Good insight here on medical records and their benefits.  The horses on the ranch have health records too, although they are not in the same position of having the "privacy" concerns we face with data base use and/or misuse and I doubt the horses are reading  emails, following up for appointments or filling prescriptions. 

Overall the article makes a very good point that electronic records make sense for better health care, coupled with the use of telemedicine and other electronic devices coming to the market in health care.  We have featured many articles here on how technology not only improves health care but the creative use and innovation at health care facilities is overall generally welcomed by patients as well.  As Mr. Barrett states, he doesn't want a "broken" system when he needs it too, the same thought I am sure we all share.  BD

Craig Barrett's latest cause comes partly because he's chairman of technology giant Intel Corp., which employs more than 90,000 people.
And it's partly because he's 67 and doesn't want the U.S. health-care system broken when he may need it.
Barrett is pushing the health-care industry to adopt technology to better track people who, because of chronic diseases or age, account for 80 percent of the U.S. spending on health care.

Barrett hosted a summit last week in Washington, D.C., that brought together experts from medical schools and insurers to nursing and caregiver groups to suggest steps for improving chronic care.  For Intel the employer, health-care costs could hit $600 million this year and $1 billion by the end of the decade. That's an "appreciable fraction of our operating budget," he said.

That such electronic advantages are available for animals on his Montana ranch and not in human health care amazes Barrett .   "From the high-tech perspective, I've seen every other industry in the world make the transition but this one," he said. "It's time for health care to turn from a mainframe-computer industry to a personal-computer industry."

"I have a ranch with 45 horses, and they all have electronic medical records, and they all get e-mail updates when their shots are needed," he told the summit.

Intel's Barrett pushes to update health care

 

Today consumers are increasingly comfortable with their home computers. National surveys show that patients embrace the idea of e-mailing doctors and electronically scheduling appointments and refilling prescriptions.

Following society's growing need for instant results, more health care providers are starting to offer online access to their patients - and the number of enrollees continues to climb. Patient and physician access to medical histories via computer provides safer and better quality care than paper files, experts say.

From December 2006 to May 2007, the number of Kaiser patients enrolled in KP Health Connect climbed from 25,000 to 42,000.

At UC Davis Medical Center, a similar program called MD Online offers prescription refills, referral requests, appointment scheduling and e-mails to physicians. Today 25,000 patients use the Web site, an increase from 15,200 in December 2005.

Such conveniences save time for people like Taylor, who said even her prescriptions are printed out by computer at the doctor's office or are sent directly to the pharmacy.

"That means," she joked, "no more messy doctor handwriting to deal with."

MyrtleBeachOnline.com | 07/28/2007 | Patients take doctors' visits online

 

Making a different point, Fred Horowitz, of Rockville Centre, a retired computer systems analyst, directs his criticism at Express Scripts, the mail-order pharmacy benefit manager used by his HMO, HIP-VIP. When he submitted his doctor's prescription for a 90-day supply of a drug, he should have checked the Express
Scripts formulary, because the co-pay, billed to his credit card, was a whopping $135. And despite appeals, Express Scripts refused to take the drug back (which is understandable) or give Horowitz credit.
When Horowitz inquired at a local pharmacy, the price was the same. And there was no generic equivalent. But from his doctor and a pharmacist he learned of another, much less expensive drug that would do the job.
The pharmacy benefit manager could have saved the patient and the HMO a little money by letting him know of this possibility. If you haven't done so lately, check your own prescriptions for cheaper generics or alternatives.

Saul Friedman: Notes of outrage, caution - Newsday.com

 

If you are one of the millions of people on this planet who suffers from itching you may be pleased to read that scientists at Washington University School of Medicine, St. Louis, have identified the first itch sensation gene. This discovery, say the researchers, may well lead to new treatments which target itchiness precisely - providing relief from severe and chronic itching.
The itch gene is Gastrin-Releasing Peptide Receptor (GRPS), a code for a receptor found in a tiny population of spinal cord nerve cells where pain and itch signals are sent from the skin to the brain.

Itch Gene Found - Could Lead To New Treatments That Target Itching

 

Just as the clarity of high definition television has transformed the entertainment world, Siemens Medical Solutions is redefining the quality of molecular imaging with the introduction of high definition positron emission tomography. Siemens has unveiled HD PET, the world's first and only high definition PET technology to offer consistently sharper and clearly defined images across the entire field of view beginning of June 2007 in the USA. "As the leading innovator in molecular imaging, Siemens raises the bar in innovation yet again by adding high definition to the Biograph TruePoint family of hybrid PET CT systems," said Michael Reitermann, president, Molecular Imaging, Siemens Medical Solutions. "The clarity of HD PET will provide greater specificity and accuracy and will enable physicians to more confidently delineate small lesions - including those in lymph nodes, abdomen, head and neck, and brain- to provide earlier, more targeted treatment."

Resolution Revolution: Siemens Unveils World's First High Definition PET-CT, Providing Unprecedented Clarity Through Entire Field Of View

Scary thought here...employers fail to pay health insurance premiums and employees had no idea they had been cut off and thought their group health insurance was still in place.  BD

Attorney General Martha Coakley filed an assurance of discontinuance in Suffolk Superior Court in connection with ConnectiCare Insurance Company, Inc.'s termination of health insurance policies of employees whose employers failed to pay their premiums. ConnectiCare, a Connecticut-based health insurer that has 5,678 Massachusetts members, violated state law by failing to provide 202 groups with notice that their employers' group health plan was terminated due to the non-payment of premiums by their employers.

"Through no fault of their own, these employees had no way of knowing that their employers had failed to send the premiums that had been withheld from their paychecks to ConnectiCare."
Under a regulation issued by the Attorney General's Office, insurers must notify employees in writing that their employers have failed to pay for their health insurance before cutting them off.

Insurer Agrees To Pay 200,000 Dollars In Restitution; Pay Claims After Terminating Coverage After Employers Failed To Pay Premiums

 

One of the biggest expenses to the bottom line for an employer is employee benefits. And employees consistently rank health insurance coverage as the most important benefit of all. Businesses spend billions of dollars every year on group health insurance.

Tips for the small business owner buying employee health insurance :: Naperville Sun :: Business

This has always been part of the case, but now finally getting some recognition, as who wants to go to a physician who will not listen to you.  In addition, the tone of how a person addresses another is also old hat, but sometimes forgotten.  We all pretty much know when we get the "blast of cold air" response of telling us what to do with an angry or arrogant tone, we have a tendency to not want to ask questions either as an effort to not receive another "blast of old air".  This really is good advice for anyone, anywhere..and even as a patient, be aware of how you address your physician too, the door swings both ways.  BD

In 2005, Fine started Bedside Advocates, a Massachusetts organization that enlists volunteers to act as patient "guides" through the confusing terrain of the health care system. Fine's job is often to "translate" information from doctors, even for those patients who are fluent in English.

"Patients will turn to someone like me and say, 'What did the doctor just say?' " he says. "They're afraid to ask questions, and if they do ask questions, they don't understand the answers."  Patients, Meaney says, are often left feeling confused, frustrated and unsure of who's in charge of their care.

Hospitals often employ teams of specialists, which can present a daunting communication challenge, according to Mark Meaney, president and chief executive of the National Institute for Patient Rights and author of 3 Secrets Hospitals Don't Want You to Know: How to Empower Patients.

Specialized care means that a patient must communicate with a different doctor for each body part that is affected by their illness, such as the heart or the liver. Often, Meaney says, specialists focus too closely on the area of the body in which they specialize and fail to diagnose the "whole" patient.

Communication now part of the cure - USATODAY.com

Yikes....no wonder it is difficult for physicians to ensure and encourage patients to be sure to fill their prescriptions and take their medications, one person's ordeal ...BD

I went to my pharmacy to get another prescription filled, an act that’s become so routine for most of us, we go through the drive-in window to get our pills. Only this time, things were different. My health provider’s card, which used to assure me of a generally reasonable price, was rejected. I had to either pay full price, which was so outrageous I could hardly believe my eyes, or straighten it out with my provider, which quit doing business the usual way two days before.

If I paid full price, the pills cost 10 times more, I kid you not. A $10 drug was suddenly more than $100. So I decided to straighten it out with my health provider.

Go to round five of voicemail hell back to my provider where, after a good half hour, I punched into my cell phone everything a robot asked about me: my S.S. #, my H.M.O. number, my birth date, my mother’s maiden name. When the robot was satisfied, I had only three more circles of hell to go through before I found a human, who asked me the exact same information the robot had. After ascertaining that I was really me, she listened to my problem and said that she couldn’t possibly change my address, because such a change had to come on a form provided by the employment benefits office of my workplace.

I decided that instead of lowering myself deeper and deeper into the bureaucratic muck they call healthcare in this country, I’d go through unorthodox channels and beg someone in a nearby office to find this “benefits” representative for me, and have him respond.

..... he e-mailed me a hugely nonsensical form full of inexplicable language that I was supposed to sign, mail back to him, after which he’d forward my address change to my health provider, so that they could forward it to their spin-off drug company, so that they could send me a card, so that I could pay for my drug what I was supposed to pay in the first place. Not to mention the fact that this workplace “benefits” guy should have done this months before when I entered my change of address in every official document.

Help, I’m in H.M.O. hell! Just another ‘Sicko’ day

Nice with the USB portable version as this would allow a handicapped individual to be mobile as well and take the software with them for use on any pc so they can communicate anywhere a PC is available.  One other last thought too, is the ability to carry this around on a UMPC small tablet too, so the unit and software could be mobile and travel anywhere with the user.  BD

The Touch & Talk Speech Communication System is designed for those patients suffering from any medical condition that has caused a speech communication disability. Touch & Talk assumes that the patient has retained the ability to read and form sentences with words and allows the patient a flexible approach for direct spoken communications to family members and caregivers. The patient simply clicks or taps words from alphabetized lists or commonly used phrases and then click the green speak button for fully automated narration of the desired text in a male or female voice. Touch & Talk utilizes large buttons and text to assist the patient in regaining motor control and coordination as a quality of life therapy tool.

