This month’s episode of “News You Can Use” on HealthcareNOWRadio features news from the month of March 2024
News You Can Use with your Hosts Dr Craig Joseph and Dr Nick van Terheyden
The show that gives you a quick insight into the latest news, twists, turns and debacles going on in healthcare withmy friend and co-host Craig Joseph, MD (@CraigJoseph) Chief Medical Officer at Nordic Consulting Partners and myself, where every diagnosis comes with a side of humor. We hope you stay curious, stay engaged, and keep seeking the truth in healthcare in a world that thrives on information.
Buckle up as we dive into the ER of excitement, the ICU of irrationality, and the waiting room of wacky wisdom in this months show that features a review of:
- Apple Vision Plus
- Change Ransomware Attack
- HIMSS Conference
- Diabetes and Digital Health Apps
- What you Can Still do with Excel
VR Meets ER: A Blurry, Costly Rendezvous
We kick off with a review of Apple’s new Vision Pro headset as Craig shares his hands-on experience trying out the $3,500 mixed-reality headset at an Apple Store demo. Despite going in with a negative attitude, he was impressed by the immersive visuals and potential use cases like virtual workspace environments and medical applications for pain/nausea distraction. However, the high price point remains a major barrier to mainstream adoption for now.
Change Ransomwared, Healthcare Despaired
The ransomware attack on healthcare IT vendor Change Healthcare was a major topic of our discussion. The incident crippled billing and claims processing for weeks, leaving many hospitals and physician practices unable to get paid. We discuss our concerns of the industry’s dependence on a single point of failure and lack of contingency planning and also discuss the complicated optics of Change’s recent acquisition by insurance giant UnitedHealthcare.
Dial D for Disappointed Diabetes Apps
Other key segments covered the disappointing findings of a recent health technology assessment questioning the real-world value of digital diabetes management solutions, the continued prevalence of Microsoft Excel in healthcare operations, Formula 1 racing and even running your own Generative AI solutions!
We hope you enjoy our take on the latest news and developments in healthcare and want to help you keep untangling the web of information, dodging the sensational pitfalls, and emerging victorious, albeit a little dizzy, on the other side. In the end, the stories we uncover, and the discussions we ignite, all shape the narrative of our shared future. We want to hear from you especially if you have topics covered or questions you’d like answered. You can reach out directly via the contact form on my website, or send a message on LinkedIn to Craig or me.
Until next week keep solving healthcare’s mysteries before they become your emergencies
Listen live at 4:00 AM, 12:00 Noon or 8:00 PM ET, Monday through Friday for the next week at HealthcareNOW Radio. After that, you can listen on demand (See podcast information below.) Join the conversation on Twitter at #TheIncrementalist.
Listen along on HealthcareNowRadio or on SoundCloud
Raw Transcript
Nick van Terheyden
Welcome to the month of March. I am Dr. Nick.
Craig Joseph
And I’m Dr. Craig.
Nick van Terheyden
This week we will be dissecting the latest healthcare news, unraveling the twists and turns and making sense of some of those do buckles. Just
Craig Joseph
remember, life’s a lot like a breaking news story unpredictable, often absurd, and occasionally leaves you wondering if it’s all just a cosmic prank.
Nick van Terheyden
This week, we’ll take a look at the digital health apps and their value. And what can you do with Excel today.
Craig Joseph
And we dive into change health and a review of the hims conference.
Nick van Terheyden
But first off, this week, we’re going to do an all singing all dancing full scale evaluation of the apple Vision Plus, Craig, you got hold of one. Tell us all about it.
Craig Joseph
Well, let’s be clear. First of all, there’ll be no no dancing or singing. Oh, thank
Nick van Terheyden
god. Yeah.
Craig Joseph
Yeah, you should, you should be thankful. I
Nick van Terheyden
have seen that.
Craig Joseph
And it’s it’s, yeah, it’s against the law in some states. I’m going to be clear with that. I don’t think I had my hands on one. I went and did a demo at the Apple Store. And I first of all, I would say
Nick van Terheyden
on how can you not have your hands on one and do a demo that doesn’t that’s the counterpoint there?
Craig Joseph
Well, I didn’t take it from the store. Right? No money was exchanged.
Nick van Terheyden
Oh, I see. So you were just in the store. So this was a store demo? Yes.
