Hospital in Stoughton Massachusetts Puts Hospital Admissions on Hold – 21 Days Until Corrections are Made

New England Sinai Hospital has closed it’s doors to new patients at the suggestion of the state inspectors.  Overall patients stated the hospital offered good care and service.  The one man interviewed stated that he thought the staff was stretched too thin, and he may just have a very good point as we read about more hospital layoffs quite frequently in the news and over 50% of the hospitals operate in the red today. 

By closing for 21 days it will allow the hospital to do the training and other matters needed.  This could happen anywhere in any city but since it is a chronic care facility they couldn’t answer whether or not chronic care patients who have to be re-admitted could return.   BD

 

(NECN: Scot Yount, Stoughton, Mass.) - Massachusetts state health inspectors have been on site at New England Sinai Hospital for seven days and found a number of specific concerns that have led the 83 year old institution to stop admitting new patients.
Inspectors identified concerns about skin and wound care, documentation and patient safety.
State officials suggested the 212 bed hospital close its doors to new patients and the hospital agreed after some patients were improperly restrained or had wounds not properly cared for.  One man nearly lost his foot after an improperly placed iv interrupted blood flow.

Concerns prompt hospital to stop taking new admissions

Technorati Tags: hospital, Sinai, New England Sinai Hospital, inspections, wound care, safety, healthcare, Stoughton

Read More

Health Insurance Company Ran an “HIV” Algorithm To Cancel Consumer’s Policy –An Automatic Fraud Investigation Revealing “False Positives” Or “Unhealthy Patients”

Earlier this week I participated on a blog talk radio show discussing this exact matter and interesting that this case makes the news this week.  As I keep saying it’s all about the algorithms.  If you don’t come to admit they exist and determine coverage and treatment, you’re missing the boat and the real mechanics of how all this takes place with health insurance.   If you have an hour, you can listen to the archive.  This is exactly what I talked about “false positives” being generated with the use of computer “algorithms”.   They are “looking for fraud” supposedly, but where do you draw the line when in the course of such action one discovers other consumers they could shut off in order to avoid paying expensive claims?  It happens all the time.  

Payors Algorithms other Dubious Deals with the MedicalQuack - Blog Talk Radio 3-16-2010

Payment and compensation all revolved around the numbers and there’s a lot of gray in some of these areas too as we don’t have sufficient laws to cover a lot of this since we are fighting the battle with swords and the health insurers for the most part with their high investments with technology and business intelligence systems have machine guns. 

Health Fraud Scores Could Be a Contributing Factor to Medical Claims Being Denied

When you read further in here the CEO justified the rescission process being necessary to hold down the cost of premiums, wait a minute, hold down, we don’t see that today.  This testimony was just done by the CEO of the health insurance company in June of 2009.  He also went on to say that those who had been cut off had omitted information and/or were not truthful with what was provided and those “bad” patients who needed care were at fault.  Nice guy, right?

Little Progress on Fighting Healthcare Fraud – Look At Who’s Getting the Anti-Fraud Contracts

By the way, this patient in 2001 was 17 years old and did what he was supposed to do, went out and bought insurance, the big market today that insurers are looking for with our youth finding it not something they want to spend money on.  On top of all of this, the insurance company audit trail showed records of deleted phone calls and other pertinent items.  So basically, once it showed he had HIV, it’s was a “fraud” case investigation.  I didn’t know that contracting HIV was fraud and see it as a huge misfortune and an individual who needs care.  

Would Someone Explain Data Aggregation and “High Frequency Healthcare” to the US Congress

What is also strange in this entire story too is that the CEO testified that Congress should pass a law that would prevent this type of rescission activity.  With this one comment alone, I say another useless CEO that wants to just take home a big fat paycheck.  I guess they need laws and lack human morals here to make the right decisions it appears.  This just goes to show how powerful those decision making “algorithms” really are – nobody will go against what is shown on the screen when presented.  To this I say we need a Department of Algorithms so we know up front how they are going to analyze all of this, we do it for electronic medical records to make sure they function properly.

“Department of Algorithms – Do We Need One of These to Regulate Upcoming Laws?

Here’s a case of fraud “algorithms” in San Diego which I understand is still tied up in court and it pitting patients against doctors, and vice versa. 

Skins game With Dermatology Offices in California – All Insurance Carriers Quit Paying For Treatment Within a 5 Day Period

It’s no wonder that Virginia and Idaho are revolting about forcing citizens to have health insurance from companies who do business like this, and they all do it.  California and Blue Cross was all over the news not too long ago in regards to rescission. 

Virginia The First State to Pass Legislation to Protect Citizens From Being Forced to Purchase Health Insurance – If the Insurance Companies Were Non Profit It Might Make A World of Difference

When you go back to re-enroll, which is what happened to me, I had to prove that I had not seen a doctor for 6 months and pay a 25% premium, now is that the preventive healthcare they talk about – NOT.  The movie “Sicko” brought all of this to our attention, but needs a sequel on how to “fight the algorithms” and get consumers some new items to do battle with besides the swords. 

Are We Ever Going to Get Some Algorithm Centric Laws Passed for Healthcare!

Here’s what can happen with the MIB records below.  One may never get items correct either that prevent individuals from securing health insurance. 

Remember all those old 10-20 claim files are around and available to insurance companies through sites like the MIB (medical insurance bureau) and if they can use that information to rescind, they probably will.  On the other hand we have this big gaping hole with Medicare that all the crooks dip into so the infrastructure and enforcement efforts definitely need to be equal and and improved.  The post below adds some information on how to fight denied claims and coverage. 

How to Fight Algorithmically “Scored” Health Care Claim Denials – Line Up and Deliver Your Own Data

After we get through with all of this on the other side of the coin we have hospitals telling doctors they are not meeting quotas, in other words there are not enough people being admitted so they can meet their costs.  Here’s a video on what happened in Texas with a contracted ER group of doctors.

In short, this is the mechanics of how the system operates today.  If you take time to check out the links there’s even more information revealed here.  I’m trying to just put this out in plain English with facts all brought together here on what really goes on behind the scenes and how you are viewed in the eyes of the algorithms that do the computations that are read by humans for profitable decision making processes, not necessarily better care and these are the current rules that patients, doctors and hospitals have been dealt.  

