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PubH 7556-001 Health and Health Systems Spring Semester Term A 2014

Credits: 2 Meeting Days: January 11 – March 14, 2014 Meeting Time: online Meeting Place: online Instructor: Jon Christianson PhD Office Address: Health Policy and Management 420 Delaware St. SE MMC 729 Minneapolis MN 55455 Office Phone: 612/625-3849 Fax: 612/624-2196 E-mail: chris001@umn.edu Office Hours: By appointment

I. Course Description This two-credit course covers a range of topics designed to provide an overview of the U.S. health care system and the challenges it now faces.

II. Course Prerequisites You must be admitted to the University of Minnesota’s Master in Healthcare Administration Program.

III. Course Goals and Objectives Specific learning objectives are provided for each lesson. The main goal of the course is to provide students with an overall knowledge of the health care system and a context for subsequent courses in the curriculum of health administration.

IV. Methods of Instruction and Work Expectations

This course consists of an in-person introduction and 8 online lessons, with one lesson a week. Lesson activities include lecture, discussion, reading, and writing assignments. You may work ahead if you wish, but note that there are specific due dates throughout the semester. The topic(s) for each lesson are introduced with narrated presentations, in which the instructor discusses significant issues with reference to the session readings.

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For this course, you will: • Complete a total of eight weekly written assignments consisting of four individual and four group assignments. • Complete one session summary pertaining to the session designated for your group. • Work with the same group members throughout the eight-week course. • Work with your group in a private forum to complete group assignments and summaries of challenges.

‒ Note: Although we recognize there are other means of communicating with your group, we ask for evaluation purposes that you make the private group forum your primary means.

‒ I have access to the private group forum, and although I will not be an active participant in your private discussions, I may monitor the activity as part of evaluating each person's contributions to group assignments.

• Share with your group members the lead role of coordinating and submitting assignments. • Share your group work with the class.

If you have any questions about the course, please use the "Course Q&A, Announcements" forum. Email the instructor with private questions that are not relevant to others in the class.

Instructions: Group Summaries

Your group is expected to provide a summary for one of the 8 lessons. You will post your summary for that lesson for the other groups to read and discuss. I will read the summaries and occasionally comment on them after they are posted. Use the private group forum to collaborate and communicate with your group.

The summary contributes up to 40 points (out of 200) towards your final grade. Your summary is intended to be a group effort, with the results reflecting discussion and consensus among group members. Every group member is expected to fully participate and every group member will receive the same grade. The grade will reflect the thoroughness of your work, the quality of your insights based on your reading of the suggested articles, and the quality of the writing.

To complete the group summary assigned to you:

1. There is a list of suggested readings for each week, organized by different subheadings. Focus on 4 different subheadings (your choice) in preparing your summary. If there are fewer than four subheadings under a given topic, organize your summary around the headings that are available.

2. Based on the readings under each subheading, identify and discuss the challenges facing the health care system.

• For example, if your group is assigned Lesson 2, it might select “Physician Education” as one of the four subheadings it addressed. After reading these articles, identify the challenges facing the health care system relating to implementing successful strategies concerning physician education and briefly describe/discuss them. Do the same for each of the other three subheadings you select under Lesson 2.

3. Your task will be to synthesize the content of the articles under each of the 4 subheadings you choose, drawing out the most important challenges, as your group sees them. Clearly, some articles will be more useful than others in this respect. Do not simply summarize or repeat the content of each individual article.

4. Your summary should be fully referenced and footnoted. If you are quoting a source, put the quotes in quotation marks and include the source in your reference list. If you a citing a source, reference the source in the text and include it in your reference list.

5. Use a 10 point font or larger when drafting your summary, keeping the total length to under 4 pages, double-spaced. You may use headings and subheadings, but provide more than a list of bullet points.

6. Read the summaries posted by other groups and engage in online discussions, especially when you feel there are

additional points to be made that would be of interest to classmates. V. Course Text and Readings

The readings are listed in and available from the weekly lesson plans in the course outline. Some suggested readings are designated by an asterisk, which indicates that the reading has a hot link attached and is a good place to start.

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VI. Course Outline/Weekly Schedule

January 11 (in-person) Health System Performance: From Three-Legged Stool to the Triple Aim • Cost and Population • Patient Experience

January 20-26 A Macro View of Physician Supply: Do We Have Enough Physicians Now? Will We Need More in the Future? Group Assignment 1 Rethinking Primary Care: What Is the Future for the Family Doctor? Group 1 Summary

January 27 – February 2 The Nurse Workforce: “Is There a Nurse in the House?” Individual Assignment 1 Long-Term Care: Balancing What We Want with What We Can Afford Group 2 Summary

February 3-9 The Hospital: From Doctors’ Workshop to “Big Med” Group Assignment 2 Group 3 Summary

February 10-16 Medical Technology and Devices: At the Cutting Edge Individual Assignment 2 Group 4 Summary

February 17-23 Pharmaceuticals: A Regulatory Rubik’s Cube Group Assignment 3 Group 5 Summary

February 24 – March 2 Health Insurance, Uninsurance, and the Private Health Insurance Market: What Works, What Doesn’t and How Will Health Reform Change It? Individual Assignment 3 Group 6 Summary

March 3-9 Medicaid: Can This “Vast Public Enterprise” Be Sustained? Group Assignment 4 Group 7 Summary

March 10-16 Financing Care for Seniors: Down the Medicare Rabbit Hole Individual Assignment 4 Medicare: A Program at the Brink Group 8 Summary

Note: All assignments are due by midnight of the last day in the session week. For example, your first group assignment

is due prior to midnight, January 26.

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Health System Performance Session 1 – Classroom Introduction – January 11, 2014 Health System Performance: From Three-Legged Stool to the Triple Aim – Cost and Population Health There is no assignment or group summary pertaining to this material. Learning Objectives Students should be able to:

1. Discuss the different components of the Triple Aim and the performance of the U.S. health care system relative to: • Cost per capita: components of costs, drivers of cost growth, variation in costs • Population health

2. Compare and contrast different views regarding whether, or under what circumstances, health care expenditures that grow at a faster rate than the rest of the economy should be regarded with concern.

3. Discuss evidence on geographic variation in health care costs in the United States. 4. Discuss and explain differences between the U.S. and other countries in health care costs and population health

Suggested Readings The Triple Aim

1*. Berwick, D.M., Nolan, T.W., Whittington, J. “The triple aim: Care, health and cost.” Health Affairs 27(3):759-769, 2008. http://content.healthaffairs.org/content/27/3/759.full.pdf+html

2. Cauchon, D. “Health care spending is transferred out of ICU.” USA Today, March 4, 2013. Available at: http://www.usatoday.com/story/news/health/2013/03/04/health-care-spending-growth-slows/1963165/

3.* Moses, III, H., Matheson, D.H.M., Dorsey, E.R., George, B.P., Sadoff, D., Yoshimura, Y. “The anatomy of health care in the United States.” Journal of the American Medical Association 310(18):1947-1963, 2013. Available at: http://jama.jamanetwork.com/issue.aspx?journalid=67&issueid=928805&direction=P

Spending on Health Care Trends

1* The Henry J. Kaiser Family Foundation. “Health care costs. A primer.” May 2012. Available at: http://www.kff.org/insurance/upload/7670-03.pdf

2. Barnes, K. “Behind the health spending numbers.” Health Affairs Blog, June 18, 2013. Available at: http://healthaffairs.org/blog/2013/06/18/behind-the-health-spending-numbers/

3. Roehrig, C. “U.S. health spending as a share of GDP – Where are we headed?” Altarum Institute, July 16, 2013. Available at: http://altarum.org/health-policy-blog/u-s-health-spending-as-a-share-of-gdp-where-are-we-headed

4. Kennedy, K., White House touts slow increase in health care costs.” USA Today, July 29, 2013. Available at: http://www.usatoday.com/story/news/politics/2013/07/29/administration-lowered-premiums-white-house/2596453/

5. Orszag, P. “Economy can’t be all that’s slowing health costs.” Bloomberg, September 24, 2013. Available at: http://www.bloomberg.com/news/2013-09-24/economy-can-t-be-all-that-s-slowing-health-costs.html

Geographic Variation in Health Spending 1*. Rau, J. “Medicare spending variations mostly due to health differences, study concludes.” Kaiser Health News, May 28, 2013.

Available at: http://www.kaiserhealthnews.org/Stories/2013/May/28/medicare-state-geographic-variation-costs.aspx 2. Joynt, K.E., Jha, A.K. “The relationship between cost and quality. No free lunch.” Journal of the American Medical Association

307(10):1082-1083, 2012. Available at: http://jama.jamanetwork.com/Issue.aspx?journalid=67&issueID=22493&direction=P Views Regarding Health Spending 1*. Pauly, M.V. “The trade-off among quality, quantity, and cost: How to make it—if we must.” Health Affairs 30(4):574-580, 2011.

http://content.healthaffairs.org/content/30/4/574.full.pdf+html 2. RWJF. “Consumer attitudes on health care costs: Insights from focus groups in four U.S. cities.” January 2013. Available at:

http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2013/rwjf403428 3*. Altman, D., Levitt, L. “We still have a health-care spending problem.” Washington Post, April 21, 2012. Available at:

http://articles.washingtonpost.com/2013-04-21/opinions/38717666_1_health-spending-health-costs-health-care-spending 4. Douthat, R. “Conservatives and health care costs.” New York Times, May 15, 2013. Available at:

http://douthat.blogs.nytimes.com/2013/05/15/conservatives-and-health-care-costs/?_r=0 5. Nichols, L. “Seven challenges for continued health care cost control: Will Congress step up to the plate?” Altarum Institute,

August 20, 2013. Available at: http://altarum.org/health-policy-blog/seven-challenges-for-continued-health-care-cost-control-will-congress-step-up-to-the-plate

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Drivers of Growth in Spending 1. Acaramenico. “Poll of emergency physicians shows more than half order tests as protection against being sued.” May 26, 2011

Available at: http://californiaprevailingwage.wordpress.com/2011/05/26/poll-of-emergency-physicians-shows-more-than-half-order-tests-as-protection-against-being-sued/

2*. Rao, A. “IOM report focuses on $750 billion in inefficient health care spending.” Kaiser Health News Blog, September 6, 2012. Available at: http://capsules.kaiserhealthnews.org/?p=12818

3*. Appleby, J. “Higher prices charged by hospitals, other providers, drove health spending during downturn.” Kaiser Health News, May 21, 2012. Available at: http://www.kaiserhealthnews.org/Stories/2012/May/21/higher-health-care-prices-hospitals.aspx

4*. Kliff, S. “Over next two decades, obesity could cost us $550 billion.” The Washington Post, September 18, 2012. Available at: http://www.washingtonpost.com/blogs/wonkblog/wp/2012/09/18/over-next-two-decades-obesity-could-cost-us-550-billion/ 5. Porter, E. “Health care’s overlooked cost factor.” New York Times, June 11, 2013. Available at:

http://www.nytimes.com/2013/06/12/business/examinations-of-health-costs-overlook-mergers.html?pagewanted=all 6. Rosenthal, E. “The $2.7 trillion medical bill.” New York Times, June 1, 2013. Available at:

http://www.nytimes.com/2013/06/02/health/colonoscopies-explain-why-us-leads-the-world-in-health-expenditures.html?pagewanted=all

7. Gordon, J. “The medical arms race.” Minnesota Medicine, February 2007. Available at: http://www.minnesotamedicine.com/PastIssues/PastIssues2007/February2007/FeatureFebruary2007.aspx

8. Fuchs, V.R. “The gross domestic product and health care spending.” New England Journal of Medicine May 22, 2013. Available at: http://www.nejm.org/doi/full/10.1056/NEJMp1305298

9. Rosenberg, Y. “Do you really need that test? Doctors warn on 90 treatments.” The Fiscal Times, February 21, 2013. Available at: http://www.thefiscaltimes.com/Articles/2013/02/21/Doctors-Warn-on-90-Overused-Medical-Treatments.aspx#page1

10. Hiatt, K. “9 warning signs of bad care.” US News, February 26, 2013. Available at: http://health.usnews.com/health-news/best-nursing-homes/articles/2013/02/26/9-warning-signs-of-bad-care

11. Pittman, G. “Unnecessary repeat cholesterol tests common: study.” Reuters, July 1, 2013. Available at: http://www.reuters.com/article/2013/07/01/us-unnecessary-repeat-cholesterol-idUSBRE96015420130701

Population Health Trends

1. Gardner, A. “America’s health a mixed bag: Report.” Health, February 16, 2011. Available at: http://news.health.com/2011/02/16/americas-health-a-mixed-bag-report/

2*. Kelly, J. “Boomers live longer, but sicker, than parents.” Pittsburgh Post-Gazette, March 4, 2013. Available at: http://www.post-gazette.com/stories/news/health/boomers-live-longer-but-sicker-than-parents-677824/ 3*. Winslow, R. “Americans are living longer, but not necessarily healthier, study shows.” The Wall Street Journal, July 10, 2013.

Available at: http://online.wsj.com/article/SB10001424127887324694904578597444105321914.html 4. US Burden of Disease Collaborators. “The state of US health, 1990-2010. Burden of diseases, injuries, and risk factors.” Journal

of the American Medical Association, Published online July 10, 2013. Available at: http://jama.jamanetwork.com/onlineFirst.aspx 5. Pitman, D. “Gains made, but U.S. still lags in life expectancy.” MedPage Today, July 10, 2013. Available at:

http://www.medpagetoday.com/PublicHealthPolicy/PublicHealth/40381 Illness-specific Measures

1. Reinberg, S. “U.S. cancer death rate continues to drop.” USA Today, July 8, 2010. Available at: http://www.usatoday.com/news/health/2010-07-08-cancer-deaths_N.htm

2. HealthDay. “Asthma cases continue to rise in U.S., affecting millions.” May 15, 2012. Available at: http://consumer.healthday.com/Article.asp?AID=664789

3. USA Today. “Percentage of severely obese adults skyrockets.” October 1, 2012. Available at: http://www.usatoday.com/story/news/nation/2012/10/01/severely-obese-americans-increasing/1606469/

4. Reuters. “U.S. cholesterol levels decline: Study.” October 16, 2012. Available at: http://www.reuters.com/article/2012/10/16/health-cholesterol-idUSL3E8LG7C120121016

5. Reinberg, S. “Nearly 30 percent of Americans have high blood pressure: CDC.” WebMD News from HealthDay, April 4, 2013. Available at: http://www.webmd.com/hypertension-high-blood-pressure/news/20130404/nearly-30-percent-of-americans-have-high-blood-pressure-cdc

Disparities 1*. HealthDay News. “Health disparities persist in U.S., report shows.” January 13, 2011. Available at:

http://health.usnews.com/health-news/family-health/heart/articles/2011/01/13/health-disparities-persist-in-us-report-shows 2. Kaiser Health News. “Race plays role in diagnosis and treatment.” July 24, 2009. Available at:

http://www.kaiserhealthnews.org/daily-reports/2009/july/24/racial-disparities.aspx?referrer=search 3. Tavernise, S. “The health toll of immigration.” New York Times, May 18, 2013. Available at:

http://www.nytimes.com/2013/05/19/health/the-health-toll-of-immigration.html?pagewanted=all 4*. Goodell, S., Escarce, J.J. “Racial and ethnic disparities in access to and quality of health care.” Policy Brief 12, The Synthesis

Project, Robert Wood Johnson Foundation, September 2007. Available at: http://www.rwjf.org/en/research-publications/find-rwjf-research/2007/09/racial-and-ethnic-disparities-in-access-to-and-quality-of-health.html

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International Comparisons Costs/Population Health

1. Baker, S. “Study: US leads in healthcare spending, but ranks last in health.” The Hill’s Healthcare Blog, May 12, 2011. Available at: http://thehill.com/blogs/healthwatch/public-global-health/160845-study-us-leads-in-healthcare-spending-but-ranks-last-in- health-

2. Fox, M. “Survey shows Americans pay a lot more for health care." NationalJournal, March 25, 2012. Available at: http://www.nationaljournal.com/healthcare/survey-shows-americans-pay-a-lot-more-for-health-care-20120304

3. Laugesen, M.J., Glied, S.A. “Higher fees paid to U.S. physicians drive higher spending for physician services compared to other countries.” Health Affairs 30(9):1647-1656, 2011. http://content.healthaffairs.org/content/30/9/1647.full.pdf+html

4. Goodwin, J. “Americans have worse health than English peers, study finds.” US News, March 9, 2011. Available at: http://health.usnews.com/health-news/family-health/boomer-health/articles/2011/03/09/americans-have-worse-health-than-english-peers-study-finds

5*. Fuchs, V.R. “How and why US health care differs from that in other OECD countries.” Journal of the American Medical Association 309(1):33-34, 2013. Available at: http://jama.jamanetwork.com/Issue.aspx?journalid=67&issueID=926163&direction=P

6. Heavey, S. “Obesity, lack of insurance cited in U.S. health gap.” Reuters, January 9, 2013. Available at: http://www.reuters.com/article/2013/01/09/us-usa-health-ranking-idUSBRE9080ZN20130109

7. Goldhill, D. “Other nations don’t compare to U.S. health care.” Bloomberg, June 20, 2013. Available at: http://www.bloomberg.com/news/2013-06-20/what-the-world-can-t-tell-us-about-health-care.html

8. Preidt, R. “U.S. stroke deaths fell 30 percent over past decade.” MedlinePlus, December 3, 2013. Available at: http://www.nlm.nih.gov/medlineplus/news/fullstory_143067.html

9. Porter, E. “Health care’s overlooked cost factor.” The New York Times, June 11, 2013. Available at: http://www.nytimes.com/2013/06/12/business/examinations-of-health-costs-overlook-mergers.html?_r=0

10. Price, Waterhouse, Coopers. “Medical cost trend: Behind the numbers 2014.” June, 2013. Available at: http://pwchealth.com/cgi-local/hregister.cgi/reg/medical-cost-trend-behind-the-numbers-2014.pdf

Further Readings

1. Wayne, A. “Health cost growth slows further even as economy rebounds.” Bloomberg, June 18, 2013. Available at: http://www.bloomberg.com/news/2013-06-18/health-cost-growth-slows-further-even-as-economy-rebounds.html

2. Goldhill, D. “Focus on health-care costs causes more spending.” Bloomberg, January 1, 2013. Available at: http://www.bloomberg.com/news/2013-01-01/focus-on-health-care-costs-causes-more-spending.html

3. Kaiser Family Foundation. “Assessing the effects of the economy on the recent slowdown in health spending.” April 2013. Available at: http://kff.org/health-costs/issue-brief/assessing-the-effects-of-the-economy-on-the-recent-slowdown-in-health-spending-2/

4. Steuerle, G. “A slower rate of health cost growth? What happens when an irresistible force meets an increasingly immovable object.” Altarum Institute Health Policy Forum, May 10, 2013. Available at: http://www.altarum.org/forum/post/slower-rate-health-cost-growth-what-happens-when-irresistible-force-meets-increasingly

5. Samuelson, R.J. “Is the health-care spending slowdown for real?” The Washington Post, May 19, 2013. Available at: http://articles.washingtonpost.com/2013-05-19/opinions/39376698_1_affordable-care-act-affordable-health-coverage-health-affairs

6. Lowrey, A. “Slowdown in health costs’ rise may last as economy revives.” The New York Times, May 6, 2013. 7. Klein, E. “One way Obamacare may already be working.” Bloomberg, May 29, 2013. Available at:

http://www.bloomberg.com/news/2013-05-29/one-way-obamacare-may-already-be-working.html 8. Eligon, J. “An oil boom takes a toll on health care.” The New York Times, January 27, 2013. Available at:

http://www.nytimes.com/2013/01/28/us/boom-in-north-dakota-weighs-heavily-on-health-care.html?_r=0&gwh=BE712B27B95AE737019CF8BBC3FD40D7

9. Philipson, T., Eber, M., Lakdawalla, D.N., Corral, M., Conti, R., Goldman, D.P. “An analysis of whether higher health care spending in the United States versus Europe is ‘worth it’ in the case of cancer.” Health Affairs 31(4):667-675, 2012. Available at: http://content.healthaffairs.org/content/31/4/667.full.pdf+html

10. Lawrence, B.R. “Cutting U.S. health-care costs doesn’t have to be harmful.” The Washington Post online, July 26, 2012. Available at: http://www.washingtonpost.com/opinions/cutting-us-health-care-costs-doesnt-have-to-be-painful/2012/07/26/gJQA1ZzJCX_story.html

11. Ledger, K. “Healthiest state?” Minnesota Medicine, May 2012. Available at: http://www.minnesotamedicine.com/PastIssues/May2012/HealthiestState.aspx

12. Goldsmith, J. “Barking up the wrong tree: Affordability, not cost growth, is the policy challenge.” Health Affairs Blog, May 7, 2012. Available at: http://healthaffairs.org/blog/2012/05/07/barking-up-the-wrong-tree-affordability-not-cost-growth-is-the-policy-challenge/

13. Healy, M. “Obesity in U.S. projected to grow, though pace slows: CDC study.” LA Times online, May 7, 2012. Available at: http://articles.latimes.com/2012/may/07/news/la-heb-obesity-projection-20120507

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14. Kenney, G.M., McMorrow, S., Zuckerman, S., Goin, D.E. “A decade of health care access declines for adults holds implications for changes in the Affordable Care Act.” Health Affairs 31(5):899-908, 2012. Available at: http://content.healthaffairs.org/content/31/5/899.full.pdf+html

15. Lowrey, A. “In hopeful sign, health spending is flattening out.” New York times, April 28, 2012, p.A.1. Available at: http://www.nytimes.com/2012/04/29/health/policy/in-hopeful-sign-health-spending-is-flattening-out.html?pagewanted=all

16. Mahoney, D. “Uncontrolled hypertension deemed pervasive in U.S. adults.” Internal Medicine News, September 4, 2012. Available at: http://www.internalmedicinenews.com/single-view/uncontrolled-hypertension-deemed-pervasive-in-us-adults/e84cc5f65b0596965e8e9b606b653355.html

17. Bipartisan Policy Center. “What is driving U.S. health care spending?” September 2012, Available at: http://bipartisanpolicy.org/sites/default/files/BPC%20Health%20Care%20Cost%20Drivers%20Brief%20Sept%202012.pdf

18. Carroll, A. “The ‘iron triangle’ on health care: Access, cost, and quality.” JAMA Forum, October 3, 2012. Available at: http://newsatjama.jama.com/2012/10/03/jama-forum-the-iron-triangle-of-health-care-access-cost-and-quality/

19. Detsky, A.S. “How to control health care costs.” Journal of General Internal Medicine 27(9):1095-1096, 2012. Available at: http://link.springer.com/content/pdf/10.1007%2Fs11606-012-2119-0.pdf

20. National Institute for Health Care Management. “U.S. health care spending: The big picture.” NIHCM Foundation Data Brief, May 2012. Available at: http://www.nihcm.org/images/stories/Data_Brief_1_-_Big_Picture_FINAL.pdf

21. Reinhardt, U.E., “Is U.S. health spending finally under control.” New York Times online, January 20, 2012. Available at: http://economix.blogs.nytimes.com/2012/01/20/is-u-s-health-spending-finally-under-control/

22. Roehrig, C., Turner, A., Hughes-Cromwick, P., Miller, G. “When the cost curve bent – Pre-recession moderation in health care.” New England Journal of Medicine 367(7):590-593, 2012. Available at: http://www.nejm.org/doi/pdf/10.1056/NEJMp1205958

23. Stein, R. “A dire sign of the obesity epidemic: Teen diabetes soaring, study finds.” NPR, May 21, 2012. Available at: http://www.npr.org/blogs/health/2012/05/21/153030283/a-dire-sign-of-the-obesity-epidemic-teen-diabetes-soaring-study-finds

24. The Economist. “An incurable disease.” September 29, 2012. Available at: http://www.economist.com/node/21563714 25. Wang, S.S. “Revealing the unexpected dangers of obesity.” The Wall Street Journal, October 29, 2012. Available at:

http://www.nytimes.com/2012/09/23/health/new-system-for-patients-to-report-medical-mistakes.html?_r=0 26. Roehrig, C.S., Rousseau, D.M. “The growth in cost per case explains far more of U.S. health spending increases than rising

disease prevalence.” Health Affairs 30(9):1657-1663, 2011. Available at: http://content.healthaffairs.org/content/30/9/1657.full.pdf+html

27. Rovner, J. “You really are paying a lot more for health care.” NPR, May 11, 2011. Available at: http://www.npr.org/blogs/health/2011/05/11/136213104/you-really-are-paying-a-lot-more-for-health-care

28. Reinberg, S.. “Aging population could send cancer costs soaring.” January 12, 2011. Available at: http://news.health.com/2011/01/12/aging-population-could-send-cancer-costs-soaring/

29. Bernstein, J., Reschovsky, J.D., White, C. “Geographic variation in health care: changing policy directions.” Policy Analysis No. 4. Washington, DC: Center for Studying Health System Change, April 2011

30. Gardner, A. “U.S. found to be losing ground in life expectancy.” HealthDay, June 15, 2011. Available at: http://health.usnews.com/health-news/family-health/heart/articles/2011/06/15/us-found-to-be-losing-ground-in-life-expectancy

31. Gawande, A. “The cost conundrum: What a Texas town can teach us about health care.” The New Yorker, June 1, 2009. Available at: http://go.galegroup.com/ps/retrieve.do?sgHitCountType=None&sort=DA-SORT&inPS=true&prodId=PROF&userGroupName=mnaumntwin&tabID=T003&searchId=R1&resultListType=RESULT_LIST&contentSegment=&searchType=AdvancedSearchForm&currentPosition=1&contentSet=GALE%7CA201451685&&docId=GALE|A201451685&docType=GALE&role=&docLevel=FULLTEXT

32. Escarce, J.J. “Racial and ethnic disparities in access to and quality of health care.” Research Synthesis Report No. 12. Robert Wood Johnson Foundation, September 7, 2007. Available at: http://www.rwjf.org/en/research-publications/find-rwjf-research/2007/09/racial-and-ethnic-disparities-in-access-to-and-quality-of-health.html

33. Banks, J., Marmot, M., Oldfield, Z., Smith J.P. “Disease and disadvantage in the United States and in England.” JAMA 2006;295(17):2037-2045. http://jama.jamanetwork.com/Issue.aspx?journalid=67&issueID=5022&direction=P

Health System Performance: From Three-Legged Stool to the Triple Aim – Patient Experience Learning Objectives Students should be able to:

1. Discuss issues and evidence relating to access to care and deficiencies on the quality of health care in the United States 2. Discuss the evidence regarding prevalence of medical errors in the U.S. health care system and their sources. 3. Use terminology related to “medical errors” appropriately. 4. Discuss basic approaches being used in hospitals and other providers to reduce medical errors. 5. Discuss how poor communication and care coordination can affect patient outcomes.

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Suggested Readings Patient Safety and Medical Errors: Concepts, Terminology, and Impact Overview

1*. Leape, L. “Error in medicine.” Journal of the American Medical Association 272(23):1851-1857, 1994 (Posted on Moodle) 2. “Hospital infections killed 48,000, report shows.” Reuters, February 22, 2010. Available at:

http://www.reuters.com/article/2010/02/22/us-hospitals-infections-usa-idUSTRE61L51D20100222 3*. Van Den Bos, J., Rustagi, K., Gray, T., Halford, M., Ziemkiewicz, E., Shreve, J. “The $17.1 billion problem: The annual cost of

measurable medical errors.” Health Affairs 30(4):596-603, 2011. Available at: http://content.healthaffairs.org/content/30/4/596.full.pdf+html

4. Young, J. “Hospital errors occur 10 times more than reported, study finds.” Bloomberg.com, April 6, 2011. Available at: http://www.bloomberg.com/news/2011-04-07/hospital-errors-occur-10-times-more-than-reported-study-finds.html

5. Weber, T., Ornstein, C., Allen, M. “Why can’t medicine seem to fix simple mistakes? ProPublica, July 20, 2012. Available at: http://www.propublica.org/article/why-cant-medicine-seem-to-fix-simple-mistakes

6. Welch, H.G. “Testing what we think we know.” New York Times online, August 19, 2012. Available at: http://www.nytimes.com/2012/08/20/opinion/testing-standard-medical-practices.html

7*. Boodman, S.G. “Doctors’ diagnostic errors are often not mentioned but can take a serious toll.” Kaiser Health News, May 6, 2013. Available at: http://www.kaiserhealthnews.org/stories/2013/may/07/doctor-errors-misdiagnosis-more-common-than-known-serious-impact.aspx

8. Ofri, D. “My near miss.” The New York Times, May 28, 2013. Available at: http://www.nytimes.com/2013/05/29/opinion/addressing-medical-errors.html

9. Zimlichman E., Henderson, D., Tamir, O., et al. “Health care-associated infections. A meta-analysis of costs and financial impact on the US health care system.” JAMA Internal Medicine, September 2, 2013. Available at: http://archinte.jamanetwork.com/article.aspx?articleID=1733452

10. Reinberg, S. “Too many antibiotics still prescribed for sore throats, bronchitis: Studies.” WebMD, October 3, 2013. Available at: http://www.webmd.com/oral-health/news/20131003/too-many-antibiotics-still-prescribed-for-sore-throats-bronchitis-studies

Causes of Medical Errors 1*. Volpp, K.G.M., Grande, D. “Residents’ suggestions for reducing errors in teaching hospitals.” New England Journal of Medicine

348(9):851-855, 2003. Available at: http://www.nejm.org/doi/pdf/10.1056/NEJMsb021667 2. Johnson, C.K. “Poor infection control at many surgery centers.” MSNBC, June 8, 2010. Available at:

http://www.msnbc.msn.com/id/37577363 3. Sittig, D.F., Singh, H. “Defining health information technology—related errors.” Archives of Internal Medicine 171(14):1281-1284,

2011. Available at: http://archinte.jamanetwork.com/Issue.aspx?journalid=71&issueID=22519&direction=P 4. Schiff, G.D. “Medical error. A 60-year-old man with delayed care for a renal mass.” Journal of the American Medical

Association 305(18):1890-1898, 2011. Available at: http://jama.jamanetwork.com/Issue.aspx?journalid=67&issueID=20328&direction=P

5. Richtel, M. “As doctors use more devices, potential for distraction grows.” New York Times, December 15, 2011, p. A.1. Available at: http://www.nytimes.com/2011/12/15/health/as-doctors-use-more-devices-potential-for-distraction-grows.html?pagewanted=all&_r=0

6*. Couse-Baker, R. “Even a doctor can’t keep his father safe in the hospital.” Cognoscenti, April 5, 2013. Available at: http://cognoscenti.wbur.org/2013/04/05/medical-errors-ashish-jha

7. Harris, G. “U.S. inaction lets look-alike tubes kill patients.” The New York Times, August 20, 2010. Available at: http://www.nytimes.com/2010/08/21/health/policy/21tubes.html?pagewanted=all

8. Robertson, J. “Digital health records’ risks emerge as deaths blamed on systems.” Bloomberg, June 25, 2013. Available at: http://www.bloomberg.com/news/2013-06-25/digital-health-records-risks-emerge-as-deaths-blamed-on-systems.html

9. Smith, K. “For doctors, too much information.” Politico, March 5, 2013. Available at: http://www.politico.com/story/2013/03/electronic-alert-glut-overloads-doctors-88394.html

10. Sun, L.H. “’Alarm fatigue’ leads hospital caregivers to ignore beeps, posing risks for patients.” Bangor Daily News, July 23, 2013. Available at: http://bangordailynews.com/2013/07/08/health/alarm-fatigue-leads-hospital-caregivers-to-ignore-beeps-posing-risks-for-patients/

Proposals to Reduce Medical Errors 1*. Gawande, T. “The Checklist.” New Yorker, 83(39):86-95, December 10, 2007. Available at:

http://www.newyorker.com/reporting/2007/12/10/071210fa_fact_gawande 2. Millenson, M.L. “Analysis: Is a new federal patient safety effort doing enough to curb medical errors?” Kaiser Health News,

February 22, 2012. Available at: http://www.kaiserhealthnews.org/stories/2012/february/23/millenson-hens.aspx 3. Ledger, K. “Safety first. How anesthesiologists launched the patient-safety movement.” Minnesota Medicine, March 2011.

