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You may notice a new SEARCH ENGINE WIDGET ON THE LEFT HAND SIDE OF THIS BLOG. THIS IS A HEALTH TRAIN EXPRESS ONLY SEARCH ENGINE.

 

Doctor 2.0

The recent Health 2.0 conference in June of 2010 had a diverse collection of participants.

The comments from these younger physicians emphasizes the true basic nature  of medicine, and the common thread of passion and enthusiasm of these internet ennervated physicians to use these tools to practice medicine.

Doctor 2.0 is a video dialogue with several physicians and how they have transitioned their practice(s) into the modern era.

Dr Jay  Parkinson

Dr. Enoch Choi

are well known enthusiasts for blending their medical expertise, caring manner with the tools of the time.

We need to look at adopting these ideas in all our practices, be leaders to move forward, and stop looking at all the negatives. My favorite saying has been "build it and they will come" (Field of Dreams).  

I like to say use it, and it will happen.  If we wait for our 'government ' to write rules and regulate, nothing will ever happen, and when it does it will self destruct.

Health 2.0 OnScreen  offered many interesting comments from physicians and non physicians.

The Next Generation of Doctors

 

 

The Next Generation of Doctors, is a topic which is timely for all of us who are past the age of 55, or so.  Whether we like it or not, we are on the 'way out'. Given the average age of 28-30 when we completed our training (if we did not stop along the way to breathe, or entered medicine as a second career, our days are numbered.

Like it or not I noticed when I reached age 55 I was definitely not the human being I was at age 25,35,or 45 years of age.  Despite the best of my intentions the last ten years and especially the last five  years gave me a clue that things had changed.

 

The development of information technology and EMR as one example sharply punctuates generations of  physicians. B.EMR, and A.EMR (before & after) clarifies the pre-internet and post internet era for me.

There would be no Health 2.0 were it not for the information highway and html. 

Looking at the introductory video from Health 2.0 conference in D.C. in June it will be obvious except to the dedicated luddite that 'we ' are on the way out....As an active practicing clinician I want to  help  prepare the next generation to do a much better job than we have done.  They are learning what has been done wrong.

The practice environment has changed drastically with dramatic increases in the elderly, and new expensive diagnostic and therapeutic choices.  We cannot use the old paradigm and business methods if we expect the system (and us) to survive.

In my next blogpost I will bring you another video from Health 1.0, It is named  Doctor 2.0

Bundle your cable TV, Internet and Phone Service with Health Information Exchange

 

 

VERIZON LAUNCHES NATIONWIDE HEALTH INFORMATION NETWORK

 

It ran through my mind about six years ago when this whole thing about RHIOs , EMR and Health Information Exchange began.

There were multiple attempts at forming business entities which were sustainable. Millions of dollars were spent setting up 'pilot programs'.  Attempts were made to reinvent the wheel.  There was more time and money expended setting up committees, seeking stakeholders and the like. Redundant non profit entities were required to access precious grant money to start some of these entities. Most failed miserably.

Even now in California there are multiple entities circling the wagons around each other.  (CAEC, eHealth, CALIPSO) I sit in on many of these meetings via webinars.  There are a lot of well meaning advocates , and 'techies' in these calls.

An intense feeding frenzy has developed around ARRA, HITECH and other governmental eponyms. Government has become a four or five-letter word.

Any fool should have been able to figure out reinventing a network was not necessary. We already had a great network, call it Verizon, Comcast, AT&T or whatever.  Plug in your EMR and off you go.  The key was and is software.  These networks are already technically capable of providing HIPAA security as needed.

The key is interoperability and that has been established by CCHIT certification. It's been around for four years. Of course now the federal government wants to usurp their developmental success and supplant it with an "equal opportunity" organization that is appproved by some governmental regulatory agency, like the NIST. 

The reward for all the hard work of EMR vendors, and voluntary industry people is cancelled out by the 'do-gooders' in D.C.

Negative reward is always the fallout from governmental -come- lately- to the table, initiatives.  They sap entrepenurial initiative, investment and commitment to success rather than 1000 page documents  written by the government. 

So what happens now to the 40 or more vendors who have CCHIT certification, and the thousands of medical practices already invested in these ' legacy systems"?  Undoubtedly they will be grandfathered in in order to satisfy medicare requirements for meaningful use to meet the governments (read medicare) requirements for incentive payments.  44,000 dollars is not a great incentive, nor adequate for someone to discard a system that perhaps cost 100,000 dollars last year or the year before.

