Health care reform should start locally not nationally

 

Edward J. O'Boyle

Edward J. O'Boyle is senior research associate with Mayo Research Institute offices in New Orleans, Lake Charles and West Monroe.

“To replace a monolith like Obamacare, whicot affiliated with the Mayo nh brings down the whole house when it fails, Mayo Research Institute (Mayo Research Institute is not affiliated with the Mayo Clinic) recommends 10 bare essentials of a more flexible and freedom-protecting reform that puts control of health care largely in the hands  of the states.

If the Supreme Court rules that Obamacare is unconstitutional, Congress will have to decide whether to attempt another federal overall or put in place entirely different reform legislation

Based on the 10th amendment that reserves all un-enumerated powers in the Constitution to the states, each state is instructed to reconstruct its own health care system according to the specific health care needs, resources, values and principles of its citizens.

Guided by the principle of subsidiarity, the federal government would provide financial support for any state that is unable to meet the basic health care needs of its citizens with its own resources. To assure that any such state continues to function as the principal party in its health care system, federal assistance would contain no mandates and would be limited to no more than 49 percent of that state's public

While the system Mr. Boyle discusses has some shortfalls, it retains the Constitutional framework of leaving to the states the responsibility of running and  financing it’s own mechanisms.  Given the large range of financial resources of each state, the federal government would only subsidize programs that the states could not.

Founded on the principle that health care is a universal human need, each state would decide the minimum health care it requires of insurance companies offering coverage to its citizens. The minimums would be recommended by an advisory group constituted of representatives from throughout the state's health care system. Whenever that advisory group reaches agreement its recommendations would be passed without revision by the legislature and signed into law by the governor. Whenever that advisory group is unable to reach agreement the legislature would define those minimums. The advisory group would revisit those minimums as circumstances change. .

Ideally this system starts from the bottom up rather than the reverse. The  state sets up it’s own devices, without Federal interventions, nor  mandates. Each state establishes it’s own priorities.

Grounded on the principle that individuals have a fundamental responsibility to provide for their own needs as far as possible, any individual without employer-backed insurance would be encouraged but not required to purchase coverage with the state reimbursing up to 50 percent of the cost of the state minimum coverage. Co-pays would be a necessary part of any insurance policy. Anyone who wants coverage above the minimum would have to pay in full the additional cost for that protection.

Taking account of the special health care needs of certain persons, catastrophic coverage policies would be required of any insurance company doing business in the state. Anyone electing that added protection but not able to afford it would get a state tax credit to cover up to 50 percent of the cost.

Relying on the principle that no one of means has a right to impose the cost of their health care on others, anyone of means who decides not to have insurance coverage and subsequently requires health care services would be restricted to the minimum coverage as defined by the state. That person would be eligible for health care beyond the minimum only if he/she is willing to pay in full the additional expense of providing that care.

Based on the fundamental dignity of all humankind, persons too poor to afford their own health care would have access to the minimum coverage as defined by the state at the state's expense. To help eliminate abuse, a nominal co-pay would be required of anyone in financial distress.”

This idea eliminates the onus of “universal payer” which most Americans want but are averse to any idea that it is ‘socialized medicine’ or a national health care plan.

The full article in the NewStar.com (Gannett)

Reference:  Subsidiarity

 

Technorati Tags: subsidiarity,obamacare,constitution

Knowledge (Data) is POWER In the Health System Part I

 

The title of today’s article is a cliché for most professionals, be it in medicine, law, accounting, education, entrepreneurship and everyone else.

“How much?” or “How many” is a key theme appearing in all of the above, whether it involves how successful you are, business planning, and budgeting.

Some prefer to keep their heads down and carry on as events swirl around them, preferring to continue on their thus far successful business and medical enterprise, rightly concerned that the chaos and confusion ‘out there’ will absorb emotional and intellectual energy which could be better put to work within their medical practice.

Some changes are gradual, like the tides,scarcely noticed on a minute to minute basis .  Other changes are waves, paradigm shifts, and even tsunamis,  inundating events as they come on shore, and causing even more damage leaving, sweeping out the remnants of the old structures.

Medical practices, hospitals, insurance companies, are all data gatherers as well as becoming the agent for exportation of their data for studies. At one time most of this data was highly private and guarded. However, today it is different. Some patients are clamoring for data, openness and transparency….access to their medical records,  and our government clamors for data to study  for information, so intently that it is willing to fund EMR and HIX at taxpayer expense. 

Your taxpayer dollars investing in information that may benefit you.  The dividends still very much in doubt.

The flow of knowledge (data) ever increases as the internet becomes the central technology in most commerce.  

It is necessary to have broadband access to avail use of Health Information Exchanges to share patient information. If not available dial up access is a poor substitute unless graphics poor, text only data is used.

Rural medical practices are in this empty space with poor access to the fiber and backbone of the global flow of information.  In fact unless you are in a metropolitan area, and even in some suburban locations you are at a disadvantage.

The next generation expects and depends upon the worldwide internet to function.

