Category: Uncategorized

Can Health Care Transparency Make A Difference?

Mar 9, 2013• 34

By Martin S. Gaynor

There’s been a lot of discussion of transparency in health care recently, e.g., a USA Today op-ed and a counterpoint by Paul Ginsburg. The appeal of transparency is obvious. As movingly documented by Steven Brill in Time, prices are high and often differ quite substantially, even across close by providers. However, we don’t know the prices for the health care that we consume, and it’s extremely difficult to find out what these things cost (e.g., this recent study in JAMA).

While the appeal of transparency is obvious, it’s important to realize that buying health care is not like buying milk at the grocery store. A key factor is health insurance. Health insurance is very important — people need to be insured against the catastrophic expenses that can occur with serious illness. Thus people with high health care expenses won’t be exposed to most of those expenses (and shouldn’t) and therefore will have no reason to respond to information about health care prices.

What Will Tomorrow’s Doctor Look Like?

Mar 8, 2013• 18

By Leslie Kernisan, MD

“What does the 21st Century Physician look like?”

Lisa Fields (@PracticalWisdom) cc’ed me on a tweet about this; it’s the featured question at www.tomorrowsdoctor.org, an organization founded by three young professionals who spoke at TEDMED last year.

I’ll admit that the question on the face of it struck me as a bit absurd, especially when juxtaposed with the term “tomorrow’s doctor.”

Tomorrow’s doctor needs to be doing a much better job of dealing with today’s medical challenges, because they will all be still here tomorrow. (Duh!) And the day after tomorrow.

(As for the 21st century in general, given the speed at which things are changing around us, seems hard to predict what we’ll be doing by 2050. I think it’s likely that we’ll still end up needing to take care of elderly people with physical and cognitive limitations but I sincerely hope medication management won’t still be a big problem. That I do expect technology to solve.)

After looking at the related Huffington Post piece, however, I realized that this trio really seems to be thinking about how medical education should be changed and improved. In which case, I kind of think they should change their organization’s name to “Next Decade’s Doctor,” but I can see how that perhaps might not sound catchy enough.

The Republican Case For Waste In Health Care

Mar 8, 2013• 25

By Phillip Longman

Conservatives love to apply “cost-benefit analysis” to government programs—except in health care. In fact, working with drug companies and warning of “death panels,” they slipped language into Obamacare banning cost-effectiveness research. Here’s how that happened, and why it can’t stand.

Why are you reading this when you could be doing jumping jacks?

And how come you’ve gone on to read this sentence when you could be having a colonoscopy?

You and I could be doing all sorts of things right now that we have reason to believe would improve our health and life expectancy. We could be working out at the gym, or waiting in a doctor’s office to have our bodies scanned and probed for tumors and polyps. We could be using this time to eat a steaming plate of broccoli, or attending a support group to help us overcome some unhealthy habit.

Yet you are not doing those things right now, and the chances are very strong that I am not either. Why not?

HIV Messenger Baby

Mar 8, 2013• 3

By J.D. KLEINKE

“Your baby did not die for nothing,” Rebekah said, looking up at the monitor so Kim would not see her tears. “Your baby was a messenger to us.”

This is how a friend who specializes in high-risk obstetrics attempts to comfort a grieving patient when she delivers a stillborn baby, as portrayed in my novel Catching Babies.

This bedside homily is small succor in the face of unspeakable devastation. But the idea that one family’s heartbreak will contribute to medical research and in some remote but real way help spare families in the future is often the only comfort an OB/GYN or nurse-midwife has to offer.

Which is all the more reason to celebrate this week’s tremendous news about HIV: this time, the messenger baby lived.

According to reports, an infant was born in Mississippi with the virus that causes AIDS, given aggressive doses of the anti-viral medications known to contain — not cure — the disease, and is now disease-free at two-and-half years old. It is the second known “cure” of an HIV-positive patient, and there are no words to describe how exhilarating it feels to read or type those words for anyone who came of age during, or lost friends to, the ugly and terrifying scourge of AIDS.

So take a moment to savor it. A baby with HIV has been cured. No viral load. Disease-free. Yes!

Most Online Patient Reviews Rate Doctors Highly. Really.

Mar 7, 2013• 16

By Jerry Lin

In a world increasingly dominated by social media, doctors are becoming more concerned about managing their online reputations. Some doctors have even resorted to making their patients sign a gag order before treatment. Despite all the controversy, medical professionals need not fear online reviews: sites like Yahoo! Local and Insider Pages show that the majority of patients rate their doctors 5 out of 5.

At DocSpot, we help patients search across hundreds of different websites to find a doctor who meets their individual needs (for example if they need a primary care doctor who specializes in managing diabetes, or an experienced psychiatrist who accepts Aetna).

Ruling Out the Wrong Diagnosis

Mar 7, 2013• 11

By Peter Pronovost, MD

Although misdiagnosis may kill up to 80,000 annually—more people each year than firearms and motor vehicle accidents combined—you won’t find it on the list of the country’s leading causes of death.

