The Health Care Blog – Page 676 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

What Missy Did Next

Jan 10, 2012

By Matthew Holt

While I was blundering around the excellent Venrock/athenahealth party last night I ran into Missy Krasner. Missy ran David Brailer at ONC and then ran Adam Bosworth at Google Health and is as good as anyone in spotting and being around the trends in health IT. So what’s she doing now? Well she’s joined Rebecca Lynn’s crew at Morgenthaler Ventures. Is this cause for the boys of health IT VC to get afraid? Probably yes.

So what is Missy actually going to do? I had the good sense to ask her and she had perhaps less sense in telling me in quite some detail:

During my 5 years at Google on Google Health, we met with alot of innovative healthcare startups who came in and pitched their solutions as possible integration partners or acquisition targets. There is still so much out there that has not be adequately addressed: end-of-life documentation, personalized health and provider search, big data and analytics, patient/provider communications via ACO trends, transparency solutions for benefit design and EBOs, patient UGC and the social web, cheaper and better reimbursable telemedicine, and on and on. With all the innovation coming out of the various health IT accelerators and government app challenges, it’s a great time to align with a seasoned venture firm and take a deeper look at what is really ripe to become a market disrupter.

Continue reading…

2012: A Year of Huge Uncertainty in Health Care Policy

Jan 10, 2012• 5

By Robert Laszweski

2013 may be the most significant year in health care policy ever.

But we have to get through 2012 first.

Once the 2012 election results are in there will be the very real opportunity to address a long list of health care issues.

If Republicans win, the top of the list will include “repealing and replacing” the Affordable Care Act. If Obama is reelected, but Republicans capture both houses of Congress, we can still expect a serious effort to change the law. Then there is the granddaddy of all problems, the federal debt. The 2012 elections could well prepare the way for entitlement reform—particularly for Medicare and Medicaid. Even if Obama is reelected, the 2013 agenda will include a serious debate about Republican ideas to change Medicare into a premium support system and block grant Medicaid to the states.

If the election is a draw with neither side able to unilaterally move their agenda—likely in the form of Obama still in the White House but facing a Republican Congress, the pressure to deal with the growing costs of Medicare and Medicaid as well as nagging concerns about the implementation of the Affordable Care Act will create an imperative for action in 2013.

Why Didn’t ICD-10 Implementation Bring Down Europe’s Health System?

Jan 10, 2012• 14

By Don Fluckinger

We’re seeing a lot of pushback against ICD-10 implementation, with the American Medical Association’s “vigorous opposition” at the extreme. Gloom and doom types equate to potential IT disaster to Y2K. Ever since watching T. Bedirhan Üstün, M.D. — curator of the International Classification of Diseases, the master coding set from which ICD-10 is derived – present at the American Health Information Managers (AHIMA) annual meeting last October, a question’s been gnawing at me:

If flipping the switch on ICD-10 come Oct. 1, 2013 will be such a disaster as groups like the AMA claim it will be, then why didn’t it bring down the European and Asian health systems that implemented their own flavors of ICD-10 years ago?

The reporter in me – especially when hearing people couch ICD-10 in terms like “unfunded mandate” and “sky-is-falling” hyperbole – suspects it’s all about politics. During the course of debate in these times, it seems as if people on both the left and right resort to browbeating rhetoric faster than I’ve ever seen in my life. And why not? Reciting the catchphrase du jour requires far less reasoning than a well-constructed, original thought.

Recession Drives Lower Health Spending

Jan 10, 2012

By Merrill Goozner

The Great Recession has achieved what 20 years of policy machinations in Washington could not. For the second straight year, the world’s most expensive health-care system did not gobble up a greater share of the nation’s economy. In fact, health care grew at a slightly slower pace.

Health spending rose just 3.9 percent to $2.59 trillion in 2010, only one-tenth of a percentage point faster than the previous year. That was slightly below the 4.2 percent nominal growth in gross domestic product (GDP), which means health care stayed at 17.9 of the total economy, no different than the prior year.

This represents the third straight year of markedly slower growth in health-care spending, compared to the prior decade. Health care was 13.8 percent of GDP in 2000 and 12.5 percent in 1990.

