The Health Care Blog – Page 574 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Physician Entrepreneurs

Mar 4, 2013• 5

By David Dranove

I have been taking a vacation from blogging as I try to get through a very busy academic quarter. But my last blog, “My Son the Electrician” elicited a lot of comments and I have always wanted to follow up. And today I see that the Chicago Sun Times has generously quoted me, in particular noting how I liken physicians to entrepreneurs. Lest anyone get the wrong impression, let me briefly explain what I mean.

Like entrepreneurs, physicians launch their careers by making large investments – up to ten years of post-graduate training. Such investments do not come with a guarantee. Entrepreneurial physicians – those who own their own practices or work in small partnerships, must build their practices and maintain relationships with other physicians. All successful physicians, whether entrepreneurs or employees, enjoy personally and professional satisfying careers and comfortable, sometimes more than comfortable, incomes. But only physicians entrepreneurs have ultimate responsibility for their practices and their patients.

What Apple Can Teach Health Care About Thinking Different

Mar 4, 2013• 18

By James Rickert, MD

Apple Incorporated has grown to be among the most valuable and most envied companies on earth. Its products are ubiquitous and beloved by many of their users. Last year, the firm generated nearly $26 billion in profits on revenues of $108 billion. When physicians and others working in health care discuss the lessons that the medical establishment can learn from these types of corporate successes, the conversations almost always revolve around the promise of information technologies, such as electronic record keeping or electronic prescription writing, and the need for increased use of these in medical practice. While these technologies are important, the most valuable lesson from Apple’s success is a demonstration of the power of empathy and the subsequent need for health care providers to emotional connect with our patients.

It is widely known that Steve Jobs and Steve Wozniak built the first Apple computer in Steve Jobs’ garage; what is not as widely known is that they quickly brought in a third partner, Mike Markkula, to join and guide the company. He began by writing a one page statement entitled “The Apple Marketing Philosophy”. This philosophy stressed only three key components of bedrock company principles; the first and most important was empathy.

The Promises and Pitfalls of Pay for Performance

Mar 3, 2013• 4

By Martin S. Gaynor

There’s been a great deal of discussion about health care payment reform. Prominent in this discussion is “Pay for Performance” (P4P). The idea is simple — rather than pay providers based on volume of care (fee-for-service) or number of patients (capitation), tie their payment to a measure(s) of performance. There has been substantial concern about the quality of care delivered to patients, so pay for performance appears to make a lot of sense. Don’t we want to reward providers for good performance? Shouldn’t this encourage them to provide high quality care?

Unfortunately, this is not as straightforward as it might appear. While the idea of pay for performance is very appealing and intuitive, there are some major pitfalls in implementation.

The Health IT Scandal the NY Times Didn’t Cover

Mar 3, 2013• 56

By Michael L. Millenson

In case you missed it, the shocking news was that health IT companies that stood to profit from billions of dollars in federal subsidies to potential customers poured in – well, actually, poured in not that much money at all when you think about it – lobbying for passage of the HITECH Act in 2009. This, putatively, explains why electronic health records (EHRs) have thus far failed to dramatically improve quality and lower cost, with a secondary explanation from athenahealth CEO Jonathan Bush that everything would be much better if the HITECH rules had been written by Jonathan Bush of athenahealth.

Next up: corporate lobbying for passage of the 1862 Pacific Railroad Bill is blamed for Amtrak’s dismal on-time record in 2013.

The actual scandal is more complicated and scary. It has to do with the adamant refusal by hospitals and doctors to adopt electronic records no matter what the evidence. Way back in 1971, for example, when Intel was a mere fledgling and Microsoft and Apple weren’t even gleams in their founders’ eyes, a study in a high-profile medical journal found that doctors missed up to 35 percent of the data in a paper chart. Thirty-seven years later, when Intel, Microsoft and Apple were all corporate giants, a study in the same journal of severely ill coronary syndrome patients found virtually the same problem: “essential” elements to quality care missing in the paper record.

Obamacare In Pictures

Mar 2, 2013• 20

By J.D. KLEINKE

A seasoned colleague recently told me that some PowerPoint presentations have no power and make no point.

But sometimes, a picture really is worth a thousand words. Or maybe — in the case of any meaningful discussion of health reform, thanks to its density and complexity — it might be worth 10,000 words. Hence our handy little exhibit.

This picture captures the 10,000 words it would require to explain with technical precision where President Obama’s Affordable Care Act fits relative to all health reform plans. It places “ObamaCare” along an ideologically scaled continuum of all serious reform options developed, debated and discarded or ignored since the 1980s.

They are all here: from the single-payer, centrally controlled models popular with those who detest corporations and the influence of money in medicine — two actual, not imagined “government takeovers of health care” — to two free market, laissez-faire models favored by those who detest regulation and the heavy hand of government in medicine.

