I'm sorry the system is too busy to take your call

Quote of the day:

Whenever you have an efficient government you have a dictatorship. - Harry S Truman

 

Beginning Oct. 1, Comcast will put a 250 gigabyte-a-month cap on residential users. The limit will not affect most users, at least not in the short-term, but is certain to create tension as some technologies gain traction.  Whether or not this might extend to commercial usage, such as Health 2.0, or Web 2.0 is not addressed in this announcement from Comcast. Certainly as technological advances proceed it is difficult to predict when 'excessive use' becomes the average utilization. The  use of PAC systems, streaming video, mobile phone solutions, remote at home monitoring, and connectivity among health care sectors is growing exponentially.

In other news,  the FAA suffered a catastrophic breakdown of it's Atlanta operations center last week, causing delays in air traffic routing for several hours.  The FAA's system is outdated and obsolete, despite a decade old effort to upgrade it. The FAA has two centers, one in Atlanta, and another in Salt Lake City. This allows for some redundancy, however, neither center is capable of providing full support without overload. The two videos which follow indicate the seriousness of this problem.

Personnel problems

 

Technical Issues

 

Why is this important to healthcare?  It places in serious doubt whether the federal government is capable  of designing, installing, or maintaining a nationwide system, something Health IT interests, providers, payors, hospitals and safety net providers  should pay close attention.  Governmental process grinds along, inexorably slow, and incapable of keeping up with technological advances that health care depends upon. The governmental role might be to encourage adoption of national standards.

Comments are welcome, and welcome to all our new readers and subscribers. The response has been  awesome!!

The Temple of Obama

Quote of the day:

The world is governed more by appearances than realities, so that it is fully as necessary to seem to know something as to know it. - Daniel Webster

I couldn't ask for a better quote of the day after last night's Graeco-Roman festival.  Where were the gladiators?

 

I have been away from the blog for several days, longer than I realized.  My focus has been on the DNC and RNC conventions.

I did not hear much in the way of real programs, just left vs right, man vs. woman, black vs. white, free market vs socialism, more taxes vs. less taxes, more spending vs. less spending and what it used to be like in the 1950s  which gave me kind of a warm fuzzy

Obama is not just a great orator, but a mass hypnotist. His voice carries with it a kind of "fragrance" that overpowers your ear, and resonates somewhere in the limbic system.  Whatever it is about his voice and resonance we should study it carefully and bottle it, to be re-broadcast at some time in the future when all is about to be lost. I am concerned that somewhere in all that oratory he left us with a post-hypnotic suggestion, which will be unleashed at some unknown time in the future. (perhaps at the polling places in November). So wear your earplugs and eye blinders when you go to the polls.

I had to get that off my chest.  Tomorrow I will be rational again.

Health Train Express is Overheating

Quote of the day:
A Hospital is no place to be sick. - Samuel Goldwyn

Medical bloggers have become recognized by some as "trouble-makers" by the powers that be.....a sure sign of increasing and recognizable influence on health care and it's reform.

My friend Dimitriy Kruglyak also known as "Hippocrates"

on the blog, Trusted.MD writes about his views on medical blogging.

Dimitrity, by the way is not a  physician. While most bloggers and others do not realize it Mr Kruglyak who has received little recognition for his "ground breaking" blog was about four years

ahead of the curve in terms of blogging and aggregated blog commentary.   He also should be credited with developing and producing the first Health 2.0 national symposium.The appearance of the blog may seem funky to all you bloggers, however Mr. Kruglyak was so far ahead of his time that he had to develop his own software to blog.

Trusted.MD  founding contributors have been Rob Lambert,Musings of a Distractible Mind Steve Beller,Quality Advocate)  Sid Schwab (Surgeon's blog), Joseph Kim,  Joseph Kim, MD, MPH. K.Cohn Healthcare Collaboration Blog, yours truly, and others.

Dimitriy makes some very interesting observations, and also how ludricous our medical societies have become and how far out of touch they are with members and non-members.

Dimitriy's unrecognized contribution was  seminal and awesome in regard to medical blogging. (I am certain when he reads this, he will be uncomfortable, shuffle a bit, and blush.). He was prescient in regards to blogs, and perhaps their ultimate contribution to health reform.

