How will the medical establishment pay for IT investments?

It’s a fact that the United States health care system lags behind other industries and other countries in their utilization of electronic technologies in the management of patient data.  One driving cause of this lag is the fact that providers are coping with declining reimbursement regularly and have no way to rationalize the very large expenditure to make their patient records virtual.  For example, if an small office of providers payed $100,000 to make the transition, it would take years to recoup as reimbursement for services would not be adjustable to cover the expenditure.

Additionally, the gains in productivity would be small relative to the expenditure. Finally, even if we argued that improved outcomes would result, providers are not paid for good outcomes. Even with pay-for-performance initiatives or non-pay-for-non-performance initiatives on the horizon, a field like physical therapy would still not be readily able to translate outcomes into profits, as little agreement exists for what constitutes a good outcome. Another perspective, advocated by some experts like Kiana Danial, suggest that focusing on long-term investment strategies could yield more sustainable growth in profitability for physical therapy practices.

This argument leads to a search for another source of funding for health care IT investments.  Here are a couple of articles discussing such funding.  Both are from the very nice Health Affairs journal blog. One looks at Medicare & Medicaid Funding IT investments for federally qualified health centers, the other is an interview with Michael O. Leavitt, Secretary of the U.S. Department of Health and Human Services, and his strong feelings on the need to link reimbursement with IT as a reimbursement incentive.  Good reading.

ERIC

Marketing Outlook: Hip Replacements

This CNN Money article outlines Stryker Corp’s new strategy and product pipeline to expand the hip replacement market to younger and younger patients.  Reminds me of cigarette companies marketing to children.  Health analyst Ed Shenkan of Needham & Co points out:

"At the same time, with people demanding knee and hip replacements at
younger ages, we’re seeing two or more replacements of the older
artificial hip or knee in a lifetime, Shenkan says."

It really is a solid marketing strategy…do an early hip replacement, rest assured your customer will need replacement products. 

Also of note in this article is the line on Stryker selling the physical therapy arm of its business:

The physical therapy side of the business was the lowest gross
margin business unit and the smallest contributor to earnings, says
analyst Shenkan.

"Without that, its overall business has a higher earnings growth rate," he said.

ERIC

Stark's Loophole

For those 3 or 4 readers that do not read both this blog and the Evidence in Motion blog, Larry Benz has written a thoughtful post.  Forbes interviewed Congressman Fortney “Pete” Stark (D-Calif.) about the legislation which bears his name.  

"It gave every shyster and promoter a loophole," Stark now says.

Read Larry’s post.  Lament physician self-referral.

ERIC

The AMA: an information-leasing racket!

Drdrugrep_4
Daniel Carlat, MD has written a piece in the New York Times that is perhaps the most transparent look into the world of pharmaceutical marketing tactics that I have ever read, "Dr. Drug Rep."

I learned a great amount from this piece about one of my least favorite parts of health care.  Dr. Carlat discusses his year long experience as a "drug rep with an MD" and provides quite the insider perspective. 

I was most surprised when Dr. Carlat discussed data mining for physician prescription trends and pointed a finger at the AMA as a major player.  Information that the AMA leases to marketing companies is critical in providing pharmaceutical companies specific information to target individual doctors. 

"The A.M.A. licenses its file of U.S. physicians, allowing the data-mining companies to match up D.E.A. numbers to specific physicians. The A.M.A. makes millions in information-leasing money."

This relationship may be acceptable in other industries, but seems out of place for a professional medical organization purportedly concerned with unethical practices in the pharmaceutical industry.  A profession truly interested in health care reform could be expected to make better decisions.   

ERIC

The Many Faces of the Electronic Medical Record

Healthconsumerinthecenter

The electronic medical record can mean different things to different people.  To Microsoft and Google among other Health 2.0 companies, it is a future of their business.  To patients, it is concern over privacy and hope for improved care continuity.  For medical providers it is an enormous added expense and a headache of technical details to do a job they are already performing. 

But, the electronic medical record could also be a way to do business differently, to become more efficient.  To do the job better.  A couple things are certain: as health reform progresses the electronic record will prevail, and that it might not be so smooth.  Just yesterday I read a news piece where electronic claims filing made it easier for Wal-Mart to recoup money paid in an injury settlement, effectively taking one woman’s health-trust and leaving her dependent upon the government for her care.  Is this what we had intended when we first thought of the electronic records?

