What are the best three life hacks?

 by:  Dan Holliday, Recruiter, Traveler, Runner, CrossFitter, Philosopher & Lover of History; 

You may be wondering what does the title have to do with Health Train Express ?

We are all on the train of life, and it is an express.  While I came up with this title almost ten years ago, it has served well all these years, providing a transportation through HMOs, Managed care, Health Reform, HIT,  the Affordable Care Act and so on and on.

Not so much "life-hacks" but things that have made me successful(ish):

• Exercise really is the solution to so many of life's issues (moods, health, etc.).  It's not just hype.  My entire life has been changed in monumental ways because of exercise.  If you're not getting enough exercise (or unless you are one of the rare like 1% of people who genuinely can be healthy without it) then you are suffering in some way.  It doesn't have to be CrossFit or running marathons, but you should be exercising.
• Make a list of your priorities (including people).  Update it as necessary, but refer to it frequently.  It will help you make decisions on what is important in life.  It's cold.  It's calculating.  But so are you, we all are; we all have priorities (and we hate to admit that we rank people and things, but you do, we all do -- I'm just honest about it and write it down; if you're in my life, you're on the list).  The difference between those who cannot prioritize and those that do is about two heartbeats in making decisions that most people agonize over.
• It's better to do things than to have things.  I'm not rich, but I can do one or the other.  I can afford nice things. I could have all sorts of great shit that people would look at and desire.  I can travel and do things and have great experiences with my husband.  But I can't do both.  Doing things together builds your relationships; having things seems to distract away from what's important.

Okay, and one more:

• If you have plans, have re-evaluation periods and benchmarks.  It's hard.  It ain't fun.  But if you don't have goals and dates that those goals need to meet, then you are unlikely to succeed in a lot of things you try to do.  Your goals should be flexible (mine change all the time), but the ones I have, have evaluation periods that I look back and think, "Why am I doing this?"  If I'm not on track to meet the goals, if I feel like I'm missing the mark (or that it's no longer worth it), I evaluate and change course.

Let's watch Dustin Garis' TEDxRenfrewColllingwood take on this:

Do you want to grow your material wealth ? or:

"Grow  your wealth of Life Profit"

So  you ask, What does this have to do with Health Care? Nothing, and everything. It should however place a proper priority on life on the Health Train Express.

In 50 years none of this will be relevant.  (I hope much sooner)

Obamacare rates to rise 4% in California for 2016 - LA Times

Peter V. Lee is the executive director of Covered California. James C. Robinson is a professor of health economics at UC Berkeley.

California's Obamacare exchange negotiated a 4% average rate increase for the second year in a row, defying dire predictions about health insurance sticker shock across the country.

The modest price increases for 2016 may be welcome news for many of the 1.3 million Californians who buy individual policies through the state marketplace, known as Covered California.

California's rates are a key barometer of how the Affordable Care Act is working nationwide, and the results indicate that industry giants Anthem and Kaiser Permanente are eager to compete for customers in the nation's biggest Obamacare market.

Leading up to Monday's announcement there had been a steady drumbeat of news about major insurers outside California seeking hefty rate hikes of 20% to 40% for Obamacare open
enrollment this fall.

Overall, 44% of Covered California customers said they found it difficult to pay their monthly premiums now, according to a recent survey. And some people have indicated that they feel shortchanged in terms of the doctors they can see and the service they get from their health insurer or the exchange when problems arise.

Free market forces can be a powerful tool to contain health costs. But for that tool to work, consumers need the support of an active purchaser that can go toe-to-toe with the insurers. Other states and the federal exchange would be wise to look at what's working in California.

California's exchange posted tepid enrollment growth in its second year, falling short of its 1.7-million goal. Health policy experts said signing up more people is key if Covered California wants to sustain its momentum on rates. The next open enrollment begins Nov. 1 for policies effective in January.

So how exactly is California getting such g 

Shopping for a Doctor Who 'Fits' - The New York Times

MIKKAEL A. SEKERES, M.D.

All newly minted physicians go through a learning curve. They have learned all the ABCs of medical science, and then some.

Life experience comes to us through dribs and drabs if we are fortunate, or it may hit us in the face all at once.

