Nationwide, about one in four Medicare patients hospitalized for heart failure is readmitted within a month of being discharged. The feds started reporting the figures for individual hospitals online earlier this year — a move that Joseph Ross, a geriatrician at Mount Sinai in New York, hopes will push hospitals to drive the rate down.

“We don’t know whether patients are going to pay attention,” Ross told the Health Blog. “But we do know that hospital administrators and physicians pay attention.”

Ross was part of the team that helped the feds figure out how to adjust the data to account for factors like varying patient populations, in an effort to allow fair comparisons between hospitals. We gave him a call this afternoon because he has a paper out today in a journal called Circulation: Heart Failure looking at readmission rates for Medicare patients in the middle of this decade. (Turns out, the rates were basically the same as they were during the more recent period captured in the public reporting).

As the WSJ reported earlier this year, hospitals that have tried to drive their rates down have figured out that the key is following patients after they go home — helping them stick to a healthy diet, sort out their meds, get in to the doctor’s office for regular visits, that sort of thing. Ross told us that his department at Mount Sinai now sends a doctor, a nurse and a social worker to meet with patients before they’re discharged, to help them sort out their plan for staying healthy.

“The challenge with all of these programs is they’re not reimbursed, so it’s up to the hospital to make them happen,” Ross told us.

Congress could provide another push. The House bill (in Section 1151) and the Senate Finance bill (in Section 3025) both call for docking Medicare payments to hospitals with high risk-adjusted readmission rates.

Bonus Data: According to the figures Medicare reports online, which are based on discharges that run from mid-2005 through mid-2008, Mount Sinai had 29.5% readmission rate for heart-failure patients — higher than the national average. Ross said that hospitals in New York and other big cities tend to have higher readmission rates.

There’s also another new effort underway to improve the safety of blood transfusions by monitoring adverse reactions and errors through a collaboration between the federal government and organizations involved in blood collection, transfusion, and tissue and organ transplantation.

A pilot program launched last spring has so far gathered data for about 764 adverse reactions and incidents at seven hospitals. The system — which will be part of the a secure, voluntary, Internet-based surveillance system run by the CDC — will use the data to identify trends and recommend practices that hospitals can adopt to reduce adverse reactions and errors, such as transmitting the wrong blood or giving blood to the wrong recipient. Bad reactions that donors may experience after giving blood will also be tracked.

Matthew J. Kuehnert, who oversees blood safety issues at CDC, told the Health Blog that most transfusion reactions don’t have to be reported at all, “and even the most serious transfusion reactions are underreported, possibly because of the threat of punishment.” A public health surveillance system “would operate with the goal of quality improvement, with each facility looking at its own data and sharing it confidentially,” Dr. Kuehnert says.

Kuehnert says the U.S. is one of the only developed countries not to have a national transfusion reporting and safety system.

Photo: Associated Press

So when the county announced a free H1N1 clinic for students, I figured we should take advantage. The first clinic was this past Saturday, at a local high school.

9 a.m. Doors opened. We arrived at 9:02. The line stretched around the school, circled the front lawn, and snaked through the parking lot. There were easily 2,000 people ahead of us. But it was a beautiful day. We decided to wait.

10 a.m. My husband drove home to bring back survival supplies: bagels and books. We ate. We read. We waited. Every so often, the line would jerk ahead and we’d advance five or 10, even 15 steps. The rest of the time, we stood there.

10:30 a.m. TV reporters from two local stations arrived to film the endless line. They heard some grumbles, but not many. Though the line was barely inching along, we didn’t see anyone leave. We thought about it, briefly, but peer pressure kept us there: So many people had been waiting so long, it felt like this had to be a wise thing to do.

11 a.m. My husband found a Frisbee and started a game of catch. Dozens of kids joined in. Their parents unfolded lawn chairs and newspapers.

Noon Still not within sight of the clinic entrance, I bailed, taking our youngest to her soccer game.

1:15 p.m. When I came back, my husband was just emerging, triumphant, with our two older kids. They had received the vaccine after more than four hours in line. What’s more, he told me with a grin, we could get the little one vaccinated, too — if we just got back in line. We promised the kids Dairy Queen and went for it.

