The Health Care Blog – Page 349 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

A Hole in the Heart, Part II

Sep 11, 2016• 3

By ANISH KOKA, MD

Click here for part 1 “A Hole in the Heart, Part I” If you have NOT read part I, we highly recommend that you go there now and then come back and read the continuation. – The Editors

Analysis of the Randomized Control Trials

The 3 randomized trials performed tested two closure devices – CLOSURE I tested the STARFLEX device (NMT Medical, Boston, MA). The PC and RESPECT trial tested the AMPLATZER device (St. Jude Medical, St. Paul, MN). Let’s look at each study closely.

CLOSURE I (Starflex device)

This study looked at patients between 18 and 60 years of age who had a prior stroke or a transient ischemic attack within the prior 6 months. This was a resoundingly negative study. At two years, the 12/447 patients in the closure group suffered a recurrent stroke, while 13/462 patients in the medical therapy suffered a recurrent stroke. The trial, however, reveals one of the important chinks in the armor of the randomized control trial (RCT). Randomized control trials are only as good as the patients they enroll. Enroll the wrong patients, and the results don’t tell you much. CLOSURE-1 didn’t provide closure because they included patients with transient ischemic attacks (TIAs).

Plans For the Quality Payment Program in 2017: Pick Your Track

Sep 8, 2016• 10

By ANDY SLAVITT

Screen Shot 2016-07-07 at 2.30.28 PM As the baby boom generation ages, 10,000 people enter the Medicare program each day. Facing that demand, it is essential that Medicare continues to support physicians in delivering high-quality patient care. This includes increasing its focus on patient outcomes and reducing the obstacles that make it harder for physicians to practice good care.

The bipartisan Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) offers the opportunity to advance these goals and put Medicare on surer footing. Among other policies, it repeals the Sustainable Growth Rate formula and its annual payment cliffs, streamlines the existing patchwork of Medicare reporting programs, and provides opportunities for physicians and other clinicians to earn more by focusing on quality patient care. We are referring to these provisions of MACRA collectively as the Quality Payment Program.

We received feedback on our April proposal for implementing the Quality Payment Program, both in writing and as we talked to thousands of physicians and other clinicians across the country. Universally, the clinician community wants a system that begins and ends with what’s right for the patient. We heard from physicians and other clinicians on how technology can help with patient care and how excessive reporting can distract from patient care; how new programs like medical homes can be encouraged; and the unique issues facing small and rural non-hospital-based physicians. We will address these areas and the many other comments we received when we release the final rule by November 1, 2016.

Health 2.0–Expediting The Health Technology Buying Process

Sep 8, 2016• 1

Screen Shot 2016-09-06 at 7.14.56 PM By ALYX STERNLICHT & MATTHEW HOLT

Like I told you, there’ll be a lot more on THCB about what’s going to be happening at Health 2.0 coming up Sept 25-8. Today’s edition–MarketConnect a new program for getting new products into provider organizations, modeled on something we’ve been doing as part of our pilot programs in Health 2.0’s Catalyst group–Matthew Holt

Through vigorous vetting of health technology companies and matching based on prospective buyers’ needs, Health 2.0 is simplifying and expediting the health tech buying and selling process during the 10th Annual Fall Conference on September 25-28 in Santa Clara. Health 2.0’s MarketConnect is an invitation only forum for buyers and sellers to be pre-matched for market compatibility and facilitate technology acquisition. Executives from organizations such as Kaiser Permanente, Cedars-Sinai and UPMC will be looking to connect with technology companies.

The networking program is designed to break down the barriers of technology adoption within large health systems and health organizations to connect tech companies directly with pre-qualified executives that are interested in seeing vetted technologies that are relevant to problems that are trying to solve.

How it works: Health 2.0 works with closely with buyers to identify specific areas where technology is needed and a solution is required within 12 months. Health 2.0 then assess the digital health marketplace and identifies relevant companies aligned with buyer’s’ technology needs and connect buyers with hand-picked companies during our MarketConnect event at Health 2.0’s Annual Fall Conference. During the event, buyers will meet with compatible companies with the intent of purchasing suitable technologies. If you want to know more contact Patrick@health2con.com

The Top Five Recommendations For Improving the Patient Experience

Sep 7, 2016

By KATHLEEN MERKLEY and ANNE MARIE-BERKMORE

Healthcare organizations are working diligently to improve patient satisfaction and the patient experience of care. After all, patient experience of care is a critical quality domain used to evaluate hospital performance under the 2016 CMS Hospital Value-Based Purchasing (VBP) Program (accounts for 25 percent of a hospital’s VBP score)—and comes with the potential for a penalty or bonus.

