T.E.D. General Stanley McChrystal

You should wonder what is General McChrystal doing on the Health Train? Hopefully by the time you have disembarked I will have conveyed to you the analogy of his leadership in the military and health care. He spoke at T.E.D. In Long Beach CA in 2011.

General McChrystal, of course is the former commander of U.S. And International forces in Afghanistan. A four-star general, he is credited for creating a revolution in warfare that fuses intelligence and operations. The analogies of changes in warfare and healthcare are immediately apparent.

The environment has changed. Health care is dispersed...using chat, video phone calls, complex communications, and may not be face-face.

1. Leadership

2. Technologies

3. Inversion of expertise, many changes at lower levels (digital)...Leadership experience.

4. Increasing reliance on electronic media places barriers for leadership, hands on.

5. Generational differences, shared purposes with different expertise, experience, vocabulary.

6. Ranger commitments to each other....Physician commitments to patients.

7. Addressing the possibility of failure, in a goal but not as a professional.

Does this sound familiar?

1. Challenges to leadership altered and magnified by generational changes.

2. Explosive and disruptive technology changes in diagnosis, delivery of care, and in technology, media and data storage, as well as process.

3. Challenges of senior health care givers and professionals obtaining expertise in #4. Inversion of electronic and media knowledge in juxtaposition to clinical expertise by senior physicians.

5. Generational differences in education and training processes, with a requirement of shared purpose in patient care and wellness.

6. Physician-patient commitments and physician-physician-hospital institution commitment and or patient care. (will this be the ACO?)

7. The possibility of failure? ACCA, ACOs. A non-system failure has already ocurred, it was not a goal, but the lack of a clearly defined endpoint.

8. Are we prepared for another failure? Was medicare a failure? Success or failure can only  be  determined in the context of time and setting. Medicare was designed in the early 1960s when there were fewer seniors eligible, and there were fewer diagnostic and therapeutic interventions as choices. continued…………..

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ACO, DOJ, ACA,IRS and WAIVERS

 

Details of the ACO, Accountable Care Organization are beginning to emerge.  This link to CMS is the actual proposed rule from Don Berwick MD, currently the Head of CMS.

42 CFR Part 425
[CMS-1345-P]
RIN 0938-AQ22      

This proposed rule would supplement section 3022 of the Affordable Care
Act which contains provisions relating to Medicare payments to providers of services and suppliers participating in Accountable Care Organizations (ACOs).

The Notice is both comprehensive and fairly specific about ACOs, and includes a glossary of acronyms that is arcane to most readers.

The Notice of Rule Making stipulates commentary be made by :

Instructions on pages 1 & 2 detail delivery methodology.  Send in your comments.

On another ACO front, the Inspector General has issued a number of Waivers allowing ACOs to bypass restrictive anti-trust law and also prior thrulings in regard to medicare restrictions including:

The application of the Physician Self-Referral Law, the Federal anti-kickback statute, and certain civil monetary penalties (CMP) law provisions to specified financial arrangements involving accountable care organizations
(ACOs) under the Medicare Shared Savings Program.

In addition, section 1115A(d)(1) of the Act, as added by section 3021 the ACA, authorizes the Secretary to waive the same fraud and abuse laws, among others, as necessary solely for the purposes of carrying out
the provisions of section 1115A of the Act with respect to the testing of certain innovative payment and service delivery models by the Center for

Medicare and Medicaid Innovation.

Commentary may also be made in accordance with the instructions on page 2 of the notice

IRS implications: NOTICE 2011-20   Another elephant in the room, the IRS, elaborates on ACOs, tax-exempt organizations qualifying for 501C status, and pretty much repeats the party-lines from HHS in regard to ACOs, all designed to grease the rails in regard to health reform as legislated by the ill-informed congress

Department of Justice, also weighs in on the liklihood of real violation of current  federal anti-trust law, and guidelines for avoiding same.

It becomes obvious to the reader that health reform is well orchestrated, designed to overcome most of the free-market rules that remain.

The law will all but paralyze the ability to  deliver  healthcare via small medical practices.

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Dr A is no longer Anonymous Mike

The doctor who was known as Dr A went public several months ago. The tension was palpable when he announced that he was admitting to who he was….Dr. Mike Sevilla, from the heartland of our great country. He and Governor John Kasich (of FoxNews fame) both hale from Ohio, where all good things Americana bloom even in the dead of winter’s snow and ice storms.  Dr. A, excuse me, Dr Sevilla, is a hearty soul, working all week, on call many nights  and then off to weekend meetings with the Ohio OSMA, summer Podcast Camp, (at least that is what he will admit to.)  He is often seen in his car (can’t quite figure out what kind it is) doing a video pod cast). Mike I hope you don’t text and drive…Here’s a sample of Dr.Mike at Ohio Student Medical Association (OSMA).