Well, back to my comments on the 'original network(s) Verizon,Comcast, or Charter.

Verizon has publicized it's involvement with MedVirginia. It is co-labelling it's HIE product with several other EMR vendors..

MedVirginia and Verizon have already partnered using the NHIN to link with Social Security for processing Disability Claims and medical records

Actually when one thinks about their 'offering' HIE, and/or Regional networks become superfluous and redundant.

Any practice EMR can 'plug in their cord and 'dial up" anywhere Verizon or a like system is in place.

Keep it Simple, Stupid !!!!  K.I.S.S.

As for me I am buying  VZW .  I thought of this five years ago, where is my cut?

If Lawyers worked like Doctors

Dr. Wes in a column from October 2009 writes a 'parody' on attorney billing. If you read it, you will chuckle....

I have a few other 'regulations' for attorneys.

Pass the Affordable Plaintiff and Defendant Act.

Establish legal preferred practice patterns

Establish evidence based legal decision making

Establish quality review and payment guidelines for outcomes.

Establish "never events" which allow clients to refuse payments to their counsel.

Incentivize attorneys to utilize legal information technology with decision making algorithms.

Encourage further the development of 'managed judicial organizations (MJO) and/or accountable judicial organizations (AJO)

Establish a sustainable growth rate formula (SGR).   This would include a built in 5% a year decrease in reimbursements, subject to a six month hold while waiting for congress to delay the changes.

Establish and publish on the internet a directory of all attorneys and a rating by clients. Call it "Legalgrades" Post uncorroborated complaints from clients about the attorney or the firm.

Establish 100 not for profit foundations and/or study groups to make recomendations to improve efficacy and safety of legal judgments. 

Establish a National Lawyer Database (NLB) to report the win/loss statistics and any disciplinary actions (to be posted on the internet) and other untoward events.

Require a search of the database prior to any legal actions posted by any attorney.

Require attorneys to become credentialled annually at the BAR for individual courts, and charge them annually for this privelege.

Washington and the Parasitic Economy

Following in the distinguished footsteps of Microsoft and Google, Apple is the latest innovative company to be targeted by politicians and regulators for being too successful. Will it be sucked into Washington's "parasite economy"?  Has medicine become a part of the government's parasitic economy?

David Boaz of the CATO Institute explores the history of success in America.

For more than a decade, Microsoft went about its business, developing software, selling it to customers, and — happily, legally — making money. Then in 1995, after repeated assaults by the Justice Department's antitrust division, Microsoft broke down and started playing the Beltway game — defensively at first.

Washington politicians and journalists sneered at Microsoft's initial political innocence. A congressional aide said, "They don't want to play the D.C. game, that's clear, and they've gotten away with it so far. The problem is, in the long run they won't be able to."

And Microsoft got the message: If you want to produce something in America, you'd better play the game. Contribute to politicians' campaigns, hire their friends, go hat in hand to a congressional hearing, and apologize for your success.

A decade later, it was Google. After a humble start in a Stanford dorm room, Google delivered a cheap and indispensable product and became the biggest success story of the early 21st century.

Politicians, seeing an opportunity to extend their power and rake in some campaign cash, are circling like sharks. When both Apple and Google declined to attend a Senate show trial on Internet privacy, Sen. Jay Rockefeller (D., W.Va.) growled, "When people don't show up when we ask them to . . . all it does is increases our interest in what they're doing and why they didn't show up. It was a stupid mistake for them not to show up."

And that's what politicians and regulators are costing America: The brilliant minds of Silicon Valley and Redmond, Wash., are going to waste time and energy on protecting their companies instead of thinking up new products and new ways to deliver them to consumer

 

Does any of this sound familiar? For the past fifty years our patients enjoyed the best of healthcare and incredible advances in science and health. The miracles of antibiotics, vaccines and advanced cardiac treatments have  extended life to the point where degenerative diseases have replaced infectious disease as the major end of life events leading to death (in an extended manner)

This measure of success is discounted and totally ignored as the source of increased expenses for health care in America.

In the past physicians have largely ignored this parallel in general business and health finances. However the interest in pandering to political expediency peaked during the past debate on health reform.  Medicine showed up at the hearings and for several decades have attempted to 'lease' representatives interest with PACs and lobbying efforts.

Well, medicine is now wasting it's time and energy protecting itself and patients. Brilliant minds are also leaving patient care and clinical research to pursue other less stressful and more innovative methods to treat  patients. 

