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National Coordinator 6.0: A Blueprint For Success

Apr 3, 2017• 48

By JACOB REIDER, MD

Now that it’s public, I’ll offer my thoughts on the next steps for Don and ONC. Don Rucker is a good pick for the nation, and will be a great National Coordinator. I’ve gone on record as saying that some others are not qualified, and as many of you know – I don’t mince words. Don is smart, focused, thoughtful, intentional, and will make good decisions for ONC and HHS. I have known Don for 20 years. He’s got a long track record of integrity, he’s a nice person, he deeply understands the challenges, limitations, and opportunities of Health IT. I have no doubt that he’ll do a good job. He’s got a lot on his plate.

Where should he focus?

Stay the course with health IT certification. I disagree with the growing meme that ONC has broadened its certification scope too far. Certification has one purpose: to provide consumers with a way to be confident that the product they are purchasing will do what the seller says it does. Some people seem to have forgotten (or don’t know) that some of the companies that sell health IT solutions have claimed that the products do things they do not do. There needs to be a process by which these claims are tested, verified and, yes, certified. If this program is scaled back, health IT systems will be less safe, less interoperable, less usable, and less reliable. #KeepCertification.
2.Keep the Enhanced Oversight Rule in place. My former colleagues (and Don’s former colleagues) in the vendor community will disagree, as do some of the house Republicans. As Don will learn first hand in his initial few weeks as NC, some of the companies that have been selling certified health IT products have been misbehaving. In some cases, products have been de-certified. In other cases, there have been investigations and resolution of problems without de-certification. ONC is protecting the public by doing what Congress asked it to do initially. The certification program is more than testing of products in a petri dish, it’s about what happens with the products in the real world. Surveillance is therefore a necessary part of making sure that the products do what they were certified to do. #KeepOversight.Continue reading…

Who Won When the AHCA Failed?

Apr 3, 2017• 19

By ANISH KOKA, MD

You may have heard that repealing and replacing Obamacare recently failed. The analysis of what went wrong comes from many corners. Andy Slavitt, former insurance executive and most recent director of CMS, writes that the ‘failure of Trumpcare can be seen as a rejection of policies that Americans judged would move the country backward.’ Apparently, the theory goes, moderate republicans, especially in states that expanded heavily and rely on Obamacare Medicaid expansion, were skittish of a repeal and replace plan that endangered the healthcare of millions of constituents. The conservative David Frum writes in the Atlantic that most Democrats and Republicans have accepted the concept of universal health care coverage – and that the idea of a repeal of the right to healthcare is sheer anathema. And if the Republicans were wavering, town halls filled with angry constituents were sure to provide an extra dollop of pressure.

The effort to get the messaging right is clearly important to many, but I find most of it functions as a smoke screen seeking to obscure the real battles being fought over your healthcare.

It is certainly true that Obamacare insures millions of Americans. But it is also true that having health insurance and having health care are two very different things. To be clear, the folks attempting to preserve the status quo want to preserve the ability to force all Americans to buy health insurance that costs hundreds of dollars per month. Put another way, the folks attempting to preserve the status quo want to force Americans to give a monthly fee to health insurance companies. Remember, these plans have deductibles so high that most of the cost of care delivered during the year in the form of labs, copays, and imaging studies falls on the hapless patient. The insurer, for the average healthy person, doesn’t pay a dime.

Interview to Michael Seres, Patient Advocate and Founder of 11Health

Apr 3, 2017

By JOSE L. CÁNOVAS PARTNER CONTENT

Patient and Advocate and Founder of 11Health, Michael Seres is considered one of the strongest patient voices around the world, Michael Seres is involved in developing and implementing patient engagement strategies using digital technologies.

(Interview with Michael Seres by Smart Health)
At the age of 12, you were diagnosed with Crohn’s disease, an incurable bowel condition. Could you explain us your experience and how have you became a leader patient advocate?

