Physician Talks About the Red Tape, Forms and Administrative Time Required by CMS to get a Wheelchair for Patients – Sounds Complicated!

As the doctor mentions this falls under the DME (durable medical equipment) provisions, which also just happens to be the big area where a lot of fraud has taken place.  A specific visit is needed for this purpose, face to face. 

He also addresses the work the staff needs to do and he speaks of paper forms that need to be filled out in addition to the exam notes, and there’s follow up, additional phone calls and questions.  I have written about some of this before as relates to fraud, the crooks know how to bill better as they do not see patients and thus they are experts at getting all the required information together. 

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

Hopefully some of this will change with CMS in time with making the process easier for the patients who need them and again keep fraud out of the picture too.  One thing that is for sure is that there will be more needing mobility as our population and self included become part of the growing group of the aging due to the baby boom in the US.  BD  

WASHINGTON, July 16 /PRNewswire-USNewswire/ -- For years, homecare equipment providers have cited the many ramifications of the Medicare program's inefficient guidelines for documenting the medical necessity of power wheelchairs for beneficiaries.  It is the root cause of claim denials that are frequently reversed, the target of excessive audits and it restricts access to power wheelchairs for patients.  But rarely, until now, have physicians offered their perspective. 

It is enlightening to hear physicians share their experiences with the documentation process for power mobility.  Jerald Winakur, M.D., F.A.C.P., C.M.D., is Clinical Professor of Medicine and an associate faculty member at the Center for Medical Humanities and Ethics at the University of Texas Health Science Center in San Antonio.

This is how Dr. Winakur describes the documentation process required by the federal agency that operates Medicare, the Centers for Medicare and Medicaid Services (CMS). This was published in the American Association for Homecare bulletin, "Mobility Matters:"

Take what should be a simple task: obtaining a power wheelchair for my patients when they need one to stay in their home.  I cannot just order this device as I would a cane or a wheelchair or a walker, that is, by writing my request on a prescription pad and having it easily filled by a Durable Medical Equipment provider with minimal input and paperwork from me or my office. 

No. My patient must come in for a CMS-mandated face-to-face 'Power Mobility Evaluation' examination.  The equipment provider – prior to this special mandated exam – is in constant contact with my office gathering its own information from my patient's demographic and medical record.  I am mandated to see the patient face-to-face even if he/she had just been in last week – at the time I suggested he might benefit from a power wheelchair.

I could have been – should have been – seeing another patient for a real illness.  I can just picture my colleagues across the country in this same situation.  How many of them would take a look at the requirements, glance at the thick stack of paper, burn with rage, and toss the forms into the trash, saying to office staff:  'Just tell Mr. So-and-So that I don't have the time for this.  If he wants one of these things he's just going to have to pay for it out of his own pocket!

Here is my epiphany:  CMS wants me to react in this way. They want me and my colleagues across America to get angry and refuse to fill out the paperwork.  They have promised our elderly and disabled countrymen the benefit of power mobility, and industry has responded to the need.  

Meanwhile, CMS looks down the road and sees a tsunami of old folks rising up out of the demographic ocean. We can't possibly pay for all these scooters and power wheelchairs, they whisper to each other in closed-door meetings. Let's just make it ridiculously hard for a doctor to get one of these things for his patient. Let's swamp 'em with paperwork!  They hate paperwork!

I have now performed two or three 'Power Mobility Evaluations.' They take me most of an hour to see my patient, examine him or her, complete the redundant paperwork.  I am also required to write a chart note in the patient's medical record re-hashing the same information I have put on a form, rather than just putting the form in the patient record. Then there is all the work my staff has to do behind the scenes – several communications with the provider by phone.   I could have seen two ill patients – ones that really needed my ministrations – in this same time frame.

By its actions, Medicare stifles innovation, discourages physician participation in the program, and – most egregiously – restricts the autonomy of elderly and disabled citizens, the very ones it is the mission of CMS to help.  And, paradoxically, CMS ends up spending more money, not less, in the long run.  This is shameful behavior that deserves the transparent light of day shone brightly upon it.

Physician Outraged by Medicare Power Wheelchair Documentation Policy -- WASHINGTON, July 16 /PRNewswire-USNewswire/ --

Technorati Tags: DME, fraud, wheelchairs, CMS, physician, red tape, healthcare, Power Mobility Evaluation, medical staff

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Paul Allen Commits Most of His $13 Billion Dollar Estate to Philanthropy – Owner of the Seattle Seahawks and Co-Founder of Microsoft

He also owns the Portland Trail Blazers and is the 37th richest person in the world.  He also founded the Allen Spinal Cord Atlas  to provide the potential for researchers to unlock the mysteries of the spinal cord and how it is altered during disease or injuries.  One of his other medical projects is the Allen Institution for Brain Science which is a non profit medical research company.  The information from the Brain Atlas is open and free for the public to use. 

In 2009 he was diagnosed with non-Hodgkin's lymphoma cancer.  In case you missed it, this is the challenge from Bill Gates and Warren Buffett with donating to charity, the challenge.

Bill Gates & Warren Buffett – Call for Philanthropy To Give 50% of Their Fortunes To Help Others With “The Giving Pledge”

I wonder if we will see any rich bankers join the group, think there’s any chance?  BD 

Billionaire Paul Allen has taken his friend Bill Gates up on his challenge to publicly pledge the majority of his wealth to philanthropy.

Paul G. Allen, owner of the Seattle Seahawks, attends a Seahawks game in Seattle in December. Allen was undergoing treatment for non-Hodgkin's lymphoma.

Allen, who is 57, said today that he plans to leave the majority of his $13 billion estate to philanthropy to continue the work of his foundation and to fund scientific research. It was also a way of marking the 20th anniversary of the Paul G. Allen Family Foundation, which he started in 1990 with his sister, Jo Lynn Allen, and has since given 3,000 grants totaling about $400 million.

