HIMSS Chair Kicks Off Conference by Touting Necessity of Health ITFebruary 26, 2007
The health IT industry should stop debating the value of electronic health records and accept the technology's importance in the future of health care, Buddy Hickman, chair of the Healthcare Information Management Systems Society board, said on Monday in his opening remarks at the annual HIMSS conference in New Orleans, Healthcare IT News reports."Placing the focus on quality, patient safety and necessary clinical process improvements is consistent with HIMSS' mission and with the reasons why adoption of [health IT] was strongly recommended by the Institute of Medicine's Crossing the Quality Chasm report," Hickman said.Hickman also encouraged the industry to have a unified voice on goals, policies and messages, including a broader view on health IT from the federal and state levels. "In this way, [health IT] becomes part of a necessary solution to critical challenges rather than being viewed as a lesser priority competing for funds," he said."Through smart public policy, alliances and the right incentives, we can create the right kind of national health information network -- one that contributes to quality, safety and better outcomes for all," Hickman said, adding, "If we don't do this now, we only create a greater challenge to fix later" (Enrado, Healthcare IT News, 2/26).
Microsoft last year acquired medical database developer Azyxxi and currently has more than 600 employees focused on health care projects, according to Microsoft Vice President Peter Neupert. Health care "is a huge sector of our economy," yet it still is relatively low tech, he said. As the country's aging baby boomers require more medical attention, the need for health care technology will become clearer, Neupert said. Microsoft CEO Steve Ballmer on Monday will speak at the Healthcare Information Management Systems Society's annual conference in New Orleans. IBM General Manager Dan Pelino said that better computer systems could improve the accuracy of data, prevent duplication and reduce errors. More than 4,000 IBM employees are working on health care products, USA Today reports. IBM also is developing a nationwide patient database with HHS that would store patient information regardless of which hospital or physician a patient visited. Intel and Motion Computing this month unveiled a laptop for physicians and nurses that includes a digital camera to take pictures of patients.
HEALTH TRAIN EXPRESS Mission: To promulgate health education across the internet: Follow or subscribe to Health Train Express as well as Digital Health Space for all the updates for health policy, reform, public health issues. Health Train Express is published several times a week.Subscribe and receive an email alert each time it is published. Health Train Express has been published since 2006.
Monday, February 26, 2007
Monday, February 19, 2007
Further Cutbacks Proposed by Bush
Featured in: RHIO MonitorPresident Bush's new proposals for cutbacks to Medicare and Public Health Funding will impact RHIO development
Further Barriers to Implementing RHIOs Submitted by gmlevinmd123 on Mon, 02/19/2007 - 9:41am.
The catch 22 of Pay for Performance. The health insurance industry as represented by IHA is big on P4P and medicare is following suit without waiting for health IT to catch up so that it can be implemented properly.. At the same time it is espousing paying MDs for improving quality the administration defocuses and presents these new proposals. Write your Congressman!!
Physicians not only pay a fair share of taxes, but are now being asked in some states (California-Schwarzzenegger proposal) to pay a 2% surtax at the state level to fund expansion of insurance to the uninsured...??undocumented aliens, as well??
Even large medical groups will not remain immune to these cutbacks, especially hard hit will be MD providers who have a disproportionate amount of seniors, ie, ophthalmologists, urologists, geriatricians, cardiologists, urologists, and more.
EARLY WARNING SIGNS: Reported in AMA news
Washington -- President Bush presented an austere fiscal year 2008 budget to Congress earlier this month, pledging no new money for Medicare physician reimbursements and proposing to slash the rate of public health program growth in other areas.
If no changes are made, doctors could see an across-the-board cut of 10% or more next calendar year.
"Without adequate funding, physicians cannot make needed investments in health information technology and quality improvement, and seniors' access to health care is placed at risk."
Several times in the past, the White House budget has not set aside money to boost doctor pay, but lawmakers have approved such appropriations anyway.
Bush has called on Congress to increase defense spending while eliminating the federal budget deficit by 2012. The plan assumes not only that physicians will undergo yearly Medicare rate reductions for each of the next five years but that lawmakers will approve more than $75 billion in additional Medicare reductions over that time. The proposal would slow the program's projected growth rate from 6.5% to 5.6% over five years.
For those of you who like to watch government budget projections, here is a summary:
Target: Medicare
President Bush has proposed cutting Medicare's projected spending by more than $75 billion over the next five years. Here are some of the biggest ways the White House hopes to save the government money:
Action
5-year savings
Inpatient hospital updates of inflation minus 0.65% each year
$13.8 billion
Home health agency updates of 0% each year
$9.7 billion
Skilled nursing facility updates of 0% in 2008 and inflation minus 0.65% each following year
$9.2 billion
Part B premiums increased for patients with higher incomes
$7.1 billion
Outpatient hospital updates of inflation minus 0.65% each year
$3.4 billion
Part D premiums increased for patients with higher incomes
$3.2 billion
Source: White House budget proposal
BLOGGING is now an important source of information for many people, and as we have seen the internet has played an important an unexpected role in political outcomes. I encourage all those interested, physicians, non physicians, health care pundits, to contribute to trusted.md and other blogs regarding health care.
