Healthcare and Technology news
39.4K views | +4 today
Follow
Healthcare and Technology news
Your new post is loading...
Your new post is loading...
Scoop.it!

Health risk assessments may benefit elderly

Health risk assessments may benefit elderly | Healthcare and Technology news | Scoop.it

When healthy elderly people fill out health risk questionnaires and get personalized counseling, they have better health behaviors and use more preventive care, according to a new study.


Eighteen percent of firms ask working-age employees to complete health risk assessments, but the use of these tools in older persons is relatively new, said lead author Andreas E. Stuck of University Hospital Bern in Switzerland.


The personal health risk assessments covered multiple potential risk factors relevant in old age, and participants received individualized feedback and health counseling, lasting two years, Stuck said.


“Thus, prevention in old age is likely effective, but only if risk assessment is combined with individualized counseling over an extended period of time,” Stuck told Reuters Health by email.


In his team’s study, conducted in Switzerland between 2000 and 2002, 874 healthy adults over age 65 filled out questionnaires and received individualized computer-generated feedback reports, which were also sent to their doctors.


Additionally, for two years, nurse counselors visited patients at home and called them every three to six months to reinforce what health behaviors they should be pursuing or preventive care they should be obtaining based on their individualized reports.


About 85 percent of those assigned to the health risk assessment group returned their questionnaires, the researchers reported in PLoS Medicine.


Counselors identified the most important risk factors for each person, and the interaction between risk factors was taken into account. For example, for a person with low physical activity who was having pain, the first step was to intervene on management of pain, then on physical activity, Stuck said.


At the end of two years, the researchers compared the risk assessment group to another 1,000 similar adults who did not get the questionnaires or counseling.


Seventy percent of those who completed the health-risk assessments were physically active and 66 percent had received a seasonal flu vaccine, compared to 62 percent and 59 percent of the comparison group, respectively.


Long-term outcomes like nursing home admission or functional status were not available, but the researchers estimated that almost 78 percent of the adults in the health risk assessment group were still alive after eight years, compared to almost 73 percent in the comparison group.


The health assessment, data entry and individualized feedback report takes patients about one hour to do and costs about $30, Stuck said, not including the cost of individualized counseling by the nurse counselor or a primary care physician.


Health risk assessment should be offered to all older people starting between age 60 and 65, he said.


“The authors report promising evidence that a complex intervention might improve longevity and functioning in older adults,” said Evan Mayo-Wilson of the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, who was not part of the new study.


“The team provided many services in addition to standard care, and we cannot tell if all of those services were important or if only certain activities would be necessary to achieve good outcomes,” Mayo-Wilson told Reuters Health by email.


But only half of the people assessed for the trial were enrolled, while many weren’t eligible or refused, and some who were assigned to the health risk assessments didn’t return their questionnaires or otherwise didn’t engage with the program, he noted.


“We should be cautious in interpreting the results of this study because previous studies found inconsistent effects of mortality and other health outcomes,” Mayo-Wilson said.

more...
No comment yet.
Scoop.it!

Google Glass Shown Beneficial for Bedside Toxicology Consults

Google Glass Shown Beneficial for Bedside Toxicology Consults | Healthcare and Technology news | Scoop.it

Although Google Glass may have been pulled as a product for the masses, Alphabet plans on continuing to develop the device for professional applications. And it’s certainly proving itself useful in medicine, as a new study in Journal of Medical Toxicology has shown that it’s useful and effective for tele-toxicology consults. The project involved emergency medicine residents who wore Glass during evaluations of poisoned patients while toxicology fellows and attendings in a remote location participated in the consults via a video connection. They essentially set back and reviewed the findings of the emergency docs, offering advice as necessary.


The study looked at how everyone involved accepted the use of the communication medium, as well as how it affected the care provided. Interestingly, the toxicologists changed their opinions of how to treat the patients in 56% of cases after using Glass. In six cases the antidote that was prescribed was accurately selected only after using Glass. In 11 of cases the connection was too poor for usability, but that can probably be attributed to the network used.

more...
Scoop.it!

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.

    more...
    No comment yet.
    Scoop.it!

    Medicare, Reversing Itself, Will Pay More for an Expensive New Cancer Drug

    Medicare, Reversing Itself, Will Pay More for an Expensive New Cancer Drug | Healthcare and Technology news | Scoop.it

    The Obama administration has decided that Medicare will pay for one of the newest, most expensive cancer medications, which costs about $178,000 for a standard course of treatment.

    Patients, doctors, hospital executives and insurers have expressed concern about the high cost of prescription drugs, especially new cancer medicines and treatments tailored to the genetic characteristics of individual patients. Medicare officials recognized the cost and value of one such product, the anticancer drug Blincyto, by agreeing to make additional payments for it starting Oct. 1. The drug is made by Amgen for patients with a particularly aggressive form of leukemia.

    The decision suggests a new willingness by Medicare to help pay for promising therapies that are still being evaluated. It is also significant because Medicare officials reversed themselves on every major scientific issue involved. After receiving pleas from Amgen and a dossier of scientific evidence, the officials agreed that the drug was a substantial improvement over existing treatments for some patients.

    At issue are special “add-on payments” that Medicare makes to hospitals for new technology whose costs are not yet reflected in the standard lump-sum amounts that hospitals receive for treating patients with a particular disease or disorder.

    In a preliminary decision in April, the Obama administration said it did not intend to pay extra for Blincyto because clinical studies were “not sufficient to demonstrate” that it substantially improved the treatment of Medicare patients with acute lymphoblastic leukemia, a cancer of the blood and bone marrow. Medicare officials said Amgen’s application was based on data from “a small sample group of patients whose age demographic is much younger than the age demographic of eligible Medicare beneficiaries.”

    But in a final rule to be published in the Federal Register on Aug. 17, the administration says it received “additional information and input” from Amgen and other experts and now agrees with their arguments.

    Blincyto “is not substantially similar” to other drugs available to leukemia patients, the administration said, and it “represents a substantial clinical improvement over existing treatment options.”

    Jane E. Wirth, 59, of Reno, Nev., a former preschool teacher, said her cancer was in remission after 28 days of treatment with Blincyto, also known as blinatumomab.

    “It was amazing to me that it could work so well so quickly,” Ms. Wirth said in an interview. “I had just spent a month going through standardchemotherapy, which did not make the cancer go away. It seemed so hopeless.”

    The drug, engineered from two antibodies, harnesses the body’s immune system to help fight cancer. It brings certain white blood cells close to malignant cells so the blood cells can destroy the cancer cells.

    Dr. Anthony S. Stein, a researcher at City of Hope National Medical Center in Duarte, Calif., who has treated more than 50 patients in clinical trials of Blincyto, said, “Its mechanism of action is totally different from that of any other approved drug.”

    After the Food and Drug Administration approved Blincyto in December, Amgen said the price would be about $178,000 for the recommended two 28-day cycles of treatment, each followed by a two-week break. Medicare says it will now allow a “new technology add-on payment” to hospitals for a fraction of that amount, up to $27,000. Actual payments will vary based on the length of a patient’s hospital stays.

    A cycle of treatment begins with intravenous infusions in a hospital. Patients typically continue treatments outside the hospital — at doctor’s offices, at infusion centers or at home, with the help of specially trained nurses — and Medicare will help pay for the drug at those sites, too.

    The prices of new cancer drugs often exceed $100,000 a year.

    Health policy experts said that President Obama had personally expressed concern in recent weeks about high drug prices and their impact on consumers and federal programs. In February, he asked Congress to authorize the secretary of health and human services to negotiate with manufacturers to determine prices for high-cost medicines taken by Medicare beneficiaries.

    poll by the Kaiser Family Foundation released last month found that 94 percent of Democrats and 84 percent of Republicans support allowing the federal government to negotiate with drug makers to get lower prices on medications for those beneficiaries.

    Dr. Steven M. Safyer, president of Montefiore Medical Center in the Bronx, said the Obama administration should use its influence with drug companies to restrain costs. “There are a number of very important breakthroughs with pharmaceuticals that can make a difference between life and death, and the price is too high,” he said.

    More than 100 oncologists from cancer hospitals around the country recently issued a manifesto decrying the prices of new drugs.

    “Effective new cancer therapies are being developed by pharmaceutical and biotechnology companies at a faster rate than ever before,” they said in a commentary in the journal Mayo Clinic Proceedings. But, they added, “the current pricing system is unsustainable and not affordable for many patients.”

    Robert E. Zirkelbach, a spokesman for Pharmaceutical Research and Manufacturers of America, the lobby for drug makers, said that new spending projections issued by the government in July undercut such claims.

    “Even with new treatments and cures for hepatitis C, high cholesterol and cancer,” Mr. Zirkelbach said, “spending on retail prescription medicines is projected to remain approximately 10 percent of U.S. health care spending through 2024, the same percentage as in 1960.” In the last two decades, he added, the cancer death rate has fallen 22 percent, thanks in part to new medicines.

    more...
    No comment yet.
    Scoop.it!

    IBM and Merge: Here We Go Again!

    IBM and Merge: Here We Go Again! | Healthcare and Technology news | Scoop.it

    Today’s announcement of IBM’s acquisition of Merge Healthcare might be called a deal changer.  In today’s rapidly changing healthcare environment, it would seem that merging IBM’s deep pockets and technological talent with Merge’s clinical technology and applications capabilities would be a good thing.  And, it may prove to be given the current environment. 


