By JEFF GOLDSMITH

The healthcare world learned with great sadness this week of the passing of our friend, Uwe Reinhardt. I met Uwe in 1982 at the Federation of American Hospitals meeting in Las Vegas. Uwe opened the meeting by apologizing, in his disarming German accent, for not being his usual sharp self. He had, he said, skipped breakfast because his wife May had instructed him not to pay for anything in Las Vegas that he could get for free at home. This was vintage Reinhardt, innocent and knowing at the same time. That meeting was the beginning of a long and warm friendship.

Uwe would have been acutely uncomfortable with his colleagues referring to him as a “giant” in our field, because he was genuinely humble, and had not forgotten what it felt like growing up poor in devastated post-War Germany after WWII. And there was no sterner test of humility that occupying the James Madison Professorship of Political Economy at Princeton, just about as flossy an academic title as you will find.

For many years, Uwe taught a standing-room-only undergraduate course in Accounting at Princeton. The way he taught it was as a cleverly disguised course in moral philosophy. A main trope: “how would a ‘seasoned adult’ look at this problem?”  A ‘seasoned adult’ was someone who had lost his or her moral compass and sense of shame. So, where would a ‘seasoned adult’ book a bribe paid to a foreign official to obtain a contract, etc.? He was cleverly goading them not to lose their sense of outrage and their own moral compass, a tricky task without patronizing them.

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By UWE REINHARDT

Although, unlike most other nations, the U.S. has only two parties worth the name, their professed doctrines compared with their actions strikes me as more confusing than the well-known Slutsky Decomposition which, as everyone knows, can be derived simply from a straightforward application of Kramer’s rule to a matrix of second partial derivatives of a multivariable demand function.

The leaders of the drug industry, for example, probably are now breaking out the champagne in the soothing belief that their aggressive pricing policies for even old drugs are safe for at least the next eight years from the allegedly fearsome, regulation-prone, price-controlling Democrats. My advice to them is: Cool it! Follow me through a brief history of Republican health policy, to learn what Republicans will do to the health-care sector when it ticks them off.

Republicans like to tar Democrats over allegedly socialist policy instruments such as price controls, global budgets and deficit-financed government spending. Democrats usually roll over to take that abuse, almost like hanging onto their posteriors signs that says “Kick me.”  I say “abuse,” because Republicans have never shied away from using the Democrats’ allegedly left-wing tactics when health care chews up their budgets or turns voters against them.

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By ANDY ORAM

Clayton Christensen, the famous economist who popularized ideas of innovation and disruption, showed up at the recent Connected Health conference in Boston. Although billed as a panelist, he turned up without warning as a guest in a keynote and posed the same question I asked in an article back in July: “The overarching question: whither technology?”

Like my article, Christensen distinguished between incremental improvements that don’t challenge current power structures or sources of revenue, and disruptive change that offers new solutions to old, intractable problems. Disruptive change, as summarized by Christensen, changes processes as well as products.

A similar question came up in a panel, where the moderator asked his guests whether device and app manufacturers were thinking just about the health care field as it is now, or the field as it will be in four or five years. It’s telling that his question went unanswered. I believe that most health care developers are seeking a niche in the current ecology, although hoping to be able to make the evolutionary leap when that ecology changes.

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By HEALTH 2.0                                        SPONSORED POST

The Technology For Precision Health Summit is just around the corner, and it’s the place to discover new digital platforms that will improve the patient experience, and access a deeper insight into the data behind key decisions for treatment and for maintaining health.

Join more than 300 healthcare providers and payers, advocates, developers, investors, entrepreneurs, policymakers, and advocates for the 1-day action-packed summit which includes:

• Keynote presentation on quality of patient experience; and initiatives to improve care providers to securely review, analyze and share medical information across the healthcare system by Claudia Williams, CEO of Manifest MedEx; and a presentation by Carlos Bustamante, Professor of Biomedical Data Science, of Genetics at Stanford Medicine on Stanford Medicine’s precision health initiative, and an insight into its Precision Health and Integrated Diagnostics Center.
• Presentations and demos from Syapse and Cota focusing on genomics and other omics technologies that are rapidly making their way to clinicians and into Electronic Health Care Records (EHRs) during the Precision Medicine – Decision Support for Clinicians session.
• New Diagnostic and Screening Tools session featuring live demos from Helix, DotLab, Ivary, and ColorGenomics.
• An in-depth look at funding sources for precision medicine and health as well as insight on how value based medicine and population health incentives and policy are shaping investment with Illumina Accelerator, GE Ventures, Cricket Health, and the California Governor’s Office of Planning and Research during the Business Models and Investing in Precision Health session.

