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Above the Fold

Building a Medical Practice: Does Government Help or Hinder?

Sep 4, 2012

By David M. Mokotoff, MD

Over 30 years ago, I began a cardiology group practice in St. Petersburg, Florida, Bay Area Heart Center. I invested $30,000––all of my savings at the time, and worked 90-110 hours per week for three years before I hired a partner. Since then the practice has grown to about 50 employees, including twelve physicians. I was taken aback by President Obama’s recent remark, “If you’ve got a business — you didn’t build that. Somebody else made that happen.”

Did I have help building this business? Yes. I have been graced with fine physician-partners, nurses, physician assistants, secretaries, medical assistants, and a remarkably efficient and dedicated administrative staff. But in all due respect, Mr. President, I must disagree with you. I did build my business, and nobody else made it happen. , along every step of the way, the federal government has been more of an impediment to the growth of my business than a facilitator.

From Medicare dictating to me how much I can charge a patient for my services, to OSHA requirements against using lip balm in “patient-care” areas; federal rules, regulations, and bureaucracies have heaped increasing administrative costs on my business without one iota of improvement in patient care. Now with the imminent implementation of “Obama Care” dangling over us, the outlook is even direr.

Demo: Healthline Launches BodyMaps for the iPad

Sep 4, 2012• 1

By Matthew Holt

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Health information and education company Healthline Networks launched the BodyMaps iPad application today. BodyMaps, which displays rotatable high-resolution 3D illustrations of human anatomical structures, was created with GE Healthymagination in partnership with Visible Productions. Here you’ll see Senior Director of Product Management at Healthline John Emerson demo the app on his iPad, and CEO West Shell talks about his own recent experience using BodyMaps at his orthopedic surgeon’s office.

Refocusing Long-Term Care on People: The Three I’s

Sep 1, 2012

By Frank Spinelli

Both participants and caregivers in long-term care programs face a myriad of difficulties. Participants with long-term services and supports needs often have many health issues, meaning they are in constant transition between care environments and providers with their needs ever-evolving. As a result of visits to a number of doctors on a regular basis and the number of providers who support them, the participant’s information lives in multiple locations. This can lead to discrepancies between providers and the participant having to constantly provide the same information.

Caregivers, especially family members, are also facing great challenges. It’s a full-time job to care for someone in the home – it takes nearly 40 hours a week – and searching for a trusted service provider to take over can be another job in and of itself.

The root of the problem is that many long-term care programs are focused on the providers and not necessarily the people – those receiving the services and those providing them. Often, no one has the full picture of the participant’s health, which can lead to suboptimal care. An ideal situation is for everyone involved with the participant to be up-to-date and have a full-picture of their health and well-being at all times. When they are, services can be administered effectively with less risk for everyone involved.

Vinod Khosla: Technology Will Replace 80 Percent of Docs

Aug 31, 2012• 90

By Davis Liu, MD

I recently viewed health care through the lenses of a technology entrepreneur by attending the Health Innovation Summit hosted by Rock Health in San Francisco. As a practicing primary care doctor, I was inspired to hear from Andy Grove, former CEO of Intel, listen to Thomas Goetz, executive editor of Wired magazine, and Dr. Tom Lee, founder of One Medical Group as well as ePocrates.

Not surprising, the most fascinating person, was the keynote speaker, Vinod Khosla, co-founder of Sun Microsystems as well as a partner in a couple venture capital firms.

“Health care is like witchcraft and just based on tradition.”

Entrepreneurs need to develop technology that would stop doctors from practicing like “voodoo doctors” and be more like scientists.

Health care must be more data driven and about wellness, not sick care.

Eighty percent of doctors could be replaced by machines.

Khosla assured the audience that being part of the health care system was a burden and disadvantage. To disrupt health care, entrepreneurs do not need to be part of the system or status quo. He cited the example of CEO Jack Dorsey of Square (a wireless payment system allowing anyone to accept credit cards rather than setup a more costly corporate account with Visa / MasterCard) who reflected in a Wired magazine article that the ability to disrupt the electronic payment system which had stymied others for years was because of the 250 employees at Square, only 5 ever worked in that industry.

Why Lance Armstrong Matters. And Always Will Matter.

Aug 30, 2012• 13

By Dr. Len

Like many of you, I have been reading the various news stories about Lance Armstrong, especially one this past weekend in a major newspaper, which went into great detail about the allegations surrounding Lance Armstrong’s cycling career.

But what I didn’t see in all of that coverage was much mention of the other side of the man, the side that I witnessed up close and personal one Friday in Texas a couple of years ago, the side that has led me to share my thoughts with you today.

I saw something that day that I had never-let me repeat, never-seen before. It was a moment that has forever influenced my opinion of Mr. Armstrong, even as these various charges have swirled about him these past couple of years. And the impression it created was indelible.

I am not here to hash/rehash the incriminations. I am here to stand up and say that no matter what the truth is regarding the allegations, this is a man who has forever changed the cancer landscape for millions of people in this country and around the world.

The Moral Case for Romneycare 2.0

Aug 30, 2012• 18

By Scott W. Atlas, MD

Since 2010, when the Affordability Care Act was signed into law, the American mainstream media has insisted that President Obama’s bill provides the most at-risk Americans, low income families and seniors, with better health care. And that must mean, by any logic, better access to doctors, more access to the modern tools of diagnosis and treatment, and ultimately better health outcomes. That poor Americans benefit greatly from the ACA, and that seniors will be more secure under the president’s law, has seemed so obvious to the left-leaning news outlets that this fact has yet to be critically examined by them.

