Ben Carson M.D. Keynotes National Prayer Breakfast

Ben Carson M.D. (podium) advising Barak Obama at the National Prayer Breakfast (February, 2013)

It’s not often that a physician gets 2 million YouTube video hits in 24 hours.

One of my favorite role models has always been a pediatric neurosurgeon from the Johns Hopkins University. As a pediatrician he touches the lives of many young people, mentors young doctors and developed the procedure for separating twins joined at the skull

Ben Carson’s appearance and speech should bring no surprise to anyone who chose him for the role at the National Prayer Breakfast as the keynote speaker earlier this week. As he stood immediately to the President's position, some in the audience had a measure of discomfort.

Carson's background should be no surprise to anyone, since he has written or coauthored several books on his subject.

The power of his words on a major national platform, first the prayer breakfast and then FOXnews should give open-minded economists, politicians, and patients food for thought.

Not only does he talk the talk, he walks the walk. His speech was the real picture of the “State of the Nation”, not the idealogy of President Barak Obama, nor the opposition. Audience reaction in real time indicated the overwhelming agreement of both Republicans, Democrats, and Independents, alike.

Juan Williams and Keith Ablow MD who both are FOXnew consultants wrote about the content of Carson's speech.

Ablow compares Carson's role as a neurosurgeon,

“ Well, let me tell you something about Ben Carson and other surgeons I was privileged to train with at Johns Hopkins during my medical and surgical rotations before I chose to become a psychiatrist: They don’t pull punches when a battle needs to be joined, and they don’t hate the people to whom they have to deliver bad news.

Ben Carson has sat with many, many families and told them that their children had tumors growing inside their heads and that he would need to cut open their skulls and remove those malignancies.

Why? Because, for him, the truth is the only thing worth speaking, no matter the audience. Another thing about Ben Carson and other surgeons I scrubbed in with:  They like to leave clean margins. That means that when they see pathology—like cancer—they want to cut it away so that only healthy tissue is left behind.  They have to be willing to make people bleed, in order to make them live.

Juan Williams,

“ Ben Carson is my hero !” Conservative, mostly white Republican critics of the president are praising Dr. Carson because they are ecstatic to see a black man express conservative ideas to the face of a liberal, Democrat and black president’s face. But that is not why I consider Dr. Carson a hero.

He is a winner to me for living by the conservative principles I want young America, especially poor black and Latino kids, to see as the prescription for success.”

Williams goes on to elaborate,

“This was the central theme of my 2006 book, “Enough”

“PC (Political Correctness) is dangerous. In this country, one of the founding principles was freedom of thought and freedom of expression...” Carson said.

“We have imposed upon people restrictions on what they can say, on what they can think. And the media is the largest proponent of this, crucifying people who say things really quite innocently.

Williams follows up,

“As the author of a 2011 book titled “Muzzled: the Assault on Honest Debate” about how PC is dangerous and imposes restrictions on what people can say and think, this warmed my heart.

Keith AblowM.D. is a psychiatrist who is a consultant to FOXnews.

And finally Keith Ablow comments on Dr Carson's approach to health care, coupling a flat tax, health savings accounts, minimizing the role of government and insurance companies to catastrophic insurance coverage.

Juan Williams concludes,

“The Wall Street Journal recently published an editorial headlined: “Ben Carson for President.” It said: “The Johns Hopkins neurosurgeon may not be politically correct, but he's closer to correct than we've heard in years.”

That’s true. But let’s not get ahead of ourselves with talk of a Carson presidential bid. For now, I’m just happy to see Dr. Carson celebrated as an example of the personal success that is possible in America for anyone willing to follow the basic steps of personal responsibility for their own future.

Ben Carson's ideas are not much different than mine. I cannot speak for physicians' thoughts on the state of America, today.

