The pMD Blog

Here's The Latest in Health Care:

•  The unintended consequences of a gluten-free diet? Increased blood levels of arsenic and mercury, apparently. While everyone has some trace amount of arsenic and mercury in their blood, those on a gluten-free diet tend to have higher than average levels due to eating many rice-based products. Rice, it turns out, absorbs metals from water and soil.  While the health impacts at these levels are still unknown, it's good to keep in mind how much more rice gluten-free eaters are potentially consuming.  Read More

•  In an age where technology is ever prevalent in the health care setting, clinicians are often bombarded with daily alerts and alarms, causing alert fatigue and proving ineffective from its intended use. Dr. Vitaly Herasevich of the Mayo Clinic proposes a smart system to be put in place in order to curb this phenomenon. The idea is to issue alerts only in a situation when clinical providers fail to do the intended action as opposed to a reminder-like alert. This approach decreases unnecessary alerts while easing cognitive overload.  Read More

•  Trump's nomination for head of the Centers for Medicare & Medicaid Services (CMS) faced ethics questions this Thursday after nearly 3 hours of questioning during her confirmation hearings. Democrats raised ethics questions about Seema Verma's consulting firm and whether the work she did there conflicted with her public duties in Indiana.  Read More

•  New studies have found that vitamin D helps reduce the risk of respiratory infections, including colds and flu, especially in those who are vitamin D deficient. However, not everyone is convinced that we should all be heading to the supplement aisle. If you're already getting the recommended daily dose of vitamin D from your diet, a supplement may not lead to any further benefit.  Read More

Each Friday, Signor Goat reports the latest from the week in health care. Check back next Friday for your dose of our little medical corner of health care news. Brought to you by pMD, innovators in charge capture software.

“Unbelievable.” “Miraculous.” “Greatest catch of all time.” These are all words and phrases to describe one particular play from this past Super Bowl. If you were one of the 111 million people watching the football game, you definitely remember this one specific play by the New England Patriots. The end of the game was quickly approaching with only 2 minutes and 28 seconds left in the game, and the Patriots were down by 8 points. In that moment, Patriots’ receiver, Julian Edelman, made one of the most memorable catches in all of football history. The odds were not in his favor as it looked like time would expire on the Patriots before they would have a chance to come back against the Atlanta Falcons. However, Julian Edelman had different plans in mind when he made an incredible catch in the last few minutes of the game to help lead a push to victory for the New England Patriots in what looked like a lost cause only minutes earlier.

So how does this epic catch relate? As the reporting deadline for CMS’s PQRS program is rapidly approaching, I’ve been speaking with many physicians and practice administrators around the country. What I’m hearing is the same sense of desperation that the New England Patriots and fans must have been feeling during the Super Bowl as their team was facing an insurmountable deficit with very little time left.

The physicians and practice administrators feel as if they need a miraculous event to save them from a 2 - 6% negative adjustment to their Medicare reimbursement in 2018. Many of these practices have had unfortunate situations where a PQRS registry was full, they were unable to follow through on successful reporting, or they simply had poor communication and planning which led to a scramble late in the 4th quarter.

I hear sentiments of anxiety, frustration, exhaustion and feelings of giving up as physicians and practices know they are almost out of time. However, as the New England Patriots can attest, “almost out of time” and “out of time” are two very different things! If you’re in a situation where you have not submitted your PQRS data for 2016, there is still time to make that game-changing diving catch to finish strong. pMD is a CMS qualified PQRS registry, and we would be happy to see if we can help. We’re accepting customers through February 28, 2017 and there is still time to work with a member of our PQRS team for a consultation and be able to submit your data to CMS to avoid the looming negative adjustment in 2018. Don’t throw in the towel!


Image: Jean-Louis Wertz/University of Liege

Here's The Latest in Health Care:

• Wearable technology and data analytics are changing the face of employee health plans. As employee wellness becomes more and more a part of corporate culture, health insurers must now compete with wellness programs and more tech-heavy newcomers that offer the appeal of health gadgets and mobile apps. Looks like these established players need to "get with the program". Pun intended. Read More

• We all associate fevers with wasting away in our beds with aches, pains, and the yearning for chicken noodle soup. And yet, while fevers conjure negative sentiments, they're actually an ancient survival method in fighting infection. Studies involving sick carp recently brought to light a phenomenon called "behavioral fever", in which infected carp consciously move towards warmer water to fight infection, similar to how a fever fights infection in the human body. Read More

• On Wednesday, the Government Accountability Office released a report citing that doctors and hospitals failed to tell the Food and Drug Administration about cases in which a surgical tool, used to operate on the uterus, spread cancer around inside women's bodies. For 20 years, the power morcellator was used on patients to remove benign uterine tumors called fibroid. This tool can spray malignant cells around inside the abdomen and pelvis like seeds, worsening the disease. Read More

• Despite promises of replacing the Affordable Care Act within the first 100 days of his administration, Trump has yet to have an ACA replacement plan in place for this year. According to a Congressional Budget Office report released in January, repealing the ACA without a replacement could leave more than 30 million people uninsured by 2026. Read More

Each Friday, Signor Goat reports the latest from the week in health care. Check back next Friday for your dose of our little medical corner of health care news. Brought to you by pMD, innovators in charge capture software.

