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Mr. Bush Goes to Washington

• 15

By Jonathan Bush

You can’t believe the play that little athenahealth gets in Washington, DC… and thank goodness for it because no one has a clue about HIT.

How could they really?

I mean, there are 535 people in our federal legislature (give or take) and there are like a million different market spaces in the nation. This is why I have such a hard time with federal control of things. It’s impossible for them to  know what’s going on…there are just not enough hours in the year.

As I’ve been thinking about care coordination and the complete lack of sustainable models or entrepreneurship in that space, it occurred to me that it’s currently not clear that it is legal for RECEIVERS of electronic health information to pay senders for the value of that health information. This means that the sender has no real motivation to send useful, relevant data in a timely manner (I know I’d pay the doc who sent me exactly what I needed about a patient more than I’d pay the doc who sends over a 30-page PDF) and that our industry will take a long time to understand the true health information exchange needs of providers.

I wanted to bring the concept with me to the Hill that Meaningful Use, in my opinion, is use that is meaningful to a medical care provider in the actual doing of business. In a space with such clear demand, we’ve got to let innovators develop a way to supply information that the market (providers of care) needs, if we want to improve outcomes and reduce costs.

So I flew down to Washington and it was tons of fun… me and Lauren Fifield and the lobbyist and a full dance card on Capitol Hill.

First, we met with Sally Canfield, policy director for Sen. Marco Rubio, R-Fla.

She’s a true health policy veteran who likes getting—and will give you—the straight story. She’s also one of the only people on the Hill with whom I could speak at my normal (lightning) pace and know she can keep up. We talked about everything from the potential fall of hospitals (Need a hospital?  Just scan the horizon for a construction crane)…to the alarming rate of physician employment…to making Meaningful Use really meaningful…to encouraging care coordination…to life in the cloud.

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Do Something Cool

• 1

By Evan Falchuk

What does it mean to be an entrepreneur in health care?

Twice in the last two weeks I had the honor of speaking at Northeastern University’s Health Sciences Entrepreneurs Program. It’s a terrific program, dedicated to fostering the creation of health care businesses by helping the people who build them figure out how to do it. That it exists is a testament to how strong the American spirit of entrepreneurship really is – and how the 21st century economic engine is going to be health care.

But the hundreds of students and alumni who attended the events already knew this. What they wanted to know were the answers to more practical questions – how do I know if it’s a good idea to try something? What happens if I make mistakes, or fail? Do I really need to start a business to be an entrepreneur? What opportunities does the changing world of health care create?

They’re the right questions because they’re hard. Being an entrepreneur means you’re willing to look at the world as it is and want to make it as you think it should be. It means being willing to take risks, try new things, and not being afraid to fail. In fact, if you listened to the panels of highly successful entrepreneurs, you’d think failure was a big part of what entrepreneurs do. You can’t create something new without making mistakes along the way.

At the end, we were all asked to give one piece of advice to the budding entrepreneurs.

Mine was this: Do Something Cool. Always put yourself in a position where you’re doing something that is so cool you want to tell people about it. When you don’t think it’s cool anymore, leave, and find something else that you think is cool. Don’t worry about whether it means starting your own business or working with someone else who has. Put yourself someplace where you think you are changing the world.

If you can do that, you’ll be an entrepreneur.

Evan Falchuk is President and Chief Strategy Officer of Best Doctors, Inc. Prior to joining Best Doctors in 1999, he was an attorney at the Washington, DC, office of Fried, Frank, Harris, Shriver and Jacobson, where he worked on SEC enforcement cases. You can follow him at See First Blog where this post first appeared.

Americans Must Stop Overusing Antibiotics

• 1

By RAMANAN LAXMINARAYAN

This week the Centers for Disease Control and Prevention will kick off its annual campaign aimed at reducing the overuse of antibiotics, drugs that one by one are becoming useless in the war against antibiotic-resistant microbes.

The CDC campaign – “Get Smart: Know When Antibiotics Work” – urges consumers to use these drugs sparingly and many Americans have taken that message to heart. Recent data from the CDC show that antibiotic use is leveling off in the United States. In 1994, 300 out of every 1,000 pediatric office visits resulted in an antibiotic prescription. By 2007, that number had fallen to 229, a 24 percent decrease. However, interactive maps by Extending the Cure, a research project of the Center for Disease Dynamics, Economics & Policy, show regional disparities in the use of antibiotics, including very high consumption in some Southeastern states.

These findings can and should be used by public health officials to understand why certain regions show high patterns of consumption and then put in place solutions, including public education campaigns tailored to stop the overuse of these powerful drugs.

