The Health Care Blog – Page 529 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

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Who Knew That Blood, Sweat and Tears Could Start a Health Care Revolution?

Oct 2, 2013• 1

By Peter H. Diamandis, MD

The staid world of diagnostic testing is about to undergo a major disruption with huge advances in sensors and sensing technologies that live in or on our bodies, within our homes and offices, and even within our computers and networks.

Today we’re witnessing a massive shift in who will collect and control diagnostic and other health information. For the first time, as people and patients, we will have control over what we measure, when we measure it, and who has access to our personal data. This is made possible by a new generation of revolutionary biosensors that contain the power of clinical lab instruments in packages that are light, small, wireless and highly efficient.

This is a new world of sensors: they can be body-attached, monitor our immediate personal environment, or even work as pure software apps that extrapolate data from our health records. Using simple, non-invasive methods to take samples of tiny amounts of blood, traces of skin tissue, breath droplets or an image of the inner eye are just some of the new methods emerging. It is exciting to consider that several of these multifunctional sensors, working in concert with powerful mobile handhelds, offer us extraordinary data collection and diagnostic tool sets that will put us in touch with our health in ways never imagined before.

These advances in health sensing, available any time and anywhere, are game changing. A continuous stream of personalized health data will transform how doctors interact with their patients to address and solve health challenges. More importantly, it puts patients at the center of the care process. Personalized data means that specific therapies or drugs will be more effectively delivered and controlled, allowing doctors to fine-tune treatments and watch incremental physiological changes as they occur.

This technology will also disrupt the clinical diagnostics business by moving testing from specialized (and expensive) labs to pharmacies and then ultimately to our homes.

My Worst Night as a Doctor

Oct 2, 2013• 7

By Rob Lamberts, MD

My worst night as a doctor was during my residency. I was working the pediatric ICU and admitted a young teenager who had tried to kill herself. Well, she didn’t really try to kill herself; she took a handful of Tylenol (acetaminophen) because some other girls had teased her.

On that night I watched as she went from a frightened girl who carried on a conversation, through agitation and into coma, and finally to death by morning. We did everything we could to keep her alive, but without a liver there is no chance of survival.

Over ten years later, I was called to the emergency room for a girl who was nauseated and a little confused, with elevated liver tests. I told the ER doctor to check an acetaminophen level and, sadly, it was elevated. She too had taken a handful of acetaminophen at an earlier time. She too was lucid and scared at the start of the evening. The last I saw of her was on the next day before she was sent to a specialty hospital for a liver transplant. I got the call later that next day with the bad news: she died.

The saddest thing about both of these kids is that they both thought they were safe. The handful of pills was a gesture, not meant to harm themselves. They were like most people; they didn’t know that this medication that is ubiquitous and reportedly safe can be so deadly. But when they finally learned this, it was too late. They are both dead. Suicides? Technically, but not in reality.

For these children the problem was that symptoms of toxicity may not show up until it is too late. People often get nausea and vomiting with acute overdose, but if the treatment isn’t initiated within 8-10 hours, the risk of going to liver failure is high. Once enough time passes, it is rare that the person can be cured without liver transplant.

According to a recent ProPublica investigation, acetaminophen overdose is the #1 cause of liver failure in the US. And between years of 2001 and 2010, 1567 people in the U.S. were reported to have died by accidentally overdosing.

I Oppose Obamacare. I Support the Affordable Care Act.

Oct 1, 2013• 21

By KENNY LIN, MD

Today, more than three years after being signed into law, and more than a year after surviving a Supreme Court challenge, the Affordable Care Act, more commonly known as Obamacare, finally begins to fulfill its promise. Most of this country has long since taken sides, despite appalling gaps in popular understanding of what the law means, what it does, and what it doesn’t do.

Let me admit that I’ve never had particularly warm feelings toward President Obama. I think his foreign policy is a mess. The trillions in debt that the U.S. has run up over the past 5 years will hurt my generation and future generations, and if Republicans can be faulted for their fantasy that the federal budget can be balanced exclusively through spending cuts, Obama has sustained the Democratic fairy tale that raising taxes on “millionaires and billionaires” is all that is necessary to pay the skyrocketing bills.

On multiple occasions during my time in government, the President had no qualms about squashing science and scientists for political convenience. He is a perpetual campaigner, preferring theatrical gestures to the backstage grunt work of governing. And for all of his rhetorical gifts when preaching to the choir, he’s been one of the least effective persuaders-in-chief to have held the office.

