Doctor Anonymous: White House Health Care Summit

Doctor Anonymous: White House Health Care Summit

Health IT Update

 

Some of you may have wondered why I have been absent from blogomania.  Wel it is because my time has been drastically impacted by the necessity of learning how to use an EMR.

In my setting I have had all the 'advantages' of having a full time IT staff to quell my frustration at not being able to perform my duties as a physician.  It is not saving me time nor is it increasing my efficiency.....it is exactly the polar opposite.

It takes me about ten minutes to correlate and coordinate  the information my assistants and data gatherers bring to me as well as perform my physical exam during which I also take relevant history from the patient.  Now it takes me an additional ten to fifteen minutes to enter it into the EMR (that is an optimistic estimate). 

I previously would see an average of 35-40 patients/day. If I add on ten minutes (conservatively) that is 350 minutes/day or almost 6 hours, leaving me with two hours to work.  So even with using my 'EMR"  I can now see about  ten patients/day.

Makes sense to me...sounds like the military.....

Health Train /stimulus

iHealthBeat reports today;

 

"Today in Denver, President Obama is scheduled to sign a $787 billion economic stimulus package that includes $19 billion for health IT that the House and Senate approved Friday, Healthcare IT News reports (Healthcare IT News, 2/17).

The House passed the stimulus package by a 246-183 margin with no Republican support, and the Senate approved the package by a 60-38 margin with the support of three Republicans (Hitt/Weisman, Wall Street Journal, 2/14).

Health IT Provisions

The legislation would:

• Provide $2 billion to the Office of the National Coordinator for Health IT, in part to support regional health information exchanges and establish regional extension centers;

• Require ONC to appoint a chief privacy officer;
• Strengthen HIPAA medical privacy rules;
• Establish health IT policy and standards committees as federal advisory committees;
• Require insurers and health care providers that participate in Medicare and Medicaid to use health IT systems that comply with national standards;
• Tap the National Institute of Standards and Technology to test health IT standards;
• Restrict the sale of information included in health records;
• Permit state attorneys general to sue individuals to enforce HIPAA medical privacy and security rules (Ferris, Government Health IT, 2/13); and
• Require vendors of electronic health records to alert individuals and the Federal Trade Commission of data breaches (Health Data Management, 2/17).

Prospects for Health IT Firms

In addition, several newspapers published articles recently examining expected financial benefits to health IT firms.  Headlines and links are provided below.

• "Electronic Health Records Closer to Reality" (Godinez, Dallas Morning News, 2/15).
• "Stimulus Has Billions for Health Technology" (DiStefano, Philadelphia Inquirer, 2/17).
• "Online Health Data in Remission" (Huslin, Washington Post, 2/16).

The bill also would provide health IT funds for the Social Security Administration, Indian Health Service, community health centers, and medical schools and other organizations.

The legislation aims to make electronic health records available to all U.S. residents by 2014 but would not require individuals to use EHRs (Government Health IT, 2/13).

Forecast

The Congressional Budget Office projects that health IT provisions in the stimulus package will result in 90% of doctors and 70% of hospitals using certified EHR systems by 2019 (Health Data Management, 2/13).

Health care experts and economists expect the health IT provisions to create jobs in IT and other related fields, reduce health care costs and improve efficiency in the health care system.

However, some Republican lawmakers and other conservatives criticized the bill's health IT provisions, arguing that the move was part of an effort by the Obama administration to rework the health care system with minimal public debate (Douglas, McClatchy/Kansas City Star, 2/13).

"No Batteries Required"

More Bailout Backwash

Move over Dr Leavitt!! Mark Leavitt has resurfaced rapidly after exiting stage left as the Obama administration takes over the center of government. He is now the Chair of the CCHIT, the body that certifies EMRs and information systems for interoperability. He and John Hamlaka as well as John Tooker, MD the head of the American College of Physicians write today in The Health Care blog about the progress of Health IT. It is an excellent read and accurately describes the present state of the ‘art’ and the forecasts and wishful thinking for the future.

