Year: 2017

Fixing MACRA Should Mean Fixing the APM Pathway

Dec 18, 2017• 5

By DAVID INTROCASO and SCOTT HINES, MD

The Medicare Payment Advisory Commission (MedPAC) has been discussing for well over a year how to reinvent the Medicare Access and CHIP Reauthorization Act’s (MACRA) Merit-Based Incentive Payment System (MIPS). As a result the commission intends to finalize substantial MIPS program reform recommendations in January. Though MedPAC has had good reason to question MIPS, the commission’s effort is misguided. By choosing to address MIPS, MedPAC has lost the forest for the trees. MIPS does nothing to fulfill MACRA’s intent. Title I of MACRA is intended to accelerate the Centers for Medicare and Medicaid Services’ (CMS’) efforts to move Medicare Part B providers into participation in what MACRA terms Alternative Payment Models (APMs), or more specifically advanced APMs. This goal remains in the balance.

MedPAC’s Critique

Authorized in 2015, MACRA was designed to replace the 1997 Sustainable Growth Rate (SGR) formula by moving physician practices from Fee For Service (FFS) to pay for performance arrangements, or APMs. The MIPS simply replaces and consolidates three previously existing FFS payment incentive programs that date back to 2006: the Physician Quality Reporting System (PQRS); the Electronic Health Record Incentive Program (termed Meaningful Use or MU); and, the Physician Value-Based Payment Modifier program (termed VM).

Trump, Stalin and the Price of Replacing Science with Ideological B.S.

Dec 16, 2017• 25

By ART CAPLAN

Donald Trump and many of his closest advisors have been accused of colluding with Russia to win his election as President. We shall see what Robert Mueller and the FBI discover in that regard. But, whatever truth emerges there is no doubt that Trump has ripped a page from a long-dead leader of the Soviet Union, the monster Joseph Stalin, to undercut science in the name of his ideological goals.

Friday the Washington Post reported that a senior leader at the Centers for Disease Control and Prevention was told not to use certain words in documents “related to the budget and supporting materials that are to be given to the CDC’s partners and to Congress”. Policy analysts at the Centers for Disease Control and Prevention in Atlanta the Post said were given a list of forbidden words at a meeting with senior CDC officials. The seven prohibited words are:

Vulnerable
Entitlement
Diversity
Transgender
Fetus
Evidence-based
Science-based

What does Trump’s disgraceful censorship of science by banning words known to be useful, valuable, essential and important have to do with Stalin and Russia? Everything.

Stalin like Trump only wanted to hear scientific words when they confirmed his political beliefs. He did not care if by implementing false news he killed millions of his citizens. Trump with his decision to ban scientific terms in public policy that don’t suit his taste is proudly marching in Uncle Joe’s bloody footsteps.

Healthier Communities Emerge From Enhanced Data Collection & Collaboration

Dec 16, 2017• 9

By PETER LONG

With the implementation of the Affordable Care Act and the push toward the Triple Aim of patient-focused care, lower costs, and improved health of populations — “population health” has become a buzzword, often coming to mean improving medical care or simply delivering healthcare to larger groups of people. While providing high-quality healthcare is critical, improving the health of a population is a much bigger endeavor.

Improving population health ultimately means creating healthy communities. It involves a myriad of interrelated factors that contribute to an individual’s health – such as safety in the home, appropriate housing, education, access to healthy food, clean air, time and space for recreation, social connections, and mental health services.

In a large, diverse, and inclusive state willing to invest in its people—with many funders pledging support for new approaches, California has become a proving ground for innovative programs to improve population health and serve as models that can be replicated elsewhere. Successful models have some things in common: They use data to precisely identify which factors are impacting health: establish shared goals and benchmarks; and track progress over time.Continue reading…

The Fight to End Alzheimer’s Should Start Earlier Than You Think

Dec 16, 2017• 2

By SHANNON HALLOWAY & MELISSA KALENSKY

A patient walked into clinic wearing only a hospital gown, feet bare and EKG wires trailing. Just hours after having surgery, his dementia had prompted him to wander out of the hospital and walk two miles to proudly show off his new surgical scar to a familiar face. Physically unharmed, his heart was easy to fix but his memory was beyond repair.

Though the road to a cure has long seemed insurmountable, dementia advocates have recently found reason to celebrate. Scientists announced this week the development of a new tool that may help identify people who are prone to Alzheimer’s disease, and Bill Gates has made a 100 million dollar pledge to join the fight. These vital research dollars give renewed hope to millions of families who already realize that by the time any kind of dementia is diagnosed, treatment options are incredibly limited.

Steal From the Poor. Give to the Rich. Rinse. Repeat. The Tax Bill and Health Care Part II..

Dec 15, 2017• 11

By STEVEN FINDLAY

“We’re going to have to get back next year at entitlement reform, which is how you tackle the debt and the deficit. Frankly it’s the health-care entitlements that are the big drivers of our debt…that’s really where the problem lies, fiscally speaking.”

— Paul Ryan, Dec. 6, 2017 on a talk radio show.

Amazing. You have to give Ryan credit for consistency and a kind of brutal Republican honesty. Within weeks of pushing a huge tax cut for corporations and the wealthy, he’s basically saying Republicans plan to pay for that by making cuts to Social Security, Medicare and Medicaid.

Ryan’s “Roadmap for America” laid it all out in 2008: privatize Social Security, transform Medicare into a premium support plan, and block grant Medicaid.

Of course, Ryan is correct about these programs from a “fiscally-speaking” point of view. The three do make up the lion’s share of the federal budget and their current rate of growth is unsustainable. Come 2035 and beyond they would start to gobble up almost the whole federal budget. The three programs will comprise about 50 percent of the $4.1 trillion federal budget in 2018.

