The Health Care Blog – Page 266 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Giving Consumers the Tools and Support They Need to Navigate Our Complex Healthcare System

Jul 27, 2018• 8

By CINDI SLATER, MD, FACR

As physicians and healthcare leaders, we are already well aware that the majority of patients do not have the information they need to make a medical decision or access to appropriate resources, so we didn’t need to hear more bad news. But that is precisely what new research once again told us this spring when a new study showed that almost half of the time, patients have no idea why they are referred to a GI specialist.

While the study probably speaks to many of the communications shortcomings we providers have, across the board our patients often don’t know what care they need, or how to find high-value care. Last year, my organization commissioned some original research that found that while a growing number of patients are turning to social websites such as YELP, Vitals, and Healthgrades to help them find a “high quality” specialist, the top-ranked physicians on these sites – including GI docs – are seldom the best when we look at real performance data. Only 2 percent of physicians who showed up as top 10 ranked on the favorite websites also showed up as top performers when examining actual quality metrics. (The results shouldn’t surprise you as bedside manner has little to no correlation with performance metrics such as readmission rates).

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As providers and health care leaders, we lament that our patients are not better informed or more engaged and yet across the board, we have not given them the tools or resources they need to navigate our complex system. But now for some good news: all hope is not lost, and patients can become better consumers, albeit slowly, if we all do our part.

Health in 2 Point 00, Episode 41

Jul 26, 2018

After the longwinded-ness of last episode, Jessica DaMassa runs a tight ship today. Lantern’s demise, GSK & 23andme’s huge deal, yet another big chunk of change for American Well, and what was going on at #GoogleNext18 with Google Cloud in health –all asked by Jessica and answered by me, in under the 2 minute wire–Matthew Holt

AI to the Rescue: 5 Semi-Finalists Advancing Through the RWJF AI and the Healthcare Consumer Challenge!

Jul 24, 2018

By DIANA CHEN

Decision making is a daunting task. Combined with navigating health insurance jargon, scattered health information, and feeling crummy as you rush to find care during the onset of a cold, making decisions can be an absolute nightmare. However, artificial intelligence (AI) enabled tools have the potential to change the way we interact with and consume healthcare for the better. AI’s ability to comprehend, learn, optimize and act are keys to organizing the varying nuisances of the healthcare experience.

In a 2018 survey by Accenture, healthcare consumers indicated they would likely use AI for after hours care, support in navigating healthcare services, lifestyle advice, post-diagnosis management, etc. While AI in health is not limited to these functions, the report highlights consumers’ trouble in making informed healthcare decisions, hence this may be an area where AI can truly help.

Health in 2 Point 00, Episode 40

Jul 24, 2018

In this episode Jessica DaMassa asks about the thunder from Down Under, well the noise about the My Health Record program in Australia, the latest on women in health IT from Rock Health, and nearly gets to Click Therapeutics $17m round…all under the watchful gaze of Buddha–Matthew Holt

Making Sense of the Health Care Merger Scene

Jul 23, 2018• 11

By JEFF GOLDSMITH

In the past 12 months, there has been a raft of multi-billion-dollar mergers in health care. What do these deals tell us about the emerging health care landscape, and what will they mean for patients/consumers and the incumbent actors in the health system?

Health Systems

There have been a few large health system mergers in the past year, notably the $11 billion multi-market combinations of Aurora Health Care and Advocate Health Care Network in Milwaukee and suburban Chicago, as well as the proposed (but not yet consummated) $28 billion merger of Catholic Health Initiatives and Dignity Health. However, the bigger news may be the several mega-mergers that failed to happen, notably Atrium (Carolinas) and UNC Health Care and Providence St. Joseph Health and Ascension. In the latter case, which would have created a $45 billion colossus the size of HCA, both parties (and Ascension publicly) seemed to disavow their intention to grow further in hospital operations. Ascension has been quietly pruning back their operations in markets where their hospital is isolated, or the market is too small. Providence St. Joseph has been gradually working its way back from a $500 million drop in its net operating income from 2015 to 2016.

Another notable instance of caution flags flying was the combination of University of Pittsburgh Medical Center (UPMC) and PinnacleHealth, in central PA, which was completed in 2017. Moody’s downgraded UPMC’s debt on the grounds of UPMC’s deteriorating core market performance and integration risks with PinnacleHealth. As Moody’s action indicates, investor skepticism about hospital mega-mergers is escalating. Federal regulators remain vigilant about anti-competitive effects, having scotched an earlier Advocate combination with NorthShore University HealthSystem in suburban Chicago. The seemingly inevitable post-Obamacare march to hospital consolidation seems to have slowed markedly.

However, the most noteworthy hospital deal of the last five years was a much smaller one: this spring’s acquisition of $1.7 billion non-profit Mission Health of Asheville, NC, by HCA. This was remarkable in several respects. First, it was the first significant non-profit acquisition by HCA in 15 years (since Kansas City’s Health Midwest in 2003) and HCA’s first holdings in North Carolina. While Mission’s search for partnerships may have been catalyzed by a fear of being isolated in North Carolina by the Atrium/UNC combination, Mission Health certainly controlled its own destiny in its core market, with a 50% share of western North Carolina. Mission was not only well managed, clinically strong and solidly profitable, but its profits rose from 2016 to 2017, both from operations and in total.

Is the Conservative Establishment Against Entitlement Reform?

Jul 22, 2018

By Avik Roy

One of the oddest aspects of the last six months has been the degree to which the Republican base has embraced symbolic (9-9-9) over substantive (Paul Ryan) positions on entitlement reform from the GOP Presidential field. Why is this happening? Over at Redstate.com, bastion of populist conservatism, Dan McLaughlin thinks he has the answer. But in fact, his essay answers a different question: why it is that conservative voters remain woefully unprepared to tackle the fiscal challenges ahead.

