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Is “Medicare For All (Who Want it)” Enough?

By MIKE MAGEE

In the 2nd night of the Democratic Primary debate on June 27, 2019, Pete Buttigieg was asked whether he supported Medicare-For-All. He responded, “I support Medicare for all who want it.” 

In doing so, he side-stepped the controversial debate over shifts of power from states to the federal government, and trusted that logic would eventually prevail over a collusive Medical-Industrial Complex with an iron lock grip on a system that deals everyone imaginable in on the sickness profitability curve – except the patient.

On July 30, 1965, President Lyndon B. Johnson signed into law “Medicare,” a national insurance plan for all Americans over 65. He did so in front of former President Truman, who 20 years earlier had proposed a national health plan for all Americans, and for his trouble was labeled by the AMA as the future father of “socialized medicine.”

For Truman, there was a double irony that day in 1965. First of all, the signing was occurring at around the same time as our neighbor to the north was signing their own national health plan, also called “Medicare”, but their’s covered all Canadian citizens, not just the elderly.

The second incongruity was that Truman was fully aware that in 1945, as he was being tarred and feathered as unpatriotic by taxpayers for having the gall to suggest that health care was a human right, those very same citizens were unknowingly funding the creation of national health plans as democracy stabilizers in our two primary vanquished enemies – Germany and Japan – as part of the US taxpayer funded Marshall Plan.

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12 Rules for Health Tech Startups

By MATTHEW HOLT

Last week Mark Cuban tweeted out 12 rules for tech startups and Jessica DaMassa challenged a bunch of people to respond for health care. VC and general health care wit Lisa Suennen came out with quite the list (she got to 13) but I thought someone ought to write the real rules…

1. Never start a health tech company if you can sucker someone into giving you a real job

2. When VCs at conferences say raising money isn’t a problem, throw a milkshake at them

3. Never work with a technical co-founder who won’t give you the last M&M in the packet

4. When a clinician wants to quit their job and co-found with you, remember that the good ones could be making $500K a year reading X-rays and be on the golf course at 4pm

5. Do the 50/2 diet. Starve for 50 weeks of the year then eat and drink as much as you possibly can at HIMSS & JP Morgan parties when someone else is paying

6. When the incubator/accelerator/matchmaker says that they “chose you from 700 applicants” remember that there are roughly 700 of them and every company applies to each one

7. When you get the elusive partnership deal with the big hospital system, tech company or corporate, you’re going to expect to work at the speed of the startup and the scale of the corporate. It’ll be the reverse . (I stole this from Michael Ferguson at Ayogo)

8. After your first few clients and funding rounds you’ll be losing money at a exponential rate that matches what you had for revenue on the hockey stick chart in your pitch deck

9. Hopefully you’ll eventually be able to start making the money the health care way, by establishing a monopoly that can arbitrarily raise prices to the moon and stick it to your customers. If not, start prepping for the really big Oscar/Collective/Clover type round. 

10. Pray to whatever God you follow that Softbank is still in business when #9 happens.

11. If after a decade or so of slog, you finally get the IPO, or semi decent exit, try to ignore the fact that the Instagram guys sold for $1 billion 11 months after they founded the company

12. Hope that you can disrupt health care, but remember that UnitedHealth Group’s revenue is $220 billion and CMS spends $900 billion a year and they both appear mostly powerless to make anything better.

Matthew Holt is publisher of The Health Care Blog and advises startups at SMACK.health using these principles and a few others too!

Was the IOM estimate of medical errors correct?

By SAURABH JHA

In 1999, the Institute of Medicine (IOM) in their landmark report – To Err is Human – estimated that the number of deaths from medical errors is 44 ,000 to 98, 000. The report ushered the Quality and Safety Movement, which became a dominant force in all hospitals. Yet the number of deaths from medical errors climbed. It is now touted to be the 3rd leading cause of death. How easy is it to precisely quantify the number of deaths from medical errors? Not many physicians challenged the methodologies of the IOM report. Some feared that they’d be accused of “making excuses for doctors.” Many simply didn’t have a sufficient grip on statistics of measurement sciences. One exception was Rodney Hayward – who was then an early career researcher, a measurement scientist, who studied how sensitive the estimates of medical errors were to a range of assumptions.

