The Health Care Blog – Page 430 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

On THCB This Week

Mar 13, 2015

By THCB STAFF

“Apple ResearchKit (Not) Ready For Prime Time – Yet. A Medical Researcher’s Perspective”
By Philip Jones, MD

“Apple’s ResearchKit Is Open Source. But Is it Open? “
By Vince Kuraitis

“King v. Burwell: Can the Supreme Court save the Republican Party From Itself?”
By Gary L. Kaplan

“A Checklist For Surviving Academic Medicine”
By Martin Samuels, MD

“Do Value-Based Payments lead to Higher Doctor Satisfaction Scores?”
By Jack Cochran, MD and Charles Kenney

“Value-based Health”
By Cyndy Nayer

“Validic meets Cerner: Drew Shiller speaks”
By Matthew Holt

From Google to New Reimbursement Models: Digital Health Trends for 2015”
By Ryan Beckland

A Checklist For Surviving Academic Medicine

Mar 13, 2015

By MARTIN SAMUELS, MD

Decide who you are and don’t kid yourself
Don’t bluff; the triple (quadruple) threat is an illusion
Know your subject; teaching is not a trick; you must have something real to transmit
Don’t replace substance with gimmicks (e.g. fancy powerpoint)
Simulated patients produce simulated doctors and de-professionalize students
Respect your teachers but don’t believe in the Days of the Giants; they have feet of clay
Don’t become “one of them.”
Develop a reputation beyond the local environment
Train people, but remember that some will not respect you (remember Bouchard)
Stand proudly for clinical excellence
Write briefly, simply and parsimoniously (remember Babinski)
Be a professional
Don’t be an asshole
Don’t bullshit

Abstracted from the “Academic Medicine Survival Guide” Martin Samuels, MD. The Health Care Blog. March 2015.

Academic Medicine Survival Guide

Mar 13, 2015• 13

By MARTIN SAMUELS, MD

The History of the Problem

The European University (e.g. Italy, Germany, France, England) descended from the Church. The academic hierarchy, reflected in the regalia, has its roots in organized religion.

The American University was a phenocopy of the European University, but the liberal arts college was a unique American contribution, wherein teaching was considered a legitimate academic pursuit. Even the closest analogues in Europe (the colleges of Cambridge and Oxford) are not as purely an educational institution as the American liberal arts college.

The evolution of American medical education (adapted and updated from: Ludmerer KM. Time to Heal, Oxford University Press, Oxford, 1999) may be divided into five eras.

I. The pre-Flexnerian era (1776- 1910) was entirely proprietary in nature. Virtually anyone with the resources could start a medical school. There was no academic affiliations of medical school and no national standards.

II. The inter-war period (1910-1945) was characterized by an uneasy alliance between hospitals and universities. Four major models emerged. In the Johns Hopkins model, led by William Osler, the medical school and the hospital were married and teaching of medicine took place at the bedside. The Harvard model in which the hospitals grew up independently with only a loose alliance with the medical school, represented a hybrid between pre- and post-Flexnerian medical education.Continue reading…

King v. Burwell: Will the Supreme Court Save the Republican Party from Itself?

Mar 12, 2015• 103

By GARY L. KAPLAN

Last week, the Supreme Court heard arguments in the most recent and pernicious attack on the Affordable Care Act – aka Obamacare. In the absence of a dysfunctional Congress, the case would be beneath the dignity of Court: it addresses no complicated legal issues that might guide future decisions of lower courts. Instead, the Supreme Court has been asked to decide whether a drafting error resulting in one unfortunate phrase in the much maligned 2000 page law –“Exchange established by the States” — means that more than 6.3 million citizens would not be eligible for federalsubsidies allowing them to afford commercial (i.e. – non-governmental) health insurance.

Ordinarily, Congress is expected to fix such drafting problems itself. Each year Congress pass dozens of “Technical Corrections” bills to fix such errors in prior legislation. These bills are akin to software patches that are regularly released by companies to fix unanticipated “bugs” previously release programs. But this is no ordinary legislation. Having spent six years vilifying for President Obama and has supporters for passing legislation that improves American lives it is far too late in the day for the Republican Congress to replace demagoguery with common sense.

So this issue is now in the lap of the Supreme Court, with its well-known partisan divide of four liberals, four arch-conservatives, and Justice Kennedy, who as the “swing vote” effectively decides many of the most divisive cases himself. The Court can decide to gloss over this drafting error, as proposed by the Obama Administration, or apply its language to devastating effect. Prior Supreme Court cases—i.e. “precedent” in the jargon of the law—can be found to support either position. In the end, there have been few cases in which the Court has more judicial freedom – assuming precedent ever really binds the Court – to do whatever it wants in keeping with the Justices own political biases.Continue reading…

Apple’s ResearchKit is Not (Yet) Ready For Primetime – But Soon? A Medical Researcher’s Perspective