Touch & Talk utilizes the latest text to speech technology from Microsoft with the option of a female or male voice. The user can select the voice gender, stop, start or even repeat the desired text to speech narration. If your computer has a soundboard and speakers, the Touch & Talk Speech Communication System allows for true communication between the disabled patient, care giver and family.

The Touch & Talk Speech Communication System is also available on a USB flash disk for complete freedom of use on other computers while the patient is away from his or her home computer. Please click the order/contact link for additional information. We also offer complete portable computer solutions with the Touch & Talk Speech Communication System.

Touch N' Talk

Hat Tip:  Mobility Site       Press Release

More mobility in action...great stories on those capitalizing on mobility...as we all know in today's mobile world, things do not always begin and end with a desktop PC...mobile technology and those who embrace the technology may save your life someday.  BD

By mid-August, the family members of at least 20 local patients with congestive heart failure will be able to check their loved ones’ latest vital signs through a secure hospital Web site.

Mercy Hospital is starting Scranton’s first telemedicine system, which lets doctors provide clinical care from afar to homebound patients.
Each machine connects to a patient’s home telephone and periodically uses an automated voice to remind them to use it to test blood pressure, weight and several other health indicators.
The data is transmitted to a computer Web site constantly monitored by Mercy nurses at a hospital terminal. Patients’ doctors and family members can access the Web site.

Use of the equipment is free, but for now it will go only to a select few of Mercy’s most needy Medicare patients with heart conditions. Mercy staff will rotate the devices, allowing an estimated 300 people to use them within the next 10 months.

But telemedicine equipment can be expensive. A $25,000 grant from Mercy’s Cincinnati-based parent company, Catholic Healthcare Partners, will supply equipment for just the new program’s first year. The hospital plans to apply for more grants to continue acquiring equipment.

The Times-Tribune - Telemedicine making house calls easier

Related story below:  Hospital and School benefit

When classes resume this fall, some Akron students will be able to be examined by a doctor without leaving their school.

Computers and videoconferencing equipment at the temporary school provide a connection to doctors at the hospital's Locust Pediatric Care Group.  ``This way, they can actually be seen by the physician on the spot,'' said Karen Mascolo, director of school health services for Children's Hospital. ``Then the doctor can make a determination about whether they can stay in school or they need to be sent home.''

With parents' permission, the nurses at the temporary school can use special equipment to send information to a doctor when children get sick.

The doctors at Locust Pediatrics will send reports from the telemedicine visits to the children's primary doctors, Mascolo said.  ``There's communication between our docs and their docs,'' she said.  The enhanced telemedicine service is being provided free to the schools, thanks in part to $43,000 worth of grants the hospital received from several area foundations

http://www.ohio.com/mld/beaconjournal/news/local/states/ohio/counties/summit_county/17548510.htm

 

Affleck says that the procedure he is teaching to other surgeons is more effective. It involves making two small incisions under each armpit, then using a surgical micro-camera 
    The Daily Herald reports that after a mini-maze surgery, patients are usually home in about two days.

Salt Lake Tribune - Utah surgeon among medical pioneers using new heart procedure

If you don't take your medications or follow your doctor's advice, they are at risk of being rated in a negative fashion, in other words when it comes to the publicly listed physician ratings, you will perhaps see a drop in their ratings.  I agree this is far cry from being accurate and it can hurt a physician with pay for performance. These are just straight numbers ran and sometimes used with a generic data base of suggested results, but in many instances, the demographics used for evaluation purposes and those actual demographics in the physician's data base of patients vary - thus it will not be accurate.  I have seen offices have to go to bat for this exact purpose as you read below, i.e. penalizing a physician for not doing a mammogram on a woman who has had a mastectomy is a real obvious example stated below. 

I still think the best policy is to go to the government section and review to see if there are any reported incidents on public record and go from there, along with word of mouth recommendations from other patients who have been satisfied with their care.  All these new ratings are again far from being accurate and does put the physicians in a spot they would rather not be in, especially if the data is not correct. 

Physicians need to keep their own set of records as well to defend themselves too in this vain, there's almost no other way to substantiate and combat the issue otherwise.  If using electronic records, make sure you have a "patient registry" module that can compile all of this for you quickly, otherwise to create a report manually with paper methods, it is not only costly, but will take your staff away from the daily business of seeing patients.  Having this available in a report format with a couple clicks on the computer will definitely be an asset that will show a return on investment for any practice, when having to create a rebuttal on either published ratings, or simply going to bat to recover payments withheld, based on inaccurate information for performance ratings.  Unfortunately I don't think the ratings game is going to change any time soon, but let's hope it gets more accurate as time goes on, in the meantime, physicians, keep your own records in your own defense so you don't get wiped on the Internet with out a defense and also don't get short changed for P4P.  Try to find an EMR that does this for you, simply creating the reports based on the information you input with day to day charting.  BD

United Healthcare announced it would delay launching its program in New York, New Jersey and Connecticut after doctors complained and after New York Attorney General Andrew Cuomo threatened legal action.

One doctor fighting ratings systems is Seattle internist Michael Schiesser, who said his rating plummeted from excellent to the 12th percentile within a few months. He said initially Regence Blue Shield, an insurer in the Northwest, ranked him in its top 90th percentile of doctors and awarded him a $5,000 check.

Later, when Regence cut him from its network and patients had to pay out-of-pocket to see him or go elsewhere, he pressed to see his report. He said he discovered that he had been penalized because of errors in data-gathering.

He said Regence faulted him for failing to control diabetes in patients who did not have the disease. He said he was docked points for not performing a Pap smear on a woman who had a hysterectomy. He added that his colleague was faulted for not performing a mammogram on a woman who had undergone a double mastectomy.

Doctors critical of ratings systems say they are held accountable for whether patients exercise, take their medications or follow their prescribed regimens.

Berkenwald, the Massachusetts internist, said he was pushed from Health New England's top 10 percent of physicians into its second tier because several of his female patients did not get the mammograms or Pap smears he But Berkenwald received a top-tier rating by several other insurers participating in the state's Clinical Performance Improvement Initiative because the health plans use different cut-points for determining who falls into which tier.prescribed. 

Doctors Rated but Can't Get a Second Opinion - washingtonpost.com

 

An FDA advisory panel on Tuesday voted in favor of recommending that Eli Lilly's bone-strengthening drug raloxifene, sold under the brand-name Evista, be approved to reduce the risk of breast cancer in some women, the Wall Street Journal reports (Corbett Dooren, Wall Street Journal, 7/25).
FDA in 1997 approved Evista to help prevent osteoporosis and in 1999 approved it to treat the disease. Tamoxifen, which blocks the production of estrogen, is the only FDA-approved drug for reducing breast cancer risk, but it increases risk for uterine cancer and blood clots. Raloxifene, which also blocks estrogen production, has been shown to be as effective as tamoxifen at reducing breast cancer risk, though it increases risk of hot flashes and other menopause-related symptoms.

FDA Panel Recommends Approval Of Eli Lilly's Osteoporosis Drug Evista To Prevent Breast Cancer

 

Hospital stays for a type of antibiotic-resistant infection have more than tripled since 2000, and since 1995 have increased nearly 10-fold, according to the latest News and Numbers from the Agency for Healthcare Research and Quality.
AHRQ found that the number of hospital stays for patients infected with Methicillin-Resistant Staphylococcus Aureus (MRSA), climbed from 38,100 in 1995 to 128,500 in 2000 and then to 368,800 in 2005, the latest year for which data are available.

Dramatic Increase In Antibiotic-resistant Infections In Hospitalized Patients, USA

 

DePuy Spine, Inc., a Johnson & Johnson company, announced that CIGNA, one of the nation's largest health insurers, will now cover artificial disc replacement for single-level degenerative disc disease.
DePuy Spine is the world leader in spine arthroplasty and the manufacturer of the CHARITE® Artificial Disc, the first artificial disc approved by the U.S. Food and Drug Administration (FDA) in 2004.
CIGNA, which provides health insurance to about 47 million people, joins Aetna, Kaiser Permanente, Horizon Blue Cross Blue Shield and dozens of regional insurers, in covering the surgical implantation of the CHARITE Disc for low back pain and disability from degenerative disc disease.

CIGNA Covers CHARITE® Artificial Disc, USA

Good article about a business executive who got tired of lugging around paper and made the move to paperless!  He makes many good points here and encompasses One Note from Microsoft as part of his routine, an excellent choice as I do the very same thing and I can't tell you the time it saves in having to reference notes from a prior meeting and the convenience of having them all in one locations.  It is also nice to take notes and use the nice export to Outlook tool as well to email the notes to all attendees!  BD

DON’T ASK ME for a pen, because I might not be carrying one. That’s because I now write down all my meeting notes in a computer that understands handwriting — even mine. Read on to see how this saves countless hours a week.

I always thought this was a terrible waste of time, so when I it came time to upgrade my computer I chose a tablet PC — a machine that behaves like a regular laptop until you give the screen a twist and it turns into a computer capable of accepting handwritten input as well as pictures and diagrams.

When it comes time to enter text, a little box pops up and you just write down the information as if you were using a pen. This works for virtually any program. For e-mails and word documents, your handwriting is converted word for word into text, and it is amazing how accurate it is.

However, it is with a program called OneNote that the pen becomes mightier than the keyboard. With OneNote (an optional part of the Microsoft Office suite), the computer can interpret your writing as you go, or you can tell it to just accept anything — words, diagrams, squiggles, whatever.

