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How to respond as new tech invades health care

Picture: Visualization of some Internet routes

— The Opte Project

Namita Seth Mohta, M.D., David Blumenthal, M.D., MPP, president of The Commonwealth Fund, and Robert Galvin, M.D., MBA, chief executive officer for Equity Healthcare discuss why and how big private-sector health-care organizations are responding to the onrush of technology into the sector.

One of Dr. Galvin’s observations:

“Sometimes the unintended consequences exceed the benefits, to be honest. When you get into a system as big as health care, as resistant to change in health care, and inherently much more complicated, this is not buying goods and services over Amazon; this is not getting an Uber or using Lyft. These are in many cases very sick people with complicated diseases in a system that’s already very complicated.

“One unintended consequence is you make it more complicated for people, so the number of choices they have — and the array of opportunities they have to access these apps — can be overwhelming. The misinformation is another unintended consequence; I’m not sure how good Alexa is going to be, or whether there’s going to be any clinical judgment in Alexa. If you go onto the Web and look for health care information, it’s as likely to be inaccurate as it is to be accurate.”

To read and hear the full discussion, please hit this link.


Warning about ‘medical directors’

An article in Physicians Practice warns practices and hospitals:

“There are often situations where a physician holds the title of medical director. The physician, however, does not necessarily perform any substantive roles or functions, but the title is sometimes given to induce patient referrals to the facility. These types of situations can — and do — give rise to liability under the False Claims Act….”

“Sham medical director agreements to induce patient referrals violate the Anti-Kickback Statute and Stark Law. Doctor’s Choice also allegedly paid some employees in a manner that accounted for the volume of referrals by their physician spouses, in violation of the Stark Law….”

“Physicians, medical professionals and facilities should appreciate the legal liability for not performing the requisite functions. They should also ensure they are meeting an Anti-Kickback safe harbor and a Stark Law exception.” 

To read the whole article, please hit this link.


Four tenets for physician incentives

“Incentives are there to try to change behavior, to try to move things along,” noted John Jenrette, M.D., executive vice president for Cedars-Sinai Medical Network, during a talk on physician incentives, as reported in NEJM Catalyst.

His four tenets of physician incentives and behaviors, reports the NEJM article and video:

  1. Follow the money. ‘Physicians like money and financial incentives, yes, but they’re not at the core, at all. They aren’t. They maybe have this kind of incremental impact if you can put them in the right direction, but I truly believe that if physicians are compensated appropriately for the work they’re doing, the incentives become that icing on the cake, that top performance, the things that we want to pay attention to, want to try to focus on, and reward physicians for that type of behavior.’”
  2. Produce meaningful data. ‘That data has to be accurate, it has to be reliable, it has to be meaningful. If you have walked into a room with a bunch of physicians with data, and they begin to poke thousands of holes into it, you walk out of the room with your tail between your legs, completely discredited, and you will spend so much energy trying to get back there, and even have another conversation. The reliability and meaningfulness of the data and how that applies is important to the why I take care of patients and do the work that I do.”’
  3. Involve physicians. ‘Physicians want to be a part of the process. They want to be in the conversation. ….They want to help guide that and direct it, and make sure the data can be meaningful and helpful to their practices and the work that they do. …”’
  4. Ask why. Jenrette stresses that this fourth tenet is the most important. ”’It goes to the core of why we are physicians, in taking care of our patients, in taking care of families, in creating great outcomes and seeing people live healthy and happy. That’s why we become physicians, and why we need to continue to focus in that direction.”’

TO read/hear the article, please hit this link.


Breaking down health-care silos

Four staffers at Boston’s Brigham and Women’s Hospital write about breaking down health-care silos in this case regarding treatment of patients with end-stage renal disease.

Among their observations:

“{I}n 2016 we launched a coordinated ESRD program within Partners Healthcare, based at Brigham and Women’s Hospital (BWH) in Boston, one of the first to bring the care-coordination principles that are increasingly common in primary care to disease-specific specialty care. While other programs, like the CMS ESRD demonstration projects, have piloted care-coordination models with large dialysis organizations, ours is the only such program that we’re aware of that coordinates care across all stakeholders (dialysis units, hospitals, primary care providers, and others) rather than focusing on care within the dialysis unit itself. Further, unlike other programs, ours extends beyond dialysis-based care to facilitate transplant evaluations and, when needed, palliative care.”

To read the whole article, please hit this link.


Severe shortage in residency slots

FierceHealthcare reports:

“There’s more medical school students than ever before, but there’s still a big obstacle to solving a predicted physician shortage.

“While U.S. medical school enrollment has increased, averting a physician shortage now depends on more residency training slots, according to the results of an annual survey from the Association of American Medical Colleges (AAMC).

“The number of residency positions has increased only 1% a year, far lower than the 52% growth in medical school spots since 2002, the AAMC said. Federally supported residency training slots have been capped by Congress for more than 20 years, limiting the spots for medical school graduates to undergo additional training in a residency program before they can practice medicine….”

