Are Physicians Becoming Extinct as Solo Practitioners?

 

While watching the  Presidential debates and listening to economists seeking the mysteries of how not to spend more than we ‘make’, it became to me that the health care industry suffers from the same malady that our economy faces.

Technology has accelerated and has outstripped our economic structure to adapt and transform. The same is true for health care. Much of it filters down to physician offices, medical staff structure, pharma, and hospitals.

Rapid obsolesence is least often recognized initially by the species that is about to disappear until it is moribund.  Early adjustments fail to correct the stresses, and finally it crumbles.  In the process the species dwindles and it’s population declines. Such seems to be the fate of primary care and solo practitioners. Studies of physicians who practice as solo practitioners reveal a dramatic shift to group pracice and to being employed by a group practice or hospital  as opposed to being employers. What and when wil the “extinction event” occur?

American physicians are hell bent to maintain autonomy and some semblance of rule and control of their workspace.  Opinions on this are wrought with emotion. So we as physicians are at the point of “I am mad as hell, and I am not going to take it anymore”. In many ways this self-serving emotion flies in the face of mounting evidence that it takes a ‘team” to treat illness and even more so with serious illness.

Much of our economy derives success on productivity. In medicine we have formerly measured productivity with volume of patients seen and/or income.

We now see productivity in health care beginning to be measured with outcome studies,, the rate of readmission to the hospital, the incidence of acute heart disease,declines in morbidity, life span, and reduction of costs, and improved efficiency delivering health care. Much of this involves wellness and modifying factors that decrease immunity, decreasing stress, avoidance of improper nutrition and encouraging physical fitness..

We need to start on all of this early in life…in early childhood.

Fast Track for Health Train Express

 

The Food and Drug Administration today approved a new drug for the treatment of Cystic Fibrosis three months earlier than expected..

This comes as exciting news for families with anyone with this dreaded illness.

Cystic fibrosis is a disease caused by a gene mutation which causes a defect in chloride transport across the cell membrane in pulmonary and pancreatic cells. It causes severe malnutrition as well as pulmonary insufficiency leading to markedly premature death. Without treatment the average survival rate is 8-13 years.

This blinded placebo study of 213 patients revealed a marked improvement in lung function and reduction of disabling symptoms

The first version of this treatment was released for immediate use. It is meant for persons with the G551D CFTR mutation. Prior  cystic fibrosis treatments included drugs that alter effects of the defective CFTR protein which produce thin mucous, antibiotics to fight infection as well as enzyme replacement  for severe pancreatic enzyme deficiencies.

                 

The drug known as Kalydeco and developed by Vertex Pharmaceuticals, counters the effect of one specific mutation in the gene that accounts for 4 percent — or about 1,200 — cystic fibrosis cases in the United States.The drug is approved for patients age 6 and older with the G551D mutation.

Although Kalydeco treats a very small subset of CF patients,The Cystic Fibrosis Foundation said there is an ongoing phase 2 trial for people with the more common CFTR gene mutation, using Kalydeco alongside a second experimental drug, VX-809. Findings from the first part of this trial have been encouraging, with the second part still underway.

Kalydeco, known generically as ivacaftor and during its development as VX-770, will cost $294,000 a year, a price roughly in line with those of some other drugs for extremely rare diseases. Vertex said it would have various programs to help patients pay for the drugs or obtain them free.

About 30,000 Americans have cystic fibrosis, which is caused by mutations in a gene called CFTR that is responsible for transport of chloride ions across cell membranes. People with the disease tend to have thick mucus in the lungs, which leads to infections and lung damage. Their average life span is 37 years.

Venture philanthropy played a large role in the drug study.  The Cystic Fibrosis Foundation invested  $75 million dollars from it’s charitable treasuries into Vertex Pharmaceuticals after assessing early animal studies which predicted  the potential for the new drug. The CF foundation raises about $ 40 million dollars each year with it’s annual “Great Strides for Cystic Fibrosis” and the “65 Roses’  fundraisers each year. The events are held annually in many cities by the local chapters of the CFF.

