The Health Care Blog – Page 374 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

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

Mar 16, 2016• 7

By MARKO VUJICIC

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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.

The End of Civilization and the Real Donald Trump

Mar 15, 2016• 17

By ART CAPLAN

Screen Shot 2016-03-15 at 9.13.00 AM The pandemic started quietly. In the spring of 2017 A few hundred dead chickens appeared in markets in Hong Kong and a few other cities in China. Public health officials in China were slow to respond. They did not want to panic the public about an avian flu outbreak. Nor were they eager to take the steps necessary to contain such an outbreak—the killing hundreds of thousands of chickens and poultry with devastating economic consequences. While the delay went on a few cases began to occur on Canadian and American poultry farms. Department of Agriculture experts traced the outbreak to waterfowl migrating from Northern flyways, probably from Asia. Inquiries were made about avian flu outbreaks in Asian nations. Then the unthinkable happened. Humans in Hong Kong began to get sick. Very sick. Some died. Those who died were in their twenties.

The avian flu virus had mutated. H7N9m had transformed into an agent that not only could infect humans but did so with a transmissibility and lethality that had not been seen since the Spanish flu outbreak of 1918.

Then the first American died. A young man back from a business trip to Hong Kong. The media, already primed for hysterical coverage following the severe Zika outbreak in the Southern United States in the summer and fall of 2016, went into full panic-dispensing mode. ‘Experts’ began to appear on the cable channels who suggested that the outbreak was the result of irresponsible genetic research in China. Still others suggested that it was the bioterror work of North Korean scientists. One or two pointed toward ISIS arguing that they had grown desperate in the face of the massive air war that the new administration had launched. Still others saw the hand of right or left wing domestic terrorists. And an accident at an American lab was put into the boiling cauldron of speculation and conspiracy.

The 5 Stages of EMR Acceptance (With Apologies to Kubler-Ross)

Mar 15, 2016

By FRANK MEISSNER

DENIAL

I can’t believe they are making me use this system!

ANGER

I CAN’T BELIEVE THEY ARE MAKING ME USE WHAT
THEY LAUGHINGLY CALL A SYSTEM!

BARGAINING

‘Look if I agree too willingly and cheerfully use this system, can you ask for and fund these change orders, add these features, re-engineer this screen…..blah! blah! Blah!, etc. ‘

DEPRESSION

I can’t beeeelieeeeeeve (sob, sob, sob, sob) theeeey (sob, sob, sob) are making meeeee (pouring tears from both eye tear wells) use this system!’

ACCEPTANCE

I believe they are making me use this system.

(Resigned Sigh)

And just as in the original Kubler-Ross model, our only release from EMR agony is death……. an eventuality that I used to accept stoically as inevitable, but now positively look forward to its release (as do my carpal-ly tunneled wrists!). Continue reading…

Xerox–Tamara StClaire interview

Mar 15, 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.

Today is an interview with Tamara StClaire, chief innovation officer of Xerox Healthcare. She not only has some information on what Xerox is up to (including a hint about its new population health management platform) called Health Outcomes Solutions. But also some data from a study Xerox did on the readiness of providers to move to value based care (Hint: not very!) I also want to know what inspired the eyeroll in the video still below? Not me, surely!

The Paradox of Evidence-based Medicine

Mar 15, 2016• 5

By MICHEL ACCAD, MD

Anish Koka recently wrote a great piece entitled “In Defense of Small Data” that was published on The Health Care Blog.

While many doctors remain enamored with the promise of Big Data or hold their breath in anticipation of the next mega clinical trial, Koka skillfully puts the vagaries of medical progress in their right perspective. More often than not, Koka notes, big changes come from astute observations by little guys with small data sets.

In times past, an alert clinician would make advances using her powers of observation, her five senses (as well as the common one) and, most importantly, her clinical judgment. He would produce a case series of his experiences, and others could try to replicate the findings and judge for themselves.

PCMH Fails Natural Experiment

Mar 14, 2016• 9

By AL LEWIS

Medical Homes Fail Yet Another “Natural Experiment”

Three “natural experiments,” three failures. Such is the fate of patient-centered medical homes (PCMH), a well-intentioned but unsuccessful innovation now kept afloat by the interaction of promoter study design sleight-of-hand with customer innumeracy.

By way of review, a natural experiment is an experiment in which the design is outside the control of investigators, yet mimics an experiment. The first two natural experiments below involve applying the intervention across entire states. The third involves a stimulus-response experiment in one specific community.

Statewide Natural Experiments: North Carolina and Vermont

In North Carolina, a statewide Medicaid PCMH was implemented years ago and steadily expanded until most Medicaid recipients belonged to one. There was no reduction in relevant event rates (for ambulatory care-sensitive admissions) and costs increased. While the overall Medicaid budgets were routinely exceeded and that should have caused legislators to realize that something in their PCMH was amiss, Milliman fabricated data to pretend the PCMH program was a success. Milliman got caught making up data (and ignoring other data that quite definitively invalidated its conclusion, and changed their story 180 degrees, a tacit admission that they lied. And shortly thereafter (at least “shortly” by the standards of state government), North Carolina announced that it is abandoning this failed experiment.

