Tuesday, June 4, 2013

Bill Gates leads $35 million investment in research network

Bill Gates speaks during Peterson Institute 2013 Fiscal Summit on Facing the Future in Washington, May 7, 2013. REUTERS/Yuri Gripas
Bill Gates speaks during Peterson Institute 2013 Fiscal Summit on Facing the Future in Washington, May 7, 2013.
Credit: Reuters/Yuri Gripas
SAN FRANCISCO | Tue Jun 4, 2013 12:03pm EDT
(Reuters) - Microsoft co-founder Bill Gates is leading a $35 million investment in ResearchGate, a Berlin-based network for scientists that ties into his interest in fighting disease.
ResearchGate allows researchers around the world to collaborate more easily. They might put out a call to colleagues to find, say, free samples of diseased tissue to analyze, or a partner to work with on a project.
A recent ResearchGate-launched collaboration between researchers in Europe and Nigeria resulted in the discovery of a deadly pathogen that had jumped from plants to humans, said ResearchGate Chief Executive Ijad Madisch in a phone interview.
The Bill and Melinda Gates Foundation works to eradicate the world's most deadly diseases and poverty. Founded by Gates and his wife in 2000, its endowment totals $36.4 billion.
A spokesman for the Gates family said the investment in ResearchGate was a private investment that did not come from the foundation. He declined to comment further.
The collaboration between Gates and ResearchGate developed after one of Madisch's existing backers, Matt Cohler of Benchmark Capital, introduced Madisch to one of Gates' advisers, Madisch said. Earlier this year, Madisch flew to France to talk with Gates about his start-up.
"He understands things extremely fast," Madisch said, adding that meeting Gates was a longtime goal because of the Microsoft founder's philanthropy. "It was the coolest meeting I had in the last year."
Gates is leading the investment with Tenaya Capital, a late-stage investment firm based in Woodside, Calif. Existing investors, Benchmark and Founders Fund, participated.
Madisch, a Harvard-trained Ph.D, co-founded ResearchGate in 2008. It now has 2.8 million members. Its most popular fields are biology, medicine and computer science, and its top four countries by membership are the U.S., India, the U.K., and Germany, a spokesman said.
Many German start-ups have become known for successfully replicating business models developed elsewhere, chiefly in the U.S., rather than coming up with their own ideas. Madisch hopes ResearchGate will help change that reputation.
When asked if he would ever consider taking an investment from the Samwer brothers, the German investors known for funding companies that excel at German replications of U.S. start-ups, Madisch said he would not.
"Definitely not," he said.

(Reporting By Sarah McBride; Editing by Bernard Or)

US News and Doximity launch physician directory

US News & World Report, which has made a business out of rankings, is getting into the physician directory business through a partnership with Doximity, an online physician network. Physicians will be able to update their profiles online and make them available to the general public. No doubt US News will try to build on the service with advertising and other add-ons over time. (I interviewed Doximity CEO Jeff Tangney last year.)
The press release for the new initiative is here.
I asked Ben Harder, General Manager, Health Rankings at US News to answer my questions about the new offering.
What information will be included in the doctor finder?
For each doctor, the U.S. News doctor finder will display essentially all of the data Doximity has aggregated, including for example which hospitals they admit to, which medical school they attended, etc. In addition, we’ll display U.S. News’s proprietary data where relevant, such as the ranking of the doctor’s hospital(s) if any of them is among the U.S. News Best Hospitals.
Will all doctors in the US be represented?
Yes. The goal is all doctors who are currently licensed to practice. A doctor does not have to do anything or buy any service to be included.
What’s new compared with what’s available from other sources?
We’ve all heard doctors complain that existing consumer-oriented directories tend to contain a lot of outdated and inaccurate information. That’s understandable because it’s nearly impossible to keep track of 700,000-plus professionals of any kind, unless they’re helping you do it. What sets Doximity apart is that it gives doctors the ability, for free, to claim their profile and make sure the info is correct and current. Just by doing that, any doctor will now be able to make sure that both Doximity and U.S. News have his or her profile complete and accurate.
Will there be information on the groups that the doctors practice in, or just the individual doctors?
Not at this time. Of course, consumers will be able to see when a doctor shares an address and suite number with another doctor, which is probably a sign they’re in practice together.
What opportunities will there be for interaction on the site? Our expanded, Doximity-powered doctor finder will have a search-driven interface, very similar to our existing search atwww.usnews.com/top-doctors/search, which is currently limited to doctors that another publisher has independently recognized as Top Doctors.
Why work with Doximity on this?
There are a lot of companies that want doctors to create and maintain  profiles on their particular web platforms. But doctors have too little time to maintain a profile here, a profile there, and a profile in half a dozen other places. We think, long-term, Doximity will be the one such platform, or one of very few, where doctors take the time and trouble to keep their CVs complete, current and accurate. That’s because Doximity provides them with a useful, free service they don’t get anywhere else. Plus, Doximity has an innovative attitude in thinking about big data, and that will be very important to U.S. News as more and more doctor-specific metrics on clinical quality become available. Our long-term goal is to use data to evaluate doctors in their areas of expertise and to help each individual patient decide which provider may be best suited to treat them.
Anything you’d like to add?
That should cover it. U.S. News just celebrated its 80th birthday, and we think of ourselves as a startup in octogenarian clothing. So it just makes sense for us to be teaming up with a young, innovative (and actually young) startup like Doximity. Thanks a lot for your interest. 
By David E. Williams of the Health Business Group.

