Health Train Obsession

 

 

I used to obsess about my clinical profession, Ophthalmology. My spouse now tells me I obsess about health care reform.  My part time activities in health information technology issues have inflated, like health care costs, into an almost full time endeavour.

The main differrence is that I was reimbursed, although poorly in later years (at least according to my assessments); now, in my present endeavour I am volunteer staff.

In order to be perceived as credible in these areas, everyday experience and more than thirty years of 'boots on the ground' seems to speak for little.  I, like many physicians seem to be outgunned by health care pundits, financial pundits, politicos,foundation pundits, and more.  Too bad none of them take night and/or weekend call, or have to pay my rent and malpractice premiums.  Not that they are not well meaning and some actually are acting in physician's best interest....throw in that non unimportant component of health care....patients. (whoops I meant consumers).  Please flog me for that error in my ways. (some of us cannot be 're-oriented', or should I say re-programmed). 

I don't understand at all why patients tolerate  being called "consumers" instead of patients.  This 'threat' or misnomer seems to have the medical establishment quaking in their boots....or at least this is the outward politically correct reaction to businesses, insurance companies and others....

Perhaps our patients  need to realize the insurance companies, pharma, and third party administrators  are the real consumers, consuming 20% of the healthcare dollar in the United States.

The value of an MBA, PhD, or title such as 'President, CEO, COO, Executive Director, Chancellor, Provost, Dean, Vice-President, Chief, Chairman, etc. etc seems to outweigh my paltry M.D., FAAO, and/or Board Certified Ophthalmologist.  That is why I never replaced all my wall paper (certification documents) when they were destroyed in 1995 in a flood in South Georgia. My reasoning was that all that "stuff" was in my head, not on my wall.

That is my rant for today.....Now that Michael Phelps is out of the pool....I will do my laps.

Another Paradigm Shift

Quote of the day:
Inspiration is wonderful when it happens, but the writer must develop an approach for the rest of the time... The wait is simply too long. - Leonard Bernstein

It seems to me we have had enough shifts, that we ought to have an automatic transmission in lieu of manual changes.

Richard  Reece, MD elaborates;

"Something profound is happening in buyers’ and the public’s attitudes towards primary care and the health system. With inexorable rises in costs and corresponding decreases in access to primary care doctors, buyers and the public are mad as hell, and they’re deciding they’re not going to take it anymore. Something is badly and sadly wrong, and corrective measures are being put in place."  in his

Medinnovation Blog.

What is driving this?

•    Major corporate buyers, led by IBM, which spends $1.7 billion on health care, have created an activist organization, The Patient-Centered Primary Care Collaborative.

•    A vibrant movement is underway to “disintermediate” health plans. “Disintermediation” occurs when access to information or services is given directly to consumers.

•    The “medical home” concept is gaining traction.

•    New business models to reduce cost and offer convenience are fast evolving. These include retail clinics, medical offices at the worksite, specialty clinics, urgent care clinics, elective surgical centers, and ambulatory facilities offering imaging, multiple specialty services, and one-stop care.

•    The physician empowerment movement is growing. The Physicians' Foundation for Health System Excellence,

Conclusion: A new primary care paradigm is upon us and will fundamentally change how the U.S. delivers care.

Post Olympic Hangover

Medicare To Launch PHR Pilot Program in Utah, Arizona

On Jan. 2, 2009, CMS will launch a new pilot that will provide Medicare beneficiaries in Utah and Arizona with personal health records, Government Health IT reports.
The pilot is part of a larger effort by CMS to encourage Medicare beneficiaries to use PHRs (Ferris, Government Health IT, 8/8).
The PHRs will be populated with two years' worth of Medicare claims data. In addition, patients will be able to add information to their PHRs and share them with health care providers.
In June 2007, CMS launched a PHR pilot project for some beneficiaries enrolled in private Medicare Advantage and Medicare Part D prescription drug plans. In April, the agency launched a similar program for traditional Medicare beneficiaries in South Carolina. CMS also has announced plans to move forward with an electronic health record pilot program in four geographic areas (Young, The Hill

 

CMS' request for proposal calls on the vendors to offer a variety of features and services, such as:

• Populating the PHR with prescriptions and lab results;
• Importing information from health care devices;
• Allowing users to view data in multiple ways; and
• Enabling users to order prescription refills

  On Sunday, Massachusetts Gov. Deval Patrick (D) signed into law a health care bill that provides $25 million to promote electronic health record adoption, the Boston Globe reports.
  The legislation, aimed at boosting health care safety and curbing rising health care costs, would establish an institute to award grants to physicians and hospitals looking to increase their use of health IT (Allen, Boston Globe, 8/11).
  In addition, the new law requires hospitals and community health centers to adopt computerized physician order-entry systems by 2013 and EHR systems by 2015, Modern Healthcare reports.
  Some of the law's other provisions include:

  • Establishing a medical-home demonstration project aimed at reducing costs through preventive, coordinated patient care;
  • Requiring hospitals to report health care-associated infections;
  • Mandating that pharmaceutical and medical device companies publicly disclose any physician payments or gifts of more than $50; and
  • Requiring the University of Massachusetts Medical School to expand its residency openings for students devoted to primary care medicine or working in underserved areas (Rhea, Modern Healthcare, 8/11).

Moving Toward the Internet

One of my favorite pieces is by Richard Reece, M.D.

from August 13,2008 on his Blog, Medinnovation

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

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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.