I’m up over at Spot-on about the health benefits system, and how it’s heading for long-term collapse, focusing on this time a wealthy company that’s not from Arkansas: Inside Intel’s Health Care System.
Meanwhile, I wrote a little about HIMSS, technology and why we’re falling behind over at TPMCafe’s excellent ongoing blog on Medicare Part D (which is fast becoming an excellent group health policy blog).
So go there and come back here for extensive HIMSS dump downloads next week….
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You are correct Matthew that tax free HSAs will cause a death spiral for employer-based health insurance companies. But none of the smart people are saying to sell their stock yet. It’s kinda funny. I bet that Bob, the CEO of Blue Cross of FL, has an idea that something is going down. Same with Dan the man in MI (CEO). US Rep. Mike Rogers (MI) (House subcommittee on health) said the government controlled employer-based health insurance scheme is “Out-of control.” (Lansing)
http://www.lsj.com/apps/pbcs.dll/article?AID=/20060219/OPINION02/602190640/1087/opinion
The most important thing to these Docs is their money, period. They run around the office screaming, “I have to make $10,000 per day.” My little brother headed the loan debt. for Physician’s Planning Service and 40% of all Docs’ loans were TD (Turned down). A large % of drug addicts. They have no social skills or business savvy. Most of them think defrauding Medicare or Medicaid is the only way to make a buck. Their offices are always totally disorganized. Don’t even ask a doc how much something costs because they will be off by a factor of 10. We should make docs pay FICA tax on all of their income because so much income comes from the taxpayers.
> relate the need to adopt HIT with the Hippocratic Oath
I should like to have heard this speech — I think he is right. The days are over when a few notes to refresh one’s own memory about a patient is sufficient. If it ever was sufficient. The cutural reistance to IT adoption is “excused” in some degree by our technical failures, but the technical failures are not addressed until there is sufficient demand.
When two application processes using the same database deadlock like this, a supervisor process comes along and kills one of the deadlocked processes. Drastic? Sure. Any other solution? Not until you redesign at least one of the processes…
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The approach that Dr. Middleton took at the HIMSS kick-off was to relate the need to adopt HIT with the Hippocratic Oath (i.e. an ethical responsibility as part of a profession).
I couldn’t agree more that HIT is one part of a cultural transformation that needs to take place in the delivery of healthcare.
At the HIMSS P4P Symposium a clear theme that came out was that large multi-specialty groups could both (collectively) afford the systems and process changes needed to improve the “peformance” of care… and that small, autonomous practices could not.
That NO ONE (payer, provider, or vendor) could point to examples of small physicians working together to pool resources (i.e. split the cost of systems, consulting, process improvement staff, etc.) makes me wonder whether even P4P will be enough of a carrot. Where there’s a will there’s a way… and clearly there isn’t enough will (or the culture of “autonomy” is too strong to allow this)…
The problem, Matthew? Come on!
Sorting out standards is not sufficient, but it is necessary and I think doing things in this order (interoperability first, actual interoperation after) is the best way to do it. And the government can help drive interoperability (standards adoption).
This is not to say we should be more idealistic than pragmatic with respect to the standards, but we have a pretty good idea of what at can work, demonstrated by X12.n, DICOM, NCPDP, and HL7. We can do a great deal for ourselves right now. This is not to say there are not certain fundamental problems besides incentives, but I do not think we should let the imaginary best be the enemy of the very real good.
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But the problem is IT use in small physician offices. I dont know how sorting out standards can figure that out without some change in the reimbursement mechanism.
> Unfortunately the government isn’t doing much about it
> other than giving a few contracts for demonstration
> projects, trying to corral data standards, and giving
> vendors something new to talk about ( the buzz word is
> “inter- operability”).
Well, this is essentially how the RSNA got the vendors to actually implement DICOM halfway reasonably, although in the main not to my satisfaction. But you should’ve seen the first couple demonstrations in Chicago. I would not call it “nothing”. And anything CMS can manage to require is not “nothing” either.
Full Disclosure: I worked for Jim Blaine in the Electronic Radiology Laboratory at Washington University from 1990 –> 1996, and our lab had a contract with the RSNA to host DICOM demonstration projects with a “vendor neutral” hub we called the Central Test Node.
I am glad an open standards process is in place, and I look forward to seeing sufficient interoperability demanded by hospital CIOs, CMS, and the various professional groups that these standards are unreservedly implemented by the IT vendors, and then that the standards are developed over time to keep up with changes in the industry. I do not think I want the government doing much more than it is doing.