Author Archives

John Irvine

The Ten Worst Wellness Programs and What They Do to Harm Employees

Dec 4, 2015• 4

By AL LEWIS and VIK KHANNA

If corporate wellness didn’t already exist, no one would invent it. In that sense, it’s a little like communism, baseball, or Outlook.

After all, why would any company want to purchase programs that damage morale,reduce productivity, drive costs up…and don’t work 90%-95% of the time? And that’s according to the proponents. What the critics say can’t be repeated in a family publication such as ours.

Still, those are the employers’ problems. However, the employers’ problems become the employees’ problems when employees are “voluntarily” forced to submit to programs that are likely to harm them. (As the New York Times recently pointed out, there is nothing voluntary about most of these programs.)Continue reading…

Very Bad Numbers

Nov 30, 2015• 51

By ANISH KOKA, MD

The date is July 17th, 2014. It is 10am in the Dirksen Senate building, and the congressional subcommittee on health and aging is about to focus on patient harm. The educating will be done by some of the leaders in the medical field, Ashish Jha and Tejal Gandhi from Harvard, Peter Pronovost from Johns Hopkins. The star of the proceedings is John James, a toxicologist, a PhD from Texas, and the founder of Patient Safety America.

The tone is set from the beginning by none other than Bernie Sanders. In somber tones, he relays that hospitals can make patients worse, and that a recent study suggests medical errors is America’s third leading cause of death behind only heart disease and cancer. Hospitals are killing patients, and something needs to be done about it. The panelists then go on to speak strongly about the ongoing epidemic of patients dying in hospitals, and re-enforce the staggering numbers introduced by Bernie Sanders.

Headlining the proceedings is an unassuming gentleman named John James. He has a Ph. D in pathology, and he worked as a Chief Toxicologist at NASA. He is at the congressional proceedings, and is one of the lead activists in patient safety because of personal tragedy. His 19 year old son died in the summer of 2002 due to “uninformed, careless, and unethical” care by cardiologists. He proceeded to write a book, “A Sea of Broken Hearts” that details the errors he believes cardiologists made in his son’s care that lead to his death. Of note 2 cardiologists that were sought by Dr. James’ lawyers believe the care his son got did not violate the standards of care. A further 2 appeals to the Texas Medical Board also rendered two opinions from two other separate cardiologists that the standards of care in this case were not only met, but exceeded. Dr. James, armed with information he has carefully selected from a number of different sources, strongly disagrees.

Cost, Value & Tools

Nov 29, 2015

By PETER PRONOVOST, MD

Like a pro golfer swears by a certain brand of clubs or a marathon runner has a chosen make of shoes, surgeons can form strong loyalties to the tools of their craft. Preferences for these items — such as artificial hips and knees, surgical screws, stents, pacemakers and other implants — develop over time, perhaps out of habit or acquired during their training.

Of course, surgeons should have what they need to be at the top of their trade. But the downside of too much variation is that it can drive up the costs of procedures for hospitals, insurers and even patients. When a hospital carries seven brands of the same type of product instead of one or two, it’s not as likely to get volume discounts. Moreover, if hospitals within a health system negotiate independently of one another, they may pay drastically different prices for the exact same item.

Carrying many brands of a given item may also increase risks for error and patient harm. Staff members need to be trained and competent in a variety of tools; the greater the number of tools, the greater the risk for error.

These physician preference items are no small contributor to health care costs. Around the year 2020, medical supplies are expected to eclipse labor as the biggest expense for hospitals, according to the Association for Healthcare Resource and Materials Management. Higher costs for physician preference items are major drivers of this increase.Continue reading…

25 Reasons It is Time to Kill Meaningful Use

Nov 22, 2015• 5

By HAYWARD ZWERLING, MD

Over the last half decade, the Federal Government has successfully convinced a majority of physicians and hospitals to begin using electronic health records by providing $30+ billion dollars in subsidies to those who use an ONC Certified electronic health record (EHR) according to the “Meaningful Use” guidelines.

Although the physician community usually consists of a multiplicity of dogmatic opinions, on the subject of Meaningful Use (MU), there is now near unanimous agreement that the MU train has not succeeded in achieving its intended purpose, which was to improve quality or reduce the cost of healthcare. Earlier this month, 111 medical organizations, led by the AMA, sent a letter to Congress asking that MU Stage 3 be delayed and MU Stage 2 be redesigned.

Dissatisfaction with MU even extends to the Chief HIT Geek, John Halamka, M.D., who has concluded MU “Stage 2 and Stage 3 will not improve (health) outcomes” and has called to “Replace the meaningful use program with alternative payment models and merit-based incentive payments.”

In an attempt to objectively assess the MU program, I put together a list of reasons to help me determine whether the MU program should be continued or terminated:

A Blue Jumps the Wellness Shark

Nov 21, 2015• 4

By AL LEWIS

I know it’s not always about me (my ex-wife was quite clear on that point), but I was deeply saddened to see one of the Blues – specifically, Blue Cross of Tennessee — descending into the fabricated-wellness-outcomes abyss.

