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Farzad MostashariWe launched Aledade on June 18th, and by the end of July we had recruited 80 primary care physicians in 4 states to join us in creating the very first Aledade ACOs. We have been work together ever since- but haven’t been able to talk about our wonderful practices until the official notification from CMS that came today.

We are thrilled to announce that beginning January 1, our two newAledade ACOs will be taking accountability for the care of over 20,000 attributed Medicare patients, and stewardship of nearly a quarter of a billion dollars of health care expenditures each year. We’re building a new delivery system on the foundation of trust between patients and the physicians who have been caring for them in their communities for decades, and enabled and accelerated with cutting-edge technology and analytics.

One ACO will operate in the state of Delaware, in close collaboration with our physician partners and our field team, Quality Insights of Delaware. Our second ACO, the Primary Care ACO, will take the same model spanning three states — New York, Maryland, and Arkansas, where we are also working with local partners like the Arkansas Foundation for Medical Care. Our hand-picked ACOs physician partners are some of the most capable and inspiring primary care physicians in the country. They are leaders in their local, state and national physician associations; they are pioneers of Meaningful Use and Patient Centered Medical Homes; they are much-decorated top doctors in quality; but most of all, they are the pillars of their communities. Continue reading “It’s Official: Aledade ACOs Up and Running”

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flying cadeuciiJacques Johndreau did not look like his usual self when I saw him in the office a few weeks ago. He looked part retired bank manager and part Disney cartoon chipmunk.

He spoke with hardly any facial movements:

“Holy Boys, my wife said to me this morning, you look like you’ve got the mumps again!”

I was aware that Jacques had an atrophic testicle from catching the mumps as a teenager. This time, it was not likely the mumps, but a bacterial parotitis. He was afebrile, and could open his mouth when asked to. I could not palpate a stone in Stensen’s duct and he didn’t experience any worsening of pain when eating acidic foods, so I wasn’t so sure he had a stone.

This was an early, mild case of parotitis and I thought he had a good chance of beating the infection with oral antibiotics. The majority of these infections are caused by staphylococci, but sometimes gram-negative bacteria are the culprit. Whatever I chose, I needed to consider that Jacques takes a blood thinner, warfarin, which interacts with many antibiotics, particularly ones with gram negative coverage.

I e-prescribed a high dose of Ceftin, or cefuroxime, a second generation cephalosporin with good coverage for both staph and gram-negatives and no effect on warfarin.

Continue reading “Zen and the Art of Antibiotics”

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flying cadeucii Omnibus Bill Impacts HIT

The 2015 federal budget includes about $60.4 million for the ONC, which is less than the $75 million requested and on par with the 2014 budget. Congress allocated an additional $38.8 million to the HHS Office for Civil Rights, the agency that enforces HIPAA. Also in the bill: a controversial requirement for the ONC to decertify products that block health information sharing.

Appalling Meaningful Use Penalties

CMS reports that more than 257,000 eligible professionals will face penalties in 2015 for failing to meet Meaningful Use requirements. The AMA quickly announced it was “appalled by the news.”

Another Call to Cut Reporting Period

A group of 30 Republican House members call on HHS to shorten the 2015 Meaningful Use reporting period from 365 days to 90 days. A number of professional groups, including the AAFP and CHIME, support the extension.

From Foes to Financiers

Former Allscripts executives Glen Tullman and Lee Shapiro invest in Lightbeam Health Solutions, a population health management solution provider. Pat Cline, the founder and former president of NextGen, is currently Lightbeam’s CEO.

ATA Offers Accreditation

The American Telemedicine Association launches an accreditation program for providers offering online, real-time consults to patients. 

Continue reading “HIT Newser: Appalling Meaningful Use Penalties”

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flying cadeucii The Board of Governors of the Patient-Centered Outcomes Research Institute (PCORI) will consider a plan for funding comparative clinical effectiveness research on hepatitis C virus infection at its day-long meeting on Monday, Dec. 8. In addition, the Board will vote on a plan to fund the second phase of development of PCORnet, PCORI’s initiative to improve the efficiency of health research by harnessing data from electronic health records (EHRs) and other resources.
The meeting will run from 10:15 a.m. to 5:45 p.m. EST Monday, Dec. 8, at the Renaissance Dupont Circle Hotel, 1143 New Hampshire Ave., NW, Washington, DC. The public may attend in person or via teleconference/webinar. Visit the meeting page on PCORI’s website to view the agenda and register to join the teleconference.
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Screen Shot 2014-11-17 at 8.00.40 PMIn 2011, the New England Journal of Medicine reported results of the National Lung Screening Trial (NLST). Screening trials have to be big, because almost all the people who are screened don’t have the disease being investigated, and screening only helps people with silent disease.

