Paying doctors for referrals isn't very smart

By Lisa Schencker | July 28, 2016

South Carolina's Lexington Medical Center will pay the government $17 million over allegations that it paid 28 physicians unreasonably high amounts in exchange for referrals.

A whistle-blower and the government alleged that Lexington bought access to patients by acquiring physician practices and then paid the doctors “commercially unreasonable compensation” with the expectation that they would make referrals to Lexington.

Lexington, a 416-bed hospital in West Columbia, S.C., has denied any wrongdoing and said in a statement Thursday the settlement (PDF) allows it to avoid “continued costly litigation that could have lasted for several years.”

“While Lexington Medical Center was prepared to vigorously defend the case and to demonstrate why it believes the compensation paid to Lexington Medical Center employed physicians is in accordance with all laws and regulations, the outcome of this inquiry reflects the challenges hospitals face navigating highly complex employment law regulations for physicians,” Lexington said in the statement.

Lexington CEO Tod Augsburger said in a statement that the hospital will “continue to strengthen our efforts to ensure full compliance by evaluating internal and external processes.”

The government alleged that Lexington's actions violated the Stark law, which prohibits doctors from referring Medicare patients to hospitals, labs and other doctors that the physicians have financial relationships with unless they fall under certain exceptions.

The government alleged that the hospital's supposed Stark violations, in turn, led to the submission of tainted claims to the government in violation of the False Claims Act.

The lawsuit was originally brought by whistle-blower Dr. David Hammett, who was formerly employed by Lexington. In successful False Claims Act cases, whistle-blowers are entitled to a portion of whatever money the government is able to recover. Hammett will get about $4.5 million.

Hammett, a neurologist, was part of a practice that Lexington bought in 2011, and he became employed by Lexington then. He alleged that Lexington pressured him and others to refer patients for services at Lexington and fired him after he continued to refer patients to other providers for MRIs.

The Lexington settlement is one in a recent string of settlements between the government and providers over similar allegations.In September 2015, Florida-based North Broward agreed to pay the government $69.5 million for alleged violations of the Stark law and False Claims Act. North Broward did not admit to any wrongdoing.

Also in September of last year, Florida-based Adventist Health System settled a similar case for $118.7 million. Adventist said in a statement at the time it has changed its process for setting physician compensation and regretted oversights.

In October of last year, Tuomey Healthcare System in Sumter, S.C., agreed to settle with the government for $72.4 million, resolving allegations that it paid doctors for referrals.

Many have criticized the Stark law as overly complex and confusing, and a Senate committee held a hearing this month on the issue after releasing a white paper that said the Stark law has created “a minefield for the healthcare industry.”

Is BIG MEDICINE coopetition the answer for small medicine?

Arlen Meyers, MD, MBA
President and CEO, Society of Physician Entrepreneurs

Published on July 27, 2016

As BIG MEDICINE gets bigger, the state of private practice is precarious and facing several existential threats. Regulatory, legal and IT mandates that don't work for small medicine further add to the burden.

While small medicine, independent, practitioners are gradually adapting, most have a "we v them" attitude and they are trying to carve out a niche based on varying business models and service excellence e.g direct primary care, using digital health technologies and pushing patient empowerment to improve the patient and doctor experience at lower cost.

More and more companies – from start-ups to incumbents– are taking a less literal approach to pursuing competitive advantage. They’re discovering untapped value potential by engaging industry rivals with a hybrid strategy of cooperation and competition, or “coopetition”. Coopetition can take many forms in sick care:

1. Integrating urgent care centers and retail based clinics into your care delivery model

2. Sharing information

3. A hybrid practice model where independent practices become part of a major integrated health system

4. Building cross referral relationships

5. Opportunities for educating and training medical students and residents

6. Translational research opportunities and human subject study patient recruitment

7. Finding common clients, like patients, and working together to lower costs or advance a mission

8. Recognizing that you are all part of the same tribe.

9. Cooperating to minimize inter-system hand off errors

10. Fighting unprofessional courtesies

Finding a middle ground is not just a practice strategy, but a policy strategy as well as we approach the November elections.

Fighting tooth and nail is one competitive strategy. "If you can't beat them, join them" is the other extreme. Coopetition might be a a reasonable and more practical middle ground.

Arlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs at www.sopenet.org and author of the free, updated Blogbook of Physician Entrepreneurship at www.hcplive.com/contributor/arlen-meyers-md-mba

Digital contact lens patented by Google aims to change the course of diabetes management by measuring blood glucose levels from tears.

Google submitted a patent to the US Patent & Trademark Office in 2014 that described a digital, multi-sensor contact lens that can also detect blinking, with benefits like turning the page of an e-book with a “blink of an eye”. Later, more details about the idea emerged, revealing a much more transformative use for the contact lens – measuring blood glucose from tears.

How will the digital contact lens help diabetes patients?

Sensors are embedded between two soft layers of lens material and a pinhole in the lens allows tear fluid to seep into the sensor and be used to measure blood sugar levels. A wireless antenna, thinner than a human hair, will act as a controller to communicate information to the wireless device. Data will then be sent to an external device. Google engineers even considered adding LED lights that could warn the wearer by lighting up when the glucose levels have crossed above or below certain thresholds, but abandoned the idea as the arsenic content of LED could prove dangerous.

The contact lens analyzes blood glucose level every second and transmits the data to an associated app. Detailed readings are available at a tap on your phone. When blood sugar crosses certain thresholds, the app notifies you instantly to act, or to contact a physician if the situation is serious.

Keeping blood sugar levels optimal all day, avoiding spikes or lulls during sleep – these everyday problems wouldn’t depend on pure luck anymore. You could also forget about pricking your finger several times each day. As one of the most powerful ways technology will change diabetes management, it sounds like utopia.

But when and how will diabetes patients be able to get their hands on this technology

How is development progressing?

Developing the digital contact lens was first assigned to GoogleX, the “moonshot” lab of the company. But today it seems Verily, Alphabet’s healthcare spin-off is working on it. The company is reportedly discussing the technology with the FDA to make sure it will meet their recommendations. To develop it for use in healthcare, they also partnered with Alcon, the pharma company Novartis’ eye care division. By having a pharma partner with experience in eye products, entering the market could be faster, and they might also tackle regulatory issues more easily.

Novartis wants to provide a way for diabetic patients to keep on top of their glucose levels by feeding the data back to a smartphone or tablet. Google’s original vision is also still on the table – helping restore the eye’s natural focus on near objects, restoring clear vision to those who are farsighted (presbyopia).

“Our dream is to use the latest technology in the miniaturization of electronics to help improve the quality of life for millions of people” Google co-founder Sergey Brin.

The prototypes being tested can generate a glucose reading once per second, and are used to help farsighted people as well.

