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Month: August 2010

Health 2.0 Northwest Chapter Kicks-off with a Big Bang

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Picture 35 The Health 2.0 Northwest Chapter is having its first meeting next week, and it’s a doozie. No starting off with a few drinks in a bar for these guys, they’ve got a serious host (the major Health Science University) and serious panelists. Congrats to Frank Ille at HealthSaaS and his crew for pulling this off, and kudos to our own (and Eugene, OR resident) Lizzie Dunklee for being on this high-powered panel. If you’re in Portland, you don't want to miss it  

Date: Wednesday August 18 2010
Location: OHSU Old Library Auditorium
Time: Networking and snacks 5:00-6:00pm followed by Panel discussion 6:00-8:00pm

Register for the event here

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Massachusetts Update

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By PAUL LEVY
Paul Levy 1Here is one of my occasional updates on theMassachusetts scene, for people looking for hints as to the kind of issues that might arise nationally as health care reform is implemented.

I have written several times about the ongoing saga between the state administration and the health care insurers in the state concerning premiums for small businesses and individuals. Over the last several weeks, several insurers have reached settlements with the Division of Insurance. At least one has not and has prevailed at the appeals board because the rates forced upon it by the state were not actuarially sound. Where settlements have been was reached, they were not based on actuarial principles: They was based on a desire to get past this impasse and provide some stability to customers.Continue reading…

A Bizarre Report

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By JOHN GOODMAN, PhD

I have been watching the release of the Medicare Trustees reports for many years and I have never seen anything as strange as what happened last week.

Although these reports are normally carefully embargoed, Health and Human Services Secretary Kathleen Sebelius released parts of it (the parts most consistent with the administration’s spin) several days in advance. Then Sebelius, Treasury Secretary Timothy Geithner and other trustees, all with happy faces, appeared for the formal release last Thursday, where one person was notably absent: Medicare’s chief actuary, Richard Foster.

Enterprising reporters who researched all the way to the end of the report (page 281), where Foster’s sign-off signature would normally appear, found instead a statement disowning the entire report, encouraging readers to ignore it, and diverting everyone’s attention to an alternative report prepared by the office of the Medicare actuaries.

As noted the other day at my blog, I think I can safely say this has never happened before in the history of Medicare.

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Why a Patient 2.0 Panel at the Health 2.0 DC conference?

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By GILLES FRYDMANGilles Frydman

This is the first of two posts about the inspiring Patients 2.0 panel I helped organized at Health 2.0 DC. This one will explain the rationale for organizing such a panel. The second will provide a link to all the presentations and to the panelist biographies.

A while back, while he entire country was wondering if “health care reform” was ever going to become a reality, I had a conversation with Matthew Holt about the need to have a patients-only panel at the Health 2.0 conference. Matt graciously accepted the idea.

The panel was originally organized to convey, from the patient viewpoint, a few ideas, based on the following facts:

  • payment reform is not health care reform,
  • nobody has more at stake in real health care reform than patients,
  • patients are the most underutilized resource of the health care system and,
  • meaningful reform won’t happen until the patients are at the center of the effort.

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Why I Don’t Accept E-mail From Patients

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By ROB LAMBERTS, MD
Rob Lamberts

Dr. Wes (a cardiology blogger who all should read) wrote a very compelling post about technology and the bondage it can create for doctors.:

The devaluation of doctors’ time continues unabated.

As we move into our new era of health care delivery with millions more needing physician time (and other health care provider’s time, for that matter) – we’re seeing a powerful force emerge – a subtle marketing of limitless physician availability facilitated by the advance of the electronic medical record, social media, and smart phones.

Doctors, you see, must be always present, always available, always giving

This sounds like dire words, but the degree to which it has resonated around the web among doctors is telling.  He continues:

Increasingly the question becomes – if we choose future doctors on their willingness to sacrifice for others without expectation of appropriate boundaries and compensation – will we be drawing from the same pool of people as the ones who will make the best technically-skilled clinicians? What type of person will enter medicine if they know that their personal life will always take second place to patient care?

