http://vimeo.com/28940439
Oh The Jobs (Debt?) You’ll Create! from Marketplace on Vimeo.
Brilliantly done from Marketplace’s senior health care reporter Gregory Warner.
Above the Fold
5 Ways You Can Avoid Being Misdiagnosed
Billionaire Teddy Forstmann has apparently been diagnosed with a serious form of brain cancer. There’s a tragic twist to the story: according to Fox Business News, Forstmann believes that for more than a year, he had been misdiagnosed with meningitis.
ABC News wonders:
How could such a misfortune befall a billionaire —- a man able to afford the best doctors, best technology and the most sophisticated diagnostic tests?
They’re missing the point. Misdiagnosis happens with shocking regularity – as much as 44% of the time, depending on the illness.
I’m sure that, as with most things, being a billionaire is better. But as a neurosurgeon quoted by ABC News points out, even for a billionaire, getting the right care is “still a bit of a crap shoot.”
So how can you improve your odds? Here are 5 tips that work.
1. Know your family history – and remind your doctor of it. Don’t assume your doctor remembers that time you told him that two of your aunts died of breast cancer, or that your grandfather and father have a history of malformed blood vessels in their brains. Research studies have shown that a family history may be a better predictor of disease than even genetic testing. Find out about your family’s medical history, write it down (the Surgeon General has a good on-line tool to help you do this), and make sure your doctor knows about it – especially if you’re sick and they’re trying to decide what’s wrong.
2. Ask questions. The typical doctor sees as a many as 40 patients a day, spending 15 minutes or less with each one. It’s all too easy to be referred to a specialist and start treatment without having all of your questions answered. But asking questions won’t just make you feel more comfortable – it can disrupt your doctor’s thought process and make him think about your case in a way that may save your life. Dr. Jerome Groopman, one of the world’s foremost researchers on how doctors think (he’s written the definitive book on it) agrees:
“Doctors desperately need patients and their families and friends to help them think. Without their help, physicians are denied key clues to what is really wrong. I learned this not as a doctor but when I was sick, when I was the patient.”
You can find some useful tips on how to do this at the U.S. government’s web site, called “Questions are the Answer.”
Urbanspoon Founder Gets Into Insurance
Ever since I helped create Urbanspoon I’ve had a penchant for building software that’s easy to use, mildly provocative and fun. Those ingredients are a potent combination when mixed in the right proportions.
My most recent project is PickHealthInsurance, which helps consumers pick a health insurance plan. I released the first version yesterday and it quickly shot up to #1 on Hacker News, my favorite startup news site. It turns out that self-employed people everywhere are having trouble picking insurance.
How did a lowly software engineer like me end up sticking my nose into the insurance business?
A few weeks ago I realized my COBRA was about to run out. I’ve purchased individual health insurance before so I wasn’t completely terrified, though my memories were unpleasant. I started poking around online and quickly became frustrated. There are only a few options for buying insurance online and I find them clunky and dated.
The Primary Care Revolt
Last Thursday Anna Wilde Mathews of the Wall Street Journal ran an article detailing the activities surrounding primary care’s gradual awakening and mobilization. With Tom McGinty, Ms. Mathews authored a damning expose on the RUC last October that precipitated our efforts against CMS’ 20 year reliance on the AMA’s RVS Update Committee (RUC) for valuation of medical services.
There is the lawsuit by six Augusta, GA primary care physicians, spearheaded by Paul Fischer MD. (See his most recent article below). The suit claims that CMS’ and HHS’ longstanding primary relationship with the RUC has rendered that panel a “de facto” federal advisory committee. That would make it subject to the management and reporting rules of the Federal Advisory Committee Act – transparent proceedings, representative composition, scientifically valid methodologies – that attempt to ensure the public over the special interest. The fact that CMS has never required the RUC to adhere to those rules presumably means that the relationship is out of compliance with the law.
