The Health Care Blog – Page 692 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

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…

Making Sense of Health Care Prices

Sep 23, 2011• 43

By JOHN GOODMAN

Take a look at the chart below. It shows representative prices for a knee replacement for different patients in different settings. The most shocking thing about the chart is that prices for essentially the same procedure are all over the map. Here are some obvious questions:

Why is the price of a knee replacement for a dog — involving the same technology and the same medical skills that are needed for humans — less than 1/6th the price a typical health insurance company pays for human operations? Why is it less than 1/3 of what hospitals tell Medicare their cost of doing the procedure is?
How is a Canadian able to come to the United States and get a knee replacement for less than half of what Americans are paying?
How are Canadians getting knee replacements in the U.S. able to pay only a few thousand dollars more than medical tourists pay in India, Singapore and Thailand — places where the price is supposed to be a fraction of what we typically pay in this country?
Why do fees U.S. employers and insurance companies are paying vary by a factor of three to one, when foreign, and even some U.S., facilities are offering a same-price-for-all package?

It’s amazing how often people cannot see the forest for the trees. Think how many volumes have been written trying (and failing) to explain why our health care costs are so high. Sometimes the answers to complex questions are more easily found by asking the simplest of questions.

The Math of E/M Coding: When Does 5=1?

Sep 23, 2011• 6

By PAUL FISCHER, MD

My typical Medicare patient expects me to deal with 5 or more problems in a single routine visit. There are usually around 3 old ones (e.g., diabetes, hypertension, hyperlipidemia) and at least 2 new ones (e.g., low back pain, fatigue). For those who come with handwritten lists, there may be as many as 10, including every health question that has come to mind over the past 6 months (Should I take a holiday off of Fosamax? Should I add fish oil? Do I need another colonoscopy? Is the shingles shot any good?).

Physicians who do procedures get paid for each one done to a single patient on a particular day. Medicare’s rule for this – the Multiple Procedure Payment Reduction Rule (MPPR) – says doctors should be paid 100% for the first procedure and 50% for each subsequent procedure up to 5. However, for those of us whose work is primarily cognitive rather than procedural, there is an important exclusion: the multiple-payment rule does not apply to E/M codes. In fact, the definitions of 99213 and 99214 unambiguously state, “Usually the presenting problem(s) are of . . . complexity.” Note the “(s)”! It clearly creates a double standard that favors doing procedures and places thoughtful solving of patients’ problems at a disadvantage.

So in my case, 5 or 10 or more separate patient problems equal one payment. The “(s)” in the AMA’s CPT book is the most outrageous injustice to primary care of this generation. Because of it, the AMA’s CPT committee is accountable for even more damage to primary care than is their RUC! Think how different life in primary care would be if the “(s)” were removed and you were paid 50% for each additional patient problem you addressed in a single office visit!

How Obama Hits Health Providers in Deficit Plan

Sep 23, 2011• 4

By MERRILL GOOZNER

President Obama’s populist message on taxes was replicated on the health savings side of his deficit-reduction plan, which would cut spending on Medicare and Medicaid by $320 billion over the next decade and $1 trillion in the following decade.

The bulk of the savings would come from companies that provide goods and services to the programs. Payments to drug companies would be slashed by $135 billion by offering seniors in Medicare the same discounts currently mandated for poor people in Medicaid. An additional $42 billion in program savings would be achieved by reducing payments to nursing homes and home health care agencies.

And those are just the major hits taken by health-care providers in the plan, which is already drawing fierce opposition from lobbyists for industries that get whacked. Rural hospitals, big city teaching hospitals, biotechnology firms, and durable equipment manufacturers also would be in for payment cuts under the Obama blueprint.

Major trade associations representing provider groups immediately blasted the proposal, playing the same jobs card the president is using. The Pharmaceutical Research and Manufacturers Association “opposes implementing Medicaid’s failed price controls in Medicare Part D,” the group said in a prepared statement. “Such policies would fundamentally alter the competitive nature of the program, undermine its success, and potentially cost hundreds of thousands of American jobs.”

Health 2.0 Launch! Finalists Announced

Sep 22, 2011• 3

By Matthew Holt

Since we first put it on at Health 2.0 in 2008, Launch! has introduced over 45 new companies and products, including Unity Medical, Remedy Ventures, TheCarrot, and the WSJ’s 2010 top (and not just in health!) start-up company, Castlight Health. Launch! is the first time a company has demoed at a conference, and the product must either be coming out soon or have been in very limited beta to this point. This year, we’re seeing some larger better funded companies on Launch! but everyone’s had to compete to get on and there are some teeny start-ups here that you’ve never heard of that might just blow you away. It’s 10 continuous 4 minute demos, and the winner gets a main stage spot next year, not to mention bragging rights. Who wins? The audience decides. Yes you can still get one of the last few tickets (but we’ll sell out in next day or two).

Below (in alphabetical order) for the first time, we’re thrilled to announce the Launch! finalists for 2011:

Basis–There’s been lots of excitement in the Health 2.0 offices about getting hold of one of these devices. It looks like a watch but it tracks heart rate more than time. CEO Jef Holove will finally show us what they’re like.
Clarimed–CEO Nora Iluri will show us her ambitious attempt to measure devices and much more in health care and communicate the results to lots of constituencies including consumers
CareCoach–Almost everything we hear in a doctor’s office is lost by the time we get to the parking lot. But a visit to the doctor is an expensive and important time that should be captured, reviewed and shared with family. CEO Jeff Kozloff shows how CareCoach does that.Continue reading…

The Super Committee—Will We Get a Deal?

Sep 22, 2011• 7

By ROBERT LASZEWSKI

It’s back to work in Washington, DC and all the attention is now on the Super Committee and their goal of cutting spending by at least $1.2 trillion over ten years.

If the committee fails to come up with a plan that passes the Congress, there would be $1.2 trillion in automatic cuts. The health care special interests have reason to hope they will fail—the fallback cuts would only impact Medicare providers in a small way—2% in provider cuts—and not directly impact beneficiaries or Medicaid generally. Any Super Committee deal would likely be more far reaching if for no other reason than to protect the defense budget from the huge cuts the fallback would require.

But the fallback would not solve any of the systemic problems the health care entitlements face and only prolong the inevitable day of fiscal reckoning.

Even a $1.2 trillion reduction—$2.1 trillion with the additional $915 billion reduction in discretionary spending that was part of the deal—is only a down payment on solving America’s fiscal woes—we face a $10 trillion budget shortfall over the next ten years.

Will the Super Committee succeed? That’s the big question in Washington.