Listen Up

Monday, October 20, 2008

Health Train Express International

 

Perhaps we should emulate the Chinese in revising our health care system.  Long considered primitive regarding health care, China is taking a bold step toward caring for it's billion or more people.

The Chinese however may have an advantage that much like building a home, it is much easier and less expensive to start from scratch.  The United States is faced with disassembling a system that has grown over the past 100 years or more and transitioning to a better means of financing health care.   We see that a large barrier to transitioning lies in the financing. Converting to a new system will be disruptive financially, and  old habits are difficult to break.

The Wall Street Journal reports that China is aiming for universal heatlh care.

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The proposed plan would be quite a shift for China. The draft plan’s overall goal is to cover 90% of the population within two years and achieve universal care by 2020. It aims to return to non-profit national health care, an idea that was largely abandoned in the country 1980s.

This all stands in contrast to China’s current system, which provides little government funding to government hospitals and requires patients to pay heavy out-of-pocket expenses. The WSJ notes that out-of-pocket payments made up more than 60% of health spending in China at the end of the 1990s.

The plan — drafted in consultation with groups including the World Health Organization, the World Bank, consultant McKinsey & Co. and a few Chinese university-based public health experts —-----The government also aims to set pricing standards for medical services.

Other news about Chinese health care, Pharma,Western style hospitals is in the Wall Street Journal. And what does Heparin have to do with hot dogs?

In China as in the United States reform has it's skeptics.

Sunday, October 19, 2008

Health Train Express--Sunday Edition

On the heels of Colin Powell's endorsement of Senator Obama, we can begin to look at the options for health care reform that the two candidates espouse.

Before I talk about that I make the following observations.

Few if any Physicians have access to the national stage in a manner that prominent senators, governors, and other publicly elected officials enjoy.  We have relied on our national organizations, the AMA, specialty societies, lobbyists.

There are other major players and foundations ,fund policy analysts, and speakers on the national circuit of speakers that elaborate on options for health care reform. In fact there is an alphabet soup variety of publicly funded organizations active in these matters. Some are underwritten by non profit organizations that are actually underwritten by payers.

National Health Policy Resources

Kaiser Family Foundation

Robert Woods Johnson Foundation

The American Hospital Association

U.S. Non- Profits Health Data and Statistics

The following two interviews detail the essentials of  the two candidates platform for health care reform.

HEALTH TRAIN MEET THE PRESS FOR SENATOR OBAMA

HEALTH TRAIN MEET THE PRESS FOR SENATOR MCCAIN

Both interviews courtesy of the Kaiser Family Foudation

Health Train Transformation

Morality, like art, means drawing a line someplace.
Oscar Wilde
Irish dramatist, novelist, & poet (1854 - 1900)
*********************************

Today's post, is indirectly related to healthcare. Electrifying news this morning, as we awoke from slumber. 

To me it was almost as punctuating as the events of JFKs assassination, and the bombings of 9-11.   Colin Powell who was George Bush's Secretary of State, and critical of the Iraqi war as it boged down, endorsed Barak Obama for the Presidency.

Colin Powell  has such enormous stature from not only his role and experience in government, but also his eminence as a person of great integrity and moral stature. 

Mr. Powell did not have to endorse anyone, he could have remained silent.  His love of his country and performance of his duties leaves no doubt as to how this will impact the election.

The sad thing is that George Bush did not listen to what Colin Powell was telling him (and we as taxpayers paid for it). 'res ipsa loquitor'. (the thing speaks for itself).

This is the final nail in the coffin of the Bush administration.

This announcement also comes as the Iraqi Government begins to renegotiate terms for our remaining in Iraq. 

Saturday, October 18, 2008

Californians' health premiums rise 5 times faster than pay

The Sacremento Bee reports

In California from 2000 to 2007, annual premiums rose from $6,227 to $12,194. During that same period, the median pay went from $25,740 to $30,702.

About 6.6 million are medically uninsured in California.

On average nationally, health premiums rose 78 percent, lower than California's rate, during the seven-year period. However, earnings in California outpaced the rest of the country, which saw wages rise by 14.5 percent.

What is clear is that health care is becoming less and less affordable," said Anthony Wright, executive director of Oakland-based Health Access California

The system is broken and needs to be fixed," said Wright, who called for greater oversight of the insurance industry.

Knowledge is Power-iNFORMATION ASSYMETRY


Quote of the day:
An ignorant person is one who doesn't know what you have just found out. - Will Rogers

^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^

I want to share an article posted on SERMO by it's creator,

Dan Palestrant M.D. (give this link a moment to load, and then click on the video window...it should open in iTunes it is an iTunes video cast          image

 

click to JOIN   LICENSED PHYSICIANS ONLY, all applications are 'vetted'.