This is truly a sad legal story here, but it is the truth on how greed corrupts healthcare and if you become ill, it is viewed as all “your” fault.  BD 

(Reuters) - In May, 2002, Jerome Mitchell, a 17-year old college freshman from rural South Carolina, learned he had contracted HIV. The news, of course, was devastating, but Mitchell believed that he had one thing going for him: On his own initiative, in anticipation of his first year in college, he had purchased his own health insurance.

Shortly after his diagnosis, however, his insurance company, Fortis, revoked his policy. Mitchell was told that without further treatment his HIV would become full-blown AIDS within a year or two and he would most likely die within two years after that.

So he hired an attorney -- not because he wanted to sue anyone; on the contrary, the shy African-American teenager expected his insurance was canceled by mistake and would be reinstated once he set the company straight.

But Fortis, now known as Assurant Health, ignored his attorney's letters, as they had earlier inquiries from a case worker at a local clinic who was helping him. So Mitchell sued.

In 2004, a jury in Florence County, South Carolina, ordered Assurant Health, part of Assurant Inc, to pay Mitchell $15 million for wrongly revoking his heath insurance policy.

Previously undisclosed records from Mitchell's case reveal that Fortis had a company policy of targeting policyholders with HIV. A computer program and algorithm targeted every policyholder recently diagnosed with HIV for an automatic fraud investigation, as the company searched for any pretext to revoke their policy. As was the case with Mitchell, their insurance policies often were canceled on erroneous information, the flimsiest of evidence, or for no good reason at all, according to the court documents and interviews with state and federal investigators.

Much of the trial record of the Mitchell case is bound by a confidentiality order and not available to the public. But two orders written by the presiding judge, Michael G. Nettles, a state circuit judge for the 12th Judicial District of South Carolina, of Florence County, describe the case in detail. Judge Nettles wrote the orders in response to motions by Assurant that the jury's verdict be set aside or reduced.

In the motions, Nettles not only strongly denied Fortis' claims but condemned the corporation's conduct.

"There was evidence that Fortis' general counsel insisted years ago that members of the rescission committee not record the identity of the persons present and involved in the process of making a decision to rescind a Fortis health insurance policy," Nettles wrote.

Elsewhere in his order, Nettles noted that there were no "minutes of actions, votes, or any business conducted during the rescission committee's meeting."

"In addition to these acts toward (Mitchell) there was evidence that Fortis has for some time been making recommendations for rescission, and acting on those recommendations, without good-faith investigation conducted fairly and objectively ... Fortis pre-programmed its computer to recognize the billing codes for expensive health conditions, which triggers an automatic fraud investigation by its "Cost Containment" division whenever such a code is recognized."

Insurer targeted HIV patients to drop coverage | Reuters

Related Reading:

Are We Ever Going to Get Some Algorithm Centric Laws Passed for Healthcare!

AARP Is Just Caught in the Middle of the Debate – Its the Algorithms That Call the Shots, Not Memberships in Senior Organizations

Brave New Films – “United Wealth Care” – It’s In the Algorithms

How Wall Street Lied to Its Computers – Software and Programming

Health Care Insurers Suggest Algorithms and Business Intelligence solutions to provide health insurance solution

Is This a Case for a New Law – Illegal Algorithms? How Do You Sleep at Night Rockefeller asked the CEO of United Health Care

Somebody Stole Goldman’s Algorithms – Code that Makes Their Money Just Like Health Insurers Use

Goldman Sachs – Healthcare Reform Bets, Hedges, and Analysis, Not About Healthcare But All About Money

Traders Profit With High Speed Computers and Servers…Health Insurers Use Them Too

Technorati Tags: Fortis, health insurance, insurance reform, algorithms, fraud, consumer, HIV, legal case, business intelligence, Judge, recission, healthcare reform, Sicko, Assurant

Read More

Mapping ICD Codes to SNOMED A Daunting Project – Men Who Smoked While Pregnant

All medical offices and hospitals are familiar with the current ICD 9 Codes used for diagnosing patient conditions and illnesses and hopefully some standards for mapping the coding over to SNOMED will improve and come along, it is work in progress.  2015 is the target year for all healthcare providers to be using SNOMED codes with patient records.  This means a lot of changes in many areas and outside of just the EHR too. 

The University of Pittsburgh is finding out how complicated this is becoming.  SNOMED is international, so it fits with having the same diagnosis all over the world.  This is somewhat amusing when looking at how some of the data they worked with from 3 different EHR systems worked, men that smoked while pregnant, so we all know this is an error. 

As mentioned below, we have the new ICD-10 Codes coming that need to be mapped too, so this is one more growing area of HIE that needs to integrate to ensure accuracy and in the long run, getting paid.  SNOMED codes are far more specific and numerous as well.  BD 

If you think getting standard medical terminology hardwired into EHR systems is simple, just ask the hundreds of Pennsylvania men whose patient records indicated they smoked while pregnant.

Those patients, served by the University of Pittsburgh Medical Center (UPMC), got caught in a quandary of words because of the vagaries of insurance coding and the different vocabularies used in five separate EHR installations (three from Cerner Corp., one from Allscripts-Misys Healthcare Solutions Inc. and one from Epic Systems Corp.).

The health system is on the vanguard of a national movement, because adoption of SNOMED CT is required of all health care providers by 2015 in order to qualify for meaningful use certification. Currently, most providers use the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), which providers will retire in favor of the next revision, ICD-10-CM, in October 2013.

Fixing the coding for the male patients smoking while pregnant was one of the many problems Hogan and Konicek addressed during the mapping process. They shared their experiences in a presentation on SNOMED CT implementation at the HIMSS10 annual conference earlier this month.

So how are they going to get the lists mapped to ICD-10-CM via SNOMED CT terminology? Watch the National Library of Medicine and the American Health Information Management Association, which are working on mapping projects. Also, some benevolent private health care systems may step up to the plate and share their maps, too.

SNOMED CT will be coming to EHR systems and patient records near you

Technorati Tags: SNOMED, HIE, heatlhcare, EHR, EMR, aggregation, mapping, data, medical records, documentation, University of Pittsburgh

Read More

Medicare Fraud – Criminals Do a Better Job With Filing Claims And Coding Than Providers

We hear a lot about Medicare fraud and how much is fraudulently billed.  I talk a lot about technology being an answer but in this case where the criminals are outdoing the doctors and hospitals in coding and doing a better job with filling out forms, the Medicare slot machine is paying off pretty big.

