Month: December 2015

What the Wall Street Journal Tells Us About Complications After Surgery: Not Much

Dec 31, 2015• 7

By ANISH KOKA, MD

The Wall Street Journal published an article on Christmas day that told the story of an 83 year old woman who suffered a heart attack after a joint replacement at a rural hospital. The story serves as an introduction to a piece about the higher cost and poorer care delivered at rural hospitals. There are certainly some very interesting points I was not aware of with regards to financial incentives provided by the government to do procedures at rural ‘critical access’ hospitals, as well as higher 30 day mortality after joint replacement surgery at these rural hospitals.

The Wall Street Journal article does provide this nugget from a Harvard public health researcher: “Patients are getting bad outcomes, probably because they are getting procedures at hospitals without the experience to do it well.”

This certainly may be true, but no data exists in the article to back-up this assertion. Are there more infectious complications of the surgery? Are there more re-operations? Are the surgeons that operate at these centers less experienced?

21st Century Cures Act: Away From the “Valley of Death”

Dec 31, 2015

By STEVEN ZECOLA

Most people would agree that the number of cures for debilitating and costly illnesses such as Alzheimer’s disease, Parkinson’s disease and cancer have been too few and far between.

To address this issue, the U.S. House of Representatives recently passed the 21st Century Cures Act, which now resides in the U.S. Senate for action. The main thrusts of the Act are to increase government funding for research and to improve several regulatory processes.

Unfortunately, the Act does not address the root cause of the dearth of cures; namely, the inhospitable investment climate for research and development (“R&D”) culminating in the “Valley of Death” for most health-related discoveries.

How Should Errors In the Patient Medical Record Be Addressed?

Dec 30, 2015• 3

By PETER ELIAS, MD

This summer an article in USA Today talked about Regina Holliday’s efforts to make the medical record more easily and promptly available to patients so it becomes as a tool patients use as they engage in co-managing their own care. Her cause is just and her story is compelling, so I was dismayed at the pushback saying: Not so fast. There are lots of errors and ambiguities in the record, so it is in everyone’s best interest to make the record hard for patients to obtain.

What a concept.

The commonest examples listed by opponents of patient access to patient information reflected a combination of poor communication with patients and concern about the extra work that transparency might require for institutions and clinicians. For example:

“…the majority of patients don’t understand differential or provisional diagnoses and want those removed, because they say they are an error. The majority of patients don’t understand trade versus generic drug names, and want those removed because they are an error. The majority of patient’s don’t understand autopopulation of fields (when you click normal) and say the doctor didn’t ask me those things, and want them removed because they are an error; the majority of patients don’t understand spontaneous abortion, and definitely want that removed it, because they never had an abortion; the majority of patients don’t want “dependence on” anything included in their records, and want it removed because it’s an error…. they are very unhappy with all the errors in their medical record. And then, there are the legitimate errors due to poor documentation on admission, hospitalists who see the patient once and don’t review the record adequately, and nursing staff who just want to get their charting done and go home.”

Wow! Everyone who works with medical records knows that the record is full of both errors and ambiguity. The question is what to do about it. There are two general categories of response.

The 2016 Regulatory Landscape: A Review For Health Care Watchers

Dec 30, 2015• 1

By PAUL KECKLEY

The healthcare industry in the U.S. is highly-regulated at the state and federal levels, and the balance between the two depends on what part of the industry you’re in. To illustrate—

Health insurers are overseen by state insurance regulators, but the Affordable Care Act added a new layer of federal oversight. The current tussle between HHS and the National Association of Insurance Commissioners over what constitutes an accessible network of providers is a case in point.

The 56,000 retail pharmacies are overseen by states, but drug manufacturers and distributors are overseen by the FDA and FTC, and the 3000 compounding pharmacies find themselves regulated by both.

Physicians are primarily self-regulated by their state licensing and disciplinary boards, but federal rules that require transparency (Physician Sunshine Act) about their performance and prescribe limitations in their business dealings (Stark rules) take precedent.

The Year of the Hacker

Dec 29, 2015• 3

By JK Wall

2015 was the year health care got serious about cyber security.

Hackers gave the industry no other choice.

