Friday
Jun222018

A Visit to Planet Gawande

By Clive Riddle, June 22, 2018

We still don’t know much at all about what the heck the Amazon-Berkshire-JPMorgan healthcare triumvirate will be doing. But we do now know who will be running it. The renowned Dr. Atul Gawande has been appointed its Chief Executive Officer, effective July 9th.

https://upload.wikimedia.org/wikipedia/commons/thumb/5/56/Atul-Gawande_%28cropped%29.jpg/220px-Atul-Gawande_%28cropped%29.jpg

 The announcement quotes Atul: “I’m thrilled to be named CEO of this healthcare initiative. I have devoted my public health career to building scalable solutions for better healthcare delivery that are saving lives, reducing suffering, and eliminating wasteful spending both in the US and across the world. Now I have the backing of these remarkable organizations to pursue this mission with even greater impact for more than a million people, and in doing so incubate better models of care for all. This work will take time but must be done. The system is broken, and better is possible.”

Amazon’s Jeff Bezos says “we said at the outset that the degree of difficulty is high and success is going to require an expert’s knowledge, a beginner’s mind, and a long-term orientation. Atul embodies all three, and we’re starting strong as we move forward in this challenging and worthwhile endeavor.”

For those who don’t already know all there is to know about Atul Gawande, let’s take a quick visit to Planet Gawande and check out the man who will be commanding the mystery ship Amazon-Berkshire-JPMorgan.

Atul’s website homepage succinctly provides this description: Atul Gawande is a staff writer for The New Yorker, and author of four books; (2) Atul Gawande practices general and endocrine surgery at Brigham and Women’s Hospital; and (3) Atul Gawande is Executive Director of Ariadne Labs, a joint center for health systems innovation. Of course, item #3 will require editing. As the already updated Ariadne Labs website announces “Atul Gawande transitions to Chairman and becomes CEO of new health care organization.”

What are Atul’s roots? He was born in 1965 in “Brooklyn, New York, to Indian immigrants to the United States, both doctors. His family soon moved to Athens, Ohio, where he and his sister grew up, and he graduated from Athens High School in 1983.”

As an undergraduate and in medical school, he dived into the worlds of politics and healthcare policy. He volunteered for Gary Hart's and Al Gore's presidential campaigns. He served a health-care researcher for Rep. Jim Cooper (D-TN). He became Bill Clinton's healthcare lieutenant during the 1992 campaign. He served as senior HHS advisor after Clinton's inauguration and directed one a committee in the Clinton Health Care Task Force, before returning to medical school, re3ceiving his MD in 1995.

During his residency his career as a writer launched with Slate, and soon he was writing essays for the New Yorker. His June 2009 New Yorker essay, The Cost Conundrum was widely read and influential,  in which he compared the health care of two towns in Texas to show why health care was more expensive in one town compared to the other.. He continues to occasional whip out New Yorker Essays, with these being the titles of his works during the past 18 months:

  • Curiosity and What Equality Really Means, The New Yorker, Jun 2, 2018
  • Is Health Care a Right?, The New Yorker, Oct 2, 2017
  • How the Senate’s Health-Care Bill Threatens the Nation’s Health, The New Yorker, Jun 26, 2017
  • Trumpcare vs. Obamacare, The New Yorker, Mar 6, 2017
  • Trumpcare, The New Yorker, Feb 27, 2017
  • The Heroism of Incremental Care, The New Yorker, Jan 23, 2017

He has also written more technical papers and studies in journals including the New England Journal of Medicine and has authored four books:

Of Gawande’s most recent book, Malcolm Gladwell wrote, “American medicine, Being Mortal reminds us, has prepared itself for life but not for death. This is Atul Gawande’s most powerful – and moving – book.”

Of course, the platforms from which Gawande has drawn the experiences and perspectives that he writes about is from being a clinician, researcher and academian. He practices general and endocrine surgery at Brigham and Women's Hospital in Boston, Massachusetts. He is a professor in the Department of Health Policy and Management at the Harvard T.H. Chan School of Public Health and the Samuel O. Thier Professor of Surgery at Harvard Medical School.

