The Health Care Blog – Page 381 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Risk Scoring and Value-based Payments Haven’t Worked: The Medicare Advantage Story

Jan 18, 2016• 5

By ANISH KOKA, MD

Mrs. Cassidy slowly walks into my office one busy afternoon. I see her out of the corner of my eye because she is hard to miss. Mrs. Cassidy has some serious style. She has a deep orange dress with a bright blue blazer on. There aren’t too many folks that can pull that outfit off, but she can. She has a wide slow smile, and she speaks with a slow southern drawl that belies her southern roots. This was supposed to be a routine follow up visit for a 67 year old woman with a history of a mechanical mitral valve replacement and coronary disease.

Unfortunately, she tells me a story that is concerning for angina. I think she needs a stress test. I slide over to the insurance tab on the EMR and I let out a somewhat audible groan. She has a Medicare Advantage (MA) plan. I explain to Mrs. Cassidy that we will need to go through an extra step to pre-certify her stress test. She expresses surprise and asks me what she should do. I will tell you what I told her, but first, let me tell you why.Continue reading…

Toyota-ism vs Taylor-ism

Jan 16, 2016• 5

By MARK GRABAN

flying cadeucii If you’re new to the idea of “Lean,” I invite you to download and read chapter 1 of my book Lean Hospitals.

Hat tip to Suresh for pointing me toward this article that was just published January 14th in the New England Journal of Medicine: “Medical Taylorism“

NEJM is the same journal that published Dr. Don Berwick’s article about Kaizen and Dr. Deming in 1989, how those concepts would be helpful in healthcare. Dr. Berwick realizes, as he talks about in that article, that not all factories are the same. Some are managed better than others. Employees are treated better in the “Lean” factories. Berwick was right to point out that medicine can learn from other industries… but that doesn’t turn the hospital into an assembly line.

In the article posted this week, Pamela Hartzband, M.D., and Jerome Groopman, M.D. (the later the author of the popular book How Doctors Think), rant about all sorts of things… some of which have nothing to do with Lean.

“Advocates lecture clinicians about Toyota’s “Lean” practices, arguing that patient care should follow standardized systems like those deployed in manufacturing automobiles. Colleagues have told us, for example, that managers with stopwatches have been placed in their clinics and emergency departments to measure the duration of patient visits. Their aim is to determine the optimal time for patient-doctor interactions so that they can be standardized.”

This is wrong headed and insulting toward Toyota. I’m pretty sure Toyota would not alienate physicians or other healthcare professionals this way.

Data Thinking In Health Care

Jan 15, 2016

By LEONARD D’AVOLIO

Clinicians have been on the receiving end of some pretty terrible practices when it comes to information technology. Instead of informed and shared decision making, clinicians experience an assault of mandates, metrics, buzzwords, and acronyms without clear explanation or expectations. Not surprisingly, the pages of THCB and beyond contain frustrated denunciations of EMRs, dares for Dr. Watson to replace them, and dismissals of “big data.” This whole “technologists are from mars, clinicians are from venus” vibe is understandable, but it isn’t productive.

Data is the building block of measurement and now that it’s finding its way into healthcare systematic use of it to measure, improve, and provision care isn’t likely to be dropped off the formulary any time soon. It would be helpful then to have a shared language to allow clinicians and technicians alike to cut through the fog of jargon and focus on using data productively.

Developed through trial and error (mostly error) is a simple heuristic that I have found useful for establishing a shared understanding around using data in healthcare. I’ll call it Data Thinking, if only to keep with the tech tradition of stealing working names from other products (in this case, Design Thinking).

Data Thinking is a simple way of coming to consensus, explaining the jobs to be done, and mapping buzzwords to function. Regardless of vendor, technology, or buzzword, making data useful falls into a few basic steps:

Access – getting your hands on the data
Structure – getting it to “apples to apples” so you can do the math
Analysis – learning what matters
Interaction – putting it to use: right place, time, people, presentation

So, You’re a Next Generation ACO …

Jan 14, 2016• 5

BY KOFI JONES

Screen Shot 2016-01-14 at 5.45.59 PM CMS recently announced the inaugural class of Next Generation ACOs – the latest accountable care models which includes higher levels of financial risk and greater opportunity for reward than have been available within the Pioneer Model and Shared Savings Program. CMSs goal is to test whether these greater financial incentives, coupled with tools to support better patient engagement and care management, will improve health outcomes and lower costs for Medicare fee-for-service (FFS) beneficiaries.
One of the most exciting opportunities for these ACOs is the ability to leverage telehealth above and beyond what is currently permissible in fee-for-service Medicare.

