Welcome to the Fall Colors Grand Rounds! We have several excellent articles from around the healthcare blogosphere for you this week. Enjoy!
HealthBlawg’s David Harlow recently attended Health 2.0 in San Francisco and provides us with an excellent summary post about the conference. The highlights: The Health Law 2.0 panel that David moderated, the evolution of data liberation and the tools that will help to facilitate health information exchange (hopefully the many different EHR systems that are being adopted by providers nationwide will eventually be interoperable enough to allow the easy exchange of data), and healthcare social media tools that may reshape the way we view wellness and patient-centered care.
Running A Hospital’s Paul Levy writes about academic medical centers (AMCs) and how they might be viewing themselves in a more positive light than they should. Apparently, some AMCs want to be exempt from federal healthcare budget cuts and are pointing to their importance in training the next generation of doctors, their research and innovation in the field of medicine, and their work in urban areas treating especially ill patients. Paul notes that while all of this may be true, AMCs shouldn’t be too self-congratulatory, as they also have plenty of flaws and areas in which they could improve – both for the sake of their patients and for the training that they’re providing to that next generation of doctors.
Dr. Phil Hickey of Behaviorism and Mental Health chronicles the sorry history of psychiatric “treatments” over the last century. While those “treatments” were barbaric and highly harmful to the patients (pretty much everyone agrees with that now), it’s important to note that they were readily accepted by psychiatry at time, and family members might have been willing to go along with the “treatment” because it was what the doctor suggested. Dr. Hickey notes that the current rush to prescribe medications to treat “ordinary problems of living” can be viewed in a similar light.
Henry Stern of InsureBlog brings us an interview with the whistleblower who has brought a lawsuit against LabCorp for allegedly charging a lower price to United HealthCare than to Medicare. The post is particularly interesting because Hank adds his own thoughts after the interview, and he sees things a little differently than Andrew Baker (the whistleblower). Hank agrees that it does look like LabCorp lowered their fees for UHC, but they charged the allowable amount to Medicare; Hanks position is that the UHC-LabCorp deal could be seen as a discount-for-volume arrangement and that it shouldn’t impact their business with Medicare. Andrew feels that Medicare should also have received the lower rate and thus saved taxpayers money. Read through the interview and Hank’s follow-up and see what you think. Definitely an interesting look at where the free market and healthcare collide.
Dr. Pullen gives us an insider’s perspective on the new Medicare wellness exams. Turns out that they’re not what patients tend to expect from a wellness exam, and they don’t pay particularly well either. In addition, patients often want to discuss other issues outside of the wellness exam parameters, or else they want to have a visit to address other issues and have it be billed as a “wellness exam” in order to avoid the copay that goes along with a regular Medicare visit. It seems like the Medicare wellness exam has just complicated matters. Dr. Pullen points out that it would have been a much wiser idea to simply allow Medicare patients one yearly visit with their doctor to address whatever issues the doctor and patient think need to be discussed, rather than a boiler plate list of topics that may or may not be pertinent to each particular patient. Another case of one-size-does-not-fit-all.
Dr. David Katz, writing at ACP Internist, takes a look at the various diets that claim to be the “best” for weight loss and overall health. His article includes lots of the most popular eating styles and diets, and his opinion (and he’s definitely got a right to one – check out the credentials listed in his bio at the end of the article. He knows his stuff when it comes to nutrition) is that there isn’t really one diet that is the best. Different styles of eating will work for different people, and there are plenty of food plans that can result in excellent health and an ideal body weight. Although the top diets are quite varied in terms of what they include, they have a common theme when it comes to what they exclude: junk food, heavily processed food, refined starches, sugars, trans fats and excess salt. Don’t eat those; eat lots of veggies, fruits, and whole, unprocessed food, and you’ll probably be just fine.
Dr. Rich, of the Covert Rationing Blog takes a look at the new Million Hearts Initiative that was recently introduced by HHS. He links to critiques written by two other electrophysiologist bloggers and also adds his own thoughts to the mix. The verdict? The Million Hearts Initiative isn’t likely to be the most successful government program ever launched. For one, it doesn’t mention exercise at all, which seems like a glaring omission when we’re dealing with ways to prevent heart disease. (In his unique style, Dr. Rich notes that adding exercise would likely have boosted the estimated number of hearts saved and they wouldn’t have had a nice round number like “a million” to use in the title.) But another big omission seems to be cardiologists themselves. Apparently, the plan is to not need them at all. Prevention is great, but what about the people who already have heart disease and are at the highest risk for a heart attack? Wouldn’t treatment by a cardiologist seem to be a good way to help prevent heart attacks in the most vulnerable sector of the population? To sum things up, Dr. Rich points out that we should forget about a million hearts and “…instead, save only one. Don’t smoke. Get plenty of exercise. And don’t eat so damned much.”
Allison from Diabetes Mine gives us the details on a new continuous glucose monitor that will talk 
to your iPhone, call someone if the alarm sounds and you don’t respond, and doesn’t puncture the skin. It’s worn on a belt under your shirt and the sensor works by just being next to your skin. Allison notes a few downsides – including the $4000 price tag – but it sounds like this device will be helpful to a lot of people, especially if they can extend the battery life (or provide several back-up batteries) and make it a bit easier to wear.
Stephen Wilkins of Mind The Gap talks about the downside of all the standardization that is going on in healthcare right now. Electronic health records are being touted as an excellent tool to aid in data sharing and prevent medical errors, but they might also be causing physician “de-skilling”. Rather than write unique chart records for each patient – as was common before the advent of EHRs – some physicians are now copying and pasting sections of data that pertain to a particular illness that might be common to more than one patient. Although the records are easily transmitted from the specialist to the patient’s PCP, the PCP might not be getting as much patient-specific data as the did in the old days. (Of course, then they might not have received the data at all, and certainly not in real time.)
The next Grand Rounds will be hosted by Jason Shafrin at the Healthcare Economist, be sure to check it out.