Category: Uncategorized

The Madison Avenue Approach to Health Policy

Oct 7, 2010• 23

By JOHN GOODMAN, PhD

Can you sell health reform the way you sell toothpaste? Can you stop health reform the way you sell soap? A lot of people apparently believe so.

I would guess that in the 10 months leading up to the vote on the Affordable Care Act (ACA), proponents and opponents spent more than $200 million on TV, radio and newsprint advertisements.

These ads were produced by agencies that basically knew nothing about health care. The clients of these agencies were groups that often knew nothing about health care. The funding often came from donors who knew nothing about health care.

By “knew nothing” I mean they did not understand health care as a complex system. That means they had no idea how you could solve real problems — like controlling costs, raising quality and improving access to care. To add insult to injury, most of the people who engaged in the ad wars knew very little about what became known as “ObamaCare.”

But this lack of knowledge didn’t slow anyone down. The abiding sine qua non for ad wars is the conviction that facts, knowledge and truth are irrelevant. It is the belief that people can be manipulated and conned into believing that what’s good for them is bad and vice versa.

Customer Service

Oct 7, 2010• 10

By ROB LAMBERTS, MD

Gosh, a whole lot of huffing over a little word!

Customer.

OK, now grab a paper bag and breathe slowly and steadily into it. I know it’s hard to hear that word. I am sorry to have caused such trouble.

Some folks misunderstood my last post, thinking that I thought patients should only be considered customers, or that they should be referred to as customers. I never said that, nor did I imply it. I simply said that patients are customers. They are. Medical care is not free, and it is being paid for by the patient (directly or indirectly). Medicine is a business that has been so mismanaged that we are now in a crisis over its financial side. The trouble is the cost of care. Cost implies money is used, and trading money for services or goods is what business is about.

We’ve been spending our dollars on healthcare like a person irresponsibly running up a credit card bill they can’t pay back. The pain doesn’t happen now, it happens down the road when the collectors knock. We can’t order whatever tests we want or prescribe gazillion dollar drugs without remembering somebody will have to pay the bill. Ignoring the business of medicine has gotten us into deep doo-doo.

Update on Modular EHR Technology: Harvard’s SMArt Research

Oct 6, 2010• 6

By DAVID C. KIBBE, MD and BRIAN KLEPPER, PhD

ONC awarded four Strategic Health IT Advanced Research Project (SHARP) grants earlier this year to

”…address well-documented problems that have impeded adoption of health IT and to accelerate progress towards achieving nationwide meaningful use of health IT in support of a high-performing, learning health care system.”

One of these grants was awarded to a Harvard group led by Drs. Ken Mandl and Isaac Kohane, based in Children’s Hospital Boston and Harvard Medical School. This research team is tackling the problems associated with developing an ecosystem of modular, plug-and-play medical applications, what we have referred to as Clinical Groupware. (Disclosure: DCK is on the Harvard SHARP grant’s advisory board.)

The research is aimed at creating a “medical apps store” based on the iPhone/iPad model of substitutable applications running on a device or platform. The name of the project, SMArt, stands for “Substitutable Medical Applications, re-useable technology.” The approach could impact both the EHR industry and the federal regulatory and standards process, possibly within a relatively short period, i.e., 1-3 years, so we think it merits your attention.

Patients 2.0, HealthCamp and Health 2.0

Oct 6, 2010• 1

By Matthew Holt

Health Innovation Week is charging ahead. Eight events have already happened, but today begins the really heavy part for the Health 2.0 team*

We start at Healthcamp. Todd Park from HHS and Jack Cochran from Permanente kick this off. Danielle Cass, Mark Scrimshire, Mike Kirkwood & Maren Connary will host 200 of their closest friends in a great unconference setting at the Kaiser Garfield Center. That one’s sold out.

Next we race back to DC to VC, a meeting where (as you might suspect) the government types are talking to the VC types. That one is oversubscribed too.

We are then super excited about Patients 2.0 which will be a new type of meeting—driven by patients for patients, or by citizens for citizens. There are a few spots for that still open (about 175 patients signed up so far) and we want to encourage patients of all types to come join us for an amazing facilitated discussion in which everyone will contribute. That’s 3pm-6pm at the SF Hilton. See Gilles Frydman’s post on e-patients.net to get you fired up

Finally we’re at around 1,000 registered attendees for Health 2.0 which kicks off with a sponsors and speakers party on Wednesday night, and then the full two days of complete amazingness. Seriously—what you are going to see will knock your socks off. We can accommodate just a very few more, so we’re not going to post the “sold out” notice but the walk-in price will increase today. So if you’re on the fence, sign up by noon.

* The Health 2.0 team is my partners & co-Founder Indu Subaiya, Executive Producer Lizzie Dunklee, Marketing & Sales Whiz Hillary McCowen, Customer Service Star Bianca Grogan, Graphics Genius Lauren Golik and amazing interns from Norway Line Lie and Ida Seljeseth, Oh, and me too. They have all worked incredible hard and I am so grateful to them all

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Oct 6, 2010

What is a Patient?

