Yelp reviews prove a reliable tool for determining hospital quality, New York State Health Foundation study says

You cannot base the quality of health care based upon one measure.

Yelp does just that, and is highly misleading to the public.

More consumers use those platforms and comment on them, creating a real-time feedback loop, Foundation says.

According to the New York State Health Foundation, 

"As online tools like Yelp become increasingly popular with consumers looking for information about doctors and hospitals, a study sponsored by the New York State Health Foundation showed yelp ratings were a clear and reliable tool for determining hospital quality as defined by potentially preventable readmissions rates."

"The news for hospitals is positive as well -- by pointing people to higher-quality doctors and hospitals, those institutions can attract market share, leading to more lives saved and more costs avoided for patients, taxpayers and employers."

The results are from crowd-sourced surveys conducted by Yelp.

These internet based rating services are highly inaccurate, misleading and contain faulty data.

Data Metrics
The authors stressed that while there's a strong correlation between Yelp reviews and 30-day readmission rates, there's a lesser correlation when it comes to other quality measures, such as mortality, morbidity and patient outcomes, infection rates, never happen episodes, none of which reflect or influence readmission rates.

The news comes as high-deductible health plans are gaining steam, covering nearly one in three Americans in 2016. The spread of these plans means consumers are paying for more and more of their care out of pocket, giving them a reason to seek out high-quality care at the lowest possible cost.

One-on-one assessment.  

I searched on Yelp for hospitals in my region of Southern California. This area includes a major University Medical Center, A UC Medical School, A regional county medical center which has merged with the new UC Riverside School of Medicine.

Here are the surprising results.  There were many small entities rated side by side along with major secondary and tertiary centers.

Typical Scores

Kaiser Permanente Riverside Medical Center 

Parkview Community Hospital

 Riverside Community Hospital

 Arrowhead Regional Medical Center

 Riverside University Health System Medical Center

Loma Linda University Medical Center

The ratings (according to the number of 'gold stars' reveal how incorrectly Yelp has rates the hospitals in my area.  Perhaps things are different in New York State. In New York State the foundation has it's own self-interests and is biased in it's results to influence acceptance of many government programs for measuring quality and cost.

There may be some lag in the accuracy of the data, even measuring this one metric. And the outcome is highly inaccurate, just based upon one data set. Healthcare is complicated, and measuring it even more so.

The public must become more literate in understanding measures of health care, who is reporting it, and if the data is truly accurate or self serving to the reporting entity.

Much more accurate data can be found at the Medicare Web Site

Medicare provides a consumer experience rating based upon patient surveys as well as metrics established to improve patient outcomes.

Other more reputable rating sites are available. Beware of some of them.

The highest rated doctors may not provide the best care

KEVIN PHO, MD | KEVIN'S TAKE | NOVEMBER 8, 2014

The public can rate and review most things today: books, hotels, and restaurants, to name a few.  Even doctors.  There are more options than ever where patients can rate their doctors online, and hospitals also routinely survey patients about how satisfied they are with their physicians. But while you’re pretty much assured a great meal at a 5-star restaurant, whether you receive excellent care from a 5-star doctor is less certain.

Doctor ratings generally focus on the patient experience, such as wait times, time spent with the doctor, and physician courtesy.  Those are obviously important issues, but they paint an incomplete picture.  Doctors with stellar interpersonal skills may not be the best at controlling patients’ blood pressures or managing their diabetes.  High ratings may identify surgeons with great bedside manner, but mask high surgical infection rates.

The quest for ratings perfection influences medical decision making, as patient satisfaction increasingly affects doctors’ salaries.  According to the management consulting firm Hay Group, more than two-thirds of physician pay incentives are based on patient satisfaction scores.  And Medicare withholds as much as $850 million in payments to hospitals who fail to meet various quality metrics, with patient satisfaction being a significant component.

