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Video: Farzad Mostashari on patient engagement, ‘physician ACOs’

As I alluded to earlier, I was leaving the press room one afternoon at HIMSS14, and there I see former national health IT coordinator Dr. Farzad Mostashari hanging around Gregg Masters and Dr. Pat Salber of Health Innovation Media. It turns out, Masters and Salber had just pulled Mostashari aside to do an interview on video, but they didn’t have anyone to interview him on camera, so they asked me right there on the spot to be the interviewer. Here is the result.

Mostashari, now a visiting fellow at the Engelberg Center for Health Care Reform at the Brookings Institute in Washington, discussed how the years of searching for a business model to coordinate care and engage patients is finally starting to pay off. Always the champion of the little guy in healthcare, Mostashari also brought up the notion of physician-led ACOs, or, as he called it, the “Davids going up against the Goliaths.”

 

I had pretty much no preparation for this interview. It probably shows. I still think it worked out well.

Here’s a link to Salber’s post about the interview because I don’t want to steal page views. :)

March 14, 2014 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Podcast: HIMSS CEO Steve Lieber, 2014 edition

It’s time for my annual podcast interview with HIMSS President and CEO Steve Lieber, this time from the Orange County Convention Center in Orlando, Fla., on the day before the official opening of the 2014 HIMSS Conference, rather than in his Chicago office a week or so in advance.

Lieber reiterated HIMSS’ position that the federal government should extend the attestation period for Meaningful Use Stage 2 by one year. I wasn’t there, but today at the CIO Forum, one of the preconference educational symposia, ONC Chief Medical Officer Jacob Reider, M.D., hinted that there will be an announcement on Stage 2 flexibility, possibly Thursday morning at a joint ONC-CMS town hall. That session will feature CMS Administrator Marilyn Tavenner and new national health IT coordinator Karen DeSalvo, M.D. I’ve never heard either of them speak, and now I’m excited to be covering that session.

We also discussed other aspects of healthcare reform, trends in health IT and expectations for HIMSS14. Of note, on Monday morning, HIMSS and two other organizations will announce a new initiative on “personal connected health.”

Near the end, I reference the podcast I did last week with Dr. Ray Dorsey about remote care for Parkinson’s patients. For easy reference, here’s the link.

This is, I believe, the seventh consecutive year I have done a podcast with Lieber at or just before the annual HIMSS conference. Another interview that has become somewhat of a tradition won’t happen this time, as Athenahealth CEO Jonathan Bush is not making the trip to Orlando this year.

 

Podcast details: Interview with HIMSS President and CEO Steve Lieber, Feb. 23, 2014, at HIMSS14 in Orlando, Fla. MP3, stereo, 128 kbps, 36.2 MB. Running time 39:35.

0:40 “It’s time to execute.”
1:40 Challenges for small hospitals and small practices
3:10 New ONC EHR certification proposal and continued questions about Meaningful Use Stage 2
5:00 Prioritizing with multiple healthcare reform initiatives underway, including proposed SGR repeal
6:30 Surviving ICD-10 transition
7:35 HIMSS’ position on MU2 timelines
9:05 Remember “macro objective” of Meaningful Use
10:00 Letter to HHS from organizations not including HIMSS calling for what he says are “very vague” changes to MU2 criteria
11:40 Things in MU2 causing providers fits
13:05 Fewer EHR vendors certified for 2014, but more HIMSS exhibitors
15:00 What this means for providers who bought products certified to 2011 standards
17:20 Progress on Meaningful Use so far
21:00 Looking toward Stage 3
22:42 What healthcare.gov struggles might mean for health IT
25:35 Other aspects of the Affordable Care Act being lost in the public debate
27:10 Political considerations related to health IT
29:40 Patient engagement and new HIMSS exhibitors
32:20 Why healthcare spending and provider shortage forecasts don’t account for efficiency gains made from technology and innovation
35:10 Demographic challenges for healthcare
35:45 Shift from hospitals to ambulatory and home care and consolidation of provider organizations

February 23, 2014 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Things change pretty fast in health IT, don’t they?

