Healthcare Price Transparency: A Look at Aetna’s Web-Based Tool

 

Illustration source: Vermont Health Connect, Vermont.gov

Would you look at comparative price information for procedures like an MRI, sleep study, or colonoscopy before you selected where to have a procedure done? Would you like to have fewer surprises on what you will pay before you go in for these procedures? Price transparency in health care has been a rallying cry, from many policymakers, elected officials, and journalists. It’s one strategy among many that many back as a way to get health care spending down and also offer consumers choice.

Many view healthcare as a market that can bring costs down when competition and comparison-shopping are in play. Others want transparent prices so consumers face no surprises before getting an astronomical bill. In both examples, the onus is on the public to choose wisely and economically.

In today’s post, I review a study of Aetna’s price transparency tool for outpatient procedures, including radiology, sleep, and cataract surgery reported in the Oct. 24 JAMA Internal Medicine led by Anna D. Sinaiko, PhD, MPP, from the Department of Health Policy and Management at Harvard University’s T.H. Chan School of Public Health. This study was slated to appear here earlier, but the election madness delayed it.

Aetna’s Member Payment Estimator for Eight Elective Procedures

Aetna developed a web-based Member Payment Estimator with the idea that patients would select care based on cost to them. It shared the tool with 94% of Aetna enrollees across the United States, but in this study, it reports just a 3.5% pick-up in using the tool. 

In the study, researchers used administrative enrollment and medical claims data to review whether enrollees aged 19 to 64 who underwent one of eight different procedures reviewed price comparison data provided by episode. The eight procedures in the study were carpal tunnel release, cataract removal, colonoscopy, echocardiogram, mammogram, several MRI and computed tomography procedures, sleep studies, and upper endoscopy procedures during the period 2010 to 2012.

“The way the web-based tool works is it adjudicates claims as if you are having the procedure in real time, factoring in your specific health insurance information (e.g. deductible, copays, age and gender), so that you can see your out-of-pocket costs at ten facilities in your geographic area of residence,” said Dr. Sinaiko, in an interview with PatientPOV. “This reflects the patient’s price information in advance of receiving care.” Results were only examined within geographic areas, not across those areas.”

How Aetna’s Member Payment Estimator Was Used

Besides finding that use was just 3.5% overall, these findings are interesting:

  • Of those who did review prices prior to selecting where to get their procedure, this group did choose facilities with lower relative price estimates, in the 46th percentile in the market versus the 54th percentile in comparison groups.
  • Of the eight procedures, MRIs, CT scans, and sleep studies were the only procedures where searching price information was associated with lower spending of $131.40 (12%) (P<.001) for imaging and $103.50 (6%) (P=0.06) for sleep studies.
  • In a related paper that Dr. Sinaiko published in Health Affairs, she reported that younger patients and those with high deductibles were the most likely users of the search tool.

Dr. Sinaiko acknowledged that sharing cost information with the public is new and that “efforts to engage patients are a work in progress.” What she recommends is “more targeted outreach at the time when the decision on where to go for care is most salient.” Web-based tools like Aetna’s are likely only to be of interest for certain elective procedures and not for emergent or urgent medical problems, she added.

The Value of Transparency

Health authorities of varying political stripes are pressing for more transparency tools. It’s clear that Stephen Brill, who wrote a high-profile article in Time questioning healthcare prices, led to a public outcry for transparency. Then, others clearly view healthcare as a market that works like buying a car. So, give people the tools to choose, and perhaps they will vote for value and lower cost.

Charles Ornstein, ProPublica says: “ProPublica has been building its data tools to allow consumers and patients to compare doctors on how they practice medicine, prescribe drugs, and interact with the medical device and pharmaceutical industry.”

Yet numerous studies point to significant resistance to going for cheaper care, particularly among the well insured. Many Americans see higher costs as a proxy for better quality. While Aetna identified facilities in their high-quality network in their tool, the information shared is extremely limited and the public might be skeptical of insurer-generated quality information.

The American public will want ways to assess quality, but quality measures are in their infancy and poorly understood by most Americans. Also, costs of care may only matter for a limited number of procedures. As this study revealed, a miniscule number of Aetna enrollees considered where to get cataract surgery based on their out-of-pocket costs.