I can also ask OneNote to search through my original notes for text I am looking for, just as I would do a search in Word, and it will actually find the text even though it is in my handwriting. Pretty slick!  Bottom line: If you find yourself juggling a lot of paper and you have a place to file electronic copies, you should consider going paperless, as I have,

Nova Scotia News - TheChronicleHerald.ca

This is great, the tablet right in the ambulance to enter information and send to the receiving hospital before arrival.  This year in particular tablets are really making their mark, especially in health care....but anyone can use one.   Mine goes with me to every client meeting to take notes and then some...BD

Mr Wyatt-Goody, who has trained staff to use the ePCR, said: “This technology is a breakthrough. It allows paramedics and technicians to send patient information ahead to A&E nurses via GPRS technology. When the patient arrives, A&E staff already know their medical history.”
Since June 2005, some 800 paramedics and technicians in East Anglia have been trained to use the new tablet docking system installed in 117 ambulances.
Paramedics enter data by tapping information on a screen. Updates on the patient's condition and information, such as blood pressure and ECG statistics, can also be sent to the receiving hospital.

Potentially vital clinical information about patients can be sent to hospital A&E departments using new electronic patient care reporting (ePCR) and data management software installed on ambulances.
Patient details are recorded using touch-screen technology, clearer and more accurate than written records.

Evening Star - Technology helping to save lives

Louisiana taking electronic medical records seriously...BD

In the future, the rows and rows of manila folders tabbed by color-coded numbers in medical offices will be part of history.
Technological advancements have changed the way that patients receive health care and in about 15 percent of the physicians offices in the state, it's already changed the way that care is recorded in a patient's medical file.

Because converting to a paperless medical record system is costly — as much as $10,000 a year in the first five years, the state is investigating ways to ease the financial burden on physicians, said Dr. Roxane Townsend, the state deputy secretary of the Department of Health and Hospitals.

The Shreveport Times

Great use of a Tablet PC, patients use the device to check themselves in...if you can write on a piece of paper, you can easily use a tablet...after all it is handwriting...and some of it gets changed to text too!  Some tablets weigh less than a paper chart too!  BD

If you haven't been in a hospital for a few years, you might be surprised at how technology aimed at making your stay safer and more enjoyable is emerging in this notoriously paperbound industry.

Your doctor may wheel a computer into your room during an exam. Your nurse may scan the bar code on your ID bracelet before giving you a pill. If you face a long wait for a procedure, a hospital employee may give you a pager much like the ones those perpetually busy chain restaurants hand out. Your preemie may send you an e-mail.

At Bryn Mawr Hospital's new outpatient building in Newtown Square, patients can check themselves in using tablet computers. 

At the hospital's emergency department, RFID chips embedded in plastic tags tell staff where patients are, when they get an EKG, and when the doctor first sees them.

"You better get smart fast or that combination of factors will put you out of business," she said.

 

At Geisinger Health System, a national leader in IT adoption, patients can schedule their own appointments by computer. "One of the things that young people love is that you can print out your child's immunization record from home," said James Walker, chief medical information officer.

Electronic medical records at Cooper University Hospital and its outpatient doctors' offices in South Jersey mean patients have to provide their personal and insurance information only once, saving them from one of the most irritating aspects of complex medical care.

The doctors want to talk directly to patients while they are with them, he said, but the computers make it easier to enter orders and access information afterward.

Hospitals Going High-tech | Inquirer | 07/22/2007

Hope this is a move for the better and does not create the scenario of having to locate a new primary MD for the seniors...BD

The transfer affects around 6,500 HN New York Medicare members covered under HN New York's Medicare Advantage HMO program in Brooklyn, the Bronx, Queens and Staten Island. Around 5,700 of those individuals currently receive their health care benefits from Touchstone under terms of a contract between HN New York and Touchstone.
The transfer is expected to become effective on September 1, subject to approval by the Centers for Medicare & Medicaid Services.

Health Net Of New York To Transfer HMO Contract To Touchstone Health Partnership - - insurancenewsnet.com

More potential joy on it's way to your inbox...good article to read and be aware of the latest scam.  BD

WASHINGTON - The federal agency charged with protecting consumers from Internet scams now finds itself wrapped up in one.

Identity thieves have sent thousands of bogus e-mails purporting to be from the Federal Trade Commission — as well as the Internal Revenue Service and Justice Department — in an attempt to trick consumers into divulging personal financial information.

The agencies are the latest institutions to be exploited in "phishing" scams, long the bane of large banks and credit card issuers.

Analysts who track online crime say that while financial institutions are still the most commonly hijacked brands, the use of federal agencies in the hoaxes is increasing and reflects criminals' desire to take advantage of the familiarity and authority of various government departments.

Government warns public on fake e-mails - Yahoo! News

Question...why was it approved if it is dangerous to diabetics?  What is the future here?  Hopefully more education on potential side effects, etc.  BD 

Patients who take Avandia, a popular but controversial diabetes medicine made by GlaxoSmithKline, are far more likely to suffer and die from heart problems than those who take Actos, a similar pill made by Takeda, according to federal drug reviewers.

Avandia is particularly dangerous to patients who also take insulin. By contrast, Actos can be taken safely with insulin, according to the review.

The findings likely spell the end of Avandia’s status as one of the nation’s most popular drugs for treating diabetics who are not dependent on insulin. Last year, more than a million patients in the United States took Avandia, and a similar number took Actos.

Avandia’s 2006 global sales were nearly $3.4 billion.

F.D.A. Review Criticizes Diabetes Drug and Maker - New York Times

This is not really medically related, but I included this as it somewhat reminds me of some of the folks I run in to with tablet pcs and the fears associated with something new.  If you read here enough, you know I am very much into privacy in all areas, but gee, knowing where the cab is?  Most major companies with vehicles use GPS and have they ever thought about the good side of technology, as it could help locate one in the case of an emergency?

I have to say this story fits right up there with folks I see that look at me like I am "Lucifer" carrying around a tablet pc, something very simple and easy to use, yet folks who have turned off the "I want to learn" switch mostly have nothing a a lot of negative energy to offer in this direction anyway and many of them are in positions of controlling budgets and purse strings that strangle the rest of us trying to make progress and make our lives a little easier, again with staying abreast of our privacy rights and how to deal with it as well.  You can stay away from all areas of technology by choice, and can still have your identity stolen just as easy too.  The cabbies I feel are right up there with techno fear and will hold back progress for all, and I am guessing a good portion of them have a tendency to shun technology.  This gets the techno bunk story of the week.  BD

As we told you in March, the technology-bucking drivers of New York City have put their collective foot down and said "no" to GPS systems in city taxis. The New York Taxi Workers Alliance, a non-unionized group with more than 8,400 members, claims it will call for its drivers to strike if city leaders don't retract plans to install GPS units in 13,000 cabs. No new information there, but recently the NYTWA announced that September would be its target month for the walkouts, putting a very real timetable on what would be a crippling move for the city. If you'll recall, the touchscreen devices would allow passengers to pay by credit card, check the news, and map their taxi's location. The systems would also track pickup and drop-off points (information taxi drivers already report), but cabbies fear their employers will use the information to keep tabs on their whereabouts. The NYTWA plans to specify the date and length of the strike next month, so you'll know more when we do.

NYC cabbies plan September strike over GPS - Engadget

Quite a story...and she didn't have scabies after all...big lawsuit for a potential case of scabies...BD

An employee of Fox 21/27 who claims she was humiliated by false accusations that she had scabies — and who says she had to lift her shirt in front of station officials to show a rash on her stomach — is suing the station’s owner, two former managers and on-air medical adviser "Dr. Dave" for $12.2 million.
Mary King, who works with contracts for WFXR/WWCW, says in a lawsuit filed Monday in Roanoke Circuit Court that her troubles began when the Roanoke television station suffered an infestation of mites last fall.

As King’s co-workers filed past, Durham began demonstrating how she should apply a cream he was prescribing by rubbing it all over her body, saying that while it was "okay to get it in your pubic hair, don’t get it inside you" and motioning between his legs, the lawsuit says.
King began screaming that she did not have scabies, and Seffens and Durham shouted that she did, the lawsuit says.
Before she left the office that afternoon, other employees began asking why she had exposed them to the mites, the lawsuit says.

Employee sues Fox 21/27 over allegations of scabies infection - Roanoke.com

What do we not simulate today?  Good story....BD

A new generation of complex, electronic birth simulators are allowing medical students to practice labor and birth -- especially when there are complications.

"It gives us the opportunity to learn and practice but do no harm," said Dr. Kay Daniels, a clinical associate professor who trains students at Stanford University.

 

Interactive simulation robots first became popular in the 1990s after scientists developed them for anesthesiologists in training. They've since been designed for various types of medical training and even for veterinary students, who work on dog mannequins.

Noelle is part of a new wave of medical-simulation technology that has moved ob-gyn training beyond its traditional low-tech plastic pelvises. "We did simulations, but it wasn't very realistic," said Jane Mashburn, a clinical associate professor who uses robots to train nurse midwives.

 

 

Delivery for Dummies: Simulators Walk Docs Through Childbirth

Hat Tip:  Medlaunches

Stay tuned for more to follow next week....benchmarks on the page are impressive...BD 

TabletKiosk recently introduced their newest Sahara Slate PC, the i440D and guess who got their hands on one. That is right, the i440D is in the TabletPCReview.com office and our model is running Vista. After spending a few hours with the i440D, I was quite impressed by how fast the wireless connection was and how responsive the pen was. Key factors to look for in a slate tablet considering it has no keyboard and probably will be lugged all over the place.

First Thoughts

There is a nice array of features on the i440D and it can be connected to a dock or you can use the included stand and connect a mouse and keyboard. Even though it is different not having a keyboard, the pen works great and is accurate. Overall the Sahara i440D seems to be a strong tablet with good battery life, but I need some more time to dive into those tests. Stay tuned next week for the complete review to come with video.

TabletKiosk Sahara i440D Slate Tablet PC First Look Review

 

The New York Times on Monday examined how "fewer young doctors want to work in many of the distressed cities and towns throughout New York state," as the "aging baby boomer population finds itself in need of more medical services." A 2006 HHS study found that the number of physicians practicing in New York increased by 6% between 2001 and 2005; however, the "way they are spread throughout the state is wildly uneven," with many new physicians seeking to practice in New York City, Long Island and Westchester County, "where there is already a glut," according to the Times.

