Wednesday, December 23, 2015

Precision Medicine: From Promise to Reality

It was nice to spot a little good news concerning our healthcare system in a recent Fierce Healthcare post by Debra Beaulieu-Volk. The author interviews Carolinas Healthcare System's Gregory Weidner, MD. Here's a link.

Thursday, December 10, 2015

Aetna's CMO advocates scale to solve our health woes; Cynic questions the good doctor's credibility given his employer

I read with amusement a recent post from Fierce Health Payer entitled Harness the power of scale to cut costs, improve outcomes, authored by Harold M. Paz, MD, Aetna's Chief Medical Officer. The author is apparently trying to justify the pending merger with Humana. The article opens with the following altruistic message:
While there are many viewpoints on the best way to fix our health care system, we can agree that a better system means bringing the best practices of medicine to as many patients as possible. The thousands of doctors and nurses that work at health insurance companies nationwide are in a unique position to help achieve this goal. We can work together with health care providers to innovate and improve care, then share what works across a wide range of settings to positively influence care at a broader level. We can also help address gaps in care, particularly for seniors and those with chronic conditions.
A better explanation would be that oligopolists like Aetna seek to gobble up markets, often times via merger and acquisition. Upon achieving market power, the firm can compress costs (in this case, largely reimbursements to providers) via scale and strong-arm negotiation tactics. Meanwhile revenues increase exponentially as the firm gains more customers and can dictate price (in this case, health premiums paid by citizens and employers). Eventually, concerned regulators come along to address the abuse. Op-eds like this piece are obvious PR attempts to sway public opinion. Then the firm's lobbyists will cozy up to politicians and government enforcers to mitigate their intervention. 

Tuesday, November 24, 2015

Is Obamacare in Trouble?

An interesting article ran yesterday in the New York Business Journal by Chris Rauber. Referencing the recent announcement that UnitedHealth Group, citing disappointing financial results, could possibly withdraw from the Obamacare market, Mr. Rauber questions the financial viability of  the new underwriting rules and warns of the potential for ACA Marketplace "death spiral".   

Meanwhile, I have yet to find an individual who bought a full priced plan (without a subsidy) on the exchange and found it to be a good value. If the insured aren't getting their money's worth and the insurers are not making a profit, the scheme will surely fail regardless of federal law and the various intimidation tactics being deployed to force insurers and beneficiaries to participate.

Tuesday, November 10, 2015

Merck, Eli Lilly targeted in federal drug pricing probe

CNNMoney, in an 11.06.15 post, reports:

Lilly (LLY), based in Indianapolis, said it is being asked about "our treatment of certain distribution service agreements with wholesalers," and how that affects the price it is allowed to charge Medicaid.

New Jersey-based Merck (MRK) said it has been asked for documents related to its "contracting and pricing of Dulera Inhalation Aerosol with...Medicare Part D [drug] plans."

Read more in the current issue of Week in Review>> http://conta.cc/1klcQHS

Tuesday, October 27, 2015

Obamacare Foes Head to Supreme Court...Again

Mark Sherman, writing for the the AP via the Huffington Post on 10.25.15, reports:

Opponents of President Barack Obama's health care overhaul are taking yet another challenge to the law to theSupreme Court, and say they will be back with more if this one fails.

A new appeal being filed Monday by the Pacific Legal Foundation contends that the law violates the provision of the Constitution that requires tax-raising bills to originate in the House of Representatives.

Pacific Legal Foundation lawyer Timothy Sandefur said the problem with the law is just one example of how "Obamacare is so unconstitutional in so many ways." Sandefur said the justices will face one challenge to the law after another until it is significantly changed or repealed.

Read more in the current issue of Week in Review>>

Tuesday, October 13, 2015

Getting the Diagnosis Wrong

Danielle Ofri, MD, in a 10.8.15 NY Times post, writes:

Diagnostic accuracy is fiendishly difficult to measure precisely, but it is estimated that doctors get it wrong in one out of 10 to one out of 20 cases. The Institute of Medicine has taken up the subject, and its new report offers the chilling observation that nearly everyone will experience at least one diagnostic error in their lifetimes.

