Author Archives

John Irvine

Physician Data on Impact of Health Reform In 2014

Screen Shot 2015-05-13 at 3.05.39 PMOver the past year, our athenaResearch team has been working with the Robert Wood Johnson Foundation (RWJF) on ACAView, an initiative that provides researchers, policymakers and the public with regular updates on how the Affordable Care Act (ACA) is affecting physician provider practices. To accomplish this, we curate and analyze data from a nationally distributed sample of 16,000 providers on the athenahealth cloud-based network. This gives us a timely view into national physician practice patterns and an ideal platform for measuring the impact of health care reform on the day-to-day practice of medicine.

After reporting some initial findings a handful of times, we’ve recently published our comprehensive report from the first year of the ACA rollout: “ACAView: Observations on the Affordable Care Act: 2014” (PDF). Here are some of the more interesting findings from the data:

Many feared a surge of new patient volume. That hasn’t occurred.

In 2014, the coverage provisions of the ACA went into effect, with the intention of bringing millions of patients into stable physician relationships that would improve their health status. Just before the coverage expansion, some commentators expressed concern that physicians might lack the practice capacity to treat these new patients, many of them with unmet medical needs. That has not happened.Continue reading…

Why Are Medicaid Visits Falling In Non-Expansion States?

Josh Gray’s post above triggered a nice Twitter exchange between @ddiamond and @Neoavatara.

Something Completely Different

The Endless Page of Scroll Is Dead .. If you’re an observant reader you may have noticed that things are looking a little different around here. That’s because we’ve “upgraded” the site to a new version of WordPress (WordPress 4.2), a new theme, a responsive new layout and made a lots of other changes that will be appearing in your browser in the near future.

The big thing: from now on you’ll need to be a registered user to comment. The good news is that registering is insanely, mindbogglingly easy.* Click on the register link at the top of the page and give us a user name and a working e-mail.

You’ll be able to join in the online discussion on the site, submit blog posts to the editors for consideration, win cool stuff like tickets to live events in your area, get invites to exclusive THCB meet ups and networking events, send our editors press releases and announcements (if that’s your thing) and do other really fun and productive things that we haven’t thought of yet.

* On the other hand, this is the Internet and stuff breaks for mysterious reasons nobody really understands. If you have trouble registering, email us. We’ll set you up.

And needless to say: if nothing shows up, check your spam filter.

The 5 Percent Conundrum

flying cadeuciiThere is something deeply disturbing about the existence of big fat dossiers of personal information, meticulously collected over a lifetime, and stored under lock and key in dark places you are not allowed to enter. There is something degrading and dehumanizing when those secret files, which contain the most intimate details about you, your children and your loved ones, are only accessible to entities empowered to make life and death decisions for you and for those you care about most. A free society cannot allow this to happen and remain free, but this is a lesson we are destined to painfully learn in the future.

The good news is that when those dossiers are your medical records, our government acted decisively to ensure that every American has a right to not just view the collected information, but also to demand and obtain a copy of the records. Every medical facility, from the largest and most powerful conglomerate, to the humblest rural doctor, is required by law to fork over copies of your medical records whenever you ask for them. Few people ever asked for their medical records, and of those who did ask, many experienced difficulties and delays. If you ever visited the medical records floor in a hospital, you should be able to figure out why.

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Do it for Mom: Sign Up to Support Electronic Access to Your Health Records Today

In many families the mother serves as the Family Health CEO, managing healthcare for her parents, kids, spouse, and herself. It’s Mom who schedules the doctor’s appointments, hunts down the immunization records for school, sorts out the bills, and reminds you to take your pills. 

What a difficult slog! In a world where we can video chat for free, book our travel and pay our bills online, and even go to college without leaving the living room, simple things like getting a list of current medications are almost impossible.  As Family Health CEO, poor Mom fills out the same information on clipboards at multiple doctors’ offices, gets stuck in infuriating phone trees, and bombarded by incomprehensible paper bills and reports on the family’s health, while she never even sees some of the most important information such as lab test results.

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An Open Letter to Sheryl Sandberg

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My heart aches for you, even more because the same thing happened to me. You will get through it. But you never will get past it.

I was so very sorry to hear about your husband’s death. You must be inundated with condolence letters and here I am, adding one more to the pile.

I write from a position of knowing, which makes me unspeakably sad for you. My own husband, Matthew Lyon, died in 2002, while on a business trip. He died suddenly, on a treadmill in the gym of a Seattle hotel. He was 45. Our daughter was eight.

