Are you a QR user?

 

The 3 Rs ,  long the basis of educational dogma in the United States has been supplemented, and at times replaced by word processors, spelling and grammar checks and calculators capable of calculating algebraic, trigonometric, and calculus ..

Add to this the spice of mobile apps, smart phones with cameras and the  QR code   

  Hold this up to your iPhone equipped with one of the  QR reader apps,   readily available at iTune for  FREE !  If it’s free, it must be free. There is also a web cam app available.

Any digital camera and web cam is capable of reading these ideograms and with the proper software spit out the message in old fashioned plain English, French, German, or whatever.

A QR (Quick Response or Quick Read) Code is a two-dimensional matrix/bar code.  Users hold their phone up to the code displayed on a sign, in a book, on a computer screen, TV, or almost anywhere.  The phone camera snaps the code and takes the user to a website or video with more information – no typing needed – just point and click.

               

The hieroglyphic figures encapsulate a new wave of capturing ,storing and transmitting information.  They have been around for awhile in the shipping industry, the IRS, legal forms and provide a means of sorting documents and packages by machines.  Bar codes may be on the way out.  Their readers are more complex expensive,and require lasers. The beauty of these little beasts is that they are easily read by a camera.

If you hadn’t noticed health related applications abound:

For example, QR codes can be used to help patients use health information in specific contexts, such as when needing to:

• take a pill
• interact with a device (for example, a glucose meter, a smart band-aid, etc.)
• engage in a behavior (e.g., finding a hospital, exercising, buying food, selecting a meal, etc.).
  • QR codes on food/drink packages to link to nutrition information, interactive calorie counters, and personal information about a patient’s diet plan (which would require the learner/patient to interact with a Web site linked to the QR code)
  • QR codes attached to medication labels, linking the codes to patient-friendly information, as well as physician and pharmacy contact information
  • QR codes to identify drug interactions (useful for patients and physicians) via an interactive or static Web interface
  • QR codes on devices patients use, to link to how-to information (e.g., text, video, or audio information, that could be presented in different languages)
  • QR codes to link medications, patient devices, physical locations, etc., to live assistance (e.g., nurses, other health care providers) via phone numbers associated with the code or links to sites with live chat capabilities
  • QR codes on a card the patient carries or on a key-chain attachment that’s linked to the patient’s personal health care record (PHR) and/or emergency contact information
  • QR codes to help patients identify health care providers or emergency medical services in their area
  • QR codes on the equipment on a jogging path or in a gym to encourage appropriate exercises, connect to heart rate monitors, etc.

  IF you’re smart, here are 22 ways you will use QR codes in health care.

  • Billboards advertising hospitals and medical groups will have QR codes so travelers can get more information about facilities or  get directions to the closest Emergency Department, Urgent Care or family practice.
• Television advertising for pharmaceuticals will have QR codes so viewers can get more information on the spot.
• Healthcare facilities will have QR codes for all types of information and videos that providers and nurses will instruct patients to scan based on their health problems.
• Magazines and newspapers will have QR codes that readers can scan to get health information and health product coupons.
• Scanning QR codes when exercising or purchasing healthy foods will get you reward points with your health plan, your doctor or your employer.
• Comparison of foods that you should or should not buy in grocery stores based on your individual health problems will be easy when you scan the food’s QR codes.
• Caregivers will scan QR codes to receive information and videos for caring for their loved one at home.
• When purchasing over the counter medications, vitamins and supplements, you will scan the QR to make sure the medication isn’t contraindicated for any prescription medication you are taking.
• Scanning the QR code on food or cleaning products will let you know if they contain anything that you are allergic to.
  1. At health fairs, attendees will scan QR codes for more information on health topics and your facility and services.
  2. Disposable diapers will each come with a unique QR code that Moms (and babies) can scan to get childcare tips, games, songs and medical advice.
  3. Urgent Care facilities and Emergency Rooms will have QR codes for instant access to wait times.
  4. QR codes in healthcare facilities will let users download helpful mobile healthcare applications like those that help you control your chronic illness or lose weight.
• In print advertising for physicians, potential patients will scan the QR code to view the physicians talking about their background, their specialties and their desire to have you as a new patient!
• Referring patients to facilities or specialty practices will be much easier when patients scan the QR code for the referral and receive information, instructions and directions to the appointment.
• Healthcare facilities will give out t-shirts and carrying bags promoting their services and the QR codes on them will spread the word to others. (Yes, people will scan each others’ t-shirt codes!)
  1. Patients taking home halter monitors and CPAPs will be able to scan the QR code on the machine to get a “how-to” video on using it.
  2. Patients taking home sample medications from physician offices will have QR codes on the bag to scan to remember how they are to take the samples.
• Temporary tattoo QR codes will identify those patients who won’t wear identifying bracelets, have dementia, or tend to wander away.   
• 
• Hospital patients will scan the menu broadcast on their TV to order their daily meals.
  1. If you are going to be late to your doctor’s appointment, you will scan a QR code to email an alert to the office that you are on the way. (Wait, maybe that’s too easy!)
  2. Pharmacies will have QRs loaded with prescription prices by insurance company plan on their website so providers can compare different drugs and chose the best drug for the patient at the best price.

