Wednesday, February 28, 2018

The Hidden Auto Transcript Button in YOUTUBE

I accidentally discovered the Hidden Transcript Button in Youtube. 

If you see the "closed caption" cc symbol (very common) tap the "three button" logo, section "open transcript."  You can copy/paste transcript.  Cool.

For a serious use, lots of CMS and FDA and Hill hearings are archived on Youtube.  I knew about the "closed caption" button [cc] but it's more useful to skim the whole video by seeing the whole text at once. 

Tuesday, February 27, 2018

WSJ: What Medicare Can Learn from Netflix.

Article:  Medicare could learn from Netflix
   Ezekiel Emanual & Robert Koch

Letter: Medicare doesn't have competition

HIMMS pre announced May 17-18 2018 Precision Medicine Summit in DC

May 17 8:00am - 18, 2018 4:30pm EDT
Washington, DC

Precision Medicine Is on Fire

In fact, it’s gotten so big that analysts expect the market to skyrocket past $87 billion worldwide by 2023. As more healthcare organizations nationwide put precision medicine into practice, the opportunities it brings for disease treatment and prevention are enormous. But the challenges are also very real.
The HIMSS Precision Medicine Summit provides attendees with the insights and tools they need to address those challenges head on – and take the next steps. Join us for 2 full days of case studies, best practices, panel discussions, and unrivaled networking opportunities.
What you'll get:
  1. Dip deeper than ever into precision medicine barriers with 2 full days of expert keynotes, panels and breakout sessions
  2. Learn emerging technologies, the latest trends, and success strategies around personal genomics, diagnostics, immunotherapy, analytics, infrastructure and more
  3. Network with peers, thought leaders, and precision medicine experts, and get the insights you need to move forward
Stay tuned, registration will be open soon!

HIMSS Precision Medicine Summit: Call for Speaking Proposals closes this Friday
There’s still time but the clock is ticking to submit a speaking proposal for the HIMSS Precision Medicine Summit in Washington DC, May 17 and 18. The deadline to submit a proposal is 5 p.m. ET on Friday, February 9. Click here to submit a speaking proposal and for more information.
Over two days, speakers will share their work, discuss industry trends, and, importantly, address what healthcare must do to make precision medicine – and personalized care – an everyday part of primary care.
The event will be attended by 150 healthcare clinical and IT leaders from hospitals, health systems, and other provider, payer, pharmaceutical, government organizations.
If your organization has a precision medicine success story to share, or you have expert insights into what’s required to move precision medicine to the point of care, you’re the perfect speaker for this event.
Topics of interest include: Technology and infrastructure, especially machine learning; big data and precision medicine; genomics; clinical integration; knowledge and expertise; reimbursement; the regulatory landscape; investment; and more.

Friday, February 23, 2018

Pulling threads together: GAO Report on Medicaid Demos Triggers Thoughts about CMMI and CMS CED

CMMI is allowed and required to do demos that aim to reduce cost and improve quality.  However, of numerous demos conducted, very few have been able to meet this dual metric.  In part, it's hard to have the data, outcomes, comparisons, and statistics.  Comparisons to historical control groups based on administrative records can be dicey for obvious reasons.  (For disease management, see Al Lewis's book (and blogs) "Why Nobody Believes the Numbers.")   CMMI has published huge collections of project summaries without having much hard data on results.   In a video interview, I once heard former CMMI director Patrick Conway say that CMMI staff were stumped by the hurdles of designing and reporting that would meet the CMS Actuary's accounting standards for cost estimates.  My point.  Maybe a missing link was enough in-service learning sessions between CMMI design staff and CMS Actuary staff to write the rulebook for outcomes and evaluations before starting the $1B a year investments.

A Health Affairs article on innovation acceleration focused on CMMI largely sidestepped the problems in February 2018.  See Perla et al., but wear your happy-hat.  Here.

Similarly, many of the evidence demo projects by the CMS coverage group under "Coverage with Evidence Development" have a mixed history at best.  Here.  And there is NO comprehensive evaluation and lessons learned written about all of them together.

