- Dr. Ted (he’s not me) | The Economist – Comment from a user of The Economist.com that refers to the Kaiser Permanente study showing a 21.5 % decrease in office visits in Hawaii. (see http://content.healthaffairs.org/cgi/content/abstract/28/2/323 ). I agree that the majority of care to Americans is provided in small practices, as well as the idea that physicians who want to perform virtual care find it difficult with today's reimbursement approach. (50% of the reason I’m posting this is to clarify that I’m not this Dr. Ted. I post comments on others’ blogs as “Ted Eytan.”
Posts Tagged ‘reimbursement’
Dr. Ted (he’s not me) | The Economist
April 27th, 2009 | Popularity: 15% 0 comments | Leave a replyDWT LLP | Practice Areas: Health Law Group Bulletin
February 23rd, 2009 | Popularity: 11% 1 comment- DWT LLP | Practice Areas: Health Law Group Bulletin – Carrots and Sticks: The Stimulus Package Promotes Health Information Technology – a nice overview of the details of health information technology stimulus.
Now Reading: “What’s the ROI on that scanner you just bought?” – Use of Medical Imaging in the United States
December 1st, 2008 | Popularity: 22% 0 comments | Leave a reply
The quote in the title of this post is the paraphrase of a conversation I have had more than a few times with someone who has asked me, “Ted, what’s the return on investment for web services for patients?” The answer I have usually gotten when I ask the question back is usually no answer.
Two papers just published in HealthAffairs provide a little more background for that conversation. The first is about the growth of the use of imaging technology in the United States. As you might expect, it is growing, and more with every new scanner put in operation.
To put things in better perspective, I created this graph from the data, showing the increase in the number of scans/beneficiary. In 2005, there were 547 CT scans per 1,000 Medicare beneficiary, or about 1 scan per 2 beneficiaries. What the article doesn’t mention is that the radiation load from a CT scan is high, anywhere to 15 – 100 times the dose of radiation from a chest X-ray. Medicare reimburses, on average $308 for a CT scan, $713 for an MRI.
A basic return on investment analysis is performed for abdominal aortic aneurysm (AAA) screening, which shows that as more people are screened using CT, less are screened using catheter angiography (which is more invasive). This is good, except, the reduction is less than 1:1, so there is overall expansion of screening to more people, and more procedures to fix AAA associated with this. The problem is that there isn’t data on whether this is overall a good thing or not from a cost/benefit perspective.
Because CT and MRI are a physician preference item, reimbursement and use is typically physician directed, which can create conflict (see Jaime Robinson’s paper in the same Health Affairs issue for more about this).
It’s interesting that the adoption curve of CT/MRI looks a lot like the adoption curve of personal health records in organizations that prioritize them, like Kaiser Permanente and Group Health Cooperative.
Currently, Medicare pays $0.00 per certified empowered/activated patient (potentially defined by more than 2 accesses to a comprehensive personal health record in 6 months).
So we know from this is example that it’s possible for health care to adopt technology. How can we recreate the magic of the CT/MRI adoption curve for something that’s patient directed? I have some ideas but want to see your comments first.
Insurers Embrace Online Physician Visits, But Doctor Participation Slow To Catch On – iHealthBeat
November 16th, 2008 | Popularity: 25% 0 comments | Leave a reply- Insurers Embrace Online Physician Visits, But Doctor Participation Slow To Catch On – iHealthBeat – “Aetna is agressively marketing the tool to its contracted providers” – some information about the support for patient-physician messaging in the fee for service sector. Also some information from Kaiser Permanente’s work. California Medical Association provides a distinctive perspective on change. See what you think. Why isn’t this catching on in the fee for service healthcare community? (Audiocast)
ConsumerReports.org – Self-test kits: Ratings, How to choose : The Good and Not So Good
September 18th, 2008 | Popularity: 24% 0 comments | Leave a reply- ConsumerReports.org – Self-test kits: Ratings, How to choose – The Good and Not So Good about this report – GOOD: Consumer Reports publishes an article looking at the accuracy of blood pressure monitors, testing them against medical technicians using a mercury sphygmomanometer. Also, nice quote from an MD representing the American Heart Association about the empowering effect of self-monitoring. NOT SO GOOD: A vague recommendation that "patients home monitor" – they did not cite the AHA recommendations about frequency and duration (just twice a day, for 7 days at a time, don’t bring the monitor to work, don’t do it more than twice per day), which may lead to excess or inaccurate monitoring of the condition. I think this is reflective of the fact that the medical profession still has not bought into the value of self-monitoring, and the industry hasn’t bought into reimbursing for it. In the future, reimbursement would be in the form of clinician time to assess and manage conditions, rather than patient time to come into the office, where the readings will be less predictive of a patient’s condition anyway. It could be as simple as a slight change to a pre-existing CPT code for Ambulatory BP Monitoring, which almost no one uses, because 24-hour around the clock blood pressure monitoring is a procedure that has not been state of the art for a long time.
