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Mar 25 2015

Report from the front lines: Technology, engagement, and killing paternalism

By healthcare industry, politics, technology

I’ve spent a good portion of the last two months on the healthcare equivalent of the political stump – called the “rubber chicken circuit” in political circles. Thankfully, there was no actual rubber chicken served during these sojourns, although there was the incident of the seductive breakfast sausage, followed by my solo re-enactment (off stage) of the bridal salon scenes from the movie “Bridesmaids.” I will draw the veil of charity (and gratitude for travel expense coverage) over the details of that incident, and just advise all of you to stick to fruit, cereal, or bagels at conference breakfasts. ‘Nuff said. My original editorial calendar plan was to turn this into a series of posts, broken down by focus into technology and clinical categories. However, since a big part of my goal in standing on the barricades at the gates of the healthcare castle, waving my digital pikestaff in service of system transformation, is breaking down silos … well, go grab a sandwich, and a beverage. This is gon’ be a long one. HIMSS Patient Engagement Summit In early February, I headed to Orlando for the first Health Information and Management Systems Society (HIMSS) Patient Engagement Summit. I was asked to participate in two panel discussions, one titled “Patient Perspectives: The State of Engagement,” the other “Can We Talk? The Evolving Physician-Patient Relationship.” Both were moderated by Dr. Patricia Salber, the bright mind behind The Doctor Weighs In. Being a person with no letters after her name (like Elizabeth Holmes [update: she’s trash, so redacted] and Steve Jobs, I’m a college dropout), I’m used to showing up at healthcare industry events and being seen as something of a unicorn fairy princess. That’s how people commonly called “patients” are usually viewed in industry settings outside the actual point of care. Healthcare professionals/executives are so used to seeing us as revenue units,…

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Nov 18 2013

Healthcare.gov and me: I win!

By healthcare industry, politics, technology

Unless you’ve been living under a rock since October 1, you’ve heard that Healthcare.gov, the site where Americans can shop for health insurance, had a rocky start in life. OK, it was an epic mess. I was one of the people who was eager to jump on the site on October 1, since I haven’t had health insurance since I completed cancer treatment in 2008. That cancer diagnosis and treatment put me in the pre-existing condition pile, which put renewal insurance premiums for my individual coverage at an eye-popping level. You can read the details on that here. On October 1, I hopped on my Mac, and surfed over to Healthcare.gov … and had the same experience everyone else seemed to be having: That continued over the following seven days, with me developing a nice little flat spot on my forehead from head/desk-ing my way through many attempts per day at getting past the first step of creating a profile on the site. Even when I had completed that process of creating a profile, every time the site announced “Success! Click here to continue.” I clicked “there” and … got a blank page. On October 8, I realized that I, and the site’s developers, might have missed something. I was using Google Chrome, my default browser, and the dominant browser across the web. Could it be that the dim bulbs that built the Frankenstein that is the Healthcare.gov site optimized the site only for native browsers? I opened Safari, and discovered that yes, they were indeed that dim, because even though the site loaded at the speed of a slug on Quaaludes, it did load. And “Success!” allowed me to continue the enrollment process. No blank pages. I re-enacted scenes from 1995, when I would log on to Netscape to download email…

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Jun 23 2013

Stetho-Snopes: Time for some rigorous myth-busting in healthcare?

