About 8 years ago, I started Health System Ed as an educational portal about the value of health information technology. It started with a blog called “Imagine” that described the dream of having all relevant patient information, all the time, in real time, to make good decisions about the patient in front of you based on best practices that had been determined by measuring what treatments worked in which patients.

Lately, as I write about genomics and sensored medical devices, it is clear that we are oh-so-close to the dream. In 2010, I didn’t have a clue how long it would take to achieve lift-off. Today, all the pieces are in place for people (masquerading as patients to the healthcare system) to know what is going on inside their bodies even before they manifest illness sometimes.

• Scientists and researchers can peer inside the genetic code to see what has gone awry, and they can snip, delete and replace poor genetic codes.
• Doctors can measure results by getting information about the patient in real time – whether it is a glucose reading to track the efficacy of your medication dosage, a heart rate monitor looking for signs of trouble, or a sensored knee brace telling your orthopedic surgeon whether you are doing your rehabilitative exercises
• Patients can know how they are doing and adjust their behaviors
• Payers know what works, what to pay for, and when to implement resource utilization strategies to encourage best practices

The electronic patient record systems are mostly in place now to capture information. They may need to be tweaked, upgraded, or replaced with the next generation of software, but the infrastructure is in place today. Next, we will build the analytics to turn data into usable information.

One of the most beneficial aspects of capturing patient data – everywhere, all the time – is that ultimately people will get the most effective treatment first which will drive down costs to the system and extend the healthy human life span. When we know what works in whom, it is a much shorter trip from disease to health.

It is nothing but exciting. We aren’t there yet. But we can see “there” from here.

Peggy is an author and writer who specializes in healthcare.

Over at Health Wonk Review, the hits keep coming. This month, Julie Ferguson posts her compilation of health wonkery at her home blog turf Worker’s Comp Insider. Click to go there for the fun or check it out right here.

Through vacations, heat waves, and days on the beach, our health policy wonks are still on the job. As we eke out the remaining days of summer and slouch toward the interim election, they continue their relentless focus on opining about the issues of the day. Check our August edition entries.

• First up, Joe Paduda unpacks the generic term to uncover the varied approaches to universal coverage currently operating at far lower cost and far better outcomes than our “multi-payer” “system” in his post What exactly is single payer at Managed Care Matters.

• Louise Norris tells us that the Trump administration has finalized rules that will make it easier for many Americans to buy short-term health insurance plans that may be less expensive – but aren’t as comprehensive as ACA-compliant plans. She explains the rules and how they’ll affect consumers in her post at healthInsurance.org Blog: ‘So long’ to limits on short-term plans.

• Folks at the Medical Care Blog look at an important public health issue, a children’s health crisis. Dr. Julie Graves – a family medicine and public health physician who previously served as a regional medical director in Texas – addresses the ongoing family separation crisis at the border: What’s Next? The Ongoing Crisis for Children Taken from Families Seeking Asylum at the US-Mexico Border. (Related, see her recent article on the topic at CNN: The surgeon general needs to step up for migrants.)
• When should services be covered by government insurance compared to private insurance? How does the public/private insurance vary around the world? Jason Shafrin, the Healthcare Economist investigates: What should be covered by government vs. private insurance?

• At Healthcare Renewal, Roy Poses says “This is starting to get tedious. ” He notes that it used to be nearly all the cases we found of ill-informed and/or mission-hostile health care management were about top leaders of big private health care organizations, eg, hospital systems, insurance companies, pharma/ biotech/ device companies, etc. But he notes that since 2016,  the locus has shifted: Ill-informed, Mission-Hostile Health Care Leadership… in the White House and the US Department of Health and Human Services. He makes his case with a roundup of cases.

