UC Berkeley DNA Testing Program Changes and Students Will Not Receive the Results

Around 700 students though already have their results so there were in under the wire.  The test still will be conducted but with anonymous identities and used for research.  No word yet on any changes at Stanford as their program offers interpretations and are not used for research and the program is offered to medical and graduate students in the form of an eight-week elective summer class so it’s not a mass testing. 

Stanford cannot use the students' physical DNA samples for research because 23andMe destroys DNA samples after testing, and Navigenics—although it may preserve the sample for a year—eventually does the same (also giving customers the option to request earlier destruction).  You can read more about both programs at the link below.  BD 

Stanford And U.C. Berkeley Offering Of Genetic Testing Is To Help Ensure Students Are Prepared to Handle Future of Personalized Medicine

Under pressure from public health officials, the University of California, Berkeley, professors behind a controversial plan to genetically test incoming freshmen and transfer students said they will scale back the program so that participants will not receive personal results from their DNA samples.

The university raised the ire of genetic-watchdog and privacy groups in May when it first launched "Bring Your Genes to Cal." The voluntary program is believed to be the largest genetic-testing project at a U.S. university.

The 5,500 incoming freshmen and transfer students for the fall semester received testing kits in the mail and were asked to submit cheek swabs of their DNA to kick off a yearly exercise to involve the new students in a common educational experience centered on a theme. This year's theme is personalized medicine.

UC Berkeley will not send students DNA results | ScrippsNews

Technorati Tags: Stanford, Berkeley, university, students, DNA, genomics, personalized medicine, heatlhcare, 23AndMe, Navigenics, tests

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El Camino Hospital Will Lay Off 140 Employees - 5 to 6% of The Hospital Workers

The reason for the cutback is a decline of patient volume and revenue.  If you are not familiar with this hospital, they are in my opinion the most wired hospital in the US and even have translator technology and the end of the beds in the ICU. 

They have done their analysis to target savings but it was not enough to stop having to lay off employees. 

Technology in Use at El Camino Hospital – Mountain View, CA (Video)

Patients here even use biometric check in with the palm of their hand.  This new facility is full of robots too. 

Patients at El Camino Hospital Check in with Biometric Authentication – Patient Security

This is a not for profit facility that has it’s own genomics center as well.  BD

El Camino Hospital in Mountain View, Calif., has announced plans to lay off 140 employees because of an ongoing decline in patient volume and revenue.

The hospital will issue 195 worker adjustment and retraining notifications to potentially impacted employees warning them they could be laid off in 60 days.

El Camino Hospital to lay off 140 - Healthcare business news from Modern Healthcare

Related Reading:

El Camino Hospital Opens New Facility in Silicon Valley – Most Wired Hospital

Patients at El Camino Hospital Check in with Biometric Authentication – Patient Security

Genomics Center Opens at El Camino Hospital - California

Steve Shihadeh, VP Microsoft Health Solutions Group – The Amalga Software Solution for Aggregating Hospital Information (Interview)

Amalga at El Camino Hospital Helping to Monitor the Status of Swine Flu – everyone can use Virtual Earth for Global Tracking

Technorati Tags: Health IT, Technology, healthcare, Silicon Valley, El Camino Hospital, earthquakes, hospital, speech recognition, Amalga, California, wireless, Microsoft, interventional procedure, layoffs

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The iDuck Floating Wireless Speaker–This Has To Be A Favorite for the Medical Quack

You have just love this one, plug in your MP3 player or IPod and let the music roll.  It is also a radio.  The design here is good too as the “egg” which stays out of the water where you plug in.

Rub a dub dub, I can another duck in the tub!  I do have to say this is some of the best use of wireless that I have seen and it doesn’t even bother me to take my blood pressure either, but I shouldn’t speak too soon as who knows in healthcare device development they may have a wireless duck that does all of that one day.  Would like to see how the FDA would deal with that one for approval <grin>.  BD  

This has to be the ultimate rubber ducky (except that it's not rubber) - one that wirelessly plays whatever you've got on your MP3 player! Far from an exercise in animal cruelty, this iDuck Floating Wireless speaker is in fact a rather neat way of livening up bath time without sending your iPod hurtling underwater like a diving musical submarine. No wires, no electric shocks, just a great fun musical bath.

iDuck Floating Wireless Speaker | IWOOT

Technorati Tags: iDuck, wireless, humor, electronics, radio, Ipod, Medical Quack

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FDA Purchasing Additional Generic Drug Simulation Software for Scientists–Faster and More Efficient Than Physically Dissolving Tablets and Cleaning Up the Lab

The FDA is not alone in their thinking here either as earlier this year Bill Gates invested in drug simulation software too.  According to the press release an additional 10 licenses were purchased. 

Bill Gates Invests In Software Company That Predicts and Helps Generate Creating New Drugs

In addition the company mentions a training course upcoming for the FDA scientists relating to their GastroPlus software. 

From the Website:

“GastroPlus is an advanced software program that simulates the absorption, pharmacokinetics, and pharmacodynamics for drugs in human and preclinical species. The underlying model is the Advanced Compartmental Absorption and Transit (ACAT) model. Since 1997, Simulations Plus has evolved the ACAT model to a high state of refinement, providing the industry's most accurate, flexible, and powerful simulation program. This smoothly integrated platform combines a user-friendly interface with sophisticated science to help you make better project decisions... faster!”

In order to approve and research a a drug they scientists need to know how it is going to dissolve.  The additional licenses purchased are for the DDDPlus software which allows for the creation of formulation data bases and simulate predictions for the drug. 

FDA Head: We're Boosting I.T.

