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Above the Fold

Should We Send Docs to Tech School?

Aug 19, 2014• 5

By BILL CROUNSE, MD

An article in Information Week caught my eye recently . It reviews a new program offered by Texas A&M with support from Dell to help medical students and other healthcare professionals “come to terms with the ways technology is changing their jobs”. The article, Doctors Can Go Back to Tech School, says Texas A&M will launch its new health technology academy later this year as part of its continuing medical education program.

Now, don’t get me wrong. I’m all for education and career improvement. I’m just not sure that the best way to improve Health IT is to get more physicians trained in IT so they can, as the article suggests, move into IT roles. How about giving full time clinicians who have an interest in improving Health IT some extra support and time so they can help those who work in IT better understand what clinicians need to do their jobs efficiently and safely? How about just a little paid time away from the daily treadmill of patient care to educate IT about the nuances of medicine and clinical workflow? I believe understanding that would do more to help IT deliver better solutions.

Over the course of my career, I’ve been many things. First and foremost, I am a physician. Only a true clinician understands how clinicians think and work. For many years, I continued to practice even when it no longer made a whole lot of sense with regards to my income or available time. I was a biology major in college. I went to medical school and did a residency in family medicine. I never had any formal training in either business or technology. I learned the ropes by doing. It was often trial by fire. I’ve had my share of success as well as a few failures along the way. When I advanced into the role of a hospital CIO and CMIO, it wasn’t because I knew tech. When my then CEO asked me to step into the CIO role, I’ll never forget what he said to me. He said, “I want to put a civilian in charge of the military”, meaning a doctor in charge of a department that existed to serve clinicians and their patients but had become a renegade army running out of control and way over budget.

HIT: How the VA Reform Bill Benefits Entrepreneurs

Aug 19, 2014• 3

By DOUGLAS NAEGELE, DAVID BLACKBURN & ERIC KLOS

Earlier this month, the U.S. Senate passed a Department of Veterans Affairs health reform bill in response to scandals in patient care at VA centers. The $16.3-billion bill,signed by President Barack Obama, includes measures that will attempt to overhaul information technology and introduce telemedicine procedures at VA clinics and hospitals.

But who’s going to implement these reforms? Infield Health President Doug Naegele talked with G2Xchange Health Cofounders David Blackburn and Eric Klos to understand how the bill might create new opportunities for health entrepreneurs.

Can you talk for a minute about how some of the bill’s provisions make room for entrepreneurs?

This bill has a number of specific information technology mandates for the VA that are ripe for innovation. Many of the mandates are a direct response to excessive wait times, the need for information sharing when our veterans access care outside the VA, and the gaming that was done by VA staff to hide wait time issues at VA facilities. Three examples of opportunity areas for entrepreneurs include:

1) Digital Waiting List – You may have seen billboards on the highway that show the Emergency Room wait time at a local hospital. This is an example of the type of transparency that would permit veterans to monitor the average wait times by facility and type of care.

2) The VA has 90 days to establish a system to monitor and issue Veterans a “Veterans Choice Card,” which will facilitate the receipt of care from non-VA health providers.

3) Data for patient safety, quality of care and outcomes must be extrapolated from the existing VA electronic health records (VistA) and published as a comprehensive database within 180 days. This data must be “fed”’ into the HHS Hospital Compare website. Again, transparency is a key driver for the VA.

An Open Letter to Primary Care Physicians

Aug 19, 2014• 46

By JACK COCHRAN, MD and CHARLES KENNEY

Dear Doctor,

The future is in your hands.

You have the opportunity to make primary care better.

More efficient.
More accessible.
And more affordable.

We know you and other primary care doctors have more responsibilities than ever. But you also have great influence, along with the ability and opportunity to change this country’s health care system for the better.

Primary care is essential to the quality of health care, and we need you now more than ever.

Maneuvering the Minefield

According to research firm Harris Interactive, “the practice of medicine is … a minefield. … Physicians today are very defensive – they feel under assault on all fronts.’’* Harris questions, “how much fight the docs have left in them. Some are still fired up … while others have already been beaten down.’’

Those who feel frustration, anger and burnout say they are squeezed by administrators, regulators, insurance companies and more. They worry about the possibility of a lawsuit that could destroy your career.

The question is: What can be done about it? Some of you may choose to remain in the status quo. Some of you have chosen to retire early or otherwise leave the field of medicine entirely. Yet some of you have said enough is enough and found specific solutions that mark a pathway forward. You sought – and found – specific solutions that mark a pathway forward.

If you’ve rejected the status quo and joined your fellows in search of innovations from other practices that you have applied at home, congratulations. You’re a physician leader who’s doing great things for your patients, your colleagues and yourself. You are undoubtedly more satisfied in your work than before, and you are quite likely providing better care.

