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Thursday, January 24, 2013

For Obama care Anxiety: Record Number Want To Become Doctors


Believe it, or Not !

 Med School Applicants, Medical School Applicants, Med School Admissions, Admission to Medical School, Admission to Prestigious Medical Schools

For all of you disgruntled curmudgeon senior physicians telling your offspring not to go into medicine, listen up ! Get your facts straight ! And don’t listen to me, I was wrong !  What was I thinking?

According to Forbes Magazine;

“The number of students applying to medical school rose again this year with applications up 3.1 percent in what a new report described as “healthy gains” in interest in the medical profession.

The Association of American Medical Colleges, which represents the nation’s medical schools and teaching hospitals,said more than 45,000 students applied to attend medical school this year.Meanwhile, first-time applicants, which AAMC executives say is “considered to be a barometer of interest in medicine” set yet another record, increasing 3.4 percent to 33,772 applicants”



Five Obama care Winners In Second Presidential Term

With the re-election of President Obama, 30 million Americans without health insurance are certainly winners because they will in less than 14 months have access to medical coverage without the threat of a Romney White House pushing for repeal of the Affordable Care Act.

Those in the health industry providing the benefits and services will also be victorious as an unprecedented number of paying customers who have struggled to pay for everything from a hip replacement surgery to prescription drugs get support to buy medical care.

five key winners as the health law’s benefits bring new paying customers in the doors of clinics, hospitals, pharmacies and doctors offices across the country:

1. The health insurance industry. Health plans like Aetna (AET), WellPoint (WLP), Humana (HUM), and others that have acquired a bigger stake in providing benefits to Medicaid patients will certainly reap millions of new customers. About half of the 30 million uninsured will gain access to an expanded Medicaid program. Meanwhile, all commercial health insurance plans including UnitedHealth Group (UNH), Humana (HUM) and the nation’s Blue Cross and Blue Shield plans are already aggressively promoting their brands in the individual and small group market to prepare for broader sales of these policies on state-run exchanges that will begin operating in 2014.


2. The hospital industry.   Hospitals will have much less to worry about when it comes to the annual $40 billion tab for unpaid medical bills and charity known as uncompensated care. In particular, investor-owned hospital chains like HCA Holdings(HCA); Tenet Healthcare (THC) and Vanguard Health Systems (VHS) will also win political cover in Washington and in the communities in which they operate where their commitment to charity care has long been called into question.

3. The retail pharmacy chains. From Walgreen (WAG) and CVS/Caremark (CVS) to Wal-Mart (WMT), these chains have pushed beyond simply filling prescriptions into becoming, as Walgreen CEO Greg Wasson says, the home for all of a consumer’s “health and daily living needs.” Given the influx of patients with a pent up demand for health care services, retailers’ efforts to provide more flu shots and other vaccinations through clinics staffed by nurse practitioners will help serve an expected spike in demand for these services from the newly insured.

4. The generic drug industry. Though health insurance companies worry about their ability to control the cost of new customers, they are expected to aggressively push outpatient care and low-cost prescription drugs as a way to keep premiums low. That means generic drugs will have an even more promising spot on health plan preferred lists known as formularies. This will be a windfall for companies like Teva Pharmaceutical Industries (TEVA).

5. The health care workforce. From nurses and doctors to health roles some say have yet to be invented, more workers beyond physicians will be needed to meet future medical needs, particularly in the outpatient care area. Already, universities and their medical schools, nursing colleges and schools of public health and pharmacy are expanding departments or creating new programs to address future health care needs. All are expected to benefit from increased federal investments in education. Philanthropic organizations, too, are expected to compliment these efforts. Just last month, the Robert Wood Johnson Foundation, a long-time advocate for nursing and nurse education, announced its budget for 2013 that will include up to $425 million in grant-making focused on helping “people stay healthy; lowering national health care costs; and improving access to high-quality care, delivered by a diverse and abundant workforce.”   “Whatever issues are the most vexing—responding to AIDS, an unprecedented shortage of nurses, millions of children being uninsured, astounding racial inequalities in health care—these are the issues we’ve taken on,” said foundation president, Dr. Risa Lavizzo-Mourey.

In fact the greatest growth in patient care will be in the outpatient arena, where new professional designations will sprout as medical schools design new curriculum to educate and train health professionals.