In the video below the individuals purchased a pharmacy operation that already had a Medicare license and went to work, billing, billing and more billing.  If we could take the criminals that code for fraud and turn these folks into legitimate employees we might have something here.  All claims are processed electronically so the ones who get the data filled in properly and the right boxes checked, get the payout, legally or illegally.

For 2 months, they had “midnight” billing going on.  If you do your paperwork correctly, you get paid.  Meanwhile back at the ranch, hospitals and doctors struggle to keep up, but unlike the criminals they are taking care of patients, the criminals do not and are only billing so thus they focus on billing to get the pay out.  Click on the image below to watch the Nightline story. 

 

The video also points out how frustrating it can be to get Medicare to investigate as well.   In addition, 60 Minutes had a video talking to an individual who actually did all of this. 

Medicare Paid More than 47 Billion in Questionable Claims

Criminals last year also found a way to use the NPI numbers of “dead doctors” to generate revenue.  Again, this type of fraud should be monitored and checked out and as you can see by the example here, it takes more than technology sometimes to find fraud as filling out the forms and checking the right boxes can be done by criminals very well when nobody is home watching the shop. 

Probe finds dead doctors used in Medicare Scam

What it interesting is watching the FBI policing agents to visit an actual pharmacy that had not filled a prescription at all, they just billed. 

In the example in the video, a quick million was billed in 2 months.  The people covered by Medicare have no clue either.  For $45,000 the existing business was purchased by the criminals along with the existing patient files and data bases. 

A four month "Nightline" investigation into Medicare fraud makes one thing perfectly clear: this is a crime that pays and pays and pays. The federal government admits that a staggering $60 billion is stolen from tax payers through Medicare scams every year. Some experts believe the number is more than twice that.

It looks to be what the agents say is a typical scam: a fraudster buys a pharmacy along with its Medicare license and entire patient database. This one was sold five months ago for just $45,000.

The scheme is relatively low-risk and requires little investment. Investigators allege that one person at a computer terminal could have submitted the million dollars worth of claims this pharmacy sent to Medicare in two months, before shuttering the place and disappearing.

Ogrosky said criminals' forms are often filled out more completely than actual health care providers'.  "Real hospitals and doctors who are struggling every day to keep up with the paperwork sometimes miss things ...whereas if you are a criminal trying to steal, all the forms look perfect every time because the whole goal of the enterprise is to check the right boxes," he said.

Judge Marshall Ader, who sat on the Florida state bench for decades, said he even had trouble getting Medicare to pay attention. When he saw that Medicare was being billed for two prosthetic legs using his Medicare number -- for the record he has both of his legs -- he hit the roof.

According to Piper, Medicare was billed three times a week at this clinic and paid out $10,000 per claim -- more than $30,000 a week for a service that was never provided.

Medicare Fraud Costs Taxpayers More Than $60 Billion Each Year - ABC News

Technorati Tags: Medicare fraud, healthcare, healthcare reform, seniors, coding, billing, Nightline, 60 Minutes

Read More

Non-Profit Hospitals Can Be Taxed if They are Not Providing Enough Charity Care to At Least Meet the Tax Benefit Given

This decision was made by the Illinois Supreme Court that yes the hospital system can pay taxes if they are not giving enough charity care.  Where does running a business and charity care cross the line? 

We need charity care, but then those complain that they don’t make any money with charity care?  Charity care is supposed to be just that – charity with no profits, thus institutions get a “non profit” status.  I can’t begin to count the number of articles I have read with healthcare organizations citing that charity care is their demise in the money game; however, that game is getting bigger all the time with insurers walking from both hospitals and patients.  It’s no wonder that 2 states, Idaho and Virginia have passed laws not to force citizens to have to pay for insurance, more like Forest Gump insurance and his box of chocolates in the fact that “you just don’t know what you are going to get”. 

Back on track here, 8.8 million is owed in taxes the courts say.  The question I wonder about is whether or not the healthcare company is operating in the red as I did see some layoffs posted, and if that is the case, what are we doing?  BD 

An Illinois Catholic medical center isn't a charitable enterprise and must pay property taxes, the state's highest court ruled Thursday in a case that has been closely watched by hospitals nationwide.

The Illinois Supreme Court ruled 3-2 that the state was correct when it decided in 2002 that the charity care provided by Provena Covenant Medical Center in Urbana was too paltry to permit the nonprofit to qualify for a tax exemption. The court also ruled that the hospital, run by three Catholic religious orders, didn't qualify for a religious exemption.

"Provena Hospitals,'' the justices wrote, "failed to show by clear and convincing evidence that it … dispensed charity to all who needed it and applied for [it]."

Illinois High Court: Nonprofit Hospital Can Be Taxed - WSJ.com

Technorati Tags: hosptials, non profit, healthcare, healthcare reform, taxes, Tax benefit, charity, Provena

Read More

Health Insurer and Hospital Disputes on the Rise – 50% of the Hospitals in the US Are in the Red – This Might Have Something To Do With The Root Of the Problem

The second part of this title might have a lot to do with what is happening with hospitals playing hardball at times and walking away from insurance carriers.  When you stop and look at how the business has operated over the years it’s somewhat hard to say the insurers have really been what one would call a “partner”.  Patients, doctors and hospitals have had to live under the auspices of the “algorithms” run to determine who and what gets paid.  We need a Department of Algorithms so this can be accurately projected.  We have never had that option, but rather a world of not knowing or being able to project costs within a few dollars.  Granted there are those times when you can’t project with emergencies, etc. at all too.

Before the crash of Wall Street, did you really see insurers as a working partner?  They did contribute but there was always a hook whereby their ideas lead to greater profits and dividend payments.  It was always a matter of throwing some money at a problem and hoping it would perhaps correct itself.  Things have changed in the last couple years though with even tighter algorithms “scoring” claims and carriers working their way into “behavioral underwriting”. 

