Iraq? Terrorism? Middle East? Health Care? IT?
None of that is in the least importance compared to what the English nation is fixated on. Will Wayne Rooney’s right foot be better in time for the world cup? The answer appears to be that a Scan rules Rooney out for six weeks. So he should be fit for the latter stages, provided we sneak past Trinidad, Sweden and Paraguay.
Xerox PARC — Silicon Valley’s most famous research center. The place where the HomeBrew Computer club used to meet. The place from which good ideas were “appropriated” and become the core of minor companies like Apple, 3Com and later Microsoft. The place of the legendary Thursday afternoon lectures, and yup, now it’s risen to its all time height (or hype) and it’s hosting me!
So if you want to hear me talk, it’s happening at 4pm on Thursday 25 May, free and open to the public. I’ll be talking about health care, IT, Doctors, bribery and corruption….the stuff you know and love
Directions here
To those of you who’ve been paying attention, this may not exactly be news.
Apparently, health insurers don’t pay claims immediately and deny some of them. But it is news because practice management/billing company AthenaHealth has quantified the numbers across its practices and published a list by plan of who’s paying when. They’ve even sent me the spreadsheet with every plan’s numbers. And they, or rather their apparently amazing PR company (which called me at 6 am—don’t worry I’ll be making them pay my divorce lawyer’s fees) have done amazingly well to get this into Milt Freudenheim’s story in the NY Times called The Check Is Not in the Mail.
But is this news? Insurance companies make money off the float—always have. So it’s in their interest to be at the bottom of the list until either they get fined by the state (as happened to United in Arizona lately) or they get sued by medical associations (as happened to all the big guys in the late 1990s) and settle as Aetna and a bunch of others did three years ago. The numbers AthenaHealth put out seem to be a little better than they were in the 1990s, but maybe not as good as the doctors would like. If I was Humana CEO I’d call my CFO in and ask why we’re on the top of the list when the bigger more profitable plans are down the bottom!
Maybe I just love conspiracy theories too much, but given the NY Times penchant for printing up any rubbish that gets pushed to it by the current administration, perhaps Freudenheim is craving some of Judy Miller’s publicity! After all the CEO of AthenaHealth is not only named Bush but he’s a blood relative.
I’m also amused by the comments from the doc quoted:
Dr. Molly Katz, a Cincinnati gynecologist and former president of the Ohio Medical Association, said she hoped the publicity would encourage insurers to improve their payment practices. "I would much rather have my staff talking to patients than talking to insurance companies," Dr. Katz said.
Be careful what you wish for, Dr. Katz. Given that the organized medicine is getting its wish and we’re seeing more high-deductible plans, she’ll find that her staff—while they may not spend less time on the phone with insurers—will be spending much more time on the phone with their patients. Trying to get them to pay their bills!
So why did I get so grumpy with the secretary of the AMA and his talk at TEPR. I actually stood up and asked a long question which he interrupted to tell a bunch of lies about Canada, ignoring that there are lots of other countries with universal health care that do it differently and better. When I finally got to ask about why when ePrescribing was originally mandated for Part B in the house version of the 2003 MMA eRx legislation and ask as to why it mysteriously was left out of the final bill, and what was the AMA’s role in that — well as Neil Versel said to me afterwards “no one dodges the question like the AMA.”
Things he featured prominently………………The uninsurance crisis and how tough that is for doctorsThings he didn’t mention……………………The AMA’s long, long history of opposing universal health insurance including 1994
Things he featured prominently………………The AMA’s proposal for tax credits for the uninsuredThings he didn’t mention……………………That those proposals do almost nothing to reduce uninsurance
Things he featured prominently……………….How Pay for Performance was unfair on doctorsThings he didn’t mention……………………The AMA’s long, long history of opposing quality improvement
Things he featured prominently……………….How Medicare pay rates have fallen by half over timeThings he didn’t mention……………………The vast real increase in physician incomes since 1965
Things he featured prominently……………….How physicians will drop Medicare patients if fees go downThings he didn’t mention……………………The research that shows that this is untrue and an empty threat
Things he featured prominently……………….How other countries government’s paid for doctors’ ITThings he didn’t mention……………………How other countries doctors earn much less than him and his colleagues
Things he featured prominently……………….How the government should pay for physician IT but not mandate its useThings he didn’t mention……………………Every other business has been force to get IT to better serve its customers
Things he featured prominently……………….How Canada has rationing and is going to allow some private medicineThings he didn’t mention……………………That low–middle income Canadians don’t go bankrupt from the cost of health care
Yup, apparently it is just everyone else’s fault and physicians have no need to change anything.
I am on record as wanting doctors to run our health care system. I want physician organizations to get the money and decide its rational allocation . But apparently organized medicine’s response is to bury its head in the sand and demand that the rest of us hand them a blank check, and let’s all pretend it’s 1972 again.
Please please someone tell me that this guy is an anachronism and that he really doesn’t represent physician opinion….or else I will get even more depressed…
I’m up at Health-IT World talking about interoperability. I interviewed the Sun guys and TeraMedica for this brief article, and will have something else on the topic out later this week. I hope that I made it understandable….it’s the kind of buzzword-full topic that makes your head spin. Please let come back and let me know what you think after you’ve read it.
Also at the TEPR Conference, Phil Sissions, who recently left working for the UK’s NHS’ National Program for Information Technology (NPfIT), gave a pretty critical account of the progress to date for the single largest program in health care IT. The only real successes were getting broadband into the various hospitals and practices, and getting some PACS systems up. Getting doctors their own email address was somewhat mocking called the biggest achievement. Sessions said that many of the other programs, including the Choose and Book appointment system are barely being used, and that GPs have revolted when being told that they had to change out their practice management systems. So far the project has spent hardly any of the money allocated to it (approx. 650m GBP each year) because most of the contracted software hasn’t been delivered. Meanwhile, local hospitals and physician authorities have little money for process change, and have stopped much IT development progress waiting for the central program to provide for them. Sissions didn’t give the attendees much cause for optimism, and indicated that there was a heightening level of hostility between the vendors and NPfIT head Richard Granger.