This post has also been posted on www.trusted.md
Gary Levin MD
-->
Further Barriers to Implementing RHIOs Submitted by gmlevinmd123 on Mon, 02/19/2007 - 9:41am.
The catch 22 of Pay for Performance. The health insurance industry as represented by IHA is big on P4P and medicare is following suit without waiting for health IT to catch up so that it can be implemented properly.. At the same time it is espousing paying MDs for improving quality the administration defocuses and presents these new proposals. Write your Congressman!!
Physicians not only pay a fair share of taxes, but are now being asked in some states (California-Schwarzzenegger proposal) to pay a 2% surtax at the state level to fund expansion of insurance to the uninsured...??undocumented aliens, as well??
Even large medical groups will not remain immune to these cutbacks, especially hard hit will be MD providers who have a disproportionate amount of seniors, ie, ophthalmologists, urologists, geriatricians, cardiologists, urologists, and more.
EARLY WARNING SIGNS: Reported in AMA news
Washington -- President Bush presented an austere fiscal year 2008 budget to Congress earlier this month, pledging no new money for Medicare physician reimbursements and proposing to slash the rate of public health program growth in other areas.
If no changes are made, doctors could see an across-the-board cut of 10% or more next calendar year.
"Without adequate funding, physicians cannot make needed investments in health information technology and quality improvement, and seniors' access to health care is placed at risk."
Several times in the past, the White House budget has not set aside money to boost doctor pay, but lawmakers have approved such appropriations anyway.
Bush has called on Congress to increase defense spending while eliminating the federal budget deficit by 2012. The plan assumes not only that physicians will undergo yearly Medicare rate reductions for each of the next five years but that lawmakers will approve more than $75 billion in additional Medicare reductions over that time. The proposal would slow the program's projected growth rate from 6.5% to 5.6% over five years.
For those of you who like to watch government budget projections, here is a summary:
Target: Medicare
President Bush has proposed cutting Medicare's projected spending by more than $75 billion over the next five years. Here are some of the biggest ways the White House hopes to save the government money:
Action
5-year savings
Inpatient hospital updates of inflation minus 0.65% each year
$13.8 billion
Home health agency updates of 0% each year
$9.7 billion
Skilled nursing facility updates of 0% in 2008 and inflation minus 0.65% each following year
$9.2 billion
Part B premiums increased for patients with higher incomes
$7.1 billion
Outpatient hospital updates of inflation minus 0.65% each year
$3.4 billion
Part D premiums increased for patients with higher incomes
$3.2 billion
Source: White House budget proposal
BLOGGING is now an important source of information for many people, and as we have seen the internet has played an important an unexpected role in political outcomes. I encourage all those interested, physicians, non physicians, health care pundits, to contribute to trusted.md and other blogs regarding health care.
This post has also been posted on www.trusted.md
Gary Levin MD
-->
Thursday, February 8, 2007
Help
Congress has officially approved of CMS’ decision to implement P4P. I recently read somewhere that CMS would increase physician reimbursements (and hospitals, too I suppose) by 300 million dollars with this incentive (if providers are able to conform to their requirements) I also read that physicians such as myself will not face the 5% annual SGR reduction in CMS payments. This has been massaged into the politically correct phrase as a “raise in reimbursements” (the lord giveth and the lord taketh away). So we are given back that which was taken from us and then told it is a “raise”.
Let’s face it, decision makers in Washington and some state capitols as well as legislators are out of touch with reality. Placing more administrative burdens on an already very dysfunctional barely functioning healthcare system is “insane”, and so are those that make these proposals, and then vote them into effect to placate a worried electorate about whether they will be able to afford another doctor visit or hospitalization.
Many physicians I know have retired in their mid 50s to sell soap or enter MLM businesses, sell real estate or go into other businesses, which tells you a great deal about the stressors on physicians.
I can find hundreds of consulting groups, and health care foundations that study everything to death, make more recommendations which increase further the cost of health care, couching their recommendations in terms such as quality initiatives, pay for performance, etc etc. There is a whole new lingo out there that most physicians do not comprehend, but must learn.
I am not optimistic about our health system in the United States. IT and RHIOs are a small part of what we need. If you are very rich or dead poor in poverty your health care is assured. The large mass of diminishing middle class are at great risk, if they lose employment, and/or their group health policies, have pre-existing illnesses, the quickly join the uninsured. Even those fully employed and insured are soon priced out of full insurance coverage.
HSAs are a joke, I tried one last year and found that it takes quite a while to meet the deductible, and the policies are worded in such a way for a family that the deductible for a family is what counts, not the individual users. You also cannot use it unless you fund the HSA upfront. If you have chronic illness and have high expenses from day one….you may not be able to save . I suspect the IRS will expect accounting through the HSA and not direct payments out of pocket. HSAs are a great deal for the banks and the insurers. It will not save healthcare dollars, nor reduce utilization. When people get sick, they seek medical care.
