BAC Medical Marketing
  • Home
  • Who we are ▷
    • Mission statement
    • Meet the team
    • We attract new patients
    • More for less
  • What we do ▷
    • Services offered
    • IdentityFind
    • MEDShield
    • Project samples
  • How we work ▷
    • Workflow process
    • BACMM affiliate program
    • Clients
    • Glossary
  • Why we're different ▷
    • Search engine optimization
    • Case studies
    • Letter from the President
    • Spotlighted products
  • When we're needed ▷
    • Consultancy compensation
    • Marketing tips
    • BACMM Blog
    • FAQs
  • Contact ▷
    • News you can use
    • Testimonials
    • Online resources
    • Jobs at BACMM
Call Today: 800.240.9473

the right to die: the suicide checklist

1/4/2015

0 Comments

 
Physician–Assisted–Suicide; the collaboration of two through a professional relationship, to cause the death of one.

Ever since Socrates took hemlock, suicide has been part of society, sometimes supported, often condemned.  Today, many argue that we have a right-to-die, sort of an infinite extension of free speech or thought.   Regardless, to actively involve doctors is a unique distortion of the medical arts, as if stopping a beating heart can somehow mend disease.  For a healer to take life is bizarre and threatens the physician-patient relationship.  If individuals really want and require assistance to die perhaps there is another solution.

A long trail of vital documents marks our lives. These include birth certificate, diplomas, driver’s and marriage license, advanced directives, wills and most recently the POLST. Perhaps we should create a new personal document.  Its purpose would be to give each person not only permission to kill themselves, but access to the means.  A permit controlled by the patient and only their responsibility.  A passport for dying.  A Suicide Certificate.

The Suicide Certificate would be a kind of application.  A legal checklist, which once complete would allow the individual to die by their own hand, but in a controlled and definite manner.

What would go on this form?  First, basic demographics; name, birth-date, address, social security number, etc.  It is important to confirm that the right person is filling out the form.  A photograph might be a good idea.

Next, statements regarding right-to-die laws.  This could include a review of the sanctioned methods available, as well as the legal indications and limits for committing suicide.  It might remind the applicant that a terminal disease is required, what is and is not a qualifying medical condition, and that suicide pacts are discouraged and therefore forbids sharing the lethal prescription. The whole form might start on-line and as part of the process an instructional video must be viewed and review answers given correctly, before it can be printed.  Alternatively, an app could be developed.

If the state requires terminal disease for suicide, the form should have a place for a doctor to confirm that the patient is dying.  Two signatures from the physician would be required, on two dates at least two weeks apart.  Either the specific disease must be entered, or, to protect privacy, a general statement of imminent natural death.  This means that while the doctor is involved in the application process, his/her role is not to prescribe the means to cause death, but rather confirm the presence of disease.

There might be a counseling section, which would require that the patient speak with a psychologist, social worker or clergy.  As an alternative a signature from a healthcare provider, other than the primary treating doctor, which affirms that the patient is not psychiatrically ill and understands their actions.

Finally, a list of organizational reminders to help with final plans.  “Is your will complete?” “Have you emptied your safe deposit box?” “Does your family know your plans and do they have copies of your important papers?” “Have you completed funeral arrangements?”   “Have you determined who will discover and/or handle your body?” “Have you said good-bye?”

Once the form was complete, itemized and notarized, the patient would take it to a suicide-assistance-registered-pharmacy or perhaps a specialty funeral home, which would exchange this ultimate document for death-inducing-drugs.  The sealed suicide kit would come with a final instructional booklet, including safety warnings.

While this idea is bureaucratic and strange, it does achieve two goals.  First, it removes doctors, healers, from the direct ordering of death.  The final signature at the bottom of the form, the “order” for the drugs, is the patient’s.  The second is that it empowers those who believe in suicide a legal outlet, as well as the tools to act.   If there is a freedom to die, then the responsibility must be each of ours, alone.

0 Comments

Enable, Don't Replace Physicians!

9/2/2013

0 Comments

 
The reality of today’s funding environment for digital health entrepreneurs is that it’s traditional tech investors who have the lion’s share of the money, while most long-time healthcare investors are on the ropes, contending with fleeing LPs and at least the perception of disappointing returns.

While it’s great news that some tech funds seem interested in dipping their toes into the healthcare space, it’s concerning that the investors with the most resources are not necessarily the ones who understand healthcare the best.

Tech investors, in general, are not always comfortable with physicians, and seem much more at home with engineers and developers.  These investors also tend to gravitate to businesses selling directly to consumers rather than dealing with the sordid complexities of our current healthcare system.

