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Premier, Inc. acquires healthcare analytics leader Healthcare Insights, LLC

Premier, Inc. acquires healthcare analytics leader Healthcare Insights, LLC | Healthcare and Technology news | Scoop.it

 Premier, Inc. (NASDAQ: PINC), a leading healthcare improvement company, today announced that it has acquired Healthcare Insights, LLC for $65 million in cash. Healthcare Insights is a privately-held,integrated financial management software developer that provides hospitals and healthcare systems with budgeting, forecasting, labor productivity and cost analytic capabilities.


“As the healthcare industry becomes more complex, value-driven, and data-dependent, the need for health systems to clearly understand their performance in every arena is a top concern,” said Keith J. Figlioli, Premier’s senior vice president of health informatics. “It is not enough to have financial, operational and clinical data. Health systems must understand how to translate that information into effective cost containment strategies, as well as superior clinical outcomes.”


The industry’s increased focus on cost is largely driven by the Affordable Care Act, which reduces overall reimbursement, and increasingly holds providers accountable for the total costs and quality of the care delivered. Coupled with the growing movement to value-based payments such as bundling or shared savings, healthcare providers need solutions that can help them understand cost drivers and opportunities for improvement in detail. Healthcare Insights is expected to enable Premier to offer a more complete solution that delivers additional value by adding budgeting, clinical financial management and productivity analytics to existing cost and quality applications, including the company’s enterprise resource planning (ERP) solution.


Thomas Johnston, Healthcare Insights’ chief executive officer, said, “This strategic combination will allow us to offer a more complete ERP solution with an end-to-end view of cost management. We expect this to increase our hospitals’ and health systems’ understanding of their clinical, operational and financial performance, and help them deliver more efficient, higher quality care.”


Founded in 2000, Healthcare Insights’ current customer base includes over 7,500 users across 200 facilities associated with 94 health systems, 49 of which do not currently have a relationship with Premier. KLAS, a leading research firm that provides ratings for more than 900 healthcare products and services, has ranked Healthcare Insights first place in budgeting for the past four years.


The Healthcare Insights acquisition, which was effective July 31, is currently projected to be modestly accretive to Premier’s fiscal 2016 revenue growth and adjusted EBITDA. Expected revenue and adjusted EBITDA contributions from the acquisition will be incorporated into Premier’s fiscal year 2016 guidance, which is scheduled to be announced on August 24, when the company reports fiscal fourth-quarter and full-year 2015 financial results.

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Is This Population Health’s Moment? Time for Data and Analytics

Is This Population Health’s Moment? Time for Data and Analytics | Healthcare and Technology news | Scoop.it

Every year, the annual HIMSS Conference, sponsored by the Chicago-based Healthcare Information and Management Systems Society, offers its attendees a kind of conference-based snapshot of where the U.S. healthcare industry is with regard to the forward evolution of healthcare information technology adoption, as well as a sense of the overall policy and operational landscape of healthcare. Attendees can get a sense of the healthcare IT Zeitgeist through attending keynote addresses, educational sessions, association meetings, and networking-focused gatherings, as well as by wandering the exhibit hall and simply by having meaningful conversations with fellow attendees.


HIMSS15, held at the vast McCormick Place Convention Center in Chicago the week of April 12, offered perhaps the clearest portrait of the current moment that has yet been offered to date. Session after session focused on the shift beginning to take place from volume-based healthcare reimbursement to value-based payment, across a very wide range of mechanisms, between providers and both the public and private purchasers and payers of healthcare, and the implications of that shift for healthcare IT leaders.


Further, as part of the keynote session on Thursday, April 16 in the Skyline Ballroom at McCormick Place, Andy Slavitt, Acting Administrator of the Centers for Medicare and Medicaid Services (CMS), made the intentions of federal authorities crystal clear, when, referencing the statement of Health and Human Services Secretary Sylvia Mathews Burwell in January that she wanted the bulk of Medicare fee-for-service payments to providers to shift as quickly as possible over to quality- and value-based payment, Slavitt said, “Our priority is simple: to drive a delivery system that provides better care, smarter spending, and keeps people healthier. The success in the first five years since the Affordable Care Act has been very encouraging… Our agenda now,” he said, “is to get busy strengthening these gains. That will mean that more providers in more communities will need to be able to transform the care they provide so that they will benefit from value-based reimbursement. And they will need technology to help them get there.”


What’s more, in his keynote address two days earlier, Humana CEO Bruce Broussard had told HIMSS attendees, “We have to change the conversation on what we are doing in healthcare from a supply-based system to a system around demand, a system where we put the customer first as opposed to the system. Over the years,” he added, “healthcare has been built by creating more and more supply. I hope I leave today by convincing you that we have to change the focus towards how we improve health for our customers, members, and patients.”