The gene controlling CFTR was discovered 25 years ago, and it has taken that long for translational research to produce a successful treatment.  This treatment is not a genetic treatment (which was attempted, and failed) but a direct repair/replacement for the defective chloride transferring protein in cell membranes.

The story of how the term “65 Roses” came about is one unto itself,

Mary G. Weiss became a volunteer for the Cystic Fibrosis Foundation in 1965 after learning that her three little boys had CF. Her duty was to call every civic club, social and service organization seeking financial support for CF research. Mary's 4-year-old son, Richard, listened closely to his mother as she made each call. After several calls, Richard came into the room and told his Mom, "I know what you are working for." Mary was dumbstruck because Richard did not know what she was doing, nor did he know that he had cystic fibrosis. With some trepidation, Mary asked, "What am I working for, Richard?" He answered, "You are working for 65 Roses." Mary was speechless.

Since 1965, the term "65 Roses" has been used by children of all ages to describe their disease. But, making it easier to say does not make CF any easier to live with. The "65 Roses" story has captured the hearts and emotions of all who have heard it. The rose, appropriately the ancient symbol of love, has become a symbol of the Cystic Fibrosis Foundation.

65 Roses^® is a registered trademark of the Cystic Fibrosis Foundation.

In 1969 when I was a pediatric intern at Henry Ford Hospital I cared for three children ages 7-10 years old with severe pulmonary insufficiency and malnutrition. None weighed more than 60 pounds. None lived another six months.

Fast forward 20 years.

In 1991 we were served  with the diagnosis of cystic fibrosis in my second son. I promptly passed out. 

He is now age 23, the beneficiary of early effective treatment  (starting in 1994) with Pulmozyme (DNAse which thinned his thickened pulmonary mucus, inhaled Tobramycin to suppress Pseudomonas and to treat MRSA. The CF gene was identified early in his life. He has been in several FDA clinical trials for new drugs that will soon be released.

The financial challenge to families with this disease is enormous. His monthly prophylactic treatments average $3500-5000/ month.(when he is well) About every 12-18 months he receives a three week course of two or three antibiotics at home via a percutaneous intravenous line. The treatment is started at the CF center and then continues as an outpatient at home.

reddit Tags: cystic fibrosis, kalydeco, fda, pulmonary insufficiency, malabsorption, failure to thrive

Heart Attack on The Health Train Express

HOW TO SURVIVE A HEART ATTACK WHEN ALONE

source: Google + Stream

Disclaimer ! Health Train Express nor it's author endorses this method of self CPR. The user must judge for themself whether to do this or not... The user accepts full responsibility, regardless of the outcomes. Note: Medicare does not allow for reimbursement...do not bill Medicare.

Let's say it's 6.15pm and you're going home (alone of course),
after an unusually hard day on the job. You're really tired, upset and frustrated. Suddenly you start experiencing severe pain in your chest that starts to drag out into your arm and up into your jaw. You are only about five miles from the hospital nearest your home. Unfortunately you don't know if you'll be able to make it that far. You have been trained in CPR, but the guy that taught the course did not tell you how to perform it on yourself..!!
KNOW HOW TO SURVIVE A HEART ATTACK WHEN ALONE..
Since many people are alone when they suffer a heart attack, without help, the person whose heart is beating improperly and who begins to feel faint, has only about 10 seconds left before losing consciousness.
However, these victims can help themselves by coughing repeatedly and very vigorously.
A deep breath should be taken before each cough, and the cough must be deep and prolonged, as when producing sputum from deep inside the chest.
A breath and a cough must be repeated about every two seconds without let-up until help arrives, or until the heart is felt to be beating normally again.
Deep breaths get oxygen into the lungs and coughing movements squeeze the heart and keep the blood circulating.
The squeezing pressure on the heart also helps it regain normal rhythm. In this way, heart attack victims can get to a hospital.
Rather than sharing jokes please.. contribute by Sharing this which can save a person's life!!!!