Those of  you wishing to check this can get one of these apps for  your camera smart phone.  You can also obtain a web camera app if you don’t have a camera smart phone.

NeoReader,   Optiscan,  QR App,  QuickMark

All of these QR apps can be downloaded from the download.cnet.com web site.

del.icio.us Tags: QR codes,health QR applications

Pills and other Things on Health Train Express

 

               

 

                                       

 

Pill cap 2.0 ? It’s time for your medicine cabinet to become IT literate. Yes, plans have been developed, the hardware and software ready to go.  The carriers are dreaming big about subscriptions to a service that reads your medicine bottles over your bathroom sink. Gigaom   reports that at C.E.S. 2011  the activity about tablets was intense,   however there were other more profitable things going on behind those doors on the sides of the exhibit hall.

For example? Your medicine cabinet. AT&T said last week it would provide the service behind an innovative pill cap that will connect to its network and text users when it’s time to take their medicine, or it could text a caregiver.

The nifty little pill bottle top costs $10 per cap and requires a $15 per month service plan. That’s likely worth it for people who need reminders about the drugs they or a loved one are taking, but on a per-megabyte basis that $15 per month nets out to about $25 per MB, although it’s not clear if AT&T gets the full $15. The folks at Vitality, the maker of the cap, said the connected cap transmits less than 20 kilobytes of data per day over the network — a mere crumb when compared to bandwidth hogs watching streaming video on their iPhones.

Vitality relies on pharmacies to dispense drugs in GlowCaps. Chains bid on how many of the caps they can distribute and get paid each time they dispense a bottle with one. Vitality recently launched its program with Express Scripts, one of the largest pharmacy benefit managers, to distribute certain medications in bottles outfitted with its caps. When does a non-event become an event?

The device has been shown to lift adherence. Data from a Partners Healthcare study released last month shows adherence increased 27%. Patients adhered to medications 98-99% of the time when the pill cap's reminder services, along with financial incentives, were used, according to data collected by the Center for Connected Health, a division of Partners Healthcare.

“Across all bottles in the field, we see compliance above 85%,” added Reim. Compared to what he said is the going compliance rate of roughly 65%, plus or minus depending on the drug, “That kind of 20% improvement in compliance has ramifications for outcomes, sales and new sources of data.”

So your spouse or significant other, mother, father will no longer have to berate you ‘not to forget your cough syrup"'’.

In 2011 expect there to be an explosion of ‘intelligent home devices"’ broadcasting your compliance, vital signs, and also most likely biopsying your wallet.  What’s in Your Wallet?

del.icio.us Tags: glocaps,express scripts,vitality,health 2.0

Health Train Express and the Sleeper Car

 

When I began this blog six years ago I had no idea how useful the title would be for my forum.  If you look at my several hundred posts I have been able to use train analogies for many of my issues with medicine and health care.

The title today says it all for today’s blog posting.

One of the largest, and ignored medical problems (sleep apnea) creates an enormous fall out of heart disease, hypertension, sleep disorder, depression, and not the least, marital dysfunction.

