Category: Uncategorized

America’s Bitter Pill: CBO was Right. The White House and Steven Brill Were Wrong.

Dec 11, 2015• 19

By KIP SULLIVAN

Steven Brill’s latest book, America’s Bitter Pill, is a frustrating mix of excellent history and muddled health policy analysis. The book is a very good addition to the literature on the history of the Affordable Care Act and by far the best reporting I’ve read on the bungled implementation of the federal health insurance exchange. But Brill’s analysis of why the ACA cannot reduce health care costs is naïve and confusing. Brill claims a few smart men on the White House “economic team,” including Peter Orszag and Ezekiel Emanuel, fought hard to push “game-changing” cost-containment into the ACA but were defeated by others who were less interested in cost containment.

That explanation is wrong on two counts:

(1)There was little evidence in 2009, and little today, to support the claims by Orszag et al. that the methods they promoted would cut costs;

(2) The ACA in fact contains most of what Orszag et al. fought for.

What Brill unquestionably gets right is his conclusion that the ACA cannot cut costs. He makes his conclusion clear at the end of the book. He quotes this astonishing statement by Obama – “Frankly what we’ve seen in progress on costs has surpassed almost anybody’s most optimistic expectations” – and then unceremoniously rejects it. “But there is actually little evidence of that,” he writes. (p. 416)

Uberizing Health, Data is the Vehicle … And a Right

Dec 10, 2015• 14

By LEONARD KISH

No, there is no Uber of healthcare, even as everyone claims to be or wants to be the Uber of healthcare. Others rail against it.

Part of it is that an Uber for healthcare sounds great! The sharing economy! But what is it? What would it even look like? Everyone has their own interpretation: is it house calls? appointment scheduling like ZocDoc? telehealth? PatientsLikeMe?

The movement Uber, AirBnB and the like embody is often referred to as “the sharing economy.” No matter what you call it: sharing, borrowing or buying, it’s a platform for effective exchange, enabled by the peer to peer connections over the internet, but it’s not new, just more mobile, more convenient with more specific use cases around surplus capacity of some sort.

The model was pioneered by companies like craigslist and eBay, who first offered free or low-cost methods of buying and selling everything from toys to automobiles; and sharing information to everything from lost dogs to love connections. Using these early internet tools to find a job, a book group, or a place to unload your old IKEA furniture led the way to today as the sharing takes place with mobile assets (cars) enabled by smart phones.

The Cost-effective Cardiologist..

Dec 9, 2015• 1

By ANISH KOKA, MD

Safe, appropriate, effective care at a reasonable cost. Such a simple goal. The message is clear. Leaders in hospitals, congress, and even my chihuahua echo the dawning of a new age in health care. Down with the private practice, fee-for-service mentality, they all say. I pay attention to a lot of this chatter since I happen to be in private practice. I split my time on the internet between the latest exploits of the Kardashians and gravestones for my practice. I can picture the epitaph:

In loving memory of

Koka Cardiology

3/1/2013 – 3/1/2016.

Shed not for her the bitter tear

Nor give the heart to vain regret

‘Tis but mere ashes that lie here

The gem that filled it sparkles yet

As I shuffled towards this abyss, my reverie was broken by a letter. It was from Independence Blue Cross (IBC) in Pennsylvania. It was titled: The Cardiology/Invasive Cardiology Comparative Cost report. It looked like a report card, so I opened it with some trepidation.
Continue reading…

Two HIT Developers Respond: Why We’re Still Optimists About Technology’s Potential

Dec 9, 2015• 17

By ANDY ORAM and SHAHID SHAH

The authors of this article like to believe that we can remain humanists while transitioning from a paper-native to a digital-native industry. We even believe you can remain a humanist while following regulations and sticking to industry guidelines. Margalit Gur-Arie doesn’t seem to feel that way. We have read her work over the years and established that she takes a staunchly humanistic approach to health IT. But even though she’s a leader in that space, she appears to doubt the contributions that either technology or regulation make to a humane health system.

Gur-Arie’s most recent posting dismisses all the tools that electronic health records throw in the way of the doctor: clinical decision support (now often called evidence-based medicine–were we Gur-Arie, we’d say it’s because who can argue against evidence?), reminders, pull-down menus to provide a limited range of choices, and more.

One immediate response is to suggest that, instead of blaming the tools, one should blame the requirements imposed on clinicians by payers and governments–the “thousands of meaningless regulatory words” as Gur-Arie writes eloquently. But the real answer is that these requirements (well, the ones that were thought through) enhance the health care system, and that the problem with current EHRs is that they just “pass through” the requirements, intensifying the burden placed on doctors, instead of finding true innovations when implementing those requirements.

Tackling Rising Pharmaceutical Prices: 50 Shades of Gray

Dec 9, 2015• 2

By SUSAN DENTZER

Global New Active Substances (NAS) Available Since 1996

Here’s the problem with high and rising pharmaceutical prices: It’s not just one problem, but many. Addressing them will require a range of solutions – many of them difficult to execute, and possibly tough medicine to swallow.

