The Health Care Blog – Page 170 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

COVID-19: Hidden Coinfections and Chain Reactions Parasitic Infectious Relationships within Us

Apr 15, 2020• 21

By SIMON YU, MD, COL, USA (Ret)

Dr. Tom Frieden, former director of the Centers for Disease Control and Prevention (CDC), opened up a new front in the Coronavirus War by saying we don’t just need to treat the acute disease, we need to treat the underlying conditions that make people more susceptible to serious disease progression. He focused on heart disease, and managing mitigating risk factors such as CVD, diabetes, hypertension and smoking in order to increase people’s odds for recovery. The initial focus has been pneumonia and acute respiratory distress syndrome (ARDS), with risk factors including asthma, chronic obstructive pulmonary disease, and emphysema.

Dr. Frieden calls for better management of people’s underlying health problems to help mitigate the impact of COVID-19. I would take this one step further and say we need to go beyond managing chronic diseases, and find and treat the pathogens that underlie and fuel their pathologies. Why?

In 2001, my work as an Army Reserve medical officer took me to Bolivia to treat 10,000 Andes Indians with parasite medications. Not only did this resolve their parasite problems, but many reported it helped them overcome a range of additional chronic health problems. When I returned to St. Louis, I began to dig deeper with my chronic disease and “mystery disease” patients and treat some of them for parasite problems, and saw many improve. I expanded this “search and destroy” mission with my patients to fungal and dental infections, as I learned many such infections – often overlooked in medicine today – are overlapping, synergistic, and can present as chronic illness.

Leadership During a Healthcare Crisis: Kaiser Permanente’s Response to COVID-19

Apr 14, 2020

A Conversation with Dr. Richard Isaacs, CEO of The Permanente Medical Group and the Mid Atlantic Permanente Medical Group

By AJAY KOHLI, MD

Organizations aren’t built in crises. Their mettle, their history and their leadership define how organizations adapt and succeed, particularly in difficult times. Of the three, the most important quality is leadership. In this regard, Kaiser Permanente is leading the way in healthcare delivery.

I had the opportunity to speak with Dr. Richard Isaacs, CEO of The Permanente Medical Group and The MidAtlantic Permanente Medical Group, to discuss the strategic vision and granular details of Kaiser Permanente’s response to the global pandemic of COVID-19.

Kaiser Permanente has a strong foundation in the history of delivering care to the vulnerable. Founded in 1945 by a surgeon, Dr. Sidney Garfield, and an industrialist, Henry J. Kaiser, the organization grew from a single hospital in Oakland, California into one of the largest physician-led organizations in the world. Currently, it boasts more than 22,000 physicians responsible for the care of more than 12.5 million lives.

Many question how large healthcare organizations, like Kaiser Permanente, can adapt to a rapidly evolving problem, like the global pandemic of COVID-19, especially when cities and even countries are struggling under the burden.

There Will Be Consequences

Apr 14, 2020• 1

By KIM BELLARD

Crises — like our current COVID-19 pandemic — force people to come up with new solutions. They slash red tape, they improvise, they innovate, they collaborate, they cut corners. Some of these will prove inspired, others will only be temporary, and a few will turn out to be misguided. We may not know which is which except in hindsight.

I covered some of these in a previous article, but let me highlight a few:

Hospitals: We’re building new hospitals, such as in convention centers, to address the expected shortage of beds. Hospitals are also coordinating where to send which types of patients.
Testing: We’re creating drive-through testing centers in parking lots and elsewhere.
Telehealth: We’ve loosened the restrictions on telehealth, improving reimbursement and rules about when it can be used.
Coverage: We’re trying to ensure that deductibles/copayments do not pose barriers to people getting tests and treatment, even for those without insurance.
Clinicians: We’re looking for clinicians everywhere we can — allowing licensed ones from other states to practice, letting people who were health care professionals in other countries practice here, calling retired ones back into service even if their license had expired, even letting almost-graduated medical professionals start practicing.
FDA approvals: The FDA is using its “emergency use guidance” authorization to start allowing use of drugs and other treatments much quicker, and with much less evidence, such as for hydroxychloroquine, diagnostic testing, and ventilators.