 

Please excuse the length of the quote, it is included since SERMO is a protected secure website accessible only to licensed physicians. 

 

Those of you who are physicians should JOIN

The pictures are mine, inserted and are not part of the original posting. (all that plain text gives me nystagmus, and I'm a picture guy.)

 

From The Founder: Knowledge is (Still) Power

I'd like to introduce a concept called information asymmetry.

Exchanges, whether it is swapping ideas in a community like ours, or goods and services in a marketplace, always work best when the information held by both parties is symmetrical.  Both parties need to be on an equal footing for the information exchange to be fair and mutually beneficial.  In economic theory, this is referred to as how "perfect" your information is.  As such, it makes sense that the party that has the "more perfect" information has an advantage. In any business transaction (such as when buying a car) if the seller knows something that the buyer does not, there is an information asymmetry and therefore an intrinsic disadvantage for one of the parties (hence the prevalence of Lemon Laws).


The Rise of Asymmetry in Medicine

As physicians, we combat information asymmetries by sharing insights from one another and benefitting from each other's collective experiences.  However, the shift towards outpatient medicine, where physicians no longer enjoy the collective gathering places of the doctor's lounge, grand rounds, or even the nursing station has left physicians "solo" in operating our practices.  Add to this the increasing time pressures that have caused us to sever other ties, and it is no small wonder that physicians feel a growing sense of loneliness and isolation.  This isolation has compounded the information asymmetry for physicians and we are unable to benefit from each other's insights in advancing the collective good of our profession.  The bottom line is that "hearing" each others' voices is a necessary prerequisite before we can have a collective voice and overcome information asymmetry.
The impact of information Asymmetry on our Earnings
Isolation and information asymmetry have had a dire financial impact on physicians. They have allowed critical changes over the past 25 years to the financial mechanisms that underpin our profession. As our isolation has become more acute, the parties that we must exchange our goods and services through (ie insurance companies) have not stood still. They have benefitted from better organization, better technology and ultimately better information.   This did not happen by accident.

Insurance companies and government agencies have leveraged information that we don't have-around costs for drugs and procedures and treatments for example-to gain advantages over physicians.  Rather than a perpetuating a system where a physician's time, efforts, and skills are rewarded based on market value, payers have incredible advantage because their information is more "perfect".   How is it that demand for physician services is exploding and physician supply is flat to declining (as physicians are retiring earlier and increasingly opting out of primary care) and yet reimbursement and physician earnings continue to plummet? Focus on the asymmetry of information.

Information asymmetries have features that can make them very attractive (if you are on the right side of the asymmetry).  They perpetuate positions of strength or authority (they are also threatened by anything that creates a level playing field or meritocracy), while creating great leverage for the party with the more perfect information.  Knowledge, or in this case "information", is indeed power.
Sermo's Role in Regaining Information Symmetry…and Physician Influenceimage

From the moment it launched, Sermo has been a medium physicians have used to overcome information asymmetry in our practices.  Indeed, the information is perfectly symmetrical among physicians within the Sermo community.  Given a level playing field, new insights, new methods, and new strategies have emerged through Sermo.  Quite to my shock, we are starting to erode that information asymmetry that had appeared so daunting, so destructive, to our profession.  The evidence of this abounds.  New clinical insights that never would have been given their due are routinely discussed in Sermo.  Difficult patient situations, clinical dilemmas, and most certainly some of the most vexing economic questions that face physicians are far less daunting when the collective brainpower of this community can be applied.  The axiom has held true: No one of us is smarter than all of us.
Creating a Healthcare Information Exchange
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Very quickly we learned that the knowledge, and consensus of physicians on Sermo also has tremendous value to outside entities.  The Sermo Team has worked to build a business model that enables physicians to project our collective voice on every subject to outside entities.  New modes of exchange like AskRx, Clinical Trials, and Earn HotSpots have created an entirely new paradigm  for Exchange with outsiders that need to understand physician perspective to advance their businesses. The community is proving incredibly adept at engaging outside entities on this community's terms and even at changing the rules and forcing outside entities to reevaluate their practices.  This Exchange mechanism has unlocked the power to regain our influence over the players that control the decisions, investments and policies that shape the healthcare landscape in this country. 

This community has been both consistent and emphatic in making sure its voice is heard outside Sermo,

Friday, October 17, 2008

Health Train Travelling Taxes

Following last night's 3rd and thankfully last presidential debate I am taking a grim view on the possibility for real reform in our health system. 

