I don’t think many patients could resist interfacing with this ‘art’. They might even forgive the long wait to see their physician.
I cannot and won’t add much to this beautiful digital art.
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 15, 2013
Sunday, April 14, 2013
Where is Your Center ??
The patient is the center of our universe. Although pundits and bureaucrats emphasize this, many of their edicts and actions run counter to this proposal.
I remember an event in residency when after a long night on call, one of my junior residents was complaining how tired and angry he was with patients calling in during the early morning hours with what he thought were ‘spurious’ and unnecessary calls. Granted he and many of us were doing every other night call and working over 100 hours/week. (back in 1977).
As it turned out the head of our department overheard his complaints about “foolish calls’ from patients.
It was as I like to call it ….a ‘Bob Hope Moment’ as written in The Laugh Makers.
Our chief came back with his one liner, “That is why you have a job !”
For my junior resident it was probably a scary moment to be caught in the act of disparaging a patient in need. For me it was a poignant moment in training which has stayed with me for over 30 years of medicine.
It was my introduction to ‘Person-Centered Healthcare’, in 1976 long before the current shift from disease centered management to patient centric healthcare.
In an outpatient environment it is easier to maintain patient centered care and management. In an inpatient setting it is far more difficult. In the hospital environment compressing activities into a limited time frame is mandatory. Patients cannot just drop in for an MRI, lab work, or surgery. Medical emergencies occur more often in hospital and the most critically ill patients are placed in an ICU so that their level of intense care is isolated and does not impact more routine hospital care.
Medicare and payers limit hospital length of stay according to diagnosis and/or procedures. Inpatient stays that are in excess of a standard length are not reimbursed, and require additional paper work for authorization and payment.
The centricity of patient care in the hospital requires some additional steps for providers, and their extenders (nurses, therapists, administrative clerks and others who have contact with a patient. Many of these requirements apply to other businesses, and in many cases hospitals have adopted these subtle techniques.
Patients by and large are very unfamiliar and anxious about hospital admissions. Anxiety can affect outcomes, if excessive. Frequently patients may exhibit the worst of their personalities under this stress, requiring additional time on the part of staff.
It helps me to remember
1. No one wants to be ill (even addicted drug dependent patients).
2. No one wants to go into a hospital, except perhaps to give birth, and then there is anxiety about pain, and a healthy newborn.
3. Illness brings out strange behavior in patients, that can only be measured in relation to the perceived threat by the patient.
4. I would be out of my job were it not for ill people.
5. Few people will pay to stay well even though most of preventive medicine is relatively inexpensive.
a. Good nutrition, balanced diet, special attention to nutritional
requirement of some diseases, ie diabetes, hypertension, cystic
fibrosis.
b. Routine exercise programs, with special attention to
physical challenges
c. Risk evaluation for a patient related to family history, genetic
profile, and past medical history.
d. Emotionally balanced life style.
6. The realization that Most of my stressors are not driven by patient demands, but from bureaucrats, and payers. In other words it is not the patients’ actions causing difficulty.
Saturday, April 13, 2013
Direct Pay and Concierge Medical Practice
Many physicians as they continue to practice medicine in an increasingly hostile environment attempt to remove aspects of their business which increase work loads at diminishing yields. I use a term coined by T. Boone Pickens (the Oil Entrepreneur who now favors recyclable energy sources, such as wind, and solar power)
He coined the term “PEAK OIL” which defines the point at which it takes more energy to find, drill, and extract oil than the energy yield from the oil.
Health care and medical care has also reached “PEAK HEALTH”
Increased administrative costs are bleeding our health system, not just for Medicare and Medicaid but private insurance and private practices.
Some physicians eliminate much of the insurance bureaucracy by refusing to accept insurance companies. They accept only direct pay…via cash, credit cards, checks or barter. By refusing to accept Medicare/medical/ and insurers many regulatory requirements no longer apply
In addition to direct pay many communities will have access to a cooperative payment method based on direct pay and administered and controlled by your local community.
