Phelps

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Olympic Week

 

I will not be posting during the next week or so.

The Olympic Games have my undivided attention.

At the end of the week I will be posting my observations and I leave you with this

Olympics Beijing 2008

Olympic Week

Health Train Express will be featuring live video links courtesy of nbcolympics.com

We emphasize excellence and performance in health care. Fitness, wellness and good health are the end point of what we strive for in clinical medicine.

Olympic Performance

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What A Wonderful World of Blogging

 

 

Health Train Express ,which began as a blog is transforming into a media hub for bloggers. Several years ago, blogging was considered a “hobby” for ‘geeks’ who were more interested in writing ‘code’ than the contents of their blogs. It still remains so for many ‘bloggers’. There are many blogs which have become “serious’ distributors of newsworthy events, much more than their original intent of ‘social networking’. White social networking remains a core component of of the efforts, new blogs have appeared from interesting sources. More blogs are written now by professional writers and health care policy analysts. Some information from symposia are published in ‘real time’, often quicker than conventional media sources. In some cases blogging appears to be another arm of marketing for corporations, health care entities, internet startups, and more.

The world of blogging is unique that a U.S. cabinet member has a blog (Mike Leavitt, head of the Department of Health and Human Services.) and Billy Joe in Georgia has a blog on growing peanuts, and pecans. Mr. Leavitt pontificates on CMS matters as well as his travelogue around the world to investigate health care in other countries as well as develop international standards for importing and exporting multinational food stuffs.

Each blog has multiple hyperlinks which can transport the reader to related references, other blogs in the same area of interest, and /or also to new subjects. This aspect of blogging will take the reader on expected journies or totally unexpected destinations.

The nut and bolts of blogging have become very user friendly and no special skills are necessary to blog

One measure of this is Microsoft’s entry into blogging with Windows Live Writer. This editing and publishing tool advances the nuts and bolts to one where even elementary school children can blog.

Most blogs have sections devoted to commentary, some moderated and some unmoderated.

So blogging has become one aspect of Health 2.0 or Web 2.0. There are other web resources such as Sermo, iMedexchange,

A quick search engine query reveals a plethora of health and medical related blogs.

Opinions of blogging range from of course acceptance, to should doctors be blogging. There is now a weekly update of medical blogs. By Forbes Magazine, The Wall Street Journal, and Medical Economics to mention a few.

Physicians, health care administrators, patients, health care policy experts, experience a common platform with instant transparency and instant access to medical information. The information becomes a learning experience for all concerned.

In many cases blogs have become an art form, an outlet for providers and administrators. Many are adorned with art, photography, cartoons, humor, videos and even music. Each blogger has their own style ranging from mundane text to carefully planned templates that are instantly recognized and form a trademark for their writings.

The total impact of health blogs is yet to be determined, but there are strong indication it will be a powerful influence not only in the delivery of health care, but also affect policy and health care reformation.

In reading through physician blogs it becomes apparent for all to see that opinions regarding the state of our system are uniform. Many physicians have previously been aware of the commonality of their opinions and the degree of burnout of all concerned. The blog is a format for revealing deeply held thoughts in a moderately impersonal manner without feeling the pain or shame of a negative opinon or a ttitude. Many times the author will express extreme depression, frustration, angst, and even rage at what has happened to their ability and training to care for patients. As this occurs a ‘wave’ of genuine agreement erupts into courage to take action. We saw this in July with the proposed medicare cutbacks. Comments from all areas, patients, physicians, administrators, patients and even a large group of seniors (AARP) decided that our present methods of controlling cost is ridiculous and counter-productive.

Many ‘ordinary’ people are attracted to health care issues, ranging from public health to exciting issues such as open hear t surgery, brain surgery, cancer treatment, as well as what their ‘doctor’ is really thinking. The transparency of blogs offers patients and all concerned entry into the doctor’s lounge and dining room to find out what is ‘really’ going on. There is nothing like being told you have a serious or fatal condition to pique interest and look for more answers.

International Health Train Express

Quote of the day:

There will always be a part, and always a very large part of every community, that have no care but for themselves, and whose care for themselves reaches little further than impatience of immediate pain, and eagerness for the nearest good. - Samuel Johnson

Who needs ICE (Immigration and Customs Enforcement? According to today's New York Times,  hospitals do not.

Many hospitals resort to this "cost-effective' means to hold expenses in check in regard to the care of undocumented immigrants.

" JOLOMCÚ, Guatemala — High in the hills of Guatemala, shut inside the one-room house where he spends day and night on a twin bed beneath a seriously outdated calendar, Luis Alberto Jiménez has no idea of the legal battle that swirls around him in the lowlands of Florida. "

Mr. Jiménez was deported — not by the federal government but by the hospital, Martin Memorial. After winning a state court order that would later be declared invalid, Martin Memorial leased an air ambulance for $30,000 and “forcibly returned him to his home country,” as one hospital administrator described it.