It appears that paying dividends and giving good efficient healthcare can’t reside on the same street anymore and are really not good neighbors either.  This year when we had extreme downtimes with jobs and the economy, record profits were made by the insurers.  We never get to really see how they operate and function and over the years there was no real solid partnership of both side working together.  This is why everyone looks at them as the bad guys today, they ran the formulas and made money hand over fist for years. 

It’s time for a minimal move to have insurers join the ranks of non profits as this is only going to get worse as we see insurers and hospitals parting ways when terms can’t come to match.  Perhaps they could all be competing big HMOs operating from a non profit status.  There’s a lot of money wasted on healthcare and the payment side is full of transactional fees that fill up the profit pots.  If we started investing in people as humans and not as dollar signs we could possibly stand to see some of the current conditions start to remedy some of the bad air. 

Arizona Becomes the First State to Drop Children’s Health Insurance Program and Roll Back Medicaid Coverage for Adults – 310,000 People To Be Dropped

We now have 2 states that feel their residents should not be forced to buy this type of “questionable” coverage and from what I have read, there’s more on the way.  To put it blankly, we don’t like the business models of the companies doing the reimbursing and they waited until times were tough to try to begin working as true partners and now it’s basically just too late. 

In some hospitals, doctors are being told “they are not meeting their quotas”.  In short, this translates down to the bottom line of how much revenue needs to come in to cover the costs a hospital has.  This get distorted all over the place so when business folks analyze to figure out where more money can come from - admit more patients, and thus doctors are presented  with being told they are not meeting admission quotas. 

I also look at the other side of research and development and read every day where millions and billions are tossed around by VCs and other investing companies and wonder how in the world are patients, doctors and hospitals going to be able to afford some of the new drugs and treatment plans that are coming out to save lives?  There’s definitely room on that side of the table for some give and take as well. 

In short, we all have to be partners, participate and show more effort than what we see today, it takes more than just throwing money around to create real solutions.  If you look around, you see premiums going up, more falling out of being able to afford health insurance, Medicaid eligibility getting stiffer, and what have we accomplished – more non or under insured citizens and no where close to any real reform.  BD 

Health insurers are fighting demands by hospitals for sharply higher reimbursement rates by threatening to drop the hospitals from their health-plan networks, and blaming them for higher insurance premiums.

"We've never seen the kind of increases we're seeing right now" from hospitals, says Aetna Inc. President Mark Bertolini. Five years ago, a typical rate increase was about 5%, but this year Aetna granted 50 "must have" rate increases of more than 20%, Mr. Bertolini says.

Hospitals argue that low Medicare rates and cuts to Medicaid mean that hospitals have to get money from elsewhere, and increasingly that is private insurers. Rising ranks of uninsured Americans have led to more uncompensated care and have swelled the rolls of Medicaid, exacerbating the problem.

Health Insurers, Hospitals Clash Over Reimbursement - WSJ.com

Technorati Tags: health insurance, hospitals, busines models, healthcare reform, reimbursements, money, rate increases

Read More

Esteem Implanted Hearing Aid From Envoy Gets Approval from the FDA – 1st Device of It’s Kind

This is very nice, no more having the “hearing aide” visible and it is implemented behind the ear.  The clinical trial was conducted with 61 individuals, which by clinical trials numbers is small, but the results seem to speak for themselves.  You can visit the website and listen to several videos from people who have the implant and how it works for them.  There’s even Bill, a pharmaceutical sales representative who has one.  Bill says it was difficult to make sure he heard the orders properly so we don’t want areas of such to be missed when making your sales calls. 

He talked about being able to go into the water now without having to worry about removing his hearing aide.  Bill the pharma rep said he thinks his hearing problems put him out of touch with being able to advance within his company.  He should be seeing higher sales now I guess:)

The battery is slated to run for 9 years so at some point in time there’s a visit back to the doctor for a battery change, or by that time perhaps a new type of advanced device may be available too, and I think that last statement is the reality of what we are seeing in device research and development today.  The device is for those who are impacted severely or moderately with hearing loss.  BD 

The advanced implanted hearing system is the revealed to be the first completely implanted system which has grabbed an approval by the U. S. Food and Drug Administration for adults suffering from moderate-to-severe sensorineural hearing loss, a permanent lack of hearing.

The system make use of sensors, processors, and drivers to convert vibrations in the eardrum and middle ear bones into electrical signals that are finally amplified and filtered to compensate for the losses in the sounds and speech signals.

The FDA approval is initiated based on a multicenter clinical trial involving 61 patients comparing Esteem to pre-implant hearing aids, revealing that nearly 56% of them scored better with the new device, with a net 93% scoring beating, in line with the initial scores on the test.

FDA Approves First Totally Implanted Hearing Aid | TopNews United States

Technorati Tags: FDA, Esteem, hearing aid, implant, processors, medical devices, clinical trials, battery

Read More

Arizona Becomes the First State to Drop Children’s Health Insurance Program and Roll Back Medicaid Coverage for Adults – 310,000 People To Be Dropped

This is pretty scary and when you look at the fact that the town can still fund pro football and high salaries there.  The state has already been selling State Buildings to help bring in additional revenue.  In my very early years I worked for the State of Arizona for around 6 years and this is sad to see.  That building in the picture is where I worked and I still the window where my office was. 

Arizona May Sell Government Buildings Including the State House, Senate, and a Hospital

Speaking of football,  the Cardinals taking over the concessions at the stadium as Arizona Sports and Tourism Authority is strapped for cash and are relying on the team to help bring more events to the stadium which has also hosted a Super Bowl in the past.

As mentioned here, Federal funds are at stake for a loss as well if states are required to maintain eligibility levels for both programs, and part of that problem goes back to an infrastructure that needs to be modernized and updated to be able to report.  In that area, Arizona is not alone. 

I think healthcare reform creates a substantial answer beyond the “cookie” cutting we have been experiencing for the last number of years as this is not going to work.   There are still a number of private industries “cutting a fat hog” in healthcare out there and everyone is in this together with making less and doing more.  This is John McCain’s state here that is allowing the children to be cut and left out.  BD   

Arizona on Thursday became the first state to eliminate its Children’s Health Insurance Program when Gov. Jan Brewer signed an austere budget that will leave nearly 47,000 low-income children without coverage.

