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Friday, November 30, 2012

It’s The Law of The Land, or is It?


For those who state “PACA is the law of the land, so get on with it”; they are sadly mistaken. While our goal is and should be a system that is universal, accessible and affordable to all...PPACA is on a course to certain death as the cancer of bureaucracy overwhelms our ability to pay for it, as will also gridlock our current system. We as physicians and healthcare providers simply can not nor should not sit by idly to let this poorly devised system be set in stone. (author: gml)

The battle begins:

Stuart Taylor, Jr. is an author, journalist and nonresident fellow at the Brookings Institution, and this work is attributed to him.

Analysis: Health Exchanges And The Litigation Landscape

The pending challenges to the law, and related regulations, range from the Goldwater Institute's claim that it gives the Independent Payment Advisory Board unconstitutionally broad powers over Medicare services and payments, to the more than 35 lawsuits by religious employers attacking a Department of Health and Human Services rule that requires them to provide their employees with insurance that covers women's contraceptives without a copayment.

The broadest and potentially most damaging of the legal challenges turns on whether Congress intended that tax credits and subsidies to help consumers buy health insurance be available only through state-created exchanges. Many states are signaling that they may not create their own exchanges, leaving the federal government to do so, as the law requires.

If subsidies and tax credits aren't available in states with federally run exchanges, conservative legal scholars say, then two other lynchpins of the law would also be undermined: the requirements that employers of a certain size offer insurance and that most individuals buy insurance.

Confident of their case, some health law opponents, including Jonathan Adler of Case Western Reserve Law School, Michael Cannon of the libertarian Cato Institute andNational Affairs editor Yuval Levin, are urging Republican-led governments to refuse to set up the online insurance purchasing exchanges, which would, as the argument goes, make their residents ineligible for the tax credits and subsidies. They say that this step also would gut the so-called employer mandate, which the law says will take effect in states where residents are eligible for such assistance.

The mandate requires employers with more than 50 full-time workers to offer health insurance policies for employees and their families that include a minimum set of benefits, or pay a tax of $2,000 per employee for failing to do so. The tax wouldn't apply to the first 30 workers.

Health law critics theorize that by refusing to set up exchanges, states could also carve a hole in the provision that requires individuals to either obtain insurance or pay a tax as a consequence of choosing not to, which the Supreme Court upheld in June. And if states could disable both the employer mandate and part of the individual mandate, they could wreak havoc with the law's overall operation.

Confident of their case, some health law opponents, including Jonathan Adler of Case Western Reserve Law School, Michael Cannon of the libertarian Cato Institute andNational Affairs editor Yuval Levin, are urging Republican-led governments to refuse to set up the online insurance purchasing exchanges, which would, as the argument goes, make their residents ineligible for the tax credits and subsidies. They say that this step also would gut the so-called employer mandate, which the law says will take effect in states where residents are eligible for such assistance.

The mandate requires employers with more than 50 full-time workers to offer health insurance policies for employees and their families that include a minimum set of benefits, or pay a tax of $2,000 per employee for failing to do so. The tax wouldn't apply to the first 30 workers.

Health law critics theorize that by refusing to set up exchanges, states could also carve a hole in the provision that requires individuals to either obtain insurance or pay a tax as a consequence of choosing not to, which the Supreme Court upheld in June. And if states could disable both the employer mandate and part of the individual mandate, they could wreak havoc with the law's overall operation.

Last year, the Internal Revenue Service issued an interpretive rule saying that federal exchanges also would have the power to distribute the tax credits and subsidies.

But Oklahoma Attorney General E. Scott Pruitt, a Republican whose state has refused to set up an insurance exchange, has urged a federal district court to invalidate the IRS rule and thereby nullify the employer mandate in Oklahoma.

With only 17 states having so far committed to creating their own health insurance exchanges -- in part because of concern that the administration has not provided clear guidance on how they should work -- more lawsuits could be on the way, brought by states, employers or both.

These arguments are detailed in a paper to be published in Health Matrix by Adler and Cannon. There are, of course, also forceful counterarguments.

All original KHN material – articles, graphics and videos – can be used for free, if you credit us and link to us. Learn more

Windows Live Tags: PPACA,cancer,bureaucracy,gridlock,physicians,providers,journalist,Brookings,Analysis,Health,Exchanges,Litigation,Goldwater,Institute,Payment,Advisory,Board,Medicare,payments,lawsuits,employers,Human,Services,employees,insurance,women,subsidies,consumers,government,scholars,size,individuals,opponents,Jonathan,Case,Western,Reserve,School,Michael,Cannon,Cato,National,Affairs,editor,Yuval,Levin,Republican,governments,argument,residents,employer,assistance,workers,policies,employee,critics,provision,Supreme,Court,Internal,Revenue,Service,Oklahoma,Attorney,General,district,administration,guidance,arguments,paper

Sun Tzu and the Art of EHR Adoption

Sun Tzu and the Art of EHR Adoption

Thursday, November 29, 2012

TEDMED Greatest Health Challenges


Social media for medicine is having a far greater effect than even many pundits predicted.