Addressing the Empty Seat at the Healthcare IT Table: Next Steps in Patient Engagement

Written by Fauzia Khan, MD, FCAP, CMO and Co-founder, Alere Analytics | June 04, 2013

The healthcare industry has made great strides in patient-centric, IT solutions such as electronic health records, personal health records, health information exchanges  and clinical decision support platforms. These platforms are finally enabling physicians, providers and payors to improve their care coordination, while increasing the quality of care for patients. While this is definitely an exciting time for healthcare IT, a very important group is conspicuously left out of the conversation — actual patients.

As we move toward value-based healthcare, there is a tremendous opportunity to engage patients in their own health. Meaningful use stage 2 and 3 has made patient engagement an industry buzzword and a checkbox to cross off, but active patient engagement could be a real game-changer. With real-time solutions such as CDS and mobile patient devices, as well as patients being engaged earlier in their own treatments, physicians would be able to provide personalized and immediate care recommendations, triggering earlier interventions, reducing avoidable errors, improving overall health outcomes and even lowering costs.

Despite all the potential benefits, we are still in the very early stages of empowering patients. The healthcare industry has made great strides in processing, accessing and reporting on patient data. But hospitals are struggling to overcome hurdles as they inch towards volume-to-value shift that requires  adopting data-based, outcomes-driven approach. Additionally, the challenge of interoperability is ever-present in today’s healthcare delivery system, often hindering the comprehensive capture and management of patient data and adding a difficult semantic layer to conveying disparate information in a simple and relevant manner.

So what's next for healthcare and increasing the role of the patient? The following are key areas to address to create a healthcare system that truly engages patients in their care process.

The role of connectivity

Although the healthcare industry has made significant strides in making sure that patient data can be captured, accessed and reported on in a timely manner, we still have a ways to go. Technology innovations have created a wealth of patient-centric solutions, but many of these innovations are struggling with how best to capture patient data and build a longitudinal care record needed to make the most informed, evidence-based decisions in real-time, and at the point of care and beyond. Once we have figured out the connectivity piece as an industry, clinicians will be able to focus on the best treatment plans using intelligent and actionable information to improve care quality while reducing costs for each patient. 

Utilizing  standards

In an effort to make data more actionable, CDS breaks down data into open formats and industry standards. These standards can specify the structure and semantics of "clinical documents," whether delivered through the EHR, PHR, HIE, or even device data, for the purpose of improved exchange between providers and their patients.

By using industry standards, data can not only be extracted easily from any format, but since the data is bi-directional, the information can also be pushed to any source, including the patient. For example through a rules-based system, the data can be redirected to any point, enabling doctors to engage with their patients and patient populations, both from a preventative and referential manner. This ability can assist clinicians manage their high-risk patient populations with chronic conditions such as diabetes, heart disease, COPD and many others.

Inviting patients to drive development

Despite all the attention paid to improving efficiencies around care, patients are continuously left out of the conversation when it comes to their own health. With ubiquitous use of mobile devices and more people opting for home healthcare, many patients want to take a more active role in managing their own health, so why not invite them into the conversation? As technology companies work to develop cutting-edge, patient-centric solutions, it will become increasingly more important to actually involve the patient in the process of developing their individualized treatment plan.

Increasing role of the "connected home"

Connecting hospital systems has been an IT priority, and during the last decade, a good amount of resources were focused on inpatient, outpatient, and ambulatory data integration and interoperability. Although we have just barely embraced this model in the clinical world, we can look beyond the hospital setting to see that these technology platforms could also be effectively used in the home as more telehealth options emerge each day for patients. Moving treatment closer to the individual closes crucial gaps, provides greater visibility, and accelerates decisions that lead to better outcomes. And with the surge of mobile technologies, internet and smart devices, the boundaries between the home, hospital, ambulatory and long-term care facilities will start to erode away and ultimately disappear.  