Getting What We Pay For: Innovations Lacking in Provider Payment Reform for Chronic Disease Care
July 18th, 2008 | Popularity: 14% 0 comments | Leave a reply- Getting What We Pay For: Innovations Lacking in Provider Payment Reform for Chronic Disease Care – From the Center for Studying Health System Change. Asking the obvious question (in a useful way) about how payment per service is helpful to patients with chronic illness
Medicare Coverage of Ambulatory Blood Pressure Monitoring
June 23rd, 2008 | Popularity: 20% 0 comments | Leave a reply- Medicare Coverage of Ambulatory Blood Pressure Monitoring – CMS's coverage criteria for ambulatory blood pressure monitoring. Could home blood pressure monitoring be covered similarly?
NCPDP Standard for Encoded SIGs
May 22nd, 2008 | Popularity: 47% 0 comments | Leave a replyI learned about this at the CCR workshop. The CCR accomodates elements of this, but CMS has not endorsed it yet as a standard.
AMCP.org – Comments on Standard SIG – The NCPDP was working on the standard for Med Sigs – a little background
The RUC Speaks of Medical Home;Gathering Data on Hypertension;HealthPlan-Hospital Conflict in Arizona
May 13th, 2008 | Popularity: 55% 0 comments | Leave a replyMay 6th through May 7th:
- The Happy Hospitalist: This Deserves The Middle Finger – I guess it is controversial (the RUC report on Medical Home Reimbursement)
- AMA (RBRVS) RUC Medicare Medical Home Demonstration project recommendations – RUC and Medical Home. Might this be controversial?
- reportonbusiness.com: Asking ‘why’ again and again is harder than you think, but it works – Good description of the 5 Why's Exercise
- What is Hypertension? – WrongDiagnosis.com – Factoids about Hypertension, useful in planning a community intervension
- Cigna clients seek answers after expiration –
- Cigna ends pact with hospitals, leaves thousands in the lurch – This local story has not made the national news. I wonder why?
AMA on NPR; Patients judge quality by presence of an EHR; CCHIT Expansion Plans for 2009
April 5th, 2008 | Popularity: 82% 0 comments | Leave a reply- Topics – e-Visits @ TransforMED – Transforming Medical Practices – Article on whether the tipping point has been reached for e-visits
- WordPress Plugin: SIMILE Timeline at freshlabs journal – Nice visualization tool
- Doctor-Patient ‘Web Visits’ Spur Privacy Concerns : NPR – Should the American Medical Association always present the contrarian view around patient access? I don’t agree with the implication that cell phone / telephone is “most secure.” Anyone who has been in an airport recently would probably agree.
- WSJ.com/Harris Interactive Study Asks: Are There Fair and Reliable Ways to Assess Healthcare Quality? – Patients are saying that having an EHR is a “fair” assessment of quality
- Expansion of CCHIT Certification for 2009 (PDF Presentation) – Overview of CCHIT’s work to date and future strategy. Disclaimer: I am on the Foundations Workgroup
- Meet the Press — Robert Scoble — The Blogosphere | Fast Company – How Tim Ferriss used the blogosphere to his advantage
- News – Diversity gap found among state’s doctors – sacbee.com – “Not just a civil rights issue, a public health issue”
- YouTube – Microsoft Surface Parody – Why not use the device the size of a small car? The peril and promise of on demand video in shaping your message.
Voicethread; Zotero; Nice Summary of Medical Home from Deloitte
April 3rd, 2008 | Popularity: 82% 0 comments | Leave a replyApril 1st through April 2nd:
- Pattern Recognition » Blog Archive » I really hate Zotero – Like the concept, wants to improve the implementation
- Medical Home | Solution to Chronic Care Management? | Health Care | Disruptive Innovation for a New Primary Care Model | Center for Health Solutions – Deloitte LLP – Very nice overview of Medical Home, particularly with the rundown of stakeholders in the back, plus the medical home cost model.
