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Monday, February 26, 2007

Information from HIMMS Summit Meeting

HIMSS Chair Kicks Off Conference by Touting Necessity of Health ITFebruary 26, 2007
The health IT industry should stop debating the value of electronic health records and accept the technology's importance in the future of health care, Buddy Hickman, chair of the Healthcare Information Management Systems Society board, said on Monday in his opening remarks at the annual HIMSS conference in New Orleans, Healthcare IT News reports."Placing the focus on quality, patient safety and necessary clinical process improvements is consistent with HIMSS' mission and with the reasons why adoption of [health IT] was strongly recommended by the Institute of Medicine's Crossing the Quality Chasm report," Hickman said.Hickman also encouraged the industry to have a unified voice on goals, policies and messages, including a broader view on health IT from the federal and state levels. "In this way, [health IT] becomes part of a necessary solution to critical challenges rather than being viewed as a lesser priority competing for funds," he said."Through smart public policy, alliances and the right incentives, we can create the right kind of national health information network -- one that contributes to quality, safety and better outcomes for all," Hickman said, adding, "If we don't do this now, we only create a greater challenge to fix later" (Enrado, Healthcare IT News, 2/26).

Microsoft last year acquired medical database developer Azyxxi and currently has more than 600 employees focused on health care projects, according to Microsoft Vice President Peter Neupert. Health care "is a huge sector of our economy," yet it still is relatively low tech, he said. As the country's aging baby boomers require more medical attention, the need for health care technology will become clearer, Neupert said. Microsoft CEO Steve Ballmer on Monday will speak at the Healthcare Information Management Systems Society's annual conference in New Orleans. IBM General Manager Dan Pelino said that better computer systems could improve the accuracy of data, prevent duplication and reduce errors. More than 4,000 IBM employees are working on health care products, USA Today reports. IBM also is developing a nationwide patient database with HHS that would store patient information regardless of which hospital or physician a patient visited. Intel and Motion Computing this month unveiled a laptop for physicians and nurses that includes a digital camera to take pictures of patients.

Monday, February 19, 2007

Further Cutbacks Proposed by Bush

Featured in: President Bush's new proposals for cutbacks to Medicare and Public Health Funding will impact RHIO development
Further Barriers to Implementing RHIOs Submitted by gmlevinmd123 on Mon, 02/19/2007 - 9:41am.
The catch 22 of Pay for Performance. The health insurance industry as represented by IHA is big on P4P and medicare is following suit without waiting for health IT to catch up so that it can be implemented properly.. At the same time it is espousing paying MDs for improving quality the administration defocuses and presents these new proposals. Write your Congressman!!
Physicians not only pay a fair share of taxes, but are now being asked in some states (California-Schwarzzenegger proposal) to pay a 2% surtax at the state level to fund expansion of insurance to the uninsured...??undocumented aliens, as well??
Even large medical groups will not remain immune to these cutbacks, especially hard hit will be MD providers who have a disproportionate amount of seniors, ie, ophthalmologists, urologists, geriatricians, cardiologists, urologists, and more.
Washington -- President Bush presented an austere fiscal year 2008 budget to Congress earlier this month, pledging no new money for Medicare physician reimbursements and proposing to slash the rate of public health program growth in other areas.
If no changes are made, doctors could see an across-the-board cut of 10% or more next calendar year.
"Without adequate funding, physicians cannot make needed investments in health information technology and quality improvement, and seniors' access to health care is placed at risk."
Several times in the past, the White House budget has not set aside money to boost doctor pay, but lawmakers have approved such appropriations anyway.
Bush has called on Congress to increase defense spending while eliminating the federal budget deficit by 2012. The plan assumes not only that physicians will undergo yearly Medicare rate reductions for each of the next five years but that lawmakers will approve more than $75 billion in additional Medicare reductions over that time. The proposal would slow the program's projected growth rate from 6.5% to 5.6% over five years.
For those of you who like to watch government budget projections, here is a summary:
Target: Medicare
President Bush has proposed cutting Medicare's projected spending by more than $75 billion over the next five years. Here are some of the biggest ways the White House hopes to save the government money:
5-year savings
Inpatient hospital updates of inflation minus 0.65% each year
$13.8 billion
Home health agency updates of 0% each year
$9.7 billion
Skilled nursing facility updates of 0% in 2008 and inflation minus 0.65% each following year
$9.2 billion
Part B premiums increased for patients with higher incomes
$7.1 billion
Outpatient hospital updates of inflation minus 0.65% each year
$3.4 billion
Part D premiums increased for patients with higher incomes
$3.2 billion
Source: White House budget proposal
BLOGGING is now an important source of information for many people, and as we have seen the internet has played an important an unexpected role in political outcomes. I encourage all those interested, physicians, non physicians, health care pundits, to contribute to and other blogs regarding health care.

