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Never Waste a (Design) Crisis

By KIM BELLARD

The Wall Street Journal reported that the American Dental Association (ADA) opposes expanding Medicare to include dental benefits.  My reaction was, well, of course they do. 

They apparently don’t care that at least half, and perhaps as many as two thirds, of seniors lack dental insurance, or that one in five seniors are missing all their teeth.  The ADA prefers a plan for low income Medicare beneficiaries only, although state Medicaid programs were already supposed to be that, with widely varying results between the states. 

The ADA is following blindly in the AMA’s opposition to enactment of Medicare, ignoring how fruitful Medicare has turned out to be for physicians’ incomes.  It’s all about the money, of course; the ADA thinks dentists can get more money from private insurance, or directly from patients, than they would from Medicare, and they’re probably right.    

As is typical for our healthcare system, good design is no match for interfering with the incomes of the people/organizations providing the care. 

By the same token, I suspect that the real opposition to “Medicare for All” is not from health insurers but from healthcare providers.  Health insurers, a least the larger ones, have done quite nicely with Medicare Advantage, and would probably welcome moving members from those balkanized, largely self-funded employer plans to Medicare Advantage plans. 

No, the bloodbath in Medicare for All would be the loss in revenue of health care professionals/organizations missing out on those lucrative private pay rates.  As Upton Sinclair once observed, “It is difficult to get a man to understand something when his salary depends upon his not understanding it.”  Or, as Guido tells Joel in Risky Business, “never, ever, fuck with another man’s livelihood.”

Very little about our healthcare system has been consciously designed.  It’s a patchwork of efforts – legislative/regulatory initiatives, tax provisions, entrepreneurial choices, independent design decisions — and many unintended consequences.   We should be less surprised at how poorly they all fit together than that some of them fit at all.   Find someone who is happy with our current healthcare system and I bet that person is either making lots of money from it, or not receiving any services from it. 

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American Primary Care is a Big Waste of Time (When…)

By HANS DUVEFELT

Before Johannes Gutenberg invented the printing press in 1450, books in Europe were copied by hand, mostly by monks and clergy. Ironically, they were often called scribes, the same word we now use for the new class of healthcare workers employed to improve the efficiency of physician documentation.

Think about that for a moment: American doctors are employing almost medieval methods in what is supposed to be the era of computers. Why aren’t we using AI for documentation?

The pathetically cumbersome methods of documentation available (required) for our clinical encounters is only one of several antiquated presumptions in American healthcare. Other inefficiencies, often viewed as axioms, especially in primary care, make the trade I am in chock full of time wasters.

Whereas in most other “industries”, people talk about reach, scale, leverage and automation, primary care is still doing things one patient at a time. The automation in our field is not one where processes happen without human involvement according to preset patterns. Instead, it is an ongoing effort to make medical providers behave in automatic fashion with patients on a one-on-one, one visit at a time basis. The value of one-on-one is when you individualize, give unique advice considering multiple individual parameters; saying “in your particular case”, rather than “everybody should eat a healthy diet”.

Primary care here is wasting time in many ways:

When health maintenance and disease prevention is done by physicians. I keep writing about this, but a standing order to offer pneumonia or shingles shots, diabetes or lung cancer screenings and so many other things to people over a certain age or with certain risk factors can be handled by non-physicians. This would keep the six figure problem solvers doing what only they can do. It would also (a not-so-wild guess) probably double physician productivity.

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#Healthin2Point00, Episode 231 | Pager, Ovivia, Meru Health, and NOCD

It’s Telehealth Awareness Week! Today on Health in 2 Point 00, we cover Pager raising $70 million, bringing their total to $132.6 million. German-based company Ovivia gets $80 million, bringing their total to $127 million. Meru Health raises $38 million, and NOCD raises $33 million. —Matthew Holt

#Healthin2Point00, Episode 230 | Commure, Spring Health, UniteUs, Nomad & Xealth

It’s been quite a while since Jess & I did a Health in 2 Point 00 and that one was buried in our Policies|Techies|VCs conference in the first week of September. But, as John Malkovich says, We’re back…