    On the other hand, this is déjà vu, as I have personally seen IBM try to play in the healthcare space several times before.  Years ago, IBM developed a product and attempted to be a player in the Radiology Information System (RIS) business.  Eventually it was sold off.  IBM teamed with GE in the early 80’s to integrate RIS and PACS (Picture Archive and Communication System), only to exit amidst the company’s financial woes in the early days of Lou Gerstner’s chairmanship. 


    There were also several failed attempts in the dictation/transcription business.  There was the IBM Executary line.  Then came the IBM VoiceType system.  And finally, there was IBM MedSpeak/Radiology, the first product to exploit IBM’s speech recognition technology.  Each time, IBM realized that the total medical market for such products could be measured in the thousands, not the hundreds of thousands of potential users.  In the end, IBM sold off these products on the basis of market dynamics versus disproportionate development and support costs.  It was unfortunate, as IBM had some of the best technology in the business!  Another part of the argument always was that IBM sold product to other healthcare vendors, and competing with them would jeopardize that business.


    So, will the past repeat itself?  Or, have IBM and the market changed enough to make this a winning proposition for IBM?  I would have to say, only time will tell.  But, 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.


    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 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, 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.


    Both IBM and Merge have sufficient technical expertise to make it work.  But, the glass is only half full.  Imaging informatics is a growing market, but it pales in comparison to the general healthcare IT market such as for EMR’s (Electronic Medical Record).  How well the market is willing to play with an IBM-Merge entity will be interesting to see.  Or, does IBM have more companies in its sights?  It’s ironic that an IBM spinoff (Lexmark) has positioned itself to be a formidable competitor in this space as well.  What will be the reaction of others such as HP and Dell that have had evolving healthcare strategies over the years?  IBM’s forays into the consumer market (remember the PC Junior or OS/2?) have not proven all that successful either. 


    Here’s hoping that IBM has evolved and learned from its past, and will find ways to make this one work!  As always your comments and perspective are welcome.

    more...
    No comment yet.
    Scoop.it!

    IBM Watson antes up $1B to buy Merge

    IBM Watson antes up $1B to buy Merge | Healthcare and Technology news | Scoop.it

    Continuing its shopping spree, IBM on Thursday announced that it will spend a cool $1 billion to acquire Merge Healthcare in a deal that will combine Merge's medical imaging technologies with IBM's Watson. 

    Watson will gain the ability to "see" by bringing together Watson's advanced image analytics and cognitive capabilities with data and images obtained from Merge Healthcare's medical imaging management platform, IBM executives said in announcing the deal.


    The intent, say IBM executives is to to unlock the value of medical images to help physicians make better patient care decisions.


    Merge is a public company, traded on NASDAQ as MRGE.

    Its technology platforms are used at more than 7,500 U.S. healthcare sites, as well as most of the world's leading clinicalresearch institutes and pharmaceutical firms to manage a growing body of medical images.


    As IBM execs see it, these organizations could use the Watson Health Cloud to surface new insights from a consolidated, patient-centric view of current and historical images, electronic health records, data from wearable devices and other related medical data, in a HIPAA-enabled environment.


    Under terms of the transaction, Merge shareholders would receive $7.13 per share in cash, for a total transaction value of $1 billion. The closing of the transaction is subject to regulatory review, Merge shareholder approval, and other customary closing conditions. It is expected to occur later this year.


    It is IBM's third major health-related acquisition – and the largest – since launching its Watson Health unit in April, following Phytel, a population health company and Explorys, a cloud-based intelligence firm.

    more...
    No comment yet.
    Scoop.it!

    NIH is asking for feedback on using smartphones and wearables to collect medical information

    NIH is asking for feedback on using smartphones and wearables to collect medical information | Healthcare and Technology news | Scoop.it

    The NIH is currently asking for pubic feedback on using smartphones and wearables to collect health and lifestyle data for its Precision Medicine Initiative — an initiative that hopes to collect data on more than 1 million individuals. The NIH’s Precision Medicine Initiative is described as:


    a bold new enterprise to revolutionize medicine and generate the scientific evidence needed to move the concept of precision medicine into every day clinical practice


    What exactly that means is a bit nebulous, but a New England Journal of Medicineperspective sheds some light:


    Ultimately, we will need to evaluate the most promising approaches in much larger numbers of people over longer periods. Toward this end, we envisage assembling over time a longitudinal “cohort” of 1 million or more Americans who have volunteered to participate in research.


    Qualified researchers from many organizations will, with appropriate protection of patient confidentiality, have access to the cohort’s data, so that the world’s brightest scientific and clinical minds can contribute insights and analysis.


    The NIH is specifically asking the following:


    • Willingness of participants to carry their smartphone and wear wireless sensor devices sufficiently throughout the day so researchers can assess their health and activities.
    • Willingness of participants without smartphones to upgrade to a smartphone at no expense.
    • How often people would be willing to let researchers collect data through devices without being an inconvenience.
    • The kind of information participants might like to receive back from researchers, and how often.
    • Other ways to conveniently collect information from participants apart from smart phones or wearable devices.


    It’s exciting to see the NIH see the potential of digital health. They specifically mention how smartphones and wearables can be utilized to collect a wide variety of data: location information, mobile questionnaires, heart rate, physical activity levels, and more.


    There is already a robust discussion taking place in the comments section at the NIH website, and we encourage our readers to contribute.

    more...
    Richard Platt's curator insight, July 30, 2015 7:37 PM

    The NIH is specifically asking the following:

    • Willingness of participants to carry their smartphone and wear wireless sensor devices sufficiently throughout the day so researchers can assess their health and activities.
    • Willingness of participants without smartphones to upgrade to a smartphone at no expense.
    • How often people would be willing to let researchers collect data through devices without being an inconvenience.
    • The kind of information participants might like to receive back from researchers, and how often.
    • Other ways to conveniently collect information from participants apart from smart phones or wearable devices.
    Lionel Reichardt / le Pharmageek's curator insight, July 31, 2015 1:31 AM

    The NIH is specifically asking the following:

    • Willingness of participants to carry their smartphone and wear wireless sensor devices sufficiently throughout the day so researchers can assess their health and activities.
    • Willingness of participants without smartphones to upgrade to a smartphone at no expense.
    • How often people would be willing to let researchers collect data through devices without being an inconvenience.
    • The kind of information participants might like to receive back from researchers, and how often.
    • Other ways to conveniently collect information from participants apart from smart phones or wearable devices.
    Heather Taylor's curator insight, August 31, 2015 10:33 PM

    #wearables #healthcare #wearabledevices

    Scoop.it!

    Pledges of $3.4 billion for Ebola recovery made at United Nations

    Pledges of $3.4 billion for Ebola recovery made at United Nations | Healthcare and Technology news | Scoop.it

     Some $3.4 billion in pledges were made at the United Nations on Friday to help Liberia, Sierra Leone and Guinea stamp out Ebola and begin rebuilding health systems and economies devastated by the worst outbreak on record of the deadly hemorrhagic fever.


    The United Nations had said that $3.2 billion was needed to support the three states' national recovery plans for the next two years. Liberia's President Ellen Johnson-Sirleaf had said $4 billion was needed to cover a separate sub-regional plan.


    Helen Clark, head of the U.N. Development Programme, said the preliminary tally of pledges on Friday took the total amount allocated so far for Ebola recovery to more than $5 billion, which she described as "a great start."


    Johnson-Sirleaf also again appealed for international donors to cancel debt owed by the West African nations.


    "The world as a whole has a great stake in how we together respond to this global threat," Johnson-Sirleaf told the pledging conference. "Diseases, just like terrorism, know no national boundaries."


    The Ebola outbreak, which began in Guinea in December 2013, has killed more than 11,200 people across West Africa. Ebola re-emerged in Liberia last week, nearly two months after it was declared free of the virus, while neighboring Guinea and Sierra Leone are still struggling to eliminate it.


    "The threat is never over until we rebuild the health sectors Ebola demolished, until we rebuild the livelihoods in agriculture that it compromised, until we shore up government revenues it dried up; and until we breathe life again into the private sector it has suffocated,"

    Sierra Leone's President Ernest Bai Koroma told the U.N. conference.


    Among the largest pledges were some $381 million from Britain, $266 million from the United States, $650 million from the World Bank, $220 million from Germany, $500 million from the European Union, $745 million from the African Development Bank and $360 million from the Islamic Development Bank.


    "We cannot yet breathe a sigh of relief. Instead, let us collectively take a deep breath and resolve to finish the job," U.N. Secretary-General Ban Ki-moon said earlier on Friday.

    more...
    No comment yet.
    Scoop.it!

    21st Century Cures Act Passes U.S. House of Representatives, Moves to Senate

    21st Century Cures Act Passes U.S. House of Representatives, Moves to Senate | Healthcare and Technology news | Scoop.it

    On Friday afternoon, July 10, the U.S. House of Representatives passed the 21st Century Cures Act, H.R. 6, by a vote of 344-77, sending it to the U.S. Senate. The main focus of the legislation is an attempt to remove regulatory roadblocks in the review process for new pharmaceuticals and medical devices on the part of the Food and Drug Administration (FDA). In addition, according to Congress.gov, the federal government’s official legislation tracking service, “Requirements are established [in the bill] for interoperability and certification of health information technology. Practices that discourage the exchange of electronic health information are prohibited.”


