US Healthcare is sick and getting sicker, and while its chaotic complexity suggests to many that it will need to fail big before it can be rebuilt, some simple rules may help to get it back on track. As this the time of year when many of us prepare to send our children on grandchildren off to school in the hopes that they will learn what they need to succeed, I thought we could revisit the lessons of Kindergarten and their application to healthcare. The following list, initially from “ALL I REALLY NEED TO KNOW I LEARNED IN KINDERGARTEN” by Robert Fulghum. has been adapted (read ‘man-handled’) for applicability to US healthcare. You’ll find the original list here: http://www.robertfulghum.com/
- Share everything – In healthcare, this means share ALL the data, all the information, all the acquired wisdom. Interoperable systems are essential. Price transparency is the right side of history. Automated, coordinated, connected systems are essential. Healthcare is too much of a team sport not to share all that we know, so that we can quickly understand what works, what doesn’t, and what it’s all going to cost.
- Play fair – It isn’t fair when decisions are made without a person’s input. It isn’t fair that a patient should bear the risks, the pain, the scars and the costs without having unfettered access to all the relevant information. Shared decision making is part of playing fair in a world where healthcare is meant to happen for patients and with patients, but not to patients.
- Put things back where you found them. Except for things like an infected appendix or a malignant growth, this continues to make great sense. And as we go about transforming healthcare, we must recognize that wholesale, sweeping changes are easier to envision than execute. While progress requires change those changes that align with / enhance / expedite existing workflows will be easiest to achieve.
Filed Under: OP-ED, Physicians, THCB
Aug 29, 2014
While fierce debate continues to envelop much of the Affordable Care Act, financial data for many of the nation’s health systems reveal one clear fact: the optional Medicaid expansion has resulted in hospital haves and have nots.
An analysis by PwC’s Health Research Institute (HRI) of newly released earnings and patient volume data shows a clear financial split between healthcare providers operating in states that expanded Medicaid and those that have not. The law as written would have provided Medicaid coverage to every American earning less than 138% of the federal poverty level ($16,105 for an individual). But a June 2012 Supreme Court ruling made the expansion optional for states, creating a patchwork of coverage.
Health systems and physician groups delivering care in the 26 states and the District of Columbia that have embraced the federally-funded expansion have reported a significant rise in patient volumes and paying consumers and a measureable reduction in uncompensated care levels.
This year alone LifePoint Hospitals has seen a 30.3% reduction in its uninsured and charity care patients, according to filings with the Securities and Exchange Commission. Tenet Healthcare, which operates in five Medicaid expansion states, saw uninsured and charity care admissions decline by 46% in the expansion states, coupled with a 20.5% increase in Medicaid inpatient admissions in those same states, according to an HRI analysis which will be released next week.
In all, HRI analyzed financial data from the nation’s five largest for-profit health systems—HCA Holdings, LifePoint, Tenet, Community Health Systems and Universal Health Services, representing 538 hospitals in 35 states. Our team also reviewed data from several mid-sized hospitals, government reportsand industry surveys.
Continue reading “Medicaid 2.0″
Filed Under: THCB, The Business of Health Care
Tagged: ACA, Community Health Systems, HCA Holdings, LifePoint, Medicaid, Medicaid Expansion, Tenet, Universal Health Services
Aug 28, 2014
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Filed Under: THCB
Aug 28, 2014
In the past few years, we’ve seen headline after headline marveling at the advancements of medical technology. From wearable tech and micro sensors to 3D printing and health-oriented apps, it’s evident that technology and medicine have merged into an industry that’s pushing healthcare to a new level.
Yet many in the health tech industry are also voicing concerns about government regulators and their standards for healthcare technology. Some have even gone as far as accusing the FDA of “stifling” the creativity of healthcare tech and hindering the value these devices and apps could bring to the public.
In early 2014, legislation was introduced in an attempt to redesign the regulatory framework for certain types of technologies and lessen the FDA’s control over this growing industry. But are the FDA’s standards and actions so bad?
I’m in the tech field myself, and while I’ve heard many arguments against the FDA’s regulations, I strongly feel that it’s completely within its rights as a regulatory agency to place limits on medical technology. The FDA’s standards are put in place to protect consumers and to correct disingenuous manufacturer claims — an alarmingly frequent trend in today’s digital world.
Continue reading “Are Federal Regulations Stifling Disruptive Healthcare Technologies in the US?”
Filed Under: Tech, THCB
Tagged: App Store, Entertainment Purposes Only, FDA, Regulation
Aug 28, 2014
In the past few years, the fortunate among us have recognised the hazards of living with an overabundance of food (obesity, diabetes) and have started to change our diets. But most of us do not yet understand that Facebook is to the mind what sugar is to the body. Facebook feed is easy to digest. It has made it easy to consume small bites of trivial matter, tidbits that don’t really concern our lives and don’t require thinking. That’s why we experience almost no saturation. Unlike reading books and long magazine articles (which require thinking), we can swallow limitless quantities of photos and status updates, which are bright-coloured candies for the mind. Sadly, we are still far away from beginning to recognise how toxic Facebook can be.
Continue reading “Facebook Is Bad For You. And Giving Up Using It Will Make You Happier”
Filed Under: THCB
Tagged: Akshat Rathi, Facebook, Social Media, Wellness
Aug 28, 2014
How much does a colonoscopy cost? Well, that depends.