Commure gets $500m and maybe one day we’ll know what it does, Spring Health adds to the mental health funding party, UniteUs buys competitor NowPow; Nomad banks $63m for its nurse hiring service, and Xealth adds $24m, even though I’m not sure it’s more than a feature! – Matthew Holt

Matthew Holt

Nomad Health’s Next Move: $63M Raise Takes On-Demand Healthcare Staffing into Workforce Management

By JESSICA DaMASSA, WTF HEALTH

Not all who wander are lost: Nomad Health lands a $63M Series D round after a year of 5X revenue growth for their tech-driven healthcare staffing marketplace that helps hospitals hire nurses on-demand. This round, led by Adams Street Partners with participation from all existing investors, brings the company’s total fundraising up to $113M. Co-founder & CEO Alexi Nazem stops by to tell us how the startup is not only planning to expand its focus from nurses to other types of healthcare providers but how the process of doing so will transform Nomad from an on-demand staffing agency to “‘THE’ workforce management platform for healthcare.”

Alexi puts it this way: “In healthcare, the product is CARE. And, who is the product team? It’s the doctors, the nurses, the allied health professionals…and the fact that there’s no intentional management of this group of people who steward $1.5 trillion dollars of cost in the US every year is beyond unbelievable.”

The problem is twofold. First, there’s the way temporary staffing is currently being handled: by 2,500 different staffing agencies that take a fragmented, predominantly people-powered approach to sourcing, vetting, and hiring candidates. The cost is high to a health system looking to shore up their nursing staff, and the experience for job-seeking nurses is very opaque, with information being revealed about a job only after a significant investment of time within the application process. If the match falls apart, all the people involved in the process are left to try again.

This leads to the second issue – that, big picture, the status-quo way of temporary staffing is leaving behind a LOT of valuable data. Data about the clinician that is useful to the management of their career, and data about the workforce that would prove valuable to a hospital looking to better manage its care delivery resources.

We journey into the details behind Nomad’s business model, which is cutting costs for hospitals while also increasing pay for the 150,000+ clinicians on its platform. AND, while we’re there, we also find out how they expect their on-demand staffing approach to playing out in the booming virtual care space.

Not Your Father’s Job Market

By KIM BELLARD

If you, like me, continue to think that TikTok is mostly about dumb stunts (case in point: vandalizing school property in the devious licks challenge; case in point: risking lives and limbs in the milk crate challenge), or, more charitably, as an unexpected platform for social activism (case in point: spamming the Texas abortion reporting site), you probably also missed that TikTok thinks it could take on LinkedIn.  

Welcome to #TikTokresumes.  Welcome to the Gen Z workplace.  If healthcare is having a hard time adapting to Gen Z patients – and it is — then dealing with Gen Z workers is even harder.  

TikTok actually announced the program in early July, but, as a baby boomer, I did not get the memo.  It was a pilot program, only active from July 7 to July 31, and only for a select number of employers, which included Chipotle and Target.  The announcement stated:

TikTok believes there’s an opportunity to bring more value to people’s experience with TikTok by enhancing the utility of the platform as a channel for recruitment. Short, creative videos, combined with TikTok’s easy-to-use, built-in creation tools have organically created new ways to discover talented candidates and career opportunities. 

Interested job-seekers were “encouraged to creatively and authentically showcase their skillsets and experiences.”  Nick Tran, TikTok’s Global Head of Marketing, noted: “#CareerTok is already a thriving subculture on the platform and we can’t wait to see how the community embraces TikTok Resumes and helps to reimagine recruiting and job discovery.”  

Marissa Andrada, chief diversity, inclusion and people officer at Chipotle, told SHRM: “Given the current hiring climate and our strong growth trajectory, it’s essential to find new platforms to directly engage in meaningful career conversations with Gen Z.  TikTok has been ingrained into Chipotle’s DNA for some time, and now we’re evolving our presence to help bring in top talent to our restaurants.”

