The Health Care Blog – Page 671 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Is Epidemiology Worthless?

Jan 6, 2012• 7

By Seth Roberts

Epidemiology has lots of critics. In this article, for example, it is called “lying on a grand scale.” Every critique I have read has ignored history. Epidemiologists have been right about two major issues: 1. Heavy smoking causes lung cancer. 2. Folate deficiency causes birth defects. In both cases, the first evidence was epidemiological. Another example is John Snow’s conclusion about the value of clean water. In my experience, epidemiologists often overstate the strength of their evidence (as do most of us) but overstatement is quite different from having nothing worth saying.

Let’s look at an example. Many people think osteoporosis is due to lack of calcium. Bones are made of calcium, right? The epidemiology of hip fractures is clear. In spite of the conventional idea, the rate of hip fracture has been highest in places where people eat a lot of calcium, such as Sweden, and lowest in places where they eat little, such as Hong Kong. (For example.) In other words, the epidemiology flatly contradicted the conventional idea. This was apparently ignored by nutrition experts (everyone knows correlation does not equal causation) who advised millions of people, especially women, to take calcium supplements to avoid osteoporosis. Millions of people followed (and follow) that advice.

The Earbud Epidemic

Jan 6, 2012• 2

By Doc Gurley

A new study shows that one in five Americans, 20%, has some form of hearing loss. That is a huge number and much larger than anyone had previously thought. According to the study, in the Annals of Internal Medicine, that means 48 million Americans hear so poorly that they cannot understand a companion in a crowded restaurant. Until this study, estimates had been that the number of Americans with this level of hearing loss was less than half the number found or under 10%.

The study looked at Americans 12 years and older who have had their hearing tested rather than previous studies that relied on self-reported data. This study used the World Health Organization’s definition for hearing loss, which is not being able to hear sounds of 25 decibels or less at the frequencies for speaking. And it found that of those 20%, 13% had hearing loss at that level in both ears. The remainder had it in just one.

The study draws no conclusions about the reasons for this – nor does it state that this is something that has changed over time. It is well known that people’s hearing deteriorates over time and it is also well-known that people can damage their hearing by listening to sounds at inappropriate volume levels for periods of time. That’s why people protect their ears when working with loud machinery, etc.

Harvard Business School Future of Healthcare Conference

Jan 5, 2012• 5

By Stephanie Bartz

Personalized medicine, iPads, insurance exchanges, non-profit/private partnerships…what will healthcare look like in 2020? The healthcare industry today is under enormous stress. Big Pharma is struggling to fill its pipeline, and the biotech industry has failed to deliver sustainable profits for its investors. Health plans operate under enormous uncertainty as reform hits one political roadblock after another. Hospitals struggle to find profitable business models, while patients struggle to find safe, affordable and high-quality care.

But the future of healthcare remains incredibly promising. Scientific discoveries and business model innovations are shaping the healthcare of tomorrow, today. But what will that future look like? On February 4th, over 600 industry leaders, professionals, and students will gather at Harvard Business School for its 9th Annual Healthcare Conference to answer that very question. Karen Ignagni, CEO of America’s Health Insurance Plans (AHIP) and one of Modern Healthcare’s “100 Most Influential People in Healthcare”, will discuss the future of the health insurance industry. Other keynote speakers include Bill Crounse, Senior Director, Worldwide Health for Microsoft and contributor to Microsoft Healthblog, and Larry Culp, CEO of Danaher, who will discuss broader trends in healthcare IT and innovation.

A variety of topics will be debated during panel sessions where moderators are encouraged to challenge panelists to envision the healthcare business models of tomorrow. In the Biotech & Pharma panel, for example, panelists will discuss the rise of tailored therapeutics―Dr. Stephen Spielberg, Deputy Commissioner of the FDA, will provide his perspective on the regulation of personalized treatments. The Payor & Provider Panel will explore the shift to an outcomes-based future―Regina Herzlinger, author of “Who Killed Health Care?” and often dubbed the “Godmother” of consumer-driven Healthcare movement, will share her viewpoint.

Winners Announced in “Using Public Data for Cancer Prevention and Control” Innovation Challenge

Jan 5, 2012• 1

By Austin Cohen

At the Hawaii International Conference on Systems Sciences (HICSS) yesterday, Wednesday January 5, the Office of the National Coordinator for Health IT (ONC) and the National Cancer Institute (NCI) announced the winners of the “Using Public Data for Cancer Prevention and Control: From Innovation to Impact” Challenge. Congratulations to the winning teams, Ask Dory! and My Cancer Genome.

The public challenge launched in July 2011 in conjunction with the National Cancer Institute and under the auspices of the ONC’s Investing in Innovation (i2) program. The Challenge asked developers to create solutions that addressed various gaps in foci across the cancer control continuum. In addition to building applications that bridge these gaps, participants were instructed to design solutions in ways that promoted and made possible healthy decision-making, early detection and adherence to treatment plans.

