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6570 Course Syllabus

PubH 6570-004 Health and Health Systems Spring Semester Term A 2013

Credits: 2

Meeting Days: January 12 – March 17, 2013

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 in the course outline. The main goal of the course is to provide students with an overall knowledge of the health care system and a context for courses in the curriculum of health administration.

IV. Methods of Instruction and Work Expectations

This course consists of a recorded 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 will be introduced with narrated presentations, in which the instructor will discuss significant issues and refer to readings. To complete each weekly lesson, view the presentations and read the recommended readings. In addition, write and submit:

1. an individual OR group assignment (instructions for these assignments are in the course outline), and

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2. a group summary of challenges facing the health system with respect to the lesson topic(s)–see instructions below

For this course, you will:

Complete a total of eight weekly written assignments, four individual and four group assignments. 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.

‒ Post group summaries in a forum open to everyone in the class (reply each week as directed in the forum, with a short list of challenges).

‒ Post group assignments in another forum open to everyone in the class (reply as directed in the forum; attach your group files to discussion messages).

You are also encouraged to share your individual assignments with your group to gain additional perspectives and insights. 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 each of the 8 lessons. You will post your summary each week for the other groups to read and discuss. I will read the summaries and occasionally comment on them individually or as a set. Use the private group forum to collaborate and communicate with your group.

Together, the summaries will contribute up to 40 points (out of 200) towards your final grade. I will not grade each summary individually; instead, at the end of the class I will assign a point grade to the collection of summaries produced by your group. This 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 these weekly group summaries:

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, your group might select “Physician Education” as one of the four subheadings you address under Lesson 2. 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.

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4. The summaries 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 is a difference in conclusions reached by the groups. 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.

VI. Course Outline/Weekly Schedule

January 12 Health System Performance: From Three-Legged Stool to theTriple Aim January 21-27 A Macro View of Physician Supply: Do We Have Enough Physicians Now? Will We Need More in

the Future? Individual Assignment 1 Rethinking Primary Care: What Is the Future for the Family Doctor?

January 28 – February 3 The Nurse Workforce: “Is There a Nurse in the House?” Individual Assignment 2 Long-Term Care: Balancing What We Want with What We Can Afford

February 4-10 The Hospital: From Doctors’ Workshop to Big Med Group Assignment 1

February 11-17 Medical Technology and Devices: At the Cutting Edge Group Assignment 2

February 18-24 Pharmaceuticals: A Regulatory Rubik’s Cube Group Assignment 3

February 25 – March 3 Health Insurance, Uninsurance, and the Private Health Insurance Market: What Works, What Doesn’t and How Will Health Reform Change It? Individual Assignment 3

March 4-10 Medicaid: Can This “Vast Public Enterprise” Be Sustained? Group Assignment 4

March 11-17 Financing Care for Seniors: Down the Medicare Rabbit Hole Individual Assignment 4 Medicare: A Program at the Brink?

 

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Health System Performance Session 1 – Classroom Introduction – January 12, 2013 Health System Performance: From Three-Legged Stool to the Triple Aim 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 issues and evidence relating to access to care and deficiencies on the quality of health care in the United States 5. Discuss the evidence regarding prevalence of medical errors in the U.S. health care system and their sources. 6. Discuss how poor communication and care coordination can affect patient outcomes. 7. 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

Spending on Health Care 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. Galewitz, P. “Nation’s health care bill to nearly double by 2020.” Kaiser Health News, July 28, 2011. Available at:

http://www.kaiserhealthnews.org/Stories/2011/July/28/health-care-spending-to-double.aspx Geographic Variation in Health Spending

1. “Crusading professor challenges Dartmouth Atlas on claims of wasteful health care spending.” Kaiser Health News, November 16, 2009. Available at: http://www.kaiserhealthnews.org/Stories/2009/November/16/Cooper-Debate.aspx

Views Regarding Health Spending 1*. Chernew, M.E., Hirth, R.A., Cutler, D.M. “Increased spending on health care: Long-term implications for the nation.” Health

Affairs 28(5):1253-1255, 2009. http://content.healthaffairs.org/content/28/5/1253.full.pdf+html 2*. 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 3*. Berwick, D.M., Hackbarth, A.D. “Eliminating waste in U.S. health care.” Journal of the American Medical Association

307(14):1513-1516, 2012. http://jama.jamanetwork.com/Issue.aspx?journalid=67&issueID=23310&direction=P 4. Kleinke, J.D. “The myth of runaway health spending.” New York Times, February 17, 2012, p. A.13.

http://online.wsj.com/article/SB10001424052970204792404577227050656680024.html Drivers of Growth in Spending 1*. Smith, S., Newhouse, J.P., Freeland, M.S. “Income, insurance, and technology: Why does health spending outpace economic

growth?” Health Affairs 28(5):1276-1284, 2009. http://content.healthaffairs.org/content/28/5/1276.full.pdf+html 2*. Vladeck, B.C., Rice, T. “Market failure and the failure of discourse: facing up to the power of sellers.” Health Affairs 28(5):1305-

1314, 2009. http://content.healthaffairs.org/content/28/5/1305.full.pdf+html 3. 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/

4. Fleming, C. “Higher physician spending in U.S. driven by fees, not practice costs.” Health Affairs Blog, September 8, 2011. Available at: http://healthaffairs.org/blog/2011/09/08/higher-physician-spending-in-u-s-driven-by-fees-not-practice-costs/

5. Rao, A. “IOM report focuses on $750 billion in inefficient health care spending.” Capsules, The KHN Blog, September 6, 2012. Available at: http://capsules.kaiserhealthnews.org/index.php/2012/09/iom-report-focuses-on-750-billion-in-inefficient-health-care-spending/