    After the House’s passage of the bill, the Ann Arbor, Mich.-based College of Healthcare Information Management Executives (CHIME) released a statement attributed to Leslie Krigstein, interim vice president of public policy, praising the bill’s focus on interoperability.  “The 21st Century Cures Act is a landmark piece of legislation that will move our nation closer to a 21st Century healthcare system,” Krigstein said in the statement. “As recognized in this bill, health information technology will serve as the foundation to foster many of the ideologies in delivering lifesaving cures to patients more rapidly.”


    Krigstein’s statement went on to say that “The Committee's choice to tackle the complex issue of interoperability is to be commended. Without nationwide interoperability, we will be unable to derive the value promised by the nation's $30 billion investment in electronic health records (EHRs). Expediting cures to patients will not be possible without a health information highway that allows providers and patients the data they need, when and where they need it.”


    Krigstein added that “CHIME appreciates the Committee's recognition that harmonizing standards adoption will exponentially move interoperability forward. We agree that clear, enforceable standards are necessary to foster nationwide interoperability. The inclusion of increased testing requirements for certified products, including 'real world' testing, is a priority for CHIME members as a means to bring value to the certification program. We appreciate the Committee's inclusion of the need to ensure the information in one's EHR belongs to the patient. We hope that this language will begin a sincere dialogue on the need to address the ongoing patient safety and care coordination challenges arbitrarily imposed by the lack of a national approach to patient identification. Without a patient identity matching strategy, patient data matching errors and mismatches will become exponentially more problematic and dangerous.”


    The CHIME statement concluded by stating that “We view this legislation as a starting point in the conversation on health IT reform. We hope to build on the language in 21st Century Cures Act to ensure the Meaningful Use Program, among other ongoing federal policy initiatives, enable the implementation and use of EHR systems to meaningfully improve patient care.”


    Additional praise for the House of Representatives’ passage of the bill came from the Charlotte-based Premier healthcare alliance. Attributed to Blair Childs, Premier’s senior vice president of public affairs, it said, “Members of the Premier healthcare alliance commend House leadership for the passage of new health information technology (HIT) interoperability requirements within the 21st Century Cures legislation that passed overwhelmingly today. Requiring free and secure exchange of health information among disparate IT assets will improve patient care, reduce costs, and unlock “big data” in healthcare.  This is also an essential ingredient in enabling providers to improve the health of a defined population health across the care continuum.” That statement concluded by stating that “We are encouraged by the Senate’s equal focus on achieving interoperability among EHR systems.”


    How did the legislation pass the House, and what are its chances in the Senate? Alex Lash, writing Friday in xconomy.com, wrote this: Passage in the House was due in no small part to the bill’s original sponsors, Reps. Diana DeGette (D-CO) (pictured) and Fred Upton (R-MI), whose work—appearances, town halls, info-gathering sessions—for more than a year leading up to the vote at times resembled a permanent campaign. But the Cures Act still must get through the Senate, where single opponents can often hold popular legislation hostage,” Lash noted. “And, despite the strong support in the House, critics are asking if the rush to approve new drugs might tilt away from traditional safeguardstoo much. Fiscal hawks will no doubt pick through the costs associated with the bill, as reported last month by the Congressional Budget Office.”

    more...
    No comment yet.
    Scoop.it!

    CVS Health quits U.S. Chamber of Commerce over tobacco stance

    CVS Health quits U.S. Chamber of Commerce over tobacco stance | Healthcare and Technology news | Scoop.it

    CVS Health Corp said it was withdrawing its membership from the U.S. Chamber of Commerce after media reports that the trade group was lobbying globally against anti-smoking laws.


    The No. 2 U.S. drugstore chain said it was "surprised" to read recent reports on the chamber's position on tobacco products outside the United States.


    The New York Times reported last week that the chamber and its foreign affiliates were lobbying against anti-smoking laws such as restrictions on smoking in public places and bans on menthol and slim cigarettes, mainly in developing countries. 


    "CVS's purpose is to help people on their path to better health, and we fundamentally believe tobacco use is in direct conflict with this purpose," CVS spokesman David Palombi said in an emailed statement on Tuesday.


    The chamber, however, said that it did not support smoking and it called the report "a concerted misinformation campaign."


    "... we support protecting the intellectual property and trademarks of all legal products in all industries and oppose singling out certain industries for discriminatory treatment," the trade group said in an email.


    CVS was the first major U.S. drugstore chain to stop selling tobacco products last year.

    more...
    No comment yet.
    Scoop.it!

    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.”

    more...
    No comment yet.
    Scoop.it!

    The Feminization of Health Care

    The Feminization of Health Care | Healthcare and Technology news | Scoop.it

    Historically, health care providers and health care leaders have been selected for and nurtured traits that are traditionally seen as “masculine” – traits such as heroism, independence, and competition. Yet it is clear that as people live longer with more complex conditions, the more traditionally “feminine” traits of interdependence, empathy, and networking become more important. Even in the most technically challenging health care event, the outcome for the patient is determined by a team.


    A successful outcome for surgery on a brain tumor requires the heroic hands of a neurosurgeon, along with the primary care diagnostician, the radiologist, nurses, physical and occupational therapists, oncologists, radiation oncologists, the spouse, children, home health aides, friends, neighbors, and the list goes on. It truly takes a village to create a healing environment around individuals with complex conditions.


    A lone hero is a lonely voice. A highly coordinated, synchronized team of participants working in concert with the goals, desires, and wishes of the patient and family create the symphony.


    A New Approach to Care


    This is what I mean by the feminization of health care – delivering care in more team-based ways characterized by collaboration and the use of social networks. This approach is in sharp contrast to the patriarchal, hierarchical model that is traditionally masculine.


    When doctors, nurses, medical assistants, and other valuable team members work in collaborative, interdisciplinary teams organized around a common goal we unleash the power of the group. We get a kind of infectious excitement to innovate and create change. The team-based care that is becoming the norm in the United States operates with outcomes in mind but is supported by a network – and a more balanced management style.


    Observation and experience during my more than 20 years as a physician reveal some well-defined patterns and trends. The traditional masculine, top-down hierarchical style of management is certainly employed by some women and, on the other side of the ledger, there are men who possess a team-based leadership approach. Yet in general, it has been my experience that the management styles of men and women as a whole are different.


    I have found that organizations with a hierarchical approach feel much more focused on compliance, and on the idea that people do things because they have to (because it’s what they are paid for) rather than because they want to (which connects with their sense of purpose). Despite the fact that a large majority of workers in health care are women, most mainstream health care organizations – like most large corporations – operate with this patriarchal mindset.


    Alignment with ACOs


    The feminization of health care is well-aligned with the trend toward Accountable Care Organizations and other team-based approaches. Creating an ACO, by definition, requires building an effective inter-professional, interdisciplinary team. And the team must be capable of caring for the patient from the clinic to rehabilitation to home – with all of the actors working together around the individual patient. The “lone-wolf” leadership style is counterproductive in this sort of setting.

    When doctors, nurses, medical assistants, and other valuable team members work in collaborative, interdisciplinary teams organized around a common goal we unleash the power of the group.


    The feminization trend is particularly evident in middle layers of management where there is rapid growth of a management style that is team-based, collaborative, interdependent, and helps people develop and perform as highly as possible. This has been happening throughout Kaiser Permanente where there are more women in leadership as chiefs of service, as physicians in chief, assistant physicians in chief, and hospital leaders.


    In addition, there are active social networks among interregional teams, using network-based learning to accelerate making care better for our members. In this model people come together as peers, organized around a common purpose rather than under a hierarchy.


    Glass Ceiling in Health Care


    While this trend is pervasive within middle management the news is less encouraging at the top. According to a report by Rock Health, women represent only 21 percent of executives and 21 percent of board members at Fortune 500 health care companies despite making up more than half the health care workforce.


    At senior management levels and in board rooms, leaders-as-heroes and leaders who drive results top-down remain highly valued. At these levels there is clearly greater comfort with authoritative rather than collaborative, servant leaders.


    I believe that greater balance in leadership and management styles can accelerate capitalizing on the benefits of the feminization of health care. If we are to transform health care in the United States we need to get “unstuck” from our reliance on the traditional models of leadership in our industry.


    Hierarchical models have moved us toward greater accountability for results. However, we are not going to manage our way out of our current health care crisis. We need to learn our way out, enabling disruptive thinking from a much larger set of contributors.


    We need to evolve our health care leadership both because the traditional hierarchical approach excludes many women and because, quite honestly, the method has not gotten us where we need to be. Adding in the “yin” to complement the “yang,” the feminine to the masculine can bring the benefits of balance, inclusion, and diversity to help transform the industry.


    Historically, health care providers and health care leaders have been selected for and nurtured traits that are traditionally seen as “masculine” – traits such as heroism, independence, and competition. Yet it is clear that as people live longer with more complex conditions, the more traditionally “feminine” traits of interdependence, empathy, and networking become more important. Even in the most technically challenging health care event, the outcome for the patient is determined by a team.