But doing what’s best for patients won’t necessarily make them happy.  Denying antibiotics for viral infections or saying no to routine MRIs for patients with back pain are both sound medical decisions, but can anger patients; some vent their frustration by poorly rating their doctors. It’s no wonder that many physicians acquiesce to patient requests. In a survey by Emergency Physicians Monthly, 59% of emergency physicians said patient satisfaction surveys increased the amount of tests they ordered.  In another survey by the South Carolina Medical Association, almost half of physicians said that pressure to improve patient satisfaction led them to inappropriately prescribe antibiotics or narcotics.  In fact, Senators Dianne Feinstein (D-California) and Charles Grassley (R-Iowa) wrote a letter to Marilyn Tavenner, administrator of the Centers for Medicaid & Medicare Services, saying that “there is growing anecdotal evidence that these [patient satisfaction] surveys may be having the unintended effect of encouraging practitioners to prescribe opioid pain relievers (OPRs) unnecessarily and improperly, which can ultimately harm patients and further contribute to the United States’ prescription OPR epidemic.”

These extra tests and treatments are expensive and can hurt patients.  A landmark study from JAMA Internal Medicine analyzed over 50,000 patient satisfaction surveys, and found that patients who were more satisfied with their doctors had higher health care costs, were hospitalized more frequently, and had higher death rates compared to less satisfied patients. That makes sense: Patients who receive more drugs and tests are exposed to their harmful side effects and complications.

Now, I’m not saying physicians shouldn’t be graded by patients. Subjective physician evaluations are valuable, but not by themselves. They need to be complemented with objective measures of medical care, like a surgeon’s operative complication rate, for instance. Until physician ratings evolve into a more holistic representation of doctors, they must not be financially tied to how physicians are paid.

And to patients: Don’t automatically choose doctors with the highest online ratings or perfect patient satisfaction scores, because they may be the ones who reflexively prescribe antibiotics or narcotic drugs to inflate their grade.  It’s conceivable that those who have mixed reviews may actually provide better care.  Because they could be the physicians who make the effort and take the time to occasionally say no to patients.

Yelp reviews prove a reliable tool for determining hospital quality, New York State Health Foundation study says

I am the Old Fish

Young fish are swimming in a river and come across an older fish. 

He says to them, “Morning, boys. How’s the water?” The young fish swim on, but after some time one asks “What the heck is water?”

As I continue to interface with younger physicians and trainees I am struck with how content and unruffled the majority of them are in today's chaotic (to me and my genre) health care world.

What seems disruptive and chaotic to the older fish is that many changes are transparent to the minnows.

At the start of my career  Medicare (1966) was just started, there wereno electronic health records, no HMOs, contracting with physicians was a questionable and frowned upon business model. There were many many diseases that were not treatable.  The life span of a child with cystic fibrosis was about 10 yrs. Professional advertising was considered unethical, and more.

There were no genomics, the understanding of DNA was in it's early phase. The idea of genetic engineering a distant gleam, stem cells were poorly understood and not yet clearly identified.

Today physicians swim in a sea of knowledge that almost seems a given, except for those who remember the 'old days'.

Perhaps the one thing that makes medicine so exciting and invigorating is the constant evolution and discovery.  However, it is a double edged sword.  The rapidity of change requires enormous energy to stay current and competent.

The old fish says lead on and the rest of health care follows. The new fish looks around, and is led by many non-physicians and/or regulators who have no knowledge of medicine other than a list of practice patterns and cost for treatments.  In a method counter to the old fish's training of treat the patient, first, worry about cost later, all fish now must add an entire new dimension to their treatment choices.

As the young fish now says to the old fish . "Tell me what it was like in the golden era of medicine?" And the old fish responds,  "I don't remember, but it seemed better, and more fun!"

I don't remember hearing about burnout...I wonder why ?

In Idaho, Tiny Facility Lights Way For Stressed Rural Hospitals By Anna Gorman

Rural hospitals are facing one of the great slow-moving crises in American health care. Across the U.S., they’ve been closing at a rate of about one per month since 2010 — a total of 78, or about 6 percent. About 14 percent of the U.S. population lives in rural counties, a proportion that has dropped as the number of urban dwellers grows. Declining populations mean a smaller base of patients and less revenue. And the hospitals are caught in a squeeze: Because many patients in the countryside are older and sicker, they require more intensive and often expensive care.

