Category: Uncategorized

An Open Letter to Ezekiel Emanuel on Life and Death

Dec 13, 2014• 49

By Suzanne Gordon

In the October issue of The Atlantic, physician and medical ethicist Ezekiel (Zeke) Emanuel, brother of Rahm Emanuel (former official in the Clinton White House, then Congressman, then Chief of Staff for President Barack Obama, now Mayor of Chicago) published an article why he thinks we should all forgo advanced age and die at 75. As a 69-year-old moving toward 75, my response to that article is this blog post requesting a stay of execution from our newly appointed Czar of American longevity.

An Open Letter to Ezekiel Emmanuel.

Dear Ezekiel Emmanuel:

Please forgive me for taking so long to comment on your article in The Atlantic arguing that we should declare our lives to have reached their productive limit at age 75 and therefore gracefully exit this world before we move into an inexorable decline. Your article – “Why I Hope to Die at 75″ –– appeared in The Atlantic in October and here it is December and I have not joined the 3000 plus people who commented on it earlier. First, I confess, I did not read it until almost a month ago, and then, I had to stew in some juices before figuring out how to reply. You make many good points in your article. Americans do indeed consider themselves to be “immortals,” do prolong death rather than extend life when they push for futile treatments or agree when their physicians who too often recommend them (if they were not so enthusiastically recommended, would so many American patients so heartily sacrifice themselves on the altar of science?) But does the solution to the out of control medicine lie in declaring that 75 should be the age of exit? See, for example, Shannon Brownlee’s Overtreated.

In your article, you carefully explain why you have picked 75 as the human sell by date.Continue reading…

Starvation: The Cure For the Obesity Epidemic. Or Will Esther Dyson Be My Next Mother-In-Law?

Dec 12, 2014• 6

By MARTY FELSENTHAL

I was enjoying drinks last week with Jody Holtzman (AARP), Terry Booker (IBC), and Doug Ghertner (change:healthcare) at a wonderful conference sponsored by Oliver Wyman. Jody was waxing eloquent about how every start-up needs a strategy for the senior population, when – after a few too many drinks – I emphatically told everyone at the table that I had the senior market cracked. I had experienced first hand the ills of the American health care system for seniors and had identified the perfect solutions.

My father-in-law grew up on a small, Kosher dairy farm outside of Pennsylvania (insert Jewish farmer joke here). He is 72 years old, he was about 40 pounds overweight, he has been widowed for about four years, and, about 30 minutes after my mother-in-law passed away, he started dating a woman that my wife never quite accepted, which is akin to saying that Russia is watching events unfold in the Ukraine from the sidelines (and to be clear, I don’t condone either position).

In January of this year, he was jumping from a backhoe onto a helicopter pad (don’t ask), fell 6 feet, and shattered his heel. The heel is a terrible bone to break in general (poor circulation) and, in particular, for someone who is older and a bit overweight (my goal is to not use the word “patient” once in this article because we aren’t patients, we’re people).Continue reading…

The Wellness Industry’s Terrible, Horrible No-Good Very Bad Week

Dec 12, 2014• 6

By AL LEWIS and VIK KHANNA

Just as the Bear Stearns implosion presaged the 2008 financial crisis, the events of the last few days, building on earlier events, are presaging the collapse of the “pry, poke, prod and punish” outsourced, vendored wellness industry.

For those readers still living in Biosphere 2, here is a brief review of how we got here. First among the precursors was Honeywell’s completely voluntary self-immolation with the Equal Employment Opportunity Commission (EEOC). We’re not sure how their benefits consultants failed to advise that all they needed to do was offer a simple wellness program alternative that didn’t require medical exams, and there was no way they’d get hit with an EEOC lawsuit. But, then again, no one ever went broke underestimating the ability of benefits consultants to misinform their clients.