Fewer Physicians Practicing In Upstate New York Causes Long Wait Times, Longer Commutes

Both do a pretty good job, but who will profit the biggest? 

Detailed health knowledge is no longer the sole possession of the medical elite. Now, once elusive information is readily available to the average person. The wealth of medical and health related resources on the Web are sparking interest amongst a growing number of people who want to be involved in their own health care.
With this heightening level of interest Google and Microsoft are both eagerly vying to get a share of the online healthcare sector. The battle seems to be heating up between these two giants as they propose different approaches for an online medical system, each one hoping theirs is the more marketable option.

The unfortunate aspect of the healthcare information on the web is that it is from a mixture of sources, sometimes the information is reliable and useful, other times it is more of a hindrance than a help. Regardless of who wins this new phase of the Google vs. Microsoft popularity contest, when online healthcare systems that give consistently useful and patient specific advice have been established, their presence will be welcomed by many medical professionals and patients alike.

Google Health vs. Microsoft e-Health: Medical search war for big profits

 

The University of California has agreed to pay $7.5 million to settle 35 claims filed on behalf of patients who waited in vain for liver transplants at UCI Medical Center and who were unaware that the school's program lacked the staffing to perform the life-saving operations.
The university closed the program in November 2005 after The Times reported that 32 patients died awaiting operations, even as the hospital in Orange turned down scores of organs proffered on their behalf.
A subsequent investigation resulted in a rapid-fire series of resignations, reorganizations and vows to restore the credibility and oversight of the Irvine school's medical programs.
The agreement by the UC Board of Regents to settle the cases largely closes the book on another embarrassing chapter in the history of UCI's medical programs, which have been plagued by various lapses over the years: the theft of eggs and embryos from patients in a fertility clinic, the failure to properly keep track of bodies in its medical cadaver program and failings in other transplant programs such as kidney and bone marrow.
The fertility cases were settled for $20 million.

UC settles liver transplant suits for $7.5 million - Los Angeles Times

Should we start with the VA?   

WASHINGTON – Sens. Patrick Leahy (D-Vt. ) and Edward Kennedy (D-Mass. ) introduced a bill last week to provide patients with more control over their electronic health records. 
The bill, introduced July 18, proposes to make changes to the current HIPAA privacy protection laws, to increase patient protection. According to a statement by Leahy, “the bill would give each citizen the power to decide when, and to whom, their health information is disclosed.”

Senators introduce healthcare IT privacy bill

 

Overall, the report found that the HMO "lacked the ability to verify consistent handling of complaints throughout its medical centers or to determine whether serious or chronic problems were being addressed."

Kaiser Permanente will be assessed a record fine today for its haphazard investigations of questionable care, physician performance and patient complaints at its California hospitals, according to state HMO regulators.
The California Department of Managed Health Care said it will levy a $3-million fine against Kaiser, the largest HMO in the state, with 29 medical centers and more than 6 million members. If Kaiser makes necessary improvements, agency director Cindy Ehnes said, she will forgive $1 million of that.

The nine Kaiser hospitals examined as part of the report are in Woodland Hills, Fontana, Baldwin Park, West Los Angeles, south Sacramento, San Rafael, South San Francisco, Fresno and San Francisco. The state did not identify which hospitals had the weakest systems.

The managed-care agency found that under the HMO's massive umbrella, individual hospitals had their own rules: Some rigorously pursued potential medical mishaps; others did not.
The vast majority of the report focused on a system called "peer review," a standard quality-assurance mechanism at hospitals in which doctors' committees examine patient cases to determine if the care was appropriate.

http://www.latimes.com/news/printedition/front/la-me-kaiser26jul26,1,946559.story?page=1&coll=la-headlines-frontpage

Missing IT Data and Computer story of the week belongs to the VA...where's HIPAA when you need them....BD

WASHINGTON -- An audit of three medical centers operated by the U.S. Department of Veterans Affairs and of the VA's headquarters found that a total of $6.4 million worth of IT equipment went missing from those facilities or was misplaced during the federal government's past two fiscal years.

About 2,400 IT devices couldn't be accounted for during inventory counts done by officials at the four facilities in fiscal 2005 and 2006, according to a report released Tuesday by the Government Accountability Office. Among the missing items were dozens of computers that could have stored personal data about VA clients, the GAO said in its report.

The GAO also found that computer hard drives scheduled for disposal at some of the facilities contained unsanitized data, including the names, Social Security numbers or medical histories of hundreds of U.S. military veterans. In some cases, the drives had sat around for several years without being wiped clean, "creating an unnecessary risk that sensitive personal and medical information could be compromised," Williams said.

The four-site audit was a follow-up to an earlier one at five other VA facilities. Based on updated information obtained from those facilities earlier this year, they couldn't account for more than 8,600 pieces of IT equipment with a combined original cost of $13.2 million, the GAO said. Across the nine audited facilities, the total value of the missing equipment was $19.6 million

Government audit slaps VA over missing IT equipment

 DEA and Clinics still having issues...legal or not legal...BD

LOS ANGELES - U.S. Drug Enforcement Administration agents raided 10 medical marijuana clinics Wednesday, the same day city leaders introduced a measure calling for an end to the federal government's crackdown on the dispensaries.

Federal officials arrested five people for investigation of marijuana distribution after serving clinics in and around the city's Hollywood area with search warrants, said DEA spokeswoman Sarah Pullen. Those arrested included clinic owners and managers, though no patients. Large quantities of marijuana and cash also were seized.

Press-Telegram - DEA raids medical pot clinics in L.A.

Bakersfield too

BAKERSFIELD - Only one medical marijuana dispensary was open Wednesday in Kern County.

Somehow this cat seems to know...unexplainable but he has been on target and the facility immediately calls family the minute he settles in to cuddle with a patient.  BD

Oscar the cat, who resides at the Steere House Nursing and Rehabilitation Center in Providence, has an uncanny ability to sense when a patient is about to die. (Globe Staff Photo / Dina Rudick)

PROVIDENCE --Oscar the cat makes his grand entrances just as life is about to leave.

A hop onto the bed, a fastidious lick of the paws, then a snuggle beside a nursing home patient with little time left. Oscar's purr, when keeping close company with the dying, is so intense it's almost a low rumble.

Oscar makes regular "inspection" rounds of the unit, sauntering in and out of patient rooms -- as if checking on the condition of the occupants. But he never joins them for a snooze.

Until.

"He only shows great interest in individuals when they are about to die," said Dosa.  As for Oscar, Dodman said, "perhaps [he] senses some change in the metabolism or mental aura of the dying person.''

Feline intuition - The Boston Globe

 

LOS ANGELES, July 25 (Reuters) - Prospect Medical Holdings Inc (PMHX.OB: Quote, Profile, Research) said it reached an agreement to buy Alta HealthCare System Inc (PZZ.A: Quote, Profile, Research) for about $104 million.

Under terms of the deal, Prospect Medical, which manages medical care for about 250,000 people enrolled in southern California health management organizations, will pay half in cash and the rest in shares.

Alta is a private, for-profit hospital management company, according to the press release.

Prospect Medical to buy Alta Healthcare | News | Mergers/Acquisitions | Reuters

 

And, to show my thanks to all of you who'll go see "Sicko" this weekend, I'm going to send one of you and a guest on a free weekend to the universal health care country of your choice! That's right. You'll get to pick one of the three industrialized countries featured in the movie where, if you get sick, you get help for free, no matter who you are. All you have to do is send us your ticket stub (make sure it says "Sicko" on it and has the name of the theater and this weekend's date on it -- Friday, Saturday or Sunday - July 20th, 21st, 22nd). Attach the stub to a piece of paper with your name, address, phone number and email and send it to: 'Sicko' Night in America, 888c 8th Avenue, Suite 443, New York, NY 10019. (Yes, you have to use that old 18th century device called the U.S. Postal Service, and it has to be postmarked on or by Tuesday, July 24th). First prize is a weekend in the city of your choice: Paris, London or Toronto. This includes airfare, hotel, meals and, most exciting, a representative from their fine universal health care system who will give you a personal tour so you can see how they treat their fellow citizens. You'll meet people who pay nothing for college and citizens who are in the fourth week of their six-week paid vacation. Oh, and you'll have time to see the Eiffel Tower, Big Ben or whatever they have in Toronto that is old and tall. (If you don't have a passport, we'll pay for that, too!)

Canadians who are reading this -- you're probably thinking, "Hey, what about us? Where do we get to go?" Quit complaining! You're already there! But just to make it up to you -- and to prove we don't hold it against you for smugly walking out of a hospital with the same amount of money in your wallet that you went in with -- we'll let you participate in the drawing, too.

MichaelMoore.com : 'Sicko' in Top 5 Grossing Docs of All Time -- This Weekend it's "'Sicko' Night in America!"... from Michael Moore

And yet one more report on the return on investment...electronic medical records.  Also, a small practice can really get started for much less than quoted in this article too...any electronic records sure beats a paper chart at any office or hospital.  Many offices use the excuse of waiting until something big and better arrives, but that is about in the same area as to when you bit the bullet and purchase a PC.  Most electronic records allow for exporting to other formats, so even if later the system changed, why not have something to transfer at that point!  It usually takes an IT specialist to accomplish this in most instances, but for gosh sakes it sure beats the labor and time compared to scanning paper charts or having to sort through a huge file of Word documents stores on a file server.  I see this at many offices as well, drives just full of unsecured Word documents with patient data, data than cannot be used in a data base program without some manual manipulation of each record.  Word documents are not electronic records, they are just take up a whole lot of room and again, most are not even protected in the offices I visit.  BD

BURLINGTON, Mass. - Doctors at the Lahey Clinic outside Boston treat patients with stethoscopes and handheld computers in tow.

From these handhelds, they record visits, prescriptions and tests for each patient in one electronic file, an effort that enables them at a later date to pull out complete medical records for patients instantly. That speed and accuracy is most valuable in cases of emergency.

