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Regina Holladay is a unique person and contributor to health care social media. Her love transcends the paints on her canvas. I cannot help but to put her work in my blogs at least twice a year. I hope it will bring to mind the human spirit in all of us, no matter our travails and challenges of daily life.
Cut to the chase and the Bottom Line:
If you are an employer, or an employee here are undisputable facts that have been and are contributing to rising health care costs and absenteeism.
“An underlying premise of the Affordable Care Act provisions that encourage employers to adopt health promotion programs is an association between workers’ modifiable health risks and increased health care costs. Employers, consultants, and vendors have cited risk-cost estimates developed in the 1990s and wondered whether they still hold true. Examining ten of these common health risk factors in a working population, we found that similar relationships between such risks and total medical costs documented in a widely cited study published in 1998 still hold. Based on our sample of 92,486 employees at seven organizations over an average of three years, $82,072,456, or 22.4 percent, of the $366,373,301 spent annually by the seven employers and their employees in the study was attributed to the ten risk factors studied. This amount was similar to almost a quarter of spending linked to risk factors (24.9 percent) in the 1998 study. High risk for depression remained most strongly associated with increased per capita annual medical spending (48 percent, or $2,184, higher). High blood glucose, high blood pressure, and obesity were strongly related to increased health care costs (31.8 percent, 31.6 percent, and 27.4 percent higher, respectively), as were tobacco use, physical inactivity, and high stress. These findings indicate ongoing opportunities for well-designed and properly targeted employer-sponsored health promotion programs to produce substantial savings.
These are all good assumptions, now let’s put some of this into action (a Physicians story about himself)
Fit4Life Radio
John C. Goodman, PhD, is president and CEO of the National Center for Policy Analysis. He is also the Kellye Wright Fellow in health care. His Health Policy Blog is considered among the top conservative health care blogs where health care problems are discussed by top health policy experts from all sides of the political spectrum.
Don’t take my word for it. John Goodman argues with Paul Krugman regarding this issue. Krugman tells us that thousands will die if PPACA is refuted. Krugman bases his opinion on Mitt Romney wanting to let people die. I don’t think Romney ever said anything like that.
The economic profession also disputes Krugman’s theory. But there is something that does cause people to die: socialism. More precisely, the suppression of free markets (the kinds of interventions Krugman routinely apologizes for) lowers life expectancy and does so substantially.
Economists associated with the Fraser Institute and the Cato Institute have found a way to measure “economic freedom” and they have investigated what difference it makes in141 countries around the world. This work has been in progress for several decades now and the evidence is stark. Economies that rely on private property, free markets and free trade, and avoid high taxes, regulation and inflation, grow more rapidly than those with less economic freedom. Higher growth leads to higher incomes. Among the nations in the top fifth of the economic freedom index in 2011, average income was almost 7 times as great as for those countries in the bottom 20 percent (per capita gross domestic product of $31,501versus $4,545).
What difference does this make for health? Virtually, every study of the subject finds that wealthier is healthier. People with higher incomes live longer. The Fraser/Cato economists arrive at the same conclusion. Comparing the bottom fifth to the top fifth, more economic freedom adds about 20 years to life expectancy and lowers infant mortality to just over one-tenth of its level in the least free countries.
None of these facts really matter because a pre-conceived idea of ‘free health care"’ or universal coverage will negate underlying experiences throughout the world.
Riverside, California
November 11, 2012
A service of Digital Health Space for Providers
The re-election of Barak Obama was a cliff-hanger, and makes the implementation of the PPACA a likely scenario. It is possible there will be necessary amendments to the law. Many medical organizations are intent on this goal, including medical associations, hospital associations, provider organizations as well as many insurance companies.
At the time when this bill was passed into law it was not a bi-partisan agreement, leaving out advice and recommendations from almost half of the country's representatives.
The American Medical Association did a flip-flop at the last minute endorsing PPACA, however it may not have been a true representation of providers.
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This week's important events:
This week's top news is the re-election of President Obama.
Hospital mass layoffs for 2012 expected to match 2011’s numbers
Last Distraction Removed from California Health Reform
A service of Digitalhealthspace.blogspot.com
Susannah Fox remembers Tom Ferguson, MD who coined the term “participatory medicine”. Dr Ferguson passed away in 2006 but not before “ePatient” became adopted by bloggers and those involved in health care social media. The “e” relates to “engagement” rather than 'electronic'.
