Breast Cancer Screening Mammography and Thermography

Everyone's Got It

It seems to be all over the place, front pages, blogs, new media, old media, radio talk shows, TV talking heads, and politicians as well.

Everyone and their brother has an opinion and  is an expert on health care, policy and reform. 

Health is something everyone has, excellent, good, bad or indifferent.  Despite our excellent technology good health is not guarranteed.   It takes careful planning, exercise, good nutrition and an attempt at leading a non-toxic life physically, and emotionally and for most people, spiritually.  Perhaps I should place spiritually first. 

Planning financially is now almost impossible for many people. The employer based funding is still a major issue one that the government only partially dealt with in health reform. A lot of people do not have employer based plans or lose them with career changes.  The current recession has made it more difficult.

The way the reform is structured if I was still an employer I would tell my employees to join a government sponsored health exchange.  It would be cheaper for me to pay the fine than to fund my own health benefit plan.  Not only would I have to pay part of my employees  premium I would have to support a human resources department to administer it.  Obama has no idea of how companies work.

Unlike the government I do not have to do multimillion dollar surveys or fund a think tank and/or foundation to make that decision.  It is pretty much common sense.

For patients and their doctors (as well as you, the taxpayer) there is no good news, however there is a little less bad news.

Committees Unveil Bill To Raise Medicare Payments Until 2013

On Thursday, Democratic leaders on the House Ways and Means and Senate Finance Committees released a summary and finalized legislative text of the so-called "extenders" bill (HR 4213), which would raise doctors' Medicare reimbursements by 1% to 2% annually through 2013, Politico reports (Haberkorn, Politico, 5/20).

 

google Tags: health train express, healthcare reform, medicare fees, employer sponsored health insurance

The Schizophrenia of the Feds

There is a lot of hype about healthcare stimulus funding, ARRA, HITECH and ONC.

Surveys amongst the nations top hospital CIOs are not 'bullish' about any of these programs.

HealthSystemCIO reports:

In what makes for a disturbing combination, CIOs are both doubtful that the federal government (HHS/CMS/ONC) will have the HITECH program fully operational by the time incentives are to be paid out, and pessimistic about their chances of qualifying for those payments, according to the healthsystemCIO.com April SnapSurvey.

more......

The takeaways are:

1. Disconnect between deadlines for payments, and finalization of Meaningful use criteria

2.Hospitals will judge and plan their HIT plans in line with improving qualityof care, efficiency and individual needs rather than the promise of dubious federal funding.

3. The program envisioned and planned by ONC and HITECH is not adequate and will run out of cash (much like the 'cash for clunkers" program).

 

Individual Providers also face the same conundrum. Caution is the better part of action at this point.  A fear of being 'left out' is driving most acquisitions at this point. Careful ROI is still prudent.

In actuality the ROI may be a negative number for many providers.  Will the losses be greater with or without an EMR. The rule of negative incentives still prevails.

Politico a well known web site published in Arlington Virginia gives a nicely worded summation of too much to soon.

But as a particularly stringent and new regulation nears, numerous medical groups say that the aggressive government push to digitize is too much, too soon. Health information technology in the United States remains highly fragmented, so any large overhauls, experts warn, must work on a timeline that stretches years into the future. 

 

google Tags: hhs, healthsystemcio, onchit, hitech, arra

Vending Machine Medicine

I was reading Distractible MD this morning and came across this photo that Rob Lambert posted.

I could not resist passing this along to my readers.  It says a lot about what has and is happening to our domain as physicians.  I wonder if it talks too.

Changes at CCHIT

Welcome to Karen Bell MD, the new Chair of CCHIT. Karen assumes the position as Mark Leavitt , former Head of CMS and HHS moves on to other responsibilities.

As ONC and NHIN develop Karen's Commission is at a critical juncture regarding certification of EMRs and the NHIN participants.  At the same time other certifying bodies, such as the Drummond Group also compete for this responsibility.