6. 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

6*. 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/

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

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

4. 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/

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

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 Patient Experience

Patient Safety and Medical Errors 1. “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 2*. 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. http://content.healthaffairs.org/content/30/4/596.full.pdf+html 3. 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 4. 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 5. 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 Access to Care 1*. Galewitz, P. “Health care increasingly out of reach for millions of Americans.” Kaiser Health News, May 7, 2012. Available at:

Population Health 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. 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

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*. 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

4. 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

International Comparisons Costs

1. PharmaTimes. “OECD nations’ spending ‘growing faster than economies.’” June 30, 2010. Available at: http://www.pharmatimes.com/Article/10-06-30/OECD_nations_health_spending_%e2%80%9cgrowing_faster_than_economies%e2%80%9d.aspx

2*. 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-

3. 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

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4. 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

Population Health 1. 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

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

Further Readings

1. Antos, J., Bertko, J., Chernew, M., et al. “Bending the curve: Effective steps to address long-term healthcare spending growth.” American Journal of Managed Care 15(10):676-680, 2009

2. 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

3. 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

4. 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

5. 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/

6. Detsky, A.S. “How to control health care costs.” Journal of General Internal Medicine 27(9):1095-1096, 2012 7. Fox, M. “Key cuts to healhcare waste saves $3.6 trillion.” Reuters, 2010. Available at:

http://www.reuters.com/assets/print?aid=USTRE65D0N920100614 8. Fuchs, V.R. “How to think about future health care spending.” New England Journal of Medicine 362(11):965-967, 2010 9. Fuchs, V.R. “Three ‘inconvenient truths’ about health care.” New England Journal of Medicine 359(17):1749-1752, 2008 10. 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 11. Gawande, A. “The cost conundrum: What a Texas town can teach us about health care.” The New Yorker, June 1, 2009 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

14. Kennedy, K. “Health care costs vary widely, study shows,” USA Today, June 30, 2011, Available at: http://www.usatoday.com/money/industries/health/2011-06-30-health-costs-wide-differences-locally_n.htm

15. 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

16. Lopatto, E. “More than 40% of U.S. may be obese by 2030, study says.” Bloomberg, May 7, 2012. Available at: http://www.bloomberg.com/news/2012-05-07/more-than-40-of-u-s-may-be-obese-by-2030-study-says-correct-.html

17. Lowrey, A. “In hopeful sign, health spending is flattening out.” New York times, April 28, 2012, p.A.1 18. 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

19. Miller, T. “Health spending projection spin cycle: Rinse and repeat, or reset?” Health Affairs Blog, August 11, 2011. Available at: http://healthaffairs.org/blog/2011/08/11/health-spending-projection-spin-cycle-rinse-and-repeat-or-reset/

20. Murray, C.J.L., Frenk, J. “Ranking 37th Measuring the performance of the U.S. health care system.” New England Journal of Medicine 362(2):98-99, 2010

21. 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

22. Orsag, P.R. “How health care can save or sink America.” Foreign Affairs, July/August 2011. Available at: http://www.foreignaffairs.com/articles/67918/peter-r-orszag/how-health-care-can-save-or-sink-america

23. Pear, R. “New system for patients to report medical mistakes.” The New York Times, September 22, 2012. Available at: http://www.nytimes.com/2012/09/23/health/new-system-for-patients-to-report-medical-mistakes.html?_r=0

24. 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/

25. 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/

26. 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

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27. 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

28. 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

29. 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

30. The Economist. “An incurable disease.” September 29, 2012. Available at: http://www.economist.com/node/21563714 31. Trust for America’s Health. “F as in fat: How obesity threatens America’s future 2012,” September 2012. Available at:

http://healthyamericans.org/report/100/ 32. 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

Care Delivery

Lesson 2 – January 21-27, 2013 Post Group Summary/Synthesis A Macro View of Physician Supply: Do We Have Enough Physicians Now? Will We Need More in the Future? Individual 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

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/files/research/070811.policysynthesis.workforce.rpt.pdf

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. http://link.springer.com/content/pdf/10.1007%2Fs11606-012-2185-3

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. 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

3. 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

4. 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

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5. 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/

6*. 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

7*. Gamble, M. “68% of graduating physicians want sign-on bonus, 29% want hospital practice.” 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

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*. Changes in Health Care Financing and Organization, 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*. Henry J. Kaiser Family Foundation. “Primary care shortage; Background brief.” Available at: http://www.kaiseredu.org/topics_im.asp?id=1032&imID=1&parentID=70

4. Sataline, S. “Medical schools can't keep up; as ranks of insured expand, nation faces shortage of 150,000 doctors in 15 years.” Wall Street Journal (Online), Apr 12, 2010. http://online.wsj.com/article/SB10001424052702304506904575180331528424238.html

5. 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

6. 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

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. Torrey, E.F. and Torrey, B.B. “The US distribution of physicians from lower income countries.” PLoS ONE, 7(3):e33076, March

2012. Available at: http://www.plosone.org/article/info:doi/10.1371/journal.pone.0033076 3*. 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 4*. 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 5. 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 6. 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 7. 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 8. 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 Public Policy Issues and Concerns About Physician Supply

1. 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

2. 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

3. Marcy, J. “Doctor shortages under health law may depend on geography.” Kaiser Health News, March 17, 2011. Available at: http://www.kaiserhealthnews.org/Stories/2011/March/17/primary-care-shortage.aspx

4*. 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

5*. 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/

6. 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/

7. 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

Further Readings

1. 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

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2. 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

3. 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

4. Cassel, C. K., Reuben, D.B. “Specialization, subspecialization, and subsubspecialization in internal medicine.” New England Journal of Medicine 364:1169-1173, 2011

5. 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

6. Gold, J. “The next frontier for elite med schools: Primary care.” Kaiser Health News, September 23, 2012. Available at: 7. Goldstein, A. “Primary-care health panel caught in partisan dispute.” The Washington Post, May 16, 2011, p. A.3 8. Hobson, K. “ Med school enrollment in 2015 will miss goal.” Wall Street Journal Health Blog, May 10, 2010. Available at:

http://blogs.wsj.com/health/2010/05/10/med-school-enrollment-in-2015-will-miss-goal/ http://www.kaiserhealthnews.org/Stories/2012/September/24/Mt-Sinai-Primary-Care.aspx

