Is Health Care a Right?

 

This edition of Health Train will be an aggregation of videos on American Health Care Reform. The sources are many, the opinions diverse.

Learn more about it because it may happen to you unless changes are brought about in the coming 2012 election. 

Alita Eck MD

Town Hall Meeting Q&A Part II

Town Hall Meeting Q&A Part I

Phil Gingrey (R-Ga)

Yaron Brook PhD.  The Immorality of Government

Health Care is Not a Right   Leonard Peikof

Health Care is Not a Right Part II  Leonard……….

Debate: Is Health Care a Right? Barak Obama

Health Insurance is not a right

Ron Paul on Many Issues with Larry King

"Seinfeld Rips Larry King": more than 3 million views.

"Ron Paul nails Larry King": less than 100,000 views.

America is 30 times more interested in sitcoms than in the future of their nation.

del.icio.us Tags: ron paul,health reform,health rights,larry king

What every Patient and Doctor Needs to Watch and Read

 

The Doctor's Story: How Obamacare is hurting the patient-physician relationship

Your life is at risk !

A frightening perspective, no physicians at the table, but it is what it is.

If you don’t want to watch the whole video or don’t have time (and what MD has time?) You may read their testimonies below:

1.Jane Orient MD        2, Richard Amerling MD

Jane Orient MD is a former VA Physician, now in private practice. She compares VA medicine with it’s bureaucracy and comparing the efficiency private practice.

Richard Amerling MD is a practicing hospital physician. His commentaries are personal opinion and do not represent the hospital.

Your New Health Care System

A system designed to fail. When will common sense guide our leaders?

In the video above, Dr (Congressman) Burgess elaborates on possible outcomes and questions about ACOs.

Capital requirements rule out Physicians running an ACO. However doctors ultimately responsible to patient.  Rules are not favorable to that outcome.

Will the Physician be accountable to the patient or the ACO?

Injunctive Relief should not be necessary since officers of the federal government should respond to court orders (may be doubtful).

Ultimately 2012 election will become a referendum for APPA, if President Obama loses most likely outcome is legislation to either repeal APPA or significant revision.

Congressman Michael Burgess M.D. (R,Texas) wrote the book, “Doctor in The House” 

Dr. Jane Orient stated that the ultimate pay for performance and/or quality is the patient.

The presenters are highly articulate, and accurate. I recommend this presentation to everyone.

del.icio.us Tags: Jane Orient,Michael Burgess,Richard Amerling,ACO,Obamacare

Specialist-o-Phobia

 

    

 

Have you noticed the recent trend against specialty physicians? Now I am not against primary care, and since the ‘policy-wonks’ and those who know more about medicine than I do,  have determined that primary  care needs incentives to attract medical students away from those ‘highly lucrative’ specialties such as plastic surgery, orthopedic surgery, interventional cardiology, and neurosurgery and others for a choice of primary care.

Our federal government believes in equal opportunity, except in medicine, and even more so if you wish to become a family doctor.There are incentives sponsored by cities, states, Indian reservations, public health service, and more if one wants to become a family doctor in turn for serving in a community. There aren’t many of those for specialists, except perhaps for psychiatrists.

  All students have equal opportunity to specialize provided they can navigate the competition for residency spaces in their chosen specialty.

Three specialty groups qualify as primary care in certain settings, OB/GYN, Pediatrics, Internal Medicine,and Emergency medicine (if one choses to be listed as a primary care physician (have I forgotten anyone?). Wikipedia defines a PCP as a physician/medical doctor who provides both the first contact for a person with an undiagnosed health concern as well as continuing care of varied medical conditions, not limited by cause, organ system, or diagnosis.

Arguments about the quality of care comparing PCPs to specialists have abounded since I  began practicing 40 years ago.

Studies that compare the knowledge base and quality of care provided by generalists versus specialists usually find that the specialists are more knowledgeable and provide better care.^[3][4] However, these studies examine the quality of care in the domain of the specialists. In addition, these studies need to account for clustering of patients and physicians.^[5] 

Studies of the quality of preventive health care find the opposite results – primary care physicians perform best. An analysis of elderly patients found that patients seeing generalists, as compared to patients seeing specialists. (would you expect a cardiologist or orthopedic surgeon to give vaccinations?) This measure of quality is open to much criticism.

