The Health Care Blog – Page 382 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

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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

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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.

What Do We Know About Medical Errors Associated With Electronic Medical Records?

Jan 11, 2016• 6

By ROSS KOPPEL

Recently, the Journal of Patient Safety published a powerful and important article on the role of EHRs in patient harm, errors and malpractice claims. The article is open access. Electronic Health Record–Related Events in Medical Malpractice Claims by Mark L. Graber, Dana Siegal, Heather Riah, Doug Johnston, and Kathy Kenyon.   The article is remarkable for several reasons:

Considerably over 80% of the reported errors involve horrific patient harm: many deaths, strokes, missed and significantly delayed cancer diagnoses, massive hemorrhage, 10-fold overdoses, ignored or lost critical lab results, etc.

Central to this article’ contribution is its data source and an understanding of the direction of causation of the findings: These errors came to light not because a healthcare provider noted an EHR-related problem, but because the patient was harmed, the provider was sued and there was an insurance payment. Continue reading…

Posts on EHRs, Data and Patient Safety

Jan 11, 2016

A Health IT Developer’s Confession: How Bad Software Is Made and What to Do About It by Margalit Gur-Arie

Two HIT Developers Respond: Why We’re Still Optimists About Technology’s Potential by Andy Oram and Shahid Shah
In Defense of Mistakes by Martin Samuels, MD
An Error about Mistakes By Paul Levy

How Should Errors In the Patient Medical Record Be Addressed? By Peter Elias, MD

The Year of the Hacker by JK Wall

The Quest For Zero Infections: A Fool’s Mission? by Anish Koka, MD

Uberizing Health, Data is the Vehicle … And a Right by Leonard Kish
The Last Checklist by Anna Reisman

Treating Chest Pain With a Cup of Tea

Jan 9, 2016• 6

By ANISH KOKA, MD

It is very early. I am running to the ‘clinical decision unit’ (CDU) to see a patient of mine sent in the night before from a local skilled nursing facility. Also known as clinical observation units, ‘obs’ units, or short stay observation units, these units were designed to help decompress busy emergency rooms and divert unnecessary, expensive inpatient admissions. The units are typically adjacent to emergency departments, and usually are run by emergency physicians.

My particular patient was admitted due to an episode of chest pain at her facility. A brief conversation the prior night with the emergency room staff revealed chest pain that clinically was not typical for any of the feared diagnoses of a heart attack, pulmonary embolism or an aortic dissection. An electrocardiogram and cardiac enzymes were also initially unremarkable. Regardless, the patient was elderly and had multiple other comorbidities, and was somewhat confused. I recommended a short stay to allow anything malignant to declare itself.

And so, here I was, at the observation unit, digging through pages upon pages of printed gibberish that clearly had achieved the nirvana stage of meaningful use (for those wondering, that’s after stage 3). Ironically, the most useful piece of information lay in a handwritten progress note describing the episode. I could see why the patient had been brought here to be further evaluated, but after 18 hours of negative biomarkers, electrocardiograms, and no recurrence of symptoms, I felt comfortable letting her go back to where she came from. I told the ER staff… who cancelled her stress test. A stress test? Yes, a stress test had been ordered prophylactically. We practice in a climate where every bad outcome has the potential for litigation – malpractice lawyers would have a field day with the case of anyone going to the ER, being discharged without some type of cardiac imaging study, and having a heart attack. My recommendation to discharge the patient shifts the liability of an adverse outcome from the ER squarely on to my shoulders, and thus, poof goes the stress test.

Help Us Build a Hospital In the Cloud

Jan 8, 2016

By JONATHAN BUSH

Since 2011, over $13 billion in venture funding has flooded into digital health. 2015 alone saw well over 200 digital health companies raise more than $2 million each. From personal DNA tests to on-demand doctor’s visits, startups are taking a page from technology giants (Google, Apple, Amazon) and digital unicorns (Uber, Slack) to bring health care into the internet age.

The consumerization of health care is en fuego(!), and rightfully so. With the rise of high-deductible plans, we as patients have been forced to take on greater financial responsibility for our own health. Adding fuel to the flame, the widespread adoption of internet and mobile tech has evolved patients from passive recipients of care into active managers of care. Health care’s consumerization wildfire is thrilling, and it’s created a perfect breeding ground not only for new models of care delivery to take root, but for entrepreneurs to introduce new tools and apps for the patient and provider alike.

Good Reads

Jan 8, 2016

Very Bad Numbers by Anish Koka, MD
What Would a Health Care Mutual Look Like? by Munk, MD
A Health IT Developer’s Confession: How Bad Software Is Made and What to Do About It by Margalit Gur-Arie
Think Again: Health Insurers Have No Reason To Reduce the Price of Health Care by JK Wall
This Visit May Be Recorded by Alan Schwartz and Saul Weiner
Saving Normal by Saurabh Jha, MD
The Right Not to Know by Benjamin Berkman

Would Patients Pay For This?

Jan 8, 2016

By HANS DUVEFELT, MD

Health care in America is fracturing right down the middle, and doctors are going to have to figure out if or how long they can straddle the divide between what patients want and what the Government and Corporate America want them to have.

Up until this point, the momentum has been with the payers, Medicare and the insurance industry. But the more heavy-handed they become, the more inevitable the public backlash is becoming.

It will come down to this, a kind of “straight face test” for health care: Would patients pay for this?

The Annual Wellness visit, better named “Medicare’s Non-Physical” and some forms of “Population Management” are examples. Both are great ideas; an annual health review and planning session as well as doctors maintaining an overview of, and reaching out to, high risk groups of patients – in theory neither would be anything to argue with.