Technorati Tags: Ben Carson,Keith Ablow,Juan Williams,national prayer breakfast,obamacare,Barak Obama,craniopagus

Health Care Reform and Political Correctness is an Oxymoron

 

During the past two years we have seen political demagoguery at it’s finest, and it has served neither side of the argument well. We see it in the financial world, and now it is present in health care.  Science has been pushed aside by statisticians anxious to prove their messages about health care systems. 

Not only is health care and political correctness an oxymoron it is against our very much “cherished’ freedom of speech.

At this week’s National Prayer Breakfast Ben Carson M.D. gave a benevolent but strong message to the crowd,which included President Barak Obama and other leaders in government. about political correctness, and the serious danger to the United States of America.

Dr. Ben Carson teachs by example….and humor.

Technorati Tags: ben carson,oxymoron,political correctedness,c-span

Health Care Social Media Resource–Glossary

 

Thanks to Barbara Ficarra, R.N.,BSN, MPA  Barbara Ficarra, RN, BSN, MPA, is an award-winning journalist, media broadcaster, speaker, medical blogger, consultant, media trainer, and health expert. She is creator, executive producer and host of Health in 30® Radio Show. Barbara is a registered nurse active on the front lines of health care: She is a head nurse at a level 2 trauma center and covers multiple medical and surgical units, critical care, oncology, cardiology and step-down units, the psychiatric in-patient unit and the Women’s and Children’s units, pediatric ER and Barbara has many years experience covering the main emergency room. Her clinical experience ranges from oncology to general medicine and surgery. Read more about Barbara. Barbara is a featuredwriter on Huffingtonpost.

20 Excellent Social Media Networking Resources for Health Professionals

1. AMA Policy: Professionalism in the Use of Social Media
2. Centers for Disease Control and Prevention (CDC) The Health Communicator’s Social Media Toolkit
3. Cleveland Clinic Social Media Policy
4. David Harlow, Esq. – HealthBlawg
5. Deloitte – Social Networks in Health Care: Communication, collaboration and insights
6. Healthworkscollective
7. Healthin30/Social Media | Social Networking
8. Found in Cache – Hospital Social Network List – Ed Bennett
9. IBM Social Computing Guidelines
10. Intel Social Media Guidelines
11. Kaiser Permanente Social Media Policy
12. KevinMD
13. Lee Aase
14. Mashable
15. Mayo Clinic Center for Social Media
16. New AMA Policy Helps Guide Physicians’ Use of Social Media
17. Pew Internet & American Life Project, August 26, 2011
18. Social Media Governance
19. Social Media Today
20. Web 2 0 Governance Policies and Best Practices

All of these websites offer guidelines for using socialmedia and setting a formal institutional policy

Unintended Consequence of the Affordable Care Act

 

The scenario: As written in the WSJ by David Lefffel M.D. (Yale University)

The Doctor's Office as Union Shop

Doctors have always been loath to strike, feeling a moral sensibility as to responsibility for their patients. And on a practical standpoint…the physician is the key producer in a medical business. Any type of work stoppage would be a self inflicted suicide gesture, for there is little wiggle room anymore in health financing.

Any strike would be self-limiting, short duration and largely a gesture as to physician discomfort with the evolving changes wrought by the Affordable Care Act.

As the country moves toward the effective start date of the Affordable Care Act in 2014, the operational and economic elements of this vast legislation are becoming clearer. Yet one likely outcome of the act that will directly affect the quality of patient care, and could affect its cost, has gone virtually unnoticed and unreported: the increasing trend for physicians to become employees, rather than self-employed. This development represents a potentially radical factor in the transformation of health care—the doctor as union worker.

Unlike hospitals, which operate under the rubric of large regulatory agencies, physicians have been much more difficult to regulate and monitor. For cost control to be effective, the professional autonomy and independent clinical judgment of the physician and other providers must in some measure be sacrificed to standardization. This can't be accomplished by overseeing thousands of doctors in thousands of offices and medical complexes, each conducting its own symphony.

