e-Patient Dave

Power to the Patient!

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The Big Ugly continues: “Hospital charges bring a backlash”

Here’s the next episode in what I’m starting to call “The Big Ugly” – a wave of suffering that will happen as the medical industry contracts, and everyone tries to find ways to maintain their income. Unfortunately when an industry shrinks, everyone can’t maintain the same income. As anyone knows who’s seen an industry die (like mine, typesetting; or steel in America, or what Detroit went through), it’s painful. Good people get hurt, and organizations fight for survival.

Medicine’s certainly not going to die – we need it – but the Institute of Medicine says (see links below) we have massive overspending, and when the overspending shrinks, that too will hurt.

Today’s Boston Globe has the newest item: Hospital charges bring a backlash:

Patients, angered by surprise surcharges that hospitals tack on bills for doctor visits, are increasingly challenging these fees — sometimes even refusing to pay.

Hospitals say the charges cover their overhead, but the fees are sometimes added to the bill even when patients are treated in offices miles away from the medical centers. …

The Globe published a story in January about a patient charged $1,525 in operating room and facility fees for a minor skin procedure. Yeah, the doctor charged $354 for her services, and the hospital (Lahey Clinic) added $1525 of overhead. Another patient is quoted as sounding like (amazingly) an empowered consumer:

“I am willing to spend my money for my doctor — I am getting expert care,’’ said the New Hampshire resident. “I am not willing to pay $500 to sit in a waiting room.’’

Watch for more stories of overhead charges, and more, as organizations gasp for air, and ask consumers to bear the burden. See other stories in the links below, like the chain that put its E.R. docs on quota.

What to do: [Read more…]

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“17 years for new medical practices to be adopted”: source

e-Patient Dave Slide - Balas IOM 17 year adoptionImportant update next day: see comment below by Michael Porembra (and my reply) with new source information and important data on changes in rate of adoption.

A tweet from South By Southwest by @DVanSickle led me to finally post this, which I dug up last spring with the help of the ever-awesome @TedEytan of Kaiser. It’s part of my presentation at the Kanter Family Foundation’s confab last May for their Learning Health System initiative. (Video of that speech is here.)

The issue is a statistic often quoted by advocates for improving medicine: “On average it takes 17 years for new practices to be adopted.” That’s pretty shocking – the idea that some docs may not know something important to your college-age kid, even if the info came out when that kid was in diapers!

The source turns out to be a paper published by the Institute of Medicine in their Yearbook of Medical Informatics 2000. I’ve been unable to locate the full text online; somebody (Ted?) emailed me a scan, from which I screen-grabbed the excerpt in this slide.

For more validation, here’s a Google search of the table’s title, and here’s a search of “Yearbook of Medical Informatics 2000″+Balas.

People always ask “Is it still true?”

[Read more…]

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Interesting new e-patient resource: Medivizor

Added 9/11/2013:  I do not endorse this product. I have no idea if the information it gathers is reliable. I add this because in a press release the company lists me in people who have “covered” their service; I want to be clear, as it says below, that although I wrote about it, I didn’t endorse it. Frankly it feels a bit dicey that a careful curator of information would be a little bit incautious about the meaning of words.

I get a lot of requests to look at new products, websites, services. If I were rich and retired (or tenured :-)) I’d spend my whole life exploring, but I’m not, so I can’t. This is one, though, that caught my eye, because it proposes to automate something that can normally only be done by peers: filter all the information out there and tell you what’s useful to you.

If this works out, it could become an essential resource for engaging patients and families.

Disclaimer: I haven’t been able to vet the site, testing it as someone with “skin in the game” because the company is currently only handling a few conditions. Also, I’m open to reports of similar products that claim to do what I describe here. This is a description of what interests me, not a final and absolute endorsement.

Okay, enough fine print:

Medivizor is a startup that culls literature and other resources, including the social web. They select portions relevant to you (based on a questionnaire and your feedback), rephrase it in ordinary language, and send it to you. As their site says:

[Read more…]

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Biggest HIMSS news for families: CommonWell Health Alliance for getting our data to be where we need it

A quick note – mark my words, this is important –

At the big HIMSS health IT conference, six vendors of electronic health records have announced that they’ll be collaborating to share data as the Commonwell Health Alliance. That’s your data, our data, your family’s data.

Significantly missing from them is the Big Dog in the field, Epic, which is notoriously “all about us,” i.e. themselves.

Of course all the lesser dogs have a motivation in this – to band together and try to knock Big Dog off the top of the mountain.

Read about it here. Top EHR vendors join CommonWell Alliance to boost interoperability

My take: Market forces are starting to emerge. If underdog vendors can combine offer something the dominator doesn’t, that’s free enterprise working!
[Read more…]

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Let Patients Help, Cost-Cutting Edition: “Chaos behind a veil of secrecy”

One blog I read regularly is “Not Running A Hospital” by Paul Levy, formerly CEO of my hospital, Beth Israel Deaconess. Today’s post is A Tale of Two Blues, in which an MIT professor colleague recounts the insane, infuriating situation with his insurance company. His tale:

The last couple of months have been very heavy duty bad medical stuff for me.  Horrendous. So, I’ve been able to see the dysfunctional medical insurance system in action.   Do you understand how Blue Cross/Blue Shield actually works?  Out of, oh, maybe 80 transactions over 2 months — they managed to get one, as in the number 1, correct.  The rest are mistakes, mis-billings, computer errors, everything one can imagine.  And the only reason I can ever figure it out is because I am dogged and know something.  I can’t even begin to imagine the bone-head database that lurks behind all of it, along with inept programming, but whatever it is, the people running the place (sorry if I tread on toes) — up to and including all the executives, are simply, sorry to say, totally bonkers.  And they are just middlemen. They aren’t providing services, just managing to extract rents. Badly.

P.S. BTW, my running statistics on them, is that out of 540 transactions with them over the past 1.8 years, they have gotten two, as in the number 2, correct.   Not a good batting average. Why are they so inept?

As regular readers know, this general subject (not BC/BS of MA) has been one of my pet peeves lately, especially since I so often hear “Our costs are high because patients are irresponsible lazy slugs.” I summarized the past year’s posts in a comment there; I’m pasting it in here:

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A quick preliminary response, Paul:

As I think you know, Paul, this is something I’ve been blogging about for the past year. [Read more…]

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Let My Data Go: the HIMSS Interop Showcase

Title slide: Let My Data Go

As regular readers know, I feel rather strongly about the power of information. As a data geek, a high tech innovation freak, and a fan of improving health and care, I want the power of data to be set free.

In health IT, that means exchanging data between systems – because if it’s locked up in one system, nobody else can add value to it. And at the point where it might save a life, it might not be there.

And when that’s you, or your daughter, or your mother, or even some male relative, that could make all the difference in the world.

You think video killed the radio star?  In my career in industry, I lived through disruptive innovation, when desktop publishing killed typesetting. I know what power there is when data gets lose and innovators can add value to it. We need that in medicine. And that’s interoperability.

That’s what I’ll be talking about at 4:00 pm Monday in the Interoperability Showcase Theater, at the big HIMSS (health IT) conference in New Orleans next week. If you’re a data geek, or if anyone you know consumes medical services, this issue is important to you. Come give it up for interop – to let my data go!