Monday, December 19, 2011

The Issue in Health Care is NOT Money

 

Contrary to what poor or affluent people think, money does not solve all problems of health care,  and it will never stop the issues of caring for one another in a health system.

I believe the entire national budget could be thrown at health care and there would still be a problem of ‘not enough money’.  There is more than enough funding to maintain good health, wellness and treat those who are no longer healthy and/or well.

Precious resources are expended on studies, fighting fraud and abuse, having analysts draw graphs that either intersect dangerously at some time in the future, or have in the past. My favorite one is the exponential graph rising vertically into infinity.

The issues are much like the impasse about the debt ceiling. Political expediency and prostituting opinions for votes.  We ask politicians to make decisions from false economics, and figures that may be highly inaccurate, against a setting of voting on issues they know nothing about except how it affects a state or federal government.

Case in point is the current conflict about mandated insurance coverage.

Much has been said about using the current medi-caid system to fill in the blanks.  This is a more than stupid idea for many reasons.

1 The current system is not designed nor can it accommodate  more patients. 

2. The current system in many states do not have enough providers to service the huge increase in patients.

3.. The current system is not designed to care for patients. It is cumbersome and designed to deny care for any possible reason, financial, missing paperwork, or a vacant modifier in the billing codes.

4. The current system does not respond to market indicators, and reimbursement methodology is byzantine.

5. The current system needs to be “occupied”

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Saturday, December 17, 2011

Ticket Price Increases on the Health Train Express in a Time Calling for Austerity

 

Like the airlines, who are not too big to fail, medical practices will need to find ways to increase revenues. It’s too bad our patients don’t carry  baggage  into our offices so that we could have a surcharge modifier such as –0000 for each item.

However physicians can emit a sigh of relief with the announcement from on high at HHS, as brought to us by the American Medical Association, in AMED News.  Included in that news are:

Physicians meeting criteria in 2011 to earn federal electronic medical record incentives will have more time before the Dept. of Health and Human Services requires them to satisfy tougher standards for attaining additional bonuses. The move is being viewed by physicians and health policy observers as a goodwill gesture by the Obama administration toward EMR early adopters. ( Who cares what Obama thinks about goodwill? The AMA ?)

True to form modifications are being made to the calendar for implementation-incentive reward-penalty dates because the initial proclamations and mandates were poorly planned. What we have in  the federal government is a group of “cheerleaders’ encouraging the workers how much health IT will improve patient care. Even the AMA buys into that.

No Doctor Left Behind ?  This sounds much like the Bush Plan of No child left behind.

Public health studies have shown that more doctors want to participate in the EMR adoption program. A study from the Centers for Disease Control and Prevention found 52% of office-based physicians plan to register and attest to meeting program requirements for 2011, which is an increase from the 41% who planned in 2010 to do so. The total portion of physicians who have adopted EMRs also is at 34% in 2011, up from 17% in 2008.

It takes a lawyer to make the following statement,

“

“There are several takeaways for physicians from Sibelius' announcement,” said Stephen Bernstein, an attorney who is the international head of the health industry practice group at McDermott Will & Emery in Boston. In general, more physicians are adopting EMRs and using the technology to improve their practices.

“HHS also is sending a message to physicians who are undecided about whether they should make a significant investment in electronic recordkeeping”, Bernstein said. “The agency will work with physicians to help them adopt EMRs”. He suggested that doctors get in touch with one of 62 federal regional extension centers that have been established to help physicians, in particular small primary care practices, adopt EMRs.

"The main message is that there are federal government programs out there to help physicians, and the federal government isn't going to stop offering help," he said.

“It’s okay, we are here from the government to help you.” (author)

Bernstein added that a robust EMR system is needed to participate in new Medicare payment models, such as accountable care organizations. If CMS wants physicians to participate in these initiatives as well, it must do everything it can to encourage doctors to use EMRs, he said.

It’s a bundled plan, just like reimbursements. Step C is dependent on steps A and B. (If they work in the first place)

Clearly it is disruption disrupting disruption. Even chaos theory fails to keep up with these advances in advanced health care physics.

image

The incentive program is clearly aimed at primary care MDs, and the recent statistics reveal it.

Specialty               # Participating in   Bonus

Family practice     1,216

Internal medicine  1,198

Cardiology               517

Podiatry                   378

Gastroenterology    232

Orthopedic surgery 201

General surgery      197

Urology                    197

Nephrology              174

Neurology                148

Other                    1,347

What Medicaid Paid for EMR Bonuses

Physician               6,609             $138.5 million

Nurse practitioner  1,463               $31.1 million

Acute care hospital   607             $483.9 million

Dentist                      333                 $7.1 million

Certified nurse midwife  172             $3.7 million

Physician assistant        107             $2.3 million

Children's hospital           15           $45.1 million

What is even more worrisome is the profound recession we are experiencing, the HHS emphasizes the ARRA and Hitech have produced 50,000 job…a mere drop in the bucket. Our budget deficit is crippling planning at the federal and state level….