Philips — Interview with Carla Kriwet

Mar 14, 2016

By MATTHEW HOLT

Now I’ve got them uploaded and semi edited I’ll be running the interviews I did at the HIMSS conference earlier this month. They will hopefully give you a quick overview of the companies, and give you a sense of where the system is going.

Today is an interview with Carla Kriwet, CEO of Patient Care and Monitoring Solutions at Philips. The Dutch electronics giant has a huge footprint in the hospital and big ambitions outside it.

Retail Clinics Raise Medical Spending: So What?

Mar 13, 2016• 1

By DEVON M HERRICK

flying cadeucii New research published in Health Affairs finds that retail clinics don’t save money. Many health policy analysts had hoped that retail clinics would reduce medical spending by replacing more costly physician office visits. The article did confirm that retail clinics are less expensive than traditional physician visits for the same service. Yet retail clinic use was associated with an increase in medical spending of $14 per year by those who used them. The $14 per person-year increase was not a complete picture, however, because the study did not compare inpatient spending or prescription drug use.

The researchers looked at Aetna insurance claims for 11 low-acuity conditions to see if people were substituting cheaper retail clinic visits for more costly doctor visits. What they found was that patients tend to visit a retail clinic when they might otherwise forgo care. In other words, patients were adding visits for conditions that would have cleared up on their own rather than necessarily substituting cheaper visits for higher cost visits. Traffic at retail clinics tends to peak during off hours (evening and weekends) when physician offices are closed.

The research was reported by Kaiser Health News and also ran in MedCity News, where I found some of the comments especially interesting. One commenter asked if changing the term “utilization” to “engagement” might make a difference, as in:“clinics increase health ‘engagement’ to the tune of about $14/person.” Increasing patient engagement sounds like a positive benefit rather than the negative connotation of utilization.

As an economist, my knee jerk reaction is patients may want to visit a retail clinic when their traditional source of care is not available. They may be willing to spend a little extra in cost-sharing to take care of a medical need rather than suffer through it.

The ACO Information Vacuum

Mar 13, 2016• 4

By KIP SULLIVAN

flying cadeucii In my three-part series on why we know so little about ACOs, I presented three arguments:

We have no useful information on what ACOs do for patients;
that’s because the definition of “ACO” is not a definition but an expression of hope; and
the ACO’s useless definition is due to dysfunctional habits of thought within the managed care movement that have spread throughout the health policy community.

Judging from the comments from THCB readers, there is no disagreement about points 1 and 3. With one exception (David Introcaso), no one took issue with point 2 either. Introcaso agreed with point 1 (we have no useful information on ACOs), but he argued that the ACO has been well defined by CMS regulations, and CMS, not the amorphous definition of “ACO,” is the reason researchers have failed to produce useful information on ACOs.

Another reply by Michael Millenson did not challenge any of the three points I made. Millenson’s point was that people outside the managed care movement use manipulative labels so what’s the problem?

I’ll reply first to Introcaso’s post, and then Millenson’s. I’ll close with a plea for more focus on specific solutions to specific problems and less tolerance for the unnecessarily abstract diagnoses and prescriptions (such as ACOs) celebrated today by far too many health policy analysts.

Summary of Introcaso’s comment and my response

I want to state at the outset I agree wholeheartedly with Introcaso’s statement that something is very wrong at CMS. I don’t agree with his rationale, but his characterization of CMS as an obfuscator is correct.

Feeling the Bern on Universal Single-Player Healthcare

Mar 11, 2016• 37

By JIM PURCELL

Screen Shot 2016-03-12 at 10.40.23 AM

“Elephant in the living room” is an English metaphorical idiom for an obvious untruth going unaddressed. In most political platforms about healthcare and its coverage, there is a most resolutely immovable elephant in our living room. It is there with every single candidate. But with Bernie….

You’ve just got to love Bernie Sanders. It makes me feel like I’m 22 years old in the 1960’s and dumb as all get out about how you pay for things. But let us consider Mr. Sanders’ healthcare proposal. From his own website:

“Bernie’s plan would create a federally administered single-payer health care program. Universal single-payer health care means comprehensive coverage for all Americans. Bernie’s plan will cover the entire continuum of health care, from inpatient to outpatient care; preventive to emergency care; primary care to specialty care, including long-term and palliative care; vision, hearing and oral health care; mental health and substance abuse services; as well as prescription medications, medical equipment, supplies, diagnostics and treatments. Patients will be able to choose a health care provider without worrying about whether that provider is in-network and will be able to get the care they need without having to read any fine print or trying to figure out how they can afford the out-of-pocket costs…[etc.].”

Bernie sure didn’t go half way on this one. All care, whenever, wherever, however. A fundamental right with no filter. OK. So he jumped in with both feet. You’ve got to admire his elan. But what might this mean and how can he ignore what happened in his own home state?