The reasons I bring all of this to the forefront is to connect his observations and very accurate predictions about proposed "regulation, and censorship of bloggers opinions". in regard to ethics and conduct.

Elder Train Express

Quote of the day:
It is our responsibilities, not ourselves, that we should take seriously. - Peter Ustinov

Karen Stevenson Brown is an accomplished student and advocate for the elderly.  I thought I knew a great deal about the concerns and care of the elderly when I stumbled upon her web site and blogs....boy was I surprised.

  Karen (she is not the lassie in the cartoon) was stamped out of good old midwestern soil.... the kind of soil where you knew your neighbors well, and in a time where family's cared for their parents and close relatives. The family was more than 'nuclear', it included the electrons, and all participated in sharing and supporting the family unit. Children were expected to contribute,

not only with chores, but for financial needs that in many cases parents could not meet.

Her historical notes outline how we got from there to here, and why our medical financial support system gradually spiralled out of control.

Anyone interested in how our modern day social welfare system(s) evolved and disintegrated needs to thoroughly review her website.

Some of the material is dated, but presents a source for current updates.

History of Long Term Care

• 1776-1799
• 1800-1899
• 1900-1929
• 1930-1939
• 1940-1949
• 1950-1959
• 1960-1969
• Timeline
• Appendix
• Bibliography

One can extrapolate how depersonalized the actual financing of care for parents and elderly relatives has become in the United States.

Karen Stevenson Brown has travelled the country,  holds several advanced degrees and has been involved in long term care for decades.

She has received many awards and media recognition from the likes of  Forbes, Time magazine, and others which you can review by clicking on the above link.

for her unique focus on resources for the elderly, their family, caregivers, long term care administrators, and physicians.

In my humble opinion this is a must read website and reference for any physician who care for elderly or chronically disabled patients.

The Journal of Accountancy credits her with:

"....In 1995 (when the world wide web was still embryonic  she started a Web site to create links to the few resources she could find to help her in her engagements. As more resources began creating their own sites, Brown made more connections, and now ?my site has a life of its own,? she said. Its original plain design has recently gone through a major face lift and organizational upgrade. And the site has become not only a powerful online research tool for clients, government agencies and the general public but also, inadvertently, a marketing tool for its creator. "My practice primarily has been providing services for health care providers. But they don't use the Web much, although consumers of health care for the elderly do; families of the elderly now consult me and my site, for example. So now I work with consumers who ask me, 'Where do I go to get help?'....."

Anyone in health care financial administration needs to read this, and contemplate that maybe the good old days were better.........

Next stop, Grand Central Station

Quote of the day:

No man is exempt from saying silly things; the mischief is to say them deliberately. - Michel de Montaigne

There are many bloggers: who are for more eloquent and gifted writers than I am.

And some are eloquent speakers

I often read their blogs, or columns and think...that's how I feel, or think.....how come I did not say that out loud

or write it down?  Perhaps one of the factors is lack of time....It could involve my whole day and night, if I freely associate....I would even have to write down my dreams....

I think of myself as a visionary and futurist.....so perhaps it is a blessing to those around me that I don't broadcast everything that comes to mind.   It would be like all those teeny boppers marching around the mall on their cell phones...

(who pays for their airtime?), or those loud rude people on cell phones  in the grocery line telling all those around them about their personal grocery list, or their laundry list.  

The measure of success of a blog is to stimulate those who read them...

 

it needs to relate to them, and also be entertaining. It should contain links to other sites, which are authored by really smart, artistic, or silly authors.  I get pretty bored without 'pictures'. I must be arrested at the third grade level... 

By  now you have realized there is nothing about health care today.

I have stepped off Health Train Express at this stop to transfer to another line.

Wait one, my cell is ringing, "hello...no I won't forget to pick up the milk on the way home....luv ya...thanks for calling"

(Ticket Please!)

The Red Eye Health Train Express

Quote of the day:

Thanks to TV and for the convenience of TV, you can only be one of two kinds of human beings, either a liberal or a conservative. - Kurt Vonnegut

 

A lot of people when they get into bed at night turn on the television, and also read a book.

