The Health Care Blog – Page 421 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Doctors Should Own Up to Creating the Mark Cuban Problem

May 4, 2015• 13

By ADAMS DUDLEY, MD

Much has been made of Mark Cuban’s medical knowledge since he tweeted, “If you can afford to have your blood tested for everything available, do it quarterly so you have a baseline of your own personal health”. Charles Ornstein shared the tweet and many physicians and others, myself included, weighed in on the costs and potential for harm from unnecessary testing.

I’ll admit that, when I tweeted to him, I expected Cuban to agree. But he didn’t. In fact, he grew increasingly resistant. I stopped responding when he announced that the opposition to his idea his had convinced him he needed to take his proselytizing to his TV show.

Instead of poking the sore, I began to wonder about the origins of Cuban’s conviction. I remembered that he is not alone in wanting tests that clinicians who worry about value, cost, and harm think he shouldn’t have.

But where do these attitudes come from? Is it possible that clinicians are contributing in any way to this situation? Quite the contrary: most Americans want tests, even when you tell them that nothing can be done with the information. Furthermore, Americans are more convinced of the benefits of tests like mammograms than people in other countries, and then go out and get more of them.

I think that we are. My team has studied why patients get so many electively placed coronary stents, when cardiologists readily admit that randomized trials have demonstrated that there are few situations in which such stents improve survival or reduce the risk of heart attacks.

Studies of the beliefs of patients who have just received an electively placed stent give a big clue: 80% thought stenting would reduce their risk of death, even though their cardiologists knew that this was not the case.

ONC Awards $300K in Funding to 6 Digital Health Pilot Projects!

May 4, 2015• 1

By ADAM WONG

The Department of Health and Human Services’ (HHS) Office of the National Coordinator for Health Information Technology (ONC) today announced the six winners of the inaugural ONC Market R&D Pilot Challenge. The six winners will live-test new health information technology (health IT) applications in health care settings administered by their challenge partners.

The winning innovator-health care organization teams will each receive $50,000 to fund their pilot programs which will become operational in August are:

ClinicalBox and Lowell General Hospital
CreateIT Healthcare Solutions and MHP Salud
Gecko Health Innovations and Boston Children’s Hospital
Optima Integrated Health and University of California, San Francisco, Cardiology Division
physIQ and Henry Ford Health System
Vital Care Telehealth Services and Dominican Sisters Family Health Service

The ONC Market R&D Challenge launched on October 20, 2014 with the goal of finding early stage health care startups from across the country and connecting them with health care organizations and stakeholders with whom they could potentially run a pilot program to test the application.

Three in-person matchmaking events were held in January, 2015, focused on connecting health care organizations with innovator companies looking to pilot test their products. Almost 500 organizations expressed interest in finding partners through the matchmaking program. More than 300 in-person meetings were held in New York, New York; San Francisco, California; and Washington, D.C., with many more conducted virtually. These “speed-dating” events allowed startups to meet face-to-face with health care organizations to identify common interests and goals. ONC and the organizer of these meetings, Health 2.0, intended for the events to have additional benefits, including facilitating the exchange of ideas that might lead to new partnerships and relationships.

To be eligible to serve as a host, organizations were required to operate in clinical, public health and community, or consumer health environments while also serving enough consumers or patients to conduct a pilot study. The innovators had to be an early-stage health information technology company with less than $10 million in venture capital funding and a readily available technology solution.

Wikipedia: Homeopathy and Evidence for Unpatentable Medications

Apr 30, 2015• 5

By FRED TROTTER

Recently, I have had some interesting conversations with doctors and medical students of Naturopathic Medicine. I am slowly getting involved in editing Wikipedia medicine articles, and I was approached by several proponents of Naturopathic Medicine, who were upset about the following phrases from the Wikipedia article on Naturopathy:

Naturopathic philosophy is based on a belief in vitalism and self-healing, and practitioners often prefer methods of treatment that are not compatible with evidence-based medicine. Naturopathic medicine is replete with pseudoscientific, ineffective, unethical, and possibly dangerous practices.

Of course, they felt this was unfair. In their mind, the Wikipedia article was “wrong” and needed to be fixed and they were frustrated by the tendency for Wikipedia editors to thwart their efforts to “fix” the article.

