Your doctor may be playing medical video games at work. That could be good for your health by Edward Baig

Can playing video games be a prescription for good health?

Dr. Zubin Damania thinks so.

Two to three times a week, the UCSF/Stanford-trained internist and founder of the Turntable Health primary care clinic is on his smartphone playing video games.

Damania isn’t seeking a diversion by parachuting into a "Fortnite" battle royale.

“People who are good at video games are actually good at some aspects of clinical medicine.”

Dr. Jacqueline Morano, University of Chicago School of Medicine

Instead, ZDoggMD, as he’s known by his pseudonym as a producer of health care videos and live shows, is among the 400,000 medical professionals practicing the craft of medicine through a series of games from Level Ex, a Chicago video games developer whose titles are specially designed for doctors, med students and other health care providers.

The Level Ex lineup currently consists of a quartet of free games for iOS and Android, with others under development.

There’s Airway Ex targeted to anesthesiologists, Gastro Ex for gastroenterologists, Pulm Ex for pulmonologists and Cardio Ex for cardiologists.

“Having grown up with video games, the idea that you could actually practice a technical skill set and a knowledge-based skill set in medicine while getting the same little burst of happiness and joy and dopamine to use the neurotransmitter from playing a game, it seems to all fit,” Damania says.

Adds Dr. Jacqueline Morano, a neurosurgical anesthesiologist and assistant professor at the University of Chicago School of Medicine, “People who are good at video games are actually good at some aspects of clinical medicine.”

Doctors earn extra credit for playing

The Level Ex games are based on actual and sometimes rare cases that have been submitted by physicians. And however unorthodox it may seem, by playing them doctors can earn CME or continuing medical education credits toward maintaining their licenses.

"It is super important for us to have access to continuing medical education,” Morano says.

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Level Ex is the brainchild of CEO Sam Glassenberg, whose background in video games (at places such as LucasArts and Microsoft) made him the “black sheep of the family” when he didn’t follow his kin to medical school.

For sure, Level Ex has hired its share of video game developers, but the company also employs full-time MDs and biomedical engineers.

Level Ex also relies on more than 150 physician advisers with pedigrees from Harvard, Stanford, Northwestern and elsewhere who submit cases and ensure the accuracy of the challenges.

To the laymen, the computer-generated graphics look realistic, down to how blood changes color when it mixes with other bodily fluids or how the patient swells or breathes. But with sound effects, music, the use of color and certain controls, there are allowances made for the gaming environment.

Some cases within games exploit augmented reality technology, in which the virtual blends in with your real-life surroundings.

One complex case inside Airway Ex involves a 45-year-old male emergency room patient who has been complaining about a shortness of breath. A large, obstructive supraglottic tumor is discovered. The patient requires intubation and the player must figure out how best to remove the mass.

In a Pulm Ex case based on a real-life incident, a patient is a carpenter who accidentally inhaled a nail. The nail punctured the wall of the trachea. A doctor/player trying to remove the nail in this complex case can consult actual chest X-rays and CT scans.

Doctors trying solve Cardio Ex cases might have to figure out which configurable stents, balloons and atherectomy drills are required to restore the flow of blood to the heart.

The Cardio Ex video game is aimed at cardiologists.

The Cardio Ex video game is aimed at cardiologists. (Photo: Level Ex)

Scoring points and consequences

As part of the various scenarios, players are scored on speed, tissue trauma, loss of blood and, of course, the accuracy of the procedure and whether the patient survives. Doctors can compete against other physicians or themselves. And yes, as with other video games, players can compare their results to the top scores.

The degree of difficulty and challenges get harder as you go. The biggest and most complex cases are where physicians can earn CME credits.

Dr. Eric Gantwerker divides his time between being Level Ex’s vice president and medical director and his medical practice as a pediatric ear, nose and throat surgeon. He jokes that he sometimes tells parents of patients or the patients themselves that he’s perfected his craft playing video games.

“You have to really measure your audience and see how they respond,” he laughs.

Though the free app games are designed for doctors and others in the medical field – and include their share of medical jargon – anyone can play them. If you’re about to have a colonoscopy, you might get a sense of what you’re about to go through by playing, Gantwerker says.

Since Level Ex combines game play and education, the designers must balance the rewards that come with doing well against making it challenging enough to keep players interested.

Losing the game – and the patient

Meanwhile, since Level Ex games are just that – games – they’re meant to be fun, even if the back story to cases may involve real life-and-death situations.

“There’s actually a big discussion in all of the simulation world and even in games about losing a patient and what that effect is on the provider or the person playing the game,” Gantwerker says.

So how does botching procedures and scoring poorly inside the games affect the confidence of a doctor who must confront those real-life cases?

“We give you the opportunity to take on very serious scenarios, but being able to do it in an environment where there's no consequences means you can try different approaches,” Glassenberg says. “One of the best ways to learn is to fail. I would much rather fail on a virtual patient than a live one.”

Source: https://www.usatoday.com/story/tech/2019/06/12/medical-video-games-help-doctors-perform-major-procedures-surgeries/3712733002/

Medtronic's latest real-world device data, Onduo and Orpyx's expanding partnership and more diabetes news from ADA 2019 by Dave Muoio

On Friday, the American Diabetes Association kicked off its annual conference in San Francisco, where academics, vendors and other stakeholders congregated to unveil new study results and major announcements related to diabetes management. And while MobiHealthNews already put together a roundup featuring an opening salvo of the show’s announcements, the past few days have seen a tidal wave of new info spill out of the diabetes industry.

Here’s a roundup of the latest news most pertinent to the digital diabetes management industry.

There was hardly a shortage of data and announcements from Medtronic regarding its diabetes management devices.

On Friday evening, the medical technology company announced a partnership with Tidepool that the pair hope will lead to an interoperable automated insulin pump system. For its part, Medtronic will be developing a Bluetooth-enabled MiniMed pump designed to work with the Tidepool Loop, an open-source iPhone and Apple Watch app that the group hopes to have FDA-cleared for automated insulin delivery. Medtronic will be supporting Tidepool financially, and through the development of an SDK for iPhone-to-pump communication.

"We think that Medtronic is making a very bold and important move here that shows tremendous courage and is the absolutely right thing for the diabetes community," Howard Look, founder and CEO of Tidepool, said in a statement. "Medtronic makes incredibly robust and reliable pump hardware, and they have extensive marketing, sales, and support organizations for people with diabetes and for healthcare providers. This network can help bring closed-loop systems to more people living with diabetes.”

This afternoon, the device maker went on to unveil real-world data regarding the use of its Guardian Connect CGM and Sugar.IQ diabetes assistant app (developed with IBM Watson Health) among more than 3,100 people with diabetes. Here, the company said that patients using the Guardian Connect system and the app stayed within their glycemic range 4.1% more often than those using the system without the app. An additional Glycemic Assist feature that allows users to review how specific foods impacted their response also boosted their time in range by another 4%.

“Sugar.IQ is the first app to use machine-learning to detect glucose level patterns for advanced notification of low and high events associated with diabetes,” Michael Hill, VP and general manager of the Multiple Daily Injection Solutions business within the Diabetes Group at Medtronic, said in a statement. “These results suggest the Sugar.IQ diabetes assistant, together with our Guardian Connect system, may help patients better understand glucose trends and increase their time in range, aiding in behavior change which may ultimately help improve clinical outcomes.”

Finally, the company said Saturday that it has kicked off two new diabetes trials. The first will involve a Bluetooth-enabled MiniMed 780G advanced hybrid closed loop system, and will enroll up to 350 adult and pediatric patients. The second will examine the Guardian CGM sensor among 460 adult participants aged two years to 80 years.

Verily-Sanofi joint venture Onduo and diabetic foot ulcer sensor company Orpyx Medical Technologies extended their collaboration today with the announcement of a new digital diabetes management offering for buyers.

Now, companies who are employing the Onduo Virtual Diabetes Clinic — a system of integrated software, devices and services — may choose to expand their programs and provide Orpyx’s sensors to those with diabetes. Conversely, those working with the sensor maker may also choose to provide their population with access to the Virtual Diabetes Clinic.

"There are a lot of diabetes management companies that do lifestyle and coaching. At Onduo, we do the same but our clinic is particularly focused on bringing deep clinical interventions that can help those who need more. One of the top complications — and cost drivers — of living with type 2 diabetes is foot ulcers. This joint offering with Orpyx gives us one more arrow in our quiver to help target and address the interventional needs for those who need it.”

Virta Health shares two-year data

Two-year data from Virta Health’s ongoing five-year study of its digital Type 2 diabetes therapeutic boasted significant reductions in HbA1c, fasting glucose, fasting insulin, weight, systolic and diastolic blood pressure and other key metrics, according to a writeup published in Endocrinology. Of note, the nutritional ketosis-based treatment reversed the condition in 55% of patients, and reduced or eliminated the need for insulin among more than 90% of those who had been using it at the study’s onset.

On the other hand, there were some dips comparing the data to the year one check in — namely, a 60% rate of condition reversal, and an attrition rate that increased from 17% at one year to 26% at two.

“These results provide evidence that sustained improvement in diabetes status can be achieved through the continuous remote monitoring and accountability mechanisms provided by this multi-component CCI including recommendations for low-carbohydrate nutrition,” the researchers concluded.

Wearable insulin delivery device lowers blood sugar

Valeritas, maker of the V-Go Wearable Insulin Delivery Device, highlighted new data implying that Type 2 diabetes patients who switched to the device from basal insulin regimens could lower their average blood sugar levels. The retrospective analysis included 73 patients, and demonstrated an average A1c reduction of −1.3. Hypoglycemia fell from 23% to 19% among the participants, while severe hypoglycemia was reduced from 10% to 3%.