A month ago, Bill and Melinda Gates and Warren Buffett began a public campaign to encourage other billionaires to make a "Giving Pledge," and donate at least half of their wealth to charity.

Allen said he has planned to do that for many years, but he had not gone public with his intentions until now.

The Business of Giving | Paul Allen commits majority of his wealth to philanthropy | Seattle Times Newspaper

Technorati Tags: Charity, Paul Allen, Microsoft, philanthropy, Seahawks, Bill Gates, Warren Buffett, Billionaires, Lynphoma

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Avastin Study Shows No Extension of Patient Lives with Breast Cancer

In order for life extension provisions to apply tumor shrinkage is taken into consideration.  Avastin is still FDA approved but whether or not it it stays, time will tell.  Avastin is also approved for other types of cancer and is used in combination with chemotherapy.  BD 

WASHINGTON (AP) — U.S. government health scientists said Friday that follow-up studies of a Roche breast cancer drug show it failed to slow tumor growth or extend patient lives, opening the door for a potential withdrawal in that indication.

Additionally, the FDA said more recent data did not confirm the tumor shrinkage seen in earlier studies.

Patients taking Avastin showed significantly more side effects, including high blood pressure, fatigue and abnormal white blood cell levels.

On Tuesday the FDA will ask a panel of outside cancer experts to review the evidence on Avastin. The panel's recommendations are not binding, but the FDA usually follows their guidance.

The FDA has the option to remove drug's approval for breast cancer.

Study: Avastin didn't extend life of breast cancer patients - USATODAY.com

Technorati Tags: Roche, Genentech, Avastin, Breast Cancer, chemotherapy, FDA, study

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Stolen Advair Demonstrates Need for Tag Bar Coding of Drugs – Encrypted Bar Codes Could Identify Stolen and Counterfeits When Scanned With a Cell Phone

Here we go again with drugs stolen and then even sold back to the pharmacies who don’t realize that the drugs were stolen in the first place.  It’s no wonder I had so many pharmacists very “high” on having prescription drugs bar coded and tagged is this is also good for recall information too.  If you have not seen the news pictures of Times Square lately there’s a big bar code up there in lights. 

The city of New York is high on bar codes and is even placing them on garbage trucks, although I kind of get this picture in my brain of someone chasing a refuse truck trying to scan a bar code, but hey they have the right idea.

What you see here is QR codes which are not developed to the level of Microsoft Tags.   You can read all over the web on the comparison, and plus there’s the availability of encrypted gateways and the work in progress for authenticating for e-prescribing too which was my idea and is being developed by a company I chat with.

FDA Plans Recall Data Base – Nice Still Need Tags on the Products ...

QR Codes do not have the image availability of Microsoft Tags and all look the same too, so little personalization and this will become more prevalent as consumers will look at the bar codes as a “brand” in time. QR Codes do not have the same level of accuracy either, so for advertising purposes not a bit issue; however for using with FDA recalls, you need this of course to tie into SQL Server and put Microsoft Tags in the cloud if you want.  Again, drug, device companies, FDA and DEA missing the boat here.

Can you not think that in the case of the Advair stolen inhalers that the DEA would have liked a way to trace down the drugs not to mention the pharmacies.  With a 3D bar code, if they don’t register and go to the intended link, then you have your first alert right there as all of this can be controlled through an encrypted gateway and it makes it easier for the FDA to synchronize the information and deal with compliance as it would be automated way beyond what is done now.  The DEA might like this idea too for using encrypted tags to authenticate MDs when prescribing controlled substances too.

RAZCODE (Microsoft Tags) Using Smart Phones to authenticate MDs When e-Prescribing Controlled Substances

The Withings Scale already has the right idea in using Tags to authenticate a user and put your information into HealthVault.

Withings WiFi Connected Body Scale Integrates with Microsoft HealthVault To Use WiFi to Record Your Weight

The link below contains the permanent post and summary of what can be done with Bar Coding technology with Microsoft Tags and it will save lives as people get implanted with devices too that are not pulled from the stock room at the hospital.

Microsoft Tags – Microsoft MSDN Posts Ideas from the Medical Quack About Use in Healthcare!

Scan that knee, hip, defibrillator before you use it, takes a few seconds and will help hospital registries function and less mistakes.  Hospitals work hard to do a good job at this, but I continue to read stories to where patients have been implanted with a device that had been recalled and it was missed.  One story in particular involved a man who was implanted with a heart device that had been recalled and he died when it malfunctioned.  To me, this could have been a preventable incident and a life could have been saved if a simple scan would have put up the red flags to not use the device.

If a device or drug notification has changed, the Tag can be changed.  In the case of the FDA and a synchronized data base an encrypted token on the Tag from the FDA could be possible to ensure the information is not a copy cat and with the access to the page only allowed when it contains their token.  Unfortunately there will be those who try to copy cat out there, so this is just a little forward thinking on my part.  Without the FDA token, the information page would not be accessed. 

We had the recent “counterfeit Alli” warning and how easy would this have been to take your cell phone and scan the product to make sure you had the “real product” in hand?

Anyway after reading this post, please take a minute to vote on the poll I have on the blog, I appreciate it and perhaps we can get some dead heads working on a solution to where we can all benefit.  This is close to post #30 on this topic.  BD 

GlaxoSmithKline (GSK)’s report that that 25,600 Advair Diskus inhalers worth $5 million, stolen from one of its warehouses in August 2009, have started showing up on pharmacy store shelves illustrates that pharmacies are often the crime-ridden ghettos of the drug business.

Now we know the answer to the question no one asked: Although some stolen drugs may be sold on the street or by dubious internet operations, much of it is resold back to the original pharmacies they were intended for.

