Author Archives

maithri

Trickle Up Economics

Mar 6, 2013• 8

By Rob Lamberts, MD

It’s been a month since I started my new practice. We are up to nearly 150 patients now, and aside from the cost to renovate my building, our revenue has already surpassed our spending. The reason this is possible is that a cash-pay practice in which 100% of income is paid up front has an incredibly low overhead. My admitted ineptitude at financial complexity has forced me to simplify our finances as much as possible. This means that the accounting is “so simple even a doctor can do it,” which means I don’t need any front-office support staff. I don’t send out bills because nobody owes me anything. It’s just me and my nurse, focusing our energy on jury-rigging a computerized record so we can give good care.

Our attention to care has not gone unnoticed. Yesterday I got a call from a local TV news reporter who wanted to do a story on what I am doing. Apparently she heard rumor “from someone who was in the hospital.” I was the talk of the newsroom, yet I’ve hardly done any marketing; in fact, I am trying to limit the rate of our growth so I can focus on building a system that won’t collapse under a higher patient volume. I explained this to the disappointed reporter why I was not interested in the interview by telling her that I left my old practice because I needed to get off of the hamster wheel of healthcare; the last thing I want to do now is to build my own hamster wheel.

Matthew Holt on HIBC.tv from HIMSS 2013

Mar 6, 2013

THCB founder Matthew Holt is reporting live from HIMSS 2013 in New Orleans. Matthew’s first guest is Ben Chodor of Happtique. We’ll then hear from Matthew on his walking tour of the floor as he drops in on a few companies, including Kareo, CareCloud, Wellness Layers, and more…

Watch the live stream here: http://www.livestream.com/hibc.

CommonWell Is a Shame and a Missed Opportunity

Mar 6, 2013• 39

By Adrian Gropper, MD

The big news at HIMSS13 was the unveiling of CommonWell (Cerner, McKesson, Allscripts, athenahealth, Greenway and RelayHealth) to “get the ball rolling” on data exchange across disparate technologies. The shame is that another program with opaque governance by the largest incumbents in health IT is being passed off as progress. The missed opportunity is to answer the call for patient engagement and the frustrations of physicians with EHRs and reverse the institutional control over the physician-patient relationship. Physicians take an oath to put their patient’s interest above all others while in reality we are manipulated to participate in massive amounts of unwarranted care.

There’s a link between healthcare costs and health IT. The past months have seen frustration with this manipulation by industry hit the public media like never before. Early this year, National Coordinator for Health Information Technology Farzad Mostashari, MD, called for “moral and right” action on the part of some EHR vendors, particularly when it comes to data lock-in and pricing transparency. On February 19, a front page article in the New York Times exposed the tactics of some of the founding members of CommonWell in grabbing much of the $19 Billion of health IT incentives while consolidating the industry and locking out startups and innovators. That same week, Time magazine’s cover story is a special report on health care costs and analyzes how the US wastes $750 Billion a year and what that means to patients. To round things out, the March issue of Health Affairs, published a survey showing that “the average physician would lose $43,743 over five years” as a result of EHR adoption while the financial benefits go to the vendors and the larger institutions.

Really Big New Thing

Mar 6, 2013• 2

By MIKE MIESEN

“Will Accountable Care Organizations (ACOs) work?”

That question has been thrown around for years, serving as fodder for Twitter-fights, myriad health care blog posts, and hours of beer-soaked barroom debates (if you’re shameless as I am). Adding to the discussion are Clayton Christensen, Jeffrey Flier, and Vineeta Vijayaraghavan (or CFV, as I’ll refer to them), of Harvard Business School, Harvard Medical School, and Innosight fame, respectively.

In a recent Wall Street Journal article, they answer the question with a resounding “No.” But, in doing so, they treat ACOs and other health care delivery mechanisms – part of what I’ll call the “New New Thing in Health Care” – as mutually exclusive. Contra CFV, ACOs may help spur the exact disruptive innovation in health care that Christensen is known for discussing.

Did Massachusetts Health Care Reform Hurt Access To Care For the Previously Insured?

Mar 5, 2013• 13

By Ashish Jha, MD

In 2006, Governor Mitt Romney signed Chapter 58 of the Acts of 2006 entitled “An Act Providing Access to Affordable, Quality, Accountable Health Care.” It has been described by many names, including Massachusetts Healthcare Reform (MHR), Romneycare, or simply, as the template for the Affordable Care Act. The goal of the act was straightforward: to ensure near-universal access to health insurance for citizens of the Commonwealth of Massachusetts. The bill quickly led to insurance expansion: by 2010, 94.2% of adults under 65 had health insurance, an 8 percent increase over the 86.6% in 2006. By all accounts, the goals of insurance expansion were met.

