The Affordable Care Act (ACA)’s health insurance exchanges opened for business on Oct. 1, and, despite website glitches and non-stop political fighting, citizens across the U.S. can now comparison shop and pick an insurance plan. Time will tell how well the exchanges will work out for consumers, employers and insurers—as well as what effect they will have on pediatricians and hospitals.
According to Wendy Warring, senior vice president, network development and strategic partnerships at Boston Children’s Hospital, the exchanges may force medical professionals to face changes in patient volume, adjustments in reimbursement rates and shifts in how employers provide benefits to insurers. Right now, she says, “people are very confused about public exchanges versus state exchanges versus private exchanges,” and opinions vary on what impact these changes will have on medical professionals. Full story »
For Eric Fleegler, MD, MPH, good legislation is good medicine. Just as the right diagnosis and treatment can make the difference in a child’s health, laws and regulations that address public health issues can reduce the incidence of injuries or disease. Fleegler, an emergency medicine physician at Boston Children’s Hospital, believes that doctors, nurses and other medical professionals can—and should—get involved in public policy debates.
“They are not only looked at as experts, they are also respected as people who represent the rights of children,” Fleegler says.
Health policy experts
For years, Fleegler has represented the rights of children by offering expert testimony to legislators and committees, and by advocating for laws and regulations that address issues like gun violence, food insecurity and asthma in inner-city school children.
“We can lose sight of the value we have in the legislative world,” he says. “In my experience, legislators ask questions of physicians because they want to interact with a doctor and understand what’s really happening. We can bring insight.” Full story »
Because unplanned hospital readmissions put patients at risk, burden families and add to the cost of health care, many medical professionals are taking steps to reduce them. To push the effort, new Centers for Medicare & Medicaid Services (CMS) rules impose escalating penalties that decrease a hospital’s Medicare payments if patients are readmitted within 30 days of discharge.
Last week on Vector, we reported research suggesting that some readmissions may be incorrectly classified as preventable (and thereby penalized), particularly at pediatric hospitals. But what steps can be taken to reduce the number of truly preventable readmissions?
One step, highlighted here last week, is making post-discharge communications much simpler with texts and emails. But how can hospitals make sure their patients are ready to go home? A new study published in the International Journal for Quality in Health Care finds that in pediatric settings, the answers may be found in parents’ perceptions, which turn out to be good predictors of an unplanned readmission. Full story »
Signed into law by President Obama in 2010 and upheld as constitutional by the Supreme Court in 2012, the Affordable Care Act (ACA) is withstanding yet another assault. Efforts to repeal or at least delay implementation of the complex, multi-part ACA are entangled with the current government shutdown. However, because many parts of the ACA rely on mandatory spending, the act is moving forward as planned. In fact, the health insurance exchanges called for under the bill opened last week.
John McDonough, DPH, MPA, of the Harvard School of Public Health, briefing clinicians at Boston Children’s Hospital just before the shutdown, maintained that Americans are “just three months away from a fundamental turning point in U.S. health care policy.” Efforts to derail the ACA, he said, are the “death throes” of the anti-Obamacare movement. Full story »
Lee's team is using proteomics and glycomics to establish normal urine profiles, as well as biomarkers of kidney damage. (Harald/Flickr)
Part 1 of a two-part series on kidney disease. Part 2 is here.
In up to 5 percent of all pregnancies, children are born with some degree of kidney dilation or swelling, known as hydronephrosis. Unfortunately, says urologist Richard Lee, MD, of Boston Children’s Hospital, “many of these kids go through a lot of testing after birth and are followed for a long period of time—sometimes unnecessarily.”
Hoping to reduce such testing, Lee and his colleagues are turning to urine. They’ve been collecting comprehensive data on the urinary proteome—all the proteins urine normally contains. With this baseline information, they hope to establish biomarkers that identify kidney damage.
