One more gene between us and bird flu

We’re always in favor of stopping a massive viral pandemic, or at least knowing more about what might make one Read more

Antibody diversity mutations come from a vast genetic library

The antibody-honing process of somatic hypermutation is not Read more

Emory Microbiome Research Center inaugural symposium

Interest in bacteria and other creatures living on and inside us keeps climbing. On August 15 and 16, scientists from a wide array of disciplines will gather for the Emory Microbiome Research Center inaugural Read more

health policy

Studying the doctor and nursing shortage

An increase in the number of the nation’s elderly and the aging population of doctors is causing a doctor shortage in the United States, with estimates that the demand for doctors will outstrip supply by 2020, according to the Association of American Medical Colleges.

The Association of Colleges of Nursing notes a similar dilemma for the nation’s registered nurses. Read Knowledge@Emory for the full article. 

Fred Sanfilippo, MD, PhD

Fred Sanfilippo, MD, PhD, executive vice president for health affairs at Emory, CEO of Emory’s Woodruff Health Sciences Center and chairman of Emory Healthcare, says, “There is an ever-changing cycle of shortages. Advances in technology and treatment can reduce or increase demand for specialists needed in one area or another much more quickly than it takes to train or absorb them.”

For instance, the demand for cardiac surgeons has slowed dramatically as a result of better medications and stents. Changes in insurance and Medicare/Medicaid reimbursement can also impact specialties, he says.

“Since medical school graduates now carry so much debt, the specialty they choose is often influenced by potential income, which is most evident in the low numbers going into primary care.”

Read more

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Chronic diseases drive up Medicare costs, study shows

A new study by Emory University public health researchers finds that outpatient treatment for chronic diseases such as diabetes, hypertension and kidney disease are to blame for the recent rise in Medicare spending. Kenneth Thorpe, PhD, chair, Health Policy and Management, Rollins School of Public Health, presented study findings today at a briefing of the National Press Club in Washington, DC.

The report, “Chronic Conditions Account for Rise in Medicare Spending from 1987 to 2006,” was published Feb. 18 by the journal Health Affairs.

Kenneth E. Thorpe, PhD

Thorpe and colleagues analyzed data about disease prevalence and about level of and change in spending on the 10 most expensive conditions in the Medicare population from 1987, 1997 and 2006.

Among key study findings:

  • Heart disease ranked first in terms of share of growth from 1987 to 1997.  However, from 1997 to 2006, heart disease fell to 10th, while other medical conditions – diabetes the most prevalent – accounted for a significant portion of the rise.
  • Increased spending on diabetes and some other conditions results from rising incidence of these diseases, not increased screening and diagnoses.

Read more

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Experts review global health care programs for answers

A recent Knowledge@Emory article looks at a new book titled The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care, by author and journalist T.R. Reid. The book provides an in-depth look at the health care systems in a number of Western nations, including Germany, France, the U.K, Japan and Canada. The countries he profiles offer a mix of public and semi-public health care options.

In addition to interviewing Reid, experts from Emory Healthcare, Emory’s Woodruff Health Sciences Center and the Rollins School of Public Health Department of Health Policy and Management, weigh in on the problem of U.S. health care reform and what can be learned from the examples abroad.

Joseph Lipscomb, PhD

According to Joseph Lipscomb, PhD, a Georgia Cancer Coalition Distinguished Cancer Scholar and a professor in the Department of Health Policy and Management, quality of care, outcomes and cost analysis must be factored into the reform process. Looking abroad, Lipscomb gives generally high marks to the outcome and cost analysis done by the National Health Service and the National Institute for Health and Clinical Excellence (NICE) in the U.K. He applauds NICE’s ongoing efforts to estimate the cost-effectiveness of new, expensive technologies by using decision processes that are transparent and solicit input from private citizens, providers and industry.

Read more

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Mammography can save lives by following ACS guidelines

The recent recommendation issued by the U.S. Preventive Services Task Force to revise screening mammography guidelines has generated considerable confusion and worry among women and their loved ones, says Carl D’Orsi, MD, FACR, director of the Emory Breast Imaging Center.

