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CMS proposes 6.1% cut in Medicare For Doctors in January 2011 – One More Reason To Have A Permanent Fix

Thank goodness Congress acted and gave the extension until December 1st, but we have the other side at CMS looking at their budget saying we want to cut based on the sustainable growth rate formula by 6.1%, which needs to go away as at this point with current series of events over the years that have occurred it is certainly outdated and no longer a viable measure.  One other item here, just think of the stress and unrest this creates every time it comes around.image

Now we know November will be a busy time with elections happening all over the country, and hopefully this will not go as long as it did this time with actually having to make data changes with check.  CMS says this cut is in addition to the standard 21% cut that has been looming over everyone’s head for years.  We keep going around and around here and this is not the first time CMS has given their recommendations and it is almost beginning to resemble a game of cat and mouse with each area “doing legally what they are supposed to do”. 

If you want additional interest with the new CMS incentive page for EHR/EMR use, this would be a good first move to fix this issue.  BD 

Physicians would receive a 6.1% cut to their Medicare payments starting Jan. 1, 2011, under a proposed rule issued by the CMS. That reduction would be in addition to a projected 23.5% cut that is scheduled to take effect Dec. 1, provided that Congress doesn't act to change it.

The proposed rule also seeks to implement an incentive payment for primary-care services as well as provisions in the new health reform law that would eliminate out-of-pocket costs for most preventive services. Comments on the proposed rule are due Aug. 24, with a final rule to be issued by Nov. 1.

CMS proposes 6.1% cut in Medicare payments to docs for January - Modern Healthcare

John Glaser VP and CIO of Partners Healthcare Leaving - New Job: CEO Siemens Health Services Business Unit

It sounds like Dr. Blumenthal might be looking for a new adviser soon, although there’s some time here as he doesn’t begin until August, but who knows a nice long imagevacation might be in order too but he won’t be that far away with going to Siemens. 

Back in 2008 Siemens did some major reorganizing and laid off around 16,000 people worldwide after the CEO of the healthcare sector resigned.  The company realigned and somewhat reinvented a lot of what they do and earlier this year the announcement was made with Microsoft to bring HealthVault to Germany.  We could possibly be seeing some involvement in this area of Health IT since we are talking medical records and Health IT. 

Microsoft HealthVault and Siemens Bringing PHR Platform to Germany – And a Look at a German EHR

“In Siemens IT Solutions and Services, we have found a reliable and competent partner with whom we can jointly bring innovative solutions to the German healthcare system. With HealthVault, we provide citizens with a platform that allows them to better manage their health and the health of their families, and facilitates their communication with providers,” said Angelika Gifford, Senior Director, Public Sector and Member of Management at Microsoft Germany.

Siemens Medical Investigation Resulting Appears to have resulted from a Whistleblower – Update

I would also be guessing a substantial raise in income would also be a big motivating factor here too.  BD 

Press Release:

ALVERN, Pa., June 25 /PRNewswire-FirstCall/ -- Today, Siemens Healthcare announced the appointment of John Glaser, Ph.D. as chief executive officer (CEO) of the Health Services Business Unit.  In his role, Glaser will be responsible for leading Siemens' global healthcare IT business, including product development, strategy, portfolio management, financial performance, and overall customer satisfaction. When his appointment goes into effect on August 16, he will begin leading over 4,500 employees, multiple health information system brands, a robust Global Services arm, and Siemens' world-renowned Information Systems Center.

"Dr. Glaser is regarded as one of the world's most influential experts on healthcare information technology, and it is a great privilege for me to welcome him to Siemens Healthcare," said Tom Miller, CEO, Workflow & Solutions Division, Siemens Healthcare Sector.  "Through his private and public roles, Dr. Glaser has shaped the way that hospitals, physicians and regulators are currently embracing information technology to deliver safer, faster and more efficient healthcare while also addressing concerns of privacy, security and cost savings.  This expertise and insight will be a tremendous asset to Siemens as we continue to lead the delivery of innovative IT solutions to the marketplace."

Most recently, John served as advisor to David Blumenthal, the national coordinator for healthcare IT, providing counsel to the Office of the National Coordinator and the Department of Health and Human Services on the HITECH portions of the federal government's stimulus bill, particularly regarding national efforts to adopt electronic medical records.  Since 1995, Glaser served as Vice President and CIO of Partners HealthCare (Boston, Mass.), directing IT for an organization of ten hospitals, 7,000 physicians, and 45,000 employees, including a team of 1,300 IT professionals.  He is founding Chair of the College of Health Information Management Executives (CHIME), past President of the Healthcare Information and Management Systems Society (HIMSS) and has served on multiple industry boards.  Most notably, Glaser received the 1994 John Gall CIO of the Year award and CHIME has established a scholarship in his name.

"John Glaser has helped put Partners HealthCare on the forefront of health information technology nationally and has enabled us to deliver safer care to our patients," said Gary L. Gottlieb, MD, MBA, President and CEO of Partners HealthCare. "John's work at Partners has shaped the conversation about electronic medical records and his efforts have helped to improve the American health care delivery system."

The Siemens Healthcare Sector is one of the world's largest suppliers to the healthcare industry and a trendsetter in medical imaging, laboratory diagnostics, medical information technology and hearing aids. Siemens offers its customers products and solutions for the entire range of patient care from a single source – from prevention and early detection to diagnosis, and on to treatment and aftercare. By optimizing clinical workflows for the most common diseases, Siemens also makes healthcare faster, better and more cost-effective. Siemens Healthcare employs some 48,000 employees worldwide and operates around the world. In fiscal year 2009 (to September 30), the Sector posted revenue of 11.9 billion euros and profit of around 1.5 billion euros. For further information please visit: www.siemens.com/healthcare.

