How the ACA’s Pay-For-Performance Programs Target Catheter-Related Bloodstream Infections
The mainstream media has primarily covered the Patient Protection and Affordable Care Act (also known as the ACA or Obamacare) for how it affects health insurance. But as healthcare insiders, readers of this blog know there’s much more to this groundbreaking piece of legislation — including its provisions aimed at upping healthcare quality and lowering healthcare costs. Many of those provisions affect the practice of vascular access because catheter-related bloodstream infections (CRBSIs) have both quality and cost implications.
Healthcare providers should be taking a close look at these sections of the law because they can affect everything from reimbursements to materials management. Vascular access specialists (VAS’s) should know the provisions, too, because the ACA targets vascular access outcomes.
The combined MammaPrint and BluePrint genomic tests provide more information about the specifics of breast cancer than does the older, 21-gene test, according to the first independent assessment comparing the assays. That study was among the major new findings about breast cancer molecular diagnostics – also called genomic tests – emerging from this year’s recent annual meeting of the American Society of Clinical Oncology (ASCO).
When most of the business news is about big companies, it’s easy to forget that there’s still room for a little guy with a great idea. Medical device maker Focal Therapeutics is clearly one of the latter, as a new scientific presentation underlines. The presentation was given at the 2014 Breast Cancer Coordinated Care (BC3) conference, held in February in Washington D.C.
Focal Therapeutics developed the BioZorb™ three-dimensional surgical marker, to help identify the surgical excision site following soft tissue removal, such as breast lumpectomy cavities. The marker makes it possible for physicians to visualize the surgical region post-surgery. This helps to improve clinical precision for post-operative treatments and follow-up.
To understand the difference this makes, consider a woman who has just had a lumpectomy and now needs post-surgical radiation to prevent her cancer from returning. Once this 3D marker is placed by her surgeon, her radiation oncologist can locate the exact site more precisely, clinicians can better target the radiation (thereby decreasing the volume of tissue that receives radiation minimizing radiation exposure to nearby healthy areas such as the heart and lungs.
The presentation showed BioZorb as an alternative to traditional tissue landmarks such as seroma and clips as well as post-operative density changes seen on CT scans done for treatment planning. The results were dramatic. The device enabled physicians to achieve a greater-than-50% percent reduction in planned treatment volume, according to poster co-author Robert R. Kuske, Jr., M.D. Dr. Kuske is an internationally known radiation oncologist who uses BioZorb in his medical practice at Arizona Breast Cancer Specialists.
What’s more, there appeared to be no downside to using the BioZorb marker. Patients tolerated placement of the device without complications, and cosmetic outcomes were excellent.
With traditional methods, treatment planners have to do a certain amount of guesswork and treat a bigger area because the borders of the area needing treatment aren’t obvious. That can mean a higher radiation dose, more risk to healthy tissue and organs, and negative impacts on the patient’s appearance.
Co-author Linda Smith, M.D. of Comprehensive Breast Care in Albuquerque, N.M. said “It was a revelation to see the surgical edges so clearly with the BioZorb device in place.” Read more about the presentation here.
BioZorb’s inventors appear to be true visionaries, because there’s no other device like theirs in the medical marketplace. Unlike other markers, BioZorb defines the treatment area in three dimensions. Its unique open spiral is made of a bioabsorbable material, which means the patient’s body absorbs it slowly over time. That makes surgical removal after completion of therapy unnecessary.
Dowling & Dennis has worked with Focal Therapeutics’ George Hermann, president and CEO, Gail Lebovic, M.A., M.D., FACS, the company’s chief medical officer, as they have created several innovative devices in breasthealth. From all appearances, BioZorb is extending their career-long hot streak.
By Eugene Spiritus, M.D. Chief Medical Officer VGo Communications
While smart phones, computers and tablets have allowed people to better see and communicate with each other over distance, the arrival of the VGo telepresence robot has added a new dimension to aging in place.