Patient experience of care is also one of three essential dimensions of the industry-guiding IHI Triple Aim (a framework for optimizing health system performance):

Improving the patient experience of care.
Improving the health of populations.
Reducing the per capita cost of healthcare.

Improving the patient experience can seem like a moving target influenced by a variety of factors. For one, despite the fact that healthcare organizations have been talking about and focusing on patient experience and patient satisfaction for a long time, universally accepted definitions don’t exist. For example, patient satisfaction survey vendors use contrasting language, leading to varying patient interpretations. The industry also lacks conclusive research that proves the connections between patient satisfaction and outcomes. And with so many resources focused on improving patient satisfaction, it’s no surprise healthcare leaders want to understand the connection.

A Hole In the Heart, Part I

Sep 6, 2016• 5

By ANISH KOKA, MD

Strokes are the third leading cause of death in the United States. 800,000 people suffer a stroke every year, and the consequences are frequently devastating. Lives are not just lost, but changed forever – speech permanently silenced, arms and legs turned into useless appendages. The brain is very expensive real estate and it is little surprise that a clot the size of a pinhead lodged in a blood vessel feeding the brain is all that is needed to wreak a devastation most fear worse than death.

Most of the time the source of the debris that results in a stroke can be readily identified, but at least one-third of the time no source can be found. These have been termed cryptogenic strokes by the medical community mostly because it is an intelligent sounding phrase when your doctor does not know why something happened. Almost 30% of strokes in patients under the age of 55 are found to be cryptogenic. Until the mid 80’s there was little progress in identifying the cause of these strokes, but around the same time I was wondering why Duran Duran was running through jungles in Sri Lanka on MTV, cardiologists began injecting air into the heart to shed light on this mystery.

On the Wondrous U.S. Market For Prescription Drugs

Sep 4, 2016• 18

By UWE REINHARDT

Citing a recent report in the Los Angeles Times, an article in FirecePharma entitled “Some generic drug prices soar despite heavy competition” rises questions on the ability of market forces to reign in drug prices – for example, on the idea that the price of Mylan NV’s EpiPen would not have risen to $614 per 2-pack from about $100 per 2-pack or less in 2007 if the Food and Drug Administration (FDA) had not prevented Sanofi’s and a new product by Teva to come on market, leaving Mylan NV in full monopolistic control, of this blockbuster market.

According to data assembled by the Los Angeles Times, prices of generic drugs can rise sharply even if multiple manufacturers compete for market share. As an illustration, the article cites the generic drug ursodiol for gall stones, produced by no less than 8 manufacturers. “Several years ago, the wholesale price ran as low as 45 cents a capsule. In May 2014, Lannett Co. ($LCI) bumped its price for ursodiol to $5.10 a capsule, a price hike of more than 1,000%. Rather than keeping their own generic versions of ursodiol low to steal market share, each competitor followed Lannett’s lead and priced their versions the same or close.”

I Wish My Doctor Knew …

Sep 4, 2016• 3

By NIRAN AL-AGBA, MD

flying cadeucii Recently the New York Times published an article What Kids Wish Their Teachers Knew. As a pediatrician, I have spent a good part of my lifetime fighting for the health and welfare of our young people. They are the future. We owe our children a safe, caring, stable childhood whenever possible. Outside of a supportive family, a long-term family physician or pediatrician can be an important role model for impressionable youngsters.

For confidentiality reasons I have altered identifying details, but will give you some of the great things heard over the years and a few tragic ones as well.

