The Health Care Blog – Page 818 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

The Evidentiary Basis for a Clinically Meaningful Benefit

Jun 1, 2010• 10

By NORTIN M. HADLER, MD and ROBERT McNUTT, MD

We entered the 21^st century awash in “evidence” and determined to anchor the practice of medicine on the evidentiary basis for benefit. There is the sense of triumph; in one generation we had displaced the dominance of theory, conviction and hubris at the bedside. The task now is to make certain that evidence serves no agenda other than the best interests of the patient.

Evidence-based medicine is the conscientious and judicious use of current best evidence from clinical care research in the management of individual patients^”.^[1,2]

But, what does “judicious” mean? What does “current best” mean? If the evidence is tenuous, should it hold sway because it is currently the best we have? Or should we consider the result “negative” pending a more robust demonstration of benefit? Ambiguity is intolerable when defining evidence because of the propensity of people to decide to do something rather than nothing. [3] Can we and our patients make “informed” medical decisions on thin evidentiary ice? How thin? Does tenuous evidence mean that no one is benefited or that the occasional individual may be benefited or that many may be benefited but only a very little bit?Continue reading…

Why do the uninsured want to stay uninsured? They won’t say

Jun 1, 2010• 42

By HARRIS MEYER

Two uninsured people who insist on their right to remain uninsured have joined 20 states and the National Federation of Independent Business in suing to overturn the new federal law requiring all Americans to obtain health insurance or else pay a tax penalty.

The lawsuit, filed in U.S. District Court in Pensacola, Fla., claims the government is exceeding its constitutional authority to regulate interstate commerce.

The states added the two individuals as plaintiffs because the government is likely to argue that the states lack legal standing to challenge the individual insurance mandate, given that it only affects individuals, not the states.

But the public can’t find out why the two new individual plaintiffs — an auto repair shop owner in Panama City, Fla. and a retired lawyer/Wall Street banker living in Port Angeles, Wa. – oppose the insurance requirement because the lawyer spearheading the suit says they aren’t speaking to the news media.

I particularly wanted to know how these two uninsured people have paid for health care for themselves and their families in the past and how they plan to pay for it in the future. So I asked David Rivkin, a partner at Baker Hostetler in Washington, D.C., who is representing them and the NFIB and serves as outside counsel for the states, if he could put me in touch with them.

Chaim Indig, Phreesia, on how to spend $16m

Jun 1, 2010• 2

By Matthew Holt

Chaim Indig has been steadily turning Phreesia from an ad-supported patient check-in service to a front end for physician’s offices to manage their relationships with patients, and collect co-pays. As such Phreesia is turning from a content company to a transaction company. Last week they raised a further $16m in venture capital, with new investor Ascension Health Ventures leading the round. Chaim dropped by the Health 2.0 world HQ to meet Charley the dog and to tell us about Phreesia’s next steps.

The Times Hits the Right Notes on Hospitalists

May 29, 2010• 13

By BOB WACHTER, MD

You probably saw yesterday’s hospitalist piece in the New York Times, arguably the best lay article on the movement to date. It hit all the right notes, and did so with uncommon grace and fairness.

The piece, written by the Times’ Jane Gross, profiled Dr. Subha Airan-Javia, a young hospitalist at the Hospital of the University of Pennsylvania. While Dr. Airan-Javia spends about half of her time in administrative, largely IT-related roles (like many of my faculty), the article (and an accompanying profile) gave us a day in her life on the wards:
seeing patients, collaborating with consultants, talking to families, and orchestrating discharges. The fundamental advantages of the hospitalist model – tremendous availability, markedly improved efficiency, and a unique focus on systems improvement – came through unambiguously. For example, regarding availability, there was this:

Because she was on the floor all day, [she] was able to schedule a long meeting with a man who held power of attorney for a patient who was close to death and incompetent to make decisions… Expansive and gentle, the doctor discussed why she would recommend a transfusion but not a feeding tube.

As for efficiency, Gross cited my 2002 JAMA review, which found that hospitalist care was associated with an approximately 15% reduction in hospital costs and length of stay.

Yahoo: The sleeping giant awakes?

