The Health Care Blog – Page 461 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

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Wait, Maybe Technology Won’t Replace Doctors After All!

Oct 2, 2014• 11

LISA SUENNEN

Such a good question from my friend David Shaywitz, MD, PhD, (and co-author with me of the book Tech Tonics). David has spoken and written about this this theme frequently, and most recently at the Health 2.0 conference held last week in Santa Clara, CA. He and I and 2000 of our closest friends were there to talk healthcare technology. Isn’t it ironic that it takes that level of human interaction to talk about the ways healthcare can disintermediate humans from healthcare?

What struck me so loudly at the conference was how easy it is for us all to forget how human the healthcare experience really is. I moderated and attended numerous sessions at the conference, each a twist on the theme of how technology can make healthcare delivery more accurate, more efficient, more effective than anything we have going today.

David participated in a session withMatthew Holt, Vinod Khosla and Dr. Jordan Shlain, who could not be farther part from each other on the topic of doctor vs. machine (David played the role of moderate guy in the middle), Mr. Khosla backed away or at least clarified his earlier statements about how 80% of doctors will be unnecessary in the coming new age of healthcare technology. His revision was that 80% of alldiagnosis will, in the future, be done by computers, not doctors, because computers are far better at seeing a holistic view of a patient and taking in all of the relevant data. He talked about how certain digital technologies can know everything about you, including when you are sleeping and when you are awake. It made me think that Santa Claus must be worried about being replaced by an app.

Innovation, Primary Care Style

Oct 2, 2014• 7

DAVID HARLOW

On a recent evening at Harvard Medical School, the Primary Care Innovation Challenge and Pitch-Off ,sponsored by WellPoint’s American Resident Project, brought together six finalists, primary care luminaries and trainees, and a host of hangers-on and camp followers for a couple of hours of demos and discussions. The tenor of the evening, which was in many ways a pep rally for primary care – not that there’s anything wrong with that — was best captured by the rhetorical question posed by Asaf Bitton to the primary care practitioners and trainees in the hall, “Are you going to be a playwright or a critic?”

The hoots and hollers in response made clear that these are not your grandfather’s primary care docs. The call to action was echoed by many of the speakers, notably community organizer turned primary care physician Andrew Morris Singer and Dennis Dimitri, both advocating for, well, advocating for primary care. Bitton’s opening also included the exhortation that proved to be predictive of the winner of the top honors from among the six pitches: Innovation in primary care is not about the technology; it needs to enable better human care.

The Kaiser Permanente Model and Health Reform’s Unfinished Business

Oct 1, 2014• 20

By JEFF GOLDSMITH

For decades, health policymakers considered Kaiser Permanente the lode star of delivery system reform. Yet by the end of 1999, the nation’s oldest and largest group model HMO had experienced almost three years of significant operating losses, the first in the plan’s history. It was struggling to implement a functional electronic health record, and had a reputation for inconsistent customer service. But most seriously, it faced deep divisions between management and the leadership of its powerful Permanente Federation, which represents Kaiser’s more than 17,000 physicians, over both strategic direction and operations of the plan.

Against this backdrop, Kaiser surprised the health plan community by announcing in March 2002 the selection of a non-physician, George Halvorson, as its new CEO. Halvorson had spent most of his career in the Twin Cities, most recently as CEO of HealthPartners, a successful mixed model health plan. Halvorson’s reputation was as a product innovator; he not only developed a prototype of the consumer-directed health plan in the mid-1990’s, but also population health improvement objectives for its membership, both firsts in the industry.

Government’s New Doctor Payments Website Worthy of a Recall

Oct 1, 2014• 6

CHARLES ORNSTEIN

If the federal government’s new Open Payments website were a consumer product, it would be returned to the manufacturer for a full refund.

Open Payments is the government’s site for publishing payments made to doctors and teaching hospitals by drug and medical device manufacturers. It includes 4.4 million payments, worth $3.5 billion, to more than half a million doctors and almost 1,360 teaching hospitals.

In a news release announcing the site’s launch, the Centers for Medicare and Medicaid Services said the goal is “to help consumers understand the financial relationships between the health care industry, and physicians and teaching hospitals.”

Free Medical School?

Oct 1, 2014• 3

By JACK COCHRAN, MD and CHARLES KENNEY

One of the most compelling medical stories in the country is unfolding within the sprawling landscape of inland Southern California. The story centers on the University of California, Riverside School of Medicine where G. Richard Olds, MD, the school’s dean, is taking on one of the uber challenges in health care today: How to get doctors into areas significantly underserved by health care professionals.

The UC-Riverside School of Medicine is in its infancy having welcomed its first class of 50 students just last year. But it has embarked on an innovative program fueled by a passion not only to get doctors into geographic areas where they are most urgently needed, but also to make sure these physicians practice specialties most in demand. “There are 18 new medical schools in the United States and the vast majority are just like existing medical schools,” says Dean Olds. “We are substantially different than most other new schools. We are designed around a unique mission – to try and address the health workforce needs of inland Southern California. We need to train health care professionals who come from backgrounds and communities they will be taking care of.”

The Ebola Outbreak: The CDC Director’s Guidance for Health care workers

Sep 30, 2014• 52

By Tom Frieden, MD

There has been a lot of fear about Ebola. The health care workers who care for Ebola patients are right to be concerned – and they should use that concern to increase their awareness and motivation to practice meticulous infection control measures.

Ebola virus is transmitted through direct contact with bodily fluids of an infected person who is sick with Ebola, or exposure to objects, such as needles, that have been contaminated with infected secretions.