Second, the Business Roundtable (BRT) decided to go to the mat with the President over this EEOC-wellness issue. They are essentially demanding to retain their Constitutional rights to deplete their treasuries while harming and alienating their employees without intrusion from the pesky EEOC.Continue reading…

The Anti-Hypocrisy Rule

Dec 10, 2014• 24

By MARTIN SAMUELS, MD

Pundits abound when it comes to health care plans. They come from many different backgrounds: conservatives, liberals, academics, business people, doctors, politicians and more often all the time various combinations of these. But they all have one characteristic in common. They all want a different kind of health care for themselves and their families than they profess for everyone else.

I am acutely aware of this as I am in a position that demands that I find special appointments for them. A day virtually never passes when I don’t receive requests (often many in a single day) for me to either see these people myself or arrange for their special care elsewhere, including other parts of the county and the world. My own personal ethical code of conduct prevents me from mentioning their names or anything that could identify them. Suffice it to say that I have yet to see a single exception to this principle.

The Great Patient Experience Survey Myth

Dec 10, 2014• 5

By REBECCA ANHANG PRICE and MARC ELLIOTT

Patient experience measures are increasingly being publicly reported and included in pay-for-performance programs, but critics express concern about the relevance and fairness of using information from patient experience surveys as indicators of health care quality. In a recent article in the Journal of General Internal Medicine, we draw on our experience developing and implementing widely used Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys to debunk seven myths.

Myth #1: Patients don’t have the expertise to answer questions about the quality of their health care. Surveys, such as CAHPS, ask about patient experience, not technical quality of care. And patients are the best and only source of that information.

Myth #2: Patient experience is too subjective to be actionable. Good patient surveys measure specific care experiences, like whether the health care provider communicated in a way that you understood. Information from such surveys can help to identify aspects of care that could be changed to improve patient experience. Many health care providers choose to act on the results, but unfortunately, not all providers use the information generated by patient surveys to improve care.

Myth #3: Emphasizing patient survey results encourages providers to meet patient expectations for their care, rather than to provide appropriate care. Research suggests that patients value how well their health care providers communicate more than whether he or she offers a specific treatment. Making sure that patients are involved in treatment plans is another way to improve patients’ ratings of their care experiences.

Myth #4: There is a tradeoff between good patient experiences and high quality clinical care. It’s no surprise that some providers have higher scores for patient experience and lower clinical quality scores, and vice versa. But importantly, we know that it’s possible for health care providers to simultaneously offer better patient experiences and better clinical quality. Dozens of studies have found either positive or no association between ratings of patient experience and ratings of clinical quality, suggesting that there is no tradeoff between the two.Continue reading…

2015 Forecast: A True Healthcare Market Takes Shape

Dec 9, 2014• 7

KELLY BARNES

2014 was the year of the Affordable Care Act. There were other profound and important developments in health, but for consumer interest, media attention, and impact on the health business, the ACA dominated the picture.

2015 is expected to be different. This increasingly wired, consumer-oriented, and innovative health industry is poised for profound transformation: 2015 will be the year that a true, industry-wide healthcare market begins to take shape. To help navigate this emerging market, we’ve identified ten Top health industry issues of 2015 driving transformation.

Three issues coalesce around consumer–centric digital health technology:

Do-it-yourself healthcare
U.S. physicians and consumers are ready to embrace a dramatic expansion of the high-tech, personal medical kit. Our Health Research Institute (HRI) surveys show that clinicians may be more open to using these tools than consumers. One-third of consumers said they would use a home urinalysis device. But more than half of physicians said they would use data from such a device to prescribe medication or decide whether a patient should be seen.

Making the leap from mobile app to medical device

The proliferation of approved and portable medical devices in patients’ homes, and on their phones, will make diagnosis and treatment more convenient, redoubling the need for strong information security systems. Regulatory approval may provide a competitive edge — 20 percent of consumers and 26 percent of clinicians said FDA approval was important when deciding to use apps.

The Federal Strategy For Collecting, Sharing and Using Electronic Health Information

Dec 9, 2014• 10

DeSALVO, PAZINKSKI, SWAIN and WYATT

Making our nation’s health and wellness infrastructure interoperable is a top priority for the Administration, and government plays a vital role in advancing this effort. Federal agencies are purchasers, regulators, and users of health information technology (health IT), as they set policy and insure, pay for care, or provide direct patient care for millions of Americans. They also contribute toward protecting and promoting community health, fund health and human services, invest in infrastructure, as well as develop and implement policies and regulations to advance science and support research.