The lingering effects of the U.S. economic slowdown were largely responsible for a slower growth of health-care consumption, economists at the Centers for Medicare and Medicaid Services said. Cash-strapped consumers postponed elective surgeries, put off doctor visits and switched to generic drugs to hold down out-of-pocket costs, which grew just 1.8 percent in 2010.

The economic downturn “caused many people to lose employer-sponsored health insurance and people cut back on their use of care,” said Anne B. Martin, an economist at the Centers for Medicare and Medicaid Services.

What Doctors Can Learn from the New England Patriots

Jan 9, 2012• 17

By Davis Liu, MD

As the new year starts, I’m eager for a fresh start and working on improving myself both physically and emotionally. I’m also eager for the NFL playoffs and seeing how my favorite team, the New England Patriots, fares under the leadership of Coach Bill Belichick and quarterback Tom Brady. Doctors and health care can learn much from their examples.

Over the past decade, the New England Patriots have been dominant appearing in 40 percent of the Super Bowls played and winning 3 out of 4. Nothing prior to 2000, would have suggested this superior performance with playoff appearances only six times from 1985 to 2000 and two Super Bowl appearances, both losses. Their new head coach Bill Belichick hired in 2000 had a losing record in his prior stint at Cleveland. Their current quarterback Tom Brady was drafted in the second to last round.

The Essential Bargain

Jan 9, 2012• 8

By Jonathan Halvorson

The ACA has included a long series of bargains to achieve universal health care in the face of two forces: a multi-trillion dollar health care industry, and an implacable political opposition that refuses to bargain. Whatever the merits and blunders of the compromises taken, it should have come as no great surprise that the guidance released at the end of 2011 for the minimum benefit set (the “essential benefits”) was yet another compromise. It bowed to the existing authority of the states by allowing them leeway to decide the essential benefit package, despite the fact that the law itself seemed to intend a single national standard. There are limits, of course: ten categories of benefit must be covered (hospital, lab, maternity, dental, etc.) and the details on what is covered must be set by reference to one of four model plans:

• One of the three largest small group plans in the state by enrollment;
• One of the three largest state employee health plans by enrollment;
• One of the three largest federal employee health plan options by enrollment;
• The largest HMO plan offered in the state’s commercial market.

Predictably, immediate reactions were mostly negative. It was almost universally described as a “punt” by the administration, but a more accurate football metaphor is that the new guidance was a field goal. It’s certainly better than not scoring at all, and games can be decided by field goals. But it also means that your offense wasn’t good enough to close the deal on a touchdown. In that way, you can look at a field goal as one step closer to losing. For different reasons, that is exactly what some foes and supporters alike of the ACA will say about the new guidance.

What if They Had Had to Pay?

Jan 9, 2012• 44

By Paul Levy

A true story, with changes made to protect privacy. An 89-year-old man with dementia, a heart condition, and other serious medical conditions fell in his Arizona apartment and broke his hip. His children, wanting the best possible care, arranged for him to be air-lifted to New York. There, the orthopaedic surgeon advised them that the chance of their father surviving hip surgery was very low, but he would do as the family wished. The man’s three children could not agree. Two would have avoided the surgery, but a third felt very strongly that everything that could be done for the father should be done. The other siblings, out of guilt and respect for the third, acceded. The surgery took place, and the father spent three days in the ICU before his heart gave out.

Here’s the terrible and hard-hearted question I pose: If the costs of this procedure and hospitalization had not been covered by Medicare, would the man’s children have proceeded along the chosen path? I am guessing not. I don’t know the total bill incurred, but it was certainly in the range of tens of thousands of dollars.

In the US, we don’t have a good societal process for making these decisions. In the United Kingdom, though, they do, as reported by Bob Wachter in a recent blog post. Here are some excerpts:

Progress made by ONC (Really!)

Jan 6, 2012

By Matthew Holt

ONC Director Farzad Mostashari is out with his review of 2011 on a month by month basis. Good to see that Farzad & colleagues took December 2011 off (just kidding!). He calls it a year of “momentous” progress. I’m doubly biased because I’m a proponent of newer and better health technology for clinicians AND citizens. Also, (FD) Health 2.0 is the main subcontractor on the i2 Investing in Innovation challenges which were–as noted by Farzad–launched in June, have had several close already, and will continue to roll off the production line for another 18 months. But as a general and occasionally cynical observer I’m very impressed with what ONC has done. Continue reading…

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.