The Health Care Blog – Page 621 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

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.

Health Care Reform and the Laws of Unintended Consequences

Jul 25, 2012• 7

By Steven M. Gillon

When the Supreme Court ruled that President Obama’s sweeping overhaul of the nation’s health care system was constitutional, about the only thing critics and supporters could agree on was the historic importance of the legislation itself. But if history is any guide, there will be one other inescapable truth: The Affordable Health Care for America Act of 2010 will generate the same unintended consequences that have shaped, distorted, and even perverted so many other important pieces of legislation in our nation’s history.

Whether tackling social security, veterans’ benefits, civil rights or immigration reform, Congress has demonstrated over the past 75 years that when it addresses significant social issues with complicated legislation, the results will, more often than not, vary dramatically from what was originally intended. In some instances, as in the case of the GI Bill, the impact was broader than the original drafters could have dared to hope. More commonly, as in the case of social security or immigration reform, a small detail has ended up undermining the loftiest goals of the original bill.

A general rule of thumb for determining how likely a bill is to veer off course is to ask how ambitious the legislation is: the more far-reaching, the more likely it is to produce unanticipated consequences. As we saw with health care reform, big, complicated laws are often the product of partisan brokering and compromise that makes their “intent” ambiguous and open to interpretation. That gives enormous power to the government bureaucrats charged with enforcing the law, and to the courts that are inevitably called upon to settle the conflicts. The gap that opens between the bill’s lofty goals and its often haphazard implementation is the breeding ground for unforeseen results.

Uninsured Aurora Victim Could Face $2 Million In Medical Bills

Jul 25, 2012• 15

By Steven Perlberg

Caleb Medley was shot in the eye in the Aurora movie theater shooting and remains in the intensive care unit in an induced coma. Medley sustained the terrible injuries only days before his wife Katie was due to give birth to a baby boy they plan to name Hugo. She now joins him in the same hospital — just one floor away — where she was set to be induced.

But even if Caleb makes a full recovery and meets his son, what happened late Friday evening at the movie theater could ruin the young family’s finances. Caleb doesn’t have health insurance, and his medical bills could amount to $2 million, according to his family.

Longtime friend Michael West has created a website to raise money for Caleb, who has been an aspiring stand-up comedian since the eighth grade. “He needs to get better because he needs to be a dad,” West said.

According to the website, Caleb performed in Denver’s biggest stand-up contest at the Comedy Works on July 18, advancing to the next round. The next night, Caleb and Katie decided to treat themselves to the midnight movie before the couple “officially” became parents.

In addition to the fundraising website, friends have set up a Facebook page dedicated to Caleb’s full recovery.

Building the Buildings of the Next Health Care

Jul 25, 2012• 2

By Joe Flower

It was some doctor show on cable: Nurse McCarthy bustles into the hospital room, says “Good morning!” brightly, and crosses the brilliantly polished linoleum floor to the window. Humming to herself, she sweeps open the curtains to the view of the brick wall across the airshaft, then goes to the patient on the right and checks his dressing, clucking and offering encouragement. After a few moments she does the same with the patient on the left, makes a note on his chart, and leaves. She’s probably been there less than 10 seconds, and I’m thinking, She just killed two patients.

Consider this: During the remainder of this decade, health care providers will be building thousands of structures — building, re-building, re-purposing, infilling, for new and rapidly shifting purposes. Details matter.

Despite its continued use as a political bludgeon, health care reform will likely be implemented, at least in its broad outlines. The truly deep changes that are transforming us into the Next Health Care are proceeding apace in any case, with different business models and revenue streams, which means new physical settings.

Health Insurers & the Affordable Care Act: Extinction or Reinvention?

Jul 22, 2012• 52

By KENT BOTTLES, MD

Now that the Supreme Court has upheld the constitutionality of the Patient Protection and Affordable Care Act (PPACA), health insurers are scrambling to reinvent themselves for a new era. In an earlier post, I quoted Aetna CEO Mark Bertolini as saying he wants to create a business model that makes sense under the new rules and regulations. In a recent speech Bertolini explained, “We need to move the system from underwriting risk to managing populations. We want to have a different relationship with the providers, physicians and hospitals we do business with.”

Starting with Aetna, this analysis will examine the ways that insurance companies are trying to reinvent themselves for a reformed health care delivery system that often wonders why we need health insurers at all.

Early this year, Aetna decided to evolve “’from an insurance carrier to a health solutions company.” ”The head of brand and consumer marketing at Aetna stated, “’More and more, the end consumer is who we need to focus on.’” Aetna has developed Care Pass Platform, an agnostic tool that all consumers can use to aggregate and organize their fitness, medical, insurance and nutrition data. Aetna is also partnering with Medicity to provide smartphone apps for providers and iTriage to provide apps for consumers.

Clinical Practice Guidelines as “Safe Harbors” against Malpractice Claims

Jul 22, 2012• 10

By Randall R. Bovbjerg, JD

Health care costs too much in the United States. One key problem is gold-plating of services driven by physicians’ fears of lawsuit for failure to do everything possible for patients. A notable example of such overutilization is increasingly routine ordering of advanced imaging or other tests. Reliable, evidence-based clinical guidelines promise to address low-value utilization by authoritatively stating standards of good care in advance.

Some thought leaders among Democrats seek to use guidelines to side step the routinized political battles over malpractice reform. Republicans have been saying that defensiveness and other problems justify caps and other limits on medical liability. Belittling defensiveness as a problem, Democrats have defended and promoted liability as an incentive for good care.

Defensiveness is a problem, acknowledge proponents of guidelines to reform liability. But it can be fixed simply by legislating that adherence to reliable guidelines constitutes a “safe harbor” against lawsuits for failure to do more. Safe harbors would remove the motivation for defensiveness and also any need to accept Republicans’ caps and other limits. Given the political stalemate in Washington, the idea is worth thinking through.

Good guidelines are a good idea, especially to improve quality of care, which is their main policy driver. And, because guidelines hold promise for cutting wasteful defensiveness, they have superficial appeal as a liability reform. However, practical feasibility limits the reach of safe harbors, as explained in a recent policy brief from The Urban Institute for the Robert Wood Johnson Foundation.

Why Nobody Believes the Numbers

Jul 22, 2012

MARKETPLACE

Did you know that the “official” industry guidelines for measuring care management outcomes are mathematically certain to overstate savings? And that about half the companies in the DM/wellness marketplace (including carriers) have invalidating mathematical mistakes right on their websites or in their brochures? And that others simply lie? And that the “gatekeepers” who are supposed to prevent these mistakes – leading benefits consulting and actuarial firms – routinely make up savings figures that are simply mathematically impossible and hope they don’t get caught?

This is the first book to treat outcomes as being math-based, not faith-based. It is aimed at the grown-up segment of the marketplace – people who really want to see how much they can save, rather than how much they can be told they can save. A dozen hilarious case studies—and we are naming names — will include:

·         Major carriers who simply make up numbers and dare you to catch them
·         Benefits consulting firms that specialize in “validating” mathematically impossible results
·         Vendors promising savings in excess of the mathematical limit of 100%
·         Carriers/vendors that are either totally clueless and/or think you are…and make up their own metrics like “reduction in undetected claims cost,” leading one to ask how they are able to detect undetected claims cost, and/or how an employee would otherwise have filed an undetected claim