Since section 1834(m) of the Social Security Act was codified well over a decade ago, telehealth has only been able to serve Medicare recipients when they got in their cars and drove to a clinical site, in a rural area of the nation. Simply translated – no homes or cities count. With the lightning speed of telehealth advancement, this structure is archaic, limiting, and frankly at this point, senseless. Now, with this Next Gen designation, these “Next Gens” will be able to offer care through telehealth technologies regardless of the patient’s location.

Why Your Culture Does Not Matter To Me

Jan 14, 2016• 13

BY UNDISCLOSED LOCATION

flying cadeucii I am a student in a health care profession. I see many different people every day that come to seek treatment at my school. Most patients are local to our area, but many come to our school’s clinic from different countries, cultures, and backgrounds. Our curriculum has recently been updated in accordance with the board of accreditation that our state mandates for professional schools. This curriculum includes a course entitled ‘Cultural Awareness.’ The goals of the course, as stated by the syllabus and our professor, is to:

Emphasize, illustrate and analyze how patient’s background, culture, beliefs and norms may impact health and health outcomes;
Enhance understanding of legal boundaries and provider’s responsibilities in the delivery of care;
Enhance the students understanding of cultural, various societal values and traditions that must be considered during the delivery of care, doctor-patient interactions and treatment outcomes;
Increase awareness of the challenges and mechanisms for providing services to special populations. Except for the second objective, I am not interested in learning about any of these. I am going to illustrate to you why classes like these are a farce, a waste of our time as professionals, and demeaning to every intelligent culture.

As a professional healthcare worker, I am bound by a code of ethics. In fact, this code is a defining aspect of the culture found among healthcare professionals. This code includes virtues like veracity, nonmaleficence, justice, beneficence, and patient autonomy. These virtues lay the groundwork for almost every aspect of clinical decision-making in healthcare. It is a defining aspect of healthcare culture. This code is well recognized by people within and without the healthcare system as it is the basis for the credibility patients give to their doctors, nurses, dentists, optometrists, etc.

And the Stars Looked Very Different Today

Jan 14, 2016

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“This is Major Tom to Ground Control
I’m stepping through the door
And I’m floating in a most peculiar way
And the stars look very different today
For here
Am I sitting in a tin can
Far above the world
Planet Earth is blue
And there’s nothing I can do”

Space Oddity. HD (YouTube.) THCB
With thanks to @jlschuster827

Meaningful Use Is Dead. Long Live Something Better!

Jan 13, 2016• 32

By MARGALIT GUR-ARIE

At the J.P. Morgan Healthcare Conference in San Francisco, Mr. Andrew Slavitt, acting administrator at the Centers for Medicare & Medicaid Services (CMS),announced on January 11th that “The meaningful use program as it has existed will now effectively be over, and replaced with something better”, and later clarified onTwitter that “In 2016, MU as it has existed– with MACRA– will now be effectively over and replaced with something better”. Meaningful Use is dead. Just like that. No apologies. No nothing. As someone who’s been lamenting the havoc wreaked by the program on both doctors and patients, I should be elated nevertheless. Well, I am not.

Let’s start with appearances. The J.P. Morgan Healthcare Conference is the “largest and most informative healthcare investment symposium in the industry which brings together global industry leaders, emerging fast-growth companies, innovative technology creators, globally minded service providers, and members of the investment community”. In other words the event is all about money for the millionaire and billionaire class. J.P. Morgan Chase itself is the largest financial institution in the country. It is the embodiment of Wall Street and its death grip on our collective neck. Was this conference really the best place to make such momentous announcement?

Besides, why would these extractors of wealth be interested in the fate of something as obscure as Meaningful Use? Shouldn’t they discuss more lucrative schemes, such as running all possible blood tests on one tiny blood droplet, or how the makers of Microsoft Office and the largest online retailer of everything are going to jointly solve for cancer? Shouldn’t they be analyzing trillion dollar addressable markets of genomic rainbows, and how mergers, acquisitions and inversions can help squeeze whatever is left in the turnips that are you and me?

