The Health Care Blog – Page 698 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Government Works (Really)

Aug 29, 2011• 4

By EVAN FALCHUK

Conventional wisdom has it that government has lost its way. It’s out of touch and out of control. It has shut out the voices and concerns of everyday Americans. Democracy — or rather, taking the concerns of ordinary Americans into account in the democratic, lawmaking process — is a notion so farfetched as to be laughable.

But what if that weren’t true?

As a private citizen — a native Bostonian with a wife and three kids who seem to think I’m okay, a job I enjoy, and a rabid Red Sox fixation — I set off to see if I could have a say that made a difference.

And here’s the clincher: It actually worked. Really.

Here’s the setup: The state of Florida had in its law a rusty old provision that made it all but impossible for an insurance company that sold insurance abroad from having offices in Florida — even though it would not be selling insurance in the state. That law cost the state untold number of jobs and tax revenue for no apparent reason. Even Florida lawmakers from both sides of the aisle were perplexed as to how and why that initial law had come to be.

This meant American companies like mine that serve the Latin American market were barred from locating in Florida, the gateway to Latin America and home of some of the country’s highest-skilled bilingual workers.

Gov. Rick Scott, I knew from reading the papers, was keen to add jobs for Floridians. So was Insurance Commissioner Kevin McCarty. So was every lawmaker in the Florida Legislature.

So I hopped on a plane (well, lots of planes), knocked on their doors, and made my case. I explained that some simple changes to the old law would create jobs and new revenue for the state — all without spending a dime of government “stimulus.” I worked with staff and legislators on both sides of the aisle — Republican Reps. Bryan Nelson of Apopka, Carlos Lopez-Cantera of Miami, Sen. Garrett Richter of Naples and Democratic Sen. Chris Smith of Fort Lauderdale among them — to create the few brief, sensible improvements, and a few months later, the Legislature included the idea in HB 1087. It took effect this month.Continue reading…

Google – Say it Ain’t So

Aug 29, 2011• 5

By Dan Munro

Webster’s has a new entry for mea culpa: A voluntary payment of $500,000,000.00 to avoid prosecution.

That’s almost a rounding error for a company with a Market Cap well north of $130 billion – but the healthcare system can definitely use the money. I remember when some of the first estimates for widespread EHR adoption were announced in 2008. One that was hotly contested (way too high) was $150 million over 8 years. Safe to say – we’ve got that fully funded – with change.

Google stock actually inched up (+$3.25) so it’s safe to say investors collectively yawned. Buried in their long forgotten Corporate Information pages is this one called:

Ten Things We Know To Be True

“We first wrote these ‘10 things’ several years ago. From time to time we revisit this list to see if it still holds true. We hope it does – and you can hold us to that. (September 2009).”Continue reading…

Harnessing the Yottabytes

Aug 26, 2011• 5

By MAYRA ZILBERBERG, MD

What if medicine in the US is just like the internet? What if it is just as difficult to separate the chaff from the wheat in medicine as it is on the web?

Both the curse and the blessing of the web is its accessibility. This means that anyone’s voice can be heard. And it also means that anyone’s voice can be heard. So, we are just as likely to stumble upon drivel as we are on information gold. And what takes time and skill is separating the two into neat piles, one to be ruthlessly discarded, and the other cherished for how it enriches us. To be sure without the web we might not have had access to either, and it is the egalitarian nature of the internet that gives us such a variety of sources in our information diet.

Now, let’s look at medicine. Every day we hear about how much noise there is in the field, and this noise is difficult, if not impossible, to separate from the signal. Some signals are becoming much clearer, and they tell us that by being too egalitarian in medicine, we have likely been causing great harm. Take, for example, PSA and mammography screenings.

The drumbeat of harm associated with these highly non-specific tests and the resultant chase after false positive results, is getting deafening, and rightfully so. Every day we hear that researchers have uncovered a breakthrough mechanism or treatment, and we hear with increasing frequency that a treatment previously thought to be sacrosanct is a bunch of rubbish. What gets lost among all this noise is the possibility of a true breakthrough in disease management or treatment or cure.

Think how hard it is to separate general valuable content from bunk on the web. Now, think of the logs of increase in the levels of difficulty of this task in medicine, where difficult concepts are further shrouded in the opaque cloth of arcane and obfuscating terminology. In fact, it is so difficult, that the class previously designated as the interpreters of this information for the lay public, physicians, are unable to keep up.

