New Jersey Legislature Getting Smart– Bill to Modify Claim Procedures to Include Asking For Insurance Company Algorithms-Bill A3334

There’s a few other states that might want to pay attention here and for that matter, Congress too.  If you have read the Medical Quack long enough I have several posts on needing algorithmic centric laws.  Mathematical formulas have made many rich and during better times it was not so much a concern, however, right now we are not living in those past times.  Here’s one from back in August of 2009 to where I explored the formulas run against claim data and the word “fraud” or “potential fraud” carries a lot of weight as if any of the parameters in the claim data fits, when the queries run it could very easily get denied and in case of someone questioning a denied claim, it usually required some human intervention at that point.  To detect fraud, insurers have historically used a so-called pay-and-chase method: They review claims after paying them, and if fraud was suspected, they come back after consumers and doctors after the fact wanting money.  The link below has a few more details on that topic.

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

Also back in August of 2009 I posed the question of whether or not we are going to get some laws that are algorithmically centric and it looks like New Jersey is starting to catch on as they have a bill that could require insurers to not only produce some copies of working algorithms (mathematical formulas) but furthermore need to explain them.  The best way to do this is to have actual example of the software code and how it calculates, a visual as words don’t cut it here and takes hundred of pages to explain.

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

I ask the same question in healthcare, can regulators keep up with the speed of innovation of the “under tow” here and protect us?  The answer lies in “Algorithmic Centric Laws”, no 2 ways about it, and the smarts to rethink the way we create laws, otherwise they end up being useless and protect nobody.

So again, to keep the hidden technologies that run mathematical formulas from stepping all over us, it would be so very helpful to have laws passed that are specific as to what type of computer language and queries that can be run, AND, make that publicly available so people know what is being done and not a big string of queries that nobody but the beholder has privilege to access.  You can read the entire pdf of the bill but here’s some meat and potatoes here as it relates to what a payer may have to come up with….those algorithms!

http://www.njleg.state.nj.us/2010/Bills/A3500/3334_I1.PDF

When a former Goldman Sachs employee had some of their code, all hell broke lose, why, it’s those algorithms and mathematical transaction fees that make income. 

Goldman Stolen Code – Has Algorithmic Fraud Become A Business Model in HealthCare Too?

All these folks that are running “machine gun” technology compare to the rest of us with swords and daggers win the transaction battles every time, ask any one on Wall Street and our insurers are traded on the open market so they too know all about this and keep plenty of “Algo Men” around. 

It’s not Superman, Spiderman or Wonder Woman that we need today, it’s “Algo Man” so our algos can go to battle and audit and ensure everything is correct. The SEC needs a bunch of “Algo Men” too as they face the same issues with managing machine gun technology.

Anyone in office today or running for office needs an Algo Man to have the business intelligence algorithms performed to make sure what they promise can be done.  We have passed the point where promises are made and then the techies make it work, it’s not that simple any more.  We read that in the news every day and not only do we have more data, we also have more data touching other data and being used and sometimes sold for profit.  Here’s a good book that will bring to light something we all need to come to terms with, everybody does not write “good” algos, some are for accurate results and others give “desired” results which may not always coincide with the word accurate.

“Proofiness–The Dark Side of Mathematical Deception”–Created by Those Algorithms–New Book Coming Out Soon

Back in August of 2009, again I speculated on the creation of a “Department of Algorithms” or something close to this effect.  There’s a video of Harry Markopoulos to remind you of how he knew what to do and how calculations were made but his comments fell on deaf ears at the SEC, thus non participants who ignore this area and don’t bother to get involved cost all of us money.  Harry says right in the video they didn’t know what to do with the information he gave them.

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

What do we use to create business models:  Computer Code or Algorithms.  Write up some new algorithms, amend and query what is already in place and “bingo” you have a new business model created with business intelligence software.  The business intelligence software is not the issue or problem, it is the creation that results which is customized and proprietary.   All the money and care we get is wrapped up in the payer side and we spend a lot of time and money with medical records, why are we not certifying the other side and getting some working algorithm samples added to today’s laws?

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

Here’s one more example and then I’ll close up here, but if you read this link about real doctors and hospitals trying to understand the insurance algorithms, you may understand a bit better why we need those Algo Men.  Instead of being able to devote more time to your care, they are fiddling around trying to figure out complicated insurance carrier algorithms. 

