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Above the Fold

Decision Fatigue. For Doctors, Too?

Aug 22, 2011• 2

By PAUL LEVY

This article by John Tierney in the New York Times suggests that humans suffer from decision fatigue, the tendency to make worse decisions as you make a series of hard decisions as the day goes along. Here are some pertinent excerpts:

No matter how rational and high-minded you try to be, you can’t make decision after decision without paying a biological price. It’s different from ordinary physical fatigue — you’re not consciously aware of being tired — but you’re low on mental energy. The more choices you make throughout the day, the harder each one becomes for your brain, and eventually it looks for shortcuts, usually in either of two very different ways. One shortcut is to become reckless: to act impulsively instead of expending the energy to first think through the consequences. The other shortcut is the ultimate energy saver: do nothing. Instead of agonizing over decisions, avoid any choice. Ducking a decision often creates bigger problems in the long run, but for the moment, it eases the mental strain. You start to resist any change, any potentially risky move. Once you’re mentally depleted, you become reluctant to make trade-offs, which involve a particularly advanced and taxing form of decision making. Continue reading…

Health 2.0 Show on Big Data–12 noon PST Monday

Aug 21, 2011

Join us for the next episode of the Health 2.0 Show, airing Monday, August 22nd at 12:00 PM PST (3pm EST)–Yes that’s tomorrow or even today (depending on when you read this!!) We’ll give a preview of the 2011 Health 2.0 fall conference session, Data Drives Decisions: The New World of Analytics, Data Mining and How Big Data Will Transform Health Care.

In recent years, the world of data has evolved and researchers are able to spend less time gathering data in the traditional sense, and more time analyzing and tailoring data that fits their needs. As data is mined and dissected in new and innovative ways, it not only affects research, but health care decisions and outcomes, and ultimately, helps our current system become smarter. In addition to diving into the content, we’ll feature a few special guests and talk about some of the exciting demos we have planned. Our guests will be:

Tod Fetherling–Health Data Source
Sarah Mihalik–Explorys
David Hadden–Therasim

So to register, just hit the button below–and yes it’s FREE

If you’d like to see past episodes of The Health 2.0 Show, check out our archives.

Dave Chase, brilliant but wrong!

Aug 19, 2011

I’d like to welcome Dave Chase, new THCB contributor who’s writing about the Carnage in Health IT.Go read his provocative article then sneak back to hear from me why he’s wrong! Love ‘em to death but the RockHealth crowd is the kids on the outside–the only slightly more seasoned Health 2.0 companies (of whom Aavdo is one) know that they have to work with the system to get going. Even the ones focused on consumer end users (patients or doctors) like Sermo & American Well have been making alliances and getting customers in the old HC world since before day 1. And in fact the carnage in Health 2.0 has been very limited compared to (say) the consumer Web world of the early 2000s. Why? because they all started much smaller and most didnt rise so much money but went looking for customers–in the old HC world. Which is why change is slower.

Finally I love ZocDoc, but equating raising money with market success is a stretch. Unlike OpenTable which only had to drop a booking system into restaurants, there’s lots of different systems that an appt booking system has to integrate with in a doc’s office. And those systems have their own vendors who are competing directly with ZocDoc’s features.

And of course while I might want to go to lots of different and new restaurants all the time, I’m likely to want to stick to only a few doctors–once I find the ones I want. So I’m not sure a consumer wants a one stop place for every possible doctor, and it’s possible that a doctor doesn’t want just a one point solution for appointments. At any rate it’s damn early in the game and I guarantee you that despite the very encouraging progress and the boatload of roubles they just got, Cyrus and his team at ZocDoc know that they’re in for a long ground war and have not declared victory and gone home yet.

Why Bother With Government?

Aug 19, 2011• 85

By EDWARD D. KLEINBARD

On Friday, a federal Court of Appeals held unconstitutional a central feature of the new healthcare law-its requirement that almost all Americans obtain healthcare insurance through private insurance markets. This ruling came only days after the debt-ceiling debacle — a “tempest in a tea party” — during which our country’s credibility for honoring its debts was held hostage to the conviction that tax revenues should regularly ratchet down, but never up. Both the subtext of the majority’s opinion in the healthcare case and the anti-tax fervor evident in the debt-ceiling debate share a common underlying philosophy: the belief that government activity is largely hostile to prosperity and the pursuit of happiness, and therefore the less of it, the better. But this view of government is incorrect.

