Month: September 2010

Consumer Groups Shut Out of Comparative Effectiveness Board

Sep 27, 2010• 4

By MERRILL GOOZNER

The Government Accountability Office last week appointed two “faster cures” patient advocates and a former insurance company executive now on the AARP board to the three slots reserved for patient and consumer representatives on the Patient-Centered Outcomes Research Institute board, which will oversee comparative effectiveness research under health care reform.

The reform legislation passed last March gave GAO the job of appointing the 17 public members, which also includes five representatives of private payers, five physicians, and three industry representatives (one each for drugs, devices and diagnostic manufacturers). A full list can be found here.

The three “patient and consumer” representatives are:

Ellen Sigal, chair, Friends of Cancer Research.

Sigal is an outspoken advocate for more money for cancer research. Her board is comprised largely of fellow executives in the research community, including staff from the American Cancer Society, Research America!, and the American Society of Clinical Oncology, which represents cancer docs. She serves on numerous non-profit boards, including the Reagan-Udall Foundation set up by the Food and Drug Administration to expedite drug development; and has served on numerous Institute of Medicine panels investigating new ways of conducting cancer research that can lead to faster access to new medicines.

The History and Future of Medical Technology

Sep 26, 2010

FILED UNDER: THCB CLASSIFIEDS

If you are curious about how the amazing technologies found in modern hospitals and clinics came about, check out Ira Brodsky’s entertaining new book, The History and Future of Medical Technology. The hardback tells the story of the people behind each technology—their dreams, their struggles, and their lucky breaks.

Told in you-are-there fashion, it gives you a front row view of the discoveries and inventions that led to today’s imaging systems, implants, prosthetics and more. The book also covers pioneering work in areas including personal health technology, robotic surgery, nanomedicine, and brain-computer interface chips.

The book contains fourteen chapters: Better Living through Biomedical Engineering / The Hidden World / Medicine’s First Power Users / Fantastic Voyage / Human Electricity / The First Cyborgs / Wireless Chemistry / The Nuclear Option / Listening to the Body / Repair or Replace? Part I / Repair or Replace? Part II / The Vision Thing / Technology with Real Teeth / Bodies in Cyberspace.

The History and Future of Medical Technology is 321 pages and includes 26 illustrations. Published in May of this year, the book is available from Amazon and other resellers. For more information, including sample pages, visit the publisher’s website: http://www.telescopebooks.com.

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How the Future of Healthcare Will Actually Work: Nuts and Bolts

Sep 26, 2010• 6

By JOE FLOWER

They are coming in fast under the radar, out of peripheral vision, in the magician’s other hand—and they will change everything. New ideas, surprising networks, stealth business models that may change health care profoundly, are bubbling up in pilot programs, experiments and full-on corporate transformations. There is something here that does not yet have a name, that no one is yet calling a movement, that no one is yet seeing as revolutionary.

While we have been mesmerized by federal health care reform, government intervention on behalf of the uninsured and government attempts to “bend the cost curve” to shave a few percentage points off medical inflation, things have been happening in the private sector for people who are already insured that result in outright medical deflation, drops in costs of 20 percent or more, all while giving people more care, not less.

Help me out here. This picture is just forming, the Ouija board is still in motion, but I think what we may have here is some truly big news about the future.

The Difference Is Integration

First, consider the huge regional differences in health care costs. Think about what it means that it costs twice as much for patients in the last six months of life to be involved with Cedars-Sinai in Los Angeles, UCLA Medical Center or New York University Medical Center than it does for them to be involved with Mayo Clinic in Minnesota or the Cleveland Clinic; or that Medicare spends half as much per patient per year in Temple, Texas, as in McAllen or Harlingen or Brownsville, Texas; or why Medicare spending per patient per year in the top and bottom quintiles of hospital catchment areas differ by 60 percent.

These are vast differences—and the more expensive areas show no better outcomes than the less expensive ones; in fact, for some conditions they show worse outcomes.Continue reading…

Why There’s An Enthusiasm Gap: An Illustration

Sep 26, 2010• 14

By ROBERT REICH

Today (Monday) at a “town hall” sponsored by CNBC in Washington, the President took questions about the economy. When a hedge-fund manager complained that Wall Street executives “feel like we’ve been whacked with a stick” by the administration, Obama said most of his critics think he’s been too soft on the Street.

He noted he still hasn’t been able to end the practice of taxing some hedge fund and private-equity earnings at the capital-gains rates rather than the higher income-tax rates. “The notion that somehow me saying maybe you should be taxed more like your secretary when you’re pulling home a billion dollars…a year I don’t think is me being extremist or anti-business.”

