Information provided by Health Train Express and Digital Health Space is informational only. We do not endorse specific solutions. Inclusions are provided as reference only. Readers should consult with their own consultants for further details.

Wednesday, August 29, 2012

Health Insurers are Feeling the Pressure of Looming PPACA


In a series of announcements it becomes apparent that things are not well in the health insurance industry.

Wellpoint's headquarters are in Indianapolis.

Shareholders of WellPoint (Blue Shield in California) are griping about a reduction of their dividend by lowering its 2012 adjusted earnings forecast to a range $7.30 to $7.40 a share, down from $7.57 a share (yes, that’s correct….approximately 15 cents/share. Times must be even tougher for them than the uninsured, and unemployed.

Further investigation

Shares of the nation's second-largest health insurer fell 12% in midday trading, and the disappointing results dragged down shares in other insurance companies.

In contrast, rival UnitedHealth Group Inc. raised its full-year profit estimate when it reported second-quarter results last week.

WellPoint said second-quarter profit decreased by 8%, which also fell short of Wall Street expectations.

The company reported earnings of $643.6 million, or $1.94 a share, compared with $701.6 million, or $1.89 a share, in the same period a year ago. More shares were outstanding in last year's second quarter.

Enrollment during the quarter ending June 30 dropped 2% to 33.5 million members as WellPoint cited heightened competition in certain markets.

The company said it expects medical costs to rise by about  7.5% for 2012, a slight increase over its previous forecast. Overall, revenue in the quarter ended June 30 rose nearly 2% to $15.4 billion.

Angela Braly, WellPoint's chief executive, said, "We are disappointed with the need to lower our guidance but believe it is the right action to take given the challenging market we see."

Later in the day Angela Braly was sacked by the Board of Directors

Angela Braly resigned as CEO under pressure from shareholders

Angela Braly, the chief executive of WellPoint Inc., resigned late Tuesday after intense pressure from shareholders who have been unhappy with the company’s performance.

WellPoint announced that John Cannon, its general counsel, would temporarily fill the CEO role until a replacement is chosen. Cannon is not seeking the role permanently.

WellPoint, one of nation's biggest insurance companies, is the parent of Woodland Hills-based Anthem Blue Cross.

“Now is the right time for a leadership change,” Jackie M. Ward, the company’s lead director, said in a statement. “We believe the remaining executive team is dynamic and strong, with great potential to drive WellPoint’s future success.”

Shareholders have been vocal in their dissatisfaction with the performance of the company under Braly. They have decried the company's lagging stock, managerial missteps and disappointing earnings.

Still, the timing of Braly’s resignation is a bit unusual in that WellPoint agreed last month to purchase Medicare provider Amerigroup Corp. for $4.9 billion. It is uncommon for companies undergoing a significant acquisition to change leadership so soon after the announcement of a deal.

The investor unrest follows years of consumer fury that beset WellPoint as it repeatedly raised premiums on many families and small businesses by 10% or more. The nation's second-largest health insurer runs Blue Cross plans in California and 13 other states and has more than 33 million customers nationwide.

A New York hedge fund, Royal Capital Management, sent a letter to WellPoint's board last week saying that Braly has "failed miserably" as CEO and that "it is incumbent upon the board of directors to fulfill its fiduciary responsibility to shareholders by changing leadership." Royal Capital, which held about 838,000 shares of WellPoint as of June 30, declined to comment further Monday.

It’s not encouraging to know that Wellpoint’s patients’ welfare is in the hands of hedge fund experts, who are not exactly known for their pristine ethics or morals.

Let’s hope that the  free market enterprise system can self correct to overcome the foolishness of Obamacare.


Thursday, August 23, 2012

Online Physician Ratings: Know What's Being Said About You By Simon Sikorski, MD | August 13, 2012


This?                                            or  This?


Last week, 50 doctors in New York gathered for a meeting to discuss one of the biggest controversial topics affecting their association: Each doctors' online reputation. Most of the attending physicians have embraced patient reviews into daily activities while others have not. How serious has the issue of online reputation become?

Like it or not, physicians are being drawn into social media.  One of your group associates may be online in other settings which might influence your own reputation.

It behooves you to ‘Google” yourself and read what is on the internet, and if necessary do whatever is necessary to edit the content.   Not having a Google identity can also have a negative connotation as much as ‘negative review’.  Ignore social media and Google at your own risk.

In less than one year, patients’ online behavior of how they look for doctors has changed by 65 percent. Eighty percent of new patient volume will screen their doctors on Google. In 2011, physician ratings sites accounted for only two percent of that behavior. Now it’s 60 percent, according to comparison of our 12 case studies vs. 120 online marketing campaigns in 2011. In early 2012, most of the digital health companies have started big advertising campaigns competing to list physicians and offer statistics about their practices.

Doctors are becoming very concerned about how their colleagues’ online reputations impact the profitability of their organizations. In one case study for an ambulatory surgery center, we showed that improving the reputation for six of 15 doctors brought in 33 new out-of-network cases in less than four weeks. Why was this so significant? Because previously the same ASC had to spend about $8,000 in advertising just to get five out-of-network patients.

Physician Reputations and Review Websites: Who Owns Your Name?

There are no longer any doubts that patients Google their doctors. In the case of patients seeking fee-for-service options, the behavior of turning to “Dr. Google” occurs 100 percent of the time. What your patients find at that point is critical for your bottom line. The information below will help you understand why taking charge of physician online reputations has never been more important and why you should take action now.

The reason for taking action now is because there are now over 100 doctor review websites creating businesses structured around your name. Any doctor without a strong online presence by the end of 2011 is already affected. At this point, any doctor with a license already has a profile somewhere. This is especially true for group practices and hospital-employed doctors who almost never have any other public-facing profiles they own outside of what their employer publishes about them on the corporate website.

The impact of doctor review sites on a medical practice and hospitals. The implications for the hospital brand and their profitability were severe. In one example, a small ASC was outcompeting a local hospital purely on the fact that their doctors embraced patient reviews and the hospital was still afraid of even featuring the doctors on its own website.

Here are some of the most disturbing findings about what physician rating sites publish and why you should do something about it now:

1. Outdated reviews, some from four to five years ago

2. Outdated addresses and phone numbers. Why is that significant? When that phone number rings at your old practice, that’s where you’re losing your patients to. Again, for group practices and hospital-employed doctors, this is even more significant because some hospitals are monetizing on this while the actual place where they do work, is failing. Yes, that's right. When patients call a physician's old phone number the receptionist schedules those patients to see their doctors.

3. Old patient satisfaction scores marked as percentages. Most of the surveys were filled out years ago by one to four people. The two most important questions for you are: How many patients do you see during the year? Are between one and four reviews representative of that number?

4. Physician rating websites advertise on Google for your name. This is perhaps the most unethical practice. Here’s the hidden business structure:
• The company publishes advertisements for your name
• Public clicks on the advertisements to go to a website where either bad reviews are posted about you, or an empty profile exists
• Next to your name are doctors that purchased an advertisement on that website and are displayed front-and-center
• In effect, your name is directing your possible patients to other doctors
•Those listings offer patients ability to call for an appointment or schedule one via their platforms

So in addition to paying for a subscription, physicians advertising on these sites are paying for new patient leads. Furthermore, the company has to be “fair” to all subscribers so it will advertise for different doctors at different times so that patient volumes can be distributed more evenly or more patient leads can be given to subscribers who pay premium fees.

For doctors in New York state, the problem is even more significant. The New York Department of Health forbids doctors to publish patient testimonials, while these businesses can. When I spoke to our legal counsel, I found out that the regulation is so broad in its meaning that it prohibits the doctors to use patient reviews in any format. There is no such regulation for the ratings websites.

“Dr. Google” has become the most feared background check available to anyone with access to the Internet. Mobile phones made that access possible to virtually everyone. In effect, Google has become a reference check that establishes a level of trust for an appointment to be scheduled. What patients find is completely up to you. I hope this short expose proves of value for doctors still thinking whether they should invest in their online reputations.


Simon Sikorski, MD is the CEO of Healthcare Marketing Center of Excellence. He is a regular speaker at physician conferences about reputation management, brand advertising, and ROI from internet strategies and social media. E-mail him here.


Wednesday, August 22, 2012

Breaking News on the Social Media Frontier


                             no preview

The Second Generation of Social Media advances on health care. We are just at the frontier of social media engagement in healthcare.

I am one who sees things out of the box. I rebel at walls, at being defined by others and observe a wave of rapid advancement triggered by the infinite number of interactions between physicians and physicians and patients and patients and patients. (read that one slowly).  Rather than being bridled by old rules in a new medium, unless we adapt and change we will be swept away by new media just as newspapers and print book now play a much less dominant role in publishing.

