Cooperating for better care.


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The decades-old ‘looming’ primary-care shortage


She writes:

“Our constant inability to address this shortage is also immutable, and it has been so for all the decades we could have used to train more primary care doctors.

“Whether by design or by happenstance, we are now working hard to reduce demand, and perceived need, for actual doctors in primary care, and at the same time, we are working equally hard, if not harder, to increase the soothing volume of cheap and inconsequential services which are considered part of primary care.”

Along the way, she also returns to the old, half-joking, half-serious comparison of primary care and Jiffy Lube.

Value of transparency in physician payments


Thomas Edison with his searchlight cart.


Here’s a discussion in JAMA of the value of transparency in physician payments.

Patient choice and equity in Sweden


This article in The New England Journal of Medicine looks at patient choice and equity in Sweden, where there’s universal healthcare but the decision-making  is highly decentralized, with power given to county councils that ”own and operate almost all hospitals and a majority of primary care facilities.”

P0licies change with the varying preferences of center-right and center-left governments about such matters as pharmacy privatization, but a consensus remains that  high-quality healthcare should be available to all.






Mickey Mouse, M.D.

(Video included in link.)

Lisa Suennen  writes in MedCity News:

”I expect we are going to see a lot more collaborations between healthcare and consumer products companies like unlikely alliances {one between Disney and Eli Lilly} that go at the core of two of the most serious healthcare challenges: health literacy and behavior change.

”If we could ‘fix’ those two problems, I suspect that we could cut the costs of the healthcare system by at least a third by eliminating many of the medical errors, treatment compliance problems borne of lack of understanding and cultural medical miscues.”

”Healthcare companies had better co-opt those consumer brand companies into helping them communicate with consumers or they may just end up working for them.”

Feds sue rich Fla. cardiologist over lucrative tests


The Feds have joined  two lawsuits that allege that Florida’s Asad Qamar, M.D., who was Medicare’s highest-paid cardiologist in 2012, taking in $18 million in reimbursements  that year, got patients to have unnecessary invasive heart testing to boost his income.

Modern Healthcare reports that in one of the lawsuits Dr.  Qamar and his group ”routinely waived patients’ Medicare copayments and deductible payments so that, the suit says, ‘patients had no reason to turn down services and would oblige Dr. Qamar’s improper recommendation that they consent to all manner of procedures for which there was no medically indicated need.’ according to the lawsuit. Qamar and the institute would then bill the government for the full cost of the treatment.”

A lawyer for the cardiologist said:

“Dr. Qamar practices under the highest medical and ethical standards. Any claims to the contrary are unsubstantiated and the doctor will defend himself vigorously against these baseless allegations.”

It’s interesting that so many of  alleged overbilling involve Florida physicians, but then, it does have so many people on Medicare.

The Blue Shield-Sutter battle



Siphnian Treasury at Delphi, North frieze, c. 525 BC, detail showing gods facing right and giants facing left.

Blue Shield of California  alleges that Sutter Health, which runs 23 hospitals in northern California, is charging excessive prices and doing it in sneaky ways that hide its expensiveness from the public. But Sutter, for its part,  said state data show that its per-hospital-discharge prices are at or below its peers.

The Los Angeles Times reports that the legal dispute between the giants has prevented Blue Shield and Sutter from reaching a new contract that would affect many employers and consumers.

Blue Shield is telling about 280,000 health plan members that they ”might lose network coverage with Sutter doctors and hospitals”  in the  fight, the paper says.

Some groups have accused Sutter of  sneakily imposing anti-competitive actions and illegally inflated prices.

“‘Blue Shield is demanding significant rate rollbacks as well as several changes to language that has been in our contracts for years, Sutter spokesman Bill Gleeson said. ‘Rate rollbacks of the magnitude that Blue Shield demands would have a negative impact on the level of healthcare services we offer.”‘

The Sutter case but one large example of complaints about big hospital systems’ pricing power,  which has grown as they buy more and more physician practices and outpatient medical facilities. Perhaps the most famous complaints are those involving Partners HealthCare, in the Boston area.

”James Robinson, a University of California at Berkeley professor of health economics, published a study in October showing hospital ownership of physician groups in California led to 10-20 percent higher costs overall for patient care,” the Times reported.

“Consolidation can create better coordination and efficiencies in healthcare. However, it can also create opportunities for higher prices.”



Big Data is far from a cure-all


Listen to this National Public Radio feature on why Big Data is far from a cure-all in medicine, despite all the hype in recent years.

Resistance to ‘Big Data’


Peter Zweifel raises some important questions regarding “Big Data”:

”The question of how manageable big data might be when applied to coordinated care is primarily the concern of health insurers, who have a strong incentive to invest in big data. Once insurers and medical directors agree on measures of performance, big data can be condensed so it is more manageable for both of these parties.

”However, it is doubtful whether the cost savings are sufficient to overcome the resistance of service providers who seek to retain their professional autonomy. Big data is a double-edged sword for consumers; improved coordination of care comes at the risk of a loss of privacy,  which governments may be eager to exploit.”



Planning for patients with advanced illness


A blog in HealthAffairs looks at redesigning the American health system to better address the needs of patients with advanced illnesses. To do this, the authors recommend  six steps, and they give examples of places with successful models.

The authors write: “To ensure that the voices of patients with advanced illness will guide treatment decisions, patients’ values and preferences must be documented. Knowing and honoring patients’ preferences requires redesign of the health system using clear and specific design principles.”

The aim is a system that is:

  • “Person- and Family-Centered: Care is focused on treating the person with an illness rather than a disease.
  • ”More Coordinated: When systems are established to document and communicate this person-centered conversation, the healthcare system becomes more organized.
  • ”Individualized: Management of disease and palliative services are not an either/or choice; rather, under individualized plans, patients receive care in the “dose” that fits their medical condition and informed preferences.”




Steps in commercializing new healthcare tech


Steve Blank, writing in MedCity News, reports on a new class of life-science/healthcare co-working collaboration space.

He says that startups seeking to commercialize new technologies should:

  • Define ”clinical utility” before spending millions of dollars.
  • Understand who core and tertiary customers are, and the sales and marketing process ”required for initial clinical sales and downstream commercialization.”
  • Assess intellectual property and regulatory risk ”before designing and building”.
  • ”Know what data will be required by future partnerships/collaboration/purchases before doing the science.”
  • “Identify financing vehicles” before they’re needed.


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