“The survey found that medical school deans are worried about the lack of residency slots: 75% expressed concern about the availability of residency slots nationally, and 44% expressed concerns about their own incoming students’ ability to find residency positions of their choice after medical school. Over half of schools reported they experienced difficulty in finding clinical training sites for obstetrics/ gynecology and pediatrics.”

To read the whole article, please hit this link.


Trump changes linked to worrisome decline in ACO partcipation

From FierceHealthcare:

“Some Accountable Care Organization (ACO) groups are worried that a dip in participation this year could be the start of a worrisome trend due to major changes made to the program by the Trump administration.

“The Centers for Medicare & Medicaid Services (CMS) announced Wednesday that 518 ACOs are part of the program as of July 1, a decline from 561 ACOs that participated in 2018. The new data have the National Association of ACOs (NAACOS) worried about whether the decline is an anomaly or the start of a trend thanks to major changes to the Medicare Shared Savings Program (MSSP).

“CMS Administrator Seema Verma wrote in a blog post on Health Affairs Wednesday that CMS approved 206 ACOs to start July 1 and that 41 of them are new to the program. The number of new entrants is below the normal rate of more than 100 ACOs that have signed up each year since the program started seven years ago.”

To read the whole article, please hit this link.


NYC value-based joint venture chalks up savings

In an NEJM Catalyst article headlined “Success in Hospital-Integrated Accountable Care Organization,” the authors write:

“Conventional wisdom holds that urban academic medical centers are ill-suited for value-based care initiatives such as the Medicare Shared Savings Program (MSSP). Nevertheless, NewYork Quality Care, the MSSP Accountable Care Organization (ACO) established in 2015 as a joint venture between NewYork-Presbyterian, Columbia University Vagelos College of Physicians and Surgeons, and Weill Cornell Medicine, achieved savings in each of its 3 performance years by implementing a range of operational, financial, and analytical initiatives.”

“The creation of NewYork Quality Care has established a blueprint for collaboration that has increased alignment among our three institutions. Looking ahead, our plan is to potentially expand NewYork Quality Care to include additional clinicians and their attributed beneficiaries. We also plan to leverage the care redesign and analytics capabilities that we have developed to inform other such efforts across our three institutions.”

To read the whole article, please hit this link.


Dealing with vast distances in health care

In a NEJM Catalyst piece, Amy Compton-Phillips, M.D., executive vice president and chief clinical officer for Providence St. Joseph Health, the big western U.S. hospital chain, discusses how to “decouple care from geography {especially in the vast and sparsely settled sections of the mountain West} so that we can break that constraint. To do this, we have to have a different business model than today. We can’t just be a hospital system.” Instead, she says, Providence is building business verticals, such as for the physician enterprise, ambulatory care and home and community services.

NEJM says:

“Providence is working on retrieving data to create a sustainable business model for this digital health care; with headquarters in Seattle, Amazon.com and Microsoft are down the street, meaning there are a lot of data scientists in the area. Providence is leveraging these data scientists to embed AImachine learning, and data science, and in terms of capacity is investing in tools that decouple care from geography, including a variety of apps.”

“The health system’s telemedicine network includes, for example, a Telestroke program in 100 hospitals. With telemedicine, Providence has been able to work around the conundrums that come with regulatory differences in different states. In addition to access to care, they’ve also developed online health professions education at the University of Providence, providing long-distance learning and simulation and matching up resources to where they’re needed so that students can stay in their rural communities rather having to move to a city,” NEJM reports.

To read and hear the full article, please hit this link.


What if our care were designed by patients?

In a NEJM Catalyst video and text piece, Stephen Swensen, M.D., of the Mayo Clinic College of Medicine, talks about what medicine would look like if patients designed it. Dr. Swensen is a Senior Fellow of the Institute for Healthcare Improvement.

Among his remarks:

“Our health care system has 40% waste by the most conservative estimates, and the top three categories of waste we own: overtreatment, failures of care delivery, failures of care coordination,” and he warns of the danger of being driven by financial considerations.

“Not only is putting patients’ interest first in the patient’s best interest, but it’s in ours. If you look at drivers of {physician} burnout, one of the drivers is moral distress, and a values dissonance. So not only is it good for patients to put their interests first, it’s good for us.”

To read/hear the package, please hit this link.


Yes, there are very good trends in medicine

In an NEJM Catalyst interview, Michael Dowling, the CEO for Northwell Health, and Charles Kenney, chief journalist there, talk about what they learned in putting together their new health-policy book, Health Care Reboot: Megatrends Energizing American Medicine. While the conventional wisdom is that the American health “system” is broken, the authors are optimistic about trends, especially regarding the benefits of value-based care, more appreciation of the social determinants of health, a growing emphasis on ambulatory care and expanded access as medicine becomes more consumer-driven.

To read and hear this feature, please hit this link.


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