Yesterday we encouraged our readers to take part in the live video chat presented by the White House, during which HHS Secretary Kathleen Sebelius and Health Reform Director Nancy-Ann DeParle took questions about President Obama’s recent health care reform proposal.

Did you watch yesterday’s live chat? If so, what are your thoughts and reactions on what was said? What additional questions do you have for the President as well as the HHS Secretary and the Health Reform Director?

The following post originally appeared on The White House Blog. The Disruptive Women in Health Care blog encourages its readers to take part in the live video chat described below, which will take place today at 3:40 EST.

---

The President has now laid out a path forward for health reform that  puts families and businesses in control of their own health care, reduces costs and the deficit, and incorporates new Republican ideas while still instituting fundamental protections again insurance company abuses.  He opened his remarks saying, “I want to especially recognize two people who have been working tirelessly on that — on this effort, my Secretary of Health and Human Services, Kathleen Sebelius — as well as our quarterback for health reform out of the White House, Nancy-Ann DeParle.”  We’re happy to have both of them in a live video chat at 3:40PM EST to take your questions on the President’s proposal.  Secretary Sebelius will also be meeting with insurance company leaders in the morning to get answers on the alarming premium hikes being ushered in on families across the country and will be able to discuss what she heard from them.

• Watch the discussion at WhiteHouse.gov/live
• Watch and join the chat through Facebook

Chairman Wu, Congresswomen Edwards and Biggert, and Committee Members. Thank you for this opportunity to testify at this hearing on the National Institute of Standards and Technology.

I ask that my written testimony be accepted into the record.

Today you will hear from accomplished researchers and leaders in their fields of study from Duke University and Stanford. These individuals are scientists, entrepreneurs and biotechnology innovators.

I come here primarily as a mom. I am here today to address the critical link between my experience as a mother striving for treatments, for my kids and millions of others, and the question before this Committee — How our National Institute of Standards and Technology can more effectively influence innovation in life sciences.

I begin with a plain statement about NIST and its activities — it can appear to be boring, non-interesting, and terribly esoteric. NIST suffers from being hidden, embedded into the foundational infrastructure of the scientific and early commercial enterprise of innovation, as well as having the thankless task of creating measurement standards for a whole array of scientific disciplines. However, it is precisely because of these elements that this Committee needs to champion a more active role for NIST in the life sciences.

Some have argued quite convincingly that the next century of scientific and technological innovations will be most profound in the life sciences. NIST is critical to a robust biomedical enterprise and must contribute high quality materials, methods, and expertise for the field to advance on a platform of certainty and high quality measurements.

(more…)

Probably the thousands of nurses who have been following this case were encouraged to read the press report of its outcome:

“Texas jury finds nurse not guilty for reporting a physician for unsafe practices.

It took the jury less than an hour on February 11, 2010, to return a not guilty verdict for the nurse, Anne Mitchell, of felony charges of “misuse of official information,” for reporting a physician to the Texas Medical Board for what she believed was unsafe patient care.

Since news of the criminal indictment – and Mitchell’s being fired from her job – first spread through the nursing community, nurses across the country have followed developments. Labeling the criminal indictments “outrageous,” an outpouring of support – and financial contributions to the Texas Nurses Association Legal Defense Fund – has continued.

According to a New York Times article on February 9, the prosecutors claimed that Mitchell intended to damage the physician’s reputation when she reported him to the Texas Medical Board, which licenses and disciplines doctors. Mitchell explained that she felt an obligation to protect patients from what she saw as a pattern of improper prescribing and surgical procedures – including a failed skin graft that was performed in the emergency room, without surgical privileges.

Conflicts of interest seemed to be part of this case with allegations that this case was, in part, a result of the local sheriff being good friends with, and a former patient of the physician, and bending the rules to protect his reputation.

A number of nurses who had previous worked at the same Winkle County Rural Health Clinic testified in court that they left the clinic because of their concern about the care provided by the same physician that had never been addressed. The case is no less perplexing as to why Mitchell was even indicted – all witnesses (even the state’s) have agreed nurses have a duty to report unsafe care.

(more…)

Immediately after the snow stopped falling in Washington DC this week, another news story took DC by storm–the resignation of Billy Tauzin, effective June 30th.

Mr. Tauzin’s departure comes at a critical time for those involved with health reform efforts, not to mention PHRMA’s own thick portfolio of issues that include patents and trade, the economy, taxes (think offshore), and shrivelling pipelines, just to name a few.

The job pays well, but the applicant will surely inherit a daunting to-do list.