While you may regard your friendly neighborhood pharmacist as the kindly person who hands over sweet chemical relief when you’re sick or in pain, underneath the white coat is a cutthroat business riddled with crooks. About 34 percent of pharmacies have rogue employees who steal merchandise or cash, according to this survey, and 44 percent of chains reported employee theft.

Stolen Advair Shows How Pharmacies Are the Crime-Infested Ghettos of the Drug Business | BNET Pharma Blog | BNET

Technorati Tags: Microsoft Tags, HealthVault, heatlhcare, technology, medical records, e-prescribing, PHR, EHR, cell phone, Tags, scanning, mobility, health IT, HealthJibe, Razcode. Razoron, DEA, prescriptions, authentication, drugs, Health IT Advair

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Johnson and Johnson (McNeil) Lays Off 300 Employees and Will Re-Tool the Tylenol Factory

Other factory locations are slated to pick up some of the manufacturing as the factory will more than likely be closed until about this time next year according to this article.  It takes time to get a whole new lot of machines in place, and at the same time add some new technology as that is always part of the deal in this century. 

I didn’t realize how large the recall was, 136 million bottles, that’s a lot when you look at the actual count.

Perhaps maybe we could see some way of recalling products when all is re-opened for business again?  This would be nice.

Johnson and Johnson McNeil Healthcare Group Recalls Children’s Over the Counter Liquid Medications

If you would like to be able to use your cell phone as a scanner to find FDA recalled products when you finish reading here, please hash in a vote on the poll if you will.  This is by far nowhere near the end of recalls for J and J and every other device/drug company and we need a system soon. 

Microsoft Tags – Microsoft MSDN Posts Ideas from the Medical Quack About Use in Healthcare!

Recalls of both medical devices and drugs are growing for a number of reasons.  First of all, we have a lot more information available today than what we have ever had and we need to capitalize on this opportunity quickly.   We read in the news every day it seems about quality control issues, devices needing software updates and so on.  How do we get the word out quickly and efficiently?  If one has times they can certainly search the web and put out a full on effort to find all of this every day, but healthcare workers have the same problems we all have and that is time.  When human lives are involved, time is everything.

The opportunity to turn a cell phone into a “scanner” with real time information is huge.  As mentioned above, this can be a daunting task at times and we have people at all different stages with using technology today and in my opinion, using a cell phone makes sense, when all one has to do is open a program on the phone and simply “shoot and aim” and relative information would be available instantly.  Back in October of 2009 I kept reading about all the recalls of devices and created my first opinion/idea post here.  It just made sense to me. 

Tracking Medical Device Recalls – Sounds Like A Good Place for a Microsoft Tag Data Base at the FDA

Employees so far have been paid and now it appears severance packages will be offered and perhaps some rehired in time next year.  BD

Consumer pharmaceutical giant McNeil announced they would be letting go three-fourths of the workforce from their Fort Washington site.

Three hundred of the company's 400 staffers were given notice Thursday afternoon that they would no longer have a job.

A division of Johnson & Johnson, McNeil Consumer makes some of the most popular over-the-counter medicines like Tylenol, Imodium and Motrin.

The company shut down medicine manufacturing at the Fort Washington plant along Camp Hill Road in May following a major recall of Children's Tylenol. The 136 million bottles child's pain reliever were voluntarily recalled by McNeil after metallic flakes were found in the medicine.

McNeil Laying Off 300 Employees From Montco Plant | NBC Philadelphia

Technorati Tags: recalls, FDA, Windows Tags, safely, medical devices. heatlhcare, technology, scanning, drugs, cell phones, Tags, information, Johnson and Johnson, McNeil Consumer Healthcare

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Lilly Cutting 340 IT Jobs By the End of the Year

Maybe that drug heist was a little more costly than first thought back in March (grin).  If you missed it, use the link below to read up as 75 million dollars worth of drugs were stolen. 

Eli Lilly Pill Heist in Connecticut – Worth a Few Million on the Black Market And Should Have Been “Tagged” for Identification To Help Identify Reselling By the Thieves

Many of those stolen drugs though could have been potentially located though if they began “tagging” their products and it would help us find FDA recalls.   Also happening at Lilly is a lot of outsourcing so perhaps some of the jobs will end up with contracts instead of employees and just normal IT and tech itself is replacing workers in companies everywhere. 

Eli Lilly Outsourcing Clinical Trial Support to Thermo Fisher in Massachusetts

Lilly also anticipates a big loss on some blockbuster medications coming off patent, the big seller being Zyprexa, which was also one of the drugs stolen from the heist back in March.  BD 

Eli Lilly and Co. told employees Thursday that it’s cutting 340 information technology positions in Indiana.
The Indianapolis-based drugmaker eliminated 140 IT jobs in June through retirements, resignations and some cuts. Another 115 cuts will be made this month, and the remainder by the end of the year, according to an e-mail from Janice Chavers, a Lilly spokeswoman.
All displaced workers will get a few months to find another job within Lilly, although those opportunities are few. Workers who leave Lilly will receive severance based on their pay grade and time served with the company.

Lilly reveals plans to cut 340 IT jobs | Indianapolis Business Journal | IBJ.com

Technorati Tags: Pill, thieves, Eli Lilly, heist, pills, drugs, anti depressants, healthcare, drug companies, Microsoft Tags, technololgy, tech denial, HealthIT

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UCI Healthcare first in the West And California to Use DaVinci Robot for a Thyroidectomy

We can add one more procedure that is successful and applicable for robotic surgery, thyroid gland.  This is amazing how they make an incision in the armpit so there is no scaring on the neck for the patient at all.  Normally there’s a pretty good sized incision for this procedure.  Also in the news UCI just received a grant from the NIH in regards to moving technology faster to the doctors and hospitals.