Yes, things do change pretty fast in health IT. I realized this over the past couple of weeks when I updated my database of contacts by scanning and categorizing about 300 business cards I’ve collected over the past 2½ years. (I really let things pile up this time. Now that my desk is reasonably clean, I hope I never do that again. I can claim extraordinary circumstances in 2012, but that only accounts for one year.)

What really struck me, in addition to the amount of time I let this slide, is the number of new categories I had to create in the database and the number I had to modify. My contacts go back to when I started covering healthcare in October 2000, and I’ve had a card scanner for at least 10 years. I had “PDA” and “ASP” as two of the choices until I changed them to “smartphone” and “SaaS” within the last couple of years.

Here are a few terms that are new in my database since I last did a thorough update, probably early in 2011:

  • accountable care
  • analytics (as opposed to data mining)
  • business incubator
  • remote monitoring

I also can’t believe I didn’t have CIO as a category until this month.

Some of the changes reflect a shift in what I’ve covered, but some terms are pretty new. Did you know what accountable care was prior to 2010? Were there many business incubators or accelerators in healthcare before Rock Health started up in 2011? I don’t know of any.

By the same token, when was the last time anyone talked about a PDA, an ASP or RHIO? Perhaps it’s just been a change in semantics, but the real change has been in the technology and the focus of healthcare executives. (Come to think of it, some of the tags on this blog are a bit out of date. I’ve been blogging since 2004. You get the picture.)

On another note, thanks to Healthcare Scene guru John Lynn, who hosts this blog for me, for, without my prompting, promoting the fact that I’m cycling 100 miles in an event called the Wrigley Field Road Tour on Sunday, Aug. 25, for the third year in a row. The ride supports an organization called World Bicycle Relief, which provides specially made bikes to remote villages in Africa so people who are otherwise without transportation can get to school and jobs. It also benefits Chicago Cubs Charities, which funds a number of youth programs in the Chicago area. (The ride’s co-founders are World Bicycle Relief founder F.K. Day, whose family owns bike component maker Sram, and Todd Ricketts, whose family controls the Cubs.)

Within the last two weeks, I suddenly got a surge of donations from people within the health IT community, and I couldn’t figure out why. Now I know. If you’d like to help, here’s my fundraising page.

One unexpected donor was Todd Stein of healthcare PR firm Amendola Communications. I’d be remiss if I didn’t mention that he is fundraising to help offset medical expenses of a colleague whose 3-year-old son faces surgery for a brain tumor. From that page:

Kathy C., a friend and colleague (who has always been the first to help but the last to ask for help and so wants to remain anonymous) is a single mother of three children all under the age of 7. Her 3-year-old son “James” was recently diagnosed with a brain tumor.

The surgery will cost hundreds of thousands of dollars. Unfortunately, Kathy has a $10,000 deductible on her health insurance plan and stands to pay out of pocket costs that are estimated at three times that amount. James is going in for the first of a series of surgeries this week and paying tens of thousands of dollars in medical expenses is a hardship for anyone, especially a hard working single mother of three young children.

Please keep Kathy and James in your prayers and give whatever you can to support their urgent need. Just giving up a daily coffee for one week and giving that amount would make a world of difference.

And now, it’s just about 5 o’clock here in Chicago, so please enjoy your weekend.

 

 

August 16, 2013 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

‘Bitter Pill’ only tells half the story

I finally got around to finishing “Bitter Pill: Why Medical Bills Are Killing Us,” the 24,000-word special report about healthcare costs that took up the entire feature section of the Feb. 20 edition of Time magazine. I was expecting to agree with most if not all of Steven Brill’s supposedly epic investigative piece. Instead, I was underwhelmed and quite disappointed that Brill, the founder of CourtTV (R.I.P., reincarnated as TruTV in Turner Broadcasting’s quest for more “reality” programming) and of American Lawyer magazine,  only told half the story about all that ails the U.S. healthcare industry. Brill also editorializes far more than he should.