In a recently published study, Lee and his coauthors compared the urinary proteomes of healthy infant boys versus men to find out what happens naturally with age. Through their work, they identified nearly 1,600 protein groups and determined that the healthy male urinary proteome changes over time. Full story »
A kidney stone seen on CT (James Heilman/Wikimedia Commons)
Two national trends have preoccupied Caleb Nelson, MD, MPH
, and his colleagues in the Boston Children’s Hospital’s Urology Department over the past few years. One is the rise in overall exposure to medical radiation. The second is specifically the increased use of computed tomography (CT)
scans—rather than clinician-preferred ultrasound
—in children with kidney stones
“We see a lot of kids with stones, and there is a clinical need to better manage their condition,” Nelson explains. “Medical radiation is a risk factor for problems down the road, and we know that the amount of radiation people are receiving has gone through the roof in recent years.”
How big is the problem? Nelson cites data collected on radiation exposure on the U.S. population from 1987 to 2006 by the National Council on Radiation Protection and Measurements (NCRP). At the beginning of the study, about 18 percent of all radiation exposure was medical. By 2006, that number had grown to 48 percent (see chart below). Full story »
When someone is terminally ill, what is the right treatment course? Should treatment be stopped altogether? What is in the patient’s best interest? What role should medical professionals, including clinical ethicists, play in the decision-making process?
Such decisions can tear families apart, and the choices can confound politicians, policy makers and the public. In 2012, Massachusetts voters rejected a ballot question that would have allowed physician-assisted suicide for terminally ill patients. The initiative lost by 1 percent of the vote. Federal legislation would have provided Medicare reimbursement to physicians for counseling patients about living wills and end-of-life care, but the provision was dropped amid claims that it would create “death panels” that would judge whether a patient is “worthy” of care.
Publicly, most palliative care and end-of-life debates focus on the elderly, but the issues are especially complex and wrenching for children and teens facing severe, painful or life-threatening conditions. Children are at the beginning, not the end, of life, and the adults involved in medical decision-making may have conflicting interests and wishes. Full story »
(Scott Foresman/Wikimedia Commons)
In the aftermath of the Boston Marathon bombings, first responders did whatever they could to help victims. For many of those injured, tourniquets proved to be the difference between saving and losing a limb—or a life.
“There’s no doubt that tourniquets played a key role in treating the bombing victims,” says Boston Children’s Hospital Trauma Center Director David Mooney, MD.
Two children who were later treated at Boston Children’s had tourniquets applied at the site of the tragedy. One arrived with extensive lacerations caused by one of the two detonated bombs. The other was in worse condition, having suffered blood vessel damage among other problems. Both children are doing better, although one will require further treatment.
Dating back to Roman times, a simple tourniquet, encircling a limb just above a wound, was the go-to method to stop bleeding. Since then, tourniquets have been used on the battlefield and in emergency rooms and operating rooms. However, had the bombings taken place 10 or 15 years ago, those wounded might not have been treated with tourniquets, Mooney believes. Full story »
In mice, boosting amounts of a microRNA family called miR-17-92 led to dramatic enlargements of embryonic and postnatal hearts, with thicker ventricle walls.
Challenging accepted wisdom about the heart, Boston Children’s Hospital cardiologist Bernhard Kühn, MD
, recently showed that infants, children and adolescents are capable of generating new heart muscle cells
, or cardiomyocytes. That work raised the possibility that scientists could stimulate regeneration to repair injured hearts.
Now, we have a potential therapeutic target to accomplish this: a family of microRNAs called miR-17-92 that regulates cardiomyocyte proliferation. In Circulation Research earlier this month, a team led by Kühn’s research colleague Da-Zhi Wang, PhD, demonstrates its potential. Full story »
How can ICU clinicians manage the data from all these monitors?
With the Internet’s meteoric rise in the last 20 years—to the point of being available 24/7 in your pocket—technology pundits, psychologists and sociologists have been sounding ever louder warnings about information overload: the constant onslaught of communication, information and media coming at us all the time, and in ever greater volume.
Now imagine you’re a doctor or nurse in an intensive care unit (ICU). For you, information overload isn’t just a daily reality—it’s a necessary one. To make the right decisions at the right time for each patient, you must keep tabs on numerous bedside monitors—in the ICUs at Boston Children’s Hospital, that’s 10 or more for each child.
Melvin C. Almodovar, MD, medical director of Boston Children’s Cardiac Intensive Care Unit (CICU), and his colleagues wanted a better way to assess the patient’s physiologic state and catch crises before they happen. Full story »