A Fairy Tale

Bricks, Straw, or ?    This is an interesting metaphor, and it may apply well to the  current health debate.

Too big to fail? Health care reform, or Dubai?

Obama's 'glow" is diminishing, even amongst the 'faithful, and gullible.

Matt Holt and THCB quote"

There’s a big to-do about whether there are really any cost-saving measures in the House and Senate bill. Most people say that the answers are “no” and “sort of”.

But let’s not dwell on that. Instead let’s have some fun. Regular THCB readers will know that AHIP’s Karen Ignagni has told half-truth after half-truth after outright lie to protect the position of her members. All the while somehow holding together a coalition that really should have broken apart long ago (and may yet still do that). And she gets paid very well for that role.

But today in the WaPo she told the truth:"

 

Karen Ignagni, president of America's Health Insurance Plans, said the Senate bill includes only "pilot programs and timid steps" to reform the health-care delivery system, "given the scope of the cost challenge the nation faces." Unless lawmakers institute changes across the entire system, Ignagni said in a statement Wednesday, "Health costs will continue to weigh down the economy and place a crushing burden on employers and families."

More Docs4Patient Care

Another rally....get involved, patients and providers alike.

Forward the link- 

Go Viral:

Meaningful Use and Incentive Payments

In one of my previous posts I alluded to this.

 

Read it here first !!

 

RECENT COMMENTS FROM IHEALTHBEAT.

MGMA Letter Details Concerns About Health IT Stimulus Funds

On Sunday, the Medical Group Management Association sent a letter to National Coordinator for Health IT David Blumenthal detailing its concerns about the implementation of the federal economic stimulus package's health IT incentive program, Modern Healthcare reports.

Under the stimulus package, health care providers who demonstrate "meaningful use" of electronic health records will qualify for increased federal incentive payments (Conn, Modern Healthcare, 11/23).

In the letter, MGMA argues that health care providers could miss out on the stimulus funds if the government fails to appropriately define meaningful use and administer the program effectively.

To avoid these pitfalls, MGMA recommended that the federal government:

• Allow for flexibility in approaches to meaningful use;
• Create a pilot program to test the incentive payment initiative;
• Develop a simple process to demonstrate meaningful use;
• Emphasize tested and widespread criteria when defining meaningful use;
• Enable physicians to test their reporting systems prior to full implementation;
• Focus on appropriate and achievable meaningful use criteria;
• Monitor the health IT industry; and
• Simplify data reporting processes.

MGMA also called on the government to encourage the health IT vendor community to develop high-quality and affordable software (Hardy, Healthcare IT News, 11/23).

Docs4Patient Care

I've been gone for a week or so on a trip to the ancestral homeland in California. (ancestral in California means longer than five years ago.)

The Docs4Patient Care movment will be very active on November 21, 2009 with chapters now in many states, including Georgia, California, Texas, as well as many other videos. Here is a 'shout out' for recent activities.

Here is a brief video:

Failed California, Failed State,Failed Health Care Reform

Undoubtedly we will see some form of compromise and legislating 'Health Care Reform".  Whether it will truly be a health care reform will be open to debate. Let's face, it seeking perfection is anathema to seeking improvement. Never let perfection obstruct improvement in the status quo. Charlie Rose interviews Friedman.

 

 

NRO, National Review Online report from Grace-Marie-Turner reflects the following.

Further, endorsements by the AARP and the American Medical Association have been largely discredited as reflecting more the narrow interest of those organizations than the will of their members.

Readers should do their part by contacting the following representatives who are most likely to influence health reform decisions.

