The Health Care Blog – Page 254 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Supreme Court Needn’t Fear Healthcare Law’s Individual Mandate Provision

Oct 1, 2018

By Vikram Amar and Alan Brownstein

The Affordable Care Act faced a possibly fatal challenge when the constitutionality of its individual mandate provision was argued in the Supreme Court.

Much of the terrain was easy going. Neither the justices nor the lawyers doubted that the healthcare and healthcare insurance markets involve interstate commerce — insurance and healthcare providers are usually national or at least regional operations, folks who cross state lines get sick and must be cared for away from home regularly, and people are often unable to relocate to another state for fear of losing employer-based coverage. Nor was it disputed that the mandate was sincerely motivated by and closely related to the regulation of these interstate markets. Those two conclusions are usually sufficient to justify the exercise of congressional power under the commerce clause of the Constitution.

But then things got more treacherous. The problem, suggested by numerous questions from the conservative justices on the court, was the slippery slope they saw created by the mandate — the idea that Congress was requiring individuals to buy something. If the feds can require each person to buy health insurance, what can’t they force people to purchase?

That Tremor? It’s U.S. Healthcare Crumbling under Pressure

Oct 1, 2018

By DIANE EVANS

On the road to healthcare reform, let’s not forget the basics: Americans still need affordable, fast access to doctors. By steamrolling too much change at one time, the risk is that basic needs will go unmet amid reforms that aren’t widely understood and that ultimately will result in patient care determined by government-approved treatment plans.

It is important that average Americans be aware of what’s happening, and what’s at stake, while there is still time to preserve stability in our current healthcare system as it transitions to high technology.

A major problem is that too much of healthcare reform is being planned and executed in a vacuum – apart from important considerations such as thepotential for mass retirements of aging doctors, potentially leading to severe shortages and longer wait times for patients, all at a time of increased demand on the system due to aging baby boomers. Curiously, doctors must focus now on entering patient data into electronic devices, when by the federal government’s own timetable, the necessary technology to accomplish healthcare reform won’t be in place until 2024.

The Unlikely Heroes of Healthcare

Oct 1, 2018

By TIMOTHY HOFF

The unlikely heroes of American health care do not have fancy degrees. They are ordinary workers with high school degrees who can do their jobs with as little as an additional year of training. On average, they earn between $30,000 and $40,000 annually. Many have never worked in health care before. They work as employees, and almost all are female. They are the indispensable go to workers of the new American health care system because they are inexpensive to use and they can be plugged into many different workflows within a medical setting. They are medical assistants.

According to the Bureau of Labor Statistics (BLS), medical assistants perform both administrative and clinical duties under the direction of a physician. In 2014 there were almost 600,000 medical assistants employed in the United States, earning on average fifteen dollars an hour. Most of these work in physician offices, primarily in ambulatory care settings. Three states—California, Florida, and Texas—employ almost a third of all U.S. medical assistants. Every health care delivery organization in the Boston area now leans heavily on these workers to meet their production demands.

Medical assistants are a highly practical, cost-effective disruption that makes doctors’ lives easier, nurses able to upskill and do more, and patients gain easier access to and reliability around their care. No other workers in health care are involved in such a wide array of duties. Physicians increasingly rely on them as their jack of all trades support staff. Many patients in primary care now have more face and phone time with an MA than they do with their primary care doctor, who increasingly is hidden from our view, funneled towards the most complex patient visits coming through their door each day.

Beyond their direct interface with patients, medical assistants also support the quality reporting and performance measurement work in today’s doctors’ offices, often making sure quality data are complete and accurate within electronic health records, tracking down needed information, steering patients to required services, and getting performance data to the various insurance plans and accrediting agencies. This work is increasingly important for health care organizations to get paid, and for patients to get better care.

Expensive Hospitals: The Enemy Within

Oct 1, 2018• 18

By ANISH KOKA MD

Everyone agrees that health care is bankrupting the nation. The prevailing winds have carried the argument that a system that pays per unit of health care delivered and thus favors volume over value is responsible. The problem, you see, was the doctors. They were just incentivized to do too much. This incontrovertible fact was the basis for changes in the healthcare system that favored hospital employment and have made the salaried physician the new normal. Yet, health care costs remain ascendant.

Why?

It turns out overutilization in the US healthcare system isn’t what its cracked up to be.

Figure 1. Utilization rates in different health care systems

A recent analysis (Figure 1) by Papanicolas et al., in JAMA demonstrates that while the United States is no slouch with regards to volume of imaging and procedures in a variety of different categories, it does not explain a health care system twice as expensive as its nearest competitor. The problem turns out not to be volume, rather its the unit price of healthcare in the United States.

Health Care Costs and Glass Houses

There are many stones cast by all the various players in healthcare when it comes to cost, and of course, everyone bears some degree of responsibility, but it’s also clear that some folks live in larger glass houses than others. The most beautiful of all the glass houses are those built by hospitals. From 1996 to 2013, it was not population growth, health status, doctors visits, or prescription drugs that drove spending increases. Sixty-three percent of the increase in cost over an almost 20-year time span can be attributed to hospital stays and testing during doctor visits. Consider that the average hospital stay in the US costs $18,142, and lasts 4.9 days compared to other industrialized countries where average hospital stays last 7.7 days, and cost $6,222. But despite these exorbitant prices hospital systems in the United States complain they barely stay afloat.

