Data Fatigue

There are signs some Americans are growing tired of data  and the gizmos to gather and measure it.

You see this fatigue  among those who employ wearable  devices to measure fitness.

An article in the Journal of American Medical Association found among those who bought fitness trackers that more than half eventually stopped using trackers,  and one third quit within 6 months. (1)

The use of these wondrous devices to track and accumulate data on  steps per day,  pulse,  heart rhythms and blood pressure even has its comic movements. At a recent sports conference , Doctor Michael  Joyner, a Mayo physiology expert, showed up what he deemed as the latest and best in fitness devices – a jump rope

It’s not that fitness trackers don’t receive benefits form their devices.   A survey of 4.2 million MyFitnessPal users found that weight watchers using the device lost more weight than non-users.  Users are  more motivated to become fit than non-users.    

I suppose users just get bored with seeing if they meet their goal of 10,000 steps per day.   Still, bored or not,  data indicates there are 13 million fitness users who bought trackers to the tune of $1.5 million in 2014, and projected to be $18 billion in 2018. 

There’s nothing fitness addicts won’t buy when left to their own devices.  It’s apparent tracker devices are fit to be tried, even if the fit become tired of the devices.

1.        M. Patel, “Wearable Devics as Facilitators, Not Drivers, of Human Behavior Changes,” JAMA. February 3, 2015. 

2.      Alex Hutchison, “ A Fitbit May Make You Fit, “ NYT, March 30. 2016.

 

 

 

Reality Time

Reality Time

I just received the following email:

Dr. Reece, we’ve been discussing the Stakeholder Syndrome, related to how entities have become invested in developments like the ACA that they defend that which is indefensible – because they have a stake in it.

Dr. Beecher wrote this email to the MPPA folks about the syndrome, and would like you to respond.

We need to analyze the "Stakeholder Syndrome" in American healthcare today.

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There is no rationale for federal or state governments, insurance companies, Pharma, hospital-clinic organizations and (establishment) organized medicine (AMA, medical specialties) to change their current third party payment business model which was cemented mafia-like with the (Democratic majority) 2010 ObamaCare cartel deal. Why should they since it works so well for them?

The AMA (along with all US specialty medical organizations) in 2008 cast its lot as a stakeholder in the new US healthcare cartel. Dr. Sue Bailey, current AMA Speaker of the House of Delegates, made that abundantly clear on March 8 in her kind and informative visit with a group of us at MPPA. [I fear there is no turning back for the AMA, Bob.] Sadly the AMA has become a de facto trade organization governed by corporations who overtly or tacitly agreed in 2008- 09 to bump off US independent medical practices.

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MACRA "alternatives" such as ACOs and other managed care incentives for "providers" are window dressing for third party-provider pay-for-performance deals which are controlled and dictated by central budgeting and administrative healthcare authorities. This is the future of "Medicare for All" in 2016.

Healthcare cartels are gaining power as oligopolies and oligopolies. When if ever will United Healthcare be too big to fail? And how could it? In Minnesota, HealthPartners is now an insurance company, hospital-clinic organization, and TPA contractor for the MN Medicaid population. What is the impact of these conglomerates on healthcare costs, access and quality? Anti-trust? 

The Mayo Clinic is an outlier and valuable case study. It charges the most and (so far) has successfully refused to accept lower payments from government and private payers. Mayo has taken over many local hospitals and clinics in Minnesota. And Mayo will not take (new) Medicare patients. Mayo is frequently lauded and receives donations from patients.

Where to start?

Your thoughts?

Lee H. Beecher, MD
President, Minnesota Physician-Patient Alliance (MPPA)
Maple Grove, Minnesota

Dave Racer, MLitt

DGR Communications, Inc.

St. Paul, Minnesota

 

My Thoughts

Lee and Dave:

My thoughts are:

1) One, the corporate transformation of medicine, or the stakeholder syndrome, is here to stay.  Corporations, unlike private independent physician’s practices, have the management structure, capital, ability to mobilize specialists and IT technologies, and the management machinery to market to large populations, or for that matter, to market to employers.