Some examples

New graduates select areas with broadband access for medical practice

Real estate values are much higher in areas with broadband. Housing sales suffer without it. Potential entrepreneurs seek regions with broadband access.

Part II of this topic  will address the enormous amounts of data now being accumulated and the developing inadequacy of our  present analytics to gather and process it.  I will discuss new techniques and processing algorithms that address this challenge to extract not just the data, but to interpret it.

Technorati Tags: incentive payments,big data,analytics,broadband,internet,emr,hix

MedPAC Raises Concern About Meaningful Use Attestation

Many are skeptical about accepting Federal Incentive payments for the adoption of meaningful use to become qualified for the payments authorized by HITECH and stimulus funding.  It may also be true that many are willing to face penalties for not adopting EMRs after the deadline for implementation passes.

The usual approach of the federal government to offer the carrot before the stick has become a hackneyed way of doing business with the Feds and the States.

Now that Medicare and some private insurers have squeezed most practices to the breaking point and the number of uninsured has soared in the past two years no one can blame beleaguered physicians for accepting the Machiavellian tactics of HHS planners.  None of this was encouraged, nor promoted by the grass roots of medical practice in the United States.

Hopefully it is not too late and freedom loving physicians and patients will take the risk of saying ‘hell no’. The end of the road is clearly in site, unless this occurs, and accepting this fiat from the Feds will only be the beginning of endless demands to add more MU criteria every few years.  The handwriting on the wall is clear, as we are marched off to get our bar of soap for the ‘showers’.   I know the comparison is grim and probably offends many..But it is the truth as I see it.

We are not in a unique situation, as this is occurring in the U.S. in general with an executive branch and congressional branch that ignore the US Constitution. This is no accident as our President is a constitutional scholar. 

Early studies, save for a very few, show a dismal ROI and a lack of meaningful  improvement in health care delivery, not withstanding the meaningless use criteria invented by social planners and ‘visionary’ leaders.

This report from MEDPAC clearly tells the story of disappointment.

During a meeting in Washington, D.C., on Thursday, several Medicare Payment Advisory Commission members raised concerns about the small number of eligible professionals and hospitals that have successfully attested to the Medicare portion of the meaningful use program, AHA News reports (AHA News, 4/5).

Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified electronic health records can qualify for Medicaid and Medicare incentive payments.

MedPAC Data

Commission members noted that health care provider participation in the meaningful use program is lower than the federal government projected.

According to CMS data released at the MedPAC meeting, total incentive payments awarded to eligible professionals for the meaningful use of EHRs reached $636 million in February, a 57% increase over the previous month, while cumulative payments to hospitals reached $1.4 billion, a 10% increase from the previous month.

The 10% increase in hospital payments in February is down from December 2011 when there was a 50% increase in cumulative incentive payments to hospitals.

According to the data, 3,280 hospitals -- or 58% of eligible facilities -- and 126,321 physicians -- or 25% of eligible professionals -- have registered for the meaningful use program.

Of those, 796 hospitals -- or 16% -- and 31,650 physicians -- or 6% -- have received payments.

Comments

Some hospital and physician advocates cited high EHR adoption costs and overly burdensome program requirements as reasons for the low adoption rates (Daly, Modern Healthcare, 4/6).

MedPAC members indicated an interest in monitoring the meaningful use program to determine if EHR adoption reduces costs and boosts efficiency (AHA News, 4/5).

Read more: http://www.ihealthbeat.org/articles/2012/4/6/medpac-raises-concern-about-meaningful-use-attestation.aspx#ixzz1rKRXQsf9

 

Technorati Tags: ehr adoption,incentive payments,medicare,penalties,cms,medpac

Sustaining the Unsustainable by Creating New Institutions Costing more to spend less.

 

In the world of health information exchange development process and implementation are very slow.

I previous posted here about the Inland Empire Health Information Exchange becoming operational on April  1, 2012.

                             

 

In an article by Lauren McSherry, California Healthline Regional Correspondent she ably outlines the processes, delays and pitfalls of developing an entirely new entity.

“After two years of planning and negotiation, an information-sharing network linking health care providers throughout Riverside and San Bernardino counties is almost ready to go live.

Health officials say the Inland Empire Health Information Exchange will be one of the largest in the nation, covering a geographic region nearly the size of Maine with a population of 4.2 million. About 15 hospitals and 2,000 doctors are expected to participate in the health information exchange. California has a strategic plan for the mobilization of health care information electronically across organizations within regions, communities and ultimately the state.

"Our challenge in the Inland Empire is that our counties have some of the lowest health outcomes when it comes to some of the more chronic diseases," said Christina Bivona-Tellez, regional vice president of Riverside and San Bernardino counties for the Hospital Association of Southern California. "This is a tool we can use to more expeditiously intervene and make a difference," she said.

In June, supervisors in Riverside and San Bernardino counties passed resolutions recognizing the exchange as the designated HIE network for the region. Each county's department of health will participate in the exchange.

In the future, regional HIEs will share information through state HIEs, with the ultimate goal being national connectivity. So far, $22 billion has been allocated through the 2009 Health Information Technology for Economic and Clinical Health Act, or HITECH Act, as part of a national push to link health care providers.

