The Healthcare Policy Podcast ® Produced by David Introcaso

Listen Now The Emergency Medical Treatment and Labor Act (EMTALA) was passed in 1986 under the Reagan administration to help prevent patient dumping.  The law requires hospitals to provide emergency medical treatment to anyone regardless of citizenship, legal status or ability to pay.  In recent years however hospitals have begun to impose upfront emergency room fees.  Today approximately half of all hospitals do so.  Hospital executives claim these fees reduce ER overcrowding by diverting patients with non-emergency needs.  Patient advocates claim the fees undermine EMTALA's intent and causes patients' health conditions to worsen.  For example, in 2011 one large national hospital chain saw 80,000 patients leave their emergency rooms untreated when faced with a $150 use fee.  During this 17 minute podcast Professor Rosenbaum explains what generally EMTALA requires, when ER fees can be legally solicted or collected, the negative effects of fee collection, she questions the legitimacy of the industry's argument that fees help to encourage more appropriate site of care use and what can be done to provide better oversight and enforcement of EMTALA.     Professor Sara Rosenbaum is the Harold and Jane Hirsh Professor of Health Law and Policy and Founding Chair of the Department of Health Policy at The George Washington University School of Public Health and Health Services.  Professor Rosenbaum is best known for her work on the expansion of Medicaid and community health centers, patients' rights in managed care, civil rights and health care, and national health reform.  She is the lead author of Law and the American Health Care System, a landmark textbook that provides an in-depth exploration of the interaction of American law and the U.S. health care system.  She has received numerous national awards for her work, serves on governmental advisory committees, private organizational and foundation boards, and is a past Chair of AcademyHealth. She is a member of the CDC Director's Advisory Committee, the CDC Advisory Committee on Immunization Practice and a Commissioner on the Medicaid and CHIP Payment and Access Commission (MACPAC).  She received her BA from Wesleyan and her JD from Boston University. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Listen NowOf the two and a half million Americans that die annually, less than half, or 45%, die under hospice care. About one-third of these deaths are cancer related the remainder are moreover from heart and lung disease and dementia.  Of the over 5,000 hospice providers nearly two-thirds are for profit.  Over 80% of all hospice care is paid for by Medicare.  While hospice care is ever-increasingly becoming accepted by the public, the program's benefits are compromised largely due to the fact that over one-third of hospice enrolled decedents were enrolled in the program for too short a period of time, or less than seven days.  During this 21 minute podcast, Dr. Doblin discusses why he became a hospice physician, what makes for good hospice care, why the benefit remains under-utilized, what constitutes a "good death," how might hospice and palliative care be improved and how these services might better fit  in ever-evolving changes in the health care industry.     Dr. Bruce H. Doblin is currently a Physician in the Department of Internal Medicine at Northwestern Memorial Hospital.  He also serves as an Instructor of Clinical Medicine-Internal Medicine at the Northwestern University Feinberg School of Medicine.  Previously, Dr. Doblin served for over ten years as the Medical Director for Seasons Hospice and Palliative Care in Chicago.  Dr. Doblin earned his BA in Economics at Williams College and his MD and Masters in Public Health from Northwestern University.  He completed fellowship training at UCLA in health services research and at the University of Chicago in Clinical Medical Ethics. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Listen Now Transcendental Meditation (TM) has long been studied as an approach to improving health status generally and lowering blood pressure specifically.  For example, the American Heart Association published research in 2012 that found African Americans who practiced TM regularly over five years were almost half as likely to have a heart attack or stroke or die from all causes compared to African Americans who attended health education classes due to lowered blood pressure and improved anger management.  Among other applications, TM has also shown to be effective in reducing PTSD and polytrauma among active military service members and veterans.  During this 21 minute podcast Dr. Schneider discusses what's meant by the "mind-body-heart" connection, what role can/does TM play in influencing these connections, the research evidence for TM's use in reducing hypertension and more generally stress and anxiety for a wide variety primary and secondary disease prevention purposes and the level of acceptance for TM within the medical community.     Dr. Robert Schneider is currently the Director and Senior Investigator of the Center for Natural Medicine and Prevention at the Maharishi University of Management Research Institute.  