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Month: December 2015

The Cost-effective Cardiologist..

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By ANISH KOKA, MD

Anish KokaSafe, appropriate, effective care at a reasonable cost.  Such a simple goal.  The message is clear. Leaders in hospitals, congress, and even my chihuahua echo the dawning of a new age in health care. Down with the private practice, fee-for-service mentality, they all say.  I pay attention to a lot of this chatter since I happen to be in private practice.  I split my time on the internet between the latest exploits of the Kardashians and gravestones for my practice.  I can picture the epitaph:

In loving memory of

Koka Cardiology
3/1/2013 – 3/1/2016.
Shed not for her the bitter tear
Nor give the heart to vain regret
‘Tis but mere ashes that lie here
The gem that filled it sparkles yet

As I shuffled towards this abyss, my reverie was broken by a letter.  It was from Independence Blue Cross (IBC) in Pennsylvania.  It was titled: The Cardiology/Invasive Cardiology Comparative Cost report.  It looked like a report card, so I opened it with some trepidation.
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Two HIT Developers Respond: Why We’re Still Optimists About Technology’s Potential

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By ANDY ORAM and SHAHID SHAH

The authors of this article like to believe that we can remain humanists while transitioning from a paper-native to a digital-native industry. We even believe you can remain a humanist while following regulations and sticking to industry guidelines. Margalit Gur-Arie doesn’t seem to feel that way. We have read her work over the years and established that she takes a staunchly humanistic approach to health IT. But even though she’s a leader in that space, she appears to doubt the contributions that either technology or regulation make to a humane health system.

Gur-Arie’s most recent posting dismisses all the tools that electronic health records throw in the way of the doctor: clinical decision support (now often called evidence-based medicine–were we Gur-Arie, we’d say it’s because who can argue against evidence?), reminders, pull-down menus to provide a limited range of choices, and more.

One immediate response is to suggest that, instead of blaming the tools, one should blame the requirements imposed on clinicians by payers and governments–the “thousands of meaningless regulatory words” as Gur-Arie writes eloquently. But the real answer is that these requirements (well, the ones that were thought through) enhance the health care system, and that the problem with current EHRs is that they just “pass through” the requirements, intensifying the burden placed on doctors, instead of finding true innovations when implementing those requirements.

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Tackling Rising Pharmaceutical Prices: 50 Shades of Gray

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By SUSAN DENTZER

Global New Active Substances (NAS) Available Since 1996

Screen Shot 2015-12-10 at 8.37.13 AM

Here’s the problem with high and rising pharmaceutical prices:  It’s not just one problem, but many.  Addressing them will require a range of solutions – many of them difficult to execute, and possibly tough medicine to swallow.

These were key takeaways from the recent U.S. Department of Health and Human Services Pharmaceutical Forum,which I moderated.  A broad group of stakeholders participated, including patients, consumer groups, pharmaceutical companies, pharmacy benefits managers, insurers and others.  The key issues: Obtaining the greatest value for the dollars we spend on drugs –and having a vital biopharmaceutical sector that produces vaccines, effective treatments,and cures, at affordable costs for patients and the nation.

Having slowed along with the rest of health care spending in recent years, pharmaceutical spending is now roaring ahead. Total pharmaceutical sales, now about $400 billion annually, are projected to reach as high as $590 billion in 2020, according to Doug Long, vice president of industry relations at IMS Health. New National Health Expenditure data show that national retail prescription drug spending grew 12.2 percent in 2014 – a sharp increase over 2.4 percent growth in 2013  — in large part due to increased spending for new drugs, such as cures for Hepatitis C.

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Health 2.0 Presents the Final Agenda for WinterTech 2016

By DEEPA MISTRY

Screen Shot 2015-12-09 at 2.18.47 PMHealth 2.0 announces the final agenda for the WinterTech conference, January 13, 2016 in San Francisco, California. As the only event dedicated to health tech and investing during the health investment mecca, JP Morgan Week, the event features leaders from Venrock, Canvas, Grand Rounds, Doximity, Livongo, Omada Health, Maverick Capital, GE Ventures, Kaiser Permanente and more. The conference brings together top health tech entrepreneurs, investors, and the health care establishment to discuss financial and business trends. “Everyone knows by now that health tech is a hot place for venture investing,” says Health 2.0’s Co-Founder Matthew Holt. “At Health 2.0 WinterTech, we are going to uncover the secrets of how the top VCs think and how they work with the star CEOs.” Key speakers will include:

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What Would Issac Asimov Do?

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By PAUL LEVY

I_Robot

The Three Laws of Robotics  are a set of rules devised by the science fiction author Isaac Asimov. The rules were introduced in his 1942 short story “Runaround“, although they had been foreshadowed in a few earlier stories. The Three Laws, quoted as being from the “Handbook of Robotics, 56th Edition, 2058 A.D.”, are:

  1. A robot may not injure a human being or, through inaction, allow a human being to come to harm.
  2. A robot must obey the orders given it by human beings except where such orders would conflict with the First Law.
  3. A robot must protect its own existence as long as such protection does not conflict with the First or Second Laws.

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This Is Not A Disruptive Blog Post

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By MICHEL ACCAD, MD

Michel AccadFrank Knight, risk and uncertainty

In this article, I wish to introduce the reader to the theory of entrepreneurship advanced by Frank Knight (1885-1972), and show that the common, everyday work of the physician could be considered a form of entrepreneurial activity in the Knightian sense.

