By THCBist

Have a prediction for 2016?

Send them in. There’s still time.

Want to know what the crystal ball holds in store? Register for athenahealth’s “The Future of Healthcare: Predictions for 2016.”

Saurabh Jha writes:

My predictions for 2016:

1. ICD-10 will not have caused a third world war centered in the middle east. However, it might have persuaded some physicians to consider a third career, may be as coders. Meanwhile, ISIS changes their torture tactics from decapitation to ICD-11.

2. We will still be discussing what is quality and what is value. Meanwhile, Propublica’s surgeon scorecard will have the same fate as Leo Tolstoy’s War and Peace – one is too ashamed to admit one didn’t read it.

3. Interoperability will finally be achieved by redefining interoperability. “Interoperability is when disparate electronic health records in disparate healthcare systems do not wage physical war against each other.”

John Irvine of THCB writes:

“In 2016 Donald Trump will propose a wild health reform plan combining free-market principles, the ritualistic destruction of most of Obamacare (except for the parts that quote “work okay”) with elements of the Swedish, French and Japanese systems and the deployment of “lots of attractive doctors.”

Pundits will spend most of year debating the insanity and surprising merits of the plan.”

Matthew Holt of THCB writes:

“In 2016 Health 2.0 technologies will add diagnostic tools to now mainstream virtual visits

ballsy prediction — Several big hospitals default on bonds as inpatient volume craters and they still have to pay for their EMR implementations

amusing prediction  — Epic tries to buy athenahealth, eClinicalWorks & Practice Fusion but is stopped by the DOJ”

B.S. writes:

1. ICD-10 will cause an explosion in fraudulent and abusive medical bills during a messy implementation

2. Health Catalyst will file for an IPO and IBM will preemptively buy them

3. Revenue Cycle Management companies, in the face of reimbursement changes, will attempt to morph into analytics companies.

4. One or both of the mega health plan mergers will not be approved due to market concentration concern.

5. Centene/Health Net merger will get done and Centene’s stock will hit a post split $100 by year end 2016.

6. United Healthcare will lose to Humana and Health Net for the new TriCare contract as three regions are reduced to two- UHC will lose its appeal”

Andy Oram of O’Reilly writes: 

“The 1980s have returned, and the HMO battles with them. In the 1908s, capitation was used by insurers to deny necessary care. Now, instead, patients are forced to accept high deductibles and are told to control costs — while the institutions in health care withhold the necessary information. See http://bit.ly/1Mxb5zj

Unable to wait for standards to evolve in structured patient data, health care providers and payers will turn on a massive scale to natural language processing to extract structured data from free-text patient notes.

We’ll admit that genetic research, the great hope held forth by the Precision Medicine initiative and other futurists, will not solve most health problems. The interactions among genetic markers and between the markers and the environment are too complex to predict or alter.

Institutions will hold back on sharing patient data for research purposes because anonymization removes too much useful detail and interoperability remains almost insurmountable. Instead of the promised future of big data crunching on enormous data sets, we’ll see more focused research based on medium-sized, local data sets.”

Rob Lamberts writes:

“1.  ICD-10 will create increased physician distress and ennui – This not only increases the overall workload of medical offices, but it does so while putting their cash-flow at risk.  At a time where physician dissatisfaction and frustration is high, adding more work and potentially less income is a disaster waiting to happen.  EMR products, of course will pose as the guy in the white hat ready to rescue doctors, but this will only serve to associate these record system with one more distasteful thing.

2.  With this increase in angst, doctors and patients will increasingly seek alternatives.  Patients will continue demanding access to their records and an increase in their role in their own care.  Doctors will move in increasing numbers toward alternative models of care, be they retail, concierge, or direct care.  The number of inquiries I’ve had over the past few months from physicians wanting to change over has increased sharply, and their level of interest is much higher.”

Dick Quinn of QuinnsCommentary writes:

“We will continue on the road to destruction of employer-based health benefits no matter who controls Washington, and on the road to a single-payer system. Obamacare won’t work to manage costs, the Republican alternatives to date are just silly.  Individual state solutions make no sense. So what’s left?”

Ron Hammerle of Health Resources Ltd.

“Implementation of elective, medical aid in dying in Canada (and maybe California) will begin to have an impact on end of life care, “informed consent,” medical costs, patient-empowerment and the reduction of unwanted medical care in the U.S.”

