Year: 2014

Preparing for Updates to the Medicare Shared Savings Program

Nov 20, 2014• 3

By FARZAD MOSTASHARI, MD and TRAVIS BROOME

Later this month – perhaps as early as this week – the Center for Medicare and Medicaid Services (CMS) is poised to release a proposed rule to update to the Medicare Shared Savings Program (MSSP). MSSP is the national program which allows providers to create ACOs, and it is the program under which Aledade ACOs operate. This will be the first update to the program in three years, and we expect there will be a great deal to unwrap once the rule is public (we also acknowledge that we are among the few who await publications of CMS rules with the anticipation of children on Christmas morning). I’m sure we’ll spend the day of the release tweeting our initial reactions — be sure to follow @Farzad_MD, @Travis_Broome, and @Aledade_ACO for those updates.

The new rule will contain a lot to unpack; but we believe that the decisions that CMS makes in 4 key areas will play a large role in whether participation in the program continues to be robust and whether the program succeeds in being the flag-bearer for new payment models.

Why You Should Ditch Your IT System

Nov 20, 2014• 38

By JOE FLOWER

So you spent millions to billions of dollars on information systems over the past few years, right?

How’s that working out for you?

For a large percentage of you, whether or not you admit it, not so well. What you bought needs some serious tweaks, re-engineering, re-thinking, re-vamping.

For an even larger percentage, maybe most of you, the best advice is: Junk it. Throw it out and start over.

Poorly designed and poorly implemented information systems are worse than useless, worse than a waste of those millions and billions of dollars. As we go through rapid, serious changes in health care, poor information systems will strangle your every strategy, hobble your clinicians, kill patients and actually threaten the viability of your organization.

A lot of health care executives dismiss the complaints about the new systems as the carping of stubborn technophobic doctors and nurses who should just get with the program. If you are tempted to do that, you need to take a step back. You need to get real. The complaints and concerns are too widespread, too deep and indeed too frightening for that kind of blithe denial. And they are not just coming from disgruntled docs.

Dr. Clem McDonald of the National Institutes of Health, a true pioneer in pushing for electronic medical records (EMRs) over the last 35 years, has called the current implementations a “disappointment,” even a “tragedy.” He is far from alone in this assessment.

Is Becoming a Doctor Worth $2.6 Million?

Nov 20, 2014• 12

By RICHARD GUNDERMAN, MD

Each year, over 20,000 US students begin medical school. They routinely pay $50,000 or more per year for the privilege, and the average medical student graduates with a debt of over $170,000. That’s a lot of money. But for some who pursue careers in medicine, the financial cost has been considerably greater. Melissa Chen, 35, a final-year radiology resident at the University of Texas San Antonio, calculates that her choice of a medical career has cost her over $2.6 million in lost wages, benefits, and added educational costs. And yet in her mind, the sacrifice has definitely been worth it.

Help With Covered California

Nov 19, 2014• 3

By ACA DATABASE

JOE wrote THCB with an interesting question that could be an outlier or could be significant:

Do you know of a consulting firm or advisory firm that can assist me in applying for insurance through Covered California? When I applied for insurance through the Covered California website, they gave me a list of places where I can get assistance. The phone numbers go to dead voice mail boxes or don’t work at all. I am willing to pay for assistance from somebody that understands the system.

Grubernomics

Nov 18, 2014• 100

By SAURABH JHA, MD

In the giddy days after the passage of ACA, I was chatting to a PhD student in health economics. He was in love with the ACA. He kept repeating that it would reduce costs, increase quality and increase access. Nothing original. You know the sort of stuff you heard at keynotes of medical meetings; ‘Healthcare post Obamacare’ or ‘Radiology in the new era.’ Talks warning us that we were exiting the Cretaceous period.

He spoke about variation in healthcare, six sigma, fee-for-value and ‘paying doctors to do the right thing.’

‘How?’ I asked.

‘I just told you, we need to pay doctors for value and outcomes.’ He smugly replied.

‘How?’ I asked again.

He did not answer. Instead he gave me the look that one gives an utter imbecile who doesn’t know the difference between a polygon and a triangle.Continue reading…

HIT Newser

Nov 18, 2014• 6

By MICHELLE RONAN-NOTEBOOM

HIMSS and CHIME to HHS: ONC Needs Full-time National Coordinator

In a letter to HHS Secretary Sylvia Burwell, CHIME and ONC stress the need to hire a full-time National Coordinator for the ONC, should Karen DeSalvo continue to serve as both the ONC head and the assistant secretary of health:

“If Dr. DeSalvo is going to remain as the Acting Assistant Secretary for Health with part-time duties in health IT, we emphasize the need to appoint new ONC leadership immediately that can lead the agency on the host of critical issues that must be addressed.”

AMA Calls for Removal of MU Penalties

The AMA calls for all MU penalties to be halted and for the program to be more flexible with a shorter reporting period. In addition, the AMA urges policymakers to refocus the MU program on interoperability and seek ways to improve product usability.

Cerner Breaks Ground at New Campus

Cerner breaks ground at a new $4.45 billion campus in Kansas City, which is expected to house 16,000 new Cerner employees within the next 10 years. The project includes about $1.75 billion in public tax subsidies.