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I Am a Decision Maker, Not a Bookkeeper

By HANS DUVEFELT

Perhaps it is because I love doctoring so much that I find some of the tools and tasks of my trade so tediously frustrating. I keep wishing the technology I work with wasn’t so painfully inept.

On my 2016 iPhone SE I can authorize a purchase, a download or a money transfer by placing my thumb on the home button.

In my EMR, when I get a message (also called “TASK” – ugh) from the surgical department that reads “patient is due for 5-year repeat colonoscopy and needs [insurance] referral”, things are a lot more complicated, WHICH THEY SHOULDN’T HAVE TO BE! For this routine task, I can’t just click a “yes” or “authorize” button (which I am absolutely sure is a trackable event in the innards of “logs” all EMRs have).

Instead, (as I often lament), I have to go through a slow and cumbersome process of creating a non-billable encounter, finding the diagnostic code for colon cancer screening, clicking on REFERRAL, then SURGEON – COLONOSCOPY, then freetexting “5 year colonoscopy recall”, then choosing where to send this “TASK”, namely the referral coordinator and , finally, getting back to the original request in order to respond “DONE”.

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Recommendations From the Coalition for Physician Accountability’s UME-to-GME Review Committee: Winners & Losers Edition

By BRYAN CARMODY

If you’re involved in medical education or residency selection, you know we’ve got problems.

And starting a couple of years ago, the corporations that govern much of those processes decided to start having meetings to consider solutions to those problems. One meeting begat another, bigger meeting, until last year, in the wake of the decision to report USMLE Step 1 scores as pass/fail, the Coalition for Physician Accountability convened a special committee to take on the undergraduate-to-graduate medical education transition. That committee – called the UME-to-GME Review Committee or UGRC – completed their work and released their final recommendations yesterday.

This isn’t the first time I’ve covered the UGRC’s work: back in April, I tallied up the winners and losers from their preliminary recommendations.

And if you haven’t read that post, you should. Many of my original criticisms still stand (e.g, on the lack of medical student representation, or the structural configuration that effectively gave corporate members veto power), but here I’m gonna try to turn over new ground as we break down the final recommendations, Winners & Losers style.

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A Man With Sudden Onset of Gastroparesis

By HANS DUVEFELT

Leo Dufour is not a diabetic. He is in his mid 50s, a light smoker with hypertension and a known hiatal hernia. He has had occasional heartburn and has taken famotidine for a few years along with his blood pressure and cholesterol pills.

Over the past few months, he started to experience a lot more heartburn, belching and bloating. Adding pantoprazole did nothing for him. I referred him to a local surgeon who did an upper endoscopy. This did not reveal much, except some retained food in his stomach. A gastric emptying study showed severe gastroparesis.

The surgeon offered him a trial of metoclopramide. At his followup, he complained of cough, mild chest pain and shortness of breath. His oxygen saturation was only 89%.

An urgent chest CT angiogram showed bilateral pulmonary emboli and generalized hilar adenopathy, a small probable infiltrate, a small pulmonary nodule and enlargement of both adrenal glands, suspicious for metastases.

He is now on apixiban for his PE, two antibiotics for his probable pneumonia and some lorazepam for the sudden shock his diagnoses have brought him.

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More Laughing, More Thinking

By KIM BELLARD

There was a lot going on this week, as there always is, including the 20th anniversary of 9/11 and the beginning of the NFL season, so you may have missed a big event: the announcement of the 31st First Annual Ig Nobel Awards (no, those are not typos).  

What’s that you say — you don’t know the Ig Nobel Awards?  These annual awards, organized by the magazine Annals of Improbable Research, seek to:

…honor achievements that make people LAUGH, then THINK. The prizes are intended to celebrate the unusual, honor the imaginative — and spur people’s interest in science, medicine, and technology.  

Some scientists seek the glory of the actual Nobel prizes, some want to change the world by coming up with an XPRIZE winning idea, but I’m pretty sure that if I was a scientist I’d be shooting to win an Ig Nobel Prize.  I mean, the point of the awards is “to help people discover things that are surprising— so surprising that those things make people LAUGH, then THINK.”   What’s better than that?

Healthcare could use more Ig.

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