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CMS Finalizes 2016 Medicare Payment Rules for Physicians, Hospitals & Other Providers

CMS Finalizes 2016 Medicare Payment Rules for Physicians, Hospitals & Other Providers | Healthcare and Technology news | Scoop.it

The Centers for Medicare & Medicaid Services (CMS) issued final rules this week detailing how the agency will pay for services provided to beneficiaries in Medicare by physicians and other health care professionals in 2016 that reflects the administration’s commitment to quality, value, and patient-centered care. Payment rules for the 2016 calendar year for End-Stage Renal Disease Prospective Payment System, the Hospital Outpatient Prospective Payment System, Home Health Prospective Payment System, and the Physician Fee Schedule were all finalized this week.


“CMS is pleased to implement the first fee schedule since Congress acted to improve patient access by protecting physician payments from annual cuts. These rules continue to advance value-based purchasing and promote program integrity, making Medicare better for consumers, providers, and taxpayers,” said CMS Acting Administrator Andy Slavitt. “We received a large number of comments supporting our proposal to allow physicians to bill for advanced care planning conversations and we are finalizing this rule accordingly.”

Key policies finalized in the 2016 payment rules include:

  • Finalizing the Home Health Value-Based Purchasing model. This model, authorized under the Affordable Care Act, is designed to improve health outcomes and value by tying home health payments to quality performance. All Medicare-certified home health agencies that provide services in Massachusetts, Maryland, North Carolina, Florida, Washington, Arizona, Iowa, Nebraska, and Tennessee will participate in this model starting January 1, 2016. Compared to the proposed rule, the maximum payment adjustment in the first year of the model was reduced from 5 percent to 3 percent. This was part of the Home Health Prospective Payment System final rule.


  • Finalizing updates to the “Two-Midnight” rule. The rule clarifies when inpatient admissions are appropriate for payment under Medicare Part A. This continues CMS’ long-standing emphasis on the importance of a physician’s medical judgment in meeting the needs of Medicare beneficiaries by providing clearer guidelines and a more collaborative approach to education and enforcement. This was part of the Hospital Outpatient Prospective Payment System final rule.
  • Finalizing the End-Stage Renal Disease Quality Incentive Program. The End-Stage Renal Disease final rule will apply payment incentives to dialysis facilities to improve the quality of dialysis care. Facilities that do not achieve a minimum total performance score with respect to quality measures, such as anemia management, patient experience, infections, and safety, will receive a reduction in their payment rates. 
  • Beginning the new physician payment system post the Sustainable Growth Rate (SGR) formula and supporting patient- and family-centered care. This is the first final Physician Fee Schedule final rule since the repeal of the SGR formula by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Through the final rule, CMS is beginning implementation of the new payment system for physicians and other practitioners, the Merit-Based Incentive Payment System, required by the legislation.
  • Finalizing provision to empower patients and their families regarding advance care planning. Consistent with recommendations from a wide range of stakeholders and bipartisan members of Congress, CMS is finalizing its proposal that supports patient- and family-centered care for seniors and other Medicare beneficiaries by enabling them to discuss advance care planning with their providers.
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Hospitals press HHS on meaningful use

Hospitals press HHS on meaningful use | Healthcare and Technology news | Scoop.it

Their patience wearing thin, a group of leading hospital organizations have implored Health and Human Services Secretary Sylvia Mathews Burwell to publish pending meaningful use modifications sooner rather than later.

In a letter this past week that CC'd Centers for Medicare & Medicaid Services Acting Administrator Andy Slavitt, eight hospital groups urged CMS "to release, in the immediate future," final rule modifications to meaningful use for fiscal years 2015 to 2017.

"The rule is past due, given that it will affect the current program year for meaningful use," according to the letter, co-signed by America's Essential Hospitals, American Hospital Association, Association of American Medical Colleges, Catholic Health Association of the United States, Children's Hospital Association, Federation of American Hospitals,Premier healthcare alliance and VHA Inc.

"Indeed, under current rules, meaningful use applies to fiscal year performance for hospitals. FY 2015 ends on Sept. 30 – fewer than 60 days from now," they write.


CMS recently floated a proposal to shift meaningful use reporting to the calendar year. Even then, however, "the last possible reporting period would begin on Oct. 3," according to the letter.


"Even if reporting is moved to a calendar year, hospitals need the certainty of a final rule now to determine the best reporting period to choose and begin the process of reviewing performance and ensuring they have met all of the revised requirements."


While recent proposed changes to MU, such as a 90-day reporting period for FY 2015 and simplified patient electronic access requirements are appreciated, the hospitals want CMS to quickly "finalize those changes as proposed."


They object to other proposals, however – mandating the e-prescribing of discharge medications, requiring new public health reporting measures – that "would make meeting Stage 2 more difficult."


Not to mention the fact that "given the delay in the release of a final rule, they would be virtually impossible for hospitals to accommodate."

Without quick action from the feds, hospitals "simply will not have sufficient time to understand the new requirements, work with their vendors to purchase and implement new or revised technology that would accommodate them, and invest in the training and work flow changes necessary to meet the new requirements," according to the letter.

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Three Tips for Hiring Better Front-Desk Staff

Three Tips for Hiring Better Front-Desk Staff | Healthcare and Technology news | Scoop.it

Many practices really struggle with hiring and training a front-desk person (the person who will create that all-important first impression for your practice). The struggles are real; most offices budget near-minimum wage for this position and seem to have difficulty finding the right person to handle the huge responsibility of this position.


My go-to answer for this problem is to pay a little more in salary to recruit for this position. It's true; you often get better quality applicants if you can raise the hourly rate of pay for this vital position. It can be difficult to find a professional with the type of experience you are looking for if you only pay a low hourly rate.


But if you can't find the extra money to increase salary, what other options are available that won't necessarily cost more? Here are some options:


1. Rearrange responsibilities.

Perhaps you should take away appointment scheduling from the front desk, as there are often face-to-face patients requiring more attention. Calls could be redirected through an automated PBX system to another staff member.


2. Search for candidates with a high attention to detail.

This is as simple as giving applicants specific instructions to follow. If they don't follow those instructions in the application process, exactly, then don't even give them a second look. After all, if they are responsible for the first impression in your office, they should be diligent in making the optimal first impression to you.


3. Hire for personality and train the skills.

You can't train someone into a bright, sunny, and welcoming demeanor. So hire for personality, attitude, and work ethic — the skills and other aspects of the job can be taught.


It doesn't have to cost you more money to find the perfect front-desk staff member. There are great candidates out there to meet every budget, who will help you create stellar front-desk first impressions.

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Four Unique Healthcare Apps

Four Unique Healthcare Apps | Healthcare and Technology news | Scoop.it

The last seven years has seen the rise of the smartphone and tablet as personal technology devices utilized by almost all professions in some capacity or another. The healthcare industry is no different and the veritable volume of applications or "apps" that have been developed and utilized by physicians and patients in the last few years has skyrocketed. Inevitably, the large volume of apps makes it difficult for individuals looking to make an impact to stand out in the crowd, as certain conventions become standard. Having a unique "hook" definitely helps to boost such apps into the spotlight, but it also serves to help physicians and patients look at new ways to utilize software (and the devices they run on).


CARROT Fit


Sometimes, "unconventional" is as simple as looking at something in a different or even humorous way. For example, CARROT Fit is an app developed by Brian Mueller that provides you with a sarcastic and merciless "fitness overlord" (modeled after his mother, sister, and wife) who motivates you through such innovative techniques as referring to you as "meatbag" and threatening you with "squirrel attacks" (yes, you read that right) when you fail to exercise. Mueller started out by writing alarm clock and to-do apps and received such a positive response about the personality of the Carrot A.I. (artificial intelligence) that a workout app seemed like the next logical step.


'"The CARROT series of apps are all about taking things that people hate doing … and making them fun and rewarding," said Mueller. "I think most people feel upset when they step on a scale … but CARROT's humor turns that around and makes it a positive experience they can laugh about — and because they connect with the character so much, they're actually motivated to do better the next day."


Bowel Mover Pro and Autism Tracker Pro


Another way to stand out in a field of "me too" health apps is to focus on areas of health that may be less common or more challenging to discuss. Case in point is developer Uwe Heiss. His company, Track & Share, developed Bowel Mover Pro and Autism Tracker Pro to empower patients with self-tracking tools that would make the patient-care team encounter more effective.


Any physician who has ever had to discuss bowel habits with an IBS patient knows how frustrating it can be to get vague feedback on patient symptoms. "All of my apps are designed to help people to spot trends, patterns, and how things might be related to each other," said Heiss. "For example, 'Does stress appear to aggravate my IBS symptoms?' 'Since I started Yoga, did my daily average stress level go down?' 'Was I able to avoid peak stress …?'"


Heiss stresses that three things which guided the design of his apps were the ability to highly customize what patients tracked, to provide powerful graphing options to identify patterns over time, and the ability to share data via external tools such as Excel, increasing the physician's ability to use the data in a meaningful way.


Symple


Developer Natasha Gajewski echoes some of these thoughts and developed her symptom-tracking app around one basic concept that also gave the app its name, "Symple." "I developed this app when I became a patient … one of my most important duties was to deliver an accurate symptom history between doctor visits," she said. "I had limited use of my hands and fingers … so I designed the touch interactions to be as simple as possible. We also worked hard to keep the cognitive load to a minimum."


One thing is certain. Regardless of the reason for defying convention, all developers believe the future of medicine will involve more integration of such apps and more active user interaction in an effort to enhance the patient-doctor encounter. At the end of the day, if visionaries succeed in this lofty endeavor, it will be because of the conventions they chose to modify or ignore in an effort to stand out and stand up for a better healthcare experience.

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In Colorado, a Collaboration Around Healthcare Technology

In Colorado, a Collaboration Around Healthcare Technology | Healthcare and Technology news | Scoop.it

Across the country, technology and clinical leaders are figuring out ways to try to promote greater interoperability of healthcare data. For seemingly everyone, it’s been an uphill climb and a steep learning curve. In the U.S., there have been pockets of success; some states are at the forefront of true data exchange, while others aren’t quite as mature.


 In one of these pockets is Colorado, where the Denver-based Colorado Regional Health Information Organization (CORHIO) recently announced that its health information exchange (HIE) has grown in number of users by 111 percent, with the amount of data available in the network having grown by 118 percent in the past year. That marks the third consecutive year of triple-digit growth rates for the organization, which, as of a few months ago, encompasses 5,705 active providers/users, 47 connected hospitals, and with more than 223 million clinical messages having been sent.