The new research reveals a high rate of antibiotic use in some Southeastern states and much lower rates in the Pacific Northwest, compared to the rest of the country. West Virginia and Kentucky had striking rates of antibiotic use: People living in those states took twice as many antibiotics as people living in states like Oregon and Alaska.

High rates, like those seen in the southeastern United States, might reflect an environment in which consumers are anxious to get an antibiotic prescription for a case of the flu – and doctors are only too willing to comply. But antibiotics do nothing to combat viral illnesses such as common colds or influenza.

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But There Are No Pit Crews

• 26

By Evan Falchuk

Atul Gawande says that we’re used to doctors working like “cowboys” – rugged individualists who are responsible for making sure your care gets done right.  We don’t need cowboys, he says.  We need “pit crews” – teams of doctors working together toward a common goal, with each playing their own role.

It’s an appealing idea.  Pit crew-like teams work, and work well, in trauma units across the country.

But there’s a problem: if you haven’t just been airlifted to a hospital after a horrible accident, you’re not going to be treated by a pit crew.  You’re going to be on your own, shuffled from one 15-minute specialist visit to the next, likely with no one person in charge of your care.

Dr. Gawande knows this, and he picks a heck of an example of the problem:

“But you can’t hold all the information in your head any longer, and you can’t master all the skills. No one person can work up a patient’s back pain, run the immunoassay, do the physical therapy, protocol the MRI, and direct the treatment of the unexpected cancer found growing in the spine. I don’t even know what it means to ‘protocol’ the MRI.”

Why is that such a good example?  Because it’s exactly what happened to my brother at one of the leading medical centers in the country.  He had a person directing the work up of his back pain and all the rest, including deciding on the right treatment for the “unexpected cancer found growing in his spine.”  It all worked well….except that he didn’t have cancer at all.  In fact, had he been treated for cancer, he might not be with us today.

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End Gaming the Supreme Court’s ACA Review

• 5

By Timothy Jost

On November 14, 2011, the Supreme Court decided to review a decision of the Eleventh Circuit Court of Appeals striking down the minimum coverage requirement of the Affordable Care Act (ACA) as unconstitutional.  The case will probably be argued before the Court in March and decided in the early summer.

Procedurally, the Court “granted certiorari.”  This means that it agreed to review certain questions raised by the certiorari petitions presented by the various parties in the Florida case, including the plaintiffs who challenged the constitutionality of the Affordable Care Act — 26 states, the National Federation of Independent Business, and two private individuals — and the federal government, which defended the Act’s constitutionality.  The Eleventh Circuit had ruled against the federal government on the question of whether the minimum coverage requirement of the ACA is constitutional, but had ruled against the plaintiffs on all other issues.

The Supreme Court did not rule on certiorari petitions pending before it from the Virginia, Liberty University, and Thomas More cases, two of which rejected a challenge to the ACA on jurisdictional grounds and the other of which held the minimum coverage requirement to be constitutional.  (The Virginia petition was not yet before the Court, as it was filed later than the others).  The fact that the Court only granted petitions in the Florida case probably signals nothing about the Court’s ultimate decision, as the Florida case raises all of the issues raised by the other cases and reviewing additional cases would have merely made the case more complex administratively.

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Denmark’s Fat Tax

• 4

By Marion Nestle

The Danish government’s now infamous “fat tax” has caused an international uproar, applauded by public health advocates on the one hand and dismissed on the other as nanny-state social engineering gone berserk.

I see it as one country’s attempt to stave off rising obesity rates, and its associated medical conditions, when other options seem less feasible. But the policies appear confusing. Why Denmark of all places? Why particular foods? Will such taxes really change eating behavior? And aren’t there better ways to halt or reverse rising rates of diet-related chronic disease?

Before getting to these questions, let’s look at what Denmark has done. In 2009, its government announced a major tax overhaul aimed at cushioning the shock of the global economic crisis, promoting renewable energy, protecting the environment, discouraging climate change, and improving health – all while maintaining revenues, of course.

The tax reforms make it more expensive to produce products likely to harm the environment and to consume products potentially harmful to health, specifically tobacco, ice cream, chocolate, candy, sugar-sweetened soft drinks, and foods containing saturated fats.

Some of these taxes took effect last July. The current fuss is over the introduction this month of a tax on foods containing at least 2.3 per cent saturated fat, a category that includes margarine, salad and cooking oils, animal fats, and dairy products, but not – thanks to effective lobbying from the dairy industry – fluid milk.

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You are Solving the Wrong Problem

• 12

By Aza Raskin

There is some problem you are trying to solve.

In your life, at work, in a design. You are probably solving the wrong problem.

Paul MacCready, considered to be one of the best mechanical engineers of the 20th century, said it best: “The problem is we don’t understand the problem.”

Story time.