California has 17 HIEs and is working to build its own state HIE, called Cal eConnect.

Costs and Other Challenges

With an estimated cost of $2.2 million to $2.5 million annually, building and maintaining the exchange is an expensive proposition.

"One of the most critical things is being able to make it work financially," Bradley Gilbert -- CEO of the not-for-profit Inland Empire Health Plan, a participant in the new HIE -- said, adding, "The difference [from other exchanges] is you've got health care entities that will be providing the dollars for the program to work. You've got different fee structures for the different kinds of entities."

The high cost of maintaining and operating HIEs is not unusual, and sustainability is one of the biggest challenges facing HIEs across the nation, said Jennifer Covich Bordenick, CEO of the eHealth Initiative, an independent not-for-profit organization in Washington, D.C.

An eHealth Initiative survey released July 14 found that at least 10 HIE initiatives have closed or consolidated since 2010. HIEs totaled 255 in 2011, but only 24 initiatives reported having sustainable business models.

"You're talking about infrastructure that can be created so that doctors can talk to pharmacies, and pharmacies can talk to labs, and patients can look up their information in their homes," Covich Bordenick said. "There are issues of who pays for this because there are so many different users of the system."

The HITECH Act spurred growth in HIEs across the nation. But as the number of HIEs grows, so does the competition to attract health care providers to participate.

"Some groups are collaborating or absorbing other HIEs," Covich Bordenick said.

Meanwhile, experts are paying particular attention to ensure that the Inland Empire HIE will be sustainable and not be reliant on grant funding, so it can survive and grow.

"HIEs that have been started predominantly with grant funding have had difficulty sustaining themselves," Gilbert said. "You cannot be dependent on grants because grants eventually dry up and stop."

Covich Bordenick said an example of a successful HIE that has not relied on public funding is HealthBridge, an HIE serving the greater Cincinnati area, which covers parts of Indiana, Kentucky and Ohio.

The Inland Empire HIE will be a subscription-based model with annual fees to support the initiative, Gilbert said. One model used in developing the Inland Empire network has been the Santa Cruz HIE, which dates back to 1995 and has brought together more than 400 health care providers.

Other HIEs are encountering challenges related to technical aspects and systems integration as they attempt to share information.

 

Looming Health Care Reform

The importance of ‘anchor participants’ for a health information cannot be overemphasized because it provides a bedrock of financial sustainability. Financial stability has been a major and impenetrable wall for most plans, save a few. Even those that became operational (Santa Cruz RHIO) failed when the initial grants expired.

Being a part of the Inland Empire HIE is particularly important for Inland Empire Health Plan because its membership is growing dramatically, Gilbert said. Compared with other health insurers in the region, the health plan has the largest proportion of low-income residents.

The importance of ‘anchor participants’ for a health information exchange cannot be overemphasized because it provides a bedrock of financial sustainability

The unemployment rate in the region has been hovering around 14%, and many residents currently are unable to afford health insurance. The Inland Empire area has more than one million uninsured residents, according to a February study by the UCLA Center for Health Policy Research.

By June 2012, the Inland Empire Health Plan expects to have more than 600,000 members, fueled by the economic downturn and the state's mandate to transition Medi-Cal beneficiaries into managed care plans, Gilbert said. Medi-Cal is California's Medicaid program.

By 2014, when many insurance provisions under the federal health reform law take effect, IEHP's membership is expected to reach 900,000, Gilbert said. The HIE will help keep patient records easily accessible and organized during a time when the sources of health care for a large number of people will be in constant flux.

"As members come in and out of our program, the HIE is very critical," Gilbert said. "People have been losing their jobs, losing their commercial insurance and transitioning to IEHP. The more data we have about them for our doctors and hospitals, the better."

If a patient has been seen in the past by another physician or was admitted to an emergency department elsewhere in the region, those records can be retrieved by the new health care provider. The key point is that the information will be easily transmittable and can be accessed wherever the patient seeks care, Gilbert said.

Starting Small

The diversity in participants -- from large hospitals to physician groups and county clinics -- makes the Inland Empire HIE unique, Gilbert said. In addition to the two counties, stakeholders include the Riverside County Medical Association and the San Bernardino County Medical Society.

A pilot project to test the exchange will be launched in the next four months. Loma Linda University Medical Center, Beaver Medical Group, Riverside Community Hospital, Parkview Hospital, Riverside Physicians Network, Riverside Medical Group and Inland Empire Health Plan have agreed to participate in the initial pilot project, Bivona-Tellez said.

The idea is to start small and then expand the exchange.

"The pilot project will last until we demonstrate it is functioning properly," Bivona-Tellez said. "You make sure you've got everything covered. Then you go bigger."

Bivona-Tellez said that a crucial aspect of the new HIE will be the design of its interface, which could make or break the success of the new system.

"You don't want to slow down the work of a frontline provider in caring for a patient in a critical situation," she said, adding, "You want the ability to look up something to enhance the care needed at that time."

