November 22, 2009
Money-Driven Medicine film now downloadable
If you want to watch the documentary Money Driven Medicine based on Maggie Mahar’s book, it’s now available for free download at moneydrivenmedicine.org (the DVD is also available for purchase). The free download is part of an ongoing “Watch-In! For America’s Health” -- a national viewing party organized in conjunction with the Consumers Union.
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November 20, 2009
So Much For Comparative Effectiveness
The Obama administration's commitment to cost control in health care can now be summed up in four words: Not on our watch.
Health and Human Services Secretary Kathleen Sebelius told American women this week that they have nothing to learn from the science that led to the U.S. Preventive Services Task Force guidelines on mammography.Insurance companies won't change their payment policies, andthe independent doctors and scientists who made up the USPSTF task force "do not set federal policy" or determine what services are covered by the federal government."
What a golden opportunity has been missed to educate Americans about the implications of their health care choices. Otis W. Brawley, the chief medical officer of the American Cancer Society, in an op-ed in today's Washington Post condemning the USPSTF guidelines, confirms that mass screening would only save at a maximum 600 out of the 4,000 women under 50 who die of breast cancer annually. What he failed to point out is that 1.14 million American women would have to be screened annually for ten years to achieve that goal. To cover the entire cohort (all women between 40 and 49) to replicate that benefit every year would require screening 11.4 million women annually. The cost, at $200 per mammogram (my initial estimate was accurate, according to this New York Times business section article), would come to $2.24 billion annually for the health care system.
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Comparative Effectiveness Research, Merrill Goozner | Permalink | Comments (50) Technorati: Healthcare, Policy, Economics
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So will the public option hurt hospitals? Not in the Ozarks
I've had this sitting in my inbox a while, but I thought that with the Senate bill out it was time to have a bit of weekend fun with it. The topic is the fear that a public option/government-run health plan/Hitler-ization of America (delete where applicable) will of necessity put all those worthy private health plans out of business. And worse because it will impose government's lower pay rates on providers, it'll also put them out of business, or at least into a position equivalent to that of Ukrainian peasants working on a collectivized farm.
Everywhere you go in the hospital world you hear complaints that Medicare pays less than private payers, and that the private insurance business is the only thing keeping providers alive.
Everywhere but Orark mountains of southwest Missouri and Northeast Arkansas.
Paul Taylor is the CEO of a tiny hospital system there called Ozarks Community Hospital. It's basically a safety net hospital and it only gets about 5% of its business from the leading commercial insurer, Blues of Missouri--part of Wellpoint. And does Wellpoint pay more for its patients than Medicare?
Err...no
In fact this chart shows that it pays less than half in many cases. I thoroughly recommend you read Pauls blog piece on the topic from which I lifted that chart. It's an entertaining, detailed and sensible read.
But what he's saying is that a public option will be better for hospitals serving lower-income populations than a simple expansion of private insurance.
Health Plans, Hospitals, Matthew Holt, Policy/Politics, Public Option | Permalink | Comments (11) Technorati: Healthcare, Policy, Economics
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This Just In
Yesterday, but the U.S. Treatment Services Task Force announced that leeches aren't a particularly good treatment for most ailments. While noting that leeches might still be useful for certain specific circulation disorders, the USTSTF recommended against their use in other situations, like treating fever and abdominal pains.
Although the Task Force has no power to make anyone do anything, Rep. Dave Camp (R-Mich) was heard on NPR's Morning Edition saying, "Some people discounted the idea that the government would actually put people to death ... this actually is really showing how the insidious encroachment of government between the patient and their doctor plays out." Camp neglected to address the facts: (1) overuse of leeches is expensive, and science-based recommendations about appropriate use would save the government money without harming patients, and (2) bloodletting can lead to negative side effects, such as upsetting the body's natural humoral balance.
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Ha Ha | Permalink | Comments (4) Technorati: Healthcare, Policy, Economics
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Harvard Study Gets it Wrong on EHRs and Quality
America’s hospitals are a triumph of modernity, stocked as they are with PET scanners, ECMO machines, and ICUs bedecked in eye-popping gadgetry.
They are also the most complex organizations ever created by man. The seemingly simple process of delivering a drug from the pharmacy to the bedside for example, typically involves a 30-step process executed by a half-dozen people on 3 floors. There are hundreds of ways it can fail.
It often does, and that’s just half the story. Each hospitalized patient requires a unique combination of services including lab tests, physical therapy, a discharge plan and so forth. Since a complex process must be executed to produce each service, the hospital becomes a job shop.
By contrast, the processes used to produce cars and silicon chips are relatively unfettered. That is why piston rods can be produced in batches with every item meeting specs to the micron, while hospital processes often feature error rates of 10-20%.
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EHR | Permalink | Comments (4) Technorati: Healthcare, Policy, Economics
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November 19, 2009
Sell Patients like Baseball Players - Seriously
Here's a health care reform strategy that I have not heard anywhere else. Think about this:
Why aren't health plans more aggressive in promoting the long-term health of their members, like getting them to eat better, stop smoking, get a little exercise, and all that? Because of "churn." For something that has immediate consequences, helping their members stay healthy has an immediate payoff for the health plans. But most of the big things that would make you healthier take a longer time to manifest: You quit smoking or start eating better, you will have a much better health profile in five years, but it won't make as much of a difference in, say, one year.