GuideWell Launches COVID-19 Health Innovation Collaborative

Apr 14, 2020

American Hospital Association’s Top Advocacy Efforts Amid COVID-19 Outbreak | WTF Health

Apr 13, 2020

By JESSICA DaMASSA, WTF HEALTH

As hospitals focus on taking care of COVID-19 patients, the American Hospital Association is stepping up its advocacy for hospitals, fighting on their behalf for everything from PPE to reimbursement for uninsured patients. AHA’s Policy Director, Akin Demehin, dives into the top issues facing U.S. hospital administrators as they scramble to adjust their businesses to meet the unprecedented demands of the pandemic.

Besides the obvious concerns related to the direct delivery of care to a surge of very sick patients, hospitals are worried about cash flow, having enough personal protective equipment (PPE) for front-line clinicians, and the challenges of rolling out massive telehealth and remote monitoring programs to care for non-COVID patients at-home.

As the pandemic wears on, and the evolution of hospitals continues, the way these institutions function as part of the U.S. healthcare system will likely be forever changed. We learn what’s important to the AHA — and its 5,000 hospitals and healthcare system members — as they redefine their role in the healthcare system of the future in real-time.

COVID-19 Makes the Case for a National Health Care System

Apr 13, 2020

By MIKE MAGEE, MD

Governors like Andrew Cuomo of New York have discovered the price for inefficiency and conflicts of interest in the face of the COVID-19 epidemic. As he said last week, “No one hospital has the resources to handle this. There has to be a totally different operating paradigm where all those different hospitals operate as one system.”

Our system is marked by extreme variability: a nation of health care haves and have-nots. Yet even when we Americans acknowledge the absurdity of our convoluted system of third-party payers and the pretzel positions our politicians weave in and out of as they try to justify it, reform it, then un-reform it, many still find solace in telling themselves, “Well, we still have the best health care in the world.”

This crisis in a matter of weeks has revealed the limitations of a conflicted network built on short-term profiteering and entrepreneurial adventurism. Here are a few early learnings:

The COVID Pandemic: WHO Dunnit?

Apr 11, 2020• 5

By ANISH KOKA, MD

COVID is here. A little strand of RNA that used to live in bats has a new host. And that strand is clearly not the flu. New York is overrun, with more than half of the nation’s new cases per day, and refrigerated 18-wheelers parked outside hospitals serve as makeshift morgues. Detroit, New Orleans, Miami, and Philadelphia await an inevitable surge of their own with bated breath. America’s health care workers are scrambling to hold the line against a deluge of sick patients arriving hourly at a rate that’s hard to fathom.

I pause here to attest to the heroic response of the medical community and the countless more working to support them. At the time of this writing, despite 368,000 confirmed cases in the United States, 11,000 deaths have been reported. A horrid number, but still a far cry from Italy with 130,000 cases, and 16,523 deaths, and Spain with 14,000 deaths amidst 140,000 cases. Italy and Spain may be a few weeks ahead of the United States, but at the moment, Italy and Spain have case fatality rates (12.5%, 10%) that are multiples of the United States (2.5%). If this rate does stand, it will be a testament to the tenacity of medical workers toiling under extenuating circumstances.

With the scale of the tragedy now obvious, the take from some very smart people is that the people who should have been paying attention were asleep at the wheel. The easy target is the bombastic New York real estate developer and current President of the United States who repeatedly assured raucous campaign crowds and the nation that the virus was under control before it wasn’t.

The charge is made that the President ignored warnings and painted a rosy picture of an unfolding crisis in a short-sighted attempt to preserve the economy and a beloved stock market. He may be guilty of the latter charge, but the real question relates to ignored warnings. Where were the warnings? Who was sounding the alarm that was ultimately ignored?

Flipping the Stack: Can New Technology Drive Health Care’s Future?