Unable to find a chronic care facility to care for him, the hospital solved it's "problem" by leasing an air ambulance to ship Mr Jiminez back to Guatemala...  A much less expensive option than the 1.5 million dollar charges that were accumulating.  Even with attendant legal battles, this was a 'bargan" for the hospital.

Martin Memorial Hospital is not a unique hospital to resort to this "ploy'.  Hospitals will do what our federal government either will not or cannot do. 

"A few hospitals and consulates offered statistics that provide snapshots of the phenomenon: some 96 immigrants a year repatriated by St. Joseph’s Hospital in Phoenix; 6 to 8 patients a year flown to their homelands from Broward General Medical Center in Fort Lauderdale, Fla.; 10 returned to Honduras from Chicago hospitals since early 2007; some 87 medical cases involving Mexican immigrants — and 265 involving people injured crossing the border — handled by the Mexican consulate in San Diego last year, most but not all of which ended in repatriation. " reports the New York Times.

It also serves as a potent reminder what the 'free market system' of entrepeneurial motivation can accomplish when our governments are frozen with inaction, and indecision.

Over all, there is enough traffic to sustain at least one repatriation company, founded six years ago to service this niche — MexCare, based in California but operating nationwide with a “network of 28 hospitals and treatment centers” in Latin America. It bills itself as “an alternative choice for the care of the unfunded Latin American nationals,” promising “significant saving to U.S. hospitals” seeking “to alleviate the financial burden of unpaid services.”

God bless "American know how".  It did not take a committee to accomplish this.

Your comments are welcome..

MORE ON P4P

Quote of the day:
The squeaking wheel doesn't always get the grease. Sometimes it gets replaced. - Vic Gold

Greg Scandlen (Consumers for Health Care Choices) extracted some facts from Health Affairs that bears some scrutiny.

Pay for Performance is a buzz word that has CMS and other payors  brainwashing and extorting providers with either incentives or negative rewards for implementing a largely unproven scheme.

Health Affairs elaborates:

Pay for Performance Doesn't Work

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Health Affairs has published an important new study on Pay For Performance (P4P) that concludes it has had virtually no impact on physician practice. That is not to say physician practice isn't improving with time, but P4P programs have little to do with it.

The study looks at 5,350 physicians in 154 physician groups in Massachusetts from 2001 through 2003. Overall about half of these physicians were in P4P programs established by five health plans that cover four million enrollees in that state. The plans reported information about physician compliance with thirteen measures of performance established by the National Committee for Quality Assurance known as HEDIS measures. It compared physicians who were "highly incentivized" by P4P bonuses to physicians who were not involved in P4P programs.

This e-mail program doesn't allow for complex tables, so it is hard to show the information graphically, but here are some highlights -

Breast Cancer Screening: "Highly Incentivized" Physicians (we'll call them HIP below) complied with HEDIS measures 82% of the time in 2001 and 82% in 2003, while the comparison group (call them non-HIP) complied 83% in 2001 and 84% in 2003.
Cervical Cancer Screening: HIP -- 84% in 2001, 86% in 2003; Non-HIP -- 84% in 2001, 86% in 2003.
Chlamydia Screening ages 16 - 20: HIP -- 31% in 2001, 41% in 2003; Non-HIP -- 30% in 2001, 39% in 2003.
Chlamydia Screening ages 21 - 26: HIP -- 31% in 2001, 36% in 2003; Non-HIP - 34% in 2001, 39% in 2003.
Diabetes Care, eye exams: HIP -- 51% in 2001, 54% in 2003; Non-HIP - 52% 9in 2001, 56% in 2003.
Diabetes Care, HbA1c tests: HIP - 81% in 2001, 85% in 2003; Non-HIP - 81% in 2001, 87% in 2003.
Diabetes Care, LDL-C screen: HIP - 79% in 2001, 88% in 2003; Non-HIP - 80% in 2001, 89% in 2003.
Well-Child, age 3 - 6: HIP - 81% in 2001, 86% in 2003; Non-HIP - 87% in 2001, 90% in 2003.
Well-Child, adolescents: HIP - 34% in 2001, 40% in 2003; Non-HIP - 57% in 2001, 62% in 2003.

Leaving aside the question about whether any of this measures anything meaningful - other than marking off boxes on a check list (notice there is nothing here about actually listening to your patient, or finding and treating anything that might be wrong, or persuading the patient to change behavior), what else does it show us?

Many athletes are paid for performance, and their are also amateurs who are not

 

It shows us that the much-vaunted pay-for-performance system is useless, not withstanding the fact that private payers, Medicare, and the presidential candidates all promise that such programs will save the health care system. In fact, on many measures the "non-incentivized" physicians improved more than those who were "highly incentivized." Golly, is it possible that physicians actually pay attention to the emerging literature and freely change their practices in the interests of good patient care? Oh, no, that can't be it.