Saurabh Jha (aka @RogueRad) speaks with Professor Hayward for the Firing Line Podcast about his research in JAMA published in 2001 – Estimating Hospital Deaths Due to Medical Errors: Preventability Is in the Eye of the Reviewer. It was a landmark publication of the time, and its objective methods have stood the test of time.

Rod Hayward a Professor of Public Health and Internal Medicine at the University of Michigan and Co-Director of the Center for Practice Management and Outcomes Research at the Ann Arbor VA HSR&D. He received his training in health services research as a Robert Wood Johnson Clinical Scholar at UCLA and at the RAND Corporation, Santa Monica. His current and past work includes studies examining measurement of quality, costs and health status, environmental and educational factors affecting physician practice patterns, quality improvement, and physician decision making. His current work focuses on quality measurement and improvement for chronic diseases, such as diabetes, hypertension and heart disease.

Listen to their conversation on Radiology Firing Line Podcast here.

THCB Spotlights: Brooke LeVasseur, CEO of AristaMD

Today on THCB Spotlights, Matthew talks to Brooke LeVasseur, who is the CEO of AristaMD. AristaMD provides eConsults to empower providers to get patients faster access to care. The average wait time to see a specialist is one to two months, and the proportion of referrals to specialists that never happen can be incredibly high, at 40% in Medicare populations for instance. AristaMD aims to provide an efficient way for primary care providers to tap into the expertise of specialists to immediately start executing on a treatment plan without the patient having to wait or travel. Tune in to find out how AristaMD is actually rolling this out and get a demo of the platform.

Sexism vs. Cultural Imperialism

By SARAH HEARNE

As I was getting ready for bed last night a friend shared a tweet that immediately caught my attention.

https://twitter.com/sbattrawden/status/1143465003409915905

The tweet was of a paper that has just been published online, titled “Does physician gender have a significant impact on first-pass success rate of emergency endotracheal intubation?” and showed the abstract which began,

It is unknown whether female physicians can perform equivalently to male physicians with respect to emergency procedures.

Understandably, this got the backs up of a lot of people, myself included. Who on earth thinks that’s a valid question to be researching in this day and age? Are we really still having to battle assumptions of female inferiority when it comes to things like this? Who on earth gave this ethics approval, let alone got it though peer review?

I then took a deep breath and asked myself why a respected journal, The American Journal of Emergency Medicine, would publish such idiocy. Maybe there was something else going on. The best way to find out is to read the paper so I got a copy and started reading. The first thing that struck me was the author affiliations – both are associated with hospitals in Seoul, South Korea. The second author had an online profile, he is a Clinical Professor of Emergency Medicine. I couldn’t find the first author anywhere which made me think they are probably quite early in their career. The subject matter wasn’t something I could imagine a male early career researcher being interested in so figured they are probably female (not knowing Korean names I couldn’t work out if the name was feminine or masculine).

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Why the Health Care System Is Incapable of Reducing Its Own Costs: A Brief Structural System Analysis

By JOE FLOWER

Leading lights of the health insurance industry are crying that Medicare For All or any kind of universal health reform would “crash the system” and “destroy healthcare as we know it.”

They say that like it’s a bad thing.

They say we should trust them and their cost-cutting efforts to bring all Americans more affordable health care.

We should not trust them, because the system as it is currently structured economically is incapable of reducing costs.

Why? Let’s do a quick structural analysis. This is how health care actually works.

Health care, in the neatly packaged phrase of Nick Soman, CEO of Decent.com, is a “system designed to create reimbursable events.” For all that we talk of being “patient-centered” and “accountable,” the fee-for-service, incident-oriented system is simply not designed to march toward those lofty goals.

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Psychiatrist: My Medicine Raised Our Patient’s Blood Sugar, Can You Help? PCP: That’s a Dump!

By HANS DUVEFELT, MD

If my hypertensive patient develops orthostatism and falls and breaks her hip, I fully expect the orthopedic surgeon on call to treat her. I may kick myself that this happened but I’m not qualified to treat a broken hip.

If my anticoagulated patient hits his head and suffers a subdural hematoma, I expect the local neurosurgeon to graciously treat him even though it was my decision and not his to start the patient on his blood thinner. After all, brain surgery is tricky stuff.

