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POLICY/PHYSICIANS: More on the AMA

• 11

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…

TECH: Iinteroperability, Schminteroperability

• 1

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.

 

TECH: Phil Sissions on the NHS–Less there than meets the eye

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….

 

 

 

PHYSICIANS/TECH: The intransigence of the AMA knows no bounds

• 11

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.

TECH: TEPR musings

• 4

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…

Policy: The LA Times on Kaiser Permanente By John Irvine

• 13

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."

POLICY: Do No Evil, Part II.

• 11

Here’s my editorial in today’s issue of FH.

This week saw more controversy regarding some of the bad boys of healthcare past
and strong hints that some of the healthcare market stars of the present may
have adopted their bad habits. Criminal investigations into United HealthGroup
and ACS are now following The Wall Street Journal story about their
stock option pricing and Bill McGuire’s huge fortune. Now Caremark has been
subpoenaed, too. Those of you with very long memories may remember Caremark in a
previous life getting into legal trouble as a home infusion operation in the
1980s and being a financial disaster as a physician group roll-up in the
1990s.

Meanwhile, Tenet accepts a death penalty on one hospital and is still
struggling to get out from the malfeasance and its appalling, if not outright
criminal behavior, in Redding, CA, and probably elsewhere. Not that this is the
first time that appalling criminal behavior has been seen from that company,
although it was called NME back when it was kidnapping children into its
psychiatric hospitals.

We won’t do more than mention the name HealthSouth. While they’ve been off
the news lately, it’s worth remembering that the other big hospital chain, HCA,
has paid two of the biggest fines ever for defrauding Medicare, and that the
Senate majority leader’s brother, who happened to be the chairman, had an SEC
investigation mysteriously end in 2002.

So it’s worth asking the question again. Is it just a few bad apples? Or is
the pressure for stock growth from Wall Street incompatible with running a
responsible healthcare company?

Continue reading…

HEALTH PLANS/PBMs: Don’t be evil?

• 3

I’m in Miami to talk to the Blues Association about blogging and new media. I think my theme is that You Shouldn’t Be Evil (or whatever the Googlers say…)

But it looks like Caremark is joining United and ACS in options woes. Given the shenanignas going on at those two places— and unnecessary shenanigans as it turned out—perhaps a bunch of others have been playing that game. And as McGuire himself said "If we can’t find new ways to provide value, we won’t grow". But then again around here THCB fans know that Wall Street hates healthcare services but doesn’t know it.

Of course it’s not the evil liberal blogosphere that’s found out all this dirt. It was real journalists—Charles Forelle and James Bandler. Meanwhile fellow WSJounralista, Barbara Martinez is hot on the trail of the PBMs. So perhaps the answer is not to blame the blog, but to call your PR flacks and ask why the MSM, or SCLM, hasn’t been warned off the way you wanted?

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