UCI Receives $20 Million Dollar Grant From NIH To Expedite Moving Scientific Discoveries to the Doctors Offices

Also happening at UCI is the first FDA approved treatment for spinal cord damage with stem cell therapy. 

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

If you have not seen how the DaVinci Robot works, take a look at the video below and there’s some nice music that makes it very interesting as this procedure the robot doing prostate removal.  BD 

UC Irvine Healthcare is the first medical center on the West Coast and the only one in California to perform robotic thyroidectomies, a procedure that removes the diseased gland without leaving a visible scar on the neck. Dr. Jason Kim, associate clinical professor of otolaryngology and a head and neck cancer specialist, has performed robotic-assisted surgery using the daVinci Surgical System on three patients with thyroid tumors.

"We're excited to be able to offer this kind of surgery to the Orange County community and beyond," Kim said. "Traditional 'open' surgery to remove the thyroid gland requires a three- to five-inch incision across the front of the neck, and other minimally invasive surgical techniques can reduce the scar to about one inch. But using the robot, we avoid the neck incision altogether by making a small, easily hidden cut in the patient's armpit. That opening provides access for the robot's arms, which then are maneuvered by the surgeon to the thyroid bed."

Surgery using the daVinci robot has been performed for years in heart, prostate and gynecologic conditions, but minimally invasive robotic thyroidectomies are new. The American Cancer Society estimates that about 38,000 cases of thyroid cancer alone in addition to other thyroid diseases will be diagnosed in the U.S. in 2010, and it usually strikes people younger than 55.

UCI Healthcare first in the West to use robotic-assisted surgery for thyroid tumor

Technorati Tags: UCI Irvine, Thyroidectomy, robotic surgery, DaVinci, medical devices, surgery, hosptial, doctors, thyroid gland, FDA

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Payment Bundling by Health Insurance Companies – Complicated Algorithms Where the Query Leads to Lower Payments for Doctors

This is a good example from a physician citing an example of what happens when medical claims are evaluated and/or “scored” and in addition scanned for potential fraud.  The word “fraud” is an open end “algorithm” that runs to find fraud of course, but in addition it also runs queries to look for least cost routing when paying medical claims as noted here by this physician. 

As you can see here the patient is also being billed for a higher co-pay and not having all the details here I don’t know if this is “in network” or “out of network”.   What is also interesting are the new laws coming into place with certain preventive care items that will be free for consumers.  Anyway, as you can see here the EOB paid the doctor for the pap test, but not for the extensive time spent for the office visit.  The doctor has the expense of sending the pap test out to the lab and with a little over $50.00 paid together with increasing the patient co-pay that about covers the lab test and the doctor gets nothing for the 45 minutes spent with the patient. 

Health Insurance Business Intelligence “Scoring” Algorithms Interfering with Human Morals

Scoring algorithms on claims are powerful too, if you read about several dermatology offices that within 5 days were cut off from ALL the insurance policies from paying, they related it back to the Ingenix scoring procedures used for detecting “potential” fraud.  This destroyed patient/doctor relationships and a couple offices had to close.  When you stop and think of not just one carrier, but all stopping payment within 5 days with no notice, this is scary.  Court and legal cases against Ingenix in the process as the other carriers subscribe to their business intelligence algorithms used.

Healthcare Reform Bill – Expect “Fraud Algorithm” Use to Increase With “Scoring” the Insured With Our Leadership Trapped Embellishing Old Paradigms

In addition there are many 3rd parties who have created algorithms that also score and query healthcare claims to detect “fraud” but in essence we don’t really know the exact levels of business intelligence being used here.  Not too long ago in the new Blue Cross ran a “breast cancer” algorithm to identify those patients so in this case above who knows what other formulas were ran to come up with the payment described by the doctor.

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

The scoring process is nothing more than mathematical queries to inquire and find out if all the conditions set forth with the algorithms are met, and if not, claims are adjusted or denied.  To save money and be effective at cost control, insurers want more algorithms.

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

This is partly why we live in a world of “Forest Gump Health Insurance” in not knowing what we are going to get as these queries and algorithms are changed all the time, so who can keep up?  When business is needed or bad public relations with news in the press occurs, formulas get adjusted to let a few more through and when things get back to normal,they are adjusted back to either prior levels or carry a whole new algorithm that is focused of course on maximized profits for care. 

This is just plain and simple business as all companies do it as I worked in logistics and they do the same thing with sales and brining on new accounts, the qualification levels float according to business levels.

In healthcare however, it is a different story as people are not getting affordable care and low compensation rates as cited in this example lead to a real “bad taste” for the way insurers do business with a lack of ethics and the mathematical formulas controlling all, no matter who the patient or doctor may be as shareholder dividends by law come first and that doesn’t make patients or doctors fell very well today about offering the best care. 

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

Nobody regulates and certifies their algorithms as is done with medical record software and they simple get by with saying “whoops” or we made a mistake for the most part, sad as the entire issue of good care doesn’t take place until the bills get paid.  We might start thinking about certifying the practices of the “other side” of this entire equation as it’s really not fair for one side to be scrutinized and not the other.  BD 

I am staring at an EOB (explanation of benefits) from Blue Shield of California for a patient I saw for a physical exam and pap test. This patient had recently been hospitalized with a life threatening throat infection and abscess and saw me for needed follow up. I spent about 45 minutes with the patient, reviewing the events leading to hospitalization, coordinating the medications, as well as addressing the routine screening and examination of a middle aged woman with some chronic health problems.