1:45 p.m. We made it to one of a dozen vaccine stations in the high-school gym. Our five-year-old sat still for the nasal mist. Then the nurse reminded us that she would need a booster dose in 30 days. “You can get it anywhere,” she said with a weary smile. “Anywhere you can find it.”

The thought of going through this again next month diminished my sense of victory. But not by much. I returned home still feeling pretty proud and tapped out an email to my relatives boasting of our perseverance.

Got a return email within minutes from my sister in Phoenix: “Holy cow!” She and her husband, she said, had walked into a Walgreens three weeks ago and walked out, fully vaccinated, two minutes later.

Oh.

Associated Press photo of an H1N1 vaccine line in Omaha, Neb., last week

That’s one example of the way med schools are shuffling their curricula to try to catch up with the changing demands — both scientific and cultural — doctors face, the Washington Post reports.

In a new case-based teaching method at Johns Hopkins, students might have a unit on heart disease where they look at sample heart attack cases to understand the genetics of heart disease, the physiology of the heart, medication options, costs and benefits of various treatments and how environment can affect heart disease risks, the Post says.

Older teaching methods at med schools tended to be more siloed into departments like anatomy, physiology, pharmacology; students didn’t really integrate what they were learning until they started doing clinical rotations.

Similar changes could be coming for pre-meds, whose basic course requirements have remained largely unchanged for decades. As we reported earlier this year, a panel convened by the Association of American Medical Colleges suggested scrapping the list of undergrad course requirements and replacing it with a set of ideas students need to understand before they enter med school. The hope is to give colleges the flexibility to move away from the old, rigid system.

Some big shots — including the deans from the med schools at Harvard and Yale — have even questioned whether pre-meds need to take a full year of organic chemistry.

“There are far too many people who would be superb doctors who somehow imagine that, because they don’t see themselves as organic-chemistry experts, they should not pursue medicine as a career,” the head of the AAMC told the WSJ.

Photo: iStockphoto

After spirited debate in Houston at an interim policy-making meeting, the AMA’s House of Delegates yesterday voted to “reaffirm the AMA’s commitment to health system reform.” Here’s the story from the Associated Press.

The vote amounted to a validation of AMA’s president, J. James Rohack, who came under intense criticism Thursday when he announced the organization’s support of the House health bill, which passed on Saturday night. “The time to make health system reform a reality is now,” Rohack said in a statement after the vote.

Rohack reiterated, however, that the House legislation is “not the perfect bill,” since it doesn’t include a solution to anticipated deep Medicare reimbursement cuts to physicians next year. “We will continue to advocate for changes that help make the system better for patients and physicians as the legislative process continues,” Rohack said in his statement.

Doctors who opposed the AMA’s endorsement maintain that the group should only lend its support to legislation when it contains the most crucial elements to many physicians, like revamping medical malpractice rules, among other issues. But doctors who support the AMA’s endorsement think it’s better to be at the table to try to influence the legislation as it moves forward — next through the Senate. Our post yesterday lays out the battle lines.

The AMA delegates voted down the resolution to rescind the group’s earlier backing of the bill by a 315-199 margin, the AP reported. Another resolution along the same lines went down by a 350-167 vote.

Image: Associated Press

On the individual market, people in their 50s can now pay five or six times as much as twentysomethings, according to a story in this morning’s WSJ on the whole age/premiums issue.

The big health-care bills in Congress would still allow variation, but the range would be capped. Under the House bill, insurers could charge older people twice what they charge younger people. The Senate bill could allow a ratio of 3 to 1, the WSJ suggests; this Urban Institute report from last month cites congressional proposals for caps as high as 5 to 1.

The core question here has to do with pooling risk, which is the central function of insurance. How much should those with lower risk (in this case, younger people) subsidize those with higher risk (older people)? The lower the ratio, the more young people wind up subsidizing older people.

For example: Under a 2-to-1 ratio, a 20-year-old could pay $2,965 per year and a 60-year-old could pay $5,930 per year, the Urban Institute estimates. Under a 5-to-1 ratio, the 20-year-old’s premium could fall to $1,884 per year, while the 60-year-old’s could rise to $9,420.

If the age-rating ratio were set at 2 to 1, a typical 58-year-old policyholder would pay about $5,900 a year for health insurance. If the age rating were 4 to 1, the premium could jump to $8,650.