I have nothing against primary care doctors. In fact I practiced general medicine in the Navy, and following that for several years in family practice and emergency medicine. I had an exceptional clinical training during medical school, and also in internship.  I had a chance to practice independently in the Navy as well with my duty station on a Naval Aircraft Carrier.  Perhaps I am biased now, because today I see few specialists who are capable of practicing general medicine. They in fact rely on PCPs and/or FPs and internists to screen their patients for surgery thereby increasing their work load significantly. Specialists know more and more about less and less as time goes by. 
In fact it takes a very very smart doc to practice general medicine. It is a  very interesting and varied practice, and also quite demanding.

Most specialists do not pick their specialty based on income alone. It is a mixture of lifestyle, knowledge base and the proven ability to exceed or show interest in the specialty to have attracted the attention of a mentor or department head of an elective rotation earlier in their career, usually in medical school. Our current medical education system is now throttled by the fact that there are few free standing PGY-0 programs (that’s medical-ese for internship.   Thus a medical student by the first part of the fourth year has to make a  decision based upon medical school experience in an academic environment. (in most cases not like real clinical practice in the real world)

The  ultimate slap in the face for specialists is the blatant prejudice in the HITECH Act and stimulus funding for electronic medical records and meaningful use. 

The Regional extension Centers are specifically designed to develop an HIT workforce and to assist doctors in developing EMRs and funded by the feds allows primary care doctors to use the resource for free, while specialists are required to pay a fee for  service. OUTRAGEOUS ! We specialists pay our taxes as well.

The entire structure of HITECH is biased toward publicly funded entities, community health centers, (federally qualified, of course) (do these entities pay taxes?)  The APPA (stimulus) mandates that the Secretary of HHS a lot these funds at his (her) discretion within the parameters of the act.

Is it too late to change these limitations for incentives, and/or RECs? The regulations blatantly discriminate against more than 3/4 of all physicians, they prioritize PAs. NPs over MDs.

All of the above are issues taking place in the setting of:

Shortages of primary care physicians are an increasing problem in many developed countries. In the United States, the number of medical students entering family practice training dropped by 50% between 1997 and 2005.^[16] In 1998, half of internal medicine residents chose primary care, but by 2006, over 80% became specialists.^[17] A survey Research by the University of Missouri-Columbia (UMC) and the U.S. Department of Health and Human Services predicts that by 2025 the United States will be short 35,000 to 44,000 adult care primary care physicians.^[18]

In 2004, the median income of specialists in the US was twice that of PCPs, and the gap is widening.^[   Causes parallel the evolutionary changes occurring in the US medical system: payment based on quantity of services delivered, not quality; aging of the population increases the prevalence and complexity of chronic health conditions, most of which are handled in primary care settings; and increasing emphasis on life-style changes and preventative measures, often poorly covered by health insurance or not at all.

Where is the AMA and the other societies in this mix. I haven’t heard much about protesting this inequality. Perhaps we should involve our patients in this quest for equal opportunity.

del.icio.us Tags: primary care,specialty care,hitech,regional extension center,emr,hie,hit,physician incomes

Why Health Reform and Medicare Reform is so Difficult

 

Here’s a classic intercourse and debate between Republicans and Democrats…Watch The video:

Do reasonable men disagree reasonably? Or is that hype for the media and the public?

del.icio.us Tags: video,republicans,democrats,medicare reform

10 Dumb Things To Do At The Doc’s Office.

 

 

Plagiarized from CNN News

These tips and instructions for patients should be printed on a placque in several places in every medical office, clinic and hospital..

From interviews with a gynecologist, a cardiologist, a rehabilitative medicine specialist, a fertility doctor and an internist, here are the Top 10 things patients do to mess up their own care.

1. You talk on your cell phone. (my favorite bugaboo..just plain bad manners)

This is your health we're talking about. Other calls can wait. Turn the (f**king) thing off.

2. You lie.

"I need to treat you the best way I can, so if you're gay, tell me. If you drink a bottle of tequila every night, I need to know. If you're having an affair and not using condoms, let me know," says Rankin, who blogs at "Owning Pink." "I promise I won't judge you."