It becomes apparent how mobile health is revolutionizing health care in countries that have a much greater shortage of physicians and larger population health challenges. In those countries there is no ‘box’ to restrict innovation and growth. It will be necessary for us to break down barriers and ‘rule’ set forth by government which decrease efficiency and increase costs.

Lift Elevator

Events in social media evolve at a quickening pace.  At a time when healthcare has accepted social media, social media evolves further.

Not so  subtle changes are being announced by the creative genius of what I would call “socialite media experts.  Simplicity of design, intimacy of intercourse, and        .

New domains, such a Medium, Branch, Beyond, Lift, all the progeny of Obvious (the original owners of Twitter).

Lift has a blog describing it’s goals .

Obvious describes itself in this manner, “The Obvious Corporation is more of a philosophy than a company or product. We focus our long term view on ideas and technology that can be generally described as “world positive.” When opportunities resonate with our worldview, we do what makes sense to help them succeed. So far, a small portfolio of companies across a variety of disciplines and a vision for how publishing could be improved have grabbed our attention.”

Medium presents a forum for stories, as  “collections” , which are defined by a theme and a template, as well as photographs.

Meanwhile  check out these:

Been There. Loved That 

Look What I Made

The Writer’s Room


All of these sites have popped up in the past several months. All are currently in beta and being rolled out by invitation .

As Steve Jobs said,

Stay hungry, Stay Foolish”  (Stanford University 2005, commencement address)  His statement was not original since it originally appears on the back page of THE WHOLE EARTH CATALOG 1974

                                       Original Whole Earth Catalog, Special 30th Anniversary Issue

Is Social Media the current  iteration of “The Whole Earth Catalog?”  Is Social media a form of counter-culture revolution in the same manner as the catalog was at that time?


Hippocratic Oath, Then and Now


In the midst of chaos and turmoil for physicians in America it is as important as ever to maintain our hippocratic oath.  Now is the time to review what we swore to (if your medical school even does this at graduation. )  This should excite you as much as your first ‘white coat’.


As you will read below it has been modified somewhat.


Let this be your ‘straight ruler’ to compare to what we are all going through at the moment, and remember, it too shall pass, and change….but real meaningful ethics barely change. The FTC, FDA, SEC, CMS and government  will change and change as people do. Physicians, Ministers, Rabbis, ( I include Priests) (and MDs are ministers to your health)

A parchment page of script bearing the name

Few medical schools today require students to recite the classical version of the oath. Enlarge Photo credit: public domain

Hippocratic Oath: Classical Version

I swear by Apollo Physician and Asclepius and Hygieia and Panaceia and all the gods and goddesses, making them my witnesses, that I will fulfill according to my ability and judgment this oath and this covenant:

To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art—if they desire to learn it—without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but no one else.

I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.

I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art.

I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.

Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves.

What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself, holding such things shameful to be spoken about.

If I fulfill this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot.

—Translation from the Greek by Ludwig Edelstein. From The Hippocratic Oath: Text, Translation, and Interpretation, by Ludwig Edelstein. Baltimore: Johns Hopkins Press, 1943.

A piece of parchment paper as a title page of Hippocratic Oath

Just as medical textbooks have come a long way from Hippocrates' archaic writings, the modern versions of the oath veer far from the classical. Enlarge Photo credit: Aldus Manutius/public domain

Hippocratic Oath: Modern Version

I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.

I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

—Written in 1964 by Louis Lasagna, Academic Dean of the School of Medicine at Tufts University, and used in many medical schools today.




Editor's note: To add your own comment as a doctor or a non-doctor,


Tuesday, August 21, 2012

Mayo Clinic Report on Physician Burnout


A national survey of 7,288 physicians (26.7 percent participation rate) finds that 45.8 percent of physicians reported at least one symptom of burnout, according to a report published Online First by Archives of Internal Medicine, a JAMA Network publication.

The Mayo Clinic today released the finding of a study on physician burnout. Not surprisingly (if you are a physician) the stunning findings, perhaps to the public, is that over 30% of physicians in general have documented burnout (according to psychiatric standards), and the highest rates of over 50% were among emergency room,family doctors (primary care physicians) and the internal medicine specialty.

Symptoms and signs include depersonalization, lack of involvement with patients, insomnia, loss of appetite and other signs of clinical depression. It was also found that over 50% of physicians are considering leaving clinical practice, early retirement or part-time medical practices.