If you have an idea, post it to your network, and I find using all of them exponentially increases your influence…right or wrong. That requires credibility and reliable sources of information as well as a thick skin. I find there are always smarter (than I am) readers out there willing and able to challenge you. It also requires the proper attribution for the original source. I like to put it in quotes, and then I add my humble by proceeding it with [authors comments].  So far, no letters from attorneys and no inquiries from the Department of Homeland Security.

TEDMED is now producing Google Hangouts every Thursday morning at 11:00 AM on the Greatest Health Challenges.

Thus far there have been two events which I have embedded here:

The Role of The Patient

The Care Giver Crisis

As these proceed I hope to include these in my blog on Thursday.

You will find these videos on the YouTube Channel for Catherine Andrews When you subscribe to her channel, you will receive an email to remind you of each broadcast.


Windows Live Tags: Health,Challenges,Social,media,medicine,pundits,information,readers,attribution,authors,attorneys,Department,Homeland,Google,Hangouts,Thus,events,Role,Patient,Care,Giver,Crisis,YouTube,Channel,Catherine,Andrews

Saturday, November 24, 2012

BLACK FRIDAY and Health Care


What we need is a Health Care Black Friday !  Yes, fellow Friday shoppers here are the stats derived from a ‘big blue’ (IBM) for you Gen Xers) data dive. Why is IBM  watching mobile?

  • Online sales are up 20 percent for this same time period over Black Friday 2011.
  • The number of consumers using a mobile device to visit a retailer’s site is at 28 percent, up from 18.1 percent in 2011.
  • The number of consumers using their mobile device to make a purchase is 14.3 percent, up from 10.3 percent in 2011.
  • Shoppers using the iPad led to more retail purchases more often per visit than other mobile devices, with conversion rates reaching 4.2 percent, higher than all other mobile devices.
  • Shoppers referred from social networks like Facebook and Twitter generated 0.18 percent of all online sales on Black Friday.

So, you might be wondering how IBM gets all this i

In fact the internet humming (or is it buzz?) on Thursday, soon after that turkey/ham/prime rib) begins .

All Things Digital reported statistics from yesterday.

Last year, it was Cyber Monday — this year, it’s turned out to be Mobile Thursday. What’s next? Social Network Saturday? Self-Driving Car Sunday? (We still have Black Friday, by the way, which is today.)

And, indeed, the Mobile Thursday phrase got some big laps around the track, with numerous online shopping surveys — coming out faster than you can buy that new tablet — using it in their flash reports yesterday and today.

This year’s anecdotal meme: Apple iPads go well with pumpkin pie.

Black Friday is “SOCIAL” as evidenced by the following video.

The poignant focus of All Things Digital’s article,

“If you think about consumers, and you think about the amount of technology that they have at their hands, to reach out to read reviews and talk to friends and families, they’re incredibly empowered. There’s not one purchase decision that they make that is not impacted by some element of social networks. What does that do to the companies that have to deal with that by offering the best products and services, and you see companies are struggling to do that: To make the right offer at the right time with the right price. When they do it well, we all talk about how it went well; and when they do it badly, we talk about how annoying it was.” Is it this way with Health Care (YET) ?

Has this phenomenon spread to Health Care?

I would like to see IBM use their analytics on health consumer habits.

Here might be some of the things patients might search for after dinner.

1.  Bloated feeling in abdomen

2..Nausea when thinking about breakfast the next AM

3..Severe headache after drinking wine with dinner

4..Somnolence after dinner

5  Stimulants after dinner

6. Channel line-up for Football

7. Channel line-up for sports reporting

8. Google maps for directions to home

9. Google maps for directions to Best Buy, Target, Wal-Mart, Sears or nearest mall.

Sirius most frequent question, “Where are the best deals today?”

So Black Friday and Health care have much in common.  They are both social.

I have an idea for the next “Developers Challenge”

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Friday, November 23, 2012

Happy Thanksgiving….now for BLACK FRIDAY


Health Train Express and Digital Health Space wish you all a very pleasant holiday Season. 

While you are awaiting the festivities here is the offering, along with the pre-game snacks and drinks (and football)


Election Results ! It's over, or is it ?