But with the recent news that healthcare premiums will rise on average about 25% in 2017, the public might have more incentive to review prices and they are bound to be pushed to look at dollars of their care or pay more.Price transparency strategies are but one approach being promoted to control costs of care. Another approach is value-based insurance design, that aims to align patients’ out of pocket costs with the value of services (evidence of benefit, etc.). PatientPOV.org will take these up in subsequent posts.

 

 

 

 

 

 

Answer Paul Ryan’s Quick Phone Survey on Whether You Back ACA/Obamacare

You have a chance to weigh in on whether or not you back Obamacare today. Paul Ryan has a phone survey for you.

It takes a short time, with a support/no support answer. These calls are logged in so they are far more important than petitions.

The number is 202-225-0600.

No conversation, but you could be on hold for 90 seconds! Do it. Share with friends, family, and coworkers!

Appendicitis in America: Time for Practice Change?

Chances are good that most readers have had personal experience with appendicitis. Appendectomy is the top inpatient surgery for kids and it far outpaces all other pediatric surgeries. Also, appendicitis is the most frequent reason adults make it to the emergency room. When people worry about their healthcare, appendicitis may seem like small change, mundane compared to big worries like chronic or debilitating conditions, and easily fixable by having your appendix surgically removed. Then it’s over.

However, the sheer volume of the surgery, done routinely and automatically in most of America, against new data that point to equivalent efficacy and a lower complication rate with antibiotic medical management for uncomplicated appendicitis make it an interesting case study of how medical paradigms change.

The tide has shifted in Europe towards using antibiotics as first-line, but probably because national health insurance programs use science much more to guide matters of the public health. In the United States, paradigm shifts towards less use of surgery come slowly and with a great deal of resistance from those threatened by the shift.

An Emblematic Case in Point

I became keenly aware of how uninformed most patients are when a friend over 70 years-old called me from the emergency room on a spring Saturday afternoon, telling me a surgeon wanted to operate on him in an hour for uncomplicated appendicitis. My initial reaction was to tell him to wait a minute because I remembered recent journal articles, notably a Finnish randomized trial suggesting antibiotic therapy had a good shot of curing the appendicitis, without the risks of surgery and an extended recovery. Appendicitis can recur in a minority of patients after antibiotic therapy, but carefully managed, one year out, there is usually no recurrence.

My friend, a skeptical medical writer to boot, had indicated that he wanted more information before he was shooed into surgery. I will say nothing more about his story because he has promised a blog post and will let him tell his story. Suffice it to say that he went the antibiotic therapy route and I am pretty darn sure that it would not have entered the picture if we hadn’t suggested it.

Decision Aid Research: Enter PCORI

This week, I received an announcement from the Patient Centered Outcomes Research Institute that they were funding research into testing a decision aid to help parents figure out what to do when their child has appendicitis. It’s a step in the right direction, but its ultimate value will depend on how widely it is used in the real world.

Decision aids purport to present the options to patients and/or caregivers so that patients can make the decisions that best suit them, based on their personal preferences, the science, and the uncertainties. In the past, they have been introduced when procedures are widely used, costly, when a paradigm shift in medicine is emerging, and when the best strategy seems debatable. Decision aids have been used for things like deciding what to do in the face of a diagnosis of prostate or breast cancer or whether or not to have joint (hip or knee) replacement.

Decision aids have been linked to more satisfactory outcomes, but I hardly think that they will provide the nexus of change in appendix care. I have seen no evidence that they are even used in the institutions that develop them. Nonetheless, they are a start.

A hellufa lot more public education will likely be needed to shift medical practice. I am sure that Rose Kushner and the women’s movement had more impact on reducing unnecessary total mastectomies than decision aids would have, but all is valuable.

The Decline of Surgery: A Moving Target

Robert Colgrove, MD, Division of Infectious Diseases, Mount Auburn Hospital, and Assistant Professor of Medicine, Harvard Medical school, captured the full measure of the shift towards treating appendicitis with antibiotics, rather than surgery.

“Having most of these managed medically means hundreds of thousands of operations averted in the US alone,” he said. “Along with the demise of routine tonsillectomy, it represents a huge reduction in the fraction of otherwise well children who get an operation.”