And so, naturally, I oppose Obamacare. I oppose a government takeover of health care that includes morally repugnant death panels staffed by faceless bureaucrats who will decide whose grandparents live or die and make it impossible for clinicians to provide compassionate end-of-life care. I oppose the provision in Obamacare that says that in order for some of the 50 million uninsured Americans to obtain health insurance, an equal or greater number must forfeit their existing plans or be laid off from their jobs.

I oppose the discarding of personal responsibility for one’s health in Obamacare. I oppose Obamacare’s expansion of the nanny-state that will regulate the most private aspects of people’s lives.

It’s a good thing that Obamacare, constructed on a foundation of health reform scare stories, doesn’t exist and never will.

Instead, the Affordable Care Act (which I support) is based on a similar law in Massachusetts that was signed by a Republican governor and openly supported by the administration of George W. Bush. It achieves the bulk of health insurance expansion by leveling the playing field for self-employed persons and employees of small businesses who, until now, didn’t have a fraction of the premium negotiating power of large corporations that pool risk and provide benefits regardless of health status.

Washington In Crisis: ONC Announces That It Will Not Tweet Or Respond to Tweets During Shutdown

Oct 1, 2013• 6

By THCBist

The U.S. government shutdown continues to claim victims.

The latest is HealthIT.gov, the website designed to help doctors and hospitals make the transition to electronic and make better use of health information technology – a key component of Obamacare’s drive to transform healthcare.

The Health Information Technology Office of the National Coordinator posted a brief announcement on the site informing visitors to HealthIT.gov that “information … may not be up to date, transactions submitted via the website may not be processed and the agency may not be able to respond to inquiries until appropriations have been enacted.”

Officials also sent a tweet saying that the ONC regrets to inform us that while the shutdown continues it will “not tweet or respond to tweets.”

This struck THCBist as slightly odd.

After all, if you’re looking for an inexpensive way to communicate with the public in a pinch, Twitter seems like the perfect choice. We get that government websites are ridiculously expensive things to run. Blogs are considerably cheaper. Operating a Twitter account — on the other hand — is almost free. Our brains were flooded with scenarios. How much could the ONC possibly be spending on Twitter? And for that matter, didn’t the Department of Defense originally invent the Internet to allow for emergency communication during times of national crisis? Doesn’t a fiscal insurrection by cranky Republicans qualify?

Fallout for the National Health IT Program

While federal officials have issued repeated assurances that the shutdown will not impact the Obamacare rollout, it does look as though there will be a fairly serious impact on the administration’s health IT program. If HHS sticks to script, only 4 of 184 ONC employees will remain on duty during the shutdown. That makes it sound like activities are going to have to be scaled back just a bit.

If you’re counting on getting an incentive payment from the government for participation in the electronic medical records program, you may be in trouble — at least until the stalemate is settled. Although ONC has not yet made an official statement, presumably because the aforementioned Twitter channel has been disabled, leaving the agency unable to speak to or otherwise communicate with the public, going by the available information in the thirteen-page contingency plan drafted by strategists at HHS, it is unclear where the money will come from.

This could be bad news for electronic medical records vendors counting on the incentive program to drive sales as the Obamacare rollout gets officially underway.

HealthTech Challenge Aimed at Reducing Readmissions

Oct 1, 2013• 1

A new international challenge has finally arrived, and not a moment too soon! The Henry Ford Innovation Institute (HFII) has partnered with Health 2.0 to launch the HFII HealthTech Challenge. The challenge encourages innovators in over 25 countries to address avoidable hospital readmissions through mobile-health and IT solutions. $50,000 in prizes and up-to $100,000 in technology development support will be awarded to the best solutions.

The HFII HealthTech Challenge aims to reduce avoidable readmissions of patients with exacerbations of chronic conditions, like pneumonia, COPD, and congestive heart failure. Rising readmissions penalties strain private insurers and capitated health systems. Not to mention, patients and providers are inadequately prepared to manage complicated medical conditions post-hospital discharge.

