Consulo Indicium - 9/14/18

Information for your Consideration…

 Breastfeeding And Stupidity – At the July World Health Assembly in Geneva the delegates barely passed a resolution promoting breastfeeding.  What?  Barely?  Why?  Because the USA delegation – by completely ignoring all available scientific evidence on the benefit of breastfeeding – put forward a resolution to remove language asking the governments of the world to “promote, support, and protect” breastfeeding.  These same USA delegates also wanted a resolution which discouraged the promotion of food products (i.e. infant formulas mixed with untreated water in developing nations) that have deleterious health effects on infants. Just one small statistic among the extensive body of literature on the benefits of breastfeeding suffices.  In a 2016 study reported in The Lancet, universal breastfeeding was highlighted as the approach that would save the lives of more than 823,000 children and 20,000 mothers with an overall savings in excess of $300B worldwide.  In my book, those are real savings across the board.  As a Family Physician I always, always, always tried to get the Moms I cared for to adopt breastfeeding and almost all did so…  Let’s not let the stupidity of delegates rein unharnessed.  I’m apoplectic and – that’s after nearly four weeks of waiting to write about it…  Argh!!

Should We Get Excited?  Or? – In a step that could very well move data sharing in a new direction for the health care community, Alphabet, Amazon, IBM, Microsoft and Salesforce recently announced that they intend to put energy and resources into solving the incorrigible problem of “interoperability.”  While I have many complaints about the health care system and how we could fix them – this singular issue is the elephant in the room of all problems facing health care.  Here’s the joint statement that they released:

 “We are jointly committed to removing barriers for the adoption of technologies for healthcare interoperability, particularly those that are enabled through the cloud and AI.  We share the common quest to unlock the potential in healthcare data, to deliver better outcomes at lower costs.”

Unfortunately, the bulk of money in information technology support was used over the last decade in making our filing systems electronic rather than addressing the core problem of moving information around seamlessly.  As a result, the big winners have been the big EMR companies, among them Cerner and Epic as two notable examples.  Data from one does not move seamlessly to the other.  While their effort is to be applauded, there is a need for one more change if interoperability is to be realized in the short-term.  We need to address incentives.  The healthcare system needs to move toward value-based reimbursement instead of fee-for-service models.  Why?  Because in value-based systems, the results are measured based on “results” or “outcomes” rather than just “doing”.  Without that shift, the front lines will not be incentivized to get behind the IT company’s quest.  It takes more than a bunch of IT companies making a statement of commitment  to realize interoperability.  What are your thoughts?

Leadership Through Walking – I got a notice recently from The Wharton School about an old tool that has gotten new support as part of the armamentarium of effective leaders – walking. It actually seems to be the rediscovery of something Nietzche said over a century ago: “All truly great thoughts are conceived by walking.”  Read the study to get the details but it’s compelling.  The folks at Wharton even offer up places that help you engage in active walking, including: 1) walk in the city, 2) walk in nature (NOTE: that must be “rural” as compared to city?); and, 3) walk in the forest (also, mostly rural 😊).  The study also noted that even walking on a treadmill increased creativity by 60% and that backpackers scored 50% better on creativity tests during a wilderness trip (again, rural 😊) compared to their pre-trip performance. It seems to be the New Old Thing.  Consider it.  Enjoy it.  Take your dog along. My faithful companion – Toto – loves it!!

Follow The Money – The Medicare Payment Advisory Commission (MedPAC) recently reviewed a Medicare staff proposal that would create a unified payment system for skilled nursing facilities (SNFs), long-term care hospitals (LTCHs), home health agencies (HHAs); and, inpatient rehabilitation facilities (IRFs).  Under the new payment model, payments would be based on patient characteristics rather than the site location where services are provided.  In addition, the model would create two payment tiers – a basic tier for “typical patients” (yet to be fully identified); and, an advanced tier for “patients with highly specialized care needs” (e.g. post-hospital stroke rehabilitation, ongoing cancer care treatment, ventilator care, etc.).  The intent is to reduce the disparities in payment for equivalent services that are provided by the different agencies. For example in 2016, HHAs received only $18.1 billion for 6.5 million episodes versus SNFs receiving $29.1 billion for 2.3 million stays.  In addition, the new payment model would stipulate requirements for patient care regardless of location. The full Medicare report is available for review. The report is now out for review.  Expect the health care community to weigh in with financial losers complaining and financial winners championing the changes.

What Is The House Of Medicine And Health Care Doing To Stop The Anti-Vaccine Movement? – In a harbinger of things to come here in the USA, the Wall Street Journal recently reported that Romania has been combating a measles outbreak since 2016.  In fact, the London School of Hygiene and Tropical Medicine in a 2016 survey reported that 7 out of the 10 countries with the strongest skepticism about vaccination safety were in Eastern Europe. The Romanian outbreak has resulted in more than 15,000 people with measles infections resulting in 59 deaths.  The anti-vaccine movement is alive and well here in the USA as well.  It’s spread by specious arguments that seem to drift hither and yon on various web sites.  As I read the article, it occurred to me that we – the medical and health care professions – are NOT doing enough to combat bad information.  And, it’s not just about vaccines.  There are a whole host of issues that are percolating up with inaccurate and even dangerous mis-information.  The professions should ban together to prevent this type of spurious information.  

Fighting Back…Finally! – It’s all too common.  Whether it’s IV bags, Lidocaine, tetracycline or some other common product – the shortage of common tools and products used in the treatment of problems is becoming all too common.  In an effort to solve the problem, Intermountain Healthcare along with HCA, Mayo and other providers plus support from a number of foundations have decided to get into the generic drug production business by starting a company Civica Rx.  And, it’s not just the shortages that are a problem.  It’s also the outrageous cost for some of these medications, devices and products despite their longstanding use in the medical community.  It’s simply a matter of price gouging.  The new company is going to focus its initial efforts on producing and marketing 14 common generic drugs that are in short supply or whose prices have abruptly increased in recent years. Applause, applause!!  Even better, the Association for Accessible Medicines – a generic drug manufacturer trade group – issued a statement extending support to the initiative by stating that it "welcomes into the generic drug manufacturing community any entity that shares our commitment to bring safe, effective and affordable treatment options to patients, providers and payers."

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