He's Back

 

Most of us realize that our government in D.C. has been out of control for over a decade (perhaps much longer).

According to this interview with Pete Stark, Congressman from California it makes sense that the more debt the government has, the wealthier the country is.

 

  I am not certain of the rationale of this statement but perhaps it alludes to the ability of our government to borrow money reflects upon our income, ability and willingness to make payments on that debt.  In October 2008 we came to an abrupt ending to that rhetoric.  The past 12 months are a witness to the failure of that economic model .  We shall call that "Pete Stark Economics".  Perhaps in 30 years or so Mr. Stark will be the Nobel Prize winner in Economics.  However I am not holding my breath,

More 'free' Things..

Health IT continues to be in the limelight of health reform. And there is a great deal of scrambling to obtain a share of the stimulus IT funding passed by congress this year.

Two cardiologists from Johns Hopkins University , David Meyerson and Sammy Zakira elaborate in the Washington Post a typical frustrating encounter for the majority of physicians who are confronted by a seriously ill patient and an unobtainable coherent medical history. Both of these physicians attend patients at the VA Hospitals in Baltimore, MD.

They write, "Most currently available electronic medical record software is unwieldy and difficult to quickly access, and there is still no vehicle for the timely exchange of critical medical data between providers and facilities." The cardiologists note that the federal stimulus package included about $50 billion for health IT, but they argue that "it will be difficult and costly to construct new systems ensuring interoperability of all current hospital software."

This does not address the issues of outpatient clinical care, which have a far greater number of clinical encounters.

The VA system has been using VISTA as their EMR. They advocate for the adoption of the VA VISTA system as the backbone for EMR in the United States. They also suggest that any other EMRs be interoperable with the VA system. Both of these suggestions enjoy considerable merit for several reasons.

1. It is a proven stable platform

2. It has been used by many or most physicians during training.

3. It is ‘free’. This is not entirely accurate. The program itself is free of charge, but does require some expertise in tweaking it for the underlying operating system. The operating system is somewhat arcane and no longer in popular demand.

4. There is a pool of IT specialists familiar with the system that can be ‘tapped’ for implementing the system and training it’s users.

5. The suggestion that other systems be interoperable with VISTA is a good one. The standard is there….and it works! This eliminates the controversy about which standard will be adopted. There are several competing certification organizations in play at this time. This will cause delays and perhaps avoid further confusion should several different regional standards emerge.

6. VISTA is scalable.

7. The taxpayers have already invested considerable ‘billions of dollars’ in this system.

The negatives are:

1. VISTA is not well designed for independent practitioners, or small group practices.

2. It bears the perhaps unwarranted ‘stigma’ of being a government computer system, with real and/or imagined prejudices against such a system. Such as the Post Office.

3. It is an ‘older system’ designed more than 15 years ago, with multiple ‘patches’.

The Uninsured Patient

One of the greatest frustrations for any physician in the U.S. is the "uninsured patient".  Coming face to face with one of the 'forgotten' patients can ruin an entire day of work. Knowing how to help a patient and being totally powerless to do so ranks right up there with an announced audit from the IRS and/or a letter from a plaintiff's attorney that you are about to get your a-- sued.

In fact what has evolved in most practice offices is a highly refined  filtering mechanism to keep these patients away from you, the physician.  This vicious and exclusionary process developed without any forethought as a means to insure the financial survival of our present health system.  It flies in the face of what  physicians are really all about....caring for people.

In order to see a physician you must be a 'card carrying" patient or have a wad of cash (which is rapidly evolving into a wad of plastic bits and bytes, or a wheelbarrow)  At any rate the 'plastic card' now carries more power that one could have ever imagined.

At one time it did not matter, doctors and hospitals could and did give away millions of dollars of care because they  were compensated fairly and sufficiently.  Even if ph ysicians gave away their services (which is a small percentage of total health care costs) the patient could not access lab work, imaging services, nor have access to medications.

THE MILLION MED MARCH

 

JOIN THE MARCH!!!

 

 

"I'm tired, mad as hell, and just not going to take it anymore," says Richard Chudacoff, MD, a gynecologist from Las Vegas. "I am going to Washington, DC. At noon, on Thursday, October 1, 2009, I will be on the Mall with a few other physicians."

How many times have YOU thought or even muttered this under your breath??

"We simply decided that we will not work that day and perhaps the day before and maybe even the day afterward," says Dr. Chudacoff. "Perhaps we will show the country that physicians are worth more than a $5 copay; that physicians are more important than a mid-level healthcare worker; and that our profession is needed, our services are required, and our practice is a calling to be respected, not a trade that is to be negotiated to the lowest bidder.

