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Saturday, December 30, 2006

The Cusp of 2006

As we end 2006 I want to thank Dimitriy for involving me with The Medical Blog Network.
For the past two years my involvement with a RHIO and Health Information Technology have given me the opportunity to meet and learn from other professionals about improving healthcare.
A fresh outlook is always a good thing. I am convinced that patients must have involvement and ownership of their healthcare "system"; it is in fact an essential element to move forward.
Government alone, nor payors nor employers can perform this great task alone.

So I wish all of you a happy and health 2007, and hope that we all do not "pay for performance".

I invite you to read my further comments at healthtrain express

Gary Levin

Friday, December 29, 2006

Good Bye to 2006

Year 2006 entertained new developments in medical social blog networks. This has provided new and "out of the box" resources for communication and discourse amongst diverse and at times historically adversarial components of our "health system". Consumer driven advocacy and health savings accounts have been introduced with varying results. Whether any or all of this will lead to reduced costs is very open to question, but it will certainly provide new resources for providers, payors, and patients as consumers to plan future developments.

RHIOs are experiencing serious difficuties in funding, and EMR promulgation although highly touted is also lagging due to financial constraints upon providers. CMS reimbursement cutbacks have also affected EMR acquisition by practices.

As a coordinator for a RHIO 2006 has been a year of quiet observation and study.

Personal health records will be supported by payors and employers. Whether they will be universal and/or interoperable remains to be seen. To be truly effective PHRs should be exportable or importable to any EMR to be useful. Perhaps employers will be enticed to provide the hardware as an employee benefit. (actually quite inexpensive at about 20 dollars for a usb flash drive, which is ubiquitous. I don't see a need to develop a new smart card or readers when everyone carries around a key chain and the device can be encrypted with u3 technology.

Many projects which have been mandated for health care have been sidelined due to the war on "terror". Personally my "terror" is the aspects of accessing health care and maintaining health insurance.

I wish you all a happy and healthy 2007.

Gary Levin MD

Wednesday, December 20, 2006

Fantasy Reimbursements

There are now many proposals by CMS regarding health information and their ability to gather data from EMRs, claims information and other sources from both hospitals and medical practices.

Not many of these have been worked out financially for the providers or the hospitals. Most of the proposals require software changes or running a parallel system to track the information they are requesting. For physicians this will cost far greater than the 1.5% proposed increase CMS is proposing as an "incentive". Most practices don't even have EMRs at all. Those without the digital EMR will be forced to workout a paper trail that again increases the paperwork burden to providers.

Here are some of the particulars. (from Health IT News, via

According to Thomas B. Valuck, MD, medical officer and senior advisor for the Centers for Medicare & Medicaid Services, CMS will administer the recent legislation providing a 1.5 percent incentive to physicians who participate in a new pay-for-performance plan, patterned after the one already in place for hospitals.

Valuck said it is going to be difficult to estimate the impact the incentive will have on physicians given the number of variables in the revenue picture: “The problem with the 1.5 percent incentive is that doctors will raise the question, ‘does $1.50 on $100 of billing cover the costs of reporting? ’”

Congress on Dec. 9 passed legislation that would increase physicians' pay -- beginning in the second half of 2007 -- if they voluntarily submit quality data measures to CMS using IT.

Sunday, December 17, 2006


I made it, in case you have not already and I as bloggers and web communicator beat out Cheney, Rumsfield, and Amadinajab (if that is how you spell it) for this annual award!

You will read all about it in the next week or so

So sit back and enjoy your is fleeting.

Tuesday, December 12, 2006

Is Pay for Performance Illegal???

Today’s news from CMA clips, The New York Times and other reliable sources reveals an impending tsunami, or at least a sea-change in the way medicare proposes to reimburse providers. Pay for performance and also Pay for Population Health care as quoted in some recent journal articles opens a whole new bag of worms. While some insurance carriers and private payors have done some initial studies and give groups incentives for following certain practice guidelines, there are serious questions and doubts amongst physicians, the AMA, CMA and even some senators and congressmen who have typically been pro-active about regulating reimbursement using a stick rather than a carrot.
Headlines read “Government will offer a carrot, rather than a stick” to control rising medical costs.
First of all the original Medicare law passed in 1964 expressly forbids Medicare from passing laws as to how medicine is to be practiced. ““Nothing in this title shall be construed to authorize any federal officer or employee to exercise any supervision or control over the practice of medicine.”
Mr. Moffit of the Heritage Foundation said the new initiative was “a backdoor attempt to repeal” this guarantee.
“It’s pay for compliance, not pay for performance,” Mr. Moffit said. “Doctors will be financially pressured to comply with government guidelines and standards. The integrity and independence of the medical profession could be compromised.”

