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Thursday, March 31, 2011

Social Media and Medical Practice III

     

Websites               Samples & How to’s        Mobile Apps

Many social media sites provide developer instructions for building APIs which can be integrated into business or personal web sites. FACEBOOK DEVELOPERS allow you to build your own social and personalized web.

Companies are proliferating, all offering a complete API interface piggy-backed onto a business web presenc e. Some of the offerings include:  GNIP. SHAREAHOLIC, SNAPLOGIC, JIVE, OPUS, PRACTICE FUSION

Owning your Name, a Practice’s Facebook Page. Like domain names facebook titles are valuable commodities. Think about having your unique Facebook, Twitter and other names reserved even if you are not ready to make the plunge.  Even if you do not use it, it can become very valuable if another practice or business wants the name, later.

There is also  another earlier form of professional social media sites, which are physician only, such as SERMO, , Doximity

An excellent source for finding programmers for your needs is Elance, a site dedicated to recruiting  freelance programmers and writers.

Social media glossary:  The Top 100 words & phrases in the social media dictionary

Social Media and Medical Practice II

Part II

……..Adoption of new software follows a process similar to adoption of most new technologies, a slow gradual awareness of a new way to do things, discovery by larger and larger groups of users accelerating exponentially during a rapid growth phase, with a gradual flattening of the growth curve as the product matures.

Social media has  filled a space in our private lives, with rare adoption in the business world.  In most businesses Facebook, Twitter, YouTube and many other social domains are restricted or blocked by corporate firewalls,  private, or public.  Internal business communication is usually accomplished via telephone, video conferencing, email and/or instant messaging. 

Marketing for business relied heavily on internet search engines, with search engine optimization maximizing ‘hits’ on a users websites, along with large email group mailing. The most recent iteration of search engine algorithms has been changed from finding the most active landing pages to one in which the actual content can be analyzed for the quality of hits and analyzing the structure of the web page, backlinks, and other trickery that falsely elevates the importance or popularity of a particular web site.

Facebook is now evolving new categories, from  personal to a clone of a typical business landing page, but offering two way communication within the API  for potential customers or just interested readers.

Physician patient usage of social media is strictly limited by privacy restrictions and reluctance of most physicians to discuss personal health information online. Some physicians encourage email communication and dedicate time each day to communicate with patients conveniently.  A limiting factor is there is no reimbursement methodology for time devoted to email.

Social media will find a role for internal medical group communication for departmental or interdepartmental communication. Twitter in particular allows for direct p2p communication and the addition of mobile APIs allows communications on the ‘run’.

 

The Mayo Clinic and other large groups use Facebook for Patient Education, Marketing,  Mayo Clinic actually uses several Facebook pages for EmploymentGeneral Information, Health Policy, and a General page on Becoming a Mayo Clinic “Fan” on Facebook.

Social Media APIs (Application Platform Interface’s) ……….

continued…..

Social Media and Medical Practice

  

The image above depicts a device that ‘tweets’ when the fetus kicks .When a father makes a gadget for his unborn son, that’s true dedication. Corey Menscher designed and built the Kickbee for his pregnant wife. The baby kicks her stomach, a piezo sensor reads it and another module twitters the response for all to see (might this be a mechanism for cardiac monitoring at home, with instantaneous notification to the physician ?  Twitter has an wireless API for smartphones as well.

If you have any children under the age of 35 you must be aware of the influence of social media in their daily lives.  Young women no longer chatter endlessly on their phones, and have developed larger calluses on their thumbs.  I even imagine hand surgeons and orthopedic surgeons finding new syndromes,  named ‘Texting Tendinitis” or “SMS Synovitis”

Those over age 45 may be exposed as their young adult kids come home or perhaps your family may follow each other on twitter or facebook.

Perhaps you have been buried in patients and/or the EMR decision making process.  M.U.+ incentives + ACOs + Health Reform = Headache.

Health Train Express this week will be featuring a series of articles on social media, where it has been, where it is now, and where it is forecast to be by the heavy venture capitalists of IT.