May 29, 2010• 5

By Matthew Holt

While Yahoo!’s most recent notable public moment has been its CEO telling some (other) ex-pat British blogger to “Fuck Off”, this British ex-pat blogger has been waiting for a long time for Yahoo! to re-emerge in health care. And finally after a big false start in 2008, they’re baaack.

As of late this week, the new Yahoo Health is now up and running and showing a good deal of (as you’d expect) Healthline’s fingerprints. Here’s my interview with Healthline’s West Shell about them winning the contract to essentially take over the Yahoo site and more.

So pretty close to the surface are Healthline products such as Symptom Checker, Doctor Search, & Treatment Search. It’s a very good first step, and clearly a big improvement.

What’s not in this iteration is any integration with Yahoo Groups which has over 100,000 groups in its Health & Wellness category. There are over 25,000 alone about “Drugs & Medication”, 56,000 in Men’s Health, 9,300 in Reproductive Health, etc, etc. Figuring out what’s in those groups and making them much more user friendly is (I vote) the next job at Yahoo!

The giant is awake, out of bed and stumbling around the cave, but it hasn’t yet come out to frighten the villagers. Let’s hope it keeps moving!

Google Irrelevant? Say It Ain’t So.

May 29, 2010• 8

By JOHN MOORE

Since its initial launch too much fanfare, Google Health has struggled to be relevant. Since its formal launch in May 2008, Google Health has not dedicated the resources to build out this platform into a truly engaging ecosystem of applications to assist the consumer in managing their health or the health of a loved one. Rather than build out new features, support a broadening array of standards, focus on the necessary business development that is required to establish partnerships, Google has taken a laissez-faire attitude to this product/service never dedicating more than a handful of engineers to the effort and most often flexing in outside vendors, such as IBM who built the module to bring in biometric from Continua compliant devices.

Rumors are now floating about that this lack of relevancy, this lack of a true commitment to Google Health has led to that oh so fateful executive decision – pulling the plug on Google Health and either letting the team go or reassigning them to other divisions within the organization. With maybe 25 employees max at any one time working on Google Health, this will not have major implications internally, but it may have some broad repercussions in the industry that include:

Without a viable competitor, will HealthVault languish in its efforts to provide a truly clean, easy to engage and use platform?
Google Health’s interface and ease of interaction has always been one of its key features. Unlike Microsoft’s HealthVault, which initially was a beast to try and use, Google Health from the start was simple, intuitive and dare one say it, almost fun to use. Though HealthVault has come a long way in improving the user experience, it remains a more trying experience. With Google Health put on the proverbial shelf, will HealthVault no longer be pushed as hard to continuously improve the user experience.

Perception that Personal Health Platform (PHP) market is dead.
Markets do not exist if there are no competitors. If the rumors are true, what we have left are Dossia, the private, employer-based platform and HealthVault. These two alone do not constitute a market, therefore, can we now boldly state that there is no market for consumer-based PHPs? Market would seem to say yes, though Chilmark has a hard-time admitting as much as we have been strong proponents of the PHP concept. It may simply be that this market is still extremely immature as the consumer is not well-educated in the value in managing their own personal health information (PHI), nor is such information in easy to access and use digital form factors. History is littered with great inventions by great inventors who ended up in the poor-house simply because the timing was off, This may indeed be the case for PHP.Continue reading…

Regina Holiday, here today & on the Health 2.0 Show Tuesday

May 28, 2010• 2

By Matthew Holt

As we get closer to Health 2.0 Goes to Washington on June 7 (Monday) we’ll be ramping up coverage of all kinds of things, and one is a big chance for you all to get to know the remarkable Regina Holiday a little better.

First, today I recorded an interview with Regina about her murals, her advocacy and what she’s going to say in her panel on the 7th. (You can listen to this interview by clicking thel ink below)

Interview with Regina Holiday

In addition Regina will be on The Health 2.0 Show with Indu & Matthew on Tuesday June 1 at 10 am PST/1pm EST, along with David Hale, creator of Pillbox and Ted Eytan from Kaiser Permanente (and the guy with that other definition of Health 2.0)

You can sign up for the Health 2.0 Show Webinar for free here

Apples to Apples, by Regina Holiday

Apples

You’ll be able to see even more about the Community Health Data Initiative on June 2 (Weds) at an IOM meeting called the Community Health Data Forum. (The meeting is full but we’ll be live-streaming it on THCB).

And finally, the Health 2.0 community will meet the DC crowd en masse at Health 2.0 Goes to Washington on June 7. At that meeting there’ll be a session led by Wil Yu from ONC and Julie Murchinson of the Health 2.0 Accelerator. If you’re attending the Conference (register here if you haven’t already) you can sign up for that session below.

Moving the Needle on Innovation Together: Calling all Health 2.0 companies! Do you have a product or service that addresses Chronic Disease, Elder Care and Personal Health Management? Come share your perspectives on these (or tell us other ideas) at a special Workshop for Federal Agencies and Health 2.0 Companies SIGN UP HERE! SPACE IS LIMITED to the first 60 people who sign up.

The Pitfalls of PPACA #1 – The Medical Loss Ratio Rule

May 28, 2010• 13

By ROGER COLLIER

The Patient Protection and Affordable Care Act, signed into law by President Obama in March, is a significant step towards a more equitable health insurance system, potentially making coverage available to millions of the currently uninsured. Unfortunately, health care reform’s political strategy of let’s-just-apply-lots-of-bandaids-to-the-present-broken-system is likely to produce some disappointments.

Positive changes like assuring coverage for children with preexisting conditions are likely to be overshadowed by others that are equally well-intentioned but fatally flawed—like PPACA’s limits on insurers’ medical loss ratios.

Beginning in 2011, unless medical loss ratios (the percentage of premiums paid out for medical care) are at least 85 percent for large group health plans, and at least 80 percent for small group and individual plans, the plans will be required to offer rebates to enrollees.

Given that the MLRs of the ten largest for-profit health insurers dropped from 95 percent in the early 1990s to around 80 percent today (or, put another way, administrative expenses, overhead and profit jumped fourfold from 5 percent of premium to 20 percent in just over 15 years), it’s easy to see why this provision seemed so attractive to its principal backer, Senator Jay Rockefeller.

Support for Berwick to Head Medicare Grows

May 28, 2010• 9

By MAGGIE MAHAR

Even Fox News acknowledges that: “In the two months” since President Obama named Dr. Donald Berwick, president of the Institute for Healthcare Improvement (IHI), as his candidate to head the Centers for Medicare and Medicaid, (CMS) “not one industry group has voiced opposition to his nomination.”

This, despite the fact that Berwick will be charged with beginning to squeeze $400 billion worth of waste and fraud out of the Medicare system over a period of ten years. One man’s sludge is, of course, another man’s bread and butter. One might expect that drug-makers, device-makers, hospitals and others who profit from the current system would join the fear-mongers who have begun the assault on Berwick, claiming that he plans to “ration” care.

But that isn’t happening. In fact the American Hospital Association (AHA) gave Berwick a flat-out endorsement in a May 20 letter addressed to Senators Max Baucus, chairman of the Senate Finance Committee, and Tom Harkin, chair of the Health, Education, Labor and Pensions Committee:

“His work at the Institute for Healthcare Improvement (IHI) has engaged hospitals, doctors, nurses and other health care providers in the continuous quest to provide better, safer care.” wrote AHA President and CEO Rich Umbdenstock. “This includes dramatic advances in quality improvement, patient safety and end-of-life care through IHI’s collaborative, breakthrough series and other activities,” he added, referring to IHI’s success in success in cutting hospital infection rates and implementing better asthma care and coronary surgery improvements with little additional costs.Continue reading…

Something Wizard This Way Comes

May 28, 2010• 11

By JOE FLOWER

The country seems to have shifted in less than 18 months from a slogan of “Yes We Can!” to “Oh, well…” and a shrug, then back to “Cool! I think. What was that, really?” Hopes for a true rebirth of health care turned into the Year of Screaming Inanely, then took that long slide from what we might hope for to what we might settle for. Yet suddenly it seems like things are popping up all over the place, like mushrooms on a forest floor in springtime. New projects and initiatives are emerging from little companies, big companies, garage startups, info-giants and mega-industrial combines.

It looks just as if, frustrated by a glacial and refractory legislative process, Americans and American companies have taken matters into their own hands, not with torches and pitchforks, but devices and codes and business models, all trying to figure out some way they can help make health care better, faster and cheaper. It is as if Rosie the Riveter of the World War II poster were once again flexing a muscle and saying, “We can do it!”