The Health Care Blog – Page 415 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

HIT Newser: We Need Interoperability, Says HELP

Jun 15, 2015

By MICHELLE RONAN NOTEBOOM

Judy Faulkner pledges to donate her wealth

Epic founder and CEO Judy Faulkner announces plans to give away 99% of her estimated $2.3 billion wealth to charity. Faulkner joins 136 other individuals and families in the Giving Pledge, which was launched by Warren Buffett and Bill and Melinda Gates to encourage billionaires to give the majority of their wealth to philanthropic causes.

What’s not to like about that? Good to know that if Epic wins the $11 billion bid for the VA’s EHR system, some of the government’s money will eventually trickle back down to charity.

Are EHRs creating disparity in care?

A study from Weill Cornell Medical College looks at “systematic differences” between physicians who participated in the Meaningful Use program and those who did not, noting that the differences “could lead to disparities in care.”

The researchers suggest that providers participating in the MU program may provide higher quality care to their patients as physicians using paper records “have less reliable documentation and weaker communication” between providers and won’t benefit from EHR-enabled quality improvements.

I suspect that physicians relying on paper records would balk at the suggestion that the care they provide is inferior to their more digitally-equipped peers. However, it’s hard not believe that the overall care process would be enhanced if all providers could electronically share critical patient information.

News Flash: Government is wasteful in its spending

The Government Accountability Office releases a report calling for urgent action on federal IT Continue reading…

What Went Wrong?

Jun 14, 2015• 6

By ROB LAMBERTS, MD

It’s been a very slow week in my office. Today we almost pitched a no-hitter, having only one patient come in toward the end of the day. Overall, we’ve been quiet in nearly every way – few phone calls, few patients stopping by, few appointments, few secure messages.

What’s wrong?

That was a trick question. This is exactly what should be happening when things are going right. My patients are happy. My patients don’t need me now. My patients are satisfied with my care. This would be a problem in most offices, as revenue depends on people having problems, having questions about their care, or anything else that would fill the schedule. In practices like mine, however, this is what we want; after all, I am paid just as much for an empty office as a full one.

Is CRM the Answer?

Jun 12, 2015• 4

By DAN HOUSMAN

The Internet has taught us valuable lessons about what works and what doesn’t in regards to identifying, engaging, and retaining customers.

Retailers are increasingly using sophisticated data aggregation and customer stratification methods to build business and grow revenues. Other industries are also leveraging technological advances to directly improve and enhance customer relationship management (CRM).

The health care industry? Not so much.

For a variety of reasons related to regulatory requirements, competitive pressures, cost considerations and privacy concerns, health care has lagged behind other industries in the development of effective CRM strategies. The industry has been slow to adopt data collection and communication models that promote value-based care and the inclusion of care team members (both clinical and non-clinical).

Since I first entered the health care industry many years ago, I’ve been surprised by the absence of innovative CRM capabilities that are typically commonplace in other industries.

Can Open Health Data Promote Entrepreneurship and Innovation in India?

Jun 12, 2015

By JULIE SCHNEIDER

There are a growing number of exciting opportunities to think about leveraging health data globally. Just imagine the possibilities when you bring open health data initiatives together with creative tech entrepreneurs across countries to address key health and health care issues. More solutions, greater global impact? This was a key area of exploration at the 2015 Health Datapalooza, and a special session featuring government representatives from India.

Health Datapalooza welcomed a delegation from the Government of India (GOI), including two representatives from the Office of the Registrar General (ORG), Ministry of Home Affairs: Rohit Bhardwaj, Deputy Registrar General, and Rajeev Kumar, Deputy Director. Both participated in a panel titled, Using Open Data to Promote Entrepreneurship and Innovation in India, chaired by Indu Subaiya, Co-Chairman and CEO, Health 2.0.

“India is poised for major growth in health IT innovation. We are excited to both share our experiences with open health data and learn from them as they leverage more than 900 million mobile phone users and a growing community of technology entrepreneurs,” said Susannah Fox, Chief Technology Officer of the Department of Health and Human Services (HHS).

The Land of Milk, Honey and Low-Priced Health Insurance

Jun 11, 2015• 5

By DAVID DRANOVE and CRAIG GARTHWAITE

Not long ago we received our first signs that all may not be well in the land of milk, honey, and low priced insurance, i.e. the ACA insurance exchanges. Many insurers, including some of the largest in each state, have requested double digit rate increases, with some asking for raises that exceed 30 percent. A casual review of these requests suggests that the increases are largest in areas where the premiums were initially lowest. If these increases are approved, it will mean dramatically higher payments for enrollees, and escalating tax bills for the rest of us. This is particularly true when the premium hikes affect the lowest priced “silver” plans available in the market (as the subsidies are tied to premiums for the second cheapest silver plan). Of course, the premium increases might backfire on insurers, but only if enrollees opt to switch to cheaper plans.

However, we have grave doubts about whether this will be the case. If participants in the exchanges behave like enrollees in employer-sponsored plans, then it seems unlikely that there will be much switching out of plan. This is a natural consequence of the way the exchanges work, combined with well documented inertia on the part of health insurance enrollees.

What is this inertia? Academic research performed here at Northwestern University and elsewhere convincingly shows that employees are reluctant to switch health plans, even if they stand to save $2000 or more without sacrificing quality or access. In addition, a pair of studies of Medicare Part D prescription drug plans also demonstrate that consumers switch plans infrequently and those that switch do those mostly in response to changes in the design of their own plan (i.e., are their preferred drugs on formulary) rather than in response to the relative financial attractiveness of theirs versus competing plans.

