This is interesting in the fact that Tiger did not have to give a blood test, even though it had been requested but was blocked by attorneys. Meanwhile amidst all the other stuff on the news his wife has released a few items of interest. Another article today had a few more details and more of the same.
He is rewriting the prenup to give Nordegren, 29, more cash for staying in the five-year marriage, according to the Chicago Sun-Times. Sounds like she can take the money and run if she likes or maybe this is money to stay, or keep quiet:)
It appears Tiger had some issues with drugs and alcohol and the extent we don’t know and but we seem to be hearing more about this issue with celebrities and athletes more and more. Maybe the next stop is Oprah for a talk with Dr. Phil for a special visit. BD
The Florida Highway Patrol requested, and was ultimately denied, a blood sample from Tiger Woods because the "witness" who got him out of his SUV when he crashed it on Nov. 27 told authorities the golfer had been drinking earlier in the day, according to a subpoena request released today.
That "witness" being Woods' wife, the golf-club-wielding Elin Nordegren, of course.
Nordegren also informed FHP officers that her hubby, who underwent major knee surgery last year, has prescriptions for Vicodin and the sleep aid Ambien.
"Impairment of the driver is also suspected due to the careless driving that resulted in the traffic crash," stated the blood-results request.
If only it were that simple...
Authorities ruled out alcohol as a factor in the crash and the report filed by the first Windemere Police officer on the scene does not mention a suspicion that Woods was under the influence.
This is a good example with the lawsuit in New Jersey that specifically talks about out of network charges. This has been a hot topic for years and this medical group was charged with “fraud”, mainly because it appeared to be out of network. It may be out of network, but how could the insurer claim this as fraud. Ok let’s step back in time for a moment here, don’t we have some currently mentioned lawsuits ongoing about this “out of network customary charges”, like all over the US and an 8-9 battle with the AMA just approaching settlement?
It was just in June of this year that Health Net stated they would quit using the “unfair or corrupt” data base and a non profit organization was going to replace this after being out there in use for 8-9 years. Just a question in light of all of this, how does Health Net have a leg to stand on when alleging fraud?
I can understand trying to keep costs down and use those in network first by all means as I think almost everyone understands that concept, but when that care is not available in network, the next choice is out of network.
It’s the algorithms that can be interpreted as fraud even though none has taken place. Here’s a story from the San Diego area which is still legal work in progress, but as it is reported now, 20 dermatology offices within 5 days stopped getting payments from all of their insurers. They were “scored” and it was determined there was potential fraud. This case as it states was lead by the algorithms provided by Ingenix. The doctor’s offices had no prior notice other than the fact they were accused of “fraud”. Is it fraud or the algorithms and how were they set to analyze with what parameters? Algorithms can be changed quickly too, ask anyone who works on Wall Street with their “algos”.
A couple more thoughts of my own here, we certify and charge EHR vendors for the assurance that their algorithms and formulas will operate and integrate correctly, but do we as insurers for the same? Could stand to be a hot topic here.
One other item that perplexes me a bit too is that with all the above said, why do we give contracts to the same folks that use algorithms and contributed to a data base that unfairly paid out of network charges? Can we trust companies like this? It’s strange they get in trouble with shorting MDs and collecting more from patients than is really customary, and yet we see their services enrolled by governments and hospitals?
Is there not anyone else out there who has developed this type of technology we can do business with that can help to prevent fraud that doesn’t have a track record of ripping off patients and doctors? Sure nobody likes fraud and if you are going to be the good guy that prevents fraud I would think you might want to have your own back yard cleaned up first.
This whole item of healthcare reform is full of stuff like this. We all took different paths to get to where we are today and once we fully understand the value of investing in the people of the US and stop all this “passing judgment” on why they have health issues, I think we stand to make progress, but again not as long as this current system of having to constantly rate and pass judgment on each other is alive and well and all about making a buck off our illnesses. BD
A New Jersey appeals court ruling is good news for the viability of ambulatory surgery centers in the state and reinforces physicians' rights to do what's best for their patients, according to the state's medical community.
On Nov. 17, the Appellate Division rejected claims by Health Net of New Jersey that physician owners of an ASC committed fraud by billing for improper referrals to their out-of-network facility. The doctors themselves were in the health plan's network.
In addition, the appeals court rejected Health Net's assertions that Wayne (N.J.) Surgical Center engaged in fraud when it waived patients' coinsurance payments so they would use the facility. Health Net alleged that the doctors misrepresented their charges because they failed to disclose the fact that they had waived the fees when submitting claims.
Insurers often punish doctors and patients for using out-of-network services, said John D. Fanburg, counsel to the New Jersey Assn. of Ambulatory Surgery Centers. The organization was not directly involved in the case, but it is helping its members fend off similar suits by other insurers.
"Ultimately it's the patients' choice, and they should decide where they want to go, especially if insurance companies are charging them a higher premium for that [out-of-network] benefit," said Fanburg, chair of the health law practice at Brach Eichler LLC in Roseland, N.J.
But health plans contend that such practices drive up health care costs and ultimately hurt patient care. Health Net sought to recover $5 million in alleged fraudulent overpayments to Wayne Surgical Center.
Along with merging the 3 unions, the group also states they are looking to help set up and organize additional members throughout the US. Nurses are who we see more than our doctors and are the day to day lifeline we have in the hospital by all means. We need good care and good nurses everywhere. When it comes to innovation and ideas for better care, ask a nurse!