The good news on the solutions side of this landscape is that vendors are rushing forward to provide population health- and accountable care-driven analytics solutions, at a time when such solutions are most desperately needed. Certainly, the hype at HIMSS15 was all around population health, care management, and accountable care solutions. The only question now, as the U.S. healthcare industry hurtles forward into the near future, is, is this a breakthrough moment for population health efforts? And if so, are provider and health plan leaders ready to effectively leverage the tools to make pop health really happen?


The long journey ahead


Leaders from all sectors of healthcare understand that the journey to population health and value-driven care delivery and payment success is going to continue to be a long, challenging one. Donald W. Fisher, Ph.D., president and CEO of the Alexandria, Va.-based American Medical Group Association (AMGA), says he and his colleagues are putting the vast bulk of their efforts into helping prepare physician group leaders for the transition. “We’re not quite there yet, and as we change to a new reimbursement system, even the large, sophisticated medical groups are going to need a few years to make the transition,” Fisher says.  “You’ve got to put the infrastructure in place, and the large integrated health systems have been putting those elements in place—EHRs [electronic health records], alert systems, analytics systems, data warehouses—and some have teams of people mining the data to assess patient status.”

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Some 30 nations have dangerously weak health systems: WHO

Some 30 nations have dangerously weak health systems: WHO | Healthcare and Technology news | Scoop.it

About 30 countries have health systems that are as dangerously weak as the ones that allowed Ebola to ravage Guinea, Liberia and Sierra Leone, the World Health Organization warned Thursday.

The UN health agency stressed the urgency of learning the lessons drawn from the outbreak that has killed more than 11,100 people in west Africa, calling for strengthening health systems so they can rapidly detect and counter looming disasters.


"We must reverse the trend in global health where we wait for the fire to flare up, run to put it out but then forget to fireproof the building," said senior WHO official Ruediger Krech.


The world, he told reporters, had to create a health system "built to withstand shocks whether from an outbreak like Ebola, a natural disaster or a financial crisis."


The fragile health systems in Guinea, Sierra Leone and Libera, weakened by conflict and poverty, were an important factor in Ebola's rapid spread through the three countries last year.


And Krech said at least 28 other countries worldwide, mainly in Africa, but also in Asia and Latin America, had similarly weak systems.


The list includes Democratic Republic of Congo, Madagascar, Burundi, Sudan, Afghanistan and Haiti.


"So our work will not be limited to west Africa," he said.

The Ebola outbreak began in late 2013 in Guinea, but was permitted to spread silently for three months before the WHO and the region raised the alarm.


The crisis sparked a global health scare, with the humanitarian response especially gaining momentum once stray cases were detected in the United States and some European countries.

Liberia, once the worst-hit country, was declared Ebola-free on May 9. But Krech said the crisis was far from over in the two neighbouring countries and refused to give a timeframe for them to acquire a similar status.


On Wednesday, the WHO's annual decision-making assembly approved a significant hike in its budget for 2016-17 to among other things help strengthen health systems in west Africa and elsewhere.

Just pouring in money will not fix the problem, Krech warned, adding that "corruption is rife in many countries."


"The elephant in the room" in many nations with poor health systems is endemic corruption and a lack of transparency of how funds are spent in key sectors such as health, he told AFP.

"To further complicate things, the private health sector in many countries in unregulated," he said.


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Drug Costs Top $50K A Year For Half Million Americans

Drug Costs Top $50K A Year For Half Million Americans | Healthcare and Technology news | Scoop.it

With the drug industry launching more expensive targeted therapies, the number of Americans with annual medication costs of more than $50,000 has jumped more than 60% to nearly 600,000, a new analysis shows.


The latest drug spending trend report from pharmacy benefit manager Express Scripts ESRX +0.33% (ESRX) shows 576,000 Americans with annual medication costs of $50,000 or more. That’s a 63% increase in 2014 from 2013 when 352,000 Americans had such high costs.

While the number of patients with annual spending above $50,000 was just 0.2% of patients, the amount of drugs they and their health plans or employers paid for accounted for 16% of total spending, the analysis showed.


“The profile emerging from this research shows these patients are overwhelmingly taking specialty medications, and have multiple comorbidities, prescriptions and prescribers,” Dr. Glen Stettin, ExpressScripts’ senior vice president of clinical research and new solutions, said in a statement accompanying the analysis.


Express Scripts certainly has a vested interest in issuing such an analysis as a pharmacy benefit management (PBM) company, hired by some of the nation’s largest employers to reign in prescription costs.

The costs are putting a spotlight on PBMs, which include companies like Express Scripts and the Caremark subsidiary of CVS Health (CVS) as well as UnitedHealth Group UNH +1.1%’s Optum Rx Corp., which is buying pharmacy benefit manager Catamaran (CTRX) for $12.8 billion. PBMs are the middlemen between drug manufacturers and employers when it comes to purchasing pharmaceuticals and some see them potentially consolidating into even bigger players to wrest control of prescription prices.


