Daily Rounds: 'Helicopter' Primary Care; Medicare Pilots Mixed; High Hospital Luxury; 'Outgrowing' Autism

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A doctor to watch over you (The Boston Globe) - "As this system spreads across the state, nearly everyone with health insurance will be required to choose a primary care provider; insurers are considering assigning providers to people who don’t make a choice. Residents who have primary care doctors can anticipate hearing from them and their staffs more often, as they focus on bringing patients into the office for preventive care. Doctors will be motivated to do this not only because it’s better care, but because they will earn more money if they keep their patients healthy - and thus out of hospitals, emergency rooms, and specialists’ offices. You’ve heard of helicopter parents. Similarly, primary care doctors will hover over their patients." (The Boston Globe)

Chefs, butlers, marble baths: Hospitals vie for the affluent (The New York Times) - The feverish patient had spent hours in a crowded emergency room. When she opened her eyes in her Manhattan hospital room last winter, she recalled later, she wondered if she could be hallucinating: “This is like the Four Seasons — where am I?” The bed linens were by Frette, Italian purveyors of high-thread-count sheets to popes and princes. The bathroom gleamed with polished marble. Huge windows displayed panoramic East River views. And in the hush of her $2,400 suite, a man in a black vest and tie proffered an elaborate menu and told her, “I’ll be your butler.” (The New York Times)

Medicare demo projects saved little money ( - "Several demonstration projects aimed at saving the Medicare program money have yielded few positive results, according to a report from the Congressional Budget Office (CBO). The CBO examined independent evaluators' reviews of 10 projects — six aimed at improving disease management and care coordination for chronically ill Medicare beneficiaries, and four that used "value-based payment" systems designed to encourage efficient, high-quality care. "Most programs have not reduced Medicare spending," wrote report author Lyle Nelson of CBO's health and human resources division. "Programs in which care managers had substantial direct interaction with physicians and significant in-person interaction with patients were more likely to reduce Medicare spending than other programs, but on average even those programs did not achieve enough savings to offset their fees.'" (

Why some children may 'grow out' of autism (Web MD) - "Some kids with autism will no longer qualify for that diagnosis as they grow older. Now a new study shows that whether or not a child “outgrows” their autism may be related to the number and severity of other physical and psychological problems that are part of their original diagnosis. The study is published in the journal Pediatrics. It compared more than 1,300 children with a past or current diagnosis of autism. About one-third of the kids in the survey had once been diagnosed with autism but were no longer considered to have the condition." (Web MD)

Thanks for nothing (Not Running a Hospital) - "From the reports, you would think that PHS [Partners Healthcare System] is reducing the rates it gets from the payers...These "savings" mask two phenomena. First, the base upon which those 2-3% rate increases will occur remains substantially above the rates paid to other hospitals and doctors. Second, the rate increases that PHS has received are no lower, and sometimes higher, than those granted to other systems whose base rates were already lower...The only good thing about these announcements is that they provide, for the first time, a sense of the tax imposed by PHS on the region's health care budget. We now see that it can forgo what it has characterized as $345 million in future revenues and still maintain its financial health." (Not Running A Hospital)

This program aired on January 23, 2012. The audio for this program is not available.