2) 95% of physicians are "stakeholders," i.e., beholden and dependent on 3rd parties, in one way or another.  America has a population of 330 million.  Of these, 160 million are covered by employers, 55 million by Medicare, 70 million by Medicaid, 10 million by ObamaCare, 10 million by VA, for a total of 305 million.  Roughly 23-30 million are uninsured.

Getting Real

So let's get real.  What are options of small private independent physicians? Go to work for hospitals or large groups? Join IPAs.?  Depend of HSAs to funnel patients to us?   Rely on AMA?  That's ridiculous. One 15% of us belong, and we don't trust AMA?  Complain and join conservative groups like American Association of Physicians and Surgeons?  Become part of large organizations like Mayo?  Unlikely these big groups comprise only 7% of all physicians, and they are picky about who joins.

Create convenient marketable "focused factories" like diabetic clinics, pain centers, wellness centers, worksite clinics, or chains of physician-owned urgent care clinics. This is doable and is being done.

Get the feds to lighten up regulations, like “meaningful “mandatory EHRs?  Because of massive protects by hundreds of physician organizations,   HHS has taken notice and is halting  or slowing down its “meaningful” use reforms and vowing to redesign EHRs to make them more useful and physician friendly.

Go into concierge or cash only practices, which I predict 10% to 15% of doctors will do.  

The important thing is: do something. Accept reality.  Don't do nothing or sit back and curse the darkness.

D.C. Hysteria

If it ain’t broke, don’t fix it.

American idiom indicating that if something is working reasonably well, don’t tamper with it.

According to my dictionary, hysteria is defined as emotional excitability with behavior exhibiting overwhelming or unmanageable fear of emotional excess. And according to a former Gerald Ford speechwriter, D.C stands for Darkness and Confusion.

Hysteria and Darkness and Confusion were in full display in today’s Washington Post,   the house organ for the Washington, D.C. establishment.  

The Post featured three pieces reflecting hysteria and confusion.

·         Editorial,  “To Defend Our Democracy against Trump, the GOP Must Aim for a Brokered Convention 

·         Jennifer Rubin,  “We Can’t Defend Our Democracy Against a Thug” 

·         Michael Gerson,  “Republicans Stain Themselves by Sticking with Trump”

How dare Trump and Republican primary voters, who have turned out in unprecedented numbers,  50% to 100% above the norm of past elections,  have the effrontery to question the wisdom of the Washington-based establishment,  to suggest that Washington does not reflect the will of the people, to question why ObamaCare is neither efficient or effective in lowering costs or quality of care,  to say there ‘s something degrading about the shrinkage of  middle class incomes,  to redistribute their wealth  from the barely  have’s to the not-so-bad off  have-nots for political gain,   to  intimate that there’s something wrong with six or the seven most affluent counties  in the land being with spitting  suburb distance of D.C.

How dare Trump and the GOP do this when we, the Washington  elite,  know that Trump would impose a tariff on Chinese goods that would spark  a trade war and a global recession,  would enact a tax plan that would bankrupt the nation,  and furthermore,  Trump would  and has  embraced violence,  demonized whites and Christians, engaged in dark conspiracies,  made sweeping lies, advocated killing of families of terrorists,  flirted with the Ku Klux Klan and libeled Mexicans and Muslims, deprive subsidized Americans of health care.

Settle down Washington.   Contain your hysteria.  Don’t strain or stain yourself prematurely.  One man's thug is another man's pug.  Keep in the mind the primaries are being conducted according to democratic rules in a democratic manner  that says the GOP  winner will be someone with more than 1273 delegates,  that similar rules apply to the Democrat winner,  who will be Hillary Clinton, the honesty of whom 60% of voters distrust.

     All the world does not think as you think, and everybody is entitled to their opinion.

