i.course description - university of minnesotasph.umn.edu/site/docs/syllabi/2013_fall/health...
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PubH 6556
Health and Health Systems
Fall 2013
Credits:3
Meeting Days:Tuesdays, September 3 December 10
Meeting Time:9:05 11:45 am
Meeting Place:W2-110 WDH
Instructor:Jon B. Christianson
Office Address:15-225 Phillips Wangensteen Building
Office Phone:612-625-3849
Fax:612-624-2196
E-mail:[email protected]
Office Hours:By Appointment
I.Course Description
The course provides an overview of the U.S. health care system and current health policy issues. Topics are addressed from a health care management perspective.
II.Course Prerequisites
Students must be admitted to the University of Minnesotas Master in Healthcare Administration Program or have consent of the instructor.
III.Course Goals and Objectives
Specific goals and learning objectives are listed below for each class session.
IV.Methods of Instruction and Work Expectations
Each topic will be introduced during the assigned class period through a didactic presentation on the part of the instructor. For each class session, PowerPoint slides and related material will be posted on the Moodle website for downloading and viewing. (To learn more about Moodle, watch Moodle: Online Orientation for Students and/or visit the Moodle support website at http://www1.umn.edu/moodle/, which has a link for Student support with user guides, help and FAQs.) Significant health care organization and policy issues will be identified and discussed, referencing the readings for the class period. From time to time, the class will be asked to read and discuss a short article distributed during class. In most classes, student teams will present policy briefs to the class on pre-assigned topics. Students will be expected to prepare for each class by completing the readings and assignments prior to class and participating in the discussion of those readings during class.
V.Course Text and Readings
1. All suggested readings have links to the article following the cite. Click on the link to access the reading. If you have any problems accessing assigned readings online, contact Jane Raasch at [email protected]. If you do not have a University of Minnesota Internet ID and password, call 301-HELP and support staff will help you set up an account (or set up your own account at www.umn.edu/initiate and follow the directions.)
2. The readings for each class session are divided into two parts: Suggested readings and Further readings. The suggested readings are organized by subtopic. For some sessions, the list of suggested readings is long, but many individual readings are quite brief. There are no Required readings. The more of the suggested readings that you are able to complete, the better prepared you will be for your quizzes, assignments, and class discussion; and, the better prepared you will be for your career. In sessions where there are a large number of suggested readings, you may want to divide responsibility among study group members, with each member summarizing a subset of readings. The Further readings provide additional information on the topics covered in each session. They are intended to be useful in clarifying areas that you feel are not covered adequately in the suggested readings, or in providing additional information on topics of particular interest to you. The following sources of information are useful in keeping up-to-date on current developments in the health care system and in health policy.
Newspapers:New York Times (liberal perspective)
Wall Street Journal (conservative perspective)
Washington Post (political issues)
Daily Feeds (all free):Kaiser Daily Health Policy Report/Kaiser Health News
AHIP Solutions Smart Brief
Ramlett, Morning Consult
Websites with short Research Briefs on Various Health Care Topics:
Center for Studying Health System Change
Urban Institute
MPR (Mathematica Policy Research)
AcademyHealth
VI.Course Outline/Weekly ScheduleSession/WeekTopics
The U.S. Health Care System and Prospects for Reform
1
Sept. 3
Health System Performance: From Three-Legged Stool to the Triple Aim Cost and Population Health
2
Sept. 10*
Health System Performance: From Three-Legged Stool to the Triple Aim Patient Experience
[Assignment 1 due, 5 pts.]
3
Sept. 17
The Health Policy Process: Crabs in a Bucket?
Care Delivery
4
Sept. 24
The Physician Workforce: Characteristics, Training and Projections of Future Need
5
Oct. 1
Rethinking Primary Care: What is the Future for the Family Doctor?
[Assignment 2 due, 10 pts.]
6
Oct. 8
The Nurse Workforce: Is There a Nurse in the House?
7, 8
Oct. 15, 22
The Hospital: From Doctors Workshop to Big Med
9
Oct. 29
Long-Term Care: Balancing What We Want With What We Will Pay For
[Quiz 1: Material from Sessions 1-8, 30 pts.]
10
Nov. 5
Medical Technology and Devices: At the Cutting Edge
11
Nov. 12
Pharmaceuticals: A Regulatory Rubiks Cube
Financing
12
Nov. 19
Health Insurance, Uninsurance, and the Private Health Insurance Market: What Works, What Doesnt and How Will Health Reform Change It?
13
Nov. 26
Medicaid: Can This Vast Public Enterprise Be Sustained?
14
Dec. 3
Financing Care for Seniors: Down the Medicare Rabbit Hole
[Assignment 3 Due, 10 pts.]
15
Dec. 10
Medicare: A Program at the Brink?
[Quiz 2: Material from Sessions 9-15, 30 pts.]
*For this class, you will listen to an audio lecture synchronized to PowerPoints. The main focus will be on patient safety. There will be a guest speaker on this topic and you will have a short assignment to complete and submit to the instructor by e-mail prior to the class.
The U.S. Health Care System and Prospects for Reform
Session 1 September 3, 2013
Health System Performance: From Three-Legged Stool to the Triple Aim Cost and Population Health
The U.S. health care system is incredibly complex (some would call it a non-system), characterized by a variety of different financing mechanisms and delivery systems. In first two sessions of the course, we examine how the U.S. health care system performs relative to components of the Triple Aim: per capita costs, patient experience, and population health. We also compare the performance of the U.S. health care system to systems in other countries.
Learning Objectives Session 1
Students should be able to:
1. Discuss the different components of the Triple Aim and the performance of the U.S. health care system relative to:
Cost per capita: components of costs, drivers of cost growth, variation in costs
Population health
2. Compare and contrast different views regarding whether, or under what circumstances, health care expenditures that grow at a faster rate than the rest of the economy should be regarded with concern.
3. Discuss and explain differences between the U.S. and other countries in health care costs and population health
4. Discuss evidence on geographic variation in health care costs in the United States.
Suggested Readings
The Triple Aim
1*. Berwick, D.M., Nolan, T.W., Whittington, J. The triple aim: Care, health and cost. Health Affairs 27(3):759-769, 2008. http://content.healthaffairs.org/content/27/3/759.full.pdf+html
2. Cauchon, D. Health care spending is transferred out of ICU. USA Today, March 4, 2013. Available at: http://www.usatoday.com/story/news/health/2013/03/04/health-care-spending-growth-slows/1963165/
Spending on Health Care
Trends
1* The Henry J. Kaiser Family Foundation. Health care costs. A primer. May 2012. Available at: http://www.kff.org/insurance/upload/7670-03.pdf
2. Barnes, K. Behind the health spending numbers. Health Affairs Blog, June 18, 2013. Available at: http://healthaffairs.org/blog/2013/06/18/behind-the-health-spending-numbers/
3. Roehrig, C. U.S. health spending as a share of GDP Where are we headed? Altarum Institute, July 16, 2013. Available at: http://www.altarum.org/forum/post/us-health-spending-share-gdp-where-are-we-headed
Geographic Variation in Health Spending
1*.Rau, J. Medicare spending variations mostly due to health differences, study concludes. Kaiser Health News, May 28, 2013. Available at: http://www.kaiserhealthnews.org/Stories/2013/May/28/medicare-state-geographic-variation-costs.aspx
2. Joynt, K.E., Jha, A.K. The relationship between cost and quality. No free lunch. Journal of the American Medical Association 307(10):1082-1083, 2012. Available at: http://jama.jamanetwork.com/Issue.aspx?journalid=67&issueID=22493&direction=P
Views Regarding Health Spending
1*.Pauly, M.V. The trade-off among quality, quantity, and cost: How to make itif we must. Health Affairs 30(4):574-580, 2011. http://content.healthaffairs.org/content/30/4/574.full.pdf+html
2. RWJF. Consumer attitudes on health care costs: Insights from focus groups in four U.S. cities. January 2013. Available at: http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2013/rwjf403428
3*.Altman, D., Levitt, L. We still have a health-care spending problem. Washington Post, April 21, 2012. Available at: http://articles.washingtonpost.com/2013-04-21/opinions/38717666_1_health-spending-health-costs-health-care-spending
4. Douthat, R. Conservatives and health care costs. New York Times, May 15, 2013. Available at: http://douthat.blogs.nytimes.com/2013/05/15/conservatives-and-health-care-costs/?_r=0
Drivers of Growth in Spending
1. Acaramenico. Poll of emergency physicians shows more than half order tests as protection against being sued. May 26, 2011 Available at: http://californiaprevailingwage.wordpress.com/2011/05/26/poll-of-emergency-physicians-shows-more-than-half-order-tests-as-protection-against-being-sued/
2*.Rao, A. IOM report focuses on $750 billion in inefficient health care spending. Kaiser Health News Blog, September 6, 2012. Available at: http://capsules.kaiserhealthnews.org/index.php/2012/09/iom-report-focuses-on-750-billion-in-inefficient-health-care-spending/
3*.Appleby, J. Higher prices charged by hospitals, other providers, drove health spending during downturn. Kaiser Health News, May 21, 2012. Available at: http://www.kaiserhealthnews.org/Stories/2012/May/21/higher-health-care-prices-hospitals.aspx
4*.Kliff, S. Over next two decades, obesity could cost us $550 billion. The Washington Post, September 18, 2012. Available at: http://www.washingtonpost.com/blogs/wonkblog/wp/2012/09/18/over-next-two-decades-obesity-could-cost-us-550-billion/
5. Porter, E. Health cares overlooked cost factor. New York Times, June 11, 2013. Available at: http://www.nytimes.com/2013/06/12/business/examinations-of-health-costs-overlook-mergers.html?pagewanted=all
6. Rosenthal, E. The $2.7 trillion medical bill. New York Times, June 1, 2013. Available at: http://www.nytimes.com/2013/06/02/health/colonoscopies-explain-why-us-leads-the-world-in-health-expenditures.html?pagewanted=all
7. Gordon, J. The medical arms race. Minnesota Medicine, February 2007. Available at: http://www.minnesotamedicine.com/PastIssues/PastIssues2007/February2007/FeatureFebruary2007.aspx
8. Fuchs, V.R. The gross domestic product and health care spending. New England Journal of Medicine May 22, 2013. Available at: http://www.nejm.org/doi/full/10.1056/NEJMp1305298
9. Rosenberg, Y. Do you really need that test? Doctors warn on 90 treatments. The Fiscal Times, February 21, 2013. Available at: http://www.thefiscaltimes.com/Articles/2013/02/21/Doctors-Warn-on-90-Overused-Medical-Treatments.aspx#page1
10. Hiatt, K. 9 warning signs of bad care. US News, February 26, 2013. Available at: http://health.usnews.com/health-news/best-nursing-homes/articles/2013/02/26/9-warning-signs-of-bad-care
11. Pittman, G. Unnecessary repeat cholesterol tests common: study. Reuters, July 1, 2013. Available at: http://www.reuters.com/article/2013/07/01/us-unnecessary-repeat-cholesterol-idUSBRE96015420130701
Population Health
Trends
1. Gardner, A. Americas health a mixed bag: Report. Health, February 16, 2011. Available at: http://news.health.com/2011/02/16/americas-health-a-mixed-bag-report/
2*.Kelly, J. Boomers live longer, but sicker, than parents. Pittsburgh Post-Gazette, March 4, 2013. Available at: http://www.post-gazette.com/stories/news/health/boomers-live-longer-but-sicker-than-parents-677824/
3*.Winslow, R. Americans are living longer, but not necessarily healthier, study shows. The Wall Street Journal, July 10, 2013. Available at: http://online.wsj.com/article/SB10001424127887324694904578597444105321914.html
4. US Burden of Disease Collaborators. The state of US health, 1990-2010. Burden of diseases, injuries, and risk factors. Journal of the American Medical Association, Published online July 10, 2013. Available at: http://jama.jamanetwork.com/onlineFirst.aspx
