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flying cadeuciiDuring a move necessitated 20+ years ago by my change from a “private practice of medicine” life to a “back to school” life, I decided to undertake the move on my own using a rented van. I also had to affix a small trailer packed with furniture to the van. As I lifted the not so heavy trailer to the hitch, one of my children ran toward the trailer. I stopped my child’s progress with a holler and an out-stretched hand. As I did that, a disc in my back popped and dropped me to the ground. I have had back pain every day since. I have managed my back pain on my own. But, I now think it is time to start using my medical insurance to pay for the care of my back pain. So, fellow insured, you owe me a BMW.

Yes, a BMW. I know that my back pain is a subjective complaint and you can’t prove or disprove that I have it. I also know that there is no measure of my back pain; I can grade it on a scale from 0-10, as some do, but that is such a difficult task that I can’t internally come up with a number. I am sure, though, that the number changes daily. Even if I could assign a number to my pain, there is no guarantee that you would assign the same number should you suffer the exact pain as me, or that you could assign a number to my complaint better than I could. The pain is there, though. I feel it and alter my activities to not exacerbate.

Recently, a friend gave me a ride in his BMW. The seats fit my back to a t and as I sat there, my pain abated. I asked him to turn on the heated seats. Even more remarkable pain relief followed. In fact, after the ride in his car, I had no back pain for over 3 weeks, the first 3-week, pain-free stretch of time in over 20 years. So, since insurance plans often pay for some types of interventions such as heaters, buzzers, or needles, as examples, to help people with their back pain, so, then, shouldn’t insurance pay for a BMW for me? I think so.

Continue reading “You Owe Me a BMW”

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Paul KeckleyUnnecessary care that’s not evidence-based—usually associated with excess testing, surgical procedures or over-prescribing—accounts for up to 30% of what is spent in healthcare. In recent months, enforcement actions against physicians and hospitals have gained increased attention. But unnecessary care and over-utilization is not a new story or one that’s easy to understand.

Background

Medical necessity means something slightly different in every part of the healthcare industry. Varied definitions and interpretations are used by providers, physicians, courts, pharmacy benefits managers, government insurers, private insurers, and consumers. Perhaps the two most important are from the largest and most influential payer, Medicare, and the industry’s most important clinical authority, the American Medical Association (AMA).

Continue reading “Medical Necessity and Unnecessary Care”

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Leslie Kernisan new headshotSix years ago, just after arriving in Baltimore for a winter conference, I fell sick with fever and a bad sore throat.

After a night of feeling awful, I went looking for help. I found it at a Minute Clinic in a CVS near the hotel. I was seen right away by a friendly NP who did a rapid strep test, and prescribed me medication. I picked up my medication at the pharmacy there. The visit cost something like $85, and took maybe 30 minutes. They gave me forms to submit to my California insurance. And I was well enough to present my research as planned by day 3 of the conference.

Fast forward to this year. After feeling a bit blah on a Monday evening, I developed a sore throat, headache, and fever overnight.

I figured it was a winter viral pharyngitis, rearranged my schedule, and planned to make it an “easy day.” Usually a low-key day plus a good night’s sleep does the trick for me.

But not with this bug.

Continue reading “A Tale of Two Sore Throats: On Retail Clinics and Urgent Care”

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Martin SamuelsI’m afraid that if we don’t drill down on our brand equity on the front end, we’ll have to model it out on the back end to align our incentives or pad our ask regarding the co-branding deliverables on the horizon.  As an FYI, this empowerment is going to require an elbow to elbow champion getting under the covers for a 360 of the eRoom to facilitate a paradigm shift in order to achieve buy-in among the stakeholders if we’re going to tip our toe into that water and get the low hanging fruit before our clients incentivize the burning platform with new metrics.  After all, you are the process owner who needs to reach out in the proper bandwidth to push back on the KOL’s or we’ll have to sunset your blue ribbon committee for not trimming the fat on the real-time escalation project.  We need to do more due diligence before we hitch our wagon to that indexed outcome measure, and let’s be careful how we message it and roll it out to the core constituency. 

We can model that projected gap, but we don’t want to get out ahead of our audience before sensitizing them to the moving target.  Let’s not drop the meat in the dirt but rather vet a pause point, collapse it up to a high level statement and assess the current state in order to connect the dots to achieve the ideal state and have you weigh in at the portal for service oriented architecture.

Continue reading “Meaningful Use Retreat Report”

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flying cadeuciiWhat do the classic children’s’ book “The Little Engine that Could” and federal investment in health information exchanges have in common? More than you’d think.

Much has been said about the fragmentation of the U.S. health care system and how this fragmentation can result in higher costs and worse outcomes for patients. Health Information Exchanges (HIEs) – organizations that facilitate the secure sharing of health information – are one effort to improve communication among providers, better coordinate care, boost patient satisfaction, and reduce health care costs.

To spur these exchanges the federal government has invested nearly $600 million to support the development of statewide HIEs. But, what has been the return on this investment and are the results worth the expense? This month, Sens. Lamar Alexander, Richard Burr, and Mike Enzi asked the Government Accountability Office to examine that very question.

The senators’ goal to learn more about what the government received in return for its investment is certainly a worthy one, but it is a difficult question to answer. To date, there has been very little research on the effect of HIEs on health outcomes, costs, or patient and provider attitudes toward HIEs. In fact, according to a recent RAND review of the existing research supporting the efficacy of HIEs, very few of the more than 100 existing operational HIEs have been evaluated. Without evaluation, it’s difficult to draw conclusions about what works and what doesn’t and to ensure that any future investment on the part of federal or state government is made wisely. By not building evaluation into this program, we’re missing opportunities to improve the health care system by learning from experience.

