The Health Care Blog – Page 418 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Life Is Complicated

May 27, 2015• 8

By ROB LAMBERTS, MD

“I want to tell you my story now,” a patient recently told me, a woman who suffers from many physical and emotional ailments. She had the diagnosis of PTSD on her problem list, along with hospitalizations for “stress,” but I never asked beyond that.

“OK,” I answered, not knowing what to expect. “Tell me your story.”

She paused for about 30 seconds, but I knew not to interrupt the silence. “I killed my husband,” she finally said.

OK. Unexpected.

She went on to explain a horrible set of circumstances involving alcoholism and physical violence, that resulted in her shooting her husband in self-defense. She spent the two following years on trial for murder, eventually being cleared on all accounts. Despite this, the rifts in her family continue, and she (obviously) still relives this terrible moment.

Deep breath. How can I ever hold any emotional instability against this woman? Who wouldn’t struggle? It brings me back to my oft-repeated mantra: everyone has a backstory.

Not all backstories are so dramatic. One woman, who is very lovely and vibrant from first meeting, revealed that it had been ten years since she was intimate with her husband. She does her best to hide the pain, but the toll of feeling unloved and rejected over ten years has taken a heavy toll. In some ways, her skill at hiding the pain inside causes even more pain, as she faces the daily need to screw up happy emotions she doesn’t have. In her own way, this pernicious pain of rejection has made her walk through life feeling distant from everyone. She smiles to everyone, but the pain doesn’t leave.

How can I know what this is like?

A Shout Out For Our Sponsors: Health Catalyst

May 27, 2015

By MATTHEW HOLT

THCB would literally not exist without the support of our generous sponsors. This blog and the work we do is made possible by the forward-thinking people at companies like HealthCatalyst who have come on board as flagship sponsors. Love THCB? Want to send a message of support? Head over and take a look at what they’re up to for a few minutes. Today’s online boot camp (Health Catalyst Academy) is a great intro. Quality improvement is a tough, bloody fight. Many enter the contest. Not everybody survives. If you’re a hospital administrator, this online boot camp event (Weds 27th 1 PM / archive available) will give you the tools you need to lead successful quality improvement initiatives at your organization and may even make you rethink how you lead data-driven change. If you’re a clinician or healthcare provider involved on the front lines of the quality improvement fight, you’ll come away with an advanced understanding of how data can transform your organization, as well as the role you can play along the way. You can find out more here. Great stuff. — Matthew Holt

Free Our Health Records: Get your health records and help save lives

May 27, 2015• 14

By BOB ROWLEY and DAVID HARLOW

What if a million patients ask for their health records all at once?

Keep in mind that each person would not be submitting a single request. We get our care from multiple health care providers, often across different health systems, with electronic health record systems that don’t really talk to each other. The older we are, the more chronic conditions we have, the greater that number of different providers.

What would the records look like? Where would they go? How would they line up with each other? Request your medical records and find out.

A day of action

The idea of a mass records request has emerged as an assertion of patients’ rights, and in part as a reaction to proposed amendments to Meaningful Use of Certified Electronic Health Records (EHRs) Stage 2 regulations which effectively eliminate patient engagement as a Meaningful Use measure (a measure requiring that at least 5% of patients seen by a provider view, download or transmit their health data in order for the provider to “check the box”).

EHR systems, built to facilitate local (single group, single institution) workflow and reimbursement, aren’t really designed for collaboration beyond the four walls of the local group or institution, or for communication and sharing with patients.

Is Healthcare Designing the Wrong Patient Experience?

May 26, 2015• 3

By CANCER GEEK

Patient experience.

It what’s in. It’s what’s vogue. It’s all the rage.

There is a not a day that one cannot open a paper, a medical journal, Twitter, FaceBook, email, or a conference brochure and not see something about patient experience.

In the U.S. its healthcare’s new version of a best practice. It’s another way to share best practices across an industry. It provides another bandwagon to hop on and spread across the great plains.

But are we scaling mediocrity?

In 1998 Joseph Pine II and James Gilmore wrote a paper published in the Harvard Business Review entitled “The Experience Economy” that was part of a similar book they published by the same title. (paper here)

GOP Has the Fear: King vs. Burwell

May 26, 2015• 1

By JOE FLOWER

Republicans have raged against Obamacare for six years now. But do they really want to see it crash?

