Two months ago Al wrote a column titled: Are Obamacare Wellness Programs Soon to be Outlawed? Truthfully that headline was picked for its sky-is-falling value, in an attempt to generalize one Equal Employment Opportunity Commission (EEOC) lawsuit against one wacky wellness program to an EEOC risk for wellness programs everywhere.
As luck would have it, the sky has now fallen — right on the head of Honeywell…and the EEOC is indicating more lawsuits are to come. The scary part here: Unlike the wacky wellness program above, Honeywell was in compliance with the Affordable Care Act (ACA), but compliance with the ACA doesn’t seem to get you a free pass on the EEOC’s own “business necessity” requirement, plucked from the Americans with Disabilities Act (ADA), which they enforce.
Essentially the Honeywell lawsuit means no company doing invasive biometric screenings and mandating doctor visits or measuring health outcomes on individuals, and that has a significant financial forfeiture attached to it, is immune to prosecution, even if they are in compliance with ACA. Continue reading “Inoculating Your Wellness Program Against EEOC Attack”
Filed Under: THCB
Tagged: Americans with Disabilities Act, EEOC, Monitoring, Wellness
Nov 7, 2014
Making Sense of Blue Button, Meaningful Use, and What’s Going on in Washington …
At the recent Health 2.0 Conference in Santa Clara, co-chair Matt Holt expressed frustration about the difficulty of getting copies of his young daughter’s medical records. His experience catalyzed a heated discussion about individuals’ electronic access to their own health information. Many people are confused about or unaware of their legal rights, the policies that support those rights, and the potential implications of digital access to health data by individuals. The Health 2.0 conference crowd included 2000 entrepreneurs, consumer technology companies, patient advocates, and other potentially “disruptive” forces in healthcare, in addition to more traditional health system players.
Why is this topic so important? Until now, most people haven’t accessed their own health records, whether electronically or in paper, and I believe that making it easier to do so will help tip the scales toward more meaningful consumer/patient engagement in healthcare and in health. Access by individuals and their families to their own health records can empower them to coordinate care among multiple healthcare providers, find and address dangerous factual errors, and take advantage of a growing ecosystem of apps and tools for improving health-related behaviors, saving money on health services, and getting more convenient, personalized care.
A shorthand phrase for this kind of personal empowerment through access to digital health data is “Blue Button,” which is also the name of a public-private initiative in which hundreds of leading healthcare organizations across the US participate. The Blue Button Initiative is bolstered by the electronic access to health information requirements for patients in the “Meaningful Use” EHR Incentive Program, which is administered by CMS (the Centers for Medicare & Medicaid Services) with companion standards and certification requirements set by ONC (the Office of the National Coordinator for Health Information Technology). Continue reading “Getting Your Own Health Records Online: The Good and the Not So Good”
Filed Under: Tech, THCB
Tagged: ACA, Blue Button, Health 2.0, Health Data, Matthew Holt, Meaningful Use, ONC, Wellness
Oct 14, 2014
Crowdsourcing is engaging a lot of news organizations today. While some journalists are nervous about crowdsourcing — “Yikes, we’d rather talk than listen, and what if they tell us something we don’t want to hear? Or something that we know isn’t true?” — we here at clearhealthcosts.com love crowdsourcing. We find, as journalists, that our communities are smart, energized, truthful and engaged, and happy to join hands in thinking, reporting and helping us make something that’s bigger than the sum of its parts. We learn great things by listening, so … now we’re going to to an experiment crowdsourcing coverage for our blog.
Our current project crowdsourcing health care prices in California, with KQED public radio in San Francisco and KPCC/Southern California public radio in Los Angeles, has been a great success, as was our previous project with WNYC public radio, and we’re looking forward to launching similar projects with other partners. Continue reading “It Cost What? Crowdsourcing Costs In An Evolving Healthcare System”
Filed Under: THCB
Tagged: Costs, Crowdsourcing, Journalism, pricing, Transparency, Wellness
Oct 12, 2014
The use of marijuana is associated with a marked increase in the risk of being involved in severe trauma particularly motor vehicle collisions. In 2009, for instance, marijuana use was a contributing factor in more than 460,000 emergency department visits in the United States.
But we also know that cannabis is potentially neuroprotective. Previous studies have found that tetrahydrocannabinol (THC), the active ingredient in marijuana, may have beneficial effects in certain types of neurodegenerative processes, like Alzheimer’s and Huntington’s disease. In addition, previous studies indicate THC may protect the brain in animal models of neurologic injury. However, clinical trials of a synthetic THC derivative were not ultimately associated with an increase in survival in patients with traumatic brain injury. Since overall findings were mixed, we hypothesized that use of the “native” form of THC could be associated with an increase in survival in patients with traumatic brain injury.
