Weekender 4/6/18

Weekly News Recap

• Orion Health Group announces a cost-cutting program and reorganization following release of poor annual results that sent shares down to a 52-week low.
• The State Department issues an RFI for an EHR following its failed attempts to install Epic as part of the Coast Guard’s halted implementation.
• GE Healthcare sells its health IT offerings to Veritas Capital for $1.05 billion in cash.
• Former VA Secretary David Shulkin disputes White House statements that he resigned, indicating that he was fired and thus raising legal questions about President Trump’s right to choose the DoD’s Robert Wilkie as his interim replacement and the possibility of legal challenges of any documents that Wilkie might sign such as the on-hold contract with Cerner.

Best Reader Comments

I would love to see more physicians embracing their role as leaders on a large, heterogeneous care team rather than technicians who operate in isolation and are subject to forces beyond their control. I don’t think many physicians perceive themselves as clinical leaders, but if they did, they could find many resources available that help teach the necessary principles and skills. (Adam K.)

I have to think that the big IDNs like Kaiser Permanente that use Epic and offer genomic testing to certain sectors of their patient population will be doing big things with data mining as more and more people in their populations have their genomes sequenced. If they could get to the point where they had 2 million people with genomic records married with multi-year structured data like what gets captured in Epic, it might be possible to discern some interesting patterns. If you add in the possibility of analyzing the gut biome, too, I have to think that we’ll be seeing an acceleration in discoveries and an improvement in targeting therapies – true personalized medicine. (CanHardlyWait)

National approaches are fraught with dangers to personal privacy and have a predisposition to stifling innovation. There’s also no good way to handle changing priorities – e.g., if a state reduces its opioid problem and has something else more important that it feels it needs to fund, the state approach allows it to focus on their state needs. A federal approach (e.g., like Meaningful Use) tends to be a one-size-fits-all, which we know is not good. Find a way to address these and you’ll find me supportive of national consolidation. What I am in favor of is a national approach to the issue with the ability to share state-level information with minimal cost or impact on workflow. (Joe Schneider, MD)

Interoperability is extremely valuable if done the right way. However, physicians and institutions must first learn to trust each other or the value is diminished. If one facility does a CT, MRI etc. and the next facility insists on repeating the test because they only trust their own techs, there is diminished return with increased patient frustration and patient cost. (Barbara)

The current PDMP process is a bad process. Improvements will only make a better bad process. The logical approach is to scrap the current submission process and move to real time using modern standards submission such as the NCPDP standards. (David)

You would not have to look very far to find some very large healthcare IT vendors being run by teams of middle-aged white men with zero software experience who all come together from company XYZ with light healthcare delivery experience. IV bag and alcohol swab logistics are very important, and while they are in fact delivered, they are definitely not healthcare delivery. Little diversity. Exorbitant compensation. Meager results. And still we wonder why. (ellemennopee87)

Watercooler Talk Tidbits

Teacher Ms. E in New York asked for a library of 30 books via DonorsChoose, saying that her kids “have the cards stacked against them because they are minorities from the South Bronx” and asking in her request, “Could you be the ‘somebody’ that helps?” HIStalk readers were indeed that somebody who funded her project. She reports, “Thanks to you, my students are now able to read new books from popular series such as ‘Fly Guy’ and ‘Elephant and Piggie.’ They are spending any free time they have in the classroom reading the books with their buddies and I am so excited that they are now part of our classroom library. Thank you so much for supporting my students. Donors like you are truly the best and we appreciate your generosity immensely!”

Also checking is Ms. F, who asked for take-home STEM activities for hew New Mexico classroom of 48 students. She says, “These math games have been such a fun and exciting addition to our math classroom. When they came in, the kids were amazed and couldn’t wait to play. It is truly a blessing to have supporters that understand that kids should enjoy learning and want to help make it possible. Now that we have learned how to play most of the games in class, I am getting ready to check them out to students to take home and play with their families next week. When I told them that they could borrow the games they were astonished and very excited for the opportunity. Thank you again for making this possible.”

Listening: last year’s solo release from former Megadeth guitarist Marty Friedman, whose music covers more genres than just metal shredding, although he does that really well. His band explodes with energy, especially Kiyoshi Manii, who is one of the most aggressive and technically competent bass players I’ve heard (not even considering that she’s a tiny Asian female). I’m also enjoying the recent reunion of Seattle-based hip hop band Common Market, celebrating the 10-year anniversary of its fabulous album “Tobacco Road.”

Forbes notes that Humana has offered to buy Kindred Healthcare’s home division for $800 million as Humana itself is rumored to be the subject of acquisition talks with Walmart. If both transactions go through, that would allow Walmart to extend beyond the walls of its pharmacies and retail clinics into the homes of patients.

Drug maker AbbVie buys itself five more years of monopoly pricing for the  world’s top-selling drug Humira, paying off a second company to refrain from marketing a cheaper version. Humira’s price has increased from $19,000 per year in 2012 to $38,000 today, generating annual sales of at least $18 billion. US patients pay multiples more than those in other countries, of course, nearly triple what those in France, Japan, and Norway are charged.

Also related to drug pricing: Bloomberg notes the success of a pair of Chicago consultants who teach drug companies the tricks needed to raise their prices by up to 4,000 percent. Their recommended methods include pressuring health plans to keep paying, using specialty pharmacies, covering patient co-pays, use analytics to find insurance policy holes that will support price hikes and to target likely prescribers, and providing big bonuses to aggressive salespeople. The consultants started as executives for a struggling drug company that has raised the price of one product from $500 to $2,500 in five years, earning the company’s CEO a single-year payday of $93 million. 

Surgeons at Memorial Hermann ask a brain surgery patient to play her flute during the operation so they could tell if they had fixed her hand tremor problem, which they did.

This seems entirely pointless, yet something Millennials would pay for. Lydian Dental offers concierge dentistry serviced out of designer RV-like clinics on wheels in trying to make dentist trips “fun.” The oh-so-hip design team also specified staff uniforms of workout pants and tee shirts bearing quippy phrases (“all up in your grill” and “nice mandibles”), instruments that remain hidden until needed, and iPads with Dre Beats headphones. The target market of the four-clinic company is clear given its smug use of insufferable hipster terms such as “aspirational,” “curate,” “touchpoints,” and their hope to “transform a transaction into an experience.” They will probably succeed – recall that endless studies have shown that Millennials don’t care how restaurant food tastes, it’s how enviable it looks when posted to Instagram that keeps them coming back.

Bizarre: a woman takes an Ancestry.com DNA test that predicts a “parent-child” relationship with the former OB-GYN who had treated her parents for infertility. The doctor had suggested a fertility procedure in which the mother would be inseminated with a mixture of sperm from her husband and a donor who met their specifications for height, eye color, and hair color. Apparently the doctor decided that the ideal donor was himself.

In Case You Missed It

• News 4/6/18
• EPtalk by Dr. Jayne 4/5/18
• Readers Write: Will PDMPs Remain a Vital Tool in the Opioid Response, or a Costly Burden?
• HIStalk Interviews Mark Savage, Director of Health Policy, UCSF’s Center for Digital Health Innovation
• News 4/4/18
• Curbside Consult with Dr. Jayne 4/2/18
• Monday Morning Update 4/2/18
• What I Wish I’d Known Before … Retiring or Career Downsizing

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