Craig Joseph
You go to the Apple Store. And a nice apple, shiny apple person, you know, walks you through a demo, it takes about about 4045 minutes, something like that. If you if you wear glasses, they have to take your glasses and calculate whatever prescriptions they’re on.
Nick van Terheyden
No, I’m curious, how did they do that? Did they measure your glasses? Because there are tools that will tell you what they did? Is they do okay,
Craig Joseph
do they take your glasses and I think I uploaded or had the opportunity to upload the prescription. I think I uploaded a prescription but they didn’t use it anyway. They, they just said hey, can we have your glasses? And I told them, I beg that don’t take the classes too far.
Nick van Terheyden
I’m just gonna say that’s exactly like all the security. Let us take you through security speak your password, what is the last 17 digits of your most recent address, and then you speak to somebody and they say, I just need to take you through some security.
Craig Joseph
All of that is true. All of that is true. But it was it was simple. They took about 30 seconds for the machine to come up with something and then they sent some information to the back of the store. And then they come out with with the headset and the headset has the insert some type of optical insert in there because I can barely see Dr. Nick, I can barely see. And then you know, they help you put the thing on it’s kind of kind of big and
Nick van Terheyden
heavy. Even without the battery. Oh, yeah,
Craig Joseph
well, batteries on your side. Yeah, yep. The batteries just connected by a wire. It’s not light. I wouldn’t say it’s heavy, but I only had it on for about 45 minutes. I’ve certainly heard about people a long time. Yeah, yeah, well, about 45 minutes and they’ve got to it chips with two different bands that connected to your head. There’s the what I call the good looking one, which is the one that I had. Yeah, that’s the one that they give you to try. And then there’s the realistic one, which is much more supportive kind of goes on the back of your head and over the top of your head and I think that’s what people actually most likely actually wear when they’re not walking through Midtown Manhattan with the the apple Pro
Nick van Terheyden
on their case. Yeah, getting run over. Absolutely.
Craig Joseph
Well, you know, hopefully not. So I would I would say that I was I went in with a kind of a negative attitude of, I’m not going to
Nick van Terheyden
know I do okay,
Craig Joseph
I did. I did. I’m an Apple fanboy. Alright, so I even even as a fanboy even as a fanboy when was the negatives kind of well, I mean, I went in because people like hey, don’t bring your wallet with you when you try because you might say you’re not gonna buy but it’s okay. I had no problems and not paying $4,000 for these headphones headset drives that
Nick van Terheyden
driver carries no cash. He has four children and they’re all Yeah,
Craig Joseph
no 100% You know, I think the base price is 3500 and then and then you have to pay I don’t know 100 or 150 for the optical inserts if you don’t have good vision and then you have tax and then you will if you want Apple Care, whichever gets Well over $4,000. So I was going for the experience, the it’s, it’s cool. I certainly understand it for watching movies, they had an interactive thing with, like dinosaurs, and you could move your hands. And as you move to your hands, the dinosaur kind of followed you and you know, was going to try and bite your hand. It was really cool. I think the coolest thing was this. I forgot what they call it. But the ability to take some of the pictures that you that you take with your with a newer iPhone or with this device. You it looks like you’re standing in the picture. Like when you look down, you see the ground. And when you look up, you know, you see whatever’s on it. It’s It was very cool. And I could totally see that device when it comes down in price, which I expect it will aggressively over time.
Nick van Terheyden
I’m sorry, you said you were an Apple fanboy. And you were expecting price folding?
