The Health Care Blog – Page 691 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

The Key to Improving Our Health? Look Beyond Health Care.

Sep 28, 2011• 3

By AARON WERNHAM, MD

The United States spent $2.5 trillion on health care in 2009, more per capita than any other nation. Yet our country is ranked 32nd in the world in life expectancy, and rates of conditions such as diabetes and obesity have increased dramatically in recent years.

If we hope to address spiraling medical costs and improve the health of all Americans, we need to begin focusing on the policies — in fields such as transportation, energy, education and agriculture — that shape the world outside the doctor’s office.

But how? Policymakers are already juggling shrinking budgets, crumbling infrastructure and competing priorities. A recently released report from the National Research Council offers a solution. The study, “A Framework and Guidance for Health Impact Assessment,” points out that good health is determined by more than money spent on the health care system. An NRC committee on health impact assessments, of which I am a member, took an in-depth look at why they are needed.

Similar to the way a Congressional Budget Office score predicts the fiscal impact of a proposed policy, an HIA identifies the likely effect on health of a decision in another field, such as building a major roadway, revitalizing a neighborhood or developing energy or agricultural policy. HIAs can help decision-makers identify unintended risks, reduce unnecessary costs and leverage opportunities to improve the health of their communities.

As a doctor, I’ve often cared for diabetics who struggle to follow exercise recommendations because there’s nowhere nearby that’s safe to exercise. I’ve seen patients with frequent asthma attacks exacerbated by living in housing with mold and poor ventilation. I’ve given diet advice to parents of overweight children, only to find that they live in a neighborhood with no grocery store for miles and eat school lunches that should but often don’t meet current nutrition guidance.Continue reading…

Too Much Responsibility/Not Enough

Sep 27, 2011• 16

By ROBERT LASZEWSKI

The Health Leadership Council (HLC), a coalition of CEOs from many of the leading health care companies, has created a list of Medicare reform recommendations for the Super Committee tasked with finding at least $1.2 trillion in budget savings.

As we begin the national debate over what to do about Medicare’s unsustainable costs, I will suggest that the HLC proposal gives us one, of what will have to be many, outlines for discussion.

Their recommendations include:

Creating a new Medicare Exchange, beginning in 2018, where beneficiaries would have the choice of private Medicare plans as well as the traditional Medicare plan. The HLC proposal would be a defined contribution program much like the Republican Ryan plan but would differ from Paul Ryan’s in a couple of key ways. First, in the HLC proposal traditional Medicare would continue to be one of the options. Second, the annual increase in the beneficiary support premium would be more generous—the HLC is proposing an annual premium support increase equal to GDP plus 1%.
Gradually increasing the Medicare eligibility age from 65 to 67—starting in 2014.
Reforming Medicare’s cost sharing structure by increasing deductibles and co-pays as well as requiring high-income beneficiaries to pay the full cost of Medicare Part B.
Implementing medical liability reform including a cap on non-economic damages, a one-year statute of limitations, and a “fair share” provision that would limit damages commensurate with responsibility for the injury.

The Challenge of ICD10 Adoption

Sep 25, 2011• 15

By JOHN HALAMKA

On October 1, 2013, the entire US healthcare system will shift from ICD9 to ICD10. It will be one of the largest, most expensive and riskiest transitions that healthcare CIOs will experience in their careers, affecting every clinical and financial system.

It’s a kind of Y2k for healthcare.

Most large provider and payer organizations, have a ICD10 project budget of $50-100 million, which is interesting because the ICD10 final rule estimated the cost as .03% of revenue. For BIDMC, that would be about $450,000. Our project budget estimates are about ten times that.

CMS and HHS have significant reasons for wanting to move forward with ICD10 including

1) easier detection of fraud and abuse given the granularity of ICD10 i.e. having 3 comminuted distal radius fractures of your right arm within 3 weeks would be unlikely
2) more detailed quality reporting
3) administrative data will contain more clinical detail enabling more refined reimbursement

Large healthcare organizations have already been working hard on ICD10, so they have sunk costs and a fixed run rate for their project management office. At this point, any extension of the deadline would cost them more.

Most small to medium healthcare organizations are desperate. They are consumed with meaningful use, 5010, e-prescribing, healthcare reform, and compliance. They have no bandwidth or resources to execute a massive ICD10 project over the next 2 years.

The Power in What We Most Fear

Sep 25, 2011• 2

By JOE FLOWER

There is fire in the valley and smoke in the mountains. A plague is on the land and danger is afoot. That may be — maybe — the good news.