His outside affiliations have included Ariadne Labs where he has been Executive Director, Lifebox, Safesurg.org, WHO Safe Surgery Saves Lives initiative and the Center for Surgery and Public Health.

Ariadne Labs might be the most instructive, in regard to the approaches Guwande might take in his new gig. Ariadne Labs is a joint center between Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health, founded in 2012 by Gawande and others.

Here’s more about Ariadne Labs direct from their website – which says their mission is “to find solutions to some of the most complex problems in health care, including life-threatening errors in surgery, maternal and neonatal mortality, failures in end-of-life care, and fragmented and ineffective primary health care systems. Leveraging a network of expertise across the Harvard-Brigham system, Ariadne Labs’ designs, tests, and spreads simple solutions to address failures in health care delivery worldwide.”

Here’s what Ariadne Labs lists as its more prominent innovations:

  • The Surgical Safety Checklist, developed in collaboration with the World Health Organization, shown to reduce post-surgical deaths and complications by 47 percent worldwide.
  • OR Crisis Checklists, a compendium of 12 checklists to guide surgical teams through critical lifesaving steps when sudden emergencies occur in the OR. In simulation testing, Ariadne Labs demonstrated that when the checklists are not used, clinical teams completed only 77 percent of lifesaving steps in an emergency. When the teams used the checklists, they completed nearly 100 percent of lifesaving steps.
  • The Safe Childbirth Checklist, developed with the World Health Organization to address the major causes of maternal and neonatal mortality. Implemented with Ariadne Labs BetterBirth Program of peer-to-peer coaching, the intervention has demonstrated significant improvement in the quality of care during labor and delivery in low-resource settings.
  • The Delivery Decisions Team Birth Project, a solution package aimed at reducing C-section rates in the U.S. by improving communication between clinicians and laboring women, defining the basic care women in labor should receive and prioritizing women’s preferences for care. The project is being tested with tens of thousands of patients across the United States.
  • The Serious Illness Conversation Guide, a structured tool to help clinicians and patients have meaningful conversations about what matters most to patients. The guide is the centerpiece of the Serious lllness Care Program, a systems-level intervention to ensure that all patients with serious illness receive care that aligns with their goals and values.
  • The Primary Health Care Vital Signs, a global data resource for measuring and monitoring the strength of primary care systems in countries around the world, developed with the World Bank, WHO, and the Bill and Melinda Gates Foundation as part of the global Primary Health Care Performance Initiative.

We’ll all stay tuned to see what happens next on Planet Gawande.

 

Friday
Jun152018

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

Court rules insurers not entitled to ObamaCare payments

A federal appeals court on Thursday ruled that insurers are not entitled to collect billions of dollars they claim the federal government owes as part of an ObamaCare program.
The Hill
Thursday, June 14, 2018

How America Got Hooked On A Deadly Drug

An inside look at how Purdue Pharma pushed OxyContin despite risks of addiction and fatalities. Purdue Pharma left almost nothing to chance in its whirlwind marketing of its new painkiller OxyContin.
Kaiser Health News
Wednesday, June 13, 2018

An unlikely winner from the AT&T-Time Warner decision — CVS Health

Shares of drugstore CVS Health jumped Wednesday, a day after a federal judge decided to permit AT&T's bid for Time Warner in what many on Wall Street are considering a tacit go-ahead for other so-called vertical mergers.
CNBC
Wednesday, June 13, 2018

Fed Up With Rising Costs, Big U.S. Firms Dig Into Healthcare

At its Silicon Valley headquarters, network gear maker Cisco Systems Inc is going to unusual lengths to take control of the relentless increase in its U.S. healthcare costs.
Reuters
Monday, June 11, 2018

How early retail health clinics set the stage for today’s mega-mergers

Fifteen years ago, we launched Take Care Health Systems, a pioneering company in retail health clinics. Little did we know that our clinics, and similar ones that followed, would become an important component of the current merger and acquisition and partnership activity currently reshaping health care.
Stat News
Monday, June 11, 2018

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.