Available at: http://www.minnesotamedicine.com/PastIssues/PastIssues2011/March2011/SafetyFirst.aspx 4*. Shaw, G. “Researchers: CPOE averted 17.4 million medication errors in one year.” FierceHealthIT, February 22, 2013. Available

at: http://www.fiercehealthit.com/story/researchers-cpoe-averted-174-million-medication-errors-one-year/2013-02-22

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5. Hartocollis, A. “With money at risk, hospitals push staff to wash hands.” The New York Times, May 28, 2013. Available at: http://www.nytimes.com/2013/05/29/nyregion/hospitals-struggle-to-get-workers-to-wash-their-hands.html?_r=0

6. Southwick, F.S. “Losing my leg to a medical error.” The New York Times, February 19, 2013. Available at: http://www.nytimes.com/2013/02/20/opinion/losing-my-leg-to-a-medical-error.html?smid=pl-share&_r=0

7. Drolet, B.C., Khokhar, M.T., Fischer, S.A. “The 2011 duty-hour requirement — a survey of residence program directors.” The New England Journal of Medicine 368(8):694-697, 2013. Available at: http://www.nejm.org/doi/pdf/10.1056/NEJMp1214483

8*. Shekelle, P.G., Pronovost, P.J., Wachter, R.M., et al. “The top patient safety strategies that can be encouraged for adoption now.” Annals of Internal Medicine 158(5-Part 2):365-368. Available at: http://annals.org/issue.aspx?journalid=90&issueID=926462&direction=P

Care Coordination and Communication Issues 1. Pham, H.H., Grossman, J.M., Cohen, G., Bodenheimer, T. “Hospitalists and care transitions: The divorce of inpatient and

outpatient care.” Health Affairs 27(5):1315-1327, 2008. Available at: http://content.healthaffairs.org/content/27/5/1315.full.pdf+html

2. Blendon, R.J., Buhr, T., Cassidy, E.F., Perez, D.J., Sussman, T., Benson, J.M., et al. “Disparities in physician care: Experiences and perceptions of a multi-ethnic America. Health Affairs 27(2):507-517, 2008. Available at: http://content.healthaffairs.org/content/27/2/507.full.pdf+html

3. Levinson, W., Pizzo, P.A. “Patient-physician communication. It’s about time.” Journal of the American Medical Association 305(17):1802-1803, 2011. Available at: http://jama.jamanetwork.com/Issue.aspx?journalid=67&issueID=20327&direction=P

4*. Schoen, C., Osborn, R., Squires, D., Doty, M., Pierson, R., Applebaum, S. “New 2011 survey of patients with complex care needs in eleven countries finds that care is often poorly coordinated.” Health Affairs 30(12):2437-2448, 2011. Available at: http://content.healthaffairs.org/content/30/12/2437.full.pdf+html

How Patients Experience the Health Care System 1. Mayer, M.L. “On being a ‘difficult’ patient.” Health Affairs 27(5):1416-1421, 2008. Available at:

http://content.healthaffairs.org/content/27/5/1416.full.pdf+html 2*. Jauhar, S. “Referral system turns patients into commodities.” The New York Times, May 26, 2009, p.D.5. Available at:

http://www.nytimes.com/2009/05/26/health/26essa.html?scp=12&sq=health%20care&st=cse 2. Colwill, J.M. “A case of ‘medical homelessness’.” Health Affairs 29(5):1067-1070, 2010. Available at:

http://content.healthaffairs.org/content/29/5/1067.full.pdf+html 3. Butler, K. “My father’s broken heart.” New York Times, June 20, 2010, p. 38. Available at:

http://www.nytimes.com/2010/06/20/magazine/20pacemaker-t.html?src=me&ref=homepage 4. Kapadia, R., Scherzer, L. “10 things your hospital won’t tell you.” msn.com, March 18, 2011. Available at:

http://money.msn.com/health-and-life-insurance/10-things-your-hospital-will-not-tell-you.aspx 5. Dimick, J., Ruhter, J., Sarrazin, M.V., Birkmeyer, J.D. “Black patients more likely than Whites to undergo surgery at low-quality

hospitals in segregated regions.” Health Affairs 32(6):1046-1053, 2013. Available at: http://content.healthaffairs.org/content/32/6/1046.full.pdf+html

Access to Care 1*. Galewitz, P. “Health care increasingly out of reach for millions of Americans.” Kaiser Health News, May 7, 2012. Available at:

http://www.kaiserhealthnews.org/stories/2012/may/07/health-affairs-care-increasingly-out-of-reach-for-millions.aspx 2. Pecquet, J. “Report: Americans still struggling with medical debt.” The Hill, March 7, 2012. Available at:

http://thehill.com/blogs/healthwatch/health-insurance/214759-report-americans-still-struggling-with-medical-debt 3. Kenney, G.M., McMorrow, S., Zuckerman, S., Goin, D.E. “A decade of health care access declines for adults hold implications

for changes in the Affordable Care Act.” Health Affairs 31(5):899-908, 2012. Available at: http://content.healthaffairs.org/content/31/5/899.full.pdf+html

4. HealthDay. “Many lacked preventive care before health reform law: U.S. report.” June 14, 2012. Available at: http://consumer.healthday.com/Article.asp?AID=665762

5. HealthDay. “Fewer U.S. patients getting weight counseling from doctors.” U.S. News, January 10, 2013. Available at: http://health.usnews.com/health-news/news/articles/2013/01/10/fewer-us-patients-getting-weight-counseling-from-doctors

Quality of Care 1. Maugh, T.H. “Nearly 70,000 Americans die needlessly each year because they are not given optimal heart failure therapy.” June

6, 2011. Available at: http://www.latimes.com/health/boostershots/la-heb-heart-failure-06062011,0,4047246.story?track=rss 2. Reuters. “Cardiac arrest survival improving in U.S. hospitals: Study.” July 16, 2012. Available at:

http://www.reuters.com/article/2012/07/17/us-heart-idUSBRE86G01F20120717 3. HealthDay. “Many lacked preventive care before health reform law: U.S. report.” June 14, 2012. Available at:

http://consumer.healthday.com/Article.asp?AID=665762 4*. PR Newswire. “U.S. physician groups identify commonly used tests or procedures they say are often not necessary.” April 4,

2012. Available at: http://www.prnewswire.com/news-releases/us-physician-groups-identify-commonly-used-tests-or-procedures-they-say-are-often-not-necessary-146046345.html

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5. Abelson, R., Creswell, J. “Hospital chain inquiry cited unnecessary cardiac work.” New York Times online, August 6, 2012. Available at: http://www.nytimes.com/2012/08/07/business/hospital-chain-internal-reports-found-dubious-cardiac-work.html?pagewanted=all

6. Mohammed, K.A., Bullard, K.M., Saaddine, J.B., Cowie, C.C., Imperatore, G., Gregg, E.W. “Achievement of goals in U.S. diabetes care, 1999-2010.” The New England Journal of Medicine, 2013;368(17):1613-1624. Available at: http://www.nejm.org/doi/pdf/10.1056/NEJMsa1213829

Further Readings

1. Seaman, A.M. “Surgeons-in-training dislike new work hours: survey.” Reuters, May 17, 2013. Available at: http://news.yahoo.com/surgeons-training-dislike-hours-survey-194513540.html

2. Commins, J. “Diagnostic errors common, costly, and harmful.” HealthLeaders Media, April 23, 2013. Available at: http://www.healthleadersmedia.com/page-1/QUA-291407/Diagnostic-Errors-Common-Costly-and-Harmful##

3. PRWeb. “Global computerized physician order entry systems market to reach US$1.5 billion by 2018, according to new report by Global Industry Analysts, Inc.” July 13, 2012. Available at: http://www.prweb.com/releases/computerized_physician/order_entry_CPOE_systems/prweb9693652.htm

4. Kennedy, K. “HHS: Hospitals ignoring requirements to report errors.” USA Today online, July 20, 2012. Available at: http://www.usatoday.com/news/health/story/2012-07-19/hospitals-preventable-errors-report/56343348/1

5. Lerner, M. “In new safety test, not all Minnesota hospitals earn A: National report card rates 38 state hospitals for patient safety.” Star Tribune, June 7, 2012, p. B3. Available at: http://www.startribune.com/lifestyle/health/157309745.html

6. O’Connell, K. “Two arms, two choices: If only I’d known then what I know now.” Health Affairs 31(8):1895-1899, 2012. Available at: http://content.healthaffairs.org/content/31/8/1895.full.pdf+html

7. Andrews, M. “New book offers checklists to help hospital patients.” Kaiser Health News, March 5, 2012. Available at: http://www.kaiserhealthnews.org/features/insuring-your-health/2012/patient-checklists-michelle-andrews-03052012.aspx?referrer=search

8. Welch, H.G. “Testing what we think we know.” New York Times online, August 19, 2012. Available at: http://www.nytimes.com/2012/08/20/opinion/testing-standard-medical-practices.html

9. Pryor, D., Hendrich, A., Henkel, R.J., Beckmann, J.K., Tersigni, A.R. “The quality ‘journey’ at Ascension Health: How we’ve prevented at least 1,500 avoidable deaths a year — and aim to do even better.” Health Affairs 30(4):604-611, 2011. Available at: http://content.healthaffairs.org/content/30/4/604.full.pdf+html

10. Pronovost, P.J., Marsteller, J.A., Goeschel, C.A. “Preventing bloodstream infections: A measurable national success story in quality improvement.” Health Affairs 30(4):628-634, 2011. Available at: http://content.healthaffairs.org/content/30/4/628.full.pdf+html

11. Joyce, J.D., Cioffi, G.A., Petriwsky, J.G., Robinson, J.S. “Legacy health’s ‘big aim’ initiative to improve patient safety reduced rates of infection and mortality among patients.” Health Affairs 30(4):619-627, 2011. Available at: http://content.healthaffairs.org/content/30/4/619.full.pdf+html

12. Crosby, J. “Getting it right (or left); Wrong-site surgeries continue to plague hospitals, but a new campaign hopes to ensure everyone takes a “timeout” before surgery.” Star Tribune, June 20, 2011, p. D.1. Available at: http://www.highbeam.com/doc/1G1-259321876.html

13. Simmons, J. “AHRQ: Hospitals give themselves high marks for patient safety.” FierceHealthcare, March 23, 2011. Available at: http://www.fiercehealthcare.com/story/ahrq-hospitals-give-themselves-high-marks-patient-safety/2011-03-23

14. Boodman, S.G. “Effort to end surgeries on wrong patients or body part falters.” Kaiser Health News, June 20, 2011. Available at: http://www.kaiserhealthnews.org/Stories/2011/June/21/wrong-site-surgery-errors.aspx

15. McCoy, J. “7 medical error disclosure deterrents.” HealthLeaders Media, February 9, 2011. Available at: http://www.healthleadersmedia.com/content/PHY-260817/7-Medical-Error-Disclosure-Deterrents.html

16. Goodman, J.C., Villarreal, P., Jones, B. “The social cost of adverse medical events, and what we can do about it.” Health Affairs 30(4):590-595, 2011. Available at: http://content.healthaffairs.org/content/30/4/590.full.pdf+html

17. Moisse, K. “HHS announces partnership for patients to save lives, money.” abc News, April 12, 2011. Available at: http://abcnews.go.com/Health/Wellness/hospital-safety-government-industry-team-reduce-errors/story?id=13355460

18. Kolata, G. “Sports medicine said to overuse a popular scan.” New York Times, October 29, 2011, p. A.1. Available at: http://www.nytimes.com/2011/10/29/health/mris-often-overused-often-mislead-doctors-warn.html?pagewanted=all&gwh=9206356E07CA1B10B397D83D480CB224

19. Terry, T. “Electronic prescriptions have as many errors as written prescriptions.” FierceHealthIT, June 30, 2011. Available at: http://www.fiercehealthit.com/story/prescription-errors-equal-whether-written-or-electronic/2011-06-30

20. Wakefield, J.G., McLaws, M-L., Whitby, M., Patton, L. “Patient safety culture: factors that influence clinician involvement in patient safety behaviours.” Quality and Safety in Health Care 19(6):585-591, 2010. Available at: http://qualitysafety.bmj.com/content/19/6/585.full.pdf+html

21. “Study Puts Cost of Medical Errors at $19.5 Billion.” Wall Street Journal (online), August 9, 2010. Available at: http://blogs.wsj.com/health/2010/08/09/study-puts-cost-of-medical-errors-at-195-billion/

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22. Salamon, M. “Despite efforts, study finds no decline in medical errors.” HealthDay News, November 24, 2010. Available at: http://news.health.com/2010/11/24/despite-efforts-study-finds-no-decline-in-medical-errors/

23. Bennett, A. “Lessons of a $618,616 death.” Bloomberg Businessweek, March 4, 2010. Available at: http://www.businessweek.com/magazine/content/10_11/b4170032321836.htm

24. Metzger, J., Welebob, E., Bates, D.W., Lipsitz, S., Classen, D.C. “Mixed results in the safety performance of computerized physician order entry.” Health Affairs 29(4):655-663, 2010. Available at: http://content.healthaffairs.org/content/29/4/655.full.pdf+html

25. O’Callaghan, T. “Study: Fatal medication mistakes surge in July.” New York Times, June 2, 2010. Available at: http://www.nytimes.com/2009/12/17/health/17chen.html?_r=1&pagewanted=print

26. Moffeit, M. “DMN investigates: Lax supervision of residents at U.S. teaching hospitals puts patients at risk.” Dallas Morning News, December 19, 2010. Available at: http://www.dallasnews.com/health/medicine/20101219-lax-supervision-of-residents-at-u.s.-teaching-hospitals-puts-patients-at-risk.ece

27. Kaiser Health News. “Race Plays Role in Diagnosis and Treatment.” July 24, 2009. Available at: http://www.kaiserhealthnews.org/daily-reports/2009/july/24/racial-disparities.aspx?referrer=search

28. Tong, A. “Hospitals stem mistakes with colored socks and sashes. Simple things send a safety signal.” The Sacramento Bee, September 14, 2009. p. B.1. Available at: http://s3.amazonaws.com/external_clips/104582/Hospitals_stem_mistakes_with_colored_socks_a.PDF?1345612636

29. Szabo, L. “Studies: Surgeons could save lives, $20B by using checklist.” USA Today, January 14, 2009. Available at: http://www.usatoday.com/news/health/2009-01-14-surgery-checklist_N.htm

30. Garbutt, J., Waterman, A.D., Kapp, J.M., Dunagan, W.C., Levinson, W., Fraser, V., Gallagher, T.H. “Lost opportunities: How physicians communicate about medical errors.” Health Affairs 27(1):246-255, 2008. Available at: http://content.healthaffairs.org/content/27/1/246.full.pdf+html

31. Skinner, J., Chandra, A., Goodman, D., Fisher, E.S. “The elusive connection between health care spending and quality.” Health Affairs – Web Exclusive 28(1):w119-w123, published online December 4, 2008. Available at: http://content.healthaffairs.org/content/28/1/w119.full.pdf+html

32. Koppel, R., Wetterneck, T., Telles, J.L., Karsh, B-T. “Workarounds to barcode medication administration systems: Their occurrences, causes, and threats to patient safety.” Journal of the American Medical Informatics Association 15(4):408-423, 2008. Available at: http://www.sciencedirect.com/science/journal/10675027/15/4

33. Buerhaus, P.I. “Is hospital patient care becoming safer? A conversation with Lucian Leape.” Health Affairs – Web Exclusive 26(6):w687-w696, published online October 9, 2007. Available at: http://content.healthaffairs.org/content/26/6/w687.full.pdf+html

34. “States making it OK for docs to say ‘sorry’.” MSNBC, April 11, 2007. Available at: http://www.msnbc.msn.com/id/18059841/ 35. Pronovost, P.J., Miller, M.R., Wachter, R.M. “Tracking progress in patient safety. An elusive target.” JAMA 296(6):696-699,

2006. Available at: http://jama.jamanetwork.com/Issue.aspx?journalid=67&issueID=5031&direction=P 36. Asch, S.M., Kerr, E.A., Keesey, J., Adams, J.L., Setodji, C.M., Malik, S., McGlynn, E.A. “Who is at greatest risk for receiving

poor-quality health care?” New England Journal of Medicine 354(11):1147-1156, 2006. Available at: http://www.nejm.org/doi/pdf/10.1056/NEJMsa044464

37. Leape, L. “Reporting of adverse events.” New England Journal of Medicine 347(20):1633-1638, 2002. Available at: http://www.nejm.org/doi/pdf/10.1056/NEJMNEJMhpr011493

Care Delivery Lesson 2 – January 20-26, 2014 A Macro View of Physician Supply: Do We Have Enough Physicians Now? Will We Need More in the Future? Group Assignment 1 Learning Objectives Students should be able to:

1. Discuss the points of controversy regarding the prediction of future shortages or surpluses in physician supply in America. 2. Explain the limitations of the present medical education system in expanding physician supply. 3. Compare the positive and negative aspects of meeting U.S. physician shortages through use of foreign medical graduates. 4. Discuss the public policy issues regarding expanding physician supply.

Suggested Readings Physician Education

1*. Saxton, J. “The medical education of physicians.” Background Paper No. 73, National Health Policy Forum. February 17, 2010. Available at: http://www.nhpf.org/library/background-papers/BP73_MedicalEducation_02-17-10.pdf

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2. Kaiser Health News. “Medical school costs, loan rates rise sharply.” March 20, 2010. Available at: http://www.kaiserhealthnews.org/Daily-Reports/2010/March/10/medical-school-cost.aspx

3. Dower, C., O’Neil, E. “Primary care health workforce in the United States.” Robert Wood Johnson Foundation Research Synthesis Report No. 22, July 2011. Available at: http://www.rwjf.org/en/research-publications/find-rwjf-research/2011/07/primary-care-workforce-in-the-united-states.html

4. Kavilanz, P. “Med students rush to primary care programs.” CNN Money, March 23, 2011. Available at: http://money.cnn.com/2011/03/23/news/economy/more_medical_students_pick_family_medicine/index.htm

5. LA Times online. “Medical school enrollment on the rise.” October 24, 2011. Available at: http://latimesblogs.latimes.com/money_co/2011/10/medical-school-enrollment.html

6*. Dower, C. “Graduate medical education. A debate continues over the size and scope of federal subsidies to support residency training of the nation’s physicians.” August 16, 2012. Available at: http://healthaffairs.org/healthpolicybriefs/brief_pdfs/healthpolicybrief_73.pdf

7. Wayne, D.B., Hauer, K.E. “Counting quality, not hours: Understanding the impact of duty hour reform on internal medicine residency education.” Journal of General Internal Medicine 27(11):1400-1401, 2012. Available at: http://link.springer.com/journal/11606/27/11/page/1

8. Iglehart, J.K. “Financing graduate medical education – mounting pressure for reform.” New England Journal of Medicine 366(17):1562-1563, 2012. http://www.nejm.org/doi/pdf/10.1056/NEJMp1114236

9. Cohen, J. “New med school aims to train primary care docs.” Kaiser Health News, April 2, 2013. Available at: http://www.kaiserhealthnews.org/stories/2013/april/02/quinnipiac-medical-school-primary-care.aspx

10*. Ofri, D. “The Darker Year of Medical School.” Slate, June 4, 2013. Available at: http://www.slate.com/articles/health_and_science/medical_examiner/2013/06/medical_school_dark_side_the_third_year_makes_students_less_empathetic.html

11. Sack, K. “Summer of work exposes medical students to system’s ills.” The New York Times, September 9, 2009. Available at: http://www.nytimes.com/2009/09/09/health/policy/09medschool.html?_r=0

12. Crosson, F.J., Leu, J., Roemer, B.M., Ross, M.N. “Gaps in residency training should be addressed to better prepare doctors for a twenty-first century delivery system.” Health Affairs 30(11):2142-2148, 2011. Available at: http://content.healthaffairs.org/content/30/11/2142.full.pdf+html

13.* Iglehart, J.K. “The residency mismatch.” The New England Journal of Medicine 369(4):297-299, 2013. Available at: http://www.nejm.org/doi/full/10.1056/NEJMp1306445

14. Hartman, B. “The 3 year medical school: Is shorter good enough?” MedPage Today, September 16, 2013. Available at: http://www.medpagetoday.com/PublicHealthPolicy/MedicalEducation/41651

Physician Concerns 1*. Ringel, S.P. “Practicing medicine versus pushing paper. A neurologist reflects on the realities of his workday after a patient asks

why doctors complain about payers’ bureaucratic oversight.” Health Affairs 30(6):1200-1202, 2011. http://content.healthaffairs.org/content/30/6/1200.full.pdf+html

2. Morra, D., Nicholson, S., Levinson, W., Gans, D.N., Hammons, T., Casalino, L.P. “US Physician practices versus Canadians: Spending nearly four times as much money interacting with payers.” Health Affairs 30(8):1443-1450, 2011. http://content.healthaffairs.org/content/30/8/1443.full.pdf+html

3. Barr, S. “Few doctors consider themselves rich, survey says.” Kaiser Health News, April 25, 2012. Available at: http://capsules.kaiserhealthnews.org/index.php/2012/04/few-doctors-consider-themselves-rich-survey-says/

4. Punke, H. “11 specialties with most satisfied physicians.” Becker’s Hospital Review, April 30, 2013. Available at: http://www.beckershospitalreview.com/hospital-physician-relationships/11-specialties-with-most-satisfied-physicians.html

5. Cortez, M.F. “Pay gap for women doctors increases to $50,000 a year.” Bloomberg, September 2, 2013. Available at: http://www.bloomberg.com/news/2013-09-02/pay-gap-for-women-doctors-increases-to-50-000-a-year.html

6. Bornstein, D. “Medicine’s search for meaning.” The New York Times, September 18, 2013. Available at: http://opinionator.blogs.nytimes.com/2013/09/18/medicines-search-for-meaning/

7. O’Malley, A.S., Bond, A.M., Berenson, R.A. “Rising hospital employment: Better quality, higher costs?” Center for Studying Health System Change Issue Brief 136, August 2011. Available at: http://www.hschange.com/CONTENT/1230/1230.pdf

Practice Choices 1*. Lee, D. “Physician-hospital links grow. Overhead, reimbursement fuel trend of doctors forgoing autonomy.” Indy.com, March 4,

2010. Available at: http://www.indystar.com/article/20100304/BUSINESS/3040377/Physician-hospital-links-grow 2. Harris, G. “More physicians say no to endless workdays.” New York Times, April 2, 2011, p. A.1.

http://www.nytimes.com/2011/04/02/health/02resident.html?pagewanted=all&_r=0 3*. Burling, S. “Why heart doctors are leaving practice to work for hospitals.” philly.com, January 27, 2012. Available at:

http://mobile.philly.com/health/?wss=/philly/health&id=138095623 4*. Gamble, M. “68% of graduating physicians want sign-on bonus, 29% want hospital practice.” Becker’s Hospital Review, August

16, 2012. Available at: http://www.beckershospitalreview.com/hospital-physician-relationships/68-of-graduating-physicians-want-sign-on-bonus-29-want-hospital-practice.html

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Projections of Future Physician Supply 1. Iglehart, J.K. “Grassroots activism and the pursuit of an expanded physician supply.” New England Journal of Medicine

358(16):1741-1749, 2008. http://www.nejm.org/doi/pdf/10.1056/NEJMhpr0800058 2*. Robert Wood Johnson Foundation. “Will the United States have a shortage of physicians in 10 years?” November 2009.

Available at: http://www.academyhealth.org/files/publications/HCFOReportDec09.pdf 3.* Cooper, R.A. “Unraveling the physician supply dilemma.” Journal of the American Medical Association 310(18):1931-1932.