Dr. Brian V (long last name, but another one who you all should read) adds his voice to this:Continue reading…

The Circle of Trust

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By MARGALIT GUR-ARIE

Picture 24 Every day millions of Americans and billions of people around the globe are routinely accepting colorful pieces of paper in return for their labor and placing those hard earned possessions in modern glass buildings whose owners they do not know. It took a few hundred years to change how business transactions are conducted, but today, there is very little apprehension about depositing one’s wealth in a bank. Public trust in both the government issued paper and the financial institution’s ability to safely store the increasingly virtual representation of buying power had to be painstakingly created and watchfully maintained.

When people, for one reason or another, lose trust in government paper or banks, the entire financial system fails miserably. Public trust is a prerequisite to any national monetary system and public trust is a very delicate thing. Nations create laws and regulations around financial institutions specifically aimed at building public trust. 

People have to trust that paper and its virtual counterpart can be exchanged for goods and they need to trust that banks, while safely storing their funds, will always make them available to their rightful owner on demand. Banks have a legal and fiduciary responsibility to take good care of your possessions, thus very few folks feel the need to store their family jewels in a strong box under their floor boards.

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Waving goodbye to Wave

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By PAUL LEVYPicture 25

Google recently announced that it was abandoning Wave, a multimedia social media collaboration tool. I’m sorry about this, as I thought it had great potential. That being said, I never used it, so perhaps I was typical. Pete Cashmere writes on CNN Tech:

Wave was perhaps the prototypical Google product: Technically advanced, incredibly ambitious and near-impossible to use.

Its demise is the canary in the coal mine for Google’s social networking plans: Facebook is destined to build the Web’s next wave, as Google continues to tread water.

Meanwhile, let’s take a look at what is going on at Facebook and elsewhere, courtesy of EduDemic. I offer #6 (regarding Facebook) and #10 (regarding Twitter) especially for those hospitals and other companies who choose to block these media on their servers, in the hope they will consider how fruitless that is.

  1. The average Facebook user has 130 friends.
  2. More than 25 billion pieces of content (web links, news stories, blog posts, notes, photo albums, etc.) are shared each month.
  3. Over 300,000 users helped translate the site through the translations application.
  4. More than 150 million people engage with Facebook on external websites every month.
  5. Two-thirds of comScore’s U.S. Top 100 websites and half of comScore’s Global Top 100 websites have integrated with Facebook.
  6. There are more than 100 million active users currently accessing Facebook through their mobile devices.
    Over at Twitter:

  1. Twitter’s web platform only accounts for a quarter of its users – 75% use third-party apps.
  2. Twitter gets more than 300,000 new users every day.
  3. There are currently 110 million users of Twitter’s services.
  4. Twitter receives 180 million unique visits each month.
  5. There are more than 600 million searches on Twitter every day.
  6. Twitter started as a simple SMS-text service.
  7. Over 60% of Twitter use is outside the U.S.
  8. There are more than 50,000 third-party apps for Twitter.
  9. Twitter has donated access to all of its tweets to the Library of Congress for research and preservation.
  10. More than a third of users access Twitter via their mobile phone.

Paul Levy is the President and CEO of Beth Israel Deconess Medical Center in Boston. Paul recently became the focus of much media attention when he decided to publish infection rates at his hospital, despite the fact that under Massachusetts law he is not yet required to do so. For the past three years he has blogged about his experiences in an online journal, Running a Hospital, one of the few blogs we know of maintained by a senior hospital executive.

EMRs, Checklists and Meeting Atul

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By JONATHAN BUSHJonathan Bush

Recently, I got to shake hands with and also have lunch with doctor-writer extraordinaire Atul Gawande! He was nearly everything I had made him out to be. He wore a snappy blue blazer, a jumble of ID tags, and round specs befitting a prominent Harvard academic doc … only he wore them in a manner that suggested a man of action. Am I gushing? Sorry. I’ll stop … except to say that he had the chicken salad on white, which sat largely untouched as he drove through the conversation.

