PERSONALIZED DESIGNER HEALTH INSURANCE PLAN NOT YOUR ORDINARY OBAMACARE

Associated Press, Judy Lin writes a post enrollment critique of Obamacare. Criticizing is all too easy now that the law is in full effect following the initial enrollment. All that needs to be done is to fine those not in compliance.  Unfortunately there are many who cannot fulfill  the requirement because the subsidized premiums are still unaffordable.  Then there are those who can buy coverage but cannot afford the copayments, or deductibles.  Some who only qualify for medicaid may be fortunate relative to those needing a subsidy.

Reporters find it easy to discover people who fall out or are in a ‘gap’ for the ACA.  

There is little doubt that the law will fail and/or require much fine tuning.

Clinical medicine takes place as  personaly designed treatment for individuals. It is not an assembly line process. In an era where treatments for cancer are personally designed using DNA guided therapy, why not Personally Designed Health Insurance?

Few if any potential patients fall into a category that is meaningful. The federal poverty level is an  easy way to categorize people, but it does not allow for different needs for many.

MORE TO  DO.

• The share of adults without insurance shrank from 17.1 percent at the end of 2013 to 15.6 percent for the first three months of 2014 according to a Galllup-Healthways Well-Being Index released this month. In California This decrease translates to about 3.5 million people gaining insurance coverage according to the study.
• Anthony Wright, executive director of Health Access California, says the work is not finished. ”California has made huge progress with the benefits of the Affordable Care Act.”

WHAT ARE THE GAPS?

• Cost remains a particularly high hurdle for low-income people who are most likely to be uninsured.
• Some are eligible for discounted policies but say they still can’t afford their share of exchange plans.
• Others earn too much for subsidies.
• Undocumented immigrants living in the U.S. illegally can’t obtain care under the law.
• Dozens of states have not expanded Medicaid. (24 states have opted out of the federal plan to expand medicaid. The federal program funds the expansion for up to three  years. The states refusing this option say they don’t trust the federal government to live up to the promise and will be stuck with huge overruns. The promise is based largely upon unknown costs and risks.
• Some employers have reduced staff hours to avoid being mandated to provide insurance.
• Some will buy minimal coverage which does not fulfill the ACA requirement for less, however they will face the fine for non-compliance.  These policies are bare bones and do not allow broad protection.

WHAT NEEDS TO BE DONE?

• A careful analysis of those in the gap itemizing the reason for each person falling into a gap
• A PERSONALLY DESIGNED PLAN can be designed for these individuals from the ground up based on their individual situation and medical needs rather than a top down plan that often is worthless.
• The current system of standards, while well meaning sabotages any real attempt to make insurance affordable for many citizens.

WHO WILL DO THIS?

• Any program requires a post introduction review by competent personell experienced in the area. This is a form of quality assurance, one that is in common in most industries, and actually is required by hospitals and HHS.
• Non-qualiifying patients will require personal interviews regarding their income, expenses. Once a base line sample is obtained a plan can be designed that would benefit.
• Local insurers,  providers, hospitals,  pharmacies, home health companies must be involved in planning for this group of patients.
• The review and analysis should not be done by the federal government, but rather at the local level (state or county). The medical records should be reviewed (and this may also be beneficial for those who do qualify for a subsidy.
• This will be labor intensive, however it may also be very cost effective and result in  a much lower expenditure for subsidies.  

A ‘shot-gun’ approach, which is what the Affordable Care Act provides is inadequate, and is a ‘roulette wheel’ solution to a complex problem. Poorly designed and poorly executed programs are designed to fail and increase cost.

Commentary is welcome.

KLAS Report: ACOs Turning to Third-Party Vendors Over EHR Vendors

Friday, April 18, 201

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The majority of physician-led accountable care organizations are using third-party ACO vendors because electronic health record vendors are not yet meeting their needs, according to a new reportfrom KLAS Research, FierceEMR reports.

For the report, researchers surveyed 46 physician-led ACOs about their software use.

Report Findings

The report found that:

• 68% of physician-led ACOs reported using a third-party vendor rather than an EHR vendor;
• Third-party vendors ranked higher than EHR vendors in all functional categories including care management, connectivity and reporting; and
• Third-party vendors ranked higher than EHR vendors for risk stratification.

