Author Archives

Matthew Holt

Persistent Nondiagnosis

Jan 9, 2009• 11

By Brad Kittredge

Brad Kittredge is an MBA/MPH student at the Haas Business School at UC, Berkeley. He is working to build an online tool to assist with complex and difficult diagnoses, which, as you’ll see, he considers among the biggest problems in medical care. He blogs more about these issues at Hyoumanity.

Every day, thousands of Americans are desperately seeking answers to complex medical conditions that doctors are unable to diagnose. Consider one example: Jenny T. is a 14 year old girl with a progressively debilitating neuro-degenerative condition that has taken her from healthy and active to nearly paralyzed in less than one year. Her parents have taken her to some of the best academic medical centers in the US, including Stanford, UCSF, and the University of Pennsylvania, but doctors have been unable to diagnose her condition, leaving Jenny and her parents desperate for answers and short on options.

“The Innovator’s Prescription”: Christensen’s Book Offers Insightful Dx, Unrealistic Rx

Jan 8, 2009• 9

By Vince Kuraitis and David C. Kibbe

Being big fans of Clay Christensen and his theory of disruptive innovation (DI), we have been awaiting his just-released book The Innovator’s Prescription: A Disruptive Solution for Healthcare . The book is co-authored by Dr. Jerome Grossman and Dr. Jason Hwang.

We have mixed reactions.

The book is mistitled. It should have been titled “The Innovator’s Diagnosis”. The book does a fantastic job at diagnosis (Dx) of problems in the U.S. health care system. It presents many new, innovative analytical frameworks and lenses through which to view the U.S. health system.

However, it’s weak on prescription (Rx): many of the proposed solutions are speculative, ungrounded, and/or defy political reality.

We understand that the very nature of disruptive innovation implies inevitable resistance from organizations that benefit economically from the status quo. But at some point a proposed solution becomes so disruptive that you have to suspend reality to believe that it could be adopted or implemented — and many proposed solutions in this book enter that realm.

The book applies Christensen’s general theory of DI specifically to the health care system. It addresses questions such as:

What is DI?
Why is it important to create an environment in health care where DI can flourish?
How can we create the right environment in health care for DI to flourish?

The introductory chapter of the book is available here at no charge (right column under Downloads). It’s a great overview.

Sanjay Gupta as Surgeon General? Not so fast.

Jan 8, 2009• 15

By VAL JONES MD

Sguptalarge150x150 This week’s news that Sanjay Gupta, CNN’s medical correspondent, is being considered for the office of
Surgeon General by President-elect Obama came as quite a shock to me. I’ve met and interviewed 3 of the
recent Surgeons General over the past few years. Of course, I like
Sanjay Gupta as a reporter. He’s a fine communicator and does a good
job covering subjects for a consumer audience. But I don’t think he has
the gravitas or appropriate experience for the role of Surgeon General
of the United States.

I spoke with one source close to the nomination proceedings, and he
said that most senior people were secretly disappointed with the
choice. My source requested that I not reveal his name.

If Sanjay Gupta is confirmed as Surgeon General he will
achieve the immediate rank of admiral, even though he has no previous
military or public health experience whatsoever. It will be difficult
for Gupta to be taken seriously by peers at the Pentagon and State
Department. The office of Surgeon General is a very important position
given only to the most senior and experienced medical professionals
with decades of achievements in their fields. Gupta is a good reporter,
he should consider a role in public relations for the U.S. government,
not the office of Surgeon General.

Commentology

Jan 8, 2009

Longtime THCB reader Barry Carol writes in on Matthew’s "Shocker …"

"Most hospital CEO’s, especially those who oversee academic medical centers, would probably tell you that their profit margins are quite low and that they could not make ends meet or continue to provide the quality of care they do now if they had to accept Medicare rates from all comers, even with no uncompensated care …"

David Kibbe continued the ongoing dialogue on the thread on the "Rebooting Health IT" series he is co-authoring with Brian Klepper.

"Having thoughtful physicians like yourself enter the debate and
discussion is one of the primary reasons that Brian Klepper and I are
doing these blogs on re-thinking health IT! Thanks for your input,
which I think is brilliant … Let’s not forget the story of John Snow and the removal of the Broad
Street pump handle, during the deadly cholera outbreak in London in
1854. While all the experts were debating the causes of the infection
and what to do about it, Dr. Snow had the simplest and most direct
answer of all: remove access to the offending source of the calamity."

The Five Myths of Healthcare Reform

Jan 8, 2009• 5

By ROBERT LASZEWSKI

The arguments that the widespread use of health information technology (HIT), improving health status, expanding outcomes research, implementing pay-for-performance systems, and covering everyone will make it possible for us to afford comprehensive health care reform are commonly cited by people on both sides of the political aisle. It’s all a myth.

Undoubtedly, these ideas will be at the core of any number of health care reform proposals as we begin the 2009 health care reform effort.There is nothing wrong with any of these things and all can make a positive contribution toward improving both the cost of and especially the quality in our health care system. All should be part of a reform proposal.The problem is that none of them would make more than a modest dent in what a reformed system would cost us and not come anywhere near close to
accomplishing the objective of stabilizing our health care costs much less reducing them.

