Nothing focuses the mind like an impending hanging. — Samuel Johnson
I’ve been preparing for tomorrow’s 3rd Health 2.0 conference in San Francisco, where I’ll join my pals Matthew, Indu Subaiya, Jane Sarasohn-Kahn and Michael Millenson amid a Who’s-Who cast of health industry luminaries. I spent part of Monday reviewing the attendee and sponsor lists, impressive indeed, testament to how seriously this topic is being taken throughout health care.
The meeting is sold out at 950 participants. It’s worth remembering that, before the first Health 2.0 conference 13 months ago, Matthew, who with Indu took enormous professional and personal financial risk to pull this off, told me he’d be surprised if 75 people showed up. There were almost 500, many of them with genuine influence.
Thank you to The Health Care Blog for this opportunity to share my patient’s
perspective on health care and how it has helped shape my new book, Original Faith: What Your Life Is Trying to Tell You. I should mention at the outset that the book speaks to human experiences and actions, not doctrine. It argues neither for nor against any form of religious belief.
My progressive illness began with the sudden onset of what was misdiagnosed for several years as Myofascial Pain Syndrome. Despite eleven years of research and medical travel, no diagnosis was ever reached. For the past several years I’ve been housebound, increasingly bedridden and essentially without access to medical care related to my condition, which includes severe peripheral neuropathy and osteoporosis, connective tissue degeneration, and special adaptive needs. My situation may be a good starting point for considering the cracks – or crevasses – in the system.
In an under-regulated health care environment where the only bottom line is the bottom line of increasing profit margins, those with long-term illnesses that are difficult to diagnosis or treat are literally not worth the extra time and effort. Here’s one example from my own experience; I could give many more.
Over at the Huffington Post, Michael Millenson walks us through McCain’s plan to end employer sponsored coverage, noting that it would apply faith-based economics to one seventh of the US economy, and pointing out that its as radical a ploy to foist on the innocent bystander American people as any bomb-thrower ever cooked up.
It’s vintage Millenson: erudite, an airtight argument, gleefully presented, and making no apologies for its partisanship. A fun and informative read.
See also: An analysis of the about-face the McCain camp made suddenly regarding funding for his health plan. He’ll now keep the payroll exemption and cut $1.3 trillion from Medicare and Medicaid to pay for his tax subsidies.
Note: Amy Tenderich, who writes and maintains the wonderful Diabetes Mine,
just did this very illuminating interview with Google Health’s Missy
Krassner. As you’ll see, she doesn’t slow-pitch to Missy. This is a
sure-footed, tough-minded exchange about the real issues that are on
the table now in Health 2.0. – Brian Klepper
Slowly but surely, using the Internet for your health needs is
becoming as mainstream as shopping on the web: no longer futuristic,
but is it for everyone? And perhaps more importantly, are mainstream
commercial health platforms from companies like Google and Microsoft
really useful for people with specific chronic illnesses? I thought it
would be interesting to hear their side of the story.
So please welcome Missy Krasner, Product Marketing Manager for Google Health, whom I was lucky enough to catch up with for an interview last week.
Missy, shortly after Google Health launched last Spring, David Kibbe, former Director of Health IT for the AAFP, noted
that most of its services were “only mildly useful and sort of
‘toyish.’” How have these services evolved to be more useful to people
with health conditions?
The September/October issue of Health Affairs is dedicated to reviewing concepts of the medical home. It is most likely the most current, authoritative, and impressive review of this emerging idea. Health Affairs is an excellent resource for health policy wonks to gather, but in recent years has become more accessible to the general health care audience. I would recommend it as required reading for anyone interested in learning about this trend.
Simultaneously, there have been some recently updated “state of the industry” reports coming out of the retail health clinic world. As noted by Jane Sarasohn-Kahn, the fact that more and more retail clinics are being created has increased access, improved quality through an evidence based approach to a limited set of clinical conditions, but has not done nothing to address the cost issue. In fact, increasing the supply of retail clinics, has simultaneously increased the demand for these services. This is a common phenomenon within healthcare, and the supply driven demand has been well described particularly in the hospital setting.
Listening to Obama and McCain you realize that some issues have no absolute right
answer. Pro-Life v. Pro-Choice, Pro-Gun v. Anti-Gun, Less Government v. More Government etc. Everyone has an opinion and often the emotions run high.
The same thing is true about health care data standards and interoperability, although the stakes are a bit lower than life and death issues.