Over the course of his career Dr. Schneider has been awarded more than $20 million in grants from the NIH for his pioneering research on natural approaches to reducing heart disease.  Dr. Schneider is a Fellow of the American College of Cardiology, a former member of the White House Commission on Complementary and Alternative Medicine Policy and has has served on numerous commissions and expert panels for the Congress, the CDC and others.  Dr. Schneider is the author of Total Heart Health and over 100 medical research articles.  He has been featured in numerous media reports including CNN, The New York Times, and Time magazine.  He received his MD from the University of Medicine and Dentistry of New Jersey and did his residency training at the University of Michigan Medical Center. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Listen NowHuman physiology or biological functioning exhibits fractal or irregular patterns.  When heart rate, (or respiration rate, blood pressure, brain waves and even walking stride length) begins to lose its fractal dimension or there is a loss of heartbeat variability, this is an indication of illness.  In order to respond best to environmental circumstances, adaptative variability (not homeostasis) is what organisms strive toward.  Measuring therefore the decline in heart rate variability over time can serve as a clinically effective biomarker for the onset of disease, for example, the onset of chronic obstructive pulmonary disease (COPD), one of the leading causes of hospitalizations and re-hospitalizations.  During this 20 minute interview Professor Palmer explains briefly the science behind what explains heart rate variability and variability more generally in biological functioning, what are the clinical or health care or clinical applications for this research, his research to avoid COPD hospitalizations and the onset of infection for leukemia patients, the larger implications of this research work and receptivity toward this different paradigm in understanding biological functioning and disease progression.Dr. James Palmer is an Assistant Professor in Family Medicine at the University of Colorado's Anshuyltz Medical Campus in Denver.  His research concerns testing and developing the use of heart rate interval dynamics as an actionable prognostic biomarker for earlier detection and diagnosis COPD exacerbation.  Dr. Palmer also has an independent professional practice that designs applications of complexity sciences to improve clinical care processes and outcomes.  His work has helped to develop and implement healthcare improvement projects both in the US and Canada.  Dr. Palmer completed his Doctor of Management in 2007 at the Complexity and Management Centre, University of Hertfordshire, UK.  He was also educated as an economist at the University of Chicago (MA) and Texas Christian University (BA).For a review of the theory behind and applications for monitoring variability see, for example, Andrew JE Seely, et al. "Continuous Multiorgan Variability Monitoring in Critically Ill Patients - Complexity at the Bedside," at: http://www.therapeuticmonitoring.com/files/IEEE-CIMVA-paper_Boston_Sep-2011.pdf  This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Listen NowAccording to Information Week there are now approximately 100,000 mobile medical applications (double the number from last year) and the market for these applications is expected to grow from $500 million in 2010 to $8 billion by 2018.  These applications promise to provide the consumer with everything from health and wellness information to cancer diagnoses.  What do we know about who uses mobile medical applications or digital therapeutics, why and to what effect?    During this 22 minute interview Ms. Marchibroda describes four general categories of mobile medical applications, their parochial uses by the public, healthcare providers, employers and insurers, what's known about their effectiveness, potential downsides and why the FDA is regulating these (and future federal regulation of health information technology more generally).  Ms. Janet Marchibroda is currently the Director of the Health Innovation Initiative and the Executive Director of the CEO Council on Health and Innovation at the Bipartisan Policy Center in Washington, DC.  Ms. Marchibroda also serves as a board member for Doctors Helping Doctors Transform Health Care.  Ms. Marchibroda previously led stakeholder engagement activities for the National Coordinator for Health Information Technology at DHHS, served as the Chief Health Care Officer at IBM, served as the founding Chief Executive Officer for eHealth Initiative (eHI) and also served as the Chief Operating Officer of the National Committee for Quality Assurance.  Among other awards she's been recognized as one of the Top 25 Women in healthcare by Modern Healthcare magazine.  Ms Marchibroda was graduated from the University of Virginia with a BS and from The George Washington University with an MBA. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Listen NowIn 1999 the Institute of Medicine published "To Err Is Human," a report that shocked the medical establishment because it concluded as many as 98,000 Americans die annually from hospital caused medical errors.  