The Obama administration, by intent or accident, has effectively driven a major change in the status of physicians. By reducing the reimbursement for certain office-based specialists while enhancing related payment to hospitals, the administration is compelling more and more physicians—many of them with an any-port-in-a-storm fatalism—to seek employment with health systems or large physician groups.

The change in the nature of physician employment will have effects never before experienced in America. As the effects of the Affordable Care Act come into focus, it becomes clear that when the majority of physicians are no longer self-employed—and barring any legislation to the contrary—their new employed status will provide doctors with the right to collective bargaining.

Leaders of the organized-labor movement already view service workers with nonexportable jobs as the last best hope of labor unions whose membership is at an all-time low. The truth is that physicians are now becoming service workers. They are well-educated and expensive to train, and their decisions have substantial significance in the lives of others. But doctors essentially provide a service, one that cannot be outsourced to India or China.

f doctors unionize, that raises an immediate question about their right to strike—the key lever in collective bargaining. That's a question for another day. For now, it's enough to contemplate what will occur when the practice of medicine becomes detached from its past as a profession—when doctors may in time come to see themselves not solely as healers but as workers, units of labor, in a system that is committed to delivering care to the greatest number.

When doctors occupy a service niche like the chambermaid in Las Vegas or the school teacher in Chicago, the expectations and compensation of the physician-worker will be defined in ways that may make the benefits of collective bargaining appear very attractive.

As has happened in other countries that have charted the course we are now on, a new reason for lack of access may at times be: "Office closed, doctors on strike."

Technorati Tags: affordable care act,union,strike,workers,healers,union shop,doctor strike,obamacare,david leffel,physician employment

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Go Triple Aim !!

 

Accountable Care Organizations

I received my first copy of Accountable Care News for January 2013 Volume 4, No 1. Judging from the Volume number I have missed three years of activity among ACO proponents.  Judging from my experience the vast majority of providers know little about ACOs.

Headlining the first page in the Banner is The Results of the Annual Accountable Care ePoll

According to ACN there are 150 ACOs participating in the Medicare Shared Savings Initiative serving more than 2.4 Million Medicare beneficiaries.

During early December 2012 Payers, Providers, MCOL and ACN sponsored a survey asking industry stakeholders their perspective on ACOs.

As in most new initiatives there are uncertainties as to how the new organizations will grow, and operate. The survey indicates some differences between 2011 and 2013. The survey which had a n=103 did not include anyone not already in an ACO, which highly biases the outcome.

In 2013 those who had the most optimistic outlook of ACO impact in the marketplace were vendors, with 56.7% saying that ACOs have or will have a significant market impact. 46 % of purchasers and providers felt the impact would be significant in the market place.

Will ACOs actually generate the necessary savings? Only 40% were confident while 31.8% were doubtful or very doubtful. Surprisingly providers had the greatest confidence levels 43.6%.

The “Triple Aim” a term bandied about now much like the DRG of the 1980s is a term coined by the Medical Advantage Group (MAG) to ascertain ACO readiness. Their criteria are developed from experience in developing one of the largest patient-centered provider network in Michigan. MAG

“Triple Aim “ was developed by the Institute for Healthcare Improvement (IHI and has become the framework for the NQ strategy of the U.S. Dept of HHS and the Centers for Medicare and Medicaid services

Triple Aim combines the pursuits of improving population health, improving patient experience of care, and reducing per capita costs.

1.Population health

2.Patient experience of care.

3. Reduction of per capita costs.

This term encompasses a vast collection of related and unrelated activities governed by the goal of 'Triple Aim”. Whether or not this term will be meaningful in the long run will be open to analysis as time goes on. Whether the criteria are called the Triple Aim or something else is moot. It seems more of a 'mantra' or cheer leading statement. For me it conj-ours up the spectacle of a thousand practice management experts at the next MGMA meeting chanting “triple aim.triple aim....triple aim and the next keynote speech of Donald Berwick (note: this writer does not intend to besmirch Dr. Berwick's stellar credentials and reputation as former head of CMS.