Part of the mission of the nurses is bring some standardization to patient care and now they will have a stronger voice in Congress as well. California and Massachusetts somewhat lead the way as far as numbers of current members and the California Nurses Association is by far the largest and has had the ability to be heard perhaps more so than some of the members of the other unions. BD
HOENIX (Reuters) - Three nurses unions merged on Monday to form the largest-ever labor organization for U.S. medical professionals, which is expected to wield greater clout in collective bargaining and the national healthcare debate.
Organizers said the new 150,000-member National Nurses United, comprising union locals from Maine to Hawaii, would use its strength to fight for patients' rights, higher healthcare standards and better working conditions for nurses.
Deborah Burger, president elect of the NNU and head of its largest constituent union, the California Nurses Association, called the merger a big step.
"It's a huge day ... not only for the nursing profession, but also for our patients," she said. "We will be able to go to the halls of Congress and advocate for stronger patient protection, for better healthcare."
Aside from a bigger voice in the healthcare debate, the merger is expected to give nurses greater leverage in collective bargaining after decades of growth in national hospital chains that have largely resisted union organizing. The merger, approved unanimously by delegates at a founding convention in Phoenix, unifies the CNA, which has 83,000 members in California and several other states; the United American Nurses, with 45,000 members, mostly in the Midwest, and the 22,000-member Massachusetts Nurses Association.
A while back I wrote about CIOs needing some “tech” knowledge and I can’t help but think some of that gained this honor for Mr. Fasano. Kaiser Permanente is very much involved with technology and innovation and is leading the way for others with some of their programs and shared information. A while back I interviewed Chris McCarthy with their innovation division and you can read more about it at the link below to get an idea of what they are in to and where they are going. BD
OAKLAND, Calif., Dec. 7 /PRNewswire/ -- Computerworld announced today that Philip Fasano, CIO for Kaiser Permanente, has been named a 2010 Premier 100 IT Leaders honoree. Fasano is one of 100 individualsfrom a broad range of companiesrecognized for exceptional technology leadership, innovative solutions to business challenges and effectively managed IT strategies.
"Phil's contributions have helped Kaiser Permanente become a national leader in health IT, widening the role of technology in delivering medical care and empowering consumers to take control of their own health," said George Halvorson, CEO, Kaiser Permanente. "He is a true ambassador for the emerging and increasingly important space where information technology meets health care."
Since joining Kaiser Permanente as CIO in 2007, Fasano has been working on moving the $40 billion not-for-profit health care system toward a vision of real-time, personalized health care for its 8.6 million members - specifically by directing the development and implementation of the technology to support and extend this vision. Fasano leads nearly 6,000 IT employees in building better tools and platforms to deliver personalized care that is smart, connected, collaborative, affordable and preventive.
The centerpiece of the technology platform is Kaiser Permanente HealthConnect®, the world's largest civilian electronic health record. Kaiser Permanente HealthConnect® gives the organization's 14,600 physicians immediate access to patients' status and medical history, as well as decision support based on evidence-based practice guidelines and the latest medical research. Kaiser Permanente's members can easily and conveniently make and reschedule appointments, check lab results, and send e-mails to care providers via My Health Manager, the online personal health record that connects directly with Kaiser Permanente HealthConnect®.
"I'm pleased to share this honor with my entire information technology team," said Fasano, "all of whom play a critical part in bringing to life technology solutions that represent the future of health care delivery."
Computerworld created the Premier 100 nearly 10 years ago to spotlight individuals who have had a positive impact on their organization through technology. Each year, 100 people are selected to receive this lifetime recognition award. Fasano joins the 1,000 honoree alumni dating back to the year 2000. Computerworld's award-winning magazine and Web site are leading sources of technology news and information for IT influencers worldwide.
About Kaiser Permanente
Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America's leading health care providers and not-for-profit health plans. Founded in 1945, our mission is to provide high-quality, affordable health care services to improve the health of our members and the communities we serve. We currently serve 8.6 million members in nine states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: www.kp.org/newscenter.
Press release below from Cook Medical with self-expanding metal stents with some interesting results as relates to patient care and effectiveness. You can read more about the Zilver Stents at the links below and and my interview with Rob Lyles, VP of the Cook Intervention Division, we need to know the interventional radiologists, cardiologists today, they can save our lives. BD
The stent is coated with paclitaxel, a cancer drug. The drug lasts in the body for 6-8 weeks, and is used to help prevent infections as well as decrease the chance of the body rejecting the stent. Our bodies are designed to heal and regrow tissue, so the drug also helps in that process with keeping excess tissue away from the area where the stent is placed. The procedure also has less risk for diabetics and those with high blood pressure and can be used for procedures related to hardening of the arteries. Not too long ago I had a chance to talk with Rob Lyles from Cook Medical and you can read the interview below for additional information.
First and Only International Study of its Kind Shakes up Metal Biliary Stent Market
December 7, 2009
WINSTON-SALEM, N.C., December 2, 2009 — The final results of the largest international, randomized, controlled trial of self-expanding metal stents (SEMS) in the treatment of biliary obstructions reveal a new, disruptive competitive dynamic in the $70-100 million metal stent market. The study, known as MOZART, published in the September issue of Gastrointestinal Endoscopy, found that the overall clinical success of Cook Medical's non-foreshortening nitinol Zilver® Biliary Stent, now available on a 25 percent smaller 6 FR introducer, parallels the effectiveness of Boston Scientific's Wallstent®. The MOZART study confirms that SEMS provide a higher level of patient care and clinical efficacy than alternative solutions.
