Category: Uncategorized

PCORI is Starting to Click. Give It a Chance.

Aug 26, 2015• 6

By STEVE FINDLAY

Earlier this month the Center for Public Integrity (CPI) published a sharp-edged piece on PCORI—the Patient-Centered Outcomes Research Institute.

The piece raised some salient issues and it’s timely to take stock of PCORI at the half way point of its authorized funding. (Unless renewed, PCORI sunsets in 2019.)

The Affordable Care Act created PCORI as an independent nonprofit (non-government) entity. But PCORI’s funding and structure makes it more or less quasi-government. It gets its money from the Medicare trust fund, treasury general funds, and a tax on private insurers and self-funded insurance plans ($2.08 per covered life). PCORI launched in late 2010 and began funding research in earnest until 2013. The main focus of that research, mandated by Congress, is to compare treatments in a way that results in meaningful results for doctors and patients as they make clinical decisions. No small task.

The CPI piece probes the emerging debate about how PCORI is being operated and spending its money—roughly $450 million a year in 2014 and 2015. The core lead-in graph of the piece: “On both the right and the left, there’s simmering doubt about whether the unusual nonprofit can live up to expectations, or even what those expectations should reasonably be.”

The report airs legitimate concerns but it skews overly critical and doesn’t fully appreciate the challenge PCORI faces. As someone who labored in the fields of comparative effectiveness for several years, I think PCORI deserves time to get fully underway and prove itself. It certainly doesn’t need ideologically driven attacks and budget threats just because it was launched by the ACA. (The House Appropriations Committee in late June voted to cut PCORI’s funding by $100 million, dubbing it wasteful spending.)

Is Your Hospital CIO Acting Like a North Korean Dictator?

Aug 26, 2015• 2

By BILL CROUNSE, MD

Screen Shot 2015-08-26 at 10.27.15 AM

Forgive me, but I simply need to vent. Think for a moment about your hospital or health system’s IT leader. Would you describe this person as controlling or collaborative? Do you even really know? And what difference does it make?

In my role at Microsoft, I meet with many business and clinical leaders in health and healthcare. I also work closely with our account executives and solutions experts who call on IT leaders of hospitals, health systems, and clinics around the world. Over the years, I’ve concluded that IT leadership often falls into one of two categories; controlling or collaborative. Within a few minutes of visiting most healthcare organizations, I can usually tell if the IT leadership is controlling or collaborative. There’s often a very direct correlation to the organization’s ability to innovate and transform.

Although the IT leader in a healthcare organization may hold a variety of titles including IT Director, Chief Technology Officer, or Chief Information Officer, for purposes of this post I am going to refer to the IT leader as the CIO.

Why Your Doctor Is Thinking About Getting an MBA

Aug 26, 2015• 1

By DAVID SHAYWITZ, MD

To understand why so many medical students (and pre-meds) (and doctors) contemplate business training, let’s consider two real-life examples: Dr. Bob Kocher and Dr. Bijan Salehizadeh. Both trained as physicians, both are currently healthcare investors, and both shared their stories with Lisa Suennen and me on our Tech Tonics podcast. (Kocher’s interview can be found here; Salehizadeh’s will available at the end of the month.)

(My usual disclosure: I work at a cloud genomics company in Silicon Valley; neither my company nor I have a financial relationship with Kocher, Salehizadeh, or their firms.)

Bob Kocher: The Hospital Consultant

Kocher is currently a partner at Venrock’s Palo Alto office, and is perhaps best known for his previous role working in the White House developing the Affordable Care Act in collaboration with Zeke Emanuel and others.

When he was growing up Seattle, Kocher says, his “dream was to be a leukemia and lymphoma doctor at the Fred Hutchinson Cancer Research Center.” He went to medical school, trained in internal medicine at the Beth Israel Hospital in Boston, and was accepted into a prized oncology fellowship at the Dana Farber Cancer Institute.Continue reading…

All the President’s E-mail

Aug 25, 2015• 2

By HANS DUVEFELT, MD

Perhaps doctors should be more like the President.

After all, we also carry the ultimate responsibility for our constituents, even though we, too, have team members who do part of that work.

The way I understand things to work at the White House, those other team members collect, review and prioritize the information the President needs in order to manage his, and all our, business.

That is how things used to work in medicine, too, before computerization revolutionized our workflows: Nurses, medical assistants or secretaries would open the mail, gather the faxes, look over the lab and X-ray reports and put them on physicians’ desks in a certain order. Highly abnormal or time-sensitive information would be prioritized over routine “signature-needed” forms, and in my case, essentially normal reports on patients already scheduled to be seen within a few days wouldn’t even reach my eyes until the patient appointment.