This year I became unemployed for a time and went onto COBRA, about a month later at the end of the year I finally reached my 4800 dollar HAS deductible. One week later it was January and the deductible started over again. True the premium was lower with the HAS but we had medical drug expenses of about 650 dollars that month….we cancelled our COBRA, went bare and are now forming our own group to obtain group health insurance. Individual coverage is out of the question. Now why is that? Seems to me all the individuals who are not in a group could be put into a group of “the individuals who are not in a group”
And now GWB is proposing tax law changes to “make healthcare more affordable”.
And another thing, when you sign up for insurance you are given an effective date which may be any part of the year, yet your deductible rolls over at each calendar year, whether it’s been six months, four months or eight months since you signed up. The contract is for one year…..so why are you cancelled if you miss one payment? Seems to me it is all weighted toward the insurer, not the patient.
As I write this article I am seeing this from the patient (now known as a consumer) aspect; let alone the physician provider side. The billing and coding aspects of reimbursement have turned into a high stakes poker game with a new industry spun off…..the reimbursement consultant who charges anywhere from 500 dollars to 3000 per year to update the practices on insurance billing practices and codes which change from year to year. It’s a bit like poker. And if you make a mistake you are accused of fraud and a buse, fined, or worse kicked out of a program.
I have been practicing over 30 years since I finished medical school. My the world has changed.
Insurance companies control everything. Recently I moved practice locations back to a community where I first started off as a young ophthalmologist. I discovered that my home hospital had disbanded the ophthalmology department and there were several outpatient centers that did all the eye surgery.
Now, insurance companies usually require the physician to have hospital staff priveleges to be on their provider list…..how does one go about that one? Some doctors already on the hospital staff are now paid to take ER standby call…..they are grandfathered in as staff members, but there is no way for new ASC doctors to be proctored in a hospital setting unless the ASC is part of the hospital. Worse than that some ASCs are privately owned and owners will not allow open access thereby eliminating competition in their geographic area. In my next article I will further details the requirements and administrative bureaucracy that has been generated to “protect” patients (from whom?)
Let’s face it, decision makers in Washington and some state capitols as well as legislators are out of touch with reality. Placing more administrative burdens on an already very dysfunctional barely functioning healthcare system is “insane”, and so are those that make these proposals, and then vote them into effect to placate a worried electorate about whether they will be able to afford another doctor visit or hospitalization.
Many physicians I know have retired in their mid 50s to sell soap or enter MLM businesses, sell real estate or go into other businesses, which tells you a great deal about the stressors on physicians.
I can find hundreds of consulting groups, and health care foundations that study everything to death, make more recommendations which increase further the cost of health care, couching their recommendations in terms such as quality initiatives, pay for performance, etc etc. There is a whole new lingo out there that most physicians do not comprehend, but must learn.
I am not optimistic about our health system in the United States. IT and RHIOs are a small part of what we need. If you are very rich or dead poor in poverty your health care is assured. The large mass of diminishing middle class are at great risk, if they lose employment, and/or their group health policies, have pre-existing illnesses, the quickly join the uninsured. Even those fully employed and insured are soon priced out of full insurance coverage.
HSAs are a joke, I tried one last year and found that it takes quite a while to meet the deductible, and the policies are worded in such a way for a family that the deductible for a family is what counts, not the individual users. You also cannot use it unless you fund the HSA upfront. If you have chronic illness and have high expenses from day one….you may not be able to save . I suspect the IRS will expect accounting through the HSA and not direct payments out of pocket. HSAs are a great deal for the banks and the insurers. It will not save healthcare dollars, nor reduce utilization. When people get sick, they seek medical care.
This year I became unemployed for a time and went onto COBRA, about a month later at the end of the year I finally reached my 4800 dollar HAS deductible. One week later it was January and the deductible started over again. True the premium was lower with the HAS but we had medical drug expenses of about 650 dollars that month….we cancelled our COBRA, went bare and are now forming our own group to obtain group health insurance. Individual coverage is out of the question. Now why is that? Seems to me all the individuals who are not in a group could be put into a group of “the individuals who are not in a group”
And now GWB is proposing tax law changes to “make healthcare more affordable”.
And another thing, when you sign up for insurance you are given an effective date which may be any part of the year, yet your deductible rolls over at each calendar year, whether it’s been six months, four months or eight months since you signed up. The contract is for one year…..so why are you cancelled if you miss one payment? Seems to me it is all weighted toward the insurer, not the patient.
As I write this article I am seeing this from the patient (now known as a consumer) aspect; let alone the physician provider side. The billing and coding aspects of reimbursement have turned into a high stakes poker game with a new industry spun off…..the reimbursement consultant who charges anywhere from 500 dollars to 3000 per year to update the practices on insurance billing practices and codes which change from year to year. It’s a bit like poker. And if you make a mistake you are accused of fraud and a buse, fined, or worse kicked out of a program.
I have been practicing over 30 years since I finished medical school. My the world has changed.
Insurance companies control everything. Recently I moved practice locations back to a community where I first started off as a young ophthalmologist. I discovered that my home hospital had disbanded the ophthalmology department and there were several outpatient centers that did all the eye surgery.