Government, to paraphrase Congressman Barney Frank, is just the name we give for the things we the people decide to do together. And taxes in turn are just the amounts we chip into the collective pot to buy whatever package of goods and services that we have agreed to purchase collectively.

In ordinary commercial settings, the private sector is more efficient at allocating scarce resources than is the government, which is why the United States relies so heavily on private markets. So why should we bother to do things together through the mechanism of government? One answer is that only government can address an “incomplete” market, which occurs when the private sector cannot or does not provide a market solution to an economic problem. Healthcare insurance is a classic case of an incomplete market that results in real economic burdens.

Lessons from the Carnage in HealthTech

Aug 19, 2011• 10

By DAVE CHASE

Recently ZocDoc had a huge funding round demonstrating the success that they are having. There’s a number of lessons learned from ZocDoc’s experience. Unfortunately, many haven’t demonstrated Zocdoc’s wisdom leading to a large number of healthtech failures. A recent study highlights this phenomena. After interviewing 110 digital health entrepreneurs, RockHealth recently released its study Rock Report: State of Digital Health demonstrating the disconnect between the startups getting funding and what many startups are pursuing. This disconnect is the last and most important reason healthtech companies have failed that are detailed below. The following are the top reasons why healthtech companies have failed or had to do major pivots in order to survive:

Lack of Specific Focus or Adoption point

It’s well documented that a lack of focus kills startups whether they are in healthcare or not but it is particularly prevalent in healthcare. The diversity of opportunities in healthcare is so great that it’s tempting to try to solve it all. These startups are ignoring the old saying about how to eat an elephant — one bite at a time. Too many startups are trying to swallow the elephant whole.

Expected consumers to pay

With the exception of weight loss programs, there aren’t many examples of consumers paying directly for health services. Over time, this is likely to change as more of the burden of healthcare costs gets shifted to consumers as was highlighted in a Healthcare Disruption series (see links below). However, I’d be very cautious about any business expecting to have consumers pay in the near-term.

Medicare Musings

Aug 18, 2011• 35

By DAVID DRANOVE

I have been thinking about the connection between healthcare cost growth and the budget crisis. Many pundits have pointed out that rising Medicare costs are one of the biggest contributors to our budget mess. Republicans want deep cuts in future Medicare spending while Democrats are sensitive to constituents who demand the Congress keeps its hands off “their Medicare.” Current Medicare spending growth trends are unsustainable – at some point the math will trump the politics.

There are several options for putting Medicare on a much lower cost trajectory. Here is what I have come up with:

1) Do nothing but pray. Projections of future spending growth are mostly guesswork. Maybe the guesses are wrong. Consider that technological change has been a major driver of cost growth. (It is interesting to ask why medical technology nearly always seems to cause spending to increase, but I will save that for another blog.) Perhaps medical science has reached the bottom of the well and that output of costly new technologies will slow to a trickle. Of course, this will also mean that a century of advances in medical care will come to an end. I don’t know if we will really be better off; we will spend less on medical care than we projected, but we will also receive fewer benefits than we projected. Besides, the head-in-the-sand approach to cost cutting hasn’t worked yet. (Note to readers. Please do not comment that we can save the system through prevention. The Committee on the Cost of Medical Care already made the same point – in 1932.)

HIT Trends Summary for July 2011

Aug 18, 2011• 1

By MICHAEL LAKE

This is a summary of the HIT Trends report for July 2011. You can get the current issue or subscribe here.

Specialty EMRs. There is a market for EMRs that specialize by practice type. This month, the ophthalmologists tell us what’s required to help them. They have specialized vital signs, testing and measurement devices. It is likely all specialties would benefit if EMRs get more specialty-specific. Some specialty EMR solutions have found a successful niche markets in cardiology, oncology and other segments. This could be another.