The Patient-Centered Practice, Revisited

Mar 2, 2013• 3

By Michael L. Millenson

It is as natural for doctors, hospitals, health plans and others to aggressively affirm their “patient-centeredness” as it is for politicians to loudly proclaim their fealty to the hard-working American middle class. Like the politicians, the health care professionals no doubt believe every word they say.
The most accurate measure of “patient-centered” care, however, lies not in intentions but implementation. Ask one simple question – what effect does this policy have on patients’ ability to control their own lives? – and you start to separate the revolutionary from the repackaged. “A reform is a correction of abuses,” the 19th-century British Parliament member Edward Bulwer-Lytton noted. “A revolution is a transfer of power.”

With that in mind, which purportedly patient-centric policy proposals portend a true power shift, and which are flying a false flag?

Falling Short Of Shifting Power

The two most prominent examples of initiatives whose names suggest power sharing but whose reality is quite different are so-called “consumer-driven health plans” (CDHP) and the “patient-centered medical home” (PCMH). Both may be worthy policies on their merits, but their names are public relations spin designed to put a more attractive public face on “defined contribution health insurance” and “increased primary-care reimbursement.

PILOT Health Tech NYC Matches Startups with NYC Health Care Service Organizations

Mar 1, 2013

By Hemali Thakkar

Pilot-health-tech-nyc-final-web-01 small Let’s face it, as a startup in the health care space, it’s not easy to land a first pilot to demonstrate the value your new technology, much less get paid for one. Strict federal regulations, billion dollar EMR implementations, and the fear of privacy leaks have made our nation’s providers very risk averse and extremely cautious about working with early stage health tech companies. Implementing new technologies in hospitals, where there are strict IT guidelines relating to ensuring patient data privacy and heavy bureaucracy, is difficult. Large hospital systems and other health care service organizations simply do not have the bandwidth or resources to guide companies through these challenges and therefore are reluctant to partner with early stage companies.

What results is a problem we are all too familiar with – failure of new technologies to diffuse into the market. Startups face the classic chicken and egg problem. As a startup, you need some traction, or proof of evidence that your technology brings some value to your customer. But in order to show that you bring value, a startup needs to test out the technology in the health care setting. Houston, we have a problem!

The New York City Economic Development Corporation (NYCEDC), a non-profit that aims to catalyze economic growth in New York City’s five boroughs, recognized this problem early on and decided to tackle the issue head-on. After many health care stakeholder working groups and other research, NYCEDC launched PILOT Health Tech NYC in collaboration with Health 2.0, Blueprint Health, and Startup Health. PILOT Health Tech NYC matches early-stage health care technology companies (‘innovators’) with key NYC health care service organizations or individuals (‘hosts’), including hospitals, physician clinics, payors, pharma companies, and nursing associations. NYCEDC will fund approximately 10 innovative NYC-based pilot projects with up to $100,000 each. That funding is equity free and acts like a milestone based grant that can be split between the ‘host’ and the ‘innovator’ as they see fit.

And the best part – the program will help facilitate connections between ‘innovators’ and ‘hosts’ via matchmaking events to promote formation of partnerships. For most startups, that eliminates months (if not years) of cold-calling and precious business development resources.

Interview with Stuart Fletcher, CEO, Bupa

Mar 1, 2013• 1

By Matthew Holt

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Founded in 1947, the United Kingdom private health insurance provider, Bupa, predates the National Health Service. Today Bupa is a global health care company, which includes subsidiary Health Dialog in the United Sates. CEO Stuart Fletcher explains Bupa’s decision to buy the health care management company.

Zen and the Art of Charting

Mar 1, 2013• 23

By Leslie Kernisan, MD

One of the many challenges I face in my clinical work is keeping track of a patient’s multiple health issues, and staying on top of the plan for each issue.

As you might imagine, if I’m having trouble with this, then the patients and families probably are as well.

After all, I don’t just mean keeping up with the multiple recommendations that we clinicians easily generate during an encounter with an older patient.

I mean ensuring that we all keep up with *everything* on the medical problem list, so that symptoms are adequately managed, chronic diseases get followed up on correctly, appropriate preventive care is provided, and we close the loop on previous concerns raised.

This, I have found, is not so easy to do. In fact, I would say that the current norm is for health issues to frequently fall between the cracks, with only a small minority of PCPs able to consistently keep up with all health issues affecting a medically complex adult.

HiMSS Countdown, with Matthew Holt

Mar 1, 2013

By Matthew Holt

Early this week Greg Masters and Pat Salber chatted with me for a fun convo about EMRs, NOLA, HIMSS, and alot more. It’s part of their overall series for the HIBCtv (Health Innovation Broadcast Network Consortium). And be warned they are giving me keys to the car for 90 minutes at HIMSS next Weds! You should be able to click on the player above to hear. If not click to this.