Available at: http://jama.jamanetwork.com/issue.aspx?journalid=67&issueid=928805&direction=P 4*. Henry J. Kaiser Family Foundation. “Primary care shortage; Background brief.” Available at:

http://www.wcl.american.edu/secle/materials/Fall_2012/Next_Steps_in_Health_Reform/TAB%2012.Background-Brief.pdf 5. Sadick, B. “In search of more primary-care doctors.” The Wall Street Journal, November 17, 2013. Available at:

http://online.wsj.com/news/articles/SB10001424052702303902404579151510997182566 6. Alliance for Health Reform. “Health care workforce: Future supply vs. demand.” Washington, DC: Author, April 2011. Available

at: http://www.allhealth.org/publications/Medicare/Health_Care_Workforce_104.pdf 7. Wayne, A. “Doctor shortage may swell to 130,000 with cap.” Bloomberg, August 28, 2012. Available at:

http://www.bloomberg.com/news/2012-08-29/doctor-shortage-may-swell-to-130-000-with-u-s-cap.html 8. Dunn, L. “What will the physician workforce look like in 2030?” Becker’s Hospital Review, May 13, 2013. Available at:

http://www.beckershospitalreview.com/hospital-physician-relationships/what-will-the-physician-workforce-look-like-in-2030.html 9. Preidt, R. “Primary care doctors still in short supply in U.S.” MedlinePlus, June 14, 2013. Available at:

http://consumer.healthday.com/general-health-information-16/doctor-news-206/primary-care-doctors-still-in-short-supply-in-u-s-study-677317.html

10. Sanner, A. “Newly insured to deepen primary care doctor gap.” TwinCities.com, June 22, 2013. Available at: http://www.loganbanner.com/view/full_story/22993974/article-Newly-insured-to-deepen-primary-care-doctor-gap

11. Gottlieb, S., Emanuel E. “No, there won’t be a doctor shortage.” The New York Times, December 4, 2013. Available at: http://www.nytimes.com/2013/12/05/opinion/no-there-wont-be-a-doctor-shortage.html?hp&rref=opinion

Options for Increasing Physician Supply 1. Hart, L.G. et al. “International medical graduate physicians in the United States: Changes since 1981.” Health Affairs 26(4):1159-

1169, 2007. http://content.healthaffairs.org/content/26/4/1159.full.pdf+html 2*. Brownlee, S., Goodman D. “Doctors no one needs.” [Op-Ed]. New York Times, December 23, 2009. p. A.31.

http://www.nytimes.com/2009/12/23/opinion/23brownlee.html 3*. Pardes, H., Miller, E.D. “We can’t afford to train fewer doctors.” New York Times, July 12, 2011, p. A.13.

http://online.wsj.com/article/SB10001424052702303544604576434470768158908.html 4. McAllester, M. “America is stealing the world’s doctors.” New York Times online, March 7, 2012. Available at:

http://www.nytimes.com/2012/03/11/magazine/america-is-stealing-foreign-doctors.html?pagewanted=all 5. Association of American Medical Colleges. “Medical school enrollment continues to climb with new diversity gains.” October 24,

2012. Available at: https://www.aamc.org/newsroom/newsreleases/310002/121023.html 6. Editorial. “An Rx for the doctor shortage.” Los Angeles Times, April 21, 2013. Available at:

http://articles.latimes.com/2013/apr/21/opinion/la-ed-medical-professionals-20130421 7*. Caramenico, A. “Med school enrollment growth won’t ease doc shortage.” FierceHealthcare, May 3, 2013. Available at:

http://www.fiercehealthcare.com/story/med-school-enrollment-growth-wont-ease-doc-shortage/2013-05-03 8. Minnesota Medicine. “Willing and able to work.” April 2010. Available at:

http://www.minnesotamedicine.com/PastIssues/PastIssues2010/April2010/PulseWillingandAbletoWorkApril2010.aspx 9. Sanders, B. “Primary physician shortage calls for intervention.” Politico, May 7, 2013. Available at:

http://www.politico.com/story/2013/05/doctors-physician-shortage-calls-for-intervention-91024.html 10. Gold, J. “Immigrant docs help ease California’s primary care shortage.” Kaiser Health News, April 4, 2013. Available at:

http://www.kaiserhealthnews.org/stories/2013/april/04/california-doctors-primary-care-latin-america.aspx 11. Torrey, E.F., Torrey, B.B. “The US distribution of physicians from lower income countries.” PLoS One 7(3):1-4, 2012. Available

at: http://www.plosone.org/article/info:doi/10.1371/journal.pone.0033076 12. Koleva, G. “Economists show primary care especially unrewarding for women doctors.” Forbes, July 16, 2012. Available at:

http://www.forbes.com/sites/gerganakoleva/2012/07/16/economists-show-primary-care-especially-unrewarding-for-women-doctors/

13. Rampell, C. “Path to United States practice is long slog to foreign doctors.” The New York Times, August 11, 2013. Available at: http://www.nytimes.com/2013/08/12/business/economy/long-slog-for-foreign-doctors-to-practice-in-us.html

Public Policy Issues and Concerns About Physician Supply 1. Lowrey, A., Pear, R. “Doctor shortage likely to worsen with health law.” New York Times, July 29, 2012, p. A.1.

http://www.nytimes.com/2012/07/29/health/policy/too-few-doctors-in-many-us-communities.html 2*. Goozner, M. “More doctors on the way, higher costs to follow.” The Fiscal Times, May 4, 2012. Available at:

http://www.thefiscaltimes.com/Articles/2012/05/04/More-Doctors-on-the-Way-Higher-Costs-to-Follow.aspx#page1 3*. Reinhardt, U.E. “Health-care reform and the ‘doctor shortage’.” New York Times online, August 17, 2012. Available at:

http://economix.blogs.nytimes.com/2012/08/17/health-care-reform-and-the-doctor-shortage/

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4. Reinhardt, U.E. “From physician glut to physician shortage.” The New York Times, August 31, 2012. Available at: http://economix.blogs.nytimes.com/2012/08/31/from-physician-glut-to-physician-shortage/

5. Davis, K.L. “Demand for doctors soaring as cuts loom.” Politico, March 5, 2013. Available at: http://www.politico.com/story/2013/03/demand-for-doctors-soaring-as-cuts-loom-88390.html

6. Ubel, P. “How much money should a cardiologist make?” Forbes, December 7, 2012. Available at: http://www.forbes.com/sites/peterubel/2012/12/07/how-much-money-should-a-cardiologist-make/

Further Readings

1. Conover, C. “Are U.S. doctors paid too much?” Forbes, May 28, 2013. Available at: http://www.forbes.com/sites/theapothecary/2013/05/28/are-u-s-doctors-paid-too-much/

2. ConsumerReports. “What bugs you most about your doctor.” June 2013. Available at: http://www.consumerreports.org/cro/magazine/2013/06/what-bugs-you-most-about-your-doctor/index.htm

3. Hixon, T. “Rebutting the premise that doctors help drive high health care costs.” Forbes, March 24, 2012. Available at: http://www.forbes.com/sites/toddhixon/2012/03/24/rebutting-the-premise-that-doctors-help-drive-high-health-care-costs/

4. Novak, S. “Luring students into family medicine.” The New York Times, September 9, 2012. Available at: http://www.nytimes.com/2012/09/10/us/10iht-educlede10.html?pagewanted=all

5. Tulenko, K. “America’s health worker mismatch.” The New York Times, September 13, 2012. Available at: http://www.nytimes.com/2012/09/14/opinion/americas-health-worker-mismatch.html

6. Viebeck, E. “House Dem floats bill to ward off doctor shortage.” The Hill, September 28, 2012. Available at: http://thehill.com/blogs/healthwatch/other/259239-house-dem-floats-bill-to-ward-off-doctor-shortage

7. Schwartz, M.D. “Health care reform and the primary care workforce bottleneck.” Journal of General Internal Medicine 27(4):469-472, 2012. http://link.springer.com/content/pdf/10.1007%2Fs11606-011-1921-4

8. Gold, J. “The next frontier for elite med schools: Primary care.” Kaiser Health News, September 23, 2012. Available at: http://www.kaiserhealthnews.org/stories/2012/september/24/mt-sinai-primary-care.aspx

9. Goldstein, A. “Primary-care health panel caught in partisan dispute.” The Washington Post, May 16, 2011, p. A.3. Available at: http://www.highbeam.com/doc/1P2-28704120.html

10. Aneja, S., Ross, J.S., Wang, Y., Matsumoto, M., Rodgers, G.P., Bernheim, S.M., Rathore, S.S., Krumholz, H.M. “US cardiologist workforce from 1995 to 2007: Modest growth, lasting geographic maldistribution especially in rural areas.” Health Affairs 30(12):2301-2309, 2011. Available at: http://content.healthaffairs.org/content/30/12/2301.full.pdf+html

11. Armstrong, D. “Doctors turn away insured patients on low payments, study finds.” Bloomberg, June 27, 2011. Available at: http://www.bloomberg.com/news/2011-06-27/doctors-turn-away-insured-on-low-payments.html

12. Cassel, C. K., Reuben, D.B. “Specialization, subspecialization, and subsubspecialization in internal medicine.” New England Journal of Medicine 364(12):1169-1173, 2011. Available at: http://www.nejm.org/doi/pdf/10.1056/NEJMsb1012647

13. Grady, D. “Foreign-born doctors give equal care in U.S.” New York Times, August 3, 2010, p. D.7. http://www.nytimes.com/2010/08/03/health/03doctors.html

14. Brown, D. “How the new health-care law might make your doctor better informed, more efficient, more responsive and, maybe, happier.” The Washington Post, May 4, 2010, p. E.1. Available at: http://www.washingtonpost.com/wp-dyn/content/article/2010/04/30/AR2010043002007.html

15. Gold, J. “Hospitals lure doctors away from private practice.” Kaiser Health News, October 13, 2010. Available at: http://www.npr.org/templates/story/story.php?storyId=130237412

16. Iglehart, J.K. “Medicare, graduate medical education, and new policy directions.” New England Journal of Medicine 359(6):643-650, 2008. Available at: http://www.nejm.org/doi/pdf/10.1056/NEJMhpr0803754

1. , T. “Health agencies predict a dearth of physicians. Can we act now to prevent it?” Los Angeles Times, June 7, 2010. p. E.1 Rethinking Primary Care: What is the Future for the Family Doctor? Learning Objectives Students should be able to:

1. Describe the factors leading to current efforts to change primary care delivery in the U.S. 2. Discuss changes in the workplace and work arrangements for primary care physicians. 3. Compare and contrast new models for reforming primary care. 4. Discuss how public policy, and health care reform in particular, is likely to affect primary care.

Suggested Readings Challenges to Traditional Models of Primary Care Delivery

1*. Bodenheimer, T. and Pham H.H. “Primary care: Current problems and proposed solutions.” Health Affairs 29(5):799-805, 2010. http://content.healthaffairs.org/content/29/5/799.full.pdf+html

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2. Vaughn, B.T., DeVrieze, S.R., Reed, S.D., Schulman, K.A. “Can we close the income and wealth gap between specialists and primary care physicians?” Health Affairs 29(5):933-940, 2010. http://content.healthaffairs.org/content/29/5/933.full.pdf+html

3. Iglehart, J.K. “Doctor-workers of the world, unite!” Health Affairs 30(4):556-558, 2011. http://content.healthaffairs.org/content/30/4/556.full.pdf+html

4. Delude, C. “It’s enough to make them say ‘aaaah!’” Los Angeles Times, June 27, 2011. Available at: http://articles.latimes.com/print/2011/jun/27/health/la-he-primary-care-doctors-20110627

5*. Iglehart, J.K. “Primary care update – light at the end of the tunnel?” New England Journal of Medicine 366(23):2144-2146, 2012. http://www.nejm.org/doi/pdf/10.1056/NEJMp1205537

6. Peterson, S.M., Phillips Jr., R.L., Bazemore, A.W., Koinis, G.T. “Unequal Distribution of the U.S. primary care workforce.” American Family Physician 87(11):1. Available at: https://www.clinicalkey.com/#!/BrowserCtrl/doBrowseTo/journalIssue/{"facet":["1-s2.0-S0002838X13X60101"],"issn":"0002838X","contentType":"Journals"}

7. Sanger-Katz, M. “Why we trust doctors.” NationalJournal, April 19, 2012. Available at: http://www.nationaljournal.com/features/restoration-calls/why-we-trust-doctors-20120419

Changes in the Workplace for Primary Care Physicians 1. Landon, B.E. “Use of quality indicators in patient care. A senior primary care physician trying to take good care of his patients.”

Journal of the American Medical Association 307(9):956-964, 2012. Available at: http://jama.jamanetwork.com/Issue.aspx?journalid=67&issueID=22492&direction=P

2. Altschuler, J., Margolius, D., Bodenheimer, T., et al. “Estimating a reasonable patient panel size for primary care physicians with team-based task delegation.” Annals of Family Medicine 10(5):396-400, 2012. Available at: http://www.annfammed.org/content/10/5/396.full.pdf+html

3. Chen, P. “Delivering Better Primary Care.” New York Times, May 13, 2010. Available at: http://www.nytimes.com/2010/05/13/health/13chen.html

4. Becker, A.E. “More physicians turning to hospital-based practice.” Ctmirror, August 15, 2011. Available at: http://ctmirror.org/story/13550/hospitalists

5. Harris, G. “Family physician can’t give away solo practice.” New York Times, April 23, 2011, p. A.1. http://www.nytimes.com/2011/04/23/health/23doctor.html?pagewanted=all

6.* Sun, L.H. “Hospitals courting primary-care doctors.” Washington Post, June 20, 2011, p. A.1. http://articles.washingtonpost.com/2011-06-19/national/35265390_1_primary-care-care-at-lower-costs-medicine

7. Swan, B.A. “After hospital care, the test begins.” Los Angeles Times, May 9, 2013. Available at: http://articles.latimes.com/2013/may/09/opinion/la-oe-swan-post-hospital-care-20130509

New Models for Primary Care Patient Centered Medical Homes (PCMHs) and Team Care

1*. Hoff, T. “The shaky foundation of the patient-centered medical home.” American Journal of Managed Care 16(6):e134-e136, 2010. http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=3&sid=b550284d-5718-448f-8e35-b785d8117a9d%40sessionmgr10&hid=24

2*. Casalino, L.P. “Analysis & commentary. A Martian’s prescription for primary care: Overhaul the physician’s workday.” Health Affairs 29(5):785-790, 2010. http://content.healthaffairs.org/content/29/5/785.full.pdf+html

3. Elliott, V.S. “Study quantifies practice boost from physicians delegating tasks.” amednews.com, November 19, 2012. Available at: http://www.amednews.com/article/20121119/business/311199967/6/

4. NCQA. “NCQA medical homes pass 6,000 mark.” NCQA, September 24, 2013. Available at: http://www.ncqa.org/Newsroom/2013NewsArchives/NewsReleaseSeptember242013.aspx

5. Johnsen, M. “California expands scope of pharmacy practice.” Drug Store News, October 2, 2013. Available at: http://drugstorenews.com/article/california-expands-scope-pharmacy-practice

6. Rosenthal, M.B., Friedberg, M.W., Singer, S.J., Eastman, D., Li, Z., Schneider, E.C. “Effect of a multipayer patient-centered medical home on health care utilization and quality: The Rhode Island chronic care sustainability initiative pilot program.” JAMA Internal Medicine 173(20):1907-1913, 2013. Available at: http://archinte.jamanetwork.com/issue.aspx?journalid=71&issueid=928839&direction=P

7. Margolius, D., Bodenheimer, T. “Transforming primary care: From past practice to the practice of the future.” Health Affairs 29(5):779-784, 2010. http://content.healthaffairs.org/content/29/5/779.full.pdf+html

8. Berenson, R.A., Devers, K.J., Burton, R.A. “Will the patient-centered medical home transform the delivery of health care?” Washington, DC: Urban Institute, August 2011. Available at: http://www.urban.org/UploadedPDF/412373-will-patient-centered-medical-home-transform-delivery-health-care.pdf

9. Adair, R., Christianson, J., Wholey, D., White, K.M., Town, R., Lee, S., et al. “Care guides. Employing nonclinical laypersons to health primary care teams manage chronic disease.” Journal of Ambulatory Care Management 35(1):27-37, 2012. http://ovidsp.tx.ovid.com/sp-3.10.0b/ovidweb.cgi?WebLinkFrameset=1&S=MJIGFPCFDPDDBKPNNCNKLDGCCBJMAA00&returnUrl=ovidweb.cgi%3f%26TOC%3dS.sh.18.19.22.25%257c3%257c50%26FORMAT%3dtoc%26FIELDS%3dTOC%26S%3dMJIGFPCFDPDDBKPNNCNKLDGCCBJMAA00&directlink=http%3a%2f%2fgraphics.tx.ovid.com%2fovftpdfs%2fFPDDNCGCLDPNDP00%2ffs047%2fovft%2fliv

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e%2fgv031%2f00004479%2f00004479-201201000-00003.pdf&filename=Community+Health+Workers+Assisting+Patients+With+Diabetes+in+Self-management.&PDFIdLinkField=%2ffs047%2fovft%2flive%2fgv031%2f00004479%2f00004479-201201000-00003&link_from=S.sh.18.19.22.25%7c3&pdf_key=B&pdf_index=S.sh.18.19.22.25&D=ovft

10*. Ghorob, A., Bodenheimer, T. “Sharing the care to improve access to primary care.” New England Journal of Medicine 366(21):1955-1957, 2012. http://www.nejm.org/doi/pdf/10.1056/NEJMp1202775

11. Green, L.V., Savin, S., Lu, Y. “Primary care physician shortages could be eliminated through use of teams, nonphysicians, and electronic communications.” Health Affairs 32(1):11-19, 2013. Available at: http://content.healthaffairs.org/content/32/1/11.full.pdf+html

12*. Hausman, S. “Yes, Virginia, there is a medical home.” Kaiser Health News, May 1, 2013. Available at: http://www.kaiserhealthnews.org/stories/2013/may/01/medical-homes-virginia.aspx

13. Rao, A. “Doctors transform how they practice medicine.” Kaiser Health News, May 15, 2013. Available at: http://www.kaiserhealthnews.org/stories/2013/may/15/doctors-transform-practices-over-financial-lifestyle-pressures.aspx?referrer=search

14. The Commonwealth Fund. “Primary care: Our first line of defense.” June 12, 2013. Available at: http://www.commonwealthfund.org/Publications/Health-Reform-and-You/Primary-Care-Our-First-Line-of-Defense.aspx?page=all

15. Frolkis, J.P. “The Columbo phenomenon.” Journal of the American Medical Association 309(22):2333-2334, 2013. Available at: http://jama.jamanetwork.com/issue.aspx?journalid=67&issueid=927088&direction=P

16. Landon, B.E. “Moving ahead with the PCMH: Some progress, but more testing needed.” Journal of General Internal Medicine 28(6):753-755, 2013. Available at: http://link.springer.com/journal/11606/28/6/page/1

Increased Reliance on Advanced Practice Nurses 1. Pittman, D. “NPs, PAs trending away from primary care.” MedPage Today, August 16, 2013. Available at:

http://www.medpagetoday.com/PrimaryCare/GeneralPrimaryCare/41038 2. Mason, M. “State bill to boost use of nurse practitioners goes nowhere.” Los Angeles Times, September 1, 2013. Available at:

http://articles.latimes.com/2013/sep/01/local/la-me-healthcare-20130902 3. Appleby, J. “Nurse practitioners try new tack to expand foothold in primary care.” Kaiser Health News, September 8, 2013.

Available at: http://www.kaiserhealthnews.org/stories/2013/september/09/nurse-primary-care-slowed-by-insurer-credentialing.aspx

4. Galewitz, P. “Urgent care centers are booming, which worries some doctors.” The Washington Post, September 17, 2012. Available at: http://www.washingtonpost.com/national/health-science/urgent-care-centers-are-booming-which-worries-some-doctors/2012/09/17/e87f1a0c-e0cb-11e1-a19c-fcfa365396c8_story.html

5*. Pohl, J.M., Hanson, C., Newland, J.A., Cronenwett, L. “Analysis & commentary. Unleashing nurse practitioners’ potential to delivery primary care and lead teams.” Health Affairs 29(5):900-905, 2010. http://content.healthaffairs.org/content/29/5/900.full.pdf+html

6. Elliott, V.S. “Sharp increase expected in number of nurse practitioners.” amednews.com, July 2, 2012. Available at: http://www.ama-assn.org/amednews/2012/07/02/bisb0702.htm

7*. Kiff, S. “Nurse practitioners look to fill gap with expected spike in demand for health services.” Washington Post online, May 12, 2012. Available at: http://www.washingtonpost.com/national/health-science/nurse-practitioners-look-to-raise-profile-fill-gap-from-doctor-shortage/2012/05/12/gIQAHmHYLU_story.html

8. Aizenman, N.C. “Nurses can practice without physician supervision in many states.” The Washington Post, March 24, 2013. Available at: http://www.washingtonpost.com/national/health-science/nurses-can-practice-without-physician-supervision-in-many-states/2013/03/24/98b241cc-8745-11e2-999e-5f8e0410cb9d_story.html

9. Punke, H. “Hiring of non-physician providers on the rise.” Becker’s Hospital Review, November 2, 2012. Available at: http://www.beckershospitalreview.com/hospital-physician-relationships/hiring-of-non-physician-providers-on-the-rise.html

10*. Beck, M. “Battles erupt over filling doctors’ shoes.” The Wall Street Journal, February 4, 2013. Available at: http://online.wsj.com/article/SB10001424127887323644904578271872578661246.html

11. State of Iowa, Iowa Board of Medicine. “Board reminds physicians of responsibilities when supervising up to 5 physician assistants.” March 11, 2013. Available at: http://medicalboard.iowa.gov/Board%20News/2013/Board%20offers%20guidance%20on%20supervision%20of%20physician%20assistants%20-%2003112013.pdf

12. SullivanCotter and Associates, Inc. “Advancing practice clinician pay – what’s happening and what’s coming.” 2012. Available at: http://www.sullivancotter.com/sites/default/files/SullivanCotter_2012_APC%20Pay_What's%20Happening%20and%20What's%20Coming_0.pdf

13. Bartolone, P. “California weighs expanded role for nurse practitioners.” Kaiser Health News, May 9, 2013. Available at: http://www.kaiserhealthnews.org/stories/2013/may/09/california-expanded-role-nurse-practitioners.aspx?referrer=search

14*. Tran, A. “Docs, nurses disagree over expanded nurse roles.” Kaiser Health News Blog, May 15, 2013. Available at: http://capsules.kaiserhealthnews.org/?p=19536

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15. Dill, M.J., Pankow, S., Erikson, C., Shipman, S. “Survey shows consumers open to a greater role for physician assistants and nurse practitioners.” Health Affairs 32(6):1135-1142, 2013. Available at: http://content.healthaffairs.org/content/32/6/1135.full.pdf+html

16. Pohl, J., Barksdale, D., Werner, K. “The latest data on primary care nurse practitioners and physicians: Can we afford to waste our workforce? Health Affairs Blog, June 18, 2013. Available at: http://healthaffairs.org/blog/2013/06/18/the-latest-data-on-primary-care-nurse-practitioners-and-physicians-can-we-afford-to-waste-our-workforce/

The Influence of Public Policy and Health Reform on Primary Care 1. Wang, S.S. “Pilot plan on health an option for states.” Wall Street Journal, June 8, 2010. Available at:

http://online.wsj.com/news/articles/SB10001424052748704749904575293044222043802 2. DoBias, M. “Adapt or else. Whether it wants to or not, the health care system is being forced to reinvent itself.”

NationalJournal.com, March 10, 2011. Available at: http://www.nationaljournal.com/member/magazine/health-reform-forces-industry-to-reinvent-itself-20110310?mrefid=site_search&page=1

3. Johnson, W. “Family care doctors are in high demand.” CBSnews, February 18, 2012. Available at: http://www.cbsnews.com/8301-18563_162-57380915/family-care-doctors-are-in-high-demand/

Further Readings

1. PR Newswire. “Minute clinic recognizes national nurse practitioner week.” November 13, 2012. Available at: http://www.prnewswire.com/news-releases/minuteclinic-recognizes-national-nurse-practitioner-week-and-invests-in-the-education-and-advancement-of-clinicians-across-the-us-179148671.html

2. Fifield, J., Forrest, D.D., Martin-Peele, M., Burleson, J.A., Goyzueta, J., Fujimoto, M., Gillespie, W. “A randomized, controlled trial of implementing the patient-centered medical home model in solo and small practices.” The Commonwealth Fund, September 10, 2012. Available at: http://www.commonwealthfund.org/Publications/In-the-Literature/2012/Sep/Randomized-Controlled-Trial-of-Implementing-PCMH-Model.aspx

3. Elliott, V.S. “Study quantifies practice boost from physicians delegating tasks.” Amednews.com, November 19, 2012. Available at: http://www.ama-assn.org/amednews/2012/11/19/bisb1119.htm

4. Fiegl, C., O’Reilly, K.B. “AMA meeting: Guidance on health care teams approved.” Amednews.com, November 26, 2012. Available at: http://www.ama-assn.org/amednews/2012/11/26/prsc1126.htm

5. Korda, H. “Where’s the patient in the patient-centered medical home?” Health Affairs Blog, April 26, 2011. Available at: http://healthaffairs.org/blog/2011/04/26/where%E2%80%99s-the-patient-in-the-patient-centered-medical-home/

6. Becker, A.L. “A Hamden doctor explores the changing medical landscape on his own.” TheCTMirror, June 20, 2011. Available at: http://healthaffairs.org/blog/2011/04/26/where%E2%80%99s-the-patient-in-the-patient-centered-medical-home/

7. Boult, C., Wieland G.D., “Comprehensive primary care for older patients with multiple chronic conditions. Nobody rushes you through.” Journal of the American Medical Association 304(17):1936-1943, 2010. Available at: http://jama.jamanetwork.com/Issue.aspx?journalid=67&issueID=4535&direction=P

8. Bohmer, R.M.J. “Managing the new primary care: The new skills that will be needed.” Health Affairs 29(5):1010-1014, 2010. http://content.healthaffairs.org/content/29/5/1010.full.pdf+html

9. Nelson, K., Pitaro, M., Tzellas, A., and Lum, A. “Transforming the role of medical assistants in chronic disease management.” Health Affairs 29(5):963-965, 2010. Available at: http://content.healthaffairs.org/content/29/5/963.full.pdf+html

10. Vaughn, B.T., DeVrieze, S.R., Reed, S.D., and Schulman, K.A. “Can we close the income and wealth gap between specialists and primary care physicians?” Health Affairs 29(5):933-940, 2010. Available at: http://jama.jamanetwork.com/Issue.aspx?journalid=67&issueID=4535&direction=P

11. Crabtree, B. F., Nutting, P.A., Miller, W.L., Stange, K.C., Stewart, E.E., Jaén, C.R. “Summary of the national demonstration project and recommendations for the patient-centered medical home.” Annuals of Family Medicine 8(Suppl 1):S80-S90, 2010. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2885727/pdf/0080080.pdf

12. LeBlanc, S. “50 Million New Patients? More Primary Docs a Must.” Fox News, September 13, 2009. Available at: http://www.foxnews.com/story/0,2933,549762,00.html

13. Bodenheimer, T., Berenson, R.A., and Rudolf, P. “The primary care—Specialty income gap: Why it matters.” Annals of Internal Medicine 146(4):301-306, 2007. Available at: http://annals.org/issue.aspx?journalid=90&issueID=20131&direction=P

Lesson 3 – January 27 – February 2, 2014 The Nurse Workforce: “Is There a Nurse in the House?” Individual Assignment 1 Learning Objectives

1. Compare and contrast the various explanations for historical and more recent periods of nursing shortage. 2. Discuss nurse scope of practice and work force issues from the points of view of nurses and health care managers. 3. Discuss recent state and federal policy initiatives directed at nursing.

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Suggested Readings Managing the Supply of Nurses

1*. Dugger, C.W. “U.S. plan to lure nurses may hurt poor nations.” New York Times, May 24, 2006. p. A.1. http://www.nytimes.com/2006/05/24/world/americas/24nurses.html?pagewanted=all&gwh=406ABEDB7F6145991210844C7D302A93

2. Brown, T. “Is there a nurse in the house?” [Op-Ed], New York Times, June 19, 2010. p. A.21. http://www.nytimes.com/2010/06/19/opinion/19brown.html?gwh=0A5962B0824676E3F9353359C2462BA9

3. Aiken, L.H. “Nurses for the future.” The New England Journal of Medicine 364:196-198, 2011. http://www.nejm.org/doi/pdf/10.1056/NEJMp1011639

5*. Auerbach, D.I., Buerhaus, P.I., Staiger, D.O. “Registered nurse supply grows faster than projected amid surge in new entrants ages 23-26.” Health Affairs 30(12):2286-2292, 2011. http://content.healthaffairs.org/content/30/12/2286.full.pdf+html

6. Robertson, T. “Nursing a favored landing spot for dislocated workers.” MPR News, May 6, 2011. Available at: http://minnesota.publicradio.org/display/web/2011/05/05/dislocated-workers/

7. Ostrom, C.M. “Hospital cuts add to oversupply of health-care workers.” The Seattle Times, November 18, 2012. Available at: http://seattletimes.com/html/localnews/2019711613_nurses19m.html

8. Georgia Health News. “Nurses without jobs: A sign of the times.” March 11, 2013. Available at: http://www.georgiahealthnews.com/2013/05/nurses-jobs-sign-times/

9. Nurse.com. “Study: More BSN nurses means lower mortality rates.” March 7, 2013. Available at: http://news.nurse.com/article/20130307/NATIONAL02/103180008

10. CareFirst. “CareFirst invests another $1 million in nursing shortage.” May 29, 2013. Available at: https://member.carefirst.com/wps/portal/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP0os3hLbzN_Q09LYwN_Fw9DA09fi1BHj6AgQwNHM_2CbEdFANmphzQ!/?WCM_GLOBAL_CONTEXT=/wcmwps/wcm/connect/content-member/carefirst/memberportal/medianews/popup/medianews20130528

Workplace Issues for Nursing 1*. McHugh, M.D., Kutney-Lee, A., Cimiotti, J.P., Sloane, D.M., Aiken, L.H. “Nurses’ widespread job dissatisfaction, burnout, and

frustration with health benefits signal problems for patient care.” Health Affairs 30(2):202-210, 2011. http://content.healthaffairs.org/content/30/2/202.full.pdf+html

2. Cheung, K. “One-fourth of nurses seek new jobs after dissatisfaction.” FierceHealthcare.com, June 29, 2011. Available at: http://www.fiercehealthcare.com/story/one-fourth-nurses-seek-new-jobs-after-dissatisfaction/2011-06-29

3. Cheung, K.M. “Hospital labor study reveals hidden costs of nurses.” FierceHealthcare.com, June 9, 2011. Available at: http://www.fiercehealthcare.com/story/hospital-labor-study-reveals-hidden-costs-nurses/2011-06-09

4. Schuster, J.L. “With nurses at risk of compassion fatigue, hospitals try to ease their stress.” The Washington Post, June 10, 2013. Available at: http://articles.washingtonpost.com/2013-06-10/national/39865768_1_burnout-intensive-care-unit-nurses

5. Horstmann, S. “When nurses bond with their patients.” The New York Times, September 13, 2013, Available at: http://well.blogs.nytimes.com/2013/09/13/when-nurses-bond-with-their-patients/?_r=0

6. Lupkin, S. “Nurses prone to injuries with heavier patients.” abc News, September 26, 2013. Available at: http://abcnews.go.com/Health/nurses-prone-injury-heavier-patients/story?id=20373428

7. Stahl, B. “In Minnesota, nurses in trouble get 2nd chances.” Star Tribune, October 6, 2013. Available at: http://www.startribune.com/lifestyle/health/226301371.html

Rethinking the Role of Nurses 1. “MD shortage? 28 states may expand nurses’ role.” CBSNews.com, April 23, 2010. Available at:

http://www.cbsnews.com/stories/2010/04/13/health/main6392167.shtml 2*. Fairman, J.A., Rowe, J.W., Hassmiller, S., Shalala, D.E. “Broadening the scope of nursing practice.” New England Journal of

Medicine 364:193-196, 2011. http://www.nejm.org/doi/pdf/10.1056/NEJMp1012121 3. Martin, T.W. “Nurses seek expanded role.” The Wall Street Journal, October 2, 2012. Available at:

http://search.proquest.com/docview/1081840579/fulltext/14127745EB35DAC84ED/1?accountid=14586 4. Villegas, A. “Doctor shortage fuels nurses, push for expanded role.” Kaiser Health News, February 22, 2010. Available at:

http://www.kaiserhealthnews.org/Stories/2010/February/22/nurse-practitioners.aspx Public Policy Towards Nurse Staffing Ratios

1. Shenoy, R. “Nurses set aside goal on hospital staffing.” MPR News, March 16, 2013. Available at: http://minnesota.publicradio.org/display/web/2013/03/16/politics/nurses-compromise-on-hospital-staffing

2. Kasperowicz, P. “Dem proposes federal regulation of nurse-to-patient ratios in hospitals.” The Hill, April 17, 2013. Available at: http://thehill.com/blogs/floor-action/senate/294477-dem-proposes-federal-regulation-of-nurse-to-patient-ratios-in-hospitals

3*. Schultz, D. “Nurses fighting state by state for minimum staffing laws.” Kaiser Health News, April 23, 2013. Available at: http://www.kaiserhealthnews.org/stories/2013/april/24/nurse-staffing-laws.aspx

4. Editorial. “Nurse ratios are for hospitals, not legislators, to decide.” TwinCities.com Pioneer Press, February 16, 2013. Available at: http://www.twincities.com/opinion/ci_22600798/editorial-nurse-ratios-are-hospitals-not-legislators-decide

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5. Shekelle, P.G. “Nurse—patient ratios as a patient safety strategy: A systematic review.” Annals of Internal Medicine 158(5-Part 2):404-409, 2013. Available at: http://annals.org/issue.aspx?journalid=90&issueID=926462&direction=P

6. Editorial. “Minnesota responds sensibly on nurse staffing ratios.” Star Tribune, March 28, 2013. Available at: http://www.startribune.com/opinion/editorials/200523861.html

Further Readings

1. HealthDay News. “Good news for those worried about U.S. nursing shortage.” USNews, December 5, 2011. Available at: http://health.usnews.com/health-news/managing-your-healthcare/economics/articles/2011/12/05/good-news-for-those-worried-about-us-nursing-shortage

2. Wood, D., “Retirees and new graduate nurses: The wild cards impacting the nursing shortage.” NurseZone.com, February 18, 2011. Available at: http://www.nursezone.com/nursing-news-events/more-features/Retirees-and-New-Graduate-Nurses-The-Wild-Cards-Impacting-the-Nursing-Shortage_36300.aspx

3. Courchane, C. “With nurse shortage looming, America needs shot in the arm.” The Washington Times, June 6, 2011. Available at: http://www.washingtontimes.com/news/2011/jun/6/with-nurse-shortage-looming-america-needs-shot-in-/

4. Krischke, M.M. “Decreased interruptions lead to more time at the bedside.” NurseZone.com, March 18, 2011. Available at: http://www.nursezone.com/Nursing-News-Events/more-news/Decreased-Interruptions-Lead-to-More-Time-at-the-Bedside_36554.aspx

5. Weber, T. and Omstein, C. “Nurses cited elsewhere kept licenses; many punished in other states will now face disciplinary action in California.” Los Angeles Times, June 28, 2010. p. A.1. Available at: http://articles.latimes.com/2010/jun/28/local/la-me-adv-nurses-20100628

6. Raines, L. “Market shift. Sluggish economy, returning workers squeeze health care jobs.” AJC, March 3, 2010. Available at: http://www.ajc.com/jobs/market-shift-344531.html

7. “Survey: Nurses should have more influence.” UPI.com, January 20, 2010. Available at: http://www.upi.com/Health_News/2010/01/20/Survey-Nurses-should-have-more-influence/UPI-48131264008452/print/

8. Bovbjerg, R.R., Ormond, B.A., and Pindus, N. The Nursing Workforce Challenge. Public Policy for a Dynamic and Complex Market. Washington, DC: Urban Institute, August 2009. Available at: http://www.urban.org/uploadedpdf/411933_professionalnurse.pdf

9. Buerhaus, P.I., Auerbach, D.I., and Staiger, D.O. “The recent surge in nurse employment: causes and implications.” Health Affairs – Web Exclusive 28(4):w-657-w668 (published online June 12, 2009). Available at: http://content.healthaffairs.org/content/28/4/w657.full.pdf+html

10. Linden, C. and Suran, M. “Nurses, once in high demand, face job shortages.” Kaiser Health News, August 28, 2009. Available at: http://www.kaiserhealthnews.org/Stories/2009/August/28/medill-nurses.aspx

11. Smith, A. “Nursing crisis looms as baby boomers age.” CNNMoney.com, December 23, 2009. Available at: http://money.cnn.com/2009/12/17/news/economy/nursing_shortage/index.htm

Long-Term Care: Balancing What We Want with What We Can Afford Learning Objectives Students should be able to:

1. Describe the different types of long-term care and the characteristics of the people who receive this care. 2. Discuss the different mechanisms, public and private, that finance long-term care. 3. Compare and contrast delivery models for long-term care. 4. Discuss factors that affect the quality of long-term care, including the potential for patient abuse in long-term care settings.