More later….
Here’s what I wrote for FierceHealthcare today.
Attendees at the 22nd annual TEPR meeting could be forgiven for being a little anxious about the future. Conference organizer and Medical Records Institute Peter Waegemann put out a call for action, noting that at the first conference some speakers thought electronic medical records would be here within three years, then ten, and now more than twenty years later we’re still arguing about different standards. The keynote from AMA secretary Joseph Heyman showed where the problems lie. Although Heyman is a solo practitioner who runs a paperless office and has been using EMRs since 2001, he trumpeted his organization’s party line—No cuts in Medicare, or risk that doctors will stop taking patients. Great suspicion of pay for performance. Opposition to mandates to use technology. Demands for straight payment to acquire and use technology. Apparently the medical world has gone to hell and it’s anyone but the AMA’s fault, so apparently we shouldn’t expect doctors to save the health care system by using IT, unless it comes at no cost and inconvenince to them.
I’ll be back with a little more, and some much harsher words later.
I’m at TEPR, the electronic patient record conference, in lovely Baltimore Maryland. The line for the $4 latte at Starbucks is way too long, but across the street at Edie’s Deli, two eggs, home fries, scrapple, toast with jam, and a large coffee is $4.95!
I gave a fascinating talk to a packed room at 8am on Sunday about the Prescribing infrastructure and eRx. Thanks to the few brave soles who showed up!
Some other things I’m hearing…
Steve Pelton, CIO, Central Region Ministry Health care in Wisconsin (built a new 112 bed hospital) “CPOE is tough. Trying to change physician practice at the points of order entry is the biggest challenge I’ve faced in 29 years in health care IT”
David Muntz, CIO Texas Health Resources (merger of Harris Methodist in Ft Worth, Presbyterian in Dallas, Arlington Health System in 1997) Have won tons of awards, including non-health care IT awards & their CEO talks about “1 Hospital at 13 locations, but we’re not there yet!” — “When they came together they had 400 applications and only 3 were the same. Now down to 157 of which 50 are the same” “63% of docs use their portal caregate—and we don’t demand CME, so they find it useful”
Saw a very packed talk in the “small practices” track, from Pamela Moore, a rather jovial editor at Physician’s Practice magazine. She thinks that small practices are taking off in their EMR use (somewhere between 15 and 30% now—Manhattan apparently say their 2006 general use number is 27%)…She then said that in 3 years no one would be talking about this any more “it would be like talking about having telephones” I started chortling and so did the guy next to me….I then noticed on his badge that he was a Research Director in Healthcare research at Gartner.
What does this mean? Most of the people asking questions of the hospital CIOs in the RHIO session are from the Social Security Administration!
More later, so long as I can keep stealing Ekahau’s network (weird because their competition PCTS is running a wi-fi location tracking exercise…perhaps they’re working together?) The Conference Center has Wifi, but it’s $15 a day! I prefer free…
The smoke appears to be clearing around Kaiser Permanente’s headquarters, where the management is no doubt wondering if the worst is over after this week’s decision
to close the HMO’s Northern California kidney
transplant center. Patients enrolled in the program have been transferred
to UCSF and to UC Davis. Embarrasingly for Kaiser, there were a few Medicare Part D style snafus with the transition (apparently nobody was picking up at the toll-free number set up for patients.) But all in all, the consensus
seems to be that Kaiser did the right thing by moving quickly to shut down the
operation once the extent of the problems became clear.
What happens next? The answer to that question is probably best known by the
reporters at the Los Angeles Times, who may or may not have something else up
their sleeves, after the first wave of stories uncovering the scandal. Historically,
the Times has been tenacious when it comes to pieces like this (For a good example see: the transplant story at UCI
Medical Center). The paper won a Pulitzer for
outstanding public service journalism in 2005 for its series on King/Drew and might well have won another last year if it hadn’t been
for the Times-Picayune’s
brilliant coverage of Hurricane Katrina.
The problem for Kaiser is that once a story like this one breaks, a chain reaction
starts. People get mad. People come forward. E-mails start flying. For reporters,
the threads begin to unravel. It should go without saying that for a large health
management organization with a long and varied history, this is not exactly
an ideal scenario …
The whole emerging Kaiser story of course, has been the topic of lively debate in the THCB comments section, where the company is far from as unpopular as one might assume. (Matthew, you’ll note from earlier posts in this thread, is
a fairly sympathetic observer.) Up from the comments to make life more interesting
comes a former Kaiser transplant patient who did not particularly care for the
detached and academic tone of the discussion between some of the posters. Sarah
had this to say:
I hate 70% of you. You have no CLUE what you are saying. I am one of those
patients in the Kaiser Nor/Cal Transplant Program, having had a kidney transplant
17 years ago. What is coming out about this program is utterly horrifying, and
how any of you can defend Kaiser or debate the merits of transplants makes me
ILL. You should be ashamed of yourselves. And I know none of this is coming
from UCSF or Davis. And I know Dr. Inokuchi personally (she was one of my docs
at CPMC). And I know the program has been crap since it started (good luck getting
a call back for a simple question about dental pre-meds).This scandal is far bigger than y’all seem to realize. A lot of people died
for no reason.And for my surgery, Kaiser saved a fortune. $40k a year for 17
years plus health care costs related to dialysis would have been far more than
the transplant cost plus rejection meds."
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