Mid-week update

Because there are so many Medicare eligible persons participating in the FEHBP, it's worth pointing out that today the Centers for Medicare and Medicaid Services announced a redesign o the Medicare Summary Notice which is sent quarterly to Medicare beneficiaries, in lieu of explanation of benefit forms on individual claims. Here's a link to a Kaiser Health News article with more background on the redesign.

The AMA News writes about efforts to control the costs generated by the costliest 1% of the American population -- more than 20% of all health care costs.

An individual in the costliest bracket typically receives much of his or her care in hospitals -- sometimes in multiple hospitals in the same city. Lack of care coordination is a significant driver of this spending. These missed connections are "probably the primary reason why we cannot manage costs on people who have multiple morbidities," said Ira Klein, MD, chief of staff to the chief medical officer at the insurer Aetna

The article discusses efforts to improve coordination efforts but the article concludes by pointing out the key role that the patient and his or her family members can play in coordinating care.

Dr. Albert said sometimes the level of family involvement in a patient's care is the difference between a frequent hospital visitor and a person who stays healthy. One of his patients, an 85-year-old widower, has congestive heart failure, hypertension and diabetes. The man ends up in hospitals regularly in part because he has difficulty adhering to his medication regimen. He has relatives nearby, but they are not closely involved in his care.

But another patient of Dr. Albert's -- a man with similar health problems -- stayed out of hospitals for three years in a row before he died at the age of 90. The extended run was possible because the man's wife doggedly tracked his medications and health care needs and monitored his diet. "We called her his little pharmacist, his little nurse," Dr. Albert said.

Such personal responsibility plays a key role in health care and controlling health care spending.

The Washington Post reported yesterday about a study suggesting that the use of electronic medical records is not bringing down health care spending.  This morning I was with my 17 year old son who has had back pain. The doctor advised that the MRI was normal but he wanted to order at CT scan to rule out a stress fracture. I thought to myself here we go -- more money down the drain. But the doctor explained what he noticed in the MRI which caused his to order the follow up test. It turned out that my son does have a stress fracture.  Good judgment by the doctor. The point is that the practice of medicine remains as much as art as it is a science, and electronic medical records won't change that. However, it may improve record-keeping and care coordination,among other things.