thcbA personal account of a transaction that went very badly, and rules of Health Reform were not followed.

Accountable Care and associated transparency have not made it to Florida, at least not in this physician’s office.

I made an appt with an ENT (ear nose and throat doctor) for ear wax.  When I get there, I need to fill out 5 papers (EMRanyone??), and I’m told there is a $35.00 copay, which she says I can pay on my way out.

The 5 page HIPAA form says they can share my info with other providers who are trying to collect fees. But you only learn this, among other clauses, if you read the form that is tacked on the wall–it’s not in the form the patient signs.

I asked the receptionist how much the office visit is, and she said, “On your insurance there’s a $35.00 copay.” Yes, but is there an additional fee for removal of ear wax? How much? “We can’t tell you that until after the doctor sees you and marks what is done. And besides, we don’t know if you have satisfied your deductible.”  I tell her I have not, but because I have to guarantee payment if the insurance company denies anything, I’d like an estimate of charges.  She repeats the deductible statement and I say yes, I understand, but that’s a problem, as I haven’t satisfied my deductible so I need to know how much this will be. She tells me she will get the Office Manager (OM).

The Office Mgr (who is disguised in a clinical suit) tells me, “You have to sign this financial form before the doctor sees you because after, you will have received the services so you or the insurance company owe the money.” No problem say I, but I need an estimate, and I can’t sign a financial responsibility form that allows you to bill me if my insurance company doesn’t pay you in 45 days AND that tacks on a 30% interest fee, when I don’t know if I can afford it.

Two visits into the doctor’s lair, she comes out and says, “Dr M is more than willing to provide the services you need but he cannot be interrupted to tell you the costs of the services.” BOOM.

Continue reading “Accountable Care: Transparency of Fees Is Mandatory”

Nortin HadlerOvertreated, overstaffed, over-administered, overpriced, over-regulated, and over-legislated: that’s for starters. How about over-diagnosed, over-medicalized, over-screened, over-digitized, and over-litigated? Then there’s unavailable, inaccessible, non-empathic, and even cruel when it comes to the disabled, disallowed the disaffected and the disavowed. To top it off there’s the American fashion of dying, alone and encumbered by the machinery of futility.

Political pundits and policy wonks point fingers at the mainstream American health care system, sometime more than one finger, often at more than one putative culprit, and often by partisans within the system. It’s open season.

Then there’s the off-off-campus American health care system decrying the on-campus system as insufficiently holistic, alternative, complementary, organic, nutritious, mindful, centered, and soothing. Worse, still, the mainstream is decried for being dismissive of the various therapeutic modalities that various practitioners believe to be essential to maintaining health and restoring well-being. The on-campus Health Care System is so dismissive of these “others” as to wield the “sectarian” label and to restrain their licensure as much as political pressures countenance.

Continue reading “The Health Care Blame Game”

alex christmas

Today we’re starting a series of more personal stories, looking at what makes interesting people in health care tick. Alex Carmichael is a rare multiple time CEO in health technology, and she has a very interesting tale to tell–Matthew Holt

Don’t worry, this isn’t your typical, syrupy founder story. Matthew asked me to share my experience selling my startup CureTogether to 23andMe, what ensued after that, and how I ended up at uBiome today.

So I thought, if I’m going to share, I might as well *really* share. Let you in behind the scenes to see what it was actually like.

(Bonus: at the end I’ve listed my top 11 life lessons, so make sure you read all the way through for that!)

The story starts…

October 1, 1976: I came into the world in Toronto, Canada, with striking violet eyes. My lawyer/politician mother and management consultant father gave me the name Alexandra, which means “leader of all mankind,” as they often reminded me. Talk about a family having high expectations!

Childhood: I remember loving to read and walk my dogs, who were probably my best friends. I went to a progressive Montessori school with an amazing teacher who believed in me and taught me the power of patience.

Teenage years: The “best” school in Toronto was a repressive and aggressive all-girls private school. My insane work ethic was drilled into me there, as well as at my mom’s political campaign offices, where I would work after school until late into the night.

College years: I met my first love, Danny, in a biochemistry lab at the University of Toronto. I chose the most difficult major (Molecular Genetics and Molecular Biology), because it would drive me hardest. Masochist much?

First startup, 1999: I dropped out of grad school, much to the horror of my extremely educated parents, to join a bioinformatics software company Danny had started in his bedroom in 1997. I taught myself how to code, design, sell, and run a company. We worked so much that we hardly left our apartment, except to get married, have a baby, and occasionally go to Tai Chi class. We lost most of our money in the dot com bust, and scraped by on rice and beans for a few years. It was so isolating and intense that I got really depressed and even suicidal once.