One of the greatest storytellers in the history of health care, Atul has discovered something very important about the way we deliver complex procedures … a series of checklists that bring down costs and improve outcomes … and yet adoption of his findings is incredibly low! He is seriously considering raising money to fund—NOT to continue his research and writing—but to literally fund a team of Maoist-like activists to cajole the ranks of docs and hospitals into adopting these bloody checklists!! These checklists are real bluebirds. Nobody loses their job from the adoption of these things. Except for a few embarrassing ‘re-operations to fix terrible mistakes, nobody loses any money either. So what gives?

Atul told me the story of penicillin adoption … I was stunned at how long it took for this miracle drug to be mainstreamed. I remember from my OB-GYN days the number of docs who were still doing continuous fetal monitoring during labor, twenty years and five studies after it was shown to be counter-indicated … and episiotomies, and circumcisions (ouch)!

How frustrating.

These are good people. I have met literally tens of thousands of docs and can count the truly questionable people on one hand. So what is it?

There is no market mechanism for the solution. That’s what.

If a payer came to me and gave me Atul’s checklist and said they’d pay even 5% more for a surgery done according to his checklist, I’d build it into an EMR and flick it in within a week! It’s a no-brainer for me and it’s good money for the doc! Ya know what that would be an example of? That would be MEANINGFUL use of an EMR.

God Bless you, Atul. I’m in for a donation … but not for the Maoists. You go find the truth and we’ll go make a market for it.

PS … Atul signed my copy of his book!

Jonathan Bush co-founded athenahealth, a leading provider of internet-based business services to physicians since 1997. Prior to joining athenahealth, he served as an EMT for the City of New Orleans, was trained as a medic in the U.S. Army, and worked as a management consultant with Booz Allen & Hamilton. He obtained a Bachelor of Arts in the College of Social Studies from Wesleyan University and an M.B.A. from Harvard Business School.

MinuteClinic’s hour may be at hand

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By DAVID WILLIAMS Picture 18

Mark Perry draws an interesting inference from two news stories: a WSJ article that suggests consumers are using less health care and another that reports a big jump in MinuteClinic volumes.

Consumers aren’t necessarily consuming less health care like the WSJ suggests; rather, they are shifting their  demand for health care away from expensive, conventional physician offices with limited hours to affordable and convenient retail clinics.  Especially when consumers are spending their own out-of-pocket money for health care and they have a choice, they prefer market-driven, consumer-driven options like affordable, convenient retail clinics over conventional physician offices.

I think Perry is on to something. It’s hard to get people out of their established habits. They have a relationship with their own doctor, they accept the long wait for appointments and even treat it as a proxy for high quality (if my doc is so busy he must be great), and just suck it up when it comes to co-pay’s and deductibles. They want access to high tech exams and the latest drugs.

But all these things change over time. MinuteClinic and its ilk are well-positioned to take advantage of these trends in the long run. To take them in turn:

  • Relationships aren’t what they once were. Your doctor may or may not remember you. If you have something routine (or even if not) you may be shunted off to see a “physician extender, ” such as a nurse practitioner. At least when you go to MinuteClinic that’s who you expect to see
  • Wait times for appointment can be lengthy. Under health reform they are likely to get worse, especially since open access scheduling is slow to catch on
  • We’ve now reached the breaking point for co-pay’s and deductibles. Even insured people are nervous about going in for treatment and want to save money. They realize it’s only going to get worse
  • High tech exams (like MRIs) and drugs have lost some of their allure. Cost is part of it, but the continued news stories of safety problems with drugs are taking a toll, too. I think Americans are finally realizing that when it comes to health care less is often moreContinue reading…