Category: Uncategorized

Doctor Versus Doctor

Apr 27, 2012• 13

By Jim deMaine

I felt sad when I went to make rounds in the hospital.

One of my patients, a colleague, had been readmitted in poor condition for recurrence of a primary lung sarcoma.

I spent a few minutes examining Dennis and chatting. He then, with a quizzical look, said, “Jim, I’m going to have to sue you. I know I’m dying. My wife Alice and the kids are still pretty young.” He saw my look of surprise and added, “You know, I don’t have much life insurance or other very significant funds for them to live on. It’s nothing personal. I know you’ve given me good care, but my wife is upset and tends to blame you for the outcome. I guess the hospital and others will be named.”

There wasn’t much more for me to say at the time except, “Dennis I can find another attending for you if you’d like.” He replied, “No, I want to stay with you.”

Dennis was a well liked family doctor. About five years earlier a “coin lesion” was discovered on a chest X-Ray. This 2cm spot in the right upper lobe had a smooth rounded border and didn’t contain calcium. A CT scan showed no enlarged lymph nodes and no other spots elsewhere. A needle biopsy of the spot was not diagnostic. We knew the spot was new because an X-Ray five years earlier was normal. He hadn’t traveled to an area where Valley Fever or other fungal infections were common.

Connecting the Dots

Apr 27, 2012• 1

By Will Saunders

Data is only data until it is structured. Then it becomes powerful, relevant and insightful.

That was a key message from Ursula Burns, Xerox chairman and chief executive officer, on the first day of the World Health Care Congress in Washington, D.C. In opening the event with a fireside chat with Dr. Nancy Snyderman, chief medical editor for NBC News, Ursula talked about Xerox’s vision to improve health care including empowerment– ensuring that patients have a stake in their health, and realizing the true value of data. As Ursula said, “It’s not the data itself, but it’s recognizing actionable data.”

Here’s another way to think of it: Xerox provides the “smarts” around each aspect of health care such as:

·Easier access to data through solutions, such as advanced document recognition, intelligent data entry and fraud detection;

·Turning information into insights through real-time clinical decision, patient behavior modeling, population management, and Meaningful Use reporting; and

·Putting insights into action, for example, through a health information exchange – connecting electronic medical records (EMRs) to give caregivers information, analytics and decision support tools that help improve patient care.

World Health Care Congress 2012 Live: Markus Fromherz, Xerox

Apr 27, 2012

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This three-part interview from World Health Care Congress with Markus Fromherz, chief innovation officer of Xerox Healthcare, covers some of the most exciting healthcare research and development going on at Xerox’s Palo Alto Research Center. Part one includes Markus’ thoughts on moving paper data to digital and describes the process in three layers – gaining access, drawing insight and taking action from what was learned.

Rethinking Cancer Guidelines

Apr 27, 2012• 1

By James Salwitz, MD

Universal treatment standards will be the basis of future medical care. In oncology, a leading organization for the development of such guidelines is the National Comprehensive Cancer Network (NCCN). This national consortium of 21 National Cancer Institute designated cancer centers publishes state of the art recommendations. Modified continuously, these are internationally respected guidelines and cover more then 97% of cancers.

The 17th Annual NCCN Conference was held in Hollywood, Florida last month. Cancer guidelines were updated in several significant ways.

The general movement of the last 20 years has been to reduce the amount of surgery for breast cancer. The NCCN recommends that during breast saving surgery (lumpectomy) the surgeon test the first lymph node (“sentinel”). If there is no cancer in the first one or two nodes, then no more nodes need to be removed. The NCCN also stated, that if breast cancer patients have small cancers and normal blood tests, they do not need a bone scan, or CT scan.

In lung cancer patients, several procedures received new support. It is recommended that doctors use ultrasound-guided biopsy to sample lymph nodes in the middle of the chest (mediastinum) instead of surgery. The new guidelines also support the use of non-invasive surgery (Video Assisted Thorascopic Surgery, VATS) instead of open surgery to treat lung cancer. The use of VATS for lung cancer has increased more than 300% in recent years. The pathologic name for an increasingly common form of lung cancer was changed. Formally, called “bronchioalveolar”, it will now be called “adenocarcinoma in situ.” Finally, the NCCN emphasized the need for accurate genetic testing for “ALK”, before using the drug that targets this mutation, crizotinib.

Who Should Apply to NY’s Newest Health Accelerator?

Apr 26, 2012

By Austin Cohen

We recently had the pleasure to sit down with Executive Director of the New York eHealth Collaborative Dave Whitlinger and President and CEO of the New York City Investment Fund Maria Gotsch to discuss the exciting New York Digital Health Accelerator (NYDHA) program.

The accelerator, which launched this morning, is run by the NYeC in partnership with the NYCIF and the New York State Department of Health. The program will fund 12 early- and growth-stage digital health companies that are developing cutting edge technology products for healthcare providers.

Why the partnership?

The NYeC formed in 2006 to advance health care information technology (HIT) in New York state and to develop the Statewide Health Information Network of New York, or SHIN-NY, a technology platform that is connecting electronic health records across New York state. Maria notes that the Investment Fund was formed as a “private fund with a civic mission to create jobs in New York City.” The partnership is logical, as Dave indicates―the fund is committed to company and job growth and the Collaborative “needs the tools to best harness innovative talent and to create new workflows.” To Maria, the timing of the Accelerator is perfect: New York has “one of the most vibrant digital markets” and is increasingly becoming the epicenter for entrepreneurial success.