MedAccess USA will provide such a structure. It is currently in development with a planned roll out in January 2014.
How would a Direct Care Practice Work For You?
The Direct Care Consulting Calculator
will analyze the results for your practice if you convert a portion or your entire practice to direct pay.
Instructions: Follow the three simple steps.
Some Physicians choose to enhance their annual revenue by adding a per visit fee or a per minute fee for patient visits. Contact us Today! To learn how you can price your practice!
MedAccess is recruiting providers interested in enrolling in the cooperative. There is no obligation. Contact MedAccess at mdtaber@mac.com Also please support our effort to develop a CMS direct pay model by contacting your Congressman and ask them to support Congressman Alan Grayson’s letter to CMS innovation program on Direct Pay and MedAccess.
Health Train Express Wheels
My Wheels are coming off the bus !
Like most of my readers we use RSS feeds to receive timely updates of blogs, news, and web sites.
My favorite reader has been Google Reader, which depends upon ‘Feedburner’. Google has deprecated Reader.
In my mind this is much like the telephone evolving from a rotary dial to a push button interface.
Much has changed in the past ten years, including the growth of social media on many platforms. Some say RSS feeds are on the way out with less usage.
I have not yet reached that point, and have researched several other RSS feeds.
Here are my choices ranked in order.
Over the next several weeks we will be experimenting with different RSS feeds.
The important thing for my readers to know is that if you are following the blogs, check what RSS feed you are using…Health Train and Digital Health Space will be listed on Feedly, Old Reader, and Newsblur.
Tuesday, April 9, 2013
CMS SENATE COMMITTEE HEARINGS ON NEW HEAD OF MEDICARE
This morning at 10 AM the CMS witness hearing will be broadcast. We are privileged to bring you the link for the live broadcast from the Senate Hearing Room on Capitol Hill.
U.S. SENATE COMMITTEE ON FINANCE
Marilyn Tavenner Acting Administrator CMS
Transcript of Testimony:
Witness Testimony Candidate Marilyn Tavenner (Currently serving at temporary Head of CMS)
Courtesy of the Hearing Channel of the U.S. Senate.
Monday, April 8, 2013
A Smorgasbord of Health News
The Medical Minute brought to you from a variety of sources.
Pentagon Struggles With High Cost Of Health Care WASHINGTON -- The loud, insistent calls in Washington to rein in the rising costs of Social Security and Medicare ignore a major and expensive entitlement program – the military's health care system.
The Drug War And Mass Incarceration By The Numbers
NEW YORK -- Despite an increased emphasis on treatment and prevention programs in recent years, the Obama administration in its 2013 budget still requested $25.6 billion in federal spending on the drug war. Of that, $15 billion would go to law enforcement, interdiction and international efforts.
The pro-reform Drug Policy Alliance estimates that when you combine state and local spending on everything from drug-related arrests to prison, the total cost adds up to at least $51 billion per year. Over four decades, the group says, American taxpayers have dished out $1 trillion on the drug war.
What all that money has helped produce -- aside from unchanged drug addiction rates -- is the world's highest incarceration rate. According to the Sentencing Project, 2.2 million Americans are in prison or jail.
Health Care Curbing Government
FILE - In this March 19, 2010, file photo, President Barack Obama speaks about healthcare reform at the Patriot Center at George Mason University in Fairfax, Va. Back when the big health care law was little more than a dream, and when he was a presidential hopeful, Obama spoke out against the idea of forcing people to get health insurance. He said that would be like solving homelessness by passing a law making people buy a house. (AP Photo/Charles Dharapak)
Big Pharma Pockets $711 Billion in Profits by Robbing Seniors, Taxpayers Here's an outrage that must be changed: Big Pharma has been systematically price-gouging the Medicare program for seniors and people with disabilities -- and raking in billions in excessive profits. The 11 largest global drug companies made an astonishing $711 billion in profits over the 10 years ending in 2012, and they got a turbo-charged boost when the Medicare Part D prescription drug program started in 2006, according to an analysis of corporate filings by Health Care for America Now (HCAN).
