Category: Uncategorized

Physician Disrupt Thyself

Nov 12, 2015• 2

By MARC-DAVID MUNK, MD

(Stepping away from health policy and business this week, a quick post on alternative careers in medicine).

Wrapping up a great week spent with emergency medicine friends attending this year’s American College of Emergency Physicians national meeting in Boston. Over the course of a few receptions and dinners, more than one old friend has stopped to ask me about how I made the decision to step away from caring for patients in the emergency department and into a nonclinical role at a progressive startup healthcare company. A few friends confessed that they love the idea of getting their hands dirty fixing a broken healthcare system– but don’t know where to begin.

I have a very limited perspective and I’m no expert on career pivots. But I often look to an article I came across a few years ago, written by Whitney Johnson in the Harvard Business Review. Her article is called Disrupt Yourself.

In the piece (and later in her book) Johnson argues that people can successfully transition into satisfying roles in new businesses but often need to “disrupt” themselves and their current careers. This disruption is needed because moving to another job or field (even one adjacent to the one you’re in) is hard. I think that this is particularly true in medicine where the time and money needed to become a doctor creates incumbents, inherently resistant to change. Physicians are, by nature of our training and regulation, IBMs and Microsofts. We are slow to change. We can plateau.

Can Community Organizing and The “third place” Improve Public Health?

Nov 12, 2015

By ANDY ORAM

The majority of health problems in modern developed countries are self-inflicted, the results of lifestyle choices. These problems don’t respond to a pill–or even to bariatric surgery. Moreover, the medical profession hasn’t found ways to change lifestyle.

For instance, one study found that only one of six overweight adults in the US have sustained a weight loss–and that was an improvement over other studies. Another site claims that 90-95% of all dieters regain their weight within five years. It’s encouraging to note an 80% improvement among people with obesity who get treatment–but the source doesn’t say what “treatment” is. It apparently goes far beyond advice and Weight Watchers–so only 10% of obese Americans get treatment in the first place.

Health problems are killing us, and bankrupting us along the way. It’s well known that a tiny percentage of patients generate the most treatment and the highest health care costs, as Atul Gawande pointed out in a famous New Yorker article.

Of course, lifestyle doesn’t lie behind all hot-spotters (for some we can blame birth defects or other debilitating accidents, and for others we can blame over intervention in dying people), but a lot of them just just exhibit exaggerated versions of the common behavior problems most Americans face: bad eating, drug use, lack of exercise, etc.

What Doctors should Know when Joining a Startup – Five Key Books

Nov 12, 2015

By DAVIS LIU, MD

What should doctors know before joining a startup? I don’t know if these were questions medical school graduates in the Bay Area asked themselves as they opted to join a startup rather than completing their medical training in residency programs. These new doctors felt they could make a bigger impact on patient care by leaving the system and its current status quo.

Why not? In the Bay Area, small startups and former startups like Facebook, Google, and Apple are literally blocks away from academic medical centers. Everyone knows someone working at a startup. At a healthcare innovation summit, Vinod Khosla, co-founder of Sun Microsystems and venture capitalist reassured technology entrepreneurs that the opportunities to disrupt healthcare were tremendous. After all,

“Health care is like witchcraft and just based on tradition.”

Khosla encouraged attendees to develop technology that would stop doctors from practicing like “voodoo doctors” and be more like scientists. Disruption required having an outsider point of view. Khosla highlighted how CEO Jack Dorsey of Square was able to disrupt and provide services more cheaply than the traditional methods of the electronic payment system accepting Visa and Mastercard because only 2 percent of the employees at Square ever worked in the industry.

Interoperability: Faster Than We Think – An Interview with Ed Park

Nov 11, 2015• 9

By LEONARD KISH

Leonard Kish, Principal at VivaPhi, sat down with Ed Park, COO of athenaHealth, to discuss how interoperability is defined, and how it might be accelerating faster than we think.

LK: Ed, how do you define interoperability?

