Data are filtering in on Massachusetts’ grand plan to extend health insurance coverage to virtually all Bay Staters. The good news is just about everyone’s covered. The bad news is just about everything else.

When it comes to controlling health care costs, the state’s performance has been abysmal. Experts recently predicted that the state will spend $600 million more in 2009 on health care than in 2006, a 42% bump.

Now comes troubling data on a measure of access to care, emergency room visit volume.

In theory, the state’s new law should cut the costly visits because more people have access to PCPs that can either treat health situations before they reach crisis proportions or prevent them altogether.

In fact, ER visits went up 7% and the cost per ER visit jumped 17% in Massachusetts between 2005 and 2007, according to data shared with the Boston Globe.

The fraction of ER visits for non-urgent matters that could have been handled by a PCP remained unchanged at an astonishingly high 47%.

Massachusetts officials said several more years were required before accurate assessments could be made regarding the impact of their law on access to care.

The law actually went into effect half-way through the data collection period used to make the conclusions above, so they may have a point there.

Still, many worry that simply extending health insurance coverage isn’t going to control costs or improve access. They say the state needs to beef up its PCP corps before the program can work.

“Just because you have insurance doesn’t mean there’s a [PCP] who can see you,” said Sandra Schneider, VP of the American College of Emergency Physicians. “I am not surprised that visits went up.”

In an effort to buffer or perhaps counteract private sector influence on the treatment decisions of its physicians, Partners HealthCare will soon enact new rules of engagement for its panels.

Partners, which includes Brigham and Women’s Hospital and Massachusetts General Hospital, has decided for example to prohibit its physicians from accepting gifts and meals from Big Pharma and medical device firms.

Also banned will be cross-country junkets as paid members of “speakers bureaus” and ghostwriting, a practice in which scientists allow themselves to be included as authors on scholarly manuscripts penned by folks on drug company payrolls.

The plan will also tighten rules on how and when drug reps can visit physicians in the hospital, and include disclosing to the public more information about the nature of the relationships its physicians have with Big Pharma. Details of this latter change have yet to be worked out.

“We don’t want our faculty being on the road” as “hired guns,” Mass. General president Peter Slavin told the Boston Globe. And those free meals are history as well because they don’t “promote a positive image of physicians and increase healthcare costs,” he added.

The new policies were announced months after congressional klieg lights found Harvard-affiliated psychiatrists that might have engaged in improper relationships with Big Pharma. 

Republican Senator Charles Grassley has for example, accused Joseph Biederman of failing to reveal he’d pocketed $1.5 million in fees from Big Pharma between 2000 and 2007.

The moves did not completely satisfy HMS professor and former New England Journal of Medicine editor Arnold Relman.  He told the Globe “there should be no, zero, industry funding for any particular educational program,” involving Harvard-affiliated physicians.

Massachusetts General Hospital can’t seem to get out of its own way lately.

Already in the doghouse with Bay state public health officials for high mortality rates in its cardiac cath program, the prestigious Harvard Medical School affiliate has suspended its pediatric cardiac surgery program after errors during 2 open-heart surgery procedures caused serious complications.

The public health officials, who have to be considering monthly parking permits in the lot on Fruit Street as a way to control costs, began looking into the incidents shortly after the General notified them last week.

Both babies survived the mishaps, although one sustained neurological damage and required transfer to Children’s Hospital across town.

Just 2 years ago, the General beefed up what had been a tiny pediatric cardiac surgery program by recruiting Jeff Myers, a specialist in the field.

The unfortunate development has reignited debate concerning the extent to which patient outcomes are compromised by policies, or the absence of same, that foster proliferation of multiple low-volume providers for complex, risky procedures like this one.

Children’s Hospital is located just 4 miles west of the General. It does 1,100 pediatric open-heart cases per year, making it the highest-volume program in the country.

The General has managed to log 90 cases in the last 20 months. Meanwhile, about 3 miles south of the General, Tufts Medical Center has a program that did 24 last year.

The General’s “numbers are pretty small” Peter Manning told the Boston Globe. The director of CT surgery at Cincinnati Children’s Hospital added, “when you get below 100 cases you really worry… whether the [surgeon] is doing enough to keep their skills up.”

The chairmen of 13 clinical departments at Boston’s Beth Israel Deaconess Medical Center agreed last week to donate $350,000 to help reduce the need for staff layoffs.
 
“This was a really easy decision,” Mary Ann Stevenson told the Boston Globe.

The Radiation Oncology chair added, “most of us have been longtime campaigners for the hospital. Most of us feel really strongly about where we work.”

And they’ve appealed to their physician colleagues and reports who are affiliated with the hospital to follow suit.

