The Health Care Blog – Page 576 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

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.

HHS CTO Bryan Sivak on Open Data

Mar 1, 2013• 2

By Matthew Holt

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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.