It’s not just appendectomies that are likely to decline going forward, but other surgeries are also declining as we move ahead, because medical management is showing advantages in lower complication rates, shorter recovery time, and cost.

But change will be resisted. Take gall bladders. “The most definitive way to manage cholecystitis (an inflamed gall bladder) is with cholecystectomy (removal of the gall bladder), a well validated procedure with over a century of experience to back it up,” Colgrove told me. “The best way to manage it now is very much an open question and a moving target. Classically, most people with acute cholecystitis would go on  to have recurrent and/or chronic cholecystitis, so the argument has been that you might as well just go ahead and take it out.”

Colgrove begs to differ. “As medical management improves, though, it is not at all clear that that is true any longer. Current data suggest that most people with uncomplicated cholecystitis do well with non-surgical management, but it will take a few more years before we really know the long-term implications. This is a big deal, representing a huge change in the management of one of the most common surgical procedures, so it is natural that the medical culture is taking some time to absorb it.”

From my vantage point as a public observer, it bothers me that my friend in the emergency room was set to be routed directly to surgery. When will patient safety people be available to consult with patients, some of whom might have fewer risks with an antibiotic course of action?

There are numerous other issues worthy of public discussion tied to appendicitis in kids and adults, too large for a blog post here.

My computer went belly-up this morning and I wanted this out before my short vacation. I regret the lack of links on this post, more comprehensive attention to the latest research, and the role of excessive imaging in evaluating appendicitis – topics covered previously here.

Please share your point of view in the comments below. We need a movement to move practice rationally forward.

 

 

 

 

Homecare Workers Flood #fightfor15 Rallies,
Wait for President Obama to Act

Home care workers organized by 1199/SEIU march in midtown Manhattan on April 15, 2015.

Home care workers organized by 1199/SEIU march in midtown Manhattan on April 15, 2015.

Homecare and direct care workers were out in droves last night in New York’s #fightfor15 rally that stretched from Columbus Circle to Times Square. Initially billed as an event for fast-food and retail workers, the #fightfor15 day expanded to home care workers, adjunct professors, and low-wage workers in general. In fact, health and home care workers lined up for blocks to participate in this demonstration. So far, home care workers have won the right to unionize in several states. This will clearly be a linchpin in moving this issue forward.

1199/Service Employees International Union (SEIU) led organizing for yesterday’s rally in New York and elsewhere. Ai-jen Poo, Director of the National Domestic Workers Alliance and Co-Director of Caring Across Generations, has been out front on in calling for radically altering the long-term-care infrastructure. In her new book, The Age of Dignity: Preparing for the Elder Boom in a Changing America, she proposes integrating access to care and affordability of care, aligning the interests of the workers, the families that they care for, and the quality of care the workers provide. At the heart of Poo’s work is the recognition that home care and domestic workers are not valued and treated with dignity. Elders don’t fare much better.

Looking at her book and other data, it becomes abundantly clear the nation’s 2-3 million home care workers live in poverty. Home care workers are overwhelmingly women, immigrants, and people of color. The health care industry does not value these workers and the workforce is often transient. According to the National Employment Law Project, in 2013, the average income of home care workers was $18,598. Is it any wonder that quality of care is an issue in elder and long-term care?

Are quality improvement proponents targeting the wrong metrics: would they do better to ensure that workers have a living wage and -fair working conditions before they check whether the elderly suffer from bedsores, get infections, or sustain falls? Are they supervised properly, available in sufficient numbers, or is the industry cutting corners?

Yet despite a mantra in health policy circles to tout value-based care, health care leaders and the medical press have proved somewhat inattentive to these pressing issues, which if addressed, would ratchet up worker quality of life, reduce burnout and workforce transiency, and enhance quality of care for patients.

It would be refreshing for health care leaders and the families to back a decent living wage for homecare and direct care workers.

But many Americans may not realize that ever since the Fair Labor Standards Act went into effect in 1938, home care and direct care workers were excluded from basic minimum wage and overtime protection. As Poo points out, this exemption stemmed from racism in the 1930s, when African-Americans provided much of the nation’s domestic work. Southern legislators refused to sign off on the Fair Labor Standards Act, unless farmworkers, domestic workers, and homecare workers were excluded from labor protective legislation. It needs to be changed.