"Churn" is the industry term for the annual percentage of members who leave a health plan, and it can be surprisingly high. If each year 20 percent of a health plan's members go to some other health plan for whatever reason (they move, lose their job, change employers, get Medicare, find a better deal), then it is not worth it for the health plan to invest in their members' long-term health. If the health plan invests time and effort (which means money) to get you to quit smoking, and you then quit and become someone else's customer, they lose that investment - and the other company gains, by getting a customer who is less likely to need expensive long-term treatments.
But what if they did not lose that investment?
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Health Plans, Joe Flower, Patients, Reform | Permalink | Comments (46) Technorati: Healthcare, Policy, Economics
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Organ Donors Shouldn't Be Penalized
It can be challenging to find an organ donor for someone who needs a transplant. But when a donor and desperately sick person are matched up, living donors should not be "punished" for their gift, especially by the health insurance industry.
This is a little-known aspect of the health care debate that should be brought to light -- the fact that there is nothing that prevents health insurance companies from either denying coverage or charging higher premiums to those who donate an organ by categorizing them as people with "pre-existing conditions."
This lack of regulation makes it potentially difficult for donors to get health insurance after giving the gift of life.
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The Health Internet vs. the NHIN -- A Matter of Control, Cost, and Timing
There is growing tension within the Obama administration's health team over who will control health data exchange: everyone (including consumers and their doctors), or just large provider organizations. The public debate will be framed in terms of privacy, security, and the adequacy of current exchange standards. But what really matters is who gets to make decisions about where health data resides, how it can be accessed, how much exchange will cost, and how long it will take for exchange to become routine.
Now is a good time to re-visit the plans for a National Health Information Network (NHIN), since we can finally observe and compare different health data sharing and exchange models in the marketplace. NHINs represent an older model that tries to use regional health information organizations (RHIOs) to establish secure networks, privately owned and operated by large provider organizations, mostly hospitals and health systems. The idea was that, over time, each private regional network would develop a gateway to other networks, creating a "network of networks" that would allow Stanford to talk to Partners Health, or Kaiser to Mayo. This communications model was enterprise/provider-centric. Patients/consumers were relegated to depending upon each RHIO's policies for access to their health information. It was also a massively expensive and time consuming - think decades - way to build a health data network.
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Brian Klepper, David Kibbe, HITECH, NHIN, RHIOs, Web/Tech | Permalink | Comments (37) Technorati: Healthcare, Policy, Economics
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November 18, 2009
Practice Fusion throws its hat in the consumer ring
Practice Fusion has been making a fair bit of noise recently with its investment from Salesforce and its trumpeting of 18,000 + physician users. If that number is true it probably makes it the most used EMR outside of EPIC or VISTA—bear in mind that AthenaClinicals only claims around 2,000 users. I’m inclined to take that number with a large grain or two of salt, and suspect that the number they’re reporting is “registered” users rather than “active” users. However, either way you slice it their “free SaaS-based” EMR model has put the cat amongst the pigeons (FD PracticeFusion was a sponsor of the recent Health 2.0 conference which I co-founded).
Today Practice Fusion adds a pretty important piece to their armory—the patient view and record called “patient fusion”. Below is a screenshot they sent me.
Now I haven’t reviewed the product nor seriously vetted their claim that it’ll be available to 1,000,000 patients already. But I can tell you that SaaS-based clinical groupware services like this one are an increasingly viable alternative to the traditional EMR vendors. And in these days of cats and dogs coming together, it’s good to see this level of innovation coming to the market.
Electronic Medical Records, Health 2.0 | Permalink | Comments (4) Technorati: Healthcare, Policy, Economics
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The Outlook for a Health Reform Bill in 2009
Readers know of my yearlong pessimism over our getting a trillion dollar health care bill in 2009.
With the historic passage of the House bill, are we now on our way to a big health care bill in 2009—or even by early 2010?
Clearly, Democrats desperately want to pass a bill. Given their compromise over abortion and the neutering of the public option in the House legislation—things most liberals said they would never agree to—it is clear the Democratic leadership will take any deal they can get.
But there are still some giant obstacles on the way to a Rose Garden bill signing late this year or early next:
- Getting and keeping 60 Senate votes across a wide spectrum of complex issues. Senate Majority Leader Reid has not achieved a 60-vote consensus on any of the dozen or more contentious issues. In the wake of Pelosi not being able to get more than a two-vote margin for the neutered public option, some Democratic Senators will have no interest in the “robust” version with the state opt-out Reid has been talking about. He has made even less progress on all of the other contentious issues--and you can put abortion on the top of that list. Figuring out the “sweet spot” on each issue that keeps the same 60 votes on side for the entire bill would take a super computer—if that were even possible.
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Extormity launches WHIO to compete with Health Internet
Electronic health records vendor Extormity, seeking to establish itself as the dominant force in the healthcare IT space, is launching its World Health Information Organization or WHIO platform at a public launch event in Brussels.
