The Health Care Blog – Page 194 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

A New Study Finds (Surprise) Americans Are Happier Than We Thought They Were

Dec 1, 2019

Governments around the world have started to rely on more digital government services. Ideally these new websites offer fast and efficient solutions. But the shaky rollout of HealthCare.gov served as a prime example of how digital government is not always good government. A new report from the Boston Consulting Group describes how different countries are approaching digital government. The authors surveyed over 12,000 users about their experiences and satisfaction with using online government services. The survey collected results from 12 different countries, including the U.S., the U.K., Australia, and France. The report finds that satisfaction varies throughout the world.

Throughout both the developed and developing world governments are expanding their online offerings. The average respondent had access to 10 different digital government services. These services include more frequently used services like community consultation, employment services, and health care. Developed countries reported higher levels of satisfaction with these digital services than developing nations. Across the spectrum of developed and developing nations, four out of five users believe that online services provided by the government have improved.

Satisfaction varied across countries. 56 percent of Malaysians and 52 percent of Indonesians perceived online government services to be far worse than private services. 60 percent of users in the United Arab Emirates and 53 percent of those in Saudi Arabia were most satisfied with online government services. Americans favor private services by a large margin (42 to 22).

The report also describes areas where users believe governments can improve. One third of users reported having no problems or issues with the online services. Those surveyed were most interested in easy to access services rather than new ones. Users want simpler and easier-to-use websites (51 percent), greater reassurances on the privacy of information (47 percent), and more personalized or tailored services (34 percent).

There is clear evidence that users want to see online services continue to grow and develop. For example despite the rocky launch of Healthcare.gov, Americans reported the highest rates of satisfaction (55 percent) with searching for, registering for, or accessing health care services. American users also reported the highest levels of satisfaction in other categories such as participating in community consultation/online surveys (58 percent), accessing cultural, heritage, or similar facilities (66 percent), and searching, registering, or accessing health care records (57 percent).

The report argues that governments should focus on adding and maintaining the value of those services constituents need and use most, rather than building content that may go to waste. Furthermore, there is a strong emphasis on building tools that incorporate concerns about the user experience into the design. In the future as technology in the private sector improves, pressure on governments to deliver digital services will only increase. Governments must develop the capacity to develop and maintain new service delivery websites and applications.

Find the full report here.

The Orphan Organ: The Brain

Dec 1, 2019

It was with much distress that I read the recent New York Times front page article by Benedict Carey about the heart wrenching plight of the Serpico family in their journey to get proper psychiatric treatment for their two sons. As a child and adolescent psychiatrist who has served children and families for more than 30 years, trained many child psychiatrists, and served as President of the American Academy of Child & Adolescent Psychiatry (2001-2003), I am deeply disturbed by the current psycho-pharmacologic practice of psychiatry.

Over the past decade, there have been amazing advances in medicine that have pushed the profession in the direction of utilizing more evidence-based practices. This is easy to see in most specialties, such as cardiovascular medicine, where implementing the latest surgical best practices results in proven, tangible positive outcomes. Unfortunately, it is not that clear cut in the field of psychiatry.

Every other medical specialty claims an organ of interest – cardiologists have their heart, nephrologists have their kidneys, hepatologists have their livers, yet the brain remains a medical orphan.

In the “mental health” field we treat diseases of the brain, yet we shy away from claiming the brain as our organ of interest. The brain is the only organ that cannot be transplanted, nor can a person survive without it. People actually survive with mechanical hearts while awaiting heart transplants. The idea that a child can go into an inpatient unit with emotional and behavioral problems and simply be treated in five days with reckless medication trials, without any diagnostic tests that guide an understanding of the genesis of the problems, is preposterous. There is no evidence-based science to support such treatment. The “health” (misnomer?) insurance industry has been the driver of such treatments, and, unfortunately, psychiatry has capitulated instead of pushing back and advocating for appropriate time to evaluate, diagnose, and properly treat our patients. I do not think there is a nephrologist in the world that would accept fewer dialysis sessions for a patient in renal failure, or a cardiologist who would deny critical diagnostic testing simply because the insurance company decided they would not pay for it. Medical necessity should drive assessments—not the insurance industry.

Most inpatient units fail to do any psychological testing. They typically do no testing to probe for language and communication problems, learning disabilities, or other cognitive challenges that may be at the root of the problem. Children with early traumatic experiences are not being diagnosed appropriately; instead behaviors associated with such trauma are targeted for treatment with medications. If the diagnosis is incorrect, then so is the treatment intervention.

Surescripts Marketplace

Dec 1, 2019

By SURESCRIPTS

Health information exchange. Connectivity. Interoperability. For the health IT crowd, these words have become staples in our vocabulary. Data exchange and accessibility are critical to improving care delivery and increasing efficiency, especially when patients move from one provider to another.

