Health­care Mile­stones Poll Re­sults

In cel­e­bra­tion of Mod­ern Health­care’s 40th an­niver­sary, read­ers were asked to choose the top health­care mile­stones since the mag­a­zine’s found­ing in 1976.

Modern Healthcare - - 40 MAJOR MILESTONES -

Over 700 re­spon­dents to the sur­vey se­lected their top five picks from each of three cat­e­gories: health­care de­liv­ery, pol­i­tics and pol­icy, and science and tech­nol­ogy. Read on for the com­plete list of the 40 most sig­nif­i­cant devel­op­ments of the past 40 years.

1. Se­quenc­ing the hu­man genome

In June 2000, Pres­i­dent Bill Clin­ton, flanked by Dr. Fran­cis Collins, then di­rec­tor of the Na­tional Hu­man Genome Re­search In­sti­tute, and Craig Ven­ter, CEO of Cel­era Ge­nomics, an­nounced the ini­tial se­quenc­ing of the hu­man genome.

2. Mag­netic res­o­nance imag­ing

A team led by John Mal­lard of the Univer­sity of Aberdeen in Scot­land ob­tained the first clin­i­cally use­ful im­age of a patient’s in­ter­nal tis­sues us­ing MRI on Aug. 28, 1980. Re­fine­ments over the next 15 years led to its wide­spread use by the mid-1990s.

3. The Patient Pro­tec­tion and Af­ford­able Care Act

A Demo­cratic-con­trolled Congress and Pres­i­dent Barack Obama in 2010 passed the largest health in­sur­ance ex­pan­sion in 45 years with­out a sin­gle Repub­li­can vote. The law re­quires cit­i­zens to have health in­sur­ance and bars in­sur­ers from deny­ing cov­er­age. Half of the law is de­voted to en­cour­ag­ing de­liv­ery-sys­tem re­form.

4. Small­pox erad­i­cated

The World Health Or­ga­ni­za­tion de­clared small­pox erad­i­cated on May 8, 1980.

5. First AIDS cases iden­ti­fied

In June 1981, the CDC re­ported a clus­ter of pneu­mo­cys­tis pneu­mo­nia in five gay men in Los An­ge­les while physi­cians in L.A. and New York iden­ti­fied an out­break of a rare skin can­cer among gay men. A July 3 ar­ti­cle in the New York Times car­ries the head­line: “Rare can­cer seen in 41 ho­mo­sex­u­als.”

6. Health In­sur­ance Porta­bil­ity and Ac­count­abil­ity Act

While the 1996 law pro­tects cov­er­age for work­ers and their fam­i­lies when they change or lose their jobs, and re­quires na­tional stan­dards for elec­tronic health­care transactions, it be­comes best known for its sec­tions pro­tect­ing patient pri­vacy.

7. The birth of DRGs

Fol­low­ing a three-year ex­per­i­ment in New Jer­sey, the Health Care Fi­nanc­ing Ad­min­is­tra­tion (now the CMS) in 1983 es­tab­lished di­ag­no­sis-re­lated groups for episodes of care within all hos­pi­tals.

8. Elec­tronic health records

Pres­i­dent Ge­orge W. Bush in his 2004 State of the Union ad­dress called for uni­ver­sal, por­ta­ble elec­tronic health records within a decade. De­spite over $30 bil­lion in fed­eral ex­pen­di­tures and tens of bil­lions more spent by providers, eas­ily trans­fer­able EHRs still don’t ex­ist in most of the coun­try.

9. Telemedicine

From its be­gin­nings in the NASA space pro­gram, telemedicine or tele­health has grown into a boom­ing busi­ness with the CMS now hav­ing over 70 HCPCS/CPT codes to pay for var­i­ous tele­health ser­vices.

10. The growth of nurse prac­ti­tion­ers

Fif­teen years af­ter the first nurse prac­ti­tioner pro­gram was es­tab­lished in 1965 at the Univer­sity of Colorado and five years af­ter the Amer­i­can Nurses As­so­ci­a­tion es­tab­lished a sep­a­rate coun­cil for NPs, their ranks by 1979 had crossed the 15,000 mark. To­day, there are more than 205,000 NPs li­censed in the U.S.

11. Medi­care’s pre­scrip­tion drug ben­e­fit

The Medi­care Pre­scrip­tion Drug, Im­prove­ment and Mod­ern­iza­tion Act, signed into law by Pres­i­dent Ge­orge W. Bush in De­cem­ber 2003, cre­ated Medi­care Part D, an un­funded man­date for Medi­care to pay for se­niors’ pre­scrip­tion drugs through pri­vate in­sur­ance plans.

12. Seat belts

Though the fed­eral gov­ern­ment re­quired man­u­fac­tur­ers to in­stall seat belts in 1969, en­force­ment of use was left up to the states. South Dakota be­came the last state to en­act fines for non-use in 1995. The Cen­ters for Dis­ease Con­trol and Preven­tion es­ti­mates seat belts have saved over 250,000 lives since 1975.