Many tech investors are also — understandably — drawn to the power of data, and the possibility of analytics, a sensible affinity but one that at times can translate into an excessively reductive view of medicine that fails to capture the maddening but very real ambiguity of medical science, and especially of clinical practice.

While almost everyone contemplating the problems of the current healthcare system acknowledges that often stubborn, intransigent doctors can be part of the problem, it’s arresting how many technologists don’t also view doctors as a key element of the solution; instead, there seems to be a common, techno-utopian  vision in which medicine has been profoundly disrupted, and the role of physicians largely replaced by computers.

In the words of digital health investor and doctor Bijan Salehizadeh, “IT rooted VCs don’t know how to relate to or speak the language of physicians. They bow at the altar of revolutionary disruption. That works in non-regulated consumer markets.  Not in highly regulated hierarchical fragmented spaces like HCIT.”

The more technology investors I speak with, the more I worry there’s something elemental about medicine that many don’t seem to understand – and worse, they don’t always know what they don’t know.

Doctors have a unique perspective

The experience of being a doctor provides unique insight into the meaning and significance of health.

For starters, as a physician, you develop a profound, overwhelming appreciation of how serious health is, and you experience and help patients and their families in dealing with every phase of illness.  When I listen to a young entrepreneur extol his or her new approach to saving large files or sharing music as an example of changing the world, I appreciate and love their enthusiasm and passion – how can you not?  At the same time, I also find myself reflecting upon other talks I’ve heard – Judah Folkman discussing his discovery of angiogenesis, or Bruce Walker discussing advances in HIV therapy – and I think: now this – this is changing the world.

Second, for all the emphasis placed in medicine on arriving at a diagnosis and suggesting a treatment, the truth is that medicine is just so much less precise than anyone could possibly imagine. Diseases, diagnoses, best practices: all are so much grayer and less-well demarcated than most appreciate, and patients are far more complex. For all the advances in molecular diagnostics and high-tech imaging, medicine remains far more scientism than science.

Third, once you’ve had the experience of caring for patients, had the privilege of developing relationships with patients over time, it’s impossible not to be moved by the power, complexity, and importance of the doctor/patient connection. Twenty-something Palo Alto engineers may struggle to understand why anyone would waste time with human care providers, but I suspect the many patients with serious concerns or chronic conditions who are fortunate enough to receive regular care would likely offer a very different perspective on the value of this unique relationship.

At the same time, while physicians may genuinely aspire to deliver the best care possible, they demonstrably struggle achieving this; many rely on vague recollections rather than current data, and are notoriously reluctant to discard bad habits (such as not washing hands), and embracing new recommendations (such as utilizing a basic checklist), despite the demonstrated evidence for both.

The real opportunity in medicine, then, is not to replace physicians, but to enable them, and enable patients. This will entail recognizing the foundational value of the close, longitudinal relationship between doctor and patient, and then building off of this by creating tools for both patients and physicians that will enhance this therapeutic connection. To develop such tools, a company will need to combine deep healthcare knowledge with technological sophistication, and create solutions that deliver not just clicks, but durable improvements in patient health.

Areas of opportunity and challenge

One category of opportunity here is turning mHealth into mMedicine (to borrow two terms from Dr. David Albert, founder of AliveCor). Right now, there’s an overwhelming number of consumer-focused wellness apps and fitness gadgets, products like the Eatery and Fitbit which may be pleasant to use, and could potentially support health. The real opportunity is robustifying these sorts of measurement technologies and approaches, so that they not only provide casual entertainment, but could also be used to drive and monitor real medical benefit – see here and here for a discussion on the importance of these sorts of measurements in medicine.

A second opportunity is behavior modification – a staggering amount of illness results from the many poor choices each of us make every day, habits that are notoriously difficult to change. The degree of user engagement engendered by many gaming and social apps is remarkable, and could be harnessed to drive measurement improvements in health. Early versions of this have been used for employee wellness programs, but I suspect there are real opportunities for platforms that can maintain patient interest over time (a huge problem right now), and which can nudge the patient towards improved behaviors and better health.

A third category: care delivery/health system improvement. It’s difficult to identify an individual aspect of the current care system – from hospital admissions to managing illness at home — that doesn’t appear to be a historical relic, and which seems thoughtfully designed with the patient in mind. There are so many opportunities to rethink aspects of this, and ask how could this process be better constructed – ideally incorporating key aspects of design thinking. Traditionally, healthcare innovation has focused on new drugs and devices, but there’s an increasing recognition of the need to improve systems as well – a key focus of leading-edge initiatives such as Dr. Arnold Milstein’s Clinical Excellence Research Center at Stanford, aimed at improving healthcare services.

