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Month: September 2010

Healthcare unwired: nearly half of US consumers are willing to pay

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By JANE SARASOHN-KAHN

40% of U.S. consumers are willing to pay for remote health monitoring devices and services that would send their medical data to doctors, according to PricewaterhouseCoopers’ Healthcare Unwired (PwC). 51% of consumers would not buy mobile health technology.

The uses of mobile health most attractive to consumers are monitoring fitness and welling (cited by 20% of consumers), physician monitoring of health conditions (for 18% of people), and monitoring a previous condition (for 11%).

88% of physicians would like to see patients monitoring various parameters at home, their highest priorities being weight (65%), blood sugar (61%), vital signs like blood pressure (57%), exercise (54%), calories (36%), pain (36%), and sleep patterns (35%).

Those people most attracted to mobile health technology include men more than women, people who have individual health insurance policies (vs. group health/employer-based), and more healthy people.

PwC’s Healthcare Research Institute (HRI) gauges the remote/mobile monitoring device market range value from $7.7 billion to $43 billion, based on the prices people would be willing to pay.

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OIG: Imaging pre-authorization may be handled by hospital for referring docs and patients

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By DAVID HARLOW
David Harlow

The OIG released an advisory opinion at the end of last month OK’ing a hospital’s proposal to provide insurance pre-authorization srevices free of charge to patients and physicians. This is an issue that has long vexed folks in the imaging world. Clearly, this is a free service provided to referral sources (to the extent they are obligated by contract with third party payors to obtain the pre-authorization before referring a patient for an MRI, for example), so why is the OIG OK with it?  In the opinion, the OIG blesses the arrangement for four reasons:

  • The arrangement doesn’t target specific referring docs, so the pre-authorization service will be provided for patients of docs who are contractually bound to handle it themselves, as well as for patients of those who aren’t, and thus the risk of using the arrangement to reward referrals is low
  • The hospital will not pay the docs under the arrangement and will not guarantee to docs that the pre-authorizations will be forthcoming (the OIG also notes — not sure why — that the hospital will collect and pass on only such personal health information as may be necessary to secure a finding of medical necessity for the pre-authorization)
  • The hospital staff will be transparent with payors and referring docs, and will have little influence on steering volume, because they get involved only after the hospital has been selected (other situations are distinguished, e.g., where referral seekers provide referral sources with staff like discharge planners)
  • The hospital has an interest in being paid for its services, and thus in ensuring that the pre-authorization process is conducted properly, thus “lower[ing] the risk that the … [a]rrangement is a stalking horse for illicit payments to [the hospital’s] referral sources”

Well, the reasoning here doesn’t really cut it, as far as I’m concerned. Referring docs and their staffs hate having to deal with the pre-authorization process, and if a hospital takes on that headache, that’s a real benefit (remuneration, in the language of the anti-kickback statute). If there are two hospitals in town, and — all other things being equal — one provides pre-authorization services and the other doesn’t, guess where all the docs will refer their patients? It doesn’t really matter that the service is provided to all docs, for all payors. It is still clearly an inducement. If, on the other hand, all hospitals take on this added cost of doing business, then nobody gains a competitive advantage. Finally, to the e xtent physician networks are more and more tightly tied to particular hospital systems (whether through employment or other relationships, post health reform), the potential for steering volume is negligible at best.

Bottom line: I agree with the outcome, but not the reasoning.

David Harlow writes at HealthBlawg:David Harlow’s Health Care Law Blog, a nationally-recognized health care law and policy blog. He is an attorney and lectures extensively on health law topics to attorneys and to health care providers. Prior to entering private practice, he served as Deputy General Counsel of the Massachusetts Department of Public Health.

Computer Error or Patient-Centered Care?

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By HERBERT MATHEWSON, MD
Hub

The saga continues, but morphs from a discussion of computer error into patient-centered care (1).

In my last two posts I tell my story of trying to speed up a six-hour infusion of intravenous medication by correcting a “computer error”; a “failure to update reference information” in the computer available to the nurses. My first clue was the discrepancy between the medication’s package insert and the computer information. Discussion with the infusion nurses and a call to the Hospital’s chief pharmacist caused a review of the computer info, the package insert, and the hospital’s Pharmacy and Therapeutics Committee minutes.

The package insert stated that “after the initial 30 minutes without a side-effect the infusion rate could be gradually increased to the maximum rate.” The infusion nurses’ interpretation of “gradually” was a infusion rate step-up every 30 minutes resulting in a six-hour infusion. My preference was for a two hour infusion. I looked diligently, and in vain, for the manufacturer’s definition of “gradually”, so I called its 800 number . A very knowledgeable and accommodating RN in the Professional Services Department ( I identified myself as a physician) explained that they did not define “gradually”  because they wished “not to be too proscribing, realized that individual patients varied, and respected each facility’s responsibility to set their own protocols.” It sounded like pretty good risk management (avoidance of increased liability) to me.  She went on to say that many facilities had used a rate step-up schedule of 15 minutes rather than 30 minutes without increased side-effects and offered to send us the articles describing this.

