The Health Care Blog – Page 464 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

What Killed Joan Rivers? Piecing Together a Medical Mystery

Sep 8, 2014• 33

KAREN SIBERT, MD

There are minor operations and procedures, but there are no minor anesthetics. This could turn out to be the one lesson learned from the ongoing investigation into the death of comedian Joan Rivers.

Ms. Rivers’ funeral was held yesterday, September 7. Like so many of her fans, I appreciated her quick wit as she entertained us for decades, poking fun at herself and skewering the fashion choices of the rich and famous. She earned her success with hard work and keen intelligence–she was, after all, a Phi Beta Kappa graduate of Barnard College. Ms. Rivers was still going strong at 81 when she walked into an outpatient center for what should have been a quick procedure.

So when she suffered cardiac arrest on August 28, and died a week later, we all wondered what happened. I have no access to any inside information, and the only people who know are those who were present at the time.

But the facts as they’ve been reported in the press don’t fully make sense, and they raise a number of questions.

What procedure was done?

Early reports stated that Ms. Rivers underwent a procedure involving her vocal cords. A close friend, Jay Redack, told reporters at the NY Post, “Her throat was bothering her for a long time. Her voice was getting more raspy, if that was possible.” In a televised interview, Redack told CNN that Ms. Rivers was scheduled to undergo a procedure “on either her vocal cords or her throat.”

However, the Manhattan clinic where Ms. Rivers was treated, Yorkville Endoscopy, offers only procedures to diagnose problems of the digestive tract. All the physicians listed on the staff are specialists in gastroenterology. Any procedure on the vocal cords typically would be done by an otolaryngologist, who specializes in disorders of the ear, nose, and throat.

So it may be that acid reflux was considered as a possible cause of Ms. Rivers’ increasingly raspy voice, and she may have been scheduled for endoscopy at the Yorkville clinic to examine the lining of her esophagus and stomach. Endoscopy could reveal signs of inflammation and support a diagnosis of acid reflux.

Upper gastrointestinal (GI) endoscopy involves insertion of a large scope through the patient’s mouth into the esophagus, and passage of the scope into the stomach and the beginning of the small intestine. It’s a simple procedure, but uncomfortable enough that most patients are given sedation or, less commonly, general anesthesia.

Was sedation given?

Three types of medication are commonly used for sedation during endoscopy:

1. Midazolam, diazepam (Valium), or other medications in the benzodiazepine family are often used to help patients relax before the start of the procedure and to produce amnesia.

2. Narcotics such as Demerol and morphine are often used to provide pain relief and make the procedure less uncomfortable.

3. Propofol, a potent sedative and hypnotic medication, may be used to induce sleep and prevent awareness. Many people first heard of propofol as the medication associated with the death of singer Michael Jackson in 2009.

Why Nobody Is Using Your Health App (And How to Fix It)

Sep 8, 2014• 19

TIM MALIYIL

People are becoming more conscious about their health. It’s why fitness apps are booming and both Apple and Google are looking to get into the health game. But apps that try to go beyond simple calorie counting and movement tracking often struggle to gain traction with users.

Although people are open to sharing how many steps they’ve taken or how much they weigh, they’re more hesitant to share their personal medical details.

Here are some data-related fears consumers often have with healthcare apps:

Personal medical information could get leaked. Revealing users’ medical information could be embarrassing and life shattering.

Companies could use the data for marketing purposes. Imagine your spam getting smarter about your personal health details. Companies are already pinpointing viewers’ interests, and revealing this information could expose you to targeted email spam and calls tailored to your health issues. Members of Congress have already discussed legislation that would forbid medical apps from selling personal data without the user’s consent.
Unqualified employees could access their information. Patients feel comfortable divulging medical information to a doctor, but they probably wouldn’t want the IT guy who supports the app to see and read their information.

There are many reasons people might hesitate to use your app. But by identifying potential concerns and considering them as you develop and market your app, you can quell their fears and ensure the long-term success of your medical app.Continue reading…

Yes, Doctors Are Sick of Their Profession. And You’re Making Things Worse!

Sep 5, 2014• 34

By KAREN SIBERT

Dr. Sandeep Jauhar, a cardiologist, believes with good reason that many physicians have become “like everybody else: insecure, discontented and anxious about the future.” In a recent, widely-circulated column in the Wall Street Journal, “Why Doctors Are Sick of Their Profession,” he explains how medicine has become simply a job, not a calling, for many physicians; how their pay has declined, how the majority now say they wouldn’t advise their children to enter the medical profession, and how this malaise can’t be good for patients.