Of course they should, and they did all that and much more. But changes to the Meaningful Use program are of strategic importance to all other rainbows, grails and unicorns. Why? Because Meaningful Use, other than funneling a respectable amount of billions of dollars into the health tech sector, is the enabler of data collection which fuels all other investment opportunities.

Health 2.0 WinterTech–Health Tech Investing at #JPM16

Jan 12, 2016• 1

Screen Shot 2016-01-12 at 8.45.08 PM

Health 2.0’s WinterTech conference is today January 13. It features leaders from Venrock, Canvas, Grand Rounds, Doximity, Livongo, Omada Health, Maverick Capital, GE Ventures, Kaiser Permanente and more. It’s the only event dedicated to health tech and investing during the health investment mecca, JP Morgan Week, WinterTech will bring together the top tech companies, investors, entrepreneurs, policy makers, and more to explore investing in the health tech landscape.

Online sales are sold out but we have released a few seats that you can buy on site.

Key sessions will address New Clinical Tools and Platforms, the Convergence of Life Sciences and Health Tech, the New Consumer Health Ecosystem and more. Additionally, there will be exclusive one on one interviews with top influencers such as Vinod Khosla, Founder, Khosla Ventures; Bryan Roberts, Partner, Venrock; Owen Tripp, CEO, Grand Rounds; Glen Tullman, CEO, Livongo Health; Sean Duffy, CEO, Omada Health and Rebecca Lynn, Co-Founder & Partner, Canvas with “her” CEO Jeff Tagney, Doximity along with a keynote from Jonathan Bush– CEO and Co-Founder, athenahealth.

Along with key speakers, Health 2.0 is famous for its incredible selection of LIVE demos, and this year you’ll see; Redox; Bigfoot Biomedical; Propeller Health; Lyra Health; Outset Medical; LifeQ; Accordion Health; dacadoo; physIQ & Jiff

Top investors will join us to discuss business models, examine trends, and explore portfolios and meet startups. This year we will have:GE Ventures; Novartis dRx Capital; Maverick Capital Ventures; Ziegler; World Bank Group/IFC Venture Capital; Kaiser Permanente Ventures; and many more.

We hope to see you there!!

The Case For Calling the Dietary Guidelines What They Really Are

Jan 12, 2016• 1

By DAVID KATZ, MD

David Katz MD Call me crazy. Or Ishmael, for that matter. I think “Dietary Guidelines for Americans” should be something vaguely like, well, oh I don’t know, maybe: guidelines for Americans. About how to eat well.

What does “dietary guidelines” make you think? Doesn’t it sound an awful lot like: guidelines for people’s diets? Doesn’t that, in turn, sound quite a bit like: here’s what we (whoever ‘we’ is) think you should eat, presumably for health? And doesn’t “guidelines” suggest “guidance” from “guides” who ought to know where they are going, suggesting that the “we” involved should qualify as such?

Yes, that’s exactly what it sounds like. And if we go a step further, and call something “Dietary Guidelines for Americans”- and we don’t say “some” Americans, or Americans in food assistance programs, or Americans eating in school cafeterias- if we just simply say “for Americans”- then doesn’t it sound an awful lot like: this is what we (whoever ‘we’ is) think ALL Americans should be eating?

You bet it does.

And so my friends, we come to it: a steaming mound of misleading BS. Watch where you step.

The Dismal Science Behind Financial Incentives For Docs

Jan 12, 2016• 4

By JAAN SIDOROV, MD

flying cadeucii “It is written: Man shall not live by bread alone.”
Luke 4:4

No matter what you think of the source of that quote, the idea that there may be limits to “aligning incentives” has some merit. In healthcare settings, physicians seem to be supportive of being fairly compensated for their work, but also seem to be quite skeptical about the use of “carrot and stick” style economic rewards to influence clinical practice.

Case in point is this interesting paper describing the results of a randomized clinical trial that used blood cholesterol-level control to assess the relative merits of a) rewarding just the patients vs. b) rewarding just the doctors vs. c) rewarding both patients and doctors vs. d) usual practice, or a control group.

The study took place in three marquee institutions, involving 340 primary care physicians who were already taking care of 1503 adult patients with 1) elevated cholesterol levels who 2) either had coronary artery disease or were at high risk for coronary artery disease.

About half of the patients were already on cholesterol-lowering pills.

The purpose of the study was to determine if real money could be used to increase the rate and level of prescribing a statin drug aimed at achieving levels of cholesterol control that were consistent with national guidelines.