Category: Uncategorized

Plug Into Meaningful Use, Don’t Try to Build It

Jun 14, 2010• 8

By JONATHAN BUSH

Earlier this month I read in The New York Times (okay, someone read it to me), that hospitals and docs are saying “meaningful use” is just too much, too fast. I have to say, I would sympathize . . . if I didn’t know about the Internet!

If someone told me that the federal government was going to make (or at least ‘encourage’) everyone commute via hot-air balloon by 2011, I’d start to feel edgy right about now. How do you make or buy one? Who sells them? What if the wind blows the wrong way?

This would be my panic—unless I knew about a little-known hot-air balloon service that DEALS with all of it. Like a taxi service. You tell it where you want to go and when and then boom! a balloon shows up piloted, prepped and ready.

Such a quandary exists in the EMR market today. Everyone thinks the government rules mean that meaningfully using electronic health information actually means meaningfully using information you BUILD YOURSELF! They think you have to buy EMRs and servers and program them to meet government rules and then re-program them to meet rule changes. This would give me hives, even if I were a giant health system. Even systems with big budgets don’t have a comparative advantage in programming software!Continue reading…

Pitfalls of PPACA – Accountable Care Organizations

Jun 14, 2010• 12

By ROGER COLLIER

In addition to Medicare Advantage payment cuts and potential reductions in fee-for-service payment updates, PPACA includes various provisions intended to facilitate ongoing Medicare cost containment, notably creation of the Independent Payment Advisory Board and the Center for Medicare and Medicaid Innovation. In addition to CMI’s broad scope, PPACA requires specific pilot projects, including (in Section 3022) demonstration of accountable care organizations (ACOs).

What does PPACA mean by an ACO? Dr. Elliott Fisher of Dartmouth Medical School, a primary originator of the concept, defined it as “a provider-led organization whose mission is to manage the full continuum of care and be accountable for the overall costs and quality of care for a defined population” and listed several provider groupings that could form ACOs. PPACA provides additional criteria, including having a formal legal structure and administrative systems, meeting CMS requirements for quality assurance and reporting, and serving at least 5000 Medicare beneficiaries. PPACA also specifies a deadline for the ACO pilot: “Not later than January 1, 2012, the Secretary shall establish…a program…”

The goal of an ACO is to reduce costs and improve quality of care through cooperation and coordination among providers, similar to that achieved by integrated delivery systems like Geisinger, HealthPartners, and Intermountain Health Care, but within what may be essentially a virtual organization superimposed on a loose network of providers and covering only a subset of patients.

Commentology: A mother’s plea for help

Jun 11, 2010• 28

Desperate and stuck in the middle

I am the mother of an 11-month-old baby girl, Cassidy, who has CCHS (Congenital Central Hypoventilation Syndrome), a very
rare genetic mutation. Our union health care company recently changed
"paperwork" companies,at which time we were told that we were getting special pediatric respiratory services that we were not entitled to
and it [coverage] would end!

We scrambled to make other arrangements since Cassidy is ventilator-dependent and suffers from frequent "blue
spells" that require oxygen to be administered asap. We were finally able to get the pediatric respiratory coverage
in a state-sponsored policy for a fee. We were starting to breathe a little easier about the situation until we called my
husband's employer. We were told that we could not remove Cassidy from the original health policy because it was a self-funded
insurance plan and federal regulations prohibit switching to a different plan.

Who Wants to Give Money to Their Toughest Competitor?

Jun 11, 2010• 4

By EDWARD PULLEN, MD

In Philanthropy It’s All About Relationships.

Last night I spent an interesting evening as the local physician asked to come along with our local hospital on a philanthropy pitch to a local specialty group to contribute to the finishing touches of a new hospital in town. Puyallup, WA has been an interesting community from a medical services standpoint. Currently we are a very desirable populace to any hospital organization. We are young, employed, insured, and growing as a community. We have a relatively high disposable income.

On top of that we have only one community hospital, Good Samaritan Hospital. The downside is that in part because of this lack of competition from another local hospital we have fallen far behind nearby larger communities in the physical plant we use as our hospital. My accounting daughter would probably say we have accrued a huge capital deficit in facilities. Good Sam was recently acquired by a larger hospital group, allowing the community to plan for, fund and build a new hospital. As physicians we are appropriately being asked to contribute to this project.