Finally, in September 2013, the fight seemed to be over, when the Department of Labor issued its Home Care Final Rule that extended these protections to the nation’s 2-million home and personal care workers The law was slated to go into effect in January 2015. However, District of Columbia Judge Richard Leon vacated the ruling in Home Care Association of America vs. Weil. The Department of Labor has filed an appeal and action is expected sometime this summer.

Advocates for enhanced worker protections for homecare and direct care workers are hoping that the Obama administration will push this forward shortly. When President Obama ran for election, he promised prompt action on this. Hillary Clinton offered this comment on twitter last night: “Every American deserves a fair shot at success. Fast food & child care workers shouldn’t have to march in streets for living wages. –H.” Clearly advocates for home care workers will want to hear a heck of a lot more before they see Hillary or any other candidate on their side.

4 Short Summer Reads: Concussion in Girls, Adult Diapers,
Gay Conversion Therapy with Electric Shock, and Chronic Pain

We’re halfway through the summer, when perhaps you have more time for reading and considering new ideas. I want to draw readers’ attention to four issues that sharpen the focus on overlooked population groups that should be part and parcel of patient-centered research and care. Presented in no particular rank order, I think that they are all worth thinking about:

1. Concussions in girls’ sports. Last fall, I wrote about concussions in school sports, sometimes resulting in long-term head injury. I asked whether culture change, involving taking kids off the field, teaching parents and coaches how to recognize concussions, and getting independent medical evaluations will be accepted and help avert long-term traumatic brain injury. Unfortunately, the story was focused largely on boys and male professional athletes. After I wrote the story, a reader approached me privately and said that I was remiss in excluding girls. Soccer is the leading sport for girls’ head injuries.

I was pleased to see a commentary in JAMA Pediatrics this week by Cynthia LaBella, MD, on concussion and female middle school athletes. The piece reviews a prospective cohort study of middle school female soccer players between March 2008 and May 2012 by John W. O’Kane and others, from the University of Washington Seattle. Concussions in middle school are studied less frequently and girls and women in sports are still not that visible in mass media despite the passage of Title IX, which aimed to end discrimination and build inclusiveness for females in sports, in 1972, more than 50 years ago.

Notably, the Washington state analysis found that:

  • younger girls are more vulnerable than older ones;
  • heading causes most of the concussions;
  • nearly 60% of girls played despite symptoms, and
  • less than half sought medical attention.
CDC-recommended Heads-Up app, in IOS and Android.

CDC-recommended Heads-Up app, in IOS and Android.

What is especially striking is that these figures follow Washington becoming the first state to pass concussion legislation in school. Clearly, more concussion awareness and early diagnosis is warranted, according to LaBella. But, in my opinion, for real culture change, we may need to look at carrot-and-stick incentives. Anecdotal data tells me that parents and coaches are reluctant to pull kids out of sports.

Adult diaper use now supplants baby diapers. Large population shifts are afoot, as this Wall Street Journal article nicely highlights, by illuminating a major shift in sales of  diapers. Adult diaper sales now outpace sales of baby diapers (up 20% versus down 8%. respectively). This parallels a drop and leveling off of the birth rate and boomers aging. Marketers are focusing on this booming 65+ market. I’d love to see this aging population actively engaged and accommodated in patient-centered research and practice. Please send me information on efforts to engage these patients.

Using electric shock for gay conversion therapy.

Bans on gay conversion therapy in the United States are proliferating at last, which is good news. Yet many other countries remain in the dark ages.

 

Electroconvulsive therapy (ECT), National Institutes of Mental Health, NIH.

Electroconvulsive therapy (ECT), National Institutes of Mental Health, NIH.

A shocking story in Friday’s Washington Post reports that gay activists in China are suing to stop electric shock therapy to “cure homosexuality.” Homosexuality is closeted in much of China. A quote from the Chongqing Center, which employs electric shock points to this attitude:

“The Chongqing center explains its views of homosexuality on its Web site: ‘Any type of homosexuality is not really homosexuality. It’s just a wrong way of sexual release. They just need to be guided.”

Taking a strong stand against the violence against GLBT groups around the world is imperative if this is to stop.