This is occuring at a time when patient load will increase by about 25% due to health reform, which includes increasing bureaucracy not directly connected with patient care.

Most physicians recognize their own burnout symptoms and categorize it as depression. It however has other signals which differentiate it from clinical depression. It mimics post traumatic stress disease, seen in the military. The duration of chronic stress exacerbates signs of burnout.

There are physiologic and biochemical changes which occur during burnout, much like clinical depression. It is well known that anxiety creates the release of circulating hormones such as norepinephrine and corticosteroids as well as changes in neuro-mediators in the brain, such serotonin and inhibitors.

The obvious outcome of this is markedly reduced physician efficiency, increased errors, and disability, either acute or chronic.

The figures reveal how health care is impacted by these numbers.

A lack of control about the future and working conditions in many professions reveals that these factors also lead to apathy and burnout.

In medicine this is apparent. Most physicians know that physicians have little to do with the operations of the business of medicine, health insurance reimbursement, regulations, medicare and medicaid regulations.and find a greater and greater percentage of work time involves non- clinical work.

When queried physicians in the majority enjoy charitable care, however cannot individually support it in the present setting of medicine in the United States. While medicare payment have a due process for adjudication of disputed or rejected claims, often times state medi-caid plans do not have a mechanism which is usable to dispute disagreements. These factors contribute much to the uninsured challenge.

Herring's Medical Cartoons - Uninsured, But No Paperwork 

For providers time is money just as it is for all employers/employees. There is a limit as to how long a medical business can pursue these claims. It is also possible to seek legal relief, however the cost of this is prohibitive for small groups. Some hospitals or larger groups can afford the legal fees to pursue this course, and occassionally successful. While a patient can be sent to collections, how does one send medicaid or medicare to collections. In fact the provider is effectively extorted to agree to the rules present in the credentialling process. It's one thing to say okay I am going to extend 'credit' or discounted rates by choice, but another to coerced or mandated discounts. In fact most insurers have a disclaimer that their rates can be altered at anytime. The provider is free to disenroll or accept the changes. The provider has an ongoing ethical and legal obligation to continue care or be sued for abandonment if continuing care is not arranged.

While patient care can be stressful, the training process usually deals with clinical issues that cause stress. It is all of the above collateral challenges that cause burnout. Long hours, lack of recognition and the blatant disregard for physicians by insurers. Rarely does an insurer send a note of appreciation to their panels for 'good care' for the companies insured.

The fact that almost 1 in 2 U.S. physicians has symptoms of burnout implies that the origins of this problem are rooted in the environment and care delivery system rather than in the personal characteristics of a few susceptible individuals," the authors conclude. "Policy makers and health care organizations must address the problem of physician burnout for the sake of physicians and their patients."


Monday, August 20, 2012

Money Money, Who’s Got The Money?


Most of us know where the money is going, and it’s not to physicians or providers. There is much money to be made and had in our health system, whether it becomes socialized, nationalized or universally paid.  Universal payor? It’s your wallet. What’s left? Not much.

Insurance companies are doubling down  to hedge their bets.

Health insurance companies bitterly opposed the health care reform law but, as the merger between Aetna and Coventry Health Care announced Monday shows, the industry knows there's still money to be made.

The $5.6 billion Aetna-Coventry Health Care merger is the biggest in the health care sector since President Barack Obama enacted the reform law in March 2010. The deal will give Aetna, the third-largest health insurer in the U.S., a big increase in Medicare and Medicaid customers, including poor elderly people on both programs, and in the number of people who buy insurance on their own or get coverage from small businesses. Aetna will gain 5 million new customers when the merger is complete and stands to get even more in the near future.

"You've got an arms race going on in health care," said Robert Laszewski, a health care consultant and president of Health Policy and Strategy Associates in Alexandria, Va. Laszewski said health insurance companies, hospitals and other players are merging into bigger entities in hopes of restraining their own costs and grabbing larger shares of the markets as they are reshaped by health care reform. What the Aetna-Coventry Health Care merger won't do, at least in the short term, is lower anyone's health insurance premiums, he said.

The health insurance industry is undergoing a transformation as a result of the health care reform law, which the Supreme Court upheld in June. Twenty-five million people will buy health insurance on the law's regulated "exchange" marketplaces in the states, according to the Congressional Budget Office. Many of those small businesses and people who don't receive health benefits from their jobs will get federal tax credits. Medicaid will also add 11 million poor people and states are expected to contract with private health insurance companies to cover them.

