Health Train Dining Car

They aren't talking to one another, while they chew their food.

Sometimes a whisper is more powerful than a shout. Here's a cartoon from Modern Medicine that shows a Medical Home counseling session between a primary care physician (PCP), a specialist and the health plan. The PCP looks forlorn, while the specialist and the insurer have their backs turned, fuming. It is perfectly true.

American primary care is a shambles, and it is now clear that it will not be viable in the future unless significant changes occur in our national attitude about its value and in the way we pay for it.

So what should we do?

The National Committee for Quality Assurance proposes a plan

Another interesting, and perhaps more far-reaching proposal (Download finalpcppaper.doc) has been made by Norbert Goldfield MD and his colleagues. Dr. Goldfield is a highly respected health care innovator,

The articles go on to elaborate how this would work, and how PCPs would be rewarded for acting as the fiduciary and patient advocate, unlike the gatekeeper model, which fails miserably.

Collapse, a book which discusses how societies choose to

suceed or collapse is a worthwhile read.

 

Given the current crisis, and quick fixes proposed by both Presidential candidates it becomes patently obvious the internal mechanisms of patient care  need to be 'fixed'' before any more money is thrown into medical care.  Physicians and educational programs need to climb on board the new Health Train.

Health Train Committees

 

Quote of the day:
Committee--a group of men who individually can do nothing but as a group decide that nothing can be done. - Fred Allen

************************************************

KevinMD..................

The High Points:

A family physician shares her ideas on fixing our health care system. Someone better put Elizabeth Pector in charge of something, because her ideas need to be instilled stat. Like this one, explaining why physicians deserve equal rights:

When it comes to equality, doctors get the short end of the stick in our health-care system.....duh !!!

In short, as part of restructuring the health-care system, physicians need to be put back on a level playing field with the rest of the health-care players, so they can provide input prior to implementation of supposed cost-saving measures that often only transfer costs to doctors.

Another must read from KevinMD---how about just writing it out?

Point of Law  (you best believe it)

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?

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

Technorati Tags: china,healthcare reform,world health,pharma,public health

Health Train Express Roundtable

Today's Health Train Express takes us to

The View from Here...my other blog.

Click Here

Post II

Financial Analytics vs. Health Analytics

Health Train Reform

I have reviewed the proposals of McCain and Obama.

Frankly I do not think either proposal is going to do much to improve health care, reduce costs, or satisfy anyone for very long.

1.The proposals do not address internal problems with delivering health care wisely , or efficiently

2.Both  proposals use tax policy to create change, and campaign issues revolve around tax credits and/or deductions.

3. Neither proposal addresses the increased utilization from baby boomers

4. Both proposals do not address medicare's approaching insolvency.

5. Each proposal is bound by partisan politics

6. We should not decide upon health care issues during

a heated political debate.

We should step back, and allow the financial crisis to cool down, assess the impact of the financial bailout program.

No one can make an educated guess until we see how our economy shakes out from the financial crisis.  There are many unknown factors operating in our free market system.

We do not know how, when or where the financial bailout will be distributed.  Initial funding has made most prudent planners skeptical as to whether the banks (the ones who perpetrated the crisis) will  judge correctly how to use the funds for the good of all of us, or probablly just go on playing the same game....save their own behinds. One obvious warning is the admonition from GWB that they need to 'loan the money" and not hoard it.  Bankers don't give a rat's  a-s about customers...only what their shareholders think and do. They have no motivation to change their game, and we have rewarded them for their incompetence. Their excuses are lame.

If you are a big banker, or insurance company the rules are different than those for you and me.  This 'bailout money" had better be a loan and not an outright gift to them.  Foisting this debt off on the American Public is an outrage, and  probably justifies throwing out the vultures at the top of the predatory feeders. Why would anyone want to appoint executives from Goldman Sachs, and other financial institutions in charge of the hen house  to these positions again?

The manner in which this is being addressed should alert anyone with common sense that this is what will happen to health care financing as well.