Dr. Jauhar gets it right in many ways, but the solutions he recommends miss their mark completely.

I was 100% in accord with Dr. Jauhar when he argued that “there are many measures of success in medicine: income, of course, but also creating attachments with patients, making a difference in their lives and providing good care while responsibly managing limited resources.”

The next paragraph, though, I read with astonishment. Does Dr. Jauhar really believe that publicizing surgeons’ mortality rates or physicians’ readmission rates can be “incentive schemes” that will reduce physician burnout? Does he seriously think that “giving rewards for patient satisfaction” will put the joy back into practicing medicine?

If so, I’m afraid he doesn’t understand the problem that he set out to solve.

Sometimes the Best Choice is the Simplest One

Sep 5, 2014• 1

By NICK VAN TERHEYDEN

CMS recently announced another change to health IT policy in order to offer healthcare providers greater flexibility. But what will the unintended consequences of this latest change be?

Over the Labor Day weekend, CMS announced that the Meaningful Use Stage 2 deadline will be extended through 2016 in order to offer more options and greater flexibility to providers for the certified use of EHRs. In the interest of full disclosure, I found the timing to be strange— a rule published over a holiday weekend seems an odd choice, particularly when it is being touted as a benefit to the industry and the impact on healthcare provider organizations and clinicians, alike, is monumental.

Unfortunately, I think the additional flexibility allotted by this rule is the latest example of the unintended consequences of health IT regulations. In an effort to make things easier and give healthcare providers more leeway, they have, in fact, made the situation unnecessarily more complex.

Agility is not healthcare’s strong suit

It seems at this point, too many options, or waffling between them (for instance the new ICD-10 transition deadline), can be more crippling than stringent regulations, particularly when there is so much on the line. Healthcare organizations don’t have the wherewithal to vacillate with implementations; they are wrestling with string-tight budgets and constantly shifting rules require large cultural and behavioral changes. As a result, as Dr. John Halamka noted, health IT agendas are being constantly hijacked by regulatory changes, such as Meaningful Use and ICD-10.

It now seems that hospital administrative teams and physicians again must endure constantly shifting rules that they’ve been coping with for years under Meaningful Use. As Dr. Ben Kanter, former CMIO of Palomar Health, so astutely noted “A computer system is a tool, just as a scalpel is a tool. What if a surgeon’s scalpel changed every few weeks? How is it possible to deliver good care if the primary tool you are using keeps changing on an irregular basis?”Continue reading…

It is Time for Clinicians to Engage: Let’s Criticize Less and Dare Greatly More

Sep 2, 2014• 104

By JOHN HAUGHOM, MD

When I write or speak about healthcare transformation, I am often asked why I do not criticize more. Criticize health system leadership. Criticize governmental policies. Criticize burdensome regulations. It’s a long list. Why avoid criticism? The answer is simple. Discerning emerging solutions is much more productive and fun.

We are living during a very interesting period in the history of health care. No doubt, it is a time of great transition. We are passing from one time to another. Transition periods are important, yet they are hard to define because it’s difficult to determine exactly when they start and when they end. To understand the transition healthcare is now experiencing, we must do our best to understand what is on either side of it.

The traditional approach to delivering care has served us well and accomplished great things over the past century. Yet, it is also being overwhelmed by complexity and producing inconsistent quality, unacceptable levels of harm, too much waste and spiraling costs.

The traditional method of delivering care is struggling and another is emerging to take its place. Because the traditional approach has served us well and accomplished great things, we want to believe that the present state will continue forever. Because conditions have changed, this will not happen. We are in need of a new approach. An approach that carries the best of the past forward, yet also addresses present day challenges. It just might be that on the other side of this current transition is potentially a time unmatched by any other in the history of healthcare. Thanks to visionary clinical leaders at institutions across the country, there is growing evidence this is not only possible; it is likely.

Who does the future belong to? If we look closely at other transition periods in history, two groups of people are apparent. The first are what we recognize as critics. They are people whose response to the need for change is criticism. Critics always exist, but in a time of transition they tend to multiply. What do they criticize? They criticize the new, they criticize the change, they criticize the change for being unnecessary or too fast, or they criticize the change for being too slow. They criticize anything and everything. Critics are abundant. The question we should consider is, “Will criticism solve problems?” Typically, it does not. While constructive criticism has its place, it alone is not likely to accomplish much especially when the world is yearning for innovative solutions.

Medicaid 2.0

Sep 2, 2014• 32

By CECI CONNOLLY

While fierce debate continues to envelop much of the Affordable Care Act, financial data for many of the nation’s health systems reveal one clear fact: the optional Medicaid expansion has resulted in hospital haves and have nots.

