The Health Care Blog – Page 427 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

The Health Care Blame Game

Mar 26, 2015• 33

By NORTIN HADLER, MD

Overtreated, overstaffed, over-administered, overpriced, over-regulated, and over-legislated: that’s for starters. How about over-diagnosed, over-medicalized, over-screened, over-digitized, and over-litigated? Then there’s unavailable, inaccessible, non-empathic, and even cruel when it comes to the disabled, disallowed the disaffected and the disavowed. To top it off there’s the American fashion of dying, alone and encumbered by the machinery of futility.

Political pundits and policy wonks point fingers at the mainstream American health care system, sometime more than one finger, often at more than one putative culprit, and often by partisans within the system. It’s open season.

Then there’s the off-off-campus American health care system decrying the on-campus system as insufficiently holistic, alternative, complementary, organic, nutritious, mindful, centered, and soothing. Worse, still, the mainstream is decried for being dismissive of the various therapeutic modalities that various practitioners believe to be essential to maintaining health and restoring well-being. The on-campus Health Care System is so dismissive of these “others” as to wield the “sectarian” label and to restrain their licensure as much as political pressures countenance.

The Real Story Of How I Sold Two Startups, The Chaos Afterwards, And What’s Next

Mar 25, 2015• 8

By ALEXANDRA CARMICHAEL

Today we’re starting a series of more personal stories, looking at what makes interesting people in health care tick. Alex Carmichael is a rare multiple time CEO in health technology, and she has a very interesting tale to tell–Matthew Holt

Don’t worry, this isn’t your typical, syrupy founder story. Matthew asked me to share my experience selling my startup CureTogether to 23andMe, what ensued after that, and how I ended up at uBiome today.

So I thought, if I’m going to share, I might as well *really* share. Let you in behind the scenes to see what it was actually like.

(Bonus: at the end I’ve listed my top 11 life lessons, so make sure you read all the way through for that!)

The story starts…

October 1, 1976: I came into the world in Toronto, Canada, with striking violet eyes. My lawyer/politician mother and management consultant father gave me the name Alexandra, which means “leader of all mankind,” as they often reminded me. Talk about a family having high expectations!

Childhood: I remember loving to read and walk my dogs, who were probably my best friends. I went to a progressive Montessori school with an amazing teacher who believed in me and taught me the power of patience.

Teenage years: The “best” school in Toronto was a repressive and aggressive all-girls private school. My insane work ethic was drilled into me there, as well as at my mom’s political campaign offices, where I would work after school until late into the night.

College years: I met my first love, Danny, in a biochemistry lab at the University of Toronto. I chose the most difficult major (Molecular Genetics and Molecular Biology), because it would drive me hardest. Masochist much?

First startup, 1999: I dropped out of grad school, much to the horror of my extremely educated parents, to join a bioinformatics software company Danny had started in his bedroom in 1997. I taught myself how to code, design, sell, and run a company. We worked so much that we hardly left our apartment, except to get married, have a baby, and occasionally go to Tai Chi class. We lost most of our money in the dot com bust, and scraped by on rice and beans for a few years. It was so isolating and intense that I got really depressed and even suicidal once.

First exit, and move to California, 2005: We were seriously running out of money, so one day I made a big wall chart of all the possible companies that could acquire us, and we started going after each one relentlessly. After a few months, we got a meeting with Hitachi. They were interested, but didn’t seal the deal until we decided to put our stuff in storage and just show up in California, baby daughter Samantha in tow. One way or another, we were determined to make it work. They did end up acquiring us, for a few hundred thousand dollars. Not much for 8 years of invested time and energy, but really we just wanted to get to California, where the sun shines and the opportunity abounds. We finally made it!
Continue reading…

No More Numbers

Mar 24, 2015• 15

By SHIRIE LENG, MD

Medicine is obsessed with numbers. Or rather, journalists and medical administrators are. Here are two related examples of how large a grain of salt one must put on numbers.

