Here Come the 20-Somethings

20 Something Manifesto !

Happy Monday boys and girls. Take your seats, silence your smartphones, restrain your iPads, and listen up. (you do it in the movie theater, so give me some of that RESPECT !

This post can probably be ignored by the under 30 crowd, but there is no penalty for reading it, it is not like meaningful use in the CMS incentive plan.

Today’s AMEDNEWS writes “Here come the 20 Somethings” about patients, and the statement can also be made about MDs.

During the past few years,  some hospitals have held a "speed-dating" event, in which young adults briefly interviewed physicians for five minutes before moving on to meet other doctors. The reasons are thus: "trying to attract young adults and educating them on the importance of seeing an established doctor, and the importance of preventative care."

And thanks to health system reform, there will be a whole lot more of 20-somethings to attract.

. Generally, people age 20 to 40 are healthy."

Even if young adults are looking for medical care, it's not automatic that a physician's office will be the first place they go. According to a May 2011 report by PwC's Health Research Institute, 42% of consumers age 18 to 24 prefer to use an independent company, a website or one owned by a pharmacy, rather than a traditional doctor's office, compared with only 15% of consumers 55 and older who would go somewhere other than a physician practice.

Reaching a younger population

By using certain techniques to reach out to young adults, experts said, practices will have a better chance at capturing the population of new, young insureds that is coming. One way to reach out, they said, is to meet young adults where they live -- online.

At least two-thirds of young adults "are likely to use health care conveniences such as online scheduling and email communication with health care professionals," according to the Harris Interactive/AAFP study.

"I am not sure if the increase in the patient base would warrant a complete retooling of the physician's communication," Tsang said. "That said, it may not be a bad idea for the doctor to be on Facebook, have a follow-me account on Twitter, and put out some videos that address the most popular concerns of the younger folks."

Click Image to Link

  

Do you have a facebook page, or twitter account? They can be used for social communication by the office without being personally attached to you for non medical issues and those not protected by HIPAA privacy and confidentiality rules.

         

How about a Google ‘Hangout” for a group session on Diabetes, or Hypertension.?  Hire a part time high schooled to advise you and setup the technical side of this media opportunity.

Unless one has their head inside an endoscope it is obvious change has  occurred.in the healthcare space.

What was once deemed a trivial pursuit is now mainstream in MDs daily lives.Be it an EMR, HIE, Smartphone, Tablet PC, Bluetooth in the car, or even when rounding at the hospital or in the office, all of this technology revolves around communication.

Who reads a newspaper anymore?  I admit to missing that newsprint smell, but I don’t miss my ink allergy. I miss my AM sneezing fit and my PC just does not have an aroma add-on.

Take a look at your waiting room!

Is that an iPad the doctor is using?  No, sadly it is an old clipboard, yellow pad and a No 2 pencil.  I hope his waiting room has wi-fi. Also I hope the office has online appointment making, and an online portal for lab and/or x-ray results. If this MD had an IT advisor he would already know about CMS incentive programs, health information exchanges, EMR, HITECH, ARRA,  and meaningful use reporting.

Online Portals are available and can even be linked to the practice EMR.

Online portals offer a secure HIPAA compliant solution to reduce telephone calls.  Many labs provide them free of charge to patients and physician offices as well.

Few 20 somethings can even go potty without their smartphone, facebook, twitter, and now G+. They hangout on G+ with nine friends at a time with streaming video audio and text chat.

You might want to put up a placque in your reception room stating ‘wifi hotspot and  ‘android certified’ or iOS certified. In addition to that a reception room kiosk for registration and time checked in.

If your patients have a long wait they can go to Starbuck’s (only if they are not having a fasting blood test.) then  have the office SMS them, or better yet, a tweet when it is their turn.

         

And have you found Linkedin?  Many  physicians now have a professional grade site which allows resumes, work experience and education as well as training. There is a place for special accomplishments,  hobbies, and a feature that allow you to network with hundreds, thousands and more people.

del.icio.us Tags: facebook,linkedin,twitter lists,google plus,gtalk,emr,online portals,hie,meaningful use,cms,wifi,smartphones,iPads google,20 somethings hangout,video chat

Pharma Not in Business of Health, Healing, Cures, Wellness

 

Gwen Olsen, a former pharmaceutical representative elaborates on some shocking news !

 

Buried in what we read and hear about health reform and the root causes of health care inflation is the cost of pharmaceuticals. We are told and shown reams of data how physician ordering, hospital inflation, aberrant and inequitable coding creates a motivation for unnecessary procedures, overuse of emergency departments, created our present morass.

Not much is told about the role of big pharma. Nor the tremendous disparity of drug costs at the counter between cash paying customers, insured customers, or the cost for patients on government programs, like Medicare, and Medi-cal.

Volume purchasers such as CMS, and other federal programs, ie, DOD, VA as well as large institutional systems such as Kaiser Permanente, Mayo Clinic, Cleveland Clinic receive a disproportionate share of discounts

Compassionate care programs offer medications to tens of thousands  of patients who are uninsured or economically disadvantaged.  Most of the processing times run in the one month time period to process a compassionate drug program order. These programs are necessary, and they must be amortized.  It’s not free, and we all pay for it since the pharmaceutical company recoups that loss in some way.

The profits of Pharma increase each year and Pharma;s profits are five to six times that of the other Fortune 500 companies.

In reality, most physicians write a prescription and don’t give much thought to it’s costs unless they belong to a system that has a formulary and trained professionals who select the drugs for the formulary.

Formal training in nutritional alternatives, exercise, and other methods is almost non-existent in most of the top medical schools, as described by Peter McCarthy, N.D. and Rahdia Gleis, M.Ed.,C.C.N. in this telling video:

Some of the material is highly biased, the speakers do not discuss the role of post-graduate education which is at times as long as formal medical school. They also do not explain the lack of evidence based medicine for many herbal treatments, nor take into account that most herbal users also are following strict nutritional programs.

While I know that this presentation is a bit over the line, however it brings some attention to the lack of knowledge and bias by allopathic physicians.

A healthy “Food for Thought”? (And Health?)

del.icio.us Tags: pharma,cms,nutrition,antidepressant,anxiolytics,herbals,nutrition education,medical doctors,naturopaths

Health Train with Fewer Cars

  

I have been advised that short blog posts with bullet points is best for readers, and writers. So here is the first edition of precise bullet pointed remarks

• I have been very active exploring Google + and the use of the ‘Hangout” in which up to 10 people can participate simultaneously with video, audio, chat, and share YouTube Videos. If you need an ‘invite’ either send me an email, or make a comment.
• Stanford University is offering a Medicine 2.0 Congress during September. I hope to see you there:  Medicine 2.0  Preliminary Program
• Social Media is what you make it. There is no paradigm..some use it for purely social reasons, some create art, music, businesses, train, educate, learn, find strangers with similar interests. I try to check in daily on all the SM platforms.
• I write to opine, not to please,impress, nor to build huge friend or follow lists. If my writing builds those, so be it.
• My blog is sometimes serious, credible, humorous, outrageous, ranting, and usually surprising.
• Health Train Express is now in it’s 8th year of existence, with a total of almost 1,000 blog posts.
• About once a month I update my blog roll, adding or deleting blogs. If there have been no new posts for 90 days or more the blog is deleted. If you would like to be added, make a comment or send me an email  fastwriter.levin@gmail.com 

See you on the net !

del.icio.us Tags: social media,twitter lists,facebook,google plus,linkedin,skype,google talk,4G,iPad,iPhone,Wifi,Morse code

Meaningful Use Virtuality

 

Now that the ‘debt ceiling has been penetrated, at least for the moment, we can turn our attention back to health. Of course health is being advertised as one of the factors driving the United States into a third world country, as the cost of correcting illness and maintaining quality life exceeds 16% or more of our GDP.

Despite this obvious state of affairs, our congress continues to approve expansion of government bureaucracy, departments, regulatory affairs and more.  The New Affordable Care Act not only rearranges health coverage but also produces a mammoth increase in  bureaucracy.

As time has progressed incentives are beginning and meaningful use becomes more meaningful to ‘earn’ the incentives.