I know I'm not the only one who gets excited when I reach 10,000 steps and sparkling letters fly across my wrist congratulating me: “GOAL COMPLETED!” For me, my competitive drive fuels my need to complete my step goal and, of course, to do it before my friends and family do! The world of technology has made it easier than ever to track these everyday health goals and be competitive from a distance. This may be why so many people have gotten hooked on electronic and wearable fitness trackers that are collecting health data points throughout the day without much effort on our end. These devices not only make collecting data and exercise fun, but they give us a rewarding experience that keeps us wanting more. But there couldn’t be any real value behind all this data we collect each day, right? It's just a number of steps or a rating of our quality of sleep...

Wrong! Nearly 60% of US adults are tracking their exercise routine, weight or diet on some sort of electronic device, whether it’s an iWatch, Fitbit, or cellphone. All this data created and collected by patients is called Patient Generated Health Data, or PGHD, and the health care industry is starting to realize the value in having so many continuous health related data points available for each person. PGHD can go far beyond simply collecting and recording your 10,000 steps a day. You could generate and record the data point that might save your life.

When thinking of this health data past simply counting steps, the possibilities are endless. For example, if you take your blood pressure every day and record that data into a health app, you could be fairly certain when using a reliable device that the average of the measurements is your true blood pressure measurement. Now think about when you go to the doctor and your heart is beating fast because you are nervous as they wrap the blood pressure sleeve around your arm. This measurement might be higher than the times you measure at home. This inflated measurement could affect what and how much you are prescribed and the care you receive.

The amazing part is, the majority of Americans are already collecting some sort of patient health data. And this means they can give a more holistic view of their health to their providers to make more informed care decisions, and all they might have to do is wear a watch or band on their wrist.

Patient generated health data allows all patients to be more involved with their health care, especially for those with chronic conditions. If a diabetic has a device that continuously records his or her glucose level throughout the day and night, irregularities and patterns can be more easily identified and addressed by health care providers when reviewing all the data points versus just a few points a day.

A study conducted at Stanford in April of 2016 explored this impact. They recorded patient generated health data from a continuous glucose monitor which they streamed into their EHR. They found an association of better care for patients between scheduled clinic visits due to automated alerts when irregularities in the data were detected and communicated to the providers.

In order to record PGHD and have health care providers be able to access it, we must have software that is accessible for all to use and collect health data that can be easily accessible to providers. pMD is building mobile software beyond charge capture; we’re building a HIPAA-compliant secure messaging app for patients and providers, which can be used for communication between patients and providers if irregularities are detected in streamed PGHD.

The possibilities within PGHD are nearly endless; whether it's simply motivating someone to get moving, or saving someone's life by an automated alert in a critical change in a person's health before physiological changes occur. So go out there, get your 10,000 steps and collect some data that can help you be more involved in your health care!

University of Illinois at Chicago

Image: Courtesy of Karen Kasmauski/USAID's flagship Maternal and Child Survival Program

Here's The Latest in Health Care:

• Scandal rocks the pharmaceutical industry once more as insulin drug-makers steal the spotlight from last year's Mylan's EpiPen fiasco. This time, three manufacturers are being named in a lawsuit accusing the three makers of insulin of conspiring to drive up the prices of their drugs, benefiting themselves and pharmacy benefit managers, and consequently resulting in dangerous situations for patients who are unable to afford the lifesaving drug. Read More

• Think you've got office drama? Well, this week, in the nation's office, Democrats decided to boycott Tuesday's Senate Finance Committee meeting to vote on the controversial nomination for head of the Department of Health and Human Services. When Democrats didn’t show up again on Wednesday, Republicans changed the rules so the committee could allow a vote to go ahead without them. That must have been one awkward Thursday morning in the office. Read More

• 'Stumped' takes on a new meaning with business students participating in Northwestern University's Kellogg School of Management competition. The challenge is to figure out the best way to convince health workers and new parents in Nigeria to apply a potentially life-saving antiseptic to the baby's umbilical cord stump.  Proper treatment and education on applying the antiseptic can reduce neonatal deaths by nearly 40 percent. Read More