A letter posted by Dr. Chudacoff on www.obgyn.net in June has been spreading like wildfire across the Internet, finding its way to personal blogs, discussion groups, and professional forums.

On July 10, an MPC contributor and one of the supporters of the Million Med March launched a Website, www.millionmedmarch.com, to build support for the October event.

 

A  TOWNHALL MEETING IN FREMONT CALIFORNIA WITH DEMOCRAT, PETE STARK .

 

Some images from the March of September 10th,2009,AND THERE WILL BE ANOTHER GATHERING ON OCTOBER 1, 2009.

 

 

Don't forget...be there on October 1, 2009

Join the March:

The Medicare Value Index

Sen. Amy Klobuchar, D-Minn., has advanced this proposal as part of her Medicare Payment Improvement Act, and it is now at the center of the Senate's discussion on how to craft health care reform.

The value index would penalize Medicare providers that spend above the national average and reward providers that spend below the national average with more funding. The idea is to raise the quality of health care and encourage efficiency, but in reality it will undercut those with the greatest health care needs, namely the poor and minorities.

By failing to consider major factors driving regional spending differences, the value index is not what proponents make it out to be. Consider this: The average monthly rent in San Mateo is $1,658 while it's $873 in Minneapolis. Salaries for medical support staff are considerably higher in California than in Midwestern states. None of that is reflected in the value index's calculation. So absent any other factors, the proposal would direct more funding to places with a lower cost of doing business, which has nothing to do with the quality or efficiency of medical treatment.

A version of the value index is part of the health care reform plan unveiled Wednesday by Sen. Max Baucus, D-Mont. (The House's health care reform bill, HR 3200, would commission a study on Medicare's spending differences and consider what to do about them at a later date.)

(these studies have been done, and are already available from previous medicare data)

OBAMA LIES??

 

A few simple solutions:  Are we up to it?

 

From the California Health Care Foundation: Another simple solution.

Gubernatorial Candidate Campbell Offers Health Plan for California

OBAMA   LIES??     or perhaps to put it more gently, HE DOESN'T KNOW WHAT HE IS TALKING ABOUT.

Recently in MedPolitics,     EvanMadianosMD    -discuses's the producers of health care.

The largest problem in our health cares system is....the uninsured. 

Physicians when they come across uninsured patients feel great angst that they cannot order tests, or do appropriate indicated procedures for a patient.  This perhaps is the greatest stress of today's medicine.  This is the reason many physicians chose to work for the VA, Military System,,, or large prepaid groups such As Kaiser Permanente, the patients are pre screened already and there is no doubt for the physicians that they will be able to provide quality care.

Lumping our present health system into the  supposed evils of capitalism, greed and avarice does a great disservice to all physicians and hospitals.  We have been thrown into an atmosphere of rhetoric not by our actions but the misappropriation of slick  phrases and comparisons to the advantages of 'socialized medicine in a 'new world order' of utopia.

  Few in the arena of proponents of health care reform elaborate on the evils of that system.  There is no reason our system should 'ration' health care.....physicians certainly don't do that unless they are economically coerced to do so.....at the expense of their very financial survival.

 

Dr  EvanMadianosMD  goes on further,

"In Ayn Rand's timeless novel Atlas Shrugged, the mysterious hero John Galt is a symbol of the man whose productive energy is withdrawn from the world in protest against living as the despised pawn of the state. But Ayn Rand was aware that the disappearance of the men of talent did not always happen as a deliberate act of protest; it is often just the natural outcome of any system that punishes hard work, ambition, and independent thought, discouraging and demoralizing men with those life-giving qualities. This is what some people have started referring to as "going Galt."

If we accept such a system in the medical profession, we could find ourselves paging Dr. Galt—and getting no answer. "

 

del.icio.us Tags: Medpolitics,healthtrain express,Ayn Rand,John Galt,Atlas Shrugged,Tom Campbell

It's True, It's True

I wanted to thank all of you who attended the recent 'golden llama awards ceremony, attended by  Representative Paul Ryan, Joe Wilson (you lie,  you lie)

Vice president Joe Biden, ex VP Dick Cheney,and numerous honored guests.

I also have it from an undisclosed source who prefers to remain anonymous  since (he,(she) is not authorized to make a statement) that Michelle Obama was lurking under one of the tables hoping that her husband would  receive a Llama.

Mr. Obama, however was making the rounds of

CNN, MSNBC, ABC,  Foxnews, NPR,  CBS,  CW, CNBC,  SciFi, The Discovery Channel, The History Channel, and his most important appearance on "Dirty Jobs".

I should also recognize Borat and Bruno

who could not attend due to other prior commitments. Borat and Bruno have made great contributions(not) to American Healthcare (not), as well.