Health Train Express (me) spent the past 36 hours watching reactions to President Obama's re-election with a clear majority of electoral college votes, and a narrow margin in the popular poll count.

Business interests remain very vocal about the delay in economic recovery with Obama's plan. Some corners attempt to remain optimistic about solidifying plans for growth, hiring, and analysis of the ACA for health reform. However, when the boots hit the ground emotion is overridden by the hard cold facts of mandatory health insurance (which is a good idea), and the merging of health insurance premiums with the  (ie, buy health insurance, pay a fine, or have your assets levied or seized) and a multiplicity of tax changes on January 1, 2013.

In healthcare there is one side that remains fervent about reform that will provide coverage to all citizens. In a country such as ours it is truly shameful this has not come about by now. Perhaps we have been involved in too many military actions. Ten or more years of military engagement using increasingly high tech weapons that minimize risk and casualties to our forces almost begs the question how and why do we expend as much on defense as on health care for our citizens.

Responsible participants examine ObamaCare and see a good beginning in it's framework, and a good chance of it being amended so that it truly is affordable to the country as a whole, while assuring adequate coverage for all.

The healthcare community remains divided, some of it on the basis of analysis of what it will cost providers, hospitals, with the addition of 'cost saving' health information technology. That claim has yet to be demonstrated. The transition from procedural billing codes to an as yet undefined paradigm other than the hospital DRG system or capitated prepaid payment plan is another major factor in health reform. Couple this unknown with the proposed accountable care organization whose payment system is a combined incentive/penalty system based on outcomes and reduced admission rates, remains largely un-defined. Also added to the task is conversion to a new expanded ICD 10 code system. Each of these tasks is in and of itself, an added burden.

While if and when this occurs health providers and hospitals will deal with a dual reimbursement system simultaneously for a time and perhaps indefinitely as business, insurers, and health insurance benefit exchanges face the task of which system and/or which ACO with which to do business.

There will be a significant number of outliers who will not participate in ACOs. In some regions which are rural there will be little competition and difficulty organizing an ACO with adequate coverage.

All of this places an unduly large task of responsibilities for timely conversion on the provider and hospital to meet yet another edict from HHS.

Here are some individual issues and opinions:

Its place assured alongside Medicare and Medicaid, President Barack Obama's health care law is now in a sprint to the finish line, with just 11 months to go before millions of uninsured people can start signing up for coverage.

But there are hurdles in the way.

Republican governors, opposed to what they deride as "Obamacare," will have to decide whether they somehow can join the team. And the administration could stumble under the sheer strain of carrying out the complex legislation, or get tripped up in budget talks with Congress.

"The clarity brought about by the election is critical," said Andrew Hyman of the nonpartisan Robert Wood Johnson Foundation. "We are still going to be struggling through the politics, and there are important policy hurdles and logistical challenges. But we are on a very positive trajectory." 

In the two years since passage of the Affordable Care Act, the Obama administration has been consumed with planning and playing political defense. Now it has to quickly turn to execution.

States must notify Washington a week from Friday whether they will be setting up new health insurance markets, called exchanges, in which millions of households as well as small businesses will shop for private coverage. The Health and Human Services Department will run the exchanges in states that aren't ready or willing.

Open enrollment for exchange plans is scheduled to start Oct. 1, 2013, and coverage will be effective Jan. 1, 2014.

In all, more than 30 million uninsured people are expected to gain coverage under the law. About half will get private insurance through the exchanges, with most receiving government help to pay premiums.

The rest, mainly low-income adults without children at home, will be covered through an expansion of Medicaid. While the federal government will pay virtually all the additional Medicaid costs, the Supreme Court gave states the leeway to opt out of the expansion. That gives states more leverage but also adds to the uncertainty over how the law will be carried out.

A steadying force within the administration is likely to be HHS Secretary Kathleen Sebelius. The former Kansas governor has said she wants to stay in her job until the law is fully enacted. "I can't imagine walking out the door in the middle of that," she told The Kansas City Star during the Democratic convention. Her office declined to comment Wednesday.

Republicans will be leading more than half the states, so governors are going to be her main counterparts.

Some, like Rick Perry of Texas and Rick Scott of Florida, have drawn a line against helping carry out Obama's law. In other states, voters have endorsed a hard stance. Missouri voters passed a ballot measure Tuesday that would prohibit establishment of a health insurance exchange unless the Legislature approves. State-level challenges to the federal law will continue to be filed in court.

But other GOP governors have been on the fence, awaiting the outcome of the election. All eyes will be on pragmatists like Chris Christie of New Jersey and Bob McDonnell of Virginia, whose states have done considerable planning of their own to set up exchanges.