5. Pitman, D. Gains made, but U.S. still lags in life expectancy. MedPage Today, July 10, 2013. Available at: http://www.medpagetoday.com/PublicHealthPolicy/PublicHealth/40381
Illness-specific Measures
1. Reinberg, S. U.S. cancer death rate continues to drop. USA Today, July 8, 2010. Available at: http://www.usatoday.com/news/health/2010-07-08-cancer-deaths_N.htm
2. HealthDay. Asthma cases continue to rise in U.S., affecting millions. May 15, 2012. Available at: http://consumer.healthday.com/Article.asp?AID=664789
3. USA Today. Percentage of severely obese adults skyrockets. October 1, 2012. Available at: http://www.usatoday.com/story/news/nation/2012/10/01/severely-obese-americans-increasing/1606469/
4. Reuters. U.S. cholesterol levels decline: Study. October 16, 2012. Available at: http://www.reuters.com/article/2012/10/16/health-cholesterol-idUSL3E8LG7C120121016
5. Reinberg, S. Nearly 30 percent of Americans have high blood pressure: CDC. WebMD News from HealthDay, April 4, 2013. Available at: http://www.webmd.com/hypertension-high-blood-pressure/news/20130404/nearly-30-percent-of-americans-have-high-blood-pressure-cdc
Disparities
1*.HealthDay News. Health disparities persist in U.S., report shows. January 13, 2011. Available at: http://health.usnews.com/health-news/family-health/heart/articles/2011/01/13/health-disparities-persist-in-us-report-shows
2. Kaiser Health News. Race plays role in diagnosis and treatment. July 24, 2009. Available at: http://www.kaiserhealthnews.org/daily-reports/2009/july/24/racial-disparities.aspx?referrer=search
3. Tavernise, S. The health toll of immigration. New York Times, May 18, 2013. Available at: http://www.nytimes.com/2013/05/19/health/the-health-toll-of-immigration.html?pagewanted=all
4*.Goodell, S., Escarce, J.J. Racial and ethnic disparities in access to and quality of health care. Policy Brief 12, The Synthesis Project, Robert Wood Johnson Foundation, September 2007. Available at: http://www.rwjf.org/en/research-publications/find-rwjf-research/2007/09/racial-and-ethnic-disparities-in-access-to-and-quality-of-health.html
International Comparisons
Costs/Population Health
1. Baker, S. Study: US leads in healthcare spending, but ranks last in health. The Hills Healthcare Blog, May 12, 2011. Available at: http://thehill.com/blogs/healthwatch/public-global-health/160845-study-us-leads-in-healthcare-spending-but-ranks-last-in- health-
3. Fox, M. Survey shows Americans pay a lot more for health care." NationalJournal, March 25, 2012. Available at: http://www.nationaljournal.com/healthcare/survey-shows-americans-pay-a-lot-more-for-health-care-20120304
4. Laugesen, M.J., Glied, S.A. Higher fees paid to U.S. physicians drive higher spending for physician services compared to other countries. Health Affairs 30(9):1647-1656, 2011. http://content.healthaffairs.org/content/30/9/1647.full.pdf+html
5. Goodwin, J. Americans have worse health than English peers, study finds. US News, March 9, 2011. Available at: http://health.usnews.com/health-news/family-health/boomer-health/articles/2011/03/09/americans-have-worse-health-than-english-peers-study-finds
6*.Fuchs, V.R. How and why US health care differs from that in other OECD countries. New England Journal of Medicine 309(1):33-34, 2013. Available at: http://jama.jamanetwork.com/Issue.aspx?journalid=67&issueID=926163&direction=P
7. Heavey, S. Obesity, lack of insurance cited in U.S. health gap. Reuters, January 9, 2013. Available at: http://www.reuters.com/article/2013/01/09/us-usa-health-ranking-idUSBRE9080ZN20130109
8. Goldhill, D. Other nations dont compare to U.S. health care. Bloomberg, June 20, 2013. Available at: http://www.bloomberg.com/news/2013-06-20/what-the-world-can-t-tell-us-about-health-care.html
Further Readings
1. Wayne, A. Health cost growth slows further even as economy rebounds. Bloomberg, June 18, 2013. Available at: http://www.bloomberg.com/news/2013-06-18/health-cost-growth-slows-further-even-as-economy-rebounds.html
2. 2.Goldhill, D. Focus on health-care costs causes more spending. Bloomberg, January 1, 2013. Available at:
3. http://www.bloomberg.com/news/2013-01-01/focus-on-health-care-costs-causes-more-spending.html
4. Kaiser Family Foundation. Assessing the effects of the economy on the recent slowdown in health spending. April 2013. Available at: http://kff.org/health-costs/issue-brief/assessing-the-effects-of-the-economy-on-the-recent-slowdown-in-health-spending-2/
5. Steuerle, G. A slower rate of health cost growth? What happens when an irresistible force meets an increasingly immovable object. Altarum Institute Health Policy Forum, May 10, 2013. Available at: http://www.altarum.org/forum/post/slower-rate-health-cost-growth-what-happens-when-irresistible-force-meets-increasingly
6. Samuelson, R.J. Is the health-care spending slowdown for real? The Washington Post, May 19, 2013. Available at: http://articles.washingtonpost.com/2013-05-19/opinions/39376698_1_affordable-care-act-affordable-health-coverage-health-affairs
7. Lowrey, A. Slowdown in health costs rise may last as economy revives. The New York Times, May 6, 2013.
8. Klein, E. One way Obamacare may already be working. Bloomberg, May 29, 2013. Available at: http://www.bloomberg.com/news/2013-05-29/one-way-obamacare-may-already-be-working.html
9. Eligon, J. An oil boom takes a toll on health care. The New York Times, January 27, 2013. Available at: http://www.nytimes.com/2013/01/28/us/boom-in-north-dakota-weighs-heavily-on-health-care.html?_r=0&gwh=BE712B27B95AE737019CF8BBC3FD40D7
10. Philipson, T., Eber, M., Lakdawalla, D.N., Corral, M., Conti, R., Goldman, D.P. An analysis of whether higher health care spending in the United States versus Europe is worth it in the case of cancer. Health Affairs 31(4):667-675, 2012. Available at: http://content.healthaffairs.org/content/31/4/667.full.pdf+html
11. Lawrence, B.R. Cutting U.S. health-care costs doesnt have to be harmful. The Washington Post online, July 26, 2012. Available at: http://www.washingtonpost.com/opinions/cutting-us-health-care-costs-doesnt-have-to-be-painful/2012/07/26/gJQA1ZzJCX_story.html
12. Ledger, K. Healthiest state? Minnesota Medicine, May 2012. Available at: http://www.minnesotamedicine.com/PastIssues/May2012/HealthiestState.aspx
13. Goldsmith, J. Barking up the wrong tree: Affordability, not cost growth, is the policy challenge. Health Affairs Blog, May 7, 2012. Available at: http://healthaffairs.org/blog/2012/05/07/barking-up-the-wrong-tree-affordability-not-cost-growth-is-the-policy-challenge/
14. Healy, M. Obesity in U.S. projected to grow, though pace slows: CDC study. LA Times online, May 7, 2012. Available at: http://articles.latimes.com/2012/may/07/news/la-heb-obesity-projection-20120507
15. Kenney, G.M., McMorrow, S., Zuckerman, S., Goin, D.E. A decade of health care access declines for adults holds implications for changes in the Affordable Care Act. Health Affairs 31(5):899-908, 2012. Available at: http://content.healthaffairs.org/content/31/5/899.full.pdf+html
16. Lowrey, A. In hopeful sign, health spending is flattening out. New York times, April 28, 2012, p.A.1. Available at: http://www.nytimes.com/2012/04/29/health/policy/in-hopeful-sign-health-spending-is-flattening-out.html?pagewanted=all
17. Mahoney, D. Uncontrolled hypertension deemed pervasive in U.S. adults. Internal Medicine News, September 4, 2012. Available at: http://www.internalmedicinenews.com/single-view/uncontrolled-hypertension-deemed-pervasive-in-us-adults/e84cc5f65b0596965e8e9b606b653355.html
18. Bipartisan Policy Center. What is driving U.S. health care spending? September 2012, Available at: http://bipartisanpolicy.org/sites/default/files/BPC%20Health%20Care%20Cost%20Drivers%20Brief%20Sept%202012.pdf
19. Carroll, A. The iron triangle on health care: Access, cost, and quality. JAMA Forum, October 3, 2012. Available at: http://newsatjama.jama.com/2012/10/03/jama-forum-the-iron-triangle-of-health-care-access-cost-and-quality/
20. Detsky, A.S. How to control health care costs. Journal of General Internal Medicine 27(9):1095-1096, 2012. Available at: http://link.springer.com/content/pdf/10.1007%2Fs11606-012-2119-0.pdf
21. National Institute for Health Care Management. U.S. health care spending: The big picture. NIHCM Foundation Data Brief, May 2012. Available at: http://www.nihcm.org/images/stories/Data_Brief_1_-_Big_Picture_FINAL.pdf
22. Reinhardt, U.E., Is U.S. health spending finally under control. New York Times online, January 20, 2012. Available at: http://economix.blogs.nytimes.com/2012/01/20/is-u-s-health-spending-finally-under-control/
23. Roehrig, C., Turner, A., Hughes-Cromwick, P., Miller, G. When the cost curve bent Pre-recession moderation in health care. New England Journal of Medicine 367(7):590-593, 2012. Available at: http://www.nejm.org/doi/pdf/10.1056/NEJMp1205958
24. Stein, R. A dire sign of the obesity epidemic: Teen diabetes soaring, study finds. NPR, May 21, 2012. Available at: http://www.npr.org/blogs/health/2012/05/21/153030283/a-dire-sign-of-the-obesity-epidemic-teen-diabetes-soaring-study-finds
25. The Economist. An incurable disease. September 29, 2012. Available at: http://www.economist.com/node/21563714
26. Wang, S.S. Revealing the unexpected dangers of obesity. The Wall Street Journal, October 29, 2012. Available at: http://www.nytimes.com/2012/09/23/health/new-system-for-patients-to-report-medical-mistakes.html?_r=0
27. Roehrig, C.S., Rousseau, D.M. The growth in cost per case explains far more of U.S. health spending increases than rising disease prevalence. Health Affairs 30(9):1657-1663, 2011. Available at: http://content.healthaffairs.org/content/30/9/1657.full.pdf+html
28. Rovner, J. You really are paying a lot more for health care. NPR, May 11, 2011. Available at: http://www.npr.org/blogs/health/2011/05/11/136213104/you-really-are-paying-a-lot-more-for-health-care
29. Reinberg, S.. Aging population could send cancer costs soaring. January 12, 2011. Available at: http://news.health.com/2011/01/12/aging-population-could-send-cancer-costs-soaring/
30. Bernstein, J., Reschovsky, J.D., White, C. Geographic variation in health care: changing policy directions. Policy Analysis No. 4. Washington, DC: Center for Studying Health System Change, April 2011
31. Gardner, A. U.S. found to be losing ground in life expectancy. HealthDay, June 15, 2011. Available at: http://health.usnews.com/health-news/family-health/heart/articles/2011/06/15/us-found-to-be-losing-ground-in-life-expectancy
32. Gawande, A. The cost conundrum: What a Texas town can teach us about health care. The New Yorker, June 1, 2009. Available at: http://go.galegroup.com/ps/retrieve.do?sgHitCountType=None&sort=DA-SORT&inPS=true&prodId=PROF&userGroupName=mnaumntwin&tabID=T003&searchId=R1&resultListType=RESULT_LIST&contentSegment=&searchType=AdvancedSearchForm¤tPosition=1&contentSet=GALE%7CA201451685&&docId=GALE|A201451685&docType=GALE&role=&docLevel=FULLTEXT
33. Escarce, J.J. Racial and ethnic disparities in access to and quality of health care. Research Synthesis Report No. 12. Robert Wood Johnson Foundation, September 7, 2007. Available at: http://www.rwjf.org/en/research-publications/find-rwjf-research/2007/09/racial-and-ethnic-disparities-in-access-to-and-quality-of-health.html
34. Banks, J., Marmot, M., Oldfield, Z., Smith J.P. Disease and disadvantage in the United States and in England. JAMA 2006;295(17):2037-2045. http://jama.jamanetwork.com/Issue.aspx?journalid=67&issueID=5022&direction=P
Session 2 September 10, 2013
Health System Performance: From Three-Legged Stool to the Triple Aim Patient Experience
Assignment 1 Due
There is widespread concern across political boundaries that patients experiences in the health care system leave much to be desired. Critics cite under use, over use, and inappropriate use of health services. Access to services is a major issue for population subgroups, and medical care costs continue to be a contributing factor to personal bankruptcies. And, for the last 12 years, the public spotlight has focused on preventable medical errors. Historically, medical errors were attributed to the failures of individuals, but the literature on patient safety also focuses on creating health care environments that limit the potential for human error. Nevertheless, estimates are that over 100,000 people die each year from avoidable errors. There is also a growing body of evidence that poor communication between providers and patients, along with inadequate coordination of care, contribute to poor quality care, medical errors, and patient frustrations with the health care system.