Friday
Jun152018

Healthcare Organization Mobile Device Use: Check That Pager

By Clive Riddle, June 15, 2018

The list of benefits derived from mobile device use by clinicians and staff at healthcare organizations is a long one. But the challenges exacted comprise a worrisome list topped by privacy and cybersecurity concerns. Organizations who promote or allow BYOD (Bring your own device) of course have significantly enhanced concerns.

So in this context its worthwhile to take a gander at the eighth annual Spok survey report: Mobile Strategies in Healthcare Results Revealed. The good news is that 57% of healthcare organizations surveyed have developed a documented mobile device strategy. The bad news is 43% have not.

They respondents say these are the challenges they are facing

  • Wifi coverage – 51%
  • Cellular coverage – 40%
  • Data security – 34%
  • Compliance with BYOD policies – 34%
  • IT support – 29%
  • Mobile adoption rates – 28%

For those with a strategy, here’s the top seven components included:

  1. Mobile management and security - 56%
  2. Mobile device selection - 51%
  3. Integration with the EHR - 48%
  4. Infrastructure assessment (wireless and mobile) - 45%
  5. Clinical workflow evaluation - 43%
  6. Device ownership strategy (such as BYOD) - 34%
  7. Mobile app strategy (in-house, third-party, hybrid) - 29%

How well are these policies enforced? 39% said extremely well, 33% said well. 24% weren’t sure and an honest 4% said poorly. With respect to validating compliance, 48% use education, 42% gather data from the devices, 37% seek feedback from the end user, 23% take surveys, and an honest 21% said they aren’t doing any validation.

With respect to devices they organization supports, 74% said smart phones, 69% wifi phones, 56% onsite pagers, 54% tablets, 45% wide area pagers, 22% encrypted pagers, 12% voice badges and 6% wearables.  

Perhaps the biggest surprise I found in the report was this passage: “Pagers are still a mainstay in healthcare. Despite the growth of other communication tools, they remain at a relatively high level of use as other mobile devices complement them (without necessarily replacing them altogether). In fact, onsite pagers are the most popular communication option for non-clinical care team members such as housekeepers, transport techs, and phlebotomists.” For non-clinical staff 54% listed some type of pager as their primary communication device (onsite 40%, wide area 10% or encrypted 4%/) Wifi phones came in at 15% and smartphones at 14%.

Friday
Jun082018

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition
 

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

 

Justice Department takes aim at heart of health law

The Trump administration said in a court filing late Thursday that it will no longer defend key parts of the Affordable Care Act, including the requirement that people have health insurance and provisions that guarantee access to health insurance regardless of any medical conditions.

The Associated Press

Friday, June 8, 2018

CDC: Suicide rates on the rise in almost every state

Suicide rates are on the rise in almost every state, according to a new analysis released Thursday by the Centers for Disease Control and Prevention (CDC).

The Hill

Thursday, June 7, 2018

Medicare Financial Outlook Worsens

Medicare’s financial condition has taken a turn for the worse because of predicted higher hospital spending and lower tax revenues that fund the program, the federal government reported Tuesday.

Kaiser Health News

Tuesday, June 5, 2018

Judge orders Maine to implement voter-approved Medicaid expansion

A Maine court has ordered the state to move ahead with Medicaid expansion, which was approved by voters last year but blocked by Republican Gov. Paul LePage.

The Hill

Monday, June 4, 2018

Medicare drug prices up 77% despite decrease in prescriptions, OIG finds

Despite an overall decrease in prescriptions, prices for Medicare Part D brand-name drugs are rising — and so are beneficiaries' out-of-pocket expenses, according to a report from the Office of the Inspector General.

Becker's Hospital Review

Monday, June 4, 2018

 

 

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.

 
Thursday
Jun072018

The 260 Page 2018 Annual Medicare Trustees Report and the Part D Rx Share of the Pie

By Clive Riddle, June 7, 2018

 

This week CMS released the 2018 Annual Medicare Trustees Report, which provides a financial/actuarial analysis of the current state of the Medicare Fund, and projections regarding the Fund solvency going into the future.  The big takeaway always emphasized from the report is at what year in the future will the Fund become insolvent, but there really is a lot of historical information in the report worth a gander.