This put me in an uncomfortable position. I had the option of remaining entirely silent, or informing these followers of Naturopathy of several issues:

Wikipedia has become a “court for facts”. The Wikipedian community focuses on what has become verifiable scientific consensus.
There is very little scientific consensus supporting Naturopathic methods while there is is a substantial amount of scientific consensus opposing some Naturopathic methods.
Naturopathic methods tend to layer “placebo effects” (Ben Goldacre is the inevitable reference for how that works).
These layered placebo effects tend to make the patients of naturopaths and the naturopaths themselves, believe that their methods are way more effective than they actually are.
I have to admit that I fully expected to have a serving of Tim Minchin’s Storm. But what the hell. Why not?? So I jumped and put the basic issues forward.

Opening the Care Conversation Through Open Notes

Apr 28, 2015

By SUSAN DENTZER

It’s a memory aid.

It’s truth serum.

Using it can transform relationships forever.

These may sound like come-ons for the type of product typically hawked on late-night television. But in fact, they’re some of the things people are saying about OpenNotes.

OpenNotes isn’t a product, but an idea: That the notes doctors and other clinicians write about visits with patients should be available to the patients themselves. Although federal law gives patients that right, longstanding medical practice has been to reserve those visit notes for clinicians’ eyes only.

But Tom Delbanco and Jan Walker, a physician and nurse at Beth Israel Deaconess Medical Center in Boston, have long seen things differently.

Their personal experiences with patients, and inability to access care records for their own family members, persuaded them that the traditional practice of “closed” visit notes had to change. So, with primary support from the Robert Wood Johnson Foundation, they launched what has now become a movement.

In 2010, Delbanco, Walker and colleagues led a study in which more than 100 primary care doctors from three health systems began sharing notes online with patients. Patients got secure messages prompting them that the notes were available, and reminders to read notes before their next appointments.

HIT: Where We Stand and Where We Go From Here

Apr 27, 2015• 3

By KAREN DeSALVO

This post is adapted from DeSalvo’s talk at the annual meeting of the Health and Information Management Systems Society in Chicago last week.

I am optimistic about the bright future we have to leverage health information technology to enable better health for everyone in this country.

One year ago, we called upon the health IT community to move beyond adoption and focus on interoperability, on unlocking the data, so it can be put to the many important uses demanded by consumers, doctors, hospitals, payers, and others who are part of the learning health system.

ONC spent the year listening to the health IT community to understand the challenges and opportunities and developing strategic roadmaps to guide our way. Our goal was to evolve to be best able to lead where appropriate, and partner wherever possible, as we all shift the national strategic focus towards interoperability. I hope you all have felt that shift.

Ridicule Mehmet Oz, Don’t Have Him Fired

Apr 22, 2015• 8

By SAURABH JHA, MD

If I could invite four people for dinner, alive or dead, they would be Mark Twain, William Shackleton, Christopher Hitchens and Homer Simpson (Bart’s dad). If Mehmet Oz turned up with a bag of Garcinia Cambogia I would excuse myself.

Few things drive me to the abyss more reliably than the banality of status updates on Facebook and the monotony of health freaks. I would rather face the aftermath of Vindaloo followed by industrial strength Picolax than watch an episode of the Dr. Oz Show.

Did you catch that? Show. Like Dog and Pony show. Punch and Judy show. The Dr. Oz Show is a show. Not to put too fine a point, but physicians asking Columbia University to fire Dr. Oz are giving his show more profundity than it self-evidently deserves.

The obvious retort is that Oz is using his position as faculty of a prestigious university to promote dodgy metaphysical claims. Ah, the narcissism of academics! Priceless! As the saying goes, for everything else there is master card…Continue reading…

Independent Practice Equals Higher Satisfaction

Apr 22, 2015• 1

By TOM GUILLANI, MD, MS

Thinking of starting a new practice? Is the lure of independence calling to you? There are more reasons than every why independent practice is a great option. Being your own boss is not only easier than it once was, it can actually make you happier.