Learning Objectives
Students should be able to:
1. Discuss issues and evidence relating to access to care and deficiencies on the quality of health care in the United States
2. Discuss the evidence regarding prevalence of medical errors in the U.S. health care system and their sources.
3. Use terminology related to medical errors appropriately.
4. Discuss basic approaches being used in hospitals and other providers to reduce medical errors.
5. Discuss how poor communication and care coordination can affect patient outcomes.
Suggested Readings
Patient Safety and Medical Errors: Concepts, Terminology, and Impact
Overview
1*.Leape, L. Error in medicine. Journal of the American Medical Association 272(23):1851-1857, 1994 (Posted on Moodle)
2. Hospital infections killed 48,000, report shows. Reuters, February 22, 2010. Available at: http://www.reuters.com/article/2010/02/22/us-hospitals-infections-usa-idUSTRE61L51D20100222
3*.Van Den Bos, J., Rustagi, K., Gray, T., Halford, M., Ziemkiewicz, E., Shreve, J. The $17.1 billion problem: The annual cost of measurable medical errors. Health Affairs 30(4):596-603, 2011. Available at: http://content.healthaffairs.org/content/30/4/596.full.pdf+html
4. Young, J. Hospital errors occur 10 times more than reported, study finds. Bloomberg.com, April 6, 2011. Available at: http://www.bloomberg.com/news/2011-04-07/hospital-errors-occur-10-times-more-than-reported-study-finds.html
5. Weber, T., Ornstein, C., Allen, M. Why cant medicine seem to fix simple mistakes? ProPublica, July 20, 2012. Available at: http://www.propublica.org/article/why-cant-medicine-seem-to-fix-simple-mistakes
6. Welch, H.G. Testing what we think we know. New York Times online, August 19, 2012. Available at: http://www.nytimes.com/2012/08/20/opinion/testing-standard-medical-practices.html
7*.Boodman, S.G. Doctors diagnostic errors are often not mentioned but can take a serious toll. Kaiser Health News, May 6, 2013. Available at: http://www.kaiserhealthnews.org/stories/2013/may/07/doctor-errors-misdiagnosis-more-common-than-known-serious-impact.aspx
8. Ofri, D. My near miss. The New York Times, May 28, 2013. Available at: http://www.nytimes.com/2013/05/29/opinion/addressing-medical-errors.html
Causes of Medical Errors
1*.Volpp, K.G.M., Grande, D. Residents suggestions for reducing errors in teaching hospitals. New England Journal of Medicine 348(9):851-855, 2003. Available at: http://www.nejm.org/doi/pdf/10.1056/NEJMsb021667
2. Johnson, C.K. Poor infection control at many surgery centers. MSNBC, June 8, 2010. Available at: http://www.msnbc.msn.com/id/37577363
3. Sittig, D.F., Singh, H. Defining health information technologyrelated errors. Archives of Internal Medicine 171(14):1281-1284, 2011. Available at: http://archinte.jamanetwork.com/Issue.aspx?journalid=71&issueID=22519&direction=P
4. Schiff, G.D. Medical error. A 60-year-old man with delayed care for a renal mass. Journal of the American Medical Association 305(18):1890-1898, 2011. Available at: http://jama.jamanetwork.com/Issue.aspx?journalid=67&issueID=20328&direction=P
5. Richtel, M. As doctors use more devices, potential for distraction grows. New York Times, December 15, 2011, p. A.1. Available at: http://www.nytimes.com/2011/12/15/health/as-doctors-use-more-devices-potential-for-distraction-grows.html?pagewanted=all&_r=0
6*.Couse-Baker, R. Even a doctor cant keep his father safe in the hospital. Cognoscenti, April 5, 2013. Available at: http://cognoscenti.wbur.org/2013/04/05/medical-errors-ashish-jha
7. Harris, G. U.S. inaction lets look-alike tubes kill patients. The New York Times, August 20, 2010. Available at: http://www.nytimes.com/2010/08/21/health/policy/21tubes.html?pagewanted=all
8. Robertson, J. Digital health records risks emerge as deaths blamed on systems. Bloomberg, June 25, 2013. Available at: http://www.bloomberg.com/news/2013-06-25/digital-health-records-risks-emerge-as-deaths-blamed-on-systems.html
9. Smith, K. For doctors, too much information. Politico, March 5, 2013. Available at: http://www.politico.com/story/2013/03/electronic-alert-glut-overloads-doctors-88394.html
10. Sun, L.H. Alarm fatigue leads hospital caregivers to ignore beeps, posing risks for patients. Bangor Daily News, July 23, 2013. Available at: http://bangordailynews.com/2013/07/08/health/alarm-fatigue-leads-hospital-caregivers-to-ignore-beeps-posing-risks-for-patients/
Proposals to Reduce Medical Errors
1*.Gawande, T. The Checklist. New Yorker, 83(39):86-95, December 10, 2007. Available at: http://www.newyorker.com/reporting/2007/12/10/071210fa_fact_gawande
2. Millenson, M.L. Analysis: Is a new federal patient safety effort doing enough to curb medical errors? Kaiser Health News, February 22, 2012. Available at: http://www.kaiserhealthnews.org/stories/2012/february/23/millenson-hens.aspx
3. Ledger, K. Safety first. How anesthesiologists launched the patient-safety movement. Minnesota Medicine, March 2011. Available at: http://www.minnesotamedicine.com/PastIssues/PastIssues2011/March2011/SafetyFirst.aspx
4*.Shaw, G. Researchers: CPOE averted 17.4 million medication errors in one year. FierceHealthIT, February 22, 2013. Available at: http://www.fiercehealthit.com/story/researchers-cpoe-averted-174-million-medication-errors-one-year/2013-02-22
5. Hartocollis, A. With money at risk, hospitals push staff to wash hands. The New York Times, May 28, 2013. Available at: http://www.nytimes.com/2013/05/29/nyregion/hospitals-struggle-to-get-workers-to-wash-their-hands.html?_r=0
6. Southwick, F.S. Losing my leg to a medical error. The New York Times, February 19, 2013. Available at: http://www.nytimes.com/2013/02/20/opinion/losing-my-leg-to-a-medical-error.html?smid=pl-share&_r=0
7. Drolet, B.C., Khokhar, M.T., Fischer, S.A. The 2011 duty-hour requirement a survey of residence program directors. The New England Journal of Medicine 368(8):694-697, 2013. Available at: http://www.nejm.org/doi/pdf/10.1056/NEJMp1214483
8*.Shekelle, P.G., Pronovost, P.J., Wachter, R.M., et al. The top patient safety strategies that can be encouraged for adoption now. Annals of Internal Medicine 158(5-Part 2):365-368. Available at: http://annals.org/issue.aspx?journalid=90&issueID=926462&direction=P
Care Coordination and Communication Issues
1. Pham, H.H., Grossman, J.M., Cohen, G., Bodenheimer, T. Hospitalists and care transitions: The divorce of inpatient and outpatient care. Health Affairs 27(5):1315-1327, 2008. Available at: http://content.healthaffairs.org/content/27/5/1315.full.pdf+html
2. Blendon, R.J., Buhr, T., Cassidy, E.F., Perez, D.J., Sussman, T., Benson, J.M., et al. Disparities in physician care: Experiences and perceptions of a multi-ethnic America. Health Affairs 27(2):507-517, 2008. Available at: http://content.healthaffairs.org/content/27/2/507.full.pdf+html
3. Levinson, W., Pizzo, P.A. Patient-physician communication. Its about time. Journal of the American Medical Association 305(17):1802-1803, 2011. Available at: http://jama.jamanetwork.com/Issue.aspx?journalid=67&issueID=20327&direction=P
4*.Schoen, C., Osborn, R., Squires, D., Doty, M., Pierson, R., Applebaum, S. New 2011 survey of patients with complex care needs in eleven countries finds that care is often poorly coordinated. Health Affairs 30(12):2437-2448, 2011. Available at: http://content.healthaffairs.org/content/30/12/2437.full.pdf+html
How Patients Experience the Health Care System
1. Mayer, M.L. On being a difficult patient. Health Affairs 27(5):1416-1421, 2008. Available at: http://content.healthaffairs.org/content/27/5/1416.full.pdf+html
2*.Jauhar, S. Referral system turns patients into commodities. The New York Times, May 26, 2009, p.D.5. Available at: http://www.nytimes.com/2009/05/26/health/26essa.html?scp=12&sq=health%20care&st=cse
2. Colwill, J.M. A case of medical homelessness. Health Affairs 29(5):1067-1070, 2010. Available at: http://content.healthaffairs.org/content/29/5/1067.full.pdf+html
3. Butler, K. My fathers broken heart. New York Times, June 20, 2010, p. 38. Available at: http://www.nytimes.com/2010/06/20/magazine/20pacemaker-t.html?src=me&ref=homepage
4. Kapadia, R., Scherzer, L. 10 things your hospital wont tell you. SmartMoney Magazine, August 11, 2010. Available at: http://www.smartmoney.com/spending/rip-offs/10-things-your-hospital-wont-tell-you-20059/
5. Dimick, J., Ruhter, J., Sarrazin, M.V., Birkmeyer, J.D. Black patients more likely than Whites to undergo surgery at low-quality hospitals in segregated regions. Health Affairs 32(6):1046-1053, 2013. Available at: http://content.healthaffairs.org/content/32/6/1046.full.pdf+html
Access to Care
1*.Galewitz, P. Health care increasingly out of reach for millions of Americans. Kaiser Health News, May 7, 2012. Available at:
http://www.kaiserhealthnews.org/stories/2012/may/07/health-affairs-care-increasingly-out-of-reach-for-millions.aspx
2. Pecquet, J. Report: Americans still struggling with medical debt. The Hill, March 7, 2012. Available at:
http://thehill.com/blogs/healthwatch/health-insurance/214759-report-americans-still-struggling-with-medical-debt
3. Kenney, G.M., McMorrow, S., Zuckerman, S., Goin, D.E. A decade of health care access declines for adults hold implications for changes in the Affordable Care Act. Health Affairs 31(5):899-908, 2012. Available at: http://content.healthaffairs.org/content/31/5/899.full.pdf+html
4. HealthDay. Many lacked preventive care before health reform law: U.S. report. June 14, 2012. Available at: http://consumer.healthday.com/Article.asp?AID=665762
5. HealthDay. Fewer U.S. patients getting weight counseling from doctors. U.S. News, January 10, 2013. Available at: http://health.usnews.com/health-news/news/articles/2013/01/10/fewer-us-patients-getting-weight-counseling-from-doctors
Quality of Care
1. Maugh, T.H. Nearly 70,000 Americans die needlessly each year because they are not given optimal heart failure therapy. June 6, 2011. Available at: http://www.latimes.com/health/boostershots/la-heb-heart-failure-06062011,0,4047246.story?track=rss
