Year: 2014

Why I’m Starting a Radically Different Kind of Medical Practice

Dec 29, 2014• 52

By ROBIN BERZIN, MD

We hear a lot about how US medicine is broken, from how much we spend annually ($4 trillion) for unimpressive outcomes, to the growing epidemic of obesity and diabetes, to problematic financial models, to the growing malaise amongst doctors.

Across US health care, a lot of smart people are crafting solutions to these problems, but in my view the reality is that many of them are generating efficiencies on top of a broken product.

The real problem is that conventional primary care as it’s practiced today no longer serves the needs of most people, be they wealthy or under-served, be they patient or provider.

I am starting Parsley Health, a new kind of medical practice that directly addresses these problems, first by providing something called Functional Medicine rather than traditional primary care, and second by providing functional medicine in a tech driven, modern and affordable way.

What is Functional Medicine?

I became a functional medicine doctor because early on I recognized two major limitations of the conventional medicine.

The Trouble with Home Health Care & Care Coordination

Dec 28, 2014• 11

By LESLIE KERNISAN, MD

Home health care is in many ways a fantastic service, especially for those Medicare beneficiaries who are essentially home bound due to frailty or illness.

But it often feels surprisingly hard to synergize with home health care.

The main problem, as I see it, is that home health care agencies have set themselves up to provide only administratively required communication with the ordering doc. (There are rules governing home health care, you know!)

Now, what I need is clinically relevant communication. As in, how is the patient clinically doing, so that you and I can coordinate our efforts together. This has apparently not been built into the home health care workflow.

And things get even more complicated when it’s a patient in assisted living, because then you have the facility nurse who should be kept in the loop as well.

Right now, I am trying to follow up on an elderly woman who lives in assisted living and has paid in-home aides (which are provided by a separate company).

I referred her to home health care a few weeks ago for help managing her skin. On one hand, she was starting to develop a pressure sore from sitting too much in the same position. And on the other hand, she had a fungal rash in her groin, under her incontinence brief.

I prescribed an antifungal cream to be used twice a day for two weeks.

Now it’s been three weeks, and the pharmacy is requesting a refill.

Well…what’s going on with that rash?

What I want to do is send an email to everyone who is involved and might know something.

Rediscovering Medical Professionalism

Dec 26, 2014• 2

By MARTIN SAMUELS, MD

I am a doctor today because of Dr. J.W. Epstein, my pediatrician in Cleveland in the 1950s. An immigrant from the Nazi terror in Europe, he had trained in Vienna and spoke English with a Germanic accent. His house calls are etched permanently in my memory. His visits were heralded by a fury of activity, led by my mother. “The doctor is coming! Put on clean underwear. Clean the house.” Water would be set to boil on the stove, in case the doctor should need to sterilize a needle for an injection. Up would drive his broken-down jalopy, which he would park directly in front of the house. No need to worry about getting a ticket. The police knew his car and would never issue a citation to The Doctor. No one – not the mayor, not the governor, not even Al Rosen, the venerated third baseman for the Indians – would have received such a royal welcome.

In he would come, wearing a suit and hat, carrying a worn black doctor’s bag. “Mudder, ver is da boy?” ”He’s in his room upstairs with a rash and sore throat.” He would put down his bag, sit on my bed, and ask me if the teacher had sent home the homework. He wouldn’t want me falling behind in my school work.

That might interfere with my becoming a doctor. Then came the ritual of the examination. Say aah; schtick out your tongue; take some deep breaths. “Gut… gut…zounds normal” as he listened with his stethoscope, feeling gently on my belly and then finally tap on some reflexes with his tomahawk hammer. “Mudder, it’s da measles, plenty of fluids, back to school in a few days.” “Veel zee you in da office next fall for da usual checkup.” “Mudder; don’t vorry, it isn’t polio.” No time for a cup of tea today; too many other house calls for this afternoon and off he would go. The enormous feeling of relief, transmitted from my mother to me, had me on the mend in no time.

This is what I wanted to do: be the agent of relief, the repository of medical knowledge, the most respected figure in the community. Some years later, as a teenager, I was waiting in Dr. Epstein’s office for my annual checkup before school started in September. I was surrounded by little babies and I realized that I might be growing out of Dr. Epstein. As he was tapping on my back in the usual reassuring fashion, I said to him, “How long can you see me as a patient?” “ Until you’re a doctor.” How could I fail him?

Fact vs Fiction – Navigating the Health Care Marketplace with Consumer Reports

Dec 23, 2014

At Health 2.0 WinterTech: The New Consumer Health Landscape speakers and sponsors are exploring the platforms that empower the informed consumer movement by providing objective reviews of consumer products. Senior Director, of Health Impact and Consumer Reports, Tara Montgomery will be joining the event to speak to their research on the health products, prescriptions, and providers that contribute to the changing consumer health landscape.