“Insulin therapy is often intensified utilizing a stepwise approach of adding one injection at a time due to the increased burden and complexity associated with basal-bolus therapy,” Dr. Trisha Zeidan, the study’s principal investigator and an endocrinologist at the Premier Physician Network, Bull Family Diabetes Center, said in a statement from Valeritas. “Although this stepwise approach is well accepted, research demonstrates in one year, the majority of patients will require full basal-bolus therapy to manage their diabetes. In our experience, V-Go offers a straightforward way to intensify directly from basal to basal-bolus therapy and has been well accepted by patients and proven effective, which is conducive to patient self-management.”

Lilly study shows Livongo promotes self-efficacy

A study conducted by Livongo and Eli Lilly and Company suggests that the majority of patients enrolled in the Livongo for Diabetes program report high psychosocial self-efficacy or infrequently overwhelmed by their condition after 12 months. More specifically, among a cohort of 957 participants aged an average of 55 years, 61 percent of diabetes patients improved their scores on the Diabetes Empowerment Scale — Short Form (DES-SF) and the Diabetes Distress Scale 2 (DDS2), while 94 percent scored higher on at least one of the validated surveys.

"These study findings are exciting as they indicate the Livongo for Diabetes program is fulfilling our mission of empowering our Members to better manage their conditions on their own terms," Dr. Bimal Shah, chief medical officer of Livongo, and senior author of the study, said in a statement. "Our Members who chose to complete the DES-SF or DDS2 are more confident after using Livongo and people with diabetes who were on insulin or had comorbid conditions saw improvements in their empowerment scores. This suggests that people with complex treatment regimens using Livongo have a great opportunity to learn more about their diabetes management."

Freestyle Libre leads to 1% HbA1c drop

Use of Abbott’s FreeStyle Libre CGM system significantly reduced the HbA1c levels of 363 European Type 2 diabetes patients receiving intensive insulin therapy, according to a late-breaking retrospective analysis. The nearly 1% change was observed after at least three months of using the system.

"These real-world findings highlight how Abbott's FreeStyle Libre system can fundamentally change how people manage their diabetes, especially for people living with Type 2 diabetes," Dr. Helene Hanaire of the University Hospital Center of Toulouse in Toulouse, France, and one of the lead authors of the study, said in a statement. "By using the real-time results, trends and patterns from the technology right at their fingertips, people with diabetes are becoming more actively engaged in making better decisions to control their glucose levels and improve their own health."

Source: https://www.mobihealthnews.com/content/medtronics-latest-real-world-device-data-onduo-and-orpyxs-expanding-partnership-and-more

The $2.1 Million Question: What Are The Medical, Ethical Implications Of The World's Priciest Drug? by Robert Pearl

With last month’s FDA approval, Zolgensma became the world’s most expensive medication. Priced at $2.125 million per patient, the one-dose gene therapy is a potential life-saver for children with spinal muscular atrophy (SMA). Now, the treatment is at the center of an intensifying debate over the rising price of medications.

Industry watchdogs are outraged. They say Zolgensma is merely the latest example of unethical and monopolistic pricing strategies among drug manufacturers.

In a Bloomberg op-ed titled No Miracle Drug Should Cost $2.1 Million, Dr. Peter Bach wrote that it’s wrong for Novartis and other pharmaceutical companies to price “orphan drugs” (medications for rare diseases) at whatever the market will bear.

“The drug industry will argue, as it always does, that unlimited and rapidly escalating prices are needed to recoup the costs of R&D,” Bach noted. However, Novartis neither researched nor developed Zolgensma. It simply acquired AveXis (the firm that did) for a price that Novartis will recoup in relative short order, according to analysts.

On the other side of the debate are the beneficiaries of Zolgensma, namely the parents of afflicted children.

“You cannot put a price on your child’s life,” said Tina Anderson, whose son will soon celebrate his fourth birthday thanks to Novartis. Anderson joins a chorus of other moms praising the FDA’s ruling. These parents believe that $2.1 million is a fair price compared to the alternative: a lifetime of paying for at-home care, ventilators and repeat hospitalizations, “all of which can add up to far more than the cost of Zolgensma.”

In ethical controversies such as these, opposing sides rarely give ground. No one will convince Dr. Bach that drug companies should be allowed to charge millions for a medication that will turn huge profits in the near future. Meanwhile, parents like Ms. Anderson worry that if drug manufacturers like Novartist weren’t allowed to make a handsome profit, there’d be no incentive to cure orphan diseases like SMA.

Rather than trying to resolve the unresolvable, it’s time to examine the ethical and medical implications of a future filled with multimillion-dollar drugs.

The United States doesn’t overtly ration medical care, unlike other nations. But Zolgensma, with its $2 million per-dose price tag, is a harbinger of rationing to come. To understand this looming threat, let’s begin with the process by which pharmaceutical companies make R&D decisions.

How Drug Makers Choose Their Targets

To their credit, the pharmaceutical and biotech industries spend more than $100 billion each year researching and developing new drugs, more than three times what the U.S. government invests in basic research.

However, the criteria currently guiding drug-company R&D decisions are based on profits, not on moral, ethical or societal considerations.

Drug companies begin by determining which treatments are likeliest to command high prices and turn fast profits. A treatment for SMA, as an example, checks both boxes. Next, drug makers look for a captive audience. They assess the needs and motivations of at-risk populations and calculate the likelihood of garnering insurance reimbursements. For diseases like SMA that are quickly diagnosed and potentially deadly, parents and advocacy groups will do anything to make sure the treatment is covered. Finally, major drug makers look for solutions that require minimal upfront investment. In the case of Zolgensma, Novartis side-stepped R&D expenses by purchasing the drug’s developer, leaving the company with no doubt about the profitability of its investment.

Because this earnings-driven approach isn’t likely to change, we should expect many more multimillion-dollar medications to hit the marketplace in the future.

The Long-Term Implications Of Today’s Drug-Pricing Strategy

Novartis spent $8.7 billion to acquire AveXis, the Illinois-based firm behind Zolgensma. But the Swiss drug giant was really only after the firm’s technology, which transfers DNA into cells through viral vectors. This groundbreaking process could lead to the development of more than 100 different gene-therapy treatments over the next two decades.

Assuming Novartis and its competitors employ the same pricing strategy going forward, the mathematics could yield frightening consequences: Multiply a $2 million sticker price by 100 gene-therapy treatments by hundreds of thousands of potential drug recipients, and costs quickly reach into the trillions.

In today’s $3.5 trillion healthcare industry, which accounts for close to 20% of the U.S. GDP, such a rapid escalation in spending would force medical providers to limit patient access. In a word: rationing.

Already, the United States engages in various forms of de facto rationing. By one estimate, less than $90 billion a year goes to treat mental illness. That’s about 2.5% of the nation’s current healthcare spending earmarked to address the second-leading cause of death among teenagers. Each year, more than 4,600 young people (ages 10 to 24) commit suicide, resulting in more age-related deaths than cancer, heart disease, AIDS, birth defects, strokes, pneumonia, influenza and chronic lung disease combined.

As a nation, we similarly fail to identify and adequately treat those who’ve experienced adverse childhood events (ACEs), such as physical or sexual abuse, which affect an estimated 35 million U.S. children. According to a large-scale study over 10 years, people who experienced six or more ACEs were 54 percent more likely to die than those with none. Clinical studies show that childhood trauma not only reduces life expectancy for the victim, but also severely impacts the victim’s future children and additional generations.

If we zoom out even further, looking at the consequences of diseases that begin in childhood, we’d see the growing need to address the epidemic of obesity, which claims 300,000 lives per year, more people than car crashes, terror attacks, and Alzheimer's combined. Yet despite the magnitude of the problem, only a few pilot interventions are in place with no large-scale programs capable of significantly moving the needle.

In the United States, a land of plenty, no one likes to talk about rationing. In fact, when the cash-strapped state of Oregon tried to implement a data-driven and transparent process to “prioritize” Medicaid services in 1990, the public outcry was so deafening that lawmakers had no choice but to quickly ditch the plan.

The reality is that rationing tends to happen slowly, and much less transparently than that. For example, rising deductibles and co-payments have slowly forced many parents of children with diabetes to administer less insulin than their pediatricians recommend. Likewise, there’s growing evidence that rising out-of-pocket expenses are forcing many to avoid or delay expensive tests and procedures.

As drug costs continue to skyrocket, rationing will accelerate.

Shining A Light On Medicine’s Unacknowledged, Unethical Practices

An independent assessment found that Zolgensma is worth up to $900,000 per patient based on the drug’s effectiveness. That’s a massive sum but not even half the going rate and only one-fifth the price Novartis originally quoted.

Pharmaceutical manufacturers receive due criticism for excessive drug pricing. But we should be reminded that drug companies are not alone in contributing to the unaffordability of medical care. Doctors and hospitals contribute to the economic challenges patients face, as well.

The Institute of Medicine (IOM), for example, estimates that U.S. doctors and hospitals waste as much as $441 billion each year on unnecessary services and inefficient care delivery.

Policy experts have long considered healthcare “waste” a financial issue—a contributor to soaring inflation and a burden on taxpayers. But that’s only part of the problem. The time has come to see inefficient healthcare for what it really is: An ethical violation of the trust that patients place in physicians and other medical professionals.

Today, one in three antibiotics are prescribed inappropriately, according to the CDC, adding an additional $2 billion in healthcare costs that negatively impact clinical quality. Likewise, surgeons perform approximately 700,000 arthroscopic partial meniscectomies each year at a direct cost of $4 billion. Yet this procedure has been shown to add no value compared to physical therapy alone.

