Category: Uncategorized

Medical Students: The Anti-Millionaires

Feb 13, 2014• 17

By Daniel Coleman

A few months ago, CBS Moneywatch published an article entitled “$1 million mistake: Becoming a doctor.” Aside from the possibility that devoting one’s life to helping others might be considered a mistake, I was struck by the “$1 million” figure.

Was it actually that much? I mean, $1 million is a lot of money. When I was younger, millionaires seemed a rarefied breed. They drove expensive cars and had houses with names like “Le Troquet” or “Brandywine Vale.” The figure was supposedly calculated using the following factors:

The cost of school, inclusive of tuition, fees and insurance
The interest on the loans incurred to pay for the above items
The income lost by not working full-time for 10 years, assuming an average income of $50,000 per year

Before coming to medical school, I worked in the pharmaceutical industry. I even turned down a hefty promotion to start my education as soon as possible, rather than defer for a year or two.

Thus, my back-of-the-envelope calculations made it fairly obvious that, including benefits, bonuses, and potential promotions, my medical decision was not a $1 million mistake, but was more like a $1.3 million dollar disaster.

Of course, people tell me that I’ll be profitable and that I’m a good credit risk, but what I really am is one of a rarefied breed that drive economy cars and have houses with names like “Apt. #203.” What I really am is an anti-millionaire.

Conversa Wants to Fill the Gap

Feb 13, 2014• 5

By Matthew Holt

Conversa is a brand new company, aiming to fill the space between physician visits with easy and useful communications between doctors and patients. The logic is that most health care happens outside the exam room, but most of the effort of automating health care has been put into recording what happens in the medical setting, with little feedback or follow up from patients (HealthLoop is another company aiming at this space).

Why are we featuring Conversa? Well somewhat unusually for a Health 2.0 startup they come with buckets of experience. CEO West Shell was at the helm at Healthline, Product Head Phil Marshall built lots of tools at WebMD and Chief Marketer Anna-Lisa Silvestre was behind the roll out of probably the biggest patient portal ever at Kaiser Permanente.

I got all three of them on the video-line to tell me about Conversa.

[youtube]http://www.youtube.com/watch?v=UVD2f1VK24M&feature=youtu.be[/youtube]

Learn more about Conversa’s launch here.

Why Healthcare Should Be Worried About the Target Cyber Attacks

Feb 11, 2014• 38

By Joe Flower

If you are a CEO or COO of a health care organization, and your IT people have been trying to get your attention, it’s time to have a serious sit-down with them.

If they haven’t been trying to get your attention, it’s time to have an more serious sit-down with them, complete with charts and graphs and arrows on fip charts.

Here’s why: Remember in November it was revealed that the Target retail chain’s computer systems were compromised? Some 70 million names, home addresses and phone numbers were stolen (pretty good raw material for identity theft) and 40 million credit card numbers.

It has turned out since then that some two dozen other companies, including Neiman-Marcus, the Michael’s arts-and-crafts chain and the White Lodging Services hotel management firm, have been hacked in similar ways, with the attackers software sitting in the companies’ servers, credit card machines and cash registers often for months before they were detected, sucking down every transaction, every bit of data moved about.

Hey wait, you say, I have every confidence in our computer security. Why we passed a security audit just recently.

Heh. So did Target — just before they discovered the break-in. They got a clean bill of health, and the auditors failed to find the malware installed on every server, every credit card terminal, every cash register.

Why? Because the attackers have gotten way more sophisticated, and they used new techniques and methods of entry. You can now buy ready-made hacking software designed to do this on the Internet for less than $1000.

Here’s the kicker: Target has security guards at the doors, it has those beeper tags on small high-value items so you can’t sneak them out without paying for them, it has burglar alarms — but the perps in the biggest heist in the company’s history entered through the thermostat.

Got that? The thermostat.

New From THCB Press: Surviving Workplace Wellness

Feb 11, 2014• 1

By THCBist

We’re excited to announce the official release of our first e-book.

You won’t want to miss “Surviving Workplace Wellness” by industry critics Al Lewis and Vik Khanna.

Go read the release. Then go buy a copy.

Go read the Fast Company piece.

Improving Clinical Document Exchange

Feb 11, 2014• 3

By David Kreda & Joshua Mandel, MD

2014 will see wide-scale production and exchange of Consolidated CDA documents among healthcare providers. Indeed, live production of C-CDAs is already underway for anyone using a Meaningful Use 2014 certified EHR.

C-CDA documents fuel several aspects of meaningful use, including transitions of care and patient-facing download and transmission.

This impending deluge of documents represents a huge potential for interoperability, but it also presents substantial technical challenges.