This sounds very familiar with Dave Boaz's analysis of the " Beltway Game."

It would be interesting to find out how you think about this analogy??

Bad Medicine

In a white paper written by The Cato Institute, Bad Medicine...A Guide to the  Real Costs.....elaborates on the true cost of the health reform act, and it's secondary consequences:

Simply having insurance is not enough to satisfy the mandate.

More than 2/3 of companies could be forced to change their insurance coverage

Some of the mandated changes may have unintended consequences.

As many as a million workers could lose their health insurance coverage they have now.

Tennessee's experience with TennCare gives a precautionary tale.

The phase-out of these benefits imposes a high marginal tax penalty

All together these changes produce an enormous increase in the welfare state

Plans offered through the exchanges must meet minimum federal standards

President Obama has been hostile to consumer directed healthplans

The fate of HSA's depends upon ruling by the Sec'y of HHS.

THE CATO INSTITUTE 

The Cato Institute was founded in 1977 by Edward H. Crane. It is a non-profit public policy research foundation headquartered in Washington, D.C. The Institute is named for Cato's Letters, a series of libertarian pamphlets that helped lay the philosophical foundation for the American Revolution.

In order to maintain its independence, the Cato Institute accepts no government funding. Cato receives approximately 75 percent of its funding from individuals, with lesser amounts coming from foundations, corporations, and the sale of publications. The Cato Institute is a nonprofit, tax-exempt educational foundation under Section 501(c) 3 of the Internal Revenue Code. Cato's 2007 revenues were over $24 million, and it has approximately 105 full-time employees, 75 adjunct scholars, and 23 fellows, plus interns.

Mission

The Cato Institute’s nationally and internationally recognized Centers and Projects tackle a wide range of topics, including health care, education, environment and energy, foreign policy, and international human rights. Scholars in these Centers and Projects vigorously apply America’s founding principles to key issues of the day, and are committed to countering the continued expansion of government beyond its constitutional constraints, and to confronting escalating attacks on individual rights.

Center for Constitutional Studies

Center for Educational Freedom

Center for Global Liberty and Prosperity

Center for Representative Government

Center for Trade Policy Studies

Downsizing the Federal Government

Project on Social Security Choice

del.icio.us Tags: cato institute,medicine,health reform,tenncare,President Obama,HSA,HHS

Health Train Express Resumes Publishing

Things seem to be working again. I spent the greater part of the past two days getting things back up and running.

After my blog platform disappeared from my menus and a number of dead desktop icons, several freezes, virus scans, and other disconnected events, and after removing several programs, re-installing several programs, which failed to load, defragmentations, etc I did a restore to several weeks ago and all is fine. It interrupted my writing schedule and diverted my attention, worrying all the while if it could be fixed, how much data I would lose, etc and  even the fear of having to replace it with  a new system.  '

 

Fortunately for me I had a disaster plan....I had an external drive with backup and also an online backup.  My onsite backup runs automatically twice a week, and my online backup is continuous as needed. Onsite backup has it's own dangers, and at times fails. An online insurance backup is not expensive, (about $ 100/annum)

It is a great sense of comfort, and I lost no data.

I bring this up because it really relates to developing total dependence on electronics.  Sooner or later it will go 'south'

If  you are in a significant size group  you probably already have expert IT support, if you are solo or a small group it can be a challenge to keep backups and disaster plans implemented and more important used on a regular schedule.  It might even be worthwhile to have disaster drills, just like fire drills.

An EMR disaster abruptly changes the focus of the practice for the manager and the doctor.

I have had it happen to me, despite  best intentions.  My staff was not performing regular backups, my vendor was unreliable, and often unavailable.  I learned a lot about computers, software as a matter of necessity. Besides losing income and losing time, it created havoc in my mind. Having a system in place is the first step, testing and using it is also vital. In todays' much harsher reimbursement environment a small blip can rapidly unravel into disaster financially.

Many of us are being diverted by all the talk about 'incentives' and meaningful use for EMR.   Another important issue is  whether your system works for 'your practice' and if it is designed to be reliable,have fail safes and totally reliable tech support from your vendor or a reliable local source.

Remember, the introduction of EMR and HIE will mean more complication...eventually.

However I think the horse (or is it cow) has left the barn.

Non Publishing Notice

Due to technical difficulties Health Train Express will not be publishing for the next 48 hours.  I know you will all be broken up about missing one of my rants.   Blame it on 'Windows'.