Now, insurance companies usually require the physician to have hospital staff priveleges to be on their provider list…..how does one go about that one? Some doctors already on the hospital staff are now paid to take ER standby call…..they are grandfathered in as staff members, but there is no way for new ASC doctors to be proctored in a hospital setting unless the ASC is part of the hospital. Worse than that some ASCs are privately owned and owners will not allow open access thereby eliminating competition in their geographic area. In my next article I will further details the requirements and administrative bureaucracy that has been generated to “protect” patients (from whom?)
Thursday, January 25, 2007
Report from the IERHIO Annual Summit Meeting
Inland Empire Regional Health Information Organization held it’s annual summit meeting this week in Riverside California under the auspices of the RCMA and SBCMS. A live meeting web conference had presenters from Canada, Pennsylvania and Northern California. The group was quite eclectic with different approaches to the challenge of health information data input, storage and exchange. The Department of Public Health of Riverside County was also represented by Janis Neuman M.D. and and Geoffrey Leung M.D They discussed their ongoing projects and needs. Dr Leung recently returned from Taiwan and stated that he wished the U.S. was on a par with Taiwan in regard to health IT. Laura Landry represented the Long Beach Initiative. Their non profit has been funded and they have selected a vendor. They have excellent support from grants as a result of the expertise of P.H.F.E.
The attendance and support of area and regional hospitals was non-existent, although we have heard each hospital and IPA are investigation EMR solutions. Also present were Dr. Ron Bangasser from Beaver Medical Clinic and Dr. Edward Hess, formerly from Kaiser Permanente. Commentary was heard regarding the Kaiser experiences and their usage of “Epic”.
A presentation was made by Sabatini Montatesti, who is the CEO of ES Enterprises Inc. ES Enterprises is building out a non profit health data exchange for northeast Pennsylvania including Geisinger Medical Center and surrounding hospitals, clinics and physicians. This rural area has unique challenges in that there are a great number of uninsured patients. Funding for the non profit was through charitable donations and hospital contributions. The depth of his knowledge and architecture for the health data exchanges is impressive.
We also heard from other vendor solutions. Clinical Integration was represented by Mark Crespin, Steve Leider and Paul Bessingminder who presented from Vancouver, B.C.
Practice Fusion presented their proposed solution as well. The vendors had an opportunity to answer some challenging questions from our steering and advisory committee.
Ellen Badley represented the California Department of Health representing Cindy Ehnes. She spoke briefly about the Governor’s proposal for health IT and his “Universal Health Care for California” The “takeaway message” for her was the importance of reducing the chasm between state health care and private health care, and that health IT for each is not mutually exclusive.
Our group is obviously biased toward developing some form of integrated health information system.
There was much philosophical and hypothetical discussion about several models both financially and technically.
There was a great concern that our dysfunctional health care system would consider starting another venture in IT regardless of our motives. The group also discussed the inadvisability of a political state ment of universal health care without a major overhaul of the IT infrastructure to support increased numbers of insured in the system. We certainly cannot provide more care for less money and not without a revolution in our health data system.
While some believe a non-profit organization offers some advantages it is the opinion of this writer that is a more expensive and time consuming entity to form and attract users.
My belief is that a sound private entrepreneurial model with a private placement and subscription service would offer greater efficiency and less cost to develop. Because of the intense capital investment to plan, build and maintain an enterprise level solution and/or small practice solutions initial start up cost is critical.
Mission critical items include time to implement, reliability, vendor experience and availability. Jeff Rose of Health Alliant discussed time to implement and train a system in Riverside County at one week per installation which added up to 900 weeks for the provider and hospital base in our region. (which is over ten years)
As a result of two years of independent study, meetings, and information gathering I have developed some opinion on what our region can accomplish in a cost effective and expedient manner.
A proposal will be forthcoming in the next several weeks.
Thank you to all who have attended these meetings, donating valuable time, effort and much expertise for the benefit our our health care system and our patients.
Gary Levin M.D.
The attendance and support of area and regional hospitals was non-existent, although we have heard each hospital and IPA are investigation EMR solutions. Also present were Dr. Ron Bangasser from Beaver Medical Clinic and Dr. Edward Hess, formerly from Kaiser Permanente. Commentary was heard regarding the Kaiser experiences and their usage of “Epic”.
A presentation was made by Sabatini Montatesti, who is the CEO of ES Enterprises Inc. ES Enterprises is building out a non profit health data exchange for northeast Pennsylvania including Geisinger Medical Center and surrounding hospitals, clinics and physicians. This rural area has unique challenges in that there are a great number of uninsured patients. Funding for the non profit was through charitable donations and hospital contributions. The depth of his knowledge and architecture for the health data exchanges is impressive.
We also heard from other vendor solutions. Clinical Integration was represented by Mark Crespin, Steve Leider and Paul Bessingminder who presented from Vancouver, B.C.
Practice Fusion presented their proposed solution as well. The vendors had an opportunity to answer some challenging questions from our steering and advisory committee.
