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Exactly How Much DOES That Appendectomy Cost?

Aug 1, 2014, 4:29 PM, Posted by Andrea Ducas

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Want to know one of health care’s dirty little secrets? While we know how much the country spends on care each year, we have little understanding of what it actually costs to provide care.

Think, for example, about an appendectomy. What does it really “cost” the health care system to perform that procedure? The answer is complex, and of course it includes everyone’s time—from the surgeon to housekeeping staff—and it also includes the drugs, equipment, space, and overhead associated with your stay.

The cost of your visit will also depend on who is delivering your care. A consult with a registered nurse (RN) is less costly to the hospital than one with a physician.

Then, consider insurance. If the price your carrier pays for that RN consult is $85, but the price another carrier pays is only $65, what does it actually cost the hospital—and how do those variances affect what you pay both out-of-pocket and for insurance premiums? Moreover, health care providers are currently not trained to think about the costs of the care they provide—and often have no incentive or means to even consider those costs.

These complexities have made it difficult to reform the way we purchase and pay for health care.

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If It’s Broken, They Fix It

Jul 30, 2014, 3:25 PM, Posted by Risa Lavizzo-Mourey

 A nurse fills a syringe, while another nurse watches

By “broken,” we mean medical equipment or processes that could use a little improvement—and sometimes a lot of improvement. And by “they,” we mean nurses who harness the power of their own creativity, often using whatever material they have on hand—and sometimes taking inventiveness to a whole new level.

They call them MakerNurses, eager participants in the emerging “maker” movement. One MakerNurse, Roxana Reyna, RN, of Corpus Christi, was honored at the recent White House Maker Faire for her innovative wound-care techniques in caring for infants born with their organs outside of their bellies, sparing them immediate surgery.

RWJF supports such nurse-inventors through the Little Devices @ MIT initiative’s MakerNurse program, because they hold the potential to make health care more effective and affordable.

It’s a sound investment with even larger possibilities, said RWJF President and CEO Risa Lavizzo-Mourey, MD, writing in the professional social networking site LinkedIn.

“The “maker” movement has the potential to empower all kinds of people to devise the solutions that make possible a Culture of Health—not just nurses, but caregivers, patients, and family members, all creating and sharing devices and ideas that improve health.”

Read Lavizzo-Mourey’s blog post on LinkedIn

Advanced Practice Nursing: Providing Care and Promoting Health

Jul 29, 2014, 10:50 AM, Posted by Susan Dentzer

Two nurses assisting one another outside a hospital patient's room.

The U.S. population is growing, getting older and suffering from more chronic disease. Thanks to the Affordable Care Act (ACA), more people are gaining health coverage and the means to obtain care. And there’s a widespread view that the country faces a drastic shortage of doctors—and primary care providers in particular.

So why are so many states seemingly determined not to let advanced practice registered nurses deliver the primary care they specifically trained to provide—and help millions of patients in the process?

Across the country, 31 states impose varying limits on the ability of nurse practitioners (one of the four types of advanced practice registered nurses) to evaluate patients; diagnose, order and interpret diagnostic tests; and to initiate and manage many treatments, including prescribing medications.

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Putting a Female Face on the Need for a Culture of Health

Jul 25, 2014, 11:29 AM, Posted by Susan Dentzer

A doctor examines a patient.  An image appears on a computer monitor.

Statistics are “human beings with the tears washed away,” an old saying goes. Sadly, the tears behind one set of statistics, showing that women’s life expectancy has been falling in just under half of U.S. counties, have rarely garnered much notice.

How to put a face on this story, to help mobilize corrective action?

Progress toward that end was made last week, when the Robert Wood Johnson Foundation teamed up with Women’s Policy, Inc, a nonprofit, nonpartisan organization that seeks to inform policy-making on women’s issues, to sponsor a briefing on that subject on Capitol Hill. About 75 people, including several female members of Congress, gathered in the Rayburn House Office Building to learn what is driving the widespread trend of poorer female health. (Watch the webcast by clicking here).

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Doing More Means Doing Less: Young Innovators Lead the Charge

Jul 23, 2014, 1:28 PM, Posted by Emmy Ganos

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Here at the Robert Wood Johnson Foundation, we often talk about the idea of making the healthy choice the easy choice. To many of us, that means putting the cookies in a high cabinet, and putting the fruit on the counter. But when I think about building a Culture of Health in America, and especially within our health care system, making the healthy choice the easy choice means so much more.