By healthcare industry, politics, technology

It was recently revealed that an Excel error contributed to the European fiscal crisis, and a continuing global economic recession/depression. Paul Krugman called the revelation the Excel Depression in the NY Times.  Certainly lives are at stake when the success or failure of large economies are at risk, but not nearly as many lives as are at stake every day given the lack of transparency (and even, in some cases, plain truth) in bioscience research and medical outcomes reporting. Ben Goldacre gave a barn-burning TED talk, “Battling Bad Science,” in 2011. He gave another one in 2012 in which he called the data manipulation in scientific research the “cancer at the core of evidence-based medicine.” His point? We cannot make a meaningful decision in the absence of ALL the data. Tim Berners-Lee, the man who invented the actually-useful-to-humans WWW part of the Internet, has consistently called for raw data – ALL the raw data – NOW. Paul Levy, the former CEO of Beth Israel Deaconess Hospital, recently blogged about the failure of the Journal of Pediatric Surgery to reveal, in a report on a surgery for sunken-chest deformity, a widely-reported death of a teenage boy after said surgery, even though that boy’s case is used as an example of avoidable medical error in safety bootcamps for medical interns and residents. Boggles the mind, doesn’t it? Even if the data is fully reported, the PR geeks who write up the announcement of results might get that report 100% wrong. Witness the recent contretemps over a University of Chicago study on patient engagement, shared decision-making, and healthcare cost control. A full outline of that mess, by ePatient Dave deBronkart in Forbes, will give you 411 on that story. The Cliff’s Notes: it was a post-discharge survey, not a full study; it measured attitudes, not outcomes; and the press release was sent out on…

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Jun 11 2013

Did someone say “palooza”?

By healthcare industry, politics, technology

I’m still recovering from the month of May. I was all up in the healthcare, pretty much 24/7, which differs not-much from my usual roll, other than that in the period of three weeks, I was in DC for eight of 21 days, May 14 through June 5, attending HM13 (the annual meeting of the Society of Hospital Medicine, which I covered for The Hospitalist magazine podcasts) and Health Data Palooza IV as just-me on a Consumer Circle scholarship. What I saw and heard at both conferences made me hopeful for the future of healthcare … sort of. As inspiring as both of them were, I found the SHM conference more of a hope engine for just-e-patient me than the rah-rah tech-fest that was #hdpalooza. Granted, HM13 was organized and run by the medical society that has a big upward swing on its membership, and on the income of said members, which means that there was a breadth and depth of content that wouldn’t be available at non-clinical conferences. I got plenty of mental floss out of both of them. Here are the high (and low) lights: Still glaringly missing from all of this rah-rah is the actual, real-world voice of the patient – HM13 can be (somewhat) forgiven for that, since it’s a medical society annual conference. I will note that, in all my interviews for HM13 podcasts, the question, “How can patients help?” was warmly welcomed by everyone asked, and answered with enthusiasm and insight. Figuring out how to break the walls down between clinicians and patients – “gimme my damn data,” two-way edition – using health IT systems as the wedge seems to be a place to start. But letting patients help there is utterly crucial. Speaking of sitting too long … time for a bike ride to my…

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Feb 12 2013

Medical Monopoly: Medicine has a major image problem

By healthcare industry, media commentary, politics, technology

When you hear the word “monopoly,” does it fill you with a warm and fuzzy feeling? (Unless you’re Hasbro, you really should say no, unless you’re a cyborg.) Healthcare is a monopoly. We can’t DIY cancer treatment, or surgically repair a broken hip for ourselves, so we have to go to the medical-industrial complex to regain our health if we wander into the weeds, health-wise. We also have deep difficulty accessing pricing information. I’ve talked about that here over the last few years. Maybe not a monopoly in the financial-reg sense of the word, but it sure is mighty like a game of Monopoly. This “chaos behind a veil of secrecy” (all credit for that phrase belongs to healthcare economist Uwe Reinhart) has created the impression in healthcare customers that there’s no way to tell what something will cost before you buy it. You checks the box and takes yer chances. No Get Out of the Hospital Free cards. No pass-the-admissions-counter-collect-$200 option. That’s a rotten way to run a railroad (one of the original monopoly industries in US history), and an even worse way to run a hospital. Dan Munro wrote about this, and the star-chamber cabal that actually sets the prices in healthcare, the RUC, on Forbes.com yesterday. I’ve talked about the RUC myself. And the search for price transparency, which seemed such an outlier activity just a couple of years ago, is now popping up in the Well blog on the New York Times site, as well as on Reuters. The Reuters piece has the addition bonus of quotes from my buddy Jeanne Pinder, founder of ClearHealthCosts.com. (Yesterday was a big day in medical price transparency.) This is the central reason I registered the hashtag #howmuchisthat with Symplur, the healthcare hashtag registry. We all have to start demanding that prices be visible, and that the RUC stop cabal-ing…