Make no mistake, the pharmaceutical industry’s R&D and pricing strategies put the health and finances of our nation at risk, and Congress needs to take action soon. But everyone in the medical profession shares responsibility for the problem.

FDA approval of the world’s first multimillion-dollar drug is warning shot for American healthcare. If we don’t put a stop to the unnecessary procedures, excessive prices and ineffective medical care, overt rationing will be inevitable. As a consequence, far more children will die than will be saved by these new, high-priced medications. To avoid this path, all the major players—doctors, hospital administrators, politicians, insurers and drug makers—will need to accept that today’s wasteful practices are ethically wrong and, if left unchecked, will prove deadly.

Source: https://www.forbes.com/sites/robertpearl/2019/06/10/zolgensma-ethics/#3c1018f262bc

Lifting the lid on medical device failure reporting in the latest Medical Technology

The US FDA has compiled a draft guidance to promote the development of brain-computer interface devices, which could give users the ability to control implants directly. We take a look at the benefits of such devices and the significant concerns that surround the concept of linking any device directly to the brain.

Also, we speak to NHS innovation hub Health Enterprise East to find out how medtech start-ups can crack the all important NHS market with new innovations, explore med tech innovation in Israel, which has rapidly become a hub for high-tech development and spinout-friendly research centres, and examine the arguments for and against the controversial medical device tax in the US.

Plus, we investigate whether there is too much secrecy around the reporting of medical device failures after the FDA was found to have enabled companies to conceal reports of serious injury and malfunctions from public view, take a look at the science behind breath biopsies, and get the latest market trends and analysis from GlobalData.

Regulating brain-device interface dilemmas

The FDA has published guidance laying out how brain-computer interface devices are to be regulated. These devices have enormous potential for returning mobility and independence to patients, but a lot remains unknown. Allie Nawrat finds out more.

Selling into the NHS: HEE’s top tips for medtech companies

Med tech companies are major drivers of innovation in healthcare, however, they face a range of challenges and barriers when cracking into the UK’s primary healthcare provider, the NHS. Allie Nawrat talks to NHS innovation hub Health Enterprise East’s director of medtech consulting and business development Joop Tanis about gaining traction in the NHS.

Israel: a medtech innovation hub for the world

Israel has long been renowned as a hub for high-tech innovation, with an active investment scene and spinout-friendly research centres helping to push the country’s medtech sector to new heights. Chris Lo examines the secrets behind the outsized performance of Israeli med tech in recent years.

US medical device tax: should it be gone for good?

The basic theory of taxation says that the more you tax something, the less of that activity occurs. That logic is now behind a move to squash unpopular medical device taxes in the US for good. But is the tax as bad as it’s made out to be? Chloe Kent reports.

Post-market surveillance is a vital component of maintaining safety in the medical device market, but recent controversies have highlighted transparency concerns around device failure reporting. Is there too much secrecy in the reporting processes of regulators like the FDA, and how can the situation be improved? Chris Lo finds out.

Take a deep breath: this could be the future of cancer diagnosis

Scientists have developed a breath sampler which is able to detect lung cancer at a far earlier stage than other tests, opening the possibility for faster, more effective treatment for patients. Could this non-invasive method become the new standard for lung cancer diagnosis? Chloe Kent reports.

In the next issue of Medical Technology, we take a look where the next breakthroughs may lie in the growing field of contact lens technology, speak with Dr Loubna Boufarna from Cambridge-based healthcare AI company OKRA Technologies about AI, start-ups and diversity in pharma, and find out how governments around the world are approaching the call for stricter device regulation.

Plus, we investigate how brands are getting away with illegally marketing devices and what can be done to stop them harming patients, find out how manufacturers can meet the standard of environmentally responsible production of devices, and examine a new blood management device that can be installed in operating theatres to collect a patient’s own blood and return it to them if needed.

Source: https://www.medicaldevice-network.com/features/lifting-the-lid-on-medical-device-failure-reporting-in-the-latest-medical-technology/

Common heartburn drug linked with fatal conditions by Ana Sandoiu

New research suggests that drugs commonly used for heartburn, acid reflux, and ulcers may raise the risk of numerous fatal conditions, including heart disease and stomach cancer.

woman's palm holding white and blue pills against yellow background

A new study warns about the dangers of a class of drugs called proton pump inhibitors.

Physicians often prescribe proton pump inhibitors (PPIs) to treat gastrointestinal conditions that involve an excess of acid production.

Nexium, Aciphex, Zegerid, Dexilant, Prevacid, Prilosec, and Protonix are only some of the brand names that PPIs have taken over the years.

More than 15 million people in the United States take prescription PPIs, according to the most recent statistics available, and even more may be taking over-the-counter PPIs.

A new study, appearing in the journal The BMJ, suggests that these drugs may increase the risk of death from various chronic health conditions.

Dr. Ziyad Al-Aly, an assistant professor of medicine at the Washington University School of Medicine in St. Louis, MO, is the senior investigator of the study.

For the new study, Dr. Al-Aly and colleagues examined data from the medical records of the U.S. Department of Veterans Affairs.

The researchers looked at data available from mid-2002 to mid-2004, a period during which 157,625 people in the cohort received PPI prescriptions from their physicians and 56,842 people received H2 blockers, another kind of acid suppressant.

The scientists clinically followed the participants — who were predominantly male, Caucasian, and 65 years old or older — for up to a decade.

They used the data to build a statistical model of a clinical trial, which would see the participants randomly assigned to take either PPI or H2 blockers.

This allowed them to estimate that during the follow-up period, there would be 45.2 excess deaths per every 1,000 individuals taking PPIs.

Honing in on the causes of death, the findings revealed associations with cardiovascular disease, stomach cancer, and chronic kidney disease.

Further evidence that PPIs may raise the risk of stomach cancer, especially after prolonged use.

The model estimates the death rates for cardiovascular disease to be 88.7 per 1,000 people in the PPI group and 73.3 per 1,000 people in the H2 blocker group.

This scientists saw 4.3 deaths in every 1,000 people from stomach cancer in the PPI group, with 4.6 deaths from the disease in the H2 blocker group in their model. The rates for chronic kidney disease deaths were 8.6 per 1,000 people in the PPI group and 4.4 in the H2 blocker group.

Also, the risk of death increased with the duration of the treatment, even when the study participants had taken low doses of the drug.

Finally, the research revealed that over half of those taking PPIs had no medical need for them. "Most alarming to me is that serious harm may be experienced by people who are on PPIs but may not need them," comments Dr. Al-Aly. "Overuse is not devoid of harm."

"PPIs sold over the counter should have a clearer warning about [the] potential for significant health risks, as well as a clearer warning about the need to limit the length of use, generally not to exceed 14 days," continues the lead researcher. "People who feel the need to take over-the-counter PPIs longer than this need to see their doctors."

"Taking PPIs over many months or years is not safe, and now we have a clearer picture of the health conditions associated with long-term PPI use," adds Dr. Al-Aly

Source: https://www.medicalnewstoday.com/articles/325372.php

Five Disruptive Innovations in Medical Technology: Takeaways from the Women Designing the Future Conference by Manuela Soto

The 2019 Women Designing the Future Conference: Game Changers! occurred on March 29 here at NJIT. Here are five key takeaways from the conference:

1. Technology is becoming an increasingly bigger part of medicine.

As the field of medicine grows and develops, technology has grown and developed with it. Medicine and technology have begun to intertwine to the point where advances in medicine are made possible becauseof the advances in technology.

Some of these innovations sound as revolutionary as expected. They include advanced imaging techniques, robot-assisted surgery, genetics, and even the use of virtual reality (VR) in therapy. However, also included in this list can be technologies that do not sound quite as astounding, but are still immensely helpful in the advancement of medicine. One such technology is 3D printing, which Riley described as “life changing.”

2. Video games can be used as a form of therapy.

Although it may sound hard to believe, video games can be and are being increasingly used in healthcare as a form of therapy. Specifically, Alvarez spoke about her team’s use of VR to treat vision issues that are uncommon in the general population, but very common in people who have suffered from concussions.

The VR therapy utilizes Virtual Eye Rotation Vision Exercises (VERVE). VERVE is a type of VR game that is controlled completely with the eyes and their movement. Alvarez calls this a way to “sugar coat therapy” because it is more exciting than regular therapeutic exercises. Not only does this innovative approach actually improve nearsighted vision, but it is also a more personalized form of therapy that will hopefully result in greater patient compliance.

3. Medicine is moving away from treatment for the masses and toward personalized medicine.

Like with most things in life, medicine is not a “one size fits all” kind of ordeal. Medications and treatments that work for some people will not necessarily work for others. That is why there has been a push towards personalized medicine, which is medicine and treatment that focuses on the individual and addresses his or her needs on a case-by-case basis..

Personalized medicine can come in many forms. With something like joint replacement surgery, Riley explained that the goal was to develop implants that were specifically fitted for the patient rather than ones that followed a “shoe size” concept. Additionally, as mentioned above, there is the development of game therapy, another individualized treatment method. In this case, the game can progress in difficulty depending on the capabilities of the patient and their level of improvement.

4. Mentoring is important.

In any field, mentoring is going to play a huge role in learning and growing, and the field of medical technology is no different. This doesn’t always mean the same thing to everyone, but the end goal is still the same—to improve and learn.

The three speakers all had different experiences with and views on mentoring. For Riley, it was a matter of leading by example for those who work for her. Alvarez, on the other hand, emphasized stepping out of your comfort zone and putting in the effort to speak with people about your passions. Similarly, Liao spoke about the importance of giving and receiving feedback to help improve your work and that of others.

5. Medical technology also has a very important business aspect to it.

The three guest speakers at this session of the conference had experience not only in research and development of products, but also in the entrepreneurial aspect that follows research. Sometimes, these two halves conflict slightly, but it is not impossible to find a middle ground.

