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Above the Fold

Shopping Trends and Physicians

Dec 17, 2016• 18

By JIM PURCELL

flying cadeucii It has happened. For the first time, consumers are purchasing more on line than in stores. Even Black Friday 2016 with its emphasis on traditional shopping saw more people buying on line than in stores (44% compared to 40%). Mobile phone sales on Cyber Monday, at $1.07 Billion, were up 34% over last year, and Cyber Monday sales exceeded Black Friday’s sales according to Adobe Digital. Personally, I would rather chew off my right pinkie than venture to a mall on Black Friday, but I did shop online taking me two minutes, without moving from my desk.

The traditional consumer shopping world is changing at light speed, and this dramatic sea change is turning shopping malls inside out, literally and figuratively. In the process, Amazon has eaten the collective lunches of Macy’s, Penny’s, Kohl’s, and even Wal-Mart.

By way of example, Amazon offers a purchasing experience that makes use by smart phone an obvious choice for Millennials who must be served if businesses are to survive the next two decades. On line price shopping is quick and incredibly convenient; price comparisons are easy; customer service is superb; and such things as Amazon Prime are eliminating shipping costs and speeding delivery. Returns are easy, requiring only some scotch tape and a stop at a UPS drop box. What’s not to like in this age of little spare time?

Consequently, brick and mortar stores are in serious jeopardy and are like deer in headlights, reminiscent of companies such as Blockbuster, Kodak, and Xerox, which fell prey to disruptive technologies, products, and trends. Only time will tell if traditional stores will survive, but the smart money is not investing in malls these days.Continue reading…

Whether They Like It Or Not, The GOP Must Repair Obamacare

Dec 16, 2016• 5

By DAVID KENDALL

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It’s very possible that the pejorative “Obamacare” could become the even more pejorative “Trumpcare” in a very short period of time. That is because Trump’s and the GOP’s promise to repeal Obamacare — the Affordable Care Act (ACA) — has already hit a snag called reality.

Reports are now circulating that the much-promised repeal of the health care law (60 plus House and Senate votes since 2010) won’t take effect until at least 2019, after the mid-term elections. The excuse is that it’ll take that long to figure out an alternative and get it into place. But congressional calendars and political expedience have nothing to do with the health care market. And without action early in 2017, the health insurance exchanges could collapse in 2018 or sooner — leaving millions without insurance, millions more without protections from pre-existing conditions, and possibly millions more cursing Trumpcare. The only constructive solution is to repair the ACA before, ironically, repealing it and then replacing it with a brand new, untested experiment in 2019.

Making the Physician-Patient Relationship Great Again

Dec 16, 2016• 3

BY ADRIAN GROPPER, MD

21st Century Cures is now law. Aside from its touted research and mental health provisions, it’s the most significant health information technology regulation since HITECH, now 8 years ago. A decent summary of the health IT provisions of the bill by John Halamka concludes with “That is just not realistic.” He’s almost certainly right to the extent your perspective is the hospital-centered mega-EHR model. You can’t get there from here.

Halamka and others who think that consolidated institutions will drive interoperability are in denial of the gap between financial integration and clinical integration. This recent post by Kip Sullivan describes some of the wishful thinking. But there’s another reason why HITECH’s institutional EHRs cannot get us to the Triple Aim, and it’s mostly about liability.

Halamka ignored one of the items in 21st Century Cures that could lead to clinical integration around a patient: a longitudinal health record. Section 4006 on page 149 includes:

“(1) IN GENERAL.—The Secretary shall use existing authorities to encourage partnerships between health information exchange organizations and networks and health care providers, health plans, and other appropriate entities with the goal of offering patients access to their electronic health information in a single, longitudinal format that is easy to understand, secure, and may be updated automatically.”

Useful longitudinal health records require curation and, almost by definition, the curators are not going to be affiliated with any single hospital or other institution operating a traditional EHR. Allowing licensed physicians, family caregivers, and the patient themselves to edit an institutional EHR is risky to the point of impossible. That’s why the current initiatives to introduce modern APIs into EHRs like SMART and Sync for Science are read-only.

Harnessing Data and Analytics to Transform the Healthcare Industry

Dec 15, 2016

By SAM OSBORN

sam-osborn As organizations in every industry invest heavily in business intelligence and analytics to transform their business models, healthcare providers are looking for opportunities to catch up. The challenges to digital transformation in the healthcare industry are significant, but the opportunities are tremendous as applying modern analytics can dramatically speed and improve quality of care while also creating opportunities for new revenue streams and customer retention.

Take, for example, the transformational opportunities presented by applying analytics to Electronic Health Records (EHRs). By applying a layer of advanced analytics to EHRs, providers can identify areas for improvement and opportunity, which is especially important when you consider that these insights can anticipate outcomes and inform actions that can directly affect (and improve) the standard of care.

