Subject: News from Dr. Kevin Fickenscher
From: "Dr. Kevin Fickenscher" <[email-masked]>
To: <[email-masked]>
Date: Tue, 16 Jun 2015 09:27:07 -0400 (EDT)

The Fickenscher Files [http://r20.rs6.net/tn.jsp?f=001xA_ZQxGO9wzPxQNs6pQUvN_Bi0ninsArpsa1HPjByiTcQcb-wSZx3Df0SB6HXBDjcUr2uGo6TwRaPoNasTtksX_6JdO1yEEhv4x8mWe6FzlaquK20bwfdXIrz6eADuQJQHQ3RpfpuOoPlIEmjSi10bFwr8JEkZrlgr4pHWPghDz7_FNBx1nLlA==&c=EzMFGs_vTqRlPgV45Txh5Ko2OToRWzIr1NOt40RMScztKQFykc_PVw==&ch=p6DNJK2RQ1qbwyj6q2RMzfRXDI4OoUNHnIqTevlYtLVO9WBtpkaEhQ==]
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

The Fickenscher Files, Vol. 3, Issue 32
Kevin M. Fickenscher [http://r20.rs6.net/tn.jsp?f=001xA_ZQxGO9wzPxQNs6pQUvN_Bi0ninsArpsa1HPjByiTcQcb-wSZx3EK4XROk97ICD92Y-S0_QoxOiN1t6ujwUplXVoC9nIdOVTdCyXyQKS2EVKLkNPrO8Yjr2JpkolQlhucec5Oi32JefnQY8eafBCxF1DM_vn5Hj415tsPEIpdQGzfU_o_8cGUnmf4hQ6xEj6Vou3W-IVoSrsntPC2LX5tr5iT14fPfNBaOWjFiC9KKg5F8I6wUlm5Iu9lA9vuUUncsmDVpSH8=&c=EzMFGs_vTqRlPgV45Txh5Ko2OToRWzIr1NOt40RMScztKQFykc_PVw==&ch=p6DNJK2RQ1qbwyj6q2RMzfRXDI4OoUNHnIqTevlYtLVO9WBtpkaEhQ==],
MD, CPE, FACPE, FAAFP
@MDKev

A compilation of information, thoughts, and perspectives on the issues of the day
related to healthcare, technology, and beyond - including the latest culinary explorations.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Quote(s) of the Week

Notable thoughts for your consideration...

"When that data can be accessed and mined and utilized for good in an instantaneous
manner that would be shattering in a positive way for the system as we know it."

Laura Arrillaga-Andreeson, wife of Internet pioneer Marc Andressen and well-known
philanthropist on the impact of big data on healthcare systems

"Placing limits on telemedicine is short-sighted.  New technology and innovations
can be intimidating - physicians even criticized the use of the stethoscope and 
the use of the EKG machine when they were first discovered.  Telemedicine will add
another tool to the physician's tool-belt in treating patients...The time to lift
telemedicine's limitations and start educating others on its uses is now..."

Jesse O'Shea, a medical student in a blog statement [http://r20.rs6.net/tn.jsp?f=001xA_ZQxGO9wzPxQNs6pQUvN_Bi0ninsArpsa1HPjByiTcQcb-wSZx3JaJ2QA9Bkc3oVbZaeB0jrEM8cVBQp5aV0EzICQmc8kacU4pYIIbDpFnXarw7erhzAJZaM1C26yR7ReQBHaogxebiRyJC8xuFHZ-CWo4hUThrf8apBvM6Byl_WYsqiuCx1tEfmrTcVYHy2OdT0NlOqjOxL-ZCCC5bkbHSti1KikE_MV02wfMQm2JRNtYKyQArdUoUsSgbCHZ3yffif1HANozoEgpcAbciPyaIkU8x0T4i5lNKwphfvE=&c=EzMFGs_vTqRlPgV45Txh5Ko2OToRWzIr1NOt40RMScztKQFykc_PVw==&ch=p6DNJK2RQ1qbwyj6q2RMzfRXDI4OoUNHnIqTevlYtLVO9WBtpkaEhQ==]
picked up by KevinMD [http://r20.rs6.net/tn.jsp?f=001xA_ZQxGO9wzPxQNs6pQUvN_Bi0ninsArpsa1HPjByiTcQcb-wSZx3JaJ2QA9Bkc3oVbZaeB0jrEM8cVBQp5aV0EzICQmc8kacU4pYIIbDpFnXarw7erhzAJZaM1C26yR7ReQBHaogxebiRyJC8xuFHZ-CWo4hUThrf8apBvM6Byl_WYsqiuCx1tEfmrTcVYHy2OdT0NlOqjOxL-ZCCC5bkbHSti1KikE_MV02wfMQm2JRNtYKyQArdUoUsSgbCHZ3yffif1HANozoEgpcAbciPyaIkU8x0T4i5lNKwphfvE=&c=EzMFGs_vTqRlPgV45Txh5Ko2OToRWzIr1NOt40RMScztKQFykc_PVw==&ch=p6DNJK2RQ1qbwyj6q2RMzfRXDI4OoUNHnIqTevlYtLVO9WBtpkaEhQ==]on
telemedicine as the next "sexiest" field of medicine
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Consulo Indicium

Information for your consideration and reflection...

