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Wednesday, October 31, 2012

Common Sense: Where Has it Gone ?

 

Common Sense has been replaced by Conventional Wisdom. A radical thought by Thomas Paine, one of the founders of the country.

[American Revolutionary leader and pamphleteer (born in England) who supported the American colonist's fight for independence and supported the French Revolution ]

“Tyranny, like hell, is not easily conquered; yet we have this consolation with us, that the harder the conflict, the more glorious the triumph

 

Here we are less than one week to elections. After four years of executive leadership by the current administration we see a commander in chief who is able to set forth goals, but one who is unable to implement his plan effectively

With all the negative press regarding Obama's poor performance, why does he remain relatively popular. Even I when I listen to his oratory , become excited by his rhetoric...he is a hypnotic speaker, well versed in public speaking, performing much like a 'method actor' careful cadence, organized presentation, highly articulate, with symbolic hyperbole about America's perseverance. This comes after a history of much of his pre-presidential interest negative opinions of the United States. Michelle Obama summed it up when he was elected. “ This is the first time I am proud of the United States. Is “Obama an Equal Opportunity President” Has this been a fine example of the 'Peter Principle”?

In 2010 the accountable care act was passed, after two years of highly partisan wrangling, at the end of which no Republican legislator could be convinced to vote for the law. That in itself is a marker for voter disapproval with the law.

Whatever success this administration had with the 'war on terror' was left over from the Bush administration. Most of the work on finding Bin Laden had been done by the former . The boots on the ground were largely the same special forces teams and CIA intelligence operation that began the search.

We can look at the accountable care act from a new focused perspective now that some of the changes have gone into effect and some other large ones loom for January 2013 which is less than two months away, and also take place shortly before inauguration.

One thing is virtually certain, if the new president is Mitt Romney he will by executive order bring the process to a screeching halt for further review of implementation in a business like manner. Can the new President do this? Yes and no.

Here would be the process:

Not exactly, according to two Georgetown University professors writing this week in the online version of the Journal of the American Medical Assn. But there are some things President Romney would be able to do if he won, and more if he were joined in Washington by a Republican-controlled Congress.

Romney’s campaign website promises that the former governor of Massachusetts would make the undoing of the Patient Protection and Affordable Care Act — often referred to as “Obamacare” — a priority:

On his first day in office, Mitt Romney will issue an executive order that paves the way for the federal government to issue Obamacare waivers to all fifty states.”

But any attempt by Romney to unilaterally repeal the entire law would run afoul of the U.S. Constitution, which requires that the president “take care that the laws be faithfully executed,” according to the authors, both lawyers who teach at Georgetown.

The ACA does allow the president to issue waivers to the states, but only so that they can implement alternatives to the law that are better, not worse, write John D. Kraemer and Lawrence O. Gostin. In any case, those waivers won’t be available to states until 2017.

Another thing Romney could probably do is effectively eliminate one of the most-criticized pieces of Obamacare: the individual mandate. Since the penalty for failing to buy an insurance policy is actually a tax, a Romney administration could direct the Internal Revenue Service not to collect that tax, sending a signal “that individuals would not be penalized for failing to purchase qualifying insurance,” they wrote. (This would be analogous to Obama’s decision to lay off deportations of nonviolent undocumented immigrants.)

Obama's project planners are way off in their implementation mandates. Perhaps  business goals can be set and changed as stages progress. However our government's goals are usually set forth as mandates giving little or no chance for periodic adjustments. It dooms itself to guaranteed failure.

Here are some examples:

Grace Marie Turner writes a some significant length on Forbes “Health Matters” which are repeated here.

 

The Avalanche Of New Obamacare Rules
Will Come In January, 2013

Grace-Marie Turner
Forbes: Health Matters, October 28, 2012

When Congress wrote 2,700 pages of legislation to create Obama Care, that was only the starting point in the government’s re-engineering of our health sector. Tens of thousands of pages of regulation –- or more -– are needed to provide detailed guidance dictating exactly how its maze of new programs must operate.