Back in the beginning of 2008 the FDA said they were boosting IT and this shows a heavier use of technology as just only 2-3 years ago not all had computers and some were still writing up studies in long hand.  The next plateau is to hire some coder and programmers so they have some in house and not rely on outside businesses as heavily as competition is sometimes getting a little in the way at times along with marketing on steroids today.  BD

LANCASTER, Calif.--(BUSINESS WIRE)-- Simulations Plus, Inc.(NASDAQ: SLP), a leading provider of software for pharmaceutical discovery and development, today announced that it has received a purchase order from the U.S. Food and Drug Administration to expand the number of licenses for the Company’s DDDPlus™ simulation software.

John DiBella, director of marketing and sales for Simulations Plus, said: “This purchase will add 10 more licenses for our DDDPlus software to those already held by the Office of Generic Drugs. DDDPlus is a unique program that simulates in vitro (laboratory) dissolution experiments, thereby enabling formulation scientists to better assess the effects of changing formulation variables such as the size of the drug particles and the amount of various excipients, as well as experimental parameters such as the composition of the fluid and the speed of agitation (stirring).

Such simulations can provide agency scientists with valuable insight into the dissolution of generic formulations compared to innovator formulations when generic drug companies submit abbreviated new drug applications (ANDAs) to the agency. Another use is to assess how changing the experiment might provide greater discrimination between the dissolution rates of different formulations. Some experimental conditions might show little difference in dissolution rate, while others might amplify the differences more effectively. It’s faster and less expensive to simulate the dissolution process than to physically dissolve tablets, make measurements, analyze the data, and clean up the lab. Once the experimental parameters have been identified, real experiments can be run to confirm the predictions.”

Dr. Michael Bolger and I will be at the FDA offices in Maryland next week to train 30 more scientists in the use of our GastroPlus™ software. FDA scientists are among the elite in the world of pharmaceutical science, so their selection of Simulations Plus software is extremely satisfying to our scientists, management, and shareholders.”

http://www.simulations-plus.com/PressReleaseDetails.aspx?pID=281

Technorati Tags: Bill Gates, Microsoft, healthcare, software, algorithms, drug development, healthcare reform, generic drugs, FDA, SimulationsPlus, simulations

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City of Buffalo Has Paid Over $2 Million to Provide Health Insurance for Hundreds of Dead People-Some as Many as 4 Years

The city is blaming Human Resources for this big oversight here and I ask too what about the insurers who kept collecting the money?  If some of the people were covered under an HMO, didn’t some of those folks come up for a mammogram screening?  Actually this is a disconnect here too as I know doctors that have been bit by their management programs and dinged out of P4P for not conducting those exams and the doctors have had to tell the insurance company that those patients needing mammograms have died.  That’s a real nice way to hack off a doctor by deducting bonus money for mammograms not done on dead patients. 

The story said the HR Department suffered a “meltdown” and some health insurance premiums were paid twice for up to 250 sanitation workers, but I bet they didn’t get double the benefits!  This reminds me of another story with dead doctors so this is the perfect storm here if you have dead doctors sending through claims for dead patients and a loophole to check out for fraud.

 Probe finds dead doctors used in Medicare scams

You never know until you audit this stuff and this is exactly why better infrastructure is needed.  With claims we pay for software that is supposed to catch stuff like this so where in the heck was that software to prevent fraud here that the insurance company was more than likely paying for from a 3rd party?

Some workers had been dead for 4 years!  I guess nobody checked when they didn’t show up for their shift. 

Someone played “cheap” on both sides of this story without using the Social Security Data base Death Index to cross reference as it does cost a few dollars, but probably a few hundred dollars compared to 2 Million here would have been a real good investment.

Most of the time higher ups in organizations make those decisions that don’t have general consumer IT knowledge and those asking and seeing the value with software like this get turned down.  I have seen CEOs do it so all of them are not that smart either.  Look what cheap did to TJMaxx, and what it created for a simple example. 

I guess this was a good thing it was caught now before some of these folks were perhaps considered to be candidates for insurance exchanges <grin>.

Aug. 13--The City of Buffalo has paid nearly $2 million for health insurance premiums for 152 deceased employees, several of whom have been dead for four years, according to an audit released Thursday.

What's more disturbing, said City Comptroller Andrew A. SanFilippo, is that officials in the city's Human Resources Department were ordered by Mayor Byron W. Brown seven months ago to tighten controls and take new steps to ferret out "systemic problems" that triggered improper payments and other glaring mistakes.

"To be honest, it's a disgrace," SanFilippo told The Buffalo News. "It's a major embarrassment to the city and a $2 million slap in the face to taxpayers."

But the comptroller stopped short of calling on Brown to fire Human Resources Commissioner Karla L. Thomas.

"It's the prerogative of the mayor to make a determination and assessment as to whether he feels there has to be some sort of an adjustment or amendment in personnel," SanFilippo said. "I don't make that decision."

Insurance News - City Paid $2 Million To Insure Dead Workers

Technorati Tags: Buffalo, Social security, data bases, health insurance, human resources, tech denial, infrastrucure, lazy, employer insurance

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Ornish And Pritikin Based Programs Cleared for Medicare Reimbursement To Help Reduce Cardiovascular Event Risk

I don’t think you get to go to the expensive spas here, but many hospitals have programs based on both Pritikin and Ornish programs and I believe this what we are looking at here to encourage better diets and exercise. 

The Pritikin program has been around a little longer than the Ornish program and has other added modules to include stress management group support and a few other items on the agenda.  I guess now we wait for the CPT codes?  There are some others that are generic that might apply in the meantime too.  BD 

Medicare will pay for intensive diet and exercise programs developed under the Ornish and Pritikin brands for reducing cardiovascular event risk, the Centers for Medicare and Medicaid Services announced.

