Moving Beyond Merchant Health Care

Brian Klepper

Published 4/05/12 on MedPage Today

Another luminary-rich panel has been formed to make recommendations about how physician and other healthcare services should be valued and paid for.

The Society for General Internal Medicine launched the National Commission on Physician Payment Reform with funding from prominent healthcare foundations. The 13 commissioners represent a mix of perspectives: a former surgeon/senator, community physicians, academics, two healthcare mega-corporations, a think tank, a state regulator, and a reform-oriented advocacy organization. A group representing large employer purchasers has one seat.

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How To Make Safer Decisions in Medicine

Marya Zilberberg

Posted 4/04/12 on Healthcare, Etc.

I love when an article I read first thing in the morning gets me to think about itself all through my morning chores and then erupts into a blog post. So it was with this little gem in the statistical publications “Significance.” The author suggests making gambling safer by placing realistic odds estimates right on the poker machines in casinos. He even goes through the generation of the odds of winning and losing and how much based on really transparent assumptions. In fact, what he has in effect constructed is a cost-benefit model for the decision to engage in the game of poker on these machines. Seems pretty simple, right? Just a few assumptions about how long the person will play, some objective inputs about the probabilities, and PRESTO, you have a transparent and realistic model of what is probable.

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Of Zombies, Emperor’s New Clothes, Documentation Inertia: LIngering Untrue Diagnoses That Persist in the Electronic Health Record

Jaan Sidorov

Posted 4/04/12 on The Disease Management Care Blog

Every practicing physician using an electronic health record (EHR) has seen them.  Past diagnosis zombies that stumble endlessly through every encounter record.  “Coronary heart disease” that the patient never really had, “diabetes” that was only one possibility among many and a “fracture” that never appeared on any x-ray.

These undead conditions clutter the technology-enabled health system basically because of two EHR value propositions:

Continue reading “Of Zombies, Emperor’s New Clothes, Documentation Inertia: LIngering Untrue Diagnoses That Persist in the Electronic Health Record”

Patient Engagement and Medical Homes – Core Drivers of a High-Performing Health System

Jane Sarasohn-Kahn

Posted 3/30/12 on Health Populi

It was Dr. Charles Safran who said, “Patients are the most under-utilized resource in the U.S. health system,” which he testified to Congress in 2004. Seven years later, patients are still under-utilized, not just in the U.S. but around the world.

Yet, “when patients have an active role in their own health care, the quality of their care, and of their care experience improves,” assert researchers from The Commonwealth Fund in their analysis of 2011 global health consumer survey data published in the April/June 2010 issue of the Journal of Ambulatory Care Management. This analysis is summarized inInternational Perspectives on Patient Engagement: Results from the 2011 Commonwealth Fund Survey, published on The Commonwealth Fund’s website on March 29, 2012.

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Free Our Data and Improve Public Health!

Paul F. Levy and W. David Stephenson

Published in the current issue of the Boston Business Journal

Massachusetts has a stunning opportunity to break open many of the mysteries surrounding delivery of health care. Doing so will help resolve important public policy issues. It will help contain rising health care expenses. And, it will even help save lives and improve the public health.

Doing this requires no new state law. The law is already on the books. It requires no addition to the state budget. The costs have already been incurred.
What could cause so dramatic an impact? Liberating data that is already in the hands of the state government.

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Exercise, Diabetes, Cancer and Autophagy: A Fascinating Connection

Dov Michaeli

Posted 3/27/12 on The Doctor Weighs In

I can already see the yawn forming: exercise again? we know it; it’s good for you, it makes you feel better because of endorphins, it makes your cardiovascular function better because it strengthens your cardiac muscle and improves your circulatory system, and it may even protect you from cancer. But have you thought about what could be the common denominator to the beneficial effects of exercise? If you did, and came up with a blank, I don’t blame you. Until recently we didn’t have a good answer, but now the outlines of an answer are forming. So here goes.

Bariatric Surgery To Cure Diabetes: 2 Compelling Studies But There Are Still 4 Reasons For Health Skepticism

Jaan Sidorov

Posted 3/27/12 on The Disease Management Care Blog

Mrs. Jones (name changed) was obese. Her weight remained persistently high despite education and entreaties about diet and exercise. She hated taking all those medications. She dreaded bathing suits.

And then…. she had bariatric surgery. She shed pounds faster than Supreme Court justices spanking a health insurance mandate. Instead of having a corpulent and unhealthy patient, the Disease Management Care Blog had a svelte and healthy patient.

Based on witnessing first hand patient transformations like this, the DMCB knows that bariatric surgery for obesity works.

Continue reading “Bariatric Surgery To Cure Diabetes: 2 Compelling Studies But There Are Still 4 Reasons For Health Skepticism”

Surgery Trumps Intensive Medical Therapy for Obese Diabetics

Patricia Salber

Posted 3/26/12 on The Doctor Weighs In

Two back-to-back articles in the March 26, 2012 issue of the New England Journal of Medicine show bariatric surgery to be more effective than intensive medical therapy when it comes to glycemic control.  Pardon the pun, but this is BIG.

The studies, one American and one Italian were both randomized, but not blinded (it is hard to blind a surgical versus a non-surgical intervention).  Both were relatively small (150 patients in the American study and 60 in the Italian study).  And, both were relatively short term (12 months in the American study and 24 months in the Italian study).  Nevertheless, the results are dramatic.

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Another Stent Device Biting The Dust

Tom Emerick

Posted 3/26/12 on Cracking Health Costs

We’re seeing a trend.  The FDA approves a stent without proper testing.  Death and complication rates with the new stent increase, the FDA is force to review it.

Remember the controversy over drug eluding stents?