At home monitoring technology offers much  to physicians and patients alike.  I am not referring to  EMR,HIT, Health Information Exchange or other in office  technology assist devices.

Home monitoring devices are now entrenched firmly in the DME space, and many  are covered by Medicare and private insurers.

How about having a FEDEX box delivered to your home with a self contained Sleep laboratory, and all the computer monitoring modules and attachments,  along with a video instruction course found on the internet or in the package? It is shipped pre paid with the material enclosed, and a return label (pre paid).

The instructions included detail the step by step process from beginning to end.  The module records all the parameters from the night’s sleep or non-sleep, as the case may be.

The test is the same given at a certified sleep laboratory. Who sleeps normally in a strange bed or environment?

Have I mentioned the sleep test is at no charge ! 

Sleep apnea represents a “sleeper” public health problem.  It is probably just as significant as diabetes, hypertension, obesity, and elevated blood lipids .  As physicians should all ask.  “Why it has never stimulated public prevention and/or diagnosis?”

It is recognized by most PCPs but the referral process for evaluation, diagnosis and treatment is circuitous and often not easily available for now avoidable reasons.

If you want or need to know more about  it don’t hesitate to ask me for further details. (no obligation whatsoever)

I can be reached at  Health.Train.Sleeper.Car@gmail.com. Include your email address or how you would like to be contacted.

 

Your travel companion,

---The Conductor, Locomotive Engineer, and Caboose Manager of the Health Train Express.. (all aboard please, next stop Dreamland.)

 

del.icio.us Tags: sleep apnea,sleep testing,hypertension,heart disease,depression,health train express,home testing,snoring

ACOs, HMOs in Drag?

 

assumptions

December 1st, 2010

by Dr. Jesse Cole

ACO models offer nothing that other ASOs--alphabet soup organizations--have not offered in the past. HMOs, PPOs, MPOs and more have all been tried and if not failed, at least have never lived up to the hype.

There is no reason to believe ACOs will fare any better. But it's possible the ACO experiment will be more dangerous than its proponents care to admit.

[More:]

Let's start with the assumption that healthcare is so fragmented and inefficient that putting people in a hospital-based ACO will reduce costs. Where's the evidence for that? Do most people actually need a complex, multiprovider team to deliver their healthcare?

The answer is no.

Throughout their lives, most people have fairly self limited acute problems, or chronic, medically managed problems which required limited interventions that can be performed in a physician's office. Private physician's offices are generally run in a cost effective manner because the physician is paying the bills.

The critic will say the physician is over-ordering examinations to pay the bills. How? Most primary care physicians have fairly limited in-office ancillary income, generally basic lab, EKG, pulmonary function tests, and perhaps X-ray. These procedures generate an income, generally enough to pay for themselves but not enough for the physician to retire on.

"Ah ha," cries the critic. "You, Dr. Primary Care, don't really have enough in office resources to provide high quality coordinated care. I see no educators, pharmacists, social workers, physical therapists, specialists, subspecialists, billing coordinators or dieticians. That's costing the health care system money."

Or, according to the experts...a primary care practice is too small to provide high quality, cost efficient coordinated care because it lacks all of these elements.

Therein lies the problem. The ACO model depends upon the assumption that all health care delivered by primary care physicians in their office is cost inefficient and of lower quality than what an ACO will provide, without the necessary evidence.

Could the care provided by private physician practices be improved? Certainly. But where is the evidence that the fee for service, private physician model of health care is not efficient and does not provide good care? The ACO model is still fee-for-service. It's just that the fee will go to a larger organization, composed of many more people, all fighting for a piece of that dollar and creating costly overhead.

Do people with the vast majority of medical problems, such as acute upper respiratory infections, urinary tract infections, hypertension, and diabetes. Do they really need a multidisciplinary task force to take care of them? Such is the nature of an ACO.

Hospitals have certainly jumped on the bandwagon for ACOs, with good reason from their point of view. Hospitals are an anachronism when it comes to providing cost effective care. That's not a bug. That's a feature. Hospitals are supposed to be for people who cannot be managed as outpatients.

