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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, April 20, 2009
Sunday, April 19, 2009
AMA joins the Health Train Express
Who said the American Medical Association is out of touch with today's rising provider stars under the age of 55? Not relevant? Does not represent the vast majority of physicians in regard to government regulations? A group of Medical Politicians? Not so! The AMA now has a place on Twitter, and "Twits" about all things medical. Actually the correct term is "Tweet".
Tweetie Pie is a 1947 Merrie Melodies cartoon directed by Friz Freleng and produced by Warner Bros. Cartoons, depicting the first pairing of Tweety and Sylvester.
I hope that my dues to the AMA are not being spent on this 'ridiculous' means of marketing and communications. The twits are limited to somewhere around 140 characters. Twit is actually meant for cell phone and smart messaging. It is equivalent to your pager going off to tell you about some medical news or other item the AMA deems important to physician members. (They ought to spend more time and money for information flowng at them, not from them.)
I started this particular entry several days ago......not much interest now in finishing it.
On to more challenging issues, such as how and why TARP is around and how we will be 'stimulated' and prodded to adopt EHR and HIT. There is much material to review and I will be back!!
Sunday, April 12, 2009
Misdirected Heat IT Funding Chapter II
I never think of the future. It comes soon enough. |
....There are other ways to utilize HIT in direct patient care that would create enormous dividends and decrease medicare and private payments to hospitals.
The Silver Bullet Approach
A recent study revealed that a great number of medicare beneficiaries are re-admitted to hospital within 30 days of their discharge due to inadequate post discharge followup.
The study published by the New England Journal of Medicine states, "Twenty-two per cent of Medicare hospitalizations were followed by a readmission within 60 days of discharge. Medicare spent over $2.5 billion per year (24 per cent of Medicare inpatient expenditures) on such readmissions between 1974 and 1977. This study supercedes similar studies in 1994-1996, and 1984-1986. The study cohorts are not similar in demographics or provider institutions and may not be comparable.
In this study, the cost of unplanned overcapitalization in 2004 was estimated to account for US$17.4 billion of the $102.6 billion in hospital payments from Medicare. A large percentage of bounce-back admissions appear to be related directly to poorly coordinated transitions of care. Given that a woeful percentage of patients attend follow-up visits, tremendous improvement might be possible if patients were seen by their primary care physicians within a few weeks after discharge.
Other articles explain how medicare's prospective payment as well as DRG reimbursement plan has created this
difficulty and increased expenditures,and how improvement might be possible if patients were seen by their primary care physicians within a few weeks after discharge. (Does a shorter hospital stay reduce costs and/or increase readmission rates. ) Are patients stable on discharge?
Would HIT spending in this area, applied in a systematic way reduce these expenditures? Why spend it all on EMR and HIE?
Richard Reece MD, who writes in Medinnovation Blog elaborates on how these billions of dollars might well be apportioned more wisely.
Misdirected Health IT Funding
Let it be said that the Federal Government knows how to spend money on the wrong things in the wrong way.
THE SILVER BULLET APPROACH
One of the hypothesis (and yet to be proven) is that EMRs, and Health Information Exchanges will lower costs for medicare and private insurers.
The recent promises of using stimulus funds to promote health information technology while well intentioned has not been well thought out.
The financial structuring of the incentives is to 'rush' to implementation. This will actually encourage the adoption of immature and inadequate electronic medical record systems. Interoperability and certifications do not ensure an efficient or useful EMR.
Those providers who adopt this incentive thinking that the initial payoff in incentives will offset any possible penalties for delaying implementation. Furthermore they may adopt a system that will actually cost them more in the long run, by being inadequate for their use.
This legislation for HIT funding is fueled by industry lobbyists (vendors), and organizations such as HIMMS which are largely directed by vendors themselves.
They wait at the doors of "public funding" for their take of stimulus funds.
Adopter
Saturday, April 11, 2009
Ask not what you can do for your Country, ask what your kids can do for you???
What did we ‘baby boomers’ do right?? How come almost everything we attempt to do, turns out to harm us more than help us??
Cover you A-s
I came across this on Matt Holt's ''The Health Care Blog" this AM during my usual scan of the health blogosphere.
Blogging has surely tapped into sources that most physicians have neither the access, nor time to analyze.
The health care situation" has now been posited for the iminent financial underpinning of the economy and it's rush toward doom. Numerous bean counters will bemoan the fact that the
health care portion of the economy is increasing in relation to the GDP to the point where it is unsustainable.
Will a "Universal Payor" (socialized, or privatized) do anything to reverse this trend?? Most providers recognized the inherent inefficiencies and redundant bureaucratic organizations operating in the healthcare sphere.
Health care has been labelled as 'the driving force' toward financial doom as it's financial underpinning and never ending demand for services.
In the past, venture capital funding for health care has been meager when compared to the rest of the financial world.
Tim Mullaney in The Health Care Blog discusses the Psilos Group's plan to raise 450 million dollars. The fund support Health Care Technology and Services.
Saturday, March 21, 2009
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.
Sunday, March 15, 2009
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.
Health Train Humor
Marge, it takes two to lie. One to lie and one to listen. |
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.
Saturday, March 7, 2009
Monday, March 2, 2009
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.....
Tuesday, February 17, 2009
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).
- "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).
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.
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"