First, there is a sort of evolution that has to happen as there is a transition from startup to big company. Liao explained, “At the beginning, I was wearing a lot of hats and I sought to be versatile to be able to do things dirty and elegant at the same time … [later] the skill set becomes how to lead people, how to align my team and align them to the same goal.” They also spoke about how it is not always easy to be able to balance being a scientist with being an entrepreneur. Riley mentioned that sometimes there is a desire to have a large study, but this may not be possible financially, nor is it always necessary or even helpful to do so.

Finally, there was a short discussion about striking a balance between the customer’s needs and the logic and reasoning of the scientist. Alvarez said that it is important to “understand your customer” and “not just take your product in terms of what you think is the right solution but actually talk to the people who are going to use it.” The main theme here is balance. In order for a business to run smoothly, there has to be a balance between its components.

Source: http://njitvector.com/2019/05/five-disruptive-innovations-in-medical-technology-takeaways-from-the-women-designing-the-future-conference/

Weekly tech roundup: medical technology edition by Laci McDowell

TechLink’s federal invention database is where entrepreneurial-minded people can go to find solutions to commercial problems.

This week’s tech roundup features innovative medical technologies that can be licensed by businesses taking strides to make the world a healthier place.

And TechLink can help you navigate the licensing process at no cost to you.

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Neurorehabilitation of brain following stroke

There is currently no established method to restore upper limb function to normal after a person suffers a stroke.

Researchers with the Department of Veterans Affairs have taken a new approach to brain activated limb movement. The method analyzes the brain of a non-impaired subject during body movement. It uses real-time functional magnetic resonance imaging in order to target brain areas associated with specific body movements.

Augmented reality surgical navigation system

Department of Veterans Affairs researchers are working to introduce more functional augmented reality in surgical navigation.

Augmented reality would be extremely useful in neuronavigation systems, which currently display the location of a pointer on a screen, requiring the surgeon to look away from the patient.

Fluid consumption sensor for hydration optimization

The Army Research Institute of Environmental Medicine has developed and tested fluid intake monitoring devices for studying and optimizing personal hydration.

An enabling component of these devices, a gear-type fluid consumption sensor, has been patented and is available.

The innovative design enables precise, real-time hydration monitoring and is adaptable to a variety of drinking containers, such as bladders, plastic bottles, and straws.

Traditional techniques for casting or splinting a fracture use a large heavy cast made from plaster-of-Paris, fiberglass, or polyurethane. While functional, there are many disadvantages.

And splints, more common in field settings, can be difficult to align and offer less protection to the injury area.

An Army orthopedic surgeon has developed and tested a new approach to immobilizing fractured bones using fast-setting foam.

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Targeted endodontic microsurgery using 3D printed guides

The Air Force has invented a novel tool for perfecting the alignment of trephine drills during complex dental surgeries.

Their new targeted endodontic microsurgery (EMS) technique brings about clinical simplicity to challenging anatomic cases involving the maxillary sinus, greater palatine artery, posterior dental arch location, mental nerve, and fused roots.

Source: https://techlinkcenter.org/weekly-tech-roundup-medical-technology-edition/

Why tech companies keep hitting the same wall when they try to get into health care by Christina Farr

Technology companies like Amazon, Google, Apple and Microsoft keep making moves in the health sector, which isn’t surprising given that it represents a $3.5 trillion opportunity.

But these companies keep hitting the same stumbling block: the inability to share health information across medical systems. Millions of patients are learning that they can’t share clinical data from their electronic medical records between doctors, especially among those working at different hospitals. They face a similar challenge getting billing information.

Paul Markovich, chief executive of Blue Shield of California, a health insurance plan with more than 4 million members, said big technology companies are highly motivated to work with the medical industry to solve this problem. It’s challenging to build systems using things like artificial intelligence, for instance, if companies can’t access the large-scale data they need to build their computer models.

“Without interoperability, they can’t scale,” Markovich said in an interview with CNBC.

‘We need to stop pricing it as a luxury good’

Markovich believes interoperability is vital to help solve what he sees as the biggest problem with health care: high prices.

“We need to stop pricing it as a luxury good, when health care is a necessity,” he said.

Improving access to health data could bring costs down. Studies have found that when consumers can’t access their health information, it leads to medical errors as well as duplicate tests and procedures. All of that is expensive for any health insurer.

Markovich said he sees value in Apple’s efforts with its Health Records application, which people can use to access medical information like labs and test results — as long as their care provider participates.

But he said that it could be a 10-year project for Apple to get data from every hospital, clinic and health plan, unless there’s a concerted effort across the industry, as well as the federal government, to improve health data sharing on a state and federal level.

Fortunately, that’s starting to happen, with recent legislation from the Department of Human Health and Services to promote patient access via a no-cost health data exchange.

Markovich is looking to open up access to claims data, which is essentially a history of things that got billed to the plan. He said he hopes others in the industry will join in these efforts because consumers change their insurance company often enough that they need access to this information across a variety of plans.

He’s also launching a series of pilot programs to test new payment models that involve patients getting more transparency about care pricing, via start-up partners like Ooda health. Ooda CEO Seth Cohen said in the next few years, health care will finally start resembling the financial sector with a “credit card-like statement” for members to see a run down of their billing history from their health plan.

Blue Shield of California is also testing start-ups like Notable, which is making it easier for doctors to annotate the medical record.

Markovich is also on the board of Manifest MedEx, a nonprofit that describes its goal as “connecting health care in California,” and Blue Shield is a member organization.

All in all, Markovich believes the health system will make major steps toward health data interoperability in the next few years, after more than a decade of attempts. And that will open up new business models for tech companies to finally get into health care.

“Finally they’ll stop running into the same wall,” he said.

Source: https://www.cnbc.com/2019/05/30/blue-shield-california-paul-markovich-why-tech-cant-conquer-health.html

Cybersecurity a growing problem in medical field by Emily Baucum

SAN ANTONIO - To tackle a growing problem, the health care industry is now investing billions of dollars each year on cybersecurity.

The Trouble Shooters learned the FBI is working every day with local hospitals and doctors to protect your confidential patient information and keep hackers out of your medical records.

"It's money, right. Data is money now," explains special agent Raymond Martinez from the FBI's cyber squad. "More and more hospitals or health care providers are bringing systems online to make it more convenient to access the data, rather than looking for a paper chart."

And many medical devices now use wireless communication, opening up huge security risks detailed in a recent report by the safety certification company Underwriters Laboratories.

The report states that in 2016, more than 100,000 people with insulin pumps were notified of a vulnerability that could have allowed a third-party to change their dosages.

And in 2017, the FDA recalled about 465,000 pacemakers because a hacker could have changed the programming without anyone knowing it.

"It's a very big deal," Martinez says.

The Trouble Shooters asked the FBI how hackers could even access medical devices implanted in your body.

"Could be the dark web," Martinez says. "Or it could just be somebody on the internet that is just looking for a vulnerable operating system, a vulnerable device."

He says to protect yourself, you need to ask questions. Start by making sure your doctor has a cybersecurity plan. Next, make sure your data's being encrypted as soon as you hit submit on that online form. Also, make sure the doctor's billing system is encrypted.

"A lot of victims think that they didn't realize that they'd be a target," Martinez says. "And when you point out that data is money, they quickly start changing their realization that everybody is a target now."

A silver lining: the Underwriters Laboratories study states there have been no reports of a hacked medical device leading to a patient's injury or death.

Source: https://news4sanantonio.com/news/trouble-shooters/cybersecurity-a-growing-problem-in-medical-field

Burnout is officially a medical condition, according to the World Health Organization by Dalvin Brown

Ever felt mentally worn out or emotionally exhausted from work?

You're far from alone, and you may be suffering from "burnout," a condition that's now officially recognized by the professional health community.

The work-related stress, which has been unofficially embedded in the cultural zeitgeist for years, has been officially recognized by the World Health Organization (WHO) through a revision of the International Classification of Diseases — a handbook for doctors and health insurers.

The official ailment can be found in ICD-11 under "Problems associated with employment or unemployment."

According to the health agency, burnout isn't just synonymous with being stressed out. It's "a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed.”

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According to the health guidelines, burnout is categorized by the following symptoms:

Feelings of energy depletion or exhaustion

Increased mental distance from one’s job, or feelings of negativism or cynicism related to one's job

Reduced professional efficacy

“Burn-out refers specifically to phenomena in the occupational context,” said WHO, “and should not be applied to describe experiences in other areas of life.”

Americans are working longer and harder than ever before, according to the American Institute of Stress. Several studies show that work stress is the major source of anxiety for American adults and that the mental ailment has escalated progressively over the past few decades.

A recent survey from the Korn Ferry research organization indicated that overall employee stress levels "have risen nearly 20% in three decades." A 2018 study by the work management platform Wrike found that 94 percent of workers feel stress in the office and almost a third say their stress level is high to unsustainably high.

The Centers for Disease Control and Prevention has looked into the effects of workplace stress for years and offers scientific guidance for managing issues and problems related to worksite pressure.

The following factors can help reduce work stress, according to the CDC:

Balance between work and family or personal life

A support network of friends and coworkers

A relaxed and positive outlook

Source: https://www.usatoday.com/story/money/2019/05/28/burnout-official-medical-diagnosis-says-who/1256229001/

Congress wants to stop surprise medical bills. But they have one big problem left to solve by Dylan Scott

President Trump and Democrats want to fix an important health care problem, but lawmakers still have one very difficult question to figure out before they can move forward.

Congress suddenly has a bunch of bills to stop surprise medical bills, which can leave even some insured people with tens of thousands of dollars in medical bills for a simple trip to the emergency room, but how much providers actually get — and by what means — is still a very open question.

