The Insider's Guide - Tech - The Business of Health Care - Physicians - Subscribe The Doctor-Patient Relationship. Is Over.
By ROB LAMBERTS, MD
Probably the hardest part of making the change from a traditional to a direct-care practice is the effect it has on relationships. I am only taking a maximum of 1000 patients (less at the start) and will be no longer accepting insurance. These changes make it impossible for me to continue in a doctor-patient relationship with most of my patients.
For some, this transition will be more hassle than anything. Some people do everything they can to avoid my office, and so are not going to be greatly affected by my absence. They will simply choose another provider in our office and continue avoidance as always. There are others who see me as their doctor, but they haven’t built a strong bond with me (despite my charm), so the change may even be a welcome relief, or a chance to avoid initiating the change to another doctor. But there are many people, some of which have already expressed this, for whom my departure will be traumatic. Read more.
Out of the Box Thinking on Avoiding Hospital Readmissions. Stop Trying
By DR. WES
As a cardiac electrophysiologist, I'm pretty far removed from public policy. But I have to admit that I was interested in the latest move by CMS to cut their Medicare payment rates to hospitals by invoking pay cuts for hospital readmissions. The Chicago Tribune's article is enlightening and filled with some interesting anecdotes after the first round of pay cuts were implemented:
(1) The vast majority of Illinois hospitals were penalized (112 of 128)
(2) Heart failure, heart attack, and pneumonia patients were targeted first because they are viewed as "obvious."
(3) "A lot of places have put a lot of work and not seen improvement," said Dr. Kenneth Sands, senior vice president for quality at Beth Israel.
(4) Even the nation's #1 Best Hospital (according to US News and World Report) lost out.
So what's a hospital to do? Read more.
The Wrong Way to Save Money on Health Care
By ROBERT REICH
Employer outlays for workers’ health insurance slowed from a 9 percent jump last year to less than half that — 4 percent — this year, according to a new survey from the Kaiser Foundation. Good news? Our political class believes it is. The Obama administration attributes the drop to the new Affordable Care Act, which, among other things, gives states funding to review insurance rate increases.
Republicans agree it’s good news but blame Obamacare for the fact that employer health-care costs continue to rise faster than inflation. “The new mandates contained in the health care law are significantly increasing the cost of insurance” says Wyoming senator Mike Enzi, top Republican on the Senate health committee. But both sides ignore one big reason for the drop: Employers are shifting healthcare costs to their workers. Read more.
The Coming Health Care Singularity
By ADRIAN GROPPER, MD
According to Wikipedia, the Technological Singularity is the hypothetical future emergence of greater-than-human superintelligence through technological means. The Healthcare singularity could be the time when patients have access to better information and make better decisions than their physicians. The drive to this near future is fueled by the open and globaIized energy of patients as compared to physicians handicapped by closed and parochial health IT.
Physicians have skills. Institutions have capital. Patients have freedom, and that is what tips the information balance in their favor. When it comes to health IT, physicians and institutions are still busy installing closed, proprietary, single-vendor systems that erect strategic barriers to communications every chance they get. The protection of professional licensure and institutional consolidation gives both parties a sense of security even as the patient and policymaker barbarians are massing on the Web. Read more.
The Great Cheesecake Robbery
By ROB LAMBERTS, MD
In a well-publicized and well-written article in the New Yorker, Atul Gawande (one of my doctor writing heroes) talks about his visit to the popular restaurant, The Cheesecake Factory, and how that visit got him thinking about the sad state of health care.
But there is one problem with this article: it misses the main problem in health care. His system deals mainly with hospital medicine, which is, for lack of a better name, sick care instead of health care. The mis-labeling of sick care as “health care” is, in my view, the most costly error in all of medicine. Read more.
Rational Rationing vs. Irrational Rationing By DAVID KATZ, MD Massachusetts has a long track record of making headlines in the area of health care reform, whether or not Mitt Romney likes to talk about it. In 2008, Massachusetts released results of its initiative requiring virtually all of its citizens to acquire health insurance. In short order, nearly three-quarters of Massachusetts' 600,000 formerly uninsured acquired health insurance, most of them private insurance that did not run up the tab for taxpayers. The use of hospitals and emergency rooms for primary care fell dramatically, translating into an annual savings of nearly $70 million.