The agency's review of published data on the Ornish and Pritikin intensive cardiac rehabilitation programs found that they effectively slowed or reversed progression of coronary heart disease and reduce the need for coronary artery bypass grafts (CABG) and percutaneous interventions.

Consequently, they are approved for coverage under Part B of Medicare, CMS said. Legislation that went into effect this year established a new benefit for intensive cardiac rehabilitation programs.

Because Medicare will make these programs available to all beneficiaries regardless of income, it expects the decision will "reduce the disparate impact of heart disease in minority populations."

CMS staff reviewed six studies of the Pritikin program and nine on the Ornish version appearing in peer-reviewed publications. Most of these were conducted or sponsored by the Ornish and Pritikin companies -- eight of the nine Ornish studies, for example, had company founder Dean Ornish, MD, as lead or senior author.

Nevertheless, CMS accepted the reported data as valid and adequate to demonstrate the effectiveness of the programs under the agency's statutory and regulatory requirements.

Medical News: Ornish, Pritikin Cleared for Medicare Payment - in Cardiovascular, Prevention from MedPage Today

Technorati Tags: Caridiology, Pritikin, Ornish, heart failure, exercise, Medicare, health programs, CMS, risk, BMI, programs and Policies, CPT Codes

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Freakonomics Movie Trailer–Incentive Based Thinking Looking at Human Behavior With Good, Bad and Outright Stupid and Funny Examples As Technology Reaches Out

This is high on my list to view and these folks do a good job explaining a lot of what we think is crazy, and maybe it is.  In doing this blog I see all kinds of stuff all over healthcare and there are good incentives, bad incentives and stupid ones too and I try my best to talk about how they play out in real life as “proof of concept” is no longer the real deciding factors.  These guys have been on ABC 20/20 with this guy below, who created the healthcare software program that Microsoft bought. 

Staying Alive – Dr. Craig Freied Co-Founder of (Azyxxi) Microsoft Amalga And Hospital Safety (ABC 20/20)

I see a lot of what I call impossible carrots hanging out there in the wind with “non participants” in what they create scratching their heads wonder why don’t people like this or why don’t they get involved.  These folks do a good job of looking at things in the same way, like them a lot.

One example I talk about a lot is using cell phones to find FDA recalls,  I do my own inquiring and run a poll here and gee, most that get over themselves after coming around to the fact that it is a good idea even though it was not theirs go nuts and love it.  Just heard about someone in the UK today that’s going to work on setting up healthcare program using Bar Codes-Microsoft Tags.  People love using their phones as scanners and best of all, it’s VALUE that can be seen immediately.  In the meantime I’ll keep up this campaign to hopefully get through some thick skulls here.  I don’t get anything for my time other than the fact of trying to suggest to others how to work and capitalize on where other see value and a good life saving tool and software. 

What is interesting too is that the video comes out in the ITunes store before it goes to the open theatre too, these guys are smart doing that and they are checking some value in the process!  They get it.  BD 

FREAKONOMICS is the highly anticipated film version of the phenomenally bestselling book about incentives-based thinking by Steven Levitt and Stephen Dubner. Like the book, the film examines human behavior with provocative and sometimes hilarious case studies, bringing together a dream team of filmmakers responsible for some of the most acclaimed and entertaining documentaries in recent years: Academy Award® winner Alex Gibney (Enron: The Smartest Guys in the Room, Casino Jack and the United States of Money), Academy Award® nominees Rachel Grady and Heidi Ewing (Jesus Camp), Academy Award® nominee Morgan Spurlock (Super Size Me), Eugene Jarecki (Why We Fight) and Seth Gordon (The King of Kong).

Freakonomics - Premieres on Magnolia On Demand September 3rd. In Theatres October 1st

Technorati Tags: Freakonomics, data, incentives, heatlhcare, life, common sense, proof of concept, humans, Microsoft, Staying alive, Bar codes, technology

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Robot Lifting Machine Wheelchair Combination From Japan– (Video)

Over at Engadget they have more dramatic version of this device with some spooky music too.  This is a home carrier robot that comes over and moves you around.  The robot works via touch screen or via voice recognition.  BD 

We already got a look at a robot wheelchair that was on display at the recent Next-Generation Robot Manufacturing Exhibition in Japan, but it wasn't the only robotic health care device on display at the show -- this so-called Yurina robot from Japan Logic Machine was also busy impressing attendees with its patient-lifting abilities.

Yurina health care robot promises to help lift, terrify patients -- Engadget

Technorati Tags: Robots, wheelchairs, Japan, lifting, patients, healthcare, technology, Yurina

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HHS On Miscoded Claims with Wrong Location Designation–Combination Claims Usually at the Root with the Complicated Coding System-Not MDS Ripping the System

I have done billing so I am qualified I feel to comment here.  Most procedures done by family practice and other specialists “do” occur in the office which is coded as an “11”.  If they leave their offices and travel to a hospital or out patient surgical center let’s not forget the time they have to take to leave their office and drive over there too, but with providing that service outside the office this is what they do for free on travel time.

Most billing software today has a template you prepare for patients and those who are in facilities are automatically coded properly when the template is generated.  Many patients have both Part A and Part B or it can be combined into an advantage plan Part C, add on prescriptions and now you can have Part D. 

Multiple services can get confusing here too with a patient that has both Part A and Part B and part of one claim may involve both office visits and a trip to the hospital, so maybe we have a Part C here too.

When a trip to the hospital occurs, then doctors coordinate coding in the case of a specialist becoming involved in the patient case.  After reading this I think there’s a real good possibility of some combined claims and questions as to which service took place at which location, as this stuff happens and fitting it into the correct data tables can be a challenge at times.  A follow up visit after hospitalization at the office is pretty standard too so now we are at an 11 which is back at the office.

