Cambridge Health Alliance


Silence As Kids’ Psych Beds Cut; What If Cancer Or Burn Beds?

The CDC has just released a report on the prevalence of mental illness among American children. It notes: “A total of 13%–20% of children living in the United States experience a mental disorder in a given year, and surveillance during 1994–2011 has shown the prevalence of these conditions to be increasing.”

Yet as that prevalence increases, treatment options are decreasing, writes Lisa Lambert, executive director of the Parent/Professional Advocacy League, which advocates for Massachusetts families with mentally ill children. Below, she discusses one particular pending loss, of Cambridge Hospital children’s psychiatric beds long especially valued by families. The hospital announced last month that it would consolidate two units with 27 beds into just one with 16 beds. It cited tight budgets, declining utilization and cyclical demand. The details are still in play.

By Lisa Lambert
Guest contributor

When Aiden was seven, it seemed like he would never be safe.

At home and in his second-grade classroom, he repeatedly talked about killing himself. He barely slept, raced from one spot to another and threatened to harm his younger sister. His parents stayed glued to his side, barely taking time to eat, shower or sleep.

One day, his mother caught him lighting a fire in his bedroom. Aiden ended up in the emergency room, and later in a bed in Cambridge Hospital. The staff had seen young patients like him before and they knew what treatment would work and what kind of follow-up care a seven-year-old needs. Without that hospital stay, his mother says, ”We don’t know where our family would be.”

Lisa Lambert of PPAL (Courtesy)

Lisa Lambert of PPAL (Courtesy)

No one likes the idea of admitting a young child to an inpatient psychiatric program. It is a last resort, something to be avoided at all costs. Parents will tell you, however, that when they’ve exhausted all the options, Cambridge Hospital has provided the best possible care. Now, it seems that a major piece of that care is coming to a close, unless a miracle happens.

Last week, the Department of Public Health held a hearing to receive comments about closing the Cambridge Hospital child psychiatric unit and eliminating beds. Nurses stood shoulder to shoulder to tell stories of families they’ve helped and of their pride in the wonderful care they’ve given. Parents came to say that this place was a lifesaver and without it, their children would never have improved.

The Child Assessment Unit is one of a kind, they all said, where parents can visit anytime and even stay overnight. Since PPAL is a grassroots organization, we surveyed families about this and want their voices to be part of the public conversation. Continue reading

One Harvard Researcher’s Surreal ‘Dr. Oz Show’ Experience

Last week, we linked to a skeptical New Yorker article about what could be called “The Dr. Oz Problem.” As The New Yorker puts it, much of what Dr. Mehmet Oz, otherwise known as “America’s Doctor,” propagates is sound medical science. But…

“…That is why the rest of what he does is so hard to understand. Oz is an experienced surgeon, yet almost daily he employs words that serious scientists shun, like ‘startling, ‘breakthrough,’ ‘radical,’ ‘revolutionary,’ and ‘miracle.’ There are miracle drinks and miracle meal plans and miracles to stop aging and miracles to fight fat…

In each of those instances, and in many others, Oz has been criticized by scientists for relying on flimsy or incomplete data, distorting the results, and wielding his vast influence in ways that threaten the health of anyone who watches the show.”

Dr. Pieter Cohen (Courtesy)

Dr. Pieter Cohen (Courtesy)

We sent a shout-out to our readers, asking if anyone had encountered health-care problems that stemmed from Dr. Oz’s more dubious reports, and one response — or rather, one surreal story — came in from Dr. Pieter Cohen, a general internist at Cambridge Health Alliance and assistant professor of medicine at Harvard Medical School. He appeared on a 2011 “Dr. Oz” show that you can watch here, if you don’t mind the ads.

You can listen to him tell the cautionary tale in the 10-minute audio file above by clicking on the play button, but here are some highlights. First, an advisory: Dr. Cohen emphasizes that he has the utmost respect for Dr. Oz as a brilliant surgeon. “This is in no way an indictment of his clinical abilities, which are amazing,” he says, “so it remains a mystery why the show is veering off in the direction it is.”

Dr. Cohen begins with some fascinating history of the “rainbow” diet pill fad of decades past, and the many doctors who were willing to prescribe them despite the risk and lack of solid evidence of benefit.

Now to more recent history: Dr Cohen was invited onto the Dr. Oz show to discuss the “hCG diet,” a crash diet aided by shots of the pregnancy hormone hCG. He assumed that he would be partnering with Dr. Oz “to help Americans realizes that this is another fad and potentially dangerous,” he says. Because in fact, there have been “a dozen randomized controlled trials to show that it doesn’t work, it’s no different than injecting salt water. The risk issues come down to the very restrictive diet” of only 500 calories a day, which can cause gallstones and other problems.

