Ticket Price Increases on the Health Train Express in a Time Calling for Austerity

 

Like the airlines, who are not too big to fail, medical practices will need to find ways to increase revenues. It’s too bad our patients don’t carry  baggage  into our offices so that we could have a surcharge modifier such as –0000 for each item.

However physicians can emit a sigh of relief with the announcement from on high at HHS, as brought to us by the American Medical Association, in AMED News.  Included in that news are:

Physicians meeting criteria in 2011 to earn federal electronic medical record incentives will have more time before the Dept. of Health and Human Services requires them to satisfy tougher standards for attaining additional bonuses. The move is being viewed by physicians and health policy observers as a goodwill gesture by the Obama administration toward EMR early adopters. ( Who cares what Obama thinks about goodwill? The AMA ?)

True to form modifications are being made to the calendar for implementation-incentive reward-penalty dates because the initial proclamations and mandates were poorly planned. What we have in  the federal government is a group of “cheerleaders’ encouraging the workers how much health IT will improve patient care. Even the AMA buys into that.

No Doctor Left Behind ?  This sounds much like the Bush Plan of No child left behind.

Public health studies have shown that more doctors want to participate in the EMR adoption program. A study from the Centers for Disease Control and Prevention found 52% of office-based physicians plan to register and attest to meeting program requirements for 2011, which is an increase from the 41% who planned in 2010 to do so. The total portion of physicians who have adopted EMRs also is at 34% in 2011, up from 17% in 2008.

It takes a lawyer to make the following statement,

“

“There are several takeaways for physicians from Sibelius' announcement,” said Stephen Bernstein, an attorney who is the international head of the health industry practice group at McDermott Will & Emery in Boston. In general, more physicians are adopting EMRs and using the technology to improve their practices.

“HHS also is sending a message to physicians who are undecided about whether they should make a significant investment in electronic recordkeeping”, Bernstein said. “The agency will work with physicians to help them adopt EMRs”. He suggested that doctors get in touch with one of 62 federal regional extension centers that have been established to help physicians, in particular small primary care practices, adopt EMRs.

"The main message is that there are federal government programs out there to help physicians, and the federal government isn't going to stop offering help," he said.

“It’s okay, we are here from the government to help you.” (author)

Bernstein added that a robust EMR system is needed to participate in new Medicare payment models, such as accountable care organizations. If CMS wants physicians to participate in these initiatives as well, it must do everything it can to encourage doctors to use EMRs, he said.

It’s a bundled plan, just like reimbursements. Step C is dependent on steps A and B. (If they work in the first place)

Clearly it is disruption disrupting disruption. Even chaos theory fails to keep up with these advances in advanced health care physics.

The incentive program is clearly aimed at primary care MDs, and the recent statistics reveal it.

Specialty               # Participating in   Bonus

Family practice     1,216

Internal medicine  1,198

Cardiology               517

Podiatry                   378

Gastroenterology    232

Orthopedic surgery 201

General surgery      197

Urology                    197

Nephrology              174

Neurology                148

Other                    1,347

What Medicaid Paid for EMR Bonuses

Physician               6,609             $138.5 million

Nurse practitioner  1,463               $31.1 million

Acute care hospital   607             $483.9 million

Dentist                      333                 $7.1 million

Certified nurse midwife  172             $3.7 million

Physician assistant        107             $2.3 million

Children's hospital           15           $45.1 million

What is even more worrisome is the profound recession we are experiencing, the HHS emphasizes the ARRA and Hitech have produced 50,000 job…a mere drop in the bucket. Our budget deficit is crippling planning at the federal and state level….

More than incentives we need austerity.

Stay tuned for more modifications

del.icio.us Tags: medicare reform,incentives,primary care,hitech,arra,papca,sibelius,hhs,obamacare,ama,amednews

Touchfire with Health Train Express

 

Another bold innovation (and why didn’t I think of this before?) The beauty of this is that it offers another functionality to the iPad form factor. without the burden of extra parts.  Although the iPad offers a keypad feature, users complain there is no tactile feedback which touch typists use unconsciously to type. And the addition of an external keyboard adds to more clutter.

This flexible plastiform rubberized overlay is held in place by magnets which attack to the border of the iPad’s frontface. It gives the user tactile feedback much like a normal keyboard. It also has other features attaching it to iPads official cover.

All in all a dandy device for the  clinic, by the bedside or in the hospital.