Though Google is the first to tackle diabetes with a digital contact lens, they aren’t the first to start developing one as a vision aid. US researchers used graphene in a lens to detect the entire infrared spectrum with visible and ultraviolet light – enhancing human vision by increasing the number of frequencies we can detect. Chinese researchers have successfully developed an invisible electrical circuit inside a polymer used for making contact lenses. A Swiss startup Sensimed has been given the green light by the FDA for its smart contact lens that aims to tackle glaucoma, a common cause for blindness. It uses a soft silicone contact lens that’s embedded with a microsensor which can be worn for 24 hours, even during sleep. But still Verily has the biggest potentials in reaching the critical mass with such a product.

Among all of these companies, Verily has the best shot to release a widely available product – the technology is set to be released for general usage around 2019, but trials are expected to start later this year. But to launch successfully, they must learn from the failure of another Google moonshot.

More details, videos and full article here

Watch how Vanderbilt is using a microchip to build a first-ever artificial kidney

Vanderbilt University Medical Center nephrologist and Associate Professor of Medicine Dr. William H. Fissell IV, is making major progress on a first-of-its kind device to free kidney patients from dialysis. He is building an implantable artificial kidney with microchip filters and living kidney cells that will be powered by a patient’s own heart.

"We are creating a bio-hybrid device that can mimic a kidney to remove enough waste products, salt and water to keep a patient off dialysis" said Fissell.

Fissell says the goal is to make it small enough, roughly the size of a soda can, to be implanted inside a patient’s body.

Watch the video here

Nanotchnology

The key to the device is a microchip.

“It’s called silicon nanotechnology. It uses the same processes that were developed by the microelectronics industry for computers,” said Fissell.

The chips are affordable, precise and make ideal filters. Fissell and his team are designing each pore in the filter one by one based on what they want that pore to do. Each device will hold roughly fifteen microchips layered on top of each other.

But the microchips have another essential role beyond filtering.

“They’re also the scaffold in which living kidney cells will rest,” said Fissell.

Living kidney cells

Fissell and his team use live kidney cells that will grow on and around the microchip filters. The goal is for these cells to mimic the natural actions of the kidney.

“We can leverage Mother Nature’s 60 million years of research and development and use kidney cells that fortunately for us grow well in the lab dish, and grow them into a bioreactor of living cells that will be the only ‘Santa Claus’ membrane in the world: the only membrane that will know which chemicals have been naughty and which have been nice. Then they can reabsorb the nutrients your body needs and discard the wastes your body desperately wants to get rid of,” said Fissell.

Sanford Health steps up precision medicine with pharmacogenomics program

By MARK TAYLOR

One of the country’s largest rural health systems is tackling the challenge of providing precision medicine in integrated health settings. Sanford Health, a 43-hospital, not-for-profit health system based in Sioux Falls, South Dakota, announced this week it has contracted with Bellevue, Washington-based Translational Software to provide pharmacogenomics services to its hospitals and nearly 250 clinics in nine states.

Sanford, which employs 27,000, is expanding its genomics program — calledImagenetics — throughout the organization’s Epic Systems electronic health records. Sanford Imagenetics integrates genetics and genomic information into primary care for adults, providing drug and gene information, as well as clinical decision-making and prescribing support.

Translational Software CEO Don Rule said that with clinical reporting data now available for nearly 40 genes, his company’s platform can be adapted to target clinical specialties like cardiovascular health, psychiatry, pain management and oncology. Rule said that digitizing biology is driving his company’s efforts to tailor medicines for individual patients.

“What we do is take data from labs that have performed genetic testing and apply what we know about individual patients and show their physicians that certain drugs are unlikely to be useful and may even be toxic to someone with their profile,” he explained.

He said that there now is much evidence to be gleaned from Food and Drug Administration drug approval testing data, information that Rule’s company inputs to form recommendations.

“Rather than giving a patient a common drug and knowing it is probably ineffective in 20 percent of patients, genetic tests will tell patients and their doctors when particular drugs would not be useful and suggest the physician switch to an alternative drug,” Rule said.

He said that Sanford will look for patients in its population who will benefit from this knowledge.

“They’re going to be able to scale it in two dimensions, involving many more people and doing this in in an automated way. It is architectured into their EHR, which will be easy to update with new information. And we can send warnings and alerts about prospective problems,” Rule said.

Rule said five-hospital, Fairfax, Virginia-based Inova Health System was the first to implement Translational Software’s program. But the Sanford deal represents a new step for the vendor.

“This is our opportunity to democratize the use of genetics data in a clinical setting: to provide data that is safe and easy and reliable. This is closer to common use than people realize. The labs are willing to do it. There is now good data on drugs,” he said.

Dr. Cornelius Boerkoel, executive director of the Sanford Imagenetics Research Center on Genomic & Molecular Medicine, offered the organizational perspective on this precision medicine program. “[T]he new pharmacogenomic software enables physicians to efficiently and effectively take the genomic detail of patients and interpret that through Translational Software to provide guidance around prescribing,” Boerkoel said.

“Pharmacogenetics as implemented around the country is the beginning of the arrival of precision medicine, where we can recognize the individuality of the patient and prescribe medication accordingly,” he said.

Boerkoel said he expects to find more appropriate prescribing system-wide and fewer adverse side effects.

“Reducing those should save the system money and lower morbidity in patients,” he predicted. “Will it save patients money in the long run? One would hope so. If it reduces adverse drug reactions, that should lower the costs of ins

Predictive analytics: Is this the wave of the future for orthopaedic surgery?

Written by Richard A. Conn, MD, Medical Director, Stryker Performance Solutions & Mary Frances Delaune, MPH, Program Manager, Stryker Performance Solutions | July 19, 2016


While transparency in healthcare delivery and reporting was a mainstream topic in 2015, Predictive Analytics looks to play a major role in orthopaedic practice protocols for years to come.

With the Accountable Care Act and payment reform, hospitals and surgeons are finding themselves placed at risk for the outcomes of patient care. Whether in a bundled payment or Accountable Care Organization Payment Model, the risk of poor patient outcomes either clinically or financially is a real concern.

Enter the world of Predictive Analytics! Predictive Analytics has been defined as "the branch of the advanced analytics which is used to make predictions about unknown future events1." While historically used in many business segments, the use of Predictive Analytics has taken hold in orthopaedic surgery as a means to quantitatively predict various outcomes of joint replacement patient care.

A risk for hospitals and surgeons in a bundled payment model is the discharge status of a patient to either a skilled nursing facility or to home. Data has shown that the clinical outcome of patients discharged home is equivocal to those who are sent to skilled nursing facilities2. Both the Risk Assessment and Prediction Tool (RAPT)3 and the AM-PAC 64 clicks tool developed at the Cleveland Clinic have been developed to assist surgeons in predicting the discharge of joint replacement patients to either a skilled nursing facility or home. With only 6 questions, the RAPT is simple and predictable in terms of probable discharge disposition for total joint replacement (TJR) patients.