The American Academy of Family Physicians (AAFP), after declining to join the suit, issued a series of demands: more primary care seats, a sunsetting of rotating sub-specialty seats, a dedicated gerontology seat, seats for non-physicians like patients, purchasers and economists. The RUC has until March to respond. If they reject the demands, the question is whether the AAFP Board will vote to walk, as David Kibbe and I urged them to do when we began this campaign last January.
Say It Loud, I’m a Gimp and I’m Proud!
Apologies to James Brown for the title of this post, as his 1968 funk classic “Say It Loud, I’m Black and I’m Proud” (click here to listen) helped galvanize the civil rights movement in America, offering a joyous rallying cry to people who for far too long had suffered at the hands of racism and oppression. The song was not only a shout of protest, but an admonition to embrace the very thing that conferred minority status on an entire people and turn what for some had at one time been a mark of shame into a badge of honor. On top of all that, the song irresistibly generates the urge to get up and shake your groove thing. That is, of course, if you are able to get up at all.
Those of us whose disease has progressed to the point where shaking our groove things is a distant memory and has left us visibly disabled – reliant on canes, walkers, or wheelchairs – also find ourselves members of a minority group, the disabled, the inclusion in which leaves some feeling invisible, helpless, and diminished. Much of the world simply isn’t designed for people who don’t have full use of their limbs, and the fully functional folks who populate it can be insensitive, uncaring, ignorant, and sometimes even intolerant. Though much progress has been made in in the fight for the rights of the disabled, the struggle is closer its beginning than its end.
Throughout much of history, victims of chronic illness, particularly of the kind that deform or disable, have often been looked upon with scorn, as if getting sick was somehow a mark of shame, the afflicted somehow responsible for their own affliction.
Reverse Innovation & The Cost Crisis in American Healthcare
By KENT BOTTLES
The realization that the American health care system must simultaneously decrease per-capita cost and increase quality has created the opportunity for the United States to learn from low and middle-income countries. “Reverse innovation” describes the process whereby an inexpensive innovation is used first in countries with limited infrastructure and resources and then spreads to industrialized nations like the United States.
The traditional model of innovation has involved the creation of high end products by companies in industrialized nations and the spread of these products to the developing world by adapting them to function in low and middle-income countries. Reverse innovation reverses the direction of spread with the United States borrowing new ideas and products designed for less wealthy countries in order to deliver health care more efficiently. (1)
Resource challenged low and middle-income countries are different from the United States in at least six ways that can serve as catalysts for such reverse innovation: 1) affordability, 2) leapfrog technologies, 3) service ecosystems, 4) robust systems, 5) new applications, and 6) the absence of intermediaries. (2,3)
These nations can’t afford expensive goods so they have to find inexpensive materials or manufacturing options. They also lack 20th century infrastructure and so they have leapfrogged to newer technologies such as mobile phones or solar energy instead of landlines and petroleum based energy sources. Service ecosystems develop in developing countries because entrepreneurs have to rely on others for help by creating new partnerships like video-game cafés where gamers test new products. Emerging markets require products that work in rugged conditions, and customers in poor countries have few product choices, providing market openings for add-ons that update and extend the lives of existing merchandise. (2) Intermediaries such as venture capitalists, universities, and regulators are also often underdeveloped in poorer countries. (3)Continue reading…
ONC Invests in Innovation Challenges
By
Health 2.0 is thrilled to announce that we are launching two challenges as part of the official kick-off of the Investing in Innovation (i2) program. 
Over the next 2 years the ONC will be issuing nearly $2 million in prize money for numerous challenges all designed to inspire innovation in health information technology. Along with our colleagues at Capital Consulting Corporation, Health 2.0 is the contractor supporting this effort. We started with a joint NCI/ONC effort which is already underway, but now the first two challenges are live. And they are:
- Reporting Device Adverse Events Challenge ONC is asking multi-disciplinary teams to develop an application that facilitates the reporting of adverse events related to medical devices, whether implanted or used in the hospital, clinic, or home. This challenge has $40,000 in total prizes
- Ensuring Safe Transitions from Hospital to Home Challenge. ONC is challenging software developers to improve care transitions and build upon these tools by generating an intuitive and easy-to-use application to empower patients and caregivers that fits into existing ways that providers communicate. This challenge also has $40,000 in total prizes.