Costs are increasingly driven by the latest biologic medicines, which are hailed for their effectiveness, but jeered for their high costs. Chief among them are pills for hepatitis C that cost $1,000 or more each and are sold by Gilead Sciences GILD +0.78% (GILD) and Abbvie (ABBV).

To combat these high costs, PBMs have been negotiating exclusive deals with hepatitis C pill makers. The PBMs essentially agree as part of the discount to provide their health plan members with coverage of one drug over the other. That brings the costs of the pills down.

But the discounts can only do so much as the size of the nation’s tab for prescription medicines climbs to new heights. Express Scripts said the number of patients taking at least $100,000 worth of medications almost tripled to 139,000 people in 2014 compared to nearly 47,000 in 2013.


Express Scripts said its analysis looked at prescription drug claims from more than 31 million Americans in 2013 and 2014. The population examined included Americans covered by commercial insurance as well as Medicare and Medicaid.


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Can doctors afford to ignore the changes in medical practice?

As the CMS Innovation Center rolls out the Next Generation ACO Model, I wonder what doctors are thinking. The Next Generation ACO model ups the ante on risk and reward and is the next delivery model iteration as CMS marches on to 30 percent at risk Medicare in 2016. Some of the docs will generally acknowledge that medicine is changing, but there is often no corresponding change in behavior. Other docs will simply ignore what is being played out right before their very eyes, expressing the same willful blindness that some of my breast patients would, presenting with huge, fungating cancers.


It is understandable that doctors would want to hang on to a health care belief system that they embraced in medical school. But many of the beliefs of years past do not work today; try not to believe everything you think. Consider these five examples.

1. I am too busy to learn how to improve. Actually, you can’t afford to not learn. As we have discussed multiple times in these pages, our current system of health care finance is unsustainable. We are broke. For that reason, fee-for-service is going away. This means you will be at financial risk for populations of patients. You can’t just change one day. You need to learn how to improve quality and reduce costs. This requires new skills.


2. I make a lot of money, and that means I am really smart. Yeah, right. Like that failed limited partnership that cost you $500,000? Or how about both of those alimony checks that go out every month, regardless of your income? We know folks who have had stellar careers who still work in some capacity because they squandered their money. Anybody can learn how to do a colonoscopy or fix a hernia, so don’t get on a high horse because you have been blessed to have a good income. The future comes with significant uncertainty. Be a good steward and be grateful. If you think that you can win going against the forces that be, it could be disastrous.


3. My hospital loves me because I make them tons of money. Really? How do you know that? You would be surprised. I have a friend who was bragging about how much money he made for the hospital doing MRIs. It turns out that they lost $150 every time they turned the machine on. Or what about the $46M service line that cost $48M to run? I guess they will make it up on volume, right?


4. My performance benchmarks are OK, so that means my quality is good. You are two clicks to the green side of the benchmark, but that doesn’t mean you have good quality. It just means you are better than 52 percent of your peers. Plenty of people will stay there at 48 percent. Time to go to #1 above and learn how to get better outcomes, and in the process, you will also reduce costs. Your patients deserve it.


5. I will always have my choice in where I work. Don’t bet on it. Everyone is replaceable. You need to protect your career. Embrace team concepts of care. Develop leadership skills. I recommend that you start thinking now about how your work will change when you and your hospital or clinics take on more financial risk. Remember that lower costs of care are becoming indicators of higher quality. Don’t be the jerk that gets fired.


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Uninsured drop by 11M since passage of Obama's law

Uninsured drop by 11M since passage of Obama's law | Healthcare and Technology news | Scoop.it

The number of uninsured U.S. residents fell by more than 11 million since President Barack Obama signed the health care overhaul five years ago, according to a pair of reports Tuesday from the federal Centers for Disease Control and Prevention.

Although that still would leave about 37 million people uninsured, it's the lowest level measured in more than 15 years.

The most dramatic change took place in comparing 2013 with the first nine months of 2014. As the health care law's major coverage expansion was taking effect, the number of uninsured people fell by 7.6 million over that time.

That's "much bigger than can possibly be explained by the economy," said Larry Levitt of the nonpartisan Kaiser Family Foundation. "The vast majority has to be due to the Affordable Care Act."

Monday was the law's fifth anniversary, and supporters and detractors again clashed over its impact.

Obama says the law in many ways is "working even better than anticipated."

House Speaker John Boehner says it amounts to a "legacy of broken promises."

The health care law offers subsidized private coverage to people who don't have access to it on the job, as well as an expanded version of Medicaid geared to low-income adults, in states accepting it.

The White House says 16 million people have gained health insurance, a considerably higher estimate than Tuesday's findings from CDC's National Center for Health Statistics.