Their forecast is for better times for health IT. Much of this results from the recent economic chaos and misery stimulating our central government to hand out dollars guised as stimulants. Health IT needs will be included in the framework of the overall program(s).

From failure comes success. Strange bedfellow….bank failure, crashing credit markets and a prediction and/or promise for a  booming health IT. Go figure! When we were ‘relatively rich’ there was nada for health IT. Five years or more ago ONCHIT was formed and RHIOs were encouraged, with mostly negative progress save for a few successful ones. Much of the work was done by volunteers, champions of IT, and others.

Mysterious Disappearance

For those of you who read my blog, my absence was due to technical problems, which have been fixed for the time being. I am awaiting my backup files to arrive.

Writing a daily blog has it's short comings, when events change hour to hour amongst the pundits and political activists.

Daschle's demise was probably devastating to Tom, since he had been an ardent supporter of Obama in his quest for the Presidency.  A " suitable "  replacement will be found quickly.

Daschle did have the unique perspective of political expediency and healthcare knowledge to guide healthcare policy through the maze of the legislative process.    This is a real set back in terms of 'trust' and the workings of the congress.  The new secretary of HHS will have to start at the gate. 

del.icio.us Tags: politics in healthcare,daschle,hhs

Highway Robbery on the Health Train

Willie Sutton, a notorious bank robber was asked, “Willy, why do you rob banks?” Willy replied, “’Cause that’s where the money is”

The WSJ blog recently ran a survey about how primary care funding can be increased.  The survey can be seen here.

The comments I made,

The poll results are most interesting, revealing a fairly even split across the board. This reflects the confusion, and disparate remedies proposed to ’save primary care and health care in general. It also tells the tale that there is no easy solution, at all. Money does not tell the entire story about primary cares negative features. I lay the entire blame on government and insurers. When CLIA came along 20 years ago many physician labs were put out of business, an important revenue source, within their own practice. Imagine a business that was ‘forced’ to use outside vendors for services easily provided in house, providing ‘convenience’ to their ‘customers’….That would be step one. Step two would be to provide additonal necessary services to patients, ie, pharmacy (which may or may not be economically feasible given today’s regulatory environment. Radiology, alternative medicine, accupuncture, chiropractic, et. also throw in  fortune tellers and palm readers (not the IT kind). As Obama once said. “It’s not a matter of too much or too little government, it’s getting it straight and doing it right.” What we need to do is signal the insurers and government that we will no longer serve their clients. Patient uproar would be so great within one month we would see a huge change. How about a 30 day withdrawal from practice. a 30 day vacation….it takes most payers 30 days to pay their bills….we can do the same thing.  If the patients take their medicine they will get better in the long run, no matter how bitter the medicine tastes. 

Comment by G. Levin M.D. - January 23, 2009 at 6:35 am

del.icio.us Tags: wall street journal,revenue,pharmacy,radiology,chiropractor,accupuncture,primary care income

The Life of Health Train Express

For almost five years now I have been blogging at this site. It has been very enjoyable. And no, this is not a farewell post, nor an explanation that I am too busy, or bored with it all.

Writing is a passion for some people, and computers and the internet give us all a new tool for creativity, networking and publication without all the hoo-ha of a formal writer’s or author’s support group, agents, publicists, book tours,  etc etc.

I have mined more from this experience, as most blogger’s have, than what I have contributed with my little blog espousing my small opinions from my perspective as a grass roots doctor.

I have written the blog with few comments made by readers, however for me it is not all about how many ‘hits’ nor comments I get.  I have refrained from ‘monetizing’ the blog as some have done.  My primary source of income has always remained clinical patient care, my  flirtation with blogging coming in  a very close second calling.  Recently I have been getting more comments and personal comments of how the blog is seen by other bloggers, Twit contacts, Facebook and the other social networking media of the ‘new generation’ of afficionados of tech. 

Inaugural Train Express

 

 

The Health Train Express joins the Obama entrance into Washington, D.C. for the beginning of a new era for the United States of America.

I must confess, I was not a big Obama supporter, with many doubts about the man.  I may have been wrong.  His campaign rhetoric seems distant from his early administrative proclamations. 

