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Skilled Healthcare Group Gets Court Verdict of Not Meeting Minimum Nursing Home Standards in California And May Not Be Able to Appeal– Skilled Healthcare’s Liability Insurance Has Been Exhausted For This Year So Now What?

The size of the award may be reduced as the article sates and one of their facilities imagein northern California was found negligent and short handed on staff with not meeting the guidelines and rules as set in California.  The company operates 22 nursing facilities in the state.

The award in court was $95 million after a patient was dropped during a bed transfer fracturing her hip and shoulder.  Two attendants should be been making the transfer and not one was the findings of the jury.  Recent news also indicated the company insurance has run dry or there was inadequate coverage for events as such.

Skilled Healthcare Fined $671 Million for Damages in Violating State Health and Safety Codes in California – Amount Beyond Their Credit Capabilities of $94 Million and Insurance Coverage

Nursing homes and long term facilities with cut backs will need to also invest in imagetechnology for help in these areas such as this facility that uses a patient lift system, could have possibly prevented this situation.  Wonder if they have bought any since the incident?

Eden Medical Center uses patient lift system

There are also sensors that could be beneficial as with staffing running short or busy this could help.  Running lean requires technology assistance. 

Hospitals to Test Bed Sensors – a “Smart Hospital Bed”

As current economic times are tough, companies will need to look for methodologies that will work in nursing homes too.  This is sad story indeed and a reminder that nursing home care is important and should not be neglected for the sake of profit earnings on the open market as Skilled Healthcare is actively traded.  BD

SAN FRANCISCO — During Cindy Cool's almost daily visits to the nursing home, she would routinely find her Alzheimer's-suffering father wearing urine-soaked clothes.

The Blue Lake, Calif. resident said it would take upwards of 20 minutes for the apparently short-handed staff of Eureka Healthcare and Rehabilitation to respond and help Cool clean her father. Other patients fared worse, she said.

"A lot of times I walked out of there crying because of the things I saw," Cool said an interview.

She provided key testimony before a Humboldt County jury last month slammed the owners of her father's nursing home with a $677 million verdict, sending shock waves through the industry and rekindling calls for tort reform.

The Associated Press: Huge verdict shakes up nursing home industry

Caritas Christi Health Care Reaches Agreement to Acquire Landmark Medical Hospital in Rhode Island–Private Equity Firm Cerberus Purchased Caritas in March Pending Final Approval

The ink has not dried yet on the acquisition of Caritas by private equity firm imageCerberus yet and the approval not final and they are reaching out to purchase a non profit to add to the for profit chain with the acquisition of Landmark Medical Center in Rhode Island.  Investors are moving fast even before the ownership transfer is approved and I guess one might say they anticipate no issues here as Caritas before the acquisition had little or few options due to the fact that were out of money and coming out of bankruptcy.

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

The potential deal does not require the hospital to become affiliated with the Catholic doctrine and who knows when the options written into the purchase will be exercised as the investors have an open hand to donate $25 million to a charity and dissolve that relationship.

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

This could also lead for another lab acquisition for Quest Diagnostics if the same organizational plans are carried through.

Quest Diagnostics buys Caritas Christi Hospitals Physician-Office Lab Business – Boston

The article also further goes on to state there have been informal talks with imageEssent Healthcare Inc., owners of Merrimack Valley Hospital in Haverhill and Nashoba Valley Medical Center in Ayer, and Cambridge Health Alliance, owner of Cambridge Hospital, Somerville Hospital, and Whidden Memorial Hospital in Everett so it appears the new private equity owner is ready to move quickly with re-organization efforts.

All of this of course is projected and analyzed with high powered business intelligence software to produce the desired projections and the private equity firm I am guessing wants to reel into action quickly as reorganization effort completions will allow for a profitable sale down the road. 

We are living in a very fast paced world today and obviously the investments in technology with being able to potentially suggest and realize profits is riding the fast track.  We need folks in government too that realize and can understand this entire concept of private equity’s advances in healthcare.  BD

Reaching across state lines, Caritas Christi Health Care asked a Rhode Island judge today to approve an agreement to buy Landmark Medical Center, a 214-bed community hospital in Woonsocket, R.I.
It would be the first acquisition by Caritas, the Boston-based chain of six Catholic hospitals that is seeking to expand its system with the resources of private equity firm Cerberus Capital Management.

Business Updates - Massachusetts business news from The Boston Globe

Nasty Coke Strike in Washington Over Health and Retirement Benefits-Drivers Go On Strike and Coke Cuts Their Health Insurance Off The Next Day Stating Premium Payroll Deduction Would Not Be Met

The article states that talks broke off and thus the workers went on strike and as we are seeing today, hardly anybody strikes over wages any more, it’s all benefits. 

You can read the entire article that goes into additional detail but here’s the crux of the matter is is the real battle zone:image

“The company canceled the employees' health care plan on Tuesday - just one day after the disgruntled workers, who are members of six local chapters of the Teamsters, walked off the job claiming the company failed to bargain in good faith.
The workers said Coke canceled their health care through the end of August even though they've already paid their premium. The Teamsters, who claim the company is trying to eliminate health care for retirees and to raise employees' health care premiums by 800 percent, said union members expected to have health coverage until the end of the month.”

