The Health Care Blog – Page 620 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Things Are About to Get Interesting

Jul 31, 2012

By Dr. Wes

It was a chance encounter.

After all it’s not every day you see an internist who still frequents a hospital. We’ve known each other for years and he’s been watching the changes in health care, too.

“Boy, they’re really not happy Over There. Seems they’ve contracted with Big Boy insurance as part of their new ACO model. Everyone’s going to get their piece before the doctors: Over There hospital, their four million administrators, lawyers, grounds crews, parking staff…. Then, after everyone else is paid, the doctors might get a few scraps if there’s some left over. No guarantees. All risk, no certainty of reward. There was no way I could still go there. I joined them, but had to leave when I saw how unworkable that was.”

“Isn’t this our new way forward?” I asked.

“I guess so. Scary. But I’ve got just a few more years. Just have to get the kids through college.”

Continue reading…

‘Help Wanted’ For Medicaid Expansion

Jul 31, 2012• 4

By John H. Schumann, MD

Despite its complexities and its politics, I support the Affordable Care Act (aka “Obamacare”). As I’ve written elsewhere, I think it would be both morally and economically wrong for Governor Fallin and the Oklahoma legislature to opt out of the ACA’s vast Medicaid expansion – a position shared by Oklahoma Policy Institute. So if Oklahoma does the right thing and opts to expand Medicaid for adults with incomes at or below 133 percent of the federal poverty level, what will happen?

Oklahoma faces a serious shortage of primary care access. The Oklahoma Health Care Authority, the agency in charge of administering Medicaid, recently compiled county-by-county maps, color-coded to classify areas of severe physician shortage based on presumptive levels of Medicaid expansion. At a glance, these maps reveal something we already know: rural areas are hurting for physicians and populous counties seem to have more capacity. In my opinion, however, the maps don’t paint a full picture of the eventual shortfall.Continue reading…

Time For Biopharma To Jump On The “Big Data” Train?

Jul 31, 2012• 2

By David Shaywitz, MD

In a piece just posted at TheAtlantic.com, I discuss what I see as the next great quest in applied science: the assembly of a unified health database, a “big data” project that would collect in one searchable repository all the parameters that measure or could conceivably reflect human well-being.

I don’t expect the insights gained from these data will obsolete physicians, but rather empower them (as well as patients and other stakeholders) and make them better, informing their clinical judgment without supplanting their empathy.

I also discuss how many companies and academic researchers are focusing their efforts on defined subsets of the information challenge, generally at the intersection of data domains. I observe that one notable exception seems to be big pharma, as many large drug companies seem to have decided that hefty big data analytics is a service to be outsourced, rather than a core competency to be built. I then ask whether this is savvy judgment or a profound miscalculation, and suggest that if you were going to create the health solutions provider of the future, arguably your first move would be to recruit a cutting-edge analytics team.

The question of core competencies is more than just semantics – it is perhaps the most important strategic question facing biopharma companies as they peer into a frightening and uncertain future.

The Supreme Court May Have Saved Lives … by Keeping People Off Medicaid

Jul 30, 2012• 15

By John Goodman

Here’s the most underreported story of the summer. When the Supreme Court ruled on the Affordable Care Act (ObamaCare) it inadvertently liberated millions of people who were going to be forced into Medicaid. Now they will have the opportunity to have private health insurance instead. What difference does that make? It could be the difference between life and death.

A Congressional Budget Office (CBO) report this week says there are 3 million such people. The actual number could be several times that size. But first things first.

Imagine that you are the head of a family of three, struggling to get by on an income, say, of $25,000 a year. You’ve signed up for your employer’s health plan because you want your family to get good health care when they need it. But that takes a big bite out of your paycheck — $250 a month.

When you first heard about the president’s health plan, you heard him say that if you like the plan you’re in you can keep it. That was good news. You also believed the whole point of the reform was to help families like yours get health insurance if for some reason you had to seek insurance on your own.

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.