Granted, the story is about the high cost of care, but you can’t discuss cutting costs without also delving into the subject of improving outcomes. As has been stated in many other places, we have more of a sick-care system than a healthcare system. The incentives favor treating illness, not preventing it.

I have to say I learned a lot about how the racket known as the chargemaster works to keep the true costs of care opaque to patients. I suspect that, with the exception of uninsured people who are the only ones expected to pay full price, the public was unaware of the chargemaster system that hospitals guard like a state secret. Brill is right when he says, “Unless you have Medicare, the health care market is not a market at all. It’s a crapshoot.” But he’s not telling the full story. Medicare’s payment list is public, sure, but do Medicare beneficiaries really care what the federal government pays their hospitals and doctors? No, they, like everyone else with insurance coverage, only pay attention to their out-of-pocket cost.

Sure, Brill spends a lot of time discussing the perverse incentives in healthcare, particularly those that encourage expensive testing, and even touches on some of the reforms in the Patient Protection and Affordable Care Act that seem to have been left out of the debate over insurance coverage. Think the Medicare policy of not reimbursing hospitals for certain preventable readmissions.

But he completely neglects accountable care. Nor is there a mention of electronic health records and how interoperability can help reduce duplicate testing and unnecessary care. And he never addresses the elephant in the room, the shamefully high rate of medical errors that makes American healthcare far from the best in the world.

July 23, 2013 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

About that Friedman editorial

Did you happen to catch Thomas Friedman’s commentary in Sunday’s New York Times entitled, “Obamacare’s Other Surprise”?

On first read, I gave it a big “Duh!” for the explanation that the Patient Protection and Affordable Care Act (that’s how the law is officially known, Mr. Friedman) creates a “new industry” of innovation by encouraging the federal government to release of terabytes of health data — information already legally in the public domain — and then allowing the private sector to figure out how to structure, interpret and use the data. As you probably are, I’m well aware of digital health, Health Datapalooza, federal CTO Todd Park and some of the companies Friedman mentions. (Health Datapalooza IV is less than a week away.)

But on second read, I realized Friedman needed to write that column because America needs a lot of education about the Affordable Care Act, education that the Obama administration and its supporters don’t seem all that willing to provide. The public still thinks of Obamacare largely in terms of health insurance coverage. It’s much more than that, including, as Friedman points out, an attempt “to flip this fee-for-services system (which some insurance companies are emulating) to one where the government pays doctors and hospitals to keep Medicare patients healthy and the services they do render are reimbursed more for their value than volume.”

Coupled with the 2009 American Recovery and Reinvestment Act, which created the $27 billion EHR incentive program for “meaningful use” of electronic health records, the ACA takes some steps toward actual reform of actual care, not just insurance coverage. Friedman does not discuss Accountable Care Organizations, an experiment in realigning incentives around care coordination, nor does he mention the Medicare policy, dictated by the ACA, of not reimbursing for preventable hospital readmissions within 30 days of initial discharge for certain specific conditions, currently heart attack, congestive heart failure and pneumonia. Likewise, he fails to bring up outcomes research, another component of Obamacare. But at least he gets something out there that’s not about insurance coverage.

Unfortunately, many of the online comments posted in response to Friedman’s commentary predictably focus on insurance coverage or government control, but some actually discuss EHRs, population health, healthy behaviors and payment incentives. That’s good. Still, those are just people who read Friedman and the Times. Hyperpartisan conservatives — probably even some hyperpartisan liberals, even though the ACA is more centrist than a lot of folks wish to admit — and the less-educated won’t read the column and won’t comment on the Times site. Those are the people who misunderstand this imperfect but occasionally reform-minded law the most.