I billed Blue Shield for a 99215 (comprehensive physical) and a G0101 for the Pap Test exam and processing. Blue Shield has reimbursed me $25.55 and states the patient owes another $25.56 as a copay. The EOB says they will pay zero (0) for the exam because "This procedure is included with the payment for the primary procedure"

Yes, they have decided the $51.11 for the pap test is payment in full for the entire visit. This is called "bundling" the payment and they have chosen to bundle at the smaller amount. The 99000 code for handling of the specimen is denied as "These services are not eligible for separate reimbursement"

Thanks, Blue Shield. (Annual revenue $9.7 Billion). That is one reason only 2% of medical students are going into primary care Internal Medicine.

City Brights: Dr. Toni Brayer : How Insurance Companies Kill Primary Care

Technorati Tags: Blue Shield, health insurance, doctors, medical claims, scoring, co-pay, reimbursements, examination, pap test, algorithms, politics

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Verizon Announces Their Entry into the HIE Market – VHIE Personal Health Records In the Cloud

Update-Correction

It was a bit confusing to myself to make sure I covered this correctly; however, Verizon was kind enough to inform me of the fact that the current focus is going to be with connection physicians and hospitals, with the PHR capabilities coming on line later, but you can see the groundwork is being laid to facilitate the entire connection in time so the consumer side will evolve in time.  

The original post is below: 

We have one more entry into the already over crowded PHR business that consumers are slowly beginning to embrace.  MedFX technology stands to perhaps make some money here, the technology used for the personal health records.  We already have Google Health, HealthVault and several others offered by insurance companies and 3rd party medical billing/analysis companies.  Just like the EHR race, this one is going strong too with PHRs. 

The service is not free though and doctors offices will have to “pay per use” so compared to the “free” programs out there, this might be a little slow taking off as the value with PHRs right now for consumers has really not been evaluated by most and heck so many don’t even know what a PHR is.  BD 

Verizon Business today announced its entry into the health information exchange business, launching a cloud-based service that makes personal medical records available to authorized medical personnel. 

The Verizon Health Information Exchange (VHIE) will provide a unified view of a patient's medical record that can be accessed via an Internet connection from a doctor's office or hospital.

Built using Oracle Corp. (Nasdaq: ORCL)'s Enterprise Master Patient Index, which enables all the medical records of a given patient to be associated to a unique key, the VHIE will have built-in identity management to protect individual records, and Verizon security to prevent denial-of-service attacks and other threats.

The VHIE is Verizon's latest foray into vertical applications for the healthcare industry, which began with the creation of a devoted business unit, Verizon Connected Health Care Solutions, and which includes the hiring of people from the health sector, such as Grundler.

Patients will be able to control who has access to their records and decide which records are available, Grundler says.

The viewer and presentation layer of the VHIE are based on technology from MedFX.

"Jane Doe can allow access to her health records, but prevent access to her mental health records or her HIV status, for example," he says.

Light Reading - Service Provider IT - Verizon Launches Health Information Exchange - Telecom News Analysis

Technorati Tags: Verizon, PHR, personal health records, Oracle, Verizon Connected Health Care Solutions, EHR, medical records, VHIE

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And Now A Word About Privacy – Digital Signs Using Hidden Facial Recognition Software To Market You and Store Data – Are They Playing in a Physician’s Office Near You?

This might be a good time to check out the “free” digital displays we all see running in physicians offices all over, and read the privacy policies of the vendors providing this service.  I am not saying that this is the case, but rather creating an awareness of potential marketing as most of the advertising we see is usually paid for by pharmaceutical companies and other health organizations.  This article mentions the use of signs in Times Square in New York and even some bill boards so there’s really nothing to stop the expansion into other areas as we all know drug companies, device companies, hospitals, etc. are all advertising today and competing to capture the consumer every where you turn.  

Digital Signage is the word used to describe this type of advertising and you can read more at Wikipedia.  The video below gives a basic introduction to digital signage.  We are already beginning to see a lot of this in retailing.  Cisco and Intel have invested a lot of time and money for these capabilities.

Anyway, when placing digital signage in your office, you might want to inquire if any hidden cameras are provided and what data is collected.  Some are very upfront and will tell you, while others may or may not be upfront.  This company has come up with a vending machine that tells whether or not you are smiling.  In healthcare we always gear towards the use of new technologies with medical records and better care, but there’s a world of advertising out there to be aware of as well. 

In healthcare there are HIPAA requirements and recently in the news, Health IT partners are responsible for privacy so again before installing one of the “free” digital networks in your office, you might want to thoroughly review and ask questions and see if in fact any data is being collected, and if so by who and where it is being used.  There’s a lot of gray area with this new technology and laws and rules to protect privacy are few and far between.  BD 

In the 2002 film Minority Report, video billboards scanned the irises of passing consumers and advertised to them by name. That was science fiction back then, but today’s marketers are creating digital signs that can display targeted ads based on information they extract from examining the contours of individual human faces.

These smart signs are proliferating in commercial establishments and public places from New York’s Times Square to St. Louis area shopping malls. They are a powerful innovation in advertising, but one that raises compelling privacy issues - issues that should be addressed now, before digital signs that monitor our behavior become the new normal.

The most common name for this medium is digital signage. Most digital signs are flat-screen TVs that run commercials on a continuous loop in airports, gas stations, and anywhere else marketers think they can get your attention. However, marketers have had difficulty determining exactly who sees the display units, which makes it harder to measure viewership and target ads at specific audiences. The industry’s solution? Hidden facial recognition cameras.

The tiny cameras can estimate the age, ethnicity and gender of people passing by and can track how long a given person watches the display. The digital sign can then play an advertisement specifically targeted to whomever happens to be watching. Tens of millions of people have already been picked up by digital signage cameras.