• At InsureBlog, Patrick Paule puts paid to the notion that Medicare4All is any great deal or panacea. he makes his case in his post On BernieCare.
• What’s worse than needing help with gait, mobility and balance? Being told you need a walker. No wonder, when the typical walker basically screams “frail elderly,” and is difficult to use as well. At Health Business Blog, David Williams talks with neurologist Patricia Kavanagh about how she teamed up with a design and production team to a modern device that is more functional and stylish in an effort to get her patients with Parkinson’s and other movement disorders to use a walker.
• Vincent Grippi of the CareCentrix’s Homefront Blog submits this month’s episode of #CareTalk, in which David Williams (Health Business Group) and John Driscoll (CareCentrix) discuss Trump’s fight with Pfizer over drug pricing, and more.
• Here at Workers Comp Insider, we’ve yet to do a post on this important occupational health issue, but call it to your attention. We were horrified to see that the EPA is loosening regulations that will expose more workers to a know carcinogen:  EPA is now allowing asbestos back into manufacturing. At least one town in Russia – Asbest – is celebrating.

Next issue: September 20 – Andrew Sprung – xpostfactoid

This article is cross-posted at www.workingwithsmes.com.

In aviation, safety is always the primary concern. In fact, aviation’s safety record is so stellar that it is considered a model for healthcare. That is quite a testament.

However, a retired pilot friend recently bemoaned that the emphasis on FAA rules and regulations has overtaken concern about safety, and aviation is not better for the change.

“Now we’re only concerned about compliance. We have a cast of thousands as support staff. When I started flying in 1964, Part 91 federal regulations were about 30 pages. You could memorize it. Today, it is hundreds, if not thousands, of pages and nobody can possibly know everything that is in there. We are less safe today than we were 50 years ago,” he complained.

Making and keeping track of all those regulations costs aviation a lot of money. It requires a boatload of federal regulators to oversee them, and costs private carriers a bundle of money to hire people to monitor every jot and tittle of the laws. One misstep, and they can shut you down. And, he concludes, neither the passengers nor the airline employees benefit from this over-regulation.

Will Healthcare Follow Aviation Again?

Just about everyone in healthcare knows about the vaunted aviation checklist, and how it has become standard procedure in many operating rooms today. Books are written and consultants make good livings just teaching the checklist approach to safety. The checklist is a great tool. Healthcare is better for following aviation down that path.

But is healthcare going to benefit by following the FAA down the road to over-regulation? We can trip on our path toward safety by using regulations as stumbling blocks instead of using some common sense rules to pave a smooth road to improved quality and performance.

So Many Rules They Can’t Be Followed

Just yesterday, I was observing a training class that I wrote for a major pharmaceutical company that shall remain nameless, but one that we all know and love. We were training hourly line employees on procedures that affect product safety. To a person, they had one complaint: standard operating procedures were becoming downright cumbersome and made it very difficult to follow, let alone implement, them.

One veteran employee said when an incident occurs, someone writes another procedure and adds it to the book of procedures. Nothing else in the book is deleted or changed, and so it is becoming nearly impossible to follow. In fact, the employee complained that SOPs are written in response to each incident, meaning that many new SOPs only relate to one isolated incident each. The SOPs are losing their meaning and rationale. It is just a jumble of unrelated knee jerk reactions to specific incidents.

The employee concluded the company was creating more problems than it was solving by having a procedure manual that could not be followed. There are now so many rules to follow, the rules can no longer be followed, the employee complained.

Is All of Healthcare Headed Toward Unwieldy SOPs?

With the passage of the Accountable Care Act, known colloquially as ObamaCare, many believe that we are headed down a path of over-regulation. Where common sense and good medical practice once dominated the industry, healthcare practitioners (formerly called nurses and doctors) are overwhelmed with rules regarding how they practice, to which the actual art and science of medicine is taking a backseat.

At a recent visit accompanying a friend to a physician’s appointment at a hospital center, we observed that we were two of only four people sitting in a new waiting room with 25 chairs, two large receptionist desks – one that seated four and another with 12 stations – and a physician accompanied by a nurse and a receptionist carrying around a brochure rack deciding where to place it. Let me say that again. A highly skilled specialist was carrying around a brochure rack with his nurse and receptionist trying to find a place for it.

