The Health Care Blog – Page 250 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

You Can’t “Elon Musk” Healthcare

Oct 30, 2018

By SOFIA NOORI

On January 26th, Philadelphia discovered that the 22-year-old organizer of its largest COVID-19 vaccination site, Andrei Doroshin, had turned away elderly members of the Philadelphia community from their vaccine appointments. Instead, he pocketed extra vaccine vials to administer to 4 friends and girlfriend. An RN witnessed the event and reported it to authorities.

Local news reporters quickly discovered that this incident was just the tip of the iceberg for Doroshin. A Drexel University graduate student with no experience in healthcare, Doroshin had enlisted his college friends to organize a group that would go on to win one of the biggest vaccination contracts from the city of Philadelphia. He told his friends that “this is a wholly Elon Musk, shoot-for-the-heaven type of thing,” and that “we’re going to be millionaires.” His organization had also amended its privacy policy allowing for patient data to be sold, administered large numbers of vaccines to people ineligible to receive the vaccine yet, and threw Philadelphia’s COVID vaccination program into chaos.

For the people in the back: One can’t simply “Elon Musk” healthcare. We have seen this too many times – a privileged young upstart with little experience believes that s/he can transform healthcare and make millions – or billions – doing so. Examples abound: we only have to look a couple years into the past to remember Elizabeth Holmes, the Stanford dropout who founded Theranos and misrepresented its technology, or to Outcome Health, whose former CEO Rishi Shah defrauded investors by overinflating business metrics. If “move fast and break things” works in other sectors, many reason, why won’t it work in the 4 trillion dollar industry of healthcare?

Healthcare is simply not the kind of business where one can shoot a rocket into the sky and accept the risk that it might explode. Simply put, this is people’s lives we’re dealing with. But a deeper layer involves trust in the medical establishment. U.S. healthcare is already marred by multiple grave issues: a complex bureaucracy, serious health inequities, and astronomical costs that can bankrupt a person in just one hospitalization. The trust that people have in U.S. healthcare has steadily dropped over the years. Further, the politicization of the COVID-19 pandemic and the U.S. government’s bungled response to it has only sowed further distrust, especially among marginalized and minoritized communities.

A Unique Offering for Students, Professors, and Lifelong Learners: “The ‘Right’ to Health Care and the U.S. Constitution.”

Oct 30, 2018

By MIKE MAGEE

“The ‘Right’ to Health Care and the U.S. Constitution.”

(Register For Virtual Zoom Access Here.) https://securelb.imodules.com/s/1878/lg21/form.aspx?sid=1878&gid=2&pgid=1306&cid=3139&srce=WBpcfall2021

Join me, in-person or virtual, on 4 consecutive Thursdays this Fall.

Together we’ll examine 250 years of history and case law, to expose what our U.S. Constitution says (and leaves unsaid) about Americans’ “right” to health care. From the Bill of Rights to the Federalist Papers, from McCulloch v. Maryland to Griswold v. Connecticut, from “Comstockery” to Sanger, and FDR’s “Court Packing,” we’ll cover it all.

You’ll learn about “penumbras” from William O. Douglas, and Due Process within the XIV Amendment; how the AMA chose Reagan as their spokesperson against “socialized medicine”, and how LBJ forced integration of hospital wards on Bible Belt states.

We’ll do a deep dive into Roe v. Wade and learn how Justice Blackmun arrived at his compromise solution for “Jane Doe” and others, and examine why Texas Governor Abbott is trying to torpedo it a half-century later.

We’ll revisit the politicization of the Terri Schiavo “Right to Die” case, and uncover “conflicts of interest” and deficiencies in “informed consent” at the University of Pennsylvania that contributed to the research death of Jesse Gelsinger.

We’ll hear the voices and opinions of students and professors, analyze Justice Roberts’ National Federation of Independent Business v. Sebelius split decision that preserved the Affordable Care Act…address mandated vaccines, and much, much more.

In just four 90-minute packed sessions, you’ll gain a perspective on the current struggle for health care in America. Most of all, you’ll learn and participate in the process. That’s a promise!

Register Today HERE. https://securelb.imodules.com/s/1878/lg21/form.aspx?sid=1878&gid=2&pgid=1306&cid=3139&srce=WBpcfall2021

How do Consumers view Technology’s Role in Healthcare?

Oct 30, 2018

By HARRY GREENSPUN, MD

As technology-enabled home health becomes more pervasive, how will consumers respond? What concerns and reservations will they have? Will they readily adopt new technologies? Deloitte conducted focus group research to better understand consumer expectations and preferences for receiving health care services in the future, focusing on care in the home.

In general, consumers are optimistic: To them, the benefits of technology-enabled home health far outweigh the risks, and they are eager to try it. For the unwell, home health technology can help manage their conditions and slow disease progression. For caregivers, it can offer peace of mind. For the healthy, it can provide the tools and support to maintain healthy behaviors.