9. Iglehart, J.K. “Medicare, graduate medical education, and new policy directions.” New England Journal of Medicine 359(6):643-650, 2008

10. Jena, A.B., Seabury, S., Lakdawalla, D., Chandra, A. “Malpractice risk according to physician specialty.” New England Journal of Medicine 365(7):629-636, 2011

11. Kaiser Health News. “Doctor shortage issue heats up with reform efforts.” November 23, 2009. Available at: http://www.kaiserhealthnews.org/daily-reports/2009/november/23/doctor-shortage-issue.aspx?referrer=search

12. 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

13. 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

14. Worth, 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

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. “What happened to the family doctor?” Los Angeles Times, June 27, 2011. Available at: http://articles.latimes.com/print/2011/jun/27/health/la-he-primary-care-doctors-20110627

Changes in the Workplace for Primary Care Physicians 1. Chen, P. “Delivering Better Primary Care.” New York Times, May 13, 2010. Available at:

http://www.nytimes.com/2010/05/13/health/13chen.html 2. Becker, A.E. “More physicians turning to hospital-based practice.” Ctmirror, August 15, 2011. Available at:

http://ctmirror.org/story/13550/hospitalists 3. 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 4*. 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

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New Models for Primary 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?sid=b1ae00b1-d01d-4f57-a3a7-c3fa2b2aa56c%40sessionmgr14&vid=4&hid=16

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. 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

4. 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

5. 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

6. 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

7. 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

8. Adair, R., Christianson, J., Wholey, D., White, K.M., Town, R., Lee, S., Britt, H., Lund, P., Lukasewycz, A., Elumba, D., “Care guides. Employing nonclinical laypersons to health primary care teams manage chronic disease.” Journal of Ambulatory Care Management 35(1):1-11, 2012. http://ovidsp.tx.ovid.com/sp-3.8.0b/ovidweb.cgi?WebLinkFrameset=1&S=PGPHFPAKDDDDMCMFNCPKKCIBFBPDAA00&returnUrl=ovidweb.cgi%3f%26TOC%3dS.sh.18.19.22.30.34.61%257c4%257c50%26FORMAT%3dtoc%26FIELDS%3dTOC%26S%3dPGPHFPAKDDDDMCMFNCPKKCIBFBPDAA00&directlink=http%3a%2f%2fgraphics.tx.ovid.com%2fovftpdfs%2fFPDDNCIBKCMFDD00%2ffs047%2fovft%2flive%2fgv031%2f00004479%2f00004479-201201000-00004.pdf&filename=Care+Guides%3a+Employing+Nonclinical+Laypersons+to+Help+Primary+Care+Teams+Manage+Chronic+Disease.&link_from=S.sh.18.19.22.30.34.61%7c4&pdf_key=B&pdf_index=S.sh.18.19.22.30.34.61

9*. 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

10*. 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

11. 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

12. 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

Further Readings

1. 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/

2. Berenson, R.A., Rich, E.C. “US approaches to physician payment: The deconstruction of primary care.” Journal of General Internal Medicine 25(6):613-618, 2010

3. Bitton, A., Martin, C., Landon, B.E. “A nationwide survey of patient centered medical home demonstration projects.” Journal of General Internal Medicine 25(6):584-592, 2010

4. 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

5. 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

6. 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

7. 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

8. 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/

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

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10. 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

11. Sandy, L.G., Bodenheimer, T., Pawlson, L.G., and Starfield, B. “The political economy of U.S. primary care.” Health Affairs 28(4):1136-1144, 2009

12. Schoen, C., Osborn, R., Doty, M.M., Squires, D., Peugh, J., and Applebaum, S. “A survey of primary care physicians in eleven countries, 2009: Perspectives on care, cost, and experiences.” Health Affairs – Web Exclusive 28(6):w1171-w1183 (published online November 5, 2009)

13. 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

Lesson 3 – January 28 – February 3, 2013 Post Group Summary/Synthesis The Nurse Workforce: “Is There a Nurse in the House?” Individual Assignment 2 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.

Suggested Readings Managing the Supply of Nurses

1*. kaiserEDU.org. “Nursing workforce.” Available at: http://www.kaiseredu.org/Issue-Modules/Addressing-the-Nursing-Shortage/Background-Brief.aspx?referrer=search

2. 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

3. 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

4. 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. 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

8. 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

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

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://online.wsj.com/article/SB10000872396390443862604578032842310254744.html 4. Gorn, D. “Physicians, nurse practitioners at odds over new roles.” California Healthline, October 3, 2012. Available at:

http://www.californiahealthline.org/capitol-desk/2012/10/one-barrier-lifted-for-nurse-practitioners.aspx

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Further Readings

1. “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/

2. 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

3. 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)

4. 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-/

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

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*. 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

2*. 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

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

4. 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

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

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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&gwh=33EA8D4C1ACD9B5EB4F210CD6BF373B4 2. 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&gwh=EC29C115F8E49EADDF0513C54BEE0E09

3. 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?gwh=5F0ACA34965318374319D98D1E136D2B

4. 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

Proposals for Reform 1. Raphael C. “Long-term care: Preparing for the next generation,” July 21, 2008. Available at:

http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=695882 2*. 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 3. 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 4*. 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 5. 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 6. 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 7. 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

8. 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

Further Readings 1. “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 2. Elliott, J. and Scharrer, G. “Nursing homes an ailing industry / state's lagging Medicaid support strains facilities.” Houston

Chronicle, February 16, 2009. p. 1 3. Gawande, A. “Rethinking old age.” New York Times, May 24, 2007. p. A.27 4. 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 5. 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

