The child was scheduled to undergo routine treatment, including the placement of dental crowns and a possible tooth extraction during her appointment, Veronica Rocha reported for the Los Angeles Times. Continue reading
It’s always a good idea for reporters to think about unintended consequences, especially when we’re talking about the latest, trendiest policy fixes. I’m thinking of such ideas as requiring people who need medical care to put more “skin in the game” and to choose medical services with more attention to the prices. What could go wrong?
In an eye-opening essay for The New Yorker, Lisa Rosenbaum explores the consequences for people with limited means to pay. She makes the case that injecting price transparency into patient-doctor encounters could, if not done thoughtfully, “end up hurting most those we are trying to help.”
Rosenbaum, a cardiologist, starts with a first-person account of suffering a serious injury, and reflects on how pain and fear in such circumstances alter the way we think and make decisions, even among those who are pretty well off: Continue reading
One issued we pursued during the AHCJ webcast last month (The cost of health care: Is transparency possible?) is whether price transparency will drive costs up or down.
The members of our panel reported that price transparency will cause providers to drop their prices, and now new research shows that when reference pricing is combined with price transparency, costs tend to decline as well.
A reference pricing initiative in California motivated hospitals to reduce prices for hip and knee replacements, according to a study released earlier this month by the Center for Studying Health System Change. HSC conducted the research for the National Institute for Health Care Reform.
The HSC report, “Potential of Reference Pricing to Generate Health Care Savings: Lessons from a California Pioneer,” showed that when the California Public Employees’ Retirement System (CalPERS) introduced reference pricing for patients seeking hip and knee replacements, the initiative had two positive results. First, it helped steer patients to lower-price hospitals, and second, it motivated hospitals to reduce prices for these joint replacement procedures. Continue reading
This is a guest post from AHCJ member Chelsea Conaboy that first appeared in “White Coat Notes” at Boston.com.
Dr. Bohdan Pomahac and others at Brigham and Women’s Hospital in Boston grappled with lots of variables as they prepared to perform some of the first-ever face transplants. One they had little control over: Would the families of potential donors support the idea?
Overwhelmingly, families have been willing to have their loved ones’ face donated for transplant, Pomahac said Wednesday night, speaking at the inaugural event of the Boston chapter of the Association of Health Care Journalists.
Pomahac credited the media in part for the response, saying journalists’ eagerness to tell the stories of patients and what the transplant has meant for them has affected public opinion.
“People have really embraced it as something important,” he said.
Pomahac and a team of plastic and transplant surgeons at the hospital performed the first full face transplant in the United States in March 2011, about two years after doing a partial transplant on James Maki. Two other full transplants have been completed since.
Pomahac said he was “scared” of the media attention early on, having heard stories of tabloid reporters and photographers trying to sneak into hospitals in Europe where the earliest procedures were done.
Body guards were posted at the doors of patient rooms, and only those surgeons and support staff on a list were allowed near the operating room, he said. But the hospital staff also worked in advance of the surgeries to create a media plan that allowed for the stories to be told, something all four patients wanted. Each posed different challenges.
During Maki’s procedure, ABC was filming Boston Med at the hospital, so Pomahac was fitted with a microphone through parts of the preparation, a stressful period. At points, he said, he “just couldn’t stand it,”
“It added another level of intensity in this very, very tight period of time,” he said.
When Dallas Wiens was in surgery for the first full transplant in the United States, a crew from a British tabloid descended on the hospital with a document alleging it had exclusive rights to his story, he said. Wiens, who is blind, thought he had signed a form allowing the newspaper to take his photo, said Brigham spokeswoman Erin McDonough, who also attended the Wednesday event at Boston University, and the hospital worked with Wiens’ attorney to call off the crew.
Charla Nash, who had had a lot of media coverage prior to her surgery, came with an agent and attorneys who worked with the hospital communications staff.
Pomahac said he became a bit of a star in the Czech Republic, with most media outlets profiling him. He said journalists there have allowed him to read their stories for fact-checking before publishing.
“That’s something I would love to see here, actually,” he said. “I hear its not going to happen.”
Pomahac compared face transplants to the first kidney transplant, performed at the Brigham in 1954, between identical twins.
People then said, “So what?” What would the procedure mean for patients without a twin?
“It seemed like this bizarre, rare operation that, okay, we’re able to do it, but it’s unlikely to lead anywhere,” he said.
For many years, it didn’t. The development of immunosuppression drugs changed that. Similarly, if the side effects of those drugs used in face transplants can be controlled, and if insurers agree to cover the costly procedure, full or partial face transplants will become more widely used, he said.
One other limiting factor, he said, is the surgeons. Face transplants are long — Mitch Hunter’s surgery, the shortest at the Brigham, ran more than 14 hours, he said. Surgeons will become more efficient as the procedure becomes more common and they develop a better workflow, Pomahac said.
Now, he added, “everyone gets tired at the same time. Everyone works slower. But no one wants to leave” the operating room.
Writing for The New York Times, Barry Meier and Janet Roberts analyzed a particularly tricky batch of federal reports detailing a variety of complaints with popular metal-on-metal hip replacements. They found that, since January, the FDA has received more complaints (5,000-plus) about the devices than it did, total, from 2007 to 2010.
While processing the data, the paper’s staff did their best to parse duplicate reports, international filings and other inconsistencies, but the reporters make it clear that the numbers are still best viewed in general terms. Even so, they demonstrate that the surge in complaints and lawsuits involving metal-on-metal hips — and the resulting mass defection of doctors who once implanted them — signals a broad shift in hip replacement surgery, one of the most common such procedures in the country. It also signals another blow for device manufacturers and patients, and a related windfall for the legal profession.
The vast majority of filings appear to reflect patients who have had an all-metal hip removed, or will soon undergo such a procedure because a device failed after only a few years; typically, replacement hips last 15 years or more.
The mounting complaints confirm what many experts have feared — that all-metal replacement hips are on a trajectory to become the biggest and most costly medical implant problem since Medtronic recalled a widely used heart device component in 2007. About 7,700 complaints have been filed in connection with that recall.
As problems and questions grow, most surgeons are abandoning the all-metal hips, saying they are unwilling to expose new patients to potential dangers when safer alternatives — mainly replacements that combine metal and plastic components — are available. Some researchers also fear that many all-metal hips suffer from a generic flaw. Current use of all metal devices has plummeted to about 5 percent of the market, though a few of the models are performing relatively well in select patients.