The Arizona budget is a vivid reflection of how the fiscal crisis afflicting state governments is cutting deeply into health care. The state also will roll back Medicaid coverage for childless adults in a move that is expected to eventually drop 310,000 people from the rolls.

The cuts also mean the state will forgo hundreds of millions of dollars in federal matching aid, and could lose far more if Congress passes a health bill that requires states to maintain eligibility levels for the two programs.

Three states, including Arizona, had in the last year capped enrollment in the Children’s Health Insurance Program, financed jointly by states and the federal government. But two of those states — California and Tennessee — quickly removed their caps, said Jocelyn Guyer, co-executive director of the Center for Children and Families at Georgetown University.

Arizona Drops Children’s Health Program - NYTimes.com

Technorati Tags: Arizona, healthcare reform, health insurance, Medicaid, budget deficits, federal funds, elegibility, children's health insurance

Read More

New York City Small Business Owners Blasted with Hikes With Insurance Premiums – Some States Creating Laws to Make It Illegal to Require Residents to Buy Health Insurance from Companies Sold on the Market

Healthcare is on everyone’s mind this week to see what we end up coming up with out of the “blender”.  That is just about what we have left to see what the outcome will be.  In New York, it is the same story that is happening everywhere else.  Pennsylvania was also in the news this week with big premium increases.  It appears we do not have a large enough data base of individuals to spread the cost over, as that’s what insurance is all about, or should be about. 

Also in the news this week we had Representatives now wanting to introduce legislation regarding the HITECH act.  What does Congress know about this as most don’t participate.  We don’t hear anything about how they manage their healthcare and for that matter Mr. Blumenthal is pretty tight lipped too. 

This year is going to go down in history for as one of the most territorial battles to create laws from a bunch of non participants that live in tech denial.  In other words without participating and understanding how things work with technology today, we get a bunch of either educated or uneducated guesses and as citizens with non participants making laws, we get very little and the frustration and demonstrations will continue. 

ONC sits there and tells us as well as Congress “what is good for us” but the heck do they know when it comes down to a personal level and how it will affect the average citizen.  They have no clue and keep creating blogs for suggestions.  Unfortunately most of these blogs don’t offer to share any insight, in other words some “give” from the other side, they are just there to take for the most part and perhaps someone might pull out the pig in the poke. 

They all forget we have smart devices emerging here too with behavioral underwriting going on with insurers too.  Tech denial at it’s best and God forbid they start acknowledging the “algorithms” that provide all the decision making processes we use today. 

The Wireless Future of Medicine – The Forgotten Element of Meaningful Use -Eric Topol –TED 2010 (Video)

Medical Device =  Algorithms  =  Medical Data  =  Data Reports  =  PHR  =  EHR  =  _____.

If you don’t believe m on the devices that report data, check this out and your hair might stand up on end.  Would you love to send this information off to an insurer that is investing heavily in behavioral underwriting with biometric monitoring.  The link above contains a video that makes sense and Mr. Topol pretty much tears up the Fitbit and discusses how do these devices work with human life, in other words without disruption and what “meaningful value” do they offer, some are better than others, but gosh we can’t even handle just cell phones on their own right now. 

Participatory Sensing – Medical Devices Reporting Data for Patient Compliance

Without proper implementation, we get something thrown at us from a company with limited VC funding that needs money on the books right away and forget the “human side” we need the money.  Recent reports are now starting to show what happens with this focus too, devices with BAD software, in other words perhaps released before it’s time, but the other folks at the NIH want to get the devices and drugs out faster, so what’s up with that?  I know what bad software is too as I used to write code, so take it from me, it does exist out there and all companies and their programmers are not created equal. 

Behavioral Underwriting With Biometric Employee Screenings – Red Brick Secures 3 More Clients

Back on course here, Virginia was the first state to pass a law to make it illegal to require health insurance.  It’s not that insurance is a bad idea, but it’s what you get or don’t get from companies sold and exchanged on Wall Street.  We don’t get good care this way with investor dividends having the first priority.  We get what is left over after investors are paid.  Now if they were all non profits, we might have a different story.

Virginia The First State to Pass Legislation to Protect Citizens From Being Forced to Purchase Health Insurance – If the Insurance Companies Were Non Profit It Might Make A World of Difference

We don’t want to have to fight for healthcare and argue with the folks that have been ripping both doctors and patients for years.  When the economy was better, the problem was not as noticeable, but it sticks out like a sore thumb today, it’s the money making algorithm game and people don’t want to be forced to have to do business with companies that are less than reputable and tied to Wall Street, that’s the long and short of it.  The Idaho Governor signed a law into effect yesterday pretty much saying the same thing. 

On the other side of the coin, Virginia also became the 12 state to mandate compensation for telehealth too, so I think they know a whole lot more than what we see in Washington these days.

Virginia Becomes the 12th State To Legislate Payment Coverage for Telemedicine

To carry this one step further, we had Mr. Grassley and others thinking the FDA is in a spot to regulate Health IT, shoot as late as 2008 some of the major investigators at the FDA didn’t have computers and were still writing their studies out in longhand, they are up to their ears in catching up their own infrastructure and don’t have the knowledge to run it, and rely on 3rd party evaluations for many device approvals.  Why can’t members of Congress read what I read and realize this up front before sticking foot in mouth? 

FDA Regulate Health IT What “Nutcase” Thought of This – Must Be A “Non Participant” Living in “Tech Denial”

Last but not least the most compelling reason I could find for not having the FDA regulate Health IT from April of 2009:

Hospital MRI and Other Medical Devices Infected with Conficker Virus – FDA Required 90 Day Notice before Windows Update Patch Could be Applied

As I said above, who’s the “nutcase” that opens mouth and insert foot here as we need realistic solutions from those in government and to do that they need to read up and participate instead of just rolling a roulette wheel.  That’s about what we have as technology has forced up on lawmakers the need and ability to participate and read further in order to create laws that will work and be in harmony with how the country operates today. 

Intellectual Property Technology Has Arrived – Digital Algorithmic Formats Needed Now to Enforce and Protect

I guess it is too much to ask to have some digital minded Congressmen around, right?  So we end up fight a battle with swords where the competition runs around with machine guns.  As I said this is going down as the year where the total non participants are feeling the power of ignorance and stifling the progression of the country with old time paradigms they can’t release.  BD 

The city's struggling small businesses are getting hammered with an average 17 percent hike in health-insurance premiums this year, The Post has learned.