Suggested Readings Overview of Long-Term Care and the Nursing Home Industry

1*. The Kaiser Commission on Medicaid and the Uninsured. “Overview of nursing facility capacity, financing, and ownership in the United States in 2011.” The Henry J. Kaiser Family Foundation, June 2013. Available at: http://kff.org/medicaid/fact-sheet/overview-of-nursing-facility-capacity-financing-and-ownership-in-the-united-states-in-2011/

2*. Greene, K. “Long-term-care insurance gap hits seniors.” The Wall Street Journal, July 1, 2013. Available at: http://online.wsj.com/news/articles/SB10001424127887323475304578501820197828966

3*. Georgetown University, Long-Term Care Financing Project. “National spending for long-term care.” Fact Sheet, January 2007. Available at: http://ltc.georgetown.edu/pdfs/natspending2007.pdf

4*. El Nasser, H. “Fewer seniors live in nursing homes; improved health, more options for care cited.” USA Today, September 27, 2007. p. A.1. http://usatoday30.usatoday.com/printedition/news/20070927/1a_bottomstrip27_dom.art.htm

5. Greene, K. The cost of living longer. The Wall Street Journal, October 26, 2012. Available at: http://online.wsj.com/article/SB10001424052970203937004578079184108523030.html

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6. Higgs, R. “Nursing-home, assisted-living costs rise.” Cleveland.com, April 30, 2009. Available at: http://www.cleveland.com/medical/index.ssf/2009/04/nursinghome_assistedliving_cos.html

7. Seewer, J. “Aging baby boomers face home health care challenge.” YAHOO News, August 12, 2012. Available at: http://news.yahoo.com/aging-baby-boomers-face-home-health-care-challenge-162044207--finance.html

8. Pruitt, A.D. “Health-care owners shun nursing homes.” The Wall Street Journal, April 30, 2013. Available at: http://online.wsj.com/news/articles/SB10001424127887323798104578453263895944642

9. Bebinger, M. “Moving people home after nursing home stay is complicated.” Kaiser Health News, August 16, 2013. Available at: http://www.kaiserhealthnews.org/stories/2013/august/15/nursing-home-money-follows-the-person-massachusetts.aspx

Long-Term Caregivers 1*. Hagerty, J.R. “As America ages, shortage of help hits nursing homes.” The Wall Street Journal, April 14, 2013. Available at:

http://online.wsj.com/article/SB10001424127887324392804578360712470799082.html 2. Lagnado, L. “Nursing homes’ drug use falls.” The Wall Street Journal, August 26, 2013. Available at:

http://online.wsj.com/news/articles/SB10001424127887323980604579031311927535226 3. Tran, A. “Obama administration mulls rule to give home health aides better wages.” Kaiser Health News, April 29, 2013.

Available at: http://www.kaiserhealthnews.org/stories/2013/april/29/home-health-aides-better-wages-rules.aspx 4. Fox, S., Duggan, M., Purcell, L. “Family caregivers are wired for health.” Washington, DC: PewResearchCenter, June 20, 2013. Available at: http://www.pewinternet.org/Reports/2013/Family-Caregivers.aspx 5. Bahrampour, T. “Huge shortage of caregivers looms for baby boomers, report says.” The Washington Post, August 26, 2013.

Available at: http://articles.washingtonpost.com/2013-08-26/national/41446539_1_boomers-family-caregiver-long-term-care Issues Relating to Fraud, Abuse and Poor Quality

1*. Pear, R. “Oversight of nursing homes is criticized.” New York Times, April 22, 2007. p. 1.20. http://www.nytimes.com/2007/04/22/health/22nursing.html?_r=0

2.* Hoffman, J. “Watchful eye in nursing homes.” The New York Times, November 18, 3013. Available at: http://well.blogs.nytimes.com/2013/11/18/watchful-eye-in-nursing-homes/?_r=0

3. Duhigg, C. “At many homes, more profit and less nursing.” New York Times, September 23, 2007. p. 1.1. http://www.nytimes.com/2007/09/23/business/23nursing.html?pagewanted=all

4. Rosofsky, I, “Escape from the nursing home.” New York Times, January 17, 2007. p. A.19. http://www.nytimes.com/2007/01/17/opinion/17rosofsky.html

5. Bayne, M. “A room with a grim view: The ‘ambient despair’ that marks life in assisted living.” Health Affairs 31(7):1633-1635, 2012. http://content.healthaffairs.org/content/31/7/1633.full.pdf+html

6.* The Washington Post, APNewsBreak: Fed watchdog report says Medicare paid $5.1B to nursing homes offering poor care.” February 27, 2013. Available at: http://news.yahoo.com/medicare-paid-5-1b-poor-130312778.html

7. The New York Times. “State rewards home care firms once rebuked.” June 24, 2013. Available at: http://www.nytimes.com/2013/06/24/nyregion/reinventing-long-term-care-and-endorsing-firms-accused-of-fraud.html?pagewanted=all

Proposals for Reform 1*. Jaffe, S. “Facing a tight deadline, long-term care panel holds first meeting.” Kaiser Health News, June 28, 2013. Available at:

http://www.kaiserhealthnews.org/Stories/2013/June/28/long-term-care-commission.aspx 2. Raphael C. “Long-term care: Preparing for the next generation,” The Commonwealth Fund, July 21, 2008. Available at:

http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=695882 3*. Koren, M.J. “Person-centered care for nursing home residents: The culture-change movement.” Health Affairs 29(2):312-317,

2010. http://content.healthaffairs.org/content/29/2/312.full.pdf+html 4. Bergal, J. Feds say nursing homes overbilled Medicare by $1.5 billion. Kaiser Health News, November 15, 2012. Available at:

http://www.kaiserhealthnews.org/Stories/2012/November/15/nursing-homes-inspector-general-medicare.aspx 5*. Konetzka, R.T., Werner, R.M. “Applying market-based reforms to long-term care.” Health Affairs 29(1):74-80, 2010.

http://content.healthaffairs.org/content/29/1/74.full.pdf+html 6. Meier, D.E., Lim, B., Carlson, D.A. “Raising the standard: Palliative care in nursing homes.” Health Affairs 29(1):136-140, 2010.

http://content.healthaffairs.org/content/29/1/136.full.pdf+html 7. Graham, J. “Ohio Medicaid program raises stakes for nursing homes.” Kaiser Health News, August 14, 2012. Available at:

http://www.kaiserhealthnews.org/Stories/2012/August/15/ohio-medicaid-nursing-homes.aspx 8. Mayer, C.E. “Calculating a long-term care policy: Will it cover your needs, can you pay for it and can you afford not to have it?”

Kaiser Health News, January 23, 2012. Available at: http://www.kaiserhealthnews.org/stories/2012/january/24/calculating-a-long-term-care-policy.aspx

9. Gugliotta, G. “Tennessee cuts Medicaid benefit funding for some long-term care patients.” Kaiser Health News, July 29, 2012. Available at: http://www.kaiserhealthnews.org/stories/2012/july/29/tennessee-medicaid-long-term-care.aspx?referrer=search

10. Castle, N.G. “The nursing home compare report card: Consumers’ use and understanding.” Journal of Aging & Social Policy 21(2):187-208, 2009. Available at: http://www.tandfonline.com/doi/pdf/10.1080/08959420902733272

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11. Jaffe, S. “Long-term care panel releases recommendations but fails to offer plan to help pay for services.” Kaiser Health News, September 13, 2013. Available at: http://www.kaiserhealthnews.org/stories/2013/september/13/long-term-care-commission-recommendations.aspx

12. Arling, G., Cooke, V., Lewis, T., et al. “Minnesota’s provider-initiated approach yields care quality gains at participating nursing homes.” Health Affairs 32(9):1631-1638, 2013. Available at: http://content.healthaffairs.org/content/32/9/1631.full.pdf+html

Long-Term Care Provisions in the Health Reform Legislation 1. Pollack, H. “Long-term care: Another tough subject for the next round of reform.” Kaiser Health News, December 22, 2010.

Available at: http://www.kaiserhealthnews.org/Columns/2010/December/122310pollack.aspx 2. New York Times. “It didn’t add up.” [Editorial], October 18, 2011. Available at: http://www.nytimes.com/2011/10/19/opinion/the-

class-program-didnt-add-up.html Further Readings

1. Comarow, A. “U.S. news’ best nursing homes – 2013.” msn.com, 2013. Available at: http://healthyliving.msn.com/diseases/caregiving/us-news-best-nursing-homes-2013

2. Available at: Graham, J. “Medicare studying plans to pay nursing homes based on quality.” Kaiser Health News, August 14, 2012. Available at: http://www.kaiserhealthnews.org/Stories/2012/August/15/medicare-nursing-homes-quality.aspx

3. Reinhard, S.C., Kassner, E., Houser, A., Mollica, R. “Raising expectations: A state scorecard on long-term services and supports for older adults, people with physical disabilities, and family caregivers.” Executive Summary. AARP, September 2011. Available at: http://assets.aarp.org/rgcenter/ppi/ltc/ltss_scorecard.pdf

4. New York Times. “It didn’t add up.” [Editorial], October 18, 2011. Available at: http://www.nytimes.com/2011/10/19/opinion/the-class-program-didnt-add-up.html

5. Pollack, H. “Long-term care: Another tough subject for the next round of reform.” Kaiser Health News, December 22, 2010. Available at: http://www.kaiserhealthnews.org/Columns/2010/December/122310pollack.aspx

6. Stevenson, D.G. and Grabowski, D.C. “Private equity investment and nursing home care: Is it a big deal?” Health Affairs 27(5):1399-1408, 2008. Available at: http://content.healthaffairs.org/content/27/5/1399.full.pdf+html

7. “How will boomers pay for long-term care?” Forbes.com, July 20, 2007. Available at: http://www.forbes.com/2007/07/19/longterm-health-care-biz-cx_0720oxford.html

8. Gawande, A. “Rethinking old age.” New York Times, May 24, 2007. p. A.27. Available at: http://query.nytimes.com/gst/fullpage.html?res=9E03E3DD1630F937A15756C0A9619C8B63

9. Kane, R.L., Arling, G., and Mueller, C. “Rewarding quality in nursing homes.” The Commonwealth Fund, May 11, 2007. Available at: http://www.commonwealthfund.org/Content/Publications/In-the-Literature/2007/May/Rewarding-Quality-in-Nursing-Homes.aspx

Lesson 4 – February 3-9, 2014 The Hospital: From Doctors’ Workshop to “Big Med” Group Assignment 2 Learning Objectives Students should be able to:

1. Describe recent changes in the configuration of the U.S. hospital industry and the public policy concerns they raise. 2. Describe the various financial challenges facing some U.S. hospitals. 3. Evaluate the competitive threat that specialty hospitals and ambulatory facilities pose for general community hospitals 4. Discuss current changes and challenges in hospital/physician relations.

Suggested Readings The Configuration of the Hospital Industry

1.* Gawande, A. “Big med.” The New Yorker, August 13, 2012. Available at: http://www.newyorker.com/reporting/2012/08/13/120813fa_fact_gawande

2.* Hoffman, J. “Watchful eye in nursing homes.” The New York Times, November 18, 3013. Available at: http://well.blogs.nytimes.com/2013/11/18/watchful-eye-in-nursing-homes/?_r=0

3. Vogt, W.B. “Expert Voices: Hospital consolidation: Trends and consequences.” Washington, DC: NIHCM Foundation. November 2009. Available at: http://www.nihcm.org/component/content/article/390

4. Weintraub, A. “In an age of consolidation, some community hospitals struggle to remain independent.” Kaiser Health News, September 9, 2010. Available at: http://www.kaiserhealthnews.org/Stories/2010/September/09/community-hospitals.aspx

5. Mathews, A.W. “Hospitals put on sick list.” Wall Street Journal, August 10, 2011, p. B.3. http://online.wsj.com/article/SB10001424053111904480904576498633493157192.html

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6.* The Economist. “American hospital companies. Bigger and better. America’s big hospital groups will continue to gobble up competitors.” April 28, 2011. Available at: http://www.economist.com/node/18621132

7. Grube, M., Kaufman, K., York, R. “Decline in utilization rates signals a change in the inpatient business model.” Health Affairs blog, March 8, 2013. Available at: http://healthaffairs.org/blog/2013/03/08/decline-in-utilization-rates-signals-a-change-in-the-inpatient-business-model/

8. Caramenico, A. “National hospital chains see better M&A value creation.” FierceHealthcare, June 3, 2013, Available at: http://www.fiercehealthcare.com/story/national-hospital-chains-see-better-ma-value-creation/2013-06-03

9. Doyle, J. “Hospital CEOs see double-digit pay hikes.” St. Louis Post-Dispatch, June 2, 2013. Available at: http://www.stltoday.com/business/local/hospital-ceos-see-double-digit-pay-hikes/article_431263e2-81c9-5367-b0bd-f48885169adb.html

10. Kliff, S. “Hospital chains keep getting bigger.” The Washington Post, June 3, 2013. Available at: http://www.washingtonpost.com/blogs/wonkblog/wp/2013/06/03/hospital-chains-keep-getting-bigger/

11. DealBook. “Tenent to acquire Vanguard health systems for $1.8 billion.” The New York Times, June 24, 2013. Available at: http://dealbook.nytimes.com/2013/06/24/tenet-to-acquire-vanguard-health-systems-for-1-8-billion/?_r=0

12. Creswell J., Abelson, R. “New laws and rising costs create a surge of supersizing hospitals.” The New York Times, August 12, 2013. Available at: http://www.nytimes.com/2013/08/13/business/bigger-hospitals-may-lead-to-bigger-bills-for-patients.html

Role of the Emergency Department 1*. Fiore, K. “Hospitals already feeling ACA pinch.” MedPage Today, June 28, 2013. Available at:

http://www.medpagetoday.com/Washington-Watch/Reform/40160 2* Goodell, S., DeLia, D., Cantor, J.C. “Emergency department utilization and capacity.” Policy Brief No. 17, RWJ Synthesis Project,

July 2009. Available at: http://www.rwjf.org/en/research-publications/find-rwjf-research/2009/07/emergency-department-utilization-and-capacity0.html

3*. Schuur, J.D., Venkatesh, A.K. “The growing role of emergency departments in hospital admissions.” New England Journal of Medicine 367(5):391-393, 2012. http://www.nejm.org/doi/pdf/10.1056/NEJMp1204899

4.* Feibel, C. “Patients can pay a high price for ER convenience.” npr, August 13, 2013. Available at: http://www.npr.org/blogs/health/2013/08/15/211411828/patients-can-pay-a-high-price-for-er-convenience

5. Rabin, E., Kocher, K., McClelland, M., Pines, J., Hwang, U., Rathlev, N., et al. “Solutions to emergency department ‘boarding’ and crowding are underused and may need to be legislated.” Health Affairs 31(8):1757-1766, 2012. Available at: http://content.healthaffairs.org/content/31/8/1757.full.pdf+html

6*. Rabin, R.C. “Statistics: Who visits the emergency room? 20 percent of Americans, insured or not.” New York Times, August 2010, Available at: http://www.nytimes.com/2010/08/10/health/research/10stats.html?_r=0

7. Galewitz, P. “ER use of CT scans rises sharply, raising questions about costs and benefits.” Kaiser Health News, August 10, 2011. Available at: http://capsules.kaiserhealthnews.org/index.php/2011/08/getting-a-ct-scan-at-the-er-becoming-routine/

8. Galewitz, P. “Study: Most seniors’ ER visits could be avoided.” Kaiser Health News Blog, October 5, 2012. Available at: http://capsules.kaiserhealthnews.org/index.php/2012/10/study-most-seniors-er-visits-could-be-avoided/

9. Grens, K. “ER crowding tied to higher in-hospital death rates.” Reuters, December 13, 2012. Available at: http://www.reuters.com/article/2012/12/13/us-er-hospital-deaths-idUSBRE8BC0Z420121213

10. Mullins, P.M., Goyal, M., Pines, J.M. “National growth in intensive care unit admissions from emergency departments in the United States from 2002 to 2009.” Academic Emergency Medicine 20(5):479-486, 2013. Available at: http://onlinelibrary.wiley.com/doi/10.1111/acem.12134/pdf

11. Morganti, K.G., Bauhoff, S., Blanchard, J.C., Abit, M., Smith, A., Vesely, J.V., et al. “The evolving roles of emergency departments.” RAND Corporation, 2013. Available at: http://www.rand.org/pubs/research_briefs/RB9715.html

12. Abelson, R. “E.R.’s account for half of hospital admissions, study says.” The New York Times, May 20, 2013. Available at: http://www.nytimes.com/2013/05/21/business/half-of-hospital-admissions-from-emergency-rooms.html?_r=0

13. HealthDay. “1 in 5 Americans goes to the ER each year.” WCAX.com, May 30, 2013. Available at: http://www.wcax.com/story/22459623/1-in-5-americans-goes-to-the-er-each-year-cdc

14. Nurse.com. “Report showcases EDs’ central role in U.S. healthcare.” June 13, 2013. Available at: http://news.nurse.com/article/20130613/NATIONAL02/106240005/0/NATIONAL01

Changing Hospital/Physician Relations 1*. Casalino, L.P., November, A.E., Berenson, R.A., Pham, H.H. “Hospital-physician relations: Two tracks and the decline of the

voluntary medical staff model.” Health Affairs 27(5):1305-1314, 2008. Available at: http://content.healthaffairs.org/content/27/5/1305.full.pdf+html

2*. O’Malley, A.S., Bond, A.M., Berenson, R.A. “Rising hospital employment of physicians: Better quality, higher costs?” Issue Brief No. 136, August 2011. Washington, DC: Center for Studying Health System Change. Available at: http://www.hschange.com/CONTENT/1230/1230.pdf

3. Mathews, A.W. “Doctor, hospital deals probed.” The Wall Street Journal, September 13, 2012. Available at: http://online.wsj.com/article/SB10000872396390444433504577649523985288422.html

4. Caramenico, A. “Hospitals woo more heart docs with employment.” FierceHealthcare, September 11, 2012. Available at: http://www.fiercehealthcare.com/story/hospitals-woo-more-heart-docs-employment/2012-09-11

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5. Mace, S. “How CPOE will make healthcare smarter.” HealthLeaders Media, December 3, 2013. Available at: http://www.healthleadersmedia.com/content/TEC-298877/How-CPOE-Will-Make-Healthcare-Smarter##

Physicians and Hospitals Competing for Patients 1. Iglehart, J. “The emergence of physician-owned specialty hospitals.” New England Journal of Medicine 352(1):78-84, 2005.

http://www.nejm.org/doi/pdf/10.1056/NEJMhpr043631 2. Kaiser Health News. “Study says lower-cost hospitals don’t have lower quality care for certain illnesses.” February 23, 2010.

Available at: http://www.kaiserhealthnews.org/daily-reports/2010/february/23/hospital-study.aspx?referrer=search 3*. O’Neill, L., Hartz, A.J. “Lower mortality rates at cardiac specialty hospitals traceable to healthier patients and to doctors’

performing more procedures.” Health Affairs 31(4):806-815, 2012. http://content.healthaffairs.org/content/31/4/806.full.pdf+html Controversy Over Hospital Pricing

1. Pell, M.B. “Huge hospital markups burden patients.” ajc.com, April 20, 2011. Available at: http://www.ajc.com/news/business/huge-hospital-markups-burden-patients/nQsmJ/

2*. Reinhardt, U.E. “Shocked, shocked, over hospital bills.” The New York Times, March 1, 2013. Available at: http://economix.blogs.nytimes.com/2013/03/01/shocked-shocked-over-hospital-bills/

3. Rau, J. “Behind the fiscal cliff deal, a prolonged hospital finance fight.” Kaiser Health News, January 3, 2013. Available at: http://www.kaiserhealthnews.org/stories/2013/january/04/fiscal-cliff-deal-hospital-finance-fight.aspx

4. Meier, B., McGinty, J.C., Creswell, J. “Hospital billing varies wildly, government data shows.” The New York Times, May 8, 2013. Available at: http://www.nytimes.com/2013/05/08/business/hospital-billing-varies-wildly-us-data-shows.html?smid=pl-share

5. Reinhardt, U.E. “American health care as a source of humor.” The New York Times, May 10, 2013. Available at: http://economix.blogs.nytimes.com/2013/05/10/american-health-care-as-a-source-of-humor/

6. Gokhale, K. “Heart surgery in India for $1,583 costs $106,385 in U.S.” Bloomberg, July 28, 2013. Available at: http://www.bloomberg.com/news/2013-07-28/heart-surgery-in-india-for-1-583-costs-106-385-in-u-s-.html

Hospitals Strategies to Improve Finances 1. “Cleveland Clinic to provide heart care in Chicago; Johns Hopkins increases primary care in D.C. area.” Kaiser Health News,

July 17, 2010. Available at: http://www.kaiserhealthnews.org/Daily-Reports/2010/July/16/Hospitals-and-health-systems.aspx 2*. Abelson, R. “New fervor for cutting costs among hospitals and insurers.” New York Times, May 24, 2012, p. A.1.

http://www.nytimes.com/2012/05/24/health/hospitals-and-insurers-join-to-cut-health-care-costs.html 3. Graham, J. “Mayo clinic seeks to extend its reach with series of affiliations around the country.” Kaiser Health News, August 24,

2012. Available at: http://www.kaiserhealthnews.org/Stories/2012/August/24/Mayo-Clinic-Extends-Reach.aspx 4*. Carrier, E.R., Dowling, M., Berenson, R.A. “Hospitals’ geographic expansion in quest for well-insured patients: Will the outcome

be better care, more cost, or both?” Health Affairs (31)4):827-835, 2012. Available at: http://content.healthaffairs.org/content/31/4/827.full.pdf+html

5. Appleby, J. “Hospitals and insurers face growing antitrust scrutiny.” Kaiser Health News, April 5, 2011. Available at: http://www.kaiserhealthnews.org/Stories/2011/April/05/Hospitals-And-Insurers-Face-Growing-Antitrust-Scrutiny.aspx

6. Mathews, A.W. “Cleveland Clinic, hospital operator forge alliance; community health deal reflects how top medical centers are leveraging brands.” The Wall Street Journal, March 11, 2013. Available at: http://online.wsj.com/article/SB10001424127887324096404578354631587446140.html

7. Beck, M. “Squeeze looms for doctors.” The Wall Street Journal, March 14, 2013. Available at: http://online.wsj.com/article/SB10001424127887324096404578356544137516914.html

8. Rabin, R.C. “Hospitals look to become insurers, as well as providers of care.” Kaiser Health News, August 26, 2012. Available at: http://www.kaiserhealthnews.org/stories/2012/august/26/hospital-insurers.aspx

9. Gregg, H. “Study: Healthcare reviews, ratings increasingly impact hospitals’ bottom lines.” Becker’s Healthcare Hospital Review, April 9, 2013. Available at: http://www.beckershospitalreview.com/quality/study-healthcare-reviews-ratings-increasingly-impact-hospitals-bottom-lines.html

10. McCann, E. “Setback for Sutter after $1B EHR crashes.” Healthcare IT News, August 28, 2013. Available at: http://www.healthcareitnews.com/news/setback-sutter-after-1b-ehr-system%20crashes

11. Bresnick, J. “EHR defaults cause medication, patient safety errors.” EHR Intelligence, September 5, 2013. Available at: http://ehrintelligence.com/2013/09/05/ehr-defaults-cause-medication-patient-safety-errors/

12. Commins, J. “Not-for-profit hospitals find opportunity amid uncertainty.” HealthLeaders Media, December 3, 2013. Available at: http://www.healthleadersmedia.com/content/COM-298876/NotforProfit-Hospitals-Find-Opportunity-Amid-Uncertainty.html

Rethinking Hospital Reimbursement 1. Goldsmith, J. “Analyzing shifts in economic risks to providers in proposed payment and delivery system reforms.” Health Affairs

29(7):1299-1304, 2010. Available at: http://content.healthaffairs.org/content/29/7/1299.full.pdf+html 2*. Gold, J. “Of ACOs and proton beams: why hospitals ‘live in two worlds.’” Kaiser Health News Blog, June 6, 2013. Available at: http://capsules.kaiserhealthnews.org/?p=19911

Patient Safety Issues – See Session 1 Readings Potential Impact of Health Reform Legislation on Hospitals

1. Appleby, J. “Hospitals and insurers face growing antitrust scrutiny.” Kaiser Health News, April 5, 2011. Available at: http://www.kaiserhealthnews.org/Stories/2011/April/05/Hospitals-And-Insurers-Face-Growing-Antitrust-Scrutiny.aspx

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2. Lipton, E. “Ex-lawmaker still a friend of hospitals.” New York Times, August 5, 2011. Available at: http://www.nytimes.com/2011/08/06/us/politics/06pomeroy.html?_r=1

3*. Bernstein, N. “Hospitals aren’t waiting for verdict on health care law.” New York Times online, June 10, 2012. Available at: http://www.nytimes.com/2012/06/11/nyregion/maimonides-medical-center-grapples-with-health-care-uncertainty.html?pagewanted=all

4. Aizenman, N.C. “Health law’s rules help hospitals cut patient readmission rate.” The Washington Post, February 27, 2013. Available at: http://articles.washingtonpost.com/2013-02-27/national/37332837_1_readmissions-providers-medicare-and-medicaid-services

5. Rau, J. “Doctor-owned hospitals prosper under healthcare law.” The Washington Post, April 13, 2013. Available at: http://articles.washingtonpost.com/2013-04-13/national/38509331_1_hospitals-health-law-kaiser-health-news

Further Readings

1. Kelly, M. “Life-saving medical machinery prone to malware?” Venture Beat, October 17 2012. Available at: http://www.fiercehealthcare.com/story/hospitals-woo-more-heart-docs-employment/2012-09-11

2. American College of Cardiology’s CardioSource. “New American College of Cardiology Practice census shows continued trend towards hospital integration.” September 10, 2012. Available at: http://www.cardiosource.org/News-Media/Media-Center/News-Releases/2012/09/Leg-Conf.aspx

3. Toland, B. “Highmark announces intent to affiliate with Erie’s Saint Vincent.” Pittsburgh Post-Gazette, October 16, 2012. Available at: http://www.post-gazette.com/stories/business/news/highmark-to-announce-affiliation-agreement-with-eries-saint-vincent-657759/

4. Shinkman, R. “The hidden costs of hospital employee health.” FierceHealthFinance, October 16, 2012. Available at: http://www.fiercehealthfinance.com/story/hidden-costs-hospital-employee-health/2012-10-16

5. Simmons, J. “GAO looks at ways to reduce, divert ED use.” FierceHealthcare, May 11, 2011. Available at: http://www.fiercehealthcare.com/story/gao-looks-ways-reduce-divert-ed-use/2011-05-11

6. Robinson, J.C. “Hospital market concentration, pricing, and profitability in orthopedic surgery and interventional cardiology.” American Journal of Managed Care 17(6):e241-e248, 2011. Available at: http://www.ajmc.com/articles/AJMC_11jun_Robinson_e241_248/#sthash.FBsYgiBz.dpuf

7. Shinkman, R. “Doctors, hospitals increasingly enter co-management arrangements.” Fierce HealthFinance, April 26, 2011. Available at: http://www.fiercehealthfinance.com/story/doctors-hospitals-increasingly-enter-co-management-arrangements/2011-04-26

8. Andrews, M. “Some hospitals turn to post-discharge clinics to help hold down readmissions.” Kaiser Health News, December 20, 2011. Available at: http://www.kaiserhealthnews.org/features/insuring-your-health/michelle-andrews-on-readmissions.aspx

9. Goozner, M. “Monopolies threaten health care cost controls.” The Fiscal Times, February 3, 2011. Available at: http://www.thefiscaltimes.com/Articles/2011/02/03/Monopolies-Threaten-Health-Care-Cost-Controls.aspx#page1

10. Galewitz, P. “Hospitals promoting bargain CT scans for smokers.” Kaiser Health News, August 16, 2011. Available at: http://www.kaiserhealthnews.org/Stories/2011/August/16/Hospitals-Promoting-Bargain-CT-Scans-For-Smokers.aspx

11. Rabin, R.C. “Study finds fewer emergency rooms as need rises.” New York Times, May 18, 2011, p. A.13. Available at: http://www.nytimes.com/2011/05/18/health/18hospital.html?gwh=8BE0A11C4D3D1AD5267D93AE06A90C58

12. Reuters. “Who’s packing ERs? Not the uninsured.” May 19, 2010. Available at: http://www.reuters.com/article/idUSTRE64I78X20100520

13. Vitez, M. “One hospital’s simple measure to defeat infections.” March 8, 2010. Available at: http://www.philly.com/philly/news/homepage/20100308_One_hospital_s_simple_measure_to_defeat_infections.html

14. Abelson, R. “Bills stalled, hospitals fear rising unpaid care.” New York Times, February 9, 2010, p. B.1. Available at: http://www.nytimes.com/2010/02/09/health/policy/09hospital.html?hpw

15. Harris, G. “Hospital shows a way to save: Doctors get salaries, not fees.” New York Times, July 25, 2009. p. A.1. Available at: http://www.nytimes.com/2009/07/25/health/policy/25doctors.html?gwh=82AC68F2C1954CC2C75891B91A912ACC

16. DeLia, D., Cantor, J. “Emergency department utilization and capacity.” Robert Wood Johnson Foundation, The Synthesis Project Policy Brief No. 17, July 2009. Available at: http://www.rwjf.org/en/research-publications/find-rwjf-research/2009/07/emergency-department-utilization-and-capacity0.html

17. Galewitz, P. “U.S. emergency rooms find ways to fix what ails them; mindful of complaints, innovative hospitals aim to cut crowding, delays.” USA Today, December 15, 2008. p. D.9. Available at: http://usatoday30.usatoday.com/news/health/2008-12-14-emergency-rooms_N.htm?csp=34

18. Goodell, S. and Casalino, L.P. “Physician self-referral and physician-owned specialty facilities.” Robert Wood Johnson Foundation, The Synthesis Project Policy Brief No. 15, June 2008. Available at: http://www.rwjf.org/files/research/062408.policysynthesis.physreferral.brief.pdf

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Lesson 5 – February 10-16, 2014 Medical Technology and Devices: At the Cutting Edge Individual Assignment 2 Learning Objectives Students should be able to:

1. Describe the process of new medical technology development in the U.S. from discovery to commercial product. 2. Discuss patient, provider and regulatory issues relating to the introduction of new medical devices and their integration into

medical care treatment. 3. Discuss provisions of health care reform that may affect the medical device industry directly and indirectly.