In fact, the irony is that outpatient medical care, largely delivered by outpatient physicians in private practice, has advanced to the point where hospitals have seen their occupancy rates plummet. Few remember the days in the 1950s and 1960s when those who survived heart attacks might spend several weeks recuperating in the hospital.

Hospitals now employ more than 50 percent of physicians, and that number is expected to grow. Among reasons cited, the new generation of doctor is more interested in lifestyle and security rather than the stress of private practice. But in accepting employment offers from hospitals, are doctors trading one set of stresses for another? I believe so, especially if the ACO model is widely adopted.

Dr. Jesse Cole is a radiologist in private practice in Butte, Montana. He is also subspecialty certified in neuroradiology, and vascular and interventional radiology and practices at Big Sky Diagnostic Imaging in Butte with a limited practice at Community Hospital in Anaconda.

del.icio.us Tags: acountable care,aco,hmo

From iHealthBeat

 

A brief visit to an excellent source of Health News

Health Care Providers Identify Roadblocks to Meaningful Use

On Monday and Tuesday, more than a dozen physicians and representatives of hospitals discussed challenges associated with meeting requirements under the meaningful use program, AHA News reports.

Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of electronic health records can qualify for incentive payments through Medicare and Medicaid (AHA News, 1/11).

Attendees spoke during a two-day meeting of the Implementation work group of the Health IT Standards Committee. The speakers were advanced users of EHRs, according to Modern Healthcare (Conn, Modern Healthcare, 1/12).

Attendees' Concerns

Attendees said that many hospitals will face challenges complying with the incentive program's meaningful use requirements.

Joanne Sunquist -- CIO of Minneapolis-based Hennepin County Medical Center -- said developing reports to demonstrate meaningful use "has become an onerous, difficult and time-consuming process" ADD EXPENSIVE (mine)(Page, Becker's Hospital Review, 1/12). Sunquist added that health care organizations might encounter difficulty implementing quality reporting systems using vendor-provided workflow information (Goedert, Health Data Management, 1/12).

According to Charles Christian -- CIO of Good Samaritan Hospital in Indiana -- smaller facilities could experience difficulty implementing health IT because they might not have appropriate in-house staff and would have to rely on outside help.

Linda Reed -- vice president and CIO of Atlantic Health in New Jersey -- said that physicians need more guidance on implementing technology to support health information exchange (Monegain, Healthcare IT News, 1/12).

According to Lyle Berkowitz -- medical director of clinical information systems at Chicago-based Northwestern Memorial Physicians Group -- independent physician practices are at a disadvantage because they do not have access to resources compared with hospital-affiliated groups (Modern Healthcare, 1/12).

Meeting attendees called for HHS to provide more time before implementing the incentive program's Stage 2 requirements (AHA News, 1/11).

Read more: http://www.ihealthbeat.org/articles/2011/1/12/health-care-providers-identify-roadblocks-to-meaningful-use.aspx#ixzz1AsYTqTww

del.icio.us Tags: ihealthbeat,ehr costs,meaningful use,hhs,incentives

SCOTUS in Mayo Clinic v. IRS

 

Health Train is back on the track again.  In another round of health care complications where getting a medical education turns into a high priced legal venture for one of the largest most famous medical clinics in the world.  You can bet your bottom dollar this had much more to do with cash flow for Mayo than whether the relatively less well off junior MDs could escape Uncle Sam’s money sucking vacuum machine.  More about Complications here.

I found some commentary on the WSJ blog on Health

 

.

• workaholic wrote:

As interns in the 70’s, we worked 128 hour weeks and loved it. We are graying now and find the trainees to be eager but lazy, not committed to their patients, while very committed to their CPOEs, EHRs, and mobile devices, as the patient lies in pain and poop. We were paid a fixed amount per year, period, with weekends on and two weeks of vacation when someone else told us to take it.

There is a reason why the Hopkins is so great. I do not remember if they took out social security, I will check my stubs (I am a packrat) but if they did, I will seek a refund plus interest.