Read more in the current issue of Week in Review>>

Tuesday, September 29, 2015

FHIcommunications presents...

CyberSecurity
                    
Protecting your patients, your practice and yourself from hackers

Tues., OCT 27 | 7:30-9:30 am

Five Star Premier Residences of Hollywood
2480 North Park Road
Hollywood, FL 33021

Register:

Sunday, September 6, 2015

Working Long Days Tied to Cardiovascular Risks

Written by HealthDay News 

Two analyses reported in The Lancet reveal that people who work long hours are putting their cardiovascular health at risk. One analysis found those who work at least 55 hours a week have a 13% greater risk of developing heart disease than those who work standard schedules. The other data set showed those who worked at least 55 hours a week were one-third more likely to experience a stroke, while those who worked 41 to 48 hours had 10% higher risk of stroke. Dr. Paul Wright of North Shore University Hospital acknowledged that reducing work hours is often not possible, so he urged people to focus on modifiable risk factors, such as eating well and exercising.

Wednesday, August 19, 2015

Standalone ERs Fail to Bend the Cost Curve

WH
Ilene MacDonald, reporting for Fierce Healthcare on 8.12.15, informs readers that:
Florida and Texas are the latest states to see an increase in the number of standalone emergency rooms popping up in high-traffic, commercial areas.

WIM
According to the author:

...the care offered is just as expensive as a hospital ER. The Sun Sentinel reports that an average charge for an ER visit in Broward County, Florida, was $3,737 and in Palm Beach County, the average cost was $4,675. Indeed, patients who go to free-standing ERs often complain that the facilities provide misleading pricing information. And critics say that many patients could receive less expensive care from a physician practice or urgent care facility...

Read more in the current issue of Week in Review>>

Wednesday, August 5, 2015

New Device Could Make Bariatric Surgery Obsolete

Varun Saxena, in a 7.29.15 Fierce Medical Devices article, reports: 
ReShape Medical's Integrated Dual Balloon System just burst regulatory barriers, becoming the first device of its kind to earn the FDA's stringent PMA approval for novel, high-risk devices. The Fierce 15 company's device consists of two salt water-filled silicon balloons that reduce appetite by taking up space in the stomach "or by other mechanisms that are not yet fully understood," according to the FDA. 
Unlike invasive weight-loss surgery, which can involve risks like malnutrition following a duodenal switch, involving removal of most of the stomach, the Dual Balloon is inserted through the mouth via an endoscope in a minimally invasive manner. The FDA says the procedure takes less than half an hour and requires mild sedation.

Tuesday, July 7, 2015

Despite provider prioritization of cybersecurity, incidents remain prevalent

In a July 1, 2015 Fierce Health IT post, Katie Dvorak reports on a recent HIMSS survey where 68 percent of respondents stated there had been an attack on their facility recently. Meanwhile, 46 percent reported the attack was due to negligence on the part of someone working within the organization.

While professionals in the healthcare industry say cybersecurity has grown as a business priority at their organizations, a large amount also admit that their facilities have seen a significant security incident recently. The need for risk management strategies, controls and safeguards as well as cybersecurity insurance has never been more clear.

See the HIMSS Executive Summary HERE>>

Read more in the current issue of Week in Review>>

Tuesday, June 23, 2015

Lots of S. FL Faces in Latest FED Takedown

What Happened
Nina Lincoff reporting in the SFBJ on June 18 , 2015:

More than 30 percent of the people charged in the largest national Medicare fraud takedown in U.S. history were charged in the Southern District of Florida, according to an announcement Thursday <6.18.15> by the U.S. Attorney's Office.

Why it Matters
Despite occasional challenges from Southern California, Texas and New York, South Florida continues its reign as Medicare fraud champion.

Read more in the latest issue of Week in Review>>

Tuesday, June 9, 2015

Female Viagra Gets FDA Nod

In a 6.5.15 CNN post, Debra Goldschmidt and Catherine E. Shoichet report:

A drug aimed at helping women who've lost their sex drive cleared a key hurdle Thursday <6.4.15>, winning backing from a Food and Drug Administration panel.

