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Matthew Holt

THCB UPDATE

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Careseek CEO Gale Wilson Steele writes in to comment on the ongoing controversy over physician ratings:

"It’s not surprising that physicians are uncomfortable with the idea of others "rating" them.  After all, what do others know about how well they provide healthcare?

This, actually, is very similar to the reactions professors first had on RateMyProfessors, where professors protested that students only cared about whether their tests were fair, and scoffed saying that the “kids” knew nothing about the professors’ degrees, research projects, etc.  In the minds of those who stood at the lectern, it was about academic qualifications; for those in the seats, it was about staying awake.  Today, professors are much more comfortable with the fact that they can be listed on a website and reviewed, and in fact, are somewhat insulted if no student has taken the time to list them.  Secretly they even hope to receive a few “chili peppers”, meaning that they are “hot” professors!

Ultimately, a few professors responded in kind and created Rateyourstudents.blogspot.com, a sort of RateMyStudents site.  By now it has turned into a cynical professorial rant about teaching.

So with new physician rating and review sites coming online nearly every week, how are doctors going to handle being rated by their patients?  Physicians also complain “What does a patient know about how well I practice medicine?…Patients don’t know about my years in school, my research, my etc.” 

Will doctors ultimately create a site called RateMyPatients, where they can rant over the injustices of healthcare and the assaults they take daily from their patients?  Or will they praise these sites as a place to learn how to improve their practices or as sources of patient testimonials to their excellence? 

The latest twist on who rates whom is eliminating the issue of reviewer qualification, namely NursesRecommendDoctors.com.  No one will deny that this population of over 3,000,000 trained medical professionals has a keen insight into the practices of physicians, their bedside manners and clinical competence.  It will be interesting to see if this trusted group of patient advocates will have the willingness to share what everyone wants to know…who are the best doctors?"

TECH: Google to Store Patients’ Health Records

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The AP has announced that Google’s first step into the world of storing health records will be in conjunction with the Cleveland Clinic—which of course already has a boatload of patients using EMRs and PHRs on the Epic MyChart system. The idea (presumably as this is a leak from within Cleveland Clinic not an official announcement) is that those records can be stored in Google, and presumably will be transportable—somewhat similar to what Microsoft and Dossia are promising. Nothing earth-shattering yet, but an interesting beginning.

And of course we’ll hopefully get some more details next week at the HIMSS conference where Google CEO Eric Schmidt is speaking, and the Health team is having a party to which they kindly invited me (Thanks, Missy!)

Google has been much criticized for its slow pace in health. But speaking as one who now runs big components of our little business on Google via Checkout (and integrates it with rival services like WuFoo and TypePad) — I think that this (and HealthVault et al) is a small step towards a much bigger online future for health care transactions. At least, I hope so!

HOSPITALS: The SEIU & Paul Levy lovefest continues

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The SEIU has been trying to organize Beth Israel Deaconess Medical Center, who’s CEO Paul Levy’s most famous accomplishment is writing a blog called Running a Hospital. (What could be more worthy than that? Yes, we feature Paul’s posts on THCB fairly often because we think he’s really good).

In his writing about the SEIU Paul has been, as Eric Idle (or was it Graham Chapman) used to say, cruel but fair. He nominally is neutral on what his employees decide to do about unionization but it doesn’t take much reading between the lines to show what he really thinks about the SEIU and its campaign.

And now, while Paul is off luxuriating on the sunny climes of an English February, the SEIU is striking back—pointing out that BIDMC includes bad debt in its charity accounting and is therefore overstating the amount of charity care it gives out. This isn’t exactly a rarity amongst hospitals, but it’s not that often that the SEIU gets it reported in that collectivist organ known as The New York Times.

POLICY: The financial castrophe of uninsurance will get worse

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Just another reminder about the perversity of our insurance system. Steve Lopez in the LA Times writes a about a 57 year undergoing chemo whose COBRA benefits are running out . Whether or not chemotherapy is always the right option in these cases (and you’ll get plenty of arguments about that here on THCB), there is no excuse for a system where financial catastrophe will be visited on families by the random luck of getting sick.

But of course this problem is growing rapidly. Health Affairs confirms today with an Urban Institute study what’s well known—health insurance coverage has been declining while the economy has been expanding. This is the complete opposite of the 1990s, where the numbers covered by employer-provided health insurance increased as the economy improved.

So of course in the coming (or present?) recession the horror stories like that of the teacher and those Jon Cohn wrote about in Sick are just going to multiply.

HEALTH 2.0 Accelerator

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At the end of Health 2.0 in September 2007, CommerceNet’s Marty
Tenenbaum proposed the creation of an industry initiative to accelerate
the Health 2.0 vision. This initiative would do for Health 2.0 what
CommerceNet did for e-commerce, educating and catalyzing the market
through visionary integration projects that demonstrate the potential
of Health 2.0 to improve people’s lives. This first organizational
meeting will forge a direction for the Health 2.0 Accelerator,
exploring potential projects and organizational structures.

