29 January 2011

ACOs – The fork in the Road

Now that the house of representatives has taken their vote to repeal, we know that much of the Affordable Care Act may never be put in place because funding will quite likely be blocked. Some we know will be done in 2011, and more in the following years. We know that some of the better parts will move forward, but even then the court battle will probably not be resolved until mid-2012.

I am not sure of the value being assigned to this, but since it is part of the new law and at present still on the books, we should understand as much of it as is possible. I mean patients need to understand. We are the people who may have the most to benefit, or lose, by the new structures being promoted.

Do be concerned, as there are some dangerous flaws in the proposed models. Most will never be transparent and will be buried in technical and legal documents which we as patients, will never see. Accountable Care Organizations (ACOs) may continue to exist, but the rules and regulations governing them have yet to be defined.

It is going to be interesting to see what the organizations are going to look like. Are they going to be centered around hospitals, or will they be physician controlled, or will they be combinations of these? This is the interesting part. From my reading, it represents a jigsaw puzzle and may have small benefits for patients. The large benefits all seem directed to the physicians and hospitals.

There will be the small benefits to patients by reducing the duplicity of tests we now undergo, better (hopefully) care because physicians and hospitals will necessarily need to communicate more openly about patient care. This could translate into less errors foisted on patients. The large concern I see, will be how to handle doctors mistakes and they will have more layers of protection and harder to be dismissed for practice mistakes.

I will not make further questions until the form of the ACOs is actually known, but you can see many of them. There will be several more blogs about these and other problems with ACOs and their formation. These will be done as I decipher this area and learn more.

For those interested read this from the New England Journal of Medicine.

28 January 2011

Assessing an ACO Prototype

This New England Journal of Medicine article is about an accountable care organization (ACOs) that is physician managed. While this has been underway for some time, it is not fully operational under the new laws which seems to be hindering its operation. This has been a demonstration project sponsored by the Centers for Medicare and Medical Services (CMS).

But understand this was directed by Congress of the Department of Health and Human Services (DHHS). The aim was to improve the quality of care to Medicare beneficiaries and reduce its cost while using the incentive-based payment. Instead they used the fee-for-service payment system. This fee-for-services payment system is faulty to begin with so this is not a good example for what the future may hold for ACOs.

In 2000, Congress gave the DHHS the task of testing incentive-based payment methods for physicians. They directed Medicare to encourage care coordination and investment in processes for more efficient service delivery and to reward physicians for improving health care results. The demonstration actually began in April 2005 and apparently still continues.

On December 9, 2010, DHHS reported results from the project's fourth year ending March 31. 2009 and announced the payout incentives. Most of the quality goals were process measures related to coronary artery disease, diabetes, heart failure, hypertension, and preventive care.

CMS is now working to transition these physician groups into the ACO program established under the reform law The CMS is drafting regulations that will guide implementation of the Accountable Care Organization (ACO) program scheduled to begin January 1, 2012.

Many questions remain because the project used the fee-for-services payment and not the incentive-based payment as directed. Will this be corrected under the ACOs or will this be a legal issue for the courts to resolve. There are many other organizational questions to be answered, but this is for future blogs.

Read the details about this here.

27 January 2011

Hospitals Medically Abuse Elderly Leaving the ICU

This is easy to believe. This study presented to the Society of Critical Care Medicine 40TH Critical Care Congress said that more than half of of the elderly admitted to the intensive care unit (ICU) receive prescriptions for drugs they do not need when it is time to go home.

A lot of terms are used. Potentially inappropriate medications (PIMs) and overtly inappropriate medications (AIMs) are the terms. The researchers were very careful in the use of terms and how they described medications. They left out many possibilities for the reasons these medications were prescribed. This does bother me that hospital doctors are doing this. Without knowledge of what the medications were, I will withhold my speculation at this point.

There are some drugs that are generally inappropriate, but turn out to be appropriate in a clinical setting. Such drugs should be stopped at discharge because they are no longer needed. Having a lot of drugs in the elderly creates problems of cognitive function, increases the risk of falls, and healthcare costs.

In addition, a hospitalist, geriatrician, and a clinical pharmacist evaluated whether PIMs medications at discharge were also AIMs by looking at their indication, efficacy, dosages, and drug interactions. It is disturbing that some patient receiving 3 or more PIMS before admission was 16 percent, but increased to 38 percent at hospital discharge. Other increases were even greater.