Cardiac surgical procedures, like everything else in medicine, have quality indicators. One of these is what we doctors call “30-day mortality”. What this term means is that surgeons are evaluated in part on how many of the patients they operated on died within a month of having surgery. Presumably a surgeon whose patients rarely die within 30 days is a better surgeon than one whose patients die all the time. The American Academy of Hospice and Palliative Medicine, whose members deal frequently with the elderly, thinks this number, 30, harms old people. http://nyti.ms/1AR3OqB. The problem, according to Paula Span of the New York Times, is that surgeons refuse to operate on people who are more likely to die within 30 days, and that they keep patients alive in ICUs until day 31 to keep their numbers up. Bad doctors! Continue reading…

Patient Self-Scheduling 2.0

Mar 24, 2015• 7

By JOSEFINA JERVIS and MICHAEL TURPIN

As the digital economy transforms health the most transformative ideas and consumer engagement solutions can sometimes challenge the industry’s ability to adopt and implement them. Reimbursement reforms, risk sharing, migration towards high deductible plans and the expansion of public and private coverage are converging to unleash an increasingly sophisticated consumer into the marketplace. Health systems and physician practices are consolidating and marketing their services direct to consumers in an attempt to underscore the critical differentiators valued by consumers – access, quality and affordability. In today’s consumer economy, access remains a critical criterion for choosing and patronizing a provider or a practice. To assist the move toward consumerism, employers are introducing tools to facilitate comparison-shopping for services seen as “consumer-driven.” The cost of elective and non-emergency services are highly variable and employers want employees to become consumers making decisions based not only on access but also cost.Continue reading…

Happy 5th Birthday, ACA

Mar 23, 2015• 23

By STEVEN FINDLAY

There are dozens of ways to take stock of the Affordable Care Act as it turns 5 years old today. According to HHS statistics:

16.4 million more people with health insurance, lowering the uninsured rate by 35 percent.

$9 billion saved because of the law’s requirement that insurance companies spend at least 80 cents of every dollar on actual care instead of overhead, marketing, and profits

$15 billion less spent on prescription drugs by some 10 million Medicare beneficiaries because of expanded drug coverage under Medicare Part D

Significantly more labor market flexibility as consumers gained access to good coverage outside the workplace

Impressive. But the real surprise after five years is that the ACA may actually be helping to substantially lower the trajectory of healthcare spending. That was far from a certain outcome. Dubbed the Patient Protection and Affordable Care Act for public relations purposes, there were, in fact, no iron clad, accountable provisions that would in the long run assure that health insurance or care overall would become “affordable.”

ACA supporters appear to have lucked out—so far. Or maybe, just maybe, it wasn’t luck at all but a well-placed faith that the balance of regulation and marketplace competition that the law wove together was the right way to go.

To be sure, other forces such as the recession were in play—accounting for as much as half of the reduction in spending growth since 2010. But as the ACA is once again under threat in the Supreme Court and as relentless Republican opposition continues, it’s worth paying close attention to new forecasts from the likes of the Congressional Budget Office (CBO) and the actuaries at the Centers for Medicare and Medicare Services (CMS).

The ACA is driving changes in 17 percent of the U.S. economy that, if reversed or interrupted, would have profound impact on federal, state, business, and family budgets. A quick look at some important numbers follows:

Spring Deliveries from Washington

Mar 22, 2015• 6

By JACOB REIDER, MD

It may have been a quiet week in Lake Wobegon, but not in Washington DC. Last week, we saw the introduction of two congressional bills here (SGR fix) and here (EHR interoperability) and two proposed rules from HHS (one from CMS and one from ONC) – all of which would have substantive impact on health care in the US, and the role of information technology in how health is optimized and care is delivered. While the iron’s still hot, let’s take a 30,000-foot view at all of this. I’ll follow up later in the week with a more detailed overview of the ONC and CMS proposed rules with a bit more of an editorial voice on the SGR fix and Burgess’ interoperability bill.

The first document to land – way back on March 10^th – was the bill from Representative Burgess.

Some context: he’s a physician. He understands the physician perspective – and is – like many physicians – confused by the paradox that several years and $20B after the passage of HITECH – we don’t have plug-and-play interoperability between health IT systems yet. He might be asking: “isn’t this what was supposed to happen by now?” Compelled by his training as a physician and (as my wife would argue) a human with a Y chromosome, Rep Burgess sees a problem and wants to fix it – hence this legislation. HHS didn’t fix this? Industry didn’t fix it? Well, then, let’s see if Congress can fix it! What’s the approach?

The bill attempts to redefine interoperability as:

“open access”

“complete access”

and

“does not block access.”