Huffington Post expands on this post.  It’s worth reading….Health Insurance companies, like the American Medical Association and others did the ‘FLIP-FLOP’ at the last minute, they saw where your money is going….



Sunday, August 19, 2012

Sunday Morning Brunch Topic, Is PPACA’s Demise Pending?


Another Elephant in The Room……summer edition.

President Obama’s dream team’s health reform law may becoming unhinged as more people read the law (thank you, Nancy Pelosi) If you have a week of spare time, you can read it also.

It shouldn’t take a panel of experts, such as healthcare executives, supreme court justices or ordinary citizens to read a document that encompasses their health and lives.

Written in verse similar to a ‘bible’ it states  multiple times that “the Secretary of Health and Human Services shall………”


GOP presidential candidate Mitt Romney, running mate Paul Ryan, and other Republicans are stressing $716 billion in cuts to Medicare that are part of President Obama's health care plan.

The $716 billion in cuts are aimed not at Medicare recipients, but at health care providers, such as hospitals and medical device makers; they also target what the administration calls waste and inefficiency in Medicare. 

Meanwhile, speaking in Florida -- where the Medicare issue is particularly resonant -- Ryan told a group of senior citizens that Obama's plan "raids $716 billion from the Medicare program to pay for the Obama care program."

Ryan said the cuts are hurting nursing homes and Medicare Advantage insurance plans, and that "Medicare should not be used as a piggy bank for Obama care."

Ryan’ plan includes a voucher system for private care, the details of which were not explained, although it has been claimed it would increase the cost of care by $6400/Medicare recipient.

Obama’s plan calls for reducing payments to nursing homes and providers amount to $ 716 billion over ten years.  Obama claims that Romney’s plan would shorten the life of Medicare by ten years and end Medicare as we know it, because of the voucher system Romney and Ryan propose.

While there is some substance to these arguments and which deserve an open, transparent and public debate, it skirts the real issues of why Obamacare is poorly constructed.

The public debate has been superficial and couched not only in political terms, but fundamental issues of the form of government our Republic proposes to represent.


Thursday, August 16, 2012

No Hospital Left Behind !


Is health care going to follow along the failed path of Education in the United States?

More than 2,000 hospitals — including some nationally recognized ones — will be penalized by the government starting in October because many of their patients are readmitted soon after discharge, new records show.
Together, these hospitals will forfeit about $280 million in Medicare funds over the next year as the government begins a wide-ranging push to start paying health care providers based on the quality of care they provide. One proposed measure is the rate of readmission.
With nearly one in five Medicare patients returning to the hospital within a month of discharge, the government considers readmissions a prime symptom of an overly expensive and uncoordinated health system.
Nearly 2 million Medicare beneficiaries are readmitted within 30 days of release each year, costing Medicare $17.5 billion in additional hospital bills. The national average readmission rate has remained steady at slightly above 19 percent for several years, even as many hospitals have worked harder to lower theirs.
These results reported by The Happy Hospitalist who also blogs and specializes in 'in patient hospital medicine".The report is in Kaiser Health News.
The penalties, authorized by the 2010 health care law, are part of a multipronged effort by Medicare to use its financial muscle to force improvements in hospital quality. In a few months, hospitals also will be penalized or rewarded based on how well they adhere to basic standards of care and how patients rated their experiences. Overall, Medicare has decided to penalize around two-thirds of the hospitals whose readmission rates it evaluated, the records show.
Kaiser Health News analysis of the records shows.  Hospitals that treat the most low-income patients will be hit particularly hard.
A total of 278 hospitals nationally will lose the maximum amount allowed under the health care law: 1 percent of their base Medicare reimbursements. Several of those are top-ranked institutions, including Hackensack University Medical Center in New Jersey, North Shore University Hospital in Manhasset, N.Y. and Beth Israel Deaconess Medical Center in Boston, a teaching hospital of Harvard Medical School
Most of these teaching hospitals treat  r uninsured patients on Medi-caid programs or other public safety net systems. Outpatient services are often very restricted, or unfunded. The patients have an increased rate of chronic illness which are more advanced in the first place since these patients do not get admitted until their disease is well advanced. Their care must be maximized prior to discharge, since their support  system is fragile or even not existent. This requires longer hospital stays, (which offsets the reduced re- admission rate)
"A lot of places have put in a lot of work and not seen improvement," said Dr. Kenneth Sands, senior vice president for quality at Beth Israel. "It is not completely understood what goes into an institution having a high readmission rate and what goes into improving" it.
Sands noted that Beth Israel, like several other hospitals with high readmission rates, also has unusually low mortality rates for its patients, which he says may reflect that the hospital does a good job at swiftly getting ailing patients back and preventing deaths.
Data for readmission rates are available in PDF or CSV files.
Atul Grover, chief public policy officer for the Association of American Medical Colleges, called Medicare’s new penalties "a total disregard for underserved patients and the hospitals that care for them." Blair Childs, an executive at the Premier healthcare alliance of hospitals, said: "It’s really ironic that you penalize the hospitals that need the funds to manage a particularly difficult population."
Does this sound familiar....??
Perhaps a wiser more prudent decision would be to implement this as a pilot program with regional distribution accordingly.