First exit, and move to California, 2005: We were seriously running out of money, so one day I made a big wall chart of all the possible companies that could acquire us, and we started going after each one relentlessly. After a few months, we got a meeting with Hitachi. They were interested, but didn’t seal the deal until we decided to put our stuff in storage and just show up in California, baby daughter Samantha in tow. One way or another, we were determined to make it work. They did end up acquiring us, for a few hundred thousand dollars. Not much for 8 years of invested time and energy, but really we just wanted to get to California, where the sun shines and the opportunity abounds. We finally made it!
Continue reading “The Real Story Of How I Sold Two Startups, The Chaos Afterwards, And What’s Next”

sherie

Medicine is obsessed with numbers. Or rather, journalists and medical administrators are. Here are two related examples of how large a grain of salt one must put on numbers.

Cardiac surgical procedures, like everything else in medicine, have quality indicators. One of these is what we doctors call “30-day mortality”. What this term means is that surgeons are evaluated in part on how many of the patients they operated on died within a month of having surgery. Presumably a surgeon whose patients rarely die within 30 days is a better surgeon than one whose patients die all the time. The American Academy of Hospice and Palliative Medicine, whose members deal frequently with the elderly, thinks this number, 30, harms old people. http://nyti.ms/1AR3OqB. The problem, according to Paula Span of the New York Times, is that surgeons refuse to operate on people who are more likely to die within 30 days, and that they keep patients alive in ICUs until day 31 to keep their numbers up. Bad doctors! Continue reading “No More Numbers”

thcbAs the digital economy transforms health the most transformative ideas and consumer engagement solutions can sometimes challenge the industry’s ability to adopt and implement them. Reimbursement reforms, risk sharing, migration towards high deductible plans and the expansion of public and private coverage are converging to unleash an increasingly sophisticated consumer into the marketplace. Health systems and physician practices are consolidating and marketing their services direct to consumers in an attempt to underscore the critical differentiators valued by consumers – access, quality and affordability.  In today’s consumer economy, access remains a critical criterion for choosing and patronizing a provider or a practice. To assist the move toward consumerism, employers are introducing tools to facilitate comparison-shopping for services seen as “consumer-driven.”  The cost of elective and non-emergency services are highly variable and employers want employees to become consumers making decisions based not only on access but also cost. Continue reading “Patient Self-Scheduling 2.0″

Screen Shot 2015-03-23 at 8.02.41 AMThere are dozens of ways to take stock of the Affordable Care Act as it turns 5 years old today.   According to HHS statistics:

  • 16.4 million more people with health insurance, lowering the uninsured rate by 35 percent.
  • $9 billion saved because of the law’s requirement that insurance companies spend at least 80 cents of every dollar on actual care instead of overhead, marketing, and profits
  • $15 billion less spent on prescription drugs by some 10 million Medicare beneficiaries because of expanded drug coverage under Medicare Part D
  • Significantly more labor market flexibility as consumers gained access to good coverage outside the workplace

Impressive.  But the real surprise after five years is that the ACA may actually be helping to substantially lower the trajectory of healthcare spending.   That was far from a certain outcome.  Dubbed the Patient Protection and Affordable Care Act for public relations purposes, there were, in fact, no iron clad, accountable provisions that would in the long run assure that health insurance or care overall would become “affordable.”

ACA supporters appear to have lucked out—so far.   Or maybe, just maybe, it wasn’t luck at all but a well-placed faith that the balance of regulation and marketplace competition that the law wove together was the right way to go.

To be sure, other forces such as the recession were in play—accounting for as much as half of the reduction in spending growth since 2010.  But as the ACA is once again under threat in the Supreme Court and as relentless Republican opposition continues, it’s worth paying close attention to new forecasts from the likes of the Congressional Budget Office (CBO) and the actuaries at the Centers for Medicare and Medicare Services (CMS).

The ACA is driving changes in 17 percent of the U.S. economy that, if reversed or interrupted, would have profound impact on federal, state, business, and family budgets.   A quick look at some important numbers follows:

Continue reading “Happy 5th Birthday, ACA”

Screen Shot 2015-03-22 at 9.22.36 PMIt may have been a quiet week in Lake Wobegon, but not in Washington DC.  Last week, we saw the introduction of two congressional bills here (SGR fix) and here (EHR interoperability) and two proposed rules from HHS (one from CMS and one from ONC) – all of which would have substantive impact on health care in the US, and the role of information technology in how health is optimized and care is delivered.  While the iron’s still hot, let’s take a 30,000-foot view at all of this.   I’ll follow up later in the week with a more detailed overview of the ONC and CMS proposed rules with a bit more of an editorial voice on the SGR fix and Burgess’ interoperability bill.

