Hospitals across Oklahoma City have invested in a da Vinci surgical robot, a highly marketed robot that can be used to perform a variety of surgeries. I’ve interviewed several doctors who use the robot to perform surgeries, and many of them rave about it.

They say patients recover faster, have fewer complications and leave the hospital faster than patients who don’t have the same kinds of surgeries using the robot.

But there’s a catch to some of their claims — comprehensive data to back it up.

As this article points out, recently published medical research has found that robotic surgery might not always prove to be more beneficial.

In the dozen years since the Da Vinci robot has been approved for surgeries in the United States, it’s been embraced by health care providers and patients alike. Surgeons routinely use the multi-armed metal assistant to remove cancerous prostate glands and uteruses, repair heart valves and perform gastric bypass operations, among many other procedures.

Lately a key study and reports of problems have raised questions about robotic surgery’s safety and cost-effectiveness, leading to a review of the Da Vinci system by the Food and Drug Administration and causing some experts to wonder whether the benefits of undergoing robot-assisted surgery may have been overstated.

To make any claim in medicine that one approach works better than the other, you need a study published in a medical journal that says “Yes, this is very, very true.” Actually, you probably need several studies by different academic institutes that agree and say, “Yes, that study is very, very true, and here’s what we found that says it’s still very, very true.”

Surgeons I’ve talked to with say the da Vinci robot allows them to operate inside a patient and affect the least amount of tissue while inside. And so far, the debate continues, with the U.S. Food and Drug Administration currently reviewing the system.

Complications can occur with any type of surgery, and so far it’s unclear if they are more common in robotic operations. That’s part of what the FDA is trying to find out.

Intuitive Surgical disputes there’s been a true increase in problems and says the rise reflects a change it made last year in the way it reports incidents.

The da Vinci system “has an excellent safety record with over 1.5 million surgeries performed globally, and total adverse event rates have remained low and in line with historical trends,” said company spokeswoman Angela Wonson.

But an upcoming research paper suggests that problems linked with robotic surgery are underreported. They include cases with “catastrophic complications,” said Dr. Martin Makary, a Johns Hopkins surgeon who co-authored the paper.

And because of that, I can get bored quickly when you start spouting out tons of numbers.

So, here’s a visual aid of what Medicaid expansion would look like in Oklahoma.The Oklahoma Health Care Authority estimates that expanding Medicaid to 138 percent of the federal poverty line would make 180,000 Oklahomans eligible for SoonerCare, the state’s Medicaid program.

What does that look like?

Gaylord Family – Oklahoma Memorial Stadium, filled up about 2.2 times.

Boone Pickens Stadium, about three times full.

Photo by Zach Gray, for The Oklahoman

Chesapeake Energy Arena during an OKC Thunder game, about 10 times full.

Photo by Bryan Terry, The Oklahoman

The BOK Center in Tulsa, about 9 times full.

Because if it weren’t for Mississippi — and generally, West Virginia and Louisiana — Oklahoma would come in last in a variety of health rankings.

But, really — Are we doing that much better? Let’s take a look.

Each year, the United Health Foundation comes out with its annual report, known as America’s Health Rankings. Although the rankings aren’t the end-all be-all of health rankings, our state leaders pay a fair amount of attention to them. That’s because the rankings provide an overall idea of how Oklahoma is doing in a range of categories.

The good news is, Oklahoma improved its ranking this past year. The bad news? We’re still in the bottom 10.

Oklahoma ranked No. 43 in overall health in the national report, the highest ranking the state has received in eight years.

Meanwhile, the top five worst states were  South Carolina (No. 46), West Virginia (No. 47), Arkansas (No. 48), Louisiana (tied No. 49) and Mississippi (No. 49). Meanwhile, Vermont ranked best for overall health.

As you can see from the comparisons below, in some instances, we’re not that far off from sinking back toward the bottom.

Gov. Mary Fallin has said, rather than expanding Oklahoma’s Medicaid program, Oklahoma will instead create its own health plan that will focus on the future health of residents.

I’m curious about what that plan will be. Oklahoma has some of the highest rates in the nation in obesity, diabetes, heart disease, cancer and stroke, and we have a major shortage of primary care doctors. We also eat the fewest fruits and vegetables of any state. And, to top all of that off, poverty in Oklahoma is at a 10-year high.

The solutions for our state won’t be simple, and it will be interesting to see how receptive our lawmakers will be to Fallin’s plan. In her State of the State address, Gov. Fallin came out in support of a bill before the Oklahoma Legislature that would have allowed cities to make their own smoking laws, an idea that multiple lawmakers have shot down in committee.

Medicaid expansion is one of the key elements of the Affordable Care Act, or “Obamacare.” (Want to know more about the health care debate? Here’s a graphic novel we created that explains the basics)

Most leaders have been quoted as saying expanding Medicaid would be too expensive for their states and that they didn’t trust the federal government to hold its end of the bargain.