Stigmatizing, humiliating reactions to chronic pain. How do we balance the chronic pain against an epidemic of opioid abuse? Not very well, writes Janice Lynn Schuster, in “Down the Rabbit Hole: A Chronic Pain Sufferer Navigates the Maze of Opioid Abuse.”  Schuster describes how bothersome pain in her tongue, felt as throbbing, burning, and pain upon eating and speaking, led to a tongue surgery that made her pain far worse. Schuster questions herself for not reviewing the outcomes online with this surgery, but the bulk of the piece deals with her frustrating search for pain relief without judgment.

It’s a compelling read, pointing to a labyrinth of pain management, difficulty returning pain pills that didn’t work, hurdles filling essential prescriptions, and a “confused national response to opioids.” “Waiting for better days,” she remains “furious” at the stigmatizing and humiliating responses she has gotten from doctors and pharmacists. “Surely,” she concludes, “for all our yearning to understand both [pain itself and the experience of seeking treatment for the pain], we can find better ways to ease the suffering and devise treatments and strategies that do more good than harm and that do not shame and stigmatize those who suffer.”

 

Concussions in School Sports: Is Culture Change Possible?

About a month ago, I stumbled across a news story in the Chicago Tribune about Drew Williams, a Lane Tech High School football player collapsing unexpectedly on the football field during a game. Ever since, he has been in a coma. Drew had no apparent collision during the game and that shocked and troubled bystanders. After the incident, a father of another boy on the team told his son that it was just fine if he didn’t want to play in the last few games this year.

Drew was taken away on a stretcher and brought to the hospital by ambulance. He was hospitalized until this week, when a transfer to a rehabilitation facility was authorized. However, shortly after his transfer, he suffered a setback and was rushed to a hospital because of a serious infection. His family asks for prayers and hopes to raise funds for him to pull through on a Facebook page dedicated to “this marathon we call recovery.

Could Drew’s injury have been prevented?  I don’t know. I certainly don’t feel comfortable bothering his family for an interview now, in what is clearly a very difficult time. But I read the story shortly after I attended a meeting on concussion prevention in school sports.  I am glad that concussion outcomes and prevention are getting the attention that they deserve.

For boys, the most worrisome sports are football, ice hockey, lacrosse, wrestling, and soccer. For girls, soccer, lacrosse, and basketball account for the most head injuries.

Recent reports of suicide, traumatic brain encephalopathy, and violence in NFL players and other athletes are troubling. In the report commissioned by the Institute of Medicine and National Research Council released Oct. 30, the authors call attention to “changing the culture.” The authors write:

“Too many times the committee read or heard first-person accounts of young athletes being encouraged by coaches or peers to “play through it.” This attitude is an insidious influence that can cause athletes to feel that they should jeopardize their own individual health as a sign of commitment to their teams.”–     p.6, Sports-Related Concussions in Youth: Improving the Science, Changing the Culture, National Academy of Sciences, Oct. 2013, prepublication copy.

Why is There Not More of a Public Outcry?

When you take a look at reports like the Institute of Medicine/National Research Council and recent peer-reviewed publications on outcomes of concussion, a huge knowledge gap is evident, but what is known is not comforting. Some of the more disconcerting issues to think about are as follows:

  1. Head injuries are invisible to observers beyond perhaps watching initial impact. Brain swelling and bleeding won’t be obvious without medical evaluations.  Problems with memory and processing speed may only be evident if objective testing is done.
  2. Research into the effects on the brain after concussions in youth, and differences between boys and girls, and different ages have only recently begun. So play continues with incomplete knowledge.
  3. After one concussion, athletes may be at greater risk for more severe concussions and take longer to recover. Not recovering from a concussion may be a key risk factor for another concussion, and increased severity of subsequent concussions.
  4. No sports figure has emerged yet that could serve as a role model for safety in sports. We have had suicides and violence in NFL active and retired players. This has propelled a research infrastructure, legislative changes, and some outreach.
  5. Only recently have we begun to track the course of recovery. Historically, questions about malingering unfairly stigmatized kids who were not recovering.
  6. Information on the race, ethnic background, or socioeconomic status of youth who sustain sports related concussions is not reported in studies, so we cannot determine if disparities exist. However, given that about 2/3 of NFL players are African-Americans and football injuries are the leading cause of head injuries for males, one wonders if a similar proportion of African-American youth is at increased risk of concussions.