• Anonymous wrote:

Perhaps they can be employees for the purpose of IRS but not employees for the purpose of some different state laws. Part of the Supreme Court’s point is that it will defer to the reasoned and careful judgment of the agency (here, IRS) when there is not some compelling reason to reverse the position of the agency. This creates a public climate and legal climate where irrational decisions of agencies can be corrected, but, all the decisions of all government agencies are not constantly being revised over and over every time a judge somewhere entertains an alternative opinion. I agree with the IRS that the job has most of the characteristics of employment, not those of being “a student.”

• Academic wrote:

This has other potential negative consequences. If residents are considered employees than there are overtime rules, and limits on work hours that could be applied depending on the states laws. This could mean that in the future newer physicians will have less time spent in training. Not a pretty picture, especially for surgeons where hours, repetition and numbers of procedures makes a huge difference in ability to perform a task correctly.

 

SCOTUS blog goes into further analysis and arguments:

 

How can the Web be used for Health Health Habits.?

Now for the real bread and butter.  I just attended a webinar from Health 2.0 where participants are meeting t he Health 2.0 challenge thrown down by Matt Holt of the Health Care Blog.

One of the solutions can be found at :  Healthy People .

Analysis for 2011

Pronouncements From on High

LOS ANGELES, CA -- (Marketwire) -- 01/11/11 -- The sluggish economy and the farthest-reaching health reform in more than 50 years will continue to ratchet up pressure on U.S. providers to reduce costs and improve quality, setting the stage for The Camden Group's annual Top 10 Trends in Healthcare in 2011. These pressures will trigger an avalanche of activity centered on accountable care organizations (ACOs), bundled payments, and patient-centered medical homes. At the same time, they will compel more physicians to seek employment with hospitals or large medical groups and spur more consolidation of hospitals and medical groups/independent practice

"2011 is the year when a growing number of providers move forward with new care delivery models and run into the very real challenges posed by overhauling traditional ways of treating patients. The fundamental question is whether providers can manage costs and improve quality while maintaining provider choice and open access," says Steven T. Valentine, president of The Camden Group. "As always, the devil is in the details."

Yes, indeed it is. (Health Train Express)

Further predictions:

The Camden Group    predicts the following Top 10 Trends will have major and continuing impact on the healthcare sector during 2011:

1. Insurance membership takes hit from slow recovery. Few unemployed will take advantage of COBRA while employees, faced with paying more of their health plan premium, will select high-deductible, low-premium PPO plans, hurting HMOs.

2. No easing on payment pressure. Although health plan payments will keep pace with inflation and operating cost increases, they will not make up for declining or stagnant Medicaid and Medicare payments.

3. Patients postpone care, hurting providers too. With high unemployment and underemployment and increased out-of-pocket costs, people will continue to put off treatment, keeping volumes at hospitals, ambulatory centers, and physician offices soft.

4. Cost is king. Soft volume, downward pressure on revenues, and deteriorating payer mix with increased bad debt will drive providers to seek more cost savings. However, unions, staffing ratios, and regulations will make cuts difficult. At the same time, health plans will begin to explore and increase the use of tiered networks and stratify payment to encourage use of lower-cost providers.

5. Capital remains elusive. As in 2010, most non-profit hospitals will find it difficult to access capital. Lenders are requiring an increase in days cash-on-hand, coverage ratio, stronger EBITDA, and smaller borrowings. Credit rating agencies want to see: 1) physician alignment strategy, 2)clinical integration and cost reduction action, 3) IT plan, and 4) plans to capture more market share.

6. Physicians make or break new care models. To improve outcomes and lower costs, hospitals and medical groups will focus on accountable care, bundled payments, patient-centered medical homes, and/or clinical integration. Reducing variation in care -- primarily by physicians -- will be central to any successful strategy. An effective bundled payment strategy, for example, requires specialists to address clinical resource consumption and supply cost and use while standardizing care protocols in conjunction with hospitalists and intensivists.

7. Construction focus is on fast returns. Construction projects will be scaled down, with a focus on regulatory compliance, enhancing throughput, improving care/outcomes, and if possible, capturing additional market share. Providers also will prioritize construction that generates superior returns, such as surgical services and imaging centers. Do not be surprised to see the growth of freestanding emergency departments to reduce the need for hospitals, increase access, and provide capacity for the newly insured.