The marketing business thrives on detailed audience information for tailored advertising. Indeed, the industry already acknowledges audience profiling as the key to its future success. There will be a greater push to identify individuals with digital signage as soon as it becomes more cost effective to do so.

http://www.cbsnews.com/stories/2009/07/14/opinion/main5158471.shtml

Technorati Tags: Privacy, digital signage, heatlhcare, physicians, tv screens, technology, advertising, marketing, kiosk

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FDA Approves Test for C. Difficile Meridian Bioscience – Results in an Hour

C Diff, along with MRSA are one of the hospital acquired infections and can lead to death.  C Diff has been associated with unsanitary conditions at some facilities and the NHS had real issues with C Diff a few years ago.  At any rate the test can have results back in an hour which is faster than any other tests currently available.  C Diff is an intestinal infection and there are sometimes more than one treatment to get rid of it and you can read about the last ditch effort below. 

The C Diff Cure, an effective (but yucky) procedure

The process involves a stool transplant and is running about a 95% cure rate, so when faced with the choices of living with it, or giving this a try, I would think the procedure is now seen in an entirely different light.  BD

Diagnostics company Meridian Bioscience Inc. (NSDQ:VIVO) received the go-ahead from the Food & Drug Administration to sell its first molecular test — illumigene C. difficile. 

The Cincinnati life science company has has success making diagnostic test kits that detect pathogens like C. difficile which is a bacterium that can cause diarrhea and, in severe cases, a life-threatening inflammation of the colon.

Its illumigene testing system detects the presence of the toxin-producing region of the C. difficile DNA within an hour. Already launched in Europe, illumigene C. difficile uses an amplification technology that makes it easier and less expensive to use than some other molecular tests in the fast-growing market for rapid test kits.

Meridian Bioscience lands FDA clearance for C. difficile test | MassDevice - Medical Device Industry News

Technorati Tags: FDA, C diff, C.Difficile, Meridian Bioscience, hosptial acquired infections, healthcare, lab

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UnitedHealth Group Owns a Bank With Deposits Surpassing a Billion – OptumHealth Bank FDIC Insured

OptumHealth is an FDIC member and is a little unlike other banks in the fact that it is not a retail bank and focuses on HSAs, health savings accounts.  This is perhaps one more side of United you may not have known about.  Why a bank?  It makes the deposit process from HSA’s easier with depositing and transferring funds with premium payments.   Only 1/4 of the clients are individuals while the rest are employer based insurance clients with HSAs. 

From the website:

“OptumHealth Bank, Member FDIC, is dedicated to health care banking. It is a leading administrator of health savings accounts (HSAs) for individuals and families, with more than 500,000 accounts. OptumHealth Bank also offers credit programs to individual account holders to help them pay for out-of-pocket medical expenses.

OptumHealth Bank is part of the financial services unit of OptumHealth, a health and wellness company serving more than 60 million people. OptumHealth is a UnitedHealth Group (NYSE:UNH) company.”

Services are available to both individuals and employers and there’s a broker’s section for other needs.  The company with subsidiaries is more than just providing straight health insurance and with algorithmic formulas set up to do transactions it becomes an add on type sale for those who are insured through United. 

I don’t know how or if this fits into the medical cost ratios?  How is a bank listed and being it is related to savings to pay for care, does it fall under healthcare services?

Health Insurance Medical Loss Ratios – How Will The Definitions Between Healthcare, Other Administrative Costs and Profits Be Spelled Out – May Need Some Algorithms to Figure It Out

None of the insurers met the recent HHS deadline for submitting their medical loss ratio information and when you have a company such as United I can’t help but think this is very complicated and of course we want transparency with all the data reported correctly as last numbers I remember seeing showed that their ratio was at 69%, way below the 80% goal set by HHS.  In California we have had a state law that required carriers to be at 80% or better for a few years, and how it is really enforced, I don’t know, but there’s a lot of algorithms at work here. 

Consumer Watchdog Warns Sebelius on Health Insurers – Good Reason for This as Insurer Subsidiaries Are in The Game to Play Just As Private Equity Groups Diversify and Collaborate Holdings

Today everything is not at face value with companies being bought and sold right and left with new types of subsidiaries working together with data in ways that have not been done in the past, so the legalities are complicated.  BD 

The success of the accounts means that UnitedHealth now owns a bank that is in the curious situation of having more than $1 billion in deposits, even as it doesn’t engage in any retail banking.

UnitedHealth established the bank (then called Exante) in 2003 as a way to simplify the financial side of health care for its customers. The bank opened its first HSAs in 2004, after Congress’ late 2003 passage of the Medicare Modernization Act which allowed for tax-exempt deposits and withdrawals for medical expenses.

OptumHealth offers three types of HSAs, as well as tax-advantaged health care savings and spending accounts, debit-card services, benefits administration services, and payment products. About three-quarters of the bank’s 1.6 million accounts are employer-generated, while the other quarter are individual accounts.

HSA deposits surpass $1B for UnitedHealth’s OptumHealth Bank - Minneapolis / St. Paul Business Journal

Technorati Tags: UnitedHealthGroup, health insurance, banks, money, HSA, Exante, premiums, OptumHealthBank

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ZocDoc Secures More Funding – Find Doctors and Make Appointments Online

So far the service is available only in a few cities and the new funding will be used to expand the service.  I tried the site myself and it is pretty straight forward as you can see the doctors, the insurance carrier contracts they honor and then set your appointment.  The technology is built around SQL Server and Dot net. 

The service is free for patients and doctors pay a small monthly fee to be listed.  The doctors like it as cancellations can be filled quickly as the openings appear on the website.  The video above from Health Tech Today gives a pretty thorough picture with Dr. Crounse from Microsoft interviewing the founder of the company.  I can see this service growing as it is very simple and easy for the consumer to navigate and set their appointment.  BD

A New York-based start-up called ZocDoc aims to expand its service of online doctor and dentist appointment bookings with a $15 million Series B venture round led by the Founders Fund. Existing investor Khosla Ventures also contributed.