Faced with these dramatic economic and demographic pressures, however, some hospitals are surviving — even thriving — by taking advantage of some of the most cutting-edge trends in health care. They are experimenting with telemedicine, using remote monitors to track patients and purchasing high-tech equipment to perform scans and other types of exams. And because many face physician shortages, they are partnering with universities and increasingly relying on nurse practitioners, paramedics and others to deliver care. In parts of rural Oregon and Washington, veterans can get counseling through a tele-mental health program. Physicians in Iowa and North Dakota have access to virtual emergency room support.

Telemedicine, remote monitoring and offsite specialty consultation are essential to maintain quality of care in many smaller towns across America.

from California Healthline

agorman@kff.org | @AnnaGorman

In Idaho, Tiny Facility Lights Way For Stressed Rural Hospitals By Anna Gorman

Four Observations from the 2018 Medicare Advantage call letter |

It's that time of year.....CMS announces the plan for 2018 for it's programs, in this case the Medicare Advantage Programs.  And there are many, with differing deductibles and co-pays as well.  

Medicare anticipates changes in premiums based upon the average rate increase for health plans after careful deliberation finalized its 2018 payment rates for Medicare Advantage plans, settling on an average rate increase of 0.45% after initially proposing a 0.25% increase.

The CMS says the updated policies included in this year's rate announcement give MA organizations the incentive to develop new plan offerings with "innovative provider network arrangements" that may further encourage enrollees to access high-quality healthcare services.

The policy drew the approval of AMGA, a trade group that represents multispecialty medical groups and integrated systems of care.

The complete 185 page CMS document can be downloaded here

A few highpoints are listed below

The Table II-1 below shows the National Per Capita MA Growth Percentage (NPCMAGP) for
2018. 

An adjustment of −0.226 percent for the combined aged and disabled is included in the
NPCMAGP to account for corrections to prior years’ estimates as required by section
1853(c)(6)(C). 

The combined aged and disabled change is used in the development of the
ratebook. 

Table II-1. Increase in the National Per Capita MA Growth Percentages for 2018 

Prior increases Current increases NPCMAGP for 2018
with §1853(c)(6)(C)
adjustment1
2003 to 2017 2003 to 2017 2017 to 2018 2003 to 2018
Aged + Disabled 54.84% 54.49% 2.76% 58.76% 2.53%
1

Current increases for 2003-2018 divided by the prior increases for 2003-2017 

The Affordable Care Act of 2010 requires the Medicare Advantage benchmark amounts be tied
to a percentage of the county FFS amounts. 

Table II-2 below provides the change in the FFS
USPCC which was used in the development of the county benchmark. The percentage change in
the FFS USPCC is shown as the current projected FFS USPCC for 2018 divided by projected
FFS USPCC for 2017 as estimated in the 2017 Rate Announcement released on April 4, 2016. 

Table II-2 – FFS USPCC Growth Percentage for CY 2018
Aged + Disabled Dialysis–only ESRD
Current projected 2018 FFS USPCC $847.73 $7,133.42
Prior projected 2017 FFS USPCC 825.20 7,023.24
Percent change 2.73% 1

The information on the CMS web site is only understood by those with accounting and statistical backgrounds.  The overall simplification appears in the blue section of the post.

4 observations from the 2018 Medicare Advantage call letter | FierceHealthcare

Patient Savings Solutions

Do you remember those Prescription discount cards ? Many patients who were formerly uninsured prior to the Affordable Care Act used them to obtain critical medications at substantial discounts. The truth may it be known is that few if any patients pay retail rates for medications.  Most of the time pharmacies have contracts with payors or pharma to offer their medications at reduced rates.

Using this new online application patients can request Patient Discount coupons online, search for your medication using the mobile app for iPhone or Google Play. By using this app and/or others to comparison shop should afford you the lowest prices.  There may be differences in prices according to ZIPcode.


