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Above the Fold

Walmart Moves Health Care Forward Again

Oct 18, 2012• 64

By Brian Klepper

Walmart’s sheer size makes almost any of their initiatives newsworthy. That said, despite being a lightning rod for criticism on employee benefits and health care, they have introduced initiatives with far-reaching impacts. Their generic drug program began in September 2006 – more than 300 prescription drugs for $4/month or $10 for a 90-day supply – and was widely emulated, disrupting retail drug markets and generating immense social benefit. Imagine the difference it made to a lower middle class diabetic who had been paying more than $120 per month for medications, and suddenly could get them for about $24.

Yesterday Walmart announced that “enrolled associates” – covered workers and their family members – needing heart, spine or transplant surgeries could receive care with no out-of-pocket cost at 6 prominent health systems around the country: Mayo Clinics (Rochester, MN and Jacksonville, FL); Cleveland Clinic (Cleveland, OH); Geisinger Clinic (Danville, PA); Mercy Hospital Springfield (Springfield, MO); Scott & White Memorial Hospital (Temple, TX); and Virginia Mason Medical Center (Seattle, WA).

Walmart’s Center of Excellence (COE) program builds on its own and other organizations’ pioneering efforts with similar programs. Walmart developed a relationship with Mayo Clinics in 2007 for transplant and lung volume reduction surgeries. In March 2010, Lowes reached a similar arrangement with Cleveland Clinic for heart surgeries and, last December, Pepsico announced a global pricing deal with Johns Hopkins for cardiac and joint replacement surgeries.

The Stockholm Syndrome and EMRs

Oct 18, 2012• 9

By Paul Levy

First the definition:

Stockholm syndrome, or capture-bonding, is a psychological phenomenon in which hostages express empathy and have positive feelings towards their captors, sometimes to the point of defending them. These feelings are generally considered irrational in light of the danger or risk endured by the victims, who essentially mistake a lack of abuse from their captors for an act of kindness.

Now, the health care connection. As a result of the billions of dollars allocated by Congress to health information systems as part of the stimulus program, those companies who had a head start in implementing electronic medical records quickly found themselves in demand. Of all those companies, Epic is the most successful. Forbes notes, “By next year 40% of the U.S. population–127 million patients–will have their medical information stored in an Epic digital record.” Here in Massachusetts, the biggest convert was Partners Healthcare System: “System development and implementation will occur over a 10-year period and represent a capital investment of approximately $600 – 700 million.” Elsewhere, notes Forbes: “The biggest win: a $4 billion project to digitize medical records for health care giant Kaiser Permanente.”

What is striking about this company is the degree to which the CEO has made it clear that she is not interested in providing the capability for her system to be integrated into other medical record systems. The company also “owns” its clients in that it determines when system upgrades are necessary and when changes in functionality will be introduced. And yet, large hospitals sign up for the system, rationalizing that it is the best. For example, Partners said, “The new health care landscape will challenge us to engage in population health management, improve the coordination of health care, and accept financial risk for the care of our patients. This new system will enable us to meet those challenges.”

Alvin Roth Receives Economics Nobel For Flawed Residency Match System

Oct 18, 2012• 3

By David Whelan

There’s a larger question here about why the scholarly world allows itself to be judged by secretive Scandinavian committees sitting on endowments funded by money made selling explosives. But let’s put anti-Nobel polemics aside.

The announcement today that Alvin Roth and Lloyd Shapley won this year’s award in economics came with the explanation that they had devised systems for matching buyers and sellers that led to more rational outcomes than existing markets.

Shapley, a contemporary of “A Beautiful Mind’s” John Nash, introduced an elegant theory 50 years ago to explain the (relative) stability of marriage pairings despite the fact that individuals have complicated preferences when choosing a mate. Shapley’s idea is that the person you end up with is the best match given everyone else’s preferences.

You might prefer someone else more than your current mate, but that person has you lower on her list, and so on. Imagine Larry. If he could Larry would have definitely married Elizabeth Taylor. But she was taken so now Larry is happy with his actual wife. (To sum it up in a way that would make an economist cringe.)

Alvin Roth built on that early theory. He designed actual markets that used the matching principle, also known as the deferred acceptance algorithm, as a guiding principle. The most famous example of a Roth market is the Residency Match.