The NLST had over 50,000 participants, all with a history of abusing their lungs through heavy smoking. Half were randomly assigned to have three annual low-dose helical chest computed tomography (CT) exams, and half were assigned to have three annual chest x-rays

All earlier trials had shown screening with x-rays to be ineffective, so many of us were surprised when CT screening proved to be effective, reducing death from lung cancer by 20 percent over the six years of the trial. Apparently, the CT proved to be effective at finding much smaller tumors than could x-ray.

Since publication of this study, the American Society of Clinical Oncology and other medical organizations have recommended screening for those at similarly high risk for lung cancer. The United States Preventive Services Task Force gave such CT screening a grade B recommendation, making coverage by private insurers mandatory and by public insurers likely.

Continue reading “Knowing When to Say Yes to Medical Technology”

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flying cadeuciiIf another case of Ebola emanates from the unfortunate Texas Health Presbyterian Hospital, the Root Cause Analysts might mount their horses, the Six Sigma Black Belts will sky dive and the Safety Champions will tunnel their way clandestinely to rendezvous at the sentinel place.

What might be their unique insights? What will be their prescriptions?

One never knows what pearls one will encounter from ‘after-the-fact’ risk managers. I can imagine Caesar consulting a Sybil as he was being stabbed by Brutus. “Obviously Jules you should have shared Cleo with Brutus.” Thanks Sybil. Perhaps you should have told him that last night.

Nevertheless, permit me to conjecture.

First, they might say that the hospital ‘lacks a culture of safety which resonates with the values and aspirations of the American people.’

That’s always a safe analysis when the Ebola virus has just been mistaken for a coronavirus. It’s sufficiently nebulous to never be wrong. The premise supports the conclusion. How do we know the hospital lacks culture of safety? ‘Cos, they is missing Ebola, innit,’ as Ali G might not have said.

They would be careful in blaming the electronic health record (EHR), because it represents one of the citadels of Toyotafication of Healthcare. But they would remind us of the obvious ‘EHRs don’t go to medical school, doctors do.’ A truism which shares the phenotype with the favorite of the pro-gun lobby ‘guns don’t kill, people kill.’

Continue reading “Six Sigma vs Ebola”

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UC Riverside Medical Research Building RS

One of the most compelling medical stories in the country is unfolding within the sprawling landscape of inland Southern California. The story centers on the University of California, Riverside School of Medicine where G. Richard Olds, MD, the school’s dean, is taking on one of the uber challenges in health care today: How to get doctors into areas significantly underserved by health care professionals.

The UC-Riverside School of Medicine is in its infancy having welcomed its first class of 50 students just last year. But it has embarked on an innovative program fueled by a passion not only to get doctors into geographic areas where they are most urgently needed, but also to make sure these physicians practice specialties most in demand. “There are 18 new medical schools in the United States and the vast majority are just like existing medical schools,” says Dean Olds. “We are substantially different than most other new schools. We are designed around a unique mission – to try and address the health workforce needs of inland Southern California. We need to train health care professionals who come from backgrounds and communities they will be taking care of.”

Continue reading “Free Medical School?”

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The term Big Data is ubiquitous and enigmatic. It’s so overused that it has practically morphed into a meme for using fancy math to make technology better. In a recent Center for Technology Innovation analysis of Big Data in education the term was defined as a, “group of statistical techniques that uncover patterns.” But, others disagree, so what is Big Data?

To answer that question Jenna Dutcher, Community Relations Manager for datascience@berkeley, the UC Berkeley School of Information’s online masters in data science, asked subject matter experts from industry, academia, and the public sector how they define Big Data. All of the answers are fascinating but there were several worth highlighting.

Continue reading “What Does Big Data Actually Mean?”

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Post Punk Vaping Dwarf

Well, it’s official: CVS has stopped selling cigarettes and other tobacco products.

The sales ban will cost the multi-billion dollar pharmacy chain about $2 billion a year in profits.  But the hope is that the move will provide a more consistent health promotion message to consumers (it has changed its corporate name to CVS Health) and lead to new business (for example, through visits to its in-store health clinics).

But will this move have any effect on smoking in the population? It’s difficult to say at this point.

The impact of the ban on overall tobacco sales nationwide will probably be negligible.  Only a very small percentage of consumers buy their tobacco at pharmacies and there are plenty of retail options available beyond the local pharmacy.

CVS is also banning the sale of electronic or e-cigarettes. Advocates from this industry are predictably agitated: “It’s smoking that causes all the health problems, not the smokeless alternatives.” Others argue that e-cigarettes and other smokeless alternatives are effective aids for those wishing to quit-smoking.

Continue reading “CVS Health: Breathing a Little Easier and Holding Our Breath”

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