Computers changed all that.

Now, most of the information goes straight to the doctors’ inboxes, unseen by other human eyes in the office. This is said to be faster. It is, to a degree, in the sense that the information leaves the laboratory or the X-ray department faster via their Internet connected computers. But in the typical medical office, we have now turned decision making doctors into frontline mail sorters and de facto bottlenecks of routine information.

The Donald Effect

Aug 24, 2015• 6

By PAUL KECKLEY

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.

How Stanford Med Got “Work-Life Balance” Wrong

Aug 24, 2015• 4

By KAREN SIBERT, MD

Did it ever occur to some of today’s physicians that many people work awfully hard and complain a lot less than they do about “burnout” and “work-life balance”?

Did it ever occur to them that “work-life balance” is the very definition of a first-world problem, unique to a very privileged class of highly educated people, most of whom are white?

Every day, I go to work and see the example of the nurses and technicians who work right alongside me in tough thoracic surgery cases. Zanetta, for instance, is the single mother of five children. She leaves her 12-hour shift at 7 p.m. and then faces a 60-mile commute to get home. She never complains, and unfailingly takes the extra moment to get a warm blanket for a patient or cheerfully help out a colleague

For Patient Safety: A Reversal. What Can Healthcare Teach the Aviation Industry?

Aug 23, 2015

By RHONDA WYSKIEL

There are more than 50 in-flight medical emergencies a day on commercial airlines — or one for every 604 flights, according to a study published in 2013.

What are the odds that two emergencies would occur on the exact same flight, above the Atlantic Ocean and hours from the nearest airport?

My colleague Mark, a critical care physician with whom I’d worked as an ICU nurse, and I were traveling to the Middle East for a patient safety conference. We were comfortably tucked into our seats, as he snored next to me.

It must have been about 3 a.m. when I was awakened by an overhead announcement asking for a medical doctor. I nudged Mark, asking him to press his call light.

As the flight attendant approached, I told her that Mark was a doctor.

“And she’s an ICU nurse, and we work together,” he said, gesturing toward me.Continue reading…

Will Private Exchanges Move Us Closer to Socialized Medicine?

Aug 21, 2015• 7

By BLAKE ASHBY

Private exchanges have become the next big thing in healthcare, the newest approach to controlling employers’ healthcare costs and maybe even a way of moving healthcare from a defined benefit to a defined contribution. But they are unlikely to control healthcare costs and the only thing they will move us towards is socialized medicine.

An increasing number of employers are having employees use online “private exchanges” to make their annual healthcare plan selections. According to an Accenture study, one in four employers is considering a private exchange and an estimated 30 million employees will select their employer-provided healthcare plan through a private exchange by 2017.

On the surface private exchanges are attractive. Instead of the employer choosing a healthcare plan for its employees, the employer gives each employee a set amount of money to spend on a healthcare plan of the employee’s choosing. The employees then use the online exchange to select plan parameters that best meet their needs. Employees are able to maximize the value they receive from their healthcare allotment. The employer is removed from the healthcare decision process, no longer providing a defined benefit, healthcare, instead just providing a defined financial contribution for the employees to spend as they see best.

Save the Hipsters

Aug 21, 2015• 1

By THCBist

Evil health plan marketing or genius? Such a fine line.

Except to see more spots like this one from Rocky Mountain Health Plans as the online marketplace for health insurance created by the Affordable Care Act continues to mature.

Filed under: Affordable Care Act, Unintended consequences. Hipster marketing schemes. Stuff our Editors Like.

Why Prisons Should Try Readmissions Penalties

Aug 19, 2015• 4

By STUART M. BUTLER

By the end of 2013 there were approximately 1.5 million people in state or federal prisons, and the U.S. incarceration rate is the highest in the world. And while there is debate about the relationship between this level of imprisonment and crime rates, there is considerable research to show that a spell of incarceration exacerbates economic and social conditions for families as well as former inmates, especially in low-income neighborhoods. That has led the Obama Administration and some interesting strange-bedfellow groups to call for alternatives to prison for some infractions.

The other side of the prison coin is recidivism. Prisons are often called “correctional facilities” but that is a cruel joke – they do a dismal job in turning lives around. According to the U.S. Department of Justice, about two-thirds of released state prisoners were re-arrested within three years and three-quarters within five. Prison is a revolving door.Continue reading…