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Above the Fold

Weight Loss Fines Are Discriminatory and Counterproductive

Feb 23, 2015• 69

By LEWIS, KHANNA and ROBISON

One year ago in these pages, Harvard Medical School’s Stephen Soumerai wrote a scathing essay arguing that employer fines on overweight employees were ineffective. We’re here to tell you that Professor Soumerai is a cockeyed optimist. A new review in the American Journal of Managed Care shows that these fines transcend ineffectiveness. They are counterproductive.

To begin with, forced corporate weight loss programs don’t work. Of roughly 1000 wellness vendors promising weight loss, only one, the iDiet, has received validation. Literally no other corporate weight loss program can check three simple boxes that are standard in medical research:

The study was controlled the way grownups would define “controlled,” not using unmotivated non-participants as a control for motivated participants, which Health Fitness Corporation inadvertently invalidated
the program was sustained for 18 months, rather than eight weeks, which seems to be the new standard for get-thin-quick programs; and
The results showed both high persistence and significant weight loss.

Even that study had significant limitations: One could argue that the sample was small and even 18 months was not a long enough period to determine if weight maintenance was likely to be permanent.

What Do Women Know About Obamacare That Men Don’t?

Feb 22, 2015• 27

By SUSAN DENTZER

For the second year running, more women than men have signed up for coverage in health insurance marketplaces during open enrollment under the Affordable Care Act. According to the Department of Health and Human Services, enrollment ran 56 percent female, 44 percent male, during last year’s open enrollment season; preliminary data from this year shows enrollment at 55 percent female, 45 percent male – a 10 percentage point difference.

What gives? An HHS spokeswoman says the department can’t explain most of the differential. Females make up about 51 percent of the U.S. population, but there is no real evidence that, prior to ACA implementation, they were disproportionately more likely to be uninsured than men – and in fact, some evidence indicates that they were less likely to be uninsured than males .

What is clear that many women were highly motivated to obtain coverage under the health reform law – most likely because they want it, and need it.

It’s widely accepted that women tend to be highly concerned about health and health care; they use more of it than men, in part due to reproductive services, and make 80 percent of health care decisions for their families . The early evidence also suggests that women who obtained coverage during open enrollment season last year actively used it. Continue reading…

HIT Newser: Black Book Rankings Not So Unbiased?

Feb 22, 2015

By MICHELLE RONAN NOTEBOOM

Black Book: Not so Unbiased and Relevant?

Black Book Rankings announces that it will change its EHR survey methods and remove ballots cast by provider organizations that serve as resellers/VARs, and/or channel partners. The organization reviewed previous surveys and discovered that 33 hospital resellers had cast EHR satisfaction and loyalty ballots for 740 physician practices, and that 93% of the physician practices and small hospitals felt obligated to only select the EHR offered by their hospital.

Well, duh! I have always been a little suspect of Black Book’s survey method since their findings are often so different than the rankings from KLAS. If I were a vendor with a website that proudly displayed a high ranking from Black Book, I think I would quietly remove that reference, at least for now.

Epic Opening App Exchange

Epic Systems is launching its own app store, giving outside companies the ability to market applications that work with Epic’s EHR. According to former Nordic Consulting CEO Mark Bakken, the app store will “open the floodgates” for anyone who knows Epic and wants to get their products in front of Epic clients quickly.

Politically it’s a savvy move, since Epic wants to continue dispelling those rumors that its system is closed and lacks the interoperability of some of its competitors vying for the DoD’s $11 billion EHR contract.

Why Anthem Was Wrong Not to Encrypt

Feb 22, 2015• 27

By DAN MUNRO

Being provocative isn’t always helpful. Such is the case with Fred Trotter’s recent headline ‒ Why Anthem Was Right Not To Encrypt.

His argument that encryption wasn’t to blame for the largest healthcare data breach in U.S. history is technically correct, but lost in that technical argument is the fact that healthcare organizations are notably lax in their overall security profile. I found this out firsthand last year when I logged onto the network of a 300+ bed hospital about 2,000 miles away from my home office in Phoenix. I used a chrome browser and a single malicious IP address that was provided by Norse. I wrote about the details of that here ‒ Just How Secure Are IT Network In Healthcare? Spoiler‒alert, the answer to that question is not very.

I encourage everyone to read Fred’s article, of course, but the gist of his argument is that technically ‒ data encryption isn’t a simple choice and it has the potential to cause data processing delays. That can be a critical decision when the accessibility of patient records are urgently needed. It’s also a valid point to argue that the Anthem breach should not be blamed on data that was unencrypted, but the healine itself is misleading ‒ at best.

A Ray of Light at the Brigham

Feb 20, 2015• 5

By MARTIN SAMUELS, MD

I work at the Brigham and Women’s Hospital in Boston. We call it The Brigham. A month ago we were subjected to a tragic murder of one of our doctors. The winter has been brutal and unrelenting. Then, as I was walking to work the other day I was struck by a ray of light.

It was 7:30 AM and the morning light shone directly into what was the original main operating room of the Peter Bent Brigham Hospital, one of the parent institutions of what we now know as The Brigham. Peter Bent Brigham was a restaurateur who left an endowment for a hospital for the poor. It was decided to site the Peter Bent Brigham in the Longwood area just behind the Harvard Medical School which had moved to this location in 1904.

After a national search, Harvey Cushing was selected to be the founding Surgeon-in-Chief. Cushing, a native of Cleveland and graduate of Yale College and Harvard Medical School, had trained in surgery at the The Johns Hopkins Hospital and was in the process of creating the modern field of neurosurgery. Between 1910 and 1913, Cushing worked with the architects of the new hospital and sited the operating room such that the morning sun would shine into its large window, thereby allowing the surgeons to see well with natural light.

