Friday, February 26, 2010

Health Train Slows Down

Things are a bit slow this morning. A welcome respite. I spoke to wifey, who is still on the "left coast' tending to our adult children, who seem a bit reticent to step off into the world we are leaving them. I thought I would be retired by now, or at least tending to an alternate career, reading, writing, sitting on the park bench playing chess....or on the beach....not so. At times I thought I had my whole life well planned and structured, fool me!!!.
This post is going to be mostly a long ramble...that's what happens when I have a few unstructured moments. For five years or more I have blogged on a variety of subjects, ranging from health information exchanges, EMRs, health reform, generalized sarcasm and humor as well as commentary on my fellow bloggers meanderings.
I often wonder how some of these "overworked" and underpaid younger brethren' have time to write so many blogs. (Do they have 'ghost bloggers' ??).
Some of my favorite medical social media sites are KevinMD,DrWes,Medinnovationblog,The Health Care Blog, WSJ Health Blog, Cutting Through the Crap (written by the former publisher of Surgeon's Blog), Buckeye Surgeon, DistractibleMD, and more.
My guiding light platform is

Like my blog ramble today, things turn on a dime. Just found out I will be 'retiring' on April 2, 2010....that will give me a lot more time to blog. Happy Hospitalist, watch too DistractibleMD.

Hal Scherz will be happy that I have more time to dedicate to Doctors 4 Patient Care.

Perhaps I can find a position in government (I hear they are hiring with all the stimulus money)...

Anyone need an ophthalmologist? ....will work for food !! Pity

Health Train at Blair House


Between patients yesterday I managed to watch the health reform forum at Blair House.  Thanks to the power of video streaming I was able to follow most of it.

The conversation seemed to present most of the issues, and even malpractice reform was brought up (at a late hour).  President Obama did not respond directly to that issue but it was estimated that the savings would run into billions of dollars, not from premium reductions, but the secondary effects of  'defensive medicine'...This brought no response from President Obama. He seemed more intent upon pushing his own vision of health care.

There were some central core issues that  both sides seem to agree upon.

1. Elimination of exclusions for insurance coverage (Universal coveragw)

2. Expanding medicaid would be very foolish, since it is a system that does not work, and not credible for quality care.

3. DEms want to push on with this bill, Republicans want to start over. 

Stay tuned...

Meaningful Use of EMRs

Many physicians are wondering what that means, in the context of their clinical practice.


Here's my 'take' on the situation. 'It depends"  on:

1. The day of the month.

2..What the feds and payors want to extract from your medical records.

It has nothing to do with your needs, or affordability

The latest insider information this week is posted by the HIT Policy Committee

So we have a moving target....and so do the software vendors.

For some specialties the term meaningful use is meaningless.

Wednesday, February 24, 2010

The Circus



Four days from now the three ring circus begins (Dems, Repubs,and Obama) on Thursday and Blair House in Washington, D.C.

Finally (maybe)an attempt at transparency will take place. It's been over a year since these plans for health reform were 'reconciled' in closed room, with secret deals, and legislative trade offs.

I am sure it makes us all feel good to know our health  care is now legislated in a back room.

I  belong to several specialty group listservs and professional health care blogs.  The tone on these forums has changed radically.  One of these groups is an ophthalmology forum.

Many on this forum plan to announce this coming week they will no longer be accepting medicare patients in their practices. This, because of the March 1 deadline for a 21% cut in Medicare reimbursement. This figure is an accumulation of about 5%/ year which is the sum of the number of times this cut was delayed by last minute tack ons to legislation delaying the reductions.

Undoubtedly this will occur again, but only by an uprising of protest by physicians  and patients.

They will all downsize, and shift their professional efforts toward elective non medicare reimbursements.  Those who still have choices will make them according to responsible measures and 'balanced budgets.    Unlike our federal government we cannot print money.