Knight was an influential American economist. He is best known for his book Risk, Uncertainty, and Profit in which he proposed to distinguish risk and uncertainty as follows:

Risk pertains to situations where outcomes occur with a frequency that is quantifiable according to probability distributions.

Risk may be mathematical and a priori knowable, meaning that the probability function that governs the outcome is known with certainty, as in the case of a coin toss (assuming the coin to be well balanced).

Risk may also be statistical, where the outcome can be estimated according to an empirically discoverable probability function. This is the case in situations where we know the set of possible outcomes and can make observations under controlled conditions to determine the probability of occurrence of each outcome.

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A Health IT Developer’s Confession: How Bad Software Is Made and What to Do About It

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By MARGALIT GUR-ARIE
It was a dark and stormy night. My computer didn’t catch fire while typing the previous sentence. No alarms were triggered warning me about the quality of such opening. I wasn’t prompted to select subjects and predicates from dropdown lists. I typed the entire sentence, letter by letter, not at all dissimilar to its first rendering back in 1830. Computer software in general, and Microsoft Word in particular, magically removed the hassles of quills, ink, paper, blotters, sharpeners, ribbons, whiteout, carbon paper, dictionaries, and all the cumbersome ancillary paraphernalia needed to support authoring, but made no attempt to minimize the cognitive effort associated with writing well.  Authoring great literature today requires as much talent and mastery as it did in the days of Edward Bulwer-Lytton.
For several decades, software builders have tried to help doctors practice medicine more efficiently and more effectively. As is often the case with good intentions, the results turned out to be a mixed bag of goods, with paternalistic overtones from the helpers and mostly resentment and frustration from those supposedly being helped.Continue reading…

What Killed Scott Weiland?

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By JOSEPH KRAININ, M.D.

Scott_Weiland_(Stone_Temple_Pilots)_Open_Air_St._Gallen_(rotated)His voice had the unusual ability to convey both aggressive muscularity and profound vulnerability. Scott Weiland and Stone Temple Pilots were icons of my adolescence. Personally, my memory of Mr. Weiland will always be inextricably linked with “Plush,” that initial hit single which, upon first listen, instantly captivated me and thousands of other kids like me. During my high school days, “Plush” was elevated to the highest sonic status possible, joining Metallica’s “Enter Sandman” and Pearl Jam’s” Black” as an essential component of our football team’s pre-game locker-room pump-up playlist.

So it was with shock and sadness that I read in the New York Times this morning that Weiland had “died in his sleep” on Thursday during a tour stop in Bloomington, MN. He was 48.

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Reduction in Hospital Errors—Progress, But Still Not Enough

By STEVE FINDLAY

Steve Findlay

Fifteen years after the landmark IOM report To Err is Human, we still haven’t figured out how to count medical errors and iatrogenic harm—let alone sharply reduce them. The debate surrounding this persists, as it must. For example, see the dialogue on THCB between Anish Koka and John James on the often-used figure of 400,000 deaths per year from medical errors. See also this Health Affairs blog from 2012 by Michael Millenson.

A simple answer to why it’s so hard to count medical errors, harm and deaths is that—well, it’s just a damn hard thing to do. Think about it: how on earth would we document every mistake, even fatal ones. It seems nearly impossible. It’s not like counting auto accidents or plane crashes. The majority of medical errors occur at a nuanced level, but yet can have profound effects down the road, as the IOM’s report on diagnostic errors recently emphasized.

A more complex analysis of why medical errors are hard to count and prevent would start with the fact that reporting is still largely voluntary. For example, we know next to nothing about medical errors in doctor’s offices and outpatient surgery centers, and we don’t have a complete picture for hospitals.

Then there’s the whole issue of which medical mistakes are truly preventable and should be counted as such—that’s part of the debate between Koka and James. The upshot: preventability remains very much in the eye of the beholder.  Patient safety activists argue that the debate over preventability is a diversion from pursuing a strategy of zero tolerance for errors. As support, they often point—justifiably—to success stories where concerted efforts have led to dramatic reductions in errors and hospital acquired infections. But doctors have long countered that medicine is a human enterprise that can never be perfect, that mistakes are inevitable, and that they have less control over medical outcomes than is often assumed.

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What’s Missing in the Debate Over Employer Wellness Programs

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By SUSAN DENTZER

Susan-Dentzer-For-PostBy now, Americans are no doubt getting used to debates that put show over substance and skirt the genuinely profound issues the nation faces. But although we may have come to expect as much in this political season, we deserve better when it comes to contemplating the role of employers in improving employees’ health.

A recent “debate” sponsored by the Population Health Alliance about employer wellness programs – the various health promotion and disease prevention strategies that about half of U.S. employers offer,  such as weight loss, smoking cessation and onsite gym classes – fell into the depressing pattern of highlighting the largely irrelevant at the expense of the important. The debate, which took place last November 2 at the alliance’s 2015 Forum in Washington, DC, pitted two frequent combatants:Al Lewis, founder of Quizzify and co-author of a book critiquing wellness programs, and Ron Goetzel, senior scientist at Johns Hopkins University’s Bloomberg School of Public Health and leader of the “Promoting Healthy Workplaces” program supported by the Robert Wood Johnson Foundation.

The ostensible topic was whether wellness programs benefited employees, companies, and society at large, but the debate never actually addressed this broad question. Most of the time, the session’s verbal jousting focused on a far narrower issue: whether companies saw any financial return on investment (ROI) on the dollars they plow into wellness programs.

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