The New GAO Report on Medicaid Demos

In February 2018 GAO released a report that demo follow up was also badly done in Medicaid.  Report here, Dive Healthcare here, MedCityNews here.
  • Author Phil Galewitz at MedCity noted that even a big Indiana Medicaid demo's reports were tardy - and the demo was designed by Seema Verma who now heads CMS.
It seems like whether CMS does innovation demos via CMMI, or Coverage "CED" or Medicaid, it's really really hard to pull off the follow-through and execution, probably in some cases, because the up front planning didn't at CMMI or Medicaid have the potential for a successful story arc.  Designing good trials is hard, whether you're a senior expert at NIH or a senior expert at Harvard, and whether you're on staff at CMMI or a Medicaid plan.

Wednesday, February 21, 2018

I don't think this is Dr Ronald Hirsch....

I don't think this is Dr Ronald Hirsch....

Simpler Medical Student Physician Documentation Rules (2018/02)

In early February 2018 there were several articles that the Trump Administration had simplified physician documentation rules in cases where medical students write notes.  Here, here.

The CMS documentation of the reduced documentation is here and here.

click to enlarge

February 21, 2018 West Health Cost Innovation Summit in DC

Missed this til after the fact - West Health foundation held a Cost Innovation Summit in DC on 2/21/2018.

Website is here.

In case website goes down, some key webpages in a zip file here.

Around 2010 I worked at Foley Hoag simultaneously with Rodger Currie, who soon became head of the Washington policy center for West Health.  In 2014 he moved to the American Psychiatric Association.  In 2016 he moved to PHRMA.

Medicare Trivia Corner: Owner Compensation Profiling

A recent article in LA Times reported that a California Medicaid plan allegedly overpaid its leadership.   Here.  Remark that MediCal (California Medicaid) didn't have clear guidelines.

Medicare has some very intricate guidelines on payments for owners of business that CMS pays by cost based methods.  These include physician owners.  I stumbled on a July 21, 2017 11 page update document on this process.  It's in the "Provider Reimbursement Manual, Part 1, Chapter 9, Compensation of Owners," and categorized as Transmittal 474.   Here.

It's pretty lengthy but one feature is a table for "physician owner compensation," clipped below.  See the link for the full text and context.

click to enlarge

Tuesday, February 20, 2018

HealthWorx Staff Post

Program Innovation & Development Program Director at CareFirst BlueCross BlueShield

Please apply before: 1/13/2017


CareFirst is a leader in the health care industry serving approximately 3.2 million members. The Medical Affairs Division is responsible for all aspects of provider contracting, network management, pharmacy policy, quality of care and care management as well as the Primary Care Medical Home (PCMH) Field Operations and the Total Care and Cost Improvement (TCCI) program.

Reporting to the Chief Medical Officer, this individual will lead a team that will apply an analytic approach to identify new clinical opportunities and develop programs to pursue these opportunities. Examples of new opportunities may include new payment models for specialists, new TCCI programs and clinical/service partnerships, and partnerships with early stage companies to bring new technologies or services that can improve the health of CareFirst members to market.

Reporting to the Chief Medical Officer, the duties of this position include:

Identify new clinical opportunities; Lead the development of new programs

Independently drives the development of new clinical programs. This includes:

* Leading a data-driven approach to identify new clinical opportunities;
* Understanding the national landscape for clinical innovation and conducting market research to identify and evaluate potential vendors/partners; 
* Supporting the Medical Affairs leadership team in discussions/negotiations with new potential clinical partners; 
* Working closely and collaboratively with front-line operational partners in the Medical Affairs Division to stand-up new programs.
* Working with TCCI program managers to shape the ongoing development and evolution of programs after their inception 

Leads proactive problem solving including: problem identification, definition, analysis and recommendation as an individual producer and as a catalyst in small group settings.

Deliverables include: verbal reports and detailed point papers designed to monitor and encourage delivery against milestones contained in Divisional Plan.

Responsible for coordinating operations and leading special projects across all aspects of the medical affairs division and will operates as a shared resource for the Medical Affairs Division.

Provide expertise in the design principles of health care payment models, innovation in health care services and technology and will track developments in this field to ensure that CareFirst leads the industry in developing best practices.