Collapse this post

 

A better idea: Use LIFE ALERT

Obama Whitehouse Hangout…what does it have to do with Health Care….NOT

 

I happened to sit in on the Google + Hangout on the Live Stream. There were only five active participants allowed. The questions were drawn from a pool of pre-submitted YouTube videos sent to the Whitehouse. Initially the guidelines were the most popular questions or watched videos watched by YouTube Videos would be addressed.  However at the last minute the guidelines were changed to the White House Selected questions.

The questions were from the usual list of candidate debate issues. It was a well manicured session from ‘the groupies’ with all smileys and nods,and thank you Mr. President.One of the questioners grilled Mr. Obama about the lack of employment opportunities for engineers, one sector of the economy that is supposedly was recovering quickly  Mr. Obama went so far as to ask one of the participant spouse’s to send his professional resume to him to assist his job search in engineering.

Some topics avoided:  SOPA, OWS, Education Costs

There was no discussion about healthcare and/or Obama care.

Mr. Obama and his managers obviously think healthcare is off the radar.

Even if healthcare was on the radar the committee of inquisition would not have known the right questions.

 

1. Will there be an ACO in my neighborhood? (Will I even have a doctor?)

2. Why doesn’t my doctor look at me during my visit instead of his computer?

3. Why did Google hibernate it’s Google Health personal health record?

4. Why (an what is) a Medicare Demonstration Program ?  Why haven’t the results been widely published from the Congressional Budget Office regarding their failure to control costs.?

5.Can HIPAA be waived voluntarily by patient and provider for the use of social media to improve efficiency and drive down the number of office visits and expense?

I summed it up like this when I was asked how it went. My response,  “I decided at half time to go out to get soda, popcorn, and a hot dog, then decided not to go back. The second half was like the first. no last minute touch down runs….interceptions, or fumbles.   At least the hot dogs were ballpark fresh !

reddit Tags: White house hangout, obama hangout, obamacare, medicare reform, demonstration project

Pilot Programs—A Waste of Tax Dollars

Vindicated ! I have always been of the opinion that ‘pilot studies’ are a good waste of the taxpayers money. HHS and CMS seem addicted to these studies. It is almost like sending a program ‘out to bid’. John Goodman just seconded my motion of three years ago, and I do not belong to any Foundation ‘study groups’. I thank John Goodman for doing the hard hands on work to prove my hypothesis. The CMS Demonstration Projects are a good example of pilot programs

Most of these pilot programs are modeled after other ‘exceptional program’ already in progress. The selection criteria is the cost of Medicare services in specific regions of the country and an attempt to duplicate practices in each of these regions. Keep in mind this is a report from the CBO (Congressional budget office) which is only one measure of success or failure of a project. Nothing is said about quality of outcomes, return on investment of new paradigms of bundled payment, readmission to hospitals, morbidity or mortality reports.  It is a report from an agency totally separate from HHS or     CMS.

Successful innovations are produced by entrepreneurs, challenging conventional thinking — not by bureaucrats trying to implement conventional thinking.

On the supply side, we have the islands of excellence (Mayo, Intermountain Healthcare, Cleveland Clinic, etc.). On the demand side, we have a whole slew of experiments with pay-for-performance and other pilot programs designed to see whether demand-side reforms can provoke supply-side behavioral improvements. And never the twain shall meet

Can you think of any other market where the buyers of a product are trying to tell the sellers how to efficiently produce it?

Well put John Goodman. You have articulated well my meager general common sense approach and decades long observations of clinical practice.

Once again, ‘boots on the ground’ can quickly size up a problem.

Read John Goodman’s article on the Health Care Blog

digg Tags: cms, demonstration project, pilot program, outcome study, health train express, health care blog

Health 2.0 India

Health 2.0 India Conference #health2india
This meeting should be extraordinary given that so much software development originates in Asia.
I invite the attendees to tweet using the  hashtag given by Matt Holt  #health2india.
I am providing information about Google Plus Hangouts. The invitation will be in my Google + stream   +Gary Levin  Instructions for joining and using Google + and hangouts are readily available via Google + and searching. I will also send invites to anyone who wants to receive a direct link, Just send me your email.
Here’s the link to look at G+ and see if you want to prepare early.
Join Google +
The Hangout will open in 6 hours (Sunday) (6 PM PST)  Monday 7AM (Delhi) It will be operational from 7AM to 7PM Delhi time.
Other participants can open their own hangout, however hangouts cannot be initiated on smartphones or tablets unless you are on Wi-Fi.

