Are We Selling our Patients Down The Road ?

 

Freedom is a tenuous liberty. While we sleep it can be stolen in the wink of an eye.  2010 has not been a bellwether year for liberty in America.

 

We should not confuse freedom with social, financial, nor emotional security promised by recent health financing legislation. The Obama Care health finance reform promises something which no man can deliver. In the interest of offering monetary security (not good health) the price will be the forfeiting of choice and intelligent decision making in regard to most aspects of health  care encounters. These choices extend far beyond  a choice of providers.

 

 It is a government takeover

 

The new law gives federal bureaucrats enormous say over nation's health care.

By Grace-Marie Turner (Philadelphia Inquirer, December 29,2010.

PolitiFact.com, the online oracle of all things true and untrue in America's political debate, is wrong in saying it is the "lie of the year" to call "Obama care" a government takeover of health care.

The proclamation shows that its editors need a Truth-O-Meter of their own. Obama care is a uniquely American government takeover of health care. Its 2,801 pages of legislation and insidious regulatory structure give the secretary of Health and Human Services almost unlimited authority to rule over every corner of our health sector.

The legislation that passed in March creates the architectural drawings for the government-controlled system the administration is busily constructing.

Because the law doesn't call for an immediate nationalization of hospitals or include the "public option" that liberals wanted, PolitiFact claims that it isn't a government takeover. Even worse, it says Obama care "relies largely on the free market" to achieve health reform.

PolitiFact disregards the legitimate fears of millions of Americans who spontaneously rose up in town hall meetings, marches, and voting booths to protest Obama care. Here are 10 reasons why most Americans are right that this is a government takeover of health care:

For the first time in our nation's history, the federal government will order citizens to spend our private money on a private product - health insurance - and will penalize us if we refuse. U.S. District Judge Roger Vinson asked in a Florida courtroom whether that would mean the government "can decide how much broccoli everyone should eat each week." U.S. District Judge Henry Hudson recently ruled in Virginia v. Sebelius that the individual mandate "would invite unbridled exercise of federal police powers."

The federal government also will determine what health benefits are essential - not us, and not our doctors.

Doctors and hospitals will face an avalanche of new reporting rules to make sure they are providing health care that fits the government's definition of "quality care."

The legislation creates the Patient-Centered Outcomes Research Institute that is modeled on rationing boards in other countries with government-run health systems. The National Institute for Health and Clinical Excellence in the U.K., for example, has a record of denying access to the newest drugs, with government officials often deciding they just aren't worth the cost. That's already happening here with the FDA's recent withdrawal of its approval for Avastin.

Obama care provides the foundation - and $6 billion - for a stealth public plan. The Consumer Operated and Oriented Plan (CO-OP) program will help set up nonprofit, member-run health insurance companies in all 50 states.

States are being treated like contractors to the federal government, ordered to expand Medicaid to levels that could bankrupt them, and to set up new health-exchange bureaucracies lest the federal government sweep in and do it for them.

Government has the authority to destroy the private insurance market by preventing insurers from earning a reasonable return. If companies charge "unreasonable" premiums, as determined by HHS Secretary Kathleen Sebelius, she can block them from participating in a huge sector of the market - as she already has threatened to do. Columnist Michael Barone calls this "gangster government."

Any employer with more than 50 employees will be told it must provide government-decreed health insurance to its workers - or face financial penalties.

As many as 80 to 100 million people will not have the option of keeping the coverage they have now, per President Obama's promise. According to analyst Allisa A. Meade of McKinsey & Co., they will be switched into other policies after the insurance mandates take effect in 2014 - whether they like it or not.

Obama care expands Medicaid, the worst health plan in the country, to cover 84 million people by 2019, stretching yet another of our government-run health programs to the bursting point.

My colleague, health attorney John Hoff, in a paper for the Heritage Foundation, calls Obama care "a new exercise in old-fashioned central planning." PolitiFact needs to revisit its decision or it will soon find that its own pants are on fire.

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Grace-Marie Turner is president of the Galen Institute, a nonprofit research organization focusing on free-market ideas for health reform. She can be reached at galen@galen.org.   

Read more:  Philadelphia Inquirer

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There is a bright-side:   

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Resolutions to Consider

by Gary Levin M.D.