With a move towards performing more traditionally inpatient joint replacement procedures as a short-stay or outpatient procedure, the ability to accurately predict whether a TJR patient could be discharged from a facility within 24 hours becomes very helpful information. Dr. Michael Meneghini and Dr. Pete Caccavallo in Indianapolis, Indiana have developed a tool they refer to as Outpatient Arthroplasty Risk Assessment5 (OARA). The OARA tool is a 60 question document that allows the pre-assessment provider (hospitalist/anesthesia) to place a percentage risk of time of discharge on potential TJR patients.

Recently, IBM has announced that they will be utilizing Watson to scan data and create outcome predictive analytics in the field of orthopedic surgery. Many other forms of predictive tools have been developed including the AJRR Risk Stratification tool6.

As healthcare continues to change so will the need for more Predictive Analytic tools to assist facilities and providers in crafting the most effective care plan for TJR patients with a predictable outcome.

Tracking patients between visits: A new care model

Tracking patients between visits: A new care model
From an AMA Wire article posted on 7/19/2016

As the health care system transitions to value-based care, new models of care will be a critical part of the new Medicare payment system. Learn how one physician is using a new model of care to track patients in between face-to-face visits in his practice.

What patients and submarines have in common
Imagine your patients, as you probably do every day, out in the world living their lives. You may wonder if their treatment is working, their medication is causing any side effects, their blood pressure is rising or any number of possibilities that could be percolating unknown—but you can’t find out until they come in for their next visit or call your practice or head to the hospital with an emergency.

“Patients are like submarines … out there submerged,” said Lawrence Kosinski, MD, a gastroenterologist and founder and chief medical officer of SonarMD. “We can’t see them; we don’t know how they are [because] they only come in when they’re in trouble. Which means that, number one, they have to recognize that they’re in trouble and, number two, realize that they can’t fix it themselves …. So we need a sonar system to ping them.”

Two years ago, Dr. Kosinski created SonarMD, a web-based platform that pings patients once a month with a set of validated questions, which allows his practice to get out ahead of any complications or progressing medical issues before an emergency occurs. And his practice has been using it since June of last year.

How it works

Dr. Kosinski led the development of an initiative known as Project Sonar, which is an intensive medical home for the management of Crohn’s disease created in partnership with Blue Cross Blue Shield of Illinois. SonarMD is the platform that coordinates with their electronic health record (EHR) system to help identify emerging health issues before they result in hospitalization.

“What we’ve created is a sonar system that pings patients in between their face-to-face visits,” Dr. Kosinski said. “One of the main issues that results in high complication rates in the patient population is that they don’t recognize they’re deteriorating when they’re deteriorating. They don’t call the physician; they don’t reach out for help, and bad things can happen to patients in the long-run.”

“If we ping them in between visits with a structured set of questions,” he said, “we get to intervene before anybody realizes things are getting bad.”

Working with Blue Cross Blue Shield of Illinois, Dr. Kosinski’s practice enrolls all of their inflammatory bowel disease (IBD) patients in SonarMD. “[The insurer] pays us a monthly management fee for these patients, and part of that payment goes to the medical practice, and part of the payment goes to SonarMD to manage the platform [and] the data,” he said.

The patient has an initial enrollment visit, and a nurse care manager works with the patient to set up an action plan for the goals they want to accomplish. “We assess barriers to attaining those goals,” Dr. Kosinski said. “It creates a team-based approach of physicians and nurse care managers interacting with patients.”

The pings go out automatically on the first Monday of every month with a set of questions to identify and track symptoms and developing conditions. It takes patients about one minute to answer all of the questions, and SonarMD calculates a “Sonar Score.” If the score is rising, that means something may be wrong, and the nurse care manager coordinates with the physician to contact the patient or bring the patient in for a visit.

Since they began using the SonarMD platform, Dr. Kosinki’s patients have responded at a rate of approximately 80 percent.

“We built parameters into an algorithm so that the scores change colors at certain levels,” he said. If the physician needs to be brought in, the nurse care manager goes into the EHR and sends a message to alert the physician that a patient’s score is rising. The nurse care managers monitor about 100 patients each.

“We’ve demonstrated a 10 percent decrease in cost of care in these patients over a year,” he said, “driven largely by a 50 percent decline in inpatient costs. So we’re keeping them out of the hospital, we’re keeping them healthy, we’re keeping the costs down, and the patients are happy.”

SonarMD started with IBD patients, but Dr. Kosinski and his colleagues have expanded it to irritable bowel syndrome and are now working on expanding it to End Stage Liver disease and Gastroesophogeal Reflux disease. “Our goal is to be able to handle over 50 percent of the encounters for a gastroenterologist so we can actually function as an alternative payment model (APM),” he said.

Making sure that SonarMD fits into the new payment system as a qualified APM is a challenge, he said.

“We’re trying very hard to do everything we have to stay in the game,” Dr. Kosinski said, speaking as a member of the governing board of the American Gastroenterological Association. “It’s very important that we are part of the solution to the problem.”

Watch for podcast interviews from ReachMD in the coming weeks with Dr. Kosinski and Robin Zon, MD, who will discuss her oncology APM and MACRA.

5 things I learned working with Uber's Travis Kalanick to secure funding

Before there was an Uber and before the company I co-founded, Kareo, raised over $100M, I was trying to raise capital for a medical management company I founded.

Travis Kalanick, who went on the become founder of Uber, was CEO of a peer-to-peer file sharing company Red Swoosh at the time and had previously worked with my CTO, Dan Rodrigues, who went on to become CEO of Kareo.

Fund raising efforts on my own were not yielding results so Dan introduced me to Travis as someone who could open doors. Dan was right, not only was Travis incredibly well connected, even back then, but he was able to get me meetings with both very deep pocketed private equity as well as high end venture capitalists. Working with Travis, I also quickly learned:

• Have someone make an introduction. There's no point in trying to talk with any institutional investors (VC, PE etc) without a personal introduction from someone who knows that person. Without an introduction any information, plans, texts, emails etc are much more likely to go into the trash than be responded to and will simply be a waste of everyone's time. If you don't have introductions, network with others until you find contacts with the connections you are looking for. 

• Be prepared, very prepared. Do not buy into the myth that you just need a good idea. Once a meeting has been secured be ready to clearly articulate why a viable business opportunity exists. Identify how and why your concept/product/software solves problems, eases "pain points" or cures market inefficiencies. Provide a road map of where the company is going and how it will get there. Provide detailed metrics for meeting key milestones and how your strategy will be implemented. Define the risks of executing the business strategy and the solutions to mitigating those risks.  By demonstrating a grasp of these fundamentals, you are conveying confidence to investors whether your venture can generate sustainable revenue, will be profitable and can be done in a reasonable time frame.

• Don't be defensive if the response is negative. Do not debate the decision and try to counter their arguments with counterpoints. Listen carefully as they'll have insights and observations that you may not have thought of. Some of the best feedback you'll ever get will be from investor meetings so use the opportunity to learn why they said no. Rejection doesn't mean your concept isn't viable, it just means that it isn't right for that particular investor. Don't forget, investors pass on good ideas every single day. 

• Don't look to others to secure your funding. While there's a place for consultants to assist, don't expect anyone, other that you (founders, CEO's) to lead you or secure capital on your behalf. If you're not passionate and driven by what your doing investors will pick up on that very quickly. Investors back people as much, if not more, than ideas. Be the person that is worth being backed by being the driving force behind your concept

• Do investor due diligence . Make sure your potential investor is a fit before taking a meeting. Find out what their preferred industry/market/sector is, are there any geographic limitations or preferences, are there any conflicts, and/or synergies, with other investments they've already made, what are there investment parameters size/range, how are their investments typically structured, what are the exit preferences. 

Healthcare spending tops $3.35 trillion - that's $10,345 per person

The United States spent a total of $3 trillion, or 17.5 percent of gross domestic product, on health care in 2014, the last year for which hard numbers are available, according to Sean Keehan, an economist at the CMS Office of the Actuary, and other economists and actuaries at the Office of the Actuary.

Forecasters are expecting national health expenditures will hit $3.35 trillion this year, which works out to $10,345 for every man, woman and child. The annual increase of 4.8 percent for 2016 is lower than the forecast for the rest of the decade.

Future predictions see spending increasing to a total of about $4 trillion, or 18.5 percent of GDP, in 2019, and $5.6 billion, or 20.1 percent of GDP, in 2025.

Estimates are that spending will rise 5.7 percent in 2019 and 6 percent in 2025, driven in part by a stronger economy, faster growth in medical prices and an aging population. Medicare and Medicaid are expected to grow more rapidly than private insurance as the baby-boom generation ages. By 2025, government at all levels will account for nearly half of health care spending, 47 percent.

How MACRA is on track to fundamentally change how physicians are reimbursed

Survey: Low Physician Awareness, Lack of Preparation for MACRA

 Posted in Healthcare Informatics

July 14, 2016
by Heather Landi

According to both independent and employed physicians surveyed, a third to two-thirds of remaining independent physicians will consolidate in the next three years due to MACRA and overall financial pressures in healthcare.

While the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is on track to fundamentally change how physicians are reimbursed under the Medicare Physician Fee Schedule (PFS), half of surveyed physicians have never heard of MACRA, according to a new survey by Deloitte.

The Deloitte Center for Health Solutions polled 600 physicians for thesurvey, with the aim of gauging physician awareness of MACRA as well as physicians’ perspectives on the law's implications and their attitudes toward and readiness for change. MACRA applies financial incentives for healthcare professionals to participate in risk-bearing, coordinated care models and to move away from the traditional fee-for-service system. MACRA’s final rule from the U.S. Centers for Medicare & Medicaid Services (CMS) is expected this fall, and the first performance reporting period, as it stands now, will begin January 1, 2017.

Although, as reported by Healthcare Informatics’ Managing Editor Rajiv Leventhal, CMS Acting Administrator Andy Slavitt left open the possibility of delaying the start date for MACRA during a recent U.S. Senate Committee on Finance hearing.

The survey findings indicate that 50 percent of non-pediatric physicians have never heard of MACRA and 32 percent only recognize the name “MACRA.”

Additionally, 21 percent of self-employed physicians and those in independently owned medical practices report they are “somewhat familiar” with MACRA compared to 9 percent of employed physicians surveyed, according to the Deloitte press release announcing the survey. As self-employed and independent physicians are more directly responsible for their practices’ business requirements, that could be the reason for the difference in awareness levels.

The survey also found that physicians with a high share of Medicare payments are just as unaware of MACRA as others.

“The changes associated with MACRA are fast approaching,” Anne Phelps, principal, Deloitte & Touche LLP, and U.S. health care regulatory leader, said in a prepared statement. “The first performance reporting period begins January 1, 2017. The fact that so many physicians and clinicians still haven't heard of the law means they'll have a lot of work to do over the next five months, including evaluating current payment processes and understanding how physicians are organized within their hospitals or practices.”

Recently, as reported in Healthcare Informatics, the U.S. Department of Health and Human Services (HHS) announced $100 in funding for on-the-ground MACRA training and education for Medicare clinicians in individual or small group practices.

According to the Deloitte survey, many physicians surveyed recognized they will need new capabilities in order to bear increased financial risk, especially supporting capabilities as it relates to reporting. Not surprisingly, 42 percent of surveyed physicians would like standardized quality measures, 29 percent cited the need for analytics and other monitoring tools to track high-cost patients and 28 percent cited the need for standardized cost measures.

MACRA offers financial incentives for physicians and clinicians to move growing percentages of their practices to risk-bearing, coordinated-care models but, according to the survey, most physicians would have to adjust their current approach and practice management to meet the law's requirements and do well under its incentives.

Currently, physicians have low preference for most value-based payment models, according to the survey, with nearly 8 in 10 physicians surveyed preferring fee-for-service or salary for their compensation.

Additionally, 71 percent of physicians would participate in value-based payment models if offered financial incentives to do so, and 52 percent would opt for sharing savings, which is not a qualifying Advanced Alternative Payment Model (APM) under MACRA.

Presently, performance bonuses are less than or equal to 10 percent of current compensation for half of physicians surveyed, and 33 percent reported that they are not eligible for performance bonuses.

One of the biggest changes for physicians under MACRA will be the need to bear increased financial risk, although the surveyed physicians indicated they feel increased financial pressures in general. For this reason, most surveyed physicians (80 percent) expect MACRA to drive increased physician consolidation, either by joining larger organizations or networks. And, half of those surveyed say financial pressures are the number one driver of consolidation.

Specifically, 58 percent of physicians would opt to be part of a larger organization to diminish individual physician risk and bear risk collectively and/or to have access to a full spectrum of resources and capabilities. One in four of independent physicians would prefer to be employed while 75 percent would prefer to join a clinical network.

A third to two-third of the remaining independent physicians will consolidate in the next three years, that’s the expectation of both independent and employed physicians surveyed.

The survey found the majority of physicians, around 70 percent, believe that the performance of the U.S. health care system can be improved by measuring care outcomes and processes and measuring resource utilization and costs, but, conversely, the survey also found most physicians believe performance reporting to be burdensome (74 percent), while 79 percent don't support tying compensation to quality.

While In fact, half of physicians surveyed do not support individual public quality reporting as would be required by the Merit-Based Incentive Payment System (MIPS) track of MACRA.

Regarding attitudes and perceptions about MACRA, it’s perhaps no surprise that surveyed physicians open to participating in value-based payment models have more positive expectations for the law, as well as healthcare transformation in general.

According to the survey report, researchers gave physicians a brief explanation of MACRA and then polled them on their expectations. The findings indicate sharp difference between physicians who are willing to participate in value-based payment models and those who are unresponsive to incentives.

