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Throwing the EHR Under the Bus …

Given what is now known about how the case of Thomas Eric Duncan at Texas Health Presbyterian was handled, the attempt to blame the hospital’s electronic health record for the missed diagnosis sounds pretty lame.

But people are still doing it:

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Critics of electronic medical records have found a case they will be talking about for years.

Consider this argument from Ross Koppel and Suzanne Gordon:

While it is too early to determine what precisely happened in this case, it is not too early to consider the critical issues it highlights. One is our health care system’s reliance on computerized technology that is too often unfriendly to clinicians, especially those who work in stressful situations like a crowded emergency room. Then there are physicians’ long-standing failure to pay attention to nurses’ notes. Finally, there is the fact that hospitals often discourage nurses from assertively challenging physicians.

Long promised as the panacea for patient safety errors, electronic health records, in fact, have fragmented information, too often making critical data difficult to find. Often, doctors or nurses must log out of the system they are on and log into another system just to access data needed to treat their patients (with, of course, additional passwords required). Worse, data is frequently labeled in odd ways. For example, the results of a potassium test might be found under “potassium,” “serum potassium level,” “blood tests” or “lab reports.” Frequently, nurses and doctors will see different screen presentations of similar data, making it difficult to collaborate.

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Ok, I Have Insurance Now. But I Can’t Use It.

flying cadeucii

THCB reader Jillian writes in with this troubling report from the marketplace:

“I got my new member ID card, but I can’t use my insurance because “there is a delay in the system” and Blue Cross needs to get an official letter from the Marketplace.

I don’t know what the real problem is, I get a different answer every time. But I can’t get authorized to see my doctor. What do I?”

ACA Signups hit 7.5 million. Sebelius Steps Down. Mathews-Burwell to Lead HHS.

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In a development that Washington insiders had been quietly predicting for months,  Kathleen Sebelius announced Thursday that she is resigning as HHS Secretary. Critics were quick to point to the disastrous launch of Healthcare.gov and the glitch-filled rollout of the administration’s signature health law.

President Obama is expected to nominate  OMB  Director Sylvia Mathews Burwell to replace Sebelius Friday morning.  The Washington Post notes that Mathews-Burwell is well regarded for her “strong management skills”  and cites her experience in global health after ten years with the Bill and Melinda Gates Foundation.

Politico reports that while publicly praising Sebelius for having overseen a late surge in enrollments that brought signups up to the 7.5 million mark  by the time she announced her departure today,  many Democrats are said to be privately “furious” about how badly the Obamacare rollout went and are worried that debacle could cost them control of the Senate in November.

If you’re curious about Burwell’s resume – after all – we’re talking about the woman who will (probably) be the official face of Obamacare until at least 2017 – WonkBlog did some digging back at the time of the hearings for the OMB job.

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Can I Record My Conversation with My Insurance Company?

A THCB reader in San Diego writes:

I am SERIOUSLY annoyed.  I just got off the phone with my insurer. I’d called a day ago and spoken to a representative (who was very helpful) about a claim. I called back today to follow up and check on a detail.

It quickly became obvious that something was very wrong. I realized immediately what had happened. She’d made a mistake.  And left out a minor but important detail on my claim.

But instead of owning up to it, the woman pretended as though nothing had happened.  It was like we’d never met before. After a five minute conversation she accused me of lying.  I  could not believe what I was hearing. I was outraged.  I asked to be transferred to a supervisor.

The super listened to me for a minute and then took the side of her employee.  “Why should I believe you? Can you prove it?”

Can I prove it? I’ve been a good customer for years.  I shouldn’t have to prove it!!! “  How can I stop this from happening?  Can I record my conversation with my insurer? After all, they’re recording me for “quality purposes”!!!

Lost in the health care maze? Having trouble with your health Insurance? Confused about your treatment options? Email your questions to THCB’s editors. We’ll run the good ones as posts.

How Reliable Are EMR Reviews, Anyway???

The dude writes:

“I’m looking into a new EMR for our just incorporated small group practice. I’m diligently doing my Google  research. Frankly, I’m not  at all impressed by the quality of the information I’m finding out there.  Both the professional and the customer reviews I’m finding leave a lot to be desired.

The tone of many of the reviews I’m reading makes me wonder how reliable and objective they are.  A suspicious number of customer reviews are blandly positive, as if they were written by a corporate drone in a cubicle somewhere. They’re full of industry buzzwords and  praise: “Met all of my expectations ” and “is everything I could ask for in an EMR system.”

I’ve read enough patient and restaurant reviews online to know that reviews generally fall into two categories: angry customer and  worshipful.  The former almost always outnumber the latter by a margin of 4:1  But not here. Here its the other way around! The tone of the professional reviews also seems strangely subdued.

At least one popular review site (Software Advice) appears to take a direct commission from EMR vendors for each referral. They say this doesn’t impact them and that they’re objective, but this clearly biases them in my mind. What resources do people recommend?

And why doesn’t THCB run user reviews???

On THCB This Week

Narrow Networks: Boon or Bane?

Bigger Hospitals Mean Bigger Hospitals with Higher Prices. Not Better Care.

Metrics: Surprisingly, people who were uninsured last year remain undecided about the ACA,

Clinic: A cautionary note about the risks of blood pressure treatment in the elderly.

In Defense of corporate wellness programs.

Do workplace wellness programs make business sense?

Doctors without (state) borders.

Amazon.com as a delivery model for population health.

How Mayo Clinic is using iPads to empower patients.

Can Oscar succeed in making health insurance fun? Maybe not just yet ….

That vitamin over there could kill you.

How Reliable are EMR reviews, anyway???

Transparency a go go

CVS Caremark is entering CommonWell.

Seven reasons your doctor is still using technology that sucks.

Are payors changing what they’re are paying for medical billing codes to adjust for supply and demand?

What you need to know about patient matching and your privacy and what you can do about it.

Are Payors Changing What They Pay For Medical Billing Codes To Adjust For Supply and Demand?

Startup Mojo from Rhode Island writes:

Hey there, maybe THCB readers can weigh in on this one. I work at a healthcare startup. Somebody I know who works in medical billing told me that several big name insurers they know of are using analytics to adjust reimbursement rates for  medical billing codes on an almost daily and even hourly basis (a bit like the travel sites and airlines do to adjust for supply and demand) and encourage/discourage certain codes.  If that’s true, its certainly fascinating and pretty predictable, I guess.

I’m not sure how I feel about this. It sounds draconian. On the other hand,  it also sounds cool. Everybody else is doing the same sort of stuff with analytics: why not insurers? Information on this practice would obviously be useful for providers submitting claims, who might theoretically be able to game the system by timing when and how they submit. Is there any data out there on this?

Is this b.s. or not?

Lost in the health care maze? Having trouble with your health Insurance? Confused about your treatment options? Email your questions to THCB’s editors. We’ll run the good ones as posts.

I’m a Doctor. And This Stuff Even Confuses Me!!!

Extremely irate on the East Coast writes:

I’m a doctor. I have an MBA from a prestigious business school. I understand medical billing. Here’s a story for you that sums it all up.

After many years as an independent, my OBGYN recently joined a large physician group affiliated with a nationally known academic medical center.

(I’ll keep the name of the institution out of this since I like my OBGYN and several of my friends work at the medical center.)

Late last year I had a minor procedure at the academic medical center. My OBGYN handled the surgery. Everything went smoothly.

When the bill came I was charged a reasonable $600. This year I had to have a repeat of the same procedure. My OBGYN again performed the procedure. Same outcome. Same nurses. Same specialist. Same room. When my bill came in the mail I got the shock of my life. The total was four times as much as it had been a year earlier!!!! I had no idea.

My OBGYN’s office told me there is nothing they can do. Prices are set by the new academic medical center supergroup. As far as I can tell, the only thing that has changed is the sign over my doctor’s door.

What recourse do I have? What consumer protections does the ACA contain designed to prevent this kind of behavior?

I’m a doctor. I understand the issues involved. If I’m confused, how is the average consumer supposed to deal with this? This is extremely bad.

Lost in the health care maze? Having trouble with your health Insurance? Confused about your treatment options? Email your questions to THCB’s editors. We’ll run the good ones as posts.

On THCB This Month …

If the massive data breach affecting millions of Target customers taught us anything, writes THCB contributor Joe Flower, it’s that we’re really not as good at computer security as we thought we were.

Uber for Healthcare? Not so much.

Does your patient have the right to refuse a flu shot? Actually, yes.

What we really need is an electronic medical record that works like Wikipedia.

The numbers are in. And the EHR incentive program is on track, writes National Coordinator Karen DaSalvo .

Teach your EMR to do e-mail??? Unthinkable! Impossible! Or is it?

Why the SGR fix won’t work. And may make things a lot worse.

PCORI chief Joe Selby writes comparative effectiveness work on cardiovascular disease shows the potential of Affordable Care Act funding for research.

Last week’s announcement that pharmacies and major retailers have agreed to participate in the Blue Button initiative drew some notice. Is Washington’s much-talked about plan to get people sharing their health records about to start a revolution?

Are ACOs the delivery model of the future? Or a passing fad?

Ode to the fat man.

N=1. My experience with the new healthcare system.

News that the much reviled SGR formula may be on the way out, but it may be a little early to start cheering, writes former finance committee analyst Billy Wynne.

Apple may be getting ready to make a big healthcare move. Maybe.

Actually,  transparency doesn’t work

Actually, I love my EMR.

How can patients on Medicaid possibly be worse off than those who don’t have insurance?

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