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Sunday, December 27, 2009

Hospital Care and Social Media


Arguments about the validity of Health 2.0 are moot. It is here!! Hundreds of thousands of patients and providers use the format in advocacy groups, using facebook, twitter, blogs, and search engines.  Is Google a health 2.0 app?


The following story is well worth the read





On Wednesday, May 27, 2009 I met Dr. Ted Eytan. I was invited to present a patient and caregiver view of hospitalization at a small health 2.0 meeting. I saw Powerpoint presentations with bar charts and graphs. I sat patiently taking notes about the state of ehealth and social media. At around 3:15 I spoke. I described the horror of my husband being diagnosed with cancer and of terror of not being told what was going on. I spoke about the fight we had fought to get to get a copy of the medical record. I recounted the numerous times I had used the information in his record to improve his care. The record sat upon the table in a three inch thick binder. There was silence in the room. We were no longer speaking in the abstract about patients. They asked me to focus on what was the worst thing that had happened through this entire tragedy. I told them the worst thing we experienced was lack of access to my husband’s data.




We are hearing different reasons why we must pass this health reform bill.  1. There is a crisis and if we don't pass the bill, we will go bankrupt (things are unsustainable). 

There are many hidden aspects to this bill, which is not being discussed in a transparent manner (which our esteemed President assured us.)"that things would be different in D.C. if he were elected"

2. If  the bill is passed costs will go up as well, including increases in premiums of a significant amount to cover the new insured,, who were previously uninsurable, or excluded to due pre-existing conditions.

3. Additional taxes will go into effect several  years before any benefits or changes will be made to coverage.

"Quick, pass the bill before anyone can read it and really understand the profound effect it will have not only on health care, but every business, and person who is insured. "What will be the ripple effect on health care costs, provider availability, and hospital survival? 

Tuesday, December 15, 2009

What's In A Name


Let's think of some titles that will be more acceptable to the approximate 50% of voters who do not want a public option.

1. Alternative integrated universal choice for Health.

2..National Public Health, Inc. (NPH)

3.  United Stated Federal Health Reserve USFR)

4. Federal Health Insurance Bank (FHIB)

5. U.S. Health Stimulus Choice (also known as USHC certified)

6. Federal United Care Combine (also known as FUCC) (sounds like Fuc@)

Or let's allow patients to 'Opt-out of the Public Option. This would be done on a state wide basis rather than as individuals. Depending on which state you live in.  This great idea comes from those two Senators Reid and Pelosi who must smoke something for breakfast that is grown in the fields of either Afghanistan or Northern California.

Plans #1 through #4  could be funded by donations from patients who "care" for only pennies a day.

For those who want the public option....I hope you will like what you won't be pretty.  If you think you can't find swine flu now, when you need it, then consider that this is typical of any government program.  The idea that the federal government is going to contract with private insurers copies what it does in most other areas of defense, manufacturing of medications such as vaccines (CDC), NASA, and others).  They cannot do the job themselves, and contract it out to others who are either not supervised or unable to perform.

Our government easily promises what it cannot or will not deliver. The war on cancer, the war on drugs.

Yes, a a physician I know it is a disgusting fact that there are many uninsured needy patients who don't get health care. I also know that programs such as medicaid will pay for a surgery, but not the necessary post op physical therapy....why? Because the states are fearful that everyone on Medi-caid will run down and sign up for chiro-massage or manipulation. That philosophy runs rampant in most state and/or federal programs.

Government programs are always trying to make a brick float.


Who's in Charge, Anyway??

Physicians no longer feel in charge for many things that occur during their daily clinical work. During our training years we are carefully monitored and have mentors who we can look to for advice, guidance and in some cases, even wisdom...For those in 'private practice' in a solo or small group practice 'autonomy' becomes a real issue, and blending this with the reality of patient care, risk, and medical politics becomes a narrow balance beam for most of us.

Health reform measures are a reflection of a conundrum. Will we be reformed from within, or without??   It is a mess.  Even the informed, educated and well read can make little sense or aggregate the impact of the legislation presently being debated in congress. Driven solely by financial analysis the legislators pretend to develop a 'quality driven, consumer oriented health care policy', a real oxymoron in itself.


Kenneth Fisher, MD in his blog, Health Care Reform in America, states,

Dr Fisher and I are classmates and graudated from George Washington UniversitySchool of Medicine

"Indeed it takes more training to take care of seriously ill patients than to fly a jet liner. Yet it is inconceivable that a jet pilot when facing a problem, instead of using his experience and judgment, would have the passengers vote on what to do. However, unlike the pilot, in today’s medical practice it is common for physicians to place the task of medical judgment on the patient/family frequently resulting in irrational care. This often leads to patient suffering and the wasting of valuable resources.

