Impact of California’s Recession on Health Care

 

It would be inappropriate to ignore the effect of further cuts in California’s budget upon health in California. He proposed cuts to hospital and nursing home funding to lower MediCal costs; a 7 percent cut in In-Home Supportive Services;

"Amazingly, a year and a half into Brown's governorship and we still hear nothing of the unemployed," Del Beccaro said. "California will continue to face chronic budget deficits because so many people remain out of work.  Of course unemployed people do not have health insurance, and even if eligible many cannot afford COBRA coverage, either. 

Unemployment also has secondary direct and indirect consequences upon health. Reduced income affects nutrition. It becomes critical that low income people are educated about nutrition and the federal SNAP (formerly called “ Food Stamps “).

Physicians do not operate in a vacuum and it is important for them to inquire about employment.

A great percentage of the population in the U.S. is obese and paradoxically malnourished.

Gov. Jerry Brown's May Revise of California Budget 2012-12

 

While reductions to public services (IHHS) are significant the overall effects on Medi-Cal could be far worse.

Unemployment continues to be a major contributing cause to reduced state income and an ever upward spiral of deficits.  Has it reached a point of no return? Would you bring a business to California

Knowing what you now know, would you open a medical practice in California? Are you considering leaving California, or just leaving medicine.?

Technorati Tags: california,bankruptcy,budget deficit,medi-california,jerry brown

Medical Tort Reform in the Nutmeg State

 

While not a complete avalanche for malpractice tort reform, the docs of the nutmeg state seem to have held off the attempt to ease restrictions on filing malpractice suits against physicians.

The Connecticut Mirror  (Hartord, CT) reports:

You don't see this every day: The speaker, majority leader and minority leader all on the losing side of a 74-69 vote in the state House of Representatives.

On a bipartisan vote, the House on Thursday gutted a bill aimed at loosening the requirements for bringing a medical malpractice lawsuit, an issue that has sharply divided health care providers and plaintiffs' attorneys.

The bill would have altered a 2005 tort reform law that requires anyone who files a medical malpractice lawsuit to submit a written opinion, called a certificate of merit, from a "similar" health care provider to the one being sued, testifying to the appearance of medical neglect.

It sailed thorugh the Senate last week, but its backers were stunned Thursday night when the House gutted the bill by rejecting a Senate amendment that effectively had become the bill. After the rejection, the House leadership shelved the bill.

Eleven Republicans -- many of them lawyers -- joined 58 Democrats in support, but 41 Republicans teamed with 33 Democrats to kill the measure after opposition on the floor led by Rep. Prasad Srinivasan, R-Glastonbury, the only physician in the General Assembly.

Rep. Prasad Srinivasan, R-Glastonbury

The measure was aimed at preventing what health care providers said were frivolous lawsuits that contributed to rising malpractice insurance costs. But critics of the requirement have said it's too restrictive. They have pointed to cases that were dismissed because the physicians who wrote the opinion letters weren't considered "similar" to the ones being sued. In one case, a court dismissed a lawsuit against an emergency physician because the certificate of merit was written by a doctor who described himself as practicing trauma surgery, even though most of his work time was spent in an emergency department.

An earlier version of the bill would have changed the requirement for the author of the certificate of merit, from requiring a "similar" health care provider to a "qualified" one. That drew opposition from health care providers, who argued that it would gut the 2005 malpractice reform measure.

The bill the Senate passed Friday would not remove the law's reference to the need for a certificate of merit from a "similar" health care provider, but it also provides another option: The letter could be written by a health care provider who the court determines has enough expertise in the type of health care at issue in the complaint that he or she could testify as an expert on the standard of care. The certificate of merit would have to include a detailed basis for the provider's belief in the evidence of medical negligence, and identify one or more breaches of the standard of care.

Legislators from both parties described the proposal as a reasonable compromise, but the Connecticut State Medical Society said it did not endorse the bill as a true compromise.

 

Technorati Tags: tort reform,connecticut,malpractice

2012 The Year of mHealth

 

Mobile Technology

REGISTER NOW: An exclusive, live webinar
May 23rd at 1pm ET/10am PT

How does mHealth improve patient access to better care?