Everyone knows that the economy stinks right now. In addition physicians now are struggling with the issues of higher expectations of service, higher overhead, reduced payment for many ancillary services, and higher state taxes in Washington, and uncertainty in future Medicare rates. I thought these would be the primary issues we faced in discussing a contribution from this specialty group. These issues were brought up and we all went through the anticipated woe-is-me discussion on the economy and politics about medical reform and compensation. To my surprise the discussion quickly turned to relationships. This was where real passion came into the conversation.

In our community many specialties are represented by only one group of physicians. This is true of the group we met with tonight, as well as many other specialties. Though less than in some other communities some local medical groups have been acquired by hospitals. This has at times led to competition between the hospital and the private groups in town at the same time that a cooperative relationship and collaboration are needed. We spent most of the evening discussing the need for respect, trust and cooperation. In other businesses this might have been more overt. Discussions of exclusive relationships or contracts for services might have been worked out. In medicine this type of discussion is forbidden. The hospitals not-for-profit status and inurnment issues, the anti-trust rules on physician fees, rules against self-referral, and more issues I only partly understand made this type of overt negotiations clearly off the table. Still there remains a major concern among private physician groups that hospitals will bring unfair competition against them, be able to operate physician groups at a loss in order to secure referral sources for inpatient and procedural care, and as a result be able to out-compete the private groups on an unlevel playing field. It was interesting to see the intensity of these anxieties. In our community we all do really work for the same cause: good patient care and community health. In the final story the group we met with will do the right thing and step up to contribute to our community hospital in order to improve the facilities for our patients to utilize. Still the anxiety level of physicians remains intense about supporting their hospital who can also be their toughest competitor.

Edward Pullen, MD, is a board certified family physician practicing in Puyallup, WA. Dr. Pullen shares his viewpoints on medical news, policy and the practice of medicine from a primary care physician’s perspective at his blog, DrPullen.com.

American Well world domination plan on course

Jun 10, 2010• 16

By MATTHEW HOLT

They may have started with a Blues plan in a small state (Hawaii) and been moving deceptively slowly for a while, but having got Optum (part of United Healthgroup) on board last year, today American Well announced the landing of the other big Kahuna. Wellpoint will be rolling out American Well’s online care program in “certain markets” in Q4 this year.

If California isn’t one of those markets, expect some bitching and whining from at least one Wellpoint member in San Francisco! More seriously, as I’ve been saying for a while, Wellpoint’s online services for its members are a mess, and I’m looking forward to what the integration with online care looks like from the user end.

More from American Well to come, as I’ll be popping by their session at AHIP this morning (yes, it’s a slow recovery from last night in Vegas).

Full Disclosure: American Well is a corporate supporter of both THCB and Health 2.0.

Health 2.0 Came to Washington—And Now it Needs to Stay

Jun 10, 2010• 1

By LYGEIA RICCIARDI

This week’s Health 2.0 conference was held for the first time in Washington, DC, plunging Health 2.0’s community of IT geeks into the heart of the land of policy wonks. The feds’ Chief Technology Officer, Aneesh Chopra, joked about the gap between the two cultures: where the Health 2.0 crowd says “there’s an app for that,” the government says “there’s a form for that.”

Chopra and officials from the Department of Health and Human Services outlined their goals and plans related to health IT and extended an invitation for the two communities to work together more closely. The feds described a transformation of the economy and an improvement in the lives of Americans, and gave examples of initiatives that open access to health data and/or provide incentives for innovative uses of it, including:

The Blue Button Initiative – A CMidentifying S and VA initiative that lets consumers download data for use in a personal health record (PHR)
Pillbox An NLM and FDA program releasing data that helps in pills
VAi2 — An $80 million VA innovation competition focused on areas including telehealth and adverse drug events
Community Health Data Initiative — An HHS and IOM initiative that releases data sets about communities (and which provides the data for the Health 2.0 Developer Challenge).
Apps for Healthy Kids A White House competition to create software tools and games toimporve kids’ health

As the Department of Health’s Farzad Mostashari said to the crowd, “We’re watching. We want to learn. Show us what is possible.”

But not everyone was impressed. Jamie Heywood of the online health community PatientsLikeMe bristled at the idea that technology entrepreneurs should step up and fix problems that rightly belong to government, such as collecting and analyzing better population health data. “Don’t look to us to save you,” he said, arguing that the feds need to build better markets for innovation. He has said, for example, that government could offer to buy data generated by the private sector that furthers public health goals.

