Demystifying Medicine One Month at a Time

Category: computers (Page 1 of 3)

The Medical Monopoly You’ve Never Heard of

Have you had a prescription filled electronically?

e-prescriptions-final_wide-2bdecca3ec71036e28abe23e4e79933261363d24-s40-c85The difference is no longer being handed a written prescription and having to take it to a pharmacy to be filled. E-prescribing enables the doctor to electronically send the Rx right from her computer. Fast. Clean. One stop shopping. If she picks a medication that’s a) not covered by your insurance or b) risky for a medication interaction, then the computer alerts her and she can make a different choice.

This is all possible because of Surescripts, a consortium consisting of national pharmacy chains, independent pharmacies, and the big “pharmacy benefit managers” (groups like Express Scripts or Caremark). Last year, the Surescripts network surpassed the 50% mark: half of all prescriptions are now generated electronically. It’s a big number: Surescripts reports handling 6 billion electronic transactions a year.

Imagine Coke and Pepsi uniting with artisanal/local cola makers to create a single distribution and delivery system nationwide, in which they’d share proportionally in the costs and the utilization. Seems inconceivable. Yet it’s exactly what’s happened in the retail drug industry.

Read more about it here, on NPR’s Shots blog.

One exception to e-prescribing I didn’t cover in the piece: Most states still require written prescriptions for narcotic (opioid) pain medications (think Vicodin, Lortab, Percocet, etc.). This is to add hurdles to the process for a variety of reasons. Fodder for future posts.

If you like what you see here or at NPR, share it!

Post by NPR.

Internet House Calls

It’s not the first, but it’s generated a fairly big announcement:

A company called American Well has introduced virtual visits directly to consumers in Massachusetts. [They’ve already been doing it in 43 states and the District of Columbia.]

A hand with a stethoscope to give an examThe company has been partnering with insurance companies to provide internet-enabled visits to select populations. But now going direct to the public in the state with the highest number of doctors per capita has increased their visibility.

For the introductory price of twenty bucks (visits usually are forty-nine per), you can sign up and have a vetted medical professional (one that you select from a roster based on background, specialty, and availability) diagnose and even treat you for your problem.

Treatments include e-prescribing of antibiotics or other medications, in addition to advice. Potentially addictive controlled substance pain medications (Vicodin, Lortab, et al.) are not permitted.

Depending on your viewpoint, this is another step forward in technology enabling consumer-driven and consumer-friendly health care. Or it’s another insult to the primacy of the doctor (aka “provider”)-patient relationship and the “Medical Home” model.

Would you confer with a doc online, if you could see her and talk to her “live?”

Quantified Selves

Are you a data junkie?

Do you feel compelled to record your vitals, throughout the day, during workouts, or while you sleep?

the-quantified-selfHave you ever tried a calorie counting app to see what you really eat in a day?

If you own a smart phone, you are now able to do all of these things as never before.

A growing movement known as Quantified Self is putting people more in charge of their data and their health. NPR ran a great story on QS (embedded below). Some of the more popular apps were featured and some devoted QS’ers were interviewed.

As a doctor, I welcome people’s engagement with their health. As the illustration shows, anything that gives people a sense of control over their lives (and their ‘well being’) can’t be bad.

Yet I do want people to keep these tools in perspective–you may find, like I do, that some of the subjects of the story are a bit, er, obsessive. And if you look at the comments, you’ll see there are many skeptics, who express doubts that these modern tools will help Americans change their unhealthy habits–arguing that those motivated enough to quantify themselves are likely to be healthy types in the first place.

Know any good tracking apps? Share them with us.

Computers and Health Care Cost$

Does your doctor use a computer instead of a paper chart?

Chances are that she does. The rate of adoption of electronic medical records (“EMRs”) over the last three years has been very steep.

“How much do we want to stamp out fraud? This much.”

The main driver of this is a government subsidy from a part of the 2009 Stimulus Act (called the HITECH Act) that incentivizes doctors and hospitals to make the conversion to electronic record-keeping.

The push has been on for medical practices to ‘go electronic’ for a long time. It’s about efficiency. Reliability. No more issues with doctors’ handwriting. A better reason: we should be able to share records electronically and analyze them collectively to discern ‘best practices.’

The NY Times ran a nice piece of investigative reporting this week, demonstrating that the transition to electronic record keeping has been anything but ‘cost-effective.’

Computers allow us to set scripts for our visits with you (whether in the hospital, the ER, the OR, or the regular office). Using the scripts, loaded with check boxes, we are able to check off many positives and negatives (e.g. the patient does have fatigue, or the patient does not have headaches, etc.).

Enumerating symptoms and signs in this way allows us to maximize the documentation trail we create. Of course, maximizing the documentation thereby allows us to maximize what we claim on bills of service to insurers like Medicare.

The Times reporters found that over a five year period, claims to Medicare increased by $1 billion. It wasn’t that more service was delivered. When they analyzed individual hospitals, they found huge increases in claims for roughly the same number of visits. As but one outlier example, Baptist Hospital in Nashville saw its ER billings increase eighty-two percent the year after installing an electronic medical record. There are many other examples, suggesting this is no coincidence.

Depending on your viewpoint, one of two phenomena are occurring:

  1. Hospitals and doctors are ‘gaming’ the system to ‘upcode’ every visit to a higher level, resulting in a higher bill OR
  2. Electronica has simply allowed us to more legitimately capture what it is we do and bill accordingly–known as ‘charge capture.’

Of course, the answer is somewhere in the middle–some are no doubt gaming, others likely just doing things better and reaping the rewards. The article noted, however, that the Department of Health and Human Services discovered that a mere 1700 doctors nationwide (out of nearly a half million doctors in practice, or 0.4% of physicians) contributed $100 million of the increased charges. That amounts to sixty thousand dollars per physician in increased year-over-year charges. Do you really think a full time doctor could increase her billing that much for roughly the same amount of work, even allowing for perhaps a small inflation in patient volume or number of office visits?

So, another esoteric post about how and why health care costs so much in the U.S., right? Yada yada yada. Does anyone really care?

Two days after the Times article, HHS Secretary Kathleen Sibelius and U.S. Attorney General Eric Holder co-signed a “strongly worded” letter to hospital associations across the country warning them to steer clear of fraud.

Wait. Does the government want us to implement these computer systems or not? Looks like we’ve hit some unintended consequences of what seemed like a reasonable policy goal.

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