The linked Infographic: A brief review of ‘what is meaningful use’.

 

del.icio.us Tags: debt crisis,meaningful use,affordable care act

Family Practice Rocks and other Cheers !

 

As I walk around my study, between thoughts about my blogs and social media lurking I am struck by the enthusiasm and total immersion of family medicine and it's cheering squad. Many young family medicine residents speak about a 'revolution' and regret the passage of what some of we older physicians lament....a long gone vision of an iconic Marcus Welby, indelibly marking our memories.

Featured statements such as, "Either you're at the table or you're on the menu." and other quotes from the blog, of the California Academy of Family Physicians (CAFP) as stated by Dr Roland Goertz, AAFP President, "Our time is now."

I have been a super specialist in the scheme of things....an ophthalmologist, now retired. I was strongly buffered and insulated from the vagaries of general medicine thanks to  family medicine doctors.. I know why I ran away from a great 'specialty' to ophthalmology after five years of general medical practice. I also read about these issues everyday. I was not  dedicated enough to stay with family medicine for my entire career. Late in my career after a heart surgery I made a temporary move back into family medicine, and found that I still enjoyed it greatly.

I think that specialists have been disloyal to general medicine as a whole, and have failed miserably to support general medicine as if specialists were a thing apart from medicine as a whole.

Granted medicine should not be lumped into one category, since each specialty is highly unique, requiring it's own paradigm clinically and administratively.

Admittedly there has always been 'the elephant in the room” a tension between specialty and PCP, not just in outpatient but in hospital between specialties, relevant to privileges and  relatively isolated from direct patient care, such as radiology, pathology anesthesiology.

As Jay W. Lee states; in regard to ACOs; Remember managed care in the 1990s? Remember how few physicians were truly engaged in the process? We do not have time to wait and see whether PPACA will live or die in our judicial system. We do not have time to sit back and hope that this will just pass us by like managed care did in the 1990s. Our time is now. Our leadership as family physicians is more crucial than ever before. We must not sit idly by and allow others to shape the health care system. We must revolt against the status quo.

"So..."
Last year, an inspired group of residents started a Family Medicine T-shirt Revolution. These t-shirts said things like: "Use all parts of your brain; be a family physician" and "Americans are dying to have a family doc." Their focus was on raising awareness, particularly among medical students, about the importance of family medicine and cautioning against being intimidated by academics, who have steered many bright students away from primary care.

           

Family Medicine’s Chief   Quarter Back

And remember as well that specialists are not all that happy either. Family practice is however set upon to provide much non medical administrative support for which there is no reimbursement, act as the 'triage' monitor the public health.

If family medicine goes away, it will also mean bad things for specialists. FPs deserve hardy specialist support. It has been sadly lacking in many cases.

PCPs must have a stronger place at the table of the RVU Committees.

So I say 'hug your referring physicians' and demand that their RVUs and CPT codes be adjusted accordingly..Don't be divided and conquered.

As I walk around my study, between thoughts about my blogs and social media lurking I am struck by the enthusiasm and total immersion of family medicine and it's cheering squad. Many young family medicine residents speak about a 'revolution' and regret the passage of what some of we older physicians lament....a long gone vision of an iconic Marcus Welby, indelibly marking our memories.

Featured statements such as, "Either you're at the table or you're on the menu." and other quotes from the blog, of the California Academy of Family Physicians (CAFP) as stated by Dr Roland Goertz, AAFP President, "Our time is now."

I have been a super specialist in the scheme of things....an ophthalmologist, now retired. I was strongly buffered and insulated from the vagaries of general medicine by family medicine doctors.. I know why I abandoned a great 'specialty' for ophthalmology after five years of general medical practice. I also read about these issues everyday. I was not strong enough, nor dedicated enough to stay with family medicine for my entire career. Late in my career after a heart surgery I made a temporary move back into family medicine, and found that I still enjoyed it greatly.

I think that specialists have been disloyal to medicine as a whole, and have failed miserably to support general medicine as if specialists were a thing apart from medicine as a whole.