2. Reuters. Cardiac arrest survival improving in U.S. hospitals: Study. July 16, 2012. Available at: http://www.reuters.com/article/2012/07/17/us-heart-idUSBRE86G01F20120717
3. HealthDay. Many lacked preventive care before health reform law: U.S. report. June 14, 2012. Available at: http://consumer.healthday.com/Article.asp?AID=665762
4*.PR Newswire. U.S. physician groups identify commonly used tests or procedures they say are often not necessary. April 4, 2012. Available at: http://www.prnewswire.com/news-releases/us-physician-groups-identify-commonly-used-tests-or-procedures-they-say-are-often-not-necessary-146046345.html
5. Abelson, R., Creswell, J. Hospital chain inquiry cited unnecessary cardiac work. New York Times online, August 6, 2012. Available at: http://www.nytimes.com/2012/08/07/business/hospital-chain-internal-reports-found-dubious-cardiac-work.html?pagewanted=all
6. Mohammed, K.A., Bullard, K.M., Saaddine, J.B., Cowie, C.C., Imperatore, G., Gregg, E.W. Achievement of goals in U.S. diabetes care, 1999-2010. The New England Journal of Medicine, 2013;368(17):1613-1624. Available at: http://www.nejm.org/doi/pdf/10.1056/NEJMsa1213829
Further Readings
1. Seaman, A.M. Surgeons-in-training dislike new work hours: survey. Reuters, May 17, 2013. Available at: http://news.yahoo.com/surgeons-training-dislike-hours-survey-194513540.html
2. Commins, J. Diagnostic errors common, costly, and harmful. HealthLeaders Media, April 23, 2013. Available at: http://www.healthleadersmedia.com/page-1/QUA-291407/Diagnostic-Errors-Common-Costly-and-Harmful##
3. PRWeb. Global computerized physician order entry systems market to reach US$1.5 billion by 2018, according to new report by Global Industry Analysts, Inc. July 13, 2012. Available at: http://www.prweb.com/releases/computerized_physician/order_entry_CPOE_systems/prweb9693652.htm
4. Kennedy, K. HHS: Hospitals ignoring requirements to report errors. USA Today online, July 20, 2012. Available at: http://www.usatoday.com/news/health/story/2012-07-19/hospitals-preventable-errors-report/56343348/1
5. Lerner, M. In new safety test, not all Minnesota hospitals earn A: National report card rates 38 state hospitals for patient safety. Star Tribune, June 7, 2012, p. B3. Available at: http://www.startribune.com/lifestyle/health/157309745.html
6. OConnell, K. Two arms, two choices: If only Id known then what I know now. Health Affairs 31(8):1895-1899, 2012. Available at: http://content.healthaffairs.org/content/31/8/1895.full.pdf+html
7. Andrews, M. New book offers checklists to help hospital patients. Kaiser Health News, March 5, 2012. Available at: http://www.kaiserhealthnews.org/features/insuring-your-health/2012/patient-checklists-michelle-andrews-03052012.aspx?referrer=search
8. Welch, H.G. Testing what we think we know. New York Times online, August 19, 2012. Available at: http://www.nytimes.com/2012/08/20/opinion/testing-standard-medical-practices.html
9. Pryor, D., Hendrich, A., Henkel, R.J., Beckmann, J.K., Tersigni, A.R. The quality journey at Ascension Health: How weve prevented at least 1,500 avoidable deaths a year and aim to do even better. Health Affairs 30(4):604-611, 2011. Available at: http://content.healthaffairs.org/content/30/4/604.full.pdf+html
10. Pronovost, P.J., Marsteller, J.A., Goeschel, C.A. Preventing bloodstream infections: A measurable national success story in quality improvement. Health Affairs 30(4):628-634, 2011. Available at: http://content.healthaffairs.org/content/30/4/628.full.pdf+html
11. Joyce, J.D., Cioffi, G.A., Petriwsky, J.G., Robinson, J.S. Legacy healths big aim initiative to improve patient safety reduced rates of infection and mortality among patients. Health Affairs 30(4):619-627, 2011. Available at: http://content.healthaffairs.org/content/30/4/619.full.pdf+html
12. Crosby, J. Getting it right (or left); Wrong-site surgeries continue to plague hospitals, but a new campaign hopes to ensure everyone takes a timeout before surgery. Star Tribune, June 20, 2011, p. D.1. Available at: http://www.highbeam.com/doc/1G1-259321876.html
13. Simmons, J. AHRQ: Hospitals give themselves high marks for patient safety. FierceHealthcare, March 23, 2011. Available at: http://www.fiercehealthcare.com/story/ahrq-hospitals-give-themselves-high-marks-patient-safety/2011-03-23
14. Boodman, S.G. Effort to end surgeries on wrong patients or body part falters. Kaiser Health News, June 20, 2011. Available at: http://www.kaiserhealthnews.org/Stories/2011/June/21/wrong-site-surgery-errors.aspx
15. McCoy, J. 7 medical error disclosure deterrents. HealthLeaders Media, February 9, 2011. Available at: http://www.healthleadersmedia.com/content/PHY-260817/7-Medical-Error-Disclosure-Deterrents.html
16. Goodman, J.C., Villarreal, P., Jones, B. The social cost of adverse medical events, and what we can do about it. Health Affairs 30(4):590-595, 2011. Available at: http://content.healthaffairs.org/content/30/4/590.full.pdf+html
17. Moisse, K. HHS announces partnership for patients to save lives, money. abc News, April 12, 2011. Available at: http://abcnews.go.com/Health/Wellness/hospital-safety-government-industry-team-reduce-errors/story?id=13355460
18. Kolata, G. Sports medicine said to overuse a popular scan. New York Times, October 29, 2011, p. A.1. Available at: http://www.nytimes.com/2011/10/29/health/mris-often-overused-often-mislead-doctors-warn.html?pagewanted=all&gwh=9206356E07CA1B10B397D83D480CB224
19. Terry, T. Electronic prescriptions have as many errors as written prescriptions. FierceHealthIT, June 30, 2011. Available at: http://www.fiercehealthit.com/story/prescription-errors-equal-whether-written-or-electronic/2011-06-30
20. Wakefield, J.G., McLaws, M-L., Whitby, M., Patton, L. Patient safety culture: factors that influence clinician involvement in patient safety behaviours. Quality and Safety in Health Care 19(6):585-591, 2010. Available at: http://qualitysafety.bmj.com/content/19/6/585.full.pdf+html
21. Study Puts Cost of Medical Errors at $19.5 Billion. Wall Street Journal (online), August 9, 2010. Available at: http://blogs.wsj.com/health/2010/08/09/study-puts-cost-of-medical-errors-at-195-billion/
22. Salamon, M. Despite efforts, study finds no decline in medical errors. HealthDay News, November 24, 2010. Available at: http://news.health.com/2010/11/24/despite-efforts-study-finds-no-decline-in-medical-errors/
23. Bennett, A. Lessons of a $618,616 death. Bloomberg Businessweek, March 4, 2010. Available at: http://www.businessweek.com/magazine/content/10_11/b4170032321836.htm
24. Metzger, J., Welebob, E., Bates, D.W., Lipsitz, S., Classen, D.C. Mixed results in the safety performance of computerized physician order entry. Health Affairs 29(4):655-663, 2010. Available at: http://content.healthaffairs.org/content/29/4/655.full.pdf+html
25. OCallaghan, T. Study: Fatal medication mistakes surge in July. New York Times, June 2, 2010. Available at: http://www.nytimes.com/2009/12/17/health/17chen.html?_r=1&pagewanted=print
26. Moffeit, M. DMN investigates: Lax supervision of residents at U.S. teaching hospitals puts patients at risk. Dallas Morning News, December 19, 2010. Available at: http://www.dallasnews.com/health/medicine/20101219-lax-supervision-of-residents-at-u.s.-teaching-hospitals-puts-patients-at-risk.ece
27. Kaiser Health News. Race Plays Role in Diagnosis and Treatment. July 24, 2009. Available at: http://www.kaiserhealthnews.org/daily-reports/2009/july/24/racial-disparities.aspx?referrer=search
28. Tong, A. Hospitals stem mistakes with colored socks and sashes. Simple things send a safety signal. The Sacramento Bee, September 14, 2009. p. B.1. Available at: http://s3.amazonaws.com/external_clips/104582/Hospitals_stem_mistakes_with_colored_socks_a.PDF?1345612636
29. Szabo, L. Studies: Surgeons could save lives, $20B by using checklist. USA Today, January 14, 2009. Available at: http://www.usatoday.com/news/health/2009-01-14-surgery-checklist_N.htm
30. Garbutt, J., Waterman, A.D., Kapp, J.M., Dunagan, W.C., Levinson, W., Fraser, V., Gallagher, T.H. Lost opportunities: How physicians communicate about medical errors. Health Affairs 27(1):246-255, 2008. Available at: http://content.healthaffairs.org/content/27/1/246.full.pdf+html
31. Skinner, J., Chandra, A., Goodman, D., Fisher, E.S. The elusive connection between health care spending and quality. Health Affairs Web Exclusive 28(1):w119-w123, published online December 4, 2008. Available at: http://content.healthaffairs.org/content/28/1/w119.full.pdf+html
32. Koppel, R., Wetterneck, T., Telles, J.L., Karsh, B-T. Workarounds to barcode medication administration systems: Their occurrences, causes, and threats to patient safety. Journal of the American Medical Informatics Association 15(4):408-423, 2008. Available at: http://www.sciencedirect.com/science/journal/10675027/15/4
33. Buerhaus, P.I. Is hospital patient care becoming safer? A conversation with Lucian Leape. Health Affairs Web Exclusive 26(6):w687-w696, published online October 9, 2007. Available at: http://content.healthaffairs.org/content/26/6/w687.full.pdf+html
34. States making it OK for docs to say sorry. MSNBC, April 11, 2007. Available at: http://www.msnbc.msn.com/id/18059841/
35. Pronovost, P.J., Miller, M.R., Wachter, R.M. Tracking progress in patient safety. An elusive target. JAMA 296(6):696-699, 2006. Available at: http://jama.jamanetwork.com/Issue.aspx?journalid=67&issueID=5031&direction=P
36. Asch, S.M., Kerr, E.A., Keesey, J., Adams, J.L., Setodji, C.M., Malik, S., McGlynn, E.A. Who is at greatest risk for receiving poor-quality health care? New England Journal of Medicine 354(11):1147-1156, 2006. Available at: http://www.nejm.org/doi/pdf/10.1056/NEJMsa044464
37. Leape, L. Reporting of adverse events. New England Journal of Medicine 347(20):1633-1638, 2002. Available at: http://www.nejm.org/doi/pdf/10.1056/NEJMNEJMhpr011493
Session 3 September 17, 2013
The Health Policy Process: Crabs in a Bucket?
