Counting Sheep

Quote of the day:

Procrastination isn't the problem, it's the solution. So procrastinate now, don't put it off. - Ellen DeGeneres

 

It's always a mistake for me to look at blogs just before bedtime. I usually come across articles and/or issues that defy normal logic and/or thought.

Just when you thought EMRs were the answer to everything I come across this:

Proposal To Move to ICD-10 Coding System Stalled

An effort to adopt new health care coding standards that some experts say might be more compatible with electronic medical records has stalled, according to an industry group advocating the changes, Healthcare IT News reports.
Some organizations - such as the American Health Information Management Association and the American Hospital Association - say switching from the current ICD-9 clinical coding system to the ICD-10 clinical coding system would provide more accurate data that would be better suited to EMRs. However, AHIMA Vice President Dan Rode said the government does not appear to be taking action to update the coding system. "Until the government gives us a green light, we're not going to have vendors implement it," he added.
The cost of switching to the ICD-10 system is a major concern, Healthcare IT News reports. BlueCross and BlueShield Association officials said they are worried that updating the codes would be too costly, especially as providers work to comply with HIPAA regulations and attempt to adopt EMRs (Broder, Healthcare IT News, 3/7).
A report released in fall 2003 by BCBS said switching to ICD-10 could cost the health care industry up to $14 billion over two to three years. A RAND study commissioned by National Committee on Vital and Health Statistics found that hospital implementation of ICD-10 could cost from $425 million to $1.5 billion, plus $5 million to $40 million annually in lost productivity. The same report, however, found the benefits of adoption could range from $700 million to $7.7 billion (iHealthBeat, 11/6/2003).
AHIMA says that EMRs would not yield much benefit unless the code is updated, and the AHA wants to switch to ICD-10 because it says ICD-9 is outdated and does not allow for accurate coding, Healthcare IT News reports (Healthcare IT News, 3/7).

Now mind you, that was  from March 2005.  Jump forward to 2008.

On Friday, HHS issued a proposed rule that would require health care providers to adopt ICD-10 code sets for electronic health transactions by October 2011, Government Health IT reports (Ferris, Government Health IT News, 8/16).
Health care providers currently use ICD-9 code sets, which were developed about 30 years ago and no longer can be expanded effectively to include codes for new diseases and procedures. ICD-9 can accommodate about 17,000 codes, while ICD-10 had space for more than 155,000 codes (Health Data Management, 8/15).
In a statement, HHS Secretary Mike Leavitt said that adopting ICD-10 code sets is a necessary step toward developing a Nationwide Health Information Infrastructure. He added, "The greatly expanded ICD-10 code sets will enable HHS to fully support quality reporting, pay for performance, biosurveillance and other critical activities."
Acting CMS Administrator Kerry Weems acknowledged that the conversion would entail some additional costs, but he added that delaying the conversion only would increase such costs. Weems pledged to "work collaboratively across the health care system to ensure a smooth transition" (Government Health IT, 8

Providers-Mortgage Your Home for your Patients

 

Budget impasse halts Medi-Cal payments

This article from the Ventura County Star is a shocking account of how irresponsible our California State Government is. Rather than prioritizing health care for disabled patients they will plan huge expenses for prison hospitals, pork barrel projects, and other non essential 'luxuries'...  Shame on Them....Shame on Us for allowing this.

Truth Out Describes the issues in New York and California

This group of patients is the most vulnerable, and requires the advocacy of every physician whether they accept medi-caid patients, or not.

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.