3. You do a sloppy job describing your pain.

Is it stabbing or burning? Sudden or constant? Tingling or hot? The answers will help your doctor make the right diagnosis.

"You should describe the exact location, how intense the pain was, what provoked it and how long it lasted," says Dr. Nieca Goldberg, director of the New York University Women's Heart Program.

The week before your appointment, keep a diary of your pain and your other symptoms, too, advises Dr. Loren Fishman, a clinical professor of rehabilitative medicine at Columbia University College of Physicians and Surgeons. He suggests using this time to also think about the questions you want to ask your doctor and what you hope to get out of your appointment.

4. You don't state up front all the reasons for your visit.

If your ear hurts, your knee pops out when you run and you have a sty in your eye, state all three concerns at the beginning of the appointment so your doctor can plan your visit efficiently, advises Dr. Howard Beckman, an internist and clinical professor of medicine at the University of Rochester.

5. You don't state up front your expectations for your visit. ( all doctors hate it when the patient on the way out tells you what they really were here for.)

If you have certain hopes or expectations -- the doctor will pop that sty in your eye or prescribe antibiotics for your sore ear -- say so. The doctor can then explain if your expectations are realistic, and you'll be happier in the end.

"Sometimes patients are out of proportion to what the reality is, like the 44-year-old woman who hopes to get pregnant in one IVF cycle," says Dr. Jamie Grifo, program director of the New York University Fertility Center. "If they don't communicate their expectations, then I can't address them."

6. You don't know what medications you're taking.

"Patients should bring a list of medications they're actually taking, not what they believe they are supposed to be taking, or what they think I want them to take," Beckman advises.

If you take supplements, Rankin suggests you bring them in, since supplements aren't standardized like prescription drugs, and your doctor will want to see all the ingredients.

7. You leave with unspoken questions and concerns.

If a question's in your head, ask it, even if you think the doctor is rushed. If you're worried your headache might be a brain tumor, say it even if you think you sound like a hypochondriac.

8. You don't bring your medical records or images with you.

Yes, even in this day and age, many doctors rely on the fax machine to send medical records to and fro. Faxes goof up, so unless you absolutely, positively know your doctor has your records and images from another office, bring them with you, doctors advise.

9. You're too scared to disagree with your doctor.

If your doctor suggests you need an antidepressant and you don't want to take it, say so instead of nodding your head, taking the prescription and throwing it away the minute you're out the door. Or if she suggests a medication you can't afford, just say so.

"I know many of you are programmed not to question your doctor, but we can't read your mind, so we need you to communicate," Rankin says. "If the treatment plan I suggest doesn't resonate with the intuitive wisdom of your Inner Healer, please tell me, instead of ignoring what I suggest."

10. You don't comply with the treatment plan.

For doctors, this is the granddaddy of them all. If you've followed all the advice above, you should have a treatment plan that makes sense to you and one you're able to execute. (If you didn’t or couldn’t tell your doctor why. no money, lost medications, made you sick, don’t believe in medications)

"Please follow through and do what you've agreed to do," Rankin says. "And if you don't, please tell me so I don't mistakenly assume the treatment failed. I won't jump all over you. I just need to know."

del.icio.us Tags: doctor visits,treatment plans,things not to do

USB & Your Health

 

This afternoon I was at my local Drugstore in line waiting for my prescription medication.  I regularly scan the shelves to see how technology is impacting the retail pharmacy business. There are the usual blood pressure monitors, glucometers, pregnancy tests,  STD tests, HIV tests, etc.

Even with all the hype about PHR, there has been a paucity and near absence of products which are supposed to make home health monitoring accessible to the patient’s physician.

Today I saw a glimmer of hope. My eye caught “USB” on a package, and no I was not in the electronics department.  Closer investigation revealed the Bayer’s CONTOUR USB meter. It looks quite like a standard USB flash device. Closer inspection reveals a few important differences.

The  device has two ends, the first has the usual insertion slot for test strips, the other end has a standard USB connection with a protective cap.

Overall the CONTOUR is the same size as a standard stick. On one side is a highly visible digital display for the measure blood glucose, and the time at which is was recorded. Software is available for Mac, Windows, to interface with a laptop, or desktop.  There was no mention for handheld portable devices, or interfaces for smartphones.