These were key takeaways from the recent U.S. Department of Health and Human Services Pharmaceutical Forum,which I moderated. A broad group of stakeholders participated, including patients, consumer groups, pharmaceutical companies, pharmacy benefits managers, insurers and others. The key issues: Obtaining the greatest value for the dollars we spend on drugs –and having a vital biopharmaceutical sector that produces vaccines, effective treatments,and cures, at affordable costs for patients and the nation.

Having slowed along with the rest of health care spending in recent years, pharmaceutical spending is now roaring ahead. Total pharmaceutical sales, now about $400 billion annually, are projected to reach as high as $590 billion in 2020, according to Doug Long, vice president of industry relations at IMS Health. New National Health Expenditure data show that national retail prescription drug spending grew 12.2 percent in 2014 – a sharp increase over 2.4 percent growth in 2013 — in large part due to increased spending for new drugs, such as cures for Hepatitis C.

Health 2.0 Presents the Final Agenda for WinterTech 2016

Dec 9, 2015

By DEEPA MISTRY

Health 2.0 announces the final agenda for the WinterTech conference, January 13, 2016 in San Francisco, California. As the only event dedicated to health tech and investing during the health investment mecca, JP Morgan Week, the event features leaders from Venrock, Canvas, Grand Rounds, Doximity, Livongo, Omada Health, Maverick Capital, GE Ventures, Kaiser Permanente and more. The conference brings together top health tech entrepreneurs, investors, and the health care establishment to discuss financial and business trends. “Everyone knows by now that health tech is a hot place for venture investing,” says Health 2.0’s Co-Founder Matthew Holt. “At Health 2.0 WinterTech, we are going to uncover the secrets of how the top VCs think and how they work with the star CEOs.” Key speakers will include:

What Would Issac Asimov Do?

Dec 8, 2015• 4

By PAUL LEVY

The Three Laws of Robotics are a set of rules devised by the science fiction author Isaac Asimov. The rules were introduced in his 1942 short story “Runaround“, although they had been foreshadowed in a few earlier stories. The Three Laws, quoted as being from the “Handbook of Robotics, 56th Edition, 2058 A.D.”, are:

A robot may not injure a human being or, through inaction, allow a human being to come to harm.
A robot must obey the orders given it by human beings except where such orders would conflict with the First Law.
A robot must protect its own existence as long as such protection does not conflict with the First or Second Laws.

This Is Not A Disruptive Blog Post

Dec 8, 2015• 4

By MICHEL ACCAD, MD

Frank Knight, risk and uncertainty

In this article, I wish to introduce the reader to the theory of entrepreneurship advanced by Frank Knight (1885-1972), and show that the common, everyday work of the physician could be considered a form of entrepreneurial activity in the Knightian sense.

Knight was an influential American economist. He is best known for his book Risk, Uncertainty, and Profit in which he proposed to distinguish risk and uncertainty as follows:

Risk pertains to situations where outcomes occur with a frequency that is quantifiable according to probability distributions.

Risk may be mathematical and a priori knowable, meaning that the probability function that governs the outcome is known with certainty, as in the case of a coin toss (assuming the coin to be well balanced).

Risk may also be statistical, where the outcome can be estimated according to an empirically discoverable probability function. This is the case in situations where we know the set of possible outcomes and can make observations under controlled conditions to determine the probability of occurrence of each outcome.

A Health IT Developer’s Confession: How Bad Software Is Made and What to Do About It

Dec 7, 2015• 30

By MARGALIT GUR-ARIE

It was a dark and stormy night. My computer didn’t catch fire while typing the previous sentence. No alarms were triggered warning me about the quality of such opening. I wasn’t prompted to select subjects and predicates from dropdown lists. I typed the entire sentence, letter by letter, not at all dissimilar to its first rendering back in 1830. Computer software in general, and Microsoft Word in particular, magically removed the hassles of quills, ink, paper, blotters, sharpeners, ribbons, whiteout, carbon paper, dictionaries, and all the cumbersome ancillary paraphernalia needed to support authoring, but made no attempt to minimize the cognitive effort associated with writing well. Authoring great literature today requires as much talent and mastery as it did in the days of Edward Bulwer-Lytton.

For several decades, software builders have tried to help doctors practice medicine more efficiently and more effectively. As is often the case with good intentions, the results turned out to be a mixed bag of goods, with paternalistic overtones from the helpers and mostly resentment and frustration from those supposedly being helped.Continue reading…

What Killed Scott Weiland?

Dec 7, 2015• 2

By JOSEPH KRAININ, M.D.

His voice had the unusual ability to convey both aggressive muscularity and profound vulnerability. Scott Weiland and Stone Temple Pilots were icons of my adolescence. Personally, my memory of Mr. Weiland will always be inextricably linked with “Plush,” that initial hit single which, upon first listen, instantly captivated me and thousands of other kids like me. During my high school days, “Plush” was elevated to the highest sonic status possible, joining Metallica’s “Enter Sandman” and Pearl Jam’s” Black” as an essential component of our football team’s pre-game locker-room pump-up playlist.

So it was with shock and sadness that I read in the New York Times this morning that Weiland had “died in his sleep” on Thursday during a tour stop in Bloomington, MN. He was 48.