In addition to data interoperability, there needs to be an emphasis on information availability. Whether that data is delivered through an HIE, EHR or a smart device, patient data needs to be accurately captured and widely available. In the same way that CDS technologies facilitate decisions in the hospital setting, data in the home should also be actionable, comprehensive and increasingly accessible to patients, physicians and payors alike. This approach will allow for the best healthcare decisions to be made by both patients and providers, ultimately leading to better health outcomes. 

With new regulations pushing the healthcare industry forward to ensure better patient management and care, it’s clear that CDS will be influential to changing the way care is currently delivered in the hospital and beyond. The vision is clear: identify efficiencies, while maintaining high clinical quality to ensure delivery of the right care, at the right place and time. However, the execution seems to be elusive, and most hospitals do not know where to even start. 

As healthcare innovation continues, we must remember that the key is to deliver high-quality, collaborative patient care. This requires collecting, analyzing and sharing information, working across silos and engaging patients in an unprecedented and innovative manner. Likewise, it is our responsibility as technology providers to develop solutions that work together to enable transparency, collaboration and information-sharing. Like many shifts in healthcare, changes won’t occur overnight. It will take time. However, by making efforts today to move treatment closer to the individual, and involving patients in the development of technologies enabling this shift, we as an industry can accelerate decisions that can lead to better outcomes.

Fauzia Khan, MD, currently serves as chief medical officer of Alere Analytics, formerly DiagnosisOne, where she provides direction and leadership to develop practical and scalable technologies that allow clinical decision support and analytic capabilities to be seamlessly incorporated into clinical workflows. She has expertise and passion for algorithm design, knowledge acquisition and engineering as well as data mining and leveraging these capabilities to improve outcomes. Prior to forming DiagnosisOne, Dr. Khan was the director of informatics at UMass Memorial Medical Center with ten years of experience in the hospital practicing pathology. She is the author, editor and primary visionary of the “Guide to Diagnostic Medicine” (Lippincott Williams & Wilkins, 2002).

Intermountain CTO: Patient experience ripe for transformation

By: Jonah Comstock | Jun 4, 2013

Intermountain Healthcare, a Utah-based hospital system with 22 hospitals and 185 clinics, has worked extensively with digital health companies — most recentlyupgrading their pilot with wristworn vital signs monitor company Sotera Wirelessinto a full partnership last month, and teaming up with MModal in February to develop a speech-enabled computerized physician order entry system.
This week, MobiHealthNews caught up with Fred Holston, Intermountain’s chief technology officer since 2008, to discuss the Sotera deal and its other digital health initiatives. Holston also oversees Intermountain’s Healthcare Transformation Lab.
Intermountain discovered Sotera when it was in its early stages and started working with them right away.
“What we went searching for were a couple of things,” he said. “There’s a section of data we were missing, the more continuous vital monitoring in healthcare. What happens when you’re not in an ICU, you’re not in the ER, you’re just in the general part of the hospital? … And then things happen and you don’t have enough information maybe to understand why. We also have nurses running around with all these devices, and every few hours they check all these vitals and write them on the piece of paper in their hand, and then go back and sit down at the nursing station and spend an hour filling out nursing documentation with that information. And we believe there are better ways to do that.”
But Sotera also has another benefit, beyond the clinical advantages. Holston believes one of the biggest areas where hospitals can fall down is not focusing holistically on patient experience.
“Being in a good mental state is also a feeder into good healing,” he said. “And when people sit and think about how much they hurt all the time and then you ask them their pain scale — ‘It’s a 10! All I do is think about how much I hurt all the time.’ Versus having their mind engaged and not thinking about that. And Sotera’s part of that, part of the role of Sotera is to get all the wires on their body so they’re free to move about or go to the bathroom or walk the halls or go sit in a chair, and not be so tied down. Because that is also a healing piece.”
As another part of keeping patients engaged, Holston sees a lot of potential in consumer-facing apps and data-collecting devices. (Intermountain inked a deal with Kony last year to build some patient-facing apps.) But Holston listed a number of problems that need to be overcome before apps and consumer devices can be effective parts of the healthcare system.
“You’ve got all these cool applications and people are throwing data in a lot of cool places, but who sees it, what does it mean?” he asked. “I think that’s something we have to figure out. As people who deliver healthcare, who understand healthcare, who have the protocols for healthcare, understand what the data is or have the means to understand what the data is. How do we bridge that gap between all these apps that are out there that are part of healthy living that are going to non-health providers, consume it, trust it, evaluate it, understand how to distill that so your physician or any physician can understand that?”
The responsibility for solving these problems is spread between several interest groups, Holston said.
“The people who are collecting that data need to find strategic relationships with real healthcare providers who can make sense of that data, but I think it’s also incumbent on the health systems to see how do we trust and consume it,” he said. “Today I would dare say that the funding models, the reuimbursement models don’t really lend themselves to that either. As health systems we’re going to have to figure out what to do with that and how do we do our part.”
Although Intermountain is an innovative establishment, Holston warns against innovation for innovation’s sake. For instance, although Intermountain is working with MModal on speech CPOE, that’s a carefully chosen and targeted mobile use case. In other cases, he’s not convinced mobile is a benefit.
“Everybody loves the new bright shiny device and they’re getting smaller and lighter and everyone’s going ‘Why wouldn’t I carry it?’” he said. “Well, be a nurse. Carry tapes, an IV bag, scissors, the water someone wanted, half a dozen other things, and then try and carry a tablet or a small phone around and try punching around on it. It doesn’t necessarily make sense in all situations.”
What healthcare really needs, he said, is not just innovation, but transformation.
“If you look at Merriam Webster, one of the definitions of innovation is a novelty. Transformation is defined as real change. I agree that innovations will be needed, but we need to look at the transformations of healthcare. And for me as a technology geek, sometimes, absolutely new technologies will be those innovations that are part of tranformation. But that isn’t always the case. And we can’t start by saying how do we make this device fit? It’s ‘What is it we need to accomplish?’  What change could we drive most? I hope what my lab is doing is trying to listen to the people who provided the care, whether that’s a doctor, a nurse, or our clinical program, and say ‘What transforms healthcare? What could really make change?’”