    A successful outcome for surgery on a brain tumor requires the heroic hands of a neurosurgeon, along with the primary care diagnostician, the radiologist, nurses, physical and occupational therapists, oncologists, radiation oncologists, the spouse, children, home health aides, friends, neighbors, and the list goes on. It truly takes a village to create a healing environment around individuals with complex conditions.

    A lone hero is a lonely voice. A highly coordinated, synchronized team of participants working in concert with the goals, desires, and wishes of the patient and family create the symphony.


    A New Approach to Care


    This is what I mean by the feminization of health care – delivering care in more team-based ways characterized by collaboration and the use of social networks. This approach is in sharp contrast to the patriarchal, hierarchical model that is traditionally masculine.

    When doctors, nurses, medical assistants, and other valuable team members work in collaborative, interdisciplinary teams organized around a common goal we unleash the power of the group. We get a kind of infectious excitement to innovate and create change. The team-based care that is becoming the norm in the United States operates with outcomes in mind but is supported by a network – and a more balanced management style.

    Observation and experience during my more than 20 years as a physician reveal some well-defined patterns and trends. The traditional masculine, top-down hierarchical style of management is certainly employed by some women and, on the other side of the ledger, there are men who possess a team-based leadership approach. Yet in general, it has been my experience that the management styles of men and women as a whole are different.

    I have found that organizations with a hierarchical approach feel much more focused on compliance, and on the idea that people do things because they have to (because it’s what they are paid for) rather than because they want to (which connects with their sense of purpose). Despite the fact that a large majority of workers in health care are women, most mainstream health care organizations – like most large corporations – operate with this patriarchal mindset.

    Alignment with ACOs


    The feminization of health care is well-aligned with the trend toward Accountable Care Organizations and other team-based approaches. Creating an ACO, by definition, requires building an effective inter-professional, interdisciplinary team. And the team must be capable of caring for the patient from the clinic to rehabilitation to home – with all of the actors working together around the individual patient. The “lone-wolf” leadership style is counterproductive in this sort of setting.

    When doctors, nurses, medical assistants, and other valuable team members work in collaborative, interdisciplinary teams organized around a common goal we unleash the power of the group.

    The feminization trend is particularly evident in middle layers of management where there is rapid growth of a management style that is team-based, collaborative, interdependent, and helps people develop and perform as highly as possible. This has been happening throughout Kaiser Permanente where there are more women in leadership as chiefs of service, as physicians in chief, assistant physicians in chief, and hospital leaders.

    In addition, there are active social networks among interregional teams, using network-based learning to accelerate making care better for our members. In this model people come together as peers, organized around a common purpose rather than under a hierarchy.

    Glass Ceiling in Health Care


    While this trend is pervasive within middle management the news is less encouraging at the top. According to a report by Rock Health, women represent only 21 percent of executives and 21 percent of board members at Fortune 500 health care companies despite making up more than half the health care workforce.


    At senior management levels and in board rooms, leaders-as-heroes and leaders who drive results top-down remain highly valued. At these levels there is clearly greater comfort with authoritative rather than collaborative, servant leaders.

    I believe that greater balance in leadership and management styles can accelerate capitalizing on the benefits of the feminization of health care. If we are to transform health care in the United States we need to get “unstuck” from our reliance on the traditional models of leadership in our industry.

    Hierarchical models have moved us toward greater accountability for results. However, we are not going to manage our way out of our current health care crisis. We need to learn our way out, enabling disruptive thinking from a much larger set of contributors.

    We need to evolve our health care leadership both because the traditional hierarchical approach excludes many women and because, quite honestly, the method has not gotten us where we need to be. Adding in the “yin” to complement the “yang,” the feminine to the masculine can bring the benefits of balance, inclusion, and diversity to help transform the industry.

    more...
    No comment yet.
    Scoop.it!

    Americans' Risk of Dying From Cancer Is Falling, CDC Finds

    Americans' Risk of Dying From Cancer Is Falling, CDC Finds | Healthcare and Technology news | Scoop.it

    The risk that any one American will die from cancer -- thecancer death rate -- is going down, regardless of sex or race, a new government study reports.

    However, because the United States has a growing aging population, the overall number of people dying from cancer is on the rise, officials from the U.S. Centers for Disease Control and Prevention reported.

    "While we are making progress in reducing cancer death rates, we still have real work to do to reduce cancer deaths among our aging population," said lead researcher Mary White, a scientist in the CDC's division of cancer prevention and control.

    Between 2007 and 2020, cancer deaths are expected to rise more than 10 percent among men and black women, the report found. Among white women, the number of cancer deaths will start to stabilize, increasing less than 5 percent during this period, according to the CDC researchers.

    "Further declines in cancer deaths might be achieved if we can reach other national targets for addressing risk factors," White said.

    These include cutting exposure to tobacco and UV radiation, increasing cancer screening for early detection, and improving access to health care to increase early treatment and survival, she said.

    White said that a decline in cancer death rates -- even as the actual number of cancer deaths rises -- is not a paradox.

    "Death rates are calculated by dividing the number of cancer deaths by the number of people in the population," she explained.

    The number of older adults continues to grow, White explained. "Because death rates for many cancers increase with age, the number of people who die from cancer is also predicted to grow, even while death rates decline," she said.

    Dr. David Katz, director of the Yale University Prevention Research Center in New Haven, Conn., agreed that reducing cancer deaths and reducing cancer are not the same.

    "Cancer death rates are declining markedly, which is excellent news and testimony to the power of early detection and improving treatments," said Katz, who was not involved with the study.

    And Dr. Rich Wender, the chief cancer control officer at the American Cancer Society, said, "We have made substantial progress for many of the common adult cancers. The key to that progress is applying research about how to prevent cancer, how to detect it early and treat it effectively."

    According to the study findings, between 1975 and 2009, the number of cancer deaths increased 45.5 percent among white men, 56 percent among white women, 53 percent among black men and 98 percent among black women.

    These increases are primarily attributed to an aging white population and an increasing black population, White said. This pattern is likely to continue, she added.

    The government's Healthy People 2020 initiative set a goal of reducing the rate of cancer deaths by 10 to 15 percent for some cancers by 2020. This target was met for prostate cancer in 2010, the study authors said.

    Researchers expect to meet the goal for breast, cervix, colon and rectum, lung and bronchus cancers in 2015. The death rates for cancers of the oral cavity and pharynx seem to be stabilizing, the report said.

    However, the goal for melanoma is not expected to be achieved. "It's discouraging to find out that we aren't reducing deaths from melanoma, the most deadly form of skin cancer," White said.

    "We know that most cases of melanoma are preventable," she said. "To lower your skin cancer risk, protect your skin from the sun and avoid indoor tanning."

    White suggested the people can lower their own risk of dying from cancer by learning about screening tests and other steps they can take to prevent cancer.

    "While we have seen improvements to lower cancer deaths, everyone can learn about screening tests and the cancer prevention steps that are right for them," she said.

    Katz pointed out that "back in 1981, researchers first highlighted the substantial preventability of cancer by changing one's lifestyle. Most authorities remain convinced that 30 to 60 percent of cancers could be prevented by avoiding tobacco, having a healthy diet, routine activity and weight control."

    more...
    No comment yet.
    Scoop.it!

    Readmissions Penalties Get Very, Very Real

    Readmissions Penalties Get Very, Very Real | Healthcare and Technology news | Scoop.it

    It was quite bracing to read the August 3 Kaiser Health News report entitled “Half of Nation’s Hospitals Fail Again to Escape Medicare’s Readmission Penalties.” As Jordan Rau wrote in the article, “Once again, the majority of the nation’s hospitals are being penalized by Medicare for having patients frequently return within a month of discharge—this time losing a combined $420 million, government records show. In the fourth year of federal readmission penalties,” Rau reported, “2,592 hospitals will receive lower payments for every Medicare patient that stays in the hospital—readmitted or not –starting in October. The Hospital Readmissions Reduction Program, created by the Affordable Care Act, was designed to make hospitals pay closer attention to what happens to their patients after they get discharged. Since the fines began,” he added, “national readmission rates have dropped, but roughly one of every five Medicare patients sent to the hospital ends up returning within a month.”


    What’s more, Rau noted, “Some hospitals view the punishments as unfair because they can lose money even if they had fewer readmissions than they did in previous years. All but 209 of the hospitals penalized in this round were also punished last year, a Kaiser Health News analysis of the records found.”


    As hospital executives already know, the fines for failure to meet the criteria of the Centers for Medicare & Medicaid Services (CMS) focus on five conditions: heart attack, congestive heart failure, pneumonia, chronic obstructive pulmonary disease (COPD), as well as elective hip and knee replacements, and are based on readmissions between July 2011 and June 2014.


    And these reimbursement cuts are everywhere—indeed, the penalties will be assessed on hospitals in every state except for Maryland, as that state has a special payment arrangement with Medicare. And the cuts will affect three-quarters or more of hospitals in the following states: Alabama, Connecticut, Florida, Massachusetts, New Jersey, New York, Rhode Island, South Carolina, Virginia, and the District of Columbia.


    What’s more, the readmissions-driven reimbursement cuts are hitting hospitals on top of cuts coming out of the mandatory value-based purchasing program and the mandatory healthcare-acquired conditions (mostly hospital-acquired infections) program.