In this brand-spanking-new facility where our doctor’s office had been moved since our last visit (from a very modern, extremely functional office building now sitting vacant in the parking lot), we also observed not one – but two – printers behind the one receptionist desk and a wall of file drawers. We filled out our medical information on a clipboard, which we have done for each of his visits for the last three years to have it inserted into his manila file folder.

Sigh.

The Trend Is…

By personal experience as well as professional observation, the trend is toward more regulation, more staff to assure compliance with the rules, and an ongoing steady stream of physical and electronic paperwork to track patients.

Instead of continuing to ramp up our regulatory oversight into the stratosphere, perhaps it is time to – if I can paraphrase my retired pilot friend – throttle back and re-evaluate what we are really trying to accomplish.

Photo by NeONBRAND on Unsplash

“Beware the Ides of March” –Soothsayer to Julius Caesar
“Fear not the Ideas of March” –Health Business Blog to the wonkosphere

Your friendly neighborhood drug dealer

Count on Drug Channels to make sense of even the most convoluted pharmacy business models –and convoluted they are. This time the topic is the emerging trend of point-of-sale (POS) rebates. Did you know that many pharmacy benefit plans act like reverse insurance, with the sickest members subsidizing the healthiest? POS rebates start to right this wrong and bring forth uncomfortable questions such as: Where have the rebates been going until now?

Crocodile tears

Managed Care Matters shares its perspective that the Administration’s efforts to undermine the ACA have yielded bitter fruit on the marketplaces. Some premiums are up by 30% and meanwhile Congress is doing little or nothing.

Two years ago you couldn’t read the news without hearing about the disastrous premium increases due to “Obamacare,” but the media is silent now.

So what’s going on? Our blogger has a theory: The media is being manipulated and chasing bright, shiny objects.

Skimpy is as skimpy does

InsureBlog likes CMS’s proposal to restore the maximum policy length of short-term medical plans to 12 months from three. That’s even though some news outlets call the plans “skimpy” and some healthcare policy analysts consider such plans to be leeches on Obamacare, because they may siphon the healthiest people out of the marketplace risk pool and drive up premiums.

Location location location

When my son was a toddler, we trained him to say “location location location” when asked, ‘what are the three most important things about real estate?’ I still remember him driving a realtor crazy when one tried to pitch us on a house we didn’t like.

Now, Workers Comp Insider has decided that location is destiny in healthcare, too, declaring ‘It’s the Zip Code Stupid.’ Insider cites a recent JAMA Internal Medicine study that shows geography is “the biggest X-Factor in today’s American Hellzapoppin version of healthcare.”

Location: Wonk zone

The Hospital Leader (not to be confused with the Dear Leader) helpfully explains that “We need creative solutions” really means “the problem we are trying to solve has no answer.” Case study: Hospitals, hospice and SNFs – The big deceit.

A pending bill seeks to establish a state-based individual mandate in New Jersey. But a provision targeting employees of small businesses could inhibit Association Health Plans from selling insurance that does not comply with small group rules. Xpostfactoid explains.

Who knew? Health Care Renewal informs us that the ostensibly libertarian Washington Legal Foundation has become a front for healthcare corporate leaders –and leaders from other fields— to operate with impunity. The foundation’s campaign to abolish the Responsible Corporate Officer Doctrine failed, but the damage was done. (Hat tip to Health Care Renewal for anticipating today’s theme by including “methinks” in its cover note.)

Local talent

The Health Business Blog is now a teenager. I ran the annual round-up of favorite posts by month.

CareCentrix CEO John Driscoll and I rant and rave about Amazon and innovation in the latest monthly episode of #CareTalk.

Singing from the himmnal

Health System Ed shares results from the 2018 US HIMSS Leadership and Workforce Survey, a survey of providers and vendors.

Top themes: privacy and security, process improvement and workflow, data analytics, business intelligence to inform clinical decision-making remain top of mind. 

Well that’s it for the Ideas of March edition. Watch your back today!

—

By healthcare business consultant David E. Williams, president of Health Business Group.