The federal government has laid out the gauntlet and what appears to be an unreasonable rush to implementing electronic medical record keeping using a carrot and stick approach. This approach compromises a fine idea without regard for providers and those who will be paying for and using the systems.

Is the Affordable Care and Patient Protection Act Constitutional?

Gregg Scandlen of Consumer Power Report #221 reveals:

"Apparently there was no “severability” clause written into this law, which shows how amateurish the process was. Virtually every bill I’ve ever read includes a provision that if any part of the law is ruled unconstitutional the rest of the law will remain intact. Not this one. That will likely mean that the entire law will be thrown out if a part of it is found to violate the Constitution."

There are innumerable senators and congressmen who hold law degrees from prestigious law schools. How did they miss this? I am sure all legislation is 'proof read' by special advisors prior to a 'vote".  Was this omission intentional on the part of those opposed to the legislation but unable to carry a negative vote at the final vote?   Time will tell about this matter.

You may subscribe to his regular news email by sending a request to: Greg Scandlen [rknox@heartland.org]i

As reported in the Wall  Street Journal:

By Katherine Hobson

In 2014, insurers will have to accept all comers, pricing coverage only by age, geographic area and family size. Until then, people with medical issues that prevent them from getting affordable insurance are being steered into so-called high-risk pools. And today is the deadline for states to tell the federal government whether they want to take on the task of running those pools themselves, the New York Times reports.

The health-care overhaul bill is a blueprint. Now Obama administration folks are working on the rules that will actually put that plan into action – and, as Kaiser Health News reports – lobbyists are really interested in how that will shake out.

We posted earlier this week about one such area of confusion, the so-called grandfather provision that says existing health plans can avoid some of the consumer-friendly changes dictated by the bill (such as an end to co-pays for some preventive care). The question is what kind of changes insurers can make to a plan and still keep it exempt from those requirement.

(commentary)...Since when is a federal law a 'blueprint'? This is no longer a bill, it is an ACT.

google Tags: Affordable Care and Patient Protection Act, ARRA, Stimulus act, cchit, drummond group, nhin, onchit, consumer power report, karen bell

Health Train Screw

Sorry guys, I could not pass this one up. Donated to the blog cause by none other than The Happy Hospitalist.

Happy recently has had some very interesting and some controversial episodes that he reports. 

Haybayles, Hijacked Medical Practice, Medicaid Insurance or Insult? The ten year cycle for new drugs, Sex with a Fat Woman who is dying.

Health Train Makes the Rounds

Okay I was a bit syrup, and emotional yesterday, but we all have our days.

Today we will feast upon a round of the health blogosphere. We will go where no man has gone before, and perhaps discover new forms of life and brave new worlds.  Buckle up buddy,  and prepare!  I also issue a disclaimer that these opinions are not that of Blogger, Microsoft, Apple, no myself.   I am not certain that Intel and AMD were not involved in this opinion.

 

I' ll start today at Dr J's Housecalls, a physician who seems to be trapped in rural North Carolina. This blogger has a real fixation on events some years ago which terminated her dream of serving her birthplace; a bit like Don Quixote and his windmills.  Although her enemies do seem real and the events quite probable, her intensity remains unaltered.  I genuinely feel her pain having been through similar but less intense events in my career.

On to a more positive blog by "The Happy Hospitalist" who seems to live a  balanced life despite being a hospitalist. Perhaps the regular hours offset working for a hospital and/or administrators. He also most likely has good relationships with his referring physicians who also most likely thank their stars for his help whilst they attend to their offices and/or clinics.  I like his Italian greyhounds, Marty and Cooper...Mrs Happy must be a happy camper.

Buckeye Surgeon is also one of my favorites, although he seems to write in spurts, and Surgeon's Blog has mostly been replaced by Cutting Through The Crap.  Surgeon's blog is worth reading through the archives, because a great deal of Sid's writing are timeless (but not odorless).