6. 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.htmlEngberg, J., Castle, N.G., and McCaffrey, D. “Physical restraint initiation in nursing homes and subsequent resident health.” The Gerontologist 48(4):442-452, 2008

7. 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

8. 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

9. 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

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Lesson 4 – February 4-10, 2013 Post Group Summary/Synthesis The Hospital: From Doctors’ Workshop to Big Med Group Assignment 1 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. Vogt, W.B. “Hospital market consolidation: Trends and consequences.” Expert Voices. Washington, DC: NIHCM Foundation. November 2009. Available at: http://nihcm.org/pdf/EV-Vogt_FINAL.pdf

3. 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

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

5*. 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

Role of the Emergency Department 1*. 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 2. Rabin, E., Kocher, K., McClelland, M., Pines, J., Hwang, U., Rathlev, N., et al. “Solutions to emergency department ‘boarding’

and drowding are underused and may need to be legislated.” Health Affairs 31(8):1757-1766, 2012. http://content.healthaffairs.org/content/31/8/1757.full.pdf+html

3*. Rabin, R.C. “Statistics: Who visits the emergency room? 20 percent of Americans, insured or not.” August 2010, Available at: http://www.computerizedscreening.com/about/news/08-13-2010/statistics:-who-visits-the-emergency-room--20-percent-of-americans,-insured-or-not

4. 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/

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

Addressing Medical Errors and Patient Safety 1. Rau, J. “Joint commission praises 620 hospitals for quality.” Capsules, The KHN Blog, September 19, 2012. Available at:

http://www.kaiserhealthnews.org/Daily-Reports/2012/September/19/2khnstory.aspx?print=1 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. 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 Competitive and Financial Challenges Facing U.S. Hospitals

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*. “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

4*. Pell, M.B. “Huge hospital markups burden patients.” ajc.com, April 20, 2011. Available at: http://www.ajc.com/business/huge-hospital-markups-burden-917750.html

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5. 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

6*. 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. http://content.healthaffairs.org/content/31/4/827.full.pdf+html

7. 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

8. 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

9*. 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?pagewanted=all&gwh=7E5E778A38C3C4EA23B85F5FDDF562E2

10. 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/

11. 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

12. Rabin, R.C. “Some hospital networks also become insurers.” The Washington Post, August 25, 2012. Available at: http://www.washingtonpost.com/business/some-hospital-networks-also-become-insurers/2012/08/25/53e90a72-eb1d-11e1-b811-09036bcb182b_story.html

13. Volpp, K.G.M., Grande, D. “Residents’ suggestions for reducing errors in teaching hospitals.” New England Journal of Medicine 348(9):851-855, 2003. http://www.nejm.org/doi/pdf/10.1056/NEJMsb021667

14. Johnson, C.K. “Poor infection control at many surgery centers.” MSNBC, June 8, 2010. Available at: http://www.msnbc.msn.com/id/37577363

15. Sittig, D.F., Singh, H. “Defining health information technology—related errors.” Archives of Internal Medicine 171(14):1281-1284, 2011. http://archinte.jamanetwork.com/Issue.aspx?journalid=71&issueID=22519&direction=P

Changes and Challenges in 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. 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

Further Readings

1. Abelson, R. “Bills stalled, hospitals fear rising unpaid care.” New York Times, February 9, 2010, p. B.1. 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. 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

4. 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

5. 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

6. Gold, J. “Trinity Health, Catholic Health East announce plans to merge.” Capsules, The KHN Blog, October 17, 2012. Available at: http://capsules.kaiserhealthnews.org/index.php/2012/10/trinity-health-catholic-health-east-announce-plans-to-merge/

7. Goldsmith, J. “Analyzing shifts in economic risks to providers in proposed payment and delivery system reforms.” Health Affairs 29(7):1299-1304, 2010

8. 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

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

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10. Harris, G. “Hospital shows a way to save: Doctors get salaries, not fees.” New York Times, July 25, 2009. p. A.1 11. 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 12. 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 13. Pear, R. “I.R.S. checking compliance by tax-exempt hospitals.” New York Times, June 19, 2006. p. A.15 14. Rabin, R.C. “Study finds fewer emergency rooms as need rises.” New York Times, May 18, 2011, p. A.13. 15. Reuters. “Who’s packing ERs? Not the uninsured.” May 19, 2010. Available at:

http://www.reuters.com/article/idUSTRE64I78X20100520 16. 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 17. 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

18. 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

19. 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

20. 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

Lesson 5 – February 11-17, 2013 Post Group Summary/Synthesis Medical Technology and Devices: At the Cutting Edge Group 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

Concerns About Conflicts of Interest Involving Medical Device Manufacturers and Physicians, and Other Controversial Practices 1*. Meier, B. “It's easier to get data on a car than on a medical device.” New York Times, June 23, 2005, p. C.1.

http://query.nytimes.com/gst/fullpage.html?res=9B00E6DF1F3BF930A15755C0A9639C8B63 2. 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 3*. Meier, B., Wilson, D. “Spine experts repudiate Medtronic studies.” New York Times, June 29, 2011, p. B.1.

http://www.nytimes.com/2011/06/29/business/29spine.html?pagewanted=all&gwh=5D3267C1F5AA400537FC8CE295463F2E 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&_r=0&gwh=A29C8F9DE9AC6A9A51611F28CCF8AAE9

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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

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&gwh=0F57BA0FEF1CFBD3C4424B761BDF2D7A .