Think, for a moment, about the puzzle pieces of your own life. Think about the pieces you know well and the ones whose edges are blurry or indistinct.
Now think about how a clinician might view your life’s puzzle. How can you help them to see how the pieces fit together? Which pieces do you want to keep private and even hide from view, because they are too personal or scary or embarrassing to reveal? What self-knowledge do you wish you had and do you want to share it with anyone other than yourself?
These are the sorts of questions that the Pew Internet Project and California HealthCare Foundation considered as we went into the field with our latest health survey. I’ll give you a sneak preview of the results related to engagement, because I think our field is moving too fast for me to wait for publication.
We found that 60% of American adults track their weight, diet, or exercise routine. One-third of American adults track health indicators or symptoms, like blood pressure, blood sugar, headaches, or sleep patterns. One-third of caregivers – people caring for a loved one, usually an adult family member – say they track a health indicator for their loved one.
Putting that all together, 7 in 10 American adults are self-trackers.
But guess what? Half of them are tracking “in their heads.” These are my people. I’m calling this group the “skinny jeans trackers.”
In addition:
One-third of self-trackers use a notebook or journal.
One-fifth of self-trackers use an app, a device, a spreadsheet, or a website.
Half track on a regular basis
The other half track when something changes, when something comes up and triggers the need to track.
Given the rise of smartphones and online tools, should we expect to see the percentage of self-trackers
go up? Should it be our goal to see 100% participation in self-tracking among people living with chronic conditions? What about among caregivers? And the general public?
Mobile health apps provide a great opportunity for self-trackers. Many will purchase these devices and software with curiosity and the current popular culture of healthcare technology. The big question is whether this will be a permanent integrated habit.
Which brings us to the topic of sharing in general.
Adult Gadget Ownership over Time
I was surprised to learn how many people track data already. Much of it is manual or kept in 'heads'. Will HIT and mHealth automate this project without conscious interaction at some point. Will minute tattooed sensors replace blood pressure cuffs, and glucometers, or pulse oximeters. Surely we are only at the beginning of mHealth.
WATSON, What is the correct answer ? Your patient is in 'JEOPARDY'
Cleveland Clinic is the latest health care organization to work with IBM Corp. to enhance the capabilities of the Watson supercomputer. The clinic is seeking ways that Watson can support medical training.
Watson has accumulated knowledge of the medical field through its work with other health care organizations. Medical students at Cleveland Clinic will work with the supercomputer to further define its “Deep Question Answering” technology for medical purposes.
Medical students will use Watson to try to resolve challenging cases in hypothetical clinical simulations. Students will learn how to navigate content from Watson, consider hypotheses and find evidence to support answers, diagnoses and treatment options. The students also will be grading Watson’s performance to improve its language and domain analysis capabilities. “The collaboration will also focus on leveraging Watson to process an electronic medical record based on a deep semantic understanding of the content within an EMR,” according to IBM.
The expectation is that students will learn how to focus on critical thinking skills and leveraging information tools, while Watson will get smarter at medical language and assembling chains of evidence from available content.
Other organizations working with IBM to commercialize Watson capabilities include:
* Memorial Sloan-Kettering Cancer Center, to develop an oncology decision support system taking advantage of its own molecular and genomic databases, and its repository of cancer cases histories;
* Nuance Communications, Columbia University Medical Center and the University of Maryland School of Medicine, to embed Nuance’s natural language processing technology to enable a computer to read and understand text and abstract data; and
* Insurer WellPoint Inc. and Cedars-Sinai Medical Center in Los Angeles, to use data from patient medical histories, recent test results, recent treatment protocols and new research findings to help physicians identify best treatment choices.
More information on Watson is available here.
Common Sense has been replaced by Conventional Wisdom. A radical thought by Thomas Paine, one of the founders of the country.
[American Revolutionary leader and pamphleteer (born in England) who supported the American colonist's fight for independence and supported the French Revolution ]
Here we are less than one week to elections. After four years of executive leadership by the current administration we see a commander in chief who is able to set forth goals, but one who is unable to implement his plan effectively
With all the negative press regarding Obama's poor performance, why does he remain relatively popular. Even I when I listen to his oratory , become excited by his rhetoric...he is a hypnotic speaker, well versed in public speaking, performing much like a 'method actor' careful cadence, organized presentation, highly articulate, with symbolic hyperbole about America's perseverance. This comes after a history of much of his pre-presidential interest negative opinions of the United States. Michelle Obama summed it up when he was elected. “ This is the first time I am proud of the United States. Is “Obama an Equal Opportunity President” Has this been a fine example of the 'Peter Principle”?