To this end, also in Colorado are the Englewood-based Centura Health (with hospitals also spanning across Western Kansas) and the Aurora-based University of Colorado Health (UC Health), two organizations that will be represented at the iHT2 Health IT Summit in Denver on July 21 (the Institute for Health Technology Transformation, iHT2, is a sister organization of Healthcare Informatics under our corporate parent organization, the Vendome Group LLC). At the conference will be a panel on “Strategies to Advance Interoperability,” where Steve Hess, CIO at University of Colorado Health and Dana Moore, senior vice president/CIO and managing director, service center, at Centura Health, among others, will address the most effective models and mechanisms for exchanging data.


In Aurora, University of Colorado Health came together as a unified system about three years ago when all of its IT components collapsed into one core set which included the Verona, Wis.-based Epic Systems as the organization’s core electronic health record (EHR), Hess says, who says the health system’s HIE strategy is multi-faceted. “We do offer hosting Epic for independent community practices that want to use our EHR for their own continuity of care and clinical collaboration needs,” Hess says. “We also use a built-in HIE, Epic’s Care Everywhere, to exchange records, and that works very well for Epic-to-Epic health information exchange. We have exchanged records with systems in all 50 states using that methodology,” Hess says.


UC Health is also a part of CORHIO, and that’s where a lot of statewide collaboration has occurred. “There is exchange of not only demographics, labs and discharge summaries, but also immunization and public health interfaces through the HIE,” Hess says. “We are on a journey of health information exchange, and we’re fairly early on that journey. Exchange is happening but the next generation functionalities of orders and results, exchanging CCDs (continuity of care documents), things like that, are still in the early stages,” he says.  “In the meantime, we collectively look at technology not as a competitive advantage but a way to help patient care, doctors, and nurses across the state and beyond. We know our organizations will compete in terms of quality and service and other things, but we’re trying out best not to compete with technology.”


Meanwhile, at Centura Health, Moore says that the organization initially started its own private HIE in 2005 with a company that is now part of Cerner’s arsenal, but wasn’t even an established vendor at the time. Once CORHIO came around, however, Centura quickly migrated over. “We didn’t want to have a competing product and wanted to promote collaboration within the state. When CORHIO was in its infancy, Steve [Hess] and I were frequently helping them build its model,” Moore says. Then, in 2006, Centura installed the Westwood, Mass.-based MEDITECH EHR across its acute care facilities first, eventually expanding into ambulatory and home care. Now, Centura, which did receive Healthcare Information and Management Systems Society (HIMSS) Stage 7 designation, is in the process of switching over to Epic, Moore notes.


Bringing the Data to the Doctor


For both UC Health and Centura, the key to successful health IT adoption and electronic data exchange is that this time around, the HIE brings data into the physician’s workflow so he or she doesn’t have to leave that workflow to see the data. “Success is always relative, and one of the big issues with HIE in Colorado five or 10 years ago was workflow,” Moore says. “Clinicians had to go out of their workflow and try to find the patient. From a user standpoint, it wasn’t successful. The advancements we made getting HIE in their workflow have proven that we are leaps and bounds from where we were,” he says.


Hess agrees that keeping clinicians in the workflow that they use predominantly is crucial. “With CORHIO’s and Epic’s tools, the idea is to bring the data within the workflow of the doctor rather than make them go out of it. There has been a lot of interface work around that,” he says. As such, UC Health has approximately 800,000 records exchanged electronically each year, Hess says, noting that examples of the data being exchanged include complete patient records, CCD summaries, electronic lab results, and immunization and syndromic surveillance exchange.


Despite successes at both organizations, Hess and Moore understand that there is still a ways to go before true interoperability is achieved. For one, Hess says that not having universal patient identifiers will continue to be a struggle for everyone. “A big part in what all these things require is knowing which patient is which,” he says. “Having to pull our different medical record and encounter numbers and hope/make sure that we’re sending data on the right patient is a struggle that might never be solved in our lifetime.”


Hess adds that if you think about the old way of exchanging records where one facility called another and got a 36-page fax of patient data sent over, oftentimes the person trying to pull the clinically relevant data from that fax wasn’t the doctor. “As a result, sometimes that data would go ignored,” Hess says. “So now our struggle will be separating the noise from the gold. If we get 10 CCDs on 10 different encounters across four different care settings, how do we take all that data and turn it into information for the clinicians? I don’t want to have a bunch of CCDs acting like a stack of a paper on a fax machine,” he says.


 This, Hess says, is the next big hurdle, what he calls “HIE 3.0.” He says, “We need to figure out how to stratify the data and present it in manner that allows clinicians to do the right thing with it. If we’re not careful we can overwhelm them and they could potentially ignore the data like they did with the faxes.”


Moore adds that another pitfall is getting providers on board to the HIE. While he notes that most of the major hospitals in Colorado are on CORHIO, there are still some that are not, and that’s a problem, he says. “Also, we talk about CORHIO and that is great, but we have hospitals that border the state too; we actually have a hospital in Kansas right now,” he says. “It’s great that Epic talks across all 50 states, but getting all of these HIEs to talk to each other has been a big challenge, which is ironic since that’s what they’re designed to do.”

Moving forward, a major part of the solution is collaboration on the part of providers as well as vendors, Moore says. “A lot of the onus is on the providers, as we need to be the ones at table bringing people together and removing roadblocks. Vendors respond to the market, so if we as providers—their ultimate customers—demand collaboration and exchange, then they’ll have to respond,” he says.  He adds that close-minded vendors are also part of the problem. “This vendor needs to exchange information with this one and you try to bring two competitors to the table. That’s not easy,” he says.


As such, according to Hess, a lot of vendors see their technology as a competitive advantage. Organizations that do this, rather than use their service or quality as the advantage, are slow to the collaboration table because they don’t want to level the playing field, Hess says. “But we all need to do things in similar ways, and our service and quality will be what brings doctors and patients to us. We need vendors and providers to say ‘we need to level the technology playing field.’ We really need to push that. When someone who is influential goes off that path and starts to do things differently, we get in trouble,” Hess says.

Moore adds that while nationwide interoperability efforts such as CommonWell have popped up, they might not be in it for the greater good as much as some people think. “I’m not necessarily buying that it’s for the greater good, but rather for a competitive advantage or a response to Epic’s Care Everywhere [product]. It would be great if all the vendors got together to make HIE transparent across all platforms without a third party, as that would make everyone’s life easier. But I don’t see that happening. I see them continuing to compete to try to gain market share,” Moore says.


Nonetheless, Hess warns that complete consolidation on one EHR vendor such as Epic or Cerner wouldn’t good either, as that could stifle innovation. “Some of these vendors are expensive and will never get into the small hospitals, the moms-and-pops,” he says. “We have to come up with better ways to share data. This is a journey; if you look back on HIE five years ago compared with today, people would be amazed with the progress. At the same time, we all wish it would be easier,” he says.


Back in Colorado, Moore notes that the healthcare IT leaders in the state meet quarterly, pick up the phone often, and collaborate to ensure the residents of the state get the absolute best care from a technology standpoint. “We want to make sure that the tools we provide our providers with are the absolute best,” he says. Hess, who has been in the state for six years after living in the Mid-Atlantic region, adds that the penetration of robust, mature adoption of health IT in care setting is pretty deep in Colorado. “Without that deep maturity level the collaboration conversations would be much harder,” Hess says. “The combination of the collaboration that goes on and the health IT adoption is a pretty powerful formula.”

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How New Jersey Public Policy Fails Primary-Care Physicians

How New Jersey Public Policy Fails Primary-Care Physicians | Healthcare and Technology news | Scoop.it

We live in a very exciting time in the healthcare industry. Regardless of how you feel or think about decisions that are made on the government level, healthcare is in a period of controlled chaos right now.


With the potential merger of Anthem and Cigna and Aetna and Humana, or Assurant closing its doors on its health insurance business, things are about to get really interesting for medical practices. Arming yourself with as much information as possible is key to not just surviving financially, but thriving in this new environment.

Let's take Assurant, for example. They've decided that doing business in the healthcare arena and competing against the dominant healthcare insurance companies was far more expensive than expected. What does this mean for your practice? If you have patients that use Assurant as their medical insurance, it's a great idea to step in and take control of those accounts, now. Create a waiver for Assurant patients that explains what is going on, what to expect from their plan, and how they can still see you with a new insurance plan. The waiver should also state that in the event Assurant does not pay the medical claim, patients will be responsible for the allowed amount, and they will have to pay out of pocket if it is a PPO Plan. If the plan is an HMO, and Assurant does not pay, the practice is not allowed to place a PR (patient responsibility) to the patient and will lose that money.


Aetna and Assurant have similar fee schedules, so suggest to your patients to look into individual Aetna plans, to ensure that you will retain those patients and not lose revenue if you are contracted with Aetna. You will also need to really follow up with those claims and make sure that Assurant is paying you. I have seen them use a delaying tactic of denying a claim with the code CO95 (plan procedures not followed), which basically means they are sending your claim to a different claim address than what was provided to you at the time of benefit verification.  


As far as the pending mergers, I really love it when this happens. I'm particularly fond of the companies that have been courting each other lately. With the possible Aetna/Humana merger, Aetna will be able to add a lot more patients to their network. It will position them as a real player and earn them much needed respect within the market. I still have some overall issues with both Aetna and Humana, but merging them together should ease some of those issues.


The Anthem/Cigna cat-and-mouse game going on is particularly interesting. Cigna claims they're worth more than $184/share, and said no to Anthem's last purchase attempt. But Anthem is not giving up. Cigna used to be a premium plan until they teamed up with American Specialty Health. They have basically cut reimbursements to providers in half (if you signed up under their new network, otherwise you are seeing Cigna patients out of network), and implemented a time-consuming authorization process that eats away at whatever profit your practice may have left over from the reimbursement cuts. They implemented this over the course of the last year, or so. Working with Anthem is pretty cut and dried: What you see is what you get, with no hidden agendas. Anthem requires few to no pre-authorizations, allowing you to see your patient and maybe make a few bucks.


Just taking a few moments and reading up on what is going on in the healthcare industry today is really key to insuring your practice is not caught off guard. Always be learning, always be aware. There are multiple newsletters you can sign up for that will drop a daily or weekly e-mail into your inbox that will help you keep up.

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Demand for Advanced Practitioners Will Continue to Grow

Demand for Advanced Practitioners Will Continue to Grow | Healthcare and Technology news | Scoop.it

Like the rest of Americans and people around the world, I eagerly awaited the Supreme Court decision on King v. Burwell. The decision, which shifts the direction of the healthcare reform debate, also affirms the demand for physicians, especially family-practice-trained physicians, and other advanced practitioners, such as PAs, NPs, and CRNAs, will continue to skyrocket.