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?gwh=D2E43EFE150329ACDFA09552B1862BC1

3. Meier, B. “The implants loophole,” New York Times, December 17, 2010, p. B.1. http://www.nytimes.com/2010/12/17/business/17hip.html?pagewanted=all&gwh=65BF02735BE184ADA19AF39A05A3B40F

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. http://go.galegroup.com/ps/retrieve.do?sgHitCountType=None&sort=DA-SORT&inPS=true&prodId=PROF&userGroupName=mnaumntwin&tabID=T003&searchId=R2&resultListType=RESULT_LIST&contentSegment=&searchType=AdvancedSearchForm&currentPosition=5&contentSet=GALE%7CA266486808&&docId=GALE|A266486808&docType=GALE&role=

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*. Meier, B., Roberts, J. “Hip implant complaints surge, even as the dangers are studied.” New York Times, August 23, 2011, p. A.1. http://www.nytimes.com/2011/08/23/business/complaints-soar-on-hip-implants-as-dangers-are-studied.html?pagewanted=all&gwh=2EA61E2FF4D608635B200915440AD9BF

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

Further Readings

1. “Defibrillators lift Medtronic's profit.” New York Times, May 23, 2007. p. C.5 2. 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

3. 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/

4. 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

5. Berenson, A. and Abelson, R. “Weighing the costs of a look inside the heart.” New York Times, June 29, 2008. p. A.1 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. Crann, T. “How a medical device tax will affect the industry.” MPR News, December 21, 2009. Available at:

http://minnesota.publicradio.org/display/web/2009/12/21/medical-device-tax-qa/ 8. Feder, B.J. “Heart therapy strains efforts to limit costs.” New York Times, July 7, 2007. p. A.1 9. 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 10. Harris, G. “After many stent procedures, multiple lawsuits.” New York Times, December 6, 2010, p. A.15 11. 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

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12. 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

13. Joffe-Walt, C. “A medical mystery: Why health care is so expensive.” NPR, September 4, 2009. Available at: http://www.npr.org/templates/story/story.php?storyId=112522353

14. Kolata, G. “New tools for helping heart patients.” New York Times, June 22, 2010. p. D.1 15. Meier, B. “Hip device phaseout followed FDA data request.” New York Times, March 23, 2012, p. B.1 16. Meier, B. “Ads for medical devices are under scrutiny.” New York Times, September 17, 2008. p, C.12 17. Meier, B. “As their use soars, heart implants raise questions.” New York Times, August 2, 2005, p. C.1 18. Meier, B. “Fight over medical device rules, sight unseen.” New York Times, July 28, 2011, p. A.1 19. Meier, B. “Growing debate as doctors train on new devices.” New York Times, August 1, 2006, p. A.1 20. Meier, B. “Surgeon vs. knee maker: Who's rejecting whom?” New York Times, June 20, 2010. p, BU.1 21. Meier, B. “Tipping the odds for an implant maker.” New York Times, April 3, 2011, p. A.1 22. Meier, B. “When heart devices fail, who should be blamed?” New York Times, April 21, 2010. p, B.1 23. 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 24. Moore, J. “Study on ICD implants turned up a surprise.” StarTribune.com, September 7, 2007. Available at:

http://www.startribune.com/business/11224551.html?elr=KArksUUUoDEy3LGDiO7aiU 25. Mundy, A. and Favole, J.A. “FDA memo hints at curbs to approval process for medical devices.” Wall Street Journal, February

18, 2010 26. Pauly, M.V. and Burns, L.R. “Price transparency for medical devices.” Health Affairs 27(6):1544-1553, 2008 27. 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

28. Pollack, A. “Medical treatment, out of reach.” New York Times, February 10, 2011, p. B.1 29. 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/ 30. Skrzycki, C. “FDA's user-fee habit.” Washington Post, April 3, 2007. p. D.1 31. 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

32. Spencer, J. “Med-tech firms fight tax on devices.” Star Tribune, September 8, 2011, p. D.1 33. 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/# 34. 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

35. 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

36. Winslow, R., Carreyrou, J. “Heart treatment: Overused---study finds doctors often too quick to try costly procedures to clear arteries.” Wall Street Journal, July 6, 2011, p. A.1

Lesson 6 – February 18-24, 2013 Post Group Summary/Synthesis Pharmaceuticals: A Regulatory Rubik’s Cube Group Assignment 3 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. Beasley, D. “U.S. branded drug prices soar as generic pressure rises.” March 23, 2011. Available at: http://www.reuters.com/article/2011/03/23/us-branded-drug-prices-idUSTRE72M57X20110323

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4. 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

5. 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/

6. 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/

7. 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

8*. Wilson, D. “Deepening drug shortages.” Health Affairs 31(2):263-266, 2012. http://content.healthaffairs.org/content/31/2/263.full.pdf+html

9. 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?gwh=3AC17391C29FE559D3D3769AF8589F9F&_r=0

10*. 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

11. Andrews, M. “Patients share of expensive specialty drugs is rising.” Kaiser Health News, May 7, 2012. Available at: http://www.npr.org/blogs/health/2012/05/08/152245452/why-your-drug-copay-could-change

12. 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

13. 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/

14*. 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

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?gwh=FF4EC3FC9647E73B81E478AFABA10B67 . 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 5*. 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

6*. 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?gwh=325612E62BBAA8EC15C73D0E6B86F1EE .

7. 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

8. Editorial. “Drug company payoffs.” New York Times, July 6, 2010. Available at: http://www.nytimes.com/2010/07/07/opinion/07wed2.html

9. 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

10. 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

11. 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

12*. 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

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

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5. “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.htmlFrates, C. “

6. PhRMA quietly spends big in 2010.” POLITICO.com, November 10, 2010. Available at: http://www.politico.com/news/stories/1110/44917.html

7. 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

Further Readings

1. “When a drug costs $300,000.” New York Times, March 23, 2008, p. WK.8 2. 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 3. Abelson, R. “Pay method said to sway drug choices on oncologists.” The New York Times, March 8, 2006, p. C.3 4. Ahmed, R. India revokes Roche patent. The Wall Street Journal, November 3, 2012. Available at:

http://online.wsj.com/article/SB10001424052970204846304578096483954249650.html 5. 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 6. Associated Press. “Walgreens and Express Scripts are at a contract impasse.” New York Times, June 21, 2011. Available at:

http://www.nytimes.com/2011/06/22/business/22walgreen.html 7. 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 8. Bakalar, N. “Study sees a slant in articles on drug.” New York Times, April 13, 2010. p. D.7 9. 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