Going to a step-up rate 0f every 15 minutes rather than 30 minutes would result in a four and a half hour infusion instead of a six hour one; still longer than my initially hoped-for two hours. Could the change in duration be labeled a triumph of “patient-centered care”? If so, was it worth all the time and effort?Continue reading…

Do Patients Want to Punish?

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LevyBy PAUL LEVY

There is a great debate set forth in the IHI’s Open School discussion of the wrong-side surgery case that  occurred at our hospital a few years ago. (I have written about this below, but there are some new postings.)

Kimberlee Ziga writes: I, as an RN working in an ICU, have also made mistakes. Thank God they have not been life threatening but nonetheless, they were mistakes. I was educated thoroughly and proven to be competent with testing. When I made that mistake, I was written up. I totally understood why. I am a licensed professional who is competent at her job, and that calls for accountability and responsibility. I believe all the medical staff involved should have been held accountable and disciplined accordingly. If that was my family member, I would have been irate for what they had to go through.

In contrast, Jessie Moon says: Paul Levy . . . made it out like it was a serious situation, but one that could happen to any surgery team. He* did not punish any one person, but instead he took care of the situation by asking, “how can we lower the chances of this ever happening again”, which makes the person and the family that this happened to feel better (or so I would assume), the public, as well as the workers in this hospital.

There are two parts to this question. What is the most effective way to reduce the likelihood of a similar event happening in the future? I have addressed this topic fully below. At heart, the answer goes to the definition of the “just culture” that has been adopted by a hospital.

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The trifecta: Reform idiocy, Hospital CEOs and the Obesity Problem

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By MATTHEW HOLT
It’s rare that you get such a delicious health care story combining human frailty, blindness and multiple stereotypes, but Julie Rovner of NPR found it. In fact I literally thought she’d been set up but she confirmed to me that it was true and put me in touch with the CMS spokesman who confirmed it. So remember, this really happened.—Matthew

An interim hospital CEO in Ohio Valley Medical Center, in West Virginia “found out” “advanced intelligence” from “word of mouth” sources in Washington DC that the “High Commissioners of the Healthcare Reform Bill” were going deny Medicare payments  to any hospital of which than 5% of employees were 25% overweight.

This rumor prompted the said CEO to panic. Now before I tell you what he did, let me tell you a little of his story. To quote the CEO as he tells it:

I am five feet, 10 inches tall. The guidelines (he’s referring to standard BMI guidelines) suggest that I should weigh between 151 and 163 for my medium frame. If you add 25 percent to the upper limit, I would need to be no heavier than 204 pounds. I currently weigh 272 pounds, down from 335. I would have three years to lose 68 pounds

That is indeed some challenge. Not to mention that the hospital is in West Virginia (albeit the northern sliver between Ohio & Pennsylvania) where the obesity rate is among the nations highest—there’s a reason that Jamie Oliver took his childhood obesity crusade there. In fact Ohio County, WV’s obesity rate is 32% according to the rather fun County Sin Rankings site. And as obesity tends to mean a BMI of roughly 25% more than the outer band of the guidelines, it’s a fair bet that somewhere close to 32% of the workforce is obese. So getting that number down to 5% would be a major struggle.

The interim CEO also wanted to promote not only his own weight loss story but the laudable activities of his hospital’s dietitians and its weight-loss programs. Here’s his counsel to hospital employees.

I strongly urge you to take advantage of the programs OVMC and EORH are currently offering employees who are battling with excess weight. Mary Velez is doing a fabulous job with Weight Watchers programs, and in addition, I have also been offering a program known as “Diet and Fitness for Love.”

And who could be against that advice?

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HIT Trends Summary for August 2010

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By MICHAEL LAKE

Picture 1

This is a summary of the HIT Trends Report for August 2010.

You can get the current issue or subscribe here

Large insurers make HIT commitments.  This month’s trends are dominated by national health plans revealing more about their HIT strategies.  Dr. Blumenthal called HIT a “team sport,” when asking for private industry support for meaningful use.  National insurers responded.  Humana announced that it will collaborate with athenahealth in 100 physician practices and pay for 85% of the costs of its EHR.  It will also pay a 20% bonus for hitting outcomes targets.  Ingenix, part of UnitedHealthcare Group, reported it is buying Axolotl, a leader in health information exchange.  Aetna announced a partnership between its ActiveHealth care management solution and IBM who will provide clinical decision support to providers in large groups using cloud computing.  And WellPoint told the WSJ that it is investing hundreds of millions of dollars to finance the HIT infrastructure for rural providers.  In response to a consumer advocate raising questions about an inherent conflict when payers support provider HIT efforts, health plans responded by insisting their focus is on improving patient outcomes which will lower costs.  Payer investments in provider HIT will be supported by its inclusion as a medical expense when insurers calculate medical loss ratios.  The National Association of Insurance Commissioners approved its inclusion in new MLR blanks.

Continue reading…

Health 2.0 Europe: Deep Dive by Pfizer

By Bianca Grogan

Cliquez pour la vidéo en français French
At the Health 2.0 Europe Conference, April 6-7, 2010, in Paris, France, Vincent Varlet, the Communication & eBusiness Director of Pfizer, France, gave a deep dive presentation. He talked about the e-initiatives for mobiles for both patients and doctors and the different services that Pfizer provides.

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