There are some positive signs. In a subsequent post, I will point to legislative changes, research, and educational programs that could help reduce concussions.

 

 

 

 

 

 

 

 

 

 

Back Pain Treatment Trends Worth Reversing

It may just be the American way –pull out all the stops and try anything or everything at great expense when it comes to medical care.

Today’s post takes up how well the United States is doing at providing back pain care in accordance with evidence-based clinical practice guidelines for back pain (including neck pain). In original research and a commentary published online July 29, 2013 in JAMA Internal Medicine, John N. Mafi, MD, and coauthors from Beth Israel Deaconess Medical Center and Harvard Medical School, in Boston, MA, point out troubling trends in back pain care using nationally representative data from the Centers for Disease Control and Prevention’s National Ambulatory Care Survey and the National Hospital Ambulatory Care Survey.

Back pain is common, with surveys showing that 65% to 80% of Americans will report back pain at some point in their lifetime. So understanding what’s going on and managing it with the best science sounds good for patients. Back pain is a loaded category for sure: it involves how well patients can tolerate pain, patience because back pain is often temporary, yet it can be a springboard for all sorts of referrals. There are some relatively inexpensive ways to manage back pain that get a grip on back pain, but the study discussed here suggests that people want to throw everything at it and that the care people are getting is moving afield from science-based guidelines.

Prescribing Patterns

oxycontinBetween 1999 and 2010, opioid use for back pain climbed substantially from 19.3% to 29.1%, while recommended nonsteroidal anti-inflammatory drugs (NSAIDs: e.g. ibuprofen) and acetaminophen have declined by nearly half, from 36.9% to 24.5%.  The latter two drug categories are recommended as first-line for patients with back pain. Additionally, doctors in the south and west prescribed narcotic medications about 1.5 times more frequently than doctors nationally.

Not everyone gets opioids prescribed. The odds that women, black, Hispanic, and other racial/ethnic groups, and the uninsured were prescribed opioids was significantly lower. Commenting on this disparity, Richard Deyo, MD, MPH, Kaiser Permanent Professor of Evidence-Based Family Medicine, Oregon Health Sciences University, Portland, OR, said: “I think this is a situation where good insurance – and greater affluence – make overuse more likely. This may be a case where underinsurance has a protective effect!”

Imaging

MRI machine

MRI machine

Subgroup analyses revealed that neurologists and orthopedic surgeons had a far greater odds of ordering CT and MRI: more than 3.5 times higher than primary care doctors. MRI scans and CT scans rose between 1999-2000, at 7.3% to 11.3%, in 2009-2010.

Referrals

Physical therapy referrals remained constant over the ten-year period, but referrals to other doctors, especially neurologists and orthopedists, doubled by 6.8% in the first year of data collection to 14.0% in 2009-2010.

One Limitation: No Surgery Data

 The data are limited in that this data set cannot be used to see whether or not people got surgery.  However, lots of previous research suggests that with the cascade of advanced imaging and physician referrals, people are getting surgery more frequently.

What About Patients?

 In this study, trends in management of back pain suggest care is moving away from science-based medicine. Many of us have endured back pain that feels acute or chronic. Some of us know people who have had back surgery, seen lots of doctors, and gotten imaging studies. As I write this post, the news is calling attention to premiums perhaps not being that high as predicted with Obamacare. But you have to wonder: if these patterns of overuse to no good end for patients persist, the costs are going to get thrown back to patients. I’ve said this before, but I think we are at a standstill. We need to move beyond documenting overuse and inappropriate use and come up with ways to get doctors and patients on board with what works and does not.

Patient POV Update: Immigration and Abortion News

I regret not posting here recently. It’s been a very busy time for me and I am following several issues that will make their way to this blog soon. I can’t give you a rank order of what’s most important, but I think there is a heck of a lot going on out there that warrants an in-depth look.

Immigrants with Mental Illness Need Rights to Counsel

US Homeland Security citizenship and immigrationImmigration is becoming a big issue (no surprise) since the Boston bombings.

The US Department of Homeland Security handles deportations. If you can,  grab a copy of this week’s New Yorker, I highly recommend reading: “The Deportation Machine.” It’s a horrifying story about what happens when a mentally ill person gets trapped by the Department of Homeland Security. In this case, the person was U.S. born! Authorities had good information and bad information, but whenever they uncovered good information, they wrote it off as being wrong.