In recent years, HIEs that were not able to present complicated information clearly and in a timely manner have failed, she said.

"Ease of use is probably the biggest concern and the ability to look at disparate information displayed in one place," she added. "If you have a system that isn't user friendly, your physicians and others won't use it. Some large institutions have dropped multimillion-dollar projects because the end users didn't like it."

Ultimately, all of the participants who join the Inland Empire HIE will be doing so with the goal of improving patient care, one of the motivations behind the passage of the HITECH Act.

Hard evidence as to whether HIEs are effective in improving patient care is difficult to come by, but anecdotal evidence suggests they are making a difference.

"The issue with collecting evidence about improved patient care is that it's hard to draw a direct correlation because there are so many groups on the exchange," Covich Bordenick said. "What we hear from doctors and patients is that it is more convenient, that the information is there when they need it. That's really important."

MORE ON THE WEB

• "Tale of Two Exchanges Shifting Gears in California" (Lauer, California Healthline, 7/7).
• "Survey: Data Exchanges Expand, but Hurdles Must Be Addressed" (iHealthBeat, 7/14).  
• "Riverside and San Bernardino Counties Designate Inland Empire Health Information Exchange To Advance Resident Health" (Hospital Association of Southern California release, 7/1

 

Technorati Tags: iehp,hix,hie,inland empire hix,inland empire health plan,inlad empire health information exchange,riverside community,hospital,riverside county regional medical center,loma linda university medical center,beaver medical clinicmedoedical clinic,riverside medical clinic,parkview community hospital,riverside physician network

Unsustainable Health Care System

 

Posted by Christopher M. Shoffner

“If we are going to fix our ineffective and unsustainable healthcare "system" the only real cure is a vibrant, diverse and independent Primary Care provider base. The only way to get that is to change the way people pay for primary care (giving everyone equal means). Everyone needs primary care and preventive services, not necessarily insurance. I even found SCOTUS making the statement that the only way to buy healthcare was to buy insurance; a false and somewhat scary assumption. By giving everyone the same means to purchase primary care and introducing pricing transparency into primary care, costs will go down and quality will improve. Why? because the patient is now the payer (the only single payer system I agree with) and they can hold the Practitioner/Practice accountable for wait times and interpersonal skills (are they listening to me?) This also alters the economics for the Practitioner; for the better. Reducing the administrative burden thrust upon each practice by the antiquated CPT Code based billing system. We are working diligently in NC (other states are waiting for the template) with all major parties to create the next major "pilot project" for meaningful reform (Medicaid, State Health Plan, Private Payers). This is not a political effort, but an effort by one state to do what is in the best interest of its residents. This is why/how decisions should be made in the political realm.

Author’s Comments: (Health Train Express)

The terms left and right are counterproductive to the process and usually create a solution that is unpalatable to each side. One alternative would be to expand (our little known service, NHS, National Health Service (the former public health service) See my blog at http://healthtrain.blogspot.com .This would in the short run it would offset the PCP shortage. ACOs will be a disaster except in already formed organization that are large and comprehensive. They can form an independent ACO

Peter,as a retired specialist (Ophthalmologist) and ex-PCP (ER and general practice for five years) I am on a mission to support Primary Care (the name of which I disagree intensely). I believe all specialists should strive to eliminate the RUC since it is not truly representative of PCP and places all principals in an adversarial position. PCPs have a far greater challenge in dealing with bureaucracy that specialists avoid. In fact that is a primary reason why young physicians chose to specialize. I agree with all of your ideas and will continue to promote them in my writing, travels and speeches

 

Technorati Tags: aco,pcp,nhs,public health,cpt code,scotus,single payer

 

Posted by Christopher M. Shoffner

The U.S. Supreme Court is debating whether the Obama administration's Affordable Care Act is constitutional. How will that decision affect the development of health insurance exchanges?

This is a very appropriate and timely question. Here in California and in other states who want to control their own HBIE time and money are already being invested into establishing HBIEs.

Not well understood is that the federal government grants only run until 2014 when HBIEs are mandated to be self sustaining. At this point the stakeholders have little financial skin in the game. That means taxpayer dollars are being expended for something that may not develop. The Obama administration has spent $729 million laying the groundwork for health insurance exchanges, according to a White House report published this morning. That number will likely tip over $1 billion in the coming months,

The Health Insurance Exchange are designed to form a financial means to support the entry of non insured and underinsured into the health market. This forms the underpinnings of uniform and mandated coverage.

At issue is whether the Obama administration overstepped itself in passing the 2010 Patient Protection and Affordable Care Act (PPACA) and mandating that all citizens purchase health insurance by 2014 or face a penalty.

The Commerce Clause of the Constitution rules that Congress is the branch of government that regulates commerce, and the states are arguing that the administration's ACA violates this clause by mandating that states be forced to implement HIXes. All states must set up HIXes by 2014, according to the ACA. If states are no longer required to set up the HIXes, the exchanges may not take off.

According to a March 26 Harris Interactive poll, 51 percent of the public would like to see this mandate to purchase insurance repealed. In the survey, Americans were split on whether they support the ACA overall. Of those polled, 36 percent support it, 41 percent oppose it and 23 are unsure.