10. 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

11. 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

12. 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

13. Carpenter, 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

14. 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

15. Chabner, B.A., “Drug shortages – a critical challenge for the generic-drug market.” New England Journal of Medicine 365(23):2147-2148, 2011

16. Chu, K. “Fake-drug raids are uphill battle.” Wall Street Journal online, July 26, 2012. Available at: http://online.wsj.com/article/SB10001424052702303644004577520563150078208.html

17. 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##

18. Donohue, J.M., Cevasco, M., and Rosenthal, M.B. “A decade of direct-to-consumer advertising of prescription drugs.” New England Journal of Medicine 357(7):673-681, 2007

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

20. 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#page1

21. Editorial. “Some legal clarity on generic drugs.” New York Times, July 18, 2012, p. A.26 22. 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 23. Editorial. The shortage of vital drugs.” New York Times, August 26, 2011, p. A.26 24. 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 25. 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 26. Harris, G. “Research ties diabetes drug to heart woes.” New York Times, February 20, 2010, p. A.1 27. Harris, G. “Study condemns F.D.A.'S handling of drug safety.” New York Times, September 23, 2006. p. A.1 28. Herbert, B. “This is reform?” New York Times, August 18, 2009, p. A.23

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29. 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

30. 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

31. Kendall, B. “White House seeks to speed up generic drugs’ path to market.” Wall Street Journal, February 15, 2011, p. D.2 32. 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 33. 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 34. 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

35. Loftus, P. “Pfizer to cut R&D, step up buybacks.” Wall Street Journal, February 2, 2011, p.23 36. Loftus, P., Thomas, G. “Health & Wellness: FDA sued over generic Lipitor release.” Wall Street Journal, March 22, 2011, p. D.2 37. 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 38. Meier, B. “Merck canceled an early study of Vioxx.” New York Times, February 8, 2005. p. C.1 39. 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

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

41. 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

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

43. Pollack, A. “New drugs fight prostate cancer, but at high cost.” New York Times, June 28, 2011, p. A.1 44. Pollack, A. “Taking big risk for big payoff, industry seeks cancer drugs.” New York Times, September 2, 2009, p. A.1 45. 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

46. 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

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

48. 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

49. 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

50. 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

51. 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

52. Rockoff, J.D. “Corporate news: Pfizer plans deeper cuts in its costs.” Wall Street Journal, June 8, 2011, p.21 53. Rockoff, J.D. “Drug prices rise despite calls for cuts.” Wall Street Journal, March 17, 2011, p. B.1 54. Rockoff, J.D. Hepatitis C drug derailed by deal. The Wall Street Journal, November 14, 2012. Available at:

http://online.wsj.com/article/SB10001424127887324073504578107421424680236.html 55. Schmidt, M.S., K. Thomas. “Abbott settles marketing lawsuit.” New York Times, May 8, 2012, p. B.1 56. 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 57. Singer, N. “A fight over how drugs are pitched.” New York Times, April 24, 2011, p. B.1 58. Stynes, T. Express Scripts earnings rise 21%. The Wall Street Journal, November 5, 2012. Available at:

http://online.wsj.com/article/SB10001424052970204349404578101353030937738.html 59. Terhune, C. “U.S. spending on genetic tests jumps.” Los Angeles Times, March 12, 2012, p. A.4 60. USA Today Editorials. “Our view: When pure profit drives drugmakers, you pay.” 2011. Available at:

http://www.usatoday.com/news/opinion/editorials/2011-04-07-editorial07_ST_N.htm 61. Whalen, J. “FDA scientist attacks Avandia safety.” Wall Street Journal, June 11, 2010. p. B.4

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

63. 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

64. 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

65. Wyatt, E. “For big drug companies, a headache looms.” New York Times, July 27, 2012, p. B.1

Financing Lesson 7 – February 25 - March 3, 2013 Post Group Summary/Synthesis Health Insurance 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.

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. Holahan, J., Chen, V. “Changes in health insurance coverage in the great recession, 2007-2010.” Kaiser Commission on Medicaid and the Uninsured, December 2011. Available at: http://www.kff.org/uninsured/upload/8264.pdf

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

6. 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

7. 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/

8. 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/

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

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?gwh=EA23DA33A802A7AFAA4D6C70EF6F498E .

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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?pagewanted=all&gwh=19AF26A1227023CDDC01F6DE5330552E

3*. Kaiser Commission on Medicaid and the Uninsured. “Five facts about the uninsured.” September, 2011. Available at: http://www.kff.org/uninsured/upload/7806-04.pdf

4. 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

5. Causey, J.E. “Want free health care? Show up at 5 a.m.” JSOnline, July 21, 2012. Available at: http://www.jsonline.com/news/opinion/want-free-health-care-show-up-at-5-am-lining-up-at-5-am-for-health-care-nm654no-163268326.html

Further Readings

1. “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

2. 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

3. AON Hewitt. “The time is now. Rethinking health care coverage.” 2011. Available at: http://www.aon.com/attachments/human-capital-consulting/Corporate_Exchange_Survey_Report_Final_2.pdf

4. Baicker, K. and Chandra, A. “Myths and misconceptions about U.S. health insurance.” Health Affairs – Web Exclusive 27(6):w533-w543, 2008

5. Brennan, T.A., Studdert, D.M. “How will health insurers respond to new rules under health reform.” Health Affairs 29(6):1147-1151, 2010

6. Burman, L. “Tax subsidies for private health insurance: Who benefits and at what cost?” RWJ Synthesis Project, UPDATE July 2009. Available at: http://www.rwjf.org/files/research/072209policysynthesis3update.brief.pdf