But no…. Continue reading

What Med Students Learn From Sticking With Their Patients

Altaf Saadi, a Harvard Medical School student doing an "integrated clerkship" at Cambridge Health Alliance

Medical school is an infamous time of maximal stress, as a student bounces quickly from specialty to specialty and patient to patient, building emotional calluses. In a fascinating interview just out in The Boston Globe about medicine’s tendency to “dehumanize” doctors, Dr. Omar Sultan Haque says, “Empathy decreases as you get more experience with patients. The nicest people you’ll ever find who are doctors are in the first two years of medical school.”

But what if it doesn’t have to be that way? At least, not all of it? A study just out in the journal Academic Medicine reports positive findings on a different model for the third year of medical school: Students follow their patients “longitudinally,” through all their treatments, even from hospital to home.

The study of third-year students in Harvard Medical School’s “integrated clerkship” at Cambridge Health Alliance found that they scored just as well as their peers on standardized tests, but they felt differently about their experience. They saw it “as more humanizing (even transformational) and less marginalizing than do their peers in more traditional clerkships. Strikingly, these strongly positive perceptions exist in the face of an experience that is described as both more hectic and more stressful than the traditional clerkship.”

Here, Altaf Saadi, a third-year Harvard medical student currently participating in the Cambridge Integrated Clerkship, describes what it’s like to have real time to spend with a patient who is going through cancer treatment and navigating the medical system.

By Altaf Saadi
Guest Contributor

This Monday, my internal medicine supervising physician and I saw Helen’s bald head for the first time. “Do you want to see it?” she asked. And, with our encouragement, she slowly removed her caramel-colored wig.

“You two are the first people to see my head like this.”

She was in her third cycle of Cytoxan and Taxol — two chemotherapy medications for treatment of her breast cancer — and she had lost her hair, among a dizzying number of other side effects she has experienced. So we sat there in the primary care clinic, weathering the initial influx of pain, bearing witness to her experience of cancer.

These are real fears patients have, fears that often do not get communicated when relationships are not established with patients.

Helen (not her real name) is one of nearly 500 patients I have seen as part of my third year at the Cambridge Health Alliance. I am one of ten students in this year’s Harvard Medical School-Cambridge Integrated Clerkship, an innovative model for third year medical education that centers learning on the experience of the patient. Traditionally, third year medical students complete discrete “block” rotations in core disciplines such as Internal Medicine, Pediatrics, Obstetrics, and Surgery. They rarely see patients more than once. As part of the Cambridge Integrated Clerkship, we instead spend time in all of the disciplines throughout the year by following “our” patients through those disciplines. Continue reading

Town Must Seem Tame To New Chief of Cambridge Health Alliance

If you’ve seen Michael Moore’s 1989 classic “Roger & Me,” with its unforgettable scenes of rabbit-skinning and boarded-up houses, you know that Flint, Michigan is a very, very gritty city — and I hear it’s even worse since the latest recession.

Hurley Medical Center is in the heart of it. I have ancient summer memories of visiting Hurley, where my late biological father was an internist, and feeling relieved when we drove into the parking garage, away from the scary neighborhoods surrounding it.

So when we just got the news that the new chief of Cambridge Health Alliance, Patrick Wardell, hails from Hurley, where he even managed to turn around the hospital’s finances and expand, my reaction was: “Wow, he was capable of all that — and then smart enough to get the heck out of Flint! Cambridge will surely seem unspeakably tame to him.”

A chunk of the Cambridge Health Alliance press release on Patrick Wardell’s selection:

CAMBRIDGE, MA – The Cambridge Health Alliance Board of Trustees today announced the selection of Patrick Wardell as the new Chief Executive Officer for Cambridge Health Alliance (CHA). Mr. Wardell currently serves as the President and Chief Executive Officer at Hurley Medical Center in Flint, Michigan. The Board of Trustees reviewed three finalists following multiple interviews and unanimously chose Mr. Wardell at this morning’s Board meeting. Mr. Wardell’s appointment as Cambridge Health Alliance’s new Chief Executive Officer is contingent on contract negotiations. Continue reading

Study: Who Remains Uninsured In MA? Mostly Working Poor. Why? Money.

You figure that when a press release comes in from Physicians for a National Health Program, it has an agenda. But that doesn’t negate the value of the research it highlights — which, in this case, was a paper from Harvard Medical School researchers just out in the Journal of General Internal Medicine.