CMS is Accepting Nominations to the Advisory Panel on Outreach and Education

This Notice document was issued by the Centers for Medicare Medicaid Services (CMS)
This notice announces that the charter of the Advisory Panel on Outreach and Education (APOE) has been renewed. It also requests nominations for individuals to serve on the APOE.

Nominations will be considered if we receive them at the appropriate address, provided in theADDRESSESsection of this notice, no later than 5 p.m., Eastern Daylight Time (e.d.t.) on July 1, 2013.

Mail or deliver nominations to the following address: Kirsten Knutson, Acting Designated Federal Official, Office of Communications, CMS, 7500 Security Boulevard, Mail Stop S1-13-05, Baltimore, MD 21244-1850 or email to Kirsten.Knutson@cms.hhs.gov.

For Further Information Contact
Kirsten Knutson, Acting Designated Federal Official, Office of Communications, CMS, 7500 Security Boulevard, Mail Stop S1-13-05, Baltimore, MD 21244, 410-786-5886, email kirsten.knutson@cms.hhs.gov or visit the Web site at http://www.cms.gov/Regulations-and-Guidance/Guidance/FACA/APOE.html. Press inquiries are handled through the CMS Press Office at (202) 690-6145.

Supplementary Information
I. Background
The Advisory Panel on Medicare Education (the predecessor to the APOE) was created in 1999 to advise and make recommendations to theSecretary of Health and Human Services (the Secretary), and the Administrator of the Centers for Medicare & Medicaid Services (CMS) on the effective implementation of national Medicare education programs, including with respect to the Medicare+Choice (M+C) program added by the Balanced Budget Act of 1997 (Pub. L. 105-33).
The Medicare Modernization Act of 2003 (MMA) (Pub. L. 108-173) expanded the existing health plan options and benefits available under the M+C program and renamed it the Medicare Advantage (MA) program. We have had substantial responsibilities to provide information to Medicare beneficiaries about the range of health plan options available and better tools to evaluate these options. Successful MA program implementation required us to consider the views and policy input from a variety of private sector constituents and to develop a broad range of public-private partnerships.
In addition, the Secretary, and by delegation, the Administrator of CMS was authorized under Title I of MMA to establish the Medicare prescription drug benefit. The drug benefit allows beneficiaries to obtain qualified prescription drug coverage. In order to effectively administer the MA program and the Medicare prescription drug benefit, we have substantial responsibilities to provide information to Medicare beneficiaries about the range of health plan options and benefits available, and to develop better tools to evaluate these plans and benefits.
The Affordable Care Act (Patient Protection and Affordable Care Act, Pub. L. 111-148 and Health Care and Education Reconciliation Act of 2010, Pub. L. 111-152) enacted a number of changes to Medicare as well as to Medicaid and the Children's Health Insurance Program (CHIP), and also expanded the availability of other options for health care coverage. In order to effectively implement and administer these changes, we must provide information to Medicare, Medicaid, and CHIP consumers, providers and other stakeholders pursuant to education and outreach programs regarding how these programs will change and the expanded range of health coverage options available. The Advisory Panel on Outreach and Education allows us to consider a broad range of views and information from interested audiences in connection with this effort and to identify opportunities to enhance the effectiveness of education strategies concerning the Affordable Care Act.
II. Provisions of This Notice
A. Renewal of the APOE
Pursuant to the charter approved on January 21, 2013, the APOE was renewed. The APOE will advise the Department of Health and Human Services (DHHS) and CMS on developing and implementing education programs that support individuals with or who are eligible for Medicare, Medicaid, and the Children's Health Insurance Program (CHIP) about options for selecting health care coverage under these and other programs envisioned under health care reform to ensure improved access to quality care, including prevention services. The scope of this Federal Advisory Committee Act (FACA) group also includes advising on education of providers and stakeholders with respect to health care reform and certain provisions of the Health Information Technology for Economic and Clinical Health (HITECH) Act enacted as part of the American Recovery and Reinvestment Act of 2009 (ARRA).
The charter will terminate on January 21, 2015, unless renewed by appropriate action. The APOE was chartered under 42 U.S.C. 222 of the Public Health Service Act, as amended. The APOE is governed by provisions of Public Law 92-463, as amended (5 U.S.C. Appendix 2), which sets forth standards for the formation and use of advisory committees.
Pursuant to the renewed charter, the APOE will advise the Secretary of Health and Human Services and the CMS Administrator concerning optimal strategies for the following:
Developing and implementing education and outreach programs for individuals enrolled in or eligible for Medicare, Medicaid, and CHIP.