Siemens Healthcare Appoints John Glaser CEO of Health IT Business -- MALVERN, Pa., June 25 /PRNewswire-FirstCall/ --

Related Reading:

Siemens and Draegerwerk at odds...
Siemens CEO of the health care sector to resign
Siemens Is The Technology And Market Leader For Connectors Associated With The Electronic Health Card
Siemens Cutting 16,750 Jobs
Siemens to Resell Kiosks

Prescription Solutions Launches Clinical Vantage(SM) – Algorithmic Software Web Client Settings For Risk Management and Cost Control

I believe I am reading this correctly but if you are a member of a company, HMO or otherwise that utilizes the services of Prescription Solutions, this new format willimage allow the employer (or who ever is the client) to set and establish parameters in which members can function and receive information.  Not too long ago Ingenix, another United HealthCare subsidiary announced desktop software for employers to analyze and I am guessing the 2 of these might be related and data possibly aggregated.  One thing that United certainly well is produce tons and tons of software to “help” everyone with statistics.  Not to say this is a bad idea, but how many people really utilize them or do they just kind of sit there. 

Ingenix (UnitedHealthCare Subsidiary) Creates Desktop Software for Employers to Analyze Employee Benefit Use To Help Cut Costs – More Analytics and Algorithms To Save That Buck

Between buying up companies in China, purchasing more wellness companies, the portfolio here is appears to be growing and with a lot of entities that one would maybe not associate together in the past, but not by today’s economy.  Companies do not buy a company for an investment, it is consumed and all their data and operations get joined together to work with each other.  There are a ton of private equity firms doing the same, so this company from China might be there to help get more Chinese drugs and devices to the US as they already have a line of collaboration with the FDA established the article states as a prime are of their expertise as they are a “gateway” company.  

UnitedHealth subsidiary (Ingenix Subsidiary I3) Acquires ChinaGate – Working to Sell Chinese Products Globally

If in fact the company is able to get more Chinese drugs here in the US as an example, you could in fact begin seeing them mentioned as a potential preferred generic alternative, as they might have a big stake in some of this.  I make this analogy to show how entities owned from different companies are working together today. 

Private equity firms plans it that way and already has a potential business model in place way before anything is announced.  There’s a lot more going on with more than just mailing your prescriptions here as the algorithms of cost and risk management are provided to HMOs and employers.  BD 

IRVINE, Calif., Jun 25, 2010 (BUSINESS WIRE) -- Prescription Solutions, a leading pharmacy benefit management organization and a UnitedHealth Group company, has launched Clinical Vantage(SM), a suite of clinical programs that enables clients to create specialized solutions to meet their particular needs to improve the health and well-being of members. 

More than 100 evidence-based clinical programs and technological innovations, covering a wide range of therapeutic categories and populations, are gathered under the Clinical Vantage(SM) umbrella. Prescription Solutions clients have the flexibility to select single or multiple program types that best meet their needs or goals to reduce pharmacy costs while improving health care outcomes for their members.

The Clinical Vantage(SM) approach has four distinct uses -- creating customized solutions, improving quality and safety, maximizing savings, achieving optimal health -- that individually provide clients with specialized solutions or, taken together, help clients achieve clinical and economic goals.

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Other quality and safety-related Clinical Vantage(SM) programs among clients include:

-- Drug Interaction Alert Program (DIAP) to help reduce and prevent potentially dangerous drug-drug interactions (DDIs)

-- Geriatric RxMonitor Program which helps reduce inappropriate medication use among people age 65 and older

-- Polypharmacy Program that notifies physicians about potentially harmful drug-disease interactions and inappropriate duplicate therapies

-- Narcotic Drug Utilization Review Program to minimize the occurrence of abuse, diversion and other inappropriate use of addictive painkillers.

Maximizing Savings: Clinically Managing Drug Formularies while Promoting Generics and Mail Order

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Prescription Solutions Launches Clinical Vantage(SM) to Help Improve Health Outcomes and Reduce Costs – MarketWatch

Anthem Blue Cross Security Breach Occurred During System Upgrade – Information Accessed by Attorneys Looking for Information Relative to Lawsuits With Carrier

As the world of health care data revolves, this is an interesting case with attorneys being the culprits looking for information, so the folks on the other side are in fact getting smarter technology.   Normally the cases we see involve loss of hardware, like a USB drive or a notebook, etc.  This was different in the fact that after the system upgrade all security evidently was NOT in place and working correctly. image

According to the article here, anyone who had a current application in process was a potential victim.  Now this opens the door for lawsuits to be filed for those who’s records were exposed.  Again, I don’t know how long the current business models can be sustained at this rate as if it has happened once, well it can and probably will happen again.  Use of private information out in the world of technology is causing a real stir for access and the information means money.

For the consumer applying for health insurance here it means a year’s worth of free credit reporting.  I wonder how much the attorney’s actually were able to see and obviously it appears this was not done to perhaps steal identities, but rather to obtain information used for future lawsuits.  The legal profession is also a good example of an industry who invests heavily in technology too and the article states the information was returned, but after being reviewed and evaluated, it’s still out there if duplicated and I might guess there’s a real good possibility of this occurring for strategic use with future lawsuits.  BD 

More than 200,000 Anthem Blue Cross customers this week received letters informing them that their personal information might have been accessed during a security breach of the company's website.

Only customers who had pending insurance applications in the system are being contacted because information was viewed through an on-line tool that allows users to track the status of their applications.

Anthem spokeswoman Cynthia Sanders said the confidential information was briefly accessed, primarily by attorneys seeking information for a class action lawsuit against the insurer.

Newport Beach attorney Mark Robinson filed a class action lawsuit on behalf of a Los Angeles County resident who discovered that her application for insurance was available for public view.