Health 2.0 in Social Media

 

Monitoring the social media stream today in #hcsm #medicine #healthreform and find that Facebook will offer a page and/or referral to FBers who are depressed and suicidal. Is this the first step into Health 2.0 and is social media going to bypass formal developments in the Health 2.0 Challenge?

Mobile apps already support API for all the social media platforms, twitter, facebook, and Google +. Twitter is very restrictive as to which APIs can use twitter’s API however health 2.0 would gain them many more users that do not compete with Twitter’s plans.

I predict that Social media will bypass the present vision for formal  health 2.0 apps, and developers should re-think their game plans or be left behind even before it happens.

G+ offers the potential for telehealth with video and it should not be hard for programmers to build a secure encrypted API to comply with HIPAA. It is accessible on smartphones, iPads and many tablet PCs.

I held a G+ hangout on Tuesday night at 6PM. The attendance was zero. A big disappointment but not a surprise at all. Not many MDs and few #hcsm users are on Google + Experience reveals it takes about one month for the stream to capture interested social media participants.

Google + has a predominance of artists, performers, and photographers. Even if you don’t want to hangout in health care…it is a broadening experience and revealing as to how much talent there is besides American Idol and the network cable offerings.

Health Train is the most prominent MD and health related +er on Google.

You can find Health Train’s profile on Google + at the Google ID.  Join and put me in one of your circles.   Hope to see you all there.

del.icio.us Tags: social media,#hcsm,#medicine 2.0 conference,Google +,twitter +,Facebook,Google+hangouts,telehealth,health 2.0

And The Webcina Winners are:

 

Webcina announced it’s winners for their contest for social media participants. Although Healthtrain Express failed to make it to the podium I enjoyed participating and ‘spilling my beans”. My reward was to be able to read these fine stories..Stories that should excite all of us in social media.

I read the winning blog posts, and found them all to be far better in appeal and content than my illiterate meanderings.

Here they are:

The Tap Code by Katherine Leon

Transient Global Amnesia and Social Media by Susan McKinnon

Suzanne Ezekiel’s Journey  Her contribution includes her vivid youtube video portraying the effects of her disease. It is one of the most telling and vivid descriptions that leaves the observer breathless and battered.  It probably should receive some type of award in videography and story content.

Take My Body Away

Thank you Webcina !!

del.icio.us Tags: webcina,motor neuron disease

G+ Hangout with Health Train Express

 

At 6 PM PST/ 9PM EST on Google + Hangout please join us tonight December 12, 2011 for a discussion on health care and reform.

Proposed agenda:

1. Effect of social media on medical  practice and business. Do you use it for;  marketing, communication, patient care.

2. Will Obama care be repealed? totally or partially

3. Will SGR formula be enacted or put on hold again this year?

4. Will you become part of an accountable care organization

5. Bring your own topics.

6. Discuss selection of special invited guest as ‘keynote speaker”  for next week’s hangout to be held on Tuesday December 20 2011 at 6PM PST.

BruceGarber.tv

On next Tuesday we will host a special invited guest, +Bruce Garber, whose interests are in video production and the use of Google hangout for medical conferencing and telemedicine.

Link to my stream to join hangout:

Join HealthTrain Express Google+ Hangout December 12, 2011 6 PM Pacific time  9 PM Eastern time.

Accessible with iPhone  iPad  as well as desktop or laptop.

See you then:

No Ticket Required on Health Train Express

Just like my office walk ins are always accepted. The same here on the Health Train Express….my plan for a subject often changes drastically when I surf the web, check my tweet box, Facebook, and Google +.

Healthcare is not all that unique. I find similar challenges in business  on Google +, Facebook, LinkedIn and Twitter. Business is also perplexed just what to do with social media. In healthcare there remains a large part of the workforce that are neophytes with health information technology and  how to use it. Questions arise about return on investment with EMRs, Health Information Exchanges, Outcome studies, and Analytics. The jury will be out for several or more years for many reasons. Statistics have a way of flowing in slowly however with the modernization of systems and new software that will take a set of tables, and charts and transform them into an easily understood graphic understanding sheer numbers may turn into a video-game like presentation.

As in healthcare business is challenged as to what portion of social media to exploit, where, and how much. Like electronic medical records the work force must be trained in social media.

del.icio.us Tags: hcsm,social media,google+,twitter,facebook,linkedin,urgent care

Health Train Conductor

Do you remember in days of old the train conductor would come by and punch your ticket. The shape of the punch hole looked quite a bit like # .

