Fundamental,Rebuild,Minor Changes

During the past several months I was certain that the public, congress and others were edging toward health care reform. However, Matt Holt points to a report from the Pew Research group, that change is 'not what we need'.

What's in a word?  Rebuild,fundamental change, minor changes, don't know....

Can we liken this to the annual  automobile re-designs? Complete rebuild---unrecognizable new model.  Fundamental changes---new fenders and bumpers. Only minor changes--new badges, relocate chrome, rename model.

Only time will tell which one of these  'revolutionary, evidence based, cost effective solutions will rise above the frey.

Health Train Express--KIA

Incredible as it may seem, the province of Quebec in Canada does not have an emergency medical helicopter transport service.

Did this contribute to the 'window of opportunity" to save Natasha Richardson's  life?

This is pure speculation on my part, but the question also arose in an article posted on the Associated Press' web site this morning.

The high visibility of this tragedy should awaken the medical community and it's provincial medical authorities to the sad nature of a system that does not meet a standard available in most of the North  American Continent.  While fairly remote and isolated Mount Tremblant

is a world class ski resort which draws an international crowd of ordinary, famous, stars and celebrities.

While skiing is not  considered a dangerous sport, in reality it is a fairly high risk activity, witness the presence of many orthopedic surgeons and/or urgent care centers dedicated to treating sportsmen with fractures, sprains, and concussions.

The Mt Tremblant web site now displays the following warning:

Warning!

The helmet is now mandatory for all snow parks users.

 

Is this the inevitable outcome of a nationalized health care system, where everything is planned and budgeted years in advance or simple negligence?  Natalie Richardson and Mr Neelsen will not benefit from this lack of services, however hopefully it will stimulate a provincial outrage in Quebec. The lack of speedy medical  helicopter transportation effects not only this ski resort but the entire province and cities in Quebec.  Undoubtedly this accident will create mandatory ski helmet rules at all ski facilities around the world. Some of the helmets are "way cool".. I might even take up skiing once again.

del.icio.us Tags: health train express,skiing,medical helicopters,mount remblant,quebec,national health care,epidural hemorrhage

Rodney Dangerfield MD on the Health Train Express

" I don't get no respect' is the mantra we have   heard from Dangerfield.  According to many pundits, public policy advisors, health insurance companies, utilization reviewers, CMS, and more than the number of ABMS approved specialty categories, we  physicians are complete 'fools'.

 

from "Dave" 's commentary on the Wall Street Journal blog

Where have you been all my life?
What a numbskull I’ve been!
First, I get a BS in Biology, then an MS in Molecular Biology, then 4 years in medical school, 4 more years of training, triple-board certification, 20 years of seeing patients honing my diagnostic skills, none-stop study, dozens of medical conferences, thousands of internet searches…
When all I really needed was your “cookbook.” Is it on Amazon?
By the way, I have no patience for idiotic CEOs who recommend cookbook medicine when no such cookbook exists.

del.icio.us Tags: ceo,dangerfield,mantra,cookbook medicine

Health Train Humor

Marge, it takes two to lie. One to lie and one to listen. Homer Simpson

 

If you want a short brief read, don't go further.  This edition will ramble, rant and rave about all things in healthcare and it's accompanying political parasites, and doctor wannabees. (those guys who could not quite get into med school, who write blogs, author medical articles, and become spokesmen for the rest of us who are too busy with patient care to have time to write much until we either semi retire, stroke out or have disablity.  Let's face it I did not go into medicine primarily to become a civil servant, although I did chose it to help my fellow man with what I then thought was my superior intellect, good looks, and the unending ability to get dates. I also thought it would never become boring.

 

Injection of Humor:

 

 

I am also wondering how our health insurance industry is enmeshed in  the AIG fiasco.  Are they the next AIG, and will they get bail out funds in several months?  You know that all these crooks and thieves play golf at the same club, don't you??

 

Admittedly I am biased about many things. One of my favorite sanctimonious and self centered prejudices is that doctor wannabes (health care pundits, consultants, hospital administrators, utilization reviewers, health policy writers, and planners, ad infinitum and nauseum in their efforts to contain health care costs actually increase them enormously.

Doctor Anonymous: White House Health Care Summit

Doctor Anonymous: White House Health Care Summit

Health IT Update

 

Some of you may have wondered why I have been absent from blogomania.  Wel it is because my time has been drastically impacted by the necessity of learning how to use an EMR.

In my setting I have had all the 'advantages' of having a full time IT staff to quell my frustration at not being able to perform my duties as a physician.  It is not saving me time nor is it increasing my efficiency.....it is exactly the polar opposite.

It takes me about ten minutes to correlate and coordinate  the information my assistants and data gatherers bring to me as well as perform my physical exam during which I also take relevant history from the patient.  Now it takes me an additional ten to fifteen minutes to enter it into the EMR (that is an optimistic estimate). 