"The ability to manipulate the web address (URL) was available for a relatively short period of time following an upgrade to the system. After the upgrade was completed, a third party vendor validated that all security measures were in place, when in fact they were not. As soon as the situation was discovered, we made the necessary security changes to prevent it from happening again."

The company is offering a free year of identity protection service. Anthem also said the attorneys have returned all improperly obtained information to a custodian of the court system.

Personal data accessed on insurer Web site | information, security, anthem - Life - The Orange County Register

Bravo Health Expanding to Hire 200 Workers – Medicare Part D Company That Made A Billion in Profits in 2009

In the future Medicare Part D contributions will be dwindling from the government, so how do they anticipate keeping such high profit levels, premium increases for the insured, like everyone else out there. 

Bravo Health – Venture Capital Backed Medicare Senior Health HMO Carrier Sees Profits of 1 Billion for 2009image

As we all know the Medicare Advantage plans have been a big cash cow for years and with healthcare reform the picture is slowing beginning to change.  When you look at the positions listed below, I don’t see any doctors listed here, but rather nurse practitioners are on the list.   Also heavy on the list are Health IT analysts, the folks that create the algorithms for cost control and profit to work with the financial gurus, so again we are back again to using business intelligence to find and locate markets and determine what portion of the expenses can be shifted to the participants.  BD 

About a year after the health care company said it was expanding its space in the city to hire another 200 workers, Bravo is now adding between 30 and 40 new employees a month, said Jeff Folick, the company’s CEO. But not all of the jobs are in Baltimore. Some are in Pennsylvania and Texas, where the company also does business.

Bravo is a private health insurance company that offers seniors coverage in so-called Medicare Advantage plans, which offer members benefits that basic Medicare doesn’t provide, such as eye glasses, house calls and 24-7 access to medical information hotlines.

So the company is looking for new staffers to accommodate the growth, Folick said. For its headquarters in Baltimore, Bravo Health is usually looking for claims processors, customer service representatives, financial gurus, individuals who can help enroll new members and IT experts. The company’s headquarters is located in Brewers Hill in Southeast Baltimore.

Among the clinical positions Bravo currently has open? Mostly pharmacists, nurse practitioners and other care coordinators.

Bravo Health on a hiring spree - Baltimore Business Journal

Miami-Dade Mercy Hospital Bought by For Profit HCA – One More “Non Profit” Joins “For Profit” Ranks

Mercy Hospital is the last Catholic hospital in the Miami area and with keeping the Catholic healthcare ethics, no abortions will be provided here.  We are seeing more and more hospitals moving from the non profit areas into profit, due to economic conditions for the most part, in other words, running out of money.  Ironically we now have this NON PROFIT association to meet and discuss and determine HOW TO MAKE A PROFIT, what’s up with this?  Give this some real thought as to where imagewe are going today

How Big Are Private Equity Investments in Healthcare – Large Enough to Create a “Non-Profit” Trade Association To Talk About How to “Profit”

As posted yesterday, private equity firms are considering hospitals a “good buy” to move in and update operations and turn the facilities into money making hospitals.  The Caritas Hospital purchase even has a clause in their contract which allows a buy out of the “Catholic religion” ethics if it gets in the way of making money and we may probably have not heard the last of this issue as the purchase agreement moves forward. If you stop and look around you can see where insurance executives are going, to private equity firms.  BD

Former CEO of United HealthCare Joins Private Equity Firm as an Operating Partner With Focus on Healthcare

In what's likely to mean a major shift in the region's hospital competition, Mercy, Miami-Dade's only Catholic hospital, is on the verge of being sold to the for-profit HCA hospital chain.

Mercy's board announced Thursday it had signed a letter of intent to sell. The price was not disclosed. A joint press release said the ``transaction is expected to close as soon as possible.''

Under the agreement, Mercy Hospital will continue to operate as a Catholic hospital, said Chief Executive Manuel Anton. Among other things, that means no abortions will be performed at the facility. The abortion issue derailed a merger with Baptist Health South Florida in 1998.

The Spiritual Care Department will be maintained and employees will be trained in ``Catholic healthcare,'' according to the agreement.

HCA buying Mercy Hospital - Business - MiamiHerald.com

Doctors At Coney Island Hospital Voted 96-19 In Favor of Joining the Service Employees Union

Last October doctors organized in Chicago.  Coney Island as well as the hospital in Chicago are both publicly run facilities.  BD

Doctors Join the Union in Chicago – Cook County Health and Hospital System

A group of employed physicians has voted by an 83% majority to unionize under the Doctors Council SEIU at Coney Island Hospital in New York. image

Full-time physicians at the 371-bed hospital on Wednesday voted 96-to-19 in favor of joining the Service Employees International Union doctors' unit (24 doctors did not vote). The decision means all 139 eligible full-time physicians at the hospital will become members of the union, SEIU said in a news release.
Part-time doctors at the hospital have long been members of the union, but Wednesday's vote brings the number of unionized docs there to more than 200, the union said.
Coney Island is a publicly run hospital that is owned by the New York City Health and Hospitals Corp., the nation's largest municipal hospital system.

Docs at Coney Island Hospital vote to unionize - Modern Healthcare

Aetna Withdraws Request To Raise Rate in California - Complicated Internal Algorithm Errors

Well first we had Blue Cross with errors and now Aetna, so perhaps their own algorithms are getting to complicated for internal use too?  This again makes anotherimage good statement for “certifying payer algorithms” just like we do with EHR systems. 

Rules on EHR Certification Should Take Back Seat to Certifying Insurance Algorithms At Present – We Need This First

ALGORITHMS – INFLUENCE OR MAKE ABOUT 99% OF ALL THE DECISIONS HAPPENING TODAY – WE NEED ALGORITHMIC CENTRIC LAWS!  Without these, how do we create audit tables that can not only audit health insurance and throw in the Federal Reserve as well.  