At times physicians must 'unlearn' best practices, ethics, and other ethereal values or face consequences.

At times bad manners, or poor judgment rather than a medical error results in a medico-legal situation. And there are many attorneys willing to help there, on either side.

Shopping for a Doctor Who 'Fits' - The New York Times

Second opinions are a normal part of my line of work. I specialize in rare diseases affecting the bone marrow, and feel privileged both to practice at a hospital where I can focus on these esoteric illnesses, and to be considered competent enough at what I do that people seek my input on their diagnoses and therapies. At the same time, I never discourage my own patients from seeking the opinions of others, as their conditions are unusual and serious, and frequently deserve advice from more than one doctor. It’s what I would ask for if one of my own family members became sick.

But that wasn’t exactly why this woman was seeing me. She had arranged this appointment because she didn’t like her other doctor, and wanted to see if she liked me better.

These kinds of clinic visits have also become a normal part of my practice.

Decades ago, when physicians worked within a much more paternalistic system, such “doctor shopping” would have been considered inappropriate. Your doctor’s medical opinions were considered authoritative, incontrovertible and often final. Patients who challenged them were labeled “difficult,” and worried about developing a reputation that would influence their care, both with their own doctor and with others – as in the 1996 “Seinfeld” episode called “The Package,” in which Elaine is blackballed from being seen in medical offices and tries to steal her own medical records to erase her “difficult patient” status.

In recent years, patients have become more empowered to demand both good care, and a good attitude. Given some of the stories I have heard, I can’t say that I blame them.

One patient recounted how, when she mentioned to her primary oncologist that she wanted to seek my opinion, he told her to take her medical records with her because if she did see me, he would refuse to ever treat her again.

Another patient called me from his hospital room to give an account of his recent interaction with a doctor who recommended a course of chemotherapy for his refractory cancer.

“When I asked some questions about it, she basically told me it was her way or the highway. This is a big decision,” he told me. “I don’t want to go into it lightly.”

I reaffirmed that he, and not the other doctor, was in control of his destiny and treatment options, and reviewed the possibilities with him so that he could make a decision. I then called that doctor to relay his choice, which happened to be what she recommended – but on his terms, where he was included in the process.

Other times the interactions aren’t quite as dramatic, but represent more of a dissonance of personalities. Patients feel their doctors may be overly confident, or not confident enough; excessively nurturing, or too aloof. Alternatively, they simply may not “click.”

It cuts both ways. Doctors may not like some of their patients.

Years ago, I was asked to care for a prisoner who had just been diagnosed with lung cancer. When I entered his hospital room, he was lying in bed in his prison jump suit, his leg handcuffed to the bed’s footboard, as two guards stood by his side. As I explained his diagnosis and treatment to him, he stared at me, unblinking, with hate in his eyes. Every hair on my body prickled until I left his room. A guard who followed me into the hallway told me why my patient was in jail: He had killed his wife using a hammer.

I did not like that patient. But I put my emotion aside and cared for him, without judgment and to the best of my abilities, because it was both my job, and my duty.

I worry that we are increasingly losing sight of why our patients are seeing us. It is not because they want to, but because they are sick – they are hurting, not us. In their moments of need, we should disregard any feelings of indignation if our patients seek the opinion of another, or our disappointment that they don’t immediately accept our advice. We should support them as they make decisions about their own health – even if those decisions don’t include us.

As I walked into the exam room to meet my new consult, I put on a warm, welcoming smile. I didn’t want her to feel the least bit uncomfortable about the reason for her visit. Because this was about her medical care, and not about anyone’s pride.

Dr. Mikkael Sekeres is director of the leukemia program at theCleveland Clinic.

Does Health Care need "The Donald" ?

The shock wave of Donald Trump is passing over the political landscape. The "Donald" has no patience for political correctness. He trucks no incompetence, and does not bear fools easily. Plainly he is in your face and does not accept standard answers for  problems we have all witnessed for what seems time immemorial.

I like him, his approach, and disbelieving attitude. First of all  he is a great actor, who won't allow himself to be upstaged.  If he goes down it will be with a flurry of the "Donald's" hair. All those who label him as a  fool or a 'jackass' are missing the point, and the more they label him, the more support he receives from potential voters, Republicans or Democrats.