And the response:

“However, Bob Phillips, Coca-Cola's vice president of public affairs, said the company did not cancel the workers' health care coverage as punishment, but rather because the striking workers are not eligible as long as they refuse to work for the company. He said the workers were paid only through Aug. 14, and a fee scheduled to be deducted from employees' Sept. 3 paycheck was to cover health care from Aug. 15 to Aug. 28. Because the coverage has been canceled, Phillips said no medical deductions will be made on the next paycheck”.

It’s been a long time ago since I was on any negotiating committees with companies who have union employees but if things are still run the way they use to, the Union was the one with the health and benefit plans and did the administration, but maybe that has changed to where it comes from the company instead? 

Under old conditions when a strike would occur it was the company doing the collecting and not paying the union, and this instance talks about deductions from employee paychecks.  Either way it sounds like the company said we’re not writing a health and welfare check because they workers are not here that I believe would go to the union and not much the business agent representative I guess could do at that point for the employees.  Now if they are by chance paying direct to an insurance company without a Union administrator, then that’s a bit different with the company saying “sorry Charlie” in essence. 

I guess Coke is starting to run short in some places and both have agreed to sit imageback down again at the table.  Perhaps nobody thought about the health insurance benefits being cancelled in a manner as such so you can tell the Coke company has a “bean counter” minded person watching every cent. 

At any rate the response on cutting off the health insurance from a human stand point was pretty doggone cold and calculates as well as the answer as strikes as such usually get settled in a few days and it’s back to business as usual.

I don’t know what the negotiation details are but the article quotes an 800% increase over all so I am guessing this is a number attached on to both health and retirement benefits. 

Things have changed too and this is not like the old Jimmy Hoffa days either as over 10 years ago when I worked in Sales for Yellow Freight I used to take time out in the mornings and help route drivers with learning their own personal computer skills before their shifts started, and heck I used to do the same over at the Pfizer facility who was a client.   

(It was interesting being the only marketing/sales rep that actually went beyond selling and helped people with their own personal learning and it kept competition at bay too so skills and knowledge does pay:) There were drivers that had more on the ball than some of the supervisors they worked for with business knowledge. 

They were into learning and asked for the help which I was glad to chime in and I would guess many of their drivers have at this time and day run their own algorithms to determine and figure out where the cost reductions the company is tasking for would take them. 

I guess we need to get those insurance exchanges rolling soon as these types of stories get uglier all the time with the “business decisions” made in order to keep and create profit  as the algorithms giveth and they take away and human ethics are being lost along the way.  BD

SEATTLE -- The 500 striking employees of Coca-Cola have filed a class-action lawsuit against the company over their canceled health care coverage.
The suit filed on Friday alleges the company violated the Employee Retirement Income Security Act (ERISA), a federal law.
A Coca-Cola spokesman said the company had not yet reviewed the complaint, and refused to comment.

Striking employees sue Coke over canceled health care coverage | KOMO News | Seattle News, Weather, Sports, Breaking News - Seattle, Washington | Local & Regional

Office of the National Coordinator Awards Lockheed Martin $9 Million to Create Real World Model of Nationwide Health Information Network (NHIN)

Occasionally I update news on this project but you may or may not be familiar with the NHIN.  This is an initiative for the exchange of healthcare information under the direction of the ONC to bring together HIE (health information exchanges), pharmacies, lab, providers, payers and others in healthcare to be able to communicate in a secure manner.  This is both a government/private venture as there are foundations already that have contributed both money, time and effort.

image

This is to ensure that EHRs and PHRS as well as payers and others will have use of healthcare data on shared subsets of data.  Consumers and providers of course will have access, and as it looks now, those patients with a PHR will have more access than just the basic portal.  There is also a site called NHIN Direct with those listed working on the project.  They do have a Twitter feed but don’t get too excited as there’s not a lot there except links to reports, etc. 

From the website:

  • Project members belong to the NHIN Direct Implementation Group (IG) imageand at least one of the following workgroups under NHIN Direct:
  • Communications Workgroup: provides clarity about what NHIN Direct is and how it fits into the health information and transformation ecosystem. Key audiences include State HIEs, RECs, HIOs, health systems, providers, and the larger general health community and media.
    • Workgroup Lead: Rich Elmore
  • Documentation and Testing Workgroup: creates effective documentation and testing guidance for various audiences.
    • Workgroup Lead: Janet Campbell
  • Implementation Geographies Workgroup: provides a powerful demonstration of cross-organizational continuity of care.
    • Workgroup Lead: Paul Tuten
  • Reference Implementation Workgroup: creates a solid open-source reference implementation and associated libraries implementing the NHIN Direct specifications.
    • Workgroup Lead: Brian Behlendorf
  • Security and Trust Workgroup: provides alternatives and highlights issues relating to security and trust enablement via technology (e.g., certificates and signatures).
    • Workgroup Lead: Sean Nolan

If you look at the last name on the security list we see Sean Nolan from Microsoft on this committee, good place for Microsoft to be I think.  I won’t bore you too much with the details on the common levels of standards that will come into play here as if you are a casual reader you probably have no idea and if you are one working on a current HIE project you may not be able to stand hearing a lot more on this topic by reading this post since you get it everywhere else.

