Analysis for 2011

Pronouncements From on High

LOS ANGELES, CA -- (Marketwire) -- 01/11/11 -- The sluggish economy and the farthest-reaching health reform in more than 50 years will continue to ratchet up pressure on U.S. providers to reduce costs and improve quality, setting the stage for The Camden Group's annual Top 10 Trends in Healthcare in 2011. These pressures will trigger an avalanche of activity centered on accountable care organizations (ACOs), bundled payments, and patient-centered medical homes. At the same time, they will compel more physicians to seek employment with hospitals or large medical groups and spur more consolidation of hospitals and medical groups/independent practice

"2011 is the year when a growing number of providers move forward with new care delivery models and run into the very real challenges posed by overhauling traditional ways of treating patients. The fundamental question is whether providers can manage costs and improve quality while maintaining provider choice and open access," says Steven T. Valentine, president of The Camden Group. "As always, the devil is in the details."

Yes, indeed it is. (Health Train Express)

Further predictions:

The Camden Group    predicts the following Top 10 Trends will have major and continuing impact on the healthcare sector during 2011:

1. Insurance membership takes hit from slow recovery. Few unemployed will take advantage of COBRA while employees, faced with paying more of their health plan premium, will select high-deductible, low-premium PPO plans, hurting HMOs.

2. No easing on payment pressure. Although health plan payments will keep pace with inflation and operating cost increases, they will not make up for declining or stagnant Medicaid and Medicare payments.

3. Patients postpone care, hurting providers too. With high unemployment and underemployment and increased out-of-pocket costs, people will continue to put off treatment, keeping volumes at hospitals, ambulatory centers, and physician offices soft.

4. Cost is king. Soft volume, downward pressure on revenues, and deteriorating payer mix with increased bad debt will drive providers to seek more cost savings. However, unions, staffing ratios, and regulations will make cuts difficult. At the same time, health plans will begin to explore and increase the use of tiered networks and stratify payment to encourage use of lower-cost providers.

5. Capital remains elusive. As in 2010, most non-profit hospitals will find it difficult to access capital. Lenders are requiring an increase in days cash-on-hand, coverage ratio, stronger EBITDA, and smaller borrowings. Credit rating agencies want to see: 1) physician alignment strategy, 2)clinical integration and cost reduction action, 3) IT plan, and 4) plans to capture more market share.

6. Physicians make or break new care models. To improve outcomes and lower costs, hospitals and medical groups will focus on accountable care, bundled payments, patient-centered medical homes, and/or clinical integration. Reducing variation in care -- primarily by physicians -- will be central to any successful strategy. An effective bundled payment strategy, for example, requires specialists to address clinical resource consumption and supply cost and use while standardizing care protocols in conjunction with hospitalists and intensivists.

7. Construction focus is on fast returns. Construction projects will be scaled down, with a focus on regulatory compliance, enhancing throughput, improving care/outcomes, and if possible, capturing additional market share. Providers also will prioritize construction that generates superior returns, such as surgical services and imaging centers. Do not be surprised to see the growth of freestanding emergency departments to reduce the need for hospitals, increase access, and provide capacity for the newly insured.

8. IT becomes more pervasive -- or else. Information technology underpins providers' ability to shift to new care models, so IT moves to center stage with efforts to implement electronic medical records, (EMRs,) computerized physician order entry (CPOE), and health information exchanges (HIEs.) Provided, of course, medical facilities already have in place ePrescribing, PACS, and online results reporting and scheduling.

9. Let's make a deal. Mergers and acquisitions will be brisk as more hospitals and physician groups acknowledge they lack the resources to invest in information technology, facilities, and equipment for new delivery models or the leverage to negotiate effectively with health plans. Given their central role in new models, the value of primary care medical groups will increase. It is possible that health plans will enter the market to acquire these medical groups.

10. Market share, market share, market share. Hospitals and medical groups have underutilized assets and must get them busy. Providers also realize that more volume will generate incremental revenue and decrease per unit cost. Hospitals will hunt for new programs to fill empty or underperforming assets.

 

We also need to factor in the “Social Media Impact” on ACOs

Social Media goes to the E.R.

Pretty soon it will be all F.U.B.A.R.

del.icio.us Tags: aco,accountable care organization,market share,cost,underperforming assets

Stem Cell and Grievous Brain Trauma.

 

First let’s go over to KevinMD where my post about Public Health, and MPH’s has been re-posted by Kevin Pho MD.  I had actually forgotten about this post and did not know which one Kevin had chosen.  As a PCP my  post must have tweaked his Kool-Aid dispenser.

 

Personally I prefer Gatorade or G2, the drink for 21st Century Health Care.

My post today is about Stem Cell Research and it’s potential for Translational application to severe head injuries such as the one sustained by Gabrielle Gifford, Congresswoman from Arizona.

My thoughts are an imaginary scenario of injecting central neuro-stem cells into the wound tract of the bullet’s pathway. There it would  become part of the healing process, integrating, transforming and establishing new connections to replace those destroyed by the injury.  If only life and medicine were ever that simple.