Health Train thinks that this may be a beginning, however the utility of the CONTOUR is severely hampered by the lack of it’s ability to transmit data directly to an online PHR. Perhaps this is the next step. Perhaps this will be a function of the PC software. At any rate Baxter fails to give it the final “kill”.

The software (which must be downloaded from an online source at Baxter does allow storage with graphs and trends for blood glucose levels as well as the ability to print results and graphs in  a pdf format.

Health Train can see a project for Health 2.0 Challenge to develop the glucometer which would plug directly into an iPhone, Android, or RIM smartphone and beam a report directly to the PHR or doctors EMR.

The price-point is amazingly low. My pharmacy was selling it for $ 75.00, about the same price as some of the high end standard glucometers.

A standard User Manual is available from their web site:

del.icio.us Tags: glucometer,usb glucometer,baxter contour,diabetes,monitoring,phr

The Reform Is Not the Change

According to Joseph Flower who writes in The Health Care Blog this weekend, Health Reform is not the Change, but rather The Catalyst, and according to him, “The enabler, and an accelerator of the change we are going through. It is not the change itself, and is not even the cause of it, because the change is driven by much larger economic and demographic factors, especially by the crushing cost of healthcare. If the reform law were to go away, the change would not go away.”

I agree with Joe. Many readers ask me if I am for or against health reform. My short answer is ‘yes’, to both.  Anyone who is vested in the present system, i.e., physicians, hospitals, health plans, pharma, payers, etc. exist with a certain level of ‘tension’ with their partners and ungarners. The tension with present system for most systems is near a breaking point. The question all are asking ‘Will this get better with a change, stay the same, or get much worse.

No doubt there will be ‘pain’ with reforms. Change seems to be difficult for most, however the human condition and potential for change is enormous with adaptability and acclimatization to seemingly impossible challenges, physically, intellectually and emotionally.  Let’s face it, Health Reform involves all of it. Fortunately our DNA was designed for changes to occur.

del.icio.us Tags: health reform,catalyst,joe flower,the health care blog,health train express NPR

A Story of Drug Addiction, Sadness and Love

Although the original version of this song by Mylene Farmer earned better critical acclaim, this version by “Moby” fits the Health Train Express for  physicians and families dealing with fatal illnesses and drug addiction will find these videos  breathtaking. I hope you will all enjoy this musical interlude:: “Blue Noir”

Moby Version

I also cannot help but include Mylene Farmer’s version of, ‘Blue Noir”

Mylene Farmer

The music and video above are copyright by the artist and the label. They should not be copied for commercial purposes. 

GML

A Thank you to SERMO

SERMO is a physician only  professional social network. It has been existence for about five years. Started by visionary Dan Palestrant MD, SERMO had a  brief romance with the AMA, however SERMO and the AMA parted ways, disagreeing agreeably that their missions were mutually incompatible. SERMO continues steady growth and has a loyal following. The business model is simple and quite stable. It is explained transparently on the web site.

Here were my comments upon receiving the SERMO Badge which is on the right hand banner.  Long Live SERMO !

On behalf of Health Train Express and all my fellow bloggers, thanks you to SERMO for the recognition of  Health Train Express.  Just as other bloggers I put some effort into the "enterprise".  It began as a simple newsletter regarding the development of a regional health information exchange in 2005. It eventually expanded into a free floating stream of 'nonsense", varying from topic to topic in health care.  This was in the days when few knew what a blog was, and there was no social media.

I find that writing the blogs offers me the opportunity to share serious, humorous and outrageous thoughts and events in my life.  It substitutes for lack of time to discuss all the important events in medicine on a daily basis and not wait for the next meeting.

It also has opened up a huge audience, and I receive many comments from around the globe. 

I highly recommend the medium.  Caution...You are entering the "NO SPIN ZONE (Bill O'Reilly) and it is highly ADDICTIVE !  (Ask my spouse)

 

del.icio.us Tags: sermo,dan palestrant,healthtrain express,blogging

Health Merger Mania

 

Medical Practice Mergers Key in Employer Healthcare Cost Hikes

By Emily P. Walker, Washington Correspondent, MedPage Today
Published: May 20, 2011

WASHINGTON -- Employers can expect to spend an additional 8.5% on employee healthcare costs in 2012, as patients who had been putting off medical treatment during the recession flock to the doctor's office, according to a new survey from the consulting firm PwC.

