We got their Attention

Quote of the day: Finance is the art of passing money from hand to hand until it finally disappears. - Robert W. Sarnoff Congress knew in advance that GWB would intervene prior to the new session of congress, by executive order.  GWB ordered that the 10% medicare fee reductions be suspended.  HHS Secretary Mike Leavitt also took administrative action to place a hold on changes as well. "WASHINGTON (AP) - The Bush administration said Monday it is freezing a scheduled 10 percent fee cut for doctors who treat Medicare patients, giving Congress time to act to prevent the cuts when lawmakers return from a July 4 recess. Physicians have been running ads hinting that as a result of the cuts, patients may find doctors less willing to treat them. The administration's delay in implementing...

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Personal Health Records and the Markle Foundation

Quote of the day: Nothing is as simple as we hope it will be. - Jim Horning   Today I need to get down to more serious issues. I inject humor from time to time to maintain equilibrium.  I have had some commentary that my mind is "blown".  That may or may not be true......Nevertheless, here we go. Medinnovation has a very comprehensive analysis of what and where medicine has gone and will go further, if the current entrenched medical power complex starts thinking out of the box. Personal Health Records have been promoted in the past couple of years as a means of maintaining personal and family medical history for future provider visits.  The issue of privacy and confidentiality are probably a bigger issue here than in institutional settings.  Some people will...

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Don't Stop Thinking about Tomorrow

Or never look back!! Quote of the day: The only paradise is paradise lost. - Marcel Proust   HMOs and where it all began.. ...

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Encore Presentation

Due to multiple requests (1) I am re-posting "Pirates of The Carribean" which was up two weeks ago. ...

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How many cars can the express pull?

  Some executives at California health insurance providers paid themselves handsomely while their companies were raking in more than $4.3 billion in profits in the last year. (As reported by the San Francisco Chronicle) In addition, HMOs spent $6 billion on administrative costs, which include hefty CEO salaries, according to a report by the California Medical Association, which said the money could have gone toward driving down premiums or better protecting the insured. The annual report, which draws on expenditures reported to the state Department of Managed Health Care, will be released Tuesday. It found that annual salaries topped $1 million for chief executive officers at providers like Aetna, Inc., CIGNA Corp., Health Net, Inc., UnitedHealth Group and WellPoint Health Networks,...

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Junk Science and Carbon Footprints

Quote of the day: He is one of those people who would be enormously improved by death. - Saki Quote of the day: I have come to believe that the whole world is an enigma, a harmless enigma that is made terrible by our own mad attempt to interpret it as though it had an underlying truth. - Umberto Eco   Today's early morning ruminations took me to FOX news where I was greeted by another analysis of how many tons of CO2 I produced this morning when taking my shower. It's been extremely hot here the past week, not cooling down at night. I follow Al Gore's example of being carbon "neutral" by cranking my thermostat down to 65 degrees each night to get a head start on what comes later in the day, 114 degrees.  Supposedly our A/C when maxed out will offset 40 degrees, brining...

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Medal of Freedom

Today's express is upbeat. President GWB awarded the Presidental Medial of Freedom to 2 physicians. The Medal of Freedom was established by President Truman in 1945 to recognize civilians for their efforts during World War II. The award was reinstated by President Kennedy in 1963 to honor distinguished service. It is given to those deemed to have made remarkable contributions to the security or national interests of the United States, world peace, culture, or other private or public endeavors. _Dr. Benjamin S. Carson Sr.: In 1987, he performed the world's first successful operation separating twins joined at the back of the head. He is director of pediatric neurosurgery at Johns Hopkins Children's Center in Baltimore. Bush talked about Carson's mother, who raised Carson and another son alone....

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Getting a Seat at the Table

Quote of the day: To invent, you need a good imagination and a pile of junk. - Thomas A. Edison This from Consumer's Health  Care Choices "There can be no more compelling testimony on what physicians are facing than the farewell address by Doctor Ian Bogle, when he stepped down as Chairman of the British Medical Association on June 30, 2003. The speech is really quite poignant because he indicates that physicians in Great Britain made the same mistakes that American physicians are in the process of making. He says, "I accept, like all of us do, that national standards, quality markers and assessment of individual and team performance are essential in a modern, patient-centered NHS." But this acceptance, the desire to get-along-by-going-along,...

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A Repeat Post

Quote of the day: I have a new philosophy. I'm only going to dread one day at a time. - Charles M. Schulz   It's been awhile since I published this message.....time for a "rerun" Fellow bloggers: When I first began “blogging” about three years ago I intended it to be a newsletter for a RHIO that I was heading up in my area of the country. About a year ago I chose to rename it “Healthtrain Express”. The term recently coined by others came to my mind in 1989 (that definitely dates me) It was in the pre-DRG, pre RVU, pre managed care (ie, the “golden days”) that my residents often wistfully mention.. I often tell them that no “age in medicine” is trouble free. It’s the nature of the “beast”. Healthtrain express conjures up the rapid changes that constantly occur in medicine....

