If I could choose only one healthcare topic two months before the election, it would be…

…difficult to choose.

  1. The escalating cost of drugs is an election year favorite
  2. Then there are several reports this week that electronic health records are a PITA to doctors, and I don’t mean the kind wrapped in flatbread
  3. Let’s not forget the fact that the Affordable Care Act is anything but – for patients who have to pay the rates (as opposed to those who get government subsidies) and for the health insurance companies trying to provide them

I thought about posting a request for a vote and then expound on the most popular topic. Each one, however, is so rich with possibility. Let’s not let any of them lie fallow.

The Escalating Cost of Drugs

Pharmaceutical companies are under public scrutiny for raising prices. We’ve had the Shkreli scandal and now another company is in the news for increases from about $100 to $600 over the course of about 8 years, give or take. Ouch. If you are a patient paying full price out of pocket, or even some copay that amounts to about 25% of the full cost, you feel that. Not seen in this diagram, however, is that much of this product finds its way into schools for free to save the lives of children.

After the public outcry, this particular manufacturer immediately cut the cost of its drug by half, then introduced a generic version.

There is the potential for a trend here. If the manufacturer releases its own generic, it wins whether it’s playing on the swings or the sliding board. And I am sure that this manufacturer’s price hike will remain political fodder for the next few months because hating on the pharmaceutical industry is such an easy win for a politician pandering to public opinion.

Beware the legislation that arises from this controversy.

Electronic Health Records

I would say it myself, except this writer said it so much better:

Electronic health records slow doctors down and distract them from meaningful face time caring for patients.

That is the sad but unsurprising finding of a time and motion study published in Tuesday’s Annals of Internal Medicine. A team of researchers determined that physicians are spending almost half of their time in the office on electronic health records (EHRs) and desk work and just 27 percent on face time with patients — which is what the vast majority of doctors went into medicine to do. Once they get home, they average another one to two hours completing EHRs…

…This is a shared problem with more than enough culpability to go around. Vendors like my company, athenahealth, and others have been required to develop EHRs that satisfy government regulations rather than the needs of providers and patients.

With limited authority and the best of intentions to oversee EHR certification and adoption, the Office of the National Coordinator for Health Information Technology continues to inflict enormous pain on our nation’s providers and care teams, turning caregivers into box-checkers and inadvertently limiting the private sector from innovating.

Motivated by more than $30 billion in incentives, vendors have lined up happily to ride the wave, building EHRs that satisfy government requirements but make it increasingly difficult and less rewarding to care for patients.

[end of excerpt]

I’ve been saying this for years, but writer Jonathan Bush just boiled it down so nicely. We’ve made progress on implementing electronic patient records throughout the system, certainly, and will continue to do so. However, so much greater progress will be made with physicians, patients and computer programmers working together in harmony rather than working against the constraints and deadlines of government regulations wending their way through a serpentine lawmaking process that can’t keep up with the pace of technological progress.

Technology should make our lives easier, don’t you think?

About the Cost of the ACA and Aetna’s Problem

I wrote about this when the ACA first passed, and it continues to be an obvious issue. The Affordable Care Act defies actuarial science. Under the ACA, rates are not set according to mortality charts, but are government-subsidized and the products are structured under regulations. In a rational health insurance scheme, healthy people pay into the plan and help fund sick people. Health insurance companies structure benefits considering the amount of risk they are willing to take on an individual given the amount of care the patient/member chooses to insure when they select a plan. Since the ACA, this concept is out the window. If someone shows up at the hospital without health insurance, the patient applies for health insurance and, at least in theory, the bill gets paid. Aetna is losing so much money on its ACA products that it is pulling out of most health exchanges.

If you are a provider, the ACA works because health insurance pays your invoice whether the patient was insured or not when they walked in the door. In fact, one hospital came up with the bright idea that they would even pay the premium of uninsured patients to make sure the bill got paid. That little scheme looks like it won’t pass court scrutiny.