According to the report, EHR vendors on average rated only a 6.3 on a 9-point scale for meeting the needs of ACOs. Just two EHR vendors -- Epic and eClinicalWorks -- ranked above the average, with scores of 7.3 and 7.0, respectively.

Meanwhile, the report found that Optum was the most popular third-party vendor, being used by four different ACOs. According to the report, seven other third-party venders were used by more than one ACO, and no other vendors were used more than twice (Durben Hirsch, FierceEMR, 4/16).

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Patent filing reveals Google may be developing a contact lens camera - FierceMobileHealthcare

Patent filing reveals Google may be developing a contact lens camera - FierceMobileHealthcare: "Patent filing reveals Google may be developing a contact lens camera"



'via Blog this'

A report on Google patents claims the search titan may be making a contact lens featuring a computerized camera along with a sensor and an integrated, thin silicon chip.

"One of Google's many patent applications regarding future smart contact lenses generally relates to systems and/or methods for capturing image data representing a scene in a gaze of a viewer via a thin image capture component integrated on or within a contact lens, processing the image data, and employing the processed image data to perform functions locally on the contact lens or remotely on one or more remote devices," states the patent report.

The camera component can track and generate image data of an image of a scene corresponding to the gaze of the wearer, without obstructing the wearer's view, notes the report. 

Augmedix gets $3.2 million to bring Google Glass to doctors

Augmedix gets $3.2 million to bring Google Glass to doctors

Augmedix gets $3.2 million to bring Google Glass to doctors

By: Brian Dolan | Mar 24, 2014     43   51   6

Tags: Augmedix | clinical documentation | DCM | dictation | digital health venture capital | Emergence Capital |Google Glass MD | Google Glass medical | Google Glass physicians | Great Oaks Venture Capital | mobile health venture capital | patient satisfaction |

San Francisco-based Augmedix, which has developed a Google Glass clinical documentation offering for physicians raised $3.2 million last week in a round led by DCM and Emergence Capital Partners. Other investors included Great Oaks Venture Capital, Rock Health’s LPs (Kleiner Perkins, Mohr Davidow Ventures, and Aberdare), and various angels. Emergence had previously invested in Doximity and Welltok, while Great Oaks is also an investor in Healthtap.

Augmedix, founded in 2012, now has 36 employees. Its CEO and co-founder Ian Shakil told MobiHealthNews that Augmedix software is already deployed at “numerous different sites”, including one “top five national health system”.

“We are going after one of the biggest pain points in healthcare: The fact that doctors spend 30 or 40 or 50 percent of their day on the computer documenting the EHR — toiling away — pushing and pulling information,” Shakil said. “They often do it right in front of the patient — back turned — and typing. Then when the patient leaves even more type, type, type — feeding the beast.” 

Shakil said Augmedix will help outpatient clinic doctors reclaim that clinical documentation time and improve their patients’ overall experience by helping them have more time to care for patients.

“When doctors use Augmedix and Google Glass, they don’t spend 30 or 40 or 50 percent of their day on this they spend about 1 percent of their day at the computer,” Shakil said. “In the process we have re-humanized the doctor-patient interaction and it, actually, believe or not, yields better patient records in terms of clinical documentation quality.”

While Shakil won’t yet explain how Augmedix goes about automatically capturing information during a patient visit, he framed the experience of using Augmedix it from the physician’s perspective.

“We can’t go too terribly deep on this but I can unveil a few layers of this onion,” he said. “It really boils down to the doctor wearing Google Glass, going into the clinic, interacting with the patient and having that humane, high touch conversation that they always wanted to have. At the end of the visit, all of the structured data, all of the EHR information, is in the EHR where it belongs. The way he wants it. Following a visit, doctors [go to their computer] and check that the information entered into their EHR doesn’t need any edits and then click confirm.”

Shakil said while pushing structured data to the EHR is Augmedix’s core offering, it also helps doctor’s call up information from a patient’s record, too. The doctor might ask Glass to find the patient’s last three blood pressure readings from their record and Glass will present them in the heads up display.

Of course, Augmedix users are not sending these requests via Google, Shakil’s company has “carved out” much of the off-the-shelf features of Google Glass for when it is in “healthcare” mode. Its healthcare facility customers have also required it to offer various mobile device management features so that administrators can track, for example, where each and every Augmedix-powered Google Glass is in its facility.