     Meanwhile, the average penalties by state are being found to vary tremendously. Nationwide, 54 percent of hospitals (2,592 organizations) are being penalized, with an average Medicare pay cut of 0.61 percent. But those nationwide averages encompass huge variations. On one end of the spectrum, in North Dakota, where only three hospitals, or seven percent of the state’s hospital organizations, are being penalized this year, the average penalty is just 0.14 percent of Medicare payments. But in Kentucky, where 62 organizations, representing 65 percent of the state’s hospitals, are being penalized, the average penalty amounts to a full 1.19 percent of Medicare revenues—that’s an 850-percent spread.


    And as everyone knows, many not-for-profit community hospitals in the U.S. are surviving on operating margins of between 1 and 3 percent; and for those with a majority of their revenues coming from Medicare reimbursement, a penalty of more than 1 percent could potentially be devastating.


    Five years ago when the U.S. Congress passed he Affordable Care Act, and President Obama signed it, I predicted that the mandatory readmissions program would be one of the healthcare system reform provisions in the ACA that would be one of its most impactful; and it already has been. As we all know, ten years ago, if you were talk walk into the office of the average CFO in the average inpatient hospital in the U.S. and were to ask that CFO what her/his hospital’s average 30-day readmissions rates were for patients with documented congestive heart failure, diabetes, or COPD (chronic obstructive pulmonary disease), s/he could likely not have told you. Now, that CFO needs to know that number—and needs to be working with all levels and disciplines of leadership in her/his hospital to reduce that number.


    What’s more, private health insurers are absolutely moving forward to implement similar programs in their hospital contracts, since, as is nearly always the case with such things, once the Medicare program, the U.S. healthcare system’s proverbial 800-pound gorilla, moves forward in an area, all the major private health insurers quickly follow Medicare’s lead and design their own versions of the same initiative.


    Industry experts have long noted that many, if not most, readmissions that occur within 30 days are relatively easily predicted. Research, and the experiences of pioneering hospital organizations, have found that the key gaps in this area have to do with care management on multiple levels—ensuring effective discharge planning, including really robust patient and family member education; and then, very importantly, case manager/care manager nurse follow-up with the discharged patient in a day or two at most following discharge, via phone communication, which must involve the scheduling of a follow-up primary care physician appointment; and then of course, that follow-up PCP visit, along with further coaching, education, and care management.


    And all of those processes must be strategically directed, excellently executed, and very strongly facilitated by robust information systems run by hospital and health system leaders with commitment to strategic goals and to success over long periods of time and across large groups of patients. Now, clearly, the leaders of many patient care organizations are moving forward with alacrity to develop accountable care organizations (ACOs), either under the aegis of one of Medicare’s ACO programs, or in collaboration with private health plans; as well as implementing population health management programs, and developing patient-centered medical homes.


    But here’s the thing about the Medicare readmissions reduction program: because it’s mandatory, it is forcing action on the part of every hospital that receives regular Medicare payment, regardless of whether or not that hospital is also pursuing ACO, population health, or PCMH strategies, or not.


    So the same “blessed cycle” of performance improvement is called for on the part of all regular U.S. hospitals receiving Medicare reimbursement, at this point. And that means creating really good data collection and reporting mechanisms, reporting the data, developing continuous clinical performance improvement processes to reduce predictable 30-day readmissions, making those improvements, and continuously sharing with clinicians, clinician leaders, and administrative executives and managers the ongoing results of those efforts, for further improvement work.


    In other words, we’re talking about a continuous learning system in U.S. healthcare. And guess what? It’s no longer optional.

    The reality is that healthcare IT leaders are playing and will continue to play, an extremely important role in all of this work; indeed, their contributions will be vital to success, at the data and information level, the process improvement level, and the strategic level, organization-wide. The one thing that neither healthcare IT leaders nor any other leaders can do is to sit any longer in denial about what is happening. Because, along with the mandatory value-based purchasing program under Medicare, and to a lesser extent as well, the mandatory healthcare-acquired conditions reduction program under Medicare, continuous clinical performance improvement is in effect now a core component of federal policy.


    In other words, folks, this is happening.


    The good news is that leaders at the most pioneering hospitals and health systems are lighting the way for others to follow. The bad news is that anyone waiting for further “clarity” on all this is going to be waiting so long as to potentially endanger the future of their hospital organization. So as the readmissions reduction program under Medicare—and inevitably under many, if not most, private health insurers as well—expands and ramps up, it will be incumbent on healthcare IT leaders and on all healthcare leaders to get ahead of the curve, because the penalties are only going to get more and more real—and won’t ever be reversing.

    more...
    Scoop.it!

    7 ways physicians can improve health care quality

    7 ways physicians can improve health care quality | Healthcare and Technology news | Scoop.it

    Patients want to receive health care that is of the highest quality. Physicians want to provide it. But what is “high-quality health care?” On that, few agree.


    Ask most Americans and they’re unsure where to find it. They know they want to be kept healthy, have rapid access to personalized care whenever they need it and be charged only what they can afford.

    Ask the leaders of the national medical and surgical societies, and they are likely to define quality as having access to the latest — and often the most richly reimbursed — procedures, diagnostic imaging, and genetic testing.

    Ask physicians themselves and, well, they’re already overwhelmed by the exponential growth in clinical measures of quality developed for public and private pay-for-performance formulas.


    Even so, medicine is coming closer to a definition of high-quality health care — and also to a system for evaluating how physicians and medical groups perform. The Institute of Medicine (IOM), a highly regarded independent organization established by Congress to advise on health care issues — the gold standard on improving our nation’s health – recently released a report: “Vital Signs: Core Metrics for Health and Health Care Progress.”


    The IOM panel of experts identified 15 measures, narrowed down from hundreds, with the best potential for improving health, including reducing the overall rate of preventable deaths.The consensus: If the U.S. systematically raises its performance in each of these 15 domains, the quality of life for millions would improve dramatically.


    This IOM report is important, even though it received surprisingly scant media attention. It should serve as a starting point and a road map about how clinical practice can most effectively lift the quality of care delivered to patients.

    But let me come back to the report itself in a minute.


    The quality conundrum


    A little context about the issue of quality might help here. At last count, the number of health care quality measures in place was in the thousands. The Joint Commission has 57 just for inpatient care at hospitals. The Healthcare Effectiveness Data and Information Set has about 81. The National Quality Forum currently endorses more than 630. The Centers for Medicare & Medicaid Services has no fewer than about 1,700.


    That may explain why keeping track is such a challenge for all parties involved.


    Perceptions of quality are of course subjective. According to the Merriam-Webster Dictionary, quality is “how good or bad something is; a characteristic or feature that someone or something has; a high level of value or excellence.” The Oxford Dictionary says quality is “the standard of something as measured against other things of a similar kind; the degree of excellence of something” It cites this example: “The hospital ranks in the top tier in quality of care.”


    The upshot here is a paradox: a definition that is itself ill-defined – and as such, leaves plenty of uncertainty and doubt.


    7 actions physicians can take


    That’s why the IOM report is so valuable and welcome. It cites 15 “vital signs,” but let’s focus on the seven that relate to direct health care delivery and better care for patients.


    1. Overweight and obesity. Physicians should help their patients exercise regularly, eat a healthy diet and maintain their weight within a normal range. More than two-thirds of Americans are overweight or obese. Specifically, physicians can make diet and weight management a vital sign and counsel every patient on the options available.


    2. Addictive behaviors. Eliminating smoking and alcohol abuse, along with reducing the percentage of people who are overweight, would dramatically lower the incidence of diabetes, lung cancer, and cardiovascular disease. Physicians should engage and educate patients about approaches to take to quit smoking and alcohol abuse, and provide advice and resources toward that end. Today, addiction to nicotine, alcohol, opiates and other psychoactive drugs continues at unacceptably high rates.


    3. Preventive services. Physicians should urge patients to take the recommended screening tests and stay current on their vaccinations. Preventive screenings alone could dramatically lower the risk of dying from cancer, heart disease, and strokes.


    Combining this with smoking cessation and exercise could help avoid 200,000 heart attacks and strokes in the U.S. each year, and reduce the mortality from cancer by tens of thousands yearly, based on an internal analysis done by The Permanente Medical Group’s Division of Research.


    Screen for colon cancer in fewer than 50 percent of patients, rather than in 80 percent to 90 percent, and you double the chances of dying from an invasive adenocarcinoma. Smoke at the national average of 18 percent, rather than at under 10 percent, and you dramatically increase lung cancer, emphysema, and heart attacks.


    Preventive services present a valuable opportunity for both improving health and reducing health expenditures.


    4. Patient safety. Physicians and nurses can, through rigorous practice, help patients avoid hospital-acquired infections, pressure ulcers, medication errors and wrong-site surgery. Even a decade after the 1999 IOM report, “To Err is Human” — with its estimate that 100,000 patients die each year from medical errors, the equivalent of a jetliner crashing each day — these so called “never events” still occur too frequently.


    And when patients develop infections like sepsis, or suffer an adverse drug reaction, they face a higher chance of dying in the hospital, and experiencing problems long after hospital discharge. Avoiding harm has been a core value of the medical profession from the time of Hippocrates, and is “first among equals” when it comes to the principal responsibilities of the health care system. Yet medical errors with adverse outcomes are still far too common.