 

 

It’s that time of the year.  As we close out 2010 we look back at another year of tremendous change in many areas of healthcare.

I made many resolutions last December 2009, and unfortunately most of them did not come to pass.  At the time they seemed well intentioned, and who does not make New Year’s Resolutions without that goal in mind.

Well, you and I, despite our self appraisal of estimates of high intelligence,  do not control government, or the weather. They however are very powerful forces, and when either runs well and the weather is fair, life can be good, and if it is stormy or a cold front meets a warm front, the results can be light rain or tornados. During the past year we had storms in both venues.  The climate change  is more apparent in government that global climate change.

Marked differences between political parties overwhelmed any effort to make intelligent legislative decisions.  It is as if the recent healthcare reform was designed to let loose the forces on both sides. The legislation is so broad it is rendered impotent by the inconsistencies so apparent to professionals in health care. The attempt to control market influence with badly worded legislation that oversteps regulatory process has catalyzed chaos. Business is unable to plan financially due to extreme uncertainty of the climate for health care expenses.  Health insurers are attempting to hedge against mandates for the uninsured which run one hundred eighty degrees against the intended outcome for health finance reform.

Perhaps there is one thing you and I can do:

 

 

Wishing all of Us:

ABBA Classic Happy New Year !

 

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More Top Events in Medicine for 2010

 

 

The Western  Journal of Emergency Medicine published The Colorado Compendium on Emergency Medicine, available online here as a pdf file from PubMed.  It offers a one stop solution for important advances in emergency medicine.

It is authored by authorities in Emergency Medicine at University of Colorado, a major trauma center.

The article should be a must read for all those in training and also practicing ER physicians.

I have a bit of a personal interest in this subject, because I practiced ED medicine for five years prior to specializing. This was many years ago and it is gratifying to see how the American College of Emergency Physicians successfully navigated the road to board certification of this vital primary care safety net.

It punctuates the difficulties changing a system that is at times entrenched in past routines, and how entrenched organizations can stifle needed changes.

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More of the Top Health Train Blog for 2010

 

With a brief interruption for holiday cheer I will continue my review of the ‘best’.

If anyone has a particular fondness of other posts please tweet me  @oculogyric.   

The List:

Medicine from 40,000 feet

Some Funny, some sad, some Ridiculous

I Work So Hard !

Laughter is The Best Medicine

How Statistics Lie

This should give you something to read this week

 

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Billion Dollar Losses

 

Many of you are implementing EMRs using laptops and now even iPad or a form-factor such as Apple’s hot new selling addition to the hardware market.  This form factor is a natural human-machine interface.

Several precautionary notes can be gleaned from other industries about these ‘hot’ items.

Lock it down, Use security software, such as lap-jack,

 

The iPad is going to have a higher theft rate than Honda automobiles.

P.S.  I can get you a real good deal on an iPad.

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The IHI Open School

 

Mention the name ‘Don Berwick’ and some physicians have a gut-wrenching feeling about him. He is the focal point and lightening rod as head of CMS due to his statements about the American Health System.

There is another side to this man’s achievements.  I think you will find this video interesting.

Will the Real Dr. Berwick please stand up

Most physicians who know Dr. Berwick will offer the opinion that he is getting a ‘bad rap’.  This is most likely due to his acceptance of the massive responsibility running CMS, and his famous speech in the U.K. washing out our ‘dirty laundry’ for the world to see.

Which one is the Real Don Berwick?

It remains to be seen if Dr. Berwick will make an impression on our health care financing bureaucracy.

In 1964 when Medicare started governmental intrusion in health care financing was limited to public health and insurance regulatory agencies. Now its’ Dr. Sam instead of Uncle Sam.  Benevolence or malevolence?  You decide.

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Cost Estimates for EMRs

 

 

eWeek.com today has a story about the true cost of EMR installation in the first year of acquisition.

In a new report, CDW Healthcare estimates initial revenue losses for physician practices due to EHR costs, but predicts monetary gains upon completion of training.   Adoption of an EHR (electronic health record) application could cost a physician $120,000 in one year, CDW Healthcare reports in its Physician Practice EHR Price Tag study.

Training of physicians on EHR platforms during the adoption period will lead to a 10 percent average loss in patient appointments in the first year of use, but then productivity should pick up, CDW reports in its survey of 200 physician practices over a six-month period.