Facing unprecedented change in how medical care will be delivered to more Americans, the American Medical Association said it will provide $10 million toward efforts to transform  medical education for tomorrow’s physicians.

American Medical Association president Dr. Jeremy Lazarus said the doctor group will provide $10 million toward efforts to transform graduate medical education for tomorrow’s physicians.

In order to help accomplish these goals;

The nation’s largest doctor group is providing the money over the next five years to fund “8 to 10 projects.

However, despite these hopeful items, there is still reticence in the eyes of the physician trainee workforce.

Despite improving pay and the critical role primary care physicians will play in the future of health care in the U.S., there remains less interest by doctors-in-training in general medicine than specialty disciplines.

The December 5 issue of the Journal of the American Medical Association showing a small percentage of medical residents plan to practice general internal medicine comes as a physician shortage looms and millions of uninsured Americans with a pent up demand for primary medical care are poised to flood doctors’ offices once they gain coverage 13 months from now under the Affordable Care Act signed into law two years ago by President Obama.

If nothing else the next five to ten years will prove interesting with challenges and accomplishments.

Wednesday, January 23, 2013

Rivalry in Federal Government threatens ACO Progress



With the newly announced 160  accountable care organizations this month, ACOs are bringing together rival hospitals. With those partnerships, however, also come fears of a healthcare monopoly.
The U.S. Department of Health & Human Services announced 106 new ACOs, bringing the total to more than 250 since the 2010 Affordable Care Act passed. Among them is OneCare Vermont Accountable Care Organization, the nation's first statewide accountable care organization, the Associated Press reported. CareOne, which covers Vermont and New Hampshire, said on Friday that 42,000 of Vermont's 118,000 Medicare beneficiaries will receive care from the new entity.
Read more: ACOs bring together rivals - Although encouraged by the ACA, ACOs are subject to review by federal anti-trust agencies that still worry collaboration teeters on anti-competiveness.

Read more: ACOs bring together rivals -  he Department of Justice and the Federal Trade Commission apply a "rule-of-reason" analysis to ACOs, in which the agencies conduct a cost-benefit analysis in weighing the anti-competitive effects of the ACO with the benefits of the ACO.

"ACOs could grow so large in some areas that they will have a monopoly on the healthcare system," Enterprise Counsel Group, a law firm in Irvine, Calif., wrote in a statement Thursday. "If any two companies work together to coordinate pricing or share confidential information, anti-trust concerns develop."
Read more: ACOs bring together rivals –Previously in June 2012 these concerns were stated

Anti-trust agencies target hospitals to promote competition

FTC challenged 17 of the 1,450 mergers reported in 2011

Read more: Anti-trust agencies target hospitals to promote competition -  All of these concerns were deftly ignored by legislators and HHS in their haste to pass health reform and micro-manage a mandate.

Depending upon which side of the argument you stand both sides argue they are there protecting the public, the FTC preventing monopolistic practices, leaving few if any other choices for patients, and ACO which is attempting to  improve quality of care and reduce cost. Are the two mutually exclusive?

The conundrum once again emphasizes the size and disparate interests of federal agencies.

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Obama’s On Fire


While watching the Inauguration and the surrounding festivities, I realized how much I was enjoying the quadrennial carnival and what has become known as the ‘peaceful transfer’ of power in the United States. And I am not a great fan of Barak Obama.


We have witnessed many un-peaceful transfers of power in the past decade or more. The fresh lessons this year in particular stand out against what has happened in a domino effect of Tunisia, Libya, Egypt, and what is now taking place in Syria. And despite our ‘non-peaceful intervention in Iraq to depose a despot and encourage democracy, stability is not insured.

Because of these recent events this inauguration is even more meaningful.  We have just completed a two year battle which has been highly partisan and reflecting the deep divisions in the United States over entitlement, health reform, economy, and indebtedness. The past 5 years have been difficult for the middle class and others, with a threat of becoming nationalized, with the GM buyout and the AIG bailout.

Certainly in most other countries this setting would instill resurrection and/or revolution.

Today in 2012 the world is not a tidy place.  In the UP.SO. we seem to have lost a moral compass, and long standing beliefs in the constitution in favor of expediency to empower a change in health care, size of government and other institutions.

Has the day of individual accomplishment gone by? It seems that way, but initiative and creativity are deeply embedded in human nature by the very real existence of our heterogeneous DNA.

