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Medical Mishigas

 Digital Health, Medical Research and Physician Incompetence

Medicare and medical care

A recent issue of The Boston Globe included an interesting juxtaposition of three medical-related articles that combined to paint an unintended picture of what plagues our deeply dysfunctional healthcare system.

In no particular order, these addressed…

  • A digital health revolution that hopes to create operational efficiencies in a healthcare system with a 51% record for efficiency. It must also, according to the physician authors of this op-ed, be expanded to “generate profound new treatments”;

  • Federal research cutbacks that could cost Massachusetts 5% of its medical research jobs. This is the result of our Washington politicians opting to allow the budget sequestration process to take effect and impose across-the-board budget cuts across many federal agencies; and

  • The failure of the state’s medical licensing board to make good on its promise to post more public information online about “Doctors charged with a crime or who have a history of negligent care”.

Let’s briefly dissect these three stories and see how they might intersect…

No Bureaucrats Need Apply

The first two have an obvious connection. Yet the op-ed writers refused to even mention a role for government in digital health or medical research. The authors are two Massachusetts General Hospital physicians – one its physician-in-chief, the other also associated with the right-wing American Enterprise Institute (hence the refusal to even acknowledge a valid role for government). So this was no mere oversight, but rather a case of an ideological agenda pre-empting a full and complete analysis.

According to them, “The rapid evolution of digital health has been driven by an impassioned cadre of entrepreneurs hoping to bring the dazzle of tech start-ups to the challenge of contemporary healthcare”. Really, they actually wrote that.

As a former healthcare entrepreneur, I’m more than willing to grant a constructive role for healthcare entrepreneurs. But to neglect to mention the federal government’s initiatives under Obamacare to increase physician use of digital health is editorial malpractice, op-ed or not.

One can only suspect that the role of one of the authors with the American Enterprise Institute and the other on the Board of Pfizer may have influenced this gross and purposeful omission.

Nor do they mention the role the medical profession has played in delaying the emergence of digital health and preventing it from achieving its potential to date. Instead, the authors credit “American medicine” with “starting starting to think about improving the way care is actually delivered”.

Again, no mention of the role Obamacare is playing in accelerating that process. Nor is there any mention of the role Medicare and other government entities have played in instigating and nudging it along from the outset – often over the resistance of those these two would now give all the credit.

Revisionist History

This, folks, is what is meant by “revisionist history”.

According to this wildly distorted view, only entrepreneurs and “large hospital systems” are doing all the heavy lifting in digital health.

Which prompts the obvious question: What planet are these two living on?

These blatant omissions and historical distortions illustrate the danger of allowing ideological blinders to frame one’s definition of problems and prescription for solutions. By denying the central role of government in this process – the most successful example of digital health so far being the Veteran’s Health Administration – they’re able to deny a role for government going forward. This is a preposterous and self-serving agenda that the Globe should be embarrassed for publishing.

None of this is to suggest the government’s role in digital health has been a raving success.  But a stronger central coordinating force would reduce the fragmentation that bottoms-up development by all those vaunted entrepreneurs has yielded to date.

And these two free-market emissaries would seem to be prescribing more of the same rather than a greater role for government in requiring digital integration among healthcare providers. So far, the market-driven, bottoms-up approach has failed to deliver the kind of integration needed for digital health to provide solutions, rather than compound existing problems.

One example of the latter is the role that electronic health records has played in facilitating “upcoding” by hospital emergency rooms – essentially overbilling Medicare and other payers by substituting higher-paying treatment codes (Click here for more examples of electronic health records driving up medical bills).

Instead of ignoring the government’s role in an expanded role for digital health, what’s needed is a stronger role for government in enforcing greater compatibility among digital health solutions and preventing abuses that threaten to make digital health part of the problem rather than the solution.

Excuse Me?

As for those other two stories in the Globe, I’ll be brief.

The second one’s a beaut. In the very same edition that two of Mass General Hospital’s top doctors were reinventing history by eschewing any role for government in digital health or medical research, the CEO of the same institution is reported as warning about the dire effects the government’s sequestration budget cuts will cause to the state’s economy (“Mass officials, scientists warn about NIH cuts“).

It seems the good doctors and their boss need to get on the same page. How can reducing something so meaningless as not to warrant even mention by his own docs be such a threat? Could they not at least have coordinated the timing of their hypocrisy a little better?

And the third story about the state’s failure to live up to promised reforms in public disclosure of errant doctors (“A data gap on doctors’ troubles“) reminded us that all this noble research and battling of disease is waged by imperfect humans subject to the same foibles as the rest of us – only with more at stake.

In short, in the  most corrupt industry in America, one of its most toughly regulated states can’t even get the basics of physician licensing done correctly. What do you suppose it’s like in the remaining states?

It just struck me as odd that these three very divergent, and contradictory, insights into our healthcare system – in what is supposedly the “medical mecca” of America – found their way into the same edition of a leading newspaper without so much as an acknowledgement that maybe something’s amiss here.

Is it any wonder we’re still chasing our healthcare tail?

For more medical mishigas, be sure to read Time’s exhaustive report
Bitter Pill: Why Medical Bills Are Killing Us“.

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