It’s titled “Reasons why patients remain uninsured after Massachusetts’ health care reform: A survey of patients at a safety-net hospital.” And here’s its summary:

After full implementation of the Massachusetts health reform, those remaining without insurance are largely the working poor who do not have access to, or cannot afford, either employer sponsored insurance or state subsidized insurance.

The reasons why people lacked insurance varied, from having recently lost coverage through a job to fear of giving their personal data. From the Physicians For a National Health Program press release:

To understand why people remained uninsured after the reform, the study authors surveyed 431 patients, ages 18-64, who were visiting the emergency room of Massachusetts’ second largest safety-net hospital.

The researchers found that of the 189 patients without health insurance, two-thirds (65.9 percent) were employed, but only a quarter had access to employer-sponsored insurance. In addition, about one-third (35.2 percent) of uninsured patients reported having lost previous insurance coverage, with the majority of these (51.9 percent) having lost their coverage due to loss of a job or transition from one job to another. Continue reading

Study: Costs Keep Med Students From Much-Needed Mental Health Care

By Fran Cronin

CommonHealth intern

Medical students are a challenged lot — sleep-deprived, stressed and driven. With the constant cramming of facts into their overloaded heads, and the constant need to steel themselves against the daily rounds of disease and injury, many medical students are left mentally and emotionally drained. Like their patients, they need a doctor. But many don’t reach out for help.

In a research letter just published in the Journal of the American Medical Association, Drs. Rachel Nardin and J. Wesley Boyd — both from the Harvard-affiliated Cambridge Health Alliance (CHA) — help illuminate the vulnerability of U.S. medical students to untreated and debilitating depression and substance abuse. These at-risk students tend not to seek the mental health services they need, the researchers found, due to the overwhelming cost of appropriate mental health services.

Schools and parents may be mandated to provide health insurance, but the study found that many of the plans offered did not provide affordable or adequate coverage for mental health and substance abuse treatment.

Data culled for this first-time survey of health insurance offered to U.S. medical students was collected from June through December 2010. The findings from 115 of the total 129 public and private medical schools in the U.S. revealed wide variability in annual dollar and visit limitations across the non-uniform plans.

‘Mounting debt from long stints at expensive schools weighs very heavily upon the students.’

For example, mental health dollar limits ran from $1000 – $200,000 for outpatient services; $800 – $200,000 for outpatient substance abuse treatment; and $1000 – $200,000 for inpatient mental health and substance abuse treatment. Continue reading

Patient ‘Navigators,’ Including One In Cambridge

You have to read pretty far down in today’s interesting Wall Street Journal story about the growing guild of “navigators” who help patients find their way through the health care system, but eventually you get to our local angle:

Sheila Profenna’s doctor had been telling her to get a colonoscopy for three or four years. But the 54-year-old says she was scared of the procedure and canceled two or three appointments. After she had some worrisome symptoms earlier this year, her doctor at Cambridge Health Alliance, a Boston-area public health-care system, put Ms. Profenna in touch with patient navigator Jennifer Murillo.

Ms. Murillo offered Ms. Profenna useful tips on swallowing the solution patients have to take to cleanse their bowels before the procedure, such as mixing it with a lemon-flavored drink. Ms. Profenna says she was concerned at first that it didn’t seem to be working, and called Ms. Murillo that day about a dozen times. On the day of Ms. Profenna’s colonoscopy, Ms. Murillo arranged transportation to and from the appointment. “I didn’t have to be alone and scared, and Jennifer made me feel as if I had someone to hold my hand through the whole thing,” says Ms. Profenna, whose test didn’t turn up any problems.

Such navigators are proliferating, the Journal reports:

Hospitals around the country have been adding patient-navigation services in recent years, helped by funding from governments and private groups. The Commission on Cancer, part of the American College of Surgeons, issued new standards this year that will require cancer centers to offer patient-navigation services by 2015 to meet accreditation requirements.

Several studies have shown that navigation services increase participation in cancer screening and adherence to follow-up care.

Tension Between Harvard Researchers, Blue Cross Escalates

In case you missed this excellent post by The Boston Globe‘s Chelsea Conaboy on Friday, here’s a snippet of the escalating tension between Blue Cross Blue Shield of Massachusetts and Harvard-affiliated researchers from Cambridge Health Alliance who last week published a study that found it’s extremely difficult to get psychiatric care in Boston, even if you have top-notch health insurance.

