Future of Health CarePatient EmpowermentResearch
August 9, 2017

How to Recognize “Fake” Medical News — And Why It Matters

Is coffee good for you? A recent headline suggested that people who drink coffee live longer. Sounds great to me. I drink a lot of coffee, so maybe I will be immortal. But, wait, another report links coffee to cancer. Dang. Estrogens were once touted as a life saving elixir for women of elegant ages, until these hormone supplements were linked to increased cancer risk. Wine will either add to your life expectancy or increase chances of breast cancer. But if you are married and have cancer, your outcome is better; you live longer (and can drink more wine?). Eggs…
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Future of Health CareMedical Decision-MakingPatient Empowerment
July 26, 2017

It’s Not What We Don’t Know That Hurts Us: It‘s What We “Know” That Isn’t So

Making a decision is a—or really—“the” fundamental activity of life. The decisions we make, the consequences of those decisions, our feelings about the consequences, our interpretation of whether we made a good or bad decision based on those consequences, in total, form the basis of our life’s experiences, and, often, how we decide the next time. My children used to say, “Duh,” to my muttering an obvious observance like, “It sure is hot today,” because the temperature just hit 100 degrees. The opening sentence of this blog may seem so obvious that it may trigger a similar response. Making a…
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Future of Health CarePerformance Improvement
January 31, 2017

The Dirty Little Secret About Performance Measurement Data

“The data just hooks up.” That was an opening remark from a competitor applauding his company’s scoring system for physician quality. He went on to explain how this data produced reliable scores on quality. The idea that data hooks up and produces a true scoring system for quality is a fantasy. Not only is data itself flawed, but it doesn’t always tell the exact truth. Treating data casually amounts to an off-hand dismissal of the complexity and inherent biases of performance measurement. But here’s the kicker: we need to measure performance, anyway. In fact, it’s more critical than ever to…
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Registry ScienceResearch
November 15, 2016

Bedside Viewpoint: Why Watson Will Never Know Enough to Replace Your Physician

Every conversation with a patient is an exercise in big data analysis. Your patient’s appearance, changes in mood and expression, and eye contact are data points. The illness narrative is rich in semiotics: pacing, timing, nuances of speech and dialect are influenced by context, background and insight, which, in turn, reflect religion, education, literacy, numeracy, life experiences and peer input. To all this, add personality traits such as recalcitrance, acceptance and personal philosophies. Taking a history generates a wealth of data. Mix in physical findings of variable reliability, laboratory markers of variable specificity, imaging bits and bytes, and you have…
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Future of Health CareMedical Decision-MakingPerformance ImprovementRegistry ScienceResearchValue-Based Health Care
October 11, 2016

Physician Culture Must Transition from Defensiveness to Performance Improvement

Physicians undergo long and arduous training, with good reason. Lives are at stake. Learning to make the correct diagnosis, to expertly perform the appropriate procedure and to properly treat conditions is essential. Mistakes or flaws are scrutinized and not tolerated. Being wrong may cause greater harm to the patient—and lead to malpractice litigation. In short, physician culture places a premium on individual performance and responsibility. Steeped in those values, most physicians take great pride in the quality of care they deliver to patients, in the examination room or the surgical suite. Teams who provide specialized services, such as Emergency Departments,…
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Alternative Payment Models (APM)Future of Health CareMACRAMerit-Based Incentive Payment System (MIPS)Performance ImprovementValue-Based Health Care
October 4, 2016

Improve Your Risk Readiness With Physician-Driven MACRA CPIA Innovation

CMS is pushing providers to accept Risk under Alternative Payment Models (APMs), and they’re sweetening the pot with incentives. But for the vast number of providers who will participate in MIPS because they don’t participate in risk-based APMs, the path to reward is murky. That’s because many Health Systems have a hard time visualizing how Performance Improvement with CPIAs can create savings under ACOs, the biggest APM model. Here’s the key: innovation that engages physicians. Historical Performance Improvement Often Leaves Out Physicians For most Health Systems, it’s rare for physicians to actively participate in Performance Improvement initiatives. There are two…
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Performance ImprovementPersonalized MedicinePopulation HealthRegistry ScienceResearch
August 30, 2016

Personalized Medicine v Population Health: Opposites or Complements?

If personalized medical care is the goal, how does that fit with the concept of “population health,” the darling of the health care industry’s drive toward better results and lower costs? Are these two concepts really at odds, or do they work in tandem? This is not a rhetorical question; in the current environment of keeping costs under control, lives are at stake. How Personalized Medicine Should Work We know that best outcomes occur when individuals are appropriately assessed and allowed to make choices based on their personal characteristics. Personalized medicine is not a concept of averages; it is a…
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Future of Health CarePersonalized MedicineRegistry ScienceResearch
August 9, 2016

Personalized Medicine Can’t Wait for Genomic Data

Personalized medicine is off and running. The effort to enroll one million people who will volunteer their genomes for science by the year 2019 kicked off recently with an event featuring President Obama that included more than 150 of the first volunteers. But this effort is not for my patient. It will be either too little, or too late, and certainly not enough. While personalized medicine is an old concept, the new push for personalization focuses on genes or gene products. These, it is hoped, may be better predictors of an individual’s outcome of a disease condition. The new efforts may…
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Clinical Data RegistryMACRAMedical Decision-MakingMerit-Based Incentive Payment System (MIPS)Performance ImprovementQualified Clinical Data Registry ReportingRegistry ScienceResearch
July 19, 2016

MACRA Match-up: How EHR Source Data Will Benefit Registry Research

At the core of MACRA and MIPS requirements, Electronic Health Record (EHR) source data will soon become a key component for Registry research. Specifically, Clinical Performance Improvement Activities (CPIAs) are a required component of MIPS. Performance improvement efforts will no longer be optional. Quality data will be essential. EHRs present an excellent data resource, but the data is not flawless. Registries are well suited for validating data and assessing performance using a continuous improvement model—testing an idea by changing a practice and measuring its impact. When done on a small scale, testing performance improvement activities and the feasibility of population-based…
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Alternative Payment Models (APM)Clinical IntegrationFuture of Health CareMACRAMerit-Based Incentive Payment System (MIPS)Performance ImprovementValue-Based Health Care
May 17, 2016

3 Ways Proposed MACRA Rules Revive Health Systems’ Clinical Integration Programs

Clinical Integration in medium to large Health Systems just received a nice push from the federal government’s Proposed Rules for MACRA. Health Systems trying to market quality-based physician and hospital networks systems— especially those with both employed and private physicians—should take note. This opportunity for Health Systems to bridge Medicare and private health plan quality is one of the best features of MACRA. Why? Look at this triple play of provisions woven through both MIPS and APMs: “Other-Payer” Advanced APMs will be allowed in the program’s third year to meet Advanced APM status by participating in both Health Plan and Medicare…
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