All you politicos, Get it straight. The public is fed up with the usual committee decisions, passing of laws that are not enforced, the border, immigration, educational incompetence, a failed economic plan, and the unearned 'tenure' of our elected representatives, and congressmen and senators who don't read or understand the bills they sign. That would fail you in elementary school. So why do we allow or condone this in our representatives?

Trump approaches issues like his flagship trade mark, the tsunami-like hair style...he leads with it, it washes over you and then  sucks you down and back.

Trumps says what we all have thought or felt, but would not say out loud. We are all too afraid to do that. We might lose friends, jobs, money, family or some other valued asset in our lives.

Frankly "Scarlett, I don't give a damn !" Donald Trump
would say.

The same can be said about health care and  health reform.

Such as it is we have had a constant flow of "experts" managing our health system.. It's a bit like the ship of fools, who are appointed because of their expertise on health.  Once in command they realize how they are outgunned by bureaucrats, and politicians who are experts in deception, half-truths, believers in algorithms and who knows what else.

For Example

The Players at HHS and CMS

Which leads most of us to ponder about our gut feelings regarding the Affordable Care Act, Accountable Care Organizations, Meaningful Use, and Value Based Reimbursements.

So,  who will be the "Donald" for Health Care?  Applicants apply here.

Hospital waiting times 'likely to get worse', health board chief says - BBC News

So. you think it's bad here in the United States.......Wait, because it will become worse as hospitals become insolvent and close, and the ACA and medi-caid force hospitals to run in the red. Our health system is on very thin ice. Who will bail you out when you cannot get into a hospital ?

Hospital waiting times 'likely to get worse', health board chief says - BBC News

Coming to America ?

BBC News NI revealed on Wednesday that the number of patients waiting for appointments at Musgrave Park Hospital in Belfast had risen by 75%.

Some patients have had to wait up to 74 weeks to see a specialist.

Valerie Watts apologised to patients who have waited an "inordinate amount of time" for surgery.

"It is both regrettable and it was also disturbing for me to hear about those [waiting times]," she said.

"I am not proud to hear some of these stories, as CEO presiding over the Health and Social Care Board, to hear about these waiting times."

Breaches

But she told BBC Radio Ulster's Stephen Nolan Show that waiting times were likely to get worse "because of the budget".

"We must understand that we have a finite budget within which we are working with this year," she said.

Musgrave Park Hospital's waiting list rises by 75%

Back surgery patients have been worst affected and can expect to wait 18 months for an appointment, according to internal documents leaked to the BBC.

They also show waiting times for knee and hip appointments are over one year.

A 43-year-old man who needs back surgery said he fears he will not be able to walk by the time he is treated.

'Breached targets'

George Anderson, a father of two from County Antrim, said he could not believe what he was hearing when he was told he would have to wait 67 weeks - almost 17 months - for an appointment.

"I don't think by then I will be able to walk. I am trying to do a day's work, trying to make a living, pay a mortgage, look after my kids and family and in 67 weeks I don't think I will be capable of doing all of that," Mr Anderson said.

"My biggest fear is that in 67 weeks I won't be able to pay my mortgage."

George Anderson told the BBC's Marie-Louise Connolly that he fears he may not be able to walk by the time he is treated for back problems

Musgrave Park Hospital in south Belfast is Northern Ireland's regional centre for orthopaedics.

The documents leaked to the BBC had been shared between management and consultants.

They show there is a 74-week (18 month) waiting list to see a back surgery consultant.

For knee appointments, the wait is 59 weeks, while hip patients have to wait 56 weeks.

The documents also show that up to this month, there had been 11,846 breaches of the 18-week waiting list target for a specialist appointment.

Recruitment

A majority of these breaches involve patients with back problems.

The BBC understands that the Belfast Health Trust is currently trying to recruit back specialists and this is part of the problem.

The 75% overall rise in the number of patients on waiting lists includes both inpatient and outpatient appointments.

In March 2013, a total of 19,644 people were waiting for inpatient and outpatient appointments at Musgrave, but by March this year, the figure had risen to 34,358 patients.

