Medicare is apparently going to be getting into the game of paying (very modestly) for quality measures, or more accurately modestly punishing for the lack of reporting on it. According to Health-IT World:

Well funnily enough this may have yet more impacts on our old friends at Tenet. Remember back when I told you about Tenet’s ending its JACHO reporting contract with Perot and giving the contract to a small company with 20 employees and one DSL line? Well apparently the small company received a scathing two page email from another company for whom it provides a JACHO reporting application. That’s 3/3 on irate emails from companies that it’s doing that for.  My source suggests that the soon-to-start Tenet operation is a train wreck in the works, which suggests that Tenet’s reporting to Medicare is also going to have the same potential problems.  At least it’s likely they’ll have fewer hospitals to deal with, I suppose!  A fact that pummelled Tenet’s stock the other week after it also took a $1.4 billion charge connected to the sale of those hospitals.

Boston Scientific is having a good run.  Its sales are up and its new drug-eluting stent Taxus, which has been doing well outside the US, is close to approval here.  J&J’s Cypher stent is likely to be the main loser when Taxus is approved here, but the arms race between these two and Guidant will continue.  Of course everyone’s ignoring what the Stanford study said about the value of these stents last year.

Boston Scientific’s stock is up nearly 30% in the last 3 months.

In the course of some other research I ran across this fascinating site the  Virtual Realty Pain Control at University of Washington’s Human Interface Technology Lab. Extreme pain, such as that experienced by burn victims while having their wounds cleaned, is so painful that strong opiates cannot make it bearable.  Apparently distracting patients by using virtual reality, can make significant improvements in how they perceive their pain. I don’t know what this says about the mind-body relationship but I found it fascinating.

In an article yesterday Modern Physician reports that several medical groups are having technical problems submitting claims via WebMD. Given that WebMD took over several claims clearing houses and transaction systems in its roll-up phase in 1999-2001, the complaint from several medical associations may signal bad news for the company.  WebMD’s stock has recovered from its tumble in September-October over accounting problems at one of its taken-over subsidiaries. But, given the extent of it’s roll-up shopping spree in 1999-2001, (which as Steve Hoffman points out is ongoing!)  when it engulfed many of the big claims transaction companies and clearing houses, WebMD plays a central role in much of the HIPAA mandated electronic administrative transactions in the country.  (For more on WebMD’s history see my post here)

Don’t forget that it was late payments that caused the final unraveling of Cigna, Aetna and the other national "managed care" plans and effectively ended the 1990s style of cost-constraints as we knew them. This problem may be just a technical hitch, but on the other hand it could indicate deeper problems within the bowels of WebMD, which will of necessity reverberate around the system. So this is one to keep an eye on.

Information Week (via iHealthbeat) reports on the World Health Congress in which lots of important political people agreed that IT is the way forward to fix the health care mess. Those saying this included not just the usual suspects from the industry but Bill Frist, Tommy Thompson and even briefly in the State of the Union address, Bush himself.

On the one hand, while it’s good that we’re agreeing on the solution, we’re not seeing even the modest kind of Federal leadership that Molly Coye suggested a while back in terms of dollars. On the other hand I suppose that this is an improvement on Clinton holding up a sheet of paper in his 1994 speech and saying that we were going to solve the administrative crisis by having one standard paper form. But it’s 10 years and counting and we haven’t got that far . . . and I don’t honestly think that Wellpoint handing out a few freebies is going to make up the difference even though it’s a noble effort.

(…and I don’t mean because of too many espressos)

Pew reports that poorer Californians use the Internet at high rates. For households with less than $30,000 in annual income 45% of Californians have Internet access versus 36% nationally, and  of those, 83% have searched for online health info versus 77% nationally.  This gives backing to some private data I have from Harris that indicates that poorer Americans who have Internet access are substituting looking online for physician visits.

If you have an online strategy you might think about what you can do for this underserved group.

Occasional contributor Matt Quinn has been on a tear this week.  He notes the following gem from a recent iHealthbeat story about the use of IT in evidence based medicine.

According to Dr. Bob Williams, principal of Cap Gemini Ernst & Young’s health consulting division, "most physicians want to include data collection in their clinical systems, but they don’t want the guidelines that come from the data to interfere with the care they provide."

Some time back I had a blogging conversation with Robert Centor over at DB’s Medical Rants about evidence-based medicine. He said:

Having physicians enter data on their patients is not an intelligent use of their skills and time. In order to understand quality we would need such a large and broad database that data entry would take longer than patient encounters.

I still have a longer reply to Robert stored up, but the gist of my argument is, just because systems for recording data are not perfect doesn’t mean that we should give up the prospect of using (and improving) them. The lack of the "perfect" in recording clinical data has been allowed too many physicians to drive out the "good" of recording what data they can and using it to guide their care. Regarding Bob Williams’ comments Matt asks:

Does this mean that:
– physicians don’t trust that the data that they’re recording (in clinical as opposed to billing/financial information systems) accurately reflects the care that they’re providing?
– they don’t feel that they should learn (i.e. change behavior) based on what works and what doesn’t work for them and their colleagues (i.e. evidence-based guidelines are so valid/established that one should not deviate from them even based on personal/group evidence)? or that
– it’s OK to collect data but it’s not OK to measure their performance against it (and other docs)?

Like Matt I’m a little puzzled by what Bob means but I suspect it’s the inverse of Matt’s second point in that many physicians don’t want to know about the guidelines because, for want of a better term, "they know better". That’s OK in one of the three methods that Michael Millenson told me are how physicians practise medicine . Millenson’s three ways are:

a) Follow the best evidence based guidelines
b) Innovate by doing something different and record that innovation so that it can be compared to the guideline. Then you can see whether it was worse than the guideline, or better than the guideline and should thus be used to change the guideline, or
c) Ignore the guideline because you just "know" that your way is better.

Millenson tends to think that way too many physicians are in category c), and I suspect that Bob Williams agrees with him. As I’ve posted about before, following the EBM guidelines is not easy, but it should be second nature amongst physicians to figure out what they are, ensure that they are widely understood by the clinicians and patients they are working with, and to check their own practice patterns against them.  With no information systems to record what was done, the last part is almost impossible.  It seems that the physicians Bob Williams was talking about are not so interested in completing that piece of the puzzle.  As I commented earlier this week, this is one area where physicians have a real opportunity to show great leadership. Millenson doesn’t think that they have done so far.

But there is hope and activity here. Fellow blogger Alwin Hawkins sent me an example from his hospital Providence in Oregon (Thanks Al!)

One project was the tracking of myocardial infarction patients. A nurse goes through all charts on the telemetry and coronary care units, checking to see whether patients are being started on the medications recommended by the American College of Cardiology. We placed on all the pre-printed admission order sheets spaces for beta blockers, ACE-I’s, statins, and aspirin, along with. Just that little reminder alone got the docs improved compliance in writing the orders, along with the parameters for holding the medications.

So there you have it. A little hint of the guideline via the information system (in this case a paper order sheet) and the guideline begins to get followed. Similar examples are all over the country, and have been for some time.  But the question is when does the tipping point occur?

Jane Sarasohn Kahn has her top ten predictions for eHealth 2004 out at iHealthbeat.  Considering that I’ll be her house guest tonight I’ve been remiss in not referring you to it!  So go read.