It’s been a time of upheaval in healthcare. Today is a far different, almost entirely new, industry than what existed simply ten years ago. The transition to ICD-10, widespread adoption of electronic health records, sophistication of data science… all of these are monumental shifts, and they’ve happened quickly and recently.
So quick, in fact, it has become almost impossible to stay on top of emerging trends and technologies. Things are happening though that will have a bottom-line impact on your practice, and we want you to stay ahead of the curve.
A woman was diagnosed with lung cancer in 2002, which later spread to her brain. She was 44, a vegetarian and had never smoked. Things looked grim, to say the least. She was introduced to a drug called getfitinib, which was created as a “genetic smart weapon” to combat more specific mutations.
As a result, she is still alive today.
This story highlights the early stages of personalized medicine, the practice of tailoring treatment and prevention based on the individual’s needs. This is different from how things have been done traditionally, which doctors describe as being a “one-size-fits-all” mindset. Someone has “brain cancer”, and they’re given treatment that has been successful for most people with brain cancer.
But we’re not all the same, are we?
The human genome has 3 billion lines of code. The scope of this was wonderfully illustrated by author Siddharta Mukherjee. He says if we were to see the genome in actual ‘book form’, it would comprise 66 full sets of the Encyclopedia Brittanica.
That means one person’s melanoma can be far different from another’s. According to Jackson Laboratory, an independent, nonprofit biomedical research center, if you have cancer today, you have a 35% chance of receiving the correct form of chemotherapy the first time.
When treating, doctors currently rely on someone’s profile – their age, weight, gender and family history. That, as well as the testimony of the patient. From there, they make their most informed decision.
Within the world of personalized medicine, this could be considered “guesswork”. It’s not perfect, but it’s the best we have.
A Very Basic Primer on What Genes Are
First, we must differentiate between the gene and the genome. The gene, whose definition has changed over years, is essentially a unit of biological information. The genome, to use Dr. Mukherjee’s metaphor, is the encyclopedia that contains all of the genes.
Genomes are made of DNA, the molecule that carries genetic instructions for all living organisms. DNA contains four basic building blocks: adenine (A), cytosine (C), guanine (G) and thymine (T). The sequence of these blocks—arranged in fours, like ACTG, GCTA, etc.—is what forms the instructions in the genome – it’s what distinguishes you from him.
Here’s what personalized medicine will make us capable of:
Among that roomful of 66 encyclopedia sets, for which each set contains 44 million words across 32 volumes, genomic mapping has allowed researchers to isolate not just the particular book, not just the page, but the exact word within this series, and to study how it influences who we are.
Meaning, in your body, among the three billion lines of code, genomic mapping can find and examine one tiny, four-letter sequence.
Now, imagine you’re seeing your physician. Your genome is sequenced and then analyzed. In this analysis, you see a list of diseases you may be at risk for, as well as your likely response to common drugs. You’ll see gene variants in your family, like ones for kidney diseases and sudden death. You’ll also see variants that are in your family but have not been discovered. This can determine the entire course of your healthcare.
Jackson Laboratory, as mentioned above, asked a clinician, “If there was one piece of information you had that would change the way you treat patients every day, what would it be?”
The reply: “If I could know which of those patients will eventually develop leukemia, it would change the way I treat them today.”
Medicine has for too long been in the ‘reactive position’ – waiting for disease to manifest before treatment is available. Again, that’s the best option we’ve had.
Instead, patients will be evaluated for the risk of disease, and treated accordingly. It’s like the science-fiction film Minority Report, but for healthcare.
We’re not there yet, though we are well on the way. It’s far from being mainstream, still costly and in the stages of further development. Something to consider, though – the Human Genome Project took 13 years and $3billion to complete. Now, researchers can sequence a genome overnight.
In the very near future, we will look at our current diagnosing and treatment methods in healthcare and describe them as “primitive”. This is natural – when new technology arrives, we often look at it’s predecessor and wonder, “how did we ever survive?” And the answer is always the same – it’s just what we had at the time.
Contact us if you have any questions on personalized medicine, and the implications it may have on the medical industry.
The field of telemedicine got a big boost when a bipartisan group of U.S. Senators led by Brian Schatz, D-Hawaii, and Roger Wicker, R-Miss., introduced a bill that would eliminate restrictions on Medicare telemedicine coverage. Proponents applaud the move, saying savings of nearly $2 billion will result with the abandonment of rules they consider antiquated and arbitrary.
The legislation has the support of a number of industry groups and organizations, such as the American Telemedicine Association, AARP, the National Association of ACOs and the American Medical Association.
According to a recent report from the Robert Wood Johnson Foundation (RWJF), states that chose not to expand Medicaid experienced an increase last year in physician reimbursements. The increase for primary care doctors was 3.3 percent, and the increase for surgeons was 4 percent. The report also showed that states that expanded Medicaid experienced a 3 percent increase for primary care doctors and a 2 percent increase for surgeons. This is likely due to an increase in the rate of reimbursements.
“Reimbursements are up a bit, so physicians are doing okay,” says Kathy Hempstead of the Robert Wood Johnson Foundation.
The report’s analysis examined data from approximately 20,000 physicians. The data was extracted from a compendium forming part of the ACAView project, a joint venture between RWJF and athenahealth.
The Centers for Medicare and Medicaid Services (CMS) says they are completely prepared for new ICD-10 claims within the current system. Recent testing has claimed to be successful and resulting in no rejections other than those caused by human error.
But what constitutes this system as “ready”? There is still a measurable amount of error in implementing both ICD-9 and ICD-10 codes into the system as it is currently programmed.
Negative testing was employed as part of the testing process, explaining some of these statistics. Over 1,000 billing companies and healthcare providers took part in the testing process. No new ICD-10-related flaws were detected during this test period. The overall pass-through rate of claims did not change significantly in the new trial compared to previous ones.
Preparations for implementing the system have included an official ombudsman for the ICD-10 program. CMS technical advisor Stacey Shagena declared the testing successful, adding that problems reported by contractors were fixed and did not re-emerge.