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Nate Silver Is King, Long Live Nate Silver

Nov 7, 2012• 3

By David Shaywitz, MD

My twitter stream is awash in math this morning, cheering Nate Silver’s exceptional forecasting (“Triumph of the Nerds: Nate Silver Wins In Fifty States”, Chris Taylor wrote), and celebrating the victory of math and big data over pompous punditry. Jeff Greenfield tweeted, “I, for one, welcome our new Algorithmic Overlord.”

At some level, I thrill to the ascendancy of math, and of math nerds – and I write this as a proud former math team captain (and math team T-shirt designer), and as someone whose very best summers as a teenager were spent in math (and writing) camp at Duke University. It’s also one of the reasons I love Silicon Valley so much – it’s where nerds rule, and where even emerging VCs promote themselves as “Geeks.”

However, before we turn all of life over to algorithms, as some are suggesting, it’s important to place the election prediction in context.

The accomplishment of Silver’s splendid forecasting was to intelligently aggregate existing data, to accurately summarize the current, expressed intentions of the national electorate. And we’ve learned that careful analysis is far more useful than blustery experts – something Philip Tetlock has been trying to tell us for years.

At the same time, all forecasting challenges are not created equal, and summarizing current public opinion is a much lower bar than predicting events far into the future – and Silver has been clear about this; it’s others who seem to be leaping ahead.

Embracing Change: Leading Through Transformation

Nov 6, 2012• 14

By Bernard Tyson

It is often said that the one and only constant in life is change. This is certainly the case in business where every change in the external market or new initiative or idea brings some type of change to the organization. As leaders, our success or failure can hinge upon how well we are able to facilitate change and how well we help our members of our team adapt to and appreciate change.

As president of a large, national health care organization, like many other business leaders, I am involved in important decisions related not only to performance today, but also preparing the organization for what will be required in the future. This means I spend a lot of time thinking about change. What can we expect with change? How will people react to change? How can I help my team work through the change? How will change affect the way we operate or service our members? What will it cost us?

The reality is most people don’t like change because it can be stressful, especially when change happens unexpectedly. Change can be scary, and understandably so. It represents the unknown, taking us out of our comfort zones. Any time an organization embarks on a new initiative there is the risk of failure, which could have significant financial consequences. Yet, if we don’t change, failure is certain. As society evolves, we must too. Organizations that not only understand the importance of change, but embrace change, are the ones that will ultimately be most successful.

Setting the Record Straight on Medicaid’s “Success”

Nov 5, 2012• 23

By David Dranove

In last Sunday’s New York Times, Paul Krugman extolled the virtues of Medicaid. Here are some excerpts from this astonishing column:

“Medicaid has been more successful at controlling costs than any other major part of the nation’s health care system.”

“How does Medicaid achieve these lower costs? Partly by having much lower administrative costs than private insurers.”

“Medicaid is much more effective at bargaining with the medical-industrial complex.”

“Consider, for example, drug prices. Last year a government study compared the prices that Medicaid paid for brand-name drugs with those paid by Medicare Part D — also a government program, but one run through private insurance companies, and explicitly forbidden from using its power in the market to bargain for lower prices. The conclusion: Medicaid pays almost a third less on average?”

In the days since this column was published, I have spoken with many experts on Medicaid who are uniformly appalled by it. While I may not reach the same audience as the New York Times (at least not yet!), I feel compelled to set the record straight on Medicaid’s “successes.”

The Future of Health Reform May Turn on Senate Races

Nov 5, 2012• 2

By Maggie Mahar

While all eyes focused on the presidential race, the ultimate fate of the Affordable Care Act (ACA) could depend on the Senate contests in the states.

Even if Mitt Romney were elected, he alone could not overturn major provisions of healthcare reform. Only Congress can pass the legislation needed to change the ACA.

Republicans are expected to maintain control of the House, but if Democrats hold the Senate, they will be able to block House bills aimed at eviscerating “Obamacare.”

What is at stake

If Republicans take the Senate, the two chambers could pass legislation that would:

· eliminate the premium subsidies designed to make health insurance affordable for middle-income and low-income families
· bring an end to Medicaid expansion, and
· rescind the individual mandate that everyone buy insurance or pay a tax.

Under “budget reconciliation,” Republicans would need only a simple majority to pass such legislation. In the Senate, 51 votes would do it. Today, Republicans hold 47 seats.

Razor-sharp margins in many states make it impossible to predict outcomes. Polls only give us a blurry snapshot of one moment in time – and in states like Arizona, candidates have been trading leads from week to week.