“It really has made it easier for clinicians,” said Dr. David Barrett, CEO of Lahey Clinic. “We feel good about what we're doing because we know it's going to be accurate.

Hospitals play catch-up in digitizing records - CNBC Special Report: Healing Health Care - MSNBC.com

Usually the busiest physician in the hospital...with long hours, and hopefully good pay!  These folks know better than anyone else the value of good record keeping since everything they do and record goes to additional locations and physicians.  BD

The hospitalist field has become the fastest-growing specialty in the history of American medicine, skyrocketing from a few hundred physicians nationally in the mid-1990s to more than 20,000 today. To assess this important trend, the California HealthCare Foundation funded researchers at UCSF to perform a study of factors driving the growth of hospitalists in California.

Having proven their ability to reduce costs and length of stay for medical patients, hospitalists' roles are expanding into surgical, intensive care, and emergency areas. In addition, they are being asked to assist with system wide efficiency improvements, as well as quality and safety initiatives. Such expansion has increased the need to define training and certification requirements for hospitalists. At the same time, it has created a large demand for hospitalists, leading to sharp rises in salary and high turnover rates.

The Rise of the Hospitalist in California - CHCF.org

Read the article to see the long wait times, many just give up and send to the ER room at any hospital...BD

Sometimes it all comes down to legwork by an already overworked primary care physician.

Adults with no health insurance face waits up to a year or longer for gallbladder or hernia surgery in Los Angeles County, a backlog that community clinic doctors say has worsened since the county downsized Martin Luther King Jr.-Harbor Hospital last year.

Still, clinic doctors were stunned earlier this month when Harbor-UCLA told them not to send any more nonemergency gallstone, hernia, orthopedic or neurosurgery patients until hospital physicians worked through the yearlong backlog for these surgeries.
Community clinics rely on five county-owned hospitals to provide virtually all specialty care, including hernia and gallbladder surgery, for their uninsured patients.

With a quarter of the county's adult population lacking insurance, patients have always had to wait a long time. But delays are growing longer as the population ages and suffers complications from such chronic conditions as diabetes and obesity.

The other alternative is to send patients to hospital emergency rooms. That's what Dr. Rachna Gupta, chief medical officer for the South Bay Family Healthcare Center, did when a young man came to her Inglewood clinic doubled over in pain from an inflamed gallbladder.

Uninsured adults face yearlong delays for some surgeries - Los Angeles Times

Tired of the old boring bandages ....here's a new look....interesting new concept...BD

Ouch! That smarts! Treat your minor cuts, scrapes and scratches with the incredible healing power of a designer bandage from Accoutrements. And if a fancy bandage isn't enough to dry up your tears, how about a FREE TOY! Each comes in a 3-3/4" tall metal pocket tin and contains a small plastic trinket to help make even the ouchiest owies feel all better in no time. The 3" x 1" Bacon Strips are cut to look like small slabs of bacon. Fifteen per tin.

Several other types are available too, such as well...such as...

 

 

 

 

Bacon Strips Bandages, Archie McPhee®

Hat Tip:  Medgadget

 

WASHINGTON - A presidential commission on Wednesday urged broad changes to veterans' care that would boost benefits for family members helping the wounded, establish an easy-to-use Web site for medical records and overhaul the way disability pay is awarded.

The nine-member panel, led by former Sen. Bob Dole, R-Kan., and Donna Shalala, health and human services secretary during the Clinton administration, also recommended stronger partnerships between the Pentagon and the private sector to boost treatment for traumatic brain injury and post-traumatic stress disorder.

Panel calls for better veterans care - Yahoo! News

 

KNOXVILLE, Tenn., July 25 /PRNewswire/ -- MinuteClinic, the pioneer and largest provider of retail-based health care in the United States, today opened 10 new health care centers at CVS/pharmacy stores throughout the Chattanooga and Knoxville metropolitan areas.

MinuteClinic health care centers are staffed by masters-prepared, board- certified nurse practitioners who specialize in family health care and are trained to diagnose, treat and write prescriptions for common family illnesses such as strep throat and ear, eye, sinus, bladder and bronchial infections. MinuteClinic also offers common vaccinations such as influenza, tetanus, MMR, and Hepatitis A & B.

MinuteClinic health care centers are open Monday through Friday from 8 a.m. to 8 p.m. and on Saturday and Sunday from 10 a.m. to 4 p.m.

MinuteClinic Treatments: (most services cost $59 or an insurance co-pay

An Innovation in Health Care Opens at CVS/Pharmacy Stores in Knoxville and Chattanooga

 

IBM and the University of Florida are working on technology that lets doctors remotely monitor patient health.

You may ask yourself, how many devices do I need?  With software solutions and "middleware" applications, the goal is to be able to use a generic device, such as a cell phone to be able to transmit this information, thus the avoidance of have multiple units to transmit the information, in other words, putting your cell phone to work for things other than phone calls, some of which just might save your life someday.  BD

IBM Corp. and the University of Florida believe they've come up with middleware that will allow doctors to remotely monitor the health of their patients.

The technology makes it possible for standard wired or wireless devices like blood-pressure and glucose monitors to be reconfigured so that when used by patients at home the devices can automatically send the collected readings to health-care professionals.

IBM, University of Florida team up on smart devices - washingtonpost.com

More about information reporting...Tenet looks to be on top of things with utilizing technology as well.  Combining whiteboards with tablet PCs can have some real outstanding results with conveying information as the tablets can be the mobile units available to staff to quickly provide the updates, no matter where the physician or staff member may be on the floor of the hospital allowing for "real time' updates.  BD 

Much discussion about pay-for-performance has focused on how hospitals measure up against one another clinically, and how the dollars may be divvied up accordingly. So far there has been less emphasis on how patients perceive their hospital care and how the public reporting of that data may drive quality improvement and eventually hospital revenue.
That's about to change.

In addition, Tenet is in the process of putting white boards in patient rooms in all of its hospitals with key information for patients and their families about their treatment, phone numbers they can call for help and departure dates. HCAHPS can provide hospitals with an opportunity to demonstrate their strengths, said Jacob Kupietzky, Tenet's vice president of operations excellence. "It's a way to showcase all the wonderful services they provide to patients," he said.

California hospitals are already getting a taste of HCAHPS accountability. Some 209 hospitals representing about 70% of the states' admissions have volunteered to submit data on quality, safety and patient experience that incorporate the HCAHPS survey with other clinical quality measures.

Hospitals are required to survey all patients eligible for HCAHPS, and the CMS is asking that they aim for at least 300 surveys completed per year.

Modern Healthcare Online

I still like a combination though of word of mouth and what is available on the web.  2nd opinions are still very much alive and well if you feel you need one.  Some of the ratings on hospitals and physicians on the web can be misleading to some degree though, so be sure and read thoroughly as some post ratings based on mortality may not have told the entire story for surgeons for example.  The condition and demographic representation of the patients make a big difference as well, so be thorough and just ask questions too.  As the article states, insurer's rankings can be controversial as they may be marketing influenced to some degree, so an impartial listing is probably going to be one of the safest bets for information.  Be sure your provider is a good listener.  BD

Even in this digital age — when one can get the temperature in Kuala Lumpur or the Zuma Beach surf report at the click of a button — most people still rely on word of mouth to pick their doctor or check up on their local hospital.
Others choose from lists provided by their health plans, cross their fingers and, well, hope for the best.
Increasingly, insurers, the government and other sources are providing information, especially on the Internet, about the quality of the nation's doctors and hospitals — details that were simply unavailable a decade ago.

A good place to start is with the state medical board. It generally provides the basics of a doctor's biography, location and education.

How well do you know your healthcare provider? - Los Angeles Times

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Related Story:  http://www.washingtonpost.com/wp-dyn/content/article/2007/07/24/AR2007072402545.html

After 26 years of a successful medical practice, Alan Berkenwald took for granted that he had a good reputation. But last month he was told he didn't measure up -- by a new computerized rating system.

A patient said an insurance company had added $10 to the cost of seeing Berkenwald instead of other physicians in his western Massachusetts town because the system had demoted him to its Tier 2 for quality.

The effort is more about cutting costs than raising quality, some say, adding that doctors could begin to "cherry pick" healthier patients whose problems are less costly to treat. Such systems fail to capture the intangibles of quality, such as a doctor who visits a dying patient at home, critics say.

Hat Tip:  Kevin, MD

Want better handwriting recognition on your tablet?  This is worth looking at if you are using a tablet.  Pricing is not bad at $59.00 and for increased handwriting accuracy for medical terminology is worth it.  From the site, some current clients include Pfizer, the AMA, etc.  More information at the site and again, well worth a look.  BD

Spellex Tablet PC Suite allows your Tablet PC to better recognize handwritten medical terms while greatly enhancing the Microsoft Office basic English spell checker with hundreds of thousands of medical terms. Comprehensive medical spell checking and increased handwriting vocabulary can be yours in one easy-to-use software suite!

Quarterly software updates available through the Spell-X-Plus subscription service keep your medical spelling dictionary up-to-date with the newest words in medicine. No other medical Tablet PC enhancement brings you this exciting option!

Spellex Tablet PC Suite for Medical Handwriting Recognition - Tablet Medical Dictionary Enhancements

Another good reason to make sure this web site is blocked from business/practice networks...BD

RALEIGH, N.C. - My Space.com has found more than 29,000 registered sex offenders with profiles on the popular social networking Web site — more than four times the number cited by the company two months ago, officials in two states Tuesday.

North Carolina's Roy Cooper is one of several attorneys general who recently demanded the News Corp.-owned Web site provide data on how many registered sex offenders were using the popular social networking site, along with information about where they live.

MySpace finds 29,000 sex offenders - Yahoo! News

They are the first state to tackle the insurance problem, but if you can't find a primary MD, what good does this do?  The average wait for those who can get an appointment with their primary MD is 7 weeks!  BD

But it takes a lot more than an insurance card to see a doctor in this state.