Apr 11, 2020• 1

By MATTHEW HOLT and INDU SUBAIYA

Indu & I have been talking about Flipping the Stack in health care for about 3 years. 2 years ago we wrote an article for a general hospital audience which appeared in the 2019 AHA SHSMD Futurescan magazine. I was talking about the changes in home monitoring that might come about due to COVID-19 and remembered this article. The one that got published went through a staid editing process. This is the original version that I wrote before which was rather more fun and hasn’t seen the light of day. Until now. Take a look and remember it is 2 years old–Matthew Holt

Over the past twenty-five years most businesses have been revolutionized by the easy availability of cloud and mobile-based computing systems. These technologies have placed power and access into the hands of employees and customers, which in turn has created huge shifts in how transactions get done. Now the companies with the highest market value are both the drivers of and beneficiaries of this transition, notably Apple, Facebook, Amazon and Alphabet (Google), as well as their international rivals like Samsung, Baidu, Tencent and Alibaba. Everyone uses their products every day, and the impact on our lives have been remarkable. Of course, this also impacts how businesses of all types are organized.

Underpinning this transformation has been a change from enterprise-specific software to generic cloud-based services—sometimes called SMAC (Social/Sensors/Mobile/Analytics/Cloud). Applications such as data storage, sales management, email and the hardware they ran on were put into enterprises during the 80s and 90s in the client-server era (dominated by Intel and Microsoft). These have now migrated to cloud-based, on-demand services.

Twenty years ago the web was still a curiosity for most organizations. But consumers flocked to these online services and in recent years businesses followed, using GSuite, AWS (Amazon Web Services), Salesforce, Slack and countless other services. Those technologies in turn enabled the growth of whole new types of businesses changing sectors like transportation (Uber), entertainment (Netflix), lodging (AirBnB) and more.

Fig 1. Growth of Cloud Computing Use (Cisco) — Figure 1. Growth in use of cloud data v s traditional data centers

What about the hospital?

Hospitals and health systems were late comers to the enterprise technology game, even to client-server. In the 2000’s and 2010’s, mostly in response to the HITECH Act, hospitals added electronic medical records to their other information systems. The majority of these were client-server based and enterprise-specific. Even if they are cloud-based, they tend to be hosted in the private cloud environment of the dominant vendors like Epic and Cerner. Of the major EMR vendors only Athenahealth had an explicit cloud-only strategy, and its influence has been largely limited to revenue cycle management on the outpatient side.

However, the hospital sector is likely to move towards the trend of using the cloud seen in other businesses.

Health in 2 Point 00, Episode 116 | Telehealth $$, Layoffs and Rock Health’s Q1 fundraising report

Apr 10, 2020

Today on Health in 2 Point 00, Jess and I run through a lot of telehealth investments including Doctor Anywhere raising $27 million, 98point6 raising $43 million, Tyto Care raising $50 million, SilverCloud Health raising $16 million, SteadyMD raising $6 million, and Aktiia raising $6 million. In addition, there’s a company called Air Doctor which matches people when they’re traveling to doctors on the ground which raised $7.8 million despite the inauspicious timing. On the flip side, there have been a slew of layoffs in the space, and Jess and I give our $.02 on Rock Health’s Q1 fundraising report which was just released. Don’t miss our tag-team interview of Livongo’s Glen Tullman, and check out these episodes in podcast form on Spotify and iTunes. —Matthew Holt

The Tipping Point for Telehealth

Apr 10, 2020• 1

By ALEXA B. KIMBALL MD, MPH

The tipping point for telehealth just happened. Many ways of doing business will change forever after the experience of the COVID-19 pandemic, and health care, too, will never be the same.

Between the release from some HIPAA requirements announced by President Trump this month, shifts in payor policies, and mandated insurance coverage of telehealth visits, innovation and adoption are taking off like wildfire. As patients and outpatient-based physicians hunker down at home, they are rapidly experimenting, and improving the way care is being delivered remotely.

Our institution, which had no prior program, faced with an imminent shut down of elective activity, developed an enterprise-wide telehealth program in days, rendering hundreds of visits as soon as we launched it. This activity is being replicated all around the country.