Key Senator Contacts for Health Care ‘Reform’ Bill

State Senator D.C. Phone # D.C. Fax # State Office Phone # State Office Fax #

AR Blanche Lincoln (2010) 202 224 4843 202 228 1371 501 375 2993 501 375 7064

PA Arlen Specter (2010) 202 224 4254 202 228 1229 215 597 7200 215 597 0406

IN Evan Bayh (2010) 202 224 5623 202 2281377 317 554 0750 317 554 0760

OR Ron Wyden (2010) 202 224 5244 202 228 2717 503 326 7525 503 326 7528

LA Mary Landrieu 202 224 5824 202 224 9735 504 589 2427 504 589 4023

NE Ben Nelson 202 224 6551 202 228 0012 402 441 4600 402 391 4725, 402 476 8753

ND Kent Conrad 202 224 2043 202 224 7776 701 232 8030 701 232 6449

DE Tom Carper 202 224 2441 202 228 2190 302 573 6291 302 573 6434

CO Michael Bennet (2010) 202 224 5852 202 228 5036 303 455 7600 303 455 8851

CA Barbara Boxer (2010) 202 224 3553 202 224 0454 213 894 5000 202 224 0357

AR Mark Pryor 202 224 2353 202 228 0908 501 324 6336 501 324 5320

CO Mark Udall 202 224 5941 202 224 6471 303 650 7820 303 650 7827

CT Joe Lieberman (Indpndt) 202 224 4041 202 224 9750 860 549 8463 860 549 8477

VA Mark Warner 202 224 2023 202 224 6295 804 775 2314 804 775 2319

VA Jim Webb 202 224 4024 202 228 6363 804 771 2221 804 771 8313

MT Jon Tester 202 224 2644 202 224 8594 406 449 5401 406 449 5462

VE Bernard Sanders (Indpndt)202 224 5141 202 228 0776 800 339 9834 802 860 6370

MO Claire McCaskill 202 224 6154 202 228 6326 314 367 1364 314 361 8649

ME Olympia Snowe (Rep) 202 224 5344 202 224 1946 207 874 0883 207 874 7631

ME Susan Collins (Rep) 202 224 2523 202 224 2693 207 780 3575 207 828 0380

To obtain all the required contact information for these senators, go to www.congressmerge.com/onlinedb/ (put this address in your favorites). When you are on the home page, just click the link Find who represents you in Congress. Go to the state of interest and you quickly get the information on every Representative and Senator by clicking on their respective state. You can copy and paste their office address in Washington, D.C. and their home district or state into your letters (with adjustments in fonts) and obtain or check their email addresses and the phone and fax numbers.

Compose your letters (cutting and pasting, inserting correct addresses, names, etc.) and fax them out! www.myfax.com is a quick, easy and inexpensive service for sending many faxes quickly by email, not fax machine!!!

Sunday Morning Bonus

Corruption in American Health Care

Saving Health Care, Saving America as written  By BRIAN KLEPPER, DAVID C. KIBBE, ROBERT LASZEWSKI and ALAIN ENTHOVEN in The Health Care Blog

"So far, Congress' response to the health care crisis has been alarmingly disappointing in three ways. First, by willingly accepting enormous sums from health care special interests, our representatives have obligated themselves to their benefactors' interests rather than to those of the American people. More than 3,330 health care lobbyists - six for every member of Congress - contributed more than one-quarter of a billion dollars in the first and second quarters of 2009. A nearly equal amount has been contributed on this issue from non-health care organizations. This exchange of money prompted a Public Citizen lobbyist to comment, "A person can reach no other conclusion than this is a quid pro quo [this for that] activity."

Continue reading "Saving Health Care, Saving America"

It goes further down hill from there.

This article should give every physician a gut wrenching reaction, if not disgust at the corruption which has become rationalzied and rampant in some parts of the country.  It  points out how immorality creeps in slowly and devours a system. I reacted to the article in such a manner. From personal experience in such an environment I can describe how market influences alter perception and actions in order to survive in such a market. The financial imperatives create overwhelming features which can only be avoided if the overall physician community reacts appropriately in unison rather than in self interest.   Beyond this the only moral choice for the individual physician is to leave that community (which in itself strengthens the hand of the 'cartel'.

In a second article on The Health Care Blog  By JEFF GOLDSMITH

Atul Gofigure: Why McAllen Should Have Mattered in the Health Reform Debate

 

Back in June, Atul Gawande, a Harvard trained surgeon, published a riveting article in the New Yorker   about the physician community in McAllen Texas.

del.icio.us Tags: McAllen,Gawande,Brian Klepper,David Kibbe,Robet Laszewski,Alain Enthoven,Health Train Express

The Public Option

The AHIP  Singers

Thanks to The Health Care Blog for publishing this musical dedicated to the public option (not).

 

This is much more fun and better sung than traditional protests!

That is my humor for today. 

The following story is well worth the read

The Mike Gallagher Show....watch out Hannity

I just had to include this as a blog post...

 

Hal Scherz is just one of the many willing to  get down and invest his own capital in growing our grass roots efforts to influence health reform.  This is one of those things our organizations just cannot do as well.  Your interest,contributions and participation are essential.

As Dr Scherz states:

""I know how much everyone enjoys opening my TNTC emails (LOL) and I'm sure that you must have wondered where I disappeared to. I was down most of this week with what I'm convinced was H1N1, although the ER wouldn't test me. (A taste of what we have to look forward to under Obamacare). Now that I'm strong enough to sit up, I can start bothering everyone again. If you had any emails bounce back, please resend them. My box was filled up because I didn't clean it out for 5 days. If you sent me an email in the last few days, I promise that I will read it over the next 48 hours.

There are 2 things that I wanted to address tonight. As I have indicated to everyone, Docs 4 Patient Care will be an embedded sponsor of the Mike Gallagher show.

