Are We There Yet?

 

 

Are you waiting for Health Train Express on the train platform? Have a seat and call  911.

If you are at all wondering if your doctor will be there next time  you call,  you are operating in reality. In a recent survey sponsored by a well known EMR vendor the results are stunning.  Practice Fusion’s independent consultants found the following:

Key findings:
* 41 percent of doctors report that their practice is doing worse this year compared to last year. Compared to 26 percent who report their practice doing better and 31 percent report no change.
* 59 percent report that new technology has made things easier for their medical practice.
* 73 percent report that the computers in their practice are over three years old on average (21 percent in the five to six-year-old range).
* 69 percent of doctors report being satisfied to extremely satisfied with their career despite these challenges.
* Doctors were also asked to report their practice's top negative pressures and positive trends in a series of open ended questions.
* Issues relating to practice administration (31 percent), insurance and reimbursement (26 percent) and difficult patients (11 percent) are the top negative pressures on the practices.
* Positive trends are led by advancements in medicine (22 percent), patient quality (19 percent) and improvement in the healthcare workforce (15 percent).
* 80% of US physicians practice in groups of 9 or less according to the AMA.

View Practice Fusion's 2011 State of the Small Practice info graphic. Raw data from the survey is available free upon request. Practice Fusion is also offering physician sources across the country to talk about their own experiences managing a small practice.
Survey Methodology
The Practice Fusion State of the Small Practice study was conducted by internet survey in December 2010 with MDLinx. Responses to 10 questions were collected from a national sample of 100 physicians. The majority of respondents were primary care providers in practices with fewer than six providers.

Admittedly this was not a very scientific study, nor was their any indication of the demographic of the study group, not taking into account the geographic location, age of the physician, or medical practice. The statistic lumped all small practices from 1-9 physicians.   That is quite a spread. The resources of a one or two man group are far different than  three or more individual practitioners.

"Small primary care medical practices are the backbone of the US healthcare system," said Ryan Howard, CEO of Practice Fusion. "These are family doctors on the front lines, they're passionate about caring for their patients and our survey indicates  that they're struggling. “

EMR vendors as part of their service will evaluate a medical practice for implementing a system. This includes a thorough analysis of costs and return on investment.  They know the financials  within which physicians operate.  If anything they are biased toward selling their system,, and having a client be able to purchase and pay for it.

This survey by Practice Fusion (which offers a totally free EMR which operates in the cloud) points out that even with a ‘free EMR”  practices cannot afford the down time or the cost of minimal hardware investment.

Most small practices, and larger ones are operated with less than optimal physician/staff ratios.  The staff has to be multi-tasking in their job description. This is not always possible.

How many times do  you receive an answering machine when you call the  doctor’s office?  My observation is it occurs a great deal of the time. The message is ‘if it is a medical emergency to call 911 or go to the emergency room.” 

How about that for improved quality of care?  Government studies do not measure that metric, “the first mile to the health care system”.

Let me have your thoughts on this matter.

You can tweet me @anophthalmus, or leave a message on facebook/garylevin

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Monday Digest for Health Train Express

And here is the top of the blogosphere news for Monday, January 31, 2011

Dr Val   5 million dollar fine for Doctors asking questions about Guns in the home

The Health Care Blog  A Medical Student’s Dilemma

Dr Wes   Carding Doctors?

Dr A  Social Media to Traditional Media, or why you should participate

Health Policy and Communications Blog Rise of the Tea Party Machine

Life as a Healthcare CIO   Cool Technology of the Week

Medinnovation   Health Reform and Pay-for Performance,Not So Fast, Macduff !

Wall Street Journal Health Blog   Six Health-Care IPOs Planned For This Week

Disruptive Women in Health Care   Who’s a Medical Doctor?

Kevin MD   Marcus Welby and the relentless growth of specialization

Edwin Leap   The Physician Exodus

iHealthbeat  Report Says Health IT Has Potential To Advance Personalized Medicine (report from the Brookings Institute

                                                  

 

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del.icio.us Tags: kevinmd,edwin leap,iHealthbeat,disruptive women,health cio,wsj blog,medinnovation,health policy,Dr A,Dr Wes,THCB,Dr Val

Health Reform—The Nail on the Head

 

Richard Reeces, author of Medinnovation reveals that two Democrats his the health reform nail on the head.