The reality here is that we have two candidates with diametrically opposed views on health care reform.

Senator McCain advocates that our health non system challenges are limited to the premiums and availablility of health care coverage.. This does not speak to all the other areas in health care that need reform.  His  proposal will be a battle of the payers, and the employers and a new book of IRS tax codes. Insurers have no real interest in providing more payments for more patients, nor hospitalizations.  His proposal is not well thought out, and fails to address most of the fundamental challenges for patients and providers alike. 

Senator Obama takes the short path....to universal payor. Although he has not mentioned it lately and backed off when pressed at the debate, his other statements are otherwise. Senator Obama also wants to use the tax codes ( but in a different manner)

Joe the plumber might as well be you the citizen, lawyer, doctor, small business man or even a large integrated health system.

Senator Obama wants to take some of your income and give it to the "guy behind you".  Senator Obama wants to make life easy for you by giving your decision making and accounting to the U.S. government to decide who should give what and who should take what.

When pressed about mandatory mandates Senator Obama was asked how much a fine would be for the employer or employee who did not provide health insurance. He fumbled a bit and mentioned that was only for the 'rich' ,those businesses that had income greater than 250,000.

Some expert economists point out that even many medium and large enterprises, such as General Motors are having problems paying the rent. This type of health reform will bankrupt some large enterprises as well.

Neither Mr. McCain nor Mr. Obama have much real world experience in running a business, making payroll or having employees they are responsible for. 

I doubt if  McCain or Obama are able to add and subtract numbers with less than nine zeroes...That is apparent since Obama sees the divide at 250,000 dollars. If you are above that figure..you are rich, if you are below that, then you are eligible for whatever grandiose federal programs he imagines.

It seems that Obama actually overtly and covertly sees our country still in terms of class warfare facing both sides off against one another.

My fundamental analysis  is that tax codes should not be the determining factor how we finance and deliver health care. The fundamental flaws must be dealt with by providers and patients.

Thursday, October 16, 2008

Health Train Express, Number Six on the List of Most Important Voter Issues

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Graph from The Health Care Blog article by Chris Weaver.

Media coverage of two issues - health care and taxes - nearly doubled. Health care stories increased across all media from 256 stories to 439. Tax stories rose from just over 400 for the week to nearly 800 between the weeks ending Sept. 29 and Oct. 6, according to stories polled for the LexisNexis Analytics dashboard.    This spike in incidence is not unrelated. Tax stories are hot as voters stare at a growing deficit and watch their 401k's plunge, but tax talk has also become a predictable symptom of health care reform stories.  

An excerpt from a New York Times article states,  (link)

"It is health care, advisers said, that they believe resonates more than other issues for Americans who are worried about their economic condition," they wrote. "It is a less threatening way to talk about the economy - showing pictures of shuttered banks, for example, could create more worry - that aides said tested well across demographic groups, but particularly among older voters who have been slower to warm to Mr. Obama."

Of course, this construction fails to appreciate the other important issues under the umbrella of health policy - id est the health part.

Rising to the occasion, the conservative Washington Times reminded us Tuesday that millions of uninsured people have a tough time finding treatment, and in a worst case scenario, camp out for days, waiting to see doctors at a Wise County, Va., health fair. It's not all about the taxes after all.

No physician has to be told this observation by pundits of what is wrong about the American HealthCare non-system.image

The portions of the debate on health care seemed to be 'muddle' on both sides.  Mr Obama appears to have backed off on his plan for UNIVERSAL PAYOR.  Mr. McCain's proposals regarding tax advantages for his program at times seemed conflicting, confusing and very unclear...and it does nothing for helping the "uninsured"...He use "Joe, the plumber" at several points attempting to relate "spreading the wealth" as a for socialism. The he used Joe' s   plumbing business as an example for small business as an example for capital, loans, and his tax bracket.  Poor Joe is a busy guy..

Neither candidate demonstrated understanding the root causes of the problem for providers.....increasing costs and fixed overhead for delivering care.  The root causes are increasing baby boomer usage,  and the internal bureaucracy of evaluating, regulating, and paying for health care. 

Health IT and data mining are forecast to evaluate outcomes, and the efficiency and accuracy of treatment.  It will take many years to develop statistically valid data on preferred patterns, and evidence based medicine...By the time this occurs, it is likely that treatment paradigms will have shifted, due to technology, and drug advances.  Don't get me wrong I am all for studying our outcomes, but a billion or so dollars down the line I doubt if we will truly save one nickel. (image hearsay, and highly biased prospective prediction) (shoot the messenger)

On a more positive note, Elizabeth Edwards and HEALTH CARE NOW seem to be on 'our side' in regard to health insurers.