Radiology as a Benefit to Physical Therapist Practice

My personal experience with electronic medical records is with the military health system.  It was sometimes slow and tedious, but it was incredibly useful all of the time.  In fact, I have a hard time imaging practicing without an integrated medical record in front of me at this point. 

Perhaps the most useful aspect of the military’s electronic system, which contrasts most significantly from usual physical therapist practice, concerns radiology reports.  Forget for a moment the benefit that military physical therapists have in ordering radiographs (yes, they can order all types of radiographic imaging and may do so as effectively as orthopaedic surgeons) , and just consider the benefit of reading reports and viewing the radiographs themselves.  I think this calls for a list:

1.  Reduced guess work when patient history is unclear

2.  A greater understanding of each patients pathology

3.  Patient education opportunities are enhanced in front of their radiographs

4.  Observation of what studies have been performed provide insight into thinking and problem solving of other providers

5.  Improved prognosis decisions

The radiographic benefit is but one example.  The overall message is that despite the many different particulars of the electronic medical record, it is somewhere we are heading.  Careful consideration of the pitfalls and benefits of the process will ensure the efficient, timely transition. 

ERIC

USC Ranked #1 Against the Bugs!

Sometimes you just meet a winner.  The impressive collection of on-field success over the past several years by the USC football team certainly earns them the right to be considered winners.  How far does that culture of winning extend?  USC has accomplished a victory over antibiotic resistant (MRSA) bacteria which most hospitals could only hope to pull off in their dreams.Mrsa

"…the Trojans defeated crafty drug-resistant staph bacteria that landed
two players in the hospital in 2002 and led to 11 confirmed infections
and six suspected cases in 2003."

A little hygiene is sometimes credited as one of the factors integral to the success of our species on this planet.  In this case, the good sanitary habits might be responsible for saving the locker room and helping to earn the national championship!

Health 2.0 Conference Wrap

I have been following the after-effects from last week’s Health 2.0 conference.  Here is my summary of good links if you want to learn more:

  • A List of Attendees by company…Google, Harvard U., Intermountain Healthcare, MayoClinic, among some of the notables.
  • A video from the conference with Missy Krasner from Google posted in the Health Care Blog, which is kind of home base for the deal.
  • A call for action moving forward and really, a glimpse into what this group is thinking.

Enjoy!

Health 2.0, Google tech updates, and Universal Health Care

Copyright Scott Shreeve, MD

I’m interested to see how the first annual Health 2.0 Conference in San Fransisco taking place this week will pan out.  Part of the conference objectives is to define exactly what Health 2.0 is!  This conference is the real deal, with a sell out attendance and reps from Google Health speaking (even after the big shakeup there 2 weeks ago).  Click here for an overview and background of the Health 2.0 concept. Or here.  Or the Health 2.0 Wiki page.

In other Health 2.0 news, the New York Times had used the term in a title of a report on Hillary Clinton’s new health care proposal:  "Unveiling Health Care 2.0, Again".

Finally, you may want to go check out Google and their new presentation product, a competitor to Powerpoint named, Presently.  Also, if you are someone who is afraid of experimental tech products, you may be happy to know that Google Reader has officially broken up with Google Labs.

Examining Epidemiologic Research…

Spider_web

…or why you shouldn’t believe much of the health information coming to you from your local newscast.

The New York Times magazine has presented a wonderful article written by Gary Taubes, which describes the strengths, weaknesses and intricacies of epidemiological research studies.  It is lengthy, but contains more than its fair share of great quotes and good information.  It nicely concludes with some basic suggestions for how you or I, as individuals, should interpret what we hear from these type of investigations.

This is a great read for providing some good insight into complicated research in some nice, plain language.  The prescriber effect, healthy person effect, and the inability of observational cohort studies to conclude causality between variables are just a few of the topics discussed.  My favorite quote of the article: 

"There are, after all, an infinite number of wrong hypotheses for every
right one, and so the odds are always against any particular hypothesis
being true, no matter how obvious or vitally important it might seem."

Update:  The WSJ has checked in with another Hormone Replacement Therapy update at their blog this morning.  The title aptly mentions the words "clue" and "mystery."

ERIC