In his blog Reece elaborates:  “Patrick Caddell, former pollster for Jimmy Carter, and Douglas Schoen, Democrat pollster, strategist, and author of The Political Fix: Changing the Game of American Democracy, say bluntly and succinctly give three cogent reasons why the health reform law has failed to impress the American people.”

Number One, the law is “anti-democratic.” It received no Republican votes, and three sneaky deals – the Louisiana Purchase, the Cornhusker Kickback, and the Connecticut U Con – made it possible. Its passage did not pass the smell test. If you believe in democratic bipartisanship and consensus, the law emits an unpleasant odor.

Number Two, the law fails flat on two false promises,
a. That everybody can keep their current policies, while in reality , employers are quickly dropping employees like flies from employer plans because it is now cheaper to do so.
b. That the individual mandate was a regulation of commercial activity and was not a tax, yet Democrats are defending it as a tax in the courts now that 28 states are challenging its constitutionality.

Number Three, the law does not deliver what the reform package the public wants,
a. Purchase insurance across state lines
b. Coverage pre-existing conditions (this being the one exception)
c. Portability from job to job
d. Support of malpractice reform
e. Incremental introduction of reform
f. Believable initiatives to hold down costs

The health reform law, in short, is a pig in a poke, an idiom referring to someone buying a low-quality pig in a bag because he or she did not carefully check what was in the bag. Now that the public is learning what’s in the law, they dislike it more than ever.

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Health Train is changing Tracks

 

The Big Switch

I spent the past several days reviewing the content of my blog over the past six years.  It amazed me that I don’t remember writing a lot of what I read.  It seemed unfamiliar and I wondered who wrote that stuff. Perhaps some other writers experience this phenomenon whereby one does not want to own what one wrote some time ago. My blogs have changed considerably and I estimate most of it is not really original, much is cut and pasted, some is repeated with attribution.

The most I have to offer to my readers is my time. I am not seeing patients anymore and have a volume of time to read many things, sit back ponder, pontificate.  Those who can do, and those who can’t either teach or write. Both of those avocations take inordinately large amounts of time, to do well. And so does keeping a medical record, hand written or via an EMR.

For those of you in practice your time is very limited and one of the things you don’t have time to do much of is read and/or surf news articles about anything.

In the next week or so my blog design will change as well as it’s content.  Stay on this ‘channel’

Also follow me @anophthalmus for interesting news, some medical, some political, some humorous, some sad. (all in a day).

World Economic Forum

 

  The World Economic Forum is live today via video streaming from Davos,Switzerland.  Many health care related interviews with Bill Gates, Tony Blair and others.   http://www.weforum.org/    Other issues regarding Information Technology, and World Health, Global Social Media Networking.

 

LIVE STREAM

Observations

 

The Medicare web site,  Medicare.gov offers a “Physician Compare” section.  The stated goal is to be ‘patient centric’ to meet consumer needs.  This section supposedly  offers a means to search for physicians to compare their demographics and expertise as well as certifications.

 

I researched the site extensively for multiple providers who I know personally. 

The amount of information was minimalistic, demographics, specialty and degrees, ( no mention of subspecialty) medical group name (if any) with no mention of hospital affiliations. There was no mention of re-certification status, when licensed. The main features most notably displayed was if the provider accepted assignment. (apparently an indicator of ‘quality”)

It is highly inaccurate. I did a search for a physician within 15 miles of my location and came up with one that had over 100 locations listed (not in a group).

I would label this web site as dangerous !!!

Hard to believe whoever was in charge of this let it slip through. Well intentioned  but poorly implemented.

The Health Care Blog also has a post today by Micihael Millenson. Thanks to him.  I will write Czar Berwick about this one.  Suggest all of us do the same. 

 

del.icio.us Tags: CMS,WEB SEARCH,PHYSICIAN COMPARE

Pharma Crisis ??

 

Today’s WSJ reports that Pharma is being squeezed from all sides.

2011 Looks Tough For Drug Companies  (clickable)

 

Despite past news of huge billion dollar profits for Pharma, the ecosystem for pharmaceuticals has gradually eroded leaving   pharma in a less tenable position.  Pressure is mounting with health reform measures, while pharma has been hit hard by restrictive formulas, and the emergence of ‘generics’.  Generics, once looked upon with suspicion and doubt have take over a large part of doctor prescribing habits.  Doctors have been forced to prescribe generics by limitations of their patient’s plans and their formularies.  Most generics are tier 1 (a classification of drugs in each formulary). It does not take long if you gaze at a typical plans formulary to see how much less the copay is for a generic drug. Specific drug formularies are easily found on plan websites. 