What does the new administration bode for us in medicine?  We have seen countless new administrations telling  us now is the time to adopt universal health care.  Congress has never agreed on how to attain that goal, either due to the fact that the devil is in the details, or a lack of conviction that it is correct to do for the United States.

I leave it at this.  “God Speed” President Barak Obama, and good luck to the rest of us.

 

del.icio.us Tags: obama,congress,universal health care,campaign rhetoric,inauguration

Health Train Express Dining Car..."Caramel Macchiato Anyone?"

QUOTES TO MUSIC  (click to listen)

My ego has been inflated (more than usual) by inclusion of Health Train Express in Richard Reece's  700th blog.   This for me is akin to making "Oprahs"  list of books to be read before "End times".

Matt Holt's recent "WONK" summarizes Dr Reeces' consistent eloquence in each of his blogs.  Medinnovation is always a 'must read' and deserves a spot in your "feeds list".  Richard"s  blog and Matt's "The Health Care Blog"  are right up there with my

"Carmel Macchiato at Starbucks !!!

While the holiday season was ongoing this "west coast ophthalmologist" has relocated to a secret undisclosed location on the "Mid-Atlantic" coast. I decided to change risk factors from earthquakes to tropical storms, tornadoes, and an occasional hurricane.

 

The Warrior Refractive Eye Surgery Program, or in militarese  WRSEP

I am safely ensconsed behind firewalls, encrypted smart cards, and two levels of separate  passwords requiring 12 characters, 2 upper case, and five lower case as well as several  of those special characters, !@#$%&* (which I have to change every 90 days).  The EMR is called AHLTA.  Armed Forces Health Longitudinal Technology Application (formerly CHCS II ; US DoD military health system 

(I could go on and on about this HIT solution, but that is a topic unto itself. So stay tuned.

 

del.icio.us Tags: wellness,medinnovation,the healthcare blog,klepper,kibbe,holt,reece,wonk,ahlta,passwords,smartcards,starbucks

Health Train Express--The New Engineer

Tom Daschle appears headed toward an easy confirmation as the head honcho at Health and Human Services, where he would oversee the FDA, Medicare and the NIH. Today, he had a friendly hearing before the Senate’s Health, Education, Labor and Pensions Committee

 He is no stranger to the hall of congress, and most legislators will be very comfortable with him as the  point man, bully pulpit for health reform.

His early pronouncements offer no new panacea, however he does espouse the new politically correct  illusion of "transparency"

Daschle cataloged a bunch of problems with the health system, from the “unacceptable” figure of nearly 46 million uninsured to a “loss of confidence” in the FDA. He of course pledged to work on these problems. Here are some highlights:

Health Reform: In his prepared statement, Daschle said reform “cannot be dictated from the White House and Washington,” but instead must come from the grassroots and must be an open and transparent process. He pledged close collaboration with Congress.

His next pronouncement is focused on the Food and Drug Administration:" 

Unfortunately, there is growing concern that the FDA may have lost the confidence of the public and Congress — much to our detriment. When Americans are nervous about eating spinach or tomatoes or cantaloupes, that’s not good for our health and it is terrible for our farmers. When nearly two-thirds of Americans do not trust the FDA’s ability to ensure the safety and effectiveness of pharmaceuticals, the result is Americans may hesitate to take important medications that protect their health. This is unacceptable."

National Institutes of Health:

The NIH’s funding has been flat in recent years, reducing the NIH’s “buying power,” Daschle said. There’s been a sharp drop in success rates for research grant applicants, with the figure at 10% for many of the institutes, he added. The NIH has also “suffered from some instances of people putting politics before science.” He said he’ll work to “strengthen NIH.”

None  of us can do anything but wish him the 'Best of Luck" and determination.

GML

del.icio.us Tags: food and drug administration,health reform,daschle,uninsured,national institute of health,transparency,health and human services

Critical

2009 brings nothing new in health care.  Tom Daschle invited me to hold a group meeting t several weeks ago to discuss what is on the minds of the country ( a kind of town meeting forum) and present a group consensus of what should be done to reform health care and health care financing.