The government plays a major role in shaping the U.S. health care system and its performance. About half of all health care spending in the United States flows through government programs, and every aspect of health care is subject to relatively extensive government oversight. In each subsequent session of the course, key health policy issues will be identified and described. This session provides a foundation for subsequent sessions. First, a general overview of the public policy process and its key participants is presented. Then, the politics of health care reform is discussed in the context of the recently passed, and continually challenged, federal health reform legislation.
Learning Objectives
Students should be able to:
1. Demonstrate an understanding of the political process as it relates to health care.
2. Describe the key components in the recently passed federal health reform legislation.
3. Discuss the role that various health care interest groups played in the passage of the federal health reform legislation and its implementation to date.
Suggested Readings
Overview of the Policy Process
1*.Marmor, T.R., Christianson, J.B. The political market for government health policies. Chapter 3 in Health Care Policy. A Political Economy Approach. Beverly Hills, CA: Sage Publications, 1982 (Posted on Moodle)
2. Murray, T.H. American values and health care reform. New England Journal of Medicine 362(4):285-287, 2010. Available at: http://www.nejm.org/doi/pdf/10.1056/NEJMp0911116
3*.Kaiser Family Foundation. KaiserEDU.org Tutorial: U.S. Congress and health policy. June 29, 2011. Available at: http://www.kff.org/us-congress-and-health-policy.cfm
4. Vaida, B., Weaver, C. Scorecard: How health industry PACs placed their election bets. Spending reflected view on health law. Kaiser Health News, November 23, 2010. Available at: http://www.kaiserhealthnews.org/Stories/2010/November/17/health-industry-pacs-election-bets.aspx
5. Israel, J. Top health information technology firms prefer revolving door lobbyists. iWatchNews, August 22, 2011. Available at: http://www.iwatchnews.org/2011/08/22/5859/top-health-information-technology-firms-prefer-revolving-door-lobbyists
6. Reinhardt, U.E. Is there hope for the uninsured? Health Affairs Web Exclusive, pp.w3-376-w3-390, published online August 27, 2003. Available at: http://content.healthaffairs.org/content/early/2003/08/27/hlthaff.w3.376.full.pdf+html
PPACA
1*.Kaiser Family Foundation. KaiserEDU.org Tutorial Health reform: An overview. October 1, 2010. Available at: http://www.kff.org/healthreform/kEDU_health_reform_overview_100110.cfm
2*.Klein, E. As health-care reform law turns 1, some clarity on what it does and how it does it. Washington Post, March 22, 2011, p. A.12. Available at: http://articles.washingtonpost.com/2011-03-21/business/35260878_1_health-care-reform-law-affordable-care-act-insurance
3. Berwick D.M. Putting health care on the right track. Washington Post online Opinions, June 21, 2012. Available at: http://www.washingtonpost.com/opinions/putting-health-care-on-the-right-track/2012/06/21/gJQAtBGltV_story.html
4. Samuelson, R.J. Why Obamacare is oversold. Washington Post, May 9, 2013. Available at: http://articles.washingtonpost.com/2013-05-09/opinions/39133432_1_affordable-care-act-health-care-uninsured-and-medicaid-recipients
5. Deparle, N-A. The successes of Obamacare. Washington Post, May 9, 2013. Available at: http://articles.washingtonpost.com/2013-05-09/opinions/39133432_1_affordable-care-act-health-care-uninsured-and-medicaid-recipients
6. Keller, B. Five Obamacare myths. The New York Times, July 15, 2012. Available at: http://www.nytimes.com/2012/07/16/opinion/keller-five-obamacare-myths.html?pagewanted=all&_r=0
7. Carroll, A.E., Frakt, A.B., New evidence supports, challenges, and informs the ambitions of health reform. Journal of the American Medical Society 309(24):2600-2601, 2013. Available at: http://jama.jamanetwork.com/issue.aspx?journalid=67&issueid=927181&direction=P
The Supreme Court Decision
1. Brooks, D. Modesty and audacity. [Op-Ed] New York Times, June 29, 2012, p. A.25. Available at: http://www.nytimes.com/2012/06/29/opinion/modesty-and-audacity.html?_r=0
2*.Rau, J., Appleby, J. Justices uphold individual mandate, set limits on Medicaid expansion. Kaiser Health News, June 28, 2012. Available at: http://www.kaiserhealthnews.org/stories/2012/june/28/supreme-court-upholds-individual-mandate.aspx
3. Jost, T.S. The affordable care act largely survives the Supreme Courts scrutiny but barely. Health Affairs 31(8):1659-1662, 2012. Available at: http://content.healthaffairs.org/content/31/8/1659.full
Implementation of PPACA
1*.Schouten, F. Health care law opponents dominate advertising wars. USA Today, July 10, 2013. Available at: http://www.usatoday.com/story/news/politics/2013/07/10/affordable-care-act-ads-nfl-president-obama-republicans-attacks/2506633/
2*.Bolton, A. Government shutdown looms over ObamaCare. The Hill, July 23, 2013. Available at: http://thehill.com/homenews/administration/312727-shutdown-looms-over-obamacare
3*.Cheney, K. House GOP unveils death by 1,000 cuts. Politico, July 17, 2012. Available at: http://www.politico.com/news/stories/0712/78627.html
4*.Editorial Board. Obamacares tricky next phase. The Washington Post, May 19, 2013. Available at: http://articles.washingtonpost.com/2013-05-19/opinions/39376708_1_health-insurance-health-coverage-obamacare-s
5. Millman, J. Exchanges, but not as envisioned. Politico, April 8, 2013. Available at: http://www.politico.com/story/2013/04/obamacare-health-care-exchanges-states-tout-employee-choice-89719.html
6. Pear, R. Racing to spread word about new health plans. The New York Times, April 23, 2013. Available at: http://www.nytimes.com/2013/04/24/health/racing-to-inform-millions-unaware-of-new-health-coverage.html?pagewanted=all&_r=0
7. Gold, J. Worries mount about enrolling consumers in federally run insurance exchanges. Kaiser Health News, April 7, 2013. Available at: http://www.kaiserhealthnews.org/stories/2013/april/08/health-insurance-exchanges-marketing.aspx
8. Krugman, P. Insurance and freedom. The New York Times, April 7, 2013. Available at: http://www.nytimes.com/2013/04/08/opinion/krugman-insurance-and-freedom.html
9. Brooks, D. Health chaos ahead. The New York Times, April 25, 2013. Available at: http://www.nytimes.com/2013/04/26/opinion/brooks-health-chaos-ahead.html
10. Kessler, D.P. The coming Obamacare shock. The Wall Street Journal, April 29, 2013. Available at: http://online.wsj.com/article/SB10001424127887324874204578441032081716170.html
11. Calmes, J. New worries for Democrats on health law. The New York Times, May 6, 2013. Available at: http://www.nytimes.com/2013/05/07/us/politics/gop-is-readying-a-new-offensive-over-health-law.html?pagewanted=all
12. Kessler, G. Is Long Beach really limiting the hours of 1,600 workers because of Obamacare? The Washington Post, May 6, 2013. Available at: http://www.washingtonpost.com/blogs/fact-checker/post/is-long-beach-really-limiting-the-hours-of-1600-workers-because-of-obamacare/2013/05/05/81e9a5b6-b4fe-11e2-9a98-4be1688d7d84_blog.html
13*.Klein, E., Soltas, E. Wonkbook: House Republicans hate Obamacare. But they also kind of need it. The Washington Post, May 17, 2013. Available at: http://www.washingtonpost.com/blogs/fact-checker/post/is-long-beach-really-limiting-the-hours-of-1600-workers-because-of-obamacare/2013/05/05/81e9a5b6-b4fe-11e2-9a98-4be1688d7d84_blog.html
14*.Samuelson, D., Cunningham, P.W. Obamacare repeal now about the IRS. Politico, May 16, 2013. Available at: http://www.politico.com/story/2013/05/obamacare-repeal-irs-91520.html
15. Carey, M.A. GOP fears about IRS access to medical records disputed. Kaiser Health News Blog, May 20, 2013. Available at: http://capsules.kaiserhealthnews.org/?p=19604
16. Bogardus, K. Labor unions break ranks with White House on Obamacare. The Hill, May 21, 2013. Available at: http://thehill.com/business-a-lobbying/300881-labor-unions-break-ranks-on-health-law
17. Weisman, J., Pear R. Partisan gridlock thwarts effort to alter health law. The New York Times, May 26, 2013. Available at: http://www.nytimes.com/2013/05/27/us/politics/polarized-congress-thwarts-changes-to-health-care-law.html?pagewanted=all
18. Esenstadt, A. Democrats 2014 strategy: Own Obamacare. Politico, June 4, 2013. Available at: http://www.politico.com/story/2013/06/dems-2014-strategy-own-obamacare-92172.html
19*.Baker, S. Court challenges could tear down major pieces of Obamacare. The Hill, June 2, 2013. Available at: http://thehill.com/blogs/healthwatch/health-reform-implementation/302895-court-challenges-could-tear-down-major-pieces-of-obamacare
Other Efforts to Expand Coverage for the Uninsured
1. Henry J. Kaiser Family Foundation. Massachusetts health care reform: Six years later. Issue Brief, May 2012. Available at: http://www.kff.org/healthreform/upload/8311.pdf
2*.Goldman, D. Leive, A. Why Medicare-for-all is not the answer. Health Affairs Blog, May 14, 2013. Available at: http://healthaffairs.org/blog/2013/05/14/why-medicare-for-all-is-not-the-answer/
3. Hsiao, W.C. State-based, single-payer health care A solution for the United States? New England Journal of Medicine 364(13):1188-1190, 2011. Available at: http://www.nejm.org/doi/pdf/10.1056/NEJMp1100972
Further Readings
1. Accenture. Are you ready? Private health insurance exchanges are looming, 2013. Available at: http://www.accenture.com/SiteCollectionDocuments/PDF/Accenture-Are-You-Ready-Private-Health-Insurance-Exchanges-Are-Looming.pdf
2. Goodnough, A. Critics of health care law outspending its supporters on ads. The New York Times, June 4, 2013. Available at: http://www.nytimes.com/2013/06/05/us/politics/critics-of-health-care-law-outspending-its-supporters-on-ads.html?gwh=36412B4E76FE81E688FB25886FB8FE9F
3. Baker, S. HHS delays Obamacare option for small businesses, saying its too complicated. The Hill, May 31, 2013. Available at: http://thehill.com/blogs/healthwatch/health-reform-implementation/302769-hhs-finalizes-delay-in-obamacare-option-for-small-businesses