In health care, often the healthy choice actually means doing less—fewer invasive tests and less dependence on medication—and instead watchfully waiting or making healthy lifestyle changes. But it’s not always easy to show a patient that you care when you only have a few minutes to spend together, and ordering a test or prescribing a medication is a simple way to show “I’m doing something to help you.” The trouble is, those tests, procedures and treatments often don't help, and sometimes they can hurt.

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Help or Hype: The True Costs of Robotic Surgery

Jul 14, 2014, 10:29 AM, Posted by Sheree Crute

Robotic Surgery

Joe Meyer is the model of a well-educated, engaged patient. A self-described “typical Midwestern guy” who settled in Chapel Hill, N.C., to raise a family and build a career, Meyer did everything in his power to make the best decisions when his 2013 physical produced unexpected and frightening results.

“I live a pretty healthy lifestyle. I exercise. I eat well,” says the 62-year-old chief operating officer of a large manufacturing company. “I was very surprised when my PSA test came back at 5.1 [3 to 4 is normal]. Further testing showed that I had prostate cancer.”

One of more than 200,000 men who are diagnosed each year, Meyer put his faith in his physician and the health care system when gathering information about treatment.

“After the biopsy, they told me my Gleason score was 7. [The higher the score on a scale of 1 to 10, the more likely a cancer will spread.] I realized I was high risk, so I started reading as much as I could about the choices I was offered—hormone therapy, radiation, or prostate removal.” He chose robotic prostatectomy over open or laparoscopic prostatectomy. Surgery, as opposed to hormone therapy or radiation, was widely considered a good decision for someone with Meyer’s prognosis.

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Let’s Help Each Other Cope With Stress

Jul 11, 2014, 12:04 PM, Posted by Risa Lavizzo-Mourey

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Just about everybody experiences stress, to a greater or lesser degree. The bad news: Too many of us fall into the "greater" category.

All of that stress has consequences not just for our mental health, but for our overall wellbeing, says Risa Lavizzo-Mourey, MD, Writing in the professional social networking site LinkedIn.

Lavizzo-Mourey cites the results of a recent NPR/RWJF/Harvard School of Public Health poll, which shows:

  • One in four said they experienced a great deal of stress in the previous month.
  • Almost half reported a major stressful event or experience within the past year.
  • Seventy-four percent said stress affected their health.
  • Forty-three percent said that a health concern is a leading cause of their stress.
  • Eighty percent of people in poor health reported that their health problems raised their level of stress.

If we are to make progress in building a Culture of Health, we need to acknowledge the deleterious role of stress in Americans' lives and health—and everybody needs to be at the table.

"This is clearly an area where health care providers, communities, and employers can help," Lavizzo-Mourey writes.

Read Lavizzo-Mourey's blog post on LinkedIn

Carrying the Burden of Stress

Jul 7, 2014, 11:36 AM, Posted by Jeff Meade

Forum at Harvard School of Public Health: The Health Burden of Stress, and What We Can Do About It. Presented in collaboration with the Robert Wood Johnson Foundation and NPR. (July 9, 2014)

Nearly half of us suffer through one major stressful event every year, and the weight of that stress can be heavy indeed. Take, for example, trouble at work, problems in a personal relationship, or the death of someone close to you.

At the top of the list: health issues—either yours, or those of a loved one. In fact, a health concern is the leading cause of stress for 43 percent of us. And all of that emotional turmoil can have a ripple effect, extending out into the realm of our overall well-being.

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How Do We Empower Communities to Get Healthy?

Jul 6, 2014, 9:03 PM, Posted by Martin Scaglione

Shoppers at an outside food market in Philadelphia

I’ve been privileged to live in many communities across the nation—16, to be exact. My wife Lisa and I recently moved from Iowa City, a "college town" of 80,000 people, to New York City, a bustling urban region of 23 million. Life from city to city and region to region is different in some ways, yet concerns related to community wellness remain the same.

On any given Saturday throughout the year, one can find dozens of farmers markets in New York City with fresh local produce and other offerings that encourage healthful choices. This is something we expected while living in Iowa, but were pleased to also find in the city. However, despite the fact that both communities benefit from farmers markets, health awareness campaigns and arguably the finest health care providers, both also struggle with obesity and chronic illness. Even within cities well equipped to promote health and provide care, certain individuals and neighborhoods thrive, while others struggle; is this merely a reflection of wealth disparity, or could it have to do with something more?

