The Health Care Blog – Page 575 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

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.

HHS CTO Bryan Sivak on Open Data

Mar 1, 2013• 2

By Matthew Holt

[youtube]http://www.youtube.com/watch?v=Y9k_oxi92vY&w=640&h=385[/youtube]

Last week I was in DC and I caught up with Bryan Sivak, a geek’s geek who has migrated from Silicon Valley (via London) to government service first in Maryland and now at HHS. He has a big job there to keep pounding out the open health data drumbeat Todd Park started. And he’ll have at least two big opportunities to do it this spring, first at Health 2.0’s developer conference Health:Refactored in Silicon Valley in May and then at the now 4th annual Health DataPalooza in DC in June.

How Mom’s Death Changed My Thinking About End-of-Life Care

Feb 28, 2013• 28

By Charles Ornstein

My father, sister and I sat in the near-empty Chinese restaurant, picking at our plates, unable to avoid the question that we’d gathered to discuss: When was it time to let Mom die?

It had been a grueling day at the hospital, watching — praying — for any sign that my mother would emerge from her coma. Three days earlier she’d been admitted for nausea; she had a nasty cough and was having trouble keeping food down. But while a nurse tried to insert a nasogastric tube, her heart stopped. She required CPR for nine minutes. Even before I flew into town, a ventilator was breathing for her, and intravenous medication was keeping her blood pressure steady. Hour after hour, my father, my sister and I tried talking to her, playing her favorite songs, encouraging her to squeeze our hands or open her eyes.

Doctors couldn’t tell us exactly what had gone wrong, but the prognosis was grim, and they suggested that we consider removing her from the breathing machine. And so, that January evening, we drove to a nearby restaurant in suburban Detroit for an inevitable family meeting.

Are Price Controls the Answer?

Feb 27, 2013• 51

By Martin S. Gaynor

A recent article in Time magazine by Steven Brill, “Bitter Pill: Why Medical Bills Are Killing Us,” is a brilliantly written expose of the excesses and outrages of health care pricing. In reaction to the story, some have suggested the price controls are the appropriate (or the only) way to rectify the situation. A recent story in the Washington Post’s Wonkblog, “Steven Brill’s 26,000-word health-care story, in one sentence,” suggests that US health care costs and cost growth are so high because we do not use rate setting, i.e., price controls.

In fact, I think it’s not easy to establish whether that is indeed the case. We don’t get to use randomized controlled trials for health policies or systems, so it’s difficult to figure out how effective a policy like rate setting is. Let me start with some simple examinations of patterns in data to see if something jumps out that strongly supports (or contradicts) the assertion that price controls reduce health care costs.

How Many States Are Really Opting In?

Feb 27, 2013• 8

By Dan Diamond

Same story, different week: A governor who opposed the Affordable Care Act changes course and announces plans to opt into the Medicaid expansion.

Supporters of the ACA rejoice, conservatives grumble, and a new number gets tacked on the board — 24 states opting in, at last count.

Yet there’s more to the story than governors’ speeches. In at least eight of those states, lawmakers are warning that they may not go along with expansion plans.

Those legislative logjams — and what governors need to do to circumvent them — vary state by state , but the fights are falling out along party lines.

In Missouri, two GOP-led House committees this week voted down Medicaid expansion plans, despite Democrat Gov. Jay Nixon’s pledge to opt into the measure last year. Republican lawmakers in Arkansas, Montana and Washington have similarly been skeptical of their Democratic governors’ expansion positions. Meanwhile, four GOP governors who have backed the expansion are having difficulty corralling members of their own party.

Now For The Rest Of The Story On Massachusetts Cost Control

Feb 27, 2013• 5

By Josh Archambault

A bureaucracy-centric governing philosophy is spreading in health care, and with it comes heavy reliance on “experts” to determine how to curb costs outside the normal legislative and democratic process. This was embodied at the national level by the Affordable Care Act (ACA), and most recently at the state level in a new Massachusetts growth-capping law. (Supporters refer to the law as cost control and payment reform or Health Reform 2.0; the legal name is Chapter 224 of the Acts of 2012).