Trump on Winning

Winning isn’t everything, it’s the only thing.

Saying often attributed to Vince Lombardi (1913-1970). Green Bay Packer Football Coach, but what Lombardi actually said was, “Winning isn’t everything, but wanting to win is.”

Yesterday Donald Trump won primary victories in the Mariana Islands, Florida, North Carolina, Missouri, and Illinois and finished second in Ohio.  Trump now has 673 delegates compared to 411 for Cruz, 143 for Kasich. To win the GOP nomination outright before the Cleveland GOP convention,   Trump must win 564 of 1061 remaining delegates.

In remarks following his victories, Trump said the election campaign was about winning, winning, winning, winning, winning, and winning.

To hear The Donald tell it, winning is about.

·         Making America great again.

 

·         Telling it the way it is.

·         Defeating ISIS.

• Rebuilding the military.
•  
• Building a wall between U.S. and Mexico

 

·         Negotiating  new trade policies with  China, Mexico, Japan, and other nations. 

·         Getting along with Putin.

·         Persuading Hispanics, blacks, women, and the young to join his cause.

·          Enlarging the Republican Party, by gaining millions of  disenfranchised silent majority voters who have never voted before to his campaign. 

·          Winning over all Americans to his health care views by vowing not to cut Medicare and Medicaid and to ultimately achieve universal coverage.

·         Winning the fight to cut health care costs by fostering competition across state lines and removing barriers to that competition.

·         Being accessible to all media,  by using  media techniques like tweets for maximal exposure,  by crowding others off the media stage,  by criticizing the media for not being fair, and by not spending his own money.

·          Attacking the “establishment” of his own and the other party, as being puppets of those who contribute money to their parties.

·         Saying he is the only one who can negotiate “win-win” deals with members of his party, the other party, and with friends and foes of foreign nations.

·         Being triumphant in victory and gracious in defeat.

 

·         Belittling   one’s rivals while inflating one’s virtues.

·         Recognizing that strict and pure conservatism is not a winning strategy in an increasingly  secular nation, but common sense conservatism may win the day.

 

Cost and Price of Quality  IT Monitoring

Everything you want is life has a price connected to it.  There’s a price to pay if you

want things better , a price to leaving things as they are, a price for everything.

Harry Brown (1933-2006), Libertarian candidate for president, 2000

Based on a survey of 1000 doctors,  Health IT News reports that individual doctor  in private practice spend more than $40,000 each to monitor quality through their electronic medical records,  for a grand total of $15.4 billion in you include all physicians.    Doctors devote 2.6 hours on a week on this effort,  and they and their staff spend 15.1 hours a week  feeding data to their electronic records.   Seventy five percent of the  surveyed doctors say they waste time and  money on measures that aren’t clinically revelant.

In 2009,  the Obama administration decided to pay $27 billion to doctors and hospitals to encourage them to install electronic medical records (EMRs).   These EMRs would allow government and insurers to gather  data that would allow them to measure outcomes,  and supposedly, to identify doctors with good outcomes,  to weed out doctors with bad outcomes,  and to reward the good doctors,  and penalize the bad doctors. Today 83% of physicians have electronic medical records.

Collectively doctors  spent $15.4 billion  in 2015 –  to maintain their  EHRs,   hiring of staff to enter data,  time spent figuring out what codes to use,  grappling with indecipherable  computer screens,  with  less  patient eye contact,  less watching of  patient  body language,  less  listening to patient  histories,  less physician contact during  examinations,  all  of which doctors claim,  does not advance quality of care.

In other words,  in the opinion of  3/4s of doctors surveyed,  the price of measuring “quality” are high overhead  costs,  less patient contact,  and time spent on busywork.   Unfortunately, to  escape  time, money, and effort expended on EMRs,  many  physicians are escaping electronic hassles and drudgeries by becoming hospital employees,  retiring early,  or entering concierge  practices,  where EMRs are not required.

