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

Shining the Light on Cancer Surgery Volume

Feb 10, 2016

By JULIANNE MORATH, MD and DAVID PERROTT, MD

flying cadeucii New data just released on cancer surgery volume in California hospitals advance an important and complex discussion about how the frequency with which a cancer surgery is performed at a hospital might influence patient, care team and hospital decisions. An effort funded by the California HealthCare Foundation has recently made these data available for the first time for 341 California hospitals on www.CalQualityCare.org. Having these data readily available opens the door to important inquiries the hospital community is investigating closely. Transparency about cancer surgery volume is, however, just one step toward better understanding and practice. More data and close deliberation are needed, and we must take caution to avoid premature conclusions with insufficient evidence.

Accompanying the release of these data is a new report, Safety in Numbers: Cancer Surgeries in California Hospitals,highlighting important findings about the frequency and location of surgeries for 11 types of cancer.The report reveals that many hospitals performed certain cancer surgeries only once or twice in 2014 and that many cancer patients were within 50 miles of another hospital performing their needed surgery with greater frequency. The report is spurring productive discussion. However,as it is descriptive of cancer surgery volume alone and does not capture patient outcome, it calls on the hospital community to gather more evidence to inform decision-making. As conveners and catalysts for hospital improvement, the California Hospital Association and the Hospital Quality Institute, along with other leaders, are capturing this opportunity to advance the research and dialogue on cancer surgery volume.

Seth Sternberg talks about Honor

Feb 10, 2016

By MATTHEW HOLT

Seth Sternberg was a founder at instant message service Meebo, which was acquired by Google in 2012, and like many tech guys he’s next decided to try to change the health care experience. But unlike many others the aspect he wanted to change was the in home caregiving market, following a bad experience with his own mother. Honor came out from under wraps last year, raised $20m, and is currently operating in Los Angeles and San Francisco. It’s not only a market place where you can hire caregivers for a loved one, but it also allows the client, whether they be the person receiving the care or their loved one–that daughter out of town–to manage the process end to end including booking and paying, and allows the caregiver to report on what they are doing, and follow a careplan.

But beyond that Sternberg is on a mission to “professionalize” the caregivers by not only increasing their pay, but accurately matching them to client needs, and increasing their control over their own situation. To that end Honor recently backed off the Uber independent contractor model and made its caregivers full employees (with stock options!). Very interesting guy with an interesting model. Here’s the interview:

https://youtu.be/6TsqQVlkptE

It’s Time to Talk about Cancer Surgery Volume

Feb 10, 2016• 2

By JENNIFER MALIN, MD

Twenty years ago as a newly trained oncologist, I faced the same challenge that many cancer patients and their families do as they try to figure out where to turn when my mother was diagnosed with ductal carcinoma in situ– or pre breast cancer. Her surgeon, who had come highly recommended by her family doctor,told her she needed to have a lymph node dissection, which can result in lifelong disability due to lymphedema or swelling of the arm. As an oncologist, I knew it was not recommended for ductal carcinoma in situ, but she resisted my suggestion to get a second opinion. Despite the fact that I—her daughter—am an oncologist, her first thought was, “I can’t go against what my family doctor told me to do.”

It is still not part of our general culture to question physicians and, in a sense, to discuss health care options. Many patients are shell shocked by a cancer diagnosis and don’t think beyond what they are immediately told to do or where they are told to go for treatment. Some highly motivated patients dig deeper to research their options for cancer treatment, but these motivated patients are still a minority.

Give up Your Data to Cure Disease? Not so Fast!

Feb 9, 2016• 2

By DEBORAH PEEL, MD

flying cadeucii This weekend the NYTimes published an editorial titled Give Up Your Data to Cure Disease. When we will stop seeing mindless memes and tropes that cures and innovation require the destruction of the most important human and civil right in Democracies, the right to privacy? In practical terms privacy means the right of control over personal information, with rare exceptions like saving a life.

Why aren’t government and industry interested in win-win solutions? Privacy and research for cures are not mutually exclusive.

How is it that government and the healthcare industry have zero comprehension that the right to determine uses of personal information is fundamental to the practice of Medicine, and an absolute requirement for trust between two people?

Why do the data broker and healthcare industries have so little interest in computer science and great technologies that enable research without compromising privacy?

Today healthcare “innovation” means using technology for spying, collecting, and selling intimate data about our minds and bodies.

This global business model exploits and harms the population of every nation. Today no nation has a map that tracks the millions of hidden data bases where health information is collected and used, inaccessible and unaccountable to us. How can we weigh risks when we don’t know where our data are held or how data are used? See www.theDataMap.org .

Aver: Analytics for Care Episodes –Nick Augustinos interview

Feb 8, 2016

By MATTHEW HOLT

Nick Augustinos was at Healtheon (later WebMD) in the early days, then at Carescience with David Brailer, and later was senior in the health care teams at Cisco and Cardinal. Given Nick isn’t as young as some health tech startup guys and did OK back in the day, you might wonder why he’d leave the cushy corporate world and take on the supervising adult role at a startup.

But he just did, with Aver–an analytics company focusing on incorporating incentives and quality improvement in bundled care. Last month it raised $13.6m in a series B and I had a quick chat with Nick to find out what Aver was up to.