The Office of the National Coordinator for Health IT (ONC) has a responsibility to coordinate across the federal partners to achieve a shared set of priorities and approach to health IT. To that end, today we released the draft Federal Health IT Strategic Plan 2015-2020, and we are seeking feedback on the federal health IT strategy. This Strategic Plan represents the collective priorities of federal agencies for modernizing our health ecosystem; however, we need your input. We will accept public comment through February 6, 2015. Please offer your insights on how we can improve our strategy and ensure that it reflects our nation’s most important needs.

A collection of 35-plus federal departments and agencies collaborated to develop the draft Federal Health IT Strategic Plan: 2015-2020, identifying key federal health IT priorities for the next six years (Exhibit 1). The landscape has dramatically changed since the last federal health IT strategy. When we released that Plan, the HITECH Act implementation was in its infancy. Since then, there has been remarkable growth in health IT adoption. Additionally, the Affordable Care Act implementation has begun to shift care delivery and reimbursement from fee-for-service to value-based care.Continue reading…

THCB Thanks Our Sponsors

Dec 8, 2014

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THCB thanks our corporate supporters.

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ONC Signals a Shift From Documents to Interfaces

Dec 7, 2014• 46

ADRIAN GROPPER, MD

All of you Meaningful Use and Health IT junkies should read Data for Individual Health Although long, it’s definitely worth a scan by everyone who cares about health tech. This is the third JASON-related report in a year out of ONC and it comes a month or so before the planned release of the first details of ONC’s announced 10yr plan. I think there’s a reason for that much of it introduced by ONC’s earlier post.

There are three key points I would highlight:

First, and most important, this report suggests that HIPAA Covered Entities (mostly hospitals, doctors and their EHRs) are no longer the center. The future, labeled as the Learning Health System, now makes mobile and patient-centered technology equally important as part of the architecture and talks about interoperability with them rather than “health information exchange” among HIPAA CE’s and their Meaningful Use mandates.

Second, this JASON report, unlike the previous two, does not talk about Meaningful Use any more. That money is spent. A lot of orgs are lobbying against any more MU mandates and, although I’m pretty sure there will be a Stage 3, it could be toothless or very much delayed.

Third, Direct, the original Blue Button, Blue Button Plus Push, and CCDA files are pretty much history. Although the JASONs don’t say it as plainly as I am, document-based interoperability has failed and we’re moving on to Application Programming Interfaces (APIs) that don’t use CCDA or any of the stuff mandated by MU 1 and 2. Blue Button Plus Pull and FHIR, both with a modern industry-standard OAuth security scheme, are the future for all sorts of good reasons which you need to read the JASON reports with some care to understand. It’s all there.

Germs. The Pseudoscience of Quality Improvement

Dec 7, 2014• 8

By Karen Sibert, MD

No one wants a hospital-acquired infection—a wound infection, a central line infection, or any other kind. But today, the level of concern in American hospitals about infection rates has reached a new peak—better termed paranoia than legitimate concern.

The fear of infection is leading to the arbitrary institution of brand new rules. These aren’t based on scientific research involving controlled studies. As far as I can tell, these new rules are made up by people who are under pressure to create the appearance that action is being taken.

Here’s an example. An edict just came down in one big-city hospital that all scrub tops must be tucked into scrub pants. The “Association of periOperative Registered Nurses” (AORN) apparently thinks that this is more hygienic because stray skin cells may be less likely to escape, though there is no data proving that surgical infection rates will decrease as a result. Surgeons, anesthesiologists, and OR nurses are confused, amused, and annoyed in varying degrees. Some are paying attention to the new rule, and many others are ignoring it. One OR supervisor stopped an experienced nurse and told to tuck in her scrub top while she was running to get supplies for an emergency aortic repair, raising (in my mind at least) a question of misplaced priorities.