Ex-Felons Are About To Get Health Coverage
Newly freed prisoners traditionally walk away from the penitentiary with a bus ticket and a few dollars in their pockets. Starting in January, many of the 650,000 inmates released from prison each year will be eligible for something else: health care by way of Medicaid, thanks to the Affordable Care Act.
A sizeable portion of the nearly 5 million ex-offenders who are on parole or probation at any given time will also be covered.
The expansion of Medicaid, a key provision of the health care reform law, is the main vehicle for delivering health insurance to former prisoners.
How Health Insurance Giants Can Avoid Obamacare Regulations For A Whole Year
Health insurance companies are looking to put off complying with health care reform rules that guarantee basic benefits and consumer protections -- and they've figured out how to do so for up to one more year.
The health care law requires insurance plans sold to individuals who don't get benefits through their employers to cover a minimum set of benefits, prohibits companies from refusing to cover people with pre-existing conditions or to charge them higher rates than healthy people, doesn't allow health insurers to levy higher premiums on women than men, limits how much more older people can be made to pay, and guarantees customers can re-up their plans each year.
But those rules don't take effect until January -- or whenever a customer's current health insurance plan expires next year, which could be later. According to the Los Angeles Times, some insurers are weighing a lawful scheme in which they would renew customers' plans before 2014, thus preventing them from having to meet Obamacare standards until as late as Jan. 1, 2015.
Obama's Budget: Medicaid Would Be Spared From Deep Cuts
WASHINGTON — President Barack Obama's budget next week will steer clear of major cuts to Medicaid, including tens of billions in reductions to the health care plan for the poor that the administration had proposed only last year.
Big cuts in the federal-state program wouldn't go over too well at a time that Health and Human Services Secretary Kathleen Sibelius is wooing financially skittish Republican governors to expand Medicaid coverage to millions who now are uninsured. That expansion in the states is critical to the success of Obama's health overhaul, which is rolling out this fall and early next year.
The president's budget is to be released next Wednesday.
Perhaps half the nearly 30 million people gaining health insurance under the law are to be covered through Medicaid. But the Supreme Court last year gave individual states the right to reject the expansion. A principal argument against the expansion in state capitals is that Washington cannot be trusted to keep its promise of generous funding for new Medicaid recipients.
And Now a Word from Our Sponsors (Of yesteryear)
With the Recent trend toward Health, Wellness and Prevention these advertisement would never make it in today’s world.
Employers Adopt Stricter Health Care Policies In Face Of Surging Costs
Faced with rising health care costs, employers are adopting stricter policies to keep workers healthy. Failure to comply with those measures could hurt employees' wallets.
Is it time for the Michelin ‘Marshmallow’ to go on a diet?
Workers at tire manufacturer company Michelin could miss out on reducing their deductibles by up to $1,000 if they show unhealthy signs like high blood pressure or waistlines over 40 inches, The Wall Street Journal reports. Companies such as Wal-Mart and Home Depot have similar policies, designed to reduce surging health care costs. But often these new policies require employees to share personal health information, something critics say is both unfair and an invasion of privacy.
With health care costs rising in 2012 to $12,136 per employee on average, according to a recent study, companies argue that the new policies not only help cut costs, but also contribute to the overall well being of their workforces. Indeed, Michelin told The Huffington Post that The Wall Street Journal’s claim that the company is penalizing workers for showing signs of obesity is not accurate. Instead, the new policy set to take effect next year “helps us help our employees” by rewarding workers who meet standards for at least three of five health indicators, such as waist size, cholesterol and blood pressure.
Sunday, April 7, 2013
Marilyn Tavener and Senate Confirmation Hearing as Head of CMS.
