The Health Care Blog – Page 285 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

The Healthcare.gov Rescue and the Hawaii False Alarm . When Good Government Tech Goes Bad.

Feb 16, 2018• 1

By ERIE MEYER

By now, you’ve heard of the Hawaii False Alarm, and about the blowback and blame as people try to sort out how this could have happened. In government circles, however, there have been empathy and knowing cringes. It is the norm, not the exception, that government systems are confusing and hard to use. Horrible mistakes happen when people use clunky government systems — they just usually don’t make the news.

In fact, the last time a government technology failure was so thoroughly plastered across the news was when healthcare.gov failed to launch. At the time, I was working for the Chief Technology Officer of the United States in the White House. It was a difficult, frustrating time — but the media glare and public outrage opened up an opportunity to make some critical progress on changes that government workers had been asking for, for years, to prevent it from happening again. Government design is news right now, so I thought I’d share some thoughts on what people working on this problem could do next.

On Data and Informatics For Value-Based Healthcare

Feb 15, 2018• 3

By SALLY LEWIS, MD

Introduction

Value-based healthcare is gaining popularity as an approach to increase sustainability in healthcare. It has its critics, possibly because its roots are in a health system where part of the drive for a hospital to improve outcomes is to increase market share by being the best at what you do. This is not really a solution for improving population health and does not translate well to publicly-funded healthcare systems such as the NHS. However, when we put aside dogma about how we would wish to fund healthcare, value-based healthcare provides us with a very useful set of tools with which to tackle some of the fundamental problems of sustainability in delivering high quality care.

What is value?

Defined by Professor Michael Porter at Harvard Business School, value is defined as a function of outcomes and costs. Therefore to achieve high value we must deliver the best possible outcomes in the most efficient way, outcomes which matter from the perspective of the individual receiving healthcare and not provider process measures or targets. Sir Muir Gray expands on the idea of technical value (outcomes/costs) to specifically describe ‘personal value’ and ‘allocative value’, encouraging us to focus also on shared decision making, individual preferences for care and ensuring that resources are allocated for maximum value.
This article seeks to demonstrate that the role of data and informatics in supporting value-based care goes much further than the collection and remote analysis of big datasets – in fact, the true benefit sits much closer to the interaction between clinician and patient.

Impact of FHIR + SMART on FHIR

Feb 15, 2018

SPONSORED POST

By HEALTH 2.0

The Future of Data Access in Health Care

The advent of FHIR and SMART on FHIR has been a huge game changer in recent years. FHIR is radically changing the way we think about integration of innovative applications, making it faster, easier and less disruptive to workflow. It has allowed developers to create medical applications, which can be easily integrated into existing systems. SMART on FHIR is a related utility, which allows web apps to run inside a browser so clinicians can use them without leaving the EMR environment.

More than 35 provider organizations have exposed their FHIR APIs. Allscripts has been leading the charge in API adoption for some years now with their plug and play-like platform that developers can build new technologies and applications on top of. Not to be outdone, Epic opened up their API in 2017, thus signaling a refusal to be made obsolete by the more nimble and comparatively newer players.

“The emergence of blockchain, FHIR and other technologies leads to a bigger question. What happens to health care when there is unfettered data access and the monopoly of the user interface goes away?”, said Health 2.0’s Matthew Holt and Indu Subaiya.

Learn about the SMART on FHIR Stack and tools that can be used to deploy world-class applications at Dev4Health on April 30 – May 1, 2018 in Cleveland, Ohio. Join developers, innovative leaders, designers, chief technology officers, chief innovation officers, start-ups, and health tech enthusiasts for two days of strategic networking, idea generation, and innovative workshops – plus live demos some of the newest health tech start-ups. Register today!

2018 Forecast: Another Theranos, Hospital Hiring Slows & Successful HIT Exits

Feb 13, 2018• 3

By BOB KOCHER MD and BRYAN ROBERTS

For what is now an annual tradition, we are once again attempting to be healthcare soothsayers. We are proud to share with you our 10 healthcare predictions for 2018. In 2017, amaz-ingly, eight of our predictions came true.

