Health Train's New Track

Make everything as simple as possible, but not simpler. Albert Einstein

 

Are they Listening? Apparently so. Providers now have an eager, and respected voice at one of the ‘decision making’ levels in the bureaucracy of those inside the “beltway”. David Blumenthal the new head of ONCHIT has made some public statements in regard to ‘haste makes waste’. In his recent statements in the April 9, 2009 edition of the NEJM Dr Blumenthal reiterates what most all providers already know. “Keep it simple”.

Dr. Blumenthal, most recently director of the Institute for Health Policy at Massachusetts General Hospital/Partners HealthCare System in Boston, states in the NEJM article that one challenge for HITECH is a tight schedule. "The infrastructure to support HIT [health information technology] should be in place well before 2011 if physicians and hospitals are to be prepared to benefit from the most generous Medicare and Medicaid bonuses," he writes. Appointed last month as the national coordinator for health information technology in the Department of Health and Human Services, internist David Blumenthal, MD, will play a key role in implementing a portion of the American Recovery and Reinvestment Act dubbed the Health Information Technology for Economic and Clinical Health (HITECH) Act.

Don't Force Physicians to Buy User-Unfriendly Systems

What those standards and policies will look like is Dr. Blumenthal's other big worry. According to HITECH, only a certified EHR system qualifies for a bonus, yet the law doesn't specify who will perform the certification. There's a contender in the wings — the Certification Commission for Healthcare Information Technology (CCHIT) — but Dr. Blumenthal writes that many CCHIT-certified programs "are neither user-friendly nor designed to meet HITECH's ambitious goal of improving quality and efficiency in the health care system."

Other “power players” in the advisory role for HIT, David Kibbe, Sam Karp, and Ben Park all summed it up by stating the following:

All the EHR authorities interviewed by Medscape Medical News agreed with Dr. Blumenthal's assertion that physicians will feel more motivated to use EHRs if third-party payers reimburse them for improving the quality and efficiency of healthcare. Family physician Ben Park, MD, an EHR user for 30 years and CEO of a 200-physician network in Indiana and Ohio, said more pay-for-performance programs and their reliance on data collection would hasten EHR adoption, assuming payers put more money on the table. "Right now, it's peanuts for performance," he said.

For many physicians and HIT advocates, the "meaningful use" requirements of HITECH represent another unsettling question mark because they have' not been fully spelled out. For example, physicians must use their EHRs to report how they perform on clinical quality measures that HHS has yet to select, but which will lean toward the management of high-cost, chronic diseases. Dr. Blumenthal warns in his NEJM article that the bar for meaningful use could be set too high, frustrating physicians and hospitals. Sam Karp recommends starting low, with quality measures as elemental as receiving lab results electronically, or reducing adverse drug interactions (made possible by automatic alerts that pop up during electronic prescribing).

Don't Force Physicians to Buy User-Unfriendly Systems

What those standards and policies will look like is Dr. Blumenthal's other big worry. According to HITECH, only a certified EHR system qualifies for a bonus, yet the law doesn't specify who will perform the certification. There's a contender in the wings — the Certification Commission for Healthcare Information Technology (CCHIT) — but Dr. Blumenthal writes that many CCHIT-certified programs "are neither user-friendly nor designed to meet HITECH's ambitious goal of improving quality and efficiency in the health care system."

Dr. Park's desire for higher pay also applies to the HITECH incentives, which he considers too low. Sharing his view is Micky Tripathi, president and CEO of the nonprofit Massachusetts eHealth Collaborative, which has helped some 600 physicians implement EHR systems. Based on his group's experience, Mr. Tripathi estimates that $44,000 in incentives under Medicare would cover only about two thirds of a physician's EHR costs over 5 years.

"The way this program is currently structured, the odds are quite low that EHRs will get high adoption," Mr. Tripathi said.

del.icio.us Tags: onchit,blumenthal,healthtrain express,karp,nejm,ehealth collaborative,ehr,hie,cchit,hhs,hitech

HIMMS REPORT from iHealthbeat

Federal Stimulus Package Hot Topic of This Month's Annual HIMSS Conference

This Audiocast  Special Report from iHealthbeat discusses the overall view of new funding of health IT.

New Stimulus package incentive payment estimates

Newly Named Health IT Chief Addresses Federal Stimulus Funding

And it just keeps getting better and better. "I'm from the government and I am here to help you."

Recovery

Recovery Dialogue:

IT Solutions
For one week beginning April 27th, The Recovery Accountability and Transparency Board and the Office of Management and Budget in partnership with the National Academy of Public Administration, will host a national online dialogue to engage leading information technology (IT) vendors, thinkers, and consumers in answering a key question:

What ideas, tools, and approaches can make Recovery.gov a place where all citizens can transparently monitor the expenditure and use of recovery funds?

Participants from across the IT community will be able to recommend, discuss, and vote on the best ideas, tools, and approaches. Your ideas can directly impact how Recovery.gov operates and ensure that our economic recovery is the most transparent and accountable in history. Mark your calendars and check back for the web link and additional information.