This is more like a partnership, because he has a strong, personal reason for wanting the doctor-patient relationship to be protected. Please begin to go to Mike's web site (http://www.mikeonline.com/) beginning on Monday and you will see Docs 4 Patient Care featured prominently. The exciting news regarding this, is that Mike is doing a 3 hour healthcare show this Thursday, Oct 29, and his co-host will be Hal Scherz. Yes, you didn't misread this. We will be discussing every aspect of the healthcare debate and we will try to have a guest or 2 to help to clarify the issues. His show is predominantly an audience participation show, so it would be a great opportunity for everyone to try to call in and to say what you would like to his national audience. If you are not familiar with his show, find out online which station his show is broadcast on in your area. It might even be a good idea to put this show on in your office waiting room and see if the hospitals will put this through into the doctors' lounges.

The second other important issue that I wanted to cover has to do fundraising. Please don't stop reading- this is different than usual.

I have received feedback from people that I have known professionally for over 20 years who I have reached out to in different parts of the country. When they heard about what we were putting together and that my practice was so committed, that we were putting up $40,000 in seed money, it was a "no brainer" for them. However, they are trying to convince people that they work with in their communities to dig into their pockets and write big checks. They are a bit reluctant because they don't know us, and they aren't sure where their money is going.

These are fair questions and concerns. First, let me assure everyone, that as a not for profit 527 political corporation, everything that we collect and spend has to be above board and transparent. If any member has any questions, they can contact our treasurer and board member, Joanne Thurston, who is a CPA.

Another question was whether I or any of the other officers have received any compensation. I wish. The truth is that not only do we not receive compensation, but we continue to put up our own money without asking for reimbursement for business related items- business cards, signs, etc. We have been to Washington twice already, and use our own money for these trips. And except for the past 4 days that I have taken off because of illness, I have averaged 5 hours of work daily for the past 5 months without any compensation. Anyone who sees what time the majority of my emails are timed can attest to this.

As to where does the money go? Well, there were start up expenses which we won't go into. But there are ongoing costs every month- mostly web site maintenance and our PR team. There are intermittent costs such as legal, marketing, other consultants.

However, we are now ready for prime time. We either move to the next level or pack up our toys and go home. What this means is that we spend a large amount of money getting out our message on a national platform and on a regular basis. This will open up more doors to us than we can possibly even imagine at this point. We need to hire an executive director, who will help to take the burden off of me. There are still many large initiatives that we need to launch, such as putting together the thousands of newsletter recipients who are not doctors and whose energy and enthusiasm is being wasted. We need to get these people working for us and contributing to our cause. The same for the allied health care professionals. There are thousands of doctors that we could get into Docs 4 Patient Care. We are poised for explosive growth. We need help to make this happen. We would like to at some point hire our own lobbyists and this will be very expensive. And there is so much more than this.

So this is where the money is going. Most of you getting this email don't know me at all, although there are ways to check on people today that didn't exist in the past. However, I think that it is worth taking a flier on this one. Do you want to write a big check in hopes that your money will actually work for you, or do you want to pretend that everything will be ok and hope that if you play nice and don't make too much noise, that you'll be left alone? This is almost too insulting to even ask this question.

Enough tonight. But those who want to contribute but just aren't sure, just do it! ""

All the best

Hal

The Arrow through Your Head

I have taken a break from health reform politicking to return to some essentials about health IT.

” The definition of a pioneer is “the guy with the arrow through his head.”

This was just one of the 'takeaways" at a recent seminar hosted in San Diego regarding the IT stimulus money train.

 

The feds have not defined “meaningful user” or “certified” yet; they are key requirements of the plan.

MEANINGFUL USER IS IN THE EYES OF THE BEHOLDER. ONLY PART OF THE DEFINITION HAS BEEN ESTABLISHED, AND NOT BY THE USERS THEMSELVES....TIME WILL TELL WHICH AND WHAT IS MEANINGFUL AND IT MAY TURN OUT THAT MEANINFUL (DEFINITION) WILL CHANGE IN THE NEXT FIVE YEARS.

ARE WE GOING TO BE CAST INTO A USELESS MOLD?

Financial incentives, even the full $44,000 available, are not going to cover your investment.

The cost difference between implementing in 2012 versus 2011 is only $5,000 less (paid out over 5 years). That year could be huge. The definition of an early adopter is the “bug on the windshield of progress.” The definition of a pioneer is “the guy with the arrow through his head.” One year to let others make the mistakes may save you much more than $5,000.

WHY ARE THE FEDS IN SUCH A HURRY WITH CUT OFF DATES AND PENALTIES FOR NOT IMPLEMENTING HIT AND EHR BY 2012???