“All the audiovisual stream capture is not going through Google’s infrastructure, it is going through HIPAA-compliant infrastructure that we have certified with our doctor customer groups,” Shakil said.

Augmedix customers pay monthly subscriptions per physician in exchange for the modified Google Glass unit, Augmedix software, support, and the HIPAA-compliant infrastructure. Shakil says that Augmedix is, in effect, a reseller of Google Glass.

The patients who visit a clinic where physicians use Augmedix’s offering are given information about the Google Glass units their doctor might wear during the visit. The front desk provides them with information about the security and privacy aspects of Augmedix and then are given the option to request that their doctor not use the device during their visit if they aren’t comfortable.

“So far, Glass stays on 99 percent of the time — at least,” Shakil said. “And we have replicated this test with so many sites, including right here in San Francisco and in the middle of nowhere Texas. It goes well beyond Glass just staying on – patient satisfaction scores actually go. That’s true for young and old patients as well as rural and urban areas.”

In addition to better eye contact with their doctors and fewer visit where doctors are entering data on their computers with their backs to them, patients get more out of the Augmedix-enabled doctor visit.

“There is also the sense that your doctor is on the cutting edge and an early adopter of technology,” Shakil said, “which even further improves those perceptions scores. I think those will fade away once people are more used to seeing Glass or hearing about it.”

Respite from the ACA

It’ Time for a new Hot Topic for the Media

The Ukraine and Vladimir Putin now will share the stage with Tax Reform.

Policy makers will shift from health reform to Tax Reform.  Media is already filling up column space with articles about the American  tax  system.

“To Tax the Community for the advantage of a class is not protection, it is plunder” -Benjamin Disraeli

“People who complain about taxes can be divided into two classes: men and women”-unknown

“The hardest thing in the world to understand is the income tax”-Albert Einstein,physicist

What comes next?  My best bet is reforming the tax code, and restructuring the IRS.  Not much will occur until President Obama is out of office. There have been many Congressional committees examining the code, that have made recommendations, including one by G.W.H.Bush that  quietly disappeared

The Healthcare portion of the GDP is said to be about 16-18%, prior to the ACA. In 12 months or at the calculation of GDP what will the healthcare GDP look like. Will it go up, stay the same, or decrease.?

The Federal and State tax portions of the GDP is It differs from state to state, however it hovers at about 15-16% of the GDP, an amazingly similar number as the Healthcare GDP. Tax reform following the affordable care act may be the perfect storm to reduce costs.

Any consideration of a repeal or major amendments to the code are overshadowed by pervasiveness of taxes, deductions, credits designed to stimulate business growth, and stimulate mortgages and home-ownership.  An entire industry feeds on the complexities of tax law.

“Income tax has made more liars out of the American people than golf” -Will Rogers, humorist

What's New in The News after ACA ? TAXES

It’ Time for a new Hot Topic for the Media

The Ukraine and Vladimir Putin now will share the stage with Tax Reform.

Policy makers will shift from health reform to Tax Reform.  Media is already filling up column space with articles about the American  tax  system.

“To Tax the Community for the advantage of a class is not protection, it is plunder” -Benjamin Disraeli

“People who complain about taxes can be divided into two classes: men and women”-unknown

“The hardest thing in the world to understand is the income tax”-Albert Einstein,physicist

What comes next?  My best bet is reforming the tax code, and restructuring the IRS.  Not much will occur until President Obama is out of office. There have been many Congressional committees examining the code, that have made recommendations, including one by G.W.H.Bush that  quietly disappeared

The Healthcare portion of the GDP is said to be about 16-18%, prior to the ACA. In 12 months or at the calculation of GDP what will the healthcare GDP look like. Will it go up, stay the same, or decrease.?

The Federal and State tax portions of the GDP is It differs from state to state, however it hovers at about 15-16% of the GDP, an amazingly similar number as the Healthcare GDP. Tax reform following the affordable care act may be the perfect storm to reduce costs.

Any consideration of a repeal or major amendments to the code are overshadowed by pervasiveness of taxes, deductions, credits designed to stimulate business growth, and stimulate mortgages and home-ownership.  An entire industry feeds on the complexities of tax law.