Tracking the Social Doctor: Opening Up Physician Referral Data (And Much More)

Nov 5, 2012• 17

By Fred Trotter

I am happy to announce the release of the doctor “referral” social graph. This dataset, which I obtained using a Freedom of Information Act request against the Medicare claims database, details how most doctors, hospitals and other providers team together to deliver care in the United States. This graph is nothing less than a map of how healthcare is delivered in this country.

For the time being, the only way to get a copy of this data set is to support the Medstartr crowd funding campaign for either $100 (for the viral “open source eventually” version of the data) or $1000 (for the proprietary friendly version of the data, that any business can freely “merge” with other data). If you need consulting around this data, you can buy in at the $5k or $10k levels. Also, we are going to have really awesome t-shirts.

I will be writing a more in-depth technical article about this dataset over on the brand new O’Reilly Strata blog (which focuses specifically on Big Data) so I will gloss over most of the technical details here, with a few important exceptions.

First, when I say a “graph” I am not talking about a diagram. I am talking about a mathematical model that supports nodes and connections between those nodes. These are visualized as diagrams, but it is not possible to really analyze large graphs without a database. In this case, the nodes are doctors, hospitals and other providers and the connections between those nodes represent the degree to which they collaborate on specific patients.

Also, despite my branding to the contrary, this is not strictly a “referral” data set, although a fairly large portion of the data do represent referral relationships. Instead, it depicts the degree to which any healthcare provider “works” on a patient in the same time frame as some other provider. This means, for instance, that many primary care doctors are linked to emergency rooms. But this just means that a patient they were seeing was also seen by the emergency room in the same time period. Referral relationships can be inferred from this data, but not presumed.Continue reading…

The Doctor as Patient

Nov 4, 2012

By James Salwitz, MD

Terry is a particularly difficult patient. She is not hard because of her cancer, which is in remission, nor is there a problem with pain, of which she has little, and Terry is not particularly demanding for the nursing staff. No the real problem, the challenge, the thing that makes her so difficult is that Terry is married. Terry is married to Dr. P and he is a particularly difficult man.

Terry’s husband loves Terry very much. He wants her to have the very best care. Dr. P makes certain that all the doctors know everything that is going on, all the time; he makes sure the nurses are on top of every detail; he demands the best from the all the hospital staff. In fact, Dr. P works so hard to control Terry’s care, to stay on top of her case, to monitor every moment, it is nearly impossible to take care of Terry.

There are many challenges for doctors taking care of other doctors or their families, or, in reverse, there are many challenges for doctors when they seek care for themselves and their families. The result of this conflict is often inferior medical care. Therefore, wanting to honor and help doctors get good quality treatment let us take a moment to review the doctor verses doctor verses medical system dilemma.

First, it is hard for doctors to decide where to go for medical care. If you stay in the same community where you practice you lose some privacy and perhaps even respect in the physician community. Who do you chose and how do you avoid offending the other physicians you do not use? If you leave your own area, you lose the convenience and familiarity of getting care close to home.

Doctorology: Communication. It’s All Good

Nov 3, 2012• 6

By Dinosaur, MD

“Doctor’s office; please hold.”

You’ll never hear that when you call me. Never. You’ll also never get an automated answering system (I’m just referring to office hours, of course. Evenings and weekends the phone goes to Google Voice. More on

that below.) We are also in the middle of a communication revolution. There are now so many other ways patients can contact me other than the telephone, the silly thing is almost becoming obsolete. I took amoment the other day just to go through all the various ways patients contact me.

Telephone

Still the most reliable fallback. Most synchronous form of communication: both parties willing and able to talk in real time. After hours, Google Voice (free) transcribes messages and texts them to my smart phone. As a rule, patients do not call my cell phone, although I’m not shy about giving out the number. Then again, those who have my cell number usually use it for…

Texting

At the moment, it’s just a few patients, but I anticipate more and more of them will partake as time goes on. It doesn’t happen very often, and so far it’s never been inappropriate. Med refill requests and pictures of kids’ rashes have been the mainstay so far. I like it. By it’s very nature, the people choosing to text me understand the limitations of synchronicity, ie, they don’t get bent out of shape if I don’t answer them right away, and they understand that it’s just for relatively minor issues. I also use it to communicate simple quick questions to specialists with all the same mutual understandings (minor issues only; response time unimportant).

Healthcare Law on the Ballot

Nov 2, 2012• 10

By David Merritt

Ezra Klein is right. In a recent Washington Post column, the left-leaning policy wonk laid plain that the future of ObamaCare is at stake in next week’s elections. If President Obama wins and Democrats hold the Senate, the Affordable Care Act will survive. If Mitt Romney wins and Republicans take the Senate, the law is dead. It is the starkest of differences.