• Imagine being completely aware of your surroundings but unable to interact or communicate with any of it. This is the sad reality for many patients with advanced forms of amyotrophic lateral sclerosis, in which the brain loses the ability to control muscles, essentially becoming "locked-in". Scientists recently created a brain-computer interface used to read the thoughts of patients to basic yes-or-no questions by detecting the change in blood color due to changes in oxygen levels in response to certain questions being asked of the patient. Read More

Each Friday, Signor Goat reports the latest from the week in health care. Check back next Friday for your dose of our little medical corner of health care news. Brought to you by pMD, innovators in charge capture software.
Today Apple will announce its fiscal year 2017 first quarter earnings and everyone is eagerly awaiting the results. Will our beloved personal technology company outperform analyst expectations or will it disappoint? We’re no analysts, but nevertheless we are here to chime in with our own predictions based on stats from the health care users of our mobile charge capture and secure messaging apps.

Let’s take a look at our own iOS and Android numbers to see what the mobile device breakdown looks like.

iOS vs. Android:

Previously we had been tracking the device trends among our mobile charge capture users, including doctors, nurse practitioners, and physician assistants. Now that we have expanded our mobile functionality to include staff, primary care physicians, medical assistants, and soon to be patients, we wanted to expand our stats to reflect these folks as well. As you can see, Android increased its slice of the pie, but Apple continues to be the predominant smartphone technology in health care.

iPhone By Model:

Looking at the iPhone adoption by model, 12.5% of users upgraded their devices to the iPhone 7 / 7 Plus. The iPhone 6 users fell slightly, so we can surmise they either upgraded to the 7 or migrated to an Android.

The speculation from industry analysts seems to be relatively less gloom & doom this time around for Apple. For one, Apple stock has been performing well. Demand for the new Apple Watch Series 2 continues to grow, especially considering that it was almost impossible to get hold of one over the holidays. The iPhone 7 and 7 Plus models seem to have done relatively well, especially considering the hefty price tag and absence of the 2-year contract subsidies from network carriers. Given our users’ adoption of the iPhone 7, we may see an upside surprise during Apple’s earnings report. Will our numbers correlate with Apple? We’ll find out at 2pm PT.

Image: Cell

Here's The Latest in Health Care:

• Recently published in JAMA, new research finds that sepsis accounts for more 30-day readmissions and associated costs than any other commonly tracked medical condition such as heart attack, heart failure, pneumonia and obstructive pulmonary disease. Sepsis contributes to as many as 50% of all U.S. hospital deaths, according to previous research. To help providers improve patient care and outcome for sepsis patients, JAMA also published updated sepsis treatment guidelines. Read More

• A Reagan-era policy, known as the Mexico City policy, has been revived by President Trump. The rule requires not only hospitals or clinics to refrain from providing education on the benefits and availability of abortion but also includes any international organizations supporting those clinics to stop promoting abortion or advocating abortion rights anywhere in the world — regardless of whether or not they use non-American money to do so. The policy spells out a few exceptions, including cases of rape and treating women who have had botched abortions. Read More

• Controversial scientific experiments have successfully resulted in part human, part pig embryos. Scientists grew embryos inside a sow, containing a 'low' amount of human tissue. The hope is to one day utilize this technique to allow for whole organs in the pig to be grown of human cells, tackling the increasing problem of organ transplant shortage. However, ethical concerns focused on the possibility that the human cells could create animals that had human brain cells or tissues, blurring the line between the species. Read More

• Finding creative and holistic ways to assess and treat a patient often times may prove to be challenging from a revenue standpoint when there is no code to reflect that treatment. It’s essential for codes to be correct, both for reimbursement and for population health. In turn, accurate population health data is essential for ensuring that the patient's home and clinical needs are being met. Read More

Each Friday, Signor Goat reports the latest from the week in health care. Check back next Friday for your dose of our little medical corner of health care news. Brought to you by pMD, innovators in charge capture software.

Image: Adriana Zehbrauskas for The New York Times

Here's The Latest in Health Care:

• The Centers for Disease Control and Prevention (CDC) released a report this week about a Nevada woman who died because the bacteria was resistant to every single antibiotic available in the United States. Dubbed as a "nightmare bacteria", Carbapenem-resistant Enterobacteriaceae, or CRE, is highly resistant to antibiotics. Recent findings indicate that CRE is more widespread than previously thought and that people may spread the germs even though they may show no sign of illness. Read More

• The number of uninsured Americans will increase by 32 million within a decade by enacting even a partial repeal of the Affordable Care Act. While most of the coverage reductions would result from the disappearance of individual mandate penalties, a mass exit from insurers from the individual market are also expected to play a role. Read More

• A group of prominent donors announced this Wednesday that they had raised almost $500 million for a new partnership with the Coalition for Epidemic Preparedness Innovations to tackle pandemics. New epidemics can be expected to occur regularly and spread quickly due to air travel, public health experts warn. Stopping them in their early stages will save lives and billions of dollars. Read More

