The Health Care Blog – Page 371 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Overoutrage and the Asymmetric Skepticism of Healthcare Journalists

Mar 20, 2016• 17

By SAURABH JHA, MD

flying cadeucii I like healthcare journalists. Some of my best friends are healthcare journalists. I’d rather read Larry Husten on clinical trials than the constipated editorials in peer review journals. Healthcare journalists are an important force against overdiagnosis, overtreatment, overprescription, overdoctoring and overmedicalization. They’re articulate and skeptical. But they seem to have a blind spot – overoutrage.

Overoutrage is excessive moral outrage. Outrage is excessive anger. Anger is excessive emotion. Emotion is excessive anti-reason. Overoutrage is the mother of all overdoing.

Overoutrage is the healthcare journalist’s kryptonite. These skeptical Rotweillers become credulous poodles when they see overoutrage. Overoutrage axiomatically assumes a moral high ground – for the transgression must have been severe for the outrage to occur. Overoutrage is circular reasoning without an exit. Overoutrage is more powerful than any randomized controlled trial. Much of healthcare policy, indeed civic life, is shaped by it.

A recent event highlights this phenomenon very well. NEJM’s national correspondent, Lisa Rosenbaum, wrote about a surgeon’s determined, and widely publicized, advocacy to ban morcellation, a procedure to treat uterine fibroids. Dr. Hooman Noorchashm’s wife, Amy Reed, underwent morcellation to treat uterine fibroids. Unbeknownst, she had uterine cancer, and the morcellation almost certainly worsened the prognosis by spreading the cancer beyond the uterus. Banning morcellation would be a no-brainer except that morcellation has fewer complications than open surgery for fibroids, and that the chances of undiscovered uterine cancer in a woman with fibroids are exceedingly rare.

How the Health Co-Ops Can Meet Their Financial Obligations

Mar 19, 2016

By WILLIAM SNYDER

flying cadeucii A congressional subcommittee held a hearing Thursday to examine the health insurance co-op loan program established by the Affordable Care Act. The program provided $2.4 billion in taxpayer-backed loans as seed money for the co-ops, which are private companies that were originally intended to bring competition, choice, and innovation to the health insurance market. In spite of this seed money, co-ops are off to a rough start. Since their inception just over two years ago, 12 of the original 23 co-ops have closed due to financial concerns. Taxpayers aren’t the only ones at risk of getting left with the tab for the co-ops.

A co-op left doctors and hospitals in Iowa and Nebraska holding over $80 million in unpaid claims when it closed. Worse still, consider that unpaid claims left behind by failed insurance companies are often allocated by state guaranty funds to the surviving insurance companies, who ultimately pass them on to consumers. One way or another, you’re likely to pay for any obligations the co-ops can’t meet. The co-ops’ leaders don’t offer much comfort, either. One co-op CEO recently offered this assessment of the co-ops’ prospects for re-paying their loans: “Will there be a little money left? Yeah, maybe.” Fortunately, the surviving co-ops have an often-overlooked asset they can tap to stay in business and meet their obligations: the recovery rights to their overpayments.

The NFL is Not Big Tobacco: Overdiagnosis and Chronic Traumatic Encephalopathy (CTE)

Mar 18, 2016• 5

By SAURABH JHA,MD

Screen Shot 2016-03-18 at 3.48.30 PM As a general rule, if you keep clobbering a body part it may, in the long run, get damaged. This is hardly rocket science. Soldiers marching long distances can get a stress fracture known as “March fracture.” The brain is no exception. Boxers can get “dementia pugilistica.” This is why we frown upon people who bang their heads against brick walls.

Footballers are at risk of brain damage, specifically a neurodegenerative disease known as chronic traumatic encephalopathy (CTE). CTE was described in a football player by forensic pathologist, Bennet Omalu, who performed an autopsy on Michael Webster, a former Pittsburgh Steeler. Webster died of a heart attack but had a rapid and mysterious cognitive decline. Webster’s brain appeared normal at first. When Omalu used a special technique, he found a protein, known as tau, in the brain.

