Health Train Leaves the Station (again)

 

The Health Train Express is moving once again, leaving the not so grand central terminal. 

The 112th Congress, 1st session has commenced, with another full plate regarding unraveling Obama care The first day consisted mostly of procedural matters.

Early today Speaker John Boehner had this to say early this morning regarding Obama care in preparation for the upcoming debate on new legislation to repeal all or parts of Obama care.  The discussion and vote which were to have taken place this week is to be postponed due to a procedural delay designed by Democratic opponents of repeal.

Speaker John Boehner ®

 

Greg Scandlen posted his “Welcome Freshman'” lecture to the  neophytes, and newbies in congress about the disastrous Obama care law.

My comments are (Yogi Berra), “It isn't over until it’s over.) We physicians must continue our opposition to this law, but not the goal of expanding health care coverage to many more of our citizens, and improving outcomes, reducing cost by increasing efficiency and reducing mindless bureaucracy.

del.icio.us Tags: health reform,Boehner,112th congress,obamacare,greg scandlen

Repeal the Health Train Express

 

Michelle Malkin has an interesting proposal, about Health Reform  H.R. _________________

The House Republicans have announced their plans to put the Obama care repeal up for a vote during the week of January 10, 2011. This evening they posted the text of the proposed legislation to the GOP House Committee on Rules website.

WAIVER-MANIA continues:

Malkin has this to say about current activity to alter or repeal the current Obama care Law.

Over the past two months, we’ve been tracking the burgeoning list of unions, companies, and insurers who have used an HHS escape hatch to avoid the costly, destructive consequences of Obama care for their members and employees (see here, here, here, and here). The list keeps growing. Jamie Dupree has the latest update on what I’ve been calling Waiver-mania! More unions and companies that employ low-wage workers have gotten their pass now. The official Obama care refugee list (here) is now at 222.

del.icio.us Tags: health reform repeal,obama,house republicans,michelle malkin,health train express

Non Compliant Physicians: Guilty Until Proven Innocent

 

Liberty Loves Justice

Richard Reece, MD in his blog, Medinnovation today discusses increasing regulatory action, “drastically increase physician legal compliance obligations and potential liability under federal fraud and abuse statutes and the suspension of the government’s need to prove “intent” will create a compliance environment many physicians will find problematic”.

Henry Faird, Computer Scientist , Dartmouth, NY Times January 1, 2011

“With every technology, there is a dark side. Sometimes you can predict it, but often you can’t.”

Many call this ‘the butterfly effect”or another interpretation, ‘remote causation’.

“It uses different techniques and approaches to bring physicians into compliance - whistleblowers to spot offenders, computer protocols to guide ordering behaviors, electronic federal audits to identify coding abuses, new regulations compelling compliance, and creation of new organizations – accountable care organizations – using capitated payments to end fee-for-service billing”,and by identifying those physicians who violate compliance rules, reformers hope to shed light on what they consider to be a dark side of medicine - physician ordering practices that enhance income for themselves and hospitals in which they practice.

 

As with any top-down, Washington-based government program to regulate private behavior, there are dark sides to what government is trying to do.

•  
  • In the first place, government compliance is by its very nature retrospective. Regulators are not present at the physician-patient encounter and have little idea of the circumstances, dynamics, or context of what occurred or what was ordered at the point of care.
  
• • Second, medical coding is so confounding, confusing, and byzantine that nobody – including government – understands its nuances and complexities. The reality is that about 20% of physicians under code while about 5% over code.
  
• • Third, much if not most of the $60 billion of fraud and abuse that occurs in Medicare, is carried out by non-physicians who steal patients’ Medicare identity cards, set up storefront Medicare and Medicaid mills, and bill for items such as wheelchairs and other equipment or devices.
  
• • Fourth, herding doctors into accountable care organizations and consolidating care in large medical institutions, which have the administrative skills only large organizations possess, will not necessarily lower costs. Costs are invariably higher for hospital charges for inpatients and outpatients, in part due to “facility fees,” than for those performed by physicians outside hospital walls or jurisdictions.
• Fifth, some 70% to 80% of care is delivered by independent private physicians on a fee-for-service basis, usually through existing, often very sophisticated billing systems.. Converting or modifying these systems or integrating them with electronic billing systems will be a herculean, long-term task, fraught with certification and standardization difficulties.
• • Sixth, there is a Big Brother aspect to all of this. Already computer controlled camera surveillance systems are being installed in hospital rooms. These systems come with ominous computer-generated voices that announce to doctors and nurses, “ You have not washed your hands.”

