The Health Care Blog – Page 993 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Congress votes for higher Medicare costs when voting down competition

Jun 25, 2008• 7

By Sarah Arnquist

Congress is bowing to pressure (read: financial contributions) from medical equipment makers that stand to lose money if Medicare expands its competitive bidding program.

The NY Times reports today that the House approved legislation Tuesday that would delay the launch of the competitive bidding program for 18 months — all to appease a few companies that are scared of staying viable in, gasp, a competitive market.

The results of the pilot bidding program show this is good policy that will save Medicare and individuals money. The Times reports:

"When Medicare awarded competitively bid contracts to some 325
companies to serve the 10 metropolitan areas, it reduced equipment
prices by 26 percent on what it would have paid for the same equipment
under the current fee schedule. That means that if the contracts were
allowed to proceed, beneficiaries would save 26 percent on their
co-payments. Medicare would save $125 million the first year and as
much as $1 billion a year if the program went nationwide."

Yet, good policy may lose this battle.

As NY Times columnist David Leonhardt and an accompanying editorial aptly point out, this small battle is ominously prophetic of the impending battles over health care reform.

"By standing in the way of this competition, Congress is really standing up for higher health care costs," Leonhardt wrote.

It will be interesting to see which Congressmen and women vote against competitive bidding now and then assail the rising costs of health care from the podium this fall.

For the cynical out there, this is a reminder of what you already know.

As industry veteran Brian Klepper told me yesterday, "Only innocents and little children think health care reform is going to happen through policy. It’s not going to happen because half of all the money is unnecessary and because Congress is on the take."

Lots of Health 2.0 articles indicates that it’s heating up

Jun 25, 2008• 2

By Matthew Holt

I don’t know if it’s just me, but there appears to be a quick vogue in round-ups of the Health 2.0 world at the moment.

UCLA doc John Luo wrote about******@**ng.com&utm_campaign=06.17.08+l+MDNG+Anesthesiology/PM+eDigest:+Futuristic+Medicine;+Cultural+Competency&utm_source=Listrak&utm_medium=Email&utm_term=/articles/PC_Taking_the_Wheel?utm_source=Listrak&utm_medium=Email&utm_term=%2Farticles%2FPC%5FTaking%5Fthe%5FWheel&utm_content=sjohnson%40mdng%2Ecom&utm_campaign=06%2E17%2E08+l+MDNG+Anesthesiology%2FPM+eDigest%3A+Futuristic+Medicine&utm_content=je******************@***oo.com&utm_campaign=06.24.08+l+MDNG+Pediatrics+eDigest:+Premature+Births+Up;+Pregnancy+and+Child+Obesity”> The People and Companies Driving Health 2.0 on MNDG. He gives a good overview, and mentions some familiar and not too familiar names

In the slightly more rarefied atmosphere of the American Academy of Neurology, Barbara Scherokman of Kaiser Permanente, and Michael Segal, from SimulConsult, give a great overview of the components in Health 2.0 for Neurologists. They focus alot of course on BrainTalk and PatientsLikeMe.

Talking of PatientsLikeMe, I missed this due to being in the Jordanian desert at the time, but in March Wired’s Tom Goetz (who was on a panel in the March 2007 Health 2.0 conference) wrote a fantastic and long article about PatientsLikeMe called Practicing Patients for the New York Times in March. I learned alot and I’ve been giving PLM demos in public for the last year (and no, I’m not a shareholder!)

The people at at nursing online education database bombard me with their posts, but this one about Taking Control of Your Health Records throws in everything including the kitchen sink, but has some interesting links.

At ReadWriteWeb, Richard MacManus has been looking at DiabetesMine and DiabeticConnect. Not surprising as he’s a geek who recently discovered that he had diabetes.

Meanwhile Indu Subaiya and I have been diving into the latest rash of companies wanting to present at Health 2.0. Just 12 months ago we were scratching around to come up with enough candidates to fill four demo panels. Now we have 20 panels and we don’t have enough room to show half of the people who want to present.

It won’t stay like this for ever of course, but it’s interesting to be in the middle of the maelstrom!

Expanding consumer ratings to home caregivers

Jun 25, 2008• 4

By Chiara Bell

It seems that everyone is chasing after doctor and hospital ratings. From Revolution Health to Yelp, consumers are encouraged to rate hospitals and physicians in their communities. Hospitals and physicians are the two obvious providers to rate in our health care system. However, I think we have left out, the largest and, arguably the most important members of the health care profession — nurses, certified caregivers and home health aides.

Let’s compare the numbers.

Today, there are approximately 4,927 community hospitals and an average of 800,000 licensed physicians in the United States. Comparatively, there are 1.4 million registered nurses, 749,000 licensed practical nurses, and 1.8 million certified nursing assistants, home health aides and non-certified caregivers.

That is roughly 4.1 Million members of the health care community that we have left out of the ratings game.

How preventing infections rose to the forefront of the patient safety movement

Jun 24, 2008• 1

By Bob Wachter Robert_wachter

The Joint Commission just released its 2009 National Patient Safety Goals, and –- no surprise –- they focus on infection prevention. While this seems natural today, it wasn’t always so. In fact, the conflation of infection control and patient safety is one of the most surprising twists of the patient safety revolution.

The inclusion – make that dominance – of infection prevention in the safety field was anything but preordained. The IOM Report on medical errors, which sparked the modern patient safety movement, mentions the word “infections” 8 times and the word “medications” 234 times. In other words, the Founding Fathers of patient safety didn’t appear to have preventing infections in mind when they articulated the scope of the endeavor.