Even the new government website to help consumers with selecting health insurance is getting a challenge as they can’t provide prices due to the complexity of the algorithms and in October they said at best there would be “estimates” of the costs to help consumers.

HealthCare.gov Portal Set to Launch July 1, 2010 To Help Consumers Research Policies – Insurer Proprietary Algorithms Will Not Allow for Pricing Information to be Included

Aetna Inc. withdrew its request to raise prices for individual policyholders in California by an average of 19% after discovering a flaw in its rate filing with state regulators, according to the California Department of Insurance.

California Insurance Commissioner Steve Poizner, a Republican candidate for governor, on Thursday said Aetna's withdrawal was voluntary. The errors imageinclude incorrectly calculating the annual cost of monthly premiums and incorrectly compounding the increases year over year, a spokesman for the department said.

The increase, filed in March and scheduled to go into effect July 1, would have hit 65,000 policyholders. A spokesman for Mr. Poizner said it was too early to say what impact the miscalculations had on the proposed percentage increase. The request followed a 17% average increase last year.

Aetna Finds Flaw in Rate Request - WSJ.com

Medicare Payment For Doctors Extended Until November – A Permanent Fix Before Turkey Day Would be Grand

We now have one more extension approved by Congress and in addition to being the month for Thanksgiving it is election time too, which may or may not have any influence.  This is what happened last week so some type of progress is being made.

Senate Votes Against Postponing the 21% Medicare Pay Cut for Doctors – The Non Participants in Healthcareimage

It would certainly be nice to have a permanent fix so both Medicare patients and doctors could breathe easier.  Every time this comes up it seems the delays get longer for the temporary fix as this time CMS had to begin issuing checks with the cuts as the 10 grace period expired this time too.  I imagine we will hear some updates on any retroactive actions.  BD 

The House voted 417-1 to pass the measure, a week after the Senate confirmed it unanimously. 

It means that a pending 21% cut in payments to physicians that see Medicare patients will be delayed through the rest of the year.

House Speaker Nancy Pelosi (D., Calif.) said earlier Thursday that in light of the Senate's failure to approve more comprehensive legislation including funds to avoid the payment reductions, the House would move to ensure doctors don't see the reduction in their payment rates.

Pelosi's initial reaction to the more targeted measure last Friday was harshly negative, calling the six-month fix "inadequate" and a "great disappointment."

On Tuesday, House Majority Leader Steny Hoyer (D., Md.) said the Senate Medicare bill was a "Band-Aid at best."

Just two days later, it appears that in the face of the Senate's inability to win sufficient support for the larger bill, House Democratic leadership feels its hands have been tied on the matter

UPDATE: US Congress Passes Six-Month Medicare-Payment Fix - WSJ.com

Patient Illness/Emergency Simulation at the Stanford University Goodman Center

This is pretty neat as when errors are made they are allowed to play out with an unintentional consequences.  The students get a surprise as they do not know what imageailment they are going to get when they start.  You can see the control panels in the picture with a director that makes the adjustments in vital signs, etc. as the training moves forward.

In a real scenario we don’t want errors and the simulation lets the students see the outcome of a decision made that may not be the best and they can’t kill anyone in here.  The situations can be scaled according to various levels of difficulty and the stress that they are exposed to stress in the simulator helps to later on work in the real world with real patients. 

A debriefing process follows at the end whereby students can talk mistakes through or talk about other options they could have used. 

It increases confidence better than just reading in the book is a better “on hands” learning experience.  BD 

Medical schools are increasingly using simulators to prepare their students for clinical experience. The robotic patient can be adjusted to exhibit a wide range of conditions, and more importantly, can be brought back to life with the push of a button. Stanford Medical School has this promotional video for their simulation center.

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Bonus:  Stanford Humor – Cat Scratch Fever – The Virtual Patient

Spoonful of Medicine: The Daily Dose - I, (Medical) Robot

Private Equity Firms And Hospital Buy Outs – More Projected to Come Along And Payer Technology Firms Too

The deal shoppers are not looking for those with efficient operations but rather those on the other side of the coin to where strategies and businesses can be realigned to show profits.  The one big example was the announcement earlier this year in the Boston area with Caritas Christie Health Systems which was coming out of bankruptcy.image

Caritas Christi Health Care Sold to Private Equity Firm Cerberus For $830M – Massachusetts

What I also found interesting on that buy out was the fact that if the established ethics and religious elements of the organization get in the way, they can cash out there and move them right out, kind of scary and just a little cold, just my opinion, but the reality of the world we live in today.

$25 Million Dollar Donation to Charity Included in New Agreement for Caritas to “Lose Their Religion” if Working With Catholic Ethics Becomes “Materially Burdensome”

How big is this business, large enough to create a “non profit” trade organization. 

How Big Are Private Equity Investments in Healthcare – Large Enough to Create a “Non-Profit” Trade Association To Talk About How to “Profit”

Apax Partners (located in the UK)  is also busy buying up the payer side of the business and you can read more at the link below.  See any trending here with hospitals and payers with Private Equity groups?  If not, take notice as we have both moving in big ways and some of the same private equity firms buy up both types of companies.  The TriZetto group is in the risk management area and is one of the companies that makes millions from medical billing auditing and processing. 

TriZetto Group, Owned by Apax Partners-London Based Private Equity Firm, Rolls Out Payer Based PHR

Private equity firms are investing and as a matter of fact the big company CareMore has partnered with is ran by a Private Equity company in the UK.  They are alsoimage all about numbers and algorithms to create profits so you can read about what they are calling their “killer” PHR they are offering with Payer information and access to who in total, I’m not quite sure.  Trizetto partners with Ingenix, the wholly owned subsidiary of United Healthcare.  This one small company made a billion dollars in profit last year and this is where the investors are going.

