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Don’t Like Obamacare? Do We Have a Plan For You!

Struggling to break free from Obamacare oppression, Idaho is offering low-cost health plans that achieve this goal by avoiding covering anyone who’s been sick in the past and skimping on coverage for any diseases that might make you sick in the future. These strategies are, inconveniently, explicitly banned by the Affordable Care Act.

Fortunately, I have a solution perfect for Idaho and other GOPers eager to emulate Idaho’s example. My plan covers young and old, sick and healthy, fitness buff and couch potato, all for the same incredibly low price. No one, and no illness, is excluded.
Welcome to the Placebo HMO, dedicated to serving every American who fervently believes you don’t need real health insurance.

We’re a faith-based plan that offers empathetic, sincere and personalized advice from a broad range of highly skilled actors pretending to be doctors. Whether it’s a “seen everything” veteran like Tom Hanks or Meryl Streep in The Post or a bright-eyed idealist like Emma Stone and Ryan Gosling in La La Land, we provide unparalleled freedom of provider choice that plans dependent on actual doctors cannot match.

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On Theranos: It’s Time to Throw the Book at Healthcare Tech Frauds

Huge news hit today as Theranos, its Chairman and CEO Elizabeth Holmes and its former President and COO Ramesh “Sunny” Balwani were charged with “elaborate, years-long fraud” by the Securities and Exchange Commission. The litany of supposed violations of the Securities Act of 1933 and the Securities Exchange Act of 1934 are almost as dizzying as the detailed factual allegations of repeated, willful fraud perpetuated by Holmes and Balwani on investors who likely should have known better.

Reviewing the SEC complaint against Holmes, it’s stunning to see the extent to which Holmes and Balwani were able to pull the wool over investors’ eyes. The highlights of the SEC allegations include:

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Dear CMS Administrator Verma

Your address to HIMSS acknowledges many of the problems with Healthcare IT, highlighting lack of interoperability, lack of data exchange, and lack of cybersecurity, and suggesting some regulations that could be eliminated. This is a welcome realization of some of EHR’s more obvious limitations and problems.  However, most of your recommendations for improvement of health IT are insufficient, unproven, or have been repeatedly shown to fail.

We applaud your acknowledgement of: 1. The frustration (and often rage) of many clinicians when using the current EHRs’ clunky and inefficient user interfaces; 2. Patients’ frustration and alienation when doctors spend much time entering data into the EHRs rather than listening to them; 3. The need for better cybersecurity; 4. Benefits of increased patient access to their data; and 5.Healthcare systems’ refusal to share patient data with others clinicians (data hoarding).

We are also delighted for your strong support for the Sync for Science program.

However, your solutions to these problems are faulty or have already failed—and thus we are obliged to explain why and how they fail:

  • Belief in the magic of value-based care as a cure for excessive spending
  • Claim that “open APIs” (defined in next sentence) will solve the problems of lack of interoperability. Here, APIs refer to software programs that try to translate different forms and formats of information into a single commonly understood item.
  • Belief that a patient’s personal data store or personal EHR, called “MyHealthEData,” will help solve the problems of patient care. 
  • Confusing patients with customers. We train doctors to make diagnoses, order and interpret tests, and help patients make profoundly complex decisions. Healthcare decisions are not like buying a toaster. 
  • Attributing so many of the problems of EHRs to the regulations created in 2009, the “Meaningful Use” rules.   In fact, meta-analyses of EHRs—both before the Meaningful Use rules, and after–fail to find they reduce costs, mortality, or morbidity.

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A National Health Encounter Surveillance System

Trust is essential for interoperability. One way to promote trust is to provide transparency and accountability for the proposed national system. People have come to expect email or equivalent notification when a significant transaction is made on our personal data. From a patient’s perspective, all health records transactions involving TEFCA are likely significant. When a significant transaction occurs, we expect contemporaneous notification (not the expectation that you have to ask first), a monthly statement of all transactions, and a clear indication of how an error or dispute can be resolved. We also expect the issuer of the notification to also be accountable for the transaction and to assist in holding other participants accountable if that becomes necessary. Each such notification should identify who accessed the data and how the patient can review the data that was accessed. Each time, the patient should be informed of the procedure to flag errors, report abuse, and opt-out of further participation at either the individual source or at the national level.