- WordPress ? Support » Tags Import As Numbers, Not Words – Importing issues Wordpress
- Web 2.0 Expo San Francisco 2008 ? Co-produced by TechWeb & O’Reilly Conferences, April 22 – 25, 2008, San Francisco, CA -
- Compare Accounts | YouSendIt – Store and forward service for the times when e-mail isn’t so efficient. I use XDrive.
- Convert Your Paper to iPaper | Scribd – An ambitious project to convert paper , no extra charge
- John Furrier Says Google?s CIO is Leaving for EMI – Interesting change of employer, could the same thing happen if a Google employee was recruited to run a health care organization?
- Twitter – A Teaching and Learning Tool | ICT in my Classroom – Nice discussion of the uses of Twitter in education
- VoiceThread – Group conversations around images, docs and videos – An interesting image, video, voice annotating service. What are the applicaitons in medical group training and patient involvement
More Health2.0 = iPhone2.0 – Apple Digital Fitness System; Larry Weed; EMC’s Hypertension Management Program; GHI+HIP = Medical Home
March 28th, 2008 | Popularity: 69% 0 comments | Leave a replyA lot of stuff going on this week…
- Apple Digital Fitness Companion System? – Mac Rumors – It was/is only a matter of time. Hello Health2.0, courtesy of iPhone
- The computer will see you now | Economist.com – A nice biographical piece about Larry Weed, father of the problem oriented medical record.
- EMC, Partners collaborate on hypertension program – Daily Business Update – The Boston Globe – An employer that thinks about population health and sets up a PHR in concert with a health system. Interesting…..
- Subscribe to ringtones via iTunes – Easy way to get ringtones – a ringcast?
- Mashable?s Guide to Upcoming Web 2.0 Conferences – A plethora of get togethers to get up to speed on the latest in Web 2.0.
- leanblog.org | Lean Blog: The Waste of Handwritten Notes | Lean Manufacturing | Lean Healthcare | Toyota Production System – Yes, Leadership. From patients and their families too. The kind of leadership that brings the patient perspective into every conversation.
- Apple – Support – Downloads – MacBook, MacBook Pro Software Update 1.1 – Help with keyboard freezing issues caused by Leopard
- Healthcare 360 -
- GHI – GHI Medical Home Pilot – I think this is very promising for supporting EHR adoption and patient access to their own clinical information. Ties in very nicely with NYC’s PCIP project.
- Public health system struggles to reach gay ?hidden population? – Washington Blade – Another vulnerable population that could benefit from outreach – many are underserved even when well insured.
- Cocoa Programming for Mac OS X – The resource for programming on MacOSX, and iPhone as well
Physicans and Blogs; Explaining the RUC; Nice Use of Second Life
March 22nd, 2008 | Popularity: 39% 4 commentsMarch 18th through March 19th:
- The ‘World Wide Computer’?Another HAL? – Businessweek’s Review of “The Big Switch” – I used it for comparison
- NPR: Doctor Blogs Raise Concerns About Patient Privacy – I agree with points raised – a patient should never seek care and then discover that they have been written about on a blog. Instead, they should receive a copy of the medical record that has been created about them. At the same time, physician bloggers are doing something very important – they are testing the boundaries of transparency, to support a more accountable health care system. If anyone saw the 60 minutes story about Dennis Quaid and his family, the rationale for this become very clear.
- What Every Physician Should Know About the RUC – January 2008 – Family Practice Management – The information is useful. As primary care providers I think we need to be careful to include our specialty colleagues in the conversation, not distance themselves from it. As a member of a large multispecialty medical group, I know that there is interest across the physician community in supporting community health and the best experience for patients.
- MindBlizzard blog: Virtual Healthcare 2: Palomar Pomerado Health – All right – More news about the utility of Second Life – testing a hospital before it launches
- What is the ROI on employee suggestion systems? – A nice example from the toothpaste industry. But not necessarily one that supports the evidence, that far less toothpaste than people think is needed to protect teeth…..Maybe a customer suggestion system might be in order.
Innovative Reimbursement for EHR-using physicians; 9 Principles of Innovation (Google); Twitter; Services for Farm Workers Online
March 12th, 2008 | Popularity: 28% 0 comments | Leave a replyMarch 7th through March 11th:
- Frist Advocates Higher Medicare Payments for Doctors Who Use EHRs – iHealthBeat – An idea to promote network preference among physicians who adopt HIT.