The year started with a massive data breach at Indianapolis-based Anthem Inc., which the health insurer revealed on Feb. 4. Hackers roamed around in Anthem’s computers for six weeks and stole personal and financial information of 78.8 million customers, as well as the information of 8.8 million customers at Blue Cross and Blue Shield plans not owned by Anthem.

There have been 269 data breaches at health care organizations this year, according to statistics collected through Dec. 22 by the Identity Theft Resource Center. That’s actually down from 2014, when health care organizations suffered 333 breaches.

But the number of records stolen has soared to 121.6 million records stolen, up from less than 8.4 million records in 2014. Even without the Anthem breach, there were still 34 million records stolen this year from health organizations.
The health care industry accounted for one out of every three breaches recorded by the Identity Theft Resource Center.

“They can and are trying to break into everything,” Doug Leonard, president of the Indiana Hospital Association, said of hackers. He added, “It’s really on everybody’s radar screen in the health care industry.”

In a survey released in August by consulting firm KPMG, 81 percent of health care executives said their organization had suffered a cyber attack in the previous two years and 13 percent said they were being attacked daily.

Why Meaningful Use Has to Go

Dec 28, 2015• 39

By MARGALIT GUR ARIE

We don’t win anymore in health care. After repeatedly drilling in our heads that America’s sick care system is a disaster, that those who care for the sick are incompetent and stupid, and that the sick themselves are losers, Meaningful Use was advertised as the means by which technology will make health care great again. The program has been in place for 5 years and the great promise of Meaningful Use is just around the same corner it was back in 2011. The only measurable changes from the pre Meaningful Use era are the billions of dollars subtracted from our treasury and the minutes subtracted from our time with our doctors, balanced only by the expenses added to our medical bills and the misery added to physicians’ professional lives.

Meaningful Use, a metastasizing web of mandates, regulations, exclusions, incentives and penalties, is conveniently defined in the abstract as a set of indisputably wholesome aspirational goals for EHR software and its users, which stands in stark contrast to the barrage of bad news flooding every health related publication, every single day. Health care in America used to be the best in the world, but now our health care is crippled. Meaningful Use of EHR technology will improve quality, safety, efficiency, care coordination, and public and population health. It will engage patients and families, and it will ensure privacy and security for personal health information. With Meaningful Use leading the way, health care will be winning so much that your head will be spinning. You won’t believe how much we’ll be winning.

Be afraid, be very afraid

Bombastic? Laughable? Easily dismissible by educated people? Not so fast. According to Dr. David Blumenthal, president of the Commonwealth Fund, and former National Coordinator for Health IT, “we probably have the worst primary care system in the world”. Yes, worst system in the whole wide world, worse than Niger, Malawi and Somalia. Probably. According to a hobbyist “study” that extrapolates its “results” from a handful of other studies based on an admittedly inaccurate tool intended for different purposes, 440,000 people are killed in hospitals due to preventable errors each year – “that’s the equivalent of nearly 10 jumbo jets crashing every wee k”. Or, with a little more math, half of all hospital deaths, and one in six US deaths, are due to negligent homicide perpetrated by psychopathic doctors and nurses.

The Quest For Zero Infections: A Fool’s Mission?

Dec 27, 2015• 5

By ANISH KOKA, MD

Joyce is sick. I am in the intensive care unit, peering at vital parameters that glow on the screen above her bed. My eyes linger on those numbers because it is easier than looking at her. A fever rages, her core temperature reads 103.4 degrees. Her white hair is plastered on her forehead with sweat, and a tube to help her breathe emerges from her mouth and heads to a ventilator that angrily tweets a musical alarm every few minutes. Her breathing is painfully obvious. Her stomach moves paradoxically inward on every breath, and I can see the muscles in her neck tense with the effort of every breath. Mercifully, her eyes are closed. A nurse walks in and starts to change a bag of fluids that is hanging by her bed. I follow the flexible plastic tubing that arises from the bag to an infusion pump, and then to a catheter that snakes under a see-through dressing underneath Joyce’s left collarbone. I ask the nurse about how long the catheter has been in place…’3 days’…I’m told. I mutter about the possibility of a central line infection – the dreaded central line-associated blood stream infection (CLABSI). The nurse shakes her head, and tells me – “we don’t get those anymore”.

