Social Media and Medical Practice

  

The image above depicts a device that ‘tweets’ when the fetus kicks .When a father makes a gadget for his unborn son, that’s true dedication. Corey Menscher designed and built the Kickbee for his pregnant wife. The baby kicks her stomach, a piezo sensor reads it and another module twitters the response for all to see (might this be a mechanism for cardiac monitoring at home, with instantaneous notification to the physician ?  Twitter has an wireless API for smartphones as well.

If you have any children under the age of 35 you must be aware of the influence of social media in their daily lives.  Young women no longer chatter endlessly on their phones, and have developed larger calluses on their thumbs.  I even imagine hand surgeons and orthopedic surgeons finding new syndromes,  named ‘Texting Tendinitis” or “SMS Synovitis”

Those over age 45 may be exposed as their young adult kids come home or perhaps your family may follow each other on twitter or facebook.

Perhaps you have been buried in patients and/or the EMR decision making process.  M.U.+ incentives + ACOs + Health Reform = Headache.

Health Train Express this week will be featuring a series of articles on social media, where it has been, where it is now, and where it is forecast to be by the heavy venture capitalists of IT.

Part I    What is Social Media?

a. Email:  We can use AOLs  original  “You’ve got Mail !” as a starting point.

b. IM, or instant messaging

c. Chat rooms

d. Blogs

e. Facebook, twitter and other platforms that use more sophisticated APIs. operating independently and on their own platform.

f. Stumbleupon, Tumblr, Digg, Delicious, Technorati and other more arcane focused niches.

g. Over 150 other social networking a sites are listed in wikipedia as of April 1, 2011.

Social networking sites are their own breed of computing power. Designed originally for sharing secrets about dates (facebook), it has transformed into a different animal. And like most events on the internet it changes on almost a daily basis.  Social media is  still a very recent happening and the niche is growing exponentially fueled by Venture Capital and the enormous cash pot of the likes of Google, Facebook and others. Larger social network predators are engulfing smaller entities, and incorporating their victim’s  platforms and technical personell into their own company,  for their own missions rather than developing them internally. In the next year or so the market will mature and become stable. ………

to be continued:………..Part II

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EMR in the Cloud

Simple ??

Two years ago the term cloud applied mostly to the weather. EMR vendors focused on selling hardware attempted to slow down the cloud as it approached HIT.  Now the first thing practices will ask is how much is the hardware going to cost?  Well, cloud computing only requires ‘thin clients”.  It seems attractive, however many physician l still consider the security as inadequate.  The  remainder of today’s post willsummarize the cloud.

 

Expert Explanation

The Slick Madison Avenue Approach

The Sun is still shining here.

 

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$3 Million Health Care Analytics Challenge

  In today’s physician’s world one has to keep one foot in the medical journals and another in the world of technology. Information technology not only serves us in storing and distributing patient information, it also serves us in analytics. I would tell any fledgling college student or medical student to develop a strong knowledge base in computer science, statistics, and bio-informatics. It is essential to be able to read journals and critically appraise medical articles. It is also important in analyzing one’s own clinical records for outcomes, treatment paradigms, and examining Evidence Based Medicine (EBM).

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Blue Buttons for Medicare and VA

 

What do the VA system and Medicare have in common besides federal funding?

BLUE  BUTTONS !!https://www.mymedicare.gov/

Consumer Savy Websites

 

 

Did you ever think there would be a ‘Kelly Blue Book” for health services and your fees?  Well buckle up Flash Gordon, and Dale Arden, strap on your ray gun and read further:

Such websites have certain limitations,

Many cost-comparison tools for health plans can be found online, beginning with a simple Google search that might draw thousands of results.

Website officials also acknowledge that the nature of medicine makes it difficult to provide consumers a price guarantee, particularly because patients' requirements for treatment can vary based on their:

• Age;
• Current medical status; and
• Family and personal medical histories.

Try these on for size

• PriceDoc;
• MyMedicalCosts; and
• HealthcareBlueBook.

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Community Health Data Initiatives

Opening by HHS leaders
0:01 – Dr Harvey Fineberg, President of IOM
0:08 – HHS Secretary Kathleen Sebelius
0:19 – Bill Core, Deputy Secy of HHS on origins of the program and how innovators built the first set of apps using this data in just 12 weeks.

