Category: Uncategorized

Simple Steps to Meaningful Health Reform

Feb 3, 2010• 5

By KIM BELLARD

Now that health reform at the federal level seems to have hit an impasse, Congress and the Administration are scrambling to see if anything can be salvaged this year. Although both the House and Senate bills are severely flawed, each falling short both on true health reform and on fiscal responsibility, it would be a shame if we walked away from these efforts with nothing to show for it.

Doing something about those “evil” insurance companies remains a primary target, with brave talk still coming out about removing the ability of health insurers to consider pre-existing conditions in accepting new applicants.

This singular focus ignores two important facts – first, that this problem is primarily in the individual market, since such use of medical underwriting/preexisting conditions exclusions is largely absent from the predominant group health insurance market, and second, that such restrictions will inevitably lead to higher costs. The latter statement is not fear-mongering; it is Economics 101.Continue reading…

10 Insights on the iPad

Feb 3, 2010• 18

By DOUGLAS GOLDSTEIN

The iPad got it right and will set the standard for a new and improved way to enjoy our connected lifestyle. The iPhone blazed the way as it shifted mobile phones from something to talk on…to powerful multi-app platforms that solve many problems and just happen to make phone calls, too.

The iPad and soon many similar devices will revolutionize the way we experience life and work from newspapers, t.v. and movies to fitness, personalized health and medical services. Here are 10 insights for delivering person- centered fitness, health and health care inspired by the iPad, iPhone and iPod Touch from Apple, the world’s leading MD (Mobile Device) company.Continue reading…

Collecting Patient Info in Haiti Using the iPhone

Feb 2, 2010• 3

Dr. Elizabeth Cote, from Harvard Humane Initiative collects patient data at Fond Parisien, Haiti using iPhone and iCharts from www.CareTools.com. The developers were kind enough to customize the form in less than a week to support fields and info required to comply with international disaster data collection standards. HT / Dr. Enoch Choi

Job Post: THCB Editorial

Feb 2, 2010

THCB is looking for talented interns to assist with editorial, research and web production tasks as our web site undergoes a major expansion. Perfect for a grad or med student with an interest in journalism, public policy, and/or the business of health care. Work out of a great home office location in the Princeton area, convenient to both Princeton University and UMDNJ. Reasonable train ride from midtown Manhattan. Production and research opportunities may also be available in our San Francisco offices for qualified candidates.

Editorial candidates should have an in depth familiarity with at least one area of the healthcare or tech industries and strong writing and editing skills. Web production candidates should know their way around content management systems like Typepad (our current platform) and
WordPress, our CMS in the not-too-distant-future. Basic photoshop /fireworks / gimp or comparable image editing software required.

Send us an email telling us a little bit about yourself and detailing the reasons you’re interested in the position. If you’re a candidate for the editorial role send us a few clips to give us a feel for your writing style.

Responses to THCB Editor in chief John Irvine jo**@***************og.com. No calls please!

Check Lists and Decision Trees versus Spontaneity and Imagination

Feb 1, 2010• 5

By KENT BOTTLES

The task of health care reform in 21^st century America is to decrease per-capita cost of care and to increase the quality of care delivered to patients. It’s complicated. A famous Rand study concluded that Americans only receive 55% of the care that science dictates. Patients intuitively believe that more health care is always beneficial. Medicare reformers would like to do comparative effectiveness research so that CMS and private insurers could wind up paying only for therapy that actually works. Some estimate that 30% of all care delivered in the United States is waste. What some call waste, others label revenue, and Atul Gawande becomes famous for identifying waste/revenue in McAllen, Texas (http://bit.ly/ENlli).

Neuroscience tells us that the smartest human can only keep track of seven variables at one time, and physicians tell us that diagnosis and treatment of a complicated patient can involve as many as 100 such variables. Computers are good at cataloging, organizing, and retrieving information, but physicians are not yet routinely utilizing them at the point of care. Computers are also good at allowing us to analyze large data sets and learn from experience. Patients yearn for the warmth and caring of a doctor who really knows and cares about them. Behavioral economics pioneered by Amos Tversky and Daniel Kahneman taught us that human brains are designed with inherent biases that make us less than rational decision-makers. We now know that human physicians and patients suffer from biases such as Pygmalion complex, confirmation bias, focusing illusion, incorrectly weighing initial numbers, and being more impressed with single cases than conclusions based on large data sets (http://bit.ly/49q4Uy).Continue reading…

THCB TV

Feb 1, 2010

Regional Variation Revisited: Price Differences Not A Significant Factor

Jan 29, 2010• 20

By MERRILL GOOZNER

Dartmouth scholars have revisited their analysis of regional variation in health care spending and found contrary to the assertions of some critics that cost-of-living differentials do not account for much of the difference. However, they confirmed that some big cities with high poverty concentrations that also serve as training grounds for future physicians may have been unfairly lumped in with areas that overuse health care services.

The new study in Health Affairs showed after adjusting for price differences that Miami, Florida and McAllen, Texas still led the pack in terms of how much Medicare spent on each beneficiary. Both areas still spent nearly three times more than the lowest spending regions of the country, which remained Honolulu, Hawaii and LaCrosse, Wisconsin.

There were a few areas of the country where the adjustments made a big difference, and they were mostly big cities. The Bronx and Manhattan in New York City fell 39 and 33 percent, respectively, from the adjustments. But price was only a minor factor, according to the researchers, who were led by Daniel Gottlieb of the Dartmouth Institute for Health Policy and Clinical Practice.

Much of the reason why the New York metropolitan area is so costly is not because of the wage index per se (what we usually think of as “cost-of-living” adjustments), but because the CMS pays hospitals in the New York area so much to reimburse them for graduate medical education and caring for disproportionate shares of low-income patients.