Craig Joseph
Well, everything. You sure? Yeah, absolutely. As they figure out what they’re doing, it’s gonna get cheaper. There’s no question about it’s going to get cheaper, and it’s gonna get smaller, and it’s gonna get lighter. That’s how that’s how phones have gone. And yeah, no, I fully, I fully expect that
Nick van Terheyden
they’re still on a second, I still have a Silverback iPhone. And that’s an awful lot smaller than some of the Gargantua. It’s
Craig Joseph
also much less functional than what we have now. Yeah, yeah. So that, you know, the question for me. And so the question for me is like, you know, if it cost half as much, and was a little bit more useful, I would, I would probably consider it. Yeah, I think it’s got its use cases, you know, we, Joan. So people are kind of looking. So I’ll tell you one person who I follow, who’s a frequent podcaster, who I listen to, he says it is helpful for him for when he has to write when he’s, you know, he writes a lot. And he sits and I think he mostly dictates so he’s not actually typing. And he’s just trying to get some words on a page somewhere. And he’s, he’s basically set his the background, so it looks like he’s on the moon. Or it looks like he’s in a log cabin, or whatever it is. And so whenever he has to do this thing, that he often procrastinates about, he he puts his mind in that context of net kind of mode, by sitting either on the moon or in the desert somewhere. And it kind of makes them you know, feel like this is the work that he’s supposed to do, because this is the only work he ever does when he’s sitting on the moon. Like,
Nick van Terheyden
I hope my legs don’t break. Alright, sorry, walking on the moon. But
Craig Joseph
can we edit that out? Do we have the ability to to not expose
Nick van Terheyden
you will only find out when this gets published? goes
Craig Joseph
to that? I think it’s got it’s got for people who have chronic pain, or who are getting chemo? Oh, no, I know, it’s being explored for that to kind of distract you and get kind of get you out of your body so that you can kind of concentrate on something other than the the issues, you know, pain or nausea or those kinds of things at hand. I think it’s very exciting for that certainly for for watching and consuming media. Makes complete sense that yeah, if you’re not watching with someone else, right, that’s the that’s the awkward part. Like we I
Nick van Terheyden
get that. I mean, I do see it I just the price point, I think my surprise with you, is that even 2000 you’re there, you’re you know, you’re wavering, I
Craig Joseph
would waiver, I would waiver it 2000
Nick van Terheyden
That’s a lot. I mean, it is so anyway, well, um, you know, sounds like people should go try it and see what they think. But I
Craig Joseph
would highly recommend people try it. I thought there’d be a long line and a long wait. Now it’s you go, you just make an appointment at the Apple store. You obviously have to have an Apple store nearby. But you can go and they walk you through it and it’s fun. And you get to look like an idiot and move your arms around in awkward ways. And people are probably looking at you but you can’t necessarily see them. So it’s, it’s fine. As long as no one’s recording you and putting it on YouTube.
Nick van Terheyden
That is an idea. Yeah. Well, off you go. I’ve got to say I did mine a while back when they were heavier with batteries or that kind of thing. And I just I aside from the issue of nausea, which I think some people suffer from some of these things. Not for me, but moving on. I think the big news this month has to be the change ransomware You know, event, we’ll call it that. And, you know, I’m gonna, I’m gonna just say straight out the gate here. If you are not sat here thinking as a business as an individual, and hey, I’ve been pretty public about some of the attacks on my own sort of, you know, computer set up and bank accounts and so forth, and not going there. But for the grace of God go I, then I think you’re missing the point of, you know, this, it could have been, and, you know, I’m sure there’s going to be plenty of blame storming, we have lots of that in healthcare. But I think the one piece that, for me is just the big shocker is, did we really put all those eggs in that single basket? Because that seems to be the big crux of this is that suddenly everything ground to a halt? And we’re sort of stuck with it. And it recently changed hands. So it was it’s with a larger company that’s, you know, maybe got better resources. I don’t know whether that contributed or not, who knows. But at this point, I’m, I’m looking at it and going, I gotta tell you shaking my head.
Craig Joseph
Yeah, well, you know, first of all, the vast majority of the human race has never heard of change, healthcare. And the vast majority of human race who went to medical school are practicing. Physicians have probably never heard of change healthcare yet. When that company went down for weeks and weeks, all of a sudden hospitals and physicians and anyone that depended on getting money from anyone learned about change healthcare, even if they never interacted with them, they are a huge intermediary, and make it you know, many a significant chunk of the claims in the United States, the bills, go through them. So they come from your hospital, from your doctor’s office, somehow go through them and then get routed to the, to the payers, and then the insurance companies, and then they theoretically pay. And when their systems all ground to a halt. There are other companies that do this, do this middleman kind of action, which I it’s too complicated for me to understand what actually happens there. But apparently, it’s a needed service. I get that. But I’ll as to your point, they were a big, big player. And we talked about with banks, he talked about too big to fail. With change, healthcare was too big to fail. And they failed.