In short what I am saying is that some of the coding are legitimate mistakes and this should not be a big sensational story about doctors ripping off Medicare as this is common and not done intentionally.  Think about it this way, every time you visit your doctor he/she is filing a 1040 tax form, some are short versions, some are itemized and some get audited, it’s just about the same thing and just think you only file taxes once a year, but the the medical billing business 1040s are flying out every 15 minutes with compliance on 100% accuracy being critiqued. Here’s a good example of a peer group, the hospital and the doctors having no clue in how to interpret a coding situation that reflected on how to bill it and this is common too.

Hospitalists, Peer Committees and Utilization Struggle to Comprehend United HealthCare Algorithms

Certainly there may some fraud and those folks need to be caught, but gee most of this is just the complicated coding of medical billing and the story deserves a much better attention line here than rather being a “crack down” on those doctors.  It’s a legitimate issue and HHS should be aware of this and less emphasis on enforcing and more on helping individuals code in our complicated system.  BD

WASHINGTON – The Department of Health and Human Services, Office of the Inspector General is recommending that the federal government crack down on physicians who have incorrectly coded their Medicare claims for the wrong place of service.

A new OIG HSS audit has found that Medicare contractors nationwide overpaid physicians $13.8 million for incorrectly coded services provided during calendar year 2007.

HHS to crack down on miscoded Medicare claims | Healthcare IT News

Technorati Tags: HHS, Medicare, billing, medical billing, CPT Codes, healthcare, red tape, CMS 1500

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Class Action Lawsuit Filed Against Principal Financial Group in Iowa-Flawed Data Base Used to Calculate Out of Network Charges

When I hear flawed data base used today on out of network charges, well it all seems to go back to the same one, but this article does not mention which flawed data base is in reference, so is it the same one that stuck everyone else with the Ingenix data base?  Again the article doesn’t mention this but it sure has that familiar ring.  A couple months ago there was a new lawsuit filed on behalf of the outpatient surgery centers relative to the same issue. 

Outpatient Surgery Centers File Class Action Lawsuit Against UnitedHealth and Ingenix for Underpayments

So far I have not heard of another flawed data base floating around but anything is possible today.  BD 

A putative class action filed in Iowa claims the insurer uses a faulty database to calculate charges in its group health plans.

A putative class action filed in U.S. District Court in Iowa alleges Principal Financial Group Inc. and subsidiary Principal Life Insurance Co. use a flawed database to calculate charges, leading them to routinely underpay out-of-network health claims.

Insurance News - Suit Targets Principal For Underpaying Out-Of-Network Claims

Technorati Tags: Lawsuit, class action lawsuit, flawed data base, health insurance, out of network charges, Principal Financial Group

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IBM Buys Marketing Automation Company Unica for $480M–More Algorithmic Marketing on the Move–Same Services Used by the AMA

I just took a brief look at the customer list and the AMA is listed as a client so you can see some other big names on the list as well.  The company offers somewhat templated marketing to focus on your interests.  Best Buy is another big client touted on the site.  We know IBM is making a big move into healthcare so add on this new tool with some automated marketing and even that area will appear to be fine tuned into determining what you are looking for and how they can best market you for sales and input.

You will also find the American Cancer Society on the list too as well as several financial concerns like Goldman Sachs and some big pharma companies like Bayer on the list.  I do have to say the banking list is pretty large.  They also have a service for predictive insight which is hot today as everyone wants to figure out how to benefit from this huge electronic crystal ball via data mining to focus where their dollars are spent. 

It’s all about those algorithms once more and a few are listed in the quote below. 

From the website:

“Marketers know that data mining and predictive modeling are powerful marketing tools that can improve the results of every marketing program.

But to put predictive models to work, many marketers must rely on trained specialists with complicated analytical tools, waiting in line for their scarce time. How can marketers get access to the power of predictive modeling without relying on these specialists?  How can they tap the power of the most sophisticated predictive algorithms, even if they have no technical or statistical training?  And even if getting an analyst's time is easy, how can marketers swiftly put predictive models in action, so they deliver value rather than simply being an intellectual exercise?”

Algorithms

Unica PredictiveInsight's intelligent algorithms choose the best-fitting models and input variables from hundreds of models generated automatically for the marketer’s data set.  Examples of the types of algorithms used include:

• Logistic regression
• Linear regression
• Neural networks
• CHAID
• CART
• Naïve Bayes
• K-means
• RFM
• Parameter optimization (exhaustive and generic search)

Obviously IBM sees value here too on wanting to know where their efforts are best spent and marketing the same to others.  We call this subsidiary watch here in knowing what is going on with corporations as a whole. 

This didn’t surprise me at all to see Blue Cross on the list as they are actively mining and finding data to work with their algorithmic behavioral underwriting procedures.  You can also see how this comes together with companies like Red Brick who use Ingenix data base information (subsidiary of United Healthcare) to also analyze and predict.  Here’s a couple links to familiarize you with the analysis process on steroids in that area since health insurance is up front in the news today. 

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

You can watch the video about Red Brick from the CEO below and see what this is all about on the healthcare side.  He sounds a bit scripted if you ask me but you can make your own opinion and go from there as you can see the big focus on reaching out to employers for intelligence to save costs, it is what it is. 

Wellpoint Enters Contract Agreement with Red Brick for Behavioral Underwriting

Now with the resources that IBM currently has, combined here, there’s almost not limit on how much marketing data will be collected with consumers so be aware and read up on all privacy statements.  Best Buy already does a good job with their data as I have had a package of M and M’s show up on my profile that I bought over 5 years ago so this has been a building process.  This is just a post in a day’s work for a blogger trying to generate a consumer awareness of what is going on behind the scenes that you may or may not be aware of as data mining and specific marketing intelligence continues to grow and stare you in the face every day whether it is health insurance or a visit to your favorite electronics store.  BD 

The Unica buy will strengthen IBM”s existing portfolio of software meant to “help companies automate, manage, and accelerate core business processes across marketing, demand generation, sales, order processing and fulfillment” — which includes the aforementioned Sterling Commerce and Coremetrics purchases. It will allow IBM to better help businesses predict and analyze customer tastes, and focus their marketing efforts.