Health Train is honored to accept the award on behalf of Thomas the Train

and will offer free transportation to the Llamas on their way to

the awardees. (please check in 2 hours early for security screening)

It is truly an honor to receive this highly coveted award at this time  in my life.

It will occupy the last remaining space on my office wall,

in lieu of any board recertification certificates.

I shall honor and treasure this award, and will submit it on my next log of CME credits....(How many CME credits do I get for it?)

Well Worth Repeating on the Health Train

September 08, 2009

From  The Health Care Blog (Thank you Matt Holt)

10,000 US physicians have something to say and we're not wasting time.

By DANIEL PALESTRANT, MD

Today, as Congress returns to session, all 100 Senators will be listening to physicians on SERMO when they deliver the “US Physician’s Appeal” on Capitol Hill.   Wasting no time, my physician colleagues and I, armed with the over 10,000 signatures will deliver the Appeal directly to lawmakers, requesting them to include us in national health reform strategy.

We are pledging our commitment to true healthcare reform focused on the real sources of spiraling, bureaucratic costs and by doing this on day one of Congress’ return, we are telling them that true healthcare reform will only succeed IF:

1. Tort and malpractice laws are reformed; 
2. Billing is streamlined and pricing made transparent, ending systemic support of the AMA owned billing codes (CPT Codes);
3. The insurance industry is reformed; and
4. Payment systems are simplified so they align with the growing need for preventive medicine.

US physicians have a unique perspective on the systemic changes needed because we are on the forefront of care every day-in between patients, hospitals, Medicare, Medicaid, and insurance companies.  Physicians more than any stakeholder group understand the need for pragmatic reform, not politically negotiated reform and we must be included for solutions to work. 

With the Appeal, the SERMO community is seeking participation from every member of the US Senate to work with us to bridge a communication gap dominated by the influence of special interest groups; inviting policy makers to engage directly with us by posting questions, discussion topics and blog entries directly into the largest physicians-only online network, in an electronic online forum to discuss ideas and developments in the healthcare reform debate, in real time.  
Today, in Washington, we’ll formally deliver the “US Physician’s Appeal” for lawmaker’s consideration to all 100 Senator’s offices. If you can’t be there, find us onlineat http://www.sermo.com/reform  where you can sign the appeal; and then make your opinion known by getting in touch with your Senators by visiting www.senate.gov and click on “Senators”.
We have strength in numbers and if the physician voice is loud enough, it will be heard.
Dr. Daniel Palestrant is the CEO of SERMO and was recently named one of the country’s “50 Most Powerful Physicians” by Modern Physician, and Business Week has named SERMO as one of the “Top 50 Tech Startups” globally. SERMO is where over 110,000 physicians are leveraging the power of social media to drive better patient care and have their voices heard.

More by this author:

• Can Social Media Save Healthcare Reform?

del.icio.us Tags: Dan Palestrant,The Health Care Blog,Health Train Express,SERMO,health reform,social media

Health care Systems in Europe

It is down  to 'crunch time'. The media are calling this the biggest speech of President Obama's first year in office.  The media thrives on playing off Republicans vs. Democrats, Left vs. Right.

We physicians are cynics when it comes to government and bureaucracy.  We like to get down and 'dirty' and see and treat with minimal interruption, minimize record keeping, and other paperwork.   Let's be real....for every patient encounter..ten minutes of recording data or notes adds up to several hours/day.

Will EMR improve efficiency?  Perhaps it will if someone other than the physician enters the data.  At 200 dollars/ physician  hour in productivity assigning this responsibility is both foolish, and not cost effective.  How many secretaries earn two hundred dollar/hour?

Physicians are a 'hard sell', by the very nature of our training, we observe, gather facts, study, analyze and render opinions, and diagnoses. 

Most of us have had the privelege and ability to chose the type of organization in which we practice and see patients.  Whether it is a group, large integrated healthcare organization or solo practice, we have had the ability to chose.

This weekend from September 10th through September 13th a number of physician groups will travel to Washington, D.C. to  meet with their representatives.  No doubt the media will be there as well.

Our angst will be shared with the unemployed, foreclosed, and uinsured, amidst a sea-change in credit markets, corporate mergers, federal bailouts of banks, financial markets, and underwriting the automobile industry, once the golden measure of American success .

Our government borrows money for many reasons...to fight wars, to fund large building projects, for operational expenses of the pentagon and many other government activities, NASA included.

Many of these activities are accomplished at the expense of healthcare. What are our priorities? 

This does not seem to be a prudent  time to make another revolutionary change in a segment of our economy which now represents 16% of the GDP. 

Most of us patients, and providers alike see access as a problem both in terms of availablilty and affordability, as well as predatoroy insurance company practices.