Here’s an analogy that is useful in thinking about federal investment in HIEs. Imagine that 150 years ago, the United States decided to build a national rail network to connect all major U.S. cities at an estimated total cost of $60 billion (in today’s dollars). What if five years into the effort $600 million had been spent to build portions of the tracks between Chicago and Pittsburgh, New York and Boston, and Washington and Philadelphia?

Continue reading “The Little Exchange that Could…Transform the U.S. Health Care System”

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Farzad MostashariEarlier today, Health and Human Services (HHS) Secretary Sylvia Mathews Burwell announced that HHS is doubling down on the historic shift taking place across the health care industry towards value-based care, and is setting a target of having 50 percent of Medicare payments under value-based care arrangements by 2018.

 This would mean that in less than three years, around a quarter of a trillion dollars of health care spending would be made to providers who are being compensated not for ordering more tests and more procedures, but for delivering better outcomes – keeping patients healthier, keeping them out of the hospital, and keeping their chronic conditions in check.

This shift will address a central problem of the US health care system, one that lawmakers and policy experts on all sides of the issue agree is a key contributor to runaway medical inflation.

The logic is straightforward: by simply paying for the volume of services delivered, every provider has a strong incentive to do more — more tests, more procedures, more surgeries. And under this system, there is no financial incentive to maintain a comprehensive overview of patient care – to succeed by keeping the patient healthy, and health care costs down.

In making this announcement, Secretary Burwell took a step that many within HHS had been advocating quietly for years, and which many outside it have advocated more loudly.

Skeptics may ask: what does this accomplish? And why announce it now, when health care costs are already rising at the slowest rate in decades?

Continue reading “A Courageous First Step”

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One of the pleasantly surprising announcements President Obama made during his 2015 State of the Union address was “a new Precision Medicine Initiative to bring us closer to curing diseases like cancer and diabetes.”

Given precision medicine’s potential to solve many outstanding health care issues and lower costs without compromising clinical quality and performance, the President’s proposal is a welcome initiative. Many of the challenges we face practicing symptom-focused intuitive medicine could be overcome by turning toward precision medicine, a process of precisely diagnosing and targeting disease.

However, announcing the initiative is one thing. As with all policy discussions, the devil is in the details – and there are three details specifically that could make the difference between political rhetoric and a policy that truly improves the health of American citizens. Continue reading “Three Recommendations for President Obama’s Precision Medicine Initiative”

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Don’t get lost amongst the 1,200+ exhibitors that will be fighting for the attention of 38,000 or so health IT professionals at next spring’s HIMSS conference. Make sure your brand is top-of-mind before the attendees descend on Chicago April 12-16.

THCB  understands that exhibiting at HIMSS requires a significant financial and time commitment for participating vendors. Our goal is to help organizations maximize their marketing success by sharing their message with the 6,000 THCB readers who visit our site each day.

HIMSS exhibitors wishing to connect with our highly healthcare-centric audience are encouraged to take advantage of one of our HIMSS Specials.

Our sweet marketing packages include:

  • Unbeatable social media exposure on THCB and Twitter
  • Awesome THCB front page placement (logo, ad unit, guest blog post)
  • Networking access to THCB’s healthcare obsessed audience of 650,000 plus healthcare pros
  • Other slick advantages that will help you stand out during and after the event

For details contact Michelle Noteboom for details on available options and to reserve your spot.

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An Epic Loss for Cerner and GE

flying cadeuciiMayo Clinic announces it will replace its existing Cerner and GE systems with Epic’s EHR and RCM system.

The prestigious Mayo Clinic name and clinical reputation make the win especially sweet for Epic, which is in the running for the DoD’s $11 billion EHR contract. Analysts estimate that Mayo will pay Epic “hundreds of millions” over the next several years.

Google Glass Confusion

Earlier this month Google announced the end of its Glass Explorer program and sales of its existing version of Glass. Many mainstream publications carried “Glass is Dead” headlines, which is certain attention-grabbing, though not entirely true.

Individual consumers had the option to pay $1,500 to purchase Google Glass through the now-defunct Glass Explorer program. Enterprise businesses, such as HIT vendors Augmedix and Pristine, are still able to buy the existing version of Glass through Google’s Glass at Work program. In other words, if you’re interested in using Google Glass in a healthcare setting, that option is still available through a Glass at Work partner.

Meanwhile, Google says it is working future versions of its Glass product – though no one is saying when the next release will be. Continue reading “HIT Newser: An Epic Loss for Cerner & GE + Google Glass Confusion”

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flying cadeuciiCall it a tale of two infections. It’s the story of how hospitals have blocked transmission of a dangerous infection that patients can give doctors, while a hospital-caused infection that can kill patients continues to be widely tolerated. It involves saved lives and endangered ones ­– and also of billions of dollars spent needlessly due to unsafe care.

The infection that’s been conquered is occupational transmission to doctors and other health care workers of HIV, the virus that causes AIDS. When AIDS first burst on the scene in the early 1980s, it was “disfiguring, debilitating, stigmatizing and inevitably fatal,” in the words of Dr. Paul Volberding, a treatment pioneer. With the disease’s spread poorly understood, “the fear of contagion [was] hanging over our heads,” Volberding recalled.

However, once the mode of transmission was identified– exposure to HIV-infected blood or other bodily fluids – precautions were rapidly put into place. From 1985 through 2013, there were just 58 confirmed cases of occupationally acquired HIV infection reported to the Centers for Disease Control and Prevention (CDC), according to a Jan. 9 CDC report. Since 1999, there’s been only one confirmed case of occupational transmission, involving a lab tech infected via a needle puncture in 2008.

Reported occupational infection “has become rare,” the CDC concluded, likely due to prevention strategies and “improved technologies and training.” Continue reading “Safe Doctors, Unsafe Patients: A Tale of Two Infections”

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