Bravo Health – Venture Capital Backed Medicare Senior Health HMO Carrier Sees Profits of 1 Billion for 2009

With reform, it may not always mean better care in the forefront but rather profits first and of course there will be improvements at how healthcare is delivered but what will be the tradeoffs for profit remains to be seen as private equity firms grow their investments.  This is one of the reasons hospitals are on the agenda as the price is right with many on the brink of either bankruptcy or having years of running in the red without a solution in near sight.  BD 

Speaking on a panel at the Dow Jones Limited Partner Summit in New York, Scott Mackesy, a general partner with Welsh Carson Anderson & Stowe, said hospitals have been one winner in the health-care reform debates.

“On a spectrum of how different subsectors came out, hospitals were on the plus side,” Mackesy said, adding that they were less affected than many other types of health-care providers.

There are a couple of buyout deals for hospitals brewing, as Cerberus Capital Management has agreed to buy Caritas Christi Health Care, a Boston-based hospital chain, for $830 million, while Blackstone Group-backed Vanguard Health Systems is buying the Detroit Medical Center for $700 million plus additional investments later.

Mackesy predicted more deals in the sector, saying there will be aggregation of existing hospital companies, diversification into outpatient sectors, and more jostling among companies to pick up larger positions in local markets.

One Impact Of Health-Care Reform: Expect More Hospital Deals - Private Equity Beat - WSJ

Study on Pill Bottle Shows Promise - Additional “Data for Sale” With Compliance Technology?

I try to see both side of this coin and yes having reminders and helpers is not a bad thing at all, it’s just the data side with privacy issues that seem to be the bug here as health insurance companies provide “behavioral underwriting” today to analyze every small item on your agenda.  Companies like Ingenix and Milliman make millions every year on “selling” your medication data.  Anytime today it seems when you participate in some of these areas, like coupons too, you might be increasing your data value, not for you but for what someone else can sell and purchase your information for. 

The financial rewards paid to the patient could easily be a portion of the money they make selling your data. 

This device is also connected to your pharmacy too, so you get a product that helps you remember when to take your pills, but the other side of the coin is that you create more medication data about yourself that can be bought and sold for profit as this information does not fall under HIPAA.  I wrote about this in another post below and when participating it’s your choice to share or not to share and it allows profiteering from your data that we pay for in either our premium payments or in other areas of care.  Someone has to pay the bill and the company for their technology and if you begin to think that it is totally funded by the companies, think again as it all rallies right back to the consumer in one form or another as business always figures a way to cover their cost. 

The Colbert Report Takes On Vitality GlowCaps (Video) – Check Out the Privacy Issues Here As Medication Data is Created That Can Be Sold To Health Insurance Companies For Use With Underwriting Algorithms

Here are 2 companies that sell prescription data and profiling information.  BD

image image

“HIPAA does not give the Department of Health and Human Services the ability to directly investigate or hold accountable entities, such as pharmacy benefit managers or companies such as Ingenix and Milliman, who are not covered by HIPAA.”

The Pill Bottle That Talks To Your Cell Phone, Creates Data Reports and More…

Reminders  =  Data  =  Reports

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

BOSTON – The Center for Connected Health, a division of Partners Healthcare, announced Wednesday encouraging initial findings from a medication adherence study, using a wireless electronic pill bottle to remind patients with high blood pressure to take their medication.

The ongoing study measured a 27 percent higher rate of medication adherence in patients using Internet connected medication packaging and feedback services compared to controls.

In total, 139 patients diagnosed with hypertension and taking an anti-hypertensive medication were enrolled in a six month study starting in August 2009. Participants were required to have Internet access and an e-mail account to receive reports. Each participant was randomized into one of three groups: Those in the control group did not receive any communication or GlowCap services, while the intervention group received visual and audio reminders from the GlowCap as well as missed dose reminder phone calls, medication refill reminders and progress reports e-mailed to the patient, family member and/or primary care provider.

Participants in an intervention-plus group additionally received a financial incentive if they exceeded a monthly adherence goal of 80 percent.

"GlowCaps use real-time feedback loops to act on a number of behavioral motivators: reminders, doctor accountability, social support and help with refills," said David Rose, CEO of Vitality. "These are instructive findings for pharmaceutical manufacturers and payors who have a vested interest in improving patient outcomes with their products and services."

Study shows promise for electronic pill bottle | Healthcare IT News

Community Hospital of Long Beach Becomes a Part of Memorial Care

A few days ago I posted about the 2 hospitals being in talks and it appears the acquisition has taken place, although there are many items to take care of and an approval needs to be given.  I hope all works out for the best here and think this is the best that could have happened.

Long Beach Memorial Medical Center in Talks to Acquire Community Hospital of Long Beach – The Best Thing That Can Happen Here

Memorial will bring the facility into current day technology I am sure as they certainly need that direction after a number of years with so many in “tech denial”, imagewhich was a huge issue, as I noted in my prior post having to work with an IS manager a few years ago and what I ran into.  Those issues unfortunately are still alive and well today in some areas and if you don’t move with the times, the times run you over.  The facility will remain separate just as Miller’s Children’s hospital exists today and a few months ago I had a tour of their brand new facility with the hospital CTO. 

Miller Children’s Hospital Long Beach – Brand New Pavilion Carries Focus on Patients and “Green”

As mentioned in the article there’s the issue of retro fitting for earthquakes with the building that also needs attention, so there’s work to be done.  It is actually advantageous as far as grants and other issues to keep the two hospitals separate as a couple hospitals recently found out in Florida with issues.  Also worth a quick note, Memorial Care is also opening up 3 new retail walk in clinics in the Orange County area.  BD 

Memorial Care Health Systems Opening 3 “HealthExpress” Walk In Clinics Inside Albertsons/Sav-On Stores – Orange County

LONG BEACH - Long Beach Memorial Medical Center's plan to eventually own and operate Community Hospital of Long Beach will strengthen Community's future and allow for the care of more patients in greater Long Beach, the head of Memorial said Thursday. 