The money will be used primarily to help ZocDoc expand geographically. Currently operating in New York, San Francisco, Washington, D.C., and Chicago, the company is soliciting users to vote on what its fifth city should be (the options include Boston, Los Angeles, Philadelphia, and Seattle). But expanding requires complicated groundwork: ZocDoc aggregates participating doctors; lets users search for them by availability, location, and insurance plan match-up; and then enables users to book appointments online. The service is free for users. It's a big change from the status quo.

Big investors backing doctor-booking site ZocDoc | The Social - CNET News

Technorati Tags: ZocDoc, appointments, doctors, healthcare, health IT, technology, scheduling web portal

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Ex Cerner President Hired by Trizetto as CEO – More Money on This Side As Payment Algorithms Are Not Certified and Held Accountable as is EHR Software

It appears reorganization and putting strategic individuals is now taking place since the company, Trizetto,  was acquired by Apax Partners Private Equity.  A couple weeks ago I somewhat challenged a study put out as I questioned where in the world they found such highly educated consumers for these results so again you have to read carefully what is out there today as everyone is marketing. 

Trizetto Group (Wholly Owned Subsidiary of Apax Partners London Based Private Equity Firm) Says Their Study Indicates the US Healthcare System is Ready to Adopt Value Based Insurance Designs – Marketing At Its Best

I noticed too that the headquarters mentioned here was moving to a new locations and living in Orange County I can tell you their current location is among the most expensive areas in the country here.  I have said this before and I repeat it a bit but there are way too many companies on the payer side of things with healthcare and we all pay for this in higher costs.  Certainly there needs to be enough companies to audit and create new algorithms for risk management intelligence, but the US as a whole has way too many.  It is an industry that feeds on itself due to the fact that as soon as someone create one new grand results oriented algorithm, here comes another to either outdo what is being used or combines new elements to process the code already in place.  Like I said it feeds on itself and creates more expensive transaction fees which all take a chunk out of paying a medical claim. 

As a matter of fact just this week the White House, US CIO and a few others looked at the VA new financial system overhaul and canned it.  This is a good indicator I feel as far as having a “glut” on financial and business intelligence software, especially when it is all to generate profits.  One company noted as a partner for software is Ingenix, the wholly owned subsidiary of UnitedHealthGroup that is now in the process of paying claims for 15 years of under payments to doctors and patients. 

VA Cans $500 Million Financial System Overhaul – Financial Transactions - The Business That Keeps Feeding Itself

Hopefully some of these businesses will either merge or go away in some point in time and actually they should get better at what they do with some standards as I mentioned in the title, their algorithms are not certified and accountable like the medical records side, which is where all the monetary bleeding is taking place while record profits are made on the other side.  We could see more EHR executives jump ship while the getting is good too as this is what is driving everything today, cost with little or not perhaps not enough value left for human ethics. 

One huge money maker for Trizetto has been CareMore, a Part D Medicare management company who uses their services.  Again over the years with cutting back and gaining better efficiencies there’s only so far you can go before vital and important care issues start to be affected.

CareMore Live On TriZetto's Clinical CareAdvance System Algorithms - Healthcare Business Intelligence

About a year ago I started speaking about a Department of Algorithms and perhaps that is not too far down the road.  BD

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

NEWPORT BEACH, Calif.--(EON: Enhanced Online News)--The board of directors of The TriZetto Group, Inc. today announced that Trace Devanny, former president of Cerner Corporation, joins the company as its new chief executive officer, effective July 19. Devanny also will be appointed to the board of directors.

“Trace is a highly experienced and growth-focused leader,” said TriZetto Founder and Chairman Jeff Margolis. “The board, along with our outstanding management team, look forward to the many ways TriZetto and its customers will benefit from his tremendous healthcare information technology experience and proven global growth expertise. Trace’s extensive knowledge of provider organizations will contribute greatly to achieving TriZetto’s Integrated Healthcare Management vision as we continue to drive the coordination of benefits and care to deliver more value for every healthcare dollar spent.”

Recruited into taking a two-year break from Cerner, Devanny was previously president and chief operating officer of ADAC Health Care Information Systems, where he led a turnaround of the company’s operations. Earlier, over a 17-year career at IBM, the healthcare experience he developed, combined with his extraordinary record in sales, led to his appointment to lead IBM’s healthcare business in the Mid-Atlantic region.

TriZetto Appoints Trace Devanny as Chief Executive Officer | EON: Enhanced Online News

Technorati Tags: TriZetto, medical billing, mergers and acquisitions, Cerner, CEO, president, healthcare reform, technology, EHR, health insurance

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Mylan Pharma Buying Bioniche Pharma in Ireland for $550M From Private Equity Owners

Mylan is the 2nd largest generic drug company in the US and with this acquisition with Bioniche in Ireland, they will have access to a new pipeline of drugs that are in development for cancer and other illnesses as well as an animal health line of products.

Most of the products with Bioniche are sold to hospitals so a new brand name, Mylan Institutional  will be applied once the deal has closed.  In reporting on this blog there’s a lot of deals going around and companies, health insurance plans, hospitals, etc. all changing hands quickly today.  BD

Mylan Inc. said Wednesday that it will buy Bioniche Pharma Holdings Ltd., a company that makes injectable drugs, for $550 million in cash.

Private equity firm RoundTable Healthcare Partners owns a majority stake in Bioniche. Mylan said Bioniche has about 30 products on the market. The Ireland-based company focuses on injectable drugs that have limited competition and which are difficult to develop and manufacture. Bioniche posted around $130 million in revenue in the 12 months ended May 31.

ICC Private Equity Fund, which is managed by the venture capital division of Bank of Scotland Ltd., is selling its stake in the company, too.

