The Health Care Blog – Page 619 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

The Olympics, Doctors, NHS, Transformation, and Heroes: Why the Difference between USA and UK?

Jul 30, 2012• 6

By Kent Bottles, MD

I was surprised when the Opening Ceremonies of the Olympics in London honored two of my favorite institutions: the National Health Service and the World Wide Web. I was not surprised when LA Times sports writer Diane Pucin posted the following tweet: “For the life of me, though, am still baffled by NHS tribute at opening ceremonies. Like a tribute to United Health Care or something in US.” @swaldman responded to the sports writer with “Well, maybe, if United Health Care were government-run and a source of national pride.”

I was not surprised when Meredith Vieira and Matt Lauer of NBC admitted they had no idea why Tim Berners-Lee was being honored by sending out a tweet. Ever since I read his book Weaving the Web: The Original Design and Ultimate Destiny of the World Wide Web by Its Inventor (HarperSanFrancisco, 1999), Berners-Lee has been one of my heroes. Finally locating my hard copy of the book in the guest bedroom where my son Colin used to sleep, I quickly located the marked passage I was looking for:

“People have sometimes asked me whether I am upset that I have not made a lot of money from the Web. In fact, I made some quite conscious decisions about which way to take my life. These I would not change…. What does distress me, though, is how important a question it seems to be to some.

Continue reading…

Doctors, Patients, or Insurers? Who Will Shape Health Care?

Jul 29, 2012• 1

By Davis Liu, MD

At a conference for America’s Health Insurance Plans, Gladwell argued that patients or consumers have been unable to be more empowered because doctors, as the intermediary, held the power of knowledge much the same way chauffeurs did for the early days of the automobile and Xerox technicians did in the early days of photocopying. A person was needed to guide and assist the individual to get the job done. At some point, however, the technology became simpler. People began to drive their own cars and make their own photocopies. The mystique of the chauffeur and technician was lifted. Now everyone could drive. Everyone could make photocopies.

Is it possible that for health care and the health care system, which for many people is a system they interact with rarely and in an area (health / illness) where the uncertainty and stakes many be too “high”, that individuals willingly defer the responsibility to someone else? Gladwell hints that might be a possibility:

“A key step in any kind of technological transition is the acceptance of a temporary deficit in performance at the beginning in exchange for something else,” said Gladwell. That something else can eventually include increased convenience and lower cost. He offered a number of examples, including the shift to digital cameras where early pictures were not as good as film and the advent of the digital compression of music, which he contends has made the quality of music worse….

HealthCamp Boston 2012: Brainstorming the Future of Health Care

Jul 28, 2012

By David Harlow

HealthCamp Boston is a forum for people with interest in all areas of health and wellness to gather, to generate ideas, and to take practical steps towards building the future of health care. HealthCamps are different from traditional conferences where speakers talk at you. At HealthCamp Boston, an “unconference,” attendees set the agenda, and all contribute to the event according to their interests.

The Boston area is a center of innovation for all aspects of health care, so you can be certain that people at HealthCamp Boston will be discussing things like:

· Big Data in health care

· Improving engagement and outcomes through mobile devices and social media

· Personalized medicine and translational medicine

· Empowered patients

· Practical impacts of health care reform

· and more…

Health Care’s New Rules: If You Don’t Buy Insurance, Will You Really Pay the Tax?

Jul 27, 2012• 7

By Joseph Antos and Michael R. Strain

Now that the Supreme Court has decided that ObamaCare’s mandate to buy health insurance is a tax, will the IRS be able to collect it?

Generally speaking, if you owe the IRS, it will get the money from you—with the possible exception of the ObamaCare tax. Though ObamaCare’s individual mandate imposes a tax on people who do not purchase government-approved health insurance, the law explicitly neuters the IRS’s ability to collect the tax.

Bizarre? Yes. And it matters. If policymakers expect uninsured young people to buy health insurance when it is even more expensive than it is today, the threat of serious consequences for not doing so must be real. Yes, the threat that the IRS might come after you if you do not do what you are told looks real at first glance. But Democratic politicians, fearing public backlash for making the mandate too intrusive, pulled its teeth.

First, the tax (nee penalty) is too small to matter to the people who are its target. In 2014, the tax will be the larger of $95 or 1 percent of taxable income for an individual. By 2016 it rises to $695 or 2.5 percent of income. Young people would not want to pay a dollar if they could avoid it, but avoiding the tax means signing up for insurance that many do not think they need. That insurance is not free. Even with subsidies, they will pay at least 3 percent of their incomes for premiums and up to 6 percent of the cost of the insurance in deductibles and copayments. That adds up to a lot more than 95 bucks.

How the iPhone Might Disrupt The Medical Device Industry

Jul 27, 2012• 10

By Dr. Wes

Doctors wanting to determine a patient’s atrial fibrillation burden have a myriad of technologies at their disposal: 24-hour Holter monitors, 30-day event monitors that are triggered by an abnormal heart rhythm or by the patient themselves, a 7-14 day patch monitor that records every heart beat and is later processed offlineto quanitate the arrhythmia, or perhaps an surgically-implanted event recorder that automatically stores extremes of heart rate or the surface ECG when symptoms are felt by the patient. The cost of these devices ranges from the hundreds to thousands of dollars to use.