It’s 1959, a time of change. Disney releases their seminal film Sleeping Beauty, Fidel Castro becomes the premier of Cuba, and Eisenhower makes Hawaii an official state. That year, a British industry magnate by the name of Henry Kremer has a vision that leaves a haunting question: Can an airplane fly powered only by the pilot’s body power? Like Da Vinci, Kremer believed it was possible and decided to push his dream into reality. He offered the staggering sum of £50,000 for the first person to build a plane that could fly a figure eight around two markers one half-mile apart. Further, he offered £100,000 for the first person to fly across the channel. In modern US dollars, that’s the equivalent of $1.3 million and $2.5 million. It was the X-Prize of its day.

A decade went by. Dozens of teams tried and failed to build an airplane that could meet the requirements. It looked impossible. Another decade threatened to go by before our hero, MacCready, decided to get involved. He looked at the problem, how the existing solutions failed, and how people iterated their airplanes. He came to the startling realization that people were solving the wrong problem. “The problem is,” he said, “that we don’t understand the problem.”

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Wal-Mart Care

• 24

By John Goodman

Can Wal-Mart provide us with health care as efficiently as it furnishes us with paper towels?

According to a Kaiser Health News report:

Wal-Mart — the nation’s largest retailer and biggest private employer — now wants to dominate a growing part of the health care market, offering a range of medical services from basic prevention to management of chronic conditions like diabetes and heart disease, according to a document obtained by NPR and Kaiser Health News.

But then the next day, according to Kaiser, the company started backtracking:

The only thing the company would say for certain is: “we are not building a national, integrated, low-cost primary care health care platform,” according to the statement from to John Agwunobi, senior vice president and president of Wal-Mart U.S. Health & Wellness.

I’ll get to what Wal-Mart might be thinking in a minute. First questions first: Can Wal-Mart provide care that is of higher quality and lower cost than conventional provision? If so, how?

My answer: Wal-Mart can indeed improve on the current system. But here’s the catch. It can do so only if it continues doing what it and other retail medical outlets are already doing: ignore the third-party payers. Almost everything that’s wrong with our health care system is the direct result of third-party payment; and some of the most striking examples of efficient care are emerging in those parts of the market where third-party payment is either nonexistent or of marginal importance.

So as not to be misunderstood, I am not saying that our problems are being created by health insurance. There is nothing in principle wrong with insurance. The source of our problems is using insurance companies to pay medical bills. It’s insurance companies acting pro emptore — in place of the buyer.

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Understanding the Supreme Court’s Health Law Review

• 2

By Stuart Taylor, Jr.

By agreeing today to hear challenges to President Obama’s 2010 health care law, the Supreme Court set the stage for a decision — probably in late June and in the midst of the presidential campaign — that could be among its most important in decades.

The case, which will probably be argued in March on a date still to be announced, is especially momentous because it not only will determine the fate of President Barack Obama’s biggest legislative achievement but also will cast important light on the Supreme Court’s future course under Chief Justice John Roberts on issues of federal government power.

The central issue — but not the only important one — is whether Congress exceeded its constitutional powers to regulate interstate commerce and to levy taxes when it adopted the so-called “individual mandate” at the heart of the health care law.

That provision would require millions of people starting in 2014 to buy commercial health insurance policies or pay financial penalties for failing to do so.

The court also agreed to decide a challenge to the Affordable Care Act’s provision essentially requiring states greatly to expand their Medicaid spending.

The court made clear that if it decides to strike down the individual mandate or Medicaid provision, it will also decide which of the 975-page law’s hundreds of other provisions should go down too, by divining whether Congress would have wanted some or all of them to be effective even without the voided provision or provisions.

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SCOTUS: Big News Is the Medicaid Grant

By BRADLEY JOONDEPH

So here are the two biggest consequences of the order:

* The Court has limited itself to the Florida case, and is presumably holding theThomas More Law Center and Liberty University petitions. (It will likely need to appoint someone to argue the AIA question against the parties.)

* The Court granted on the Medicaid question. This is a bit of a surprise, raising the constitutional stakes of the case rather substantially. For if the Court were cut back on Congress’s spending power, it would have significant long-term ramifications for the scope of federal power.

Again, the really big news of the morning — if there is anything surprising — is that the Court has decided to take up the constitutionality of the ACA’s Medicaid amendments. Specifically, the question is whether the spending conditions that the ACA imposes on the states are effectively “coercive,” such that they amount to an impermissible commandeering. There is no split on the question, and no lower court judge has yet voted to uphold the states’ claim. But the Court will take it up.

As a purely legal matter, this is a bigger issue than the individual mandate. For much of the modern liberal state is undwerwritten by Congress’s use of the conditional spending power.Continue reading…