Most Americans -- myself included -- think we live in the greatest country on earth. After all, we have the biggest economy, the most powerful military, the most pervasive popular culture, and, of course, the American Dream. We've got Wall Street and Silicon Valley, Walmart and Amazon, Hollywood and Nashville. We have -- well, we used to have -- the biggest city, the tallest building, and the largest manufacturing output. But when it comes to some of the basics, we're not doing so well. Take health care, for example. If you listen to politicians, we have the best health care in the world. And, indeed, if you have enough money (or really good insurance), happen to live in the right zip code, and manage to stumble upon the right doctors/hospitals, that's true. You can get the best health care in the world here. But fail any one of those qualifiers, maybe not...
Commonwealth Fund
See the following -
A Pro- Single Payer Doctor’s Concerns About Obamacare
Believe me, the right's approach would be much worse. But the underinsured are getting a worse deal than you think
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America's Dismal International Rankings - Time to Innovate Our Way Out of Our Messes
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Commonwealth Fund Spotlights 3 Telemed Model Citizens
While the nation’s healthcare costs continue to drain the economy, several forward thinking provider organizations are finding ways to turn the situation around with carefully thought out telemed programs. A recent report from the Commonwealth Fund highlights the cost effective approaches used by three “model citizens.” Read More »
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EHR Business Environment Must Change to Achieve Interoperability
The main challenges for the nation’s health IT interoperability are not technical but business related. That’s the word from former National Coordinators for Health IT speaking in a panel session on Tuesday at ONC’s Annual Meeting in Washington. Farzad Mostashari, M.D., former National Coordinator for HIT and currently CEO of start-up Aledade which partners with independent primary care physicians, warned that business practices among some electronic health records vendors are inhibiting the sharing of health information by restricting information exchange with users of other EHR products.
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Guess What: Docs Don't Like EHRs
It's kind of "dog-bites-man" type news, but there is even more evidence that physicians not only don't think EHRs are helping them but actually see them as contributing to burnout. Researchers at the Mayo Clinic found that use of EHRs (or computerized physician order entries -- CPOEs) was associated with lower satisfaction with time spent on clerical tasks, with nearly half of physicians saying the amount of time spent on clerical tasks was unreasonable. No wonder the AMA CEO recently complained that physicians were turning into the "most expensive data entry force on the face of the planet."
Health IT Security, FHIR Focus of ONC Secure API Server Challenge
ONC is challenging healthcare stakeholders to build secure Fast Healthcare Interoperability Resources (FHIR) servers to improve health IT security and ensure that secure FHIR options are available in the future. The Secure API Server Showdown Challenge will ideally “identify unknown security vulnerabilities in the way open source FHIR servers are implemented,” ONC Office of Standards and Technology Director Steven Posnack, MS, MHS, wrote in a blog post...
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Insurance Industry Myths About the Uninsured
In 2007, a few months before I left the health insurance industry, I was tasked to write a “white paper” designed to help convince media folks and politicians that the problem of the uninsured wasn’t much of a problem after all. If demographic data was sliced just so, I was expected to write, it was easy to conclude that many of the uninsured — some 46 million at the time — were that way by choice.
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Popular Mobile Health Apps Fail to Serve Vulnerable Populations
A new UC San Francisco study of top-rated mobile health apps showed that they offer little help to vulnerable patients – those who might benefit the most from these tools. The new study, published in the July 14, 2016 online issue of the Journal of General Internal Medicine, was conducted with 26 patients at The Priscilla Chan and Mark Zuckerberg San Francisco General Hospital and Trauma Center (ZSFG), a UCSF partner hospital that treats many low-income patients. Although participant income was not directly queried, a majority of patients at ZSFG qualify for publically funded insurance, or do not have insurance.
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Quality Matters: "Hospital at Home" Programs Improve Outcomes, Lower Costs But Face Resistance from Providers and Payers
Hospital at home programs that enable patients to receive acute care at home have proven effective in reducing complications while cutting the cost of care by 30 percent or more, leading to entrepreneurial efforts to promote their use. But widespread adoption of the model in the U.S. has been hampered by physicians’ concerns about patient safety, as well as legal risk, and by the reluctance of payers, including Medicare, to reimburse providers for delivering services in home settings. Read More »
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Technology Helps Drive High Cost of U.S. Healthcare
Higher prices and greater use of technology appear to be the main factors driving the high rates of U.S. spending on healthcare, rather than greater use of physician and hospital services, according to a new study from the Commonwealth Fund. The study found the U.S. spends more on healthcare than 12 other industrialized countries, yet does not provide “notably superior” care. Read More »
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The Big Get Bigger, Until They Don't
You may have missed it, but the Open Markets Institute released a report on what it calls "America's Concentration Crisis." The report begins bluntly: "Monopoly power is all around us: as consumers, business owners, employees, entrepreneurs, and citizens." As David Leonhardt wrote in his op-ed about the report, "The federal government, under presidents of both parties, has largely surrendered to monopoly power." Their associated data set details market concentration within 32 industries, several of which are health related. For example, in electronic health record systems, the top 3 firms account for 58% of the market, whereas in pharmacies/drugstores, the top 3 control 67% (and the top 2 alone have 61% share).
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U.S. Healthcare Is a Cadillac...Unfortunately
The good news: the U.S. healthcare is a Cadillac. The bad news: it's not an Escalade or even an XTS, it's a Cimarron, which is on most experts' list not only of the worst Cadillacs ever but also the worst cars ever -- expensive and poor quality. It was literally a Chevy Cavalier dressed up and trying to pretend to be a luxury car. You probably get the metaphor. There was a time when "Cadillac" was essentially a synonym for quality. Products aspired to be "the Cadillac of ____." It was a compliment of the highest order, understood worldwide. Foreign auto manufacturers tried to match its quality and make a dent into its market share. There was a time with U.S. healthcare had that kind of status too.
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Universal Healthcare Doesn't Mean Waiting Longer to See A Doctor
A new report from the Commonwealth Fund shows that people in other industrialized nations get doctors' appointments faster than Americans do. Read More »
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What Are We Prepared to Do in the United States to Save Primary Care?
I propose two significant changes to help make primary care relevant in the 21st century...I wrote a longer piece on [Virtual Care] earlier in the year. In short, it's a disgrace that we've put so many hurdles on telemedicine, and that it continues to be so underused. It is widely available in health plans, but rarely practiced by physicians nor by patients. Instead, we still mostly go to our doctors offices, to ERs, or perhaps now to drugstores.A televisit should be the first course of action for non-emergencies. We must remove regulatory and reimbursement barriers, and incent patients to take advantage of the speed and convenience of the option. Moreover, as AI options for diagnoses and advice quickly become more viable, we can use them to triage our needs, help assure continuity with physicians, and eventually reduce the need to talk to a human...
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Why Doctors Still Use Pen And Paper
The health-care system is one of the most technology-dependent parts of the American economy, and one of the most primitive. Every patient knows, and dreads, the first stage of any doctor visit: sitting down with a clipboard and filling out forms by hand.
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