Analytics aren’t just improving the quality of patient care; they are creating entirely new revenue opportunities in the healthcare industry. MediGain for example, which provides revenue cycle management services to medical practices, hospitals and other care providers, was able to harness advanced analytics to combine data from 300+ sources to deliver on-demand revenue management analytics to their clients. As a result, reporting time was reduced from weeks to near real-time, greatly improving client performance while earning MediGain 1044 percent ROI.

These are just a few examples of healthcare companies leveraging their data and analytics to transform their businesses. These services are no longer optional offerings; Nucleus Research confirms that customers are demanding accessibility to analytics in their daily workflow, meaning that organizations need adapt and offer these solutions in order to remain competitive.

GoodData recently partnered with Anne Moxie, Sr. Analyst of Nucleus Research and Ian Maurer, CIO at MediGain to create a webinar that features the latest strategies and tactics that healthcare companies are using to turn their data and analytics into a profit center, click this link to view on-demand session.

Sam Osborn is head of content at GoodData. This is post is published in conjunction with GoodData‘s sponsorship of the Health 2.0 Conference

Unpacking the 21st Century Cures Act

Dec 15, 2016• 1

By STEVEN FINDLAY

President Obama signed the 21^st Century Cures Act into law this week. It’s the largest piece of health legislation since the Affordable Care Act. No doubt you’ve heard or read that—and it’s true.

But while the legislation was three years in the making and much hyped, it became the best recent example of that old saying that passing federal laws is akin to sausage making: You don’t really want to watch what goes into it.

(An aside: I made venison and bacon sausages from scratch for the first time this year and can attest to the “visceral” nature of that exercise.)

There’s something for almost everybody in this new law. That’s one reason it was the most lobbied health bill since the ACA. In particular, the pharmaceutical and medical device industries were big winners. Fifty-eight drug companies, 24 device companies and 26 biotech companies lobbied the bill, spending close to $200 million altogether, according to a Kaiser Health News analysis of lobbying data compiled by the Center for Responsive Politics.

What they got: a big nudge to the FDA to find ways to approve drugs and devices faster.

For example, one change in the law allows FDA to accept as proof of safety and effectiveness less rigorous clinical trials, as well as other types of studies and data—both for the initial approval of drugs and to authorize new uses for drugs already on the market.

MedPAC: Medicare Advantage and ACOs Can’t Cut Costs And We’ll Never Know Why

Dec 14, 2016• 12

By KIP SULLIVAN, JD

What would you do if you were a member of the Medicare Payment Advisory Commission (MedPAC) and you were told Medicare Advantage and Medicare’s ACO programs are losing money and there’s no way to determine why they’re losing money? That is what happened over the course of two MedPAC meetings, one in October and another in November. At the morning session of the October 6, 2016 meeting, MedPAC staff reported data on the Pioneer and MSSP ACO programs indicating that the two programs together raised Medicare’s costs slightly in 2015. And at the morning session of the November 3, 2016 meeting, staff reported that Medicare Advantage (MA) raised Medicare costs by 5 percent in 2016 (which is down from 14 percent in 2009) and, moreover, that it’s extremely unlikely anyone will ever know why MA plans and ACOs are raising costs.

If you were a commission member, wouldn’t you at least inquire why the staff thinks it’s impossible to determine the causes of the MA and ACO programs’ failure to cut costs? And if you confirmed that it really is impossible to know why they’re failing, wouldn’t you say it’s high time to terminate those programs? Not one of the 16 commission members present at those meetings did that. Many of the commissioners expressed frustration with the poor performance of the ACO programs (for some reason they spared the MA program from similar criticism). But not one demanded to know why the commission knows so little about what goes on inside HMOs, PPOs and ACOs, nor why the staff thinks the information vacuum will go on forever. Surprisingly, two commissioners (Buto and Gradison) did suggest it was time to terminate the MSSP ACO program. But they received no support from any other commissioners or staff.Continue reading…

Does Life Expectancy Matter?

Dec 12, 2016• 88

By NIRAN AL-AGBA, MD

U.S. life expectancy declined in 2015 for the first time in more than two decades, according to a National Center for Health Statistics study released last week. The decline of 0.1 percent was ever so slight ― life expectancy at birth was 78.8 years in 2015, compared with 78.9 years in 2014. However, this reversal of a long-time upward trend makes these results significant.

While many researchers are scratching their dumbfounded heads in utter astonishment, I hypothesize the decline in life expectancy is partly due to the decrease in the primary care physician supply. Studies have shown the ratio of primary care physicians per 10,000 people inversely correlates with overall mortality rate. It is a well-known and reproducible statistical relationship that holds true throughout the world. In the U.S., increasing by one primary care physician per 10,000 population, decreases mortality by 5.3%, ultimately avoiding 127,617 deaths per year.