This exaggerated sense of patient autonomy along with the fear of legal action has augmented medical consumerism. This problem has been enhanced by drug and device advertisements directly to the public and by the medical profession’s undue reliance on the legal system to decide what are, in effect, medical questions. Instead of our various medical societies forming referral mechanisms to help decide difficult issues, hospitals and doctors have abdicated this responsibility to the courts with the result being an ever-present fear of legal action.

It should be noted that till this day our medical societies have not answered this challenge. Again, in May, 1994 (New England Journal of Medicine) while discussing the Baby K court case, an encephalic baby with no chance of recovery, George J. Annas had a similar message. He commented that for medicine to avoid becoming a consumer commodity and thus unbearably expensive requiring control by payers, physicians will have to set standards and follow them. Again organized medicine did not and has not responded

A few weeks ago (November 2009) a talented second year resident told me that, in his opinion, American medicine is no longer about treating patients’ problems. It has become a hospitality industry focused on customer satisfaction regardless of the appropriateness of the medical plan.

For health care reform to be successful we have to insist that our medical societies set up procedures so that patients are treated as individuals, each with unique needs. At the same time mechanisms must be established so that we uniformly practice high quality medicine with evidence-based use of resources. We must have expanded peer review so that difficult situations and overuse can be quickly resolved using medical experts.

Dr Fisher's Interview on National Public Radio

Saturday, December 12, 2009

The Real Deal


It Is obvious how the world of blogging.has displaced the coffee room and the water cooler as sources of inside information. In fact, blog sources are frequently the first place that relevant information appears.

In addition to classical newspaper and Journal sources these entities have their own blog section. Add to this, facebook, twitter, digg, my space and others yet to be determined the relationships become infinite.

Take for example, this posting on ‘Dr Wes’ blog:

On Dec. 3 the U.S. Senate voted to keep significant Medicare cuts in the health-care overhaul bill despite polls showing seniors are concerned about their benefits. Senators voted 50 to 42 to reject an amendment by Sen. John McCain, R-Ariz. that would have stripped more than $400 billion in Medicare cuts from the health-care bill. The measure would have sent the health-care bill back to the Finance Committee for redo

What this means for our seniors is Medicare benefits will be cut in important health-care programs. In my specialty, cardiology, this will mean draconian cuts to Medicare-dependent seniors in cardiology services.

The real deal is this”

A new survey of U.S. cardiologists indicates the following:

Practice effects

* 94 percent would be forced to reduce paid staff such as nurses and technologists.

* 80 percent would be forced to cut employee benefits.

* 67 percent would elect to retire earlier than planned.

* 59 percent would limit practice hours.

* 56 percent would be forced to sell their practice and merge with a local hospital.

* 45 percent would no longer perform imaging services such as nuclear stress testing or echocardiography.

* 25 percent would be forced to close their practices.

Patient effects

* 97 percent believe that Part B costs to Medicare will increase in their area because patients will have to receive imaging tests in the hospital setting where the Medicare reimbursement rate is significantly higher than under the Medicare Physician Fee Schedule (MPFS) for private practice.

* 92 percent believe patients’ co-pays will increase as much as 20 percent if they are forced to have imaging tests done in the hospital setting.

* 89 percent believe early detection of heart disease will be greatly reduced because of patients’ lack of access to cardiology procedure services.

* 76 percent would refer patients to the nearest hospital for imaging procedures.

* 79 percent believe current Medicare patients will no longer be able to have imaging done at private practice offices and would be forced to have imaging done only at the nearest hospital.

* 45 percent would no longer be able to accept Medicare patients.

With these cuts physicians may not be able to provide the services that patients have come to depend on and in the long run, if the current policies are not changed, cardiologists may be forced to close their doors to their patients.

The law is clear — our seniors will realize these cuts unless Congress acts. We all have seen the response to government studies which want to limit mammograms to women in their 40s. You have seen the outcry to this type of foolish rationing. The Senate just voted to reverse that ruling and provide mammograms through their insurance carriers.

These Medicare cuts are the first step in Medicare rationing of our seniors’ health care. We must stop these cuts to the Medicare system. Our seniors are living longer and in better health because of the Medicare system. We can keep current Medicare benefits if fraud and abuse are eliminated. There are good-practice guidelines which have been enacted by the specialties societies. Let us enforce these practices and let Medicare survive.

On the ‘street’ it looks very different from the view at 40,000 feet.  Its about the same as President Obama receiving the Nobel Peace Prize.

Call and write to your senator today. Let him know how you his constituents feel about these proposed changes in health care.