It can be said that whether we were created, or evolved this basic foundation virtually guarantees the ability to overcome tyranny, despots, and inadequate and incompetent forms of government, unable to change or morph into better functioning entities.

In healthcare issues physicians who have always been relatively altruistic and idealistic, can still do so, however it has become more difficult. Medical schools who have previously benefitted from the annual fund raisers are finding donations more difficult to come by in these relatively lean years. This is a byproduct of health reform and will effect projects by schools of medicine.

Monday, January 14, 2013

Meaningful Use


HHS is progressing with it’s definitions of what meaningful use is in their opinion. It bears no relationship to how physicians use their EMR, but rather is a data base for HHS to extract data from an HER.

Thus far there has been no mention of how providers, hospitals and or patient will have access too this data.  (Give us our data !) says  ePatient Dave. It certainly would fit the parameters of “Patient-centric healthcare” as the new mantra in quality health care. Perhaps we need to have our patients lobby for that capability.

(David Harlow “The Society also responded to the Committee’s request for information on the use of patient-generated data, endorsing its use, and noting that: “The patient is the most highly qualified expert on his or her own health, and his or her own experience of the health care system.”


More on this later @glevin1 and +digital health space.

M.U. ver 1.0 and ver 2.0 have been released and appear to be stable. M.U. ver 3.0 .

The Society for Participatory Medicine #S4PM  filed comments on the draft Meaningful Use  Stage 3 objectives,

On another front,

patient Dave and Susannah Fox announce that the Pew Internet Research Center is releasing the results of their study, Health Online 2013 today, at 7 AM. I have not yet reviewed it., however here are the basic findings:

Interested providers (anyone who cares for patients would do well to review this report.  The important take-away is that 50% of consumers get information from the internet, and even more significant is how many use Smartphones to retrieve answers.  This will drive development of Smartphone applications for both the iOS and Android phones. all of this will augment your ability to care for patients, however it will require adjustments to the practice patterns for educational material.



Summary of Findings

One in three American adults have gone online to figure out a medical

Clinicians are a central resource for information or support during serious
health episodes — and the care and conversation take place mostly offline

Eight in 10 online health inquiries start at a search engine 

Half of health information searches are on behalf of someone else

The social life of health information is a low-key but steady presence in

Specific diseases and treatments continue to dominate people’s online

Internet access drives information access 

Since one in five U.S. adults do not go online, the percentage of online health information seekers is lower when calculated as a percentage of the total population: 59% of all adults in the U.S. say they looked online for health information within the past year in American life

Younger adults and minorities lead the way with mobile health information


Half of smartphone owners have used their phone to look up health

Some seek counsel from fellow patients and caregivers


Health care reviews have not caught on among general consumers


The report is quite detailed and goes beyond the extent of this article with a multitude of tables and survey details.


Sunday, January 13, 2013

Too Big to Fail ?


The following is a transcript taken from Google Plus "+Health Care Tallk Community

+Mark Browne +Kathi Browne +David Harlow +Mark Taber discussed the proposed ACO movement.     Perhaps I am  jaundiced as far as government inspired modifications to Medicare and organizational imperatives. In 1964 when Medicare began physicians almost unanimously opposed Medicare, not because it was government insurance or intrusion into the healthcare market, but because physicians knew an inflow of federal dollars would fuel increases in healthcare spending.  Physicians knew that modeling the payment system whereby 80% coverage of patient cost created an  ability to bill more and  fueled much of the medical device development.A little known feature of the original Medicare reimbursement was the payment rate was tied to the usual and customary charge of physicians;

New physicians originally set ther reimbursement rate by increasing their charges when they first began in practice.  Often times new physicians would receive higher Medicare payments as compared to established physicians. Physicians and hospitals in the private sector could now offer healthcare to seniors who prior to this had no coverage unless it was included in their pension plan. Uninsured seniors would depend upon the public hospital system.  In 1971 contracting became  legal with passage of the HMO law and prepaid contracting. It took about ten years and by 1981 PPOs and HMOs were epidemic.  Many HMOs went bankrupt and providers were left 'holding the bag'  In many cases local or regional managed care plans were formed with a withhold of 15% or more administered by small groups. This mechanism allowed capitalization of the small entities, using withholds meant to be paid back to providers, and instead used to line pockets when the smaller managed care entity was   bought by much larger entities. Providers were duped by a relatively few unscrupulous organizers who came away with windfall profits.

