Deciding on a Good Article Title

How important is the title of an article?  I would think it is important enough to catch the reader’s attention.  So, I find an article title interesting enough to click on it and read it, only to find that the title is misleading.  Had I not clicked on the link, I would not know what the main story was. That is what happened when I read the article titled, “Low-Income Adults Less Likely To Have Coverage, Regular Source of Care,”  published earlier this month by the California Healthline.

My first thought was – Do we need a study to tell us that low-income adults cannot afford to have health coverage, but I anyway clicked on the linked article.  And, was I surprised to find that the intent of the main article was not to stop at stating that low-income adults have lesser health coverage, but also that the healthcare reform could bridge those gaps!  The original article published by The Commonwealth Fund was titled, .”The Income Divide in Health Care: How the Affordable Care Act Will Help Restore Fairness to the U.S. Health System.”

Had I scrolled all the way to the end of the article, I would have found a concluding paragraph referencing the healthcare reform law.  It wasn’t intentional I think, but the online article may have lot several readers due to the misleading title.  Or perhaps, the writer thinks of the healthcare reform or Obamacare (as it popularly known) as socialized medicine!  I don’t know the answer.

 

U.S. Healthcare Needs Improvement: Results from the National Scorecard on U.S. Health System Performance, 2011

The Commonwealth Fund, a New York based healthcare foundation, released its National Scorecard, 2011, which updates a series of national assessments that measure and monitor population health, quality, access, efficiency, and equity in the U.S.  After assessing 42 healthcare indicators of quality, access, cost, performance and other measures, the U.S. scored 64 out of 100 on its performance compared to best performing countries, states,regions, and healthcare plans.  In 2006, the Fund’s first report gave the U.S. a score of 67, followed by 65 in 2008.

The scorecard portrays a unique assessment of the ways in which the nation’s healthcare system is underperforming and failing, and shows the areas it has gotten better.  The scorecard showed improvements in quality-of-care indicators that were the focus of public reporting and other initiatives. 

Promising improvements were noted in effective care for chronic conditions like high blood pressure control, hospital performance in preventing complications from surgery, and treating heart attacks, heart failure, and pneumonia.  Preventable hospitalizations dropped by 13 percent probably due to improved disease management.  Cigarette smoking dropped to 17 percent in 2010 from 20 percent in 2004, with Utah and California exceeding the Healthy People Goal 2010 of 12 percent.  However, the rate of deaths that might have been prevented with timely and effective care—improved 21 percent in the U.S. between 1997–98 and 2006–07 (from 120 to 96 deaths per 100,000).  Nevertheless, rates improved by 32 percent, on average, in 15 other industrialized nations, with U.S. at the bottom of the list with a rate 68 percent higher than the rate in the leading countries.

The U.S. does poorly in how efficiently healthcare resources are utilized, treatments are wasted, while limiting administrative costs.  Nearly 44 percent of adults, 81 million, were either uninsured or underinsured but had medical bills that were high relative to their incomes.  Rate of re-hospitalization for some conditions were as high as 20 percent.

Indicators that raise serious concern are infant mortality, childhood obesity, safe care,  patient-centered care, and disparities in care. 

The Commonwealth Fund report argues that “fundamental to a high-performing health care system is having ample capacity to innovate and improve.” This requires a skilled healthcare workforce, payment and insurance benefits that motivate consumers to make optimal use of the system, continued quality improvement, public health initiatives, and research.  Some of these issues will be addressed by the Affordable Care Act that makes investments in prevention and provides incentives to encourage physicians to select and maintain primary care careers.

The report states that “Successful implementation of reforms will require stakeholders at all levels to adopt a coherent, whole-system approach in which goals and policies are coordinated to achieve the best results for the entire population. By integrating all components of the health system to ensure better access, higher quality, and greater value, we would be far more able to safeguard the health and economic security of current and future generations.”

 

Low-performing hospitals care for greater numbers of elderly minority patients

A recent study,  Low-Quality, High-Cost Hospitals, Mainly In South, Care For Sharply Higher Shares Of Elderly Black, Hispanic, And Medicaid Patients,  published in Health Affairs reported some previously unknown statistics that could have serious implications for Medicare‘s Value-Based Purchasing Program.   In the Commonwealth Fund supported study, the Harvard researchers led by Ashish K. Jha found that low-performing hospitals with high costs have double the proportion of elderly black patients compared to high-quality, low-cost hospitals. Similar disparities were also found for elderly Hispanic and Medicaid patients.

The researchers report that the lower-performing hospitals are the typical small public or for-profit institutions in the South, while the higher-performing facilities are mostly nonprofit institutions in the Northeast.  According to the authors of the study “The fact that the worst hospitals have more than twice the proportion of elderly black patients than the best hospitals is both startling and unknown.”

Hospital data was drawn from different sources including Hospital Compare, Medicare, the American Hospital Association, and the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). Process measures were used to assign quality of care scores for acute myocardial infarction, congestive heart failure, pneumonia, and prevention of surgical complications. 

Because the Affordable Care Act authorizes Medicare to give out higher payments to hospitals that achieve better performance while cutting reimbursements for those hospitals that fail to perform better, hospitals that can simultaneously provide high-quality care and manage their costs well are likely to come out ahead under health reform, the authors say.  Financial penalties  incurred by lower-performing hospitals may inadvertently worsen existing disparities in health care unless these hospitals improve on quality and cost of care.