Suggested Readings Overview of the Medical Device Industry

1*. Kaiser Family Foundation. “How changes in medical technology affect health care costs.” March 2007. Available at: http://www.kff.org/insurance/snapshot/chcm030807oth.cfm

2*. Robinson, J.C. “Value-based purchasing for medical devices.” Health Affairs 27(6):1523-1531, 2008. http://content.healthaffairs.org/content/27/6/1523.full.pdf+html

3. Curfman, G.D., Redberg R.F. “Medical devices – balancing regulation and innovation,” New England Journal of Medicine (Online), August 10, 2011. Available at: http://www.nejm.org/doi/full/10.1056/NEJMp1109094

4. Sorenson, C., Drummond, M., Burns, L.R. “Evolving reimbursement and pricing policies for devices in Europe and the United States should encourage greater value.” Health Affairs 32(4):788-796, 2013. Available at: http://content.healthaffairs.org/content/32/4/788.full.pdf+html

5. Hollmer, M. “Medtronic, Boston Scientific battle in declining cardiac device market.” FierceMedical Devices, May 7, 2013. Available at: http://www.fiercemedicaldevices.com/story/medtronic-boston-scientific-battle-declining-cardiac-device-market/2013-05-07

6. Garde, D. “Devicemakers plot paths out of CRM funk.” FierceMedical Devices, March 4, 2013. Available at: http://www.fiercemedicaldevices.com/special-reports/2012s-top-5-cardiac-rhythm-management-companies

7. Walsh, J., Spencer, J. “Boomers’ embrace of devices gives rise to new med-tech age.” Star Tribune, September 15, 2013. Available at: http://www.startribune.com/business/223770251.html

8. Hollmer, M. “Medtronic debuts health services arm.” FierceMedicalDevices, September 3, 2013. Available at: http://www.fiercemedicaldevices.com/story/medtronic-debuts-health-services-arm/2013-09-03

9. Cortez, M.F. “Medical device’s slow growth forces search for new areas.” Bloomberg, September 24, 2013. Available at: http://www.bloomberg.com/news/2013-09-24/medical-device-s-slow-growth-forces-search-for-new-areas.html

10. Cortez, M.F. “Medtronic’s sales miss estimates on defibrillator demand.” Bloomberg, August 20, 2013. Available at: http://www.bloomberg.com/news/2013-08-20/medtronic-s-quarterly-profit-rises-on-demand-for-heart-devices.html

Concerns About Conflicts of Interest Involving Medical Device Manufacturers and Physicians, and Other Controversial Practices 1*. Whoriskey, P. “Rise in spinal fusion surgeries may be driven partly by financial incentives, study says.” The Washington Post,

November 13, 2013. Available at: http://www.washingtonpost.com/business/economy/rise-in-spinal-fusion-surgeries-may-be-driven-partly-by-financial-incentives-study-says/2013/11/13/2c87188a-4c87-11e3-be6b-d3d28122e6d4_story.html

2*. Meier, B. “Johnson & Johnson to offer $2.5 billion hip device settlement.” The New York Times, November 19, 2013. Available at: http://www.nytimes.com/2013/11/20/business/johnson-johnson-to-offer-2-5-billion-hip-device-settlement.html

3. Boden, W.E. and Diamond, G.A. “DTCA for PTCA – Crossing the line in consumer health education?” New England Journal of Medicine 358(21):2197-2200, 2008. http://www.nejm.org/doi/pdf/10.1056/NEJMp0801433

4. Carreyrou, J. “Senators request probe of surgeons,” Wall Street Journal (Online), June 9, 2011. http://online.wsj.com/article/SB10001424052702304778304576373592455703056.html

5. Reinberg, S. “Many may get unneeded implantable defibrillators.” Health.com, January 4, 2011. Available at: http://news.health.com/2011/01/04/many-may-get-unneeded-implantable-defibrillators/

6. Carreyrou, J., McGinty, T. “Taking double cut, surgeons implant their own devices.” Wall Street Journal online, October 8, 2011. Available at: http://online.wsj.com/article/SB10001424053111904106704576582621677354508.html

7*. Meier, B., Thomas K. “Troubling flaws in heart device shake industry.” New York Times, April 7, 2012, p. A.1. http://www.nytimes.com/2012/04/07/health/flaws-in-st-jude-heart-defibrillator-shake-the-industry.html?pagewanted=all

8. Weaver, C. St. Jude riata heart-device flaws known for years. The Wall Street Journal, October 10, 2012. Available at: http://online.wsj.com/article/SB10000872396390444223104578036752346768278.html

9. Meier, B. “Outside review of clinical data finds a spinal treatment’s benefit overstated.” The New York Times, June 17, 2013. Available at: http://www.nytimes.com/2013/06/18/business/infuse-a-spinal-treatment-found-no-better-than-older-remedy.html?pagewanted=all

10*. Meier, B. “Doctors who don’t speak out.” The New York Times, February 15, 2013. Available at: http://www.nytimes.com/2013/02/17/sunday-review/the-hip-replacement-case-shows-why-doctors-often-remain-silent.html

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11. Andrews, M. “Questions arise about robotic surgery’s cost, effectiveness.” Kaiser Health News, April 23, 2013. Available at: http://www.kaiserhealthnews.org/features/insuring-your-health/2013/042313-michelle-andrews-robotic-surgery.aspx

12. BusinessWire. “Three large health systems and UnitedHealthcare launch SharedClarity, a new venture to study long-term effectiveness of medical devices.” April 9, 2013. Available at: http://www.businesswire.com/news/home/20130409005531/en/Large-Health-Systems-UnitedHealthcare-Launch-SharedClarity-Venture

13. Carreyrou, J. “Warning over doctor-run groups.” The Wall Street Journal, March 26, 2013. Available at: http://online.wsj.com/article/SB10001424127887323466204578384793253488174.html

14. Egbuonu-Davis, L. “System transformation intensifies demand for evidence: The trust conundrum.” Health Affairs Blog, September 10, 2013. Available at: http://healthaffairs.org/blog/2013/09/10/system-transformation-intensifies-demand-for-evidence-the-trust-conundrum/

15. Carreyrou, J. “Surgeons eyed over deals with medical-device makers.” The Wall Street Journal, July 25, 2013. Available at: http://online.wsj.com/news/articles/SB10001424127887324263404578615971483271856

The Medical Device Industry and the FDA 1. Harris, G. and Halbfinder, D.M. “F.D.A. reveals it fell to a push by lawmakers.” New York Times, September 25, 2009. p. A.1

http://www.nytimes.com/2009/09/25/health/policy/25knee.html?pagewanted=all&_r=0 . 2. Meier, B. “F.D.A. seeks better data from tests of devices.” New York Times, December 30, 2009. p. B.1.

http://www.nytimes.com/2009/12/30/business/30device.html?_r=0 3. Meier, B. “The Impants Loophole,” New York Times, December 17, 2010, p. B.1.

http://www.nytimes.com/2010/12/17/business/17hip.html?pagewanted=all 4. Zuckerman, D.B., Brown, P., Nissen, S.E. “Medical device recalls and the FDA approval process.” Archives of Internal Medicine

171(11):1006-1011, 2011. http://archinte.jamanetwork.com/Issue.aspx?journalid=71&issueID=5819&direction=P 5*. Economist, The. “Left to their own devices.” 400(8750):71-73, 2011. Available at: http://www.economist.com/node/21528644 6*. Kaiser Health News. “Study: Expedited Medical Device Reviews Account for Majority of Recalls.” February 15, 2011. Available

at: http://www.kaiserhealthnews.org/Daily-Reports/2011/February/15/medical-devices.aspx 7. Gottlieb, S. “How the FDA could cost you your life.” Wall Street Journal, October 3, 2011, p. A.17.

http://online.wsj.com/article/SB10001424052970204831304576597200095602270.html 8*. Meier, B. Remedy is elusive as metallic hips fail at a fast rate.” New York Times online, September 30, 2011. Available at:

http://www.nytimes.com/2011/10/01/health/01hip.html?pagewanted=all 9. Kolata, G. “Stroke therapy device fails in study.” Star Tribune online, September 7, 2011. Available at:

http://www.startribune.com/lifestyle/129423093.html?refer=y 10. Carroll, L. “Shocking ending: Implanted defibrillators can bring misery to final hours.” Vitals on NBCNEWS.com, October 10,

2011. Available at: http://vitals.nbcnews.com/_news/2011/10/10/8212715-shocking-ending-implanted-defibrillators-can-bring-misery-to-final-hours?lite

11. Challoner, D.R., Vodra, W.W. “Medical devices and health – creating a new regulatory framework for moderate-risk devices.” New England Journal of Medicine (Online), August 10, 2011. Available at: http://www.nejm.org/doi/full/10.1056/NEJMp1109150

12. Resnic, F.S., Normand, S-L.T. “Postmarketing surveillance of medical devices – filling in the gaps.” New England Journal of Medicine 366(10):875-877, 2012. http://www.nejm.org/doi/pdf/10.1056/NEJMp1114865

13. Norman, B. “FDA user fee bill appears safe from GOP poison pills.” Politico, May 6, 2012. Available at: http://www.politico.com/news/stories/0512/75966.html

14. Hollmer, M. “Budget battles hold new FDA user fees hostage.” FierceMedicalDevices, March 4, 2013. Available at: http://www.fiercemedicaldevices.com/story/budget-battles-hold-new-fda-user-fees-hostage/2013-03-04

15. Editorial. “Move forward on medical device tracking.” Star Tribune, June 21, 2013. Available at: http://www.startribune.com/opinion/editorials/212405031.html

16. Tavernise, S. “F.D.A. to regulate some health apps.” The New York Times, September 23, 2013. Available at: http://www.nytimes.com/2013/09/24/health/fda-to-regulate-only-some-health-apps.html

Health Care Reform and the Medical Device Industry 1*. Spencer, J. “Med-tech firms fight tax on devices.” Star Tribune, September 8, 2011, p. D.1. Available at:

http://www.startribune.com/business/129425158.html 2. Barr, S. “Dream of a medical ‘price list’ dies in Florida legislature.” Kaiser Health News Blog, January 20, 2012. Available at:

http://capsules.kaiserhealthnews.org/index.php/2012/01/dream-of-a-medical-price-list-dies-in-florida-legislature/ 3. Bayh, E. Evan Bayh: ObamaCare’s tax raid on medical devices. The Wall Street Journal, September 27, 2012. Available at:

http://online.wsj.com/article/SB10000872396390444620104578012281306687070.html 4. Rao, A. “New website will disclose health industry payments to doctors.” Kaiser Health News Blog, April 23, 2013. Available at:

http://capsules.kaiserhealthnews.org/?p=18765 5. Carey, M.A. “What’s at stake if Congress repeals the medical device tax.” Kaiser Health News, October 11, 2013. Available at:

http://www.kaiserhealthnews.org/stories/2013/october/11/faq-medical-device-tax.aspx 6. Becker, B. “GOP senators push for medical device tax repeal vote.” The Hill, September 24, 2013. Available at:

http://thehill.com/blogs/on-the-money/domestic-taxes/324371-gop-senators-push-for-medical-device-tax-repeal-vote

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Further Readings

1. Donnelly, L. et al. “Experts call for transparency over medical devices.” The Telegraph, May 7, 2013. Available at: http://www.telegraph.co.uk/health/healthnews/10042607/Experts-call-for-transparency-over-medical-devices.html

2. Thomas, K. Unpredictable danger looms close to the heart. The New York Times, September 7, 2012. Available at: http://www.nytimes.com/2012/09/08/business/patients-with-st-jude-medicals-defibrillator-wires-face-a-dilemma.html?pagewanted=all

3. Walsh, J. “A flawed device brings a tough choice for Riata patients.” Star Tribune online, March 10, 2012. Available at: http://www.startribune.com/business/142118413.html?refer=y

4. Silverman, E. “Commercial support for CME dives, again.” Pharmalot.com, July 30, 2012. Available at: http://www.pharmalot.com/2012/07/commercial-support-for-cme-dives-again/

5. Barr, S. “Dream of a medical ‘price list’ dies in Florida legislature.” Kaiser Health News Blog, January 20, 2012. Available at: http://capsules.kaiserhealthnews.org/index.php/2012/01/dream-of-a-medical-price-list-dies-in-florida-legislature/

6. Cortez, M.F. St. Jude faces boon-or-bust verdict on heart-plus studies. Bloomberg, October 24, 2012. Available at: http://www.bloomberg.com/news/2012-10-24/st-jude-faces-boon-or-bust-verdict-on-heart-plug-studies.html

7. Gormley, B., Maltby, E. Medical start-ups challenged by health-care reform. The Wall Street Journal, October 31, 2012. Available at: http://online.wsj.com/article/SB10001424052970203400604578074870506887766.html

8. Institute of Medicine of the National Academies. “Medical Devices and the Public’s Health. The FDA 510(k) clearance process at 35 years.” Report Brief, July 2011. Available at: http://www.iom.edu/~/media/Files/Report%20Files/2011/Medical-Devices-and-the-Publics-Health-The-FDA-510k-Clearance-Process-at-35-Years/510k%20Clearance%20Process%202011%20Report%20Brief.pdf

9. Pecquet, J. “Dems slam FDA critics ahead of medical device hearing.” The Hill, July 20, 2011. Available at: http://thehill.com/blogs/healthwatch/medical-devices-and-prescription-drug-policy-/172521-dems-slam-fda-critics-ahead-of-medical-device-hearing

10. Pollack, A. “Medical treatment, out of reach.” New York Times, February 10, 2011, p. B.1. Available at: http://www.nytimes.com/2011/02/10/business/10device.html?pagewanted=all

11. Baker, S. “Report faults FDA oversight of device recalls.” The Hill’s Healthcare Blog, June 21, 2011. Available at: http://thehill.com/blogs/healthwatch/medical-devices-and-prescription-drug-policy-/167681-report-faults-fda-oversight-of-device-recalls

12. Snowbeck, C. “U.S. charges Guidant over device woes – Firm allegedly gave FDA a false report on defibrillators.” St. Paul Pioneer Press, February 26, 2010. Available at: http://infoweb.newsbank.com/iw-search/we/InfoWeb?p_product=NewsBank&p_theme=aggregated5&p_action=doc&p_docid=12E236032D50A5A0&p_docnum=93&p_queryname=1

13. Tanner, L. “Medical device problems hurt 70,000+ kids annually.” msnbc.com, July 26, 2010. Available at: http://www.msnbc.msn.com/id/38413252/ns/health-childrens_health/t/medical-device-problems-hurt-more-kids-annually/#

14. Mundy, A. and Favole, J.A. “FDA memo hints at curbs to approval process for medical devices.” Wall Street Journal, February 18, 2010. Available at: http://online.wsj.com/article/SB10001424052748704398804575071791464778482.html

15. Hillman, B.J., Goldsmith, J. “Imaging: The self-referral booms and the ongoing search for effective policies to contain it.” Health Affairs 29(12):2231-2236, 2010. Available at: http://content.healthaffairs.org/content/29/12/2231.full.pdf+html

16. Pauly, M.V. and Burns, L.R. “Price transparency for medical devices.” Health Affairs 27(6):1544-1553, 2008. Available at: http://content.healthaffairs.org/content/27/6/1544.full.pdf+html

17. Meier, B. “Hip device phaseout followed FDA data request.” New York Times, March 23, 2012, p. B.1. Available at: http://www.nytimes.com/2012/03/23/business/fda-asked-depuy-for-safety-data-just-before-hip-implants-phaseout.html

18. Meier, B. Panel says Medtronic edited product studies. The New York Times, October 25, 2012. Available at: http://www.nytimes.com/2012/10/25/business/senate-panel-says-medtronic-edited-studies.html?_r=0

19. Meier, B. “Fight over medical device rules, sight unseen.” New York Times, July 28, 2011, p. A.1. Available at: http://www.nytimes.com/2011/07/28/health/28institute.html?_r=2&adxnnl=1&seid=auto&smid=tw-nytimesbusiness

20. Meier, B. “Tipping the odds for an implant maker.” New York Times, April 3, 2011, p. A.1. Available at: http://query.nytimes.com/gst/fullpage.html?res=9502E2DF1E30F930A35757C0A9679D8B63

21. Meier, B. “When heart devices fail, who should be blamed?” New York Times, April 21, 2010. p, B.1. Available at: http://www.nytimes.com/2010/04/21/business/21device.html?hpw

22. Meier, B. “Ads for medical devices are under scrutiny.” New York Times, September 17, 2008. p, C.12, Available at: http://www.nytimes.com/2008/09/17/business/17device.html

23. Meier, B. “Growing debate as doctors train on new devices.” New York Times, August 1, 2006, p. A.1. Available at: http://www.nytimes.com/2006/08/01/business/01train.html?pagewanted=all

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Lesson 6 – February 17-23, 2014 Pharmaceuticals: A Regulatory Rubik’s Cube Group Assignment 3 Learning Objectives Students should be able to:

1. Describe the pharmaceutical “supply chain” and public policy issues relating to the marketing of pharmaceuticals. 2. Discuss contrasting views pertaining to the proliferation of prescription drugs and the growth in pharmaceutical expenses. 3. Explain what a pharmacy benefit management company is and describe the products and services it provides. 4. Compare and contrast the nature and significance of different regulatory issues relating to pharmaceuticals. 5. Discuss how the pharmaceutical industry may be affected by health reform.

Suggested Readings Overview of the Pharmaceutical Industry and the Role of Prescription Drugs in the Health Care System

1*. Kleinke, J. “The price of progress: prescription drugs in the health care market,” Health Affairs 20(5):43-60, 2001. http://content.healthaffairs.org/content/20/5/43.full.pdf+html

2. Hobson, K. “Spending more on drugs doesn’t mean spending less on other care.” Wall Street Journal, June 10, 2010. Available at: http://blogs.wsj.com/health/2010/06/10/spending-more-on-drugs-doesnt-mean-spending-less-on-other-care/

3. Mogul, F. “Big-name drugs are falling off the ‘patient cliff’.” Kaiser Health News, October 24, 2011. Available at: http://www.kaiserhealthnews.org/stories/2011/october/24/big-name-drugs-are-falling-off-the-patent-cliff.aspx?referrer=search

4. Mathews, A.W. “Combined Express Scripts/Medco may face off against UnitedHealth unit.” WSJ blogs, July 21, 2011. Available at: http://blogs.wsj.com/health/2011/07/21/combined-express-scriptsmedco-may-face-off-against-unitedhealth-unit/

5. Johnson, L.A. “Growth in prescription drug spending slows.” boston.com, April 19, 2011. Available at: http://www.boston.com/business/healthcare/articles/2011/04/19/growth_in_prescription_drug_use_continues_to_slow_1303215087/

6. Anonymous. “Push to spur more drugs for deadly rare diseases.” USA Today News online, April 25, 2011. Available at: http://www.usatoday.com/news/health/healthcare/health/healthcare/story/2011/04/Push-to-spur-more-drugs-for-deadly-rare-diseases---/46504330/1

7. Japsen, B. “Walgreen and Express Scripts reach deal.” New York Times, July 20, 2012, p. B.2. http://www.nytimes.com/2012/07/20/business/walgreen-and-express-scripts-settle-their-dispute.html

8*. Mann, D. “Half of heart patients make mistakes with their meds: Study.” USNews, July 3, 2012. Available at: http://health.usnews.com/health-news/news/articles/2012/07/03/half-of-heart-patients-make-mistakes-with-their-meds-study

9. Andrews, M. “Why your drug copay could change.” Kaiser Health News, May 7, 2012. Available at: http://www.npr.org/blogs/health/2012/05/08/152245452/why-your-drug-copay-could-change

10. Express Scripts. “Express Scripts study reveals keys to controlling specialty drug costs.” PRNewswire, March 7, 2013. Available at: http://www.prnewswire.com/news-releases/express-scripts-study-reveals-keys-to-controlling-specialty-drug-costs-195839241.html

11.* Thomas, K. “U.S. drug costs dropped in 2012, but rises loom.” The New York Times, March 18, 2013. Available at: http://www.nytimes.com/2013/03/19/business/use-of-generics-produces-an-unusual-drop-in-drug-spending.html?pagewanted=all&_r=0

12. Huh, J., DeLorme, D.E., Reid, L.N., An, S. “Direct-to-consumer prescription drug advertising: History, regulation and issues.” Minnesota Medicine, March 2010. Available at: http://www.minnesotamedicine.com/PastIssues/PastIssues2010/March2010/ClinicalJisuMarch2010.aspx

13. Ross, J.S., Kravitz, R.L. “Direct-to-consumer television advertising: Time to turn off the tube?” Journal of General Internal Medicine 28(7):862-864, 2013. Available at: http://link.springer.com/journal/11606/28/7/page/1

14. Tran, A. “Study: Per capita Rx spending fell for the first time in 2012.” Kaiser Health News Blog, May 9, 2013. Available at: http://capsules.kaiserhealthnews.org/?p=19289

15. Thomas, K. “Pills tracked from doctor to patient to aid drug marketing.” The New York Times, May 16, 2013. Available at: http://www.nytimes.com/2013/05/17/business/a-data-trove-now-guides-drug-company-pitches.html?pagewanted=all

16. Avorn, J. “Healing the overwhelmed physician.” The New York Times, June 11, 2013. Available at: http://www.nytimes.com/2013/06/12/opinion/healing-the-overwhelmed-physician.html?hp

17. Johnson, L.A. “Study: Wiser medication use could cut health costs.” Fox News, June 20, 2013. Available at: http://www.foxnews.com/health/2013/06/20/wiser-medication-use-could-cut-health-costs/

18. Torsoli, A. “Lilly bets quality will pay off in U.S. diabetes battle.” Bloomberg, September 24, 2013. Available at: http://www.bloomberg.com/news/2013-09-24/lilly-bets-quality-will-pay-off-in-u-s-diabetes-battle.html

19. Wayne, A. “Express Scripts raised 2013 forecast for second time.” Bloomberg, July 29, 2013. Available at: http://www.bloomberg.com/news/2013-07-29/express-scripts-raises-2013-forecast-for-second-time.html

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Pharmaceutical Pricing 1. Beasley, D. “U.S. branded drug prices soar as generic pressure rises.” Reuters, March 23, 2011. Available at:

http://www.reuters.com/article/2011/03/23/us-branded-drug-prices-idUSTRE72M57X20110323 2. Carey, M.A. “Drug industry rebates: The sequel.” Kaiser Health News, July 15, 2011. Available at:

http://capsules.kaiserhealthnews.org/index.php/2011/07/drug-maker-rebates-the-sequel/ 3. Thomas, K. Brand-name drug prices rise sharply, report says. The New York Times, November 28, 2012. Available at:

http://www.nytimes.com/2012/11/29/business/cost-of-brand-name-prescription-medicines-soaring.html 4. Martin, T.W. “Drugstores press for pricing data.” The Wall Street Journal, March 27, 2013. Available at:

http://content.healthaffairs.org/content/31/4/780.full.pdf+html 5. Viebeck, E. “Drugs cheapest at Costco, priciest at CVS, study finds.” The Hill, March 29, 2013. Available at:

http://thehill.com/blogs/healthwatch/medical-devices-and-prescription-drug-policy-/290945-drugs-cheapest-at-costco-priciest-at-cvs-study-finds

6. Viebeck, E. “Liberal groups push for lower Medicare drug prices.” The Hill, February 14, 2013. Available at: http://thehill.com/blogs/healthwatch/medicare/283077-liberal-groups-push-for-lower-medicare-drug-prices

7. Pollack, A. “Doctors denounce cancer drug prices of $100,000 a year.” The New York Times, April 25, 2013. Available at: http://www.nytimes.com/2013/04/26/business/cancer-physicians-attack-high-drug-costs.html?partner=rss&emc=rss

8. Reuters. “Analysis: Drugmakers face more scrutiny of discordant U.S. prices.” May 10, 2013. Available at: http://www.reuters.com/article/2013/05/10/us-usa-health-drugs-analysis-idUSBRE9490MH20130510

Drug Shortages 1*. Wilson, D. “Deepening drug shortages.” Health Affairs 31(2):263-266, 2012.

http://content.healthaffairs.org/content/31/2/263.full.pdf+html 2*. Thomas, K. Drug shortages persist in U.S., harming care. The New York Times, November 16, 2012. Available at:

http://www.nytimes.com/2012/11/17/business/drug-shortages-are-becoming-persistent-in-us.html?pagewanted=all 3*. Thomas, K. Lapses at big drug factories add to shortages and danger. The New York Times, October 17, 2012. Available at:

http://www.nytimes.com/2012/10/18/business/drug-makers-stalled-in-a-cycle-of-quality-lapses-and-shortages.html?pagewanted=all

4. Mettner, J. “Running short.” Minnesota Medicine, October 2011. Available at: http://www.minnesotamedicine.com/PastIssues/PastIssues2011/October2011/RunningShort.aspx

5. Anand, G., Shah, S., McKay, B. “Shortage of drugs threaten TB fight.” The Wall Street Journal, June 6, 2013. Available at: http://online.wsj.com/article/SB10001424127887323469804578523262257381332.html

Controversial Practices in the Pharmaceutical Industry 1. Rubin, R. “Pfizer fined record $2.3b for illegal marketing in off-label drug case.” USA Today, September 3, 2009. Available at:

http://www.usatoday.com/money/industries/health/2009-09-02-pfizer-fine_N.htm 2. Harris, G. “Drug maker hid test data, files indicate.” New York Times, July 13, 2010, p. A.1

http://www.nytimes.com/2010/07/13/health/policy/13avandia.html?_r=3&hp . 3*. Bartz, D. “US sees jump in “pay-for-delay” drug settlements.” Reuters, July 27, 2010. Available at:

http://www.reuters.com/article/idUSN2712034820100727 4*. “When a drug fails.” New York Times, July 26, 2010, P. A.22. Available at:

http://www.nytimes.com/2010/07/26/opinion/26mon1.html 5*. Wilson, D. “Pfizer gives details on payments to doctors.” New York Times, April 1, 2010. p. B.2

http://www.nytimes.com/2010/04/01/business/01payments.html 6. Wolston, M. “An MS patient loses trust when she finds out her doctor is paid by drug companies.” Health Affairs 30(12):2449-

2452, 2011. http://content.healthaffairs.org/content/30/12/2449.full.pdf+html 7. Editorial. “Drug company payoffs.” New York Times, July 6, 2010. Available at:

http://www.nytimes.com/2010/07/07/opinion/07wed2.html 8. Kesselheim, A.S., Murtagh, L., Mello, M.M. “’Pay for delay’ settlements of disputes over pharmaceutical patents.” New England

Journal of Medicine 365(15):1439-1445, 2011. http://www.nejm.org/doi/pdf/10.1056/NEJMhle1102235 9. Meier, B., Thomas, K. “Insurers pay big markups as doctors dispense drugs.” New York Times online, July 11, 2012. Available

at: http://www.nytimes.com/2012/07/12/business/some-physicians-making-millions-selling-drugs.html?pagewanted=all 10*. Los Angeles Times. CVS Caremark has become a frequent subject of government probes. October 24, 2012. Available at:

http://articles.latimes.com/2012/oct/24/business/la-fi-cvs-caremark-20121024 11. Reuters. “U.S. Files 2nd lawsuit accusing Novartis of kickbacks.” April 26, 2013. Available at:

http://www.reuters.com/article/2013/04/26/us-novartis-fraud-lawsuit-idUSBRE93P16120130426 12. Elliott, C. “Useless studies, real harm.” The New York Times, July 28, 2011. Available at:

http://www.nytimes.com/2011/07/29/opinion/useless-pharmaceutical-studies-real-harm.html?_r=2 13. Clapp, M., Rie, M.A., Zweig, P. “How a cabal keeps generics scarce.” The New York Times, September 2, 2013. Available at:

http://www.nytimes.com/2013/09/03/opinion/how-a-cabal-keeps-generics-scarce.html 14. Carlson, J. “Supreme court slates generic drug ‘pay-for-delay’ case.” ModernHealthcare, December 8, 2012. Available at:

http://www.modernhealthcare.com/article/20121208/NEWS/312089949

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15. Rowley, J. “Tighter compounding pharmacy oversight advances in Senate.” Bloomberg, November 13, 2013. Available at: http://www.bloomberg.com/news/2013-11-13/tighter-compounding-pharmacy-oversight-advances-in-senate.html

Relationship between Pharmaceutical Industry and the FDA 1. Pecquet, J. “Dems: FDA should be able to recall drugs.” The Hill, May 27, 2010. Available at: http://thehill.com/business-a-

lobbying/100375-dems-fda-should-be-able-to-recall-drugs 2. Alexander, G.C., O’Connor, A.B., Stafford, R.S. “Enhancing prescription drug innovation and adoption.” Annals of Internal

Medicine 154:833-837, 2011. http://annals.org/issue.aspx?journalid=90&issueID=20233&direction=P 3*. Boldrin, M., Swanidass, S.J. “A new bargain for drug approvals.” Wall Street Journal, July 27, 2011, p. A.15

http://online.wsj.com/article/SB10001424052702303812104576441610360466984.html . 4. Ponnuru, R. “Too much FDA meddling means not enough drugs.” Bloomberg View, June 21, 2011. Available at:

http://www.bloomberg.com/news/2011-06-21/too-much-fda-intervention-equals-too-few-drugs-ramesh-ponnuru.html 5. Gever, J. “Clinical notes: FDA turns up heat on compounders.” MedPage Today, April 14, 2013. Available at:

http://www.medpagetoday.com/InfectiousDisease/PublicHealth/38438 6. Pittman, D. “FDA to poll docs on impact of DTC ads.” MedPage Today, April 19, 2013. Available at:

http://www.medpagetoday.com/Washington-Watch/FDAGeneral/38582 7. Caroll, J. “Bristol-Myers gains FDA’s ‘breakthrough’ track in race for hep C drug approval.” Fierce Biotech, April 25, 2013.

