The Health Care Blog – Page 672 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

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.

The Crash of Air France 447: Lessons for Patient Safety

Jan 2, 2012• 7

By Bob Wachter, MD

From the start of the patient safety movement, the field of commercial aviation has been our true north, and rightly so. God willing, 2011 will go down tomorrow as yet another year in which none of the 10 million trips flown by US commercial airlines ended in a fatal crash. In the galaxy of so-called “high reliability organizations,” none shines as brightly as aviation.

How do the airlines achieve this miraculous record? The answer: a mix of dazzling technology, highly trained personnel, widespread standardization, rigorous use of checklists, strict work-hours regulations, and well functioning systems designed to help the cockpit crew and the industry learn from errors and near misses.

In healthcare, we’ve made some progress in replicating these practices. Thousands of caregivers have been schooled in aviation-style crew resource management, learning to communicate more clearly in crises and tamp down overly steep hierarchies. Many have also gone through simulation training. The use of checklists is increasingly popular. Some hospitals have standardized their ORs and hospital rooms, and new technologies are beginning to catch some errors before they happen. While no one would claim that healthcare is even close to aviation in its approach to (or results in) safety, an optimist can envision a day when it might be.

The tragic story of Air France flight 447 teaches us that that even ultra-safe industries are still capable of breathtaking errors, and that the work of learning from mistakes and near misses is never done.

Matthew’s end of year letter

Jan 2, 2012

OK, the new year has started, but those of you who are interested in my personal “End of 2011” letter about charities & causes can find it on my barely-used personal blog here—Matthew Holt

Which Health Incubator Should You Apply To?

Jan 2, 2012• 4

By Thuc Huynh, MD

Health startups are emerging in high numbers this year and it’s no surprise. The health tech space is booming with new advances in HTML5, mobile health, and social media. But with the economic downturn, it’s hard to go out on your own without funding or guidance. But there’s help. Over the past year, four startup incubators have surfaced offering a mentoring program specific to health technology entrepreneurs. But, which one should you apply to? Here’s a breakdown of each accelerator and their offerings:

How Did My 2011 Predictions Turn Out?

Jan 2, 2012• 1

By Evan Falchuk

Pretty well, actually.

As predicted last December, there was no big change to health care reform, doctors still didn’t have enough time with their patients, Microsoft (disclosure: Microsoft is a Best Doctors client) made moves to create a “Windows” for electronic health records, and “ACO” became the hot buzzword in health care. Some state governments started major redesigns of their benefits programs, saving money in the same ways private sector employers do. Meanwhile, more than ever, private sector employers are penalizing employees who don’t take care of themselves.

Misdiagnosis finally started to be recognized as a public health problem. At Best Doctors we got a great deal of press coverage in 2011 on this (for a few examples, go here, here, here, here and here). I will sneak in a 2012 prediction and tell you that you will hear a lot more about this this year, and not just from us.

What did I get wrong?

Well, I said no major employer would drop their health benefits – and none did, so I didn’t really get this wrong. But I was surprised to hear some very major employers quietly talking about their plans for dropping coverage in 2014. It’s a bad idea – and I would have thought its badness would have been enough to keep it off the table. For some employers, apparently not.

Why Getting to a Digital Health Care System Is Going to Be Harder Than We Thought Ten Years Ago

Jan 1, 2012• 1

By David Shaywitz, MD and Tory Wolff

A leading scientist once claimed that, with the relevant data and a large enough computer, he could “compute the organism” – meaning completely describe its anatomy, physiology, and behavior. Another legendary researcher asserted that, following capture of the relevant data, “we will know what it is to be human.” The breathless excitement of Sydney Brenner and Walter Gilbert —voiced more than a decade ago and captured by the skeptical Harvard geneticist Richard Lewontin [1]– was sparked by the sequencing of the human genome. Its echoes can be heard in the bold promises made for digital health today.

The human genome project, while an extraordinary technological accomplishment, has not translated easily into improved medicine nor unleashed a torrent of new cures. Perhaps the most successful “genomics” company, Millennium Pharmaceuticals, achieved lasting success not by virtue of the molecular cures they organically discovered, but by the more traditional pipeline they shrewdly acquired (notably via the purchase of LeukoSite, which ultimately yielded Campath and Velcade).

The enduring lesson of the genomics frenzy was succinctly captured by Brown and Goldstein, when they observed, “a gene sequence is not a drug.”