If you’re uninsured, this is a big question. We’ve learned that cash or self-pay prices can range from $600 to over $5,400, so it pays to ask.
If you’re insured, you may think it doesn’t matter. Routine, preventive screening colonoscopies are to be covered free with no co-insurance or co-payment under the Affordable Care Act.
However, we’re learning that with colonoscopies, as with mammograms, people are being asked to pay sometimes. It’s not clear to us in every case that they should pay, and since we don’t know all the details of these events, we can only offer some general thoughts. We’ve also heard from Medicare enrollees without supplemental Medicare policies that they think they’re responsible for 20 percent of the charged price — so 20 percent of $600 vs. 20 percent of $5,400 is a big deal.
If you’re on a high-deductible plan and the charge to you will be, say, $3,600, you can probably ask around and find a lower rate.
A thorough view of some colonoscopy billing issues is in this article in The New York Times by Libby Rosenthal, who has been covering health costs for the paper. We’ve heard also about in-network providers using out-of-network anesthesiologists, so it pays to pay attention.
Continue reading “How Much Is My Colonoscopy Going to Cost? $600? $5,400?”
Filed Under: THCB
Tagged: Anesthesia, Billing, Colonoscopy, Facility fee, Gastroenterology, Labs, pricing, Wellness
Aug 27, 2014
Want to achieve effective health care, reduced costs, increased quality, population health, widespread prevention and seamless health information access?
It’s easy, says this article in Population Health Management: mix one part PHO with one part HRB to create a HAPPI.
This correspondent was confused too, but that’s what’s proposed by three smart academics from Johns Hopkins, Arizona State University and UC Berkeley.
As I understand it, Population Health Organizations (PHOs) would be responsible for all medical, public health, community and social services in a defined geographic area and coordinate them with local education, housing and labor. Much of it would be paid for by a pooled risk-adjusted global or capitated payment (budget) from all insurers.
Each organization would be paired with a Health Record Bank (HRB), which would act as a huge data warehouse that not only stores all medical information, but any other publically available information on every individual enrolled in the PHO. The HRBs would be owned and operated by “trusted custodial organizations.” Data access would be ultimately controlled by each patient.
The authors believe that patient payments would be a source of additional revenue for their PHOs. Examples include buying “apps” that are tailored to their individual health needs, or selling their personal health information, especially if it means helping physicians buy an electronic health record or access cutting edge research.
Continue reading “Doubling Down on ACOs and Health Information Networks”
Filed Under: Economics, THCB, The Business of Health Care
Tagged: ACOs, HAPPI, Health Information Networks, Health Records Bank, HRB, PHO, Population Health Organization
Aug 27, 2014
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Filed Under: THCB
Aug 25, 2014
Celebrating its 40 anniversary this year, Robert M. Pirsig’s Zen and the Art of Motorcycle Maintenance bears several distinctions. It is listed in the Guinness Book of World Records as the eventual bestseller that was rejected by more publishers than any other, 121. It went on to sell more than 5 million copies, making it the most popular philosophy book of the past 50 years. And it focuses on a truly extraordinary topic, which its narrator refers to as a “metaphysics of quality.”
Quality is a hot topic in healthcare today. Hospitals and healthcare systems are abuzz with the rhetoric of QA and QI (quality assessment and quality improvement), and healthcare payers including the federal government are boldly touting new initiatives intended to replace quantity with quality as the basis for rewarding providers. Yet as Pirsig’s narrator, Phaedrus (see Plato’s dialogue of the same name), comes to realize, quality is very difficult to define.
In fact, giving an account of quality is so difficult that it drove Zen’s author mad. And this is a man whose IQ, 170, would make him one of the most intelligent people in any health system. The problem, of course, is that there is a big difference between intelligence and wisdom, and in the quest for wisdom, mere intelligence often leads us dangerously astray. Something similar is happening in healthcare today, where schemes to improve quality often precede sufficient efforts to understand it.
For example, we seek to gain greater control over healthcare outcomes through measurement, only to discover, to our chagrin, that people are massaging the data to meet their numbers. We create new programs intended to increase patient throughput, only to discover unintended perverse effects on the quality of relationships between patients and physicians. Initiatives intended to reduce error rates turn out again and again to stifle innovation. Continue reading “Zen and the Quest For Quality”
Filed Under: Physicians, THCB
Aug 25, 2014
Where: Harvard Medical School
When: September 16th, 2014
What: Primary Care Innovations Pitch Off
By 2015 the U.S. will need an additional 52,000 physicians to meet the country’s needs. Primary care providers are in particularly high demand for the valuable role they play in managing chronic conditions, providing preventive care services and leading patient-centric care delivery models. The health care community is coming together to ask: What does the future of primary care look like?
What innovations are already being implemented?
The Primary Care Challenge
For two months, we will be accepting submissions as part of the effort to raise the profile of innovative ideas in primary care delivery. Any U.S. medical student, resident or physician is encouraged to submit a description of a creative program that their practice has implemented around primary care delivery. A variety of prizes will be offered to finalists and participants, including an all-expenses paid trip to Boston for five finalists to share their proposals in-person with experts and peers at our Primary Care Innovations event.
Starting this month you can check out the Primary Care Challenge website for step-by-step instructions on how to submit your program and take advantage of this great opportunity. Feel free to share your thoughts with us on Twitter and use #PCC14
Continue reading “Share Your Primary Care Innovations”
Filed Under: THCB
Tagged: American Resident Project
Aug 24, 2014