Job Qualifications

It’s a given that she would have impeccable bipartisan connections at the highest levels of government (both here and abroad); a robust rolodex full of private sector titans and Wall Street mavericks; a keen understanding of marketplace complexities (both here and abroad); superior people skills (it can be a b*tch managing those board room egos); not to mention a thorough grasp of and respect for the unique political and policy complexities that define health, health care, and innovation.

But that won’t  be enough.  I would love to see the next CEO take some bold action and harness the power of e-patients:  increasingly, patients (e-patients and their e-caregivers) are hungry to engage in participatory, user-generated health care, often referred to as Health 2.0.  Kaiser’s Dr. Ted Eytan explains it this way, “enabled by information, software and community that we collect or create, we the patients can be effective partners in our own health care and we the people can participate in reshaping the health system itself.”[1]

(more…)

On January 23, the Boston Globe reported that Lawrence DuBuske, M.D., Harvard Medical School Instructor, Asthma and Allergy Specialist and lecturer/consultant to pharmaceutical companies would resign his posts at Harvard and Brigham at the end of the month because remaining there would require he cease his work with industry. Failing to do so would be a violation of the Harvard/Partner’s conflict of interest policy.

If the article is accurate and he followed through on those plans, he’s gone now.

I know how carefully industry vets their speakers and consultants. That should come as no surprise. Any event planner, organization or company engaging a speaker or consultant wants just that – an expert.

I have no way of knowing how carefully Harvard Medical School vets its instructors or Brigham vets its clinicians, but I imagine both to be tailored to assure that only the best and only the experts are hired. Surely, were I a student at Harvard or a patient at Brigham, I’d want just that – and expert.

I’ve not met Dr. DuBuske, but ‘on paper’ he seems to be just that—an expert. He’s ‘passed muster’ more than once to gain – and retain – positions at elite institutions. The fact that he has associated with major, respected institutions is a credit to his qualifications.

In addition, he has achieved Fellow status in five major clinical societies: the American College of Physicians, the American Academy of Allergy, Asthma and Immunology, the American College of Allergy, Asthma and Immunology, the American College of Rheumatology and the American College of Chest Physicians. I’ll forego mentioning those organizations in which he is only a member, his European affiliations and all the awards except one – 2004 Distinguished Fellow of the American College of Allergy, Asthma and Immunology.

(more…)

I’ve grown weary of the public continuing to rate nurses as the most trusted profession (annual Gallup polls every year of this decade except 2001 when fire fighters understandably led the ratings), only to have leaders in health care agree but ignore us.

The Robert Wood Johnson Foundation released a Gallup poll that surveyed over 1500 opinion leaders in health care, including government officials, health care and insurance executives, and university faculty.

The survey found that:

• Doctors (54%) and nurses (42%) are the information sources about health and healthcare in whom opinion leaders have a great deal of confidence.
• Government (75%) and health insurance executives (56%) are viewed as most likely to exert a great deal of influence on health reform, compared to only 37% for doctors and 14% for nurses.
• 51% say nurses have a great deal of influence in reducing medical errors and improving patient safety
• 18% say nurses exert a great deal of influence on increasing access to care, including primary care.
• 39% say nurses will not have much influence on reforming health care over the next 5 to 10 years, compared with 10% of MDs.

Nothing new here to most nurses. We continue to have to be vigilant about whether nurses are included at decision-making and advisory tables, as speakers at national and regional conferences on quality and safety in health care, and on boards of health-related organizations. The next time you’re in a meeting on health care, look around the table and ask whether nurses are included — and not just a token RN. If they aren’t, ask why not and call for RNs to be appointed. Organizations and the nation are missing out if we don’t all change our expectations about who is at the table.

As we all know, children can’t speak for themselves, but if they could, they’d probably point out the obvious: they need more attention.    There have been some great strides over the years and some compelling examples such as those shown in Bill and Melinda Gates’ Living Proof project and the Measles Initiative.  In the recent installment of Raj Shah, the new USAID Administrator, he touts the progress that his new agency has already made in preventing unnecessary deaths.  He is pragmatic and encouraging as he also says that much more should be done.  To save more lives, we need to make sure the US investments are there. Look at the numbers: More is needed to ensure two leading childhood killers are addressed.  More global funding is needed for new vaccines such as pneumococcal and rotavirus vaccines offered through the GAVI Alliance to prevent much of the disease in these at risk children.  Vaccines can’t do the whole job, so inexpensive treatments such as antibiotics or oral rehydration therapy are also needed along with training of health workers to prescribe or education of parents to seek care – certainly not impossible, but requiring some effort and focus.

