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Travel Ban Is Revealing—but Does Not Threaten American Medicine

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A 90-day ban on travel from seven countries has sparked tremendous outpourings of worry or outright opposition by some 33 medical organizations.

“The community is reeling over the order, fearing that it will have devastating repercussions for research and advances in science and medicine,” states an article in Modern Healthcare.

Certainly the order is disrupting the lives of individual physicians who have won coveted positions in American medical institutions and were not already in the U.S. when the order was issued. Also their employers have a gap in the work schedule to fill. War tears people’s lives apart, however innocent they may be. And countries that sponsor terrorism have effectively declared war on the U.S.

But is American medicine so fragile that it can’t survive a 90-day delay in the arrival of physicians, most of them trainees, from Iran, Iraq, Libya, Syria, Yemen, Somalia, and Sudan? After all, every year more than a thousand seniors in U.S. medical schools do not land a position in a post-graduate training program through the annual computerized “Match” of graduates with internships.

Say You’re Sorry, Donald

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I’ve never met Dr. Suha Abushamma or Dr. Kamal Fadlalla. 

But of all the frustrating stories circulating since President Trump issued an executive order barring immigrants from several predominantly Muslim countries, their travails hit closest to home. 

Both Suha and Kamal are internal medicine resident physicians. From Cleveland Clinic and Brooklyn Interfaith Medical Center, respectively. Like me, they have endured the rigorous calling that is American medical training, including not only graduation from medical school, but also the completion of four board exams, a vigorous interview process, acceptance to a medical residency and ultimately working long hours caring for very sick patients.

Should We Blame Technology For the Growth In Healthcare Spending?

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Should we blame technology for the growth in healthcare spending?  Austin Frakt, a healthcare economist who writes for the New York Times, thinks so.  Citing several studies conducted over the last several years, he claims that technology could account for up to two-thirds of per capita healthcare spending growth.

In this piece, Frakt contrasts the contribution of technology to that of the ageing of the population.  Frakt notes that age per se is a poor marker of costs associated with healthcare utilization.  What’s important is the amount of money spent near death.  If you’re 80 years old and healthy, your usage of healthcare services won’t be much more than that of a 40-year-old person.

Mobile Apps Are Reflecting the Changing Role of the Patient in the Healthcare Ecosystem

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By ALINE NOIZET

The 4th edition of Trophées de la Santé Mobile took place last week in Paris which showcased the best French healthcare mobile apps in different categories.

The winning apps were clearly showing the changing role of the patient in the healthcare ecosystem. The patient is at the center, more informed, and plays an important role in his or her own health. Since the patient has a better understanding of his or her own health, they can detect a disease earlier, co-create their own treatment with the doctor, and adjust it based on the information being continuously collected through apps or wearables.

The winner of the Grand Trophée for this 2017 edition was Novi-Chek, an app that empowers and informs diabetic patients. Developed by Roche Diabetes Care France, Novi-chek is an app for patients who have recently been diagnosed with Diabetes type 1. It supports them during the 1st month of the disease, explaining what diabetes type 1 actually is, the treatments available, why they need to auto-check their glucose level, and how diabetes will impact their everyday life. The patient can also use the app to set up alarms to check glucose levels or enter useful information to track the diabetes.

An Open Letter to Kaiser Permanente Northern California

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I am writing this letter because for two months I tried to get ahold of Darryn Carter, a case manager at your company who was assigned to process a complaint I filed about care I received that I feel was harmful and irresponsible.

The legal and rational reason for this current writing is this: the letter I received from Darryn Carter rejecting my complaint claim stated that I have a legal right to see the documentation and evidence used to make the decision about my case. I would like to see that evidence file, and I have not been able to get in touch with Mr./ Ms. Carter or anyone else at Kaiser to send the file.

The emotional and human reason I want to talk with Darryn Carter–and I think it’s appropriate to share this reason too, given that you are a care provider–is that I believe I received bad care at Kaiser, and yet no one at Kaiser has ever listened to what I have to say about it, despite months of my trying to tell someone. My concern and frustration, which is so strong that it drove me to spend a Saturday writing this letter, is not primarily about the bad care I believe I received but rather the wholehearted dismissal that your organization has levied through an unnavigable bureaucracy. This dismissal has kept me up nights, sometimes crying, sometimes fuming, sometimes brooding, always feeling that special type of indignity reserved for a patient with a care provider who blatantly and systematically refuses to care.