Of those surveyed physicians willing to participate in value-based payment models with financial incentives:

23 percent indicated that the law would reduce costs

19 percent indicated it would improve quality

47 percent believe that value-based payment models can improve the performance of the U.S. healthcare system

Of those surveyed physicians who are unresponsive to incentives:

9 percent felt that the law would reduce costs

5 percent said it would improve quality

23 percent believe in value-based payment models

Obamacare and the Private Practitioner: 2016

By Keith Jackson

Private practice medicine in the United States is rapidly going away. In the past few years, the percentage of doctors who own their own businesses has plummeted. The middle class, the supposed beneficiaries of Obamacare, can't afford their deductibles and are avoiding necessary treatments and tests because of costs, leading doctors to have to care for them at more advanced stages of disease. Doctors (and nurses), the highest trained and most knowledgeable providers of patient care, are mostly data input vehicles for the massive electronic medical records systems. And the amount of money that has been shoveled into the great abyss of the new government bureaucracy is enough to have bought all of us excellent private care, yet our care and our coverage for that care is worse.

Before Obamacare, the percentage of physicians owning their own businesses was around 70%. It is now hovering around 30%. The reason for the shift is not widely reported. As costs to run their businesses have been going up, reimbursements to doctors are going down, making the margin for being able to stay open smaller and smaller. Meanwhile, hospitals are doing comparatively better. Why? Because they can charge more for a service than doctors can charge. Hospitals can do this because they have traditionally taken care of the uninsured, and states have written into their books a differential in the reimbursement to make things "fair." This differential allows hospital corporations the ability to afford to buy doctors' practices

This affects costs adversely. (Get ready for a lesson in medical billing "transparency"). As an example, if Dr. Jones charges $535 for a C.T. scan of the sinuses as a private practitioner and submits the bill to an insurer, he may receive as payment $235. If a hospital owns the practice, and the billing is done through the hospital's auspices, they can charge $895 and may get $695. If the doctor then looks down your throat through your nose with a fiber-optic endoscope, he charges $180 and receives $60 in payment from the insurers, while the hospital can charge $365 and get $285.

Because of these differentials, the hospital can negotiate with the doctors to buy their medical and surgical practices with the ability to stabilize their drop in take-home income and allow their offices to remain open. Doctors who used to be staunch advocates of private practice health care have little choice and join "the Borg." Your costs go up. Private practice goes away.

(Interestingly, hospital corporations still don't get what they pay for, as doctors often work less diligently as a part of a conglomerate, and even when they do, the costs of running the practices are frequently higher than hospitals predict. They make up for this by restricting that surgeries be done only at their facilities, as surgeries can make up the profit differential, as anyone who has gotten a surgery bill will attest.)

The middle classes and upper middle classes are bearing the brunt of Obamacare, and it negatively impacts physicians and their ability to care for them. In order to afford insurance, people often choose very high deductible plans, usually with no health care savings account to assist them with unexpected costs. And as every American knows, we tend to live right on the edge of what our paychecks allow. As a result, because it is essentially a cash proposition to go to the doctor until that deductible is met, and since billing for health care is done with the knowledge that most bills are negotiated down by insurers and are inflated as a result, affording a visit to the doctor is financially untenable. Because we don't have cash stashed away for this contingency, we tend to allow disease to progress farther before it is addressed.

A typical example of the plight of the middle and upper middle class with high insurance deductibles is seen in hospital infusion centers. When checking in, these groups frequently are counseled that they need to see the financial department to go over their situation. Americans with a good income may buy a house that is just around the maximum allowed by the banks. They may choose to send their kid to a private school. They know that if they work hard, they can eventually pay the bill, because that formula has worked for them in the past. Then they get cancer. An $8,000.00 deductible and owing 20% of the bill has them staring bankruptcy right in the face. This negatively effects care and makes the job of the private practitioner nearly impossible, with "can I do something less expensive?" a chronic refrain. Many choose no care at all.

Surgeons who used to do frequent semi-elective procedures in communities with relative above average wealth have seen their number of surgery cases plummet, as people will live with their "bum knee" or "sinus" rather than pay to have the problem improved. (As a result, it would probably not be all that surprising if health care costs are going down, as people are not doing things for their health that used to be commonplace. After all, a surgeon doing less surgery saves a bunch of money.)

If you have been to a hospital in the past few years, you have probably noticed that nurses and doctors are not in patient's rooms like in the past. They are camped out at portable computer stations, inputting data so that proper billing is justified. They are the only people in the system who truly know what care has been delivered and how it should be coded into the electronic medical record system. From a bureaucratic point of view, this would seem optimal. Reasonably and practically, however, it is a nightmare.

To adequately fill in all of the checked boxes to justify levels of care for billing purposes would take more time than can reasonably be extended to a patient than the practitioner has available. Then there is the necessary impersonality of having to look at the computer while talking to the patient so that you don't have to catch up later, making the patient think that you are not listening and are not relatable. When a patient doesn't trust the doctor, the compliance to the recommended care plan is gone. That doctor's effectiveness in helping the patient suffers, as does the patient.

The impact of the electronic medical records systems (EMRs) is profound. Doctors see fewer patients. They end up bringing more work home. The resulting notes that are sent to the referring physicians are cumbersome and almost unreadable. Unless editing is done by some provider with a lot of time on their hands, misdiagnoses are forever listed under "patient problems," as are medications that were never received. Doctors who spend 45 minutes discussing what another provider might take 5 minutes to do frequently miss out on differential reimbursement because they are not up to speed on the latest coding changes. Cleaning up a chart to reflect all that had been asked and done could take two or three ancillary assistants that the doctors cannot afford to employ. Doctors incrementally do less health care for their patients and more data entry facilitation, decreasing the joy and accomplishment of the profession and decreasing the quality of the encounter.

In addition, the whole point of EMR is to data-mine. The reason for data-mining is essentially to help third parties decide what service that they will pay less for in the next billing cycle. So by checking the interminable boxes in the medical record, the doctor is complicit in his own financial demise.

The instillation and management of Obamacare is so entrenched now as to be almost unassailable. It has cost us untold monies. It promised us much more than it delivered. It has not been worth the investment. Yet with the number of people dependent on the government-run elements of covered care, such as Medicare, Medicaid, and Tricare, the possibility of reversing the course back to private care delivery from private hands is about zero.

When the BBC came to America before voting on Obamacare, they sought out people to interview who didn't have health coverage and asked about their concerns. One woman in Georgia with a strong breast cancer family history was afraid to see the doctor because of cost. The BBC essentially shamed us for the situation, castigating our system as unfair. At the time, however, the chance of that uninsured American surviving her breast cancer diagnosis was substantially higher than a corresponding "covered by the National Health Service" woman in England. No one ever mentioned this fact.

Private practice medicine run by doctors who could "adjust the bill," make payment plans more suitable for indigent patients and create "lost leaders" – taking a financial hit on one service knowing that they could make up for it with the better reimbursement from another service – were a much better means to provide care. The government-initiated efforts to save us money and increase affordability were dumb from the beginning and have taken away from us one of the greatest things about American health care, namely doctors working with patients to provide care that the doctor and patient both deem is best for that individual. They have skyrocketed costs and impersonalized care.