For 2018, we are betting on the following:

1. Another Theranos

We think at least one healthcare information technology company with an enterprise value of more than $1 billion (not including Outcome Health, which we could not have predicted tanking so spectacularly quickly) will be exposed as not having product results to support their hype. It will also expose embarrassed investors who did not do careful diligence and founders with poor integrity.

2. Hospital hiring slows

After a decade of sustained hiring every month, hospitals will stop. Many will downsize their administrative staffs as admissions continue to slowdown and reimbursement pressures intensify. We expect multiple months with net healthcare job losses which would be the first time this has occurred since the Bureau of Labor Statistics started tracking the data.

3. Successful HCIT exits

After a long wait, and more than $10 billion of venture capital invested in startups over the past five years, we will begin to see successful IPO and M&A exits. These will reassure growth investors to keep pouring money into companies with traction.

4. Amazon does not disrupt PBMs

Despite daily rumors, we think Amazon will not shake up the PBM sector. Instead, Amazon will limit its healthcare market footprint to its existing consumer products and distributing non- regulated healthcare goods to healthcare providers (adopting a B2B and not B2C strategy).

Questioning the Link Between Sports-Related Concussions and CTE

Feb 12, 2018• 9

By JASON CHUNG, PETER CUMMINGS MSc, MD and UZMA SAMADANI

On Jan. 18, an article by Dr. Lee Goldstein of Boston University and colleagues in Brain, a leading neurological journal, was released and touted as proving the link between subconcussive hits to the head and chronic traumatic encephalopathy (CTE) (“Real risk of CTE comes from repeated hits to the head, study shows,” Feb. 4). That same day the CTE advocacy group — the Concussion Legacy Foundation — announced a national campaign called F14G Football to convert all under-14 football into flag football, thereby eliminating tackle football.

The message sent to assembled media and onlookers was that eliminating tackle football for youth is the key to safeguarding the brains and futures of America’s youth.

The truth is not so simple.

The scientific evidence linking youth casual sports play to brain injury, brain injury to CTE, and CTE to dementia is not strong. We believe that further scientific research and data are necessary for accurate risk-benefit analysis among policymakers for two reasons.

First, evidence-based science calls for research to be conducted under generally accepted principles. The case series presented by the Boston University group, primarily due to its ascertainment bias, is weaker than the evidentiary standard sufficient to demonstrate an association or causation and conflicts with pathologic findings in other studies.

CTE pathology in the brain has been shown by British pathologists to be present in approximately 12 percent of normal healthy aged people who died at an average age of 81 years (Ling et al. Acta Neuropathologica). The presence of CTE pathology in the brain on autopsy has not been shown to correlate with neurologic symptoms before death.

To be clear, CTE pathology could be present in a normal person.

The Doctor Squared Movement: An Alternative to Regulatory Burden

Feb 12, 2018• 14

By NIRAN AL-AGBA, MD

The 4th amendment of the U.S. Constitution shields an individual (or business) from unreasonable government intrusion. It is inferred this right extends to ALL people, regardless of profession. Advanced nurse practitioners are independently practicing medicine in 23 states yet are not subject to onerous Maintenance of Certification (MOC) requirements– physicians are not equally protected under the law. Physicians must fight, as one group, against the burden of MOC. We have two choices: become a Doctor Squared (Dr. ²) or join an alternative certification organization such as the National Board of Physicians and Surgeons (NBPAS.)

A Doctor Squared (Dr. ²) denotes one who obtains both an MD and a DNP (Doctor of Nurse Practitioner) degree. This allows independent practice and eliminates the power of MOC. Reviewing a list of affordable DNP programs in the country shows a degree from the University of Massachusetts – Boston DNP program only costs $10,180. Coursework is online, and will take only 3 years if attending part-time. Renewal of an MD license in Washington State costs $697 biannually while DNP license costs $125, putting more money in my pocket. Additionally, the continuing education requirement is different; advanced practice nurses must complete 15 hours annually while physicians need 50 hours annually even though both professions are independently practicing medicine. According to Medscape, malpractice insurance rates are $12,000 yearly (2012) for a family physician, while a family nurse practitioner pays $1200, one-tenth as high. Remember, the cost of MOC for internal medicine is $23,600 every 10 years.