Help Bring Health 2.0’s Panel to SXSW!

Aug 18, 2014

Its that time of year again! Time to choose your favorite panels for South by Southwest (SXSW) and we need your help again to get us into the select few!

In case you’re wondering what a panel at SXSW means, let us fill you in. Panels are a chance for companies to share ideas and each year companies duke it out for as many “thumbs up” as they can get for their chance to foster collaboration and innovation of the greatest minds in techs.

Health 2.0 is no stranger to the SXSW stage. In 2012, we hosted one of the most well attended health sessions at SXSW Interactive titled, “Sensor Technologies: The Future of Health” and we know that this year’s panel, “Turning a Pilot into a Success” is sure to be an even bigger hit!

That’s where you come in! We need you to cast your votes for our panel this year. While you’re at it, tell your friends, family and followers to vote for Health 2.0’s panel. With your help, we’ll deliver another great panel in 2015!

So please give your “thumbs up” for Health 2.0 today (you’ll have to log in to vote) and help us spread the word!

How Much Market Power Do Hospitals Really Have?

Aug 17, 2014• 17

By JEFF GOLDSMITH

Orginally published June 6th 2014, back by popular demand. – The Eds

Sometimes big game hunters find frustration when their prey moves by the time they’ve lined up to blast it. That certainly appears to be the case with the health policy target de jour: whether providers, hospital systems in particular, exert too much market power. A recent cluster of papers and policy conferences this spring have targeted the question of whether hospital mergers have contributed to inflation in health costs, and what to do about them.

Hospitals’ market power appears to be one of those frustrating moving targets. The past eighteen months have seen a spate of hospital industry layoffs by market-leading institutions, and also a string of terrible earnings releases from some of the most powerful hospital systems and “integrated delivery networks” in the country. These mediocre operating results raise questions about how much market power big hospital systems and IDNs do, in fact, exert.

The two systems everyone points to as poster children for excessive market power-California-based Sutter Health and Boston’s Partners Healthcare, both released abysmal operating results in April. Mighty Partners reported a paltry $3 million in operating income on $2.7 billion in revenues in their second (winter) quarter of FY14. Partners cited a 4.5 percent reduction in admissions and a 1.6 percent decline in outpatient visits as main drivers. Captive health insurance losses dragged down Partners’ patient care results. Sutter did even worse, losing $22 million on operations in FY13 (ended in December), — compared to a gain of $697 million in FY11 — on more than $9.6 billion in revenues. A 3 percent decline in admissions led to FY13 revenue growth of 0.9 percent (that is, nine-tenths of one percent), against 7.3 percent in expense growth.

Why Doctors Shouldn’t Be Healers

Aug 16, 2014• 27

By ROB LAMBERTS, MD

It’s a seductive idea. We doctors possess knowledge and experience which can not only help people, but can save their lives. We get opportunities to be the right person at the right time to offer the right help that makes all of the difference. It’s one of the greatest things about our profession. It’s also one of its greatest traps.

I’ve heard many doctors refer to themselves as “healers,” as if we have some special power to bring about healing in our patients. This idea confers some sort of a higher status and originates, to some, from a “higher calling” to a more noble life. Again, this is a logical step, in that we have opportunities on a regular basis to help and even save the lives of people. It’s natural to believe that somehow the healing power comes from our touch, or even from our knowledge.

It doesn’t. I am not a healer.

Healing is what the patient does, not the doctor. As a physician, I am certainly one who can help the patient find a faster road to healing, but I don’t heal. I help.

Why am I taking the time to talk about this? Why get stressed out over whether I am a helper or a healer? I think that the belief in doctors as healers causes significant harm to both doctors and patients, and that getting a better perspective about the roles of each will greatly improve the care given. Here’s why I believe this is a topic that needs addressing:

1. Doctors Often Fail at Healing (And Will Always Ultimately Fail)

There are many patient problems that do not get better, despite my best efforts. There are countless pains I can’t remove, and many problems I do not solve. Even when I succeed, the success is always temporary, as a new problem will eventually come back. And if healing is our ultimate goal as physicians, we all are total failures, as all of our patients eventually die. If healing is held as our goal, we fight a losing battle. We are the soldiers in the Alamo, offering impotent resistance to an overwhelming force.

How Effective is CER?

Aug 15, 2014• 2

By ROBERT DUBOIS,MD

Having the best evidence at hand is vitally important for making health care treatment decisions. But even when the right—or best—information is available, it isn’t always put to use in clinical practice.

Why? Although we are getting better at generating evidence, we’re still not doing a great job of using it.

Our progress in creating a robust pipeline of comparative effectiveness research (CER) is clear. By 2019, the Patient Centered Outcomes Research Institute (PCORI) is expected to receive an estimated $3.5 billion from the PCOR Trust Fund to fund CER. CER is not new, but the investment in PCORI represents a national appetite for a robust and reliable queue of research to overcome one of the greatest perennial challenges in health care delivery—knowing what works, for whom it will work and under what conditions.

