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Compliance

Apr 13, 2012• 6

By Rob Lamberts, MD

“Why aren’t you taking your cholesterol medication?” I asked the woman.

With the coronary disease I diagnosed a year ago, my discovery that she had not taken her medication was very troubling.

“It made me tired,” she replied matter-of-factly. ”And besides, the cardiologist said the stress test was negative, so my heart is fine!”

I ordered the stress test after her heart calcium score was significantly elevated, revealing significant atherosclerosis. She totally misunderstood the results, and I needed to fix that problem. So I pulled out my secret weapon: a good analogy.

“The purpose of the calcium score test was to see if you had termites in your home” I explained. ”I found them. The negative stress test just said that the termites hadn’t eaten through your walls. It’s good news that your walls aren’t falling down, but they will if we don’t stop the termites.”

Her eyes opened wide comprehension: the termites were eating her walls. She was living on borrowed time.

“Would you take a medication if it didn’t have side effects?” I asked.

She quickly nodded. Of course she would. From now on she would be a compliant patient.

Compliance is good. Noncompliance is bad. It’s something I learned very early in my training: patients who do what their doctors say are compliant (good), and those who don’t follow instructions are noncompliant (bad). If you are lucky as a doctor, you have compliant patients. They are the best kind. They obey their doctors. They are submissive. Noncompliant patients are bad; they are a bunch of deadbeats.

Please hold your nasty comments; I don’t really believe my patients should obey or submit to me.*

Medicare Announces 27 ACOs. A New Species?

Apr 12, 2012• 22

By Vince Kuraitis

I’m surprised and intrigued by Medicare’s announcement of 27 new Shared Savings model ACOs.

Surprised

I had been anticipating this announcement as a defining moment for Medicare’s thrust into accountable care. My expectations had been that we would see either:

Boom — a big splash of new Medicare shared savings ACOs announced, including big name hospitals and medical groups that were starting large scale ACOs, perhaps with hundreds of thousands of patients.

Bust — no one showed up at the party. Providers would have concluded that Medicare ACOs were too risky, bureaucratic, and high effort.

Intrigued

What we got is something in the middle:

Very small ACOs. Many only meet Medicare’s minimum of 5K patients; most are in the 8 to 25K range; and the largest ACO anticipates 70K patients. Collectively these 27 ACOs plan to serve 375K patients, less than 1% of the entire Medicare population.
13 are smaller, physician led
Only 10 hospitals are involved across the 27 ACOs
Very few household names

TEDMED 2012: HBO Documentary Films “Weight of the Nation”

Apr 11, 2012

[youtube width=”560″ height=”270″]http://www.youtube.com/watch?v=zYrOW_WGJj0[/youtube]

HBO Documentary Films premiered clips from its upcoming feature “The Weight of the Nation” at TEDMED 2012. The film debuts May 14.

What Keeps Me Up at Night 2012

Apr 11, 2012• 1

By John Halamka, MD

I’ve written several posts about the issues that keep me up at night. Here’s what I wrote in 2011.

Today, my team presented a list of risks to the Compliance, Audit and Risk Committee at BIDMC. Here’s my list of top risks for 2012:

1. Old Internet browsers – many vended clinical applications require specific versions of older browsers such as Internet Explorer 6, which are known to have security flaws. We’ve worked diligently to eliminate, upgrade or replace applications with browser specificity. At this point we are 96% Internet Explorer 8/Firefox 7/Safari 5 minimizing our risks to the extent possible.

2. Local Administrative rights – Of our 18,000 devices on the network, a few thousand are devices that require the user to have local administrative rights to run their niche applications (often the research community doing cutting edge research with open source or self developed software). We have done everything possible to eliminate Local Administrative rights on our managed devices.

3. Outbound transmissions – Security has historically focused on blocking evil actors from the internet. Given the current challenges of malware and infections brought in from the outside, it’s equally critical to block unexpected outbound activity.

4. Public facing websites – any machine that touches the internet has the potential to be targeted for attack. We’ve implemented proxy servers/web application firewalls on most public websites.

5. Identity and Access management – Managing the ever changing roles and rights of individuals in a large complex organization with many partners/affiliates is challenging. If an affiliate asks for access to an application, how do you automatically deactivate accounts when users leave an affiliate, given the lack of direct employment relationships?

If the Supreme Court Kills ObamaCare, Should We Thank Mitt Romney?

Apr 11, 2012• 5

By John R. Graham

There is no doubt that the campaign to “repeal and replace” ObamaCare will have its weakest standard bearer if Mitt Romney becomes the Republican candidate for President. His embrace of an “individual mandate” to buy health insurance or pay a penalty, as legislated in his 2006 Massachusetts health reform, is anathema to those faithful to the ideal of limited government. When Mr. Romney declares that he will issue a universal waiver from ObamaCare’s regulations as his first executive order, the people who should be voting for him fear that such action would be a substitute for repeal, instead of a preparation for it. (Do these folks really think a clean repeal bill, like the one passed by the House of Representatives in January 2010, will be on the president’s desk on inauguration day?)