Even though interest is high, we heard some concerns. Consumers value the personal nature of health care and the patient-doctor relationship. Many are concerned that increasing reliance on technology will erode the relationships that they feel are already threatened by the fragmented nature of health care, decreasing face time with doctors, and difficulty establishing and maintaining those meaningful relationships. While it may seem obvious that technology should reinforce and facilitate relationships rather than supplant them, consumers’ previous experiences with technology temper their enthusiasm.

Technology-enabled solutions that are perceived to intrude on people’s privacy, such as sensors that monitor an individual’s sleep quality or motion patterns at home, face resistance. Education may be required to effectively convey the benefits of such monitoring; consumers are then able to evaluate the pros and cons, and many are amenable to the tradeoff.

As more care moves to self-care, consumers want to have influence and control over their own care and health information. They expect to learn about new technologies and to be actively involved—as patients or caregivers—in deciding which technologies are used for their care, how they are used, and what data will be disclosed and shared.

Companies—whether newcomers or traditional players—developing the technology for home health are expected to negotiate a number of challenges:

Medicine is Child’s Play: Where’s Waldo, Spot the Difference and Whack-a-Mole

Oct 30, 2018

By HANS DUVEFELT, MD

I started writing a post a few days ago about the challenge of quickly finding what you’re looking for in a medical record. As I came back to my draft this morning, it struck me how much this felt like some of the games my children played when they were young. This got me thinking…

Where’s Waldo: Finding what’s important in the medical record

I did a peer review once of an office note about an elderly man with a low grade fever. The past medical history was all there, several prior laboratory and imaging tests were imported and there was a long narrative section that blended active medical problems and ongoing specialist relationships. There was also a lengthy Review of Systems under its own heading.

In what would probably have printed out over ten pages long, the final diagnosis was “Urinary tract infection” and the man was prescribed antibiotics.

This final diagnosis seemed to come out of left field. I didn’t recall reading anything about urinary symptoms, urinalysis, an abdominal exam or pain on percussion over the back.

During National Kidney Month, Protect Patients by Protecting Their Health Care Choices

Oct 30, 2018

By ALLYSON Y. SCHWARTZ and ELENA RIOS MD, MSPH

The recent coronavirus outbreak has millions of Americans thinking carefully about their health and wellness. For the 37 million of our friends and neighbors battling chronic kidney disease, however, health care risks that the rest of us often take for granted are never far from their mind.

Every year, 124,000 patients with kidney disease see their condition progress to end-stage renal disease (ESRD), also known as kidney failure and will require dialysis at least three times per week to survive.

Hannah, an ESRD patient in Henrico, Virginia, describes dialysis as “the most painful thing, physically and emotionally, I’ve had to endure.”

As a physician who represents medical providers in the Hispanic community – a demographic disproportionately impacted by kidney disease (Rios) – and a former lawmaker who worked to reduce the uninsured rate and improve quality of care (Schwartz), we know that stories like Hannah’s are all too common.

Facts, Conclusions, and More Questions on the Road to Solving Disparities

Oct 30, 2018• 2

By SCOTT COOK PhD

We tested whether new payment mechanisms could be harnessed in health care delivery reform to reduce health and health care disparities. Here’s what we found.

First, there were facts that couldn’t be ignored:

#1: Children in rural Oregon on Medicaid suffered more health-related dental challenges compared to children with private insurance, including the pain, systemic health problems and disruptions to education that come with them. Advantage Dental, the state’s largest provider of Medicaid services, was determined to do something about it.

#2: New mothers on Medicaid in a New York City hospital were less likely to have a postpartum care visit compared to privately insured women. As a result, they missed assessments and screenings for a number of health conditions, some of which can lead to chronic health problems throughout their lives. For many women, the postpartum visit is one of the few chances to engage them in ongoing health care. The providers and care teams at the Icahn School of Medicine and the Mount Sinai Health System wanted to find out what it takes to increase postpartum visit rates.

#3: In Fairfax County, Virginia, multi-racial and multi-ethnic populations being served in three County-funded safety-net clinics were less likely to receive the typical high-quality care provided for hypertension, diabetes, and cervical cancer screening when compared to their Hispanic counterparts. The providers and teams at the Community Health Care Network stepped forward to address the issue.
Continue reading…

Silencing Noisy Health Care?

Oct 30, 2018

By MATTHEW HOLT

As you’ve probably heard (enough!) from me and Indu Subaiya over recent months on video, at Health 2.0 or here on THCB, we are finally arriving at the point where health care tech is “flipping the stack” — where we realize that we can’t practice the old way, and instead need to move the care of the chronically ill to an always on, always monitoring, always measuring, always messaging tech platform.