What the White House doesn’t highlight are states that haven’t bought in — those that have resolutely resisted setting up an exchange. Florida, Louisiana, Texas and others have committed to not moving forward on implementation until the Supreme Court rules on the health reform law’s constitutionality. Two years after the health reform law passed, many states are taking a wait-and-see approach: As the above map shows, 22 states are still studying their options on health insurance exchanges.

HIX Map

Health Information Technology Fallout

At the same time this judicial battle is occuring, the HIT industry is ramping up for web portals for consumer choices. Some of these companies are implementing Travelocity-like HIXes powered by technology from companies such as Adobe, Microsoft and Oracle. This sounds much like Expedia, Kayak and other platforms that can easily be modified into health exchange data bases.

The Adobe Digital Enterprise Platform (ADEP) incorporates Adobe's PDF reader to produce welcome kits and digital signatures for health insurers that offer plans in the Web-based exchanges.

Meanwhile, Oracle's HIX platform includes a built-in rules engine to allow states to meet federal eligibility requirements. The Oracle platform is built on the Fusion Middleware application infrastructure.

Microsoft's HIX platform allows states to determine enrollment and eligibility, and it provides tools for business intelligence and case coordination.

In addition, vendors have been introducing software that allows health care companies to get reimbursed for expenses based on quality of care, or outcomes, rather than getting paid per visit.

The ACA as a whole is unlikely to be ruled unconstitutional, but the mandate for buying insurance could be, said Shah. Business models for HIX platforms may need to be tweaked if individuals and small businesses aren't required to buy health insurance, he noted.

"If the insurance mandates are unconstitutional, then the demand side for HIXes goes away, and the government would need to figure out where to get the money for exchanges," said Shah. "I think HIXes could still survive, but they'd need to be reworked quite a bit."

He noted that the government may raise taxes on businesses to pay for Web-based HIXes without a mandate for citizens to join .

It makes sense that many states have delayed their HIXs until the smoke settles at the Federal level.  HIX planning may be premature, even though the deadline looms.

States are already heavily challenged managing what exists now…medi-caid, state disability programs and more. 

Introducing further chaos for the states is a mis-directed political move.  The court may rule sooner than June, and a two month wait is not very long.

States should cool their “heels” a bit longer.

Health Train Express provides the personal opinions of Gary M. Levin M.D., a lone wolf in the wilderness of healthcare.  Comments are always invited, either here or a tweet to @glevin1

 

Technorati Tags: health insurance exchange,ACA,insurance mandate,supreme court,web portal,microsoft hix platform,oracle hix platform

The Pulse of the Health Train Express

 

Next month we plan to offer a smartphone or mobile app for Health  Train Express.

Study Says DNA’s Power to Predict Illness Is Limited

If every aspect of a person’s DNA is known, would it be possible to predict the diseases in that person’s future? And could that knowledge be used to forestall the otherwise inevitable? The answer, according to a new study of twins, is, for the most part, “no.”

 

Can Bicycling Affect a Woman’s Health ?

Spending time on a bicycle seat, which has been linked to erectile dysfunction in men, may also be a hazard to a woman’s sexual health, a new study shows

Why Facebook will soon soon tell you which of your friends has an STD.

We title this one, “How not to get a date, or hook up.

How this tactic would work seems to us a Catch-22, an oxymoron and  quick way to get ‘unliked’ , and lose followers.  Bad science, bad idea. Perhaps good for tracking the flu and/or food poisoning

Gene Clue to Post Traumatic Stress

Susceptibility to post-traumatic stress disorder could be partially determined by gene variants, says a study.

A US team looked at the DNA from 200 members of 12 families who survived the 1988 Armenian earthquake.

It found those who carried two gene variants which affect the production of serotonin - which affects mood and behaviour - were more likely to display symptoms of PTSD.

Obama takes shot at Supreme Court over Health Care

"Ultimately, I am confident that the Supreme Court will not take what would be an unprecedented, extraordinary step of overturning a law that was passed by a strong majority of a democratically elected Congress," Obama said at a news conference with the leaders of Canada and Mexico.

Spring Training for the Health Team 

The problem with health care is people like me—doctors (mostly men) in our fifties and beyond, who learned medicine when it was more art and less finance. We were taught to go to the hospital before dawn, stay until our patients were stable, focus on the needs of each patient before us, and not worry about costs.

 

Technorati Tags: dna,stds,supreme court,obamacare,ptsd,women's health

What Doctors Know about ObamaCare

by Marc Siegel 

At the heart of the multi-headed abominable creature known as Affordable Care Act aka ObamaCare, there resides a singular deceit. It is too easy for lawyers and even U.S. Supreme Court Justices to miss this deceit in the process of arguing abstractions, but I and other doctors experience this reality every day our offices

Insurance does not equal care. One patient’s needs can get in the way of another’s needs. My waiting room is like so many others in America, and when it is clogged with several patients with low-paying highly-regulated insurance, the waiting times goes up and the access to quality medical care goes down.

That is it in a nutshell.  The rest follows something like this.

It is not true that health insurance automatically provides you with that care.
I can tell you as a practicing physician that the regulations and restrictions and red tape of health insurance (all increasing under ObamaCare) hamstring my office staff and interfere with my ability to take care of you.
 

Though politicians may even have the best of intentions when they compel you --  in defiance of the Constitution, in my opinion -- to purchase a product known as health insurance, in fact they are not even achieving their stated goal of providing for the public good, since this insurance doesn't equal care

There wouldn’t even be a case before the Supreme Court if Congress and the president had stayed within their roles and expanded the National Health Services Corp and federal clinics expressly designed to care for the underserved. If there is a public health care need then let's get our government to provide for it directly.

This service could easily be expanded to provide coverage in rural areas, underserved communities and function as a ‘payback’ for increasingly expensive loans to students. It would also serve as a public service for young physicians. Initially when first formed it served as period between internship and specialty residency.  In today’s world it could also serve as a primary care or family practice residency. The change from a free standing internship to an integrated PGY residency has had the effect we now see in inadequate primary care physicians.  When I graduated from medical school in 1968 this was known as the US Public Health Service.

Most of my patients are rooting for the Affordable Care Act to unravel especially if the individual mandate is declared unconstitutional. -- Transcripts and audiotape from the court this week make this possibility appear likely.

If ObamaCare somehow survives with or without the mandate, 16 million new Medicaid patients will quickly find out what current Medicaid patients already know; that it is very tough to find a doctor or network of doctors who will work with your insurance.

 

ObamaCare’s Independent Medicare Advisory Board and other regulatory committees and mandates will make it more and more difficult for doctors like me to practice and to order the tests and treatments we feel our patients need. We will require more staff hours to deal with all the red tape. As more of us drop out and no longer accept insurance, another unconstitutional mandate will become necessary to compel doctors to participate again.
 

Marc Siegel, M.D. is a professor of medicine and medical director of Doctor Radio at NYU Langone Medical Center. He is a member of the Fox News Medical A team and author of several books. His latest book is "The Inner Pulse; Unlocking the Secret Code of Sickness and Health."

 

Technorati Tags: medicare advisory board,national health service,supreme court,affordable care act

  

Dying in the 21st Century

 

Most of us will die in the Twenty-First Century

I happened to  run across this TEDxNewy 2011 (Newcastle, AU). Not only are we on a health train express we are all on the way to the end of the line.

Paul Saul

Peter Saul is Senior Intensivist in the adult and pediatric ICU at John Hunter Hospital, and Director of Intensive Care at Newcastle Private Hospital. Having trained in Cambridge, London, Sydney and Harvard, he came to Newcastle to help start up the new ICU at John Hunter, and never left. He has been accused of being an "ethicist", which he tries to deny, but does admit to having been Head of Discipline for Medical Ethics at Newcastle University in the past, and now provides ethical advice to the State and Federal health departments. Having been deeply involved in the dying process of over 4000 patients in the past 35 years, Peter has taken an interest in how we die, and how this has changed beyond all recognition in a single generation.

Paul Saul relates in a study of over 4000 patients medical records, only 1% had any documentation about how the patient wanted to die or the end of life treatment they desired. This leaves health professionals and sometimes family or guardians in a quandary as to when and if to stop life support.  Think about this, if 99 people out of a hundred don’t leave instructions their care can be extended significantly. The economics may be staggering since ‘end of life’ care is the most expensive, spent in intensive care units.

How we die lives on in the minds of all who survive us. Stress increases seven fold by dying in intensive care units. In the U.S. one in five will die in intensive care, in Miami three out of five, and in Australia one in ten.”

Comment: from Tonya Roberts:

“The key point is that we're not having conversations around our impending deaths, for reasons of fear predominantly. As a rule, we can assume that most of us don't want to die and not before we have to. It's a fine line b/w delaying death and prolonging life. Don't throw out the whole talk b/c of the euthanasia element. I felt the missed opportunity for the funded 'conversations' keenly - like with many cultural shifts, this one may need to happen at a political level first.

Least frequent, sudden death is rare now, increasing frailty and disability are now the most frequent means of dying.

Intensive care units may be misconstrued as ‘life-saving’  when they are ‘life extending’.

Saul goes on further to say that a continuous dialogue is needed to elevate awareness of choice on dying. If the dialogue ceases the awareness decreases rapidly.

People may need to use the political process to make the entire process patient and family centered rather than ‘medicalized’  This is also fraught with fear and resistance as demonstrated in the Patient Affordability and Care Bill, when fierce emotional reactions resulted yielding the term “Death Board”. This ‘split type’ of analysis does not serve patients or families well. Death cannot be codified by society.

Dame Cicely Saunders, the founder of the hospice movement made these remarks,

“You matter because you are you

And you matter to

The last moment of

Your life”

 

Technorati Tags: TedxNewy 2011,Paul Saul,Euthenasia

The Many Platforms of Social Media in Healthcare

 

Social media in health care began with the formation of a number of interactive web sites, including SERMO, and iMedXchange some time ago.  SERMO and iMedXchange are more formal, and almost a peer reviewed forum requiring authorization and proof of a medical license. They cover subjects organized by specialty category and have business management and policy reform categories.