Today I received an email from him requesting my report, in a survey form. 

 

Dear Gary,
Over the past two weeks, thousands of people representing all 50 states and every corner of the country have hosted health care discussions in their homes and communities. Just this week, I attended a discussion hosted by the Fire Department in Dublin, Indiana, and one hosted by a Senior Wellness Center in Southeast Washington, D.C.
Leading your discussion was the first step. Equally important, we want to hear back from you. I learned so much from attending discussions this week, and we want to know about your discussions, too.
The President-elect has asked me to share your feedback from these discussions -- that's why your submission is so essential.
Please tell us how your discussion went by visiting http://change.gov/reportback. We need to hear from you as soon as possible -- by Sunday, January 4th, 2009 at the latest -- so we can prepare our report for the President-elect.
Both President-elect Obama and I are committed to reforming the health care system from the grassroots up -- and leaders like you are crucial to that effort.
I'm looking forward to reading your submissions about your Health Care Community Discussions.
Thank you,
Tom
Tom Daschle
Secretary-designate
Department of Health and Human Services

Matthew Holt on The Health Blog accurately assesses this effort and mirrors my personal opinion on the liklihood of a political solution for what ails health care in America.

Matt's  takeaway points are:

Like legions of other wonks when I discovered that Tom Daschle was going to be Obama’s point guy on health care, I sent off for a copy of his book Critical. It’s a fast and easy read, but in its examination of the problem it doesn’t add much to superior books on what’s wrong with health care (much of the first section reads like an undergrad’s attempt to summarize Jonathan Cohn’s Sick) and there are some pretty weak logic flows and basic editing throughout (he refers to the book Uninsured in America on p155 as though it’s already been introduced before it actually gets introduced on p161). But ignoring all that, what does Daschle suggest we actually do?

The ill-fated & exclusive White House study groups of Feburary to May 1993 are therefore only to be repeated in set of window dressing home study groups & Internet bulletin boards—who’s participants will have as little actual positive impact on health reform as Ira Magaziner did in 1993–4. Still the process now is notably open.

Daschle likes and wants to see more of. Mental health parity is one, dental insurance is another, and long-term care a third. To be fair these are three areas crying out for a better solution, but Daschle doesn’t make it clear how we’re going to expand the current definition of insurance to include them. In addition these are areas for which Medicaid is the current de facto half-assed solution. Medicaid is a program Daschle likes, while many health policy wonks (well me anyway) think it should be abolished and rolled into a genuine universal social insurance system, or at least (as Paul Krugman suggests) be Federalized and thus removed from the vagaries of state budgets.

But the actual coverage solution Daschle proposes, which is pretty similar to the ones emanating from Clinton & Baucus are basically to expand FEHBP and give it both a Massachusetts Connector-type role and include in it a buy-in to Medicare, and to impose a pay or play option onto employers. Somehow he’d also expand Medicaid and S-CHIP, and then add to all this an individual mandate with subsidies to those who can’t afford to buy-in to FEBHP. The whole thing is tied together, sort-of, by a Federal Health Board

Daschle is damn lucky that he didn’t call his board Fannie Med, but he’s also unlucky in that he links it to the success of the Federal Reserve at a time when that “success” is looking, shall we say, shaky. However, the main role of the Federal Health Board would be as a cost-effectiveness review organization with teeth—in that Medicare, Medicaid & FEHBP would all be bound to follow its guidelines.

So the problem with this always comes back to two things.

One; most of the uninsured are working poor and their employers are the NFIB small employer crowd who are all for health reform until they figure out that it means they have to pay for it. Even despite the incredibly confused rhetoric coming out of NFIB lately, my guess is that only a puny Massachusetts type “pay” fine ($213 or so) will be little enough to get them to willingly back a public and compulsory plan for their employees. And of course at that point all but the richest of the remaining 55% or so of small employers who offer coverage will ditch it too, meaning that the public subsidy for the working poor to get insurance will have to be much greater than Daschle thinks. Not to mention the continuing administrative nightmare of figuring out whether someone should be in Medicaid, the new plan, or covered by their family member.