CLABSIs are ground zero in the war on preventing patient harm. The story entered the mainstream consciousness in the lyrical words of Atul Gawande in the New Yorker in 2007. There he told a story of an unlikely Superman in the form of a critical care intensivist named Peter Pronovost. Dr. Pronovost was waging war against infections from these nefarious central lines that were saving and killing patients at the same time. He published a landmark study in the New England Journal of Medicine that used an evidence-based intervention to dramatically reduce infection rates in the intensive care unit. Some form of the implementation bundle that worked for Dr. Pronovost soon found itself in ICUs everywhere. Dramatic reductions in CLABSI rates followed.

Thirty Events That Really Did Very Little to Change Health Care’s World

Dec 27, 2015

By PAUL LEVY

It was with some dismay that I read Modern Healthcare’s article called, “The 30 events that rocked healthcare’s world in 2015.” I jumped into the piece, confident that I would, indeed, find some developments that have made a difference in the quality and safety of patient care, that would introduce transparency, and that would encourage a greater partnership between clinicians and patients and families.

What I found instead was a version of The Nightly Business Report–a series of stories mainly about the corporate and financial interests of pharma, insurance companies, big hospitals, and big government. These stories have nothing to do with what actually happens on the floors and units of America’s hospitals or in the offices of local physician practices. There is nothing in the stories that is motivational to the doctors, nurses, and other health care professionals who have devoted their lives to taking care of us. There is nothing in the stories that presents an empathetic view of what happens to us when we interact with the health care system as patients or families.

This Year Give The Gift of the Health Care System

Dec 26, 2015• 5

By NATHAN MOORE, MD and ELISABETH ASKIN,MD

The United States health care system is a big, expensive mess, and the people working in the system today often don’t even know how to start learning about the system, and it’s problems. My own frustration with the health care system – and lack of teaching about it during medical school – lead me to write The Health Care Handbook: A Clear and Concise Guide to the US Health Care System with my colleague Elisabeth Askin. The goal was to create an understandable primer on the health care system for providers so that we can all work together to improve the system and help our patients.

We have partnered with THCB to provide excerpts from the 2nd edition of the Handbook, which will provide background and insight on important health care issues that we face today. We would love your questions, comments and feedback. Today’s excerpt provides a brief overview of the state of the US health care system today.

Cost

The U.S. currently spends more than 17% of its national gross domestic product (GDP) on health care, far more than any other country in the world. Health care spending now averages almost $9,000 per American,¹and health care is the fastest growing industry in the country.²Private (nongovernmental)health care spending accounts for a large portion of the difference between spending in the U.S. and in other industrialized countries.

Organisation for Economic Co-operation and Development, “Health Statistics2013,” June 2013. Note: Values in U.S. $ Purchasing Power Parity. Data for Japan and Australia refers to 2008.

Access

The U.S. has fewer physicians,hospital beds, physician visits,and hospitalizations per capita than most other industrialized countries.³ Eighty-five percent of Americans report having a regular source of ongoing care, but more than a quarter encounter difficulty accessing the healthcare system.⁴ There are large disparities in access by type of health insurance coverage.

Was Martin Shkreli Arrested For Hiking Drug Prices?

Dec 22, 2015• 10

By SAURABH JHA, MD

I don’t subscribe to conspiracy theories. I never believed a second shot was fired. Nor do I believe that Bill Clinton was stalked on the grassy knoll. So I won’t speculate that Martin Shkreli’s arrest for alleged securities fraud that happened years ago is related to his raising Daraprim’s price by 5500 %.

Just because something isn’t suspicious doesn’t mean that it isn’t odd.

Shkreli is a perfect poster child for rapacious pharmacocapitalism – so perfect that it’s odd. He openly admits “I have a sworn duty to my shareholders to maximize profit.” Shkreli’s admission is odd not for its implausibility, but brazen honesty.

Who, in the business of making money, says they’re in the business for profit?

Elizabeth Holmes wants to change the world, including Africa, by biotechnology, and she has recruited Henry Kissinger, known for his contributions to emerging economies and biotechnology, to help. Even Goldman Sachs believe their work leads to greater good. Their CEO once said banking is “doing God’s work.” I developed a Richter’s hernia reading that.