Available at: http://www.fiercebiotech.com/story/bristol-myers-gains-fdas-breakthrough-track-race-hep-c-drug-approval/2013-04-25

8. Dimond, P.F. “FDA speeds things up. What’s happened so far eiwth breakthrough therapy designation?” Genetic Engineering & Biotechnology News, September 4, 2013. Available at: http://www.genengnews.com/insight-and-intelligence/fda-speeds-things-up/77899888/

9. Kesselheim, A.S., Green, M.D., Avorn, J. “Who is now responsible for discovering and warning about adverse effects of generic drugs.” Journal of the American Medical Association 310(10):1023-1024, 2013. Available at: http://www.bloomberg.com/news/2013-09-24/lilly-bets-quality-will-pay-off-in-u-s-diabetes-battle.html

Health Reform and the Pharmaceutical Industry 1. “Pharmaceutical companies offer $80 billion toward health care reform.” PBS NewsHour, June 22, 2009. Available at:

http://www.pbs.org/newshour/updates/health/jan-june09/pharma_06-22.html 2. Frates, C. “PhRMA quietly spends big in 2010.” POLITICO.com, November 10, 2010. Available at:

http://www.politico.com/news/stories/1110/44917.html 3. Van Dyke, A. “Sebelius, health industry leaders meet in Kansas City to talk drug development.” Kansas City Business Journal,

July 6, 2010. Available at: http://www.bizjournals.com/kansascity/stories/2010/07/05/daily7.html 4. Kendall, B. “White House seeks to speed up generic drugs’ path to market.” Wall Street Journal, February 15, 2011, p. D.2.

Available at: http://online.wsj.com/article/SB10001424052748703584804576144610898923424.html 5. Lipton, E., Sack K. “Fiscal footnote: Big senate gift to drug maker.” The New York Times, January 19, 2013. Available at:

http://www.nytimes.com/2013/01/20/us/medicare-pricing-delay-is-political-win-for-amgen-drug-maker.html Further Readings

1. Langreth, R. “Drugmakers open new front against cancer with next generation of experimental drugs.” The Washington Post, May 12, 2013. Available at: http://www.bloomberg.com/news/2013-05-13/human-immune-boosting-cancer-drugs-seen-extending-lives.html

2. Gottlieb, S. “Why we should be spending more on pricey cancer drugs.” Forbes, June 10, 2013. Available at: http://www.forbes.com/sites/scottgottlieb/2013/06/10/why-we-should-spend-more-on-pricey-cancer-drugs/

3. Newcomer, L.N. “Changing physician incentives for cancer care to reward better patient outcomes instead of use of more costly drugs.” Health Affairs 31(4):780-785, 2012. Available at: http://content.healthaffairs.org/content/31/4/780.full.pdf+html

4. ABCNews. New study highlights dangers of over-medicated seniors. August 23, 2012. Available at: http://abcnews.go.com/Health/study-highlights-dangers-medicated-seniors/story?id=17060793

5. Stynes, T. Express Scripts earnings rise 21%. The Wall Street Journal, November 5, 2012. Available at: http://online.wsj.com/article/SB10001424052970204349404578101353030937738.html

6. Terhune, C. “U.S. spending on genetic tests jumps.” Los Angeles Times, March 12, 2012, p. A.4. Available at: http://news.zurichna.com/article/fea92e233d6de94b59a120cfe6a0c158/us-spending-on-genetic-tests-jumps

7. Ahmed, R. India revokes Roche patent. The Wall Street Journal, November 3, 2012. Available at: http://online.wsj.com/article/SB10001424052970204846304578096483954249650.html

8. Andrews, M. “Why your drug copay could change.” NPR health blog, May 8, 2012. Available at: http://www.npr.org/blogs/health/2012/05/08/152245452/why-your-drug-copay-could-change

9. Reuters, Drug shortage led to spike in kids’ infections. October 11, 2012. Available at: http://news.yahoo.com/drug-shortage-led-spike-kids-infections-204333255.html

10. Reuters. Bayer CEO decries pressure to lower drug prices. September 19, 2012. Available at: http://www.reuters.com/article/2012/09/19/us-bayer-dekkers-idUSBRE88I1HR20120919

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11. Reuters. Drop in hospital visits seen with lower drug copay. October 3, 2012. Available at: http://www.reuters.com/article/2012/10/03/us-drop-drug-idUSBRE8921AP20121003

12. Pollack, A. New drugs for Lipids set off race. The New York Times, November 5, 2012. Available at: http://www.nytimes.com/2012/11/06/business/new-drugs-for-lipids-set-off-race.html?gwh=EA0CDFB609598B0CE03A72AA05D1D5E8&_r=0

13. President’s council of advisors on science and technology releases report on innovation in drug discovery and development. September 25, 2012. Available at: http://www.whitehouse.gov/sites/default/files/microsites/ostp/pcast_fda_release_final.pdf

14. Bach, P.B., Salta, L.B., Wittes, R.E. In cancer care, cost matters. The New York Times, October 14, 2012. Available at: http://www.nytimes.com/2012/10/15/opinion/a-hospital-says-no-to-an-11000-a-month-cancer-drug.html

15. Pittman, D. Fewer drugs in short supply. MedPage Today, September 24, 2012. Available at: http://www.medpagetoday.com/Washington-Watch/FDAGeneral/34935

16. Bloomberg, Arizona sues McKesson over allegations of inflated drug prices. September 20, 2012. Available at: http://www.bloomberg.com/news/2012-09-19/arizona-sues-mckesson-alleging-it-inflated-drug-prices.html

17. Drug Channels. Pharmacy ownership: Getting less profitable. October 23, 2012. Available at: http://www.drugchannels.net/2012/10/pharmacy-ownership-getting-less.html

18. Editorial. “Some legal clarity on generic drugs.” New York Times, July 18, 2012, p. A.26. Available at: http://www.nytimes.com/2012/07/18/opinion/some-legal-clarity-on-generic-drugs.html?_r=0

19. Editorial. “Why do drug shortages persist?” USA Today, May 16, 2012. Available at: http://www.usatoday.com/news/opinion/editorials/story/2012-05-16/drug-shortages-FDA/55028206/1

20. Kolata, G. Cancer study points to tighter pairing of drugs and patients. The New York Times, September 9, 2012. Available at: http://www.nytimes.com/2012/09/10/health/research/for-a-lung-cancer-drug-treatment-may-be-within-reach.html

21. Kresge, N. Roche $5.7 billion tumor drug sales hinge on rival tests. Bloomberg, September 23, 2012. Available at: http://www.bloomberg.com/news/2012-09-23/roche-5-7-billion-tumor-drug-sales-hinge-on-rival-tests.html

22. Meier, B. “F.D.A. won’t order doctors to get pain-drug therapy.” New York Times online, July 9, 2012. Available at: http://www.nytimes.com/2012/07/10/health/fda-rejects-mandatory-training-in-painkillers-for-doctors.html

23. Whalen, J. Gene-therapy approval marks major milestone. The Wall Street Journal, November 2, 2012. Available at: http://online.wsj.com/article/SB10001424052970203707604578095091940871524.html

24. Whoriskey, P. As drug industry’s influence over research grows, so does the potential for bias. The Washington Post, November 24, 2012. Available at: http://articles.washingtonpost.com/2012-11-24/business/35511825_1_drug-companies-avandia-steven-e-nissen

25. Wilson, D. “Drug firms face billions in losses in ’11 as patents end.” New York Times, March 6, 2011. Available at: http://www.nytimes.com/2011/03/07/business/07drug.html?pagewanted=all

26. Pecquet, J. “Kohl urges trade officials to be wary of drug industry consolidation.” The Hill’s Healthcare Blog, May 19, 2011. Available at: http://thehill.com/blogs/healthwatch/medical-devices-and-prescription-drug-policy-/162153-kohl-urges-trade-officials-to-be-wary-of-drug-industry-consolidation

27. Pollack, A. “New drugs fight prostate cancer, but at high cost.” New York Times, June 28, 2011, p. A.1. Available at: http://www.nytimes.com/2011/06/28/health/28prostate.html

28. Mishori, R. “Some doctors insist on brand-name drugs even when cheaper generics are available.” Washington Post online, July 11, 2011. Available at: http://www.washingtonpost.com/national/some-doctors-insist-on-brand-name-drugs-even-when-cheaper-generics-are-available/2011/06/13/gIQAmC0L9H_story.html

29. Lippmann, R. “How the merger of two health care giants may affect your wallet.” NPR, August 17, 2011. Available at: http://www.npr.org/blogs/health/2011/08/17/139680770/how-the-merger-of-two-health-care-giants-may-affect-your-wallet?ps=sh_sthdl

30. Loftus, P. “Pfizer to cut R&D, step up buybacks.” Wall Street Journal, February 2, 2011, p.23, Available at: http://online.wsj.com/article/SB10001424052748703445904576117902803504210.html

31. Loftus, P., Thomas, G. “Health & Wellness: FDA sued over generic Lipitor release.” Wall Street Journal, March 22, 2011, p. D.2. 32. Editorial. “The shortage of vital drugs.” New York Times, August 26, 2011, p. A.26. Available at:

http://www.nytimes.com/2011/08/26/opinion/the-shortage-of-vital-drugs.html 33. Gatesman, M.L., Smith, T.J. “The shortage of essential chemotherapy drugs in the United States.” New England Journal of

Medicine 365(18):1653-1655, 2011. Available at: http://www.nejm.org/doi/pdf/10.1056/NEJMp1109772 34. Harris, G. “U.S. scrambling to ease shortage of vital medicine.” New York Times online, August 19, 2011. Available at:

http://www.nytimes.com/2011/08/20/health/policy/20drug.html?pagewanted=all 35. Duncan, D.W. “New drugs at lower costs—investing in growth.” The Fiscal Times, April 6, 2011. Available at:

http://www.thefiscaltimes.com/Articles/2011/04/06/New-Drugs-at-Lower-Costs.aspx#page1Carpenter, D. “Free the F.D.A.” New York times online, December 13, 2011. Available at: http://www.nytimes.com/2011/12/14/opinion/free-the-fda.html?_r=1

36. CBO. “Potential effects of a ban on direct-to-consumer advertising of new prescription drugs.” Economic and Budget Issue Brief, May 2011. Available at: http://www.cbo.gov/ftpdocs/121xx/doc12164/5-25-PrescriptionDrugAdvertising.pdf

37. Chabner, B.A., “Drug shortages – a critical challenge for the generic-drug market.” New England Journal of Medicine 365(23):2147-2148, 2011. Available at: http://www.nejm.org/doi/pdf/10.1056/NEJMp1112633

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38. Clark, C. “Price gouging spikes drug costs up to 4500%, purchasing group says.” HealthLeaders Media, August 17, 2011. Available at: http://www.healthleadersmedia.com/page-1/MAR-269856/Price-Gouging-Spikes-Drug-Costs-Up-to-4500-Purchasing-Group-Says##

39. Baker, S. “AARP: Generics keep getting cheaper.” The Hill, July 21, 2011. Available at: http://thehill.com/blogs/healthwatch/medical-devices-and-prescription-drug-policy-/172783-aarp-says-generics-keep-getting-cheaper

40. Hirschler, B. “Drug R&D spending fell in 2010, heading lower.” Reuters, June 26, 2011. Available at: http://www.reuters.com/article/2011/06/26/pharmaceuticals-rd-idUSL6E7HO1BL20110626

41. Kavilanz, P. “FDA: Another tainted drug crisis seems inevitable.” CNN Money.com, March 14, 2011. Available at: http://money.cnn.com/2011/03/14/news/economy/us_drug_safety_challenges/index.htm

42. Baker, S. “FTC: ‘pay-for-delay’ settlements up 60 percent.” The Hill’s Healthcare Blog, May 3, 2011. Available at: http://thehill.com/blogs/healthwatch/medical-devices-and-prescription-drug-policy-/159085-ftc-pay-for-delay-settlements-up-60

43. Bate, R. “Beware of risks of generic drugs: Copies aren’t always as good as the original—especially when ingredients are sourced in China.” Wall Street Journal (Online), July 6, 2011. Available at: http://online.wsj.com/article/SB10001424052702303339904576406163574698214.html

44. Singer, N. “A fight over how drugs are pitched.” New York Times, April 24, 2011, p. B.1. Available at: http://www.nytimes.com/2011/04/25/business/25privacy.html?pagewanted=all

45. Whalen, J. “FDA scientist attacks Avandia safety.” Wall Street Journal, June 11, 2010. p. B.4 46. Bakalar, N. “Study sees a slant in articles on drug.” New York Times, April 13, 2010. p. D.7. Available at:

http://www.nytimes.com/2010/04/13/health/13diab.html 47. Harris, G. “Research ties diabetes drug to heart woes.” New York Times, February 20, 2010, p. A.1. Available at:

http://www.nytimes.com/2010/02/20/health/policy/20avandia.html?pagewanted=all&gwh=1B20072821AC5BD6C92D94B065C041F9

48. Rockoff, J. “Prescription-drug sales rise 5.1%; revenue, usage increase as drug makers, retailers offer discounts on co-pays.” Wall Street Journal, April 2, 2010, p. B.4

49. Herbert, B. “This is reform?” New York Times, August 18, 2009, p. A.23. Available at: http://ic.galegroup.com/ic/suic/NewsDetailsPage/NewsDetailsWindow?failOverType=&query=&prodId=SUIC&windowstate=normal&contentModules=&mode=view&displayGroupName=News&limiter=&currPage=&disableHighlighting=false&displayGroups=&sortBy=&source=&search_within_results=&action=e&catId=&activityType=&scanId=&documentId=GALE%7CA206181609

50. Martinez, B. and Johnson, A. “Drug makers, hospitals raise prices --- double-digit increases in pharmaceutical, other costs come as Washington gears up for a fight.” The Wall Street Journal, April 15, 2009, p. B.1. Available at: http://search.proquest.com/docview/399044208/fulltext/13EE1258E455CA3C752/1?accountid=14586

51. Shrank, W.H., Porter, M.E., Jain, S.H., Choudhry, N. “A blueprint for pharmacy benefit managers to increase value.” American Journal of Managed Care 15(2):87-93, 2009. Available at: http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=3&sid=344b0ee4-f46f-42d0-adec-347cccf52d38%40sessionmgr14&hid=26

52. Rampell, C. “Marketing drugs to consumers.” December 2, 2009. Available at: http://economix.blogs.nytimes.com/2009/12/02/marketing-drugs-to-consumers/

53. NACS Online. “Pharmaceutical industry backs health care reform” August 17, 2009. Available at: http://www.nacsonline.com/NACS/News/Daily/Pages/ND0817094.aspx

54. “When a drug costs $300,000.” New York Times, March 23, 2008, p. WK.8. Available at: http://www.nytimes.com/2008/03/23/opinion/23sun3.html?gwh=8AC468FFFA76E84B4F5221DF8CC85358

Financing Lesson 7 – February 24 - March 2, 2014 Health Insurance, Uninsurance, and the Private Health Insurance Market: What Works, What Doesn’t and How Will Health Reform Change It? Individual Assignment 3 Learning Objectives Students should be able to:

1. Discuss the logical foundations for health insurance. 2. Contrast the characteristics of different types of health insurance benefit designs. 3. Describe the strengths and weaknesses of the current private health insurance system. 4. Discuss how health reform will affect the private health insurance market.

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Suggested Readings History and Current State of Private Health Insurance

1*. Blumenthal, D. “Employer-sponsored health insurance in the United States – Origins and implications,” New England Journal of Medicine 355(1):82-88, 2006. http://www.nejm.org/doi/pdf/10.1056/NEJMhpr060703

2*. Blumenthal, D. “Employer-sponsored insurance – riding the health care tiger.” New England Journal of Medicine 355(2):195-202, 2006. http://www.nejm.org/doi/pdf/10.1056/NEJMhpr060704

3*. Henry J. Kaiser Family Foundation. “How private health coverage works: A primer, 2008 update. Available at: http://www.kff.org/insurance/7766.cfm

4.* Hancock, J. “How employer-sponsored health insurance is changing.” Kaiser Health News, September 17, 2013. Available at: http://www.kaiserhealthnews.org/stories/2013/september/17/employer-sponsored-health-insurance-trends.aspx 5. Fronstin, P. “Employment-based health benefits: Trends in access and coverage, 1997-2010.” EBRI Issue Brief #370, April

2012. Available at: http://www.ebri.org/pdf/briefspdf/EBRI_IB_04-2012_No370_HI-Trends.pdf 6. Muligan, C.B. Employer-provided health insurance and the market. The New York Times, November 21, 2012. Available at:

http://economix.blogs.nytimes.com/2012/11/21/the-future-of-employer-provided-health-insurance/ 7. Archer, D. “Private insurance is bankrupting Americans: Is Congress paying attention?” Health Affairs Blog, June 26, 2012.

Available at: http://healthaffairs.org/blog/2012/06/26/private-insurance-is-bankrupting-americans-is-congress-paying-attention/ 8. Smialek, J. “Obamacare competition has roots in economist’s passion.” Bloomberg, May 30, 2013. Available at:

http://www.bloomberg.com/news/2013-05-30/obamacare-competition-has-roots-in-economist-s-passion.html 9. Collins, S.R., Robertson, R., Garber, T., Doty, M.M. “Insuring the future. Current trends in health coverage and the effects of

implementing the Affordable Care Act.” Commonwealth Fund, April 2013. Available at: http://www.commonwealthfund.org/~/media/Files/Publications/Fund%20Report/2013/Apr/1681_Collins_insuring_future_biennial_survey_2012_FINAL.pdf

10. “Employers plan aggressive response to shifting health care landscape, Towers Watson/National Business Group on health survey finds.” Towers Watson, March 7, 2013. Available at: http://www.towerswatson.com/en/Press/2013/03/Employers-Plan-Aggressive-Response-to-Shifting-Health-Care-Landscape-TW-NBGH-Survey-Finds

11. National Institute for Health Care Management. “Spending for private health insurance in the United States.” January 2013. Available at: http://www.nihcm.org/component/content/article/722

12. Andrews, M. “Large companies are increasingly offering workers only high deductible health plans.” Kaiser Health News, March 26, 2013. Available at: http://www.kaiserhealthnews.org/features/insuring-your-health/2013/032613-michelle-andrews-on-high-deductible-plans-and-large-employers.aspx

Characteristics of Organizations Providing Private Health Insurance and the Products They Offer 1*. Nussbaum, A. “WellPoint’s Kleinman sees health insurer ‘oligopoly’ fed by U.S. overhaul.” Bloomberg.com, June 24, 2010.

Available at: http://www.bloomberg.com/news/2010-06-24/wellpoint-s-kleinman-sees-health-insurer-oligopoly-fed-by-u-s-overhaul.html

2. Johnson, A. “WellPoint aims to diversity.” Wall Street Journal online, January 27, 2011. Available at: http://online.wsj.com/article/SB10001424052748703293204576105604272858170.html

3. Hancock, J. “Health savings account membership up 18 percent.” Kaiser Health News blog, May 30, 2012. Available at: http://capsules.kaiserhealthnews.org/index.php/2012/05/health-savings-account-membership-up-18-percent/

4*. Kulkarni, S.S. “Quick facts about high-deductible health plans.” Kaiser Health News, April 27, 2012. Available at: http://www.kaiserhealthnews.org/stories/2012/april/27/high-deductible-health-plans.aspx?referrer=search

5. Baker, S. “Insurers: Hospital prices rising steeply.” The Hill, March 18, 2013. Available at: http://thehill.com/blogs/healthwatch/health-insurance/288705-insurers-hospital-prices-rising-steeply

6. Tocknell, M.D. “’Dismal’ understanding of health plans among consumers.” HealthLeaders Media, August 21, 2013. Available at: http://www.healthleadersmedia.com/page-1/HEP-295480/Dismal-Understanding-of-Health-Plans-Among-Consumers##

Strengths and Weaknesses of the Current Private Health Insurance Market 1*. Abelson, R. “Health insurers profit as many postpone care.” New York Times, May 14, 2011, p. A.1

http://www.nytimes.com/2011/05/14/business/14health.html?_r=0 2. Pear, R. “Health care premiums soar as coverage shrinks.” New York Times, March 5, 2011, p. A.13.

http://www.nytimes.com/2011/03/05/health/policy/05cost.html?_r=1&hp 3*. Kaiser Commission on Medicaid and the Uninsured. “Key facts about the uninsured population.” September 26, 2013. Available

at: http://www.kff.org/uninsured/upload/7806-04.pdf 4. Andrews, M. “With high deductible health plans, it pays to shop around for care.” Kaiser Health News, May 20, 2013. Available

at: http://www.kaiserhealthnews.org/stories/2013/may/19/with-high-deductible-plans-it-pays-to-shop-around-for-care.aspx 5. Silver-Greenberg, J. “Patients mired in costly credit from doctors.” The New York Times, October 13, 2013. Available at:

http://www.nytimes.com/2013/10/14/business/economy/patients-mired-in-costly-credit-from-doctors.html Potential Impact of Health Reform

1*. “Ezra Klein’s Wonkbook.” The Washington Post, July 24, 2013. Available at: http://view.ed4.net/v/VP6EHT/BMA0WF/WT6XV0Z/HFNG26/

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2. Darling, H. “Health care reform: perspectives from large employers.” Health Affairs 29(6):1220-1224, 2010. Available at: http://content.healthaffairs.org/content/29/6/1220.full.pdf+html

3. Brennan, T.A., Studdert, D.M. “How will health insurers respond to new rules under health reform.” Health Affairs 29(6):1147-1151, 2010. Available at: http://content.healthaffairs.org/content/29/6/1147.full.pdf+html

4. Pear, R. “Health insurers to be required to justify rate increases over 10 percent.” New York Times, December 22, 2010, p. A.21. Available at: http://www.nytimes.com/2010/12/22/health/policy/22insure.html?_r=0

5. Johnson, A. “Reforms prod insurers to diversify.” Wall Street Journal, May 12, 2011, p. B.1. Available at: http://online.wsj.com/article/SB10001424052748703643104576291022457851278.html

6. Pecquet, J. “Healthcare lobbying cools down one year after reform law’s passage. The Hill’s Healthcare Blog, April 21, 2011. Available at: http://thehill.com/blogs/healthwatch/lobbying/157231-healthcare-lobbying-cools-down-one-year-after-reform-laws-passage

7. Pecquet, J. “Employers unlikely to drop coverage because of health law, survey finds.” The Hill, August 2, 2011. Available at: http://thehill.com/blogs/healthwatch/health-insurance/174961-employers-unlikely-to-drop-coverage-because-of-health-law-survey-finds

8. Terhune, C. “California insurance commissioner chides Blue Shield over rates.” Los Angeles Times, March 7, 2013. Available at: http://articles.latimes.com/2013/mar/07/business/la-fi-mo-blue-shield-rates-20130307

9. Galewitz, P. “Health insurers see big opportunities in health law’s Medicaid expansion.” Kaiser Health News, March 8, 2013. Available at: http://www.kaiserhealthnews.org/stories/2013/march/08/molina-health-care-florida-medicaid-managed-care.aspx

10. Fisher, N. “Employers dropping health care coverage could benefit health care quality and cost.” Forbes, February 20, 2013. Available at: http://www.forbes.com/sites/aroy/2013/02/20/employers-dropping-health-care-coverage-could-benefit-health-care-quality-and-cost/

11. Appleby, J. “Insurers’ efforts to delay health law compliance could affect premiums, benefits for millions.” Kaiser Health News, April 5, 2013. Available at: http://www.kaiserhealthnews.org/stories/2013/april/05/health-law-insurance-deadlines.aspx

12. Maltby, E., Needleman, S.E. “Some small businesses opt for the health-care penalty.” The Wall Street Journal, April 8, 2013. Available at: http://online.wsj.com/article/SB10001424127887323916304578401413507987532.html

13*. Klein, E. “The six ways Obamacare changes insurance premiums.” The Washington Post, June 3, 2013. Available at: http://www.washingtonpost.com/blogs/wonkblog/wp/2013/06/03/the-six-ways-obamacare-changes-insurance-premiums/

14. Bernasek, A. “Why a health insurance penalty may look tempting.” The New York Times, June 22, 2013. Available at: http://www.nytimes.com/2013/06/23/business/why-a-health-insurance-penalty-may-look-tempting.html

15. Doyle, J. “Grace Hill’s funding is in jeopardy.” St. Louis Post-Dispatch, September 3, 2013. Available at: http://www.stltoday.com/news/local/metro/grace-hill-s-funding-is-in-jeopardy/article_53844c47-71a6-54d4-aeec-12a0961d401a.html

Further Readings

1. Bridgeforth, S. “Employers and employees agree on the value of voluntary benefits.” Preduential, March 5, 2013. Available at: http://news.prudential.com/article_display.cfm?article_id=6526

2. Sonier, J., Bried, B., Au-Yeung, C., Auringer, B. “State-level trends in employer-sponsored health insurance. A state-by-state analysis. Robert Wood Johnson Foundation, April 2013. Available at: http://www.rwjf.org/content/dam/farm/reports/reports/2013/rwjf405434

3. Abelson, R. “Health insurance companies get in shape for 2014.” The New York Times, February 5, 2013. Available at: http://www.nytimes.com/2013/02/06/business/florida-blue-and-other-health-insurers-prepare-for-new-regulations.html?pagewanted=all&gwh=833B26A78906F2CC635B132B5FF568C6

4. Abelson, R., Greenhouse, S. Small employers weigh impact of providing health insurance. The New York Times, November 30, 2012. Available at: http://www.nytimes.com/2012/12/01/business/small-employers-weigh-impact-of-providing-health-insurance.html?pagewanted=all

5. Galewitz, P. Quality of community health centers varies widely. Kaiser Health News, October 31, 2012. Available at: http://www.kaiserhealthnews.org/stories/2012/november/01/community-health-centers-quality-varies-widely.aspx

6. Hall, S.D. Survey: Most employers won’t drop health coverage. FierceHealthPayer, August 29, 2012. Available at: http://www.fiercehealthpayer.com/story/survey-most-employers-wont-drop-health-coverage/2012-08-29

7. Hancock, J. “The new normal in health insurance: High deductibles.” Kaiser Health News, June 3, 2012. Available at: http://www.kaiserhealthnews.org/stories/2012/june/04/high-deductible-health-insurance.aspx?referrer=search

8. Kaiser Health News. Analysis: Health exchanges and the litigation landscape. November 20, 2012. Available at: http://www.kaiserhealthnews.org/stories/2012/november/29/health-law--litigation-and-exchanges.aspx

9. Kaiser Health Reform Source. How small business owners get health insurance. September 28, 2012. Available at: http://policyinsights.kff.org/2012/september/how-small-business-owners-get-health-insurance.aspx

10. Robertson, R., Stremikis, K., Collins, S.R., Doty, M.N., Davis, K. Realizing health reform’s potential: Jobs without benefits: The health insurance crisis faced by small businesses and their workers. November 2012. Available at: http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2012/Oct/1640_Robertson_jobs_without_benefits_small_businesses.pdf

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11. Stawicki, E. Biz groups push for answers on Minnesota exchange. Kaiser Health News, September 6, 2012. Available at: http://www.kaiserhealthnews.org/stories/2012/september/06/minnesota-insurance-exchange-businesses.aspx

12. Cheung, K.M. “Three-quarters of Fortune 50 firms in booming health industry.” FierceHealthcare, June 9, 2011. Available at: http://www.fiercehealthcare.com/story/three-quarters-fortune-50-firms-booming-health-industry/2011-06-09

13. Colliver, V. “Insurer wants focus on what drives up health costs.” SFGate.com, March 19, 2011. Available at: http://www.sfgate.com/news/article/Insurer-wants-focus-on-what-drives-up-health-costs-2388258.php

14. Editorial. “Watching the health insurers.” Los Angeles Time online, April 26, 2011. Available at: http://articles.latimes.com/2011/apr/26/opinion/la-ed-insurance-20110426

15. Mendes, E. “U.S. employer-based health coverage continues to decline.” Gallup, March 4, 2011. Available at: http://www.gallup.com/poll/146492/employer-based-health-coverage-continues-decline.aspx

16. “Only one in six employers favor a universal health care system funded by tax dollars.” PRWeb, April 20, 2011. Available at: http://www.prweb.com/releases/UnitedBenefitAdvisors/HealthCare/prweb8320280.htm

17. Baicker, K. and Chandra, A. “Myths and misconceptions about U.S. health insurance.” Health Affairs – Web Exclusive 27(6):w533-w543, October 21, 2008. Available at: http://content.healthaffairs.org/content/27/6/w533.full.pdf+html

18. Henry J. Kaiser Family Foundation. “Tax subsidies for health insurance. An issue brief. July 2008. Available at: http://www.kff.org/insurance/7779.cfm

Lesson 8 – March 3-9, 2014 Medicaid: Can This “Vast Public Enterprise” Be Sustained? Group Assignment 4 Learning Objectives Students should be able to:

1. Discuss the distribution of funding and administrative responsibilities between the states and the federal government under Medicaid.