Sunday, February 14, 2010


If you are like me, then you are fed up with hearing about “bipartisan support” for health care reform. Most of us would like to see non-partisan health reform. The recent pronouncement from on high is about the coming conference between Dems and Repubs regarding health care reform.  A dollar late and a dollar short.
Most interested parties could  care less about ‘bipartisan support’.   This wraps the process in a shroud of chaos and cloaks what the people really want and that is  MEANINGFUL change in our health system, not just another step in the path to federalized and/or socialized medicine. The TEA (party), which is not  a political party, but a movement amongst both Democrats and Republicans who agree that our federal government is out of control, not just in health care matters, and also violating constitutional guarantees regarding the limits of federal power as conceived by some very smart folks such as Thomas Jefferson, Ben Franklin and others.

Case in point:  The recent election of Scott Brown in Massachussetts surprised most dyed in the wool Democrats, however it bespeaks the deep distrust of politics as usual in the “Cradle of Liberty”, now an oxymoron.  The citizens of Massachussetts are burdened with their “socialized medical system”, in a state where the longest wait times occur for primary care (over 50 days).  It’s not hard to believe that now, a  heavily Democratic stronghold given what the ‘people’ really think about government health care, and it’s intrusion into medical care. 

Parachutes (and balloons)

Do you have your parachute on?


No, I am not speaking about the ‘golden one’ that many CEOs and financial wizards seem to deserve for their “financial wizardry”.
I mean the one that you will need when you are swept off the cliff by the ‘lemings’ cascading before the onslaught of insurance companies, Medicare, software vendors, EMRs, RHIOs, P4P, QA and hundreds of other eponyms.  Even as I back-pedal my feet slip closer and closer to the cliff of doom.
Sid Schwab in his most recent blog post of Cutting through the Crap seems to nail the problem on it’s head. (posted February 11, 2010…UNWORKABLE). It goes far beyond healthcare and medicine. It is a problem we physicians have recognized two or more decades ago.   Perhaps it is not because we are smarter or more intelligent than other citizens, but we do seem to be exposed to more human suffering and tragedy as well as a cornucopia of human experience, both good and bad.  For the longest time we were privileged to be able to rise above the morass and observe, without personal threat or financial anxiety.  It gave us the benefit of a certain altruism and privilege of caring for people, not out of financial necessity, but of moral compass and humanity.

How Much is a Trillion Dollars

A trillion here, a trillion there. In the words of Governor Bobby Jindall of Louisiana fame, “This here is a fine pot of gumbo”. 


He continues in his comments for the WSJ “I honestly do not know one single individual who is happy with this situation. Not one. Not a Republican, a Democrat or an independent. These actions are all problematic individually, but taken as a whole, they are devastating. So against that backdrop, we enter the health care reform debate. I honestly do not know one single individual who is happy with this situation. Not one. Not a Republican, a Democrat or an independent. These actions are all problematic individually, but taken as a whole, they are devastating. So against that backdrop, we enter the health care reform debate. I know a little something about health care policy, and I can tell you exactly the game that is currently afoot. If the House Democrats’ plan were to become law, the president’s statement that “if you like your health care now, you can keep it” will not be true. This is not an opinion, this is a fact.”

Wednesday, February 3, 2010

You Lie, and Too Many mis-statements


Obama's lieutenants (Heads of Cabinet positions and Departments) seem to make outrageous statements that any simpleton can see through.  The first egregious mis-step was on the part of Secretary Napolitano (her name reminds me of an ice cream, a mix of pink, white, and brown flavors (like Obama's mindset).


Her initial statement that all went well with DHS's methods of preventing terror attacks such as the one on a recent airline flight, was quickly retracted and modified into a politically correct statement. 


The next misstep  was by the head of the Department of Transportation, that everyone owning a Toyota should stop driving it until a fix can be accomplished.  Obviously again retracted the next day.  Has Obama hired a bunch of idiots based upon political correctness?  Let's not even talk about our attorney general. Afraid to back down and turn the terrorist over to military police, he has spun this story into the success measured by events which took place prior to the detention facility at Guantanamo and the organization of military tribunals.

Can we afford these kinds of mistakes in general, and what will happen to health care?  Whoops I didn't mean to give you the wrong diagnosis.  

Certainly our adversaries have noticed these incompetencies. And where is congress?  Buried in a dark hidden 'transparent' room masturbating over health care legislation. Strong words, not politically correct, nor tasteful, but true.......