- Marissa Mayer’s 9 Principles of Innovation | Fast Company – I love number 5
- The Curious Genius of Twitter – Evan Williams – Tweet | Fast Company – Will Twitter go the way of friendster? I think there could be applications of Twitter in Health Care (really)
- Area Tap Water Has Traces of Medicines – washingtonpost.com -
- Farm Workers Service Wheel – Services for farm workers in Sonoma County. Showing that the Internet can serve everyone
Blog Post: A NEW AND DIFFERENT WAY TO PAY FOR CARE (in MA)
February 14th, 2008 | Popularity: 17% 2 commentsThis blog post, by Andrew Dreyfus, the executive vice president for health care services at Blue Cross Blue Shield of Massachusetts and former president of the Blue Cross Blue Shield of Massachusetts Foundation, caught my eye.
Commonhealth » Blog Archive » A NEW AND DIFFERENT WAY TO PAY FOR CARE by Andrew Dreyfus
At the level the information is presented it sounds promising – that delivery systems might have more lattitude to use all of the tools available today to coordinate care (including patient access to their records online). The details are not listed, though. I wonder what about the plan would enable a more patient centered approach to implementing health information technology. Would a delivery system under this plan be spurred to promote personal health record adoption?
As we found when we visited Boston recently, adoption of relatively robust patient access systems has been less than desired, especially compared to systems where incentives are aligned. Maybe this might help?
I’m posting this as a trackback to the blog post to see if more information might be shared about this, either here or on the original blog. How does this new payment methodology stimulate patient access to health information technology and non-visit based care?
Better walking in DC; BIDMC going LEAN?; CEO Blogging; Best Companies 2008
February 7th, 2008 | Popularity: 71% 0 comments | Leave a replyFebruary 4th through February 6th:
- DC Moves for Safer Sidewalks – Get There – Washington government takes a step toward promoting walkability. Sidewalks stay open for business.Walkers rejoice!
- Apple //c – a photoset on Flickr – The OOB experience of an unopened AppleIIc computer. Remember when technology was fun? It still is. And I never even learned to program in Pascal.
- Ryanair’s Changing Altitude – Efficient cost management and charging for everything keeps margins high at RyanAir – a great example of “copy how we think” in terms of being like Southwest
- Running a hospital: More on fetching and work-arounds – BIDMC launches an improvement methodology called SPIRIT. Looks like it’s at least partially based on LEAN?
- The Health Care Blog: Bad Medicine: How The AMA Undermined Primary Care in America – Brian Klepper – Analysis of RBRVS and impact on primary care.
- The ethics of CEO blogging – Nice discussion from Paul Levy about the approach that a CEO takes to blogging. I’m in support!
- Insurers Begin To Reimburse for Online Visits, Concerns Remain – Nice profile of Kaiser Permanente’s program.
- Marriot Rolls Out Web-Based PHR System to Employees Nationwide – iHealthBeat – An employer-sponsored PHR. Will the lack of connection to the health care team be an issue?
- KUOW: Program Archive: Patient Safety, January, 2008 – Dr. Matt Handley, from Group Health Cooperative, is featured
- Best Companies 2008 – FORTUNE Magazine’s Top 100 Employers to Work For – The 2008 list is out. From an HR/Leadership perspective, it is interesting to look at some of the most important qualifications for being on the list, such as support for diversity.
Promising Reimbursement Methodology; More on Music and Real Estate Industries; Another Blog Post Goodbye to an Employer
January 15th, 2008 | Popularity: 45% 1 commentJanuary 12th through January 13th:
- Prometheus Payment, Inc. – A new payment model that supports outcomes, evidence-based care, and transparency
- The music industry | From major to minor | Economist.com – “Then they had the money and could have built the competence by buying concert agencies and merchandise companies,”…Now it may be too late.
- Coverity Incorporated Scan – Company working with the US Govt to harden open source code for use by agencies including Homeland Security. They are finding bugs and the bugs are being fixed.
- Online Real Estate Sites Work To Get A Listing Standard – Another industry that is seeing the benefits of standards, and the challenges of disruption
- Gone Indie ? Thought Palace – Interesting insight on the work environment at Apple. LEAN production? You decide. I will say, though, that even though Apple is not embracing Web 2.0 like other companies are, I have solved many problems using their hosted discussions. These actually work well on Apple’s site I think because they do a great job of leveraging their loyal customer base. Yet another blog “goodbye” to an employer.