Whither The American GDP - Rather than expanding, the American economy seems to 
be shrinking a bit.  The annualized rate of growth was recently projected as a paltry
0.8%, which is a sign of a struggling economy.  According to recent report, retail
sales have faltered along with corporate profits - although corporate retained earnings
are at an all time high, in the trillions of dollars!  This is generally the time
of year when we get a downturn (i.e. the winter months) so it was not totally unexpected.
 So, the Fed is thinking that the downward blip is only a temporary phenomenon. 
 Let's hope so...

Oops - The Diet Will Get You If The Cancer Doesn't! - In a recent report from Brigham
and Women's Hospital / Harvard Medical School, [http://r20.rs6.net/tn.jsp?f=001xA_ZQxGO9wzPxQNs6pQUvN_Bi0ninsArpsa1HPjByiTcQcb-wSZx3JaJ2QA9Bkc33QFNWNVvBlLzdmkYOfbPTc243Skcg-VIX2Gto_zXEKbOlXXH4LByfaVpRspgKGU1CSFtPdmFt-O1kzhDUraxrb2LSuIGDbeG_bhqMV6XdsBM646A3gPn4_5NAcO5Nrr1p79wMv-BBQSfGhoUXqR43KDQP6c12nwBNnX_fOZa7ejVsm-ygbs_6mCUpFThZGVIFO6S_21Y2desoI87bPCIrA==&c=EzMFGs_vTqRlPgV45Txh5Ko2OToRWzIr1NOt40RMScztKQFykc_PVw==&ch=p6DNJK2RQ1qbwyj6q2RMzfRXDI4OoUNHnIqTevlYtLVO9WBtpkaEhQ==]it
was reported that prostate cancer survivors who continue to consumer the "typical"
American diet filled with red meat, cheese and white bread are much more likely 
to see a recurrence of their cancer.  On the other hand, those who switch to a healthier
diet fared much better.  The findings only support the ongoing reports that the 
so-called Western diet makes health worse  [http://r20.rs6.net/tn.jsp?f=001xA_ZQxGO9wzPxQNs6pQUvN_Bi0ninsArpsa1HPjByiTcQcb-wSZx3JaJ2QA9Bkc36Yf_lJynsLV6ZsP_-CG3j_vWzlwl3YSMgcsLUEJq-JVF1ZYSgwImvw6WPJKhaK-PbKNDD8UL600n_hBNdMH0yLHCVh--bFALOuCTnsfuYJp84F6n-AupnF-tCtwiZJMEdyPWegynZ5-1qhI9FXjVkg7rDwKnhkZcaSgaqqnWmMNgKzr-5QB_8WzNSQ2Sg8guYvv9TzTyWEsfst5s_2uu7Q==&c=EzMFGs_vTqRlPgV45Txh5Ko2OToRWzIr1NOt40RMScztKQFykc_PVw==&ch=p6DNJK2RQ1qbwyj6q2RMzfRXDI4OoUNHnIqTevlYtLVO9WBtpkaEhQ==]for
cancer, [http://r20.rs6.net/tn.jsp?f=001xA_ZQxGO9wzPxQNs6pQUvN_Bi0ninsArpsa1HPjByiTcQcb-wSZx3JaJ2QA9Bkc3oAG1MNY3KVK37hNdgHj3fGq_HbyYnpSN_THEAbsV6faG6MFBVV_K9vmOvbQBS-kV9cFbDZUudTGro0pB_EAUA-Mo-yEEmPZGXOR9pVgiK3b-4x-MiARTqHDL5OMH2UzDlWOk2jngMnodPyiBN35-yEE70R3Iy6N8bHA8gVsVnyYvsqrCfDRI9GBzgtbJ82TBsUwZMq3HOk_aZKJSHuspJXG36VZDbUwHNayBm3fvgI8TzPG3RPJXjg==&c=EzMFGs_vTqRlPgV45Txh5Ko2OToRWzIr1NOt40RMScztKQFykc_PVw==&ch=p6DNJK2RQ1qbwyj6q2RMzfRXDI4OoUNHnIqTevlYtLVO9WBtpkaEhQ==]
heart disease,  [http://r20.rs6.net/tn.jsp?f=001xA_ZQxGO9wzPxQNs6pQUvN_Bi0ninsArpsa1HPjByiTcQcb-wSZx3JaJ2QA9Bkc3X4vLb6ZlpJXb3nYqV7FLKXd8oiweZNvHQDOlFdF8mMVF3gLuXRMZdaRNlLr59vB5y4Eq-i73g71Vi9XpR6G7nGfoelqPI1bf-tjZ_xeMixMDirYZO24nuaXKyFNtCviLVTYu1xQo9qRadAnrQuqdpCcT3wwfMUuPSrViXpdG1HVvkY51ZKpZGQ==&c=EzMFGs_vTqRlPgV45Txh5Ko2OToRWzIr1NOt40RMScztKQFykc_PVw==&ch=p6DNJK2RQ1qbwyj6q2RMzfRXDI4OoUNHnIqTevlYtLVO9WBtpkaEhQ==]Alzheimer's
and a host of other medical problems. Jorge Chavarro, MD the lead on the study noted
that "It's really not a shocking discovery." He noted in his report that many studies
have shown the risks associated with the Western diet versus the so-called Mediterranean-style
diets, with plenty of fresh vegetables and fruit, olive oil instead of saturated
 fat, whole grains and more fish than meat to diminish the incidence [http://r20.rs6.net/tn.jsp?f=001xA_ZQxGO9wzPxQNs6pQUvN_Bi0ninsArpsa1HPjByiTcQcb-wSZx3JaJ2QA9Bkc3jn3_7loyg1l1-dIoF6ERHW49n0EvwjPbqn6IQRKvfFsoZkvJv8CB4Re09-Q1ECv9WOsFHI2bw-flc3yY3O6YFlvJ9FHIYa195HlYXGXWe2grAaFQpQ6noVwoPeHufxPwQFagbcaaikW-dVIdQmTzMyTb246dP1ZD2ew4scyEyr-O5uPfs4q2R14Cqd474sc3f1adZcjaVPos-dEJqWaNBU9x-g68IuOm&c=EzMFGs_vTqRlPgV45Txh5Ko2OToRWzIr1NOt40RMScztKQFykc_PVw==&ch=p6DNJK2RQ1qbwyj6q2RMzfRXDI4OoUNHnIqTevlYtLVO9WBtpkaEhQ==]of
these same diseases.  Prostate cancer affects 240,000 men every year and 30,000 
die from the disease.  Even though I've temporized a lot compared to my youth, it
would probably be wise to give up the ways of my North Dakota younger days, which
very much follow the Westernized diet...

Gazing Into Toto's Eyes - In another report from Harvard Medical School [http://r20.rs6.net/tn.jsp?f=001xA_ZQxGO9wzPxQNs6pQUvN_Bi0ninsArpsa1HPjByiTcQcb-wSZx3JaJ2QA9Bkc3c00P1julqC9bNTuD-1cZng_afxW-fwosabba0lcLrztwDrRISKl3sAf_CP-78wEr3wCWeFRDNJ1oRqUUtp25J9pYmpIjkcDICcqdH8CI8vrmRgv3w119-31vJJVS7Ohf4zErAD1Ltn-7thsMqzusTlMZ09QEOn8FCN22tr9_Gew=&c=EzMFGs_vTqRlPgV45Txh5Ko2OToRWzIr1NOt40RMScztKQFykc_PVw==&ch=p6DNJK2RQ1qbwyj6q2RMzfRXDI4OoUNHnIqTevlYtLVO9WBtpkaEhQ==],
Dr. Elizabeth Frates noted that simply owning a dog can reduce a person's blood 
pressure, help people lose weight and assure that they maintain a healthy body mass
index. It's the trifecta of healthcare!  My dog - Toto - seems to agree.  He's on
a regime where I have to walk him every couple of hours or face the wrath of the
 puppy who finds all sorts of interesting places to make deposits throughout the
 house.  So, it's partly the required exercise from simply having a pet.  But, there's
more!  Dr. Frates also reported on the psychological benefits which are also attributed
to dog ownership because of reduced sadness, loneliness, stress, and anxiety.  And,
if that were not enough evidence, there is also data showing that when a dog owner
looks into a dog's eyes and pets the dog, the owner releases oxytocin [http://r20.rs6.net/tn.jsp?f=001xA_ZQxGO9wzPxQNs6pQUvN_Bi0ninsArpsa1HPjByiTcQcb-wSZx3JaJ2QA9Bkc3yYmC7qzDYnilz44pMXNAwwduFZEYJ6KfCxdIesaOqkZQu-4RgsNGfk0rMS2iix6hOZfz1fk7wNbN5HRCge3wnTC1YwHH5Fj7M0M2u8D5SKA95ORBrZv2g_Qi4ES2JRvHrz4uPPl_WEZSkW4fdFRwGHtqtq6TQNR-EFzkPCNhPDA=&c=EzMFGs_vTqRlPgV45Txh5Ko2OToRWzIr1NOt40RMScztKQFykc_PVw==&ch=p6DNJK2RQ1qbwyj6q2RMzfRXDI4OoUNHnIqTevlYtLVO9WBtpkaEhQ==]into
their blood stream - the love hormone.  The calming effect of petting a dog is something
I can clearly point to as a benefit of Toto's presence in my life.  So, the data
 continues to pile up that dog ownership makes difference in the health of their
 owners.  The same cannot be said about cat ownership; however.  At the same time,
I've notice that our cat - WillieNelson - keeps trying to warm up to me...

From Smoking To Sun Exposure - I predict that the next big push that will garner
 the backing of the public and the healthcare community will be sun exposure.  According
to the CDC, melanoma - which is only one of the cancer complications from sun exposure
- is going to increase from the current level of 19.7 incidents and death rate of
2.7 per 100,000, respectively.  At present, melanoma is the 5th most common cancer
in men and 7th in women.  The cost?  In 2011, the annual cost of treating newly 
diagnosed cases was $457 million and run about $3.3 billion in annual costs.  The
costs are expected to triple by 2030.  Implementation of preventive measures [http://r20.rs6.net/tn.jsp?f=001xA_ZQxGO9wzPxQNs6pQUvN_Bi0ninsArpsa1HPjByiTcQcb-wSZx3JaJ2QA9Bkc3L0koJ8bfwOSmHwbbdagzPRfJv35sHs48wYDrdMkLOSply--y9g_YYOuEzXs91iYiAJTyNjK_SgXiCQnKP5GpXeXnCychXYT8TRkUKNol0bKGCI000-WsUDA0rZdGCOo7SD4gdveweZd8R8ITRdkKG0K8fKIpY3TV&c=EzMFGs_vTqRlPgV45Txh5Ko2OToRWzIr1NOt40RMScztKQFykc_PVw==&ch=p6DNJK2RQ1qbwyj6q2RMzfRXDI4OoUNHnIqTevlYtLVO9WBtpkaEhQ==]is
very straight forward - reduce exposure to ultraviolet light.  In other words, protection
your skin from sunburn which affects 40% of Americans every year.  Yes, 40%!  Now,
if 40% of the public was smoking - would there be a backlash?  In fact, that's about
the percent of people that were smoking in the USA when efforts began to stop smoking
in public places.  The incidence how now dropped to just below 20% although vaping
has now increased the incidence of e-cigarettes.  Long story short, sun exposure
 is very much like smoking and lung cancer.

But, CMS Poised To Expose The Data - The Centers for Medicare and Medicaid Services
(CMS) recently announced that the agency will release its data to the private sector
with the expectation that it "...will create new streams of tools to improve care"
according to Andy Slavitt, the Acting Administrator.  In a move that will support
the continuing evolution of big data in healthcare, the Agency will also let private
organizations merge the data with private data when it starts accepting proposals
in September.  While it will not allow identification of individuals, it will allow
identification of providers.  Furthermore, new data will be released on a quarterly
basis rather than annually, a fairly dramatic shift for the federal government. 
 Slavitt, in announcing the CMS decision at Datapoloza (the annual healthcare data
confab in Washington, DC) encouraged the private sector to not focus on cool gizmos
but to "build products and service that help us take care of the sickest and most
difficult to treat people."

Accountable Care Organizations Options Improved - In another CMS announcement, a
 new final rule designed to improve the Accountable Care Organizations (ACO) shared
savings initiatives established by Section 3022 of the Accountable Care Act were
 announced in a number of areas.  The changes include:

* A  new Track 3 program, based on the Pioneer ACO initiative, will allow higher
 rates of shared savings, the prospective assignment of beneficiaries and the opportunity
to use new care coordination tools;
* Data sharing between CMS and ACOs will be streamlined to foster quality improvement
and care coordination;
* The 3-day stay Skilled Nursing Facility (SNF) rule will be waived for beneficiaries
that are prospectively assigned to ACOs under Track 3, which is a major improvement
that will allow for the more seamless extension of care for post-acute patients 
as they transition from the hospital to the home;
* Resets the ACO policies for benchmarking programs so that incentives for improving
patient care and generating cost savings are improved.

Over 400 ACOs are participating in the Medicare Shared Savings Program, serving 
over 7 million beneficiaries. Early results released last November indicated the
 Medicare Shared Savings Program ACOs starting in the first two years of the program
improved quality of care for beneficiaries, as ACOs improved performance in 30 of
33 quality measures.

According to an independent evaluation report [http://r20.rs6.net/tn.jsp?f=001xA_ZQxGO9wzPxQNs6pQUvN_Bi0ninsArpsa1HPjByiTcQcb-wSZx3JaJ2QA9Bkc3i7ex_7sRRoyQLCLv2hfTSQeLYo4_Fts-TeadmNuizmitCIEeinlwmKYLQ-KdSvMvSLKP7QHuuY9ssOZQedFuoqxFh30kAIaT9W2HJRM3y0rxfF8cG82DDru5lTpbeA8WlKaVNThnBBBSxnoo_dymZQb0DIxZ8vtajUVGWqVF2pbP-BwbdvE-fxoRsllKhKxkiwN-oUj9QIBd-WkSPY0FQA==&c=EzMFGs_vTqRlPgV45Txh5Ko2OToRWzIr1NOt40RMScztKQFykc_PVw==&ch=p6DNJK2RQ1qbwyj6q2RMzfRXDI4OoUNHnIqTevlYtLVO9WBtpkaEhQ==]
released by CMS earlier this month, the Pioneer Accountable Care Organization (ACO)
Model generated over $384 million in savings for the Medicare over its first two
 years - or an average of approximately $300 per beneficiary - and improved the 
quality on 30 of 33 measures.  These results have served as the stimulus for an 
early CMS decision to move toward 30% of Medicare payments being tied to value-based
models of care delivery in 2016 and, 50% by 2018.  As the largest payer of healthcare
benefits in the nation, Medicare sets the stage for where we are headed.  It's clear
that the move toward value-based from volume-based payment models is on a fast track.
 All of the private insurers are introducing products on this front as well.  The
move is creating transformational change in how, where and who is delivering care.

Post-Discharge Clinics Expanding - As one of the strategies for reducing readmissions,
hospitals are increasingly turning to post-discharge clinics according to a recent
Care Transitions Management Survey [http://r20.rs6.net/tn.jsp?f=001xA_ZQxGO9wzPxQNs6pQUvN_Bi0ninsArpsa1HPjByiTcQcb-wSZx3JaJ2QA9Bkc3j1ryEzVPPBMWshYDFD6hX-f_oWStYrpbmfGZnkE5Nk-z2jeaFfuezGMbyAdujtDHrMDw2isNK73qNjQoMHNJEQWgTGyt1N7zSG6FFY32lVFhkswRaABIR1rEhWFEVKXMGTrKHiEpVj2oplJU-4E8CdKa-9uIAqH7p9VyJp0CCHQ=&c=EzMFGs_vTqRlPgV45Txh5Ko2OToRWzIr1NOt40RMScztKQFykc_PVw==&ch=p6DNJK2RQ1qbwyj6q2RMzfRXDI4OoUNHnIqTevlYtLVO9WBtpkaEhQ==]
by the Healthcare Intelligence Network.  About one quarter of healthcare organizations
who responded to the survey are now offering these clinics.

If You're Curious About Your Own Demise - If you're so inclined, you may want to
 check out a new risk calculator [http://r20.rs6.net/tn.jsp?f=001xA_ZQxGO9wzPxQNs6pQUvN_Bi0ninsArpsa1HPjByiTcQcb-wSZx3JaJ2QA9Bkc3G1yGnq3tS_ttIgpKBaF2aZjePdL7jK8xhWjxYlyRLLR4OBfkKV7Kr4uk29JekWfB7UPfwaYCaC1AYAn8tThUuY9WZByjcslZut-0ADiiXU8qEU2EewQ-Xda0Iyg7gHTYefecvnyLwb0MXu9JRMaI4g==&c=EzMFGs_vTqRlPgV45Txh5Ko2OToRWzIr1NOt40RMScztKQFykc_PVw==&ch=p6DNJK2RQ1qbwyj6q2RMzfRXDI4OoUNHnIqTevlYtLVO9WBtpkaEhQ==]
that has been posted on the web from the United Kingdom.  You enter some data about
yourself and get an assessment of the likelihood of healthcare problems in the upcoming
years.  I tested out at about 10 years younger than my age so it appears that I'll
be around for a while.  Now, about that memory problem J.

Oncologists Call Out The High Cost of Cancer Drugs - The American Society of Clinical
Oncology (ASCO) just held their annual confab a couple of weeks ago and several 
speakers called for action on the need for evaluating the cost-effectiveness in 
the drug approval and insurance coverage processes for cancer care.  For example,
Deborah Schrag, MD, Chief of the Population Sciences at the Dana-Farber Cancer Institute,
presented some compelling data comparing two different monoclonal antibodies - bevacizumab
(Genentech) and cetuximab (Bristol-Myers Squibb) used for the treatment of metastatic
colorectal cancer.  The cost difference was substantial with the Genentech drug 
coming in at $9,324 for a course of treatment versus the BMS drug at $20,856.  At
more than double the cost but with the same results, there is a compelling case 
for using the less expensive alternative.  As a result, the oncologists were calling
for more scrutiny on the "value" equation for the many drugs coming to market, which
makes sense.  There are increasing fears among clinicians, policymakers and pharmaceutical
manufacturers that the rising cost of cancer drugs is creating a socio-economic 
divide in state-of-the art cancer care.  In fact, a number of advocates are calling
for the Food and Drug Administration (FDA) to include cost-effectiveness as a part
of the approval process for new drugs.  Such an approach would bring the USA into
conformance with other nations that now require their governments to consider such
costs and even negotiate with the drug companies on the cost of drugs for state 
run insurance programs.  As the present time, Congress prohibits Medicare from negotiating
drug prices.  Others, however, argued that the FDA may not be the appropriate agency
for evaluating the cost effectiveness of drugs because their primary role is evaluation
of clinical effectiveness.  The debate is not over and will no doubt continue with
the ASCO's annual report [http://r20.rs6.net/tn.jsp?f=001xA_ZQxGO9wzPxQNs6pQUvN_Bi0ninsArpsa1HPjByiTcQcb-wSZx3JaJ2QA9Bkc3ebI4TT51PFfXmJVa-C8z3q_zyxs08UZsWgpoEzW-_8KmLvsIA6TcNM1x_pfB5Ns8voDaTsVee5KrU0n3qJjWTWZY0unXV1ZOH1K7wk14kw4wTrJkW-jHtlb05D1t1LifSrAese4AdrbwxkE05NuTF7ph8O0kUy4y1ATUPScAFM5nSNiHMpPaUw==&c=EzMFGs_vTqRlPgV45Txh5Ko2OToRWzIr1NOt40RMScztKQFykc_PVw==&ch=p6DNJK2RQ1qbwyj6q2RMzfRXDI4OoUNHnIqTevlYtLVO9WBtpkaEhQ==]
noting that 7 of the 10 most expensive drugs covered by Medicare in 2013 were cancer
medications.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Future Health

Delivering care in the new virtual world...

Notes From China - I attended the China Health Information Management Association
as a keynote speaker this past week.  The conference was held in Xiamen, China whose
latitude is similar to Houston and where the weather seems to be about the same 
- humid.  One of the first speakers talked about the Fuijin Province is establishing
a Uniform Personal Identification Card that will be used across all platforms providing
access to all provincial information systems with one card held by the individual.
 The provincial team is now working on the possibility of moving toward a compulsory
rather than voluntary model for participation in the initiative.  The National Reform
and Development Committee has given preliminary approval of the approach being taken
in the province as a potential model for the rest of the nation.  The province is
also moving ahead with regulations to oversee how data is managed, integrated and
analyzed.  The approach reminds me of the book "Laboratories of Democracy" which
 noted that experimentation in the states has served as the incubator for federal
initiatives over time (e.g. post office, rail regulations, etc.).  We should more
aggressively consider using the model again in the US for the benefit of healthcare.
 China is moving forward along with Europe and much of the rest of the world.  As
I travel around the world, I'm not confident that we will continue to hold our position
of leadership related to healthcare innovation.  Now is the time to reassess our
 approach.

Are Designer Babies On The Horizon? - It is probably inevitable but we appear to
 be crossing the Rubicon ever so slowly but surely.  Sun Yat-sen University recently
published results where they revealed used a gene-editing tool on embryos to modify
the gene responsible for a blood disorder.  While the intent is good, it crossed
 the proverbial "red line" that researchers have held for this type of research 
over the years.  Only 4 of the 86 embryos was successfully transmuted through the
process and there were "unintended" genetic changes that also resulted in most of
the embryos.  As a result, the researchers halted the tests noting that the procedures
at this point are "too immature".  The whole issue has raised quite a stir in the
genetics community where the debate on next steps is hotly contested.  Some are 
arguing that such research could ultimately solve genetic problems such as hemophilia,
cystic fibrosis and other debilitating diseases.  There is clearly both "good" and
"bad" that will evolve from the research.  I have always believed; however, that
 we should not build brick walls that are supposedly impenetrable.  Rather, we should
determine how best to adapt and govern research in these areas.  In addition, this
is not a medical or scientific debate but a societal debate.  Much like nuclear 
armaments are a societal debate, we need to have everyone - from all perspectives
- weighing in the directions we should consider...

The Future Is Not Plastics, It's Mobility - Do you remember that famous scene in
 The Graduate where Dustin Hoffman is forewarned that the future is in plastics!
  Well, according to recent research released by Pew Research, the shift has been
from plastics to mobility.  Fully 64% of Americans now own a smartphone and about
25% of this population has only limited or no broadband availability at home aside
from the smartphone.  Furthermore, more than 50% of the mobile citizenry use their
devices to do more than simply calling, texting or browsing.  A full 62% use their
handheld devices for accessing information on health care concerns, 57% to handle
online banking, 43% to look up job information, 40% to search government services,
30% to obtain educational information and 18% to submit job applications.  The smartphone
is fast becoming the utilitarian everyman device.  The other interesting part of
 the report were the findings on how smartphone users "feel" about their device.
  The results:

* 54% believe it is not always needed but 46% couldn't live without it,
* 70% believe it gives them freedom but 30% feel it's a leash on their life,
* 72% feel it connects them but 28% find it distracting,
* 80% find it worth the cost while 19% find it to be a financial burden.  I guess
the other 1% don't know?; and,
* 93% find them helpful while 7% view the smartphone as annoying.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Article Of The Week

Information for your Consideration...

Toto Hits The Big Time - I received a notice last week that Investor's Business 
Daily [http://r20.rs6.net/tn.jsp?f=001xA_ZQxGO9wzPxQNs6pQUvN_Bi0ninsArpsa1HPjByiTcQcb-wSZx3JaJ2QA9Bkc3p0rhKV8hTeR9zegpBPKOVtq2pNPIhHxNI2Kayp72H-MGnK_LZML-ESI4waEObA4Y8wRzgUdJDQ0mbG6AlBmA7zFv0jjAfPbWRIVLcCmrZRWq0lV4bGxWawDMYNfDDksihO01PhrDSWV89XqVQZ4y7NcLjPVPN6KHrMfDA8MMzHokG6mDU0BF8oQlEaHECJuQE305cZFv-JspBqgSwDtj9uISClYP6Gbg2PiGdItxBwaejmXiPQnkTW5FxnJzHUTy6DOoU7Vo_Rc=&c=EzMFGs_vTqRlPgV45Txh5Ko2OToRWzIr1NOt40RMScztKQFykc_PVw==&ch=p6DNJK2RQ1qbwyj6q2RMzfRXDI4OoUNHnIqTevlYtLVO9WBtpkaEhQ==]decided
to do a piece on the "lessons of leadership" derived from music and books.  Nonetheless,
I was quite excited when they let me know that Toto's Reflections: The Leadership
Lessons From The Wizard of Oz [http://r20.rs6.net/tn.jsp?f=001xA_ZQxGO9wzPxQNs6pQUvN_Bi0ninsArpsa1HPjByiTcQcb-wSZx3JaJ2QA9Bkc3GI8LxzBiD0zYjrl21QzoitGzbos8GUfwYM3dJp7P05Dm419eN5HTbpmtnX4NyhClOdfhiv3SxkxakCYEe3vJtbltVGaSPyumgcCovkY5N0rde6udEtKwUlp-he0Q_8jygRy0sONUYbNH34mQOClvVvCQkDi_43VvRxgErgPGIfGihGnG8-KHbFIEVRRah5i-jYKuMZMJVauuujaqmbL_q8KoH1UUb68aMRoUYiEwZP1qYLzcyt9zMHj04DwrKaLjYwtlrYyzgbwd-4aM9C6zhc87NcuPS8NAY-zTf2zDGvT0-n6nXjoKOF0JyJlr2j_WQZaJYBp2o4M=&c=EzMFGs_vTqRlPgV45Txh5Ko2OToRWzIr1NOt40RMScztKQFykc_PVw==&ch=p6DNJK2RQ1qbwyj6q2RMzfRXDI4OoUNHnIqTevlYtLVO9WBtpkaEhQ==]had
been selected as a prime example.  So, I sheepishly offer Kudos to Kevy!!