Demos of apps using this data
0:27 – Introduction
0:31 -Palantir (Alex Fishman) – “AnalyzeThe.US” freely available data analysis tool. (Not limited to health data)
0:43 – Alain Rappaport – Microsoft Bing has added CHDI data into its search results.
0:53 – [Bridge about customer service]
0:54 – Healthy Communities Institute, and Trilogy – public/private partnership that’s created a data dashboard. Valerie Brown of Sonoma Co. board of supervisors & pres. of National Assn of Counties; Trilogy’s Bruce Bronzan & Derek Van Brunt(?), creators of Network of Care for Counties
1:09 – Asthmopolis    – improving asthma care by providing data to patients & providers
1:17 – IHI (Lindsay Martin) and Ingenix – mashing together healthcare quality data
1:30 – Roni Zeiger, Google – HHS’s Hospital Compare database, sliced & diced & presented using Google’s Fusion Tables cloud database app
1:41 – Chris Carter, HealthWays

Conclusions / observations
1:50 – Todd Park (HHS Chief Technical Officer): Release data, build apps, catalyze change
2:01 – Aneesh Chopra (Chief Technical Officer of the US), telling Todd “Free it, brother!”

 

 

 

Network of Care

Self-Congratulatory Seminars

 

So, Why are these people Smiling?

1. They just voted to give themselves a raise.

2. They learned how to pass legislation without reading the bill

3. All doctors will be replaced by computers.

4. 1&3

5. None of the above.

6. All of the Above.

 

President Obama to Eric

No arguments here.

 

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PERSPECTIVE The ACO Model — A Three-Year Financial Loss?

 

The NEJM” reports on ACO in their “Health Policy and Reform” Report.

The accountable care organization (ACO) model is rather controversial among health care experts. Its proponents tout the potential savings and coordinated care that could be achieved through this model.¹ Others, however, point out that the model is not without risks, such as the potential for anticompetitive effects as providers leverage it to concentrate market power.^2,3

Because of the need to stem the spiraling costs of the Medicare program and the need to shift the health care system from volume-based to value-based rewards, the ACO has been put forward as a possible model for restructuring traditional Medicare coverage.⁴ In particular, Section 3022 of the Patient Protection and Affordable Care Act requires the Secretary of Health and Human Services (HHS) to establish the Medicare Shared Savings Program by January 1, 2012. With this rapid movement toward ACOs, one would expect that the previous government demonstration of the model would have produced promising results that warranted its rapid expansion. Our analysis of the results from the demonstration suggests otherwise.

CMS conducted the PGP Demonstration from 2005 to 2010, using a hybrid payment model that consisted of routine Medicare fee-for-service payments plus the opportunity to earn bonus payments known as shared savings. Eligibility was narrowly restricted to a select group of large physician group practices with the necessary experience, infrastructure, and financial strength (participants invested $1.7 million, on average, in the first year alone) to succeed in the demonstration. Thus, the structure of the demonstration should have resulted in a high likelihood of positive results. Yet most PGP participants did not break even on their initial investment.

The available data indicate that 8 of the 10 PGPs in the demonstration did not receive any shared savings payments in year 1. In the second year, 6 of the 10 practices did not receive such payments, and in the third year, half the participants were still not eligible for any shared savings to offset their initial investment. Given that the percentage of shared savings in the first 3 years was so low for experienced, integrated physician practices, it seems highly unlikely that newly established, independent practices would be able to average the necessary 20% return on their investment.

In addition, the participants did not receive provider- feedback reports and bonus payments in a timely manner, which may have negatively affected their ability to perform more effectively and receive greater shared savings. These limitations, however, do not significantly alter our overall findings. In fact, we were very conservative in our analysis, since we did not incorporate the operating costs for the second and third years of the demonstration. If we had included such costs, the projections would have been even worse.

The high up-front investments make the model a poor fit for most physician group practices; the time frame in which one can expect a reasonable return on the initial investment is more than 5 years; and even the majority of large, experienced, integrated physician group practices could not recover their initial investment within the first 3 years. Absent changes to the design of the ACO model, the analysis suggests that before agreeing to become part of an ACO, physician group practices must conduct due diligence and explore participation in viable alternatives such as other initiatives involving bundled payments for episodes of care.

Caution:

For policymakers, the urge to do something must be tempered by the risk of disrupting the entire value-based–purchasing movement. We are concerned that physicians and providers may unwittingly undermine future value-based–purchasing efforts if the ACO model fails to live up to the high expectations that do not comport with the data. Our analysis suggests that there are options for addressing the design weaknesses of the ACO model. One is for CMS to limit participation in the Medicare Shared Savings Program to a narrow group of provider organizations that can absorb the likely financial losses in the early years of participation. CMS could limit eligibility in a manner consistent with the original design framework for the PGP Demonstration. This option would be consistent with the GAO report, which questioned how far the ACO model could be extended beyond the 1% of physician practices that resemble the organizations that participated in the original demonstration.

Alternative Solutions:

A second, more inclusive option would be to change the payment design

from an annual model to a cumulative model. In the cumulative model, CMS could assess performance over the aggregate number of years during which an organization had participated in the ACO program and reduce the shared-savings threshold accordingly, making it more likely that physicians could demonstrate significant improvements. For policymakers and payers, such a cumulative model would distinguish organizations that wish to leverage the ACO model for short-term, anticompetitive gains from those that wish to be rewarded for an investment in better-coordinated delivery of health care.

The conceptual underpinnings of the ACO model are laudable. By addressing the payment defect in the current model, policymakers would reward organizations for making the long-term financial commitment necessary to establish and maintain a value-based delivery system.

Sec’y Sibelius, “Can You Hear Me Now?”

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What Can Anyone Say or Do?

 

Neither physicians, nor patients (not consumers) really have much control

over  health care, despite what all the MBAs, Pundits, Consumer Advocacy Committees and Wanabees running all over the country going to seminars, meetings, Health 2.0 and the like. Physicians are always pictured as rich, fat and living off their unfortunate patients who are misled by the government and payors in the name of money. These organizations attribute their own feelings and attitudes upon doctors about the expense of caring for sick patients. They project their own attitudes on physicians.

During my early career years (about 20 or more  years ago) I made a very nice living, if I say so myself I saw  many patients for free. I would do surgeries for free, arranged for charitable care, had colleagues I could refer to who would be gratified that I would send them poor patients because they saw my trust in them to do the ‘right’ thing. I never sent a patient to collections, (doctors would just not do that sort of thing)  Not that I was so wonderful, but the vast majority of doctors would do the same as I did.

Physicians would graciously go to an Emergency department, when called, grateful for the referral. In fact physicians who would not respond to an ER call were shunned, and even reprimanded by the chief of staff or even would have their hospital privileges revoked. Today many physicians, if at all possible will resign from a hospital to avoid ER call.

Did you know that most insurance companies require you to have hospital privileges or have someone who will sign off that they will cover you to be on their panels?

When I observe what is happening in our world I realize that as Americans our greatest entitlement is freedom. That doesn’t mean freedom to ‘redistribute the wealth’, nor free healthcare, nor huge pensions.

 

The beauty of freedom is freedom allows for corrective changes without concern for rigidity of bureaucracy.The beauty of freedom is the ability for creation of new transformative ideas, and the implementation.Liberty and freedom are risky, and ultimately requires more input and energy than socialism or collective action. Why should your health depend upon a politician who knows little about healthcare, distracted by other decisions such as war,immigration issues, foreign policy and the liittany of challenges facing our nation. What would a former Governor know about running HHS?. Did anyone ask the doctors or for that matter congress and the people if Don Berwick MD was a suitable head for CMS?

As most physicians think in the doctor’s lounge (if your hospital still has one), our system is badly broken, unrepairable except by a sweeping dictatorial reform such as Obamacare,  It.doesn’t matter if it will work or not,

All of this is not unique to medicine, it has become endemic in all of America.

A.C.O. More on

 

Ken Cohn, wrote to me today about ACOs. Ken Cohn describes multiple issues and complete ambiguity regarding how to form or implement an ACO.

Here is what he  wrote to me.

“Dear Gary,

I participated in a panel discussion of physicians' roles in Accountable Care Organizations two weeks ago.  The blog post that summarized the discussion resulted in a firestorm of comments.  When you would like to learn more about ways that you can engage physicians to improve healthcare collaboration, please read on.

Doug Hastings, a lawyer and Chairman of Epstein, Becker, Green, empathized with the difficulties that healthcare leaders face, planning for an uncertain future in the absence of specific regulations regarding Accountable Care Organizations (ACOs).  When he summarized the 2011 National Committee for Quality Assurance (NCQA) draft guidelines, he mentioned the following overriding concepts related to ACO formation and operation:

ACOs must include a group of physicians with a strong primary care base and sufficient other specialties that support the core needs of a defined population of patients.

Performance measurement across the triple aim domains of cost, quality and patient experience must be a key element in the evaluation of ACOs.