'Regret'

Within the Belfast Trust, waiting lists for ophthalmology (eyes), neurology, gastroenterology, and ear, nose and throat (ENT) appointments have also grown considerably.

Belfast Health Trust waiting lists

Ophthalmology - 9 047

Gastroenterology - 4,595

Neurology - 4,556

ENT - 4,050

Health Policy Legislative Update - 7/25/2015

The Federal Register lists some very important votes which are pending this week regarding repeal, and/ or amendments tothe Affordable Care Act.

Please contact your U.S. Representative (s)

Health Policy Legislative Update - 7/25/2015

Health Policy Legislative Update - 7/25/2015

Jul 25, 2015

Marilyn Singleton, MD, JD summarizes recent healthcare-related legislative activity on Capitol Hill.

Senator Mike Lee Takes Bold Step to Repeal ObamaCare

The Washington Post and Freedom Works are reporting on Senator Lee's plan to force the Senate to take a substantive vote on repealing ObamaCare. If successful, only 51 votes would be needed to proceed on the repeal amendment instead of 60. Lee's effort ties into the highway funding bill and votes are likely to be taken in a Sunday, July 26th session of the Senate. Freedom Works is urging Americans to ask their Senators to support this plan to repeal ObamaCare.


Bills that Assume the ACA is Here to Stay.

Expansion HSAs under the Affordable Care Act

On July 9, 2015, H.R. 3006, the Helping Save Americans’ Health Care Choices Act was introduced by Rep. John Fleming (R-LA) and referred to the House Ways and Means Committee. The bill would allow the treatment of a high deductible health plan as a qualified health plan under PPACA.

The bill would amend the Affordable Care Act to repeal:

• the 20% penalty for distributions from a health savings account (HSA) or an Archer medical savings account (Archer MSA) not used for qualified medical expenses,
• the prohibition on distributions from an HSA for over-the-counter drugs, and
• the limitation on health flexible spending arrangements under cafeteria plans.

The bill would amend the Internal Revenue Code to allow:

• a retirement savings tax credit for contributions to an HSA;
• payment of premiums for high deductible health plans from an HSA;
• a tax deduction for medical expenses incurred prior to the establishment of an HSA;
• an increase of the HSA maximum allowable contribution amount to match the limit on deductible and out-of-pocket expenses under an HSA;
• an exclusion from gross income of employer-provided coverage for qualified long-term care services that is provided through a flexible spending or similar arrangement;
• eligibility for veterans with a service-connected disability, participants in Tricare, and certain Medicare beneficiaries for participation in an HSA;
• both spouses to make catch-up contributions to the same HSA account; and
• a tax deduction for amounts paid by patients to their primary physician in advance for the right to receive medical services on an as-needed basis.

Full text: https://www.govtrack.us/congress/bills/114/hr3006/text.


Attack on ACA Provisions that Could Ration Care

On July 8, 2015, S. 1718, the Four Rationers Repeal Act of 2015 was introduced by Sen. Pat Roberts (R-KS) and referred to the Senate Finance Committee. The bill would repeal:

• the ACA’s Independent Payment Advisory Board;
• the ACA provisions establishing the Center for Medicare and Medicaid Innovation.
• the provisions with regard to preventive health services that prohibit cost sharing requirements for evidence-based items or services that have in effect a rating of “A” or “B” in the current recommendations of the United States Preventive Services Task Force.
• The ACA requirements that: (1) the Director of the Agency for Healthcare Research and Quality convene an independent Preventive Services Task Force, and (2) the Director of the Centers for Disease Control and Prevention (CDC) convene an independent Community Preventive Services Task Force. Restores provisions of law amended by such provisions.

The bill would prohibit the Secretary of Health and Human Services (HHS) from using data obtained from comparative effectiveness research to deny or delay coverage of an item or service under a federal health care program. It also requires the Secretary to ensure that comparative effectiveness research conducted or supported by the federal government accounts for factors contributing to differences in the treatment response and preferences of patients, including patient-reported outcomes, genomics and personalized medicine, the unique needs of health disparity populations, and indirect patient benefits.

Full text: https://www.govtrack.us/congress/bills/114/s1718/text.


