The Health Care Blog – Page 327 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

If You Can’t Cure Me, Get Back to Living

Feb 7, 2017

By ALAN PITT

Several months ago I had a conversation with Dr. Robert Spetzler, the Director of the Barrow Neurological Institute. During our interview Dr. Spetzler mentioned that the patient needs to become captain of their own ship. I agree. Although most of us (as patients) would like someone to step in and care for us when we’re sick, rising costs and limited providers make it impossible for the healthcare industry to meet America’s expectations for care. Healthcare needs patient partners.

But in all fairness, I thought to ask a patient what they need. So, with the start of 2017, I thought to ask turned to someone who deals with her care everyday, my mother.

Sheila Pitt is an Art Professor at the University of Arizona. In 2008 my mom suffered a fall from a horse and became a quadriplegic. Since then she has gone back to work teaching and continues to make art with a new process she developed using the abilities left to her. In the past I wrote about my perspectives on her accident. I thought I’d discuss my mother’s journey in healthcare.

Alan: So, Mom, can you tell me when you first realized you were quadriplegic?

Sheila: Yes, I can. I was in my hospital bed having just returned from the surgical floor when one of the nurses referred to me as a quad. And—not to me but to someone else—they said, get this quad ready for whatever the procedure was. I was shocked. I had no idea I was a quad. No one had talked to me about it. No one had explained what that was about. And it was like I wasn’t there. They were talking about me as a quad and I was really quite shocked that they did that. But I realized I must have been a quad.

Why Surgical Volumes Should Be Public

Feb 6, 2017• 15

By PETER PRONOVOST, MD

Her voice cracked with strain. I could imagine the woman at the other end of the line shaking, overcome with remorse about the hospital where her husband had had esophageal surgery. Might he still be alive, she asked me, if they had chosen a different hospital?

The couple had initially planned to have the procedure done at a well-known medical center, but when she went online to do her homework, she discovered that the hospital’s patient safety scores were poor. Another hospital in her community had stronger patient safety ratings, so they decided to have the procedure there.

It made sense. Why wouldn’t they go to a safer hospital?

What she didn’t know was that multiple studies over several decades have shown outcomes are better when procedures are handled by surgeons and hospitals with higher volumes, and while the well-known hospital had performed the procedure her husband needed many times during the previous year, the hospital they chose had done one.

Repealing the Right to Redistribute ‘Other Peoples’ Money’

Feb 5, 2017• 17

By DEVON HERRICK

Republicans are having a hard time agreeing on how and when to repeal Obamacare. The Patient Protection and Affordable Care Act (ACA) is difficult to unravel because it was designed to alleviate a problem too costly for the government alone to fix. The health care law was passed to make medical care more accessible for low-income Americans and those with pre-existing conditions. This was to be done largely by socializing the costs and spreading the burden among a much broader segment of the healthy population. This is not unlike a pyramid scheme, where a broad base of people at the bottom get ripped so a few at the top can benefit.

Republicans have it within their power to use a process known as budget reconciliation to repeal Obamacare provisions that involve the budget, with a simple majority vote. For example, Republicans can repeal the taxes, fees and appropriations that fund the ACA. The individual and employer mandates, with associated penalties, can also be repealed. What Republicans cannot do is repeal the costly insurance regulations that drive up premiums for most people. That would require the help of perhaps a dozen skeptical Democrats.

The Inconvenient Truth about the Military and Veterans Health Systems? They’re Working Just Fine.

Feb 5, 2017• 5

By PAUL KECKLEY

Lieutenant colonel Justin Constantine USMC

Through the years, I’ve had the honor of speaking to groups after they heard from notables like Michael J. Fox, Sammy Hagar, Jeff Immelt, U.S. Secretaries of Health Tommy Thompson and Mike Leavitt, Warren Buffet and others. They’re the headliners and I usually follow them with a less celebrated presentation about the current issues and future in healthcare.

Earlier this month, in Arizona, I spoke to 3M’s annual healthcare conference following Lt. Colonel Justin Constantine, a Marine who served from 1997-2013. Justin’s story is profound: he was plying his trade as a military lawyer in the Al Anbar province of Iraq on October 18, 2006 when a sniper’s bullet tore through his head. After an emergency tracheotomy by Navy Corpsman George Grant, scores of surgeries and years of treatment, he survived and now shares his story as an inspirational speaker, crediting the Military and Veterans Health Systems for saving his life.

His message was riveting: Leaders lead. Never give up. Don’t be afraid. His scarred face and slurred speech commanded the rapt attention of the 250 in the audience. As he concluded, we all stood in a spontaneous expression of appreciation for this man, his message and his courage.

Later that day, he shared more about his decade-long climb experience as we traveled together back east. And through this week, I found myself reflecting on his ordeal and the roles of our Military and Veterans systems about which I confess I’d given little thought prior.

Dinosaur-Driven Health Reform

Feb 3, 2017• 4

By MICHAEL TURPIN

I grew up during the last great age of Jurassic parenting.