Tools such as VGo will be increasingly valuable as the American population ages. According to the AARP, 90% of people over the age of 65 would prefer to remain in their own residence as they age. Many Baby Boomers must now take on the role of caregiver for aging parents or provide economic support in the form of paid caregivers. A recent study suggests that by 2026 there will not be enough caregivers, paid or unpaid, to support the growing population of seniors.
By looking at seniors who have been able to remain in their homes, research suggests that success in remaining in one’s residence in old age is usually a function of being able to successfully manage illness, avoid accidents and injuries, and maintain communication with friends and family. Also, according to a survey by AARP, a majority of seniors said it was important to stay involved and continually learn.
In his book The Creative Destruction of Medicine, Eric Topol talks about the “new medicine.” It results from the convergence of wireless sensors, genomics, imaging, information systems, mobile connectivity, the Internet, social networking and computing power. While the future holds great promise for “individualized medicine,” the question remains: Are there now technologies and approaches for seniors who may not be technologically sophisticated?
Technologies are available and affordable that capitalize on smart phones and the Internet to collect and store data such as weight, blood pressure, blood sugar, sleep efficiency and oxygen level. Most of these can be done with little or no understanding of technology. Even more valuable are websites that allow elders to learn from others and track any illness.
Seniors with chronic disease may take more than 10 medicines a day and consequently are more prone to errors that may lead to disability or death. There are now a number of e-tools available including simple pillboxes, complex organizers with dispensers and alarms, vibrating watches, and smart phone apps with reminders. Recently the FDA approved a system that uses a small sensor to track pill taking and send the information to a smart phone.
VGo, because it is a lightweight, affordable robot that is controlled remotely from either a laptop computer or iPad, allows caregivers and family members to visit and interact with elders from across town — or anywhere in the world that has a high-speed Internet connection or Verizon 4G. This telepresence robot has been shown to be an effective tool in the period after hospital discharge, to ensure care plans are being carried out and to have close follow-up without requiring the patient to leave home.
The VGo is being widely accepted by patients, family members and care providers, because it offers a cost-effective means of follow-up, engagement and social interaction.
Exchanging medical information in the cloud is getting more attention these days, as its patient-safety and economic advantages become more apparent.
Among the leaders in this field is eMix, a client of ours. Florent Saint-Clair, eMix general manager, recently led an On-Demand Education Session of Virtual HIMSS12 titled “Cloud-Based Medical Data Exchange: What We’ve Learned So Far.” Virtual HIMSS 12 was held online from Feb. 20-24. To see Saint-Clair’s post on the HIMMS blog, click here.
HIMSS provided the virtual sessions as a way to take part in activities related to the HIMSS 2012 Annual Conference & Exhibition, other than attending the event in person. Attendees were able to participate from any location in the world. Virtual HIMSS12 included both interactive activities and on-demand sessions such as the one on cloud-based medical data exchange.
Saint-Clair’s session described the evolution of cloud-based medical data exchange from its introduction in 2010 to its increasingly wide use today. He discussed why the technology is a giant leap forward from such troublesome, limited workaround solutions as exchanging files on CDs and sending them via virtual private networks (VPNs).
CD and VPN file exchanges are plagued by such issues as time delays, reliability, and security. Cloud-based medical data exchange has created a sharp, and welcome, break with this troubled past. Thanks to the new technology, a hospital can now securely send an imaging or other medical file to a radiologist’s EHR, PACS, or mobile device – indeed, any computer with a broadband connection – in just minutes.
The technology is similar to using email and just as reliable. It is also vender-neutral, which means it neatly hurdles the fact that medical information technology systems are often proprietary and don’t easily “talk to” each other. This was the problem that created workarounds such as CD- and VPN-mediated file exchanges in the first place.
Saint Clair’s presentation detailed the various ways that patient care has been improved by the increased reliability and speed brought about by services like eMix. He also noted the adjustments that adopters of the services face with respect to their workflow, protocols for handling images, and business processes. For those who couldn’t make it to HIMSS, the session provided an opportunity to get updated on an important new advance in medical data exchange with the depth and sophistication that HIMSS attendees expect.
Medical information technology (IT) users and users of consumer IT have at least one thing in common: they both have a fascination with the next big thing.
