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Doctors: We Can’t Leave It to Business to Educate Us

Apr 5, 2013• 9

By Leslie Kernisan, MD

Recently I came across yet another media article with suggestions as to how digital health products can gain more widespread adoption. The writer notes that “we can learn a lot from the pharma and healthcare industries,” and goes on to discuss the importance of engaging the doctor.

This article, like many I read, doesn’t acknowledge the downsides of using pharma’s tactics.

I have to assume that this is because from a business perspective, there aren’t a lot of downsides to pharma’s tactics. Pharma, along with many other healthcare industry players (hospitals, insurance companies, device manufacturers) has overall been extremely successful from a business standpoint.

So if the intent is to help digital health companies succeed as businesses, then by all means one should encourage them to copy pharma’s tactics.

But as we know, what works for business has often not worked well for serving the needs of individual patients, or to society from a health services and public health perspective.

Could Private Investment Be A Game Changer For Med Student Debt?

Apr 5, 2013• 7

By Shady Henien

Each year, medical students incur more than $166,750 in medical school debt, according to the AAMC. Despite the organization’s conclusion that medical student debt is not a determining factor in choosing a medical specialty, the cost of education is a major concern for the future of health care. Medical students and physicians across the US have made extensive time commitments during their 20s to mastering the foundations of medicine and completing a residency. New physicians today face an exorbitant amount of debt that takes anywhere from 10 to 30 years to repay. We must continue to attract the brightest and smartest students into medicine without deterring them by cost. All Americans and the newly insured 32 million US citizens are counting on my generation to become the future of medicine. We cannot afford to let a price tag deter us from this responsibility.

When a friend and I created our medical school’s first student state lobby day, the solution proposed by many legislators was to find a side job or take out more student loans. As any physician would know, medical students already work and study for more than 70 hours a week, which does not allow for earning a substantial side income.

I propose a unique business model, “Invest in a Medical Student’s Tuition Program,” (IMSTP) to help mitigate student loan debt. I began working on this idea three years ago, after I presented it to the AAMC’s Organization of Student Representatives. My goal is to create a new venture that would eliminate one of the two financial problems facing students: cost of tuition and interest rates. Because the cost of tuition is set by the university, I decided to tackle the 6.8 percent interest rate set by federal government Direct Loans.

Think NCAA Athletes Shouldn’t be Paid? What the Kevin Ware Story Says About the Risks of College Sports

Apr 5, 2013• 4

By Dan Diamond

In many ways, it had been an exemplary few days for the NCAA and its signature basketball tournament—a weekend that put the madness back in March.

On Friday, Michigan and star guard Trey Burke completed an epic comeback over Kansas. On Saturday, Cinderella team Wichita State crashed the Final Four.

But for many people watching the Louisville-Duke game unfold, a disturbing injury to Louisville guard Kevin Ware illustrated a different sort of madness: the continued lack of compensation for the players who make the tournament so special.

“Pray for [Ware],” columnist Dave Zirin tweeted. “There is no safety-net for the injured NCAA athlete.”

Injury worst seen on TV

Ware’s broken leg—”about the most gruesome injury I’ve seen in a basketball game,” bemoaned analyst Seth Davis—came on a routine play, as he landed awkwardly after trying to block a shot by Duke’s Tyler Thornton.

Zombie Hospital Economics

Apr 5, 2013• 8

By David Dranove

The Illinois hospital dinosaurs continue to defy evolution and prove that they are not extinct. I am talking about our health facilities planning board, which just turned down another Certificate of Need application for a new hospital, this time in the northwest suburbs of Chicago. The board justified the decision by stating that the new hospital would harm existing hospitals.

I know that the Chicago School of economics tells us that regulators serve the interests of those they regulate, usually at the expense of the public. But just because the Illinois planning board sits in Chicago, that doesn’t mean they have to slavishly follow the Chicago School. They could act in the public interest at least once in a while! (Though if the board started approving too many new health facilities, someone might notice that they are not needed and put them out of a job.)

Should Small to Medium-Sized Practices Use Cloud-Based EHR?