SOURCE:
Health Affairs P4P Study.

An interesting take from a  consumer advocate, that is very pro-physician.

Special Edition XTRA XTRA!

While I  was gone, my feeds have updated. Lots of interesting news, and opinions.

Let's start with iHealthbeat

150 Billion dollars !! to implement Health IT, says Dr Robert Miller from UC San Francisco

Dr Miller quoted these figures at a recent meeting of The Institute of Medicine

Dr. Miller is a Professor of Economics at UCSF.

Government Health IT  elaborates further on the Feud that is breaking out regarding the ultimate costs of implementing Health IT.

Ladies and Gentlemen.....the ship is sinking, let's not fight over which side of the ship to jump off.

 

I am going back to my sleep number bed

Another Post with No Title

I need to find another title. One that is catchy and is tagged well so that the search engines rank me up there with The Health Care Blog. How does Matt do it? My ratings have never crashed,, largely because I have never soared into a  gleaming takeover possibility.  I was hoping to become  " a cult blog". Perhaps I need a better research department.  I secretly dream that readers are so enthralled with my writings, and meanderings that they are struck by 'shock and awe' and are dumbfounded into silence. Now and then I find snippets or complete ideas on other blogs several days or weeks after I post the same opinion. Are they reading my blog, and not admitting it?  Is there such a thing as mental telepathy?  I will have my legal department investigate.

Besides I have notice my reimbursement rate has declined much llike my fees for seeing patients. Perhaps a new business model is necessary, such  as:

Besides I started blogging to relax and freely associate with my writings.  Now I have to get up and first thing is read my  'prayer for the day' check the weather forecast to see if it will be 95 or 105 degrees, sunny or more sunny, and read the ozone levels, followed by reading all my relevant blogs.

I am up too early this A.M. The  blog feeds are not in, and this is getting to be too much like med school, and residency. It reminds me of morning rounds at 5:30 am walking around seeing sleeping patients (and nurses), cruising empty hallways.

I am going back to my sleep number bed, I may be back today again.

Quote of the day:
To achieve the impossible dream, try going to sleep. - Joan Klempner

A Post with No Title

Quote of the day:
I was born not knowing and have had only a little time to change that here and there. - Richard Feynman

 

Several comments and studies regarding the National Effort for Health Information Technology.  The Heartland Institute and the Center for Consumer Directed Health Care published an opinion piece regarding how government is failing and will establish a non working and instantly obsolete health IT network.

"Any system that is imposed today will be obsolete in five years," Greg Scandlen, director of the Heartland Institute's Consumers for Health Care Choices, said, adding, "Yet the federal government is woefully incapable of changing or eliminating outdated rules and regulations. So we will be stuck for all time with whatever they come up with today."

The Heartland Institute describes itself as a national not-for-profit research and education group that is unaffiliated with any political party, business or foundation (Monegain

  Many feel the government should perhaps set an interoperability standard, and then butt out.  They and I feel private companies would be better suited in our market to accomplish this task

It remains my opinion from the onset of the furor over EMRs, RHIOs that the best route is to go to those who already know more about networking than anyone else....the telecommunications industry.  The solution is to contract with these entities to set up this network..

Some things are better left to those who specialize in telecommunications.   There have only been a few health entities that have developed regional HIEs that are operating successfully.

Much of the work thus far has been local with "boots on the ground", with voluntary workers. 

They do this as a "love" effort for health care, knowing this is necessary.  At the end of the day there are few stakeholders.  Yes there are some isolated, disconnected  demonstration projects.

There are also false illusions about making this a patient centric network.  That sounds alluring, and does peak the public interest and involvement.

Let's distill that idea down to the idea of the public setting up and operating there own  ATM network.

Patients do need transparency, should be running the business of your office or your hospital?

If anyone believes the government can or will fund these 'mandates' then I have this bridge I will sell to you for $1.00.

 

We do need system changes, perhaps EMR and/or RHIOs will play a part.

Health Train Engines

Today's New York Times carries an article by Natasha Singer, "The Price of Beauty".  It points out how this has become the 'Engine for Success" in many dermatology, ophthalmology, and ENT practices. It however failed to point out that this is ocurring in non surgical practices such as family medicine, and yes, even OB/GYN.  Reader's comments range from understanding and commiseration to outright condemnation of these practices.

Cosmetic laser treatments, botox injections, collagen filling procedures, vein removal procedures, ophthalmologic procedures such as laser refractive surgery, premium multifocal intraocular lense cataract procedures offer the opportunity to stay afloat or drown in a sea of rising cost, and reductions in reimbursement.

For most physicians who practice without these cosmetic procedures, it is an easy step into this realm, at first noting that the economic pressure is reduced, then gradually it begins to take over the practice....It is not an admirable occurence, and those who do it cringe at what they have become.

