Category: Uncategorized

An Anatomy of Chairs

Jul 1, 2015

By CLIFTON MEADOR, MD

R had been my patient for over a year. She was referred to me by a colleague. She had 38 symptoms. All tests and imaging studies failed to find any demonstrable medical disease; I considered her to have “symptoms of unknown origin”.

I had little information on R’s personal and family history. I did know she was 43 years old and was 7 years into her second marriage. Her first marriage ended in divorce from a severe alcoholic husband. She had no children. She dwelled on her many symptoms and avoided all my attempts to gather more personal or social information.

Before I can share my full experience with R, I need to provide some back ground on my clinical thinking.

FTC Files First Ever Complaint Against a Kickstarter Project …

Jul 1, 2015

By DARRELL WEST and JACK KARSTEN

Crowdfunding platforms like Kickstarter have exploded in popularity over the past few years. As the number of funded projects has grown so have the number of projects that never deliver on their stated goals. The Federal Trade Commission (FTC) recently filed its first ever complaint with a Kickstarter project that did not provide its stated rewards to backers.

The complaint charges Erik Chevalier with misusing the $122,874 in pledges he received for a board game called The Doom That Came to Atlantic City, which features characters from the works of H.P. Lovecraft on a Monopoly-style board. Chevalier agreed to a settle with the FTC that includes a fine of $111,793.71. Kickstarter’s Terms of Use states that a funded project must either deliver the promised rewards to its backers or refund their money, but the website does not rigorously enforce the policy. Although Kickstarter claims that its projects have an excellent record of delivering on their promises, a lack of transparency could scare potential backers away from the website.Continue reading…

Health 2.0 Quarterly: What’s New in Q2?

Jun 30, 2015

By KIM KRUEGER

Every quarter, Health 2.0 releases a summary set of data that explains where industry funding is going, which product segments are growing fastest, and where new company formation is happening. Health 2.0’s precision and clarity when it comes to market segmentation and product information make this quarterly release the cream of the freebie crop.

The major news this quarter is that funding has slowed compared to this time last year, notwithstanding a significant bump from Allscripts’ $200M investment in NantHealth on the last day of the month. Yet, we’re still seeing growth in the Health 2.0 Source Database — both in number of products and companies. We also highlight the release of the Apple Watch, the growing momentum around FHIR, some key moves in the data analytics space, and the success of the latest Health 2.0 IPOs. For more, flip through below.

Kim Krueger is a Research Analyst at Health 2.0

How Might Crushes Right In Healthcare

Jun 29, 2015• 4

By RICHARD GUNDERMAN, MD

Dr. Melos is a gastroenterologist in solo practice in a medium-sized Midwestern city. One day she hears a knock on her door. When she answers, she finds two representatives of Athenian Health System, who request a few minutes of her time. She invites them to take a seat in her office.

After exchanging pleasantries, the visitors get down to business. They extend Dr. Melos an offer to join the ranks of Athenian’s employed physicians. If she declines, they say, they will hire their own gastroenterologist, whose practice will grow rapidly on referrals from their large network.

The representatives of the health system are remarkably candid. “We will not take up your time with arguments about the appropriateness of what we are doing. What we have here is a large imbalance of power, and as a business matter, you really have no choice.”

Dr. Melos replies that she has always worked amicably with Athenian Health, using many of its diagnostic testing services and admitting her patients to its facilities, so the health system has no need to deliver such an ultimatum.

The representatives respond that, if they allowed Dr. Melos to maintain her practice in the form she is accustomed to, it would make Athenian Health, which is seeking to consolidate its market position in the area, look weak.

Disruptive Regulation

Jun 29, 2015

By MARGALIT GUR-ARIE

The latest salvo in the interoperability and information-blocking debate comes from two academic experts in the field of informatics, and was recently published in JAMIA. In the brief article, Sittig and Wright are endeavoring to describe the prerequisites for classifying an EHR as “open” or interoperable. I believe the term “open” is a much better fit here, and if the EHR software happens to come from a business dependent on revenues, as opposed to grant funding from the government, bankrupt may be a more accurate description. Since innovation in the EHR market seems to lack any disruptive effects, perhaps a bit of disruptive regulation would help push everything over the edge.

How to Win Friends and Influence Doctors

Jun 27, 2015• 5

By EDWARD CORBETT, MD

I remember the meeting as if it were yesterday.

It was a fine, crisp morning. My Health Catalyst team and I were at a new partner hospital with a national reputation, known for its excellent coordinated care and its outstanding performance on key quality measures.

I was looking forward to a low-key presentation. After the meeting, I planned to escape and take a relaxing run and catch the early flight back home.

Unfortunately for me and my running plans, when we began showing some of the data Health Catalyst had compiled, the confrontational questions began:

“And what does that show?”