"Good thing I never snipped one of these off," Ms. Lewis jokes, wiggling 10 fingers. Earlier this month, she signed up for state-subsidized insurance under a new Massachusetts law that aspires to universal coverage. The plan costs her $80 a month.

On the day Ms. Lewis signed up, she said she called more than two dozen primary-care doctors approved by her insurer looking for a checkup. All of them turned her away.  For those residents who can get an appointment with their primary-care doctor, the average wait is more than seven weeks, according to the medical society, a 57% leap from last year's survey.

As it happens, primary-care doctors, including internists, family physicians, and pediatricians, are in short supply across the country. Their numbers dropped 6% relative to the general population from 2001 to 2005, according to the Center for Studying Health System Change in Washington. The proportion of third-year internal medicine residents choosing to practice primary care fell to 20% in 2005, from 54% in 1998.

Doctor Shortage Hurts A Coverage-for-All Plan - WSJ.com

Strange coverage story here, will pay for the surgery, but not the device to making hearing possible.  BD

FORT WORTH — For most people, the billing practices of health insurance companies are confusing, at best.   United HealthCare urges all consumers to "refer to their policies" "to make sure they understand what is covered and what may not be."

Still, a North Texas family found themselves surprised to be locked in a battle with their insurance company over a device you may think is covered under most policies.

But time after time, the Collin's medical insurance company, United Healthcare, has refused to cover the $15,000 device. United HealthCare will pay for the expensive surgery to install it.

"What is most perplexing to me is the fact that the insurance company will approve the placement of the anchor and the initial operation to set the stage for the application of the hearing aid, but then they won't pay for the hearing aid," says Dr. Genecov. "That doesn't make any sense to me."

Girl with no ears denied hearing aid | Latest News | WFAA.com

This article discusses the role of the AMA...BD

The cycle is bringing about the imminent collapse of the medical profession -- which gravely endangers our health-care system. We and doctors deserve better advocates.

America's physicians are the most trusted and valuable resources in our health-care system. Yet doctors' professionalism and incomes have taken a terrible beating recently. The American Medical Association, which received $286 million in revenue last year to protect the profession, has served physicians poorly.

Physician incomes, when adjusted for inflation, declined 7 percent from 1995 to 2003, while those of professional and technical workers rose. But unlike other professionals -- lawyers, architects, authors and economists -- doctors' work is dictated by the policies of insurers and governments. Increasingly, independent physicians, accountable only to their patients and the Hippocratic oath, have been replaced by salaried doctors who are accountable to the hospitals or insurers that employ them. Salaried physicians are closely policed for productivity, leading to ever-shorter and more numerous appointments per day.

Regina E. Herzlinger - Who Killed U.S. Medicine? - washingtonpost.com

 

TUESDAY, July 24 (HealthDay News) -- The pulmonary artery catheter, a once-lauded cardiac monitoring device, appears to be fading into medical history, a study finds.

Use of the device -- a thin tube inserted into a lung artery to get information about a patent's condition -- decreased by 68 percent in the United States between 1993 and 2004, according to a report in the July 25 issue of the Journal of the American Medical Association

The reason behind the drop in the device's popularity: "Multiple studies have shown that it doesn't help," according to lead researcher Dr. Renda Soylemez Wiener, an assistant professor of medicine at Dartmouth Medical School and a physician at the Department of Veterans Affairs Medical Center in White River Junction, Vt.

Cardio Monitoring Device Falls Out of Favor - Forbes.com

 

Today, I filed a class action lawsuit against United Healthcare for misrepresentation and fraudulent marketing in violation of The Florida Medicare Supplement Act. The lawsuit states that the defendants, United Health Group, Inc. and United Healthcare of Florida Inc. enrolled Medicare recipients into their Medical Advantage HMO and PPO plans without obtaining their signatures and consent to enter into the insurance contract and without informing or advising them that enrollment into their HMO and PPO medicare advantage plans disenrolls them from their rightful benefits under the United States Medicare Program.

These enrollees were also not informed that the Medicare Advantage Plans such as Secure Horizons and Complete Care provide limited or no skilled nursing home case while U.S. Medicare covers 100% of such care for 20 weeks. The company also failed to inform them that the UNITED plans have significant copayments and significantly more limited availability of physicians who will accept their plan than will accept medicare.
The suit also states that United Healthcare's marketing practices fraudulently implied by names such as CompleteCare and SecureHorizons that the UNITED insurance policies provide equal or complete care when in fact they provide far less care that the Medicare coverage that they replace.

Editor: Joe Saunders

Firm: Saunders & Walker, P.A.

Class Action Lawsuit Filed Against United Healthcare - Sarasota Personal Injury Lawyer

 

Scrutiny of not-for-profit hospitals' tax exemptions is increasing, as an Internal Revenue Service report found that 45% of not-for-profit hospitals spend 3% or less of their revenue on uncompensated care and as state and federal lawmakers consider imposing restrictions on the hospitals, the Wall Street Journal reports. According to the IRS study -- which involved 487 hospitals -- from 2003 to 2005, nearly a quarter of not-for-profit hospitals spent less than 1% of revenue on charity care and one in five spent 10% or more. The Congressional Budget Office says that not-for-profit hospitals received more than $12 billion in tax breaks in 2002, and a recent CBO analysis of hospitals in five states found that not-for-profits provide only slightly more uncompensated care than for-profit hospitals.

Not-For-Profit Hospitals Face Increasing Scrutiny From Lawmakers; IRS Report Finds Many Hospitals Spend Less Than 3% Of Revenue On Charity Care

 

NEW ORLEANS (Reuters) - All charges against a doctor accused of murdering four patients in the aftermath of Hurricane Katrina have been dropped, a spokesman for the state prosecutors office said on Tuesday.

A grand jury in New Orleans decided not to pursue charges against Anna Pou, who was arrested along with two nurses from Memorial Medical Center on second-degree murder charges in June 2006.

Murder charges dropped against Katrina doctor | U.S. | Reuters

Register before September 15, 2007.  The Sprint 6700 phone is a deluxe  Pocket PC phone and has many additional features, I use the same phone and use the blue tooth to tether to my tablet for Internet access too.  According to the article, there are additional discounts available as well.  Be sure to check out the "free" eprescribing initiative if you are not already established.  BD

OVERLAND PARK, Kan. and CHICAGO, July 24 /PRNewswire-FirstCall/ -- Studies indicate that a key barrier to the adoption of electronic prescribing is the reluctance of physicians to change their workflow of pulling out a prescription pad and handing patients a paper prescription. Through a new initiative launched by Sprint (NYSE: S) and Allscripts (Nasdaq: MDRX), physicians now have the option to use a Sprint smartphone to generate electronic prescriptions, without physically leaving the exam room.

(As part of this new initiative, Sprint will donate a customized PCS Vision(SM) Smart Device PPC-6700 to 1,000 licensed prescribers who register for the National ePrescribing Patient Safety Initiative(SM) (NEPSI SM) and activate NEPSI's Web-based eRx NOW(SM) electronic prescribing software before September 15, 2007. Recipients of the smartphone will also benefit from a 15 percent discount on the required Sprint two-year voice and data plans.

Sprint Provides Free, Customized Smartphones for the National ePrescribing Patient Safety Initiative

Related article :  Modern HealthCare

Unfortunately, I think some physicians are missing the point of electronic prescribing. Physicians should be the ones putting the prescription information into the computer or handheld device. This is the best way for the prescriber to be notified of any drug interactions, formulary incompatibility and yes—even less expensive alternatives—all at the point of care. Faxing individual forms from pharmacies circumvents these valuable safety features as well as the potential to save the patients some money. I guess some of us must go kicking and screaming into the electronic age.

Hat Tip:  Mobility Site

The bionic foot....BD

An Army veteran who lost part of his leg in Iraq walked with more spring in his step Monday as he unveiled the world's first robotic ankle -- an important advance for lower-limb amputees that was developed by a team at MIT.

Garth Stewart, 24, who lost his left leg below the knee in an explosion in Iraq, demonstrated the new powered ankle-foot prosthesis during a ceremony at the Providence, R.I., Veterans Affairs Medical Center. Stewart walked in the device, which, unlike any other, propels users forward using tendon-like springs and an electric motor.

The prototype device reduces fatigue, improves balance and provides amputees with a more fluid gait. It could become commercially available as early as the summer of 2008.

 

Joint effort: Robotic ankle research gets off on the right foot - MIT News Office

Hat Tip:  Medgadget

 

The U.S. Food and Drug Administration has approved the first molecular-based laboratory test for detecting whether breast cancer has spread (metastasized) to nearby lymph nodes. The GeneSearch BLN Assay detects molecules that are abundant in breast tissue but scarce in a normal lymph node.
The presence or absence of breast cancer cells in underarm lymph nodes is a powerful predictor of whether the cancer has spread and is used to help decide appropriate therapy for a woman with metastatic breast cancer.

FDA Approves First Molecular-Based Lab Test To Detect Metastatic Breast Cancer

 

OPTIMIZE HF also provided tools to help hospitals improve the reliability of heart failure care, including standardized admission orders, discharge checklists, pocket cards, medical chart stickers, best-practice algorithms and critical pathways. Researchers found that use of these tools impacted outcomes. In-hospital mortality dropped from 4.1 to 2.5 percent for cases in which hospital staff utilized standard admission orders to help direct treatment. Post-discharge death and re-hospitalization rates decreased from 38.2 to 34.8 percent when tools were utilized during care.
Fonarow said that the American Heart Association has adopted OPTIMIZE HF for use in its Get With the Guidelines Heart Failure quality improvement program, in which more than 400 hospitals nationwide are now participating.