 

Last year, employers' costs for providing healthcare to employees rose 8%, and the year before, they grew by 7.5%. Both rates were much lower than predicted.

Most larger employers -- including two-thirds of those who responded to the PwC survey -- are "self-insured," meaning that they pay employee healthcare costs themselves rather than paying premiums to an insurance company.

Economists and actuaries realized that during the flagging economy, people were putting their healthcare needs on the back burner in order to save money. But as Americans move further out of the recession, they are expected to seek out the healthcare they've been putting off for the past two years. And that should contribute to an uptick in medical treatments in 2012.

The survey includes four main components in its definition of healthcare costs: physician services, inpatient hospital care, outpatient services, and prescription drugs.

The largest single component of these costs is physician services, which makes up one-third of the cost of healthcare benefits. Inpatient hospital care is a very close second (31%), followed by outpatient hospital services (17%) and prescription drugs (15%).

Three factors are contributing to the projected increase, according to PwC analysts:

Increased mergers: More and more hospitals and physicians are consolidating, which is seen as a way to increase efficiency and reduce costs. This can mean more treatment is delivered at a hospital-based outpatient clinic rather than a freestanding physician office.

Medicare rates paid to a hospital-based practice can be more than 50% higher than those paid to a freestanding practice, and private insurers often use Medicare as a guide for their own rates.

Cost-shifting: Both Medicare and Medicaid plans have been paying less and less; the report noted that the increase in Medicare inpatient hospital rates is expected to be 3.3 percentage points below the expected growth in their costs.

"Hospitals and health plan executives agree that when Medicare and Medicaid pay less than costs, private payers must make up the difference," the report said.

Increased stress: Post-recession stress will lead to poorer health once people start going to the doctor again. Several health plans interviewed by PwC said they are already seeing more claims for stress-induced illnesses.

As stress increases, people are less likely to maintain a healthy lifestyle, and more prone to stress-related ailments, including heart disease and cancer.

The PwC analysts said that if employers decrease the benefits they offer, and pass more costs on to workers, the increase companies face could be more along the lines of 7%.

"The big question is how much of the medical cost increase will be passed on to employees, as employers recognize the economic burden on their workers given that wages have been stagnant over the past few years," PwC said.

There are also a few factors that will drive down costs in 2012:

• The trend toward increased use of high-deductible plans will continue. In 2011, 17% of employers said plans in which their employees paid a high deductible were the most common plan, up seven percentage points from 2010.
• A historic number of blockbuster brand-name drugs will go off patent, including Lipitor, Seroquel, Actos, Zyprexa, and Levaquin, paving the way for the sale of cheaper generics.

• Employers are increasing deductibles for seeing out-of-network providers and are becoming more selective about who's in-network.

The Affordable Care Act won't have much effect on employer costs next year because many of its main provisions don't go into effect until 2014 or later.

The survey was conducted by PwC's Health Research Institute and involved 1,700 employers across 30 industries; it also included interviews with hospital executives and insurance actuaries.

 

del.icio.us Tags: hospitals,mergers,cost hikes,self insured,cost shifting,employers,deductibles,affordable care act

Cloud Computing: A Reply from Practice Fusion

Some of you may have read my comments about the  “death of cloud computing”.  My comments may be premature according to Ryan Howard, CEO and founder of Practice Fusion:

Mr. Howard sends me this quote;

“On April 21-22, there was a major Amazon EC2 outage that brought down many business and websites. Some of the data was unrecoverable and transactions were lost. The outage event, however, actually might have some unexpected beneficial effects, by raising the awareness and understanding of cloud computing – and the differences implicit in their implementation. 

In this particular case, the major distinction between two types of cloud computing is infrastructure management/control: a) cloud applications dependent upon and written on top of a utility-style service, like Amazon, where the application is susceptible to outages by its host and b) much more dependable and robust cloud applications hosted in a truly private, scalable, protected infrastructure, like Practice Fusion’s, that allow more efficient management of computing traffic and a guaranteed level of uptime for users of time-critical enterprise applications.

Ryan Howard, Founder and CEO

Practice Fusion EMR

Ryan, Thanks for the response.  Let’s hope you are correct. 

