The Health Care Blog – Page 409 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Are Studies Overestimating the Cost of EHRs?

Sep 3, 2015• 1

By TOM GIANNULLI, MD

On August 6, this article was posted, Are Electronic Medical Records Worth the Costs of Implementation?, in the American Action Forum. The article stated that there is value in the use of EHRs but the cost is significant. They estimated nearly $164,000 for a single physician and over $233,000 for a five provider practice.

I was surprised in 2015 to see this piece. Why? Because they used data from 2009 to 2011 on practices largely using server-based EHRs. The landscape of the EHR market has radically changed in the last 5 years. There are a wide range of more affordable, cloud-based EHRs today, including some that are free.

A free EHR doesn’t mean no cost, but it does make a big dent in the vendor related costs around hardware, software and implementation. This is often true for cloud-based EHRs that do charge a monthly per provider feeas well.

The Phonemic Path: A Way to Measure Health That Can Lead to Health Improvement

Sep 3, 2015• 3

By ANDY ORAM

We know what improves health–but we’re simply years away from having the tools to achieve it. We know that we can reduce the chronic conditions plaguing the world’s populations by a subtle combination of:

Closely monitoring the behavior of individuals
Linking health goals to treatments and behavior changes
Upgrading the problems in communities that contribute to disease

Such activities call for supple and sophisticated ways to link together disparate types and sources of information–the subject of this article. Doing such linking requires a new way of approaching data that is lacking today in our health care system.

The process of developing the new data approach will have to be incremental (no “Health Data Manhattan Project” for us), will involve thousands of contributors in crowd sourced fashion, and will take unanticipated directions based on the insights of the contributors. I am not laying out a framework in this article, but just touching on the themes that the project will likely explore. I’ll also mention a few of the people working in this area, notably the Yosemite Project. I call this idea Phonemic Path, in reference to the extensive research biologists are carrying on to find genomic paths that explain disease.

Clinical Research Rebooted

Sep 3, 2015

By SCANADU RESEARCH

The traditionally conducted clinical trial model requires increasing amounts of time, cost, and resources for both sponsors and sites. In fact, fewer than 10% of clinical trials are completed on time due to poor patient recruitment, retention and protracted budget negotiations. And since 2008 per-patient, clinical trial costs in the US have risen an average of 70% across all development phases.

In March 2015, however, BLOOMBERG BUSINESS
reported “Stanford University researchers were stunned when they awoke Tuesday 10 March to find that 11,000 people had signed up for a cardiovascular study using Apple Inc.’s ResearchKit, less than 24 hours after the iPhone tool was introduced. ‘To get 10,000 people enrolled in a medical study normally, it would take a year and 50 medical centers around the country’ said Alan Yeung, medical director of Stanford Cardiovascular Health. ‘That’s the power of the phone.”‘

Rebuilt

At Scanadu, data collection and clinical studies are key to the development and deployment of our medical devices, and we’re fully aware of the kind of scale and speed and power we’re talking about here. And as a startup developing the next generation of medical devices for consumers, we had to innovate the clinical study process, while bucking the traditional assumptions of how a clinical study should operate.

Value-based Telemedicine

Sep 2, 2015• 5

By BLAKE McKINNEY, MD

When a family member was a new mom she called me concerned about her 7-day old baby’s breathing.I almost sent them to the ER. Then she asked me if we could FaceTime. What I saw was a warm, pink, dry baby looking around, looking quite well to me. I was able to tell that she had no labored breathing, no retractions or nasal flaring. She just had a little stuffy nose. I had been answering questions, treating minor ailments and triaging the acutely ill for several years via text, but it was in that moment that I knew the iPhone and other smartphone devices would fundamentally and forever change the way physicians can deliver our services.

Fast forward to next year. An estimated 2 billion people will have smartphones across the world in 2016. Industries are being transformed radically by the widespread uptake of these devices. Healthcare will be no different and will continue to move toward more virtual care enabled by smartphones. As the example above demonstrates, it makes sense for both care and economics.Virtual care and telemedicine worldwide is expected to be a $34 B market by 2020 according to Mordor’s Market Intelligence, with the US accounting for 40% of that, nearing $15 Billion in the next five years. Several early stage tele-medicine companies have raised many millions of dollars in the last several months.

Payment reforms are driving the market toward value-based care and will only accelerate the use of telemedicine via smartphone. Many new forms of payment for medical services are emerging that are not tied to the legacy fee-for-service reimbursement model. Patients are paying more out of pocket and therefore have increasingly aligned interests with payers to reduce costs while achieving better overall health. These changes are, in turn, driving the empowered healthcare consumers’ demand for a better experience and convenience.

The Finns are coming, the Finns are coming (to Health 2.0!)

Sep 2, 2015

By MATTHEW HOLT

One of the great things that I’ve seen in a couple of decades of watching health tech has been the democratization of technology, and the amazing ideas coming from all across the globe. Health care is no exception and one of the most active regions in health technology has been a tiny European country most people don’t know much about–other than they once had a phone from there on which they played snake. In fact the relative demise of Nokia has been a big boost for tech startups in Finland because it freed up so much technical talent.

Some 100 entrepreneurs, technologists, finance & government types will represent Team Finland at Health 2.0 on oct 4-7. Companies will include the cancer patient communication app NoonaHealthcare, the sleep tracker Beddit, and Jamie Oliver backed You-App, and many, many more. Late last month I interviewed Ilona Lundtsröm, the Executive Director at the Finnish Innovation Fund Tekes to find out more about what was happening in Finland, and why the rest of the world should pay attention.