IndustryYoda writes

“Uncertainty about the outcome of the 2016 election will lead to increasing fear and gridlock as large healthcare organizations elect to play a wait and see game. GOP attacks on the Affordable Care Act will spook many. Doc morale will continue to spiral as a consequence. If the Republicans win the White House, the shit is going to seriously hit the fan …

ICD-10 will (flip a coin) either be delayed yet again in a last minute reversal by red-faced administration officials or be pushed through incompetently, causing stress and economic chaos among providers. Those who prepared will survive. Those who did not will feel extreme pain. The real winner? The consultants.

At least one ineptly-run electronic health record vendor will flame out spectacularly (note: this is not the company mentioned above), with dire consequences for customers. Citing obscure contractual language, the vendor will attempt to monetize customer data in various sleazy ways. Outrage and vows of official action will follow in Washington but no substantive action will be taken.”

Salesforce.com will Eat the World writes:

“You want predictions? Okay. Fine. Here’s my totally-insane world-changing-prediction-that-could-change everything. Salesforce will win over at least one huge healthcare name, causing a major freakout among vendors. Several will see the writing on the wall and announce plans to launch compatible services. Will it actually happen? Who knows. Not a fan of Salesforce, but I almost hope it does. ”

The University of South Carolina’s Joan Creed writes: 

“We now have retail health care.  I’ve thought for years we’ll one day have drive-thru health care: stop at the first window with your symptoms, then stop at the second window to pick up prescriptions, whether for medications, tests, whatever.”

Terry Bennett of Clinic on the Commmons writes:

“I am strongly tempted to say ” More of SOS”

There do not appear to be any trending stories about the return to the classic model, wherein an individual physician is responsible for an individual patients’ care.

Ditto any nationwide look at the impact of nonprofit hospitals becoming for profit gigantic Taj Majals, dominating both the jobs market and the real estate market in their communities, and the redundant duplicating/reduplicating of the servicers and technologies offered at the just-down-the -road former community”not for profit hospital”

Add to that the “90 day contract”that most young docs are forced to sign upon landing a job at one of these centers, wherein the doctor may be fired without recourse and without any stated cause. This widespread ” hear no, see no, speak no evil policy does very little for constructive criticism/two way discourse as to the best way forward.

By ART CAPLAN

The New York Times editorial page is the latest in a lengthening series of commentaries worrying about the impact of two proposed corporate mergers in the health insurance market.   Anthem has agreed to acquire Cigna and Aetna is taking over Humana. That means the number of big health insurers will drop from five to three.

The Times and every other commentator who has weighed in including the AMA has warned that diminished competition is not good for taxpayers or consumers. They want the Justice Department to take a long hard look at these latest mergers to insure that consumers are not stuck with higher premium costs as many parts of the country turn into markets with only one insurance provider.

The critics are wrong. Blocking these deals is a terrible idea. The mergers should be allowed to continue. In fact they should proceed until there is only one private insurer left. Only, at that point should the government step in, declare the last company standing to be required to merge with Medicare thereby letting the free market produce what many reformers have only been able to dream of—a single payer system.

Continue reading…

By SOUMERAI, STARR and MAJUMDAR

Evidence is mounting that publication in a peer-reviewed medical journal does not guarantee a study’s validity. Many studies of health care effectiveness do not show the cause-and-effect relationships that they claim. They have faulty research designs. Mistaken conclusions later reported in the news media can lead to wrong-headed policies and confusion among policy makers, scientists, and the public. Unfortunately, little guidance exists to help distinguish good study designs from bad ones, the central goal of this article.

There have been major reversals of study findings in recent years. Consider the risks and benefits of postmenopausal hormone replacement therapy (HRT). In the 1950s, epidemiological studies suggested higher doses of HRT might cause harm, particularly cancer of the uterus. In subsequent decades, new studies emphasized the many possible benefits of HRT, particularly its protective effects on heart disease — the leading killer of North American women. The uncritical publicity surrounding these studies was so persuasive that by the 1990s, about half the postmenopausal women in the United States were taking HRT, and physicians were chastised for under-prescribing it. Yet in 2003, the largest randomized controlled trial (RCT) of HRT among postmenopausal women found small increases in breast cancer and increased risks of heart attacks and strokes, largely offsetting any benefits such as fracture reduction.

The reason these studies contradicted each other had less to do with the effects of HRT than the difference in study designs, particularly whether they included comparable control groups and data on preintervention trends. In the HRT case, health-conscious women who chose to take HRT for health benefits differed from those who did not — for reasons of choice, affordability, or pre-existing good health. Thus, although most observational studies showed a “benefit” associated with taking HRT, findings were undermined because the study groups were not comparable. These fundamental nuances were not reported in the news media.

