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HIMSS and CHIME to HHS: ONC Needs Full-time National Coordinator

In a letter to HHS Secretary Sylvia Burwell, CHIME and ONC stress the need to hire a full-time National Coordinator for the ONC, should Karen DeSalvo continue to serve as both the ONC head and the assistant secretary of health:

“If Dr. DeSalvo is going to remain as the Acting Assistant Secretary for Health with part-time duties in health IT, we emphasize the need to appoint new ONC leadership immediately that can lead the agency on the host of critical issues that must be addressed.”

AMA Calls for Removal of MU Penalties

The AMA calls for all MU penalties to be halted and for the program to be more flexible with a shorter reporting period.  In addition, the AMA urges policymakers to refocus the MU program on interoperability and seek ways to improve product usability.

Cerner Breaks Ground at New Campus

Cerner breaks ground at a new $4.45 billion campus in Kansas City, which is expected to house 16,000 new Cerner employees within the next 10 years. The project includes about $1.75 billion in public tax subsidies.

Continue reading “HIT Newser”

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flying cadeuciiA rash could be leukemia or idiopathic thrombocytopenic purpura. A sore throat could be glossopharyngeal neuralgia or a retropharyngeal abscess. A blocked ear could be Ramsay-Hunt syndrome, a self-limited serous otitis or sudden sensorineural hearing loss with an abysmal prognosis if not treated immediately with high doses of steroids. A headache or sinus pain could be cancer, and a cough could be a pulmonary embolus or heart failure.

Treating the Well:

In my early career in Sweden, well child visits were done in nurse-led clinics, some of them only open on certain days, with a local doctor in attendance. Parents carried the children’s records with them, containing growth charts, immunization records and so on.

These nurses had great expertise in differentiating normal from abnormal appearance of children, and would direct the attending physician’s attention to children with abnormal metrics, appearance or behavior.

With this arrangement, the physician time requirement was reduced, and limited to evaluating children attending the clinics who needed special attention. Physicians also performed specific examinations at certain ages, such as checking for hip clicks. These clinics freed up the local pediatricians to evaluate more sick children.

Well-baby visits are now the bread and butter of American pediatricians and family practitioners, and with the ever expanding mandates of politically determined items that must be covered in order for doctors to get paid for their services, we sometimes have trouble accommodating illness care demands.

Continue reading “The Nurse Practitioner … Er, We Mean Doctor Is In”

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flying cadeuciiI think it’s fair to say Jonathan Gruber will not be offered the role of Pinocchio. Although intelligence agencies, in search of the truth serum, might have an interest in the ingredients of what he drinks.

Please put away the pitchforks. Gruber deserves credit for honesty and bipartisanship. Plus a complete rejection of Disneyland economics. If you’re looking for transparency, the other face of honesty, Gruber is ground zero.

‘Stupidity’, though, was an unfortunate choice of noun. And inaccurate. Gruber should have said ‘rational ignorance’ or ‘boundless optimism in technocracy,’ which describes most voters in any democracy.

‘Rational ignorance’ sounds smart. The cognoscenti know what you’re trying to get at. And the rationally ignorant, well they’re rationally ignorant. The term means something we do all the time: that is we can’t be bothered to seek information whether something is factually correct or not. It’s an information heuristic (mental short cut).

Imagine the information overload if we were presented itemized bills for everything we consumed in a restaurant. We’d know the costs of transporting that fine rack of lamb to the city, of its slaughter, of cleaning the abattoir after the slaughter. But to what avail is this information?

Unless you’re a payer hunting for pseudofraud, granularity is a nuisance. So that to avoid long term anhedonia from figuring CBO’s myriad calculations from magical Keynesian models we watch the Kardashians instead.

When you’re rationally ignorant you can be duped. Or rationally duped. But here is the key point: we choose what we allow ourselves to be duped about. No one can fool us twice without our consent.

Continue reading “Gruber’s Voters: Rational Ignorance”

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The proposed NATE Trust Community  is a privacy-invasive, rent-seeking, and cynical measure that will further fragment the already balkanized Direct secure messaging system and disenfranchise individual patients and physicians.

The proposed NATE Trust Community is a combination of:

  • weak, self-asserted security and privacy claims by institutions and corporations (privacy-invasive), who are

  • willing to pay the membership fee (rent-seeking), to the

  • exclusion of individuals bearing strong identity-proofed certificates such as those issued by the Federal Bridge Certification Authority as originally designed into the Direct secure messaging concept (cynical).

By excluding individual real people from participating in Direct, NATE is violating the core of the physician-patient relationship. The Massachusetts Medical Society has formally voted its objection to this method of implementing Direct in resolutions declaring that FBCA certificates be acceptable for Direct messaging. Physicians paying many $thousands in licensing fees and malpractice insurance each year deserve the opportunity to message with other physicians and with their patients under their medical license. This was our right and practice with Fax and US Mail and it should not be removed as we move to digital messaging.

