The Health Care Blog – Page 392 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

The Profitability (or Not) of Harming Patients

Dec 14, 2015

By MICHAEL L. MILLENSON

When the government announced recently that a patient safety partnership with hospitals had saved 87,000 lives and nearly $20 billion over four years, there was an oblique reference to the role played by “financial incentives.”

Left unsaid was that a quiet effort has been going on for years to persuade hospitals they can make more money preventing harm than by allowing it to occur. In recent years, that’s included articles in the medical literature looking at the profitability of preventing serious bloodstream infections in critically ill infants in the neonatal intensive care unit(NICU) and in kids with leukemia.

For adults, there have been analyses of the financial impact of serious infections and surgical complications. In a presentation I heard earlier this year, a vendor mentioned the return on investment (ROI) of a technology that more rapidly detects when a post-surgical patient unexpectedly stops breathing.

HEART for the Stage 3 API

Dec 14, 2015• 3

By ADRIAN GROPPER, MD

It is imperative that we support the interoperability components of Meaningful Use Stage 3. The promise of reform to justify our massive investment in MU must be supported by broad, patient-centered interoperability mandates so that “data follows the patient”. The Stage 3 API requirement will be the centerpiece of interoperability because only patient-directed exchange can solve the challenges of patient matching and governance as described in the recent General Accounting Office report.

The Stage 3 API requirement will serve both patients and providers by enabling patients to delegate access to their records on the API to anyone, including apps, providers, and other EHRs. The vision for how this will happen is taking place in two workgroups: the OpenID Foundation Health Relationship Trust (HEART) and ONC’s API Task Force.

How this will work is the subject of a HEART use-case titled Elderly Mom with Family Caregiver. Based on the Kantara User Managed Access (UMA) and the HL7 FHIR standards, HEART profiles for healthcare are the foundation for broad interoperability and improved cybersecurity.Continue reading…

This Is America: You Don’t Have to Do Anything You Don’t Want To

Dec 13, 2015

By HANS DUVEFELT, MD

“I just want you to know, I won’t have a colonoscopy”, my new patient said with some amount of fervor in his voice. “And I don’t want to take a lot of medications.”

I looked him straight in the eyes and said “This is America, you don’t have to do anything, and I work for you. My job is to help you know your options.”

He seemed to relax. I reflected on the words I had just uttered, yet another time – it is the way I often try to set the tone as a non-authoritarian, patient focused physician.

“You don’t have to do anything”, of course, only applies to the patient.

The doctor has to do a lot of things, like document a treatment or follow-up plan for Medicare patients with a BMI over 30, or provide computer generated patient education to a minimum percentage of patients, and achieve a certain percentage of e-prescriptions. And right about now, we are starting to see financial consequences if too many of our patients, like the man I had just met, don’t want to take the medications that can bring their blood pressures or blood sugars below certain targets.

Headlines We’ll See In 2016

Dec 13, 2015• 3

By PAUL KECKLEY

Amidst the rhetoric of Campaign 2016, the reality of escalating health costs, and the acceleration of consolidation across the industry, healthcare headlines in 2016 will highlight major changes that will reshape the future for the next decade and beyond. Here’s the top 10 you can expect to read next year:

Insurance Mega-Deals Approved, Blues Align more Tightly to Compete:

The Department of Justice approved the mega-deals allowing Anthem’s acquisition of Cigna and Aetna’s takeover of Humana. With certain provisions, the deals will go forward which means United, Anthem and Aetna will together control 44% of the U.S. insurance market. In response, the Blue Cross Association announced it is moving forward with its plans to create a more cohesive national strategy for its 36 members to compete with the Big 3. Collectively, the four serve 242 million members, or more than 80% of the insurance market in the U.S.

America’s Bitter Pill: CBO was Right. The White House and Steven Brill Were Wrong.

Dec 11, 2015• 19

By KIP SULLIVAN

Steven Brill’s latest book, America’s Bitter Pill, is a frustrating mix of excellent history and muddled health policy analysis. The book is a very good addition to the literature on the history of the Affordable Care Act and by far the best reporting I’ve read on the bungled implementation of the federal health insurance exchange. But Brill’s analysis of why the ACA cannot reduce health care costs is naïve and confusing. Brill claims a few smart men on the White House “economic team,” including Peter Orszag and Ezekiel Emanuel, fought hard to push “game-changing” cost-containment into the ACA but were defeated by others who were less interested in cost containment.

That explanation is wrong on two counts:

(1)There was little evidence in 2009, and little today, to support the claims by Orszag et al. that the methods they promoted would cut costs;

(2) The ACA in fact contains most of what Orszag et al. fought for.

What Brill unquestionably gets right is his conclusion that the ACA cannot cut costs. He makes his conclusion clear at the end of the book. He quotes this astonishing statement by Obama – “Frankly what we’ve seen in progress on costs has surpassed almost anybody’s most optimistic expectations” – and then unceremoniously rejects it. “But there is actually little evidence of that,” he writes. (p. 416)

Uberizing Health, Data is the Vehicle … And a Right

Dec 10, 2015• 14

By LEONARD KISH

No, there is no Uber of healthcare, even as everyone claims to be or wants to be the Uber of healthcare. Others rail against it.

