Robert Wood Johnson Foundation

Study: Family medicine woefully underrepresented at NIH

Anne Zieger — Mon, 17 Nov 2008 10:56:11 -0500

A new study has found that family physicians and departments of family medicine are woefully underrepresented in grants from the NIH. Researchers from the Robert Wood Johnson Foundation analyzed data about NIH grants from 2002 to 2006. They found that grants to family medicine accounted for a measly 0.2 percent of the total grants given out in 2006.

Perhaps part of this comes from the lack of representation for family medicine on NIH advisory committees. Family medicine department members only accounted for 21 of the 5,500 on an NIH committee or subcommittee, and only nine of those 21 members were actually family physicians.

Perhaps these findings, which appear in the Annals of Internal Medicine, will push the NIH to make efforts to increase the representation of family physicians in its funding.

To learn more about the study:
- read this Washington Post piece

Trend: ED 'super users' generating big expenses

Anne Zieger — Tue, 15 Jul 2008 12:28:17 -0400

Everyone in the hospital business knows about the emergency department's "frequent fliers"--folks who show up a few times a month due to one pain or another, either because they're uninsured, fearful or maybe just lonely. While ED nurses and administrators may be used to such folks, they're a big problem, one that researchers are beginning to look at more closely. Researchers, who have named such people "super users," are trying to understand how to cope with the most extreme behavior--and by doing so, take significant costs out of the healthcare system as a whole.

One way to approach the problem is to look at one community's patterns, which professionals are doing in Camden, N.J. In the small, impoverished city, researchers estimate that that hospitals could save $46 million by reducing ED overuse. A Camden physician, family physician Dr. Jeffrey Brenner, began earlier this year to document how Camden residents used the area's EDs. Having analyzed five years of records from the city's three hospitals, he concluded that the top 1 percent of ED and hospital users (about 1,000 patients) between 2002 and 2007 accounted for about 10 percent of total admissions. These patients came to the city's EDs more than 39,000 times over the five year period, with one patient using a record $3.5 million in services.

When he saw these figures, Brenner took action, creating a "medical home without walls" with a $300,000 grant from the Robert Wood Johnson Foundation. With the money, he built a small team including a nurse practitioner, community health worker and social worker that goes to homes and homeless shelters to find super users and keep them well. Other cities--such as San Francisco--have developed similar programs.

To learn more about this trend:
- read this piece in The Star-Ledger

Related Articles:
Hospitals working to avoid non-emergency ED care
Study: ED crowding affects care
Atlanta hospitals screen out non-emergent ED patients
Survey: ED overcrowding getting worse

Philanthropy challenges nursing homes to improve facilities

Abby Christopher — Tue, 24 Jun 2008 14:01:09 -0400

The Robert Wood Johnson Foundation says it wants to shutter America's nursing homes in order to save them. The foundation has already started to fund the construction of Green Houses, small environmentally friendly homes that house 10 to 12 seniors currently living in large, more conventional nursing facilities. The philanthropy, spurred in 2003 by a grant proposal presented by Dr. Bill Thomas, will build these new alternatives to conventional nursing homes in all 50 states. So far, RWJF grantees have erected 41 houses in 10 states. Although a modest number of seniors have moved out of their old nursing homes, if the foundation has its way, all 16,000 of the nation's conventional senior facilities will be replaced. The American Health Care Association, a lobby that represents the $122 billion nursing home industry, believes the foundations criticism of conventional nursing homes is overly harsh and claims that providers are making an effort to improve their facilities. RWJF has delegated management of the Green House projects to NCB Capital Impact, a Washington, D.C.-based not-for-profit that has been offering help in consulting, education, architecture and other areas, to organizations interested in establishing and operating the new homes.

For more information:
- read the full Wall Street Journal story

$300M grant from RWJF intended to reduce health disparities

Thu, 05 Jun 2008 06:59:56 -0400

Today the Robert Wood Johnson Foundation is expected to announce a $300 million initiative designed to reduce significant regional and ethnic care disparities across the U.S.--and ultimately, if successful, provide a model for healthcare reform. The study, which will be conducted by researchers at Dartmouth Medical School, will target 14 communities and regions across the country. One major goal of the project is to cut down on hospital admissions for certain conditions. For example, right now, states like West Virginia, Kentucky, Louisiana and Mississippi have high hospitalization rates for problems like poorly-controlled diabetes or worsening heart failure, exceeding 100 discharges per 1,000 beneficiaries. Also, blacks often get worse care than whites; in Memphis, black Medicare beneficiaries are almost six times as likely as whites to have a leg amputated due to vascular disease and diabetes.