But the bill has not been without controversy. There have been two main concerns: first, that the bill did too little to control rising healthcare costs. The cost crisis led to the 2012 bill that many refer to as “Mass Health Reform 2.0” – formally called Chapter 224 of the Acts of 2012. Its focus is to curtail healthcare spending, and while reasonable people have reasons for skepticism about the likelihood of success, that’s a topic for another day.

Paging Dr. Google

Mar 5, 2013• 18

By Rob Lamberts, MD

For the record: I am a geek. I love technology. I adopted EMR when all the cool kids were using paper. Instead of loitering in the “in” doctors lounge making eyes at the nurses, I was writing clinical content and making my care more efficient. I was getting “meaningful use” out of my EMR even when nobody paid me to do it.

But now who’s laughing? While they are slaving away trying to get their “meaningful use” checks, I’ve moved on to greener pastures, laughing at their sorry butts! It’s just like my mom promised it would be. Thanks mom.

Really, for the record, I am not so much a technology fan as a “systems” guy. I like finding the right tool for the job, building systems that make it easier to do what I want, and technology is perfect for that job. I am not so much a fan of technology, but what technology can do. Technology is not the goal, it is the best tool to reach many of my goals. There are two things that measure the effectiveness of a tool:

1. Is the tool the right one for the job?
2. Is the person using the tool properly?

So, when answering the question I posed at the end of my last post, what constitutes a “good” EMR, I have to use these criteria.

How the Best Innovate and Commercialize

Mar 5, 2013• 1

By Chris Coburn

With an unprecedented amount of attention and dollars spent on healthcare-related research at academic medical centers, institutions are often blazing their own trails with regard to innovation and commercialization. In an attempt to consolidate a diverse array of approaches, Cleveland Clinic Innovations and the Council for American Medical Innovation have joined forces to release the first-ever comprehensive study of technological innovation and commercialization at the nation’s top healthcare institutions.

The Medical Innovation Playbook will offer an in-depth characterization of how each of the top medical centers has organized to stimulate innovation and its commercial application. The Playbook will include profiles of at least 75 academic institutions and medical centers that, when combined, will result in an easy-to-understand guide that will be a resource for practitioners, academic executives, trustees, policy makers, companies, entrepreneurs and investors.

Physician Entrepreneurs

Mar 4, 2013• 5

By David Dranove

I have been taking a vacation from blogging as I try to get through a very busy academic quarter. But my last blog, “My Son the Electrician” elicited a lot of comments and I have always wanted to follow up. And today I see that the Chicago Sun Times has generously quoted me, in particular noting how I liken physicians to entrepreneurs. Lest anyone get the wrong impression, let me briefly explain what I mean.

Like entrepreneurs, physicians launch their careers by making large investments – up to ten years of post-graduate training. Such investments do not come with a guarantee. Entrepreneurial physicians – those who own their own practices or work in small partnerships, must build their practices and maintain relationships with other physicians. All successful physicians, whether entrepreneurs or employees, enjoy personally and professional satisfying careers and comfortable, sometimes more than comfortable, incomes. But only physicians entrepreneurs have ultimate responsibility for their practices and their patients.

What Apple Can Teach Health Care About Thinking Different

Mar 4, 2013• 18

By James Rickert, MD

Apple Incorporated has grown to be among the most valuable and most envied companies on earth. Its products are ubiquitous and beloved by many of their users. Last year, the firm generated nearly $26 billion in profits on revenues of $108 billion. When physicians and others working in health care discuss the lessons that the medical establishment can learn from these types of corporate successes, the conversations almost always revolve around the promise of information technologies, such as electronic record keeping or electronic prescription writing, and the need for increased use of these in medical practice. While these technologies are important, the most valuable lesson from Apple’s success is a demonstration of the power of empathy and the subsequent need for health care providers to emotional connect with our patients.

It is widely known that Steve Jobs and Steve Wozniak built the first Apple computer in Steve Jobs’ garage; what is not as widely known is that they quickly brought in a third partner, Mike Markkula, to join and guide the company. He began by writing a one page statement entitled “The Apple Marketing Philosophy”. This philosophy stressed only three key components of bedrock company principles; the first and most important was empathy.

The Promises and Pitfalls of Pay for Performance

Mar 3, 2013• 4

By Martin S. Gaynor

There’s been a great deal of discussion about health care payment reform. Prominent in this discussion is “Pay for Performance” (P4P). The idea is simple — rather than pay providers based on volume of care (fee-for-service) or number of patients (capitation), tie their payment to a measure(s) of performance. There has been substantial concern about the quality of care delivered to patients, so pay for performance appears to make a lot of sense. Don’t we want to reward providers for good performance? Shouldn’t this encourage them to provide high quality care?

Unfortunately, this is not as straightforward as it might appear. While the idea of pay for performance is very appealing and intuitive, there are some major pitfalls in implementation.