Headlines last week highlighted how much these unexpected results left the researchers baffled. Jiaquan Xu, a lead author of the study told The Washington Post, “This is unusual, and we don’t know what happened…so many leading causes of death increased.” Age-adjusted death rates went up by 1.2 percent, from 724.6 deaths per 100,000 people in 2014 to 733.1 in 2015. Death rates increased for eight of the ten leading causes of death, including heart disease, chronic respiratory illness, unintentional injuries, stroke, Alzheimer’s disease, diabetes, renal disease and suicide. Differences in mortality were most prevalent in poorer communities, where smoking, obesity, unhealthy diets, and lack of exercise are ubiquitous.

The HIT Emperor Has Never Had Any Clothes

Dec 12, 2016• 13

By HAYWARD ZWERLING, MD

Over the last several months, I have worked to make the following the official policy of the Massachusetts Medical Society:

That the MMS will advocate to our State and Federal Representatives to end all legal constraints and financial inducements arising from the use or non-use of Office of National Coordinator (ONC) Certified EHR Technology.

That the MMS will encourage our Massachusetts Federal Legislators to introduce legislation to end the ONC’s EHR certification program, and will ask the President of the United States to immediately request that such legislation be introduced.

While the MMS’s Committee on Information Technology voted unanimously to support the above proposal, the MMS rejected the above and choose instead to make the following official MMS policy:

That the MMS will work with appropriate government entities to foster EHR innovation, affordability, and functionality by modifying the certification process for EHRs to improve patient care.

Without a doubt, ONC’s EHR certification program has stifled innovation in EHRs in particular and in health information technology (HIT) in general. In addition, the data accumulated to date has shown these ONC’s Certified EHRs have failed to have a meaningful impact on either the cost or quality of healthcare.

The 6 December 2016 issue of Annals of Internal Medicine has an article which shows that for every hour a physician is involved with direct patient care results in an additional 2 hours of EHR work (in the office/clinic) and then more EHR work from home. No wonder MDs are so dissatisfied with the practice of medicine. The accompanying editorial (Ann Intern Med. 2016;165:818-819) concludes “Now is the time to go beyond complaining about EHRs and other practice hassles and to make needed changes to the health care system ”

Lead Time Bias and Court Rooms

Dec 11, 2016• 3

By SAURABH JHA MD

In 2014, a jury in Massachusetts awarded $ 16.7 million in damages to the daughter of a Bostonian lady who died from lung cancer at 47, for a missed cancer on a chest x-ray. The verdict reminds me of the words of John Bradford, the heretic, who was burnt at the stakes: “There, but for the grace of God go I.” Many radiologists will sympathize with both the patient who died prematurely, and the radiologist who missed a 15-mm nodule on her chest x-ray when she presented with cough to the emergency department few months earlier.

The damages are instructive of the tension between the Affordable Care Act’s push for both resource stewardship and patient-centeredness, and between missed diagnosis and waste. But the verdict speaks of the ineffectualness of evidence-based medicine (EBM) in court. If EBM is a science, then this science is least helpful when most needed, i.e. when trying to influence public opinion.

EBM tells us that had the patient’s cancer been detected thirteen months before it actually was, it would have made little difference to her survival, statistically speaking. Researchers from Mayo Clinic examining the impact of frequent chest x rays in screening for lung cancer in a large number of smokers found that the intensively screened group knew about their cancers earlier, had more cancers removed, but did not live longer as a result. This is known as lead time bias, where early detection means more time knowing that one has the cancer, not more time one is actually alive. This means had the nodule been seen on the patient’s initial chest x-ray she would probably, though not certainly, not have survived much beyond 47.

Could Price Be Right?

Dec 8, 2016• 10

By GILBERT WELCH, MD and ELLIOTT FISHER, MD

If confirmed as Secretary of HHS, Tom Price will oversee a $1 trillion budget – roughly one-third of all health expenditures. His proposed legislation “Empowering Patients First” seeks to control costs by giving patients more choices and providing the information required to make them. He calls for publicly available standardized information on the price and quality of physicians, hospitals and other health care institutions.

It sounds like Dr. Price is prescribing a single data system.

Medicare has had a single data system on the over-65 population for decades. Since 2005, these data have informed Hospital Compare, a consumer oriented website comparing the quality of over 4000 hospitals. And while prices in Medicare are relatively fixed, these same data have shown substantial variation in costs because the quantity of service – the number of hospital admissions, procedures and physician visits – varies substantially from place to place.

But Medicare is only one piece of the data puzzle. A National Bureau of Economic Research report[nber.org] added another piece last year with data from large insurance companies like Aetna and United. For the under-65 commercially insured population, it’s not just the quantity of services that are all over the map – it’s also the prices.