Kim Bellard

See the following -

Just Doing Our Jobs

Health care fraud is bad.  Everyone agrees about that (except those who profit by it).  We'd similarly agree it is all too pervasive.  Just in the past few days racketeering charges have been brought against former executives of Insys Theraputics, numerous charges brought against leaders of Forest Park Medical Center (Dallas), 18 people in Pittsburgh were charged in a prescription fraud scheme, a New Jersey chiropractor was arrested for health fraud, and the feds settled a $4.5 million fraud case against a Florida orthopedic clinic. The list goes on and on, week after week, in every state, for every type of medical specialty, and against most health insurers.  Some estimate that fraud could account for up to 10% of health care spending.  But that's chump change: estimates are that other kinds of wasteful spending, such as unnecessary care and excessive administrative costs, are easily double that...

Kangaroos, Insurance Companies, and the Rising Cost of Healthcare

Complaining about health care prices is nothing new. The medical component of CPI has been higher than the overall CPI for decades. As far back as 1989 Gerry Anderson and colleagues showed "It's the Prices, Stupid" that explained why our national spending was so high compared to other countries. More recently, Elizabeth Rosenthal detailed those prices in an series of reports in The New York Times. She recently followed those up with her incisive book An American Sickness. Dr. Rosenthal also illustrated some of the clever techniques used to wring the most money out of our pockets, such as the upcoding industry and tacking facility fees onto visits. As the saying goes, if you're sitting at a poker table and you can't figure out who the sucker is, it's you.

Let's Hope This Bores You

I think I know what is wrong with health care: not enough people are bored. These are stressful times for health care. There's a never-ending stream of innovation, constant pressures about costs, concerns about the quality of care, conflicting research findings, ongoing uncertainty about how we should finance what coverage for which people, and new business models and organizational structures. There's too much to take in, and everyone in health care is working too hard, too long.  Honestly, who has time to be bored? But that's a problem. We usually think of being bored as a bad thing. You don't often find people saying they're looking to be bored. You don't find many activities that bill themselves as being boring...

Let's Place Some Big Bets - Reinventing Medical Care

When we think about market research and Big Data, think about Henry Ford's (possibly apocryphal) quote: Most of our healthcare innovations and reforms take the existing healthcare system as a given and try to build upon it in some way. They add more on-ramps to the healthcare superhighway, widen its lanes, try to smooth the pavements, maybe even automate our driving on it. But sometimes we need to tear the highway down. Here, in brief, are some big bets I'd like to see someone take on...

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Living in a Retro Health Care System

EHRs are a perfect example of how we took something that should revolutionize health care, and turned it into something that not only no one is happy with but that many feel often impedes care, to the point some want to go back to paper records.  That's not retro, that's just stupid.  We didn't do the wrong thing with EHRs, we just are doing it wrong. As I've written before, we should be thinking big and bold about how we want our health care system to work in the 21st century.  We should be setting tough goals for how effectively it works for us -- and expecting to achieve them.  We should be looking forward, not backward...

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Losing the Doctor Lottery

Donna Jackson Nakazawa's insightful Health Affairs article "How to Win the Doctor Lottery" is, in turn, sad, frightening, wise, and hopeful.  She recounts some of her personal travails in finding the right doctors, the ones who will truly listen and become "a partner on my path to healing," and offers several suggestions about what has to happen for us to have more chance to "win." The real question, though, is not how to win the doctor lottery we find ourselves in, but why we're playing it at all. Getting the right doctor is hard.  Consider the following: It's easy enough to find out where a physician went to medical school and did their residency.  It's not as easy to know what the best medical schools or best teaching hospitals are, other than by reputations (that may or may not be deserved)...

Lost in the Signal...Is Most Healthcare Spending Being Wasted?

I finally got around to reading Bryan Caplan's The Case Against Education: Why the Education System Is a Waste of Time and Money. In it, Dr. Caplan, an economics professor at George Mason University and self-avowed libertarian, argues that, aside from basic literacy and numeracy, our educational system serves less to educate and more as a way to signal to employers who might make good employees. Oh, boy did this book make me think about our healthcare system.Dr. Caplan's views on economic signaling are by no means out of the mainstream, although his application of it to education may be. Think of it this way:

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Make No Little Plans

Ever seen the new TV show 'Pure Genius'?  Probably not; its ratings are dismal.  I've seen it, and, well, it isn't very good.  But what I like is the premise: a young tech billionaire builds a hospital using only the latest technology, and treats patients regardless of cost. Gotta give the creators props for trying to re-imagine hospitals.  The health care industry could do with some serious attempts at re-imaging, and not just for hospitals. What made me think about this were two stories about the auto industry, which is desperately trying to remain relevant in a world of Uber, self-driving cars, and our love affair with our various digital devices...