The Waltham, Mass.-based Unica has more than 1,500 customers worldwide — including Best Buy, eBay, ING, and Monster. Its 500 employees will move to IBM’s Software Solutions Group, and its software will bolster IBM’s Business Analytics and Optimization Consulting organization — which IBM describes as “a team of 5,000 consultants and a network of analytics solution centers” that’s backed by $11 billion in acquisition investments made over the past five years.

IBM acquires marketing automation firm Unica for $480M | VentureBeat

Technorati Tags: Red Brick, Ingenix, wellness coaches, biometrics, behavioral underwriting, Blue Cross, Target, health insurance, privacy, IBM, Urica, AMA

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Bacteria-killing Paint For Hospital Walls In Development–Working So Far in the Lab With Killing Bacteria

We all know the value of a sterile environment and fight this all the time.  The new approach would a coat of bacterial killing paint.  Enzyme coating in the paint could take any surface and make it sterile.  They are using what nature uses with nano particles.  So far this is just in the labs but working.  It will be around 5 years they project until available. 

It is working better than washing surfaces and takes a few hours to rid the environment of bacteria and this would also be good for the food industry.  BD

Aug 13 - Researchers at the Rensselaer Polytechnic Institute in New York have developed a paint that can kill even the most resistant bacteria. Ben Gruber reports.

Bacteria-killing paint for hospitals | Video | Reuters.com

Technorati Tags: reserach and development, infections, hospital acquired infections, technology, enzymes, lab, food safety

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Proteus Biomedical Announces European CE Approval–Bluetooth Communication Via Chip on a Pill aka The Raisin

The FDA here in the US has not cleared the entire Proteus system for use with the chip but did give approval to the wireless monitoring device portion; but the folks in Europe get to have the first crack at taking a pill that will send back an audit trail of all the information. 

FDA Clearance of Wireless Proteus Wireless Monitoring Device Reported – Novartis and Medtronic Have $50 Million Invested in the “Raisin”

The pill can talk to your blue tooth phone or any other blue tooth device. Novartis has invested a few dollars with the technology.  Novartis is continuing with investing with Proteus to have a chip on pill that will report data.  The technology is called “ChipSkin”.  How does this work, you swallow your pill and your pill starts talking and sending information.  The information from the pill goes to a patch or a tiny device implanted under your skin and will send your heart and respiratory rates.  The company states this is inexpensive to produce.  In a couple prior posts, I covered a bit about how the Raisin system works.

Novartis Invests 24 Million with Proteus – Chip On A Pill Also Known as IMeds as Discussed at TEDMED

So far we are approved for the patch and device in the US and Europe gets the chip on a pill so all the way down it will be talking and sending your heart rate and other pertinent information.  Compliance and data are both objectives here and again we don’t want to see data used against a patient should a dose be forgotten, etc. so privacy is a must.  BD   

REDWOOD CITY, Calif.--(EON: Enhanced Online News)--Proteus Biomedical Inc., a pioneer in intelligent medicine, announced today that it has received CE Mark approval to market its ingestible sensor and personal physiologic monitor system in the European Union. The CE Mark certifies that the Proteus system has met European Union consumer and health requirements. Proteus also received ISO 13485:2003 certification for the design, development and manufacture of its product system.

Proteus’s ingestible sensor and personal monitor system, called the Raisin^TM System, is indicated under the CE Mark to timestamp, via ingestion, any discrete event (such as the ingestion of a specific pharmaceutical) and to record this event along with physiologic information such as heart rate, activity, body angle and patient-logged information. The unique ingestion event and personalized physiologic information are then communicated via Bluetooth to any computerized device, such as a mobile phone for emerging mHealth applications.

Proteus Biomedical Announces European CE Mark Approval of Ingestible Sensor and Monitor System | EON: Enhanced Online News

Technorati Tags: Novartis, pharma, chip on a pill, Raisin, Chipskin, Proteus, biomedical, heatlhcare, Heatlh IT, technology, drugs, pills, IMeds, TEDMED, devices that report data, wireless, Europen CE mark

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Medicare Contractor Gets Deal to Monitor Physician Incentive Payments–Same Folks Earlier This Week Admonished For Not Doing Enough for Fraud Prevention?

Ok that was just on Monday I posted about the disappointment with fraud prevention and I guess it has earned this this bit big of business, is this all there is to this?  I realize the contractors have the data but like commercial insurance carriers do they run the work to a 3rd party a lot of time.  Usually the software used for anti fraud comes from subsidiaries of commercial insurance companies like Ingenix, a subsidiary of United Health Group and I’m sure their software is in the mix here too, so more transaction profits for those folks. 

Medicare Fraud Prevention Has Cases Falling Through the Cracks–Looks Who’s Getting the Contracts And Check Out the Algorithms For Their Profitable Business Models

When you look at the site under Part A you can clearly see Wellpoint as a huge administrator for many of the states, so in case you were not aware here’s another area of integration with health insurers and the administration through contractors and I am adding this as information so to create an awareness of where and how companies function today so you can see the tie ins with Medicare contractors.  It is a bit shocking to see a contract for Congressional Contacts have a Wellpoint email address I must say, so what kind of an office is this you might ask? 

In essence the contract looks like a win for Well Point as a partner with this contractor for Medicare so again we have transaction fees that enter into the picture here and hopefully Wellpoint does this in house and doesn’t outsource their part of the Medicare Contractor business.  Today in the news another Blue Cross Office unrelated to Medicare announced their new outsourcing solution. 