Health in 2 point 00, Episode 1

Feb 12, 2018

We are going to start some new content on THCB in the next few weeks including a lot more video hosted by Jessica DaMassa. And one weekly show will be her asking me as many questions as I can answer in two minutes. Here’s the first crack at it. Hope you enjoy it!–Matthew Holt

Artificial Intelligence & How Doctors Think: An Interview with Thomas Jefferson’s Stephen Klasko

Feb 11, 2018• 1

AJAY KOHLI, MD

As I walk into the building, the sheer grandiosity of the room is one to withhold — it’s as if I’m walking into Grand Central station. There’s a small army of people, all busy at their desks, working to carry out the next wave of innovations helping more than a million lives within the Greater Philadelphia region. However, I’m not here to catch a train or enjoy the sights. I’m at the office of the President and CEO of Thomas Jefferson University, Dr. Stephen Klasko, currently at the helm of one of the largest healthcare systems in the U.S.

Let me backup a little.

The theme of nearly every conversation about the future of technology now revolves around Artificial Intelligence (AI). Much weight is placed on the potential capacity of AI to disrupt industries and change them to the very core. This pressure has been felt to a large extent within nearly every aspect of healthcare where AI has been projected to improve patient care delivery while saving billions of dollars.

Unfortunately, most discussions exploring the implications of AI only superficially look at either the product or the algorithm that powers these products. The short-sightedness of this approach is not an easy one to fix. Yes, clinical studies validating AI backed products are vital but AI cannot be viewed just like any other drug or a medical device. There’s much more to be considered when we examine the broader role of this technology, because this technology can shape the entire healthcare system. To place the impact of a far reaching technology, you need an even longer sighted vision. It’s a rare breed of people that have experienced the tumultuous history of change within medicine but can still call upon the lessons learned to execute innovations and bring meaningful results.

Why Raising Hospital Prices is a Zero Sum Game

Feb 9, 2018• 8

By ROBERT PEARL, MD

In the early 1960s, President John F. Kennedy said, “The time to repair the roof is when the sun is shining.” It was a clarion call, a full-throated warning against national complacency in an era of great prosperity.

It was during this same period that community hospitals stood as the dominant force in American healthcare. By the mid-20th century, some 6,000 inpatient facilities had spread throughout the country, often serving as the financial glue of their respective communities. With well-paying jobs and boards made up of dignitaries, local hospitals aroused a great chorus of civic pride.

But in recent times, the proverbial roof over America’s hospitals has fallen into disrepair. Thanks to operational inefficiencies and declining utilization, more and more hospitals are experiencing financial problems and waning influence.

As health plans, pharmaceutical companies and new care-delivery entrants gain market clout at the expense of the hospital industry, panic is starting to set in. These developments have spurred a recent uptick in hospital mergers, which look more like deals of desperation than long-term growth strategies.

The Doctor and the CFO

Feb 9, 2018• 4

By SUHAS GONDI, MD

When my classmates and I returned to Boston to continue our first year of medical school early last month, we returned to a very different type of course, called “Essentials of the Profession.” In it, we explored health policy, social medicine, ethics, and other topics outside the realm of traditional physiology and disease but just as important to our roles as physicians. In the health policy class, we learned about escalating healthcare costs and how the landscape of American healthcare is changing. While the inclusion of these topics in our curriculum reflects a significant advance in medical education, our health policy teachings also exposed a critical gap in our training – one that will leave us ill-prepared to meet our future obligations as physicians.

Healthcare providers, we learned, are increasingly expected to consider the cost of clinical care, and the costs of care we deliver will influence how much we’ll be paid. Medicare is increasingly tying physician payment to spending benchmarks such that wasteful healthcare services will be punished with lower reimbursements. Further, providers are being pressured by public and private payers to enter into alternative payment models that force physicians to bear financial risk. This means that doctors may lose money if they spend more on patient care than government-set benchmarks. The goal is to incentivize cost-effective care and penalize inefficiency, in stark contrast to the traditional fee-for-service scheme, which encourages overutilization and contributes to cost growth.