But deadlines are looming for Obama Care for programs that are required to begin in 2014. And the administration is significantly behind schedule, with insiders speculating the White House is waiting until after the election to issue an avalanche of rules, many of which are sure to be controversial.

Government re-engineering of the private marketplace is a complex task. So far, more than 13,000 pages of federal Obama Care regulations have been issued, but employers, states, and health companies say they need much more.

One recent rule took 18 pages to define a “full time employee.” That’s needed because a company employing 50 or more full-time workers must provide health insurance or pay a fine. But part-time employees working fewer than 30 hours a week are exempt. How the government defines a full-time employee has huge financial implications for a company. The rule describes the difference between “variable hour employees” and “ongoing employees,” for example, and how to determine what time period to measure with definitions of “standard measurement periods” and “look-back measurements.”

Employers are hiring battalions of lawyers to help them decipher the bureaucratese, and some companies already have announced they plan to cut the hours of many of their workers so they fit within the part-time threshold, arguing even the $2,000 to $3,000 per-employee fines would more than wipe out their profit margins.

States also are in a quandary. HHS claims it is giving states “significant flexibility” in implementing Obama Care, including the controversial health insurance exchanges, but even those supporting the law are increasingly alarmed because they say they simply don’t have enough information to proceed.

The law requires exchanges to be created as a funnel for hundreds of billions of dollars in new health insurance subsidies and also as a vehicle to implement significant new regulations of the health insurance market.

The exchanges are required by law to begin enrolling members on October 1st of next year, and a huge amount of work needs to be done to meet that deadline.

But first, states need information. For example, the law says that if states don’t set up an exchange, the federal government will swoop in and set up its own, and they want to know what a federal exchange would look like before they decide whether to set up their own exchanges.

The Republican Governors Association wrote a letter to President Obama in July saying, “As the exchange issue is currently interpreted, states are essentially being tasked with shouldering all the responsibility without any authority.”

The governors listed 17 critical questions just on the exchanges that they must have answered before they can determine best how to proceed so they can “have full and complete knowledge of all the implications of our decision.” They are still waiting for a reply.

Health plans also are in a dilemma. Health insurers that plan to offer policies through the exchanges need to know what benefits must be covered and at what price so they can design and price their offerings. And they must get state approval for the new plans before they can be offered in the exchanges, a process which can take up to a year -– or more in some states –- to complete. They also need time to contract with providers, develop marketing materials that meet as-yet-to-be-announced government specifications, and figure out how to navigate the complex web of subsidies, risk adjustment, and calculations for cost-sharing – for starters. They have hundreds of other critical questions.

Dan Durham of America’s Health Insurance Plans said in recent testimony before the House Ways and Means Health Subcommittee, “There is an urgent need for more regulatory clarity with respect to exchanges and insurance market reforms,” adding “there is a tremendous amount of work that needs to be done” if the law is to get up and running.

“Unless such guidance is forthcoming, it will be difficult for health plans to complete product development, fulfill network adequacy requirements, obtain necessary state approvals and reviews, and ensure that their operations, materials, training and customer service teams are fully prepared for the initial open enrollment period that begins on Oct. 1, 2013,” Durham said.

Administration officials are mum on when the regulations will be issued. A Health and Human Services official repeated that prediction in an email to reporters in October. “HHS has worked to give states maximum flexibility in implementing the law and consumers in all fifty states will have access to an exchange” by next October, the official said.

There is some speculation that the regs are being held back because of the elections, since the deeper one dives into the details, the more problems and conflicts are created. But Neil Trautwein of the National Retail Federation says it’s also an extraordinarily complex task.

“We know that many of the regs have been delayed,” says Trautwein. “Part of it I’m sure is the political calendar, but a large part of this, and I can say with some confidence because we’ve worked well with the administration on a lot of these questions, is that the subject matter is so infernally complex. They’ve got a lot of tough questions to answer.”