Landmark Study The MOZART study included a total of 241 patients in nine centers in the U.S., Canada and Europe who presented with malignant biliary obstructions – a complication associated with several forms of cancers – in which the bile ducts of the liver become blocked by tumors. Biliary obstructions or strictures impair liver function and cause a range of symptoms including abdominal pain, nausea, vomiting, fever and fatigue. The blocked ducts can be opened using stents inserted endoscopically that expand upon deployment. Plastic stents are cheaper than metal for this purpose, but data suggest that plastic stents occlude more readily when compared to SEMS, necessitating repeat procedures. In fact, SEMS have proved more robust and cost-effective in many clinical settings.
According to the MOZART study, the 6-mm SEMS demonstrated a higher occlusion rate than the 10-mm SEMSs; therefore, the study agreed to close this arm to further patient entry and continue to follow the exiting enrolled patients. The remaining 10-mm SEMS patients revealed equal patency among SEMS.
The two biliary stents in the MOZART study differ significantly in design, materials and mechanism of expansion, but achieved equal patency by several measures: for both, fewer than a quarter became occluded after placement over the life of the study. Treating physicians, who had more experience with Boston Scientific's stent, reported the ease of positioning of the Zilver during the study.
“The significance of this study is defined not only by its scope and global reach, but also the noteworthy findings,” said Raj J. Shah, MD, a lead investigator on the study, associate professor of medicine at the University of Colorado Denver School of Medicine and director of pancreaticobiliary endoscopy services at the University of Colorado Hospital. “The Zilver stent has all the advantages of the industry's leading SEMS, including helping us to deliver excellent patient care and expanding cost-effective options for malignant biliary obstruction.”
Cook Medical: The Only Full Line Supplier of Endoscopic Devices Cook Medical's Zilver Biliary Stent is the first stent of its kind made of flexible laser-cut nitinol tubing. Nitinol, which is inherently kink-resistant, allows Zilver to conform to the ductal wall while providing reliable patency. Through the interlocking design construction, Zilver's stent ends are atraumatic, potentially reducing the risk of ulceration or perforation. Its non-foreshortening design gives precise accuracy in placement; potentially reducing instances of migration and the need for repeat procedures. Additionally, four gold radiopaque markers at each end of the stent provide greater fluoroscopic visualization and exacting placement.
The Zilver Stent is available with the market's smallest introducer platforms (6 and 7 FR), making it ideal for accurate navigation through tighter strictures. Combining the latest in access capability and the proven benefits of Zilver, the 635 is yet another addition to Cook's full line of innovative endoscopic accessories.
Benefits and Offerings of the Zilver 635:
Zilver 635 has the markets only 6 FR introducer, the optimal platform for hilar and bifurcation stenting;
Utilizes Cook's proprietary Flexor coil-reinforced introducer technology: a truly unique material that has excellent pushability and flexibility while providing a distinct advantage in stent placement due to its kink resistance;
The only system in the world that allows two stents to be placed simultaneously through a standard 4.2-mm channel duodendoscope, thereby increasing procedural efficiency;
Includes a shelf-less tip design to ensure smooth withdrawal of the introducer through the deployed stent.
“The MOZART study results inject a major disruptive element into the SEMS market by unequivocally stating that Zilver performs with a clinical efficacy equal to that of the market leader, but with an introducer 25 percent smaller and on a non-foreshortening nitinol platform,” said Barry Slowey, Business Unit Leader, Endoscopy. “We are pleased to offer Zilver to our customers while delivering the most comprehensive line of endoscopic devices that enhance patient care.”
About Cook Medical Founded in 1963, Cook Medical pioneered many of the medical devices now commonly used to perform minimally invasive medical procedures throughout the body. Today, the company integrates medical devices, drugs and biologics to enhance patient safety and improve clinical outcomes. Since its inception,Cook has operated as a family-held private corporation. For more information, visit http://www.cookmedical.com/. You may sign up to follow Cook Medical on Twitter at twitter.com/cookmedicalpr.
Since May 2008, SU2C has raised more than $100 million from a wide range of philanthropic, corporate, and organizational donors, as well as the general public. Watch the video below for additional details on how the grants were unlike most in the fact that the scientists were able to take on risk with research, good risk and the ability to go outside the the normal boundaries and go after riskier, but perhaps research that will represent greater reward on winning the battle against cancer. BD
Press Release: Dec. 7, 2009, New York, N.Y./Los Angeles, Calif.: Stand Up To Cancer (SU2C) announced today that it is awarding $9.68 million to support high-risk/high-reward cancer research conducted by 13 young scientists. Over a three-year period, each investigator will receive a total of up to $750,000 as part of SU2C’s Innovative Research Grants program, which supports the next generation of cancer research leaders. “We asked our best and brightest young researchers to step outside their comfort zones and strive to make big differences with bold initiatives,” said Richard D. Kolodner, Ph.D., professor of medicine at the University of California, San Diego, senior researcher at the Ludwig Institute for Cancer Research in La Jolla, Calif., and chairman of the review committee for the grants. “If these projects come to fruition, some of the ideas could be game-changers in cancer research.” The Innovative Research Grants program is the second major funding commitment made by Stand Up To Cancer. Earlier this year, SU2C awarded $73.6 million to five interdisciplinary, multi-institutional Dream Teams with more than 300 members from 20 institutions. All of these SU2C-funded projects focus on groundbreaking translational research aimed at getting new therapies to patients as quickly as possible. Since its launch in May 2008, SU2C has raised more than $100 million from a wide range of philanthropic, corporate, and organizational donors, as well as the general public, much of it in connection with an SU2C telecast on September 5, 2008, that aired simultaneously on ABC, CBS, and NBC.