The 2018 U.S. HIMSS Leadership and Workforce Survey provides some insights about the state of health IT today and where its efforts will be focused for the next 12 months. With input from 369 hospital/health system and vendor respondents, the survey revealed that privacy and security, process improvement and workflow as well as data analytics and business intelligence to inform clinical decision-making remain top of mind.

For a glimpse of the 2018 priorities of the HIMSS respondents, this chart shows the Top 10 concerns of hospital leaders and the correlating priorities of the vendors who serve them. While there tends to be agreement about the top 10 issues facing health IT today, vendors and their customers do not always have alignment about their relative importance.

TOP 10 HEALTH IT PRIORITIES FOR HOSPITALS AND VENDOR CORRELATION (click to enlarge)

A Saturation Point

One of the most telling discrepancies between hospital and vendor respondents was the fact that hospitals overwhelmingly either anticipated stagnation or reduction in hiring in 2018 while vendors are still showing aggressive hiring practices. Vendors may be responding to last year’s demand and this survey indicates a need for them to adjust their projections to align with their customers.

CURRENT WORKFORCE VACANCY (click to enlarge)

This trend may show a saturation point for hospitals regarding how much more change and expense they are currently willing to incur to play the expanding health information technology game to the level that the government, innovators and vendors would like to push them.

Willingness is only part of the equation. The next generation of health information products in development will move information and technology to further integration and greater utility for patients, providers and payers. This trend is a juggernaut that will take both hospital and vendors with it in the next few years. Guaranteed.

Source: https://www.healthinsurance.org/blog/2018/02/15/health-wonk-review-for-february-15-2018/
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Here it is…the FIRST EVER Double Edition of HWR. Part One is all ACA and Part Two is everything else you have come to expect from the Wonkers who wander through healthcare land. Enjoy. And comment below. We love hearin’ from ya.

Also, thank you to The Precision Medicine Daily this week that saw fit to include Health System Ed’s blog on CMS Meaningful Use Payments to Providers: Incentives or Sophie’s Choice.

Sophie’s Choice was an award-winning 1983 movie based on the William Styron novel about a Nazi concentration camp survivor who was forced to choose which of her two children to send to the death camps. In this most heart-wrenching scene ever filmed, the woman must choose and begs to choose “neither”.

For healthcare providers who are caught in a regulatory net by participating in government-funded programs, they were given a choice between installing an electronic health record system, attesting to meeting a list of nearly-impossible targets to get reimbursement for their multi-million dollar investments, or choosing not to participate which resulted in losing participation in said government-funded programs and incentives.

Most providers bit. They had no choice. And when it came time to collect the Meaningful Use incentive dollars, they attested to meeting at least the minimum requirements. The government bit back.

Department of Human Service auditors in the Office of Inspector General most recent review estimated that the Centers for Medicare and Medicaid Services has overpaid more than $729 million to providers whose paperwork didn’t pass muster. That’s more than a big whoops for many organizations. That can be an organizational nightmare to reconstruct and prove that your claims were accurate.  Click here to read the story.

Here’s an excerpt from the HealthcareITNews story reporting the overpayments:

All of these providers should begin – if they haven’t already – gathering the required documentation. While it varies by the program, [Erin} Whaley [partner at international law firm Troutman Sanders]  explained it will range from security risk assessments to screenshots. For other measures, providers will need a patient list of an audit log.

And documentation is required for every year attestations are made.

[Matthew] Fisher [partner at corporate law firm Mirick, O’Connell, DeMallie & Lougee] recommended that healthcare providers run an internal audit or review to ensure all documentation and information resides in one place and can be easily accessed.

Financial and Administrative Burdens

Yesterday, I met a young physician at a barbeque. Our conversation led to the typical “what do you do?” When I asked her what specialty she was most interested in, she said she was considering geriatrics or ob-gyn but that the business of medicine had become so dominant that instead she was thinking about getting her MBA and switching her focus completely. This woman spent her early career as a trauma nurse. She loves medicine and loves patient contact. She is currently doing toxicology research and interested in Alzheimer’s Disease research.  But her experience in the medical field is leading her to the conclusion that her brain and talents might better be used analyzing spreadsheets and business plans.