How to Avoid Being a Dumb-Ass Doctor, Blog Edition

Feb 20, 2015• 9

By DR. ROB

It’s been two years since I first started my new practice. I have successfully avoided driving my business into the ground because I am a dumb-ass doctor. Don’t get me wrong: I am not a dumb-ass when it comes to being a doctor. I am pretty comfortable on that, but the future will hold many opportunities to change that verdict. No, I am talking about being a dumb-ass running the businessbecause I am a doctor.

We doctors are generally really bad at running businesses, and I am no exception. In my previous practice, I successfully delegated any authority I had as the senior partner so that I didn’t know what was going on in most of the practice.

The culmination of this was when I was greeted by a “Dear Rob” letter from my partners who wanted a divorce from me. It wasn’t a total shock that this happened, but it wasn’t fun. My mistake in this was to back off and try to “just be a doctor while others ran the business.” It’s my business, and I should have known what was happening. I didn’t, and it is now no longer my business.

This new business was built on the premise that I am a dumb-ass doctor when it comes to business. I consciously avoided making things too complicated. I wanted no copays for visits (and hence no need to collect money each visit). I wanted no long-term contracts (and hence no need to refund money if I or the patient was hit by a meteor or attacked by a yeti). The goal was to keep things as easy as possible, and this is a very good business policy.

The Hospital That Shall Remain Nameless

Feb 19, 2015• 30

By LISA SUENNEN

Let me start this story by telling you the end: I am just fine. For those of you who like me, there is nothing to worry about and all is well. For those of you who don’t like me, sorry to disappoint you, but you’re stuck with me for a while.

I’m telling you these things—news to make you happy or disappointed, depending on your point of view about me—because this story is about my recent trip to the hospital, an unexpected journey that I wasn’t sure I was going to talk about publicly.

First of all, I didn’t want people calling and fretting and thinking I was suddenly in need of hushed whispers and pats on the head and casseroles. Second of all, I didn’t want people thinking they were finally rid of me and gladly so. But mostly I wasn’t sure I was going to tell this story because I just didn’t want to make a big deal about it. But in the end, I couldn’t help myself. I decided I learned so much on my little stint on the other side of the healthcare desk that I felt I had to share.

It started as a bit of tachycardia, sadly brought on not by a George Clooney sighting, but rather by some anomaly of life which will likely never be known. As my heart started to race faster and faster over a series of hours, and when it became clear that I couldn’t count as high as my pulse was going, I called 911.
Continue reading…

Reality-Based Policy and the Digital Doctor: An Interview with Mark Smith

Feb 18, 2015• 25

By ROBERT WACHTER, MD

Mark Smith, MD, MBA, was the founding CEO of the California HealthCare Foundation; he served in that role for 17 years before stepping down last year. I’ve known Mark since we were residents together at UCSF in the mid-1980s, and both of us were influenced by training at the epicenter of the AIDS epidemic. Mark continues to see AIDS patients at San Francisco General Hospital one day each week. He was the lead author of Best Care at Lower Cost, a major Institute of Medicine report, published in 2012. Mark is one of those rare people who can take complex and politically charged concepts and distill them into sensible nuggets – while managing to be hilarious and profound at the same time.

In the continuing series of interviews I conducted for my upcoming book, The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age, here are excerpts of my interview with Mark Smith, conducted on July 24, 2014.

Bob Wachter: Put yourself back about 10 or 15 years ago when you were thinking about the promise of healthcare IT. As you’ve watched the last 15 years play out, what’s been surprising to you?

Mark Smith: As with most of life, it’s a lot harder in fact than in theory. My first hint of this came with the implementation of computerized order entry at Cedars-Sinai in 2002. [In a story I tell in the book, Cedars’ physicians all but threatened to go on strike after they turned on the clunky system. Within a month, they pulled the plug on the system, a hiccup that cost the organization $34 million in 2002 dollars.] That was my first window into the gap between what sounds lovely in a policy paper, and what it means in practice to implement this stuff.Continue reading…

My Doctor Just Gave Me His Cell Phone Number …

Feb 17, 2015• 15

By JASON GRAIS

That’s right…it really happened.

At the conclusion of a recent doctor visit, he gave me his cell phone number saying, “Call me anytime if you need anything or have questions.”

In disbelief, I wondered if this was a generational thing – and whether physicians in their late thirties had now ‘gone digital’.

My only other data point was our family pediatrician, who is also in her late thirties. Our experience with her dates back nearly seven years when my wife and I were expecting twins. A few pediatricians we met with mentioned their willingness to correspond with patients’ families via email as a convenience to parents. The pediatrician we ultimately selected wasn’t connected with patients outside of the office at that time, but now will exchange emails.

The Myth of Doctors Getting Overwhelmed by E-mail

Feb 17, 2015• 18

By DAVID CHASE

”Email is the killer app of patient portals.”

I heard a variation of that quote when interviewing people for the patient-provider communication chapter of the book I co-wrote (HIMSS 2014 Book of the Year –Engage! Transforming Healthcare Through Digital Patient Engagement). For the organizations who’ve pushed patient portals the furthest into their patient base, email has always been the foundation. In other words, email is the gateway drug for patient engagement which Leonard Kish called the blockbuster “drug” of the century.

Physicians are understandably concerned about being overwhelmed by emails if they provide an option for secure messaging. As healthcare transforms, financial incentives have a big effect on the willingness to take on what many perceive to be “more unpaid work” (forgetting the fact that playing voicemail tag is also unpaid and frustratingly inefficient). Interestingly, the physicians who have given out their phone number or enabled secure email (without remuneration) haven’t found they are overwhelmed by any means. In the case of the groundbreaking Open Notes study, many of the doctors just heard crickets.