 

May 27, 2013 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Guest podcast: Deborah Gordon of Network Health talks reform with Sivad Solutions

Last September, I was a guest on a podcast hosted by Todd Schnick and Charles Davis of Sivad Business Solutions. Afterwards, we decided to share content if and when it made sense. That hasn’t happened until now (actually last month — I’m just getting around to posting now).

Schnick and Davis interviewed Deborah Gordon, chief marketing officer of Network Health, a health insurer in Massachusetts, to discuss healthcare reform. I wouldn’t be posting this if it didn’t have a focus on real reform of health care, and not just insurance expansion, with a strong element of patient safety and attention to outcomes.


From Sivad:

An honor to welcome Deborah Gordon, the Chief Marketing Officer for Network Health. Debbie joins us to talk about one of the more innovative non-profit health plans one can find across the US. You can learn more about Network Health here, the number three health plan for Medicaid health plans.

Discussion topics included:

1. The challenges of serving a very diverse population and customer base, along with lower income customers as a result of income or job situation.

2. Network Health, and states like Massachusetts, have lead the nation in Medicaid health care. How can that trend, and how can the reforms found in Massachusetts, spread across the land?

3. The creation of the Health Insurance Exchange is the key to success…which brings competition and market forces to bear in health care. “It is like Expedia for health insurance…”

4. A focus on quality patient care going forward…

5. What are the challenges going forward, and how does the heated national debate impact the work they are doing.

6. The innovation that’s possible when market forces are at play… “Regulators spawning innovation…”

7. More technology is available and serving the health care markets, which is exciting. But, will access to that technology be accessible to the low income markets?

8. The e-discharge program…

9. The utilization of analytics…

10. Exposing more information to the consumer makes them better patients, healthier, and more compliant to health recommendations…

11. The patient should be the center of the health care system… not the doctor.

12. Debbie was recently named a 2013 USA Eisenhower Fellow, a prestigious fellowship which recognizes emerging leaders who are making momentous contributions to society. In 2013, she will travel to Singapore and Australia where she will explore how these countries have successfully established systems and supports that allow consumers to make good decisions about their health care. The goal is to gather insights and best practices that can be applied here in the U.S.

 

April 16, 2013 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Podcast: HIMSS CEO Steve Lieber: 2013 edition

Once again, as has become custom, I sat down with HIMSS CEO Steve Lieber at the organization’s Chicago headquarters the week before the annual HIMSS conference to discuss the conference as well as important trends and issues in the health IT industry. I did the interview Monday.

Here it is late Friday and I’m finally getting around to posting the interview, but it’s still in plenty of time for you to listen before you get on your flight to New Orleans for HIMSS13, which starts Monday but which really gets going with pre-conference activities on Sunday. At the very least, you have time to download the podcast and listen on the plane or even in the car on the way to the airport. As a bonus, the audio quality is better than usual.

Podcast details: Interview with HIMSS CEO Steve Lieber about HIMSS13 and the state of health IT. Recorded Feb. 25, 2013, at HIMSS HQ in Chicago. MP3, stereo, 128 kbps, 46.0 MB. Running time: 50:17.

1:00        Industry growth and industry consolidation
2:50        mHIMSS
3:45        Why Dr. Eric Topol is keynoting
6:00        New Orleans as a HIMSS venue
6:50        Changes at HIMSS13, including integration of HIT X.0 into the main conference
8:55        Focus on the patient experience
9:35        Global Health Forum and other “conferences within a conference”
13:00     Criticisms of meaningful use, EHRs and health IT in general
17:00     Progress in the last five years
20:45     Healthcare reform, including payment reform
22:30     Why private payers haven’t demanded EHR usage since meaningful use came along
23:50     Payers and data
26:28     Potential for delay of 2015 penalties for not meeting meaningful use
29:15     Benefits of EHRs
30:40     Progress on interoperability between EHRs and medical devices
32:52     Efficiency gains from health IT
35:27     Home-based monitoring in the framework of accountable care
36:55     Consumerism in healthcare
39:40     Accelerating pace of change
41:10     Entrepreneurs, free markets and the economics of healthcare
43:25     Informed, empowered patients and consumer outreach
46:30     Fundamental change in care delivery