2. Describe the relative importance of different categories of expenditures under Medicaid. 3. Describe the experience of Medicaid programs in contracting with managed care organizations. 4. Discuss how economic downturns and state efforts to respond to budget crises have affected Medicaid programs. 5. Discuss how health reform could affect Medicaid programs.

Suggested Readings How Medicaid Is Structured and Financed

1*. Iglehart, J. “Medicaid revisited – skirmishes over a vast public enterprise,” New England Journal of Medicine 356(7):734-740, 2007. http://www.nejm.org/doi/pdf/10.1056/NEJMhpr066650

2*. National Health Policy Forum. “Medicaid financing,” The Basics, The George Washington University, Washington, DC, January 15, 2009, pp 1-4. Available at: http://www.nhpf.org/library/details.cfm/2528

3. Iglehart, J.K. “Medicaid at a crossroads.” New England Journal of Medicine 364:1585-1587, 2011. http://www.nejm.org/doi/pdf/10.1056/NEJMp1103305

4. Tran, A. “Expanding Medicaid didn’t lead to big health gains in Oregon, study finds.” Kaiser Health News, May 1, 2013. Available at: http://capsules.kaiserhealthnews.org/?p=19086

5. Klein, E., Soltas, E. “Wonkbook: Everything you need to know about the Oregon health study.” The Washington Post, May 2, 2013. Available at: http://www.washingtonpost.com/blogs/wonkblog/wp/2013/05/02/wonkbook-everything-you-need-to-know-about-the-oregon-health-study/

6. Lowrey, A. “Medicaid access increases use of care, study finds.” The New York Times, May 1, 2013. Available at: http://www.nytimes.com/2013/05/02/business/study-finds-health-care-use-rises-with-expanded-medicaid.html?_r=0

7. Pugh, T. “Most doctors still reject Medicaid as program expansion nears.” McClatchy Washington Bureau, May 13, 2013. Available at: http://www.mcclatchydc.com/2013/05/13/191105/most-doctors-still-reject-medicaid.html

8. Galwitz, P. “Nearly half of U.S. births are covered by Medicaid, study finds.” The Washington Post, September 3, 2013. Available at: http://articles.washingtonpost.com/2013-09-03/national/41716418_1_medicaid-coverage-health-law-state-federal-health-insurance-program

Expenditures Under Medicaid and the Impact of Recession on Medicaid Programs 1. Rowland, D. “Health care and Medicaid – Weathering the recession.” New England Journal of Medicine, 360(13):1273-1276,

2009. http://www.nejm.org/doi/pdf/10.1056/NEJMp0901072 2. Shinkman, R. “Providers may face Medicaid payment cuts in 33 states.” Fierce HealthFinance.com, June 6, 2011. Available at:

http://www.fiercehealthfinance.com/story/providers-may-face-medicaid-payment-cuts-33-states/2011-06-06 3. Morgan, D. “Analysis: Medicaid cuts may limit care for new 2014 enrollees.” Reuters, August 11, 2011. Available at:

http://www.reuters.com/article/2011/08/11/us-usa-health-medicaid-idUSTRE77A5DB20110811

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4*. Galewitz, P., Fleming, M. “13 states cut Medicaid to balance budgets.” Kaiser Health News, July 24, 2012. Available at: http://www.kaiserhealthnews.org/Stories/2012/July/25/medicaid-cuts.aspx

5*. Reuters. “Fewer jobs means more spending on U.S. Medicaid.” May 4, 2012. Available at: http://www.reuters.com/article/2012/05/04/us-usa-states-medicaid-idUSBRE8431IQ20120504

6. Kaiser Commission on Medicaid and the Uninsured. “Medicaid in a historic time of transformation: Results from a 50-state Medicaid budget survey for state fiscal years 2013 and 2014.” The Henry J. Kaiser Family Foundation, October 2013. Available at: http://kff.org/medicaid/report/medicaid-in-a-historic-time-of-transformation-results-from-a-50-state-medicaid-budget-survey-for-state-fiscal-years-2013-and-2014/

Medicaid Contracting with Managed Care Plans 1*. Frakt, A., Carroll, A.E., Pollack, H.A., Reinhardt, U. “Our flawed but beneficial Medicaid program.” New England Journal of

Medicine 364:e31, 2011. http://www.nejm.org/doi/pdf/10.1056/NEJMp1103168 2*. Iglehart, J.K. “Desperately seeking savings: States shift more Medicaid enrollees to managed care.” Health Affairs 30(9):1627-

1629, 2011. http://content.healthaffairs.org/content/30/9/1627.full.pdf+html 3. Galewitz, P. “Health law expected to boost Medicaid enrollees in managed care.” Kaiser Health News, November 12, 2010.

Available at: http://www.kaiserhealthnews.org/Stories/2010/November/12/health-law-medicaid-managed-care.aspx 4*. Forbes. “Benefits and challenges of Medicaid managed care.” October 18, 2012. Available at:

http://www.forbes.com/sites/aroy/2012/10/18/benefits-and-challenges-of-medicaid-managed-care/ 5. Nussbaum, A., Wayne, A. “WellPoint deal shows Medicaid prospects trump court view.” Bloomberg, July 10, 2012. Available

at: http://www.bloomberg.com/news/2012-07-10/wellpoint-deal-shows-medicaid-prospects-trump-court-view.html 6. Thompson, B., McLean, J. “Kansas’ great hope: Managed care will tame Medicaid costs.” Kaiser Health News, February 6, 2013.

Available at: http://www.mcclatchydc.com/2013/05/13/191105/most-doctors-still-reject-medicaid.html 7. American Health Insurance Plans. “Innovations in Medicaid managed care: Highlights of health plans’ programs to improve the

health and well-being of Medicaid beneficiaries.” March 2013. Available at: http://www.ahip.org/MedicaidInnovationsBook/ Policy Proposals for Reforming Medicaid

1*. Sommers, B.D., Epstein, A.E. “Why states are so miffed about Medicaid — Economics, politics, and the “woodwork effect.”” New England Journal of Medicine 365:100-102, 2011. http://www.nejm.org/doi/pdf/10.1056/NEJMp1104948

2. Holahan, J. “Restructuring Medicaid through a swap: An alternative to a block grant.” Urban Institute Health Policy Center, April, 2011. Available at: http://www.urban.org/uploadedpdf/412327-restructuring-medicaid-through-swap.pdf

3*. New York Times Editorial. “The Ryan plan for Medicaid. A good deal for the federal government would be a very bad deal for the states.” May 1, 2011, p. WK.9. http://ic.galegroup.com/ic/suic/NewsDetailsPage/NewsDetailsWindow?failOverType=&query=&prodId=SUIC&windowstate=normal&contentModules=&mode=view&displayGroupName=News&limiter=&currPage=&disableHighlighting=false&displayGroups=&sortBy=&source=&search_within_results=&action=e&catId=&activityType=&scanId=&documentId=GALE%7CA255130314

4. Pecquet, J. “Pending Medicaid rate regulation raises GOP concerns.” The Hill, March 16, 2011. Available at: http://thehill.com/blogs/healthwatch/medicaid/150237-pending-medicaid-rate-regulation-raises-gop-concerns

5. Editorial. “The rush to abandon the poor.” New York Times, July 18, 2012, p. A.26. http://ic.galegroup.com/ic/suic/NewsDetailsPage/NewsDetailsWindow?failOverType=&query=&prodId=SUIC&windowstate=normal&contentModules=&mode=view&displayGroupName=News&limiter=&currPage=&disableHighlighting=false&displayGroups=&sortBy=&source=&search_within_results=&action=e&catId=&activityType=&scanId=&documentId=GALE%7CA296741950

6. Howard, P., Sykes, R. Medicaid is broken—let the states fix it. The Wall Street Journal, October 10, 2012. Available at: http://online.wsj.com/article/SB10000872396390443982904578046161332775362.html

7. Kaiser Commission on Medicaid and the Uninsured. “Emerging Medicaid accountable care organizations: The role of managed care.” May 2012. Available at: http://kaiserfamilyfoundation.files.wordpress.com/2013/01/8319.pdf

8. Hancock, J. “The Arkansas Medicaid model: What you need to know about the ‘private option’.” Kaiser Health News, May 1, 2013. Available at: http://www.kaiserhealthnews.org/stories/2013/may/02/arkansas-medicaid-private-option-faq.aspx’

9. Baker, S. “Republicans propose Medicaid caps.” The Hill, May 1, 2013. Available at: http://thehill.com/blogs/healthwatch/medicaid/297301-republicans-propose-medicaid-caps

10. Takach, M., Buxbaum, J. “Care management for Medicaid enrollees through community health teams.” The Commonwealth Fund, May 21, 2013. Available at: http://www.commonwealthfund.org/Publications/Fund-Reports/2013/May/Care-Management.aspx

PPACA and Medicaid 1. Jost, T.S., Rosenbaum, S. “The Supreme Court and the future of Medicaid.” New England Journal of Medicine online, July 25,

2012. Available at: http://www.nejm.org/doi/pdf/10.1056/NEJMp1208219 2. Frakt, A. “Gaming out the new Medicaid option.” JAMA Forum, July 19, 2012. Available at:

http://newsatjama.jama.com/2012/07/19/gaming-out-the-new-medicaid-option/ 3. Kaiser Health News. “What will the states do on Medicaid?” June 28, 2012. Available at:

http://www.kaiserhealthnews.org/Stories/2012/June/28/what-will-states-do-on-medicaid.aspx 4. Samuelson, R. “The Medicaid albatross.” Real Clear Politics, July 23, 2012. Available at:

http://www.realclearpolitics.com/articles/2012/07/23/the_medicaid_albatross_114865.html

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5. Somashekhar, S. “Medicaid shapes up as major battleground.” Washington Post online, August 14, 2012. Available at: http://www.washingtonpost.com/politics/medicaid-shapes-up-as-major-battleground/2012/08/14/c9b8d164-e592-11e1-8f62-58260e3940a0_story.html

6. Kaiser Commission on Medicaid and the Uninsured. Faces of the Medicaid expansion: Experiences profiles of uninsured adults who could gain coverage. November 2012. Available at: http://www.kff.org/medicaid/8385.cfm

7*. Somashekhar, S. “GOP governors’ endorsements of Medicaid expansion deepen rifts within party.” The Washington Post, June 2, 2013. Available at: http://articles.washingtonpost.com/2013-06-02/national/39697956_1_medicaid-expansion-medicaid-plan-gop-governors

8*. Aizenman, N.C. “Health-care law could backfire for thousands on Medicaid.” The Washington Post, April 6, 2013. Available at: http://articles.washingtonpost.com/2013-04-06/national/38327847_1_medicaid-program-childless-adults-poverty 9. Pear, R. “States’ policies on health care exclude some of the poorest.” The New York Times, May 24, 2013. Available at:

http://www.nytimes.com/2013/05/25/us/states-policies-on-health-care-exclude-poorest.html?pagewanted=all 10. Henneberry, J., Gifford, K.D. “Medicaid expansion: What’s at stake for 2014 and beyond?” National Institute for Health Care

Management, April 2013. Available at: http://www.nihcm.org/images/stories/Medicaid_Expansion_-_Whats_at_Stake_for_2014_and_Beyond.pdf

11. Klein, E. Soltas, E. “Wonkbook: The terrible deal for states rejecting Medicaid.” The Washington Post, June 4, 2013. Available at: http://www.washingtonpost.com/blogs/wonkblog/wp/2013/06/04/wonkbook-the-terrible-deal-for-states-rejecting-medicaid/

12. Kaiser Family Foundation, Kaiser Commission on Medicaid and the Uninsured. “Characteristics of uninsured low-income adults.” August 2012. Available at: http://kff.org/health-reform/fact-sheet/characteristics-of-uninsured-low-income-adults/

13. Wayne, A., Mildenberg, D. “Working poor losing Obamacare as states resist Medicaid.” Bloomberg, June 25, 2013. Available at: http://www.bloomberg.com/news/2013-06-25/working-poor-losing-obamacare-as-states-resist-medicaid.html

14. Kaiser Commission on Medicaid and the Uninsured. “Faces of the Medicaid expansion: Profiles of uninsured adults who could gain coverage.” The Henry J. Kaiser Family Foundation, November 2012. Available at: http://kff.org/health-reform/issue-brief/faces-of-the-medicaid-expansion-experiences-and/

Further Readings

1. Kellermann, A.L., Weinick, R.M. “Emergency departments, Medicaid costs, and access to primary care – understanding the link.” New England Journal of Medicine 366(23): 2141-2143, 2012. http://www.nejm.org/doi/pdf/10.1056/NEJMp1203247

2. Aizenman, N.C. State lawmakers gird for battle over Medicaid. December 2, 2012. Available at: http://articles.washingtonpost.com/2012-12-02/national/35584820_1_medicaid-expansion-medicaid-rolls-state-lawmakers

3. Alfred, R. Medicaid provider to terminate contract with state. October 17, 2012. Available at: http://www.vcstar.com/news/2012/oct/17/medicaid-provider-to-terminate-contract-with/

4. Angeles, J. “How health reform’s Medicaid expansion will impact state budgets.” Center on Budget and Policy Priorities, July 25, 2012. Available at: http://www.cbpp.org/cms/index.cfm?fa=view&id=3801

5. Bernstein, N. With Medicaid, long-term care of elderly looms as a rising cost. The New York Times, September 6, 2012. Available at: http://www.nytimes.com/2012/09/07/health/policy/long-term-care-looms-as-rising-medicaid-cost.html?pagewanted=all&gwh=B1F9D581D1BEFF5095F1E3383662CD14

6. Carey, M.A. “FAQ: Ryan’s plan would make key changes in Medicaid, too.” Kaiser Health News, August 14, 2012. Available at: http://www.kaiserhealthnews.org/Stories/2012/August/15/medicaid-ryan-faq.aspx

7. Cowen, T. The new tug of war over Medicaid. The New York Times July 14, 2012. Available at: http://www.nytimes.com/2012/07/15/business/medicaids-new-tug-of-war-economic-view.html?gwh=E558BF2424118B33B125C6CF5BFBFB79

8. Decker, S.L. “In 2011 nearly one-third of physicians said they would not accept new Medicaid patients, but rising fees may help.” Health Affairs 31(8):1673-1679, 2012. Available at: http://content.healthaffairs.org/content/31/8/1673.full.pdf+html

9. Galewitz, P. “Study: Nearly a third of doctors won’t see new Medicaid patients.” Kaiser Health News, August 6, 2012. Available at: http://www.kaiserhealthnews.org/Stories/2012/August/06/Third-Of-Medicaid-Doctors-Say-No-New-Patients.aspx

10. Galewitz, P. GOP plan would cut Medicaid by $1.7 trillion, study says, KHN Blog, October 23, 2012. Available at: http://capsules.kaiserhealthnews.org/index.php/2012/10/gop-plan-would-cut-medicaid-by-1-7-trillion-study-says/

11. Goodnough, A. “Lines are drawn over opting out of Medicaid plan.” New York Times, July 13, 2012, p. A.1. Available at: http://www.nytimes.com/2012/07/13/health/policy/in-florida-a-fight-brews-over-governors-vow-to-opt-out-of-medicaid-expansion.html?pagewanted=all&_r=0&gwh=773D13624922754D8D4F1BF241A9E670

12. Kenen, J., Norman, B. “Paul Ryan’s Medicaid changes may be bigger.” August 16, 2012. Available at: http://www.politico.com/news/stories/0812/79795.html

13. Levey, N.N. “Medicaid could be scaled back sharply under GOP plans.” Los Angeles Times online, July 30, 2012. Available at: http://www.latimes.com/news/nationworld/nation/la-na-medicaid-rollback-20120731,0,1410769.story

14. Smith, M.D. “The Supreme Court’s Medicaid surprise.” JAMA Forum, July 6, 2012. Available at: http://newsatjama.jama.com/2012/07/06/jama-forum-the-supreme-courts-medicaid-surprise/

15. The New York Times. New York’s Medicaid reforms. September 17, 2012. Available at: http://www.nytimes.com/2012/09/18/opinion/new-yorks-medicaid-reforms.html?gwh=1E20B72A1A0A842EEF8A2F4CE72499F5

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16. Walker, S. “Our obsolete approach to Medicaid.” New York Times, April 22, 2011, p. A.23. Available at: http://www.nytimes.com/2011/04/22/opinion/22walker.html?gwh=51BFB1F675D980918916E7CB149E834F

17. Radnofsky, L., Weaver, C. States seek a middle ground on Medicaid. The Wall Street Journal, September 18, 2012. Available at: http://articles.washingtonpost.com/2012-12-02/national/35584820_1_medicaid-expansion-medicaid-rolls-state-lawmakers

18. Rosenbaum, S. “Medicaid and access to health care – a proposal for continued inaction? New England Journal of Medicine 365(2):102-104. 2011. Available at: http://www.nejm.org/doi/pdf/10.1056/NEJMp1106046

19. Carroll, A. “Don’t cut Medicaid, fund it better.” CNN.com, March 15, 2011. Available at: http://articles.cnn.com/2011-03-15/opinion/carroll.medicaid.budget_1_medicaid-low-income-medicare-beneficiaries-spending?_s=PM:OPINION

20. Galewitz, P. “Insurers clash with health providers as states expand Medicaid managed care.” Kaiser Health News, April 26, 2011. Available at: http://www.kaiserhealthnews.org/Stories/2011/April/27/Insurers-Providers-States-Expand-Medicaid-Managed-Care.aspx

21. Hobson, K. “GPhA report: Generics offer big Medicaid savings opportunity.” Wall Street Journal, July 26, 2010. Available at: http://blogs.wsj.com/health/2010/07/26/gpha-report-generics-offer-big-medicaid-savings-opportunity/

22. Palmeri,C., Wechsler, P. “Medicaid pushes U.S. states off ‘cliff’ as governors seek cuts.” Bloomberg.com, December 21, 2010. Available at: http://www.bloomberg.com/news/2010-12-22/medicaid-demands-push-states-toward-cliff-even-as-governors-cut-benefits.html

23. Sack K. and Pear R. “States consider Medicaid cuts as use grows.” New York Times, February 19, 2010, p.A-1. Available at: http://www.nytimes.com/2010/02/19/us/politics/19medicaid.html?gwh=669AE48751561FC9553D3D323F4EE3A9

24. The Henry J. Kaiser Family Foundation. “Explaining health care reform: questions about Medicaid’s role.” Issue Brief, April 2010. Available at: http://www.kff.org/healthreform/upload/7920-02.pdf

Lesson 9 – March 10-16, 2014 Financing Care for Seniors: Down the Medicare Rabbit Hole Individual Assignment 4 Learning Objectives Students should be able to:

1. Compare the Medicare Trust Funds A and B with respect to the way they are funded and the coverage they provide. 2. Describe the benefit coverage under Medicare and compare it to typical private insurance benefit coverage. 3. Discuss the structure and evolution of Medicaid Part C. 4. Describe how the Medicaid Part D prescription drug benefit is structured. 5. Compare and contrast how hospitals and physicians are paid under Medicare.

Suggested Readings The Structure of the Medicare Program

1*. Henry J. Kaiser Foundation. “Medicare. A primer. 2010. Available at: http://www.kff.org/medicare/upload/7615-03.pdf 2. Henry J. Kaiser Family Foundation. “Health care on a budget. The financial burden of health spending by Medicare households.”

June 2011. Available at: http://kff.org/medicare/issue-brief/health-care-on-a-budget-the-financial-burden-of-health-spending-by-medicare-households/

3. Rosenblatt, B. Understanding Medicare. Figuring out the Part D. market. The Medicare NewsGroup, November 29, 2012. Available at: http://www.medicarenewsgroup.com/context/understanding-medicare-blog/understanding-medicare-blog/2012/11/29/figuring-out-the-part-d-market

4. Brandon, E. “10 things to know about Medicare.” U.S. News & World Report, May 10, 2013. Available at: http://money.msn.com/retirement/10-things-to-know-about-medicare

5. Kaiser Family Foundation. “Medicare spending and financing.” November 2012. Available at: http://kff.org/medicare/fact-sheet/medicare-spending-and-financing-fact-sheet/

6. Hendrickson, M. “Did you really pay for your Medicare benefits?” Forbes, March 7, 2013. Available at: http://www.forbes.com/sites/markhendrickson/2013/03/07/did-you-really-pay-for-your-medicare-benefits/

7. Kaiser Family Foundation. “Medicare advantage 2013 spotlight: Enrollment market update.” June 2013. Available at: http://kaiserfamilyfoundation.files.wordpress.com/2013/06/8448.pdf

8. MSN Money. “Can you opt out of Medicare?.” December 4, 2013. Available at: http://money.msn.com/health-and-life-insurance/article.aspx?post=96174b15-c2cb-44c8-b0a7-71efe5d8d79e

Issues Facing Medicare Hospitals

1. Kenen, J. “Medicare eyes hospice savings.” Politico, October 17, 2011. Available at: http://www.politico.com/news/stories/1011/66177.html

2*. Rau, J. “Medicare to add hospital efficiency, patient safety to payment formula.” KHN Blog, April 24, 2012. Available at: http://capsules.kaiserhealthnews.org/index.php/2012/04/medicare-to-add-hospital-efficiency-patient-safety-to-payment-formula/

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3*. Abelson, R., Creswell, J., Palmer, G.J. Medicare bills rise as records turn electronic. The New York Times, September 21, 2012. Available at: http://www.nytimes.com/2012/09/22/business/medicare-billing-rises-at-hospitals-with-electronic-records.html?pagewanted=all

4. Rau, J. “Medicare spotlights hospitals with especially costly patients. Kaiser Health News, May 9, 2012. Available at: http://www.kaiserhealthnews.org/Stories/2012/May/09/Medicare-Hospitals-Costly-Patients.aspx

5. Rau, J. “Medicare to penalize 2,217 hospitals for excess readmissions.” Kaiser Health News, August 13, 2012. Available at: http://www.kaiserhealthnews.org/Stories/2012/August/13/medicare-hospitals-readmissions-penalties.aspx

6. Rau, J. “Panel tells Congress Medicare is unfairly penalizing hospitals serving the poor.” Kaiser Health News, June 14, 2013. Available at: http://www.kaiserhealthnews.org/stories/2013/june/14/medpac-hospital-readmissions-poor-congress.aspx

7*. Pear, R., Abelson, R. “Hospitals fear they’ll bear brunt of Medicare cuts.” The New York Times, December 18, 2012. Available at: http://www.nytimes.com/2012/12/19/business/medicare-cuts-how-deep-and-where.html?ref=business&_r=1&

8. Goldhill, D. “The high costs of Medicare’s low prices.” The Washington Post, March 10, 2013. Available at: http://articles.washingtonpost.com/2013-03-10/opinions/37605696_1_medicare-beneficiaries-private-insurers-health-care

9. Kowalczyk, L. “Hospital charges bring a backlash.” The Boston Globe, March 11, 2013. Available at: http://www.bostonglobe.com/lifestyle/health-wellness/2013/03/10/patients-surprised-high-medical-bills-challenge-hospital-overhead-charges/EY2x6jKTiPLiGXpSCyskKM/story.html

Physicians 1. Carey, M.A. “FAQ: The ‘doc fix’ dilemma.” Kaiser Health News, February 17, 2012. Available at:

http://www.kaiserhealthnews.org/stories/2011/december/15/faq-doc-fix.aspx 2. Ornstein, C., Weber, T., LaFleur, J. “Medicare’s failure to track doctors wastes billions on name-brand drugs.” ProPublica,

November 18, 2013. Available at: http://www.propublica.org/article/medicare-wastes-billions-on-name-brand-drugs 3*. McClellan, M. “Medicare physician payment reform: The bipartisan congressional proposal and how to strengthen it.” Health

Affairs Blog, November 12, 2013. Available at: http://healthaffairs.org/blog/2013/11/12/medicare-physician-payment-reform-the-bipartisan-congressional-proposal-and-how-to-strengthen-it/

4. Schulte, F., Eaton, J., Donald, D. Doctors, others billing Medicare at higher rates. The Washington Post, September 15, 2012. Available at: http://articles.washingtonpost.com/2012-09-15/national/35496252_1_data-codes-medicare

5*. Carey, M.A. “FAQ on Medicare doctor pay: Why is it so hard to fix?” Kaiser Health News, February 10, 2013. Available at: http://www.kaiserhealthnews.org/stories/2011/december/15/faq-doc-fix.aspx

6. Kliff, S. “Obama’s new fiscal cliff offer would repeal the ‘doc-fix’.” The Washington Post, December 18, 2012. Available at: http://www.washingtonpost.com/blogs/wonkblog/wp/2012/12/18/obamas-new-fiscal-cliff-offer-would-repeal-the-doc-fix/

7. Pittman, D. “Uniform quality measures sought for an SGR repeal.” MedPage Today, May 7, 2013. Available at: http://www.medpagetoday.com/PracticeManagement/Reimbursement/38959

8. Baker, S. “GOP floats permanent ‘doc-fix’ bill.” The Hill, May 28, 2013. Available at: http://thehill.com/blogs/healthwatch/medicare/302165-gop-floats-permanent-doc-fix-bill

9. Hensley, S. “Doctors fleeing Medicare? Not so fast, feds say.” npr, August 23, 2013. Available at: http://www.npr.org/blogs/health/2013/08/23/214894592/doctors-fleeing-medicare-not-so-fast-feds-say

10. Schwartz, A.Y. “Fix the ‘doc fix’ for good.” The Hill, July 31, 2013. Available at: http://thehill.com/blogs/congress-blog/healthcare/314827-fix-the-doc-fic-for-good

11. Beck, M. “More doctors steer clear of Medicare.” The Wall Street Journal, July 29, 2013. Available at: http://online.wsj.com/news/articles/SB10001424127887323971204578626151017241898

Pharmaceuticals and Devices 1. “Medical equipment prices highlight some of Medicare’s difficulties,” July 21, 2009. Available at:

http://www.medicalnewstoday.com/articles/158369.php 2. “Specialty drugs force high Medicare out-of-pocket costs.” March, 2010. Available at: http://www.advfn.com/news_Specialty-

Drugs-Force-High-Medicare-Out-Of-Pocket-Costs_41779029.html 3. Jaffe, S. “Strange pricing details can bedevil Medicare beneficiaries.” Kaiser Health News Blog, November 13, 2013. Available

at: http://capsules.kaiserhealthnews.org/index.php/2013/11/strange-pricing-details-can-bedevil-medicare-beneficiaries/ 4*. Jaffee, S. “Seniors cautioned to pay close attention to details as enrollment begins in Medicare plans.” Kaiser Health News,

October 15, 2013. Available at: http://www.kaiserhealthnews.org/stories/2013/october/15/medicare-open-enrollment-begins.aspx 5*. Hoadley, J. “Medicare Part D spending trends: Understanding key drivers and the role of competition.” KFF Medicare Policy Issue Brief, May, 2012. Available at: http://www.kff.org/medicare/upload/8308.pdf

Health Plans 1*. Gold, M. “Medicare Advantage: Facts, fallacies, and the future.” Health Affairs Blog, March 14, 2011. Available at: http://healthaffairs.org/blog/2011/03/14/medicare-advantage-facts-fallacies-and-the-future 2. Kliff, S. Does Medicare Advantage cost less? Or does it cost more? The Washington Post, August 22, 2012. Available at:

http://www.washingtonpost.com/blogs/wonkblog/wp/2012/08/22/does-medicare-advantage-cost-less-or-does-it-cost-more/ 3. Antonio, J. “Medicare advantage customers value quality over price.” FierceHealthPayer, November 13, 2013. Available at:

http://www.fiercehealthpayer.com/story/medicare-advantage-customers-value-quality-over-price/2013-11-13

