Changes in Clinical Practice Among Physicians with Legal Problems

David Studdert, LLB, ScD, MPH with Co-Authors Michelle Mello, PhD, JD & Matthew Spittal, PhD

Recent evidence indicates that a small group of physicians accounts for a surprisingly large share of all malpractice claims and patient complaints.  Next to nothing is known about the career trajectories of these claim-prone physicians.  Do they continue to practice, and if so, do they alter their clinical load?  Do they cut ties—voluntarily or involuntarily—with hospitals and large practice groups?  Do they seek to put their checkered history behind them by relocating—interstate or to areas where clinicians are in short supply?  We explore these questions in a large cohort of US physicians. 

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The Effect on Healthcare Costs of Treating Comorbid Depressive Disorder with Chronic Disease

Objective: Does the cost of treating depressive disorder comorbidity inflate the cost of treating other chronic conditions?  The answer is important both to payers and to those organizing health care delivery.

Methods: Results from the national Medical Expenditure Panel Survey of 2015 (N≈30,000) provided the data. We estimated costs from medical records and from the self-reported utilization of healthcare. Using the Mental Health Component Summary score of the 12-Item Short Form we estimated the level of depression. We used a general linear model to estimate costs with fixed effects for chronic disease (present or absent) and depression (highest third, middle third, lowest third). Physical health/functional status served as a covariate. We analyzed each of eight different chronic conditions (arthritis, chronic obstructive pulmonary disease, high cholesterol, cancer, diabetes, stroke, coronary heart disease, and asthma) separately.

Results: In each of these analyses, the presence or absence of the chronic condition had a strong impact on cost. In addition, being at the highest level of depression also had a significant impact on cost. However, the interaction between depression and chronic disease diagnoses tended to account for only a small amount of variation in cost.

Conclusion: The combination of depression and chronic disease diagnosis did not have a strong synergistic effect on the cost of medical care. An additive model provides a more parsimonious explanation of data from this national sample.

Robert M. Kaplan, PhD

Clinical Excellence Research Center, Stanford University School of Medicine

Robert M. Kaplan, PhD is research director at CERC.  He has served as Chief Science Officer at the US Agency for Health Care Research and Quality (AHRQ) and Associate Director of the National Institutes of Health, where he led the behavioral and social sciences programs.  He is also a Distinguished Emeritus Professor of Health Services and Medicine at UCLA, where he led the UCLA/RAND AHRQ health services training program and the UCLA/RAND CDC Prevention Research Center. He was Chair of the Department of Health Services from 2004 to 2009.  From 1997 to 2004 he was Professor and Chair of the Department of Family and Preventive Medicine, at the University of California, San Diego. He is a past President of several organizations, including the American Psychological Association Division of Health Psychology, Section J of the American Association for the Advancement of Science (Pacific), the International Society for Quality of Life Research, the Society for Behavioral Medicine, and the Academy of Behavioral Medicine Research. Kaplan is a former Editor-in-Chief of Health Psychology and of the Annals of Behavioral Medicine.  His 20 books and over 500 articles or chapters have been cited more than 30,000 times and the ISI includes him in the listing of the most cited authors in his field (defined as above the 99.5th percentile).  Kaplan is an elected member of the National Academy of Medicine (formerly the Institute of Medicine).  Dr. Kaplan is currently Regenstrief Distinguished Fellow at Purdue University and Adjunct Professor of Medicine at Stanford University.

Lunch will be provided to those who RSVP.

Moving Precision Medicine into Clinical Care and Health Policies: UCSF, Stanford, and Beyond

Precision medicine has evolved from a distant promise to reality, with many genomic tests now used in clinical care. Dr. Phillips will discuss the opportunities for researchers and clinicians to address the health policy implications of precision medicine, with a particular focus on opportunities at UCSF and Stanford. She will discuss a case study of a recent and highly controversial CMS national coverage decision on sequencing tests for cancer patients based on her article in JAMA 4/16/2018 (Phillips KA. Evolving Payer Coverage Policies on Genomic Sequencing Tests: Beginning of the End or End of the Beginning?)

Kathryn A. Phillips, PhD

Professor of Health Economics and Health Services Research and Founding Director, UCSF Center for Translational and Policy Research on Personalized Medicine University of California, San Francisco

Kathryn Phillips’s expertise is in the implementation of new technologies to improve healthcare. In 2007, she founded the UCSF Center for Translational and Policy Research on Personalized Medicine, which focuses on how to develop objective evidence on value and payer coverage of precision/personalized medicine. Dr. Phillips has published ~150 articles in major journals, including JAMA, New England Journal of Medicine, and Health Affairs, and has had continuous funding from the NIH as a Principal Investigator for 25 years. She serves on the editorial boards of the journals Health Affairs and Value in Health as well as all of the leading journals on precision medicine. A distinguishing characteristic of Dr. Phillips’ work is the translation of science into policy by bringing together perspectives across stakeholders. She has worked extensively with health plans, industry, and government agencies across the globe and has served on national and international scientific advisory committees for the National Academy of Medicine, Food and Drug Administration, and the President’s Council of Advisors on Science and Technology. Dr. Phillips is now serving on the Board of Directors for GenomeCanada (a non-profit organization that oversees and funds genomic research in Canada). In 2016, she was awarded a Rockefeller Foundation Bellagio Residency to pursue her work from a global perspective. Dr. Phillips holds degrees from UC-Berkeley, Harvard, and UT-Austin.