Travel from Affected Region

There is a risk for Ebola to be introduced to the United States via an infected traveler from Africa. If that were to happen, widespread transmission in the United States is highly unlikely due to our systematic use of strict and standard infection control precautions in health care settings, although a cluster of cases is possible if patients are not quickly isolated. Community spread is unlikely due to differences in cultural practices, such as in West Africa where community and family members handle their dead.

CDC has advised all travelers arriving from Guinea, Liberia, Nigeria, and Sierra Leone to monitor their health for 21 days and watch for fever or other symptoms consistent with Ebola. If they develop symptoms, they should call ahead to their hospital or health care provider and report their symptoms and recent travel to the affected areas so appropriate precautions can be taken.

Changing My Mind on SES Risk Adjustment

Sep 29, 2014• 15

ASHISH JHA, MD

I’m sorry I haven’t had a chance to blog in a while – I took a new job as the Director of the Harvard Global Health Institute and it has completely consumed my life. I’ve decided it’s time to stop whining and start writing again, and I’m leading off with a piece about adjusting for socioeconomic status. It’s pretty controversial – and a topic where I have changed my mind. I used to be against it – but having spent some more time thinking about it, it’s the right thing to do under specific circumstances. This blog is about how I came to change my mind – and the data that got me there.

Changing my mind on SES Risk Adjustment

We recently had a readmission – a straightforward case, really. Mr. Jones, a 64 year-old homeless veteran, intermittently took his diabetes medications and would often run out. He had recently been discharged from our hospital (a VA hospital) after admission for hyperglycemia. The discharging team had been meticulous in their care. At the time of discharge, they had simplified his medication regimen, called him at his shelter to check in a few days later, and set up a primary care appointment. They had done basically everything, short of finding Mr. Jones an apartment.

Ten days later, Mr. Jones was back — readmitted with a blood glucose of 600, severely dehydrated and in kidney failure. His medications had been stolen at the shelter, he reported, and he’d never made it to his primary care appointment. And then it was too late, and he was back in the hospital.

The following afternoon, I spoke with one of the best statisticians at Harvard, Alan Zaslavsky, about the case. This is why we need to adjust quality measures for socioeconomic status (SES), he said. I’m worried, I said. Hospitals shouldn’t get credit for providing bad care to poor patients. Mr. Jones had a real readmission – and the hospital should own up to it. Adjusting for SES, I worried, might create a lower standard of care for poor patients and thus, create the “soft bigotry of low expectations” that perpetuates disparities. But Alan made me wonder: would it really?

To adjust or not to adjust?

Because of Alan’s prompting, I re-examined my assumptions about adjustment for SES. As he walked me through the data, I concluded that the issue of adjustment was far more nuanced than I had appreciated.

Graphic Warning Labels on Cigarettes Are Scary, but Do They Work?

Sep 27, 2014• 2

DEBORAH SHARF and WILLIAM SHADEL

Looking at cigarette packaging in some countries, you might think Big Tobacco and AMC have entered into a bizarre cross-promotion for The Walking Dead. You’ll see blood-drenched corpses, facial scars and head wounds, people dying in hospital beds, screaming children, crying women—the list goes on.

These “graphic warning labels” pair gruesome images with warnings about the dangers of smoking, covering anywhere from 30 to 80 percent of cigarette pack “faces” (the front and back). The goals of such labels are informing consumers about the risks of smoking, encouraging quitting among smokers, and preventing others from ever starting.

Research shows people exposed to these labels are understandably repulsed and disgusted. When asked, they express the belief that labels should keep people from smoking. And after viewing them, they have more negative thoughts and feelings about smoking.

But do graphic warning labels actually prevent people from starting to smoke? Do they cause current smokers to quit?

Ceci Connolly: Will Technology Replace Doctors?

Sep 26, 2014• 35

Ceci Connolly

It’s a provocative question, but it’s also the wrong one.

The question ought to be: When will healthcare fully embrace technology and all it has to offer?

It’s widely known that the $2.8 trillion US health system has significant waste and errors – between 25% and 30% of our health dollars go to services that do not improve health. Technology has the ability to put a big dent in that through standardization, real-time insights, convenient gadgets and complex data analysis the human brain simply cannot perform.

Consider some of the early innovators. There’s the heart monitor in the phone. The wristbands that count steps. And then there’s Oto, the cellphone attachment that snaps an image of the inner ear sparing frazzled parents one more trip to the doctor’s office for yet another infection.

Have Doctors Joined the Working Class?

Sep 26, 2014• 19

By Richard Gunderman, MD

On September 28, 1864, exactly 150 years ago this weekend, the first meeting of the International Workingmen’s Association (IWA) was convened at St. Martin’s Hall, London. Among the attendees was a relatively obscure German journalist by the name of Karl Marx. Though Marx did not speak during the meeting, he soon began playing a crucial role in the life of the organization, in part because he was assigned the task of drafting its founding documents.

The work of the IWA and Marx is increasingly relevant to the practice of medicine today, largely because of the rapidly shrinking percentage of US physicians who own their own practices. This moves physicians into the category of what Marx and his associates called, “working people.” According to data from the American Medical Association, in 1983 76% of physicians were self-employed, a number that had fallen in 2012 to 53%. And the trend is accelerating. It is estimated that in 2014, 3 in 4 newly hired physicians will go to work for hospitals and health systems.

To put this change in Marx’s terms, the rapid fall in physician self-employment means that a shrinking percentage of physicians own what he called the means of production. In his view, this alienates workers – in this case physicians – from other physicians, themselves, the work they do, and from patients. Whether we agree with Marx on every point, his writings on this topic provides a provocative perspective from which to survey the changing landscape of contemporary medicine.