8. IT becomes more pervasive -- or else. Information technology underpins providers' ability to shift to new care models, so IT moves to center stage with efforts to implement electronic medical records, (EMRs,) computerized physician order entry (CPOE), and health information exchanges (HIEs.) Provided, of course, medical facilities already have in place ePrescribing, PACS, and online results reporting and scheduling.

9. Let's make a deal. Mergers and acquisitions will be brisk as more hospitals and physician groups acknowledge they lack the resources to invest in information technology, facilities, and equipment for new delivery models or the leverage to negotiate effectively with health plans. Given their central role in new models, the value of primary care medical groups will increase. It is possible that health plans will enter the market to acquire these medical groups.

10. Market share, market share, market share. Hospitals and medical groups have underutilized assets and must get them busy. Providers also realize that more volume will generate incremental revenue and decrease per unit cost. Hospitals will hunt for new programs to fill empty or underperforming assets.

 

We also need to factor in the “Social Media Impact” on ACOs

Social Media goes to the E.R.

Pretty soon it will be all F.U.B.A.R.

del.icio.us Tags: aco,accountable care organization,market share,cost,underperforming assets

Stem Cell and Grievous Brain Trauma.

 

First let’s go over to KevinMD where my post about Public Health, and MPH’s has been re-posted by Kevin Pho MD.  I had actually forgotten about this post and did not know which one Kevin had chosen.  As a PCP my  post must have tweaked his Kool-Aid dispenser.

 

Personally I prefer Gatorade or G2, the drink for 21st Century Health Care.

My post today is about Stem Cell Research and it’s potential for Translational application to severe head injuries such as the one sustained by Gabrielle Gifford, Congresswoman from Arizona.

My thoughts are an imaginary scenario of injecting central neuro-stem cells into the wound tract of the bullet’s pathway. There it would  become part of the healing process, integrating, transforming and establishing new connections to replace those destroyed by the injury.  If only life and medicine were ever that simple.

The only positive aspect of this horror would be to stimulate a young (or old) clinical and basic science team to embark on the animal, pharma, and microbiology study toward succeeding in that goal.

 

del.icio.us Tags: Gabrielle Gifford,Stem Cells,Kevin Pho,KevinMD,Public health,MPH

The Medical Blogosphere

 

KevinMD.com will be hosting Health Train Express tomorrow, Monday January 9th 2011 . You can look for it at KevinMD.com

Kudos  to Dr. Pho !  All good  things start and end in New Hampshire.

Kevin Pho. MD has been at this about the same amount of time that I have been at my blog space.  Judging from the number of ‘hits’ his site has daily compared to mine reveals how ignorant I have been in regarding to the new age of information exchange.

I seem to know what to do,  but just have not invested time, money or staff into doing it.  He has been published in many big-time media spaces, such as CNN, USA Today,

Kevin’s appearances include the CBS Evening News with Katie Couric, New England Cable News, and WNYC-New York Public Radio’s The Takeaway, and he has spoken at the New England Journal of Medicine, Blog World and New Media Expo, and at academic Grand Rounds nationwide.

As social media’s leading physician voice,KevinMD.com was voted 2008′s Best Medical Blog.Forbes.com calledKevinMD.com a “must-read health blog,” and CNN.commanded @KevinMD one of its five recommended Twitter health feeds.

The Wall Street Journal had this to  say about KevinMD, ““punchy, prolific blog that chronicles America’s often dysfunctional health care system through the prism of a primary care provider,” while others have noted that “a lively comment stream on one of Kevin’s posts provides more insight on the day-to-day realities of health care than any piece of journalism can ever hope to impart.”

Forbes.com hailed KevinMD.com as a “must-read blog,” and CNN.com named @KevinMD as one of its five recommended health care Twitter feeds.

Kevin Pho on the Medical Blogosphere

 

With over 40,000 RSS subscribers and 33,000 followers on Facebook and Twitter, KevinMD.com is among the web’s most influential and prominent health care platforms.

Dr Pho, when do you have time to make an appointment for me?

del.icio.us Tags: blogosphere,medical,kevinmd,medical bloggers,medical social media

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