Patients are NOT Customers

Mar 21, 2015• 27

By SHIRIE LENG, MD

Recently I wrote about the problems with Maintenance of Certification requirements. One of the phrases I read repeatedly when I was researching the piece was “the patient as customer.” Here’s a quote from the online journal produced by Accenture, the management consulting company:

Patients are less forgiving of poor service than they once were, and the bar keeps being raised higher because of the continually improving service quality offered by other kinds of companies with whom patients interact—overnight delivery services, online retailers, luxury auto dealerships and more. With these kinds of cross-sector comparisons now the norm, hospitals will have to venture beyond the traditional realm of merely providing world-class medical care. They must put in place the operations and processes to satisfy patients through differentiated experiences that engender greater loyalty. The key is to approach patients as customers, and to design the end-to-end patient experience accordingly.

Except for one thing. Patients are NOT customers.

The definition of a “customer” is a person or entity that obtains a service or product from another person or entity in exchange for money. Customers can buy either goods or services. Health care is classified by the government as a service industry because it provides an intangible thing rather than an actual thing. If you buy a good, like a car, you voluntarily decide to shop around and get the best car you can for the price. Even a vacation, especially a vacation package or a cruise, is a good. A nice dinner, while a good in the sense of the food, is also a service. You buy the services of the cook and servers.

Here is why the patient shouldn’t be considered a customer, at least not in the business sense.

1. Patients are not on vacation. They are not in the mindset that they are sitting in the doctors office or the hospital to have a good time. They are not relaxed, they have not left their troubles temporarily behind them. They have not bought room service and a massage. They are not in the mood to be happy. They would rather not be requiring the service they are requesting. Which leads to number 2:

2. Patients have not chosen to buy the service. Patients have been forced to seek the service, in most cases.

3. Patients are not paying for the service. At least not directly. And they have no idea what the price is anyway.

4. Patients are not buying a product from which they can demand a positive outcome. Sometimes the result of the service is still illness and/or death. This does not mean the service provided was not a good one.

5. The patient is not always right. A patient cannot, or should not, go to a doctor demanding certain things. They should demand good care, but that care might mean denying the patient what the patient thinks he or she needs. The doctor is not a servant; she does not have to do everything the patient wants. She is obligated to do everything the patient needs.

6. Patient satisfaction does not always correlate with the quality of the product.A patient who is given antibiotics for a cold is very satisfied but has gotten poor quality care. A patient who gets a knee scope for knee pain might also be very satisfied, despite the fact that such surgery has been shown to have little actual benefit in many types of knee pain.

Congress Can’t Solve the EHR Interoperability Problem

Mar 21, 2015• 31

By NIAM YARHAGI

Rep. Mike Burgess (R-Texas) has released a draft bill entitled “ensuring interoperability of qualified electronic health records” in which interoperable (Electronic Health Records) EHRs are defined as those that do not block sending and receiving data to and from other EHRs and provide users with complete access to the captured medical data. The draft bill proposes that detailed methods to assess interoperability be defined by a “Charter Organization.” According to the draft bill, this Charter Organization shall consist of one member from each of the standard development organizations accredited by the American National Standards Institute and representatives that include healthcare providers, EHR vendors, and health insurers. To keep its certification after January 2018, an EHR vendor should comply with the definitions of the Charter Organization, publish API’s to enable data exchange with other EHRs and attest and demonstrate that it has not willfully interrupted data exchange with other EHRs. The draft bill suggests that the Inspector General of HHS shall have the authority to investigate both EHR vendors and medical providers with regards to claims that they have interrupted interoperability.

The proposed Charter Organization will not be successful.

Google Algorithm to Favor Websites That Work on Mobile Devices

Mar 21, 2015• 5

By JOHN SUNG KIM

In a major update, the search giant has announced that on April 21, the algorithm will be updated to favor websites that are designed to work on both mobile and desktop devices, now often referred to as Responsive Website Designs.

Does your practice have a responsive website?

Google has had multiple mobile initiatives, including the GoMo campaign where the company provided free tools to help small businesses build websites that worked on mobile devices without the dreaded pinching, resizing, and squinting. That campaign had limited success because the technology didn’t quite work as elegantly as possible, but just last week Google took its most aggressive approach yet by declaring that they were going to start penalizing websites that did not have mobile capabilities.

Once referred to as mobile-friendly website design, geeks refer to it simply as responsive website design now. So how does one get a mobile-friendly, er, responsive website?