Medical residency is a job that lasts three to seven years, depending on the program, and follows graduation from medical school. It is required for a doctor to complete a residency in order to be licensed to practice.

In the “old days” medical students would apply to hospitals and rank their preferences in a way that was visible to those institutions. A hospital would first review those applicants who had indicated them as the first choice. If spots remained to fill, a hospital would then look at those who had picked it second, and so on. You can quickly see how this system punished people who shot high and missed. They would end up at one of their last choices because the best places would fill up quickly.

Health 2.0 Berlin Code-a-Thon Sponsored by Aetna International

Oct 17, 2012

By Health 2.0 Staff

Health care stakeholders join forces with developers to build new apps for health and wellness

On 3-4 November 2012 web and mobile developers meet health professionals, patients and other health care stakeholders at the Health 2.0 Berlin Code-A-Thon 2012 to create innovative solutions and build brand new prototype applications for improved health and wellness in only two days.

Berlin, October 18, 2012 – What if a smartphone app could check for signs of sleep apnea and help patients and their families sleep more soundly? Or what about an app that lets Parkinsons patients take standard motor skill tests at home instead of in the doctors office? Sound too good to be true? And how long do you think it would take to develop a working prototype? The answer is as few as 48 hours.

These are just some of the many excellent prototypes that have been developed by Health 2.0 Code-A-Thon teams in the past. Find out on 3-4 November 2012 what brilliant health care solutions will be created at the Health 2.0 Berlin Code-A-Thon. For this two-day event, sponsored exclusively by Aetna International, gifted coders and health professionals will come together in Berlin to compete to develop the most innovative solution to improve health and wellness. The event is part of the Health 2.0 Code-a-Thon series, which includes a range of developer-focused events happening in the United States, Europe and Asia.

Ensuring the Long-Term Viability of Health Insurance Exchanges

Oct 17, 2012• 7

By Phil Poley

November 16 marks the deadline for states to submit their plans for establishing a health insurance exchange—or HIX—either on their own or with some level of assistance from the federal government. For those states, a majority, according to Kaiser Family Foundation research, have yet to set up a HIX or develop concrete plans to do so. That’s an uncomfortably tight timeline in which to make some tough decisions.

According to the Supreme Court’s June ruling on the Affordable Care Act, states will no longer forfeit federal funding for Medicaid if they choose not to expand their Medicaid programs to all residents with incomes below 138 percent of the federal poverty level. Nevertheless, they must ensure coverage for an estimated 16 million currently uninsured people with an income between 100 percent and 400 percent of that poverty level. And by October 2013, each state needs to demonstrate that it has a HIX in place that can provide such cover: A user-friendly, one-stop shop for affordable healthcare, or affirmatively state that it intends to participate in the Federal exchange..

A HIX needs to have sufficient scale to support large and balanced risk pools. But there may not be sufficient numbers of uninsured state residents to make the HIX viable, particularly if a state is small, or has an extensive Medicaid program already in place. How will such states attract and sustain enrollment? How will they attract payers?

The EMR and the Case of the Disappearing Patient

Oct 16, 2012• 9

By Christopher Johnson, MD & Maggie Mahar

The electronic medical record (EMR) is here to stay. Its adoption was initially slow, but over the past decade those hospitals that do not already have it are making plans for implementing it. On the whole this represents progress: the EMR has the ability to greatly improve patient care. Physicians, as well as all other caregivers, no longer have to puzzle over barely legible handwritten notes or flip through pages and pages of a patient’s paper chart to find important information.

With the EMR, it is easy to see what medications a patient is taking, when they were started, and when they were stopped. Physicians can easily find key vital signs – temperature, pulse, respirations, and blood pressure – plotted over any time frame they wish. All the past laboratory data are displayed succinctly. But it is not all gravy.

There is a Problem

I use the EMR every day, and I am old enough to have trained and practiced when everything was on paper. While overall, I am happy to have electronic records, there is a problem: The EMR is trying to serve too many masters. The needs of these various masters are different, and sometimes they are incompatible, even hostile to one another. These masters include other caregivers, the agencies paying for the care, and those interested in medico-legal aspects of care. What can happen, and I have seen it many times, is that the needs of the caregivers take a back seat to the needs of the payers and the lawyers. The EMR is supposed to improve patient care, but sometimes it makes it worse. Physician progress notes illustrate how this happens.