Carl D'Orsi, MD

Carl D'Orsi, MD

D’Orsi says he is counseling women who are concerned about mammograms and deciding what screening schedule to follow that they should use the long-established American Cancer Society guidelines: annual screening using mammography and clinical breast examination for all women beginning at age 40.

The recent recommendations by the task force advise against regular mammography screening for women between ages 40 and 49. It suggests that mammograms should be provided every other year (rather than yearly) for women between ages 50 and 74, and then breast cancer screening in women over 74 should be discontinued.

Mammography is not a perfect test, but it has unquestionably been shown to save lives, says D’Orsi, professor of radiology and of hematology and oncology in the Emory’s School of Medicine, and program director for oncologic imaging at Winship Cancer Institute of Emory. Since the onset of regular mammography screening in 1990, the mortality rate from breast cancer, which had been unchanged for the preceding 50 years, has decreased by 30 percent.

Winship Cancer Institute of Emory University

Winship Cancer Institute of Emory University

These new recommendations – which are based on a review that did not include experts in breast cancer detection and diagnosis – ignore valid scientific data and place a great many women at risk, continues D’Orsi.

Ignoring direct scientific evidence from large clinical trials, notes D’Orsi, the task force based its recommendations to reduce breast cancer screening on conflicting computer models and the unsupported and discredited idea that the parameters of mammography screening change abruptly at age 50.

The task force commissioned their own modeling study and made recommendations in reliance on this study before the study had ever been published, made public or held to critical peer review, and did not use both randomized, controlled trials and already-existing modeling studies, explains D’Orsi.

If Medicare and private insurers adopt these flawed recommendations as a rationale for refusing women coverage of these life-saving exams, it could have deadly effects for American women, says D’Orsi.

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Academic medicine at the table in health care debate

As the debate on health care reform legislation continues to move forward in Congress, Association of American Medical Colleges President and CEO Darrell G. Kirch, MD, urges leaders of the nation’s medical schools and teaching hospitals to be the standard bearers for innovation in health care delivery.

Darrell G. Kirch, MD

Darrell G. Kirch, MD

Kirch says that a year ago he was asked if he believed that academic medicine would have any voice in the health care reform debate. He answered that academic medical centers do have a strong voice in ensuring that the special contributions of our members are recognized in any proposed changes in the current legislation.

Kirch, who recently presented at Emory’s Woodruff Health Sciences Center Future Makers Lecture Series, says, “Just as we have a moral imperative to give people basic health insurance, we have an innovation imperative, as educators, researchers and clinicians, to finally make our health care system work well for everyone.”

In his presentation, Kirch pointed out that, by establishing new models of high-performance, high-value, integrated health systems, academic medical centers across the country are already undertaking clinical care innovations. Similar efforts are also occurring in research, where greater collaboration helps to address complex problems, and in medical education, where cutting-edge technologies are used to train physicians and promote lifelong learning, he noted.

AAMC-supported legislation, introduced by Rep. Allyson Schwartz (D-Pa.), to establish Healthcare Innovation Zones (HIZs), would promote the rapid expansion of successful pioneering efforts. These zones would empower centers to partner with local providers and hospitals to conduct large-scale experiments in health care delivery for specific patient populations.

Combining innovations in health care delivery, critically studying the effectiveness of these innovations and educating professionals to work in these new models play to the strengths of academic medicine, continues Kirch. The innovation imperative will allow academic medical centers to finally attain alignment of all three missions, while truly fulfilling their goal to improve the health of communities.

Listen to Kirch’s Emory presentation or read his recent address to the American Association of Medical Colleges.

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Costs will rise as rates of obesity in the U.S. grow

Today’s news points to a study on projected obesity costs released by Kenneth E. Thorpe, PhD, Robert W. Woodruff professor and chair of health policy at Rollins School of Public Health, and colleagues from Emory. The unique study departs from looking at historical costs of obesity and uses an econometric model developed by Thorpe and team to estimate the growth of health care costs over time that are linked to changes in obesity rates.

Obesity costs rising

Obesity costs rising

Using nationally representative data on adults, the study estimates the effect of the increasing prevalence of obesity on total direct health care costs in the next decade. The report is titled “The Future Costs of Obesity: National and State Estimates of the Impact of Obesity on Direct Health Care Expenses.”

