The Health Care Blog – Page 462 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Surviving Healthcare

Sep 26, 2014• 9

Joe Flower

Health care is fragile. It survives in a much narrower band of circumstances than most of us realize. Right now many hospitals and systems are having a second down year in a row. They’re consolidating, laying off people, working through major shifts in strategy — all because of what we must admit (if we are honest) are relatively minor economic shifts, such as small reductions in utilization and Medicare payments, a blunting of accustomed price rises, and stronger bargaining from health plans.

If minor revenue stream problems put your entire institution in jeopardy of chaotic deconstruction, it cannot be called robust.

At the same time, an increasing number of vectors outside the sealed world of health care could overwhelm and kill your institution, from climate chaos to pollution disasters to epidemics and the loss of antibiotics.

The Org Chart of the Damned

Sep 26, 2014• 1

THCBist

HAT TIP: Mr. Nosta

Ask Me Anything with CDC Director Tom Frieden

Sep 26, 2014• 13

Thomas Frieden, MD

The Ebola outbreak in West Africa is an international public health emergency. As the world responds, there is a risk that American responders working on the ground may be exposed to the virus or become ill. This summer, two American health care workers infected with Ebola while working in West Africa were successfully treated at Emory University Hospital. Their health care team used the proper infection control practices and there was no transmission of the virus to the health care team or others in the hospital and community.

Now two more American health care workers working in West Africa have become infected with Ebola virus and are being treated in the United States.

CDC has already consulted with state and local health departments on almost 100 cases where travelers had recently returned from West Africa and showed symptoms that might have been caused by Ebola. Of those cases, only eleven of were considered to be truly at risk. Specimens from all eleven patients were tested and fortunately Ebola was ruled out in all cases.

There is understandably a lot of fear surrounding Ebola. The health care workers who might need to care for Ebola patients are right to be concerned – and they should use that concern to increase their awareness and motivation to practice the meticulous infection control measures we know will prevent transmission of the virus.

Biosurveillance at the Point of Care

Sep 26, 2014• 1

ROBERT ARKIN and JITEN CHHABRA, MD

Living in Atlanta and working within the healthcare delivery innovation community, the mounting Ebola outbreak taught us all how quickly the “global” can become local.

For a healthcare system threatened by infectious disease, complex chronic illness, environmental and population management issues, the outbreak also reinforces how new technologies are advancing patient and caregiver safety, prevention, patient monitoring, diagnosis and even treatment.

The answer, through non-contact medicine, is literally in the airwaves.

Researchers at Stanford are pursuing the combined use of laser and carbon nanotubes to provide a more detailed view of blood flow in the brain – down to single capillaries – to increase the understanding of cerebral-vascular disease beyond the imaging provided by CT scan or MRI.

It’s a Trade-Off, Stupid.

Sep 25, 2014• 17

SAURABH JHA, MD

An advantage of being a foreigner, or a recent immigrant to be precise, is that it allows one to view events with a certain detachment. To analyze without the burden of love, hate or indifference for the Kennedys, the Clintons or the Bushes. To observe with both eyes open, rather than one eye looking at the events and the other looking at a utopian destination.

The most striking thing I’ve observed in the healthcare debate in the US is the absence of an honest discussion of trade-offs.

I’ve found that “trade-off” carries a sinister connotation in American healthcare parlance. Its mere utterance is a defeatist’s surrender. If optimism is the iron core of the United States, acknowledging trade-offs is her kryptonite.

I was raised in Britain. I learnt to guard optimism with pursed lips. You never knew when it would rain. I also learnt in Britain’s NHS where healthcare resources really are finite, there is a trade-off between coverage and access.

In the discussions preceding the implementation of the Affordable Care Act (ACA) two disparate truths were conjoined by a single solution. The unsustainable trajectory of healthcare spending. And the large number of uninsured population. It was scarcely acknowledged that solution of these problems are inherently oppositional.

This has led to the search for utopian payment models. Fee for service incentivizes physicians towards generously reimbursable services of marginal benefits. Capitated systems dissuade physicians from taking sicker patients.