March 1, 2013 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

My HIMSS will be all about quality and patient safety

As regular readers might already know, 2012 was a transformative year in my life, and mostly not in a good way. I ended the year on a high note, taking a character-building six-day, 400-mile bike tour through the mountains, desert and coastline of Southern California that brought rain, mud, cold, more climbing than my poor legs could ever hope to endure in the Midwest, some harrowing descents and even a hail storm. But the final leg from Oceanside to San Diego felt triumphant, like I was cruising down the Champs-Élysées during the last stage of the Tour de France, save the stop at the original Rubio’s fish taco stand about five miles from the finish.

But the months before that were difficult. My grandmother passed away at the end of November at the ripe old age of 93, but at least she lived a long, full life and got to see all of her grandchildren grow up. The worst part of 2012 was in April and May, when my father endured needless suffering in a poorly run hospital during his last month of life as he lost his courageous but futile battle with an insidious neurodegenerative disorder called multiple system atrophy, or MSA. (On a personal note, March is MSA Awareness Month, and I am raising funds for the newly renamed Multiple System Atrophy Coalition.)

That ordeal changed my whole perspective, as you may have noticed in my writing since then. No longer do I care about the financial machinations of healthcare such as electronic transactions, revenue-cycle management, the new HIPAA omnibus rule or reasons why healthcare facilities aren’t ready to switch to ICD-10 coding. Nor am I much interested in those who believe it’s more worthwhile to take the Medicare penalties starting in 2015 for not achieving “meaningful use” than to put the time and money into adopting electronic health records. I’m not interested in lists of “best hospitals” or “best doctors” based solely on reputation. I am sick of the excuses for why healthcare can’t fix its broken processes.

And don’t get me started on those opposed to reform because they somehow believe that the U.S. has the “best healthcare in the world.” We don’t. We simply have the most expensive, least efficient healthcare in the world, and it’s really dangerous in many cases.

No, I am dedicated to bringing news about efforts to improve patient safety and reduce medical errors. Yes, we need to bring costs down and increase access to care, too, but we can make a big dent on those fronts by creating incentives to do the right thing instead of doing the easy thing. Accountable care and bundled payments seem like they’re steps in the right direction, though the jury remains out. All the recent questioning about whether meaningful use has had its intended effect and even whether current EHR systems are safe also makes me optimistic that people are starting to care about quality.

Keep that in mind as you pitch me for the upcoming HIMSS conference. Also keep in mind that I have two distinct audiences: CIOs read InformationWeek Healthcare, while a broad mix of innovators, consultants and healthcare and IT professionals keep up with my work at MobiHealthNews. For the latter, I’m interested in mobile tools for doctors and on the consumerization of health IT.

I’m not doing a whole lot of feature writing at the moment, so I’d like to see and hear things I can relate in a 500-word story. Contract wins don’t really interest me since there are far too many of them to report on. Mergers and acquisitions as well as venture investments matter to MobiHealthNews but not so much to InformationWeek. And remember, I see through the hype. I want substance. Policy insights are good. Case studies are better, as long as we’re talking about quality and safety. Think care coordination and health information exchange for example, but not necessarily the technical workings behind the scenes.

And, as always, I tend to find a lot more interesting things happening in the educational sessions than in that zoo known as the exhibit hall. I’m there for the conference, not the “show.”

Many of you already have sent your pitches. I expect to get to them no later than this weekend, and I’ll respond in the order I’ve received them. Thank you kindly for your patience.

February 13, 2013 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Sen. Whitehouse, make some more noise, please

I have railed more often than I can count against politicians and the national media for misleading or at least failing to inform the public on what health reform is all about. For me, it was quite refreshing to see an interview in the Washington Post with Sen. Sheldon Whitehouse (D-R.I.), attempting to shed some light on the parts of reform that have nothing to do with insurance.