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Gary Levin MD

Thursday, February 8, 2007


Congress has officially approved of CMS’ decision to implement P4P. I recently read somewhere that CMS would increase physician reimbursements (and hospitals, too I suppose) by 300 million dollars with this incentive (if providers are able to conform to their requirements) I also read that physicians such as myself will not face the 5% annual SGR reduction in CMS payments. This has been massaged into the politically correct phrase as a “raise in reimbursements” (the lord giveth and the lord taketh away). So we are given back that which was taken from us and then told it is a “raise”.
Let’s face it, decision makers in Washington and some state capitols as well as legislators are out of touch with reality. Placing more administrative burdens on an already very dysfunctional barely functioning healthcare system is “insane”, and so are those that make these proposals, and then vote them into effect to placate a worried electorate about whether they will be able to afford another doctor visit or hospitalization.
Many physicians I know have retired in their mid 50s to sell soap or enter MLM businesses, sell real estate or go into other businesses, which tells you a great deal about the stressors on physicians.
I can find hundreds of consulting groups, and health care foundations that study everything to death, make more recommendations which increase further the cost of health care, couching their recommendations in terms such as quality initiatives, pay for performance, etc etc. There is a whole new lingo out there that most physicians do not comprehend, but must learn.
I am not optimistic about our health system in the United States. IT and RHIOs are a small part of what we need. If you are very rich or dead poor in poverty your health care is assured. The large mass of diminishing middle class are at great risk, if they lose employment, and/or their group health policies, have pre-existing illnesses, the quickly join the uninsured. Even those fully employed and insured are soon priced out of full insurance coverage.
HSAs are a joke, I tried one last year and found that it takes quite a while to meet the deductible, and the policies are worded in such a way for a family that the deductible for a family is what counts, not the individual users. You also cannot use it unless you fund the HSA upfront. If you have chronic illness and have high expenses from day one….you may not be able to save . I suspect the IRS will expect accounting through the HSA and not direct payments out of pocket. HSAs are a great deal for the banks and the insurers. It will not save healthcare dollars, nor reduce utilization. When people get sick, they seek medical care.
This year I became unemployed for a time and went onto COBRA, about a month later at the end of the year I finally reached my 4800 dollar HAS deductible. One week later it was January and the deductible started over again. True the premium was lower with the HAS but we had medical drug expenses of about 650 dollars that month….we cancelled our COBRA, went bare and are now forming our own group to obtain group health insurance. Individual coverage is out of the question. Now why is that? Seems to me all the individuals who are not in a group could be put into a group of “the individuals who are not in a group”
And now GWB is proposing tax law changes to “make healthcare more affordable”.
And another thing, when you sign up for insurance you are given an effective date which may be any part of the year, yet your deductible rolls over at each calendar year, whether it’s been six months, four months or eight months since you signed up. The contract is for one year… why are you cancelled if you miss one payment? Seems to me it is all weighted toward the insurer, not the patient.
As I write this article I am seeing this from the patient (now known as a consumer) aspect; let alone the physician provider side. The billing and coding aspects of reimbursement have turned into a high stakes poker game with a new industry spun off…..the reimbursement consultant who charges anywhere from 500 dollars to 3000 per year to update the practices on insurance billing practices and codes which change from year to year. It’s a bit like poker. And if you make a mistake you are accused of fraud and a buse, fined, or worse kicked out of a program.
I have been practicing over 30 years since I finished medical school. My the world has changed.
Insurance companies control everything. Recently I moved practice locations back to a community where I first started off as a young ophthalmologist. I discovered that my home hospital had disbanded the ophthalmology department and there were several outpatient centers that did all the eye surgery.
Now, insurance companies usually require the physician to have hospital staff priveleges to be on their provider list… does one go about that one? Some doctors already on the hospital staff are now paid to take ER standby call…..they are grandfathered in as staff members, but there is no way for new ASC doctors to be proctored in a hospital setting unless the ASC is part of the hospital. Worse than that some ASCs are privately owned and owners will not allow open access thereby eliminating competition in their geographic area. In my next article I will further details the requirements and administrative bureaucracy that has been generated to “protect” patients (from whom?)