Bloomberg Business Week goes into greater detail on the decisions states and the feds must make very soon.

Part and parcel for Health Care Reform and the Health Care Act is to help people understand the Act. Louis W. Sullivan, former Chief of HHS.

Although senior voters trusted both candidates with the future of the Medicare and Medicaid programs, and though the American people were deeply dividedregarding the Affordable Care Act, 45 percent of voters saying the law should be fully or partially repealed and 47 percent wanted it intact or expanded, in the end President Obama won the election and now faces the challenge of grappling with these issues over the next four years, especially health care.

Louis W. Sullivan clearly states he is strongly in support of the Health Care Act,

“Thus, I believe the principal imperative for President Obama is to focus on the law’s implementation since it is his landmark achievement, putting the United States on a path to universal coverage. Specifically, I believe the president should first give priority to communicating to the American people how the complex law works.Although the law was passed by the Congress more than two years ago, many Americans are still confused, trying to figure out what it means for them and their families. This unfortunate situation has its roots in the fact that President Obama and his team did not get the facts out sufficiently in 2010, before the opponents of the legislation were able to successfully spin the issues and confuse the public even more.”

So who will the act benefit?

Millions of Americans will be eligible for subsidized health insurance under the Affordable Care Act, starting in 2014.

Most of those people, however, have absolutely no idea that they’re qualified to sign up.

“More than three quarters of the uninsured who will be eligible for coverage, either in Medicaid or the exchange, are unaware of those new opportunities,” says Ron Pollack. He chairs the board of Enroll America, a nonprofit aimed at ensuring that Americans do get coverage.

Enroll America has been around for about a year now. It’s meant to be a temporary organization, solely devoted to ensuring that people know about the benefits coming online in 2014.

The CBO estimates that the health reform law will cover 30 million more Americans in 2022. But it also predicts that 30 million Americans will remain uninsured. Some will be illegal immigrants, who aren’t eligible for the reform law’s insurance subsidies. About 6 million are expected to live in states that do not participate in the Medicaid expansion.

That still leaves millions of Americans eligible for benefits but not enrolled. The CBO, for example, expects that nearly 6 million of those newly-eligible for Medicaid just won’t sign up for the program. They already have some reason to be skeptical: The health law’s High Risk Insurance Plans, meant to be a bridge to 2014 for those with preexisting conditions,have seen lackluster enrollment.

This leaves open a pretty wide playing field for a group like Enroll America. If it does its job really well, the number of Americans who go way past 30 million. If it doesn’t, the number who sign up could fail to meet CBO projections.

Now that the Affordable Care Act is here to stay, Enroll America is about to kick into high gear: They have a little over a year to educate millions of Americans about the new benefits that they’ll have access to, and how to get them.

Enroll America has contracted with two research firms to figure out how best to communicate with potential beneficiaries, what might be the best messages and who would be best to deliver them. The group recently wrapped up a national survey on questions like these, and is now sifting through the results.

They will start next week with focus groups in three cities aimed at answering these same kind of questions. “The focus groups will drill down on key demographic groups that can be disproportionately helped by the law,” Pollack says. 

In the coming months, they expect to start convening other nonprofits, as well as officials from Health and Human Services, to share research on best messaging strategies. 

Pollack also hopes that  with the Affordable Care Act’s fate secured, fundraising for his group might become a little easier, too.

And with that…………let’s get on with “BLACK FRIDAY”

NOTE: This post will not be duplicated at Digital Health Space

Monday, November 19, 2012

Tidal Wave Of Health Law Rules Expected In Days And Weeks Ahead


Kaiser Health News reports;

With the national health law’s political future now entrenched, a deluge of new rules is expected in the coming days and weeks as the Obama administration fleshes out the law’s complex components.

I expect my Twitter stream(s) to be flowing on many of these topics, as well as commentary on blogs, Facebook, the Wall Street Journal Health pages, and others.

States and insurance companies had put on hold the many changes necessary to comply with PPACA.  The outcome of the 2012 Presidential campaign was murky enough for Secretary of HHS, Kathleen Sibelius to delay state decision making in regard to their intent to participate in Health Insurance Exchange organization and participation using Federal funds.

The anticipation so far has been focused on rules that determine how the new state-based insurance marketplaces called exchanges will operate. But also closely awaited are decisions about how the government will tax medical devices, allot the shrinking pool of money for hospitals that treat the uninsured, and determine how birth control insurance coverage can be guaranteed for employees of religious schools, universities and charities.