The figures cited by the White House cover a longer period of time, through the beginning of this month. That includes the law's second sign-up season. The estimate was produced by the principal policy adviser to Health and Human Services Sylvia M. Burwell.

The CDC reports compared the first nine months of 2014 with annual statistics going back as far as 1997, from the National Health Interview Survey. Among the highlights:

— The number of uninsured dropped from 48.6 million in 2010 to 37.2 million for the period from Jan.-Sept. last year. That amounted to 11.4 million fewer uninsured since the signing of the health care law.

— In 2014, about 27 million people said they had been without coverage for more than a year.

— Some 6.8 million people were covered through the health care law's new insurance markets during July-Sept. of 2014.

— The most significant coverage gains last year came among adults ages 18-64. Nearly 40 million were uninsured in 2013. But that dropped to 32.6 million in the first nine months of 2014.

— States that moved forward with the law's Medicaid expansion saw a bigger decline in the share of their residents uninsured.

The main question hanging over the law now is a Supreme Court case in which opponents argue that its subsidies are illegal in most states. They contend that the exact wording of the law only allows subsidized coverage in states that have set up their own insurance markets. Most have not done so, relying instead on the federal HealthCare.gov.

The administration counters that the context of the law makes it clear the purpose was to expand coverage in every state. A decision is expected to be announced by late June.


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What Do Women Know About Obamacare That Men Don’t?

What Do Women Know About Obamacare That Men Don’t? | Healthcare and Technology news | Scoop.it

For the second year running, more women than men have signed up for coverage in health insurance marketplaces during open enrollment under the Affordable Care Act. According to the Department of Health and Human Services, enrollment ran 56 percent female, 44 percent male, during last year’s open enrollment season; preliminary data from this year shows enrollment at 55 percent female, 45 percent male – a 10 percentage point difference.

What gives? An HHS spokeswoman says the department can’t explain most of the differential. Females make up about 51 percent of the U.S. population, but there is no real evidence that, prior to ACA implementation, they were disproportionately more likely to be uninsured than men – and in fact, some evidence indicates that they were less likely to be uninsured than males .

What is clear that many women were highly motivated to obtain coverage under the health reform law – most likely because they want it, and need it.

It’s widely accepted that women tend to be highly concerned about health and health care; they use more of it than men, in part due to reproductive services, and make 80 percent of health care decisions for their families . The early evidence also suggests that women who obtained coverage during open enrollment season last year actively used it.  According to Inovalon, a company that tracks and analyzes data for health plans and providers, people who used the coverage they bought through the marketplaces last year tended to be older, sicker, and more female than the general commercially insured population. As of June 2014, 41 percent of females who purchased coverage through exchanges had face-to-face visits with health care professionals, versus 32 percent of males.

Those numbers are consistent with the notion that many women who signed up for coverage under the ACA had preexisting conditions or other health issues that led them to seek treatment.  In some cases, their pre-ACA insurance may have excluded those conditions, or the preexisting conditions may have prevented them from obtaining coverage at all.

What’s more, as HHS points out in a recent report, there are plenty of benefits in the ACA’s qualified health plans that are especially attractive to women. These include coverage at no out of pocket cost for many preventive measures, such as mammograms or screening for gestational diabetes.  An estimated 48.5 million are benefitting from that provision of the law alone.

Other data support the notion that many U.S. women are in disproportionately higher medical need, relative to men – even adjusting for the fact that they typically live longer.  According to an analysis of Medical Expenditure Panel Survey data from the Agency for Healthcare Research and Quality, women constitute nearly 60 percent of people in the top tenth of medical expenditures in 2011 and 2012.  Most of those in the top tenth of spending are either ages 45 to 64, or 65 and older.

One obvious conclusion is that many, and perhaps most, of those who’ve benefited from coverage under the Affordable Care Act are female – and especially women in middle age and beyond. Another is that, if the Supreme Court rules in King v. Burwell that subsidized coverage can’t be obtained through the federal marketplace, women will be disproportionately harmed.

A case in point: Rosemary Forrest, 63, who lives in Augusta, Georgia.  Laid off from her job at a university science lab at age 55, she spent five years unemployed and without health insurance.   She now works as a contractor to a small nonprofit agency; battling painful osteoporosis, she sometimes earns less than $400 a month.  Last year, when the federal health insurance marketplace went live, she signed up for coverage.  This year, she re-enrolled, and after federal tax credits, pays $86 per month in premiums.


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Texas Gov. Signs Bill for Expanded Health Data Interoperability

Texas Gov. Signs Bill for Expanded Health Data Interoperability | Healthcare and Technology news | Scoop.it

Texas Gov. Greg Abbott has signed a bill into law to promote improved and expanded health data interoperability for Texas public health.