ACA Enrollment Final Numbers for 2017—A Cautionary Tale for Trump and Republicans

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Graphic Credit: AP

For the record and as we crawl chaotically towards repeal & replace or repair, the final numbers on ACA enrollment for 2017 are in.  They reflect coverage in the 39 states that operate through healthcare.gov plus the 11 states and DC that run their own insurance exchanges.    

A total 12.2 million people signed up.  That’s 3% to 4% fewer than last year.  HHS and the Associated Press (AP) put enrollment through healthcare.gov at 9.2 million; AP puts the number of enrollees in the 11 states plus DC at 3 million.

Of the 9.2 million who signed up through healthcare.gov, 6.2 million were returning customers and 3 million were new.    

According to an analysis by Charles Gaba, who runs the website acasignups.net, enrollment through healthcare.gov was down about 5% while enrollment in the 11 states and DC was up 2%. 

Gaba and other analysts attribute the healthcare.gov decline to consumer confusion about the fate of the ACA and the Trump administration’s pull back on consumer outreach and ads in the final weeks of sign-up in January.  So the last minute rush this year was much reduced.   

Gaming the System

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As physicians ready themselves for the future of medicine under onerous MACRA regulations, it seems appropriate to glance into the future and visualize the medical utopia anticipated by so many.  Value-based care, determined by statistical analysis, is going to replace fee for service.   

Six months ago, I received my first set of statistics from a state Medicaid plan and was told my ER utilization numbers were on the higher end compared to most practices in the region.  This was perplexing as my patients tend to avoid ER visits at all costs and can be found milling about in my parking lot at 7am on Mondays with their sick children waiting for my office to open. 

A Purpose-Driven App Tests Work-Life Balance

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Your employer sends out an email saying they want to make sure you’re getting enough sleep and physical activity, are eating well and feeling creative and, finally, have a sense of “mindfulness.” So they’re providing a free app designed to facilitate finding your “anchoring purpose in life.”

Sound like a nice perk? Now add in one more detail.

All the information, albeit with individual data de-identified, goes into a giant database meant to boost productivity and reduce medical costs by improving worker physical and mental health.

Any less excited?

The app, from a start-up called JOOL Health, raises the question of when good engagement can bleed into overtones of Big Brother. The answer is complicated.

JOOL is the brainchild of Victor Strecher, a professor of health behavior and health education at the University of Michigan School of Public Health and a successful entrepreneur. Marketed to third parties rather than direct-to-consumer, the app was pitched at a recent consumer experience conference sponsored by America’s Health Insurance Plans (AHIP) as a way to go “from wellness to engaged wellbeing in the Digital Age.”

Don’t Believe the Media Narrative. Repeal + Replace Is On Track For 2017

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Many recent press reports have centered around the notion that Republicans are stuck in the mud trying to get their repeal and replace promises moving.

That line appeared to be reinforced over the weekend when President Trump said, in a pre-Super Bowl interview, that the process could draw out into next year. My sense is that what Trump was talking about was the fact that the whole process, that includes implementing the replacement, could take well past 2017. Trump, never one for getting the details right, was taken literally by the press looking to write stories about how the whole process was foundering.

Speaker Paul Ryan quickly countered in his press briefing that Republicans will legislate a repeal and replace of Obamacare this year.

The Sahara Model of Value-Pricing

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Consider the poor bloke depicted below. He lies, exhausted, on a sand dune in the Sahara desert, literally dying of thirst.

Along comes a camel caravan, evidently with a group of tourists in the lead. The caravan is bound to be loaded with water.

Surmising that the dying man’s demand for water is bound to be highly price-inelastic (the economist’s jargon for “insensitive to price”), one of the camel riders jumps off his camel and waves a bottle of water in front of the dying man’s face, asking him: “What would you give me for this bottle of water?”

“Everything I own,” moans the dying man, knowing that none of his assets would be worth anything to him unless he got water soon.

“Done deal,” says the tourist, beckoning one of his fellow travelers, a lawyer, to draft up the necessary documents, which the thirsting man quickly signs in return for that life-saving bottle of water.   

What might we call this hypothetical transaction and the price the tourist extracted from the dying man for that life-saving bottle of water?