Increases in premiums filed by small-group HMO plans with the state Insurance Department in January show:

* GHI HMO Select and Healthnet plan premiums shot up 30 percent.

* Aetna boosted premiums by 20 percent

* HIP of Greater NY policy rates went up 20 percent

* Empire Health Choice plans increased by 15 percent in Manhattan and 7.6 percent in The Bronx.

"Double-digit premium increases -- coming at a time when so many New Yorkers are financially struggling -- demonstrated dramatically why insurance rates must be regulated," said state Insurance Superintendent James Wrynn.

Insurers sock NYC small biz - NYPOST.com

Technorati Tags: Health insurance, healthcare reform, Virginia, Idaho, Aetna, Manhattan, New York, small businesses, politics, Washington DC, meaningful use, devices that report data, tech denial, participation, Wall Street, Dividends

Read More

1 Out of Every 4 Residents in California Now Lacks Health Insurance – We Need True Reform and Not Band Aids

The numbers are growing rapidly while we still wait around and discuss and talk about healthcare reform.  One thing for sure this year in Congress should certainly go down in history as one of the most out of touch years with a Representatives so bent on telling the American public what to do, and yet themselves are far from being any type of participant. Even the children are affected with less than half getting coverage from Mom or Dad.  

Keep in mind these numbers included stimulus relief and without it, things would have been worse, much worse.  They are not improving and we still see the “fat cats” on Wall Street also oblivious as to what is happening as well.  BD  

More than 45,000 Sacramento County residents joined the ranks of the medically uninsured in the past two years, according to a new report that further illustrates the staggering depth of the recession: a surge of 2 million Californians without health insurance.

One in four Californians, or 8.2 million people, now lack coverage, according to UCLA researchers.

The study, released Tuesday, quickly became a talking point in the national debate over health care legislation, which could culminate later this week in a dramatic up-or-down vote on Capitol Hill.

On Monday, the Robert Wood Johnson Foundation estimated that as many as 59.7 million Americans could be uninsured in five years – and perhaps as many as 67.6 million by 2020 if policymakers don't take action to contain health care costs.

Once again, California gets to be Exhibit A on why we desperately need health care reform," said Anthony Wright, executive director of Health Access California.

Fewer than half of the state's children now get health coverage from their parents' jobs, according to the UCLA study.

Ranks of those without health insurance soar in California, Sacramento County - Medical News - sacbee.com

Technorati Tags: healthcare reform, health insurance, healthcare, California, ecnonomy, children, Robert Wood Foundation, UCLA

Read More

Stem Cell Research in the US – Focus on UCI Irvine With First FDA Approved Treatment for Spinal Cord Damage

The video speaks of where stem cell research is currently in the US and revisits the big breakthrough from a couple years ago when skin cells could be used instead of the actual embryo for research.  That discovery rapidly set things on fire for research in so many areas. 

Mentioned in the video is the project at UCI and you can hear a patient speak about how during the trial stage she has made an almost complete recovery from her spinal cord damage. 

Also mentioned here is all the millions of dollars that are invested in stem cell research across the country. 

Embryonic Stem Cell Therapy Data Submitted – UCI Irvine Waiting for FDA to Approve For Treatment of Patients with Spinal Cord Damage

At UCI the doctor is turning stem cells into nerves and the doctor has one big ambition, his daughter and is working diligently to help cure her.  Stem cells are also helping with cancer research with the development of a drug that attacks “cancer stem cells” in the body.  BD 

After years of research and billions of dollars spent, stem cell research is promising, but how close are we? Dr. Jon LaPook shows us 'Where America Stands' on stem cell research.

Where America Stands: Stem Cell Research - CBS News Video

Technorati Tags: Stem Cells, FDA, healthcare, R and D, Biotech, Clinical Trials, Geron, UCI Irvine, Embryonic stem cells

Read More

Think Tank Suggested that NHS should Tank More Than 30,000 Hospital Beds

The number of beds has been decreasing over the years and the think tank believes this should be done quickly as the article appears.  As you can see by reading through here there are objections on whether or not this is being done strictly for financial reasons and if it would impact the care received.

Just what is the number needed for care it appears is the big question here as you can’t get rid of all of beds?  BD 

Reform says the NHS's focus should move away from hospital treatment as more people suffer from conditions, such as diabetes, which can be treated at home.

The think tank suggested that more than 30,000 beds could close in the coming years if all areas matched the bed to population ratio achieved in the south central region.

The government said local health chiefs could decide, while the British Medical Association said cuts made for purely financial reasons would be "immoral"  There were just under 300,000 beds in 1987, but by last year that had fallen to 160,000 as advances in treatment have meant patients do not need to spend as long in hospital.

But Dr Mark Porter, chairman of the BMA's consultants committee, was skeptical about the suggestions.

He said that, while cutting bed numbers was perhaps necessary, carrying out such a program so quickly was "nonsense".

And he added: "Cutting beds for purely financial reasons would be immoral and catastrophic for patient care."

BBC News - Hospitals 'should axe thousands more beds'

Technorati Tags: NHS, patients, hospital, think tanks, healthcare, treatments

Read More

Health Clouds Forming in California – State HIE (Health Information Exchange) ONC Grant

Hard hat area:  The state project is aligned with the federal NHIN standards.  Last month 15 organizations received grants to begin electronically sending Social Security disability claims via the National Health Information Network.  As I understand the California infrastructure would connect and transport information to the national level network. 

Social Security Awards Contracts for Electronic Medical Records – 15 New Recipients for Disability Claim Info

The NHIN network is a “private”’ government network and there has been talk about someday allowing more available use for the public as well. 

The Health Internet – Government Looking to Expand The National Health Information Network For Public Use

The Open Source “Connect” community portal also has a plug in that can be used to transport the data via the National Health Information Network .  You can also read more about the prototype being developed for web based software to populate EHR/EMR records with CMS reporting formats.  BD 

Today, the California Health and Human Services convened a summit with an expected three hundred people in the interest of a state HIE (Health Information Exchange). This project has been tasked by volunteers and state groups and led by Jonah Frolich, deputy secretary of California Health and Human Services. The teams formed have met a series of hurdles already in preparation for the next big phase of executing the next generation system and raising an initial seed of $38.8m to move the effort forward.