The Association of American Medical Colleges (AAMC) studies the supply and demand of physicians, and indirectly, other providers who perform services in the healthcare system. The most recent report discusses research and findings within the lens of Affordable Care Act (ACA) initiatives and programs having been underway for several years.


The summary essentially reinforces the need to train more physicians, and clinicians such as PAs, NPs, and CRNAs. The ACA has increased the demand for providers at all levels, over previous predictions, and that demand will only continue to grow as more patients continue to enter the healthcare system.


Key findings in the report were as follows:


• The AAMC predicts a projected shortfall between 12,500 to 31,100 primary-care physicians by 2025, while demand for non-primary care (specialty) physicians will exceed supply by 28,200 to 63,700 physicians. This has significant impact especially on PAs, in that we practice in teams with physicians.


• Expanded medical coverage achieved under ACA, once fully implemented, will likely increase demand for healthcare providers, especially those in primary care, by about 2 percent over the current increased demand resulting from changing demographics.


• Due to new data and the dynamic nature of projected assumptions, the projected shortfalls of physicians in 2025 are smaller than shortfalls projected in the earlier study. The lower ranges of the projected shortfalls reflect the rapid growth in supply of clinical providers such as PAs, which have helped to close the gap between physician supply and demand.


• The critical role PAs play in patient care delivery has implications for all providers on the healthcare team. Right now, we cannot train physicians, PAs, and NPs fast enough to meet the demands of the healthcare system.


The AAMC concluded that additional study is needed to determine the impact that providers like PAs have on the supply and demand of physicians. As always, hindsight is 20/20, and the AMCC recognized the limitations and caveats of making predictions about the supply and demand of all members of the healthcare delivery team. Areas of future recommended study included physician retirement patterns, changing wants, needs, and preferences of young physicians, the evolution of clinician staffing patterns, and the effect of payment models.


Speaking for PAs, all of the above areas of future research are important to my profession, especially in the area of retirement. As a growing profession, we are experiencing the first major cohort of PAs approaching retirement. However, as the demand for providers increases, demand for PAs is also skyrocketing due to our rigorous education in the medical model — similar to physicians — and our training in team-based care (on which many new models of care delivery depend).


As PAs practice medicine in nearly every setting and every specialty and subspecialty, our future continues to be tied to the present and future supply and demand challenges confronting our health system. To meet the ever-expanding demand and reflect the realities of today's U.S. healthcare system, it is more important than ever to modernize laws and regulations to allow PAs to practice to the fullest extent of their education and abilities.

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Obamacare ruling ends threat to U.S. hospitals, insurers

Obamacare ruling ends threat to U.S. hospitals, insurers | Healthcare and Technology news | Scoop.it

The U.S. hospital and health insurance industries breathed a collective sigh of relief on Thursday after the U.S. Supreme Court upheld subsidies for individuals under President Barack Obama's signature healthcare law.


Shares in hospitals surged, with several hitting all-time highs, on the expectation that patients would be able to continue paying for services. Health insurer stocks also gained. Wall Street analysts called the ruling positive for an industry on the edge of consolidation.


Health economists have estimated $15 billion to $22 billion in healthcare spending was at risk with the decision. About 10 million Americans have insurance through the healthcare law's insurance exchanges and, of those, 6.4 million have subsidies.


The court ruled 6-3 that the 2010 Affordable Care Act (ACA), widely known as Obamacare, did not limit subsidies to states that establish their own online healthcare exchanges. It marked the second time in three years that the high court ruled against a major challenge to the law.


Trinity Health, one of the largest not-for-profit health systems, was holding a board meeting when the ruling hit.


"There was a ‘Yahoo!’ and a big round of applause," Dr. Richard Gilfillan, chief executive of the Livonia, Michigan-based hospital chain said.


Insurers said subsidies were key to bringing in new customers.

"For a lot of the individuals who were depending on these subsidies in order to have coverage, I think it is a major sigh of relief," said J. Mario Molina, chief executive of insurer Molina Healthcare.


Annie Wisecarver, 53, of Shepherdstown, West Virginia, receives a monthly subsidy of about $200 to buy Obamacare insurance.

"I really only purchased insurance for an emergency, like if I fell off a mountain and broke my leg," Wisecarver said. "I can’t see myself spending $300 or $400 a month on insurance just because I might have an accident."


The ruling could remove uncertainty for the insurers who are seeking deals, like Anthem Inc and Aetna Inc, Leerink Partners analyst Ana Gupte said.


Anthem is pursuing an acquisition of Cigna even after being rejected, while sources previously told Reuters that Humana put itself up for sale last month, with Cigna and Aetna making offers. Bloomberg reported on Thursday that an Aetna-Humana deal could be reached as soon as this weekend.


Humana jumped 7.5 percent. Aetna Inc gained 3.6 percent, Anthem Inc 1,1 percent, Cigna Corp 2.6 percent, and UnitedHealth Group Inc rose 2.7 percent.


Among hospitals, shares of Community Health Systems were up 13.3 percent, HCA Holdings rose 8.5 percent and Tenet Healthcare jumped 12.2 percent. HCA, Universal Health Services and LifePoint Health hit lifetime highs.


'PEACE OF MIND'


Since the subsidies were introduced last year, they have helped hospitals reduce the losses from covering the cost of uninsured patients.


"It's just a very positive thing because it takes away the overhang on the company and the industry," said Alan Miller, CEO of Universal Health Services, which has hospitals in 37 states.


Bill Carpenter, chief executive of Lifepoint Hospitals, which has 64 hospitals in 20 states, was at an offsite patient safety event and said everybody in the room was excited about the ruling.


"We are just are so pleased that those people who have secured coverage through state exchanges will have the peace of mind to know that their coverage is going to continue," Carpenter said, calling on states to expand Medicaid to more income levels, another goal of the ACA. "In many states, this has been about politics and not policy."


In Florida, one of the biggest remaining issues is expanding Medicaid, said Jim Nathan, president and chief executive of Lee Memorial Health System in Fort Myers, one of Florida's largest public, not-for-profit health systems.


Jason Montrie, president of Land of Lincoln Health, a non-profit CO-OP health insurance company launched in 2013 with the government funding of the Affordable Care Act, said subsidies are vital to most of its more than 50,000 members.


"We're relieved that our court made the right decision here," Montrie said.


Options activity had been sanguine in the days and weeks leading up to the ruling, with many traders betting on a rally in the hospital names after the Supreme Court decision.


The S&P 500 healthcare sector is up 11.3 percent in 2015 so far. The sector accounts for about 15 percent of the S&P 500 index.

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Margarito Cruz's curator insight, December 10, 2015 10:05 PM

The role being discussed in this article is about Cheif Executive. I didnt realize that so many people were under Obama's Obamacare. I agree with these actions because of all the accidents that happen everyday. People who dont have insurance face the same dangers that the people that do have it. It would be nice to know that theres something that will pay for the ones not as wealthy. Obama is the organizer of Obamacare.

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What new doctors don't realize. And it's holding them back.

What new doctors don't realize. And it's holding them back. | Healthcare and Technology news | Scoop.it

She wants to be busy, with lots of patients, operating every day. In fact, it is better not be busy, and instead to think long and hard about each patient, listening, pausing, recommending non-operative treatments and being patient. Doctors learn the most from the patients they take the time to truly listen to and care for with extreme attention and lovingness. They learn nothing from those they have little time for.

A new doctor wants to market himself. He wants to tell the world how well trained he is, how up to date he is with the literature, how knowledgeable he is about the latest techniques and tools. What he should really do is read more than he speaks, listen more than he argues, and apply the accepted techniques, while ever so slowly introducing novel approaches. He should stay under the radar, find and cultivate the wisest mentors, stand behind the pillars of the community, and gain their trust for several years before challenging and eventually leading them.

The new doctor wants to computerize, modernize, electronic medical ‘recordize’, and robotize every aspect of medical care. What she doesn’t realize is that most of the current digital data is not compatible with any other system, can’t be moved to a new hospital, and is subject to viruses, malware, and corrupted programs. Mostly likely, 20 years from now, all her computerized records will be unreadable, inaccessible, and useless. She must take note of the growing trend of a computer humming between every doctor and their patient, further distancing the doctor from learning the subtleties of the patient and of medicine, and she must find a way to overcome this.

The new doctor wants security while making money, independence while having a job, freedom to practice while contracted with insurance companies. What he doesn’t realize is that the security of working for someone else can evaporate in the first downsizing; the independence once visualized in medical practice is lost when taking a paycheck, the freedom to practice crushed when contracting with the lowest cost bidders, i.e., the health plans. The socialization of medicine is a choice a doctor makes when they choose not to work independently.

The new doctor wants to lead her field. She understands that performing research, presenting papers, writing books, and lecturing are the paths to stardom. She doesn’t understand how to do this while also practicing full time and meeting the financial and personal demands of a new practice and maybe a family. What she really needs to do is accept that to be both a fabulous doctor and a researcher one must commit full-time to both, integrating the research directly into the practice and setting the practice up to permit the research. It is all possible, and definitely worth it, though the sacrifices are usually financial and personal for many years.

New doctors want to be all that they can be on day one. The reality is that each decision on how to become the superstar affects the likelihood of getting there, and that patience, exquisite care of each patient, quiet tactical maneuvering, phenomenally hard work and a low profile early on under the guidance of wise mentoring is by far the best way.

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Preventing Physician Burnout

Preventing Physician Burnout | Healthcare and Technology news | Scoop.it

In a cross-sectional survey ("Predictors of physician career satisfaction, work-life balance, and burnout," Obstetrics & Gynecology) of randomly selected physicians from across the country just under half of all respondents indicated that they were satisfied with their work-life balance, and half of respondents indicated that they felt some level of emotional "resilience." It turns out that the lack of these two factors plays a significant role in the development of physician burnout; a syndrome that occurs when a person is under constant pressure, and is marked by emotional exhaustion, cynicism, feeling ineffective in one's work, and experiencing interpersonal difficulties. Burnout in physicians, which has been on the rise, has been linked to impaired job performance, poor health, marital difficulties, and alcohol or substance abuse.

The good news is that there are strategies that can be taken to significantly reduce the incidence and negative effects of burnout. Factors that are critical to combating burnout are having control over one's schedulethe number of hours worked, and emotional resilience. Unfortunately, in this current era of healthcare reform, controlling the first two factors can be quite challenging, but not impossible, if one takes a conscious and deliberate approach to managing priorities and time. Many physicians find that they spend a significant amount of time on activities that do not provide enough value — one way to think about this is to determine your "time ROI" (return on investment).