Today in my clinic, a patient brought me her atrial fibrillation burden history on her iPhone and it cost her less than a $10 co-pay. For $1.99 US, she downloaded the iPhone app Cardiograph to her iPhone.

Every time she feels a symptom, she places her index finder over the camera on the phone, waits a bit, and records a make-believe rhythm strip representing each heart rhythm. With it, comes the date and time.

From Nursify to Visit Minder: Seven iPhone Apps We’d Like to See

Jul 27, 2012• 2

By David Sack, MD

I read a few months ago that the number of available iPhone apps had exceeded a million, with new apps now appearing that are intended to help sort through the mountain of other apps. We have reached the age of meta-apps.

Parenthetically, I have always loved that “meta”concept. In college, when people asked why I majored in philosophy despite the fact that I was pre-med, I explained that my intention was to become a metaphysician.

In any case, there are now many thousands of medical apps, and the number seems to be growing arithmetically! (Perhaps it was exponential at first, but I suspect the viral replication phase for apps has peaked, so anyone who uses the term exponentially at this point probably needs to review their 8th grade algebra.) In spite of this seeming plethora of handy apps, there are still a few I have yet to encounter and would like to see created, although I will probably receive some comments on this post alerting me to the fact that some of what I am looking for has already been produced.

So here are, in no particular order, 7 apps I would like to see:

Physicians Aren’t (Feeling Very) Social

Jul 26, 2012

By Jim Golden

There were two interesting developments in the field of social networks for healthcare practitioners last week. The first was the publication of a paper in JAMA “Variation in Patient-Sharing Networks of Physicians Across the United States”. The second was the sale of Sermo Physician Network to WorldOne for an undisclosed price. Sermo had raised $40+m in venture capital prior to sale, making a bet that social networking for physicians could drive value to pharmaceutical and financial firms based on disclosing interactions between members of the network.

If physician behavior and prescribing activity are key to your healthcare business, I think it is important to understand the relationship and differences between these two events.

Sermo bet hard on the Facebook model – physicians would interact on social networks, share knowledge and insight, and third parties could benefit from getting access to those interactions concerning their products or services. Sermo had also begun expanding its revenue model by providing paid content and sponsored education programs to network members, trying to capture “digital” dollars from life science companies. Pharma companies are desperately trying to gain advantage through digital advertising campaigns to influence physician prescribing behaviors, and multi-channel marketing efforts including the development of web sites for branded medications.

To Gauge ObamaCare Impact, Ignore CBO and Focus on AQC

Jul 26, 2012• 1

By Dan Diamond

The big health care story in Washington, D.C this week comes down to three letters: CBO. The Congressional Budget Office released its latest projections about the Affordable Care Act’s cost and coverage, concluding that the Supreme Court’s changes to the ACA will lead to some states to opt out of its Medicaid reform. As a result, the ACA’s cost would fall by $84 billion over 11 years but lead to about three million fewer people receiving health insurance.

The CBO numbers are incredibly important in one sense: They reframe the debate over the ACA yet again. As I noted last week, more than two-thirds of states are waffling on whether to participate in the law’s Medicaid expansion, and the new CBO numbers will offer new targets for supporters and opponents of ObamaCare to make their case.

But the CBO score is also more of a political story than policy news. And as both parties continue to haggle over the ACA’s price and impact, keep in mind that the CBO’s projections about health law costs are often wrong.

So rather than focus on estimates of future reforms, we’ll focus on results from a current one: the Alternative Quality Contract. It’s an important payment pilot developed by Blue Cross Blue Shield of Massachusetts — and a key forerunner of the ACA’s accountable care organizations.

AQC Offers Template for ACO

Under the AQC, which Blue Cross launched in January 2009, a hospital or physician group negotiates a budget — or global payment — that covers the cost of care for all patients in their practice. If participating providers stay under budget, they receive bonuses; if they overspend, they pay the difference.

Does Your Oncologist Care?

Jul 26, 2012• 4

By Peter Ubel, MD

Facing advanced cancer, who among us wouldn’t look to our oncologist for expert advice on whether another round of chemotherapy makes sense? But do you know what your oncologist cares about, and can you be sure her recommendations map onto your own treatment preferences?

A recent study lead by Michael Kozminski (I was senior author) shows that American oncologists downplay the value of treatments that improve quality of life, compared to the value they place on life prolonging treatments.

In our study, we surveyed oncologists across the United States and presented them with hypothetical treatment scenarios, to see what value they placed on potential treatments for patients with advanced cancer.

In one scenario, we estimated how cost-effective a new life prolonging chemotherapy would need to be before oncologists prescribed it. We described the chemotherapy as prolonging patients’ lives, but also explained that we had no other data on how it impacted quality of life. On average, we found that oncologists would be willing to spend as much as $200,000 for every year of life gained by this new treatment.