Our friend Amy Tenderich does a wonderful job every year with her ever-growing Diabetes Mine Design challenge. We’re late to the party (it was announced last week) but here are the winners!
WIHI On Imaging Practices
By PAUL LEVY
Here's a notice about an upcoming WIHI program.
The Image of Better (Radiation) Imaging Practices
Thursday, June 17, 2010, 2:00 PM – 3:00 PM Eastern Time
Guests:
James R. Duncan, MD, PhD, Associate Professor of Radiology and Surgery, Washington University School of Medicine, St. Louis, Missouri.
Richard T. Griffey, MD, MPH, Associate Chief for Quality and Safety, Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri.
Imagine an electronic card that has all your vital medical information on it. Not too farfetched. Now, imagine that this same “smart card” also contains your radiation exposure history. Who needs to know, you ask? Well, a growing number of global patient safety experts believe this is precisely the type of information patients and medical providers should be tracking to help prevent unnecessary CT scans and the like, especially as evidence mounts that all these tests begin to add up in ways that that can endanger people’s health. Cancer is being studied the most, which is of course ironic since powerful and advanced radiation imaging is what also helps diagnose cancerous tumors at their earliest and most treatable stages.
Health 2.0 DC Exhibit Hall Companies and Descriptions!
The Health 2.0 Goes to Washington conference in DC last Monday, June 7th was an exciting and successful event. Thank you to everyone who attended along with HHS and ONC, who helped us put on a great show!
We also couldn't have done it without the generous support of our sponsors and exhibitors…Everyday Health, dLife, ICYou, Gaming 4 Health, Enhanced Medical Decisions, Surveyor Health, Unity Medical, Vitality, Humetrix, Destination Rx, 5am Solutions, Terpsys, Aquilent, Sage, Kaiser Permenente, Cisco, RelayHealth, Practice Fusion, Vision Tree, Myca, Hello Health, Eliza and Alere.
The DC Exhibit Hall was specially curated and different from any other event. We designated each company under a certain category and organized the hall to be a self-guided tour. To see a full list and descriptions of each company that was displayed at the event – CLICK HERE!
We know your all waiting for Matthew to publish his conference summary and survey…both will be coming soon!
AHRQ’s Outstanding Achievement in Healthcare Research Award
- Calling all published and graduate student researchers who have used
Healthcare Cost and Utilization Project (HCUP) data!
- Nominations and applications accepted through July 16.
To
celebrate its 20th year of HCUP data, AHRQ will be honoring researchers
who have addressed healthcare research and policy issues using HCUP
data, software or tools.
AHRQ encourages published researchers
to apply in two areas: Scientific Contributions and Policy Impact. Graduate students can only apply for the scientific contribution
award.
Award recipients will be honored at the AHRQ Annual
Meeting (September 27-29, in Bethesda, Maryland). They will have the
opportunity to present their research at a session during the
meeting. Transportation and accommodations will be provided.
Apply
and get more information here: http://www.hcup-us.ahrq.gov/hsra.jsp.
How Can We Encourage Medical Students to Choose Primary Care?
A Radical Suggestion – Pay Specialists Less
Since 1997 the number of US medical students choosing to go into primary care has decreased by more than 50%. It seems that sources as diverse as the Obama Administration and the Wall Street Journal think that we should find a way to encourage medical students to choose primary care specialties in order to allow Americans to have the best and most cost effective care. This is very problematic when primary care specialists earn considerably less, often 50-70% less than physicians in specialties where most of the revenue is produced by doing procedures. For years when asked about the disparity in physician salaries I’ve said, “I think primary care physicians are fairly compensated. I just think a lot of other physicians are overpaid.”
If you look at the 2009 AMGA survey of physician income it is clear that the pay you can expect as a physician has little to do with how hard you work, how long you train, or how stressful or difficult your work is, and everything to do with whether you perform procedures that are highly compensated. It is hard to think of specialties less demanding in terms of afterhours call, emergent life-threatening care, and overall lifestyle than dermatology ($350,627), diagnostic non-interventional radiology ($438,115) and Radiation Therapy ($413,518) (median salary in parentheses). Compare these to what I’d consider some of the most difficult, intellectually challenging, and demanding specialties: Pediatric Oncology ($205,999), Infectious Disease ($222,094) and Adult Neurology ($236,500). Family Medicine is one of the very few specialties where the first number in the median salary is a 1.
Plug Into Meaningful Use, Don’t Try to Build It
By JONATHAN BUSH
Earlier this month I read in The New York Times (okay, someone read it to me), that hospitals and docs are saying “meaningful use” is just too much, too fast. I have to say, I would sympathize . . . if I didn’t know about the Internet!
If someone told me that the federal government was going to make (or at least ‘encourage’) everyone commute via hot-air balloon by 2011, I’d start to feel edgy right about now. How do you make or buy one? Who sells them? What if the wind blows the wrong way?
This would be my panic—unless I knew about a little-known hot-air balloon service that DEALS with all of it. Like a taxi service. You tell it where you want to go and when and then boom! a balloon shows up piloted, prepped and ready.