Back to the nuts and bolts of this post, Lockheed with their contract will be creating a working model to test and see if all this connectivity with relative standards will work.  In short this is somewhat meant to be the “grand daddy” aggregator of health data no matter where it comes from so there’s a lot of work to be done and we are still at the baby stages right now with hospitals talking with other hospitals and then doctors too. 

image[15]

Instead of this method though we could all jus resolve ourselves to have a chip implanted that contains all our medical data <grin> but that’s only half the battle in reality as studies and other information will be included in the network, that is if it works.  A meltdown though of an exchange this side would be a million times worse data wise though than Wall Street and I say that to demonstrate the magnitude of what this project is.  It is also possible that I may never see the completion of this in my lifetime too as there will be new technologies that come out and new algorithms and systems so this will be a roller coaster ride for sure. 

Right now with transparency we are seeing some real data issue with errors and information that is not accurate in systems, and that goes back a number of years and some of it was just simple data input mistakes so there’s a lot clean up that goes with all of this too.  BD   

The Office of the National Coordinator awarded $9 million in contracts to Lockheed Martin Corp. to create real-world models of the nationwide health information network (NHIN) in order to demonstrate its features and hasten its use by prospective health care offices.
The IT integrator will set up  demonstration Web sites to test NHIN technology and standards as well as the interaction of  network components required for secure health information exchange.
“This is the equivalent of taking a new medical therapy out of a controlled clinical trial and assessing the value of that therapy in a real-world setting,” said Michael Leff, director of Lockheed’s Health Information Management Solutions group in announcing the work on Aug. 25.

ONC has lined up other contracts to move the NHIN forward Earlier this month, it awarded about $20 million in NHIN work to Stanley, an IT services provider, to build a standards database with related tools to enable their reuse and to manage the network’s testing infrastructure.

http://www.govhealthit.com/newsitem.aspx?nid=74517

Stephen Colbert Talks Social Media–Eric Schmidt Says You Should Not Make Mistakes and You Can Change Your Life

This is funny and talks about how social networks function , your online pass could destroy your real life future he says.  It does no good to stay away as other can imagepost items.  You can be the ideal job candidate with creating a “none” identity.

He makes fun of Eric Schmidt of Google staying “just don’t make any mistakes”.  When social media first started entering the healthcare area, people were talking about having communities to where they could openly discuss their disease and problems, well there’s places to do that, but not on publicly searched social networks as insurance companies and other look there. 

WHAT GOES ON THE INTERNET, STAYS ON THE INTERNET

The Colbert Report Mon - Thurs 11:30pm / 10:30c
The Word - Control-Self-Delete
www.colbertnation.com
Colbert Report Full Episodes 2010 Election Fox News

In Germany this week the are ready to ban employers from looking at Facebook before hiring an employee.  Linked In and Xing will still be ok as they are more professional and work related anyway where you want to look good and make sure there’s nothing on there like we see on Facebook.  BD 

Stephen Colbert took on online privacy and the dangers of oversharing on social networks last night.

Interestingly, Foursquare was one of the first networks he mentioned, after MySpace and Facebook, and well before Twitter.

Stephen Colbert Tears Into Eric Schmidt On Privacy

El Camino Hospital Offers New Treatment for Severe Asthma–Bronchial Thermoplasty Approved by FDA in April

This is a new procedure for those who has serious asthma problems and where medication is not working well.  The process sends thermal energy to the airway walls and reduced muscle tissue constrictions.image

The procedure requires 3 minimally invasive outpatient bronchoscopies and each targets a different area of the lungs.  Light anesthesia is required and the patient goes home the same day and each treatment is 3 weeks apart.  This treatment is for adults 18 years of age or older. 

FDA Approves Procedure Therapy for Severe Asthma That Can’t Be Controlled with Medication

When the hospital was built it was staged as the hospital of the future and below is imagea video that shows some of what has been built into the ultra modern hospital, where the wireless network lives in the walls.  It also was kind of a shock to hear too that due to economic times and fewer patients with less revenue, the brand new facility is in the same boat at many other hospitals in laying off employees.

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

The new bronchial procedure was approved by the FDA in April of this year and El Camino is one of the first facilities to offer the procedure.  When you watch the video they have 5 operating rooms that are only for “interventional procedures” and there’s of course more ORs for other surgeries. 