Part I    What is Social Media?

a. Email:  We can use AOLs  original  “You’ve got Mail !” as a starting point.

b. IM, or instant messaging

c. Chat rooms

d. Blogs

e. Facebook, twitter and other platforms that use more sophisticated APIs. operating independently and on their own platform.

f. Stumbleupon, Tumblr, Digg, Delicious, Technorati and other more arcane focused niches.

g. Over 150 other social networking a sites are listed in wikipedia as of April 1, 2011.

Social networking sites are their own breed of computing power. Designed originally for sharing secrets about dates (facebook), it has transformed into a different animal. And like most events on the internet it changes on almost a daily basis.  Social media is  still a very recent happening and the niche is growing exponentially fueled by Venture Capital and the enormous cash pot of the likes of Google, Facebook and others. Larger social network predators are engulfing smaller entities, and incorporating their victim’s  platforms and technical personell into their own company,  for their own missions rather than developing them internally. In the next year or so the market will mature and become stable. ………

to be continued:………..Part II

Sunday, March 27, 2011

EMR in the Cloud

Simple ??

Two years ago the term cloud applied mostly to the weather. EMR vendors focused on selling hardware attempted to slow down the cloud as it approached HIT.  Now the first thing practices will ask is how much is the hardware going to cost?  Well, cloud computing only requires ‘thin clients”.  It seems attractive, however many physician l still consider the security as inadequate.  The  remainder of today’s post willsummarize the cloud.

 

Expert Explanation
The Slick Madison Avenue Approach

The Sun is still shining here.

 

$3 Million Health Care Analytics Challenge

hhp logo  In today’s physician’s world one has to keep one foot in the medical journals and another in the world of technology. Information technology not only serves us in storing and distributing patient information, it also serves us in analytics. I would tell any fledgling college student or medical student to develop a strong knowledge base in computer science, statistics, and bio-informatics. It is essential to be able to read journals and critically appraise medical articles. It is also important in analyzing one’s own clinical records for outcomes, treatment paradigms, and examining Evidence Based Medicine (EBM).

Friday, March 25, 2011

Blue Buttons for Medicare and VA

 

What do the VA system and Medicare have in common besides federal funding?

BLUE  BUTTONS !!https://www.mymedicare.gov/

Consumer Savy Websites

 

 

Did you ever think there would be a ‘Kelly Blue Book” for health services and your fees?  Well buckle up Flash Gordon, and Dale Arden, strap on your ray gun and read further:

Such websites have certain limitations,

Many cost-comparison tools for health plans can be found online, beginning with a simple Google search that might draw thousands of results.

Website officials also acknowledge that the nature of medicine makes it difficult to provide consumers a price guarantee, particularly because patients' requirements for treatment can vary based on their:

  • Age;
  • Current medical status; and
  • Family and personal medical histories.

Try these on for size

Community Health Data Initiatives

Opening by HHS leaders
0:01 – Dr Harvey Fineberg, President of IOM
0:08 – HHS Secretary Kathleen Sebelius
0:19 – Bill Core, Deputy Secy of HHS on origins of the program and how innovators built the first set of apps using this data in just 12 weeks.

Demos of apps using this data
0:27 – Introduction
0:31 -Palantir (Alex Fishman) – “AnalyzeThe.US” freely available data analysis tool. (Not limited to health data)
0:43 – Alain Rappaport – Microsoft Bing has added CHDI data into its search results.
0:53 – [Bridge about customer service]
0:54 – Healthy Communities Institute, and Trilogy – public/private partnership that’s created a data dashboard. Valerie Brown of Sonoma Co. board of supervisors & pres. of National Assn of Counties; Trilogy’s Bruce Bronzan & Derek Van Brunt(?), creators of Network of Care for Counties
1:09 – Asthmopolis    – improving asthma care by providing data to patients & providers
1:17 – IHI (Lindsay Martin) and Ingenix – mashing together healthcare quality data
1:30 – Roni Zeiger, Google – HHS’s Hospital Compare database, sliced & diced & presented using Google’s Fusion Tables cloud database app
1:41 – Chris Carter, HealthWays

Conclusions / observations
1:50 – Todd Park (HHS Chief Technical Officer): Release data, build apps, catalyze change
2:01 – Aneesh Chopra (Chief Technical Officer of the US), telling Todd “Free it, brother!”

 

 

 

Network of Care

Self-Congratulatory Seminars

 

So, Why are these people Smiling?