Long Beach Memorial and Miller Children's Hospital Chief Executive Officer Diana Hendel said that a potential merger offers the promise of "more stability and sustainability," especially during a difficult economy.

That effort will "look at the concerns, the wants and the needs of the community that (Community Hospital) serves," Arias said.

Hendel said that assuming ownership could take as long as a year or sooner, since it needs to be approved by the Attorney General.

For now, however, nothing changes, Hendel said. Community will remain a separate corporation with a separate license, staff and governing board. Community's Chief Operating Officer Diane DeWalsche and management team will remain, Hendel said.

When the transition is complete, Community would remain a separately licensed facility with a separate medical staff, just as Miller Children's Hospital is.

Memorial's CEO 'very excited' about takeover of Community Hospital - Press-Telegram

Alliance of Specialty Medicine Group Meeting With Congress Relative to Patient Access and Medicare Fix

This adds more support to a permanent fix for the Medicare compensation fix too, a good thing.  Perhaps this group can make some impact where others have not been able to get their attention. Most members of Congress from what I read though, are “non participants” in most areas of healthcare themselves.  I watched the Senate hearings in January of 2009 and none of them knew what a personal health record was as Kaiser and Microsoft explained it to the Finance committee.  Perhaps when discussions are done here some convincing of the membership may have some impact.  Check it out if you like, it was their video too.  image

Investing in Health IT: US Senate Testimonies

We wouldn’t have to spend all this time in many areas of healthcare explaining what is going on if members participated themselves, they would have a clue of what it is like to be consumer and at the same time increase their own knowledge.  Health is something we are born with and is not a choice like buying a car. Our members of Congress appear to be right up there in the group that is clueless by all means.

Americans Are Clueless When It Comes to Understanding Value and Use of Electronic Medical Records – Study

Here’s another study that was done due to non participation, so much of this just comes to you if you join in with a bit of Health IT, otherwise folks have to do studies and explain to you what is obvious to others that participate. 

HHS To Conduct Study on Patient Perception on Health IT – Got A Better Idea Why Don’t They Become E-patients Role Models, and Participants – Make IT Personal and Believable

I hope they have some luck here in breaking through some of the dead walls we have been attempting to tear down for years.  BD

WASHINGTON--(EON: Enhanced Online News)--More than 50 specialty doctors from across the country, representing the Alliance of Specialty Medicine, met in Washington, D.C. today to talk to their members of Congress about the recently passed health care reform law and the need to foster and protect patient access to high quality specialty care.

The specialty doctors were scheduled to meet with nearly 80 Members of Congress, from both sides of the aisle, and provide them with a physician’s view on the health care industry and discuss what can be done to better ensure that patients receive the highest quality of care. Physicians specifically highlighted the need to reform the Medicare physician payment system in a way that recognizes advances in medical science, technology, and treatment.

Doctors urged their representatives to permanently replace the outdated Medicare physician payment system, the sustainable growth rate (SGR) formula, and asked that Congress repeal the Independent Payment Advisory Board (IPAB), a 15-member board of non-elected officials who will recommend Medicare spending reductions in order to reduce the per capita rate of growth in Medicare in years when spending exceeds a targeted growth rate.

The Alliance of Specialty Medicine is an organization of national medical societies, based in Washington, DC, which represents specialty physicians in the United States. This non-partisan group is dedicated to the development of sound federal health care policy that fosters patient access to the highest quality specialty care. Member organizations include: American Academy of Facial Plastic and Reconstructive Surgery; American Association of Neurological Surgeons; American Association of Orthopaedic Surgeons; American Gastroenterological Association; American Society of Cataract & Refractive Surgery; American Urological Association; Coalition of State Rheumatology Organizations; Congress of Neurological Surgeons; National Association of Spine Specialists; Heart Rhythm Society; and Society for Cardiovascular Angiography and Interventions. For more information, please visit www.specialtydocs.org.

Doctors Gather in DC to Fight for Patient Access to Specialty Care | EON: Enhanced Online News

Nortel Asks Federal Court In Bankruptcy Proceedings for Permission to Terminate Insurance Coverage for More Than 4000 Retirees

Nortel filed for bankruptcy in January of 2009.  The company has arranged for the retirees and dependents the ability to sign up with United Health Care without a imagephysical exam.  No word yet on the cost though as that is the next issue, is it affordable. 

With many companies filing bankruptcy, this is yet one more group that is facing higher premiums and some perhaps with affordability being out of reach may also join the ranks of the uninsured.  Also in the news of late, many big companies are considering paying fines rather than to provide health insurance so how this all plays out remains to be seen with the big picture.  BD 

As it winds down bankruptcy proceedings, Nortel Networks has asked a federal court to terminate insurance coverage for more than 4,000 retirees and their dependents, many of whom live in the Triangle.

Nortel told the federal judge in Delaware who is overseeing the bankruptcy proceedings that the retiree benefits are costing the company $2 million a month. As of Sept. 1, Nortel wants to cut off retirees' medical coverage, prescription drug coverage, long-term disability and life insurance.

The move will almost certainly increase medical costs for the retirees and their families, who had been promised Nortel-subsidized health care coverage for life. In some cases Nortel was subsidizing nearly half the cost of medical coverage for its former employees.

Joe Samuel, who retired from Nortel in 2008 after 28 years with the company, fears a pre-existing condition will limit his insurance options. He's 61 and had his colon removed after he developed cancer.

Samuel said his health care costs him $560 a month out of pocket for him and his wife, with Nortel covering the other half of the cost.