Mar 12, 2015• 7

By PHILIP JONES, MD

I am a clinician and a clinical trialist. Medical research in some form or another (performing it, consuming it, reviewing it, editing it, etc.) occupies much of my time. Therefore, you can imagine my excitement while watching Apple’s product announcement yesterday when they introduced a new open source software platform called ResearchKit. Apple states ResearchKit could:

“revolutionize medical studies, potentially transforming medicine forever”

ResearchKit allows clinical researchers to have data about various diseases collected directly from a study participant’s iPhone (and perhaps other devices in the future — see below). The software is introduced as a solution to several important problems with current clinical studies, such as:

limited participation (the software allows everyone to participate; anyone with an iPhone can download a specific app for every study they want to participate in)
frequent data entry (patients can enter data as often as required/desired, rather than only at limited opportunities such as hospital or clinic visits)
data fidelity (currently-used paper patient “diaries” are prone to entering implausible or impossible values — the iPhone can limit the range of data entered)

Specifically, the website states:

ResearchKit simplifies recruiting and makes it easy for people to sign up for a study no matter where they live in the world. The end result? A much larger and more varied study group, which provides a more useful representation of the population.

This is a bold claim. We’ll see below that it doesn’t yet ring true.

Validic meets Cerner–Drew Schiller speaks

Mar 12, 2015• 1

By MATTHEW HOLT

Validic is one of the more interesting companies in what we define as the “data utility layer.” They’ve had a bit of a meteoric rise in the past 2 years, and now have over 45 employees, over 90 customers and are now one of the main names that come up when the conversation turns to “how do we get all that device data into the EHR?” Today they announced a new deal with Cerner (release here). This is the quick interview with CTO Drew Schiller.

[youtube width=”450″ height=”275″]https://youtu.be/yvlXdAQb9lY[/youtube]

Apple Research Kit is Open Source But Is It “Open”?

Mar 12, 2015• 7

By VINCE KURAITIS

For now, the answer is “we don’t know”.

But… the question is very important and worth tracking over the coming months. Let’s not assume that open source will equate to “open”.

What is ResearchKit?

Apple’s press release provided an overview of ResearchKit:

Apple® today announced ResearchKit™, an open source software framework designed for medical and health research, helping doctors and scientists gather data more frequently and more accurately from participants using iPhone® apps. World-class research institutions have already developed apps with ResearchKit for studies on asthma, breast cancer, cardiovascular disease, diabetes and Parkinson’s disease.

…With hundreds of millions of iPhones in use around the world, we saw an opportunity for Apple to have an even greater impact by empowering people to participate in and contribute to medical research,” said Jeff Williams, Apple’s senior vice president of Operations. “ResearchKit gives the scientific community access to a diverse, global population and more ways to collect data than ever before.”

Many members of the research community have had high praise for ResearchKit. For more details and perspectives about ResearchKit, see the list of articles appended at the bottom of this post.

Understanding Value-Based Purchasing

Mar 12, 2015

By THCB STAFFER

Value-based care is one of the most misunderstood and controversial areas in a rapidly evolving healthcare system. This helpful webinar introduces and clarifies many of the core concepts involved in the transition to the value-based model. You’ll get a walk through of programs offered by CMS. Learn how programs are measured. Hear about the success of programs to date. Find out what organizational changes are necessary for the transition.

Hosted by Bobbi Brown, Vice President, Financial Engagements at Health Catalyst this event will be held Wednesday, May 13th at 1 PM EST and is free of charge. Bobbi’s healthcare finance background includes high profile roles as an executive with Kaiser Permanente, Sutter Health and InterMountain. Register now to guarantee your spot.

Do Value-Based Payments Lead to Higher Doctor-Satisfaction Scores?

Mar 11, 2015• 19

By JACK COCHRAN, MD and CHARLES KENNEY

Recently we wrote a blog post promoting the benefits of shifting from fee-for-service to value-based payments. We praised the recent decision by leaders at the U.S. Department of Health and Human Services (HHS) to accelerate that shift, and we were then and remain convinced this shift paves the way for better, more affordable care.

There were some strong reactions to the post.

Some people think capitated payments have been discredited, others believe the change from fee-for-service will change little. One physician told John Irvine, editor at The Health Care Blog, that he got the impression from our post that we were saying value-based payments would make physicians lives easier. “Really?” Irvine’s doctor friend said. “You’re making my life easier? Prove it.”

How Will the Practice of Medicine Change?

We didn’t actually use the word easier in the post though we did say that “increasingly, physicians seek liberation from the constraints of fee-for-service in order to focus on the overall health of their patients. Value-based payments allow doctors to do exactly that.” So we definitely hear what Irvine’s friend is saying — and we understand his frustration. Has there ever been a time when so many physicians have been worn thin — angry with the direction of our health care system?

Irvine invited us to respond to his friend and we thought we would do so by soliciting the thoughts of Scott Young, MD, executive director of Kaiser Permanente’s Care Management Institute and associate executive director for Clinical Care and Innovation at The Permanente Federation.

“Easier?” said Dr. Young. “No, value-based payments don’t make doctors’ lives easier. But I think it does make the practice of medicine more rewarding and fulfilling.”