Startups Vie to Build an Uber for Health Care -

The uberization of health care access in the United States is a real  possibility.

Given the enormous change in the business of health, and it's rapid adoption of new technologies the trend may bein place for this to occur.  Insurers are desperate to control costs,and providers seem to have become pawns in the chess game of health care management.

There has already been a reduction in hospital admissions and penalties for readmissions. Outpatent care reigns, and that too will come under scrutiny.  The house call may return with the assistance of wearables, remote monitoring of cardiac EKG, thermal imaging and technician ultrasound, (technicians already perform these tests in office). Results can be electronically transmitted and analyzed remotely by a provider and other  certified mobile devices that measure blood chemistry, urine analysis. external photography, including diabetic eye screening for diabetic retinopathy.

Most of these procedures can be reimbursed for the service and provider interpretation. Insurers may w ish to contract directly with mobile health services for efficiency and to reduce administrative burden on  provider facilities.
Many rapid micro-analytic devices are in the FDA approval pipeline.

In the coming decade medicine and health care routines may become unrecognizable compared to today's practice patterns.

Eve Rorison, a nurse who works for Pager, conducts a wellness check for Facebook executive Kunal Merchant at his New York offices. Services like Pager are putting a high-tech spin on old-fashioned house calls. PHOTO: MELINDA BECK/THE WALL STREET JOURNAL

Can providers and regulatory bodies survive the change as providers and patients demand patient centered medicine.  Perhaps forward looking boards and licensing organizations will become leaders.

But don't hold your breath.  Current and past behavior runs counter to this change..  The synergy of HIT,increasing utilization, and the mandates of the Affordable Care Act will conspire to accelerate the process of change.





tartups Vie to Build an Uber for Health Care - WSJ

We're overdosing on medicine – it's time to embrace life's uncertainty

The more we learn about the problem of too much medicine and what’s driving it, the harder it seems to imagine effective solutions. Winding back unnecessary tests and treatments will require a raft of reforms across medical research, education and regulation.

But to enable those reforms to take root, we may need to cultivate a fundamental shift in our thinking about the limits of medicine. It’s time to free ourselves from the dangerous fantasy that medical technology can deliver us from the realities of uncertainty, ageing and death.

We’re all ill now

A growing body of evidence shows that when it comes to health care, we may simply be getting too much of a good thing. In the United States, it’s estimated that more than US$200 billion a year is squandered on unnecessary tests and treatments. In the United Kingdom, senior medical groups are calling on doctors to reduce all the wasteful things they do. And in Australia, the Choosing Wisely campaign recently kicked off with lists of unnecessary and harmful health care.

Not only are we overusing pills and procedures, we’re creating even more problems with “overdiagnosis” by labelling more and more healthy people with diseases that will never harm them.

Screening programs targeting the healthy can detect potentially deadly cancers and extend lives. But they can also find many early abnormalities that are then treated as cancers, even though they would never have caused anyone any symptoms if left undetected.

The common ups and downs of our sex lives are often re-labelled as medical dysfunctions. Older people who are simply at risk of future illness – those with high cholesterol, for instance, or reduced kidney function, or low bone mineral density – are portrayed as if they were diseased.  Have we set the threshold for illness and/or disease too low?

•   

The more we learn about the problem of too much medicine and what’s driving it, the harder it seems to imagine effective solutions. Winding back unnecessary tests and treatments will require a raft of reforms across medical research, education and regulation.

But to enable those reforms to take root, we may need to cultivate a fundamental shift in our thinking about the limits of medicine. It’s time to free ourselves from the dangerous fantasy that medical technology can deliver us from the realities of uncertainty, ageing and death.

We’re all ill now

A growing body of evidence shows that when it comes to health care, we may simply be getting too much of a good thing. In the United States, it’s estimated that more than US$200 billion a year is squandered on unnecessary tests and treatments. In the United Kingdom, senior medical groups are calling on doctors to reduce all the wasteful things they do. And in Australia, the Choosing Wisely campaign recently kicked off with lists of unnecessary and harmful health care.

Not only are we overusing pills and procedures, we’re creating even more problems with “overdiagnosis” by labelling more and more healthy people with diseases that will never harm them.

Screening programs targeting the healthy can detect potentially deadly cancers and extend lives. But they can also find many early abnormalities that are then treated as cancers, even though they would never have caused anyone any symptoms if left undetected.

The common ups and downs of our sex lives are often re-labelled as medical dysfunctions. Older people who are simply at risk of future illness – those with high cholesterol, for instance, or reduced kidney function, or low bone mineral density – are portrayed as if they were diseased.

The doctors expanding disease definitions and lowering the thresholds at which diagnoses are made are often being paid directly by the companies that stand to benefit from turning millions more people into patients.

Fundamental shifts in thinking

Indeed, intolerance of uncertainty has been suggested as among the most important drivers of medical excess. Doctors order ever more tests to try, often in vain, to be sure about what they’re seeing – to be more certain. But disease and the benefits and harms of treating it are inevitably fraught with uncertainty because we’re trying to apply knowledge derived from populations to unique individuals.

More broadly, uncertainty is the basis of all scientific creativity, intellectual freedom and political resistance. We should nurture uncertainty, treasure it and teach its value, rather than be afraid of it.

No matter how much the marketers of medicines try to make us feel broken by the

mere passing of time, ageing is not a disease. Disease definitions that equate “normal” with being young are fundamentally flawed and require urgent review.

Everyone must die and everyone, patients and doctors alike, is more or less fearful of dying. So, it’s perhaps not surprising that we so often turn to biotechnical approaches rather than paying real attention to the care of the dying – a core purpose of medicine.

But, there are many positive signs of change within medicine. The Choosing Wisely campaign mentioned above is a partnership between doctors and wider civil society. And it’s now an international movement to wind back excess medicine.

A new approach called shared decision making is promoting much more honest conversations between doctors and the people they care for, embracing uncertainty about benefits and harms, rather than peddling false hopes. Another new approach among GPs called quaternary prevention is urging doctors to protect people from unnecessary medical labels and unwarranted tests and treatments.

Quaternary prevention is a group of measures taken to prevent, decrease and/or alleviate the harm caused by health activities. Health activities not only generally produce benefits, but also harm. That is to say, although medical intervention is mainly favourable, there is a dynamic balance that requires continuous assessment of the clinical situation as naturally only those health activities that achieve more benefit than harm at the end are justified. Quaternary prevention is the avoidance of unnecessary medical activity, such as "check-ups". In another example, quaternary prevention is the recommendation of preventive measures of proven efficacy. As regards diagnosis, quaternary prevention is, for example, the avoidance of screening without foundation, such as in prostate cancer. The appropriate use of antibiotics in upper respiratory tract infections serves as an example of quaternary prevention in the field of treatment. Another example is the application of the correct rehabilitation techniques in non-specific low back pain, such as swimming and maintaining an active life as much as possible. Not to forget other important "non-classic" aspects in the elderly, such as to limit the harm that can be caused by physical movement restriction devices. These and other examples in daily practice are considered in this article to encourage the continual assessment of quaternary prevention, the classic primum non nocere "first, do no harm".



We're overdosing on medicine – it's time to embrace life's uncertainty

Small Businesses Face New Obamacare Threat - Forbes

Small Businesses Face New Obamacare Threat - Forbes

Health IT Cyber Thieves have their own "ENIGMA"` machines

Veterans of World War II will remember the efforts to crack the Japanese encryption used for military communication during WWII.

Enigma was invented by the German engineer Arthur Scherbius at the end of World War I.^[1] Early models were used commercially from the early 1920s, and adopted by military and government services of several countries, most notably Nazi Germany before and during World War II.^[2] Several different Enigma models were produced, but the German military models are the most commonly recognised.

The mechanical/electrical components of the device were easily duplicated. The secret sauce was in the encryption method. 

German military messages enciphered on the Enigma machine were first broken by the Polish Cipher Bureau, beginning in December 1932. This success was a result of efforts by three Polish cryptologists, Marian Rejewski, Jerzy Różycki and Henryk Zygalski, working for Polish military intelligence. Rejewski reverse-engineered the device, using theoretical mathematics and material supplied by French military intelligence. Subsequently the three mathematicians designed mechanical devices for breaking Enigma ciphers, including the cryptologic bomb. From 1938 onwards, additional complexity was repeatedly added to the Enigma machines, making decryption more difficult and requiring further equipment and personnel—more than the Poles could readily produce.

On 25 July 1939, in Warsaw, the Poles initiated French and British military intelligence representatives into their Enigma-decryption techniques and equipment, including Zygalski sheets and the cryptologic bomb, and promised each delegation a Polish-reconstructed Enigma. The demonstration represented a vital basis for the later British continuation and effort.^[3] During the war, British cryptologists decrypted a vast number of messages enciphered on Enigma. The intelligence gleaned from this source, codenamed "Ultra" by the British, was a substantial aid to the Allied war effort.^[4]

What does this have to do with health information technology and mobile health in particular?

Ask Google, since they are planning regular weekly updates to the android operating system.

Google's comment regarding the 'stagefright' hack, 

"This vulnerability was identified in a laboratory setting on older Android devices, and as far as we know, no one has been affected. As soon as we were made aware of the vulnerability we took immediate action and sent a fix to our partners to protect users...As part of a regularly scheduled security update, we plan to push further safeguards to Nexus devices starting next week. And, we'll be releasing it in open source when the details are made public by the researcher at BlackHat."  How to see if your Android Device is vulnerable to the Stagefright hack ?

Google's Android Blog  "Nexus devices will continue to receive major updates for at least two years and security patches for the longer of three years from initial availability or 18 months from last sale of the device via the Google Store."

In recent months many breaches have been reported by health insurers. In most instances medical records were not accessed other than an attempt to gather consumer identification and credit information. Identity theft is a major concern.

The moral of the story is that security breaches will be present for a long time. Thieves are inventive.

Catch and Release - Finding Life in Death: Michael Fratkin at TEDxEureka

Dying is not a medical Condition



The Boundaries of Living and Dying, is discussed by Michael Fratkin describing his first experience with death as a six year old, and his anger with  adults keeping a secret about dying from a child.

A palliative physician manages his fear that he would fail a family.   Story telling and laughing replace the handwringing at death. The family reconnects in a way never possible before.

He reviews the stages of dying, as set to stages by  Elizabeth Kubler-Ross. Anger, Bargaining  Depression, Denial, & Acceptance








"We prepare for birth, but rarely prepare for death."  .
Manage yourself to be present at death.

Dr Michael Fratkin practices in Humbholdt community, Eureka, California.  Listening to a SoundCloud Presentation audio file, Dr Fratkin discusses one of his major goals to help people dying where there is no hospice and few trained cancer specialists (oncologist)

Dr. Fratkin developed a Crowdfunding Campaign to support these services, for patients who could not afford these types of services.

Closing Music on Dying (Alex Fox) Soundcloud audio file

Clinton Meets With Home Care Workers - California Healthline

As we struggle towards nominating conventions Hillary Clinton addresses home health care.

Democratic presidential hopeful and former Secretary of State Hillary Clinton speaks during a Service Employees International Union event with home care providers in Los Angeles on Thursday. Getty Images

This subject will become more important as  health care transitions to lower cost and patient-centered care....in the home with remote monitoring, wearables, telehealth and home care organizations.

Home care has a spectrum of tiers

1. Professional certified care givers, RNs LVNs Hospice, Domestic aides, and family or friends.
2. Private agencies
3. Public agencies, which may contract with any of the above for patients with Medicaid.

Caregivers in general are paid very poorly. If we rate the importance of health care at home according to reimbursement, then it is abysmally unimportant both economically and in terms of quality of care.

A succession of home health caregivers and some recipients of that care told their stories to Clinton and they spoke generally about the changes needed in home care.  

Sumer Spika, a caregiver from Minnesota, said when she first started, she entered a profession with low pay, no benefits, no retirement, no overtime and no paid time off.

Home care workers are advocating for a $15 minimum wage, which would approach a living wage, they say. Lizabeth Bonilla said she has been a caregiver for 42 years, the last 23 of them in Nevada, where she made $10 an hour when she first came to Nevada 23 years ago -- and, she said, she still makes the same $10 an hour. This amounts to a huge decrease in real income, when the consumer price index has risen more than 250 % in those intervening years. What that means is that to buy $ 100.00 of merchandise in 1980 would cost $289.00 today in 2015.

Clinton commented, ""The work you're doing actually saves Medicaid money," she said. "People do better when they get care at home. That's good medicine." "If you think about the fact that we're going to have more and more elderly in this country, we are going to face a care crisis," Clinton said. "If we don't think through that, I don't know how we're going to be able care for people. Our highest obligation we have is to take care of each other. At the end of the day, I don't think anything matters more."

This economic chasm will be even more difficult to close with the emphasis on cost containment by the Affordable Care Act.

Clinton Meets With Home Care Workers - California Healthline

Medicine Is Going Through A Revolution -- With Doctors' Help - Forbes

from Forbes Magazine, as written by David Chase

"You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete. Buckminster Fuller"

"It is only after a revolution concludes that one can clearly look back and fully understand what triggered the revolution. External factors such as technology shifts can create the conditions for a revolution where it may not have been possible before. A generation that has a different worldview than their elders may not accept that status quo. From what I’m observing, I believe we are seeing a revolution’s first phase happen before our eyes. (ZdoggMD)

As you can see in the picture accompanying this article after the post-Velvet Revolution celebration, it’s all ages who celebrate. It’s worth noting that the Velvet Revolution was triggered by a crackdown on students.



I’m convinced that the only way there will be a true revolution in healthcare is if there is a partnership between clinicians and individual citizens (aka patients/consumers/people). One without the other isn’t sufficient to unseat deeply entrenched systems. However, I feel doctors will play a unique role in catalyzing the revolution (not to say that clinicians of all types won’t play important roles as well). As I’ve been a Johnny Appleseed of sorts chronicling the far-reaching and transformational work of doc-entrepreneurs, it feeds my optimism that it’s possible to overcome the “Preservatives” who have 3 trillion reasons to protect the status quo. " 

One might interchange the word Conservative for Preservative, since conservatives usually like the status quo.

For those of us who have seen how much better the system can work when goals are properly aligned, it’s “good news” that doctor burnout and dissatisfaction is at an all-time high (see The Quadruple Aim: A Square Deal for Clinicians for more). Why? Dissatisfaction is the seed corn for change and revolution. Make no mistake. There is extremely high level of dissatisfaction amongst a large chunk of doctors who yearn for change. The contrast between those inside of flawed versus optimized care delivery and payment models is stark. One the one hand, I have heard and seen docs who are seeing 30-50 patients a day, dealing with unwieldy/outdated EHRs optimized for billing (vs. care) and getting more bureaucracy thrown on top of an already-flawed model. On the other hand, it’s breathtaking when I visit clinics like CareMore, ChenMed, Iora Health, Qliance, Vera Whole Health and others where the clinicians and patients are both extremely satisfied.

In the video below, Dr. Zubin Damania powerfully captures the sorts of internal dialogue doctors have had one by one with themselves.

I suspect all the doctor entrepreneurs/leaders I’ve highlighted below had some similar internal discussions. This is how revolutions begin. By no means is it limited to young doctors but typically it’s the young who foment revolutions and they are then joined by those older than them.

It’s worth noting that the Velvet Revolution was triggered by a crackdown on students.  This is what we see in medical school and in young physicians in training, or in the early years of practice. More likely it will occur when they enter the practice world. For most MDs it has been a shock to adjust how they practice.
***************************************************************

In their own way, each of the doctors listed below is contributing to building the new ecosystem and ignoring the Preservatives who are wedded to the status quo. As mentioned above, there are non-physician clinicians and individual citizens having a big impact but I focus on doc-entrepreneurs and intrapreneurs here.

• Dr. Rajaie Batniji co-founded Collective Health in the belief they could help employees receive better care and coverage than what many experience with incumbent health plans
• Dr. Steven Eisenberg for adding love & music to #oncology and humanity to medicine (h/t Bunny Ellerin)
• The late Dr. Tom Ferguson coined the term e-patient many years before others were focused on equipped, enabled, empowered and engaged patients. This is a whitepaper (PDF) finished by his colleagues after his untimely passing.
• Dr. Rushika Fernandopulle founded Iora Health to restore humanity to healthcare. They have proven to take on the most challenging patient populations and achieve outstanding outcomes and even take on individuals not addressed by the new health law with the support of a Nobel Prize winner.
• Dr. Paul Grundy has led IBM’s transformation in healthcare shifting their thinking from healthcare as a soft benefits item left to HR to something that is a critical supply chain cost and source of competitive advantage.
• Dr. Rob Lamberts showed how an independent family physician can strike out on their own and provide better care and be more professionally satisfied
• Dr. Risa Lavizzo-Mourey is leading the Robert Wood Johnson Foundation spearheading their major re-focus on creating a Culture of Health that is impacting communities throughout the country.
• Dr. Harry Leider is leading Walgreens retail clinic and telehealth expansion that promises to reach half of the country by the end of the year.
• Dr. Geraldine McGinty for her work creating innovative radiology payment models & spearheading payment reform (h/t Bunny Ellerin)
• Dr. Farzad Mostashari described Aledade’s goals as follows: ”It’s to help independent primary care doctors re-design their practices, and re-magine their future. It’s to put primary care back in control of health care, with 21st century data analytics and technology tools. It’s to support them with people who will stand beside them, with no interests other than theirs in mind.”
• Dr. Stan Schwartz saw what Dr. Keith Smith was doing and has been creating a true transparent medical network and making that available to employers  — both doctors and patients are saved from excruciating amounts of bureaucracy in a very appealing economic model to both parties. It’s also the first Health Rosetta item to be delineated.
• Dr. Danny Sands co-founded the Society for Participatory Medicine while practicing and famously taking care of ePatient Dave.
• Four years ago, I observed how doctors such as Wendy Sue Swanson, Natasha Burgert & Howard Luks were doing something similar to how Sal Khan had “flipped the classroom”. This led to the Robert Wood Johnson Foundation initiating a major program called Flip the Clinic to improve outcomes and participation by patients.
• Dr. Mike Sevilla for using #hcsm to educate, elucidate and save family medicine #FMRevolution (h/t Bunny Ellerin)
• Dr. Eric Topol has written and spoken extensively about how central the patient will be as a participant in their care compared to traditional practices. He highlights how the smartphone is the equivalent of the Gutenberg Press for medicine
• Dr. Bryan Vartabedian is showing other doctors how to be a “public” physician & the impact that can have on outcomes
• Dr. Sheldon Zinberg founded CareMore creating a national leader in treating the frail elderly.

By no means is the list above complete. Add your comment below on a revolutionary doctor that has inspired you. Let us know what they are doing. Whether it is private practice, venture-backed startups, public health or health benefits, each doctor is contributing to the revolution. In their own way, they are fostering a Velvet Medical Revolution.

 

Medicine Is Going Through A Revolution -- With Doctors' Help - Forbes

Second 40% Excise Tax ("Cadillac Tax") Notice Issued for Obamacare

The IRS is coming for you. Part of the Affordable Care Act is  to gain tax revenue to offset the increase in uninsured and to support premium subsidies

On July 30, the Department of the Treasury and the Internal Revenue Service (IRS) issued a second notice regarding the 40% Excise Tax a.k.a. the Cadillac Tax. The notice provides information on possible approaches that are being considered for administering the Cadillac Tax and continues the process of gathering input that will be used to develop regulations.


What are the proposed thresholds?

The Cadillac Tax is a 40% excise tax scheduled to take effect in 2018 to reduce health care usage and costs by encouraging employers to offer cost-effective plans that engage employees in sharing in the cost of care. The tax impacts plans exceeding the following thresholds, which will be adjusted annually for inflation:

$10,200 for individual coverage

$27,500 for family coverage

The notice addresses several issues, including:  Who pays the tax How the tax will be determined How the tax will be paid:

Each “coverage provider” must pay the tax on its share of the excess benefit. A coverage provider is:

           The health insurer for insured coverage.

• The employer for accounts such as Health Savings Accounts (HSAs) to which the employer contributes.
• The plan benefits administrator – the agencies are seeking comments on whether this should be the third-party administrator or the entity that has ultimate responsibility for plan administration, typically the employer.

How the Tax will be Determined

The notice seeks comments on how to calculate and administer the tax. The following are some of the proposed approaches.

Timing – Following the end of each calendar year, employers will need to determine whether and by how much the cost of coverage exceeded the allowed limit for each month. The employer must then notify the IRS and each coverage provider of their share of the excess benefit so the tax can be calculated and paid.

Cost – The cost of coverage may be determined in a manner similar to determining COBRA premiums. 

Age and Gender Adjustments – The current thresholds for 2018 are $10,200 for individual coverage and $27,500 for family coverage. These amounts may be increased for some employers based on how the age and gender of their employee population compares to the national workforce. No downward adjustments will be made. The notice seeks input on how these adjustments should be determined.

Allocation of Accounts – The notice proposes that employer and employee contributions to accounts such as HSAs, Health Reimbursement Accounts (HRAs) and Flexible Spending Accounts (FSAs) would be allocated equally to each month of the plan year, regardless of when the contributions were actually made. For FSAs, the agencies propose that the annual contribution amount be used, regardless of whether all funds were spent during the year or some funds were carried over to the next year.

Employer Aggregation – Related employers would be aggregated and treated as a single employer.