Other key decisions will be determined outside the rulemaking process, as the Obama administration selects participants in several experimental programs, including a new payment method for doctors, hospitals and other providers.

Medical Device Excise Tax. Last February, the Internal Revenue Service proposed a rule on how to apply this 2.3 percent tax, which kicks in at the start of January. The major unresolved issues concern which devices will be included and how the tax is applied and collected.

Among the questions: Should the tax apply to devices commonly used by veterinarians if the device is also used in human medicine? What about items sold in retail settings but also used in medical procedures, like dental instruments and latex gloves? Does the tax apply to kits—two or more medical tools packaged and sold together—even if the manufacturer of each individual component had already collected the tax when it was sold to the kit maker?

Brendan Benner, a spokesman for the Medical Device Manufacturers Association in Washington, D.C., said companies are making marketing and sales decisions based on what they expect will happen, but that presents problems. "When you don’t know what the answer to the question is, it’s hard to make a decision," he said.

Hospital Payments. Between 2014 and 2019, the government will cut $36 billion out of the money that goes to hospitals that treat large numbers of poor patients. The cuts were included in the health law under the rationale that many currently uninsured patients would be covered either through the expansion of Medicaid or through subsidized insurance.

The administration has to figure out how it will allocate those cuts among hospitals—a task made more complicated by last summer’s Supreme Court ruling that allows states to opt out of expanding Medicaid

Insurance plans. For the administration, some of the trickiest decisions concern how insurance policies must be designed, priced and sold starting next October, when open enrollment begins for the new online marketplaces, called exchanges, that will offer plans to individuals and small businesses. For instance, the law allowed insurers to alter their prices for people based on their age, family size, where they live and tobacco use. The Department of Health and Human Services has to determine how insurers can go about setting those prices.

Political Cartoons

Bundled Payments The administration has already gotten off the ground two major changes to the way the government pays hospitals and doctors. One designates accountable care organizations that reward hospitals and doctors for working together to provide more efficient care. The other begins to pay hospitals on the quality of the care they provide through the value-based purchasing program. By January, the law calls for the government to launch another major initiative: bundled payments

Republican Govs' Decision To Forego Exchanges Will Bring In Federal Option, Others Still On Fence
HHS Delays Health Exchange Decision Deadline To Dec. 14
States Declare Their Health Exchange Intentions

This report can also be found at Digital Health Space


Web Health Awards


Follow the Web Health Awards on Twitter #whasf .

Today through Wednesday a series of important announcement occurs from Web Health Awards. 

The awards program is organized by the Health Information Resource Center[sm] (HIRC), an 19-year old clearinghouse for professionals who work in consumer health fields.

The Web Health Awards, and the new Web Health Awards | MOBILE are extensions of the HIRC’s 19-year old National Health Information Awards[sm], the largest program of its kind in the United States.

Web Health Awards | MOBILE

Because of the dynamic nature of digital health resources, the Web Health Awards competition is held twice each year: Winter/Spring and Summer/Fall.



Entry Classifications
Organizations submitting entries for the Web Health Awards and the new Web Health Awards | MOBILE must select an Audience (Consumers or Health Professionals) a Division (type of organization that produces the entry) and a Category (type of entry being submitted). Web Health Awards | MOBILE features a subset of entry categories focused specifically on mobile devices.

(Click here for a detailed list of entry classifications)

All winners in the Summer/Fall 2012 Web Health Awards receive international recognition on, a colorful award certificate, a listing of all winners, national publicity from the HIRC, and a one-year license to use the awards program logo for marketing and promotional purposes.

The National Health Information Awards 


Now in its 19th year, the National Health Information Awards program honors high-quality consumer health information. The awards program is organized by the Health Information Resource Center (HIRC), a national clearinghouse for consumer health professionals who work in consumer health education fields.

These awards reward developers of mobile health and other software application for healthcare monitoring, coaching, and tracking treatment plans.

Health Train Express and Digital Health Space share in congratulating and promoting the awardee’s innovative work.


Saturday, November 17, 2012

15 Healthcare Leaders Who have Something to Say


2012 has seen the rapid development of mobile health applications and more public awareness of home based preventive medicine, mobile coaching and data tracking using smartphones, and table PCs.

Then in November, after a long and contentious presidential campaign health reform  the PPACA became center stage, although it was replaced by the economic crisis, the Benghazi Embassy attack,  and finally the General Petraeus scandal. 

Public opinion remains deeply divided on how to initiate health reform. Some are exhausted by the battle which was lost by a very narrow margin in the closest Presidential campaign recorded in recent memory. Some now want to roll over and state PPACA is the ‘law of the land’, and ‘resistance is futile.