A fourth category: Chunking big data. While the idea of chasing big data in health is certainly not new, figuring out how to actually acquire the relevant data remains non-trivial, and turning this information into actionable insight remains an abiding challenge – with the key word being actionable, i.e. usable by physicians, or patients, in as frictionless – and ideally delightful – a fashion as possible. Success will require far more than robust analytics. Combining clinical and payor data, meanwhile could be used to support value-based healthcare, highlighting the best way to allocate limited resources. This information could used to improve the quality and efficiency of care, and also could be provided to other financial stakeholders (which will likely increasingly include patients themselves) to support informed decision making, a la Castlight.

A key challenge that all entrepreneurs face, and which seems especially pronounced in the healthcare space, is finding not only an important problem to solve, but a way to get paid for solving it. The perverse incentives in the current healthcare system mean that in many cases, physicians and hospitals are actually rewarded for not being better – they often make money on the extra charges that suboptimal care can generate.

This may explain better than anything else why tech investors like consumer plays – investors understand them, and know how to assess the value, how to monitor, and when to pivot. They’ve also made a lot of money on at least some of these companies, and understand the business model.

In contrast – and unfortunately – the business case for improving care can be surprisingly difficult to make; it’s likely that entrepreneurs may need to carefully identify a specific situation (a concierge practice? A private oncology clinic?) where their proposed improvements can demonstrate the most compelling impact. It’s also why some forward-thinking healthcare entrepreneurs such as Avado’s Dave Chase have focused so much of their efforts on the need for incentives better aligned with patients’ interests.

Partnerships for the Future

While there’s not going to be a magic formula for digital health companies, a leadership team combining healthcare and technology experiences seems a common pattern.

“Homogenous teams all coming from outside of healthcare have the deck stacked against them,” digital health investor Salehizadeh asserts. “The best teams couple doctors with savvy business people or technical founders.”

These sorts of partnership are exactly what Halle Tecco of digital health incubator Rock Health, say she’s seeing among many of the young companies Rock Health supports.

According to Tecco, “Any startup that excludes the MD perspective puts themselves at a disadvantage… just like any doctor-founded company that overlooks design or business model puts themselves at a disadvantage. Most startups in the space need it all! An understanding of the system, an insight for disruptive business models, an eye for design, and a back-end engineering ninja to help the product scale.” She adds, “This is an exciting time for cross-collaboration.”

While it’s far too early to say whether these collaborations are going to yield transformative digital health companies, it’s hard to argue with the approach. Moreover, given the urgent need for innovative healthcare solutions, we should all hope that these broad-based partnerships involving physicians and technologists represent the beginning of a wonderful, productive, and healthy relationship.
0 Comments

The Doctor Is...Overbooked!

6/5/2013

0 Comments

 
At the New York Times’ City Room Blog, Joel Cohen writes:

"My wife and I are convinced that all medical students should have to pass Overbooking 101 before they can become doctors.  Again and again, we arrive at a doctor’s aptly named waiting room on or before the scheduled time, only to learn that three or four others sitting there have been given the same appointment."

He says doctors need to understand the impact of this on their patients.  I agree, but not just because it’s annoying.

A typical doctor sees thirty patients a day.  Some see even more.

Reflect on that math.  If your doctor sees 30 patients a day, that’s 150 a week, 600 a month, maybe 7,000 a year.

It means that if it’s been even two months since you last saw your doctor, he has probably seen more than a thousand people since your last visit.  It’s why there’s often that moment of disconnect when you see your doctor.  You’re living every day with the fears and anxieties of your medical condition, but your doctor can’t quite place which one of the worried patients you are.  So you have to remind him why he ordered that extra test a few months ago, why you switched medications the last time you were there, how he already ruled out that possibility the last time he saw you.

We all work through these awkward moments- but they are a symptom of a more serious problem.

Doctors who are starved for time in a patient visit are also starved for time to think about their patients, reflect on what is wrong, and find good solutions.  It’s why studies show such alarming rates of incorrect diagnosis and treatment.

But what else can a doctor do?  There’s a room full of patients outside.  Just like there was yesterday, and just like there will be tomorrow.
0 Comments

A New Grassroots Movement By Doctors

3/5/2012

0 Comments

 
There’s a new movement in healthcare – and it’s growing from a surprising place. Instead of emerging from government or industry, it’s budding from the grassroots –from everyday physicians. The movement is democratizing health information and giving birth to a new landscape: Interactive Health.

Interactive Health is transitioning clinical care from real-world, costly encounters to virtual, inexpensive, cloud-based care. And the view from the cloud is better. This transformation is starting with the most fundamental interaction in healthcare: patient question, physician answer.