But we need to figure out a way to both create that platform and the services for the people who need help–without overwhelming them. Too often we are putting too much technology into patients’ and clinicians’ lives and creating too much noise. While I’ve been aping Bob Wachter calling for an air traffic control function in health care, one of the most interesting new companies in health tech/services, Livongo, has been working on a related idea. They’ve been promoting it by looking to #SilenceNoisyHealthCare on Twitter and Linkedin recently

Tuesday 30th at 1 ET – 10 PT I’m hosting a webinar with Livongo’s CEO Glen Tullman & & Chief Medical Officer Jennifer Schneider, M.D. Jessica DaMassa tweeted that Glen and I are in a cage match, and it is an Oxford v Cambridge affair (although Jennifer brings some Stanford & Hopkins class to the proceedings).

But what’s really going on is that Livongo is adopting a new philosophy that they think will silence the noise and fix the patient experience. What do they mean by that? Join me on the webinar to learn more.

All Health Policy Is Local: The Case of the Individual Mandate Penalty in New York

Oct 29, 2018• 2

By CHRISTINE EIBNER PhD, SARAH NOWAK PhD, MS, PREETHI RAO PhD

Although signed into law in 2010, the Affordable Care Act has been in constant flux, with key aspects changing due to time-dependent provisions, Supreme Court decisions and shifts in U.S. policy. The effects of changes to the ACA on health insurance enrollment and premiums often depend on state regulatory decisions and other state-specific factors. The elimination of the individual mandate penalty is a prime example of this when applied to New York state, which has unusual rules in its individual insurance market.

In 2019, consumers will no longer face financial penalties stemming from the ACA’s individual mandate, which requires most people to secure health insurance. Without pressure from the individual mandate to enroll, younger and healthier people might drop coverage, leading to premium increases. New York’s health insurance regulations and expansive safety-net programs could make the state’s insurance market particularly susceptible to premium increases after the penalty’s elimination.

New York uses what is known as “full community rating” in its individual health insurance market, which means that all adult enrollees, regardless of age or whether they use tobacco, are charged the same premium. In most states, the youngest adults in the market pay one-third of what older adults do, and tobacco users are charged 1.5 times as much as non-users. New York’s flat premium structure raises costs for younger enrollees and nonsmokers, making them more likely drop coverage when the penalty goes away.

Hospitals Can and Should Support Employees Who Are Victims of Domestic Violence: Here’s How

Oct 26, 2018• 6

By PATRICK HORINE

Every October we recognize Domestic Violence Awareness Month, an important opportunity to discuss this widespread social and public health problem and to take stock of what we can do better to protect victims of domestic abuse.

Unfortunately, the data shows us that health care is often a dangerous profession that is also rife with domestic abuse. Earlier this month a new poll of ER physicians revealed nearly half report having been physically assaulted at work (largely by patients and/or visitors in the ER). However, other data shows us that individuals in the health care professions – especially women—may be at greater risk of domestic abuse from a spouse or partner, while on the job as well. Data on domestic violence nationwide shows us one in four women are in a dangerous domestic situation, and one in four victims are harassed at work by perpetrators. Women make up 80 percent of the healthcare workforce and an even greater percentage in most hospitals. When we do the math, this means one in 20 female healthcare workers are likely to be harassed or even assaulted on the job.

Furthermore, given that hospitals and most healthcare organizations are “open” facilities where anyone can walk onto the premises this further heightens the risk of a violent incident happening in the workplace. Over half of the homicides committed by intimate partners occur in parking lots and public buildings. News stories like the ones about a California healthcare worked stabbed in the hospital parking lot by her estranged husband while her co-workers looked on are all too tragic and common.

The Futility of Patient Matching

Oct 25, 2018• 5

By ADRIAN GROPPER, MD

The original sin of health records interoperability was the loss of consent in HIPAA. In 2000, when HIPAA (Health Insurance Portability and Accountability Act) first became law, the Internet was hardly a thing in healthcare. The Nationwide Health Information Network (NHIN) was not a thing until 2004. 2009 brought us the HITECH Act and Meaningful Use and 2016 brought the 21st Century Cures Act with “information blocking” as clear evidence of bipartisan frustration. Cures, in 2018, begat TEFCA, the draft Trusted Exchange Framework and Common Agreement. The next update to the draft TEFCA is expected before 2019 which is also the year that Meaningful Use Stage 3 goes into effect.

Over nearly two decades of intense computing growth, the one thing that has remained constant in healthcare interoperability is a strategy built on keeping patient consent out of the solution space. The 2018 TEFCA draft is still designed around HIPAA and ongoing legislative activity in Washington seeks further erosion of patient consent through the elimination of the 42CFR Part 2 protections that currently apply to sensitive health data like behavioral health.

The futility of patient matching without consent parallels the futility of large-scale interoperability without consent. The lack of progress in patient matching was most recently chronicled by Pew through a survey and a Pew-funded RAND report. The Pew survey was extensive and the references cite the significant prior efforts including a 100-expert review by ONC in 2014 and the $1 million CHIME challenge in 2017 that was suspended – clear evidence of futility.