EP: Interoperability is the ability for different systems to exchange information and then use that information in a way that is helpful to the users. It’s not simply just the movement of data, it’s the useful movement of it to achieve some sort of goal that the end user can use and understand and digest.

LK: So do you have measures of interoperability you use?

EP: The way we think about interoperability is in three major tiers. The first strata (1) for interoperability can be defined by the standard HL7 definitions that have been around for the better part of three decades at this point. Those are the standard pipes that are being built all the time. So lab interoperability, prescription interoperability, hospital discharge summary interoperability. Those sort of basic sort of notes that are encapsulated in HL7. The second tier (2) of interoperability we are thinking about is the semantic interoperability that has been enabled by meaningful use. The most useful thing that meaningful use did from an interop standpoint was to standardize all the data dictionaries. And by that I mean that they standardized the medication data dictionary, the immunizations, allergies and problems.

The Self-Pay Paradox

Nov 10, 2015• 4

By JESSICA SWEENEY-PLATT

One of the most important trends in healthcare today is the inexorable shift towards high-deductible health plans. Over the past few months, my colleagues and I have analyzed tens of millions of visits to practices using athenahealth’s practice management and EHR services to understand the impact that this shift is having. We believe there are some reasons for providers and practice leaders to worry–the average patient obligation has increased by 20% over the past 4 years, and the number of patients carrying large balances is increasing as well. We have also seen that practices’ ability to collect these obligations is highly variable.

Across our network, patient payments provide nearly one-fifth of physician income, with the median athenahealth provider failing to collect 30% of what patients owe. And the situation is getting worse. As the graphic below shows, patient deductible obligations are up 22% in the past two years–while commercial payments have grown only 4%.

My colleagues and I have studied these trends, and we’ve identified a few things that top-performing practices do to ensure that they are able to collect the dollars that they are owed. In fact, at every step of the collections process–from scheduling to follow-up months after a visit–top-performing practices take a different approach than others. Please join us on November 11th to learn what these organizations are doing to improve patient collections, and how your practice can get to similar results.

Jessica Sweeney-Platt is a lead with athenaResearch

What Does it Mean When We Say a Treatment “Works?”

Nov 10, 2015• 2

By ROBERT McNUTT, MD

Making a decision requires you to compare tests/treatments that have been contrasted in researh studies to see if one over another results in improved chances of good outcomes. In a sense, medical decision making is a competition. To assess the competition, you compare the chances of outcomes, or results from groups of people taking different options. The comparison is a simple subtraction in the amounts of outcomes that occur in each studied group.

Subtracting results in a difference that is either a benefit (if better for you) or a harm (if worse for you). For nearly all decisions, however, the test/treatment that is better for disease outcomes (benefit) is worse for complications (harm). Comparing, then, results in the following possibilities:

The chances of outcomes associated with the condition you have and the tests/treatments available will be the same for all options. In this case, chose the cheapest option.

The chance of outcomes associated with the condition you have will be less with one option. That option provides added benefit

The chance of a complication caused by the test/treatment that adds benefit for the disease outcomes will be greater (harm).

Since the test/treatment that is better for you in terms of the disease you have will be, simultaneously, worse for you in terms of complications caused by that test/treatment, a trade-off of benefit and harm is required.

Hence, the definition of “works” is that:

A test/treatment works when you feel there is more to gain from the greater chance of better disease associated outcomes than there would be to lose from suffering the complications caused by your chosen treatment.

So, medical-decision-making is a competition between options and there is always some good to be balanced against some bad.

The balance of good and bad from your perspective is what makes one treatment work over another.

Robert McNutt, MD is a board certified internist in Clarendon Hills, Illinois. He is a Professor at Rush Medical College of Rush University.

The End Game–Live in Finland!

Nov 10, 2015

By Matthew Holt

Today I am in Finland at the Vertical digital health accelerator, part of a really impressive network of accelerators and incubators in Helsinki. Tomorrow is the huge SLUSH festival at which I (plus Steven Krein of Startup Health) will be talking on Thursday. Today, I’m speaking and moderating a great seminar with excellent speakers at Vertical for the End Game.

