Category: Uncategorized

Why We Need Good Primary Care Physicians

Feb 15, 2021• 2

By HANS DUVEFELT

I have made the argument that being the first contact for patients with new symptoms requires skill and experience. That is not something everybody agrees on.

One commenter on my blog expressed the opinion that it is easy to recognize the abnormal or serious and then it is just a matter of making a specialist referral.

That is a terribly inefficient model for health care delivery. It also exposes patients to the risks of delays in treatment, increased cost and inconvenience and the sometimes irreversible and disastrous consequences of knowledge gaps in the frontline provider.

UNNECESSARY SPECIALIST REFERRALS ARE COSTLY

Seeing a high charging, high earning specialist when the primary care provider can’t diagnose and manage the condition involves higher cost and, in many cases, a comprehensiveness that is based on the fact that the patient traveled 200 miles for their appointment. In such cases patents aren’t likely to come back for a two week recheck. Consequently, specialists tend to do more in what may be the only visit they have with a patient.

UNNECESSARY SPECIALIST REFERRALS CREATE TREATMENT DELAYS

For my patients, seeing a neurologist involves a one year wait for the out of state neurologist who does consultations almost 100 miles from my clinic, or a three to four month wait for an appointment more than 200 miles away in Bangor. The situation for rheumatology or dermatology is about the same.

Modern Day “Victory Gardens” – Planting the Seeds for Covid Vaccination Success

Feb 12, 2021• 2

By MIKE MAGEE

In the wake of Pearl Harbor, FDR found our nation ill-prepared for war. He lacked manpower and tools. In response, he took deliberative action with the support of Congress, drafting soldiers and redirecting supply chains toward weapons of war. Compliance was requested, then demanded. Those industries that served, including Pfizer with penicillin production, benefited in the short and long-term.

FDR not only harnessed the power of industry and science, and ramped up the military, but also asked every family and every community to participate in the war effort. Community volunteering soared, and sacrifice for the public good was the rule, not the exception.

One idea was “victory gardens”, planted in back yards, to allow stressed food manufacturers the ability to focus on meeting the demand to “feed the troops.” These gardens in 1943 provided 1/3 of all the vegetables consumed in the states that year.

President Biden now finds himself in a similar predicament – the need to redirect our vast industrial productive capacity while mobilizing our citizens to both support and participate in vaccination efforts.

Our President and his team understand that interventional and privatized high science is of little avail if that science (in this case vaccines) is unable – by limited supply or logistic ineptitude or the absence of public trust – to find it’s way efficiently and quickly into the arms of our citizens.

Signify Health IPO: CEO Kyle Armbrester on $7.1B Market Debut

Feb 12, 2021

By JESSICA DaMASSA, WTF HEALTH

Signify Health’s CEO Kyle Armbrester stops by on IPO day! Hours after ringing the bell on $SGFY’s launch on the New York Stock Exchange, Jess DaMassa digs into the health tech company’s $7.1B valuation and plans to help providers, payers, and self-insured employers scale-up their value-based care offerings. Kyle calls it “Value-Based Care 2.0” and, for the uninitiated, does a great job of stepping back and explaining this healthcare payment model’s history and how Signify is building its next-gen approach from the groundwork laid over the past decade.

What’s unique about Signify Health’s model is that it’s not just relying on tech to make it easier to find where managed care organizations can help cut healthcare costs and drive better outcomes – they also provide in-home health services that send nurses, doctors, and social workers out into patient’s homes to physically look for potential roadblocks to recovery and wellness. It’s in this critical “last mile” where Signify is possibly making the greatest impact, connecting the social determinants of health (physical environment, social support networks, economic status, etc) back into the healthcare system in a way that not only helps patients, but is also aligned with how all the stakeholders along the care continuum are incentivized. (And that includes Signify, which goes at-risk along with their clients and only gets paid when they drive better outcomes and cut-out costs.) So, what is the ultimate opportunity for this kind of “deep healthcare” business? We get into Signify Health’s business model, the competition, and its plans for growth and M&A activity now that they’re backed by $564M in capital from their initial day on the public market.

Pledge to the Participatory Medicine Manifesto!

Feb 12, 2021

By THE SOCIETY FOR PARTICIPATORY MEDICINE

We are excited to announce that the campaign to pledge to the Participatory Medicine Manifesto is launching today — and we need your support!

Our Participatory Medicine Manifesto is a call to action for patients, caregivers and health care professionals to equally share decision-making and respect one another.

We want you and your organization to help us fix a broken healthcare system from the ground up. We want to put democracy back into the culture of healthcare by enabling patients, healthcare professionals and caregivers to all have an equal voice. We need your influence to inspire people. We will list individuals and organizations that support the Manifesto.