Let it be said however, that those following the 'enlightened path' should be cautious and analytical as the 'system'' becomes operative and adjust it accordingly. ACOs may very well fail to produce their intentions, however may be so thoroughly engrained in health systems that they will survive, with many 'workarounds' for it to operate at all. Defective organizations often survive in this manner, such as HHS, CMS and countless other inspired organizations.

There will be all sorts, sizes and shapes of ACOs…One model will not fill all. Some regions will be fertile ground for ACOs and in other regions ACOs will be inappropriate and fail to become established.

ACN goes on to say that there may be unintentional consequences in the market place. The growth of larger and larger provider organizations, stifling competition, and the acceleration of hospitals acquiring physician practices. Lawrence P. Casalino M.D.,PhD., M.P.H. elaborates his hopes for a pluralistic system with many choices for patients and providers.

Technorati Tags: aco,accountable care,epoll,triple aim,medicare shared savings program,accountable care news,population health,per capita cost patient experieince

Accountable Care (Cost) Act

 

One of the biggest disappointments regarding Obamacare it its failure to address the impact of defensive medicine. The direct and indirect costs of medico-legal misadventures contributes to increased costs. Some are arguing that it is insignificant.

The Iceberg Effect

In an article written by Kathleen Baiker in Health Affairs she and her co-authors evaluated the Malpractice Liability Costs And The Practice Of Medicine In The Medicare Program  (2007)

In addition to the observable financial figure, is the not so apparent and difficult to factor is the time/energy equation which diverts physicians from patient care where weeks and sometimes months are spent preparing defenses, attending depositions and court.

When one studies the exact nature and success rate of malpractice lawsuits, it becomes very apparent that the ‘injury'’ resulting in the lawsuit could be adjudicated in a better more professional and accurate way. It is often surprising to see just how often plaintiff’s do not gain financially as would be predicted. Juries often perform miscarriages of justice. Malpractice cases cannot be measured in terms of justice, right, wrong or terms of negligence.

A better model would be that of an investigative board, much like the National Transportation Board (NTSB) after an incident on public transportation. This investigative board would have the same subpoena and deposition power as a court of law.Fact gathering is performed by a variety of experts, presented to a board of review and a decision is rendered as to causation and assignment of responsibility for the event.

Tort Reform would reduce cost, and even more important it would increase the quality of care.  Time and energy could be better spent evaluating diagnostic and treatment protocols.

The Medical Malpractice Tort system in the United States has three goals;

from;  Presentation “Patients for Fair Compensation” given to Florida Medical Association by Richard Jackson and Jeffrey Segal M.D. J.D.

1. deterrence of unsafe practices

2. compensation for injured purposes and

3.corrective justice

The Tort System is not accomplishing these goals.

              Sarah Z. Hoffman, ANNALS OF HEALTH LAW

 

The United States is unique in regard to medical malpractice.

 

Technorati Tags: malpractice,aca,defensive medicine,litigation,pacific researchsurvey,kathleen baiker,health affairs,medicare,justic

For Obama care Anxiety: Record Number Want To Become Doctors

 

Believe it, or Not !

 

For all of you disgruntled curmudgeon senior physicians telling your offspring not to go into medicine, listen up ! Get your facts straight ! And don’t listen to me, I was wrong !  What was I thinking?

According to Forbes Magazine;

“The number of students applying to medical school rose again this year with applications up 3.1 percent in what a new report described as “healthy gains” in interest in the medical profession.

The Association of American Medical Colleges, which represents the nation’s medical schools and teaching hospitals,said more than 45,000 students applied to attend medical school this year.Meanwhile, first-time applicants, which AAMC executives say is “considered to be a barometer of interest in medicine” set yet another record, increasing 3.4 percent to 33,772 applicants”

 

 

Five Obama care Winners In Second Presidential Term

With the re-election of President Obama, 30 million Americans without health insurance are certainly winners because they will in less than 14 months have access to medical coverage without the threat of a Romney White House pushing for repeal of the Affordable Care Act.

