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Congratulations! We have a new buzzword trending in health care IT - Public APIs.  You can say public APIs everywhere you used to say interoperability. You can also replace the very unprofessional “EHRs can’t talk to each other” with “EHRs lack public APIs”. People will nod in solemn agreement, and you will sound very informed and up to date on the latest developments, but just in case you encounter the quintessential child inquiring about the king’s rather scant wardrobe, here is a little background information. (Very) Brief Introduction to Public APIs API stands for application programming interface. Yes, interface, like the ones you have with your claims clearinghouse or your lab service provider or pharmacies. There are several ways to classify APIs, but for our discussion, we only need to consider two types of APIs: data APIs and services APIs. Data APIs are the simplest, and go something like this: software A sends a request for information to software B, and software B sends...

Physicians, whether practicing medicine or not, should not be involved in clinical research. They should never be consulted on development of new drugs and medical devices. Doctors should not invent new treatments, and should never supervise clinical trials. They should not travel to or speak at conferences either, and they should banish all entrepreneurial notions out of their heads. If they insist on engaging in these activities, they should do it all for free, out of the goodness of their Hippocratic heart. A medical degree should immediately disqualify you from making money in the health care industry, which is a privilege reserved for technocrats, business executives and garden variety ex-political appointees. Matt Bai, a veteran political journalist, wrote a new book titled “ All The Truth Is Out: The Week Politics Went Tabloid ”, where he is attempting to pinpoint the demise of serious political journalism to the Gary Hart scandal of 1987. If you recall, Mr. Hart, the all but ce...

The Senate Appropriations Committee has defined a new transgression perpetrated in the committee’s expert opinion by vendors of certified EHRs, as well as “eligible hospitals or providers”. Since the committee has no data or evidence of any kind that this transgression is actually occurring, it requires the Office of the National Coordinator for Health Information Technology (ONC) to embark on a fishing expedition to locate all perpetrators of “information blocking” and devise a “comprehensive strategy on how to address the information blocking issue”. The committee is recommending that “ONC should take steps to decertify products that proactively block the sharing of information”. The Senate committee does not specify which information should be shared, but it unequivocally states that information blocking practices “frustrate congressional intent”. Interoperability is the means by which computers communicate with each other. It is not necessarily the means by which people use comput...

In a new Forbes article, David Shaywitz ponders whether patients are the best judges of physician quality. This is a very interesting question, not because the answer is elusive, but because the question itself is rather unusual, and may prove to be the harbinger of a new way of thinking about health care. The question raised by Dr. Shaywitz is not whether patients have enough damning information to select their doctors, which is the common drivel in the media right now. The question is whether regular people are mentally competent to make that decision. Responding in the negative to this question implies that someone, or something, other than the patient should be empowered to judge physician quality, and pick your doctor for you.  It seems that Dr. Shaywitz was inspired to write this article in the wake of an opinion piece in the Wall Street Journal , where a practicing physician, Dr. Mark Sklar, is railing against the oppressive bureaucracy engulfing his medical practice tod...

Value-based health care is antithetic to patient-centered care. Value-based health care is also diametrically opposed to excellence, transparency and competitive markets. And value-based health care is a shrewdly selected and disingenuously applied misnomer. Value-based pricing is not a health-care innovation. Value-based pricing is why a plastic cup filled with tepid beer costs $8 at the ballpark, why a pack of gum costs $2.50 at the airport and why an Under Armour pair of socks costs $15. Value-based pricing is based on manipulating customer perceptions and emotions, lack of sophistication, imposed shortages and limitations. Finally, value-based prices are always higher than the alternative cost-based prices, and profitability can be improved in spite of lower sales volumes. Health care pricing is currently a smoldering mixture of ill-conceived cost-based pricing with twisted value-based pricing components. For simplicity purposes, let’s examine the pricing of physician services. As...

According to a new Commonwealth Fund sponsored study published in Health Affairs , “ Small Primary Care Physician Practices Have Low Rates Of Preventable Hospital Admissions ”. The study of over one thousand practices of various sizes and ownerships, conducted by some of the most respected names in health care, found that the smallest independent primary care practices, that are physician owned, provide better care at lower overall cost. Considering the current, and rather belligerent, advocacy and policy efforts to eradicate small independent medical practice, and the massive move of physicians from private practice to hospital employment in the name of efficiency, quality, value and economies of scale, this study should have created quite the furor. It has not, and chances are excellent that it never will. The study, consisting of 1045 practices and 284,000 patients, is a combination of survey responses regarding practice characteristics, and Medicare claims data used to calculate ra...

The venerable University of Texas MD Anderson Cancer Center in Houston will accept patients with traditional Texas Medicaid health insurance, and some patients in Medicaid managed care plans. Memorial Hermann, another large health system in Houston, will accept traditional Medicaid patients and also those in Medicaid managed care plans. Neither institution will accept the Blue Cross Blue Shield HMO silver plan sold on the Affordable Care marketplace, according to NPR , and as clearly outlined on the MD Anderson website . As it turns out, the conservative state of Texas is able to obtain best in the world health care for its poorest and sickest citizens, while the private market representative, Blue Cross Blue Shield in this case, is barring its “customers” from the best and most popular Houston hospitals, including the public system (!), and all the doctors that go with these hospitals. This situation is hardly unique to the Lone Star state. The Affordable Care Act (ACA) is mandating t...