Dr Wes corresponds on a varietyof topics, ranging from cardiac electrophysiology, to reimbursement issues as well as his thoughts, and opinions ranging from The Vanishing Oath, Computer hijinx, to The Top Ten Reasons to be a Doctor.

Edwin Leap is a nice blend of spirituality, life in the ER with bizarre patients, family vacations, and his 'formophobia'. NPs, PAs and RN PhDs beware...sign your own charts.

The Health Care Blog written by Matt Holt is always a great combination of writing by consultants, insurers, doctors, and I envy his traveling to international Health 2.0 conferences. on everyone else's dime.  What a great scheme; and all concerned get to write it off.

KevinMD likewise alternates between interesting medical cases, doctor attitudes and philosophies and also g uest bloggers. Kevin Pho has a long following and is one of the original well known and often quoted bloggers in other venues.

Musings of a Distractible Mind carries with it a dose of humor, Zippy, the Golden Llama Award (which has not been seen lately) and the author of The House Call Doctor

Placebo Journal Blog, Medical Humor with a Purpose a video musical production blending the best of new media, cartoon humor and vaudeville....carry on PlaceboJournal.

And last but not least; Medinnovation Blog the musings of a retired pathologist, who really does understand primary care.

I could go on and on, and don't be offended if I did not include your wonderful blog.......but duty calls.

Quote of the Day:
The depth and the willingness with which we serve is a direct reflection of our gratitude.
--Gordon T. Watts

Mom's on the Health Train Express

This past month I turned 67 years old. Today is Mother’s day in America. Mother’s are the strongest and deepest bonds we experience in life. They are our first and lasting imprint on our minds, auditory, visual and sensory. Fathers are important, however Mothers are crucial to sons, and daughters.

My mother passed away five years ago at age 89. Her last three years were spent in an assisted living facility and towards the end she knew not my brother or myself. She became less lucid as the end approached. My brother lived near her and made sure her needs were met as to where she lived and he became the executor for her personal financial affairs. I lived some distance from her and had many of my own responsibilities, a disabled wife and very ill son. I will never forgive myself for not making time for her.

During the last few years of her life I would speak with her on Mother’s day and apologize for not being there with her. She would respond saying it’s okay you have your own family now, it’s enough you remembered me…it’s enough…..

It’s enough rings in my ears to this day. No, it was never enough and that clarified itself on these past mother’s day when my first and lasting thought  was to call her. It was not a thought, it was a deep emotional reflex, lingering throughout the day.

So Happy Mother's Day to all you Mom's....and boys and girls don't forget 'the mom".

del.icio.us Tags: mothers day,moms,bonds,sons,daughters

Today's Post on Health Train Express

I was up very early this AM and set off on my daily surfing of health blogs.  There seems to be a division of those who focus on patient encounters and clincal care isssue, both humorous, commonplace and very sad stories.  The other end of the axis are those blogs focusing on health IT, health policy and reform.

Matthew Hold on the Health Care Blog always seems to have a reservoir of important health policy wonks emoting good stuff.

I envy the guy for creating Health 2.0  meetings all over the world. What a gig!!

Anyway today he has

 

  David Kibbe,

ePatent Dave, and

Vince Kuraitis

all well known writers on a number of health blogs, discussing disruptive changes in health care.

ePatient Dave  brings this approach to our challenge:

"It’s possible to look at the patients issue from a moral or ethical perspective, or from a business planner’s ecosystem perspective. In this post we’ll simply look at it pragmatically: is our approach going to work? It’s our thesis that although you won’t see it written anywhere, the stage is being set for a kind of disruption that’s in no healthcare book: patient-driven disruptive innovation."

ePatient Dave's comments at the Meaningful Use Workgroup of the HIT Policy Committee revolve about the potential for Consumer and Patient Involvement

We assert that to disrupt within a non-working system is to bark up a pointless tree: even if you win, you haven’t altered what matters. Business planners and policy people who do this will miss the mark. Here’s what we see when we step back and look anew from the consumer’s view:

1. We’ve been disrupting on the wrong channel.
2. It’s about the consumer’s appetite.
3. Patient as platform:
   • Doc Searls was right
   • Lean says data should travel with the “job.”
   • “Nothing about me without me.”
4. Raw Data Now: Give us the information and the game changes.
5. HITECH begins to enable patient-driven disruptive innovation.
6. Let’s see patient-driven disruption. Our data will be the fuel.
We don’t hear it often in healthcare, but disruption Is driven by shifts in buyers’ appetites over time. As products improve, some buyers reach a point where “more” is no longer attractive.