Other items in today's blogs

Wall Street Journal  Hospital closes in Chicago

Medinnovation blog  Geeks, formulas, and algorithms

Trusted MDTrusted MD  Health 2.0  busted??

Guarranteed Health Care  Treatment delayed for months, policy cancelled when payment one day late.

Fresh MD  New perspectives on American Health Care, why are we bitching  ??

That's it for today....it's time for my medications.

GML

Wednesday, October 15, 2008

Who will Rule Gotham?

Will it be McCain, or Obama?  or  perhaps there is a 'spoiler lurking in the shadows...

Tune in tonight.

Try this link

Or this one

Or this one

If those don't work,

CLICK HERE TO GO TO HOFSTRA UNIVERSITY DIRECTLY

image

THE LINKS WILL OPEN IN A SEPARATE WINDOW

Tuesday, October 14, 2008

Ding,Ding Health Train Express on Track 134

"Arriving on track 134, the Health Train Express bound for Everywhere, USA. Stand back please, and have your boarding pass ready.   This train is a local and will stop at HMO haven,DRG depot, P4P pitstop, JCAH junction, Copay Circle, H&P Place, EMR Exit,  and points beyond!"

The train is late, and overloaded, image standing room only and passengers hanging out the windows, on the roof, and swinging from the doors.  The engine speeds by the platform and the cars smoothly glide  to a halt.

Track 134 is a new 'high speed" mag-lev train,

image with very limited service, since the infrastructure of new technology, magnetic lev cars and rails are not yet put into place.  America has talked about this new technology for over 25 years, and there has been little  progress.

You board this special health train on your way to work, and have a seat, awaiting your destination......as you work on your laptop, fiddle with your PDA and/or take SMS and phone calls on your IPOD, or new G1 phone, the train leaves the station gliding smoothly on a cushion of air.

As you pick up speed and pass by roads, overpasses, crossings, and small towns now vacant from migration to city centers, suddenly, you are distracted by:

Ding, Ding..... go the strings of my heart

Dr. Wes began this scenario for me in his blog today

* Ding Ding * You get a best practice alert!
Have a patient without an mammogram in the last year?
*Ding Ding* You get a best practice alert!
Haven't had your colostomy and over age 50?
*Ding Ding* You get a best practice alert!
Haven't counselled you patient about their smoking each year?
* Ding Ding * You get a best practice alert!
Haven't had your cholesterol checked?
* Ding Ding * You get a best practice alert!
Didn't screen your patient over 18 for depression?
* Ding Ding * You get a best practice alert!
Didn't know that there 134 potential alerts for 2008?
*Ding Ding * You clearly need a best practice alert!

DING DING GO THE STRINGS OF MY HEART  (be patient while this loads (Chuck Berry)

"Best Practice Alerts" are computer algorithms triggered from diagnosis codes.
"Best Practice Alerts" are an Electronic Medical Record's (EMR) means to assure that the "voluntary" Physicians Quality Reporting Initiative is undertaken. Never mind that failing to comply means certain discrimination between physicians. Just remember, it's voluntary! Really.
"Best Practice Alerts" force doctors to cross tacit specialty treatment boundaries and risk alientating referral doctors.
"Best Practice Alerts" drive testing and procedures, and therefore costs, to our health care system.
"Best Practice Alerts" are encouraged by those with a stake in health care.
"Best Practice Alerts" remove judgement from medical care in favor of mandates.
"Best Practice Alerts" are disruptive to doctor-patient interactions, consuming precious clinic time as "why" or "why not" must accompany each alert response.
"Best Practice Alerts" have not been shown to improve patient outcomes over more conventional care.
So how, then, are we to assume such alerts represent "Best Practice?"

image credit:  Google images

Theme Song from Father Knows Best....opens in player, be patient while it downloads. (click on photo)

Well, it's simple: because image

Father knows best.
-Wes

image Dr Wes......you are brilliant!! And thanks!!

photo credit: Dr Wes blog photo

Sunday, October 12, 2008

Free Pass on the Health Train Express.

Sign up for free government programs for EMR

image Did you know that right now the state and federal government has programs that you may be eligible for.  You do not have to have a disabiity, nor be a member of a special class.  Our operators are waiting to hear from you for these special programs set up by the government.  Don't wait to sign up for these programs.  If you were born between 1900 and 2000 you are elibigle for one of these little known government subsidies. 