The report was commissioned by three groups – the UnitedHealth Foundation, the Partnership for Prevention and the American Public Health Association – in conjunction with their annual America’s Health Rankings report.

Major findings from the report include:

  • Obesity is growing faster than any previous public health issue our nation has faced. If current trends continue, 103 million American adults will be considered obese by 2018.
  • The United States is expected to spend $344 billion on health care costs attributable to obesity in 2018 if rates continue to increase at their current levels. Obesity‐related direct expenditures are expected to account for more than 21 percent of the nation’s direct health care spending in 2018.
  • If obesity levels were held at their current rates, the United States could save an estimated $820 per adult in health care costs by 2018 ‐ a savings of almost $200 billion dollars.

Thorpe says, “At a time when Congress is looking for savings in health care, this data confirms what we already knew: obesity is where the money is. Because obesity is related to the onset of so many other illnesses, stopping the growth of obesity in the U.S. is vital not only to our health, but also to the solvency of our health care system.”

The Partnership to Fight Chronic Disease, co-directed by Thorpe, says that a top priority must be addressing the obesity epidemic through meaningful, evidence-based approaches, including:

  • Removing barriers and empowering Americans to take control of their health.
  • Educating Americans to see being obese as a serious medical condition that significantly heightens their risk for other health problems
  • Ensuring that fear about the stigma of obesity does not eclipse the need to combat it
  • Redesigning our health care system to treat obesity like a preventable medical condition
  • Engaging employers and communities to get them invested in promoting wellness

Follow Thorpe on his Health Reform Blog.

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Malpractice insurance rates examined

A recent article published by Knowledge@Emory, an online business journal, presented the view of a leading Emory expert on health care reform regarding malpractice insurance rates. The article is titled “Will Medical Practices Survive Malpractice Insurance Rates?” and covers recent health care reform news including a discussion of medical malpractice insurance rates.

Excerpts from the article:

  • President Barack Obama’s planned overhaul of America’s healthcare system took a step forward October 13 when the powerful Senate Finance Committee voted 14 to 9 along party lines, except for Republican Senator Olympia Snowe, to move its healthcare bill along for broader consideration. While this vote is a positive sign in a debate that has raged on for years, it comes too late for many physicians in high-risk specialties who have made the difficult choice to either restrict their practice, relocate to friendlier states, or to shut down shop altogether because of galloping increases in malpractice and other liability insurance.
  • Kenneth E. Thorpe, PhD

    Kenneth E. Thorpe, PhD

  • Kenneth E. Thorpe, Robert W. Woodruff professor and chair of health policy and management at Emory’s Rollins School of Public Health, said, “In response to rising medical malpractice insurance rates, many physicians feel compelled to practice so-called defensive medicine, which may involve ordering extensive patient tests primarily to help defend their decisions in case the physician is later sued. Concern over malpractice insurance costs are also driving more specialists like obstetricians and gynecologists, and neurosurgeons, to restrict, sell or close their practices, leading to some question about whether or not there will be enough specialists available to meet the demand for their services.
  • Part of the challenge is that the standard rules of a business model don’t always apply to medical providers, according to Thorpe.
  • In a traditional business model, a larger organization can generally reduce many costs with economies of scale, but even if a doctor sells his or her practice to a larger group practice or a hospital, the insurance rates are still set by state commissioners,” he notes. “So even though a hospital practice may be substantially larger than a typical physician group practice, a hospital generally can’t exercise any more leverage when it comes to med-mal rates.”
  • Regulatory restrictions on the medical business model may limit the ability of medical practitioners to respond to liability insurance rates, but Thorpe says other approaches could put a dent in the costs.
  • “To begin with, more than 60 percent of med-mal claims go to identifying fault and administering the medical malpractice system leaving only 40 percent of the premium dollar paid to injured patients,” he says. At the same time 70 to in some states up to 90 percent of claims filed never receive any payment and are dismissed or dropped. “So it would likely be helpful if regulatory authorities or the courts can weed out the frivolous ones. Setting up specialized courts—similar to tax and other highly focused courts that already exist—might help to fast track the adjudication of these claims, which would cut down on administrative and other overhead costs. Will the proposed healthcare reforms address these issues? It remains to be seen if true reform can overcome the efforts of special interest groups that are trying to place their own interests above the public good.”
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America’s health care system: Emory experts weigh in

It’s broken, and it needs fixing. That much everyone can agree on when it comes to U.S. health care. Much of the conversation about health reform centers on cost, but access and quality of care are key factors, too.

