The Health Care Blog – Page 662 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Context Is Everything

Feb 10, 2012• 5

By Joseph Kvedar

A few weeks ago, I had the opportunity to talk with an innovative company about a new product. I make it a policy not to endorse any particular company or product on this blog, so this is not an endorsement. Rather it is a fascinating story that tells us lots about human nature and gives us clues on how we should design healthcare programs, apps, etc. as we move into the world of patient engagement and accountability. And we are moving there. Whether your focus is achieving meaningful use of your EMR (increasingly we’re going to be graded on how we engage our patients in this regard), the journey to becoming an Accountable Care Organization (as we enter an environment where we’re compensated for quality and efficiency, patient engagement becomes key) or simply that you realize that we don’t have enough healthcare providers to take care of all those folks who need it (in this case, patient engagement becomes a tool to give patients the opportunity to be their own providers, taking work off of our beleaguered primary care workforce), patient engagement is all the rage.

Right out of the gate, we health care providers have a big hill to climb. We are the ones who remind you that you are sick. Who wants to be engaged with that? Once patients get into the mindset of being sick, the context becomes pain, suffering, inconvenience, depression, time out of work, rehabilitation, and on and on. It’s no wonder that patients don’t engage much (other than the occasional masochist among us). And the conversation immediately gravitates to whether insurance will pay or not. We’ve observed patients in our connected health programs who are happy to go to the sporting goods store to fork over their own money for a heart rate monitor so they can watch their heart rate during a work out, but baulk at paying for a blood pressure monitor to be part of a hypertension program. After all, fitness is your own business, but when we’re talking about sickness your insurer owes you ….

Will People Eat Less If You Ask Them to?

Feb 10, 2012• 1

By Aaron Carroll MD

There are times I wish I had a macro for the beginning of a post on obesity. Some way to say obesity is bad, obesity is prevalent, and nothing seems to work. You know the drill.

But there’s a new study in Health Affairs that was surprisingly promising:

We performed three related field experiments at a single fast-food restaurant to determine whether these reported sentiments could be translated into a strategy to alter calorie consumption. All of the experiments addressed three important elements of eating behavior.

First, do people spontaneously request smaller portions—that is, even if smaller portions are not specifically noted as an option on a menu or signage? Second, do people accept explicit spoken offers to take smaller portions in order to reduce calories? Third, does taking a smaller portion of one meal component lead to indulgence in other meal components, so that the calorie “savings” from downsizing are immediately lost?

Each experiment addressed an additional question. In experiment 1, we explored whether offering a nominal (twenty-five-cent) discount for downsizing would result in more customers’ accepting the offer than offering no discount. In experiment 2, we examined whether offering an opportunity to accept a smaller portion would be more effective than providing calorie labels in encouraging moderation. In experiment 3, we investigated whether downsizing appealed only to customers who would otherwise have thrown away uneaten food, thereby affecting calories ordered but not calories consumed.

Let’s start with experiment 1. First, they measured how many customers would spontaneously request a smaller portion of a high-calorie, high-starch side dish. Not surprisingly, only 1% did. But if customers were asked, on the other hand, one third accepted the offer, regardless of whether a discount was offered. What’s more, those that did downsize did not compensate by up-sizing any other portions of the meal. Those that downsized ordered significantly fewer calories, 100 fewer on average.
Continue reading…

Obama’s Broken Promises

Feb 9, 2012• 22

By John Goodman

I didn’t vote for Barack Obama. But like a lot of Americans, I was hopeful about his presidency.

Just as it took a Republican to thaw our relationship with China, it will probably take a Democrat to reform our entitlement programs. Again and again, Obama promised to step up to the challenge. Then he left the country at the altar and pursued partisan politics instead.

Bill Clinton was going to be the first Democratic president to tackle entitlement spending. Although the effort has been completely ignored by the establishment media, Clinton was planning historic reforms during his second term. These were to include private accounts under Social Security and vouchers for Medicare.

If that doesn’t knock your socks off, you haven’t been paying attention. When Republicans propose these things, Democrats invariably claim the GOP is trying to destroy the social safety net and leave the elderly to fend for themselves.

Clinton was serious. He had his Treasury Department draw up detailed plans. In fact, when Pat Moynihan, the colorful intellectual senator from New York, was appointed by President George W. Bush to co-chair the Social Security reform commission, the first thing he did was ask the Treasury to send him the Clinton-era planning documents so that the commission could continue where Clinton’s policy team left off.