To learn more about the initiative:
- read this Seattle Times piece

PLUS: Racial care disparities are widespread among patients with kidney disease, according to a new study. Article

Related Articles:
Why are men dying earlier than women?
Study: Hispanics get lower-quality medical care
CMS hopes to close Medicare race, ethnicity gap

Using claims data for doctor ratings poses big problems

Fri, 23 May 2008 06:59:59 -0400

In theory, physician ratings and rankings aren't as scary as they used to be a few years ago.

With activists like New York Attorney General Andrew Cuomo helping to spark systematic changes in such programs, health plans aren't shooting from the hip as much as they were before. Not only do health plans have to "behave" in New York, they're taking the new standards with them to their entire commercial populations (such as Cigna, which brought in the NCQA to oversee its entire ranking system).

Not only that, it's looking like some big stakeholders are starting to agree on what they want to measure. According to a recent announcement from the oh-so-respectable Robert Wood Johnson Foundation, a group of leading stakeholders in provider rating including the Leapfrog Group, the National Business Coalition on Health, the AFL-CIO, the American Medical Association and America's Health Insurance Plans have all agreed on a "Patient Charter" that sets principles for measuring doctors' performance. That ought to help, right?

Still, not everybody's happy, despite the progress that's been made to date. For example, just consider the Massachusetts Medical Society, which is suing over rankings it says are capricious and actively defraud consumers. It's main beef is that the claims data health plans are using to rank its members just don't cut it.

And there, folks, is one of the most stubborn obstacles to straightening this mess out. Let's say that the industry's leaders all agree on what's fair and reasonable to measure clinically, and that they reach some grudging consensus that cost is an issue worth using as some form of ratings scale. Given the extraordinarily complex, flawed and cryptic puzzle that is claims data, it seems unlikely that anyone can use it to make fair deductions about physician performance on a granular level.

OK, I realize that some of you will blanch when you read that, but I have to tell you that the preponderance of what I've read and seen suggests that this is true--if for no other reason than that in attempting to do a good job and pay fairly, the system is breaking under its own weight. (If you think I'm way off base, please feel free to write and tell me so. Some of these folks might be first in line.)

Look, it seems pretty clear that some form of ranking will arrive at some point. But in the meantime, it just isn't going to work to force quality numbers onto a data set that arrives at the door broken. Maybe, when we have a fully-implemented electronic medical records universe out there, we can rethink the whole thing. For now, perhaps health plans can come up with some other way of motivating doctors to play ball? - Anne

Harvard, RAND-backed provider payment model to be tested

Wed, 21 May 2008 06:59:57 -0400

An evidence-based healthcare payment model driven by researchers at RAND Corporation and the Harvard School of Public Health will be rolled out in January at four pilot test sites with funding from a $6.4 million grant.

The project, dubbed Prometheus--for payment reform for outcomes, margins, evidence, transparency, hassle-reduction, understandability and sustainability--is funded by the Robert Wood Johnson Foundation. Payments will be built around a total amount to be paid to all providers for a patient's condition. The project includes 12 evidence-based case rates, which included input from health insurers, employers, physicians and others through a not-for-profit collaboration.

The payment scheme will be kicked off in Rockford, Ill., and Minneapolis, with two other sites still to be announced. HealthPartners, a not-for-profit health plan, will run the project in Minneapolis, and employers will test the model with providers in Rockford.

To learn more about the project:
- read this article from Modern Healthcare (reg. req.)

Related Articles:
Pushing the envelope on evidence-based medicine
Geisinger offers flat-fee surgery package

Study: Health views vary along ethnic lines

Tue, 11 Mar 2008 07:59:58 -0400

A new study suggests that how you rate your healthcare provider may depend somewhat on your ethnic background. The study, which will be published in the journal Health Affairs, found that minorities are more likely than white patients to rate their healthcare as fair or poor, particularly Chinese-Americans, blacks born in Africa and Vietnamese-Americans. This is a particular concern given that improving patients' perception of their care is important to improving outcomes; patients who don't feel their care is satisfactory spend less time with physicians and may suffer as a result. Unfortunately, many minorities feel that their time spent with doctors isn't that productive. While three-quarters of whites reported that their doctor listened to them carefully, that percentage fell sharply, to 62 percent, for Korean-Americans, and 58 percent for Central and South Americans. These statistics were drawn from a survey of 4,334 adults by researchers with Harvard University and the Robert Wood Johnson Foundation.

To get more data from the study:
- read this Associated Press piece

Related Articles:
Medical homes cut racial care disparities. Report
UnitedHealthcare offers racial disparity education. Report
Racial disparities persist in health outcomes. Report
Medicare should help fix disparities. Report
Researchers fight for ethnic diversity in trials. Report