7. 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

8. 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

9. 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

10. Freudenheim, M. “When even one illness can push insurance costs up,” The New York Times, May 5, 2007, p.C.1 11. 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 12. 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 13. 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 14. Henry J. Kaiser Family Foundation. “Tax subsidies for health insurance. An issue brief. July 2008. Available at:

http://www.kff.org/insurance/7779.cfm 15. 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 16. 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 17. 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 18. Murphy, T. “Survey: Overhaul may push employee benefits shift.” YAHOO news, August 24, 2011. Available at:

http://news.yahoo.com/survey-overhaul-may-push-employee-benefits-shift-210428121.html 19. Pear, R. “Health insurers to be required to justify rate increases over 10 percent.” New York Times, December 22, 2010, p. A.21 20. 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

21. 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

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Lesson 8 – March 4-10, 2013 Post Group Summary/Synthesis 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. 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

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*. 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 3. Pear, R. “Cuts leave patients with Medicaid cards, but no specialist to see.” New York Times, April 2, 2011, p. A.1.

http://www.nytimes.com/2011/04/02/health/policy/02medicaid.html?gwh=203D08F88A6740F44F139B838CCFFAE8 4. 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 5. 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 6*. 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 7. 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 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/fdc/welcome_mjx.shtml

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

Policy Proposals for 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://www.nytimes.com/2011/05/01/opinion/01sun1.html?_r=0&gwh=439916496A36A694011E66C376E2145F

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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://www.nytimes.com/2012/07/18/opinion/the-rush-to-abandon-the-poor.html?gwh=E9462C323501587AE46EE7536C7A67F1

6. 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

7. 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/

8. 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

9. 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

10. 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

11. 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

Further Readings

1. 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

2. 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/

3. 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

4. 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

5. Carey, M.A. “FAQ: Ryan’s plan would make key changes in Medicaid, too.” Kaiser Health Network, August 14, 2012. Available at: http://www.kaiserhealthnews.org/Stories/2012/August/15/medicaid-ryan-faq.aspx

6. 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

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

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. “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

11. 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/

12. Goodnough, A. “Lines are drawn over opting out of Medicaid plan.” New York Times, July 13, 2012, p. A.1 13. 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/ 14. Kaiser Commission on Medicaid and the Uninsured. Faces of the Medicaid expansion: Profiles of uninsured adults who could

gain coverage. November 2012. Available at: http://www.kff.org/medicaid/8385.cfm 15. 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 16. Lane, C. “Medicaid mystery at SCOTUS.” Washington Post online, June 28, 2012. Available at:

http://www.washingtonpost.com/blogs/post-partisan/post/medicaid-mystery-at-scotus/2012/06/28/gJQAaOAk9V_blog.html 17. 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 18. 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

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19. 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

20. Rosenbaum, S. “Medicaid and access to health care – a proposal for continued inaction? New England Journal of Medicine 365(2):102-104. 2011

21. Sack K. and Pear R. “States consider Medicaid cuts as use grows.” New York Times, February 19, 2010, p.A-1 22. 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/ 23. 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 24. 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 25. Walker, S. “Our obsolete approach to Medicaid.” New York Times, April 22, 2011, p. A.23

Lesson 9 – March 11-17, 2013 Post Group Summary/Synthesis 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 Foundation. “Medicare spending and financing.” 2011. Available at: http://www.kff.org/medicare/7305.cfm 3. Henry J. Kaiser Family Foundation. “Health care on a budget. The financial burden of health spending by Medicare households.”

June 2011. Available at: http://www.kff.org/medicare/8171.cfm Issues Facing Medicare

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. Rau, J. “Medicare penalties for readmissions could be a tough hit on hospitals serving the poor.” Kaiser Health News, December 19, 2011. Available at: http://www.kaiserhealthnews.org/stories/2011/december/20/medicare-penalties-readmissions-hospitals-serving-poor.aspx

4. Kenen, J. “Medicare eyes hospice savings.” Politico, October 17, 2011. Available at: http://www.politico.com/news/stories/1011/66177.html

5*. 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

6*. 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

7*. 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/

8*. 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

9. 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

10*. 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

11. Rau, J. “Medicare to penalize 2,211 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

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12. 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

13. 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/

14. Bloomberg. Hospital Medicare cash lures doctors as costs increase. November 19, 2012. Available at: http://www.bloomberg.com/news/2012-11-19/hospital-medicare-cash-lures-doctors-as-costs-increase.html

Further Readings

1. 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):1865-1875, 2012

2. 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

3. 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-

4. 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

5. Japsen, B. “Study: Drug benefit a boon for seniors, costly for U.S.” Chicago Tribune, January 9, 2008, p.1 6. Altman, D. “The new Medicare prescription-drug legislation,” New England Journal of Medicine 350(1): 9-10, 2004 7. Berenson, R.A. and Dowd, B.E. “Medicare Advantage plans at a crossroads – Yet again.” Health Affairs – Web Exclusive, pp.

w29-w-40, November 24, 2008 8. 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 9. 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

10. Seaman, A. “US Medicare prescription drug premiums to fall.” Reuters, August 4, 2011. Available at: http://www.reuters.com/article/2011/08/04/health-medicare-premiums-idUSN1E7730JG20110804

11. 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

12. Bloomberg. AMA, physician groups outline payment reforms to finance committee. October 17, 2012. Available at: http://www.bna.com/ama-physician-groups-n17179870268/

13. 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

14. Yahoo!Finance. Express Scripts unveils 2013 Medicare prescription drug plan options, including $0 copay for generics and broad pharmacy network. October 8, 2012. Available at: http://finance.yahoo.com/news/express-scripts-unveils-2013-medicare-130000867.html

15. 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/

16. Appleby, J., Serafini, M.W. Is a competitive health care model all it’s cracked up to be? Kaiser Health News, September 20, 2012. Available at: http://www.kaiserhealthnews.org/stories/2012/september/20/competitive-health-care-model.aspx