At the age of 16 I was told by my gastroenterologist that the only way he would treat me is if we did this together as a team. I learnt very early on that I needed to take responsibility for my health. That led me to understand more about my blood levels, the important markers and what I needed to do next to assist my recovery. In the last 5 years, post my intestinal transplant, I really decided that I have a responsibility to give back to the surgeons who saved my life. The best way I could do that was to live my life. I started mentoring patients with IBD and intestinal failure and then started talking to the new transplant patients. From there I understood more the power of the patient and the role we can play in healthcare in the future. At Stanford Medicine X we have a philosophy of everyone included which is around the fact that everyone, including the patient, has a role to play and each role has to be based on mutual respect and empathy.
Continue reading…

Solutions That Will Be Essential for the Future of Healthcare

Apr 3, 2017

By ROBERTO ASCIANO PARTNER CONTENT

We are living in an age where thousands upon thousands of individuals and companies are trying to find faster, better and cheaper ways to get things done leveraging the latest digital technologies. We are so completely surrounded by efforts to innovate, disrupt and accelerate, that it may come as a surprise to find out that “innovation” has been around ever since our earliest ancestors shed their body hair and started walking upright.

Since those early days, our ancestors have sought solutions to their everyday problems and the “technology” they leveraged was whatever the environment around them gave them to use. These early humans started to make tools and weapons out of stone and thus came up with a clever solution to help them hunt, grind grains, start fires and build shelters. It may however come as a surprise to find out that, even in the stone age, our earliest ancestors applied their latest innovation to also find solutions to their health problems!
Continue reading…

Calcium Scan and Subtractive Medicine

Apr 3, 2017

By SAURABH JHA MD

Being a radiologist, I rarely speak to patients, but I was asked to counsel Mrs. Patel (not her real name, so calm down HIPAA totalitarians), who was worried about the risks of radiation from cardiac calcium CT scan. Because of her risk factors for atherosclerosis, her cardiologist wanted her to take statins for primary prevention, but she was reluctant to start statins. They eventually reached a truce. If she had even a speck of calcium in her coronary arteries she would take statins. If her calcium score was zero she wouldn’t. This type of shared decision making is the most frequent reason why cardiologists order calcium scans at my institution.

Health Care: What Should a Populist Do Now?

Mar 31, 2017• 1

By CLARK HAVIGHURST

Why not a plan that would actually help the forgotten folks who voted for change—and even attract some liberals’ support?

How can the Trump administration and the Republican Party make history forget their embarrassing failure to “repeal and replace” Obamacare? Interestingly, their best strategy—if they can withstand the political heat from all those who prosper under health-care business-as-usual—would be to embrace an explicitly populist program aimed at correcting the numerous and serious economic injustices deeply embedded in American health care today. The victims of these injustices include many of the lower-income Americans who in 2016 voted against elite interests in both political parties and in favor of fundamental, not just incremental, change. A program to right their wrongs should appeal even to some liberals, specifically those whose principal concern is the welfare of the people themselves, not just aggrandizing government or restoring the Democratic Party’s rightful dominance.

The political chances of the reform program outlined below would depend on making a direct, explicitly populist appeal to the many millions of Americans whom the health-care system currently exploits economically almost entirely without their knowledge.

Health-Sector Monopolies and Those Who Pay Their Prices

In the great populist era around the turn of the last century, the people’s anger was directed not, as now, at political elites or government itself but at huge private monopolies, the “trusts.” Teddy Roosevelt’s trust-busting effort broke up large agglomerations of market power while also establishing competition as America’s fundamental mechanism for inducing private businesses to satisfy consumers. If today’s populists are truly serious about protecting ordinary Americans from abuse by elite interests, they should begin by declaring a similar war against monopoly in health-care markets. Liberals should be invited to join this effort.

The Child Sexual Abuse Conspiracy

Mar 31, 2017• 8

BY DAVID INTROCASO

(After this essay was submitted to THCB the Senate Judiciary Committee held a hearing on March 28th titled, “Protecting Young Athletes From Sexual Abuse.” USA Gymnastics refused to appear and provide testimony likely, in part, because USA Gymnastics’ President, Steve Penny, was forced to resign on March 16th. The issue was framed by Committee Chairman Chuck Grassley as a “heinous crime,” no health care or public health expert testified and the hearing and was reported in sports pages of the The New York Times and The Washington Post.)