This study points out why if you have elderly parents, you should know what medications they are taking when they enter the hospital and then know what is absolutely necessary when they are discharged. Make sure that the primary care doctor for them is also aware of this. Make sure that you have the necessary powers to take care of them medically to make sure that they are not over-medicated on purpose or even by accident. If they are capable, just check the prescriptions to make sure they are not over-medicated.

To me this is necessary. Read the entire article here and see if you don't agree.

26 January 2011

Update on U of MN Clinical Trials

Now I have a better understanding of what is happening at the U of MN Schulze Diabetes Institute. I am now not surprised about not hearing anything from them. I just appreciate that Scott Johnson wrote his blog January 24, 2011 here. He covered his conversation with a participant of the clinical trials. Read his blog for information on that.

I appreciate his links to the Schulze Diabetes Institute web site which gives me insight into what is happening. From Scott's blog, it is clear that the clinical trials are much different from what happened in Russia and are being done in New Zealand. Here they are using immunosuppressants or anti-rejection drugs. This makes the procedure much more dangerous.

Scott has several links to further information so take time to follow them and do some reading. My blog from yesterday is the reason for this when I came across this information. The U of MN site is here and then read about the clinical trials here.  Kathy White's blog has lots of related links and is here.

A lot of information, but I think it is worth reading if you are interested.

25 January 2011

Russia First to Approve Marketing of Porcine Cells

This may not be approved for people with diabetes, Type 2, it is well worth reading and following the results obtained. This is presently for those with Type 1 diabetes and represents the first actual use of porcine cells in any country outside of the trials. Russia has approved this for human use.

I had hoped for more press, but over a month has passed and nothing. For people with Type 1 diabetes, this has to be very hopeful. The US will probably take several years to even consider this, but this is very hopeful and should be followed closely. I have tried to find out what stage the University of Minnesota is at in their trials, but emails have not been returned, or never received – two were returned, but the third one I have nothing on.

Living Cell Technologies (LCT) is the first company to have clinical trials using porcine cells implants. These implants are implanted in the abdomen using a simple laparoscopic procedure. Then the “DIABECELL” (LCTs registered trademark) implants work by self regulating and efficiently secreting insulin and glucagon in response to the patient's changing glucose levels. Using their own LCT proprietary encapsulation, the DIABECELL patients do not require any immunosuppression or anti-rejection drugs.

LCT has a web site here with a press release and other related areas that are excellent to read. Then a Type 1 blogger from New Zealand has this to say about progress in New Zealand.

24 January 2011

Big Pharma in Social Media

Four of the Big Pharma companies have now entered the social media. Allison Blass writing for Diabetes Mine pulled together much good information and analysis of the three sites. Yes, two companies joined for one site and partnered with the American Association of Clinical Endocrinologists (AACE) and its educational arm, the American College of Endocrinology (ACE). This group is aiming to help the people with Type 2 diabetes.

So a quick summary of the three sites. Note: I have not joined any of these sites as I presently have little interest in them. I feel that everyone should have the knowledge and be able to access them to make their own decision.

The first and least well developed to date is discuss diabetes presented by Sanofi-Aventis. There are several tabs all containing the same information.

The second is for US citizens only and is corner stones 4 care and is presented by NovoNordisk. There is a small amount of activity.

The third is the partnership of Bristol Myer Squibb and AstraZeneca and is the most complete site at this time. It is the one partnered by AACE and ACE. While this may make the site more valuable, be careful as they will not vary much from the professional standards and positions of the organization.  It is the type 2 talk.

The blog with more detail on Diabetes Mine is here. It is a good blog and deserves your time.

23 January 2011

Prevention's “Outsmart Diabetes” Entry

This article sounds interesting, but my suspicions about Prevention just won't let me join. I do not like the privacy rights statement and the fact that my information will be available to all their other entities. I have had one bad experience with Prevention and that has affected my outlook about them.

I followed them for several years and enjoyed reading their magazine, but then the bad experience really soured me. So if anyone likes this site, joins, and would care to explain it to me, I will listen as this could be valuable for some people. So please do not let me turn you off if this is good for you. I encourage you to investigate on your own. It may be just what you need.

Apparently this is just a recent entry as the article is dated January 21, 2011. I have visited the introduction page and the “Your Privacy Rights” page, but that is as far as I have gone after reading the privacy policy statement. It says “Outsmart Diabetes” is free. Of course this is by Rodale, Inc. They make some bold statements, but from what I remember, they normally deliver on content.

So if you are interested, read the article here, and visit the web site here.