The Health Care Blog – Page 309 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

MD vs. DNP: Why 20,000 Hours of Training and Experience Matters

May 29, 2017• 75

By NIRAN AL-AGBA, MD

As southern states entertain legislation granting nurse practitioners independent practice rights, there are some finer details which deserve careful deliberation. While nurse practitioners are intelligent, capable, and contribute much to our healthcare system, they are not physicians and lack the same training and knowledge base. They should not identify themselves as “doctors” despite having a Doctor of Nursing Practice (DNP) degree. It is misleading to patients, as most do not realize the difference in education necessary for an MD or DO compared to a DNP. Furthermore, until they are required to pass the same rigorous board certification exams as physicians, they should refrain from asserting they are “doctors” in a society which equates that title with being a physician.

After residency, a physician has accrued a minimum of 20,000 or more hours of clinical experience, while a DNP only needs 1,000 patient contact hours to graduate. As healthcare reform focuses on cost containment, the notion of independent nurse practitioners resulting in lower healthcare spending overall should be revisited. While mid-level providers cost less on the front end; the care they deliver may ultimately cost more when all is said and done.

Information Blocking Under Attack: The Challenges Facing EHR Developers and Vendors

May 28, 2017• 6

By DAVID KIBBE, MD

In March 2017 Milbank Quarterly, researchers Julia Adler-Milstein and Eric Pfeifer found that information blocking — which they define as a set of practices in which “providers or vendors knowingly and unreasonably interfere with the exchange or use of electronic health information in ways that harm policy goals” – occurs frequently, and is motivated by revenue gain and market-share protection.

Among the practices most often cited were deployment of products with limited interoperability (49%) and high fees for health information exchange unrelated to [actual] cost (47%). Of note: This is the first empirical research identifying and quantifying the specific information blocking practices reported by a group of information exchange experts.

The authors concluded “Information blocking appears to be real and fairly widespread. Policymakers have some existing levers that can be used to curb information blocking and help information flow to where it is needed to improve patient care. However, because information blocking is largely legal today, a strong response will involve new legislation and associated enforcement actions.”

The legal situation regarding the controversial subject of information blocking may have already changed dramatically. Two important events occurred since this research was undertaken. First, the strongly bipartisan-backed 21st Century Cures Act was signed into law by President Obama late last year. The health information technology (HIT) provisions of the law now make it illegal for a vendor or provider to engage in information blocking. Second, the new law provides the nation with a new and comprehensive statutory definition of information blocking:

How CMS Undermines ACOs and What to do About It

May 26, 2017• 12

By KIP SULLIVAN

In my first post in this three-part series, I documented three problems with Pioneer ACOs: High churn rates among patients and doctors; assignment to ACOs of healthy patients; and assignment of so few ACO patients to each ACO doctor that ACO “attributees” constitute just 5 percent of each doctor’s panel. I noted that these problems could explain why Medicare ACOs have been so ineffective.

These problems are the direct result of CMS’s strange method of assigning patients to ACOs. Patients do not decide to enroll in ACOs. CMS assigns patients to ACOs based on a two-step process: (1) CMS first determines whether a doctor has a contract with an ACO; (2) CMS then determines which patients “belong” to that doctor, and assigns all patients “belonging” to that doctor to that doctor’s ACO. This method is invisible to patients; they don’t know they have been assigned to an ACO unless an ACO doctor tells them, which happens rarely, and when it does patients have no idea what the doctor is talking about. [1]

This raises an obvious question: If CMS’s method of assigning patients to ACOs is a significant reason why ACOs are not succeeding, why do it? There is no easy way to explain CMS’s answer to this question because it isn’t rational. The best way to explain why CMS adopted the two-step attribution method is to explain the method’s history.Continue reading…

What’s Behind the Spike in Food Allergies?

May 25, 2017

By BASIL KAHWASH, MD

We are surrounded by evidence of the enormous impact food allergies are making in our society. The peanut butter and jelly sandwich, once a staple of elementary school lunchboxes, has been banned in numerous school districts across the country. Candy bars are required to alert consumers about any other products processed in the factories where they were made. Gluten-free diets are trumpeted by celebrities and have spawned communities of devoted followers (there’s even a “gluten-free” dating site – I’m not making this up).

However, the spectrum of food allergies is still poorly understood by the general public. The phrase “food allergy” conjures one image: a child who, after eating, say, a kiwi, becomes flushed and has trouble breathing until an Epi-pen can be administered. While certainly dangerous, that scenario represents only one aspect of what may be called modern food allergy (or the broader spectrum of food intolerance). Other, milder-appearing food allergies may exist in a larger percentage of the population than previously thought. These mild intolerances can still cause a great deal of discomfort, and when they go unrecognized, may lead to years of expensive and unnecessary testing.

Open Season on Health Privacy in Washington DC

May 24, 2017• 9

By ADRIAN GROPPER, MD

With Senate bill S.3530, data brokers would remove the last shreds of transparency and control that patients still have over our health data and drive healthcare costs even higher in the process. Will hospitals and the pharmaceutical industry go along?

It’s been 17 years since patients lost control over how our hospitals and insurance companies use our personal health data without any consent or a convenient accounting for disclosures. HIPAA allows so-called Covered Entities to use and sell our data without consent and, separately, often under the pretense of de-identification, through a $100 Billion network of hidden data brokers that we know don’t know about, choose, or oversee. Our data is worth $100 Billion because it helps health businesses to maximize profits and it contributes to an unknown extent to the uniquely high cost of healthcare in the US.