Part of it is that an Uber for healthcare sounds great! The sharing economy! But what is it? What would it even look like? Everyone has their own interpretation: is it house calls? appointment scheduling like ZocDoc? telehealth? PatientsLikeMe?

The movement Uber, AirBnB and the like embody is often referred to as “the sharing economy.” No matter what you call it: sharing, borrowing or buying, it’s a platform for effective exchange, enabled by the peer to peer connections over the internet, but it’s not new, just more mobile, more convenient with more specific use cases around surplus capacity of some sort.

The model was pioneered by companies like craigslist and eBay, who first offered free or low-cost methods of buying and selling everything from toys to automobiles; and sharing information to everything from lost dogs to love connections. Using these early internet tools to find a job, a book group, or a place to unload your old IKEA furniture led the way to today as the sharing takes place with mobile assets (cars) enabled by smart phones.

The Cost-effective Cardiologist..

Dec 9, 2015• 1

By ANISH KOKA, MD

Safe, appropriate, effective care at a reasonable cost. Such a simple goal. The message is clear. Leaders in hospitals, congress, and even my chihuahua echo the dawning of a new age in health care. Down with the private practice, fee-for-service mentality, they all say. I pay attention to a lot of this chatter since I happen to be in private practice. I split my time on the internet between the latest exploits of the Kardashians and gravestones for my practice. I can picture the epitaph:

In loving memory of

Koka Cardiology

3/1/2013 – 3/1/2016.

Shed not for her the bitter tear

Nor give the heart to vain regret

‘Tis but mere ashes that lie here

The gem that filled it sparkles yet

As I shuffled towards this abyss, my reverie was broken by a letter. It was from Independence Blue Cross (IBC) in Pennsylvania. It was titled: The Cardiology/Invasive Cardiology Comparative Cost report. It looked like a report card, so I opened it with some trepidation.
Continue reading…

Two HIT Developers Respond: Why We’re Still Optimists About Technology’s Potential

Dec 9, 2015• 17

By ANDY ORAM and SHAHID SHAH

The authors of this article like to believe that we can remain humanists while transitioning from a paper-native to a digital-native industry. We even believe you can remain a humanist while following regulations and sticking to industry guidelines. Margalit Gur-Arie doesn’t seem to feel that way. We have read her work over the years and established that she takes a staunchly humanistic approach to health IT. But even though she’s a leader in that space, she appears to doubt the contributions that either technology or regulation make to a humane health system.

Gur-Arie’s most recent posting dismisses all the tools that electronic health records throw in the way of the doctor: clinical decision support (now often called evidence-based medicine–were we Gur-Arie, we’d say it’s because who can argue against evidence?), reminders, pull-down menus to provide a limited range of choices, and more.

One immediate response is to suggest that, instead of blaming the tools, one should blame the requirements imposed on clinicians by payers and governments–the “thousands of meaningless regulatory words” as Gur-Arie writes eloquently. But the real answer is that these requirements (well, the ones that were thought through) enhance the health care system, and that the problem with current EHRs is that they just “pass through” the requirements, intensifying the burden placed on doctors, instead of finding true innovations when implementing those requirements.

Tackling Rising Pharmaceutical Prices: 50 Shades of Gray

Dec 9, 2015• 2

By SUSAN DENTZER

Global New Active Substances (NAS) Available Since 1996

Here’s the problem with high and rising pharmaceutical prices: It’s not just one problem, but many. Addressing them will require a range of solutions – many of them difficult to execute, and possibly tough medicine to swallow.

These were key takeaways from the recent U.S. Department of Health and Human Services Pharmaceutical Forum,which I moderated. A broad group of stakeholders participated, including patients, consumer groups, pharmaceutical companies, pharmacy benefits managers, insurers and others. The key issues: Obtaining the greatest value for the dollars we spend on drugs –and having a vital biopharmaceutical sector that produces vaccines, effective treatments,and cures, at affordable costs for patients and the nation.

Having slowed along with the rest of health care spending in recent years, pharmaceutical spending is now roaring ahead. Total pharmaceutical sales, now about $400 billion annually, are projected to reach as high as $590 billion in 2020, according to Doug Long, vice president of industry relations at IMS Health. New National Health Expenditure data show that national retail prescription drug spending grew 12.2 percent in 2014 – a sharp increase over 2.4 percent growth in 2013 — in large part due to increased spending for new drugs, such as cures for Hepatitis C.

Health 2.0 Presents the Final Agenda for WinterTech 2016

Dec 9, 2015

By DEEPA MISTRY

Health 2.0 announces the final agenda for the WinterTech conference, January 13, 2016 in San Francisco, California. As the only event dedicated to health tech and investing during the health investment mecca, JP Morgan Week, the event features leaders from Venrock, Canvas, Grand Rounds, Doximity, Livongo, Omada Health, Maverick Capital, GE Ventures, Kaiser Permanente and more. The conference brings together top health tech entrepreneurs, investors, and the health care establishment to discuss financial and business trends. “Everyone knows by now that health tech is a hot place for venture investing,” says Health 2.0’s Co-Founder Matthew Holt. “At Health 2.0 WinterTech, we are going to uncover the secrets of how the top VCs think and how they work with the star CEOs.” Key speakers will include: