Gastric bypass “surgery in a pill” points to inspired new treatment for diabetes

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An illustration of how the pill coats the intestine mimicking the effect of bariatric surgery (Credit: Brigham and Women’s Hospital, Randal Mckenzie, and New Atlas)

Gastric-bypass, or bariatric, surgery has been found to be extraordinarily effective in reversing type 2 diabetes. An exciting new study has now demonstrated an oral agent that can potentially mimic the effects of this surgery by artificially lining the stomach.

A family member has undergone gastric bypass surgery, and she swears by it. Conceive of  getting the benefits of this type of surgery without actually having to go through the process. Though these procedures are commonplace, they aren’t cheap. As the United States slowly moves towards some form of universal healthcare, cost savings become of paramount importance.

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Source: Gastric bypass “surgery in a pill” points to inspired new treatment for diabetes

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Regenerative bandage accelerates healing in diabetic wounds – Northwestern Now

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Stained epidermis cells cultured on A5G81 (Credit: Northwestern University via NewAtlas.com)

As a diabetic who have persistent wounds on my right leg, I can identify with any wrap or solution that can help my legs to grow and fluid to flow. For example below, this is a recent photograph of my right leg in a state of lymphedema.

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My right leg as of 5/3/2018

The pink found in the picture is suggestive of healing skin with limited exudence (draining). This has been a condition I’ve lived with for the past 4 years.

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Typical 3-Layer Wrap

A 3-Layer wrap, generally Abdominal Pad with Tritec™ Silver, Kerlix Gause, and Coban™ Wrap. Applied by Wound Care medical professionals with some specialized training, change at least weekly is required; more with excessive drainage.

Imagine a Hydrogel Dressing bandage that can replace the water with protein cells that have a mission to multiply and regenerate new skin. If a wider trial works, my leg prayers will have been answered.

Source: Regenerative bandage accelerates healing in diabetic wounds – Northwestern Now

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When John Oliver Made a Gift of $16 Million to 9,000 People By Forgiving Their Medical Debts

Even though this didn’t happen during the Christmas period and I sorta watched the episode on YouTube, it didn’t dawn on me of the significance of this action until a person I respect blogged about it. Now I think the world, my city, or at least my tens of followers should know as well.

Diane Ravitch's blog

John Oliver broadcast this show in mid-2016. It remains one of the most amazing, most generous gestures I have ever seen.

Oliver, as you may know, mixes up great information and in-depth reporting with funny graphics and unexpected jokes. He keeps viewers entertained as he educates them.

In this segment, he explains debt collection agencies, how they buy debt of all kinds for pennies on the dollar, try to collect, and if they don’t succeed, sell it to another debt collector. The hapless consumer can expect to be harassed with increasingly unscrupulous and aggressive tactics.

Oliver’s team goes to debt collection industry meetings, where the industry leaders talk about consumers as dumb clucks. He films an Arkansas legislator pushing a bill to reduce consumer rights and misrepresents its purpose. It passes easily.

Finally, he does something utterly remarkable.

He creates and incorporates a new debt collection agency Of his…

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Five Blockchain Use Cases for Healthcare Payers, Providers

Five Blockchain Use Cases for Healthcare Payers, Providers

This is a technology I am really excited about. The common wisdom and current case uses are an underpinning of cryptocurrencies, such as Bitcoin and Ethereum. While this is important, only secondary to the technology highlighted below and from the base article.

 

Blockchain may offer a solution to these issues by keeping all members of the community instantly updated on where a provider is allowed to practice, whether or not she is accepting new patients, and what new affiliations she has formed.

This is important, because of current mHealth initiatives, such as CMC Virtual Visit, requires you to physically be in North Carolina, though the system servers both Carolinas. That has to change.

Administrative tasks such as claims processing and underwriting may also benefit from a blockchain approach, since managed permissions make it easier for payers to assess the validity of a claim, manage pre-authorizations, and ensure that providers are meeting the criteria laid out in their value-based contracts.

“Smart contracts could automate these processes and decrease the time and resources needed to execute the terms and conditions [of value-based contracting],” the report says.  “And because smart contracts are decentralized and cannot be changed, all parties can be confident that terms will be consistently executed.”

Pages from CMC Mercy Wound Care 10062017_Redacted_Page_1I continue to get notice of bill payments, similar to an actual bill image to the left, despite my plan being straightforward, at least as I know about it. Possibility to save much headaches and time wasting.

Blockchain would nearly eliminate this as rules can be set; such as “only render services covered under Medicare” to a particular patient. This removes the doubts about all parties getting compensated.

 

Enhanced security and transparency may also drastically reduce the amount of fraud that slips through the defenses of public and private payers.  When entities must have current and authenticated identities before a transaction is approved, the ability to push suspect claims through the reimbursement process is diminished.

Payers with access to a patient’s complete medical record and all of the individual’s approved providers would be more able to identify suspect claims or payment requests that do not match the patient’s documented conditions or normal care habits, explains Deloitte.