Shocker–Karen Ignagni almost tells the truth

Jan 8, 2009• 21

The NY Times’ Robert Pear has an article on the politics of the Obama Administration introducing a public plan as part of FEHBP.

As you might expect a boat load of Republicans who were told in grade school that private is good and public is bad are concerned about this causing the demise of private health plans–even though that would clearly benefit the country. Of course Pete Stark is quite happy to say that it’s not that Medicare underpays (as Charlie Baker said here last week), but it’s that private plans over pay.

So why is that the case? Well you knew that I couldn’t resist the appearance of my favorite lobbyist. Here’s what Karen Ignagni says, and — this is the shocker– it’s half true.

Karen M. Ignagni, president of America’s Health
Insurance Plans, a trade group, said the consolidation of the hospital
industry in the last seven or eight years had increased the market
power of hospitals, thereby reducing the ability of insurers to
negotiate discounts.

Actually it’s been more
like twelve to fifteen years since big players started merging (IFTF’s
Ellen Morrison wrote a great report about that in 1994 called "The Six Americas").
By the late 1990s Sutter, for example, was facing down Blue Cross of
California on price and winning. And of course in Boston Partners was
getting bigger and bigger, and facing down Blue Cross and the other plans. (Leading occasional THCB contributor and Beth Israel Deaconess CEO Paul Levy to become a big whiner, according to Partners Chairman Jack Connors). So Karen is telling the truth.

Poizner: talks tough, wimps out WITH UPDATE

Jan 7, 2009• 16

By Matthew Holt

Previously in the long running retroactive insurance cancellation story I’d accused Steve Poizner (yes, the only Republican I’ve ever voted for and) California state insurance commissioner of being a bit soft. Now he really needs calling out.

Saint Lisa Girion reports in the LA Times today that to make up for cancelling 678 policies, Blue Shield, yes the warm cuddly pro-universal care loving non-profit insurer that’s not Wellpoint, has to reinstate them. Which means they have to reinstate the policies and pay the bills that they’d previously decided not to pay.

Now Blue Shield has been the most aggressive of all the insurers in the state in claiming that it had the right to retroactively cancel policies. Most of the others settled ages before. Meanwhile Poizner last year said this about Blue Shield:

Confusing ‘Standards’ With ‘Interoperability’–Lessons For The 111th Congress From HIPAA

Jan 7, 2009• 12

By RICK PETERS, MD

As we debate whether or not the Obama Administration and the 111th Congress should work towards directly funding EHRs, one of the key questions seems to be whether or not EHRs and interoperability standards are mature enough.

My colleague, John Halamka, Chair of the Healthcare Information Technology Standards Panel (HITSP), made an rational and impassioned plea last week that we have reached a state of interoperability that is at least good enough not to delay allocating Federal funds for investments in EHRs. Dr. Halamka had earlier in December advocated direct grants from the Federal government of $50,000 per U.S. clinician to states to fund the purchase of CCHIT compliant commercial EHR products.

In the ideal world, I agree with John’s position, but have spent perhaps too much time in the real EHR world and in health care standards to truly believe we are where we think we are. We have been here before and our best intentions were subverted.

Cool Technology of the Week

Jan 7, 2009

By JOHN HALAMKA

Community_map_2 As part of the Harvard Clinical and Translational Science Awards, we’ve built a number of social
networking tools while also leveraging components built by others such as NetAge. These tools typically work by analyzing collaborators on publications, co-PIs on grant funding, and subject matter interests.

A possibly more precise way to identify networks and communities is by analyzing email traffic patterns – senders, receivers and subjects. A novel social networking tool from Metasight called Morphix, does this.

MetaSight Communities of Interest and Communities of Relationships are web applications which can be implemented as standalone applications or integrated with a corporate portal or intranet.

The tools work by automatically analysing e-mail subject titles and recipients. Personal, private and confidential e-mails are excluded.

Per the Metasight website, social networking applications of this analysis include:

Whata Gupta Fuss

Jan 7, 2009• 4

By Matthew Holt

Mostly because he went off erroneously at Michael Moore in what I remember as two amateur policy analysts being unable to either get their facts straight or explain what was important, Sanjay Gupta’s floated appointment as surgeon general has got the left in a tizzy. And I agree that a neurosurgeon is not exactly who I’d go to for information about public health. But part of the amusement/confusion is that via a now contrite Merril Goozner, CNN’s Sanjay Gupta was confused with another Sanjay Gupta who was a big time recipient of drug company funding.

But does any of this this matter? I know that the rumor is that he’ll have input into health reform, but then again so does anyone who went to a Daschle house party. And if this position is so important, answer me this: who is the current Surgeon General and what notable thing has he or she done?

I knew you couldn’t do it sans Google….

If you really care, Val Jones has recently interviewed the last but one surgeon-general Richard Carmona. In your piece of trivia for today Carmona knows about Health 2.0, or at least is on the board of Healthline.

Anyway we may not have enough general surgeons according to their trade group, but why should the head of public health for the nation be a surgeon. Shouldn’t they be an epidemiologist? And why are they a general? Don’t we waste enough money on the military as it is?