Now is the time to speak up and insure that the right investments will be made.  Please Call to USAID to take action on pneumonia and diarrhea.  You can submit a letter to Dr. Shah both welcoming him and asking for him to speak up for children.  Visit: http://www.change.org/actions/view/call_to_usaid_to_take_action_on_pneumonia_and_diarrhea.

Perhaps you’ve seen it: the grocery-shopping mom, complaining about a sugar tax, saying it’s hard enough to raise a family in these times.

I saw it, and could not believe it. Was this ad actually claiming that families need sugared sodas to make it through tough times?

It took watching it on line at http://www.nofoodtaxes.com/ads/ several times to see that yes, indeed, that’s what it claimed.

I’ll agree that a soda and other sugared items are a nice occasional treat, but I see no evidence that they’re necessary to keep a family happy – or that there are no alternatives.

I’ve begun talking to kids about what they drink. Here is what I got:

• I used to drink apple juice, now I drink water.
•  I drink water; that’s good for you.
•  I drink milk when I eat and water other times.
•  I used to drink (naming a brand soda) but now I drink water. The (soda) made my feel icky and I did not know how much until I stopped drinking it all the time.

Personally, I’m not a huge fan of plain water. I like a slice of lemon in it.

What about you?

Do you have a favorite alternative to sugared drinks?

Do you have any recipes for the beleaguered Mom trying to keep her family happy in these tough times? Do you have any tricks for weaning a family off sugared drinks?

With Labor Day a few hours away, a turbulent summer draws to a close.  But Democracy is a messy thing and rather than dwell on the gross distortions and histrionics we sweated through this past August, I prefer to focus on the chance to get health reform back on track. Now that’s something to sing about.

That is, moving from the THEME SONG FROM MISSION IMPOSSIBLE to WE SHALL OVERCOME.

I started thinking about how various songs could represent different aspects of health reform.  And once I started thinking about music, Elvis immediately came to mind.

I just happened to have a copy of Elvis Presley’s Commerative Issue: The Number One Hits nearby when writing this post.  Almost every one of them could be related to health reform.  In addition to Elvis, a few other songs seemed to have something to say about health care.

Here then, is my playlist:

I WANT YOU, I NEED YOU, I LOVE YOU–What Obama should be singing to the Blue Dogs

HARD HEADED WOMAN–This one’s for Senator Olympia Snowe–a true Disruptive Woman–keep up the good work.

IT’S NOW OR NEVER–Congress, are you listening?

ALL SHOOK UP–The state of the American public after all the town halls this recess

HEARTBREAK HOTEL–What the White House will become if health reform ends up DOA

SURRENDER–Not an option

TOO MUCH–Bend that cost curve, stat

SUSPICIOUS MINDS–a condition that runs along K street

DON’T BE CRUEL–Message to those in elected office who think things are fine just the way they are

ARE YOU LONESOME TONIGHT–This one’s for all the staffers who haven’t been home in months

JAILHOUSE ROCK–Congress, jail…enough said

TEDDY BEAR–No discussion (or song) about health reform is complete without the mention of Senator Ted Kennedy, may he rest in peace

In addition to Elvis, there are so many other artists who, whether they knew it or not, have been singing about health policy issues:

H1N1

ROCKIN’ PNEUMONIA & THE BOOGIE WOOGIE FLU (Johnny Rivers)

FEVER (Peggy Lee)

Aging

FOREVER YOUNG (Bob Dylan)

YOU MAKE ME FEEL SO YOUNG (Frank Sinatra; Ella Fitzgerald)

Politics–Senator Grassley’s Theme Song

THE GREAT PRETENDER (The Platters)

 

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.”

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.

(more…)

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.

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…)

Jennifer Berk is Director of Marketing and Internet Strategy at Amplify Public Affairs, and she’s behind most of the news links posted to Disruptive Women’s Twitter account.

I’m a fairly informed patient, but by no means a health care expert.  That makes working on this blog a wonderful opportunity: I can learn about complex health care systems from blog posts, news stories, and events – and share the information I’ve found.

Jonathan Sheffi is a friend of mine from college and a future biotech executive (he’s interning at the FDA this summer before heading to Harvard Business School). He recently wrote a comprehensive blog post about follow-on biologics, and I had a chance to talk with him about why he’s drawn to health care, biologics issues, and the upcoming BIL:PIL unconference. Listen to the podcast:

Audio clip: Adobe Flash Player (version 9 or above) is required to play this audio clip. Download the latest version here. You also need to have JavaScript enabled in your browser.

Read more:

• http://jonathansheffi.com/ or @sheffi
• http://bilpil.com (October 30-31, San Diego)