“There’s been a lot of talk,” Dan opens, “about the struggle between the GOP ‘Establishment’ and ‘Outsiders,’ sometimes—but sometimes not—meaning the Tea Party…it’s time to clarify the core issue that has people…scratching their heads at their own constituents.” So what is it that divides conservatives? Is it social issues? Knowledge of French? “The answer is a simple one: it’s almost entirely about spending.”

According to Dan, the divide between the Establishment and the Outsiders is their commitment to reducing government spending. “There is general philosophical agreement among both Republicans and conservatives about [the need to reduce spending]. Where the fault line lies is in exactly how far we are willing to go to do something about it.” According to Dan, the establishmentarian candidates are “the two Northeasterners,” Mitt Romney and Rick Santorum, with Rick Perry and Ron Paul as the outsiders and Newt Gingrich “in the middle.”

Are Doctors Bribed by Pharma? An Analysis of Data

Jul 21, 2018• 23

By RAFAEL FONSECA, MD & JOHN A. TUCKER, MBA PhD

A Critical Analysis of a Recent Study by Hadland and colleagues

Association studies that draw correlations between drug company-provided meals and physician prescribing behavior have become a favorite genre among advocates of greater separation between drug manufacturers and physicians. Recent studies have demonstrated correlations between acceptance of drug manufacturer payments and undesirable physician behaviors, such as increased prescription of promoted drugs. The authors of such articles are usually careful to avoid making direct claims of a cause-effect relationship since their observations are based on correlation alone. Nonetheless, such a relationship is often implied by conjecture. Further, the large number of publications in high profile journals on this subject can only be justified by concerns that such a cause-and-effect relationship exists and is widespread and nefarious. In this article, we will examine a recent paper by Hadland et al. which explores correlational data relating opioid prescribing to opioid manufacturer payments and in which the authors imply the existence of a cause-and-effect relationship.¹

We propose the relationship between transactions between the private sector (e.g., meals provided, consulting payments) and prescribing habits can fall into one of three categories:

Type	Effect	Comments
0	There is no cause-effect relationship between these transactions and prescribing habits. Correlative observations may merely be reflections of practice patterns, and likelihood to use a drug category.	No harm exists.
Ia	There is a demonstrable cause-effect for transactions and prescribing patterns. However, this relationship is associated with increased use of drugs that have been proven to be an improvement over the current standard.	The effect is beneficial for patients. “Beneficial marketing.”
Ib	An adverse causative effect is documented with establishment of causation. There is a possibility of patient harm.	Patient harm occurs because the wrong medication is administered and contravenes medical standards. A minor damage is done but arguably exists, if a physician prescribes a more expensive medication when a cheaper alternative exists. “Nefarious marketing.”

Hadland et al.: Opioid Prescriptions and Manufacturer Payments to Physicians

The authors of this paper linked physician-level data from the 2014 CMS Open Payments database to 2015 opioid prescribing behavior described in the Medicare Opioid Prescribing Database. They explored the hypothesis that meals and other payments increase physician opioid prescribing by examining the association between receipt of meals and other financial benefits with the number of opioid prescriptions written[1]. Specifically, they found the following:

The Rise of Litigation in the US

Jul 21, 2018• 2

By SAURABH JHA

How did Americans become so litigious? What is the rationale of tort? Will tort reform work? I discuss these questions with Walter Olson, senior scholar at the Cato Institute, and author of the book, Litigation Explosion.

Listen to our discussion on the Radiology Firing Line Series, hosted by the Journal of the American College of Radiology, and sponsored by Healthcare Administrative Partners.

Information Blocking–The AHA Comments & PPR Responds

Jul 20, 2018• 3

By ADRIAN GROPPER

The focus on the CMS rules on information blocking continues on THCB. We’ve heard from Adrian Gropper & Deborah Peel at Patients Privacy Rights, and from e-Patient Dave at SPM and Michael Millenson. Now Adrian Gropper summarizes — and in an linked article –notates on the American Hospital Association’s somewhat opposite perspective–Matthew Holt

It’s “all hands on deck” for hospitals as CMS ponders the definition and remedies for 21st Century Cures Act information blocking.

This annotated excerpt from the recent public comments on CMS–1694–P, Medicare Program; Hospital Inpatient Prospective Payment Systems… analyzes the hospital strategy and exposes a campaign of FUD to derail HHS efforts toward a more patient-centered health records infrastructure.

Simply put, patient-directed health records sharing threatens the strategic manipulation of interoperability. When records are shared without patient consent under the HIPAA Treatment, Payment and Operations the hospital has almost total control.Continue reading…

What’s Next in Health Tech Investment? 500 Startups VC Marvin Liao Weighs In

Jul 19, 2018

By JESSICA DAMASSA

What do health tech investors think is ‘hot’ these days? Where is the money going? I ran into Marvin Liao, partner at 500 Startups (a VC fund/accelerator program that has made more than 2000 investments in early-stage tech startups over the past eight years) at ICEE Health in Bucharest, Romania, last month and had a chance to ask.

With refreshing candor, Marvin weighs in on whether or not digital therapeutics, mental health, and biotech have room to grow — and if Apple, Google, and Amazon really have the power to change the future of health.

Where is he most bullish? It’s no surprise I ran into him outside the US. He’s got his eyes on bleeding edge innovations coming out of foreign markets…especially Japan. Have a look!

Filmed at ICEE Health in Bucharest, Romania, June 2018. Find more interviews about health & technology at www.wtf.health.