Medical Boards Behaving Badly

Rats!  I was all excited to write about virtual reality -- what with the long-anticipated release of the Oculus Rift -- or about how perhaps augmented reality is going to be the new reality, as some experts predict.  Then Consumer Reports came out with a report that I had to write about: What You Don't Know About Your Doctor Could Hurt You. Long story short: chances are you don't know what you'd like to. Consumer Reports did a deep dive on the actions of the California medical board, obtaining their entire database of doctors on probation...

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Millennials Are (Not) So Different

Millennials get a bad rap. If we believe conventional wisdom about them, they like to live with their parents, at least until they can move into their urban-center condo.  They hate to drive.  They're maddening in the workplace, demanding lots of frills and constant praise yet returning little loyalty.  They're hyperconnected through their various digital devices.  And, when they deign to think about health care, which isn't often, they want all digital, all the time. There's some truth to the conventional wisdom, but not as much as you'd think.  A new study from Credit Karma flatly asserts that "everything you thought you knew about Millennials may be wrong," finding that they still have aspirations to much of the same "American Dream" as previous generations...

My Phone Says I've Looked Better

Current AI can sift through millions of photos to pick you out of a crowd, with varying degrees of success.  Camera angles, make-up, hats, quality of image all factor into how successful such software is.  Given the recent rapid rates of improvement, though, these are bumps in the road, not insurmountable barriers. Other software can process your facial expressions, allowing them to make some good guesses about your emotions.  If you are a marketer, or a law enforcement officer, this information might be gold, but if your privacy is important, it might be a scary invasion.  Someone is always watching. What I want to know is when this AI can tell if I look sick.

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Mystery Consent Forms and the Scourge of Surprise Medical Bills

We are, it appears, shocked -- shocked! -- that there are "surprise" bills in healthcare. That is, bills from out-of-network healthcare professionals, even when patients thought they were going to in-network professionals/facilities. The problem is bad enough that even our deeply divided Congress has bipartisan agreement that it should act (although whether it will, of course, remains to be seen). Of course, surprise billing shouldn't come as a surprise to anyone who knows much about healthcare; it is more of a symptom of problems with our healthcare system than a problem itself. Kaiser Health News/NPR deserve much credit for getting more attention for the issue, with their Bill of the Month crowdsourced investigation.

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Nanoparticles On My Mind

Nanoparticles are everywhere! By that I mean, of course, that there seems to be a lot of news about them lately, particularly in regard to health and healthcare.But, of course, literally they could be anywhere and everywhere, which helps account for their potential, and their potential danger. Let's start with one of the more startling developments: a team at the University of Miami's College of Engineering, led by Professor Sakhrat Khizroev, believes it has figured out a way to use nanoparticles to "talk" to the brain without wires or implants.They use "a novel class of ultrafine units called magnetoelectric nanoparticles (MENPs)" to penetrate the blood-brain barrier.

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No Forms For You!

What do you hate worst about health care?  It could be the uncertainty about diagnoses, or the impreciseness of treatments.  Or there is the opaqueness about the actual performance of our providers.  Maybe it is the drabness and/or confusing layout of many health care settings, or the interminable waiting we do in them.  But somewhere on the list has to be having to fill out all those forms, over and over, at practically every stop along the way. If only someone would do for health care what Amazon is trying to do with grocery stores with Amazon Go. If you've missed the many stories about Amazon Go, or don't want to bother with the above video, it goes something like this...

No Thanks, I Already Have a Number

Health care has a problem.  Well, of course, it has many problems, but one of them is that the various parties involved in the health care system can't agree on who we are. Twenty years ago HIPAA called for creation of unique patient identifiers to accomplish this task, but within two years Congress put this on hold until further notice, and we're still waiting. Everyone used to use social security numbers for this purpose, until we finally figured out the folly of that (especially since that number was never intended to be used as a national identification number).  The private sector continues to clamor for federal action, while CHIME launched a National Patient ID Challenge in order to come up with solutions. News flash; we already have a unique, non-government-issued identifier: it's called a cell phone number...