4. Baker, S. Despite talk, no effort in Congress to change Obamacares employer mandate. The Hill, May 19, 2013. Available at: http://thehill.com/blogs/healthwatch/health-reform-implementation/300489-despite-talk-no-effort-to-change-obamacares-employer-mandate
5. Viebeck, E. Botched Obamacare rollout tops Democratic fears for 2014 election. The Hill, May 1, 2013. Available at: http://thehill.com/blogs/healthwatch/health-reform-implementation/297103-botched-obamacare-tops-dem-fears-for-14
6. Klein, E. Republicans will clobber Obamacare until they hug it. Bloomberg, April 24, 2013. Available at: http://www.bloomberg.com/news/2013-04-24/republicans-will-clobber-obamacare-until-they-hug-it.html
7. Pittman, D. Docs must take active role in reform, HHS says, Medpage Today, February 12, 2013. Available at: http://www.medpagetoday.com/Washington-Watch/Reform/37336
8. Vestal, S. Lack of competition might hamper health exchanges. Kaiser Health News, April 23, 2013. Available at: http://www.kaiserhealthnews.org/stories/2013/april/23/stateline-lack-of-competition-hamper-health-exchanges.aspx
9. Chen, L. How Obamacare will distort the health-care market. Bloomberg, April 7, 2013. Available at: http://www.bloomberg.com/news/2013-04-07/how-obamacare-will-distort-the-health-care-market.html
10. Carey, M.A. How the fiscal cliff affects health care: Six questions. Kaiser Health News, December 4, 2012. Available at: http://www.kaiserhealthnews.org/stories/2012/december/05/fiscal-cliff.aspx
11. Dionne Jr., E.J. A victory for Obama and for Roberts. Washington Post online Opinions, June 28, 2012. Available at: http://www.washingtonpost.com/opinions/ej-dionne-jr-a-win-for-obama--and-roberts/2012/06/28/gJQAlWta9V_story.html
12. Horwitz, J., Levy, H. Health care economics 101 and the Supreme Court. Health Affairs Blog, May 23, 2012. Available at: http://healthaffairs.org/blog/2012/05/23/health-care-economics-101-and-the-supreme-court/
13. Steuerle, C.E. How much did the Supreme Court settle? Urban Institute Research of Record, July 2, 2012. Available at:
http://www.urban.org/publications/901516.html
14. Gawande, A. Something wicked this way comes. The New Yorker online, June 28, 2012. Available at: http://www.newyorker.com/online/blogs/comment/2012/06/something-wicked-this-way-comes.html
15. Kessler, G. Fact checker: Does Romneys assessment of the economic impact of Obamas health-care law hold up? Washington Post online Politics, June 16, 2012. Available at: http://www.washingtonpost.com/politics/fact-checker-does-romneys-assessment-of-the-economic-impact-of-obamas-health-care-law-hold-up/2012/06/16/gJQAJjsqhV_story.html
16. Daschle, T. Obamas 4 major ACA hurdles to go. Politico, July 8, 2012. Available at: http://www.politico.com/news/stories/0712/78207.html
17. Gerstein, J., Haberkorn, J. Supreme Court health care ruling: 6 takeaways. Politico, June 28, 2012. Available at: http://www.politico.com/news/stories/0612/77986.html
18. Parker-Pope, T. What you need to know in the first year. New York Times, March 30, 2010, p. D.1. Available at: http://ic.galegroup.com/ic/suic/NewsDetailsPage/NewsDetailsWindow?failOverType=&query=&prodId=SUIC&windowstate=normal&contentModules=&mode=view&displayGroupName=News&limiter=&currPage=&disableHighlighting=false&displayGroups=&sortBy=&source=&search_within_results=&action=e&catId=&activityType=&scanId=&documentId=GALE%7CA222455099
19. Rago, J. The Massachusetts health-care train wreck. The Wall Street Journal, July 7, 2010, p. A.17. Available at: http://online.wsj.com/article/SB10001424052748704324304575306861120760580.html
20. Pear, R. Short of repeal, G.O.P. will chip at health law. New York Times, September 21, 2010, p. A.1. Available at: http://ic.galegroup.com/ic/suic/NewsDetailsPage/NewsDetailsWindow?failOverType=&query=&prodId=SUIC&windowstate=normal&contentModules=&mode=view&displayGroupName=News&limiter=&currPage=&disableHighlighting=false&displayGroups=&sortBy=&source=&search_within_results=&action=e&catId=&activityType=&scanId=&documentId=GALE%7CA237499337
21. Cafarella, N., Carrk, T. Myth vs. fact: Health care reform in Massachusetts. The state model for the affordable care act is working and broadly popular. Washington, DC: Center for American Progress. April 2011. Available at: http://www.americanprogress.org/issues/2011/04/mvf_healthcare_mass.html
22. Krugman, P. Hurray for health reform [Op-Ed]. New York Times, March 19, 2012, p. A.21. Available at: http://ic.galegroup.com/ic/suic/NewsDetailsPage/NewsDetailsWindow?failOverType=&query=&prodId=SUIC&windowstate=normal&contentModules=&mode=view&displayGroupName=News&limiter=&currPage=&disableHighlighting=false&displayGroups=&sortBy=&source=&search_within_results=&action=e&catId=&activityType=&scanId=&documentId=GALE%7CA283436112
Care Delivery
Session 4 September 24, 2013
The Physician Workforce: Characteristics, Training and Projections of Future Need
Assignment 2 Due
People are the critical element in any health care delivery system. In this session, we will focus on physicians, particularly on physician education and aggregate-level supply. There is now a major disagreement about whether there will be a future physician shortage and, if so, how to address it. There is also concern that health reform will make matters worse. This session presents opposing perspectives on these issues and discusses the likelihood of a public policy response. Subsequent courses in the MHA program will cover material relating to physician payment and management of physician practices.
Learning Objectives
Students should be able to:
1. Discuss the points of controversy regarding the prediction of future shortages or surpluses in physician supply in America.
2. Explain the limitations of the present medical education system in expanding physician supply.
3. Compare the positive and negative aspects of meeting U.S. physician shortages through use of foreign medical graduates.
4. Discuss the public policy issues regarding expanding physician supply.
Suggested Readings
Physician Education
1*. Saxton, J. The medical education of physicians. Background Paper No. 73, National Health Policy Forum. February 17, 2010. Available at: http://www.nhpf.org/library/background-papers/BP73_MedicalEducation_02-17-10.pdf
2. Kaiser Health News. Medical school costs, loan rates rise sharply. March 20, 2010. Available at: http://www.kaiserhealthnews.org/Daily-Reports/2010/March/10/medical-school-cost.aspx
3. Dower, C., ONeil, E. Primary care health workforce in the United States. Robert Wood Johnson Foundation Research Synthesis Report No. 22, July 2011. Available at: http://www.rwjf.org/files/research/070811.policysynthesis.workforce.rpt.pdf
4. Kavilanz, P. Med students rush to primary care programs. CNN Money, March 23, 2011. Available at: http://money.cnn.com/2011/03/23/news/economy/more_medical_students_pick_family_medicine/index.htm
5. LA Times online. Medical school enrollment on the rise. October 24, 2011. Available at: http://latimesblogs.latimes.com/money_co/2011/10/medical-school-enrollment.html
6*.Dower, C. Graduate medical education. A debate continues over the size and scope of federal subsidies to support residency training of the nations physicians. August 16, 2012. Available at: http://healthaffairs.org/healthpolicybriefs/brief_pdfs/healthpolicybrief_73.pdf
7. Wayne, D.B., Hauer, K.E. Counting quality, not hours: Understanding the impact of duty hour reform on internal medicine residency education. Journal of General Internal Medicine 27(11):1400-1401, 2012. http://link.springer.com/content/pdf/10.1007%2Fs11606-012-2185-3
8. Iglehart, J.K. Financing graduate medical education mounting pressure for reform. New England Journal of Medicine 366(17):1562-1563, 2012. http://www.nejm.org/doi/pdf/10.1056/NEJMp1114236
9. Cohen, J. New med school aims to train primary care docs. Kaiser Health News, April 2, 2013. Available at: http://www.kaiserhealthnews.org/stories/2013/april/02/quinnipiac-medical-school-primary-care.aspx
10*.Ofri, D. The third year of medical school turns students from altruistic to bitter. Slate, June 4, 2013. Available at: http://www.slate.com/articles/health_and_science/medical_examiner/2013/06/medical_school_dark_side_the_third_year_makes_students_less_empathetic.html
11. Sack, K. Summer of work exposes medical students to systems ills. The New York Times, September 9, 2009. Available at: http://www.nytimes.com/2009/09/09/health/policy/09medschool.html?_r=0
12. Crosson, F.J., Leu, J., Roemer, B.M., Ross, M.N. Gaps in residency training should be addressed to better prepare doctors for a twenty-first century delivery system. Health Affairs 30(11):2142-2148, 2011. Available at: http://content.healthaffairs.org/content/30/11/2142.full.pdf+html
Physician Concerns
1*.Ringel, S.P. Practicing medicine versus pushing paper. A neurologist reflects on the realities of his workday after a patient asks why doctors complain about payers bureaucratic oversight. Health Affairs 30(6):1200-1202, 2011. http://content.healthaffairs.org/content/30/6/1200.full.pdf+html
2. Morra, D., Nicholson, S., Levinson, W., Gans, D.N., Hammons, T., Casalino, L.P. US Physician practices versus Canadians: Spending nearly four times as much money interacting with payers. Health Affairs 30(8):1443-1450, 2011. http://content.healthaffairs.org/content/30/8/1443.full.pdf+html
3. Barr, S. Few doctors consider themselves rich, survey says. Kaiser Health News, April 25, 2012. Available at: http://capsules.kaiserhealthnews.org/index.php/2012/04/few-doctors-consider-themselves-rich-survey-says/
4. Punke, H. 11 specialties with most satisfied physicians. Beckers Hospital Review, April 30, 2013. Available at: http://www.beckershospitalreview.com/hospital-physician-relationships/11-specialties-with-most-satisfied-physicians.html
Practice Choices
1*. Lee, D. Physician-hospital links grow. Overhead, reimbursement fuel trend of doctors forgoing autonomy. Indy.com, March 4, 2010. Available at: http://www.indystar.com/article/20100304/BUSINESS/3040377/Physician-hospital-links-grow