But that's pocket change in the scheme of things, so the other shoe had to drop -- and now it has. Massachusetts made news recently, this time for passing legislation that aims to impose a cap on overall health care spending. That ambition implies, even if it doesn't quite manage to say, a very provocative word: rationing. Read more.
Obama vs. Romney: A Detailed Analysis of Mitt Romney’s Health Care Reform Plan
By ROBERT LASZEWSKI
“On his first day in office, Mitt Romney will issue an executive order that paves the way for the federal government to issue Obamacare waivers to all fifty states. He will then work with Congress to repeal the full legislation as quickly as possible.”
The Affordable Care Act (ACA) does give the President power to issue states waivers from the Democratic health plan legislation. But, not before 2017 and only if the state can demonstrate that it can cover as many people as the Democratic health care law is covering in the state.
“Obamacare” is the law of the land having been passed by Congress. It can’t be just pushed aside on the first day of a Romney presidency. If Romney tried this, I would have to believe advocates for the ACA would quickly be in federal court. Read more. It's the Patient, Stupid
By ANIL SETHI
Electronic health records (EHRs) offer many valuable benefits for patient safety, but it becomes apparent that the effective application of healthcare informatics creates problems and unintended consequences. As many turn their attention to solving the seemingly intractable problems of healthcare IT, one element remains particularly challenging–integration–healthcare's “killer app.” Painfully missing are low-cost, easy to implement, plug-and-play, nonintrusive integration solutions. But why is this?
First, we must stop confusing application integration with information integration. Our goal must be to communicate data (i.e., integrate information), not to integrate application functionality via complex and expensive application program interfaces (APIs). Communicating data simply requires a loosely coupled flow of data, as occurs today via email. In contrast, integration is a CIOs nightmare. Integrating applications, when we just wanted a bit of information, is akin to killing a gnat with a brick. Read more.
Health Care's Man on the Moon Moment? By PETER PRONOVOST, MD
On a snowy night in February 2001, Josie King, an adorable 18-month-old girl who looked hauntingly like my daughter, was taken off of life support and died in her mother’s arms at Johns Hopkins. Josie died from a cascade of errors that started with a central line-associated bloodstream infection, a type of infection that kills nearly as many people as breast cancer or prostate cancer.
Shortly after her death, her mother, Sorrel, asked if Josie would be less likely to die now. She wanted to know whether care was safer. We would not give her an answer; she deserves one. At the time, our rates of infections, like most of the country’s, were sky high. I was one of the doctors putting in these catheters and harming patients. No clinician wants to harm patients, but we were. Read more.
My Open Source Cure
SALVATORE IACONESI
TED Fellow Salvatore Iaconesi released a video along with his digital medical records – everything from CT and MRI scans to lab notes. He posted the health files to invite the online world to participate in the process of treating his brain cancer. Watch the video.
Healthcare Reform's Missing Link — Nurse Practitioners
By PATRICIA DENNEHY, RN
Within the next two years, if federal healthcare reforms proceed as expected, roughly 30 million of the estimated 50 million uninsured people in the United States — 6.9 million in California — will be trying to find new healthcare providers.
It won't be easy. Primary care providers are already in short supply, both in California and nationwide. That's because doctors are increasingly leaving primary care for other types of practices, including higher paid specialties. As the demand increases, the squeeze on providers will worsen, leading to potentially lower standards of care in general and longer wait times for appointments for many of the rest of us.
Nurse practitioners can help fill this gap. We are registered nurses with graduate school education and training to provide a wide range of both preventive and acute healthcare services. Read more. THCB Marketplace: Reach a focused audience of thousands of health care professionals. Post a classified in the THCB marketplace. Email ad_sales@thehealthcareblog.com.
NEW RELEASES
The Health Care Handbook The American health care system is vast, complex and confusing. Books about it shouldn’t be. The Health Care Handbook is your one-stop guide to the people, organizations and industries that make up the U.S. health care system, and the major issues the system faces today.
How to Live Forever *Results May Vary. Nominee Palm Springs International Film Festival. Nominee Hamptons International Film Festival. How to Live Forever Director Mark Wexler embarks on a worldwide trek to investigate just what it means to grow old and what it could mean to really live forever. But whose advice should he take? Does 94-year-old exercise guru Jack LaLanne have all the answers, or does Buster, a 101-year-old chain-smoking, beer-drinking marathoner?