Nick van Terheyden
That’s right. Yeah. It wasn’t a case of being able to prevent it at this point. Because they’ll take it. And
Craig Joseph
and again, whose fault was it? I don’t think we know yet. If it’s, it’s ultimately the fault of the of the hackers, hackers, terrorists, thieves, whatever we want to call them. Obviously, it’s their fault, yet. There was some security vulnerability that they they were able to hijack. It gets a little more sensitive. When you look at, as you said, the company was recently or at 234 years ago, recently acquired by what company? Okay, United Healthcare, which is one of if not the biggest insurance company payer provider, you know, in the United States. And so, it had been pointed out that this was actually benefiting part of their company, because no one could send bills to United Healthcare. Right. So, again, some bills,
Nick van Terheyden
by the way, the income was still coming in from the insurance boom, yes.
Craig Joseph
Yes, it was. Yes, it was. So this was a major deal. And, and especially smaller physician practices, couldn’t there today, even I think everything’s back. The backlogs are still there. I don’t think the backlogs have gotten rid of but I think everything is functional, at least we talked a month later. But there are a physician practices who can’t make payroll, they can’t make payroll because they’ve seen patients they’ve tried to send claims to the insurance company to get paid or at least to find out what they’re allowed to build the patient us and there they can’t send the bills the bills won’t go through to the to the insurance companies to the insurance company can’t pay and and for you know, larger hospitals, they healthcare systems, they they have resources that they can tap and money they can find because they were all know they’re gonna get that money. It’s just they’re not getting that money in a timely fashion and right. Yeah, yes, being a big deal.
Nick van Terheyden
It’s a major, major tragedy but you know, to be clear, if we go Back, uh, I’m not sure how many years but you know, solar winds, if that triggers any memories for folks, that was the underlying software that was used by millions of companies spread across most of the government, you know, including the NSA, who, you know, they specialize in this stuff. And that all sort of got there. It was there for a long time before it was even discovered. So this is I don’t want to call it inevitable. I think that would, that’s entirely wrong. But I if if it does anything for you, I think it should say, Boy, you should really sit up and pay attention as a as an individual. And I just unfortunately, it makes me even more paranoid, paranoid than I am whenever I get anything from anybody. So much so that I’m sure I miss things at this point. But anyway, well, hopefully that resolves. But big news hims was the one of the big conferences that took place you went. Any thoughts on? how it went? I know you got your cleaning supplies when you were there, because that was the one picture I did see. I was super impressed that you got your vantage stick to get stains out because I’m always having to look at those on this. This podcast.
Craig Joseph
At first, I didn’t know what you were referencing. But yes, I did have one of I go on an annual booth crawl. You know, there’s a big exhibit hall. And by big I mean, gargantuan exhibit hall and you know, people are always trying to get you to come and talk to them because they want to sell your stuff. And there was one booth that was giving out these little tied pens. And the person I was with had an eye we’d never seen that before. So yeah, I was able to clean the inevitable stains I get from food that I seemingly throw it my shirts, if you ask my my dry cleaning company. I thought oh, pleased. Yeah, thank you. I actually had one of those already. But to get a free one, instead of having to pay $1. Alright, so much better. Yeah. Was was really amazing. I I’m going to invest that dollar 99. And it’s going to be worth 225 Put it in blockchain or who? Yes, I’ll put it on blockchain. I don’t know even what that means. But I’ll do that. I thought the hims conference was good. It seemed busy. It seemed to me busier than in the past. But I know the numbers were down a bit. So the number of attendees was down significantly. But I tell you worked there are a lot of people and everyone seemed excited. And so yeah, I thought I thought it was good. There were a lot of new new exhibitors that I that I saw a lot of old friends that I saw, I learned a thing or two. So it was a good conference. We’ll see what we’ll see what happens. You know, the numbers of the economy’s supposed to be really great. But the people that are buying some of these health care services, they haven’t gotten the message or the memo, apparently. And so yeah, I think we’re all everyone in health care, and it are looking forward to a brighter future. This change healthcare thing, certainly not helping. And but, you know, we’ll we’ll see, we’re, we’ll see where everything goes. It was a good, it was a good meeting.
Nick van Terheyden
Well, and I think if I recall, the timing of this was the Peterson Health Technology Institute report that came out, came out after the fact. It was a health technology assessment on digital diabetes management solutions, and essentially, the news, I’m afraid was not good. It essentially adds cost and delivers very little value. And I think the underlying question in there not only for all the diabetic apps that, you know, these apps that we keep loading onto people’s phones is to any of them actually deliver. I’m not gonna say any value, but sufficient value to warrant the investment. If that’s the case, and I owe all credit to the authors, I think they did a pretty bang up job of, you know, reviewing that, and it didn’t show the benefit. And that, you know, I feel would have impacted him, certainly, because there’s a lot of that digital health. That’s what we talk about. That’s what we see. Right?