Health 2.0: Tara can you start by speaking to what really pushed this expansion into research and advocacies surrounding health products and when you sort of saw this started shifting?

Tara Montgomery: Yes. Well, actually, you might not know, but we have been in health since day one, and it was actually in our charter back in 1936 to look out for the well-being of all consumers. We started in our very first issue of our magazine and we rated Alka-Seltzer and said that its claims vanish — like gas bubbles in the air. So that was our first foray into health, but that was in a small scale, and I think it was typical of the kinds of health products being advertised to consumers earlier in the 20th century, but over the decades, we covered health lightly. And then, really, about 10 years ago, we saw the shift in healthcare where the consumer’s role really was shifting much more consciously from a compliant patient to a need to be a more savvy health consumer. That was a real call to action for us because our role in helping consumers out in the world is really to give people savvy information about value, and everything we’ve done in washing machines and cars and toasters has been about helping people evaluate the benefits, their satisfaction, and the value for money of the products and services they choose. When the burden of health costs started to shift towards consumers, and you know that definitely has been more intense in the past couple of years, we’ve needed to rise to the occasion and helpconsumers navigate that new role. So, that was a moment for us along with transparency, because when we wanted to rate healthcare products and services more than 10 years ago, the data wasn’t available, and obviously, you can’t look at health the same way as we look at cars and washing machines and bang — our national lab.Continue reading…

Health is All Around Us : How Our Environment Informs Our Health

Dec 23, 2014• 1

As Health 2.0 gears up for Health 2.0 WinterTech, January 15th in San Francisco, their reporters sat down with Environmental Working Group Executive Director, Heather White to discuss the many pathways consumer health advocacy takes and the barriers that continue to keep many of us in the dark about the relationship between our health and our environment.

Health 2.0: To get things started, Heather, I wanted to talk with you a little bit about some of the insight you’ll be providing at WinterTech, which is in relation to the Skin Deep App. From what I’ve researched, it offers ratings on over 70,000 products. I was hoping you could share your thoughts on how you and your team envisioned this app and the way it’s changing how consumers shop for skin products, and what has been the response thus far?

Heather White: Yeah. Well, it definitely has been making waves in the market for a pretty long time. Our site was developed 10 years ago, but we launched our app last year. So far, we’ve had about 300,000 downloads on iPhone and about 95,000 on Android, so close to 400,000 consumers have downloaded the app and are able to make decisions on safer cosmetics and personal care products right at the store. So, we’ve gotten a lot of response and support from our community, but we’re also finding that our brand is reaching a much broader audience. It’s really exciting for us because EWG is all about making sure people make this connection between our health and the environment and really start thinking about the environment as something that they connect to everyday. It’s not just that place you go on vacation, but it also incorporates the chemicals that you buy and that you put on your skin and the chemicals that you buy and then you bring into your home. Skin Deep is trying to really push the market for safer cosmetics and we’ve really seen a lot of consumers make more switches to safer alternatives and we’re also seeing each day new brands coming onto the markets that are less toxic. So, there’s been a tremendous response so far. It’s a free app. It’s available both on the Android and iPhone and our supporters and people who are interested in this issue have really welcomed it.

Reactive vs. Proactive Health Care: The Intersection of Payment Reform & Consumer Data Powering Clinical Insight

Dec 23, 2014• 1

By JOSHUA SEIDMAN

One of the greatest opportunities that exists in moving from “turnstile medicine” (or fee-for-service) to value-based payment models is the shift from reactive to proactive health care. The focus on accountability for population health forces providers to adopt a completely different mindset: Instead of waiting for sick patients to come knocking on your door, you need to figure out what they need, when they need it, and how to get it for them.

At the upcoming conference, Health 2.0 WinterTech: The New Consumer Health Landscape (January 15, San Francisco), I will moderate a panel on “Consumer Data Powering Clinical Insight.” The panel features several different perspectives on how consumer-facing technologies can translate discrete consumer-generated data into useful information that providers and others can use to deliver more personalized and proactive support and care management.

The dramatic proliferation of electronic health records (EHRs) in the last five years means that much more clinical patient data exists in electronic form than ever before. True meaningful use of that data involves organizing it into meaningful and useful information by building algorithms, leveraging machine learning principles and delivering the right information to the right person at the right time. In addition, de-identified data in the cloud provides a scale for that kind of data analytics. Practice Fusion, a cloud-based EHR company uses patient-derived data—everything from booking an appointment to patient intake questionnaires—to drive proactive health management. CEO Ryan Howard will discuss how, in early 2015, they’ll begin incorporating qualitative and quantitative data from the patient and machine learning based on how physicians react to it to better target diagnosis, treatment and other support.

