Demand For Genetic Testing

The demand for genetic testing in the United States continue to grow. According to Bradley Kreit of IFTF, It’s likely that getting a genetic scan will become a routine part of growing up–not too different from an eye exam or a physical.

However, the direct-to-consumer genetic testing are more difficult and time consuming to explain, since with only a handful of exceptions, genes don’t predict disease, but instead offer probabilities that certain diseases are more or less likely. As a result some think that the test results are misleading and of little use to consumers.

The FDA has also started notifying genetic testing companies that direct-to-consumer genetic testing qualifies as a “medical device” which could potentially subject genetic testing to federal regulation. Whether or not these tests get regulated–and what those regulations could look like–are obviously open questions.

At the same time, it’s unlikely that even the strictest regulations would spell the end of direct-to-consumer genetic testing. In other words, the future of regulating genetics is up in the air, but demand for testing in the United States–regardless of what regulatory decisions get made–is likely to continue to grow.

Daniel MacArthur, who just launched Genomes Unzipped with Vorhaus, has a very insightful take about where we might see this demand finding its supply: Singapore and China!

It’s no more difficult to send a vial of saliva from Texas to California than it is to send one from Texas to China. Which is another way of saying that the genetic testing will be around, regardless of what happens in the regulatory sphere in the United States. You won’t take your kid to a community center or school to find out those genetic risk probabilities; you’ll walk over to the computer and Skype over to India or China for a counseling session….

Source: Bradley Kreit, IFTF July 26, 2010

Patient’s Bill of Rights

The Departments of Health and Human Services (HHS) issued regulations to implement a new Patient’s Bill of Rights under the Affordable Care Act – which will help children (and eventually all Americans) with pre-existing conditions gain coverage and keep it; protect all Americans’ choice of doctors; eliminate the need for a referral to see an ob-gyn or seeking emergency care; and end lifetime limits on the care consumers may receive.

The new rules also ensure that if you like your current health care plan, you can keep it; youth up to the age of 26 can stay on their parents health care plan; tax credits for small businesses that have been struggling to provide care to their employees; and $250 checks to tens of thousands of seniors who have reached the ‘donut hole’ — a term used to describe the gap in Medicare Part D prescription coverage.

Source: HHS and HealthReform.Gov; June, 22nd 2010

Improvement Map

The sheer volume of often conflicting demands placed upon hospitals — coupled with a deteriorating financial climate—can make the notion of improving care quality seem like an idealistic improbability at best, an impossibility at worst. Many healthcare executives are pretty skeptical that quality improvement is a realistic goal in current healthcare landscape.

In response to the current situation The Institute for Health Improvement (IHI) has designed an “improvement map” to help hospital leaders sift through myriad regulations, measurements, and demands to hone an essential set of processes and craft an organization-specific plan for quality improvement.

The Improvement Map™ is an interactive, web-based tool designed to bring together the best knowledge available on the key process improvements that lead to better patient care. It offers clear guidance helping hospitals set change agendas, establish priorities, organize work, and optimize resources.

View The Gap Analysis Chart

View The Introductory Video

Source: The Institute of Health Improvement

Healthcare Reform in California

The Affordable Care Act has many positive provisions, including new coverage for two million low-income Californians under Medi-Cal and other public coverage programs and for another two to three million who would be eligible for subsidies to purchase private coverage.

Also, people with health problems (“pre-existing conditions”) will not be denied the ability to purchase private coverage based on their health status. And it will be much less likely that a serious illness will be followed by bankruptcy.

However, the law has only a few elements to help reduce costs, and none of that will work as quickly as we need. If we are to avoid bankrupting our society, we must find ways to reduce costs while maintaining and improving the quality of care.

So what is to be done?

  • Change the way we pay for health care: paying health care providers to do more things with more expensive equipment will bankrupt California.
  • Squeeze out inefficiency in the system: improve the efficiencies through the proper use of modern information technology.
  • Give patients real power to choose: give patients, employers and payers more access to cost and quality information so they can understand the value of what they are buying
  • Innovate, innovate, and innovate some more: innovations should allow consumers to participate in their own care, promote use of cost-reducing technologies
  • Coordinate the hand-off: decisions on implementing reform must be made soon by the current Administration and Legislature. Today’s leaders should focus on establishing effective governance, defining private and public sector roles, and assuring that patients are well-served by new coverage systems. We need a durable foundation to allow a smooth hand-off to a new administration in 2011.