“Income tax has made more liars out of the American people than golf” -Will Rogers, humorist

HEALTH LEADERS MEDIA

HealthLeadersMedia is a less known publication to physicians. The April print edition arrived on my desk, Monday.  The cover story is titled, “Physicians at the Crossroads”

Doctors face critical decisions that will affect their future role in healthcare delivery,especially when it comes to developing care and payment models.  What remains critical is the continuing engagement of clinicians in the process, which has become more difficult with increasing regulations, incentives and penalties driving change for the sake of change rather than applying proven models for increasing quality of care.

What people have underestimated is the complexitiy of workflow in healthcare in general and particularly in outpatient and primary care. The patient flow and variability of work require extreme flexibility for an outpatient clinic. This frankly is not assembly line production. Assembly line production is very modlable; you can calculate changes. The workflow that comes into doctor’s offies is a lot more complicated.

As health care administration has become more complex, more physicians seek and gain hospital or integrated health system employment.  Hospitals and providers alike now recognize that employment does not guarrantee effective integrated care, nor coordinated care.  Typically each hospital environment has had it’s own medical-politic of referrral relationships and services to it’s community.  This is often based upon decades of community involvement, and development.  This trend colors the new relationship between providers and inpatient facilities.

Integrated health systems, although growing. develop a silo mentality and are competitive, some times in the same or surrounding location.  While they are individual business and medical entities, the Health Information Exchange serves to bind them together overcoming regional competitive issues. At the same time the HIX also serves to strengthen the internal workings of the integrated health system.

THE MEDICARE DUMP

No I don’t mean the claims that are denied or returned due to an error in a code, ,or a mismatched diagnosis and procedure code…

The dump of which I speak is the release of 2012 CMS payments to individual providers according to CPT  code.

The reactions are as predicted, whether true or false,

CMA-“MDs upset by Medicare’s release of payments”

U.S. CTO Todd Park puts it an “unprecedented” opportunity for transparency. But what will researchers--and ultimately seniors and taxpayers--be able to actually learn from it?

Consumer’s Watchdog- “Doctors fighting physician accountability to Public get paid millions by Public via Medicare: Most dangerous docs lead pack

And down to the ridiculous from MDigital Life- “Doctors who tweet aren’t ones who bill Medicare for millions”.

In case you had not heard HHS Secretary Kathleen Sebelius resigned. Her parting words were; “ And I thought being a Governor was tough Try being an administrator”. Sebelius served as the sounding board and magnet for opposition even before the health benefit exchange suffered it’s startup meltdown.

Can Doctors speak their minds without getting into trouble?

Will the new Secretary of HHS, Sylvia Matthews Burwell, the President’s pick to head HHS be able to carry out the implementation of the ACA, in the face of intense opposition which continues as when the ACA was first passed.

Health Train Express opines that the release of this data is good, very good for providers, especially those in the top 5% of payments. Further information may reveal high costs for drugs, and  equipment for specialty practices such as neurosurgery, ophthalmology, cardiology, radiology and others.  Contrary to many opinions someone making a lot of money is not necessarily a felon, greedy, or lumped in with terrorists or pediophiles.  Chances are Obama will use this information to ‘spread the wealth’ by decreasing payments to the most productive MDs and give it to those most deserving...and needed...pediatricians, psychiatrists and some primary care providers.

Patients (taxpayers) now will be informed where their tax money goes, besides defense, and other branches of the government. Ir might even turn out to one-up-manship. (My doctor makes more money than yours, so he must be better)

As most charts and tables that are published there is much to be seen in the footnotes, which this document does not include.  

It gives me a warm feeling to know that we are supporting more algos to analyze this ‘BIG  DATA”

Whatever happened to that Federal law designed to reduce paper?

Proponents of an initiative seeking more public accountability for California physicians said the federal government's posting online of Medicare payments to specific physicians puts California Medical Association leaders in an uncomfortable position.

And finally--In other news John Lynn asks, “Are you optimistic or pessimistic about healthcare?”

