The Health Care Blog – Page 259 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Matthew Holt Interviews Regina Holliday at HIMSS

Sep 1, 2018

By PRIYA KUMAR

Another in a series of interviews that should have been posted months ago, but Matthew Holt is just getting to now.

If you don’t Regina Holliday, well you should. Regina is a patient rights activist and artist, and she founded The Walking Gallery of Healthcare in 2009 after attending her first medical conference. We are also pretty sure that Health 2.0, in 2010, was the first conference she was invited to speak at! She is on a mission to amplify patients’ voice by painting jackets for patients and providers.

Several companies and individuals are now asking Regina Holliday to paint their story. Today, The Walking Gallery has a total of 43 artists and 400+ painted jackets. Individuals who believe in the movement are asked to join Regina at Salt and Pepper Studios in Maryland, and are able to paint their patient narrative. Matthew Holt caught up with Regina at HIMSS back in February, where her painting was sponsored by Xerox Health for the first time at the conference. A very interesting woman with a different approach to supporting patient rights.

Priya Kumar is an Operations & Marketing Intern at Health 2.0, and a student at the George Washington University

Income Taxes and Healthcare: The Disconnect

Sep 1, 2018

By PAUL KECKLEY

After leaving Navigant in February, my pondering of ‘what’s next’ was interrupted by the reality of income taxes due weeks later. By midnight tonight, 240 million Americans will have filed, 53% will have paid something to Uncle Sam and all of us will be puzzled by where it goes and how it’s used.

Our federal individual taxes provide 47% of the federal government’s revenues, or $1.48 trillion for FY15. Payroll taxes paid jointly by workers and employers make up another 34%, or $1.07 trillion and corporate taxes 11%, or $342 billion.

The federal government will spend more than it receives: for FY2015 just ended, federal receipts from all sources were $3.25 trillion and expenditures were $3.68 trillion billion. And 25% of that went to Medicare and the federal its portion of the CHIP and Medicaid programs.

Healthcare makes up the biggest chunk of Treasury spending followed by Social Security (24%), Defense (16%), and a bucket of expenditures called Discretionary Spending (16%) over which Congress exercises its influence most directly. And when Defense spending for healthcare is added ($51 billion annually), the state portions of Medicaid and CHIP payments are added, and health coverage for federal employees are added, more than 30% of the federal spending goes to healthcare. So one might reason that if individual income taxes are 47% of total federal receipts, income taxes paid for more than $500 billion of the healthcare tab. But that’s not widely known or understood by taxpayers nor is it a complete picture.

150 Ways to Measure Healthcare Quality. Which One is Best?

Sep 1, 2018

By TOM EMERICK and DAVID TOOMEY

In a previous article, we referenced CMS’s new provider reimbursement model, called Medicare Access and CHIP Reauthorization (MACRA), which replaces the current reimbursement formula. MACRA will include an incentive component that will replace the incentive programs in plans today, and the details of the performance criteria are being determined for roll-out in 2019. From the providers’ lens, they are faced with the need to hire more administrative resources to keep up with the tracking of their performance, and the big question is – are consumers making different choices based on the performance results of a physician or hospital? When there are over 150 different measures in place today, how is an occasional consumer of healthcare services able to assess the most important criteria in finding the right physician?

During a recent employers’ conference on the east coast, the forum featured two panels consisting of the healthplans and the providers. The panels were set in a Q&A format to enlist the leaderships’ views on various topics facing the employers, and it was a fascinating dialogue that we have attempted to capture below.

In the first panel with the execs of five major carriers, the opening question asked for a one minute overview of their healthplan’s area of focus in addressing the employers’ challenges. The responses were consistent amongst the leaders – the focus is on the individual consumer and value-based contracting. When we evolved the discussion into quality criteria and outcomes to identify high performing physicians, the leaders acknowledged that defining quality and outcomes is a challenging endeavor, and each health plan has their own formula to assess the providers’ performance. One commented that a physician practicing in the morning could be viewed as a top performer by a carrier, while that afternoon, they could be ranked as a poor performer by another, even though the physician was delivering the same process of care for all their patients. They agreed that the employers really needed to weigh in on what was important to them, so there was greater consistency in the scoring logic with the physician community.