Independent physicians have many more options available to help them today than they used to. Affordable technology has revolutionized private practice from EHRs to easy-to-use practice management and billing software, adding flexibility to staffing and simplifying paperwork needs. And, the increased availability and ease of outsourcing has further reduced the burden of running your own practice. Physicians can now choose to outsource inbound calls, reminder calls, pre-authorizations, marketing, and of course, billing. In addition, independent providers can transition to new agile practice models such as concierge and hybrid that can offer higher incomes and smaller patient census and reduce some of the headaches associated with traditional practice structures.

Added to the fact that starting and running a private practice is now easier than ever, is the higher level of happiness experienced by independent physicians. In fact, a study done by Medscape in March 2014 reported that 74% of self-employed doctors are satisfied in their practice and that of the physicians who left employment in favor of independent practice, 70% felt happier in their new practice while only 9% were less happy being self-employed. Seventy-four percent of these self-employed doctors also said that their opportunity to practice quality medicine met or exceeded their expectations.

There are many factors contributing to these high satisfaction rates in independent physicians but one of the biggest is the control these doctors have over their practice, their schedule, their treatment of patients, and their destiny. A survey in Hospital Topics on the impact of practice arrangements on physician’s satisfaction backs this up, reporting that physicians who work for HMO’s have much less autonomy and decision-making power than self-employed physicians. And, the report by Health Affairs found that 85% of doctors in private practice felt free to control their schedules compared to only 39% of HMO physicians.

Self-employed doctors also avoided the pitfalls of employment cited by the Medscape study while the doctors working for hospitals and group practices listed administrative headaches, added rules, and a more limited income potential as reasons for dissatisfaction in their careers. It’s easy to see why the 2014 Great American Physician Survey conducted by Physician’s Practice found that over half of independent physicians would do things the same way all over again. This isn’t to say independent providers done have regulatory challenges or administrative responsibilities. However, they have more control over the day-to-day operations and administration, eliminating frustrating bureaucracy.

Better, more affordable, easier-to-use technology, simple outsourcing options, greater autonomy and control, and higher levels of satisfaction…all of these factors make private practice a more attractive option than ever. So, if you are considering starting a new medical practice, now is the time. Just remember, doing it right from the beginning will save you from unnecessary stress, making the process of opening your new practice a much more enjoyable experience.

By joining the ranks of independent physicians, you will be in control of both your practice and your life. You will be free to set your own schedule, manage patient care to your standards, work with a staff of your choosing, and have the final control over your income potential. All new practices will face challenges along the way but you will find a wealth of resources to make your life easier and guide you to success in your new venture.

Tom Giannulli, MD, MS, is the chief medical information officer at Kareo. He is a respected innovator in the medical technology arena with more than 15 years of experience in mobile technology and medical software development. Previously, Giannulli was the founder and chief executive officer of Caretools, which developed the first iPhone-based EHR.

SGR Appeal: Fixing the Present, Setting a Foundation for the Future

Apr 22, 2015• 6

FARZAD MOSTASHARI

Last week, I was riveted to the deliberations on the Senate floor, as the fate of the Medicare Access and CHIP Reauthorization Act (MACRA – so far, more commonly called the “SGR fix”) was decided. One amendment after another failed to pass; the legislation ultimately passed by a vote of 92-8, and was signed into law shortly thereafter.

To date, much of the coverage of MACRA has focused on how it has fixed the “doc pay” problems of the last 18 years – rescuing us from a yearly round of negotiations about how to temporary avoid painful cuts in Medicare’s physician reimbursement rates.

It’s true that MACRA wiped out (and only partially paid for) the accumulated burden of postponed pay cuts. But it also took a huge step in ending the volume-based “fee-for service” payment system that the pay cuts were trying to restrain in the first place. In a volume-based health care world, the only way for the government and other payers to control runaway medical inflation is to make it harder for doctors to get paid (through rejected claims, paperwork, and prior authorizations), and to reduce the price they pay for each office visit, test, or medical procedure. Providers, paid less and less for each visit and service, can try to maintain their income by further increasing volume — seeing more and more patients in less and less time — or routing patients through increasingly questionable services, tests, and procedures. That is the dysfunctional state of US health care today, with patients caught in the middle of the arms race between those who pay the bills, and those who bill them– collateral damage.Continue reading…

Finding the Stars of Hospital Care In the US

Apr 21, 2015• 6

By ASHISH JHA, MD

Why do star ratings?