In late April of 2011, HealthTap decided to help facilitate this movement by bringing together physicians to engage online and create a road map for “care in the cloud.” Nine months later, the growth of physician engagement on HealthTap and beyond proves that Interactive Health is here to stay.

Today, HealthTap announced that 10,000 physicians have joined their Medical Expert Network, where they are sharing and evaluating the best health information online, dramatically improving care within a transparent meritocracy.

The Three Pillars of the new movement: Quality, Access, and Care

Interactive Health is supported by three pillars: quality, access, and care.

Quality

We live in a world of abundant heath information – but this information can create
confusion, frustration and mistrust. The Interactive Health movement is changing
this by ensuring quality through trust, pluralism, merit and peer review. HealthTap is facilitating this movement in three ways.

HealthTap creates trust by allowing only U.S.-licensed physicians in excellent standing to join its Medical Expert network. Admission is even stricter than state licensing requirements.

HealthTap also supports pluralism by enabling doctors to add better answers to all patient questions, even if already answered by other doctors. These, in turn, are being commented on by additional doctors adding multiple opinions and approaches to the available body of knowledge.

HealthTap supports meritocracy and peer review by ensuring that answers are not based on the assessment of a single individual or organization, but are based on the combined evaluation provided by the medical community, and by allowing participating physicians to review, rank, and evaluate answers.

Access

HealthTap makes the highest quality health information readily available to everyone for free. Physicians can also compare and contrast their own approach to that of other doctors.

HealthTap is built around transparency: when patients view answers, they can see who created them. They can see the physician’s real name, learn where the doctor was educated and practices, and eventually follow up with an appointment.

In real Interactive Health, physician participation is voluntary, not dictated. The participating’s physicians’ goals are to improve care and to make the best health information available to all.

Care

HealthTap helps facilitate better care through creating a culture of gratitude and kindness between doctors and patients. In addition to recognition from fellow physicians, HealthTap lets users “Thank” doctors when they appreciate answers. Hundreds of physicians have written to us that the “Thanks” they receive from patients on HealthTap remind them of why they decided to practice medicine in the first place.

The second element of true care is availability. Interactive Health makes doctor wisdom readily available 24/7 – without additional effort by physicians or cost to patients.

How HealthTap is leading the Interactive Health movement

The democratization of health information involves more than just bringing the best
information to people everywhere – it also means giving an opportunity for top licensed physicians in good standing to have a real voice.

The Medical Experts participating on HealthTap include leading doctors from top
institutions, as well as physicians practicing in rural areas, giving them all the same opportunity to have their voices heard, and to share their knowledge on equal footing.

Physicians on HealthTap are known both locally and nationally. The fast-growing network includes respected medical practitioners in communities of all sizes. Doctors on HealthTap were trained in and practice at top institutions like Harvard (the #1 represented medical school for physicians in our network), Johns Hopkins, and UCSF, and have been published in medical journals, such as JAMAand the New England Journal of Medicine. The network also includes experts who have served as department  chairs or division chiefs at premier medical centers, including Cedars-Sinai, Memorial Sloan-Kettering, and Baylor University.

HealthTap’s Medical Expert community includes physicians like Dr. Barry Rosen, a surgeon listed as one of America’s Top Doctors in U.S. News and World Report; Dr. George Kalber, a Professor of Urology and Pediatrics at the Tufts University School of Medicine; and Dr. Cornelia Franz, a Pediatrician and author of Common Sense Pediatrics.

The HealthTap Medical Expert Network also includes physicians like Dr. R. Wayne
Inzer, an OB/GYN who serves as the program Director for the Obstetrics and
Gynecology Resident training program at Baylor University Medical Center; Dr.
Latisha Smith, an assistant professor in the University of Texas Health Science
Center at Houston’s comprehensive wound care and hyperbaric medicine center; and
Dr. Bert Mandelbaum, the Chairman of the department of pediatrics at the University Medical Center of Princeton.

Together, these six doctors have answered more than 2,200 questions, which have received over 3,400 Agrees from the physician community, and which have helped almost 200,000 people to date (a number that will continue to grow in the future with no additional effort by these doctors as more users find them through their mobile devices and online). This is what moving the best information to the cloud is all about.

By enabling doctors to compete with one another on the quality of their answers, and to assess the answers of other doctors, HealthTap has become both the voice of the most well recognized physicians and the voice of those who are most deserving of recognition. A true meritocracy, HealthTap is the podium for both the super-known, and for those who deserve to be—but are not yet as well known as they will be very soon.
0 Comments

Rating the Raters: Physician Compare

11/2/2011

1 Comment

 
Let’s say you’ve enrolled in a new health insurance plan and need to find an internist who participates. How do you decide which doctor to choose? My (long deceased) grandmother made her choices by using the following criteria: She looked for a male doctor with a Jewish-sounding last name who graduated from an American medical school—preferably one located in New York City. Nowadays her narrow (and culturally biased) criteria would have excluded some of the most esteemed practitioners around.