Let’s Have APIs for Those Provider Directories!

Dec 23, 2014• 7

By Matthew Holt

This was a comment I submitted submitted to this proposed set of regulations on health plans participating in the ACA. (Use ctrl-F to search “provider directory” within the page). HHS is proposing forcing insurers to make their provider directories more accurate and machine readable, and it would be great for consumers if that was made the case–especially if APIs (which means basically giving access for other computers to read them) were mandated–here’s why:

Subject–Immediately updated provider directories machine readable via APIs should be mandated for health insurers.

Finding accurate information about providers is one of the hardest things for consumers to do while interacting with the health care system. While regulation cannot fix all of these issues, these proposed regulations in section 156.230 can greatly help, But they should be strengthened by requiring (under subsection 2) that health insurers immediately add new information about providers in their networks to a publicly available machine readable database accessible via a freely available API.

Currently companies trying to aid consumers in provider search and selection tell us that the information pertaining to which providers are in a particular network is the least accurate of all data they can receive. For consumers the biggest question for plan selection is trying to find out which provider is in their plan, and at the least this requires searching multiple websites. Worse, particular insurer’s plans can even have the same name but can have different networks (in one instance in our personal experience Aetna in New York state had two different plans with effectively the same name but different networks). This is essentially impenetrable for consumers and that is assuming that the information on the websites is accurate or timely–which it is often not.

HIT Newser: Appalling Meaningful Use Penalties

Dec 23, 2014

By MICHELLE RONAN NOTEBOOM

Omnibus Bill Impacts HIT

The 2015 federal budget includes about $60.4 million for the ONC, which is less than the $75 million requested and on par with the 2014 budget. Congress allocated an additional $38.8 million to the HHS Office for Civil Rights, the agency that enforces HIPAA. Also in the bill: a controversial requirement for the ONC to decertify products that block health information sharing.

Appalling Meaningful Use Penalties

CMS reports that more than 257,000 eligible professionals will face penalties in 2015 for failing to meet Meaningful Use requirements. The AMA quickly announced it was “appalled by the news.”

Another Call to Cut Reporting Period

A group of 30 Republican House members call on HHS to shorten the 2015 Meaningful Use reporting period from 365 days to 90 days. A number of professional groups, including the AAFP and CHIME, support the extension.

From Foes to Financiers

Former Allscripts executives Glen Tullman and Lee Shapiro invest in Lightbeam Health Solutions, a population health management solution provider. Pat Cline, the founder and former president of NextGen, is currently Lightbeam’s CEO.

ATA Offers Accreditation

The American Telemedicine Association launches an accreditation program for providers offering online, real-time consults to patients.

The Value of Workplace Health Promotion (Wellness) Programs

Dec 22, 2014• 27

By RON GOETZEL

The recent Health Affairs Blog post by Al Lewis, Vik Khanna, and Shana Montrose titled, “Workplace Wellness Produces No Savings” has triggered much interest and media attention. It highlights the controversy surrounding the value of workplace health promotion programs that 22 authors addressed in an article published in the September 2014 issue of the Journal of Occupational and Environmental Medicine titled, “Do Workplace Health Promotion (Wellness) Programs Work?” That article also inspired several follow-up discussions and media reports, including one published by New York Times columnists Frakt and Carroll who answered the above question with: “usually not.”

There are certainly many points of contention and areas for continued discussion on this topic. It turns out that Lewis et al. and I agree on many things, and there are other areas where we see things differently.Continue reading…

Grading the Federal Health IT Strategic Plan

Dec 22, 2014• 4

By JAMES SALWITZ, MD

It is a heart pounding, head spinning, edge of your seat page-turner; the sort of rare saga that takes your breath away as it changes you, forever. It hints at a radically different future, a completely new world a few years away, which will disrupt the lives of every man, woman and child. Available now, from the National Coordinator for Health Information Technology (ONC), Office of the Secretary, United States Department of Health and Human Services, is finally, without further ado; the Federal Health IT Strategic Plan 2015 – 2020.

You think I am kidding. A satirical dig at another monstrous, useless, governmental report? Absolutely not. The concepts outlined in this blueprint will transform healthcare. It is a tight, clear, document, which at only 28 pages, delivers almost as much change per word as the Declaration of Independence. This may be the most powerful application yet of computerized information technology.

If you want to know where healthcare and health IT are headed, The Plan is absolutely worth a read.

I have only one complaint; it is coated with too much sugar. Restricted by policy structure and jargon, the report does not go far enough.