HealthBlawg

Down, Down, Down: Avoidable Errors, Uninsurance, Cost Inflation

Today was a good news day. The headlines, at least, would have us believe that we are making great strides in achieving the Triple Aim, dealing with quality, access and cost issues.

Exhibit A: Deaths due to Healthcare-Acquired Conditions are Down. Per the WaPo, AHRQ says:

 

Hospitals reported 1.3 million fewer hospital-acquired infections in all between 2011-2013 compared to the rate of mistakes that hospitals made in 2010, according to the report from the Department of Health and Human Services. That represented a 17 percent drop in hospital errors from 2010, but about 12 percent of all hospitalizations as of 2013 still experienced an adverse event during the course of care.

The reduction of these avoidable incidents — such as falls, pressure ulcers, adverse drug events and more — meant $12 billion in savings to the health-care system between 2011 and 2013, according to HHS.

Health Wonk Review: The Turkey Edition

Welcome to Health Wonk Review, the bi-weekly blog carnival featuring the latest and greatest blogging by a staggeringly wonkish agglomeration of health care policy nerds. The last edition of Health Wonk Review was hosted at Wing of Zock. The story behind the name of that blog seems (to this health wonk, at least) oddly relevant to this edition's theme, given the recent news that the construction costs of the new presidential palace in Turkey seem to have doubled ... again.

Well, our frame this week is the other turkey, the turkey that will lull many of us into a stupor late next week, and the health care policy decisions (and decisionmakers) that sometimes make us wish we were in more of a stupor ... so as to lessen the pain. Top of mind in that department this week is #GruberGate:

HIPAA: Liability to Private Parties for Violations

This week, Connecticut joined at least nine other states (DE, KY, ME, MN, MO, NC, TN, UT, WV -- see cases cited in the opinion, linked to below) in recognizing that, while HIPAA does not create a private right of action for violation of privacy, it does constitute a standard against which the actions of a defendant in such a case will be judged. In other words, if a covered entity or business associate or downstream contractor releases PHI other than in accordance with HIPAA (i.e., for treatment, payment or health care operations purposes, or to or at the direction of the data subject or his or her legal representative), the breach of the HIPAA rule may be the basis for a finding of a breach of a duty of care in a state court negligence action.

As the Connecticut Supreme Court observed in its opinion in Byrne v. Avery Ctr. for OB GYN, which was released earlier this week:

[A]ssuming, without deciding, that Connecticut's common law recognizes a negligence cause of action arising from health care providers' breaches of patient privacy in the context of complying with subpoenas, we agree with the plaintiff and conclude that such an action is not preempted by HIPAA and, further, that the HIPAA regulations may well inform the applicable standard of care in certain circumstances . . . .

Telemedicine: CY 2015 MPFS reportage and dangers of the echo chamber

Many of us are waiting with bated breath for CMS to broaden its coverage of telemedicine services. Upon the release of the CY 2015 MPFS, the American Telemedicine Association got a little ahead of itself in the excitement over some changes in the physician fee schedule, and announced that CMS had added payment for remote patient monitoring of chronic conditions (99091). In fact, CMS's response to the proposal that this and other E&M codes should be payable if provided via telemedicine was: "These services are not separately payable by Medicare. It would be inappropriate to include services as telehealth services when Medicare does not otherwise make a separate payment for them." (79 FR at 67600.)

Apple HealthKit - Epic Integration at Ochsner Health System - David Harlow Interviews Dr. Richard Milani

The first health system to announce that it had integrated HealthKit into its Epic EHR is Ochsner Health System in Louisiana. It is a 12-hospital, 40-clinic operation with over 900 physicians. I spoke recently with Dr. Richard Milani, Ochsner's Chief Clinical Transformation Officer. He was enthusiastic about the improvements in clinical outcomes realized to date through homegrown integrations of things like Withings scales, and sees significant expanded potential using the Epic-HealthKit integration including dissemination of data to clinicians for more efficient and effective management of care and presentation of data to patients in a way that may motivate behavior change to improve health status.

Innovation, Primary Care Style

On a recent evening at Harvard Medical School, the Primary Care Innovation Challenge and Pitch-Off brought together six finalists, primary care luminaries and trainees, and a host of hangers-on and camp followers for a couple of hours of demos and discussions. The tenor of the evening, which was in many ways a pep rally for primary care – not that there’s anything wrong with that — was best captured by the rhetorical question posed by Asaf Bitton to the primary care practitioners and trainees in the hall, “Are you going to be a playwright or a critic?”

The hoots and hollers in response made clear that these are not your grandfather’s primary care docs. The call to action was echoed by many of the speakers, notably community organizer turned primary care physician Andrew Morris Singer and Dennis Dimitri, both advocating for, well, advocating for primary care.  Bitton’s opening also included the exhortation that proved to be predictive of the winner of the top honors from among the six pitches: Innovation in primary care is not about the technology; it needs to enable better human care.

mHealth Fitness Trackers Have a Long Way to Go

A report on a survey regarding wearable fitness trackers arrived in the HealthBlawger's mailbox this week. An interesting dose of reality, after spending a few days in Silicon Valley recently with a cadre of early adopters.

Here are the highlights:

>> 74.9 percent of adults do not track their weight, diet, or exercise using a fitness tracking device or app
>> The most commonly cited reason for not tracking fitness or health is a general lack of interest (27.2 percent), followed by concerns over device cost (17.7 percent)
>> 43.7 percent respondents did not have a specific reason for not tracking their fitness
>> 57.1 percent of non-tracking adults said that the possibility of lower health insurance premiums would make them more likely to use a fitness tracking device
>> Less than half of respondents (44.3 percent) said that better healthcare advice from their physician would be an incentive to use a fitness tracker

HealthCamp Boston, November 3, 2014 - Register Now For The Health Innovation Unconference

HealthCamp is heading back to Boston. Once again we will be at the Microsoft NERD in Cambridge, MA. This was the venue for the inaugural HealthCamp Boston in 2009 and for the second edition in 2012. We are excited to be returning to this fabulous facility.

Register now!

Our date is set. HealthCamp Boston will take place on Monday November 3, 2014.

This is the day before the Digital Healthcare Innovation Summit. So come a day early and really turbocharge your conference experience by joining other passionate healthcare innovation people at Health Care’s leading unconference – HealthCamp.

#ThinkFurther – The Future of Medicine

This post is part of the ‘Think Further’ series, sponsored by Fred Alger Management, Inc. Follow the link for more #ThinkFurther content.

It is human nature to think about the future, and to predict great advances. Fifty years from now – we say to each other – the world will be entirely different. But in what ways? Some futurists, including some great science fiction writers, get parts of the future right -- but the big picture is often elusive.

Waiting for HIPAA Clarity? Who Has Time?

I recently read that the App Association (aka ACT) is lobbying Congress to promote clarity in HIPAA regulations for app developers, based in part on the experience that health care systems "don’t understand the intersection of HIPAA and mobile, and their reaction is to say ‘no’, [which means that] apps that improve outcomes don’t make it through the front door.”

Blaming the government for a regulated industry's failure to understand regulations, and suggesting that the government should publish its regulations through channels other than the official channels are interesting strategies. It seems to me that there are more productive ways of engaging with the issues.