How to Avoid Death in the ICU

Aug 26, 2011• 7

By ELAINE SCHATTNER, MD

Something I learned as a medical intern is that there are worse things than dying.

As I recall, it was sometime in April, 1988. I was putting a line in an old man with end-stage kidney disease, cancer (maybe), heart failure, bacteria in his blood and no consciousness. Prince was on the radio, loud, by his bedside. If you could call it that – the uncomfortable, curtained compartment didn’t seem like a good place for resting.

An attending physician, a smart guy I respected, approached me as I completed the procedure.

“It’s kind of like Dante’s seventh circle,” he noted.

Indeed. A clear, flexible tube drained greenish fluid from the man’s stomach through his nose. Gauze covered his eyes, just partially. His head, hands and feet swelled with fluid. A semi-opaque hard-plastic instrument linked the man’s trachea, through his paper-taped mouth, to a noisy breathing machine. His skin, barely covered by a stained hospital gown, was pale but blotchy from bleeding beneath. An arterial catheter inserted by his wrist, just where I might have taken his pulse had he been healthier. A fresh adhesive covered the cotton gauze and brownish anti-bacterial solution I’d placed over his lower right neck.

“Yeah,” I said as we walked out of the room to review another patient’s chart.

The Untold Obama Administration Success Story

Aug 26, 2011• 14

By MERRILL GOOZNER

One wonders what the Obama administration has to do to get a little credit. I’m sitting on vacation, looking at the ocean most of the day, and spending about a half hour on line at night erasing unread emails, killing out unread RSS feeds, and checking up on my declining retirement prospects. Amid the clutter, a series of press releases from the Inspector General of the Health and Human Services Department caught my eye. Here are the headlines, with links (I’d link to the press coverage, but near as I can tell, there was none):

Miami-Area Doctor Pleads Guilty in $25 Million Health Care Fraud Scheme

Owner of Miami-Area Mental Health Care Corporation Convicted on All Counts for Orchestrating $205 Million Medicare Fraud Scheme

Miami-Area Medical Equipment Company Owners Sentenced to Prison for Medicare Fraud Scheme

That was Tuesday. On Monday, the HHS sleuths put out this press release:

FORMER CHAIR OF TEMPLE’S OPHTHALMOLOGY DEPARTMENT CONVICTED OF HEALTH CARE FRAUD

PHILADELPHIA – A federal jury today convicted Dr. Joseph J. Kubacki, 62, of Destin, Florida, of 150 counts of health care fraud, wire fraud, and making false statements in health care matters, announced United States Attorney Zane David Memeger. Kubacki was the Chairperson of the Ophthalmology Department of the Temple University School of Medicine and also served as the Assistant Dean for Medical Affairs when, between 2002 and 2007, he caused thousands of false claims to be submitted to health care benefit programs with false charges totaling more than $4.5 million for services rendered to patients whom Kubacki did not personally see or evaluate. A sentencing hearing has not yet been scheduled.

Work Hour Restrictions – A Painful Gift to Medicine

Aug 25, 2011• 2

By VIPAN NIKORE, MD

When I completed my overnight shift and left the Medical ICU the morning of July 1, I raised my arms victoriously. I uttered, “Finally, internship is done!” I may have been one of the last to speak such words.

As of July 1, 2011, intern year forever changed. In the world of medicine the first year of residency, or intern year, is when doctors earn their stripes. Traditionally it is the most demanding year in a decade-long quest to become a practicing physician. But this year, the Accreditation Council of Graduate Medical Education (ACGME) mandated that interns can no longer work more than 16 hours straight, and must have 10 hours off between shifts. Second- and third-year residents can still work 28-hour shifts, but no more 30-hour shifts for interns.

To the outsider, this may seem like a common sense change that would only improve patient safety. Within the medical field, however, this change is arguably the most controversial in the history of medical education.

Advocates believe these duty-hour modifications will decrease medical errors and improve unacceptable working conditions for residents. ACGME officials still believe that residents should be able to handle the vigorous hours and workload, but believe launching the least experienced physicians — new interns — into those demanding conditions just days after medical school is inappropriate and unsafe. As well, the general public generally favors the new changes.