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

Algorithms for profit only get the carriers drug into court too and yet the next day we turn around we have more complicated algorithms built on ones that already exist that generate additional transaction charges and fees, so unless one takes hard look at what is being done, it keeps feeding itself, and this is part of the reason why being a healthcare CIO today is so tough.

If you are in purchasing without some IT background making software decisions, check with your IT folks as this is where it gets tricky as the software may do what the sales person said, but what is the cost behind the scenes with transactions and associated fees.  CIOs today are studying overtime on how to get rid of some of this and it may require an upheaval, but they are the folks that know the data trails and how it connects to either making or losing money. 

Insurance Companies Under Attack with Lawsuits – Generated by Their Algorithms

So hopefully let’s see where this bill goes as it’s a goods start and as I said the terminology is right, we should be able to see the algorithms. 

Last Session Bill Number: A2086
McKeon, John F.   as Primary Sponsor
Stender, Linda   as Primary Sponsor

New Jersey Legislature - Bills

Technorati Tags: Health Insurance,laws,bills,claims,healthcare,audits,medical care,legislation,algorithms,New Jersy,Algo Man,mathmatics

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FDA Head of Generic Drug Division Going to Work for Teva Pharmaceuticals

Teva is probably one of the most interesting pharmaceutical companies out there as they are pretty much generic with the exception of some of their own research products.  Recently in the news the company quit manufacturing propofol here in the US so now our supply comes from Europe.

Teva gets FDA Approval for Breast Cancer Drug Arimidex – First US FDA Approved Generic

Merck and Teva have had some long ongoing court battles over making generics from some of their name brands and in some cases with the pressure to get more generics on the market it may have just been timing to land some of the cases in court where patents and intellectual property are in dispute.  BD 

Teva Pharmaceutical Has Approval to Begin Marketing Generics for 2 Merck Hypertension Drugs – Hyzaar and Cozaar

They even tried to get generic Viagra out on the market sooner too. 

Pfizer Suing Teva To Block Generic Version of Viagra Until 2019 Instead of 2012 Expiration Date – Viva Teva

This is a big change for Buehler after 40 years in government work and no doubt he will be contributing in the sometimes confusing world of generic biologics.  Teva is one of the largest and aggressive generic drugs companies.  Back in March the FDA lost one of their top Medical Device Regulators to Microsoft.

FDA Medical-Device Regulator Leaves to Take Position at Microsoft Health Solutions Group – Director of Regulations and Policy

Dr. Tillman came under fire last year in an FDA report about the agency's approval of a knee-surgery device called Menaflex, made by ReGen Biologics Inc. of New Jersey.  BD

Longtime head of the generic drug division at the U.S. Food and Drug Administration is going to work for the world's largest generic-drug maker, Teva Pharmaceutical Industries Ltd.

Gary Buehler will become vice president for regulatory strategic operations at Teva, the company said.

In March, Mr. Buehler was nudged out of his leadership post at the FDA's generic office into another role at the agency.

The generic office has been criticized by Congress and some pharmaceutical companies because of a backlog of some 2,000 drug approvals, which means applications take an average of about two years to process.

Teva Hires Former FDA Senior Official - WSJ.com

Technorati Tags: Anastrozole,Teva,breast cancer,drugs,FDA,Arimidex,generic drugs,Buehler

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Botox Gets FDA Approval for Treatment with Chronic Headaches

Once only for making us look younger, the clinical value of Botox continues to grow.  Also see another recent FDA approval for Cervical dystonia below.  The botox shots are for those who have chronic headaches and not an occasional situation. 

FDA Approves Xeomin® A Botulinum Toxin Type A (Botox)To Treat Cervical Dystonia

A visit every 12 weeks for injections is the treatment plan so it looks like 3 months is the amount of time before the next visit to the doctor is due.  Botox has been approved in Europe for migraines since July and there’s even clinical trials in place for topical Botox so perhaps even the shots maybe be a thing of the past one day.  BD

SILVER SPRING, Md., Oct. 15 /PRNewswire-USNewswire/ -- The U.S. Food and Drug Administration today approved Botox injection (onabotulinumtoxinA) to prevent headaches in adult patients with chronic migraine. Chronic migraine is defined as having a history of migraine and experiencing a headache on most days of the month.