Medicare in the past ten years has struggled to contain costs by using a flawed sustained growth rate formula (SGR) attempting to cut physician reimbursement by 3 to 6% each year. This was built into law about ten years ago, and each year at the 11th hour congress must struggle with modifying or eliminating or postponing the fee cut.
Pay for performance offers a “carrot” of 1.5% increase for providers to report their “compliance” with a practice pattern derived by their specialty organizations, or some other benchmark provided by a heath insurance carrier. The amount of paperwork, or computer investment to provide these numbers far exceeds the increase in payments. Perhaps there are some groups large enough who already have such systems in place. They were given special grants to develop these as “pilot programs”.
Representative Stark said, “Doctors and others who like pay-for-performance have to remember that it’s a zero-sum game.” As a result, he said, most doctors will have to accept lower fees if Medicare is to pay bonuses to the best performers.
What Medicare is doing may be “illegal”. I am surprised that this has not been challenged in the courts. Previous actions by medicare merely provided lack of payments and restricted benefits to reign in costs.
Providing incentives is definitely an inducement to “practice differently”
Other strong arguments are that practice patterns, pharmacology change fairly rapidly. Keeping up with the codification and timely documentation will remove assets from patient care to provide more bureaucracy.
As a believer in “open source” and development of regional health information organizations some are attempting to use P4P as an incentive for RHIO funding and development. I believe this is a very bad idea…the flow of private patient information even if “stripped” of identifying information should not be conveyed by RHIO data infrastructure. Open source refers to “code” and computer language, not patient information.
Later this week
The demise of HMOs, , PPOs and their replacement by “consumer drive plans”
Gary L

Tuesday, December 5, 2006

Web Seminars from Microsoft

As I have traveled along the health highway several trains have either run over me or passed me by.
In some cases all is well, but in others I have been caught on the track and unable to “get out of the way”
In today’s world one has to be a visionary with an open mind to see all the possibilities that are on the horizon or already quietly developing without your knowledge. Knowledge is power and the limiting factor on gathering important knowledge for you as a physician is critical.
It is as important to know what not to read as it is to read the sources that are credible and reliable. One also has to have discernment to differentiate between them. Time is wasted reading the wrong material, time that would be better spent relaxing.
In your daily activities operating, seeing clinic patients, overseeing business affairs, and keeping up with CME, licensure, credentialing requirements, legal affairs and business plans it is no wonder you may be tired and/or fed up by the end of a day. Balance is key to medical practice success as is location is to real estate.
Are you an entrepreneur and own your practice, or does it own you? Almost all physicians see themselves as entrepreneurs, but they are not. We as physicians set up our own businesses but are truly just “technicians”, be it medical or business. Entrepeneurship is entirely different…..requiring visionary thinking, not replicating something already in existence.
Have you read “E-Myth” by Michael Gerber, or his new book “The Dreaming Room”? Mr Gerber gave an eloquent and exciting presentation via Microsoft Live Web Conference on Tuesday December 5 2006. This web presentation is now archived. Judging from this initial presentation sponsored by Microsoft, and Intel the remainder of the series will also be dynamite. The series can be found at:
· Michael Gerber, December 5. 'E-myth' author kicks off Office Live seminar series. Register now.
· Stephen Covey, December 12,=. Get free small business advice from Stephen Covey. Register now.
Microsoft Office Live Seminar: The Age of the Alpha Dog with Donna Fenn
Microsoft Office Live Seminar: Lessons of The Natural Entrepreneur with Andrè Taylor

Microsoft Office Live Seminar: Effectively Influencing Up with Marshall Goldsmith

Microsoft requires that you have a “Passport Account”. If you have a hotmail email or msn email you already have a “passport”. If not it is simple to acquire one.

I was surprised at the quality of these webinars, totally not technical in nature and of interest to all who are in business or the professions.
So, the health train is about to leave the station ..Will you be on it??

Friday, December 1, 2006

Web 2.0 Applications for Medicine

Some of you may have heard about what is now called Web 2.0. This is another term for .asp solutions that run over the internet. Businesses in other sectors are now using this more and more rather than investing in expensive software and hardware that often require upgrading and expensive maintenance contracts. This portion of the expenditure for IT is often not appreciated and can run up to 20% of the investment in IT. Many medical practices utilize this method to transition to inhouse EMR.

Several applications are now becoming available for RHIO development, and may be the best solution not only in the short run but in the long run as well. The scalability of this solution is enormous and fits both small, medium and large practice needs. It does not require affiliation with a group, IPA or institution, although this solution would do well in all of these practice settings.

Privacy and security are issues that concern most health care providers, however secure and certificated web sites already are robustly protected, and backed up. They are run by IT professionals in a professional IT environment. Often they are mirrored and run on multiple servers geographically separated. My own personal experience with an .asp solution for prescription writing has been excellent, with no outages for a year's worth of use, as opposed to our in house EMR which goes down about once a month.

I would like for each of your to look at Practice Fusion for your input and analysis.

The next Inland Empire RHIO meeting will take place in mid-January. The announcement will be sent via email and posted to the blog(s)

Happy Holidays to everyone

Gary Levin