ACOs must facilitate timely information exchange between primary care, specialty care, and hospitals for care coordination and transitions (NCQA 2011 ACO Criteria and Implications for ACO governance. BNA's Health Law Reporter, 19PVLR1573)

Jeff Petry, VP of Business Development at Premier, said that the 3 R's of ACOs include:

• Regulations
• Reimbursement
• Relationships 

Possible roles for physician champions in ACOs include:

• Presenting and discussing clinical data with fellow physicians
• Minimizing physician-hospital battles
• Creating a safe environment for learning
• Helping to build transparency and trust

The above strategies and tactics have worked in hospitals in 40 states where I have worked.  What is working for you where you work?”

He did not mention specific hospitals

Mr. Cohn then goes on to discuss building relationships and possible roles for physician champions, suggesting some of the following:

Possible roles for physician champions in ACOs include:

• Presenting and discussing clinical data with fellow physicians
• Minimizing physician-hospital battles
• Creating a safe environment for learning
• Helping to build transparency and trust

Physician Champions  Collaborative Listening  

Observations:

EMR, and HIE are works in progress

ACO….the foundation has yet to be excavated..

The cart is definitely in front of the horse(s)

 

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M.U. or A.C.O. Pick Your Poison

 

HIMSS 2011 has just adjourned, and the reviews are filled with prognosis and predictions.

by Neil Versel (Xerox)  

M.U.

The healthcare world is waiting nervously for HHS to release its proposed ACO regulations. HHS Secretary Kathleen Sebelius was on hand for a keynote address Wednesday morning, but gave no hint of when the regs might come. Instead, Sebelius and departing national health IT coordinator Dr. David Blumenthal mostly stuck to their general stump speeches, perhaps not wanting to stir up political controversy in this time of divided government.

In some ways, Blumenthal’s presence at HIMSS was notable for something he didn’t show up for. Deputy National Coordinator Dr. Farzad Mostashari, likely to be the interim coordinator when Blumenthal returns to Harvard in April, led the ONC town hall on Tuesday. Mostashari caused some seismic ripples through much of the vendor community on Monday by saying that ONC will be working with the National Institute for Standards and Technology and other organizations in the next six months to find ways to measure EHR usability, and that usability likely will be part of Stage 2 meaningful use, starting in 2013.

Farzad Mostashari, likely to be the interim coordinator when Blumenthal returns to Harvard in April, led the ONC town hall on Tuesday. Mostashari caused some seismic ripples through much of the vendor community on Monday by saying that ONC will be working with the National Institute for Standards and Technology and other organizations in the next six months to  find ways to measure EHR usability, and that usability likely will be part of Stage 2 meaningful use, starting in 2013. (Nothing like putting the cart before the horse)..Stage I was obviously designed for CMS and insurers, so those who wisely wait for a better standard, such as usabiity wil not receive a large incentive, and be penalized for caution. We must adopt inferior hardware and software platforms by such and such a date or suffer the consequences of a reduced reimbursement and/or reduced incentives. As usual our government would race to an implementation for it’s own self –centered purposes, since the funding actually comes from taxpayer pockets.

A.C.O.

HIMSS 2011 was not all about meaningful use. “Meaningful use in some ways fell off the radar,” another CMIO said on the same bus ride. The new buzz—and source of anxiety—is about Accountable Care Organizations.

An eponym ranked right up there and as controversial as the PACA law ACO is a new name looking for an organization upon which to plant it’s banner.

Hospitals and physicians alike are frantic to filter through the impending changes in billing and reimbursement model. Who will bill..  hospitals,.. physicians, or a third organism  which the hospital and physicians will create as a ‘holding entity?  This looks like another level of bureaucracy which will compromise whatever savings HHS is proposing by a huge re-organization of the industry. Efficiency in health care seems to be a moving target….a bit to the right, and then a bit to the left.

Just as some of the visionary ideas such as HIE and EMR are beginning implementation, the bureaucrats add more ingredients to the mix, further congealing real progress.

Sherry Turkle, the Director of MIT’s Initiative on Technology and Self, has become deeply pessimistic about our digital future. In her controversial new book, Alone Together,Turkle argues that the development of emotionally sympathetic robots like Tamagotchis and Furbies means that the “robotic moment” has arrived for the human race.She elaborates. In several interviews on TechCrunch

 

Turkle is not optimistic about social media, robotics, nor the development of emotionally sympathetic robots.  Please view the videos and read the TechCrunch interview then leave your comments here:

 

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Preventive Measures, Exercise, and Fluids….never too early

 

Go Daddy, Go

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