The fate of Obama Care is, of course, predicated on who wins the election on November 6. If Gov. Mitt Romney wins, he has vowed to begin immediately the process of working with Congress to repeal the law. And Congress will surely begin actively blocking any new rules that come out and working to unwind those already on the books.

But even if President Obama were to be reelected, his Rube Goldberg health law may well implode from the nearly impossible task of re-engineering one-sixth of our economy to fit his centrally-controlled archetype.

Read online at Forbes

Organized medicine reports in AMEDNews, the plan devised by them and Medical specialty Societies for input from medical professionals and providers to place really meaningful health reform.

Thursday, October 25, 2012

Revolution in Medical Publishing- The Article of the Future

 

While some bemoan the downward trend in classic publishing and the supposed death of books, they will be replaced by a new, more dynamic medium, three dimensional with new spatial intelligence.'

The transition to electronic publishing has already occurred. This is the ‘Model T’, expect more advanced formats coming very soon. Innovation is the word in teaching.

The knowledge base continues to expand and it is essential for us to use tools to keep up with the KB. Engagement is the answer for active engagement over passive learning.

These changes must also come to  scientific journals. No doubt ‘old school’ authorities, editors and publishers will at first balk at these changes. Openness and transparency will lead to new categories of credibility tagged and authenticated for scientific accuracy by a certifying academic authority to which editors will be able to document the review process.

A well known scientific publisher, Elsevier has already introduced the expanded format in some of their electronic editions. They compare the old as a flat presentation and the new as a three dimensional interactive presentation. Graphs become alive and can be measured in real time with tools built into the software.

Elsevier now offers eVolve, a site dedicated to teaching and learning with the new tools. The site offers numerous webinars dedicated to improved teaching using the new simulation software in textbooks. The Webinars relate to nursing curriculum but the methodology can easily be transferred to teaching medicine in general, and surgery in particular.

The Article of the Future is Live

The possibilities are endless:

Obamacare, Boom or Bust ?

 

While most physicians bemoan the effects of the Affordable Care Act, there are many segments of the health care industry that are bulllish at the possibilities. I remember asking one of my financial advisors what were the best investments ?  His answer, “put your money into something you know….well.

And that appears to be happening with the ‘smart money’ and capital being invested by health enterprise. Many start ups and kickstarter are being flooded with potential investors, and startups no longer just belong in Silicon Valley.

While there is significant competition, opportunities abound as indicated here:

 

Here is a quick copy-paste of what is brewing

 

Startups offering everything from personalized nutrition and pregnancy apps to live online fitness instruction and a smart, souped-up toothbrush are among the members of Rock Health’s latest class of companies.

The San Francisco-based health tech accelerator on Thursday announced its fourth class of 14 startups, saying that it accepted less than 3 percent of the applicants.

The accelerator said this seasons’ applicant pool included more companies with hybrid hardware/software models, which is reflected in a couple of the startups selected to be part of the class.

In addition to introducing the new class, Rock Health said that Kaiser Permanente will join its roster of partners, which already includes the Mayo Clinic, GE, Genentech, Harvard Medical School, Nike and other health and investment companies.

In August, venture capital firm Kleiner Perkins Caufield & Byers announced that it was partnering with Rock Health to raise the amount of capital provided to member startups from $20,000 to $100,000.

Aside from the capital (and other perks like office space and tech and operational support), one of the big benefits of being a part of Rock Health – as well as other programs for health tech startups, such as New York-based Startup Health and Blueprint Health – is the network of industry professionals. Given the density and complexity of the healthcare system, health tech accelerators play an important role in helping startups find mentors, navigate the sector, identify markets and forge partnerships.

Here’s an overview of the 14 new startups to join Rock Health (language from Rock Health):

Beam Technologies
Beam Technologies focuses on the convergence of technology and oral health, and makes the Beam Brush, the first app-connected toothbrush for mapping brush behavior to achieve a better understanding of oral care’s impact on overall health.