The Delta of Discomfort and
the Agony of Despair

May 24, 2017• 2

By ALAN PITT, MD

I’m a radiologist. I spend my day looking at CT scans and MRI scans. When it’s a good day, I have interesting scans to review, but much of my work is not too dissimilar from a TSA screener’s. One normal scan after the next, it’s akin to trying to stay alert so that the gun someone’s trying to sneak through in their luggage isn’t missed. In my case, of course, it’s a cancer or other unexpected medical abnormality finding.

Computer-Assisted Diagnosis

Most of my day I work on a computer workstation presenting the exams. In my dream, my workstation does more than simply display the exam. It assists in reading the case. If there’s an abnormality, I can click on the area, and the workstation takes the image and compares it to millions of other cases in the cloud. It tells me, based on that patient’s age and sex and other information, how likely it is the finding is a tumor and maybe even, if so, what kind of tumor. At other times the workstation tells me whether a study is normal or not, freeing me to do other activities. However, this dream is not shared by all of my colleagues.

When I mentioned this work-flow scenario to one of my residents—this idea of computer-assisted diagnosis with constant improvement, or what is known as artificial intelligence, or AI—he said it sounded awesome, but he really didn’t want to have it if it was available to everyone. His comment is something of a mixed message: Yes, I see value but no, I don’t want it.

It’s largely based on fear of being replaced by computers. And it’s a song I’ve heard before.

Compete for 2017’s Startup Spotlight at Health 2.0’s Traction Competition!

May 24, 2017

By DEEPA MISTRY

Pitch and Get Funded!

With a new political climate, exponential growth in tech, and an increasing awareness on key issues, the health care industry is ever changing, and now’s the best time for your startup to breakthrough in the digital health community.

Demonstrate your company’s potential to prominent investors and enter your startup in Health 2.0’s Startups Pitch competition, Traction, and give your company the perfect opportunity to pitch to a room full of attendees looking to get involved with your startup. You’ll work with industry experts to perfect your pitch and to ensure it is stage-ready by the time of the conference. Investors will be so impressed they’ll be left with no choice but to invest in your company!

On Teaching Hospitals and Conflict of Interest and Other Politically Charged Topics

May 23, 2017• 4

By ASHISH JHA, MD

How much does it matter which hospital you go to? Of course, it matters a lot – hospitals vary enormously on quality of care, and choosing the right hospital can mean the difference between life and death. The problem is that it’s hard for most people to know how to choose. Useful data on patient outcomes remain hard to find, and even though Medicare provides data on patient mortality for select conditions on their Hospital Compare website, those mortality rates are calculated and reported in ways that make nearly every hospital look average.

Some people select to receive their care at teaching hospitals. Studies in the 1990s and early 2000s found that teaching hospitals performed better, but there was also evidence that they were more expensive. As “quality” metrics exploded, teaching hospitals often found themselves on the wrong end of the performance stick with more hospital-acquired conditions and more readmissions. In nearly every national pay-for-performance scheme, they seemed to be doing worse than average, not better. In an era focused on high-value care, the narrative has increasingly become that teaching hospitals are not any better – just more expensive.

But is this true? On the one measure that matters most to patients when it comes to hospital care – whether you live or die – are teaching hospitals truly no better or possibly worse? About a year ago, that was the conversation I had with a brilliant junior colleague, Laura Burke. When we scoured the literature, we found that there had been no recent, broad-based examination of patient outcomes at teaching versus non-teaching hospitals. So we decided to take this on.

Only Alternative Facts Can Support the Protecting Access to Care Act

May 23, 2017• 5

By CHARLES SILVER and DAVID HYMAN

In late March of this year, JAMAInternal Medicine published a study finding that the “the overall rate of [malpractice] claims paid on behalf of physicians decreased by 55.7% from 1992 to 2014.” The finding wasn’t new. In 2013, the Journal of Empirical Legal Studies published a study co-authored by one of us (Hyman) which found that “the per-physician rate of paid med mal claims has been dropping for 20 years and in 2012 was less than half the 1992 level.” In fact, peer-reviewed journals in law and medicine have published lots of studies with similar results. It is (or should be) common knowledge that claims of an ongoing liability crisis are phony.

But inconvenient facts have never stopped interest groups or politicians from making false claims about med mal litigation. Since 1991, when Dan Quayle struck gold by asserting that the U.S. had too many lawyers, Americans have heard non-stop about “jackpot justice” in which patients who weren’t even injured win millions; about the flood of frivolous lawsuits in which doctors are sued even though they didn’t make any mistakes; about jury verdicts skyrocketing out of control; and about doctors working all their lives only to have their savings wiped out by a single malpractice suit. All of these charges are false—you can find the evidence here, here, here, and here. But in politics, it’s staying on message that counts; it doesn’t seem to matter whether the message is true.Continue reading…

House v. Price and the CSR
Payments Paradox

May 23, 2017

By STEVEN FINDLAY

Many countries in the world have dysfunctional governments. Some have corrupt and devious ones, or even deadly ones. We’ve lived with serious dysfunction in Washington for two decades. Now we join the ranks of countries with a corrupt and devious government, one without a moral compass.

And I’m not just talking about Trump.

The news and blogosphere is replete with this sentiment surrounding the White House, of course, a la the “Russia thing” and Comey’s firing and all the rest.

But the cynicism and political bankruptcy that suffuses our elected leaders’ failure to assure that the cost-sharing subsidies for people buying health insurance through the exchanges will be secured for 2017 and 2018 is a new low in the wretched ongoing saga of Obamacare vs. Trumpcare.

This is playing out right now and could affect 12 million people come this fall and in 2018.