In 2000 the highly respected scholar Dr. Barbara Starfield estimated medical errors or adverse events actually amount to 225,000 deaths annually making them the 3rd leading cause of death after heart disease and cancer.   Most recently a study published this past September in the Journal of Patient Safety estimated medical errors cause between 210,000 to 440,000 deaths annually.  Added to these sobering estimates is the fact there's never been an actual count of how many patients have been killed by medical errors and what progress that has been made in reducing errors, or at least the growth in the number of errors, has been charterized as "frustratingly slow" and "agonizingly slow."During this 23 minute intereview Ms. Gibson discusses the prevalence of medical errors and why she believes the rate of medical harm is actually getting worse.  She explains why she believes both the medical community's response as well as federal and state government responses have been inadequate and what is needed to reverse this extraordinary number of medical-related deaths.       Ms. Rosemary Gibson is a Senior Advisor at the non-profit Hasting Center, a research organization dedicated to addressing ethical issues in health, medicine and the environment.  Ms. Gibson is also an editor for JAMA Internal Medicine.  Previously, Ms. Gibson was a Program Officer at the Robert Wood Johnson Foundation where she addressed safety and quality issues particularly in palliative care.  Among other books Ms. Gibson is the author of "Wall of Silence, The Untold Story of the Medical Mistakes That Kill and Injure Millions of Americans."  Ms. Gibson serves on numerous boards including the Consumers Union Safe Project and among others she received the Lifetime Achievement Award from the American Academy of Hospice and Palliative Medicine.  Ms. Gibson is a graduate of Georgetown University and the London School of Economics.To learn more about Ms. Gibson's work go to: http://www.amazon.com/s/?ie=UTF8&keywords=rosemary+gibson&tag=googhydr-20&index=stripbooks&hvadid=18834377909&hvpos=1t1&hvexid=&hvnetw=g&hvrand=187281419643604594&hvpone=&hvptwo=&hvqmt=b&hvdev=c&ref=pd_sl_6ynacw5hh2_b This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Listen NowIt's estimated in the next few years the Affordable Care Act will add 25 million Americans to the health care insurance rolls.  In addition, 10,000 Americans age into Medicare every day.  Current estimates by the Health Resources and Services Administration and others show the country already has a shortage of health care providers, particularly primary care physicians, and the shortage is projected to grow substantially worse by 2025.   Since we can neither meet the demand nor improve supply without changes or improvements to medical workforce training what then can be done to reform federally-funded graduate medical education (GME), particularly since GME policy has been frozen since 1997.   During this 17 minute interview Dr. Goodman discusses the adequacy of the current health care workforce, what can be done in the near term to improve supply particularly to reduce the maldistribution of providers, policy alternatives he is recommending to improve (or incent) provider supply via changes to federal funding of GME and how (any) reform to GME can avoid the consequence of more physicians simply accelerating health care spending without improving healthcare outcomes or population health.  (Please note: Dr. Goodman's comments are his own.)     Dr. David C. Goodman is a Professor of Pediatrics, the Co-Principle Investigator of the Dartmouth Atlas of Health Care and leads the Institute for Health Policy and Clinic Practice at Dartmouth.  His primary research interest is the relationship of outcomes to health workforce supply and its implications for health workforce policy.  He also leads and mentors a wide range of projects investigating the causes and consequences of variation in health care capacity and utilization. Dr. Goodman is the co-founder of the Wennberg International Collaborative, a research network that advances the study of unwarranted medical practice variation.   He is the author of numerous research publications and serves on several editorial boards.  Dr. Goodman was graduated from SUNY, Syracuse with a MD degree, he did his medical training at Johns Hopkins and earned a MS in epidemiology from Dartmouth. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Listen NowConservative estimates show hospital-acquired infections (HAIs) sicken two million Americans, directly kill 23,000 and contribute to a total of 100,000 deaths each year.  The bacterial infection C. diff (Clostridium difficile) alone causes 250,000 people to be hospitalized annually.  Healthcare costs associated with these infections are estimated at over $50 billion.  These illnesses and deaths are largely the result of an overuse or misuse of antibiotics that causes bacteria to become over time drug or anti-microbial resistent.  (Fifty percent of all antibioticis prescribed for people are not needed.)  