Wednesday, August 8, 2012

A Critical Need. The System needs CPR


The passage of the Patient’s Protection and Affordable Act may be a mandate with an empty  promise.  Although it sets forth a detailed plan to build a new health insurance system, it does not address many issues in an orderly fashion. 

In fact the majority of physicians recognize and espouse the observation that the law will make the system worse.  It has been designed for political expediency to deliver visible benefits to expand access to healthcare, remove pre-existing barrier to coverage, and other highly visible benefits that are front-end loaded which will drive up costs, not decrease them.

One system cannot solve the multitude of challenges which are quite diverse between communities such as New York, Chicago, Los Angeles, rural cities such as Indio, California, Desert Hot Springs, California, Atlanta, Georgia or Oglethorpe GA.

A study that is often quoted is the “Dartmouth Study” of utilization and costs of a community such as McAllen Texas and  Portland Maine or Madison, WI or Mason City Iowa.  Statistics do not lie, but can be very deceiving when comparing such radically different demographics and diverse cultures.

Our community in the Inland Empire region of Southern California  combines a multi-cultural population, a high rate of unemployment (one of the highest in the  nation) and uninsured or medi-caid eligibles.  Riverside County and San Bernadino Counties are large, as large as some of the smallest states in the east. The western portions of both counties are metropolitan and the eastern portions rural, much like many states such as Maryland, New York and Georgia. This is not a unique problem in most states.             .




Health Train at the Olympics 2012


Most of us have been watching the Olympics from London. It’s amazing  how records keep being broken.  Is it about more information about physiology, nutrition, and hopefully not  ‘doping’.  The medal winners seem to be getting younger and younger. ..why is that ?

As you may  be sitting on your couch or favorite chair some of you my increase your heart rate by that bag of popcorn, chips, cookies and milk, or that fast food brought home on the way from home.

Since studies have shown that 55% of us hold a smartphone in one hand while surfing the TV channels you want to look at all the new health mobile apps for exercise, and monitoring the state of your health and wellness.

Health Care IT: 2012 Olympics Shines Spotlight on Mobile Health and Fitness Apps

By Brian T. Horowitz on 2012-08-02

The Olympics are truly a great motivational event for young and older adults. Physical fitness is encouraged as a social event.

We hope your days are full of feel good summer fun! Those Olympians sure know how to play hard, so as the Olympic Games race full speed ahead, let's capture some of the athletes' positive energy and be inspired to live healthier today. Luckily, over 13,000 compassionate Medical Experts on HealthTap are always there to help you with your health questions, so ask away, and you'll learn ways you can feel better one day at a time. Wishing you all the best for a healthy week!

Here is a great place to begin your quest for “Olympic Gold”’.

Here's what's happening on HealthTap:



WELLNESS SERIES- Let’s Get Grilling !

How do you Match Up  for the Gold ? Your Olympic athlete body match

Imagine the rush of an Olympic sprint, high dive, or pole vault: now that's easier than ever with the BBC's "Your Olympic athlete body match" app. Find out if you are built like a Chinese gymnast, an American swimmer, or a Ukrainian lifter. Dream big and be inspired!

Find a Social Media Companion for Wellness




Tuesday, August 7, 2012

Health Train Express is Social Media, is Your Blog?


I spoke to soon. Health Train Express will be around for a long time.

The responses to my announcement surprised me. I had many more readers than I had realized.  I guess analytics don’t always work, or I used the wrong ones.