Significant professional and public reticence remains to initiate parts of PPACA, stemming from loss of local and regional controls, fiscal responsibility in  a time of crushing debt and the partisan manner in which the law passed.

Those who still feel strongly will plan to stop or delay it’ implementation attacking the law on the basis of state’s rights, constitutional issues, restriction of free trade, and ethical issues during the bill’s promotion by Health and Human Services.


some of the most memorable quotes from healthcare leaders during the past year. Check out our favorite quotes and the leaders who said them:

1. "It's not hotel amenities. It's not china plates for meals. While those things are very nice, a true patient/family-centered care model is really at the core of the heart of care."
Who said it: Michele Lloyd, vice president for Children's Services at NYU Langone Medical Center,



2. "In a Muggle world--the world we live in--the provider can't go into the room of paper charts and flourish their wand and say, 'All the patients with diabetes!' and the charts fly out and hover in the air. 'All those who didn't come back to see me, over here!' Send in an owl."
Who said it: Health IT coordinator Farzad Mostashari, M.D., discussing the problems with using paper records at CHIME's Fall CIO forum last month.

3. "People might think you're crazy by giving out all those contact numbers. When I first did it, the staff thought it was a bad idea. They said, 'You'll never have time to do anything else besides answer the phone.'"
Who said it: Windsor Regional Hospital CEO and President David Musyi, a FierceHealthcare advisory board member, who has taken an unconventional approach to patient and staff communication, freely giving out his email, office number, home number and cell number to the public.”

Openness and transparency often simulate better communications with less time involvement. Many studies have shown that opening access leads to a paradoxical decrease in demand upon time, quicker resolution of challenges and increased efficiency. Organizational restructuring can lead to reduced costs and less bureaucracy.

Wednesday, November 14, 2012

Using the F-word when it comes to EHRs


As EHRs gain ground I suspected that all would not be as HHS had hoped. HHS fueld the fire incentivizing and penalizing providers according to the time period in which they adopted EHRs.

I suspected that standardized and automated coding that would operate by totalling the procedures and diagnostic evaluation and management codes that were previously neglected or forgotten by providers engaged in a patient visit.


Richard Patterson MD seconds my motion in his post on KevinMD (blog). His post is in response to the HHS suspecting there is a lot of “F” going on in billing and coding. Not so says Dr Patterson, and I agree. Most providers already know this as they have seen their income increase due to proper coding and billing as compared to pre electronic paper and pencil coding.

Previously providers would use a 'superbill' and manually check off diagnoses and CPT codes for billing. Charges were frequently missed. Thanks to HHS edicts they are now getting what they asked for and what they deserve. Their activites never save money. That would be a 'never event' Ironically they invested about 45,000 per MD to 'incentivize EHR and are now paying the price of more efficient billing. It is hard for this writer to avoid sarcasm, and it does not take a multi-million dollar study to analyze what has happened.

Now the doctor, without sacrificing time-efficiency, can incorporate fully informative entries into the chart that will satisfy the criteria by which the coders are bound, and the result will be a universal billing form that more accurately describes what was wrong with the patient and what the institution and doctor did for him or her.

Of course HHS assumes that 'F” is involved...Dr Patterson goes into some length in unravelling this supposed gordion knot which my 8th grader could figure out. This is what happens when bureaucrats who have no clinical or patient experience make rules, set edicts and in general go where they don't belong. This is what happens when an ex-governor with no prior medical involvement is appointed Head of HHS.

My mantra is 'keep the politicos out of my health care.' Most Americans will espouse that, however are willing to let them write the checks for their health bills.

Patterson aptly sums it up:

The Secretary and AG allege that providers are “cloning” EHRs, somehow documenting services that were not actually provided. If so, that deserves the “f-word” and all the legal consequences that go with it. I think any such behavior represents a vanishingly small fraction of the increase in charges they have observed, though. I think they are seeing the consequences of ARRA EHR mandate, and I believe they will see more and more as EHRs become more widely utilized.

This is a completely predictable outcome. One of the attributes touted for EHRs is the standardization and completeness of the medical record, creating one that can be shared by multiple users and be meaningful for all.

I am confident that HHS/Medicare and the insurance companies will find ways to neutralize the resulting increases in charges.

Stand by for another SGR fiasco.

Monday, November 12, 2012

How Consumers Engage OnLine


There are an abundance of developers working on mobile health apps and the search for venture capital, kickstarter funding and medstartr funding is in full swing.

One great question is will consumers (patients) pay for this, and just how is mobile health engaging patients and providers?