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Elon Musk, and the Fate of Man and Machine | Roy Smythe, M.D.

The Fate of Man and the Machine

Roy Smythe, M.D.

“Fata homo et machina” - the fate of man and machine. Elon Musk is so concerned about this combined fate he has created an enterprise to merge humans and technology - in hopes of modulating any dominance artificial intelligence could develop over our organic form.

This has become a dominant worry for many people. Who are they ?
Health care algorithms are becoming prevalent and are already in daily use by payers, CMS, health policy pundits, and analysts.

The evolution of the process for health care is similar to most other industries.

Rather than considering it the 'evil twin brother' of health information technology, consider it's positive attributes:             

• Creation of machines allowing us to be more effective or efficient at a task
• Reliance on a limited number of experts to operate these machines so we may benefit, and eventually...
• Democratization of competence so individuals may operate these machines themselves.

Other examples besides transportation include things such as cooking, reading and writing as well as making music and art. In the future this will extend to countless other things such as much of the delivery of diagnostic and therapeutic healthcare by individuals themselves, and their manufacture of increasingly complex objects. What is dramatically different for our species in the present moment; however, is this fourth step:

• Machines become competent to complete tasks more effectively and efficiently themselves, without the need for human involvement, or skill.

As long as we all become more effective and efficient at completing tasks, shouldn’t we welcome this fourth step? There is no simple yes or no answer. While the task itself is more effectively and efficiently completed by the machine, our individual contribution and competence become irrelevant. The car drives itself.

I first began to ponder this topic while teaching medical students. When I was one of them myself, I had to commit large amounts of information to memory in order to be able to answer my professor’s bedside questions. When in turn I became the professor, I witnessed the increasingly common use of the hand held computer’s memory by students, rather than their own, to answer my questions. I rationalized this on the basis of two considerations - one, the continually expanding codex of medical knowledge renders it absolutely impossible to commit all to memory, and two, it didn’t seem as if we would run out of electricity any time soon. Now, of course, we contemplate technologies that will replace the need for any human medical decision-makingwhatsoever, perhaps making my rationalization as dated as the actual memorization of facts in medical education.

One oft-stated argument in support of machine competence is not democratization, but rather liberation. Wouldn't it be wonderful to no longer be a slave to "doing things"? Wouldn't we have more time to be creative, and connect with one another in deeper, richer ways? Couldn't this actually make us "more human"? Perhaps... but perhaps not. While allowing technology to relieve us of the imperative to interact with our somewhat random environment, and accept human successes as well as mistakes in the process - we may deprive ourselves of critical human needs. We know dopamine release is modulated by both reward (up) and error (down) in the brain, and we likely need both to be motivated to explore, and to learn. In addition, throughout history we have repeatedly seen excessive centralization of authority and subsequent emasculation of individuals leads to what the philosopher Bertrand Russell characterized as human “listlessness”. Historically, this has often then led to defeat or collapse of civilizations. Consider how authority is increasingly being centralized in technologies - and ponder the fate of Rome. 

If we are increasingly insulated from the contingencies of the world by our technology, we could become a listless and perhaps even irrelevant species - providing little value to each other, or to our machines. If this is indeed "fata homo et machina", I support the desire of Elon Musk and others to eventually merge our minds with artificial intelligence. Doing so might keep us in the real world, rather than allowing our machines to be in the world exclusive of us. It could also allow us to continue to perceive and interact with unpredictability and randomness. As a result we would still struggle with trial and error - which we may require to learn - rather than just having “experiences” facilitated by technology. Finally, we could continue to insert unpredictable human emotion and behavior - our own randomness - into the mix. This seems important, as a great deal of human inspiration defies logic or algorithm. After all, Neils Bohr’s concept of atomic structure, Mary Shelley’s Frankenstein and even Einstein’s relativity were all conceived in dreams.