Pharmaceutical R &  D is expensive, as well as the FDA approval process,   The previous model of marketing a new  generation  or modification of an older drug with attendant new  patents (at a much higher price) will not work today. We have and will see a marked increase in new drug cycle times.

So bad is the situation that this documentary was written by the Bureau of Investigative Journalism (clickable link) 

 

NYSE Floor

 

The NIH National Center for Drug Research (clickable)

“The National Institutes of Health has approved Obama’s decision to assist with funding for drug research and development through a Federal Research Center.

 

                  

Federal officials concerned about the slowing pace of new drugs coming out of the pharmaceutical industry have decided to start a billion-dollar government drug development center to help create medicines.”

The New York Times reported on its website Saturday about the new effort that comes as many large drug makers, unable to find enough new drugs, are trimming back research

“ NIH chief Francis Collins is pushing ahead with ambitious plans to create a new center for translational medicine that will do some of the early-stage work for the drug development industry.

Collins' plan, endorsed by HHS Secretary Kathleen Sebelius and outlined over the weekend by the New York Times, is to bring together $700 million in R&D work under one roof at the National Center for Advancing Translational Sciences, where government scientists will pursue a billion dollars in funding to push the projects through the Valley of Death. Collins' blueprint calls for scientists to get enough proof-of-concept data in hand to whet pharma's appetite, spurring them to step in and finish the discovery work needed to obtain an approval.”

If I read this correctly, the FDA will have one arm to assess the safety of new drugs, and     it’s sister  NIH will be dueling.

There is some opinion  the NIH has no business  in pharma other than to provide basic science and early translational work.  It may be a different story for Orphan disease and Orphan Drugs  (clickable)

 

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Algo Men to the Rescue

 

When all else fails, do a study. President Obama reigns supreme in this area. 

Algorithms sound impressive, not like Algo Gores. This is what higher math is for…to prove the discontinuities of existence, the universe or whatever you are plagued with in modern times. Algos are supposed to make decision making easier with a formula or diagrams directing a ‘machine’ (computer) to make stem choices. (Best stem I have had was on an apple (not the computer)

1. President Obama will soon be appointing a new Czar. The algorithm Czar who will be the final arbiter of algoland.  The AlgoCzar will reign over health care, politics, economics, defense, security, foreign policy and the Rest rooms.
2. You can read the entire article at the New York Times but in essence the President ran out of folks who could help him out with the technological war far that is occurring and thus has reached out and grabbed William M. Daley whoworks in the financial industry. They work worth with algorithms day in and out and while Mr. Daley may not be a hands on person, believe me he knows his “Algo Men” as all the banks have quite a few of them.

Before I get any further I need to give attribution to Medical Quack whose recent posts have been in reference to Algo-Medicine and our great hope for the good side of “The Force”. Barbara, or as I like to call her “Ducky”, not to be confused with Ducky from NCIS’ whose forensic abilities defy most pathologists. (why don’t more pathologists blog?) (where was I now?)

Oh yes,  Medical Quack always has an aggregation of topics that fuel my limbic system.   This is not Ducky’s fault…..it’s a bit like shooting the messenger.  Ducky, you bring a lot of bad Karma to the table. I like you very much. It keeps me grounded and diminishes my euphoria. Thank you very much. 

Now what was the point of this post ??

del.icio.us Tags: medical quack,healthtrain express,algorithms,william daley,barak obama

More on Jack

 

My colleague and blog friend,   The Hospitalist   expanded better than I ever could about Jack Lalanne in his blog on Monday.  It’s worth reading.

He was the original ‘health nut’. But he was ‘bolted’ down. He exemplifies the fact that we all die, but the journey to it can be a gradual slope of declining health, unhappiness, disability or a good quality of life until one goes over the cliff  suddenly.

Jack,   the original ‘Juicer"’ did not need MLM,Facebook, Twitter, Tumblr,MySpace, or coupons from Groupon to spread his ideas

So really, disciplined eating habits, exercise, avoidance of unhealthy stress counts more than blockbuster drugs and high tech enhanced hospitals. Accountable care organizations will do little for your longevity, politicians, not withstanding.