Mylan to buy Ireland-based Bioniche for $550M - BusinessWeek

Technorati Tags: Mylan, Bioniche, private equity, RoundTable, ICC Private Equity, drugs, pharma, science, research, Ireland

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Suffer from Urinary incontinence – There’s an Mobile Application To Find a Bathroom - Sit or Squat

It’s time for a little humor here but this again can be useful for anyone and so far they have over 90,000 toilets listed.  Of course there’s a mobile version as that’s when you need it, on the phone!  We need to get some more listed in Orange County for sure with Sitorsquat. 

There’s even a function to sent a text and get a message back for the closest restroom too.

SMS/Texting
Text message the word "sitorsquat" to DOTCOM (368266) and follow the instructions to find the closest bathroom to you, very similar to how we have made donations via our phones except this is a little different type of donation if you will. 

If you find a toilet you like, add it to the data base so others will be aware, I like this idea of peer to peer toilets as you never know when you may e in need.  BD

Urinary incontinence (UI) is any involuntary leakage of urine. It is a common and distressing problem, which may have a profound impact on quality of life. Urinary incontinence almost always results from an underlying treatable medical condition but is under-reported to medical practitioners.^[

Urinary incontinence - Wikipedia, the free encyclopedia

Technorati Tags: Incontience, sitorsquat, restroom, incontinence, toilet, bathroom, peer to peer, mobile apps, cell phone

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Senate GOP Demanding to Hear From Berwick – Perhaps They Would Learn More About Healthcare if They Asked Some Intelligent Questions….

As far as answering questions, they could get educated as long as there’s no effect on Dr. Berwick’s appointment after all it has been years since CMS has had a director.  What is interesting is the point they make about how he feels about the NHS system. Well the NHS is going through a major shift here so what he has referenced is the past operation as nobody knows yet how the new revisions will work, so that’s a dead topic of sorts. 

NHS Putting Doctors Back in Charge Throughout the System – Unknown If Savings Will Occur & US Health Insurance Companies May See Business Opportunities Through Managing Care With GPs

On the qualifications side, where would you find someone better qualified, it’s just a political battle and one more opportunity to stall progress.  He is only one person in the entire scheme of healthcare reform, an important one, but not crucial enough to stall and take more time that could be devoted to other pressing issues the US has right now.  I think Dr. Berwick can hold his own pretty well.  BD  

Senate Republicans are demanding to hear from Don Berwick, the physician President Barack Obama recess-appointed last week to run the Medicare and Medicaid programs.

Republicans on the Finance Committee, which has jurisdiction over the post, say that not holding a hearing with Berwick would “result in circumventing the open public review that should take place for a nomination of such importance” and “casts a shadow over his legitimacy and authority to serve as administrator during a critical time for CMS.”

They argue in a letter to Committee Chairman Max Baucus (D-Mont.) that Berwick needs to answer questions raised about his qualifications — namely, question they have regarding his statements in support of the British health care system and rationing. The letter was signed by all 10 Republicans on the committee.

Senate GOP wants Berwick hearing - Jennifer Haberkorn - POLITICO.com

Technorati Tags: Berwick, healthcare, GOP, NHS, government, politics, Senate, Finance, Baucus, CMS

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Digital Drugs – MP3s that Induce a State of Ecstasy – I Dosing?

This is a bit wild with the statement saying that the music can bring about the same feelings as being on weed, Cocaine, opium and peyote, but I can believe that certain sounds can be irritating and some very relaxing, we all see that in real life. 

I can also see this as being a form of disconnect from the world too, but the sites come along with a 40 page brochure that tells one how to get addicted.  I guess between the sounds and real drugs, this seems like a better choice for the body’s sake if you had to choose.  The dangers though as stated in this article though is that the music does in fact lead to getting addicted to real drugs with links and so on.  

Some schools are now banning IPods as well but it looks to me like a means to escape for a while from reality as that is what real street drugs are supposed to do and this seems a bit less costly.  It’s all about the fascination of the mind today it seems and we can’t get enough mind game analytics to read up on:) 

I find tons of articles in healthcare addressing what effects certain things and devices have so it sounds like the kids are finding their own way out to disconnect for a while, as an overdose of sensors and devices can certainly have the potential to send one off to the funny farm.  Yesterday the electric company was all excited in telling me that soon I can have alerts sent to my phone on how much power my house is using, do I want that, of course not as it’s too much with everything else I do with my phone, so you can see how integrated everything is becoming.

I also wondered too about how long before the electric company will tie into a blue tooth device taking my blood pressure so we could analyze that too and see what effect looking at my electricity use has on my blood pressure (grin). 

Yes this is in jest but I am trying to suggest that some of what we analyze today and combine with other data can get pretty stupid, but it’s out there is someone believes they can market it, and thus we have a difficult time today in determining “what is marketing and what is a substantial analysis”. 

So second thoughts maybe I should try out one of these songs and zone out for a few (grin) as it physically is not a pill or anything to ingest or inhale by all means. (grin).  BD 

Kids around the country are getting high on the internet, thanks to MP3s that induce a state of ecstasy. And it could be a gateway drug leading teens to real-world narcotics.

At least, that’s what Kansas News 9 is reporting about a phenomenon called “i-dosing,” which involves finding an online dealer who can hook you up with “digital drugs” that get you high through your headphones.

I-dosing involves donning headphones and listening to “music” — largely a droning noise — which the sites peddling the sounds promise will get you high. Teens are listening to such tracks as “Gates of Hades,” which is available on YouTube gratis (yes, the first one is always free).

Report: Teens Using Digital Drugs to Get High | Threat Level | Wired.com

Technorati Tags: I Dosing, street drugs, addictions, healthcare, psychology, music, MP3s

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