Telehealth or Telehell ?

It is touted that telehealth, video conferencing, telemedicine and mobile health applications will assist in reducing the cost of medical visits.  However, CMS has thus far not addressed reimbursed issues which is a major deterrent.  At first glance this may be true, however nothing is that simple and technology and regulations always alter the equation.

TeleMedicine encompasses many functions

Remote monitoring

Physician-patient video conferencing, email or chat

Physician-physician consultation ie,

 

Ultrasound

Video documentation:

Hospital internal conferencing

 

Because of recent intense interest I did some research on this issue and found many states are outlining the requirements for telemedicine.

Health Providers have no difficulty proposing cost effective uses for tele medicine. The issues are that regulations and fear that privacy would be breached. Thus far I have not seen any rules regarding  patient and provider waiving HIPAA rights.  Does anyone know anything about waiving HIPAA? Leave a comment or tweet me @glevin1

California has issued guidelines for telemedicine on their California Board of Medicine online website.

Recently, the Medical Board received an inquiry regarding informed consent and whose obligation it was to obtain the necessary consent from the patient who would be undergoing the medical procedure.  Specifically, the question was whether physicians could delegate this task to another licensed health care provider or other personnel under their supervision.  While the Board could find no statutory or regulatory bar to this proposed process, the Board suggests that public policy is best served when the physician performing the procedure secures the consent from the pa tient.  In this manner, if the patient has questions or concerns, the physician is in the best position to address those matters.  The following is provided as a reminder of the legal requirements when practicing medicine via telehealth: Telehealth (previously called telemedicine) is seen as a tool in medical practice, not a separate form of medicine.  There are no legal prohibitions to using technology in the practice of medicine, as long as the practice is done by a California licensed physician.  Telehealth is not a telephone conversation, e-mail/ instant messaging conversation, or fax; it typically involves the application of videoconferencing or store- and-forward technology to provide or support health care delivery.

Business and Professions Code §2290.5 (b) states: “Prior to the delivery of health care via telehealth, the health care provider at the originating site shall verbally inform the patient that telehealth may be used and obtain verbal consent from the patient for this use.  The verbal consent shall be documented in the patient’s medical record.” This is important:  Please note that the standard of care is the same whether the pa- ent is seen in- person, through telehealth, or other methods of electronically enabled health care.  The Medical Practice Act, including informed consent laws, applies in every area of medicine and in every practice setting and circumstance.  California laws pertaining to the use of telehealth should not be construed to alter the scope of practice of any health care provider or authorize the delivery of health care services in a setting, or in a manner, not otherwise authorized by law.  Physicians need not reside in California, as long as they have a valid, current California license.

Many individual States are preparing or already have issued guidelines and/or regulations regarding Telehealth and Telemedicine.

Provided here are sources of information for those considering adding telemedicine to your  practice.

New CMS Rule on Telemedicine Credentialing and Privileging

Federal Spotlight on VA's SCAN-ECHO

Some perils of telemedicine

New York Statement on Telemedicine

State Reimbursement Policy appears to be addressed in New York

AN OVERVIEW OF STATE LAWS AND APPROACHES (2001-2002)

HHS reports progress on telehealth regulations

Regulations for tele-medicine are developing very rapidly and are in a state of flux.  Those considering tele-health in their  practice are advised to review current law and regulations from their state licensing authority. Most articles are dated, and incomplete.

 

Technorati Tags: telehealth,telemedicne,hipaa,california medical board telemedicine,california medical board,video conferencing

America, Land of the Free, Home of the Brave, and Home of the Unhealthy

 

               

“There are those who look at things the way they are, and ask why... I dream of things that never were, and ask why not?”
Robert Kennedy

This often quoted statement is very applicable to today’s conundrum of providing health care to all American’s

“Progress is a nice word. But change is its motivator. And change has its enemies.”

“I believe that, as long as there is plenty, poverty is evil.”
Robert Kennedy

These quotes from R.F.K. ring in the ears of those who knew the man in the 1960s.  It was true then as Americans traversed the world of civil rights and inequality.

Today we also have marked inequalities  in health care,  some due to inherent systemic flaws, some due to our present economic morass, and some due to an obsolete medical bureaucracy.