 

In regard to when the Fund is projected down, we are told the “Trust Fund will be able to pay full benefits until 2026, which is three years earlier than last year’s projections, attributable to adverse changes in program income. The Trustees project that total Medicare costs (including both HI and SMI expenditures) will grow from approximately 3.7 percent of GDP in 2017 to 5.8 percent of GDP by 2038, and then increase gradually thereafter to about 6.2 percent of GDP by 2092.”

 

But in addition to the voluminous portion of the report dedicated to projections taking us to near the end of the century, there’s plenty of history and present tense buried in the 260 page report as well. Here’s a snapshot from the report of Medicare in 2017:

It’s interesting to look out what portion of the expenditures are from Part D. On a gross basis, $100.1 Billion in Prescription Drug expenditures out of $702.1 Billion in benefits represents 14.3% of benefit expenditures.

 

But not all beneficiaries have Part D coverage, so that’s not an apples to apples percentage.

Looking at 2017 benefits for Part A, Part B, Part C and Part D combined, total benefits were $702.1 Billion, of which 29.9% ($209.7 Billion) was spent through Part C, the Medicare Advantage program. Given the analysis doesn’t break down the benefit expenditure categories for the contracting Part C Medicare Advantage plans, here’s a breakdown of the Regular Medicare expenditures including Part D (backing out Part C):

  • Hospital:  43.6% ($197.9 Billion)
  • SNF: 6.2% ($28.3 Billion)
  • Home Health Care: 4.1% ($18.4 Billion )
  • Physician Fees: 15.2% ($69.1 Billion)
  • Prescription Drugs (gross adjusted): 13.5% ($61.6 Billion)
  • Other: 17.4% ($78.8 Billion)

Regarding the Gross Prescription Drugs adjustment: You will note the above Prescription Drugs total $61.6 instead of the $100.1 Billion in the above snapshot. That’s because the Medicare Advantage Part C enrollees with Part D enrollment were backed out, given that the other benefit expenditure categories didn’t include a breakdown from Part C. So the Part C enrollment in Part D plans, as a percentage of total Part D enrollment – taken from the December 2017 Medicare Advantage/Part D Contract and Enrollment Data Summary Report - was extrapolated (61.5% of Part D Enrollees are not enrolled in Part C; 61.5% of $100.1 Billion in total Prescription Drugs expenditures = $61.6 Billion.)

 

But the only problem with stopping there, is not all regular Medicare beneficiaries are enrolled in Part D. There were 43.2 million PDP enrollees at the end of 2107, while there are 58.5 million total Medicare beneficiaries. Of the 15.3 million 2017 beneficiaries with no Part D, 1.9 million were from Part C, leaving 13.4 million regular(non-part C)  Medicare beneficiaries with no Part D, and 26.2 million with Part D, out of a total 39.6 million regular Medicare beneficiaries. Now if we extrapolate 66% (26.2/39.6 million) for regular Medicare with Part D, from the other benefit expenditure categories (reducing the expenditures by one third for the other categories) we can get an apples to apples look.

 

This will reflect the percentage benefit expenditures extrapolated for Regular Medicare beneficiaries with Part D coverage:        

 

  • Hospital:  40.7% ($130.6 Billion)
  • SNF: 5.8%  ($18.7 Billion)
  • Home Health Care: 3.8% ($12.4 Billion )
  • Physician Fees: 14.2% ($45.6 Billion)
  • Prescription Drugs (net adjusted): 19.2% ($61.6 Billion)
  • Other: 16.2% ($52.0 Billion)

 

19.2% of the Medicare benefit pie for prescription drugs, get us a lot closer to the Milliman analysis just conducted for AHIP in the commercial population, which found Rx representing 23.3% of total costs including administration. If we add in the extrapolated portion (66%) of the $8.2 Medicare administrative expenses from the above snapshot, the regular Medicare prescription drug portion represents 18.9% including administration.