By using EHRs to speed up their workflow, physicians will be able to see 15 percent more patients and gain about $150,000 in annual revenue when EHR platforms are fully implemented, according to CDW.

Although 66 percent of respondents mentioned hardware and software costs as their main concerns in EHR adoption, these areas comprise only 12 percent of total EHR adoption costs. A more significant cost factor was a loss in revenue due a workflow slowdown.

On average, physicians in the survey expected a 10 percent loss in workflow during the first year, but 40 percent of respondents predicted that patient visits would fall by 25 percent or more in year one.

To minimize the potential reduction in productivity during the transition to EHRs, Karl advises that physician practices invest heavily in training. "Move as quickly as possible to bring your staff up to speed," he said. "The longer you take to adopt, the longer your productivity suffers and the greater the cost over time," he explained.

In the Dec. 13 report, CDW also highlighted the potential benefits of cloud computing in EHR implementation. Of the respondents, 38 percent were considering cloud computing, which would cut $4,400 from the costs of hardware, software, services, telecom and data center environment (power and cooling) per physician.

 

Placing this in the framework of the promised incentive of up to 44,000 per physician for meaningful use of an EMR still nets out a significant loss to physician business’ bottom line.

 

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Health Train's Top for 2010 Part I

 

And here are the winners !!  Some of this is my bizarre sense of humor.

 

 

December 20,2010

December 18, 2010

December 5, 2010

November 23, 2010

November 21,2010

November 10,2010

October 26,2010

September 23,2010

September 12,2010 A Gem on HIT, even if I say so myself, a moment of inspiration !

August 24,2010

August 11, 2010

 

I will be posting Part II in the next blog post.

 

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Predictions for Beyond 2011

 

Perhaps I am foolish to even try to predict 2011, and even more so for the coming decade.

However, I have found a reasonably credible business source for these predictions.

The Crystal Ball

The effects of information technology will increase not only in healthcare, but for the rest of the economy and the percentage of the GDP to which it will contribute.

Gartner Consulting of Stamford, CT prognosticates

By 2015, a G20 nation's critical infrastructure will be disrupted and damaged by online sabotage.

By 2015, new revenue generated each year by IT will determine the annual compensation of most new Global 2000 CIOs.

By 2015, information-smart businesses will increase recognized IT spending per head by 60 percent.

By 2015, tools and automation will eliminate 25 percent of labor hours associated with IT services.

By 2015, 20 percent of non-IT Global 500 companies will be cloud service providers.

By 2014, 90 percent of organizations will support corporate applications on personal devices.

By 2013, 80 percent of businesses will support a workforce using tablets.

By 2015, 10 percent of your online "friends" will be nonhuman.

 

Additional details are in the Gartner report "Gartner's Top Predictions for IT Organizations and Users, 2011 and Beyond: IT's Growing Transparency" which is available on Gartner's website

 

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Top Advances in Medicine during the Past Decade

 

 

1. Thermo stabile vaccines and Nano particle enhancements

The first attaches vaccines to nanoparticles that can be absorbed by the skin inside the nostrils. Dr. James R. Baker Jr., director of the University of Michigan’s nanotechnology institute, said it works with hepatitis B and flu vaccine. He won a new grant to test the respiratory syncytial virus, which causes pneumonia.

The particles are in what Dr. Baker described as a “proprietary formulation of mayonnaise” based on soybean oil. The vaccine ends up inside the oil particles, which protect it from temperature changes and microbes. The immune system is “made to eat oil droplets,” Dr. Baker said, because it targets viruses, which are essentially time bombs of genetic instructions inside casings of fats. The “mayonnaise” is so safe, he said, that rats fed the equivalent of two quarts a day had only one side effect — weight gain. The emulsion by itself cures viral lesions like cold sores, he said; its surfactants harmlessly penetrate the skin but break up the herpes virus inside.

The second thermo stabilized vaccine the foundation is still backing is a complex one against malaria. It fuses the genes for parasite proteins onto a “genetic backbone” from vaccines against smallpox and a chimpanzee virus.

Rather than being bottled, the vaccine can be dried onto a bit of filter paper.