Ellen Badley represented the California Department of Health representing Cindy Ehnes. She spoke briefly about the Governor’s proposal for health IT and his “Universal Health Care for California” The “takeaway message” for her was the importance of reducing the chasm between state health care and private health care, and that health IT for each is not mutually exclusive.
Our group is obviously biased toward developing some form of integrated health information system.
There was much philosophical and hypothetical discussion about several models both financially and technically.
There was a great concern that our dysfunctional health care system would consider starting another venture in IT regardless of our motives. The group also discussed the inadvisability of a political state ment of universal health care without a major overhaul of the IT infrastructure to support increased numbers of insured in the system. We certainly cannot provide more care for less money and not without a revolution in our health data system.
While some believe a non-profit organization offers some advantages it is the opinion of this writer that is a more expensive and time consuming entity to form and attract users.
My belief is that a sound private entrepreneurial model with a private placement and subscription service would offer greater efficiency and less cost to develop. Because of the intense capital investment to plan, build and maintain an enterprise level solution and/or small practice solutions initial start up cost is critical.
Mission critical items include time to implement, reliability, vendor experience and availability. Jeff Rose of Health Alliant discussed time to implement and train a system in Riverside County at one week per installation which added up to 900 weeks for the provider and hospital base in our region. (which is over ten years)
As a result of two years of independent study, meetings, and information gathering I have developed some opinion on what our region can accomplish in a cost effective and expedient manner.
A proposal will be forthcoming in the next several weeks.
Thank you to all who have attended these meetings, donating valuable time, effort and much expertise for the benefit our our health care system and our patients.
Gary Levin M.D.
Saturday, January 20, 2007
SUMMIT MEETING IERHIO RIVERSIDE CALIFORNIA
DATE: TUESDAY JANUARY 23 2007
TIME: 6:00 PM
PLACE: RIVERSIDE SAN BERNARDINO MEDICAL SOCIETY HEADQUARTERS
LIVE WEB CONFERENCE: MICROSOST OFFICE LIVE MEETING
Attendees have received email invitation. If you have not received an email invitation and wish to attend send email request to:
gmlevinmd@gmail.com
TIME: 6:00 PM
PLACE: RIVERSIDE SAN BERNARDINO MEDICAL SOCIETY HEADQUARTERS
LIVE WEB CONFERENCE: MICROSOST OFFICE LIVE MEETING
Attendees have received email invitation. If you have not received an email invitation and wish to attend send email request to:
gmlevinmd@gmail.com
Sunday, January 14, 2007
House Keeping Notes
Some of you may have noticed that Health Train Express now has an RSS Feed. The Icon which is orange and located on the right sidebar allows you to "subscribe" to the feed. If you click on the icon (orange) it will pop up the option to subscribe directly to your browser favorite folder, or whatever feed you use. Any time you use your browser you can find and click "Health Train Express" and see the short summary of the latest posting, without remembering urls.
If you wish please make comments on the blog. If you have problems doing so, please email me directly at gmlevinmd@gmail.com I have not been getting any commentary since I converted to the new blogger and new title. Perhaps it is a glitch.
I look forward to the meeting on January 23 2006. Contact me with suggestions at my email as well, or leave a comment here.
The meeting will be interesting with new participants from around the country via web feeds and audio conferencing.
If you wish please make comments on the blog. If you have problems doing so, please email me directly at gmlevinmd@gmail.com I have not been getting any commentary since I converted to the new blogger and new title. Perhaps it is a glitch.
I look forward to the meeting on January 23 2006. Contact me with suggestions at my email as well, or leave a comment here.
The meeting will be interesting with new participants from around the country via web feeds and audio conferencing.
Friday, January 12, 2007
Which Locomotive are you in Front of?
This article in Southern California Physician in early January seemed to juxtapose with the title of my blog. Lytton Smith M.D. categorizes five different locomotives in the "health train express" which threaten to either derail or provide synergy in converting our present health care non-system into an efficient one focused on optimal patient care and outcomes.