Continue reading “An Open Letter on the NATE Trust Community”

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flying cadeuciiThe Dallas/Fort Worth Healthcare Daily ran a fascinating excerpt from the Steve Jacob’s book So Long, Marcus Welby, M.D.* The excerpt contained some very interesting assertions and statistics. For example:

  • Consultant PwC, relying on that Congressional Budget Office (CBO) report, estimated that malpractice insurance and defensive medicine accounted for 10 percent of total health-care costs. A 2010 Health Affairs article more conservatively pegged those costs at 2.4 percent of healthcare spending.
  • In a 2010 survey, U.S. orthopedic surgeons bluntly admitted that about 30 percent of tests and referrals were medically unnecessary and done to reduce physician vulnerability to lawsuits.
  • A 2011 analysis by the American Medical Association found that the average amount to defend a lawsuit in 2010 was $47,158, compared with $28,981 in 2001. The average cost to pay a medical liability claim—whether it was a settlement, jury award or some other disposition—was $331,947, compared with $297,682 in 2001.
  • Doctors spend significant time fighting lawsuits, regardless of outcome. The average litigated claim lingered for 25 months. Doctors spent 20 months defending cases that were ultimately dismissed, while claims going to trial took 39 months. Doctors who were victorious in court spent an average of 44 months in litigation.
  • A study in The New England Journal of Medicine estimated that by age 65 about 75 percent of physicians in low-risk specialties have been the target of at least one lawsuit, compared with about 99 percent of those in high-risk specialties.
  • According to Brian Atchinson, president of the Physician Insurers Association of America (PIAA), 70 percent of legal claims do not result in payments to patients, and physician defendants prevail 80 percent of time in claims resolved by verdict. Continue reading “A Culture of Overtreatment”
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65 million people lost weight with MyFitnessPal. Really?

Now, let’s see, according to Gallup, 18% of American adults are at their ideal weight, so we’ll assume they don’t want to lose weight.

That means 82% of American adults or about 198 million people might want lose weight. Thus, based on My Fitness Pal’s headline boast, their market penetration is nearly a third of the adults who need to lose weight, which is just boffo if you are a potential advertiser.

Or, is it? Observe, my dear Watson, as we play 20 questions with My Fitness Pal:

  1. How many of these people were repeat customers?

  2. How often did they come back?

  3. At what time intervals?

  4. When they came back, how much weight had they (re) gained?

  5. How much weight did the average user lose? Continue reading “65 Million People Lost Weight With MyFitnessPal?”

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Montoya

“Prepare to Die”, said Inigo Montoya to the six fingered man.

Reimbursement, prepare to die.

Doctors get reimbursed? Interesting….

Do Lawyers get reimbursed? Do accountants get reimbursed? When you send your check to pay for your Aetna premiums, are you reimbursing them?

The last time I checked, the act of being reimbursed implies that a person gave money and awaiting for someone to give them the money back.

Let’s take a quick look at Webster’s Dictionary.
reimburse |ˌrē-imˈbərs|
verb [ with obj. ]
repay (a person who has spent or lost money): the investors should be reimbursed for their losses.

• repay (a sum of money that has been spent or lost): they spend thousands of dollars that are not reimbursed by insurance.
#wtf
How did it come to pass that doctors don’t get paid, but reimbursed?

Continue reading “Reimbursement, Prepare to Die!”

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flying cadeuciiMany health care executives and professionals are wary, glass-half-empty people, conditioned by long experience to dwell on business risks. However, today’s health care environment is actually full of good news. Reflect on the following:

Expanding coverage. We’re on the way to cutting the number of uninsured Americans in half. No, we didn’t get to universal coverage with the Affordable Care Act. And its implementation has not been a pretty sight. But after decades of political failure, tens of millions of Americans are receiving coverage, no longer having to postpone care for serious health risks. Hospitals are already seeing their uncompensated care decline rapidly, especially in those states that expanded their Medicaid programs.

Cost crisis abated. We’ve achieved durable health cost stability. Since 2008, health costs have grown only 3.6 to 3.9 percent per year — growth rates not seen since the Eisenhower administration (five years before Medicare). The Congressional Budget Office recently forecast that 2016 per capita Medicare spending would be almost 30 percent lower than they projected in 2006. The difference, around $4,000 per capita, translates into a 2016 Medicare bill hundreds of billions of dollars lower than forecast in 2006. It’s worth repeatedly reminding policymakers that hard work from hospital executives and their clinical partners in controlling expenses and reducing readmissions have made a major contribution to this welcome cost stability.

Continue reading “The Glass Is Half Full”

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flying cadeuciiThe last day of October was the deadline for proposals in response to the U.S. Department of Defense’s call to overhaul its electronic health record software, also known as the Defense Healthcare Management Systems Modernization (DHMSM). PwC’s proposed solution, called the Defense Operational Readiness Health System (DORHS), seeks to bring innovations from the commercial marketplace to the military health system by using technology that is seamless, proven and reliable.

With team members DSS, Inc., Medsphere Systems Corporation, MedicaSoft and General Dynamics Information Technology, PwC’s goal is to enable every healthcare professional to provide the finest medical care possible to members of the military and their families during every phase of service, through retirement, and assist the Defense Health Agency in its continued business transformation to help implement and manage effectively the world’s largest healthcare delivery system.

Continue reading “A New Era for our Military Health System”

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