    5. Unintended pregnancy. Physicians should take the opportunity to focus on ensuring the health of an expectant mother in order to increase the chances for a healthy baby and safe delivery, whether a pregnancy is unintended or the result of careful planning.


    An estimated 50 percent of pregnancies in the US are unplanned, and occur in women across the spectrum of child-bearing years, and among women in every socioeconomic demographic. Unintended pregnancy results from social, behavioral, cultural, and health factors, including — and perhaps most especially — women’s lack of knowledge about and access to tools for family planning.


    Research has demonstrated that medical care soon after conception is critical, and identified ways to reduce the risks of a maternal or fetal complication. Good nutrition, along with avoidance of drugs, alcohol and cigarette smoke, are essential. After birth, comprehensive medical care and early diagnosis of problems can prevent longer-term health problems and future complications.


    6. Access to care. Access to health care is one of the most powerful determinants of clinical outcomes. The ability to access care when needed is a vital precondition for a high-quality health system.

    Physicians in integrated, multi-specialty practices have advantages in ensuring patients get all the care needed thanks to comprehensive electronic health records. But in today’s fragmented health care system, with close to 15 percent of the population still uninsured, health care still remains beyond the reach of all too many Americans. Policy makers are relentlessly pursuing affordable access.


    7. Evidence-based care. Physicians should see to it that patients receive medical care based on the most current scientific evidence for what is appropriate and effective, rather than on an anecdote or an “in my experience” approach. Physicians working in hospitals with electronic health records can do so, deciding about care according to scientifically validated protocols for complex problems like heart attacks, strokes, and hip fractures.


    In the not-too-distant past, when physicians lacked many of the current diagnostic tools and access to sophisticated information technology, medical practice was far more art than science.


    Even today, variation in how physicians treat patients with the same problem is unwarranted, and leads to system-wide under performance and less-than-optimal clinical outcomes.


    Fortunately, medical practice today is far more science than art.


    What patients should do


    The best quality, then, according to the IOM, is not based on using a robot, providing transplantation or completing genetic sequencing. The reality is that, contrary to what some might assume, these often advertised technologies have minimal impact on mortality.


    And quality is not a result of individual technical excellence in performing procedures such as heart surgery, neurosurgery or hip replacement surgery. The variation from surgeon to surgeon is far less than people assume. In fact, many health care experts now perceive overuse of these high-intensity surgical interventions to be a problem that sometimes results in associated complications and minimal improvements in clinical outcomes.


    The list, in short, is more practical than exotic or “sexy,” offering the interventions which have the greatest impact on human life.

    The IOM committee concluded that leadership “at nearly every level of the health care system” will be required to adopt, implement, refine and maintain these core measures. And among the many stakeholders, physician leadership will be key.


    Patients should make health choices based on these 15 vital signs from the IOM. They enable people to distinguish the most important quality measures from all the “noise” about what are the newest and most exotic tools and approaches available. More specifically, patients would be wise to select a personal physician or medical group whose practice philosophy incorporates these approaches — and whose clinical results in each area are superior.


    We physicians are obligated to heed the IOM recommendations on behalf of our patients, the better to fulfill health care’s promise of easing suffering and extending lives. This is where American health care should invest its efforts. The IOM is a gift to both physicians and patients. Taking our eyes off what will most impact the health of all would be a mistake our nation can ill afford.

    more...
    No comment yet.
    Scoop.it!

    Health insurers working the system to pad their profits

    Health insurers working the system to pad their profits | Healthcare and Technology news | Scoop.it

    One of the reasons the health insurance industry worked behind the scenes in 2009 and 2010 to derail Obamacare was the fear that changes mandated by the law would cut their Medicare Advantage profits. Medicare Advantage plans are federally funded but privately run alternatives to traditional fee-for-service Medicare. 

    Although the industry’s biggest trade group, America’s Health Insurance Plans, said repeatedly that insurers supported Obamacare, the group was secretly financing the U.S. Chamber of Commerce’s TV campaign against reform. Among the companies most concerned about the law were those benefiting from overpayments the federal government had been making to their Medicare Advantage plans since George W. Bush was in the White House.  


    Bush and other Republicans saw the Medicare Advantage program as a way to incrementally privatize Medicare. To entice insurers to participate in the program, the federal government devised a payment scheme that resulted in taxpayers paying far more for people enrolled in the Medicare Advantage plans than those who remained in the traditional program. The extra cash enables insurers to offer benefits traditional Medicare doesn’t, like coverage for glasses and hearing aids, and to cap enrollees’ out-of-pocket expenses.


    When the Affordable Care Act became law in 2010, the payments to Medicare Advantage plans exceeded traditional Medicare payments by 14 percent. To end what they considered an unfair advantage for private insurers, and to reduce overall spending on Medicare, Democrats who wrote the reform law included language to gradually eliminate the over-payments.  So far, the 14 percent disparity has been reduced to 2 percent.  The final reductions are scheduled to be made next year.


    Despite that decrease, the fears by Republicans and insurance company executives that the reductions would lead to a steady decline in Medicare Advantage enrollees have proved to be completely unfounded. In fact, the plans have continued to grow at a fast clip.

    In March 2010, the month Obamacare became law, 11.1 million people were enrolled in Medicare Advantage plans—one of every four people eligible for Medicare. That was an increase from the 10.5 million Medicare Advantage enrollees in March 2009. Since then, Medicare Advantage membership has grown by more than 8 percent annually. Now 17.3 million—one in three people eligible for Medicare—are enrolled in private plans.


    As Center for Public Integrity senior reporter Fred Schulte has written over the past year, many insurers have discovered that even though the overpayments are being reduced, they can boost profits another way: by manipulating a provision of a 2003 law that allows them to get additional cash for enrollees deemed to be sicker than average.


    A risk-coding program was put in place by the government primarily because insurers were targeting their marketing efforts to attract younger and healthier—and thus cheaper— beneficiaries. Under the risk-coding program, insurers are paid more to cover patients who are older and sicker; the idea was to encourage the firms to cover those folks by offering a financial incentive. They get more money, for example, to cover someone with a history of heart disease than they do for someone with no such risk.  Last week Schulte uncovered whistleblower accusations that a medical consulting firm and more than two dozen Medicare Advantage plans have been ripping taxpayers off by conducting in-home patient exams that allegedly overstated how much the plans should be paid.

    more...
    Ketty Mishra's curator insight, September 2, 2015 12:19 PM

    Great content speech

    chance to inccrease height

    Ketty Mishra's curator insight, September 16, 2015 11:38 AM

    Best Blog give me you link i will add

    http://fairlookprice.blogspot.in/2015/09/post-7-fairness-fair-look-cream-for.html

    Scoop.it!

    What Obama's precision medicine plan needs to succeed

    What Obama's precision medicine plan needs to succeed | Healthcare and Technology news | Scoop.it

    President Obama's Precision Medicine Initiative to accelerate understanding of individual variability and its effect on disease and treatment is going to necessitate a regulatory system robust enough to facilitate big data analytics for genomics research – no small feat.


    That's according to a white paper by the Center for Data Innovation and Health IT Now Coalition, in which the authors contend that to be maximally effective this initiative will require the public and private sectors to work in tandem to realize the next generation of medicine and overcome the institutional challenges that increasingly hinder progress.


    Policymakers, in other words, must modernize the regulatory system. To that end, the authors recommend the following:


    1. Improve interoperability and data sharing. Stronger federal requirements are needed to ensure that genomic and other health data can be retrieved and compared across health record systems


    2. Engage patients. The public and private sectors share an interest in raising the tone of discourse on the role that genomics and other big-data applications might play in revolutionizing our expensive and underperforming health system


    3. Re-think privacy law. The strict privacy requirements of the Health Information Portability and Accountability Act and complementary federal and state laws, including the Common Rule, present formidable obstacles to realizing the potential of genomic medicine


    President Obama included $215 million in his latest budget to fund initiatives at the National Institutes of Health, the National Cancer Institute, the Food and Drug Administration, and the Office of the National Coordinator for Health Information Technology.

    more...
    No comment yet.
    Scoop.it!

    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.

    more...
    No comment yet.
    Scoop.it!

    Do doctors really hate Obamacare?

    Do doctors really hate Obamacare? | Healthcare and Technology news | Scoop.it

    Anti-Obamacare critics often claim that “every” physician they know hates Obamacare. For instance, pediatric neurosurgeon and GOP Presidential candidate Dr. Ben Carsontold Fox News that “he’s spoken to hundreds of doctors throughout the country about the Affordable Care Act, and not one of them ‘liked’ President Barack Obama’s signature health care law.”

    Doctors hate Obamacare, it’s alleged, because it authorizes government to “control” the practice of medicine and impose “rationing” of care, thereby harming patients.  The conservative Examiner website quotes a New Jersey family physician, Dr. John Tedeschi as saying, “Just as a guitar string has to be tuned, so does a person’s health to get the right tone. The government has taken away, or refocused the intelligence part of the tuning, and has just about destroyed the creative, or compassion component. Now, with Obamacare, we are left with an incompetent mechanism that does not have the best interest of the patient in mind.”  An ER physician quoted in the articles said that the “storm of patients [created by Obamacare] means when they can’t get in to see a primary care physician, even more people will end up with me in the emergency room.”