Photo: iStockphoto

But as it turns out, the amount of time primary-care docs spend with each patient actually increased a little bit between 1997 and 2005, according to an analysis published today in the Archives of Internal Medicine.

This may have been driven in part by the aging population, because older people tend to be sicker and require more complex treatment. But even within each age group, the average time docs spent with patients increased, the authors said.

Another possible driver, they suggest, is an increased focus on having patients participate in making decisions about their care — it takes a longer to explain things to patients and seek their input than simply to tell them what to do.

Overall, the average length of time the patient spent with the doctor rose from 18 minutes to 21 minutes.

The findings were based on data from a detailed survey of office-based primary-care docs that’s funded by the federal government and conducted at regular intervals.

Bonus Time: A separate study, also published today in the Archives of Internal Medicine, found that the percentage of emergency-room patients seen by a doctor within the recommended triage time declined between 1997 and 2006.

Photo: iStockphoto

Ninety-nine percent of hospital board chairmen think their hospital fares at least as well as a typical hospital on standard quality measures. Among the chairmen of hospitals that perform worst, 100% say their hospital performs at least as well as a typical hospital.

The figures are from a survey published in the journal Health Affairs, based on responses from 722 people who chair the boards of nonprofit hospitals.

Yes, measuring quality can be a tricky thing. Yes, some hospitals treat sicker patients, on average, than others. Still, the quality data the authors used are drawn from those reported on the feds’ Hospital Compare Web site, which uses quality measures that are pretty widely accepted, and which adjusts to account for differences in the mix of patients seen by different hospitals.

The authors, who are affiliated with the Harvard School of Public Health, say that getting hospital boards to pay more attention to quality of care may be tough, given boards’ focus on hospital balance sheets. “With hospitals’ financial margins at 2–3 percent nationally and likely even lower in the recent economic downturn, the focus on financial issues may reflect the reality of assuring financial viability for many hospitals,” they write.

Photo: iStockphoto

The company will move a number of functions from Collegeville, Pa.; Pearl River, N.Y.; and St. Louis to other locations and will discontinue R&D operations in Princeton, N.J.; Chazy, Rouses Point and Plattsburgh, N.Y.; Sanford and Research Triangle Park, N.C.; and Gosport, Slough/Taplow, U.K. In addition, Pfizer will consolidate R&D functions from its New London, Conn., site to its nearby research facility in Groton, Conn.

The company says its research efforts will be spread at more than a dozen sites around the world, with a particular focus on five centers: Cambridge, Mass.; Groton; Pearl River; La Jolla, Calif.; and Sandwich in the U.K.

The company has previously said it plans to cut 15% of the combined Pfizer-Wyeth work force, but didn’t release specific figures on how many R&D jobs are being cut as part of this consolidation. Job cuts are rolling through the industry these days; for more, read our recent posts on cuts at Pfizer, as well as recently announced cuts at Merck, J&J and Eli Lilly.

Photo: Associated Press

Morris thought there might be some link between occupation and heart-attack risk. And when he looked at the men who worked on London’s double-decker buses, he found a striking result: The conductors — who went up and down the stairs on the bus all day long — were half as likely to die of heart attacks as the drivers, who sat at the wheel all day.

He was admirably cautious about interpreting the results, trying to poke holes in his hypothesis that exercise lowered heart-attack risk. “We set about destroying this observation,” he told the FT, which ran a profile of Morris earlier this year.

But the data held up; among postal workers, Morris found, those who delivered mail by bike or on foot were far less likely to die of heart attacks than those who sat behind the counter at the post office. He published his findings in the Lancet in 1953, under the title “Coronary Heart-Disease and Physical Activity of Work.”

Morris, who would have turned 100 next year, died of pneumonia and kidney failure, the New York Times said in its obit. He swam, rode an exercise bike or walked for at least half an hour on most days until he was well into his 90s. And in recent years, he often walked up and down the stairs of the London School of the London School of Hygiene and Tropical Health, where he was an emeritus professor.

“I’m constantly being asked: ‘Your long life, what would you advise?’ and so forth,” Morris told the FT. “To start telling other people what to do – I’m very reluctant. Except on exercise, where to a large extent I feel it’s what I’ve done myself that’s contributed to longevity.”

Photo: iStockphoto