There is no doubt that the 'engine for health care' should and must be caring for those who are ill.  When and if money is removed from the equation is a very doubtful prospect....communism tried it.....and failed.  Would socialized medicine, or universal payor solve the problem? 

Sights, Sounds and ......

Quote of the day:
That which has always been accepted by everyone, everywhere, is almost certain to be false. - Paul Valery

Today I discovered while editing my blog that my list of blog links over to the left sidebar was totally missing. 

I spent part of today re-posting it, and it looks a bit ragged, but I will clean it up later this week. 

You may note I have a new link on the left sidebar  http://www.healthpolcom.com/blog/

Mike Miller M.D. contacted me via Sermo.  After reading several of his posts I can recomend  him without hesitation for quick and pithy observations that are not verbose and to the point.

Mike, thank you for contacting me.

My brain is tired tonite. It's been a long week.  I have added some video and sound links to the site as well.  Let me know if you experience problems.

Toot-Toot on the Health Train Express

embargoed until  July 24,2008
Quote of the day:
My definition of an expert in any field is a person who knows enough about what's really going on to be scared. - P. J. Plauger

The horns are blowing at the health train express hurtles down the track, first leaning to the right, then the left travelling along tracks laid in 1960 or even further back than that.

Who is blowing the horns? Is it the government, health insurance plans, consumer advocacy groups, employers, or some hidden

Demonic Forces TRAILER - For more of the funniest videos, click here

demonic forces

 

Here are several relevant news articles in regard to health information technology.

iHealthbeat reports the following:

PHR Networks Better Model Than RHIOs To Exchange Health Data

Speakers at the Third Annual Leadership Summit on the Road to Interoperability in Boston on Tuesday said personal health record networks likely will provide a better model for health data exchange than regional health information organizations, Healthcare IT News reports.
R. Tim McNamar -- founder and CEO of e-certus, a software company, and former member of the Reagan administration -- said PHR platforms offer hope for the exchange of health data sooner than could be achieved through RHIOs. McNamar criticized President Bush for not pushing interoperability. He added, "There's no viable model for RHIOs."
David Kibbe, senior adviser to the American Academy of Family Physicians, said, "We can't expect government to build a network. Government didn't build the Internet. Government didn't build PCs."
Vince Kuraitis, a lawyer and principal of Better Health Technologies, predicted that companies would begin developing applications for PHR platforms such as Google Health, Microsoft's HealthVault and Dossia (Monegain, Healthcare IT News, 7/23

There actually are models for RHIOs, that will work. The technology is there, but the financing is not. I am not at all sure how consumers, or employers or whomever are going to build a PHR  that would work for providers, or hospitals.  PHRs as they now stand do not address the issue of P4P, management of chronic diseases and many other important issues. 

This is a little like asking the consumers to design their own ATM network for banking , or a computer inventory system for their local supermarket.

iHealthbeat goes on:

House Committee Passes Revised Health Care IT Legislation

Today, the House Energy and Commerce Committee approved health IT legislation (HR 6357) aimed at driving widespread adoption of electronic health records, Health IT Strategist Alert reports.
The legislation also is intended to strengthen federal patient security and privacy laws.
The bill would authorize more than $560 million in grants and loans for health care providers (Health IT Strategist Alert, 7/23).

Changes to Bill

On Tuesday, House Energy and Commerce Committee Chair John Dingell (D-Mich.) and ranking member Joe Barton (R-Texas) released a revised version of the bill.
According to CongressDaily, the lawmakers significantly changed the legislation's information-sharing and privacy provisions to address recent concerns from health care, high-tech and consumer advocacy stakeholders (Noyes, CongressDaily, 7/22).
Under the revised bill, patients would give their consent only once to health care companies that want to access health care records without identifying information for HHS-approved purposes, such as hospital audits or fraud and abuse allegations. The bill previously would have required patient consent each time the records were accessed.

Comments

Mary Grealy, president of the Healthcare Leadership Council -- who on Monday sent a letter to Dingell and Barton stating her concerns about the proposed bill's effect on the Confidentiality Coalition -- said, "They did make improvements in those provisions we had some concerns about, so I do feel like we're making progress." However, she added, "Do I think they have completely addressed all the issues? No" (Young, The Hill, 7/22).
A spokesperson for America's Health Insurance Plans said the provision that would allow patients to access their medical records and require them to provide consent for third-party access could restrict health care providers from developing wellness, disease management, quality assurance and other essential programs (CongressDaily, 7/22).
A spokesperson for Patient Privacy Rights said the revised bill is being reviewed and declined to comment (The Hill, 7/22).

It is apparent there are many hands in the cookie jar. Health data exchanges will undoubtedly be heterogeneous and probably never be fully integrated, nor should they be.