On a related note, in California, a class action suit is underway that raises the issue that mentally ill immigrants should have access to counsel before they are hurdled into deportation. It’s a right that has been denied unfairly until now. The case may come to closure in the coming weeks.

Separating the Gosnell Case from Safe, Legal Abortions

Kermit A. Gosnell is a 72-year-old black doctor who performed abortions at  Women’s Medical Services, an abortion clinic in Philadelphia. Many women treated there were poor and black. Abortions were done late, many beyond the legal limit of 24 weeks for abortion in Pennsylvania.

It’s the one and only case that I’ve ever heard of since abortion became legalized in 1973 rife with charges of a doctor operating outside the law,  aborting viable infants long past legal gestational age for abortions in Pennsylvania, stockpiling infant parts in jars, filthy conditions, using unlicensed staff to do abortions, and practicing outside of the law. I am appalled by the conditions presented related to this case. However, it is noteworthy that the Judge cleared Gosnell of several charges earlier this week, as reported in the New York Times last night.

The case has been on my mind quite a bit. I was active in the movement to legalize abortion. and writing about this case requires attention to detail. The lurid details of the case revolt people, no matter what side of the abortion spectrum they are on.

Concerns I have about this case include the following:

  • that Gosnell is brought to justice;
  • that the media makes clear that Gosnell is a renegade, who based all accounts, operated outside the law, with no regard for safety.
  • that Gosnell does not resemble licensed abortion providers;
  • Legal abortions are extremely safe, far safer than childbirth;
  • Restrictive abortion laws do not serve the public’s health, but that make it unacceptably onerous for women to get timely abortions and clinics to operate economically.

I hope that the public and lawmakers put this case into proper perspective because it could unjustly continue policies that already have negatively affected access to timely abortions in many states.

I have serious concerns about the media handling of this story. My points are actually quite different from what you might have read. Expect to hear more from me on this in the coming weeks.

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Judge to SUNY/Downstate:
Halt Long Island College Hospital Closure

State University of New York Trustees were ordered in no uncertain terms to put a temporary stop to the closing of Long Island College Hospital (LICH) in North Brooklyn. The order came down from a Brooklyn judge earlier today, who was responding to a suit filed by the New York State Nurses Association, Local 1199 of the Service Employees International Union, and a group of doctors from the hospital, protesting SUNY’s planned closure of LICH. SUNY/Downstate personnel are also barred from “any communication” with the State Health Department concerning their proposed plans, which were initially made in a closed-door meeting.

PatientPOV.org outlined the specter of hospital closures in Brooklyn threatening patient and emergency care for patients in North and Central Brooklyn in a post Feb. 8th. SUNY Trustees had met privately and stunned the community when it announced it would reorganize hospital care, closing Long Island College Hospital, and beefing up services at Downstate, which is directly across the street from Kings County Hospital Center. The SUNY Trustees’ plan flies in the face of the State’s commissioned report on Medicaid Redesign in Brooklyn.

Even though a March 7th public hearing is scheduled on the suit, SUNY/Downstate has been starving LICH, not assigning attending physicians, interns and residents to the facility, according to LICH staff. Although the plaintiffs view this temporary restraining order as a huge win for patients and staff, the long-term future of hospitals in Brooklyn remains up in the air. A key question is whether the State Health Department and Governor Cuomo will rise to the occasion, back their own Medicaid Redesign Report, and orchestrate a solution to keep the hospital open.

 

 

 

Repeating Koch’s Biggest Blunder

Few people remember Mayor Edward Koch regretting anything, much less anything he fought tooth and nail for, and belligerently. Tucked into the New York Times obituary Feb. 1 was a little-known fact that Koch, who championed the closure of Harlem’s Sydenham Hospital, later acknowledged privately that he regretted closing it. Despite fierce community opposition and his closest aides telling him to give it up, he insisted on the closure of the hospital. He told an audience at New York’s 92nd Street Y that it was a huge mistake.