An analysis by PwC’s Health Research Institute (HRI) of newly released earnings and patient volume data shows a clear financial split between healthcare providers operating in states that expanded Medicaid and those that have not. The law as written would have provided Medicaid coverage to every American earning less than 138% of the federal poverty level ($16,105 for an individual). But a June 2012 Supreme Court ruling made the expansion optional for states, creating a patchwork of coverage.

Health systems and physician groups delivering care in the 26 states and the District of Columbia that have embraced the federally-funded expansion have reported a significant rise in patient volumes and paying consumers and a measureable reduction in uncompensated care levels.

This year alone LifePoint Hospitals has seen a 30.3% reduction in its uninsured and charity care patients, according to filings with the Securities and Exchange Commission. Tenet Healthcare, which operates in five Medicaid expansion states, saw uninsured and charity care admissions decline by 46% in the expansion states, coupled with a 20.5% increase in Medicaid inpatient admissions in those same states, according to an HRI analysis which will be released next week.

In all, HRI analyzed financial data from the nation’s five largest for-profit health systems—HCA Holdings, LifePoint, Tenet, Community Health Systems and Universal Health Services, representing 538 hospitals in 35 states. Our team also reviewed data from several mid-sized hospitals, government reportsand industry surveys.

PRICE INCREASE TODAY 9/2: Health 2.0 8th Annual Fall Conference

Sep 2, 2014• 1

Hope you had a fantastic Labor Day weekend! Now that you’re back, don’t forget the 8th Annual Fall Conference PRICE INCREASE is TODAY, Sept. 2! Join over 2,200 attendees as we showcase over 200 LIVE demos, innovative solutions and thought leadership on over 50 panels, with 150+ speakers over the course of four days on Sept. 21-24 at the Santa Clara Convention Center.

Highlights of speakers and sessions include:

Keynotes from Dr. Eric Topol (Scripps Health),Patrick Soon-Shiong (NantHealth), Indu Subaiya(Health 2.0), Matthew Holt (Health 2.0), Bernard J. Tyson (Kaiser Permanente)
Health Care Data Analytics will show how genomics, non-invasive diagnosis tools, and integrated data collections are uncovering new discoveries, promoting personalized medicine, and new care protocols.
Consumer Tech and Wearables: Powering Healthy Lifestyles showcasing the NEW Health 2.0 Wearable Tech Runway with new solutions from companies such as Adidas, OM Signal,Walgreens, Withings, WebMD, Samsung
Electronics, Qualcomm Life, and many more!
New Landscapes for Digital Diagnosis showcases tools for providers and consumers, while demonstrating new ways in which both communities are reaching the proper diagnosis.

New conference features:

Traction: Brings together series A ready companies center stage as they vie to get the nod as the most fundable startup from venture capitalists and corporate investors. Notable judges and mentors include:
- Jack Young, Qualcomm Life Ventures
- Esther Dyson, EDventure Holdings
- Andrew Colbert, Ziegler Corporate Finance
Pharma & Hospital Roundtables: During these invite-only sessions, participants will discuss how their institutions create and utilize cutting-edge technologies to tackle complex health care issues ranging from care coordination to data exchange and how digital health is changing the pharmaceutical landscape from the earliest phases of research to clinical trials to the way consumers interact with their products in the real world. Email Kim Krueger (ki**@********on.com) for more info.
Bootstrapped Bootcamp: Have less than $2M in total funding? This year’s exhibition hall includes premier space for companies with less than $2 Million in funding to get traction and visibility in front an audience of over 2,200 health care professionals, thought-leaders, venture capitalists, and entrepreneurs. Reserve your space to demo your technology LIVE in our exhibit hall and enjoy a pass to the conference.

including many more new panels, sessions, and speakers found on the agenda online!

Limited S tart –up rate applications are available – submit yours today. Really tight on budget or a student? Apply to volunteer.

A Crystal Ball for Medicine

Sep 2, 2014• 6

By BEN HAMLIN

Twenty years is a long time to rely on one measurement approach. Imagine if in this technology-centric world we still relied on dial-up to connect to the internet. That’s basically where we are on quality assessment today. But we don’t need to be.

Predictive risk calculations allow doctors to look into the future. A risk score tells doctors how likely their patient is to develop heart disease or have a stroke. Working with their patients, doctors can discuss options for lowering this risk with the goal of preventing such events from happening.

With data from electronic health records, we should be able to create risk profiles for individual patients that actually take into account the different factors affecting their personal health—not just their age and gender, but their family history, whether or not they smoke, what medications and treatments they are receiving, and their own perspective on how they feel.

