THCB

Categories

Above the Fold

Bribery, Corruption and the American Health Care Way

These days you just have to wonder about the greed and corruption that is going on all around. Senator Dick Blumenthal is one of many who’ve been pointing out the naked corruption in the Trump family–Qatari jets, memecoins, Trump’s son being on the board of so many defence and prediction market companies you can’t keep it straight. Issac Saul has tried to detail it all, but reading just the cryptocurrency part of his piece has me spinning. And we’re nowhere near assessing the naked corruption of so many others in the administration. Kristi Noem, despite being fired, is still living in her government house, and has not had to answer for routing some of a totally unnecessary $220m ad campaign to a company that her friends own. The company was incidentally established a whole 8 days before it got the contract.

So it’s a little absurd to be worrying about fraud and corruption in health care. But apparently HHS is. At least Oz and RFK Jr are going on about Somalis defrauding Medicaid and Armenians running fake hospices in California. (Let’s not even consider the optics of a Turkish citizen with close ties to the Erdogan regime criticizing Armenians–I mean the genocide was over a century ago!)

But of course, fraud and corruption in health care has been going on forever. Back in 2011 a Florida man was convicted of Medicare fraud to the tune of tens of millions and got a 50 year sentence. Don’t be surprised that Trump commuted his sentence. And that’s just one of thousands and thousands of cases, mostly by providers inventing fake patients to defraud Medicare or Medicaid.

But the ones who get convicted and go to jail are the amateurs.

If you’re a big company in health care, you fight with lawyers and you settle. For example, every big pharma company has settled for things like off-label promotion of their drugs. GSK paid $3bn, Pfizer over $2bn, J&J over $2bn. In fact back in the 2000s THCB had a regular correspondent called The Industry Veteran who basically suggested that whistleblowing in qui tam suits inside big pharma was the way to wealth and fame.  And of course HCA in its days when Rick Scott – now (somehow not a) convicted felon as well as Florida senator – settled for $1.7bn. This was all back in the 1990s and early 2000s, but it’s all still going on.

The venue though may have moved. Risk adjustment in Medicare Advantage has become one of the biggest venues for fraud. The key here is that the DOJ and HHS found that while Medicare Advantage plans were upcoding their patients, and therefore getting paid more for them, they weren’t actually delivering more services.

Continue reading…

Come help save democracy!

Tuesday, May 5 | 8-9 pm ET, 5-6 pm PT 

Protecting Healthcare and Our Democracy: A conversation with Mandy Cohen, Former Director, Centers for Disease Control and Prevention PLUS former NC Governor Roy Cooper & Dr. Donald Berwick, IHI founder/former president

REGISTER & DONATE

A matching fund of $70,000 is in effect for this event!

This supports the Movement Voter Project which makes grassroot investments to organize to support democracy at the local level.

I’m a co-host–Matthew Holt

Bevey Miner, Consensus Cloud Solutions

This is a transcript of my HIMSS interview with Bevey Miner, EVP Healthcare Strategy & Policy at Consensus Cloud Solutions. Usually I’d show the video but in this case my fancy new microphone didn’t work so you’d only hear a one sided conversation. Luckily Youtube’s transcript somewhat came to the rescue–Matthew Holt

Matthew: Another THCB Spotlight, I am here with Bevey Minor who a year ago I interviewed as Consensus Cloud Solutions and now your sign says eFax. So, what the hell happened?

Bevey: Interesting question, Matthew. The company is Consensus Cloud Solutions. And the company’s always been Consensus Cloud Solutions since we spun off and went public ourselves. You’ll notice at our booth we’ve got the eFax brand — it’s eFax by Consensus Cloud Solutions. The reason we are showing up as eFax is because this year at HIMSS we really wanted to set the record straight: digital cloud faxing is not the problem with interoperability. Paper faxes are, but digital cloud faxing is not the problem.

The problem is all this unstructured data — all the unstructured data that happens with faxes, with scanned images, with TIFF images. All that unstructured data can’t be queried. It can’t be part of TEFCA. You can’t query what you can’t find.

Cloud faxing is send and receive all day long, and we do that very well and have been doing it for 27 years. About three years ago, we introduced an intelligent extraction solution. That solution doesn’t even have to start with the fax, but it allows the “find” piece to actually become the critical thing that we need to do. CMS defines interoperability as send, receive, find, and integrate. Fax technology handles send and receive all day long, but can’t find. So once we introduced a “find and intelligent extraction” solution, we can fire up TEFCA.