With his permission I have copied a few key remarks:
After 30 years in healthcare, I think of these payment conflicts as locomotives of varying size and power. Each train carries a different constituency.Locomotive No. 1 represents the health plans. Thinking they drive the healthcare train, they charge ahead. Focusing on profits to maintain their stock value causes them to ignore the economics of actually paying for the care they expect from physicians and hospitals.Locomotive No. 2 includes hospitals. They carry the EMTALA burden as best they can. Despite complaining about being underpaid, many thrive by billing high charges for basic services. Health plans ignore the hospital charges because they are contracted. The hospitals with poor payer mixes and poor contracts close their doors or sell to alleviate their burden.Shoveling coal in Locomotive No. 3, the physicians rattle down their track. Due to antitrust rules and their own sense of independence, physicians have trouble coordinating the function of their train. With so many internal conflicts--group practice vs. solo practice, primary care vs. specialties--who has time to watch where the train is headed?In flashy Locomotive No. 4, a scenic rail car, are the legislators. With their top-rated medical insurance and VIP status, they protect themselves from the vicissitudes of medical financial struggles by passing laws to assure themselves that all will be well. Locomotive No. 4, fueled often by the engineers of Locomotive No. 1, looks sleek and rumbles along, trying to avoid seeing Locomotive No. 5.Locomotive No. 5 is the longest train of all, containing patients. With many classes of service, it consumes enormous energy as it moves down the track. Like No. 3, No. 5 has no focused leadership. But because of its enormous size, this train has the most potential momentum. No. 5 occupies the most important track as all the other trains exist to serve it.If Locomotives No. 1, 2 and 3 cannot resolve "fair and reasonable" vs. "usual and customary" issues, I fear that Locomotive No. 5 will push Locomotive No. 4 into crushing the others. The resulting collision will create a force for a single-payer system. The drive for all parties to "get their fair share" may result in an oligarchy in which no one is well served. In this environment, mavericks like Dr. Reddy will surely need to look elsewhere for financial satisfaction.Lytton W. Smith, MD, editor for the OCMA, is a physician practicing family medicine with the St. Jude Heritage Medical Group in Yorba Linda. Dr. Smith welcomes feedback on his articles and can be reached at editor@socalphys.com.
Perhaps the advent of social health care blogs and the entry of consumer driven plans and opinons will become the "caboose"
www.socalphys.com
With his permission I have copied a few key remarks:
After 30 years in healthcare, I think of these payment conflicts as locomotives of varying size and power. Each train carries a different constituency.Locomotive No. 1 represents the health plans. Thinking they drive the healthcare train, they charge ahead. Focusing on profits to maintain their stock value causes them to ignore the economics of actually paying for the care they expect from physicians and hospitals.Locomotive No. 2 includes hospitals. They carry the EMTALA burden as best they can. Despite complaining about being underpaid, many thrive by billing high charges for basic services. Health plans ignore the hospital charges because they are contracted. The hospitals with poor payer mixes and poor contracts close their doors or sell to alleviate their burden.Shoveling coal in Locomotive No. 3, the physicians rattle down their track. Due to antitrust rules and their own sense of independence, physicians have trouble coordinating the function of their train. With so many internal conflicts--group practice vs. solo practice, primary care vs. specialties--who has time to watch where the train is headed?In flashy Locomotive No. 4, a scenic rail car, are the legislators. With their top-rated medical insurance and VIP status, they protect themselves from the vicissitudes of medical financial struggles by passing laws to assure themselves that all will be well. Locomotive No. 4, fueled often by the engineers of Locomotive No. 1, looks sleek and rumbles along, trying to avoid seeing Locomotive No. 5.Locomotive No. 5 is the longest train of all, containing patients. With many classes of service, it consumes enormous energy as it moves down the track. Like No. 3, No. 5 has no focused leadership. But because of its enormous size, this train has the most potential momentum. No. 5 occupies the most important track as all the other trains exist to serve it.If Locomotives No. 1, 2 and 3 cannot resolve "fair and reasonable" vs. "usual and customary" issues, I fear that Locomotive No. 5 will push Locomotive No. 4 into crushing the others. The resulting collision will create a force for a single-payer system. The drive for all parties to "get their fair share" may result in an oligarchy in which no one is well served. In this environment, mavericks like Dr. Reddy will surely need to look elsewhere for financial satisfaction.Lytton W. Smith, MD, editor for the OCMA, is a physician practicing family medicine with the St. Jude Heritage Medical Group in Yorba Linda. Dr. Smith welcomes feedback on his articles and can be reached at editor@socalphys.com.
Perhaps the advent of social health care blogs and the entry of consumer driven plans and opinons will become the "caboose"
www.socalphys.com
Monday, January 1, 2007
Amazing factoids from 2006
Brought to you with permission of the AMA. Comments are most welcome.
http://www.ama-assn.org:80/amednews/site/facts06.htm
http://www.ama-assn.org:80/amednews/site/facts06.htm
Saturday, December 30, 2006
The Cusp of 2006
As we end 2006 I want to thank Dimitriy for involving me with The Medical Blog Network.
For the past two years my involvement with a RHIO and Health Information Technology have given me the opportunity to meet and learn from other professionals about improving healthcare.
A fresh outlook is always a good thing. I am convinced that patients must have involvement and ownership of their healthcare "system"; it is in fact an essential element to move forward.
Government alone, nor payors nor employers can perform this great task alone.
So I wish all of you a happy and health 2007, and hope that we all do not "pay for performance".
I invite you to read my further comments at healthtrain express www.healthtrain.blogspot.com
Gary Levin
For the past two years my involvement with a RHIO and Health Information Technology have given me the opportunity to meet and learn from other professionals about improving healthcare.
A fresh outlook is always a good thing. I am convinced that patients must have involvement and ownership of their healthcare "system"; it is in fact an essential element to move forward.
Government alone, nor payors nor employers can perform this great task alone.
So I wish all of you a happy and health 2007, and hope that we all do not "pay for performance".