Open to the international community, this Challenge invites innovators in over 25 countries to compete for $50,000 in prizes. The five best finalist will be awarded $10,000 each. These teams will then compete for a chance to receive an offer of a rapid commercialization investment, consisting of up-to $100,000 for technology development, up-to 9 months of product development support and clinical validation within the Henry Ford Health System, technology and business support from HFII’s commercial partners, and access to world-class mentors and experts across a variety of fields. Throughout the development period, the winners will receive exposure to capital investors that can provide additional funding to fuel the growth of these technologies.

Check out the challenge details at www.healthtechchallenge.com, and make sure to stay tuned with us for all your HealthTech Challenge needs!

Submissions are due January 3, 2014.

Announcing the Winners and Finalists of the RWJF Hospital Price Transparency Challenge!

Oct 1, 2013

RWJF

With the Health 2.0 Fall Conference underway, we’re excited to to announce the winners of the Robert Wood Johnson Foundation (RWJF) Hospital Price Transparency Challenge! The Foundation launched the RWJF Hospital Price Transparency Challenge on June 3, 2013 at the Health Datapalooza tasking innovators to build tools and visualizations that can enable consumers to make more informed decisions based on recently release CMS hospital inpatient and outpatient pricing data.

This challenge was broken into two categories: the Visualization Category and the Apps & Tools Category. The Visualization Category tasked innovators to build interactive or static visualizations that can better display aspects of the pricing data like regional patterns or differences by procedure while the Apps & Tools Category challenged teams to create a tool or app that allows users to analyze and potentially leverage the data for purchasing decisions or to negotiate hospital bills.

The foundation received a tremendous response from the technology and design community, with over 130 total submissions received for both categories. Health 2.0 is thrilled to announce the results!

Interactive Visualization Category Winners:

1st place ($9,000): Optimal Hospital by Adam McCann
2nd place ($7,000): Clinic Optimizer by Drake Pruitt, Mauro Brunato, and Roberto Battiti
3rd place ($3,000): Crystal Care by Sagar Sawant

Static Visualization Category Winners:

1st place ($6,000): Imaginary Office by Esther Chak, Mary-Jo Valentino
2nd place ($3,500): wHealth by Edward Kim
3rd place ($1,500): Hospital Prices and Consumer Assessment Survey by Melvin Hill

For the applications/tools category, five finalist were chosen out of 85 submissions! It was a close race, no doubt. These teams won $5,000 each, and are now tasked with building out their conceptual designs into real applications! The five finalists were:

Consumer Reports by Chris Bailey
Haberham Health by Jacob Byrne
Nerdwallet Health by Christina LaMontagne
ProcedureTap by Tony Webster
ReferMe by Arjun Ohri

Learn more about the challenge HERE and stay tuned for results from Phase II of the Apps & Tools Category of the challenge that will be announced at the mHealth Summit in December!

Why Explaining the Affordable Care Act Turns Out To Be A Lot Harder Than We Thought It Would Be.

Oct 1, 2013• 16

Bauhoff, Carman & Wuppermann

One of the chief aims of the Affordable Care Act (ACA) is the expansion of insurance coverage to individuals who at present either cannot afford it or choose not to purchase it. Unfortunately, many Americans lack the financial literacy needed to navigate the numerous and complex options thrust upon them by the ACA.

The ACA contains a number of mechanisms through which coverage will be expanded, including the individual mandate, the state insurance exchanges, and the expansion of Medicaid.

Yet, while many more Americans will be able to obtain health insurance under the law, the new policies present a complex new choice environment for consumers, one that contains new penalties, new subsidies, and a potentially vast number of plans to choose from. Successfully navigating these choices requires consumers to be financially literate.

As recognized in research on related areas of financial decision-making – such as retirement planning, investing, and debt – consumers often lack the understanding, ability and confidence to make financial choices that are in their best interest.

To shed light on consumers’ ability to navigate the ACA, we recently examined the distribution of financial literacy by household income. Our findings were recently posted on the Health Affairs Blog and in a working paper by RAND’s Bing Center for Health Economics.

Will Obamacare Survive? Nine Key Questions

Sep 29, 2013• 28

By ROBERT LASZEWSKI

How did it go? Unavoidably, that will be the big question come Tuesday.

But there will be much more to it than that.

A 180-Day Open Enrollment––Not a One-Day Open Enrollment

What happens on the first day, for good or bad, will constitute only a tiny percentage of the open enrollment period. Consumers will likely visit the new websites many times before they make any decisions, and that is exactly as it should be.