Bridging the Gap between MUS2 and Patient Engagement Through Appointment Reminders

Jun 11, 2015

By MOLLY MALOOF, MD Sponsored Content

Medical technology has undergone dramatic changes in the last 10 years. Right now, I make and cancel appointments, get prescriptions filled, look at test results, pay bills and email my doctor—all from my computer. I track multiple health markers on my cellphone, and am proactive about my preventive screenings. I am the definition of an engaged patient.

But, I know how the system works from the inside out. The question for most doctors is how to teach patients to be more engaged with the convoluted, fragmented, and confusing healthcare system. They are asking this because they are struggling to meet Meaningful Use Stage 2 requirements.

Most docs complain that the 5% patient portal requirement is unfair because it is out of their control. Maybe it is, or maybe there are smarter ways to work the system in their favor that they just don’t know about.

Health DataPalooza 2015: The Download

Jun 10, 2015• 2

By STEVE FINDLAY

Health Datapalooza once again lived up to its reputation as the liveliest and most eclectic health IT confabs of the year. Energetic and sleek young entrepreneurs mingled with government bureaucrats, academic types, consultants, current and former ONCers, a smattering of providers, app developers, data geeks, and patient advocates at this year’s conference, held in Washington D.C. June 1 to 3 with about 2,000 in attendance.

Although the speeches, app demonstrations, and panel sessions broke little new ground, that’s not the point. The point is to maintain the excitement, optimism and commitment, to update the vision, showcase the creativity, and extol the virtues and power of data-driven care improvement. Perhaps not as the solution to all the health system’s woes, but a fair share of them.

I didn’t discern a dominant theme, but amid the ra-ra and fun there was a good amount of hand-wringing around these issues:

1. Failure to engage the vast majority of consumers/patients in their own care—with data, medical records and Yelp reviews in hand. Some two-thirds of providers attesting to stage 2 meaningful use reported that not a single patient had requested their data or records. Continue reading…

What India’s Teleradiology Market Teaches Us About the Future of Medicine

Jun 10, 2015• 4

By SAURABH JHA, MD

Teleradiology has the same effect on radiologists as Lord Voldemort has on Muggles. It’s the feared end point of the commoditization of imaging, with Rajeev in Bangalore outpricing Rajeev in Chicago for reading follow-up CTs for lung nodules.

But despite the fears of U.S. radiologists, their counterparts in India have more pressing things on their mind.

“U.S. radiologists think that Indian radiologists are [itching] to steal their jobs. We have plenty of work in India,” reassured Dr. Sumer Sethi, director of TeleRad Providers of New Delhi.

A tech-savvy blogger, Sethi founded TeleRad Providers in a flash of inspiration and an appreciation of market forces.

“There is unimaginable competition in private medical imaging in New Delhi,” he said.

A new radiologist wishing to set up shop in one of India’s metropolitan areas faces large upfront costs: There is little discount for a 1.5-tesla MRI scanner. This means one must have abundant spare change floating around — or ancestral wealth. And once the shop is set up, the aspiring radiology entrepreneur embarks on a long and uncertain road toward establishing reputation and market share.

Employment models in the U.S., such as partnership tracks and buying into a practice, are not generally available to Indian radiologists. The alternative to entrepreneurship is working as a salaried employee for a corporate hospital, private imaging center, or government hospital. That was not the career pathway for Sethi, whose teleradiology practice is a pure fee-for-service model.

“It’s a low-cost operation,” he explained. “We read from home.”

An elegant model

The costs of an Indian teleradiologist are certainly low. Sethi does not have to deal with intermediary agents. There are no concerns about using the wrong billing code, and there are no separate state licenses to acquire. The model is elegant in its simplicity. He gets a study, renders a report, and gets paid.

However, the low operating costs belie the actual effort that is required of Sethi to grow his practice. He negotiates with hospitals directly. Being an entrepreneur means recognizing the need for teleradiology, and persuading others of the need and its solution.

Most of Sethi’s clients are hospitals in tier 2 and tier 3 cities in India, the equivalent of Dayton, OH. The hospitals have the machines and patients but not always the radiologists.

“We mostly plug the gaps in the rota at these places,” Sethi said.

This must mean that the radiologists at these centers welcome his efforts, I surmised.

“The scrutiny of our reports is intense,” he said. “This does not mean all our reports are overread. But were we to miss something, we could lose the contract, as the local radiologists would say, ‘See, this is a report from a teleradiologist.’ I tell my team that we must be at the top of our game, always.”

Can the EHR Save the Private Practice?

Jun 9, 2015

How to Out-Argue Your Doctor with Data

Jun 8, 2015• 5

By MICHAEL L. MILLENSON

Your doctor believes he’s “patient-centered” because he wants to provide the the treatment he thinks you need as quickly as possible. Or as the fictional Dr. Heart tells his chest pain patient right after recommending a stent, “As it happens, I can do the procedure for you next week. Does that work for you?”

Before giving in to the gurney, what questions should patients ask? One data-driven script was presented in skit form at the recent Health Datapalooza 2015 meeting in Washington, D.C. The drama was light-hearted; the clinical and financial issues underlying it are not.

Dr. Heart was played by Glyn Elwyn, a theater student-turned-family practitioner recognized as one of the world’s leading researchers in patient preferences and values. Casey Quinlan, a writer and activist widely known for her unfiltered expression of those preferences and values, played the patient.

In the skit, a persistent Quinlan keeps pestering the doctor with questions about what a stent will accomplish that changing her medications won’t. At first glance, a stent sounds appealing because it props open the blood vessel. What could be better? However, when Quinlan asks directly about the effect of meds versus stenting on preventing a heart attack, the doctor admits that data show medication lowers the odds but stenting does not.