1. They just voted to give themselves a raise.

2. They learned how to pass legislation without reading the bill

3. All doctors will be replaced by computers.

4. 1&3

5. None of the above.

6. All of the Above.

 

Wednesday, March 23, 2011

PERSPECTIVE The ACO Model — A Three-Year Financial Loss?

 

The NEJM” reports on ACO in their “Health Policy and Reform” Report.

The accountable care organization (ACO) model is rather controversial among health care experts. Its proponents tout the potential savings and coordinated care that could be achieved through this model.1 Others, however, point out that the model is not without risks, such as the potential for anticompetitive effects as providers leverage it to concentrate market power.2,3

Because of the need to stem the spiraling costs of the Medicare program and the need to shift the health care system from volume-based to value-based rewards, the ACO has been put forward as a possible model for restructuring traditional Medicare coverage.4 In particular, Section 3022 of the Patient Protection and Affordable Care Act requires the Secretary of Health and Human Services (HHS) to establish the Medicare Shared Savings Program by January 1, 2012. With this rapid movement toward ACOs, one would expect that the previous government demonstration of the model would have produced promising results that warranted its rapid expansion. Our analysis of the results from the demonstration suggests otherwise.

CMS conducted the PGP Demonstration from 2005 to 2010, using a hybrid payment model that consisted of routine Medicare fee-for-service payments plus the opportunity to earn bonus payments known as shared savings. Eligibility was narrowly restricted to a select group of large physician group practices with the necessary experience, infrastructure, and financial strength (participants invested $1.7 million, on average, in the first year alone) to succeed in the demonstration. Thus, the structure of the demonstration should have resulted in a high likelihood of positive results. Yet most PGP participants did not break even on their initial investment.

The available data indicate that 8 of the 10 PGPs in the demonstration did not receive any shared savings payments in year 1. In the second year, 6 of the 10 practices did not receive such payments, and in the third year, half the participants were still not eligible for any shared savings to offset their initial investment. Given that the percentage of shared savings in the first 3 years was so low for experienced, integrated physician practices, it seems highly unlikely that newly established, independent practices would be able to average the necessary 20% return on their investment.

In addition, the participants did not receive provider- feedback reports and bonus payments in a timely manner, which may have negatively affected their ability to perform more effectively and receive greater shared savings. These limitations, however, do not significantly alter our overall findings. In fact, we were very conservative in our analysis, since we did not incorporate the operating costs for the second and third years of the demonstration. If we had included such costs, the projections would have been even worse.

The high up-front investments make the model a poor fit for most physician group practices; the time frame in which one can expect a reasonable return on the initial investment is more than 5 years; and even the majority of large, experienced, integrated physician group practices could not recover their initial investment within the first 3 years. Absent changes to the design of the ACO model, the analysis suggests that before agreeing to become part of an ACO, physician group practices must conduct due diligence and explore participation in viable alternatives such as other initiatives involving bundled payments for episodes of care.

Caution:

For policymakers, the urge to do something must be tempered by the risk of disrupting the entire value-based–purchasing movement. We are concerned that physicians and providers may unwittingly undermine future value-based–purchasing efforts if the ACO model fails to live up to the high expectations that do not comport with the data. Our analysis suggests that there are options for addressing the design weaknesses of the ACO model. One is for CMS to limit participation in the Medicare Shared Savings Program to a narrow group of provider organizations that can absorb the likely financial losses in the early years of participation. CMS could limit eligibility in a manner consistent with the original design framework for the PGP Demonstration. This option would be consistent with the GAO report, which questioned how far the ACO model could be extended beyond the 1% of physician practices that resemble the organizations that participated in the original demonstration.

Alternative Solutions:

A second, more inclusive option would be to change the payment design

from an annual model to a cumulative model. In the cumulative model, CMS could assess performance over the aggregate number of years during which an organization had participated in the ACO program and reduce the shared-savings threshold accordingly, making it more likely that physicians could demonstrate significant improvements. For policymakers and payers, such a cumulative model would distinguish organizations that wish to leverage the ACO model for short-term, anticompetitive gains from those that wish to be rewarded for an investment in better-coordinated delivery of health care.