These are both critical parts of health care where new innovation can make a big difference–and developers can win a substantial prize to get them on their way.
Have We Not Been Looking at Things We Should Have Seen?
A remarkable aspect of the Parkland Memorial Hospital saga was the degree to which the hospital’s Board was not given information by senior management about the clinical outcomes in their hospital. The lack of transparency, in other words, even went to management’s relationship with its fiduciary board.
A recent article by the Dallas Morning News outlines some of these points:
On August 19, the hospital’s seven-member board of directors got its first chance to read the full report by the U.S. Centers for Medicare & Medicaid Services. Almost 10 days had passed since [the CEO] first received the findings. As members began leafing through pages of the report, surprise, even shock, began to register.
The Chair of the board said, “We had direct culpability, but none of us even knew we were in the report.”
The Anti-Injunction Act Complications
The big news from [last Friday’s] two decisions was not that Virginia lacks standing; that was a problem lurking in that case from the beginning, a nettlesome issue going all the way back to Judge Hudson’s first opinion (in August 2010) rejecting the United States’s motion to dismiss on 12(b)(1) grounds. Virginia would have stood on much stronger ground had it also alleged an injury in fact from the effect of the minimum essential coverage provision’s necessarily pushing more Virginia residents onto the state’s Medicaid rolls, and thus imposing a significant financial cost on the state. But the Commonwealth failed to do this, instead resting on the claim that it had standing based on the alleged “conflict” between its Virginia Health Care Freedom Act and the individual mandate. This was a weak argument from the beginning, and the Fourth Circuit’s holding was entirely unsurprising.
What is surprising–perhaps not on the merits, but in relation to the attention the issue has received to date, from the courts and the parties–is the court’s holding in Liberty Universityv. Geithner that federal courts lack any subject matter jurisdiction over a suit seeking to enjoin enforcement of the individual mandate because such jurisdiction is precluded by the Anti-Injunction Act. In this respect, there are some important points worth noting:
* This is a potential problem in every lawsuit currently challenging the individual mandate. That is, if the Fourth Circuit’s analysis is correct, then the Supreme Court would lack jurisdiction to hear any private plaintiff’s claim that the minimum coverage provision exceeds Congress’s enumerated powers until after a taxpayer was assessed a penalty under ACA 1501, paid the penalty, and sued the federal government for a refund. The case thus would not reach the Supreme Court until somewhere in the neighborhood of 2015 or 2016.
The Doctor is Social
Doctors and hospitals are going social, adopting social media for professional and clinical use, based on surveys conducted in mid-2011 by QuantiaMD and Frost & Sullivan and the Institute for Health Technology Transformation (iHT2).
In Doctors, Patients & Social Media, dated September 2011, QuantiaMD and the Care Continuum Alliance report a high level of physician engagement with online networks and social media. Two-thirds of physicians are using social media for professional purposes, and see potential in the use of these channels to facilitate patient-physician communication. The survey found a cadre of “Connected Clinicians” who use multiple media sites to positively impact patient care. Over 20% of clinicians use 2 or more sites.
Only 1 in 10 physicians is familiar with one or more online patient communities, as the first chart illustrates. Among those who know about at least one community, a majority believe the sites have a positive impact on patients (either very positive or positive in the survey response). This is true across various condition categories, especially for rare diseases, cancers, chronic conditions, maternal and child health, and wellness/prevention. As one physician shared anecdotally, “Patients can share their stories, learn from others, spread knowledge, and instill hope.”