Healthcare is in a state of flux, not from medical advances, although rapid progress is continuing in genomics, proteomics, diagnostics and all the other ‘ics”. but in how we fund health and wellness, along with treating chronic illnesses. Some illness is acute and brief, some develops from acute illness followed by prolonged chronic illness, and/or disability.  Along with these economic demands and included in chronic illnesses is prevention of disability and ongoing rehabilitation.

Loss of employability contributes great dependency and further economic stress on our economy.   It frequently severs the ability to earn income.

Important items missing from PPACA are tort reform and re-organizing medico-legal adversity.

Republicans and Democrats need to step back and look at the goals for health care in America.  This is a non-partisan issue, however self-interest and fear of economic failure dominate the process, not just for individuals, but industry as well.

 

                                        

 

Technorati Tags: robert kennedy,robert kennedy quotes,ppaca,health reform,non- partisan,healthcare,medical bureaucracy,chronic illness

<a rel=”author” href “https://plus.google.com/114503806689722509896”>Gary Levin on Google+</a>

Organ Donors Simplified

 

 

Infographic Printing Human Organs

A New Epidemic

 

Epidemic?  Most think of some serious or potentially fatal disease sweeping a country or around the world. This one is different, and perhaps beneficial.

You have “webitis”. No, its not a new medical malady inflicted by endless moussing, clicking, surfing, emailing or participating in social media.

Chances are however that you are among the millions who search the internet for information about what ails you.  Your last doctor visit went off well, but there were some issues you did not understand and your doctor ran off (since he only has about ten minutes to spend with you,(most of the time) without being sure you knew what ‘webitis’ really is.

You are among those who search for health care information on the internet. The phenomenon continues to grow rapidly.

Health Site Audience Grows 60 Percent Over Past Three Years
Over the past three years, U.S. Internet users have shown a steadily increasing trend in visitors to sites in the Health category, which range from general health content sites to branded pharmaceutical sites. The number of total unique visitors accessing these sites on a monthly basis has increased from 86.9 million in June 2008 to 139.1 million in June 2011, representing a 60-percent increase.

Interestingly, the rate of growth in visitors to health properties over the past three years outpaces the growth of the total U.S. Internet audience by more than a factor of 4 (60 percent vs. 13 percent), showing the demand for health information continued to increase at a strong pace.

Even more telling is the growth in audience penetration of Health properties over the past few years. Three years ago, less than half of the total U.S. online population visited health sites. Currently, health sites now reach approximately 2 out of every 3 Americans going online monthly, an increase in penetration of nearly 20-percentage points since June 2008.

 

Mobile health is also experiencing a rise in those seeking health information, which parallels the growth of mobile apps overall. This may also indicate the importance of your web information being programmed for best visibility on tablet pcs or smartphones.  Patients look for information on the fly, perhaps even as they leave your clinic on the way home, or on the way to the pharmacy following a clinic visit.

At the end of the day, these trends we’re seeing from comScore data show the demand for online health information to be far from waning and the prospect for sustained health visitation to be strong. Consumers have never before had as much ability to find health information to inform their health care decisions as they do now, and with the proliferation of connected devices enabling greater access and constant connectivity, it is only likely that the use of online health sources to engage with health information will continue to grow.

source:

 

Technorati Tags: comscore,mobile health apps,web search,health

The Singularity of Health Reform

 

Medicine in the United States is approaching a singularity, the hypothetical future emergence of greater-than-human intelligence through technological means. The occurrence of a technological singularity is seen as an intellectual event horizon, beyond which events cannot be predicted or understood. Proponents of the singularity typically state that an "intelligence explosion"[2][3] is a key factor of the Singularity where super intelligences design successive generations of increasingly powerful minds. (Wikipedia)

Big Data and advancing algorithms are approaching a singularity as current ideas  studying outcomes, and analysis of practice standards merge together.

The effects of health reform as mandated by PPACA attempts to control the “butterfly” (chaos theory) with micro-management of reform.  Nevertheless an ‘event horizon’ quickly appears in the equation. Micro-management inevitably devolves into inefficiency when an entity is given free reign without an expiration date for it’s authority.

