Well, frankly I need a break from blogging, healthcare and politics. I am going on a 7 day media fast (not fest).
So you all enjoy Health 2.0, don't step on the homeless people, and use protection!!!
See you in a week.
HEALTH TRAIN EXPRESS Mission: To promulgate health education across the internet: Follow or subscribe to Health Train Express as well as Digital Health Space for all the updates for health policy, reform, public health issues. Health Train Express is published several times a week.Subscribe and receive an email alert each time it is published. Health Train Express has been published since 2006.
Tuesday, October 21, 2008
Health Financial Markets Impacted
iHealthbeat reported this morning that the merger between WEBMD and HLTH was cancelled due to current economic situation. They cited several reasons for cancelling the merger which was announced in February 2008
In a statement, Martin Wygod, chair of HLTH and WebMD, said, "The boards of directors of HLTH and WebMD believe that, in the current economic environment, it is important for a growth company like WebMD not to be encumbered by $650 million in [HLTH's] long-term debt that would be coming due in 18 to 36 months" (Washington Post, 10/21).
Health IT experts tackle vendor collaboration
Dan Michelson -- chief marketing officer of physician software vendor AllscriptsMisys Healthcare Solutions -- recommended that physician group buyers "contractually obligate" their vendors to provide systems that can easily share data with other vendors.
Health Train 2008
Health 2.0's annual conference begins tomorrow in San Francisco. Although registration deadline has passed and there are over 900 attendees, an additional room has been opened across the hall from the main room. There will be large screen presentations, and audio. You will be able to attend the breakout sessions, and exhibit hall.
You can't go in the ballroom for the main sessions, but you can attend the breakout sessions, the exhibit hall, the "unconference" lunch, the IDEO session (there are actualy only limited spaces available anyway
HEALTH 2.0 REGISTER HERE MEETING OCTOBER 22,2008
Prognosticators are theorizing how our current economic crisit will affect health care reform and what the impact will be on Health 2.0, Web 2.0 and health information technology adoption.
Richard Reece M.D. analyzes our current predicament(s) and gives a futuristic prediction for HealthCare 2020 at
Medinnovation
Richard Reece, M.D. (photo from his blog)
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.
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?
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
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
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
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 Influence
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 
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
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.
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. (
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.
If those don't work,
CLICK HERE TO GO TO HOFSTRA UNIVERSITY DIRECTLY
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, 
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,
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 
Father knows best.
-Wes
Dr Wes......you are brilliant!! And thanks!!
photo credit: Dr Wes blog photo
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