And here’s a whooping number for you: Social Security, Medicare and Medicaid will cost the government $28 trillion through 2027.

But let’s be very clear about what is happening now that could set a dangerous precedent for the future. The Republican-led House and Senate, with the support of the Trump administration, have passed tax reform bills that primarily cut taxes for corporations and people making over $150,000 a year.

Applying Psychology to the Challenge of Internal Health Adoption

Dec 14, 2017• 2

By AMELIA EDWARDS

Adoption of technology in the healthcare field has been happening at an incredibly slow pace. This is a fact that few would disagree with. The market is saturated with health tech companies that are vying to be the next big unicorn in the field, but long sales cycles and simple underestimations of what is needed for HIPAA and FDA approval has led to the demise of many of these projects. The ones that do receive enough series funding to produce finessed products for health systems and pharmaceutical companies however soon realize that the battle against time is not over.

Simply getting into a health system is not enough. Once a contract is finally ironed out and the software is exchanged, the next uphill battle against the slow-pace of internal adoption is mounted. Not only is a speedy adoption important for hospitals to demonstrate that their purchases and investments were appropriate, but it is also key for founders who hope to demonstrate that their product works. Nothing is worse than the painfully slow adoption internally of a piece of technology. One bad experience has the potential to tarnish an organization’s appetite for future tech ventures.

The Boys From Silicon Valley

Dec 14, 2017• 12

By MARGALIT GUR-ARIE

A few weeks ago one man, named @jack, decided that millions of people will be allowed to use up to 280 characters when expressing themselves on Jack’s public square platform. One man decides how many letters each and every one of us, including the “leader of the free world”, can use when we talk to each other. Just like that. Nobody seemed the least bit perturbed by this notion. Another dude, named Mark, decided to ask people for nude pictures of themselves, so he can better protect them from the bad guys. We shrugged that off too. Then, in a most embarrassing exercise in public humiliation, our democratically elected representatives begged three slick lawyers representing these platforms to effectively regulate what people can say or see on “their” platforms.

So here we are, in the land of the free and the home of the brave, where Jack and Mark decide what you can or cannot say, and what you can or cannot hear or see. This, my friend, is the power of “platforms”. In the old days, it used to be that he who pays the piper calls the tune. In the artificially intelligent technology age there are no pipers. He who owns the pipe makes it play whatever the hell he wants it to play. And as Sean Parker, a Facebook founder, elegantly put it, “God only knows what it’s doing to our children’s brains”. Perhaps God knows, but he is certainly not the only one who knows, because these platforms are built with the explicit intent to get people addicted to and dependent on the platform.

Funded with cash from sexist pigs and harassers, a startup, whose business model is to help other startups “hook” people on trashy little apps, is calling itself Dopamine Labs. “Dopamine makes your app addictive” is their promise. According to the website, they use AI and neuroscience to deliver jolts of dopamine that “don’t just feel good: they rewire the brain’s habit centers” of users to “boost usage, loyalty, and revenue”. “Your users will crave it. And they’ll crave you”.

See What You Missed At The Tech For Precision Health Summit

Dec 14, 2017

Health 2.0 just wrapped up its inaugural Technology For Precision Health Summit. A collective group of investors, entrepreneurs, and precision health workers gathered for a day of sharing, charged discussion, and live technology demos; all with the goal of pushing hard to advance an industry that is often a matter of live or death.

Some major themes emerged throughout the day including:

>Consumer Fear
>Bridging Data Silos
>Identifying Federal Policies that are either stifling or catalyzing innovation

Check out the full recap here!

OptumCare Can Reach 70 Percent of the US Population

Dec 13, 2017• 2

By TORY WOLFF

Who will be the first to take integrated health care delivery national?

A few years ago, the best bet might have been an established provider with a nationally compelling brand and a growing affiliate federation such as Cleveland Clinic or Mayo. Instead, Optum – just a decade ago three separate services largely focused on serving United’s health benefits business – has entered care delivery and — by a constant stream of acquisitions big and small — built up beachheads in a majority of markets and is – via ongoing big acquisitions, tuck-ins and greenfield expansions – laying the foundations of a national integrated ambulatory system.

Particularly in light of the latest rumors about the role of clinics in driving the value of a potential AET-CVS combination, it is timely to take a look at what Optum has put together, size its geographic reach and discuss some strategic implications.

Job Ad: CEO for Soleforce

Dec 13, 2017

Soleforce, Inc., a new digital health startup based in New York City and incubated out of the Hospital For Special Surgery (HSS), is looking for an energetic and resourceful Chief Executive Officer (or CEO) to join its founding team. Soleforce, Inc. markets the SOLEFORCE™, a patented device that helps patients successfully recover from lower limb injuries. The SOLEFORCE™ allows fractures to heal by ensuring the proper weight distribution on an injured limb and greatly reduces the possibility of damaging hardware, bones, ligaments and tendons post surgery. The SOLEFORCE™ displays how much weight is being applied to an affected limb in real time and outputs sensory notifications that ensure the patient remains at or below prescribed weight-bearing targets. Information from the device is shared with physicians and physical therapists who can use the data to monitor a patient’s progress and customize the care plan. The SOLEFORCE™ addresses a major unmet need in a large market that includes approximately 2 million lower limb injuries per year in the United States alone. The device is FDA-cleared (via Class II 510(k) exemption) and the patent for the underlying sensing technology was issued in early 2017. A pilot clinical study demonstrating safety and efficacy has already been completed, and additional studies are being planned. More information about the opportunity can be found here.

Interested applicants should contact Jean-Luc Neptune at je************@***il.com.