Now we’re giving star ratings to hospitals? Does anyone think this is a good idea? Actually, I do. Hospital ratings schemes have cropped up all over the place, and sorting out what’s important and what isn’t is difficult and time consuming. The Centers for Medicare & Medicaid Services (CMS) runs the best known and most comprehensive hospital rating website, Hospital Compare. But, unlike most “rating” systems, Hospital Compare simply reports data on a large number of performance measures – from processes of care (did the patient get the antibiotics in time) to outcomes (did the patient die) to patient experience (was the patient treated with dignity and respect?). The measures they focus on are important, generally valid, and usually endorsed by the National Quality Forum. The one big problem with Hospital Compare? It isn’t particularly consumer friendly. With the large number of data points, it might take consumers hours to sort through all the information and figure out which hospitals are good and which ones are not on which set of measures.

To address this problem, CMS just released a new star rating system, initially focusing on patient experience measures. It takes a hospital’s scores on a series of validated patient experience measures and converts them into a single star rating (rating each hospital 1 star to 5 stars). I like it. Yes, it’s simplistic – but it is far more useful than the large number of individual measures that are hard to follow. There was no evidence that patients and consumers were using any of the data that were out there. I’m not sure that they will start using this one – but at least there’s a chance. And, with excellent coverage of this rating system from journalists like Jordan Rau of Kaiser Health News, the word is getting out to consumers.

Our analysis

In order to understand the rating system a little bit better, I asked our team’s chief analyst, Jie Zheng, to help us better understand who did well, and who did badly on the star rating systems. We linked the hospital rating data to the American Hospital Association annual survey, which has data on structural characteristics of hospitals. She then ran both bivariate and multivariable analyses looking at a set of hospital characteristics and whether they predict receiving 5 stars. Given that for patients, the bivariate analyses are most straightforward and useful, we only present those data here.

Why Microsoft May Be the One to Watch

Apr 20, 2015• 1

By MATTHEW HOLT

Matthew Holt: I’m talking with one of the most interesting people in healthcare, Dale Sanders who these days is the Senior Vice President for Strategy for Health Catalyst, a really fast growing data warehousing analytics company. Dale, before that, did a bunch of stuff in the Air Force, at Intermountain, was involved with starting the Health Data Warehouse Association, and even for a while running the National Health IT System in Cayman Islands

Anyway we’re here to chat about some work that Health Catalyst is doing, that you guys have been doing these webinars, very successful ones, a few months and years. You actually had a big conference last year, which you’re repeating again this year, I know, but specifically coming up on April 22nd 1 – 2 PM PST is a webinar about Microsoft.

So let me tell you my Microsoft story from HIMSS last week I was in one of the last sessions in Thursday, actually, and it was a guy named Dave Francis talking about the future of consumer health. Someone said, “I am a Microsoft guy. I work for Microsoft. They send me out to health systems and I help in dealing with technical issues. You’re talking about the future of online consumer health. The Google Health guys, they had that thing, it failed. We have Healthvault, we failed and close it down. Oh no, we didn’t officially close it, so I’m not supposed to say that, but anyway”. So that’s the kind of way people think about Microsoft and healthcare. But you’re saying not so fast. So what’s the story here?

Dale Sanders: Yeah, it’s very interesting. In this webinar, I spend the first few minutes talking about my life on Microsoft. So I’ve been an IT now for 32 years, starting out in the Air Force and now in Health Catalyst. So I put this timeline together and I put all these significant events in my life that had some relationship to some event in Microsoft. Most of the time, it’s like horrible, right? I want to poke my eyes out. My Microsoft experience as a healthcare IT guy or just an IT guy in general has been terrible, right? Security problems, backwards compatibility problems, scalability problems. But now I’m very bullish in Microsoft, so it’s kind of unusual that I’ve completely turned my opinion

Matthew Holt: Perhaps because they’re no more the evil monopoly, they’re David vs Goliath?

Dale Sanders: Yeah. Really, it’s fascinating. This webinar is about their cultural transformation as much as it is their technical transformation. It’s fascinating, and I was never a big fan of Bill Gates, never a big fan of Steve Ballmer. They’re just contrary personalities to me.

Matthew Holt: They may care less about what you think.