Source: Five Blockchain Use Cases for Healthcare Payers, Providers

Marcus Welby M.D. had it right all along

marcus_welby_intro_screenFor those too young to remember, this was an ABC series that ran from 1969-1976. Though the program had house calls as part of its outreach, this was not the main point of the series. Having said that, wise people understand what is old tends to come back as new again to a different audience. With Sen. Bernie Sanders (I-VT) announcement (PDF) of Medicare-for-all sponsored legislation being first an impetus to cover everyone with healthcare and second to do so cheaper than the current system, all opportunities to flip the current fee-for-service payment model are welcome; that is if your ox is not gored by doing so. Right now, the throwback concept of House Calls is limited to the most intensive patient care clients, as is the case with most test programs. Hey, it’s 2017, it is known what works and what doesn’t by now; let’s just get on with it.

Personally, I have a chronic leg situation that has alternating bouts of treatment. If home visits from Nurse Practitioners at a minimum and Doctor’s based on need were truly funded, the system and my condition would be greatly improved.

This is not an isolated cause, despite it being new to me. Another organization in Virginia is employing a provision of the Affordable Care Act named Independence at Home. It is a project that involves 14 practices and consortia with the closest branch being a group in Durham (NC). A team-based approach to care that involves physician assistants, pharmacists, social workers, and other staff (Daniel Farmer, 2016), I would be interested to know what the other staff is; one way it can be enhanced is the utilization of Electronic Health Records that are clean and functional.

via Bringing Back House Calls to Cut Spending on High-Risk Patients

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EHR & our healthcare system, match made somewhere?

EHR & our healthcare system, match made somewhere?

Electronic Health Records are a good thing, except when they are not. Being disabled, medical professionals are a major part of my life. Interactions with them, for the most part, can’t be avoided. I consider myself a geek and reasonably wise to electronic communication means. I even have a working knowledge of HIPAA and all that entails. Coming to grips with the utter lack of EHR implementation at the consumer level is difficult to deal with. One of the providers has a reasonably popular medical specific web portal. It’s not very functional, but it exists. Another group is part of the region’s largest system. My mind struggles with the concept of a total lack of confidence in modern medical communications and associated technology. Having a secure HIPAA compliant communication portal, app, or even Whatsapp, which is 100% encrypted, suitable for transferring files that can be imported into the record keeping that all facilities are mandated by law to control. As the nation nudges toward a single payer system, despite current politics, inefficiencies become sore wounds and costly. The lack of portable EHR with a common format for the secure interchange of data will come back and bite the clients who are in no position to weather the outcomes. Nobody, not even TPTB, wins in that environment.

Recently, I had a doctors appointment with my family physician. What is interesting about this event? He carried a tablet with a keyboard dock with him as he discusses with the patient. All of our conversations are transcribed and available for reference. The rest of the office only has the standard technologies; desktop computers, printers, faxes, that sort of thing. I printed out the most recent list of medications, and the staff either scanned or typed the information in their systems; couldn’t tell which, and it didn’t occur to me to ask.

As I was researching this post, there are few events in life that haven’t happened to someone else, this being no exception. As early as five years ago, this entered my view:

Healthcare facilities need to work with providers to make it easy for them to deliver excellent care. This includes having ready, instant, and continuous access to complete patient records – access resulting from compatible EHR systems and dependable computer networks. Standards must be set and enforced that allow compatibility across systems. A start has been made in this direction, but it needs to progress quickly yet carefully (Tong, 2012)

If any of my interactions are any guide, these lessons were not learned nor executed. And that is a shame really. Anything close to a potential utopian solution must have the free and fair interchange of Electronic Health Records while automating as much of the nonclinical minutiae of the American Health Care system; even if it remains a continuation of the Affordable Care Act.

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Medicare Spending on Telehealth Increases, But Barriers Remain

By Eric Wicklund

August 28, 2017 — Healthcare providers may be using more telehealth and telemedicine than ever before, but Medicare Is still a significant barrier to growth.

An analysis of the Centers for Medicare and Medicare Services’ 2016 payments for telehealth and telemedicine shows a strong uptick in total reimbursements, claims submitted and originating site claims, but the total is still a small fraction of CMS’ total payments of $600 billion-plus and nowhere near what the federal government anticipated spending some 15 years ago.

That difference between actual use and potential use is pushing a groundswell of support to change how CMS reimburses for digital and connected health technology. Aside from several letters calling on CMS to loosen the purse strings, more than a half-dozen bills have surfaced in Congress seeking those changes.


Notable for its absence is the patient’s home. Medicare does not reimburse for telehealth or telemedicine services provided to a patient at home, hindering many mobile health and remote monitoring programs.

 

The current cost of the service.

And therein lies the problem. People on all sides of the political spectrum can agree that the US Government does not always use common sense in making regulations and rules. This is one of those times. If the goal of medical treatment is positive outcomes at less cost, seems to me that telemedicine is one of the tools to achieve this. There is a disincentive to do that, especially if the goal is a single-payer system where most would have Medicare/Medicaid and everyone would have some form of healthcare plan/insurance. To someone on a fixed income, even the amount listed (actual price for the service, fewer insurance considerations) is a barrier to treatment.

 

 

Source: Medicare Spending on Telehealth Increases, But Barriers Remain