Clinicians may have the opportunity to use wearables to help PTSD sufferers.
A good primer on bundled payments for anyone that wants to understand more about that value-based care experiment. Oh, and enrollment in Medicare’s BPCI voluntary bundled payment program dropped 16% when providers had to take on risk. A number of reasons why are offered in the article, and they’re all valid to some extent. But, this program was introduced in April 2013. So, in reality, that’s over 6 years for providers to figure out their costs, what causes readmissions etc. Clearly, that hasn’t been a priority for some.
Skilled Nursing Facilities (SNFs) fret that value-based care is going to drive them out of business unless they adopt technology. Well, they’re right to worry, because there’s likely to be a bloodbath. There are over 15,000 SNFs, many of them smaller, independent facilities. And many of them are about to get squeezed out of the market. First, Medicare is trying to bypass SNFs altogether, and discharge people directly to their homes, with home health agencies to provide rehab. That’s because it’s cheaper, all other things being equal (although comparing readmission rates would be interesting…). In addition, in the past, patients needing further rehab have been free to choose any SNF when discharged from hospital. As Medicare tries to make hospitals accountable for reducing readmissions, hospitals need more control over the entire episode of care, end-to-end. So, they are going to develop preferred partnerships with SNFs so they can manage and improve quality. Ergo, there will be far fewer patient days in SNFs, and only the SNFs that can guarantee quality outcomes and integrate seamlessly with hospitals will survive. A good opportunity for companies likes EarlySense and Curavi Health to help out. Even so, some SNFs will go out of business, others will be gobbled up by large SNF corporations or healthcare systems. Expect that 15,000 SNFs to become 12, maybe even 10, thousand over the next few years.
The most impressive thing from the Apple Watch heart study isn’t it’s ability to detect afib. It’s the fact that they collected data from 419,000 people. In the era of AI and machine learning, that’s a game changer. Because, all other things being equal, in the era of AI and machine learning, the person with the most data wins.
I’ve been of the opinion for many years that the best path to bring healthcare costs under control is to make it a fully transparent and competitive market for consumers. A bit like buying a car, or a fridge, or a central heating upgrade. The push for value based care – ACOs, bundled payments etc. – haven’t really got into that yet. Now the federal government is pushing harder for transparency, and predictably the hospitals are starting to squeal louder. I touched on site neutral payments in my last piece, and predictably hospitals aren’t keen on that either. Because both transparency and site neutrality will mean lower costs for you and I, and lower margins for the hospitals.
Still on the topic of site neutrality, Fresenius reports huge growth in home dialysis. Which is just as well for a couple of reasons: First, Fresenius has to go to home dialysis if it wants a business because Medicare is pushing on that for cost reasons. Second, that’s the main reason it acquired NxStage. Relatively speaking, the US has low rates of home dialysis. Because, it seems, decades ago Medicare policy drove people into dialysis centers. Apart from the cost, I have to believe that in a country like the US with large, sparsely populated rural areas, home dialysis can provide a much better quality of life for many people.
Forest Devices wins a pitch competition for a device to help EMS crews rapidly diagnose a stroke.
Some people are very upset that Google has access to patient data through a partnership through Ascension Health. Google has since clarified things a bit. Me, I’m not that concerned about it. If healthcare is going to become affordable and accessible, we need a revolution, not tinkering. And revolution never comes from within, always from the outside. So I’m all for new approaches that might dramatically improve quality and lower costs.
Humana reports $3.5bn savings from value based care in its Medicare Advantage program.
Docs still don’t like EHRs. Never have, almost certainly never will if it takes away from their patient time. But, hard to deny that having a permanent record that could be shared is better than paper and all its limitations. Nevertheless, it unfortunately seems that EHRs are a good idea badly executed.
But wait, another plus for EHRs….the UKs NHS reports good result with the early detection of in-hospital sepsis. I think this is the full study here, so it looks like an algorithm running in Cerner is the business end of that. We can only speculate how much better the results might be if fed by continuous data from patient monitoring.
More good news on sepsis, University of Colorado has developed a predictive algorithm that runs against the EHR to predict sepsis in children.