“By any measure, Stand Up To Cancer has been making significant progress in facilitating new ways of doing cancer research,” said Laura Ziskin, one of SU2C’s founding members and the executive producer of the Sept. 2008 broadcast, who is also a cancer survivor. “Cancer claims 1,500 lives every single day in this country, and by 2010 it will become the leading cause of death worldwide, so the need for more and better treatments has never been more urgent. We set out to engage people all over the United States in supporting the scientists who are working to end this disease ... We’re grateful to everyone — from the person who contributes one dollar through our website, to the philanthropists and companies who’ve made multimillion dollar gifts — who is standing up with us.”
Innovative Grant Funding Formula Departs from Traditional Approach
Stand Up To Cancer’s funding model for the Innovative Grants was designed specifically to support work that utilizes new ideas and new approaches to solve critical problems in cancer research. These innovative projects are characterized as “high-risk” because they challenge existing paradigms, and because in order to receive a grant the applicants were not required, as they would be by most conventional funding mechanisms, to have already conducted a portion of the research resulting in an established base of evidence. If successful, the projects have the potential for “high-reward” in terms of saving lives. The American Association for Cancer Research, Stand Up To Cancer’s scientific partner, assembled the expert SU2C Scientific Advisory Committee as well as the Innovative Research Grants Review Committee, who administered the scientific review process and will provide ongoing scientific oversight of the grants. “Traditionally, the projects most likely to be funded are those with a demonstrable expectation of success, which means that some of the research has to be done before an investigator can submit a proposal,” explained Kolodner, who is also a member of Stand Up To Cancer’s Scientific Advisory Committee. “There are not many opportunities to receive funding for cancer research where young scientists are freed from the requirement of having ‘proof of concept’ data in order receive grants, and certainly not such large grants.”
The grant selection process began in late 2008 with a call for Letters of Intent from young researchers in the early stages of their careers. The 45-member Innovative Research Grants Review Committee considered 412 eligible letters in an intense, multi-step evaluation process that began in May, 2009. Based on the initial review of each proposal by three committee members, the group was narrowed to 73 semi-finalists who were invited to submit full research proposals, which were then reviewed late this past summer. The list was narrowed again, to 19 finalists who made in-person presentations to the Grants Review Committee during an intensive two-day meeting in early October. From that group, the committee selected the 13 recipients. The committee evaluated the submissions using these criteria: potential for high-risk/high-reward; innovation in method or approach; potential for significant translation to clinical application; promise to improve and save the lives of cancer patients; and potential to develop into a Dream Team project. “The review process was unusually interactive; it’s very rare in cancer research funding for young investigators to present their proposals to a group of senior scientists in face-to-face meetings,” said Scientific Advisory Committee Member and Innovative Research Grants Review Committee Vice-Chairperson William G. Nelson, V., M.D., Ph.D., professor of oncology and director, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University. “The seasoned scientists on the committee provided direct feedback to the finalists on their projects, which the grant recipients can integrate as they begin to undertake their research.”
Grants are Living Legacy to Research Pioneer Judah Folkman
The Innovative Research Grants program was established in honor of the late Judah Folkman, M.D., to recognize him as one of the great innovators in cancer research, an outstanding teacher of young investigators and an early contributor to the SU2C project. Folkman’s pioneering work led to a new understanding of angiogenesis in cancer and the development of important new treatments based on his discoveries. “At our very first meeting, as we were just beginning to formulate the plans for Stand Up To Cancer, Dr. Folkman spoke passionately about the need to fund young investigators. They say that science always stands on the shoulders of the giants that come before, and we lost a true giant when Dr. Folkman died just six weeks later. It’s fitting to honor him by funding the next generation of potential research stars. Their work will be an important tribute to his legacy and his dream of defeating cancer,”" said Sherry Lansing, a SU2C founding member and board chair of the Entertainment Industry Foundation, the underlying 501(c)(3) charitable organization that serves as the initiative’s fiduciary.
Funded Projects Address Wide Range of Challenges
Margaret Foti, Ph.D, M.D. (h.c.), chief executive officer of the American Association for Cancer Research, said she was very excited by the scientific excellence and the scope of the research projects selected by the committee. “The Innovative Grant recipients are thinking broadly and creatively, with one end goal in mind: making scientific progress to save lives from cancer,” Foti noted. “We are at a very important juncture in cancer research; its pace is increasingly rapid, and that enhances the speed at which we can move new discoveries out of the lab and into the clinic. Support for the next generation of remarkable young scientists is critical to ensuring that we continue to accelerate that pace. The AACR is proud of its partnership with Stand Up To Cancer and the contribution this important initiative is making to advancing cancer research.”