# now represents the hashtag on twitter as well as other social media platforms.. Speaking from my anecdotal story of one in the cohort, I found them to be confusing at first, especially if there was a hashtag salad of multiple #s.

The  Hashtag Project. Hashtag Project is organized and administered by the Foxepractice.com Consulting Firm.  In addition to their epractice modules and advice on Web 2.0 they provide a full menu of services. If you don’t have time yourself to dive into social media (and few doctors do) they can set you up and your staff can do the daily operations. Put your efforts into your own area of expertise.

The proper use of a hashtag allows others to search the twitter stream for your subject, #hcsm is the most often used tag for medical issues, and there are also specific hashtags for medical meetings. ( a topic I covered in one of my recent blog posts).

Recent analysis of social media in medicine reveals some positive dividends and a return on investment, according to FiercePractice Management. One primary care physician attributes 30 new patients/month from social media engagement prior to an office visit, conservatively estimating a $125,000 annual return on his $60 investment.

According to the update from online physician learning collaborative QuantiaMD, 87 percent of physicians make personal use of social media, while 67 percent use it professionally.

The QuantiaMD report also indicates that most physicians using social media are heeding to best practices, with 75 percent of those who've received friend requests from patients saying they declined. While challenges persist in navigating the best ways for physicians to use sites such as Facebook, Twitter, Google+ and the like, some doctors who've dipped a toe in the water report unexpected advantages.

Natasha Burgert MD, a pediatrician committed to one year of social media with surprising results as published at Pediatric Inc

On Monday evening, 6PM PST December 12, 2011 there will be a Google + Medical  Hangout. If you would like to attend send me an email gmlevinmd@gmail.com or tweet @glevin1 

 

del.icio.us Tags: social media #hcsm,quantiaMD,hashtag

HealthTrain RaP

 

Some of you already know about Zdogg and Dr. Harry, so this may seem lame, but for those of you who have not seen them, they are the “rappers” of medicine.

On another front, today I held the first Google + Medical Hangout with a friend  +Bruce Garber (with  his waiver regarding HIPAA). He had an eye problem which I was able to diagnose using Google + Hangout with an ordinary webcam. If your webcam is good enough with HD and you have a good video graphics card, it works well. 

I hope you will all join me tonite at 5PM PST for my medical hangout on Google +. Let me know what prominent doctors  you would like to be in the hangout and I will invite them for tonite or next Friday nite.  You are all invited to participate. Admission is FREE !!!

 

del.icio.us Tags: Google Hangout,Medical Hangout,ZdoggMD,#hcsm

Health Train Hangout with Newt Gingrich

 

I spend an inordinate amount of time on social media, Google + and Google Hangout in  particular. Most of the time on sites relevant to healthcare and medicine. I also attend events worldwide on SM in general, research large business consulting firms such as Forrester. Now and then I bump into a Presidential candidate. Watch this one, and you might see me.

Speak withi a Presidential Candidate from the comfort of your Couch at Home

Facebook and Twitter serve some specific needs that I use for messaging and communicating one on one. Many of my followers are not at all familiar with Google +

I am here visiting the LeWeb  Conference in Paris France. This is the Euro-Web event.and my G+Stream as well as Tweetdeck.are busy. I also am using a social media browser, RockMelt which aggregates twitter, facebook, and several of my favorite RSS feeds.

Rockmelt also facilitates customization of website you visit frequently. The page is simplistic with most of the desired links on the left banner. I can switch from web sites to a social media site very quickly.

Is all this social media relevant? I think it is, as a tool and for some as a revenue stream,  and information stream.

The roster of presenters reads like the Who’s who of software application developers and famous internet entrepreneurs.

Today at the LeWeb Conference, Marisa Meyer (Google +) pointed out that Social Media is “green”. Conferences and social media interact to decrease travel to meetings, Forrester Gartner, business consultants predict that  social media is running out of time (limits of time available), and running out of people…Social Media is in a bubble. SM will have to be more efficient…the next wave will be faster, easier to use and have a higher value per unit of time.

In the Enterprise (Hospitals, Integrated Health Systems, Universities) tremendous growth is taking place, newer platforms, and for professional services. SM will become the central hub with radiating spokes to the cloud, to mobile apps and classical desktop services. These changes are taking place rapidly in business, healthcare is a laggard (as usual).

Anyone who attends a social media event comes away excited, either because of the energy of the presenters, or because of the ideas for applications in health care, which at present remain unfulfilled.

In a parallel universe the occupy movement reflects the earliest indicator of looming change for business, government and healthcare. The old paradigms will disappear with the ineffectual systems we now use.

Is healthcare boring? No, but healthcare systems are staid and  about to face the apocalypse of Armageddon.

All experts advise not rushing in to social media where only fools dare to tread. Adequate preparation, education and training are essential to prevent damage to your brand or reputation. The analogy is ‘screaming in the middle of the room to get attention”.

It is very much like choosing an electronic medical record…choosing the wrong one or how to use it can be a disaster and have a negative effect.

And that’s all I have to say about that ! I can be reached at twitter @glevin1

 

del.icio.us Tags: healthcare hangout,twitter,social media,#hcsm,Gingrich,LeWeb,Google +,Rockmelt

Social Media Lawsuits??

 

Is it safe to socialize?

It seems bloggers are not immune to large legal settlements. A judge decided that bloggers are not journalists.

(from Mashable)

In a case that’s sending a frightening message to the blogger community, a U.S. District Court judge ruled that a blogger must pay $2.5 million to an investment firm she wrote about — because she isn’t a real journalist.

Judge Marco A. Hernandez said Crystal Cox, who runs several blogs, wasn’t entitled to the protections afforded to journalists — specifically, Oregon’s media shield law for sources — because she wasn’t “affiliated with any newspaper, magazine, periodical, book, pamphlet, news service, wire service, news or feature syndicate, broadcast station or network, or cable television system.”

The Obsidian Finance Group sued Cox in January for $10 million for writing several blog posts critical of the company and its co-founder, Kevin Padrick. Obsidian argued that the writing was defamatory. Cox represented herself in court.

The judge threw out all but one of the blog posts cited, focusing on just one (this one), which was more factual in tone than the rest of her writing. Cox said that was because she was being fed information from an inside source, whom she refused to name.

The debate over whether bloggers are journalists has been going on for years, but the consensus has been largely settled — on the opposite side of what Judge Hernandez has ruled. Attorney Bruce E. H. Johnson, who wrote the media shield laws in next-door Washington State, told Seattle Weekly that those laws would have protected Cox had her case been tried in Washington.

Will Medicare sue a blogger? How about Aetna, or Humana, or Blue Shield?

Are your tweets protected information, or your Facebook comments?

del.icio.us Tags: social media,legal,settlements,journalism,bloggers

Social Media and Art Galleries

 

Regina Holliday brings to life in her art work much of the confusion in healthcare and the misery and heartache it brings to patients.

If you have been to a medical meeting she is the lady in the back intently  painting her reaction to the subject of the meeting. I’ve known about Regina Holliday for several years. Although we have never met, I hope someday to meet her, I feel I know her well and her family as well.

I want to share her latest art work which she has shared on her Facebook pages.

Here are some of her paintings, and her comments:

Halloween night:

“I boarded an Airplane at 7:30pm at Regan National on October 31^st still wearing my Wizard’s Robes.  I spoke the next morning before the folks at OCHIN.  My Presentation was called Trick or Treat, and I wove references to Halloween throughout the speech.

I then began to paint.  I painted in two sessions in the morning.  The painting is called: “50%.”

          

I saw the first presentation “Integrating Mental Health into Primary Care,” delivered by Tami Hoogestraat, Psy. D., M.B.A. and Demetrio Sanchez, MSW-OHSU, Richmond Mental Health Integration Team.  I was very impressed by their slides.  An early one really caught my eye with its statistic: “50% of mental health problems are missed in primary care.”

“In this painting the patient is divided in half just like our statistic.   Half in darkness half in light he clutches his medical home.  The medical home is colored like and reminiscent of a Monopoly house.  It is an ideal but will not work without a supported reimbursement model.  “

To the left of our figure the spider web diagram of integrated care places the patient in the center.  But this no comforting circle enclosing clinical text.  Here the patient looks up staring at the viewer whilst frightened.  Practitioners that are trying to care for him surround him.  I added other threads crossing the path of the diagram to the other care agents and detriments in the man’s life, be they friends, foes or family.”

Here patients race up a stairs trying to make their appointment time.  A mother glances nervously at her watch as she hurries her child up the stairs.  A doctor waits at the top reaching out to the registered patients with one hand.  In the other he hoists a rope that ends in a watch.  A patient in an examination robe strenuously climbs the rope.  She is not scheduled but direly needs care, and the doctor is trying to fit her in, hence the term advanced access.