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

It makes sense that El Camino with their new facility and operating rooms would be a choice to offer the procedure.  BD 








MOUNTAIN VIEW, Calif.--(EON: Enhanced Online News)--El Camino Hospital has been selected as one of the first hospitals in Northern California to offer bronchial thermoplasty, a new medical treatment for the most severe cases of asthma. Approved by the FDA in April and now becoming available at leading pulmonary institutions across the country, the treatment promises significant relief for the 10 to 15% of asthma sufferers whose out-of-control symptoms cannot be contained by current medications.

“Bronchial thermoplasty is an important step forward for patients with severe asthma”

Dr. Ganesh Krishna, an interventional pulmonologist renowned for his skilled minimally invasive approach to diagnosis and treatment of lung diseases, heads the new treatment program at El Camino Hospital.

El Camino Hospital Offers Revolutionary New Asthma Treatment | EON: Enhanced Online News

Personal Health Records–Updated and New Link under the Medical Quack Resources Column

I like to keep the far right hand side open for both advertisers and resources to be imageused by healthcare individuals as well as consumers. Today I did an update with both the graphics and added a new PHR to the list, Patient Ally.  Patient Ally is also a “free” PHR that is offered and stored on the Office Ally servers.  I try to keep this area open for those personal health records that are not stored on insurance company servers or their subsidiary companies so you know where your records are.  This is important today.

Patient Ally offers the opportunity for physicians and patients to communicate securely and being Office Ally is a “free” clearinghouse service for providers and hospitals, they are in a position to populate medications, labs and even some insurer claim information.  If you want to get started with a PHR and open up the avenues to communicate with your doctors, you might want to take a look as all they need to do is sign up and use the EHRR Lite imageservice and the patient and doctor have a secure way to communicate via email and templated request formats.  Once both patients and doctors are signed up on both ends, the physicians can get paid for their time too.   If you are a patient click on the Image on the right to find out more about it and it is also permanently bookmarked on the blog, same image right next to Google Health and HealthVault.

If you are a physician interested in this service you can read more at their blog about how it works as was featured by the AMA a few months ago.  This can be helpful with all in network as the information can be shared with both primary MDs and specialists alike with the patient being in control. 

American Medical Association Talks About Getting Paid for Online Consults – Patient Ally A Featured Solution

From the website:

“Today, Patient Ally was discussed by the American Medical Association as a physician’s solution imagefor getting paid for e-visits or online consults.   In addition to working with Blue Shield, the service is free for physicians to sign up and become part of the network.  When a doctor becomes part of the network, they are also searchable by patients and other doctors within the network.

Patient Ally is working with Blue Shield in California to supply this service for those patients insured under the program.  If you have seen or worked with Relay Health, this is very similar and the same concept. 

Patient Ally Expanding Services to Blue Shield Customers in California

The company provides free software as a service offerings s well as additional imageservices that are available via subscription which are very reasonable in price.  Information can also be transferred to other programs too, good thing to keep in mind today as well as knowing where your data is stored and who has access. 

Additional updates and information can be found at the Office Ally blog.  BD

SonoSite Catheter Guidance System Gets Approval from FDA

This is good news as we always can use more visuals when placing a catheter.  The system uses an infrared technology combined with fiberoptics so having a visual to enable a visual on the screen.  Below SonoSite is working with another partnership with a division of Medtronic.  BD 

SonoSite Developing Partnership with Physio-Control – Emergency Medical Services With Ultrasound

image

SonoSite Inc. (NSDQ:SONO) won 510(k) clearance from the Food & Drug Administration for its LumenVu catheter guidance system.

The Bothell, Wash.-based portable ultrasound maker said it designed the system to increase the accuracy of peripherally inserted central catheter placement. Physicians incorrectly place 30 percent of peripherally inserted central catheters, according to the company.

The LumenVu System has the potential to mitigate these risks by providing clinicians with the ability to visualize the catheter tip as it travels through the vessel. Healthcare professionals in hospitals or long-term care facilities will be able to track the progression of a catheter with greater confidence and quickly make navigational adjustments, if necessary.

This proprietary solution potentially offers a number of advantages in the PICC marketplace. The LumenVu System is compatible with standard catheter suppliers and is designed to allow clinicians seamless integration of the product into their current PICC line process. Additionally, the LumenVu System does not rely on a magnetic field and will not interfere with medical equipment or with devices in the patient’s body, such as a pacemaker.

SonoSite wins FDA nod for catheter guidance system | MassDevice - Medical Device Industry News

HealthSpring To Pay $545M For Bravo Health Medicare Company With Profits of 1 Billion in 2009-Over 800 Million in 2010 Thus Far

Bravo also had profits of over 800 Million in the first half of 2010 and HealthSpring is in the same business with Medicare coverage.  In 2012 cuts from Medicare become effective so there’s a good year and a half left at present rates.  Bravo Healthcare is a venture backed company and there was talk earlier of a possible IPO this year.

Bravo also use electronic services from Emdeon to check for eligibility.  Emdeon is imageanother 3rd party company that supplies business intelligence software to hospitals, providers, etc. in the area of claim payments and more.  Here’s a part of the package is that is marketed, “Denial Manager”.  You might want to read up and check this out.  BD 

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

HealthSpring Inc. (HS) has agreed to acquire closely held Medicare-coverage provider Bravo Health Inc. for $545 million, bolstering the health insurer's position in the changing Medicare Advantage market.