Another pattern in the evolution of science is that early studies of new treatments tend to show the most dramatic, positive health effects, and these effects diminish or disappear as more rigorous and larger studies are conducted. As these positive effects decrease, harmful side effects emerge. Yet the exaggerated early studies, which by design tend to inflate benefits and underestimate harms, have the most influence.

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By THCBist

By THCBist

Undisclosed location, TN writes:

I have a concern that some of the medical specialty groups of physicans in my area are forming their own monopolies. They are joining together in a way that patients can no longer have access to a new physician if they feel they are not getting the care they need or are not comfortable with the physician they chose.

The [ name withheld ] or [ withheld ] Tn. is one of those groups.

I had been seeing one of their physicians for a number of years and had wanted to try someone else for a long time before I actually tried.  I was told that I could not see any other physician in the group.  When I then tried to go elsewhere, I discovered their group was the only game in town.  I called several hospitals to try and find a doctor.  They all named this one group.  There were a lot of physicans, but they were all connected to the group.  I then tried Maryville only to find, they also were part of this group.

My cardiologist tried to get me an appointment only to be told they could not see me.

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By PHILIP LEDERER, MD

Guys:

You don’t know me, but I’m a physician and loyal gmail user writing for your help improving Google Scholar. As Google’s mission is to “organize the world’s information” and you are Google’s CEO and Executive Chairman, respectively, I’ll bet you can make this happen.

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By MICHAEL MILLENSON

Perhaps the most well-known part of the 1965 Medicare creation tale is the opposition by the American Medical Association (AMA) to “socialized medicine.” Yet with financial incentives assuming a new prominence for provider and patient alike, we shouldn’t overlook the AMA’s equally unsuccessful battle against the excesses of capitalistic medicine. The forgotten story of the professionalism’s failure to contain physician greed provides an important policy perspective.

The Myth Of Medicine’s ‘Golden Age’

Medical practice pre-1965 is often portrayed as a mythical “Golden Age.” The truth, as I found researching my 1997 book, Demanding Medical Excellence: Doctors and Accountability in the Information Age, was that the post-war years were a time when way too many doctors grasped for the gold.

The most common “entrepreneurial” excesses were fee splitting, where a specialist paid a kickback to the referring doctor, and ghost surgery, where a surgeon secretly paid a colleague to operate on an anesthetized patient. The first surgeon paid the “ghost” a small part of the total fee and pocketed the difference. Even worse was rampant surgical overuse, where common excesses included appendectomies for stomachaches and hysterectomies on young women with nothing more than back pain.

Although professional societies wielded far more influence than now, efforts by leaders of the AMA and the American College of Surgeons to stop these abuses repeatedly fell short. Doctors “display a consistent preoccupation with their economic insecurity,” a 1955 report by the AMA concluded with discomfiting bluntness.

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By MATTHEW HOLT

We’re taking your predictions for what 2016 will hold in store for health care.  A President named Trump? The much-rumored Uber for Healthcare? The end of Meaningful Use? The beginning of the ACO era?  New incentive payments? New penalties?  Something else nobody has thought of yet?

You’re invited to a special online event hosted by athenahealth’s COO Ed Park (no he’s not his bro Todd whatever HIStalk may think), on Tuesday September 15, 2015 at noon.  With a program created with doctors in mind, this is one event you won’t want to miss.  Ed will talk about what 2016 is likely to bring for doctors, what probably won’t happen (despite what the skeptics say)  and how health information technology is rapidly evolving to meet a new generation of pressing challenges.  You’ll also get a rare insider’s look at athenahealth’s plans for 2016, including rumored new products and the company’s plans for expansion in the competitive electronic medical records space. If you track this much-talked about health IT company and its CEO Jonathan Bush and the broader health IT industry, you’ll want to be sure to mark your calendar.

The Wisdom of the Blog

Meanwhile, we want to know what THCB readers think is ahead in 2016. What do you expect to see? What’s next for Obamacare?  What new technologies are poised to change everything? More importantly: What won’t we see?   If you have a prediction for 2016, e-mail the editors at ed****@***************og.com or use the contact form at the top of the page. Write us a brief blog post. Submissions should be between 300 and 500 words in length.  Tell us what you think will happen and why it’s important. Strong submissions will be published on THCB.