 

Me, I put my laptop on my

tummy,

  and surf the net, read and research my interests in health policy reform.  There is no shortage of pundits in this realm.  However tonite, as I was watching the olympics with one eye and the proceedings on my laptop my mind forgot all about the .  It was interesting that in the relays the U.S. team dropped the baton in both the women's and the men's relays.  Undoubtedly the United States had the finest track team but 'dropped the ball' and was disqualified.  Sound familiar?  One could say the same thing about our system....in pieces it is the best health  care in the world, however overall we too fail to pass the baton, and are disqualified. 

As the evening went on I came to "The Shattuck Lecture" sponsored by the NEJM and the Massachussetts Medical Society.

The lecture is also available in a video format . It is well worth the time to watch.  The most interesting thing is that there was nothing the panel stated that physicians and patients don't already know.  Some of the proposed solutions bordered on the ridiculous and were contradictory.  I leave it to you to see the video or read the transcripts....they talk the talk, now let's see if they walk the talk.  They agree with my contention that a president should not be selected based upon his health care proposal for reform.  This will not be nor should be a presidential decision....it's up to the people and the congress.  Stay tuned,

Health Train Lawyers

Quote of the day:

The great enemy of clear language is insincerity. When there is a gap between one's real and one's declared aims, one turns as it were instinctively to long words and exhausted idioms, like a cuttlefish spurting out ink. - George Orwell

How much will this cost the people of California?  (for lawyers)

Attorneys for the people, and the federal government:

Judge blocks state's cut in Medi-Cal fees
San Francisco Chronicle - 08-20-2008 - A federal judge has blocked California's 10 percent cut in Medi-Cal fees for doctors, dentists and pharmacies, saying the money-saving measures appear to violate federal law and would worsen medical care for millions of poor people. In her ruling Monday, U.S. District Judge Christina Snyder of Los Angeles said she was aware of California's gaping deficit, now $17.2 billion (including $2 billion in reserves) with the budget 50 days overdue and legislators still deadlocked. But she said the state has accepted federal funds for Medi-Cal and is bound to use them to provide quality health care to low-income residents... Dr. Richard Frankenstein, president of the California Medical Association, said this was the third ruling in five years to conclude that "the state of California has put at risk the access to health care for millions of Californians by underfunding the Medi-Cal program." He was referring to a previous state attempt to reduce fees to health providers, overturned by the courts

vs.

Attorneys for the State of California

State officials plan to appeal Medi-Cal ruling

Elizabeth Fernandez, Chronicle Staff Writer

Thursday, Aug 21, 2008

(08-20) 18:04 PDT SAN FRANCISCO -- State officials are planning to appeal a federal judge's decision this week that blocked 10 percent cuts in Medi-Cal fees to doctors, pharmacists and other medical professionals.

• The state also plans to ask next week for a reconsideration and a stay of the decision by U.S. District Judge Christina Snyder of Los Angeles, contending her ruling would cost California $575 million a year. The state is confronting a $17.2 billion shortfall for the fiscal year that began on July 1. The state has been without a budget since that date.

"We believe this ruling can be overturned," H.D. Palmer, a spokesman for the California Department of Finance, said today. "When we first proposed (the cut) in January, we knew it was difficult but necessary. We need to achieve these savings."

Doctors and other health-care professionals, however, hailed the ruling, saying it stops Medi-Cal from being decimated. "It really is great news for those who provide health-care, but also for Medi-Cal patients," said Dr. Ronald Labuguen, who sits on the board of the California Academy of Family Physicians. He practices medicine at San Francisco General Hospital.It's been very difficult for patients in a lot of communities to get the kind of care they need," he said. "It is hard to express how big a victory this is. A lot of patients are going to the emergency room or to urgent care services when they could be better served if they had a regular health-care provider."

The Elephant in the Room

Emergency Waiting Room

The 10 percent reductions took effect last month to a large network of doctors, dentists, pharmacists, adult day health centers, and others in the health-care system. Some 6.6 million low-income people receive Medi-Cal.In her ruling, Snyder said Medi-Cal patients would be "irreparably harmed" by the cuts.Dr. Bo Greaves, a Santa Rosa physician who runs a private, primary-care practice, called the decision "a step away from the wrong direction.""The current reimbursement was so substandard - for them to reduce it by another 10 percent was appalling. It would have created a crisis for the entire state," Greaves said.

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