Category: Uncategorized

Why Trump Won? A Brief Tutorial for Harvard Medical Students

Nov 27, 2016• 45

By ANISH KOKA, MD

Mike Milligan, a Harvard medical student, recently wrote in THCB about the shock felt throughout his medical school upon the election of Donald Trump. Seeking to understand how it may be that ‘equality, service and compassion’ were defeated, Mike settles on the narrative that appears to have taken hold of the elites on the left – Trump did not really win, Hilary lost. While he does not say so in explicit terms, clearly we are to understand that the recent election was lost, and that in order to assure a better outcome the next election, physicians should urge their patients, and particularly their ‘poorer and less educated patients’ to register to vote. Hopefully, these voters can then ensure that access to ‘affordable, high-quality medical care’ through constructs like Obamacare and MACRA are nevermore placed in jeopardy.

What complete hogwash.

Let me start with the factually incorrect parts.

Mike writes that ‘Mr. Trump received fewer votes in victory than the previous two republican nominees garnered in defeat.’ As of today Donald Trump has received 62.2 million votes out of a total of 126.6 million votes cast. Mitt Romney received 60.9 million votes out of a total of 126.8 million votes, and John Mccain received 59.9 million votes out of a total of 129.4 million votes cast. So despite the fact that his opponent raised and spent close to 1 billion dollars on ads promising the literal apocalypse if Trump was elected, no republican candidate in history garnered more popular votes than Donald Trump. While it is true that nearly half of all Americans did not cast a ballot in this election, 3 million more votes were cast in 2016 than were cast in 2012. The percentage of eligible voters casting their vote in 2012 was 55%. The percentage of voters casting their vote in 2016? Also 55%. I realize the desire to deligitimize Trump by arguing this was a low turnout election that delivers no mandate is a very strong one among the millions on the losing side. Unfortunately, wishes and reality sometimes find themselves in conflict.Continue reading…

The Uncertainty Bomb

Nov 26, 2016• 2

By PAUL KECKLEY

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I like certainty and routine. I like my daily Tall Dark Roast with no room for cream at 5 am at Starbucks. I like the same restaurants, the same suits and ties and the same TV shows. Holidays throw me off and I get bored quickly when I have down time.

For six years, the healthcare industry in the U.S. has been adjusting to its new normal based on the regulatory framework of the Affordable Care Act (ACA). It became routine to discuss the volume to value, accountable care organizations, bundled payments, Medicaid expansion and Healthcare.gov. We were certain they’d be around for years to come.

Then came the election. When 61 million voters elected Donald Trump to the White House and kept GOP majorities in both houses of Congress, it signaled our routines in healthcare would be disrupted. The campaign promised to repeal and replace the ACA: its repeal appears certain but it’s replacement injects uncertainty into our routines around a number of meaty issues:Continue reading…

How Doctors Can Help Win the Next Election

Nov 26, 2016• 5

By MIKE MILLIGAN

On the morning of November 9^th, the day after the 2016 U.S. Presidential Election, a visceral sense of shock was felt throughout the campus of Harvard Medical School. Donald Trump’s victory appeared to be an abrupt rebuke of so many of our commonly held values—equality, service, compassion. As medical students and physicians in Boston, we understood that we were isolated—both geographically and ideologically—from the myriad forces that swept Mr. Trump into office. However, there was something unsettling about our collective disbelief. How was it that so many of us had failed to recognize the depth of pain and divisiveness that existed within our country? There arose, in all of us, a need to understand.

In the aftermath of the election, political analysts have ascribed Trump’s victory to several themes—condemnation of the intellectual elite, widespread economic disaffection, and the rise of a potent strain of populism. However, closer inspection reveals another contributor to this startling election result. Though the final votes are still being tallied, it is clear that Mr. Trump will have received fewer votes in victory than the previous two republican nominees garnered in defeat. Instead of representing a powerful mandate, Mr. Trump’s victory hinged on vast portions of the electorate choosing to stay home. Nearly half of all Americans did not cast a ballot in this election¹. As captured poignantly by Jon Favreau, former speechwriter to President Obama, “democracy is fragile and belongs to those who show up.” Continue reading…

Two Nations Separated by 5.3 mm

Nov 25, 2016• 7

By SAURABH JHA MD

A popular meme is that the U.S. spends more on healthcare than other developed nations but has nothing to show for that spending. This is different from saying that the U.S. spends more, but achieves something, but the something it achieves is so little that it isn’t worth the public purse. The latter is difficult to assert because the asserter must then say how little is too little in regards to how much is spent, and why. It is easier believing the excess spending has no effect whatsoever, zilch in fact, because this absolves one from having to apply a value judgment on how much a life is worth. This meme, a convenient heuristic, like other convenient heuristics, is wrong.