2. Alzheimer’s Disease is now a public health challenge. Over the past quarter of a century and with the relative success dealing with infectious disease, cardiovascular disease, longevity has produced CNS deterioration as a major social and public health issue. Much research and clinical trial resources are now focused on Alzheimer’s Disease.  Dr. Howard Fillet, also a geriatrician and executive director of the Alzheimer's Drug Discovery Foundation, said this week that more than 150 clinical trials worldwide are testing dozens of drugs that may be the answer to combating the disease itself, and not just the symptoms. (Seattle Times)  . Clinical Trials.go lists 861 studies in progress or completed.

3.  The Intraoperative MRI For Brain Tumors

4.  Advances in Oncology  The use of targeted monoclonal antibodies has gained wide acceptance as the SOC. The use of anti-vascular growth factor also has become SOC.

5. Advances in Urology  Two major advances over the past decade have markedly reduced human suffering;  alpha agonists for the almost elimination of urinary retention from BPH (benign prostatic hypertrophy) and the pharmacologic treatment of male impotence with the use of Viagra (Sildenafil), Cialis (Tadafil)  and others

6.  The advent of Robotic Surgery as well as the use of  Endoscopic Surgery has revolutionized many surgical specialties It has had multiple applications: (Wikipedia)

3 Applications

• 3.1 General surgery
• 3.2 Cardiothoracic surgery
• 3.3 Cardiology and electrophysiology
• 3.4 Gastrointestinal surgery
• 3.5 Gynecology
• 3.6 Neurosurgery
• 3.7 Orthopedics
• 3.8 Pediatrics
• 3.9 Radiosurgery
• 3.10 Urology

There are many more, these are just the highlights and ‘Gee Whiz” items.

8. Regenerative Medicine or the use of stem cell biology for treatments of degenerative or traumatic injuries as well as many other applications. (Regenerative Medicine.net)

9.Finally, the use of Health Information Technology has and will create a tsunami of events, improving patient care, easing clinicians access to medical records, imaging, learning and CME experience as well as telemedicine and communication with colleagues.

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TOP 20 Software and Service Vendors (in HIT)

The end of a year and a decade (wasn’t it just 2000, Y2K)?. I have been busy reviewing things new, things old, things good, and things bad. 

Here is the next.

As part of the annual review of best and worst, here is the lineup for HIT.

 

 

KLAS, an organization that evaluates medical software has announced it’s top 20 list for 2010. The top are:

 

For software:

The 2010 "Best in KLAS" vendors for software:

• Acute Care EMR – Epic EpicCare Inpatient EMR
• Ambulatory EMR (more than 100 Physicians) – Epic EpicCare Ambulatory EMR
• Ambulatory EMR (26-100 physicians) – eClinicalWorks EMR
• Ambulatory EMR (6-25 physicians) – Greenway Medical PrimeSuite Chart
• Ambulatory EMR (2-5 physicians) – e-MDs Chart
• Business Intelligence/Reporting – Dimensional Insight The Diver Solution
• Cardiology – Digisonics DigiView
• Community HIS – McKesson Paragon
• Decision Support – Business - Allscripts Sunrise EPSi Decision Support (Eclipsys)
• Document Management and Imaging – MedPlus ChartMaxx
• Emergency Department – Wellsoft EDIS
• Enterprise Scheduling – Unibased Systems Architecture RMS
• Financial/ERP – McKesson Pathways Fin./Materials/HR Mgr
• Homecare – Homecare Homebase
• Laboratory – Siemens Novius Lab
• PACS – DR Systems Unity
• Patient Accounting and Patient Management – Epic Resolute Hospital Billing
• Pharmacy – Epic Willow
• Practice Management (more than 100 physicians) – Epic Resolute/Prelude/Cadence
• Practice Management (26-100 physicians) – McKesson Horizon Practice Plus
• Practice Management (6-25 physicians) – Greenway Medical PrimeSuite Practice
• Practice Management (2-5 physicians) – e-MDs Bill
• Radiology – Epic Radiant
• Speech Recognition – Nuance eScription
• Surgery Management – Unibased Systems Architecture ORMS

 

For Services:

The 2010 "Best in KLAS" vendors for professional services:

• Application Hosting (CIS/ERP/HIS) – Cerner
• Claims and Clearinghouse Services – Navicure
• Clinical Implementation Principal – Deloitte Consulting
• Clinical Implementation Supportive – Innovative Healthcare Solutions Inc.
• Financial ERP Implementation – ACS
• IT Outsourcing (extensive) – CareTech Solutions Inc.
• Planning and Assessment – Impact Advisors
• Revenue Cycle Transformation – Deloitte Consulting
• Technical Services – ACS
• Teleradiology Services – Virtual Radiologic (vRad)
• Transcription Services – Webmedx

To purchase the full report, providers and vendors can visit www.KLASresearch.com/top20 

Who is KLAS?