13. Af­ford­able Care Act sur­vives at Supreme Court: Round 2

In a 6-3 vote last year, the Supreme Court ruled in King v. Bur­well that in­sur­ance sub­si­dies were valid in all parts of the coun­try, thus putting an end to the last se­ri­ous le­gal chal­lenge to the ACA.

14. Advance di­rec­tives or liv­ing wills

An advance health­care direc­tive spec­i­fies what ac­tions a per­son wants from health­care providers if they are no longer able to make de­ci­sions for them­selves. The first liv­ing will was de­vel­oped in 1969. In 2009, Pres­i­dent Barack Obama be­came the first pres­i­dent to say he had a liv­ing will.

15. Com­puted to­mog­ra­phy scan­ning

The first CT scan of a patient took place in Eng­land in 1971. This year, an es­ti­mated 78 mil­lion CT scans will be con­ducted on far more so­phis­ti­cated ma­chines.

16. Ac­count­able care or­ga­ni­za­tions

Coined by Dart­mouth re­searcher Dr. El­liott Fisher in 2006, the term de­scribes an en­tity “held ac­count­able” for com­pre­hen­sive health ser­vices for a de­fined pop­u­la­tion. Sim­i­lar to health main­te­nance or­ga­ni­za­tions, ACOs dif­fer in that they are usu­ally run by providers, not in­sur­ers, and take on less risk.

17. The Emer­gency Med­i­cal Treat­ment and La­bor Act

EMTALA, signed into law by Pres­i­dent Ron­ald Rea­gan in 1986, re­quires hos­pi­tal emer­gency de­part­ments pro­vide ap­pro­pri­ate med­i­cal care re­gard­less of cit­i­zen­ship, le­gal sta­tus or abil­ity to pay.

18. Vac­cines for chil­dren

A fed­er­ally funded pro­gram cre­ated in 1994 pro­vides free vac­cines to chil­dren in low-in­come fam­i­lies. Vac­cines in­clude MMR, flu and HPV.

19. Dis­cov­ery of AIDS virus

In 1984, re­search groups led by Dr. Robert Gallo at the Na­tional Can­cer In­sti­tute in Bethesda, Md., Dr. Luc Mon­tag­nier at the Pas­teur In­sti­tute in Paris, and Dr. Jay Levy at the Univer­sity of Cal­i­for­nia at San Fran­cisco, iden­tify a retro­virus as the cause of AIDS. A global fight over who dis­cov­ered the retro­virus en­sues.

20. The Stark law

This 1989 law, named af­ter for­mer Rep. Pete Stark (D-Calif.), who spon­sored the orig­i­nal bill, bars physi­cians from re­fer­ring Medi­care pa­tients to hos­pi­tals, labs and other doc­tors with whom they have fi­nan­cial ties (ex­cept in some cir­cum­stances). Many providers sued un­der the law crit­i­cize its com­plex­ity.

21. FDA ap­proves di­rect-to-con­sumer drug ad­ver­tis­ing

The FDA de­ci­sion in 1997 made the U.S. only one of three coun­tries in the world where di­rect-to-con­sumer ad­ver­tis­ing for phar­ma­ceu­ti­cals is le­gal. The flood of tele­vi­sion and print ad­ver­tis­ing for pharma prod­ucts con­tin­ues to this day.

22. Ge­net­i­cally tar­geted can­cer ther­a­pies

The FDA ap­proves the first tar­geted can­cer ther­apy, ima­tinib or Gleevec, in 2001 for chronic myel­oge­nous leukemia. In 2015, Pres­i­dent Barack Obama an­nounces a pre­ci­sion medicine ini­tia­tive.

23. Statin drugs

The FDA ap­proved lo­vas­tatin for preven­tion of heart dis­ease in 1987. Mar­keted by Merck & Co. as Me­va­cor, it was the first drug in a class that would be­come the best-sell­ing drugs in U.S. his­tory.

24. In-vitro fer­til­iza­tion

Louise Brown, the first “test tube baby,” was born July 25, 1978, at Old­ham Gen­eral Hos­pi­tal in Eng­land. Her par­ents, Les­ley and John Brown, had been try­ing to con­ceive for nine years.

25. The Chil­dren’s Health In­sur­ance Plan

Pres­i­dent Bill Clin­ton signed CHIP into law in 1997 as part of the Bal­anced Bud­get Act. By 2015, more than 8 mil­lion chil­dren re­ceived health in­sur­ance cov­er­age un­der the pro­gram.

26. Per­cu­ta­neous coro­nary in­ter­ven­tions

The first coro­nary an­gio­plasty was per­formed in Zurich on Sept. 16, 1977, by Dr. An­dreas Gru­entzig. The pro­ce­dure spread quickly to the U.S. af­ter he moved to Emory Univer­sity in At­lanta. By the mid-1980s, PCI had be­come the lead­ing pro­ce­dure for treat­ing coro­nary artery dis­ease.