I invite you to read my further comments at healthtrain express www.healthtrain.blogspot.com
Gary Levin
Friday, December 29, 2006
Good Bye to 2006
Year 2006 entertained new developments in medical social blog networks. This has provided new and "out of the box" resources for communication and discourse amongst diverse and at times historically adversarial components of our "health system". Consumer driven advocacy and health savings accounts have been introduced with varying results. Whether any or all of this will lead to reduced costs is very open to question, but it will certainly provide new resources for providers, payors, and patients as consumers to plan future developments.
RHIOs are experiencing serious difficuties in funding, and EMR promulgation although highly touted is also lagging due to financial constraints upon providers. CMS reimbursement cutbacks have also affected EMR acquisition by practices.
As a coordinator for a RHIO 2006 has been a year of quiet observation and study.
Personal health records will be supported by payors and employers. Whether they will be universal and/or interoperable remains to be seen. To be truly effective PHRs should be exportable or importable to any EMR to be useful. Perhaps employers will be enticed to provide the hardware as an employee benefit. (actually quite inexpensive at about 20 dollars for a usb flash drive, which is ubiquitous. I don't see a need to develop a new smart card or readers when everyone carries around a key chain and the device can be encrypted with u3 technology.
Many projects which have been mandated for health care have been sidelined due to the war on "terror". Personally my "terror" is the aspects of accessing health care and maintaining health insurance.
I wish you all a happy and healthy 2007.
Gary Levin MD
RHIOs are experiencing serious difficuties in funding, and EMR promulgation although highly touted is also lagging due to financial constraints upon providers. CMS reimbursement cutbacks have also affected EMR acquisition by practices.
As a coordinator for a RHIO 2006 has been a year of quiet observation and study.
Personal health records will be supported by payors and employers. Whether they will be universal and/or interoperable remains to be seen. To be truly effective PHRs should be exportable or importable to any EMR to be useful. Perhaps employers will be enticed to provide the hardware as an employee benefit. (actually quite inexpensive at about 20 dollars for a usb flash drive, which is ubiquitous. I don't see a need to develop a new smart card or readers when everyone carries around a key chain and the device can be encrypted with u3 technology.
Many projects which have been mandated for health care have been sidelined due to the war on "terror". Personally my "terror" is the aspects of accessing health care and maintaining health insurance.
I wish you all a happy and healthy 2007.
Gary Levin MD
Wednesday, December 20, 2006
Fantasy Reimbursements
There are now many proposals by CMS regarding health information and their ability to gather data from EMRs, claims information and other sources from both hospitals and medical practices.
Not many of these have been worked out financially for the providers or the hospitals. Most of the proposals require software changes or running a parallel system to track the information they are requesting. For physicians this will cost far greater than the 1.5% proposed increase CMS is proposing as an "incentive". Most practices don't even have EMRs at all. Those without the digital EMR will be forced to workout a paper trail that again increases the paperwork burden to providers.
Here are some of the particulars. (from Health IT News, via iHealthbeat.org
According to Thomas B. Valuck, MD, medical officer and senior advisor for the Centers for Medicare & Medicaid Services, CMS will administer the recent legislation providing a 1.5 percent incentive to physicians who participate in a new pay-for-performance plan, patterned after the one already in place for hospitals.
Valuck said it is going to be difficult to estimate the impact the incentive will have on physicians given the number of variables in the revenue picture: “The problem with the 1.5 percent incentive is that doctors will raise the question, ‘does $1.50 on $100 of billing cover the costs of reporting? ’”
Congress on Dec. 9 passed legislation that would increase physicians' pay -- beginning in the second half of 2007 -- if they voluntarily submit quality data measures to CMS using IT.
Not many of these have been worked out financially for the providers or the hospitals. Most of the proposals require software changes or running a parallel system to track the information they are requesting. For physicians this will cost far greater than the 1.5% proposed increase CMS is proposing as an "incentive". Most practices don't even have EMRs at all. Those without the digital EMR will be forced to workout a paper trail that again increases the paperwork burden to providers.
Here are some of the particulars. (from Health IT News, via iHealthbeat.org
According to Thomas B. Valuck, MD, medical officer and senior advisor for the Centers for Medicare & Medicaid Services, CMS will administer the recent legislation providing a 1.5 percent incentive to physicians who participate in a new pay-for-performance plan, patterned after the one already in place for hospitals.
Valuck said it is going to be difficult to estimate the impact the incentive will have on physicians given the number of variables in the revenue picture: “The problem with the 1.5 percent incentive is that doctors will raise the question, ‘does $1.50 on $100 of billing cover the costs of reporting? ’”
Congress on Dec. 9 passed legislation that would increase physicians' pay -- beginning in the second half of 2007 -- if they voluntarily submit quality data measures to CMS using IT.
Sunday, December 17, 2006
Time MAN OF THE YEAR
I made it, in case you have not already read......you and I as bloggers and web communicator beat out Cheney, Rumsfield, and Amadinajab (if that is how you spell it) for this annual award!
You will read all about it in the next week or so
So sit back and enjoy your fame....it is fleeting.
You will read all about it in the next week or so
So sit back and enjoy your fame....it is fleeting.
Tuesday, December 12, 2006
Is Pay for Performance Illegal???
