgy, and fun, but useful, convenient, and easy to use.  They stimulated demand.

Now if the Apple  folks could only do for colonoscopies what they did for telephones.  I am only half joking.  How do we make taking care of ourselves and our loved ones cool?  How do we make boring, sometimes not so pleasant preventive measures cool and edgy?

Hospitals are scary places–while some newer facilities have made efforts to look more appealing (open atriums with green trees, brighter colors and lighting), many are dark, smell strange, are old and creaky, have tons of frightening tubes, machines, noises, and for most people are places to be feared and avoided.

What amenities can be added to make it harder for patients to find excuses not to get that mammogram (valet parking, anyone?), not to go for that follow up, not to just give up and leave after waiting for two and a half hours in the waiting room (Elise and I waited that long–and the friendly folks at Apple handed out water, and updated us on our progress).  The only water I could find in my local hospital emergency room last week (when we were there with my son) was a nasty water fountain that had stuff in it that would make a petri dish cringe.  There were vending machines with chips, candy and soda, but it was broken.

Service. Imagine for a minute that when you enter a clinic, doctor’s office, or hospital, you are accompanied by a knowledgeable, helpful, pleasant individual who can speak to you in a non-condescending, judgmental manner, in language that you understand.  Someone who can help you navigate a complex system of decision making.

Quality. Pretty obvious attribute.  Quick–think Mayo, Cleveland Clinic, Johns Hopkins.  What is it about these institutions that people think of when asked to list “best” hospitals.  How do you (should you?) rate different doctors? Nurses?  Most people buy the iPhone because they believe they are buying a high quality product.  How can we be sure we are buying high quality health care?

It’s interesting when you look at the literature.  Quality is defined in many different ways by health care professionals and by patients.  Sure there’s overlap.  But in addition to better health outcomes, living longer and better–patients highly rank items such as convenience, hours of operation, waiting times, and location as quality indicators.  Apple stores have better hours than most clinics and physician offices.  My dog’s vet has better hours than most doctors.

Value. Why was a 15 year old willing to save her hard earned money for an expensive phone (and why was I willing to pay not insignificant monthly charges) for the iPhone?  Because we thought it was worth it.

If only we could figure out a way to get people to see that it’s worth it to exercise, eat healthy, get annual check ups, not smoke… and get that colonoscopy.

Congress has almost hit recess, and already policymakers and stakeholders are shifting their persuasive energies from Washington, DC to the general public. So, this week we’re doing a video-themed Roundup, starting with the Administration’s Office of Health Reform’s response to the video featured on Drudge of the President saying “His Health Care Plan Will ‘Eliminate’ Private Insurance.”

Brave New Films, the American Academy of Family Physicians (AAFP), and Herndon Alliance, have produced a new video, “450,000 Can’t Be Wrong About Health Care Reform,” that features family doctors voicing support for health care reform:

Meanwhile, Americans United for Change, an organization dedicated to supporting President Obama’s health care initiatives, has released a new TV ad called “GOP Rx”: (more…)

I just finished a great book: Why She Buys. I was stunned to learn just how much of the US economy is controlled by women: 65% of apparel, 52% of all auto and truck, 45% of consumer electronics and 70% of travel purchases. If influence over purchases is considered, women influence 80% of auto and truck, 91% of home, and 61% of consumer electronics purchases.  

Wondering about health care? It turns out that Dr. Mom makes more decisions than Dr. Welby; directing 80% of expenditures. It’s not just Dr. Mom, I’m guessing, but Dr. Wife, Dr. Sister, Dr. Friend and Dr. Daughter (or Daughter-in-Law) who help others with the health care maze.

A great book. I recommend it, though it raised my ire and blood pressure more than once as I realized how even with that level of seeming economic power that product design, marketing and purchasing is not woman/customer/consumer-friendly.

More women are in the workforce, complicating the activities of daily living.  Have children, a special-needs child and/or get divorced and life gets more complicated still. Time compression and multi-tasking is a way of life. How I wish that health care was like Ryland Homes, who designs and builds for the life a woman leads: a window over the kitchen sink to watch younger children in the back yard as she prepares dinner in open-plan kitchen-family room while supervising the older children’s homework, and of course, a computer workstation to check her own emails. Her day likely starts at 5 and ends at 11, errands are saved for weekends. Getting to the gym? Well, someday…..

Of course, that assumes she’s able to afford a Ryland Home. Many women are not. They face those chores in neighborhoods where the kids are not safe playing outside.

Heaven help any woman if she or someone she loves gets sick. Yeah, heaven help her, because it’s likely that health reform won’t. For women, the “unintended effects” of health policy decisions are not hypothetical. There’s a fight on, a battle, a war on the Hill and we’ll be left to deal with the collateral damage.

Drawing on some insights offered by author Bridget Brennan, sifting them through what I experience and what other women tell me, here are some reasons I’m not buying…

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