If you are like most people, you don’t depend on your grandmother’s advice to find a physician, but rather ask friends, colleagues or other doctors for recommendations. But taking one person’s experience with an internist or surgeon as a signal that he or she is “really good” is still far from the optimal way to choose a practitioner.

Over the years, several commercial websites like HealthGrades and Angie’s List have cropped up that provide such consumer-friendly information as the distance a doctor’s office is from the patient, and whether foreign languages are spoken there. They usually include ratings that reflect consumers’ personal experiences with the practitioner. For people who want to dig deeper, most state medical boards collect data that can be searched to find out where your doctor went to medical school, where he did his residency and what board certifications she has. In some states you can also search to see if the doctor in question has received disciplinary action or been sued for malpractice.

This is a lot of on-line legwork for the average person—a task that even professionals can find difficult. Chip Amoe, assistant director for federal affairs at the American Society of Anesthesiologists told a group recently, “When I tried to go find a primary care physician, I couldn’t. You know, it was very difficult. I had to go on several different Web sites to be able to find [one].”

In the end, you may pick a doctor who graduated from a prestigious medical school, hasn’t been sued often, is only a 10-minute drive away and has a nice, clean waiting room; but none of this information will necessarily increase the likelihood that he or she will provide high-quality, cost-effective care. That’s where the nascent Physician Compare website, designed by the Center for Medicare and Medicaid Services, comes in. The site, which is still under development and will be modeled after CMS’s existing “Hospital Compare” site, was mandated by the Patient Protection and Affordable Care Act and is slated to go up on-line on Jan. 1, 2011.

Don’t expect too much. Next year, the information posted on Physician Compare will be little more than that already available in CMS’s Healthcare Provider Directory. This directory, designed to be used by Medicare beneficiaries, lets consumers search for a physician or other health care professional by specialty and location. Additional search criteria allow the user to search by gender and whether or not the physician or other health care provider accepts Medicare reimbursement as full payment on all claims. Information about languages spoken, education, and hospital affiliation is also available for some providers.

For now, Physician Compare will post information only about physicians enrolled in the Medicare program, and will note those providers who participate in CMS’s voluntary Physician Quality Reporting Initiative (PQRI). The PQRI program requires that doctors report data for at least three of 170 or so evidence-based quality measures (examples include; giving aspirin to patients experiencing heart attack and recording vital signs for patients presenting with community-acquired pneumonia). By reporting this information (positive or negative) for at least 80% of patients over the course of a year, the provider earns an incentive payment from CMS that can reach 2% of total Medicare reimbursement.

This kind of information, if displayed in an easy-to-use format, will be more helpful perhaps than a friend’s recommendation, yet still limited. But over the next several years, the Physician Compare site promises to become something more. For one, health care reform legislation requires that by 2019, doctors must report and the public must have access to the following sources of physician quality and performance data:

• Measures collected under the Physician Quality Reporting Initiative
• An assessment of patient health outcomes and the functional status of patients
• An assessment of the continuity and coordination of care and care transitions, including episodes of care and risk-adjusted resource use
• An assessment of efficiency
• An assessment of patient experience and patient, caregiver, and family engagement
• An assessment of the safety, effectiveness, and timeliness of care

According to Regina Raymond-Chell, a registered nurse who is part of CMS’s quality measurement health assessment group, January 2012 marks the beginning of the reporting period for more detailed physician performance information. A year later, in 2013, the agency will implement a plan for publicly reporting physician performance data through the Physician Compare Web site. By 2015, doctors who fail to report data on quality measures will face penalties—a 1.5% reduction to fee schedule payments the first year; a 2% reduction in 2016. Finally, in January 2019, a demonstration project will begin that will use this performance data to provide financial incentives (i.e. Medicare will reimburse patients’  medical charges at a higher rate) to beneficiaries who use “high-quality” physicians.

On October 17, CMS held a town hall style meeting to hear suggestions from stakeholders in the Physician Compare site about what kind of quality information should be included and where it should come from. Doctors groups insisted that performance information must be risk-adjusted to not penalize those who treat sicker patients. They also worried about how data will be presented for physicians who provide care in a hospital (hospitalists) versus those who see patients in an office or out-patient clinic setting. Finally, they want a physician to have the chance to review all information associated with his listing before it goes public.