We are rapidly approaching the day when the Supreme Court announces its decision in King v. Burwell. The case found a four-word phrase in the 900-page law that says that the tax subsidies are available to people who get insurance through exchanges “established by the state.” Both Republicans and Democrats who actually put the law together, as well as their staffs, say that was a mistake, that no one meant to exclude people on the federal exchange, it is just an artifact of the drafting process that contravenes the whole sense of the law.

The result, if the course found for the plaintiffs, could be rapid and dire: Some 7.5 million would suddenly be paying full freight for healthcare insurance, most would probably stop paying and be force off the plans, and both healthcare and the insurance industry would face a sudden large drop in the revenue streams they need to stay afloat.

But what do Republicans really think?

Doctors Going the Distance (In Education)

May 26, 2015• 2

By EDGAR T. WILSON

We need more doctors.

Between older care providers retiring, and the general population shift that is the aging of the Baby Boomers, we are running into a massive demographic of more, older patients, living longer and managing more chronic conditions. This puts incredible pressure not just on the remaining doctors and nurses to make up the gap, but strains the capacity of schools to recruit, train, and produce competent medical professionals.

So how can schools do more to reach students and empower them to enter the healthcare field?

The increasing popularity of online programs (particularly at the Masters level, among working professionals looking for a boost to their career advancement) has called forth a litany of studies and commentaries questioning everything from their technology to their academics,compared to traditional, on-campus programs. More productive would be questioning the structure and measuring the outcomes of degree programs in general, rather than judging the value of a new delivery mechanism against an alternative more rooted in tradition than science.

In terms of sheer practicality, though, a distance education—yes, even for doctors and surgeons—makes a certain amount of sense. One of the hottest topics in the medical community right now is Electronic Health Records (EHRs) and the ongoing struggle to fully implement and realize the utility of such technology.

Credibility of Evidence: A Reconsideration of the Logic and Strength of Our Healthcare Decisions

May 22, 2015• 4

By ROSS KOPPEL and STEPHEN SOUMERAI

A few days ago, we wrote an editorial for US News and World Reports on the scant or dubious evidence used to support some healthcare policies (the editorial is reproduced in full below). In that case, we focused on studies and CMS statements about a select group of Accountable Care Organizations and their cost savings. Our larger point however is about the need to reconsider the evidence we use for all healthcare-related decisions and policies. We argue that an understanding of research design and the realities of measurement in complex settings should make us both skeptical and humbled. Let’s focus on two consistent distortions.

Evidence-based Medicine (EBM). Few are opposed to evidence-based medicine. What’s the alternative? Ignorance-based medicine? Hunches? However, the real world applicability of evidence-based medicine (EBM) is frequently overstated. Our ideal research model is the randomized controlled trial, where studies are conducted with carefully selected samples of patients to observe the effects of the medicine or treatment without additional interference from other conditions. Unfortunately, this model differs from actual medical practice because hospitals and doctors’ waiting rooms are full of elderly patients suffering from several co-morbidities and taking about 12 to 14 medications, (some unknown to us). It is often a great leap to apply findings from a study under “ideal conditions” to the fragile patient. So wise physicians balance the “scientific findings” with the several vulnerabilities and other factors of real patients. Clinicians are obliged to constantly deal with these messy tradeoffs, and the utility of evidence-based findings is mitigated by the complex challenges of the sick patients, multiple medications taken, and massive unknowns. This mix of research with the messy reality of medical and hospital practice means that evidence, even if available, is often not fully applicable.