The only positive aspect of this horror would be to stimulate a young (or old) clinical and basic science team to embark on the animal, pharma, and microbiology study toward succeeding in that goal.

 

del.icio.us Tags: Gabrielle Gifford,Stem Cells,Kevin Pho,KevinMD,Public health,MPH

The Medical Blogosphere

 

KevinMD.com will be hosting Health Train Express tomorrow, Monday January 9th 2011 . You can look for it at KevinMD.com

Kudos  to Dr. Pho !  All good  things start and end in New Hampshire.

Kevin Pho. MD has been at this about the same amount of time that I have been at my blog space.  Judging from the number of ‘hits’ his site has daily compared to mine reveals how ignorant I have been in regarding to the new age of information exchange.

I seem to know what to do,  but just have not invested time, money or staff into doing it.  He has been published in many big-time media spaces, such as CNN, USA Today,

Kevin’s appearances include the CBS Evening News with Katie Couric, New England Cable News, and WNYC-New York Public Radio’s The Takeaway, and he has spoken at the New England Journal of Medicine, Blog World and New Media Expo, and at academic Grand Rounds nationwide.

As social media’s leading physician voice,KevinMD.com was voted 2008′s Best Medical Blog.Forbes.com calledKevinMD.com a “must-read health blog,” and CNN.commanded @KevinMD one of its five recommended Twitter health feeds.

The Wall Street Journal had this to  say about KevinMD, ““punchy, prolific blog that chronicles America’s often dysfunctional health care system through the prism of a primary care provider,” while others have noted that “a lively comment stream on one of Kevin’s posts provides more insight on the day-to-day realities of health care than any piece of journalism can ever hope to impart.”

Forbes.com hailed KevinMD.com as a “must-read blog,” and CNN.com named @KevinMD as one of its five recommended health care Twitter feeds.

Kevin Pho on the Medical Blogosphere

 

With over 40,000 RSS subscribers and 33,000 followers on Facebook and Twitter, KevinMD.com is among the web’s most influential and prominent health care platforms.

Dr Pho, when do you have time to make an appointment for me?

del.icio.us Tags: blogosphere,medical,kevinmd,medical bloggers,medical social media

Health Train Leaves the Station (again)

 

The Health Train Express is moving once again, leaving the not so grand central terminal. 

The 112th Congress, 1st session has commenced, with another full plate regarding unraveling Obama care The first day consisted mostly of procedural matters.

Early today Speaker John Boehner had this to say early this morning regarding Obama care in preparation for the upcoming debate on new legislation to repeal all or parts of Obama care.  The discussion and vote which were to have taken place this week is to be postponed due to a procedural delay designed by Democratic opponents of repeal.

Speaker John Boehner ®

 

Greg Scandlen posted his “Welcome Freshman'” lecture to the  neophytes, and newbies in congress about the disastrous Obama care law.

My comments are (Yogi Berra), “It isn't over until it’s over.) We physicians must continue our opposition to this law, but not the goal of expanding health care coverage to many more of our citizens, and improving outcomes, reducing cost by increasing efficiency and reducing mindless bureaucracy.

del.icio.us Tags: health reform,Boehner,112th congress,obamacare,greg scandlen

Repeal the Health Train Express

 

Michelle Malkin has an interesting proposal, about Health Reform  H.R. _________________

The House Republicans have announced their plans to put the Obama care repeal up for a vote during the week of January 10, 2011. This evening they posted the text of the proposed legislation to the GOP House Committee on Rules website.

WAIVER-MANIA continues:

Malkin has this to say about current activity to alter or repeal the current Obama care Law.

Over the past two months, we’ve been tracking the burgeoning list of unions, companies, and insurers who have used an HHS escape hatch to avoid the costly, destructive consequences of Obama care for their members and employees (see here, here, here, and here). The list keeps growing. Jamie Dupree has the latest update on what I’ve been calling Waiver-mania! More unions and companies that employ low-wage workers have gotten their pass now. The official Obama care refugee list (here) is now at 222.

del.icio.us Tags: health reform repeal,obama,house republicans,michelle malkin,health train express

Non Compliant Physicians: Guilty Until Proven Innocent

 

Liberty Loves Justice

Richard Reece, MD in his blog, Medinnovation today discusses increasing regulatory action, “drastically increase physician legal compliance obligations and potential liability under federal fraud and abuse statutes and the suspension of the government’s need to prove “intent” will create a compliance environment many physicians will find problematic”.

Henry Faird, Computer Scientist , Dartmouth, NY Times January 1, 2011

“With every technology, there is a dark side. Sometimes you can predict it, but often you can’t.”

Many call this ‘the butterfly effect”or another interpretation, ‘remote causation’.