The Nurse Practitioner … Er, We Mean Doctor Is In

Nov 17, 2014• 7

By HANS DUVEFELT, MD

A rash could be leukemia or idiopathic thrombocytopenic purpura. A sore throat could be glossopharyngeal neuralgia or a retropharyngeal abscess. A blocked ear could be Ramsay-Hunt syndrome, a self-limited serous otitis or sudden sensorineural hearing loss with an abysmal prognosis if not treated immediately with high doses of steroids. A headache or sinus pain could be cancer, and a cough could be a pulmonary embolus or heart failure.

Treating the Well:

In my early career in Sweden, well child visits were done in nurse-led clinics, some of them only open on certain days, with a local doctor in attendance. Parents carried the children’s records with them, containing growth charts, immunization records and so on.

These nurses had great expertise in differentiating normal from abnormal appearance of children, and would direct the attending physician’s attention to children with abnormal metrics, appearance or behavior.

With this arrangement, the physician time requirement was reduced, and limited to evaluating children attending the clinics who needed special attention. Physicians also performed specific examinations at certain ages, such as checking for hip clicks. These clinics freed up the local pediatricians to evaluate more sick children.

Well-baby visits are now the bread and butter of American pediatricians and family practitioners, and with the ever expanding mandates of politically determined items that must be covered in order for doctors to get paid for their services, we sometimes have trouble accommodating illness care demands.

Knowing When to Say Yes to Medical Technology

Nov 17, 2014• 1

By EMMETT KEELER

In 2011, the New England Journal of Medicine reported results of the National Lung Screening Trial (NLST). Screening trials have to be big, because almost all the people who are screened don’t have the disease being investigated, and screening only helps people with silent disease.

The NLST had over 50,000 participants, all with a history of abusing their lungs through heavy smoking. Half were randomly assigned to have three annual low-dose helical chest computed tomography (CT) exams, and half were assigned to have three annual chest x-rays

All earlier trials had shown screening with x-rays to be ineffective, so many of us were surprised when CT screening proved to be effective, reducing death from lung cancer by 20 percent over the six years of the trial. Apparently, the CT proved to be effective at finding much smaller tumors than could x-ray.

Since publication of this study, the American Society of Clinical Oncology and other medical organizations have recommended screening for those at similarly high risk for lung cancer. The United States Preventive Services Task Force gave such CT screening a grade B recommendation, making coverage by private insurers mandatory and by public insurers likely.

Gruber’s Voters: Rational Ignorance

Nov 17, 2014• 37

By SAURABH JHA, MD

I think it’s fair to say Jonathan Gruber will not be offered the role of Pinocchio. Although intelligence agencies, in search of the truth serum, might have an interest in the ingredients of what he drinks.

Please put away the pitchforks. Gruber deserves credit for honesty and bipartisanship. Plus a complete rejection of Disneyland economics. If you’re looking for transparency, the other face of honesty, Gruber is ground zero.

‘Stupidity’, though, was an unfortunate choice of noun. And inaccurate. Gruber should have said ‘rational ignorance’ or ‘boundless optimism in technocracy,’ which describes most voters in any democracy.

‘Rational ignorance’ sounds smart. The cognoscenti know what you’re trying to get at. And the rationally ignorant, well they’re rationally ignorant. The term means something we do all the time: that is we can’t be bothered to seek information whether something is factually correct or not. It’s an information heuristic (mental short cut).

Imagine the information overload if we were presented itemized bills for everything we consumed in a restaurant. We’d know the costs of transporting that fine rack of lamb to the city, of its slaughter, of cleaning the abattoir after the slaughter. But to what avail is this information?

Unless you’re a payer hunting for pseudofraud, granularity is a nuisance. So that to avoid long term anhedonia from figuring CBO’s myriad calculations from magical Keynesian models we watch the Kardashians instead.

When you’re rationally ignorant you can be duped. Or rationally duped. But here is the key point: we choose what we allow ourselves to be duped about. No one can fool us twice without our consent.

An Open Letter on the NATE Trust Community

Nov 14, 2014• 22

ADRIAN GROPPER, MD and DEBORAH PEEL, MD

The proposed NATE Trust Community is a privacy-invasive, rent-seeking, and cynical measure that will further fragment the already balkanized Direct secure messaging system and disenfranchise individual patients and physicians.

The proposed NATE Trust Community is a combination of:

weak, self-asserted security and privacy claims by institutions and corporations (privacy-invasive), who are
willing to pay the membership fee (rent-seeking), to the
exclusion of individuals bearing strong identity-proofed certificates such as those issued by the Federal Bridge Certification Authority as originally designed into the Direct secure messaging concept (cynical).

By excluding individual real people from participating in Direct, NATE is violating the core of the physician-patient relationship. The Massachusetts Medical Society has formally voted its objection to this method of implementing Direct in resolutions declaring that FBCA certificates be acceptable for Direct messaging. Physicians paying many $thousands in licensing fees and malpractice insurance each year deserve the opportunity to message with other physicians and with their patients under their medical license. This was our right and practice with Fax and US Mail and it should not be removed as we move to digital messaging.