Health Train #

No, the # sign is not an unprintable explicative. Any tweep recognizes # as the hashtag for identifying interest group. The one we use most often in health social media is #hcsm (health care social media). If you search using the # it will identify and stream that interest.  If you are sending a tweet using that # it will appear in those tweeps who are searching for #hcsm. It is a bit like the Search of twitter like Google Search.

The Foxe group provides the definitive wiki for #hcsm. T. Lee has developed a glossary of hashtags for specialties, conferences,diseases and more. The Fox Group had the prescience to develop a division strictly devoted to social media in all of it’s iterations.

We are still working out some ‘bugs’ in the new template(s)  Our blogroll and other items of interest do not appear in the templates other than in the ‘classic’ view. Our webmaster (me) is working feverishly on this with Larry Paige’s staff.

Despite Google hibernating Google Health there is still a strong interest in the Health Space. Health Train is encouraging this interest. Google has the power, market influence and capital to do some great innovative things in supporting healthcare, such as chrome books and the android operating system which is ‘open source’.  Many great innovations (like health and medical science advances) are developed by young developers, many of whom do not work directly for Google.  It is amazing how much of it is from high school students who are not employed by anyone and who either donate their ideas or are paid on a contract basis.

I encourage you all to search Google for their product development division to open a dialogue with your ideas.

For now, Health Train Express is leaving the station, bound for our next stop.

del.icio.us Tags: healthcare social media,google,google hangouts,chromebook,blogger dynamic view

What Will Google + Hangouts Offer ?

 

Anyone who has been observing social media can see that Social Media adoption in Medicine will make electronic medical record adoption seem turtle slow, , and SM has not required governmental funding or incentives. No you won’t be penalized financially for not adopting it, and it’s meaningful use becomes apparent without a cookie cutter list developed by some unknown bureaucrats who have never seen, treated or healed a patient.

Google has a winner in Google Hangouts….almost as large an impact as the original Google claim to fame…SEARCH .

Here are only some of the things doctors and their staff will be using it for.

1 Human Resources:  Interviewing job candidates with two or three of your staff in the hangout.  Prospective employees will be able to share documents right in the hangout. Your staff can “grill” the candidates and size them up. This will save enormous time for both sides in the process of hiring. Unemployed people do not have much disposable cash for driving to interviews.

2.Purchasing: A hangout with your supplier or medical device representative to ask questions and receive direct video feedback on items you wish to purchase.

3.Pharmacy reps no longer have to visit you directly to talk about their new wonder drugs.  However food cannot be served in the hangout. You can order Domino’s Pizza online.

4. Medical Management meetings between you, your consultants and staff members.

5.There are many other potential uses for G+ Hangouts, I am sure your staff and patients will think of many more.

The new dynamic view is in full swing, and I hope you are enjoying it. You may have noticed you have a choice of views from the tabs on the top banner. I like Flip board due to it’s ability to find older posts without scrolling.

Our next step will be integrating Google + Hangouts directly from the blog where you will be able to Join Me in my hangouts to offer criticism, and knowledge. You will be able to share documents, you tube videos, and windows running in the background, such as spreadsheets, slide programs, and PowerPoint decks.  Isn't technology great?!

  Who will rule, after man destroys himself?

del.icio.us Tags: google +,hangouts,bloggers,social media

Health Train Makeover

About a year ago I had thoughts about a major change in the Health Train layout. Well, I thought about it, and thought about it, and thought about it some more. Much happened in health reform, health IT and also in social media during 2011 As it turned out I am  happy I waited..

Six months ago 64% of physicians were using social media. In January 2012 over 95% of MDs were using social media in some form in their medical practice routine.