For the purpose of writing this article I shall incorrectly assign the title “Obama Care” to the PPACA. Like it’s non-decipherable eponym the contents of Obamacare are overwhelmingly written in government-ese.  The Law requires over 11oo pages, and 2.75bmb of data.  It already has been amended several times with numerous waivers and has faced one serious challenge before the Supreme Court..

Amendments

House of Representatives Passes Amendments to Defund PPACA

The 2011 budget agreement just passed by U.S. Congress on April 14, 2011, contains provisions that repeal and de-fund certain provisions of the Patient Protection and Affordable Care Act (as amended by the Health Care and Education Reconciliation Act of 2010) (PPACA).

Complexity abounds: Health Care Reform for Cafeteria, HRA and Wrap plans

Some changes to PPACA original requirements already have been made both at the legislative and regulatory levels.  For example, the Republicans succeeded in repealing the infamous 1099 filing requirement earlier this spring -- albeit through a bipartisan vote

The Cooperative Health Insurance Program Repealed

Free Choice Voucher Program Takes a Hit

Medical Liability Reform has yet to be addressed, and does contribute significantly to cost containment, and defensive medicine.

 

LiveJournal Tags: ppaca,obamacare,chaos theory,singularity,event horizon,defund,repeal

Social Media Is No longer Just Social

 

Mission creep  is the descriptive term which explains how a previously focused goal becomes another things .

For those who use social media in healthcare regularly this apparent.. The internet began as a ‘sideshow’ and within five to ten years it became a necessity. If you are not using social media you would not be aware of the advantages and power of the social media sphere.

   

HOW TO Sell Social Media to Cynics, Skeptics & Luddites

For example: (personal uses)

1. Twitter , along with use of hashtags provides the opportunity to direct traffic to your web site, blog, and/or even Google Drive or Live drive.  GDrive provides sharing to anyone who has the link to that document (or folder).

2. Information source: Many physicians and others regularly tweet from meetings and symposia using a meeting hashtag.  Specific hashtags can be found on Symplur, a site devoted to medical hashtags with some specificity.  It’s not just for social contact at the meeting, (ie, “meet me at Starbuck’s afterward”). Tweets can be linked with photos and/or graphic using a smartphone or tablet with Flickr, yFrog, and other photo sharing sites. (most are free with limited storage capacity) Videos can be uploaded to YouTube and linked to Twitter announcements.  Imagination leads one to many other outbound messages. The 2012 Top Ten Photo Sharing Sites.

3. Search on twitter using hashtags is a primitive form of search, limited only by your knowledge of which hashtags are useful in the area you are interested in. Unfortunately at this time hashtags seem to appear by popular  acclaim and usage. There is as yet no nomenclature that is officially blessed by the twitter community.

4. Facebook and Google can be used as well, offering more than 140 characters. (I preface this with the fact that there are several url shorteners, as well as text abbreviation services which truncate tweets longer than 140 characters, providing a link within your tweet.  Linkedin is well known among professionals. It offers much to professionals. This sleeper network has become more popular and is now more integrated with other social media sites.  Although Linkedin recently prevented twitter feeds to their site, the reverse is not true, allowing a Linkedin  user to simultaneously tweet.

5. Many applications have been developed which offer simultaneous social media messages across multiple applications. Tweetdeck allows a single tweet to also be placed Facebook, and Linked in.  A  post on a Google stream can be shared on Twitter, or  Facebook. Google is closely linked with YouTube, and can be used for live video and Google on Air Hangouts. Buffer app creates the ability to send your tweets repeatedly during a 24 hour period (at times when most users are active). Inserting a hashtag improves the chance that your recipients get the message(s).

6. Analytics, BuddyMedia,  Social Media Examiner,  SocialBro,  Sprout Social (free trial), Google Analytics,  Twitter Analytics are available to measure your impact, followers, networking, influence and the times your tweets are most read.  It is possible to schedule your tweets at those times. MentionMapp is one of the coolest maps of  the twitter universe. Type in your “twitter handle” and presto you have a map of your own twitter galaxy. For those of you proficient in spreadsheets and APIs there are a host of free Macros and apps.