The American Medical Association points out that even CMS’s basic physician directory (providing name, address, credentials for physicians) has had problems with accuracy, and the group says they often field complaints from physicians about interacting with this system.

Jennifer Shevchek, assistant director of federal affairs for the AMA said at the town hall meeting; “Physicians and other providers involved in the treatment of a patient must have the opportunity to prior review and comment and the right to appeal with regard to any data that is part of the public review process. Any such comment should be included with any publicly reported data. This is necessary to give an accurate and complete picture of what is otherwise only a snapshot and possibly…[a] skewed view of the patient care provided by physicians and other professionals or providers involved in that patient’s care.”

Meanwhile, consumer advocates want to put a limit on how long doctors can take to “review” their data so that the site is comprehensive and stays up-to-date. They also want Physician Compare to be user-friendly. At the October meeting, Tanya Alteras, associate director of the Consumer Purchaser Disclosure Project, a group that advocates for “a transparent health care market, in which, decision-making is supported by publicly reported comparative information,” said; “Physician Compare needs to be populated with information that’s meaningful to consumers and that is presented in a way that’s simple, intuitive and easy to navigate.” She continued, “We need measures on patient outcomes, patient experience, functional status, care coordination and resource use.”

Steven Findlay, a senior health policy analyst at Consumer’s Union added: “I think we all know that the existing CMS and HHS [Health and Human Services] Compare Web sites have been evolving and improving over recent years, but they’re still struggling to effectively support consumer choice.”

The other “compare” sites Findlay refers to include Hospital Compare, Dialysis Compare, and Skilled Nursing Home Compare. They have all been on-line for several years—although interestingly, they are not used very often by consumers. One study estimated that only 12% of consumers considering nursing homes for themselves or relatives actually used the CMS comparison site.

Why the low utilization? According to Findlay, “Nursing Home and Hospital Compare sites use extracted data from the Medicare database and although it is displayed in a way that’s meaningful and good, it tends to be packaged in a way that’s not easy to use for people who are not well educated or do not have advanced computer skills.” Considering that the majority of folks who would be using these sites are 65 and older, that is a real problem. This is especially apparent, says Findlay in CMS’s site that allows seniors to compare and choose a prescription (Part D) plan available through Medicare. “This site is god-awful,” he says, structured for a very sophisticated population but used primarily by senior citizens who are easily intimidated by on-line information. “I even find it intimidating,” says Findlay.

Besides being hard to use, some of the CMS sites have recently come under attack for providing consumers with inaccurate data or for using the wrong quality measures.

The Dialysis Compare site is one glaring example. This website allows patients requiring dialysis to find centers near where they live and then compare how the facilities rate in anemia control, hemodialysis effectiveness (how much waste is removed from blood), and patient survival.

But a new investigation by ProPublica along with The Atlantic finds that the Dialysis Compare site is not always providing accurate information about this costly medical service and that quality varies widely from site to site. Since 1972, Medicare has covered dialysis treatment for all patients, regardless of age or income. Each year, more than 100,000 Americans start dialysis treatment, according to Robin Fields, a senior editor atProPublica and author of the report. “Taxpayers spend more than $20 billion a year to care for those on dialysis—about $77,000 per patient, more, by some accounts, than any other nation,” writes Fields. Yet the United States continues to have one of the industrialized world’s highest mortality rates for dialysis care: One in four patients will die within 12 months of starting treatment.

Fields says that over the years, clinics have gotten better at hitting biochemical targets (anemia control, removing waste from blood, etc.) that are set by CMS and reported on the Compare site, but “overall rates of death and hospitalization have seen little change.” She continues; “Medicare’s record of making sure that clinics meet health and safety standards has been spotty. Clinics are supposed to be inspected once every three years on average, but as of October, almost one in 10 hadn’t had a top-to-bottom check in at least five years.” The ProPublica investigation found striking problems in some dialysis centers, including unsanitary conditions, high rates of patient infection and no nephrologists or other physician consistently on-site to oversee care.

The Hospital Compare site has also come under criticism recently. Researchers at the University of Michigan published a study this month in the Archives of Surgery that concluded; “Currently available information on the Hospital Compare Web site will not help patients identify hospitals with better outcomes for high-risk surgery. The Centers for Medicare and Medicaid Services needs to identify higher leverage process measures and devote greater attention to profiling hospitals based on outcomes to improve public reporting and pay-for-performance efforts.” The problem, according to the authors, is that CMS has put more emphasis on measuring processes (whether antibiotics were given or measures were taken to prevent blood clots) rather than outcomes—how patients fared after their surgeries.