Universal Patient Identifiers for the 21st Century

Sep 1, 2015• 5

By ADRIAN GROPPER, MD

Healthcare is abuzz with calls for Universal Patient Identifiers. Universal people identifiers have been around for decades and experience can help us understand what, if anything, makes patients different from people. This post argues that surveillance may be a desirable side-effect of access to a health service but the use of unique patient identifiers for surveillance needs to be managed separately from the use of identifiers in a service relationship. Surveillance uses must always be clearly disclosed to the patient or their custodian each time they are sent by the service provider or “matched” by the surveillance agency. This includes health information exchanges or research data registries.

As a medical device entrepreneur, physician, engineer, and CTO of Patient Privacy Rights, I have decades of experience with patient identifier practices and standards. I feel particularly qualified to discuss patient identifiers because I serve on the Board and Management Council of the NIST-founded Identity Ecosystems Steering Group (IDESG) where I am the Privacy and Civil Liberties Delegate. I am also a core participant to industry standards groups Kantara-UMA and OpenID-HEART working on personal data and I consult on patient and citizen identity with public agencies.

On Moving the Physician Movement Forward

Sep 1, 2015

By RICHARD L. REECE, MD

There are always two parties, the party of the Past, and the party of the Future. The Establishment and the Movement.

— Ralph Waldo Emerson (1903-1882), Notes on Life and Letters of New England

On July 20-26, 2015, a new physician organization, the United Physicians and Surgeons (UPSA), held a conference, dubbed the Summit at the Summit, in Keystone, Colorado.

The conference featured over 40 speakers. Speakers represented many physicians and physician organizations, both bearing workable innovative ideas. The conference was designed to restore physician autonomy, protect the patient-physician relationship, and reset relationships between overreaching government and corporate entities.

Conference attendees were enthusiastic about this physician Movement to restore the voice of medicine.

But inevitable questions arose: Where do physicians go from here? How do we sustain the movement? Where will funding come from? What form will the Movement take? How will physicians inform hundreds of thousands of fellow physicians and millions of their patients about grievances of physicians, their ideas for the future, and what can be done to improve quality and convenience and confidentially of care?

Reforming the Reformers

Sep 1, 2015• 4

By PAUL SLOBODIAN

In the midst of sluggish economic growth, finding a sector of the economy growing from 15 percent of the economy up to 19 percent would normally be a cause of celebration, except that this is health care. The lack of good cheer about this growth is an indirect acknowledgement of a stark reality: We are not realizing much increased value as we spend more on health care because too much of our health dollars are going to ineffective (and often harmful) procedures.

Estimates of the waste from this overconsumption of health care range from 30 percent to 50 percent. While all of the experts talk about reducing this waste (the phrase of the day is “bending the cost curve”), the reality is that hospital administrators, pharmaceutical companies, device manufacturers, insurers, consultants, think tanks and government bureaucrats all are seeing their power, control and financial remuneration increase due to this medical-care consumption growth.

All of the reformers’ trendy ideas have failed and will likely continue to fail in spite of the experts telling us they will soon figure it out. Electronic health records are a hugely expensive disaster. So far, they decrease doctor efficiency, reduce quality and increasingly make patients fearful of sharing sensitive information with their doctors for fear hackers or others will access their private data. Accountable Care Organizations turn doctors into rationers, introducing a conflict of interest between doctor and patient. Price controls by Congress or bureaucrats or oligarchic insurers only reduce access to care, demoralize doctors and introduce the risk of game playing by health systems by “up-coding” (labeling a doctor visit as more complex than it is).

Don’t Repeal the Cadillac Plan Tax – Replace It

Aug 30, 2015• 1

By JOHN C. GOODMAN

John Goodman Beginning in 2018, high-cost, private sector health plans will be subject to a special levy, popularly known as the “Cadillac plan” tax. Under a provision of the Affordable Care Act, health plans must pay a tax equal to 40 percent of each employee’s health benefits to the extent they exceed $10,200 for individual coverage and $27,500 for family coverage

In many ways, the Cadillac Plan tax is a stealth tax. It doesn’t even become effective until eight years after the Affordable Care Act passed Congress. And back in 2008, the thresholds were so high that it must have seemed like the tax would apply only to a handful of employers. But health care inflation has a way of escalating base line costs through time.

So much so that a Kaiser Family Foundation study estimates that the first year it is applicable, one in four employers will be subject to the Cadillac plan tax unless they change their benefits. Going forward, the thresholds are indexed to the rate of general inflation – which historically is well below the rate of medical cost inflation. As a result, the study estimates that the share of employers potentially affected could grow to 30 percent by 2023 and 42 percent by 2028.

The Human Side of Corporate Medicine

Aug 29, 2015

By EVE SHVIDLER, MD

“I want to explore employment opportunities with you.”

He is looking at me. Trying his hardest. Passion, yet anger, in his eyes.

Everything I know about him and his tenure in the community helps me understand how difficult this conversation is. Everything I see in his eyes helps me understand how painful this is.

Private practice is dying…on the vine…in America.

The practices fold or reach a critical point and they come running to Big Med to fix all the problems.

Absorb. Acquire. Integrate. Consolidate.

Every week I get a call.

“Will you buy my charts? Why not? I have been a longstanding provider in this community?

“Will you buy my practice? Why not? I have been loyal to the system?”Continue reading…