Mobile Health, or mHealth, is a rapidly growing strategy that many healthcare professionals say can increase efficiency, cut costs, provide better customer service, and help handle tough circumstances such as a remote or incapacitated patient. mHealth consists of the use of the latest communication devices and technology to bring healthcare services to the patient. Advocates claim the applications of mHealth are numerous, aiding with: remote monitoring, behavior modification, data collection, step-by-step instruction, question and answer forums, doctor visits, and even diagnosis.
Join us as our panel will provide their expert advice and answer your questions, as we ask:

• Has the public accepted the idea of mHealth? Do they agree that a "remote" doctor consultation provides value to the patients and improves the care process?
• Does this technology interfere with the professional ethos of physicians to examine and treat individuals holistically?
• Are there privacy concerns involved in taking healthcare to the communication networks?
• What are the Telehealth, Web, and Mobile phone models, and why does the model you use suit your needs best?
• What's in the future for mHealth?

If you cannot attend the live session, please feel free to register and you will receive an email notice when the archived webinar is available on-demand.

Register now to join us and ask these experts your own questions!

Dr. Marc Mitchell, MD, MS founder and president of D-tree International, is a pediatrician and management specialist who has worked in over 40 countries in Africa, Asia, and Latin America on the design and delivery of health care services.

Alex Blau, MD, Medical Director at Doximity, is a graduate of the University of California San Francisco School of Medicine and trained in emergency medicine at Stanford Hospital and Clinics.

Herb Rogove, DO, FCCM, FACP, is President/CEO of C3O Telemedicine, which is a multispecialty virtual practice that solves the problem of quick and affordable access to specialists in Tele-ICU, Tele-Neurology/Neurocritical Care and Tele-Psychiatry.

Moderator Brian S. McGowan, PhD is a research scientist who has worked as a medical educator, mentor, accredited provider and commercial supporter.

Sign up for this exclusive webinar »

Technorati Tags: mhealth,mobile apps,telehealth,telemedicine

The Battle over Health Care

 

Now that we have “Obama Care:” we have a proposal that indicates Americans do want a major health system revision. 

If one reviews the long term evolution of how this played out in Congress, Democrats were intent on getting ‘anything’ passed for the political expediency and gain, while Republican’s cool reception seemed to be more of a “we can get a better bill”, and were reticent to pass a global sweeping law that despite it’s voluminous size missed major key points to control costs.

eJanardan Prasad Singh, and Rosemary Gibson in “ The Battle over Health Care” continue on the theme of their previous book, “Wall of Silence” which was critically acclaimed.

Each of these books are available in electronic form. I read parts of Wall of Silence and found it emotionally draining, even after 40 years of treating patients. Equanimity and imperturbability only go so far.

The battle (s) over health care is by no means over. Passage of Obamacare sets the framework from which hopefully better solutions will arise.

According to Gibson the conundrum resides in the fabric of the American economy, corporate attitudes, profit margins, durable medical device manufacturers, and an insurance industry that has a firm lock on health care.

Gibson and Singh take a broader perspective on health care reform not as a single issue but as part of the economic life of the nation. The national debate unfolded while the banking and financial system teetered on the brink of collapse. The authors trace uncanny similarities between the health care industry and the unfettered banking and financial sector. They argue that a fast-changing global economy will have profound implications for the country’s economic security and the jobs and health care benefits that come with it, and they predict that global competition will shape the future of employer-provided insurance more than the health care reform law.

The judicial review serves as an interlude or recess in the process while the Supreme Court is faced with unlocking the myriad details of the law including but not limited to the ‘individual mandate”

One could say that politics should play no role in your healthcare, however the basic underlying relationships between the free enterprise system, insurers, providers, and patients has evolved into near anarchy….thus the government steps in.

Gibson and Singh provide the stage on which we are players, however they do not propose a solution.

Technorati Tags: health care,scotus,supreme court,gibson,singh,obama Care

A New Beginning in the Digital Health Space

 

Today’s post is the first using our new and as yet unproven template design. So follow along with me and send me your comments via twitter @glevin1 or on Google Plus.

The first design is called “Flip Card”.

We’ll be departing the station with some entertainment, “World’s 25 best Health Systems. Hope you enjoy the content and the music.  Blogs should not be boring, they should be fun.

Here we go !

World’s Best Health Care

Telemedicine

 

Sadly, the United States lags behind many other nations in applying telemedicine, however with concerns about increasing cost of conventional office visits it is now becoming  more common.

In Europe SAMU or (SAMU - System of Emergency Medical  Assistance)  in France- has been in operation for many years. A similar system operates in Brazil.

Telemedicine  incorporates the use of broadband and/or satellite communication between provider-provider provider-patient and provider-provider depending upon the need.

Telemedicine is defined the use of telecommunication and information technologies in order to provide clinical health care at a distance. The term includes a wide array of functionality

Most patients and providers picture a physician at one end of a link sitting in front of a video monitor talking to a patient in a different location.  However telemedicine is much more inclusive, including the following.