“It was Sydenham all over again,” a Brooklyn resident told me, reflecting on last night’s packed Town Meeting and scores of pickets outside. What’s at stake is the closure of two Brooklyn hospitals: Long Island College Hospital (LICH) now managed by Downstate Medical Center in Downtown/North Brooklyn, and Interfaith Medical Center, in Central Brooklyn. Have New York policymakers learned the lesson that Koch learned too late, or will this mistake be repeated in Brooklyn? Will Brooklyn residents with emergencies: strokes, heart attacks, what have you, get to the hospital in time to survive?

Credit: wikitravel.org

At a Town Meeting last night in Manhattan, elected leaders, patients, and staff spoke out, vociferously opposing Downstate’s vote to close Long Island College Hospital. A protester called H. Carl McCall, chair of SUNY Board of Trustees, a “sell-out.” The story continues to unfold, but it must be stressed that the State Health Commissioner has opposed the Long Island College Hospital Closure.

A Nov. 28, 2011 Brooklyn Medicaid Design Report (titled At the Brink of Transformation: Restructuring the Healthcare Delivery System in Brooklyn), a report commissioned and approved by the New York State Health Commissioner concluded:

“In light of the recent acquisition of LICH, SUNY Downstate should consider consolidating inpatient services at the LICH campus, thereby eliminating excess capacity and permitting the medical center to focus on inpatient resources and the expansion of services at Kings County Hospital, SUNY Downstate should reconsider any planned expansion of beds at the former Victory Hospital site and any development of an ambulatory care facility in the vicinity of University Hospital or at the former Victory Hospital site should be denied.”-NY Medicaid Redesign Report, 2011, Downloaded from NYS Department of Health website.

The Long Island College Hospital Community

The community is livid. For more than ten years, Continuum owned LICH. According to many at the meeting, Continuum sold off valuable properties in Downtown Brooklyn and used them to bolster Manhattan facilities. Downstate was brought in to rescue LICH, yet voted earlier this week to close Long Island College Hospital.

Anyone who has driven in North Brooklyn knows that the traffic is excessive. Without Long Island College Hospital, North Brooklyn residents might never get to a hospital in time. Last night, a resident spoke about his wife who had a heart attack and made it through at Long Island College Hospital. He argued that with the excess minutes driving to Brooklyn Hospital or Lutheran Hospital, or across the bridge, and his wife would have been dead. Downstate cannot act in a vacuum and public hearings will be held. Many people doubt that the State will authorize Downstate to go ahead. That should reassure residents in Brooklyn.

According to a press release issued today by Brooklyn City Council Member Letitia “Tish” James, “Employees of both hospitals have criticized SUNY, and have suggested that the proposed closures will facilitate the transition to for-profit healthcare in Brooklyn, citing “an experimental ‘pilot program’ in the governor’s draft budget that would allow private investors to create a for- profit hospital in Brooklyn.”

“There is no justification for closing hospitals, instead of providing them with the resources they need to be successful,” said James. “These proposed shutdowns are deeply upsetting and should concern all Brooklyn residents.” Also troubling are media reports that SUNY plans to sell LICH to residential developers likely to create luxury condos, noted James.

Interfaith Medical Center

Interfaith Medical Center is another story. Serving poor African-American and Caribbean American residents in Central Brooklyn, Interfaith declared bankruptcy on December 3rd. About one-third of the beds at Interfaith are for behavioral and substance abuse. Without these beds, marked gaps in mental health services will remain. Medical and surgical beds account for other beds.

The Brooklyn Medicaid Design Group recommended an integration between Interfaith Hospital, Wyckoff Hospital, and Brooklyn Hospital, with Brooklyn Hospital, the lead. Wyckoff Hospital refused the plan. Earlier this week, Interfaith signed a Memorandum of Understanding, leaving Interfaith and Brooklyn to negotiate the terms of integration.

But the group, Save Our Safety Net, worries that Brooklyn Hospital will take over, cutting all but psychiatry services, services for the elderly, and a hospice.  “The community needs more services than that,” said health activist Judy Wessler.

James said: “New York State needs to step up and secure the $20 million needed to guarantee another year of health services for Bed-Stuy and Crown Heights residents. Under the leadership of Governor Cuomo, I believe a merger that incorporates the vision of Interfaith can be established. It is imperative that we move towards that goal to save this comprehensive hospital and the 1600 jobs that would otherwise be eliminated.”