"While the debtors recognize the importance of the benefits provided under the Retiree Medical Plan to their retired employees, the debtors have determined that it is necessary to terminate the plan at this state of the restructuring," the company told the court.

Nortel wants to dump retirees - Economy - NewsObserver.com

President Obama Message to Insurers – Time to Dump Risk Management Algorithms That Are No Longer Legal

This is basically it in a nutshell, some of those mathematical formulas are no more.  When you listen to the President speak, this is the entire issue of the entire imagehealth insurance business and what has made the American public unhappy over the last number of years.  Everyone understands business but when you look at the massive profits made where dividends took precedence over better care, nobody is happy.  The methodologies used for years are now coming to the surface with transparency and the White House is taking numbers.  

Sure it’s an ugly picture as to what has been allowed to continue as a business model for health insurance for years and nobody was minding the shop.  I have said this many times but the prior administration has not come to terms with how transactional charges that carve out profits for services rendered are eating up money that should be available for actual care. 

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

You can talk about it in many different fashions, but the bottom line is that algorithms were used for profit that crossed the line when it came to providing good care for many.  I wonder how the health insurance business will fully adjust with the new laws in place and no doubt, they will be looking for new “algorithms” and ways to slice the pie.  I think one thing that absolutely keeps this issue in the forefront is the “first hand” experience the President had with his own mother and he saw the nightmare first hand and knows it exists, so no matter how many fancy wrappers the packages contains, the same thing is inside.  As I always say, there’s a lot to be said for hands on experience, as it helps one stay in touch with the real world. 

Recently in California the news was big about increases with premiums and Blue Cross made a trip to Washington. 

HHS to California Blue Cross – Bring Your Algorithms to Washington And Explain

Back in December of 2008 health insurers recommended more business intelligence and algorithms and look where we are today, perhaps the type of algorithms used were for profit only as we have all seen their numbers.  We certainly need business intelligence to help us work smarter and more intelligently but again with transparency today, the reality of what business models were used is out in the open and frankly people don’t like it as it was not a “human” way of doing business.

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

The algorithms of healthcare as they continue to develop, fragmented and with the overall focus on risk management business models are not the answer to our current dilemma and as we continue to fuel the fire, as we have seen in the last few years it continues to elevate.  Perhaps if we could come together on algorithms with the same goal someday, we might just see some progress.

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

In summary it’s a risky game here as some of the very same people that used algorithms for profit are now vying for contracts to help fight fraud, and the big question now is can they be trusted any more today with new business models or are we going to see the same old mathematical manipulations to find holes to cut for additional high profit yields?  The President’s message today basically is a warning to cut to the chaise and become partners and operate with ethics.  BD 

WASHINGTON -- President Barack Obama and Health and Human Services (HHS) Secretary Kathleen Sebelius warned insurance companies not to impose outsize premium increases while healthcare reform is being implemented.

In a call with reporters, Sebelius said she is urging state insurance commissioners to investigate suspicious premium increases and said the federal government is also monitoring such increases.

President Barack Obama Gets Tough on Insurers, Releases New Regs - ABC News

CCHIT Requests Application to Become ONC Authorized Testing and Certification Body

With the recent news we may have been wondering where CCHIT, the body that has been certifying medical records would go and this is the answer.  CCHIT will imagesubmit to be a certifying party along with others to work with medical record vendor to certify integration and functionality.  BD

CCHIT is pleased that the Office of the National Coordinator for Health Information Technology (ONC) has issued the final rule to establish the temporary certification program for electronic health records (EHRs), and we are currently reviewing the rule to determine the impact it has on our plans for a final ARRA certification program.  We will request an application to become an ONC Authorized Testing and Certification Body (ONC-ATCB) as soon as it is available this week.

Assessing the final rule to establish temporary certification: A statement from Karen M. Bell, MD, Chair, CCHIT — EHR Decisions

Ozzy Osbourne Is Having His Genome Sequenced And Has A New Gig As a UK Healthcare Journalist

This could lead to some very interesting information, that is if Ozzy decides to share his information as I think we would all like to know what his secret is that has given him nine lives. 

He has also picked up a journalism gig writing a healthcare article in the Sunday Times of London, telling people what not to do.  In a related article from last year, imageKeith Richards says science wants his body too when he goes. 

Guitarist Keith Richards - Being A Medical Marvel

Ozzy never ceases to amaze all.  BD 

Ozzy Osbourne is among the “worried well” who are signing up for a luxury map of their whole genome.

And while the founder of Knome Inc. admits they won’t unlock the secret to the hard-living musician’s survival, they will be able to find some clues lingering in his liver.  “Ozzy may in fact share gene variants with people who may be able to metabolize recreational drugs better than others,” Nathaniel Pearson told the Star on Monday.

But given the high sensitivity of liver genes to revealing how the body deals with drugs and alcohol, Osbourne’s results might be a revelation.

Osbourne, though, is a paying client. He was likely spurred, said Pearson, by his new gig as a health columnist for the Sunday Times of London. He’s written two so far, riffing on syphilis, euthanasia and the laxative effects of spicy food.

“By all accounts, I’m a medical miracle,” Osbourne wrote in his introduction to the Dr. Ozzy Osbourne column. “I was knocking back four bottles of cognac a day. While filming The Osbournes, I was shoving 42 types of prescription medication down my neck, and that was before all the dope I was smoking.

“And then there was the rabies treatment I had to go through after eating a bat.”

Ozzy among first to get revealing whole-genome sequencing - thestar.com

What is a Creative Technologist – Hybrid Executives - We Have a Big Shortage in Healthcare

I have often talked about the need for “hybrids” in healthcare technology and I found the answer with this post – it’s the Creative Technologists that are also in short supply in Health IT.  I’ll add my 2 cents here too in that this is something you either have or do not have and yes it takes a lot of studying, research and the right personality to carry it off, and as mentioned in the article, not be afraid of code.image

The Creative Technologist spans many realms and areas and again as mentioned below, has the sense to hone in on what works and doesn’t jump on every new bit of praising new technology just for the sake of technology.  I see enough of that on the web myself.  