Patients’ digital expectations are growing too, their health records must be easy to share with other care providers in a secure manner. To keep up with industry demands, regulations and the pace of innovation, the entire healthcare ecosystem must continue to take steps forward in their respective – and collective – interconnectivity journeys.

According to a recent article from Health Affairs, 78 percent of office-based physicians reported adopting some form of EHR system in 2013, however only 14 percent electronically shared data with care providers or hospitals outside their own organization, which is one of the most critical pieces of the interoperability puzzle. The secure transfer of information between each stakeholder group is no longer nice to have, but a necessity – not only for the assurance of high quality care, but also for the improvement of healthcare overall.

But the journey isn’t easy, the challenges are great, and the questions are plentiful. How are hospitals going beyond compliance to take Meaningful Use from a regulation to a framework for connected success? How can you achieve seamless connectivity between disparate entities? How can tracking immunizations drive down costs for patients, providers and pharmacies, while improving population health?

To tackle these questions and more, please join Surescripts and a panel of experts – from Kaiser Permanente, Mt. Sinai and Walgreens – tomorrow September 23rd at the Health 2.0 fall conference, as we address “How a Connected Health Infrastructure and Data-Driven Solutions are Improving Quality, and Your Bottom Line.” Be sure to follow us @Surescripts on Twitter!

Texas Abortion Case Isn’t about Abortion, but The Rule of Law

Dec 1, 2019

By CHARLES SILVER

Whole Woman’s Health v. Cole, the Texas abortion case that is now before the Supreme Court, is really about the rule of law and how federal judges maintain it by holding states to external standards. The case follows Planned Parenthood of Southeastern Pa. v. Casey, which forbade states from using the desire to protect women’s health as a pretext for curtailing their access to abortion services. But how is a judge to distinguish a pretext from a genuine concern for patient safety?

Casey seemed to say that unless all possible connections between a regulation and patients’ wellbeing can be ruled out completely, a state’s proffered reason is bona fide. That’s far too weak a standard, and later cases seemed to confirm it by saying that states don’t have to show that their laws will actually protect women from documented perils. Seeing this, Texas and other pro-life states have done exactly what Casey forbids. They’ve enacted laws that shut down abortion clinics while shouting “Women are in danger! Women are in danger!” The issue in Cole is whether states must prove that access-impeding laws address real safety problems. If the Court says no, Casey will be a dead letter.

It should be plain to everyone that lawmakers won’t respect constitutional limitations on their own. Politics is a brass-knuckles world. The people who thrive in it aren’t rule-followers by nature, and their incentives are terrible. When they can gain by doing something, they will, the Constitution be damned. That’s where judges come in. They’re supposed to keep lawmakers in line by delivering swift kicks to their posteriors when they violate the Constitution.

As health IT Matures, Security Approaches Must Mature With It

Dec 1, 2019

By IRV LICHTENWALD

Not that long ago, healthcare worried mostly about the physical loss of personal health information (PHI) by way of a lost thumb drive, a stolen laptop, some misplaced paper files. These were the primary concerns in HIMSS initial security survey, published in 2008. It wasn’t until five years later, in 2013, that the largest healthcare security breaches came from cyberattacks instead of lost or stolen devices.

So, is it encouraging to see how far the rapid pace of change has carried health IT in just a few years? Well, yes and no. Growth is good, but it always presents a new set of challenges.

To be sure, healthcare has joined the rest of the wired world as a frequent target of technically skilled ne’er-do-wells. In 2014, cyber breaches in the form of systems hacking, credit card skimming and phishing (obtaining sensitive personal data by pretending to be someone trustworthy) totaled 29 percent of all security breaches. In 2015, that number rose to 38 percent.

Expect the trend to continue.

And expect it to get more complicated based on what’s happening in other industries. You may, for example, remember an interesting experiment last summer in which hackers demonstrated the susceptibility of a car’s onboard computer system by taking control of a Jeep going 70 miles per hour on a freeway outside St. Louis.

Surgeons Doing Math

Dec 1, 2019

By ARNON KRONGRAD, MD

I bought a car as a package. It had wipers and tires and brakes. The car dealer gave me a simple price after he added the costs of components and labor plus profit. I wanted to buy surgery as a package. I wanted a surgeon and anesthesiologist and facility. There was no dealership for surgery packages, so I asked a facility to put one together. “Add sutures and gloves and some graspers,” I pleaded, “please, I have to have choice.”

Turnkey surgery packages are hard to find. That is partly because most surgery is paid for in separate fees for separate services by faceless third parties that take the patient’s money, dictate his choice, and keep price largely hidden behind a bureaucratic curtain. So why can’t a facility just put a surgery package together? Doesn’t the arithmetic of tires work just as well on sutures?