More than incentives we need austerity.

Stay tuned for more modifications

Wednesday, December 14, 2011

Touchfire with Health Train Express

 

Another bold innovation (and why didn’t I think of this before?) The beauty of this is that it offers another functionality to the iPad form factor. without the burden of extra parts.  Although the iPad offers a keypad feature, users complain there is no tactile feedback which touch typists use unconsciously to type. And the addition of an external keyboard adds to more clutter.

This flexible plastiform rubberized overlay is held in place by magnets which attack to the border of the iPad’s frontface. It gives the user tactile feedback much like a normal keyboard. It also has other features attaching it to iPads official cover.

All in all a dandy device for the  clinic, by the bedside or in the hospital.

Tuesday, December 13, 2011

Health 2.0 in Social Media

 

Monitoring the social media stream today in #hcsm #medicine #healthreform and find that Facebook will offer a page and/or referral to FBers who are depressed and suicidal. Is this the first step into Health 2.0 and is social media going to bypass formal developments in the Health 2.0 Challenge?

Mobile apps already support API for all the social media platforms, twitter, facebook, and Google +. Twitter is very restrictive as to which APIs can use twitter’s API however health 2.0 would gain them many more users that do not compete with Twitter’s plans.

I predict that Social media will bypass the present vision for formal  health 2.0 apps, and developers should re-think their game plans or be left behind even before it happens.

G+ offers the potential for telehealth with video and it should not be hard for programmers to build a secure encrypted API to comply with HIPAA. It is accessible on smartphones, iPads and many tablet PCs.

I held a G+ hangout on Tuesday night at 6PM. The attendance was zero. A big disappointment but not a surprise at all. Not many MDs and few #hcsm users are on Google + Experience reveals it takes about one month for the stream to capture interested social media participants.

Google + has a predominance of artists, performers, and photographers. Even if you don’t want to hangout in health care…it is a broadening experience and revealing as to how much talent there is besides American Idol and the network cable offerings.

Health Train is the most prominent MD and health related +er on Google.

You can find Health Train’s profile on Google + at the Google ID.  Join and put me in one of your circles.   Hope to see you all there.

Monday, December 12, 2011

And The Webcina Winners are:

 

Webcina announced it’s winners for their contest for social media participants. Although Healthtrain Express failed to make it to the podium I enjoyed participating and ‘spilling my beans”. My reward was to be able to read these fine stories..Stories that should excite all of us in social media.

I read the winning blog posts, and found them all to be far better in appeal and content than my illiterate meanderings.

Here they are:

The Tap Code by Katherine Leon

Transient Global Amnesia and Social Media by Susan McKinnon

Suzanne Ezekiel’s Journey  Her contribution includes her vivid youtube video portraying the effects of her disease. It is one of the most telling and vivid descriptions that leaves the observer breathless and battered.  It probably should receive some type of award in videography and story content.

Take My Body Away

Thank you Webcina !!

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G+ Hangout with Health Train Express

 

gml

At 6 PM PST/ 9PM EST on Google + Hangout please join us tonight December 12, 2011 for a discussion on health care and reform.

Proposed agenda:

1. Effect of social media on medical  practice and business. Do you use it for;  marketing, communication, patient care.

2. Will Obama care be repealed? totally or partially

3. Will SGR formula be enacted or put on hold again this year?

4. Will you become part of an accountable care organization

5. Bring your own topics.

6. Discuss selection of special invited guest as ‘keynote speaker”  for next week’s hangout to be held on Tuesday December 20 2011 at 6PM PST.

BruceGarber.tv

On next Tuesday we will host a special invited guest, +Bruce Garber, whose interests are in video production and the use of Google hangout for medical conferencing and telemedicine.

Link to my stream to join hangout:

Join HealthTrain Express Google+ Hangout December 12, 2011 6 PM Pacific time  9 PM Eastern time.

Accessible with iPhone  iPad  as well as desktop or laptop.

See you then:

Sunday, December 11, 2011

No Ticket Required on Health Train Express

Just like my office walk ins are always accepted. The same here on the Health Train Express….my plan for a subject often changes drastically when I surf the web, check my tweet box, Facebook, and Google +.

Healthcare is not all that unique. I find similar challenges in business  on Google +, Facebook, LinkedIn and Twitter. Business is also perplexed just what to do with social media. In healthcare there remains a large part of the workforce that are neophytes with health information technology and  how to use it. Questions arise about return on investment with EMRs, Health Information Exchanges, Outcome studies, and Analytics. The jury will be out for several or more years for many reasons. Statistics have a way of flowing in slowly however with the modernization of systems and new software that will take a set of tables, and charts and transform them into an easily understood graphic understanding sheer numbers may turn into a video-game like presentation.

As in healthcare business is challenged as to what portion of social media to exploit, where, and how much. Like electronic medical records the work force must be trained in social media.

 
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