Zika and Correlation vs. Causation

Feb 8, 2016

BY JOHN SCHUMANN

Last week I told you of my admiration for Dr. Mona Hanna-Attisha, the Michigan pediatrician and epidemiologist whose strong research and advocacy was able to finally bring a shining light to the problem of lead in the water supply of Flint.

Continuing with a theme, I now bring you the story of Dr. Adriana Melo of Campina Grande, Brazil.

Dr. Melo is an OB-GYN who subspecializes in Maternal-Fetal Medicine (MFM), the branch of obstetrics that deals with high-risk pregnancies.

She lives and works in northeast Brazil, which is less populous and more economically challenged than the southern, more well-known parts of the country (including Rio de Janeiro and Sao Paulo).

Dr. Melo noted an uptick in the number of fetuses with small heads on ultrasound — which is the main tool used by MFM doctors to diagnose babies in utero.

How much of an uptick? A rough look at the statistics shows ONE HUNDRED times the ‘normal’ rate of babies born with microcephaly, the medical name for the condition.

Dr. Melo had a suspicion that the mothers giving birth to these babies all had a common trait: they’d all told her that they’d had the characteristic rash associated with the mosquito-borne Zika virus.

Can the Exchanges Be Saved?

Feb 6, 2016• 3

By MICHAEL TURPIN

Michael Turpin 1 “The pessimist complains about the wind; the optimist expects it to change; the realist adjusts the sails.” —William Arthur Ward

Looking confidently past the skeletons of drowned state and federal healthcare experiments, America’s health insurance exchanges set sail in January 2014. Disregarding the rough seas ahead, healthcare reform pundits and legislators applauded the Affordable Care Act’s signature public expansion vehicle as an impenetrable solution for achieving affordable coverage and competition.

Less than two years later, the exchanges are taking on water.

In November, United Healthcare lowered earnings projections, a move driven primarily by its hesitancy to commit to enrolling new exchange members until risks are better understood. While other insurers were quick to reassure investors that the public exchange market remains a viable means for organic growth, a low-pressure system of doubt is already building over the nascent public exchanges.

Initial enrollment projections for 2016 are fewer than 10 million members—about half of the 20 million target estimated by the Congressional Budget Office. In their rush to expand coverage to the uninsured and under insured, many public officials and industry neophytes failed to consult with those who have firsthand experience with the difficulties of underwriting those who are obtaining insurance for the first time.

FAST FOCUS

Enrollment projections for 2016 are fewer than 10 million members—about half the Congressional Budget Office target of 20 million.
The rush to participate in public exchanges has attracted inexperienced players seeking a piece of a $300 billion premium opportunity.
Investors want desperately to believe healthcare is ripe for transformational disruption.

Interoperability Form and Function: Interview with Doug Fridsma

Feb 6, 2016• 8

By LEONARD KISH

Screen Shot 2016-02-02 at 4.02.03 PM Leonard Kish talks to Douglas Fridsma, President and CEO at American Medical Informatics Association, about his work in the Office of the National Coordinator for Health Information Technology, or ONC, and the barriers to implementing MIPS in the most useful and transparent way. In order to communicate the data, of course, we’ll need informatics; but how will that work? And which comes first, policy or technology?

Leonard Kish: When you first began your studies in medical informatics, was there a sense that the field was a science?

Doug Fridsma: After working on the Standards of Interoperability Framework for the National Cancer Institute – which was essentially crowdsourced, I engaged government, research and other pharmaceutical companies and standards organizations to basically come up with what that standard should be – I had an opportunity to go out to the University of Arizona and ASU. Ted Shortliffe, who had been my mentor at Stanford, had just been appointed to be the Dean of the new medical school at the University of Arizona.

Nominate a Speaker For TEDMED

Feb 6, 2016

By JOHN IRVINE

Neeti writes:

I am on the 2016 TEDMED speaker review committee/research scholar i.e. I am among the group of people who will be reviewing potential speakers for this year’s event.

If you know someone (does not have to be an MD or PhD) who is doing great work in medicine, public health and policy or education (any aspect of healthcare including basic science research) and would be interested in giving such a talk, please nominate them here. It is a short form which needs their bio and pitch for a talk, also a speaking sample in public domain (i.e. YouTube or Vimeo) if available but not a necessity.

A little background about their nomination process: “There is no deadline to nominate a speaker, and we accept nominations year-round. Typically, we consider about 10,000 nominations for about ~50 spots on our stage, and are nearly done with the speaker selection process for this year. However, if we receive your nomination after we have completed the selection process, we will keep it in our database for future years.”

Biden’s Moon Shot and the 21st Century Cures Bill

Feb 6, 2016• 2

By STEVE FINDLAY

Screen Shot 2016-02-06 at 12.33.50 PM

Lawmakers in Washington are gearing up to pass major, far-reaching legislation on drug approval and cancer research. This is a good thing in the main but—no surprise here—Republicans and Democrats differ on approach and details, and things are already getting messy.

This makes the proposed legislation very risky. It could all implode in an election year, but momentum is building fast and both parties have something to gain by passage.

This blog is a primer on what’s happening. Future posts will track the legislation’s progress and delve into some of the issues at stake. Comments are invited.