Re-distribute the Wealth

 

Don Berwick's commandered appointment to be head of CMS seems to have only caused a flicker of congressional shock.

Some of this may have been their own reticence to start the confirmation process, because Max Baucus had not yet scheuled the hearings.  Perhaps the Republican leadership should learn that political stalling and meandering only lead to surreptitious acts. The Republicans are not alone in this form of political extortion and deal making.

Berwicks' candid and open opinion that health care  reform should 'redistribute wealth, and that is one of it's primary missions".  (See The Video, below)

That statement  is one that neither I nor most doctors have ever heard from a highly appointed M.D.  I can accept that health reform should 'transform, and perhaps open access to those who are not yet covered. "   If this is a true 'redistribution of health care, or wealth, then someone else will get less access or treatment.

Redistribution of wealth or health care is a euphemism for 'rationing'.....'with your eyes open'. 

Essentially Don Berwick has become the 'lap-dog' for the socialist agenda of Barak Obama.  Dr. Berwick has been a respected member and head of many organizations that are held in high esteem by the government for advice.  [the Institute for Healthcare Improvement (IHI)^[1], a not-for-profit organization]He has been awarded many  titles, and is a professor of pediatrics.

Obama's actions in health care is juxtaposed to his bail our of financial markets and the automotive industry.  In those cases the wealth was 'redistributed' toward the already wealthy barons of finance and industry.

Never before has the head of CMS (who is basically supposed to be an administrator, and not a policy maker), a function which should be left to the congress acted in such a manner.

The combination of the Affordable Patient Care Act and it's mandates for the Head of HHS to do certain things and the appointment of Don Berwick to CMS  are a double pronged attack on the freedom of patients and physicians to make choices. Make no mistake about it we all have lost much.

 

Hopefully when and if confirmation hearings do occur when the Congress resumes they will oppose the nomination.  Hopefully public opinion and backlash from those in the trenches will keep this issue in the headlines.  I doubt it....the attention span of the media today is about 24 hours.

A sad day for the American Dream

Richard Reece MD in his Blog Medinnovation asks;

"How should physicians respond??"

Team NY TIMES

Finally, a Medicare/Medicaid Chief

Published: July 7, 2010

The New York Times  Op - Ed, today

 

"President Obama made a sensible move Wednesday when he bypassed the Senate and appointed Dr. Donald Berwick, an expert on reducing health care costs, to oversee Medicare and Medicaid. Republican senators had made it clear that they would use confirmation hearings to distort his record and rehash their arguments against the recently enacted health care reforms, mostly to score political points for the November elections.

By using his power to make recess appointments while the Senate is on vacation, Mr. Obama put Dr. Berwick in a position of vital importance in implementing the new reform law. His appointment will run until late 2011, giving him time to get things moving before he would have to be renominated. The Centers for Medicare and Medicaid Services, which Dr. Berwick will run, has been without a permanent administrator since 2006.

The obscure but influential agency runs two huge public insurance programs that will play central roles in health care reform. The new law requires Medicare for older Americans and the disabled to become more efficient and to serve as a testing ground for innovations to improve the quality and lower the cost of health care, the core of Dr. Berwick’s professional interests. Reform will also entail a big expansion of the state-federal Medicaid program for the poor, requiring strong guidance and leadership from Washington.

Dr. Berwick’s major credential for the job is that he leads the Institute for Healthcare Improvement, a consulting group that promotes measures to improve the quality and safety of health care while reducing its costs. He has been enormously successful at getting health care professionals and institutions to work together to reform their practices — exactly what the agency needs.

His appointment is backed by the American Medical Association, the American Hospital Association and scores of other health organizations and patient advocacy groups. He has been endorsed by three predecessors who held the same job in Republican administrations.

Even so, some Republican senators have portrayed Dr. Berwick as a proponent of socialized medicine because he has expressed great admiration for Britain’s National Health Service. They also call him an advocate of rationing care and even suggest he favors “death panels,” a politically potent falsehood.

Yet Dr. Berwick spoke an obvious truth when he declared that “the decision in not whether or not we will ration care — the decision is whether we will ration with our eyes open.” Care is already rationed by insurance company decisions about what services to cover and by high prices that make insurance and medical care unaffordable to millions of Americans.

Senators jealous of their prerogatives in confirming presidential nominations are grumbling about being bypassed. But there is no telling when or whether the Senate would have been ready to confirm Dr. Berwick. The job is too important to leave open any longer. "

For the record, a serious conversation about Berwick’s qualifications and plans would have been worthwhile. I’ve heard even people sympathetic to Berwick question whether his administrative experience is adequate. But, again, it’s hard to have a serious conversation when one of the two political parties refuses to be serious.