Those in the health industry providing the benefits and services will also be victorious as an unprecedented number of paying customers who have struggled to pay for everything from a hip replacement surgery to prescription drugs get support to buy medical care.

five key winners as the health law’s benefits bring new paying customers in the doors of clinics, hospitals, pharmacies and doctors offices across the country:

1. The health insurance industry. Health plans like Aetna (AET), WellPoint (WLP), Humana (HUM), and others that have acquired a bigger stake in providing benefits to Medicaid patients will certainly reap millions of new customers. About half of the 30 million uninsured will gain access to an expanded Medicaid program. Meanwhile, all commercial health insurance plans including UnitedHealth Group (UNH), Humana (HUM) and the nation’s Blue Cross and Blue Shield plans are already aggressively promoting their brands in the individual and small group market to prepare for broader sales of these policies on state-run exchanges that will begin operating in 2014.

 

2. The hospital industry.   Hospitals will have much less to worry about when it comes to the annual $40 billion tab for unpaid medical bills and charity known as uncompensated care. In particular, investor-owned hospital chains like HCA Holdings(HCA); Tenet Healthcare (THC) and Vanguard Health Systems (VHS) will also win political cover in Washington and in the communities in which they operate where their commitment to charity care has long been called into question.

3. The retail pharmacy chains. From Walgreen (WAG) and CVS/Caremark (CVS) to Wal-Mart (WMT), these chains have pushed beyond simply filling prescriptions into becoming, as Walgreen CEO Greg Wasson says, the home for all of a consumer’s “health and daily living needs.” Given the influx of patients with a pent up demand for health care services, retailers’ efforts to provide more flu shots and other vaccinations through clinics staffed by nurse practitioners will help serve an expected spike in demand for these services from the newly insured.

4. The generic drug industry. Though health insurance companies worry about their ability to control the cost of new customers, they are expected to aggressively push outpatient care and low-cost prescription drugs as a way to keep premiums low. That means generic drugs will have an even more promising spot on health plan preferred lists known as formularies. This will be a windfall for companies like Teva Pharmaceutical Industries (TEVA).

5. The health care workforce. From nurses and doctors to health roles some say have yet to be invented, more workers beyond physicians will be needed to meet future medical needs, particularly in the outpatient care area. Already, universities and their medical schools, nursing colleges and schools of public health and pharmacy are expanding departments or creating new programs to address future health care needs. All are expected to benefit from increased federal investments in education. Philanthropic organizations, too, are expected to compliment these efforts. Just last month, the Robert Wood Johnson Foundation, a long-time advocate for nursing and nurse education, announced its budget for 2013 that will include up to $425 million in grant-making focused on helping “people stay healthy; lowering national health care costs; and improving access to high-quality care, delivered by a diverse and abundant workforce.”   “Whatever issues are the most vexing—responding to AIDS, an unprecedented shortage of nurses, millions of children being uninsured, astounding racial inequalities in health care—these are the issues we’ve taken on,” said foundation president, Dr. Risa Lavizzo-Mourey.

In fact the greatest growth in patient care will be in the outpatient arena, where new professional designations will sprout as medical schools design new curriculum to educate and train health professionals.

Facing unprecedented change in how medical care will be delivered to more Americans, the American Medical Association said it will provide $10 million toward efforts to transform  medical education for tomorrow’s physicians.

American Medical Association president Dr. Jeremy Lazarus said the doctor group will provide $10 million toward efforts to transform graduate medical education for tomorrow’s physicians.

In order to help accomplish these goals;

The nation’s largest doctor group is providing the money over the next five years to fund “8 to 10 projects.

However, despite these hopeful items, there is still reticence in the eyes of the physician trainee workforce.

Despite improving pay and the critical role primary care physicians will play in the future of health care in the U.S., there remains less interest by doctors-in-training in general medicine than specialty disciplines.

