Category: Uncategorized

Clinical Groupware: Platforms, Not Software

Apr 24, 2010• 32

By David C. Kibbe, MD, MBA and Brian Klepper, PhD

Clinical Groupware is rapidly gaining acceptance as a term describing a new class of affordable, ergonomic, and Web-based care management tools. Since David first articulated Clinical Groupware's conceptual framework on this blog early last year — see here and here — we've been discussing Clinical Groupware with a growing number of people and organizations who want to know what it is, where it's going, and what problems it may solve, particularly for small and medium size medical practices, their patients and their institutional/corporate sponsors and networks.

Clinical Groupware heralds a shift away from medical applications that are primarily based in local hardware and software. It creates a more fluid functionality in those applications, and empowers communications as well, by leveraging Internet connectivity, Web-based data resources, and new services (i.e., capabilities) performed upon these data by agents or applications.

In other words, Clinical Groupware is about platforms that can integrate modular applications, which in turn are supported by subsystems of data services. Although it is still in its infancy, Clinical Groupware is an end-to-end digital revolution in health IT.

(More) Madness in Massachusetts

Apr 22, 2010• 57

By DANIEL PALESTRANT, MD

Lately I have been watching with complete horror the events playing out in my home state of Massachusetts. A bill currently under review by the state legislature will make participation in the state and federal Medicare/Medicaid programs a condition of medical licensure, effectively making physicians employees of the state.

This is particularly alarming because Massachusetts is essentially a leading indicator of what will happen in the rest of the country. Several years ago the state passed a series of laws mandating health coverage. Like the recently passed national health reform bill, the Massachusetts law did not address any of the well known causes of runaway costs, including tort reform, drug costs, or insurance regulation.

Although the state now has one of the highest percentages of its population insured, it is grappling with exploding healthcare costs. In response, it is imposing capitation schedules, reductions in payment rates and now mandatory participation in the health programs by physicians. What most people don’t understand is that the private insurers are also free to lower their physician payments, based on the Medicare/Medicaid benchmarks. This is all the more concerning given the fact that the Federal reimbursement rate is now scheduled to be reduced 21% on April 15.

We will no doubt see the same sequence of events play out across the country as the current versions of healthcare reform are implemented. The net effect of these laws is that it will make it close to impossible for physicians to stay in private practice. Patient access to physicians will suffer as more and more physicians retire and/or move to different states. For our academic colleagues who think this turn of events can only “help” them because they won’t have to compete with physicians in private practice, just wait. 28 states are now imposing “comparability” laws that allow nurse practitioners and other allied healthcare professionals to work without the supervision of a physicians with equal pay. Few academic departments can avoid hiring “physician extenders” if they want to stay competitive. As this gains momentum, physician payments will be pushed downwards. As the “going rate” goes lower, academic salaries will also get pushed downwards. I knew this reform effort would be bad for the practice of medicine and even worse for patient care. I just had no idea things would deteriorate this fast.

Daniel Palestrant, MD, is the CEO of Sermo.

Nurseanomics

Apr 22, 2010• 62

By MAGGIE MAHAR

Twenty-eight states are now engaged in a heated debate over the difference between a doctor and a nurse: Legislators in these states are considering whether they should let a nurse practitioner (NP) with an advanced degree provide primary care, without having an M.D. looking over her shoulder. To say that the proposal has upset some physicians would be an understatement. Consider this comment on “Fierce HealthCare”:

“An NP has mostly on the job training…they NEVER went to a formal hard-to-get into school like medical school,” wrote one doctor.

“I have worked with NPs before, and their basic knowledge of medical science is extremely weak. They only have experiential knowledge and very little of the underpinning principles. It would be like allowing flight attendants to land an airplane because pilots are too expensive. HEY NURSIE, IF YOU WANT TO WORK LIKE A DOCTOR…THEN GET YOUR BUTT INTO MEDICAL SCHOOL AND THEN DO RESIDENCY FOR ANOTHER 3-4 YEARS. NO ONE IS PREVENTING YOU IF YOU COULD HACK IT!” [his emphasis]

Fortunately, not all physicians exhibit the same degree of rancor. Some support the movement. Another reader notes the commenter’s emphasis on just how brutal med school can be: “The anger reflected in the previous comments reveals not only the writers’ ignorance of scholastic achievement required of Nurse Practitioners, but mainly their fear that NPs will not be under physicians’ control…Many older doctors’ schooling and experience was conducted in punitive ways, sacrificing self esteem. It seems that anything less, isn’t sufficient.”