Democrats need the ObamaCare plan to appear to work, even when the evidence is glaringly against it. Again, this New York Times writer was much more eloquent and succinct on this issue:

Premiums in many areas are expected to go up by double digits and some insurers are bailing out or scaling back after having lost hundreds of millions of dollars. Going into their fourth year, the law’s health insurance markets don’t seem to be on a stable footing yet. But they are also unlikely to implode, because subsidies will cushion the impact of premium increases for most customers.

[end of excerpt]

In election years, the cost and availability of healthcare have become perennially favorite scapegoats. If I were a politician, I’d promise free drugs, free health insurance, free exams, free everything because, after all, the government can just print more money and pay the bills.

What could possibly go wrong?

Nota bene: The opinions expressed are my own and reflect disillusionment with the politically-motivated solutions to our healthcare crisis. My opinions do not reflect lack of care for those who can’t afford to see a doctor or pay for a drug. Quite the opposite. My opinions reflect frustration, and I join with others looking for reasonable, rational, workable, affordable answers so people can get the healthcare they need, when they need it with the promise of technology providing part of the answer.







Posted in biotechnology, electronic patient records, health economics, health insurance, health IT, health policy, health reform, pharmaceutical sales | Leave a comment

Blogging to Aid the Pelican State and Flooding’s Affect on Hospital Workers

Source: U.S. Department of Defense - http://www.defense.gov/Media/Essay-View/CollectionId/15653


Insure Blog’s Hank Stern, best known in this space as a constant contributor to Health Wonk Review, rallied an effort to send some love – and money – to flood victims in the U.S. Gulf Coast region, particularly Louisiana. Ironman at Political Calculations answered Hank’s call for help and assembled a collection of charities in this post, “Aid Across Acadiana”. Click here for Ironman’s post to learn how you can help.

For a little news on how the flooding is affecting healthcare workers, here is an article from HealthLeaders Media John Commins today, “Louisiana Hospital Workers Struggle with Flood Recovery“.

Thanks to Hank Stern, Ironman, and all the people in the blogosphere calling much-needed attention to this tragedy. And don’t forget to click here and learn what you can do to help the flood victims, if you are so inclined.

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Jason Shafrin’s Health Wonk Review: Short and Sweet Edition at Healthcare Economist

Jason Shafrin has posted Health Wonk Review: Short and Sweet Edition at Healthcare Economist.  

Jason offers an easy-reading digest format of an eclectic mix of topics. You can find a link to the post to our single August edition here .

Thanks for hosting an great edition, Jason – much appreciated!

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The Little Black Doctor Bag Circa 2016 and the Physician Gender Pay Gap

Last week was a truly memorable occasion in our family. My daughter entered medical school. The White Coat ceremony was lovely, joyful and dignified. I don’t often write about my personal life, but this one triggered a few thoughts that I would like to share, if you can indulge me.

So155358003_-university-little-rock-black-leather-nurse-doctor-metime in 2009, I began blogging about the promise of electronic patient records – all info, all the time, where you need it, when you need it at the point of care. What is most memorable about those early essays was developing the character Health System Ed, a little blue doctor holding an iPad.

In Ed’s first incarnation, he was holding a clipboard. And that just seemed so wrong. It was everything Ed was not about – static paper records stuck in a manila folder in a wall of files. So I went to an artist and we revised Ed and gave him an iPad. And yes, even though I wanted Ed to look gender, ethnically and racially neutral, I needed to give him a name, and “Ed” represented Health System Education.

Today, the iPad is an essential piece of medical equipment. Remember the little black doctor bag? Today, the little black doctor bag is a stylish black leather tote emblazoned with my daughter’s initials, just big enough to hold a MacAir and an iPad. With those tools, she’ll be able to know a lot about her patients, their labs, their vitals, their activity level. So I was just moved to see that we have come this far this fast, and that the little black doctor bag actually looks good with a little black dress, if necessary.