The U.S. health-care overhaul calls for $136 billion in cuts over the next decade to government-subsidized Medicare Advantage health plans that private insurers offer to seniors. In acquiring a smaller peer, HealthSpring, nonetheless, is expanding its exclusive focus in the area and expects to benefit from operating savings.

Shares recently traded up 8.3% to $19.92 on word of the deal, which the company said will make it the largest U.S. managed-care company focused exclusively on Medicare Advantage. After the deal, HealthSpring will provide Medicare Advantage plans to some 300,000 members in 11 states and Washington, D.C., as well as Medicare prescription-drug benefits to 700,000 members nationwide.

UPDATE: HealthSpring To Pay $545M For Medicare Co Bravo Health - WSJ.com

Pet Insurance Reform Bill Passes in California–Waiting for Governor to Sign-Some Employers Now Offer As Part Of Benefit Packages-It’s Gone to the Dogs!

I love my dog a lot and I guess this is a good thing but human health insurance is far more important in my book and I hope this bill didn’t take up too much administrative time for the Legislature to hash over.  imageWith some policies they have to deal with pre-existing conditions too, depending on age and when the dog or cat is enrolled. 

One thing about pets is they don’t ICD9 or ICD 10 codes or the AMA CPT Codes for their billing.  I guess we didn’t have enough transparency with their insurance either.  More than likely this has come about due to the fact now that some employers are offering Pet Insurance as part of some of the benefit packages out there so everything needs to be legal down to dotting the last “I “ and crossing the last “T”. 

PurinaCare To Offer Employer Benefit Managers Pet Insurance to Attract and Retain Employees

Well my little guy (yup that’s him in the picture") is not too excited here with this being the first law of it’s type in the US.  BD   

Pets could find greater health care protections than their masters under a pet insurance bill that was approved by the California State Assembly in a 42-22 vote on Tuesday.

The bill -- now under review by California Governor Arnold Schwarzenegger -- requires that insurance companies with veterinary care plans disclose more information about the limits of coverage.

The law would require insurance companies to provide information about co-pays, lifetime benefit limits and restrictions based on pre-existing conditions on websites. Democratic Assemblyman Dave Jones is pushing the bill, AB2411, forward.

The bill could would change the practices of several big name insurers, such as Nationwide, which underwrites VPI Pet Insurance. Also in the mix are Allianz( ALV) owned Fireman's Fund, which underwrites ASPCA Pet Insurance; and Aetna( AET) , which underwrites Pets Best Insurance.

Pet Insurance Reform Bill Passes in California - TheStreet

E-commerce Gateway for Determining Eligibility Recommended by Health IT Policy Committee Along with Prototype Algorithms/Portals for States to Utilize To Build

In the last couple of years this is a big deal for practices in keep current as many are changing plans and a big part of this is due to consumers looking a policies that are less expensive and have higher deductibles to get what they feel they can afford in today’s economic conditions.  image

Aggregating rather than building new data sets is the plan of action here and as mentioned above with constant change real time information is needed.  2014 is the year for healthcare insurance exchanges to all be in place (if we make that far) with all of our data issues and IT situations, as we have new stuff coming at us every day so the left curves we get every day are continuing too.  As mentioned below, other agencies are building data base programs such as the IRS and Homeland Security.  You can see now that our data is going to be expanded to potentially touch several more locations and thus here comes the coding. 

Also mentioned was a proto type portal/software application for the states so they would not have to start from scratch on their portions and have the pre-requisites for the algorithms to run up front.  There’s so much catching up here to do with so many years of a past administration that didn’t keep up with infrastructure.  BD  

WASHINGTON – The federal Health IT Policy Committee is backing a plan to build a federal database of business rules that states could use to help determine the eligibility for Medicaid and other federal health insurance programs.

The database would make enrollment data for insurance and healthcare programs accessible to all states. The states could use the data to build electronic health insurance exchanges required by the recent health reform law.

The exchanges would act as an e-commerce gateway to help insurance consumers who are not eligible for Medicaid- or employer-provided insurance find an alternative source of health coverage.

Having all state health program enrollment data in a single database would also keep states from having to rebuild data sets that have already been compiled elsewhere, said Aneesh Chopra, the White House's chief technology officer and chairman of the enrollment work group.

The Internal Revenue Service, the Social Security Administration and the Homeland Security departments are developing Web services that states can use to help determine eligibility for health and human service programs.

Government to build e-commerce gateway for health insurance | Healthcare IT News

California Legislation Bill on Breached Data Should Be Vetoed by the Governor-He Did It Before and Should Do It Again-Legislature Not in Touch With IT and California Still Needs Infrastructure Updates to Be Compliant–Unrealistic Law

I hate to sound like a broken record here but the provisions of what is on imagethis bill are enough to make a CIO commit suicide.  Our Governor gets is and is a big user of technology but for those who are not living in the real world today with technology this bill is asking for information that may not be readily available and will burden companies and government offices.  Most are in compliance and put information out according to Federal rules and standards, but this one is over the edge.  One could find out months after the fact that there was in fact more exposure too. 