COULD IT BE THAT THE FEDS ARE IN BED WITH SOME BIG IT PLAYERS???  ALLSCRIPTS IS BUSY RUNNING NATIONAL SEMINARS ON 'HOW TO" (DIP INTO THE FEDERAL TREASURY)

DON'T SPEND MY MONEY!!!

If you implement a bad process, you still have a bad process. Now is the time to dig into your operations, make them better, and THEN automate.

There are four “I”s that are key in shopping for an EHR/EMR:

• Implementation—This is the hardest part; it can sink you, and the vendors may not there for the long haul.
• Identity—How are you going to secure your data? Big penalties for doing it badly.
• Interoperability—Will it work with a MAC, your hardware, your PM system?
• Intersection—Will it work with the hospital/s, or the IPA/s, or any other of the as-yet-unnamed entities that will be required? THANKS TO MODERN MEDICINE, AND JUDY BEE

del.icio.us Tags: meaningful use,stimulus package,health IT,health train express,EHR,EMR adoption,judy bee

Medical BlogWorld New Media Expo

If you missed it, here it is. Excerpts from Las Vegas and the Blog World New Media Expo.

I regret not being able to be there. 

Prudent Buyers-not another insurance company

from: iHealthbeat

 

Quote of the Day:
Intelligence without ambition is a bird without wings.
--C. Archie Danielson

MGMA: Many Physician Groups Not Yet Ready To Invest in EHRs

Many physician group practices are likely to delay electronic health record adoption because of logistical and financial concerns, experts said this week at the Medical Group Management Association's annual convention, Healthcare IT News reports.

MGMA represents 22,500 medical group administrators and managers from across the country.

Robert Tennant, senior policy adviser for MGMA, said most of the physician practices MGMA represents will not qualify by 2011 for incentive payments under the federal economic stimulus package.

Under the stimulus package, health care providers who demonstrate "meaningful use" of EHRs will qualify for incentive payments through Medicare and Medicaid. However, the federal government has yet to issue a final definition for meaningful use.

William Jessee, CEO of MGMA, said many physician practices experienced declining revenue in 2008. He noted that nearly 37% of MGMA members have said they are postponing capital expenditures, which could include EHR adoption (Healthcare IT News, 10/13).

Moreover, many physician groups are concerned that the federal government will reduce Medicare payment rates this year under its sustainable growth rate formula, Jessee said.

He added that uncertainty about the rate reductions is leading many medical groups to delay EHR implementation (Monegain, Healthcare IT News, 10/13).

It seems as if many physicians are reticent to spend money they do not have. (unlike our federal government).  Despite all the rhetoric and politically incorrect statements about how much HEALTH IT will save, the government programs will have physicians lay out the funds to start up the  HIT transition and will only  receive grants if they can prove they are using EMR effectively (meaningfully) and according to a standard which has yet to be defined by them. The deadline is 2011 for implementation.  This is less than one  year from the probably final passage of any health reform bill. Although the original stimulus funding took place several months ago, the reality of these funds filtering down to the medical community will take at least another 12 months, based upon previous experience with ARRA and other stimulus packages.

Care---DENIED!!!

Quote of the Day:

An argument is the longest distance between two points of view.
--Dan Bennett

Gov. Arnold Schwarzenegger vetoed AB 2 over the weekend, rejecting legislation that would put a stop to the insurance industry's outrageous practice of wrongfully canceling patients' coverage once they get very sick and run up large medical bills, the Los Angeles Times and other major papers report. Sponsored by the California Medical Association, AB 2 called for an independent review of decisions by insurers to rescind coverage.

The insurance industry's widespread abuse of the practice has drawn condemnation from Republicans and Democrats alike.

In June, a congressional investigation found that three insurers had rescinded coverage for 20,000 patients over five years, saving their companies $300 million.

"With this veto, the Governor told Californians that insurance company profits are more important than their access to health care when they get sick and treatment becomes costly," said Dev GnanaDev, CMA president. "Without the patient protections of legislation like AB 2, there is no guarantee that Californians will have health insurance when they need it most."

Dev GnanaDev, president of the California Medical Assn., said Schwarzenegger's veto told Californians that "insurance company profits are more important than their access to healthcare."
Insurance firms and business leaders countered that the bill proposed unnecessary regulation and would have hurt the state's economic recovery.

 

Why did Governor Schwarzenegger terminate this bill?

 Read on about the current federal legislation unfolding.....He punted this one over to the U.S. Congress, and maintained ties with the insurance industry, who wield a lot of power  in California, besides health insurance.

 

SENATE PASSES HEALTH BILL  (FINANCE)