Manage the development of new clinical partnerships

Works closely with the VP for Quality, Performance Measurement and Improvement, SVP/Chief Medical Officer and EVP for Medical Affairs to identify and develop key strategic clinical partners, including vendors, health care services and technology companies and specialist providers. Initial areas of focus will include new specialist payment and service delivery pilots, home based monitoring, and new technology and services that enable both CareFirst and its network providers to better manage members with multiple chronic diseases. This includes but is not limited to:

* Serving as a point of first contact and management for the creation of new, innovative partnerships;
* Convening and working with key stakeholders within CareFirst to analyze and vet potential new partners;
* Working with Medical Affairs senior leadership to develop programmatic material, terms and, eventually, service level agreements for new partnerships.

Form partnerships with early stage companies to bring new technologies or services that can improve the health of CareFirst members to market; Develop and manage HealthWorx portfolio of companies.

Helps to create and launch HealthWorx, a CareFirst incubator that will work with early stage companies to bring new technologies and services to market. This includes: 
* Maintaining a robust pipeline of potential portfolio companies through relationships with venture capital firms, industry and other seed-stage incubators; 
* Vetting and conducting research on potential partner companies; 
* Working with the Chief Medical Officer to select and prepare companies for presentation to CareFirst senior leadership; 
* Working with Medical Affairs leadership and colleagues in legal and finance to negotiate, draft and execute agreements with selected companies; 
* Managing the tracking the overall HealthWorx portfolio of companies; 
* Providing operational support to HealthWorx portfolio companies


Required Education/Experience:
* An advanced degree in a health care related field (PhD, JD, MBA or MPH, with a concentration in health care or health economics) or equivalent work experience. Understanding of managed care concepts and operations. A minimum of 3-5 years experience with progressively increasing responsibility in health care environment, health insurance payer environment, or related industry.

Required Skills and Abilities:
* Proven project/program management skills, working collaboratively and effectively to drive complex deliverables in a matrixed environment.
* Proven experience with developing innovative health care delivery and payment models
* Demonstrated ability to effectively analyze and present data
* Excellent presentation skills
* Must be able to work independently with minimum oversight and demonstrate attention to detail, accuracy and quality awareness
* Proven analytical and problem solving skills
* Proven effective written and interpersonal communication skills, well organized, ability to multi-task and work independently, promote flexibility and teamwork
* Strong PC skills, Microsoft Word, Microsoft Outlook, Excel, database applications and fluency in statistical analysis (SAS, Stata, R or other statistical software)
* Strong understanding of the health care industry, with a specific focus on early stage health care companies and innovation in health care technology and services.
* Demonstrated leadership skills including the ability to: 1) train and motivate the performance of team members in a matrixed environment; 2) positively impact the performance of close colleagues as a trusted consultant.

Must be able to effectively work in a fast paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time. Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

* Experience with vendor selection and management including RFPs, contract negotiation, service level agreements, etc.


Department: SVP & Chief Medical Officer

Sunday, February 11, 2018

Procalcitonin in Antibiotic Stewardship Programs: 8 Links

Stover KR, Kenney RM, King ST, Gross AE.
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Broyles MR.
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Fung AWS, Beriault D, Diamandis EP, Burnham CD, Dorman T, Downing M, Hayden J, Langford BJ.
Clin Chem. 2017 Sep;63(9):1436-1441. doi: 10.1373/clinchem.2017.272294. Epub 2017 Jun 20. No abstract available.
Ammar AA, Lam SW, Duggal A, Neuner EA, Bass SN, Guzman JA, Wang XF, Han X, Bauer SR.
Pharmacotherapy. 2017 Feb;37(2):177-186. doi: 10.1002/phar.1887. Epub 2017 Feb 3.
Salahuddin N, Amer L, Joseph M, El Hazmi A, Hawa H, Maghrabi K.
Crit Care Res Pract. 2016;2016:6794861. doi: 10.1155/2016/6794861. Epub 2016 Jul 14.
Cai Y, Ee J, Liew YX, Lee W, Chlebicki MP, Goh YC, Kwa AL.
J Infect. 2014 Oct;69(4):412-5. doi: 10.1016/j.jinf.2014.06.008. Epub 2014 Jun 23. No abstract available.
Liew YX, Chlebicki MP, Lee W, Hsu LY, Kwa AL.
Eur J Clin Microbiol Infect Dis. 2011 Jul;30(7):853-5. doi: 10.1007/s10096-011-1165-6. Epub 2011 Jan 29.
Harbarth S, Albrich WC, Müller B.
Crit Care. 2009;13(4):165. doi: 10.1186/cc7935. Epub 2009 Jul 13.