The conceptual underpinnings of the ACO model are laudable. By addressing the payment defect in the current model, policymakers would reward organizations for making the long-term financial commitment necessary to establish and maintain a value-based delivery system.

Sec’y Sibelius, “Can You Hear Me Now?”

del.icio.us Tags: ,,

Friday, March 18, 2011

What Can Anyone Say or Do?

 

Neither physicians, nor patients (not consumers) really have much control

over  health care, despite what all the MBAs, Pundits, Consumer Advocacy Committees and Wanabees running all over the country going to seminars, meetings, Health 2.0 and the like. Physicians are always pictured as rich, fat and living off their unfortunate patients who are misled by the government and payors in the name of money. These organizations attribute their own feelings and attitudes upon doctors about the expense of caring for sick patients. They project their own attitudes on physicians.

During my early career years (about 20 or more  years ago) I made a very nice living, if I say so myself I saw  many patients for free. I would do surgeries for free, arranged for charitable care, had colleagues I could refer to who would be gratified that I would send them poor patients because they saw my trust in them to do the ‘right’ thing. I never sent a patient to collections, (doctors would just not do that sort of thing)  Not that I was so wonderful, but the vast majority of doctors would do the same as I did.

Physicians would graciously go to an Emergency department, when called, grateful for the referral. In fact physicians who would not respond to an ER call were shunned, and even reprimanded by the chief of staff or even would have their hospital privileges revoked. Today many physicians, if at all possible will resign from a hospital to avoid ER call.

Did you know that most insurance companies require you to have hospital privileges or have someone who will sign off that they will cover you to be on their panels?

When I observe what is happening in our world I realize that as Americans our greatest entitlement is freedom. That doesn’t mean freedom to ‘redistribute the wealth’, nor free healthcare, nor huge pensions.

 

The beauty of freedom is freedom allows for corrective changes without concern for rigidity of bureaucracy.The beauty of freedom is the ability for creation of new transformative ideas, and the implementation.Liberty and freedom are risky, and ultimately requires more input and energy than socialism or collective action. Why should your health depend upon a politician who knows little about healthcare, distracted by other decisions such as war,immigration issues, foreign policy and the liittany of challenges facing our nation. What would a former Governor know about running HHS?. Did anyone ask the doctors or for that matter congress and the people if Don Berwick MD was a suitable head for CMS?

As most physicians think in the doctor’s lounge (if your hospital still has one), our system is badly broken, unrepairable except by a sweeping dictatorial reform such as Obamacare,  It.doesn’t matter if it will work or not,

All of this is not unique to medicine, it has become endemic in all of America.

Tuesday, March 15, 2011

A.C.O. More on

 

Ken Cohn, wrote to me today about ACOs. Ken Cohn describes multiple issues and complete ambiguity regarding how to form or implement an ACO.

Here is what he  wrote to me.

“Dear Gary,

I participated in a panel discussion of physicians' roles in Accountable Care Organizations two weeks ago.  The blog post that summarized the discussion resulted in a firestorm of comments.  When you would like to learn more about ways that you can engage physicians to improve healthcare collaboration, please read on.

Doug Hastings, a lawyer and Chairman of Epstein, Becker, Green, empathized with the difficulties that healthcare leaders face, planning for an uncertain future in the absence of specific regulations regarding Accountable Care Organizations (ACOs).  When he summarized the 2011 National Committee for Quality Assurance (NCQA) draft guidelines, he mentioned the following overriding concepts related to ACO formation and operation:

  • ACOs must include a group of physicians with a strong primary care base and sufficient other specialties that support the core needs of a defined population of patients.
  • Performance measurement across the triple aim domains of cost, quality and patient experience must be a key element in the evaluation of ACOs.
  • ACOs must facilitate timely information exchange between primary care, specialty care, and hospitals for care coordination and transitions (NCQA 2011 ACO Criteria and Implications for ACO governance. BNA's Health Law Reporter, 19PVLR1573)

    Jeff Petry, VP of Business Development at Premier, said that the 3 R's of ACOs include:

    • Regulations
    • Reimbursement
    • Relationships 

    Possible roles for physician champions in ACOs include:

    • Presenting and discussing clinical data with fellow physicians
    • Minimizing physician-hospital battles
    • Creating a safe environment for learning
    • Helping to build transparency and trust

    The above strategies and tactics have worked in hospitals in 40 states where I have worked.  What is working for you where you work?”

