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Above the Fold

Personalized Medicine: Back to the Future

Apr 23, 2008• 6

By Scott Shreeve

Personalized Medicine

The type of sing molecular analysis to achieve optimum medical outcomes in the
management of a patient’s disease or disease predisposition,
Right treatment for the right patient at the right time.

As I have mentioned in several of my posts, I have been working on a
couple of health care finance reform initiatives over the last six
months. After banging away now for awhile, I am starting to see some
emerging ideas that are starting to bring out that old revolutionary
feeling of doing something that can have an industry changing impact.
The opportunity lies in the ongoing pace of innovation, with new forms
of health care delivery, with new models of health care financing, and
that fact that eh American public and politicians are slowly waking up
to the fact that our health care system is headed toward radical surgery (not the cosmetic kind).

So lets start this out by talking about the personalization of medicine.
This is typically thought of in a genetic sense, wherein people are
customizing medications and therapies based on your individual genetic
profile. Said in other words, the “Right treatment for the right patient at the right time”.
However, most consumers already assume Right/Right/Right is happening,
and more likely consider personalized medicine as a type of practice
delivery style. This is where the physician knows the patient
intimately, their social and demographic context, and the correct
diagnostic or therapeutic approach given the patient’s preferences that
have been learned throughout the relationship. The only physician I
have ever had whom I had this type of relationship with was Dr. Richard Jones who took care of me from age 6-21 (when the front office lady finally told me that I “really should find another doctor“).

An Open Response To HHS Secretary Mike Leavitt – Brian Klepper and Michael Millenson

Apr 22, 2008• 1

By Brian Klepper and Michael Millenson

A few months ago, the two of us – both long-time advocates for
transparency and accountability – posted separate comments on Secretary
Mike Leavitt’s blog. Brian asked Secretary Leavitt to square his
support of "Chartered Value Exchanges” with the attempt to block
release of physician-specific Medicare claims data to Consumers’
Checkbook, which wants to rate doctors. After a court ruled that the
data should be provided to the group, HHS appealed. Michael urged the
secretary to go beyond supporting Consumers’ Checkbook and use his
“bully pulpit” to promote sophisticated data analysis that could be
used to create national quality comparisons.
Secretary Leavitt graciously asked us to consider and comment on the
department’s proposed "Medicare trigger legislation" calling for the
release of physician performance measures. We are delighted to continue
the conversation.

First, let’s give credit where credit is due. We agree that the proposed legislation is a major step in the right direction.

Snooping at Britney’s Chart: Why Should Docs and Nurses Have Different Rules?

Apr 22, 2008• 7

By Robert Wachter

Robert_wachter Should doctors and nurses be subject to different penalties for
precisely the same infraction? Of course not. Are they? Sure. Just ask
Britney Spears.Britney was hospitalized at UCLA at least
twice in the past few years –
once when she gave birth to her first son in 2005, and again in early
2008 for psychiatric care. Both times, dozens of UCLA staff members
peeked at her medical records, despite having no clinical reason to do
so.

This voyeurism, of course, is hard wired into our DNA, and
we aren’t about to purge our inner paparazzis any time soon. But even
celebs have a right to keep their medical records private. Although the
Health Insurance Portability and Accountability Act
(HIPAA) has caused some real mischief, one of its beneficial effects is
that it put the issue of medical record snooping on our radar screen.
Whether the victim is a Hollywood starlet or your next-door neighbor,
it is just plain wrong.

Most organizations have hired HIPAA
police and done extensive HIPAA training with their staff.
Nevertheless, all the UCLA snoops were documented to have passed an
on-line HIPAA tutorial. When Britney hit the door, Inquiring People
just wanted to know.

Lest you think this is a UCLA thing, we had
a similar situation (with another famous actress) a few years ago, as
have dozens of other hospitals. In fact, human nature being what it is,
I can’t imagine this not happening – unless the rules are clear, widely disseminated, and strictly enforced.

Around the Web in 60 Seconds (Or Less)

Apr 22, 2008

By THCB Staff

VentureBeat: Emphasis Search, This Year’s WebMD, Raises 1M for Specialist Matching Service
Surgeons Meet in Second Life: First International Virtual Association Formed
(Hat Tip: Medical Quack)

WSJ Health Blog: Are General Surgeons the Primary Care Docs of the Operating Room? Aggravated DocSurg: "The harder the patient, the less the reimbursement we usually get."

WIRED SCIENCE: PETA offering $1 million prize to first scientist who can produce lab-grown meat in bulk.

Web 2.0h … really? "The OrgChart wiki is one of the coolest and most wonderfully dangerous features I’ve seen on a suit-and-tie site like Forbes.com."

Columbia Journalism Review: Dems Are Not Calling for Government Health Care. "After his abysmal debate performance" Stephanopoulos tries (unsuccessfully) to set the record straight.

DC City Council Pushes for Mandatory Universal Healthcare CoverageComing to a Hospital Near You: Mouth Swabs Swifty Diagnose Heart AttacksLAT: Men Don’t Get Healthcare Because They Don’t Want to Take it Off for Docs?