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Jun 13 2012

The black box that caused the crash (of healthcare)

By healthcare industry, politics

This week, NPR’s Marketplace aired a piece on what I have taken to calling the “black box of healthcare” – pricing. There is a committee, called the RUC, set up and run by the American Medical Association, that reports to CMS (the federal unit that runs Medicare and Medicaid) on relative value numbers for the thousands of medical procedures that wind up as billing codes in Medicare and your health insurer. Those relative value numbers = PRICES. This isn’t considered price-fixing under anti-trust rules because the RUC reports to CMS, which then publishes the numbers on the Medicare reimbursement rate schedule. So the AMA isn’t publishing the prices, CMS is. Fox, meet henhouse. Or, stated in another way: airplane, meet the black box that is making you crash and burn. The Marketplace page linked in the 1st graf has plenty of linkage to additional context for this issue. Read them, and weep. How is it that an industry whose aggregate cost is now at close to 20% of US GDP gets to set its own prices, and then have them published by the federal government as The Official Price List? It’s called effective lobbying, and it’s so effective that it’s essentially kept access to the pricing committee process a secret for decades. Which makes it pretty clear why so much of our GDP goes to healthcare, doesn’t it? The sound bite in the story that I found the most hilarious was from Charlie Baker, the former CEO of the Harvard Pilgrim health plan in Massachusetts. His quote: By having a process that for all intensive [sic] purposes isn’t a public process, and doesn’t appear to actually be accountable to much of anybody, I think that’s kind of un-American! I find this hilarious because Harvard Pilgrim is a member of America’s…

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Mar 27 2012

Did Warren Buffett really say THAT?

By healthcare industry, healthcare price transparency, politics

Well, it turns out he did. What did he say? Hang on. I’ll get there in a sec. First, I’ve been silent here for a while (holy crap, I haven’t posted since Jan. 31!) – my only excuse is that I’ve started blogging for clients, and ran out of words. Not really, but that’s my story, and I’m stickin’ to it. Back to our programming already in progress: Did Warren Buffett really say THAT? WHAT DID HE SAY? Well, he said this (on CNBC in July last year), kids: “I could end the deficit in 5 minutes. You just pass a  law that says that anytime there is a deficit of more than 3% of  GDP, all sitting members of Congress are ineligible for re-election.” Boo-yah! This is essentially what my buddies at No Labels have been saying since they released their 12-point plan to make Congress work back in December. #1-with-a-bullet of those 12 points is No Budget, No Pay. Which, by the way, had a subcommittee hearing earlier this month. Progress. It’s a game of inches, but we’re racking up those inches. Speaking of fighting for inches, the healthcare reform act – or Obamacare, whatever your radio tells you that you should call the Patient Protection and Affordable Care Act – is in oral-arguments phase in front of the Supremes this week. I’m on record as thinking that this iteration of healthcare reform isn’t anything but an attempt at healthcare *payment* reform, but that’s not why I brought this up. If you care about controlling healthcare costs – your own or anyone else’s – you must read e-Patient Dave deBronkart’s latest epic opus on what happens when a healthcare consumer tries to find out what something costs. The insurers don’t know, the hospitals sure as **** don’t know, so what’s a…

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Jan 31 2012

FDA paranoia – who knew?