An FDA advisory committee voted 18-6 to recommend that the agency approve the drug flibanserin for the treatment of hypoactive sexual desire disorder in pre-menopausal women.

Dr. Margery Gass, a sexual dysfunction expert at Cleveland Clinic, said after Thursday's vote. "I think women are going to be very appreciative of having something they can try for this problem."

Critics have accused the FDA of 'gender disparity'. This is clear evidence that the FDA strives to protect and advance women's health. Of course, millions of men stand to benefit from the new drug as well.

Tuesday, May 26, 2015

Risks are High in Low-Volume Hospitals

WHAT HAPPENED
According to a story by Steve Sternberg and Geoff Dougherty posted to US News and World Report on 5.18.15:

These large numbers of low-volume hospitals, the analysis found, continue to put patients at higher risk even after three decades of published research have demonstrated that patients are more likely to die or suffer complications when treated by doctors who only occasionally see similar patients rather than by experienced teams at hospitals with more patients and established protocols.

WHY IT MATTERS 
Patients at thousands of hospitals face greater risks from common operations, simply because the surgical teams don't get enough practice. One of the benefits of consolidation in the healthcare industry may be in the area of patient safety.

Read more in the current issue of Week in Review>>

Monday, May 11, 2015

Almost half of Obamacare exchanges face financial struggles in the future

According to Lena H. Sun and Niraj Chokshi in a recent Washington Post article:

Nearly half of the 17 insurance marketplaces set up by the states and the District under President Obama's health law are struggling financially, presenting state officials with an unexpected and serious challenge five years after the passage of the landmark Affordable Care Act.

Read More>>

Monday, April 27, 2015

mHealth innovation: payer/provider development success stories

Week in Review: 4.27.15

What Happened
In this upbeat article by Judy Mottl and posted to FierceMobileHealthcare on 4.22.15, the author reports on:

•     An app created by employees at the University of Pennsylvania's Perelman School of Medicine that gives providers real-time access to clinical data
•     A tablet-based software program, Care at Hand, serving as a health coach tool for patients
•     An app that enables doctors to share medical images

Why It Matters
Finally, some good news!

Read more in the current issue of Week in Review.

Friday, April 10, 2015

SGR Update

According to Medscape:
 
Senate Majority Leader Mitch McConnell (R-KY) said the Senate will not vote on the SGR repeal bill until after it returns from an Easter-Passover break on Monday, April 13.

Friday, March 27, 2015

Supply Creates Its Own Demand: Capitalist Dream, Patient Nightmare

By Tara Pihn (Guest Blogger)

Pfizer's blockbuster Lipitor (generic name Atorvastatin) is a household name globally. It is considered to be among the most effective of all of the statins, a class of drugs that work in a similar way. Used to treat CVD, it is very effective in reducing cholesterol, a known villain in the war against heart disease.

Cholesterol is also, among other things, a building block for the body's natural ability to create testosterone. And testosterone, as we well know, is a key ingredient in male libido and sexual function. According to WebMD (citing a European clinical trial), statins may lower testosterone, libido resulting in erectile dysfunction.

That said, men suffering from CVD, and their lovers, should not worry because there are several ways to address the emergent issue.

For example, Depo-Testosterone is an injectable hormone (androgen) replacement used to treat men diagnosed with low testosterone (Low T), and, you guessed it, Pfizer's unit Pharmacia & Upjohn Co. currently market the medication.

Meanwhile, Pfizer also makes Viagra (I am pretty sure the reader has heard of this one) and according to their website "works for men with erectile dysfunction (ED) by increasing blood flow to the penis so you can get and keep an erection hard enough for sex".

Despite the criticism often heaped on Big Pharma, this brief article illustrates the hard work they are doing to ensure our good health. 

Saturday, March 14, 2015

Healthcare Roundtable Program on End of Life Care Held March 3

We had a great program on Tuesday, March 3, 2015.