So how did it come to pass that infection prevention became one of, if not the, central focus of the patient safety enterprise? The first step was recognition of the importance of measurement. Without measurable rates of adverse events, there could be no public reporting, no research demonstrating improvements, no pay for performance (or, more au currant, “no pay for errors” – note that more than half of the “no pay” entities on CMS’s present and proposed list are infections), and ultimately no one who could be held accountable for progress in safety.

Consumers seek health information to solve marketplace problems

Jun 24, 2008

By Jane Sarasohn-Kahn

Consumers, employers, payers and providers agree that information flows are critical to helping stem health care costs. While there is shared concern about health care costs, there is also a shared desire for more, accessible information and better online tools for managing it.

TriZetto’s report, Research Shows Healthcare Market Constituents Seek Information as Key to Solving the Affordability Crisis, surveys the landscape of stakeholders in American health care and lays out a rational approach to what the IT services firm calls integrated health care management.

TriZetto lays out five key themes that drive the imperative toward integrated health care management:

Health care affordability
Aligning incentives to change activities
Information access as king
The importance of leveraging information technology
Payers as change agents.

Health care is not recession-proof

Jun 23, 2008• 10

By Jeff Goldsmith

It is often accepted as conventional wisdom that health care is recession proof.

People get sick regardless of economic cycles, and the publicly funded safety net programs insure that people who need care get it. Yet if you look around the health system, what you see looks suspiciously like a recession: low single digit pharmaceutical cost growth, a collapse in high tech imaging and cardiovascular sales and clinical volumes, declining hospital admissions and rising bad debts. Is it possible that health care isn’t recession proof after all?

Whose DNA is it anyway?

Jun 23, 2008• 3

By Sarah Arnquist Dna

News of the California Health Department’s mailing of cease and desist letters to 13 direct-to-consumer genetic testing firms, such as 23andMe, Navigenics and DeCodeMe, has sparked intense debate over balancing regulations to guarantee quality and individual rights to genetic data.

Here on THCB, Matthew Holt called the move the "first establishment challenge of Health 2.0."

"This is a case where the regulations are running way behind the technology, and the trade protection organizations of health care providers are, I’m sure, whispering in the ear of the regulators," Holt wrote.

Why all the fuss now?

CA regulators say doctors must be involved in ordering and deciphering the genetic tests, which currently are offered directly to consumers. Currently, customers pay about
$2,500 at Navigenics for an initial one-year membership — and then an
annual fee of $250.
23andMe and DecodeMe both charge about $1,000 for permanent access.

Untangling the electronic health date exchange

Jun 23, 2008• 12

By David Kibbe Kibbe

The purpose of this post is to help a non-technical audience untangle some of the confusion regarding health data exchange standards, and particularly come to a better understanding of the similarities and differences between the Continuity of Care Record (CCR) standard and the CDA Continuity of Care Document
(CCD). But what I’m most interested in is getting beyond the technical, political, or economic positions and interests of the proponents of any particular standard to arrive at some principles that demonstrate in plain language what we are trying to achieve by using such standards in the first place.

Frankly, I don’t give a hoot about what standardized XML format for
capturing clinical data and information about a person becomes the norm
in the health care industry over the next several years. I do care
that the decision is made by the people, institutions, and companies
who use the standards, and not made by a quasi-governmental panel or a
group of "industry experts" whose economic or political interests are
served by the outcome, and dominated by a particular standards
development organization with whom they are very cozy.

In other words,
I do want free and open market forces to be able to operate freely and
openly as health information exchange evolves, in part because I
believe market forces will work in the direction of continuously
improving health IT, whereas in my experience top-down efforts are
often protective of established interests and discouraging to
innovation.

Editor’s note: When republishing Kibbe’s post today, we accidentally deleted the great conversation going on in the comments section. If your comment was deleted, we encourage you to submit again.

Going Dutch for Health Reform Ideas

Jun 22, 2008• 12

By MAGGIE MAHAR & NIKO KARVOUNIS

Every now and then HealthBeat takes a look at health care systems in other countries So far we’ve tackled Germany and China. Next on our list was the Netherlands, but it turns out Health Affairs beat us to the punch. In May, Wynand van de Ven and Frederik T. Schut, two professors at Erasmus University in Rotterdam, authored an excellent profile of the Dutch health care.

Why should we care how they deliver health care in a tiny country most of us will never visit? Few European health care systems have garnered the kind of attention from Americans that the Dutch system has received — especially from folks not known for their Euro-philia, including the Bush Administration. In the fall, the White House sent a delegation to the Netherlands to learn more about the Dutch system. The Wall Street Journal also has praised the Dutch system for accomplishing “what many in the U.S. hunger to achieve: health insurance for everyone, coupled with a tighter lid on costs.”

What could make conservatives entertain the possibility that we might learn from Europeans? Under the Health Insurance Act of 2006, the Dutch have created a system of universal coverage delivered entirely through private insurers. In this, the Dutch plan is very much like the plan Dr. Ezekiel Emanuel proposes for the U.S. in his new book Healthcare, Guaranteed. (We wrote about Emanuel’s plan here and here), calling it a “fresh” proposal for reform.)

Diabetes reloaded

Jun 22, 2008

By THCB Staff

To mark the advancements and ongoing journey in diabetic care DiabetesMine, an online community and resource for diabetics, created this video.

The theme, Diabetes Reloaded, stands for "redefining not only the role of technology in managing chronic diseases, but also for the newfound self-confidence and ambitions of 21st century people living with health conditions. What’s special about this new web-enabled world of healthcare? It’s proactive, technology-based, empowered, revolutionary, against all odds, and – if needed – outside the establishment."