Second, while it may be getting harder and harder for the Sally Pipes of the world to get people worried about rationing when it’s clear that we already have it here but that they don’t really have it in Switzerland, Germany or France, the Federal Health Board will be fought tooth and nail by the industry. Sally Pipes is the author of "Miracle Cure"

As I’ve been saying for a long time, to rationally rationalize the health care system, we need to make cardiologists in Miami behave like cardiologists in Minnesota with a consequent impact on the incomes of doctors, hospitals and stent & speedboat salesman in high cost areas (Yes, Jeff, I do mean Louisiana, New York, Los Angeles and Boston too). If the Federal Health Board has teeth, that’s what it’ll do, and the AMA, AHA, AdvaMed, PhRMA et al know it.

So my guess is that the Federal Health Board, if it gets established, will get defanged by lobbyists immediately. The consequence of that is that the mish-mash of an “expand what we got now” system will cover a few more people at a lot more cost (as has been the Massachusetts experience). That’s OK because suddenly we’re rich (or at least suddenly the government is pretending it is!).

 

There is much more to be read on Matt Holt's Health Care Blog.
----

del.icio.us Tags: Daschle,Federal Health Bank,Medicaid,FEHBP,Matthew Holt

Health Train Analytics

No degree of dullness can safeguard a work against the determination of critics to find it fascinating.
  - Harold Rosenberg

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

This is my preface for today's stories

It's the end of 2008, and between nodding off and consuming egg nog there are some interesting blog writings, analyses, and reports emanating from various congressional reports, foundations, and health care think tanks.

If you are a pessimist the tanks are half empty or even empty, if you are an optimist the tank is half full.  If you are like most people, the 'tank' is meaningless and does not apply to the real world.

There is a certain amount of common sense that is lacking in many things we now have to deal with in our daily lives.

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

Robert Laszewski in THCB writes about two reports from the CBO detailing the options for reform of health care policy.

Caution, this is over a 600 page report, all written by Peter Orszag, Director of the CBO.

Mr Orszag is President-elect Obama's nominee for Director of the Office of Management and Budget.

Key Issues in Analyzing Major Health Insurance Proposals

Budget Options for Health Care (Volume 1)

Federal Perspective on Health Care Policy and Costs

Abbreviated summaries of the articles are here.

Key Issues

Budget Options, Volume 1

• Robert Laszewski opines, "After reading these two reports, totaling more than 400 pages of some of the most valuable health policy analysis I have ever seen, I now know that I had no reason to worry that the CBO would just tell the politicians what they wanted to hear."
• "It is also clear that, whoever the Congressional Democratic leadership appoints to succeed Orszag, a marker is down. The CBO is on the record about what the likely reform options will cost before anyone had a chance to bring political pressure to bear. And, that just might have been intentional."
• "The work contains an inventory of about all of the health care reform options being discussed complete with a thorough cost/benefit analysis detailing their impact on federal spending."

More details are forthcoming for the reader at The Health Care Blog, 

NAIVE POLICY MAKERS NEED NOT APPLY

 

I agree with Docanon that this is the best article on the subject I have read thus far.  Kudos to Mr. Laszewski......and to Peter Orszag.

del.icio.us Tags: OMB,Peter Orszag,Health Insurance proposals,federal perspective,congressional reports,health care think tanks

Content for 2008 Health Train Express

The end of 2008 certainly has been remarkable. What unexpected cataclysmic events await us in 2009? Will what we have experienced in 2008 give us a better understanding of other impending chaos, without our taking serious proactive measures, rather than retroactive reflexes.??? Read more at Health Train Express

Monthly Content for Health Train Express—December 2008

Primary Care

Interruption

Express 2008

Denoument

Brain Train and Fitness

Transitions

Transparency

Bailout

Cooling Down

Throwing Money

Consensus

Transition Team

Arogant Physicians (Surgeons)

Hypoprimarenia

And have a safe and blessed Christmas.