Measurement of Interoperability and the Transaction Receipt

Sep 1, 2018

By ADRIAN GROPPER, MD

Our aptly named Office of the National Coordinator needs your help. Congress wants to know if the regulations are working to enable interoperability and reduce information blocking. So, ONC wants us to “Help Inform the Department of Health and Human Services’ (HHS) Measurement of Interoperability” and has produced a helpful 19-page description of the issue. This interesting issue also made it to last week’s most august Joint HIT Committee for some lively discussion.

The only reasonable way to measure something is to consider the denominator as well as a numerator. Without the denominator to indicate the scope of what’s being measured, the numerator is likely to be misleading. With respect to interoperability, the denominator is simply all transactions that move individual-level patient data in or out of an institution.

Data moves in or out of an institution for different reasons and in different ways. The reasons include HIPAA Treatment, Payment, or Operations (TPO), to business associates, under patient authorization (regardless of whether it’s opt-in or opt-out), for research (e.g.: the Precision Medicine Initiative), and de-identified (to various data brokers and analytics services).

The ways that individual-level data moves is via analog fax, paper and film, digital media, or digital network. Measurement of interoperability would do well to consider all of these transports as part of the denominator.

We can define a data sharing transaction and hopefully allow a patient to request notification of that transaction. As individuals, we expect an accounting for data movement from our banks, email, and package services and we should expect the same for our health records. Specifically, I would define the following essential elements of a personal health data transaction:

Transaction Receipt and Notification

Resource (medication, problem, demographic, note, order, etc…HL7 coded, if possible)
Transport (fax, paper, film, digital device, digital network)
Client / Requesting Party (by institution, app, or individual name)
Date /Time (for any single client or requesting party, a monthly notice might be sufficient)
API Class (is the specific Resource also available through a patient-directed interface?)
Fee (who paid how much for this transaction or a link to the appropriate contract)

For a description of the API Class see https://thehealthcareblog.com/blog/2016/02/22/apple-and-the-3-kinds-of-privacy-policies/

Establishing the denominator from the transaction receipt perspective works whether or not an individual patient chooses to supply an email address for notification. The mere fact that such a notification is available improves transparency, cybersecurity, and trust.

As Bob Wachter has said, http://www.clinical-innovation.com/topics/analytics-quality/wachter-transparency-inexpensive-and-effective-tool transparency is an essential step to health system improvement. Let’s start with a transaction receipt and notification whenever our personal data is shared.

Is Medical Imaging a Ricardian Derived Demand?

Aug 30, 2018• 7

By SAURABH JHA

Medical Imaging and the Price of Corn

After the Napoleonic wars, the price of corn in England became unaffordable. The landowners were blamed for the high price, which some believed was a result of the unreasonably high rents for farm land. Economist David Ricardo disagreed.

According to Ricardo, detractors had the directionality wrong. It was the scarcity of corn (the high demand relative to its supply) that induced demand for the most fertile land. That is, the rent did not increase the price of corn. The demand for corn raised the rent. Rent was a derived demand.

Directionality is important. Getting directionality wrong means crediting the rooster for sunrise and blaming umbrellas for thunderstorms. It also means that focusing on medical imaging will not touch healthcare costs if factors more upstream are at play.

Medical imaging is a derived demand. The demand for healthcare induces demand for imaging. Demand is assured by the unmoored extent to which we go for marginal increases in survival.

Why Cochrane is Wrong About Hypertension. Very Wrong.

Aug 29, 2018• 6

By SWAPNIL HIREMATH MD, MPH

Archie Cochrane and the Cochrane Collaboration

Archie Cochrane was born in Scotland, educated in London (King’s College, University College and London School of Hygiene and Tropical Medicine) and worked in Cardiff, Wales. His work as a doctor during the Spanish Civil War and World War II, especially in a prisoner of war camp in Salonica, is credited with his push towards generating higher quality evidence. In his description of the clinical trial he conducted, he mentions James Lind as his hero. Ironically, that clinical trial – with weak randomization, open allocation, non-blinding of investigator or participants, and use of surrogate outcomes, would rate poorly in the Cochrane risk of bias tool.