By politics, PR, technology

In its rigorous search for food & drug safety, the FDA added searching through the personal emails of agency employees who questioned FDA decisions. That would be an oops – for both sides of that story. Here’s the lowdown: on Sunday (Jan. 29, 2012) the Washington Post reported that the FDA was being sued by staffers – scientists and doctors charged with testing medical devices – for harassment and wrongful dismissal as a result of the agency’s surveillance of their personal email accounts. That email surveillance revealed that the FDA staffers were contacting Congressional staff with whistle-blower complaints about FDA approval of devices that the scientists and docs thought were a risk to patients. Hue and cry! Bad FDA! Actually, I agree that the snoopy surveilling of personal email accounts is creepy, even wrong. However, here’s the rub: the FDA staffers were accessing their personal email using computers at work. At the FDA. Within the Federal government IT infrastructure. You know, the people that oversee other stuff like Echelon. And the Pentagon. Gee, FDA guys plotting whistle-blower campaigns on work computers – stupid much? On the FDA side of the story, we have creepy fascist tactics deployed by an agency that should be all about making sure that no pharmaceutical, no medical device, no food product makes anyone sick. Or worse, dead. The record there? Not so stellar. Can you say Vioxx? On the outraged-former-employee side of the story, we have some folks who thought they were veryvery smart (scientists and MDs always think that, trust me), but who played veryvery stupid on the interwebz. Accessing personal email on a computer that belongs to your employer is pretty dumb if you’re doing or saying anything that casts a shadow on the hand that feeds you. Yes, that means you become…

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Jan 24 2012

It’s the education, stupid …

By media commentary, politics

The headline on this post is inspired by both the 1992 Clinton campaign meme, and by my personal belief – shared by many – that education in the U.S. is in trouble, and will sink us if we don’t act decisively and quickly to change a broken system. The infographic tells the story. You can click it to open up the source in a new tab, and get the full weight of the problem broken down pretty darn well. Some high(low?)lights: only 30% of U.S. students in K-12 are grade-proficient in math and reading 70% (that’s SEVENTY PERCENT, my friends) of 8th graders can’t read at grade level Every 26 seconds, an American kid drops out of school (can you say “brain drain”?) There are only 50 million skilled workers in the U.S. – there are 123 million skilled job openings (still wonder why jobs get outsourced?) In Finland, South Korea, and Singapore, teachers are drawn from the top 1/3 of college graduates. In the U.S. they’re typically from the bottom 1/3 of college graduates. Looks like the old cliché “those that can’t, teach” might be true? Newly-minted lawyers in the U.S.  make, on average, $115,000 per year more than a newly-minted teacher here. Newly-minted engineers and lawyers earn less than teachers in South Korea and Singapore. Is that math you can understand? The U.S. comes in at 30th in math, 23rd in science, and 17th in reading when stacked up against global competition. Is the picture starting to become clear to you? We’re in trouble, not just right now, but our future’s looking pretty dim, too. If we can’t educate our children at a level that makes them – and our society – competitive globally, we’re looking like Rome after the lead poisoning set in: bleedin’ dim, and getting…

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Jan 19 2012

Does voting still matter in the wake of Citizens United?

By politics

It’s [still] the silly season – which seems like it’s been going on forever, even though it’s only been a little over a YEAR now – and the field of Republicans jockeying for the chance to run against Barack Obama in November is shrinking by the day. Off the list are Tim Pawlenty, Gary Johnson, and Herman Cain, who all bailed before there was an actual voting opportunity. Michele Bachmann dropped out after coming in dead last in her home state’s caucuses, and Jon Huntsman drop-kicked himself today (Jan. 16, 2012) after a down-in-the-pack finish in Iowa and New Hampshire. Still in the hunt are Mitt Romney, Rick Santorum, Ron Paul, Newt Gingrich, and Rick Perry. My question, driven by what seems to be a very short selection process: Does voting still matter? I worry that the answer has drifted no-ward, particularly since the Bloviating Herd (so effectively tagged by Calvin Trillin as the Sabbath Gasbags) shove endless streams of drivel at us 24/7 about projected winners in the days, weeks, and months leading up to a primary or election. The fact that they then, day-of, become so very Caesar’s Wife about not calling anything until all the polls close is … laughable. The actual citizens I hear talking about voting and candidates often say they vote their wallet. That’s a human reaction. My human reaction is to vote my humanity, not my pocketbook. I’m sure that puts me in the Crazy as a Shithouse Rat column for many people, but here’s my reasoning: I’d rather vote with an eye on human history – past, present, future, all of the above – instead of for someone who solely promises to put more money in my hands. Or at least take less out of them. Because the sad truth is they’ll…

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