“Because you pay your income taxes on time, you have been awarded a free $12,500 government grant! To get your grant, simply give us your checking account information, and we will direct-deposit the grant into your bank account!” Even if you don't pay taxes on time....our program has a waiver for that requirement.

Our program outlines all the monies that have been allotted for you to purchase and EMR for your  medical practice."

Not withstanding the above  "fantasy financing for EMR", the reality is that the situation remains grim for most providers.

Joseph Britto, CEO of Isabel Healthcare writes in The Health Care Blog,

"September 25, 2008, the Certification Commission for Healthcare Information Technology (CCHIT) issued a report that reviewed 90 EMR incentive programs (state, federal, private) with a total funding of $700 million available.

Of course there are some disclaimers.

Many health policy experts believed that “if you subsidize it, they will come.” While that approach has worked in persuading people to take mass transit, it hasn’t lured many physicians into using EMRs. ............................

image Health Industry Insights, a private research firm, reviewing the CCHIT report, estimated that the cost to implement an EMR is roughly $25,000 per physician and that the $700 million currently available would represent only 9% of the expected total national cost  to furnish all physicians in private practice with an EMR. "

With these realistic limitations in mind, it may be time for a new mindset of what the best utiization is for our limited IT resources.

 

"As we endure financially difficult times, we believe it is time for IT leaders at hospitals and medical groups to take second look at a different set of technologies, one which, like EMRs, can align physicians and hospitals in the shared goals of improving patient care and reducing clinical risk. "

"Clinical decision support (CDS) technology is not new, it has been available in various forms since 1986, but as computer hardware has become vastly more powerful, the newer versions of the systems have become faster and more practical for physicians to use. One particular kind of CDS technology, diagnosis decision support (DDS), has been adopted in many hospitals in the past two years, as medical executives realize its value in attracting leading physicians who understand and value medical knowledge tools.  "DDS systems include two key components: a dynamic medical knowledge data base and an inferencing or logic engine to sort and select decision options for clinicians.

There are some skepticism as to the value of CDS, by some physicians

Ira Breite states, "The real reason that internists and other PCPs have been slow to adopt the EHR systems (EMR is sooo 20th century)is that they are not ready for prime time. Data entry is slow to the point of ridiculous, and while "decision support" may work in a hospital where lots of available data can be condensed into an algorithm, its still not real useful for the question of whether to give antibiotics in the case of sinusitis. Yes, I know there is an algorithm for that, but the reality is I don't always follow it and neither do the guys who wrote it (if they actually take care of patients)."

With this in mind.....call 800-FRE-EEMR or run down to the mailbox and send off your application(s) for these  FREE GOVERNMENT GRANTS

Saturday, October 11, 2008

Help us Help them

Help us Help them

Don't vote until you see the video

How can we help these people?

Real Stories about Real People

http://www.youtube.com/watch?v=DNHNCScYpX8

Nathan Wilkes

http://www.youtube.com/watch?v=2peGqRrjXek

Cynthia Campbell

http://www.youtube.com/watch?v=McGm00Mvakc

In a stunning turn around, insurance giant CIGNA has capitulated to community demands, and protests that the California Nurses Association/National Nurses Organizing Committee helped to generate, and agreed to a critically needed liver transplant for Nataline Sarkisyan, a 17-year-old girl in the intensive care unit at UCLA Medical Center. Unfortunately, Nataline passed away yesterday just after six o'clock the same day of the massive protest

http://www.youtube.com/watch?v=Wh0mgiwXzGM

Emily Cannon is a young woman in the prime of life, the daughter of a registered nurse, and a former elementary school teacher whose life has ground to a halt since developing a chronic but treatable illness. She is now being denied care she needs to return to the active life she once enjoyed.

http://www.youtube.com/watch?v=K1uXUgTakk4

Watch this compelling video about a mother and daughter living on a fixed income and having to fight their health insurance provider for coverage.

http://www.youtube.com/watch?v=Q4xcV4bULRQ

Retiree Juanita Anderson doesn't just fear the rare disease that attacks her organs and sends her to the ER,she also fears the insurance companies who can change her coverage at any time and destroy her finances.

http://www.youtube.com/watch?v=TqSshZZMHGA

Linda Peeno-Sicko

http://www.youtube.com/watch?v=itKJRq3NU7s

Michael Moore-Sicko

http://www.youtube.com/watch?v=aC7zI7VXcCA

Andy Bales: Rescue Mission

http://www.youtube.com/watch?v=tqmk3ycTmuY

Deborah Burger—RN

Zorses and The Health Train

If you are wondering what a zorse is, check out my other blog