I’ve talked to a lot of regulators, including Dr. Thomas Keane and Amy Gleason with the CMS Align networks. You can’t ignore this pile of unstructured data and just assume the industry is going to go magically everything’s on FHIR. We’re all using FHIR because all of this stuff has really important patient information in it.

What we want to solve in the industry is: don’t say we have to axe the digital cloud fax. Let’s axe the paper fax machine. Digital cloud faxing isn’t going away — in fact, it’s growing, especially as we get rural health off of paper fax machines. The next level of maturity is digital cloud faxing. From there, once it’s digital, now you can do all sorts of things with it.

When we introduced electronic health records during meaningful use — I was at Allscripts at the time — our dream was that we would take this paper record and transform it into an electronic health record, so we could just get rid of the paper. Once we did that and there were discrete data elements in that EHR, we could do population health, clinical decision support, efficacy, all sorts of things — because there are discrete data elements now inside that electronic health record. That’s what a digital fax will do with the capability to do intelligence on top of it.

So we want to make the industry understand that the fax is not the problem. Extracting it and getting rid of all that unstructured data is the solution.

Continue reading…

It’s Got a Good Beat and You Can Kill It

By KIM BELLARD

Most of us can identify dogs from cats just by the sounds they make. We could probably even separate a dog’s bark from a wolf’s howl. If you are a nature lover, you might be able to identify different species of birds by their calls.  If you are a cetologist, you might be able to separate the vocalizations whales make versus those dolphins make. Across the animal world, we’ve learned the different sounds that different species make, which has been useful in our survival.

But did you ever wonder if you can identify, say, e coli from other bacteria?

It turns out that you can, thanks to research at Delft University of Technology (TU Delft) in the Netherlands. Four years ago, they showed that bacteria made noise, which was, in itself, a startling finding (admit it: would you have ever guessed that?). They used a thin layer of graphene to create a graphene “drum” small enough to fit a single bacterium. Team member Cees Dekker observed: “What we saw was striking! When a single bacterium adheres to the surface of a graphene drum, it generates random oscillations with amplitudes as low as a few nanometers that we could detect. We could hear the sound of a single bacterium!”

The team used this finding to accomplish an important purpose: to find out if bacteria were resistant to specific antibiotics. If an antibiotic was applied and the sound continued; it hadn’t worked. If the sounds stopped, the bacteria had been killed.

The team wasted no time in creating a start-up – SoundCell – to commercialize the finding. It promised to identify the “right” antibiotic in one hour, rather than subjecting patients to rounds of different antibiotics in search of one the bacteria wasn’t resistant to.

The team isn’t resting on their laurels. Some of them got to wondering, huh, I wonder if different bacteria make different sounds. And, their latest research shows, not only do they but, through machine learning, those different species can be distinguished. Team lead Farbod Alijani says. “With this new study, we take a significant leap forward: we show that each bacterial species has its own nanomotion signature.”

Mind. Blown.

The researchers focused on three bacteria that are common in hospital settings: E. coli, S. aureus (which causes staph infections) and K. pneumoniae (which causes pneumonia). They tested two different machine learning models; one correctly classified the bacteria 87% of the time, and the other 88% of the time.

Continue reading…

Samira Daswani, Manta Cares

Samira Daswani is CEO of Manta Cares. Her career in consulting and digital health startups took a left turn when she was diagnosed with breast cancer and had 18 months of visits with 123 appointments, 5 ER visits and much more. And it was very hard to manage her journey. So she built a paper based map/guide and started distributing it via hospitals in the gift shops and elsewhere. Manta Cares is the digital instantiation of that cancer map with symptom tracking and an AI chatbot on top of the map. Samira demoed it extensively for me. She raised some seed funding, and is now building it out for 80% of cancers–Matthew Holt