7 Facebook uses “friends” or ‘likes’. Google Plus for Business as well as Personal Google Plus  uses “circles”. Twitter uses “followers” to organize your audience.  There are some nuances, which go beyond the limits of my blog.

8. Blogs and web sites provide insider information about health and facilities as well as providing meeting schedules, agendas, and speaker lists.

  Microsoft has already said that Windows 8 tablets, irrespective of their x86 or ARM underpinnings, are PCs.

9. Web 2.0 and Health 2.0 may be ending to be replaced by Mobile    Studies and surveys indicate that mobile applications in health care will multiply exponentially in 2012.  They also reveal a relative decrease in laptop, and desktop computers as compared to sales of tablet pc and smartphones. Almost everyone will use their mobile device much like a pc, giving facebook, twitter and google plus an advantage with applications designed especially for mobile, and consumers carry them wherever they are, waiting for your message.   And yes all of this is coming to an EMR for your examining room. Just like your progress notes used to be.

  

After all isn’t this what separated the MDs from the RNs and others? (Illegibility) And this is probably why CPT codes and ICDs evolved.

If you are not using social media for some vague reason such  as stereotyping, you are cheating yourself out of an efficient and powerful medium. The caveat is ‘learn how to use it”

Mayo Clinic even offers a Residency in Health Care Social Media .

Social Media Toolkit from Doctors 2.0  2012 Meeting

Let’s talk about the Internet & Social Media in Healthcare – Kathi Apostolidis

“Come on, Dad, get with it”  (a favorite lecture from my kids).

 

LiveJournal Tags: google,twitter,linkedin,analytics,#hcsm,mayo clinic,social media,heathcare,hashtags,yFrog,skydrive,google drive,flikr,photobucket mobile app,web 2.0

Doctors 4 Patient Care on The Health Train Express

 

TESTIMONY BEFORE CONGRESS  Doctors 4 Patient Care

Tomorrow, July 10th Doctors 4 Patient Care will give testimony in Congress regarding the impact of the Patient Protection Affordability Care Act. Never before has a Law had such an oxymoron for a title. The law is not about patients, not about protection, not about care. It however is an  act….an imaginary folly created by who knows.

Included in today’s post is the link to testimony of the participants.  Erick Novak MD states the issues simply, and without useless rhetoric.   Most of what you read here is read by you the “choir”.  It’s meant for our patients and governmental officials to read.

Please forward this to all your contacts

I urge you to respond with a ‘ROAR’

 

Technorati Tags: ppaca,patient care and affordability act,congress,docs4patientcare

This Week on Health Train Express

Mark your calendars; set your iPhones - Artificial Intelligence in Healthcare this Friday on Voice of the Doctor http://bit.ly/MMr0y9
What’s In Your Record? Contest on Challenge.gov http://bit.ly/NDjO4n
How does Your EHR Calculate Meaningful Use Measures? http://bit.ly/PBAJZk

Mayo Clinic Offers Two Day Program on Social Media in Healthcare http://bit.ly/Pvatje

Latest on MGMA Conference in October in San Antonio http://bit.ly/M4dZLa
Our Health IT Business News Wrap-up for week ending July 6, 2012 http://bit.ly/MOORgF
Listen to HealthcareNOWradio.com  http://www.hitechanswers.net/
Latest post on ONC Health T Buzz: National Priorities for Research on the Use of Health IT http://bit.ly/ND6ayp
Live Webcast Thursday from NeHC: Beacon Communities and EHR Vendors Working Together to Accelerate Interoperability and Exchange http://bit.ly/OU2auC
Missed these recent great articles?
OIG Study Shows EHR Use in Medicare Physicians http://bit.ly/LCVpQe
Protocol for HIPAA Audits Released http://bit.ly/MGxdf7
American Medical Association Takes Up ICD-11 Cause http://bit.ly/OhSkET
A classic post from the archives:
Confessions of an EHR Project Manager http://bit.ly/ndJTlY
Miss tuning in weekly to MU Live!? Don't worry -- we'll be back starting August 14, gearing up for the release of all those final rules. Sign up here to be notified of upcoming guests and topics http://bit.ly/odbatZ

 

And who doesn't like free white papers?
2012 HIPAA Audits: Will the Past Predict the Future...Preparing for HIPAA Security Rule Again...Do EHRs Increase Liability and others. Get them all here: http://www.hitechanswers.net/free-downloads/

All this and more from Hitech Answers
Carol Flagg
Group Manager
www.hitechanswers.net
www.healthcareNOWradio.com

Technorati Tags: mayo clinic,artificial intelligence,social media in healthcare,hipaa,ehr adoption,ama,beacon communities,health it,mgma,onc

Social Media Nihilist…are you one of them?