Blue Cross and Blue Shield of North Carolina To Outsource Jobs–Laying Off About 90 Employees

To get right down the the bottom here, this clearly shows how the US Government is lacking with technology and Health IT capabilities to not be able to do this in house.  It’s a big catch up game.  Just this week Wellpoint made their commitment to HIT and with what appears to be a lot of business on the line here with this contractor, it was the politically correct thing to do. 

WellPoint Joins Meaningful Use in HIT–It’s the Politically Correct Thing To Do With Pay for Performance Algorithms For Analysis

One other big issue that hurts the government from increasing internal infrastructure was this move out of the Senate, which shows they just don’t get it as Web and Cloud work together, so they approved one and not the other, duh?  Do pay close attention to items as such as those are the folks that somehow rationalize their thoughts to make law?  It scares me and the reasoning here for not approving is due to lack of proper and detailed guidance” with the Cloud.  Proper guidance these days is not stopping anyone from running for office though <grin>.

Senate Cuts Cloud Services From Budget That Would Allow for Data Center and IT Infrastructure Consolidation–Back to the 8 Track Tapes Next?

Anyway, so much for my rant but again the big contracts for those that were in the news for not fighting fraud….hmmmmm…we really need people that can make sense out of some of this and have good consumer digital IT and Health IT knowledge in these places, otherwise I guess I’ll have more posts like this.  The Government needs some good coders internally working.   BD 

To support its efforts, CMS recently awarded a $5.5 million five-year contract to National Government Services Inc., a large Medicare contractor in 20 states, to assist in preparing and processing incentive payments beginning in fiscal 2011.

The services will help ensure the proper accounting of the payments to eligible physicians and hospitals under the HITECH Act, according to CMS.

The agency has estimated that up to 50,000 physicians and more than 2,000 hospitals will participate in the first year of the meaningful use program.

Indianapolis-based National Government Services will develop software to create provider incentive payment files, prepare the files to prompt payment and track the payments.

Data will flow into this system from CMS’s National Level Repository (NLR), which will contain healthcare providers’ registration for incentive payments, documents verifying their eligibility and banking information for each recipient.

Other CMS’s Medicare administrative contractors will supply supporting information about participating Medicare providers, such as their identification numbers, banking information and medical claims payments history. 

http://www.govhealthit.com/newsitem.aspx?nid=74430

Technorati Tags: healthcare, fraud, Ingenix, United Heatlhcare, algorithms, non profit, shareholders, contracts, healthcare reform, technology, EHR, EMR, claims, Medicare, Incentives, Wellpoint

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Blue Cross and Blue Shield of North Carolina To Outsource Jobs–Laying Off About 90 Employees

The work will be sent to a company named SOURCECORP with locations in the Carolinas and the Philippines.  The data entry will be done in North Carolina, but you might guess where everything else might be going.  You know I get tired of reading these notices where the boss says it is difficult and granted nobody likes to lay anyone off, but it keeps happening as technology and outsourcing continue to do the work that we used to do and much of this is normal business situations but much is driven by current economic conditions. 

Right now, especially in Healthcare, technology is on steroids and a lot in the wireless and automation areas and no doubt technology will be consuming some of these jobs as well as being out sourced.  I guess this is one way one part of Blue Cross might be looking at reducing costs that may not fall under the Medical Loss Ratio areas? 

I talked to someone the other day that experienced a lay off of this type at Citi Bank and it was strange as the group didn’t even get to clean out their own desks and was completely canned with scripts read out loud and checks in envelopes ready to go and within 15 minutes they were out the door.  The part about not even being able to clean out your own desk was cold as hell thought and it was like they were treated like some kind of criminal who had done nothing but their job.  No wonder we have things like what happened at Jet Blue this week.  BD 

Blue Cross and Blue Shield of North Carolina will cut as many as 90 jobs and outsource some claims data-entry work and other, related functions as part of an effort to reduce administrative costs, the company announced Thursday.

Blue Cross, the state’s largest insurer, says it can save $1.6 million to $2.1 million through the outsourcing plan.

“This is a difficult decision that will affect good employees whom we care about,” says Brad Wilson, chief executive. “It is part of our ongoing work to reduce our costs to keep premiums as affordable as possible for our customers and to remain competitive as a company. We have met with these employees and we will do all we can to treat them with fairness, respect and sensitivity as we make the transitions in the months to come.”

Read more: Blue Cross and Blue Shield of North Carolina to slash 80 to 90 jobs - Charlotte Business Journal

Blue Cross and Blue Shield of North Carolina to slash 80 to 90 jobs - Charlotte Business Journal

Technorati Tags: Blue Cross, North Carolina, healthcare, health insurance, layoffs, technology, humans, Sourcecorp, Phillipines, labor, data entry

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Kingdom Insurance Files Lawsuit Against United Health Group & Protectors Insurance –Conspiracy To Not Pay Commissions On Polices for Baptist Convention Policy Sales

The lawsuit is about greed according to this article and the Kingdom group that was supposed to be selling policies appears to have been left out of the arrangement or contract.  From what I am reading here the 2 other insurance carriers cheated and kept the business for themselves, thus not having to pay commissions for the sales of policies to the National Baptist Convention which kind of makes this look a little worse if the folks from the church were cheated.

The church group also contends they would have sold more policies too, so it looks like the group from Texas took over and the group from Georgia did not get the opportunity to sell insurance contracts. 

Now it looks like sales commission is the next level with the ongoing issues of health insurers.  BD 

THOMASVILLE, Ga.--(BUSINESS WIRE)-- Thomasville, Georgia-based Kingdom Insurance Group, LLC, which brokered a standard industry-accepted arrangement to sell health insurance products to the 7.5-million-member National Baptist Convention is suing its two former business partners, claiming they cheated it out of thousands of commissions it would have earned and left the church group with fewer insurance choices than it could have had.