“What’s the point of this exercise?”

“Not my patients …”

It was all I could do to not duck behind my notepad and shield myself from the onslaught.

After several years of successful quality improvement initiatives and a string of successes that had the won the hospital national recognition, tensions between the administration and the doctors had reached a breaking point.

HIT Newser: ACA upheld – Can We Talk Health IT Now?

Jun 27, 2015

By MICHELLE RONAN NOTEBOOM

AMGA requests funds and policies to support care for chronically ill

In a letter to members of the Senate Finance Committee Chronic Care Workgroup, the AMGA asks Congress to consider policies and financial and operational technologies that support care for the chronically ill. The AMGA stressed that clinical data from EHRs and details from administrative claims are valuable for analyzing trends on utilization and outcomes.

The AMGA supports the development and use of sophisticated predictive analytic software that have the potential to improve care coordination, cut hospital re-admissions, and reduce the overall cost of patient care. The organization is also encouraging the use of telehealth to care for the chronically ill, as well as financial incentives to encourage provider investment in care management tools.

And now back to us

On the heels of the Supreme Court ruling on the ACA, several health IT organizations express hope that Congress will renew its focus on interoperability, telehealth, Meaningful Use, and other HIT-related issues. Politico reports that Health IT Now Coalition executive Joel White is hoping for a “continued bipartisan focus on interoperability and telemedicine,” while HIMSS believes the decision will create more predictability in the healthcare sector, which may facilitate the advancement of its IT agenda.

It’s great to be optimistic, but I’m sure no one will be shocked if lawmakers find alternative distractions.

How Population Health Is Driving Merger Mania Among Anthem, Cigna and the Rest of the Big Insurers

Jun 26, 2015• 1

By JK WALL

The nation’s Big 5 health insurers have thrived under the Affordable Care Act, seeing their profits grow and their stock prices soar.

They also continue to dwarf their main sparring partners—hospital systems—in size. Consider that the largest health insurer, United Health Group, has annual revenue of $130 billion, while revenue at the largest hospital system, HCA, is a tick under $37 billion. The second-largest health insurer, Anthem Inc., has $74 billion in annual revenue, while the second-largest hospital system, Ascension, has $20 billion.

So why are health insurers so desperate to get bigger? Anthem has offered $47 billion to acquire Cigna Corp., and United, Humana and Aetna are all trying to counter with mega-deals of their own.

Well, it’s about economies of scale and all that—the Affordable Care Act and other changes are squeezing the amount of profit insurers can make per customer, even as the pool of paying customers is growing. Also, hospital systems, while still more fragmented than insurers, are consolidating, as are drug and device makers. So insurers want to boost their bargaining power.

But the real reason is population health.

“In order to do population management, you need populations,” Dhan Shapurji, a Deloitte consultant to health insurers, quipped in a phone call with me this week.

Uber and the Twisted Logic of the Affordable Care Act’s Employer Mandate

Jun 25, 2015• 12

By DAVID DRANOVE and CRAIG GARTHWAITE

We have recently blogged about what is perhaps the best feature of the Affordable Care Act – the individual insurance exchanges. These exchanges have the potential to create one of the first well-functioning individual insurance markets in the United States. In addition, they are an implicit recognition of the nature of the contemporary American economy – one where workers frequently move employers and are increasingly serving as independent contractors for multiple firms.

However, a recent ruling by the California Labor Commission reminds us of what must be one of the worst features – the requirement that large employers provide health insurance to all employees working more than 30 hours per week. This mandate is a remnant of a 1950s economy where workers remained employed at the same firm for decades and the Internet was just a series of tubes that existed in our dreams. Ironically, the ACA insurance exchanges not only make the employer mandate obsolete, but the mandate actually weakens the viability of the exchanges by locking a large portion of the healthy population into the employer provided insurance market.

Driving Innovation Through an Apps-Based Information Economy

Jun 25, 2015

By JAAN SIDOROV, MD

In case you think the future for healthcare apps will be characterized by health information technology (HIT) “dead zones” of free downloads, fun gadgetry and vacuous consumerism with nothing to show for it, you should take a look at this article appearing in the peer-reviewed journal Cell Systems.

If authors Kenneth Mandl, Joshua Mandel and Isaac Kohane are even half right, “apps” could truly revolutionize HIT. They argue that a superimposed “apps layer” ecosystem will demolish the “walled gardens” of EHRs and allow for true information sharing across clinics, systems and regions.

And that’s just for starters.

As your correspondent understands it, “Application Programming Interfaces” (or “APIs”) will enable multiple third party apps to bridge to legacy EHRs. That, in turn, will catalyze the creation of newer and better user experiences that reconcile doc and patient preferences with the current clunky one-size-fits-all EHRs.