How about we pay for outcome, value and quality? Sounds simple enough.

What’s So Wrong With Randomized Trials?

Sep 24, 2014• 6

URMIMALA SARKAR, MD

Often, at scientific conferences, the most important learning happens in the question and answer period.

I spoke at the American Diabetes Association conference earlier this year, presenting results of an observational study we did on medication adherence and diabetes.

We found that if people starting using the online patient portal (sometimes called the personal health record), to order their medication refills, they were more likely to take their medication regularly. Dr. Katherine Newton of Group Health Research Institute spoke before me, describing a randomized study showing that a clinical pharmacist-led blood pressure management program did not lower blood pressure any more than usual care by an outpatient provider.

The first audience comment came from a program officer from the National Heart, Lung, Blood Institute, part of the National Institutes of Health. Program officers are incredibly important because they help set the research priorities for the major funding mechanism for medical research. I will never forget her comment, because it was so strongly worded.

HCA: The Bashful Giant

Sep 24, 2014• 14

JEFF GOLDSMITH

Judging by its nearly invisible public presence, you’d never know that this is prime time for HCA, the nation’s largest hospital chain. A former HCA regional VP, Marilyn Tavenner, runs the nation’s Medicare and Medicaid programs. Former CMS Head and Obama White House health policy chief Nancy Ann DeParle, sits on the HCA Board. Its longtime investor relations chief, Vic Campbell, is immediate past Chair of the highly effective trade group, the Federation of American Hospitals. And its Chief Medical Officer, Jonathan Perlin, MD, is Chair Elect of the American Hospital Association.

This astonishing industry leadership presence is something most health systems would be trumpeting, perhaps even placing ads in Modern Healthcare. But not HCA, the bashful giant of American healthcare. Most hospital systems make a show of “branding” their hospitals with the company logo. Yet in its corporate home, Nashville, and the surrounding multi-state region, HCA’s 15 hospital network is called TriStar. Everyone in Nashville’s tight knit healthcare community knows who owns their hospitals, but you have to read TriStar’s home page closely to find the elliptical acknowledgement of HCA’s ownership.

Despite a nationwide merger and acquisition boom, HCA hasn’t done a major deal in twelve years (Health Midwest in Kansas City joined HCA in 2002). The company has not participated in the post-reform feeding frenzy, continuing a long-standing and admirable tradition of refusing to overpay for assets. For the moment, owning 160 hospitals is plenty.

Will Technology Replace Doctors?

Sep 23, 2014• 24

JOE FLOWER

Put the question in 1880: Will technology replace farmers? Most of them. In the 19th century, some 80% of the population worked in agriculture. Today? About 2% — and they are massively more productive.

Put it in 1980: Will technology replace office workers? Some classes of them, yes. Typists, switchboard operators, stenographers, file clerks, mail clerks — many job categories have diminished or disappeared in the last three decades. But have we stopped doing business? Do fewer people work in offices? No, but much of the rote mechanical work is carried out in vastly streamlined ways.

Similarly, technology will not replace doctors. But emerging technologies have the capacity to replace, streamline, or even render unnecessary much of the work that doctors do — in ways that actually increases the value and productivity of physicians. Imagine some of these scenarios with me:

· Next-generation EMRs that are transparent across platforms and organizations, so that doctors spend no time searching for and re-entering longitudinal records, images, or lab results; and that obviate the need for a separate coding capture function — driving down the need for physician hours of labor.Continue reading…

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Sep 23, 2014

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Eric Topol: The Patient Will See You Now …

Sep 23, 2014• 2

JANE SARASOHN-KAHN

Moore’s Law is coming to medicine. And it will look and feel a lot like Uber: with rich technology underpinning, consumer-service oriented and friendly, and shaking up the professionals at the front line of the business (from taxi drivers to physicians).

Eric Topol, physician and editor-in-chief at Medscape, told a standing-room-only audience at the kickoff of the 8th annual Health 2.0 Conference that the democratization of health care is coming based on consumers’ use of eight drivers: sensors, labs, imaging, physical exams, access to medical records, transparency of costs, and digital pills.