So what derailed Bill Clinton’s ambitious reform agenda? Monica Lewinsky. Left wing Democrats in Congress threatened to throw him under the bus in the impeachment proceedings unless he completely dropped the reform ideas they regarded as heresy. Unfortunately for the country, he obliged.

Dismantling the Affordable Care Act

Feb 9, 2012• 9

By Robert Laszweski

I have no idea which way the Supreme Court will rule this year on the Affordable Care Act. Let me go out on a limb and predict a 5-4 vote on the question of whether the individual mandate is Constitutional. Just don’t ask me which way the vote goes.

I found the recent Obama administration brief submitted to the Court on the mandate question somewhat ironic. Not surprisingly, the Obama Justice Department argued that a finding by the Court that the individual mandate is unconstitutional should not jeopardize the vast majority of the new health law.

But the Obama Justice Department did concede that there are two provisions of the Affordable Care Act that should also be declared invalid if the Court rules the individual mandate is unconstitutional—the health insurance guaranteed issue and community rating provisions.

Now, I know there are lots of other people, many of them filing briefs with the Court, that disagree arguing that the whole law needs to be found invalid because the mandate is the lynchpin for all of it. But I will suggest it is significant that the administration would appear to be building a firewall for the rest of the law as they concede these points.

But consider this potential scenario.

Getting Better

Feb 9, 2012• 3

By David Shaywitz

In my last column, I discussed the need for a better way of connecting the discrete healthcare-related problems identified by patients and physicians with solvers who might be able to develop a solution – perhaps an immediate fix, perhaps a longer-term effort.

I’m grateful for the volume of feedback received about this idea, which has included specific suggestions from patients; an introduction by several CEOs to a range of relatively-new efforts designed to tackle different key elements of this idea; and a few frustrated entrepreneurs who poignantly describe their struggles trying to change a fairly intransigent system.

A few observations about some of the online patient communities that I’ve encountered: First, there appear to be a number of patient-support (peer-to-peer) communities, both disease specific and more general. Several in the general category (e.g. MDJunction, Inspire, HealingWell) seem at least superficially similar; presumably the user experience depends upon the level of participation within a particular patient community.

Other models seem obviously distinctive: for example, AskaPatient provides fairly detailed patient-submitted reviews of various medications; the prose tends to be a bit less dry than the typical drug label – for example, a recent user of one neuropsychiatric medication reported that “Having an orgasm is like smashing a pimple. I am not sure if I want to continue taking this drug.” Yes, think that one over.Continue reading…

The Political Economy of Health Information Technology

Feb 8, 2012• 3

By Mike Miliard

Healthcare reform is arguably the hot-button political issue of our time. And with the Supreme Court locked and loaded to decide the fate of the Affordable Care Act this summer, it’s a safe bet the controversial two-year-old legislation will have a huge impact on the 2012 election and beyond.

But what about health IT? If “Obamacare” has been a lightning rod, sparking historically nasty partisan bickering – Congress vs. President Obama, Republicans vs. Democrats, Fox News vs. MSNBC, the Tea Party vs. MoveOn.org – Washington’s efforts to spur healthcare information technology have enjoyed much broader support, on both sides of the aisle.

Just last week, a Washington think tank whose healthcare wing is led by two erstwhile rival Senate Majority Leaders put its weight behind smarter and more widespread use of technology and data exchange in healthcare organizations nationwide.

“To deliver high-quality, cost-effective care, a physician or hospital needs good information,” said former senator Bill Frist, MD, upon the release of a report, on Jan. 27, from the Bipartisan Policy Center’s Task Force on Delivery System Reform and Health IT. “Data about patients has to flow across primary care physicians, hospitals, labs, and anywhere that patients receive care.”

Health Hack the Planet: Japan’s Upcoming Code-a-thon

Feb 8, 2012

By Deb Linton

Health 2.0 and the Health 2.0 Fukushima Chapter are proud to announce the next competition in the Developers World Cup series: The Health 2.0 JAPAN Hackathon. On February 21st and 22nd, Health 2.0 will host this inaugural event at Nihon University in the Fukushima prefecture (map) in conjunction with Medical Creation Fukushima Exhibition and the Health 2.0 Fukushima Chapter Meeting.