Most do not realize how fragile data systems are and what is needed to make them click as we have tons and gluts of different data systems that need to communicate and as I write there’s tons of programmers all over the world working on this.  You don’t just sit down and crank it out in an evening.  Sometimes I think I have a project all together and I find I have to go back or find something new that was missed before even though I spent days, hours, week on the IT project, stuff happens and when something new is introduced you need to take the time to follow it through.image

Even Bill Gates as I saw on a recent interview talked about how he progressed as in the early days, yes he could go home and crank out some code to add to Windows 95, but we way beyond this today and it’s not that simple.  He realized early too what future IT project updates were going to be like and the amount of work involved, why, because he writes code!

The California Legislature is not alone as we had the US Senate block funding for IT Cloud projects, don’t ask why but the best explanation still going is they don’t get it as many refuse to jump in there to attain basic simple consumer digital literacy.  I have asked around to many consumers as to what they thought infrastructure meant and you know what I head…ready…this is an average consumer response.

“it means I need to get a new computer, I think”

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

If you want to go a step further with infrastructure, let’s take Medicare who has very little of their own and is all run by insurance and other IT entities where it has been outsourced over the years.  We all talked about Single Payer plans but how can this happen until the US government builds it?  That is a big daunting project and they are on it with Code-A-thons, etc, – something a prior administration has done little with and sat back and contracted everything.  It does get frustrating to hear individuals sit there and still point fingers at one person as they too, don’t know and don’t get it.  It does nothing except stir up emotions.  Here’s a quote below from someone who took a lot of time to write on the comment section of my blog that explains a little of this but read all the comments if you want to know more.  image

"“In the beginning, in 2006, these fiscal intermediaries thought that they could bid and win these contracts...WellPoint bought UGS, Administar, and Empire; they merged to form NGS. They won the contract for J-13, New York. At one time, they had 24% of the MAC contracts and thought that they were the top contractor for CMS.
However, CMS didn't really have experience with awarding contracts and competition was fierce. Companies hired lawyers and protested with the GAO...The GAO had major findings that required corrective action, re-bidding, and major delays in awarding these contracts. These delays were measured in years and they're still going on as we speak.
Only the companies with lots of cash flow could withstand waiting years to win a contract and get through all the protests.:

This is good stuff as far as information and is the reality of what we are dealing with today.  A lot of what you think is there to handle your IT needs today is not there yet as all are working to aggregate all the data to communicate across so darn many platforms because every one wants to create the best algorithm and be the creative hero today.  There is no one hero, it’s collaboration and team work and that is something we are learning the hard way at times.  Consumers get confused because on that end of the stick all the fun and good stuff is out there on the web, but it’s not there on the enterprise and imagegovernment end that you may want to react with, it’s work in progress. 

So why is Governor Schwarzenegger up to date on this – he’s a participant and uses technology and does a lot of listening and participating and not a dead head like many who sit in leadership areas creating laws.  If you listen to any of his talks and speeches within the last year he stresses INFRASTRUCTURE.

Take a stop over at ZDNet and see what their editor in chief wrote today and if you are not familiar with ZDNet, they are techs, geeks, IT specialists who cover all of this and are one of the oldest tech sites on the web as I started reading them at least 10 years ago.  They know their stuff.  image

“IT has its own bridges to nowhere and $600,000 toilet seats. Sure, the government is inefficient, but IT is too.  Add it up and IT is a mess. And chances are your IT organization is a disaster too. The big questions: What are you going to do about it? Where do we even start?”


ALL NEW LAWS REQUIRE ALGOIRTHIMS

FIRST STOP TODAY BEFORE CREATING ANY NEW LAWS, CONTACT IT AS THEY ARE THE ONES WHO MAKE IT WORK AND WILL GIVE YOU THE SUPPORT YOU NEED AND THEY CAN ESTIMATE HOW LONG OF A PROCESS IT WILL BE AND WHAT IS INVOLVED WITH SOME GUESSTIMATES ON COMPLEXITIES.


A privacy breach notification bill recently passed by the California legislature would expand the state's existing law for how organizations notify consumers of a data breach.

California's existing data breach law does not specify what the breach notification should include information-wise. "This bill is intended to fill that gap by establishing standard, core content for breach notification letters," reads the California Senate Bill 1166, which was first introduced to the legislature in March.

Whether the new bill becomes law is up to Governor Arnold Schwarzenegger, who had previously vetoed a similar data breach bill because it put too much "unnecessary mandates on businesses without a corresponding consumer benefit," he said at the time.

California Legislation Would Require Companies To Specify The Data Exposed In Breaches - DarkReading

St. Johns Hospital In Santa Monica Agrees to pay $5.25 million For Over Inflated Claims to Medicare

The hospital agreed to the payment without admitting any guilt or wrong doing.  The imagecharges were in excess of what is considered normal inpatient fees.  There are not additional details here. 