New NIH Recovery Act Opportunity Seeks to Fund High Impact, Large-Scale, Accelerated Research

Monday, April 13, 2009

Goal to Promote Growth and Investment in Biomedical R&D, Public Health and Health Care Delivery

The National Institutes of Health highlighted a new funding opportunity under the Recovery Act that will support approximately $200 million in large-scale research projects that have a high likelihood of enabling growth and investment in biomedical research and development, public health and health care delivery. The purpose of this new program, the Research and Research Infrastructure "Grand Opportunities" (GO), is to support high impact ideas that lend themselves to short-term funding and may lay the foundation for new fields of scientific inquiry.

Read More.

 

del.icio.us Tags: healthtrain express,recovery.gov nih recovery act opportunity,health information technology vendors

Health 2.0

For you afficionados of SAS, and asp solutions,stay tuned to the imminent meeting of the new improved merger of Health 2.0  and Ix . Much  more information is available by clicking here or on the logo below.

AMA joins the Health Train Express

 

Who said the American Medical Association is out of touch with today's rising provider stars under the age of 55? Not relevant? Does not represent the vast majority of physicians in regard to government regulations?  A group of Medical Politicians? Not so! The AMA now has a place on Twitter, and  "Twits" about all things medical.  Actually the correct term is   "Tweet".

Tweetie Pie is a 1947 Merrie Melodies cartoon directed by Friz Freleng and produced by Warner Bros. Cartoons, depicting the first pairing of Tweety and Sylvester.

I hope that my dues to the AMA are not being spent on this 'ridiculous' means of marketing and communications. The twits are limited to somewhere around 140 characters. Twit is actually meant for cell phone and smart messaging.  It is equivalent to your pager going off to tell you about some medical news or other item the AMA deems important to physician members.  (They ought to spend more time and money for information flowng at them, not from them.)

I started this particular entry several days ago......not much interest now in finishing it.

On to more challenging issues, such as how and why TARP is around and how we will be 'stimulated' and prodded to adopt EHR and HIT. There is much material to review and I will be back!!

Misdirected Heat IT Funding Chapter II

I never think of the future. It comes soon enough. Albert Einstein

 

 

....There are other ways to utilize HIT in direct patient care that would create enormous dividends and decrease medicare and private payments to hospitals.

The Silver Bullet Approach

A recent study revealed that a great number of medicare beneficiaries are re-admitted to hospital within 30 days of their discharge due to inadequate post discharge followup.

The study published by the New England Journal of Medicine   states,  "Twenty-two per cent of Medicare hospitalizations were followed by a readmission within 60 days of discharge. Medicare spent over $2.5 billion per year (24 per cent of Medicare inpatient expenditures) on such readmissions between 1974 and 1977.  This study  supercedes similar studies in 1994-1996, and 1984-1986.  The study cohorts are not similar in demographics or provider institutions and may not be comparable.

In this study, the cost of unplanned overcapitalization in 2004 was estimated to account for US$17.4 billion of the $102.6 billion in hospital payments from Medicare. A large percentage of bounce-back admissions appear to be related directly to poorly coordinated transitions of care. Given that a woeful percentage of patients attend follow-up visits, tremendous  improvement might be possible if patients were seen by their primary care physicians within a few weeks after discharge.

Other articles explain how medicare's prospective payment as well as  DRG reimbursement plan has created this

difficulty and increased expenditures,and how improvement might be possible if patients were seen by their primary care physicians within a few weeks after discharge.  (Does a shorter hospital stay reduce costs and/or increase readmission rates. ) Are patients stable on discharge?

Would HIT spending in this area, applied in a systematic way reduce these expenditures?  Why spend it all on EMR and HIE?

Richard Reece MD, who writes in Medinnovation Blog elaborates on how these billions of dollars might well be apportioned more wisely.

del.icio.us Tags: Health Train express,medinnovation blog,richard reece,NEJM,Medicare,DRG,Prospective payments,readmissons,telemedicine,health it spending,stimulus package,emr,hie

Misdirected Health IT Funding

Let it be said that the Federal Government knows how to spend money on the wrong things in the wrong way.

THE SILVER BULLET APPROACH

One of the hypothesis (and yet to be proven) is that EMRs, and Health Information Exchanges will lower costs for medicare and private insurers.

The recent promises of using stimulus funds to promote health information technology while well intentioned has not been well thought out.

The financial structuring of the incentives is to 'rush' to implementation.  This will actually encourage the adoption of immature and inadequate electronic medical record systems. Interoperability and certifications do not ensure an efficient or  useful EMR.

Those providers who adopt this incentive thinking that the initial payoff in incentives will offset any possible penalties for delaying implementation.  Furthermore they may adopt a system that will actually cost them more in the long run, by being inadequate for their use.

This legislation for HIT funding is fueled by industry lobbyists (vendors), and organizations such as HIMMS which are largely directed by vendors themselves.

They wait at the doors of "public funding" for their take of stimulus funds. 

 

Adopter

 

Medpedia

Ask not what you can do for your Country, ask what your kids can do for you???

 

What did we ‘baby boomers’ do right?? How come almost everything we attempt to do, turns out to harm us more than help us??