The Health 2.0 Developers World Cup is an international innovation competition to improve the technology supporting our world’s healthcare systems. Through our local chapters, Health 2.0 invites teams to use the growing number of open health datasets and APIs now being made available to rapidly prototype health related applications for the chance to win prize money and international visibility. The first place winners of each local code-a-thon will be flown to San Francisco to face-off against other finalist teams at the 6th Annual Fall Health 2.0 Conference for the Developers World Cup title. Regional competitions are being held in New Delhi, New York, Amsterdam, Austin, Boston, Russia, China and Washington DC.

We’re particularly excited to see the results of this regional competition given the increasing popularity of hacking events in Japan. Hack For JAPAN, a series targeting solutions for disaster recovery after earthquakes, has established a strong community of developers ready to tackle big problems. With its more experienced teams, it will be interesting to see who Japan sends to the international finals in the Fall.

The competition has been divided into 3 categories because of the large number of innovators expected to attend. There will be a traditional Code-a-thon, a Design-a-thon, and an Ideathon. The Code-a-thon will center around disaster recovery services, smartphone use and Osirix applications. The Design-a-thon will focus on improving breast cancer exams and 3D virtual animations to improve patient-doctor communication. Finally, the Ideathon will look at how to improve healthcare for disaster victims, remote populations and healthcare recovery in Fukushima.

Registration is filling up quickly and there are only a few more days left to sign up. You can learn more about the event and register HERE but we recommend that you first fire-up Google Translate if your kanji is a little rusty.

Should Sugar Be Controlled Like Alcohol? Part II

Feb 7, 2012• 16

By Aaron Carroll MD

Lots of interesting feedback on my post on sugar regulation. Some of you have accused me of making straw man arguments; others have used straw man arguments to question my post. So let me take a few minutes to be clear about what I was saying. The article I referenced specifically questioned whether sugar should be regulated like alcohol and tobacco.

We regulate alcohol by making it illegal to use it before the age of 21. Period. We regulate alcohol by making businesses get a specific, and often hard-to-get, license to sell it. Where I live, it’s illegal to sell it on Sunday. We don’t regulate alcohol by limiting the amount you can put in a drink. Any bar can make any drink they like, with as much or as little alcohol as they want.

We regulate tobacco by making it illegal to use it before the age of 18. Period. We regulate it by making businesses sell it in specific areas, often hard-to-get at. It’s illegal to put it in vending machines. But we don’t regulate tobacco by limiting the amount you can put in a cigar. Any cigar maker can put as much or as little tobacco in as they want.

So when someone says that they want to regulate sugar like alcohol or tobacco, that’s what I think of. And it was what they meant, according to reports:

Sugar is so toxic it should be controlled like alcohol, according to new report that goes so far as to suggest setting an age limit of 17 years to buy soda pop.

A Better Way to Avoid Pregnancy

Feb 6, 2012• 86

By John Goodman

You know we have entered the silly season when a major national debate gets underway over whether people should be given something for free that they could easily pay for out-of-pocket. Take the decision of the Obama administration to force Catholic universities, hospitals and charities to provide health insurance that includes free contraceptives. The reaction was poignant and hyperbolic, but (what can I say?) completely deserved:

“An edict delivered with a sneer,” wrote Michael Gerson in The Washington Post.
“An attack on Christianity so severe that every single church in Florida had a letter read from the bishops,” said Newt Gingrich.
“We can’t just lie down and die and let religious freedom go,” said a spokeswoman for the Conference of Catholic Bishops.
“We do not happen to think pregnancy is a disease,” said the president of the Association of Catholic Colleges and Universities.
People who postpone conception with “chemicals and latex” are part of the “culture of death,” said Archbishop Timothy Dolan.

What makes this so amazing is that it is déjà vu all over again, as Yogi Berra might say. Do you remember the death knell for HillaryCare? I bet you can’t.

Mammograms and Pap smears. Hard to believe, isn’t it?

[Yes, I know. There were many things that helped derail HillaryCare. The biggest mistake was the White House’s failure to throw everything aside and endorse the Senate Republican health plan, which was about as close to HillaryCare as RomneyCare is to ObamaCare. Hillary would have ended up with about 90% of everything she wanted. More about that, perhaps, in a future Alert.]