After the announcement I quickly realized that blogs will never be dead. They amount to the  21st century ‘Journal’ for daily thoughts (used to be called a diary).  Perhaps I should rename it  e-Diary

While I enjoy using Google Plus, Twiiter, Facebook, to gesticulate, propose, analyze or ridicule.

Health Train will remain an important piece in my social media project.

I admit it, I failed I could not give up my platform.  There are  too many issues to  write about and a blog is the best for me. 

Physicians must not allow their patient to remain passive and just accept what Government decides to offer them in health. 

Physicians empower your patients. Patients empower your physicians.

What changed my attitude?   Of course, it is Regina Holladay


Here is a larger version of The Walking Gallery…deserves a better view.


There you have it.  Regina Holladay has been at this for several year . All of the stories are a visual treat and a testimony to patients.  Regina expresses her pain and frustration let hospital systems while her husband suffered with cancer.  Something we all know about and share our concerns with her.  Thank you Regina Holladay


MedStarter is an outgrowth of a social network innovation, KickStarter. Kickstarter is another social media approach to funding startups that require small amounts of capital as an investment through donations for worthwhile ideas.


Friday, August 3, 2012

End of An Era


As I have read somewhere, ‘Nothing lasts forever’.

And so too are the lights going off here at Health Train Express.

It has been an eight year run with close to 1000 posts.

This will be the last Health Train Express blogpost.  A big thank you to ‘Blogger’ as well, now owned by Google.

In keeping with the trend Digital Health Space will assume the role of The Health Train Express

Health Care is undergoing some radical and important changes, and deservedly so in the 21st Century,  Now that we have survived Y2K (I think that is a pretty safe bet) I have evaluated the blog and what is happening in social media as well.

During the past six months our analytics reveal that my opinions and comments receive a much more global audience using social media, and further analysis also revealed that Google Plus will become my exclusive platform for the forseeable future. Of course nothing on the internet can be set in stone. Social media in medicine and health care has become well established. While Twitter and Facebook offer platforms, the unity of Google, Google Docs, Gmail, YouTube, Google Plus and Video Conferencing will allow me to video broadcast and interview important social media personalities using an integrated platform.

See you on the ‘other side’.

Gary Levin MD

This will allow the use of a central publishing source and eliminate much repetitive work.

Look for my comments, opinions, and diatribes on Google Plus at  +Digital Health Space.  Better yet put +Digital Health Space in one of your favorite circles.


The Costly Consequence of Health Care Reform


The Costly Consequences of Health Care Reform (Courtesy of the Budget Committee)

image-descriptionPaul Ryan, Chairman, Committee on the Budget, U.S. House of Representatives


Let’s carry that a little bit more, forward, “If you earned a medical degree, or PhD, thank the government.  I remember borrowing and working my way through college and medical school.  The government did not give me loans, the banks did and the government ‘backed them’ since students did not have income or usual credit standing.  For a man who went to Harvard, Obama does not seem to understand very much. Who paid for his education?  Did he make it on his own, does he thank the government for what he has….the best insurance in the nation, a 747 to fly on, limousines, secret service, free room and board.  Barry, give us a break ! You are a liar and a hypocrite.  I don’t expect you to tell us that you lie, liars never do and liars never even know they lie !

Posted April 8, 2010

“I can make a firm pledge.  Under my plan, no family making less than $250,000 a year will see any form of tax increase.  Not your income tax, not your payroll tax, not your capital gains taxes, not any of your taxes,”
President Obama, September 12, 2008

Beginning January 1, 2013, Obama Care imposes a 3.8% Medicare tax on unearned income of “high-income” taxpayers which could apply to proceeds from the sale of single family homes, townhouses, co-ops, condominiums, and even rental income, depending on your individual circumstances and any capital gains tax exclusions. Importantly, the “high income” thresholds are not indexed for inflation so will reach increasing numbers of middle-class taxpayers over time.

In February 2010, 5.02 million homes were sold, according to the National Association of Realtors (NAR). On any given day, the sale of a house, townhome, condominium, co-op, or income from a rental property could slam middle-income families with a new tax they can’t afford.

The new Obama Care tax is the first time the government will apply a 3.8 percent tax on unearned income. This new tax on home sales and unearned income and other Medicare taxes raise taxes more than $210 billion to pay for Obama Care.

The Costly Consequences of Health Care Reform (A legislative Review)

The issues are bi-partisan, Responsibility lies both at the feet of Republicans and Democrats.  Neither side can plead innocence.