I Wish My Doctor Knew… there is not enough food at home. Many years ago, I was seeing twins for a yearly checkup and giving them shots when one, older by 4 minutes, blurted out there was not enough foods to eat at night when she was hungriest. I contacted the school counselor to ensure both children were offered free breakfast and lunch at school. They were added to the program sending home a backpack full of food every weekend. At Thanksgiving, this family received one of the donated dinner baskets with turkey, mashed potatoes, and all the trimmings. The children grew better and crossed percentiles in the positive direction; their grades improved as an added bonus.

EpiPenEconomics

Sep 3, 2016• 2

By DEVON HERRICK

U.S. Patent No. 4031893, Hypodermic Injection Device Having Means for Varying the Medicament Capacity Thereof

Americans throw away unused epinephrine auto-injectors worth more than $1 billion annually. Or maybe it would be more accurate to say that Americans waste more than $1 billion annually on $50 million worth of epinephrine auto-injectors that are discarded unused. The devices should only cost $20 a pair. So, why do they cost $608 instead?

First, a little background. Severe allergic reactions can result in anaphylaxis, including skin irritation, hives and a person’s windpipe can even begin to swell closed. Children allergic to peanuts or tree nuts are especially a concern since their parents are not always there to supervise them. By some estimates, perhaps 4 percent to 6 percent of children have some type of food allergy. Yet, the likelihood of children suffering anaphylaxis is low. Estimates vary, but a study from Washington State back in the 1990s found only 1 kid in 9,524 had an episode in any given year. A similar study from Minnesota found the rate was one in 1,400. The difference in the prevalence had to do with how strict a definition was used.

IoT: A Transformative Ecosystem or a Race to the Bottom?

Sep 2, 2016• 1

By ROB HAVESEY

A couple of weeks ago, I was invited to speak on a panel at the Brookings Institution discussing the 5^th-Generation (5G) wireless revolution, how it will enable the Internet of Things (IoT) and the implications for healthcare. In the paper that spawned the Brookings panel, Darrell West noted that 5G networks will incorporate cloud storage and a distributed computing model into a true Internet of Things, where billions of devices will share data in new ways.

The possibilities for identifying important health trends and intervening at just the right time to affect behavior — using everyday objects and systems — opens the door to all kinds of possibilities for improved health. But for me, that idea is positively frightening, given the current state of interoperability in healthcare.

The IoT only works if there are standards. An essential function of IoT standards is to allow devices to identify their capabilities to each other, and provide basic information regarding format. Several organizations are working on this, but none seem well-versed in healthcare needs.

As low-cost, consumer-grade sensors are embedded into devices without regard for the unique needs and requirements for healthcare data exchange, will we experience trouble? Will the 5G healthcare IoT become a ‘race to the bottom,’ where data of dubious or unknown quality will power our new healthcare ecosystem?

Take, for example, a connected weight scale. Even if a device collects data accurately, the way the scale transmits data can enhance or nullify its accuracy. For general wellness, this probably doesn’t matter. But for monitoring a condition like heart failure, it does.Continue reading…

Obama Channeled Orszag, Orszag Channeled the Dartmouth Institute

Sep 1, 2016• 9

By KIP SULLIVAN, JD

flying cadeucii In an open letter to President Obama that I posted here on August 24, I stated that his expectation that the Affordable Care Act would have a deflationary effect was naive. I said he was badly misled by the managed care movement, and that he should never have accepted the movement’s diagnosis (overuse) and solutions (shifting insurance risk to doctors and micromanaging them). To help him understand that, I said I would post criticism of three prominent managed care proponents who influenced him: Elliott Fisher and his colleagues at the Dartmouth Institute, Atul Gawande, and Peter Orszag.

I will start with Elliott Fisher and his colleagues at the Dartmouth Institute for Health Policy and Clinical Research because they have been so influential with the entire health policy elite, not just Obama. I will devote this post and the next to them. I devote this post to demonstrating how influential they have been; I devote the next post to demonstrating how misleading they have been.

The Dartmouth Institute deserves credit for assembling data that shows substantial variation in the rate at which medical services are provided, both within small areas and between regions of the country. This data is very useful for generating hypotheses in need of further research. But the group deserves severe criticism for promoting the conclusion that variation can be explained primarily by overuse and virtually none of it can be explained by underuse, and for promoting “accountable care organizations” and other forms of “integrated care” as the solution that will address their erroneous overuse diagnosis.