For more information link to my other blog

Out of the Fog

The fog lifted quickly this morning. It burns off in mid morning and things become clearer as I head off , not on call, not worrying about seeing 40 or 50 patients with itchy burning eyes, floaters, flashing lights, computer vision problems, chldren referred for evaluation of dyslexia referred by a  school psychologist for eye exercises. Mixed in with that mix are the retinal detachments, acute narrow angle or undiagnosed chronic glaucoma, the ocassional herpes dendritic keratitis, zoster, macular hemorrhage, vein occlusion and central artery occlusions. and the bread and butter for most ophthalmologists....that cataract !

But as I said I am not going to be doing any of that for awhile.....perhaps never.  I have made my mind up to become 'cognitive' again after several decades of assembly line medicine seeing 50 or more patients a day. I sometimes lie awake at night, and also during the day (between naps). It must be the sleep apnea as well as my antidepressants and meds for bipolar spectrum disorder.  Now that you know the 'truth' about me you will understand the reason(s) for the nature of my writing.

I had always attributed my sense of anxiety and apprehension as well as occassional irritability and impatience to my sense of superiority in all  things medical and surgical. I mean I survived college, med school, internship, residency, military service in a combat zone, with several episodes of moderately severe depression which I always attributed to my meager financial resources,  and family responsibilities and seemingly endless nights on call and moonlighting to survive residency. Early on my anxiety would bring me to a therapist. It felt good to ventilate. So after 30 years or more my last therapist told me that I sounded 'bipolar'.   Well, shit yes...!! How else would any normal human be able to have normal SSRIs with little sleep and staggering hours and workload without a bit of an imbalance in vital neural brainwash.??

Now, I don't know what bipolar sounds like.

There, I have exposed myself.... my hidden vulnerability.

I have not changed, but the world around me has changed. All the things I studied for and worked for are gone. (but not my family) So it's not my fault and it is not my responsibility to adapt anymore.  I now have a new fundamental understanding and gestalt for those 'old eccentric folks' walking around babbling and seemingly inappropriate....

During my 'seeking'  a career transition (a euphemistic saying to cover up boredom, burnout,or whatever) I visited a local Starbucks near a UC campus.  There it was....the future of the world, a lot of Apple Macs (all white) and lots of Asians. (no insult intended).

I  am not certain what the p.c. term is for those of asian descent.  It seems many Asians excel into getting into the UC system.

This is a wonderful that they  move to the U.S.to keep our universities full, since our own public school system cannot keep up feeding the greater University system.  The unemployment of college professors would be much greater without Asian participation.  What goes around in the business world also comes around in education.  So our educational institutions also participate in the global economy I am just concerned that our balance of education is negative. We need to export more students!!

If you haven't applied for a job in the normal workplace in the last ten years, you will be in for a shocker. 

You have to do most or all of it online....No face to face

unless  you can penetrate the software algorithms screening for key words in your resume.

I am even suspicious that you do not have to write coherently, just put the correct keywords, or tags in the appropriate fields.

Guess the correct combination and your resume does not get filtered into some giant resume spam file.....

presto it appears in the 'incoming resume file for some lower level flunkie to bring into the dean's office, or the human resource filter to be forwarded to the appropriate department in whatever business you will be hired to continue your financial plans.

del.icio.us Tags: fog,flashing,keywords,resumes,interview,finances,nest egg,burn out

Health care vs. Health Care

Yesterday's posts were truncated by some other important issues.

Today I am a bit overwhelmed by what to post. The issues are legion.

Our first great event is the State of California being held in contempt regarding funding of Prison Health Reform  The issue is that  the courts are insisting that California write a bad check to initiate planning for the new prisons. (when I do that I get charged for overdrafts, and possible criminal charges.)

Our second great event is the State of California v. the County of Santa Barbara.  The state claims it overpaid Santa Barbara in Medi-cal funds. 

Just what I love...my government using my tax dollars to fight with one another...net gain less than zero...pure stupidity, audit it and report it, and don't make the same mistake again.

We need more government involvement in healthcare (sarcasm)

 

del.icio.us Tags: prison reform,healthcare lawsuits,santa barbara,Schwarzenegger,medi-cal overpayments

Health Train Express Travels through the Cloud, or should we say Fog??

What's in a name? Is it a cloud or fog? It depends upon your altitude.....and the dew point....

Sublimation....the transformation of a solid directly into a gas, ie dry ice to vapor.