If you view your health data as a modular component in the “health web of the future,” you see that today it’s tightly integrated – with your provider. That prevents you from seeking care elsewhere, and it prevents you from adding value to your own data by applying innovative tools. To us that’s harm. It’s not just restraint of trade, it’s restraint of health.

At one time in the not so distant past it was posssible for the patient and the provider to get the consultation from whomever the consumer and provider wanted.

 

Raw Data Now: Give us the information and the game changes.

People often ask, “If we give you your data, what are you going to do with it?” We don’t know – that’s the point: innovators haven’t gotten their hands on it yet!

Twenty years ago Tim Berners-Lee invented the Web. In his TED talk a year ago he told why: he worked in a fascinating lab, and people would bring fascinating and useful information on all sorts of computers. “I would find the information I wanted in some new data format. And these were all incompatible. The frustration was all this unlocked potential.” He proposed the Web: linked data.

It can be hard to see huge potential in a simple change. After Tim’s boss died, the original proposal was found in his papers. In the corner he’d written, “Vague, but exciting.”

Tim’s next big vision says today’s internet stops short: it lets us see other people’s interpretations of datasets, not the data itself. So his 2009 TED talk agitates for change. By the end of the talk he had people chanting,

“Raw Data Now.”

 

Healthcare in America

 

What do you think about healthcare in America? This question was poised by

Deloitte in a recent survey

Survey Highlights

• 76 percent of consumers grade the system as “C” or below.
• 48 percent believe that more than half of health care money is wasted.
• Less than a quarter (23 percent) of consumers believes they understand how the health care system works.
• 42 percent of consumers surveyed support government-required health insurance compared with 38 percent who say they are against it.
• However, 42 percent say they would choose an employer-sponsored plan over the government’s (25 percent), all other factors being equal. Among the uninsured, a government-sponsored plan is favored (38 percent vs. 28 percent).
• One in three consumers believes that the market needs 10 or more insurance companies competing to ensure consumer choice.
• 7 out of 8 consumers believe themselves to be in "excellent," "very good" or "good" health yet, more than half (54 percent) have been diagnosed with one or more chronic conditions.
• Only one in five (22 percent) participates in a wellness program.
• A quarter (24 percent) of consumers remain confident about managing future health care costs, but of the people who skipped care when sick or injured, 4 out of 10 did so due to cost.
• More consumers are seeking alternative or natural remedies before seeing a physician (17 percent in 2010 compared with 12 percent in 2009) and more consumers are supplementing their current regimes with alternative remedies (20 percent in 2010 vs. 16 percent in 2009).
• One in five consumers rates their interest in accessing their health records by a secure Internet connection as high, would switch physicians to obtain access and would be very likely to use a mobile communication device to maintain them. However, only 10 percent report having a computerized personal health record (PHR).
• 15 percent of all consumers say they used a retail clinic in the past 12 months.

HIMSS and HIE

 

The playing field in health information data exchanges amongst vendors is beginning to look a lot like EMR offerings several years ago.  However, today there appears to be a de-facto standard set by CCHIT.  It remains to be seen if the feds will mess this up, too in their quest for 'higher standards' such as NIST.

The recent offerings were displayed and discussed at HIMSS 2010, which can be found here...............