Emory University experts are adding their voices to the health reform debate. Here are some of their thoughts and suggestions for fixing America’s health care system.

Modernizing Medicare

Adam Atherly, PhD, health policy professor at Emory’s Rollins School of Public Health (RSPH), says eliminating Medicare Parts A and B would make the federal program more user friendly. “It makes sense to do a good job of running the programs we already have,” says Atherly.

Medicaid promises

Kathleen Adams, PhD, RSPH health economist, says Medicaid is fragmented and should be uniformed for all states. “State Medicaid programs are our labs for health care reform,” says Adams. “Unfortunately, that is adding to the fragmentation in health care. What we really have is not one but 50 Medicaid programs.”

Universal consequences

The President, Congress, and leaders in the public and private sector need to figure out how to achieve health insurance coverage for everyone,” urges Art Kellermann, MD, MPH, Emory School of Medicine health policy dean and professor of emergency medicine. “Uninsurance has consequences for everyone,” says Kellermann. “Communities struggle to recruit and retain doctors. Specialists are reluctant to take ER and trauma calls because of payment issues, and hospitals are less likely to offer vital but unprofitable services.”

Primary care pulpit

As director of the Emory Center on Health Outcomes and Quality at the RSPH, Kimberly Rask, PhD, wants to go beyond the debate on health care costs. “In the long run, achieving cost savings depends on how we organize our health care,” she says. “We need programs that provide the right care at the right time for the right condition.”

Controlling chronic conditions

Kenneth Thorpe, PhD, chair of the RSPH department of health policy and management, reports that 75 percent of national health spending is for chronic conditions such as diabetes and hypertension. Rising rates of obesity account for 20 percent to 25 percent of the overall rise in spending. And right now, less than 1 percent of national health spending is directed to avoiding health problems rather than preventing them. Thorpe says prevention could significantly lower overall health care costs.

Arguing for basics

William Bornstein, MD, chief quality officer for Emory Healthcare, says medical innovation and discovery has shifted focus from health care fundamentals. “We have focused on the rocket science instead and have left out the basic blocking and tackling,” says Bornstein. “If we just gave regular immunizations, we’d have had more impact on saving lives than we’ve had with some groundbreaking discoveries.”

Read more Emory experts’ health care reform analysis in the new issue of Emory Health magazine.

Please note that, unless stated otherwise, the opinions of these experts do not necessarily reflect official Emory health care reform policy positions.

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Prevention counts in health care reform

As Congress and President Obama’s administration work to hammer out the details of health care reform, Emory health policy expert Kenneth E. Thorpe, PhD, says prevention and quality care for chronic diseases are an integral part of reshaping America’s health care system.

Kenneth E. Thorpe, PhD

Kenneth E. Thorpe, PhD

Nearly half of people in the United States suffer from a chronic condition. More than two-thirds of all deaths are caused by one or more of five chronic diseases: heart disease, cancer, stroke, chronic obstructive pulmonary disease (COPD) and diabetes.

Thorpe says transforming the U.S. health care system to better meet the needs of people with chronic disease will require a renewed focus on preventing disease when Ray Ban outlet possible, identifying it early when it occurs, and implementing evidence-based prevention strategies that slow disease progression and the onset of activity limitations, as well as save money for the patient and the health care system.

By preventing costly diseases or better managing them, Thorpe says we can help contain our out-of-control health spending and boost productivity. In our troubled economy, we need to do both.

Read more about Thorpe at Rollins School of Public Health, Institute for Advanced Policy Solutions/Center for Entitlement Reform, and the Partnership to Fight Chronic Disease.

Thorpe’s views can be found by visiting AJC.com, Big Think and The Huffington Post.

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