Tiny Bubbles

 

Best of the WSJ Health Blog for 2010

By Katherine Hobson

Tonight the Health Blog will close the book on 2010 as we head out for the long holiday weekend. Not, however, before highlighting a few of our favorite posts from the more than 1,100 that ran this year. Our thoroughly subjective list includes posts notable for their subject matter, news value or just because we liked them a lot. In no particular order:

Cavs Have a Word for LeBron James: Narcissistic Jilted Cleveland Cavaliers majority owner Dan Gilbert put King James on the couch in July and came up with this diagnosis, but the sports psychologist we consulted disagreed. As things stand today, LeBron can certainly be described as “winning”; his new team, the Miami Heat, is 25-9.

Here’s What Primary Care Doctors Do All Day A study by a Philadelphia internist lays bare the paperwork involved in running a small practice. One stat: the number of phone calls a physician made each day was higher than the number of patient visits.

For Dendreon, It’s 500 Prescriptions for Provenge and Counting No one’s neutral on the Yankees, and no one’s neutral on Dendreon. This year the company won FDA approval for its prostate-cancer treatment Provenge, and in this August post we polished our math skills and calculated how many patients had completed treatment in the second quarter.

Prevention Task Force Cancels November Meeting; Would Have Included Prostate Screening Vote The U.S. Preventive Services Task Force rescheduled this meeting, originally set for Election Day, for March 2011; one staffer later quit, saying “politics trumped science.”

Caution: This Blog Post May Be Under Embargo The rules surrounding when the media can report on scientific papers are often convoluted, but rarely do they reach the extremes seen in this cancer-drug study saga involving Novartis and the annual American Society of Clinical Oncology meeting.

XMRV: Raising the Issue of Contamination This is just the latest thoroughly reported post Amy Dockser Marcus has written on the controversy surrounding the XMRV virus and its possible link to chronic fatigue syndrome. Click here to see all the Health Blog’s coverage on this topic from this year and earlier.

Tapeworms, Cow Gestation and Malpractice: Trolling the NEJM Archives After the venerable journal put its archives online, we took a spin through the articles published in the 1800s to learn about the hot medical issues du jour. (And for once, we knew we’d get no comments about the evils of electronic medical records!)

TEDMED: Soprano and Double-Lung Transplant Recipient Charity Tillemann-Dick Inspirational stories about patients and their physicians are everywhere in medicine, but this one — about a dangerously ill young soprano who refused to give up her singing and the doctor who told her “a happy patient is a healthy patient” — is one of our favorites. Happy new year, everyone.

 

FOX NEWS has their own list of the top health blogs

Of Course I have my own favorites

  It is almost time for Auld angzine, and some bubbly.

HAPPY NEW YEAR !!

The AMA is Lurking and Lurching

 

 

The American Medical Association checked in and made a comment about my last posting.  The Good news is that I know someone out there is reading my  stuff. My post was about commentary published on SERMO for their fifth anniversary in regard to the AMA and it’s relationship with physicians.  It has been disseminated by many that the AMA represents 33% or less of physicians.

You can  see the comments at my last post, or I will insert a few catchy PR mission statements  here. Actually the comments were made on Medpedia a blog aggregating service.

 

 

In all fairness I will publish the entire comment sent to me from the AMA.

“As the nation’s largest physician organization, the American Medical Association welcomes the diversity of physician opinions, but falsehoods and conspiracy theories do nothing to advance the common goals physicians share. The AMA’s support for the health reform law was based on it meeting a majority of strong principles, particularly expanding coverage to millions more Americans, that reflected policies established by medicine’s broadest forum of physicians with members from every state and specialty. The AMA has made expanding health coverage to all Americans a top priority and we made clear that this law, while historic, was a starting point and that Congress would still need to act on vital issues important to patients and physicians. Day in and day out, AMA is working hard to provide physicians with the advocacy and practical tools they need to care for patients and lead enhancements to our health system. In the past year alone, AMA has spurred improvements in the insurance industry’s chaotic payment system by exposing flaws and waste, helped physicians recoup millions in short-changed insurance payments, given physicians a powerful tool for negotiating fair contracts with insurers and held insurance companies accountable for questionable business practices.”

Perhaps we misjudge the AMA.

del.icio.us Tags: advocacy,AMA,Health Reform,insuance,contracts,health train express,medpedia,sermo

Are Doctors lurking, or lurching?

 

These are comments borrowed from SERMO (a physician only forum) and as they appeared in the Washington Times on December 27, 2010.

 

Doctors left in the lurch by own medical associations

 

 

      

 

By Dr. Douglas A. Perednia

The Washington Times

6:53 p.m., Monday, December 27, 2010

Here's a tip for those wanting to overhaul Obama care: Ask doctors how to make health care more efficient. They can tell you where to find hundreds of billions of dollars in cost savings. But don't imagine that you'll get any useful insights from the American Medical Association (AMA), the American College of Physicians (ACP), the American Academy of Family Physicians (AAFP) or most other big medical associations. Entrenched "professional" organizations like these are increasingly part of the problem.