Microsoft has announced it's new "Azure" platform...it's answer to Google's online microsoft look alike solutions available on the internet. They are calling this "Cloud computing".  We'll see if it a cloud or fog (vapor)  soon. Cloud Computing according to Wikipedia

This announcement reveals a major shift in software development applications for health solutions in both business and clinical applications.  Look here for more information at a later date on specifics about cloud computing and healthcare.

Our medical practices have gone from being solid business platforms into vapor at times. Is this sublimation? At one time our medical practices were a sublime portion of our daily lives.

Happy Hospitalist Express

 

from THE HAPPY HOSPITALIST VIA GRUNT DOC

For most of you out there, I will never meet you. You will live long, prosperous, healthy lives. You will raise families, remain gainfully employed, go to church, give back to the community and generally live. You will play by the rules. You will have your ups and downs and life will go on. What I describe in my blog and experience in my life as a hospitalist represents a very skewed representation of America. I am often lambasted by others for being unHappy and distressed with my situation. That couldn't be farther from he truth. What I try and present to you on the Happy Hospitalist is the gross abuse running rampant in our health care system. The abuse, I believe, entirely the result of third party rules and regulations, has become intolerable for many health care providers. Enough to make many quit. The abuse running rampant by the few has also had the effect of driving up prices for everyone looking for health care security.
So I ask the question, what type of patient are you? Are you contributing to the demise of the third party model so ingrained in our current culture.

del.icio.us Tags: health care abuse,patient,hospitalist,third party model

More Medicare Nonsense

 

CMS in it's infinite wisdon has declared war on those of you who are recalcitrant to adopt eRx. AmedNews reports this morning that since the  ''carrot" didn't work as fast as they wanted it to, and eRx adoption is lagging they would up the stakes.

With electronic prescribing still far off the radar screen for many physicians just weeks before new Medicare e-prescribing incentives kick in, the Centers for Medicare & Medicaid Services hosted an event here in October to jump-start an all-out push for widespread adoption of the technology.

(Most of the attendees were vendors, administrators, and a few physicians who have already adopted eRx (1400 attended).

 

Only about 2% of eligible prescriptions nationwide in 2007 were ordered electronically. While physicians in some states used the technology more extensively, few states broke the 3% mark when it came to paperless drug orders.

Prescriptions sent electronically

Massachusetts
13.43%

Rhode Island
9.05%

Nevada
7.06%

Delaware
4.21%

Michigan
4.20%

Maryland
3.17%

North Carolina
3.07%

Arizona
2.89%

Connecticut
2.57%

Washington
2.57%

New Jersey
2.51%

Pennsylvania
2.46%

Ohio
2.46%

New Hampshire
2.34%

Source: RxHub, National ePrescribing Conference, October. RxHub is owned by SureScripts.

Back to top.

---

The power of incentives

In Massachusetts, the number of prescriptions sent electronically surged after the state's Blue Cross Blue Shield plan started offering e-prescribing incentives in 2004. Medicare officials hope to see a similar boost nationwide from the bonuses they will begin offering in January.

 

Electronic prescriptions written

Q4-2003
13,039

Q1-2004
19,288

Q2-2004
51,126

Q3-2004
107,098

Q4-2004
294,272

Q1-2005
454,896

Q2-2005
599,321

Q3-2005
720,138

Q4-2005
958,569

Q1-2006
1,060,402

Q2-2006
1,095,986

Q3-2006
1,064,357

Q4-2006
1,145,295

Q1-2007
1,167,501

Q2-2007
1,156,112

Q3-2007
1,072,824

Q4-2007
1,095,237

Q1-2008
1,122,761

Q2-2008
1,036,784

Note: Incentives took effect in Q1-2004.

Source: Blue Cross Blue Shield of Massachusetts

 

---

Weblink

"A Clinician's Guide to Electronic Prescribing", October (www.ehealthinitiative.org/erx/clinicians.mspx)

 

In other news from AmedNews:

Caught unaware, doctors get delay in FTC enforcement of ID theft rules

 

When the FTC begins enforcing the rules, failure to comply could mean administrative penalties or up to $2,500 in fines per violation.

According to AmedNews the rules extend to

"If, on a regular basis, a physician allowed a patient to leave knowing they were not going to be paying immediately, even for a co-payment or deductible, the provider would be considered a creditor.