Consumers’ gaze always seems pointed toward the next big thing, needed or not. Over the years, interest has shifted from desktop computers to laptops to tablets and mobile devices.
The situation in medicine is not so unidirectional. In fact, right now, attention appears focused on an old, invaluable favorite: the picture archiving and communication system (PACS).
According to a recent report from market researcher KLAS, the PACS replacement market seems to be gathering momentum.
Large hospitals are leading the parade. Of hospitals and health systems with more than 1,000 beds, nearly one in six told KLAS they are in the planning process of replacing their PACS.
One of the reasons that the PACS replacement market is heating up again: The early PACS were strictly radiology systems. They were used to store, access, and distribute digital imaging files.
The current PACS generation encompasses radiology information systems (RIS) and cardiovascular information systems (CVIS), too. A RIS is a computerized radiology database with functions that include results reporting, patient tracking and scheduling, and image tracking. Interfaced with PACS and in many cases a hospital information system (HIS), the RIS plays a central role in radiology workflow, from radiology practices to hospitals. In a similar way, a CVIS is a workflow solution for cardiology departments and practices.
But the large hospital/health system decision makers who responded to the KLAS survey don’t want just any PACS/RIS/CVIS. They said they wanted innovative technology from a new PACS vendor with in-depth clinical and radiological expertise. They demand reliability, scalability, interoperability, mobility and accessibility, as well. Finally, they want their vendor to be a strategic partner.
Those are not unreasonable expectations. In fact, they are all qualities, according to KLAS voters themselves, of the company they chose as 2011’s top PACS vendor in the large hospital category: DR Systems (San Diego) (a Dowling & Dennis client).
Besides DR’s industry-leading technology, KLAS voters cite the company for working extremely well with customers. A PACS is not – or at least should not be– be an off-the-shelf product. Customers should have access to executives and product designers at the vendor company so they can customize and even help evolve the product to better fit their needs.
Which is why we think hospitals may be better off purchasing from “best of breed” companies like DR Systems, rather than from large corporate vendors that have a medical division but also divide their attention among many other divisions.
While it’s mainly large health systems that are planning PACS replacements now, it probably won’t stay that way. The KLAS analysts believe the wave the big institutions are starting will eventually envelop smaller hospitals, too.
How far behind is healthcare in the full and efficient use of information technology?
So far behind that even The Onion has noticed.
The satirical newspaper and website normally focuses on “stories” such as Joe Biden’s fascination with hot babes and his muscle car. Recently, though, The Onion took aim at the shortcomings of healthcare IT with an article titled “Quick-Lube Shop Masters Electronic Record Keeping Six Years Before Medical Industry.” Written in typical Onion style that makes it seem like an actual news report, the article quotes a fictitious garage owner:
‘We figured that a basic database would help us with everything from scheduling regular appointments to predicting future lubrication requirements,’ said the proprietor of the local oil-change shop, Karl Lemke, who has no special logistical or programming skills, and who described his organizational methods, which are far more advanced than those of any hospital emergency room, as ‘basic, common-sense stuff.’
‘We can even contact your insurance provider for you to see if you’re covered and for how much, which means we can get to work on what’s wrong without bothering you about it. The system not only saves me hundreds of thousands of dollars per year, but it saves my customers a bundle, too.’
And here’s the part that really hurts: “Lemke added that he also routinely and politely inquires about his customers’ health and well-being, which puts him roughly 145 years ahead of the medical industry.”
Of course things aren’t nearly as bad as The Onion makes them out to be.
Thanks to the efforts of cloud computing pioneers such as eMix and others, things are in fact getting better. And hundreds of millions of federal stimulus dollars are flowing into healthcare to get MDs’ office online and to computerize and interconnect hospitals’ records through PACS and other technology.
But as one wag said about The Onion story to blogger Neil Versel, the current status of medical industry It is “so pathetic that a bunch of young joke writers in NYC who almost never go to the doctor have noticed.”