But the scientific method of measuring stuck with him, and among many other achievements, he did perform a proper randomized clinical trial (RCT) a few decades later. He continued to be a strong supporter of RCTs and pushed for the Medical Research Council (MRC) to move from purely fundamental research towards applied clinical research. As an aside, the first proper RCT in the modern era was funded by the MRC and was published in 1950 – on the use of Streptomycin vs para-aminosalicylic acid, or a combination, in tuberculosis. Far more influential was his paper (and later book) published as part of the Rock Carling Fellowship, available here freely and worth a read. It’s where he puts forward the vision for RCTs in moving towards what he termed an ‘effective, efficient health service’.

Health in 2 Point 00, Episode 46

Aug 29, 2018• 1

Jessica DaMassa asks me about single payer polling high, big VC for women’s pelvic floor digital therapeutic Renovia, 23andme cutting off API access to its data, plus guest mentions for Shafi Ahmed and Glen Tullman. All in 2 minutes (more or less!)–Matthew Holt

Prior Authorizations: Will They Become Damocles Sword?

Aug 28, 2018• 29

By NIRAN AL-AGBA MF, FAAP

In July 2009, the family of Massachusetts teenager Yarushka Rivera went to their local Walgreens to pick up Topomax, an anti-seizure drug that had been keeping her epilepsy in check for years. Rivera had insurance coverage through MassHealth, the state’s Medicaid insurance program for low-income children, and never ran into obstacles obtaining this life-saving medication. But in July of 2009, she turned 19, and when, shortly after her birthday, her family went to pick up the medicine, the pharmacist told them they’d either have to shell out $399.99 to purchase Topomax out-of-pocket or obtain a so-called “prior authorization” in order to have the prescription filled.

Prior authorizations, or PAs as they are often referred to, are bureaucratic hoops that insurance companies require doctors to jump through before pharmacists can fulfill prescriptions for certain drugs. Basically, they boil down to yet another risky cost-cutting measure created by insurance companies, in keeping with their tried-and-true penny-pinching logic: The more hurdles the insurance companies places between patients and their care, the more people who will give up along the way, and the better the insurers’ bottom line.

PAs have been a fixture of our health care system for a while, but the number of drugs that require one seems to be escalating exponentially. Insurance companies claim that PAs are fast and easy. They say pharmacists can electronically forward physicians the necessary paperwork with the click of a mouse, and that doctors shouldn’t need more than 10 minutes to complete the approval process.

Comprehensiveness is Killing Primary Care

Aug 24, 2018• 20

By HANS DUVEFELT, MD

Dr. Hans Duvefelt

In most other human activities there are two speeds, fast and slow. Usually, one dominates. Think firefighting versus bridge design. Healthcare spans from one extreme to the other. Think Code Blue versus diabetes care.

Primary Care was once a place where you treated things like earaches and unexplained weight loss in appointments of different length with documentation of different complexity. By doing both in the same clinic over the lifespan of patients, an aggregate picture of each patient was created and curated.

A patient with an earache used to be in and out in less than five minutes. That doesn’t happen anymore. Not that doctors and clinics wouldn’t love to work that way, but we are severely penalized for providing quick access and focused care for our well-established patients.

A Cross-Party Win: Empowering Consumers Through Digital Health

Aug 23, 2018• 1

By LYGEIA RICCIARDI

These days Americans are more politically divided than ever, disagreeing vehemently about everything from guns to the role of the press. Despite the distrust and inflammatory rhetoric, there are examples of cross-party, trans-Administration collaboration and success. Let’s celebrate them and be motivated by what happens we put differences aside and focus on shared long-term goals.

Using digital technology to empower healthcare consumers is one example of a cross-party win, a still-developing success story that has been cultivated for more than a decade by the efforts of public and private sector leaders from a wide variety of affiliations and political perspectives.