I previously would see an average of 35-40 patients/day. If I add on ten minutes (conservatively) that is 350 minutes/day or almost 6 hours, leaving me with two hours to work.  So even with using my 'EMR"  I can now see about  ten patients/day.

Makes sense to me...sounds like the military.....

Health Train /stimulus

iHealthBeat reports today;

 

"Today in Denver, President Obama is scheduled to sign a $787 billion economic stimulus package that includes $19 billion for health IT that the House and Senate approved Friday, Healthcare IT News reports (Healthcare IT News, 2/17).

The House passed the stimulus package by a 246-183 margin with no Republican support, and the Senate approved the package by a 60-38 margin with the support of three Republicans (Hitt/Weisman, Wall Street Journal, 2/14).

Health IT Provisions

The legislation would:

• Provide $2 billion to the Office of the National Coordinator for Health IT, in part to support regional health information exchanges and establish regional extension centers;

• Require ONC to appoint a chief privacy officer;
• Strengthen HIPAA medical privacy rules;
• Establish health IT policy and standards committees as federal advisory committees;
• Require insurers and health care providers that participate in Medicare and Medicaid to use health IT systems that comply with national standards;
• Tap the National Institute of Standards and Technology to test health IT standards;
• Restrict the sale of information included in health records;
• Permit state attorneys general to sue individuals to enforce HIPAA medical privacy and security rules (Ferris, Government Health IT, 2/13); and
• Require vendors of electronic health records to alert individuals and the Federal Trade Commission of data breaches (Health Data Management, 2/17).

Prospects for Health IT Firms

In addition, several newspapers published articles recently examining expected financial benefits to health IT firms.  Headlines and links are provided below.

• "Electronic Health Records Closer to Reality" (Godinez, Dallas Morning News, 2/15).
• "Stimulus Has Billions for Health Technology" (DiStefano, Philadelphia Inquirer, 2/17).
• "Online Health Data in Remission" (Huslin, Washington Post, 2/16).

The bill also would provide health IT funds for the Social Security Administration, Indian Health Service, community health centers, and medical schools and other organizations.

The legislation aims to make electronic health records available to all U.S. residents by 2014 but would not require individuals to use EHRs (Government Health IT, 2/13).

Forecast

The Congressional Budget Office projects that health IT provisions in the stimulus package will result in 90% of doctors and 70% of hospitals using certified EHR systems by 2019 (Health Data Management, 2/13).

Health care experts and economists expect the health IT provisions to create jobs in IT and other related fields, reduce health care costs and improve efficiency in the health care system.

However, some Republican lawmakers and other conservatives criticized the bill's health IT provisions, arguing that the move was part of an effort by the Obama administration to rework the health care system with minimal public debate (Douglas, McClatchy/Kansas City Star, 2/13).

"No Batteries Required"

More Bailout Backwash

Move over Dr Leavitt!! Mark Leavitt has resurfaced rapidly after exiting stage left as the Obama administration takes over the center of government. He is now the Chair of the CCHIT, the body that certifies EMRs and information systems for interoperability. He and John Hamlaka as well as John Tooker, MD the head of the American College of Physicians write today in The Health Care blog about the progress of Health IT. It is an excellent read and accurately describes the present state of the ‘art’ and the forecasts and wishful thinking for the future.

Their forecast is for better times for health IT. Much of this results from the recent economic chaos and misery stimulating our central government to hand out dollars guised as stimulants. Health IT needs will be included in the framework of the overall program(s).

From failure comes success. Strange bedfellow….bank failure, crashing credit markets and a prediction and/or promise for a  booming health IT. Go figure! When we were ‘relatively rich’ there was nada for health IT. Five years or more ago ONCHIT was formed and RHIOs were encouraged, with mostly negative progress save for a few successful ones. Much of the work was done by volunteers, champions of IT, and others.

Mysterious Disappearance

For those of you who read my blog, my absence was due to technical problems, which have been fixed for the time being. I am awaiting my backup files to arrive.

Writing a daily blog has it's short comings, when events change hour to hour amongst the pundits and political activists.

Daschle's demise was probably devastating to Tom, since he had been an ardent supporter of Obama in his quest for the Presidency.  A " suitable "  replacement will be found quickly.

Daschle did have the unique perspective of political expediency and healthcare knowledge to guide healthcare policy through the maze of the legislative process.    This is a real set back in terms of 'trust' and the workings of the congress.  The new secretary of HHS will have to start at the gate. 

del.icio.us Tags: politics in healthcare,daschle,hhs

Highway Robbery on the Health Train

Willie Sutton, a notorious bank robber was asked, “Willy, why do you rob banks?” Willy replied, “’Cause that’s where the money is”

The WSJ blog recently ran a survey about how primary care funding can be increased.  The survey can be seen here.