Perhaps the most important position along side the Head of Health and Human Services is the long awaited appointment of a permanent Head of CMS (previously known as Medicare. The name change was made to cancel out the previous effects of Medicare’s triumphs and failures.
Congress always seems to misstep approvals and/or denials to confirm this position. It would seem that this seat would be far less political than other cabinet seats, such as DOD, Commerce, State, etc.
However given now that health consumes 17% of GDP, and also provides jobs to a large percentage of the employed the position now is crucial for budget planning and it’s indirect effect on debt.
Health Train Express has prioritized these hearings for the week in lieu of our usual health care social media, health reform and health information technology news.
The hearings are being carried live on the web, 7 AM PDT/10 AM EDT.
During a time when so much is changing in health care it seems almost negligent to have had a temporary appointment for so long following Don Berwick’s resignation.
Common sense would indicate this is a ‘hotspot’ for the Obama Administration, and Berwick’s honest appraisal of the British Health System was a ‘faux paux’ and created a nuclear exchange for policy makers. Many brilliant minds have been ignored at the whims of political executioners . Dr Berwick’s signature comment,
Donald Berwick MD
"I am romantic about the NHS; I love it. All I need to do to rediscover the romance is to look at health care in my own country."
With this one remark, Don Berwick relegated himself to the chopping block. However it was not his final answer. Dr Berwick has taken up a role in the NHS program for improving safety
However despite that Berwick has been tapped to improve safety for the U.K. NHS.
Stay tuned and don’t miss the Senate Hearings on April 9 2013 Tuesday, 7AM PDT 10 AM EDT.
Saturday, April 6, 2013
Charles and William Mayo, the Original Tweeps
The Mayo Clinic in Rochester, Minnesota has always been fearless and has gone where others have feared to tread.
So it should not be surprising to learn that Mayo Clinic took a leadership role in Social Media in Medicine and Health Care in the past 36 months.
And while may of the naysayers and critics focused on the negative aspects of the origins of social media Mayo Clinic chose to objectively analyze, collect and build a highly visible and credible platform using social media to become patient centric as well as provider centric in their mission to educate and further transform our Health System.
So, it should be no surprise to see this in my social media stream,
“Mayo Clinic president and CEO John Noseworthy, M.D., will be speaking at the National Press Club on Tuesday at 1 p.m. EDT on “Three Imperatives to Transform Health Care in America,” and we’re using our social platforms to enable virtual participation and engagement.”
“The address will be streamed live from our newly redesigned Mayo Clinic News Network site, a community platform with resources for journalists. We will have more background on the News Network project in future posts, because it is another application of the social networking technology we’re using here in the Social Media Health Network.”
John Noseworty MD, CEO of the Mayo Clnic outlines the historical importance of the Mayo Clinic’s Charles and William Mayo’s use of social media over one hundred years ago.
Using Social Platforms for Live Webcast of Mayo Clinic CEO Address at National Press Club Tuesday « Social Media Health Network
The Mayo Clnic The Original Social Media in Health Care
Using Social Platforms for Live Webcast of Mayo Clinic CEO Address at National Press Club Tuesday « Social Media Health Network:
'via Blog this'
Using Social Platforms for Live Webcast of Mayo Clinic CEO Address at National Press Club Tuesday « Social Media Health Network:
'via Blog this'
Friday, April 5, 2013
Tuesday, April 2, 2013
Biological Genomic Diversity in Food
Preventive Health Care
Numerous studies show that proper nutrition and intake of proteins, carbohydrates, fats, vitamins, minerals and trace elements are essential to normal health. The human gastrointestinal tract harbors a universe of microbial life required to maintain normal bowel function. It functions in symbiosis with the remainder of our body systems. It is small wonder our systems are thrown out of balance by antibiotics.