• A.I. can be applied today to ever-expanding health data sets. Its many uses can be applied to settings such as clinical decision support, research data mining and analytics, as well as pattern classification for tasks such as tumor detection. One of many limitations to keep in mind, however, is that A.I. is only as good as the quality of data they are being fed. But hospitals holding off on A.I. might be missing out on the opportunity to help shape the technological advancements in health care. Read More

Each Friday, Signor Goat reports the latest from the week in health care. Check back next Friday for your dose of our little medical corner of health care news. Brought to you by pMD, innovators in charge capture software.
As I've worked with several health systems on how they have been handling PQRS reporting and how they intend to report MIPS quality data to CMS, I've seen some things that I can't unsee: the thick binder overflowing with handwritten pages describing various quality measures; the room full of data entry personnel busily reading patient charts; the EHR screens packed with data fields for a physician group that turned on every single outpatient quality measure.

"We'll capture them all up front, then we'll figure out which ones to submit to CMS later," they said. But it turned out that they were having a hard time convincing physicians to go into that EHR screen at all because it was so heinous. Hence the room full of data entry folks.

MIPS is complicated to begin with; and for complicated health systems, it can get REALLY complicated. They have physicians reporting under multiple Tax ID Numbers (TINs), and often many completely different specialties that ended up sharing a single TIN. Assuming they're reporting as a group (GPRO), that means they often pick "lowest common denominator" measures centered around primary care. This burdens their already-overworked Primary Care Providers with additional data entry, and it effectively excludes many hospitalists, surgeons, and other specialists from quality reporting - certainly from any quality metrics that matter to them.

But with ever-increasing risk from mandatory bundled payments, Accountable Care Organizations and other advanced payment models, and the upcoming cost component of MIPS, I'm hearing from more and more of these enterprises that they can no longer afford to make quality something that only the Primary Care Providers and care coordinators worry about. It's something that involves the specialists too - for example, if a hospitalist fails to talk with a patient about their advance care planning, that patient could end up receiving a very costly and unpleasant intervention that perhaps they didn't want. Getting buy-in from the specialists, and giving them a way to measure their success on these metrics, is vital.

Thinking back to the room full of data entry specialists reading charts, I'm struck by the gap between the ostensible intention of these quality programs (improve the quality of care by rewarding physicians who follow evidence-based care) versus their result (the physicians are not engaged, and the hospital suffers additional costs to hire a room full of people to read their charts and enter data into a registry). There is a better way to engage specialists in quality programs and to actually improve outcomes in the process, but it has to meet them where they are - which is not necessarily sitting in front of a computer - and it has to offer them targeted measures that are relevant to their specialty, not just smoking cessation.

At pMD, we say: bring it on! We love working with specialists of all kinds, and we've developed some innovative tools that help with measure selection and targeted mobile data capture during hospital rounds and immediately after surgeries. There is no one-size-fits-all solution for MIPS, but the future is bright for organizations that embrace their own complexity and find a nuanced solution that will work for them and their physicians.

Image: Getty Images

Here's The Latest in Health Care:

• In a recent analysis released this week by the nonprofit Fair Health, studies have shown a sharp rise in obesity-linked diagnosis among kids and teens. These findings come amidst a rise in obesity-related insurance claims for youth under the age of 22. Whatever the underlying cause of the increase, one thing remains certain: the longer children remain obese, the more likely they are to get diabetes. The challenge is providing the resources that will be necessary to address this emerging situation. Read More

•  The ongoing Affordable Care Act (ACA) debate continues as Republicans push forward with a repeal. Lawmakers have cautioned about moving too quickly and some even Republicans have asked to delay repeal of the ACA until a replacement plan is in place. However, after seven hours of voting this Thursday and objections from Democrats, a budget that could possibly dismantle the ACA received the needed simple majority, 51-48, to pass the Senate. Read More

•  Recent observational studies have found that "weekend warriors", or individuals who pack in their workouts into one or two sessions over the weekend, are equally less likely to die prematurely as individuals who meet the recommended guidelines of five moderate 30-minute sessions each week. But don't get too comfy on the weekdays. There are still a lot more health benefits to spreading out your exercise throughout the week! Read More

• A new study recently published by Health Affairs has found that hospitals affiliated with accountable care organizations (ACOs) were able to reduce readmission rates of nursing home patients in contrast to other hospitals. What exactly are ACOs doing differently to improve readmission rates? Researchers are calling for additional studies to examine the discharge behaviors and care coordination of ACO-affiliated hospitals to determine their impact on these statistics. Read More

Each Friday, Signor Goat reports the latest from the week in health care. Check back next Friday for your dose of our little medical corner of health care news. Brought to you by pMD, innovators in charge capture software.