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Above the Fold

Does This ACO Thing Really Mean We Need to be ‘Accountable’?

Nov 12, 2010• 4

By VINCE KURATIS, JD

Last month The American College of Physicians (ACP) released a well-reasoned and thorough position paper, The Patient-Centered Medical Home Neighbor: The Interface of the Patient-Centered Medical Home with Specialty/Subspecialty Practices.

As I’ve written before, the Big Idea behind ACOs (Accountable Care Organizations) is the notion of accountability, not the specifics of organizational structure.

The purpose of the ACP position paper is to address the gaps that exist in care coordination when a physician refers a patient to a specialist. The obvious and logical answer proposed is to develop “Care Coordination Agreements” between primary care physicians and referring specialists, and the position paper takes 35 pages to explain why and how.

A simplified way of thinking about Care Coordination Agreements is that they recognize that coordination of care is a team sport, that specialists are part of the team, and that this paper proposes rules of the game about how primary care physicians and specialists should play together on behalf of their common patients.

However, there’s a great big CAVEAT buried in the position paper. I don’t doubt the earnestness of the authors, but I do take this caveat as a Freudian slip recognition that not all specialists will be eager to play on the team and to play by the rules:

At this time, implementation of the above principles within care coordination agreements represents an aspiration goal…

The care coordination agreements should be viewed solely as a means of specifying a set of expected working procedures agreed upon by the collaborating practices toward the goals of improved communication and care coordination — they are not legally enforceable agreements between the practices. [emphasis of “solely” is in the original document, not added]

Translation:

Don’t expect to hold us accountable….and don’t expect to be able to sue us if we don’t get it right

Vince Kuraitis, JD, MBA is a health care consultant and primary author of the e-CareManagement blog where this post first appeared.

Alzheimer’s Disease: The $20 Trillion Enemy We Must Not Forget

Nov 12, 2010• 10

By LISA SUENNEN

In the last several weeks I lost my phone (recovered), my iPod (gone) and even a piece of jewelry (I am pretty sure the cat is guilty). I was at the airport when I couldn’t remember where I parked my car for long enough to wonder if I actually did drive myself there. (Don’t judge me; I know you do it too.)

All of us are prone to losing objects and forgetting appointments and struggling for that word on the tip of our tongue that we definitely should know. Sometimes we even forget the names of people who live in our house just for a second; admit it: how many times have you called your child by the dog’s name?

Those momentary lapses of memory can be amusing or frustrating, but they usually don’t slow us down much. We laugh it off and say, “wow, I must be getting old” and move on to the next task. An op-ed I read recently in the NY Times, however, made me realize we don’t long have the luxury of humor when it comes to this issue.

Authored by Supreme Court justice Sandra Day O’Connor (ret.), Nobel Laureate neurologist Dr. Stanley Prusiner and Age Wave expert Ken Dychtwald, and entitled The Age of Alzheimer’s, the article pointed out these astonishing facts:

Starting on Jan. 1, our 79-million-strong baby boom generation will be turning 65 at the rate of one every eight seconds. That means more than 10,000 people per day, or more than four million per year, for the next 19 years facing an increased risk of Alzheimer’s. Although the symptoms of this disease and other forms of dementia seldom appear before middle age, the likelihood of their appearance doubles every five years after age 65. Among people over 85 (the fastest-growing segment of the American population), dementia afflicts one in two. It is estimated that 13.5 million Americans will be stricken with Alzheimer’s by 2050 – up from five million today.Continue reading…

Suzanne Delbanco on the new Catalyst for Payment Reform

Nov 12, 2010• 3

By MATTHEW HOLT

Catalyst for Payment Reform is a new organization set up by several large employers. The organization’s goal is to pay for health care differently, and make sure that those employers run ahead of any Medicare payment reform coming down the track. Suzanne Delbanco, formerly of Leapfrrog, is now the first Executive Director and Founder of the new organization. Last week I interviewed her about what the organization is going to do, what employers care about, and (despite decades of employers being simple price takers in health care) why this time it’s going to be different.

Keep watching to the very end to see the great view from Suzanne’s office!