2. Harris, G. More physicians say no to endless workdays. New York Times, April 2, 2011, p. A.1. http://www.nytimes.com/2011/04/02/health/02resident.html?pagewanted=all&_r=0
3*.Burling, S. Why heart doctors are leaving practice to work for hospitals. philly.com, January 27, 2012. Available at: http://mobile.philly.com/health/?wss=/philly/health&id=138095623
4*.Gamble, M. 68% of graduating physicians want sign-on bonus, 29% want hospital practice. Beckers Hospital Review, August 16, 2012. Available at: http://www.beckershospitalreview.com/hospital-physician-relationships/68-of-graduating-physicians-want-sign-on-bonus-29-want-hospital-practice.html
Projections of Future Physician Supply
1. Iglehart, J.K. Grassroots activism and the pursuit of an expanded physician supply. New England Journal of Medicine 358(16):1741-1749, 2008. http://www.nejm.org/doi/pdf/10.1056/NEJMhpr0800058
2*.Robert Wood Johnson Foundation. Will the United States have a shortage of physicians in 10 years? November 2009. Available at: http://www.academyhealth.org/files/publications/HCFOReportDec09.pdf
3*.Henry J. Kaiser Family Foundation. Primary care shortage; Background brief. Available at: http://www.kaiseredu.org/topics_im.asp?id=1032&imID=1&parentID=70
4. Alliance for Health Reform. Health care workforce: Future supply vs. demand. Washington, DC: Author, April 2011. Available at: http://www.allhealth.org/publications/Medicare/Health_Care_Workforce_104.pdf
5. Wayne, A. Doctor shortage may swell to 130,000 with cap. Bloomberg, August 28, 2012. Available at: http://www.bloomberg.com/news/2012-08-29/doctor-shortage-may-swell-to-130-000-with-u-s-cap.html
6. Dunn, L. What will the physician workforce look like in 2030? Beckers Hospital Review, May 13, 2013. Available at: http://www.beckershospitalreview.com/hospital-physician-relationships/what-will-the-physician-workforce-look-like-in-2030.html
7. Preidt, R. Primary care doctors still in short supply in U.S. MedlinePlus, June 14, 2013. Available at: http://www.nlm.nih.gov/medlineplus/news/fullstory_137836.html
8. Sanner, A. Newly insured to deepen primary care doctor gap. TwinCities.com, June 22, 2013. Available at: http://www.loganbanner.com/view/full_story/22993974/article-Newly-insured-to-deepen-primary-care-doctor-gap
Options for Increasing Physician Supply
1. Hart, L.G. et al. International medical graduate physicians in the United States: Changes since 1981. Health Affairs 26(4):1159-1169, 2007. http://content.healthaffairs.org/content/26/4/1159.full.pdf+html
2*.Brownlee, S., Goodman D. Doctors no one needs. [Op-Ed]. New York Times, December 23, 2009. p. A.31. http://www.nytimes.com/2009/12/23/opinion/23brownlee.html
3*. Pardes, H., Miller, E.D. We cant afford to train fewer doctors. New York Times, July 12, 2011, p. A.13. http://online.wsj.com/article/SB10001424052702303544604576434470768158908.html
4. McAllester, M. America is stealing the worlds doctors. New York Times online, March 7, 2012. Available at: http://www.nytimes.com/2012/03/11/magazine/america-is-stealing-foreign-doctors.html?pagewanted=all
5. Association of American Medical Colleges. Medical school enrollment continues to climb with new diversity gains. October 24, 2012. Available at: https://www.aamc.org/newsroom/newsreleases/310002/121023.html
6. Editorial. An Rx for the doctor shortage. Los Angeles Times, April 21, 2013. Available at: http://articles.latimes.com/2013/apr/21/opinion/la-ed-medical-professionals-20130421
7*.Caramenico, A. Med school enrollment growth wont ease doc shortage. FierceHealthcare, May 3, 2013. Available at: http://www.fiercehealthcare.com/story/med-school-enrollment-growth-wont-ease-doc-shortage/2013-05-03
8. Minnesota Medicine. Willing and able to work. April 2010. Available at: http://www.minnesotamedicine.com/PastIssues/PastIssues2010/April2010/PulseWillingandAbletoWorkApril2010.aspx
9. Sanders, B. Primary physician shortage calls for intervention. Politico, May 7, 2013. Available at: http://www.politico.com/story/2013/05/doctors-physician-shortage-calls-for-intervention-91024.html
10. Gold, J. Immigrant docs help ease Californias primary care shortage. Kaiser Health News, April 4, 2013. Available at: http://www.kaiserhealthnews.org/stories/2013/april/04/california-doctors-primary-care-latin-america.aspx
11. Torrey, E.F., Torrey, B.B. The US distribution of physicians from lower income countries. PLoS One 7(3):1-4, 2012. Available at: http://www.plosone.org/article/info:doi/10.1371/journal.pone.0033076
12. Koleva, G. Economists show primary care especially unrewarding for women doctors. Forbes, July 16, 2012. Available at: http://www.forbes.com/sites/gerganakoleva/2012/07/16/economists-show-primary-care-especially-unrewarding-for-women-doctors/
Public Policy Issues and Concerns About Physician Supply
1. Lowrey, A., Pear, R. Doctor shortage likely to worsen with health law. New York Times, July 29, 2012, p. A.1. http://www.nytimes.com/2012/07/29/health/policy/too-few-doctors-in-many-us-communities.html
2*. Goozner, M. More doctors on the way, higher costs to follow. The Fiscal Times, May 4, 2012. Available at: http://www.thefiscaltimes.com/Articles/2012/05/04/More-Doctors-on-the-Way-Higher-Costs-to-Follow.aspx#page1
3*. Reinhardt, U.E. Health-care reform and the doctor shortage. New York Times online, August 17, 2012. Available at: http://economix.blogs.nytimes.com/2012/08/17/health-care-reform-and-the-doctor-shortage/
4. Reinhardt, U.E. From physician glut to physician shortage. The New York Times, August 31, 2012. Available at: http://economix.blogs.nytimes.com/2012/08/31/from-physician-glut-to-physician-shortage/
5. Davis, K.L. Demand for doctors soaring as cuts loom. Politico, March 5, 2013. Available at: http://www.politico.com/story/2013/03/demand-for-doctors-soaring-as-cuts-loom-88390.html
6. Ubel, P. How much money should a cardiologist make? Forbes, December 7, 2012. Available at: http://www.forbes.com/sites/peterubel/2012/12/07/how-much-money-should-a-cardiologist-make/
Further Readings
1. Conover, C. Are U.S. doctors paid too much? Forbes, May 28, 2013. Available at: http://www.forbes.com/sites/theapothecary/2013/05/28/are-u-s-doctors-paid-too-much/
2. ConsumerReports. What bugs you most about your doctor. June 2013. Available at: http://www.consumerreports.org/cro/magazine/2013/06/what-bugs-you-most-about-your-doctor/index.htm
3. Hixon, T. Rebutting the premise that doctors help drive high health care costs. Forbes, March 24, 2012. Available at: http://www.forbes.com/sites/toddhixon/2012/03/24/rebutting-the-premise-that-doctors-help-drive-high-health-care-costs/
4. Novak, S. Luring students into family medicine. The New York Times, September 9, 2012. Available at: http://www.nytimes.com/2012/09/10/us/10iht-educlede10.html?pagewanted=all
5. Tulenko, K. Americas health worker mismatch. The New York Times, September 13, 2012. Available at: http://www.nytimes.com/2012/09/14/opinion/americas-health-worker-mismatch.html
6. Viebeck, E. House Dem floats bill to ward off doctor shortage. The Hill, September 28, 2012. Available at: http://thehill.com/blogs/healthwatch/other/259239-house-dem-floats-bill-to-ward-off-doctor-shortage
7. Schwartz, M.D. Health care reform and the primary care workforce bottleneck. Journal of General Internal Medicine 27(4):469-472, 2012. http://link.springer.com/content/pdf/10.1007%2Fs11606-011-1921-4
8. Gold, J. The next frontier for elite med schools: Primary care. Kaiser Health News, September 23, 2012. Available at: http://www.kaiserhealthnews.org/stories/2012/september/24/mt-sinai-primary-care.aspx
9. Goldstein, A. Primary-care health panel caught in partisan dispute. The Washington Post, May 16, 2011, p. A.3. Available at: http://www.highbeam.com/doc/1P2-28704120.html
10. Aneja, S., Ross, J.S., Wang, Y., Matsumoto, M., Rodgers, G.P., Bernheim, S.M., Rathore, S.S., Krumholz, H.M. US cardiologist workforce from 1995 to 2007: Modest growth, lasting geographic maldistribution especially in rural areas. Health Affairs 30(12):2301-2309, 2011. Available at: http://content.healthaffairs.org/content/30/12/2301.full.pdf+html
11. Armstrong, D. Doctors turn away insured patients on low payments, study finds. Bloomberg, June 27, 2011. Available at: http://www.bloomberg.com/news/2011-06-27/doctors-turn-away-insured-on-low-payments.html
12. Cassel, C. K., Reuben, D.B. Specialization, subspecialization, and subsubspecialization in internal medicine. New England Journal of Medicine 364(12):1169-1173, 2011. Available at: http://www.nejm.org/doi/pdf/10.1056/NEJMsb1012647
13. Grady, D. Foreign-born doctors give equal care in U.S. New York Times, August 3, 2010, p. D.7. http://www.nytimes.com/2010/08/03/health/03doctors.html
14. Brown, D. How the new health-care law might make your doctor better informed, more efficient, more responsive and, maybe, happier. The Washington Post, May 4, 2010, p. E.1. Available at: http://www.washingtonpost.com/wp-dyn/content/article/2010/04/30/AR2010043002007.html
15. Gold, J. Hospitals lure doctors away from private practice. Kaiser Health News, October 13, 2010. Available at: http://www.npr.org/templates/story/story.php?storyId=130237412
16. Iglehart, J.K. Medicare, graduate medical education, and new policy directions. New England Journal of Medicine 359(6):643-650, 2008. Available at: http://www.nejm.org/doi/pdf/10.1056/NEJMhpr0803754
Session 5 October 1, 2013
Rethinking Primary Care: What is the Future for the Family Doctor?
Improving the delivery of primary care is a growing challenge for policymakers, clinicians, and health care managers. The flaws in the present system are painfully evident, with various alternatives now being adopted in hopes of correcting, or at least, mitigating them. In this session, we describe the challenges currently facing primary care, with particular focus on new models for organizing the delivery of care, and the potential expanded role for advanced practice nurses in rethinking primary care.