Oct 5, 2010• 36

By ROB LAMBERTS, MD

What is a patient? What do they do? What’s their role in the doctor’s office? Are they chassis on a conveyor belt? Are they puzzles for doctors to solve? Are they diseases? Are they demographics? Are they a repository for applied science?

Or are they consumers? Are they paying customers? Are they the ones in charge? Are they employing physicians for their own needs?

It depends. It depends on the situation. It depends on perspective.

Some physicians are very offended when the “consumer” and “customer” labels are applied to patients. They see this as the industrialization of healthcare. We are no longer professionals, we are made into “providers” – a sort of smart vending-machine made out of flesh.

Reckless REC Wrecking

Oct 5, 2010• 16

By MARGALIT GUR-ARIE

The Health Information Technology Extension Program, created and funded by ONC, has completed funding for all 62 Regional Extension Centers (REC), with a grand total of well over half a billion dollars and, predictably, criticism of the program was immediately forthcoming. The RECs are supposedly an impediment to free EHR markets and doomed to failure from the start, which may seem a bit contradictory if you think about it. Anyway, before making further statements and assertions regarding the “recklessness” of the RECs, or the impeding “train wreck” they represent, it may be beneficiary to take a closer look at the program.

Overview

The HIT Extension Program consists of 62 RECs, at least one for each State and territory, and one national Research Center (RC). The stated goal of the program is “to provide outreach and support services to at least 100,000 priority primary care providers within two years”. The individual RECs are supposed to conduct outreach and education campaigns in their respective States and inform physicians on the latest HIT developments and available programs and incentives. The RECs are also chartered to offer support and guidance to physicians selecting and implementing EHRs, particularly Primary Care docs in small practices and in underserved areas. These are the doctors that were left out by the regular market process because they were hard to reach, too expensive to implement and too poor to bother with. While the individual RECs are locally oriented, with feet on the ground in each State and each County, the RC is basically a National forum for RECs to share information and exchange lessons learned.

Funding

Other than a small amount of seed money, RECs are not handed out all those hundreds of millions of dollars of grant funds. RECs are paid for performance. For each physician they touch and manage to recruit, the RECs are paid about $1500. If and when the provider implements an EHR, the RECs receive another equal payment. The last third of the money is handed to the REC if, and only if, the provider achieves Meaningful Use. This arrangement is only in effect for two years. All those who believe that RECs are bound to fail should be reassured by the fact that in that dire case most of the allocated funds will remain with ONC. The RECs are expected to use the ONC seed money and find a way to become sustainable businesses after ONC ceases to support them financially.

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Oct 5, 2010

Seeds of Destruction

Oct 4, 2010• 11

By JONATHAN BUSH

I never used to talk much with hospital CEOs. After all, if you’re running a hospital, improving the revenues of the physician practice by 6%, when the physician revenues only make up 10% of your overall revenues, doesn’t really make it to the scheduling screen.

Now it seems that hospital CEOs are the only new people I meet. In fact, I recently had dinner with over 100 of them at a meeting of the Leadership Institute in Washington, D.C. I gave the breakfast speech the next morning…it was awkward.

You see, I’m dying to be liked by these people—all people really—but these are health system/hospital CEOs and CMOs, many of whom are currently thinking about adding hundreds or even thousands of doctors to their payrolls. For a guy who does business services for doctors, who better to be friends with?! And yet, the only thing I could think to say to them was that they were sowing the seeds of their own destruction! I try to be smooth and cool when I get up in front of these groups, but somehow, when the microphone turns on, I can’t keep what’s on my mind from pouring out of my mouth!

I’m not exactly sure how I said it then, but let me try to say it like a grown-up now.Continue reading…

A more palatable path to rationing

Oct 4, 2010• 3

By DAVID WILLIAMS

Rationing is a very dirty word in America, evoking grim images of wartime Great Britain and –in the health care context– withholding of needed care from patients based on cost. But cut back on costs we must, and with magical thinking about the deficit becoming every more popular, we’ll have to find other ways to convince folks to do it.

Patient safety is a promising guise under which to achieve cutbacks, especially in costly areas where the dangers are real. The new radiation protection bill signed into law in California yesterday is a great example. From AuntMinnie (Calif. governor signs medical radiation bill into law):

The bill requires that radiation dose be recorded on the scanned image and in a patient’s health records, and that radiation overdoses be reported to patients, treating physicians, and the state Department of Public Health (DPH).

The law is clearly focused on overdoses, but once patients realize how much radiation they’re being exposed to –especially by repeated CT scans– many will start cutting back on what they request or accept. Over time, perhaps this attitude will spread to other areas of medicine such as surgical procedures and prescription drugs, where the risks are not always recognized today.

The federal government has done a great job whipping people into a sustained frenzy about airport security. All the time I hear people say they’ll put up with whatever hassles it takes at the airport in the name of security, and it almost seems the greater the hassle, the more satisfied people are to be subjected to it. I don’t admire this approach in airport security, but if the same zeal were devoted to patient safety (with the idea of reducing health care costs) I think it could succeed.

David E. Williams is co-founder of MedPharma Partners LLC, strategy consultant in technology enabled health care services, pharma, biotech, and medical devices. Formerly with BCG and LEK. He blogs regularly at Health Business Blog, where this post first appeared.