• KLAS conducts over 1,900 healthcare provider interviews per month, working with over 4,500 hospitals and over 3,000 doctor’s offices and clinics
• KLAS is independently owned and operated
• KLAS has ratings on over 250 healthcare technology vendors and over 900 products and services
• KLAS publishes approximately 40 performance and perception reports per year
• KLAS is headquartered in Orem, Utah, with independent researchers working throughout North America

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The Cookie Monster or Who Ate My Cookie ?

 

Kermit and the rest of the Sesame Street not withstanding, there is a great danger in talking about cookies. So  Steven Duckett discovered when he was summarily dispatched from the cookie jar of Alberta’s Health System.  He was caught with his hand in the ‘ proverbial cookie jar, and on camera.  When discovered,  he had the audacity to exclaim “ I am eating my cookie, you will have to wait.” Politely he offered the remains of one cookie to an eager news lady as she chased him through the lobby.  Numerous passerby's were noted to ignore the incident and offered no assistance to Duckett. Neither Duckett or his attorney are returning telephone calls.

The incident has been documented on several videos that have been ‘leaked’ to you tube which have become viral.   Canada’s Department of Health is investigating the incident.  Although Duckett posted bail his passport has been revoked, and he is required to wear an ankle bracelet, as well as being forbidden from entering the U.S. for health care. The Canadian Minister of Finance is reviewing Duckett’s  financial records to determine if public funds were diverted into cookie dough.

The Cookie Caper

Several media companies have capitalized on his mis-fortune cookie.

 

Caught on Sesame Street

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More on Merger Mania

There is a flurry of mergers and acquisitions in the health insurance and hospital industry. There are several driving forces creating this activity. The first is the mandate to obtain electronic medical records both by individual providers, and hospital systems. The federal government is incentivizing this activity but also holding a big stick threatening penalties in reimbursements if providers do not adopt EMR and HIT systems.

The second factor is the proposition to form Accountable Care Organizations (ACOs).

The merger mantra is not fueled by healthcare reform, the rationale is market share.

The acquisition of HIT is expensive, either way. However hospital administrators wish to capitalize on size for market share, as well as IT. Other HIT requirements regarding interoperability amongst differing hospitals creates the need for forming regional health information exchanges. Merging two entities into one enables easier legal requirements for exchanging data without the complexities of separate Health Information Exchanges. The incentives offered by the federal government to fund EMR and HIE are inadequate, and do not take into consideration ongoing maintenance expenses. To be sure, reimbursements will continue to decrease just as the water level subsides when the tide goes out.

The health care market place has already seen mergers, such as [Humana-Concentra[,[ Community Health Systems-Tenet Care], [Steward Health Systems-Merrimack Valley-Neshoba Valley], [Peace Health System – Southwest Washington Medical Center][Inova Health Systems – Prince William Health System ]

These mergers and the need for IT mean big business for IT hardware and software vendors.

There have been several mergers and dissolutions amongst EMR vendors. Misys was purchased by All scripts about 24 months ago. That marriage dissolved quickly in June 2009, when Misys dumped Allscripts by merging it with Eclypsys, another EMR software vendor. Mike Laurie read very well the signs of demand for HIT companies in purchasing Misys, and then taking a quick profit by dumping Allscripts when it became evident that the EMR market is highly competitive and not very profitable.

Wise investors in Health IT and software must have knowledge and expertise about much minutiae and realize that HIT software is not something bought off the shelf. The applications are highly specialized in a market that is not user friendly amongst providers.

The number of overall mergers peaked in 2006, and the number of independent hospitals as opposed to hospital systems has decreased during that same time period (see figure)

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