Follow these five steps to significantly improve your work-life imbalance:


1. Identify the five to eight most important aspects of your life (what you value most).

2. Now determine how much time you devote to those areas (and how much time is spent in areas not on your list).

3. If there is a disconnect between what you value and how you spend your time, this is a signal to you to make changes in your life.

4. Plan your time so that you are focused on what you value most.

5. Determine what can be delegated to others.


Preventing burnout also involves developing emotional resilience — the ability to manage stressful situations effectively and prevent stress from building up. For this we turn to some interesting research from the field of neuroscience that explores the link between stress, sleep, and positivity. These three factors have an interdependent relationship with one another — cause a change in one, and the other two are impacted.


So for example, the more stress in your life, the worse your sleep and mood. If you get too little sleep, then you will experience more stress and a lowered mood. In general, it can be difficult to derive meaningful change in the first two factors, sleep and stress, but much easier to have an impact on the latter one — positivity. If you are able to increase positivity, you will experience a significant improvement in sleep and a significant reduction in stress (negative emotional state).


Follow these simple brain-training steps to increase your positivity:


1. Practice positive "self-talk" by cultivating self-encouragement optimism, recognizing accomplishments, and appreciating good fortune.

2. Challenge your negative (typically distorted) thinking, the most common of which are:


• Catastrophic thinking. Identify a more realistic assessment of the situation. Usually, things are not as bad as we think they are. And often, our greatest learning comes from adversity.

• Black and white thinking. Challenge all-or-nothing thinking. Usually there is some gray area to work with. It is very seldom absolute.

• Jumping to conclusions. Avoid leaping to a foregone conclusion, such as thinking you know what others must be thinking. Learn to get curious, ask questions, and look for alternative explanations.

• Over generalizing. Look for a more accurate appraisal of the situation. When we look more closely at situations, we often find that negative or stressful outcomes are limited to that event, not generalizable across all situations.

• Excessive criticism. Whenever you hear yourself thinking, "should," substitute "it would be nice." This allows you to avoid excessive self-criticism or the belief that there is only one solution.

Changing thinking leads to changes in behaviors which leads to changes in results. So the easiest and most efficient method to change the results you are getting is to engage in positive and constructive thought patterns. As you transform your thoughts, you actually create an alteration in the neural connections in your brain. This in turn, leads to the development of new habits, ensuring that the changes you create are lasting ones.

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Dan Diamond, MD's curator insight, June 12, 2015 2:16 PM

I also suggest that people have a team of at least 10 people that will encourage and challenge them. If you team is too small, it is easy to burn them out. Write the name of your ten on paper and post it on the back of your medicine cabinet. Reconnect, stay connected. 

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Even Without Meaningful Use Dollars, EMRs Still Selling

Even Without Meaningful Use Dollars, EMRs Still Selling | Healthcare and Technology news | Scoop.it

I don’t know about you, readers, but I found the following data to be rather surprising. According to a couple of new market research reports summarized by Healthcare IT News, U.S. providers continue to be eager EMR buyers, despite the decreasing flow of Meaningful Use incentive dollars.


On the surface, it looks like the U.S. EMR market is pretty saturated. In fact, a recent CMS survey found that more than 80% of U.S. doctors have used EMRs, spurred almost entirely by the carrot of incentive payments and coming penalties. CMS had made $30 billion in MU incentive payments as of March 2015. (Whether they truly got what they paid for is another story.)


But according to Kalorama Information, there’s still enough business to support more than 400 vendors. Though the research house expects to see vendor M&A shrink the list, analysts contend that there’s still room for new entrants in the EMR space. (Though they rightfully note that smaller vendors may not have the capital to clear the hurdles to certification, which could be a growth-killer.)


Kalorama found that EMR sales grew 10% between 2012 and 2014, driven by medical groups doing system upgrades and hospitals and physician groups buying new systems, and predicts that the U.S. EMR market will climb to $35.2 billion by 2019. Hospital EMR upgrades should move more quickly than physician practice EMR upgrades, Kalorama suggests.


Another research report suggests that the reason providers are still buying EMRs may be a preference for a different technical model. Eighty-three percent of 5,700 small and solo-practitioner medical practices reported that they are fond of cloud-based EMRs, according to Black Book Rankings.


In fact, practices seem to have fallen in love with Web-based EMRs, with 81% of practices telling Black Book that they were happy with implementation, updates, usability and ability to customize their system, according to the Q2 2015 survey. Only 13% of doctor felt their EMRs met or exceeded expectations in 2012, when cloud-based EMRs were less common.


Now, neither research firm seems to have spelled out how practices and hospitals are going to pay for all of this next-generation EMR hotness, so we might look back at the current wave of investment as the time providers got in over their head again. Even a well-capitalized, profitable health system can be brought to its knees by the cost of a major EMR upgrade, after all.


But particularly if you’re a hospital EMR vendor, it looks like news from the demand front is better than you might have expected.

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Mayo Clinic, Apervita Collaborate for Self-Service Health Measures Marketplace

Mayo Clinic, Apervita Collaborate for Self-Service Health Measures Marketplace | Healthcare and Technology news | Scoop.it

The Rochester, Minn.-based Mayo Clinic and the health analytics and data community and marketplace Apervita are launching a health measures platform that will allow health professionals to publish or subscribe health measures which will turn definitions into analytics.


According to the companies, while there are already thousands of health measures for quality, safety, outcomes, and finance that are increasingly the basis for measurement of performance and reimbursement for value-based care, they are notoriously complex and organizations struggle with the costly process of implementing and maintaining them. This often results in delays of more than 12 months to report new measures or update existing measures.


With this new approach, Apervita will offer a family of open interfaces, including open web service APIs, allowing standard measure definitions to be imported, edited, published, executed and exported. Once an author has developed a measure, it can be connected to different data sets as well as shared through a global marketplace. Measure results can be displayed on the Apervita platform or accessed through APIs for display within electronic medical records (EMRs), third-party systems and mobile applications. The import and export of measures supports the Centers for Medicare and Medicaid Services (CMS) quality data model (QDM) through which all modern measures are today made available, the companies say.


“Healthcare providers and facilities should focus on what they do best, providing high quality patient care. After all, that’s what health are measures are designed to enable,” Dr. Jyotishman Pathak Ph.D., professor of Biomedical Informatics at Mayo Clinic, said in a statement. “With thousands of healthcare measures which continuously evolve, keeping track of, implementing and monitoring the measures has shifted some of that focus away from the patients, and it needs to shift back.”

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Are Bigger MD Groups Better Prepared for Population Health?

Are Bigger MD Groups Better Prepared for Population Health? | Healthcare and Technology news | Scoop.it

It was fascinating to interview Donald W. Fisher, Ph.D., the president of the Alexandria, Va.-based American Medical Group Association (AMGA), earlier this spring, as I researched and reported our May/June cover story on population health and data analytics. For one thing, Dr. Fisher has been in the trenches in supporting the management of larger medical groups in the U.S. for decades now, so his perspectives are weighted with many years’ experience and understanding of the healthcare system at the physician group management level.


What’s more, anyone familiar with AMGA knows that the leaders of its member medical groups have been at the forefront of healthcare delivery and payment innovation for years now. It was in fact the participation of a number of a number of AMGA member medical groups whose involvement and learnings in several different Medicare-facilitated primary care and care management initiatives helped convince senior CMS (Centers for Medicare and Medicaid Services) officials to move forward to the go-live of the Pioneer ACO Program a few years ago.


And it has been not only in the Medicare accountable care organization sphere that the leaders of large medical groups have been trailblazers; large medical groups have been pioneers, with a “small p,” in private-sector ACOs, collaborating in very innovative ways with private health insurers nationwide.


So what has been learned? Among other things, as Dr. Fisher told me this spring, and as was revealed in our extended interview published this week, one key challenge remains that, as he put it, “Some medical groups still have gaps in their primary care base; and if you’re going to do population health, you need a very good primary care base. So some are still struggling in that area. And then,” he added, “there is the cultural piece, which encompasses reimbursement-related goals related to this. You can try to change your culture, but if you’re still being paid fee-for-service, and still mostly paying your doctors fee-for service, you need to change that, and that is something they’re trying to get over pretty quickly.”


Beyond those issues, there is this issue that Dr. Fisher brought up in our interview, and which I think goes to the heart of the question of how the leaders of larger medical groups are turbocharging their learning process around accountable care and population health: “The thing is,” he told me, “that you have to go beyond the data; you have to reengineer the care process. The way it is today, it’s a reactive kind of care process. If you’re using predictive analytics and data sets, you’ve got to be proactive, and reach out to patients in advance. And that requires different skill sets, different providers; it’s a very, very big job to work these data sets and predictive analytics, but,” he added, “it can make a very big difference in patients’ lives; patients are just doing so much better as a result.”


And therein lies one of the keys to unlocking the secret of population health and accountable care success—the interplay between the harnessing of data analytics and the continuous process change work that needs to undergird everything.


In other words, at the same time that the leaders of a medical group—or, for that matter, any patient care organization—are collecting data, analyzing that data, making determinations of how to act on their analyses, and moving forward to make changes based on those analyses, they need to be engaged in continuous clinical and operational performance improvement, whether using methodologies like Lean management, Six Sigma, and Toyota Production System for healthcare, or any combination of those or other methodologies, or developing their own.


It’s all about a virtuous cycle or “blessed cycle,” as some are calling it, in which process change and analytics work are all intelligently and strategically combined. Now, here’s a legitimate question: what size medical group might do this best?


Of course, every physician group has a different organizational structure, specialty and clinician composition, history, culture, and set of IT and other tools, at its disposal. And it goes without saying that every medical organization has a different set of personalities. But, given sufficient leadership capability, and the taking on of personal-professional risk on the part of leaders in an organization committed to transformational change, anything is possible. But it does seem that larger medical groups—those with enough management skill individuation that they have not only a chief medical officer but also probably a CMIO, as well as someone who serves as a chief quality officer, and with each of those leaders having some team with at least part-time responsibility to participate in robust change management—it does seem that larger medical groups are more fully advantaged in the context of this kind of work.


And even though Medicare’s Pioneer ACO Program in particular has been facing challenges as of late, what is clear is that larger medical groups are moving forward with alacrity to pioneer, again with a “small p,” a lot of the innovations that are beginning to emerge as groundbreaking for the population health/accountable care path ahead for all of us. So it will be important for everyone to keep their eyes on all these developments in the next few years, as the ramp-up towards broader innovation is going to be both rapid and challenging. But as the leaders of some of the most innovative larger medical groups know, their organizations are continuing to be amazing test-beds of real innovation along all dimensions, in healthcare, and that combination of continuous process change around care delivery and the intensive, strategic leveraging of healthcare IT and especially data analytics, is bound to reap major rewards in the coming months and next few years.