Telemedicine can be broken into three main categories: store-and-forward, remote monitoring and (real-time) interactive services

Contents

• 1 Disambiguation  Telehealth, eHealth (Health 2.0) can define the use of internet.
• 2 Early precursors
• 3 Types of telemedicine
  • 3.1 Categories
  • 3.2 Emergency telemedicine
• 4 General health care delivery
  • 4.1 Benefits and uses
  • 4.2 Telenursing
  • 4.3 Telepharmacy
  • 4.4 Telerehabilitation
  • 4.5 Teletrauma
• 5 Specialist care delivery
  • 5.1 Telecardiology
  • 5.2 Telepsychiatry
  • 5.3 Teleradiology
  • 5.4 Telepathology
  • 5.5 Teledermatology
  • 5.6 Teledentistry
  • 5.7 Tele-audiology
• 6 Licensure
• 7 U.S. licensing and regulatory issues
• 8 Advanced and experimental services
  • 8.1 Telesurgery
• 9 Enabling technologies
  • 9.1 Videotelephony
  • 9.2 Health information technology

Real Telemedicine in Action, Ready for the big time

Thousands of heart patients can take advantage of new technology at two Piedmont hospitals that makes their lives much easier.

Cone Health and Forsyth Medical Center are part of a pilot program testing Carelink Express by Medtronic. Carelink allows doctors to collect information from defibrillators and pacemakers in five minutes, much faster than before.

Steven Klein, cardiac electrophysiologist at Cone Health, said hospitals used to call in technicians at all hours of the day to get information from the implant.

“Once they made the decision to do it, it would probably take 30 minutes to an hour before someone could get there to look at the information,” Klein said.

And if there’s nothing, patients can be released more quickly, saving them money, Klein said.

“The patient care is improved because they don’t have to spend so much time in the emergency room,” Klein said.

Carelink device also allows doctors to get information while the patient is at home.

The pilot program will last for another six months. If things continue to go well like they have been so far, the technology will expand to other parts of the country, Klein said.

Surveys indicate the increasing use of telemedicine in daily operations. It will undoubtedly become main-stream as reimbursement standards address the cost of this functionality. Even with the expected increase in capital investment the savings will more than offset the  expense and a documented ROI.

 

Technorati Tags: samu,telemedicine,telehealth,teleradiology,broadband,health20,monitoring,eHealth

Summary of HIT Meetings and Offerings in May and June

 

HIT offers multiple events in May and June 2012

Here are the first 14 events scheduled on/after May 11, 2012

MAY 14

DOD, VA Meeting on Data Sharing, Integrated EHRs

May 14-15, Alexandria, Va.

MAY 14

Health 2.0 Spring Summit on Health IT, Innovation

May 14-15, Boston

MAY14

Harvard Summit on Leadership in Health IT Sector

May 14-18, Boston

MAY 15

Meeting of ONC's Meaningful Use Panel, Subgroup 2

May 15, Online, Teleconference

MAY 16

Meeting on Taking Small Steps in Mobile Health

May 16-17, Palo Alto, Calif.

MAY

22

Brookings Event on Mobile Technology, Health Innovation

May 22, Washington, D.C.

MAY 24

HealthTech's Annual Exhibition, Conference

May 24-25, San Francisco

MAY

30

Meeting of ONC's Meaningful Use Panel, Subgroup 2

May 30, Online, Teleconference

JUN 5

Meeting of ONC's Meaningful Use Work Group

June 5, Online, Teleconference

JUN 5

Third Annual HDI Forum & Health Datapalooza

June 5-6, Washington, D.C.

JUN 6

Summit on Issues Related to Health Data Privacy

June 6-7, Washington, D.C.

JUN 12

Conference on Health-Related Video Games

June 12-14, Boston

JUN 14

Summer Summit on Successful Use of Digital Health

June 14-15, San Diego

SEP 9

Mayo Clinic's 2012 Symposium on Health Innovation

Sept. 9-11, Rochester, Minn.

Read more: http://www.ihealthbeat.org/events.aspx#ixzz1ub6IrgcB

CHCF releases results of Medi-Cal Survey

 

According to a new survey by the California HealthCare Foundation, most Medi-Cal enrollees have a favorable view of this essential health coverage program. However, barriers to access and enrollment exist.

If upheld by the Supreme Court, the Affordable Care Act could add two to three million people to the Medi-Cal program, potentially exacerbating the issues raised by enrollees.

CHCF announces a Sacramento briefing that explores the results of this survey of more than 1,000 Medi-Cal enrollees — the largest of its kind. Presenters will explore the experiences and attitudes of enrollees to illuminate where the program excels and where improvement is needed.