Answer- “About the same as for the general state of America”

#medicare #health #healhcare #data #hhs #sebelius #cmsdata

What MDs should know about Security on the Internet and using the cloud for your EHR

Heartbleed 'top of food chain' forhealth care industry, says CISO Although providers are not information technology experts, it is essential that they understand some aspects of security on the internet. We already know it is a complex process involving multple layers of privacy beginning with passwords, and encryption. In additon to these layers the operating systems for the internet include built in safe guards. When it comes to security threat severity, the Heartbleed bug doesn't miss a beat. That's according to Phil Lerner, chief information security officer at Beth Israel Deaconess Medical Center, who, on a scale from 1 to 10, ranks the bug a solid "high priority" at 7.5. For those of you familiar with the recent discovery of the bug named Heartbeat you know that this affects a major component of web site security allowing unauthorized intrustion into an otherwise secure system.  SSL is the eponym for secure socket layer, which appears in  your internet setting of your browser. It affects all browser.  A patch has been released which is supposed to cure the problem.  The ‘bug’ was in the wild for several weeks before it was discovered. This particular version of SSL is ‘open source’, which means the computer code is open and readily available. Open source is used in many programs for developers to use, as opposed to proprietary source codes such as used by Microsoft, Apple and many others.  Google uses open source in Android and their Chrome browser. Website owners can find if the bug is present on their system. Estimates are that 2/3rds of web sites are effected. The idea of using an open source seems anathema to developing a secure socket layer. However, the internet is designed to be an open network of which SSL is a basic commodity. Proprietary  SSLs would create more isolation of diverse providers and web sites. The original SSL was developed in the late 1990s by a non-profit concern that contracted with the U.S. Government. I plays an essential role for management of domain names such as .com .net and .org.  Many new domains have been issued in the last several years--.med .fr .za .bus .tv and others.  The organization that issues domain names is currently based in California, (ICANN) Internet Commission Assigning Names and Numbers.  The organization was set up as an international non-governmental organization and allow for an agency completely free from government interference.   Many potential changes are forseen, among them the U.S. withdrawing from ICANN.  ICANN will be assigned the task of evaluating and making policy for domain names, and then handing it off to anothe agency to manage the technical aspects.

Medicare-Provider Payment Information

In the past it has been illegal for physicians to collude by comparing their fees in an effort to set fees.

CMS however has unique powers to reveal physician fees and has done so to the general public this week.  Will this be a net positive or negative? How will patients put this info into proper perspective?

Some possible uses for Medicare fee disclosures:

1. Spotting fraud and abuse

2. Educating the public

3. Providing some misleading information

4. Creating fodder for quality ratings.

5. Directing patients to low cost procedures

6. Providing leverage to group physicians

What do you think about this?  

CMS on April 9 did release several very large  spreadsheets reimbursment with the details driling down to each physician.  

The numbers require some analysis, as to demographics, and regions

MEDICARE HAS RELEASED YOUR INCOME FIGURES TO THE PUBLIC

By now most providers know that CMS has released numbers to the general public that were once privileged.  This is a major change in the policy of the past 4 decades.

For me this is equivalent to posting an annual IRS tax return for individual providers. Is this a civil rights violation, or a violation of privacy ? When I submitted my Medicare Enrollment Application I do not remember hearing or reading any small print stating that my medicare reimbursement figures would be made public.  Certainly the figures could have been masked with an identification code.

Is this a form of ‘crowdsourcing” ? Throw out the data and have readers compare notes to find previously hidden patterns to root out fraud and abuse?

When publishing this data CMS should have included several caveats when interpreting this information.  Although those in  health care know that these figures do not reflect operating expenses, or capital outlay.. Regional differences also play a role in big cities, rural areas, regional deficits in provider availabiltiy.  Some areas may have only one cardiologist and others may five cardiologists.  The figures did not distinguish age groups, a serious deficit in trying to interpret what the numbers mean. It also does not take into consideration areas of excellence whereby patients seek out experts in cancer, cardiology, neurosurgery, or referrals to such experts, at Universities.

Medicare equates this with the ongoing increased access to provider rankings and help in choosing a doctor.

Knowledgable experts and authorities have always had access to these important numberes for planning and reducing fraud and abuse.

NPR reported this story and adequately explained the caveats and pitfall with this change.

Reports indicate further reports will be announced, in regard to pharmaceutical use, payments to providers from pharma, durable medical equipment, entertainment lunches during lunch or evening CME activities.

Let’s equalize this process and disclose CMS reimbursements to the thousands of hospitals who receive CMS reimbursements.

It seems providers are the target for reform. If I were a paranoid person I might think this is designed to intimidate providers.  There are already effective means for CMS and insurers to analyze what doctors do and are paid.