BY THCBist

Anonymous writes:

Currently nursing homes are dumping vent patients,and respiratory services due to reimbursement dollars. The home I will be removed from at the end of the month has succeeded in removing respiratory services and sending residents against their will to other facilities. This has begun. Staffing has been minimal due to inhospitable working conditions. Imagine your bill being thousands of dollars a month and lying in feces for hours waiting for one aide to get to you, who has 45 other patients. The mission statements all so wonderfully worded to make you feel your loved one getting the best care possible. But these are just words not to be followed just a sales pitch. Their defense we can’t get staff! No wonder everything under disciplinary action you may not go home cause nobody is coming in to relieve you. Mgmt does not answer phones on their off hours to provide help or solutions but arrives monday to write up whom ever was involved.

By DAVID SHAYWITZ, MD

The world looks different when you’re eighteen and when you’re thirty – in some cases because your perspective has evolved, other times because the world has changed.  Men and women drawn to careers in medicine while in high school or college are finding that when they emerge on the other side, things aren’t quite what they expected.

Typically, this is portrayed as the (well-worn) “Narrative of Disillusionment” – i.e. idealistic youth drawn to help people discover the practice of medicine is more rushed/bureaucratic/corporate/burdensome than they were expecting, and now are searching for new opportunities.  While there’s a measure of truth to this arc, I’m not sure how different it is from any other career choice, which tend to be attractive in the abstract (A prosecutor!  A screenwriter!  A journalist!), perhaps less so when you’re actually doing it.

While there’s no doubt that practicing physicians face many (well-documented) challenges, many also continue to love what they do, and find the opportunity to help others — even with all the paperwork — still accessible, and still rewarding.

My hunch is that many of the physicians who leave medicine do so not because the negative externalities have become so bad, but rather because the range of potentially appealing alternatives has become so good.

A recent NPR blog focused on Bay area physicians leaving medicine to become entrepreneurs has sparked considerable dialog on social media (see here for my recent discussion of physicians-turned-entrepreneurs).  My sense is that many physicians are attracted to entrepreneurship not to escape medicine, but to deliver on their perception of medicine’s promise.  Frontline providers, as Aenor Sawyer of UCSF’s Center for Digital Health Innovation frequently emphasizes, offer vital insights into where the existing system may not be working, and where innovation is sorely needed.

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By MATTHEW HOLT

I’m steadily getting all those interviews I did 3+ months ago at HIMSS up onto THCB. (For those of you not paying attention we had a bunch of tech issues at THCB needing a big change and had to forswear videos for a while. But we’re baaack…)

Dan Burton is CEO of Health Catalyst which is a data warehousing and analytics company that’s seen remarkable growth by selling to big names like Kaiser, Partners & Allina. It’s raised over $150m and has even gone at risk with Allina over outcomes–to show how confident they are in their data and analytics. This is a very interesting interview about a company that’s at the crux of the world of clinical data management, with over $100m booked revenue in 2014.

Dan will also be interviewed at Health 2.0 this fall as one of our “3 CEOs”. (And FD Health Catalyst is a THCB sponsor, but as I tease Dan they’re also in the conference business themselves, running the Health Analytics Summit!)

By THCBist

After several attempts at trying to find doctors who accept my lame-o ACA health plan (Blue Cross Blue Shield advantage HMO), I finally reached my limit today when a rather important appointment got cancelled unless I wanted to pay cash, because “we don’t accept your policy”.  When I googled “none of my doctors accept my Obamacare health insurance”, your article came up.

Do you or does anyone else know if there is some kind of plan of action for doctors to be forced to accept these ACA plans?  This year alone, I have yet to visit ONE of my previous doctors who will accept an ACA plan (and I didn’t even get the cheapest plan!).  Having had past surgeries, I feel it imperative to “go with who you know”, in that I want to see my past surgeon when there is a problem a year later that might need to be addressed.  Beyond frustrated!  And I don’t even live in a small town!!  I am in Dallas, Texas, with thousands of doctors!

By THCBist

Joyce J wrote in with this to say after reading Steve Findlay’s post on Medicare’s 50th Anniversary last week.

“Just yesterday, I was on my last and final rant relative to the price of not only specialty drugs, but also Tier 3 drugs! So much of a rant that I considered writing my Congressman Tim Murphy. After much thought, I decided to suck it up, pay the price and let my congressman work on bigger issues.(before reading your article today!)

I realize that I am not he only pathetic one that this drug price debacle affects, but for some reason, as a hard worker my entire life (in, none other than the healthcare profession), an upstanding, tax paying, law abiding citizen, somehow I feel I am being raped by the system.

I am 66 years old. I am a widow for 20 years. I am on Medicare part A and part B.(?$104/month) My secondary insurance is Highmark PPO Blue. ($605.89/month). After retirement, I maintained my husband’s health insurance as my supplement because of 1 tier 3 drug that I currently use. Due to Multiple Sclerosis, Lupus, breast cancer (none of which I chose to have) I could essentially be using multiple specialty drugs. I’ve declined all, except for the one Tier 3 drug, brand name, Provigil.

It has been a miracle drug for me relative to severe fatigue and loss of concentration and overall, daily function.”

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By ROB LAMBERTS, MD

The drug test came back abnormal.  There was THC present.  I walked back to Mrs. Johnson and raised my eyebrows.

“What’s wrong?” she asked, not used to whatever kind of look I was giving her.

“Uh, you forgot to mention to me that you smoke weed.”

She blushed and then smirked.  “Well, yes, I guess I forgot to put that down on the sheet.  I don’t do it real often, but sometimes it takes mind off of things.  I just get real anxious about my kids, my husband…and my heart problems. I only smoke one or two a night”

She’s not your usual picture of a pot-head.  She’s in her sixties, has coronary heart disease, irritable bowel, hypertension, is on Medicaid, and is the essential caricature of the the poor white folk who live in the deep south.  And she smokes weed.

I was doing drug testing on her as part of my office policy.  Mrs. Johnson gets 30 Percocet per month, and so clearly poses a high risk of drug trafficking, escalation to PCP, crystal meth, and LSD, and ending up behind bars for the rest of her life.  That’s why I had to test her.  And now I caught her in a lie, trying to cover-up her use of illegal drugs.Continue reading…

By ASHISH JHA, MD

Last week, Marshall Allan and Olga Pierce, two journalists at ProPublica, published a surgeon report card detailing complication rates of 17,000 individual surgeons from across the nation. A product of many years of work, it benefitted from the input of a large number of experts (as well as folks like me). The report card has received a lot of attention … and a lot of criticism. Why the attention? Because people want information about how to pick a good surgeon. Why the criticism?  Because the report card has plenty of limitations.

As soon as the report was out, so were the scalpels. Smart people on Twitter and blogs took the ProPublica team to task for all sorts of reasonable and even necessary concerns. For example, it only covered Medicare beneficiaries, which means that for many surgeries, it missed a large chunk of patients. Worse, it failed to examine many surgeries altogether. But there was more.

The report card used readmissions as a marker of complications, which has important limitations. The best data suggest that while a large proportion of surgical readmissions are due to a complication, readmissions are also affected by other factors, such as how sick the patient was prior to surgery (the ProPublica team tried to account for this), his or her race, ethnicity, social supports—and even the education and poverty level of their community.

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