Enhancing the Federal government's effectiveness in informing the Medicare, Medicaid, and CHIP consumers, providers and stakeholders pursuant to education and outreach programs of issues regarding these and other health coverage programs, including the appropriate use of public-private partnerships to leverage the resources of the private sector in educating beneficiaries, providers and stakeholders.
Expanding outreach to vulnerable and underserved communities, including racial and ethnic minorities, in the context of Medicare, Medicaid, and CHIP education programs.
Assembling and sharing an information base of “best practices” for helping consumers evaluate health plan options.
Building and leveraging existing community infrastructures for information, counseling and assistance.
Drawing the program link between outreach and education, promoting consumer understanding of health care coverage choices, and facilitating consumer selection/enrollment; which in turn support the overarching goal of improved access to quality care, including prevention services, envisioned under health care reform.
B. Requests for Nominations
The APOE shall consist of no more than 20 members. The Chair shall either be appointed from among the 20 members, or a Federal official will be designated to serve as the Chair. The charter requires that meetings shall be held approximately four times per year. Members will be expected to attend all meetings. The members and the Chair shall be selected from authorities knowledgeable in one or more of the following fields:
Senior citizen advocacy
Outreach to minority communities
Health communications
Disease-related advocacy
Disability policy and access
Health economics research
Health insurers and plans
Health information technology (IT)
Direct patient care
Matters of labor and retirement
Representatives of the general public may also serve on the APOE.
This notice also announces that in July 2013, there will be 3 expired terms of membership and in October 2013, there will be an additional 3 expired terms of membership. This notice is an invitation to interested organizations or individuals to submit their nominations for membership for all six vacancies on the APOE (no self-nominations will be accepted). The CMS Administrator will appoint new members to the APOE from among those candidates determined to have the expertise required to meet specific agency needs, and in a manner to ensure an appropriate balance of membership. We have an interest in ensuring that the interests of both women and men, members of all racial and ethnic groups, and disabled individuals are adequately represented on the APOE. Therefore, we encourage nominations of qualified candidates who can represent these interests. Any interested organization or person may nominate one or more qualified persons.
Current members whose terms expire in 2013 may be considered for reappointment, subject to committee service guidelines.
Each nomination must include a letter stating that the nominee has expresseda willingness to serve as a Panel member and must be accompanied by a curricula vitae and a brief biographical summary of the nominee's experience.
While we are looking for experts in a number of fields, our most critical needs are for experts in Health IT, Tribal Affairs, Community Health Centers/Medically Underserved Populations, African-American Health/Disparities, Health/Disability/Quality and State Programs/Medicaid/Rural.
We are requesting that all curricula vitae include the following:
Date of birth
Place of birth
Title and current position
Professional affiliation
Home and business address
Telephone and fax numbers
Email address
List of areas of expertise
Phone interviews of nominees may also be requested after review of the nominations.
In order to permit an evaluation of possible sources of conflict of interest, potential candidates will be asked to provide detailed information concerning such matters as financial holdings, consultancies, and research grants or contracts.
Members are invited to serve for 2-year terms, contingent upon the renewal of the APOE by appropriate action prior to its termination. A member may serve after the expiration of that member's term until a successor takes office. Any member appointed to fill a vacancy for an unexpired term shall be appointed for the remainder of that term.
III. Copies of the Charter
The Secretary's Charter for the APOE is available on the CMS Web site at: http://www.cms.gov/Regulations-and Guidance/Guidance/FACA/APOE.html, or you may obtain a copy of the charter by submitting a request to the contact listed in theFOR FURTHER INFORMATION CONTACTsection of this notice.
Sec. 222 of the Public Health Service Act (42 U.S.C. 217a) and sec. 10(a) of Pub. L. 92-463 (5 U.S.C. App. 2, sec. 10(a) and 41 CFR 102-3).
(Catalog of Federal Domestic Assistance Program No. 93.733, Medicare—Hospital Insurance Program; and Program No. 93.774, Medicare—Supplementary Medical Insurance Program)
Dated: May 23, 2013.
Marilyn Tavenner,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 2013-12957 Filed 5-30-13; 8:45 am]

www.crowdit.com - A unique opportunity currently exists for stake holders to improve the way ...