The End Game is a thought leader seminar that finds answers to questions. The most insightful speakers from around the world will talk about digital health. Speakers include the Head of Health & Medical equipment division of Samsung France, the Head of Healthcare of Telia, and many others including Luis Barros VC expert from Boston.

The seminar is streaming live on www.endgame.fi on November 10th at 3pm Finnish time (8 am ET, 5 am PT) The video will also be available for later viewing.

Being Graded

Nov 9, 2015• 7

By MUNIA MITRA, MD

“Lawyers aren’t graded.”

“CEOs aren’t graded”

“How would you feel if I tracked every e-mail you sent and tracked how many people responded to them? You wouldn’t like that very much would you?”

“The people who make EMRs. Why aren’t they graded?”

If there’s one negative I hear time and time again from doctors when the subject of quality measurement comes up, it’s this one near-universal complaint. The world is unfair, the cards are stacked against us.

As a specialist at a busy urban medical center I hear the complaints almost every day from colleagues and peers at other hospitals. We’re being singled out for unfair treatment: They’re out to get us. It’s the world against the doctors.

Many of the so-called experts I’ve talked to at meetings around the country express disdain when the topic of physician resistance to quality improvement programs comes up.

But it shouldn’t be terribly surprising that the idea that one’s performance is being tracked can be seen as intrusive and threatening. The reaction is in many ways completely predictable.
Continue reading…

The Network You May Not Like

Nov 7, 2015• 1

BY PAUL LEVY

This has been my week to discuss networks (Internet and electricity), but I would be remiss if I didn’t spend a few moments on the networks that are most likely to rob us of personal choice and increase costs: Health care networks.

Wait, didn’t President Obama promise us that the new health care law would preserve choice for us? Didn’t he promise us lower costs? Well, in spite of much good that the law accomplished in terms of providing access to health insurance, these are two areas that have gone awry. For a variety of reasons–most of which have little to do with providing you with better care–the hospital world has grown more centralized. It’s done so to reduce competition and get better rates from insurance companies. It’s done so to create larger risk pools of patients under the “rate reform” that incorporates more bundled and capitated payments. It’s done so to keep you as a captive customer for your health care needs. It’s been aided and abetted by electronic health record companies that find a mutual advantage with their hospital colleagues in minimizing the ability of your EHR to be easily transferable to other health systems. As I’ve noted, we truly have created “business cost structures in search of revenue streams,” rather than a vibrantly competitive system focused on increasing quality and satisfaction and lowering costs.

Many people don’t even know they are part of a health care network until they discover its limitations. It might be that the insurance product they bought has different rates for in-network doctors and facilities from out-of-network doctors and facilities. It might be that their primary care physician subtly or not so subtly directs them to specialists in his or her network because they share in the financial reward of eliminating “leakage” to other systems. It might be that they discover that an MRI or other image taken in one health system cannot be transferred electronically to another, perhaps necessitating a second image and its accompanying cost.

Better Living Through Research Design

Nov 7, 2015• 1

By STEPHEN SOUMERAI

What if policymakers, science reporters and even scientists can’t distinguish between weak and trustworthy research studies that underlie our health care decisions?

Many studies of healthcare treatments and policies do not prove cause-and-effect relationships because they suffer from faulty research designs. The result is a pattern of mistakes and corrections: early studies of new treatments tend to show dramatic positive health effects, which diminish or disappear as more rigorous studies are conducted.

Indeed, when experts on research evidence do systematic reviews of research studies they commonly exclude 50%-75% because they do not meet basic research design standards required to yield trustworthy conclusions.

In many such studies researchers try to statistically manipulate data to ‘adjust for’ irreconcilable differences between intervention and control groups. Yet it is these very differences that often create the reported, but invalid, effects of the treatments or policies that were studied.

In this accessible and graph-filled article published recently by the US Centers for Disease Control and Prevention, we describe five case examples of how some of the most common biases and flawed study designs impact research on important health policies and interventions, such as comparative effectiveness of medical treatments, cost-containment policies, and health information technology.