Health Train Express was one of the first health related blogs in the  social media stream;  we have been a loyal user of the blogger platform all these years (almost ten years)

Under-rated blogger has given us consistent performance all along. It is much simpler to use than WordPress, Drupal and other blog platforms. 

It suffers from the illusion that since it is not a standard .com domain it receives less respect among bloggers.  Platforms however do not make the content.

The announcement  Health Train Express will transform later today or tomorrow onto the new Blogger dynamic platform. This will create an exciting visual display of posts which will easily allow access of older posts and archived posts without a more……tab at the bottom of each page

As you may know Blogger has been owned by Google for some time. You also know that Google turned of it’s Google Health Platform on December 3, 2012.

Look for the

          

The change will create a tight integration with most of Google’s services and applications. Health Train Express will also be  available as a Google Page.

It will increase it’s readership and visibility using all of Google’s power with integration into Google plus with each post and also enable real-time access to Google Hangout’s for those who wish to do so. There will be a Google + widget to enter our Google + stream and any active hangouts.  If you own a Google plus ID it will allow you to send an invitation to Health Train Express’ hangouts by way of a ‘JOIN’ button that pops up in our G+ stream, our email and a pop-up Google IM chat box. 

It may be several days until all is working smoothly.

Health Train Express is now aggregated by Health Works Collective, Friendfeed, Social Media Today, Summify,

del.icio.us Tags: Google+hangouts,health train express social media,#hcsm,dynamic view,blogger

Obama Care Makes Medicaid An Offer States Can't Refuse

 

Have the feds stepped over the line? It would appear so according to a report  from Forbes Magazine. Peter Ferrara reports the Social Security Institute (not to be confused with the  SSA) and the American Civil Rites Union (ACRU) filed an amicus curiae brief at the Supreme Court.arguing that Obama Care's expansion and transformation of the Medicaid program violates the Tenth Amendment under the Court’s Coercion Doctrine.  In overstepping the bounds between acceptable pressure and unacceptable compulsion, Obama Care transgresses state sovereignty and violates the constitutional framework of federalism.

Without going into great detail the Medicaid requires an all or none approach to receiving federal matching funds. A refusal to accept the mandate could lead to a loss of all Medi-caid matching funds.

Medicaid is an all-or-nothing, take-it-or-leave-it proposition for the states; they must comply with all federal terms and conditions as a requirement of participating in any part of the program.  Consequently, Medicaid has become a contract of adhesion, which gives the appearance of mutual consent between both parties but, in fact, allows one party to impose terms on the other party who has no real ability to negotiate terms due to its extremely unequal bargaining position.

To change the terms so drastically to the detriment of the states of what might originally have been a truly “voluntary” program—now, after the states have become financially dependent on (literally addicted to) the federal aid it offers—saps all semblance of “voluntariness” from Medicaid.

The brief calls this ‘unacceptable coercion’ and violates the terms of the tenth amendment of the U.S. Constitution.

 

del.icio.us Tags: obamacare,supreme court,medicaid,constitution

Obama on the Health Train

(AP)

Some say;

This is the year that will make or break the health care law  States were supposed to be partners in carrying out the biggest safety net expansion since Medicare and Medicaid, and the White House claims they're making steady progress.

However, Three out of four uninsured Americans live in states that have yet to figure out how to deliver on its promise of affordable medical care.

It reveals a patchwork nation. If it continues, it will mean disparities and delays from state to state in carrying out an immense expansion of health insurance scheduled in the law for 2014. That could happen even if the Supreme Court upholds Obama's law, called the Patient Protection and Affordable Care Act.

 

About half the states are suing to overturn the law. The Obama administration says uninsured patients have nothing to fear. Steve Larsen, director of the Center for Consumer Information and Insurance Oversight at the federal Department of Health and Human Services.says “"The fact of states moving at different rates does not create disparities for a particular state's uninsured population,"

That's because the law says that if a state isn't ready, the federal government will step in. Larsen insists the government will be ready,

Easier said than done.  It’s complicated. Some of the necessary steps follow.

Someone has to set up health insurance exchanges, new one-stop supermarkets with online and landline capabilities for those who buy coverage individually. Many states have refused to do this.