Social Media in Art

Regina Holladay is a unique person and contributor to health care social media. Her love transcends the paints on her canvas. I cannot help but to put her work in my blogs at least twice a year. I hope it will bring to mind the human spirit in all of us, no matter our travails and challenges of daily life.


Sunday, November 11, 2012

Your Employees are Depressed. Why Employers and You Should Care



Cut to the chase and the Bottom Line:

If you are an employer, or an employee here are undisputable facts that have been and are contributing to rising health care costs and absenteeism. 

Depression in The Workplace

“An underlying premise of the Affordable Care Act provisions that encourage employers to adopt health promotion programs is an association between workers’ modifiable health risks and increased health care costs. Employers, consultants, and vendors have cited risk-cost estimates developed in the 1990s and wondered whether they still hold true. Examining ten of these common health risk factors in a working population, we found that similar relationships between such risks and total medical costs documented in a widely cited study published in 1998 still hold. Based on our sample of 92,486 employees at seven organizations over an average of three years, $82,072,456, or 22.4 percent, of the $366,373,301 spent annually by the seven employers and their employees in the study was attributed to the ten risk factors studied. This amount was similar to almost a quarter of spending linked to risk factors (24.9 percent) in the 1998 study. High risk for depression remained most strongly associated with increased per capita annual medical spending (48 percent, or $2,184, higher). High blood glucose, high blood pressure, and obesity were strongly related to increased health care costs (31.8 percent, 31.6 percent, and 27.4 percent higher, respectively), as were tobacco use, physical inactivity, and high stress. These findings indicate ongoing opportunities for well-designed and properly targeted employer-sponsored health promotion programs to produce substantial savings.

These are all good assumptions, now let’s put some of this into action (a Physicians story about himself)

Fit4Life Radio

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Saturday, November 10, 2012

Socialism Kills ?!


John C. Goodman, PhD, is president and CEO of the National Center for Policy Analysis. He is also the Kellye Wright Fellow in health care. His Health Policy Blog is considered among the top conservative health care blogs where health care problems are discussed by top health policy experts from all sides of the political spectrum.

Don’t take my word for it.  John Goodman argues with Paul Krugman regarding this issue. Krugman tells us that thousands will die if PPACA is refuted. Krugman bases his opinion on Mitt Romney wanting to let people die. I don’t think Romney ever said anything like that.

The economic profession also disputes Krugman’s theory. But there is something that does cause people to die: socialism. More precisely, the suppression of free markets (the kinds of interventions Krugman routinely apologizes for) lowers life expectancy and does so substantially.

Economists associated with the Fraser Institute and the Cato Institute have found a way to measure “economic freedom” and they have investigated what difference it makes in141 countries around the world. This work has been in progress for several decades now and the evidence is stark. Economies that rely on private property, free markets and free trade, and avoid high taxes, regulation and inflation, grow more rapidly than those with less economic freedom. Higher growth leads to higher incomes. Among the nations in the top fifth of the economic freedom index in 2011, average income was almost 7 times as great as for those countries in the bottom 20 percent (per capita gross domestic product of $31,501versus $4,545).

What difference does this make for health? Virtually, every study of the subject finds that wealthier is healthier. People with higher incomes live longer. The Fraser/Cato economists arrive at the same conclusion. Comparing the bottom fifth to the top fifth, more economic freedom adds about 20 years to life expectancy and lowers infant mortality to just over one-tenth of its level in the least free countries.

None of these facts really matter because a pre-conceived idea of ‘free health care"’ or universal coverage will negate underlying experiences throughout the world.


Friday, November 9, 2012

Post Election Edition of Digital Health Space


Riverside, California

November 11, 2012

A service of Digital Health Space for Providers

The re-election of Barak Obama was a cliff-hanger, and makes the implementation of the PPACA a likely scenario. It is possible there will be necessary amendments to the law. Many medical organizations are intent on this goal, including medical associations, hospital associations, provider organizations as well as many insurance companies.

At the time when this bill was passed into law it was not a bi-partisan agreement, leaving out advice and recommendations from almost half of the country's representatives.

The American Medical Association did a flip-flop at the last minute endorsing PPACA, however it may not have been a true representation of providers.

Digital Health Space curates information from many sources and publishes important opinions and observations from


California Health Care Foundation

American Enterprise Institute

Institute for Health Care Improvement

Institute of Medicine

Wall Street Journal (Health)

American Hospital Association

U.S. Dept of Health & Human Services

Centers for Medicare & Medicaid Services

T.E.D. And T.E.D.M.E.D.

Association of Medical Colleges


HEALTH RSS feeds/US Government

ADP RSS Services

Inside Health Policy

Health Access

as well as others:

This week's important events:

This week's top news is the re-election of President Obama.