Kingdom alleges United Healthcare, a subsidiary of UnitedHealth Group (NYSE: UNH) of Minnetonka, Minn., and Houston-based Protectors Insurance & Financial Services, LLC, schemed to cheat Kingdom out of millions of dollars revenue it would have made from the sale of health insurance policies to the Nashville-based National Baptist Convention, one of the largest African-American church groups in the United States.

“This is a case of greed, a giant insurance company from Minnesota conspiring with a small insurance agency from Texas to swindle their partner from south Georgia that put the two together and steal the business for themselves,” said Michael P. Bruyere, an attorney with Fields Howell, LLP, in Atlanta, who is representing Kingdom. “It’s wrong in principle, it’s wrong legally, and it’s wrong morally because they were supposed to be working together to serve a group of churches and its members.”

“Kingdom recognized that United would broaden its suite of insurance products, but lacked the network or contacts to market them to the church, and Protectors had access to the church’s members, but lacked the vast network and products offered by Kingdom. Without Kingdom, the joint venture between the insurance giant and Texas insurance agency to better serve the church groups would never have occurred,” said Bruyere. “But by 2009, United and Protectors essentially conspired to cut Kingdom out of the agreement to enrich themselves. They need to be held accountable.”

Insurance News - Lawsuit Claims United Healthcare Cheated Kingdom Insurance, Church Clients

Technorati Tags: United Health Care, Kingdom Insurance, Portectors Insurance, health insurance, marketing, sales, commissions, church group, Baptist Convention

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Trizetto Adding Disease Management Algorithms For Insurers With “Value Based Benefit Solutions” To Manage Program Members And Log Compliance

In short we have more algorithms and transaction fees being added to pay for additional intelligence with software.  Patients will essentially be guided to remain in network when identified as chronic care members, and gee any more are we not all in that category with something diagnosed? I think chronic are is being a bit over used these days perhaps not so much in the clinical end but in the analytic and payment end of things as one more identifiable identify that needs additional algorithmic studies to bottom line every expense paid out on one patient.  The company CEO came from Cerner and Trizetto is owned by a private equity firm in the UK, APAX so all profits go abroad to that group of investors. 

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

Not too long ago I questioned some of the marketing information they released and wish I had a group of consumers that were as smart as this survey said, read up and see for yourself. 

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

The company has 3rd party contracts and works with one senior group in the Los Angeles area called CareMore to supply algorithmic business intelligence and claim processing.  Much of the focus of the company as you can see from the image above is “power to the employer” with their targeted audiences of payers. 

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

Trizetto works with many of the algorithmic formulas created by Ingenix (a wholly owned subsidiary of United Healthcare) for their reporting, “scoring” and algorithmic formulas to verify enrollment, pay claims and so on.   As you can see United Healthcare is in here for a cut of the profits with their subsidiary and with share holder liabilities taking the front run and we heard about the record profits made.

The question is here are we creating more VALUE or just more analytic algorithms that really help with healthcare and expediting claims?  Insurers buy and pay for such services and we get passed down in the premiums we pay. The more complicated you keep the system, the more it leads to additional analytics that we all pay for and some of these programs programmatically deny our claims too as many insurers outsource quite a bit today too.  BD

Trizetto Group has introduced a software solution that enables healthcare payers to customize benefits and provide incentives for individual members based on their health status, chronic conditions, and health and wellness activities.

The Greenwood Village, Colo.-based health IT company said Wednesday that its new Value-Based Benefits Solution works with Trizetto's Facets and QNXT, two value-based insurance design platforms that help health insurance companies automate enrollment, as well as provide premium billing, claims adjudication, and other administrative functions. These tools are used by 137 health plans to provide coverage to 107 million Americans.

Value-based insurance products are used to identify and reduce patients' out-of-pocket costs for proven, effective pharmacy and medical services for chronically ill patients. By doing this, patients with chronic diseases are better able to afford doctor visits, medicines, and other health and wellness activities, which could prevent a further decline in their health.

Trizetto Intros Disease Management Platform For Insurers -- Health Insurance -- InformationWeek

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

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NutriSleuth UPC Barcoding Company Kicks the FDA in Back End When It Comes to Food Safety-Using a Smartphone to Scan for Info

If you read this blog often enough then you area aware of my campaign for drug and device recall with Windows Tags, which is another type of 2-3D bar coding solution.  Nutrilseuth addresses the nutrition and food side of this puzzle and you can use your Iphone to locate food information, especially important when it comes to food allergies, like peanuts.  You set up profiles in the software with what you are allergic to and instant warnings when you scan, what a great idea. 

Perhaps we will see this expanded to other smartphones in the near future.  The cost is $4.99 at the app store to load up and go.  Below is a video on how to use the software.  I think this is great and it is the way mobile health information is moving.  Watch the video from “Untethered” for additional information for a bit more history from both the developer and user side. 

Nutrisleuth

We also need this technology for going beyond nutrition:

Tags for Use in Healthcare – Medical Stents, Medications - One Scan Away From Safety Information in Real Time

Below are a couple paragraphs from one of my many prior posts as devices and drugs need additional information compliance with the FDA.  Now we have the potential to cover all areas if we can get the FDA, device and drug companies on the same note.  For Drugs and Device Recalls we need a little more sophistication and this is where Tags come into play.  Shoot in New York they are putting QR tags on garbage trucks and I get this funny picture in my head of a person chasing the truck to scan See what this grocery chain does if you shop there. 

