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Truth or Consequences

Paul Levy 1 By PAUL LEVY

While we are on the topic of medical errors, let’s see how doctors feel about disclosing them when the patient has not been harmed. Medscape recently surveyed doctors on this question and published the results in a provocative article by Gail Garfinkel Weiss entitled: ‘Some Worms Are Best Left in the Can’ — Should You Hide Medical Errors?” (A subscription is required, but it is free.)

To the doctors reading this, into which camp do you fall? To the patients reading this, what would you expect of your doctor in this kind of situation?

Some excerpts:

In response to the question “Are there times when it’s acceptable to cover up or avoid revealing a mistake if that mistake would not cause harm to the patient?” 60.1% of respondents answered “no,” and the remaining respondents were almost evenly divided between “yes” (19%) and “it depends” (20.9%).

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Ready, Set…ACO?

• 19

By JONATHAN BUSH Jonathan Bush

Happy New Year, everyone!  2010 was certainly action-packed, and 2011 promises the same.

I hear a lot of thunder about getting ready for ACOs.

This isn’t a crystal ball forecast, but I see hospitals spending tons of capex on new HIT from old-fashioned “software-based” companies, and it seems like the EMR is the new “pavilion.”  I see hospitals buying medical practices using arrangements that are certain to require the hospital to subsidize doctor income.  [For another take: Paul Levy on ACO.]

These two major waves are explained by clients and prospects alike as “readiness for ACO.”

I have three thoughts:

  1. Don’t worry.  We at athenahealth will do our part.  If and when ACO payment models emerge, you won’t need to buy a new “module” from us in order to get payment.  We will go get you that money the same way we are getting you the “Meaningful Use” stimulus payments, the P4P money, and the plain old health care reimbursements that we have always delivered.  The changes to our technology and service needed to accomplish all that will be on us.
  2. Don’t turn blue holding your breath waiting for the big bonus opportunity.  The fundamental underlying principle of an ACO is that you will get a bonus in exchange for lower utilization.  If that bonus is bigger than what you’d get from the utilization, then why would Medicare pay it?  If that bonus is LESS than what you are getting now, why would you do it?
  3. I have met newly elected Republican lawmakers of late and few of them are thinking that money will be saved with this approach.  As with other aspects of health reform law, they appear to be eager to… well, let’s just say…scrutinize the mechanics closely.

None of this is certain and there will be exceptions to all the rules anyone tries to write.

This leaves one thing certain.

Do NOT make multi-year investments that depend upon ACO actually happening.

So as far as ACO goes, pay as you go.

With me?

Jonathan Bush co-founded athenahealth, a leading provider of internet-based business services to physicians since 1997.  He blogs regularly at THCB and at the athena blog where this post first appeared. Prior to joining athenahealth, he served as an EMT for the City of New Orleans, was trained as a medic in the U.S. Army, and worked as a management consultant with Booz Allen & Hamilton. He obtained a Bachelor of Arts in the College of Social Studies from Wesleyan University and an M.B.A. from Harvard Business School. He blogs regulary at the athena blog, where this post first appeared.

The Myth of Consumer-Directed Health Care

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By JANE SARASOHN-KAHN Health Populi 1

The theory behind “consumer-driven health care” is that when the health care user has more financial ‘skin in the game,’ they’ll become more informed and effective purchasers of health care for themselves and their families. That theory hasn’t translated into practice, based on data from the Employee Benefits Research Institute’s (EBRI) latest Consumer Engagement in Health Care Survey.

Health Reimbursement Accounts (HRAs) began appearing in employer benefit packages around 2001, with Health Savings Accounts emerging in 2004. 20% of large employers (with >500 employees) offered either an HRA or HSA plan in 2010, covering 21 million people or 12% of privately insured people in the U.S. Among these, there were 5.7 million accounts in 2010 containing $7.7 billion (including a couple thousand dollars from my own household).

Employees with HRAs and HSAs who exercised, didn’t smoke, and weren’t obese had higher account balances and higher rollovers than those who had less healthy behaviors.

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Doctors in Congress

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By RICHARD REECERichard Reece

When new members of Congress are sworn in this January, there will be a total of 19 doctors in Congress – 3 Senators and 16 Congresspersons. That will be a 27% increase over 2009,from 15 to 19, in doctor members of Congress. These doctors will make up 3.5% of the 535 members of Congress, but will fall far short of the 10.7% who were signers of the Declaration of Independence.

Eighteen of the 19 new members are Republican. This may say something of the mood of America towards health reform, but it may have little effect on whether the health reform bill is repealed or retained in its present form.

Fifteen of the 19 are from the South or West, 5 are Ob-Gyn specialists, and 12 represent specialties who perform surgery. What this means or portends I do not know. Perhaps they will not hesitate to perform surgery on the bloated national budget and cut deficits. I take solace in recent polls, which indicate 77% of the public trust doctors to do right thing vs. 11% who trust Congress.