Craig Joseph
Yeah. You know, it’s just to be so to be clear, I think that this was, theoretically and I have no reason to doubt an independent report, where they tried to actually look at publicly available data, right? And so, so that’s that’s the the limit, that’s the good part and the bad part. So they don’t have access to data that aren’t published yet, or something that the companies are Holding, holding back. They didn’t necessarily find for these, this set of digital, you know, apps and devices, they didn’t find that they didn’t help from a quality perspective, they found that they didn’t save money over the long run. Right. So that there, so that’s a little different, right? It’s not like, oh, no, this won’t help, you know, it actually might help you. But if it if it, you know, cost $2,000 A year to the insurance company, and over time, the benefit is, you know, $1,000 reduction in hospitalization costs or something like that. Well, then, it doesn’t make sense financially, that’s not to say that it’s not helpful in some way. So, yeah, it’s a it’s, you know, it’s a good thing, that there are independent folks kind of doing these studies, it’s certainly not great for the industry in general, or those, you know, specific companies and, and technologies that they looked at. The companies have pushed back, understandably, and I guess, predictably, that, hey, you know, we have some data points that you don’t have yet. And, and we, you know, we have smaller studies, or, or one off hospitals or healthcare systems where we have shown that the costs have gone down, and the quality has gone up. And so I think the jury’s still out, I don’t think anyone’s gonna throw these things away. But certainly, you’re going to have to make your pitch a little bit more evidence based when you’re talking about some of these things to payers. Yeah,
Nick van Terheyden
I would say, focus on ROI here, if you can’t show that it’s, it’s, it’s got a race and additional questions. So I, you know, moving on from that digital health. You know, one of the things that strikes me is, you know, we’re much like COBOL still runs the financial systems, at least that’s what I’m told. Apparently, Excel is still highly prevalent and still doing amazing things. I built a full resource costing management system for hospitals that was built and sold extensively. Back in Excel version two, I think it was, but apparently, you also track f1 parts. I believe that it was the Williams team that use Excel for many 10s of 1000s of parts and tracking what’s going on. And I saw that you can build your own chat GPT. And if you can understand that spreadsheet, then you can understand chat. GPT was the premise of this particular piece. Are you still using Excel?
Craig Joseph
Of course, of course, I don’t think I’m using it for anything as sophisticated as as, as tracking gazillions of dollars of, of race equipment. But yeah, I think I think we all use spreadsheets, I think probably 99% of us use them for very simple and basic needs. But hey, you know, my question is, if it’s not broken, why are you trying to fix it? What’s the big deal if you if you’re able to make it in in the spreadsheet? And if it works, and I think that’s great, that I guess the big deal is, I’ll answer my own question. It might break a lot. Or it might not have, you know, there might not be a way for multiple people to be in it at the same time. I don’t know.
Nick van Terheyden
Well, you know, what strikes me about this is we talk about it, I mean, what do we say we say Excel. And that wasn’t the original spreadsheet, I want to say it was VisiCalc. And then Lotus bought that. And it became what was it just called it?
Craig Joseph
Was it a lotus? 123? Or? Yeah, 123?
Nick van Terheyden
That was it. And yeah, because they put such terrible copy protection on it. Nobody could, you know, it was one person in the office could use it. And Excel came, you know, on floppy disks that people just shared around. And I want to say that that’s part of the reasons that they went out in that space. And nobody know. Well, not nobody, but you know, very few, nobody refers to people are still using VisiCalc or Lotus 123, which is kind of a shame, because it’s such a significant piece of software. But there you go.
Craig Joseph
I would like their names. I would like their names of the people that are still using the software.
Nick van Terheyden
Well, we’ll work on that for next next month. Before we close, for those of you that are sci fi buffs, as I told my friend and colleague Craig, the three body problem that has recently been released, that was a book or actually a series of books, part one book one is out and I think I have to say is fine antastic sci fi journey and exploration of all sorts of quantum physics issues and extra terrestrial life, but we don’t have time to talk about it. Unfortunately, as we do each and every month we find ourselves at the end of another episode exploring Healthcare’s mysteries before they become your emergencies. So until next time, I’m Dr. Nick. And I’m Dr. Craig.