What are you waiting for? Register for the Technology for Precision Health Summit to see healthcare technology demos from some of the most innovative personalized medicine companies, and hear penetrating discussions on precision medicine delivery, innovation in clinical trials, and advances in oncology.

By ROBERT PEARL, MD

A strange thing happened last year in some the nation’s most established hospitals and health systems. Hundreds of millions of dollars in income suddenly disappeared.

This article examines the economic struggles of inpatient facilities, the even harsher realities in front of them, and why hospitals are likely to aggravate, not address, healthcare’s rising cost issues.

According to the Harvard Business Review, several big-name hospitals reported significant declines and, in some cases, net losses to their FY 2016 operating margins. Among them, Partners HealthCare, New England’s largest hospital network, lost $108 million; the Cleveland Clinic witnessed a 71% decline in operating income; and MD Anderson, the nation’s largest cancer center, dropped $266 million.

How did some of the biggest brands in care delivery lose this much money? The problem isn’t declining revenue. Since 2009, hospitals have accounted for half of the $240 billion spending increase among private U.S. insurers. It’s not that increased competition is driving price wars, either. On the contrary, 1,412 hospitals have merged since 1998, primarily to increase their clout with insurers and raise prices. Nor is it a consequence of people needing less medical care. The prevalence chronic illness continues to escalate, accounting for 75% of U.S. healthcare costs, according to the CDC.

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By KIP SULLIVAN, JD

The managed care movement thrives on misleading words and phrases. Perhaps the worst example is the incessant use of the word “quality” to characterize a problem that has multiple causes, only one of which might be inferior physician or hospital quality. [1] To illustrate with a non-medical analogy, no one would blame auto repair mechanics if 50 percent of their customers failed to bring their cars in for regular oil changes. We would attribute the underuse of mechanics’ services to forces far beyond the mechanic’s control and would not, therefore, refer to the problem as a “quality” problem.

But over the last three decades it has become acceptable among American health policy experts and policy-makers to characterize any measurement of under- or over-use of medical care, or any measurement of a medical outcome, no matter how poorly adjusted to reflect factors outside provider control, as an indication of “quality.” The widespread, inappropriate use of “quality” long ago set off a vicious cycle. It helped spread the folklore that the quality of America’s doctors and hospitals is awful, and that in turn was used to justify taking even more crude measurements of quality, and so on. [2]Continue reading…

By SAURABH JHA, MD

The reactions of physicians to ORBITA, a blinded, randomized controlled trial (RCT) from Britain, with a sham arm, comparing percutaneous coronary intervention (PCI) to placebo, in patients with stable angina, are as fascinating as the cardiac cycle. There were murmurs, kicks, and pulsating jugulars. Though many claimed to be surprised, and many unsurprised, by the null results of the trial, the responses were predictably predictable. Some basked in playful schadenfreude, and some became defensive and bisferious.

No shame in sham

The coverage of the trial in the NY Times was predictably jejune and hyperbolic. Predictably, the most nuanced and divergent viewpoints were curated by Larry Husten. Predictably, medical Twitter was set alight. The trial vindicated Vinay Prasad and Adam Cifu who predicted that PCI for stable angina will get placeboed, in their popular book, Ending Medical Reversal. Prasad and Cifu are tireless advocates for using sham control trials to judge the true efficacy of procedures, such as PCI, in relieving symptoms, and reject the notion that invasive placebos are unethical. There’s no shame in sham, they say. They were right.

The Objective Randomized Blinded Investigation With Optimal Medical Therapy in Stable Angina (ORBITA) is an impressive trial, which enrolled 230 patients with stable angina and single vessel stenosis greater than 70 %. The vast majority had class 2 (59 %) and class 3 (39 %) angina. Majority of the patients, 70 %, had LAD lesions. If you look in the appendix, which has pictures of catheter angiograms of all patients, you’ll see scary tight proximal LAD stenosis – yes, even these patients had 50 % chance of getting sham. This takes balls. The trialists deserve applause, as do the Brits who volunteered. These were no snowflakes.

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BY HEALTH 2.0                                   SPONSORED POST