We’re No. 37? Or Maybe Not …

Apr 22, 2010• 7

By MERRILL GOOZNER

Phil Musgrove, now at Health Affairs, was an editor at the World Health Organization when it compiled its international comparison of nations’ health status that ranked the U.S. 37th in the world, largely because of its poor performance on infant mortality and longevity. In a letter to the editor in today’s New England Journal of Medicine, he points out that the U.S. had no statistics for nearly half the measurements used in the rankings and that most of the national rankings were inputed from data from 30 of 191 countries in the survey who fully reported their health outcomes.

He concludes:

The number 37 is meaningless . . . Analyzing the failings of health systems can be valuable; making up rankings among them is not. It is long past time for this zombie number to disappear from circulation.

Fair enough. But the U.S. ranking in infant mortality and its lagging longevity are cause for alarm because they show that the U.S. lags in health status. There’s many factors well beyond the quality of the health care system that contribute to these lagging indicators: persistent poverty in certain parts of the country and among certain subpopulations; chronic un- and underemployment; high levels of income and status inequality; and high levels of social stress and insecurity, for instance.

Someone should update the rankings and stress that they measure health status, not the quality of health care systems. If not WHO, who?

Medicare To Cover Preventative Care

Apr 22, 2010• 6

By ED PULLEN, MD

A nice surprise buried somewhere in the Health Care Reform Bill is that starting next year Medicare patients will be able to get annual preventative care exams that are paid for by their health insurance. It may come as a surprise to those of you with commercial insurance who think of coverage of an annual exam as a routine thing for insurance to cover, but up to now Medicare has only covered a “Welcome to Medicare” exam in the first year after turning 65. From then on no physical exams at all are covered, and many preventative services like colonoscopy and mammography were either not covered, or subject to fairly high copays and deductible costs. As a physician this has always seemed like this is backwards. I can make a pretty good argument that a physical exam for a 27 year old man is not needed annually, but it is essentially always a covered benefit in any plan the young insured patient has through an employer. Older adults are far more at risk for cancer, heart disease, diabetes, hypertension, depression, and safety at home issues than young adults. I am pleased that better preventative services coverage for our older and more vulnerable adults will be a paid service starting in 2011. This is discussed nicely in a recent NY Times article by Leslie Alderman in his Patient Money column.

Starting Sept 23, 2010, 6 months after the signing of the bill, all new insurance plans, or current plans which make certain changes will be required to cover preventative services recommended by the United States Preventative Services Task Force as category A or B ratings (A = conclusive evidence and B = very strong evidence showing benefit of receiving the services) and beginning Jan. 1, 2011 Medicare will also cover these services with no copay or deductible applicable.

This is good news for our seniors and should make it much easier for their physicians to convince our seniors, some of whom now have to choose between shelter, food or medicine on their poverty level fixed incomes, to receive preventative care.

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

Reputation versus quality: U.S. News Hospital Ranking

Apr 21, 2010• 9

By PAUL LEVY

Each year, US News and World Report publishes its list of the top 50 hospitals in various specialties (example here). Now, an article has been published suggesting that one aspect of the methodology used by the magazine is flawed.

“The Role of Reputation in U.S. News & World Report’s Rankings of the Top 50 American Hospitals,” by Ashwini R. Sehgal, MD is in the current edition of theAnnals of Internal Medicine. (You can find an abstract here, and you can obtain a single copy for review from Dr. Sehgal by sending an email to axs81 [at] cwru [dot] edu.)