Most Americans don’t realize how frequently well-meaning medical providers get it wrong. Just last year Johns Hopkins researchers found that one in 12 ICU patients die from something other than what they were being treated for. Aside from a handful of instances covered by the national media, misdiagnosis hasn’t received much attention from the public or the medical community. One such tragedy is the death of Rory Staunton, a 12-year-old boy who was treated for an upset stomach and dehydration instead of sepsis, a severe response to infection that requires immediate treatment with antibiotics. To make a complex diagnosis like sepsis, a doctor may need to assess a couple dozen different factors.

One solution is to arm clinicians with better problem-solving tools and improved IT systems to help them identify possible diagnoses faster and more accurately, especially for conditions that are commonly confused or missed altogether. This week at Johns Hopkins, a team of researchers shared some promising results about a new way for emergency medicine doctors to accurately detect stroke in patients with dizziness.

The Radical Rethinking of Primary Care Starts Now

Mar 7, 2013• 10

By Dan Diamond

In November 2008, the New England Journal of Medicine convened a small roundtable to discuss “Redesigning Primary Care.”

U.S. primary care is in crisis, the roundtable’s description reads. As a result … [the] ranks are thinning, with practicing physicians burning out and trainees shunning primary care fields.

Nearly five years out — and dozens of reforms and pilots later — the primary care system’s condition may still be acute. But policymakers, health care leaders and other innovators are more determined than ever: After decades where primary care’s problems were largely ignored, they’re not letting this crisis go to waste.

Ongoing Shortage Forcing Decisions

The NEJM roundtable summarized the primary care problem thusly: Too few primary care doctors are trying to care for too many patients, who have a rising number of chronic conditions, and receive relatively little compensation for their efforts.

Trickle Up Economics

Mar 6, 2013• 8

By Rob Lamberts, MD

It’s been a month since I started my new practice. We are up to nearly 150 patients now, and aside from the cost to renovate my building, our revenue has already surpassed our spending. The reason this is possible is that a cash-pay practice in which 100% of income is paid up front has an incredibly low overhead. My admitted ineptitude at financial complexity has forced me to simplify our finances as much as possible. This means that the accounting is “so simple even a doctor can do it,” which means I don’t need any front-office support staff. I don’t send out bills because nobody owes me anything. It’s just me and my nurse, focusing our energy on jury-rigging a computerized record so we can give good care.

Our attention to care has not gone unnoticed. Yesterday I got a call from a local TV news reporter who wanted to do a story on what I am doing. Apparently she heard rumor “from someone who was in the hospital.” I was the talk of the newsroom, yet I’ve hardly done any marketing; in fact, I am trying to limit the rate of our growth so I can focus on building a system that won’t collapse under a higher patient volume. I explained this to the disappointed reporter why I was not interested in the interview by telling her that I left my old practice because I needed to get off of the hamster wheel of healthcare; the last thing I want to do now is to build my own hamster wheel.

Matthew Holt on HIBC.tv from HIMSS 2013

Mar 6, 2013

THCB founder Matthew Holt is reporting live from HIMSS 2013 in New Orleans. Matthew’s first guest is Ben Chodor of Happtique. We’ll then hear from Matthew on his walking tour of the floor as he drops in on a few companies, including Kareo, CareCloud, Wellness Layers, and more…

Watch the live stream here: http://www.livestream.com/hibc.

CommonWell Is a Shame and a Missed Opportunity

Mar 6, 2013• 39

By Adrian Gropper, MD

The big news at HIMSS13 was the unveiling of CommonWell (Cerner, McKesson, Allscripts, athenahealth, Greenway and RelayHealth) to “get the ball rolling” on data exchange across disparate technologies. The shame is that another program with opaque governance by the largest incumbents in health IT is being passed off as progress. The missed opportunity is to answer the call for patient engagement and the frustrations of physicians with EHRs and reverse the institutional control over the physician-patient relationship. Physicians take an oath to put their patient’s interest above all others while in reality we are manipulated to participate in massive amounts of unwarranted care.

There’s a link between healthcare costs and health IT. The past months have seen frustration with this manipulation by industry hit the public media like never before. Early this year, National Coordinator for Health Information Technology Farzad Mostashari, MD, called for “moral and right” action on the part of some EHR vendors, particularly when it comes to data lock-in and pricing transparency. On February 19, a front page article in the New York Times exposed the tactics of some of the founding members of CommonWell in grabbing much of the $19 Billion of health IT incentives while consolidating the industry and locking out startups and innovators. That same week, Time magazine’s cover story is a special report on health care costs and analyzes how the US wastes $750 Billion a year and what that means to patients. To round things out, the March issue of Health Affairs, published a survey showing that “the average physician would lose $43,743 over five years” as a result of EHR adoption while the financial benefits go to the vendors and the larger institutions.