House Bill 2641 helps better define health information exchange (HIE) within Texas statute and aims to ensure that all public health systems are able to exchange health information securely, in accordance with applicable national data exchange standards. The bill was signed into law by Gov. Abbott on June 19 and will take effect September 1, 2015.


Authored by state representative John Zerwas, M.D., an anesthesiologist from Houston, the new law also allows health-related information to be transmitted through local health information exchanges to the appropriate state public health agencies, a critical provision for technology innovators working to facilitate the secure exchange of health data.


The bill is called “Ken’s Bill” after Dr. Ken Pool, M.D., who was president of the board of directors of the Texas e-Health Alliance when the bill was drafted. TeHA is credited with pulling together a broad coalition of stakeholders—hospital associations and medical associations, among others—that saw the bill through to passage.


“HB 2641 is an important step towards making sure that we are empowering providers to get the most out of their investments in health information technologies, and in moving our state health care data systems into the modern era” Representative John Zerwas, M.D., author of the bill, said in a statement.

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Ignoring the Penalty for Not Buying Health Insurance

Ignoring the Penalty for Not Buying Health Insurance | Healthcare and Technology news | Scoop.it

Obamacare’s big stick doesn’t seem to be scaring many people into buying health insurance.

The health law includes many inducements for people to obtain health insurance — including free Medicaid coverage for many low-income Americans and subsidies for those with moderate incomes. But it also includes the notorious “individual mandate,” a fine for those who can afford insurance but don’t buy it.

Because the law, and the fine, are new, many policy experts expected that some people would decline to sign up for insurance until they were hit with a penalty at tax time. Forecasters have estimated a big bump in marketplace enrollment next year, the first sign-up period after people have been fined. The Congressional Budget Office, for example, estimates 10 million more people will have Obamacare plans next year. The law’s structure relies on even healthy and otherwise disinclined consumers to enter insurance markets to help stabilize prices.



Certainly, some people who might otherwise go uninsured have been persuaded by the penalty. Polls have shown that it is a well-known provision of the law. And studies of the uninsured have shown that mentioning the penalty changes some people’s thinking about health insurance. At the end of the normal enrollment period in February, about 11.7 million people had selected marketplace health plans or renewed their plans from 2014, according to the federal government.



But the Obama administration just conducted a small experiment into how much the penalty would affect the behavior of the remaining uninsured. And the results leave some experts concerned that next year’s sign-ups will come in below expectations.

Because of the timing of the sign-up season and tax filing deadlines, it turned out that many people would find out about the penalty only after it was too late to enroll for 2015 coverage. Consumer advocates argued that this situation would lead many people to face a needless second year of uninsurance — and penalties. So, in February, the administration and most states agreed that people who were uninsured in 2014, faced a penalty and were still uninsured for 2015 could sign up late for new health insurance. The eligible population is a small slice of the country, but precisely the sort of people whom you might expect to be most motivated by the fine, if they were going to be.

The I.R.S. estimated that between 3 million and 6 million people faced penalties for being uninsured in 2014. On Tuesday, the federal government announced in a tweet that 147,000 people had signed up for the plans using the federal website that operates in most states during the new sign-up period. Not all of the states that run their own marketplaces and offered similar opportunities have published final numbers, but Charles Gaba, who tracks Obamacare enrollment data at his website, ACASignups.net, estimates that total national tax-time sign-ups are around 200,000. Only three states — Colorado, Idaho and Massachusetts — declined to allow penalty-payers to sign up during a special period.

To be clear, the number of people eligible for the special sign-up period was probably quite a bit less than 6 million. Some who paid fines for 2014 may have gotten insurance with a new job in the intervening year. And some may have signed up for Obamacare insurance during the normal sign-up period, which ran from mid-November through mid-February. The Department of Health and Human Services has provided no estimates on how many people might have been eligible for the special sign-up period.

Some advocates have criticized the way the special period was set up, saying the low sign-ups merely reflect the last-minute nature of the decision to extend deadlines. Given more time to prepare, tax preparers might have been able to help enroll more people in health insurance, said Brian Haile, a former senior vice president at the tax preparation firm Jackson Hewitt. “H.H.S. refused to provide any information until the very last minute,” he said in an email. “As a result, the companies were not able to plan effectively.”

But several close watchers of the law say that the special enrollments look low enough to raise more substantial questions about whether the health law’s penalty will have the intended effect of increasing sign-ups for insurance in the coming years.




“It makes me more pessimistic,” said Caroline Pearson, a vice president at the health care consulting firm Avalere Health. When the government announced the special enrollment period, she estimated that between half a million and a million people would take advantage of it. “All the evidence is enrollment is not going to be where people thought.”

