TSR's "Small Incisions" - 9/15/2024
Hot healthcare takes from the Surgeon's Perspective
A rundown of stories from across the healthcare ecosystem — health tech, health policy, digital health, value-based care, and more — with commentary.
Presented by Commons Clinic
This week:
Are AirPods Pro 2 overhyped as hearing aid replacements?
Corporate primary care: A failed experiment
The real healthcare unicorns
GAM: The Future of Evidence-Based Medicine
Doctors and patients are frustrated — build for that
A doctor’s guide to startups
Apple’s AirPods Pro 2 could forever change how people access hearing aids (The Verge)
The biggest buzz coming out of last week’s iPhone event wasn’t about new phones or AI — it was about hearing aids. More specifically, Apple’s announcement that it’s bringing “clinical grade” hearing aid features to the AirPods Pro 2. Sure, traditional hearing aids are expensive, cumbersome, and finicky. But there's one key reason seniors are reluctant to use them: stigma. Patients with hearing loss experience negative self-perception and express concerns over ageism and vanity. As a result, they don’t like wearing hearing aids. Can AirPods overcome this stigma? Maybe. Apple’s brand strength has made wearing them acceptable in many social situations (for better or worse). There are drawbacks. Accessing the features requires iPhone ownership and a degree of tech savvy. Battery life isn’t great. I’m just not sure I see seniors wearing these solely for hearing aid capability. Meanwhile, Apple continues to follow the playbook of slowly adding health related features to existing devices (the Watch will be able to detect sleep apnea).
The Failing Experiment Of Primary Care As A For-Profit Enterprise (Health Affairs)
Primary care isn’t particularly lucrative in the US. Specialists offset declining reimbursement by offering procedures and ancillary services. Meanwhile, PCPs are being asked to do more for less — fewer resources, lower reimbursement, and increasingly complex patients. The lack of a robust profit margin didn’t stop corporate interests from investing heavily in primary care. Recent headwinds and strong retrenchment (detailed in our collaborative post with Hospitalogy) are evidence of a failed experiment. Alternative (advanced) primary care models promise to innovate care through better coordination and a focus on value creation. Until now, these models have been propped up by investor capital while struggling to find a sustainable business model. Arbitraging Medicare Advantage and medical loss ratio isn’t innovative. Using primary care as a loss leader and reducing overhead by shifting to virtual visits hasn’t resonated either. The principles of advanced primary are sound, but the corporate approach doesn’t seem to be working. Direct primary care may be one answer. CMS continues to iterate value-based models too. The future of alternative primary care remains murky. The solution is still out there.
Harvard, Penn, Columbia tap doctors to lead troubled campuses (Stat News)
We’ve heard all the tropes. Physicians aren’t great at business. They don’t make good founders or CEOs. Docs don’t possess the leadership skills necessary to excel outside the clinical setting. We’re not all Ralph de la Torre. There are plenty of us who succeed in healthcare and non-healthcare leadership roles. Not every doc can (or even wants to) make this transition. And that’s fine. But I see a future where more do — out of necessity and an understanding that leading is the best way to affect change. The article eloquently calls this a “push-pull” phenomenon. Much of what we experience on the frontlines translates to other high pressure, high stakes, uncertain situations. Success requires humility and a willingness to learn. Growth mindset is a must. There are many ways we can leverage our clinical acumen to positively impact healthcare reform. I believe the strongest physician leaders are those who have clinical experience, hard and soft leadership skills, business acumen, and a startup mentality. Such individuals aren’t easy to find, but they’re the real healthcare unicorns.
Really enjoyed this podcast with Stacey Richter and Dr. Marty Makary. It’s surprisingly difficult to define what “appropriate” care is. Low value care isn’t no-value care. What’s appropriate for one patient may not be appropriate for another. The absolutism of “necessary” v. “unnecessary” glosses over the nuances that permeate medicine. Dr. Makary argues that traditional healthcare features blind spots — areas where we cling to antiquated notions or fail to recognize what we don’t know. (His thoughts closely echo our recent “Evidence-Based Medicine is a Lie” post). I was especially interested to learn about the Global Appropriateness Measures (GAM) initiative, a movement to marry the principles of practice pattern measurement, clinical wisdom, and medical evidence to promote a more efficient healthcare system. I’ve long argued that healthcare innovation demands novel, practical mechanisms to measure real world impact. We have plenty of outcomes measures, but a limited understanding of what really matters when it comes to delivering “value.” As Commons Clinic Senior Clinical Fellow, this is an issue I think about a lot. Solving it will be critical to defining and achieving VBC.
Healthcare Leaders: Doctors Are Just As Frustrated As Patients (Forbes)
How much of healthcare innovation is aimed specifically at making things better for clinicians? Doctors are desperate for it. Too often, “practice at the top of your license” is code for “you’re an afterthought.” Physicians are fed up with the continued deterioration of the doctor-patient relationship. What if we built solutions designed to restore that relationship? How many docs would stay on the frontlines instead of leaving the profession? More resources. Fewer barriers. Tech innovations that solve problems, not create them. I’m most bullish on fixes that understand this dynamic. Less clicking. Fewer pointless administrative tasks. Ownership, autonomy, and a seat at the table. Health records that serve their intended purpose. Medicine has lost its way for a lot of reasons. What’s happening on the frontlines is the fundamental problem. Without addressing it, failure is near certainty. Doctors and patients are frustrated. Fix that.
A Doctor's Guide to Startups (The Surgeon’s Record)
Startups are about pivots, unpredictability, and comfort with fast moving environments. So is medicine. Appreciating these similarities makes the transition to working with startups easier. Docs are increasingly turning to the healthcare startup ecosystem to stay engaged and find fulfillment. The ability to responsibly walk the line between risk and innovation makes physicians invaluable to startups. Healthcare innovation needs clinicians comfortable driving change but experienced (and ethical) enough to do so safely. This is our superpower — it uniquely positions us as the catalysts of a healthcare revolution.
Ben Schwartz, MD, MBA
Editor-in Chief, The Surgeon’s Record
Commons Clinic Senior Clinical Fellow