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4. Baker, S. “Insurers ready to battle Medicare cuts.” The Hill, March 6, 2013. Available at: http://thehill.com/blogs/healthwatch/medicare/286419-insurers-ready-to-battle-medicare-cuts

5. Pittman, D. “More $$$ going to Medicare advantage plans.” MedPage Today, April 2, 2013. Available at: http://www.medpagetoday.com/PublicHealthPolicy/Medicare/38202

6. Norman, B., Haberkorn, J. “CMS reverses course on cuts.” Politico, April 3, 2013. Available at: http://www.politico.com/story/2013/04/insurance-medicare-advantage-cuts-health-care-89569.html

7. “The liberal Medicare advantage revolt.” The Wall Street Journal, March 29, 2013. Available at: http://online.wsj.com/article/SB10001424127887323501004578388980625858300.html

8. Garland, E. “Avalere analysis reveals first drop in Medicare Advantage offerings since 2011.” Avalere, September 23, 2013. Available at: http://avalerehealth.net/news/avalere-analysis-reveals-first-drop-in-medicare-advantage-offerings-since-2

9. Clark, C. “CMS sets 2014 pay rates for hospital outpatient and physician services.” HealthLeaders Media, December 2, 2013. Available at: http://www.healthleadersmedia.com/content/FIN-298845/CMS-Sets-2014-Pay-Rates-for-Hospital-Outpatient-and-Physician-Services.html

10. Health Affairs. “Next steps for ACOs.” Health Policy Brief, January 31, 2012. Available at: https://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=61

Further Readings

1. Congressional Budget Office. “CBO’s May 2013 Medicare baseline.” May 14, 2013. Available at: http://www.cbo.gov/sites/default/files/cbofiles/attachments/44205_Medicare_0.pdf

2. Overland, D. “Medicare advantage poised for strong membership growth.” FierceHealthPayer, May 17, 2013. Available at: http://www.fiercehealthpayer.com/story/medicare-advantage-plans-see-50-increase-membership/2013-05-17

3. Kaiser Family Foundation: “Medigap: Spotlight on enrollment, premiums, and recent trends.” April 2013. Available at: http://kff.org/medicare/report/medigap-enrollment-premiums-and-recent-trends/

4. Wayne, A. “Humana rises as U.S. reverses Medicare rate cut decision.” Bloomberg, April 2, 2013. Available at: http://www.bloomberg.com/news/2013-04-01/humana-among-insurers-winning-u-s-medicare-payment-rise.html

5. Government Accountability Office. Medicare physician payment: Private-sector initiatives can help inform CMS quality and efficiency incentive efforts.” December 26, 2012. Available at: http://www.gao.gov/products/GAO-13-160

6. Lowes, R. “Bill would repeal SGR, phase out Medicare fee-for-service.” Medscape News, May 9, 2012. Available at: http://www.medscape.com/viewarticle/763589?src=mpnews&spon=16

7. Bloomberg. AMA, physician groups outline payment reforms to finance committee. October 17, 2012. Available at: http://www.bna.com/ama-physician-groups-n17179870268/

8. Rau, J. Are Medicare’s new quality incentives large enough to change hospital behavior? Kaiser Health News, September 4, 2012. Available at: http://www.kaiserhealthnews.org/Stories/2012/September/04/incentives-on-hospital-quality

9. Hancock, J. How is your Medicare drug plan like your cable company? KHN Blog, September 12, 2012. Available at: http://capsules.kaiserhealthnews.org/index.php/2012/09/how-is-your-medicare-drug-plan-like-your-cable-company/

10. Greene, K. Lowering your Medicare bill. Wall Street Journal, October 26, 2012. Available at: http://online.wsj.com/article/SB10001424052970203937004578077293381706414.html

11. Marte, J. Medicare open-enrollment: Find the right drug plan. The Wall Street Journal, October 13, 2012. Available at: http://articles.marketwatch.com/2012-11-08/finance/34421801_1_coverage-gap-medicare-plans-drug-plans

12. Pew Research Center. Medicare voucher plan remains unpopular. August 21, 2012. Available at: http://www.people-press.org/2012/08/21/medicare-voucher-plan-remains-unpopular/

13. Porter, E. Rationing health care more fairly. The New York Times, August 21, 2012. Available at: http://www.nytimes.com/2012/08/22/business/economy/rationing-health-care-more-fairly.html?pagewanted=all

14. Tran, A. Seniors satisfied with Medicare, anxious about future, survey finds. KHN Blog, October 18, 2012. Available at: http://capsules.kaiserhealthnews.org/index.php/2012/10/seniors-satisfied-with-medicare-anxious-about-future-survey-finds/

15. Miller, M. The real Medicare villain. The Washington Post, August 24, 2012. Available at: http://articles.washingtonpost.com/2012-08-24/opinions/35493016_1_health-care-rich-nations-medicare

16. Feder, J., Zuckerman, S., Lallemand, N.C., Biles, B. Why premium support? Restructure Medicare Advantage, not Medicare. Urban Institute, September 2012. Available at: http://www.urban.org/UploadedPDF/412662-Why-Premium-Support-Restructure-Medicare-Advantage-Not-Medicare.pdf

17. Davis, K., Stremikis, K., Doty, M.M., Zezza, M.A. “Medicare beneficiaries less likely to experience cost- and access-related problems than adults with private coverage.” Health Affairs 31(8):1866-1875, 2012. Available at: http://content.healthaffairs.org/content/31/8/1866.full.pdf+html

18. Rau, J. “Hospitals’ readmission rates still too high, government says.” Washington Post online, July 19, 2012. Available at: http://www.washingtonpost.com/politics/hospitals-readmission-rates-still-too-high-government-says/2012/07/19/gJQAZIqdwW_story.html

19. Viebeck, El. “lawmakers propose a permanent ‘doc fix’.” The Hill, May 9, 2012. Available at: http://thehill.com/blogs/healthwatch/medicare/226413-reps-propose-a-permanent-doc-fix-

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20. Klepper, B. “A legal challenge to CMS’ reliance on the RUC.” Health Affairs Blog, August 9, 2011. Available at: http://healthaffairs.org/blog/2011/08/09/a-legal-challenge-to-cms-reliance-on-the-ruc/

21. Alonso-Zaldivar, R. “AP newsbreak: Medicare’s drug coverage gap shrinks.” YAHOO News, November 27, 2011. Available at: http://news.yahoo.com/ap-newsbreak-medicares-drug-coverage-gap-shrinks-140356865.html

22. Kaiser Health News. “With rate cut looming, doctors threaten to stop accepting Medicare patients.” February 26, 2010. Available at: http://www.kaiserhealthnews.org/Daily-Reports/2010/February/26/Medicare-Cuts-and-Other-Payment-Issues.aspx

23. Appleby, J. “Administration unexpectedly expands bonus payments for Medicare Advantage plans.” Kaiser Health News, November 16, 2010. Available at: http://www.kaiserhealthnews.org/Stories/2010/November/16/Medicare-Advantage-bonuses.aspx

24. Bott, D.M., Kapp, M.C., Johnson, L.B., Magno, L.M. “Disease management for chronically ill beneficiaries in traditional Medicare.” Health Affairs 28(1):86-98, 2009. Available at: http://content.healthaffairs.org/content/28/1/86.full.pdf+html

25. Hargrave, E., Hoadley, J., Thompson, J. “Coverage and pricing of drugs that can be covered under Part B and Part D.” MedPAC, October 2007. Available at: http://www.medpac.gov/documents/Oct07_PartB_D_contractor_JS.pdf

26. Altman, D. “The new Medicare prescription-drug legislation,” New England Journal of Medicine 350(1): 9-10, 2004. Available at: http://www.nejm.org/doi/pdf/10.1056/NEJMp038224

Medicare: A Program at the Brink Learning Objectives Students should be able to:

1. Discuss the challenges that enrollment growth poses for Medicare. 2. Describe proposals for Medicare reform. 3. Explain how health reform and the growing federal government debt could affect Medicare.

Suggested Readings The Medicare Solvency Issue

1. Pizzi, R. “Chronic conditions drive Medicare spending growth.” February 18, 2010. Available at: http://www.healthcarefinancenews.com/news/chronic-conditions-drive-medicare-spending-growth

2. Galewitz, P., Carey, M.A. “Gloomier-than-expected forecast for Medicare.” Kaiser Health News, May 13, 2011. Available at: http://www.kaiserhealthnews.org/Stories/2011/March/13/medicare-trustees-report-2024.aspx

3*. Serafini, M.W. “An even bleaker prognosis for Medicare?” KHN Blog, April 24, 2012. Available at: http://capsules.kaiserhealthnews.org/index.php/2012/04/an-even-bleaker-prognosis-for-medicare/

4*. Wasson, E., Baker S. “Medicare on track for insolvency in 2026, Social Security seven years later.”. The Hill, May 31, 2013. Available at: http://thehill.com/blogs/on-the-money/budget/302719-social-security-insolvent-by-2033

5. Goodman, J.C., Kotlikoff, “Medicare by the scary numbers.” The Wall Street Journal, June 24, 2013. Available at: http://online.wsj.com/article/SB10001424127887323393804578555461959256572.html

6. Lawrence B.R. “The illusion of health-care ‘trust funds.’” The Washington Post, October 18, 2012. Available at: http://articles.washingtonpost.com/2012-10-18/opinions/35502037_1_trust-fund-medicare-trustees-health-care

7. Stern, L., Heavey, S. “Insight: What if baby boomers don’t live forever?” Reuters, August 14, 2012. Available at: http://www.reuters.com/article/2012/08/14/us-usa-babyboomers-life-expectancy-idUSBRE87D0ZT20120814

8. American Action Forum. “Primer: The sustainable growth rate.” December 4, 2013. Available at: http://americanactionforum.org/research/primer-the-sustainable-growth-rate

The Impact of Health Reform on Medicare 1. Kliff, S. “Romney’s right: Obamacare cuts Medicare by $716 billion. Here’s how.” Washington Post online, August 14, 2012.

Available at: http://www.washingtonpost.com/blogs/ezra-klein/wp/2012/08/14/romneys-right-obamacare-cuts-medicare-by-716-billion-heres-how/

2. Pasternak, S. “End-of-life care constitutes third rail of U.S. health care policy debate.” Medicare Newgroup, June 3, 2013. Available at: http://medicarenewsgroup.com/context/understanding-medicare-blog/understanding-medicare-blog/2013/06/03/end-of-life-care-constitutes-third-rail-of-u.s.-health-care-policy-debate

Medicare and the Federal Budget 1. Goldstein, A. “Medicare funds to last longer than earlier forecast, report says.” The Washington Post, August 6, 2010. p. A.6.

http://www.washingtonpost.com/wp-dyn/content/article/2010/08/05/AR2010080500643.html 2. Cohn, J. “GOP budget: Time travel back to when seniors couldn’t afford health care — guest opinion.” Kaiser Health News, April

26, 2011. Available at: http://www.kaiserhealthnews.org/Columns/2011/April/042611cohn.aspx 3. Pear, R. “Agreement on debt talks: Health groups dislike proposals.” New York Times online, July 12, 2011. Available at:

http://www.nytimes.com/2011/07/13/us/politics/13health.html 4. Klein, E. “Paul Ryan’s budget keeps Obama’s Medicare cuts. Full stop.” Washington Post online, August 14, 2012. Available

at: http://www.washingtonpost.com/blogs/ezra-klein/wp/2012/08/14/ryans-budget-keeps-obamas-medicare-cuts-full-stop/

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5. Fairchild, C. “Simpson says Medicare to squeeze out government spending.” Bloomberg.com, August 13, 2012. Available at: http://www.bloomberg.com/news/2012-08-13/simpson-says-medicare-to-squeeze-out-government-spending.html

6*. Serafini, M.W. “FAQ: Obama v. Ryan on controlling federal Medicare spending.” Kaiser Health News, May 3, 2012. Available at: http://www.kaiserhealthnews.org/stories/2012/may/04/obama-ryan-controlling-federal-medicare-spending-faq.aspx 7*. Carey, M.A. “FAQ: Decoding the $716 billion in Medicare reductions.” Kaiser Health News, August 17, 2012. Available at: http://www.kaiserhealthnews.org/stories/2012/august/17/faq-716-billion-medicare-reductions.aspx 8. Carey, M.A. “3 hill panels examining changes to Medicare.” Kaiser Health News, February 25, 2013. Available at:

http://capsules.kaiserhealthnews.org/?p=17172 9. Reinhardt, U.E. “Medicare spending isn’t out of control.” The New York Times, December 21, 2012. Available at:

http://economix.blogs.nytimes.com/2012/12/21/medicare-spending-isnt-out-of-control/?_r=0 10*. Kaiser Family Foundation. “Medicare and the federal budget: Comparison of Medicare provisions in recent federal debt and deficit reduction proposals.” March 2013. Available at: http://kaiserfamilyfoundation.files.wordpress.com/2013/04/8124-02-2.pdf 11. Tyson, L.D. “Evidence vs. ideology in the Medicare debate.” The New York Times, August 24, 2012. Available at:

http://economix.blogs.nytimes.com/2012/08/24/evidence-vs-ideology-in-the-medicare-debate/?_r=0 Alternatives for Medicare Reform

1. Wilensky, G.R. “Reforming Medicare — Toward a modified Ryan plan.” New England Journal of Medicine 364:1890-1892, 2011. http://www.nejm.org/doi/pdf/10.1056/NEJMp1104425

2*. Rosenthal, M.B. “Hard choices — Alternatives for reining in Medicare and Medicaid spending.” New England Journal of Medicine 364: 1887-1890, 2011. http://www.nejm.org/doi/pdf/10.1056/NEJMp1104428

3. Appleby, J., Carey, M.A., McGinley, L. “CBO: Seniors would pay much more for Medicare under Ryan plan.” Kaiser Health News, April 5, 2011. Available at: http://www.kaiserhealthnews.org/Stories/2011/April/06/CBO-Seniors-Pay-More-Medicare-Ryan-Plan.aspx

4. Cohn, J. “Analysis: Medicare, liberals and the lesser of two evils.” Kaiser Health News, August 15, 2011. Available at: http://www.kaiserhealthnews.org/Stories/2011/August/15/medicare-super-committee-cohn-analysis.aspx

5. Miller, M. “Paul Ryan’s path to nowhere.” Washington Post online, March 21, 2012. Available at: http://www.washingtonpost.com/opinions/paul-ryans-budget-to-nowhere/2012/03/21/gIQAe8qYRS_story.html

6. Samuelson, R.J. “Flunking the Medicare debate.” Washington Post online, March 21, 2012. Available at: http://www.washingtonpost.com/opinions/how-partisan-language-poisons-the-medicare-debate/2012/03/21/gIQARTtwRS_story.html

7. Antos, J. “The Ryan plan: The cliffs notes version of Republican health reform.” Health Affairs Blog, March 21, 2012. Available at: http://healthaffairs.org/blog/2012/03/21/the-ryan-plan-the-cliffs-notes-version-of-republican-health-reform/

8*. Serafini, M.W. “FAQ: How Paul Ryan proposes to change Medicare.” Kaiser Health News, August 11, 2012. Available at: http://www.kaiserhealthnews.org/stories/2012/august/11/faq-paul-ryan-house-republican-medicare-plan.aspx?referrer=search

9. Brookings Institute. “Why the Medicare fight matters to Americans over 55.” August 20, 2012. Available at: http://www.brookings.edu/research/opinions/2012/08/20-ryan-medicare-aaron

10. Orszag, P.R. “Paul Ryan is thoughtful, handsome and misguided.” Bloomberg.com, August 11, 2012. Available at: http://www.bloomberg.com/news/2012-08-11/paul-ryan-is-thoughtful-handsome-and-misguided.html

11. Gruber, J. “Proposal 3: Restructuring cost sharing and supplemental insurance for Medicare.” In: Greenstone, M., Harris, M., Li, K., Adam Looney, Patashnik, J. (eds.) 15 Ways to Rethink the Federal Budget. Brookings, February 2013, pp. 23-26. Available at: http://www.brookings.edu/~/media/research/files/papers/2013/02/thp%20budget%20papers/thp_15waysfedbudget_prop3.pdf

12. Berenson, R., Holahan, J., Zuckerman, S. “Can Medicare be preserved while reducing the deficit? Timely analysis of immediate health policy issues.” Urban Institute, March 2013. Available at: http://www.urban.org/UploadedPDF/412759-Can-Medicare-Be-Preserved-While-Reducing-the-Deficit.pdf

13. Guterman, S., Zezza, M.A., Schoen, C. “Paying for value: Replacing Medicare’s sustainable growth rate formula with incentives to improve care.” The Commonwealth Fund Issue Brief, March 2013. Available at: http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2013/Mar/1678_Guterman_paying_for_value_ib.pdf

14. Rau, J. “IOM panel raises concerns about lowering Medicare pay for high spending areas.” Kaiser Health News, March 22, 2013. Available at: http://www.kaiserhealthnews.org/Stories/2013/March/22/IOM-panel-pans-idea-of-lowering-Medicare-pay-to-high-spending-areas.aspx?p=1

15. Emanuel, E.J., Liebman, J.B. “Cut Medicare, help patients.” The New York Times, August 22, 2011. Available at: http://www.nytimes.com/2011/08/23/opinion/cut-medicare-help-patients.html?pagewanted=all&_r=0

16. Gregg, J. “Opinion: A way out of the Medicare maze.” The Hill, April 8, 2013. Available at: http://thehill.com/opinion/columnists/judd-gregg/292237-opinion-a-way-out-of-the-medicare-maze

17. Viebeck, E. “Unified Medicare benefit would save billions, study says.” The Hill, May 6, 2013. Available at: http://thehill.com/blogs/healthwatch/medicare/298019-unified-medicare-benefit-would-save-billions-study-says

18. Davis, K., Schoen, C., Guterman, S. “Medicare essential: An option to promote better care and curb spending growth.” The Commonwealth Fund, May 6, 2013. Available at: http://www.commonwealthfund.org/Publications/In-the-Literature/2013/May/Medicare-Essential.aspx

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19. McArdle, M. “Who should set Medicare prices?” Bloomberg, July 29, 2013. Available at: http://www.bloomberg.com/news/2013-07-29/who-should-set-medicare-prices-.html

20. Eaton J. “How the other Washington may hold the key to the Medicare cost crisis.” Kaiser Health News, July 29, 2013. Available at: http://www.kaiserhealthnews.org/stories/2013/july/29/lessons-from-washington-state-for-medicare.aspx

Prospects for Near Term Changes in Medicare 1. Serafini, M.W. “AARP arming for Medicare battle.” Kaiser Health News, March 19, 2012. Available at:

http://www.kaiserhealthnews.org/stories/2012/march/19/aarp-medicare-battle.aspx?referrer=search 2. Calmes, J., Pear, R. “Talk of Medicare changes could open way to budget pact.” The New York Times, March 28, 2013.

Available at: http://www.nytimes.com/2013/03/29/us/politics/common-ground-in-washington-for-medicare-changes.html?pagewanted=all

3*. Porter, E. “Medicare needs fixing, but not right now.” The New York Times, February 26, 2013. Available at: http://www.nytimes.com/2013/02/27/business/medicare-needs-fixing-but-not-right-now.html?pagewanted=all 4. Editorial. “Raising Medicare age creates more problems.” Shreveport Times, March 25, 2013. Available at:

http://www.shreveporttimes.com/article/D2/20130326/OPINION03/303260056 5. Edsall, T.B. “The war on entitlements.” The New York Times, March 6, 2013. Available at:

http://opinionator.blogs.nytimes.com/2013/03/06/the-war-on-entitlements/ 6. Harwood, J. “A complex role for Medicare in the standoff in Washington.” The New York Times, February 24, 2013. Available at:

http://www.nytimes.com/2013/02/25/us/politics/medicare-is-at-the-heart-of-the-fiscal-fight.html?pagewanted=all 7. Levin, Y. “Old and rich? Less help for you.” The New York Times, February 19, 2013. Available at:

http://www.nytimes.com/2013/02/20/opinion/old-and-rich-less-help-for-you.html?gwh 8. Holzer, H.J., Sawhill, I. “Payments to elders are harming our future.” The Washington Post, March 8, 2013. Available at:

http://articles.washingtonpost.com/2013-03-08/opinions/37561450_1_federal-budget-entitlement-programs-debt-to-gdp-ratio 9. Hiltzik, M. “The five biggest lies about entitlement programs.” Los Angeles Times, March 8, 2013. Available at:

http://articles.latimes.com/2013/mar/08/business/la-fi-hiltzik-20130310 10. White, C. “Medicare spending limits: Issues and implications.” KKF Issue Brief, March 2013. Available at:

http://kaiserfamilyfoundation.files.wordpress.com/2013/03/8428.pdf 11*. Carey, M.A. “Five ways the President’s budget would change Medicare.” Kaiser Health News, April 15, 2013. Available at: http://www.kaiserhealthnews.org/stories/2013/april/15/medicare-and-obama-budget.aspx

Further Readings

1. Taylor, A.. “CBO: Deficit estimate for 2012 hiked to $1.2T after payroll tax cut, jobless benefits.” YAHOO News, March 13, 2012. Available at: http://news.yahoo.com/cbo-deficit-estimate-2012-hiked-1-2t-192323423.html

2. Klein, E. “The GOP’s Medicare confusion.” The Washington Post, November 29, 2012. Available at: http://www.washingtonpost.com/blogs/wonkblog/wp/2012/11/29/the-gops-medicare-confusion/

3. Krugman, P. “Republicans and Medicare.” New York Times, February 12, 2010. p. A.31. Available at: http://ic.galegroup.com/ic/suic/NewsDetailsPage/NewsDetailsWindow?failOverType=&query=&prodId=SUIC&windowstate=normal&contentModules=&mode=view&displayGroupName=News&limiter=&currPage=&disableHighlighting=false&displayGroups=&sortBy=&source=&search_within_results=&action=e&catId=&activityType=&scanId=&documentId=GALE%7CA218792481

4. Newhouse, J.P., Garber, A.M. “Geographic variation in Medicare services.” New England Journal of Medicine 368(16):1465-1468, 2013. Available at: http://www.nejm.org/doi/pdf/10.1056/NEJMp1302981

5. Huesch, M. “How ideas from private industry help combat Medicare fraud, waste, and abuse.” Health Affairs Blog, May 23, 2013. Available at: http://healthaffairs.org/blog/2013/05/23/how-ideas-from-private-industry-help-combat-medicare-fraud-waste-and-abuse/

VII. Evaluation and Grading Grades will be determined based on four group assignments (20 points each), four individual assignments (20 points each) and one group summary posted on the course website (40 points). The student will receive a grade of zero on any assignment not submitted as scheduled, unless prior arrangements have been made for late submission. Grading Scale An A/F letter grade will be determined based on the following:

A=93-100% Represents outstanding achievement relative to the level necessary to meet course requirements

A- = 90-92.99%

B+ = 87-89.99%

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B = 83-86.99% Represents achievement that is significantly above the level necessary to meet course requirements

B- = 80-82.99%

C+ = 77-79.99%

C = 73-76.99% Represents achievement that meets the minimum course requirements

C- = 70-72.99%

D+ = 65-69.99%

D = 60-64.99%

F = < 59.99% No credit. Signifies work was below level of achievement that represents minimum threshold to obtain credit or work was not completed and there was no agreement between instructor and student that the student would be awarded an I.

The instructor reserves the right to adjust final grades “upward” based on the overall distribution of points for the class. That is, students may receive a higher grade than expected based on their overall point total, but not a lower grade. Course Evaluation The SPH collects student course evaluations electronically using a software system called CoursEval: www.sph.umn.edu/courseval. The system will send email notifications to students when they can access and complete their course evaluations. Students who complete their course evaluations promptly will be able to access their final grades just as soon as the faculty member renders the grade in SPHGrades: www.sph.umn.edu/grades. All students will have access to their final grades through OneStop two weeks after the last day of the semester regardless of whether they completed their course evaluation or not. Student feedback on course content and faculty teaching skills are an important means for improving our work. Please take the time to complete a course evaluation for each of the courses for which you are registered.

Incomplete Contracts A grade of incomplete “I” shall be assigned at the discretion of the instructor when, due to extraordinary circumstances (e.g., documented illness or hospitalization, death in family, etc.), the student was prevented from completing the work of the course on time. The assignment of an “I” requires that a contract be initiated and completed by the student before the last official day of class, and signed by both the student and instructor. If an incomplete is deemed appropriate by the instructor, the student in consultation with the instructor, will specify the time and manner in which the student will complete course requirements. Extension for completion of the work will not exceed one year (or earlier if designated by the student’s college). For more information and to initiate an incomplete contract, students should go to SPHGrades at: www.sph.umn.edu/grades. University of Minnesota Uniform Grading and Transcript Policy A link to the policy can be found at onestop.umn.edu.

VIII. Other Course Information and Policies Grade Option Change (if applicable) For full-semester courses, students may change their grade option, if applicable, through the second week of the semester. Grade option change deadlines for other terms (i.e. summer and half-semester courses) can be found at onestop.umn.edu. Course Withdrawal Students should refer to the Refund and Drop/Add Deadlines for the particular term at onestop.umn.edu for information and deadlines for withdrawing from a course. As a courtesy, students should notify their instructor and, if applicable, advisor of their intent to withdraw. Students wishing to withdraw from a course after the noted final deadline for a particular term must contact the School of Public Health Student Services Center at sph-ssc@umn.edu for further information.

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Student Conduct, Scholastic Dishonesty and Sexual Harassment Policies Students are responsible for knowing the University of Minnesota, Board of Regents' policy on Student Conduct and Sexual Harassment found at www.umn.edu/regents/polindex.html. Students are responsible for maintaining scholastic honesty in their work at all times. Students engaged in scholastic dishonesty will be penalized, and offenses will be reported to the SPH Associate Dean for Academic Affairs who may file a report with the University’s Academic Integrity Officer. The University’s Student Conduct Code defines scholastic dishonesty as “plagiarizing; cheating on assignments or examinations; engaging in unauthorized collaboration on academic work; taking, acquiring, or using test materials without faculty permission; submitting false or incomplete records of academic achievement; acting alone or in cooperation with another to falsify records or to obtain dishonestly grades, honors, awards, or professional endorsement; or altering, forging, or misusing a University academic record; or fabricating or falsifying of data, research procedures, or data analysis.” Reference: “a mention or citation of a source of information in a book or article” (Compact Oxford English Dictionary, 2012) Citation: “a quotation from or reference to a book, paper, or author, especially in scholarly work” (Compact Oxford English Dictionary, 2012) Quotation: “a group of words taken from a text or speech and reported by someone other than the original author or speaker” (Compact Oxford English Dictionary, 2012) Plagiarism: “the process of taking another person’s work, ideas, or words, and using them as if they were your own” (Macmillan Dictionary, 2012) You will be asked to review a variety of sources of information when completing assignments for this course. It is important that you acknowledge these sources of information appropriately in your written assignments and verbal presentations. If you are quoting a source directly (using the words in the source, not your words) you must indicate this by using quotation marks, as in the definitions above, and by including a citation to the reference from which the quote was extracted. There is nothing wrong with including quotes in your assignments, but you are expected to put them in quotation marks and cite them appropriately. If you use the words of someone else, but do not put them in quotation marks, this is called plagiarism (even if you include a citation), and it violates the University’s academic code. Essentially, you are saying that you wrote these words, when that isn’t true, so you are lying to your instructor and classmates. In addition to using citations for quotations, you should use citations in the text to indicate instances where you have drawn on specific works of others in framing your answer or arguments. In using citations for this purpose, you acknowledge that the thoughts are not entirely yours, even though you may have expressed them in your own words. You should include a reference list at the end of your assignment. This list should include a complete description of all citations included in the text. References 1. Compact Oxford English Dictionary, Oxford University Press, 2012, http://oxforddictionary.com/definition/english (accessed on

August 21, 2012). 2. MacMillan Dictionary, 2012, http://www.macmillandictionary.com/dictionary/american (accessed on August 21, 2012). Plagiarism is an important element of this policy. It is defined as the presentation of another's writing or ideas as your own. Serious, intentional plagiarism will result in a grade of "F" or "N" for the entire course. For more information on this policy and for a helpful discussion of preventing plagiarism, please consult University policies and procedures regarding academic integrity: http://writing.umn.edu/tww/plagiarism/. Students are urged to be careful that they properly attribute and cite others' work in their own writing. For guidelines for correctly citing sources, go to http://tutorial.lib.umn.edu/ and click on “Citing Sources”. In addition, original work is expected in this course. Unless the instructor has specified otherwise, all assignments, papers, reports, etc. should be the work of the individual student. It is unacceptable to hand in assignments for this course for which you receive credit in another course unless by prior agreement with the instructor. Building on a line of work begun in another course or leading to a thesis, dissertation, or final project is acceptable. Disability Statement It is University policy to provide, on a flexible and individualized basis, reasonable accommodations to students who have a documented disability (e.g., physical, learning, psychiatric, vision, hearing, or systemic) that may affect their ability to participate in course activities or to meet course requirements. Students with disabilities are encouraged to contact Disability Services to have a confidential discussion of their individual needs for accommodations. Disability Services is located in Suite180 McNamara Alumni Center, 200 Oak Street. Staff can be reached by calling 612/626-1333 (voice or TTY).

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Mental Health Services: As a student you may experience a range of issues that can cause barriers to learning, such as strained relationships, increased anxiety, alcohol/drug problems, feeling down, difficulty concentrating and/or lack of motivation. These mental health concerns or stressful events may lead to diminished academic performance or reduce a student’s ability to participate in daily activities. University of Minnesota services are available to assist you with addressing these and other concerns you may be experiencing. You can learn more about the broad range of confidential mental health services available on campus via www.mentalhealth.umn.edu.