Nobody plans for this. We would all go insane if we did. Because we live life as if we have time.

Here is what I can tell you: From now until forever — a forever your husband will not get to share with you, which contributes to the pain of this — you will question everything you thought was true about your life. Your trust in everyone’s ability to get from A to B without incident will never be the same. We all know that nothing is certain, but we know it in a vague, theoretical, I’ll-think-hard-about-that-tomorrow way. You now know it as established fact, and this changes the way you see everything.Continue reading…

Real Meaningful Use? Curing Healthcare’s Digital Divide

Jaan SidorovFor better or worse, policymakers, politicians and health leaders in the United States are committed to achieving paperless healthcare environment. Even if there is lack of high quality research and reasonable skepticism over the ultimate cost and quality merits of “e”care, there is no going back.

As a result, visitors to ehospitals and eclinics are increasingly surrounded by monitors that, in turn, are surrounded by providers. To gain their attention, patients need to have internet access to make appointments, update medications, obtain education and communicate with their doctor.

And what if they don’t have that access? For the last decade, that worry has been characterized as “the healthcare digital divide. ” As recently as 2014, it’s been documented that the lack of computer hardware and access can have important healthcare implications for persons with low socioeconomic status.

For the doctors and nurses staring at screens all day, the millions of Americans who are living paycheck to paycheck risk being out sight and out of mind.

But it turns out that that it doesn’t need to be that way.

Check out this telling report from the Federal Deposit Insurance Corporation on the “unbanked” and “underbanked.” Not having a bank account (unbanked) or using any financial services (underbanked) are linked to persons with low income, being of color, disability and being unemployed.

In other words, these are the very persons at risk of being on the losing end of the health care digital divide.

While there’s interesting data on how close to 8% of U.S. households are unbanked and just over 20% were underbanked, there were also these stunning observations:

“Relative to fully banked households (86.8%), underbanked households were somewhat more likely to have had access to mobile phones (90.5%) and smartphones (64.5% of underbanked households compared with 59.0 percent of fully banked households).”

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It’s Time to Stop Calling Them EHRs


Jacob RiderIt’s time to stop calling them EHRs.  Yes – we also need to stop calling them EMRs.  In 2011, ONC discussed the difference between the two terms, but I think that conversation missed the point:  whether it’s “medical” or “health” that is the focus, these aren’t (shouldn’t be) RECORD systems at all.  We need to expand our expectations from CRUD to something that we really need: smart tools that help us collaborate toward improving health for individuals.   In November, when I floated this concept, I was teased (corrected?) for focusing on terminology and missing the point that we need EHRs to do more than just store data.

But it’s more than just terminology.  Our words mean a lot. A “record” system is for storage of records.  It saves information.  Our expectations will always focus on storing and retrieving information.  

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Understanding Value-Based Purchasing

Value-based care is one of the most misunderstood and controversial areas in a rapidly evolving healthcare system. This helpful webinar introduces and clarifies many of the core concepts involved in the transition to the value-based model.  You’ll get a walk through of programs offered by CMS. Learn how programs are measured.  Hear about the success of programs to date. Find out what organizational changes are necessary for the transition.

Hosted by Bobbi Brown, Vice President, Financial Engagements at Health Catalyst this event will be held Wednesday, May 13th at 1 PM EST and is free of charge. Bobbi’s healthcare finance background includes high profile roles as an executive with Kaiser Permanente, Sutter Health and InterMountain. Register now to guarantee your spot.

Open Sourcing What Works in Health & Wellness

Screen Shot 2015-05-12 at 9.28.09 AMFew argue that we have a fully optimized healthcare system. In fact, many argue the opposite. I have good news for you. All of the components of a high achieving health ecosystem have not only been created — they have been proven with solid evidence backing them up.

The future is here. It is just unevenly distributed. — William Gibson

Mr. Gibson could have been speaking about healthcare when he made this oft-cited quote. Unfortunately, while we have the components to fix health and healthcare, they are scattered all over the country and world. Healthcare, in it’s present state, is a design failure given the money, smarts and compassion that we invest. Put simply, it rewards the wrong activities. We pay for illness and treatment, and we get more illness and treatment. Even if we had a perfectly designed health ecosystem, the emerging convergence of new genomic insights, smartphones and mobile Internet, the Internet of Things, sensors, wearables and changed reimbursement models creates an enormous new challenge.

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