Other high-spending areas frequently targeted by critics did not do so well under the adjustments. Los Angeles, for instance, dropped just 14 percent after adjusting for cost-of-living, graduate education and disproportionate share payments for low-income residents.

The Medicare Payment Advisory Commission issued a report late last year that suggested regional variation in use patterns were less than the Dartmouth Atlas of Health scholars had previously estimated. This latest study says regional variation still matter — a lot. The debate clearly isn’t over.

Here’s the list of the ten highest and ten lowest spending areas in the country both before and after adjustments for price, graduate medical education and disproportionate share payments:

10 high-spending hospital regions:

BEFORE AFTER % CHG.

FL-Miami               $15,909     $14,966      6%
TX-McAllen              13,633       13,881      -2
NY-Bronx                12,004         8,653    39
NY-Manhattan          11,744         8,861    33
TX-Harlingen            11,489       11,324      1
CA-Los Angeles        10,674         9,325      14
NY-Long Island        10,608         8,740      21
MI-Dearborn            10,460         9,791        7
LA-Monroe               10,226       11,385     -10
MI-Detroit                 9,954         9,541       4

10 low-spending hospital regions:
ND-Minot                   6,033         6,711     -10
VA-Lynchburg           6,022         6,524      -8
CO-Grand Junction      5,983       6,075      -2
OR-Eugene                5,968         5,798       3
IA-Iowa City               5,902         6,254      -6
SD-Rapid City             5,854         6,176      -5
OR-Salem                  5,810         5,642       3
IA-Dubuque               5,799         6,219      -7
WI-La Crosse             5,715         5,757      -1
HI-Honolulu               5,293         5,212       2

5 hospital regions with biggest drop due to price and other factors:

NY-Bronx                 12,004         8,653   39
NY-Manhattan            11,744         8,861    33
CA-Alameda County   9,251     7,094 30
CA-San Francisco         8,140        6,278    30
CA-San Mateo County 7,878        6,104     29

Cost, Choice, and Value

Jan 29, 2010• 7

By JOHN V. JACOBI

The Massachusetts Massacre has everyone stepping back a bit. The President says that we should “coalesce around those elements of the package that people agree on,” but it is unclear just which elements those might be, given the extreme polarization that has defined the debate. He suggests that points of agreement might center on insurance reform and cost containment, which are both important goals. I’m skeptical that a sudden flowering of bipartisanship will allow such agreement, however. Ezra Klein, on the other hand, has a paring proposal that goes in another direction, and reminds us of why we got into this in the first place: to extend coverage to the uninsured. If we must narrow our focus, Klein says we should extend Medicare to those over 50, and expand Medicaid to those under 200% of poverty. This would get lots of people insured, and could well be accomplished through budget reconciliation if no Congressional coalescing is to be had.

However the parsing, paring, and palavering goes, cost control is and will be at or near the health reform debate for years to come. Two recent articles are worth a look for those interested in analysis of cost-containment strategies.

The Cost of Fear

Jan 28, 2010• 27

By ROB LAMBERTS

I was talking to a fellow physician about a mutual patient. I had
information that would help him in their care and he was taking the
unusual step of asking me for my information. I was impressed.

“Could you fax me those documents?” he asked. ”Here’s my fax number.”

I scrambled to get a pen to write down his number. Then I had a
thought: “I could email you those documents much easier. Do you have
an email address?”

Silence.

After a long pause, he hesitantly responded, “I would rather you just fax it.” He said no more.

This is a typical reaction I get from my colleagues when suggest
using the new-fangled communication tool called email. The palms
sweat, the speech stumbles, and the awkwardness is thick in the air.
It’s as if I am suggesting they join me in an evil conspiracy, or as
if I am asking them to join my technology nerd cult. There is a
culture of fear in our healthcare system; it’s a wall against change, a
current of stubbornness, a root of suspicion that looks at anything
from the outside as a danger. Instead of embracing technology, doctors
see it as a tool in the hands of others intent on controlling them.
They see it as a collar on their neck that they only wear because
others are stronger than them.

It’s the only reason I can see for the resistance of a transforming
technology. It’s the only way to explain how they would favor a
non-system that hurts their patients over a system that can improve
their care immensely. After all, what good is it to embrace a
technology – no matter how good – if it will take away their ability to
practice medicine? ”It’s good for you!” they hear from politicians and
academics, but they see it as a poison pill.

The Info-Button Standard: Bringing Meaningful Use to the Patient

Jan 28, 2010• 6

By DON KEMPER

Regardless of the U.S. administration’s “meaningful use” requirements, if health information technology (HIT) is to become meaningful for patients, it must include the prescription of information and tools to help each patient better manage his or her own care.

Ask patients what they want from HIT systems, and they will tell you three things:

– “Tell me my diagnosis, what will happen, and what I can do myself to better manage the problem.”

– “Tell me my medical tests results and what they mean to me.”

– “Tell me my treatment options, and help me participate in the treatment decisions.”

The soon-to-be-finalized HL7 International Context-Aware Information Retrieval standard (nicknamed the HL7 “Infobutton” standard) makes it far easier for providers of electronic health records (EHRs) and personal health records (PHRs) to deliver just what the patient wants. And that is what will put the meaning into meaningful.

Using the HL7 Infobutton Standard for Information Prescriptions

The HL7 Infobutton standard has been widely adopted since 2007. It facilitates the delivery of a set of standardized information about the patient, the provider, and the activity of a specific care encounter or moment in care. An Infobutton manager (or equivalent) accessed by an EHR application can then pull from that set the information it needs for any relevant use case. In most cases the Infobutton has been used to bring up decision support information for the clinician.