In 2010 the accountable care act was passed, after two years of highly partisan wrangling, at the end of which no Republican legislator could be convinced to vote for the law. That in itself is a marker for voter disapproval with the law.
Whatever success this administration had with the 'war on terror' was left over from the Bush administration. Most of the work on finding Bin Laden had been done by the former . The boots on the ground were largely the same special forces teams and CIA intelligence operation that began the search.
We can look at the accountable care act from a new focused perspective now that some of the changes have gone into effect and some other large ones loom for January 2013 which is less than two months away, and also take place shortly before inauguration.
One thing is virtually certain, if the new president is Mitt Romney he will by executive order bring the process to a screeching halt for further review of implementation in a business like manner. Can the new President do this? Yes and no.
Not exactly, according to two Georgetown University professors writing this week in the online version of the Journal of the American Medical Assn. But there are some things President Romney would be able to do if he won, and more if he were joined in Washington by a Republican-controlled Congress.
Romney’s campaign website promises that the former governor of Massachusetts would make the undoing of the Patient Protection and Affordable Care Act — often referred to as “Obamacare” — a priority:
“On his first day in office, Mitt Romney will issue an executive order that paves the way for the federal government to issue Obamacare waivers to all fifty states.”
But any attempt by Romney to unilaterally repeal the entire law would run afoul of the U.S. Constitution, which requires that the president “take care that the laws be faithfully executed,” according to the authors, both lawyers who teach at Georgetown.
The ACA does allow the president to issue waivers to the states, but only so that they can implement alternatives to the law that are better, not worse, write John D. Kraemer and Lawrence O. Gostin. In any case, those waivers won’t be available to states until 2017.
Another thing Romney could probably do is effectively eliminate one of the most-criticized pieces of Obamacare: the individual mandate. Since the penalty for failing to buy an insurance policy is actually a tax, a Romney administration could direct the Internal Revenue Service not to collect that tax, sending a signal “that individuals would not be penalized for failing to purchase qualifying insurance,” they wrote. (This would be analogous to Obama’s decision to lay off deportations of nonviolent undocumented immigrants.)
Obama's project planners are way off in their implementation mandates. Perhaps business goals can be set and changed as stages progress. However our government's goals are usually set forth as mandates giving little or no chance for periodic adjustments. It dooms itself to guaranteed failure.
Here are some examples:
Grace Marie Turner writes a some significant length on Forbes “Health Matters” which are repeated here.
When Congress wrote 2,700 pages of legislation to create Obama Care, that was only the starting point in the government’s re-engineering of our health sector. Tens of thousands of pages of regulation –- or more -– are needed to provide detailed guidance dictating exactly how its maze of new programs must operate.
But deadlines are looming for Obama Care for programs that are required to begin in 2014. And the administration is significantly behind schedule, with insiders speculating the White House is waiting until after the election to issue an avalanche of rules, many of which are sure to be controversial.
Government re-engineering of the private marketplace is a complex task. So far, more than 13,000 pages of federal Obama Care regulations have been issued, but employers, states, and health companies say they need much more.
One recent rule took 18 pages to define a “full time employee.” That’s needed because a company employing 50 or more full-time workers must provide health insurance or pay a fine. But part-time employees working fewer than 30 hours a week are exempt. How the government defines a full-time employee has huge financial implications for a company. The rule describes the difference between “variable hour employees” and “ongoing employees,” for example, and how to determine what time period to measure with definitions of “standard measurement periods” and “look-back measurements.”
Employers are hiring battalions of lawyers to help them decipher the bureaucratese, and some companies already have announced they plan to cut the hours of many of their workers so they fit within the part-time threshold, arguing even the $2,000 to $3,000 per-employee fines would more than wipe out their profit margins.
States also are in a quandary. HHS claims it is giving states “significant flexibility” in implementing Obama Care, including the controversial health insurance exchanges, but even those supporting the law are increasingly alarmed because they say they simply don’t have enough information to proceed.
The law requires exchanges to be created as a funnel for hundreds of billions of dollars in new health insurance subsidies and also as a vehicle to implement significant new regulations of the health insurance market.
The exchanges are required by law to begin enrolling members on October 1st of next year, and a huge amount of work needs to be done to meet that deadline.
But first, states need information. For example, the law says that if states don’t set up an exchange, the federal government will swoop in and set up its own, and they want to know what a federal exchange would look like before they decide whether to set up their own exchanges.