Collaboration and Transparency in the SU2C Funding Model
Fostering increased collaboration among cancer researchers at different institutions is a key SU2C goal. Planning is underway for both formal and informal communication and meetings among all the SU2C-funded scientists to share ideas and progress. It is expected that these interactions between the Innovative Research Grant recipients and Dream Team members will lead to new synergies and potential collaborations. The AACR, through the SU2C Scientific Advisory Committee and Innovative Research Grants Review Committee will conduct regular reviews to ensure accountability and that objectives are being satisfactorily achieved. Stand Up To Cancer is committed to transparency in both the funding process, and the outcomes of the projects. Progress reports will be made available to the public at: www.su2c.org and www.aacr.org.
The SU2C Movement’s Online Community
SU2C’s robust online community (www.su2c.org) offers various ways for people to share opinions and support, view video updates, contribute, and learn of ongoing initiatives and progress in the fight against cancer. The scope of donation opportunities on the SU2C website ranges from naming a star in honor of a loved one to web team challenges that encourage collaborative fundraising efforts by groups of various sizes all over the country. The online community provides ample opportunity to share SU2C’s efforts via a variety of social media outlets, including Twitter, Facebook, AOL, MySpace, YouTube, flickr, and several other sites that are accessible through the SU2C website. SU2C is implementing ongoing grassroots efforts, and is participating in national and regional events to raise awareness and funds.
For additional information on Stand Up To Cancer, visit www.su2c.org About the Stand Up To Cancer Initiative
Stand Up To Cancer (SU2C) raises funds to hasten the pace of groundbreaking translational research that can get new therapies to patients quickly and save lives. In the fall of 2007, a group of women whose lives have all been affected by cancer in profound ways began working together to marshal the resources of the media and entertainment industries in the fight against this disease. The SU2C founding members include Laura Ziskin, executive producer of the Sept. 5, 2008 broadcast, who is a cancer survivor; Sherry Lansing, chairperson of the Entertainment Industry Foundation’s Board of Directors and founder of the Sherry Lansing Foundation; EIF President and CEO Lisa Paulsen; Katie Couric; Noreen Fraser, founder of the Noreen Fraser Foundation (NFF) and a cancer survivor; EIF Vice President Kathleen Lobb; Rusty Robertson and Sue Schwartz of the Robertson Schwartz Agency; and nonprofit executive Ellen Ziffren. SU2C was formally launched on May 27, 2008, and Diane Balma serves as its executive director.
The American Association for Cancer Research (AACR), which consists of over 30,000 scientists engaged in the fight against cancer, is the oldest and largest scientific organization in the world focusing on every aspect of high-quality, innovative cancer research from the bench to the bedside. Lauded internationally for its scientific breadth, innovation and spread of new knowledge about cancer, the AACR is on the front lines in the quest for the prevention and cure of cancer. The AACR holds meetings on critical cancer research topics around the world and publishes six major cancer research journals. As Stand Up To Cancer’s scientific partner, the AACR is responsible for administering the grants, and — in conjunction with the SU2C Scientific Advisory Committee, led by Nobel Laureate Phillip A. Sharp, Ph.D., Institute Professor at the Massachusetts Institute of Technology and David H. Koch Institute at MIT — providing scientific oversight.
About the Entertainment Industry Foundation
Stand Up To Cancer is a program of the Entertainment Industry Foundation (EIF), the 501(c)(3) not-for-profit organization that serves as the collective philanthropy for the television and film businesses. EIF has distributed hundreds of millions of dollars to support programs addressing critical health, education and social issues.
Wendell Potter is now writing at the Huffington Post and write very clearly here and I agree whole heartedly, it’s the formulas as he calls them, in other words the complicated algorithms that cut you off and deny care when you or your group no longer provides profit. In the text he makes one point very clear and this has been said many time on the web and on this blog to, but the words about sum it up better than I have heard. He knows, he spent years working with those formulas and algorithms at Cigna.
Claims that fall into categories that show any indication of “fraud” as programmed by the algorithms that can be changed, can be denied. One of the strangest parodies about all of this is that that the exact same companies who have used corrupted data bases that have resulted in court cases with more to come, are some of the same companies that are being awarded contracts to prevent fraud, like in the state of Washington, does this make sense to hire the ones who were fraudulent to prevent fraud? I don’t understand this process and in addition the state is also trying to figure out whether or not to rebid their contracts for insurance carriers too.
Last, Wendell Potter speaks about the provision proposed by Al Franken which of course are not popular with the insurance carriers.
Is the health insurance business tightly tied to Wall Street, you bet and Wall Street makes all their money too from those algorithms, ask any broker, investor, etc. and they can all tell you “about the algos” and depending on how they are calculated, it requires pulling funds from somewhere, usually the dollar amounts actually going to healthcare which has been a major battle in California as well with court cases filed.
There was a time, in the early 1990s, when health insurance companies devoted more than 95 cents out of every premium dollar to paying doctors and hospitals for taking care of their members. No more. Since President Bill Clinton's health reform plan died 15 years ago, the health insurance industry has come to be dominated by a handful of insurance companies that answer to Wall Street investors, and they have changed that basic math. Today, insurers only pay about 81 cents of each premium dollar on actual medical care. The rest is consumed by rising profits, grotesque executive salaries, huge administrative expenses, the cost of weeding out people with pre-existing conditions and claims review designed to wear out patients with denials and disapprovals of the care they need the most.
Sen. Al Franken (D-Minn.) is now leading a group including Sens. Jay Rockefeller (D-W. Va.) and Blanche Lincoln (D-Ark.) to introduce an amendment that would go further by requiring that 90 percent of the money consumers spend on health insurance premiums go directly to health care costs.