Lunch will be provided to those who RSVP.

Please note the venue change to the Bechtel Conference Center

Encina Hall, 1st floor. We have reached venue capacity. RSVPs are closed.

Peter Baker is the chief White House correspondent for The New York Times covering President Donald J. Trump. He previously covered the presidencies of Barack Obama, George W. Bush and Bill Clinton.

Mr. Baker joined The Times in 2008 after 20 years at The Washington Post. He began writing about Mr. Obama at the inception of his administration, through health care and economic debates, the raid that killed Osama bin Laden, the re-election campaign and decisions over war and peace in Iraq, Afghanistan and Syria. During his first tour at the White House, Mr. Baker was a co-author of the original story breaking the Monica Lewinsky scandal and served as The Post’s lead writer on the impeachment battle. During his next White House assignment, he covered the travails of Mr. Bush’s second term, from the Iraq war and Hurricane Katrina to Supreme Court nomination fights and the economy.

In between stints at the White House, Mr. Baker and his wife, Susan Glasser, spent four years as Moscow bureau chiefs, chronicling the rise of Vladimir V. Putin, the rollback of Russian democracy, the second Chechen war and the terrorist attacks on a theater in Moscow and a school in Beslan. Mr. Baker also covered the wars in Afghanistan and Iraq. He was the first American newspaper journalist to report from rebel-held northern Afghanistan after Sept. 11, 2001, and he spent the next eight months covering the overthrow of the Taliban and the emergence of a new government. He later spent six months in the Middle East, reporting from inside Saddam Hussein's Iraq and around the region before embedding with the United States Marines as they drove toward Baghdad.

Baker is the author of four books, most recently “Obama: The Call of History,” an illustrated history of the 44th president.

A native of the Washington area, Mr. Baker attended Oberlin College.

The Payne Lectureship is named for Frank E. Payne and Arthur W. Payne, brothers who gained an appreciation for global problems through their international business operations. Their descendants endowed the annual lecture series at the Freeman Spogli Institute for International Studies in order to raise public understanding of the complex policy issues facing the global community today and to increase support for informed international cooperation.

The Payne Distinguished Lecturer is chosen for his or her international reputation as a leader, with an emphasis on visionary thinking; a broad, practical grasp of a given field; and the capacity to clearly articulate an important perspective on the global community and its challenges.

Hate propaganda has been a feature of politics in India, Indonesia, and other Asian democracies long before the recent surge in interest in so-called “fake news” and intolerant populism in the West. This presentation dissects the political strategy of “hate spin,” which includes not only the use of hate speech or incitement, but also the creative manufacture of righteous indignation and popular mobilization framed as responses to victimhood. Examples include the “love jihad” conspiracy theory in India and blasphemy allegations in Indonesia, which have been used to devastating effect by religious nationalists. Existing religious-offense laws have backfired, while incitement laws, though necessary, are systemically incapable of dealing with hate propagandists’ highly sophisticated and distributed disinformation campaigns.  The speaker's book on this topic, Hate Spin, will be available for sale at his talk.

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Abstract:

In 2002 and 2003, Americans pointed to Japan after the Second World War as a model which proved that enemy countries could be remade into stable democratic allies through short military occupation. Planners and politicians drew on their understanding of events in Japan to learn "lessons" for a post-Saddam Iraq. In the years since, it has become common to blame the failures of intervention in Iraq on American ignorance and insufficient planning. But is that popular characterization correct? This talk discusses whether and how the planning phases for Japan and Iraq differed, and with what implications for the occupied countries.

Speaker Bio:

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Abstract:

The South African democratic process has crossed two significant milestones. One is political legitimacy in the sense that there is no significant threat to the constitution or political systems that the country adopted in 1996. Secondly, the systemic instability threat arising from the counter-revolutionary apartheid forces is now something of the past. There is simply no imminent threat of a retreat to the country’s authoritarian and racist past. The elusive goals remain in the economic arena – namely inclusive growth, widening inequality and slow development. How is the country shaping up to these challenges?

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Speaker Bio:

Beatriz Magaloni

Abstract:

Financial markets expose individuals to the broader economy. Does participation in financial markets also lead individuals to re-evaluate the costs of conflict, their views on politics and even their votes? Prior to the 2015 Israeli elections, we randomly assigned financial assets from Israeli and Palestinian companies to likely voters and gave them incentives to actively trade for up to seven weeks. Opportunities to trade in financial markets systematically shifted vote choices and increased support for peace initiatives. These effects persist a year after the experiment, and appear consistent with financial market exposure leading to increased awareness of the economic risks of conflict.

Speaker Bio:

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