Please view and sign the SPM Manifesto Pledge today

We have designed a promotional campaign encouraging people to pledge to the Participatory Medicine Manifesto. As part of this campaign, we created a pledge form and social media toolkit for people and organizations to use in spreading the work about Participatory Medicine.

And spread the word to your colleagues and friends to help us reach our goal. After you pledge you will find the easy to use social media toolkit.

We greatly appreciate your help and support!

Eric Bersh, Judy Danielson, Kevin Freiert, Matthew Holt, Dr. Danny Sands, Amber Soucy—all board members of SPM

Pledge Today!

PS – Please share with your friends & followers!

If It Ain’t Real Time, It Ain’t Really Real

Feb 10, 2021

By KIM BELLARD

Here’s a damning opening paragraph from an article in The New York Times about the frustrations that COVID-19 vaccinations are causing:

For a vast majority of Americans, a coronavirus vaccine is like sleep for a new parent: It’s all you can think about, even if you have no idea when you will get it.

Because, as Kaiser Health News reported: “Many states don’t know exactly where the doses are, and the feds don’t either.”

Think about that: in 2021, we can’t – or don’t – track something as vital as where vaccine doses are, in the midst of the pandemic they were designed in record time to mitigate. Nor, as it turns out, are we doing a good job of tracking how many have already had them, who is now eligible for them, or assuring that essential workers or disadvantaged populations are getting them.

Amazon tells me when my purchases have shipped, where they are in the shipping process, and when they’ve been delivered. They even send me a picture of purchases sitting on my porch to make sure I notice. Walmart’s supply chain management is equally vaunted.

Health care executives evidently aren’t required to learn supply chain management.

#Healthin2Point00, Episode 183 | Oscar IPO, Plume, Sitka, & Alma

Feb 9, 2021

Today on Health in 2 Point 00, we’ve apparently got 58 different SPACs looking to acquire health tech companies – so looks like Jess and I will be staying busy! On Episode 183, Jess asks me about Oscar Health filing their S1 and all the dirt people are digging up for IPO, Plume raising $14 million for their full stack clinic for transgender people, Sitka raising $14 million, and Alma raising $28 million providing practice management software for mental health providers. —Matthew Holt

You Can’t “Elon Musk” Healthcare

Feb 9, 2021• 2

By SOFIA NOORI

On January 26th, Philadelphia discovered that the 22-year-old organizer of its largest COVID-19 vaccination site, Andrei Doroshin, had turned away elderly members of the Philadelphia community from their vaccine appointments. Instead, he pocketed extra vaccine vials to administer to 4 friends and girlfriend. An RN witnessed the event and reported it to authorities.

Local news reporters quickly discovered that this incident was just the tip of the iceberg for Doroshin. A Drexel University graduate student with no experience in healthcare, Doroshin had enlisted his college friends to organize a group that would go on to win one of the biggest vaccination contracts from the city of Philadelphia. He told his friends that “this is a wholly Elon Musk, shoot-for-the-heaven type of thing,” and that “we’re going to be millionaires.” His organization had also amended its privacy policy allowing for patient data to be sold, administered large numbers of vaccines to people ineligible to receive the vaccine yet, and threw Philadelphia’s COVID vaccination program into chaos.

For the people in the back: One can’t simply “Elon Musk” healthcare. We have seen this too many times – a privileged young upstart with little experience believes that s/he can transform healthcare and make millions – or billions – doing so. Examples abound: we only have to look a couple years into the past to remember Elizabeth Holmes, the Stanford dropout who founded Theranos and misrepresented its technology, or to Outcome Health, whose former CEO Rishi Shah defrauded investors by overinflating business metrics. If “move fast and break things” works in other sectors, many reason, why won’t it work in the 4 trillion dollar industry of healthcare?

Healthcare is simply not the kind of business where one can shoot a rocket into the sky and accept the risk that it might explode. Simply put, this is people’s lives we’re dealing with. But a deeper layer involves trust in the medical establishment. U.S. healthcare is already marred by multiple grave issues: a complex bureaucracy, serious health inequities, and astronomical costs that can bankrupt a person in just one hospitalization. The trust that people have in U.S. healthcare has steadily dropped over the years. Further, the politicization of the COVID-19 pandemic and the U.S. government’s bungled response to it has only sowed further distrust, especially among marginalized and minoritized communities.