The December 5 issue of the Journal of the American Medical Association showing a small percentage of medical residents plan to practice general internal medicine comes as a physician shortage looms and millions of uninsured Americans with a pent up demand for primary medical care are poised to flood doctors’ offices once they gain coverage 13 months from now under the Affordable Care Act signed into law two years ago by President Obama.

If nothing else the next five to ten years will prove interesting with challenges and accomplishments.

Technorati Tags: primary care,medical schooll admissions,AMA,Lazarus,Forbes,pharma,insurance,hospitals

Rivalry in Federal Government threatens ACO Progress

 

           

With the newly announced 160  accountable care organizations this month, ACOs are bringing together rival hospitals. With those partnerships, however, also come fears of a healthcare monopoly.
The U.S. Department of Health & Human Services announced 106 new ACOs, bringing the total to more than 250 since the 2010 Affordable Care Act passed. Among them is OneCare Vermont Accountable Care Organization, the nation's first statewide accountable care organization, the Associated Press reported. CareOne, which covers Vermont and New Hampshire, said on Friday that 42,000 of Vermont's 118,000 Medicare beneficiaries will receive care from the new entity.
Read more: ACOs bring together rivals - Although encouraged by the ACA, ACOs are subject to review by federal anti-trust agencies that still worry collaboration teeters on anti-competiveness.

Read more: ACOs bring together rivals -  he Department of Justice and the Federal Trade Commission apply a "rule-of-reason" analysis to ACOs, in which the agencies conduct a cost-benefit analysis in weighing the anti-competitive effects of the ACO with the benefits of the ACO.

"ACOs could grow so large in some areas that they will have a monopoly on the healthcare system," Enterprise Counsel Group, a law firm in Irvine, Calif., wrote in a statement Thursday. "If any two companies work together to coordinate pricing or share confidential information, anti-trust concerns develop."
Read more: ACOs bring together rivals –Previously in June 2012 these concerns were stated

Anti-trust agencies target hospitals to promote competition

FTC challenged 17 of the 1,450 mergers reported in 2011

Read more: Anti-trust agencies target hospitals to promote competition -  All of these concerns were deftly ignored by legislators and HHS in their haste to pass health reform and micro-manage a mandate.

Depending upon which side of the argument you stand both sides argue they are there protecting the public, the FTC preventing monopolistic practices, leaving few if any other choices for patients, and ACO which is attempting to  improve quality of care and reduce cost. Are the two mutually exclusive?

The conundrum once again emphasizes the size and disparate interests of federal agencies.

Technorati Tags: FTC,HHS,monopoly aco,antitrust

Obama’s On Fire

 

While watching the Inauguration and the surrounding festivities, I realized how much I was enjoying the quadrennial carnival and what has become known as the ‘peaceful transfer’ of power in the United States. And I am not a great fan of Barak Obama.

 

We have witnessed many un-peaceful transfers of power in the past decade or more. The fresh lessons this year in particular stand out against what has happened in a domino effect of Tunisia, Libya, Egypt, and what is now taking place in Syria. And despite our ‘non-peaceful intervention in Iraq to depose a despot and encourage democracy, stability is not insured.

Because of these recent events this inauguration is even more meaningful.  We have just completed a two year battle which has been highly partisan and reflecting the deep divisions in the United States over entitlement, health reform, economy, and indebtedness. The past 5 years have been difficult for the middle class and others, with a threat of becoming nationalized, with the GM buyout and the AIG bailout.

Certainly in most other countries this setting would instill resurrection and/or revolution.

Today in 2012 the world is not a tidy place.  In the UP.SO. we seem to have lost a moral compass, and long standing beliefs in the constitution in favor of expediency to empower a change in health care, size of government and other institutions.

Has the day of individual accomplishment gone by? It seems that way, but initiative and creativity are deeply embedded in human nature by the very real existence of our heterogeneous DNA.