We forecast these challenges with unusual confidence because of what we learned during the SMART C-CDA Collaborative, an eight-month project conducted with 22 EHR and HIT vendors.

Our effort included analyzing vendor C-CDA documents, scoring them with a C-CDA scorecard tool we developed, and reviewing our results through customized one-on-one sessions with 11 of the vendors.

The problems we uncovered arose for a number of reasons, including:

material ambiguities in the C-CDA specification
accidental misinterpretations of the C-CDA specification
lack of authoritative “best practice” examples for C-CDA generation

Ode to the Fat Man

Feb 11, 2014• 5

By Saurabh Jha, MD

Here is a sweeping generalization: When doctors write for the lay public they tend towards tiresome self-flagellation.

Samuel Shem’s House of God is an exception; a refreshing read.

Perhaps he wrote for physicians so he wrote with such open face honesty.

In today’s politically correct world, Shem would have been castigated as an ageist for his brilliant acronym, GOMER (Get out of My Emergency Room), for peri-ninety year olds with advanced dementia who are skirting that narrow zone between St. Peter’s Gate and fractured ribs post-CPR.

Time for a pronouncement for medical students: There are two things you must do before starting your internship. Pass your USMLEs and read House of God.

I have read Shem’s classic twice. I remember the Rules of House of God more reliably than I recall the names of the carpal bones.

My first read was a few days in to my internship in elderly care medicine. The hospital was a rickety establishment in Britain’s National Health Service, not quite the Best Medical School that Shem described. But I seemed to share the same clinical experiences as Roy Basch, Shem’s Gomer-phobic protagonist.

There was a deluge of Gomers on New Year’s Eve; the old practice of granny dumping. I had to justify admission by finding nitrates in their urine for suspected urinary tract infection (grandson attending New Year’s bash still does not have an ICD code), or the vaguest T wave changes on EKG (unstable angina is a useful bet in a 90 year old).

If medical taxonomy could not be clinically justified there was always “acopia.”

Shem was remarkably prescient.

Take rule 13: “The delivery of good medical care is to do as much nothing as possible.” This was before physicians were inserting stents through rock hard femoral arteries to give patients an aggregate of two extra hours of survival.

Basch’s elderly patients would do the best precisely because his caring was the least aggressive. He would occasionally forget to prepare them with laxatives for a barium enema, saving them from dehydration and its cascade.

If Shem realized in the seventies that nothing was more futile than an investigation leading to a futile treatment, God knows what he would have written today.

The Pharmacies and Retailers Say They’re In. Is the Blue Button Initiative About to Change Everything?

Feb 11, 2014• 11

By Alex Howard

The Obama administration announced significant adoption for the Blue Button in the private sector on Friday.

In a post at the White House Office of Science and Technology blog, Nick Sinai, U.S. deputy chief technology officer and Adam Dole, a Presidential Innovation Fellow at the U.S. Department of Health and Human Services, listed major pharmacies and retailers joining the Blue Button initiative, which enables people to download a personal health record in an open, machine-readable electronic format:

“These commitments from some of the Nation’s largest retail pharmacy chains and associations promise to provide a growing number of patients with easy and secure access to their own personal pharmacy prescription history and allow them to check their medication history for accuracy, access prescription lists from multiple doctors, and securely share this information with their healthcare providers,” they wrote.

“As companies move towards standard formats and the ability to securely transmit this information electronically, Americans will be able to use their pharmacy records with new innovative software applications and services that can improve medication adherence, reduce dosing errors, prevent adverse drug interactions, and save lives.”

While I referred to the Blue Button obliquely at ReadWrite almost two years ago and in many other stories, I can’t help but wish that I’d finished my feature for Radar a year ago and written up a full analytical report.

Extending access to a downloadable personal health record to millions of Americans has been an important, steady shift that has largely gone unappreciated, despite reporting like Ina Fried’s regarding veterans getting downloadable health information.

According to the Office of the National Coordinator for Health IT, “more than 5.4 million veterans have now downloaded their Blue Button data and more than 500 companies and organizations in the private-sector have pledged to support it.”

PCMH Certification and Designing the Perfect Car

Feb 9, 2014• 5

By Hans Duvefelt, MD

Our clinic is now a Certified Patient-Centered Medical Home. The whole process leading up to this reminds me of one of my favorite subjects – buying cars. Specifically, buying cars based on technical specifications in color brochures. It takes real, on-the-road experience to know if a car is right for you.

When I moved to this country in 1981, I bought a 1980 Chevrolet Citation. Back in Sweden I had owned a Volvo wagon, but secretly admired the front-wheel-drive SAAB 900. Once in America, I figured I’d buy American. My wife’s relatives sent me car brochures to help me prepare for my choice of car.