Other control mechanisms were put in place, such as prior authorization, and Medicare’ switched to allowable charges.

Regardless of these governing actions medical inflation became even worse, far outpacing the increase in GDP overall,

ACOs likely will go the same way as margins dip to near zero and perhaps into the negative numbers. Hospital boards and ACO management will follow the prevailing wisdom, when solvency is threatened. Sell, or merge. The next step within five years will be mergers and outright purchases  of ACOs

The trail leads to government intervention and bail outs of health entities, 'too big to fail".  Sound familiar? Where have we heard this before?

I hate being right about these inevitabilities. Truth is, getting larger does not mean more savings.

I have given in to my worst fears in the middle of the night..

Saturday, January 12, 2013

The Future of Mobile Health Apps.


What is ?

If you have not heard about the Wireless Gigabit Alliance, listen up. Perhaps you remember the fledgling days of wireless 802.11/a/b/n and soon their will be another iteration, so don’t get too cozy with your present wireless router and your Wi-Fi enabled gizmos.

This morning I happened to disconnect my laptop from my secured router, and had to re-connect.  As some of you know your wireless adapter finds all the wireless signals in  your vicinity so you can chose your own router. Most of the signals are secured by encryption to avoid ‘stealing’ your neighbor’s internet. I was amazed that my laptop recognized 30 other router signals ranging from 5 bars all the way down to 1 bar. And their were no unsecured routers. My times have changed. I used to be able to bootleg on at least two other routers if something happened to my own connection.

Perhaps you have noticed that your internet speed has decreased as there are more users of wireless in homes, apartments, and at meetings. In fact all connectivity can be lost if the spectrum becomes to saturated.

Each of the standards a/b/n uses different frequencies and may use two or more to spread their signal to improve speed, bandwidth and streaming video applications. The technology of MIMO (multiple input, multiple output and more than one antenna maximizes our current state of the art. However it is becoming unable to handle the increasing demand of multiple users, even in one household with multiple tablets, and streaming video to televisions and video conferences on Google plus, Live stream and many other consumer grade applications. Ever notice when the kids use the microwave oven, your laptop connection grinds to a halt.

If fast is good, then faster is better, if far away is good, farther away is even better and if you can have both, why not? As John F. Kennedy once proclaimed about going to the  moon “Some ask why? and I say Why not.”

It is hard to believe that was almost 40 years ago…Forty years from now it is hard to imagine what will be in mobile communications

A group of forward looking radio frequency engineers, WiGig Alliance was established by technology leaders within the CE, PC, semiconductor and handheld industries to address the need for faster, wireless connectivity between computing, communications and entertainment devices. The organization has developed a unified specification that allows devices to communicate at multi-gigabit speeds never before experienced with wireless technology. This white paper explains most of it. Wireless 802.11/ad will use RF in the 60 ghz range.


As you may observe it is more challenging to fit the uses of RF spectrum  into a single diagram.

Why is this important to Health Train Express? Whatever changes are taking place in health reform, business practices, technology advances, politics, entertainment are accelerated even more by social media.  The synergy of a post on Twitter, Facebook, Twitter and now Pinterest is obvious. Some say, what about the duplication of posts? Educators will tell you that you have to see or hear something three times in order to learn it. So like Real Estate…Location, location, location for social media the three key things are: Repetition, repetition, repetition

The space is an enormous influencer, for positive and negative opinions. If it is on the internet, blogosphere or social media land…it is in the public domain.


Friday, January 11, 2013

My Dream, or is it a Nightmare?


I’ve been doing my blog thing now since 2004, mainly because I like writing and the sound of my keyboard…clack clack, click click.

My spouse has threatened several times (actually a lot more) to get a new one, for some reason losing this keyboard would be like, well, I don’t know. I just know it soothes me. Here is the one I am thinking of getting. Readers please make further recommendations.  My marriage depends upon it.

On with my ‘sad’ story.  I blog because I love to do it. I have made some friends, but not so much from the blog, but knowing how to use twitter, facebook, pinterest, and Google + as inbound sources. Slowly I have built my following to 12,000 on Google, my twitter follower are mired down at about 900 (not exactly Paris Hilton, or Piers Morgan…..) a bit disheartening.

2013 is here and I have made a resolution.  Like you probably do, I read a number of blogs and networks that curate blogs.  My niche has always been health care or health information technology and health reform.