The ultimate fate of man and machine is obviously yet to be determined.  The essential ingredient will be an active interface with any system and the choice of accepting the computed recomendation, or denying it.

I remain the optimist. I believe mankind will not yield to a machine....(then again, how many times have I heard,  "I am sorry, but the computer says this or that, and it cannot be changed". I usually revert to my polished answer. "Then connect me with someone who can, or your supervisor".






Elon Musk, and the Fate of Man and Machine | Roy Smythe, M.D. | Pulse | LinkedIn

The Evidence-Based Metaphor | Evidence Based Communication

Corresponding Author: Brit Trogen, MS (brit.trogen@nyumc.org).

Grace and I are trying to keep the vaccines minimal for Annie, if we can.”

Jeremy, the man sitting in front of me, is tall, slender, and politely tattooed. Despite appearing distinctly well rested, he’s every bit the new parent: exhilarated and, equally, terrified.

“There are just so many of them,” he says. “I was concerned about overloading her system.”

It’s a situation that many pediatricians encounter on a regular basis: a parent who is resistant to the idea of childhood vaccinations for a son or daughter. The only difference here is that Jeremy isn’t really an anxious parent but a standardized patient—an actor trained to re-create this scenario—and I’m not a physician but a medical student. We’re in the midst of an OSCE, an “objective structured clinical examination,” designed to train medical students in the real-life practice of medicine.

Sitting in a perfect replica of an examination room, wearing a white coat and stethoscope, I’m tasked with changing Jeremy’s mind. I launch into my carefully prepared talking points, explaining that vaccines are remarkably safe and effective, that they won’t overstrain his daughter’s immune system. The vaccine we’re discussing doesn’t even contain living virus, I tell him.

“It’s more like a fingerprint of the germ,” I explain. “When Annie’s body sees it, she learns to recognize that tiny fragment so she can attack it if she ever encounters it again.”

Later, in the debriefing, Jeremy reviews the case with me, providing lengthy feedback on everything from eye contact and posture to professionalism.

“I’ve done this scenario hundreds of times,” he says, finally, “and I’ve heard a lot of explanations of how vaccines work. I thought the fingerprint analogy worked well.”

This statement came almost as an afterthought, a high note to close the encounter. Yet as I left the examination, I began to wonder about the hundreds of other medical students stretching back through the years, each armed with their own individual script, each trying to accomplish the same task with different metaphors. Just how dissimilar were our explanations?

Curious, I asked around. One of my classmates had described the vaccine as a “personal trainer” for the immune system, “pumping up” the patient’s natural immunity. Another portrayed vaccination as a kind of insurance policy against future illness. In a case where we had all carefully memorized the same statistics, cellular pathways, and adverse effects, it occurred to me that our patient explanations seemed wildly, and perhaps unwisely, variable.  What if, instead of a medley of vaccine analogies of varying efficacy, patients like Jeremy heard only tried and tested messages from the medical community?  But not all metaphors are created equal. A vaccine is more analogous to an insurance policy than it is to, say, a bowl of petunias. Yet virtually no consideration is given in medical school, or in health care as a whole, to exactly which metaphors ought to be used. There seems to be a prevailing view that while physicians may, according to their tastes, use different figures of speech, one is not inherently better or worse than the next (or if it is, it’s impossible to know which is which). The study of oncologists, for example, found metaphors ranging in theme from militaristic (eg, cancer as an invading army), to sport themed (eg, treatment as a marathon), to agricultural (eg, stem cells as seeds), to animal inspired (eg, bone marrow as an elephant that never forgets). Should the framing of these important conversations be left entirely to the whims of individual physicians?

We implement evidence-based medicine, so why not evidence-based communication?

There will never be just one “right” way of explaining illness. Things like tone, gesture, cultural background, and personal experience will have at least as much influence over how someone interprets a given metaphor as the words themselves. In the absence of an evidence-based approach, however, physicians may be missing out on a powerful clinical tool or, worse, using metaphors that are unintentionally harmful or counterproductive in their long-term effect on patient behavior or public health.