Many of the health plans touted as being low-cost plans are going to be very limited access plans. It won’t be easy for consumers to compare one plan’s provider network to the other. In the best of circumstances, consumers will be confused by what is being offered for some time and will have to make a major effort to make sense of it for themselves.

Let’s not forget, they will be buying something that will cost thousands of dollars––their money or the government’s––and that kind of purchase will never be as simple as going to Amazon and buying a book.

I will suggest that if the local press wants to be helpful they will waste less time asking how things went the first day and more time doing stories on the quality of the various health plans in their local communities––particularly over provider access, which will be the only major product differentiator between health insurance companies.

Will There Be Administrative Problems With the Exchanges?

There already are. And, there will be lots more.

During the last 24-hours I have been told that the information technology testing between insurance companies and the federal government, particularly around the government telling insurance companies who they will be covering, continues to be a real mess.

But whatever obvious problems there are at launch, there will likely be more problems and more serious problems behind the scenes in the lead-up to January 1, the initial problems will be worked out in a few days or a few weeks. Operational expectations are now so low for Obamacare’s health insurance exchanges a small disaster will be considered a political victory.

Continue reading…

After the Navy Yard Shooting: A Call to Action On Mental Illness

Sep 27, 2013• 32

By Jeffrey A. Lieberman, MD

The Navy Yard shooting in Washington, D.C. has once again confronted us with the issues of guns and mental illness, but what we really should address is the inadequacy of mental health care in the United States. Since 2009 there have been 21 mass shootings and the perpetrators in over half of these were suffering from or suspected to have a serious mental illness like schizophrenia, bipolar disorder and depression. (The other killers with no signs of mental illness were ideological zealots, disgruntled employees and disaffected loners.)

After each incident there is a great hue and cry, and calls for action but no substantive action is taken. Our reflexive approach has repeatedly failed to provide care in a timely fashion to individuals in need. As a country, we continue to ignore the growing public health need for greater access and a more proactive approach to mental health care. It is time that we say enough is enough and do something to prevent future tragedies.

When you strip away the hype and politics, the causal factors in these horrific incidents are clear and solvable. Yet we’ve lacked the social and political will to fashion and apply the solution.

The plain truth of the matter is that we do not provide adequate services to the 26% of the U.S. population with mental illness. The scope of and access to mental health services available to most people are limited and fragmented. Moreover, insurance coverage is all too often lacking and discriminatory. Consequently, we do not provide the level and quality of care of which physicians and health care providers are capable. It is the equivalent of knowing that a woman has breast cancer but not offering the indicated treatment options of surgery, radiation and chemotherapy. The result is that many people go untreated or inadequately treated.

Will ACA Implementation Lead to a Spike in Demand for Care?

Sep 26, 2013• 21

By David I. Auerbach

As the Affordable Care Act’s (ACA) exchanges open and Medicaid expansion takes effect, millions of uninsured Americans will gain new coverage. This raises a key question: how are we possibly going to meet the demands of all of these new individuals entering the system? The physician workforce is growing slowly, at best, at a time when an aging population is increasing demand for care.

Predictions include long lines for everyone, rising prices and premiums as physicians are able to command greater market power, and reduced quality of care. Some have recommended additional government funding to help train more medical residents as a response.

But while studies predict ACA implementation will prompt an increase in demand for medical services, there is evidence that the increase in demand will not be as great as the raw number of newly insured Americans might suggest.

The latest CBO forecast projects the reduction in the number of uninsured Americans under the ACA will be 11 million people next year and 24 million by 2016. That’s an increase in the percentage of Americans with insurance of roughly 5% in 2014 and 12% in 2016. If the uninsured used zero health care today, but upon becoming insured used the same amount as a typical insured person, then the increase in demand for care would be the same as the increase in coverage.

In reality, the uninsured use substantial amounts of health care – but only about half the care that the insured use today. One reason is because they are uninsured – paying full prices for care rather than a small copay discourages use. Another reason also explains why many (but not all) are uninsured in the first place: they are healthy and don’t anticipate needing or wanting medical care.

When the uninsured gain coverage, demand does increase, but not dramatically, studies show. Evidence from the Oregon Health Insurance experiment, in which a funding cap forced the state to grant Medicaid coverage to some applicants but not others using a lottery-type system, found that those who did gain coverage increased their use of both hospital and physician care by about one-third relative to controls.