Who in his right mind would want to "hang up a shingle" in this environment?

Keith Jackson is a otolaryngology, head, and neck surgeon in Atlanta, Georgia

Read more articles by Keith Jackson here

3 Exciting things happening in medicine right now

Scientists restore key parts of vision in blind mice for first time

In Nature Neuroscience, a team led by senior author Andrew Huberman, an associate professor of neurobiology who heads a neural vision lab at Stanford University School of Medicine in California, reports unprecedented success in restoring broken links between retinal ganglion cells and various parts of the brain in mice.

The researchers describe how they coaxed optic-nerve cables that carry vision information from the eye to the brain, to regenerate. They found the cables not only repaired themselves, but also re-traced the same routes they had before being severed.

Full article here

How to enroll in medicine’s most exciting experiment

The Precision Medicine Initiative announced by President Obama last year generated excitement across the scientific and medical worlds. Instead of a one-size-fits-all approach to treating health problems and preventing disease, the initiative seeks to usher in a new era of medical effectiveness by calibrating treatment to the individual based on his or her genes, environment and lifestyle

Details here

Artificial intelligence finds cancer cells more efficiently

By using a laser at nanosecond speeds, in combination with deep learning algorithms, a new microscope detects cancer cells more efficiently than standard methods.

The "photonic time stretch" was invented by Professor Barham Jalali, who holds a patent for this technology, and its use in microscopes is just one of many possible applications. It works by taking pictures of flowing blood cells using laser bursts in the way that a camera uses a flash. This process happens so quickly – in nanoseconds, or billionths of a second – that the images would be too weak to be detected and too fast to be digitised by normal instrumentation. The new microscope overcomes those challenges using specially designed optics that boost the clarity of the images and simultaneously slow them enough to be detected and digitised at a rate of 36 million images per second. It then uses deep learning to distinguish the cancer cells from healthy white blood cells. Deep learning is a form of artificial intelligence that uses complex algorithms to extract meaning from data, with the goal of achieving accurate decision making.

lick for details

Personalized medicine: The way forward?

Edited from an article originally written by Yvette Brazier

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Genome sequencing and advancing technology are shifting the perspective on healthcare, bringing tailor-made treatment further within reach. Advances to date include: 

Identifying genes to prevent disease before it starts

People's genetic makeup affects their future health and longevity. Genetic information can help scientists to predict what diseases people are likely to get, and how their bodies are likely to react.

In April 2016, scientists from the Scripps Translational Science Institute (STSI) found that in a group of over 1,400 healthy 80-105-year-olds, there was a "higher-than-normal presence of genetic variants offering protection from cognitive decline."

In particular, they found an absence of the coding variant for COL25A1, a gene that has been associated with the development of Alzheimer's disease.

Gene-editing techniques, such as "CRISPR," that modify DNA by "snipping" it, could prevent the onset of age-related diseases such as Alzheimer's in later years.

Women with a family history of breast cancer can undergo screening for BRCA1 and BRCA2 mutations to decide whether to take preventive action, such as a mastectomy, to minimize the risk of developing breast or ovarian cancer in future.

Recent research has suggested that women with the BRCA1 mutation should consider having children earlier, because the fault may affect the number of eggs in the ovaries.

Jen Trowbridge puts it this way: "Conventional medicine continues to treat the symptoms, but genetic scientists are now working to get right to the roots of diseases, the 'birth of a cancer,' starting from cell one."

Personalized medical devices

Advances in biotechnology also contribute to personalized medicine.

New imaging technology means that assessments of a patient's condition and needs can be ever more precise.

The data gathered can lead to tailor-made devices, and even regenerative medicine.

One example is the personalized tinnitus masker, with custom-tailored audio signals that can be configured to meet the needs of the individual patient.

Mobile health (mHealth) solutions include interconnected, wearable medical devices that feed back to the doctor a person's heart rhythms and other vital data, enabling remote monitoring, and any appropriate tweaking of treatment.

Replacement body parts

3-D printing and regenerative medicine have already provided patients with replacement body parts, including bone and a windpipe.

A CT scan assesses patient needs, computer-aided design plans the structure, and 3-D printing creates the final product. A device that is implanted surgically can then dissolve over time, as the body naturally replaces it with human tissue.

Researchers in the U.K. recently created the prototype of a 3-D-printed bone scaffold. The device would allow tissue to grow around it and new human bone to develop, as the artificial bone dissolves.

The device would match the patient's exact size and shape, and its porous nature would allow blood flow and cell growth to occur.

In 2013, physicians at the University of Michigan and Akron Children's Hospital created a bioresorbable airway splint to treat a critically ill infant. The child's airway walls were so weak that breathing or coughing could cause them to collapse. The device provided a placeholder for cells to grow naturally around it, as the body healed itself.

An FDA report describes this as "a glimpse into a future where truly individualized, anatomically specific devices may become a standard part of patient care."

Personalizing drug therapy for depression

Research suggests that around 50 percent of patients with depression do not respond to first-line antidepressants. What can explain this, and how can it be solved?

Current treatment is often a case of trial and error. A patient may take one medication after another, often for 12 weeks or more each time, while symptoms remain the same, or worsen.

A team from King's College London in the United Kingdom recently announced a blood test that can predict with accuracy and reliability whether an individual patient will respond to common antidepressants.

This, they say, "could herald a new era of personalized treatment for patients with depression."

High levels of blood inflammation have been linked to a lower response to antidepressants, so the team designed a test to distinguish levels of blood inflammation.

It evaluates the levels of two biomarkers: macrophage migration inhibitory factor (MIF) and interleukin (IL)-1β.

Results showed that none of the patients with levels of MIF and IL-1β above a certain threshold responded to conventional antidepressants, while with inflammation levels below this threshold did tend to respond. The findings indicate that patients with higher levels of inflammation should use a combination of antidepressants from the early stages to stop their condition from getting worse.

The two biomarkers affect a number of brain mechanisms involved in depression, including the birth of new brain cells, connections between them, and the death of brain cells as a result of oxidative stress, related to the processing of free radicals.

Depression can result when chemical signaling is disrupted, and the function of the brain's protective mechanisms is reduced.

"The identification of biomarkers that predict treatment response is crucial in reducing the social and economic burden of depression, and improving quality of life of patients."
Prof. Carmine Pariante, King's College London

Getting the right medication from the start would enhance the well-being of patients, and it would also save on healthcare costs, in terms of time and money.

Doctors wrote fewer prescriptions in states where Medicinal cannabis is legalized

From Reuters: Published July 7th 2016

Physicians wrote significantly fewer prescriptions for painkillers and other medications for elderly and disabled patients who had legal access to medical marijuana, a new study finds.

In fact, Medicare saved more than $165 million in 2013 on prescription drugs in the District of Columbia and 17 states that allowed cannabis to be used as medicine, researchers calculated.