Wall Street investors expect insurers to pay as little as possible for medical claims. As a result, the nation's health insurance industry has evolved into a cartel of huge for-profit companies that together reap billions of dollars a year at the expense of their policyholders. The seven largest firms -- UnitedHealth Group, WellPoint, Aetna, Humana, CIGNA, Health Net, and Coventry Health Care -- enroll nearly one in three Americans in their health insurance plans. This year the industry will take about $25 billion in profits for getting between American patients and their doctors, according to the industry's trade group.
And they do this by finding every excuse in the book not to pay a claim, even if it means canceling individual policies when people get sick or ridding their rolls of unprofitable small business group policies if an employee or family member falls seriously ill. They issue confusing benefit statements to members so only highly motivated and persistent challengers of their denials stand a chance of reversing an unfair decision. And in the final analysis, when an insurance company has decided it no longer can make enough profit on a particular person or employer-sponsored group, it drives them away in a process known as "purging." In this unconscionable profit-protection maneuver, an insurer will hike premiums so high that the policyholder has no choice but to pay outlandish rates for what may be a reduced benefit package, find another insurer, or simply go without coverage. The consequences of such decisions can be deadly -- but Wall Street always has the last word when profits are the main consideration.
Instead of being a formula to reward investors, a properly regulated medical loss ratio in combination with other cost containment measures in the legislation would be a reliable tool for keeping insurance company profits and administrative waste in check.
This is a heart breaker and nice he was able to make his last wish before being blind come true. He had tumors behind his eyes and at a young age lost one eye and after fighting cancer many times with the other eye, the last effort failed and he had to have the surgery to remove the cancer which leaves him blind.
At least he will have memories and knows what the world looks like. When you listen to him, he’s one brave young man. He spends his night before surgery with the Trojans. One of the players came to see him before the surgery and said when he received the IV, he broke down and cried. Six days after his surgery he returns to visit the team and his is their inspiration this time. Watch the video and cry your eyes out, I did. Jake wrote a book and is writing aanother one in Braille to inspire and help other children who are dealing with cancer. BD
It's the heartwarming story of 12-year-old Jake Olson as he prepares for a surgery that will blind him permanently. His left eye had been removed years earlier, which was inflicted by retinoblastoma. With surgery looming on his right eye, he told his parents the last thing he wanted to see was a University of Southern California Trojan football game, according to a story on ESPN. Word spread to the ears of USC head coach, Pete Carroll, who brought Jake in for a practice and meeting with the players. Jake's involvement with the team grew to an inseparable bond -- his favorite player, center Kris O'Dowd, was at the hospital the day of the surgery -- and the two look to each other as inspiration to succeed.
Dr. Berci Mesko, from Science Roll, has take time to create a simple aggregated website to review and find pathology information by topic, search, etc. You can choose the topics you want to read and keep up to date with.
When researching or reading this stands to make getting your journal information a lot easier instead of having to do everything manually and going to each site. The mouse over brings up a summary of the posted article. BD
You can search in the database. It means you will find medical information only from a quality selected portion of the world wide web.
You can personalize any of the sections.
You can also receive the newest Pubmed articles focusing on your search term. Just insert your field of interest, a therapy, a condition, etc. and click Search. Then you can add the newly created box to your personalized medical “journal”.
PeRSSonalized Medicine is a free, easy-to-use aggregator of quality medical information that lets you select your favorite resources and read the latest news and articles about a medical specialty or a medical condition in one personalized place. Please let us know which quality resources should be added to the database.
So far I have pretty much just seen “fun” use marketed here but why not send out invitations with a “tag” and password protect them so only the Secret Service can access and scan with a simple cell phone when guests arrive? It makes sense to me and this way the officers of the Secret Service can operate independently too and not have to worry about one person missing something? It makes sense to me.
If the tag when scanned from the invitation doesn’t match, you don’t get in and the tag could be rescanned at any time again as well. Here’s a prior post I made on using the tags with healthcare and I have copied most of the prior post here. Gee you can even store the information on the tags on encrypted servers so guest information is secured. The set up is pretty cool also in the fact that it helps tally the guest count too! Perhaps the Secret Service could contact RazCode for some help, great technology in the works and it will soon help us use tags to easily update our personal health records. Below is an example of a statement with a “tag” and all that is needed is a cellphone with the software to scan and see the information displayed. Put this on the invitations! BD
Yesterday I posted about Windows Tags being a solution for medical devices, to inventory them and be able to scan a code or tag with a cell phone, as they connect to the web and any recall notices that go to where the tag is placed connects and shows on the screen. Also, the FDA could keep a copy of all the tags on reference in a data base, as a double check. You can read more at the link below.
This is the next step forward with using Windows Tags through RazCode to input information with your cell phone. Sean Nolan was kind enough to point me in their direction today. They provide a secure gateway so in order to use this service, you need a provider or perhaps an insurance company that is a subscriber to their service. One this has been established you could get copies of EOBs, images,
etc. that are tagged. Point the cell phone at the tag, enter your logon and password and get the document and upload to your PHR or EHR. How many times have you tried to describe to someone how to upload a document on a website, take the phone and shoot.
You can visit the site and set up a consumer account here. I was not able to link HealthVault yet but Google Health worked fine. Again, I have nothing yet to include but wanted to test the waters here. The real value comes in when you actually have data arriving from a RazCode client. The services uses CCR format. BD
For the general FDA suggestion for just tracking device information and displaying updated notices and/or recalls, the simple Windows Tag solution I think would work the best.