One surprising result of the study is that there was little correlation between how well hospitals complied with Medicare’s process measures, (the information posted on Hospital Compare) and patient outcomes. In fact, according to a recent post on a blog published by the California HealthCare Foundation, “the hospitals with the poorest compliance rate with Medicare safety measures reported the fewest patient complications, while the hospitals with better compliance records had higher complication rates.”

The lesson from the shortcomings of current CMS Compare sites must be taken into account as Physician Compare develops. At the town hall meeting it was clear that decisions still have to be made about what quality measures will be included on the site and where this data will come from. Besides PQRI, groups like the National Quality Forum also have devised good quality metrics and the Consumer Assessment of Healthcare Providers and Systems (CAHPS) devises free surveys that can help measure patient satisfaction and the communication skills of a given practitioner. Finally, in the next few years, “meaningful use” data generated by the widespread adoption by doctors of electronic health records could provide a powerful resource for measuring the quality of individual practitioners—especially in meeting process goals.

Consumer advocates want to see additional information included on the site that is not specified in the Affordable Care Act. CU’s Findlay believes consumers should know if their physician has kept up with the latest care available, so they will want to see evidence that their doctor’s certification is up to date. Also, he thinks consumers should have access to information about gifts and payments individual doctors and group practices receive from drug companies or device makers to help alert patients to potential conflicts of interests their physician might have. These figures will be publicly available under the Physician Payment Sunshine Act starting in 2013, and could be integrated into the Physician Compare site quite easily. “If they don’t do this, we will,” warns Findlay.

Finally, consumers should have access to some of the valuable volume and outcomes information that is gleaned by analyzing individual physician claims data—both from government insurers and private ones. This includes letting consumers know such relevant information like how many knee replacements a particular surgeon does a year, how many scans or other tests he or she orders compared to similar practitioners, and how much the physician is paid for these procedures.

Making claims information public will be a challenge. Three decades ago, the AMA successfully sued the government to keep billing and reimbursement data secret; citing privacy issues. And in the last year the AMA has fought and defended doctors against two other lawsuits from consumer groups that wanted to make physician claim information public to help detect fraud and overuse of certain procedures. In the interest of providing valuable information for Physician Compare, it may be worthwhile for the CMS to take the AMA back to court once again over this issue.

In the end, the short-term goal of Physician Compare is to empower consumers and give them truly useful information in an easy-to-use format so they can make important choices about their health care. One model to consider is the new healthcare.gov site, a comprehensive health insurance comparison website created by HHS that gets high marks from consumers and professionals for ease of use. “It’s a giant leap in the right direction,” says CU’s Findlay.

The longer-term goal of these Compare sites goes beyond consumer empowerment. Eventually CMS and even private insurers will begin using meaningful measurements and data from these sites to promote pay-for-quality schemes. The idea is to offer financial incentives (and disincentives) to encourage providers to improve the quality of their practice, or in the case of nursing homes, hospitals and dialysis centers, improve the quality of their facilities.The government has just begun to embark on its quest toward evidence and quality-driven medicine; for the public, it’s an early step toward making educated choices about care.
1 Comment

Global Health Progress Encourages Global Partnerships

4/4/2011

5 Comments

 
Starting this month, members of Congress will be looking closely at U.S. spending as they work with the White House to build the 2012 budget. One area that has come under increased scrutiny is U.S. spending on global health programs. Several groups last week announced a petition (http://www.supportglobalhealth.org/) seeking support for global health spending through the United States Global Health Initiative. Many fear that even flat spending in this area could jeopardize important programs in vaccine research and treatment.

News like this highlights the important role that public-private partnerships play in supporting access to global health care. The Global Health Progress initiative seeks to bring research-based biopharmaceutical companies and global health leaders together to improve access to medicine and health care in the developing world. We are committed to being part of the effort to create a sustainable health care system that includes improving access to health care and continuing medical innovation and progress for all people.

Research-based biopharmaceutical companies and their partners around the world are working to implement sustainable solutions and strengthen the health care delivery systems so they can meet tomorrow's challenges. Millions of people lack access to essential medicines due to factors including incomplete delivery systems, lack of training for health personnel, lack of infrastructure and the cost of treatments. We must address the underlying barriers to health care, such as weak and fragmented health systems, limited health care personnel and inadequate resources for scaling up proven solutions. The innovative research and development (R&D) of new drugs and vaccines is a critical component of improving health care and combating epidemics in developing countries.