It can be said that whether we were created, or evolved this basic foundation virtually guarantees the ability to overcome tyranny, despots, and inadequate and incompetent forms of government, unable to change or morph into better functioning entities.

In healthcare issues physicians who have always been relatively altruistic and idealistic, can still do so, however it has become more difficult. Medical schools who have previously benefitted from the annual fund raisers are finding donations more difficult to come by in these relatively lean years. This is a byproduct of health reform and will effect projects by schools of medicine.

Meaningful Use

 

HHS is progressing with it’s definitions of what meaningful use is in their opinion. It bears no relationship to how physicians use their EMR, but rather is a data base for HHS to extract data from an HER.

Thus far there has been no mention of how providers, hospitals and or patient will have access too this data.  (Give us our data !) says  ePatient Dave. It certainly would fit the parameters of “Patient-centric healthcare” as the new mantra in quality health care. Perhaps we need to have our patients lobby for that capability.

(David Harlow “The Society also responded to the Committee’s request for information on the use of patient-generated data, endorsing its use, and noting that: “The patient is the most highly qualified expert on his or her own health, and his or her own experience of the health care system.”

More on this later @glevin1 and +digital health space.

M.U. ver 1.0 and ver 2.0 have been released and appear to be stable. M.U. ver 3.0 .

The Society for Participatory Medicine #S4PM  filed comments on the draft Meaningful Use  Stage 3 objectives,

On another front,

patient Dave and Susannah Fox announce that the Pew Internet Research Center is releasing the results of their study, Health Online 2013 today, at 7 AM. I have not yet reviewed it., however here are the basic findings:

Interested providers (anyone who cares for patients would do well to review this report.  The important take-away is that 50% of consumers get information from the internet, and even more significant is how many use Smartphones to retrieve answers.  This will drive development of Smartphone applications for both the iOS and Android phones. all of this will augment your ability to care for patients, however it will require adjustments to the practice patterns for educational material.

 

 

Summary of Findings

One in three American adults have gone online to figure out a medical
condition

Clinicians are a central resource for information or support during serious
health episodes — and the care and conversation take place mostly offline

Eight in 10 online health inquiries start at a search engine 

Half of health information searches are on behalf of someone else

The social life of health information is a low-key but steady presence in

Specific diseases and treatments continue to dominate people’s online
queries

Internet access drives information access 

Since one in five U.S. adults do not go online, the percentage of online health information seekers is lower when calculated as a percentage of the total population: 59% of all adults in the U.S. say they looked online for health information within the past year in American life

Younger adults and minorities lead the way with mobile health information
search

Half of smartphone owners have used their phone to look up health
information 

Some seek counsel from fellow patients and caregivers

Health care reviews have not caught on among general consumers

 

The report is quite detailed and goes beyond the extent of this article with a multitude of tables and survey details.

 

Technorati Tags: meaningful use,mobile health,pew,hhs,s4pm,david harlow,digital health space

Too Big to Fail ?

 

The following is a transcript taken from Google Plus "+Health Care Tallk Community

+Mark Browne +Kathi Browne +David Harlow +Mark Taber discussed the proposed ACO movement.     Perhaps I am  jaundiced as far as government inspired modifications to Medicare and organizational imperatives. In 1964 when Medicare began physicians almost unanimously opposed Medicare, not because it was government insurance or intrusion into the healthcare market, but because physicians knew an inflow of federal dollars would fuel increases in healthcare spending.  Physicians knew that modeling the payment system whereby 80% coverage of patient cost created an  ability to bill more and  fueled much of the medical device development.A little known feature of the original Medicare reimbursement was the payment rate was tied to the usual and customary charge of physicians;

New physicians originally set ther reimbursement rate by increasing their charges when they first began in practice.  Often times new physicians would receive higher Medicare payments as compared to established physicians. Physicians and hospitals in the private sector could now offer healthcare to seniors who prior to this had no coverage unless it was included in their pension plan. Uninsured seniors would depend upon the public hospital system.  In 1971 contracting became  legal with passage of the HMO law and prepaid contracting. It took about ten years and by 1981 PPOs and HMOs were epidemic.  Many HMOs went bankrupt and providers were left 'holding the bag'  In many cases local or regional managed care plans were formed with a withhold of 15% or more administered by small groups. This mechanism allowed capitalization of the small entities, using withholds meant to be paid back to providers, and instead used to line pockets when the smaller managed care entity was   bought by much larger entities. Providers were duped by a relatively few unscrupulous organizers who came away with windfall profits.