As time evolves, A crisis is looming: To feed our growing population, we’ll need to double food production. Yet crop yields aren’t increasing fast enough, and climate change and new diseases threaten the limited varieties we’ve come to depend on for food. Luckily we still have the seeds and breeds to ensure our future food supply—but we must take steps to save them.
Like the animal world the plant world evolves and some species become endangered or extinct as a result of normal evolution or from the effects of herbicides, genetically modified crops and organisms.
The animal kingdom also evolves slowly as do human beings. Genetic changes are occurring in all species, some beneficial and others aversive or even fatal or species extinction.
Prevention has become important, our healthcare needs have rapidly accelerated our ability to finance our health system.
Differing populations may require unique approaches to food intake.
Today’s ecosystem offers a different crop from hundreds of years ago.
Much of this change may have an unmeasured effect on health and disease which has yet to be studied or understood.
The Food Ark and The Seed Savers Exchange
Six miles outside the town of Decorah, Iowa, an 890-acre stretch of rolling fields and woods called Heritage Farm is letting its crops go to seed. It seems counterintuitive, but then everything about this farm stands in stark contrast to the surrounding acres of neatly rowed corn and soybean fields that typify modern agriculture. Heritage Farm is devoted to collecting rather than growing seeds. It is home to the Seed Savers Exchange, one of the largest nongovernment-owned seed banks in the United States.
In 1975 Diane Ott Whealy was bequeathed the seedlings of two heirloom plant varieties that her great grandfather had brought to America from Bavaria in 1870: Grandpa Ott's morning glory and his German Pink tomato. Wanting to preserve such unique varieties, Diane and her husband, Kent, decided to establish a place where people could store and trade the seeds of their own past. The exchange now has more than 13,000 members and keeps in its walk-in coolers, freezers, and root cellars the seeds of many thousands of heirloom varieties. The farm grows a glorious profusion of select vegetables, herbs, and flowers around an old red barn that is covered in Grandpa Ott's stunningly deep purple morning glory blossoms.
There are many examples of the reduction in biological diversity fueled by the modification of native species into high yield, low disease plants and animals, to the exclusion of more natively robust crops. The increased need for more food due to exploding human population fuels this negative effect of ‘technology’. It may also fuel new diseases or nutritionally deficient foods.
Food varieties extinction is happening all over the world—and it's happening fast. In the United States an estimated 90 percent of our historic fruit and vegetable varieties have vanished. Of the 7,000 apple varieties that were grown in the 1800s, fewer than a hundred remain. In the Philippines thousands of varieties of rice once thrived; now only up to a hundred are grown there. In China 90 percent of the wheat varieties cultivated just a century ago have disappeared. Experts estimate that we have lost more than half of the world's food varieties over the past century. As for the 8,000 known livestock breeds, 1,600 are endangered or already extinct.
This is not occurring in an isolated manner, and must have a secondary effect on all living organisms.
Svalbard Global Seed Depository
The Svalbard Global Seed Vault (Norwegian: Svalbard global frøhvelv) is a secure seedbank located on the Norwegian island of Spitsbergen near the town of Longyearbyen in the remote Arctic Svalbard archipelago, about 1,300 kilometers' (810 mi) from the North Pole.[4] It was started by conservationist Cary Fowler in association with the Consultative Group on International Agricultural Research (CGIAR),[5] and functions to preserve a wide variety of plant seeds in an underground cavern. The seeds are duplicate samples, or "spare" copies, of seeds held in gene banks worldwide. The seed vault is an attempt to provide insurance against the loss of seeds in gene banks, as well as a refuge for seeds in the case of large-scale regional or global crises. The seed vault is managed under terms spelled out in a tripartite agreement between the Norwegian government, the Global Crop Diversity Trust (GCDT) and the Nordic Genetic Resource Center (NordGen).[6]
Rather than considering this facility a “Doomsday Resource”, perhaps it will function to restore biological diversity when the time comes as our natural health deteriorates from deficiencies.
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