We called our Dad “T-Rex” because he was the ultimate alpha predator with a big mouth, sharp teeth, limited peripheral vision and small arms that prevented him from doing any housework. His home was his castle.

Our dining room table was his bully pulpit, and fact-checking was an act of sedition, prohibited when he was on a roll. On occasion, a courageous teen would put his college education to work to question my father’s draconian position on the war in Vietnam (“Bomb the NVA back into the Stone Age”) or social protest (“America, love it or leave it”). My father would listen incredulously and then ruthlessly suffocate the nascent rebellion like a banana republic dictator.

My father is no Archie Bunker. At 86, he’s lost a step and repeats himself, but he still understands Keynesian economics. He’s a tried-and-true carnivore capitalist who borders on being libertarian. He has an IQ of 170, and in his heyday he was the regional CEO of a large ad agency. But he has major blind spots and a black-and-white view of the world. His reptilian brain is in fear mode thanks to Fox News and a world that has been reduced to a dozen meds and 3,000 square feet. Before the election, he was angry—always interpreting any action by Obama as a sign of a decline in the values and ethic that made America great. His contradictions would come fast and furious:

“No, I don’t want immigrants. Oh, yes, I do love my immigrant caregivers.”

“I hate socialized medicine, but I love Medicare and don’t want to pay more for it.”

“Bush Jr. was an idiot, but Obama is worse.”

When I listen to Donald Trump, I hear my father.Continue reading…

The Mysterious Case of Ohio’s Disappearing Price Transparency Law

Feb 3, 2017• 8

JIM BUTLER

When is the last time anyone received an estimate of the cost of a healthcare service upfront? With premiums and deductibles going up thousands of dollars a year, patients have a need and a right to know the cost of any nonemergent healthcare service to help them make an informed decision.

Meanwhile, the healthcare industry, backed by its powerful lobby and the many politicians it seems to control, obstinately clings to a status quo where we are all kept guessing about the cost of our healthcare.

In June of 2015, a law was passed in Ohio that sought to upend that status quo. Starting January 1, 2017, the Ohio Healthcare Price Transparency Law requires that patients in Ohio must receive a good-faith estimate of the cost for anticipated healthcare services they are scheduled to receive. Emergencies are obviously excluded, including hospital admissions for acute issues. The estimate must provide the amount to be charged, the insurance share and the patient share. Straight-forward enough one would think.

Unfortunately, over the year and a half since the Ohio Healthcare Price Transparency Law was passed, the healthcare lobby (led by the Ohio Hospital Association) has vigorously sought to kill the law rather than prepare for its implementation.

Mirroring honed strategies utilized to defeat transparency laws in multiple states, the healthcare lobby claims it really believes in transparency, but offers disingenuous excuses as to why true transparency is “impossible” to provide. It offers to support the creation of some difficult-to-navigate and nebulous website, or to provide estimates for only a small number of services or only upon formal request.

What Experts in Law and Medicine Have to Say About the Cost of Drugs

Feb 2, 2017• 3

By ANDY ORAM

Pharmaceutical drug costs impinge heavily on consumers’ consciousness, often on a monthly basis, and have become such a stress on the public that they came up repeatedly among both major parties during the U.S. presidential campaign–and remain a bipartisan rallying cry. A good deal of the recent conference named Health Law Year in P/Review, at the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School, covered issues with a bearing on drug costs. It’s interesting to take the academic expertise from that conference–and combine it with a bit of common sense–to see which narratives about drug costs hold up.

The Industry Narrative

In defending the ever-growing cost of drugs, the pharmaceutical industry can’t roll out a single, intuitive explanation. Rather, their justification breaks down into many independent but interacting parts. We have to tease these apart before examining their validity.

Headlines We Won’t See In 2017

Feb 2, 2017• 1

By BILL REID

Earlier, I offered a sarcastic headline view of the coming year. Yet, underlying these headlines are some more serious issues that we as an industry have to address. They may not happen this year, but we need to continue to make progress. Wouldn’t it be awesome if for once we under predicted what will happen?

Healthcare Organization Wakes Up In Strange Place, Reports Massive Headache

Reality: Many organizations are not quite sure what hit them – they have purchased and implemented a number of systems, sometime more than once, in the last several years and now are waking up to the reality that that might not be enough or even the right set of technologies for the emerging payment models. Return on investment is hard to show, debt used to finance purchases along with stimulus funds are coming due. System after system has had to report negative results on financial reports due to higher than expected costs, longer than anticipated implementations. It’s enough to give any CIO a headache.

Healthcare Interoperability Finally A Reality

Reality: Interoperability remains elusive despite ongoing talk and the creation of various coalitions. Sometimes it seems that few want to actually solve the problem. Healthcare organizations are afraid to lose patients to competitors. Vendors are fighting for the last remaining market share, and aggressively seeking to displace others, and using local market coverage as a selling point. Sure there are lots of sites now propped up showing FHIR APIs – but in reality these are mostly read-only and not particularly functional.