The Dems were well within their rights to use the recess appointment mechanism (as the Bushies did hundreds of times in their day), just as they were to use the reconciliation mechanism to pass the healthcare reform bill. Of course, the GOP is now completely free to paint the Berwick appointment as unacceptably anti-democratic. Who’s right? Who cares? The voters will ultimately decide.

Some or all of the above may be true, but why the rush to the appointment.  Some of those recommendations come from previous temporary heads of CMS. So, why didn't they keep their job?

The American  People deserve to hear the questions from their elected representatives, and answsers from Dr. Berwick, both about positive and negative attributes of this highly achieved and touted academician.

It has been shown the AMA represents only about 115,000 physicians out of over 800,000 physicians, most are students,  and academicians.

Senators are not 'jealous of their prerogatives" they have the sworn duty to represent their constituents.

As  usual the NY Times is highly biased in favor of liberal social agendas, rather than expressing any discontent with President Obama's wanton disregard of procedural matters.

GML

Your Health on the Ballot Box

So, how are you going to like your health care on the ballot?

Would you like a Republican diagnosis, A Democratic diagnosis, or perhaps the Libertarian or Independent opinion?  Worry not, no matter what the decision it will take months to implement, if it is funded, at all.

The situation in Massachussetts is dire.

Mitt Romney signs health-care reform into law as Ted Kennedy (third from right) looks on, April 2006.

U.S. President Barack Obama (C) is applauded after signing the Affordable Health Care for America Act during a ceremony with fellow Democrats in the East Room of the White House March 23, 2010 in Washington, DC.

 And in large measure Obamacare is on the same path.

Rago of the Wall Street Journal has this to say:

 

President Obama said earlier this year that the health-care bill that Congress passed three months ago is "essentially identical" to the Massachusetts universal coverage plan that then-Gov. Mitt Romney signed into law in 2006. No one but Mr. Romney disagrees.

The state's universal health-care prototype is growing more dysfunctional by the day, which is the inevitable result of a health system dominated by politics.

In the first good news in months, a state appeals board has reversed some of the price controls on the insurance industry that Gov. Deval Patrick imposed earlier this year. Late last month, the panel ruled that the action had no legal basis and ignored "economic realties."

Sure enough, the five major state insurers have so far collectively lost $116 million due to the rate cap. Three of them are now under administrative oversight because of concerns about their financial viability. Perhaps Mr. Patrick felt he could be so reckless because health-care demagoguery is the strategy for his fall re-election bid against a former insurance CEO.

The deeper problem is that price controls seem to be the only way the political class can salvage a program that was supposed to reduce spending and manifestly has not. Massachusetts now has the highest average premiums in the nation.

Liberals write off such consequences as unimportant under the revisionist history that the plan was never meant to reduce costs but only to cover the uninsured. Yet Mr. Romney wrote in these pages shortly after his plan became law that every resident "will soon have affordable health insurance and the costs of health care will be reduced."

One junior senator from Illinois agreed. In a February 2006 interview on NBC, Mr. Obama praised the "bold initiative" in Massachusetts, arguing that it would "reduce costs and expand coverage." A Romney spokesman said at the time that "It's gratifying that national figures from both sides of the aisle recognize the potential of this plan to transform our health-care system."

Perhaps Mr. Obama never took Economics 101 at Harvard. He has certainly never run a business.

What do you think?

del.icio.us Tags: deval patrick,obama,romney,health care bill discussion,health train express,insurance caps,affordable Care and Patient Protection Act

Wellness Wiki.....What is?

About five years ago I was asked to participate in the founding of the "Wellness Wiki".  This was during the dawn of the age of HIT.

Several luminaries participated in this early talk about wellness, and health care transformation.

Welcome to the Wellness Wiki! We offer this wiki to help clarify the complex problems plaguing the U.S. healthcare system and develop sustainable ways to improve the health and well-being of all people. This virtual encyclopedia of the healthcare crisis and potential remedies. We welcome your comments! To become a contributor, please contact Dr. Beller

The program of which I was privileged to have my name put on it (with little real contribution, other than an enthusiastic "go for it" from me) now is on wiki.wellspaces.com  and is available for purchase at the web site.

It is well worth the read, from two experts well ahead of the curve.