Escaping COVID-19

Sep 30, 2018

By RAGHAV GUPTA, MD

“In seeking absolute truth, we aim at the unattainable and must be content with broken portions.”
– William Osler

A colleague shared an experience with me about testing one of his patients for the novel coronavirus and it left me a bit puzzled. An elderly gentleman with past medical history of severe COPD and non-ischemic cardiomyopathy came to ER with shortness of breath, edema and fatigue. Chest X-ray suggested pulmonary edema. He wanted to test him for SARS-CoV-2 but hesitated. Eventually he was able to order it after discussions with various staff administrators. Dialogue included sentences like “why do we need testing? He has CHF, not COVID-19” and “it could create panic amongst staff taking care of him”. I applauded my colleague’s persistence as eventually the test was done. Few of us have probably gone through or are going to encounter a similar scenario as we ‘re-open’. To not test is counter-intuitive and more like an escape from diagnosing the virus rather than the virus itself.

One – the mere fact that we might hesitate before testing for a virus which is a cause of a (currently ongoing) pandemic should ring all the bells of concern about lack of an optimal strategy. Inadequate testing has remained the Achilles heel of our stand against COVID-19 because, to have a lasting stand, we must know where to take the stand.

You Can’t “Elon Musk” Healthcare

Sep 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 Whole New Ball Game. Same Problems to Solve, Though.

Sep 30, 2018

By STEVEN FINDLAY

I’ll dive right in, with the stipulation that this blog is initial reaction in a very fluid, unprecedented and soon-to-be even-more-intense political environment. Fasten your seat belts!

The ACA. Replace is the critical word in “repeal and replace.” Consensus is already emerging that Trump and the Republicans will indeed repeal the ACA in early 2017, via the reconciliation process Congress used earlier this year. That resulted in the Senate’s first an only full ACA repeal vote. Obama vetoed the bill, of course. But Republicans demonstrated the do-ability of the reconciliation process. Lacking 60 votes in the Senate, they’ll very likely try repeal again that way. Continue reading…

Apple Watch Leaves Patients Connected with No Where To Go

Sep 28, 2018• 13

By GRACE CORDOVANO, Ph.D., BCPA

The highly anticipated unveiling of the Apple Watch Series 4 caused a news and social media sensation. Apple coined the iconic timepiece as the “guardian of your health”, with health tracking functionalities such as the ability to detect atrial fibrillation (AFib) by a self-performed electrocardiogram (ECG). But from patients’ and carepartners’ perspectives, there is a long road to a universally accessible, seamlessly implemented, mass-adoption, and meaningful use for this wearable technology.

Many experts, such as Dr. Eric Topol a cardiologist at the Scripps Research Institute, and other reports, were quick to highlight concerns about the consequences of false positives. The Apple Watch was criticized as a source for unnecessary anxiety. A letter from the Center for Devices and Radiological Health (CDRH) of the FDA, which cleared the ECG app as a class II over-the-counter (OTC) device, highlighted the risks to health and potential mitigation measures that the Apple Watch posed. Unfortunately, the vast majority of concerns in the public domain haven’t emphasized the risks to health due to poor implementation, integration, and adoption strategies of digital tools and wearables.

The current health care system needs to be significantly refreshed as it is not positioned to simply drop in advancements, such as those offered by the Apple Watch Series 4, into everyday patient care. Having Dr. Ivor Benjamin, president of the American Heart Association (AHA), endorse the Apple Watch at the Apple Keynote Event did wonders for the mass marketing appeal. It would’ve have been more credible and demonstrated more value if he stated that the AHA devised a strategic clinical practice implementation guide for cardiologists, created patient education materials for using the Apple Watch, partnered with payers to incentivize doctors to adopt the technology, and reimburse for virtual consults to support remote patient monitoring (RPM).

Will Apple Track Your Mind, Not Just Your Heart?

Sep 27, 2018• 5

By MICHAEL MILLENSON

If your heart throbs with desire for the new Apple Watch, the Series 4 itself can track that pitter-pat through its much-publicized ability to provide continuous heart rate readings.

On the other hand, if you’re depressed that you didn’t buy Apple stock years ago, your iPhone’s Face ID might be able to discover your dismay and connect you to a therapist.

In its recent rollout of the Apple Watch, company chief operating officer Jeff Williams enthused that the device could become “an intelligent guardian for your health.” Apple watching over your health, however, might involve much more than a watch.

The iPhone models introduced at the same time as the Series 4 all deploy facial analysis software. The feature works in part by projecting a grid of more than 30,000 infrared dots on the user’s face in order to create a three-dimensional map for user recognition. Continue reading…

Making Healthcare a Consumer Biz: Livongo’s Glen Tullman on his New Book & IPO Rumors

Sep 26, 2018• 1

By JESSICA DA MASSA, WTF Health

“If we just shop for healthcare like we shop for everything else…we would take care of a lot of the problems…”

So says Glen Tullman, CEO of Livongo, a very hot startup with a chronic condition management platform that has been batting away IPO rumors since earlier this year when it closed a $52.M round funded by existing investors.

Glen has just literally written the book on consumerizing healthcare and stopped by to talk about it at the HIMSS TV set on location at Health 2.0’s Fall Conference (where I was guest hosting interviews!)

Called On Our Terms the book tries to push us toward thinking about the buying-and-selling of healthcare the same way we’d think about buying-and-selling anything else. Glen argues it’s possible if we start looking at healthcare as an ‘information business’ – and pivot our thinking and our business models accordingly to provide greater access to that information.

Are we as consumers ready for all this responsibility? Is the healthcare system ready for us and our purchasing power? Is anyone doing this right?? Glen fires back with some strong examples of where he already sees this working, and gets real about who’s in trouble if they don’t pivot and pivot fast. (We’re looking at you, payers.)

Bonus Intel: Will Glen take Livongo to an IPO like he did Allscripts? It’s a multi-million dollar question…

Get a glimpse of the future of healthcare by meeting the people who are going to change it. Find more WTF Health interviews here or check out www.wtf.health. Filmed at Health 2.0’s Fall Conference in Santa Clara, September 2018.