Today’s news from CMA clips, The New York Times and other reliable sources reveals an impending tsunami, or at least a sea-change in the way medicare proposes to reimburse providers. Pay for performance and also Pay for Population Health care as quoted in some recent journal articles opens a whole new bag of worms. While some insurance carriers and private payors have done some initial studies and give groups incentives for following certain practice guidelines, there are serious questions and doubts amongst physicians, the AMA, CMA and even some senators and congressmen who have typically been pro-active about regulating reimbursement using a stick rather than a carrot.
Headlines read “Government will offer a carrot, rather than a stick” to control rising medical costs.
First of all the original Medicare law passed in 1964 expressly forbids Medicare from passing laws as to how medicine is to be practiced. ““Nothing in this title shall be construed to authorize any federal officer or employee to exercise any supervision or control over the practice of medicine.”
Mr. Moffit of the Heritage Foundation said the new initiative was “a backdoor attempt to repeal” this guarantee.
“It’s pay for compliance, not pay for performance,” Mr. Moffit said. “Doctors will be financially pressured to comply with government guidelines and standards. The integrity and independence of the medical profession could be compromised.”
Medicare in the past ten years has struggled to contain costs by using a flawed sustained growth rate formula (SGR) attempting to cut physician reimbursement by 3 to 6% each year. This was built into law about ten years ago, and each year at the 11th hour congress must struggle with modifying or eliminating or postponing the fee cut.
Pay for performance offers a “carrot” of 1.5% increase for providers to report their “compliance” with a practice pattern derived by their specialty organizations, or some other benchmark provided by a heath insurance carrier. The amount of paperwork, or computer investment to provide these numbers far exceeds the increase in payments. Perhaps there are some groups large enough who already have such systems in place. They were given special grants to develop these as “pilot programs”.
Representative Stark said, “Doctors and others who like pay-for-performance have to remember that it’s a zero-sum game.” As a result, he said, most doctors will have to accept lower fees if Medicare is to pay bonuses to the best performers.
What Medicare is doing may be “illegal”. I am surprised that this has not been challenged in the courts. Previous actions by medicare merely provided lack of payments and restricted benefits to reign in costs.
Providing incentives is definitely an inducement to “practice differently”
Other strong arguments are that practice patterns, pharmacology change fairly rapidly. Keeping up with the codification and timely documentation will remove assets from patient care to provide more bureaucracy.
As a believer in “open source” and development of regional health information organizations some are attempting to use P4P as an incentive for RHIO funding and development. I believe this is a very bad idea…the flow of private patient information even if “stripped” of identifying information should not be conveyed by RHIO data infrastructure. Open source refers to “code” and computer language, not patient information.
Later this week
The demise of HMOs, , PPOs and their replacement by “consumer drive plans”
Gary L
Headlines read “Government will offer a carrot, rather than a stick” to control rising medical costs.
First of all the original Medicare law passed in 1964 expressly forbids Medicare from passing laws as to how medicine is to be practiced. ““Nothing in this title shall be construed to authorize any federal officer or employee to exercise any supervision or control over the practice of medicine.”
Mr. Moffit of the Heritage Foundation said the new initiative was “a backdoor attempt to repeal” this guarantee.
“It’s pay for compliance, not pay for performance,” Mr. Moffit said. “Doctors will be financially pressured to comply with government guidelines and standards. The integrity and independence of the medical profession could be compromised.”
Medicare in the past ten years has struggled to contain costs by using a flawed sustained growth rate formula (SGR) attempting to cut physician reimbursement by 3 to 6% each year. This was built into law about ten years ago, and each year at the 11th hour congress must struggle with modifying or eliminating or postponing the fee cut.
Pay for performance offers a “carrot” of 1.5% increase for providers to report their “compliance” with a practice pattern derived by their specialty organizations, or some other benchmark provided by a heath insurance carrier. The amount of paperwork, or computer investment to provide these numbers far exceeds the increase in payments. Perhaps there are some groups large enough who already have such systems in place. They were given special grants to develop these as “pilot programs”.
Representative Stark said, “Doctors and others who like pay-for-performance have to remember that it’s a zero-sum game.” As a result, he said, most doctors will have to accept lower fees if Medicare is to pay bonuses to the best performers.
What Medicare is doing may be “illegal”. I am surprised that this has not been challenged in the courts. Previous actions by medicare merely provided lack of payments and restricted benefits to reign in costs.
Providing incentives is definitely an inducement to “practice differently”
Other strong arguments are that practice patterns, pharmacology change fairly rapidly. Keeping up with the codification and timely documentation will remove assets from patient care to provide more bureaucracy.
As a believer in “open source” and development of regional health information organizations some are attempting to use P4P as an incentive for RHIO funding and development. I believe this is a very bad idea…the flow of private patient information even if “stripped” of identifying information should not be conveyed by RHIO data infrastructure. Open source refers to “code” and computer language, not patient information.
Later this week
The demise of HMOs, , PPOs and their replacement by “consumer drive plans”
Gary L
Subscribe to:
Posts (Atom)