    There is no question that some doctors (mainly conservatives) hate Obamacare, and if they were the only ones you talked to (like the ones who apparently talked to Dr. Carson), you might think that all doctors feel the same way. But the reality is that — surprise, surprise! — primary care physicians’ views are just like the rest of us, split by their partisan leanings.


    A new survey by the respected Kaiser Family Foundation found that 87 percent of Democratic-leaning physicians view Obamacare favorably, while the exact same percentage of GOP-leaning physicians view it unfavorably. Independent doctors split 58 percent unfavorable to 42 percent favorable.  Because there were more GOP and independent physicians among the survey respondents, the overall breakdown of primary care physicians’ views on the ACA is  52 percent unfavorable to 48 percent favorable.  Yet only 26 percent of all primary care physicians viewed the law “very unfavorably. “  So it might be said that just one out of four primary care physicians “hate” Obamacare.

    And a deeper dive into the survey results directly refutes the contention of anti-Obamacare doctors that the law is leading to poorer quality, physicians turning away patients, or longer waits for appointments:


    • Most primary care physicians say that quality has stayed the same: 59 percent said that their ability to provide high-quality care to their patients has stayed about the same, while 20 percent said it has improved, and 20 percent said it has gotten worse.
    • More primary care physicians report that Medicaid expansion has had a more positive impact on quality than a negative one: “When asked more specifically about the expansion of Medicaid under the ACA, nearly four of 10 providers (36 percent of physicians and 39 percent of nurse practitioners and physician assistants) said the expansion has had a positive impact on providers’ ability to provide quality care to their patients. About two of 10 said it has had a negative impact, and the remainder said it has not made a difference, or they are not sure.”
    • Ease of getting same-day appointments is about the same as before the ACA: “Overall, about four of 10 primary care providers said almost all their patients who request a same- or next-day appointment can get one; another quarter said most of their patients can get such appointments” which is largely unchanged from 2009 and 2012.
    • Most continue to accept new patients: “A large majority of primary care providers (83 percent of physicians, 93 percent of midlevel clinicians) said they are currently accepting new patients . . . A survey conducted in late 2011 through early 2012 found that 89 percent of primary care physicians were accepting new patients and 52 percent were accepting new Medicaid patients.  This indicates that while physicians’ rates of accepting new patients overall may have declined slightly since the ACA coverage expansions went into effect, acceptance rates for Medicaid have remained about the same.”


    When asked specifically about their views on the impact of the Affordable Care Act on five dimensions, the ACA fared well, with one exception (costs to patients).


    • Access to health care and insurance in the country overall: 48 percent positive, 12 percent no impact,  24 percent negative, and 14 percent not sure.
    • Overall impact on practice: 31 percent reported no impact, 23 percent a positive  impact, 36 percent negative  and 9 percent not sure.
    • Quality of care their patients receive: 50 percent reported no impact, 18 percent positive, 25 percent negative, and 6 percent not sure.
    • Ability of the practice to meet patient demand: 44 percent no impact, 18 percent positive, 25 percent negative, and 10 percent not sure.
    • Cost of health care for their patients: 17 percent no impact, 21 percent positive, 44 percent negative, and 16 percent not sure.


    However, “physicians’ responses to questions that mention the ACA by name are deeply divided along party lines. For example, by a three-to-one margin, physicians who identify as Democrats are more likely to say the ACA has had a positive (44 percent) rather than a negative (15 percent) impact on their medical practice overall. Republican physicians break in the opposite direction by about seven-to-one (57 percent negative, 8 percent positive).”

    The survey also does not support the contention that the ACA is contributing to primary care physician dissatisfaction with practice and burn-out:


    “Even though providers with different political affiliations do not share views about the Affordable Care Act, a large majority of primary care providers (83 percent of physicians and 93 percent of nurse practitioners and physician assistants) — both Republicans and Democrats — reported they are very or somewhat satisfied with their medical practice overall. The changing environment does not appear to be affecting overall provider satisfaction even among providers who see a larger share of Medicaid patients or work in Medicaid expansion states. Indeed, current satisfaction levels are slightly higher than what was reported by primary care physicians before the ACA. In 2012, 68 percent of primary care physicians reported they were very satisfied or satisfied with practicing medicine.”


    Interestingly, Democratic physicians (56 percent) are more likely to recommend a career in primary care than Republicans (39 percent)  or Independents (40 percent).


    I know that many conservative primary care doctors have a strong and principled objection to Obamacare, believing  passionately that it gives the government too much power and the physicians, and their patients will be hurt as a result.  I (and ACP) may not agree with them, but I respect their views, and their right to make their case to their colleagues and to the public.


    But the Kaiser Family Foundation survey shows us that the anti-Obamacare doctors do not represent the views and experience of most primary care doctors on the front lines, never mind “all” of them.  Doctors (at least those in primary care, who knows about surgeons?) clearly don’t “hate” Obamacare.  Rather, more of them see Obamacare as doing some good things, like improving access; and doing not as well on other things, like lowering costs to patients.  Much of what they do and see in their practices remains unchanged by it, for good or bad.


    And that strikes me about right, Obamacare is making many things better, but there is a lot more that needs to be done to improve quality and access, lower costs to patients, and sustain and support primary care.  Of course, such nuances do not make for as good a headline or political talking point as “Doctors Hate Obamacare.”

    more...
    No comment yet.
    Scoop.it!

    The Hidden Side of Health Care: How Rural Pennsylvania Is Facing and Overcoming Obstacles

    The Hidden Side of Health Care: How Rural Pennsylvania Is Facing and Overcoming Obstacles | Healthcare and Technology news | Scoop.it

    Although Pennsylvania is the sixth most populous and ninth most densely populated state in the Union, based on information from the United States Census Bureau from 2010 and 2013, it also is home to a significant amount of rural areas. According to the Pennsylvania Rural Health Association, 48 of the 67 counties in the state are classified as rural, and all but two counties have rural areas. Approximately 27 percent of Pennsylvanians lived in rural counties in 2010, The Center for Rural Pennsylvania reports.


    Although rural living offers many advantages, according to the National Rural Health Association (NRHA), rural healthcare in America faces challenges not seen in urban areas. Population loss, poverty and access to healthcare have been problematic in recent years. Here are just a few of the initiatives that have been launched to improve the health needs and overall well-being of rural Pennsylvanians.


    Healthcare Issues in Rural Pennsylvania


    In general, rural residents in the U.S. are less healthy than those in urban environments. According to Unite for Sight, “rural residents smoke more, exercise less, have less nutritional diets, and are more likely to be obese than suburban residents.” Already against the odds, residents in rural Pennsylvania face several specific problems that jeopardize the state of healthcare in the area.


    Population Loss


    Between 2000 and 2010, Gary Rotstein of the Pittsburgh Post-Gazettereports, rural Pennsylvania counties grew by 2.2 percent while urban counties grew by 3.9 percent. However, the small increase in rural counties was only due to eastern counties. Western rural counties decreased by 0.9 percent, and by another 0.5 percent from 2010 to 2012.


    In some places, the situation is bleak. Rotstein highlights the population loss in Taylor Township, a part of Lawrence County that experienced a 13.6 percent population loss from 2000 to 2010. “Of its 1,052 residents, more than twice as many are over age 65 as under 18,” Rotstein adds. “That ratio is practically unheard of among municipalities and doesn’t bode well for the township’s future.”


    For rural areas where population is declining or (slowly) rising, healthcare faces challenges. Economic opportunity is threatened when workers and students pursue a better future. And when healthcare professionals depart, accessibility is undermined. In addition, communities with a disproportionately older population can require more healthcare resources, at the same time as access is dwindling.


    Economic Challenges


    According to the Rural Assistance Center (RAC), rural Pennsylvania lagged behind urban areas in poverty, unemployment and income for 2013:


    14.3 percent poverty rate; 13.6 percent in urban areas

    7.9 percent unemployment rate; 7.3 percent in urban areas

    $36,099 per-capita income; $46,202 for the state

    The Center for Rural Pennsylvania adds that from 2007 to 2011, 39 percent of rural households had incomes below $35,000.


    Access to Healthcare


    Rural Pennsylvania also has less access to healthcare than is available in urban areas. The Center for Rural Pennsylvania reports that in 2008, rural counties had just one primary care physician for every 1,507 residents, while urban counties had one physician for every 981 residents. In 2009, rural counties had one practicing dentist for every 2,665 residents, while urban areas had one for every 1,845 residents.


    Solutions and Initiatives


    In response to some of the healthcare challenges facing residents in rural Pennsylvania, the following solutions and initiatives have been developed.


    Telehealth


    Based on a 2014 research report from The Center for Rural Pennsylvania, telehealth can promote strong health to reduce chronic conditions and diseases, educate the public and healthcare workers, enable senior citizens to remain in their homes and much more. Using videoconferencing, online remote monitoring and diagnostic scans, electronic health records and other tools, telehealth can help providers give high-quality, affordable and accessible healthcare even in remote locations.


    The study estimated that telehealth’s universal implementation would result in a 22 percent savings for the first year, increasing to 66 percent for the 20th year. Instead of a healthcare cost of $25,500 per person each year, the cost would be just $8,500; Pennsylvania would save $194 billion in the 20th year of implementation. Not only would the healthcare be less expensive, it would also be higher quality.


    Currently, telehealth in rural Pennsylvania is not widely used and quality is poor. However, investing in the infrastructure and getting more healthcare providers on board can help improve the quality and access to this care, giving rural residents the chance to experience affordable, quality healthcare.