Here is the list of the 19 doctors in Congress:

Senate Incumbents

  1. Tom Coburn (R, Republican), Oklahoma, family physician and ob-gyn
  2. John Barasso (R, Wyoming), orthopedic surgeon New Senator
  3. Rand Paul, (R, Kentucky), ophthalmologistContinue reading…

Data Mining Case Reaches the Supreme Court

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By GLENN LAFFEL, MD, PhD Glenn Laffel

Twenty years ago, IMS Health got the idea to purchase prescription records from pharmacies, license physician information from the AMA’s Physician Masterfile, and link the two databases so as to create something new and different: prescriber-level data (PLD).

It was a brilliant idea. Almost immediately, pharmaceutical and device companies, government analysts and public health officials began lining up to buy raw PLD and/or the reports that IMS created from it.

And with good reason. By applying statistical tools to analyze PLD (a technique known in the vernacular as “Data Mining”) IMS and the purchasers of its data could obtain fresh insight into many topics of interest. These include prescribing pattern variations across regions, where and when influenza outbreaks occur, how physicians respond to these outbreaks and hundreds of others. Drug makers found PLD information to be particularly helpful. With it, they could refine marketing pitches and improve sales force efficiency, among other things.

Since those early days, the scope of the data compiled by IMS and other PLD providers has expanded to a point where it is truly breathtaking. The AMA Masterfile includes current and historical data on 880,000 physicians. IMS and similar companies collect information on more than 70% of all prescriptions filled in the US. SDI Health, another PLD provider, has billing information from 100% of inpatient and outpatient activity at 500 hospitals dating back to 2002. Their databases are large enough to detect national trends and withstand the most exquisite stratification analyses. Furthermore, PLD providers have perfected ways to exclude information from their databases that could be used to identify patients, so the data comply with HIPAA and other privacy-protecting laws.

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Cyber Insurance

• 2

By MICHAEL OVERLY, ESQPicture 30

Insurance exists to cover a wide range of potential business risks. Cyber insurance is worth considering as companies increase their presence, business practices and data storage online. In fact, Cyber insurance is not just for companies conducting transactions online (e.g., online retailers).

It is valuable to any company who has critical systems or sensitive data, which is almost every business. While it is possible to have insurance that covers damage to your servers and other computer equipment, it is almost certain the insurance only covers the physical damage to the hardware, itself, and not the valuable data housed within. In fact, insurance policies regularly state that the policy is limited to the replacement costs of the hardware and not the data.  This means that in the event a hacker gains access to your systems and disrupts operations, standard insurance coverage will probably offer little or no protection unless hardware is actually damaged.

The costs associated with restoring lost or damaged data, sending breach notifications to consumers, and other potential liability under each state’s breach notification statues can be astronomical. Cyber insurance can help cover some of the costs of a data breach, including the expense of sending notification to affected individuals, public relations, fines, penalties, responding to regulators and any subsequent litigation by affected individuals. The potential for attacks and breaches is growing exponentially as more and more businesses move operations to the cloud. Moreover, attacks do not necessarily derive from an outsider. Data breaches have resulted from careless, frustrated and vengeful employees who often attempt to profit from someone else’s information. Depending on the policy, Cyber insurance can offer protection from hackers, viruses, data breaches, denial of service attacks, and copyright, trademark, and website content infringement.

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What Do Medical Errors Cost Your State?

• 1

By PAUL LEVY

GE Healthcare offers this calculator, based on data from the Society of Actuaries, to show the cost of medical errors for a given population. I inserted the population of Massachusetts from the most recent US Census to see what would pop up. Here is the result.

I suspect this figure of $260+ million is actually an underestimate because there is a lot of preventable harm that does not get counted as such. For example, we reduced our rate of ventilator associated pneumonia at BIDMC considerably over the last three years by rigorous application of the VAP bundle. Likewise at Cooley Dickinson Hospital in Northhampton, MA.

As best as I can tell, VAP is not included in the statistics above. Chances are those cases previously would not have been counted as medical errors. They were just part of the mentality of “these things happen,” a belief by many that the current level of harm caused by hospitals is a statistically irreducible number.

Notice that I say “caused by hospitals,” and not “occurring in hospitals.” Until we take ownership of the fact that a great degree of harm that occurs in hospitals is caused by failures in the manner of delivering care, we will not make progress.Continue reading…

Health 2.0 San Francisco РTim O’Reilly Keynote

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By THCB STAFF

How are Web 2.0 technologies changing healthcare?  What are the implications of trends like cloud-based computing for major healthcare players like pharma companies and large health systems? What about mobile computing? What are the practical implications for providers? What can healthcare providers learn from like dominant Web 2.o players like Google? Silicon Valley legend Tim O'Reilly (The Web 2.0 conference, O'Reilly publishing) gives an overview in this keynote from this years Health 2.0 conference in San Francisco in October.

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