Sens. Lamar Alexander (R-TN) and Patty Murray (D-WA), the top Republican and Democrat on the Senate health committee, introduced a health care costs bill on Thursday but it did not come up with a way for out-of-network health care providers to get paid by health insurers. Instead, it offers three options for determining those payments, and they will decide later which one to actually include in the final version. It’s a pretty big hole left to fill in otherwise quite ambitious legislation.

Provider payments are the thorniest issue to figure out for any plan to prevent surprise medical bills. It affects the bottom lines for doctors, hospitals, and insurers, so they care a lot about those provisions and lobby hard on them. Different House and Senate bills would set up different systems for how those payments would be determined.

Trump has pledged to sign a bill blocking surprise medical bills. For now, the lawmakers working on surprise billing sound diplomatic about the differences between their plans. But solving the provider payments issue is a substantial hurdle to doing something.

“My No. 1 goal is clear: Let’s protect patients by ending surprise medical bills. The path to achieving this goal has multiple roads,” Walden told Vox. “I believe it’s fair to base the compensation mechanism off of private-market rates and that any solution should not raise federal health care costs. This is one solution. Arbitration is another.”

Congress’s plan to stop patients from facing surprise bills, explained

The Alexander-Murray proposal joins several others that have already been introduced: a recently released House bill from Reps. Frank Pallone (D-NJ) and Greg Walden (R-OR); another Senate bill by Sens. Bill Cassidy (R-LA) and Maggie Hassan (D-NH) released last week; yet another House proposal from Rep. Raul Ruiz (D-CA) and Phil Roe (R-TN) that came out on Thursday. Rep. Lloyd Doggett (D-TX) also introduced a bill back in January. Congress really is serious about doing something on surprise bills.

Broadly speaking, the various House and Senate bills to prevent surprise medical bills would have the same consequences for patients: They would be obligated to pay only in-network costs for out-of-network emergency care.

Under the proposal legislation, if somebody ends up in the emergency room or they get surgery, and the facility or one of their providers is not in their health insurer’s network, they can’t be asked to pay the full cost for their medical care. The practice known as balance billing — when a provider bills a patient the balance between what the patient’s insurer paid for a service and the price the provider wants to charge for that service — is prohibited.

The legislation from Alexander and Murray dictates that patients can’t be charged extra money for any emergency care, ancillary care (anesthesia, radiology, etc.), or diagnostic care they receive from an out-of-network provider. They can only be billed for whatever co-pays, co-insurance or other cost-sharing they would have been required to pay for an in-network provider under their health insurance plan. If somebody is moved from the emergency room to a general hospital setting, they must be notified in advance about any potential out-of-network care and its costs. They must also be informed of the in-network options available to them.

The new Alexander-Murray bill also includes a bunch of other provisions beyond surprise billing to reduce health care costs for patients. Given the Tennessee senator’s pending retirement, he might be trying to group together some other cost-controlling provisions into an omnibus health care costs package, using the popularity of doing something about surprise billing as an incentive. Some of the other provisions in the Senate bill include:

preventing “parking” of generic drug applications that delays other drugs entering the market;

prohibiting “pay-for-delay” payments between brand-name and generic drug manufacturers;

requiring insurers to provide timely information on provider networks to their patients;

new federal grants for maternal mortality and integrated pregnancy care.

Surprise bills seem like the surest bet for action at the moment. But there is one other big piece to this puzzle.

The fight over provider payments in lieu of surprise billing, explained

If a patient’s bill will be limited to what it would be for an in-network provider, but the health care provider and insurance company don’t have a preexisting contract, then Congress has to come up with some way to figure out how much the insurer pays the provider for the out-of-network care. That is the real money at stake in this legislation, so the lobbyists for the health insurers and the doctors care a lot about these provisions.

The Alexander-Murray bill punts on this question; they instead lay out three options and plan to pick one after soliciting feedback from the interested parties representing health insurers, doctors, and patients. The three options are:

Guaranteeing to patients and insurers that all individual providers at an in-network facility will also be considered in-network. That prevents patients from getting hit with a bill from a specific out-of-network doctor when they went to an in-network hospital. Providers can either join the network voluntarily or they can bill insurers through the in-network facility. For any remaining out-of-network care, insurers and providers have 30 days to agree on a price; otherwise, the median price in the area for that service will be used.

Allowing arbitration for bills above $750. For bills less than that amount, the health insurer will just pay the average price in the area. For bills above the threshold, either side could request that a third-party arbitrator review best final offers from both the provider and the insurer. The arbiter will then pick the best one in a binding decision.

Mandating that the health insurer pay the out-of-network provider whatever the median in-network price is in that geographic area. Just setting the price the insurer will pay the provider is maybe the cleanest solution from a policy perspective. It guarantees the price will simply be whatever the insurer has already negotiated with other providers in the same region for the same service.

Doctors and health plans really prefer some kind of arbitration. They want to have the opportunity to appeal and seek a better price, rather than being wholly bound by what is effectively a government-set price. Cassidy and Hassan, who have been working on a surprise bills proposal for a year, certainly found that to be true while they drafted their plan. The Cassidy-Hassan bill would allow for arbitration, with the median in-network price acting as the default payment if neither side seeks arbitration within 30 days.

“I continue to believe that the bipartisan STOP Surprise Medical Bills Act – given its support from stakeholders on all sides of this issue – is the most viable option to become law and end the absurd practice of surprise medical bills,” Hassan told Vox in a statement. “Every day, patients continue to receive these outrageous bills in the mail, and I will keep working with my colleagues on both sides of the aisle to pass bipartisan legislation without delay.”

Some experts believe having a regulated price or network matching, rather than allowing for arbitration, is better policy because arbitration could end up leading to higher prices than the other two options, mitigating the cost-saving potential for these plans. The House bill from Pallone and Walden notably goes with price-setting. The White House has signaled it would prefer something other than arbitration as well.

But the politics are trickier: Doctors, hospitals and insurers could mobilize against such a bill, whereas they have sounded supportive of the provisions in the legislation from Cassidy and Hassan that allow for arbitration within certain limits.

“The pure payment standard approach tied to median in-network rates ... would much more clearly reduce health care costs, as the median rate for specialties most commonly involved in surprise billing is notably below the mean,” said Loren Adler, associate director of the USC-Brookings Schaeffer Initiative for Health Policy. “The price-setting approach is pretty clearly preferable to arbitration from a policy perspective, but it’s certainly possible that the politics are easier on arbitration.”

It could be that highly regulated arbitration — like Option No. 2 in the Alexander and Murray legislation — becomes the middle ground to clear this policy obstacle. New York, when passing its own surprise medical billing plan, took such an approach, and the new plan from Ruiz and Roe is modeled on that state’s law.

But for now, Congress is leaving this space blank, as demonstrated by the unusual Option A, B, or C in the Alexander-Murray bill.

Congress really does want to fix surprise medical bills

The safest bet is always against health care legislation passing Congress, especially in a time of divided government. But surprise medical bills might be the exception.

Alexander and Murray lead the Senate’s foremost health care committee, and Pallone and Walden are the top members of a powerful House panel. To have the top Democrat and Republican on those committees co-sponsoring these bills denotes a real intention to pass something — if they can first resolve this dispute over payments and arbitration.

Surprise bills are really only a symptom of the underlying disease plaguing American health care — exorbitantly high and irrationally set prices — but they are a particularly egregious example, as they can leave even patients who have insurance with medical bills that total tens of thousands of dollars. Vox’s Sarah Kliff summarized her findings after collecting ER bills for a year like this:

Patients find themselves in a vulnerable position during these encounters with the health care system. The result is often high — and unpredictable — bills. Hospitals are not transparent about the cost of their services, their prices vary wildly from one ER to another, and it’s hard to tell which doctors are covered by insurance (even if the hospital itself is covered). In many cases, patients can’t be certain what they owe until they receive a bill in the mail, sometimes weeks or months later.

States like California and New York are acting on their own to crack down on surprise bills, but Congress looks insistent on taking action nationwide. These new bills are a hopeful sign that the days of patients ending up in the emergency room with not only a broken arm but also a huge bill might be numbered.

Li Zhou contributed to this report.

Source: https://www.vox.com/policy-and-politics/2019/5/23/18637016/trump-health-care-surprise-medical-bills-congress-legislation

3 medical specialties, 3 common misconceptions by Brendan Murohy

When medical students are researching medical specialties, they may have surface-level beliefs about what those specialties entail. The deeper realities, however, often differ. There is no one better suited to give students a picture of the things they may overlook in certain specialties than the physicians practicing in those specialties.

The AMA’s Specialty Guide simplifies medical students’ specialty selection process, highlights major specialties, details training information and provides access to related association information. It is produced by FREIDA™, the AMA Residency & Fellowship Database®.

Three physicians elaborated on the common misconceptions that students may have about their specialties. Here’s a look at what they had to say.

Neurology is too complicated

“The first misconception is that it’s too complex,” said Rachel Salas, MD, a sleep neurologist who is also core clinical clerkship director at Johns Hopkins University School of Medicine. “We don’t have the luxury of an eight-week clerkship to slow things down for students. But we have at least 28 subspecialties in our field, so I think another misconception is that being a neurologist is the end of the road—but our field is blooming. There’s so much opportunity to look at career fields people don’t think of like neurological palliative care or neurological geriatric care. …

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“We can cure certain neurological disorders,” Dr. Salas said. “There’s just more things that we can offer our patients than we used to and neurology really gives people many options where you can build relationships with patients.”

Psychiatrists are immune to mental-health bias

“Sometimes you can go into psychiatry and still have to work with the same sort of stigma and bias about people and mental illness within yourself,” said Karen Miotto, MD, a psychiatrist who is interim director of the Behavioral Wellness Center at the David Geffen School of Medicine at the University of California, Los Angeles.