Recently folks have asked me to comment about Carol Diamond and Clay Shirky’s article in Health Affairs which contains potentially controversial statements such as:
Yet after three years of standards documentation and the resolution of several standards ‘disputes,’ we remain a long way from seeing these standards used and implemented to enable health information sharing. As Sam Karp of the California HealthCare Foundation stated in his testimony to the Institute of Medicine Board on Health Care Services and National Research Council Computer Science and Telecommunications Board, ‘Not a single data element has been exchanged in real world health care systems using standards this process has developed or deployed.’
I did not find Carol and Clay’s article controversial. Both are good friends of mine and I agree with their thesis that technology is not enough to ensure successful interoperability. We need to agree on appropriate policies to protect privacy, incentives for implementation, and justifications for continued use of technologies to ensure widespread adoption.
It started as a whisper and then grew to a roar. Last year, the Detroit Free Press wrote the first in what would become series of articles questioning the wisdom of medical blogging. In 2007 and 2008, USA Today and National Public Radio featured stories that noted the benefits of physician blogging, but also highlighted patient privacy and legal concerns associated with this activity. Finally, early last month, the Los Angeles Times and other publications featured a study that has generated a lot of heated commentary in the blogosphere and beyond.
In an analysis of medical blogs published in the July 23rd edition of the Journal of General Internal Medicine, Dr. Tara Lagu suggested that some doctor bloggers are painting an unflattering picture of the medical profession and fail to disclose financial conflicts. Lagu cited a 2006 poll produced by my firm Envision Solutions and the social network Trusted.MD indicating that public relations professionals approached nearly one-third of health bloggers responding to the survey. Lagu recently toldAmerican Medical News that she believes medical associations should “adopt policies explicitly addressing blogging ethics.”
I have watched the meteoric rise of popular term “Medical Home.” While I personally dislike this phrase, it has caught on in the popular vernacular and looks like it is here to stay. In conjunction with the rise of the term is the growing popularity of a practice model that includes a higher level of service on a membership basis. It is essentially, next-generation concierge medicine, but now being promoted under the more politically correct banner of “direct practice.” Multiple variations of the model exist, from an all-inclusive single fee to a membership structure that retains a fee for service financial arrangement.
So discerning patients evaluating these practices are forced to determine the relative value of this new direct practice concept, and having passed that test, determine which type of practice model actually makes sense to them (All inclusive or Fee-for-Service). Lets look at these questions using a traditional four-person family with an annual all-in health care spending of $15,000 (consistent with Milliman’s 2008 numbers).
Not-for-profit hospital monopolies are helping make health insurance unaffordable for millions of Americans.
In its Thursday edition, The Wall Street Journalprofiles the near monopoly that Carilion Health System has in Roanoke, Virg., and how it uses its monopoly power to inflate prices and enrich its executives.
The impact graph:
Carilion’s market clout is manifest in other ways. With eight hospitals, 11,000 employees and $1 billion in assets, the tax-exempt hospital system has become one of the dominant players in the Roanoke Valley’s economy. Its dozens of subsidiaries include businesses ranging from athletic clubs to a venture-capital fund.
The power of nonprofit hospital systems like Carilion over their regional communities has increased in recent years as their incomes have surged. Critics charge this is creating untaxed local health-care monopolies that drive the costs of care higher for patients and businesses.
The Journal also published a story in its Jan. 17, 2005, edition. about how the Federal Trade Commission was trying to stop monopolistic hospital mergers. I commented on it here.
On Jan. 24, 2007, I said health care reform should include breaking up not only health systems, but also medical groups and large regional insurers.
The Journal continues to call not-for-profit, tax-exempt health care providers “nonprofit.” Its stories show that tax-exempt health care providers are not “nonprofit.”
Stanford University’s medical school announced this week new restrictions on educational contributions by drug and medical device companies, which turn out to be among the strictest in the nation.
The rules are an effort to limit industry influence on physician practice. Currently, the continuing education programs tend to follow the market’s needs and not necessarily the best advancements for optimal patient care.
"The school will no longer accept funds from pharmaceutical or device companies that are targeted to specific programs, as industry-directed
funding may compromise the integrity of these education programs for
practicing physicians," a press release states.
SiliconValley.com reported that "Drug and medical-device company
contributions for continuing medical education have surged nationwide
from $302 million in 1998 to $1.2 billion in 2006, according to the
Accreditation Council for Continuing Medical Education. Stanford
officials said about $1.87 million — or 38 percent — of the medical
school’s budget for continuing education came from industry sources in