Omalu’s discovery inspired the movie Concussion in which Will Smith plays the pathologist. The Fresh Prince plays convincingly a god-fearing, soft-spoken but brilliant physician, who is up against incredulous colleagues and the National Football League (NFL). The NFL clearly has a lot to lose from Omalu’s discovery. However, the director’s attempt to emulate The Insider, where big tobacco tailgates the scientist, fails at many levels.

More on Loneliness as a Major Health Risk Factor

Mar 18, 2016

By TOM EMERICK

flying cadeucii One of the myriad reasons wellness programs are not performing well is that all humans have about 100 risk factors, of which obesity, high blood sugar, high blood pressure, and high cholesterol are only four. If those four are in pretty good shape but the other 96 are out of whack, don’t expect good health results.

Further, putting bandages on symptoms of metabolic disease has limitations. Such bandages do not address the root causes of metabolic syndrome. According to Wikipedia:

“Root cause analysis (RCA) is a method of problem solving used for identifying the root causes of faults or problems. A factor is considered a root cause if removal thereof from the problem-fault-sequence prevents the final undesirable event from recurring; whereas a causal factor is one that affects an event’s outcome, but is not a root cause.Though removing a causal factor can benefit an outcome, it does not prevent its recurrence within certainty.” (Emphasis mine.)

One thing sorely missing from most modern wellness methods is RCA. Unless one deals with RCA in metabolic syndrome it will continue to recur.

Some other huge health risks factors are job misery, terrible marriages, very poor money handling skills, envy, general lack of contentment in life, and loneliness. Another health risk is how far you live from a “dial-911-first-responder”. Yet another is how safe your neighborhood is. I could go on and on. Worksite wellness does nothing to address the vast majority of personal health risks. My book, An Illustrated Guide to Personal Health*, elaborates on such health risks.

Unique Device Identifiers: Medicare Claims Should Include Implant IDs

Mar 18, 2016• 4

By JOSH RISING, MD

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New findings from Medicare’s independent auditor indicate that faulty medical implants—such as cardiac pacemakers and artificial joints—are harming seniors and costing taxpayers billions of dollars. According to the Department of Health and Human Services inspector general, the solution is a step recommended by patient safety experts and the Food and Drug Administration: collecting device-identifying data in Medicare claims.

In a letter to Senators Chuck Grassley (R-IA) and Elizabeth Warren (D-MA), the inspector general wrote, “Collecting UDI [unique device identification] data on claims forms would add significant long-term value and benefits.” The auditor’s investigation finds that taking this step would not only help the Centers for Medicare & Medicaid Services (CMS) improve care for beneficiaries, but would also strengthen Medicare’s program integrity, because the costs associated with defective devices could reach several billion dollars due to additional hospitalizations, surgeries, and other care.

While FDA and multiple groups of experts have called for this change, the inspector general indicates that, to date, CMS has not taken action or developed plans to support the policy.

Interview: Steve Curd, CEO Wanda

Mar 18, 2016

By MATTHEW HOLT

Another interview from the HIMSS conference earlier this month. The idea behind these interviews is that they give you a quick overview of the companies, and a sense of where the system as a whole is going.

As opposed to interviews with Philips & Xerox, this is one with a real start up called Wanda. CEO Steve Curd was early on at Healtheon (later WebMD) and then CEO of a startup called CareinSync which sold to Hearst. Now Wanda is a brand new well-funded startup (from a UK based-fund called Net Scientific) focused on patient engagement and behavior change using an interesting mix of psychology and analytics (unlike Monty Python’s suggested technique of sarcasm and extreme violence!).

https://youtu.be/w_BplpKC6yo

Precision Medicine’s First Test is Blue Button on FHIR

Mar 17, 2016• 2

By ADRIAN GROPPER, MD

flying cadeucii President Obama’s legacy for health information technology is about to see its first test at the hands of a little-known project for access to Medicare beneficiary data. The President’s Precision Medicine Initiative (PMI) database is the big brother of Medicare’s database. Although both databases will be managed by the Government, the PMI one will also have our DNA and as many of our health records as we are willing to move there. How much control will patients have over our data in either of these databases? Federal policy on these databases will impact all of healthcare.
The test is whether either of these databases will limit one’s ability to control and use our own data.

Can I have free first-class network access to my own data?