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Hospitals work on allowing patients to actually sleep

Hospitals work on allowing patients to actually sleep | Healthcare and Technology news | Scoop.it

It's a common complaint — if you spend a night in the hospital, you probably won't get much sleep. There's the noise. There's the bright fluorescent hallway light. And there's the unending barrage of nighttime interruptions: vitals checks, medication administration, blood draws and the rest.

Peter Ubel, a physician and a professor at Duke University's business school, has studied the rational and irrational forces that affect health. But he was surprised when hospitalized at Duke -- in 2013 to get a small tumor removed -- at how difficult it was to sleep. "There was no coordination," he said. "One person would be in charge of measuring my blood pressure. Another would come in when the alarm went off, and they never thought, 'Gee if the alarm goes off, I should also do blood pressure.'"

"From a patient perspective," he added, "you're sitting there going, 'What the heck?'"

As hospitals chase better patient ratings and health outcomes, an increasing number are rethinking how they function at night — in some cases reducing nighttime check-ins or trying to better coordinate medicines — so that more patients can sleep relatively uninterrupted.

The American Hospital Association doesn't formally track how many hospitals are reviewing their patient-sleep policies, though it's aware a number are trying to do better, said Jennifer Schleman, an AHA spokeswoman.

And, though few studies specifically link quality of shut-eye and patient outcomes, doctors interviewed said the connection is obvious: patients need sleep. If they get more of it, they're likely to recover faster.

    Traditionally, hospitals have scheduled a number of nighttime activities around health professionals' needs — aligning them with shift changes, or updating patient's vital signs so the information is available when doctors make early morning rounds. Both the sickest patients and those in less serious condition might get the same number of check-ins. In some cases, that can mean patients are being disturbed almost every hour, whether medically necessary or not.

    "The reality for many, many patients is they're woken up multiple times for things that are not strictly medically necessary, or...multiple times for the convenience of staff," said Susan Frampton, president of Planetree, a nonprofit organization that encourages health systems to consider patient needs when designing care.

    Changing that "seems like kind of easy, low-hanging fruit," said Margaret Pisani, an associate professor at Yale School of Medicine. She is working with other staff at the Yale hospital to reduce unnecessary wake-ups, using strategies like letting nurses re-time when they give medicines to better match patient sleep schedules, changing when floors are washed or giving nurses checklists of things that can and should be taken care of before 11 p.m.

    Not only is the push for better patient sleep part of a larger drive to improve how hospitals take care of their patients, but it is fueled in part by measures in the 2010 health law tying some Medicare payments to patient approval scores. As more hospitals try to improve those numbers, experts said, more will likely home in on improving chances for a good night's sleep.

    "There's a movement toward patient-centered care, and this is definitely a part of it," said Melissa Bartick, an assistant professor at Harvard Medical School.

    That focus makes sense, since federal patient approval surveys specifically ask about nighttime noise levels. A number of hospitals initially struggled to get good scores on that, said Richard Evans, chief experience officer at Boston-based Massachusetts General Hospital.

    His hospital instituted quiet hours -- a couple of hours in the afternoon and between six and eight hours at night, depending on the hospital unit, in which lights are turned low and staff encouraged to reduce their noise levels. It also encourages staff members to consider whether patients really need particular care at night before waking them. "We're trying to [increase awareness] that patients need to rest, and we need to structure our care as much as possible to allow that to happen."

    It's hard to delineate the degree to which such efforts have affected patient approval scores, Evans said. Anecdotally, though, patients have expressed appreciation, he added.

    The Department of Veterans Affairs New Jersey Health Care System is taking this concern even further. In addition to quiet-time restrictions, in which they try to reduce the use of noisy equipment, staff chatter and things like phone volume, patients can opt to have lavender oil sprayed in their rooms or an evening cup of herbal tea to facilitate sleep.

    All of these kinds of changes can help, said Planetree's Frampton. But they don't get at the real problem for most patients.

    "Low scores on quiet-at-night [questions on patient suarveys] are not because it's overly noisy...but because patients are woken up repeatedly," she said. "Their sleep is disturbed so they're lying awake."

    To address that, hospitals may need to look at less obvious questions. At New York's Mount Sinai Hospital, doctors are rethinking when they prescribe medicines as well as what kind, said Rosanne Leipzig, a professor of geriatrics and palliative medicine and who practices at the hospital. For instance, some antibiotics can be given at six-hour intervals rather than four-hour intervals, reducing the need for nighttime interruptions. And some drugs usually given every six hours can instead be given four times a day during the hours patients are usually awake.

    The hospital is also working to develop a system to classify patients who need repeated checks from the medical staff, such as those who might face imminent health threats or are at risk for serious infections such as sepsis. For those patients, frequently checking vitals is important, even if patients sleep less, Leipzig said. But not every patient's condition requires that they be roused every four hours, she added.

    About half of all patients woken up for vitals checks probably don't need to be, according to a 2013 study published in JAMA Internal Medicine. The study suggests waking those patients may contribute to bad patient results and dissatisfaction, and could increase the odds of patients having to come back to the hospital.

    Another study, published in 2010 in the Journal of Hospital Medicine, looked at efforts to encourage patient sleep — particularly by rescheduling activities, nighttime checks and overnight medication doses so as not to wake patients. That paper, co-written by Bartick, the Harvard professor, found a 49% drop in the number of patients who were given sedatives. That can have the added benefit of improving patient outcomes, since sedatives are associated with dangerous side effects such as falling or hospital delirium or confusion.

    "Sleep disruptions are actually not benign as far as patients are concerned," said Dana Edelson, an assistant professor of medicine at the University of Chicago and an author on the 2013 study. "We're putting them at unnecessary risk when we're waking them up in the middle of the night when they don't need to be." And possibly making the recovery a bit more difficult.

    "Patients will tell you, 'I was so exhausted, I couldn't wait to get home and go sleep,'" said Yale's Pisani.

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    What Does IBM’s Acquisition of Merge Healthcare Say About the Healthcare IT Market?

    What Does IBM’s Acquisition of Merge Healthcare Say About the Healthcare IT Market? | Healthcare and Technology news | Scoop.it

    As if everyone’s heads in healthcare IT weren’t already spinning like that of Linda Blair in 1973’s “The Exorcist,” here comes yet another acquisition in healthcare IT, this time the Armonk, N.Y.-based IBM announcing on Thursday its acquisition of the Chicago-based Merge Healthcare.


    All mergers and acquisitions are interesting, but this one offers particular facets worth pondering. First of all, of course, its timing, less than four months after that giant company had just swallowed up the Dallas-based Phytel and the Cleveland-based Explorys back in April, a move announced during the HIMSS Conference.


    That double acquisition is one of the reasons that we editors at Healthcare Informatics made IBM one of our “Most Interesting Vendors” this year, as its trajectory has encapsulated some of the mergers and acquisitions that have taken place in order to give some vendors a particular edge as competition intensifies in the healthcare IT world. As Senior Editor Rajiv Leventhal wrote regarding IBM’s analytics push, “Enter the Watson Health Cloud, which IBM will sell to doctors, hospitals, insurers and patients. That offering will be the centerpiece of a new dedicated, Boston-area business unit, IBM Watson Health, which now includes both Explorys and Phytel.” Leventhal quoted Anil Jain, M.D., chief medical officer (CMO) for Explorys, as saying that “[IBM] is complimenting much of what we do around traditional analytics using machine learning algorithms with some of the cognitive computing and the Watson analytics that Watson Health group will be leveraging. We became the content that will fuel some of the next generation analytics that Watson has become famous for.”


    In a blog published today on AuntMinnie.com, staff writer Erik Ridley wrote this: “For IBM's new Watson Health unit, the deal gives the company access to Merge's image management and analysis software and its installed base of more than 7,500 U.S. institutions, clinical research institutes, and pharmaceutical companies. IBM is adding Merge to other recent acquisitions, such as population health firm Phytel and cloud-based healthcare intelligence company Explorys.”

    Ridley went on to note that “IBM plans to offer Watson Health Cloud to analyze and cross-reference images against lab results, electronic health records (EHRs), genomic tests, clinical studies, and other health-related sources. In aggregate, these represent 315 billion data points and 90 million unique records, according to the company. This could provide Merge's installed base with a useful consolidated, patient-centric view of current and historical images, EHRs, data from wearable devices, and other related medical data.”


    So far, so good. I think that IBM is gaining clear advantage in acquiring Merge Healthcare at this time., as it brings imaging informatics into the fold and potentially will integrate elements of imaging informatics with its already-advancing work in analytics. Indeed, Joe Marion, a Wisconsin-based consultant who blogs regularly for Healthcare Informatics and who is one of the most knowledgeable observers of the imaging informatics sector around, sees clearly the advantages to this pairing. As Joe wrote Thursday in a blog on this site, “Today, IBM is a different company than it was thirty years ago, as is the healthcare industry.  Much of the “big iron” emphasis is gone, and the company has much more of a services focus these days.  Cloud computing was never a factor in the past, and today, coupled with Watson, it offers much more potential for delivery of storage and analytics solutions.”


    Joe further noted that, “In the age of past efforts, there were much larger barriers between Information Technology (IT) and clinical departments.  That is why IBM chose to partner with GE to address RIS-PACS [radiology information system/picture archiving and communications system (issues)] previously, as the two complemented one another in terms of hospital administration emphasis.  Today, there is much more IT emphasis on clinical systems and their integration across the enterprise.  And,” he added, “the healthcare environment today is radically different than in the age of past efforts, given increased regulation and greater provider consolidation.  An IBM-Merge combination should have much broader appeal to integrated delivery networks (IDN’s) who might benefit from greater interoperability and better business analytics.”


    I agree completely with Joe’s perspective on this. Now, what about Merge Healthcare itself? I’ve been following Merge very closely as a company for several years now. Merge has some very talented senior executives, and solutions that are respected and appreciated by providers. The challenge for the company’s senior management has been facing is the shifting landscape of the imaging informatics market right now. PACS solutions have become almost totally commoditized; I’m sure there are PACS systems that are at last marginally better than others, but, given the accelerating demands facing patient care organizations, the need to move quickly into accountable care- and population health-based arrangements, and clinicians’ demands for always-available computing, even significant solution quality differentiation is simply no longer enough (and let’s not even talk about how commoditized RIS solutions have become).


    So, clearly, for senior executives at Merge, a respected company that has been going through some major management changes and has been treading water in a rapidly shifting imaging informatics vendor landscape, this deal makes a lot of sense, too.