Throughout medical school, much is made of the importance of using research to optimize decisions about patient care. When evidence shows that one treatment is more effective than another, physicians incorporate this knowledge into practice. We strive to make conscious, empirical decisions on everything from drug dosing and treatment modalities to medical education and health policy. We should be just as rigorous with our words.

A good idea. Perhaps we should compile a glossary of metaphors, not only for medical students, but residents and physicians.  This is an effort for which I would gladly be editor.

Corresponding Author: Brit Trogen, MS (brit.trogen@nyumc.org).

The Evidence-Based Metaphor | Humanities | JAMA | The JAMA Network

Physicians have little Scientific Evidence for using Medical Marijuana

Medical Marijuana Is Legal in Most States, but Physicians Have Little Evidence to Guide Them

Ask a teenage high school student about Marijuana and there is a good chance they know quite a bit . about it. Marijuana has become a regularly used substance for recreational use.  Chances are good that the average 'user' knows far more about marijuana, THC or CBD than your physician.

Medical Schools do have pharmacology courses, where students can read the basic science and neurobiology of the molecule(s), however there are few clinical references of studies on the matter. There are plentiful articles in lay  press, Internet articles about the substance.

Five patients have confided to Key West internist John Norris III, MD, that they use marijuana to relieve painful, persistent muscle spasms resulting from strokes or multiple sclerosis. 

Gaps in Knowledge

Norris’s complaints highlight the knowledge gaps physicians confront when it comes to medical marijuana, now legal in 28 states, the District of Columbia, Puerto Rico, and Guam. They didn’t learn about it in medical school, and, because it is not a US Food and Drug Administration–approved drug backed by randomized controlled trials, they can’t turn to the Physicians’ Desk Reference for information about dosage, indications, and contraindications. The federal Drug Enforcement Administration (DEA) still classifies marijuana as a schedule I drug, along with heroin and ecstasy, that has a high potential for abuse and no accepted medical use. As a result, studies of its therapeutic use are limited and physicians have prohibited from prescribing it.

However the situation is changing rapidly with recent legalization of marijuana in multiple states. Abrams and his coauthors reviewed more than 10 000 scientific abstracts. They found that the strongest evidence of a health benefit from cannabis and cannabinoids is in the treatment of chronic pain and muscle spasms associated with multiple sclerosis and chemotherapy-induced nausea and vomiting.

As the number of states that have legalized medical marijuana rises, the need for research becomes even more pressing, according to a recent editorial in Lancet Oncology: “For a product rapidly becoming mainstream, clinical trials and basic research are crucial: The requirement for evidence of the benefits and risks of marijuana use will grow as access increases and regulations, including clear guidelines for safe and effective use, must be developed.”

“There’s insufficient to no evidence for most of the claims [about medical marijuana],” said University of California, San Francisco (UCSF) oncologist Donald Abrams, MD, coauthor of a new report from the National Academies of Sciences, Engineering, and Medicine on the health effects of cannabis and cannabinoids (constituent compounds in cannabis). “If you like having evidence on which to base your patient recommendations, it’s really not available.”

Abrams and his coauthors reviewed more than 10 000 scientific abstracts. They found that the strongest evidence of a health benefit from cannabis and cannabinoids is in the treatment of chronic pain and muscle spasms associated with multiple sclerosis and chemotherapy-induced nausea and vomiting.

As the number of states that have legalized medical marijuana rises, the need for research becomes even more pressing, according to a recent editorial in Lancet Oncology: “For a product rapidly becoming mainstream, clinical trials and basic research are crucial: The requirement for evidence of the benefits and risks of marijuana use will grow as access increases and regulations, including clear guidelines for safe and effective use, must be developed.”  Although Abrams recommends cannabis to patients, he recognizes that many questions remain, such as the best strain to treat a particular symptom. When patients ask for his thoughts on such matters, “All I can say is I don’t know,” Abrams said. “I just advise my patients to go to the dispensary and explain to them what you would like to treat. They’re [dispensaries] on the front lines.”