If every state in the nation legalized medical marijuana, the study forecast that the federal program would save more than $468 million a year on pharmaceuticals for disabled Americans and those 65 and older.

'When states turned on medical marijuana laws, we did see a rather substantial turn away from FDA-approved medicine,' he said.

Researchers analyzed Medicare data from 2010 through 2013 for drugs approved by the U.S. Food and Drug Administration (FDA) to treat nine ailments – from pain to depression and nausea – for which marijuana might be an alternative remedy.

They expected to see fewer prescriptions for FDA-approved drugs that might treat the same conditions as cannabis.

Indeed, except for glaucoma, doctors wrote fewer prescriptions for all nine ailments after medical marijuana laws took effect, the study found.

The number of Medicare prescriptions significantly dropped for drugs that treat pain, depression, anxiety, nausea, psychoses, seizures and sleep disorders.

For pain, the annual number of daily doses prescribed per physician fell by more than 11 per cent.

'The results show that marijuana might be beneficial with diverting people away from opioids,' Bradford said.

A 2014 study found that opioid overdose death rates were on average nearly 25 percent lower in states where medical marijuana was legal compared to states where it remained illegal.

Chronic or severe pain is considered a primary indicator for medical marijuana in most states where it is legal.

Nearly two million Americans either abused or were dependent on prescription opioids in 2014, according to the U.S. Centers for Disease Control and Prevention (CDC).

Since 1999, more than 165,000 Americans have died from prescription opioid overdoses.

Addiction psychiatrist Dr. Kevin Hill questioned whether medical marijuana patients might in some cases be getting inferior or incorrect treatment, and if so, whether the resulting extra healthcare costs would overshadow the Medicare drug savings.

Hill, a professor at Harvard Medical School in Boston, was not involved in the new study.

'Fewer opioid prescriptions in medical marijuana states might be a good thing, but I am concerned about the overall quality of care delivered in medical marijuana specialty clinics,' he told Reuters Health in an email.

He criticized the implementation of medical marijuana laws in many states as often leading to 'medical care that is of poor quality.'

Part of the problem stems from a dearth of research into the efficacy of medical marijuana.

Although California became the first state to legalize medical marijuana in 1996, federal law enacted by Congress in 1970 continues to put cannabis in the same category as heroin, Schedule 1 of the Comprehensive Drug Abuse Prevention and Control Act, and finds it has no medicinal value. Consequently, research has been severely limited.

Sheigla Murphy, a medical sociologist who was not involved in the current study, praised it as a major contribution to the literature on the role of medical marijuana in older adults.

Murphy directs the Center for Substance Abuse Studies in San Francisco and has done prior research on marijuana and baby boomers. She said some older adults prefer marijuana to painkillers and sleeping pills.

'It fits with the problems of older age, problems with sleeping, depression, arthritis, worn-out body parts that begin to hurt. Marijuana can relieve these without the side effects of grogginess and worrying about addiction,' she said.

'As we're trying to reduce the number of pain medications, I think marijuana would be a welcome addition to the pharmacopeia,' she said. 'The one thing we know is no one has ever died of it.'

10 Medical Breakthroughs That Sound Like Science Fiction

Great article by Denny Watkins which originally appeared in Men'sHealth

High-tech innovations that just might save your life

By Denny Watkins

The news that comes out of research universities and hospitals often sounds too hopeful: Here's a gene that maybe, could potentially end obesity. This newly discovered protein pathway might sort-of, some day cure cancer.

Do any of the thousands of studies published each year really result in a meaningful change in someone's life?

Here's your answer: For the eighth consecutive year, the Cleveland Clinic has selected 10 technologies and discoveries that are already making an impact.

“We look for innovations that are somewhat disruptive, so a new medication isn't just a little better, it's substantially better,” says Michael Roizen, M.D., who headed the panel of 30 medical professionals that selected this year's finalists. Check out the technology of the future that's already on our doorstep.

THE BIONIC EYE

The “Argus II” takes a video signal from a camera built into sunglasses and wirelessly transmits that image to implants in the retinas of people who have lost their vision. Though it’s been available in Europe since 2011, the U.S. Food and Drug Administration (FDA) only approved the eye earlier this year.

“This really is like Star Trek technology,” Dr. Roizen says.

The system isn't perfect. It lets a blind person regain basic functions like walking on a sidewalk without stepping off a curb, and distinguishing black from white socks, but only lets you read one giant-sized word at a time on a Kindle.

Plus, as the retina itself heals over the implant, the quality of vision decreases. The Argus II is currently only approved for people who have lost their sight from retinal pigmentosis—which affects 1 in 4,000 Americans.

But the technology could soon help the more than 1.75 million people who suffer from macular degeneration.

THE CANCER GENE FINGERPRINT

Not all cancers are equally lethal—cancer in your prostate means a longer survival rate than a malignancy in your brain, for example.

But even prostate cancer comes in multiple flavors ranging from manageable to very bad. By analyzing the mutated genome of a tumor, doctors can now pinpoint whether a cancer is sensitive to a certain chemotherapy, or one that doesn’t respond at all to current treatments.

Knowing the subtype might mean jumping directly to a clinical trial that could save your life.

THE SEIZURE STOPPER

For the 840,000 epileptics suffering from sudden, uncontrollable seizures, the NeuroPace is like “a defibrillator for your brain,” Dr. Roizen says.

The system includes sensors implanted in the brain that can spot the first tremors of an oncoming seizure. Then it sends electrical pulses that counteract the brain's own haywire signals, stopping the seizure in its tracks.

Even more impressive: The NeuroPace can be fine-tuned by doctors based on its performance. In the first year it was available, seizure episodes were reduced by an average of 40 percent—but 2 years later, they dropped by 53 percent.

THE HEPATITIS CURE

Until recently, treatment for hepatitis C fell into the good-but-not-great category, with only around 70 percent of patients being cured.

And that was after as much as 48 weeks of a strict anti-viral drug regimen, including injections of interferon—which causes a number of debilitating side effects.

But the new drug Sofosbuvir is a much more potent killer of hep C, with success in as many as 95 percent of patients. Even more, the medication only has to be administered for 12 weeks, sans interferon injections.

THE ANESTHESIOLOGIST'S IPAD

Surgeons may get more glory, but anesthesiologists probably play the most vital role in keeping you alive during surgery. They're the last face you see before you're put into a medicated sleep so deep you don't even notice that your body is being peeled open.

Between keeping track of your heart rate, breathing, and brain functions, an anesthesiologist also needs to be familiar with the ins and outs of the procedure so they can adjust sedatives and painkillers—without causing complications.

The new “perioperative information management systems” include software on touchscreen-enabled computers that can warn doctors if things are going south, keep track of the surgeon's workflows, and document every step of the procedure. All are essential when surgeries last up to 16 hours and docs need to pass the reins to a fresh pair of eyes.