“I hope it’s a misconception and I hope it’s part of the learning curve. Being a psychiatrist doesn’t make you immune to bias,” Dr. Miotto said. “I hope that, over time, trainees find the common humanity and compassion. In every medical specialty, part of the training is an us-and-them mentality, that otherness of who we treat and separating ourselves. That’s adoptive and important.”

Internal medicine residents make their biggest impact in the hospital

Hannah Moser, MD, a first-year internal medicine resident with intentions on subspecializing in gastroenterology. One misconception she had about life as an internal medicine resident is that primary care wasn’t going to be a significant part of her workload.

“The importance of being a primary care doctor as part of internal medicine residency training was a big surprise,” said Hannah Moser, who is doing her residency at California Pacific Medical Center.

“In every residency interview you learn about clinic, whether it’s continuous throughout the year or if it’s in stretches. As someone who came into medicine intending to go into a subspecialty, I didn’t give a whole lot of thought to having an outpatient clinic and being a primary care provider for a lot of patients, yet I love that aspect of training. It’s a tremendous responsibility, and I didn’t realize how much ownership I was going to feel over my panel of patients.”

Source: https://www.ama-assn.org/residents-students/specialty-profiles/3-medical-specialties-3-common-misconceptions

New 3-D-printed technology lowers cost of common medical test by Jaclyn Severance

A desire for a simpler, cheaper way to do common laboratory tests for medical diagnoses and to avoid "washing the dishes" led University of Connecticut researchers to develop a new technology that reduces cost and time.

Their pipette-based technology could also help make certain medical testing available in rural or remote areas where traditional methods might otherwise be prohibitively expensive and complicated to conduct.

The 3-D-printed pipette-tip test developed by the researchers leverages what "has long been the gold standard for measuring proteins, pathogens, antibodies and other biomolecules in complex matrices," they say. The method still employs the enzyme-linked immunosorbent assay, also known as ELISA, but through a different route. They detailed their findings in a paper recently published online in Analytical Chemistry.

For 30 years or more, ELISA has been used to test blood, cells and other biological samples for everything from certain cancers to HIV, from Lyme disease to pernicious anemia.

Traditional ELISA tests are performed on plates featuring 96 micro-wells; each well works as a separate testing chamber where samples can be combined with various agents that will then react with the sample, typically by changing color. Technicians can then analyze whether a sample contains indicators of a particular disease or condition depending on the intensity of the color produced during the reaction.

While effective and accurate, the equipment used to run ELISA is expensive—often costing thousands of dollars to install in a lab—and requires specialized training to conduct testing, as improper techniques can lead to incorrect results. The agents used in the actual tests—usually various forms of antibodies—can be expensive as well.

Like many research laboratories, James Rusling's chemistry lab where research assistant Mohamed Sharafeldin and his primary collaborator, Karteek Kadimisetty '18 Ph.D., conducted their work, doesn't have an automated ELISA washing machine, meaning that plates being used for tests must be manually washed—a time consuming and difficult process.

"The ELISA washing techniques take forever," said Sharafeldin, who is currently working toward his doctorate in chemistry. "It's very tough, especially in a lab like ours. We don't have those kind of fancy washing machines."

When Kadimisetty was running ELISA one day, he mentioned, "I wish doing ELISA was as simple as pipetting." That offhand comment was the impetus for what followed: a design for a 3-D-printed adapter for commonly used pipettes that could run an ELISA test right in the pipette tip, without the need for a traditional ELISA plate and the expensive equipment that goes with it.

Each single-use pipette tip represents one micro-well on an ELISA plate; the researchers also designed a multi-tipped version that allows for eight tips to be pipetted at the same time. The tips fit snugly onto most pipettes used in laboratory settings, making fluid handling much easier than with the standard ELISA plate.

"We didn't want to make a big change in the traditional ELISA; we just made engineered, controlled changes," Sharafeldin said. "So, the basics are the same. We use the same antibodies at the same concentrations that they use with conventional or traditional ELISA, so we are using the same protocols. Anything that can be run by normal ELISA can be run by this, with the advantage of being less expensive, much faster and accessible."

The researchers tested the pipette tips on samples from prostate cancer patients and found not only were the test results from the tips as accurate as ELISA tests, they were able to conduct the tests with one-tenth of the amount of testing agent—significantly reducing the overall cost of the test—and at a fraction of the time. Tests conducted by different users with different levels of skill ultimately demonstrated the same results.

Traditional ELISA plate micro-wells hold 400 microliters of fluids each, but the reactions needed to measure test results only occur on the plastic walls of the well. While the 3-D-printed ELISA tips hold only 50 microliters, the design of the reservoir inside the tip dramatically increases the surface area where reactions occur, allowing the researchers to use much less of the costly antibodies used to conduct the test, and significantly reducing the time needed to process the test and read the results.

"Here we have a chamber where the reaction happens at all points," Sharafeldin said, referring to the pipette tip design. "This reduces the time of the assay, which is an important thing, because the ELISA assay takes from five to eight hours to run. This one can be run in 90 minutes."

The pipette tips also don't require an expensive or sophisticated plate reader to determine test results, as ELISA tests do. In the trials with the prostate cancer samples, the pipette tip results were accurately read by taking a cell phone photo and using a free app that measures color intensities in the image.

The benefit, Sharafeldin said, is that the user conducting the test with the pipette tips doesn't have to be a scientist; they just need simple pipetting instructions, then to take a photograph and send it to a technician who could remotely read the results to help make a diagnosis—potentially providing new, lower-cost testing options in rural or isolated areas where establishing a traditional ELISA lab would prove challenging and expensive.

While additional sample testing is needed, Sharafeldin is optimistic about the future potential for the pipette tip design to reduce costs. He is also engaging with engineers to design an automated, vacuum-assisted pipette that would further ease the use of the pipette tips and the conducting of ELISA tests, and would be available for significantly less cost than traditional ELISA equipment.

Source: https://phys.org/news/2019-05-d-printed-technology-lowers-common-medical.html

Lawmakers Sprinting to Address Surprise Medical Bills by Jacqueline LaPointe

Congress and the White House are actively seeking solutions to protect patients from surprise medical bills, with some legislative proposals looking to set provider payment rates for out-of-network care.

Surprise medical bills are charges that patients did not expect or did not expect to be so high. These surprise bills usually occur when insured individuals receive care from out-of-network providers even when they go to an in-network hospital.

Receiving a surprise medical bill can be catastrophic for patients who already face higher deductibles and out-of-pocket expenses. Recent research shows that patient financial responsibility for care increased 11 percent in 2017, resulting in patients paying an average of $1,813 in out-of-pocket costs that year.

As patient financial responsibility continues to rise, lawmakers are moving quickly to create legislation that will shield patients from receiving surprise medical bills. Chief among them is the White House.

On May 9, President Trump held a surprise medical bill event in which he emphasized the seriousness of receiving an expected charge for healthcare services.

“For too long, surprise billings – which has been a tremendous problem in this country – has left some patients with thousands of dollars of unexpected and unjustified charges for services they did not know anything about and, sometimes, services they did not have any information on,” he said in the address. “They weren’t told by the doctor. They weren’t told by the hospitals in the areas they were going to. And they get, what we call, a ‘surprise bill.’ Not a pleasant surprise; a very unpleasant surprise.”

President Trump stated that his administration is prepared to hold insurance companies and hospitals accountable for surprise medical bills. He urged Congress to do so by prohibiting balance billing in which providers charge patients the difference between what the patient’s health plan chooses to reimburse and what the provider chooses to charge.

He also called on Congress to create bipartisan legislation that requires providers to give patients out-of-pocket cost estimates for scheduled, non-emergency care and stops out-of-network providers from billing patients that did not choose their services.

The bills should also include impacts all types of insurance companies without increasing federal healthcare spending, the President stated.

Since President Trump’s address, several lawmakers, including those sitting on the House Energy and Commerce Committee, have proposed legislation that would protect patients from surprise medical bills.

The Energy and Commerce Committee’s bipartisan discussion draft would eliminate surprise medical bills for both emergency and non-emergency services, as well as across different sites of care (e.g., hospitals, ambulatory surgery centers, freestanding emergency departments), experts from the Brookings Institution explained in Health Affairs.

Importantly, the legislation would also prohibit surprise medical bills for all commercial insurance plans by forbidding balance billing. Instead, the bill would set a minimum payment amount that health plans must pay to out-of-network providers, the experts continued. The payment amount would be the median of the negotiated rates recognized by the plan or issuer for a specific service in the geographic area.

A similar bipartisan bill from Senators Bill Cassidy, M.D. (R-LA), Michael Bennet (D-CO), Todd Young (R-IN), Maggie Hassan (D-NH), Lisa Murkowski (R-AK), and Tom Carper (D-DE) would also implement set payment rates. According to a summary of the STOP Surprise Medical Bills Act, providers would automatically receive a median in-network rate for services where a surprise bill occurs.

Lawmakers argue that setting provider payment rates for out-of-network care corrects a current market failure that enables specialties to receive high in-network payment rates relative to what they would receive under typical market forces.

But allowing the federal government to dictate payment rates for providers is a slippery slope, hospital advocates contend.

“We strongly oppose approaches that would impose arbitrary rates on providers. Insurers should maintain comprehensive networks and this plan takes us in the opposite direction by removing incentives to contract with providers,” Rick Pollack, president and CEO of the American Hospital Association (AHA), said in response to the House Energy and Commerce Committee’s draft legislation.

The Federation of American Hospitals (FAH) also said that rate setting strategy is “untested, unproven and an unnecessary government intrusion into the private market.”