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The Intractable Debate over Guns

When Russian forces stormed the school held hostage by Chechen terrorists, over 300 people died. The Beslan school siege wasn’t the worst terrorist attack arithmetically – the fatalities were only a tenth of September 11th. What made the school siege particularly gruesome was that many who died, and died in the most gruesome manner, were children.

There’s something particularly distressing about kids being massacred, which can’t be quantified mathematically. You either get that point or you don’t. And the famed Chechen rebel, Shamil Basayev, got it. Issuing a statement after the attack Basayev claimed responsibility for the siege but called the deaths a “tragedy.” He did not think that the Russians would storm the school. Basayev expressed regret saying that he was “not delighted by what happened there.” Basayev was not known for contrition but death of children doesn’t look good even for someone whose modus operandi was in killing as many as possible.

There’s a code even amongst terrorists – you don’t slaughter children – it’s ok flying planes into big towers but not ok deliberately killing children. Of course, neither is ok but the point is that even the most immoral of our species have a moral code. Strict utilitarians won’t understand this moral code. Strict utilitarians, or rational amoralists, accord significance by multiplying the number of life years lost by the number died, and whether a death from medical error or of a child burnt in a school siege, the conversion factor is the same. Thus, for rational amoralists sentimentality specifically over children dying, such as in Parkland, Florida, in so far as this sentimentality affects policy, must be justified scientifically.

The debate over gun control is paralyzed by unsentimental utilitarianism but with an ironic twist – it is the conservatives, known to eschew utilitarianism, who seek refuge in it. After every mass killing, I receive three lines of reasoning from conservatives opposed to gun control: a) If you restrict guns there’ll be a net increase in crimes and deaths, b) there’s no evidence restricting access to guns will reduce mass shootings, and c) people will still get guns if they really wish to. This type of reasoning comes from the same people who oppose population health, and who deeply oppose the sacrifice of individuals for the greater good, i.e. oppose utilitarianism.

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The Conference Created by Innovators for Innovators

Get set for a new exciting conference experience coming this spring from Health 2.0 and HIMSS, focused on the collaboration between developers and healthcare providers on building emerging digital health technologies: Dev4Health.

Join hundreds of developers, innovative leaders, designers, chief technology officers, chief innovation officers, start-ups, and health tech enthusiasts for two days of strategic networking, idea generation, and innovative workshops – plus live demos some of the newest health tech start-ups.

Top Reasons to Attend Dev4Health

  • Innovation Leaders: Hear cutting edge ideas to infuse your technology strategy with the latest insights and methodologies.
  • Developers: Benefit from immersive content and hands-on learning by sharing open-source code, applications, interfaces and other resources with like-minded developers.
  • Health Systems: Discover the latest health tech products to hit the market with live demos by some of the most innovative start-ups in healthcare.
  • All Attendees: Join in-depth panel sessions focusing on health tech trends, including open tools in the U.Shealthcare server; healthcare focused developer programs; artificial intelligence and machine learning; blockchain; and more!
What are you waiting for? If you’re looking to collaborate with developers on building new applications

or discover new tools to enhance the healthcare experience, then Dev4Health is the place to be this spring.

Register today!

Take advantage of the early bird savings. Save up $100 when you register by March 16, 2018.

Looking for sponsorship opportunities? Please contact Patrick Ryan at 781-424-2755.

The Kentucky Armageddon

The Commonwealth of Kentucky, best known for its weirdly colored grass, fine bourbon and equestrian pageantry, is about to be destroyed by the Trump administration. Many will suffer and perhaps die because Kentucky obtained a Medicaid waiver to impose additional and often insurmountable hardships on poor people receiving their free health care from the State. Since all I need to know, I learned on Twitter, allow me to share with you some illuminating insights from the Twitterati.

The evil Republican Governor of Kentucky, Matt Bevin, is salivating at the prospect off changing Medicaid as we know it, which obviously means that poor people and especially people of color will be suffering greatly under this plan. You really don’t need to know more, since this should be reason enough to mobilize the worried wealthy, who are tossing and turning in their featherbeds night after night, searching for ways to save the poor. For those who are neither worried nor wealthy enough to really care, here are the ominous provisions of the Kentucky racist, homophobic and xenophobic plan to change Medicaid (it is all these things because it was not only approved, but encouraged by the Trump administration, and we all know what that means).

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The Price of Progress

No one knows who Bennie Solis is anymore.