Why is it then that primary care docs, sometimes myself included, feel a little annoyed when we have to deal with the consequences of psychiatric medication prescribing?

My psychiatry colleagues diligently order the blood work that is more or less required when prescribing atypical antipsychotics, for example. But when the results are abnormal I get a fax with a scribble indicating that the PCP needs to handle this.

We need to just deal with that and appreciate that there has been communication between treating providers. Because that doesn’t always happen. Particularly with medication prescribing, we don’t always get a notification from our psychiatry colleagues when a patient is started on something new because their records are so much more secret than ours.

The other day I sat in my monthly conference with staff from the Behavioral Health Home that I serve as the medical director for. I consult on clinical and policy matters.

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Health in 2 Point 00, Episode 87 | Omada, Call9 & Politics

Today on Health in 2 Point 00, Jess and I are getting in the spirit of things with this week’s Democratic debate. In Episode 87, Jess asks me about Omada Health’s $73 million raise, bringing its total to $200 million, and about what happened with nursing home telehealth startup Call9 shutting down. We turn to politics with Trump telling HHS to have hospitals publish their price list—and it’s unclear that this is even going to make a difference—and to health care coverage in the Democratic debate. —Matthew Holt

Whole Genome Sequencing Heads for Consumers – Rodrigo Martinez of Veritas Genetics

By JESSICA DaMASSA, WTF HEALTH

DNA testing companies like 23andMe and Ancestry have made DNA testing mainstream, with adoption skyrocketing among consumers. Meanwhile, health tech startups like Veritas Genetics are starting to push the trend even further – from genotyping to whole genome sequencing. What’s the difference? Well, genotyping looks at less than half of 1% of your genome, while whole genome sequencing looks at over 99% of your genome.

Veritas is betting that consumers are ready for what’s revealed by looking at more than 6.4 billion letters of DNA and are promising that the value of that information will only get richer as time goes on and the science that makes sense of our genome achieves new breakthroughs.

In fact, Veritas is positioning their $999 test as “a resource for life” and Rodrigo Martinez, their Chief Marketing & Design Officer who I chat with here, shares a vision for the future that includes asking Alexa to scan your genome before taking medications or risking allergic reactions to foods.

This is fascinating proposition for the future of health (investors are jazzed too, having poured $50M into the company), but ethical questions abound. How do you make this information useful and actionable? How do you handle situations where major health issues are reveled? And what about data privacy? This is about as personal as personal health information can get. Rodrigo weighs in…

DANGER! COURSE CORRECTION ALERT!

By JOE FLOWER

A hot take on healthcare in the Democratic debate: They’re doing it wrong.

Healthcare is not a reason to choose between the Democratic candidates. 

They are all for greater access and in some way to cover everyone, which is great. 

None of their plans will become law, but if they are elected those plans will become the starting point of a long discussion and legislative fight. The difference in their plans (between, say, Buttigieg or Biden and Warren or Sanders) is more of an indication of their general attitude toward governance rather than an outline of where we will end up.

Democrats are focused on coverage, Trump is on cost. 

Around 90% of Americans already have coverage of some sort. Polls show that healthcare is voters’ #1 priority. Read the polls more closely, and you’ll see that it’s healthcare cost specifically that they are worried about.

Democrats seem to assume that extending more government control will result in lower costs. This is highly debatable, the devil’s in the details, and our past history on this is good but not great. 

The President, on the other hand, can make flashy pronouncements and issue Executive Orders that seem intended to bring down costs and might actually. It’s highly questionable whether they will be effective, or effective any time soon. Still, they make good headlines and they especially make for good applause lines at a rally and good talking points on Fox.

But, Ms. and Mr. Average Voter will hear that Trump is very concerned about bringing down their actual costs. The Democratic plans all sound to the untutored ear (which is pretty much everyone but policy wonks like you and me) like they will actually increase costs while taking away the insurance that 90% already have in one way or another.

It is important to take care of everyone. But it is a mistake for the Democrats to allow this to become a battle of perception between cost and coverage. Voters’ real #1 concern is about cost, not coverage.

Joe Flower has 40 years of experience in the healthcare world and has emerged as a thought leader on the deep forces changing the system in the United States and around the world.

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