Tuesday, October 18, 2016

On Call by Casey Ross

Good morning, and welcome to On Call. It was great to hear from so many readers yesterday. I appreciate the warm welcome! Now, to the news...

C-Suite Chat: The Mayo Clinic CEO has a question

what price a diagnosis? Dr. John Noseworthy is pondering that question. (Mark Lennihan/AP)

How do you pay doctors for solving a medical mystery?

That's a question that's been on the mind of Dr. John Noseworthy, chief executive of the Mayo Clinic. He told me he supports national efforts to cut health care costs and devise payment models that reward quality over volume. But he also sees a trap for elite hospitals like Mayo, which often serve the patients with the trickiest conditions.

Mayo doctors may spend many, many hours trying to arrive at a diagnosis for such patients, and hours more devising a treatment plan. How to compensate that time?

The question is particularly relevant as the Centers for Medicare and Medicaid Services prepares to implement the payment reform known as MACRA, which rewards or penalizes doctors based on their patients' outcomes. With the sickest patients, positive outcomes sometimes are not always obvious — or easy to wedge into a payment formula, Noseworthy said.

“How do you recognize going from an inaccurate to an accurate diagnosis? How do you recognize moving from unnecessary medications to a simplified medication plan?” Noseworthy asked me.

“The science of that,” he said, “is still in its early days.”

Are we losing the innovative spirit in med tech?

Medical technology innovation has slowed to a crawl. 

That’s hard to believe if you spend much time around hospitals. But consider these numbers in a report just out from the AdvaMed trade group:

  • Just 600 med tech startups are launched each year. That may sound like a lot, but three decades ago, there were 1,500 startups a year.
  • The industry is “graying,” with more than 30 percent of med tech firms at least 25 years old.
  • Med tech’s share of venture capital investment has dropped to 4 percent, from about 13 percent in the early 1990s.

And to fix all that? Among the group’s proposals are some familiar pleas — a quicker and more consistent FDA approval process, and repeal of the medical device tax.

Another thought: Maybe more MedTech-ers just need to grow non-ironic mustaches and move to Silicon Valley.

Tackling (and tweeting about) the global crises of obesity and diabetes

Heavy hitters from the world of public health gathered in D.C. yesterday for a National Academy of Medicine conference on obesity and diabetes. Urgent calls to action abounded, as did advice for everyone in the health world on how to frame the problem.

Some of the tweets that caught my eye:

Why a small rise in TB could be a big reason to worry

It’s easy to dismiss tuberculosis as a remote and dwindling threat. After all, there were only 9,563 cases in the United States last year.

But that number is deceiving. It's an uptick over the previous year. The first such uptick, in fact, since 1992. And that's alarming, because each case of TB requires a massive amount of work from public health officials; they have to track down everyone who may have been exposed, test them at least twice; and monitor sick patients for months — even making house calls to ensure they take their daily meds.

My colleague Eric Boodman writes about the burden on public health clinics and nurses by tracing one case, of a doctor-turned-TB patient.

Read it here.

Zag of the Day: Finding friends for lonely patients

Hospitals can be places of extreme isolation for older patients, whose family members and friends are often too infirm or physically remote to visit.

At least one hospital is now taking aim at that problem.

UCLA Medical Center Santa Monica launched a Geriatrics Companion Program earlier this year, reports my colleague Bob Tedeschi, who covers end-of-life issues for STAT.  Nearly three dozen volunteers sign up for four-hour shifts to take walks and play games with the patients — or just sit by their bedside and chat.

David Reuben, the geriatrics department’s chief, called the program a success, but noted a few challenges. For one, the volunteers sometimes end up taking care of chores that are supposed to be done by hospital staff. For another, it’s hard to measure how much the companionship means to the elderly patients.  

“Sometimes because of their illness, patients may not remember volunteers being there, or they may be too sick to appreciate it,” he said.

Scientific evaluation may also prove elusive. “You might think that this could help people recover better,” he said. “But to tease that out among all the other things, and find the signal from the noise, is really a challenge.”


  • Transgender patients often struggle with gaps in care. (New York Times)
  • The last US medical school to use sedated cats to train students in intubation has stopped the practice. (Associated Press)
  • Improving health care through the simple act of listening. (STAT)
  • The new iPhone and iPad models don't work when you're wearing sterile gloves. (MedPage Today)

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Stay well, and come back tomorrow.


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