Foolproof Security Strategy Unveiled: Don’t Click on $h!t

Reality: We expect to continue to see rise in reported security incidents. Attackers are not script-kiddies, but sophisticated hacking businesses making hundreds of millions a year in paid ransoms. Our industry has a large surface area – with lots of organizations and millions of employees on millions of computing devices. Our treatment facilities are filled with millions of connected devices monitoring at the bedside. Like in any public health crisis, we need to not just wait around for the all-powerful anti-biotic. We need to do basic hygiene well – patching, training, monitoring and rapidly responding to small outbreaks before they become bigger. We are an industry that has experience in facing one set of viruses – we need to turn that thinking on securing our systems and keeping them healthy.

Affordable Care Act Files for Divorce, Claims Infidelity

Reality: It is uncertain what the final fate of the Affordable Care Act will be. Chances are that some changes will be made – too much public bluster was made about repeal for there to be any backing down, but the potential real harm that may come to the electorate that loses coverage or sees prices resume their rapid rise, will prove to be a check on full-scale repeal.

Family Physician Found Dead in Pool of Alphabet Soup

Reality: It is challenging to remain in a small practice today. There is an ever changing set of requirements and initiative from payers and from government entities and it can all sound like a pool of random letters. For example, MACRA is now in effect and yet surveys show that many providers have no idea what it means or what is involved. Radiology providers will soon have to ensure that ordering doctors begin using clinical decision support management (CDSM) tools to subject orders to appropriate use criteria (AUC) that were developed by Provider Led Entities (PLEs). This is on top of HIPAA, HITECH, OPPS, and many others.

Consumer-Driven Healthcare Recalled, Engagement Engine Too Weak

Reality: For all the talk about consumer driven healthcare, there seems to be little change in the position patients find themselves. There remains little pricing information, payment terms and coverages are difficult to understand for the average reader, and Health Savings Accounts aren’t much other than a new form of deductible for insurance companies. Most consumer online tools provide little utility, other than provider-out reporting. Patients continue to have difficulty getting access to medical records in any useable form. Mobile applications seldom exist, and when they do few if any are on par with the experiences of other tools like Uber, Amazon, Snapchat or Facebook. It’s bad enough if you are reasonably healthy; it’s worse if you are trying to manage a chronic illness. You can completely organize a complex trip on a phone, but just try to pay a healthcare claim, set up a number of visits to a variety of providers, or understand what you need to do next to care for yourself.

What Is This Strange & Confusing Healthcare Language We Have Invented?

Jan 30, 2017• 2

By PAUL KECKLEY

Public understanding about how our health system operates is woefully low: surveys show only one in five adults has functional knowledge about how to choose a physician, hospital or insurance plan, or compare treatment options. The lexicon we use in our industry lends to this confusion: powerful words and phrases that convey something different depending on the user’s intent.

As we debate the replacement for the Affordable Care Act, it might be worthwhile to ask lawmakers to clarify what they mean when they use them and examine our own uses in tandem:

Quality: In U.S. healthcare, quality is not defined by a consistent set of metrics that address diagnostic accuracy and clinical outcomes. Physicians associate it with access to a clinician; insurers associate it with necessary care; employers with provider network scale and premium costs and the public thinks it’s about scheduling and parking, not results. There are a dozen websites where information about the quality of care in hospitals and medical practices is available, but each has its own methodology and results vary widely. As a result, every hospital and every physician affirms they deliver “high quality care” and every insurer tells its enrollees, groups and regulators its plans are “high quality”. Little wonder quality is confusing.

WaPo Leaked Tape of GOP Repeal & Replace Talks is Troubling. But Also Weirdly Reassuring …

Jan 30, 2017• 1

By STEVEN FINDLAY

“We’re telling those people that we’re not going to pull the rug out from under them, and if we do this too fast, we are in fact going to pull the rug out from under them.”

– Rep. Tom MacArthur (R-N.J)

“The fact is, we cannot repeal Obamacare through reconciliation. We need to understand exactly: what does that reconciliation market look like. And I haven’t heard the answer yet.”

– Rep. Tom McClintock (R-Calif)

“It sounds like we are going to be raising taxes on the middle class in order to pay for these new tax credits.”

– Sen. Bill Cassidy (R-La)

These quotes, and many others, from a leaked recording of the Republican closed-door strategy session in Philadelphia last week are both jarring and reassuring.

They reveal in harsh light what the media, pundits, and commentators have been saying for weeks: the Trump administration and congressional Republicans are in a deep quandary about the best path forward on repeal and replace, and are just beginning to weigh the pros and cons of the complex policy options involved.

But the discussion also shows us that rank and file Republican lawmakers understand the difficulty of the task and know the political price they’ll pay if they screw it up. Their remarks also imply frustration with the cavalier, ill-informed, and mixed-message statements coming out of the White House.