As the marketplace continues to gain calories, a number of vendors in EMR, and even mobile platforms are jumping into the fray

You can take at some of these offerings here:

Inter

Systems Healthshare

inFrame (Medecison)

Axolotl

Medical-Data-Exchange Verizon

CONNECT  (NHIN Open Source)

KLAS is a reputable consulting company that evaluates software and certification standards.  They offer a white paper regarding EMRs and HIE offering for both providers, consultants and vendors.  They offer an overview and analysis of the current state of data exchanges throughout the United States.

State Run High Risk Insurance Pools

 

The date has passed for states to notify the Feds whether they will accept additional responsibilities for uninsured patients.

The New York Times reported on Friday,

"Friday is the deadline for states to tell the Obama administration whether they want to run the high-risk insurance pool for uninsured people with pre-existing conditions, or whether they will leave the task to Kathleen Sebelius, the secretary of health and human services."

 

Some states such as California already have a Major Risk Insurance Board, and some funding for the uninsured through the Major Risk Insurance Program. The coverage is not inexpensive, has a low cap, but does subsdize the plan using not Medi-cal, but programs such as Kaiser Permanente, Bllue Shield, and others depending on the region of California.  If one can afford it, it does work well, and is transparent to providers. ie, it looks like private insurance.  (meaning the provider does not have to be a medi-cal provider.

"Democratic officials in Montana, Pennsylvania, Washington and Wisconsin, among other states, said they intended to operate the program under contract with the federal government. They were joined by Gov. Arnold Schwarzenegger of California, a Republican, who gave a rousing endorsement of President Obama’s health plan at a news conference."

 

 

"But Republican officials in Georgia, Indiana, Nebraska and Nevada turned down the opportunity to run the high-risk pool, as did at least one Democratic governor, Dave Freudenthal of Wyoming."

More...........

del.icio.us Tags: new york times,major risk,medi-cal,uninsured,sibelius,HHS,California,Georgia,Schwarzenegger

Primary Care....What is THE Problem?

Now that health care reform has been passed, attention is being given to the shortage of 'primary care'.  What is the problem?

1. The new "politically  correct term 'Primary Care' Provider,rather than family physician, or general practitioner. This lumps MDs in with NPs. PAs, MedicalCorpsmen, and who knows what else.  (would you go through 4 years of college, 4 years of medical school, and 3 or 4 years of serfdom as a resident to be 'lumped in '

2. The enormous amount of non clinically related administrative tasks and secretarial work to be done each day. A recent article by Richard Baron MD in the NEJM chronicles the day in the life of an internist.  This publication is a MUST READ for anyone in pre-med.  It gives an accurate appraisal of what to expect if one selects to become a general internist or family physician.

In addition to the daily acts of diagnosis, treatments, and minor procedures, these generalist internists did the followng:

• Made 24 telephone calls
• Refilled 12 prescriptions (a vast underestimate of the daily refills, since a) the number reported in the study doesn't count refills done during an office visit, and b) the study counted the act of refilling 10 meds for a single patient as one refill)
• Wrote 17 e-mails to patients
• Looked at 11 imaging reports, and
• Reviewed 14 consultation reports.
• Beyond what happens during the 18 patient visits, the docs perform nearly 80 acts of data exchange and review each day. After Rich’s practice analyzed this workflow, they re-defined a “full-time physician” as one with 24 scheduled visit-hours per week, embedded in a 50 hour work-week. In other words, docs in Rich’s practice can expect to spend half their time on office visits with patients, and the remaining half on non-visit paper/computer/telephone work.

I would say that the number of patients these physicians see is very very conservative.  From my experience it is much more like 25-30 patient encounters a day.

Now I am NOT saying this is a bad thing.  Many young aspiring students go into medicine for this vision of their careers.  In fact most go into medical school, either undecided, or want to become a family physician either because of a personal experience with their own family's physicians or a personal life experience from an illness or that of a family member.

 

3. The fatal flaw of the CPT procedural coding system aligned with performing procedures rather than the extent of complexity and cognitive work for the event.  This results in an enormous disparity of income for generalists and specialistss.

4.