BenefitsMe
BenefitsMe helps employers more strategically manage their HR benefits approach and helps employees appreciate their HR benefits again.

CliniCast
CliniCast enables providers to improve outcomes and reduce costs through predictive analytics. Its first product, ARTO, helps providers reduce unnecessary hospital admissions in patients with chronic disease.

Eligible
Eligible is an API that streamlines insurance eligibility checks for doctors and patients.

Kit Check
Kit Check helps hospital pharmacies process medication kits faster and without error.

LabDoor
LabDoor builds report cards for supplements and over the counter medications, grading them based on their safety, efficacy, and price.

Mango Health
Mango Health makes fun and elegant mobile applications to help consumers better manage and improve their health.

Moxe Health
Moxe Health is increasing access to medical care, first through triage.me, which combines community-wide routing schemes with individualized patient data to provide optimized recommendations.

OpenPlacement
OpenPlacement empowers people on all sides of the continuing care process with real-time information and tools to more efficiently and effectively match Seniors with Senior Housing and Care Providers.

SuperBetter
SuperBetter turns your health goals into an on-the-go game, with a current focus on helping players manage mental health challenges including depression and anxiety.

Wellframe
Wellframe combines mobile technology and artificial intelligence to extend the provision of care from the hospital to the home, empowering patients to optimize their recovery and helping providers thrive in an evolving payment landscape.

Wello
Wello aims to make the world a healthier place by making fitness more personal, accessible, and affordable through an online marketplace of fitness professionals who instruct over live, 2-way video.

Wildflower Health
Wildflower Health is making pregnancy healthier, safer and lower cost through personalized mobile apps.

Zipongo
Zipongo delivers prescriptions for healthy living through its GroceryRx platform which helps families save money on personalized healthy meals and earn rewards for buying nutritious food.

 

Monday, October 22, 2012

Digital Health and Expectations

A story about health care and it’s pitfalls.

Medical students and naivette seem to go together.  Attaining the somewhat envied position as a medical school acceptee most students are not well grounded in the tribulations and expectations that they will be serfs and servants to those one year ahead of them in the long ladder to licensure.  We gird  our loins at each step fully expecting things will lighten up as we approach doctor-hood.

We manage our lives, our finances, our spiritual life, however for emotional well-being we need to manage expectations.

 

A popular blogger and social media expert, Seth Godin, writes in his blog, Seth Godin’s Blog

“From the stock market to tech to what's under the Christmas tree, we let expectations determine whether or not something good has happened. Not whether it was useful or kind or productive or delightful, but whether it beat our fantasies.

There are two things you can do with this truth:

1. Spend a lot more effort managing expectations, and

2. Focus on the wonderful instead of the exceeded.”

Seth blogs, and pontificates in several basic lessons (books) for marketing. (For our times, I recommend ‘LYNCHPIN” You can download a Kindle version sample here Eventually most MD’s realize that on some level they are “salesmen”, either in convincing a patient they need a procedure or to gain more patients for their practice.   During our years of training this skill is largely not encouraged (for obvious reasons). We are to remain objective, and imperturbable.  MDs by and large do not endure self-aggrandizement well, we are reticent to describe how we are so wonderful, or the best, unless we hire or someone voluntarily want to magnify our image.

 

Health care is in a state of confusion, in some ways a contest between modernity and meidevilasm, the old way and the new way.  We are confounded with operating our medical organization, large or small in a bifurcated  paradim, on one side fee for service and the other with accountable care, unleashed from procedural billing.  The pressure increases to maintain financial viability, and at the same time maximize quality, decrease untoward outcomes as measured by arbitrary standards by outside forces, such as readmission rates to a hospital.

Cycle worse, cycle better

The downward spiral is all too familiar. A drinking problem leads to a job lost, which leads to more drinking. Poor customer service leads customers to choose other vendors, which of course leads to less investment in customer service, which continues the problem.

Your boss has a temper tantrum because he's stressed about his leadership abilities. The tantrum undermines his relationship with his peers, which of course makes him more stressed and he becomes more likely to have another tantrum. An employee is disheartened because of negative feedback from a boss, which leads to less effort, which of course leads

 

Most things that go wrong, go wrong slowly.

The answer isn't to look for the swift and certain solution to the long-term problem. The solution is to replace the down cycle with the up cycle.

This is incredibly difficult. But identifying the down cycle and investing in replacing it with the up cycle is the one and only best strategy. The alternative, which is to rationalize and defend the cycle as a law of nature or permanent habit, is tragic.  Much of this includes our attitude of where we are in health care.  Are we stuck in a cycle of renewal?

 

Digital Health and Expectations

A story about health care and it’s pitfalls.

Medical students and naivette seem to go together.  Attaining the somewhat envied position as a medical school acceptee most students are not well grounded in the tribulations and expectations that they will be serfs and servants to those one year ahead of them in the long ladder to licensure.  We gird  our loins at each step fully expecting things will lighten up as we approach doctor-hood.

We manage our lives, our finances, our spiritual life, however for emotional well-being we need to manage expectations.

 

A popular blogger and social media expert, Seth Godin, writes in his blog, Seth Godin’s Blog

“From the stock market to tech to what's under the Christmas tree, we let expectations determine whether or not something good has happened. Not whether it was useful or kind or productive or delightful, but whether it beat our fantasies.

There are two things you can do with this truth:

1. Spend a lot more effort managing expectations, and

2. Focus on the wonderful instead of the exceeded.”

Seth blogs, and pontificates in several basic lessons (books) for marketing. Eventually most MD’s realize that on some level they are “salesmen”, either in convincing a patient they need a procedure or to gain more patients for their practice.   During our years of training this skill is largely not encouraged (for obvious reasons). We are to remain objective, and imperturbable.  MDs by and large do not endure self-aggrandizement well, we are reticent to describe how we are so wonderful, or the best, unless we hire or someone voluntarily want to magnify our image.

 

Health care is in a state of confusion, in some ways a contest between modernity and meidevilasm, the old way and the new way.  We are confounded with operating our medical organization, large or small in a bifurcated  paradim, on one side fee for service and the other with accountable care, unleashed from procedural billing.  The pressure increases to maintain financial viability, and at the same time maximize quality, decrease untoward outcomes as measured by arbitrary standards by outside forces, such as readmission rates to a hospital.

Cycle worse, cycle better

The downward spiral is all too familiar. A drinking problem leads to a job lost, which leads to more drinking. Poor customer service leads customers to choose other vendors, which of course leads to less investment in customer service, which continues the problem.

Your boss has a temper tantrum because he's stressed about his leadership abilities. The tantrum undermines his relationship with his peers, which of course makes him more stressed and he becomes more likely to have another tantrum. An employee is disheartened because of negative feedback from a boss, which leads to less effort, which of course leads

 

Most things that go wrong, go wrong slowly.

The answer isn't to look for the swift and certain solution to the long-term problem. The solution is to replace the down cycle with the up cycle.

This is incredibly difficult. But identifying the down cycle and investing in replacing it with the up cycle is the one and only best strategy. The alternative, which is to rationalize and defend the cycle as a law of nature or permanent habit, is tragic.  Much of this includes our attitude of where we are in health care.  Are we stuck in a cycle of renewal?

Friday, October 19, 2012

About $7.7B in Meaningful Use Payments Doled Out, CMS Says

 

On Wednesday, CMS officials provided an update on the meaningful use program, saying that about $7.7 billion in incentive payments had been distributed as of last month, Government Health IT reports.

Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified EHR systems can qualify for Medicaid and Medicare incentive payments.

The officials offered the update during the Healthcare Information and Management Systems Society's Government Health IT Virtual Briefing.