They will also consider implications of the findings for state lawmakers and program officials who are considering ways to slow the growth of Medi-Cal spending as they prepare to integrate millions of new enrollees. A series of short videos will offer individuals' reflections on their experiences with the Medi-Cal program.

Presenters and panelists include:

• Len Finocchio, associate director, California Department of Health Care Services
• Elizabeth Landsberg, director of legislative advocacy, Western Center for Law and Poverty
• Chris Perrone, deputy director, Health Reform and Public Programs Initiative, CHCF
• Tresa Undem, partner, Lake Research Partners

The conference will be broadcast via Webinar or you  can attend in person.

 

Technorati Tags: medi-cal survey,chcf

Health Information, Social Media and Broadcasting

 

              

At this point in my writing most of you now realize I have become indoctrinated in all aspects of social media, from Twitter and Facebook to the new G on the block. No not Guy…but G+.  Google plus offers some unusual features, the best of which in my opinion is the  Google Plus Hangout.  A new feature which just ‘rolled out’ is the ‘Hangout Live On Air”.  

A normal hangout allows for a total of 10 participants, nine others besides you. Google now owns You Tube and has integrated many features from YouTube into Google and vice-versa.  The integration of this feature allows for an unlimited audience as the broadcast occurs beyond the limited 10 in the hangout. In addition the HOA is recorded, archived and can be viewed at anytime.

What does all this cost…you ask ? Zilch, if you discount the need for a broadband internet connection and a computer capable of supporting a web camera.

I hope that some of you will join the G+MD hangouts to be held regularly to organize this as a regular “Hangout Event”  It will be titled  “Medical Minutes”.

The initial hangouts will consist of some ‘housekeeping tasks” and organizational information. If you use twitter set a hash tag for #glevin1. Announcements schedules will be sent via twitter and Google plus. The Stream is at +Digital Health Center.

 

Technorati Tags: Google +,Google Hangout,G+MD,hangout on air,digital health space,twitter,facebook

Report: Some Good News California Health Care Spending Grows, Rate Slows

 

Despite my gloomy report yesterday on the failures of many medical and group practices, todays statistics offer some encouragement.

Total spending on health care in California grew by almost 300% from 1991 to 2009, but the state's spending growth rate has slowed in recent years, according to a new report from the California HealthCare Foundation, the Los Angeles Times' "Money & Co." reports.

According to the CPI as published by the U.S. Dept. of Labor the overall rate of inflation for the CPI is 2.7% for the last 12 mos. (03/12) and 0.3 for 03/12.

Medical care commodities             

                        09/11  10/11 11/11 12/11 01/12 02/12   03/12     
                            2    .3    .2    .2    .6    .8    .4         0.8           0.4     end 03/12 3.3

CHCF publishes California Healthline.

Report Findings

According to the report, "Since reaching its peak of 9.7% in 2003, the pace of growth in health spending has been decelerating. By 2009, towards the end of the recession, spending grew [by] 4.5%, similar to the U.S. rate of 4.6%, and the slowest pace since 1999." Although medical inflation continues to exceed the general increase in the CPI the rate of increase is declining,  with the general CPI at 2.7%  and the Medical CPI at 3.3%

The report also found that:

• Health care spending in California per capita in 2009 was $6,238, the ninth-lowest in the U.S.;
  
• Spending on health care accounted for 12.2% of California's economy, a smaller portion than most states;
  
• Hospital and physician services accounted for the majority of health care spending, at 63%; and
  
• Medicare and Medi-Cal, California's Medicaid program, accounted for nearly 40% of the state's health care spending, compared with 27% in 1991 (McMahon, "Money & Co.," Los Angeles Times, 5/9).

 

Technorati Tags: cpi,consumer price index,medical cpi,inflation

Shocking Medical Financial News

During the initial period of my medical practice in California (1970-1980) the finances of running a medical practice seemed straight  forward. In 1980 things began to change and by 1986 most physicians were bracing themselves for what seemed to be an Armageddon.

Looking at physical facilities for medical clinics and hospitals and the  development of marketing techniques and continuing profitability of insurance companies and their stockholders it  became apparent who was suffering the most…providers and patients.

I had the opportunity to review financial reports from the California Health Care Foundation.  I knew things were bad, but had no idea how bad it has become.

 

Beginning in 1999 until  May 1,  2012  there were 260 medical groups that were closed due to financial failure and/or absorbed by another entity. 5,695,685 lives were effected by these group closures.  NUMBER/PERCENT OF CLOSURES DUE TO FINANCIAL PROBLEMS 97/ 37.3%.