Taxation – No deduction is allowed for the payment of the tax.

How the Tax will be Paid

Each coverage provider will be responsible for paying the tax on its share of the excess benefit. IRS Form 720, the Quarterly Federal Excise Tax Return, may possibly be used to pay the tax. If so, a specific quarter of the calendar year would be designated for payment.

Proposed Regulations Still to Come

The agencies will review all comments and leverage the feedback to help draft regulations.

For more information, view the notice. 

Second 40% Excise Tax ("Cadillac Tax") Notice Issued



The new tax is retrogressive and is actually a double taxation, not allowing any deduction against income, sales, or excise taxes.  There is also no mention of how state tax would be impacted.



The notice reveals a poorly constructed, and poorly thought out notice.  The ACA law is so non-specific in regard to taxes.  It already includes penalties to non-compliant patients in regard to obtaining health insurance, medical device taxes, and now this latest round of mining for scarcer health care dollars.



The mechanism for controlling cost is to tax any excessive premium to penalize all those concerned, even if the benefits are excellent. The Dept. of HHS cares not one bit about quality or excellence of the healthcare delivered.  It wants to reduce it's costs, in a CATCH 22 scenario.

5 things Atul Gawande learned on his return to McAllen, TX

The Brookings Institution is a nonprofit public policy organization based in Washington, DC. Our mission is to conduct high-quality, independent research and, based on that research, to provide innovative, practical recommendations that advance three broad goals: Much of this post is taken from their May 8, 2015 blog report. One of  the 14 Policy groups  is the Center for Health Policy . 

Gawande returned to  McAllen after a five  year hiatus since his original visit to investigate the extreme variation in health costs at McAllen,TX vs.the rest of the United States. In May 2015 Dr Gwande published an article on health overspending in the New Yorker In this article he explains,

As a follow up to his seminal New Yorker articles, “The Cost Conundrum” and “The Cost Conundrum: Redux,” surgeon and author Atul Gawande provides an update on the very interesting town of McAllen, Texas and their health care spending problem. Six years ago Atul Gawande went on a fact finding mission to McAllen-- a community with double the average Medicare spending ($14,000 versus $7,000)-- to explore what the IOM calculated to equal a third of all health expenditures including unnecessary, redundant, and medically and scientifically ineffective tests, procedures, and treatments. He found a system in denial and with high rates of hospital admissions, evasive-expensive surgeries, and outpatient home health care.

Gawande returned to  McAllen recently and was greeted by an entirely new system. Inpatient visits had fallen by 10 percent; home health care spending was down 40 percent; ambulance rides were down 40 percent; and cost per beneficiary dropped almost $3,000 resulting in nearly half a billion dollars saved. What happened in Texas was unprecedented.  

But Why?

Five Lessons from the McAllen Experience:  

Evidence is hard to ignore, especially if it is out in the open.

Physicians also do not have all the right information. 

Local clinical leadership and clinical knowledge are important in promoting health.

More evidence shows payment and delivery reforms may be working.

The biggest opportunities for cost reductions are with complicated patients.

The development of an ACO (accountable care organization) may provide resources, financially, with leadership and coordination of care. This may be unique  in McAllen since PPOs, Managed care and other group practices were not in existence during the initial study by Dr. Gwande.

"An avalanche of unnecessary medical care is harming patients physically and financially. What can we do about it?"

The one that got Gwande thinking, however, was a study of more than a million Medicare patients. It suggested that a huge proportion had received care that was simply a waste.  The researchers called it “low-value care.” But, really, it was no-value care. They studied how often people received one of twenty-six tests or treatments that scientific and professional organizations have consistently determined to have no benefit or to be outright harmful. Their list included doing an EEG for an uncomplicated headache (EEGs are for diagnosing seizure disorders, not headaches), or doing a CT or MRI scan for low-back pain in patients without any signs of a neurological problem (studies consistently show that scanning such patients adds nothing except cost), or putting a coronary-artery stent in patients with stable cardiac disease (the likelihood of a heart attack or death after five years is unaffected by the stent). In just a single year, the researchers reported, twenty-five to forty-two per cent of Medicare patients received at least one of the twenty-six useless tests and treatments.

Why Medicare Has Been Slow to Adopt Telemedicine | KQED Future of You | KQED Science

Why Medicare Has Been Slow to Adopt Telemedicine | KQED Future of You | KQED Science