Social Media Nihilist…are you one of them?

Social Media Nihilist…are you one of them?

 

The term Nihilist encompasses a broad array of issues. I am not one to write dispassionately about the impact and/or importance of social media in healthcare.

Others do not agree. In the interest of fairness many MDs are downright negative about social media.

Some would call it a waste of time and perhaps even dangerous.   HappyMD sees it as adding another theme hastening  “burnout” for MDs who use or anticipate using social media in medicine.

I personally disagree with him, although if you see social media as just another burden, or  more bureaucracy, don’t do it….it’s meant to be fun!  Some practices ‘outsource’ their blogging and/or social media. It’s not expensive and can be done with free lance writers available at eLance.com, and you will find them on Facebook, Twitter or G+.

Dike Drummond MD is an  expert on counseling physicians on burnout, he provides a needed and urgent service to you. MDs are not immune to drug dependency, alcoholism, depression, acting out behavior, nor the  ever mounting aspects of frustrations with daily life, at home, at the hospital and in the office.  In today’s disruptive health reform, many are not the masters of their own office or space, a once prominent feature of solo or small group practice where you have the ultimate control of your destiny, finances, and choices. Many occupational psychology surveys reveal how these changes have led to more dissatisfaction at work.

Young Guns in Medicine

 

Are you one of these “Young Guns” ?

I am watching a Facebook Live Video meeting with Paul Ryan, Eric Kantor and, Kevin McCarthy designated as ‘The Young Guns” of the U.S. Congress. They are, as quoted by Facebook as politically and technologically savvy.

Surely we must have “Young Guns in Healthcare”.

 

Who are ‘they"?’  Can we define young guns in all areas of healthcare? Are they defined by specialty, mode of practice, such as group practice, proponents of health reform, public health policy, or health reform?  Can they be found in blogs, or social media?

Young guns seem to define their role as ‘initiators of change’.

Are our ‘Young Guns” the initiators of health reform, health information technology, innovative  uses of mobile health, remote monitoring, telehealth.  Would it be the top 10 MDs  Twitter, Google +, or Facebook?  Are they in Government, or Clinical Medicine?

Are Young Guns selected from their reputations in the private sector, then selected for positions at HHS, NIH, FDA or other Health Related sites.  Are they the creators and innovators of our health system.  Who designates the “Young Guns”?

Senator Paul Ryan correctly identifies the impact of social media to allow instantaneous connections which may be global on topics of interest. Government-government: Business to business: Business to consumer: people to people:

Social Media is a two way medium, it allows a direct two way connection with government.

Government should learn from social media as an efficient and almost instantaneous method for change. Are committees out?

Social media allow you and me to converse and render our  research, comments and opinion to potentially millions of social media users, blog readers, government officials.

 

Technorati Tags: young guns,eric kantor,paul ryan,social media,hhs,nih,fda,telehealth,remote monitoring,policy,blogs

Expert Opinions on PPACA

 

The CATO Institute reported on June 25, 2012,

Even if the Affordable Care Act survives its first Supreme Court test — the lawsuits won't end. Citizens have already filed challenges to what critics call the law's "death panel" and its impact on privacy rights, religious liberty and physician-owned hospitals. Still another potential lawsuit poses as great a threat to the law as the case now before the high court.

Under the guise of implementing the law, the Internal Revenue Service has announced it will impose a tax of up to $3,000 per worker on employers whom Congress has not authorized a tax. To make things more interesting: If the IRS doesn't impose that unauthorized tax, the whole law could collapse. 