Continue reading “Can Pot Protect the Brain After Injury? A New Study Says It Can”
Filed Under: THCB
Tagged: alcohol, critical care, Los Angeles Biomedical Research Institute, Marijuana, Neurologic injury, THC, Trauma, Wellness
Oct 3, 2014
The search for an antidote to the ills of our ailing healthcare system inevitably bumps up against the pervasive mindset that more is better. Each year we develop and prescribe more drugs, more tests, more technology. Yet, despite these investments, more treatment doesn’t always result in better outcomes. Procedures can be invasive or have unintended consequences, medications can have side effects, and tests can be unnecessary. But what is the alternative? As we look to improve quality and reduce cost, less can actually be more.
Results of recent research indicate that there is much to tap into beyond reliance on drugs and other interventions when helping patients heal. For example:
The doctor’s connection with a patient can improve clinical outcomes
In a treatment experiment where the only variable was the quality of the clinician’s engagement with the patient, those in the “higher engagement” group reported much greater relief. 1
Seeing a treatment administered increases effectiveness
Morphine injected directly by syringe has greater pain-killing effects than when added, out of view, to a patient’s IV.
Sugar pills can work as well as “real” medicine 2
In a study concerning migraine, patients reported as much relief after taking a dummy pill labeled as a proven medication as patients who took the proven medication that was labeled as a dummy pill. 3
These occurrences tend to be aggregated under the rubric of the “placebo effect.” Once pigeonholed as a nuisance factor in clinical drug trials, the placebo effect is now the subject of a promising list of studies and experiments in the fields of neurophysiology, psychology, neuroscience, molecular biology, and genetics.
Continue reading “PiPS: When Less Is More”
Filed Under: THCB
Tagged: Harvard Program in Placebo Studies and the Theraputic Encounter, Placebo Studies, Wellness
Sep 23, 2014
I am a public health professional, educated at the vaunted Johns Hopkins University Bloomberg School of Hygiene and Public Health. I like guns, and I believe the Second Amendment clearly secures the rights of individuals to own firearms.
You read that correctly. I am a public health professional.
And I like guns.
This make me a heretic in American public health, where embracing firearms and the rights of gun owners is a gross violation of orthodoxy.
As a society, our focus on guns and not gun users derives from the shock of mass killings, such as those in Newtown, CT, Aurora, CO, Virginia Tech, and Norway, which has some of the strictest gun control laws on the planet. Mass killings, however tragic, get distorted by saturation media hysterics and 24-hour political grandstanding. What gun opponents refuse to discuss is the precipitous fall in violent crime and deaths by firearms over the past 20 years, and how it coincides with an equally dramatic increase of guns in circulation in the US.
While that isn’t cause and effect, the association is certainly curious.
In 2013, the Institute of Medicine, at the behest of the Centers for Disease Control, produced a report on firearms violence that has been ignored by the mainstream media. The upshot: defensive use of firearms occurs much more frequently than is recognized, “can be an important crime deterrent,” and unauthorized possession (read: by someone other than the lawful owner) of a firearm is a crucial driver of firearms violence.
That report went away for political reasons. Translation. Nobody wanted to talk about it because it raised more questions than it answered.
Continue reading “Why Public Health Needs a New Gun Doctrine”
Filed Under: OP-ED, THCB
Tagged: Gun Control, Institute of Medicine, Newton, public health, Vik Khanna, Virginia Tech, Wellness
Sep 11, 2014
There are minor operations and procedures, but there are no minor anesthetics. This could turn out to be the one lesson learned from the ongoing investigation into the death of comedian Joan Rivers.
Ms. Rivers’ funeral was held yesterday, September 7. Like so many of her fans, I appreciated her quick wit as she entertained us for decades, poking fun at herself and skewering the fashion choices of the rich and famous. She earned her success with hard work and keen intelligence–she was, after all, a Phi Beta Kappa graduate of Barnard College. Ms. Rivers was still going strong at 81 when she walked into an outpatient center for what should have been a quick procedure.
So when she suffered cardiac arrest on August 28, and died a week later, we all wondered what happened. I have no access to any inside information, and the only people who know are those who were present at the time.
But the facts as they’ve been reported in the press don’t fully make sense, and they raise a number of questions.
What procedure was done?
Early reports stated that Ms. Rivers underwent a procedure involving her vocal cords. A close friend, Jay Redack, told reporters at the NY Post, “Her throat was bothering her for a long time. Her voice was getting more raspy, if that was possible.” In a televised interview, Redack told CNN that Ms. Rivers was scheduled to undergo a procedure “on either her vocal cords or her throat.”