Adrian Owen & Faraz Shafaghi, Creyos

I spoke with neuroscientist Adrian Owen, co-founder and Chief Scientific Officer & Faraz Shafaghi, Chief Product Officer, at neurological testing company Creyos (which rhymes with “chaos”). Their cognitive assessment platform gives a baseline of neurological function and is essentially getting objective data at a point of care. This can now be done as part of the annual wellness visit (in fact it’s officially required under Medicare!), and there are things you can do about it. We dove into how it works, Faraz showed a whole demo of the test itself, Adrian explained what the impact of testing will be, and they shared Creyos’ progress in moving into practice.–Matthew Holt

Dayne Williams, Quantum Health

Quantum Health is one of the biggest and original navigation companies. Dayne Williams came out of retirement to take over as CEO after Zane Burke retired for personal reasons (to care for a relative). Quantum has in recent months added two acquisitions, Embold Health that analyzes which are the best doctors to go to, and CirrusMD which is a online telehealth & primary care company. I started though asking Dayne, with health plans and primary care docs, why do we need navigators? That’s a layup for him, but this is a great explanation of how Quantum is the front door/first call for the employees of its clients–what they call first time intercept–and where it’s going with that trust–Matthew Holt

Philippe Pouletty, Carvolix

Philippe Pouletty is a physician who’s an inventor, French venture capitalist, and the founder of Carvolix. Carvolix is a medical technology company that is introducing AI into cardiology. Before Carvolix, Philippe was the founder of Abivax, which makes drugs for chronic inflammatory diseases like ulcerative colitis. He’s been working on helping French medical products develop before having to sell to bigger US companies, and Carvolix is the latest. It’s an AI system that guides cardiologists and a robot that places heart valves. It’s of particular interest to me, as I need a new heart valve. I had a long and interesting discussion with Philippe about the future of cardiology, particularly heart valve replacement, and also about their upcoming product, a robot to bust brain clots–Matthew Holt

Peter Stetson, TigerConnect

Peter Stetson is the CMIO of TigerConnect. It’s now calling itself an AI platform to connect people, especially workflows between doctors, nurses, EMTs and devices. Until recently he was CMIO at Memorial Sloan Kettering, so I asked him about what the real problems in communications were. He believes it’s all about routing the calls to the right people and figuring out which is the right person to get the message escalation based on context. That can be in the hospital, or in the home. Tiger’s evolution has been to work on that orchestration. Peter gave the example of orchestrating surgery to improve patient care & save hospitals money, but similar issues are triggered by sepsis, heart attacks, etc, all in the Tiger system, increasingly automated off devices. And I raised the issue of where does Epic stop and where does Tiger start. Always controversial these days. But Peter is confident Tiger is “safe” for now!—Matthew Holt

A Unified Sense of Self

By MIKE MAGEE

Stanford neuroscientist, David Eagleman, reminded us this week that “A coherent explanation of consciousness eludes modern science.” That was his opening line in the New York Times book review of Michael Pollan’s latest effort, “A World Appears.” In it, Pollan asks innocently, “How does the brain generate a unified sense of self?”

According to Eagleman, “Pollan is not able to furnish the answers (no one can, yet), but he presents a captivating exploration, one that is highly personal and sensitive.” In this, he is not alone. Other fields are engaged in the same pursuit.

To begin with, there are the epigeneticists. They study “how our environment influences our genes by changing the chemicals attached to them.” In the hands of these scientists, genes are not “set in stone and (fully) predetermined.” Of late, these investigators have been unraveling how various chemicals, working on the surface and inside cells are constantly altering and adjusting how our genes work. Thus the title, since “epi” is Greek for “over, outside of, around.”

Other investigators like Professor Eddy Keming Chen in the department of Philosophy at University of California San Diego come at the problem from a different direction. She bolstered her PhD in Philosophy with a Masters in Mathematical Physics, and a graduate certificate in Cognitive Science. She teaches the PHIL 130 course on Metaphysics.

In the UCSD college syllabus, she tees up the question, “Why study metaphysics?” She promises enrollees that if they sign up, they’ll find a bit of magic in exploring tough questions, like: “Do we have free will? Is it compatible with causal determinism? What is the place of the mind and of the consciousness in a physical world?”

In the Jesuit world that I came from, such courses were mandatory as part of the core curriculum. In my own alma mater, they no longer carry the same mandate, but still remain alive and well.

Consider, for example PHL 365 – a 3 credit course at LeMoyne College titled Philosophy of Mind. Once again, there is magic in the air for inquiring minds.

Continue reading…
assetto corsa mods