Innovation center offers $1 billion to test Medicare pay models

 Physicians and other health professionals are encouraged to apply for funds to develop innovative payment concepts that reward quality and keep federal costs down.

By CHARLES FIEGL amednews staff — Posted June 3, 2013
The Center for Medicare and Medicaid Innovation is looking to invest $1 billion in new payment models to support initiatives that improve care in federal health programs.
Grants will be awarded to organizations seeking to develop and test new payment models that promise to deliver better health care services at a lower cost, Obama administration officials announced May 15. The innovation center is favoring models that will grapple with health care problems considered the costliest for Medicare, Medicaid and the Children’s Health Insurance Program.
“We believe there are organizations that are out there eager to transform the way health care is delivered and help [the Centers for Medicare & Medicaid Services] develop new payment systems to support these innovations,” said Richard Gilfillan, MD, director of the innovation center, during a call with reporters to discuss the grants.
This will be the second opportunity to apply for innovation awards. The first round supported a broad range of more than 100 care models with between $1 million and $26.5 million each in 2011. For instance, the surgery benefits management company Welvie LLC teamed with insurer Anthem Blue Cross Blue Shield in Ohio after receiving an award grant for a care decisions program assisting Medicare beneficiaries. Nearly half of 3,500 participating patients considered surgery alternatives under the program, and 17% chose less invasive treatment options, according to the innovation center. Each surgery that was avoided saved the system an average of $7,000.

Costliest illnesses targeted

Awards during the second round will be more focused. The innovation center is seeking models that rapidly reduce costs in Medicare and Medicaid outpatient hospitals and other settings; care for specialized populations, such as patients with Alzheimer’s disease or HIV/AIDS; support specialties, such as oncology, cardiology and others treating patients with complex chronic diseases; and treat health populations defined by geographical, clinical or socioeconomic areas or status.
Officials hope the target areas will fill gaps in the current pay system, Dr. Gilfillan said. The innovation center also will judge applicants on their ability to demonstrate that the pay models will improve health care quality and be sustainable over the long term.
The financial awards will help with the transition to new models of care that have the potential to improve quality and reduce costs in Medicare and Medicaid, said American Medical Association President Jeremy A. Lazarus, MD. In the case of Medicare, the Association has stated its case for transitioning from the current pay system to one with an array of payment models that support clinical innovations led by physicians.
“We are pleased that these new grants will provide expanded opportunities for physicians in a wide array of specialties,” Dr. Lazarus said. “As the AMA recently announced a long-term initiative to improve health outcomes for patients with cardiovascular disease and type 2 diabetes, we are encouraged that the grants will support innovation in addressing these chronic conditions.”

Serious work put into making primary care fun again

 Innovative clinics say redesigning the flow of care and freeing doctors from administrative hassles may boost physician satisfaction.

By KEVIN B. O’REILLY amednews staff — Posted June 3, 2013
Amid alarming rates of physician burnout, hundreds of clinics nationwide are redesigning their practices with a goal in mind beyond improving the quality of care. They are aiming to make life as a primary care doctor enjoyable once more.
Twenty-three of these clinics are profiled in a report in the May/June Annals of Family Medicine that describes practice innovations that can ease the chaos, administrative overload, miscommunication and computerized busy work that too often characterize primary care. These clinics find that planning visits ahead of time, delegating more tasks to nurses and medical assistants, holding daily meetings and using standing orders for recurring items not only improves patient satisfaction but also creates happier doctors.
Physician satisfaction is an essential ingredient in transforming the delivery of medical care, said Andrew Schutzbank, MD, co-author of the Annals of Family Medicinestudy. He also is assistant medical director of Iora Health, a Cambridge, Mass., physician group that started in 2012 and operates several primary care clinics.
“All medical care, and especially primary care, is incredibly complex, creative work that requires willing, engaged participants and strong support to be successful,” Dr. Schutzbank said. “We use silly words like 'joy' and 'love' and 'hope' because that's what we need. We don't need more rules or checklists or regulations.”