According to an article in the WSJ by Thomas Burton, the so-called Stryker stent…aka the Wingspan device… is increasing rates of  death of patients who have received them.  Following protocol a panel has been convened.  According to the WSJ article, “The FDA had asked the outside panel to advise it on what to do in the wake of a large study last year showing more strokes and deaths in patients with the Wingspan device than among those whose condition was treated using drugs.”

Further, “Researchers in the study concluded the rate of stroke in the patients who got the Wingspan device was ‘substantially higher than the rates previously reported
with the use of the Wingspan stent.’ ”

This is yet another reason for patients to be cautious in agreeing to a stent, and another reason employers need to consider favoring clinics who practise strict evidence-based medicine constructs.

The Law Always Lags Technology: Implications for Digital Medicine

Kent Bottles

Posted 3/21/12 on Kent Bottles Private Views

Three recent developments have highlighted how difficult it is to predict when and if disruptive technologies will transform clinical medicine in the United States. That we are undergoing an avalanche of new information and new technology is hardly newsworthy. From the dawn of civilization to 2003, human beings created 1 billion gigabytes of new information. In 2012, Google says they catalog 2 billion gigabytes of information every two days.

One of the confounding factors on how this new knowledge and technology is adopted by an industry like health care is the law. Henry Perritt, Jr. describes two ways to think about the relationship between the law and technology. Technological change is “a major source of human problems that the law must address.” The law also always lags technology because the common law tradition requires “that the legal system should not predetermine the course of technological application and product development.”http://jolt.law.harvard.edu/articles/pdf/v10/10HarvJLTech689.pdf

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The Amazing Journey of the Lowly Aspirin

Dov Michaeli

There are few stories in the annals of medicine that can rival the rise of aspirin from an obscure chemical to the status of something akin to a folk hero (well, at least among medical history buffs). And now it has attained new heights of media fame; every newspaper, news broadcast or blog worth its name has commented on the latest finding of its cancer-protective effect.

Who discovered aspirin?

Like everything else, all paths lead to the ancient Greeks.  Hippocrates, who lived in the 4th century B.C.E described a powder made from the bark and leaves of the willow tree to help heal headaches, pains and fevers. And there it lay for 23 centuries, unexplored and forgotten.

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MedShare – Recycling Medical Supplies for the Good of the World

Patricia Salber

Posted 3/06/12 on The Doctor Weighs In

This post was inspired by Kathryn Johnson, Western Regional Council Member of  MedShare, a friend, and a most wonderful connector of people.

Today, I drove over to San Leandro, California, the San Francisco Bay Area town where I went to high school.  I wasn’t there to reminisce, however.  I was there to visit one of the most innovative medical charities in the country, MedShare.

MedShare’s Western Region Executive Director, Chuck Haupt welcomed a small group of visitors to MedShare’s 32,000 square foot West Coast facility by framing the need that the charitable organization is meeting.   He showed us a video of the birth and death of a baby born to an HIV positive mom in Lesotho (Southern Africa).  The baby was born limp and in respiratory distress.  In the US, a newborn like this would have been rushed to the neonatal ICU (NICU), intubated, placed on a respirator and then be expertly cared for by a highly trained medical team, with a NICU nurse devoted just to her.  This Lesotho baby was rushed to a nurse already caring for seven other sick babies who were receiving oxygen from a jerry-rigged device that allowed oxygen from a single tank to be shared with other babies in distress.  This newborn died because there was not enough tubing to share the O2 with an eighth.

Continue reading “MedShare – Recycling Medical Supplies for the Good of the World”

Will the Pace of Innovative Change Overtake the Financial Imperative to Slash Spending?

Robert Laszewski

Posted 3/08/12 on Health Policy and Marketplace Review

I thought it was worth passing along the comments by Jim Tallon, president of New York’s United Hospital Fund, in a recent post.

Tallon reflected on an international meeting he attended with health care leaders from a number of industrial nations–“nations whose health care systems, indeed underlying philosophies, ranged from market orientation through hybrids to government authority:”

Continue reading “Will the Pace of Innovative Change Overtake the Financial Imperative to Slash Spending?”

Screening – Illiterate Physicians May Do More Harm Than Good

Kenneth Lin

Posted 3/05/12 on Common Sense Family Doctor

On the first day of the clinical preventive medicine course that I teach every spring, I review the concept of lead-time bias and its potential to make a screening test look more effective than it really is (or, effective when it’s not). Frugal Family Doctor recently explained how lead-time bias deceptively improves 5-year survival statistics. If you are unfamiliar with this concept, I recommend reading his post, but the basic idea is that by advancing the time in the disease course that cancer (or some other condition) is detected, screening will always increase the percentage of patients who survive for 5 years or more, even if it doesn’t do anything to reduce mortality. This concept is as basic to the appropriate use of screening tests as vital signs are to the practice of medicine. In my opinion, any physicians who don’t understand lead-time bias ought to have their test-ordering privileges suspended until they do.

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Data Breach: How Much Will One Cost You?

David Harlow

Posted 3/06/12 on Health Blawg

MP900440914The going rate for a compromised medical record seems to be $1000 (well, at least that’s the asking price) as seen in papers filed in the eleven class action lawsuits against Sutter Health following the theft of a desktop computer last fall.  The computer contained unencrypted protected health information on about 4.24 million members.  The eleven class action suits are likely to be consolidated for ease of handling by the courts.

For an outfit whose most recently reported year-end financials show just under $900 million in income on just over $9 billion in revenue, a $4.24 billion claim certainly qualifies as a big deal.  The data breach claims against Sutter Health were filed last year following its self-reporting of the computer theft, and are in the news again due to the potential consolidation.

Continue reading “Data Breach: How Much Will One Cost You?”