The Republican Governors Association wrote a letter to President Obama in July saying, “As the exchange issue is currently interpreted, states are essentially being tasked with shouldering all the responsibility without any authority.”
The governors listed 17 critical questions just on the exchanges that they must have answered before they can determine best how to proceed so they can “have full and complete knowledge of all the implications of our decision.” They are still waiting for a reply.
Health plans also are in a dilemma. Health insurers that plan to offer policies through the exchanges need to know what benefits must be covered and at what price so they can design and price their offerings. And they must get state approval for the new plans before they can be offered in the exchanges, a process which can take up to a year -– or more in some states –- to complete. They also need time to contract with providers, develop marketing materials that meet as-yet-to-be-announced government specifications, and figure out how to navigate the complex web of subsidies, risk adjustment, and calculations for cost-sharing – for starters. They have hundreds of other critical questions.
Dan Durham of America’s Health Insurance Plans said in recent testimony before the House Ways and Means Health Subcommittee, “There is an urgent need for more regulatory clarity with respect to exchanges and insurance market reforms,” adding “there is a tremendous amount of work that needs to be done” if the law is to get up and running.
“Unless such guidance is forthcoming, it will be difficult for health plans to complete product development, fulfill network adequacy requirements, obtain necessary state approvals and reviews, and ensure that their operations, materials, training and customer service teams are fully prepared for the initial open enrollment period that begins on Oct. 1, 2013,” Durham said.
Administration officials are mum on when the regulations will be issued. A Health and Human Services official repeated that prediction in an email to reporters in October. “HHS has worked to give states maximum flexibility in implementing the law and consumers in all fifty states will have access to an exchange” by next October, the official said.
There is some speculation that the regs are being held back because of the elections, since the deeper one dives into the details, the more problems and conflicts are created. But Neil Trautwein of the National Retail Federation says it’s also an extraordinarily complex task.
“We know that many of the regs have been delayed,” says Trautwein. “Part of it I’m sure is the political calendar, but a large part of this, and I can say with some confidence because we’ve worked well with the administration on a lot of these questions, is that the subject matter is so infernally complex. They’ve got a lot of tough questions to answer.”
The fate of Obama Care is, of course, predicated on who wins the election on November 6. If Gov. Mitt Romney wins, he has vowed to begin immediately the process of working with Congress to repeal the law. And Congress will surely begin actively blocking any new rules that come out and working to unwind those already on the books.
But even if President Obama were to be reelected, his Rube Goldberg health law may well implode from the nearly impossible task of re-engineering one-sixth of our economy to fit his centrally-controlled archetype.
Organized medicine reports in AMEDNews, the plan devised by them and Medical specialty Societies for input from medical professionals and providers to place really meaningful health reform.
While some bemoan the downward trend in classic publishing and the supposed death of books, they will be replaced by a new, more dynamic medium, three dimensional with new spatial intelligence.'
The transition to electronic publishing has already occurred. This is the ‘Model T’, expect more advanced formats coming very soon. Innovation is the word in teaching.
The knowledge base continues to expand and it is essential for us to use tools to keep up with the KB. Engagement is the answer for active engagement over passive learning.
These changes must also come to scientific journals. No doubt ‘old school’ authorities, editors and publishers will at first balk at these changes. Openness and transparency will lead to new categories of credibility tagged and authenticated for scientific accuracy by a certifying academic authority to which editors will be able to document the review process.
A well known scientific publisher, Elsevier has already introduced the expanded format in some of their electronic editions. They compare the old as a flat presentation and the new as a three dimensional interactive presentation. Graphs become alive and can be measured in real time with tools built into the software.
Elsevier now offers eVolve, a site dedicated to teaching and learning with the new tools. The site offers numerous webinars dedicated to improved teaching using the new simulation software in textbooks. The Webinars relate to nursing curriculum but the methodology can easily be transferred to teaching medicine in general, and surgery in particular.
The Article of the Future is Live
The possibilities are endless:
While most physicians bemoan the effects of the Affordable Care Act, there are many segments of the health care industry that are bulllish at the possibilities. I remember asking one of my financial advisors what were the best investments ? His answer, “put your money into something you know….well.
And that appears to be happening with the ‘smart money’ and capital being invested by health enterprise. Many start ups and kickstarter are being flooded with potential investors, and startups no longer just belong in Silicon Valley.