Come prepared to share your ideas about the need for a Health 2.0
Accelerator and what it should focus on: What are the problems that are
preventing your technology or organization getting specific tasks done?
What standards are needed to facilitate data exchange and mash-ups?
What partnerships would make your services or products more valuable?
How could a Health 2.0 Accelerator help?

This session is open to attendees at Health 2.0 San Diego only. Please pre-register for this session by clicking on this link.
You are also encouraged to propose a specific topic for discussion as a
potential project, and should come prepared to speak about it briefly
(PowerPoint ok).

UPDATE: Health 2.0 Connecting Consumers and Providers is officially sold out. You can sign up for the waiting list here. You will be notified by email if additional passes become available due to cancellation or a capacity increase.

EXHIBITORS: Want to get your healthcare service or product in front of the right people?  Health 2.0 is the place to be. Connect with investors and high level executives and opinion leaders at the top health systems, health plans and technology companies around the country.  Email in**@********on.com with "exhibitor info please" in your subject line and we’ll get back to you in two shakes.

PODCAST: American Well’s Roy Schoenberg

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Ever since I saw Roy Schoenberg (of American Well)’s view of the future of patient to physician communication I’ve been waiting to bring it to you on THCB and the Health 2.0 Blog. And finally I was able to get him to tell me about it.

So first whip over to the American Well site and watch the video about how it works, and then come back here and listen to the podcast of the interview I did with Roy last week. (I’m afraid the levels are slightly problematic in a few places in the interview, but luckily Roy is louder than I am!)

In addition Roy will be giving an in-depth look at American Well in a sponsored "deep dive" expedition at the Health 2.0 Conference in March.

PHARMA: The ACP does the right thing

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In 1937 marijuana was banned by Congress. The only question asked was, "what’s the position of the American Medical Association?". It actually was in favor of keeping marijuana legal for medical purposes. But the response given to Congress by whoever was pushing the bill (some diligent drug war historian will tell me who) was that the AMA wanted to ban it. And banned it was. And soon the AMA decided that it didn’t approve of medical marijuana–a position it holds to this day

60 years and billions of wasted dollars later, one major physician’s group has decided to change its mind. The American College of Physicians is now urging and easing of the ban on medical marijuana. We can only hope that the ridiculous ban on medical marijuana use, despite its therapeutic properties that exceed many FDA approved medications, are closer to being lifted with this type of support.

A Blueprint for Healthcare Reform by Maggie Mahar

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On this blog, we have often debated these questions: “Why is U.S. healthcare so expensive? Why is it that states like Massachusetts and California just can’t seem to find a way to provide high quality, affordable medical care for all of their citizens?”

In the past, I have suggested that the answer can be found in the work done by Dr. Jack Wennberg and his colleagues at the Dartmouth Medical School. The story that I have posted below provides the narrative behind that assertion, tracing how, over a period of thirty years, Wennberg and his team uncovered the incredible, incontrovertible waste in our health care system.

Wennberg’s work reveals that roughly one out of three of our health care dollars is squandered on unnecessary tests, ineffective, unproven, sometimes unwanted procedures and over-priced bleeding-edge drugs and devices that are no better than the less expensive products that they have replaced.

Only a Luddite would fail to appreciate the wonders of 21st century medical technology. And Wennberg is no Luddite. He is quick to acknowledge that the most expensive, aggressive care that U.S. doctors and hospitals provide is often the most effective care.

But not always. This is what is less obvious. It would seem that by spending so much more than other countries, we would be buying the best care on earth. But the evidence shows that, often, we are not. And therein lies the conflict at the heart of our money-driven health-care system: while more health care equals more profits, it does not necessarily lead to better health.

Continue reading…

Where will all the employees go? By Eric Novack

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A quick question:  With calls for a substantial increase in government involvement in health care by so many—and, among the major justifications is the claim of high administrative overhead in the private sector relative to government—what do the proposals plan to do with the hard working people currently working in the health insurance industry?The insurance workforce is estimated at close to 2.5 million.  It would be not unreasonable to say that 25% of that is health care related.  And that does not even include the people working on health insurance related issues on the provider/ hospital end—a number that absolutely exceeds 600,000.So, put another way: what do the reformers plan to do (a) for, (b) with, the potential displacement of over 1 million workers?Just asking, but could it be that the claimed efficiencies will not materialize and they will stay employed?  Could it be that the costs of ‘retraining’ and financial support for these families will exceed the ‘savings’ claimed?  Which group really will be displaced—will the size of the in-office, and in-hospital administrative workforce even be counted when looking at ‘streamlined’ administrative costs?  Will many of the displaced workers simply end up working as government employees in a similar capacity?I would hope that supporters of the Obama plan, the Clinton plan, and the single-payer plan would weigh in here with real specifics—and not ad hominem attacks…Eric Novack

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