Good as far as he went. But that’s as far as he was willing to go. It was a golden opportunity for Obama to connect the dots — to make the case that

(1) super-rich financiers on Wall Street and top corporate executives have grown even richer than they were before the Great Recession, even though most Americans are getting poorer or losing their jobs and homes and savings, and more Americans are in poverty.

(2) Yet the lobbyists for the financiers and top corporate executives, and their Republican allies have blocked or tried to block every effort of the Administration to widen the circle of prosperity, including enacting a major jobs program, providing major relief for mortgage holders who are under water, helping working families afford college for their kids, making sure states and cities have enough money to pay our classroom teachers, and cutting taxes on average working people.

(3) They almost scuttled the effort to make sure health care would be affordable to average Americans.

(4) The super-rich say the nation can’t afford any of this because of budget deficits. Yet at the same time their platoons of lobbyists are fighting off efforts to treat their income as taxable earnings rather than capital gains. So last year the 400 richest families in America, with an average income of $300 million each, were taxed at an average rate of only 17 percent. That’s the same tax rate paid by a family earning $30,000.Continue reading…

Caring

Sep 25, 2010• 13

By ROB LAMBERTS

The “empowered patient” movement (which I think is a good thing) strives to take the doctor out of the center of care and put the patient at its focus. The role of doctor is not to be the star of the show, the quarterback, the superhero, but the advocate and helper for the patient to accomplish their goal: health. Many rightly attack doctor prima donnas who want the exam/operating room to be about them instead of the patient. This is healthcare, not health performance. They want doctors who care more about the people they treat than they do about money, praise, or status.

I get it. I get the message that doctors have to adjust to this new age of patient empowerment and patient-centeredness. I get the fact that making patients wait is a bad thing, and that communication is as essential of a skill as is medical knowledge – remove either one of them and you don’t have care. I hear the message: doctors should care about patients more than they careabout themselves. That is what we are paid to do, and that is what we have neglected at our own peril.

So why is it, then, that those of us who try to be patient-centered in our careend up getting penalized? If the days of the doctor-god are over, then why are we still paying premium dollar for those huge egos? Why do we pay more for technology than humanity? When I face the continued threat of declining reimbursement (don’t forget, then next SGR battle will be over a 30% drop in Medicare reimbursement) I feel angry. I am the point of care, not cost. I am cheap. I spend my day trying to keep people well, trying to find cheaper medications for them, trying to avoid expensive procedures and consultants. How am I rewarded for fighting the tide of spending? With increased expectations, increased fear of the future, and decreased pay. I see the gratefulness of my patients, and that keeps me from fleeing altogether; but I also face the callous cuts by CMS, the increased micro-management by the insurance industry, and accusations of being a “greedy doctor” for not wanting my pay cut.Continue reading…

New Study Proves Reducing Healthcare Costs While Improving Care Is Achievable

Sep 23, 2010• 37

By DAVID WENNBERG, MD

The results are in: population-based care management doesn’t just improve patient satisfaction – it also can significantly reduce medical costs.

It is widely known that chronic disease accounts for 75% of the total cost of healthcare in the United States. In the late 1990s, the care management industry grew out of the need to combat this problem, by increasing medication compliance, reducing gaps in care, and helping individuals become more empowered to actively manage their own health.

Care management programs have long been shown to increase medication compliance and use of other preventative services, and individuals who participate in care management programs find them extremely valuable. Yet the care management industry has always faced challenges in verifiably demonstrating the effectiveness of its programs in reducing medical costs. Several methodologies have been created to attempt to reverse-engineer a calculation of savings delivered by care management programs, but the gold standard of healthcare effectiveness measures, a randomized controlled trial, has rarely been done and none in a large population.

I’m pleased to say that this is no longer the case. A study from Health Dialog appearing in the New England Journal of Medicine today, uses a randomized controlled trial to definitively show the savings delivered by an enhanced care management program. The trial looked at 174,120 individuals over twelve months, measuring those individuals’ health outcomes and the total savings as a result of an enhanced care management program. The program included chronic condition management and patient decision support programs, and these services were delivered telephonically as well as online.Continue reading…

Accountability, Accountable Care Organizations, and Human Mindsets

Sep 22, 2010• 8

By KENT BOTTLES, MD

“Great companies have high cultures of accountability, it comes with this culture of criticism I was talking about before, and I think our culture is strong on that.” – Steve Ballmer

“I am responsible. Although I may not be able to prevent the worst from happening, I am responsible for my attitude toward the inevitable misfortunes that darken life. Bad things do happen; how I respond to them defines my character and the quality of my life. I can choose to sit in perpetual sadness, immobilized by the gravity of my loss, or I can choose to rise from the pain and treasure the most precious gift I have – life itself.”
– Walter Anderson

“When it comes to privacy and accountability, people always demand the former for themselves and the latter for everyone else.” – David Brin

Accountable care organizations (ACOs) are all the rage as the perfect tool to achieve our most important goal in present day American health care: decreasing per-capita cost and increasing quality at the same time. Just this week I am presenting on ACOs at a law firm conference co-sponsored by two state hospital associations and the MGMA in Minneapolis and at a hospital system board retreat in Pennsylvania. Everybody wants to know how to implement ACOs.