As a health care consumer, you want access to and control over your health information. Get started today by creating a free basic RAZCode account.
Your RAZCode account will allow you to easily and securely upload your health information to your choice of online personal health record whenever a participating health care provider or payer provides you with a RAZCode image or ID code. Typically RAZCodes are included on receipts, labels, account summaries, explanation of benefit statements, and other health related documents.
WASHINGTON -- The head of the Secret Service accepted full responsibility Thursday for last week's security breach at President Barack Obama's first state dinner, but he said that the president and Vice President Joe Biden were never in danger from a party-crashing couple who shook hands and posed for pictures with them.
Secret Service Director Mark Sullivan told the House Homeland Security Committee that his agents were at fault for allowing uninvited Washington socialites Tareq and Michaele Salahi into a lavish state dinner for Indian Prime Minister Manmohan Singh.
Sullivan told the committee that three uniformed agents had been put on administrative leave in the wake of the incident.
Maybe Moore’s law lives on. This is pretty fascinating technology and the speed that it will create. Granted when this is released this is going to the server market first you can bet on that. I remember back when memory disambiguation was the hottest item out there with advancing the ability to determine memory versus execution order. Ok enough technical talk here, in layman’s terms this is really fast and we will probably need some accelerated video cards to keep up. With 48 cores you are getting a lot of cache (memory on the chip) for sure, so the power of what is held in cache here is like that of a cloud. Power management is important as well as the resources not being used for current calculations wait in reserve. With all the multi mass sequencing and genomic research we are doing today, this can really cut down the compiling and processing times.
A little off topic, but could you imagine a gaming computer with all this power, I’m sure the gamers are drooling all over this one. BD
Intel Labs has created an experimental Single-chip Cloud Computer, (SCC) a research microprocessor containing the most Intel Architecture cores ever integrated on a silicon CPU chip 48 cores. It incorporates technologies intended to scale multi-core processors to 100 cores and beyond, such as an on-chip network, advanced power management technologies and support for message-passing.
Hospitals and clinics are connecting in Hawaii. Pacific Health consists of 4 hospitals and several clinics. Patients will now be able to log on and have their own PHR with lab results, get refills and communicate via email with their physicians. If you look at the image, the log on shows MyChart from Epic on the screen. Epic is the same system used by many large hospitals on the mainland to include Cedar Sinai and Kaiser Permanente.
With the doctors at the clinics being connected patients will have the ability to interact and better participate in their own healthcare. A short while back I spoke with Dr. Leo from Long Beach Memorial Hospital who also uses Epic and they were able to accomplish the same/similar arrangement with Talbert Medical Offices. BD
Hawai'i Pacific Health today announced the launch of MyHealthAdvantage, a free online, 24/7 health connection that will allow patients at Straub Clinic & Hospital and Kaua'i Medical Clinic to access and manage their medical records and communicate with their doctors online.
MyHealthAdvantage offers a completely secure online connection that is fully compliant with federal and state privacy laws and provides an easy-to-use, 24/7 connection that allows patients to:
Schedule medical appointments
View test results
Request prescription refills
View health summaries from the MyHealthAdvantage electronic health record
Access trusted health information resources
Communicate electronically and securely with their primary care physicians
Hawai'i Pacific Health is a nonprofit healthcare system and the state's largest healthcare provider, committed to providing the highest quality medical care and service to the people of Hawai'i and the Pacific Region through its 4 affiliated hospitals, 44 outpatient clinics and 2,263 physicians and clinicians. The network is anchored by its four nonprofit hospitals that share strength and resources: Kapi'olani Medical Center for Women & Children, Kapi'olani Medical Center at Pali Momi, Straub Clinic & Hospital and Wilcox Memorial Hospital. The hospitals of Hawai'i Pacific Health collectively lead the state in the areas of women's health, cancer care, pediatric care, cardiovascular services, and bone and joint services. Hawai'i Pacific Health hospitals are among the top 3.8 percent of hospitals nationwide in electronic medical record adoption. Its EMR implementation allows its hospitals to offer integrated, coordinated care statewide. Learn more at: http://www.hawaiipacifichealth.org.
We talk a lot today about hospital and healthcare devices and marketing. PBS ran a series going back in time about the birth of the incubator for babies. When you look at some of the links here, of course a marketing practice like this would not stand today, but babies were taken from their parents who needed care and were put in incubators, and were on display at the World’s Fair, in other words the babies were getting care, but also were participants in a side show of sorts.
Recently there was a reunion of many of the patients who were in these incubators and they were given a silver cup. Dr. Couney was the brain child behind the marketing and creation of the program and you can read more here. People paid admission to come and see the “babies” in the incubators. After the various shows were over, the babies were returned to their parents when they reached what was considered normal weight ranges. His first show was set up on Coney Island in New York. There were some well known babies in some of the exhibits, such as the daughter of James Keeley, the renowned editor of the Chicago Tribune so this was not just a show for orphans or such.
The Coney Island show attendance dwindled when a New York hospital opened their own premature infant station. In 1939 babies were shown at the World’s Fair in New York For more than 30 years Dr. Courney focused on “baby incubator” shows and the final was the World’s Fair in Chicago.
