Henry writes:
“What if someone approaching age 65 who lives in New Hampshire does not want to enroll in Medicare—what kind of health insurance alternatives might be available?”
Only the Information You Need – Physicians’ Desk Reference Gets Mobile Upgrade
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.
A Near Death from Voodoo Hexing
In 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.
Blood Clots Show Limits of Quality Care Penalties
I
n 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.
Does Prevention Save Money? ____ Yes ____ No
Or…it’s complicated.
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.
Inside Baseball: The DoD EHR
The health information technology (HIT) world has been hit by a watershed event like no other. The Department of Defense (DoD), widely respected for its indiscriminate generosity to contractors, has awarded the most coveted prize in recent HIT memory – the Defense Healthcare Management Systems Modernization (DHMSM) contract.
And the winner is… Leidos, the contractor formerly known as SAIC. A couple of years ago, when the race for the DoD contract began, Leidos/SAIC selected Cerner as its EHR of choice for this contract. The smart money though was on Epic and its Big Blue partner because they are and seemingly always have been the safest procurement choices for top brass in any large organization.
A stunned HIT “community” initiated its favorite game of providing post facto authoritative explanations ranging from cute to grotesque. Here are the most common and least specious opinions:
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.
ACA Database: I’m In Hell. Long-term Facilities Are Cutting Services Due to the ACA’s Reimbursement Changes
Anonymous writes:
Currently nursing homes are dumping vent patients,and respiratory services due to reimbursement dollars. The home I will be removed from at the end of the month has succeeded in removing respiratory services and sending residents against their will to other facilities. This has begun. Staffing has been minimal due to inhospitable working conditions. Imagine your bill being thousands of dollars a month and lying in feces for hours waiting for one aide to get to you, who has 45 other patients. The mission statements all so wonderfully worded to make you feel your loved one getting the best care possible. But these are just words not to be followed just a sales pitch. Their defense we can’t get staff! No wonder everything under disciplinary action you may not go home cause nobody is coming in to relieve you. Mgmt does not answer phones on their off hours to provide help or solutions but arrives monday to write up whom ever was involved.
Why Doctors Are Leaving Medicine For Tech
The world looks different when you’re eighteen and when you’re thirty – in some cases because your perspective has evolved, other times because the world has changed. Men and women drawn to careers in medicine while in high school or college are finding that when they emerge on the other side, things aren’t quite what they expected.
Typically, this is portrayed as the (well-worn) “Narrative of Disillusionment” – i.e. idealistic youth drawn to help people discover the practice of medicine is more rushed/bureaucratic/corporate/burdensome than they were expecting, and now are searching for new opportunities. While there’s a measure of truth to this arc, I’m not sure how different it is from any other career choice, which tend to be attractive in the abstract (A prosecutor! A screenwriter! A journalist!), perhaps less so when you’re actually doing it.
While there’s no doubt that practicing physicians face many (well-documented) challenges, many also continue to love what they do, and find the opportunity to help others — even with all the paperwork — still accessible, and still rewarding.
My hunch is that many of the physicians who leave medicine do so not because the negative externalities have become so bad, but rather because the range of potentially appealing alternatives has become so good.
A recent NPR blog focused on Bay area physicians leaving medicine to become entrepreneurs has sparked considerable dialog on social media (see here for my recent discussion of physicians-turned-entrepreneurs). My sense is that many physicians are attracted to entrepreneurship not to escape medicine, but to deliver on their perception of medicine’s promise. Frontline providers, as Aenor Sawyer of UCSF’s Center for Digital Health Innovation frequently emphasizes, offer vital insights into where the existing system may not be working, and where innovation is sorely needed.
Dan Burton explains what Health Catalyst does!
I’m steadily getting all those interviews I did 3+ months ago at HIMSS up onto THCB. (For those of you not paying attention we had a bunch of tech issues at THCB needing a big change and had to forswear videos for a while. But we’re baaack…)
Dan Burton is CEO of Health Catalyst which is a data warehousing and analytics company that’s seen remarkable growth by selling to big names like Kaiser, Partners & Allina. It’s raised over $150m and has even gone at risk with Allina over outcomes–to show how confident they are in their data and analytics. This is a very interesting interview about a company that’s at the crux of the world of clinical data management, with over $100m booked revenue in 2014.
Dan will also be interviewed at Health 2.0 this fall as one of our “3 CEOs”. (And FD Health Catalyst is a THCB sponsor, but as I tease Dan they’re also in the conference business themselves, running the Health Analytics Summit!)