The AMA and other groups won a six-month reprieve for doctors to implement a prevention program originally mandated for Nov. 1.

The so-called "red flag" rules require entities that regularly extend credit, or defer payment for services, to establish a written program for preventing identity theft as well as detecting and responding to warning signs of such thefts. The commission first released the rules last November as directed by the Fair and Accurate Credit Transactions Act of 2003.

• Discuss on Sermo
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Until recently, physicians and health care facilities were largely unaware of the regulations, which were thought to pertain mainly to banks and other financial institutions that offer credit in the traditional sense. But in recent weeks, the FTC signaled that the rule was intended to apply more broadly, including to the health care arena.

So, have a nice day.

del.icio.us Tags: cms,identify theft,ftc,copays,credit,AMA,eRx,incentives

Health Train Express & Halloween

I decided to post my Halloween 2006 blogpost here, again. I brought it forward from my original iteration, RiversideHealth

THIS IS HALLOWEEN

Friday, November 03, 2006

Halloween and RHIOs

Several nights ago we participated in the annual ritual of door to door "trick or treating".
It seemed to me there are some analogies between Halloween night and RHIOs.
We are all looking for some "treats" without being "tricked". Some of the takers would shove their whole hand enthusiastically into the candy barrel and come out with a fistful of treats, while some would gingerly pick out one. My wife cautioned me to hand them out one at a time or we would soon run out. The same can be said about enthusiasm for RHIOs. Some are enthusiastic takers, and givers, others are reticent about their choice(s). One thing was for sure, I had to go out and replenish the barrel several times.
We had just moved into a new family neighborhood, and discovered there were literally thousands of children coming to our door. Having been on the far side of the half century mark for some time, we had recently been living in the relative quiet and senior demographics of the desert. There were wonderful fairies, pumpkins, spidermen, supermen, fantastic fours, and even a few dated ninja turtles, coming to our door that evening. In the desert we were lucky if we saw one or two. The future of our country abounds in Riverside neighborhoods.
It came to me that we are not building health IT and/or RHIOs for ourselves but for our children. How critical this need is demonstrated by recent articles about outsourcing not only transcription services but actual health care delivery, such as surgery, and diagnostic testing where these services can be obtained for 10% of what it costs in the United States. A bit shameful for us.
Physicians are now faced with the annual adversarial role with CMS, and it appears, as usual that our fees will be slashed 5.7% on the average. If you do the math, this makes RHIOs and EHRs even more unlikely.
Then there is legislation pending that would mandate EMRs with funding from Congress through a variety of sources. Which is the trick, and what is the treat?
As for me, give me those

little foil wrapped chocolate balls.

HealthVault Express

I was planning a post this AM, and my internet is flaky, fortunately I use Live writer from Microsoft. It's a simple task to write off line and then save a draft and/or upload to the blog.

The internet is a complex "spider" of networks and supposed redundancy. This morning I only have access to google, and whatever is on their servers. The rest of the bilions of sites are unavailable.  I guess Google will save the world. I wonder if HealthVault is up.

This brings to mind the fallibility of all things electronic. Imagine you are at your docs office and he want to pull up your PHR which is stored in Healthvault and/or Google Health. What now?

Or how about your front or back office running an EMR on as asp solution?  Nada!!  Although not requiring much hardware investment and offering 24/7 maintenance .asp solutions are not as cheap as you might think.

That's the downside....

The upside is that my internet has never has gone down for more than an hour or so.  But never say never...I live in a fairly metropolitan area of Southern California.

With a client-server configuration, I have personally been the victim of servers, client work stations fizzle out and be down for a day or even up to a week while a part or major component is replaced, along with the software that may have been lost. Not a happy situation either.

More bad news....I called my ISP to see just how long the outage will  be.  I received one of those messages. "We are experiencing an outage in your area"  (how do they know  where I am...must be one of those caller ID thingys.  The voicemail was upgraded to

"If you would like a call when the technical difficulty is fixed, push one.  (how do they know I don't have a rotary phone?_) For you late season "boomers" go to wikipedia or google....  "we will call you back between the hours of blah blah blah...  This does not sound good.  How will they voicemail blast this message?  

BuzzNet Tags: isp,google,boomer,web 2.0,internet,server,client,voicemail