    The challenge now will be to make this pairing work for current Merge Healthcare customers and for IBM customers—and customers of the former Phytel and Explorys, too. We all know about the trajectories of healthcare IT vendors that have grown too rapidly through acquisition and that have ended up becoming a jumble of unintegrated parts.

    IBM’s moves so far seem thoughtful and precisely judged. Only time will tell how everything turns out ultimately—and clearly, that will depend on execution. Skillful execution is to healthcare IT what location is to real estate—a fundamental element of success. And this trajectory for IBM is a fascinating one. So stay tuned—because this is going to be an interesting path ahead.

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    Epic at work on new tech to avert falls

    Epic at work on new tech to avert falls | Healthcare and Technology news | Scoop.it

    Healthcare IT giant Epic is working on a clinical decision tool aimed at helping healthcare providers reduce the risk of falls in unsteady patients. The technology is expected to be ready and available to Epic's EHRclients by year's end.


    Longtime Epic customer Kaiser Permanente will roll out the tool at its facilities across the country and will also make its evidence-based falls prevention program widely available to other health systems and health plans.

    The technology is called STEADI, an acronym for Stopping Elderly Accidents, Deaths & Injuries. The tool is being designed based on CDC's guidelines for falls assessment. The goal is to make it easier for healthcare providers to screen for falls, intervene to reduce risk and provide follow-up care.


    The announcement came at the end of a White House Fact Sheet released this morning regarding The White House Conference on Aging, which President Barack Obama is hosting today.


    The sweeping conference agenda focuses on issues facing Americans as they plan for retirement. Many of the measures proposed build on the Affordable Care Act and on efforts to improve Medicare and Medicaid.


    "In a year that marks the 50th anniversary of Medicare, Medicaid and the Older Americans Act, as well as the 80th anniversary of Social Security, the White House Conference on Aging is an opportunity to recognize the importance of these programs, highlight new actions to support Americans as we age and focus on the powerful role that technology can play in the lives of older Americans in the decade ahead," the White House announced.

    Federal data to be released

    The Administration announced that by September 2015, federal data sets relevant to aging and to elderly Americans would be made easily available on Data.gov, the repository for the U.S. government's open data. This resource will continuously be updated with datasets on aging, much like it is for other important Administration priorities such as climate, public safety and education. 

    Health IT efforts

    Like Epic's several of the planned initiatives surrounding the aging initiative have healthcare IT underpinnings. These are put forward by the private sector:


    • As part of its annual HackFest, LeadingAge, an association of 6,000 not-for-profit organizations and businesses representing a broad field of aging services, will partner with Hewlett-Packard using HP's 3D immersive computing platform and Federal open data to challenge innovators to create technology-driven tools to improve the lives of older adults and their families.
    • The employer coalition ReACT (Respect a Caregiver's Time), Care.com and the Massachusetts Institute of Technology are joining forces to generate the tools employers need to effectively support employees who are caregivers. MIT and Care.com will jointly conduct a case study based on MIT's approach to employer-supported elder care. 
    • Uber is announcing pilot programs in Florida, Texas, Ohio, Arizona and California that will partner with senior community centers and other advocates to provide free technology tutorials and free or discounted rides to older Americans to increase access to transportation options and support mobility and independence.
    • Airbnb has conducted research to support and understand the experience of older Americans in their travels and in their use of technology and is partnering with communities to enhance accessibility and the user experience for older populations. 
    • Walgreens has made advancements in its digital technologies to connect individuals with its telehealth services provider, which offers 24/7 access to U.S. board-certified doctors.  Seniors also can track their health behavior with personal wellness smartphone technologies from Walgreens and WebMD.
    • Peapod has adopted "best in class" Web accessibility standards to ensure that all individuals, including those with disabilities and those who are unable to shop at traditional stores, can use its website and mobile applications. 
    • Honor, a tech-enabled company that matches seniors with care professionals, will offer $1 million in free home care across 10 cities in the country and work with established care providing organizations in those communities to ensure this care goes to helping older Americans. 
    • The University of Washington's School of Nursing and the HEALTH-E (Home-based Environmental Assisted Living Technologies for Healthy Elders) initiative are introducing an Aging and Technology Laboratory, which includes hardware and software tools to support participatory design of technology for older adults.  The laboratory will allow scientists, engineers, and others to engage older adults and their families to accelerate the generation of new solutions to support aging.
    • The Stanford Center on Longevity will develop a State of Longevity Index to be released in early 2016 that will measure how well the U.S. is doing to improve the prospects for long-term well-being in financial security, physical health, social connectedness, educational attainment, and age-friendly communities. 
    • IDEO is announcing the launch of "The Powerful Now," a project to build a cross-sector collaboration around positive aging for all.


    Among the planned government initiatives are.


    • Facilitating state efforts to provide workplace-based retirement saving opportunities: About a third of the workforce lacks access to a workplace retirement plan, the White House notes. That's why, in every budget since taking office, the President has put forth proposals to provide access for 30 million Americans to workplace-based retirement savings by requiring employers not currently offering a retirement plan to automatically enroll their workers in an IRA.  But in the absence of Congressional action, the states are leading the charge.
    • Launching Aging.gov – today: The intent is to provide older Americans, their families, friends and other caregivers, a one-stop resource for government-wide information on helping older adults live independent and fulfilling lives.
    • Modernizing federal rules that affect long-term care, healthy aging and elder justice: Steps announced today include: a new Centers for Medicare and Medicaid Services proposed rule to update, for the first time in nearly 25 years, the quality and safety requirements for more than 15,000 nursing homes and skilled nursing facilities to improve quality of life, enhance person-centered care and services for residents in nursing homes, improve resident safety, and bring these regulatory requirements into closer alignment with current professional standards.
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    Why Hasn't Mobile Moved Medicine Further Yet?

    Why Hasn't Mobile Moved Medicine Further Yet? | Healthcare and Technology news | Scoop.it

    The advent of the smartphone and mobile "apps" has opened the floodgates in hospital and clinic settings. With the ease of communication and newfound ability to access the web in the palm of our hand, the world has grown smaller for everyday users. Given its current host of systemic predicaments, the medical industry has justifiably shifted its attention to these new technologies to rectify inefficiencies.


    Mobile technology raises expectations for health care consumers with the obvious prospect of improved communication between providers and patients. From having your physician's prescriptions on-the-go to being able to rapidly authorize medical record transfers in emergent situations, a promising solution to chronic issues obstructing submaximal care is at our doorstep.


    Why, then, have we not reached our full potential? StartUp Health reported a burgeoning digital health sector with $6.9 billion in funding over 551 deals in 2014. Mobile health savvy health insurance company Oscar has captured significant market share with a whopping $320 million of funding and 40,000 members to date. While these strides prove consumer and investor belief in mobile technology, few applications have proven valuable to stakeholders' stringent criteria despite the sheer number of available applications.


    No single firm has demonstrated an intimate knowledge of the medical industry with delivery of high-quality tools that engage users. The lack of a clear winner in this noisy space has stunted broad adoption. For this reason, heavyweights in the technology industry like Google, Amazon, Facebook and Apple are exciting new entrants to the mobile health scene. In addition to the modular infrastructure offered by these established giants, the greatest value is their proven track record in customer validation and the user experience.


    Established technology firms are by no means a shoe-in to win. The inherently low barrier to entry in the mobile health space is a double-edged sword. Though sparse quality control mechanisms are responsible for the sheer volume of subpar apps, they are also the reason why no innovator can be excluded from disrupting the space with the help of hired digital development shops. Excluding the fundamental challenges of operating within the health care industry (i.e. security and compliance standards), the delay in realizing the impact of mobile health technology can be distilled to four fundamental failures.


    First, the end user is often forgotten. Often times, hospitals will excitedly reveal a mobile app that provides useful information but has such a poor interface that consumers fail to engage. Fewer apps have engaged users better than Instagram with over 300 million monthly active users. Instagram represents an exceptional product stakeholders in digital health care should not trivialize and learn from greatly. With two-thirds of the Americans owning a smartphone, the problem today is less so the access to digital tools than it is the actual engagement with them.


    Second, the balance scale tilts heavily towards "wellness" and less towards "care." Though the return on investment for a mobile app may be greater for a healthy user willing to pay to track health and fitness metrics, those who actually need the increased vigilance in our health system are patients suffering from chronic disease or recovering from surgery. From the perspective of optimizing health outcomes and preventing frivolous costs, the attention needs to shift to vulnerable populations stressing the system. Furthermore, some insurance companies incentivize members by providing mobile apps under the moniker of "mHealth;" this terminology runs the risk of misleading individuals into skipping preventive care visits with their doctor. These apps should optimize medical management in the appropriate clinical context through physician supervision with appropriate FDA regulation as an "mCare" effort instead. The FDA already applies a risk-based approach for assessing mobile medical apps considered accessory to regulated medical devices or transformational into a regulated medical device. More of this patient-centered innovation is needed to solve our system's real issues.


    Third, we fail to play to the strengths of smartphones in medicine. Smartphone technology is fundamentally advantageous because users have the freedom to move and communicate without restriction. Given that outcome metrics for the fields of orthopaedic surgery and rheumatology are predicated on physical mobility and patient-reported response to interventions, smartphone technologists should target these specialties first to realize benefits of afflicted patients in real-time. Joint replacement is one of the most common surgical interventions in the world, and being able to track steps taken, or the steps not taken, using the phone's native pedometer has the potential to alert a surgeon of post-operative complications in advance. The current strategy is focused on creating the best apps for the fittest individuals, but the most impactful technologies would be directed towards streamlining assurances of patient safety and physical activity for those with musculoskeletal conditions.


    Finally, collaboration is lacking. Smartphones track and store the "small data" of millions of potential patients. When put together, the data tells a greater story. Numerous insidious diseases, from major depression to ovarian cancer, could be detected earlier and managed better when sharing our stored mobile data. While there do exist standout organizations like Fitbit which offer an open developer API, the current landscape is not set up to exchange user data. One such organization that recognizes the meaningful macroscopic conclusions that can be drawn from sharing mobile data is Open mHealth. Founded on the value of facilitating the sharing, storage, and processing of mobile data using an open infrastructure, Open mHealth has already made great strides among individuals with diabetes and veterans with PTSD.


    Today, the smartphone is one of the greatest commercially available technologies. With emerging wearable devices like Apple Watch and Jawbone, who knows what our go-to device will be tomorrow? Thus, validation of mobile technology in medicine cannot hinge on today's version of devices. The evidence supporting application of mobile technologies to the medical workflow must maintain modularity and iterative capacity. One example of modular capacity is Apple's open source ResearchKit. Though in a perfect world Apple and Google would have partnered to cover nearly all smartphone users, ResearchKit has the laudable benefit of availability across all current and future iOS devices. Thus, validation is needed just once for survivorship of mobile technology in medicine to be ensured.