I am almost betting one could audit almost hospital today and find items as such and perhaps not as high as this, but when you go back and run audit tables over what has been done over the years, this is what happens.  image

Just as a footnote, this is where the John Wayne Cancer Institute is located which is one of the most comprehensive centers for advancing surgical oncology and is supported largely with donations.  BD

A Santa Monica hospital has agreed to pay the federal government $5.25 million to resolve allegations it submitted inflated claims to Medicare.

Federal prosecutors say from 1996 through 2003, Saint John's Health Center engaged in "turbocharging," meaning it dramatically increased charges billed to Medicare for care provided to hospital inpatients far in excess of any increase in costs associated with that care.

http://www.sfgate.com/cgi-bin/article.cgi?f=/n/a/2010/08/25/state/n161758D90.DTL&type=health

TriZetto (Owned by Apax Partners PE Firm) Buys Tela Sourcing And Gains IT Resources to Outsource Claim and Other Transactions To India With US Medical Billing

We have a large Senior HMO/Medicare group in southern California that does big imagebusiness with Trizetto which you can see from the title above was purchased by a Private Equity Firm earlier this year and is moving from Newport Beach.  Below I have quoted the “about”section of the Tela website for more information.  Trizetto also wants to store your personal health records too but right now with the potential of merging data systems could they be stored on a server in India?  It’s always a good question to ask and who and where access to your records will be. 

CareMore Health Plan Invests in Business Intelligence for Acute and Chronic Illness Management

Trizetto also has a high focus with marketing to employers too so this acquisition of Tela Sourcing might give them an edge on providing cheaper pricing for the companies they solicit for their business. 

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

About a month ago Trizetto hired the former CEO of Cerner.

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

You can see where the demand for squeezing out additional profits from investors is going here, not brain surgery.  A couple months ago they put out a release about a survey they took and I wondered where in the world they found such up to date and health literate consumers, as I can’t find them, so be careful what you read today before going to the bank as there’s a ton of marketing out here today with everyone saying they are the best. 

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

With all these transaction fees and combining of companies I still say we need to certify them and create something like a Department of Algorithms as everything takes place in the background as the algorithms giveth and they take away.  Trizetto also licenses and uses software programs from Ingenix.  imageBD

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

From the Tela Sourcing Website:

“TÄ“la Sourcing (pronounced “Tea-la”) is a privately-held company headquartered in Baltimore, Maryland. Since it’s founding in 2003, TÄ“la has grown to 500+ employees serving more than 85 US-based healthcare clients and processing greater than 100,000 claim transactions per day or 24 million claim transactions annually.

Tēla has been providing US-based and offshore services through its wholly-owned operational center located in Pune, India, since 2003. Customers include US HMOs, TPAs, other insurance payers, managed care organizations and technology vendors.

The domain expertise, experience and delivery expertise of Tēla offers imagea wide range of solutions for business process outsourcing (BPO) and software application development.

In 2007, Tela acquired HealthASPex, adding two additional onshore processing centers, 35 additional clients, and additional service offerings such as electronic PPO routing.

TÄ“la has a team of domain consultants and operations experts with in-depth knowledge of the healthcare, managed care, insurance markets and operations management with significant healthcare experience from having worked in the industry for 8 – 20 years.”

Baltimore-based Tela Sourcing offers outsourced staffing of operational functions such as claims administration, enrollment and billing using personnel in the U.S. and India. The acquisition expands Greenwood Village, Colo.-based TriZetto's existing business process outsource services. The vendor now has such services on-shore, near-shore and/or off-shore to meet client preferences.

image

http://www.healthdatamanagement.com/news/health-care-technology-news-acquisition-payer-trizetto-outsource-40932-1.html?ET=healthdatamanagement:e1387:120588a:&st=email&utm_source=editorial&utm_medium=email&utm_campaign=HDM_Daily_082610

Buffalo Beacon Community To Begin Improving Health Care With Use of IT-Connect and Get the “Dead Patients” Out of the Rank and File of the City Benefit Packages Too

When we combine insurer information we need to make sure we have “live” patients here so the information is not skewed.  I mention this as a couple weeks ago the city found 2 million dollars worth of money spent on insuring patients who had been dead for a number of years.  When participating with an HMO doctors get notices too that patients are due for mammograms, etc. and I have heard this in a few doctors offices that they get notices to recall patients for screenings and tests for patients that are dead and the fact that the provider did notify but for some reason or another the data doesn’t get connected.  image

Perhaps with the new Health IT money here some of this can be ironed out.  All of this has to come together today so we have accurate and good data to work with.  BD

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

The HIE was one of 15 community-based organizations awarded a total of $220 million in economic stimulus funds to create "Beacon Communities" to serve as pilot sites for comprehensive use of health information technology. The goal is to accelerate and demonstrate the benefits of health I.T. while laying the groundwork for establishment of tens of thousands of health I.T. jobs