One could also include the many ‘listserv’ forums as social media, although not immediately interactive it functioned as a ready solution for communications. Chat rooms came into existence in the form of mIRC, AOL messenger, MSN messenger, and other chats in Facebook, and Skype

If today’ s most popular social media is considered, Facebook, Twitter, MySpace, Tumbler, and Foursquare come to mind.

Google + is relatively new, beginning in July 2011, and not yet one year old. Despite the fact that Facebook is the most popular platform and twitter is heavily used, Google launched Google + and a videoconferencing capability for ten users simultaneously. For the uninitiated Google + is somewhat more cumbersome and technically  challenging for new users.

Each social media platform has its own set of strengths and weaknesses differing in  linking friends and messaging. One major factor is the extent of privacy settings, and who can see your posts.

Initialling designed for short texting (as in Twitter) and ‘friending’ as in Facebook iSocial media has grown into a marketing tool for business purposes in  and enhancing visibility and search engine ranking.

A recent study has revealed an increase in physician use of social media for both for personal and professional use.  Personal use far exceeds the professional ;use of social media, however the trend is changing as professionals become more familiar and standards for it’s use are  promulgated by medical societies.

 

source:  PowerDMSuite

In setting standards the medical organizations give implicit approval for the use of social media with emphasis on protecting patient confidentiality and privacy.  And many health organizations recognize the strength of social media as it relates to direct patient relationships and as a means of increasing their visibility in cyberspace advertising their hospital and meetings and centers of excellence.

Google abandoned it’s Google Health Record due to lack of interest on the part of patients, lack of a support base with EMRs and a nervousness on the part of health providers as to the security and privacy of patient’s EHRs

Google + with their new social media platform has expressed a direct interest in supporting advocacy and support applications for disabled people, and for professional use. They have already developed special screen readers for use in chat rooms and on Google hangouts for visually impaired patients.

We have had some success in early development of “Blind Veterans Help Desk” as part of the Veterans Workshop.  This non-profit organization will facilitate the use of Google technology so that deaf veterans and blind veterans can assist each other and also facilitate caregivers improving communications and assistance to patients requiring support and/or in home health service. Google hangouts may reduce the frequency of at home visits by visiting nurses, or post hospitalization.  In my opinion the potential is endless.

We will be announcing a mechanism for interested parties to contribute to veterans wellness through the Veterans Workshop

We expect an announcement and demonstration around Memorial Day of this year.

Technorati Tags: veterans today,veterans workshop,non profit,google plus,google,deaf,blind veterans,deaf veterans,sermo,imedxchange,facebook,twitter,myspace

If Health Care Reform Falls, Look in the Mirror

 

 

Karen Dolan is a fellow at the independent Institute for Policy Studies and Director of the Cities for Peace and Cities for Progress projects there. She specializes in domestic economic inequality issues.

At times those sitting dispassionately at the sidelines see much more than we do, those who are immersed in a chaotic system, and are attempting to salvage what we use on a daily basis.

Hypothetically we all want the same, an improved health system with benefits for all,  but are fearful of the unknown even if the present system is untenable.

In her Huffington Post Blog,

“Supporters of Obama's health care reform are "keeping a stiff upper lip" reports The Hill as reaction to three tough days of oral argument and questioning on aspects of President Obama's Affordable Care Act (ACA)."

“The entire health reform effort seems to hang in balance, dangerously. It looks like a very real possibility that Americans who do and will need health care, and who do or will have health conditions -- i.e., pretty much everyone -- will again be excluded from coverage for pre-existing conditions and others priced out of coverage at alarming rates if the unusually conservative and ideological Supreme Court backs the GOP”

It didn't have to be this way. We had the power to make things different. In fact, we still have the power to make things different.

“As poorly as the administration calculated, strategized, composed and communicated their reforms, they did what Administrations do. They brought industry to the table, they excluded single payer advocates, they vastly overestimated their ability to bring the other side on board, they vastly underestimated the extreme ideology that opposed reform and they botched the messaging of all of it.”

“Candidate Barack Obama campaigned on universal coverage. He told would-be supporters that, if he were "starting from scratch," single-payer would be ideal. Indeed, he even understood that the only true reform, that would sufficiently control costs and actually achieve universal coverage, was a single payer, government-sponsored health care system. The evidence is overwhelming that only such a system can achieve those goals.”

Of course this smacks of downright socialism, yet we already have a large segment of the population using socialized funding for healthcare (seniors, disabled, children in poverty.

President Barack Obama however, not only quickly abandoned any thought of a fight for a true universal system, he set his left flank where he wanted to end up: the public option.(VIDEO Robert Reich).   In addition to current private plans, geographical regions would have another choice, a "public option" which would have the power of the federal government behind it to negotiate down premiums.