A secure infrastructure must be created to verify income, legal residency and other personal information, and smooth enrollment in private insurance plans or Medicaid.(this sounds like a lot of duplication and paperwork. It also  raises the specter of the IRS and State taxation agencies providing data to the HHS or State Health Departments. (or send your W2s to the State HIE, and then they will cross check with the IRS….That sounds very ominous but should be no surprise seeing how Congress passed NDAA and almost did the same with SOPA. note: Secure infrastructure? Does this sound like health care and/or health insurance?

Over half the states are suing the federal government, which will be heard by the Supreme Court this spring. Not much will take place at the state level until there is a decision regarding constitutional issues.  It is pitiful that the states had to resort to quoting the constitution when there are so many other good reasons for not enacting this financially irresponsible mandate..

The startup, re-organization and continuing maintenance of these new bureaucracies will undoubtedly devour any ‘savings” predicted from ACOs, revisions of payment methodology based upon better outcomes and improved quality of care.

The final coup d’ etat  is the state of the economy where job production is poor. These added responsibilities will not foster new businesses, nor jobs.

So be insured, and remain unemployed. Does it have to be one or the other?

How about some sensible moderation and common sense? Is anyone listening in Washington?

del.icio.us Tags: obamacare,health insurance exchange,supreme Court,constitution,ndaa,sopa,pipa

Mobile Technology Is Transforming The Health Industry

 

Mobile Technology Is Transforming The Health Industry, But To What Extent?

Dave Chase

Technology is in the process of bringing change to every piece of the health industry — wellness, fitness, healthcare, medicine — you name it. And as it always seems with introduction of new technologies, it’s awe-inspiring how quickly they can transform entire industries yet, at the same time, make us realize just how far we have to go (or how far behind we really are). The health industry has been touched (and defined) by cutting-edge technology for years, yet its relics, legacy infrastructure, paper-pushing, and archaic procedures are as obvious today as ever before.

Mobile Technology for health  can be classified in two categories:

Physician oriented: Apps designed to access reference materials, calculators, formularies, eRx, EMR remote access, Social Media, Calendaring, email, Video Conferencing, Algorithms

Patient oriented:Health Knowledge Base, Remote monitoring sensors, like Basis’ heart and health tracker,Lark, Fitbit, and Jawbone’s Up.

Some mobile apps interface patient and physician, Mobile devices will also change the way that we communicate with our doctors, as physicians may help describe possible treatments or procedures to patients on an iPad using multimedia, visual cues, genomic/anatomical maps, etc., prescribe post-treatment apps to our smartphones so that treatment doesn’t end once you walk out the door of the hospital, or become a conduit for modern communication platforms, a la Skype, that will facilitate remote checkups, treatments, diagnostics, through the phone, or over video. Got a strange looking rash? Take a picture, or scan it on this app. Telemedicine is there in a pinch!

All this has developed almost spontaneously with the development of competing hardware devices and software which is open source. and at affordable prices given the size of the patient market. The primary ingredient is innovation, entrepreneurial spirit, and with little governmental funding and/or intrusion.

Contrast this with the stuttering acceptance of EMRs and HIEs with government mandates, artificial support with incentive subsidies to support the HIT vendor market. The real beneficiary for CMS’ incentive program are the HIT vendors, not patients, not doctors nor insurers. The data collectors will benefit from the system which will be mined for the benefit of cost containment and perhaps better outcomes.

del.icio.us Tags: health 20,mobile apps,mobile technology,emr,hie,hit

Social Media in a Hospital Bed

 

No this post is not about pubescent hormonal hyper sexuality nor the story about the sex life of fan boys or fan girls,  G+strings,, or tantalizing twitter tweepes. It is a story about Fred and Regina Holladay and their experience (bad) when Fred was diagnosed with advanced Renal Cancer.

Dr. to Dr.

View more presentations from Regina Holliday

The program is self-explanatory and does not require expansion here.

del.icio.us Tags: hospitals,social media,healthcare,cancer,twitter,facebook,Google plus