Consider the facility executive: he has no real subject expertise. For example, he rarely knows the difference between a nylon and chromic suture. He is also not used to costing and packaging, because he has had little incentive. This is because there has for decades been little market for simply priced packaged services. The big market for surgery is fee-for-service. To integrate a simply priced surgery package into legacy fee-for-service systems would require technical effort. Simplicity is complicated.

There is a second issue: legacy structures have brought atrophy to healthcare accounting. Paternalistic third parties allow payment of specific amounts and thus render informedactivity based costing and rational cost-plus-margin pricing irrelevant. The executive’s costs and profit don’t matter because his allowance has been set by another.

These are two of the reasons behind our wasteful excess capacity. Think about it. If the executive with little subject expertise indexes his price to third-party allowable, which is common, and those allowables are lower than true cost, the facility would subsidize care. If the executive indexes to third-party allowable and those allowables are higher than is marketable, the facility may sell nothing. Both propositions are losers for the facility and its patients.

Playing Poker With the Devil: “Prior Authorizations” are Paralyzing Patients and Burning out Providers

Nov 30, 2019

By HANS DUVEFELT

The faxes keep coming in, sometimes several at a time. “Your (Medicare) patient has received a temporary supply, but the drug you prescribed is not on our formulary or the dose is exceeding our limits.”

Well, which is it? Nine times out of ten, the fax doesn’t say. They don’t explain what their dosage limits are. And if it isn’t a covered drug, the covered alternatives are usually not listed.

So the insurance company is hoping for one of a few possible reactions to their fax: The patient gives up, the doctor tries but fails in getting approval, or the doctor doesn’t even try. In either case, the insurance company doesn’t pay for the drug, keeps their premium and pays their CEO a bigger bonus.

First problem: This may be in regards to a medication that costs less than a medium sized pizza. And the pharmacy generally doesn’t even bother telling the patient what the cash price is.

Second problem: A primary care physician’s time is worth $7 per minute (we need to generate $300-400/hour). We could spend half an hour or all day on a prior authorization and there is absolutely zero reimbursement for it.

THCB Spotlights: Todd Clardy, EVP Marketing at Accolade

Nov 29, 2019

Today on THCB Spotlights, Matthew interviews Todd Clardy who is the EVP of Marketing at Accolade. Accolade is a company well-known for being in employee/patient advocacy. They’ve created an advocacy model that focuses on creating an outstanding member experience and supporting patients through their whole journey, whether it’s an acute or chronic condition or helping people maintain their health and wellness. Where do Amazon, Google and Haven fit into this space? Find out how many people have got this and how Accolade will be expanding going forward.

Changing EMR – Seamless Continuation, Dreaded Chore or Fresh Start?

Nov 28, 2019• 1

By HANS DUVEFELT, MD

At the end of the year my patients and I will start over. That is what changing EMRs does to us. I have mixed feelings about data migration, if it even happens.

I will move into a new virtual environment and my patients will take on slightly different appearances, maybe even alter their medical histories. Some will perhaps be asking me to edit diagnoses that have haunted them since we went from paper to computer records almost a decade ago.

With our first EMR, we scanned in a few things from patients’ paper records – sometimes only a few pages from years or decades of first handwritten and later typed notes. Much got lost, because we were doing something we never really had thought through, and we had to do it with a clock ticking: “Hurry, before the Federal incentives go away”. The Feds wanted EMRs because the vision was that more data would help research and population health and also reduce medical errors.

This time, another factor is pushing us forward: The EMR we have will no longer be supported after a certain date, and for an EMR that requires continuous tinkering in order to do basic tasks consistently, that is an untenable scenario. Only yesterday, I was suddenly unable to send prescriptions electronically and it took the national headquarter’s involvement to get me up and running again.

Concrete Problems: Experts Caution on Construction of Digital Health Superhighway

Nov 27, 2019• 1

By MICHAEL MILLENSON

If you’re used to health tech meetings filled with go-go entrepreneurs and the investors who love them, a conference of academic technology experts can be jarring.

Speakers repeatedly pointed to portions of the digital health superhighway that sorely need more concrete – in this case, concrete knowledge. One researcher even used the word “humility.”

The gathering was the annual symposium of the American Medical Informatics Association (AMIA). AMIA’s founders were pioneers. Witness the physician featured in a Wall Street Journal story detailing his use of “advanced machines [in] helping diagnose illness” – way back in 1959.

That history should provide a sobering perspective on the distinction between inevitable and imminent (a difference at least as important to investors as intellectuals), even on hot-button topics such as new data uses involving the electronic health record (EHR).

I’ve been one of the optimists. Earlier this year, my colleague Adrian Gropper and I wrote about pending federal regulations requiring providers to give patients access to their medical record in a format usable by mobile apps. This, we said, could “decisively disrupt medicine’s clinical and economic power structure.”