By way of background, regular readers of this irregular column and/or www.theysaidwhat.net have seen multitudinous examples of vendors telling lies that any fifth-grader could see through. Perhaps the best two examples on this site are Staywell and Mercer reporting mathematically impossible savings for British Petroleum and Health Fitness Corporation admitting they lied about saving the lives of cancer victims in Nebraska.Continue reading…

Academic Tossers

Nov 21, 2015• 7

By SAURABH JHA, MD

When John Milton (Al Pacino) chuckled in the Devil’s Advocate “vanity, definitely my favorite sin,” he may have been referring to academics, not attorneys.

In academia skins are thin, hairs are split, emails are long, humor is self-congratulatory, and everyone cites themselves thinking that they’re Shakespeare. In the land of geniuses pettiness lies next to godliness. Wallace Sayre, a political scientist, once said that academic politics is vicious because the stakes are so low.

The iconoclast, Nassim Taleb, reserves special derision for academics. He took Steven Pinker to task for claiming that violence has progressively declined because of a decline in religion. According to Taleb, Pinker was ignoring fat tails – or the long lull before the storm. Pinker responded by saying that Taleb was being fooled by belligerence.

UnitedHealth Threatens to Pull the Plug. Why? The Obamacare Business Model Does Not Work

Nov 19, 2015• 9

By ROBERT LASZEWSKI

It’s official. The Obamacare insurance company business model does not work.

UnitedHealth Group just announced they expect to lose $450 million in the Obamacare exchanges and are seriously considering withdrawing from the program in the coming year.

This morning, the Wall Street Journal reported just about everybody else is losing their shirts in Obamacare as well:

Several other big publicly traded insurers also flagged problems with their exchange business in their third-quarter earnings Anthem Inc. said enrollment is less than expected, though it is making a profit Aetna Inc. said it expects to lose money on its exchange business this year, but hopes to improve the result in 2016. Humana Inc. and Cigna Corp. also flagged challenges…

There are signs that broad pattern has continued–and in some cases worsened–this year. A Goldman Sachs Group Inc. analysis of state filings for 30 not-for-profit Blue Cross and Blue Shield insurers found that their overall company wide results were “barely break-even” for the first half of 2015.

Three Rules For a Healthy mHealth App

Nov 19, 2015• 1

By JAAN SIDOROV, MD

According to this Wall Street Journal article, the prospect that “your doctor may soon prescribe you a smartphone app” is ushering in a new era of m-healthiness.

e-Researchers from marquee academic institutions are assessing the impact of handheld apps on medication use, symptom management, risk reduction and provider-patient communication. There’s not only an technology platform but an accompanying library of tailored e-prompts, e-reminders, e-pop-ups, e-recommendations, e-messaging, e-images and e-videos.

In other words, mix one part app with one part patient and bake until quality goes up and costs go down.

Why Doctors Still Don’t Text or E-mail their Patients

Nov 15, 2015• 5

By NIAM YARAGHI

According to the Nielsen survey earlier this month by the Council of Accountable Physician Practices and the Bipartisan Policy Center, the majority of medical providers in the United States still do not use emails or text messages to communicate with their patients, despite the fact that such communication channels are in very high demand from the patients.

The survey results are appalling. After all, when you receive text message reminders about your upcoming credit card bill or ask your airline a question about your flight reservation via email, why can’t you communicate with your doctor in the same convenient way? Why are we still using the technology of the 20^th century to communicate with our doctors in the 21^stcentury?

The answer has three sides to it: Economics, technology management and regulations.

The Self-Pay Paradox

Nov 10, 2015• 4

By JESSICA SWEENEY-PLATT

One of the most important trends in healthcare today is the inexorable shift towards high-deductible health plans. Over the past few months, my colleagues and I have analyzed tens of millions of visits to practices using athenahealth’s practice management and EHR services to understand the impact that this shift is having. We believe there are some reasons for providers and practice leaders to worry–the average patient obligation has increased by 20% over the past 4 years, and the number of patients carrying large balances is increasing as well. We have also seen that practices’ ability to collect these obligations is highly variable.

Across our network, patient payments provide nearly one-fifth of physician income, with the median athenahealth provider failing to collect 30% of what patients owe. And the situation is getting worse. As the graphic below shows, patient deductible obligations are up 22% in the past two years–while commercial payments have grown only 4%.

My colleagues and I have studied these trends, and we’ve identified a few things that top-performing practices do to ensure that they are able to collect the dollars that they are owed. In fact, at every step of the collections process–from scheduling to follow-up months after a visit–top-performing practices take a different approach than others. Please join us on November 11th to learn what these organizations are doing to improve patient collections, and how your practice can get to similar results.

Jessica Sweeney-Platt is a lead with athenaResearch