The Citation sounded like America’s answer to the SAAB: a front-wheel-drive car with a powerful engine, quirky interior and a hatchback design. A car magazine at that time ran a comparison test between the Citation, the SAAB 900 and one of the German sports sedans, and the Citation almost won. I pretty much walked onto a used car lot and bought a silver Citation with red vinyl seats.

What does this have to do with PCMH certification?

Well, I bought a Citation based on a checklist of features that on paper made it look comparable to a SAAB. Once I owned it, I noticed the cracks between the door panels, the uneven paint and the awkward positioning of the controls, some of which felt like they could break if I wasn’t careful.

Not long afterward, I found myself hitting the front bumper on the pavement in sharp turns; I heard the rear shock absorbers snoring on dirt roads; I watched the dashboard dry out and crack in the temperate Maine summer weather, and I realized with the first frost that my car did’t have a rear defroster, and it never seemed to warm up in the winter.

Please Don’t Feed the Morons!!

Feb 9, 2014• 7

By DAVID KATZ, MD

With the exception of rare and particularly bleak days, I don’t tend to think of myself as a moron — nor, as far as I can tell, do those who know me well and love me. I will hazard a guess that neither you nor those who love you think of you as a moron, either.

So let’s be bold, proffer one another the mutual benefit of any disparate doubts, and declare: We are not morons!

I propose, then, that this be the year we stop ingesting as if we were. Still with me? Let’s find out.

On the matter of morons, I think they are very much the exception rather than the rule. I have met a lot of people over my years. I’ve taken care of many patients over decades and come to know their intimate thoughts as the privilege of doctoring uniquely allows and requires. So I know firsthand that most of us are endowed with our fair portion of both sense and sensitivity. Formal education, the color of a collar, degrees and credentials don’t distinguish us nearly as much as some might like to think. In most ways that matter, most people have that practical brand of folksy wisdom and intelligence that serve most handily on any given day.

And yet, as a matter of routine we are fed a steady diet of both food and food for thought as if we were abject morons. That’s how it’s served to us — but of course, only we get to decide whether or not to swallow such insalubrious slop. It’s a New Year, and time for new chances. Here’s our chance to stop the slop.

On the matter of common sense, I have been driven many times over the span of my career to lament the fact that it isn’t nearly common enough. But as just noted, I think it really is — in most areas. We apply it routinely to finances, home care, our careers and our families. We just turn it off when captivating promises about effortless weight loss, miraculous vitality, or age reversal waft our way. The result, of course, tends to be that even as we get fatter, sicker and older, we get poorer — spending our sensibly earned money on a senseless parade of false promises.

Don’t Be Fooled, Prospects for Long-Term SGR Fix Still Dim

Feb 9, 2014• 5

By Billy Wynne

In light of Thursday’s bicameral, bipartisan release of a Medicare physician payment policy to permanently replace the Sustainable Growth Rate (SGR) formula – an achievement to be celebrated in its own right – some are seeing momentum toward passage of such a deal before the current doc fix expires on March 31.

But the scope of what the committees issued Thursday represents as much of a step back as a step forward, at least relative to their aspirations and timeline for accomplishing them.

Once the appointment of Senator Baucus to be Ambassador to China was announced, the committees agreed to make it “as far as they could” toward a comprehensive SGR replacement policy prior to his confirmation, including identifying offsets to pay for the $125-150 billion (over 10 years) bill. For those who missed it, Senator Baucus was confirmed on Thursday.

Only in the past week did the key committees acknowledge that achieving agreement on offsets by this deadline was unattainable, but finalization of the so-called “extenders,” a hodge podge of Medicare payment plus-ups and other polices perennially included with the doc fix, was still the goal.

(Recall that the Senate Finance Committee passed an SGR replacement bill with extenders in December, but their House counterparts have yet to do so.)

In negotiations on that extenders element, House Republican leads reportedly would not agree to include beneficiary-oriented policies, such as funding for outreach to Medicare enrollees regarding low-income subsidy programs and for Family-to-Family Health Information Centers.

While some Democrats involved in the talks may have been inclined to make this concession, others sharply objected, scuttling a deal on this front and demonstrating the difficulty of compromise on this relatively non-controversial topic.

Furthermore, and has always been the assumption, identifying offsets for the package continues to be an exponentially heavier lift than any other aspect of the process. On that front, the key camps have outlined their broad parameters for what they might accept.

House Republican leads desire and likely require meaningful cuts to ACA-related spending as well as a substantial balance of Medicare beneficiary-impacting cuts, such as those relating to premiums and coinsurance.