An entire new industry is spawning, with consulting specialists, compliance attorneys, and their legions of clerical assistants.

And finally Dr. Reece forecasts these ‘dark aspects’ of health reform,accountability, and non-compliance.

“I can foresee camera. face recognition, and computer surveillance systems in doctors’ offices. I pray this will not occur. These systems have the potential to destroy confidentiality, limit personal freedoms, and induce physicians paranoia. Privacy is central and essential to effective medical care. “

Crazy ideas,  I think not !  Who would have ever forecast the use of body scanners at airports, invasive monitoring of routine electronic communications, emails, data mining without consent or prior knowledge…who would have thought a President would bypass congressional consent for appointments (such as the head of CMS.), nor the congress sending sweeping health regulatory law , empowering the Secretary of HHS with total control over health care reform.without reading nor analyzing it’s ramifications not just for health care, but the overall secondary impact on the foundering U.S. economy.

Citizens should be outraged an should not be duped into  believing (Doctor) Sam will “care for them”. 

del.icio.us Tags: dark side,HHS,Congress,Health Reform,Don Berwick,compliance,health regulation,accountable care organization,fraud and abuse,medinnovation,health train express

Cleaning Health Train Express

 

 

At the end of the year it’s time to clean house. Yes, it is  a bit early for Spring Cleaning, but Health Train has been advised of  climate change and perhaps increased ambient temperatures, and perhaps an early spring so here goes. Costco is already stocking up for spring and spring break, and the Easter flowers, bunnies and water toys are displayed.

Health Train reviewed the blog friend list and found only three blogs that have been dormant for more than six months.  Frankly I was surprise to see the longevity of health blogs. 

Observation #1

There appears to be two classes of health blogs:

1. Those dedicated to  patient information, case studies, educational information and anecdotal stories. Some are very sad, some are inspiring, and some despair at the follow of some humans who are resistant to being helped in their suffering.

2. Those dedicated to political issues, rants, raves, frustration at the realities of medical practice today. A great deal is published by ‘medical experts’ without clinical experience but ‘grounded’ with MBAs, MPHs, and those on ‘committees, or national foundations.  Some of these ‘experts’ have considerable power and authority to make decisions that effect our patients.

3.Blogs related to health information technology and the ‘build out’ of the medical digital world.

In addition to blogs, there are other more structured forums:

Medpedia, which aggregate a large number of health blogs.

SERMO, a physician only blog limited to licenses MDs. This blog has specialty sections, and sections devoted to political commentary, practice management. The site is supported by Pharma and mined for physician comment about treatments. No patient information is disclosed.

Large media publication blogs (columns, such as WSJ, NY Times, LA Times and newspapers from cities around the United States.

Community Groups dedicate to specific disease entities

The Health Well,  an aggregation of many health blogs, and journal references

Futurists weight in with prognostication seeing into the future with what seems to be unwarranted certainty at the outcome of health reform.

 

Here’s Johnny. You make up the answer and question.  The best answer about health reform, (post in comments) will receive an iPad. The deadline for entering is January 31, 2010

del.icio.us Tags: free iPad,Carnac,Health Blogs,forums

Blogger Takes Leave

I have been told the most boring thing in the world is a blogger who writes about blogging.

Actually blogging is all about people, and yesterday I was a bit saddened to hear that one of my best blogging friends is taking a break from blogging.

 

Unplugging

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I have made a very big decision: I am going to unplug myself from the internet world for a while.  That means that I am hanging up my blogging for now.

Distractible MD(Rob Lambert MD) has been around since the dawn of the age of blogging….at a time when blogging was not user friendly at all. Even the cloud blog publishers were arcane and byzantine

After five years or so of blogging one makes some close friends, not at all unlike having a pen pal when I was knee-high to  a grasshopper. (not sure if that is a relevant metaphor for Gen X,Y,Z or iGadgets.)

Bloggers tend to develop a circle of friends.   Our circle has been broken. 

Hope he will be back soon.  Have a good rest. Hope you don’t have carpal tunnel syndrome. 

Recharge   your batteries, guys like you always come back !

 

GML

del.icio.us Tags: Musings of a Distractible MD,Doc Rob,Health blogs

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