If you do not read the sports page you may have missed the news that this past November, December and February Dr. Larry Nassar, a former USA Gymnastics and Michigan State physician, was charged with numerous counts of criminal sexual misconduct and for possessing 37,000 child pornography images and videos of him sexually molesting girls. Beyond these charges, there are at present another 80 and counting related police complaints and several related civil lawsuits filed against Nassar. 1 Before he retired in September 2015, Nassar served on the USA Gymnastics National Team’s medical staff for 29 years and before he was fired last October, he also worked as a physician at Michigan State where for two decades he treated, among others, members of the university’s women’s basketball, crew, field hockey, figure skating, gymnastics, soccer, softball, swimming and track and field teams. Dr. Nassar was also associated with a Lansing-area girls’ gymnastic club and a high school.

Trump’s Obamacare Debacle: Vanquished by a Ghost!

Mar 30, 2017• 30

By JEFF GOLDSMITH

Judging by the dazed expression on President Trump’s face at his Friday afternoon press conference, it is clear that he never saw his first major political defeat coming. It was as if he had stepped off the curb looking the other direction into the path of an uncoming bus.

The key to any political victory is situational awareness- clarity about your goals and mastery of the details. There were warning signs of a potentially fatal disengagement, for example, in Trump’s periodic references to “the healthcare” when discussing the issue.

It doesn’t make Trump’s political pain any more bearable to know that he was mugged by a ghost, by a potent political symbol nourished by the Obama administration. The stunningly rapid political failure of the American Health Care Act more resembled a botched exorcism than a serious exercise in health policy.

From his successful campaign, Trump knew that repealing and replacing ObamaCare was the most reliable thunderous applause line in his stump speech. This visceral connection moved the issue to the top of his political agenda. To Trump’s political base, repealing ObamaCare was striking a blow against a paternalistic all-knowing federal government, against interference in citizens’ private lives, against confiscation and redistribution of peoples’ wealth, to a new “entitlement” program, but most of all, against a President they reviled.

Dr. Smith Goes to Washington

Mar 29, 2017• 8

By NIRAN AL-AGBA, MD

Last week, the AHCA was pulled from the House floor after not enough votes could be secured in favor of its passage. A Washington Post article reported President Trump’s thoughts on the matter. “We couldn’t get one Democrat vote, not one. They [Democrats] own Obamacare. So when it explodes…we make one beautiful deal for the people.”

Journalist Robert Costa asserted “there was little evidence that either Trump or House Republicans made a serious effort to reach out to Democrats.”

Well Robert, I sure did. And I did not get very far.

In the interest of full disclosure, over the past 20+ years, I have been a Democrat, Republican, and just about everything in between. I recently reached out to lawmakers on both sides of the aisle, yet the responses were lopsided. A recent entry myself into the political physician realm, I gave a presentation last week on lowering Medicare drug costs to the National Physicians’ Council for Healthcare Policy (NPCHP), in the Energy and Commerce Committee Hearing Room in Washington DC. This phenomenal group of physicians was assembled by Congressman Pete Sessions (R) from Texas; and they are innovative, engaged, and working to improve the lives of their patients and fellow physicians.

Did Medical Darwinism Doom the GOP Health Plan?

Mar 29, 2017• 9

By MICHAEL L. MILLENSON

“We are now contemplating, Heaven save the mark, a bill that would tax the well for the benefit of the ill.”

Although the quote reads like it could be part of the Republican repeal-and-replace assault against the Affordable Care Act (ACA), it’s actually from a 1949 editorial in The New York State Journal of Medicine denouncing health insurance itself.

Indeed, the attacks on the ACA seem to have revived a survival-of-the-fittest attitude most of us thought had vanished in America long ago. Yet, again and again, there it was in plain sight, as when House Speaker Paul Ryan (R-WI) declared: “The idea of Obamacare is that the people who are healthy pay for the people who are sick.” Contemporary language, but the same thinking that sank President Harry Truman’s health care plan almost seven decades ago.

Ryan’s indignation highlighted a fundamental divergence in attitudes that repeatedly turned the health care debate into a clash over the philosophy behind Obamacare-style health insurance. To some, the communal pooling of financial risk of medical expenses seems too often an unacceptable risk to personal responsibility.

As a researcher who has documented this approach to health care, I’ve been startled to see the debate over the AHCA reignite a political philosophy and policy approach that seemed to be have been discredited – and be in sharp decline.