A recent study looked at trends and outcomes in the management of abdominal aortic aneurysm (AAA) in the U.S. and the U.K. An aneurysm, dilation of the aorta, is more likely to burst the bigger it gets. Aneurysms should be repaired before they rupture because the mortality of ruptured aneurysms can be 50 %. The study, which analyzed several databases that recorded surgery, size of aneurysms, and cause of death, found that Americans repair twice as many aneurysms as the Brits, and the repaired AAAs are smaller, on average, in the U.S. Between 2005-2012 elective AAA repair (i.e. repair of non-ruptured aneurysms) increased from 27 to 32 per 100, 000 in the U.K, and from 58 to 64 per 100, 000 in the U.S.

American Healthcare Rackets: Monopolies, Oligopolies, Cartels and Kindred Plunderbunds

Nov 25, 2016• 23

By NORTIN HADLER, MD

The Healthcare Dollar, the Healthcare Industry and the Healthcare System are shibboleths. All are parlance. All render terms such as Healthcare Profession, Service Profession, and Healthcare Professionals quaint. All drive linguistic determinism: if it’s labeled so, it must be so. Furthermore, all have become jingoistic. This is our dollar, our industry, our system and don’t dare tread on us.

These are shibboleths that engender considerable cognitive dissonance. If healthcare is no longer a service profession but an industry that transfers wealth in a systematic fashion, shouldn’t it comply with the legal constraints that tightly govern other industries including others that serve essential needs of the population?Continue reading…

Will Trumpcare Repeal & Replace Obamacare?

Nov 23, 2016• 8

BY DEVON HERRICK

Donald Trump made repealing Obamacare one of the cornerstones of his campaign. Now that he has won, his administration will face the daunting task of unraveling nearly seven years of Obamacare. Republican policymakers cannot agree how to proceed. Some Republicans believe Trump should repeal Obamacare piecemeal; others worry that would be a disaster.

Whether you oppose or support the Affordable Care Act (ACA), it has structural flaws that will have to be addressed. Addressing those flaws will be less painful if repeal of the costly insurance provisions is accompanied by a replacement plan. Congress can repeal some Obamacare provisions using budget reconciliation, which requires only a simple majority. Only those provisions involving taxes and the budget can be repealed this way. The individual and employer mandates and all the ACA taxes can be repealed using budget reconciliation. However, the regulations that prevent insurers from designing affordable health plans cannot. Repealing the insurance mandates require a filibuster-proof majority. A slight Republican majority in Congress means the Trump Administration likely has the power to gut the ACA. However, Trump cannot replace Obamacare without maybe a dozen Senate Democrats willing to go along.Continue reading…

Congress Shouldn’t Pass FDA Reform Bills Without Addressing Patient Safety and Drug Prices

Nov 23, 2016

By DIANA ZUCKERMAN

A major proposed law that alters the way the Food and Drug Administration (FDA) approves drugs and medical devices has been wending its way through Congress since 2014. Momentum is building on Capitol Hill to pass the legislation in the current “lame-duck” session of Congress.

That shouldn’t happen.

The House passed its version of the legislation—the 21^st Century Cures Act (hereafter the Cures bill) —in July 2015. The Senate health committee created and passed 19 related bills, under the banner “Innovation for Healthier Americans,” this past spring.

Sen. Lamar Alexander (R-Tenn) pushed, without success, to get the legislation to the Senate floor this past summer. Now, he and proponents—which include the pharmaceutical and medical device industries and dozens of research and patient groups who get support from those industries—seek to pass the legislation in the lame-duck session.

Want to help Technologies for Healthy Communities?

Nov 22, 2016• 2

By ALEXANDRA CAMESAS

Health 2.0 is actively expanding Technology for Healthy Communities and looking for large healthcare organizations and foundations to help support technology adoption at a community level.

Technology for Healthy Communities is a dynamic pilot program designed to catalyze the adoption of technologies in communities. The program fosters the development of sustainable partnerships to address the social determinants of health in the under-served regions that need it the most. Over 200 innovators across the U.S. submitted applications to the program, and through curated matchmaking and access to funding, selected innovators were matched with three participating communities to conduct pilot projects.