Mike is an avid first adopter !!

Dr Mike Sevilla

Hat’s off to you Dr. Mike Sevilla, a real family doctor !

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The Death of Transparency and User Friendly Health Information from CMS, HHS, Public Health

 

 

It was two short, short years ago that the Obama administration thrilled data and transparency wonks by launching Data.gov, USASpending.govand a number of other ambitious sites. But as Marshall Kirkpatrick reported in our top story this week, Congress is now planning to eliminate the sites' funding. There's a push to save them (check the story for the updates), but I have a sinking feeling that it was just too good to last.

Two years ago the incoming Obama administration launched a number of ambitious websites, most notably Data.gov, that were dedicated to offering public and government data to the outside world. The stated intention was to foster transparency and offer a platform for the development of new software and services. It appears those experiments may be over for now.

Today the Sunlight Foundation and Federal News Radio reported that the public projects Data.gov, USASpending.gov, Apps.gov/now, IT Dashboard and paymentaccuracy.gov as well as a number of internal government sites including Performance.gov, FedSpace and many of the efforts related the FEDRamp cloud computing cybersecurity effort would be taken offline in coming weeks due to budget cuts by Congress. Perhaps things like electronic government, software platforms and public accountability were just fads, anyway.

The Victims: 

2011 County Health Rankings

What’s New

 

US Government Web Services and XML Data Sources

 

Update:. We're hearing from several places that there's a potentially viable effort to save these sites and organizations. Here is one perspective on that and you can also see the Sunlight Foundation'sSave the Data petition. See also Alex Howard's in-depth reporting on this news published on Friday

 

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Socializing on The Health Train Express

Gary M Levin M.D.

Health Train Express is now being followed and featured on Social Media Today.

While not  particularly a health care related topic, the fact that Health Train Express was aggregated by a highly visible social media site bodes well for the rapidly increasing interest in Social Media in the Health Care space. Social Media Today is an independent online community for professionals in PR,  or any other discipline where a thorough understanding of social media is mission critical. Every day, we provide insight and host lively debate about the tools, platforms, companies and personalities that are revolutionizing the way we consume information. This  mission also applies to health care. As medicine progresses through the use of EMR and the  implementation of Health Information Exchanges, health professionals will also adapt social media in their patient relationships, hospital to practitioner communications, and B2B .

These two presentations give example and vision as to what Social Media can be.

Social Media Today and MVP at Womma 09

Medicine is unique in that important privacy and confidentiality issues must be addressed as well, and there will be certain limits for healthcare professionals.  

Commentary is welcome:

.

del.icio.us Tags: social media,facebook,twitter,health train express,b2b,privacy,hipaa

HHS Change of Command

 

Kathleen Sebelius is stepping away from her present position of Secretary of  Health and Human Services, and Obama’s crusade for Health Reform.  Why? In the next week we will hear many reasons.

Why is this Lady smiling??

Let’s go through the littany of reasonable explanations, that are all politically correct. I assign no  specificity to this news, however here is the usual boilerplate form  stored in each personel file of indiviuals hired by the government.(on the day they are hired)

1 I regret  having to inform you that due to personal and family (or  health related) issues I must step aside from my position. I have enjoyed working with you, and wish you every success with your ongoing endeavor.

2. In lieu  of being terminated, I resign.

3. The specifications and duties of my position are not as what was described in your position offering.

Mrs. Sibelius stepped into an almost impossible situation, given the change of administration, the ensuing debate over health-reform, and the consequent mandates placed upon the Secretary of Health and Human Services.  The scope of the project exceeded that of putting a man on the moon.  Congress did not read the legislation, let alone the fine print.  There are no less than 1000 ‘the secretary shall…….”in the law.  The ensuing reaction of the electorate was deafening.

Mrs. Sebelius’ background, education and work record is exemplary. As a former Governor of Kansas (2002-2010). she dealt with serious budget challenges, 

In 2001 Sebelius was named as one of Governing Magazine's Public Officials of the Year while she was serving as Kansas Insurance Commissioner.