Rather than setting payment rates, hospital groups are pushing lawmakers to include arbitration clauses.

Providers and payers should be able to negotiate payment rates for out-of-network services without the patient being put in the middle, the AHA advised Congress.

The state of New York relies on arbitration to prevent surprise medical bills. Providers and payers in the state abide by “baseball style” arbitration in which payers and providers put in payment offers and an arbiter decides which payment offer will stand.

Researchers from Georgetown University recently called New York’s arbitration law a success after finding that the number of surprise medical bill complaints from consumers dramatically dropped after the law’s implementation.

“For the most part, insurers and providers appear to be working out their differences without resorting to arbitration,” the study states.

A bipartisan group of Senators recently released legislation to eliminate surprise medical bills that includes arbitration, while the House Energy and Commerce draft legislation left it out.

Experts from the Brookings Institution argue arbitration is “unpredictable, lacks transparency, and could involve significant administrative costs.” Insurers and the White House have also come out against arbitration.

Lawmakers and healthcare stakeholders are at odds over surprise medical bills. But how lawmakers decide to fix the widespread problem will significantly impact hospital revenue whether Congress members approve new payment rates or arbitration as solutions.

Source: https://revcycleintelligence.com/news/lawmakers-sprinting-to-address-surprise-medical-bills

Phoenix nonprofit helps homeless get to medical appointments by Griselda Zetino

PHOENIX — Sylvestre Primous stopped seeing doctors for several months when he became homeless.

The 71-year-old Vietnam veteran couldn’t get to his medical appointments. It started affecting his health.

It was painful to walk, his stress levels were high and his diabetes was uncontrolled.

“Everything was mentally and physically wearing me down,” he said.

All that changed when he learned about Elaine, a nonprofit formed in February that drives homeless individuals to their medical appointments and helps them navigate the health care system.

The group takes him to his medical appointments several times a month, including to the VA Medical Center in Phoenix where he sees a counselor for his post traumatic stress disorder caused by his military service.

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Vivienne Gellert formed Elaine after getting the idea as a premed student at Arizona State University. She said she noticed there was a gap in the numerous services being offered to people experiencing homelessness.

“We are hand holders,” she said. “We help people who are extremely vulnerable and don’t have the easiest time getting to appointments, scheduling appointments, getting prescriptions, refiling prescriptions and connecting to behavioral health services.”

The group has several drivers who pick up homeless individuals as they’re getting released from the hospital. They also drive them from shelters to doctor’s appointments and helps connect them to resources, including housing.

Gallert said the nonprofit is named after Elaine Herzberg, a homeless woman who was hit and killed by a self-driving Uber vehicle last year.

“We thought as an organization it was a great way and a really beautiful way to honor her memory and to remind us why we’re here every day,” she said.

Since launching in February, Elaine has served about 90 people. Many of them have gotten a ride to their medical appointments by Michelle Detrick, the transportation director for Elaine.

Detrick said she and Primous, both military veterans, have developed a close bond.

“His health was horrible when I first met him,” she said. “He was unable to take his pills, because he couldn’t get the pill bottles open.

“He was unable to prick his fingers because of his hands and the neuropathy.”

But a lot has changed since Detrick began helping Primous keep track of his medical appointments and medications.

“He’s up and moving more,” she said. “He’s becoming a little bit more self-sufficient and his health is — it’s not perfect but it’s real close.”

Primous said Elaine has gone above and beyond to help him get back on his feet.

Besides helping him navigate the health care system, the nonprofit also has helped him find housing and to care for his service dog, Cheech.

“I couldn’t ask for more, I’m blessed,” he said.

Source: https://ktar.com/story/2578868/phoenix-nonprofit-homeless-medical-appointments/

The doctor who invented 18 medical devices by Suzanne Bearne

Consultant Dr Jagdish Chaturvedi is not your typical healthcare professional. He's also an entrepreneur.

Since 2010, Bangalore-based Dr Chaturvedi, has co-invented 18 medical devices to help address inefficiencies he's spotted in the Indian healthcare system.

And he's part of a growing band of professionals who are using their frustrations at work to come up with money-making ideas to solve their problems.

He came up with his first idea before he even qualified in 2008 when he was still training to be a doctor.

Now a fully qualified ear, nose and throat (ENT) specialist he remembers the rudimentary conditions in rural India where he learned his craft.

"We were using long mirrors and headlamps to check patients, whereas my hospital had a flat-screen TV and more advanced technology," he recalled in his book, Inventing Medical Devices - A Perspective from India.

Dr Chaturvedi has co-invented medical devices to help address inefficiencies in Indian healthcare

So he came up with the idea of a portable ENT endoscope with a digital camera attached.

But he found that being an entrepreneur was very different from being a doctor.

"Being a doctor and not having training on how to make a product, I really struggled, so I licensed it out to a design firm," he says.

He got full backing from senior professors in the ENT department which was vital as he was missing training days to get out and meet investors. His colleagues had to pick up his work load which, unsurprisingly, caused resentment.

Biodesign

Whilst the ENT endoscopy device was being developed - it launched in 2015 - Dr Chaturvedi applied to study biodesign at Stanford University in the US as part of a fellowship funded by the Indian government.

Dr Chaturvedi has also launched a platform to connect Indian doctors with the innovation industry

On his return, he set up a company focused on bringing more medical devices to market, including a tool to help chronic sinusitis, and a nasal foreign body extractor.

As though that wasn't enough, he also has a sideline as a stand-up comedian, performing a handful of shows a month.

Last year he launched a platform to connect Indian doctors with those working in the innovation industry.

"Bringing tech to the system becomes easier when you're part of it," says Dr Chaturvedi, who has no intention to give up his medical practice.

"My products are not looked at through the eyes of a corporate, they're created from a doctor's perspective, from within."

Getting the message across

In the UK another junior doctor also discovered a gap in the system - and the market.

Dr Lydia Yarlott was frustrated at the time colleagues wasted every shift trying to contact each other to discuss patients or medical information. They were using inefficient, old-style pagers, radios and telephone landlines.

Dr Lydia Yarlott was amazed at how much time colleagues wasted trying to contact each other

Many medical staff resorted instead to using WhatsApp and other messaging apps. But Dr Yarlott says that such platforms are "tools for social media not for clinical healthcare".

"I was astonished to find that it was virtually impossible to get hold of people you needed, even in an urgent situation," recalls Dr Yarlott.

"Patients would be sick on the wards and you couldn't get in touch with anyone to help you. It was a scary feeling."

When she mentioned the daily struggles staff were facing to Philip Mundy, an entrepreneur, one evening after work, they then joined forces to work on a solution.

With fellow doctor Barney Gilbert, they set up Forward Health, a secure messaging app.

"We knew there needed to be system that didn't make you more stressed, and again, as a healthcare professional, it's actually designed and built for you," says Dr Yarlott, who has reduced her hours to four days a week so she can spend more time at Forward Health.

"It was virtually impossible to get hold of people you needed," says Dr Yarlott

Since the firm was founded in 2016, more than 8,000 doctors and nurses across six NHS Trusts have used the platform, which received $3.9m (£3m) in funding last year.

Source: https://www.bbc.com/news/business-48132022

New medical technology helps blocked sinuses by

A 2016 study found that of 15 adults who received balloon sinuplasty, all reported improved symptoms 3 and 6 months after surgery, without any unanticipated side effects.

Some of the options include opening up blocked sinuses, helping with allergy relief, and aiding with eustachian tube dysfunction.

These procedures can be performed in an operating room under anesthesia or in the office with sedation. When the operation is done, the balloon is expanding the boney opening-- without breaking it.

“It’s more of a fine membranous bone that is as thin as a wafer. And when you inflate that balloon with water, water does not compress," explained Dr. Berger, “So when that balloon expands 360 degrees, it actually moves the bone out of the way and it stretches the membrane that covers it so when it heals it remodels over a bigger opening.”

Berger said this procedure doesn’t tear any of the membrane because that creates scar tissue which would then cause sinuses to close back up.

Debbie Cannon, Patient of Dr. Berger (Source: WALB)

Debbie Cannon, Patient of Dr. Berger (Source: WALB)

One woman said she had sinusitis for many years with sinus infections three and four times a year.

“He did the surgery a little over two months ago. I’ve not had the sinus pressure, drainage. It’s been wonderful,” said Debbie Cannon, a patient of Dr. Berger.

In some cases a patient could feel immediate relief after the operation is complete.

Other times it takes a few weeks.

Source: https://www.walb.com/2019/05/16/new-medical-technology-helps-blocked-sinuses/

Ocutrx Sets the Pace for AR Medical Device Technology at Third Annual Medical Devices Innovation Conference by Ocutrx Vision Technologies, LLC

IRVINE, Calif., May 15, 2019 (GLOBE NEWSWIRE) -- Ocutrx Vision Technologies, LLC, an advanced research and development California-based manufacturer of augmented reality (AR) glasses, is pleased to announce that the company’s founder and CEO recently detailed its breakthrough eye-tracking technology from their flagship Oculenz ARwear glasses to a distinguished audience of healthcare CEO’s, visionaries and analysts at the 3rd Annual Medical Devices Innovation Conference in Boston, Massachusetts.

Freeman served as a key thought leader for the AR medical device space at the conference, which featured a wide array of the brightest minds and medical device innovators who design, develop, manufacture and commercialize life-saving products. Freeman shared the stage with a distinguished healthcare panel including Johnson & Johnson/DePuy Synthes Companies’ Director of Enabling Technologies, Emir Osmanagic, and Google’s Senior Program Manager, Heidi Dohse. The Associate Director of Device and Digital Health at Merck & Co., Inc., George Cusatis, MS, RAC introduced Freeman to the audience.