For the Rest of the Story, Visit Digital Health Space

 

Monday, October 8, 2012

The End of The Beginning

 

You are in the right place, but the party has ended here.  According to the webmaster you should not be seeing this page.

Then please click here to go to Digital Health Space…..all will be fine.

Several Announcements

 

1. This week Health Train Express will be re-branded as Digital Health Space. It’s time for a change. Frankly I am burned out on trains, and relating health care issues to cars on a train. It is a bit dated, since most people have never been on a train, and most trains haul freight.  Today’s world operates much faster.  It also coincides with a deeper dyve into social media as a consultant and enabler for medical practices and hospital to also dyve into social media and m a  Digital Health Space now has a Facebook page and a Google Plus Page.

2. Once a week  “60 Minutes of Health” will be on Google Hangouts, time and day of the week TBA. Each week we will feature a different aspect of health care, information technology, and integrating social media into medical practice. We will have guests and discuss how social media is impacting business as well as medicine, politics and more.

3. Redirect to the blog ‘Digital Health Space'”

Photo

Happy Columbus Day !

 

Sunday, October 7, 2012

Health Radio Now

 

 

We have added a new feature on our blog, which updates daily.  Health Radio Now, and audio news dialogue, sponsored by Live365.  You will find the link on the right banner about 2/3rd of the way down.

Now for the news:

As reported on EMR Thoughts:

About:  Allscripts

The rumblings are starting to get more and more solid about Allscripts plans to discontinue MyWay. It seems they’ve started by informing their VARs and that’s where the word has gotten out most. Allscripts hasn’t quite said that they’ll be sunsetting MyWay, but the writing is on the wall.

That’s because MyWay is the descendant of Mysis which was bought by Allscripts as a ‘leader” for their Professional Allscripts.  The code is not Allscripts, the ;product bears no relationship to the professional version. Caveat Emptor.  They maxed out their purchase price.   Caveat Emptor

One person I talked to about this said that the fact that Allscripts discontinuing MyWay wasn’t much of a surprise considering what a terrible product it’s been. The term he used most often to describe the product was “buggy.” This wasn’t surprising to me since one of my most discussed posts was one on Evaluating Allscripts EMR which I wrote on my EMR & EHR website.

It seems that Allscripts plan is to discontinue MyWay and try and move those users to Allscripts Professional. The migration of the data seems like it will be free, but it doesn’t seem that Allscripts has yet indicated whether they’ll tack on an extra fee for the more expensive Allscripts Pro product.

I was told that Allscripts did say that they’d be incorporating the best features of MyWay into Allscripts Professional. The person I talked to about this laughed a bit since there were very few features in MyWay that users loved. He assumed that it HAD to be referencing the Full Note composer in MyWay which he said providers seemed to like for documenting the clinical side of things.

I’ve also heard a rumor that Allscripts might be looking for a way to do the Allscripts professional training through some sort of online means. Considering the complexity of Allscripts pro and the configuration and training required to make it functional and workable, this seems like a failed strategy to me. We’ll see how this plays out since I’m sure Allscripts is still defining this strategy.

Of course, the VARs that are supporting all the MyWay implementations will be scrambling with their own plan. I expect many of them won’t be happy with the idea of switching from MyWay to Allscripts professional and will consider other EHR. The obvious option is Aprima since they created the original MyWay and then forked the project to create their current Aprima EHR offering.

I’m told that Aprima has totally redone the PM side of their Aprima EHR which is a good thing since many weren’t satisfied with the PM in MyWay. It certainly makes a lot of sense for Allscripts MyWay VARs to consider Aprima since it will provide a similar user experience for their users and I have little doubt that Aprima will be able to port the data out of MyWay and into Aprima. My only question is if that’s the right move. Should you move to Aprima because it’s an easy transition or should a Var instead search to find the best EHR out there (which could be Aprima in the end anyway, I’ll leave that judgment to others)?

