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Simon Nath

Reforming the Reformers

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In the midst of sluggish economic growth, finding a sector of the economy growing from 15 percent of the economy up to 19 percent would normally be a cause of celebration, except that this is health care. The lack of good cheer about this growth is an indirect acknowledgement of a stark reality: We are not realizing much increased value as we spend more on health care because too much of our health dollars are going to ineffective (and often harmful) procedures.

Estimates of the waste from this overconsumption of health care range from 30 percent to 50 percent. While all of the experts talk about reducing this waste (the phrase of the day is “bending the cost curve”), the reality is that hospital administrators, pharmaceutical companies, device manufacturers, insurers, consultants, think tanks and government bureaucrats all are seeing their power, control and financial remuneration increase due to this medical-care consumption growth.

All of the reformers’ trendy ideas have failed and will likely continue to fail in spite of the experts telling us they will soon figure it out. Electronic health records are a hugely expensive disaster. So far, they decrease doctor efficiency, reduce quality and increasingly make patients fearful of sharing sensitive information with their doctors for fear hackers or others will access their private data. Accountable Care Organizations turn doctors into rationers, introducing a conflict of interest between doctor and patient. Price controls by Congress or bureaucrats or oligarchic insurers only reduce access to care, demoralize doctors and introduce the risk of game playing by health systems by “up-coding” (labeling a doctor visit as more complex than it is).

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The Commonwealth Fund Gets It Wrong

flying cadeuciiA new report from the usually sensible Commonwealth Fund got lots of media attention this past week. The report –“Competition Among Medicare’s Private Health Plans: Does It Really Exist?” –quickly led to headlines like “Is private-sector Medicare becoming a monopoly? [PBS]” and “Robust Medicare Advantage competition almost non-existent [Modern Healthcare],” and “Health insurance is staggeringly uncompetitive in America, and is poised to get even worse for everybody [Quartz].”

It sounds like Medicare Advantage is headed for disaster, but is this really the case?

The Commonwealth report’s major findings are summarized in one sentence, likely the one that grabbed media attention: “Using a standard measure of market competition, our analysis finds that 97 percent of markets in U.S. counties are highly concentrated and therefore lacking in significant [Medicare Advantage] plan competition.”

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The Donald Effect

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No one knows how Donald Trump’s meteoric rise to the top of the GOP primary race ends, its impact on Campaign 2016 or its domestic and foreign policy implications for the U.S. will play out. What we know is the man knows how to get a crowd, spark discussion, and steal media attention from his 16 GOP primary rivals. He has built his brand as a straight shooter on tough issues and unapologetic foil of political correctness.

Friday night, the Donald show flew into Mobile, AL, and lit up a crowd estimated at 20,000 at the University of South Alabama football stadium. He left town on Trump Air dominating the weekend’s media coverage, perplexing the pundits who were betting the Donald show would flame out.

Political theatre is prone to big stories like “the Donald”. He’s brash, cocky and unfiltered as he talks about dicey issues. He has simple solutions to immigration reform and the threat of ISIS. He promises to be a tough commander in chief in war zones and fierce negotiator in trade pacts. Healthcare is on his list as well.

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What’s the Definition of Interoperability? A Conversation With EXTREME’s Adam Wright

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Adam Wright of Partners and colleague Dean Sittig asked themselves, with all the talk about information blocking and interoperability happening in congressional hearings this year, “How should we actually define interoperability?”

To answer their question, they did research on use cases and published a definition in a JAMIA article, “What makes an EHR “open” or interoperable?

Leonard Kish, Principal at VivaPhi, sits down with Wright to talk about the EXTREME (EXtract, TRansmit, Exchange, Move, Embed) use-case based definition and more.

LK: So let’s just start from the beginning. Introduce yourself, how’d you get into interoperability and what are you working on.

AW: I’m an associate professor of medicine at Harvard and I work at one of the Harvard affiliated teaching hospitals – Brigham and Women’s Hospital in the general medicine division there although my background is in biomedical informatics…I have a PHD in biomedical informatics. Before that I studied math and  computer science. I got into health IT and interoperability because it just seemed like a ripe and interesting place to be applying things that have worked in other industries and asking “How can we apply some of this thinking to problems in healthcare?”  Continue reading…

Employee Health Codes Of Conduct: What Would They Look Like and Who Would Accept Them?

You start a new job, you sign a contract, and then the division hands you the employee code of conduct. Now, in addition to the “no wearing a speedo” to the office, dress code clause, there is a section on health. Imagine, just as important as your job description or dress code, is your health. From the first day you join the company, you are offered resources, motivation, and encouragement to also maintain health during the duration of your employment? This is the idea behind Health Codes of Conduct.