The CHCF report is 46 pages long and can be found amongst these other reports:

PDF File 1

PDF File 2

PDF File 3

ZIP File 4

PDF File 5

PDF File 6

PDF File 7

PDF File 8

PDF File 9

 

Approximately one in five Californians lost continuity of coverage, or moved to another group. The not so hidden legal costs are obvious and added to the legal tort fiasco.  Other financial impacts are not accounted for by the inefficiency involved in transferring care to  a new doctor or medical group.

In Summary":

Highlights for 2009 include:

• Health spending in California reached $230 billion, triple 1991 levels.
• California's per-capita spending of $6,238, was the ninth lowest in the nation. By comparison, the US spending per capita was $6,815.
• Health spending accounted for 12.2% of California's economy — a smaller share of the economy than most states or the nation.
• Hospital and physician services continued to account for the majority of spending, totaling 63%.
• Medicare and Medicaid accounted for nearly 40% of California health spending, up from 27% in 1991.

Read more: http://www.chcf.org/publications/2012/05/health-care-costs-101#ixzz1uLUqbwej

What will health information technology, health information exchanges, electronic health records, accountable care organizations, outcome studies, new ICD codes, elimination of procedural based reimbursement accomplish.

How will our system increase the number of primary care physicians.

All these issues face the current and next generation of health experts and physicians.

 

Technorati Tags: health reform,medicare,medicaid,medical group closures,bankruptcy

My Struggles with Social Media

 

Breaking Blogs (from Summify)

Doctor’s Love-Hate  Relationship with Electronic Health Records…It goes something like this  LOVE/HATE

Creative Destruction, What it Means for Healthcare, Clinical Practice and Consumers?

It goes a bit like this, Creative Destruction

Insurers Embrace 'Virtual' Doctor Visits’ (does this mean they will pay for them?)

 

Strategic Investment in Health Resources (Financial)  Editor’s note: Dave Chase is the CEO of Avado.com, a patient portal & relationship management company that was a TechCrunch Disrupt finalist.

 

Following in a long shadow cast by eminent blogger and social media expeert, Dr. Mike Sevilla (formerly known as Dr Anonymous) Health Train Express will partner with Digital Health Space for a series of interviews on Google Plus Hangouts, Live on Air

I am developing a list of interested social media experts in health care for an interview. Social media in healthcare is a  rapidly developing function for patient involvement in a niche unrelated to HIPAA regulations.  Our goal is to educate providers and hospitals how to use the new platforms safely without violating the law.

Check back here or at Digital Health Space for upcoming events.

 

Technorati Tags: google plus,google plus hangouts,live on air,summify,electronic health records,twitter,facebook,hipaa,creative destruction,virtual doctor visits

Social Media and Meaningful Use…will be Symbiotic for Digital Patient & Provider Empowerment

 

Now that is a mouthful, one that came to me while reading an article from Healthcare  IT News.

Jennifer Dennard, Billian's HealthDATA, Porter Research, HITR.com talks about “Blowing the Social Whistle on Patient Acquisition” Jennifer Dennard is Social Marketing Director for Atlanta-based Billian's HealthDATA, Porter Research and HITR.com. Connect with her on Twitter @SmyrnaGirl.

***********************************************************************

Social Media seems a total disconnect from criteria for meaningful use of electronic medical records and the ability to qualify for incentive funding by Medicare.  Well, guess again. One of the Meaningful Use, stage II requirement is digital inclusion of patient involvement in access to electronic portals, and medical data.

Not only does Stage II of Meaningful Use call for patient portals and the like it will require enticing patients to use them

This is where Social Media becomes almost essential to a medical practice. “The ‘empowered patient’ responds to this type of marketing – they don’t even pay attention to traditional media. They are the influencers. As Stage 2 of Meaningful Use comes out and providers are required to activate patients online, they’ll need to grab the empowered patients they already have and turn those folks into evangelists.”

It’s a marketing concept not unlike that used in traditional consumer areas. Connect with consumers online, establish trust and credibility with those fans/followers, and then make them an evangelist for your product. Eventually, their fans, followers and family members will also become your customers. That’s the simplified version, anyway.

Sengbusch and his team realize that providers will often jump out of their comfort zone to engage with patients in these more social areas. He stresses that it’s important docs realize “they don’t personally need to be on social media, but they need to be open to their brand being on social media so the can capture positive reviews and become aware of patient advocates.”

And now the added attributes required for Stage II meaningful us.

 

Technorati Tags: medicare,meaningful use,social media,emr,patient portals,web,health it tutorials,#hcsm