Dr. Sehgal finds that the portion of the U.S. News ranking based on reputation is problematic because reputation does not correlate with established indicators of quality:

The relative standings of the top 50 hospitals largely reflect the subjective reputations of those hospitals. Moreover, little relationship exists between subjective reputation and objective measures of hospital quality among the top 50 hospitals.Continue reading…

Another physician tool: mPay Gateway interview

Apr 21, 2010• 3

By Matthew Holt

While I clear out interviews that I have had in the can that were interrupted by first health reform and then Health 2.0 Europe, here's an interesting one on a very niche application mPay Gateway that helps physicians get paid by allowing them to collect co-pays and co-insurance from consumers.

The interview is with CEO Brian Beutner. Note that since this interview was taken a little over a month ago, mPay Gateway has been getting quite some plaudits from one of their major partners, Allscripts.

Catching up with Anvita Health

Apr 21, 2010• 1

By Matthew Holt

Another one of my HIMSS interviews that's taken a while to make it onto THCB. But that shouldn't fool you–Anvita Health is one of the more interesting companies out there, doing complex analytics to personalize and identify individuals who need various types of help and intervention (think medication safety, gaps in care). It essentially connects reference clinical information with huge databases with individual patient data.

Here’s CEO Rich Noffsinger to tell you more and catch you up. (But he’s still very quiet about identifying who their big clients are!)

Health 2.0 in the Doctor’s Office

Apr 20, 2010• 7

By Matthew Holt

The Health 2.0 meetings are coming thick and fast at the moment. No sooner have we finished Health 2.0 Europe in Paris (a very successful first venture abroad—and fortuitously held before the Icelandic eruptions suspended air travel in the EU), than it’s time for another new territory. And this territory is the world of physicians. We’re going to be in Ponte Vedra Beach near Jacksonville, FL for the Health 2.0 in the Doctor’s Office conference.

The audience will be a little unusual for a Health 2.0 Conference, as this is specifically about the emerging Health 2.0 tools aimed at improving the practices of physicians. That includes both EMRs, practice management tools, and many other lightweight applications for various physician and patient-provider communication and analysis.

Here’s the agenda in Florida, and there’s still room for both physicians and others interested in the physician practice to come join us.

What kind of tools will be there? Well to give you some idea, Allviant (a subsidiary of Medicity) will be demoing their CarePass solution which helps manage patient flow in physicians’ offices, and helps increase the number of patients who come to their appointments while reducing work for the clinic staff—and it makes patients happier too!

Carepass is just the first of Allviant’s big ideas. Here’s a video interiew I did with Lilian Myers (CEO) and Tom McHale (VP, Business Development) at HIMSS a few weeks back to tell you more. You can meet Tom in Florida.

Myths and Facts About Health Reform Part II

Apr 16, 2010• 77

By MAGGIE MAHAR

Lobbyists representing the many who profit from our $2.6 trillion health care industry spent millions in the war over healthcare reform. Yet National Journal Contributing Editor Eliza Newlin Carney suggests that “it’s unclear whether all that lobbying, advertising and check-writing yielded much.”

No question, the reform legislation that finally passed falls short of many reformers’ hopes. The public option is gone. Private sector insurers will scoop up all of the new business. Meanwhile, by agreeing to support reform—and make some financial concessions—Pharma bought protection from generic competition, plus a promise that it can continue to set prices, without worrying about Medicare trying to bargain for discounts.

Nevertheless, as I argued in part one of this post, Carney has a point. Lobbyists lost on many issues. Under the legislation, insurers who offer Medicare Advantage are going to lose their windfall payments. Some relied on that corporate welfare to stay in the black. In addition, insurers who cover large groups will have to pay out 85% of premiums to physicians, hospitals and patients, keeping only 15%. This rule kicks in next year, and makes raising premiums far less attractive. If an insurer lifts premiums by 10%, it will have to increase pay-outs by 8 ½%. Meanwhile a 10% hike means that it the company likely to lose market share, particularly in the more transparent new exchanges that open up in 2014.

Insurers will gain millions of new customers, but the majority will be expensive. Some patients suffering from pre-existing condition will need extensive care, and many others will come from low-income families who, as a rule, are not as healthy as more affluent Americans. Moreover, between now and 2014, it’s likely that Congress will bring back the public option.