Other control mechanisms were put in place, such as prior authorization, and Medicare’ switched to allowable charges.

Regardless of these governing actions medical inflation became even worse, far outpacing the increase in GDP overall,

ACOs likely will go the same way as margins dip to near zero and perhaps into the negative numbers. Hospital boards and ACO management will follow the prevailing wisdom, when solvency is threatened. Sell, or merge. The next step within five years will be mergers and outright purchases  of ACOs

The trail leads to government intervention and bail outs of health entities, 'too big to fail".  Sound familiar? Where have we heard this before?

I hate being right about these inevitabilities. Truth is, getting larger does not mean more savings.

I have given in to my worst fears in the middle of the night..

The Future of Mobile Health Apps.

 

What is ?

If you have not heard about the Wireless Gigabit Alliance, listen up. Perhaps you remember the fledgling days of wireless 802.11/a/b/n and soon their will be another iteration, so don’t get too cozy with your present wireless router and your Wi-Fi enabled gizmos.

This morning I happened to disconnect my laptop from my secured router, and had to re-connect.  As some of you know your wireless adapter finds all the wireless signals in  your vicinity so you can chose your own router. Most of the signals are secured by encryption to avoid ‘stealing’ your neighbor’s internet. I was amazed that my laptop recognized 30 other router signals ranging from 5 bars all the way down to 1 bar. And their were no unsecured routers. My times have changed. I used to be able to bootleg on at least two other routers if something happened to my own connection.

Perhaps you have noticed that your internet speed has decreased as there are more users of wireless in homes, apartments, and at meetings. In fact all connectivity can be lost if the spectrum becomes to saturated.

Each of the standards a/b/n uses different frequencies and may use two or more to spread their signal to improve speed, bandwidth and streaming video applications. The technology of MIMO (multiple input, multiple output and more than one antenna maximizes our current state of the art. However it is becoming unable to handle the increasing demand of multiple users, even in one household with multiple tablets, and streaming video to televisions and video conferences on Google plus, Live stream and many other consumer grade applications. Ever notice when the kids use the microwave oven, your laptop connection grinds to a halt.

If fast is good, then faster is better, if far away is good, farther away is even better and if you can have both, why not? As John F. Kennedy once proclaimed about going to the  moon “Some ask why? and I say Why not.”

It is hard to believe that was almost 40 years ago…Forty years from now it is hard to imagine what will be in mobile communications

A group of forward looking radio frequency engineers, WiGig Alliance was established by technology leaders within the CE, PC, semiconductor and handheld industries to address the need for faster, wireless connectivity between computing, communications and entertainment devices. The organization has developed a unified specification that allows devices to communicate at multi-gigabit speeds never before experienced with wireless technology. This white paper explains most of it. Wireless 802.11/ad will use RF in the 60 ghz range.

 

As you may observe it is more challenging to fit the uses of RF spectrum  into a single diagram.

Why is this important to Health Train Express? Whatever changes are taking place in health reform, business practices, technology advances, politics, entertainment are accelerated even more by social media.  The synergy of a post on Twitter, Facebook, Twitter and now Pinterest is obvious. Some say, what about the duplication of posts? Educators will tell you that you have to see or hear something three times in order to learn it. So like Real Estate…Location, location, location for social media the three key things are: Repetition, repetition, repetition

The space is an enormous influencer, for positive and negative opinions. If it is on the internet, blogosphere or social media land…it is in the public domain.

 

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