Tune Into The Kroll Webcast On The Security of Patient Data – Brian Klepper

Apr 22, 2008

By Brian Klepper

Exclusive to THCB: A couple weeks ago I pointed to a new study, commissioned by Kroll Fraud Solutions and conducted by HIMSS Analytics, that makes startlingly clear the gap between what most health systems are doing to comply with HIPAA, and what they need to do to actually safeguard the patient data in their possession.Tomorrow, Wednesday, April 23rd at 2PM EST, and again next Tuesday, April 29th at 2PM, EST, you’re invited to a 40 minute Webcast, moderated by Yours Truly, that goes through the issues. Jennifer Horowitz, the investigator from HIMSS Analytics, Lisa Gallagher, HIMSS Senior Director of Privacy and Security and Brian Lapidus, Kroll’s COO, will talk about how health care executives typically perceive the issue and how they report their own awareness and preparedness, in stark contrast to the threat and what happens when a breach actually occurs. I was a bystander in this energetic discussion, but it was an eye-opener for me.

If you’re at all involved in managing health system security or if you’re simply interested in the deeper realities of what’s necessary to protect patient data, this one’s a must. Join us for this revealing and important Webinar. Click here to get the study report and to register.

The Legacy of Dr. Jerome Grossman

Apr 21, 2008• 2

By Jane Sarasohn-Kahn

We’ve lost a major force for good in health care. Dr. Jerome Grossman, once CEO of Tufts-New England
Medical Center, passed away yesterday. He was only 68, an example of another good-man-dying-too-young.

Dr. Grossman’s ideas made big impacts on American health care for decades. He chaired many Institute of Medicine (IOM) panels and wrote countless pieces in peer-reviewed journals (including the seminal Crossing the Quality Chasm
report). He was one of the earliest proponents of analyzing quality and
medical outcomes in health care. He was an early champion and adopter
of information technology in health care.

Listen to a podcast of him
talking about aligning IT in health care for quality here from an IOM meeting held in 2000.
Most recently, at Harvard, he had been was the founder of the Center for Business & Government’s Health Care Delivery Policy Program, which he directed during the past seven years.
He had been co-authoring a book on innovative disruptions in health care with Clayton Christensen,
a fellow colleague at Harvard. It will be published by the end of the
year, and I can’t wait to hear Dr. Grossman’s voice again through his
writing.

Batalden updates Machiavelli

Apr 20, 2008• 4

By Paul Levy

There is nothing more difficult to
take in hand, more perilous to conduct, or more uncertain in its
success, than to take the lead in the introduction of a new order of
things. For the reformer has enemies in all those who profit by the old
order, and only lukewarm defenders in all those who would profit by the
new order, this lukewarmness arising partly from fear of their
adversaries … and partly from the incredulity of mankind, who do not
truly believe in anything new until they have had actual experience of
it."

This famous quote by Machiavelli is both a hearty
warning and a healthy piece of advice to those who seek to change a
political or social system. If those in today’s health care system were
looking for the equivalent piece of warning and advice, they might just
have obtained it from Paul Batalden,
Professor and Director of the Center for Leadership and Improvement at
the Dartmouth Institute for Health Policy and Clinical Practice. He
presented it to a small group of us today, in a talk entitled "The
challenge of leading the leading of the improvement of health care". I
present it with his permission. I think he has nailed the issue and
admire his ability to do it so succinctly.

Dollars to Doughnuts

Apr 20, 2008• 4

By Eric Novack

From the L.A. Times: Dollars to doughnuts diagnosis

Do the many THCB proponents of government-run, bureaucrat-controlled, global-budget, everybody in- nobody out, health care advocates want to drive doctors like the author of this article out of medicine?

For more than a year, I haven’t received a single dollar from any insurance company. I work for my patients. A few hundred doctors across the country are working the same way, some in blue-collar towns. Routine
care should be affordable to the middle class, and as more doctors and more patients form relationships that exclude insurance companies, prices will drop. Insurance doesn’t make routine care affordable; it
makes it more expensive by adding a middleman. I know that some patients can afford nothing, so two afternoons a month I volunteer at a clinic that cares for indigent patients, which I could not have done
with the huge patient volume I was seeing a few years ago…

Quotable

Apr 20, 2008• 2

By THCB STAFF

We asked THCB contributor Maggie Mahar for her quick take on the health care policies of each of the presidential candidates. We were pretty much expecting one of Maggie’s trademarked dissertations – a meticulously researched critique of each politician’s views on various important substantive issues. Instead this entertaining reply turned up in our email inbox.

“If Clinton wins we have real national health care reform.

If Obama wins, I’m not so sure, given that Cutler thinks we’re getting value for our dollars, and healthcare doesn’t seem to be a big priority for Obama (although his plan seems a lot like hers).

If McCain wins, we all move to Canada. Northern Canada, where will not only have healthcare, but may be able to avoid the fall-out from the nuclear war that he starts.”

McCain Would Increase Medicare Part D Premiums

Apr 18, 2008• 4

By Robert Laszewski

Oie_399px_john_mccain_mackinac_isla As part of his broader speech on economic issues John McCain last week called for high income seniors to pay more for their D drug coverage. Couples making more than $160,000 a year would pay higher premiums.

This is a good idea and a down payment on something I believe is ultimately unavoidable– means testing for entitlement programs.

It isn’t news that the cost of senior programs –Medicare, Social Security, and Medicaid–are not sustainable. The current federal cost for these three programs now tops $27,000 a year for each senior over the age of 65. That number increased 24% since 2000– after adjusting for inflation.