Changes to Medicare

Expanding Government Control Over Medicare Program

On July 14, 2015, H.R. 3061, the Medicare Prescription Drug Price Negotiation Act of 2015 was introduced by Rep. Peter Welch (D-VT) and referred to the House Energy and Ways and Means Committees. The bill would require the Secretary of Health and Human Services (HHS) to negotiate with pharmaceutical manufacturers the prices that may be charged to Medicare part D prescription drug plan (PDP) sponsors and Medicare Advantage (MA) organizations for covered part D drugs for part D eligible individuals who are enrolled under a PDP or under an MA-Prescription Drug (MA-PD) plan.

Full text https://www.govtrack.us/congress/bills/114/hr3061/text.


Medicare Advantage Changes

On June 17, 2015, H.R. 2570, the Strengthening Medicare Advantage through Innovation and Transparency for Seniors Act of 2015 which was introduced by Rep. Diane Black (R-TN) passed the House. The bill combines some issues addressed piecemeal in earlier bills. First, the bill revises criteria for qualifying as a meaningful user of electronic health records (meaningful EHR user). For any payment year after 2015 any patient encounter of an eligible professional occurring at an eligible ambulatory surgical center shall not be treated as one in determining whether an eligible professional qualifies as a meaningful EHR user.

The bill also requires the Department of Health and Human Services (HHS) to establish a three-year demonstration program to test the use of value-based insurance design methodologies under the eligible Medicare Advantage (MA) plans offered by MA organizations under part C (Medicare+Choice Program). “Value-based insurance design methodology” is one for identifying specific prescription medications, and clinical services payable under Medicare, for which copayments, coinsurance, or both would improve the management of specific chronic clinical conditions because of the high value and effectiveness of such medications and services for such specific chronic clinical conditions, as approved by HHS. Hopefully, this will not be a stepping stone to rationing.

Full text: https://www.govtrack.us/congress/bills/114/hr2570/text.


Expansion of Medicare Telehealth Services

On July 7, 2015, H.R. 2948, the Telehealth Parity Act of 2015 was introduced by Rep. Mike Thompson (D-CA) and referred to the House Energy and Commerce and Ways and Means Committees. The bill would expand Medicare coverage of telehealth services. The bill would expand the term “originating site” to include federally qualified health centers and any rural health clinic where the patient is located. The bill authorizes as additional telehealth providers certified diabetes educator or licensed respiratory therapist, audiologist, occupational therapist, physical therapist, or speech language pathologist.

The bill requires the Comptroller General (GAO) to study the effectiveness of remote patient monitoring on decreasing hospital readmissions for specified chronic conditions, and the savings to the Medicare program associated with use of such monitoring.

Full text: https://www.govtrack.us/congress/bills/114/hr2948/text.


On July 15, 2015, H.R. 3081, the TELEmedicine for MEDicare Act of 2015” or the “TELE–MED Act of 2015 was introduced by Rep. Devin Nunes (R-CA) and referred to the House Energy and Commerce and Ways and Means Committees. The bill would permit certain Medicare providers licensed in a state to provide telemedicine services to Medicare beneficiaries in a different state. Any disciplinary actions would be under the jurisdiction of the health provider’s licensing state.

Full text: https://www.govtrack.us/congress/bills/114/hr3081/text.


On July 15, 2015, the identical bill in the Senate was introduced by Sen. Mazie Hirano (D-HI) with bipartisan support and referred to the Senate Finance Committee.

Full text: https://www.govtrack.us/congress/bills/114/s1778/text.


Women’s Health

Bill to End All Restrictions on Abortion Coverage

On July 8, 2015, H.R. 2972, the Equal Access to Abortion Coverage in Health Insurance (EACH Woman) Act of 2015 was introduced by Rep. Barbara Lee (D-CA) and 25 co-sponsors and referred to the House Energy and Commerce and Oversight and Government Reform Committees. The bill would overturn the 1976 congressional ban on providing federal funds for abortions. Specifically, the bill would require the federal government to: (1) ensure coverage for abortion care in public health insurance programs including Medicaid, Medicare, and the Children’s Health Insurance Program;

(2) in its role as an employer or health plan sponsor, ensure coverage for abortion care for participants and beneficiaries; and (3) in its role as a provider of health services, ensure abortion care is made available to individuals who are eligible to receive services in its own facilities or in facilities with which it contracts to provide medical care.