Bottom line: The only way to get health costs down is when consumers are presented with a range of options in a truly competitive marketplace


Another Observation:

Grace Marie Turner, The Galen Insitute, "More Nutty Ideas from the Senate," December 8
Two thousand seventy-four pages and trillions of dollars later, this bill doesn’t even meet the basic goal that the American people had in mind and what they thought this debate was all about: to lower costs.

Mitch McConnell, Senate Minority Leader, December 8, on Senate Health Care Bill
It’s beginning to look like health care consumers are going to have to take lowering health care into their own hands since no answers are coming down from above. "

My own thoughts on this matter (Health Train Express)

Add to the cost of insuring additional patients, the cost  of the regulatory mechanism .  We have already witnessed this with HMOs and Medicare Advantage. Add to this the costs of    outcome analysis, preferred payment schedules for EMR usage, health information exchanges, etc and you will see that ‘savings’ are imaginary.  Keep it simple, and accountable on the local level. "

Here are ten tips for lowering your costs.
One, encourage your employer to offer a health savings account with a high deductible. Encourage the employer to pay half the deductible. Your premiums will be much lower, and your employer will save up to 50% over current HMOs and PPOs.
Two, investigate a company called Simplecare. The SimpleCare story has appeared in U.S. News & World Report, in Forbes, and on NBC News. SimpleCare , a fee-for-service organization, accepts money for medical treatment without the bother and hassle of insurance forms, co-payments, and other third-party payment related procedures. SimpleCare has an alliance of doctors offering cash discounts. Itsmembership includes 38,000 patient members working with 1,500 doctors nationwide. Discounts range from 15 percent to 50 percent for patients paying in cash.

Three, ask your doctor if he or she accepts cash only. About 10 percent of doctors accept cash only. The idea is to pay for care at the time and point of care with cash, check, or credit card without the expense or trouble of going through an insurance company. Dealing with third parties creates a 50 percent to 60 percent overhead, and many doctors are finding they can charge less and make just as much or more money without going through a third party. Often the doctor’s fee is negotiable.
Four, find out if your doctor dispenses prescriptions in the office. Prescriptions dispensed in this way average 50 percent less. A company called Physicians Total Care has installed prescription systems in 30 states and is growing by 170 percent a year. For more information, google Physicians Total Care or read a chapter “Physician Office Dispensing Stages Comeback” in my book Innovation-Driven Health Care (Jones and Bartlett, 2007).
Five, fill your prescriptions at Walmart, Target, or discount stores. Walmart has more than 300 generic drugs and 1000 over-the-counter medications it sells at $4 for a 30 day supply and $10 for a 90 day supply. Fifty percent of Americans live within 5 miles of a Walmart or Target.
Six, ask your primary care physician if he or she performs common procedures like skin biopsies, abscess drainage, joint injections in the office. An organization called the National Procedures Institute ( has trained over 15.000 primary care doctors to perform simple office procedures, and these can be done less expensively without waiting than in a surgeon or other specialist’s office.
Seven, consider visiting a retail clinic in drug store or discount outlet for minor ailments or immunizations. Nurse practitioners using protocols and electronic medical records run these clinics, which may have physician or hospital backups. The charges are listed are transparent and predictable. About 2000 of these clinics are now operating, and their locations may be found at The services of these clinics cost about half as much as a visit to a physician’s office but do not have a physician’s expertise and may miss serious underlying conditions.
Eight, if you work for a larger employer, ask executives if they are considering setting up worksite clinics. About half of the nation’s corporations with headquarters employing more than 100 employers on site are organizing these clinics, which offer the services of a primary care physician and staff, which may include a nurse, nutritionist, and other health professionals. Employees can receive free generic drugs and other treatments or advice on site, or may be referred to cost-effective networks of specialists off-site.
Nine, if you are uninsured or underinsured consider visiting a federally-qualified community health clinic. These were launched by President Bush as a Health Centers Initiative in 2002. These clinics, which are present in all 50 states, have 4000 locations and have served 15 million people. They are administered by Health Resources and Service Admistration (HRSA. Services include checkups when well, treatments when sick, complete pregnancy care, immunizations, dental, and mental care. To find a clinic near you, google HRSA – Find a Health Center.
Ten, in general low cost and convenient care is available at a local primary care physician. There is now a shortage of these physicians. Therefore, these physicians are now very busy, and you may have to wait for an appointment. Because of low reimbursements, some no longer accept new Medicare or Medicaid patients.


It becomes apparent that we should not expect ‘government ‘ to fix the problem . Initiatives from patients, employers and insurance companies are far better than throwing up our hands and relying on the government(s) to solve a problem that really has nothing to do with governing, or defending our country.  It remains to be seen if patients,and employers can bring pressure to bear on insurers without governmental intervention and/or regulations.

Care for each other, your parents, your brothers and sisters, and relatives to the best of your abilities.