    The potential for mobile technology in medicine is great, but the current landscape is not yet set up to transform the health care industry. There exists no reliable winner in the marketplace because either our goals are misaligned or our focus has been misplaced. If the objective is to help the well become more well, then we are thriving. However, if we choose to unbridle the capability of mobile technology in medicine by remembering the end user, helping the suffering, playing to the strengths of our resources, and enabling collaboration, we are on the precipice of a truly transformational era in modern medicine.

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    Getting a checkup will be very different in the not-so-distant future

    Getting a checkup will be very different in the not-so-distant future | Healthcare and Technology news | Scoop.it

    Sometime in the not-so-distant future, getting a checkup will be very different.


    When the doctor writes down your symptoms, it will be cross-checked with others in your area, making it easier to identify outbreaks and epidemics sooner. If you complain of shortness of breath, your phone’s heart rate monitor will instantly report how well your heart has functioned over the last month. Those readings then could be aggregated with others in your community, revealing hidden trends. As your doctor thinks about the best treatment for you, big-data analysis will help her assess how various options have worked for others with similar histories and body chemistry.


    This is the promise of big data in healthcare. And, it’s not just while you’re at the doctor. Medical research and findings are now being combined into massive searchable databases, making it easier to assess and compare results. Databases can absorb terabytes worth of disparate data, including things like the weather. This will make it clearer whether it’s the drug — or something extraneous like humidity — that’s making people feel better.


    But all this is in its infancy, with the sector moving slowly and cautiously. The Affordable Care Act now mandates that doctors switch to electronic health records when they treat Medicare patients. So far, they’re not especially sophisticated.

    “Electronic health records right now are only collecting about 100 megabytes of data per patient, per year,” says Dale Sanders, senior vice president of strategy at Health Catalyst, an analytics firm. “Most patients, if they knew how poorly informed healthcare was from a data perspective, would be really disappointed.”


    Health Catalyst is one of a number of companies — big and small — working to change that, seeing the immense potential to both improve care and save money. US healthcare industry expenditures are approaching $3 trillion annually. The McKinsey Global Institute estimated in 2013 that deploying big data could create $100 billion in value every year across the healthcare industry.


    In Pittsburgh, a major hospital system teamed up in March with the city’s biggest universities to advance big-data analytics in healthcare. As part of a consortium, Carnegie Mellon University is working on artificial intelligence that draws on databases of studies and health records.


    Andrew Moore, Dean of Carnegie Mellon’s School of Computer Science, imagines a day when his phone gives his doctor a more accurate report on his health than he can himself.

    “If he or she asks me, ‘have you been getting out of breath much lately?’ and I say, ‘I don’t think so,’ at that point I would like my cell phone to chime in and say, ‘yes, you have, actually, Andrew,'” he says. “That would be awesome for me and the physician.


    Moore expects the systems to be able to trace hospital-borne infections back to a specific piece of equipment or patient. Or, some might make it possible to diagnose a rash with a smartphone photo.

    The Pittsburgh Health Alliance plans to spend $10-$20 million a year on its big-data collaboration. Carnegie Mellon joins with the University of Pittsburgh Medical Center and the University of Pittsburgh on the project, and UPMC already takes in info from 200 sources.


    And big data has the potential to become big business. In 2013, investors put nearly $200 million into analytics and big-data startups, according to research firm Gartner. There have been similar size investments in digital medical devices and personalized medicine. The government is investing millions in analyzing medical databases, too. That’s not to mention health-tracking research and products from the likes of Apple, Google, and FitBit.


    “Hospital systems realize that healthcare is becoming more and more an information technology business,” Moore says.


    For all the excitement over big data’s potential for personalized medicine and better public health, it’s not without obstacles and risks. Moore worries about security, knowing that any breach of privacy will threaten public acceptance of the whole industry.


    Sanders of Health Catalyst thinks the real promise of big data is improving the basics of healthcare. “We keep attaching big data to these moonshot kinds of expectations,” he says. To Sanders, big data isn’t a revolution. It’s a way to improve the fundamentals of care, like reducing hospital-borne infections.


    “Reducing variability in care and reducing over treatment of patients is probably the most important place for any organization in healthcare to start,” he says.


    And perhaps the biggest challenge for big data is culture. Doctors and hospitals tend to be understandably cautious and skeptical about adopting new technology, waiting for it to be sufficiently proven safe and effective. But as analytics improve, and the pressure to bring down the cost of healthcare builds, most agree big data will become a big deal in medicine.

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    Digital health venture cash keeps pace with 2014

    Digital health venture cash keeps pace with 2014 | Healthcare and Technology news | Scoop.it

    Venture capital for the digital health market is still holding its own, keeping pace with last year's "record-breaking growth," according to a new report from digital health startup accelerator Rock Health.

    In fact, this year's Q2 raked in $2.1 billion from investors for digital health startups, just shy of last year's mid-year number which reached $2.3 billion.


    "Now at the half-year mark, investors have spoken," wrote Malay Gandhi, managing director at Rock Health, in a July 6 post, unveiling the numbers. "Digital health isn't slowing down."


    Although the number of deals were fewer than last year at this time – 139 deals in 2015 compared to 146 in 2014 – the average deal size was $400,000 bigger this time around.


    One of the big changes this year was around the most funded digital health category. Last year, the winner was payer administration startups, which collectively scored $211 million. This year, wearables and biosensing companies walked away with the lion's share of funding, at $387 million. However, San Francisco-based wearable company Jawbone accounted for $300 million of that pie.


    Analytics and big data came in at No. 2 for most funded digital health category, bringing in $212 million by mid 2015. That represents a $16 million increase in this category from last year's numbers. Salt Lake City-based analytics startup Health Catalyst brought in $70 million.

    According to another digital health accelerator StartUp Health's mid-year report, however, analytics and big data came in third place, below wellness/benefits and patient/consumer experience. The company bills itself as the world's largest portfolio of digital health companies. 


    One category in Rock Health's report that failed to emerge as top theme last year – EHR and clinical workflow – brought in $74 million this time around. One of those startups, the San Francisco-based Augmedix, which integrates Google Glass with the electronic medical record, earned $16 million of that.


    This year, Rock Health officials also tracked digital health IPOs, which "outperformed" S&P 500 by the end of Q2.


    "Coming off a record-smashing year for digital health funding, where dollars into the space totaled more than 8 percent of all venture funding, it would not have been surprising if 2015 was a letdown," Rock Health officials wrote in the 2015 mid-year report. "However, 2015 has more or less kept pace with 2014."


    But this growth, as they explained, also comes with a drawback. And that's "noise." In other words, it's a tough, saturated market, with a record number of digital health companies "vying for the attention of both the industry and the consumer."

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    Five Reasons the Future for Private Practice Is Bright

    Five Reasons the Future for Private Practice Is Bright | Healthcare and Technology news | Scoop.it

    I believe the future remains bright for private practice. While market indicators a few years ago were interpreted by many in the industry as signaling the demise of private practice, more recent data suggests the move away from private practice has not only leveled off, but may move back toward more independence.

    Here are five reasons why private practice will remain healthy for the foreseeable future:


    1. The trend of hospitals buying physician practices is not as strong as it once was.


    While it's true that hospitals and integrated delivery systems have purchased physician practices since well before Congress passed the Affordable Care Act in 2010, some hospitals also have lost money on these acquisitions. Some say the losses total as much as $100,000 per physician, per year. Also, some physicians are not happy being employed by these larger systems.


    2. New practice models help physicians stay independent.


    Patient-Centered Medical Homes, for example, allow physicians to organize care to meet patients' needs in a way that was not possible in the past. Recognizing that the center-of-care has shifted to patients, providers and insurers are investing in systems to meet patients' needs and boost patient satisfaction scores. One reason for this shift has been the focus on delivering more preventive care under the ACA, a factor aimed at keeping patients well rather than simply treating them when they're ill. And patients want to keep their doctors, meaning they'll follow them wherever they go.


    3. Accountable care organizations (ACO) are another option for physicians seeking to remain independent.


    Physicians can contract with ACOs or do as some large physician groups have done and form their own ACOs. Either way, these organizations allow physicians to stay in private practice while focusing on improving care. Some ACOs offer shared-savings contracts that let physicians reap the benefits if they keep costs below a target amount calculated at year's end.


    4. Health insurers are emerging as physician partners.


    In the recent past, health insurers have not had much of an opportunity to affect whether a doctor or physician group sells out to a hospital. But since the ACA became law, health plans have changed how they pay physicians to support the transition from volume-based reimbursement to value-based care. Developing financial incentive programs to get doctors to focus on keeping costs down and quality up have taught health insurers that physicians can and should be considered partners in care delivery.


    5. Health plans also recognize that physicians deliver care in low-cost settings.


    Hospitals and health systems are much more expensive sites of care. The fact that physicians keep costs down is perhaps the most critical success factor for any health plan or health system. Cost has always been the most important factor for individuals buying insurance plans on the health insurance exchanges and for employers buying health insurance for their workers and family members.


    For all these reasons, I believe physicians have a large and maybe even a growing role to play in any reformed health system. Of course things have and continue to drastically change for physicians today, but it's safe to say the sky is not falling for those in private practice.

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    Online health info balances power between patients, docs

    Online health info balances power between patients, docs | Healthcare and Technology news | Scoop.it

    Online health information can empower patients and even shift the balance of power between patients and their doctors, according to an article at the Journal of Medical Internet Research.


    The study is based on focus groups with 32 participants recruited from an arthritis research center in British Columbia, Canada. Participants were asked to talk about the types of online health sites they visited as well as how the information they gleaned affected their relationships with their doctors.


    The participants looked to sites that include university and medical webpages, as well as social media sites (Twitter and Facebook), chat rooms and other sites for information on research and treatment options, medication self-management strategies and resources.

    Three predominant themes emerged from the discussions: the changing roles patients have with their doctors, partnership in their healthcare and tensions and burdens.


    About the changing roles, one participant said, "Before we would accept what the doctor said, but in the last 10 years, we've had access to the information and now we question more." Along with more information, patients reported the need to be better prepared to discuss issues with their doctor based on what they learned online.

    The study's participants, all of whom had multiple chronic health conditions, discussed teamwork and emphasized the importance of effective communication with multiple doctors.


    One patient conveyed how online information equipped her to change the power balance, be heard and get support from her doctors, saying online information is "ammunition."


    The participants also noted downsides, such as feeling overwhelmed and frustrated with the amount of information to wade through.

