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Matthew Holt

Around the Web in 60 Seconds (Or Less)

A clinic in Minnesota is routinely dropping patients with high-deductible health plans who aren’t paying their bills, the Star Tribune reports. "For the most part, these are college-educated and middle-class folks," Dr. Rochelle Taube told the Tribune. "We send them a letter and say unfortunately, we’re not able to care for you." Some clinics and doctors’ offices that aren’t dropping patients have had to exert more effort or new approaches to getting paid, "such as swiping a credit card at check-in just like at a hotel."

Sicker patients are better off getting bypass surgery than medicated coronary stents, according to the Wall Street Journal. Boston Scientific funded the study using its own stents. It’s the first head-to-head study of its kind, but hopefully not the last if analysts’ predictions are accurate that the failure to show stents as the obvious treatment of choice for complicated heart patients will lead to a drop in sales. The BSX stock price increased 1 percent Tuesday.

In 2006, U.S. pharmaceutical companies spent about $5 billion on consumer marketing campaigns, but the Washington Post reports a Harvard Medical School study in the British Medical Journal found the spending may have less impact on consumer behavior than previously assumed.

Also in BMJ, a review of Britain’s National Health Services records shows that patients undergoing a hip or knee joint replacement using the new resurfacing technique are more than three times as likely to need a replacement than if the joint were fully replaced and cemented. The study tracked more than 150 000 people who underwent a hip or knee replacement between April 2003 and September 2006. To learn more about the U.S. failure to track the safety of joint replacements, read this New York Times article.

Health 2.0 User-Generated Healthcare

How are Web 2.0
technologies like social networks, wikis and online communities
changing the face of the health care industry? How are hospital systems
and physician practices evolving as a result of rapid technological
change?  How can health plans evolve in
the face of emerging challenges with the help of new technologies and
new thinking? What will come of the recent controversies over genetic
testing and the privacy of patient data? Where does the hype over social networks and
user-generated content end and the reality begin?H20logo

Come learn more about these questions and many more at Health 2.0 on October 22nd – 23rd at the San Francisco Marriott.
You’ll meet industry insiders and new players entering the field. You’ll see
rapid-fire demos of new technologies and hear both expert reaction from
established players in the field and fresh perspectives from newcomers.
You’ll also get critical insight from industry observers as well as practical,
common-sense advice on employing these new technologies in your own
business or organization.

Confirmed speakers include: Google Health, Microsoft, Yahoo Health, Healthline, Cisco, Eliza, Silverlink, DestinationRX, AthenaHealth CEO Jonathan Bush, Sermo CEO Daniel Palestrant, HealthGrades CEO Kerry Hicks,  WebMD CEO Wayne Gatinella, Clay Shirky, author of "Here Comes Everybody: Organizing Without Organizations." Dr. David Kibbe, Jay Parkinson, M.D., Jane Sarasohn-Kahn, THCB’s Matthew Holt, Health 2.0’s Indu Subaiya,  CrossoverHealth founder Scott Shreeve, 23andMe and many, many more.

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A long way to go in price and quality transparency

Providing price and quality information is viewed as a Holy Grail among health plans and providers, who see transparency as the key for igniting health care consumerism. However, that Grail remains elusive, as issues of tool usefulness and consumer trust cloud the market."A Health Plan Work in Progress: Hospital-Physician Price and Quality Transparency," a report from those indefatigable folks at the Center for Studying Health System Change (CSHSC), explains that health plans are ramping up transparency efforts in what is still an early phase of market development and adoption.

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Do membership practices offer privileges or just reserved for the privileged?

Scott_shreeveI have watched the meteoric rise of popular term “Medical Home.” While I personally dislike this phrase, it has caught on in the popular vernacular and looks like it is here to stay. In conjunction with the rise of the term is the growing popularity of a practice model that includes a higher level of service on a membership basis. It is essentially, next-generation concierge medicine, but now being promoted under the more politically correct banner of “direct practice.” Multiple variations of the model exist, from an all-inclusive single fee to a membership structure that retains a fee for service financial arrangement.

