Daily Rounds: Arkansas Bundling; Judy Blume's Breast Cancer; Health Cost Chasms; Steward Scoops Another Group

The Arkansas Innovation (Ezekiel Emanuel in The New York Times) - "Mention medical innovation, and you might think of the biotech corridor around Boston, or the profusion of companies developing wireless medical technologies in San Diego. But one of the most important hotbeds of new approaches to medicine is … you didn’t guess it: Arkansas...The costs of all the hospitalizations, office visits, tests and treatments will be rolled into one “episode-based” or “bundled” payment. “In three to five years,” John M. Selig, the head of Arkansas’s Department of Human Services, told me, “we aspire to have 90 to 95 percent of all our medical expenditures off fee-for-service.”

!@#$% Happens (judyblume.com — Author Judy Blume writes about everyday things) "The biopsy report came back a few days later while I was with my GYN in her office (a long standing appointment). It was good that I wasn't alone and that she, who has been my doctor for seventeen years, could explain it to me. Very early. Very small. Well differentiated. All good news. But it was ductal carcinoma. Wait – me? There’s no breast cancer in my family (recent extensive genetic testing shows no genetic connection). I haven’t eaten red meat in more than 30 years. I’ve never smoked, I exercise every day, forget alcohol - it’s bad for my reflux - I’ve been the same weight my whole adult life. How is this possible? Well, guess what – it’s possible."

Insurer's files show big cost differences for same illnesses (NPR-Shots) "Many reports on cost and quality disparity (the best known is the Dartmouth Atlas of Health Care) are based on data from the government's Medicare program for seniors. But one published in the latest issue of Health Affairs focuses on care provided by nearly 250,000 doctors treating non-elderly patients insured by UnitedHealthcare from 2006 through part of 2009. Some of the cost variations are startling. For treating a basic asthma episode, cases in the 10th percentile of distribution cost $98 each while those in the 90th percentile the cost was $1,535 per case. As usual, the study's authors, all of whom work for UnitedHealthcare or a sister company, attempted to adjust for case severity. That means you can't explain the difference by saying expensive patients were 15 times sicker than the cheap ones."

Hawthorn Medical leaves Partners to link up with Steward (The Boston Globe) - "Nine months after scooping up 150 doctors from Beth Israel Deaconess Medical Center’s physician group, fast-growing Steward Health Care System has lured away more than 110 other health care providers affiliated with the giant Partners HealthCare System. Hawthorn Medical Associates, the largest multi-specialty practice in the New Bedford area, disclosed Wednesday that it has signed a 10-year affiliation deal with Steward, a Boston-based chain of 11 hospitals and other medical care facilities across Eastern Massachusetts."