    He did not mention specific hospitals

    Mr. Cohn then goes on to discuss building relationships and possible roles for physician champions, suggesting some of the following:

    Possible roles for physician champions in ACOs include:

    • Presenting and discussing clinical data with fellow physicians
    • Minimizing physician-hospital battles
    • Creating a safe environment for learning
    • Helping to build transparency and trust

    Physician Champions  Collaborative Listening  

    Observations:

    EMR, and HIE are works in progress

    ACO….the foundation has yet to be excavated..

    The cart is definitely in front of the horse(s)

     

    del.icio.us Tags: ,,,

  • Monday, March 14, 2011

    M.U. or A.C.O. Pick Your Poison

     

    HIMSS 2011 has just adjourned, and the reviews are filled with prognosis and predictions.

    by Neil Versel (Xerox)   Neil Versel

    M.U.

    The healthcare world is waiting nervously for HHS to release its proposed ACO regulations. HHS Secretary Kathleen Sebelius was on hand for a keynote address Wednesday morning, but gave no hint of when the regs might come. Instead, Sebelius and departing national health IT coordinator Dr. David Blumenthal mostly stuck to their general stump speeches, perhaps not wanting to stir up political controversy in this time of divided government.

    In some ways, Blumenthal’s presence at HIMSS was notable for something he didn’t show up for. Deputy National Coordinator Dr. Farzad Mostashari, likely to be the interim coordinator when Blumenthal returns to Harvard in April, led the ONC town hall on Tuesday. Mostashari caused some seismic ripples through much of the vendor community on Monday by saying that ONC will be working with the National Institute for Standards and Technology and other organizations in the next six months to find ways to measure EHR usability, and that usability likely will be part of Stage 2 meaningful use, starting in 2013.

    Farzad Mostashari, likely to be the interim coordinator when Blumenthal returns to Harvard in April, led the ONC town hall on Tuesday. Mostashari caused some seismic ripples through much of the vendor community on Monday by saying that ONC will be working with the National Institute for Standards and Technology and other organizations in the next six months to  find ways to measure EHR usability, and that usability likely will be part of Stage 2 meaningful use, starting in 2013. (Nothing like putting the cart before the horse)..Stage I was obviously designed for CMS and insurers, so those who wisely wait for a better standard, such as usabiity wil not receive a large incentive, and be penalized for caution. We must adopt inferior hardware and software platforms by such and such a date or suffer the consequences of a reduced reimbursement and/or reduced incentives. As usual our government would race to an implementation for it’s own self –centered purposes, since the funding actually comes from taxpayer pockets.

    A.C.O.

    HIMSS 2011 was not all about meaningful use. “Meaningful use in some ways fell off the radar,” another CMIO said on the same bus ride. The new buzz—and source of anxiety—is about Accountable Care Organizations.

    An eponym ranked right up there and as controversial as the PACA law ACO is a new name looking for an organization upon which to plant it’s banner.

    Hospitals and physicians alike are frantic to filter through the impending changes in billing and reimbursement model. Who will bill..  hospitals,.. physicians, or a third organism  which the hospital and physicians will create as a ‘holding entity?  This looks like another level of bureaucracy which will compromise whatever savings HHS is proposing by a huge re-organization of the industry. Efficiency in health care seems to be a moving target….a bit to the right, and then a bit to the left.

    Just as some of the visionary ideas such as HIE and EMR are beginning implementation, the bureaucrats add more ingredients to the mix, further congealing real progress.

    Sherry Turkle, the Director of MIT’s Initiative on Technology and Self, has become deeply pessimistic about our digital future. In her controversial new book, Alone Together,Turkle argues that the development of emotionally sympathetic robots like Tamagotchis and Furbies means that the “robotic moment” has arrived for the human race.She elaborates. In several interviews on TechCrunch

     

    Turkle is not optimistic about social media, robotics, nor the development of emotionally sympathetic robots.  Please view the videos and read the TechCrunch interview then leave your comments here:

     

    Wednesday, March 9, 2011

    More Butterfly Effect

     

    The Laws of Unintended Consequences, or Whose Money is it Anyway?