Ms. Pearson pointed out that people earning higher incomes, who would have to pay a higher proportion of their premiums, have been less eager to sign up than those whose low incomes qualify them for substantial government help with their health premiums. She recently published an analysis describing the penalty as “too low” to move many higher earners.

Mike Perry, a partner at the polling firm PerryUndem, says focus groups he’s held with the uninsured are consistent with Ms. Pearson’s theory. “A lot of them seem to be making calculations throughout the year what their premium would be versus this fine,” he said.

Behavioral economists who study incentives like the mandate penalty say it may just take time for people to learn about the incentive structure set up by the penalty. It is set to increase for the next several years, so people who remain uninsured will face not just repeated but rising bills for doing so.

Some people who learned about the fine late may not have had enough time to make room in their budgets for an insurance premium, said Brigitte Madrian, a professor at Harvard’s Kennedy School who has studied how incentives affect 401(k) plan sign-ups. Next year, uninsured people may have more time to plan ahead, and may remember the unpleasant experience of paying a fine.

“People learn from their mistakes, and this is true in the financial domain,” Ms. Madrian said. “The learning may be more effective a few years in as they see the penalty going up.”


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Fixing health care doesn't necessarily need political reform

Fixing health care doesn't necessarily need political reform | Healthcare and Technology news | Scoop.it

It’s very hard to find a product or service that is both lousy and unaffordable. Such expensive duds are usually quickly replaced by cheaper and better competitors. Prior to the Affordable Care Act, health care was becoming more expensive every year while simultaneously becoming less convenient, less personal, and less satisfying. In 2009, I wrote a series of four posts explaining how the health care marketplace reached such a sorry state and offering a suggestion for reform.


Since then, the Affordable Care Act has passed. For many, insurance has become much more affordable, but whether this translates to better or more affordable care remains to be seen. If it results in many patients receiving affordable insurance that very few physicians accept, then the situation will be a repetition of the Massachusetts experience with universal coverage: Everyone has insurance; no one has a doctor.

At the same time, the intrusive and complex bureaucracy that physicians must navigate to collect insurance payments has vastly expanded. Physicians are now coerced into serving as the workforce for Federal plans to collect health care data, cut costs, and make their care increasingly legible to payers but increasingly opaque to patients.

Bear with me for just a few examples. In an ill-advised plan called “meaningful use,” physicians receive incentives for submitting complex reports documenting their use of electronic health records (EHRs). The time and effort required to comply with this program has earned it much scorn from physicians. And the incentives will likely distort the true value of EHRs and inflate their costs.


The International Classification of Diseases (ICD) is the coding system used by physicians and billers to report to insurance companies patients’ diagnoses. In October, the government will update ICD to its tenth version. ICD-10 will contain radically more complexity than its predecessors. It is widely ridiculed for the detail with which diseases must be reported. (Code V91.07XA is for a “burn due to water-skis on fire.”) The transition to ICD-10 was already postponed once, and I predict it will cause much disruption and grief.


My last example is the recently passed sustainable growth rate (SGR) fix which gets rid of the annual congressional scramble to increase Medicare reimbursement to physicians by increasing reimbursement in the short term, but tying reimbursement to outcomes measures in the long term. This is sure to become a data collection and reporting hassle that makes doctors long for the simpler days of meaningful use.

I honestly believe that there has been more bureaucratic complexity added to the typical physician’s life in the last few years than in the twenty years before that. None of it cares for a single patient.


Two weeks ago, my family and I spent ten days visiting New York City. We had a wonderful time. The services that completely transformed our experience were the ride sharing services of Uber and Lyft. We never used public transportation. We never hailed a taxi. For longer trips (and a family of five) this was likely cheaper than train tickets. For shorter trips, it meant not handling cash, never finding bus or subway stops, and never referring to transit schedules.


For years, passengers complained about high taxi prices and poor taxi service, and potential competitors complained about the legalized monopolies given to taxi companies by city governments. But rather than bang their heads against these barriers, companies like Uber and Lyft just started giving people rides.


This was an epiphany to me. I had always assumed that fixing the health care marketplace would mean political reform — undoing the myriad laws that substituted insurance for health care and caused prices to skyrocket, and dismantling the byzantine bureaucracy that physicians must navigate. Now, I understand that political reform is both unrealistic and unnecessary.


Doctors and patients aren’t waiting for political reform. More and more doctors are “going off the grid” to provide excellent care unencumbered by insurance regulations. Concierge primary care is just one example. The Surgery Center of Oklahoma lists on its website the prices for every surgery it offers. The prices are all-inclusive. You won’t get a separate bill from the anesthesiologist, the surgeon, and the facility. And they don’t care what insurance you have because they won’t deal with any insurance company. Other innovative companies are using video conferencing technology to connect patients to doctors thousands of miles away. LUX Healthcare Network (with which I’m proud to be associated) is building a multi-specialty concierge physician network.


