Congressional Health Train Express

  Quote of the day: The greatest pleasure in life is doing what people say you cannot do. - Walter Bagehot ******************************************************** The response to my recent email newsletter was surprising and encouraging.  I had a response that I wish to share with all of you. Healthcare in the United States is on the crux of great change. During change we have broken the inertia and are able to more easily transform the system during the period of plasticity. One proposal is in the U.S. Senate Bill  SB 1019 sponsored by Senator Tom Coburn.  Jim Rowsey MD an alumnus (along with me) of GW Medical School has been working with Senator Coburn. Together, they have prepared this video, which I would like to share with you, and ask you to forward it...

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I'm sorry the system is too busy to take your call

Quote of the day: Whenever you have an efficient government you have a dictatorship. - Harry S Truman   Beginning Oct. 1, Comcast will put a 250 gigabyte-a-month cap on residential users. The limit will not affect most users, at least not in the short-term, but is certain to create tension as some technologies gain traction.  Whether or not this might extend to commercial usage, such as Health 2.0, or Web 2.0 is not addressed in this announcement from Comcast. Certainly as technological advances proceed it is difficult to predict when 'excessive use' becomes the average utilization. The  use of PAC systems, streaming video, mobile phone solutions, remote at home monitoring, and connectivity among health care sectors is growing exponentially. In other news,  the...

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The Temple of Obama

Quote of the day: The world is governed more by appearances than realities, so that it is fully as necessary to seem to know something as to know it. - Daniel Webster I couldn't ask for a better quote of the day after last night's Graeco-Roman festival.  Where were the gladiators?   I have been away from the blog for several days, longer than I realized.  My focus has been on the DNC and RNC conventions. I did not hear much in the way of real programs, just left vs right, man vs. woman, black vs. white, free market vs socialism, more taxes vs. less taxes, more spending vs. less spending and what it used to be like in the 1950s  which gave me kind of a warm fuzzy Obama is not just a great orator, but a mass hypnotist. His voice carries with it a kind...

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Health Train Express is Overheating

Quote of the day: A Hospital is no place to be sick. - Samuel Goldwyn Medical bloggers have become recognized by some as "trouble-makers" by the powers that be.....a sure sign of increasing and recognizable influence on health care and it's reform. My friend Dimitriy Kruglyak also known as "Hippocrates" on the blog, Trusted.MD writes about his views on medical blogging. Dimitrity, by the way is not a  physician. While most bloggers and others do not realize it Mr Kruglyak who has received little recognition for his "ground breaking" blog was about four years ahead of the curve in terms of blogging and aggregated blog commentary.   He also should be credited with developing and producing the first Health 2.0...

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Elder Train Express

Quote of the day: It is our responsibilities, not ourselves, that we should take seriously. - Peter Ustinov Karen Stevenson Brown is an accomplished student and advocate for the elderly.  I thought I knew a great deal about the concerns and care of the elderly when I stumbled upon her web site and blogs....boy was I surprised.   Karen (she is not the lassie in the cartoon) was stamped out of good old midwestern soil.... the kind of soil where you knew your neighbors well, and in a time where family's cared for their parents and close relatives. The family was more than 'nuclear', it included the electrons, and all participated in sharing and supporting the family unit. Children were expected to contribute, not only...

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Next stop, Grand Central Station

Quote of the day: No man is exempt from saying silly things; the mischief is to say them deliberately. - Michel de Montaigne There are many bloggers: who are for more eloquent and gifted writers than I am. And some are eloquent speakers I often read their blogs, or columns and think...that's how I feel, or think.....how come I did not say that out loud or write it down?  Perhaps one of the factors is lack of time....It could involve my whole day and night, if I freely associate....I would even have to write down my dreams.... I think of myself as a visionary and futurist.....so perhaps it is a blessing to those around me that I don't broadcast everything that comes to mind.   It would be like all those...