Physicians, Nurses and the Coming Transformation of our Health System

Nov 11, 2010• 22

By GLENN LAFFEL, MD

Last week, we highlighted an unintended consequence of the Affordable Care Act: it will dramatically worsen an already gaping mismatch between the demand for and the supply of physician services in the US. Put simply, there aren’t enough white coats out there to care for 32 million Americans who will obtain health insurance coverage for the first time as a result of the new law. It’s not even close.

We also speculated that the recommendations made by the American Association of Medical Colleges to address the burgeoning crisis will not work. The AAMC wants Congress to increase the number of Medicare-funded medical residency training slots—essentially, to increase the pipeline for new physicians. This isn’t a bad idea except that Congress is gridlocked on a good day, bitterly divided on all things health reform, and in no mood to enact spending programs of any sort.

That brings us to an alternative solution, proposed recently by the Institute of Medicine. In a report titled, The Future of Nursing: Leading Change, Advancing Health, the IOM concluded that the best way to meet the coming tidal wave of demand for medical services is through a sweeping expansion in the roles and responsibilities of nurses.

Reasoning that nurses are cheaper and quicker to produce than doctors, the IOM recommended the implementation of incentive programs which would assure that 80% of nurses have a bachelor’s degree within 10 years, and that 10% of such nurses enter advanced degree programs. It recommended further that nurses should assume central roles in redesigned, team-based care systems, and that regulatory and institutional obstacles, including limits on nurses’ scope of practice, should be removed so that advanced practice registered nurses (APRNs, including nurse practitioners) can practice more freely. This includes increasing their power to prescribe drugs.

mHealth: Is It a Market?

Nov 11, 2010• 3

By JOHN MOORE

I’ve been attending the mHealth Summit for the last 3 days and an over-arching theme has been: mHealth is unlikely to ever become a market in its own right.

Backing up this claim have been the countless projects/products being presented at this event with very few having a model that is scalable across a broad population base. There is also the issue of a lack of clear, repeatable and sustainable business models for mHealth. None have been laid bare for before all to see and learn from in any of the sessions I attended (maybe we are just very early in the evolution/adoption cycle). Likely 90% of the mHealth technologies presented at this conference have been funded by grants that are unsustainable (most often for pilot studies by academic institutions) making one wonder: Where’s the money? Where’s the scale? Where’s the opportunity? Again, circling us back to the title of this post…

Is there really a mHealth market?

This is the wrong question to ask.

The question is not whether or not there is an mHealth market, the question is: How will mobile technologies and devices change care delivery models? Mobile technology is not going away anytime soon and is simply becoming more and more a part of our daily lives, both personal and work related. It is rapidly becoming ubiquitous. Likewise, as I have said many times before, health does not occur when you are sitting in front of a computer, it is mobile, it is with you, it is you.

AMA Opens Online News Archive

Nov 11, 2010

American Medical News, the award-winning newspaper published by the American Medical Association (AMA), announced today it is offering unrestricted access to its online news archive at amednews.com.

The online news archive dates back to January 2000, with selected earlier content. It represents a rich resource on issues confronting physicians and trends in medicine. Content includes in-depth reporting on the business and regulatory sides of health care, practice management and hot issues in public health and patient care.

“The American Medical Association hopes the accessible online news archive, and digital conveniences offered by American Medical News, will better help readers stay on top of the trends and forces shaping a complex, ever-changing medical environment, said AMA President Cecil B. Wilson, M.D.

Job Post: THCB Editorial

Nov 11, 2010

THCB is looking for talented interns to assist with editorial, research and web production tasks as our web site undergoes a major expansion. Perfect for a grad or med student with an interest in journalism, public policy, and/or the business of health care. Work out of a great home office location in the Princeton area or remotely, convenient to both Princeton University and UMDNJ. Reasonable train ride from midtown Manhattan. Production and research opportunities may also be available in our San Francisco offices for qualified candidates.

Doctor Patient

Nov 10, 2010• 13

By ROB LAMBERTS, MD

I did a little “self care” earlier this week. I did it by not caring for myself.

I went to the doctor.

I was sitting in the waiting area for my appointment and saw the mother of one of my patients. ”Why are you here?” she asked.

“I have a doctor’s appointment.”

She got a curious look on her face, asking, “Don’t you doctors just take care of yourselves? I thought that was what doctors did.”

We do take care of ourselves, in fact we do it far more often than we should. Being your own doctor allows for a lot of denial. When you spend your day advocating healthy lifestyles after you had trouble finding pants would fit in the morning, denial is necessary. Do as I say, not as I do.