How Obama Botched and Bungled the Health Reform Message

Apr 26, 2012• 105

By Michael L. Millenson

While it’s comforting to just blame the GOP for the unhappiness with health reform threatening the president’s re-election, the truth is that Barack Obama repeatedly botched, bungled and bobbled the health reform message. There were three big mistakes:

The Passionless Play

While Candidate Obama proclaimed a passionate moral commitment to fix American health care, President Obama delved into legislative details.

When a Baptist minister at a nationally televised town hall asked in mid-2009 whether reform would cause his benefits to be taxed due to “government taking over health care,” Candidate Obama might have replied that 22,000 of the minister’s neighbors die each year because they lack any benefits at all. Instead, President Obama’s three-part reply recapped his plans for tax code fairness.

While Republicans railed about mythical “death panels,” and angry Tea Party demonstrators held signs showing Obama with a Hitler moustache, the president opted to leave emotion to his opponents. The former grassroots organizer who inspired a million people of all ages and ethnicities to flock to Washington for his inauguration never once tried to mobilize ordinary Americans to demand a basic right available in all other industrialized nations. In fact, he hasn’t even mobilized the nearly 50 million uninsured, who have no more favorable opinion about the new law than those with health insurance!

The Medical Loss Report: Fiddling while Rome Burns

Apr 26, 2012• 1

By Robert Laszweski

Today’s headline was “Millions Expected To Receive Insurance Rebates Totaling $1.3 Billion.”

The Kaiser Family Foundation estimates that 3.4 million people in the individual market will receive $426 million in consumer rebates because of the Affordable Care Act’s new MLR rules. In the small group market 4.9 million enrollees will see $377 million in rebates, and 7.5 million people will get $540 million in the large group market.

Wow!

But take a closer look at the report. Only 19% of those in the large group market will be getting a rebate and that rebate will average $72.31 per person. In the small group market 28% of those enrolled in these plans will get a rebate averaging $76.37. And, in the individual market 31% of consumers who have these plans will get a rebate averaging $126.81.

The Wall Street Journal, citing a Goldman analysis, is reporting that Aetna will be paying out $177 million in rebates. But Aetna has $11 billion in premium so that’s only a 1.6% rebate. UnitedHealth will be paying out $307 billion but that is only 1% of its $28.8 billion in premium. Wellpoint will pay out $94 million in rebates but that is only .28% of its premium for the year.

The average cost of employer-provided family health insurance is now about $13,000 per year. A family rebate of perhaps $200 will amount to only about 1.5% of premium for the relatively few people who will even get one.

World Health Care Congress 2012 Live: McKesson

Apr 25, 2012

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Matthew Holt sat down with McKesson at the World Health Care Congress 2012. Medical Director of McKesson Health Solutions Douglas Moeller, MD and McKesson VP of Enterprise Architecture and Technology Bob Franceschini explained what they’re doing to keep up with evolving payment methods.

Anatomy of a Walletectomy

Apr 25, 2012• 17

By Merrill Goozner

It all began when Dr. Renee Hsia of the University of California at San Francisco received a simple request from a good friend who had checked into a local hospital for an emergency appendectomy. The fairly routine procedure took place 19,368 times during 2009 in California.

After he returned home, he received a bill from the hospital for $19,000, his co-payment for the parts of the $54,000 operation that his insurance company didn’t cover. “He wanted to know if this was the usual and customary charge for a one-day stay in the hospital,” she recalled.

And thus began her research into pricing variability in the state, which was published this week in the Archives of Internal Medicine. The prices ranged from $1,529 to $182,955 with the median hospital charge of $33,611, the study showed.

The prices not only varied between hospitals, they varied within hospitals. The largest spread occurred at one hospital, which Hsia wouldn’t reveal, where the cheapest appendectomy went for $7,504 while the most expensive charged was $171,696. There were numerous hospitals where the spread was $100,000 or more.

“They had the same diagnosis, but different things could have been done,” she said. For instance, one patient could have had multiple imaging tests and robotic laparoscopy, while the other received no imaging and a regular laparoscopy. There’s no evidence to suggest one set of alternatives had better outcomes than the other.

Top 10 Reasons Why Warren Buffett’s Decision to Treat Prostate Cancer Bugs Me

Apr 25, 2012• 7

By Laura Newman

On April 17th, 81-year-old Warren Buffett told investors that he had very early prostate cancer. The Washington Post headline read: “Warren Buffett Has Prostate Cancer that is Not Remotely Life Threatening.’” Within hours, news accounts said that the story unfolded after discovering a high PSA in a routine appointment. Next, he had a prostate biopsy. A few hours later, news accounts said that Buffett decided to get radiation therapy for prostate cancer. What’s wrong with this picture?

10. He’s an icon who other men will follow, and there is limited (or no) evidence of benefit of aggressive treatment in men as old as Buffett. At 81, his life expectancy is 7.41 years, shy of the 10-year life expectancy mark doctors look for when they recommend aggressive treatment for prostate cancer.

9. Although Buffett can afford whatever care he so desires, it would cost a fortune if tons of men in his age group went for active treatment and there would be little yield and plenty of side effects.