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It's Not all in the DATA

Quote of the day: For a list of all the ways technology has failed to improve the quality of life, please press three. - Alice Kahn I was sent a survey last week from the Harvard Business School, by Julia Adler-Milstein, of the Harvard Business School.  It was a query on the status of the Inland Empire HIE, or RHIO. It was an online 'Survey Monkey' which one the surface looked nice, simple format and was enjoyable to fill out. My first, second and third attempts resulted in an error message. I gave up in frustration, but did email JAM that it didn't work. (no reflection of  HIT, here.  I was sent another link which did work well. At the end of the day  I sent along an email with some attached comments.... I appreciated her response to my 'footnotes'.   ...

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The Failure of RHIOs and ONCHIT

  Quote of the day: In a time of universal deceit, telling the truth is a revolutionary act. - George Orwell Today' iHealthbeat reveals why government is inept in many regards.  What starts out with innovative ideas quickly becomes bogged down on internal machinations, politics and the inability to adapt to rapidly changing market forces.  As I stated fouryears ago HIT and RHIOs could not be produced from the top down, rather it would develop from the bottom up as we are witnessing now. Ihad compared the development of our national telephone network as an example.  The many 'Bell' companies eventually merged into one company serving the majority of the United States. Perhaps the most important item to come from ONCHIT was it's stimulus to develop CCHIT standards. ...

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What Doctor's Think

Quote of the day: Three may keep a secret, if two of them are dead. - Benjamin Franklin Here is what fuels our "health train" Doctor Insights Doctors directly influence more than a third of the entire USA health care economy. Consider these important facts: 902,000: number of physicians in the USA in 2005 $2.1 trillion: USA healthcare expenditures in 2006 $274 billion: sales of physician-prescribed medications in 2006 $587 billion: cost of various patient services and devices ordered by physicians and healthcare providers in 2004 These figures are from  What Doctor's Think....

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Health Train Express -- Derailed

“It is better to know some of the questions than all of the answers.” James Thurber (1894 -1961)   When I named my blog several years ago I did not quite realize the analogy would have so many applications to health care. Our "train" is certainly not travelling a straight line on the track. In fact at times the train seems to have left the track. One unfortunate observation is that like our country overall there is no  ten year or twenty year cohesive plan. Healthcare has become a hodge podge of entities and chaos.  In fact if we can plan beyond next month  running our medical practices we are lucky. A train with a locomotive at each end pulling in opposite directions won't move very far....

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Hijinx 101

Enough gloom and doom with healthcare, medicare, universal care, dental care, heart care, bone care, who cares, an NO CARE for this week. Norman Vincent Peale decided for the rest of us that "laughter is the best medicine".  Now that is not on  medicare part D., so Idon't know how to order it, or if it requires a special RX pad. The sad fact is that most of you "intelligient" docs got where you are due to you ability to adapt, work hard, and check off the boxes that your teachers wanted you to check off.   Creativity has been smashed beyond recognition in clinical care. So, to cheer you all up I am including some links to stimulate the "other" side of your brain.  I am saddled with being left handed, which it turned out has been a boon to my career as an ophthalmologist....

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The Flawed SGR Formula

When more is less............... Quote of the day: Democracy means government by discussion, but it is only effective if you can stop people talking. - Clement Atlee   Usually before I start my blog writing I do some surfing around for current news in the blogosphere. Buckeye Surgeon has a few interesting links that are germane.  The Wall Street Journal blog cuts right to the Chase.  It's not difficult to see how payors enjoy playing us against one another....divide and conquer techniques which have been demonstrated to be quite effective thus far. No specialty or primarycare physicians should take glee in reaping benefits as a result of these tactics.  Remember, first they came for "them" then they came for "me".    To quote Buckeye Surgeon, "There's...

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Conductors for the Health Train Express

Quote of the day: Politicians are the same all over. They promise to build a bridge even where there is no river. - Nikita Khrushchev   It's been a very long time since I have been on a train. I remember them as walking down the aisles of passenger cars punching your ticket.  Do they still exist? I think "Health Train Express"  needs fewer ticket punchers. When was the last time you thought about a Surgeon General? The last one I remember was  David Satcher , before that the memorable  C. Everett Koop .   I am not certain why but the most memorable Surgeon Generals  had beards. The complete List of Surgeon Generals is here. Another Surgeon General was Jocelyn Elders,  who I like...

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