About Doctors in Little Black Dresses

Which leads me to my next point. We all know about the gender pay gap. Women have been railing about it for decades. Turns out that the gender pay gap is just as prevalent among physicians. This article today in FierceHealthcare states:

Reports of pay discrepancies based on physician gender have rolled in for years, as previously reported by FiercePracticeManagement. While the reason for the pay gap has long been in question, hard evidence has been virtually nonexistent, according to the current study. Researchers sought to adjust reimbursement data to account for the three primary theories accounting for the difference in pay: female physicians undervaluing their services, spending less time on the job or being less productive than their male counterparts.

As a basis for its report, the study used Medicare Fee-for-Service Provider Utilization and Payment Data Physician and Other Supplier Public Use File (PUF) data covering 13 specialties, which yielded an average pay gap of $34,125.68. Adjusting for hours worked, productivity and years of experience narrowed the gap to $18,677.23. While female physicians earned less across all specialties, two (hematology and medical oncology) showed statistically insignificant differentials. The largest gap occurred among nephrologists, at $16,688.96.

Cost and Passion is the Same for Women and Men

The cost of medical school is the same for men and women. The hard years of study, practice, relentless dedication to patients and the art of the science of medicine are the same for both sexes. If women can expect a 5 to 10 percent reduction in pay, that does not mean they will get a break on the high cost of pursuing their passion.

So with this little soapbox I’ve built over the years, let me add to the laundry list of policy issues this very critical issue of gender pay equality for physicians.

When that medical school tuition bill comes due, her bill will look the same as the next guy’s. It is both our hopes that her paycheck will look the same, too.

Posted in electronic patient records, health economics, health IT, health policy, health reform | 1 Comment

A Yuuuuuuge Edition: Health Wonk Review Channels Inner Trump

donald-trump-health-wonk-reviewSteve Anderson at Medicareresources.org channels his inner Trump to bring us a yuuuuuge edition of Health Wonk Review. Thanks to Steve for a tremendous undertaking in the service to his fellow countrymen and countrywomen.


Posted in biotechnology, consumer health apps, electronic patient records, health economics, health insurance, health IT, health reform, healthcare change management, healthcare marketing, pharmaceutical marketing | Leave a comment

The Public Option or (ahem) Single-Payer: Solutions to a Growing Healthcare Monster?

Politically, I’ve been accused of being just a little to the right of Attila the Hun. That’s really not fair…to Attila.

I only open with that slight bit of hyperbole to underline the fact that this is not a corner of the world where you might expect to find a discussion about the value of the public option or a single-payer healthcare system as a solution to what is becoming a completely out-of-control sector of the economy. But in this political season, where vicious verbal spitballs are tossed at opponents with nary a care for veracity, perhaps it’s time for each of us to take a step back and look at point of view we haven’t really considered before. Just to set an example to the flamethrowers in Cleveland and Philadelphia, of course.

Not Just Too Expensive, But Too Complicated

The loud political rants about healthcare focus on the exorbitant costs of hospitals, nursing homes, drugs, doctor’s salaries – if you are reading this you are already familiar with the litany of complaints. Drugs running more than $100,000 a year are hitting the pharmacy shelves with increasing frequency.  Health insurance premiums are skyrocketing  to pay for it, with patients bearing much higher deductibles just so they can feel a bit of the consequence of their choices – both in taking responsibility for maintaining their health and for the treatments they select. 

Within the last year, I’ve seen a proposal that patients be allowed to take out what amounts to a mortgage to pay for some of the higher-priced treatments. That means as you begin to pay off your college debt sometime around the age of 50, you can start to look forward to assuming another big bill to stay on this side of the grass. Ouch!

Patients aren’t the only ones feeling the pinch. Health insurance companies are sinking under the weight of regulations and requirements so onerous that they can no longer operate under a legitimate business model – meaning one that might result in a profit. (“Heaven forfend any private entity make a profit,” – thus spoke Attila’s little sister sarcastically.) Instead, we saddle the insurance companies with so many competing requirements (medical loss ratios and basic plan standards, for example) that not even Houdini could get out alive.