The Act's "employer mandate" taxes employers up to $3,000 per employee if they fail to offer required health benefits. But that tax kicks in only if their employees receive tax credits or subsidies to purchase a health plan through a state-run insurance "exchange."

The IRS doesn't have a leg to stand on here.

This 2,000-page law is complex. But in one respect the statute is clear: Credits are available only in states that create an exchange themselves. The federal government might create exchanges in states that decline, but it cannot offer credits through its own exchanges. And where there can be no credits, there is nothing to trigger that $3,000 tax.

States are so reluctant to create exchanges that Secretary of Health and Human Services Kathleen Sebelius estimates she might have to operate them for 15 to 30 states. Even if she manages that feat, the law will still collapse without the employer mandate and tax credit.

The IRS doesn't have a leg to stand on here.  This may now be a moot argument since the SCOTUS ruled the ‘penalty’ is really a tax. Congress under pressure could vote to amend the PPACA to prohibit this being a  tax, athough the law mandates that the IRS would administer the penalty (tax)

This is only the first barrage fired across the bow of PPACA.

Lost completely in this current round are the underrepresented uninsured, unemployed, and disabled Americans.

The law is desperately flawed, built by persons who do not, did not, nor ever will understandthe physician patient interface, the byzantine multilayered approaches to payments, and the new calling to laminate the system with another stratum of sediment.

Unauthorized Tax

To prevent that from happening, on May 18 the IRS finalized a rule making credits available through federal exchanges, contrary to the express language of the statute.

Because those credits trigger penalties against employers, the IRS is literally taxing employers and spending billions without congressional authorization. Estimates by the Urban Institute indicate that had this rule been in effect in 2011, it would have cost at least $14.3 billion for HHS to run exchanges for 30 states. About 75% of that is new federal spending; the remainder is forgone tax revenue.

The IRS doesn't have a leg to stand on here. It has not cited any express statutory authority for its decision, because there is none. The language limiting tax credits to state-established exchanges is clear and consistent with the rest of the statute. The law's chief sponsor, Senate Finance Committee chairman Max Baucus (D-Mont.), is on record explaining creation of an exchange is among the conditions states must satisfy before credits become available. Indeed, all previous drafts of the law also withheld credits from states to push them to cooperate.

Employers can sue

Under the Congressional Review Act, Congress has 60 days from the date of issue to block the rule. Reps. Scott DesJarlais, R-Tenn., and Phil Roe, R-Tenn., have introduced a resolution. It may receive a cold reception from President Obama, but "taxation without representation" is a difficult position to defend. If that approach fails, states that have refused to establish a health insurance exchange, and large employers the IRS will hit with this unauthorized tax, could challenge the rule in court.

The authors of the Affordable Care Act wrongly assumed states would be eager to implement it. If saving the law from that miscalculation requires letting the IRS tax Americans without authorization, then it is s not worth saving.

Technorati Tags: irs,ppaca,scotus,taxation,congressional review act,cato

The Treacle of Social Media

 

Well, there it is… The Higgs Boson particle…It took 50 years to prove it is there. We cannot see it, we can prove it’s there using highly sophisticated physics. What is it? It’s the ‘glue’ that exists throughout the universe which allows matter to exist. Without it all there would be is pure energy flying around at the speed of light. There would be no stars, no planets, no life (as we know it). Without it would  beings of pure energy, much like some of the creatures we read about in science fiction or Star Trek’ s ‘Q’ who materialized or the other malevolent energy fields the Enterprise would encounter on their journey to ‘where no one had gone before’.

Happy Independence Day everyone 1776-2012. 236 years have passed. The U.S.A. is still a relatively young nation, our national identified thus far by exceptionalism in private investment and entrepreneurial enthusiasm.  We have always striven for excellence based upon individual effort coupled with team work.

Social media is a form of teamwork….Competition abounds in the social media sphere between Facebook, Twitter, Google plus, and many other social platforms.  How many platforms can you name  ?

Social media’s treacle is the very essence of humanity, the need for social interaction, the glue of what makes us human, along with primates and an inborn need to communicate and have sensory input from outside each of our beings.

 

Technorati Tags: social media,boson particle,higgs,treacle