Such a quandary exists in the EMR market today. Everyone thinks the government rules mean that meaningfully using electronic health information actually means meaningfully using information you BUILD YOURSELF! They think you have to buy EMRs and servers and program them to meet government rules and then re-program them to meet rule changes. This would give me hives, even if I were a giant health system. Even systems with big budgets don’t have a comparative advantage in programming software!Continue reading…
Pitfalls of PPACA – Accountable Care Organizations
By 
In addition to Medicare Advantage payment cuts and potential reductions in fee-for-service payment updates, PPACA includes various provisions intended to facilitate ongoing Medicare cost containment, notably creation of the Independent Payment Advisory Board and the Center for Medicare and Medicaid Innovation. In addition to CMI’s broad scope, PPACA requires specific pilot projects, including (in Section 3022) demonstration of accountable care organizations (ACOs).
What does PPACA mean by an ACO? Dr. Elliott Fisher of Dartmouth Medical School, a primary originator of the concept, defined it as “a provider-led organization whose mission is to manage the full continuum of care and be accountable for the overall costs and quality of care for a defined population” and listed several provider groupings that could form ACOs. PPACA provides additional criteria, including having a formal legal structure and administrative systems, meeting CMS requirements for quality assurance and reporting, and serving at least 5000 Medicare beneficiaries. PPACA also specifies a deadline for the ACO pilot: “Not later than January 1, 2012, the Secretary shall establish…a program…”
The goal of an ACO is to reduce costs and improve quality of care through cooperation and coordination among providers, similar to that achieved by integrated delivery systems like Geisinger, HealthPartners, and Intermountain Health Care, but within what may be essentially a virtual organization superimposed on a loose network of providers and covering only a subset of patients.
Social media interlude
By PAUL LEVY
Two items about social media.
1) I often get the question in interviews, “How much time do you spend on your blog and other social media?” I often answer, “You wouldn’t think of asking me how much time I spend on the telephone, and it is a lot less efficient than social media.”
Think about it this way. A major advantage of social media is its asynchronicity. The person or people with whom I am communicating do not have to be doing it at the same time as I do. Another advantage, of course, is the broader reach of social media, being able to be in touch with dozens, hundreds, or thousands of people.
Commentology: A mother’s plea for help
Desperate and stuck in the middle
I am the mother of an 11-month-old baby girl, Cassidy, who has CCHS (Congenital Central Hypoventilation Syndrome), a very
rare genetic mutation. Our union health care company recently changed
"paperwork" companies,at which time we were told that we were getting special pediatric respiratory services that we were not entitled to
and it [coverage] would end!
We scrambled to make other arrangements since Cassidy is ventilator-dependent and suffers from frequent "blue
spells" that require oxygen to be administered asap. We were finally able to get the pediatric respiratory coverage
in a state-sponsored policy for a fee. We were starting to breathe a little easier about the situation until we called my
husband's employer. We were told that we could not remove Cassidy from the original health policy because it was a self-funded
insurance plan and federal regulations prohibit switching to a different plan.
Who Wants to Give Money to Their Toughest Competitor?
By EDWARD PULLEN, MD
In Philanthropy It’s All About Relationships.
Last night I spent an interesting evening as the local physician asked to come along with our local hospital on a philanthropy pitch to a local specialty group to contribute to the finishing touches of a new hospital in town. Puyallup, WA has been an interesting community from a medical services standpoint. Currently we are a very desirable populace to any hospital organization. We are young, employed, insured, and growing as a community. We have a relatively high disposable income.
On top of that we have only one community hospital, Good Samaritan Hospital. The downside is that in part because of this lack of competition from another local hospital we have fallen far behind nearby larger communities in the physical plant we use as our hospital. My accounting daughter would probably say we have accrued a huge capital deficit in facilities. Good Sam was recently acquired by a larger hospital group, allowing the community to plan for, fund and build a new hospital. As physicians we are appropriately being asked to contribute to this project.
Everyone knows that the economy stinks right now. In addition physicians now are struggling with the issues of higher expectations of service, higher overhead, reduced payment for many ancillary services, and higher state taxes in Washington, and uncertainty in future Medicare rates. I thought these would be the primary issues we faced in discussing a contribution from this specialty group. These issues were brought up and we all went through the anticipated woe-is-me discussion on the economy and politics about medical reform and compensation. To my surprise the discussion quickly turned to relationships. This was where real passion came into the conversation.
In our community many specialties are represented by only one group of physicians. This is true of the group we met with tonight, as well as many other specialties. Though less than in some other communities some local medical groups have been acquired by hospitals. This has at times led to competition between the hospital and the private groups in town at the same time that a cooperative relationship and collaboration are needed. We spent most of the evening discussing the need for respect, trust and cooperation. In other businesses this might have been more overt. Discussions of exclusive relationships or contracts for services might have been worked out. In medicine this type of discussion is forbidden. The hospitals not-for-profit status and inurnment issues, the anti-trust rules on physician fees, rules against self-referral, and more issues I only partly understand made this type of overt negotiations clearly off the table. Still there remains a major concern among private physician groups that hospitals will bring unfair competition against them, be able to operate physician groups at a loss in order to secure referral sources for inpatient and procedural care, and as a result be able to out-compete the private groups on an unlevel playing field. It was interesting to see the intensity of these anxieties. In our community we all do really work for the same cause: good patient care and community health. In the final story the group we met with will do the right thing and step up to contribute to our community hospital in order to improve the facilities for our patients to utilize. Still the anxiety level of physicians remains intense about supporting their hospital who can also be their toughest competitor.
Edward Pullen, MD, is a board certified family physician practicing in Puyallup, WA. Dr. Pullen shares his viewpoints on medical news, policy and the practice of medicine from a primary care physician’s perspective at his blog, DrPullen.com.