“WHIO is like a mega-RHIO or HIE, and it is pronounced the way Barbara Walters would say RHIO,” said Extormity CEO Brantley Whittington from a shareholders meeting in Monte Carlo. “We view the repackaging of the NHIN into the Health Internet as a disruptive move capable of making us obsolete, so we decided to make a bold play and launch a global health ecosystem that will one day combine search, advertising, content, connectivity, partners, devices, health and wellness tips, recipes, diagnostic tests, medical advice, physician and hospital ratings, car care guidelines, health related ringtones and a whole bunch of functionality we haven’t even dreamed of yet.”
To cement its international position, Extormity is going to offer WHIO in every language on the planet, including obscure dialects. “We even have a team of programmers working on the way some remote tribes communicate using a series of clicking noises, which is incredibly difficult to code,” added Whittington.
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Ha Ha, Weird press releases | Permalink | Comments (3) Technorati: Healthcare, Policy, Economics
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Controlling Health Care Costs: How to “Bend the Curve”
As Congress nears passage of the first substantial health care reform in decades, there is an ominous challenge: No reform will be sustainable unless we slow the rapid growth of health care spending.
Health care costs are rising at a staggering pace. Expenditures have been increasing at 2.7% per year faster than the rest of the economy over the past 30 years. In 1980 the US spent about 8% of GDP on health care. We now spend over 17%. We need to rein in growth of health care spending to levels no higher than overall economic growth -- or ideally "bend down" the growth curve to an even lower figure.
How do we “bend the curve”? What are the best ways to slow the growth of health care costs, thus making other reforms sustainable?
There are three major areas in which reforms will help bring health care spending under control.
Prevention: US health care is burdened by diseases that are preventable. If we can improve lifestyle issues – nutrition, exercise, obesity, tobacco use – we will lower the future incidence of diabetes, heart disease, cancer, and other costly maladies. Current health reform proposals that allocate $10 billion for a Prevention and Wellness Fund represent a major step in the right direction. Disease prevention likely provides the greatest return on investment regarding health care costs of anything we do.
Hospital and Physician Behavior: Hospitals have no incentives to prevent unnecessary hospitalization. Physicians, paid mostly by fee-for-service, have every incentive to order more tests and procedures. Neither is rewarded directly for making – or keeping – patients healthy. Key to controlling health care costs in the future will be to realign these incentives.
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| Permalink | Comments (14) Technorati: Healthcare, Policy, Economics
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November 17, 2009
"The possible" vs "what we want," resumed
Not so long ago (actually less than 2 weeks), there was quite the spat on THCB between the Four Horseman (Klepper, Kibbe, Lazewski & Enthoven) and Maggie Mahar. Essentially it came down to this question:
Is there enough in the current House & Senate bills to restrain spending and remake the health care system? Or is the whole effort so bought off by the health industry as to be a waste of time?
I put myself in the camp of agreeing with both the Four Horsemen (that the bills were pretty much emasculated) and with Maggie (in that at least we’ll get some significant improvements in coverage for the uninsured).
And don’t they need it. In fact I wonder how many of the 50–odd million uninsured and the 50–odd million Americans who don’t have enough to eat are the same people.
But today the chorus of “fiscal responsibility through health reform” being orchestrated by the Administration got a little louder. It started about a week ago with Peter Orzsag banging the drum for health care reform being deficit neutral. He pointed to a letter from a group of moderate to liberal economists supporting HR 3962.
Today many of that same group (although not all and without the non-economists) were joined by some heavy hitters on the health economics side supporting many of the tenets of the Senate bill. This new group includes many of the same liberals but also some sensible Republicans (well Mark McClellan) and some real big guns including Uwe Reinhardt, Victor Fuchs, Joe Newhouse, Laura Tyson, Henry Aaron, Alan Garber and Kenneth Arrow. Alain Enthoven (one of the Four Horsemen) is notable by his absence.
However, the economists probably wouldn’t disagree with the Four Horsemen about how limited the changes in the Senate and House bills actually are, and they appeal for an independent Medicare Commission and serious delivery system reform—all of which will be emasculated in Congress. But nonetheless they are providing valuable intellectual cover for the Administration—no one on the other side will be able to put a crew like this together! Meanwhile over on the Health Affairs blog Jack Wennberg (with Shannon Brownlee) is giving an assist by stepping up his counter-attack against the Academic Medical Centers who are complaining that their patients are sicker.
So the “realists” are coming out in support—all believing that once we get the legislation out of Congress and into sensible hands within the Administration there’s a chance that we might be able to do some good in terms of delivery system change.
Stay tuned. This is a good reason to keep reading THCB for the next decade.
Matthew Holt, Medicare, Policy, Policy/Politics | Permalink | Comments (5) Technorati: Healthcare, Policy, Economics
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November 16, 2009
Spotlight on Health 2.0: In The Doctors Office, from SF 2009
Every week we bring you a new video from Health 2.0! This week we're featuring Health 2.0 In the Doctors Office, a special showcase featuring physician-facing tools and services from the recent Fall conference in San Francisco.