Buffalo Beacon Community Set to Go

Finding Value with Healthcare and Education Spending In Tough Economic Times-Special Interests And Lack of Business Intelligence Sometimes Clouds The Issues of the Big Picture

This week it was education in the news and we have the same thing in Healthcare too with the announcement of the most expensive public school slated to open in Los Angeles.  This facility is not alone and there are other such examples in the country.  Our governor was right up front about his comments on this as well saying it was almost embarrassing to see this when the school district itself has had to lay off teachers and is running in the red.  We see this too with hospitals and everyone has their corner of interest in what is needed.image

New LA County-USC Hospital Is Too Small – Los Angeles Supervisors Looking for Money to Add 150 Beds

That’s the big question today, what is “really” needed and what “would be nice to have”.  All you have to do is watch the video and you get the idea.  We have a county hospital that was built and now is too small, again planning here and perhaps a lack of individuals making decision that don’t understand or comprehend the full impact of infrastructure and IT Technology.  It flat out does not make sense to see the healthcare of individuals suffer and yet have this big expensive school open.  The governor stated the money spent here could have been spread out  in a number of various ways so that more would have benefited. 

Doctor Reimbursements Cut by Los Angeles County – Wake Up and Smell Some “Servers” & “Algorithms” – Let’s Plan the Next Bail Out As It Might Be Healthcare

In the LA district over 3000 teachers have been laid off in the last couple years.  Here’s a couple more links from the last couple of years with some City plans with having to educate new nurses in Mexico.  It does not make sense and once again we need people in positions of leadership that can understand how one decision touches another today to get the big picture, on other words use business imageintelligence software projections to avoid spending like this. 

Outsourcing education in California- Nursing Schools in Guadalajara, Mexico
Bordering on a solution - Nurses from Mexico

Overall this shows a lack of skills to really look at the entire impact and we end up once again with the unintended consequences and people look stupid to put it bluntly.  Is it any wonder that teachers and nurses are frustrated and angry when they see the system suffering with lay offs and working short handed? 

We hear the old story that the money was no available in the budget; ;however when looking at other areas there could be money available and not being used so again with business intelligence and the ability to shift money in the proper directions for best use and benefit, we need those folks who understand the concept of business intelligence and what it can do to avoid more of these types of situations with better use of taxpayer and other funds.  States need to work with counties, counties with cities and so on to maximize where the money goes.  BD 

The most expensive public high school in the nation's history will open its doors to students next month in Los Angeles, but critics say the $578 million school is already teaching a lesson on wasteful spending.

The money troubles come on top of the district's serious academic shortfalls. With a dropout rate upwards of 35 percent, LA Unified is one of the lowest-performing school districts in America.

New Public School in Los Angeles Named After Robert Kennedy is Most Expensive in American History - ABC News

DePuy (Johnson and Johnson) Issues Recalls Hip Replacement Systems And Commits To Working with Related Cost

The DePuy knee and hip systems have had their share of news coverage of late and now an official recall has been initiated. Just a few days ago the FDA issued a warning letter about some of the DePuy products not being marketed and utilized imagecorrectly. 

DePuy (Johnson & Johnson) - FDA Issues Warning Letter on Marketing Products and Software Not Specifically Approved

A few months ago reports came out regarding failure rates on some of their units as well.  The system being recalled was initiated for use in 2004 so there’s quite a few of them out there and a statement released from DePuy said the company is committed to pay for costs of doctor visits, tests and any procedures associated with the recall so perhaps this statement leaves the door open for those patients who have had severe failure to purse and see what options are out there. 

DePuy (Johnson and Johnson) Warning Doctors of High Failure Rates – Hip Product Being Phased Out

Perhaps with this purchase of a company in the UK, they have have a route to offer knee and hip replacements that stand to show better outcomes in the future too. 

Johnson and Johnson Company, DePuy Orthopedics Acquires Finsbury Orthopaedics from the UK

As usual, here’s my pitch for a system at the FDA for drug and device companies to use with such recalls too.  As of now go to the web and dig through all the information and see if you have been affected and find the relevant information.  Scanning with a cell phone would certainly be much more efficient to find the recalled items. 

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

If you like this idea take a moment and cast your vote before leaving the site!  Over the counter recalls could be handled the same way and empower consumers with the real time information they need today when recalls are released.  BD

Johnson & Johnson's orthopedic-device unit is recalling hip replacement parts implanted in about 93,000 people world-wide because of a high rate of repeat surgeries needed, adding a new quality problem for the health-products company.

A Johnson & Johnson spokesman said Thursday the company is still evaluating the financial impact of the recall, which doesn't require patients to have implants removed. Instead, the company's DePuy Orthpaedics subsidiary advised patients with its ASR hip parts to visit their surgeons for evaluation of device performance. It also recommended yearly monitoring and said it plans to cover "reasonable and customary costs" linked to the recall

J&J Unit Recalls Hip Replacement Systems - WSJ.com