Since I have spent much of my career consulting in the pharmaceutical industry, I might let this particular sleeping dog lie. Suffice to say, patients and other payers in the United States pay the brunt of the cost of drugs mostly because we can. We just can’t for much longer. In most of the rest of the world, drug prices are capped or some places are just so poor the drug companies give it to them. Expect that to change as the economic balance in the world shifts. It’s an industry that is shifting its business model because the old one is not sustainable.

Let’s Talk Complicated

If you couldn’t sink our healthcare system with ridiculous costs, including more indigent patients, you might be able to poke the last hole in the boat by saddling all the stakeholders with an increasing amount of paperwork and regulation. At some point, the players just give up.

Doctors, hospitals, health plans, patients, biopharmaceutical and device manufacturers all now live under so many regulations and requirements to do business, that doing business in a rational way is becoming increasingly impossible.

That is not hyperbole. That is reality. Think Meaningful Use.

At tax time, patients have to prove they have health insurance or pay a penalty.

Physicians are required to prove they meet quality measures which change all the time, are incomplete or just plain un-meetable. In order for physicians and hospitals to qualify to be paid by Medicare and Medicaid, they have to meet so many constantly changing rules, regulations and requirements with shifting deadlines that some have thrown up their hands and want to opt out of taking public money completely. But not so fast. If you are a physician or a hospital, most of your patients are over 65 and have Medicare or are indigent, disabled or in some way unable to work and are on Medicaid. It isn’t that easy to just opt out.

I’ve already discussed the difficult rock and hard place in which health insurance companies find themselves.

Would Single Payer Just Be Easier?

What does all this have to do with the public option or a single payer system? A lot. At some point, the focus needs to return to a simple transaction between a patient and a healthcare provider where the only issue on the table is the patient’s health. Perhaps the only way to make that happen is to remove business from the business of healthcare and provide a universal option. Because simply, if government needs to regulate business to the point where it is almost impossible to conduct it in a rational way, perhaps it’s time to get out of the business altogether and just concentrate on providing healthcare where payment is off the table completely for most patients.

Attila’s little sister could argue against that previous paragraph all day long because every word comes with a caveat. None of the aforementioned is as simple as I’ve stated it, but in the end, it seemed important enough to look at how other people see the problem. The problem is getting healthcare to people who need it, and a lot of effort and money is spent doing anything but getting doctors and patients together in the interest of the patient’s well-being.

I really do invite all kinds of comments and disputes to my facts and my reasoning. It’s a political season, and it seems like a good time to look at a political solution to a growing monstrosity of a problem high on the agenda of both parties.





Posted in biotechnology, electronic patient records, health economics, health insurance, health IT, health policy, health reform, healthcare marketing, pharmaceutical marketing | Leave a comment

A Pot Luck Health Wonk Review – Breathe This In


Chris Fleming has posted A Pot Luck Health Wonk Review at Health Affairs Blog.  Many thanks to Chris & crew for hosting a great edition – we all greatly value Health Affairs ongoing participation!

As Chris said in his post, “Despite the absence of a post on medical marijuana, we’ll call this a “Pot Luck” edition of the Health Wonk Review.”

So breathe deeply, or as some contemporary presidents have preferred, don’t inhale, and ingest this panoply of wonkery.

Posted in biotechnology, consumer health apps, electronic patient records, health economics, health insurance, health IT, health policy, health reform | Leave a comment

Human Nucleus: Your Analyzed Individual Genome is the Basis for Population Health In Extremis

diamandis and HLI Human Nucleus (2)

You can know and affect your health future now. Human Longevity Institute is launching Human Nucleus, a place where you can have your genome completely analyzed into its millions of component pieces of information. That information is actionable immediately, and remains as part of a learning database from which you continue to benefit.