Relative vs. Absolute Drug Efficacy:

Let’s talk a tiny bit about arithmetic. Say we have a medication (called X) that works satisfactorily for 16 out of a hundred cases, i.e., 16% of the time. Not great, but not atypical of many medications. Say then that another drug company has another medication (called “Newbe”) that works satisfactorily 19% of the time. Not a dramatic improvement, but a tad more helpful (ignoring how well it works, how much it costs, and if there are worse side effects). But what does the advertisement for drug “Newbe” say? That “Newbe” is almost 20% better than drug “X.” Honest. And it’s not a total lie. Three percent (the difference between 16% and 19%) is 18.75%, close enough to 20% to make the claim legit. Now, if “Newbe” were advertised as 3% better (but a lot more expensive) sales would probably not skyrocket. But at close to 20% better, who could resist? Continue reading…

Rick Scott is an Idiot

May 22, 2015• 3

By STEVE FINDLAY

I’ve never met the man, and I don’t mean this personally, but Florida Gov. Rick Scott is an idiot. Rather, more specifically, the way he has managed Florida’s Medicaid expansion, or lack thereof, is idiocy on the altar of political ideology and kneejerk Republican healthcare doctrine.

Other governors are fighting Medicaid expansion, of course. It’s a major battleground in the implementation of the Affordable Care Act (ACA). But Scott, 62, and governor since 2011, has raised his resistance to the level of high political theater that defies commonsense and hurts Florida residents.

If you haven’t been following this lately, here’s a quick recap: In April, Scott filed suit against the federal government (HHS) over federal funding for a special Florida program, launched in 2005, called the Low Income Pool (LIP). The funding—due to be about $1.3 billion in 2015-16 and combined with about $1 billion in state funds—compensates safety-net hospitals for care of low-income, uninsured people. It’s set to expire on June 30 and must be reauthorized by HHS.

Scott and Florida claim in the suit that HHS is trying to force the state to expand Medicaid against its will and in violation of federal law—that law being the now-famous 2012 Supreme Court decision that gave thumbs up to constitutionality of the ACA but nixed the law’s mandate requiring states to expand Medicaid. Medicaid expansion is thus voluntary. (A half dozen or so Republican governors who were initially opposed to Medicaid expansion have relented; the most recent are in Utah and Missouri. To date, 29 states plus DC have expanded Medicaid under the ACA and 17 have not. In four states, including Fla, it’s being debated.)

The Purpose-Driven Hospital

May 21, 2015

By JOSHUA LIU, MD

I was incredibly impressed by the announcement this week that three top U.S. health systems – Dartmouth-Hitchcock Medical Center, Johns Hopkins Medicine, and the University of Michigan Health System – will be enforcing standards that prevent low-volume hospitals from performing certain surgeries.

This comes on the heels of a major U.S. News story which showed that patients who had surgeries at low-volume hospitals faced significantly higher risks of complications and death.

The data itself is not surprising. The relationship between low procedure volume and worse outcomes has been well documented since a first major publication on the topic in 1979.

It’s also common sense. The more times you perform a procedure, the better you will be at it. If you’re only performing a hip replacement surgery 3 times a year, chances are you won’t do it as well as a surgeon who performs 200 a year. Practice makes perfect.

Instead, what’s surprising is that these three major medical systems are putting their feet down, even though they don’t need to.

There’s no Obamacare incentive. In fact, this decision could cost these health systems a lot of revenue. And this will certainly upset some surgeons and staff who want to keep performing those surgeries.

Value-Based Care’s Data Problem

May 21, 2015• 2

By RACHEL KATZ

Lisa is an administrator at an Accountable Care Organization, or ACO — a new healthcare payment model that encourages coordinated, high-quality, and efficient care. Lisa’s ACO facilitates the program at about 100 clinics around California, and her mission in the first year of operating might seem elementary to an outsider: to report a set of metrics to Medicare that indicate the health of patients who had been seen at these clinics.

At the start of 2015, Lisa received a panel of patients to review. She had expected a list of about 600, but instead there were 2,400. For each, she needed to report on a specific outcome or physician practices — like which beneficiaries with hypertension had blood pressure less than 140/90 and which had been screened for a risk of falling.

The kicker: she had just six weeks to submit this data. Most of the clinics didn’t have staff to do the required reporting, so Lisa contracted an assistant to travel from clinic to clinic, collecting the information they needed. About a quarter of the clinics used paper records, so the pair of administrators leafed through stacks of paper charts for the blood pressure and screening data.

In six weeks, Lisa collected 2,400 data points from across the clinics and submitted them to a third party vendor who would produce reports for Medicare. Lisa will wait until August to find out whether the ACO met its goals.