While there is significant competition, opportunities abound as indicated here:
Here is a quick copy-paste of what is brewing
Startups offering everything from personalized nutrition and pregnancy apps to live online fitness instruction and a smart, souped-up toothbrush are among the members of Rock Health’s latest class of companies.
The San Francisco-based health tech accelerator on Thursday announced its fourth class of 14 startups, saying that it accepted less than 3 percent of the applicants.
The accelerator said this seasons’ applicant pool included more companies with hybrid hardware/software models, which is reflected in a couple of the startups selected to be part of the class.
In addition to introducing the new class, Rock Health said that Kaiser Permanente will join its roster of partners, which already includes the Mayo Clinic, GE, Genentech, Harvard Medical School, Nike and other health and investment companies.
In August, venture capital firm Kleiner Perkins Caufield & Byers announced that it was partnering with Rock Health to raise the amount of capital provided to member startups from $20,000 to $100,000.
Aside from the capital (and other perks like office space and tech and operational support), one of the big benefits of being a part of Rock Health – as well as other programs for health tech startups, such as New York-based Startup Health and Blueprint Health – is the network of industry professionals. Given the density and complexity of the healthcare system, health tech accelerators play an important role in helping startups find mentors, navigate the sector, identify markets and forge partnerships.
Here’s an overview of the 14 new startups to join Rock Health (language from Rock Health):
Beam Technologies
Beam Technologies focuses on the convergence of technology and oral health, and makes the Beam Brush, the first app-connected toothbrush for mapping brush behavior to achieve a better understanding of oral care’s impact on overall health.
BenefitsMe
BenefitsMe helps employers more strategically manage their HR benefits approach and helps employees appreciate their HR benefits again.
CliniCast
CliniCast enables providers to improve outcomes and reduce costs through predictive analytics. Its first product, ARTO, helps providers reduce unnecessary hospital admissions in patients with chronic disease.
Eligible
Eligible is an API that streamlines insurance eligibility checks for doctors and patients.
Kit Check
Kit Check helps hospital pharmacies process medication kits faster and without error.
LabDoor
LabDoor builds report cards for supplements and over the counter medications, grading them based on their safety, efficacy, and price.
Mango Health
Mango Health makes fun and elegant mobile applications to help consumers better manage and improve their health.
Moxe Health
Moxe Health is increasing access to medical care, first through triage.me, which combines community-wide routing schemes with individualized patient data to provide optimized recommendations.
OpenPlacement
OpenPlacement empowers people on all sides of the continuing care process with real-time information and tools to more efficiently and effectively match Seniors with Senior Housing and Care Providers.
SuperBetter
SuperBetter turns your health goals into an on-the-go game, with a current focus on helping players manage mental health challenges including depression and anxiety.
Wellframe
Wellframe combines mobile technology and artificial intelligence to extend the provision of care from the hospital to the home, empowering patients to optimize their recovery and helping providers thrive in an evolving payment landscape.
Wello
Wello aims to make the world a healthier place by making fitness more personal, accessible, and affordable through an online marketplace of fitness professionals who instruct over live, 2-way video.
Wildflower Health
Wildflower Health is making pregnancy healthier, safer and lower cost through personalized mobile apps.
Zipongo
Zipongo delivers prescriptions for healthy living through its GroceryRx platform which helps families save money on personalized healthy meals and earn rewards for buying nutritious food.
A story about health care and it’s pitfalls.
Medical students and naivette seem to go together. Attaining the somewhat envied position as a medical school acceptee most students are not well grounded in the tribulations and expectations that they will be serfs and servants to those one year ahead of them in the long ladder to licensure. We gird our loins at each step fully expecting things will lighten up as we approach doctor-hood.
We manage our lives, our finances, our spiritual life, however for emotional well-being we need to manage expectations.
A popular blogger and social media expert, Seth Godin, writes in his blog, Seth Godin’s Blog
“From the stock market to tech to what's under the Christmas tree, we let expectations determine whether or not something good has happened. Not whether it was useful or kind or productive or delightful, but whether it beat our fantasies.
There are two things you can do with this truth:
1. Spend a lot more effort managing expectations, and
2. Focus on the wonderful instead of the exceeded.”
Seth blogs, and pontificates in several basic lessons (books) for marketing. (For our times, I recommend ‘LYNCHPIN” You can download a Kindle version sample here Eventually most MD’s realize that on some level they are “salesmen”, either in convincing a patient they need a procedure or to gain more patients for their practice. During our years of training this skill is largely not encouraged (for obvious reasons). We are to remain objective, and imperturbable. MDs by and large do not endure self-aggrandizement well, we are reticent to describe how we are so wonderful, or the best, unless we hire or someone voluntarily want to magnify our image.