Health care is more unstable than it has been at any time in living memory. That’s pretty scary, but that instability may turn out to be its most important asset in this moment, as the whole industry becomes open to profound change.

As long as I can remember, thoughtful analysts have been saying, “We need to do this differently. This is not working.” In this century, the voices became louder and more insistent, and they spread. But health care has been very slow to evolve in any fundamental way. Even health care reform, when it came through extraordinary political pain and maneuver, was more a way to bolster business as usual, a way to shore up revenue streams and patch holes in the fee-for-service business model, than it was any fundamental restructuring.

Now the ground under our feet is liquefying.

Educating the Health 2.0 Workforce

Sep 25, 2011• 1

By Charles Friedman & Wil Yu

As any new field of human activity evolves into something important, its original participants are drawn to it from a range of other fields and bring to it a wide range of backgrounds and experiences. For example, the original computer scientists were not schooled in computer science. The field didn’t exist when they were in school. The first generation of computer scientists were mathematicians, engineers, philosophers, among other things, who came together around shared interests in a set of challenging and important problems.

As computer science matured and proved its worth, however, something inevitable happened. Programs specifically to educate the next generation of computer scientists began to develop, and a range of questions arose about how best prepare them—how to combine math, engineering, philosophy into a new interdisciplinary program of studies.

Exploration of how to train its next generation gives shape to a new field, stimulates further growth and innovation, and ensures that that the next generation will be large enough to support a thriving enterprise. So it is with Health 2.0—a new field that has attracted an eclectic group of energetic pioneers and is beginning to mature. It’s time to think about the next generation.Continue reading…

Fun with Heritage on Health Affairs blog

Sep 25, 2011• 1

Here’s my comment on a recent Health Affairs blog post from Heritage’s Nina Owcharenko whining about the ACA as a g’vermint takeover.I wrote “I’m really pissing myself about this one. Only in the bizzarro world of American politics can the nutjobs on the right, and not just any nutjobs but on the right but Nina’s actual colleagues at Heritage design the basics of a health care policy and then declare it something that’s antithetical to their very being. Furthermore, it’s only in bizzarro world of American politics that a massive expansion of PRIVATE health insurance legislated in the ACA is called a government takeover, or in Nina’s words puts the “trend toward government-based coverage on the fast track”. If Nina had bothered to check she’d realize that the vast majority of Medicaid enrollees — 66% according to KFF– are in private plans and the rest are being moved there. Yet this is another expansion of government!” Of course if you look at the Health Affairs version where they moderate comments, you’ll note that some of the words I wrote and the words they publish are slightly different

Pre-Conferences kick off Health 2.0

Sep 25, 2011• 1

By Matthew Holt

We were coding up a storm yesterday (Saturday) at the Health 2.0 Developer Challenge Code-a-thon and that goes on today–you can even stop by the PariSoma Loft to see the live judging at 3pm — with $13,000 in prizes on the line.

But the main act is starting up TODAY with 4 fabulous pre-conferences. Don’t forget these are FREE to anyone registered to attend the main conference and to doctors, patients and employers as appropriate for their sessions. There’s also an Innovation Exchange with the Beacon Communities which has some public availability.

The Pre-Conferences: Patients 2.0 brings together more than 150 patient activists. Doctors 2.0 has several leading physicians on stage and in the audience, and more than 15 demos and active panel discussions. Employers 2.0 has leading employers again on stage and in the audience (Wanna meet Facebook’s head of benefits? -scan the badges!) and more demos than you can shake a stick at–as long as some cool case studies from Pfizer on wellness and Cisco on worksite clinics.Continue reading…

DC to VC: Health 2.0 Companies Pitch!

Sep 24, 2011• 1

By Laura Montini

Health Innovation Week continues in San Francisco, but, this past Thursday, Health 2.0 zipped down to the Microsoft campus in Mountain View for “DC to VC” – a fabulously organized event by Rebecca Lynn & Ching Wu of Morgenthaler Ventures and MC’ed by our very own Matthew Holt. Despite the prominent names of the organizers, the stars of this show were really the eleven HIT startups from across the US selected from a list more than 125 companies who had pitched for a spot on the stage.

Up first were six companies in the Seed stage category. Each was under two years old and has raised less than $500K so far. They were followed by slightly older, slightly more experienced startups in the Series A category. These companies were under three years old and have received less than $1.5 million in funding.Continue reading…