Medscape reports that AAFP’s smaller practice members like EMRs that focus on them. This report is focused on user satisfaction. The combination of easy-to-use software and physician involvement is leading to high satisfaction with products from vendors focused on small practices. And yet, we have also heard from prior KLAS reports that many practices (30%) are abandoning current vendors for market leaders.

A national study also reports that smaller practices are interested in new care models, but may lag implementation because they tend to underutilize needed technology. The study included 1,344 practices with fewer than 20 physicians each. The EMR is central to success of emerging collaborative and more accountable care models. Using registries to help manage patient populations is a core element as is medication management through e-prescribing. This study confirms that it will take a while for smaller practices to get the utilization required to be effective in the new model.

WhiteGlove Health’s Growth Fueled by Technology

Aug 18, 2011• 2

By DAVE CHASE

Bob Fabbio is a tech industry veteran most known for founding systems management company Tivoli which went public in 1995 and a year later sold to IBM for $743 million. He’s been a part of other successful exits such as selling Dazel Corp., which was acquired by HP in 1999. His latest venture is WhiteGlove Health’s which now has 500,000 members primarily in its home state of Texas.

An enterprise software veteran isn’t the obvious person to lead a healthcare provider. However, as outlined in Healthcare Disruption: Healthcare Providers Repeating Newspaper Industry Mistakes, it’s frequently not the obvious competitors that create the greatest disruption in the marketplace.

The legacy healthcare payment model for primary care is a Gordian Knot designed by Rube Goldberg. Consider the legacy model versus WhiteGlove’s model in the tables below.

(Some) Illinois Hospitals Losing Tax-exempt Status

Aug 17, 2011• 4

By HAROLD POLLACK

From the Chicago Tribune and AP.

The decisions were announced to the hospitals Tuesday morning, Revenue Department officials told The Associated Press. They follow last year’s Illinois Supreme Court ruling that found a central Illinois hospital wasn’t doing enough free or discounted treatment of the poor to qualify for an exemption, costing it $1.2 million in local property tax payments per year.

In addition to Prentice Women’s Hospital [a Northwestern facility] in Chicago’s Gold Coast neighborhood, the revenue department now has decided that Edward Hospital in Naperville and Decatur Memorial Hospital in Decatur don’t quality for property tax exemptions. The hospitals have 60 days to ask an administrative law judge to review the decisions. In Illinois, property taxes are collected by county governments, and the Department of Revenue decides which institutions are eligible for tax exemptions.

In a written statement, Illinois Hospital Association President Maryjane A. Wurth said she was disappointed and “deeply concerned” by the Revenue Department’s preliminary rulings, and worries that the hospitals will be forced to reduce services and increase costs for patients and employers.

It’s neither surprising nor inappropriate that state policymakers are holding hospitals to account.

Individual Mandate: Can PPACA Survive Without It?

Aug 17, 2011• 6

By DAVID E. WILLIAMS

Ever since the Patient Protection and Affordable Care Act (PPACA) was passed, opponents have looked for ways to overturn it in the court of law and the court of public opinion. They’ve had reasonable success in both arenas, using opposition to the individual mandate to buy health insurance as Exhibit A. Ironically, President Obama wasn’t a big fan of the individual mandate at the outset. In the primary election, Hillary Clinton favored an individual mandate while Obama opposed it. But somehow the mandate –at its core a Republican concept of personal responsibility– has become synonymous with so-called Obamacare.

With the recent court decision, it seems reasonably likely we will end up in a situation where the individual mandate is overturned but the rest of the law is upheld. Observers have some thoughts on what would happen:

Insurance companies will be unhappy. PPACA puts many restrictions on health plans, e.g., minimum medical loss ratio, no exclusions for pre-existing conditions but the upside is the mandate: lots of new customers, and a reduction in adverse selection, because everyone has to buy insurance and you can’t wait till your sick
Many fewer people will be enrolled in insurance. Jonathan Gruber’s objectivity may be suspect, but he persuasively argues that repeal of the mandate would lead to many fewer people in coverage and higher premiums due to adverse selection. And the cost of the law wouldn’t drop by much despite the lower impact
Some opponents think/hope that eliminating the mandate will cause the whole law to collapse. I really doubt it.