The comments I made,

The poll results are most interesting, revealing a fairly even split across the board. This reflects the confusion, and disparate remedies proposed to ’save primary care and health care in general. It also tells the tale that there is no easy solution, at all. Money does not tell the entire story about primary cares negative features. I lay the entire blame on government and insurers. When CLIA came along 20 years ago many physician labs were put out of business, an important revenue source, within their own practice. Imagine a business that was ‘forced’ to use outside vendors for services easily provided in house, providing ‘convenience’ to their ‘customers’….That would be step one. Step two would be to provide additonal necessary services to patients, ie, pharmacy (which may or may not be economically feasible given today’s regulatory environment. Radiology, alternative medicine, accupuncture, chiropractic, et. also throw in  fortune tellers and palm readers (not the IT kind). As Obama once said. “It’s not a matter of too much or too little government, it’s getting it straight and doing it right.” What we need to do is signal the insurers and government that we will no longer serve their clients. Patient uproar would be so great within one month we would see a huge change. How about a 30 day withdrawal from practice. a 30 day vacation….it takes most payers 30 days to pay their bills….we can do the same thing.  If the patients take their medicine they will get better in the long run, no matter how bitter the medicine tastes. 

Comment by G. Levin M.D. - January 23, 2009 at 6:35 am

del.icio.us Tags: wall street journal,revenue,pharmacy,radiology,chiropractor,accupuncture,primary care income

The Life of Health Train Express

For almost five years now I have been blogging at this site. It has been very enjoyable. And no, this is not a farewell post, nor an explanation that I am too busy, or bored with it all.

Writing is a passion for some people, and computers and the internet give us all a new tool for creativity, networking and publication without all the hoo-ha of a formal writer’s or author’s support group, agents, publicists, book tours,  etc etc.

I have mined more from this experience, as most blogger’s have, than what I have contributed with my little blog espousing my small opinions from my perspective as a grass roots doctor.

I have written the blog with few comments made by readers, however for me it is not all about how many ‘hits’ nor comments I get.  I have refrained from ‘monetizing’ the blog as some have done.  My primary source of income has always remained clinical patient care, my  flirtation with blogging coming in  a very close second calling.  Recently I have been getting more comments and personal comments of how the blog is seen by other bloggers, Twit contacts, Facebook and the other social networking media of the ‘new generation’ of afficionados of tech. 

Inaugural Train Express

 

 

The Health Train Express joins the Obama entrance into Washington, D.C. for the beginning of a new era for the United States of America.

I must confess, I was not a big Obama supporter, with many doubts about the man.  I may have been wrong.  His campaign rhetoric seems distant from his early administrative proclamations. 

What does the new administration bode for us in medicine?  We have seen countless new administrations telling  us now is the time to adopt universal health care.  Congress has never agreed on how to attain that goal, either due to the fact that the devil is in the details, or a lack of conviction that it is correct to do for the United States.

I leave it at this.  “God Speed” President Barak Obama, and good luck to the rest of us.

 

del.icio.us Tags: obama,congress,universal health care,campaign rhetoric,inauguration

Health Train Express Dining Car..."Caramel Macchiato Anyone?"

QUOTES TO MUSIC  (click to listen)

My ego has been inflated (more than usual) by inclusion of Health Train Express in Richard Reece's  700th blog.   This for me is akin to making "Oprahs"  list of books to be read before "End times".

Matt Holt's recent "WONK" summarizes Dr Reeces' consistent eloquence in each of his blogs.  Medinnovation is always a 'must read' and deserves a spot in your "feeds list".  Richard"s  blog and Matt's "The Health Care Blog"  are right up there with my

"Carmel Macchiato at Starbucks !!!

While the holiday season was ongoing this "west coast ophthalmologist" has relocated to a secret undisclosed location on the "Mid-Atlantic" coast. I decided to change risk factors from earthquakes to tropical storms, tornadoes, and an occasional hurricane.

 

The Warrior Refractive Eye Surgery Program, or in militarese  WRSEP

I am safely ensconsed behind firewalls, encrypted smart cards, and two levels of separate  passwords requiring 12 characters, 2 upper case, and five lower case as well as several  of those special characters, !@#$%&* (which I have to change every 90 days).  The EMR is called AHLTA.  Armed Forces Health Longitudinal Technology Application (formerly CHCS II ; US DoD military health system 

(I could go on and on about this HIT solution, but that is a topic unto itself. So stay tuned.

 

del.icio.us Tags: wellness,medinnovation,the healthcare blog,klepper,kibbe,holt,reece,wonk,ahlta,passwords,smartcards,starbucks