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Greed linked to healthcare ‘corporatization’ said to ravage America

“Avarice,” by Jesus Solana.

Vikas Saini, M.D., president of the Lown Institute, and Shannon Brownlee, the healthcare reform organization’s vice president, discuss in the Huffington the massive, greed-fueled corruption in U.S. healthcare that drives up costs to astronomical levels and ravages the economy.

They write:”

“Our health care system is no longer about relieving the suffering of patients… It’s about making money.
“Why? Because our increasingly corporatized healthcare system is driven by an insatiable appetite for profit. Our healthcare system is no longer about relieving the suffering of patients or the intrinsic value of maintaining the health of our population. It’s about making money: for pharmaceutical companies, device manufacturers, hospitals, insurance companies, and increasingly, for doctors. And all of these players are gaming the system and hurting patients in the process.”

“Healthcare spending consumes one-fifth of GDP. While health care does create jobs, it also takes jobs away by reducing spending for other public goods: housing, education, and infrastructure. Healthcare costs bankrupt patients, choke small businesses, contribute to stagnate wages, and force governments at all levels to trim public services.”

To read the piece, please hit this link.

FDA chief leads redefinition of digital-health-product regulation


— Graphic by Paul Sonnier

The Food and Drug Administration is redefining how it regulates digital health products.

The agency’s new commissioner, Scott Gottlieb, M.D., says its new Digital Health Innovation Plan will “include a novel, post-market approach” to digital devices and that the FDA will present new guidance for digital health product design to provide more clarity for manufacturers.

Dr. Gottlieb asserts that that program will help eliminate regulatory ambiguity while promoting innovation and free  regulators to focus  on more pressing  healthcare matters.

Digital health industry leaders were happy about Dr. Gottlieb’s remarks.

“All in all, I feel like I’ve died and gone to heaven,” Bradley Merrill Thompson, a medical-device lawyer with Epstein Becker Green and the Clinical Decision Support Coalition’s general counsel, told FierceHealthcare.

Health IT Now Executive Director Joel White said he is “deeply encouraged” by the  Dr. Gottlieb’s approach, adding that regulations need to keep pace the “rapid development cycles of health IT.”

“This is all about a modern FDA that better serves the needs of patients,” he said.

Dr. Gottlieb likes a “third party certification program” in which lower-risk devices could be marketed without FDA approval, while  approval of higher- risk devices could be streamlined and speeded based on a company’s history.

To read more, please hit this link.

Dividing up those quality bonus payments


In a Medical Economics piece, Lori Rousche, M.D., writes about the tricky task of dividing quality bonus payments in physician groups as they head deeper into the brave new world of reimbursements based on quality and outcomes rather than on the number of procedures.

She concludes:

“If we are going to survive going forward with the changes in payments from all of our insurers, we must stand as one group all together for the common good of providing quality care. In the next quarter, when the bonus check is dispersed, it could be my office that scores zero on utilization, even though I am doing my best at trying to keep my patients well.

“In the end, we voted to divide the utilization bonus evenly among all of the offices according to full time equivalents because that was the fair thing to do. And it was the right thing to do even though there was some grumbling about it. I believe it strengthens our group and our partnership heading forward into the messy future of medicine.”

To read her entire piece, please hit this link.

Price: High outlays on Medicaid don’t equal success


U.S. Health and Human  Services  Secretary Tom Price, M.D., has defended massive budget cuts proposed by the Trump administration for his department’s services by saying that government spending doesn’t equal government success.

“If how much money the government spends on a program were truly a measure of success, Medicaid would be hailed as one of the most successful in history,” Dr. Price told the Senate Finance Committee in a hearing.  He noted that a  a third of U.S. physicians don’t take Medicaid patients, and  that Medicaid coverage does not necessarily translate into better medical outcomes for individual patients.

To read more of his remarks in a Medscape report, please hit this link.

Safety across the care continuum


Video: Tejal Gandhi, M.D., chief clinical and safety officer at the Institute for Healthcare Improvement, discusses the need to consider safety issues across the entire care continuum. This, of course, becomes increasingly important as more and more care moves out of hospitals and into clinics, physician groups and other non-hospital settings and as more nurse practitioners and physician assistants do the work once  done only by doctors.

To see the video, please hit this link.


Massive ransomware seen as more proof of perilous over-reliance on IT


The Web site of Roy Poses, M.D., sees the worldwide ransomware attack underway, including against hospitals and other healthcare institutions, as yet another ominous sign of our extreme over-reliance on computer systems.