The bill would also prohibit any federal or state restrictions on private insurance coverage of abortion care.

Full text: https://www.govtrack.us/congress/bills/114/hr2972/text.


Over-the-Counter Contraceptives

On May 21, 2015, S. 1438, the Allowing Greater Access to Safe and Effective Contraception Act was introduced by Sen. Kelly Ayotte (R-NH) and Sen. Cory Gardner (R-CO) and referred to the Senate Finance Committee. The bill would require priority review by the FDA of applications for contraceptive drugs intended for routine use and the drug is intended for those 18 years and older. This would pave the way for over-the-counter hormonal contraceptives.

Full text: https://www.govtrack.us/congress/bills/114/s1438/text.


Is this a Joke?

On July 20, 2015, H.R. 3117, the Fund Essential Menstruation Products Act of 2015 or the FEM Products Act of 2015 was introduced by Rep. Grace Meng (D-NY) and referred to the House Ways and Means Committee. The bill would provide for reimbursement from health flexible spending arrangements for feminine hygiene products, such as tampons, pads, liners, cups, sponges, douches, wipes, sprays, and similar products used by women with respect to menstruation or other genital-tract secretions.

Full text: https://www.govtrack.us/congress/bills/114/hr3117/text.


Bill to Improve Surveillance and Education About Overdoses

Fortunately, the bill does not take the “punish the doctor” approach.

On June 23, 2015, S. 1654, the Overdose Prevention Act was introduced by Sen. Jack Reed (D-RI) and referred to the Senate Health, Education, Labor, and Pensions Committee. The preamble to the bill notes that nearly 44,000 people in the United States died from a drug overdose in 2013. More than 80 percent of those deaths were due to unintentional drug overdoses, and many could have been prevented. Opioid medications such as oxycodone and hydrocodone were involved in nearly 46 percent of all unintentional drug poisoning deaths in 2013.

Accordingly, this bill would require the Substance Abuse and Mental Health Services Administration (SAMHSA) to enter into cooperative agreements to reduce deaths from drug overdoses by: (1) purchasing and distributing naloxone (a medication that rapidly reverses overdose from heroin or other drugs with effects similar to opium) or a similar drug; and (2) educating or training the public, first responders, or health professionals on drug overdose prevention or response. The Centers for Disease Control and Prevention must improve drug overdose surveillance by entering into cooperative agreements to: (1) provide training to improve identification of drug overdose as the cause of death, and (2) establish a national program for reporting drug overdoses. The National Institute on Drug Abuse (NIDA) must prioritize, conduct, and support research on circumstances that contribute to drug overdose, drugs associated with fatal overdose, and overdose prevention methods. NIDA must support research on drug overdose treatments that can be administered by lay persons or first responders.

Full text: https://www.govtrack.us/congress/bills/114/s1654/text.

The Slow, Painful Death of the Doctor-Patient Relationship

The Slow, Painful Death of the Doctor-Patient Relationship

Dr. Mark Siegel appears on a weekly FOXNEWS television show.

Marc Siegel is an American doctor and author. He is an associate professor of medicine at NYU Langone Medical Center, a Fox News medical correspondent, and a columnist for several news outlets, including the New York Post and Forbes.Wikipedia

I’ve been taking care of a particular patient for more than 20 years. She first came to see me after suffering a stroke, which severely weakened her right side. She has always arrived in my office in her wheelchair. She has diabetes, which I manage, as well as a heart condition. I’ve treated her through several urinary and skin infections. I also manage her blood pressure, but mostly I hold her hand and smile and look into her eyes. We talk about our families. She has many grown children, and she has always maintained an active interest in my growing children and remembers their birthdays. Re 

