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Issue Date: February 2006

Health Reform Solutions Worth Considering
President Bush wants to get more employers and workers to participate in health savings accounts (HSAs). Premiums for HSAs should be paid from tax-free accounts and HSAs should be portable, Bush says. Also, employers should be allowed to put more cash in these accounts for chronically ill workers, he adds. What’s more, Bush aims to eliminate taxes on out-of-pocket spending. Currently, an estimated 3 million Americans are enrolled in HSAs, which is roughly 1.5% of the 195 million Americans who have commercial health insurance policies. The Democrats countered, however, that a government study shows low-income and sicker people are unlikely to enroll in HSAs because the high deductibles are too costly. Healthy Americans prefer the tax advantages and investment returns of HSAs, the say. When healthier people drop traditional coverage, they leave sicker people in the risk pool, causing premiums to rise and making comprehensive health benefits unaffordable, the Democrats add.

Network Compiles Quality Data
Cardiologists and health care experts alike acknowledge the value of tracking indicators related to the care of cardiac patients. By analyzing trends in practice patterns and outcomes, cardiologists can enhance quality. Many cardiologists turn to data registries to study and benchmark care practices. Others use internal tracking strategies to measure their performance and drive quality improvement. To facilitate research on cardiac care, health technology experts have developed registries of data on the care and outcomes of cardiac patients. Some of these registries are state-specific, such as those in Washington state and Rhode Island. Others are national registries such as The National Cardiovascular Data Registry, the Acute Decompensated Heart Failure National Registry, the Merged Cardiac Registry, and the Merged Percutaneous Coronary Intervention (PCI) Registry. In addition, the Society of Thoracic Surgeons in Chicago has developed an Adult Cardiac National Database.

Consider a Physician-Centered Practice
Physicians are knowledge workers. According to one definition of knowledge workers, they have high degrees of expertise, education, or experience, and the primary purpose of their jobs is to create, distribute or apply their knowledge. Then it follows logically that building a job that meets their unique needs would require a physician-centered practice. Simply using the term “physician-centered practice” may be enough to make physicians question the strategy. After all, one of the goals of health systems today is to be patient-centered. But, in fact, it may be possible to have a physician-centered practice that actually delivers better care more effectively than one that is patient-centered.

Assessing and Discussing Cancer Risk
Assessing a patient’s risk of colorectal cancer is particularly important for identifying the age at which a patient should be screened initially and for planning surveillance after the initial screen. By discussing with each patient his or her level of risk, gastroenterologists can encourage greater compliance with screening recommendations. Age is the biggest risk factor for colorectal cancer. The American Cancer Society (ACS) guidelines state that for average risk individuals, screening should begin at age 50 for Caucasian patients and at age 45 for African-Americans. Increased risk designates those cases in which either colorectal cancer or adenomatous polyps are found in any first-degree relative before age 60, or in two or more first-degree relatives at any age.

Implications of Being Overweight
Children are like adults in that those who are significantly overweight either have or may develop significant health problems. Pediatric gastroenterologists are aware of the special risks these children face and can provide nuanced diagnoses and treatment plans for the gastrointestinal conditions that arise. Children with body mass index between the 85th and 95th percentile for age and gender are considered at risk for overweight, while children with body mass index equal to or greater than the 95th percentile for age and gender are considered overweight, according to the federal Centers for Disease Control and Prevention.