Apr 5, 2013• 11

By John Halamka, MD

Recently I was asked if SaaS/Cloud computing is appropriate for small practice EHR hosting.

I responded: “SaaS in general is good. However, most SaaS is neither private nor secure. Current regulatory and compliance mandates require that you find a cloud hosting firm which will indemnify you against privacy breeches caused by security issues in the SaaS hosting facility. Also, SaaS is only as good as the internet connections of the client sites. We’ve had a great deal of experience with ‘last mile’ issues.”

JAMA EHR Study: Misdiagnosis Poses Significant Potential for Harm

Apr 5, 2013• 21

By Evan Falchuk

An important study in the Journal of the American Medical Association finds that misdiagnosis is more common than you might think. According to the study, almost 40% of patients who unexpectedly returned after an initial primary care visit had been misdiagnosed. Almost 80% of the misdiagnoses were tied to problems in doctor-patient communication, and more than half of those problems had to do with things that were missed in the patient’s medical history.

The results of this study shouldn’t be surprising if you’re a regular reader here – they are another example of a system that isn’t working as well as it could for patients, and doctors. Doctors – and the medical professionals who help them in their work – are the best educated and best trained than they have ever been. They have more access to medical information and technology than at any time in our history. And yet, U.S. government data show that the typical doctor visit involves 15 minutes or less with your doctor. Medical records are kept in fragmented, uncoordinated ways.

Inside the New Data on ADHD Diagnosis Rates

Apr 5, 2013

By Brendan Saloner

The New York Times had a cover story recently reporting on the estimated prevalence of Attention-Deficit/Hyperactivity Disorder from the 2011-2012 National Survey of Children’s Health (they don’t identify the survey by name).

The story is going to get a lot of people interested in what is happening to children — every new datapoint on ADHD is noteworthy because it allows journalists to reopen the black box on childhood behavioral health disorders, and to raise the perennial alarm bells about over-diagnosis of children.

All of the issues raised in the article are valid. Many children with very mild impairments are getting a diagnosis, and enterprising drug companies are increasing demand for their product by implying that ADHD medications are a cure for generalized social impairments.

But — and this is critical – we have little systematic population-level data to compare the reported prevalence of a diagnosis with underlying data on ADHD symptoms in children. Continue reading…

Strength In Numbers

Apr 5, 2013• 1

By Doctor Girl

Data = Power. The Surviving in Numbers Project.

A Model for Health Care Reform:Would You Guess Medicare Part D?

Apr 4, 2013• 11

By Hank Pomeranz

Every day, over 7,600 baby boomers turn 65. By 2029, this number will rise to over 11,000. As more and more Americans approach senior citizenship, health care for seniors through Medicare becomes increasingly relevant. The question is, how will this affect you?

We all have questions about how the current budget battle and resulting spending cuts are going to impact Medicare. It seems unavoidable that Medicare costs will have to be reduced in some manner. Both Democrats and Republicans have proposed fixes to counteract these budget cuts. President Obama, in his State of the Union address, recommended adjustments to Medicare Part D that would enforce mandatory rebates–in other words, price controls–on drug companies.

But we need to ask ourselves: why would we make changes to the most successful part of Medicare by far? Polls indicate that 90 percent of seniors are happy with their current Part D coverage. Not only is Part D popular; it is also cost effective. It has cost 30 percent less than originally estimated. Premiums are an average of half the price originally estimated. Meanwhile, price controls are estimated to increase drug costs by 40 percent. Clearly, they are not the answer to cutting Medicare costs.

Healthy Community Data Summit — A Call to Action

Apr 4, 2013• 1

By Wil Yu

Do we live in times of barbarism?

While I imagine many reading this would disagree that we live as a primitive culture based on our technological progress, I contend that how we operate as a community may be vastly improved in supporting the health and well-being of everyday citizens. Furthermore, I believe that one day we’ll look back on ourselves as society and marvel at how primitive the tools were to improve the health of communities.

On a daily basis, our individual health is driven by countless decisions. Where we shop for food, how we commute, where we choose to live and spend our time outdoors are all contributors to our health and wellbeing. Each of these actions can be improved—optimized so they contribute to a maximum level of health—if adequate data is available.