Through meaningful public-private partnerships with others in the field, including policymakers in the developed and developing world, multi-lateral institutions, non-governmental organizations, and academia we can help shape sustainable solutions that improve the health of all people.
5 Comments

    Author

    Bruce A. Cadkin, MBA President                          BAC Medical Marketing

    Archives

    October 2019
    September 2019
    August 2019
    July 2019
    June 2019
    May 2019
    April 2019
    March 2019
    February 2019
    January 2019
    December 2018
    November 2018
    October 2018
    September 2018
    August 2018
    July 2018
    June 2018
    May 2018
    April 2018
    March 2018
    February 2018
    January 2018
    December 2017
    November 2017
    October 2017
    September 2017
    August 2017
    July 2017
    June 2017
    May 2017
    April 2017
    March 2017
    February 2017
    January 2017
    December 2016
    November 2016
    October 2016
    September 2016
    August 2016
    July 2016
    June 2016
    May 2016
    April 2016
    March 2016
    February 2016
    January 2016
    December 2015
    November 2015
    October 2015
    September 2015
    August 2015
    July 2015
    June 2015
    May 2015
    April 2015
    March 2015
    February 2015
    January 2015
    December 2014
    November 2014
    October 2014
    September 2014
    August 2014
    July 2014
    June 2014
    May 2014
    April 2014
    March 2014
    February 2014
    January 2014
    December 2013
    November 2013
    October 2013
    September 2013
    August 2013
    July 2013
    June 2013
    May 2013
    April 2013
    March 2013
    February 2013
    January 2013
    December 2012
    November 2012
    October 2012
    September 2012
    August 2012
    July 2012
    June 2012
    May 2012
    April 2012
    March 2012
    February 2012
    January 2012
    December 2011
    November 2011
    October 2011
    September 2011
    August 2011
    July 2011
    June 2011
    May 2011
    April 2011
    March 2011
    February 2011
    January 2011
    December 2010
    November 2010
    October 2010
    September 2010
    August 2010
    July 2010
    June 2010
    May 2010
    April 2010
    March 2010
    February 2010
    January 2010
    December 2009
    November 2009
    October 2009
    September 2009
    August 2009
    July 2009
    June 2009
    May 2009

    Categories

    All
    Advertising
    Affiliate Marketing
    Affiliate Program
    Anna Deavere Smith
    Avoiding Malpractice Suits
    Best Practices
    Blogs
    Branding
    Cash Only Medical Practice
    Concierge Medical Practice
    Crisalix Estetix
    Customer Service
    Defensive Medicine
    Dental Practice Marketing
    Developing Physician Leaders
    Electronic Medical Records
    Emwave Products
    Expert Panels
    Facts And Figures
    Gene Smart Wellness
    Going Dutch
    Gum Disease
    Healthcare Reform
    Heartmath
    Holiday Poems
    Ingenio Expert Advice
    Internet Marketing
    In The News
    Let Me Down Easy
    Liveperson Expert Advice
    Managing By The Numbers
    Marketing Momentum
    Marketing Strategies
    Martin Luther King
    Medical Marketing
    Medical Tourism
    Meta Tags
    Mobile Marketing
    Money Driven Medicine
    Most Influential Physicians
    Omega 3 Index
    Online Reviews
    Patient Advocate
    Patrick Soon-Shiong
    Physicians At Funerals
    Practice Advertising
    Prayer Over Treatment
    Pro Football Head Trauma
    Psychographics
    Public Relations
    Referral Marketing
    Search Engine Optimization
    Social Media Marketing
    Solution To Medicare
    Staff Training Programs
    Steve Jobs
    The Art Of Apology
    Top Medical
    Web Site Design
    Web Site Marketing

    Bookmark and Share

    RSS Feed

    Picture

    I'm an expert on Maven!

    Consult with me on Maven



    Zintro Expert
    zintro.com/expert/Marketing-Maven

    Ingenio Expert

    Picture
    Liveperson Expert

    Reuters Insight Expert

    Which of the following changes in your practice most accurately reflect your goal? (Check all that apply) I would like to...
     
    pollcode.com free polls
    YouTube
    Twitter
    Code Of Ethics
    Medical Blog Award
    Picture
    Picture
    Picture
    Picture
    Picture
    Picture
    Picture
    Picture
    Picture
    Dosie Award
    Weblog Award
    AlleyDog Award
    Best Blog Contest Award
    Blogtrepreneur Award
    Top 100 Blog Award
    Blogger's Choice Award
    Blogger's Choice Award
    Blog Advertising - Advertise on blogs with SponsoredReviews.com
Privacy Policy & Cookies Policy -- Terms & Conditions of Use -- Site Map 
                
      BAC Medical Marketing, BACMM and BAC / BACMM logos are trademarks of BAC Medical Marketing.


           © Copyright 2005 - 2019 BAC Medical Marketing. All rights reserved.


Picture

Protected by Copyscape Duplicate Content Detector
Website designed by Black Mamba