But maybe we should look at it another way: If Mitt Romney had never signed his 2006 law (which was motivated, as the president’s men are so fond of telling us, but an idea generated at The Heritage Foundation), those of us committed to defeating ObamaCare would never be in the fortunate position we are today – the whole, ungodly mess hanging by a thin thread after a brutal hazing in the Supreme Court last week.

Without Massachusetts’ 2006 law, there is almost no likelihood that the Democrats would have written an individual mandate into the bill. Instead, they would have just hiked taxes. The only reason they painted a thin varnish of so-called “individual responsibility” onto the bill was so that they could pin some of the blame on Mitt Romney and certain conservatives who had embraced it. As noted by Avik Roy, the individual mandate was traditionally anathema to liberals, who prefer straight-forward tax hikes.

Does Anybody Want to Pay for Depression Treatment?

Apr 11, 2012• 10

By Peter Ubel

Imagine for a moment you are suffering from an illness that makes you feel like your soul has been run over by an angry defensive lineman, a disease that interferes with your desire to sleep, eat and make love. Oh, and this illness will continue to make you feel this way for the rest of your life. How much would you be willing to pay for a treatment makes you feel normal again?

My colleagues and I posed that question to a nationally representative sample of more than 700 Americans and we discovered something troubling—people’s willingness to pay for medical interventions depends in large part on whether the illness in question is “physical” or “mental.” People are much less willing to part with money to treat mental illnesses, even after accounting for the perceived severity of those same illnesses. Our article—“What’s It Worth?”—is available online at the Journal of Psychiatric Services.

Let me tell you a bit more about our study. We described a handful of illnesses to people and asked them to tell us, in effect, how bad each one would be to experience. For instance, we describe type 2 diabetes to people, and told them that it was uncomplicated by any other medical problems. People thought that would be pretty hard on their quality of life. We also described below-the-knee amputation, and they thought that would be even worse than diabetes. We described severe blindness, which only leaves one able to distinguish shadows. People thought that one was worse than either of the first two problems.

We also described a case of moderately severe depression to people, a level bad enough to cause the victims to “feel sad and downhearted a lot of the time.” The description went on to explain that it would make people “feel like a failure” and lose interest in food and sex. Trust me, it was a thorough and devastating picture of how depression can affect people’s lives. Indeed, people thought it was horrendous, at least as bad as any of the physical illnesses we described.

Health 2.0’s Spring Fling: Matchpoint Boston – Final Agenda Announced

Apr 10, 2012

In case you haven’t heard, Health 2.0’s Spring Fling is returning to Boston on May 14-15. The panels and sessions will focus on commercializing Health 2.0, and feature Matchpoint, the industry’s preeminent deal-making and partnership forum.

Highlights include:

Matchpoint Boston. Face-to-face meetings between entrepreneurs and decision makers from the nation’s leading health care organizations and investors including: Aetna Inc., Angie’s List, athenahealth Inc., AT&T, Bristol-Myers Squibb, California HealthCare Foundation, Healthline Networks Inc., Kaiser Permanente, Virgin Healthmiles Inc., and Ziegler. The deadline for entrepreneurs to apply to meet with the leading companies is April 17th.

Featured speakers. Farzad Mostashari, M.D., National Coordinator for Health Information Technology, will announce the latest winners of the ONC’s i2 Developer Challenges. The competitions, run by Health 2.0, were created to accelerate the development and adoption of health technology solutions. Jonathan Bush, CEO of athenahealth, will be the keynote speaker, detailing his company’s rise from start-up to $2.5 billion market cap segment leader.

What Can We Do to Simplify Healthcare?

Apr 10, 2012• 6

By Markus Fromherz

Information is power, but sometimes it can be too much of a good thing. Information overload affects workers in every industry – this is particularly true for data-reliant and intensive industries like healthcare. And, it’s not getting any better – by 2020 the healthcare industry alone is estimated to have 25,000 petabytes of data – that’s equivalent to 500 billion four-drawer filing cabinets. With its complexity and breadth, and not least with its impact on our lives, healthcare has to be the poster child for how efficient management of data can improve productivity and help providers make better, more informed decisions.

A first trick, however, is getting at the relevant pieces of information. Today, a lot of manual work goes into accessing and cleaning up data that is siloed and unstructured. Too much information is still on paper, but even where it has been migrated to electronic medical records (EMR), practice management systems, or lab diagnostic systems, much of it is still unstructured. The majority of hospitals are finally implementing EMRs, and many of us are working to provide advanced analytics based on the information going online, but, at a recent Xerox healthcare client council meeting, several CIOs emphasized that there still remains a huge challenge in cleaning, standardizing, and integrating data before it can be used for decision making.

Fortunately, powerful methods are becoming available that can extract relevant events from physician narratives, intelligently aggregate data, customize information for clinicians based on context, and visualize information. For instance, in France, a number of hospitals are testing an emerging application based on Natural Language Processing technology developed at the Xerox Research Centre Europe in Grenoble, France. Researchers designed the solution to help prevent the spread of hospital-acquired infections by finding, extracting, and combining key information in physician narratives distributed in medical records. As another example, our Midas+ Live product accesses and integrates information from diverse hospital systems and puts them on a single dashboard, multiple patients at a time, hugely simplifying a physician’s task to monitor all of his or her patients.