An essential ingredient in ACOs is accountability, and yet human beings are not always comfortable with being held accountable. The two blog posts I wrote on physician report cards generated a lot of comments both in favor and opposed to personal accountability. And yet we know that hospitals and physicians are going to have to change the way they utilize medical resources if we are to indeed decrease per-capita cost and increase quality. Hospitals account for 40% of the rise in health care costs. Physicians account for only 20% of total health care expenditures, but when they treat patients they control the use of hospitals, drugs, medical devices, and laboratory tests.

If we are to control health care costs, hospital admissions will have to go down and physicians will have to order fewer and less expensive tests and treatments than they do today.

Profit-seeking Health Insurers Seek Profits

Sep 22, 2010• 20

DAVE DRANOVE
No one who sees this headline should read any further. There is no news here. So why is everyone getting lathered up about it? Let me explain.

Healthcare reform becomes official this week, as many of the provisions of the legislation kick in. One provision requires insurers to accept children with preexisting conditions while capping what they can charge, undoing a standard industry practice. Several insurers have indicated that they will stop selling child-only policies. Industry officials are having a field day criticizing insurance industry greed.

Maybe these officials haven’t noticed, but insurers are greedy and there is nothing anyone in the Obama administration can do about it. Maybe it needs repeating. Insurers are greedy, have always been greedy, and always will be greedy. So are all investor-owned companies. People don’t invest in health insurance companies (or any other investor-owned companies) for charity. They invest in them to make money. (Investors tend to be greedy too, and that includes the pension funds that most working Americans rely upon for their comfortable retirements.)Continue reading…

Risky Business

Sep 22, 2010• 15

By PAUL LEVY

At my annual physical exam last week, my primary care doctor employed a widely used web-based calculator to plug in cholesterol levels and other risk factors to estimate my likelihood of having a heart attack during the next ten years. I thought this was a neat idea until it produced an answer of 8%.

Wait, you mean I have a one in twelve risk of a heart attack over the next decade? That sounded really high. She calmly and thoughtfully explained that the main value of the algorithm was to help make a judgment about prescribing statins or other interventions that could lower risk. She also noted that anything under 10% at my age was a very good number.

So, I was going to write this post to tell this story and to make the point that these kinds of estimates can be shocking for the uninformed unless we have a context within which to interpret them.

I was also going to assert that the estimates give an impression of precision that may not be valid. What is the standard deviation around the estimate? How often is the actual estimate found to be true?Continue reading…

Live Health 2.0 Code-a-Thon at Google, Oct 2

Sep 21, 2010• 1

By Indu Subaiya & Matthew Holt

Health 2.0 is thrilled to announce the kick-off to Health Innovation Week: our first official code-a-thon where developers of all skill sets will get together, learn more about the vast amounts of health data that are available, build innovative health applications, and win prizes. The Health 2.0 Developer Challenge Code-a-thon will build on the existing online challenges, follow on from the Hacking4Health event on September 11, and introduce new datasets with some live on-site challenges.

Where & when?:

Saturday, October 2, 2010 — 9am – 8pm
Google Campus, Olympus Mons Room,
Building 1400 Crittendon,
Mountain View, CA

Confirmed speakers include:

Roni Zeiger, Chief Health Strategist, Google
Samantha Chui, Solutions Engineer and Mike Mee, API and PAT Product Manager, Keas
Sean Duffy and Zhen Zeng, IDEO
Walter Luh, CTO and interim CEO, Ansca Mobile….and more to come

But this not about sitting back and listening–it's about getting your hands dirty in the code and the data AND in a ground-breaking first for the Developer Challenge, we are pleased to announce that First DataBank will provide its drug databases free-of-charge to anyone developing applications – for any of the Challenges – that require content to support medication-related decisions and help improve patient safety and healthcare outcomes. You will want to take advantage of this unprecedented opportunity! More details on accessing this data will be announced soon.

This event is free to all–bring your laptop and ideas and we'll supply the pizza and jolt cola (or maybe something healthier). Come to the LIVE CODE page on health2challenge.org to sign up.