It’s important, of course,  to put EMRs in perspective.  In the opinion of federal overseers,  “In God we trust, all others use data.” The  theoretical  virtue of EMRs is that  the records contain essential information on the patient’s  medical history, including past medical records, lab tests, X-rays and other imaging studies.  

If  only every patient  could carry their medical record from doctor to doctor in a thumb drive and could insert it into the new doctor’s EMR,  the patient’s record  would end  misunderstandings and duplicate testing,  But we are not there yet,   and many EMRs do not accept data from other EMRs.  

 Ideally,  EMRs could reduce medical errors, end duplications, engage patients in their own care, create coordination of care.  Presently, however, EHRs are clunky to use and to interpret,  and most do not contain a narrative history of the patient’s history and do not accept doctors’ dictations,   their normal way of communicating with other doctors.   And most physicians do not consider to be either doctor-friendly or useful. Perhaps some day we shall total transparency ,  even total access to charts and doctors’ clinical notes,  but we are not there yet.

"On top of the obscene waste of billions of dollars each year on quality measures, the most alarming thing about this study of MGMA member practices is that nearly three-fourths of the groups reported being measured on quality measures that are not clinically relevant," said Halee Fischer-Wright, MD., MGMA's president and CEO, in a statement.

"The vast majority also stated current measures are useless for improving patient care," she added. "This study proves that the current top-down approach has failed. It serves no purpose to have over three thousand competing measures of quality across government and private initiatives."

Quality  remains subjective and like beauty, is in the eyes (and pocketbooks)  of  federal and  physician beholders.

Stop Trump Campaign and Trump Quotes on Health Care

I’ve been following the Stop Trump Before He Gets the Nomination campaign.  It’s multifaceted.  It includes  rumors of organized of a resistance by the GOP Establishment, planted violent protestors by MoveOn.org and Black Lives Matter,    conspiracies  by Jeb Bush and others to ambush Trump  at the GOP convention,  orchestrated  catastrophic dangers of  hate Trump talk of war and economic collapse  by the liberal media .   Even rivals Cruz, Rubio, and Kasich are said to be involved in the Stop Trump plots.  

Who am I to judge?  Analyzing these threats is beyond my pay grade.  My interest is health care.  All I can really judge Trump by is what he says about health care, which he is free to do.   As George Orwell said in 1984, “Freedom is the freedom to say that two and two make four.  If that is granted, all else follows.”

Here are Trump  quotes on health care.

·         We must have universal health care (2000).

·         Increase insurance competition across state lines(2011).

·         Kill ObamaCare before it becomes a trillion dollar weight (2011).

·         Save Medicare and Medicaid before cutting them to bone (2015). 

·         ObamaCare deductions are so high that its useless (2015).

·         ObamaCare is a catastrophe that must be repealed and replaced (2015 

·         We didn’t have a free market before ObamaCare (2015) 

·         Don’t’ cut Medicare: grow the economy to keep benefit (2015).

·         I’m for vaccines, only in smaller doses to prevent autism (2015) 

·         Replace ObamaCare with health savings accounts (2015).

·         I want to repeal ObamaCare and replace it(2015).

·         ObamaCare is a disaster if you look at where premiums are going up 40,  45, 50-55% (2015).

·         The government is going to pay for it.   But it’s going to be a private plan, and people are going t6o be able to get the government to negotiate great plans with lots of different competition  with lots of great companies and they can have their doctors, they can have their plans.   They can have everything (2016).

·         I support health care for people, I want people taken care of, but all want health care we can afford as a country.  I have people and friends closing down their businesses because of ObamaCare (2016)

Sounds like we can have our health care cake and eat it too, thanks to unbridled competition and government largess.  It’s not quite as pithy and memorable or poetic  as Ted Cruz’s statement.  “I will repeal every word of ObamaCare.   My plan will  be personal, portable, and affordable.” But it’s clear and vague enough to defy analysis for detail seekers.