New Year’s Predictions: More Mandates (Maybe), House Rules at CMS

Jan 5, 2012• 3

By DAVID DRANOVE

As the New Year begins, I look forward to reading and commenting on the latest developments in health economics. I thought I would start by making a few predictions:

1) With the economy on a slow but steady road to recovery, Republicans will resurrect health reform as a key issue in the fall election. They run a controversial ad showing a patient named Debbie getting diagnosed by her iPhone’s Siri. In response, Democrats show Debbie filing for bankruptcy because her insurance refused to pay for Siri’s consultation fee.

2) The Supreme Court will uphold the purchase mandate in the Affordable Care Act. Lobbyists for every major industry flood Congress with requests for more purchase mandates.

3) Healthcare continues to be a bright spot in a sluggish labor market. As a way to simultaneously address persistent unemployment and the growing needs of the elderly, Nancy Pelosi proposes a new law mandating that all baby boomers purchase a caregiver for their parents.

4) CMS will release new revised rules for ACOs. The new rules discourage ACOs from only covering patients in good health by reducing reimbursements for patients who are able to lift the new 1200 page ACO rulebook.

The Decline of the Public Good

Jan 5, 2012• 69

By Robert Reich

Meryl Streep’s eery reincarnation of Margaret Thatcher in “The Iron Lady” brings to mind Thatcher’s most famous quip, “there is no such thing as ‘society.’” None of the dwindling herd of Republican candidates has quoted her yet but they might as well considering their unremitting bashing of everything public.

What defines a society is a set of mutual benefits and duties embodied most visibly in public institutions — public schools, public libraries, public transportation, public hospitals, public parks, public museums, public recreation, public universities, and so on.

Public institutions are supported by all taxpayers, and are available to all. If the tax system is progressive, those who better off (and who, presumably, have benefitted from many of these same public institutions) help pay for everyone else.

“Privatize” means pay-for-it-yourself. The practical consequence of this in an economy whose wealth and income are now more concentrated than any time in 90 years is to make high-quality public goods available to fewer and fewer.

Much of what’s called “public” is increasingly a private good paid for by users — ever-higher tolls on public highways and public bridges, higher tuitions at so-called public universities, higher admission fees at public parks and public museums.

The slow integration of community into health care

Jan 3, 2012• 1

For a long time now patients have been meeting in online (and offline) communities, sharing experience, advice and more recently data and measurements. And the health care system–which knows that communities improve health–has done virtually nothing–other than some doctors having doctors answer questions on MedHelp. That is just starting to change. Last year Geisinger did a small trial with dLife that showed improvement in diabetics outcomes. More recently Aetna inked partnerships with MindBloom and OneRecovery, two communities focused on spirituality and addiction, and today Diabetic Connect (part of Alliance Health) announced a deeper integration with the Joslin Diabetes Center. It’s been a while, but the heart of Health 2.0 (communities) are starting to move towards the mainstream.

Teaching Residents about Costs: The Price is Right

Jan 3, 2012• 8

By Shilpa Iyer

It all started while out to dinner with a couple of my fellow Brigham/Massachusetts General Hospital OB/Gyn residents. We were discussing our favorite old TV shows and one fellow resident’s love of The Price Is Right with Bob Barker. After talking about the game show, a light bulb went off in my head and I thought, “Why can’t we play The Price is Right with hospital charges to our patients?”

With further discussion we realized that none of us knew the hospital charge, or the cost to our patients for routine workups we routinely order in our gynecology clinic. We really had no idea.

After asking around, I realized that I was not alone in my lack of knowledge, or the idea to play The Price is Right with hospital charges. A couple of years prior the Massachusetts General Hospital Internal Medicine residents had played a similar game with the goal to create awareness of the costs associated with routine workups.

Usual, customary and made up

Jan 2, 2012

By Matthew Holt

It’s been a while since THCB discussed usual customary and reasonable charges, and it’s been longer since health plans did much about them–other than cover them at a low rate and let providers charge what they like. That’s mostly because Ingenix (now Optum Insight) got itself and United beaten up about the topic a while back. But I noticed today (via a company selling expensive webinars about the topic) that Aetna is starting to go after providers that are gilding the Lilly on out of network charges again. In this case a couple of surgeons who were self-referring to a surgery center they owned, not charging the patients their official share, and meanwhile somehow managed to charge nearly $100K for ear wax removal. Aetna, don’t forget, was the “nice” insurer that started the trend of settling with doctors and being nice to them over pricing back in Jack Rowe’s time as CEO. If Aetna’s now starting to get aggressive about out of network charges to its members, then perhaps we really are entering a new era of health insurer activity.