    Rural Healthcare Funding


    Federal programs are available to help rural areas across the country improve healthcare delivery. One example is the Rural Health Care Coordination Network Partnership Program, which supports organizations that are trying to improve the outcomes chronic diseases, specifically chronic heart failure (CHF), chronic obstructive pulmonary disease (COPD) and Type 2 diabetes. It awards up to $200,000 per year for three years to qualified rural health networks.

    These types of programs can help overcome the economic disparity that most rural communities faced, compared to urban areas.


    The Office of Rural Health Policy (ORHP), part of the Health Resources and Services Administration (HRSA), offers other grant programs and initiatives to help support healthcare in rural areas across the country.


    Expanding the Scope of Healthcare Workers


    The need for more accessible healthcare is not just an issue in rural areas. According to the HRSA, there is a projected shortage of 20,400 primary care physicians across the U.S. for 2020, if the current system remains unchanged. To counter this trend, the HRSA projects the number of nurse practitioners and physician assistants to increase.


    Nurses are expected to play an integral role in meeting the need for increased healthcare practitioners. In 2010, the Institute of Medicineannounced that nurses would need to respond to the changes taking place in the healthcare system, which gives nurses more opportunities to provide quality care. It called for higher education standards, including 80 percent of all nurses to hold bachelor’s degrees. To meet these needs, nursing is growing quickly; the Bureau of Labor Statistics already expects the profession to grow by more 19 percent through 2022, making it one of the fastest growing professions in the country.


    In rural Pennsylvania, a higher concentration of educated nurses could help make up for this shortage of physicians and the changes taking place in the healthcare system.

    more...
    No comment yet.
    Scoop.it!

    White House Announces New Precision Medicine Commitments

    White House Announces New Precision Medicine Commitments | Healthcare and Technology news | Scoop.it

    The Obama Administration has announced new commitments to its precision medicine initiative (PMI) that it unveiled six months ago.

    The initiative, which President Barack Obama touched on in his State of the Union address in January, aims to pioneer a new model of patient-powered research to accelerate biomedical discoveries and provide clinicians with new tools, knowledge, and therapies to select which treatments will work best for which patients.


    This week, the Administration launched new commitments, which include:


    Guiding Principles for Protecting Privacy and Building Trust: The White House is unveiling draft PMI guiding principles that seek to build privacy into the design of the PMI research cohort, which will include one million or more Americans who agree to share data about their health. The White House is seeking public feedback on the privacy and trust principles online through August 7, 2015.


    New Tools for Patients: In collaboration with federal partners, the Department of Health and Human Services Office of the National Coordinator for Health IT (ONC) and Office for Civil Rights (OCR) will work to address barriers that prevent patients from accessing their health data. OCR will develop additional guidance materials to educate the public and health care providers about a patient’s right to access his or her health information under the Health Insurance Portability and Accountability Act (HIPAA).


    Research Awards to Unlock Data Insights: The Department of Veteran Affairs (VA) is announcing awards to support four research projects on key questions relevant to precision medicine using the rich data from the Million Veterans Program (MVP), the largest U.S. repository of genetic, clinical, lifestyle and military exposure data.

    Additionally, private sector commitments related to the initiative launched this week include:


    Duke Center for Applied Genomics and Precision Medicine: Duke has developed a platform called MeTree that helps individuals have challenging but necessary conversations with loved ones and care providers about family health histories, so that physicians can tailor care to patients’ unique risk profiles.


    Flip the Clinic: Flip the Clinic, a project of the Robert Wood Johnson Foundation, is announcing a collaboration with more than 160,000 clinicians and staff practicing at sites across the United States, who have pledged to inform patients about their right to get digital copies of their medical records.


    Genetic Alliance: Along with collaborators, such as Cerner, Genetic Alliance is launching new capabilities for Platform for Engaging Everyone Responsibly (PEER), a data registry that empowers participants to share their data with medical researchers, advocacy groups, and others.


    GetMyHealthData: The GetMyHealthData campaign is pledging to help thousands of consumers over the next 12 months access and download their own clinical health data, so they can use it to understand and improve their health, their care, and the system as a whole—including donating their data for research.


    Sage Bionetworks: Recognizing the importance of health-data liberation, and the role of data in driving research studies, Sage Bionetworks is announcing that it will support clinical studies that import electronic health-record information to its open source research platform and that it will release open-source informed-consent prototypes to support these studies.


    The White House also is honoring "Champions of Change" in precision medicine, which includes nine individuals who are working to use data and innovation to improve healthcare.

    more...
    Sophia Nguyen's curator insight, July 24, 2015 7:55 AM

    I found this interesting because it shows how important the world of healthcare and how the president has taken notice that it's important for consumers to understand their health and take charge of it.

    Scoop.it!

    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.

    more...
    No comment yet.
    Scoop.it!

    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.

    more...
    No comment yet.
    Scoop.it!

    Ebola-stricken nations need $700 mln to rebuild healthcare

    Ebola-stricken nations need $700 mln to rebuild healthcare | Healthcare and Technology news | Scoop.it

    Guinea, Liberia and Sierra Leone need a further $696 million in donor funding to rebuild their battered health services over the next two years in the wake of the deadly Ebola epidemic, senior World Health Organization (WHO) officials said on Monday.


    WHO Assistant Director General for Health Systems and Innovation Marie-Paule Kieny said that donors had pledged $1.4 billion of an estimated $2.1 billion required by the three countries before December 2017.


    U.N. Secretary-General Ban Ki-moon will host an international Ebola recovery conference in New York on Friday to raise additional funds for reconstruction.


    More than 500 healthcare staff are among the over 11,200 people killed in West Africa by the worst recorded outbreak of the hemorrhagic fever, which erupted in Guinea in December 2013 and continues to claim lives.


    "Full recovery in the three countries will not happen if we don't strengthen the health system," Kieny told a conference call with journalists. She said additional funding would also be required after 2017.


    Even before Ebola struck, Guinea, Liberia and Sierra Leone had some of the poorest healthcare systems in the world, but the damage inflicted by the outbreak has left them more vulnerable than ever, officials say.


    In Guinea, WHO officials have reported a drastic increase in deaths from malaria and measles. Before the crisis, the country's annual healthcare spending stood at just $7 per person in 2013, one of the lowest rates in the world.


    Pre-Ebola healthcare expenditure in Liberia and Sierra Leone was little better at $14 and $11 per person respectively, well below the WHO's recommended minimum of $84 per person per year.


    The re-emergence of Ebola in Liberia last week, nearly two months after it was declared free of the virus, has stoked fears that it may take longer than expected to defeat the epidemic.


    Kieny said it was too soon to say how the three new cases in Liberia - one of whom has died - became infected. Tests are being carried out by the Liberian government and international health agencies.


    The European Union on Monday approved 1.15 billion euros in aid for West Africa through to 2020, nearly doubling its previous commitment to a region that is a major source of migrants seeking to enter Europe.

    more...
    No comment yet.
    Scoop.it!

    Health insurer Centene adds muscle with $6.3 billion Health Net deal

    Health insurer Centene adds muscle with $6.3 billion Health Net deal | Healthcare and Technology news | Scoop.it

    U.S. health insurer Centene Corp will buy smaller rival Health Net Inc for $6.3 billion, underscoring the healthcare industry's rush to bulk up to negotiate better prices with suppliers and hospitals, and attract new customers.


    Health Net's shares touched a record high of $76.67 on Thursday, but stayed shy of Centene's offer of $78.57, which is at a 21 percent premium. Centene shares were down 3 percent at $78.42.


    The deal comes a week after the U.S. Supreme Court upheld subsidies for individuals under President Barack Obama's signature healthcare law, keeping a large chunk of patients intact under the Medicare and Medicaid programs.


    Insurers have said subsidies are key to bringing in new customers and the ruling has removed uncertainty for insurers looking for acquisitions. It could also spur more deal making in the health insurance sector, which has already seen a blitz of merger activity this year.


    Aetna Inc, the third largest insurer is looking to buy smaller rival Humana Inc. No. 2 Anthem Inc has offered to buy Cigna Corp to create the largest insurer in the country, toppling UnitedHealth Group Inc . Media reports have also said UnitedHealth could be eyeing Cigna and Aetna.


    Health insurers are not alone in trying to beef up.


    Drugmakers, retailers and pharmacy benefit managers have contributed to the wave of healthcare acquisitions since 2014, pushing deal-making in the industry to record levels.


    Also, an expected increase in federal interest rates, which will make borrowing costly, is expected to push companies to close deals over the next few months.


    UnitedHealth could bid for either Health Net or Centene, or even the combined company, Leerink & Co analyst Anagha Gupte said. Gupte said she now expects other smaller insurers such as WellCare Health Plans Inc and Molina Healthcare Inc to merge.


    Centene's buyout of Health Net will catapult it to the top of the government insurance heap, ahead of bigger rivals who dominate the private insurance market.


    The combined company will serve more than 10 million members across the country, but will still be small in terms of total membership. Market leader UnitedHealth, for example, has nearly 46 million members.


    Centene, which will also assume $500 million in Health Net debt, said the deal is expected to boost adjusted profit by more than 20 percent in the first year.

    more...
    No comment yet.