The Right Way to Do IT, and I don't Mean Information Technology

Howard County in Maryland is proposing a pilot demonstration project for uninsured patients.

Rather than planning a grandiose project that would fall short of their goals, they have set a limited program on a fairly small scale, working from the ground up.Central to the program is careful case management and 'health coaches'.  Enrollment in the program and continuing benefits is predicated on the requirement that patients enroll and continue in the coaching program. 

The program called  "Health Howard"  offers a window for other counties and states can reform their medicaid programs. It appears to be well thought out and organized. Cost containment is built into the program from the beginning with personal coaching and commitment to each patient.  The outcomes will be better measured by individual sucess of each patient rather than financial measures.

Ruling Health Care by Judicial Edict

The trouble with fighting for human freedom is that one spends most of one's time defending scoundrels. For it is against scoundrels that oppressive laws are first aimed, and oppression must be stopped at the beginning if it is to be stopped at all.

H. L. Mencken
US editor (1880 - 1956)

 

The cure for the common cold seems to be declaring bankruptcy.

SACRAMENTO -- The court-appointed overseer for healthcare in state prisons moved Wednesday to seize $8 billion from the California treasury, asking a federal judge to hold Gov. Arnold Schwarzenegger and California Controller John Chiang in contempt of court.

 

The receiver's court filing

With the state mired in fiscal crisis, J. Clark Kelso, the federal receiver, asked U.S. District Judge Thelton Henderson to force officials to turn over the money he says he needs to raise healthcare in the state's prisons to constitutional standards after years of neglect.

Judge Kelso is seeking a paltry eight (yes that is 8) billion dollars  (and 8 with 9 zeros after it) or 8 X 10 to the 9th to build new prison hospitals, hire competent professionals and in general improve the standards of care for incarcerated citizens, and undocumented "aliens". The State of California will be 'forced' to give prisoners better care than medicare or medi-cal recipients.

Judge Kelso has 'chutzpah'.  He might fit into the category of 'Being a Mentsch"

Think of it.  "Declare Medicare "Bankrupt" and 'seize the treasury'.

As California goes, "So goes the Nation"

Readers are encouraged to leave a comment....

Phelps

Exclusive Summer Olympics news & widgets at NBC Olympics.com!

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

Exclusive Summer Olympics news & widgets at NBC Olympics.com!

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?