Kroger uses technology to help identify and inform consumers of recalled products

More Bar Coding Information for Device and Drug Recalls:

“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

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.  Recently the FDA put out an announcement to help individuals identify recalls and below is a personal opinion with several other links as to my perceived concept on how this can be done much better with technology.  We had the recent “counterfeit Alli” warning and how easy would this have been to take your phone and scan the product to make sure you had the “real product” in hand? 

FDA Publishes Information on How to Identify Recalls – Why Not Scan That Stent With A Cell Phone and Make It Easy for the Public and Manufacturers To Keep Up, Notify And Automate Compliance

Perhaps now that the nutrition side of this is being address maybe some other folks might take this technology seriously.  Everyone I talk to is ecstatic about using their phones to scan, and breaking through tech denial to bring something to consumers that shows “VALUE” is difficult at times.  I say this as I have been on this campaign since October of 2009.  Take time to vote too if you will.  BD 

Within seconds of scanning a UPC barcode label, the NutriSleuth app searches a database of +200,000 name-brand grocery store products and delivers instant results. Each user profile has customizable severity levels (including anaphylaxis) for a multitude of nutritional criteria, including serious medical conditions like pancreatitis and diabetes. The iPhone application instantly “translates doctor’s orders” of dietary requirements into a visual “yes or no” for a food product.

There are no other applications- web, mobile or otherwise- that allow a user to aggregate multiple dietary parameters resulting in a set of allowed food items that meet all of their specified needs. Preset Nutrition Criteria are programmed to the general guidelines of the professional medical industry; lifestyle preferences can be customized by the user.

Mom is grocery shopping for her family. Her husband has a heart condition, her daughter has diabetes, her son has peanut and dairy allergies, and she personally just wants to eat a low fat, high protein diet. Mom picks up a box of crackers- are they safe for everyone? She shakes her iPhone, aims the camera at the UPC barcode on the package, and with a quick scan NutriSleuth gives her a readout: a Red Light indicates a severe conflict with her son’s profile. There’s no need to read the ingredients, she puts the box down and moves on

NutriSleuth Medical and Wellness iPhone Application | NutriSleuth

Technorati Tags: NutriSleuth, healthcare, barcoding, Microsoft Tags, mobile technology, cell phone, allergies, applications, UPC codes, nutrition, FDA

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Plastic Surgeon Performs Wound Repair Surgery-Approved by Health Insurance Company-Later Denied When Claim Data Clashed With the “Denial Algorithm”

Plastic surgery is not always a nose job or something cosmetic and there are cases such as this one here with a patient who literally had a big gaping wound that required surgery to heal properly.  When you read below about the size where you could put 2 hands inside the wound?  This sounds to me like a major need for repair as one could be subject to all types of infections if not healed properly too.

As the doctor states it will probably be granted on an appeal but here we have the perfect example of how the data lines up, is evaluated through a series of algorithms to determine qualification and payment authorization and still hits the wall, it’s all the formulas relied on by insurance companies and if data is not entered correctly on the claim, the software mechanisms deny the claim, this happens all the time and is why we can’t totally rely on data system for our care as it does not see people, only data which is culminated to determine profits with carriers who have to report dividends on Wall Street as that is their first area of concern, not healthcare for people. 

This is why for 2 years now I have the word “algorithms”, along with it’s meaning plastered center stage on this blog.  It is what it is and almost every decision we make today revolves around going to the computer for decision making information.  With insurance companies most of this is automated so if a person gives the ok for payment and it is not documented in the data according to their own internal procedures, it this the “denial algorithm”.  This is text long process on how to battle an algorithmically denied claim.

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

It does make you wonder why fraudulent claims zip right on through and when you look at it from a dollars and cents standpoint, the same companies that scan, review and deny claims are the same ones making a profit from this process too, so how do fix that?  They make money on transactions and it’s maybe a fine line here on what to deny and what to approve as with fraud prevention if you cut too many transactions out of the process, there goes the profits. 

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

I said this over a year ago that we go through all the troubles of certifying medical records so they perform accurately but yet we don’t require insurance carriers to submit so we can certify how their processes work so we only have half the puzzle here and it makes it difficult for government insurance entities to audit and track all of this.  We are living in the day of data, data and more data. 

We cover one side and make feeble attempts with text and verbiage to try to regulate an industry that lives on algorithms, not going to work until we use the same types of resources they use. 

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

In this case it appears the doctors recommended this procedure as it would improve the quality of life for the patient, and I don’t think it’s too difficult to picture a big gaping wound and hole in one’s body that would need repair.  This is yet one more example on how transactional profits and many of them are generated by 3rd parties too interfere with care and sometimes just make those involved in the entire process look pretty stupid and they waste a lot of administrative time with the doctors and the patients with this fire drill.  This is the part of health insurance everyone hates, the “denial algorithms” designed for profit.  BD

After receiving a payment denial letter from an insurer for an operation I performed a few months ago, I figured it was time to share.

Health insurance companies play endless games with your local doctor in order to delay or avoid paying the bill.

Let’s talk by means of example:

Mr M is a 50 year old man who was admitted to a long term care hospital when I first saw him. He had a large wound on his hip that was big enough to allow both of your fists to fit inside. Wound care resulted in a clean, but very large hole. The doctors taking care of him requested the assistance of plastic surgery to shorten what would have been a 6-12 month expected healing time.

This patient has commercial medical insurance. I am the only plastic surgeon who works at this hospital. After seeing him and interfacing with his insurance company they agreed to the surgery. I even had to speak with some kind of insurance company medical director who requested that the patient be allowed to be discharged home prior to the operation, a skin graft.

Health Insurance Company BS – Out Of Network Edition » Truth in Cosmetic Surgery

Technorati Tags: health insurance, plastic surgery, wound repair, healthcare, denials, algoirthms, healthcare reform, patients, doctors, claims

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