These are depressing times for doctors in America. Real physician income is stuck in a decades-long decline. Adjusted for inflation, physician fees have fallen more than 25 percent since 1995. Indicators favorable to clinical practice are at or near record lows. The Physician Practice Environment Index for Massachusetts - the state model for Obama care - has declined in 16 of the past 18 years. Once-routine clinical tasks have become bureaucratic nightmares. The average physician now spends more than four hours each week on insurance and regulatory paperwork. Frustrated and tired, doctors are cutting hours and giving up independent practices to become hospital employees. Forty-six percent of U.S. physicians are over the age of 55. One-third are considering career change or retirement.

Obama care promises to make life even harder. The so-called Independent Payment Advisory Board is supposed to reduce Medicare spending by $500 billion but is powerless to do anything except cut payments to providers. Small Marcus Welby-type private practices are to be squashed. The White House has told doctors, "...Physicians need to embrace rather than resist change...The economic forces put in motion by the [Affordable Care] Act are likely to lead to vertical organization of providers and accelerate physician employment by hospitals...." In other words, forget private practice; prepare to be assimilated.

But it's not just money at stake. Many doctors sense that "reforms" are undermining their integrity. While the Hippocratic Oath obligates doctors to act only in the best interest of patients, many health care activists and medical associations are pushing a "new medical ethics." This says that physicians must consider "the needs of society" in their clinical decisions. In this new age, society's needs are divined by government regulators. In his book "New Rules," President Obama's Medicare chief, Dr. Donald Berwick, explains, "Traditional medical ethics, based on the doctor-patient dyad must be reformulated...The primary function of regulation in health care, especially as it affects the quality of medical care, is to constrain decentralized individualized decision making."

For many doctors, association support for Obama care and this "new ethics" has been the final straw. Before, during and after passage of the Affordable Care Act (ACA), organizations such as the AMA, ACP and the AAFP worked hard to curry favor with the Obama administration and congressional Democrats. The AMA initially insisted on a fix for Medicare's automatic sustainable-growth-rate cuts in physician payments; it then reversed course and prominently endorsed Obama care without one. The ACP went further, calling the passage of the ACA "an extraordinary achievement" and "a cause for celebration." Not to be outdone, the AAFP wrote every Congress member who had supported the law to "congratulate you on your extraordinary commitment to better health care." Other associations simply chose to be intimidated. In a letter to members, the American College of Surgeons admitted that it had "been so quiet in voicing opposition to the legislation...[so as] to maintain a good relationship with policymakers."

What explains this behavior? Money. Once genuine advocacy groups, many medical organizations have morphed into vendors that thrive on ever more credentialing, government regulation and administrative complexity. They fight to protect revenue sources, not physicians or the practice of medicine. The AMA is typical. Its membership has declined from nearly three-quarters of physicians to fewer than one-third today. Just 16 percent of revenue comes from membership dues; chicken feed when compared to product sales or its government-sanctioned monopoly on Medicare billing codes. Other associations rake in millions hawking products from medical education and certification programs to electronic records and liability insurance. Each new government initiative is an opportunity to sell new products and services to physicians who are forced to comply.

There are two take-home lessons. First, the public and our elected leaders should be talking to real doctors about real health care reform. Those in the trenches are in the best position to see the inefficiencies and insanities firsthand and to recommend practical solutions. They'll tell you that what's really needed is a massive simplification of the system, less administrative overhead and the substitution of efficient free markets for government price-fixing.

Second, it's time for doctors to reform their own professional organizations. Powerful medicine is needed: mass membership cancellations and/or defections to true advocacy organizations such as Docs4PatientCare or the Association of American Physicians and Surgeons. The Great American Healthcare Debate is not yet over. Real doctors need to be included this time around.

Dr. Douglas A. Perednia is author of "Overhauling America's Healthcare Machine: Stop the Bleeding and Save Trillions," forthcoming from FT Press. He writes for the health care blog the Road to Hellth.

 

My thoughts, exactly……no need to expand.  I hope this brings to light the corner into which your doctor has been thrust.

 

del.icio.us Tags: sermo,docs4patientcare,ama,organized medicine,cpt codes,obamacare

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.

---

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

^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^

 

There is a bright-side:   

del.icio.us Tags: obamacare,health reform,takeover,grace marie turner,health train express,central planninig,liberty,freedom

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 !

 

del.icio.us Tags: resolutions,happy new year,climate change

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.

del.icio.us Tags: emergency,resident Physicians,primary care,safety net,american college of emergency physicians

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

 

del.icio.us Tags: health train top 20 posts,health train express,medicine,stastics

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.

del.icio.us Tags: iPad,theft,security

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.

del.icio.us Tags: Berwick,medicare,HCFA

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.

 

del.icio.us Tags: emr,emr adoption,health train express,ehr costs,meaninful use,HIT incentives

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

 

del.icio.us Tags: predictions,gartner,health train express,information technology,cloud services,tablet pc

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.

del.icio.us Tags: future medicine,stem cells,HIT,healthtrain express