So discerning patients evaluating these practices are forced to determine the relative value of this new direct practice concept, and having passed that test, determine which type of practice model actually makes sense to them (All inclusive or Fee-for-Service). Lets look at these questions using a traditional four-person family with an annual all-in health care spending of $15,000 (consistent with Milliman’s 2008 numbers).

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Around the Web in 60 Seconds (Or Less)

Chrome

Google launches its own Web browser, Chrome. The latest competitive move with Microsoft is available for download today.

About 800 people in New Hampshire are about to lose their health insurance because the plans don’t meet the minimum requirements set by the state. Can you say unintended consequences of consumer protection laws?

The Joint Commission will now grade hospitals on their level of "cultural competency." The Commonwealth Fund will fund a panel to "explore how diversity, culture, language and health literacy issues can
be better incorporated into current Joint Commission standards or
drafted into new requirements."

The National Quality Forum has endorsed nine new national standards for health information technology in the areas of electronic prescribing, electronic health record, interoperability, care management, quality registries, and the medical home.

California steps into uncharted territory without a state operating budget. The Legislature’s failure to agree has led to the longest overdue budget in state history.

Medicare hospital quality reporting steps up in sophistication

Robert_wachter
Medicare is now reporting actual risk-adjusted mortality rates for pneumonia, MI, and heart failure. The topic must be important because NPR’s "Talk of the Nation" spent 30 minutes interviewing Don Berwick and me about it — on the day of Hillary’s speech nonetheless!

To listen to the show, click here. Also, here’s an article from USA Today that got the ball rolling, as well as Avery Comarow’s thoughtful blog on these new reports.

Here are a few observations about the new Centers for Medicare & Medicaid Services initiative, some of which I made on the NPR broadcast:

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Keep tabs on your digital footprint

Is it "disordered" behavior to Google your doctor? An article in JAMA suggests that doctors should be on their guard.

The Journal of the American Medical Association recently published an article about how doctors should be aware of how they are portrayed online and consider taking steps to manage their digital identities.

It is an article that, for the most part, could have been written about any profession with its warnings about “slanderous information published about someone with the same name” or “by a vengeful…colleague or ex-lover.” And the advice given is also familiar: create your own Web page to be sure correct information is available about you and use appropriate privacy settings on social network sites.

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Voila! Uninsured problem solved by not counting them

John McCain’s health adviser John Goodman in the Dallas Morning News on solving the problem of the uninsured:Jcgoodman

"So I have a
solution. And it will cost not one thin dime," Mr. Goodman said.
"The
next president of the United States should sign an executive order
requiring the Census Bureau to cease and desist from describing any
American – even illegal aliens – as uninsured. Instead, the bureau
should categorize people according to the likely source of payment
should they need care.

"So, there you have it. Voila! Problem solved."

Read Matthew’s comments and a great discussion on Goodman’s quote here.

Obama and Krugman — almost mirror each other

I thought Obama was fabulous last night at the convention. He’s a great speaker, but
also able to gently laugh with his audience. His introduction showed what a tough road he had. If the Republicans manage to convince the American people that a black kid with a single white parent living in middle America is an elitist son of privilege then Karl Rove is better than I thought.

He was happy to rip McCain not on personality but on the issues. I’d like to have seen a lot more from the Democrats at this convention ripping Bush and Cheney on personality, personal corruption and the issues, and I wish Kerry had done even more in 2004, but that’s water under the bridge.

But the key point is that for most Americans things aren’t going well. Paul Krugman, who’s had his differences with Obama says it well today showing just how much key Republicans are out of touch — especially on the economy and health care.

Of course all he has to do is quote Phil Gramm, who appeared in Obama’s speech, and John Goodman who didn’t but does make it into Krugman’s column today. Goodman, of course, was pilloried in THCB yesterday. But I still think it’s a triple bluff on his part.

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