As part of the study, which was published in the form of a letter in the Annals of Emergency Medicine, researchers posed as severely depressed patients with Blue Cross insurance and tried to get an appointment for psychiatric care at a facility in downtown Boston. Of the 64 facilities they called, they were only able to get 8 appointments, and only 4 of those were within two weeks.

Here’s Chelsea’s ongoing coverage of the dispute, which began when Blue Cross expressed annoyance to the researchers that its “brand” was used in the study without permission:

“We are VERY concerned about the use of BCBSMA’s name and brand in a published study without BCBSMA authorization,” [Blue Cross] spokesman Jay McQuaide wrote. “We’d like to talk with you about that.”

Today [Friday] in an e-mail titled, “Your intemperate 7/20/11 letter to Cambridge Health Alliance regarding the Annals study,” McQuaide received an admonishment of his own.

Dr. Sidney Wolfe, director of the Health Research Group at Public Citizen, a national consumer advocate, sent McQuaide an e-mail calling the idea that the researchers needed the insurer’s authorization “absurd.”

“Please send me a copy of the BCBSMA policy manual that specifies the need for such censorship,” he wrote.

Wolfe suspected that the statement from McQuaide was meant to bully the researchers, he said in an interview this afternoon.


Cambridge Health Alliance Leader To Head RI Hospitals

WBUR’s Martha Bebinger reports:

The CEO of Cambridge Health Alliance, which includes Cambridge Hospital, is leaving.

Dennis Keefe will run a three-hospital network in Rhode Island anchored by Women and Infants Hospital. CHA’s board chair thanks Keefe for steering the Cambridge network through “extremely challenging time.” Keefe says it’s a good time for change for him personally and for Cambridge Health Alliance, one of the state’s largest safety net hospital systems.

From Dennis Keefe’s message to staff:

I did not go looking for this new opportunity and frankly hadn’t given a lot of thought to making any change. But the more the discussions progressed, the more it all began making sense. I will miss all of you but I leave knowing that the institution is in good hands and that it is on a course that I believe will make history as CHA becomes the centerpiece of health care payment reform and the initiatives to establish the patient-centered medical home and Accountable Care Organization.

I’d like to think that I left a stamp on this institution but in reality, CHA left more of an impression on me and I will carry its sense of pride and mission and commitment with me wherever I go.

Report: Cost Of Care Varies Widely, Depending On The Hospital

A new report says MGH was reimbursed about double the rate of Cambridge Health Alliance for C-section deliveries

Why, you may ask, is the price tag on a C-section $5,000 at one Boston-area hospital and $10,000 at another?

A new report from the state Division of Health Care Finance and Policy on medical cost trends doesn’t offer the answer, but it does document numerous cases in which certain hospitals are reimbursed by insurers at far higher rates than others despite comparable levels of care, The Boston Globe reports. For instance:

Cambridge Health Alliance was paid less than $5,000 each for 55 caesarean sections performed in 2009, while Massachusetts General Hospital was paid more than $10,000 each for 483 caesarean deliveries that year, state officials found.

They said it was unclear why insurers paid some hospitals dramatically more, since officials found no obvious differences in quality of care, and their analysis allowed for instances in which hospitals treat sicker patients.

Disparities in payments were first documented by Attorney General Martha Coakley’s staff last year, which concluded after an investigation that the highest paid hospitals had more market clout, some because of their brand names, but that they were not necessarily providing better care. The new report, which the governor’s office planned to release to the public today, mirrors Coakley’s initial findings.

How much hospitals and doctors are paid and whether those payments are justified are central issues as the state and private insurers search for ways to control soaring health care costs.

Among the other findings:

— Prices vary significantly state wide for inpatient and professional services as reported by the AG last year
–The differential in rates ranges from a 3 fold to a 6-7 fold variation depending on the service.
–Tertiary care hospitals account for the highest proportion of prices above the state median price
— Medicaid and Medicare pay less than private insurers
— Providers with the highest percent of Medicaid patients often receive the lowest commercial rates
–There is little measurable variation in quality

This cost variation report was released with a companion report on insurance premiums. (The analysis found that “private group health insurance premiums in Massachusetts increased roughly 5 to 10 percent annually over the two year period [2007-2009] when adjusted for benefits. However, the Consumer Price Index increased by only 1.7 percent nationally and 2.0 in the Northeast region over the same period, signaling that the rate of increase in the cost of health care far outpaces the rate of inflation.”)

The reports were released in advance of hearings on health care cost trends, which are scheduled to take place between June 27 and June 30 in conjunction with the attorney general’s office.