Above the Fold
ACA Database: The Doctor Is a Monopoly
Undisclosed location, TN writes:
I have a concern that some of the medical specialty groups of physicans in my area are forming their own monopolies. They are joining together in a way that patients can no longer have access to a new physician if they feel they are not getting the care they need or are not comfortable with the physician they chose.
The [ name withheld ] or [ withheld ] Tn. is one of those groups.
I had been seeing one of their physicians for a number of years and had wanted to try someone else for a long time before I actually tried. I was told that I could not see any other physician in the group. When I then tried to go elsewhere, I discovered their group was the only game in town. I called several hospitals to try and find a doctor. They all named this one group. There were a lot of physicans, but they were all connected to the group. I then tried Maryville only to find, they also were part of this group.
My cardiologist tried to get me an appointment only to be told they could not see me.
Goldilocks and The Three Bearers of Value-Based Health Reform
While serving as a panelist at a recent health care conference in New York, an audience member asked me how we’re advising clients to help them navigate the transition from volume to value-based systems.
So I talked about Goldilocks, using the time-honored children’s story as a metaphor for steering clear of extremes, maintaining a steady pace, and not going too fast or too slow. Heads nodded in agreement, a sign I was striking a responsive chord.
I’m not comparing the complexity of current health reform to a fairy tale. But, choosing the path that’s “just right,” to quote Goldilocks herself, is central to an organization’s ability to adapt to a value-based care system that relies on new and creative collaborations and data analytics to reduce cost and improve patient outcomes.
An Open Letter to Larry Page and Eric Schmidt
Guys:
You don’t know me, but I’m a physician and loyal gmail user writing for your help improving Google Scholar. As Google’s mission is to “organize the world’s information” and you are Google’s CEO and Executive Chairman, respectively, I’ll bet you can make this happen.
Getting (to the Value) of Value In Health Care
How would you judge the value of your health care? A longstanding definition of treatment holds that value is the health outcomes achieved for the dollars spent. Yet behind that seemingly simple formula lies much complexity.
Think about it: Calculating outcomes and costs for treating a short-term acute condition, such as a child’s strep throat, may be easy. But it’s far harder to pinpoint value in a long-term serious illness such as advanced cancer, in which both both the outcomes and costs of treating a given individual—let alone a population with a particular cancer—may be unknown for years. And then there’s the complicating issue of our individual preferences, since one person’s definition of a good outcome—say, another few years of life—may differ from another’s, who may be seeking a total cure.Continue reading…
The AMA’s Forgotten Fight Against Physician Greed
Perhaps the most well-known part of the 1965 Medicare creation tale is the opposition by the American Medical Association (AMA) to “socialized medicine.” Yet with financial incentives assuming a new prominence for provider and patient alike, we shouldn’t overlook the AMA’s equally unsuccessful battle against the excesses of capitalistic medicine. The forgotten story of the professionalism’s failure to contain physician greed provides an important policy perspective.
The Myth Of Medicine’s ‘Golden Age’
Medical practice pre-1965 is often portrayed as a mythical “Golden Age.” The truth, as I found researching my 1997 book, Demanding Medical Excellence: Doctors and Accountability in the Information Age, was that the post-war years were a time when way too many doctors grasped for the gold.
The most common “entrepreneurial” excesses were fee splitting, where a specialist paid a kickback to the referring doctor, and ghost surgery, where a surgeon secretly paid a colleague to operate on an anesthetized patient. The first surgeon paid the “ghost” a small part of the total fee and pocketed the difference. Even worse was rampant surgical overuse, where common excesses included appendectomies for stomachaches and hysterectomies on young women with nothing more than back pain.
Although professional societies wielded far more influence than now, efforts by leaders of the AMA and the American College of Surgeons to stop these abuses repeatedly fell short. Doctors “display a consistent preoccupation with their economic insecurity,” a 1955 report by the AMA concluded with discomfiting bluntness.
Why Data Governance Needs a Henry Kissinger
The number of mergers, acquisitions, and collaborative partnerships in healthcare continues to skyrocket. That’s not going to change for the next few years unless the FTC decides to be more restrictive. In all of these activities, older generation executives (I can say that because I’m older) have underestimated the importance and difficulties—technically and culturally—of integrating data and data governance in these new organizations, and the difficulties are exponentially more complicated in partnerships and collaboratives that have no formal overarching governance body. In 2014, 100 percent of Pioneer ACOs reported that they had underestimated the challenges of data integration and how the lack of data integration has had a major and negative impact on the performance of the ACOs.
Seamless Data Governance
After 33 years of professional observations and being buried up to my neck in this topic, especially the last two years as the topic finally matures in healthcare, I’m convinced that the role model organizations in data governance practice it seamlessly. That is, it’s difficult to point a finger directly at a thing called “Data Governance” in these organizations, because it’s completely engrained, everywhere. As I’ll state below, it reminds me of the U.S. transition in the early 1980s when organizations finally realized that product quality was not something that you could put in an oversight-driven Quality Department, operating as a separate function. Quality must be culturally embedded in every teammates’ DNA. Data governance is the same, especially data quality.Continue reading…
The World In 2016: Health Care Edition
We’re taking your predictions for what 2016 will hold in store for health care. A President named Trump? The much-rumored Uber for Healthcare? The end of Meaningful Use? The beginning of the ACO era? New incentive payments? New penalties? Something else nobody has thought of yet?
You’re invited to a special online event hosted by athenahealth’s COO Ed Park (no he’s not his bro Todd whatever HIStalk may think), on Tuesday September 15, 2015 at noon. With a program created with doctors in mind, this is one event you won’t want to miss. Ed will talk about what 2016 is likely to bring for doctors, what probably won’t happen (despite what the skeptics say) and how health information technology is rapidly evolving to meet a new generation of pressing challenges. You’ll also get a rare insider’s look at athenahealth’s plans for 2016, including rumored new products and the company’s plans for expansion in the competitive electronic medical records space. If you track this much-talked about health IT company and its CEO Jonathan Bush and the broader health IT industry, you’ll want to be sure to mark your calendar.
The Wisdom of the Blog
Meanwhile, we want to know what THCB readers think is ahead in 2016. What do you expect to see? What’s next for Obamacare? What new technologies are poised to change everything? More importantly: What won’t we see? If you have a prediction for 2016, e-mail the editors at ed****@***************og.com or use the contact form at the top of the page. Write us a brief blog post. Submissions should be between 300 and 500 words in length. Tell us what you think will happen and why it’s important. Strong submissions will be published on THCB.
Is Obamacare working? Where’s the data?
As President Obama’s healthcare reform unfolds in the last years of his administration, critics and supporters alike are looking for objective data. Meaningful Use is a funding program designed to create health IT systems that, when used in combination, are capable of reporting objective data about the healthcare system as a whole. But the program is floundering. The digital systems created by Meaningful Use are mostly incompatible, and it is unclear whether they will be able to provide the needed insights to evaluate Obamacare.
Recent data releases from HHS, however, have made it possible to objectively evaluate the overall performance of Meaningful Use itself. In turn we can better evaluate whether the Meaningful Use program is providing the needed structure to Obamacare. This article seeks to make the current state of the Meaningful Use program clear. Subsequent articles will consider what the newly released data implies about Meaningful Use specifically, and about Obamacare generally.
ACA Database: How Do I Report a HIPAA Violation?
I know my HIPAA rights were violated and would like to know the best recourse to settle the matter. By myself or via an attorney?Can you suggest a referral agency for attorneys?