President Obama’s ACA law purports to provide new health coverage to upwards of 16 million low income Americans by way of Medicaid. We already see in the wake of the Supreme Court decision that many, if not most, states simply cannot be burdened with massive increases in their Medicaid outlays, regardless of the promise of financial support from the federal government (itself a financially unsustainable funding source).

But President Obama’s assertion about new insurance for the poor and all it brings is, in fact, a grand deception. We know that 55 percent of primary care physicians and obstetricians already refuse all or most new Medicaid patients (about four times the percentage that refuse new private insurance patients), and only half of specialist doctors accept most new Medicaid patients. Clearly, granting poor people Medicaid is not equivalent to providing access to doctors.

What Next After Implementation? Challenges For the Informatics Community

Aug 30, 2012

By WILLIAM HERSH, MD

I had the opportunity recently to attend this year’s Healthcare Forum, put on by Xerox’s the Breakaway Group, an organization whose mission is to improve healthcare through optimization of the electronic health record (EHR). The forum brought together about 100 leaders from healthcare delivery organizations, academia, and industry. We had the great opportunity to take a break from our daily grind to step back and take a look at the big picture. Clearly much progress has been made, but there is still so much more to do to improve healthcare and its use of information technology.

In my reflection of the event, I had the opportunity to gather some thoughts on what the biomedical and health informatics (BMHI) field must do to contribute to the larger picture going forward. The last few years have been very good for those who work professionally and academically in BMHI, which I have defined as the field that is concerned with the optimal use of information, often aided by the use of technology, to improve individual health, health care, public health, and biomedical research [1]. The Health Information Technology for Economic and Clinical Health Act (HITECH) Act has provided tremendous opportunity to expand the use of informatics systems to improve health.

Much of the focus of the early (2009-present) HITECH era has focused on implementation of electronic health record (EHR) systems. Many healthcare organizations, especially larger ones, have made the transition to electronic systems and collected their meaningful use dollars.Continue reading…

Nationwide Health Information Network Comes of Age

Aug 30, 2012• 2

By Brian Ahier

The Nationwide Health Information Network Exchange (NwHIN Exchange, or just Exchange) has been operating as an ONC program since 2007. For the past three years, a rapidly growing community of public and private organizations (Exchange Participants) has been routinely sharing information in production. That community now represents thousands of providers and millions of patients. Healtheway is new a non-profit, public-private partnership that will operationally support the eHealth Exchange (formerly referred to as the NwHIN Exchange).

On August 1, 2012, the Exchange Coordinating Committee appointed three representatives to serve on the Healtheway Board of Directors, including: Michael Matthews (CEO, MedVirginia), Paul Matthews (CTO, OCHIN) and Jan Root (CEO, Utah Health Information Network). These individuals, along with Healtheway’s Interim Executive Director, Mariann Yeager, will serve as the initial board of directors for the non-profit. The remaining Healtheway board seats will be filled by up to nine elected Healtheway members. The company launched its Member Program in August 2012, with elections for the member board seats expected in the Fall 2012.

Doctors Really Do Die Differently

Aug 29, 2012• 27

By Ken Murray, MD

In late 2011, I wrote an essay called “How Doctors Die.” Drawing on my observations and experiences as a doctor, I reported that doctors tend to seek less end-of-life care than ordinary patients do. They know when further treatment is likely to be futile and when life would cease to be worth living. The point I wanted to make was that all of us should have the choice to die that way if we wish—at home, with family, without dramatic hospital interventions, without pain.

The response to this simple idea was overwhelming. I read thousands of comments people posted online regarding the end-of-life care of loved ones. They told of near-dead relatives being assaulted with toxic drugs and painful procedures for no good reason. I am haunted by one description of a patient who could neither talk nor move, begging with her eyes for it all to stop. Thankfully, such stories are slowly becoming less common, and, with an advance directive or POLST, you have considerably better chances of having a peaceful death, if that is what you want.

While the article rarely provoked hostility, it did, among some readers, prompt skepticism. I’d written the article in a personal, anecdotal style, so I rarely made use of numbers, studies, or charts. For example, Ezra Klein, writing in The Washington Post, wanted to see more evidence for my assertions. “Does anyone know of data on end-of-life spending for doctors?” he asked. “Or even on the percentage of medical professionals who have signed living wills?”

How to Replace the AMA

Aug 29, 2012• 14

By George Lundberg, MD

There is nothing more powerful than an idea whose time has come. There is nothing less powerful than an idea whose time has come and gone.

In 1846, and for more than 100 years after that, the American Medical Association as a nationwide organization for all physicians was a powerful idea whose time had come. It worked well for many things and OK for many more.

Then, in the 1970s, 80s, 90s, it came apart and now has the least representation of actual members of a widely diverse base than ever and shows few signs of recuperation. Recently, I advocated that ALL American physicians should become members of the AMA for their entire time in medicine.

Responses, both published and unpublished, were vigorous.

The divide between physicians who think that the AMA should fight for them and those who think that the AMA should fight for the health of the people seems too large to bridge in 2012.