Recently, as she has gotten older and sicker—she is now approaching 90—she has required more frequent hospitalizations and her medical problems have grown more complex. Her family expects me to be responsive to their concerns for every decline in her health. Unfortunately, her decline is taking place at a time when much of health care is delivered semi-automatically without a human face attached. The new technology may even keep her alive longer, but her family is not used to the change. They say it was the frequent face-to-face interactions and instructive phone calls with me that always gave her the confidence to follow my recommendations. But these days my time is so consumed with computer management that I find I have less time for direct patient care. Patient expectations haven’t changed, but there is less time available now to seek the undercurrent of illness rather than focusing on the “chief complaint” that rides the surface. Read more at http://observer.com/2015/07/the-slow-painful-death-of-the-doctor-painter-relationship/#ixzz3gliEGgOL  

With Medicare on the verge of approving payment to doctors for end-of-life discussions, I can’t help but wonder exactly when and where these discussions will take place. Don’t get me wrong, it is as crucial as ever for a doctor to know under exactly what circumstances a patient wants to be placed on a respirator or have someone pound on their chest or shock them with electricity if their heart stops. But it is harder and harder to find the time for such a dedicated conversation. The wheels of health are turning ever forward, in constant step with technical progress and the implementation of exciting new discoveries. Medicare is moored in the nostalgic past, in a time when an ineffable rapport with our patients was the most important thing we had. We need to find a better way to preserve that relationship. Simply asserting its importance isn’t enough.  Read more at 

http://observer.com/2015/07/the-slow-painful-death-of-the-doctor-painter-relationship/#ixzz3glidmDaT Follow us: @newyorkobserver on Twitter | newyorkobserver on Facebook Read more at: http://tr.im/jjOJB

VA hospitals in danger of closing unless lawmakers fix newest funding mess | Fox News

VA hospitals in danger of closing unless lawmakers fix newest funding mess | Fox News

VA hospitals in danger of closing unless lawmakers fix newest funding mess

Is the VA FUBAR ?  The Veterans Administration seems to fumble and fall into the next disaster at least once a year.  Despite a new man at the helm who is a proven expert in consumerism, and the leader of a fortune 500 company another fiasco....this time financial.  Perhaps Congress needs to have it's own committee and the IG keep a ready eye on this mega-operation. 

The VA is still managing post Vietnam PTSD and now has a new wave of Desert Storm, Iraqi, and Afghanistan warrriors who have returned home.  

Why can't the VA get it correct......Medical care seems to be up to par, if veterans can get in, and the Congress keeps funds flowing.

Over a Quarter-Million Vietnam War Veterans Still Have PTSD | Science | Smithsonian

Over a Quarter-Million Vietnam War Veterans Still Have PTSD | Science | Smithsonian

The 49 Best Health and Fitness Apps of 2015 | Greatist

The 49 Best Health and Fitness Apps of 2015 | 

Here it is....all you have been looking for health and fitness on your phone, tablet, wearables.

Brought to you by Health Train Express  and Digital Health Space.



This information is not intended as medical device recomendation and we do not endorse any product. It is intended as a reference source.  None of these products have been approved by the FDA, nor is their reliability.

Statistics, Statistics, Lies and More Damn Lies, or is it just Ignorance ?

Health Care     A Tree of Life

It is becoming harder to surf the web looking for health related article without stumbling over another article about  HIT and Data. So here is the latest finding.

• Percent of adults who had contact with a health care professional in the past year: 82.1%
• Percent of children who had contact with a health care professional in the past year: 92.8%
• Number of visits (to physician offices, hospital outpatient and emergency departments): 1.2 billion

Source: Selected patient and provider characteristics for ambulatory care visits to physician offices and hospital outpatient and emergency departments: United States, 2009-2010[PDF - 127 KB]

• Number of visits (to physician offices, hospital outpatient and emergency departments) per 100 persons: 408.2

Source: National Ambulatory Medical Care Survey: 2010 Summary Tables, table 1[PDF - 382 KB]
National Hospital Ambulatory Medical Care Survey: 2010 Outpatient Department Summary Tables, table 1[PDF - 330 KB]
National Hospital Ambulatory Medical Care Survey: 2010 Emergency Department Summary Tables, table 1[PDF - 481 KB]

E pluribis Unum

Freedom is one of the features of a nation known for  "exceptionalism" . The term we all have heard is used as a global adjective to describe the United States.  In truth we do not excel in many areas.