PBS did an excellent video on the entire history and you can view the video at the link below:
When you watch the video a reporter tracks back some of the history. When you listen to the woman describe what happened to her, she was taken by the Chicago Board of Health to be exhibited at the World’s Fair in Chicago as she was under weight. She was a preemie and put in a shoebox by the oven to keep warm. The Chicago World’s Fair was almost cancelled as it occurred during the Depression with unemployment at record marks.
The Baby exhibit was not in the technology area, but in the midway, the side show area of the fair and was run like a side show and had an exotic dancer booth right next to where the babies were. The dancer was arrested 4 times during the show but the attention continued to bring viewers and once the show was over, well the baby exhibit was right next door. When you listen to the critics who tried to shut the show down, it appears he had monetary backing as well as physicians to keep the show rolling, any paradigms maybe to how we function today?
In the video the reporter also talks to a current day doctor and shows the incubators of today and discusses “shaky medical ethics”. The shows did give local doctors access to see the incubators in the smaller cities. He said Dr. Couney did not charge parents, it was being part of the show as the cost to the families was to be on display. Each parent received a silver cup with the name of their baby inscribed. The babies lives were saved no doubt and are here today to talk about it, again, the marketing and how this all came about was the ethical question. Four years after the incubator area of Cornell in New York was opened, Dr. Couney closed his exhibitions.
Again, I found this extremely interesting and again it shows somewhat of the same issues we work with today with ethics in healthcare and how to advertise for pharmaceutical companies, hospitals, doctors, and so on.
Some things in healthcare appear to still have the same and similar issues, how do we get the technology out there and respect the “human” and “private” side of healthcare and our battle today is still with devices, except ones that are a lot smarter and require a bit more of our time with participation, along with laws and regulations that help protect our privacy. BD
"For the 1939-1940 New York World's Fair, Couney planned a major exhibit. The quarters were designed by Skidmore and Owings, architects for eight of the largest exhibits at the fair. A U-shaped structure was erected at considerable expense (the cost exceeded the original estimate because of trouble with pilings at the site -- a huge ash heap, known as the 'Corona dump,' in a tidal marsh near Flushing). There was a suite for Madame Recht and for Hildegarde, rooms for others on the staff -- including 15 trained nurses (Fig. 15), 5 wet nurses and their own nursing infants, as well as a cook and a chauffeur -- and a sumptuous apartment for the incubator-doctor himself (e.g., bedroom, living room, bath and a private garden).
Each set of parents was presented with a silver cup inscribed with the name of their baby, and a certificate signed by Couney and by Grover Whelan, the president of the fair; it declared that the baby gained a start on life at the incubator station. The 'vital statistics' of the two-year show were published in the Medical News columns of the Journal of the American Medical Association on Nov. 9, 1940....
The following article appeared in the New York Times on August 8, 1904:
Excursions Make Crowd A Record Breaker -- The Tiniest Baby
Coney Island entertained within its borders yesterday more strangers, that is, more people from beyond the confines of New York than on any day this year, and it is likely that the crowd has never been greater on any day in the resort's history. A number of excursions were run to the Island yesterday from points in Pennsylvania, New Jersey, Maryland, Washington and other points, and more than half a million people viewed the wonders of the rejuvenated resort.
The beach was thronged during the day, and nearly all the big bath houses were forced to close up early in the day, as all their suits had been hired out and the rooms taken.
Dr. Couney's incubators at Dreamland have now the smallest baby which has ever been received in any like institution and it is claimed that no record of a child of its size having lived over a few hours, exists. Dr. C. S. Patterson, brought the little fellow from Brooklyn yesterday. He was swathed in cotton and weight just 1 pound and 6 ounces, being 11 1/2 inches tall. It is too small to be put into the incubators and is being fed by hand. Frequent inhalations of oxygen are necessary to keep its little heart beating. Dr. Couney said yesterday that it had a very good fighting chance for its life.
This is fiction but it makes you wonder where’s the next plateau on healthcare to cut costs? Actually you can read below about a novel written that explores this. You may have read about ships though that are portable hospitals and they do exist, as used in New Orleans for temporary relief a few years ago. The novel as I understand takes this idea to the next platform with parking cruise ships to provide surgical services at a discount with being parked in international waters.
Could you imagine taking a helicopter to a cruise line luxury ship and get your hip or knee done, or take your chemotherapy treatments or imagine being a clinical working on a ship? The novel talks about this being a solution to dealing with all the greed, long waits, law suits, etc. that are experienced in healthcare today. BD
Later this month, you could be misled into thinking that the Salvare is a real cruise ship offering medical tourism. The advertising with images and even a video looks authentic, but it is only fiction.
“Universal Coverage”, a novel by Daniel Putowski, comes out on December 15th and is based on the premise that the US healthcare system has succumbed to fraud, greed, long waits, and uncertain outcomes. In the book, Bob Smith believes that the only affordable solution to save his dying son is a medical tourism cruise on the Salvare. As it is in international waters, the Salvare falls outside any national or international regulation or licensing of health care providers. It is an unlicensed hospital ship providing treatment to anyone with money. The Salvare cruises off New Jersey. It is a 120,000-ton ocean liner with private staterooms for every patient, chef prepared meals and nightly entertainment. Fully staffed by doctors and nurses, although with dubious medical credentials, it is a fully functioning hospital and recovery centre, even offering open-heart surgery and chemotherapy
information. A while back I interviewed Chris McCarthy with their innovation division and you can read more about it at the link below to get an idea of what they are in to and where they are going. BD
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