Greater focus on physician satisfaction

The Annals of Family Medicine study is just one sign of growing interest in how to address low physician morale. The research project is funded by the American Board of Internal Medicine Foundation in Philadelphia, which hosted a conference in March 2012 that focused on how work flow innovations could improve the efficiency and appeal of primary care.
The American Medical Association also is leading an extensive project on how to improve physician satisfaction across many different specialties, not just primary care. The Association has contracted with RAND Health to help, and researchers have completed nearly two-thirds of their site visits to 30 practices in six states to determine the care delivery and payment models linked to higher physician satisfaction.
RAND Health, a nonprofit research organization in Santa Monica, Calif., is on track to deliver the findings to the AMA in the fall. The Association will use the research to help develop practice-focused tools as well as advocate for payment and hospital partnership models that promote physician satisfaction.
“Taking physician satisfaction seriously does not mean giving physicians anything they want, but it should mean creating an environment where physicians are always able to put patients first,” Francis J. Crosson, MD, who has been hired to lead the AMA initiative, co-wrote in a May 9 post to the Health Affairs Blog. Dr. Crosson is the Association's group vice president, professional satisfaction — care delivery and payment.
The AMA project on professional satisfaction is one of three major initiatives announced as part of the Association's strategic direction in June 2012, along with a $10 million competitive grant program for innovative medical education curricula and a multimillion-dollar, multiyear effort to improve diabetes prevention and blood pressure control.

Less busy work for physicians

In the Annals of Family Medicine paper, a common theme at the innovative primary care clinics was a focus on team-based care designed to improve patient care and free doctors from work that others could do. For example, at the Southern Illinois University School of Medicine's so-called Office of the Future in Quincy, Ill., family physicians are spared much of the arduous task of electronic documentation. Instead, a medical assistant accompanies the patient and physician into the exam room as a “scribe” to electronically enter the physician's findings and treatment plans. The doctor later reviews and signs off on the scribe's documentation.
“That way, I can just move on to the next patient. My charts are done before the visit is over, and I don't have to redo a lot of the stuff later on,” said Joseph M. Kim, MD, who works in the two-physician office and is an assistant professor of family and community medicine at SIU. “My time with the patient is 100% face to face. No matter whether it's a five-, 10- or 15-minute visit, they get personable service from a physician.”
At the Southcentral Foundation, a health system based in Anchorage, Alaska, that employs 115 primary care physicians to serve the Alaska native population, each team of a physician, medical assistant, nurse case manager and clerk is aided by a behavioral-health expert to help care for patients with mental illness or substance-use disorders. Also, each member of these “integrated care teams” sits close to one another to facilitate ongoing communication about patient care.
For example, a patient's cholesterol is slightly above goal. Should she be scheduled for a visit to re-examine medications? With the advantage of sitting close together, the case manager or clerk can run the question quickly by the physician and get an answer, instead of giving the patient inappropriate instructions or sending another email that may go unread for hours, said Steve Tierney, MD, medical director of quality improvement at the foundation. Each team is measured on how well it meets quality-improvement goals such as vaccination rates and the proportion of diabetics with their blood glucose controlled, but they are given autonomy on how to get it done.
“We tell you what the mission is, but we're not going to tell you how to do it,” Dr. Tierney said. “As long as you've found a creative way to do it and get it done without breaking the law, I don't care.”
The overall employee-satisfaction rate at the foundation is 94%, he said. A breakout on doctors' satisfaction was not available by this article's deadline.

1 in 3 doctors is burned out

About a third of physicians are suffering burnout at any given time, said an April 15, 2003, study in The American Journal of Medicine. And nearly half of doctors say they have at least one symptom of burnout, according to a nationwide survey of more than 7,000 physicians published Oct. 8, 2012, in JAMA Internal Medicine, formerly Archives of Internal Medicine.
Low physician satisfaction can degrade the doctor-patient relationship and lead to physicians leaving practice. For example, a February 2000 study of 2,620 Boston-area patients and the 166 internists treating them found that patients were twice as likely to be pleased with the care provided by extremely satisfied physicians compared with patients treated by less-satisfied doctors. Physicians who are “very dissatisfied” are more than twice as likely as other doctors to retire and nearly four times as likely to cut back on their hours, said a March 2006 study of nearly 17,000 physicians in the journal Medical Care.
Stuart M. Pollack, MD, a general internist, said he often has thought of his daily routine as a giant dump truck of work being unloaded in front of him, while he slowly shoveled the pile the rest of the day. As medical director of another of the clinics studied — Brigham and Women's Advanced Primary Care Associates, South Huntington, in Boston — that load has been eased by social workers and pharmacists who engage patients in time-consuming activities such as addressing psychosocial barriers to care and reconciling medication regimens.
“Every morning I get up, and I'm excited to go in,” Dr. Pollack said. “I get to do what I love, but I'm doing it in a way that's not leading to physical and emotional exhaustion. It's still 10 to 12 hours a day, but you go home feeling it's a job well done.”