The actual numbers of people in this niche are miniscule compared to entertainment, artists, sports, general news, photographers, education, business and marketing.

I did not recognize where I had been failing until I read Derek Halpern and Social Triggers.

Sometimes I awaken in the middle of the night wondering how KevinPhoMD, Matt Holt, Dr Anonymous, Edwin LeapDr Wes, Life as a Healthcare CIOScienceRoll and many others who live on the highest peaks of social media with thousands of followers, circlers,and likers….. As  sleep eludes me  I see a kaleidoscope of icons hovering over me like a bad migraine headache.


I see my blogging as a mixture of seriousness, humor, and the ever present desire for humans to be recognized.

I am off to incorporating Derek Halpern’s recommendations to become a social media ‘king’.

Wednesday, January 9, 2013

HTE AND DTE Become the Levin Internet Media Group LIMG


On February 1, 2013 Health Train Express and Digital Health Space will become subsidiaries of "The Levin Internet Media Group. LIMG”

This change expands our already existing service to businesses beyond those involved in health care.  The health division will retain their original brand names.

We want to thank our readers for the engagement in our health care social media publications. Our emphasis has always been on content and our growth is totally organic.

Health Train Express and Digital Health Space will continue to publish as previously.

Festivities to follow. Watch for our Hangout Event on Air coming soon to a desktop, smartphone or tablet near you.

Tuesday, January 8, 2013


Many of my readers know that I have been a proponent os significant health reform, however remain critical of PPACA as passed into law. It is misguided to call this law “OBAMACARE”.  President Obama did not draft the legislation, had little to do with it’s writing and formation,  but signed it into law.  We can safely assign it’s passage to the Democratic Party, for not one Republican voted to pass this law. Despite Republican suggestions their advice was ignored and rejected. The media has vastly distorted the law, and it’s effects to the American Public. Other than academic physicians and the ‘flip flop’ American Medical Association, very very few clinical physicians in practice support it, whether they are in group practice or small solo practices.

If  you are an idealist, there is much to  say that this is a moral law, and creates social justice. However social justice at the expense of a significant minority tramples upon the minority rights to freedom of choice.  Those who still oppose PPACA deserve and have a right to be heard with some measure of respect.  They all too well know the danger of this law and many of these people are the same ones who are not insured at present.

On Saturday, the Oregonian reported that Oregon residents who buy their own health insurance "face major cost changes."

"The coverage cost shake-up for those purchasing their own coverage is just one of many major changes to the health care landscape rolling out this year courtesy of the Affordable Care Act," the newspaper said.

One of the major reasons I oppose it are the fact that is not ‘affordable’ and not protective.  Almost nothing in the law prevents insurance companies from raising their premiums and their costs to fall under the rule of 15% profit or 85% of their premiums going toward patient care.   So add to the equation the significant cost of audits of all health insurers.  It is almost as daunting as auditing the Department of Defense, or the audits of the General Accounting office of the U.S. Government.

The issue of the IRS monitoring the mandate and imposing penalties is groundbreaking having the IRS intrude into other areas of life, not withstanding the cowardly act of SCOTUS saying that is a tax to avoid ruling on the issue of constitutionality.  It is a surprising fact that Congress and the American people did not revolt at this decision. Shame on Scotus !

Tonight I saw an add on television promoting a new book “” or The Survival Guide to Obamacare, a hidden minefield of disingenuous choices.

Health Train Express hopes to find a ‘side track’ as ObamaCare passes in the express lane.  I prefer a slow and deliberate “local’ stopping at all stations to take on passengers.

P.S.   This is one train I would rather miss.

Monday, January 7, 2013

Openness and Transparency



Openness and transparency are not limited to medical records within the confines of health care (regulated by HIPAA for privacy), but is also occurring rapidly in academia and the logistics of publication of peer reviewed journals.

At one time articles were not published until they were presented at medical meetings, and symposia. This has changed radically.

Our sister blog, Digital Health Space also attempts to guide readers to close the space between providers, scientists, and patients. This mission statement is in the header for each post.

If one searches the medical articles a decade or more ago, you would find many findings reported in “Transactions…..of the Academy of ………. These articles would sometime take months or even a year to become public knowledge.

The process sequestered many findings from other professionals and even the general public  It tended to magnify ‘the secret society of academia” and specialists.

Change has taken place, and is explained further on PMC (PubMed Central).