Many physicians aren’t comfortable relinquishing that much control, Abrams acknowledged. However, most also don’t know the difference between CBD (cannabidiol) and THC (tetrahydrocannabinol). Although both are cannabinoids, only THC makes marijuana users high.

Physicians today lack such basic knowledge about cannabis because they never learned about it in medical school. “Physicians could prescribe cannabis in this country until 1942, when it was removed from the [US] Pharmacopoeia,” Abrams said. “There hasn’t been education about cannabis as medicine for 75 years.”

Back in 1996, California became the first state to legalize medical marijuana, but a 2-week, 12-hour elective for first-year medical students this past fall was UCSF’s first attempt to educate future physicians about cannabis as medicine, said Abrams, who taught the course.

The UCSF marijuana course was 1 of 20 electives from which students could choose. It could have accommodated 12 students, but only 6 enrolled, Abrams said, adding that he “was a little surprised I only got 6 [students] here in San Francisco.”  

Pot 101 . Change us in the air

On the other side of the country, a University of Vermont (UVM) Larner College of Medicine pharmacology course, PHRM 296: Medical Cannabis, drew more than twice as many students as expected when it was first offered last spring semester.

The school had to twice change the location of the elective course, as enrollment grew to 99—filling the largest available lecture hall, said Kalev Freeman, MD, PhD, an emergency department physician and assistant professor of surgery at UVM whose wife, a botanist on the medical school faculty, co teaches the class. Thought to be the first of its kind at a US academic institution, it delves into molecular biology, neuroscience, chemistry, and physiology. Students who’ve taken it include undergraduates, medical students, physicians, and a state legislator.

Thanks to the enthusiasm of pharmacology chair Mark Nelson, PhD, Freeman said, he expects that beginning this fall, the subject of cannabis will be woven into the UVM medical school curriculum, instead of offered only as a stand-alone course. In other words, he said, when medical students study psychiatry, neuroscience, cell biology, and chronic pain, cannabis will become part of the discussion. “These kids are going to graduate from medical school, and they need to know some data,” Freeman said. 

Kalev Freeman, MD, PhD is a physician-scientist with a background in molecular biology and specific research interest in inflammation and injury. He is Co-Founder of the Phytoscience Institute and the Medical Director of Vermont Patients Alliance Inc., a non-profit plant-based pharmaceutical research center that serves over 800 patients with debilitating medical conditions. He is also the co-director of the Cannabis Science and Medicine Program the University of Vermont Medical School. Dr. Freeman completed his BA at the University of Michigan, and both his MD and PhD at the University of Colorado, where he specialized in molecular biology.

Cannabis . Testing for Public Safety, A course prepared for the Vermont Legislature

White Paper Download

Other Reference:

1.   Use of Marijuana for Medical Purposes Among Adults in the United States

2.  The Risks of Marijuana Use During Pregnancy

3.  Medical Board Expectations for Physicians Recommending Marijuana

Physicians are cautioned not to use marijuana which would effect their practice of medicine and certainly not when on duty.

Health reform is dead. So what can we do now?

 

Do we just give up for now? I don’t think that is advisable. Too much is at stake. And there are many other significant ways, all far less politically charged, and therefore more politically possible, that we could improve the American health care system.One of the most important ways we could improve things is through administrative simplification. Modern health care workers and patients alike are caught in a huge tangle of administrative paperwork, confusing rules, and confounding regulations. It is estimated that one-third of every dollar spent on health care in America goes towards administrative costs. Therefore, reducing the administrative burden could significantly lower the overall costs of health care to the nation (or we could increase the amount we spend on actual medical care). Administrative simplification would be relatively easy and should be politically palatable. Done well, it could be wildly popular with both patients and physicians.


The American medical billing and coding system is long overdue for just such a makeover. Getting paid for even the most basic medical goods and services is a multi-stepped, convoluted nightmare that creates huge and unnecessary costs, and invites mistakes and abuses. Ridiculously complicated coding systems and documentation requirements are the rule and have the same effect. It is a distraction for all medical professionals almost every moment of the day. Medical practices must focus on billing and payment issues almost more than medical care.