“We invite you to consider making as generous a contribution as possible,” the chiefs penned in a letter to 1,100 staff physicians that was obtained by the Globe. Donated funds “will support job preservation among the hospital staff (so) they can continue to provide great service to our patients.”

Beth Israel Deaconess is affiliated with Harvard Medical School. It announced last month that it faced a $20 million operating loss for the fiscal year, and planned to enact cost-reducing moves including RIFs as a consequence.

After that announcement, hospital CEO cum blogger extraordinaire Paul Levy began working with employees on money saving, job preserving ideas.

That let BIDMC reduce the number of layoffs from 600 to 150.

The ideas included a temporary halt in funding employees’ 401(k) and 403(b) retirement plans, suspending a planned 3% salary increase for certain employees, eliminating the annual employee barbecue and ending hospital reimbursement for staff cell phones.

In addition, Levy has cut his own pay by 10%, and that of his executive staff by 5%.

Hospitals across the country have seen patient volumes drop as the Great Economic Crisis prompts people to defer elective procedures. Inpatient volume at BIDMC is off 1% this year.

When Massachusetts treasurer Tim Cahill floated the idea of licensing a trio of slot parlors in the state, mental health and gambling experts said he was asking for trouble.

For fun-seekers susceptible to gambling addiction, those new video slot games might as well be crack cocaine, they claim. 

The computer-driven sound-and-light extravaganzas create an allure so strong it has prompted some to wear adult diapers so they don’t have to worry about bladder control when they get on a roll.

Video slots let players gamble rapidly. There’s no more waiting for wheels to stop, cards to flip or horses to run. That’s been replaced by a mash-up of colors, bells, crowds cheering “Wheel of Fortune!” and just the right amount of payouts.

The slots also generate a disproportionate share of near-wins designed to convince players their luck is about to change.

“Slot machines (are) more problematic than other types of gambling in terms of addiction,” Mark Griffiths told the Boston Globe.

The professor of gambling studies at England’s Nottingham Trent University noted that nearly 90% of calls to gambling help-lines in Europe involve slots.

But Holly Thomsen, spokeswoman for the American Gaming Association says that despite recent growth in gambling outlets across the nation, gambling addiction rates remain flat at 1%.

And the pragmatic Cahill argues that people are going to gamble anyway, in Rhode Island and Connecticut for example.

“All we’re saying is, let Massachusetts people do what they want with their money in their state,” he told the Globe.

Adding a skosh of reason to the endless cacophony emanating from Atkins advocates, Ornish impresarios  and South Beach braggadocios, scientists at the Harvard School of Public Health have shown they all work equally well and what really matters is total caloric intake…pure, plain and simple.

Frank Sacks and colleagues randomly assigned 811 overweight or obese men and women to one of 4 heart-healthy, reduced-calorie diets that differed in the proportions of carbohydrates, fats and protein.

They followed participants for 2 years, asking that they exercise for 90 minutes per week and inviting them to attend group support sessions along the way. There was some periodic individual counseling as well.

The dieters recorded details of their food intake and tracked progress on a Web site.

Eighty percent of the subjects hung in there for the duration. By 6 months they had lost an average of 13 pounds, and they weighed-in at a minus 9 soaking wet when the study ended.

But the key was that subjects in all 4 groups had lost the same amount of weight and reduced waist girth by the same 2 inches. And all 4 groups experienced similar, modest beneficial effects on serum cholesterol and triglyceride levels and blood pressure.

The most successful dieters were those who regularly attended counseling sessions. They were good for a drop of 22 pounds on average.

“It’s just the calories that count,” Sacks underlined for the Boston Globe.

“The most important thing…to lose weight is to choose a heart-healthy diet and to keep the amounts down.”

Scientists at Dana-Farber Cancer Institute and the CDC have produced monoclonal antibodies that can destroy most strains of flu virus, a new line of attack that promises to overcome the virus’ maddening ability to mutate and thus fool today’s vaccines.

Such antibodies “could provide broad protection against all seasonal and pandemic influenza A viruses,” according to Wayne Marasco of Harvard Medical School and colleagues.

The potion targets the flu virus near its base, a region that turns out to be genetically stable.

The base mediates viral entry into cells, Marasco’s team wrote in Nature Structural & Molecular Biology.

Today’s vaccines stimulate antibody production against the viral head, a region that demonstrates extraordinary genetic polymorphism. That’s why flu vaccines are useless after one year at best and queueing-up for a jab has become an annual ritual for millions.

Coauthor Ruben Donis of the CDC is confident his group has flu by the short hairs, pointing out to MedpageToday that “By mutating (at the base, the flu virus) commits suicide.” 

The monoclonal antibodies appear to work against multiple strains of flu, including H5N1 avian flu and the H1N1 Spanish flu strain that killed 50 million people in 1918.

