Harvard's Big Heart for Primary Care

Harvard Medical School sure knows how to make itself look good. This week's news is loaded with reports and accolades for Harvard's new initiative to support primary care.


But Harvard's record on funding for primary care research and education is actually pretty terrible. 


Harvard Medical School educates very few primary care doctors every year - only 10% of their 2009 class went into front line medical care, and that's the lowest rate of the region's medical schools. By contrast, the University of Massachusetts graduated 39% into primary care in 2009.

Also, Harvard's recent history of funding for primary care initiatives is dismal. Just a little over a year ago, Harvard made news for eliminating funding for its primary care division. This action caused a stir just as the nation was gearing up for a vote on health reform. We now know that health reform included several provisions that will shift massive amounts of new funding to primary care research, education and practice.

This new effort is welcome, but it is not funded by the generosity of Harvard's big heart, or even by a small dose of creativity. It's the direct result of hindsight on health reform. HMS now sees major new funding streams coming down the pike through accountable care organizations (ACOs) and through new initiatives in training of primary care doctors. 

The upshot of this? If you are a primary care center in Massachusetts and you see opportunities for growth as a result of reform, you're on the right track. Community Health Centers, for instance, stand to grow substantially. But these centers must beware of competition from the 800 pound gorilla. Harvard is positioning itself to gobble up as much as possible of the region's anticipated new primary care dollars.

The Comparative Effectiveness of STEMI Regionalization Strategies

In our new study published in Circulation: Cardiovascular Quality and Outcomes, we compared strategies to increase the use of PCI for patients with ST segment elevation myocardial infarction (STEMI). Expanding patient access to PCI is critical to improving outcomes after heart attack and there are a range of approaches to accomplish this.

We found that an ambulance diversion strategy was more than two times more effective and nearly 20 times less costly than any strategy involving expansion of PCI capacity at hospitals. The results strongly favor the use of EMS diversion strategies, which are already in place in some areas of the United States. The authors concluded that construction and staffing of new PCI-capacity at hospitals may not be warranted if an EMS strategy is feasible.

A podcast on the study can be heard on MedPage Today: http://www.medpagetoday.com/Cardiology/PCI/21405

Feel free to contact me directly to obtain a toll free link to the article:  tconcannon@tuftsmedicalcenter.org






Citation:



Concannon TW, Kent DM, Normand SL, Newhouse JP, Griffith JL, Cohen J, Beshanksy JR, Wong JB, Aversano T, Selker HP, Comparative Effectiveness of STEMI Regionalization Strategies. Circulation: Cardiovascular Quality and Outcomes 3[5]. 2010.

Health Care Stocks Rise on Death of Health Reform

In "Markets Salivate at Prospect of Healthcare Reform's Defeat," Ken Terry hits the nail on the head: http://industry.bnet.com/healthcare/10001627/markets-salivate-at-prospect-of-healthcare-reforms-defeat/ . He reports that "investors are pumping up healthcare stocks in the hope that reform will fail and that the free market will continue to push up health costs- and profits for the health industry." The Wall Street Journal reports separately that Pfizer and Merck stocks rose on investor "hopes for more concessions to be made in health legislation."http://online.wsj.com/article/SB10001424052748704561004575013480490353788.html?mod=googlenews_wsj

Where will these higher health costs and profits come from? Expect health insurance premiums to go up. Expect little help from the government or from the proposed center for comparative effectiveness research. The proposed center, whose intent was to compare alternative treatment regimens and suggest incentives for those that work best, will die with health reform.

I don't think this is what voters in Massachusetts had in mind yesterday. They wanted compromise on health reform, not open season on their wallets. Pharmaceutical and medical device manufacturers, hospitals, some insurers, and many medical specialists can celebrate. Their stocks are on the rise and healthcare markets remain almost entirely in their hands.