Tufts Summer Institute on Web Strategies for Health Communication, July 18-23, 2010

Jun 10, 2010• 3

Many healthcare organizations who are trying to reach healthcare consumers share these problems: “our website hasn’t been updated in three years”; “we set up a Facebook page but don’t know what to do with it”; and “what exactly is Twitter and how do we use it?” With 61% of American adults looking online for health information [Pew, 2009], healthcare organizations need a Web strategy and healthcare professionals need to understand the latest technologies to plan and execute health communication initiatives. There can be a risk in not embracing the Web if other health organizations are and if healthcare consumers expect it.

Yet it is difficult to decide which of the rapidly evolving Web technologies to select and how to use them to provide effective health communication, especially as part of a coherent Web strategy. This course covers how to develop and implement a Web strategy to drive a health organization’s online presence, specifically the processes for selecting, using, managing, and evaluating the effectiveness of Web technologies for health communication. The course will use case studies from organizations to illustrate initiatives with a discussion of what worked and the recommended improvements and will work in small teams on a Web strategy redesign for Harvard Health Publications.

The Axis of Evil

Jun 9, 2010• 15

By ROB LAMBERTS, MD
My recent post about Medicare allowing patients to use drug vouchers was met by a rousing reception.

By crickets.

It seems that some saw me as one who (gasp) trusted the pharmaceutical companies to do something good. Has Dr. Rob lost (what’s left of) his mind?? Drug companies do everythingwith themselves in mind, and there are alwaysstrings attached. They can’t be trusted. They are evil. Doesn’t Dr. Rob realize that?

I have heard the same thing about insurance companies. I had a patient a few days ago use the word evil when describing the insurance industry. I myself have called them rabid wolves, have decried the outlandish CEO salaries, and have declared that they do a whole lot of things that hurt patients and make my life difficult.Continue reading…

CORRECTION, APOLOGY & CLARIFICATION about “You Want To Have It Both Ways”

Jun 8, 2010• 17

At THCB we regularly repost content from other blogs and we delight in giving those authors access to a different audience as well as giving our audience access to other viewpoints that I and the team here frequently don’t agree with. However, sometimes we make mistakes and this post represents one of those times. This post originally was published on the Sermo blog as an example of a community post–one that non-MDs cannot access–which stirred a lot of controversy on Sermo. This post attracted more than 200 comments on Sermo, and they highlighted it on the Sermo blog from which we syndicated it.

But unlike how we originally bylined and presented it on THCB, this post was not written by Daniel Palestrant MD, CEO of Sermo, and does not represent Sermo’s corporate opinion, and I can assure you definitely does not represent Daniel’s personal opinion.

The first 19 comments on THCB come from people who we misled by our error into thinking this was Daniel’s post. We’d like to apologize to Daniel, Sermo, drspuds and our readers.

But as this post (like it or not) does represent the view of at least one physician and maybe rather more, we’re going to keep it up on THCB-–Matthew Holt

* * *

Dear Mr. and Mrs. America, by Sermo member “drspuds”

You live in one of the greatest countries on earth, one of the
richest ones, yet arguably not one of the best for medicine.
You may question why that is. I think I may have some
answers. Essentially, you want to have your cake and eat it too.

When you are sick or injured, you want the best healthcare money
can buy. But you want someone else to pay for it. You
feel should not be made to pay for things that are not your fault,
as you perceive it.

When you do not feel you have gotten the best healthcare someone
else’s money can buy, you scream, yell, threaten and generally act
like a child. Then you demand to be respected as an adult.
You take the same approach to “free” care, such as telephone calls,
disability paperwork and public aid.

When your treatment does not go as you planned, you want to keep the legal option to sue a doctor for “everything he’s got”, but want to keep “good” doctors in your community so you don’t have to drive 6 hours to get your brain tumor operated on.

You want to be able to drink and smoke as much as you want, and then when years of beating the crap out of yourself makes its presence known, you want us to rescue you. We told you 40 years ago not to smoke. Now you want us to save your life from the CAD, emphysema and lung cancer you caused.

You want to drive a car at 90 mph while drunk, “because I’m having fun” but want us to put all the pieces back together when the inevitable happens.

You want a single-dose pill to take care of anything that ails you, aka the “magic pill.” But you complain about the realistic medications you will need to take every day for the rest of your life. 20 years ago, these pills did not exist and you would have had only a few years left to live. Now we can keep you around for many more years for you to keep complaining about the pills you have to take.