The annual Medical Devices Conference was developed as an opportunity to bring together key healthcare decision makers and medical device developers to discuss what’s happening in the industry today and prepare for what’s coming next. Attendees receive unparalleled insight into the latest cutting-edge technologies and approaches disrupting the medical devices industry.

“It was an honor to share the stage with some of the brightest minds in the medical device technology space at such an important and prestigious event,” said Freeman. “The ideas expressed—and technology shared—at this conference will likely shape the future of our healthcare and medical devices. The feedback we’ve received here for our patented technology and freshly redesigned Oculenz AR wear glasses is both humbling and motivating to continue to push the boundaries of AR/XR for medical devices to help patients with low vision conditions to lead healthy, enriched lives.”

At the event, Freeman walked the audience through the groundbreaking eye-tracking technology Ocutrx is currently pioneering as well as provided a sneak-peek at the incredible results of very successful early clinical trials for the company’s ARwear glasses. Freeman also discussed the growth of the AR medical device market for technology aimed at assisting patients with low vision in their everyday lives (as well as professionals in executing specialized tasks), the encouraging and overwhelmingly positive reception their technology is receiving in the medical community, amongst patients, media and industry analysts and much more.

For more information about Ocutrx and the company’s revolutionary new low profile, lightweight Oculenz AR glasses with patented eye-tracking technology, please visit www.oculenz.com.

Source: https://www.apnews.com/Globe%20Newswire/b3e95df8d1b85762f8316892e1253eaa

Human lifespan could soon pass 100 years thanks to medical tech, says BofA by Thomas Francke

One of the biggest investment opportunities over the next decade will be in companies working to delay human death, a market expected to be worth at least $600 billion by 2025, according to one of Wall Street's major investment banks.

Bank of America Merrill Lynch analysts Felix Tran and Haim Israel believe that genome sequencers such as Illumina, high-tech players such as Alphabet and biotech companies such as Novartis are on the cusp of "bringing unprecedented increases to the quality and length of human lifespans."

Innovation in genome science, big data and "ammortality," which includes wearable technology and products in the so-called wellness space, could soon prolong healthy human life well beyond 100 years, BofA told clients Wednesday.

"Medical knowledge will double every 73 days by 2020 vs. every 3.5 (years) in 2010, and genomic sequencing costs have fallen 99.999% since 2003," Israel and Tran wrote. "This has enabled a new frontier in precision medicine to further extend life expectancy, heralding a 'techmanity' (technology meets humanity) revolution."

Extending human life to new bounds — long the domain of science fiction novels — could increasingly be a compelling way to make money in the public markets. With a market size already at $110 billion, the Bank of America team highlighted five key sub-themes — genomics, big data/AI health, future food, "ammortality" and "moonshot medicine" — as well as several stocks that offer exposure to the trend.

Genomics

Genomics, or the study of the human genome, is expected to be a $41 billion industry by 2025 and will provide the "next generation of gene editing technology offering potentially revolutionary advances in prevention and disease treatments," Bank of America said.

Companies such as $46 billion genome sequencer Illumina, $27 billion lab instrument manufacturer Agilent and $89 billion life science equipment maker Danaher all have exposure to the space.

Illumina in particular plays "an important role in helping advance disease research, drug development, and the creation of molecular tests," Tran and Israel wrote.

Big data/AI health

The growth of artificial intelligence combined with an ever-growing body of health-care data should help researchers analyze pathology, or the study of the causes and effects of diseases, in the years to come. Improvements in the technology have the potential to bring down health-related costs and enable precision medicine, the BofA analysts said.

Names in this space, which is expected to grow to $36 billion by 2025, include Google parent Alphabet, Amazon (including its joint venture with Berkshire Hathaway and J.P. Morgan Chase) and Apple.

Future food

Future of food companies, which are expected to ensure "healthier eating and sustainable humanity on the planet," include Dow DuPont and WW International. These companies, according to BofA, should leverage agricultural gene editing as well as healthier lifestyles and consumption.

'Ammortality'

The "ammortality" theme, expected to be worth $504 billion by 2025, "will help to improve health spans & [lifespans] to the betterment of human vitality, enabling the world population to live freer of disease rather than forever."

Companies that represent "ammortality" plays as described by BofA include health-care technology firms such as Intuitive Surgical and Zimmer, which worked with Apple Watch to start a clinical study for 10,000 knee and hip replacement patients.

'Moonshot medicine'

"Moonshot medicine" companies — or those that offer revolutionary solutions for health care — include the aforementioned Illumina and genomics companies as well as therapy makers such as Sangamo, Vertex Pharma and Neurocrine.

These companies are working on cures or treatments for some of humanity's toughest diseases, ranging from cystic fibrosis to Parkinson's and Alzheimer's.

Source: https://www.cnbc.com/2019/05/08/techs-next-big-disruption-could-be-delaying-death.html

OUT-OF-NETWORK MEDICAL BILLS ARE A PROBLEM. HEALTH-CARE NETWORKS ARE A BIGGER ONE. by Natalie Shure

The scourge of so-called "surprise medical bills"—a label nearly always referring to out-of-network emergency care provided by an in-network facility, resulting in outlandish bills for the patient—has stoked outrage in recent years. Since 2017, investigative reporting driven by outlets including Vox, NPR, and Kaiser Health News has highlighted cases like that of Scott Kohan, who was saddled with an $8,000 bill for emergency oral surgery it turned out had been performed by an out-of-network surgeon. Some 57 percent of Americans have reportedly experienced this problem; three-quarters say government action should be taken against it.

In Congress, opposition to surprise medical bills appears to be a rare matter of bipartisan consensus: The House of Representatives held its first-ever hearings on the issue in early April after President Donald Trump himself declared a distaste for the practice, and senators from both parties allegedly are working on legislation to curb them. In late April, the California state assembly unanimously voted to pass further patient protections against surprise bills out of committee.

While any relief for patients experiencing astronomical bills is an undeniably good thing, surprise medical bills are but one product of the systemic failures of the health-care system in the United States—and are a narrow category of harms that befall patients within it. Placing such outsized focus on surprise bills as a uniquely galling one replicates the market logic that's so badly perverted American health care in the first place. An equitable health-care financing system simply cannot include networks and such wildly different plans for different people.

Surprise medical bills exist for a number of reasons, each of which are specifically rooted in problems inherent to a privatized, profit-driven health-care system. For one thing, there wouldn't be out-of-network bills without networks themselves—a health insurance innovation put forward in the 1980s. Unlike more regulated health-care systems in peer nations, the American health-care system lacks a robust mechanism to control prices. This leaves each insurance plan to negotiate with providers on its own, and gives the latter more power to set prices.

Once health-care prices began to skyrocket in the 1970s, insurance companies began to try several cost-cutting measures that are now all too familiar to modern policyholders, as described in essays throughout History and Health Policy in the United States, edited by Rosemary A. Stevens, Charles E. Rosenberg, and Lawton R. Burns. These included expanded use of cost-sharing through copays and deductibles to shift more of the financial burden for care onto patients and curtail their use of care, and through the introduction of networks that limited the facilities and doctors a patient could see. The theory behind networks was simple enough: By contracting only with certain providers, insurers could deliver a higher volume of patients to each one and thereby gain more leverage over pricing negotiations. They could then translate the savings into lower premiums, attract more customers, and increase market share.

Around this time, health insurers began peddling a wide variety of plans that suited different needs, allowing "consumers" to choose what worked best for them. Each plan had its own combination of cost-sharing structure, networks, covered benefits, and lifetime caps, with lower premiums offered for skimpier coverage. In the 2010s, the Affordable Care Act implemented a few rules to curtail these practices by outlining 10 "essential health benefits" that all compliant policies must cover, and striking down lifetime caps on coverage, effectively scrapping the most egregious junk plans from being sold to patients. But the ACA didn't intervene as strictly when it came to networks, stipulating only that plans must include "a network that is sufficient in number and types of providers" so that "all services will be accessible without unreasonable delay."

That vagueness leaves a lot of wiggle room, which insurers have clearly capitalized on to cut costs: A 2018 study by consulting firm Avalere showed that 72 percent of plans sold on the Obamacare exchanges had so-called "narrow networks," which included less than 70 percent of the providers in a given geographic region.

There's a very obvious problem with that, and it's the same problem underlying the proliferation of varied "insurance products" that cater to different types of patients. The degree of "choice" a given person has is overwhelmingly determined by their income and health status, which is a shamefully unjust way to allocate the costs of running a health-care system. The healthiest people are able to take their chances on a narrow network, while those with greater health-care needs are financially penalized for needing a wider breadth of providers. Meanwhile, the less money someone has available, the more they're coerced into "choosing" a plan based on price rather than benefits.

Out-of-network billing is the inevitable consequence of having networks at all. Marshaling sympathy specifically for those experiencing "surprise out-of-network bills" amounts to a sort of victim-blaming, wherein only those patients who followed the litany of rules perfectly are entitled to support and legislative action on their behalf. However barbaric "surprise out-of-network bills" are, they comprise a narrow swath of the financial harms suffered by American patients—a great many of which are built right into standard plans in the form of deductibles so high they exceed the total liquid assets of an average family.

Discussing and tackling the inequities—and potential for financial ruin—in our health-care financing system demands an acknowledgment that the sheer diversity of insurance plans in this country, each with their own pricing and benefit structures, is an inherently bad thing. When it comes to insurance policies, a multitude of consumer choices translates into genuine differences in the ability to access care. "Surprise out-of-network bills" are one highly visible example of how that hurts people. Others are never hard to find.

Source: https://psmag.com/ideas/out-of-network-medical-bills-are-a-problem-health-care-networks-are-a-bigger-one