THE FECAL TRANSPLANT

The idea of taking someone else's poop and giving it a new home in your own colon may sound repulsive, but the treatment has proven remarkably effective in curing infections of C. difficile—a nasty bacteria that kills 15,000 people each year.

Take heart: The digested food waste in feces isn't itself the cure. You're simply gaining some of the helpful bacteria living in the donor's gut—like a farmer choosing the hardiest crops to seed next year's fields.

“The bacteria produce proteins that are involved in a lot more diseases than we realized,” says Dr. Roizen. Still grossed out? Researchers in Canada have developed a method to deliver just the bacteria—no feces—via an oral pill, skipping the need for a poo enema.

THE HEART-SAVING HORMONE

Around 1 in 4 people who are hospitalized for heart failure don't last much longer than a year.

But a new drug called Serelaxin has upped the odds of survival by as much as 37 percent, according to a University of California, San Francisco study. It's a synthetic version of the hormone relaxin, which is produced by pregnant women to help with the increased stress carrying a fetus places on the heart.

“It not only opens up your blood vessels to supply your organs oxygen, but it has anti-inflammatory properties,” Dr. Roizen says. Serelaxin's life-saving potential is profound enough that in June, the FDA dubbed it a “breakthrough therapy,” putting it on a faster track for approval in hospitals.

THE ROBOT DOCTOR

If you're undergoing a colonoscopy, you'll want something to take the edge off (for obvious reasons).

But even a light sedative to help you snooze while doctors spelunk your butt requires the presence of an anesthesiologist—which translates to $1 billion in additional medical expenses, according to a study in the Journal of the American Medical Association.

Enter the Sedasys: a computer with an attachment on the IV that meters out the correct amount of sedative and monitors vitals.

It even includes an earpiece to wake patients up if necessary. That allows docs to administer “light to moderate” sedation on their own, with a single anesthesiologist supervising multiple patients.

“If Michael Jackson's doctor had this and knew how to use it, then Michael Jackson would still be alive today,” says Dr. Roizen.

THE BETTER HEART-ATTACK RISK TEST

Today you get a cholesterol test to assess your risk of heart attack, but soon you'll be more worried about your trimethylamine N-oxide (TMAO) levels.

Why? People with the highest levels of TMAO in their blood have 2.5 times the risk of a heart attack compared to those with the lowest levels, according to a recent study in the New England Journal of Medicine.

TMAO is a compound produced by intestine bacteria—yep, the same ones involved in fecal transplants—after you eat choline, which is found in eggs, red meat, and dairy.

Once in your bloodstream, TMAO accelerates the process of cholesterol forming into plaques in your arteries.

“We're learning why red meat is hazardous, and what could be done to avoid that hazard,” Dr. Roizen says. Beyond simply avoiding red meat, preventive steps could include probiotics or medications that pinch off TMAO-producing pathways.

THE PRECISION-GUIDED CANCER TREATMENT

The difficult goal in any cancer treatment is to kill the tumor while leaving healthy cells alone.

Recently, a better understanding of what makes cancer cells tick has allowed scientists to develop a class of drugs that pinpoint a weakness in cancer's uncontrolled growth.

For example, in lymphomas and leukemias, scientists have determined that the growth is controlled by a protein called Bruton's tyrosine kinase (BTK). After years of experimentation, doctors developed a new drug called Ibrutinib that blocks BTK.

A pair of studies in the New England Journal of Medicine this summer found that the oral pill helped 71 percent of chronic leukemia patients and 68 percent of patients with a type of non-Hodgkins lymphoma. Most importantly, Ibrutinib killed off the lymphoma while leaving the rest of the immune system alone.

“Hopefully this will lead to a whole new class of drugs that will be cancer cell-specific,” says Dr. Roizen.

Best ways to sabotage your funding efforts

I've been through the dog & pony show of raising money a few times, the post below is spot on despite being originally posted on March 10 2011.

By Marty Zwilling

A while back I received a discouraging note from an entrepreneur with a patent and a medical software application who couldn’t find a dime of investment, and was grousing that seed funding just wasn’t available anymore. After exchanging a couple of notes, I concluded that she was more likely a victim of item #1 on my reject list, rather than a drought on seed funding.

Too many people still believe the urban myth that you can sketch your idea on a napkin, and people will throw money at you. Fundraising is indeed brutally tough at all stages, and the seed funding is the hardest to find. The simple answer is that if you need funding, do your homework early and completely.

I seem to see common threads in the stories from people who don’t get money, so I checked my list against ones from Brian Emerson, president of Starlight Investments, as quoted in a recent book by Barry H. Cohen and Michael Rybarski, titled “Start-Up Smarts.” We agree on issues we see sabotaging most funding efforts, in decreasing priority sequence:

1. Lack of a compelling story. That story has to begin with a painful problem shared by a large collection of viable customers, with your competitive solution. Additionally, you need to be able to communicate the essence that story and value to investors in a couple of sentences – your elevator pitch.

2. Lack of clear objectives/goals. Often, the number one question that entrepreneurs fail to address is: “How much money do you need, and what valuation do you place on your company?” Then you have to have evidence to support your request. I’ve asked this question many times of presenters in angel meetings, and often get a blank look.

3. Failure to prepare for due diligence. Any serious investor will perform a thorough review of your business and personal background before signing the check. They don’t like surprises, so you should explain any possible issues first, in the best possible light, before being asked.

4. Lack of understanding of the fund process/rules. The key here is to create a win-win situation for your investors. Discussion of risks and rewards in an open fashion, without sleight-of-hand or shortcuts, will convince investors that they can count on you, and will avoid shareholder lawsuits later.

5. Reliance on inappropriate business professionals. Using well-respected professionals to bolster your endeavor is key. If you can attract well-known advisors, attorneys, and accountants, it will give potential investors comfort that you have been able to get implied endorsement of your concept, as well as your integrity.

6. Poor choice of funding sources. It is not helpful to you for funders to love an idea that does not fit the criteria for their investing capability. Don’t waste time talking to VCs for requests less than $1M, or very early stage, and don’t expect professional investors to jump in if you have no “skin in the game.”

7. Not doing due diligence on the funding source. You need to complete due diligence on your prospective funders as they complete due diligence on you. Find out what they have invested in recently, what stage, and what is their track record of expectations and follow-through. You don’t need surprises or disappointments either.

8. Being unprepared for the next steps. After a good elevator pitch or initial presentation, investors will ask for your formal business plan and financial projections. Don’t derail their enthusiasm or risk your professional image by not having these materials immediately available. The same thing goes for incorporating your company, having key hires lined up, and facilities arranged as required.

There are many others opportunities for funding to be derailed. Rather than play the victim, you can be proactive on all these items, and stay one step ahead of your “competitors” in professionalism, timing, and preparation. The resources are out there to help you, like the book mentioned, this site, and many more. Use them and win.

Martin Zwilling is the founder and chief executive officer of Startup Professionals, a company that provides products and services to start-up founders and small business owners.