Category: Uncategorized

The Accidental Socialists

Aug 30, 2010• 62

By DAVID DRANOVE

Over the next few years, the U.S. healthcare system will be in the hands of academics from Cambridge, Massachusetts. New CMS Czar Donald Berwick was a member of the Harvard Medical School faculty. Joe Newhouse, who has been the senior adviser to Medicare for as long as I can remember, holds appointments in three different schools at Harvard. David Cutler, Dean of Harvard’s Undergraduate College, seems a good bet to lead the Independent Medicare Advisory Board. Countless of their colleagues and former students have taken key policy making positions in Washington.

I know most of these scholars. They are brilliant as a rule and are acting in the truest sense of public service. None of them are socialists in the usual sense of the word; they do not believe that the government is an efficient provider of most goods and services. I don’t think they want the government to provide health care either. They have never called for government ownership of hospitals or suggested that physicians join the civil service. But whether they realize it or not, they are the vanguard of a movement bringing socialized medicine to America.Continue reading…

Running Behind

Aug 30, 2010• 10

By ROB LAMBERTS

I walk into the exam room and the patient looks up at me with a surprised expression. ”Wow! I didn’t expect to see you so quickly!”

I smile and turn around to walk out of the door, saying: “Sorry! I’ll leave then and come back later.”

“No, no!” They respond, smiling. ”I’m happy to see you so soon. It’s just a surprise.”

I walk back into the room with a smirk. ”I just don’t want to offend you by being on time. I’ll try to do better next time.”

I am not sure if I should be happy or sad with such an interchange. On one hand, it feels good to stay on time with my appointments, holding up my end of the bargain of the schedule. On the other hand, the patient’s surprise betrays the fact that this is not the usual state of affairs. And it isn’t. I generally don’t run on time and don’t expect to run on time.

When I first started practice, the stated objective was to get the person out of the office within an hour of their scheduled appointment. This seemed a blend of realism and responsibility. At first it was easy to stay up on things. My schedule was sparsely filled, so I could make up time. After sixteen years of practice, however, my schedule almost never has open slots; when it does have openings, they are quickly filled. I still try to get them out within an hour.Continue reading…

Medicaid EHR Incentives – A Learning Experience

Aug 30, 2010• 12

By MARGALIT GUR-ARIE

By now almost everybody that has any remote interest in Health Care is aware of the much publicized incentives made available to health care providers for the adoption and meaningful use of certified EHR technology. The most quoted number is $44,000 to be paid by CMS to Medicare physicians. Practically every EHR vendor website is adorned with a Flash banner “educating” doctors on this cash windfall, and practically every HIT detractor is warning that the incentives are just a pittance compared to the real costs of ownership of a certified EHR. Very rarely does anybody go into the intricacies of the available incentives for Medicaid providers, which are almost 50% higher than Medicare and involve clinicians providing care to our most vulnerable citizens. However, there is much to learn from the structure of the Medicaid incentives program.

The HITECH statute sets forth a “net” average allowable cost for purchasing and implementing an EHR at $25,000 for the first year and $10,000 for subsequent years. Of this “net” allowable cost, the Secretary of HHS is authorized to pay Medicaid Eligible Providers up to 85% in stimulus incentives for a total of 6 years. It appears that the Government is about to pay you 85% of your EHR costs for the next 6 years, which is a pretty good deal. Looks, however, can be deceiving. As any early adopter of EHR knows, the total cost of ownership for an EHR over 6 years is well over the “net” allowable of $75,000 set forth in the HITECH Act, and Congress knew that too. This is why the statute instructs the Secretary of HHS to determine the actual average allowable costs of EHR:Continue reading…

A Meaningful Use and Standards Rule FAQ Part II

Aug 30, 2010• 2

By JOHN HALAMKA

As a followup to the HIMSS Webinar I gave last week, here’s an FAQ in the spirit of last month’s Meaningful Use and Standards Rule FAQ.

1. The Emergency Department is mentioned in 9 Core Measures and 3 Menu Measures, yet industry discussions seem to focus on the ED for CPOE and Discharge instructions. What functions do ED Information Systems need to support? Are these functions for just admitted patients or all ED Patients?

In my conversations with CMS, I believe that CMS will be issuing a corrections notice to clarify the role of the ED in the rule.Continue reading…

Health Reform Without Apologies

Aug 27, 2010• 23

By JOHN GOODMAN, PhD

Have you ever seen a fair, unbiased, evenhanded explanation of the Patient Protection and Affordable Care Act? Have you ever seen anything that even appeared to be objective? I haven’t.

So to fill the gap, my colleagues and I have produced “What Does Health Care Reform Mean To You? A Consumer’s Guide,” which explains how the new health care overhaul works, in a question-and-answer format. You can also get a pamphlet version— ideal for doctors’ offices, clinics, work places and everywhere else that people meet and socialize.

That it’s the first effort anyone has made to even try to be objective is in itself rather amazing. See if you agree on whether we succeeded and give us your comments.

During the nine-month period leading up to the passage of the Patient Protection and Affordable Care Act (PPACA), Americans were subjected to more than $200 million worth of TV, radio, newsprint and Internet ads. Almost all of these — pro and con — were pure propaganda.Continue reading…

The New Frontier of Medicine?