Obama's Win Seen As ACA Win, But Path Unclear As Deficit Talks Loom

Progressives In Open Letter Demand WH Stick to Guns on Medicare, Medicaid

Stark's Loss Removes Key House Dem For Fiscal Talks, ACA Implementation

National Accountable Care Organization Congress

Hospital mass layoffs for 2012 expected to match 2011’s numbers

Last Distraction Removed from California Health Reform

CMS releases 2013 Medicare physician fee schedule as big cuts loom


A service of

Sunday, November 4, 2012

Self Tracking

Susannah Fox remembers Tom Ferguson, MD who coined the term “participatory medicine”. Dr Ferguson passed away in 2006 but not before “ePatient” became adopted by bloggers and those involved in health care social media. The “e” relates to “engagement” rather than 'electronic'.

Think, for a moment, about the puzzle pieces of your own life. Think about the pieces you know well and the ones whose edges are blurry or indistinct. 

Now think about how a clinician might view your life’s puzzle. How can you help them to see how the pieces fit together? Which pieces do you want to keep private and even hide from view, because they are too personal or scary or embarrassing to reveal? What self-knowledge do you wish you had and do you want to share it with anyone other than yourself?

These are the sorts of questions that the Pew Internet Project and California HealthCare Foundation considered as we went into the field with our latest health survey. I’ll give you a sneak preview of the results related to engagement, because I think our field is moving too fast for me to wait for publication.

We found that 60% of American adults track their weight, diet, or exercise routine. One-third of American adults track health indicators or symptoms, like blood pressure, blood sugar, headaches, or sleep patterns. One-third of caregivers – people caring for a loved one, usually an adult family member – say they track a health indicator for their loved one.

Putting that all together, 7 in 10 American adults are self-trackers.

But guess what? Half of them are tracking “in their heads.” These are my people. I’m calling this group the “skinny jeans trackers.”

In addition:

  • One-third of self-trackers use a notebook or journal.

  • One-fifth of self-trackers use an app, a device, a spreadsheet, or a website.

  • Half track on a regular basis

  • The other half track when something changes, when something comes up and triggers the need to track.

Given the rise of smartphones and online tools, should we expect to see the percentage of self-trackers

go up? Should it be our goal to see 100% participation in self-tracking among people living with chronic conditions? What about among caregivers? And the general public?

Mobile health apps provide a great opportunity for self-trackers. Many will purchase these devices and software with curiosity and the current popular culture of healthcare technology. The big question is whether this will be a permanent integrated habit.

Which brings us to the topic of sharing in general.

What's the future for self-tracking?

Adult Gadget Ownership over Time

Download data here

I was surprised to learn how many people track data already. Much of it is manual or kept in 'heads'. Will HIT and mHealth automate this project without conscious interaction at some point. Will minute tattooed sensors replace blood pressure cuffs, and glucometers, or pulse oximeters. Surely we are only at the beginning of mHealth.

Friday, November 2, 2012




WATSON, What is the correct answer ? Your patient is in 'JEOPARDY'


Cleveland Clinic is the latest health care organization to work with IBM Corp. to enhance the capabilities of the Watson supercomputer. The clinic is seeking ways that Watson can support medical training.
Watson has accumulated knowledge of the medical field through its work with other health care organizations. Medical students at Cleveland Clinic will work with the supercomputer to further define its “Deep Question Answering” technology for medical purposes.
Medical students will use Watson to try to resolve challenging cases in hypothetical clinical simulations. Students will learn how to navigate content from Watson, consider hypotheses and find evidence to support answers, diagnoses and treatment options. The students also will be grading Watson’s performance to improve its language and domain analysis capabilities. “The collaboration will also focus on leveraging Watson to process an electronic medical record based on a deep semantic understanding of the content within an EMR,” according to IBM.
The expectation is that students will learn how to focus on critical thinking skills and leveraging information tools, while Watson will get smarter at medical language and assembling chains of evidence from available content.
Other organizations working with IBM to commercialize Watson capabilities include:
* Memorial Sloan-Kettering Cancer Center, to develop an oncology decision support system taking advantage of its own molecular and genomic databases, and its repository of cancer cases histories;
* Nuance Communications, Columbia University Medical Center and the University of Maryland School of Medicine, to embed Nuance’s natural language processing technology to enable a computer to read and understand text and abstract data; and
* Insurer WellPoint Inc. and Cedars-Sinai Medical Center in Los Angeles, to use data from patient medical histories, recent test results, recent treatment protocols and new research findings to help physicians identify best treatment choices.
More information on Watson is available here.