GML

del.icio.us Tags: cloud computing,practice fusion,amazon web services

A Word About SERMO

 

I had a bit of a surprise email from SERMO this week. HealthTrain received a prize, no it was not monetary, something even nicer…some recognition for all the early morning wakeups to post prior to the clinical load for the day.

It’s in the form of a ‘badge’ (of honor?).  It will be displayed on the right hand side of the ‘widgets’.

It gave me an urge to look back in HealthTrain’s Archives to read  observations HealthTrain expressed in mid 2010. :

What hath Sermo Wrought?

Average Rating  (3 ratings) 

Posted by gmlevinmd123 on June 29, 2010 - 01:06PM EDT
Author Specialties: Ophthalmology, Geriatrics

Sermo represents the best of what Matt Holt of The Health Care Blog calls 'Health  2.0'.   While some aspects of Health 2.0 are 'consumer oriented' (ie, patient oriented) Sermo has offered a network for physicians. Originally conceived as a medium for feedback from physicians regarding treatments and diagnoses, it has evolved into something much more than that.

Especially noteworthy is the cross-specialty open access to information which might not be immediately available to readers.

Some have  used the SERMO platform to seek out consultations in regard to difficult cases, or recommend treatments in response to requests from other physicians.

Others have chosen to use the SERMO platform to serve social issues, political discord, and at times allows physicians to vent and share other serious concerns.

Many comments are made in the forum that are controversial, and open to inquisitive minds and scholarly thought.

A certain banter has developed on SERMO, ( a virtual forum) humor, sarcasm, and all that human interaction one would expect at a real social occasion.  I as well as others look at SERMO daily as a routine, much like stopping by the Doctors Lounge to chat, gripe, find out who did what and to whom, and then continue the daily routine.

At times the level of discussion becomes quite academic along with references to  peer reviewed articles, and at time quite anecdotal....Frequently SERMO regulars await responses from others who have become close and respected colleagues.

As a relative old timer it keeps me current with our future generation of physician leaders, and also allows me to mentor in whatever way I can.

For physicians in relatively isolated practices it serves a commendable purpose.

The evidence is in regarding SERMO. It has played a unique role in Health Care Reform. While we still have much to accomplish, SERMO has earned national recognition in the media, and has also stimulated the AMA to become more relevant. SERMO has chastised the AMA for it's false impression that they represent physicians. At one time this may have been true, and hopefully physicians will come together in one forum to represent us all.

However just as in national and local politics, we all do not agree, and the difference in opinion are what makes us all the same.

My best wishes for continuing success to SERMO and all of us.

KEYNOTE BLOGGERS IN THE HEALTH UNIVERSE

 

About five years ago there were few physicians and/or health industry gurus who even knew what a blog was. Pedal forward a few years to today in mid-2011 and the scene has changed enormously.  Although I have been a blogger since mid 2004, using blogging to bring a newsletter to our community of IT aficionados information about our health information exchange, I am a ‘newbie’ compared to elementary, middle school and high school bloggers, FBers, and tweeps.  My own children and grandchildren have blocked me from their personal sites.  FBing, tweeting, and blogging are categorized now into personal, business, and professional. Blogging or FBing, tweeting in the wrong space is considered taboo, and marks you as ‘inappropriate’ much like being a nerd in high school or an “uncouth visitor at the local fraternity or sorority house. 

There are bloggers and then there are bloggers who use SM for purposes such as marketers, artists, musicians, politicos, writers, celebs, and even terrorists. Blogging and social media can be and is used for the writer’s own purposes.  I have seen some bloggers burn out, otherwise very capable and excellent communicators announce they are done with blogging.(like some physicians burnout on medical practice)  SM is an addiction, some who no longer have time will often recruit others to write their blog for them, or have invitees publish for them at regular intervals.

Health Train Express has long had a blogroll of the blogs that I read, however there are many other sites that are outstanding, and other venues worth following on twitter and/or Facebook. And while Twitter and Facebook are the best known SM sites, there are many others.

Blogging nor Social media is not for the lazy or faint of heart. There are readers out there that have RSS feeds and other links watching for the posts that are their favorites.  There are now awards, not unlike the Academy Awards, or perhaps a better term “The Pulitzer Prize” for blogging excellence.

                              

End Part I   Part II to follow.