Why Nobody Believes the Numbers Ever wonder if those wellness, disease management, medical home and other programs imposed on your medical practices really work? Answer that question for yourself by reading Why Nobody Believes the Numbers, the first population health outcomes measurement book not infused with THC.
The Great Experiment is about much more than a single state experiment, or the immediate questions the presidential primary may raise regarding Mr. Romney’s term as governor of Massachusetts. Rather, Pioneer assembled some of the best thinkers to outline the options before state and federal officials. The Great Experiment aims to lay out a market-oriented blueprint for the next decade. Download free chapters, including an introduction by Dr. Jeffrey Flier, Dean of Harvard Medical School, or purchase a copy at greatexperiment.org.
True Medical Detective Stories by Clifton Meador, MD 2012. Modern technology has given rise to electronic medical records, remote monitoring systems, and satellite-enabled real-time examinations in which patient and physician might be separated by thousands of miles. Yet, when it comes to diagnosing difficult cases, the clinician’s strongest asset might just be one of the oldest tools of the medical profession — careful listening. True Medical Detective Stories is a fascinating compendium of nineteen true-life medical cases, each solved by clinical deduction and facilitated by careful listening. These accounts present puzzling low-tech cases—most of them serious, some humorous—that were solved either at the bedside or by epidemiological studies.
FILM & VIDEO
MONEY AND MEDICINE As rising health care costs threaten to bankrupt the country, MONEY AND MEDICINE tackles the medical, ethical, and financial challenges of containing runaway health care spending. In addition to illuminating the so-called waste and overtreatment that pervade our medical system, this timely documentary explores promising ways to reduce health care expenditures while improving the overall quality of medical care. MONEY AND MEDICINE captures the painful end-of-life treatment choices made by patients and their families, ranging from very aggressive interventions in the ICU to palliative care at home. The film also investigates the controversy surrounding diagnostic testing and screening as well as the shocking treatment variations among patients receiving a variety of elective procedures.
CONFERENCES
AARP Health Innovation@50+ LivePitch
Sept. 21, New Orleans Convention Center
Please join us for AARP Health Innovation@50+ LivePitch, Friday, September 21 at the New Orleans Convention Center. Health Innovation@50+ is the premier showcase featuring the most exciting companies in the “50 and over” health technology and innovation sector. The pitch event offers the venture capital and angel investor community as well as the media, the opportunity to connect with outstanding startups in the field of health technology and innovation.
Health Innovation@50+ takes place at the annual Life@50+ AARP National Event & Expo, which is attended by 20,000+ members and guests from across the U.S. and the globe. This is the best opportunity of the year for entrepreneurs and investors to capitalize on the world’s largest and fastest-growing consumer market. Register now at http://Health50.org
Health 2.0 San Francisco
October 7-10, Hilton San Francisco
The groundbreaking conference series returns to San Francisco. Keynotes by Joe Flower and Aetna CEO Mark Bertolini. Speakers from Qualcomm, AT&T, Mayo Clinic, National Cancer Institute, ZocDoc, OptumHealth and RedBrick Health, along with presentations from top health care startups changing the field and many more.
The First Annual Open Source EHR Summit and Workshop
October 17-18, Gaylord National, National Harbor, MD
It is projected that more than 200 hospitals and 1000 clinics, within the federal sector alone, will be managing and maintaining their EHRs using open source codes within the next few years. An increasing number of state agencies are deploying open source solutions as well. In recent months, many private sector health care communities facing the unsustainable high costs of health IT have started calling for alternate approaches to maintain and manage traditional proprietary electronic health records. These open source activities create a huge market opportunity for both private and public sectors.
REAL ESTATE 61,000 Square-Foot Building Available For Lease Near Boston
Ideal for Medical Offices, Back Office Uses
A 61,000 SF building that can be easily converted to medical use is available for lease just 17 miles from downtown Boston. Located in Hingham Technology Park 3 on a 9-acre parcel in Hingham, Mass., and there is close proximity to numerous hotels and conference centers, and easy access to Rtes. 3, 93, 128 and 95. The site is a quick drive to Plymouth and Cape Cod.
For more information, contact Richard McKinnon at 617-472-2000, or email richmck@grossmanco.com. To learn more about the additional development potential of this site, visit www.HT3park.com.
THE FINE PRINT
Reach a focused audience of thousands of health care professionals. Post a classified in the THCB marketplace. Email ad_sales@thehealthcareblog.com 