Learning Objectives
Students should be able to:
1. Describe the factors leading to current efforts to change primary care delivery in the U.S.
2. Discuss changes in the workplace and work arrangements for primary care physicians.
3. Compare and contrast new models for reforming primary care.
4. Discuss how public policy, and health care reform in particular, is likely to affect primary care.
Suggested Readings
Challenges to Traditional Models of Primary Care Delivery
1*. Bodenheimer, T. and Pham H.H. Primary care: Current problems and proposed solutions. Health Affairs 29(5):799-805, 2010. http://content.healthaffairs.org/content/29/5/799.full.pdf+html
2. Vaughn, B.T., DeVrieze, S.R., Reed, S.D., Schulman, K.A. Can we close the income and wealth gap between specialists and primary care physicians? Health Affairs 29(5):933-940, 2010. http://content.healthaffairs.org/content/29/5/933.full.pdf+html
3. Iglehart, J.K. Doctor-workers of the world, unite! Health Affairs 30(4):556-558, 2011. http://content.healthaffairs.org/content/30/4/556.full.pdf+html
4. Delude, C. What happened to the family doctor? Los Angeles Times, June 27, 2011. Available at: http://articles.latimes.com/print/2011/jun/27/health/la-he-primary-care-doctors-20110627
5*.Iglehart, J.K. Primary care update light at the end of the tunnel? New England Journal of Medicine 366(23):2144-2146, 2012. http://www.nejm.org/doi/pdf/10.1056/NEJMp1205537
6. Peterson, S.M., Phillips Jr., R.L., Bazemore, A.W., Koinis, G.T. Unequal Distribution of the U.S. primary care workforce. American Family Physician 87(11):1. Available at: https://www.clinicalkey.com/#!/BrowserCtrl/doBrowseTo/journalIssue/{"facet":["1-s2.0-S0002838X13X60101"],"issn":"0002838X","contentType":"Journals"}
7. Sanger-Katz, M. Why we trust doctors. NationalJournal, April 19, 2012. Available at: http://www.nationaljournal.com/features/restoration-calls/why-we-trust-doctors-20120419
Changes in the Workplace for Primary Care Physicians
1. Landon, B.E. Use of quality indicators in patient care. A senior primary care physician trying to take good care of his patients. Journal of the American Medical Association 307(9):956-964, 2012. Available at: http://jama.jamanetwork.com/Issue.aspx?journalid=67&issueID=22492&direction=P
2. Chen, P. Delivering Better Primary Care. New York Times, May 13, 2010. Available at: http://www.nytimes.com/2010/05/13/health/13chen.html
3. Becker, A.E. More physicians turning to hospital-based practice. Ctmirror, August 15, 2011. Available at: http://ctmirror.org/story/13550/hospitalists
4. Harris, G. Family physician cant give away solo practice. New York Times, April 23, 2011, p. A.1. http://www.nytimes.com/2011/04/23/health/23doctor.html?pagewanted=all
5*. Sun, L.H. Hospitals courting primary-care doctors. Washington Post, June 20, 2011, p. A.1. http://articles.washingtonpost.com/2011-06-19/national/35265390_1_primary-care-care-at-lower-costs-medicine
6. Swan, B.A. After hospital care, the test begins. Los Angeles Times, May 9, 2013. Available at: http://articles.latimes.com/2013/may/09/opinion/la-oe-swan-post-hospital-care-20130509
New Models for Primary Care
Patient Centered Medical Homes (PCMHs) and Team Care
1*.Hoff, T. The shaky foundation of the patient-centered medical home. American Journal of Managed Care 16(6):e134-e136, 2010. http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=b1ae00b1-d01d-4f57-a3a7-c3fa2b2aa56c%40sessionmgr14&vid=4&hid=16
2*.Casalino, L.P. Analysis & commentary. A Martians prescription for primary care: Overhaul the physicians workday. Health Affairs 29(5):785-790, 2010. http://content.healthaffairs.org/content/29/5/785.full.pdf+html
3. Margolius, D., Bodenheimer, T. Transforming primary care: From past practice to the practice of the future. Health Affairs 29(5):779-784, 2010. http://content.healthaffairs.org/content/29/5/779.full.pdf+html
4. Berenson, R.A., Devers, K.J., Burton, R.A. Will the patient-centered medical home transform the delivery of health care? Washington, DC: Urban Institute, August 2011. Available at: http://www.urban.org/UploadedPDF/412373-will-patient-centered-medical-home-transform-delivery-health-care.pdf
5. Adair, R., Christianson, J., Wholey, D., White, K.M., Town, R., Lee, S., et al. Care guides. Employing nonclinical laypersons to health primary care teams manage chronic disease. Journal of Ambulatory Care Management 35(1):27-37, 2012. http://ovidsp.tx.ovid.com/sp-3.8.1a/ovidweb.cgi?WebLinkFrameset=1&S=OHFMFPMFGBDDCDJDNCOKJDIBFLAMAA00&returnUrl=ovidweb.cgi%3f%26TOC%3dS.sh.18.19.22.25%257c4%257c50%26FORMAT%3dtoc%26FIELDS%3dTOC%26S%3dOHFMFPMFGBDDCDJDNCOKJDIBFLAMAA00&directlink=http%3a%2f%2fgraphics.tx.ovid.com%2fovftpdfs%2fFPDDNCIBJDJDGB00%2ffs047%2fovft%2flive%2fgv031%2f00004479%2f00004479-201201000-00004.pdf&filename=Care+Guides%3a+Employing+Nonclinical+Laypersons+to+Help+Primary+Care+Teams+Manage+Chronic+Disease.&link_from=S.sh.18.19.22.25%7c4&pdf_key=B&pdf_index=S.sh.18.19.22.25
7*. Ghorob, A., Bodenheimer, T. Sharing the care to improve access to primary care. New England Journal of Medicine 366(21):1955-1957, 2012. http://www.nejm.org/doi/pdf/10.1056/NEJMp1202775
8. Green, L.V., Savin, S., Lu, Y. Primary care physician shortages could be eliminated through use of teams, nonphysicians, and electronic communications. Health Affairs 32(1):11-19, 2013. Available at: http://content.healthaffairs.org/content/32/1/11.full.pdf+html
9*.Hausman, S. Yes, Virginia, there is a medical home. Kaiser Health News, May 1, 2013. Available at: http://www.kaiserhealthnews.org/stories/2013/may/01/medical-homes-virginia.aspx
10. Rao, A. Doctors transform how they practice medicine. Kaiser Health News, May 15, 2013. Available at: http://www.kaiserhealthnews.org/stories/2013/may/15/doctors-transform-practices-over-financial-lifestyle-pressures.aspx?referrer=search
11. The Commonwealth Fund. Primary care: Our first line of defense. June 12, 2013. Available at: http://www.commonwealthfund.org/Publications/Health-Reform-and-You/Primary-Care-Our-First-Line-of-Defense.aspx?page=all
12. Frolkis, J.P. The Columbo phenomenon. Journal of the American Medical Association 309(22):2333-2334, 2013. Available at: http://jama.jamanetwork.com/issue.aspx?journalid=67&issueid=927088&direction=P
13. Landon, B.E. Moving ahead with the PCMH: Some progress, but more testing needed. Journal of General Internal Medicine 28(6):753-755, 2013. Available at: http://link.springer.com/content/pdf/10.1007%2Fs11606-013-2434-0.pdf
Increased Reliance on Advanced Practice Nurses
1. Galewitz, P. Urgent care centers are booming, which worries some doctors. The Washington Post, September 17, 2012. Available at: http://www.washingtonpost.com/national/health-science/urgent-care-centers-are-booming-which-worries-some-doctors/2012/09/17/e87f1a0c-e0cb-11e1-a19c-fcfa365396c8_story.html
2*.Pohl, J.M., Hanson, C., Newland, J.A., Cronenwett, L. Analysis & commentary. Unleashing nurse practitioners potential to delivery primary care and lead teams. Health Affairs 29(5):900-905, 2010. http://content.healthaffairs.org/content/29/5/900.full.pdf+html
3. Elliott, V.S. Sharp increase expected in number of nurse practitioners. amednews.com, July 2, 2012. Available at: http://www.ama-assn.org/amednews/2012/07/02/bisb0702.htm
4*.Kiff, S. Nurse practitioners look to fill gap with expected spike in demand for health services. Washington Post online, May 12, 2012. Available at: http://www.washingtonpost.com/national/health-science/nurse-practitioners-look-to-raise-profile-fill-gap-from-doctor-shortage/2012/05/12/gIQAHmHYLU_story.html
5. Aizenman, N.C. Nurses can practice without physician supervision in many states. The Washington Post, March 24, 2013. Available at: http://www.washingtonpost.com/national/health-science/nurses-can-practice-without-physician-supervision-in-many-states/2013/03/24/98b241cc-8745-11e2-999e-5f8e0410cb9d_story.html
6. Punke, H. Hiring of non-physician providers on the rise. Beckers Hospital Review, November 2, 2012. Available at: http://www.beckershospitalreview.com/hospital-physician-relationships/hiring-of-non-physician-providers-on-the-rise.html
7*.Beck, M. Battles erupt over filling doctors shoes. The Wall Street Journal, February 4, 2013. Available at: http://online.wsj.com/article/SB10001424127887323644904578271872578661246.html
8. State of Iowa, Iowa Board of Medicine. Board reminds physicians of responsibilities when supervising up to 5 physician assistants. March 11, 2013. Available at: http://medicalboard.iowa.gov/Board%20News/2013/Board%20offers%20guidance%20on%20supervision%20of%20physician%20assistants%20-%2003112013.pdf
9. SullivanCotter and Associates, Inc. Advancing practice clinician pay whats happening and whats coming. 2012. Available at: http://www.sullivancotter.com/sites/default/files/SullivanCotter_2012_APC%20Pay_What's%20Happening%20and%20What's%20Coming_0.pdf
10. Bartolone, P. California weighs expanded role for nurse practitioners. Kaiser Health News, May 9, 2013. Available at: http://www.kaiserhealthnews.org/stories/2013/may/09/california-expanded-role-nurse-practitioners.aspx?referrer=search
11*.Tran, A. Docs, nurses disagree over expanded nurse roles. Kaiser Health News Blog, May 15, 2013. Available at: http://capsules.kaiserhealthnews.org/?p=19536
12. Dill, M.J., Pankow, S., Erikson, C., Shipman, S. Survey shows consumers open to a greater role for physician assistants and nurse practitioners. Health Affairs 32(6):1135-1142, 2013. Available at: http://content.healthaffairs.org/content/32/6/1135.full.pdf+html
13. Pohl, J., Barksdale, D., Werner, K. The latest data on primary care nurse practitioners and physicians: Can we afford to waste our workforce? Health Affairs Blog, June 18, 2013. Available at: http://healthaffairs.org/blog/2013/06/18/the-latest-data-on-primary-care-nurse-practitioners-and-physicians-can-we-afford-to-waste-our-workforce/
The Influence of Public Policy and Health Reform on Primary Care
1. Wang, S.S. Pilot plan on health an option for states. Wall Street Journal, June 8, 2010. Available at: http://online.wsj.com/article/NA_WSJ_PUB:SB10001424052748704749904575293044222043802.html.
2. DoBias, M. Adapt or else. Whether it wants to or not, the health care system is being forced to reinvent itself. NationalJournal.com, March 10, 2011. Available at: http://www.nationaljournal.com/member/magazine/health-reform-forces-industry-to-reinvent-itself-20110310?mrefid=site_search&page=1
3. Johnson, W. Family care doctors are in high dem