Initiative To Improve Heart Failure Care At Nation's Hospitals Makes Major Gains

I am guessing this is a real challenge to stay updated on the frequent changes as well to correctly advise the consumer as well.  Are attorneys employed here to help in the effort?  Hopefully the answers might be a little more accurate than the ones folks have received in recent Medicare articles that reflect a substantial error factor with information being given to consumers.  BD 

Hotline counselors now give free and expert information about a range of topics, including: how to appeal Medicare private health and drug plan denials; help for victims of Medicare private health plan marketing schemes; how the Medicare drug benefit works with Medicaid, state pharmaceutical assistance programs and other drug coverage; resources for low-income people with Medicare; and how Medicare covers care in the home, skilled nursing facilities and hospitals, and durable medical equipment.

National Hotline Expands To Assist Professionals With Clients' Full Array Of Medicare Questions And Problems, USA

Read this article...do you get it...much less understand how to implement.  This is a summary and not the actual CMS page too.  I guess soon we might all need attorneys to  interpret our health care needs...sad state of affairs indeed when one needs medical attention and all these factors have to be examined before we can be examined.   BD

The Centers for Medicare & Medicaid Services (CMS) issued a final rule revising the payment system for services furnished to people with Medicare in ambulatory surgical centers (ASCs) to better align payments for similar services furnished in a hospital outpatient department (HOPD) or a physician's office. CMS also issued a proposed rule that would update Medicare payment for services in HOPDs under the Outpatient Prospective Payment System (OPPS) and would set new payment rates for ASCs under the revised system effective for services in calendar year (CY) 2008.
The ASC final rule expands beneficiary access to surgical procedures in ASCs and implements steps to make ASC payments more accurate, while aligning payments across Medicare's payment systems to encourage efficient and appropriate choices of outpatient settings for ambulatory surgical procedures. CMS expects to make payments of almost $3 billion in CY 2008 to the approximately 4,600 ASCs that participate in Medicare.

CMS Revises Payment Structure For Ambulatory Surgical Centers And Proposes Policy And Payment Changes For Hospital Outpatient, USA

I am guessing there may be more statements like this on the way.  BD

Minnesota

Maine

Something we sometimes may not think about....BD

According to the survey, physicians involved with a serious medical error were most likely to report higher levels of occupational stress, although one-third of physicians involved in near misses also reported higher stress. Amy Waterman, a psychologist at Washington University in St. Louis and lead author of the study, said the survey findings highlight the need for hospitals to provide support to physicians after medical errors, which she said could push them to quit, become depressed or commit other errors. Among physicians participating in the survey, 10% said hospitals offered sufficient resources to help them manage stress stemming from medical errors (Tanner, AP/San Jose Mercury News, 7/18).

Medical Errors Increase Physicians' Stress Levels, Study Finds

Changes already in the making....BD

Moore at the hearing said that he supports increasing from 33% to 50% the amount employers must contribute to workers' health care to avoid a $295-per-employee penalty. Moore has asked the administration of Gov. Deval Patrick (D) to make the proposed change, but if the administration does not, he said he would push for the change to be added to the revision bill. According to the Globe, another proposed change to the law would limit to 10% of income the maximum amount residents would have to pay out of pocket under health insurance, which differs from the current law that bases the limit only on premiums (Dembner, Boston Globe, 7/19).

Massachusetts To Revise State Law Mandating Residents Have Health Insurance

 

One Orange County hospital topped the others here in heart bypass surgery performance, while two surgeons scored below average, according to state data released Thursday.

Fountain Valley Regional Hospital is the only local hospital that scored significantly higher than the state average in survival rates for heart bypass surgeries in 2003 and 2004. Of 121 hospitals statewide that perform the surgeries, four received the distinction.

More than 90 percent of hospitals and surgeons statewide performed as expected, according to the ratings released Thursday by the Office of Statewide Health Planning and Development. The average death rate for the surgeries was 3 percent statewide.

Dr. Himmet Dajee, who recently retired from Fountain Valley Regional, was also noted for better-than-average performance.

News: Hospital top in heart bypass | statewide, heart, bypass - OCRegister.com

 

TennCare Director Darin Gordon last week said CMS proposed new caps on Medicaid payments to hospitals before contract negotiations were finalized. According to Gordon, other states with similar Medicaid funding structures would not be subject to the caps. State officials say the caps could cost Tennessee up to $400 million over three years and would "severely reduce" funding for the program at a time when the state is planning to expand enrollment to more adults. The payment caps particularly would affect not-for-profit hospitals that provide large amounts of charity care, according to the Commercial Appeal.
Bredesen said, "We're not asking for anything different from what other states are getting. At the same time, Massachusetts, California and Florida have all gotten huge sorts of additional benefits. We have saved [the federal government] a lot of money, and they are still trying to pull us back even further, and I just don't believe it's fair and appropriate" (Locker, Memphis Commercial Appeal, 7/19).

Tennessee Officials Criticize CMS Proposal To Cap Hospital Payments; TennCare Waiver Negotiations Continue

Be wary of colloidal silver....BD

Will the colloidal silver products currently on the market turn you blue? The Harvard Health Letter says if you use them for a short time and in recommended amounts, probably not. But some people overdo it. For example, a 59-year-old man was sent to the emergency room because he looked cyanotic -- the bluish color that indicates a person is not getting enough oxygen. It turned out he'd been taking a homemade version of colloidal silver whenever he felt a cold coming on.

Dietary Supplement Can Turn The Skin Permanently Blue, Reports The Harvard Health Letter

More uses for the cell phone and they just keep coming.  BD 

BASKING RIDGE, NJ — Verizon Wireless, the leading wireless company with the most reliable wireless voice and data network, announced today that its customers are the first in the nation that can record video with their wireless phones and upload the videos directly to YouTube using an easy to remember number – YTUBE (98823), which is the shortcode for uploading videos to YouTube.

Verizon Wireless customers simply need to update their YouTube accounts with their wireless phone numbers by visiting www.youtube.com/mobile. Verizon Wireless customers can then quickly and easily upload their short mobile videos to YouTube over Verizon Wireless’ high-speed wireless broadband network by simply sending their message to YTUBE (98823). Videos will post live in just minutes; standard messaging rates apply. Verizon Wireless currently offers more than two dozen video messaging-capable phones.

Verizon Wireless Customers First To Upload Videos To YouTube Using Multimedia Messaging

They need help.  BD

Information technology services provider Computer Sciences Corp. said Monday it was awarded a task order contract worth up to $96 million to provide technological support to the Centers for Medicare and Medicaid Services.

The agreement has a seven-month base period, one nine-month option, and one one-year option. If all options are exercised, the deal is worth roughly $96 million.

CSC Wins $96M Medicare Contract - Forbes.com

 Nice feature that once the unit is paired to your cell phone, the connection remains.  BD

The Just Mobile® Bluetune “Solo” hands free car kit offers both terrific sound quality and easy installation.

The speaker and microphone are integrated in a stylish and compact design with a Digital Sound Processor (DSP) to minimize echo effect and background noise.
Powered by the vehicle lighter socket. Once paired to your mobile phones, PDA’s or smart phone it automatically connects each time turning on power to the vehicle.
Additional features include an automatic answer on/ off button, support for voice dialing, volume control, call mute and last number redial*

http://www.just-mobileonline.com/products_communicationseries_3.html

Hat Tip:  Mobility Site

Patient registry reports are a huge asset with check and balances too for those practices participating in P4P with managed care.  If you are using an EMR, be sure to see if registry reporting modules are included as they will save you a lot of work and gain some potential income for you at the same time in case of number and statistic discrepancies.  BD

The IHA's P4P program is reportedly the nation's largest, involving more than 40,000 California physicians in 220 medical organizations that care for over 12 million individuals. Participating health plans include Aetna, Blue Shield of California, Blue Cross of California, CIGNA, Health Net, Kaiser Permanente, PacifiCare, and Western Health Advantage. Funding for P4P bonuses comes from individual health plans, based on their interpretation of IHA's criteria.

The program's information technology measures examine how physician groups use IT to manage patient populations and how information technology is used at the point of care, for e-prescribing, drug interaction checks, monitoring lab results, electronic messaging, and preventive and chronic care reminders. When P4P results were first published four years ago, "two-thirds of physician groups did not meet any IT criteria," said Tom Williams, executive director of IHA. "Today, only one-third do not meet any of our IT criteria."

Report: Increased use of IT helps medical groups improve clinical quality - San Francisco Business Times:

Hmmmmmm......time to set up e-prescribing?  BD 

Millions of Medicaid beneficiaries might "not be able to obtain their medications" after Oct. 1, when a law requiring pharmacists to reject prescriptions not written on tamper-resistant pads goes into effect, pharmacist groups wrote in a recent letter to lawmakers, the AP/Seattle Post-Intelligencer reports. The new law is a "tiny provision tucked into a spending bill" for the Iraq war, according to the Post-Intelligencer.
The law was designed to make it more difficult for patients to obtain controlled substances through forged prescriptions and to save the government money. Some tamper-proof pads contain identifying serial numbers that can be matched to the doctor's prescription. Others contain a chemical that makes the prescription illegible when photocopied.

CMS spokesperson Steve Hahn said the agency has no plans to change the Oct. 1 deadline

Physicians Unprepared For Law Requiring Tamper-Proof Medicaid Prescription Pads

As the article states, physicians will be passing the extra cost to the patients due to the current payment structures.  Some increases will be present, but what are they and do they cover large health ticket items?  BD 

Doctors object to lower reimbursements. The insurer says new rates will pay physicians at 'sustainable levels.' 

Blue Cross "won't renegotiate," Nagel said. "They will say, 'You take it or leave it.' "

Blue Cross of California's latest antidote to rising healthcare costs isn't going down very well with physicians.
The state's largest for-profit health plan is set to roll back its payments for about half the services and procedures provided by physicians next month.
And many of the 53,408 physicians in Blue Cross' preferred provider organization (PPO) networks say that's a prescription for disaster.

One Newport Beach oncology practice figures the new rates will result in a $400,000 annual loss on the cost of treating their Blue Cross patients, who make up 40% of its cases.
As a result, Newport Cancer Care & Medical Associates sent letters to those patients explaining that they would be expected to pay the difference between the reimbursement rate and the costs of their chemotherapy.