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    400 million people still lack access to key health care services

    400 million people still lack access to key health care services | Healthcare and Technology news | Scoop.it

    Some 400 million people worldwide lack access to essential health services, and the cost of healthcare is forcing many into poverty, the World Bank and World Health Organization reported Friday.

    A new report by the bank and WHO on tracking universal health care (UHC) coverage said more people than ever around the world, 80 percent, have access to key health services.


    Universal health care, the two institutions say, encompasses services that should reach everyone regardless of socioeconomic level: family planning, antenatal care, skilled support when giving birth, child immunization, TB treatment, HIV antiretroviral therapy, improved water sources and improved sanitary facilities.


    But hundreds of millions are reached by only a few of those services. In addition, in low and middle-income countries, six percent of the people were at risk of being forced into or pushed further into poverty by health care costs.


    "This report is a wakeup call: It shows that we're a long way from achieving universal health coverage," said Tim Evans, senior director of health, nutrition and population at the World Bank.


    "We must expand access to health and protect the poorest from health expenses that are causing them severe financial hardship."

    For some kinds of services, well over 80 percent of people have access, the report says.


    And it said that the impoverishing impact of catastrophic health expenses has diminished over the past decade.

    "However, there is still a long way to go on the road to UHC, both in terms of health service and financial protection coverage," the report said.


    The new report seeks to define UHC, in terms of measurable essential services, to be able to assess how governments and communities are performing.

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    Where are the most expensive hospitals?

    Where are the most expensive hospitals? | Healthcare and Technology news | Scoop.it

    Talk about sticker shock: Some U.S. hospitals charge patients more than 10 times the rates paid by Medicare.

    Of the 50 U.S. hospitals with the highest charges, 49 are for-profit institutions, 20 operate in Florida, and half are owned by a single chain, according to a study published in the journal Health Affairs Monday.

    That doesn't mean all or even most patients end up paying those charges. Private insurers are able to negotiate the sticker price down significantly. Patients paying out of pocket can often negotiate discounts or get charity care if they are low-income.

    The average U.S. hospital charges a somewhat less staggering sum: 3.4 times the rates paid by Medicare, the federal health care plan for the elderly and disabled which pays fixed rates for procedures.

    But for uninsured patients asked to pay full charges, insured patients who end up at an out-of-network hospital and patients whose treatment is covered by casualty or workers compensation insurance, these charges can matter a lot.

    "Hopefully this is a wake-up call for people to recognize there's a problem," said Gerard Anderson, a professor of health policy at Johns Hopkins Bloomberg School of Public Health, and one of the authors of the study, which analyzed 2012 Medicare cost reports.

      "There is no justification for these outrageous rates but no one tells hospitals they can't charge them," Anderson said. "For the most part, there is no regulation of hospital rates and there are no market forces that force hospitals to lower their rates. They charge these prices simply because they can."

      Even after full expansion of coverage under the Affordable Care Act, 30 million Americans will remain uninsured and may face particularly high charges, the study said. The law requires nonprofit hospitals to offer reduced-cost or charity care to eligible patients, but the provision does not apply to for-profit hospitals.

      "Hospitals' high markups, therefore, subject many vulnerable patients to exceptionally high medical bills, which often leads to personal bankruptcy or the avoidance of needed medical services," the study said.

      Of the 50 highest chargers, half are owned by Community Health Systems, a for-profit chain with 199 hospitals. The company made $18 billion in profits in 2014 — 45 percent more than in 2013. The researchers looked at charges at nearly 4,500 Medicare-certified hospitals nationwide.


      Florida most likely had the most high-charging hospitals because it has an exceptionally high proportion of for-profit hospitals, consumer advocates said. North Okaloosa Medical Center, a CHA hospital in the Florida panhandle, had the highest charges of all: 12.6 times Medicare's rate.

      In a written statement, CHA spokesperson Tomi Galin said CHA provided more than $3.3 billion in charity care, discounts and other uncompensated care for patients in 2014, as well as "millions of dollars in taxes that help fund critically important services in every community where we operate."

      The charges examined by the study, Galin said, "are not relevant measures of what consumers, insurers or the government pay for services."

      Chip Kahn, president and CEO of the Federation of American Hospitals, a trade group representing for-profit hospitals, also argued that the charges examined by the study were not a fair assessment of hospital prices. If the study had instead examined the actual payments by patients, they would have found that hospitals on the list charge just 1.3 times what Medicare pays, compared to a national average of 1.2, he said.

      A hospital's charges can matter even for patients with private insurance, said Ge Bai, a co-author on the study and a professor at Washington and Lee University. Hospitals use those charges as leverage during negotiations with insurers, and starting from a higher price point can drive up even discounted prices.

      "Except for patients with government insurance, few consumers are immune from negative financial impacts caused by hospitals' high markups," Bai said.

      "We as consumers are paying for this when hospitals charge 10 times what they should," added Anderson. "What other industry can you think of that marks up the price of their product by 1,000 percent and remains in business?"

      The highest charging hospitals were in 13 states, mostly in the South. Besides Florida, the states included Alabama, Arkansas, Arizona, California, Kentucky, New Jersey, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, and Virginia.

      The markups charged by the 50 hospitals on the list varied dramatically by procedure. Anesthesiology had the highest charges: an average of 112 times more than Medicare rates. The markup for nursery services, on the other hand, was three times the Medicare rate.

      The authors recommended that state and federal lawmakers enact policies to limit these charges. In Maryland and West Virginia, for example, state agencies set the rates that hospitals are allowed to charge for services. Requiring hospitals to disclose their charges for individual procedures could also help patients shop for the lowest-cost option, they said.

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      FDA-Approved Digital Health Should Save $100B+ Over Next Four Years

      FDA-Approved Digital Health Should Save $100B+ Over Next Four Years | Healthcare and Technology news | Scoop.it

      Here’s some research which suggests that a lack of “medical grade” digital health tools is perhaps the final obstacle holding healthcare back adopting them full scale — and reaping the benefits.


      Accenture released a study last week concluding that FDA-regulated digital health solutions should save the U.S. healthcare system more than $100 billion between now and the next four years.


      The scant number of digital health solutions the FDA has already approved has already had a meaningful impact, generating $6 billion in cost savings last year courtesy of improved med adherence, fewer ED visits and digitally-supported behavior changes, Accenture reports.

      But that’s just a drop in the bucket, if Accenture is right. The consulting firm expects our health system to save $10 billion this year thanks to use of such devices. And then, as the FDA approves more digital health technology, the savings figure should make dramatic jumps over the next few years, hitting $18 billion in ’16, $30 billion in ’17 and $50 billion in ’18.


      What’s intriguing about these numbers is that they assume each FDA approval will seemingly generate not only more savings, but also a cumulative “whole is greater than the sum of its parts” effect.


      After all, in raw numbers, the number of devices Accenture is relying on to achieve this effect is small, from 33 approved last year to 100 by the end of 2018. In other words, 67 devices will help to generate an additional $44 billion in savings.


      That being said, what makes Accenture so sure that the ever-so-slow FDA will approve even 70-odd devices over the next few years?


      * Provider demand: At present, about one-quarter of U.S. doctors “routinely” use tele-monitoring devices for chronic disease management, researchers found. As hospitals and medical practices look to integrate such solutions with their core EMR infrastructure, they’ll look to please providers who want digital health tech they can trust.


      * Reimbursement shifts: Accenture argues that as value-based reimbursement becomes more the norm, health leaders will increasingly see digital health solutions as a means of meeting their goals. And medical device providers will be only to happy to provide them.


      * Regulatory conditions: With FDA guidelines in place specifying when wellness tools like heart rate monitors become health devices, it will be easier for the FDA to speed up the process of digital health technologies, Accenture predicts. This should support 30% annual growth of such solutions through 2018, the study found.


      * Consumer health tracking: Consumer demand for health tracking devices, especially wearables, should continue its rapid expansion, with the number of consumers owning a wearable fitness device to double from 22% this year to 43% by 2020, according to the consulting firm.


      While Accenture doesn’t address the impact of digital health tech that doesn’t get FDA approval, there’s little doubt that it too will have a significant impact on both health outcomes and cost savings. Ultimately, though, it could be that it will take an FDA seal of approval to get widespread adoption of such technologies.

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      IT could save $100B for US healthcare

      IT could save $100B for US healthcare | Healthcare and Technology news | Scoop.it

      New research from Accenture projects that digital health tools will save the U.S. healthcare industry more than $100 billion over the next four years.


      In 2014 alone, it calculates, technology such as Web-enabled devices, digital diagnostic tools and other FDA-approved IT help achieve some $6 billion in reduced costs – mostly thanks to things such as improved medication adherence, behavior modifications and fewer emergency room visits.

      Accenture expects that number to approach $10 billion this year and $18 billion next year – increasing to $30 billion in 2017 and $50 billion in 2018 as these technologies take hold, proliferate and evolve.


      It also predicts that FDA approval of digital health tools will triple by the end of 2018, to 100 (up from from just 33 this past year).


      "A digital disruption is playing out in healthcare, as witnessed by the emergence of new business models and technology that will change the nature of patient interactions, alter consumer expectations and ultimately improve health outcomes," said Rick Ratliff, Accenture's managing director of digital health solutions in a press statement.

      Factors, such as government health IT mandates, payment reform and other regulatory changes are accelerate the growth of FDA-approved digital solutions, the report shows.


      Increasing ubiquity of health IT among physicians and patients will enable more and more devices to integrate withpatient portals and digital health records, according to Accenture, which finds that one in four U.S. physicians routinely use telemonitoring devices for some aspect of chronic disease management.


      Meanwhile, as more and more patients take charge of their own care, the number of U.S. consumers who own a wearable fitness device will double in the next five years, according to Accenture, from 22 percent this year to 43 percent by 2020. More than half (57 percent) of consumers track their health online, such as medical history (37 percent), physical activity (34 percent) and symptoms (33 percent), according its poll.


      Recent FDA guidelines for low-risk health products – setting a regulatory line between wellness tools and medical devices – will enable more clarity, expedite regulatory pathways and could drive 30 percent annual growth of digital tools through 2018.


      The evolution toward value-based care is also creating fertile ground for clinical and business strategies that incorporate these technologies, with Accenture projecting digital health funding to reach $6.5 billion by 2018.


      "The proliferation of Internet-connected solutions and evolving regulatory guidelines are blurring the lines between clinical and consumer health solutions," said Ratliff. "As consumer health platforms support more 'medical' devices, rather than just today's wellness trackers, they'll create a viable self-care model in a segment that today is occupied by chronic-disease monitoring companies."

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