    There are provisions in the health care bill which paradoxically, and perhaps predictably increase the cost of Rxes and add additional burdens to the doctor. 

    Patients are demanding doctors' orders for over-the-counter products because of a provision in the health-care overhaul that slipped past nearly everyone's radar. It says people who want a tax break to buy such items with what's known as flexible-spending accounts need to get a prescription first.

     

    The result is that Americans are visiting their doctors before making a trip to the drugstore, hoping their physician will help them out by writing the prescription. The new requirements create not only an added burden for doctors, but also new complications for retailers and pharmacies.

    "It drives up the cost of health care as opposed to reducing it," says Dr.Chung, who rejected much of a 10-item request from a mother of four that included pain relievers and children's cold medicine.

    Some doctors, irked by the paperwork and worried about lawsuits, are balking at writing the new prescriptions. Pharmacists and retailers say the changes mean they have to apply a personalized label on some 15,000 different everyday products for customers paying with certain debit cards.

    The Unintended Consequences of Hasty and Poorly Thought out Legislation

    Retailers and pharmacies, meanwhile, say another aspect of the change caught them flat-footed. Many flexible-spending accounts come with a debit card, making it easy for consumers to draw down the money in the accounts when they shop at a pharmacy. But under the original IRS guidance, people couldn't use those cards for the prescribed over-the-counter medications.

    An industry group representing Wal-Mart, CVS Caremark Corp., Visa Inc. and other large corporations warned that could temporarily halt use of the debit cards for any pharmacy purchase. The IRS eventually decided the cards could be used—as long as the pharmacist labels and processes the over-the-counter item exactly like a prescription.

    That had another unintended effect. Thousands of over-the-counter products now must pass behind the pharmacist's counter when the customer pays with the special debit card.

    Doctors are also concerned about malpractice lawsuits, since a prescription potentially puts them on the hook for any problems a patient suffers from over-the-counter drugs.

    Some malpractice insurers are urging doctors not to write any prescription without seeing the patient in person, says Lawrence Smarr, president of the Physician Insurers Association of America, which represents malpractice insurance providers.

    The over-the-counter provision isn't the only part of the health-care law that has defied expectations.

    Health-policy experts predicted that new insurance pools for high-risk patients would attract so many expensive enrollees that funding would be quickly exhausted. In fact, enrollment is running at just 6% of expectations, partly because of high premiums.

    A provision preventing insurers from denying coverage to children with pre-existing health conditions prompted insurers in dozens of states to stop selling child-only policies altogether.

    And a piece of the law designed to centralize patient care by encouraging health-care providers to collaborate is running into antitrust concerns from regulators.

    Much of the health law, which passed last year despite overwhelming opposition by Republicans, doesn't take effect until 2014. The nonpartisan Congressional Budget Office has projected that an additional 32 million Americans will get insurance, and the law has already extended tax credits to small businesses for buying insurance and allowed many parents to keep their children on their health plan until their 26th birthday.

    But opponents say it costs too much and gives the federal government too much control over health care.

    As that larger battle plays out, the over-the-counter provision is emerging as a top target for change. Republicans in both the House and Senate have introduced legislation to repeal it and return to the old system. The largest chain drugstore lobbying group is backing the effort, arguing that the new rules are inefficient and limit access to the medicines.

    Asked whether she would support such legislation, Kathleen Sebelius, secretary of Health and Human Services, said: "I'd take a look at it."

    Tax breaks for over-the-counter drugs date to 2003, as popular drugs like the allergy medicine Claritin began switching to over-the-counter status. The Internal Revenue Service loosened the rules on flexible-spending accounts so consumers could use them to buy thousands of nonprescription medications. The tax-free dollars can also go for insurance co-payments, eyeglasses and other out-of-pocket health costs.

    Critics say the accounts encourage overconsumption of medical services. Since consumers typically must forfeit unused funds by year's end, they often ended up scrambling in December to drain their funds by loading up on aspirin, antacid and the like.