The CDC has recently termed these "nightmare bacteria." They pose, the CDC has stated further, a "catastrophic threat" to the public's health. During this 23 minute interview Ms. Jezek explains why antimicrobials are overused both in human and food animal populations, why drug companies have been pulling out of doing research in this area, what's being done to spur researchers to develop new anti-bacterials including the IDSA's 10 x 2020 program, what IDSA is doing regarding bacterial transplants, what's being done by the FDA under 2012 GAIN Act and what the Congress has tried to do, or is trying to do, to address this substantial public health problem.Ms. Amanda Jezek is the VP for Public Policy and Government Relations at the Infectious Diseases Society of America (IDSA) which represents over 10,000 physicians and scientists.  In her position Amanda is responsible for policy development and advocacy on IDSA priority issues including antimicrobial resistance, antimicrobial and diagnositcs development, preparedness and federal funding.  Prior to joining IDSA, Amanda was the Deputy Director for Federal Affairs at the March of Dimes Foundation.  Amanda has lobbied for Mental Health American and worked as a Legislative Assistant and Press Secretary for Rep. Grace Napolitano (D-CA).  Amanda received her BA from Dartmouth College. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Listen NowUS medical malpractice policy is considered to be substantially flawed.  Only a small percent of patients harmed file claims, awards even for similar injuries vary widely, and "defensive" medicine that leads to over-testing and treatment inflate health care costs by as much as $55 billion annually.  What reforms can be made to "medmal" policy to improve patient safety, reduce health care costs and create greater trust between the public and the health care industry. During this 22-minute interview Ms. Mulligan explains why there's actuallly been a recent downward trend in medical tort claims, she discusses the meaning and merits of "defensive medicine" and other alleged medmal-driven adverse affects on health care delivery, she critiques several proposed reform solutions including "safe harbors," "sorry works" and "health courts" along with state reforms in California and Texas, finally she offers her own prescriptions in improving medical malpractice policy.      Ms. Janice F.Mulligan is a partner with the San Diego law firm of Mulligan and Banham.  Ms. Mulligan's particular expertise is in medical malpractice and personal injury.   Previously to forming her own practice, Jan worked in the California Attorney General's Office prosecuting physicians for malfeasance.  Jan has served in leadership positions in the American Bar Association, is a former President of the San Diego Inn of Court and a former Board member of the San Diego County Bar Association.   In addition to her full time law practice, Jan regularly teaches at the University of California San Diego, School of Medicine.  Jan attended the University of San Diego and St. Anthony's College at Oxford University and graduated with honors from the University of San Diego School of Law. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Listen NowFor nearly four decades, Maryland's “all payer” system has set hospital prices for the state's 53 hospitals.  The state regulates prices for every insurer including Medicaid, Medicare and patients who pay their own bills.  Last week the state proposed to substantially alter how it pays state hospitals by creating over time a capitated payment system (a hard cap) that would increase overall spending using a ten year rolling average.  Maryland would save a minimum projected $300 million over the first three years of the program if the state managed to keep the pace of hospital costs commensurate with the state's economic growth.  If successful, Maryland would join one other state, Massachusetts, in tying hospital spending to the growth of the state's economy. During this 21-minute interview Mr. Cohen explains why Maryland's all payer system remains unique, why the state is now proposing to reform its all payer system, he explains how specifically it intends to revise its reimbursement formula, how it will work practically, how it will generate cost savings (largely through health care quality improvements) and what challenges the state will face should the federal goverment approve its proposal to revise its payment system.    Mr. Robb Cohen is currently Senior VP of Public Policy with the Gorman Health Group.  Prior to Robb founded XLHealth, a Special Needs Plan (SNP), and served as their Chief of Goverment Affairs.  Prior still Robb was the Founder and President of Phoenix Healthcare Consulting.  Robb graduated from the Wharton School of the University of Pennsylvania, the Leonard Davis Institute in Health Economics with an MBA in Finance and Healthcare Management.  Among other community activites Robb has served on a number of State of Maryland Department of Health & Mental Hygiene workgroups and task forces.To learn more about the Maryland proposal go to: http://dhmh.maryland.gov/SitePages/Medicare%20Waiver%20Modernization.aspx. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com