They also were shown to prevent flu symptoms in animals even when given 24 hours after exposure to flu virus, so long as they’re given in higher but “achievable” doses, according to the scientists.

The next step is to see whether the antibodies work in ferrets, which strangely enough have immunologic responses to flu virus more like humans than any other species.

Clinical trials could begin in 2 years.
 
The Dana-Farber holds patents on the discovery of the static region and the monoclonal antibodies against it.

Bay State public health officials have discovered that the cardiac catheterization programs at Boston’s vaunted Massachusetts General Hospital and Worcester’s St. Vincent Hospital had unexpectedly high death rates in 2007.

In fact 43 of 1,543 patients undergoing the procedure at the General died and a ridiculous 16 of 112 patients died at St. Vincent.

That was significantly higher than state norms after accounting for severity of illness.

Hospital officials at both facilities attributed the high mortality rates to aggressive treatment strategies involving seriously ill patients, often at the request of family or referring physicians.

Which is better than leaving the old meat cleaver inside the body but it sure sounds like a quality problem in any case.

“Some of these patients are very difficult and quite ill,” St. Vincent’s CMO Octavio Diaz told the Boston Globe.  “Sometimes it’s very difficult to say no to those patients and their families.”

But he and Michael Fifer, director of the General’s cath lab promised to give it the old college try. They’re mandating a second opinion from a cardiologist before green-lighting caths on critically ill patients.

Conveniently, at the time of the announcement Paul Dreyer, the state’s director of healthcare safety and quality already had data in hand for 2008 and the death rates had settled down at both facilities so he saw no need to suspend the programs.

Which is good for everyone because that’s a story that would have gone national in a heartbeat.

So there’ll be a few extra inspections, an outside expert will fly in for a look before catching a Sox game and the shuttle home, maybe some extra documentation here and there and that’ll be the extent of it.

If Massachusetts Governor Deval Patrick has his way, the state’s major restaurant chains will soon be required to post calorie counts for all offerings, either on the menu or at the counter.

And public schools will have to measure the height and weight of all children in grades 1, 4, 7 and 10, determine which students are overweight using a BMI calculation, and report the results to parents or guardians.

Patrick’s anti-obesity proposals must first be approved by the Public Health Council and that is expected to happen shortly.

“Our approach here is comprehensive – like with smoking cessation and HIV-prevention, a single message is not enough,” state public health commissioner John Auerbach told the Boston Globe.

Massachusetts is one of the nation’s most health conscious states but even here the percentage of overweight or obese adults increased from 43% to 59% between 1990 and 2007. Meanwhile, a third of the state’s middle school and high school students are overweight, 3 times more than 20 years ago.

Massachusetts officials estimate that about 2,000 restaurants would be subject to the new rules, which apply only to chains having 15 or more stores in the state.

Massachusetts-based Dunkin’ Donuts said it embraced a “responsibility to provide health-related public information,” but whined that “for multistate operators…the complex, localized regulatory approach to menu labeling is costly and disruptive.”

New York City has required that fast-food chains post calorie counts on menu boards since April and the information surprised even Gotham’s health commissioner. 

“It was sticker shock,” Thomas Frieden told the Globe. “Who knew a bran muffin could have 450 calories?”

Omaha resident Pam Ford has participated in several clinical trials in the last 2 years. She likes participating in efforts to get low cost generic drugs on the market and doesn’t mind the free health care she gets along the way.

But these aren’t her primary motivations. “It’s absolutely to make extra money,” she told the Boston Globe, and if that’s the case, she’s not alone.

The US economy shed 2.5 million jobs last year, the most since 1945. No region or sector was spared and the unemployment rate stands at 7.2%.

Meanwhile Ford has pocketed $10,000 for her efforts, a nice supplement to what she makes from her cleaning business.

During the Great Economic Crisis of ’08-’09, record numbers of people are applying for positions in clinical research trials that pay participants up to several thousand dollars in return for a commitment of between a few and several weekends to various clinical protocols.

At Omaha-based Qualia Clinical Services for example, the participant database has risen from 9,000 to 16,000 in the last year. Qualia handles Phase 1 testing of generic drugs on healthy volunteers.

And the pool has grown more diverse than the usual college crowd, according to Steve Peck, director of operations. The trend is large enough to possibly convince some clinical research organizations to cease outsourcing early phase trials to developing nations like India.

The weakening economy has probably also helped increase plasma donation rates by 50% in the last 2 years, according to Josh Penrod, VP of the Plasma Protein Therapeutics Association.

Penrod added that payment is essential to assuring an adequate supply of blood products. Plasma collection centers develop their own payment rules, although overall compensation and time commitment remains a small fraction of that associated with clinical trials.