But right now, a 50 year old woman’s risk of developing heart disease is determined by a threshold set for the entire population of women aged 50-65 across the country. That’s a crude science. Everyone is not built the same. We should create risk profiles that change as patients change: as they reduce their risk by losing weight, quit smoking, or lowering their high blood pressure, thus reducing their chances of a heart attack or other adverse event.

That’s the vision of NCQA’s Global Cardiovascular Risk Score (GCVR). Leveraging the pioneering risk prediction work of Archimedes, it extracts data from electronic health records and uses a sophisticated algorithm to generate a highly sensitive, patient-centric risk profile for each clinician. It works like this: the higher the score the less likely a clinician’s patient will develop heart problems in the next five years.

Why Physicians Are Turning to Startups

Sep 2, 2014• 35

By DAVID SHAYWITZ, MD

To appreciate the potential impact of the startup movement on health and medicine, you really need look no further than Drs. Rushika Fernandopulle and Farzad Mostashari (disclosure: I was colleagues with both at college and later at MGH).

Both are passionate about transforming healthcare – Fernandopulle has an M.D. and a public policy degree from Harvard, and was the first executive director of the Harvard Interfaculty Program for Health Systems Improvement; Mostashari served as Assistant Commissioner for NYC’s Department of Health, and more recently as the National Coordinator for Health Information Technology in the U.S. Department of Health and Human Services in the Obama administration. Both are committed to improving the delivery of patient care. And both have deliberately chosen to pursue their vision by creating a company as the vehicle to deliver the change they each believe in.

“The world of start-ups may not be the usual path for those leaving a senior federal post,” wroteMostashari about his new direction, “but it’s the right decision.”

Last month, Mostashari founded Aledade, which seeks to enable independent, primary care physicians to establish accountable care organizations.

A few years earlier, in 2010, Fernandopulle co-founded Iora Health, aninnovative model of direct primary care, and continues to serve as CEO.

Explains Fernandopulle,

“As a practicing physician it soon became obvious our current model of care delivery does not work; instead of simply complaining about it I felt I needed to try to fix it, but got frustrated trying to do it within existing health systems, and found studying the problem (in academics), working through the government, and consulting was not effective. I decided that the best way to make change happen quickly was to simply strike out myself and just do it- being an entrepreneur allows you to break what others think are the rules (they aren’t) and take change into your own hands.”

Fernandopulle and Mostashari aren’t alone – across the country (and the world), physicians from every specialty are creating, joining, or hoping to joinstartups. While many of these doctors are fairly junior, and have little (if any) substantive clinical experience, some are more seasoned – HealthLoop’s Jordan Shlain comes to mind, for example.

A Hospital That Is a World Leader On Transparency

Aug 31, 2014• 4

By LEAH BINDER

Jeremy Hunt, secretary of state for health in Britain, recently toured the Virginia Mason Medical Center in Seattle. He said the visit was “inspirational” and announced plans to have the British National Health Service (NHS) sign up “heart and soul” to a similar culture of safety and transparency. Hunt wants doctors and nurses in NHS to “say sorry” for mistakes and improve openness among hospitals in disclosing safety events.

I had a similar reaction to my tour of Virginia Mason. The hospital appears impressive—and truly gets impressive results. My nonprofit, the Leapfrog Group, annually takes a cold, hard look at the hospital’s data and named Virginia Mason one of two “top hospitals of the decade” in 2010. Every year, it ranks near the top of our national ratings.

Virginia Mason’s success is rooted in its famous application of the principles of Japanese manufacturing to disrupt how it delivered care, partly at the behest of one of Seattle’s flagship employers, Boeing. There are numerous media stories and a book recounting the culture of innovation Virginia Mason deployed to achieve its great results, so I won’t belabor the point here. But at its essence is Virginia Mason’s unusual approach to transparency. Employees are encouraged to “stop the line” – that is, report when there’s a near miss or error. Just as Toyota assembly workers are encouraged to stop production if they spot an engineering or safety problem, Virginia Mason looks for every opportunity to publicly disclose and closely track performance.

It is not normal for a hospital to clamor for such transparency. Exhibit A: the Leapfrog Hospital Survey, my organization’s free, voluntary national survey that publicly reports performance by hospital on a variety of quality and safety indicators. More than half of U.S. hospitals refuse the invitation of their regional business community to participate in Leapfrog, suggesting that transparency isn’t at the top of their agenda. But for Virginia Mason and an elite group of other hospital systems, not only is the transparency of Leapfrog a welcome feature, but they challenge us to report even more data, faster.