Policy and Submission Process

A a result of NIH's Public Access policy, the final, peer reviewed author manuscripts of journal articles that are supported by NIH funding must be deposited into PMC via the NIH Manuscript Submission System (NIHMSS), as soon as the articles have been accepted for publication.

Specifically, the final manuscript supplied to PMC is the version that the journal has accepted for publication, including any revisions that the author has made during the peer review process.

The published version of the article usually includes additional changes made by the journal's editorial staff after acceptance of the author's final manuscript. These edits may be limited to matters of style and format or they could include more substantive changes made with the concurrence of the author.



Display of the Citation in PMC

The citation for the manuscript version of an article in PMC includes a reference to the published article. In addition, if the article includes a digital object identifier (DOI) or is from a journal that participates in NCBI's Link Out service, then the reference to the published article also provides a direct link to the full text of the article at the journal site.

For those physicians and scientists as well as patients this is a direct shortcut to knowledge….Patients do have a caveat that some of these articles are difficult to understand.  However most articles  have a summary/comment at the end which very nicely summarizes the gobbledygook .

Similar policies are also in place for papers supported by funding from agencies in the UK, Europe, and Canada. These manuscripts may be deposited through the Europe PMC submission system or the PMC Canada submission system.


Health Insurers Raise Some Rates by Double Digits


Health Train Express and the New York Times are reporting Health insurance companies across the country are seeking and winning double-digit increases in premiums for some customers, even though one of the biggest objectives of the Obama administration’s health care law was to stem the rapid rise in insurance costs for consumers.

Particularly vulnerable to the high rates are small businesses and people who do not have employer-provided insurance and must buy it on their own.

In California, Aetna is proposing rate increases of as much as 22 percent, Anthem Blue Cross 26 percent and Blue Shield of California 20 percent for some of those policy holders, according to the insurers’ filings with the state for 2013. These rate requests are all the more striking after a 39 percent rise sought by Anthem Blue Cross in 2010 helped give impetus to the law, known as the Affordable Care Act, which was passed the same year and will not be fully in effect until 2014.

In other states, like Florida and Ohio, insurers have been able to raise rates by at least 20 percent for some policy holders. The rate increases can amount to several hundred dollars a month.

The proposed increases compare with about 4 percent for families with employer-based policies.

This fact emphasizes how poorly PPACA performs in regard to "AFFORDABILITY”, a key feature in it’s name. The new law allows insurance premiums to have a huge difference in premiums between group and individual policies.  Individuals are excluded from  “leveling the playing field” and are paying an extra-ordinary price for health insurance, as has always been the case.

The review process not only reveals the sharp disparity in the rates themselves, it also demonstrates the striking difference between places like New York, one of the 37 states where legislatures have given regulators some authority to deny or roll back rates deemed excessive, and California, which is among the states that do not have that ability.

New York, for example, recently used its sweeping powers to hold rate increases for 2013 in the individual and small group markets to under 10 percent. California can review rate requests for technical errors but cannot deny rate increases.

The double-digit requests in some states are being made despite evidence that overall health care costs appear to have slowed in recent years, increasing in the single digits annually as many people put off treatment because of the weak economy.

The review process not only reveals the sharp disparity in the rates themselves, it also demonstrates the striking difference between places like New York, one of the 37 states where legislatures have given regulators some authority to deny or roll back rates deemed excessive, and California, which is among the states that do not have that ability.

Currently the public and patients have little knowledge of this glaring fact, and how misleading PPACA is in it’s current state.

We can lay this fact on congress who failed to read and/or understand the PPACA they passed for political expediency and gain by Democrats. Not one Republican voted for this law, a sure indicator something serious was wrong that goes beyond the partisan excuse.

Brace yourselves, the worst is yet to come.

At the same time while the law increased eligibility, premium rates will cause many to be unable afford insurance, and the difference may very well negate any gains from PPACA.

Where were the auditors, and the CBO, or anyone for that matter on this glaring and sad fact !

Friday, January 4, 2013

Apologies Necessary


Mea Culpa !


