KHN: Kaiser Health News

Last Thursday Dr. L. Markham McHenry, a family physician, held a meeting with some patients to tell them about changes he was planning. After 15 years of working in a private practice, the Scottsdale, Ariz.-based doctor is in the process of transitioning to a subscription-based model.

His patients, who he said come from a range of economic backgrounds, will pay an annual fee of $3,000. In return, McHenry will limit his capacity to 400 patients a year, spend more time with each one, and be able to focus on preventing and treating chronic diseases like diabetes and obesity.

“I don’t think patients should just pay for convenience,” he said regarding the new practice model that he adopted from n1Health. “It wasn’t until I found the value added that I thought this was worth offering.”

A new report projects the number of physicians who practice independently — rather than become employed by medical groups  or systems, for example – will fall to 36 percent by 2013, from 57 percent in 2000. And, for those who remain in private practice, one in three may choose this type of ”subscription” approach over the more traditional formats, according to the study conducted by Accenture, a research and analysis firm.

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As the race for the White House has tightened, President Barack Obama has seen his advantage on several key health issues narrow significantly among likely voters, according to a Kaiser Family Foundation poll released Wednesday. (KHN is an editorially independent program of the foundation).

Most troublesome for Obama is that, among likely voters, GOP candidate Mitt Romney has pulled nearly even with him on which candidate would do a better job with Medicare — an issue that resonates in battleground states with large elderly populations like Florida and Pennsylvania.  Obama’s advantage on that question has shrunk despite the fact that six in 10 likely voters continue to oppose Romney’s idea of changing Medicare to a premium support system, in which the government would guarantee each senior a fixed amount of money to help them purchase coverage.   Overall, about 46 percent of voters said they prefer Obama on Medicare compared to 41 percent  for Romney, a gap that is not statistically significant. In September, Obama held a 16 point lead on the Medicare question.

Senior voters are even more likely to oppose switching to premium support, but they prefer Romney to Obama on Medicare, 48 percent to 43 percent — also not a statistically significant gap.

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Photo by Michael Heiman/Getty Images

This story comes from our partner ‘s Shots blog.

One of the most dramatic stories to come out of New York last night is the critical evacuation of New York University Langone Medical Center.

As CNN reports it, around 7:45 p.m. Monday, the hospital’s basement started taking on water. At one point, the “lower floors and elevator shafts filled with 10 to 12 feet of water.”

The hospital’s main power went out, and then the backup power failed.

The New York Times reports:

“The medical center, NYU Langone Medical Center, a sprawling complex in the low 30s near the East River, began transporting all 215 patients at the hospital to other facilities on Monday evening, They were still being transported to other nearby hospitals, including Sloan Kettering and Mount Sinai, early on Tuesday, a spokeswoman for the hospital said.

” ‘They evacuated everybody,’ said the spokeswoman, Lorinda Klein, who said the main communications systems at NYU Langone — phones and e-mail — were down. She could not say what had caused the failure of the hospital’s emergency systems, which power critical care units there.”

CBS’s Jonathan LaPook arrived at the hospital shortly before midnight. He writes that by that time the intensive care unit had already been evacuated and it was eerily empty, lit only by the flashlight he was carrying.

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This story comes from The Texas Tribune.

If President Obama wins a second term and the Affordable Care Act stays in place, the debate will likely turn to whether Texas will join an expansion of Medicaid.

Illustration by Fry1989 via Wikimedia Commons

Gov. Rick Perry says Texas will opt-out of that expansion. But Anne Dunkelberg of the Center for Public Policy Priorities, a liberal state policy think-tank, says the state’s largest counties — which have the most to gain monetarily from joining the program — may band together to force the expansion.

“I don’t see them doing an end run,” Dunkelberg said. “I do see them potentially coming together and trying to figure out if there is a way outside of the basic state budget general revenue system that they can come up with the rather modest, less than a billion dollars a year, that the state would need to do this expansion.”

Conservatives hope a victory for Mitt Romney would be the end of federal health care reform. But it could be the beginning of new Medicaid block grants. Arlene Wohlgemuth of the conservative Texas Public Policy Foundation says multiple states have asked the federal government for the freedom to spend Medicaid dollars as they wish.

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Sure there are those who support the health care law, and those who want to repeal it. But how many people in the U.S. actually understand the Affordable Care Act?

That’s what a Stanford University professor asked in a nationwide survey in collaboration with the Robert Wood Johnson Foundation, GfK and the Associated Press.

The survey, which was conducted in 2010 and in 2012, showed more than 2,000 participants 18 different statements about the health care law. Twelve of those statements correctly portrayed provisions of the law and six of them were false. Participants were also asked to how certain they were of each of their answers.

Jon Krosnick, a social psychologist and a professor of communication and political science at Stanford University and a co-author of the report on the survey, said no one identified all 18 statements correctly on either the 2010 or the 2012 survey. Still, in 2012, the survey found fairly high numbers of correct responses. For instance, 80 percent of respondents knew that the law allowed adult children to stay on parents’ health plans and that companies with more than 50 employees are required to provide coverage to workers.

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Attention medical students: When selecting your residency program, there’s more than just geography and the hospital’s reputation to consider.

The nation’s 23 top academic medical centers also vary drastically in what researchers are calling “the intensity” of care they provide patients at the end of life, according to a new report from the Dartmouth Atlas Project.

And more intense care can translate into worse and more expensive care at the end of life, according to the authors. The thinking is that physicians who train at hospitals with better and more efficient care will be better-prepared to become leaders in changing how health care is delivered in this country.

The authors call this phenomenon the “hidden training curriculum.”

“Learning how to use health care resources wisely, provide high-quality care, and incorporate patient preferences into a care plan is just as important as learning to work up a patient,” said Alicia True, report co-author and medical student at the Geisel School of Medicine at Dartmouth.

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This story comes from our partner ‘s Shots blog.

Bill Sneddon had a feeling he was in trouble when his doctor called with his latest test results.

“I just had a premonition that something’s not right,” said Sneddon, 68, of Ocean Township, N.J.

Photo by Leo Reynolds via Flickr

And, sure enough, Sneddon’s instincts were right. He had prostate cancer.

“Well, it’s an eye-opener, you know. I didn’t know if I had to buy a yard sale sign, you know,” he said. “It’s a shocking thing … It always happens to someone else.”

After getting over the shock, Sneddon, a retired police chief, quickly started investigating his options, including surgery and radiation. The next day, a golfing buddy told him about a new kind of radiation treatment for prostate cancer.

“He told me that I should look into proton therapy. And I’ve known him a long time, so when he told me this is a treatment I should get, I knew this is a treatment I better get,” Sneddon says.

So Sneddon was excited when he discovered that the ProCure Proton Therapy Center had recently opened in Somerset, N.J., about an hour and a half away from his house.

“It’s like coming to a health club or a five-star hotel,” Sneddon said recently as he waited for the next round of his nine weeks of treatment.

Sneddon looked more like he was at his country club than in the waiting room of a cancer clinic. The lobby has big windows, high ceilings, a rock wall surrounding a blazing fireplace. Relaxing music was playing.

But beyond the comfortable atmosphere, what really draws patients like Sneddon to proton therapy is how it works.

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