- Lean Manufacturing Blog: 1 Hour Kaizen – Excellent template and approach to small improvements. Just takes an hour. Can we have physicians shadowing nurses and vice versa?
Adding more voices to “HIT before HIE”; Free samples Do Not Support the Safety Net
January 5th, 2008 | Popularity: 47% 0 comments | Leave a reply- RIAA Unfairly Maligned? Give Me a Break. – More on the RIAA and attempts to manage disruption, from Mashable.
- Characteristics of Recipients of Free Prescription Drug Samples: A Nationally Representative Analysis — Cutrona et al., 10.2105/AJPH.2007.114249 — American Journal of Public Health – Study demonstrating that free drug samples are not a safety net. In my practice career I have never used samples (and I’ve never prescribed celecoxib or rofecoxib, either).
- Health Affairs — eLetters for Walker et al., 0 (2005) 5101 – Comment on interoperable HIT being a net gain/loss for physicians, by Peter Basch, MD, of Medstar Health. I agree that we have to be cautious of theorized benefit in this case.
- Health Affairs — eLetters for Adler-Milstein et al., 0 (2007) 271601 – Comment from Peter Basch, MD, about the sequencing and business case for RHIOs not being ready yet.
- Dupont Circle Citizens Association – Learning more about my community. There has been an uptick in crime, unfortunately.
Cost-effectiveness of clinical messaging, Markle convenes around PHRs, More on Computer use
December 21st, 2007 | Popularity: 9% 1 commentPCHIT links for December 17th:
- Clinical Messaging Is Costly but Worth It, Says Vanderbilt Study ? Digital Healthcare and Productivity – Useful information when doing cost-utility analyses around messaging, perhaps.
- e-patients: Markle Foundation Policy Meeting 2007 – Notes from the meeting. What will be achieved, e-patients asks?
- Exploring Social Contextual Correlates of Computer Ownership and Frequency of Use Among Urban, Low-Income, Public Housing Adult Residents | McNeill | Journal of Medical Internet Research – A respectable 51% owns and 42% of adults in low income public housing uses computers, narrowing the disparity gap. Do they have internet access? Interesting correlates with neighborhood safety.
Blog commentary, an idea for a Wellness Trust, Employers sponsoring less insurance
December 13th, 2007 | Popularity: 25% 0 comments | Leave a replyDecember 4th through December 10th:
- A Wellness Trust to Prioritize Disease Prevention – Brookings Institution –
- Blog Schmog – www.healthleadersmedia.com – Tips on how to blog well, from a blogophobe (self-described)
- Smaller percentage of small firms covering health – Washington Business Journal: – More individuals will be responsible for the cost of their care
- Revolution Health Group buys 2 Web companies – Washington Business Journal: – Revolution now has employees in Seattle….
How to talk to a doctor (?), Indiana and Patient-Centered Care, Patients want EHRs
December 6th, 2007 | Popularity: 20% 0 comments | Leave a replyPCHIT links for November 29th through December 4th:
- How to talk to a doctor – USATODAY.com – I wonder how much if the burden being placed on patients is necessary in the era of PCHIT?
- Delivering a new kind of care | IndyStar.com – Patient centered HIT starts with patient-centered care, from Indiana
- Benefits of Electronic Health Records Seen as Outweighing Privacy Risks – WSJ.com – Poll by WSJ/Harris: Consumers want interaction with their care providers online. Less agreement on reimbursement.
Health reform comparisons; Blog penetration statistics
November 26th, 2007 | Popularity: 23% 0 comments | Leave a replyNovember 19th through November 21st:
- Analysis – health08.org – Side by side analysis of candidates’ health reform proposals. From Kaiser Family Foundation
- Technorati Weblog: Blogosphere – Important reference on the growth of blogs and splogs, from Technorati
- Pew Internet & American Life Project – Internet Typology Quiz – What are you?
Payers and Patient-Centered Primary Care; Google; Quality info in MA
October 30th, 2007 | Popularity: 12% 0 comments | Leave a replyPCHIT links for October 26th through October 27th:
- Major U.S. payers support Patient-Centered Primary Care Collaborative – Picking up steam – a way to support these activities in every day practice
- Google says it’s working to solve health record dilemma | CNET News.com – The title says it all
- The Partnership for Healthcare Excellence – A new Web site to empower consumers in seeking the best care in the Massachusetts area.