Instead of just one area of focus, the Creative Technologists “consider all media and experiences as their venue”.  I think I fit in here along this line with being able to work both in healthcare with the patient focus and also being able to relate to the physician and healthcare organization focus, and of course add in some code work with having written an EMR years ago and my sales and marketing background, an exhaustive mix at times too.  

“The job title itself is less important than being open to a hands-on and holistic view of technology as part of communication, as part of business, as part of the human experience, and therefore as part of culture.”

Below are some of the highlights from this article which I recommend reading and see if you have any of these people working at your place of employment as they are the '”bridge builders” needed today and are the thinkers.   Bill Gates earlier this year focused on the same subject with his speech given at Berkeley with trying to give the graduating students direction on where to fit in with the business world today.  “Technology doesn’t live down the hall anymore.” 

One item I talk about a lot as well is the “hands on approach” and that is the first key usually in identifying the “hybrid” or Creative Technologist, they do roll up their sleeves and participate with a big degree of enthusiasm.  The quote above mentions exactly this same fact and they are by all means “participants”.  BD 

Back in the 90s, the first time “convergence” was brought up as an important idea, I was asked as a “new media expert” to write an article on its importance – and found just about as many definitions for the term as places I looked. When I was part of a panel of psychologists defining “media psychology,” again, we found that just about everyone using the term defined it differently. Same with “engagement.” These still remain relatively loosely described constructs, words or phrases that, to quote Carroll’s Humpty Dumpty, “mean exactly what [we] choose it to mean – neither more nor less.”

We’re at a similar point with the term “creative technology.” What exactly IS a creative technologist? What makes her different from a programmer or a flash animator? What makes him different from a copywriter, brand manager, or strategist who can use Dreamweaver? What’s the role of a creative technologist at an agency or in our industry?

I think about this a lot, and not just because I head up the Creative Technology track at VCU Brandcenter’s graduate program and continually refine and redefine our curriculum, but also because I consider myself a creative technologist. And, believe me, I’m different from my students and graduates, and imagewe’re all different from other people who also consider themselves to be creative technologists. The confusion is exacerbated by the fact that the position called “creative technologist” is defined differently at places that use the name, and the role is filled at other agencies by other titles.

Here’s my take on it. CTs understand the business of advertising, marketing, and branding, take a creative, strategic and people-centric view of how to connect people and brands, and understand the kinds of mediating technologies that can best be used to make those engaging experiences where the connection happens.

They sketch with technology, just like a visual creative can sketch with a pencil.

They’re steeped in strategy, so the things they come up with make sense – it’s not about technology just for the sake of technology.

The experiences they design address real needs of people and brands.

Creative technologists share a creative and inquisitive view of the world. They’re on top of technology trends, aren’t afraid of coding (just as a modern visual designer isn’t afraid of Photoshop or Illustrator), and take both strategic and tactical approaches to creativity. They also understand that we’re in a business, and we’re solving business goals by addressing people’s needs as a priority.

In addition, there’s a shared creative technology mind-set that I describe as “learn, do, teach.” Stay up-to-date on the latest in technology, in research, in business, in design, in advertising, in human behavior. Then do something with it – build something, try out a new API, prototype an idea, make something talk to something else, come up with a new business model. Then show others how this stuff works – evangelize, be a resource, help people move beyond what they already know (and learn from them while you’re doing that). Rinse, repeat.

These “T-shaped” thinkers come from many different disciplines, and they’re likely to consider all media and experiences as their venue – every medium is enabled by a technology (even print and speech), and the fewer artificial barriers we put up, the better. Choose the right medium or media, and remember that something doesn’t need electricity to be interactive.

In agencies with a more siloed approach, first, please rethink that – technology can’t live down the hall anymore; it’s part of everything that everyone in the agency does. Second – CTs fit nicely in the strategic and creative functions, and as floating resources mostly affiliated with one function and that move where needed.

What the Heck is a Creative Technologist? « Mark Avnet

Nuance Acquires ShapeWriter Touchscreen Technology With Continuous Touch Keyboard Input

This is a little different from how we pretty much recognize Nuance with their expertise in speech recognition and the software from ShapeWriter is geared for touch screen use, both with mobile phones and with tablet computers.  As you can see below most mobile platforms are covered with software applications.

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Being a continuous touch application, this means you move your fingers or stylus from one area to another for entry without the standard keyboard punch, like shorthand.  BD 

From the Website:

“ShapeWriter™ Inc. designs software that makes mobile phones, tablet computers, game pads, and all other touch-screen devices more useful – and user friendly.image
Shape writing is the next step in the evolution of touch-screen interactivity. ShapeWriter's cutting-edge text input technologies make using these devices easier, faster and more enjoyable than ever before. Manufacturers can now create innovative new products with ShapeWriter serving as a reliable partner.

The speech-recognition and imaging software giant (NASDAQ: NUAN), based in Burlington, MA, has acquired ShapeWriter, a Silicon Valley-based spinout from the IBM Almaden Research Center, for an undisclosed sum. Nuance has not spoken publicly about the acquisition, but a message on the ShapeWriter website as of yesterday reads, “ShapeWriter, Inc. is now part of Nuance. The ShapeWriter continuous touch application has joined Nuance’s portfolio of patented text input solutions recognized as the industry’s leading predictive text technology.” E-mail messages sent to Nuance’s media representatives this morning were returned, but the company hasn’t commented on the deal yet.

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Nuance Acquires ShapeWriter, Ramps Up Pressure on Seattle Startup Swype | Xconomy