Can I send my own data instantly to anywhere I choose?

Can I direct my data digitally, without paper forms?

These three questions apply equally to my Medicare data, my data in a private-sector EHR, and my PMI data. Current HIPAA law allows it but will the Government and hospitals actually implement it? The policy for the Medicare database is being implemented as Blue Button on FHIR this summer, and so-far it doesn’t look good.

If our Federal Health Architecture (FHA) will not allow us the maximum control allowed by the law, then how can we expect private-sector healthcare systems to do it? I wrote about the current HIPAA law and how it needs to be changed to make a patient’s first-class access a right, instead of an option, in a previous post.

What Healthcare Can Learn From Silicon Valley

Mar 16, 2016• 4

By ED PARK

flying cadeucii As consumers, we expect that when we bank, our ATM card will work in any machine worldwide, dispensing the cash we need and sending the record back to our home financial institution. Similarly, we would be enraged if we bought a new MacBook and couldn’t access our Gmail or load Microsoft Office. We expect this level of connection in so many aspects of our lives. Yet we accept a great deal less from health care than we do from our ATM cards and MacBooks.

How we got to this state is a long and complicated story. Health care has had few incentives to open up to innovation. Hospitals and physician groups have worked on their own closed information systems, hoarding data to keep their care in-network and maintain market share. This practice discouraged innovation and created a generation of ugly, unusable, and disconnected technology that has failed woefully to connect care for patients.

Congress Has a Little Drug Problem

Mar 16, 2016• 15

By BRIAN KLEPPER

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The Congressional committee that recently demanded Martin Shkreli’s appearance must have hoped to spotlight a smug jerk responsible for the outrageous prescription drug pricing that we’re all up against. Of course there are lots of Shkrelis running drug companies, but most are shrewder and less brash, and might not make for such good theater.

Rep. Elijah Cummings (D-MD), one of the Committee’s questioners, seemed to think that his witness could move healthcare forward by disclosing the machinery of the drug sector’s excesses. “The way I see it, you could go down in history as the poster boy for greedy drug company executives or you could change the system. Yeah, you.”

Excessive treatment and cost are at the core of the entire U.S. healthcare crisis. The fact that other societies and a few innovative firms here consistently deliver equal or better quality care at dramatically lower cost betrays the idea that conventional U.S. healthcare is necessarily superior or even appropriate.

Every part of healthcare is guilty, but the pharmaceutical sector is a case in point. An open record of lobbying spending and what pharma has obtained from Congress makes clear that its contributions have worked to that sector’s economic advantage and against the interests of American patients and purchasers.

Rethinking How U.S. Health Care Policy Approaches the Mouth

Mar 16, 2016• 7

By MARKO VUJICIC

flying cadeucii

Dental care has traditionally been financed and delivered separately from medical care. This is despite the Surgeon General’s report in 2000 that emphasizes the importance of oral health to whole body health. Now, new data show the consequences of the approach taken in U.S. health care policy to oral health.

Medicaid Children Seeing Big Gains in Access to Dental Care

The American Dental Association Health Policy Institute (HPI) recently launched The Oral Health Care System: A State-By-State Analysis. This first-of-its-kind data repository brings together data from multiple sources related to oral health and is meant to serve policy makers and researchers. One of the most significant findings from these data is that access to dental care has been increasing steadily among Medicaid children for more than a decade.

Nationally, the percent of Medicaid children who visited a dentist within the past twelve months went from 29% in 2000 to 48% in 2013, the most recent year for which data are available. What is striking is that the trend is remarkably widespread across states, with all but one state experiencing gains over this time frame. As a result, the gap in dental care utilization between Medicaid- and privately-insured children has been shrinking steadily. In fact, it narrowed in every single state for which we have data between 2005 and 2013 (see figure below). There are two states – Hawaii and Texas – where there is actually a “reverse gap”: children enrolled in Medicaid are more likely to visit a dentist than children who have private dental benefits. Moreover, this progress has all been happening during a time when the number of children enrolled in Medicaid and the Children’s Health Insurance Program (CHIP) has been rising steadily. In 2013, nearly four out of ten children in the U.S. were enrolled in Medicaid or CHIP compared to two out of ten in 2000.