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The Red Eye Health Train Express

Quote of the day: Thanks to TV and for the convenience of TV, you can only be one of two kinds of human beings, either a liberal or a conservative. - Kurt Vonnegut   A lot of people when they get into bed at night turn on the television, and also read a book.   Me, I put my laptop on my tummy,   and surf the net, read and research my interests in health policy reform.  There is no shortage of pundits in this realm.  However tonite, as I was watching the olympics with one eye and the proceedings on my laptop my mind forgot all about the .  It was interesting that in the relays the U.S. team dropped the baton in both the women's and the men's relays.  Undoubtedly the United States had the...

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Health Train Lawyers

Quote of the day: The great enemy of clear language is insincerity. When there is a gap between one's real and one's declared aims, one turns as it were instinctively to long words and exhausted idioms, like a cuttlefish spurting out ink. - George Orwell How much will this cost the people of California?  (for lawyers) Attorneys for the people, and the federal government: Judge blocks state's cut in Medi-Cal fees San Francisco Chronicle - 08-20-2008 - A federal judge has blocked California's 10 percent cut in Medi-Cal fees for doctors, dentists and pharmacies, saying the money-saving measures appear to violate federal law and would worsen medical care for millions of poor people. In her ruling Monday, U.S. District Judge...

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Counting Sheep

Quote of the day: Procrastination isn't the problem, it's the solution. So procrastinate now, don't put it off. - Ellen DeGeneres   It's always a mistake for me to look at blogs just before bedtime. I usually come across articles and/or issues that defy normal logic and/or thought. Just when you thought EMRs were the answer to everything I come across this: Proposal To Move to ICD-10 Coding System Stalled An effort to adopt new health care coding standards that some experts say might be more compatible with electronic medical records has stalled, according to an industry group advocating the changes, Healthcare IT News reports. Some organizations - such as the American Health Information Management Association and...

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Providers-Mortgage Your Home for your Patients

  Budget impasse halts Medi-Cal payments This article from the Ventura County Star is a shocking account of how irresponsible our California State Government is. Rather than prioritizing health care for disabled patients they will plan huge expenses for prison hospitals, pork barrel projects, and other non essential 'luxuries'...  Shame on Them....Shame on Us for allowing this. Truth Out Describes the issues in New York and California This group of patients is the most vulnerable, and requires the advocacy of every physician whether they accept medi-caid patients, or not....

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Health Train Obsession

    I used to obsess about my clinical profession, Ophthalmology. My spouse now tells me I obsess about health care reform.  My part time activities in health information technology issues have inflated, like health care costs, into an almost full time endeavour. The main differrence is that I was reimbursed, although poorly in later years (at least according to my assessments); now, in my present endeavour I am volunteer staff. In order to be perceived as credible in these areas, everyday experience and more than thirty years of 'boots on the ground' seems to speak for little.  I, like many physicians seem to be outgunned by health care pundits, financial pundits, politicos,foundation pundits, and more.  Too...

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Another Paradigm Shift

Quote of the day: Inspiration is wonderful when it happens, but the writer must develop an approach for the rest of the time... The wait is simply too long. - Leonard Bernstein It seems to me we have had enough shifts, that we ought to have an automatic transmission in lieu of manual changes. Richard  Reece, MD elaborates; "Something profound is happening in buyers’ and the public’s attitudes towards primary care and the health system. With inexorable rises in costs and corresponding decreases in access to primary care doctors, buyers and the public are mad as hell, and they’re deciding they’re not going to take it anymore. Something is badly and sadly wrong, and corrective measures are being put in place."  in his Medinnovation...

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Post Olympic Hangover

Medicare To Launch PHR Pilot Program in Utah, Arizona On Jan. 2, 2009, CMS will launch a new pilot that will provide Medicare beneficiaries in Utah and Arizona with personal health records, Government Health IT reports. The pilot is part of a larger effort by CMS to encourage Medicare beneficiaries to use PHRs (Ferris, Government Health IT, 8/8). The PHRs will be populated with two years' worth of Medicare claims data. In addition, patients will be able to add information to their PHRs and share them with health care providers. In June 2007, CMS launched a PHR pilot project for some beneficiaries enrolled in private Medicare Advantage and Medicare Part D prescription drug plans. In April, the agency launched a similar program...