Granted medicine should not be lumped into one category, since each specialty is highly unique, requiring it's own paradigm clinically and administratively.

Admittedly there has always been 'the elephant in the room” a tension between specialty and PCP, not just in outpatient but in hospital between specialties relatively isolated from direct patient care, such as radiology, pathology anesthesiology.

As Jay W. Lee states; in regard to ACOs; Remember managed care in the 1990s? Remember how few physicians were truly engaged in the process? We do not have time to wait and see whether PPACA will live or die in our judicial system. We do not have time to sit back and hope that this will just pass us by like managed care did in the 1990s. Our time is now. Our leadership as family physicians is more crucial than ever before. We must not sit idly by and allow others to shape the health care system. We must revolt against the status quo.

"So..."
Last year, an inspired group of residents started a Family Medicine T-shirt Revolution. These t-shirts said things like: "Use all parts of your brain; be a family physician" and "Americans are dying to have a family doc." Their focus was on raising awareness, particularly among medical students, about the importance of family medicine and cautioning against being intimidated by academics, who have steered many bright students away from primary care.

And remember as well that specialists are not all that happy either. Family practice is however set upon to provide much non medical administrative support for which there is no reimbursement, act as the 'triage' monitor the public health.

If family medicine goes away, it will also mean bad things for specialists. FPs deserve hardy specialist support. It has been sadly lacking in many cases.

PCPs must have a stronger place at the table of the RVU Committees.

So I say 'hug your referring physicians' and demand that their RVUs and CPT codes be adjusted accordingly..Don't be divided and conquered.

 

del.icio.us Tags: rvu,cpt,rbrvs,primary care,specialists,family medicine rocks,family medicine revolution,future of family medicine

Vermont’s Bold Experiment: A Rebuttal

As commented on The Health Care Blog

Vermont's Bold Experiment

         

Hsaio 1989                                  Hsaio 2010

Harvard Professor William Hsiao is fond of the phrase “bold experiment'.

In the late 1980s Hsiao supervised and analyzed a study of expenses in medical practice which specifically analyzed services by physicians accounting for physician time, overhead, capital outlays, malpractice and other physician overhead items.

He developed the RBRS scale based upon RVUs (relative value units). The formula was based upon a survey and analysis of practices among different specialties, in different locales in the United States. The current system of fees is based upon these units coded for by the CPT codes (current procedural terminology).

I am very familiar with this since my ophthalmology practice was one of those in the 1989 survey. My opinion is that whatever input was put into that study....the output was pre-determined.. My evaluation of the figures garnered from the study bore little resemblance to what I found in my typical solo ophthalmology practice.

The RVBRS methodology set off a wave of high specialty fees vs primary care physician fees, based upon Hsaio's flawed methodology Move forward 30 years to 2011 where the disparity between PCP fees and specialty fees is now even greater. For one thing there are many more procedures available to specialists as the explosion in technology took place. By comparison there have been few changes available to PCPs. I am not even sure if the RVUs were adjusted over the past 30 years.

The increasing divide between specialty and PCP reimbursement can be squarely placed at the feet of “Harvard superstars”.

Harvard's academic staff is always available for another study, or to evaluate and/or pontificate about things surrounding the Boston region. Vermont borders on and touches a good part of Massachussetts.

Vermont may be bold, however it is far different in demographics and/or challenges delivering health care.

Let's assess the following:

Vermont: Total Population (2010 census) 625,741

New York Total Population (2010)  19,378,102

Texas Total Population (2010)  25,145,561

California Total Population (2010) 37,253,958

Census Map by County-- Vermont (pdf)

Using Vermont as a ‘representative’ case for health reform is comparing apple’s to oranges, or at least disingenuous. Any statistician can easily negate the results of this ‘pilot example’.

Other confounding metrics are:

1. Vermont has largely been untouched by multiculturalism

2.It is predominantly a rural state.

3.The population is not mobile, nor immigrant, it is uniform and fairly homogeneous.

4.What is bold about Vermont is that it is highly atypical.except for a few      other states such as Wyoming, Montana, No. & So. Dakota,

del.icio.us Tags: hsaio,census,vermont,rvs,cpt,health reform