Most workplace health programs achieve modest gains in health behavior. In a study with 147 employees we collected reactions to a novel approach to workplace wellness that suggests promising directions for future programs. Specifically, the idea is to engage and motivate employees to assume responsibility for their health through a Health Code of Conduct from the first day they are hired.

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Only the Information You Need – Physicians’ Desk Reference Gets Mobile Upgrade

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Drug reference apps have become a go-to resource for healthcare professionals, with 46% of smartphone-using physicians accessing them at least once per week, and 26% daily. With so many choices, how do you know if the information you are referencing is accurate?  The good news is the most trusted resource for drug information just received an upgrade this summer.

Redesigned with the healthcare professional in mind, the new mobilePDR provides quick, easy access to the drug information you need, especially “when you’re on the clock, oncall, or on vacation” says PDR Chief Medical Officer, Salvatore Volpe, MD.

Make Informed, Patient-Centric Decisions with Fast, One-Tap Access to Powerful Drug Look Up

Amongst the enhancements, the new mobilePDR provides fast, one-tap access to powerful drug reference tools where you can search by brand, generic, or pharmacological class name. Plus, you can personalize the experience by saving searches for frequently prescribed drugs or access recent searches with a single tap.

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A Near Death from Voodoo Hexing


Screen Shot 2015-08-10 at 2.04.19 PMIn the spring of 1938, Dr. Drayton Doherty admitted a sixty-year-old African –American man to the hospital. The small hospital was located at the edge of town in an old house that had been converted into a fifteen-bed hospital. Six of the beds were located upstairs at the rear of the house in what previously served as a sleeping porch. The patient was admitted to that porch.

Dr. Doherty went on to tell me that the patient, Vance Vanders, had been ill for many weeks and had lost over fifty pounds. He looked extremely wasted and near death. His eyes were sunken and resigned to death. The clinical suspicions in those days for anyone with a wasting disease were either tuberculosis or widespread cancer. Repeated tests and chest x-rays for both of these diseases were negative, as was the physical examination. Despite a nasogastric feeding tube, Vanders continued on a downhill course, refusing to eat and vomiting whatever was put down the tube. He said repeatedly he was going to die, and he soon reached a stage of near stupor. Coming in and out of consciousness, he was barely strong enough to talk.

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Blood Clots Show Limits of Quality Care Penalties

Iflying cadeuciin the world of medicine, blood clots during hospitalization have become synonymous with imperfect care. As many as 600,000 patients per year experience a blood clot, and more than 100,000 die as a result, accounting for between 5 and 10 percent of hospital deaths. Regulatory agencies have taken clots as signals that safety and quality have been compromised, and have instituted significant financial penalties on physicians and hospitals for these “preventable events.”

In reality, clots aren’t always as preventable in real-world practice as they are in theory. Blood clots happen even under conditions of perfect, best-practice patient care, which should be seen as testimony to the limits of penalty schemes aiming to improve the quality of care. These penalties should be re-examined.

In a study recently published in JAMA Surgery of 128 blood clot or venous thromboembolism (VTE) cases, my team found that nearly 50 percent of the cases reviewed at The Johns Hopkins Hospital were not actually preventable. In fact, these patients received perfect care by all objective measures — all appropriate preventive measures were taken, including the prescription of the ideal medication and assuring that every dose of medicine was administered. Yet the blood clots still occurred, and the hospital was still financially penalized.

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Does Prevention Save Money? ____ Yes ____ No

Or…it’s complicated.flying cadeucii

The New York Times today published a story titled, “No, Giving More People Health Insurance Doesn’t Save Money.” A piece of the argument is, as the author Margo Sanger-Katz puts it, “Almost all preventive health care costs more than it saves.”

What do you think? What’s the evidence? Leave aside, for the moment, the “big duh” fact that at least in the long term saving people’s lives in any way will cost more, because we are all going to die of something, and will use a lot of healthcare on the way. Leave aside as well the other “big duh” argument: It may cost money, but that money is worth it to save lives and relieve suffering. Leave that argument aside as well. The question here is: Does getting people more preventive care actually lower healthcare costs for whoever is paying them?

My thoughts? #1: No consultant worth his or her salt trying to help people who are actually running healthcare systems would take such a blanket, simple answer as a steering guide. Many people running healthcare systems across the country are seriously trying to drop real costs, and how you do that through preventive care is a live, complex and difficult conversation all across healthcare.

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Will Software Eat Healthcare?

When Ben Horowitz was asked last November by Stanford Professor Tom Byers how the venture capital firm Andreessen-Horowitz (“a16z”) became so successful so quickly, and was able to crack open what had been an exclusive and self-perpetuating club of top VCs, Horowitz replied, “We were the first VC firm to super-aggressively market itself.”

Presumably one manifestation of this strategy is a phenomenal podcast series the firm produces, featuring senior partners, distinguished guests, and frequently both, discussing with some granularity a topical issue in technology or entrepreneurship.

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