People share a lot about themselves on Facebook and other social media — so much so that social media can even be a lifesaver. See this account of a recent case where doctors were able to save the life of a comatose woman with whom they couldn’t communicate — because she had recorded her health problems on her Facebook page: http://aol.it/gQH9WP.
We’ve heard a lot about teens and others who “overshare” on Facebook. But this woman’s postings probably saved her life.
Reporting this case, Newt Gingrich and a neurosurgeon who authored the article said: “A personalized system that puts the individual at the center and helps us make decisions based on the needs of the individual will become even more accessible — and more important — as the digital world expands in ways that can save lives and save money.”
We can all hope that with individuals “at the center,” though, there’s still plenty of room for knowledgeable clinicians to bring their expertise and technology to bear on individuals’ health problems.
Informed patients clearly will play a much greater role in the healthcare of the future. Regarding the social media part of that equation, the always interesting HISTalk blog on healthcare information technology (http://histalk2.com) comments:
“Since Facebook is taking over the world, maybe it makes sense to create a PHR (personal health record) add-on for it since Microsoft and Google aren’t getting anywhere with theirs. … After all, a new survey shows that 72% of adults in England check Facebook in bed right before they go to sleep.”
There are loads of advantages to cloud-based sharing of medical data, but bottom-line, it’s about patient safety, says radiologist Murray Reicher, M.D.
Writing in the latest issue of Patient Safety & Quality Healthcare (“Riding the Cloud to Improve Patient Safety,” November/December 2010), Reicher says that sharing data via the cloud makes it possible to move information much faster than old methods. This can save patients from unnecessary procedures and radiation – and in emergency cases, potential injury from delayed treatment. (Full article at http://psqh.com/novemberdecember-2010/684-information-exchange.html.)
Dr. Reicher is the founder and chairman of DR Systems, which created eMix, one of the first of the new cloud-based medical information sharing services. He’s also a practicing radiologist.
In the article, Dr. Reicher describes a number of common scenarios that can harm patients because the conventional ways of sharing data – such as burning files to CDs and sending them by express mail – are too slow and clumsy. For instance, if doctors assigned to an emergency patient need to see a prior CT scan from another facility before starting treatment, the patient’s condition could worsen while they wait. In other circumstances, facilities might re-image a patient whose files can’t be obtained in time, which exposes the patient to extra radiation.
Cloud-based data-sharing such as eMix addresses all these situations because it moves data quickly on the Internet, which also overcomes the hurdle of incompatible, proprietary IT systems at different facilities. It is also secure, trackable, and affordable because it is priced on a low, per-use basis without any software or hardware purchase. It is versatile, too. Besides medical institutions, the files can be pushed to patients’ computers, doctors offices, and other remote locations.
“The limitation is no longer the technology itself but simply the speed of adoption,” Reicher writes. The rest of the business world is catching on – 20 million businesses and more than a billion people use cloud-based services, he says, citing a Microsoft claim. His gentle nudge to his own industry: Get with the program!
Healthcare Informatics magazine reports in its new issue on eMix and the Montana consortium known as IMOM. Using eMix (Electronic Medical Information Exchange — http://www.emix.com) IMOM facilities are sharing radiology images and reports.
Montana facilities use eMix to share radiology images and reports much more quickly and at less expense — realizing a key goal for many of the state’s rural healthcare facilities.
The article puts it this way:
“eMix uses cloud-based technology to house images after they are encrypted and pass through eight layers of security that include a physically secure data center and member and user authentication. The uploaded images are then accessible to the intended recipient through a simple download following an e-mail notification.
“Beginning in November 2009, three Montana health providers-Great Falls Clinic, St. Luke Community Hospital in Ronan, and Kalispell Regional Medical Center in Kalispell, all with different PACS, started beta testing the eMix service. No significant problems were encountered, and three additional facilities-Benefis Health System in Great Falls, St. Vincent Healthcare in Billings, and Glendive Medical Center in Glendive, were added as beta sites. In March 2010 beta testing concluded and the facilities signed up with eMix to continue sharing images.”
eMix is a venture of DR Systems (www.dominator.com), a client of Dowling & Dennis PR.