Aug 25, 2010

By ALLEN L. GEE, MD, PhD, FAAN

I hear the same sentiment frequently from my physician colleagues. They’ll say something like, “I am just an expensive data entry person.”

All the bells and whistles, drop-down boxes and multiple windows to navigate in their electronic health record (EHR) require them to focus more on the technology than the patient. Contrary to intent, technology is slowing them down and distracting them. A lot of self-employed physicians using an EHR as well as those working on a production basis will feel this pain.

Rest assured my friends, it is not just you and your inability to use a computer or to change your workflow—as IT experts and administrators would have us believe. The EHR industry has failed to deliver the solutions. Could this possibly be the reason so many doctors have failed to adopt an EHR? (In 2007, the U.S. Office of National Coordinator for Health IT reported that about 50% of EHR implementations failed.)

“If There’s a Doctor on Board, Please Ring Your Call Button”

Aug 25, 2010• 1

By BOB WACHTER, MD

Well, it happened again. Last Thursday evening, I was somewhere over Saskatchewan, returning from a lovely Mediterranean cruise, in that uncomfortable semi-conscious state that passes for sleep when you’re flying coach, when the airplane’s PA system rang out:

“If there’s a doctor on board, please ring your call button!”

If you’re old enough to remember the show “To Tell the Truth,” you know what happened next. In the show, four B-list celebrity judges guess which of three contestants holds a certain unusual job. Once the judges have made their guesses (guided by contestants’ answers to a series of questions), the real skunk breeder, or tea taster, or cemetery lot saleswoman is asked to stand. One contestant begins to rise, then checks herself and sits down. Then another. Finally the correct contestant stands. The audience lets out a collective “oooh.”

I’m guessing that the average packed Boeing 777 has at least a handful of doctor-passengers. When the call comes for a physician, I’m sure a few mutter, “no f-ing way” and go back to their Sudoku. But most, I think, respond like I do: we reach tentatively for our call button then, thinking better of it, stop, look around, start again, then finally push the damn thing. Even as we nobly hit the button, in our heart of hearts we hope that we’re number two – our guilt assuaged but our services unneeded.Continue reading…

To Med Students Considering Primary Care

Aug 24, 2010• 13

By ROB LAMBERTS, MD

Dear Student:

Thank you for your consideration of my profession for your career. I am a primary care physician and have practiced for the past 16 years in a privately-owned practice. (At some point I intend to stop practicing and start doing the real thing. It amazes me at how many patients let me practice on them.)

Anyhow, I thought I’d give you some advice as you go through what is perhaps your biggest decision regarding your career. Like me, you probably once thought that choosing to become a doctor was the biggest decision, but within medicine there are many options, giving a very wide range of career choices. It is the final choice that is, well, final. What are you going to do with your life? ”Being a doctor” covers so much range, that it really has little meaning. Dr. Oz is a doctor, and he has a very different life from mine (for one, he’s not the target of Oprah’s contempt like I am – but that’s a whole other story).

Here are the things to consider when thinking about primary care:

1. Do you like talking to people who are not like you?

Primary care doctors spend time with humans – normal humans. This is both good and bad, as you see all sides of people, the good, bad , crazy, annoying, funny, and vulnerable sides. If you see mental challenge as the main reason to do something, and would simply put up with the human interaction in primary care, don’t do it. The single most important thing I have with my patients that most non-pcp’s don’t have is relationship. I see people over their lifetime, and that gives me a unique perspective.

Op-Ed: The Government EHR

Aug 23, 2010• 19

By MARGALIT GUR-ARIE

No, you didn’t miss anything, there is no Government EHR. But should there be one? And if so, what should it look like?

The argument in favor of a Government EHR goes something like this: If we have 19 Billion dollars to spend on EHR adoption, why not spend a small fraction of that money and buy or build an EHR and make it freely available to all physicians and hospitals? Not a bad idea. I would add that, if we must, we could spend the rest of those billions on training and supporting physicians in their efforts to computerize their records. So how would a Government go about accomplishing such monumental task?Continue reading…

It’s My Life, It’s Now or Never

Aug 22, 2010• 16

By LISA SUENNEN

You can walk into a pharmacy any day and buy a test kit to find out if you are ovulating so that you can undertake family planning activities. You can buy home testing kits to screen for high cholesterol, presence of the HIV virus, even illicit drug use. You can also pony up $500 and buy yourself a genetic test kit from 23andMe, a retail DNA testing service, to find out what might be in your genetic blueprint. Hey, you can even visit a fortune teller if you feel that is how you want to make pre-emptive healthcare decisions.

While some might look askew at how you get information to make choices about your life, it is rare that someone steps in and tries to stop you from doing so. In general, the American way is to say, “Hey, you’re an adult and it’s your life. If you want to engage in self-actualization, whether or not it has a scientific basis, that’s your beeswax.”

As medicine has evolved to a point where over-the-counter testing has become more and more accessible, many consumers have responded to the perceived advantages of privacy, convenience and the heightened ability to make health decisions early. In fact, these are part of the key principles espoused by those who believe that consumers have a right to their own healthcare information. The idea is that the information is about you, the healthcare consumer, and thus should be both readily available to you and yours to do with what you wish. And yet, that is not always the case. Often it’s not even close. Continue reading…