In health we do excel in research and development and technology as applied to medicine. We fail miserably in access to health care and the bureaucracy surrounding it. We probably earn a C- in regard to social programs, not that we don't invest billions of dollars into helping certain segments of society to survive with basic necessities of life, food, shelter (inadequate) and a safety net for health-care.

Fee-for-Service is not Dead.......It is not even Wounded

Most industry leaders believe that, in the near future, fee-for-service payment will be replaced by “population-based payment,” intended to reduce incentives to over-treat patients and to encourage prevention. However laudable these goals, we believe the expected shift to population-based payment is unlikely to materialize.

We take population-based payment to mean time-limited fixed per-capita payment for a defined population of covered lives. Much of the inevitability of the trend toward population health is attributed to the Medicare ACO/Shared Savings programs created by the Affordable Care Act. The accountable care organization has been touted as the eventual successor to DRG and Part B payments in regular Medicare. Medicare's ACO programs now cover about 8 million of its beneficiaries (compared to 17 million in Medicare Advantage).

While advocates in the CMS claim hundreds of millions in savings (in an overall program spending more than $600 billion a year), the Pioneer ACO program and its much larger younger sister, the Medicare Shared Savings program, have struggled to gain industry acceptance. Medicare ACOs have so far had minimal impact in reducing costs. (PDF)Managed-care veterans (hospital- and physician-based) that have succeeded in Medicare Advantage or commercial HMO markets have largely failed with ACOs.

After a decade of experimentation, the pattern in these ACO programs is that a small fraction of ACOs generate most of the bonuses, and that excessively high prior Medicare spending, rather than excellent infrastructure and clinical discipline, may be the real reason for those successes. For the majority of ACOs, the return on investment for setting up and operating them is negative and likely to remain so. The recently issued ACO regulations did not materially improve the ROI calculus. In our view, it is extremely unlikely that ACOs will evolve into a “total replacement” for regular Medicare's current payment model.

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On the commercial side, about 15 million patients participate in ACO-like commercial insurance contracts. More than 90% are so-called “one-sided” contracts, where there is no downside risk for providers who miss their spending targets. Yet some providers are giving up 30% discounts upfront to enter commercial ACOs that are really narrow-network PPOs. The discounts function as withholds with an earn-back if providers can meet spending and quality targets.

The commercial ACO deals we've looked at are one-sided in more than one sense: they frequently limit future rate increases, so nearly all inflation risk is borne by providers. As structured, they are a no-lose proposition for insurers that deliver real benefits to providers only if their competitors are excluded from the networks. Shifting more insurance risk to providers is unnecessary since insurers have already shifted a large amount of the first-dollar risk to patients (and therefore providers) through deductibles and copayments.

Moreover, with commercial medical-cost growth trends continuing in the mid-single digits, there is no cost emergency requiring a major change in insurers' contracting strategy; the present hybrid discounted fee-for-service model is doing its job. Deeply discounted fee-for-service with a small fraction of payments tied to “performance'” is not population health.

While many healthcare executives have embraced population health in concept, it is our experience that many of their physicians are not participating in a meaningful way. A recent RAND study of clinician acceptance of these models concluded that they have not substantially changed how physicians deliver face-to-face care, and that the additional nonclinical work required (mostly documentation) is perceived to be irrelevant to patient care.

Economists remind us that pursuing a given strategy means sacrificing gains from pursuing alternatives—the concept of “opportunity costs.” Not only are the potential gains from public or private ACO models limited, but the opportunity costs are steep. For hospitals and systems, they include recruiting and retaining physicians; improving hospital operations and profitability; reducing patient risk and improving their clinical experience; and commitment of clinician time to actual practice. Squandering scarce resources on a low-payoff strategy could prove costly for many health systems.

As industry veterans well know, our field is prone to periodic spasms of groupthink. The inevitability of population health is one of them. Though some may succeed in mastering population-health models, fee-for-service is likely to remain the core of the U.S. healthcare payment system for some time to come.

Jeff Goldsmith is president of Health Futures and an associate professor of public health sciences at the University of Virginia. Nathan Kaufman is managing director of Kaufman Strategic Advisors.