For those of you who attended, thanks for being there. You were a great audience. Meanwhile, the panelists and moderator were stellar. Thanks also to the sponsors and host.

For those of you unable to attend, you were missed.

I hope you can all come to our June 2 program to be held at Vi at Aventura from 7.30-9:30 am. An official announcement with link to the registration page will be sent shortly.

To view the "Wrap Story" on the End of Life Care program, click HERE.

-Jeff Herschler

Friday, February 27, 2015

CMS pitches 1.1% boost to Medicare Advantage payments

WH
Bob Herman reports in a Modern Healthcare post dated 2-20-15:

The CMS has proposed increasing health insurers' Medicare Advantage payment rates by 1.05% for 2016, a move that kicks off a 45-day dogfight in Washington before the rates are cemented.

The base rate was an 0.95% average decrease, but "when combined with expected growth in plan risk scores due to coding," Advantage plans will actually receive the 1.05% hike in revenue next year, according to a release from the CMS posted late Friday afternoon. Risk scores relate to how Medicare pays for the health status of beneficiaries. CMS pays more for patients who have more health conditions and less for those who are healthier.

Comments on the proposed rates are due by March 6. Final rates will be released April 6.

WIM

An increase of a hair over 1% in payment rate falls far short of fair compensation for managing the influx of complex medical cases.

Read More in the current issue of FHI's Week in Review.

Monday, February 16, 2015

Medicare moves toward value-based oncology payments

What Happened

In a Modern Healthcare article posted February 12, 2015,Sabriya Rice reports:

The CMS Innovation Center plans to test a new oncology payment model intended to address the spiraling costs of cancer care and improve quality for beneficiaries. 

As part of a broader federal push to reward hospitals and doctors for value rather than the volume of services they provide, the CMS is inviting oncology practices and solo practitioners to join a five-year test set to begin in the spring of 2016.

Read More (complimentary registration/log in may be required)>>

Why It Matters

Although many practitioners are unimpressed by the push toward value-based care, the train has left the station. See related article entitled Quality-based health care is based on false assumptions by Thomas D. Guastavino, MD and posted to KevinMD.

Read More from this week's issue of Week in Review HERE>>.

Sunday, January 25, 2015

Healthcare Roundtable Announces March 3rd Program

 
and FHIcommunications present...

End of Life Care: The Elephant in the Room

One of the least talked about and most formidable issues in healthcare today

The aging US demographic intersects with some sobering statistics. According to a report published in MONEY magazine:

One out of every four Medicare dollars, more than $125 billion, is spent on services for the 5% of beneficiaries in their last year of life. Yet even with Medicare or private insurance, you’re likely to face a big bill: A recent Mount Sinai School of Medicine study found that out-of-pocket expenses for Medicare recipients during the five years before their death averaged about $39,000 for individuals, $51,000 for couples, and up to $66,000 for people with long-term illnesses like Alzheimer’s.


How will we provide compassionate and competent end of life care to our loved ones without going broke?

It’s time to have the conversation about life legacy and end of life alternatives.

Tues., March 3, 2015 | 7:30-9:30 am


Register/Learn More>>

Wednesday, January 14, 2015

Do No Harm?

Written by Florida Health Industry Week in Review   

What Happened. Why it Matters.

WH
In a NY Times blog called TheUpshot, Austin Frakt, pens a post entitled Do No Harm? It May Be Hard to Avoid with Health Law's Medicare Cuts. Mr. Frakt, a health economist and researcher, describes how the ACA is forcing hospitals to cut costs. He warns that research shows cost cutting by health systems has, in the past, resulted in compromised quality.  

WIM
Despite the pessimistic title of his January 5th article, Mr. Frakt is enthusiastic about new payment models being implemented by Medicare and some insurers (e.g. Accountable Care Organizations, Bundled Payments) as well as the rapid advances in health IT. He is quite hopeful that heightened productivity will lead to improved quality and simultaneous cost reductions. He points to preliminary research indicating that we are on the right track.

Read More from Week in Review HERE.