I argued six years ago that using insurance for routine care is wasteful. I now realize that attempts at universal coverage and the bureaucracy that comes with it — ICD-10, meaningful use — will never be repealed. This bureaucracy will become the taxi monopolies of health care — increasingly ignored by both doctors and patients and increasingly irrelevant. The successful enterprises in health care will connect doctors and patients and then get out of the way. Like Uber and Lyft they will help patients find the service they want at a price they’re happy to pay, and they will facilitate not regulate the delivery of excellent care.


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Quake overwhelms Nepal's weak healthcare system

Quake overwhelms Nepal's weak healthcare system | Healthcare and Technology news | Scoop.it

A massive earthquake in Nepal has exposed the woeful state of its medical facilities as hospitals struggle to treat vast numbers of injured with limited supplies and staff.


The country of 28 million has only 2.1 physicians and 50 hospital beds for every 10,000 people, according to a 2011 World Health Organization report.


The situation is worsening a humanitarian crisis triggered by Nepal's worst earthquake in 81 years. The 7.9 quake, which struck just before noon on Saturday, has killed more than 2,200 people and injured more than 5,400.


Casualties are expected to rise, as many more people are feared trapped in debris across the country, from the capital Kathmandu to remote villages and mountain peaks.


So far many of the seriously injured in Kathmandu were being referred to Bir Hospital's Trauma Centre, which opened in February this year with 200 beds.


Doctors said they needed more than 1,000 more beds to treat the patients that were being brought in ambulances and taxis.

"The earthquake has exposed that Nepal's best public hospital infrastructure has crumbled at a time when it should serve more people in a hurry," said Sarvendra Moongla, a senior surgeon there.


Children with multiple injuries were laid on the dusty marble floors of the hospital, while hundreds of other patients with fractured and bloodied limbs lay on the ground outside the hospital under tents as family members struggled to find drinking water and food for them.

A lack of morgue facilities meant that 13 bodies lay outside the hospital, one of the oldest in Nepal.


Many patients were prematurely discharged to accommodate the waves of injured survivors: Doctors shifted wheel-chair bound patients and several quake survivors with multiple injuries to a playground opposite the hospital.


Anita Dhungana, 31, said she was admitted to the trauma center last week and operated on just hours before the quake. Doctors had advised 48 hours of bed rest in the hospital.


"My father begged and pleaded before the doctor to keep me in the hospital. I am still bleeding and cannot walk but there is no one to examine me," Dhungana said.


Her father pitched a tent near a sewage pit where survivors washed their faces and cooked rice with lentils on kerosene stoves.

Outside the Kathmandu Medical College, about half an hour's drive east from Bir Hospital, Khile Sherpa, 20, sat in the street waiting to be treated. His right eye was lacerated, and he wore a bandage around the head, covering half his face.


He said he had been evacuated from Mount Everest base camp, where an avalanche triggered by the quake killed at least 17 climbers and injured scores.


While Nepal's healthcare facilities are limited, they quickly become much worse outside its major cities. Remote regions have only very basic medical centers that are ill-equipped to handle serious injuries.


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Congress Approves Bill Eliminating 21 Percent Medicare Cut While Senate Delays Decision

Congress Approves Bill Eliminating 21 Percent Medicare Cut While Senate Delays Decision | Healthcare and Technology news | Scoop.it

A 21 percent cut in Medicare physician payments went into effect last week on April 1, 2015. While Congress passed legislation intended to eliminate the automatic cut that resulted from the Medicare Sustainable Growth Rate (SGR) formula, the Senate failed to take action before its current two-week spring recess. In response, last week the American Optometric Association (AOA) released a statement informing optometrists how they can attempt to avoid being impacted by the cut until further action is taken.
 
On March 26, Congress passed H.R. 2: the Medicare Access and CHIP Reauthorization Act of 2015 to prevent the automatic 21 percent payment cut for doctors who treat Medicare patients. The bipartisan bill would replace Medicare’s SGR formula with a new merit-based incentive payment system. However, while Congress approved the bill, the Senate will not vote on the measure until after it returns from its spring recess on April 13. This means that technically with no stopgap measure that the automatic 21 percent cut to Medicare physician payments took effect on April 1.
 
However, there is still time for physicians, including optometrists, to prevent having their reimbursements cut. The U.S. Department of Health and Human Services announced that it would hold off processing claims at the lower rate until April 15.
 
Also, according to the AOA’s statement: “ODs and other Medicare physicians are unlikely to immediately feel the impact of this cut. By law, the Centers for Medicare & Medicaid Services (CMS) may not process and pay claims any sooner than 14 days. CMS does have the option of delaying claims until the Senate acts on the bill. CMS plans to update providers by April 11. In the meantime, AOA has advised members to hold off on submitting April claims for as long as practical, giving Congress time to complete the legislative process on H.R. 2 and Medicare contractors the ability to implement new payment rates. No processing or payment delays should occur for claims submitted to Medicare that are dated March 31 or earlier.”