“It uses different techniques and approaches to bring physicians into compliance - whistleblowers to spot offenders, computer protocols to guide ordering behaviors, electronic federal audits to identify coding abuses, new regulations compelling compliance, and creation of new organizations – accountable care organizations – using capitated payments to end fee-for-service billing”,and by identifying those physicians who violate compliance rules, reformers hope to shed light on what they consider to be a dark side of medicine - physician ordering practices that enhance income for themselves and hospitals in which they practice.

 

As with any top-down, Washington-based government program to regulate private behavior, there are dark sides to what government is trying to do.

•  
  • In the first place, government compliance is by its very nature retrospective. Regulators are not present at the physician-patient encounter and have little idea of the circumstances, dynamics, or context of what occurred or what was ordered at the point of care.
  
• • Second, medical coding is so confounding, confusing, and byzantine that nobody – including government – understands its nuances and complexities. The reality is that about 20% of physicians under code while about 5% over code.
  
• • Third, much if not most of the $60 billion of fraud and abuse that occurs in Medicare, is carried out by non-physicians who steal patients’ Medicare identity cards, set up storefront Medicare and Medicaid mills, and bill for items such as wheelchairs and other equipment or devices.
  
• • Fourth, herding doctors into accountable care organizations and consolidating care in large medical institutions, which have the administrative skills only large organizations possess, will not necessarily lower costs. Costs are invariably higher for hospital charges for inpatients and outpatients, in part due to “facility fees,” than for those performed by physicians outside hospital walls or jurisdictions.
• Fifth, some 70% to 80% of care is delivered by independent private physicians on a fee-for-service basis, usually through existing, often very sophisticated billing systems.. Converting or modifying these systems or integrating them with electronic billing systems will be a herculean, long-term task, fraught with certification and standardization difficulties.
• • Sixth, there is a Big Brother aspect to all of this. Already computer controlled camera surveillance systems are being installed in hospital rooms. These systems come with ominous computer-generated voices that announce to doctors and nurses, “ You have not washed your hands.”

An entire new industry is spawning, with consulting specialists, compliance attorneys, and their legions of clerical assistants.

And finally Dr. Reece forecasts these ‘dark aspects’ of health reform,accountability, and non-compliance.

“I can foresee camera. face recognition, and computer surveillance systems in doctors’ offices. I pray this will not occur. These systems have the potential to destroy confidentiality, limit personal freedoms, and induce physicians paranoia. Privacy is central and essential to effective medical care. “

Crazy ideas,  I think not !  Who would have ever forecast the use of body scanners at airports, invasive monitoring of routine electronic communications, emails, data mining without consent or prior knowledge…who would have thought a President would bypass congressional consent for appointments (such as the head of CMS.), nor the congress sending sweeping health regulatory law , empowering the Secretary of HHS with total control over health care reform.without reading nor analyzing it’s ramifications not just for health care, but the overall secondary impact on the foundering U.S. economy.

Citizens should be outraged an should not be duped into  believing (Doctor) Sam will “care for them”. 

del.icio.us Tags: dark side,HHS,Congress,Health Reform,Don Berwick,compliance,health regulation,accountable care organization,fraud and abuse,medinnovation,health train express

Cleaning Health Train Express

 

 

At the end of the year it’s time to clean house. Yes, it is  a bit early for Spring Cleaning, but Health Train has been advised of  climate change and perhaps increased ambient temperatures, and perhaps an early spring so here goes. Costco is already stocking up for spring and spring break, and the Easter flowers, bunnies and water toys are displayed.

Health Train reviewed the blog friend list and found only three blogs that have been dormant for more than six months.  Frankly I was surprise to see the longevity of health blogs. 

Observation #1

There appears to be two classes of health blogs:

1. Those dedicated to  patient information, case studies, educational information and anecdotal stories. Some are very sad, some are inspiring, and some despair at the follow of some humans who are resistant to being helped in their suffering.

2. Those dedicated to political issues, rants, raves, frustration at the realities of medical practice today. A great deal is published by ‘medical experts’ without clinical experience but ‘grounded’ with MBAs, MPHs, and those on ‘committees, or national foundations.  Some of these ‘experts’ have considerable power and authority to make decisions that effect our patients.

3.Blogs related to health information technology and the ‘build out’ of the medical digital world.

In addition to blogs, there are other more structured forums:

Medpedia, which aggregate a large number of health blogs.

SERMO, a physician only blog limited to licenses MDs. This blog has specialty sections, and sections devoted to political commentary, practice management. The site is supported by Pharma and mined for physician comment about treatments. No patient information is disclosed.

Large media publication blogs (columns, such as WSJ, NY Times, LA Times and newspapers from cities around the United States.

Community Groups dedicate to specific disease entities

The Health Well,  an aggregation of many health blogs, and journal references

Futurists weight in with prognostication seeing into the future with what seems to be unwarranted certainty at the outcome of health reform.

 

Here’s Johnny. You make up the answer and question.  The best answer about health reform, (post in comments) will receive an iPad. The deadline for entering is January 31, 2010

del.icio.us Tags: free iPad,Carnac,Health Blogs,forums