Cover you A-s

I came across this on Matt Holt's ''The Health Care Blog" this AM during my usual scan of the health blogosphere.

Blogging has surely tapped into sources that most physicians have neither the access, nor time to analyze.

The health care situation" has now been posited for the iminent financial underpinning of the economy and it's rush toward doom. Numerous bean counters will bemoan the fact that the

health care portion of the economy is increasing in relation to the GDP to the point where it is unsustainable.

 

Will a "Universal Payor" (socialized, or privatized) do anything to reverse this trend??  Most providers recognized the inherent inefficiencies and redundant bureaucratic organizations operating in the healthcare sphere.

Health care has been labelled as 'the driving force' toward financial doom as it's financial underpinning and never ending demand for services. 

In the past, venture capital funding for health care has been meager when compared to the rest of the financial world.

Tim Mullaney in The Health Care Blog  discusses the Psilos Group's plan to raise 450 million dollars. The fund support Health Care Technology and Services.

del.icio.us Tags: Bill Maher,health care,tim mullaney,healthtrain express

Fundamental,Rebuild,Minor Changes

During the past several months I was certain that the public, congress and others were edging toward health care reform. However, Matt Holt points to a report from the Pew Research group, that change is 'not what we need'.

What's in a word?  Rebuild,fundamental change, minor changes, don't know....

Can we liken this to the annual  automobile re-designs? Complete rebuild---unrecognizable new model.  Fundamental changes---new fenders and bumpers. Only minor changes--new badges, relocate chrome, rename model.

Only time will tell which one of these  'revolutionary, evidence based, cost effective solutions will rise above the frey.

Health Train Express--KIA

Incredible as it may seem, the province of Quebec in Canada does not have an emergency medical helicopter transport service.

Did this contribute to the 'window of opportunity" to save Natasha Richardson's  life?

This is pure speculation on my part, but the question also arose in an article posted on the Associated Press' web site this morning.

The high visibility of this tragedy should awaken the medical community and it's provincial medical authorities to the sad nature of a system that does not meet a standard available in most of the North  American Continent.  While fairly remote and isolated Mount Tremblant

is a world class ski resort which draws an international crowd of ordinary, famous, stars and celebrities.

While skiing is not  considered a dangerous sport, in reality it is a fairly high risk activity, witness the presence of many orthopedic surgeons and/or urgent care centers dedicated to treating sportsmen with fractures, sprains, and concussions.

The Mt Tremblant web site now displays the following warning:

Warning!

The helmet is now mandatory for all snow parks users.

 

Is this the inevitable outcome of a nationalized health care system, where everything is planned and budgeted years in advance or simple negligence?  Natalie Richardson and Mr Neelsen will not benefit from this lack of services, however hopefully it will stimulate a provincial outrage in Quebec. The lack of speedy medical  helicopter transportation effects not only this ski resort but the entire province and cities in Quebec.  Undoubtedly this accident will create mandatory ski helmet rules at all ski facilities around the world. Some of the helmets are "way cool".. I might even take up skiing once again.

del.icio.us Tags: health train express,skiing,medical helicopters,mount remblant,quebec,national health care,epidural hemorrhage

Rodney Dangerfield MD on the Health Train Express

" I don't get no respect' is the mantra we have   heard from Dangerfield.  According to many pundits, public policy advisors, health insurance companies, utilization reviewers, CMS, and more than the number of ABMS approved specialty categories, we  physicians are complete 'fools'.

 

from "Dave" 's commentary on the Wall Street Journal blog

Where have you been all my life?
What a numbskull I’ve been!
First, I get a BS in Biology, then an MS in Molecular Biology, then 4 years in medical school, 4 more years of training, triple-board certification, 20 years of seeing patients honing my diagnostic skills, none-stop study, dozens of medical conferences, thousands of internet searches…
When all I really needed was your “cookbook.” Is it on Amazon?
By the way, I have no patience for idiotic CEOs who recommend cookbook medicine when no such cookbook exists.

del.icio.us Tags: ceo,dangerfield,mantra,cookbook medicine

Health Train Humor

Marge, it takes two to lie. One to lie and one to listen. Homer Simpson

 

If you want a short brief read, don't go further.  This edition will ramble, rant and rave about all things in healthcare and it's accompanying political parasites, and doctor wannabees. (those guys who could not quite get into med school, who write blogs, author medical articles, and become spokesmen for the rest of us who are too busy with patient care to have time to write much until we either semi retire, stroke out or have disablity.  Let's face it I did not go into medicine primarily to become a civil servant, although I did chose it to help my fellow man with what I then thought was my superior intellect, good looks, and the unending ability to get dates. I also thought it would never become boring.

 

Injection of Humor:

 

 

I am also wondering how our health insurance industry is enmeshed in  the AIG fiasco.  Are they the next AIG, and will they get bail out funds in several months?  You know that all these crooks and thieves play golf at the same club, don't you??

 

Admittedly I am biased about many things. One of my favorite sanctimonious and self centered prejudices is that doctor wannabes (health care pundits, consultants, hospital administrators, utilization reviewers, health policy writers, and planners, ad infinitum and nauseum in their efforts to contain health care costs actually increase them enormously.