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CDC investigates deadly bacteria's link to doctors' offices

CDC investigates deadly bacteria's link to doctors' offices | Healthcare and Technology news | Scoop.it

The Centers for Disease Control is raising a red flag that a potentially deadly bacteria may be lurking in your doctor's office.

The bacteria, C. difficile, is typically found in hospitals, but a study out Wednesday reports a substantial number of people contracted the bug who hadn't been in a hospital, but had recently visited the doctor or dentist.

The bacteria can cause deadly diarrhea, according to the CDC, with infections on the rise. The new report shows nearly half a million Americans infected in various locations in one year, with 15,000 deaths directly attributed to C. diff.

In a 2013 study, researchers found C. diff present in six out of seven outpatient clinics tested in Ohio, including on patients' chairs and examining tables.

The CDC is so concerned that they're starting a new study to try to assess nationally whether people are getting C. diff in doctors' offices.

"This is really an important issue. We need to understand better how people are getting C. diff," said Dr. Cliff McDonald, a medical epidemiologist at the CDC.

In the meantime, patients should wash their hands after visiting the doctor's office -- with soap and water, because alcohol-based gels don't get rid of C.diff.

Another tip: Question your doctor whenever you're prescribed an antibiotic. Powerful broad-spectrum antibiotics wipe away good bacteria in your gut that fight off the bad bacteria, which leads the way to C. diff.

Johns Hopkins safety expert Dr. Peter Pronovost recommends asking your doctor if you really need an antibiotic, if there's a less powerful one that will treat your infection, and if you're being prescribed the antibiotic for the shortest time possible.

The CDC study, published Wednesday in The New England Journal of Medicine, said 150,000 people who had not been in the hospital came down with C. diff in 2011. Of those, 82% had visited a doctor's or dentist's office in the 12 weeks before their diagnosis.

The CDC is hoping its new study will help determine cause and effect, because it's possible the patients had C. diff to begin with and went to the doctor to get help. It's also possible that antibiotics prescribed during the doctor's visit, and not microbes at the doctor's office, caused the infection.

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You Will Feel Better's curator insight, February 26, 2015 3:56 PM

This is why PureWorks foam is an absolute necessity! 

https://youwillfeelbetter.buyygy.com/90forLifeStore/en/pureworks

4CalebWalker's curator insight, March 12, 2015 10:11 AM

CDC/ I did not realize that they investigated things that did not apply to a general population/ I agree with them taking their time to investigate and control the situation

Ashley Maddox's comment, March 12, 2015 3:00 PM
1 scoop plus 1comment =20
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Samsung and Fitbit currently leading wearables markets

Samsung and Fitbit currently leading wearables markets | Healthcare and Technology news | Scoop.it

With the Apple Watch launch, and its potential to upend the wearables market, a few months away, Canalys reports that the current market leader for “smart wearable bands” — any wristworn device that can run third-party applications — is Samsung. Meanwhile, the “basic wearable band” market, which Canalys defines as wearables that can’t run apps, is still led by Fitbit.

The up-and-comer in the non-smartwatch wearable market is Xiaomi, whose focus on the Chinese market and low price point have catapulted it into the spotlight. It has shipped more than a million Mi Bands, 103,000 of those on the first day. 

“Though the Mi Band is a lower-margin product than competing devices, Xiaomi entered the wearables market with a unique strategy, and its shipment volumes show how quickly a company can become a major force in a segment based solely on the size of the Chinese market,” analyst Jason Low said in a statement.

Canalys didn’t share the total shipment numbers for basic bands, but said 4.6 million smart bands shipped in 2014, only 720,000 of which were Android Wear. Of those, Motorola led the market with its Moto 360.  Samsung led the smart band segment overall, owing to the wide range of devices the company has available.

“‘Samsung has launched six devices in just 14 months, on different platforms and still leads the smart band market,” VP and principal analyst Chris Jones said in a statement. “But it has struggled to keep consumers engaged and must work hard to attract developers while it focuses on [operating system] Tizen for its wearables.”

Canalys predicts Apple’s entry into the market will blow up the category, and says the device’s battery life will be the main advantage over Android Wear to begin with.

“Apple made the right decisions with its WatchKit software development kit to maximize battery life for the platform, and the Apple Watch will offer leading energy efficiency,” analyst Daniel Matte said in a statement. “Android Wear will need to improve significantly in the future, and we believe it will do so.”


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Cheryl Palmer's curator insight, February 19, 2015 7:06 PM

WEARABLES - Market report summary on the current (Feb 2015) state of the wearables market with link to data source.  Useful to get insight into where major players are focusing their development dollars.