I realize that this is hypocrisy; that is why I was at the doctor on Monday. My patients have noticed my expanding waistline, commenting on it more than I would wish. Certainly my pants get in the way of denial as well, not forgiving the fact that I have been under a whole lot of stress. Pants don’t accept excuses.

HIT Trends Summary for October 2010

Nov 10, 2010• 2

By MICHAEL LAKE

This is a summary of the HIT Trends Report for October 2010. You can get the current issue or subscribe here.

The evolving health information exchange market. The HIE segment was center-stage this month with a game-changing announcement by Surescripts. It will combine its national physician directory and EMR connectivity with apps from its strategic investment in Kryptiq to offer physician-to-physician clinical messaging beginning in December, extending its dominant market position. As first to market with these functions, it will likely cement its standing as the country’s premiere neutral national network. It also enables a platform for additional web services from collaborating partners in the future. We are also reminded this month in Healthcare IT News of the relative dominance of Epic in the IDN and large practice market with the startling statistic that 75% of Wisconsin residents are in the databases of its state user group. Using Epic tools and with patient consent physicians in the state can see patient information across institutions. And there’s a story this month that Verizon is expanding its vision as an HIE by adding clinical lab and imaging results to its networking services with leading transcription companies. These three lenses: (1) Surescripts as the leading national network; (2) Epic as the leading national EMR; and (3) Verizon as the leading national telecom, exemplify the rapidly changing dynamics in this segment.

EHRs and HIT have become central to transformation of clinical practice. One large driver is the announcement by the insurance commission of the inclusion of HIT as well as wellness and care management as medical expenses for insurers under PPACA. In the past these areas were generally allocated to the administrative budget of health plans which limited participation. This will increase payer investment. A CMS exec, Anthony Rogers, reported to Healthcare IT News on early results of CMS accountable care organization (ACO) pilots. He noted that practices with EMRs were getting most of the $36M in incentives and said, “If that’s not a business case [for EHRs], I don’t know what is.” The Patient-Centered Primary Care Collaborative, the organization driving medical homes released two reports this month also highlighting HIT’s role in transformation. One report looks at best practices to engage patients in a medical home project using HIT. It’s a compendium of 15 essays by a diverse set of experts on different perspectives about using health IT to engage patients, plus snapshots of two dozen case examples. The other report focuses on five ways to implement HIT effectively to enable clinical decision support. And CSC released a roadmap for HIT in ACOs with an elegant six factor model: member engagement; medical management; clinical information exchange; quality reporting; business intelligence; and risk and revenue management.

The War Between the States

Nov 10, 2010• 3

By MICHAEL TURPIN

Christmas is the time when kids tell Santa what they want and adults pay for it. Deficits are when adults tell government what they want and their kids pay for it. ~Richard Lamm

The day after a mid-term tidal wave of anti-incumbency sentiment swept through Congress resulting in the GOP reclaiming a controlling majority in the House and closer parity in the Senate, a seemingly contrite President Obama took personal responsibility for his party’s dismal showing at the polls. In a carefully worded conciliatory message, the President shared that, “the American people have made it very clear that they want Congress to work together and focus their entire energies on fixing the economy.”

Newly minted House Majority leader, John Boehner, subsequently reconfirmed that the GOP would not rest until Congress had reined in government spending. This would be partly achieved by deconstructing the highly unpopular and “flawed” Patient Protection and Affordable Care Act – a “misguided” piece of legislation that would actually increase costs for employers thereby reducing the nation’s ability to jump-start an economy that relies on job creation and consumer spending. In Boehner’s mind, government is not unlike the average American, overweight – it’s budget deficits bloated by the cost of financial bailouts, Keynesian stimulus spending and failure to discuss the growing burden of fee for service Medicare.

The President’s failure to acknowledge healthcare reform in his speech was interpreted by many as deliberate and only served to cement the perception that in Washington, it will impossible to have constructive dialogue around the imperfections and potential unintended consequences of PPACA. The White House’s resolve to defend its hard-fought healthcare legislation is likely to extend the polarizing partisanship that has come to characterize Congress. The impasse may very well spark a two-year period of bruising, bellicose finger-pointing over how to fix rising healthcare costs.