He had the misfortune of being born in the early 1960s marked for death. He had a rare peculiar condition called biliary atresia – a disease defined by the absence of a conduit for bile to travel from his liver to his intestinal tract. Bile acid produced in the liver normally travels to the intestines much like water from a spring travels via ever larger channels to eventually empty into the ocean. Bile produced in the liver with no where to go dams up in the liver and starts to destroy it.

That the liver is a hardy organ was a fact known to the ancient Greeks who told the tale of the punishment given to the god Prometheus for stealing fire from the gods. Chained to a mountain, an eagle would feast on his liver by day. The liver would regenerate by night to allow the eagle a full meal on its return making this a truly eternal punishment.

So it is that the poisoned human liver remarkably continues to function to allow beautiful appearing normal children to be born. It would make the eventual discovery of the disease all the more painful. How could that beautiful child harbor something so black inside?

When Bennie was born, every child with his condition had one fate. Death.

And it did not come slowly. As the liver becomes progressively damaged and scarred, the flow of blood through the liver is impeded. The obstructed blood, seeking a way to return to the heart, travels through collateral channels. These vessels, normally minute and invisible in the esophagus and the stomach, now become engorged and thin walled and prone to rupture. Complicating matters even further, the body lacks clotting factors that were normally synthesized by the liver, giving blood the consistency of water. The horrors only multiply. Blood pours from the mouth and rectum when vessels rupture, free fluid fills the abdominal cavity, the lack of bile in the intestine means fat isn’t absorbed, and the body starves. When death mercifully does intervene, it arrives as the liver completely loses its ability to manage toxins, sending the children into a coma.

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The Death of Objectivity

For veterans of the healthcare industry, the current debate over the future of the Affordable Care Act – and proposed changes that would fundamentally alter Medicaid and individual market exchanges – is a frustrating battle of ideologies with the future of healthcare at risk. Our debate over who should be eligible for expanded coverage and how we reform reimbursement is often laced with self-preservation, which in our case means preserving an employer-sponsored system that is riddled with inequities, opacity, dubious middlemen and weak public and private sector fiduciary oversight. Those who provide, pay for and/or consume healthcare are drowning under rising per capita costs while many in the middle of these transactions grow fat.

As brokers, consultants and advisors, we have to face an inconvenient truth: we have presided over and benefited from a system in crisis. Not everyone believes our industry’s purpose is noble or necessary.

Health system stakeholders long to deal direct with employers. Many professional benefits managers hate being on the end of the latest pitch from their advisor  to sell a project or broker to hawk a new product to increase commission income. In the digital age, there is a heavy bias in favor of disintermediation and the elimination of distribution costs that are often not easily rationalized.

How does one grade the contribution of a sentinel? How does a client know whether the advisor who is paid a commission or fee is acting out of self-interest or as a trusted change agent?

How one makes money is as important as how much one makes in certain industries. There are ethical implications to anyone who adds cost to a healthcare system fraught with waste, fraud and abuse. This expense translates into higher cost and erodes the ability for employers and public entities to finance care for those that are often most in need.

In the last two decades, ineffective regulatory and advisory oversight of the financial and healthcare industries has allowed abuses to take place in the form of mergers and protected opacity in pricing.

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Trump, Stalin and the Price of Replacing Science with Ideological B.S.

Donald Trump and many of his closest advisors have been accused of colluding with Russia to win his election as President. We shall see what Robert Mueller and the FBI discover in that regard. But, whatever truth emerges there is no doubt that Trump has ripped a page from a long-dead leader of the Soviet Union, the monster Joseph Stalin, to undercut science in the name of his ideological goals.

Friday the Washington Post reported that a senior leader at the Centers for Disease Control and Prevention was told not to use certain words in documents “related to the budget and supporting materials that are to be given to the CDC’s partners and to Congress”. Policy analysts at the Centers for Disease Control and Prevention in Atlanta the Post said were given a list of forbidden words at a meeting with senior CDC officials. The seven prohibited words are:

  • Vulnerable
  • Entitlement
  • Diversity
  • Transgender
  • Fetus
  • Evidence-based
  • Science-based

What does Trump’s disgraceful censorship of science by banning words known to be useful, valuable, essential and important have to do with Stalin and Russia? Everything.

Stalin like Trump only wanted to hear scientific words when they confirmed his political beliefs. He did not care if by implementing false news he killed millions of his citizens. Trump with his decision to ban scientific terms in public policy that don’t suit his taste is proudly marching in Uncle Joe’s bloody footsteps.

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