If Jack Lalanne could do all that in the 1950s and 60s, imagine what he would have done now…..that is if he did not spend his time surfing and blogging, twittering and face booking all day.

How about an internet enable set of barbells, or workout machine?I know someone out there has an iPad accessory to attach the iPad to my treadmill.

Jack had this saying,

“YOUR HEALTH ACCOUNT IS YOUR WEALTH ACCOUNT!
LONG LIVE LIVING LONG!”

WATCH JACK

Long before  HSAs !

 

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An Icon Passes

 

 

For some of you the name of Jack Lalanne brings forth images of a ‘jumping jack’ on your TV screen, or memories of “Bally” gyms, the chain that Jack started.

He was among the first to popularize weightlifting and his physical fitness techniques – including the fingertip press-up – formed the centerpiece of The Jack LaLanne Show, which ran on American television from the 1950s to the 1980s. Long before the age of celebrity exercise videos, LaLanne was telling people how to get fit.

Jack left us yesterday at the age of 96 years.  The original 20th century beacon of fitness and preventive living he was a disciplined man, At the time a  version of Arnold Schwarzenegger. 

Just a moment of science from us all to thank and remember him for starting it all. We will miss the juices as well.

 

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Health Care and Reform Film Festival

 

“We” are going to introduce a new forum for ‘film” or digital productions regarding our health system.  Here is our “World Class” presentation.

 

Study Looks For, Can’t Find Much Evidence of E-Health’s Benefits

 

There is a bit of a new link on the right hand sidebar. Levin’s Shout Out. Expands the audience a bit.

With the U.S. and the U.K. heading full steam towards electronic medical records and other health IT applications, how much evidence is there that they improve care?

The Wall Street Journal speaks to this issue.

Let’s keep it all realistic.  !!

 

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Locomotives can only Pull So Many Cars

 

Bird's eye view of more than a mile long rake as seen from Lowell's Observatory.(Arizona)

 

 

Clive Peedell in The Health Care Blog picks up today where I left off regarding the NHS in U.K.  He correctly identified that the NHS white paper is a plan to dismantle the NHS by allowing market forces to operate to disengage the NHS from health care bit by bit.  He call this task “creative destruction.”  This NHS will not fall overnight because the market’s invisible hand will destroy it in a piecemeal fashion, leaving the unprofitable areas of healthcare firmly in public sector hands.

“The key policy levers enabling this to happen are:

1. The purchaser provider split, with GP commissioning consortia taking the leading role on the purchaser side of the divide.

2. Patient Choice.

3. Competition between a plurality of ‘any willing providers’.

4. Payment by Results with price competition.

5. Patient held budgets.

6. Foundation trusts becoming social enterprises and the abolition of the cap on their private income.”

This demonstrates the absolute power of economics. Sooner or later most if not all nationalized systems lose influence.  They cost more than predicted,  and collapse inwardly. 

Mr. Obama, with his “community organizer” banner has had a steep learning curve in this regard.  He either disregarded his lessons in Economics at Harvard, or failed to attend all the classes.  Mr. Obama never ran a business. Observers, participants and voters see this as the reforms measures are put in place in the U.S.

Anyway, I digress, back to Mr. Peedell’s predictions.

Either way, moving to a more nationalized system,  or leaving one is a messy process for doctors and hospitals.   The players will remain the same, their checks will come from different payers,  and the taxpayer will pay for it all.

The white paper is therefore designed to fulfill a longstanding Tory dream - to dismantle the NHS and replace it with the private sector, which will receive its profits from the UK taxpayer.

Health reform, either way is always a hot political potato, It is also political suicide to dismantle the NHS, so it is being performed using the political rhetoric of patient empowerment through the patient choice agenda, and clinician empowerment by giving GPs a budget of £80bn.

 

Amazingly, Andrew Lansley is getting away with it because there is far too little understanding and resistance from the medical profession, which is realistically the only group of people that can prevent this assault on the NHS.

Either way politicians lose votes. This most recent election in the U.S. demonstrates this phenomenon as the democrats lost control of the US Congress.

Clive Peedell is a consulting oncologist and is co-chair of Britain's NHSCA. He contributes regularly to: Hospital.dr.co.uk

…..(to be continued)

del.icio.us Tags: nhs,andrew Lansley,uk Health system