How has this occured ?  Much of it began with Medicare's unbalanced approach to reducing or eliminating fraud and abuse of the Medicare system.  To reduce it Medicare began a system of 'over documenations' to provide a trail of evidence to be able to allege fraud.   The intensity of billing and coding for diagnosis has become an overriding concern and time parasite on healthcare.  It produces a heavy cost on medicine and healthcare for providers, hospitals, and medical suppliers.

How do we fix it?

Coding and documentation requirements should be markedly streamlined, and most billing should be eliminated in favor of point-of-care payment cards. This would represent an incredible improvement and money-saver for American health care.Health reform is dead. So what can we do now?  

The next area of focus should be health care computerization. A generation of American physicians is now forced, by government mandate (the dreaded federal meaningful use program, which started in 2011), to use electronic health record (EHR) software systems that are not ready for prime time — they don’t work well, slow things down, and cost too much. Many physicians now spend hours, often late at night, catching up on chart notes and other tasks because their EHRs were too slow to use during actual patient care hours. EHRs have simply failed to deliver on their great promise. And because of their huge costs, most physicians are stuck with what they have.  The federal government with incentives coerced the health system into purchasing inadequate poorly designed EHRs. Billions of dollars were wasted.

There are many other ways we could improve the nation’s health care system even without broad payment reform. I will mention one way we could lower the costs of care in the U.S. that does not receive enough emphasis — healthier Americans. It is estimated that two-thirds of every dollar spent on actual medical care (non-administrative spending) relates to preventable chronic diseases, such as heart disease (the nation’s number one killer) and diabetes. The best way we could lower the costs of care in this country is to reduce demand — by preventing such preventable diseases. Health promotion should be a centerpiece of our national health care policy. Schools, and even more importantly, places of work should set aside time every day (it could be 5 minutes of every hour) for structured exercise. We must go beyond past efforts to create a new American health culture. The economic impacts could be huge. And, as I said in a recent BBC interview, your best bet until things get better in health care is, “Don’t get sick.”

After the many bureaucratic changes that followed the passing of the Affordable Care Act (Obamacare) and other legislation, patient care has become secondary to satisfying the whims of government and giant insurance company administrators, who are in total control. The result is a web of complicated rules and misguided programs whose chief effect has been to distract doctors and nurses from their proper focus on patient care. Access to health care now depends on the ability of patients, doctors, and nurses to navigate in and around this cumbersome and ever-changing system.Improving health in the United States should not be a political problem. Whose problem is it ?

How are hospitals using mobile devices for care? - MedCity News

The results of the survey show 79.8 percent of respondents said they use tablets to coordinate and provide patient care, and 42.6 percent said they use smartphones to do so. Despite these findings, desktop computers still take the lead for the most commonly used devices. Approximately 94.6 percent of respondents said they use desktops, and 37.2 percent said they use laptops to support care.

HIMSS Analytics Director of Research Brendan FitzGerald said he wasn’t shocked by the survey results. “I wasn’t necessarily surprised, primarily because when you look at mobile technology, it’s not widely used in the hospital setting,” he told MedCity via phone.

Among respondents who use smartphones and tablets, 76.5 percent indicated they use them to access clinical information. Approximately 70.6 percent said mobile devices are used to access EHRs and 66.2 percent said they’re used to access nonclinical information such as educational resources. Nearly half — 48.5 percent — said they use mobile devices for systemwide communication.

While healthcare organizations appear to be putting mobile devices to use in a variety of ways, there are still a number of hurdles to widespread adoption. One such barrier is security.

Looking ahead, FitzGerald noted that many people are worried that technology adoption in the healthcare world may slow down. But in his opinion, that’s not the case. “The horse is out of the barn,” he said. “Organizations aren’t going to go back and say they were better with a paper-based system. It’s here to stay.

How are hospitals using mobile devices for care? - MedCity News