  1. The first document to land – way back on March 10th – was the bill from Representative Burgess.

Some context: he’s a physician.  He understands the physician perspective – and is – like many physicians – confused by the paradox that several years and $20B after the passage of HITECH – we don’t have plug-and-play interoperability between health IT systems yet.  He might be asking: “isn’t this what was supposed to happen by now?”  Compelled by his training as a physician and (as my wife would argue) a human with a Y chromosome, Rep Burgess sees a problem and wants to fix it – hence this legislation.  HHS didn’t fix this?  Industry didn’t fix it?  Well, then, let’s see if Congress can fix it!  What’s the approach?

  1. The bill attempts to redefine interoperability as:

“open access”

“complete access”

and

“does not block access.”

Continue reading “Spring Deliveries from Washington”

Niam YaraghiRep. Mike Burgess (R-Texas) has released a draft bill entitled “ensuring interoperability of qualified electronic health records” in which interoperable (Electronic Health Records) EHRs are defined as those that do not block sending and receiving data to and from other EHRs and provide users with complete access to the captured medical data. The draft bill proposes that detailed methods to assess interoperability be defined by a “Charter Organization.” According to the draft bill, this Charter Organization shall consist of one member from each of the standard development organizations accredited by the American National Standards Institute and representatives that include healthcare providers, EHR vendors, and health insurers. To keep its certification after January 2018, an EHR vendor should comply with the definitions of the Charter Organization, publish API’s to enable data exchange with other EHRs and attest and demonstrate that it has not willfully interrupted data exchange with other EHRs. The draft bill suggests that the Inspector General of HHS shall have the authority to investigate both EHR vendors and medical providers with regards to claims that they have interrupted interoperability.

The proposed Charter Organization will not be successful.

Continue reading “Congress Can’t Solve the EHR Interoperability Problem”

Screen Shot 2015-03-22 at 10.28.41 AM
In a major update, the search giant has announced that on April 21, the algorithm will be updated to favor websites that are designed to work on both mobile and desktop devices, now often referred to as Responsive Website Designs.

Does your practice have a responsive website?

Google has had multiple mobile initiatives, including the GoMo campaign where the company provided free tools to help small businesses build websites that worked on mobile devices without the dreaded pinching, resizing, and squinting. That campaign had limited success because the technology didn’t quite work as elegantly as possible, but just last week Google took its most aggressive approach yet by declaring that they were going to start penalizing websites that did not have mobile capabilities.

Once referred to as mobile-friendly website design, geeks refer to it simply as responsive website design now. So how does one get a mobile-friendly, er, responsive website?

Continue reading “Google Algorithm to Favor Websites That Work on Mobile Devices”

Screen Shot 2015-03-21 at 3.47.47 PMThere has been much enthusiasm in the health IT industry regarding the health data standard that HL7 International is working on, HL7 FHIR, which is now a DSTU (draft standard for trial use). Everyone involved with health data – EHR vendors, interoperability vendors, medical app developers, “big data” proponents and hospital CIOs, to name a few – have high hopes that FHIR can be the golden ticket that leads to true health care interoperability.

Most of the enthusiasm is around the technologies being utilized in the standard including RESTful web services, JSON encoding, and granular data content called resources.

Technology-Empowered FHIR Data

RESTful web services, in particular, is a technology that has been strongly embraced by other industries and has the potential to be leveraged for engaging patients by connecting mobile technologies with their provider’s EHR system. This advancement represents a huge step toward building a patient-centered health care system.

FHIR Interest

Over the last decade, the healthcare industry has utilized SOAP-based web services to transfer documents. Most programmers today, if given their choice, would likely lean towards RESTful web services, preferably with data encoded in the JSON format. It is a better choice for mobile applications independent of whether the client device technology is iOS, Android, Windows, or even Mobile Web. Most social media sites today, such as Twitter and Facebook, publish RESTful APIs for connectivity.

This preference towards RESTful web services is based on some of the advantages that REST has over SOAP:

Continue reading “FHIR: Technology and Governance”

MASTHEAD STUFF

MATTHEW HOLT
Founder & Publisher

JOHN IRVINE
Executive Editor

MUNIA MITRA, MD
Editor, Business of Healthcare

JOE FLOWER
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MICHAEL MILLENSON
Contributing Editor

MICHELLE NOTEBOOM
Business Development

VIKRAM KHANNA
Editor-At-Large, Wellness

ALINE NOIZET
Editor-At-Large, Europe
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