By JOSHUA ELDER and GAIL D’ONOFRIO

The United States is facing an alarming rate of opioid and heroin overdoses. The recent death of Prince highlighted yet again a tragic event that is occurring 78 times everyday in the United States according to the Center for Disease Control (CDC). With more deaths from overdoses occurring annually than motor vehicle collisions, President Obama’s administration recently asked Congress for more than $1 billion to fight the opioid epidemic. Fortunately for Obama the issue has garnered strong bipartisan support and what remains is how to responsibly allocate this funding toward a variety of strategies aimed at prevention, treatment and harm reduction.

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By HOSPITAL TALK

In this Carelogistics podcast, THCB editor Sanchayeeta Mitra talks about how thinking like an engineer can eliminate breakdowns in care delivery, the eternal quest to make a trip to the doctor’s office more like the experience of using Amazon.com and why doctors and engineers (and nurses and the IT department) should all love each other. Really.

If you have a story to tell about something innovative you’re doing or a hack you’re using to change medicine or improve care delivery at your hospital or practice – drop us an email to considered for an interview.

By ANISH KOKA, MD

Like many cities, Philadelphia is a city defined by its neighborhoods.  I practice in two neighborhoods separated by a few miles but leagues apart in every other way.  One of the hospitals is a tertiary care facility in the heart of Center City – a well to do upcoming part of town – and the other is a small community hospital a few miles South.  The patients at the two locations are quite different, and the mechanism of health care delivery is also starkly different.  Medical care at the Center City campus is provided mostly by employed physicians, and care at the community hospital is provided mostly by private practice physicians.

The debate about employed physicians vs. private physicians was one that until very recently was thought to have been settled.  To the nascent Obama administration in 2008 charged with ‘fixing’ health care, it was obvious that health care delivery in the United States was of low quality and needed change.  Enamored by models like the Mayo Clinic, the Cleveland Clinic, and Geisinger the answer clearly was large clinically integrated networks.  And just like that, with little discussion, and no evidence, the Obama administration set into motion legislation in the form of the Affordable Care Act that brought private practice to its knees. Declining reimbursement and increased overhead costs from regulations meant that percentage of private practice physicians went from 57% in 2000 to 37% in 2013.
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By MARGLIT GUR-ARIE

Some wars are supposed to last forever. Lyndon B. Johnson started a war on poverty. Richard Nixon kicked off a war on drugs. Ronald Reagan initiated a war on terror. Poverty, drug use and terror are booming. It’s time to launch another good ol’ war. Let’s make it relevant, cool, hip and infinite. So how about a 21st century war on Cybertheft?  This may sound trifle by comparison to those other wars, but wars are rarely about the actual title we bestow upon them. The war on terror evolved into a war on people living under secular dictators, the war on poverty ended up being a war on poor people, and the war on drugs became a war on black people. The war on Cybertheft will be the war on all people everywhere.

The war on Cybertheft has been simmering since the banks decided to do business online. The threat of “identity theft” should have been a monumentally mobilizing battle cry. But it wasn’t. Oh sure, it spawned a bunch of fear inducing exposés and some mildly successful businesses, but all in all, it failed to generate the zombie apocalypse panic it was supposed to trigger. Luckily, our wise leaders decided to put all our medical information on the Internet. It’s one thing for a Romanian hacker to gain access to your checking account balance, and quite another if Marcel is suddenly able to peruse your history of vaginal yeast infections. It makes no sense really, but the latter seems like an unbearable and humiliating violation of who you are. Wars have been launched for much less than that.

Let me give you an example that is splashed all over the news lately. A nondescript bunch of hackers broke into Democratic Party servers, stole all sorts of documents and emails and provided them to WikiLeaks for publication. This incident proved to be an embarrassment for the global money cartel behind our democratic curtain, and at the same time a great opportunity to score some cheap points in this weird election while stoking the fires of war. Within 24 hours, and with ample assist from corporate media tools, the conversation moved from corrupt, political machinations to an alternate universe where the Kremlin is colluding with insurgents to overthrow the rightful rulers of America. Terrifying stuff.

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By SAURABH JHA, MD

To paraphrase Tolstoy, all competence is alike, but every incompetence is incompetence in its own way. Every time I think I’ve seen the horizon of incompetence, I’m dealt a surprise. The sun never sets on incompetence. In healthcare, incompetence can be found in odd places, such as three recent examples I encountered with third party payers.

Case 1: Downgrading Caviar to Boiled Salmon

A patient was referred for a CT angiogram run off – which is a CT scan of the arteries of the belly, pelvis, both legs and feet – a very detailed and costly study. The cardiologist suspected a pseudoaneurysm of the femoral artery. The exam was an overkill, I felt, as the femoral arteries could be covered in a CT angiogram of the abdomen and pelvis – you don’t need to image down to the toes. I was confident that a pseudoaneurysm in the femoral artery would not extend to the arteries of the feet – it would be a world record, if it did. I suggested we stop the exam in the middle of the thigh.

“That’s fraud,” warned the chief technologist, who was also an expert in billing.

“Why is it fraud to restrict the field of view to the area of clinical relevance?” I asked.

“You can’t bill for a CT angiogram run off and only do the abdomen and pelvis. That’s fraud.”

“Why don’t we bill just for CT angiogram of the abdomen and pelvis?” I asked.

“You can’t bill just for the abdomen and pelvis, the patient has been pre-authorized for a run off.”Continue reading…

By LEONARD D’AVOLIO

I was walking with colleagues debating the merits of the latest round of healthcare payment reforms when we came across the ultimate symbol of American entrepreneurialism.  A young girl had set up a lemonade stand with a sign marketing 25 cents a cup.

“I’ll take one” I declared and was impressed with how confidently the young entrepreneur announced my total.  As I settled my tab my colleague stated that he too would like a cup of lemonade and was willing to pay 30 cents.  Except, he would pay half now and the other half would arrive after the cup was emptied, assuming a list of 8 pre-determined criteria were met.  Before he could finish explaining the 30 possible criteria from which she could choose, the third companion announced his thirst.  He would buy lemonade for two of the three of us!  For this, he would offer a dollar.  The catch was that two of us would receive all the lemonade we required for this flat rate.  She eyed each of us up and down carefully, gauging our potential lemonade intake and asked which two were to be covered?  To which my colleague answered, “you will not know until you sign the contract.”

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By TAMARA ST. CLAIRE

Consumers know that their primary care doctors don’t talk to their specialists, who don’t talk to their pharmacists, who don’t talk to their insurance providers. The rise of consumerism in healthcare may be in its infancy, but according to research recently released by Xerox, a full 64% of consumers wish their pharmacist, healthcare provider, and insurance company were more connected regarding their health.

Consider your most recent travel experience. You probably used a website like Expedia.com to look up flights, hotels, and even rental cars. With all the relevant information displayed conveniently (and often beautifully) side-by-side, you were probably able to make an informed decision and instantly book the exact travel package that suited your needs.

Now imagine your most recent healthcare experience. Scheduling the appointment was probably a painful logistical balancing act, accompanied by terrible hold music. You likely had to find and present an insurance card, possibly even filling out another set of insurance forms and a health history for the thousandth time.

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