27. The HIV/AIDS triple cock­tail

The FDA’s ap­proval of the first pro­tease in­hibitors in 1996 en­abled three-drug com­bi­na­tion ther­apy, which turned a fa­tal dis­ease into a man­age­able con­di­tion.

28. CO­BRA

The Con­sol­i­dated Om­nibus Bud­get Rec­on­cil­i­a­tion Act, passed by Congress in 1985 and signed into law in 1986, re­quired em­ploy­ers to of­fer par­tially sub­si­dized health in­sur­ance to em­ploy­ees who lost their jobs.

29. Fram­ing­ham heart study

Be­gun in 1948, this epi­demi­o­log­i­cal study dis­cov­ered the links be­tween heart dis­ease and smok­ing (1960), high choles­terol and blood pres­sure (1961), psy­cho-so­cial fac­tors (1978) and atrial fib­ril­la­tion (1998).

30. Nu­tri­tion La­bel­ing and Ed­u­ca­tion Act

In a ma­jor break­through for di­etary health, this 1990 law re­quired nu­tri­tion in­for­ma­tion on all pack­aged foods and reg­u­lated the use of health claims on la­bels.

31. Coro­nary stents

In spring 1986, Dr. Jac­ques Puel in Toulouse, France, and Dr. Ul­rich Sig­wart, work­ing in Lausanne, Switzer­land, im­planted the first coro­nary stents— de­vices that act as scaf­fold­ing to prop open dis­eased ar­ter­ies.

32. United Net­work for Or­gan Shar­ing

In 1984, Congress passed the Na­tional Or­gan Trans­plant Act to co­or­di­nate the al­lo­ca­tion of or­gans. UNOS was in­cor­po­rated in March of that year and re­ceived its ini­tial con­tract in 1986.

33. Ore­gon’s Death with Dig­nity Act

In 1997, Ore­gon be­came the first state to pass a law al­low­ing ter­mi­nally ill in­di­vid­u­als to end their lives with lethal med­i­ca­tion pre­scribed by a doc­tor. Since then, five other states have le­gal­ized the prac­tice.

34. The or­tho­pe­dics rev­o­lu­tion

By the early 1970s, sur­geons had de­vel­oped ef­fec­tive re­place­ments for arthritic knees and hips. By 2010, an es­ti­mated 7.2 mil­lion Amer­i­cans have un­der­gone to­tal knee and to­tal hip arthro­plasty. Women ac­counted for over 60% of the op­er­a­tions.

35. Af­ford­able Care Act sur­vives at Supreme Court: Round 1

In a 5-4 de­ci­sion, the U.S. Supreme Court in NFIB v. Se­be­lius up­holds most of the ACA when it de­clares the penalty levied on peo­ple who didn’t buy in­sur­ance a tax. The high court also al­lows states to opt out of ex­pand­ing Med­i­caid.

36. Pa­tient­cen­tered med­i­cal homes

An Amer­i­can Academy of Pe­di­atrics state­ment in 1992 de­fines a med­i­cal home as pro­vid­ing fam­i­ly­cen­tered, com­pre­hen­sive, con­tin­u­ous and co­or­di­nated care for in­fants and chil­dren. The Amer­i­can Col­lege of Physi­cians in 2005 en­cour­ages their use with all pa­tients.

37. Fight­ing health­care fraud and abuse

The U.S. Jus­tice De­part­ment and HHS in 2009 cre­ate the Health Care Fraud Preven­tion and En­force­ment Ac­tion Team, which fo­cuses on pre­vent­ing and re­duc­ing Medi­care and Med­i­caid fraud. Since then, the Jus­tice De­part­ment has re­cov­ered more than $16.4 bil­lion in health­care fraud cases.

38. Health sav­ings ac­counts

Part of the Medi­care Pre­scrip­tion Drug, Im­prove­ment, and Mod­ern­iza­tion Act of 2003, HSAs were de­signed to of­fer a tax­ad­van­taged ac­count to pay for out-of-pocket costs un­der high-de­ductible health plans.

39. Mas­sachusetts health­care re­form

The 2006 law, signed by Gov. Mitt Rom­ney, man­dated res­i­dents buy health in­sur­ance, and em­ploy­ers with 11 or more work­ers of­fer cov­er­age. The law be­came the model for the Af­ford­able Care Act.

40. Ar­ti­fi­cial hearts

The first ar­ti­fi­cial heart, de­vel­oped by Dr. Robert Jarvik, was im­planted in Dr. Wil­liam DeVries of the Univer­sity of Utah on Dec. 2, 1982. Seat­tle den­tist Bar­ney Clark lived an­other 112 days.

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