"If we're not getting reimbursed, we can't pay for the drugs for the other patients," Donegan said. "The pharmaceutical companies and the insurance companies are the ones who are truly the profit-takers, and we're caught in the middle. The patients and the physicians are caught in the middle."
Dr. Ralph Armstrong, an osteopathic obstetrician-gynecologist in Hollister, said the reimbursements for procedures he performs often are being slashed. Gall bladder removals and appendectomies, for instance, are set to be reduced 28%.

Troughton said the new rates include almost as many increases as decreases. Primary care physicians will tend to fare better than specialists under the new rates, she said.
This reflects an industrywide effort to counter an emerging shortage of primary care physicians by raising the pay for these general and preventive care practitioners relative to specialists.
But even some primary care physicians say their practices will suffer under the new rates.

The state Department of Managed Health Care's hearing is scheduled for Tuesday, Aug. 7, from 10 a.m. until 3 p.m. in the Carmel Room Auditorium at the Junipero Serra Building, 320 West 4th St., Los Angeles.

Blue Cross cuts causing pain - Los Angeles Times

Any physician who wants to use e-prescribing can also go to the link on this site to enroll for free e-prescribing under the NEPSI initiative.  Health Net is promoting e-prescribing for an IPA (Independent Physicians Association) in Connecticut.  BD

Health Net will subsidize the cost of providing access to Emdeon's ClinicianRx web-based software to all physician members of the CSMS-IPA who wish to participate. Physicians will be able to write e-prescriptions for all of their patients whether or not they are Health Net members.

Health Net to Enable Connecticut Physicians to Automate Prescription Writing and Processing - - insurancenewsnet.com

 

PORTLAND, Ore., July 10 /PRNewswire/ -- Kryptiq Corporation, one of the nation's fastest-growing providers of solutions for healthcare transformation, today announced that InterHospital Physicians Association (Portland IPA) has selected Kryptiq's Connect IQ(TM) Secure Messaging to connect providers across the Portland, Oregon, metropolitan area. Kryptiq's Connect IQ serves as a vendor neutral platform enabling Portland IPA providers to securely share patient information for improved coordination of care. With this solution, the Portland IPA will support collaboration among its members so that patient information may be shared securely and electronically across physician systems where it is needed, improving clinical and economic

InterHospital Physician Association Implements Kryptiq's Connect IQ(TM) Secure Messaging

Information on how the "concierge" or "boutique" practices work for better patient care.  Not everyone can afford the service, but for those who can it seems to be a win-win for both patient and physician.  There are many different ways an office can approach this and we have put several threads here that offer an alternative look.  Each office has to determine their structure and fees.  Some have been very reasonable too in some area of the country as well.  BD

"I wish I had done it a long time ago," said Dr. Edward Portnoy, a Westlake Village internal medicine physician who once had a practice of about 2,800 patients. Now he sees about 380 people but takes home about the same profit, thanks to the $1,800 each patient pays yearly.

At Dr. Stanley Frochtzwajg's family practice in Ventura, patients don't face annual fees but pay at the office for whatever services they receive. A routine office visit is about $80. They're given the paperwork to submit to their insurance companies. One patient said she ends up paying about 30 percent of the bill but is happy with her care and willing to pay for it.

But Carol Miller of Thousand Oaks thinks the $3,600 she and her husband pay in annual fees to see Portnoy is worth it because it brings peace of mind. The money covers an annual physical and a battery of screenings for everything from Alzheimer's to sleep apnea. The fee also covers follow-up that focuses on preventive care.

Patients are given wallet-sized CDs bearing their medical histories. They're promised same-day appointments, sometimes within 45 minutes. If they have problems, they're given the doctor's cell phone number.

"You don't get that with a regular doctor. They don't give out private numbers," Miller said. "I feel like he's more than a doctor. With this kind of practice, they know our name. I call on the phone and they say Hi, Carol, how are you doing today?' "

Local doctors are opting out of insurance-based medicine : Local News : Ventura County Star

 

Both Medicare and commercial insurers have long paid physicians different amounts for each of the five levels of office visits. Now Anthem Blue Cross and Blue Shield Ohio, a subsidiary of WellPoint, the nation's largest insurer, has thrown that system into question by blending payments for level 3 and 4 visit codes into a single rate. This new policy, which became effective in Cincinnati, Dayton, and the rest of southern Ohio last November, greatly concerns physicians and medical leaders on both the local and national level.

"Common sense would tell us that if you're using codes that have been carefully developed over the years to reflect a level of service, you should be reimbursed more for more service," says ob/gyn Molly A. Katz, president of the Ohio State Medical Association (OSMA).

OSMA says the reimbursement changes—which raise payments for level 3 visits and lower those for level 4 visits—are tantamount to downcoding. While Anthem has predicted that only 25 percent of physicians will get paid less and that nearly half will receive more overall, the prevailing view among physicians is that they'll be losers. In fact, Group Health Associates, a 102-doctor practice that's the largest in Cincinnati, could lose several hundred thousand dollars a year in revenue, says FP Michael J. Barber, the group's CEO.

Blending: The new downcoding - This Ohio Blue Cross/Blue Shield plan makes the same payment for level 3 and level 4 visits. Is it the start of a trend? - Medical Economics

 

Next time someone asks, "Is there a doctor in the house?" don't be surprised if no one comes forward -- especially if the question is asked in rural Georgia.  While rural Georgia has more trouble wooing physicians, metro Atlanta suffers as well. Home to about 9,400 physicians, Atlanta has 87 primary care physicians for every 100,000 residents. The national average is 97. A recent HealthLeaders-InterStudy Market Overview determined that Atlanta has 190 total physicians per 100,000 residents. The national average is 218 per 100,000.

Running out of Doctors - The Business Journal of Phoenix:

To help with these matters it is useful to use the Internet as much as possible as well as any other automated processes you can.  The front office responsibilities eventually over flow to the back office these days too.  When using the Internet, data bases are not always updated as quickly as they need to be and there still is the occasion when a phone call needs to be made to check eligibility and claim processing.  Take advantage where you can and do the best to take advantage where possible, including streamlining other office and charting functions to get some relief.  BD

It is not the back office staff -- the hands-on medical help -- that has grown in the typical doctor's office, but the front office staff. The business of managing the doctor's office is growing and growing.

"The typical doctor in the early '90s had a front office person and a back office person, a medical assistant.  "It is the only commercial transaction I can think of where the patient is not responsible for paying. A person providing the services has to go to a third party and fight them for their payment."

Reed argued that with managed care now in its second decade in Atlanta, it takes more people not directly involved in the health care of a patient to make the system work. On the other hand, insurance companies argue that they are weeding out waste and unnecessary procedures and keeping costs down.

Reed said doctors spend more time than they should trying to collect payment, and that has been the biggest change in the institution of being a physician.  "The presence of a third-party payer has contributed to a fragmentation in care and the skyrocketing cost of health-care delivery."

He said the median income nationally for an internist is $160,000, but the sole practitioner is making less than half that because of business costs.

Business side of office becoming more intensive - The Business Journal of Phoenix:

The numbers of physicians who will see Medi-Cal patients is getting to be less and less and finding referrals for specialist care is also becoming a chore for the primary care physicians who do honor Medi-Cal.  BD

The question for doctors and hospitals is whether a boost in Medi-Cal rates would be sustained over time. Schwarzenegger has tried to shave rates in the past to balance the state budget. Doctors and hospitals want assurance not only of stable funding, but also annual increases to keep pace with the cost of living.

Healthcare reform fight hinges on Medi-Cal cash, indigent care - Orlando Business Journal:

With technology ever present and audit tables and cameras everywhere, it just does not pay to snoop as you will more than likely be caught if it is outside the parameters of your job.  This article goes on to compare how banking handles privacy as well, something for all in the health care industry to think about.  BD

Now, the human tendency to pry has been given super powers through technology, causing unease about the ramifications of increasing personal transparency.  And while a hospital may seem the most likely place where such privacy can be violated, the same data that are illegal for hospitals to divulge can surface in places unrelated to a patient's medical care through hospital vendors -- such as computer technicians -- or in lawsuits.

A Health and Human Services law that will go into effect Aug. 1 includes a provision allowing doctors to bypass filling out forms that limit access to patient records kept by another physician, said Rich Neumeister, a privacy rights activist.

For example, a chiropractor could request medical files of a patient from another doctor and receive mental health records, even though the patient didn't intend to reveal them, he said. 

If a worker at a company that has nothing to do with medical information sues over an on-the-job injury, that company then gets access to the person's medical history. So does Nolan's law firm, which is also responsible for keeping the data private.

Although technology has made snooping more immediate and potentially harmful, Tanick said he is just as likely to see a case in which the snooper is a clinic receptionist who simply blabbed about a client to friends.

"Good, old-fashioned, low-tech gossip," he said.

Don't go there

Something to think about if you travel.  This is a good article that makes a lot of points and gives some real good information.  BD

I learned later that the cost of a medical evacuation from China to a hospital in the United States would have been about $50,000 and it would not have been covered by my existing medical insurance.

I'm a believer

Yes, medical evacuation -- if you end up paying for it yourself -- is expensive. Recently, the doctor aboard my cruise ship in the South China Sea said it could easily cost close to $100,000 to arrange an air evacuation at sea.

These days I buy medical evacuation insurance, which generally takes care of immediate expenses and brings you back home as soon as possible.

Roy Berger, president of MedjetAssist, outlined his company's annual emergency evacuation policy: "If your condition is critical and you can gain inpatient status at the hospital at both ends, we will bring you home from abroad in a dedicated air ambulance to the hospital of your choice."

Members of the American Automobile Association can also get emergency transport through the "Plus" plan that provides up to $25,000 of emergency medical transportation coverage and 24-hour medical emergency assistance.

ContraCostaTimes.com - Sick abroad? I wanna go home