I used to think that healthcare was a positive driver of gross domestic product and a thriving sector of the economy. Now, I wonder if our focus on healthcare as a business isn’t costing us our focus on patients and causing us to lose some of our talented and dedicated medical professionals to regulation and bottom-dollar mentality. Loss for the patient. Loss for the doctor. Loss for society.

This is not a new thought.  But this is a problem that is becoming so acute that to save medicine, we need to reprioritize what we incent, how we incent it and whether the recordkeeping is worth the price of time, focus and energy toward the business rather than the medicine.

Health technology – like all technology – is making quantum leaps forward while we are looking backward to reconstruct Meaningful Use criteria that are quickly becoming meaningless.

In this article on the future of Precision Medicine here, architects of the future of healthcare at the Precision Medicine Summit in Boston last week said that the future of Precision Medicine is more accurately Precision Health. Precision Medicine was about the use of system data to help doctors make decisions about patients; Precision Health is about patient access to their own data to make good decisions about their own health.

This one move from focus on the system to focus on the individual calls into question the future value of the content of the electronic health record stored in your health system database as it relates to patient care. After all, we knew all along that the patient record was, at best, incomplete. It also further calls into question the value of the Meaningful Use criteria as they relate to the practice of medicine where it is today.

Perhaps CMS needs to call a timeout on the HHS auditors, call the MU money well-spent where it incented progress, sunk costs where it impeded progress, and walk away from this program that was as well-designed as it could have been nearly 10 years ago before we knew what we know now.

I’ve been hanging around the virtual water cooler in healthcare for two decades, and now the promise of technology as it affects and improves our lives is beginning to come to fruition. With that, here is a roundup and just a few developments and their significance to the future of healthcare from a medical, business and financial perspective.

Med-Tech: At the head of the futurist pack is Dr. Peter Diamandis, known for oh-so-many things including a founder of the X-PRIZE, Singularity University and the Human Longevity Institute. In his May 19 Abundance Insider, he looks  at a bionic hand developed in the UK “capable of grasping objects without the wearer’s focused thoughts.  The researchers created a convolutional neural network training the hand and its algorithm on the images of over 500 objects in various orientation and lighting conditions with four programmed grasps that you might use to pick up things.”  Go to the link to see the video. Under that entry, you can read the next story about an 18-year-old Mexican student who designed a bra that detects breast cancer.

Health Biz-Tech: The business of healthcare is all about how we pay for medical services and the structure of the business model. Our current system is focused on an insurance-based payment model. Already, insurance companies are toying with issuing insurance policies in real time based on your current medical history that involves instantaneous analysis of your condition, the company’s risk and what it will cost you to be covered by them. This could blow all the regulations out of the water. It could also call into question the current model of trying to cover everyone with insurance and could instigate a movement to have us begin to look at a different business model completely, especially in light of the kind of Med-Tech advances in the pipeline that will completely alter our outcomes and lifespan.

Health Fin-Tech: How and why certain goods and services get paid keep many an insurance agent, claims administrator and government regulator up at night., not to mention the security people who need to lock down our data to maintain patient privacy. The blockchain has the promise of changing the financial world, and healthcare payments and security will be part of this revolution. I am attending a Meetup of blockchain people in my area this Saturday and I’ll report back at some point.

They say those in a movement need to either lead, follow or get out of the way.

At some point in the history of the evolution of healthcare, government was in a position to lead. In the past few years, it has been in the unfortunate position of having to follow as technical advances outpaced the ability of government to legislate and regulate at the pace of change. Now it is time for government to get out of the way. At some point, we’ll need to regulate for safety and security reasons. But this is not that time.

Julie Ferguson at Workers’ Comp Insider is our creative mistress of ceremonies this week. Here’s what she has to say:

It’s quite the day to be going to press with a new Health Wonk Review. We were trying to think of  a movie themed metaphor for today’s edition but can’t decide between Back to the Future, Groundhog Day or a zombie flick, so we’re going for a mashup.  Click here to read more.