In November 2005, Time named Sebelius as one of the five best governors in America, praising her for eliminating a $1.1 billion debt she inherited, ferreting out waste in state government, and strongly supporting public education – all without raising taxes, although she proposed raising sales, property, and income taxes. The article also praised her bipartisan approach to governing, a useful trait in a state where Republicans have usually controlled the Legislature.

In February 2006, the White House Project named Sebelius one of its "8 in '08," a group of eight female politicians who could possibly run and/or be elected president in 2008.

In 2009, Forbes named Sebelius the 57th most powerful woman in the world.  In 2010, Forbes named Sebelius the 23rd most powerful woman in the world.

In reviewing her qualifications for Head of HHS, the only relevant health  item is her stand regarding abortion.(pro-abortion)u

Sebelius was doomed from the start, but exhibits fortitude in facing down considerable and credible opposition to the Obama plan for health reform. The

del.icio.us Tags: HHS,Sebelius,Health Reform

However the majority of the implementation falls squarely on the Head of HHS. 

Thus far President Barak Obama’s selection to lead the most powerful institutions in American Medicine have been spectacular failures. Don Berwick will most likely be leaving rather than facing a heated congressional hearing.

The Opinions expressed here are solely the property of the author.

 

Social Media and Medical Practice III

     

Websites               Samples & How to’s        Mobile Apps

Many social media sites provide developer instructions for building APIs which can be integrated into business or personal web sites. FACEBOOK DEVELOPERS allow you to build your own social and personalized web.

Companies are proliferating, all offering a complete API interface piggy-backed onto a business web presenc e. Some of the offerings include:  GNIP. SHAREAHOLIC, SNAPLOGIC, JIVE, OPUS, PRACTICE FUSION

Owning your Name, a Practice’s Facebook Page. Like domain names facebook titles are valuable commodities. Think about having your unique Facebook, Twitter and other names reserved even if you are not ready to make the plunge.  Even if you do not use it, it can become very valuable if another practice or business wants the name, later.

There is also  another earlier form of professional social media sites, which are physician only, such as SERMO, , Doximity

An excellent source for finding programmers for your needs is Elance, a site dedicated to recruiting  freelance programmers and writers.

Social media glossary:  The Top 100 words & phrases in the social media dictionary

del.icio.us Tags: facebook,twitter,social media,api developer,sermo,doximity,elance,gnp,shareaholic,snaplogic,jive,opus,practice fusion,healthtrain express

Social Media and Medical Practice II

Part II

……..Adoption of new software follows a process similar to adoption of most new technologies, a slow gradual awareness of a new way to do things, discovery by larger and larger groups of users accelerating exponentially during a rapid growth phase, with a gradual flattening of the growth curve as the product matures.

Social media has  filled a space in our private lives, with rare adoption in the business world.  In most businesses Facebook, Twitter, YouTube and many other social domains are restricted or blocked by corporate firewalls,  private, or public.  Internal business communication is usually accomplished via telephone, video conferencing, email and/or instant messaging. 

Marketing for business relied heavily on internet search engines, with search engine optimization maximizing ‘hits’ on a users websites, along with large email group mailing. The most recent iteration of search engine algorithms has been changed from finding the most active landing pages to one in which the actual content can be analyzed for the quality of hits and analyzing the structure of the web page, backlinks, and other trickery that falsely elevates the importance or popularity of a particular web site.

Facebook is now evolving new categories, from  personal to a clone of a typical business landing page, but offering two way communication within the API  for potential customers or just interested readers.

Physician patient usage of social media is strictly limited by privacy restrictions and reluctance of most physicians to discuss personal health information online. Some physicians encourage email communication and dedicate time each day to communicate with patients conveniently.  A limiting factor is there is no reimbursement methodology for time devoted to email.

Social media will find a role for internal medical group communication for departmental or interdepartmental communication. Twitter in particular allows for direct p2p communication and the addition of mobile APIs allows communications on the ‘run’.

 

The Mayo Clinic and other large groups use Facebook for Patient Education, Marketing,  Mayo Clinic actually uses several Facebook pages for Employment,  General Information, Health Policy, and a General page on Becoming a Mayo Clinic “Fan” on Facebook.

Social Media APIs (Application Platform Interface’s) ……….

continued…..

del.icio.us Tags: mayo clinic,facebook,fan pages,marketing

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

del.icio.us Tags: twitter,facebook,social networking,medical applications

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.

del.icio.us Tags: consumer,medical pricing,online medical pricing,pricedoc,mymedicalcosts,healthcarebluebook