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GirlTrek: Black Women Walking for Body, Mind and Soul

Jul 3, 2014, 10:21 AM, Posted by Keecha Harris

Keecha Harris GirlTrek

I first met my friend Leah in September 2013, when she started walking with GirlTrek in Birmingham, Ala. GirlTrek is a movement of thousands of Black women across the country mobilized in response to the problem of staggering rates of obesity and its co-morbidities. Leah read a local NPR article about Black women walking for wellness under the banner of GirlTrek, and she decided to check it out.

As a GirlTrek volunteer, it is always a pleasure to connect with women new to our local organizing efforts. Leah joined us on a Full Moon Trek. Under celestial brilliance, Leah and I walked into the woods of the Hillsboro Trail as strangers. By the end of the trek, I had a new and humorous sister who fearlessly faced the possibility of running into snakes and other wildlife.

And when there is the promise of a storm, if you want change in your life, walk into it.
If you get on the other side, you will be different.
And if you want change in your life and you’re avoiding the trouble, you can forget it.
—Bernice Johnson Reagon

Friends were exactly what Leah needed. She and her husband had moved to Birmingham in 2007 to escape Michigan winters, and to establish a vibrant community of people with common interests. The winters are warmer here, true—but friends aren’t always easy to come by when you’re a stranger in a new city.

And that was the beginning of Leah’s relationship with a warm, welcoming organization of women passionate about improving their health—and fostering change. In short: she found the new friends she had been seeking. But these friendships gave her much more than she anticipated. Her doctor had delivered the grim news the month before that she was pre-diabetic. So walking with others was very timely.

Leah found herself in good company. GirlTrek has a goal of engaging 1 million Black women and girls in its walking-related programming by 2015. The program is sparking a health revolution, and it does so by building upon the rich cultural legacy and assets of the African American community.

Take, for example, Harriet Tubman. She’s a patron saint to GirlTrek supporters. Tubman was known to walk as many as 15 miles per day in uncut forests, through mossy swamps and across the Appalachian Ridge. Within the course of a decade, Tubman walked north toward freedom with hundreds escaping slavery. If Harriet Tubman could walk her way into new realities, the thinking goes, then so can we.

Leah was intrigued by the Full Moon Trek—and why would she not want to be part of a group of Black women who trekked to the light of the moon?  We connected through Facebook, excited to learn more about each other during a night walk in nature.

Walking to bring about change was a familiar theme for Leah. In fact, she was born to trek.

“Thinking back, walking has always held importance in my life—even before I took my first steps or took my first breath of air. My mother was weeks past her due date. Upon her third trip to the hospital, she was put in a hospital gown and instructed to walk up and down the halls.”

Thereafter, Leah and her mother racked up quite a few miles on foot. On weekends and evenings, her mom walked to relish joy or to ease pains, with little Leah in tow: “She’d walk, and walk, and walk, and walk. My little legs would go as fast as they could to keep up. When we returned home, I’d nearly collapse. But of course the next time she put on her shoes, I’d be ready to go again!“

That began to change in October. Leah has stepped up to lead other walkers to wellness. For the past eight months, she has led daily treks at the University of Alabama at Birmingham. These “smokeless breaks” are about 30 minutes each, with two to six women walking together.  Sometimes they walk to Railroad Park. During inclement weather, they trek inside along the long corridors connecting area hospitals.  

All of that walking has paid off for Leah—in a way that the everyone should applaud her for. In 2003, Leah did her first half-marathon. Over the last eight months, she has lost 30 pounds ... and shaved 17 minutes off her half-marathon time. She is no longer taking Metformin to treat her pre-diabetes. She feels more confident and peaceful. Moreover, Leah has found the warm, vibrant community of friends that she desired when she moved here.

For Leah, there is now no challenge too great. In May, Leah and other GirlTrekkers committed to walk at least 52.4 miles to honor their mothers. She walked at work and on weekends with her 5-year-old daughter, Neah Imani, in tow. Neah’s name means "moving faith."

Movement has been transformational for these three generations of trekkers. Leah’s mom continues to inspire her walking journey. In fact, Leah’s mom lost over 40 pounds in 2013, by walking the hallways at the University during her breaks.  

These days, though, mom can’t keep up with Leah any longer. She says Leah walks too fast. But even though they can’t walk together, they’re still walking in common cause: to heal their bodies, soothe their souls and form community with other black women.

About the Author
Keecha Harris, DrPH, RD is a walking enthusiast who has trekked every day since October 2012.  Her consulting company has provided support to the Robert Wood Johnson Foundation Childhood Obesity Team and the Research, Evaluation and Learning unit.