Critical Care Nurse Shortage During COVID-19 Pandemic: A Call for Nurse Anesthesia Students to Bedside

Feb 8, 2021• 1

By TONYCHRIS NNAKA

In March of 2020, when we had limited knowledge on the infectivity and virulence of the virus that causes COVID-19, I joined a team of critical care nurses who were willing to risk their lives to care for those suffering from COVID-19. As a full-time PhD student in nursing, a new parent to my infant son, a primary caregiver to my 73-year-old mother, and as someone with a known history of severe asthma, I knew that I was embarking on a journey that could potentially cost me my professional and personal dreams and endanger those I care for the most in life: my family. My intentions to practice only part-time as a critical care nurse while pursuing full-time studies were halted after only two weeks of managing critically ill COVID-19 patients early in the pandemic. The countless code blues and unprecedented levels of patient deaths made it clear that we were in uncharted territory. After seeing the pain and fear on the faces of my nursing peers, I knew I could never leave them behind in this new battlefield. So, I stayed at bedside full-time for a year while also maintaining my full-time status as a PhD student. I had to. I could not turn my back on my practice oath, or my future professional goals as a nurse scientist. It is in this spirit that, on behalf of myself and my exhausted colleagues, I call on those with critical care experience who have stepped away from bedside to return, as they are able, and answer this same call to action.

The extent of the critical care nursing shortage we are currently experiencing is alarming to me and almost beyond my comprehension. This shortage has forced critical care nurses who have been at bedside since March of last year to remain at bedside even as several of us have reached the breaking point of psychological exhaustion. Our desperate outcry for backup from our fellow critical care nurse colleagues seems to have yielded no outcome. It is obvious that addressing this shortage would require a solution with immediate implementation as we do not have time for the training of more critical care nurses. Thus, an immediate call to all nurse anesthesia students to return to bedside should be a part of any strategy geared towards quickly addressing issues of this critical care nursing shortage.

At a time when the role of critical care registered nurses is most needed, several nurse anesthesia programs continue with their regular admission cycle protocol: pulling critical care nurses away from bedside. At my current hospital, we lost nearly a dozen critical care nurse colleagues to nurse anesthesia programs between March and May of 2020 at the peak of the pandemic. Since the nurse anesthesia program requirements stipulate a minimum of one year of critical care nursing experience, all program applicants possess highly specialized clinical skills needed for the care of critically ill COVID-19 patients. While there are unarguable reasons as to why some nurse anesthesia students have yet to answer this urgent call to duty, we as a profession, and as a society must do what we can to incentivize them to return to bedside to help relieve the suffering of patients and exhausted nurses who have fought tirelessly at the frontlines since the onset of the pandemic – many of whom have lost their lives as a result.

The Art of Asking: What’s Your Biggest Fear?

Feb 5, 2021

By HANS DUVEFELT

When a patient presents with a new symptom, we quickly and almost subconsciously create a hierarchy of diagnostic possibilities. I pride myself in my ability to effectively share my process of working through these types of clinical algorithms.

But sometimes I seem to get nonverbal clues of dissatisfaction or simply no reaction at all to my eloquent reasoning. And only then do I remember to ask the important questions, “do you have any thoughts on what’s causing this” and, most importantly, “what’s your biggest fear that this could be”.

It doesn’t matter how brilliant a diagnostician you are if a patient with less medical knowledge than you has a thought, fear or hunch that diseases and symptoms work in ways that don’t make sense to you.

An uncle may have had a burning sensation in his nose minutes before a stroke, so this symptom may seem like a much more obvious harbinger of disaster to your patient than it does to you. How would you know, if you didn’t ask, what the number one question is that your patient wants the answer to?

We are often so focused on our own thinking process, especially with our time pressures and the bureaucratic requirements of medical encounters these days, that we risk forgetting our patients may not think the way we do.

Local Doctors Get the “Centers of Excellence” Treatment: Embold Health’s CEO on Data-Driven Quality

Feb 4, 2021

By JESSICA DaMASSA, WTF HEALTH

Apparently, self-insured employers hot on better managing their healthcare spend are finding truth (and dollars) in Embold Health’s mantra that “quality is the best, most sustainable way to control costs.” This health tech startup is applying the old “Centers of Excellence” framework to the individual physician level; helping identify high-performing primary care docs and specialists in local markets for employers who not only want to offer their employees better quality care, but also improve the healthcare system in the communities in which they live and work.

Daniel Stein, Embold Health’s co-Founder & CEO, explains the company’s model, which is being perfected with one of the most demanding-yet-coveted “health activist” employers out there: Walmart. In this particular case, Walmart is actually incentivizing its employees to go to the providers ranked highest by Embold’s assessment, which looks at physician performance along three categories: 1) appropriateness of care; 2) outcomes; and 3) cost-effective compared to peers in-market. Backed by the robust national BlueCross BlueShield dataset, the information Embold Health is collecting, analyzing, and doling out to employers can definitely cause some health systems to take pause — and their docs to bristle. So, how does Embold Health diffuse potential blowback? Here’s where the competitive nature of local healthcare, particularly in the world of primary care, becomes clutch. Tune in to hear the details, including some very interesting stats, as well as Embold’s latest endeavors to help docs make better referrals to specialists.