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This three-part interview from World Health Care Congress with Markus Fromherz, chief innovation officer of Xerox Healthcare, covers some of the most exciting healthcare research and development going on at Xerox’s Palo Alto Research Center. Part one includes Markus’ thoughts on moving paper data to digital and describes the process in three layers – gaining access, drawing insight and taking action from what was learned.
Universal treatment standards will be the basis of future medical care. In oncology, a leading organization for the development of such guidelines is the National Comprehensive Cancer Network (NCCN). This national consortium of 21 National Cancer Institute designated cancer centers publishes state of the art recommendations. Modified continuously, these are internationally respected guidelines and cover more then 97% of cancers.
The 17th Annual NCCN Conference was held in Hollywood, Florida last month. Cancer guidelines were updated in several significant ways.
The general movement of the last 20 years has been to reduce the amount of surgery for breast cancer. The NCCN recommends that during breast saving surgery (lumpectomy) the surgeon test the first lymph node (“sentinel”). If there is no cancer in the first one or two nodes, then no more nodes need to be removed. The NCCN also stated, that if breast cancer patients have small cancers and normal blood tests, they do not need a bone scan, or CT scan.
In lung cancer patients, several procedures received new support. It is recommended that doctors use ultrasound-guided biopsy to sample lymph nodes in the middle of the chest (mediastinum) instead of surgery. The new guidelines also support the use of non-invasive surgery (Video Assisted Thorascopic Surgery, VATS) instead of open surgery to treat lung cancer. The use of VATS for lung cancer has increased more than 300% in recent years. The pathologic name for an increasingly common form of lung cancer was changed. Formally, called “bronchioalveolar”, it will now be called “adenocarcinoma in situ.” Finally, the NCCN emphasized the need for accurate genetic testing for “ALK”, before using the drug that targets this mutation, crizotinib.
We recently had the pleasure to sit down with Executive Director of the New York eHealth Collaborative Dave Whitlinger and President and CEO of the New York City Investment Fund Maria Gotsch to discuss the exciting New York Digital Health Accelerator (NYDHA) program.
The accelerator, which launched this morning, is run by the NYeC in partnership with the NYCIF and the New York State Department of Health. The program will fund 12 early- and growth-stage digital health companies that are developing cutting edge technology products for healthcare providers.
Why the partnership?
The NYeC formed in 2006 to advance health care information technology (HIT) in New York state and to develop the Statewide Health Information Network of New York, or SHIN-NY, a technology platform that is connecting electronic health records across New York state. Maria notes that the Investment Fund was formed as a “private fund with a civic mission to create jobs in New York City.” The partnership is logical, as Dave indicates―the fund is committed to company and job growth and the Collaborative “needs the tools to best harness innovative talent and to create new workflows.” To Maria, the timing of the Accelerator is perfect: New York has “one of the most vibrant digital markets” and is increasingly becoming the epicenter for entrepreneurial success.
While it’s comforting to just blame the GOP for the unhappiness with health reform threatening the president’s re-election, the truth is that Barack Obama repeatedly botched, bungled and bobbled the health reform message. There were three big mistakes:
The Passionless Play
While Candidate Obama proclaimed a passionate moral commitment to fix American health care, President Obama delved into legislative details.
When a Baptist minister at a nationally televised town hall asked in mid-2009 whether reform would cause his benefits to be taxed due to “government taking over health care,” Candidate Obama might have replied that 22,000 of the minister’s neighbors die each year because they lack any benefits at all. Instead, President Obama’s three-part reply recapped his plans for tax code fairness.
While Republicans railed about mythical “death panels,” and angry Tea Party demonstrators held signs showing Obama with a Hitler moustache, the president opted to leave emotion to his opponents. The former grassroots organizer who inspired a million people of all ages and ethnicities to flock to Washington for his inauguration never once tried to mobilize ordinary Americans to demand a basic right available in all other industrialized nations. In fact, he hasn’t even mobilized the nearly 50 million uninsured, who have no more favorable opinion about the new law than those with health insurance!
Today’s headline was “Millions Expected To Receive Insurance Rebates Totaling $1.3 Billion.”
The Kaiser Family Foundation estimates that 3.4 million people in the individual market will receive $426 million in consumer rebates because of the Affordable Care Act’s new MLR rules. In the small group market 4.9 million enrollees will see $377 million in rebates, and 7.5 million people will get $540 million in the large group market.
Wow!
But take a closer look at the report. Only 19% of those in the large group market will be getting a rebate and that rebate will average $72.31 per person. In the small group market 28% of those enrolled in these plans will get a rebate averaging $76.37. And, in the individual market 31% of consumers who have these plans will get a rebate averaging $126.81.