So what’s the alternative plan?

Gov. Fallin hasn’t yet announced what Oklahoma’s alternative plan might be, but a few state leaders have made a proposals on how to help the uninsured in their states.

Wisconsin

In Wisconsin, Republican Gov. Scott Walker announced in mid-February that he is rejecting Medicaid expansion and instead pushing forward with his own plan.

Walker said he would instead work to increase health coverage for Wisconsinites with an alternate plan that involves lifting an enrollment cap on Medicaid programs for childless adults, tightening income eligibility for state residents able to use Medicaid programs, and bumping thousands of people from such programs to federal government-run health care exchanges where they can buy private insurance.

Avik Roy, a contributor at Forbes, wrote a detailed piece on Walker’s approach, noting:

Prominent Republican governors, like John Kasich in Ohio, have said yes to Medicaid, reasoning that if Ohio doesn’t grab the federal money, other states will. But, as Wisconsin governor Scott Walker now shows, there is a far better path forward, one that reduces the footprint of Medicaid while providing coverage to the uninsured.

Alabama

In Alabama, lawmakers are looking at Oregon’s model and discussing whether they could duplicate something similar:

Over the decades, Oregon has built a relatively generous Medicaid program and has been a bellwether for health policy experimentation. Alabama, like most other southern states, has run a barebones program with few optional benefits.

Launched last year, Oregon’s current Medicaid plan relies on local health care organizations to coordinate all forms of health care, from acute medical services to mental health and dental care, all in an effort to lower costs and improve health. Basically, the local entities, which may be headed by a hospital, physician group, community service provider or a managed care organization, are given a budget and challenged to beat it. If costs exceed the budget, the organization takes the loss.

Alabama lawmakers will soon consider a proposal from Bentley for a Medicaid overhaul based in part on Oregon’s groundbreaking “community care organizations.” Although Bentley has said he would not support an expansion of Medicaid “under its current structure,” the expected reforms are seen as paving the way for a possible expansion as early as 2015.

South Carolina

Lawmakers in South Carolina have proposed their alternative to expanding Medicaid, which includes paying hospitals to send uninsured patients to community health centers.

Instead, House Republicans this week put forward an alternative plan that would pay hospitals up to $35 million to steer uninsured patients to community health centers, free health clinics and rural health clinics. Lawmakers also pledged to give those health centers and clinics an extra $10 million in state money to care for those uninsured patients.

Those clinics, which the state gave $1.8 million this year, hailed the plan Thursday.

“The new plan is a positive alternative if the state does not decide to participate in the Medicaid expansion,” said Lathran Woodard, chief executive of the S.C. Primary Health Care Association.

In case you watched the first presidential debate tonight and found yourself saying, “I have a question!” — you have a chance to ask that question.

WebMD has teamed up with the nonpartisan Commission on Presidential Debates (CPD) to help gather questions for the upcoming debates. If you have a question for the candidates about health care, please submit it below. WebMD will compile the questions to share with the debate moderators.

To ask your question, visit this WebMD page before the next debate.

If I were to submit a question, it would likely be about health care costs (which I might have already submitted…). This Washington Post graphic shows the difference in what residents in the U.S. pay for medical procedures versus in other countries.

What would you ask about? What did you want to hear more about tonight?

Let me know either here on the blog or via Twitter at @jaclyncosgrove.

In the things-to-consider-for-the-sake-of-considering-them category, take a gander at this story from the May 27 edition of The Boston Globe: 

After healthcare reform was made law in Massachusetts in 2006, the number of newly insured patients in the state started to grow, and so did the demand for care. The demand, coupled with a longstanding shortage of primary-care physicians, is creating a real crunch for community clinics, say advocates of healthcare reform as well as area medical professionals.

About 80 percent of the new patients at a community health clinic who are covered under the state’s new health insurance program were formerly uninsured, a clinic supervisor told the newspaper. The result is a lengthy waiting list.

Clinics the newspaper contacted have had difficulty recruiting doctors.

‘What Chapter 58 has done is highlighted the crisis and the problem that we have with the primary-care workforce,’ said Dr. Bruce Auerbach, president of the Massachusetts Medical Society. According to a study conducted in 2006 by the society, 53 percent of patients who had an appointment with a primary-care physician were able to see a doctor within a week of initiating contact. Last year, only 42 percent were able to see a doctor within a week. …

Critics have said healthcare reform should not have been attempted without first addressing the workforce shortages, said John E. McDonough, executive director of Health Care for All, an advocacy group that helped craft the healthcare law. …

Healthcare advocates and providers say that the real problem is that the state underestimated the number of residents without health insurance. …

According to Jon Kingsdale, executive director of the Commonwealth Health Insurance Connector Authority, which administers the new health law, 340,000 people who had been mostly uninsured were covered through the state’s program as of Jan. 1. Of that number, about 110,000 have bought private insurance through Commonwealth Choice. But, he said, the remaining 230,000 people have MassHealth or Commonwealth Care, the state’s subsidized health insurance programs.