Health care is in a state of confusion, in some ways a contest between modernity and meidevilasm, the old way and the new way. We are confounded with operating our medical organization, large or small in a bifurcated paradim, on one side fee for service and the other with accountable care, unleashed from procedural billing. The pressure increases to maintain financial viability, and at the same time maximize quality, decrease untoward outcomes as measured by arbitrary standards by outside forces, such as readmission rates to a hospital.
The downward spiral is all too familiar. A drinking problem leads to a job lost, which leads to more drinking. Poor customer service leads customers to choose other vendors, which of course leads to less investment in customer service, which continues the problem.
Your boss has a temper tantrum because he's stressed about his leadership abilities. The tantrum undermines his relationship with his peers, which of course makes him more stressed and he becomes more likely to have another tantrum. An employee is disheartened because of negative feedback from a boss, which leads to less effort, which of course leads
Most things that go wrong, go wrong slowly.
The answer isn't to look for the swift and certain solution to the long-term problem. The solution is to replace the down cycle with the up cycle.
This is incredibly difficult. But identifying the down cycle and investing in replacing it with the up cycle is the one and only best strategy. The alternative, which is to rationalize and defend the cycle as a law of nature or permanent habit, is tragic. Much of this includes our attitude of where we are in health care. Are we stuck in a cycle of renewal?
A story about health care and it’s pitfalls.
Medical students and naivette seem to go together. Attaining the somewhat envied position as a medical school acceptee most students are not well grounded in the tribulations and expectations that they will be serfs and servants to those one year ahead of them in the long ladder to licensure. We gird our loins at each step fully expecting things will lighten up as we approach doctor-hood.
We manage our lives, our finances, our spiritual life, however for emotional well-being we need to manage expectations.
A popular blogger and social media expert, Seth Godin, writes in his blog, Seth Godin’s Blog
“From the stock market to tech to what's under the Christmas tree, we let expectations determine whether or not something good has happened. Not whether it was useful or kind or productive or delightful, but whether it beat our fantasies.
There are two things you can do with this truth:
1. Spend a lot more effort managing expectations, and
2. Focus on the wonderful instead of the exceeded.”
Seth blogs, and pontificates in several basic lessons (books) for marketing. Eventually most MD’s realize that on some level they are “salesmen”, either in convincing a patient they need a procedure or to gain more patients for their practice. During our years of training this skill is largely not encouraged (for obvious reasons). We are to remain objective, and imperturbable. MDs by and large do not endure self-aggrandizement well, we are reticent to describe how we are so wonderful, or the best, unless we hire or someone voluntarily want to magnify our image.
Health care is in a state of confusion, in some ways a contest between modernity and meidevilasm, the old way and the new way. We are confounded with operating our medical organization, large or small in a bifurcated paradim, on one side fee for service and the other with accountable care, unleashed from procedural billing. The pressure increases to maintain financial viability, and at the same time maximize quality, decrease untoward outcomes as measured by arbitrary standards by outside forces, such as readmission rates to a hospital.
The downward spiral is all too familiar. A drinking problem leads to a job lost, which leads to more drinking. Poor customer service leads customers to choose other vendors, which of course leads to less investment in customer service, which continues the problem.
Your boss has a temper tantrum because he's stressed about his leadership abilities. The tantrum undermines his relationship with his peers, which of course makes him more stressed and he becomes more likely to have another tantrum. An employee is disheartened because of negative feedback from a boss, which leads to less effort, which of course leads
Most things that go wrong, go wrong slowly.
The answer isn't to look for the swift and certain solution to the long-term problem. The solution is to replace the down cycle with the up cycle.
This is incredibly difficult. But identifying the down cycle and investing in replacing it with the up cycle is the one and only best strategy. The alternative, which is to rationalize and defend the cycle as a law of nature or permanent habit, is tragic. Much of this includes our attitude of where we are in health care. Are we stuck in a cycle of renewal?
On Wednesday, CMS officials provided an update on the meaningful use program, saying that about $7.7 billion in incentive payments had been distributed as of last month, Government Health IT reports.
Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified EHR systems can qualify for Medicaid and Medicare incentive payments.
The officials offered the update during the Healthcare Information and Management Systems Society's Government Health IT Virtual Briefing.
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