Linking Meaningful Use and HIT Sector Consolidation

Oct 16, 2012

By Barrett Lynner

Since January, the Centers for Medicare and Medicaid Services (CMS) have implemented incentive programs to drive meaningful use of Electronic Medical Records (EMR) technology – software and support tools that represent a roughly a $40B marketplace.

In August, CMS reported that $6.9B in total EMR incentives were paid to 143,800 physicians and hospitals – a number that will likely increase markedly in the coming quarters. This is because hospitals and eligible professionals know that to receive the highest possible financial incentive they must deploy and demonstrate meaningful use of an EMR before 2014.

Curiously, these incentives don’t seem to be enticing as only 20% of Medicare and Medicaid eligible providers are taking strides toward EMR implementation and only 55% of eligible hospitals have received an EMR incentive payment. We think they’re delaying investments for a few reasons.

· Implementation costs are high, and the financial return of EMR systems isn’t fully proven
· Poorly preforming EMR vendors are causing senior hospital executives to consider their options
· Clinical leadership unwilling to change the clinical processes required to derive value from an EMR system
· Creating and maintaining clinical content for a successful EMR system is very complex

The Future of Health Is in #Opendata

Oct 16, 2012

By Eugene Borukhovich

This Saturday I had the pleasure of helping organize a hackathon that was put together by the Open State Foundation (HackDeOverheid). The theme was “Open Data, open for business” and took place at a very unique place in Rotterdam – WORM (an institute for avant garde recreation). It was a perfect spot to gather almost 150 people from all disciplines and sponsors/partners ranging from the Hogeschool Rotterdam, TNO, Internet Valley Rotterdam to name a few, but also a contribution from Health 2.0.

Open health data is relatively a new initiative within the Open State Foundation with a simple but strong message:

“Open Zorg Data is an initiative to build a community that utilizes open healthcare data, encourages innovation & entrepreneurship, improves transparency in our healthcare system and most importantly turns healthcare into health for our digital citizens”

In the last few weeks, we worked with the Ministry of Health (Ministerie van VWS) to plan out the OpenZorgData Workshop and help inspire the community of developers to use the data for social and entrepreneurial good.

The turn out was great!! We have more then doubled (2X) the number of attendees to the workshop from the previous workshop that took place in Amsterdam. First up in the morning data pitch session was, Ron Roozendaal (CIO of the Ministry of Health), who took a few minutes to introduce all the stakeholders within the Ministry and the newly opened data sets. He exuded enthusiasm and excitement!

Our workshop kicked off at 11:45 with standing room only, but when I asked how many people were hackers planning to use the open health data, only one guy raised his hand (but noted that he had no plans of doing it that day). Here we are: room full of people, Ministry of Health in the room and not one single individual was planning to hack away at the data. We carried on with the presentations where Lany Slobbe, Hans Loonen & Christian Gonzales presented their respective data sets. The workshop presentations finished off with Seth van den Bossche from TNO presenting their open data & Atilla Erdodi showcasing an open API he put on top of the KiesBeter data (opened up back in June of 2012).

Outlawing Templated Notes in the Electronic Health Record

Oct 16, 2012• 12

By Jaan Sidorov, MD

It was just a matter of time until this would happen.

Buried in the middle of this New York Times article on The Ups and Downs of Electronic Medical Records is the observation that a Medicare administrative contractor dubbed National Government Services has announced that it, on behalf of CMS, will “deny payment” for medical services that are documented in an electronic health record (EHR) using “cloned documentation.”

The topic was covered more than 2 years ago. “Cloned documentation” is the widespread practice of copying, pasting past documentation in an EHR into the current encounter record to inflate the recorded patient evaluation to primarily justify a higher payment. Thanks to this OIG report, the Feds have figured out that the true value proposition for an EHR is not “meaningful use” but wasteful abuse.

In addition to congratulating the Times for their crack cutting-edge reporting, here is a prediction…

1. The mere threat of payment denials and the possibility of sanctions will prompt health administrators everywhere to announce at medical staff meetings that “cloned” notes are verboten.

2. Until the “templated note” functionality is deleted in future EHR software updates, physicians will respond to this latest edict from their administrators in the traditional manner: they’ll ignore it.