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THCB Reader Mail

Bazian’s Tom Donald responds to critics of evidence-based-medicine in
our post discussing the company’s

new approach to the controversial field
.

"Unfortunately EBM has, in many circles, become a “dirty word” through its
  blunt application by insurers and regulators, as well as its devaluation by  groups (mostly published products) who say they’re evidence-based when they’re
  not. EBM does, however, play a critical function, as you note. So it’s time 
for a fresh start. The sullying of its reputation leads us all to evidology –
  aka EBM 2.0. Evidology recognises that “getting evidence based” requires a new
  specialisation, one which sits between the clinical front line and the bean
  counters, assuring quality care without wasteful expenditures. As a company,
  we’re working towards the day when evidology bridges the clinicians’ world to
  the bean counters’ world, allowing them to better understand each others
  needs, requirements and decisions."

Bob Mooney has this to say to critics who think too much time is spent at medical schools teaching prospective doctors to "think like entrepreneurs" and not enough on the trickier subject of teaching them how to cost-effectively treat disease.

"What you learn in school and during training is how to diagnose and to treat disease.  As Dr. Bradley observes, little attention is payed to doing so in a cost effective manner.  There are physicians who are positioned so as to have a financial incentive to order diagnostic testing."
  Most physicians, however, have no such incentive.  We see a patient and we try
  to get through the encounter without overlooking something that will cause us
  to have to face the patient months or years later having to own up to the fact
  that we missed a diagnosis.  Every office encounter presents an opportunity to
  make a mistake that is going to get us sued.  We don’t know what the MRI
  costs, what the CT scan costs, or what cost is of the exhaustive laboratory
  workup that our patient is demanding to explain why they are always tired." 

Xoova VP of Communications, Miriam Bookey was so inspired by the post on the HEALTH AFFAIRS
interview with Regina Herzlinger
that she wrote to us. (Disclosure, as
required by the unwritten Geneva convention for blogs  we now humbly disclose the fact that Xoova is a Health 2.0 sponsor.)

"I know more about my Raisin Bran than about the guy who delivered my
children or the hospital in which he practiced. That’s because there’s
no consumer market yet in health care, and these information
organizations exist only in consumer market." — Regina Herzlinger Yes, there’s a need for physician ratings, and there are resources on the
Internet that already provide that. But we need more than the nutrition label on
the side of the cereal box. We need a real connection with the doctors who
provide our care, because selecting a doctor is both an intellectual and an
emotional choice. That’s where an enhanced profile rather than a simple
directory listing can make a difference. Today we have thousands of enhanced
physician profiles nationwide, and in time, Xoova aims to be the most popular,
trafficked site for doctors to communicate directly to patients. Today they can
do this by updating their own profiles, offering forms for download, and adding
online appointment scheduling…for free. Soon we’ll incorporate the consumer
voice in moderated testimonials, along with physician to physician referrals.
Hopefully, this will take us a step further to the world Herzlinger envisions in
which we know as much about the person who, say, performs our mastectomy as we
know about the restaurant that prepares our dinner …"

Rebecca, meanwhile, isn’t entirely thrilled about Sermo’s much-ballyhooed partnership with
the AMA

"I’m a member of the American Academy of Family Physicians, but not of the
  AMA, because I disagree with too much that the AMA does, … (and) … the
  dues are WAY too high.  I am a SERMO member, and I’m ok with some cooperation
  between AMA and SERMO, but I don’t want the AMA feeling like they in any way
  control/own/or have "exclusive" rights to SERMO.  They may have an exclusive
  contract with Dan, but they made no contract with me…. 

Sarita particularly liked the post about Laura Locke’s profile of Facebook founder Mark Zuckerberg.

"Opening up the Facebook platform to developers was a
brilliant move by   the young CEO.  Applications that marry expert
technology with an impressive  user base creates a breeding ground for
new ideas and relevant solutions. Take   Nurse Central, the first peer
referral network on Facebook.  Beyond the   application’s slick
technological features, the site creates an opportunity to   allow
nurses across the globe to network and stay connected – in essense, 
creating a richer pool of nurse professionals within a social utility 
platform."

CaringBridge executive director Sona Mehring wrote in to lobby us to
include her organization on the social media for patients panel at
Health 2.0, a field that the company has been active in for more than a
decade. (We’ll be allowing THCB readers to vote for their favorite
nominee final spot on the panel some time in the next week or so. More
on that later.)   

 

Here are some interesting facts about CaringBridge and
how widely used our service is today:  1. Around 17 million people are
part of a CaringBridge experience each year. 2. Every 12 minutes,
someone somewhere around the world creates a CaringBridge site. We
directly connect over 250,000 individuals each day through our e-mail
notification of a
  CaringBridge site update.  Overall, 425 million visits have been made
to CaringBridge websites.
 
The individuals and families who have used CaringBridge
always tell our story the best.  Perhaps you read Jonathan Alter’s
account of his battle with cancer and the amazing role CaringBridge had in his
recovery.  It appeared in the April 9, 2007 cover story of Newsweek.
I have attached pdf of the excerpt for you.  Also in April, Jonathan
did a feature story on NBC
Nightly News
stressing the importance of CaringBridge when dealing with
cancer or other healthcare issues. 

Jon Kessler of Wageworks weighs in on the eternal question that divides the two sides in the debate over pay for performance — what should be measured, and just who should be measuring it?

"Now
here’s my question regarding "accurate and measurable levels of service
quality."   What role should patient satisfaction play in all of this
versus more utilitarian measures of outcomes? 

My father recently died very quickly of an aggressive lymphoma.
Nothing his physicians tried was remotely useful at stopping the rapid
course of his deterioration, and indeed, some of what happened,
including contracted infection, may have contributed to it.  But I
would say that the care he and we received (at MD Anderson) was
nonetheless exceptional from both a medical and emotional standpoint. 

It at least has the virtue of being easy to measure."   

John R. Graham of the Pacific Research Council wrote in on Matthew’s post on the battle over SCHIP in Washington.

"I agree with Ms. Mahar that it’s cruel to shuffle kids between
healtlh plans just because the state has determined an arbitrary income
cut-off for the families. The answer (and I am not the only genius to
figure this out) is to eliminate the tax prejudice between
employer-sponsored and individual health plans with a refundable tax
credit for those who drop below the cut-off so they can keep the health
plan of their choice.  Let’s call it "RudyCare."

Matt Guldin thinks the conventional wisdom on Medicare Advantage plans may be wrong.

 

"What I really want to see is the margins that United is making
with their two Medicare products.  Everyone screams about the 19%
premium on the PFFS approach and automatically assumes that United
pockets that as a straight pass though. 
 
If you are a rural hospital and your health system doesn’t have any
major competition around you for 50-100 miles, you have a lot more
flexibility on pricing with an insurer.  I would be willing to bet that
a decent portion of that 19% premium gets sucked up by increased prices
and losing economies of scale.  In the end, I bet that two products are
both quite profitable for United but I don’t think the PFPS plans are
quite the golden egg that some people assume. "   
 

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Chiron
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I recently blogged about the fallout from the network of hospitals in CA that have cancelled all their insurance agreements. Of course, I’m just guessing. Anyone else care to speculate on where this will lead? (see LA Times story at… http://www.latimes.com/news/local/la-fi-reddy8jul08,1,2454708.story?ctrack=1&cset=true )