Snapshot of the three pilots:

Spartanburg, SC: ACCESS Health Spartanburg, a non-profit agency primarily working with the uninsured population, is piloting with Healthify to provide community interventions for social determinants of health at the point of care. With support from Spartanburg Way to Wellville and the Mary Black Foundation, the pilot aims to address current pain points in community health care, such as the inefficiency of addressing social needs of patients and helping to make case management easier.
Jacksonville, FL: The City of Jacksonville and the Health Planning Council of NE Florida, with support from the Clinton Foundation is piloting with CTY to deploy its signature product, NuminaTM. With this technology, bicycle and pedestrian traffic data will be collected to assess current safety conditions and plan improvements in the built environment for residents to be more physically active.
Alameda County, CA: The Community Health Center Network is piloting with Welkin Health to implement a case management tool that engages members and eases current healthcare worker burden. Together, they will pilot this case management tool in four centers to help community health workers to effectively and efficiently coordinate care.

Due to the high demand from tech innovators and communities, Health 2.0 is expanding the program to new communities, tech startups and organizations who can benefit from technology adoption. By addressing the social determinants of health, the program has the potential to implement unique tech applications and address some of the most important systemic issues at the community level.

Health 2.0 is looking for partners such as foundations, large health systems and corporations who want to support pilots to test innovations in communities, interact with the fastest growing startups in the tech scene, and help create business opportunities for technology companies. Program sponsors will also have the opportunity to address local health needs by bringing exciting, new technologies to under-served regions across the U.S.

The program will focus on tools that support access to a healthy lifestyle, in categories such as:

Access to healthcare services
Food insecurity
Affordable housing
Behavioral/mental health

If you are interested in partnering with Health 2.0 to help deliver technology to communities, contact pa*****@********on.com to learn about opportunities to support the program.

Alexandra Camesas is a program manager at Catalyst @ Health 2.0

Rethinking Outcomes Improvement and Data Governance

Nov 21, 2016

By HEALTH CATALYST

Over the last year, we have noticed a very common trend. As organizations decide that they are ready to embark on a data-driven journey, they go through a rigorous process to select their technology and vendor(s) of choice, but then they often slow to a crawl when considering how to organizationally manage and handle the many changes that will be needed to succeed. A small sample of the many questions we hear are:

Who will lead out on data-driven outcomes improvement?
Where will this function be funded and led?
Who owns the data?
How do we identify opportunities and prioritize what we will do?
How do we resolve discrepancies?
How do we measure success?

So, this week we are featuring a webinar on Outcomes Improvement Governance, presented by our co-founder, Tom Burton and David Grauer, a former Intermountain Healthcare executive with years of executive governance experience. Plus, we’ve included three articles that we have written on ‘data’ governance, a sub-component of governance. If your organization faces any of these important issues, please join us for this informative webinar and its question and answer period.

Randomized Trialomania

Nov 18, 2016• 2

BY ANISH KOKA, MD

This story is old, but the age of the story should not detract from the lessons of the story.

It was 1982, the place was Tsukuba, Ibaraki Prefecture, Japan. Workers at Fujisawa pharmaceuticals began testing fermented broths of Streptomyces species that had been retrieved from soil samples at the base of Mount Tsukuba. They were working to solve the remaining achilles heel of organ transplantation – effective suppression of the immune system that would prevent the body from attacking its new guest. It had quickly became apparent to the medical community that the key to long term survival of patients now lay in the development of effective, non-toxic immunosuppressive agents.

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After two years of testing, isolate no. 9993, which later came to be named FK506, or Tacrolimus, showed promise in inhibiting lymphocyte reactions. First reports emerged in the literature in 1987, and were impressive. The agent appeared to suppress mixed lymphocyte culture at concentration 30 to 100 times lower than the gold standard at the time: cyclosporin. (1)

The father of organ transplant, Thomas Starzl was in Pittsburgh at the time, and quickly seized on the potential of this new agent. By 1990, he had used the drug successfully in patients who were rejecting their liver transplants on conventional cyclosporine based immunosuppression. The positive results of the ‘rescue’ trial prompted initiation of a randomized control trial in Pittsburgh that compared cyclosporine to FK506 from the time of transplant.
At the time, the randomized control trial was in its relative infancy, and had not yet achieved the hallowed status it has today. This, of course, was changing rapidly. Physicians recognized the fallacy of epistemology sourced purely from intuition and tradition, and sought the shelter of certainty that randomized control trials (RCTs) promised with the random allocation of patients to treatment and control arms. The Pittsburgh team thus randomized 81 patient, 40 to cyclosporine – the conventional treatment – and 41 to FK506, the new kid on the block. Investigators studied patient mortality and survival of the transplanted organ at various time points. By convention, results were analyzed using statistical hypothesis testing – and to the lay person would seem to be underwhelming.