Dr. Poses writes:

“InformaticsMD reviewed the recent global ransomware attack in the health care context, focused on the hacking of British NHS  {National Health Service} hospitals.  As seems usual in health care information technology debacles, hospital managers were quick to soft-pedal what aspects of it they could (the NHS was not the ‘target’ of the attack?  There was no evidence that “patient data was accessed”?)  Preliminary reports indicated that the NHS was using an outdated version of Windows which had not been updated.  Once again, advocates for commercial health information technology have been exaggerating (if not fabricating) its benefits, while pooh-pooling its harms for a long time.  The use of technologies whose benefits and harms have never been properly assessed by clinical research studies continues to pose dangers for patients.  Insiders in the health IT industry seem to be collaborating with government bureaucrats to promote this unproven technology.  True health care reform would require rigorous assessment of all new medical/ health care technology, regardless of who might be offended if such assessments provide negative results.”

To read more, please hit this link.

Hire more staff to help deal with MACRA?


An article in Physicians Practice looks at the pros and cons or hiring additional staff to address MACRA issues. Among the stuff:

The article asserts that Charles Saunders, M.D.,  who is CEO of Integra Connect, a technology and service provider specializing in value-based care,  is one of the few experts who says that hiring more staff may be necessary.

The article reports:  “He says this is the case if a practice chooses to participate in the other MACRA pathway, an advanced alternative payment model (APM). These models have requirements for certain activities such as care coordination and quality improvement programs, which can’t simply be automated. ‘To be successful in driving savings, some investments in these activities will be required for care coordinators and case managers,’ he says. This is because, as with MIPS measures, reporting on them can be a labor-intensive exercise requiring chart reviews, depending on the ability of the EHR to automate this process.”

“Other experts disagree, suggesting that MACRA shouldn’t radically change the way physicians staff their practice or collect information from their patients. ‘In effect, MACRA simply is a requirement that physicians document that they’ve actually performed the next step in terms of a slightly more complicated process of documentation,’ says Stuart Hochron, M.D., chief medical officer and co-founder of Uniphy Health, a physician’s communication and collaboration app. He says the changes won’t require new staff, just more staff education. He recommends turning to CMS’s extensive online resources on the topic, as well as medical societies that offer MACRA education as a start. ‘I’d either attend a respectable conference that was targeted as your organization is focused, or hire a consultant,’  he says.”

To read the whole article, please hit this link.

‘Rethinking U.S. Military Health System’



Arthur Kellermann, M.D.,  dean of the School of Medicine at the Uniformed Services University (USU) of the Health Sciences, has written a highly thoughtful piece for Health Affairs headlined “Rethinking the United States’ Military Health System”.

He discusses ways to make it work better. In  stripped-down form, here are some:

  1. “Make greater use of enlisted providers—Overseas and aboard ships, the Military Health System relies on its corpsmen, medics, and med techs to deliver routine care under supervision, as well as save lives in combat. However, the moment these skilled providers come home, they are relegated to minor clinical or clerical tasks because no comparable role exists in civilian health systems. If the Military Health System allowed them to function as “primary care technicians,” it could expand access to care, reduce use of emergency departments and urgent care centers, and strengthen readiness for future deployments.”
  2. “Consolidate treatment of complex cases—When a service member is wounded in combat, he or she is MEDEVACed to the nearest combat support hospital, then flown by Critical Care Air Transport to a stateside military hospital. Two decades ago, the Military Health System used a similar approach inside the United States to concentrate complex care to its top medical centers. If it reinstituted the practice, patients and taxpayers would benefit.”
  3. “Systematically improve practice—Many of the advances in trauma care in Iraq and Afghanistan came from the Joint Trauma System, which systematically analyzed casualty data to identify opportunities to improve. If the Military Health System employed a similar approach to assess delivery of high-risk care in stateside hospitals, it could ensure that beneficiaries get the right care at the right place for the right reason.”
  4. “Standardize to optimize—The U.S. armed forces have learned the value of training and fighting as a joint force. Military health care providers have learned the same lesson in combat zones but when they return home, they tend to revert to the old ways. Some variations in approach are inevitable, but the Military Health System should strive to standardize key workflows, equipment, and even the layout of its operating rooms and delivery suites.”
  5. “Keep patients healthy— In war zones, protecting the health of the force is a top priority. Taking an equally diligent approach to population health at home could produce substantial benefits. Redoubling efforts to boost rates of vaccination, discourage smoking and use of smokeless tobacco, prevent injuries, and treat hypertension and obesity could generate huge downstream savings.”
  6. “Treat selected civilians—In war zones, commanders have the latitude to treat ill and injured civilians if doing so will help win the support of the local population. Currently, most lack this authority in the United States. At present, only two military medical centers participate in their state’s trauma system. If more were allowed to do so, their medical staffs would benefit from the extra caseload, and the civilians they treat would benefit from the world-class trauma, burn, and rehab care available at these medical centers.”
  7. “Ensure clinical proficiency—Military surgeons are already partnering with the American College of Surgeons to devise objective ways to assess surgeons’ readiness to deploy. Recently, they devised a way to cross-walk Current Procedural Terminology codes used to track performance of surgical procedures to critical wartime surgical skills. Once this approach is refined, it will be extended to other wartime specialties such as emergency medicine, anesthesiology, and intensive care.”
  8. “Measure what matters—To ensure military providers address the ‘quadruple aim’—readiness, better health, better care, and lower per capita costs—the Military Health System has adopted 30 ‘Partnership for Improvement‘ measures. Adopting a smaller, high-yield set of ‘vital signs’ metrics devised by the National Academy of Medicine would allow Military Health System leaders to compare their system’s overall performance to other large health systems and satisfy Section 730 of the NDAA.”
  9. “Embrace Telehealth—In deployed settings, the Military Health System uses telehealth to support health care providers working in small forward operating bases and on ships at sea. Global teleconferencing allows trauma experts across 12 time zones to regularly meet, discuss complex cases, and identify opportunities to improve. Despite its success with telehealth overseas, the Military Health System was slow to adopt it at home due to stringent information security requirements and budgetary constraints.”

To read the whole article, please hit this link.

Using hospital-satellite emergency departments to reduce strain on hospitals


Most hospital emergency departments seem to get busier and more crowded each year, placing ever-greater strains on patients and clinicians. Ricardo Martinez, M.D., suggests that hospital-satellite emergency departments (HSEDs) can offer considerable relief.

He writes in Hospital Impact that they “provide a more distributed access model of emergency care that can be integrated into the healthcare system to relieve the strain on existing EDs and bring emergency care closer to patients.

“HSEDs are structurally separate from a hospital, but offer patients emergency services that are equal to or surpass those at hospital-based facilities. The acuity levels for patients seen in HSEDs are similar to those seen at hospital-based EDs as well (broken bones, burns, chest pain, abdominal pain, pulmonary symptoms, head traumas and concussions). In short, when it comes to treatment, there is little to no difference between the two types, but HSEDs have the ability to provide more accessible and a greater value of care.

“Having multiple HSEDs throughout local communities expands access to emergency medical care for more patients, including those who live far from a centralized hospital system. This type of medical delivery system is already implemented with decentralized imaging centers, laboratories and urgent care centers.”

To read more, please hit this link.

Making the most of boards’ immersion days’




Hospitals & Health Networks looks at how “Immersion Day” gives hospital boards a  very  close-up look at these institutions. This piece focuses on Mission Health, a community hospital system in western North Carolina.

Among the observations:

“Perhaps counter-intuitively, it seems that once board members understand {after participating in Immersion Day} how complicated the delivery of care is today, they come to appreciate even more the skill and expertise of management — and to leave operations to the management team.

“The benefit of immersion for boards seems to be the focus it brings to strategic planning, the experience and authority it gives to board members when they advocate for the system, and the bonding that forms between board and management as both face the stress and rapid change of modern care delivery.’’

“Here are some of the best practices followed by Richard Bock, M.D., of Immersion Advisors in Asheville, N.C., when he conducts an Immersion Day program:

  • “Meets with health system leadership to understand their goals.
  • “Drafts immersion plans tailored to the institution.
  • “Meets with the system’s chief medical officer to refine the plans.
  • “Individualizes standard HIPAA releases and other agreements as needed.
  • “Communicates directly with medical staff and nursing leadership ahead of time.
  • “On Immersion Day, prepares, orients and accompanies participants in all hospital areas.
  • “Conducts debriefings afterward.
  • “Optionally arranges end-of-day discussions with the CEO and other key leaders — particularly valuable for policymaker immersions.”

To read more, please hit this link.



The main facility of Mission Health, in Asheville, N.C.



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