The Wall Street Journal, citing a Goldman analysis, is reporting that Aetna will be paying out $177 million in rebates. But Aetna has $11 billion in premium so that’s only a 1.6% rebate. UnitedHealth will be paying out $307 billion but that is only 1% of its $28.8 billion in premium. Wellpoint will pay out $94 million in rebates but that is only .28% of its premium for the year.
The average cost of employer-provided family health insurance is now about $13,000 per year. A family rebate of perhaps $200 will amount to only about 1.5% of premium for the relatively few people who will even get one.
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Matthew Holt sat down with McKesson at the World Health Care Congress 2012. Medical Director of McKesson Health Solutions Douglas Moeller, MD and McKesson VP of Enterprise Architecture and Technology Bob Franceschini explained what they’re doing to keep up with evolving payment methods.
It all began when Dr. Renee Hsia of the University of California at San Francisco received a simple request from a good friend who had checked into a local hospital for an emergency appendectomy. The fairly routine procedure took place 19,368 times during 2009 in California.
After he returned home, he received a bill from the hospital for $19,000, his co-payment for the parts of the $54,000 operation that his insurance company didn’t cover. “He wanted to know if this was the usual and customary charge for a one-day stay in the hospital,” she recalled.
And thus began her research into pricing variability in the state, which was published this week in the Archives of Internal Medicine. The prices ranged from $1,529 to $182,955 with the median hospital charge of $33,611, the study showed.
The prices not only varied between hospitals, they varied within hospitals. The largest spread occurred at one hospital, which Hsia wouldn’t reveal, where the cheapest appendectomy went for $7,504 while the most expensive charged was $171,696. There were numerous hospitals where the spread was $100,000 or more.
“They had the same diagnosis, but different things could have been done,” she said. For instance, one patient could have had multiple imaging tests and robotic laparoscopy, while the other received no imaging and a regular laparoscopy. There’s no evidence to suggest one set of alternatives had better outcomes than the other.
On April 17th, 81-year-old Warren Buffett told investors that he had very early prostate cancer. The Washington Post headline read: “Warren Buffett Has Prostate Cancer that is Not Remotely Life Threatening.’” Within hours, news accounts said that the story unfolded after discovering a high PSA in a routine appointment. Next, he had a prostate biopsy. A few hours later, news accounts said that Buffett decided to get radiation therapy for prostate cancer. What’s wrong with this picture?
10. He’s an icon who other men will follow, and there is limited (or no) evidence of benefit of aggressive treatment in men as old as Buffett. At 81, his life expectancy is 7.41 years, shy of the 10-year life expectancy mark doctors look for when they recommend aggressive treatment for prostate cancer.
9. Although Buffett can afford whatever care he so desires, it would cost a fortune if tons of men in his age group went for active treatment and there would be little yield and plenty of side effects.
Last week I found my usually-diverse Twitter feed had coalesced into a single hashtag, the trolley buses chugging through the streets of Washington, D.C. were sporting bold logos on their sides, and all around the city people were wearing giant nametags bearing their name, face, and three things they liked to talk about. There was no mistaking it: TEDMED was in town.
For the world of health care, TEDMED was the only party at which to see and be seen. The thousand or so delegates had been specifically “curated” to encapsulate the epitome of health care innovation. For 3.5 days they basked in cutting-edge, quirky talks by people “shaping and creating the future of health and medicine,” punctuated by lavish dinners and parties, TEDMED-themed M&Ms, and morning runs, as sanctioned by the Cookie Monster (one of the celebrity speakers at this extravaganza). Meanwhile, the rest of the medical world followed the #TEDMED hashtag on Twitter or soaked up the inspiration in real time at one of TEDMED’s mostly academic simulcast venues around the U.S.
And as for me? I threw myself into getting invited to the cool kids’ party. Or to be more accurate, the cool, privileged kids’ party. Because as well as being accepted on merit, attending TEDMED in person costs an eye-watering $4,950. A wealth of sponsors paid for 200 people to attend on scholarships (and for the Simulcasts), but by the time I’d realized this and persuaded them of my innovative brilliance, they’d already allocated their funds and I was consigned to their priority waiting list. But at the last minute, delightfully, my persistence and anticipation were rewarded with a pass for the Thursday night party and the final Friday morning session.
On the eve of the release of this year’s Medicare Trustees report, the Obama administration released its own version of it. In the administration’s telling:
But whereas the Trustees report is expected to be a serious document, reflecting accepted accounting principles, the administration’s document was clearly a piece of political propaganda — one that stretched the truth so much that the word “spin” would be a charitable description. For example, the administration’s document failed to mention that:
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