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Moving Toward the Internet

One of my favorite pieces is by Richard Reece, M.D. from August 13,2008 on his Blog, Medinnovation...

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The Right Way to Do IT, and I don't Mean Information Technology

Howard County in Maryland is proposing a pilot demonstration project for uninsured patients. Rather than planning a grandiose project that would fall short of their goals, they have set a limited program on a fairly small scale, working from the ground up.Central to the program is careful case management and 'health coaches'.  Enrollment in the program and continuing benefits is predicated on the requirement that patients enroll and continue in the coaching program.  The program called  "Health Howard"  offers a window for other counties and states can reform their medicaid programs. It appears to be well thought out and organized. Cost containment is built into the program from the beginning with personal coaching and commitment to each patient.  The outcomes will...

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Ruling Health Care by Judicial Edict

The trouble with fighting for human freedom is that one spends most of one's time defending scoundrels. For it is against scoundrels that oppressive laws are first aimed, and oppression must be stopped at the beginning if it is to be stopped at all. H. L. Mencken US editor (1880 - 1956)   The cure for the common cold seems to be declaring bankruptcy. SACRAMENTO -- The court-appointed overseer for healthcare in state prisons moved Wednesday to seize $8 billion from the California treasury, asking a federal judge to hold Gov. Arnold Schwarzenegger and California Controller John Chiang in contempt of court.   The receiver's court filing With the state mired in fiscal crisis, J. Clark Kelso, the federal receiver, asked...

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Phelps

Exclusive Summer Olympics news & widgets at NBC Olympics.c...

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Olympic Week

  I will not be posting during the next week or so. The Olympic Games have my undivided attention. At the end of the week I will be posting my observations and I leave you with this Olympics Beijing 2008...

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Olympic Week

Health Train Express will be featuring live video links courtesy of nbcolympics.comWe emphasize excellence and performance in health care. Fitness, wellness and good health are the end point of what we strive for in clinical medici...

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Olympic Performance

Exclusive Summer Olympics news & widgets at NBC Olympics.c...

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What A Wonderful World of Blogging

    Health Train Express ,which began as a blog is transforming into a media hub for bloggers. Several years ago, blogging was considered a “hobby” for ‘geeks’ who were more interested in writing ‘code’ than the contents of their blogs. It still remains so for many ‘bloggers’. There are many blogs which have become “serious’ distributors of newsworthy events, much more than their original intent of ‘social networking’. White social networking remains a core component of of the efforts, new blogs have appeared from interesting sources. More blogs are written now by professional writers and health care policy analysts. Some information from symposia are published in ‘real time’, often quicker than conventional media sources. In some cases blogging appears to be another arm...

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International Health Train Express

Quote of the day: There will always be a part, and always a very large part of every community, that have no care but for themselves, and whose care for themselves reaches little further than impatience of immediate pain, and eagerness for the nearest good. - Samuel Johnson Who needs ICE (Immigration and Customs Enforcement? According to today's New York Times,  hospitals do not. Many hospitals resort to this "cost-effective' means to hold expenses in check in regard to the care of undocumented immigrants. " JOLOMCÚ, Guatemala — High in the hills of Guatemala, shut inside the one-room house where he spends day and night on a twin bed beneath a seriously outdated calendar, Luis Alberto Jiménez has no idea of the legal battle that swirls around him in the lowlands of Florida....

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MORE ON P4P

Quote of the day: The squeaking wheel doesn't always get the grease. Sometimes it gets replaced. - Vic Gold Greg Scandlen (Consumers for Health Care Choices) extracted some facts from Health Affairs that bears some scrutiny. Pay for Performance is a buzz word that has CMS and other payors  brainwashing and extorting providers with either incentives or negative rewards for implementing a largely unproven scheme. Health Affairs elaborates: Pay for Performance Doesn't Work ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Health Affairs has published an important new study on Pay For Performance (P4P) that concludes it has had virtually no impact on physician practice. That is not to say physician practice isn't improving with time,...

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