At stake is at least $3 billion by connecting to these services for doctors and hospitals that qualify by using the HIE as built. This means that doctors can bill for more Medi-Cal and Medicare payments that are expected to be available in coming years from the American Recovery and Reinvestment Act funds while using HIE services. Additionally, the services being created will need to support applications that engage consumers as they play a role.

Last week, Governor Arnold Schwarzenegger and California Health and Human Services Agency Secretary Kim Belshé named a new nonprofit entity called Cal eConnect to oversee the development of Health Information Exchange services. One of the first tasks at hand is to finish the CA HIE Operational plan and to finalize details in budget, technical, and engagement plans to execute with the recent first grant by ONC for $38.8m.

Health Clouds Forming: California's Health Internet Exchange - ReadWriteCloud

Technorati Tags: California, grants, ONC, Schwarzenegger, healthcare, Health IT, Cal eConnect, hopsitals, medical records, EHR, PHR, personal heatlh records, infrastruture

Read More

Microsoft and New York City Launch Virtual Senior Center - Using Windows 7 and Touch Screen Computers to Connect Homebound Seniors to the Outside World

This is just an overall “nice” story.  I know as I have a mother who is a senior and the computer is a big connection for her to the outside world.  She doesn’t have Windows 7 and a touchscreen, but even without the new hardware and software it is a huge companion for her.

The article mentions Microsoft HealthVault and yes my mother has hers too, and she is not close to me and lives a distance away in another state.  She feels much better knowing that her health records and other documents are stored as we both have access in case I need them. 

Do you think seniors are interested in having their health records in a software system, you bet they are.  You can read this post from September of 2008 talking about a talk I gave to a senior group in southern California.  The 2 things on their minds were speech recognition use and medical records, and many of them had already taken advantage of the free USB drive offered by the fire department to store them. 

Microsoft Speech Recognition Presentation - Computer Friends at the Oasis - Newport Beach, CA

With the Virtual Senior Center, those who are homebound can now connect via the internet if they are homebound and can’t participate in person.  BD

NEW YORK — March 10, 2010 — Microsoft Corp., the city of New York and Selfhelp Community Services Inc. today unveiled their Virtual Senior Center, an innovative public-private partnership and demonstration project that is showing how cities can use technology to revitalize senior centers and enhance the lives of homebound seniors. The Virtual Senior Center uses computer, video and Internet technology to create an interactive experience for homebound seniors that reduces social isolation and gives them better access to community services.

“The New York City Department for the Aging is deeply committed to improving the quality of life for older New Yorkers, and this partnership with Microsoft and Selfhelp Community Services in creating the Virtual Senior Center is one more step toward making New York City the most age-friendly city in the nation,” said Lilliam Barrios-Paoli, commissioner of the New York City Department for the Aging (DFTA). “Senior centers are the social hub for many older New Yorkers, and this new model — the Virtual Senior Center — has shown us that technology will help seniors age in place and remain integrated into the community by bringing that same senior center experience into the home.”

Creating the Virtual Senior Center

The Virtual Senior Center demonstration project — jointly undertaken by Microsoft, the New York City DFTA and the Department of Information Technology & Telecommunications (DoITT), and Selfhelp Community Services — links six homebound seniors (ranging in age from 67 to 103) to Selfhelp’s Benjamin Rosenthal Senior Center in Flushing, Queens. Each of the six seniors’ homes is equipped with a desktop computer running Windows 7 as well as a touch-screen monitor, a small video camera, a microphone and broadband Internet service.

“Broadband technology is the new infrastructure of the 21st century, and serves as a bridge by which an increasing number of homebound seniors are linked to family, friends, activities and services,” said Carole Post, DoITT commissioner. “The Virtual Senior Center, and the important role it plays in improving the lives of these seniors, should serve as a model for public-private partnerships in expanding broadband adoption among underserved populations across the five boroughs.”

Video cameras and monitors have been strategically placed around the senior center to enable the homebound seniors to interact with classmates and instructors at the center, and to take part in activities such as armchair yoga, painting classes, current events discussions and tai chi. Using the technology, seniors at home can see and hear the other people in the class and actively participate in two-way discussions and activities. Since beginning the project, some have even made new friends. It’s Never 2 Late, a Colorado company that creates specialty technology packages for seniors, provides the custom interface.

Seniors with age-related impairments use assistive technology, such as screen readers or track balls, or take advantage of some of the built-in accessibility options and programs in Windows 7 that make it easier for them to see, hear and use their computers, such as the full-screen magnifier.

Participating seniors also have full access to the Internet and are finding new ways to re-engage with the world. One senior woman now enjoys live streaming religious services from New York Central Synagogue, and uses a video link to communicate face-to-face with her children and grandchildren. Many of the seniors play games online, watch videos or listen to music, and use programs designed to improve memory and cognitive function. One of the men in the project used the Internet to track down former co-workers and to get reacquainted with a childhood friend he hadn’t seen in more than 70 years. He has also started ordering groceries online and is exploring ways to streamline and expand his home-based business.

“Even in a large and vibrant city like New York, people can feel isolated and alone,” said Bonnie Kearney, director of Marketing for Trustworthy Computing at Microsoft. “At Microsoft, we work with governments, technology partners and nonprofit organizations around the world to create inclusive communities that welcome people because of their abilities rather than excluding them, even inadvertently, because of their disabilities. One way we help make that possible is by continually developing accessible technology that is safer and easier to use.

“As personal computers and the Internet become increasingly important in our society, many seniors — especially homebound seniors — are being left behind because they don’t have access to technology or an opportunity to learn the necessary skills,” Kearney said. “With the Virtual Senior Center, this innovative public-private partnership is demonstrating a model that other cities can use to help homebound seniors stay connected and keep contributing to their communities.”

The Need for Homebound Senior Services Is Growing

People are living longer, and the population is aging rapidly. According to the U.S. Census Bureau, by 2030 the number of people who are 65 and older will be growing faster than the total population in every state — and 26 states will have doubled their senior population by that date.