        

I decided to take the OCHIN logo and modify it to a Meaningful Use Sun image.  So a logo tree becomes the tree of knowledge, weighted heavily with apples.  Surrounding this tree are dots.  But these dots have become faces, just as much as data points and statistics represent real people.  These are the patients and providers creating the workflows for Meaningful Use.”

    All are  Vivid paintings in which many issues are illustrated, and which actually don’t require words for the admirer to understand.  It speaks to me.

Regina’s work can be found on Flickr

LiveJournal Tags: regina holliday,meaningful use,medical home,artists

Health Reform Politicization

Those of you who read Health Train know that I invite others to post here. Since I am a physician I cannot write as well as some devotees to journalism. I have many other sources listed on the blog in the lower portion of the right hand banner.

Later this week  I will be featuring a new source.”Reforming Health” written by Naomi Freundlich  an award-winning journalist, policy wonk and health advocate with over 25 years experience writing and thinking about health care, medicine, and the absolute necessity of creating an equitable, affordable and high-quality health care system that offers coverage to all who need it.

The discussion of health reform and policy must be in an open and transparent forum which Health Train Express attempts to encourage. The diversity of opinion will strengthen and increase chances for a successful outcome.

Health reform has already fallen victim to politicization and radicalized thinking which benefits no one. If it fails, everyone loses. No party will be immune from criticism and will suffer the consequences of irresponsible positioning and stereotyping the opposition.

Don Berwick Controversy

Dr Don Berwick resigned from his position at CMS this past Thursday.He resigned with little chance of being approved by congress in a long delayed hearing process. President Obama doomed him to failure with the ‘rush’ to appoint him to the position as head of CMS while Congress was not in session. Dr. Berwick is an outstanding physician and analytical expert, His experience and record as President of the Institute of Medicine (I.O.M.) portended significant accomplishments at Medicare and HHS. He is such an individual with strong convictions and integrity. He is now the first to admit the difficulty and challenge of framing and implementing changes in not only HHS,CMS but our entire Federal and State systems of government.

In a world of politics where there are no shades of gray, but only the rigidity of black and white differences of political opinion he was faced with his own unintended skeletons.  In addition to his own opinions he was sabotaged by President Obama,, himself in the manner of his appointment, perceived by congress as a detour around the process. Congress had some serious questions to ask Dr Berwick, and had he the chance to answer critics, Obama may not have faced the intense resistance to implementing Obama care. In return Congress made it clear he would not be permanently appointed.

Deep partisan divides have stopped Congress from confirming Berwick since mid-October 2006, creating instability in the agency that oversees the Medicare and Medicaid programs. Obama installed Berwick in July 2010 as a recess appointment, which was heavily criticized by Republicans who accused the pediatrician of favoring health care rationing -- a charge Democrats dismissed as nonsense. (Senior Journal.com).

 

Those of you who read my opinions know that I was not a Berwick fans. However in his departing commentary he pointed out,

“The extremely high level of waste,” as exemplified by overtreatment of patients, failure to coordinate care, administrative complexity, burdensome rules, and fraud.

• “Much is done that does not help patients at all,” Dr. Berwick said, “and many physicians know it.”

• “I came with an agenda, I wanted to try to change the agency to be a force for improvement, covering one out of three Americans.”

• It’s a complex, complicated law. To explain it takes a while. To understand it takes an investment that I’m not sure the man or woman in the street wants to make or ought to make.”

• “We are a nation headed for justice, for fairness and justice in access to care,”

• “We are a nation headed for much more healing and much safer care. There is a moon shot here. But somehow we have not put together that story in a way that’s compelling.”

• “Government is more complex than I had realized. Government decisions result from the interactions of many internal stakeholders — different agencies and parts of government that, in many cases, have their own world views.”

• “The decision is not whether or not we will ration care — the decision is whether we will ration with our eyes open.”

• Berwick added, “Republicans have completed distorted my meaning. My point is that someone, like your health insurance company, is going to limit what you can get. That’s the way it’s set up. The government, unlike many private health insurance plans, is working in the daylight. That’s a strength.”

In another ‘interim appointment’ President Barack Obama is nominating Marilyn Tavenner (Washington Post Wonkblog) to succeed Donald M. Berwick as administrator of the Centers for Medicare and Medicaid Services.The current political climate on Capitol Hill may mean that Tavenner is just as likely to see her nomination stall.

del.icio.us Tags: berwick,tavenner,cms,hhs,medicare reform,papca