Flash forward to today: technologists, investors, providers, and policy makers all exalt the potential of digital health [2]. Like genomics, the big idea – or leap of faith — is that through the more complete collection and analysis of data, we’ll be able to essentially “compute” healthcare – to the point, some envision, where computers will become the care providers, and doctors will at best be customer service personnel, like the attendants at PepBoys, interfacing with libraries of software driven algorithms.

A measure of humility is in order. Just as a gene sequence is not a drug, information is not a cure. Getting there will take patience, persistence, money and aligned interests. The most successful innovators in digital health will see the promise of the technology, but also accept, embrace, and ideally leverage the ambiguity of disease, the variability of patients, and the complexities of clinical care.
Continue reading…

A Look Back at 2011

Dec 31, 2011• 12

By John Halamka, MD

2011 was a year of change and tumult. For a day by day look at the top stories of 2011, check out this impressive chart from the UK Guardian.

It was a year in which the economy sputtered worldwide, the Arab Spring toppled several regimes, and unprecedented acts of nature (severe weather, earthquakes) caused billions in worldwide damage.

What about the world of healthcare IT?

Federal

In 2011, Meaningful Use and Certification accelerated healthcare IT adoption and doubled implementation of EHRs throughout the country. Every aspect of the industry was stressed along the way

Vendors were challenged to add the features necessary for certification resulting in some “haste makes waste” lack of usability and workflow integration. GE admitted its faults and should be congratulated for its honesty, since many other vendors had the same problems but did not communicate them.
IT organizations created productivity miracles to meet meaningful use timeframes with limited staff and limited budgets. Many organizations will apply their meaningful use payments to general operations and not IT department budget increases, so the sacrifice of IT staff may remain unrecognized.
Providers had to radically change workflows to accommodate new business processes, resulting in staff turnover and short term frustration.

Acne Cured by Self-Experimentation

Dec 30, 2011• 9

By Seth Roberts

In November, at Quantified Self Europe, Martha Rotter, who lives in Ireland, gave a talk about how she cured her acne by self-experimentation. She summarizes her talk like this (slides here):

When I moved to Ireland in 2007, I began to have skin problems. It began gradually and I attributed it to the move, to stress, to late nights drinking with developers and clients, to travel, to whatever excuses I could think of. The stress was multiplied by the anxiety of being embarrassed about how my face looked, but also because my new job in Ireland involved me being on stage in front of large audiences constantly, often several times a week. A year later my skin was perpetually inflamed, red, full of sores and very painful. When one spot would go away, two more would spring up in its place. It was a tough time. I cried a lot.

Frustrated, I went to see my hometown dermatologist while I was home for holidays. He told me that a) this was completely normal and b) there was nothing I could do but go on antibiotics for a year (in addition to spending a fortune on creams and pills). I didn’t believe either of those things.

I was not interested in being on an antibiotic for a year, nor was I interested in Accutane (my best friend has had it multiple times and it hasn’t had long term results, plus it can be risky). What I was interested in was figuring out why this was happening and changing my life to make it stop. I refused to accept my dermatologist’s insistence that what you put in your body has no effect on how you look and feel.

Continue reading…

2011’s Last Viral Lie About Health Reform

Dec 30, 2011• 19

By Linda Bergthold

When so many good things have happened as the result of health care reform, I hate to end this year with a rebuttal to a viral lie about the Affordable Care Act. However, this one seems to come from a credible source but is so wrong that I can’t resist.

This is how the email reads:

“MUST LISTEN This needs to go viral. A brain surgeon called into the Mark Levin show. If you are over 70 years of age and you go to the ER and you are on government supported care, you will get comfort care instead of surgery. A government panel (a group of people that know absolutely nothing about medicine) will decide if you can have surgery and it has been decided that it will be denied if you are over 70. Patients will also be called “units” instead of “patients”. Sarah Palin was correct–DEATH PANELS!”

http://www.youtube.com/watch?v=0wsnHGI5K-E&feature=player_embedded

The video shows the radio host, Mark Levin, listening to this so-called brain surgeon call into his show. The surgeon claims that he has just been to a meeting of the American Association of Neurological Surgeons in Washington, D.C., where he learned something shocking! Obamacare will require only “comfort care” for people over 70. If you read the comments below the YouTube video, you are directed to the AANS site itself, where the Society blasts this person and his claim as a complete hoax. This disclaimer is on the AANS site under the “AANS news” subtitle: