The Health Care Blog – Page 983 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Wal-Mart launches telemedicine business

Jul 29, 2008• 6

By Jane Sarasohn-Kahn

Leave it to Wal-Mart to continue to grow its franchise in health through yet another Walmart_logo2
revenue center. This time it’s telemedicine.

The company will pilot telemedicine through retail clinics in Houston, and will be trademarked as Walk-In Telemedicine Health Care. Wal-Mart will be partnering with My Healthy Access and NuPhysicia, the private company that comes out of the long-successful telemedicine program at the University of Texas Medical Branch at Galveston. Telemedicine was been pioneered at U-T in Galveston over the past 10 years, and the program has global reach.

Instead of employing nurse practitioners, the medical model for this program will use paramedics working under the supervision of physicians via various scopes technologies — electronic stethoscopes and beyond. NuPhysicia describes this process as, "interactive physician visits."

Jane’s Hot Points: While the retail clinic business may be flat, as I wrote on July 25, this new model will enhance patient choices on the retail health front beginning in Houston. If this program pans out in terms of process and outcomes measures, you can be sure Wal-Mart will replicate it in other metropolitan markets. Telemedicine in retail health clinics could differentiate Wal-Mart’s offering from other emerging clinic brands such as Minute Clinic, RediClinic, Take Care, and the many other storefronts among the 900+ clinics currently operating across the U.S.

The result of the primary care crisis

Jul 29, 2008• 11

By Matthew Holt

Over at Spot-on I’m writing about the primary care crisis in partial response to the great stuff from Bob Wachter last week on THCB and also from Maggie Mahar and Brian Klepper. Hopefully, it’s a primer for the politico types over there about the primary care crisis and also what the likely results of it are. Hint, no pay equality, but more retail clinics and online visits.

Meanwhile, my piece at Spot-on two weeks back about the Two Ted Kennedy’s appears rather smarter than it probably was given the long piece in the NY Times today about exactly how risky his surgery was and exactly the level of agreement (i.e. not much) that existed among the wide medical team he convened. Evidence based medicine? Well let’s just say that the oft heard rumors of Medicare’s impending bankruptcy may be truer than I tend to believe if every patient wants that level of service.

At any rate, please take a look at the new piece and the older piece and as ever come back here to comment.

Ask any health care wonk and they’ll tell you that within the larger
health care crisis is a primary care crisis. There is more and more
demand for primary care physicians – the person you probably call your
"family doctor" – but America’s medical schools are producing fewer of
them.

Why? Well in a word, money.

It’s not actually medical school that’s the problem. It’s what happens next. A newly graduated physician, looking a big chunk of debt used to pay for medical school tuition gets to chose their residency and, as such, decides what type of doctor to become.In the U.S. we let medical students choose what to do. Not being dummies, most of them notice that diagnostic radiologists and orthopedic surgeons make three times what primary care doctors make, and choose their career path accordingly. Why the vast difference in compensation? Doing something to a patient – fixing a broken hip, reading an x-ray – has always been better rewarded more than talking to them about their high blood pressure or their son’s excema.

Read the rest.

Herd immunity — vaccinations protect us all

Jul 29, 2008• 6

By Sarah Arnquist

I’m currently in the masters in public health program at Johns Hopkins University and am taking my first course in epidemiology. I have my first midterm tomorrow and among the many concepts the professors want me to understand is herd immunity.

Herd immunity is the ability to resist an attack of a disease because the majority of the members are immune to it. Disease passes from person to person so when a large portion of the population is immune — most likely through immunizations — this protects those who aren’t immune by decreasing the likelihood a susceptible person will come in contact with the disease.

I hope that was review for the clinicians. But for me, though I had been reporting on health care for four years, this was a new concept. It helps put the importance of mass vaccinations into context. Immunizations don’t only protect those who receive them, but the entire population.

That’s why this seemingly growing movement by parents not to immunize their children is so worrisome. I want to know why public health experts have not taken a stronger, more public position about the importance of immunization.

From Description To Action: The Future of Health 2.0 Tools

Jul 28, 2008• 1

By Brian Klepper

Last week, The Health Care Blog ran two articles about new wiki sites
that will develop
and continuously update medical information. A wiki
is a “content collaborative” that allows anyone (or anyone authorized
by the site) to contribute or modify content; Wikipedia is the best
known example. H20logo

In Medicine Meets Wiki, Jane Sarasohn-Kahn brought our attention to MedPedia, a
collaboration between major academic institutions and governmental
agencies to clearly describe the entirety of current medical knowledge.
Then Bob Wachter described Google’s new Wikipedia competitor, Knol, and
suggested sites like this could threaten the stranglehold that
traditional medical journals have had on emerging information.

If McCain chooses Romney as a running mate, Obama’s health plan is off-limits to attacks

Jul 28, 2008• 2

By Robert Laszewski

John_mccain
Mitt Romney seems to be at the top of the list when it comes to speculation over who John McCain will pick for his vice presidential running mate. I am not sure if that is what John McCain is thinking as much as the Romney people, trying to boost their guy, want us to think.

But if McCain picks Romney, it will make for an interesting health care debate this fall.

The Obama Health Plan is a virtual clone of the Massachusetts health law. Romney signed it and continues to support it–most recently a couple of weeks ago in an enthusiastic Wall Street Journal Op-Ed.

With Romney on the Republican ticket, how would McCain ever be able to criticize Obama’s proposal as just another Democratic government-run tax and spend health plan?

MedSphere CEO talks about big goals

Jul 28, 2008

By John Halamka

I had lunch recently with the CEO of MedSphere, Mike Doyle, to learn about the
company’s plans for OpenVista. The idea is simple — take the the publicly available code from the Veterans Administration clinical information system, add new modules such as revenue cycle interfaces that are needed in practices outside the VA system and include support/implementation services. In effect, you’ll have the "Red Hat Linux" of the electronic health record world. Medsphere

Medsphere has chosen to package Vista in two forms – Enterprise for large hospitals/integrated delivery systems needing departmental system and Clinic for small offices/multi-specialty clinics needing strong outpatient functionality.

Friday frolicks in Nawlins

Jul 25, 2008• 4

By Matthew Holt

I’m in New Orleans taking the day off (shhh…wife is sleeping, don’t wake her yet!). Yesterday I gave a talk about Health 2.0 to a very confused looking group of state legislators at the National Conference of State Legislators.

But what was really confusing was the exhibit hall. There was a complete dogs breakfast of interest groups there. The NRA across from the Brady campaign to ban handguns; There were 4 or 5 variations of the humane society, and PETA had 2 booths, one explicitly about cruelty to elephants in circuses, and Barnum & Bailey/Ringling Bros also had a booth (presumably to try to stop legislators caring about cruelty to elephants). The oil & gas industry was next to a big booth of plug-in electric cars. All the right-wing think tanks (Cato, Heartland et al) were spread around, while the lefties (ACLU, Planned Parenthood, People for the American Way) were all sequestered in a ghetto. There were the correctional guys, the taser sellers, and about 4 booths selling ways to put alcohol breath locks on cars. Plus a bunch of companies selling micro-targeting marketing software—all used for targeting voters….not to forget the nudists—their trade association (who knew? or should that be, who nude?) was there and gave me a “naked-nation” pin. Not sure where I was supposed to pin it!

And of course the health care people were all there. Who knew that there are two different masseuse associations (with booths dead opposite each other), and of course the lab guys, the NPs, etc, etc were all there too. There was a mobile optometrists truck put on by an vision care insurer (VPS) which goes to under-served areas giving free eye exams and glasses.

Knol and web publishing challenge medical journals’ stronghold

Jul 25, 2008• 7

Robert_wachter By Bob Wachter

Yesterday, Google launched Knol, immediately branded as Google’s answer to Wikipedia. As health care adviser to the project, I’ll say a few words about Knol, but focus on how it – and other forms of electronic self-publishing – may signal the end of medical publishing as we have known it.

First, a word about Knol (the name is short for “a unit of knowledge”). Google’s vision is that providing a tool for people to write about “things that they know” will make the world a better place. Unlike Wikipedia’s anonymous, collaborative writing/editing process, Knols have authors, with names, faces, and reputations. (Authors can choose to have their identity verified, through a cross-check on their credit card or phone records.) Google provides Knolers a tool; authors enter their content and click “publish.” And poof, there it is, on the Web. Users can rate and comment on Knols, send them to friends, and suggest changes. But the author remains the sole owner of the content, able to update and modify it (or remove it) at any time.

Medicare Could Pave the Way for National Reform

Jul 25, 2008• 8

By MAGGIE MAHAR

Thanks the unbridled rise in health care prices, Medicare is going broke. As I mentioned in a recent post, four years ago the Medicare trust fund that pays for hospital stays started to run out of money. In 2004 the fund began paying out more than it takes in through payroll taxes.

Since then, the balance in the fund, combined with interest income on that balance, has kept the fund solvent. But in just 11 years, it will be exhausted,” the Medicare Payment Commission reported in its March. “Revenues from payroll taxes collected in that year will cover only 79 percent of projected benefit expenditures.” And each year after 2019, the shortfall will grow larger.

Make no mistake: this is not an example of an inefficient government program spending hand-over-fist without caring whether it is getting a bang for the taxpayer’s buck. As I discussed in that earlier post, health care prices have been climbing—without a concomitant improvement in patient outcomes or patient satisfaction—in the private sector as well.

Medicare Reform Could Pave the Way for National Reform

Before trying to roll out national health insurance, the next administration needs to address the structural problems that undermine the laissez-faire chaos that we euphemistically refer to as our health care “system.” Otherwise, we run the risk of winding up with a larger version of the dysfunctional, unsustainable system that we have today. Ideally, the administration should make Medicare reform a demonstration project for high quality, affordable universal coverage.

Century Foundation launches group to study Medicare reform

Jul 25, 2008

By THCB Staff

The Century Foundation announced this week the creation of a working group to create a blueprint for Medicare reform.

Maggie Mahar, award winning journalist, author of the HealthBeatBlog and regular THCB contributor, will direct the group of prominent physicians and health care experts.

Bob Wachter, another regular THCB contributor, UCSF physician and author of Wachter’s World, is also part of the eight-member working group.

The group’s blueprint will be based on recommendations in the Medicare Payment Advisory Commission’s 2007 and 2008 reports. Among the issues the group will review are:

Revising Medicare’s physician fee schedule to pay more for primary care, palliative care, and co-ordination and management of chronic diseases.

Rethinking Medicare’s fee-for-service system to reward doctors for quality, not volume.

Creating an independent Comparative Effectiveness Institute that reviews head-to-head testing of drugs, devices, and procedures to ensure that they are effective.

Identifying and rewarding hospitals that provide better outcomes and higher patient satisfaction at a lower cost while helping other hospitals meet benchmarks.