No doubt many of the other EHR vendors out there are going to look at this as a great opportunity for them as well. I’d be interested to learn more about Allscripts MyWay technology structure and how well the data can be ported to another EHR.

And may I also add:

It must be an interesting time at Allscripts with this happening along with talks of Allscripts considering a sell out to a Private Equity Buyer.

Is CEO Tullman preparing his “exit strategy/”

 

Friday, October 5, 2012

Social Media Camp sponsored by Mayo Clinic

 

Slideshare by Lee Aase

The Debate----Who won?

Last night’s presidential debate turned out to be a big surprise to the Democrats who have been behind Barak Obama since 2008’s Presidential campaign and the past almost four years.

It has been the first opportunity to see Barak Obama mano a mano with a Republican opponent. since he took office The first debate was largely about the economy, a subject that Mitt Romney knows well, and has a market place recovery plan based on solid economic theory.

Obama seemed to be on the defensive, basing his facts on the present recovery plan initiated by him during his term in office. He seemed to be on the defensive, as well as unskilled in debate tactics and appearance at the podium.  His advisors either did not prepare him well for a debate, or he decided to ignore their advice.

This is typical of Barak Obama and reflects his actions and lack of bipartisan communications. He seems to march on and inevitably will self-destruct.

Anticipation will run high about the debate on health reform. Given his performance last night, health reform is in danger as Obama and the Democrats passed the law without one Republican vote. In fact Romney took the occasion to announce that his first action the day after he is inaugurated would be to repeal PPACA and put a hold on further implementation while revisions are studied.

Governor Romney’s  bold statement even before the debate on health reform announces the aggressive campaign the Republicans will run against PPACA. Mitt Romney is certainly the expert on working out bipartisan support for health reform he accomplished in Massachusetts.

His performance gives great hope to the health care community for significant revision and/or repeal of PPACA as it stands.

What the debate crystallized is the opportunity to significantly alter the present course of health reform.  It may polarize the debates further, although it may created an opening for more discussions.  Romney in his comments on PPACA emphasized the negative effect on Medicare Beneficiaries from PPACA.

What physicians need  to do now is to advance the causes of patients, advocacy for them and providers to strengthen that patient-centric model being espoused by supporters of PPACA, without real meaning for the term.  PPACA is not about patients and providers. It is much more about insurers, more bureaucracy, poorly devised cost control methods, fines, penalties and negative incentives.

Causes for concern include the lack of primary care providers to support 25 million or more patients entering the system, the uncertainty of how the federal government and states will partner ( and even in some cases, states have already balked at cooperation with the federal government),  the rapid rollout of HIT in the form of EHRs that may be unproven and even inaccurate,  HIEs that are still in their infancy, Looming changes for the ICD 10 diagnostic codes, planning and implementation of Accountable Care Organizations (ACO).  In the real world whatever projected savings in health care will be eaten up by the sheer volume of technology and simultaneous projects, all inter-related.

Physicians are aware of the complexity of change and the laws of unintended consequences, health planners are optimistic that they can forecast unforseen changes, which has been disproven time after time. 

The debate will continue………..

 

Health Train Express Back on the Track ?

 

Here is a quick response from HIMSS (less than 24 hours after Congress asks for hold on HIT.

(from EMR and  Health IT News)

About HIMSS

Washington, DC)  HIMSS opposes the October 4th call from four House Republican leaders for the Department of Health and Human Services (HHS) to “immediately suspend the distribution of incentive payments until [the Department] promulgates universal interoperable standards.”  HIMSS emphasizes the significant progress that has been made towards the adoption of Electronic Health Records (EHRs) and exchange of health information since the Medicare and Medicaid EHR Incentive program began in 2011.

The House Republican leaders’ letter asks HHS to take additional steps to “advance  interoperability and meaningful use” of health information technology (IT).  HIMSS notes that the Stage 2 Final Rule, published by the Department on September 4, moves the Nation definitively towards interoperability.

These conflicting opinions are undoubtedly due to the ‘rush to EMR and HIE’ in a frenzy of spending frenzy to benefit the HIT industry.