CER offers every provider, patient and payer the promise of better care, yet its impact on patient outcomes remains on the horizon, rather than a reality in health care settings today. Why? Research published recently in the American Journal of Managed Care suggests that changes are needed in order to see more consistent translation of research findings into clinical practice. In short, at the moment, we have a hard time using what we learn from CER.

This research examined how major CER studies have impacted care. We evaluated real-world utilization trends before and after a) publication of CER findings and b) the release of relevant clinical practice guidelines (CPGs) from four high-profile CER studies published within the last decade.

The research we examined tells the story. Under the microscope were four major studies, including: PROVE-IT, an examination of cholesterol-lowering treatment strategies from 2004; MAMMOGRAPHY WITH MAGNETIC RESONANCE IMAGING (MRI), a comparison of diagnostics to detect breast cancer from 2004; SPORT a comparison of surgical and non-operative treatments for herniated disks from 2006; and COURAGE, a comparison of percutaneous coronary intervention (PCI) to optimal medical therapy (OMT) for people with coronary artery disease, from 2007.

These studies delved into pressing therapeutic questions, and the findings of each study revealed new thinking in optimizing care for patients. But, despite the shifts in care that could have—or should have—occurred, our analysis revealed no clear pattern of utilization in the first four quarters after publication. Even after the studies were incorporated into CPG, we were not able to consistently find changes in utilization or clinical practice.

Giving Startups their Big Start: How Developer Challenges Make the Difference

Aug 15, 2014

By The Health 2.0 Challenge

The best way to get your startup noticed is to have your product validated by experts in the industry. As a young startup connecting with that community of experts can be quite difficult. Participating in a developer challenge can not only lead to funding and credibility but provides a valuable testing ground for products.

What is a developer challenge? These virtual competitions build on the concept of their in-person cousin the code-a-thon/hack-a-thon, prompting teams to develop technologies to address some of healthcare’s most complex issues. Over 3 – 6 months teams work on design concepts and prototypes for a variety of challenges sponsored by all types of organizations from charitable foundations to for-profit companies. Final submissions are judged by a panel of industry experts and winners are awarded cash prizes.

Health 2.0 has run over 75 challenges in the past 4 years and awarded over $6M in funding to burgeoning digital health companies. But its not only money that draws teams to these competitions, participants gain validation of their product, publicity and market access.Reflecting on the past few years, we want to share the successes of these challenges.

Ready? Here we go!

So That’s What You Get The Big Bucks For?

Aug 14, 2014• 25

By JOE FLOWER

What motivates a healthcare executive?

Remember Flower’s Laws of Behavioral Economics? The first two are:

People do what you pay them to do.
People do exactly what you pay them to do.

That is, it’s not general. It’s not “be a good doctor.” It’s more like, “Do lots of complex back fusion surgeries.” What’s more profitable gets done more.

I know that some people say that money has nothing to do with people’s motivation in healthcare, and that’s fine, I totally respect that opinion. You’re just in the wrong section. You want Aisle C, between Dr. Seuss and the Disney fairy tales.

But what about healthcare executives? What gets them more money? What constitutes hitting it into the cheap seats for them?

There are of course lots of compensation surveys. There’s a whole industry of people who do that. But they don’t tie compensation to anything specific. So when someone does a study that does look at correlations, that’s interesting information. One came out a few months ago in JAMA’s Internal Medicine .

Karen Joynt, MD, and her colleagues used 2009 data, so things might be beginning to change now. And they only looked at CEOs, so we will have to speculate whether the same things apply to other C-suite suits.

What did they find? They found great variation in the salaries, with a mean (average) salary of $595,781, a median (half are above and half below) of $404,938). The nearly $200,000 difference tells us that the sample is skewed by a smaller number of really large salaries at the top.

There is nothing surprising in the size of the salaries or their variation. That’s normal for any industry. No matter how much you might think that healthcare is special and different and sacred, it is nonetheless a very big business. In many or most towns, the hospitals and health systems are the biggest businesses in town. A typical suburban three-hospital system might have an annual budget in the $5 billion range.

What correlates with a higher salary? Size.

More beds means a higher salary ($550 for each extra bed, to be exact). Teaching status means $425,078 more — in other words, doubling the median. And most teaching hospitals are much bigger than average. Urban location gets you more, but this is likely also a marker for size, or the cliché phrase “big city hospital” wouldn’t roll off the tongue so easily. High tech gets you more, too. Hospitals with high technologic capabilities paid their CEOs $135,862 more than hospitals with low levels of technology — but this again is likely a marker (a co-variate) for size and teaching status.