Source: Mark D. Smith, M.D., M.B.A. June 2010, California Healthcare Foundation

L.A. County Sees Gains From Mental Health Care Initiative

Nearly six years after California voters approved Proposition 63, Los Angeles County has seen a sharp decline in hospitalizations (67%), incarcerations (75%) and homeless (68%) rates among people with mental illnesses, according to county data. Countywide, the number of clients under the age of 18 hospitalized at psychiatric facilities due to mental health issues has dropped by 40%, according to LACDMH. The number of adults under the age of 60 hospitalized has dropped 44%, and the number of older adults has dropped 42%.  Hospitalization days dropped 16% for adults and 17% for older adults.

Proposition 63 levied a 1% tax on individuals with annual incomes higher than $1 million to raise funds for mental health initiatives. Officials said the extra funds have allowed Los Angeles County to contract with more private health care providers and mental health caseworkers.  County officials claim that the drops in jail and hospital days alone have saved $39.8 million overall

Hospital Association of Southern California” which represents most of the hospitals county wide.  LACDMH spokesperson Kathleen Piche said the programs have been effective in terms of diverting the mentally ill from ERs and into urgent care facilities or primary care physicians with extended office hours.

Source: California Healthline, June 4th 2010

Pentagon Virus Detector

Imagine a sensor attached to your telephone, that instantly diagnoses viral agents and transmits that to a central community database. That’s the potential of an ongoing Pentagon-funded research project, spearheaded by geneticists at Duke University. Since 2006, they’ve been hunting for a genetic signature that can accurately assess, well before symptoms appear, whether someone’s been infected with a virus. Eight months into a $19.5 million grant from Darpa, the Pentagon’s out-there research agency, the expert behind the program is anticipating a tool with implications far beyond military circles.

What’s realy exciting is tha the benefits of this Darpa initiative goes beyond that. Not only have the researchers found a specific genetic signature that indicates viral infection, but the team has concluded that viruses and bacterial infections trigger different genes. Which means physicians could one day know whether to prescribe antibiotics, which can treat bacteria but not viruses. The drugs are so overused and wrongly prescribed, experts at a recent congressional hearing warned that Americans face “a post antibiotic era.”

The privacy and regulatory aspects will be a barrier to make these devices available for use, but one day they will be!

Source: Katie Drummond, May 13, 2010 Wired Magazine

Arizona Immigration Law and Medical Practice

According to Dr. Lucas Restrep, the new Arizona state immigration bill signed into law on April 23, 2010 will seriously obstruct, if not undermine, the practice of medicine in the state of Arizona. Arizona practitioners, hospitals, and medical associations need to ponder the extent of their liability under the new law and draft clear institutional policies to defend their patients and employees from potential harassment. As Dr. Resterp states this bill threatens one of the oldest traditions of medicine: physicians shall protect patients regardless of nationality or race. This legislation, if unchallenged, will force health care providers to choose between the dignity of their profession and the indignity of violating the law.

Source: New England Journal of Medicine

Moving Towards a Patient-Centered Healthcare System

Does USA have “the best health care system in the world as claimed by conservative senate republicans? Not… according to Donal Berwick the president of the Institute for Healthcare Improvement (IHI).

Despite the fact that Berwick will be charged with beginning to squeeze $400 billion worth of waste and fraud out of the Medicare system over a period of ten years, in the two months since President Obama named Dr. Donald Berwick as his candidate to head the Centers for Medicare and Medicaid, (CMS) not one industry group has voiced opposition to his nomination. Industry insiders understand that as Berwick reins in unnecessary spending, their revenues will be trimmed. Nevertheless Berwick’s reputation for integrity, wisdom and success in protecting patients is such that the health care industry stands behind him, endorsing the president’s choice.

Berwick who has traveled the world seeing foreign health care system first-hand understands how much we have to gain by studying success in other nations as we design a “patient-centered” system that is both more affordable and safer. Berwick often points out that in other countries health care systems are more “system-like.” Doctors and hospitals collaborate to improve the population’s health. They share electronic records and co-ordinate care. Our system, by contrast, is fiercely competitive and fragmented, with most physicians working in small practices while surgical centers vie with hospitals for the most lucrative cases.

According to Berwick, the entire Western world testifies that there are fine ways to provide health insurance to absolutely everybody while investing less than 60 cents on every dollar that we spend today. We need to have the courage and confidence to figure out how to do that ourselves. To say that we spend 15 percent of our gross domestic product on health care and that that is not enough. . . . is ridiculous. It is dishonest. We have enough. We have plenty. What we lack is not social resources, it is honesty.

Source: Maggie Mahar Posted May 26,2010 @ Health Beat