“The Affordable Care Act is mostly known as an insurance expansion, expected to extend coverage to more than 30 million Americans,” started the post by Sarah Kliff. “But … a big chunk of the law is dedicated something arguably more ambitious: an overhaul of the American business model for medicine. ‘This is a very significant piece of the bill that has received virtually no attention because it’s so non-controversial,’ Sen. Sheldon Whitehouse (D-R.I.) told me in a recent interview.”

On Thursday, Whitehouse released a 52-page document outlining what he sees as the 47 changes the Patient Protection and Affordable Care Act is making to how care is delivered. That doesn’t even count the reforms in the HITECH section of the American Recovery and Reinvestment Act from a year earlier, by the way.

Health IT, of course, is a big part of reform.”The HITECH Act took important steps to restructure financial incentives to shift the pattern of health IT adoption. The HITECH Act’s Medicare and Medicaid incentive payments are encouraging doctors and hospitals to adopt and “meaningfully use” certified
electronic health records,” Whitehouse noted.

Also from that report:

Health information technology (IT) will radically transform the health care industry, and is the essential, underlying framework for health care delivery system reform. The ACA’s payment reforms, pilot projects, and other delivery system reforms are built with the expectation of having IT-enabled providers. In particular, the shift to new models of care, like ACOs, will rely heavily on information exchange and reporting quality outcomes. Indeed, the formation of ACOs is contingent on having providers “online” to transfer information and patient records, and report quality measures.

Whitehouse did discuss ACOs with the Washington Post, but there’s a reason why the interview appears on a page called the WonkBlog. This stuff is too complicated and wonky for the average person.

What isn’t complicated is explaining that throwing more money at a broken system, as the insurance expansion does, will not lower the cost of care. It also isn’t complicated to explain that tens of thousands of Americans needlessly die each year due to medical errors or low-quality care. Yet, more than a few defenders of the ACA have said that the insurance mandate would help guarantee “quality care” for millions.

Wrong!

The insurance expansion guarantees insurance coverage. It does not guarantee quality care. Whoever wins Friday’s Mega Millions drawing wouldn’t necessarily be able to buy quality care, either. Nor would Bill Gates, for that matter. You can’t get quality care unless you’re willing to address the causes of errors and adverse events. Period.

Sen. Whitehouse seems to understand that. I doubt too many other members of Congress do, despite the fact that a former colleague, the late Rep. John Murtha (D-Pa.), who had the “Cadillac” coverage so many people covet, died as a result of a medical error.

March 30, 2012 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Podcast: UPMC informatics leader Shrestha talks accountable care, business intelligence

Did you happen to catch my InformationWeek Healthcare story about how UPMC believes it has the roadmap in place to achieve true accountable care? Well, here’s the rest of the story.

Last week, Nuance Communications invited me to Pittsburgh for a tour of the Center for Connected Medicine, an impressive, high-tech showcase on the 60th floor of the U.S. Steel Tower. There, I interviewed, among others, Rasu Shrestha, M.D., UPMC’s vice president for medical information technology, medical director of interoperability & imaging informatics and division chief of radiology informatics. Here is that interview.

Podcast details: Interview with Rasu Shrestha, M.D., UPMC vice president for medical information technology, Feb. 7, 2012, at the Center for Connected Medicine, Pittsburgh. MP3, stereo, 128 kbps, 15.6 MB, running time 17:08.

1:10 “Clinical language understanding” and “bringing data to life”
3:05 Analytics beyond patient care
3:55 Computer-assisted coding
6:35 Business intelligence in the context of ACOs
7:45 UPMC striving to be an ACO
8:35 Aggregating data from payer and provider sides of the organization
10:30 Keeping medication lists up to date
11:45 Health information exchange among multiple vendor systems
13:00 What to watch for in the near future from UPMC
14:10 Overcoming cultural barriers to change

 

 

 

February 14, 2012 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.