But progressives did fight for the public option. With some notable exceptions, almost exclusively. Instead of being the rallying grassroots campaign and reasonable solution desired by all progressives, universal, single-payer health care became the pariah of the organized progressives, scoffed at and scorned as unachievable.

The administration should have allowed it, encouraged it, engaged it, used it. Progressives should have fought like hell for it.

“So, while progressives, Democrats, Americans who want affordable health care for all of us go forward wringing our hands and "keeping a stiff upper lip," blaming the misinformed conservative ideologues in Congress, in the Supreme Court, in Tea Party get-ups, perhaps we should take a long look in the mirror.”

If we had ended up with a single-payer system, then of course the "individual mandate problem" is non-existent. Even if we had ended up with a "public option," we would not have had this the question before the Supreme Court this spring. Justice Kennedy himself suggested so in his comments that the Individual Mandate problem could be avoided by a tax funded single payer national health service.

“This is a fight for the most basic value a society can have. Will we care for our people or let them become sick, bankrupt, disabled and die unnecessarily because we failed to fight for an affordable quality health care system that covers everyone. Will we slash every other government program virtually out of existence to fund an ever-escalating for-profit insurance system? Isn't it time to fight for Medicare for all?”

(GML)  It’s time to cut our losses, and not travel down a doomed path guaranteed to fail miserably at building a system that will keep us healthy. Perhaps we should not call it ‘health insurance’.  That system has not functioned effectively for many years.”

 

Technorati Tags: justice kennedy,universal payer,karen dolan,affordable care act

Twitter Melts down covering Three Rounder at SCOTUS may be a Technical Knockout

 

News reports seem to be biased towards a favorable decision for the plaintiff (28 states, and AAPS.

The participants are licking their wounds and the states appear optimistic about a decision.

The defendants’ counsel came out of his corner of the court ring stumbling and staggering as he was unable to make the first jab. A quick glass of water from his corner energized him a bit.

SCOTUS will have more than two months to decide a ‘winner’  Health Train Express proclaims that it will be a split decision with one vote carrying the prevailing party. I am making no predictions. Either side will lose no matter the decision. The costs will be measurable for administrative cost, insurance company losses, and the delay in  planning and implementing a good plan should Obamacare, or parts of it be negated.

The larger issue, as to the legal severability of Obamacare may be the deciding punch in the contest.

In Supreme court matters this is the most frequent outcome…all the way to the end.

The Three Round Contest went something like this:

Medicaid expansion issue

Severability Issue

Individual Mandate Issue

Anti-Injunction Act Issue

The details are forthcoming here:

The Decision Expected by June 2012

 

Technorati Tags: supreme court,scotus,obamacare,severability,mandate,medicaid

Inland Empire Health Information Exchange

Inland Empire Health Information Exchange will “Go Live” April 1, 2012.

The Inland Empire Health Information Exchange (IEHIE) is a collaborative of Riverside and San Bernardino County hospitals, medical centers, medical groups, clinics, IPAs, physician practices, health plans, public health and other healthcare providers. IEHIE brings needed technology to access and securely share electronic patient health records for more than 4.1 million people living in the Inland Empire. The IEHIE gives healthcare providers immediate access to a state-of-the-art electronic health records network. IEHIE technology allows doctors, clinics, hospitals and other healthcare providers to electronically review and access medical records, resulting in timely, safer and improved quality of healthcare for the patients in our community.

With that announcement the real purpose and mission begins.

Physicians, provider groups and hospitals are all at different stages of implementing eHR.

Many providers also are using practice management software and focused software solutions already implemented for practice workflow.

The health information exchange means nothing without proper use by providers.  It is perhaps the last link in the workflow equation, but may present it’s usefulness at the first patient encounter with the provider who requires historical information about a patient, or a laboratory result.

Not all health information exchanges are created equal nor do they provide identical information. HIE is not something that is delivered in a 'black box' and is just plugged in.

Similar to planning for an electronic medical record, it will be important to assess a workflow of a practice to determine where the HIE fits. It may have several applications at different segments of your workflow....pre-visit, admissions, laboratory portal and others.

Anticipate that your HIE may not deliver all that you expect initially. Each component of the EMR and medical record requires interoperability to exchange information, and each type of data set uses different standards.

The standards have been designed by the NHIN so that any NIST certified electronic medical record should work with the IHIE. Meaningful use requires that your EMR communicate with the IHIE.

The Inland Empire Health Information Exchange can also be utilized by providers who do not yet use an EMR by using the WEBportal for laboratory, imaging, and patient identifiers. Patient identifiers can be assigned, such as diagnosis, immunization and others

Inland Empire EHR Related Links & Resources: (RESOURCE CENTER)

Electronic Health Records Desk Reference 

Eligibility Crosswalk

IEEHRC's Meaningful Use (Stage 1) Reporting Guide

Health IT Tutorials for Physician Practices

 

The key to choosing an EMR or eRX platform is studying workflow to determine how and which EMR will serve  you best.

Technorati Tags: emr,hie,workflow planning,nhin,interoperatility,meaningful use,health it tutorials,rec