However, the Manhattan clinic where Ms. Rivers was treated, Yorkville Endoscopy, offers only procedures to diagnose problems of the digestive tract. All the physicians listed on the staff are specialists in gastroenterology. Any procedure on the vocal cords typically would be done by an otolaryngologist, who specializes in disorders of the ear, nose, and throat.
So it may be that acid reflux was considered as a possible cause of Ms. Rivers’ increasingly raspy voice, and she may have been scheduled for endoscopy at the Yorkville clinic to examine the lining of her esophagus and stomach. Endoscopy could reveal signs of inflammation and support a diagnosis of acid reflux.
Upper gastrointestinal (GI) endoscopy involves insertion of a large scope through the patient’s mouth into the esophagus, and passage of the scope into the stomach and the beginning of the small intestine. It’s a simple procedure, but uncomfortable enough that most patients are given sedation or, less commonly, general anesthesia.
Was sedation given?
Three types of medication are commonly used for sedation during endoscopy:
1. Midazolam, diazepam (Valium), or other medications in the benzodiazepine family are often used to help patients relax before the start of the procedure and to produce amnesia.
2. Narcotics such as Demerol and morphine are often used to provide pain relief and make the procedure less uncomfortable.
3. Propofol, a potent sedative and hypnotic medication, may be used to induce sleep and prevent awareness. Many people first heard of propofol as the medication associated with the death of singer Michael Jackson in 2009.
Continue reading “What Killed Joan Rivers? Piecing Together a Medical Mystery”
Filed Under: THCB
Tagged: Demerol, Hypotension, Joan Rivers, Midazolam, outpatient care, Propofol, Wellness, Yorkville Endoscopy
Sep 8, 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
Last year, we soundly criticized the American Heart Association (AHA) on this blog for its proposal to lower the thresholds for treating cholesterol and getting larger numbers of Americans to swallow statins. We also exposed wellness vendor StayWell, for its mathematically impossible claims of success in British Petroleum’s wellness program. Proving that great minds aren’t the only ones that think alike, StayWell and the AHA have now joined forces. Specifically, the AHA invited the CEO of StayWell, Paul Terry, Ph.D., to help write its workplace wellness policy statement, sort of like Enron inviting Bernie Madoff to help design its financial plan. You don’t learn of this fox-in-the-henhouse conflict of interest unless you read the table on the penultimate page of text.
Naturally, Mr. Terry parlayed this windfall to StayWell’s advantage. The statement: “currently available studies indicate that employers can achieve a positive ROI through wellness” is footnoted to two studies authored by: Paul Terry, along with other Staywell executives. One wonders how a StayWell executive writing policy for the AHA based partly on StayWell’s own articles passes the AHA’s own test of “making every effort to avoid actual or potential conflicts of interest that may arise as a result of an outside relationship.”
How did this conflict of interest get by the peer reviewers? Look at the list of peer reviewers. Prominent among them is Ron Goetzel. Readers of THCB may recall Mr. Goetzel not just from his central role in the Penn State debacle, but also from the ”The Strange Case of the C. Everett Koop Award,” in which it was documented that his committee gave the ironically named award to a sponsor of the award (without disclosing that conflict), even though that sponsor had admitted lying about saving the lives of 514 cancer victims, who, as luck would have it, didn’t have cancer. (The sponsor, Health Fitness Corporation, a division of the equally ironically named Trustmark, has won the Koop award several times, thus proving the cost-effectiveness of their sponsorship.)
If this litany were not enough to dismiss the policy statement forthwith, there is small matter of the actual policy itself, a full employment act for wellness vendors and cardiologists alike, advocating more screening of more employees more often, while ignoring more self-evident facts than Sergeant Schultz. Specifically, they cherry-picked the available literature, continuing to cite the old “Harvard study” whose lead author has now walked it back three times. Except that they didn’t call it the “old Harvard study,” but rather a “recent [italics ours] meta-analysis,” despite the fact it was submitted for publication in 2009, and the average year of the analyses in the study was 2004. Some studies began in the 1990s and were able to use sleight-of-hand to “show savings” despite presumably — in accordance with the conventional wisdom of the era — getting people to eat more carbohydrates and less fat. No wonder Soeren Mattke of RAND Corporation dismissed the Harvard data as archaic in his interview with CoHealth radio in February 2014.
Continue reading “Circulation: The Nineties Called. They Want Their Wellness Policy Back”
Filed Under: THCB
Tagged: American Heart Association, Circulation, Rand, Ron Goetzel, Screening, Wellness, Workplace Wellness
Jul 15, 2014