The new Massachusetts law was discussed by Mechanic, Altman and McDonough in a past Health Affairs issue, and on the blog by Turnbull and Lee. Yet, the unintended consequences of using this method to reform health care have not been fully explored.

What’s In The Law?

Promising savings of $197 billion over 15 years, Chapter 224 sets a cap on statewide health care spending growth by tying it to state growth, enforced by a flat $500,000 civil penalty if health care entities don’t meet reporting deadlines or take reform efforts seriously enough. The law grants strict preference to alternative payment methods (capitated or bundled payment contracts) and accountable care organizations (ACOs).

Certifying apps? Happtique’s big new idea

Feb 27, 2013• 2

By Matthew Holt

Happtique has been spending a lot of effort cataloging all the health, clinical and fitness Apps in the Apple App Store, Google Play and more. Their goal is to create prescribable apps, and proprietary app stores for providers. The idea is that a hospital or clinic can help its physicians suggest the right apps to patients by giving them a select group to choose from, and by having them cataloged in a way that is far more detailed than Apple or Android can do.

That in itself is a big advance, but even though they’ve cataloged 15,000 of the approx. 40,000 health apps out there, they don’t think it’s enough. Happtique is introducing a new certification program today. The idea is to have all apps assessed both for technical proficiency and also for content. Happtique will be reviewing the applications for technical, security and privacy–in other words, where any data goes and whether the app does what it says it does. In addition it’ll assess whether the app links properly to a particular devices or a particular EMR–something that presumably is pretty important to users. (I had an Android phone once which a major tracking device could not link to, even though the device had an Android app!). Here’s the release.

Happtique’s partners (academic med center group AAMC, nurse credentialers CGFNS International & testing lab Intertek) will provide clinicians and other experts who will review the apps for content. The idea here is not to rate or review the content but to see whether the content is from a valid source, and is true to what it says it is.

The HIT Job

Feb 26, 2013• 44

By Bob Wachter, MD

I’m well aware that a good fraction of the people in this country – let’s call them Rush fans – spend their lives furious at the New York Times. I am not one of them. I love the Grey Lady; it would be high on my list of things to bring to a desert island. But every now and then, the paper screws up, and it did so in a big way in its recent piece on the federal program to promote healthcare information technology (HIT).

Let’s stipulate that the Federal government’s $20 billion incentive program (called “HITECH”), designed to drive the adoption of electronic health records, is not perfect. Medicare’s “Meaningful Use” rules – the standards that hospitals’ and clinics’ EHRs must meet to qualify for bonus payments – have been criticized as both too soft and too restrictive. (You know the rules are probably about right when the critiques come from both directions.) Interoperability remains a Holy Grail. And everybody appreciates that today’s healthcare information technology (HIT) systems remain clunky and relatively user-unfriendly. Even Epic, the Golden Child among electronic medical record systems, has been characterized as the “Cream of the Crap.”

Employee Benefits Gone Wild

Feb 26, 2013• 4

By John Goodman

Say “employee benefits” and pensions and health care will jump to most people’s minds. Maybe life and disability insurance will pop up as well. But employers in Silicon Valley are going way beyond that. They’re providing housekeeping, cooking, babysitting and a host of other services as perks for their employees. According to The New York Times, here is what some California companies are doing:

At Evernote, a software company, 250 employees — every full-time worker, from receptionist to top executive — have their homes cleaned twice a month, free.
Stanford School of Medicine is piloting a project to provide doctors with housecleaning and in-home dinner delivery.
Genentech offers take-home dinners and helps employees find last-minute babysitters when a child is too sick to go to school.

To hear the employer representatives tell it, companies are providing their workers with services that make it easier to balance home and family life in an age when there are few stay-at-home spouses and work is stressful.

But a more likely explanation is economics.