As people age, many become homebound due to chronic illness, injury or various age-related disabilities. Currently, there are at least 2 million homebound seniors in the United States, according to a report published in the Journal of the American Medical Association. As the population ages, however, the number of homebound seniors with multiple chronic conditions and disabilities will increase dramatically — a trend that is creating deep concerns for cities and other governments that provide services and benefits to seniors as well as baby boomers and other family members who must care for aging parents or other relatives.

“Homebound seniors who are unable to visit their local senior centers or participate in outside activities with their friends often feel lonely and isolated, which can lead to depression, dementia, poor health and a lower quality of life,” said Stuart Kaplan, CEO, Selfhelp Community Services. “For seniors who are homebound, using the Internet to stay connected to family, friends, caretakers, social workers and community services can yield tremendous health and wellness benefits by enriching their lives, providing greater access to health resources and preserving their independence.”

One of the seniors was interested in learning more about Microsoft HealthVault, which offers people a way to better manage their health without leaving home. As a personal health-management platform, HealthVault connects with health and wellness applications as well as home health-monitoring devices such as blood pressure cuffs and blood glucose monitors, which generate information that users can make available to medical professionals, family members or other caretakers. That senior is now using HealthVault and the American Heart Association’s free online heart health center, Heart360.org, to track and monitor his blood pressure. He can upload data from the blood-pressure cuff into his HealthVault account and share the information with his physician. Together, he and his doctor can track his progress and decide on the best course of treatment.

The Virtual Senior Center project included a psycho-social assessment that measured a number of attitudes, health attributes and emotional factors for the six participating seniors at the start of the program and at various stages. As a group, the seniors showed marked improvement throughout the course of the project.

“The opportunity for homebound seniors to interact virtually with caregivers, providers, peers, family members and friends has made a significant and measurable difference in the quality of their lives,” said Becky Bigio, director, Selfhelp Senior Source Geriatric Care Management Program. “Nearly all the candidates have described feeling more connected to others and show an increasing awareness and appreciation of those connections.” 

New York City Department for the Aging

The Department for the Aging’s (DFTA) mission is “to work for the empowerment, independence, dignity and quality of life of New York City’s diverse older adults and for the support of their families through advocacy, education and the coordination and delivery of services.” It serves approximately 1.3 million New Yorkers age 60 and older in the five boroughs. DFTA assists seniors in remaining independent and involved in the life of their communities as they age.

New York City Department of Information Technology and Telecommunications

The Department of Information Technology and Telecommunications (DoITT) enhances the way the City interacts with its residents, businesses, visitors, and employees by leveraging technology to enhance the delivery of City services. DoITT is currently leading a consortium of New York City entities to increase public access to, and adoption of, broadband technologies through public computer centers, school programs, and expansion of public Wi-Fi in parks.

About Selfhelp Community Services Inc.

For the past 70-plus years, Selfhelp Community Services, Inc., a non-profit organization, has been dedicated to enabling seniors and at-risk families to live in their own homes, independently and with dignity. We provide a comprehensive network of community-based home care, social services, and senior housing programs, which integrate progressive strategies and cutting-edge technologies that address the changing needs of our clients. In addition, we also operate the largest and oldest Nazi victim services program in the country for aged survivors of the Holocaust.

About Microsoft

Founded in 1975, Microsoft (Nasdaq “MSFT”) is the worldwide leader in software, services and solutions that help people and businesses realize their full potential.

Technorati Tags: Microsoft, healthcare, seniors, Department for the Aging, telecommunication, technology, Windows7, virtual senior center, Selfhelp Community Services, HealthVault

Read More

We Need to Fix Wall Street To Help Stop Some Of the Heart Attacks – American College of Cardiology Study

By fixing the corrupt algorithms running Wall Street, it will stand to help healthcare, so the 2 go hand in hand.  One other thing that some of the folks on Wall Street might give some thought is the demise and reduction of number of family practice physicians too.  If you take all their money away, who’s going to take care of you?

Specialist Nurses - (Certified Nurse Anesthetists) Earn More Than Family Doctors - Report

Ask any broker on Wall Street on how the money is made, it’s the algorithms.  This is especially stressful to those investing today, as most know the big money is being made in bonds and private equity.  So you see as long as we have health insurance companies heavily traded on the open market with a liability for payments of dividends to stockholders first, this is not going to get any better and we have more stress.  When algorithmic codes are making profits and decisions behind the scenes, more complex than the average individual can conceive and understand, stress enters the picture big time as much of what was used in the past to make what is felt to be a “sound investment” is down the tubes.  It’s more about who can run the better financial code in many areas.  In the link below are some interesting facts on how the chief lobbying employee for United Healthcare came right from Goldman Sachs. 

United Healthcare CEO Profile and HCAN (HealthCare for America Now)

This short video below shows exactly where some of today’s stress is coming from too.  Until Wall Street comes back to a somewhat civil world of investing without the complicated algorithmic formulas running complicated investment schemes that nobody can really understand, heart disease will continue to rise and be impacted by the stock market.  BD   

ATLANTA, Georgia — Doctors have found a relation between stock market fluctuations and heart attack frequency, a preliminary study by North Carolina's Duke University Medical Center has said.

"In analyzing our local patient population... during the recent period of increased volatility in the stock market, we found that when stock market values decreased, heart attacks seemed to increase, and then decreased when stock trends improved," said the study's lead investigator Mona Fiuzat on Saturday.

The results of the research were presented at the American College of Cardiology?s 59th annual scientific conference held this weekend in Atlanta.

"While more and larger studies are needed to examine the reason for these findings, it?s important for healthcare providers to be aware of social stressors that may potentially affect their patients," Fiuzat said.

The study focused on patients registered at the Duke Hospital Catheterization Lab between January 2006 and July 2009, using data from the Duke Databank for Cardiovascular Disease.

It included patients who suffered a heart attack within three days prior to undergoing a heart procedure.

Data was then plotted against the stock market daily values during the same period of time.  She concluded that "learning stress management strategies may be beneficial, especially for people with or at high risk of heart disease."

AFP: Stock market dips 'linked to heart attack surge'

Technorati Tags: Wall Street, American College of Cardiology, healthcare, heart disease, healthcare reform, cardiovascular disease, politics, financial markets, stocks, brokers, greed

Read More