DC to VC Start-up Showcase

Aug 25, 2011

By Matthew Holt

This time of year is all about selection. Which demos should we have for the Health 2.0 Conference coming up next month? Who to have speak in the Health 2.0 Europe Conference in Berlin in October? How to fit in a vacation around the Health 2.0 India Conference in December? But believe it or not, Health 2.0 isn’t all there is!

Rebecca Lynn, Ching Wu, & their colleagues at Morgenthaler Ventures started DC to VC last year, and this year they’re hosting the DC to VC Start-Up Showcase during Health Innovation Week in San Francisco. It’ll be on September 22nd at the Microsoft Campus in Mountain View, CA. I’m delighted to be MCing this event, and was even more fascinated to be a (minor) part of the selection process. Rebecca really showed that it is hard to be a VC (I’m not kidding), but with great skill and lots of patience she helped us cut to the chase of the more than 125 applications and elevator pitches. There were lots of great submissions and some companies everyone loved didn’t even make the final group.

Today the finalists were announced including a class ready for seed stage (very early) and one slightly further along (ready for Series A). So drum roll please and get ready.Continue reading…

The Emperor Remains Unclothed

Aug 23, 2011• 33

By PAUL LEVY

I guess I shouldn’t be surprised when two of the architects of the health care reform act write an op-ed that continues in the deception that the law would deliver access, choice, and lower costs. But that is what Ezekiel Emanuel and Jeffrey Liebman offer in their New York Times article, “Cut Medicare, Help Patients.”

The authors start by saying some things that make a lot of sense. They point out that it would be smart to “eliminate spending on medical test, treatments and procedures that don’t work — or that cost significantly more than other treatments while delivering no better health outcomes . . . [and that} can be made without shortchanging patients.”

But they quickly give up that fight: “The sad truth is, Washington is never going to do a good job of making smart cuts to Medicare. Elected officials hate being blamed for directly restricting access to medical treatments — even when those treatments are proven to be worthless.”

So then they revert to their underlying bias, er, theology: “The responsibility for ending unnecessary medical spending needs to be placed in the hands of doctors and hospitals. This can happen only if we change our fee-for-service payment system.”

And What Happens if the Individual Mandate is Struck Down?

Aug 23, 2011• 4

By ROGER COLLIER

An alarming article in Politico.com looks at what could happen if the Supreme Court determines that the Affordable Care Act’s individual mandate provision is unconstitutional—something that the current conservative leaning of the Court seems to indicate is somewhat more likely than not.

Assuming that such a possible decision by the Court follows that of the Eleventh Circuit Court of Appeals in ruling that the mandate is unconstitutional but the remainder of the ACA may stand, the Politico.com article anticipates some potentially disastrous consequences.

The provisions of the ACA—some of them already in force—include guaranteed issue, elimination of annual and lifetime limits, and a ban on basing premiums on health status, essentially decoupling coverage and premiums from insurance risk. Without the requirement for almost everyone to have coverage, there will be nothing to ensure that the risk pool contains a large percentage of individuals in good health as well as those with medical problems, and nothing to stop anyone from waiting until they’re sick or injured to demand coverage.

Peter Pronovost is a Liar. He Must Be. Isn’t He?

Aug 23, 2011• 1

By PAUL LEVY

Peter Pronovost and his subversive friends are at it again. Imagine, first they assert that implementation of a standard protocol and checklist could reduce the rate of central line associated bloodstream infections.

“It wouldn’t work here. Our patients are sicker.”

Then, to make matters worse, they go and contend that reducing the rate of central line infections saves money. Here’s the abstract from the American Journal of Medical Quality:

This study calculates the costs and benefits of a patient safety program in intensive care units in 6 hospitals that were part of the Michigan Keystone ICU Patient Safety Program. On average, 29.9 catheter-related bloodstream infections and 18.0 cases of ventilator-associated pneumonia were averted per hospital on an annual basis. The average cost of the intervention is $3375 per infection averted, measured in 2007 dollars. The cost of the intervention is substantially less than estimates of the additional health care costs associated with these infections, which range from $12,208 to $56,167 per infection episode. These results do not take into account the additional effect of the Michigan Keystone program in terms of reducing cases of sepsis or its effects in terms of preventing mortality, improving teamwork, and reducing nurse turnover.