The Takeaways: Week 3 of 2022

This week, mostly ups and downs in health care, interoperability, and medical debt - plus a couple of cogent web3 observations.


Ted Gioia, The Honest Broker. Is old music killing new music? (January 19, 2022)

Even so, I refuse to accept that we are in some ugly endgame, witnessing the death throes of new music. And I say that because I know how much people crave something that sounds fresh and exciting and different. If they don’t find it from a major record label or algorithm-driven playlist, they will find it somewhere else. Things can go viral nowadays without the entertainment industry even noticing until it has actually happened. And that will be how this story ends—not with the marginalization of new music, but with something radical emerging from an unexpected place.

Ed Zitron, Where's Your Ed At? Crypto, Web3, And The Big Nothing (January 21, 2022)

All of this exists to give you the sense that you’re early. If you’re early, you’re going to be more willing to tolerate product or company issues, but also more likely to invest more - either through playing with the system they built to enrich themselves or through literally buying the token in question. They want you to believe you and all your friends are accessing the seed stage of startup investing that the cruel fat cats have been guarding when those fat cats have already invested and you are the mechanism they are using to realize their returns.


Julie Appleby, KHN. HHS Proposal for Marketplace Plans Carries a Hefty Dose of Consumer Caution (January 19, 2022)

That might be one factor behind the growing concern about consumers enrolled without their consent — with no monthly bill, consumers have few ways of knowing they’re in a plan.

“There are a lot more zero-dollar premium plans available,” said Sabrina Corlette, a researcher at Georgetown University’s Center on Health Insurance Reforms. Bad actors “can essentially fake an email address or phone number, fake someone’s income to say they are eligible for a zero-dollar plan, and the person would never know.”

Regulators have seen “several instances where consumers have gone months” without realizing they are enrolled, according to the proposed HHS rule. By that time, their insurers may have been paid hundreds — even thousands — of dollars in subsidies, also called tax credits, which the policyholder might have to pay back if their actual income is above the subsidy threshold.

Blake Farmer, Nashville Public Radiu and KHN. App Attempts to Break Barriers to Bankruptcy for Those in Medical Debt (January 11, 2022)

Bankruptcy is a last-resort fix, but the financial reset button is also out of reach for many because the act of declaring bankruptcy is relatively expensive. Most people use one of two options under the federal bankruptcy laws to get out of debt. Chapter 7 bankruptcy is intended for those without many assets to protect. It essentially cancels most debts — though rarely student loans — while the other commonly used option, Chapter 13, often sets up repayment plans.

Constant’s web search for a cheaper solution led her to the Upsolve site, where users can download a free app that helps them file without the expense of hiring an attorney. Users still owe a $335 court filing fee, though the app helps them apply to have it waived... By answering questions in plain English through the app, users add their financial data to nearly two dozen forms required to file bankruptcy with federal courts.

Olivia Goldhill, STAT. Wary of a backlash, telehealth startups focused on women’s sexual health steer clear of abortion pills (January 18, 2022)

To offer telemedicine abortion, the companies would have to contend with regulatory hurdles: 19 states have banned remote prescribing of abortion pills, and in other states, rules vary, and pills need to be prescribed by a specially certified health provider. But four former employees of Hims & Hers and The Pill Club told STAT the bitterly polarized debate around abortion in the U.S. and concerns about losing customers are major reasons these firms have avoided adding abortion pills to their offerings. Meanwhile, a former physician at Nurx said the clinical team had recommended providing the abortion pills, but leadership had yet to act on it, and a consultant to Tia described how the pressure for revenue drove company strategy.

Kat Jercich, Healthcare IT News. Even using the same EHR vendor doesn't guarantee interoperability (January 18, 2022)

Summarizes Quantitating and assessing interoperability between electronic health records

To assess interoperability, the scientists measured the likelihood that an unmodified record transmitted from one site to another can be understood – meaning, as they wrote, "the specific text string used to define the meaning of the data element was used in the recipient site."

Zack Kanter, Stedi. What makes EDI so hard? (January 5, 2022)

What we’re seeing here is that while a standard can be opinionated about the structure of a document and the naming of fields, it cannot be opinionated about the contents of a business transaction – the contents of a business transaction are dictated by the idiosyncrasies of the business itself. If a standard doesn’t provide enough flexibility to account for the particulars of a given business, businesses would choose not to opt into the standard.

Rebecca Pifer, Healthcare Dive. The future of ONC's interoperability framework hinges on adoption. But the agency — and industry — is optimistic (January 21, 2022)

The goal of TEFCA is to get rid of individual legal agreements between health information networks, health plans, providers and other entities by instituting one common agreement that qualified networks and their participants sign onto, paring back on administrative burden. The framework standardizes the operational side of data exchange, while raising the privacy and security bar for entities that want to be certified as qualified health information networks (QHINs), groups of organizations that agree to the same data-sharing infrastructure.

It's composed of two parts: the Trusted Exchange Framework, which describes a set of principles for data-sharing across health information networks; and the Common Agreement, a legal contract signed by QHINs.

Mohana Ravindranath, STAT. For doctors drowning in emails, one health system’s new strategy: pay for replies (January 21, 2022)

UCSF has seen an average reimbursement of $65 per email consultation, though patients typically pay much less if at all.

[Primary care physician Maria] Byron said patients at UCSF have largely embraced the system, which notifies them when they send messages through the patient portal that they might incur a co-pay, depending on how much time a response requires from their provider. For the vast majority of patients on Medicare and California’s Medicaid program, the new billing system hasn’t led to a co-pay, Byron said. Patients on some commercial plans have seen co-pays in the $5 to $10 range for a message.

She said UCSF rebranded the portal emails as “medical advice message” instead of “e-Visit” — the term CMS uses for billing — because some patients initially thought they’d be billed for a telehealth visit, which typically costs more.

Molly White. Abuse and harassment on the blockchain (January 22, 2022)

There is surprisingly little discussion of the enormous potential for abuse built in to blockchain-based technologies, and I’ve barely even scraped the surface here. Indeed, I did a search for “blockchain harassment” and found little more than promotional materials for some startup apparently solving workplace harassment ~~ with the blockchain ~~ (god help me).