We need to plug the holes in our system.  There are many other health systems that do just this.  Universal payor is not synonymous with socialized medicine, despite what the AMA and some physicians state.

T.R. Reid points out the strengths of the systems in France, and Switzerland, which provides guarranteed health care for all citizens. 

Depending on the way of financing there are 4 healthcare models

Health Care Systems - Four Basic Models

“Semashko” model – state monopoly

“Bismark” model –social health insurance system

“Beverage” model – a combination of National Health Service and health insurance

“Kennedy” model – also a mixed system, with private structures prevailing in both healthcare and health insurance.

THE GATEKEEPER

Labor Day

Here it is the last of the four day weekend for me.  Seems it was just Friday with three days off.

I had a chance to do much reading and study all the different propositions for health care reform.

Analysts all agree that the United States has the best quality of science, and technology available to those who can pay for it. Our system of health care payments is failing (or has failed), much like the 'bubble' in real estate, financial markets, and internet technology.

So why should we be any different?

T.R. Reid offers a dispassionate appraisal of health systems throughout the developed world.  Reid is a strong proponent of unified health care delivery. He states that the best programs, such as those in Switzerland, France, Germany and Taiwan (yes Virginia, Taiwan). are actually private models, unified by universal access, universal payment standards, and governmental subsidy for those that are uninsured, or uninsurable. They are not employer based.

He espouses the opinion these systems are not 'socialized medicine systems.

His 2008 Frontline documentary, "Sick Around the World", looked at the comprehensive health care systems of five developed economies from around the world. The first two countries visited were the U.K. and Japan, where he had previously worked and also received medical care.^[4] They were followed by Germany, Taiwan, and Switzerland.^[5]  

The AMA has a Blog

The AMA has a blog (no comments allowed, yet), and a VISION for Health Reform. It all sounds so wonderful and idyllic. Some of us bought into this mindset decades ago with good intentions, only to be used, abused, and betrayed by many who we thought were on the same road to provide care to our patients. The AMA still has good intentions, but it may be warped into positions which are not intended by the membership, (and non-membership). These physicians have little to say in the organization, if they continue voting with their feet.

del.icio.us Tags: ama,blog,social media,health reform

Universal Debt

I have not been posting as regularly as I would like to. I've been busy working and spending whatever leftover time reading about proposed health care reform....The townhall meetings have raised a lot of questions and questionable answers.  Legislators admit, there is no bill.  (How could President Obama even suggest it could be decided an passed before the August recess?)

One has to learn to read between the lines and hear what is not being said during these townhalls.

A disturbing trend is how the media develops opinions and offers criticisms regarding the proposals.  I've taken some time to read parts of the drafts and read some analysis by those who have a lot more time than I do.

There is a high interest and    opinions in the blogosphere as well. I check on that daily to find bloggers have a lot of  'sechel', a yiddish term for common sense and smarts.

To keep my brain from rotting out as I approach retirement I have  contracted with the --------- (at an undisclosed location). After a long and busy professional life in private practice I am now a 'humble" worker in a defense installation. I've been here about a year and as I have always suspected that this is how socialized medicine would be.

I see 14 patients a day, spend about half of my day entering histories and finding into the EMR.  Sometimes I have a technician, and rarely have an assistant with me at surgery. In private practice most eye surgeons will do 4 cases/hour, here it's about one and maybe 2 cases/hour.  No ASC or surgery center could make it on that volume.  In a socialized system, it would not matter....in fact it would be a good thing.  I do my own clerical work, phone calls, chase down small things (much like an intern). I have volunteer workers who come to my office and open my cabinets, to explore and see if I have any 'unauthorized and/or expired bottles of drops in my cabinets. If so, they disappear without any communication with me.  I am not allowed to keep things like 1% Atropine in my lane, for fear I might use it to dilate a general by mistake for over a week. 

Surprisingly coding is a big issue....and I spend at least half of my documentation with CPT and ICD coding.  The  ----- does use an accountability system based on RVUs and each doctor is audited, so that the budget can be justified.  The system however is a bit unique and allows 'up-coding' generously, in that bilateral procedures are coded for twice the RVUs.

On the up side,as I head closer to retirement, this phase of my career allows me to continue caring for patients...the reason I went into medicine in the first place...We all know how much commitment, dedication and sheer will power and energy is required to practice medicine either solo or in a group setting.

Interspersed with all of this  is the necessary day to day family and individual personal and financial commitments.

Unless you have walked in my shoes....don't criticize, or give me unneeded advise, unless I ask.  I am not bashful about telling some pundits and 'reformers' to "buzz off"

HR 3200--The not so Fine Print

Congressman Mike Rogers, Michigan speaks about HR 3200.

 

Pass this along to your colleagues, and  your patients.....

Perverse incentives:::