One thing that’s unclear is why the formerly uninsured choose the types of clinics mentioned in the story when it looks although they could go to any doctor. Maybe they can’t, or maybe the story didn’t address it.

Either way, the unintended consequences of insuring hundreds of thousands of people are worth considering.

Thoughts? Leave a comment on this blog.

Jeff Raymond, Medical Writer

 Is retirement going to be a luxury for thirty- and forty- something workers? I increasingly think it will be, and a new estimate from investment giant Fidelity does nothing to dispel that.

A 65-year-old-couple retiring this year will need approximately $225K to cover medical costs in retirement, Fidelity estimates. Let’s not lose sight of the fact that this is in addition to the coverage available under Medicare, which may itself not be available when I and others retire.

The hypothetical retirees will still have to have enough money to live, either independently or in long-term care.

Perhaps what’s even more sobering than the estimate is its growth since 2002 — 41 percent.

The roughly 6 percent annual growth in the Fidelity projection about matches the growth of my 401K fund during a slow year. I know that doesn’t take into account contribution matching and interest compounding, but I think it raises a worthwhile point nonetheless.

And health care costs show no signs of flattening or decreasing.

Does paying for retirement terrify you as much as it terrifies me? Leave me a comment at http://blog.newsok.com/health.

Fidelity recommends:

- Creating an individual retirement plan

- Starting early and maximizing opportunities to save

- Assessing health status and becoming a smarter consumer of health care

- Determining details of any employer-sponsored coverage

- Understanding the financial impact of health care costs on Social Security income

Jeff Raymond, Medical Writer

If you’re interested in keeping tabs on your doctor, HealthGrades now offers a notification service.

The Web site, www.healthgrades.com, is best known for its hospital ratings. But given the information it compiles, a physician notification service is a natural addition.

The “Watchdog” e-mail alert service costs $4.95 a month.  

Notification items include board certification, disciplinary actions, malpractice suits and patient safety reviews.

Would you monitor your doctor? Would you pay to have someone notify you of lawsuits and other information of interest? Leave a comment at The Medicine Bag blog at http://blog.newsok.com/health. I’d like to hear what you think.

HealthGrades maintains quality profiles on almost every practicing physician in the country. The profile includes information on the doctor’s medical training, patient ratings, state and federal sanctions, malpractice judgments (in 15 states), procedure costs and hospital affiliations.

Subscribers to the service receive e-mail alerts when a physician’s information changes. Comprehensive physician profiles cost $29.95.

Jeff Raymond, Medical Writer

Statistically speaking, men will die six years sooner than women. We have higher death rates for the 15 leading causes of death.

Here are some stats from the National Center for Health Statistics:

• In 1950 the age-adjusted death rate per 100,000 men was 1,647.2.
• For women it was 1,236.
• In 2000 the rate for men was 1,053.8.
• For women it was 731.4.
• In 2004 the rate for men was 955.7.
• For women it was 679.2.
• In 1950 the death rate among men from heart disease was 697.
• For women it was 484.7.
• In 2000 the rate for men was 320.
• For women it was 210.9.
• In 2004 the rate for men was 267.9.
• For women it was 177.3.

The numbers, whether taken together or broken down by cause of death, show that while age-adjusted death rates of men and women have made huge strides, men still trail.

Check out the rest of the document here.

I bring this up to spotlight Integris Health’s annual Men’s Health University Men’s Fit Club. The program appropriately began the day after the Super Bowl. It is a weight-loss class offered just for men, of all ages. It focuses on eating habits and increasing fitness.

Men-U is a series of events throughout the year to educate men and their loved ones on how to take care of their health. Health checks such as prostate cancer screenings are featured, and then there’s the Man Card, from Integris and WWLS The Sports Animal. Cardholders earn points that can be redeemed for prizes.

The class runs through April 17 and will be every Monday from 5:30 to 7:30 p.m. at Integris Pacer Fitness Center. The cost is $240 — less for those with a Man Card. Call (405) 951-2277 or (888) 951-2277 for more information.

One reason men die earlier may be because they avoid going to the doctor. A 2007 survey of more than 1,000 men for the American Academy of Family Physicians showed almost one-third wait as long as possible before seeking medical attention.

For health and medical news and commentary, read The Medicine Bag blog at http://blog.newsok.com/health.

Jeff Raymond, Medical Writer

With an average annual growth rate in hospital charges of 4.5 percent, researchers predict the bill will reach $1 trillion by 2008.

AHRQ also found:

-Medicare paid $411 billion of the national bill, followed by private insurance ($272 billion) and Medicaid ($124 billion). 

-The uninsured accounted for $38 billion. 

This is taken from the AHRQ report:

For more health and medical news and commentary, read The Medicine Bag blog at http://blog.newsok.com/health.  

Jeff Raymond, Medical Writer