We recently did some analytics for Health Train Express and our sister blog, Digital Health Space.  We notice a sharp uptick in the number of duplicate cross posts on twitter, facebook and Google plus.  Yecch !  I know how much I hate that, as I am sure you do.  So we are doing a serious revision of our IT structure.  The past year we have experienced a gradual and encouraging growth in our readership. While not as explosive as Google, our budget is a bit more Spartan.   The blogs are curated by Health Works Collective (thank you Joan Justice ) and Networked Blog. We are experimenting on Pinterest having heard that the demographics there are uniquely “Women” and we want to embrace that community. In fact I see that the majority of bloggers are ladies who love socializing. Women have always been more verbal than men as shown by the fact they excel in language skills at an early age of development.  I know that I cannot out-talk my better half….she will consistently wear me down and ‘win’ the argument.

So five me a week or so before you “unfriend” me, unfollow me, and report me to Google for ‘abuse’, spam, or for being a ‘troll"’. I promise to behave.

Employment Incentives for Physicians



Physicians now share many of the ‘employment’ concerns as others. As more MDs become employees of health systems they forfeit their own self-initiative and freedom to change their personal course, hours, and ability to perform for their patient’s best interest without concern for their employer’s mindset.

It is often a difficult walk.

According to CEB’s Quarterly Global Labor Market research Most employees when surveyed about jobs are searching  for the top five things employees look for when seeking a new job are:

  1. Stability
  2. Compensation
  3. Respect
  4. Health Benefits
  5. Work-Life Balance


In today’s rapidly changing and evolving health organizations, the lone wolves and/or even small groups are at the mercy of larger health systems, and insurers who look for wide coverage availability.  The larger organizations may actually not be more efficient or better but they offer stability just on the basis of inertia.

Compensation has consistently risen in group practices

Respect. The day of the exceptional solo physician and/or specialist who is sought out is gone.  In a former time, individual exceptionalism drove solo practice or small group practice.  Today where searching for a physician personal recommendations have diminished except in a group practice where the primary care doctors have a closed system of specialists they must refer to in their group.  The quality is totally dependent upon the standards set by the group practice. Most solo physicians were and are respected because of their individualism and insistence on the physician-patient relationship.  The relationship is derived by patient choice of physician in a free market (which is rapidly disappearing). Patients still recognize the benefit of seeing a physician who is a ‘free agent’ to make decisions to refer to the “best” regardless of insurance restrictions and distance.  This becomes critical when diseases are severe, and not common, necessitating a search for providers who have experience with a disease or particular procedure in greater numbers.

Health Benefits:  Even physicians are unable to access or choose affordable care. This applies to their staff as well as themselves personally.. The quicksand of health plan reorganization, and uncertainty of PPACA, and ACOs and rising premiums will not change with health reform.  Health care may be somewhat more accessible especially to the previously uninsurable, but it will not be less expensive, and the currently insured will be paying more, as well as higher taxes, a hidden insurance premium cost.

Work-Life Balance:  Perhaps this is the major factor driving Physicians to becoming employed.  The relief of ‘running a business’  removes much stress from financial and legal liability. Having an institution with administrators increases cost, however it should professionalize the ‘C’ Suites and yield better business.  In a smaller private practice backup is less assured, dependent upon loose organization and often enforced by a department or emergency room coverage agreements. Today with many MDs avoiding hospital privilege the available consultants has diminished. Group practices have a built in enforceable duty schedule, and it is doable. “When people talk about work life balance they’re not saying they don’t want to work as much,” he says, maybe by way of calming the nerves of exasperated employers. “They’re simply saying they want flexibility in the time that they do work. The word flexibility needs to be recognized as not about how much to work but when that work is getting done.”

Physicians have rarely been under-employed, however there are great disparities in specialties due to severe shortages in mental health, pediatrics, and certain niche specialties. Shortages are often addressed by using allied health providers, nurse practitioners, or physician assistants.

In the past most physicians desired were self-employed. The Bureau of Labor and Statistics reported that  in the past 24 months the balance has shifted. A number of jobs in professional and related occupations have relatively high (above 10 percent) incorporated self-employment rates. For instance, the rate was very high for dentists, architects, physicians, and lawyers.  A recent survey by the Medical Group Management Association shows a nearly 75 percent increase in the number of active doctors employed by hospitals since 2000, and recent hospital announcements suggest this trend is accelerating.

With the changing paradigm of health care, the Massachusetts Medical Society conducted an email survey to Massachusetts physicians in order to learn more about the current practice environment in Massachusetts as it relates to employed physicians or physicians considering moving to an employed position.  

The email survey was sent to physician members and non-members in October 2012. Of those who responded to the survey, 60% were employed, 38% were self employed and 2% were self employed but considering an employed position.

(to be continued)