17. Greene, K. Lowering your Medicare bill. Wall Street Journal, October 26, 2012. Available at: http://online.wsj.com/article/SB10001424052970203937004578077293381706414.html

18. 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

19. 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/

20. Calmes, J. Patients would pay more if Romney restores Medicare savings, analysts say. The New York Times, August 21, 2012. Available at: http://www.nytimes.com/2012/08/22/us/politics/costs-seen-in-romneys-medicare-savings-plan.html?pagewanted=all

21. 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

22. Kliff, S. Romney health plans would affect seniors’ care, studies find. The Washington Post, September 16, 2012. Available at: http://articles.washingtonpost.com/2012-09-16/business/35495353_1_health-care-law-medicare-beneficiaries-medicare-overhaul-plan

23. 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/

24. 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

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25. Rosenblatt, B. Understanding Medicare. Figuring out the Part D. market. The Medicare NewsGroup, November 29, 2012. Available at: http://medicarenewsgroup.com/context/understanding-medicare-blog/understanding-medicare-blog/2012/11/29/figuring-out-the-part-d-market

26. 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

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/

The Impact of Health Reform on Medicare

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

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. 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

5. 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

6. 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

7. 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

8. 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/

9. Pear, R. “Romney Medicare plan draws a stark contrast.” New York Times online, May 15, 2012. Available at: http://www.nytimes.com/2012/05/15/us/politics/romney-medicare-plan-draws-stark-contrast-with-obamas.html?pagewanted=all

10*. 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/

11. 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/

12*. 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

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13. 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

14. 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

Medicare and the Presidential Election 1. Armey, D., Kibbe, M. “The Medicare test for president. A candidate who is timid on entitlement reform is not qualified to lead the

country.” Wall Street Journal (Online), May 20, 2011. http://online.wsj.com/article/SB10001424052748704816604576333150097033250.html

2. Baker, S. “DCCC targets 41 GOP members with Medicare attack.” The Hill, March 19, 2012. Available at: http://thehill.com/blogs/healthwatch/medicare/216643-dccc-targets-41-gop-members-with-medicare-attack

3.* 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

4. Hulse, C. “Two-way jabs on Medicare recast races for Congress.” New York Times online, August 14, 2012. Available at: http://www.nytimes.com/2012/08/15/us/with-ryan-in-medicare-fight-recasts-races-for-congress.html

5. 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

6*. 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

7. 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

Further Readings

1. Krugman, P. “Republicans and Medicare.” New York Times, February 12, 2010. p. A.31 2. 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 3. Carey, M.A. “How the health law might be changed by the next president.” Kaiser Health News, November 1, 2012. Available

at: http://www.kaiserhealthnews.org/stories/2012/october/31/health-law-obama-romney-election.aspx 4. 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/ VII. Evaluation and Grading

Grades will be determined based on four group assignments (20 points each), four individual assignments (20 points each) and eight group summaries posted on website (5 points each). 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%

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%

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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 sends 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. 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)

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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 University policy relating to academic dishonesty. 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 and further information on 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). 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

ADDENDUM

*The MHA program uses the National Center for Healthcare Leadership (NCHL) Health Leadership Competency Model (v 2.1). Copyright 2006. NCHL. All rights reserved.

The number following the decimal indicates the level to which that competency is addressed, as further described in the Competency Model, available here: http://www.nchl.org/Documents/NavLink/NCHL_Competency_Model-full_uid892012226572.pdf.

    Addendum Page 1 of 3 

PubH 6556 (Health and Health Systems) NCHL* Competencies

Based on the course objectives listed in the Self-Study Year syllabus, the following competencies have been addressed by this course:

3 – Analytical Thinking 4 – Change Leadership 5 – Collaboration 6 – Communication Skills 7 – Community Orientation

11 – Information Seeking 18 – Process Management and

Organizational Design 24 – Strategic Orientation

The course objectives are listed here with the corresponding NCHL competencies:

Learning Objectives – Session 1 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 and explain differences between the U.S. and other countries in health care costs and population health

4. Discuss evidence on geographic variation in health care costs in the United States.

NCHL 3.2; 3.3; 4.1; 7.1; 11.3

Learning Objectives– Session 2 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.

NCHL 4.1; 6.3; 11.3

Learning Objectives– Session 3 Students should be able to:

NCHL 3.2; 3.3;

    Addendum Page 2 of 3  

1. Demonstrate an understanding of the political process as it relates to health care. 2. Describe the key components in the recently passed federal health reform

legislation. 3. Discuss the role that various health care interest groups played in the passage of

the federal health reform legislation and its implementation to date. Learning Objectives– Session 4 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.

NCHL 4.1; 5.1; 6.3; 11.3

Learning Objectives– Session 5 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.

NCHL 4.1; 5.1; 6.3; 11.3; 18.1; 18.2; 18.3; 24.1

Learning Objectives– Session 6 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.

NCHL 4.1; 5.1; 6.3; 11.3; 18.1; 18.2; 18.3

Learning Objectives– Session 7 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 Discuss current changes and challenges in hospital/physician relations.

NCHL 4.1; 5.1; 6.3; 11.3; 18.1; 18.2; 18.3; 24.1

Learning Objectives– Session 8 & 9 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.

NCHL 4.1; 5.1; 6.3; 11.3; 18.1; 18.2; 18.3

    Addendum Page 3 of 3  

Learning Objectives– Session 10 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.

NCHL 4.1; 5.1; 6.3; 11.3

Learning Objectives– Session 11 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.

NCHL 4.1; 5.1; 6.3; 11.3

Learning Objectives– Session 12 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.

NCHL 4.1; 5.1; 6.3; 11.3

Learning Objectives– Session 13 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.

NCHL 4.1; 5.1; 6.3; 11.3

Learning Objectives– Session 14 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.

NCHL 4.1; 11.3

Learning Objectives– Session 15 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.

NCHL 4.1; 11.3