    Tuesday, March 8, 2011

    Dr Berwick’s Numbers are Almost In

    image   And he and President Obama are not going to like it. Unlike his calculations for decreased costs with better outcomes the number of senate Republicans and Democrats has increased to not hold a confirmation hearing. Apparently  congress does not wish to embarrass President Obama, nor does President Obama wish to face down nor delay a new Head of CMS, and there are suitable alternatives. Berwick was appointed as an interim and temporary head of CMS in the rush  to reform. (haste does make waste) It also points out the crucial lack of time given to Congress,, and their outright negligence in analyzing the bill set forth by Obama and the Democratic controlled congress.

    In a report from Katherine Hobson of the Wall Street Journal, She describes,

    “The road ahead looks so difficult that some Democrats are joining Republicans in calling for a new nominee, The New York Times reports. It’s a matter of math; 42 Republicans have already urged President Obama to pick someone else, and by voting accordingly, they could block confirmation, the paper says. A White House spokesman tells the NYT the nomination won’t be withdrawn and praised Berwick’s performance thus far.”

    It seems there will be another protracted confrontation between congress with President Obama. Obama appears to be a one man show dedicated to his getting his way with some questionable tactics e

    It is clear that Obama chose Berwick because  of their intertwined motivation to re-distribute the wealth and the health of the nation.

    The Times reports Berwick’s principal deputy, Marilyn Tavenner, would be more acceptable to Republicans and is a potential replacement.

    Readers who wish to learn more about Don Berwick M.D may go link to several past Health Train Express Articles:

    The Boondogle    

    Don Berwick vs Congress

    I agree with some of the utopian ideals that Dr Berwick espouses, however it is obvious that neither side has drilled down on the impact of true costs to patients, employers, or care providers The bureaucracy will be stultify everyone ...

    Dr Price Tears into Don Berwick (CMS)..Feb 10, 2011…A live web video from the hearing on Health Reform Repeal Legislation. Web Video Live. image. Rep. Tim Price MD. You listen, you decide, but a must view for everyone.

    Health Train Express: Foreign Perspective on US Health Economics  Feb 25, 2011……Today we are faced with demagogues in health care, the Sebelius', the Berwick's, the health care foundations, and all those wannabees who are sabotaging health care with politically correct statements. They come, they go at the end of ...

    Observations   Hard to believe whoever was in charge of this let it slip through. Well intentioned but poorly implemented. The Health Care Blog also has a post today by Micihael Millenson. Thanks to him. I will write Czar Berwick about this one. ..

    Which Planet am I on? ….Jan 21, 2011  .. running in the opposite direction from the US Health Reform. I wonder what Dr Berwick is thinking now? del.icio.us Tags: NHS,Andrew Lansley,UK Health system,Primary care trusts,acountable care.

    Are Doctors lurking, or lurching?….Dec 30, 2010….Donald Berwick, explains, "Traditional medical ethics, based on the doctor-patient dyad must be reformulated...The primary function of regulation in health care, especially as it affects the quality of medical care, is to constrain ...

    The IHI Open School…Dec 25, 2010…Mention the name 'Don Berwick' and some physicians have a gut-wrenching feeling about him. He is the focal point and lightening rod as head of CMS due to his statements about the American Health System. ...

    A Good Guy or a Bad Guy?….Don Berwick is a controversial candidate for being the head of the Medicare (CMS) system. The name change several years ago from Medicare to CMS (Center for Medicare,Medicaid Services) was a subtle. beginning for the projected changes ….

    Re-distribute the Wealth…Jul 09, 2010….Essentially Don Berwick has become the 'lap-dog' for the socialist agenda of Barak Obama. Dr. Berwick has been a respected member and head of many organizations that are held in high esteem by the government for advice.

    Health Reform in the NHS vs.The US…Aug 24, 2010…The UKs NHS system is running away from itself as fast as Obama and Berwick are running toward an obsolete model. From the BBC News Online today,. image. Hospitals are to be set free from central control

    Liberating the NHS UK

    Dec 05, 2010

    Dec 05, 2010

    Unfortunately Don Berwick, the present head of CMS totally ignores this feature of the NHS. The NHS system has not been self correcting due to it's massive bureaucracy and inertial guidance system. This is typical of government. ...

    What tha !?…Jul 27, 2010…Seems like Don Berwick was preaching to the wrong choir several months ago when he addressed an audience in the UK. Today, The New York Times announced,. LONDON — Perhaps the only consistent thing about Britain's socialized health care ...