The Healthcare Tax - In an article that recently appears in Forbes [http://r20.rs6.net/tn.jsp?f=001xA_ZQxGO9wzPxQNs6pQUvN_Bi0ninsArpsa1HPjByiTcQcb-wSZx3JaJ2QA9Bkc3UW89ZJ2L-ntWmCS5xJbSjzK8r1ds1Os22eLT0YDASIAGpm0sR9H5tF0lSzrlH8-lIgD-wKq2L-VFC1Mshujc4b2sT8QGPEFxZbL6xFCOGsSwqVRfSUXLJRKQynhI0G9k51NzGmqfVscHJap2c1bj2ul3HywtpFKE0okZB2n4D50-H0Cc-iQ9rZsBqYI8mOhn3_-X9FOY7bjBociGesZDefOmYl6aKPq-&c=EzMFGs_vTqRlPgV45Txh5Ko2OToRWzIr1NOt40RMScztKQFykc_PVw==&ch=p6DNJK2RQ1qbwyj6q2RMzfRXDI4OoUNHnIqTevlYtLVO9WBtpkaEhQ==],
David Chase contributes a very interesting piece that will surely find attention
 in the non-healthcare C-suites around the nation over the next year.  He discusses
a new book by James Clifton, Chairman of Gallup on The Coming Jobs War [http://r20.rs6.net/tn.jsp?f=001xA_ZQxGO9wzPxQNs6pQUvN_Bi0ninsArpsa1HPjByiTcQcb-wSZx3JaJ2QA9Bkc3UW89ZJ2L-ntWmCS5xJbSjzK8r1ds1Os22eLT0YDASIAGpm0sR9H5tF0lSzrlH8-lIgD-wKq2L-VFC1Mshujc4b2sT8QGPEFxZbL6xFCOGsSwqVRfSUXLJRKQynhI0G9k51NzGmqfVscHJap2c1bj2ul3HywtpFKE0okZB2n4D50-H0Cc-iQ9rZsBqYI8mOhn3_-X9FOY7bjBociGesZDefOmYl6aKPq-&c=EzMFGs_vTqRlPgV45Txh5Ko2OToRWzIr1NOt40RMScztKQFykc_PVw==&ch=p6DNJK2RQ1qbwyj6q2RMzfRXDI4OoUNHnIqTevlYtLVO9WBtpkaEhQ==].
The article is definitely worth a read for any leader in healthcare who is strategically
trying to position their organization for the future.  In essence, Chase discusses
the hidden corporate tax that is levied by inefficient or non-value oriented healthcare
delivery systems and how that will impact the long-term ability of a community to
attract and retain jobs in the future.  He argues that to the extent healthcare 
systems do not offer "value" is to the extent that they will hamper their community's
ability to realize long-term, sustainable economic growth.  That means that over
 the longer term, Minneapolis is in a far better position than Boston for creating
and sustaining economic growth.  Portland will be better than San Francisco.  And,
the list goes on.  The ideas are worthy of a debate...
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

The Weekly Whisk

Musings from a foodie...

I've only had the opportunity to visit Vancouver, British Columbia a couple of times
but each visit has been well worth the effort.  My most recent visit was no exception.
 So, I planned my culinary visits with gusto.  I selected the Fish House [* * *]
 nestled amidst the wonderful gardens of Stanley Park in part because of its location
but also because of its focus on seafood.  While I was prepared to indulge in exceptional
seafood, I would only rank the food as mediocre.  The wait service was great and
 the view absolutely wonderful.  We had a view from the deck and watched all of 
the tourists walking about along with the locals.  So, I won't even get into the
 specifics.  Nothing was very memorable except the location and that all of the 
seafood was sustainable.  I guess it would be worth that if for nothing else.  Go
there for ambiance. Fish House in Stanley Park - 8901 Stanley Park Drive - Vancouver,
BC, Canada - (604) 681-7275 -www.fishhousestanleypark.com [http://r20.rs6.net/tn.jsp?f=001xA_ZQxGO9wzPxQNs6pQUvN_Bi0ninsArpsa1HPjByiTcQcb-wSZx3JaJ2QA9Bkc3Fs9hODEMF3ViHzksA1vTi3JTjq7fvU7x_Q06-015EF611qGTfhKBvl1aSUwMIcmsfmpsuGvtBZZzEbEgXsG-z7obMte8fweoFg0dWUv5SZASLEoNP3qjI8SkV7quJExW&c=EzMFGs_vTqRlPgV45Txh5Ko2OToRWzIr1NOt40RMScztKQFykc_PVw==&ch=p6DNJK2RQ1qbwyj6q2RMzfRXDI4OoUNHnIqTevlYtLVO9WBtpkaEhQ==].
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

The Good, The Bad, And The Ugly

The ongoing saga...

The Great - The passage and subsequent signing of Medicare into legislation by President
Lyndon Johnson on June 30, 1965 will go down as one of the most important pieces
 of legislation to be passed by any Congress in my estimation.  The provision of
 healthcare services for the elderly has reduced poverty among the elderly, maintained
equitable access to services, and fueled the growth of care delivery as a right 
for all citizens in the nation.  Kudos to all who were involved - and, the list 
is very long...

The Good - The US Department of Labor announced that an additional 280,000 jobs 
were added in May which was good news for those who keep their eyes on the economy.
 The official unemployment rate ticked up to 5.5%.

The Bad - The uptick in healthcare prices by an additional 7% portends ongoing escalation
in costs in an environment that is increasing demanding accountability and value.

The Ugly - The sad state of affairs of the international community in managing the
"boat people" fleeing war and persecution in various nations for the security of
 any place but home.  Surely, the world community can do better...

The statements in The Fickenscher Files are the personal views of Kevin Fickenscher,
MD and do not reflect the views or policies of any organization with which he is
 affiliated.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

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