The Power Of Patient-to-Patient Groups

6/03/2013 @ 9:10PM |182 views

By Laurie Edwards, Next Avenue Contributor
When I received a diagnosis of primary ciliary dyskinesia, a rare genetic lung disease, 10 years ago, one of the first things I did was look it up on the internet. The disorder, known as PCD, is a rare or “orphan” disease, meaning it affects fewer than 200,000 patients in the United States. With only 400 appropriately identified PCD patients in the country, I certainly didn’t know anyone else with the condition. I was 23, I’d been seriously ill since birth, and I wanted to know what I could expect now that my symptoms finally had a label.
Enter the internet and its robust network of patient-to-patient groups. Within a few days of my diagnosis, I’d found listservs, Yahoo groups, a patient advocacy foundation and, later, Facebook groups for patients with my disease and related conditions. The majority of my basic medical knowledge about PCD came from my specialist and respiratory therapists. But I gained much of my insight into the emotional aspects of living with this incurable disease from the anecdotal experiences and shared wisdom of other patients, who answered such questions as: How long would it take my skin to adjust to daily chest physiotherapy, in which the lobes of the lungs are clapped vigorously to help break up secretions? How would this disease influence my mortality? Would I be able to have children? (After a long journey, I am now the parent of a healthy toddler, thanks in no small part to the support and advice of other PCD patients.)
Research from the Pew Internet and American Life project has found that 81 percent of healthy adults report going online regularly, compared with 62 percent of those living with at least one chronic condition. This disparity is attributed to lack of digital access, though, not a lack of interest. And once demographic variables are controlled, being chronically ill significantly increases the likelihood that a person will report working on a blog or contributing to an online discussion, listserv or other Web-based forum that helps people with personal or health problems.
In “Peer-to-Peer Healthcare,” another report from the Pew project, 1 in 4 patients living with high blood pressure, heart disease, diabetes, lung conditions, cancer and other chronic conditions reported turning to the Internet to connect with others who share the same diagnoses, illustrating the widespread desire we have to identify, learn from and support one another.
For the estimated 133 million Americans who live with at least one chronic condition, this shift to patient-centered networks represents a new, more empowering mode of communication, rather than the more narrow one-way dissemination of health facts from doctors alone. It was through a social media patient group that I was able to arrange an in-person meting with another PCD patient — it will likely be the one and only time I ever sit face-to-face with someone else who shares my diagnosis.
It was incredibly validating for me finally to have an accurate diagnosis of my condition and to have entry into a virtual community of people just like me. For millions of others who live with controversial, poorly understood or otherwise neglected disorders, particularly pain-related conditions like fibromyalgia, chronic fatigue and many autoimmune diseases, patient groups offer similar camaraderie and emotional support. Often, such patients feel disenfranchised from the medical establishment that is supposed to help them receive appropriate diagnoses and ongoing care. An “us versus them” mentality is, in many cases, inevitable.
In decades past, patients’ rights activism often included in-person protests and physical mobilization — the disability rights and women’s health movements of the 1960s and ’70s are compelling examples of this. Today, such advocacy groups have adapted particularly well to the virtual environment. These online platforms provide more than emotional comfort. They offer opportunities to get involved in clinical trials and disseminate (and sometimes finance) medical research. They can also be powerful advocates for new research, more effective treatment and improved social support systems for patients and families.
Again, for patients with more marginalized conditions — Lyme disease or chronic fatigue syndrome, for example — the sharing of information and virtual mobilization for research and acceptance is particularly significant. Illness can be incredibly isolating, especially for patients whose symptoms and diagnoses are routinely dismissed by the medical establishment. For these people, patient-to-patient networks don’t simply supplement more traditional support — often, they are the only sources of it.
Yet for all their benefits, virtual patient groups and networks also present challenges. Individual experiences that may be extreme examples of disease symptoms or trajectory may get amplified in an online echo chamber, and potentially misleading or confusing information may be repeated as if it is the norm. Alternative interventions may be perceived as accepted medical treatments, leading patients to adopt approaches that might not be fully vetted for safety or appropriate for all patients. Advocates who may lack the health literacy or research experience to interpret data might unwittingly misconstrue published results.
The exchange of ideas and experiences online occurs in real time. For better and worse, this immediacy stands in stark contrast to the much slower pace of academic research from publication to clinical practice. Patients need to be discerning readers of online information. The more material that is out there, the greater the responsibility on all parties to be transparent, reliable and credible. Patients need to be aware of who finances the research and information they come across and any potential conflicts of interest that may be at play.
The ultimate goal is a collaboration between patients and health-care providers that delivers improved methods of diagnosis and treatment. When patient groups enable us to be informed participants in our own care and to drive such progress, everyone wins.
Laurie Edwards is the author of two books on chronic disease, including the recent In the Kingdom of the Sick: A Social History of Chronic Illness in America. She teaches writing for the health sciences at Northeastern University in Boston.