The first cohort of 200 participants is through the pilot phase, and the program is now opening to a wider audience on his email list, explained Peter Diamandis MD, co-founder of Human Longevity Institute  and the force behind this transformation of the way we think about healthcare. Dr. Diamandis is a leading futurist, Chairman and CEO of the XPRIZE Foundation and the co-founder of Singularity University.

To participate, you can fill out an application for the team to determine if you fit the criteria. If you make  the cut, you spend a day in LaJolla, CA with some of the sharpest and most forward-looking healthcare minds on the planet for a new level of a full medical workup. The cost? $25,000 buys you the chance to be part of a massive initiative to move healthcare into a future.

Manage Your Health Portfolio

Dr. Diamandis envisions that patients in the future will be able to “manage your health information the way that you currently manage your wealth portfolio,” he said during a Google Hangout  on Saturday afternoon with HLI’s Chief Medical Officer Clay Perkins. HLI’s stated goal to help move healthcare from Sick Care to a true healthcare system.

“Over time, we’ll see more emphasis on this time of care and less hospital beds,” Dr. Perkins said.

Exciting? Just a little. And by the way, if you wait a few years, the price of the genome sequencing is expected to drop to about $3,000. What is the price of waiting? You may save $22,000 by waiting for the commercial rollout or, like at least one participant in the first 200, if you spend the $25,000 today you may save your life by finding something that would not have been discovered until it was much more advanced and fatal.

If they find something amiss, they work with your physician to immediately find a top specialist to take action. Already, the team has found serious issues in about one-third of participants – issues that were able to be proactively addressed – and now the team is already getting thank you notes from a few people whose lives have been saved.

Population Health In Extremis

The idea of medicine being this personalized almost runs counter to the notion of population health, but actually it is population health in extremis.  Your highly secure information is first analyzed for your personalized health risk assessment and individual care plan around the assessment. Then you data is aggregated and analyzed along with all the other de-identified data resulting in ongoing machine learning insights. “The more data we have, the more we learn about you.” Participants are learning more about themselves as Human Nucleus learns more about the pool of participants.

The studies are being conducted in tightly controlled experiments that will be published in peer-reviewed journals.

“It’s a fundamental concept. If we can determine based on your genomics, [we can determine] what you are likely to die from. . .Your genome is your health future and it give you the probabilities, mixed in with nurture and your style…it tells us what to look for early on. . . it’s as fundamental as it gets,” Dr. Diamandis said.

The long view on the project is to find the secret to aging well by studying people who are healthy into their 90s and beyond. For details, check out Human Longevity Institute here and click on the Health Nucleus video on the home page.

“This is an early prototype of what human health will look like,” Dr. Perkins said.


Posted in biotechnology, consumer health apps, electronic patient records, health economics, health insurance, health IT, health policy, health reform, healthcare change management | 2 Comments

Health Wonk Review, The Musical


And now, for your dancing and listening pleasure, Health Wonk Review, the musical

David Harlow of HealthBlawg’s Health Wonk Review is Bustin’ Out All Over. Hat tip to Rogers and Hammerstein. Listen here.

For more Harlowfun, tune in every other Tuesday to Health Wonk Review On Air with David Harlow. Click here to listen or participate on Blab.

Posted in biotechnology, consumer health apps, elearning, electronic patient records, health economics, health insurance, health IT, health policy, health reform | Leave a comment

HIT, LGBT and ACA: Health Wonk Review from Tinker Ready

untitledTinker Ready of Boston Health News delivered a wide range of health policy thought for this edition of Health Wonk Review.

Read it here just in time to study for David Harlow’s Health Wonk Review Blab today at 1 p.m. Eastern. Catch him and join in the conversation. Just click on this link.

Photo: Great hospital design! Tinker Ready offers a little color from the former home of the Hospital de la Santa Creu i Sant Pau in Barcelona.

Browser alert: I found that Chrome worked best to get full functionality of Blab. With Edge and my Android browser, I could see and hear David but couldn’t speak to him. So if you want to chat with David, try Chrome.

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