How likely is each scenario? At this moment Democrats have the advantage. According to Real Clear Politics, the president is running slightly ahead in six out of ten battleground states. He could actually lose seven of these, but still be reelected if he hangs onto Ohio, Wisconsin, and Iowa.

While key Senate races have tightened, such as Tommy Thompson in Wisconsin, Democrats have a slight advantage there too. If the elections were held today, Republicans would fall two seats short.

What would this future look like? Implementing ObamaCare would be accelerated. HHS and states will have less than fourteen months to finalize major provisions of the law before they take effect on January 1, 2014.

Thousands of pages of regulation will be released shortly after the election, on everything from IRS rules for employers to essential health benefits to covering pre-existing conditions. It remains to be seen how prescriptive these regulations would be.

State officials will have to submit a blueprint for their insurance exchanges by November 16th. They will need to decide if they will create and exchange and how it will be designed.

They will also have to decide whether to expand their Medicaid programs, and they’ll need to determine essential health benefits and benchmark plans for the insurance options to be sold through their exchanges.

The Unheard Heart: A Metaphor For Medicine In the Digital Age

Nov 2, 2012• 10

By Clifton Meador, MD

A few months ago, a young cardiologist told me that he rarely listens to hearts anymore. In a strange way, I was not surprised.

He went on to tell me that he gets all the information he needs from echocardiograms, EKGs, MRIs, and catherizations. In the ICU, he can even measure cardiac output within seconds. He told me that these devices tell him vastly more than listening to out-of-date sounds via a long rubber tube attached to his ear.

There was even an element of disdain. He said, “There is absolutely nothing that listening to hearts can tell me that I don’t already know from technology. I have no need to listen. So I don’t do it much anymore.”

I began to wonder. I called my longtime friend and colleague, also a cardiologist. I knew him to be one of the best heart listeners. I asked him if he still listens to hearts. He answered, “Of course I do. I could not practice medicine if I didn’t. But you know every week, several patients tell me when I listen to their hearts that I am the first doctor ever to do that. Can you imagine that?”

Playing the devil’s advocate, I challenged my friend to tell me what he learned from listening to hearts.

He answered, “How could anyone not want to hear those murmurs, sometimes ever so soft, like whispers? Murmurs from the heart, even very faint ones, are trying to tell us significant things. Some sounds are very localized, even hidden or obscured by layers of air. And then there is the rhythm and the beat and the cadence that you cannot hear on the paper strip of the EKG. Also, careful listening is the only way to appreciate the rubs of friction if there are any. The devices are important, but the heart has its own spoken and unspoken language if you know how to listen.

Großes Potential für digitale Gesundheitsdienste

Oct 31, 2012• 1

By Martin Schmucker

Digitale Innovationen mit echtem Mehrwert für die Patienten sind europaweit auf dem Vormarsch. In Deutschland gibt es jedoch viele Vorbehalte gegenüber neuen Technologien. Alexander Schachinger, Gründer und Geschäftsführer von healthcare42.com und Moderator auf der Konferenz Health 2.0 Europe, über die Chancen digitaler Gesundheitsdienste in Deutschland.

Herr Schachinger, derzeit bereiten Sie mit healthcare42 und Publicis Healthware / razorfish eine Haushaltsbefragung zur Nutzung von Gesundheitsinformationen im Internet durch chronische Patienten vor. Worauf genau zielt die Studie ab?

Alexander Schachinger: In Deutschland wurde noch nie repräsentativ und basierend auf der internationalen E-Patientforschung untersucht, wie sich die Nutzung von Gesundheitsinformationen durch Chroniker auf deren Wissen, ihre Einstellungen und ihr Verhalten auf dem Gesundheitsmarkt, also vor allem gegenüber Ärzten und Apothekern auswirkt. Hier wollen wir eine Forschungslücke schließen, denn das Thema „E-Patient“ ist in Deutschland bisher sträflich vernachlässigt worden. Unter anderem in Zusammenarbeit mit der KWHC GmbH haben wir bereits eine Online-Befragung mit 3.500 E-Patienten durchgeführt. Wir konnten zeigen, dass das Internet, der Austausch in Foren und ähnliches Auswirkungen auf die Patienten haben, insbesondere auf das Arztgespräch und auf die Entscheidung für oder gegen eine bestimmte Therapie.

Wie definieren Sie den “E-Patienten“?

Mit diesem Begriff meinen wir Patienten, die an chronischen Erkrankungen leiden, aber auch Akutpatienten, die das Internet zur Information über Gesundheitsthemen und zum Austausch nutzen. Wir verwenden einen sehr umfassenden Begriff, der auch die Angehörigen mit einbezieht, die sogenannten „Caregiver“, also Eltern, Kinder oder Ehepartner, die sich im Internet über Krankheiten von ihnen Nahestehenden informieren.