Congress and HHS rolled out incentives for unproven and largely non-vetted systems.

There are 3 stages in the meaningful use criteria for eligibility for federal incentives. The requirements are supposed to be staged in regard to difficulty to attain with new HIT and EMR systems. Now there is some disagreement to the credibility of the Stage II criteria as Stage I has been completed.  The government incentive is dependent upon an  unrealistic schedule which imposes penalties for delayed installation of EHRs , which motivates providers to buy immature and inadequate EMR systems.

 

EMR Incentives Derailed?

 

Friday, October 05, 2012

Lawmakers Urge HHS To Halt Payments for EHR Incentive Program

ln a letter to HHS Secretary Kathleen Sebelius, House Ways and Means Committee Chair Dave Camp (R-Mich.) and GOP chairs of several House health subcommittees asked HHS to suspend incentive payments for Stage 2 of the meaningful use program,Modern Healthcare reports.

Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified electronic health record systems can qualify for Medicaid and Medicare incentive payments.

Letter Details

The letter charges that nearly $10 billion might have been wasted because the rules under Stage 2 of the meaningful use program -- created by CMS and the Office of the National Coordinator for Health Information Technology -- are "weaker" than the rules for Stage 1.

The letter specifically states that certain standards in Stage 2 are either "insufficient" or "woefully inadequate," including requirements that:

  • A summary transfer be provided in electronic format only 10% of the time;
  • Radiology and laboratory orders be electronic 30% of the time; and
  • Medication reconciliation and electronic prescribing take place 50% of the time.

According to CMS data, the EHR incentive program as of June 2012 has disbursed $7.1 billion. Meanwhile, ONC has received $2 billion through the federal stimulus package for health IT programs (Zigmond/Conn, Modern Healthcare, 10/4).

ONC Response

During a forum in Chicago on Thursday, National Coordinator for Health IT Farzad Mostashari defended the stage 2 rules and downplayed the lawmakers' request, noting that the period before a presidential election is known as "the silly season."

Mostashari noted that the requested changes would require congressional and presidential approval (Cadet, Cardiovascular

 

Monday, October 1, 2012

HealthCare Oktoberfest and Social Media Planning

 

Yes, it’s true the beginning of October in healthcare signals a highpoint for innovation conferences in San Francisco.

Either  by design or fortuitous coincidence there as several major health reform meetings in the next two weeks in the city by the bay, San Francisco.

About Health Innovation Week

Following the success of Health Innovation Week in 2010 and 2011, Health 2.0, LLC and Health Care Conference Administrators, LLC (HCCA) are delighted to announce our return. For 2012 Health Innovation Week in San Francisco. will be October 3-12. (Yes, we’ve turned it into a 10 day week!)

Core events of Health Innovation Week include the National Medical Home Summit and the 6th Annual HIPAA Summit West, followed by the HealthCampSFBay unconference (CANCELLED) and the 6th Annual Health 2.0 Conference. You can click on the graphics above to get more information about any one of the conferences. Finally the DC to VC event will harvest the best startups.

 

The HIT Startup Showcase Challenge include these functions

  • Care Transitions/Care Coordination
  • Big Data/Healthcare Analytics/Predictive Risk Modeling
  • Health Information Exchange/Interoperability & Integration
  • TeleHeath/Remote Diagnosis/MD Virtual Consult
  • Healthcare Transparency Solutions (Pricing, EBOs “made easy,” Risk Calculators)
  • Marketplaces for Healthcare Services (Insurance, Directories, Pre-paid Cards, Discounts)
  • New Models of Primary Care (Concierge Medicine, Patient Centered Home)
  • Social Networking for Providers (Shared Best Practices & Evidence, Professional Networking & Referral Management)
  • EHRs/Clinical Documentation
  • Consumer Wellness & Gaming or Social Networking for Patients
  • mHealth and mobile apps (with a large vision)