"Chronic migraine is one of the most disabling forms of headache," said Russell Katz, M.D., director of the Division of Neurology Products in the FDA's Center for Drug Evaluation and Research. "Patients with chronic migraine experience a headache more than 14 days of the month. This condition can greatly affect family, work, and social life, so it is important to have a variety of effective treatment options available."

Migraine usually begins with intermittent headache attacks 14 days or fewer each month (episodic migraine), but some patients go on to develop the more disabling chronic migraine.

To treat chronic migraines, Botox is given approximately every 12 weeks as multiple injections around the head and neck to try to dull future headache symptoms. Botox has not been shown to work for the treatment of migraine headaches that occur 14 days or less per month, or for other forms of headache. It is important that patients discuss with their physician whether Botox is appropriate for them.

FDA Approves Botox to Treat Chronic Migraine -- SILVER SPRING, Md., Oct. 15 /PRNewswire-USNewswire/ --

Technorati Tags: dystonia,neurological disease,Botox,FDA,healthcare,drugs,injections

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Extormity Launches EHR Abstinence Program

Extormity is the product of SEEDIE and there’s a few more of their articles around the Quack and they do make us laugh and think about what we are doing or trying to do out there.  The are supplying several copies of popular mechanics for you to read while they do their work and look for employees to train your <grin>.  BD

SEEDIE – The Society for Exorbitantly Expensive and Difficult To Implement EHRs Submits Meaningful Use Recommendations

Electronic health record vendor Extormity today announced an initiative designed to encourage physicians to sign an ironclad EHR contract which includes a commitment to wait for 9-12 months until the company can hire and train implementation resources to bring practices online.

"The Extormity Abstinence program promotes our EHR as one worth waiting for," said Extormity CEO Brantley Whittington. "We are educating physicians on the dangers of fooling around with EHR vendors flaunting their affordable, web-based and easy to implement solutions. While tempting, these low-cost and try-it-before-you-buy-it EHRs remind me of the old adage 'why buy the cow when you can get the milk for free.'"

"Like our other big-name competitors, our complex client-server solution requires a team of implementation consultants who will spend weeks on-site, re-configuring practice workflow, training practice personnel and disrupting patient revenues," added Whittington. "All of us are creating waitlist programs as we scramble to find employees. We have already extended offers to four of the recently extracted Chilean miners, and we are expecting a dozen new recruits to be released from a halfway house next week."

The Extormity Abstinence program requires a $50,000 per physician down payment and includes a laminated pocket pledge card, an "Extormity – I'm Worth It" wristband, and access to a virtual waiting room modeled after a customer lounge adjacent to the service operation at an auto dealership.

"While I was enticed by some of the cloud-based EHRs out there, I have resisted the allure of an affordable and practical solution that can help me qualify for stimulus funds right away," explained Dr. Lewis McFaddenson. "I have been spending quite a bit of time in the Extormity virtual waiting room, which is stocked with back-issues of Popular Mechanics that date to the mid-70's."

Brantley Whittington/CEO

“My sole focus is on maximizing shareholder value, period…oh, and improving patient care, too.”

Whittington, a former Wall Street hedge fund manager, has a keen interest in EHR technology that dates back to a 2004 analyst report projecting exponential growth in the healthcare IT sector. Whittington provides leadership and vision, balancing perceived customer needs with the very real demands of Extormity investors.

About Extormity
Extormity is an electronic health records mega-corporation dedicated to offering highly proprietary, difficult to customize and prohibitively expensive healthcare IT solutions. Our flagship product, the Extormity EMR Software Suite, was recently voted “Most Complex” by readers of a leading healthcare industry publication. Learn more at www.extormity.com

Technorati Tags: EHR,EMR,humor,Seedie,healthcare,medical records,Extormity,ARRA,meaningful use

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Pfizer Looking At Pain Relief with Purchase of King Pharma With Lipitor Patent Facing Expiration Next Year–Could FDA Approved Antidote for Those Who Become Addicted Be Next?

This is big purchase and they are perhaps looking to anticipated reduced revenue once generic drugs for Lipitor come on line.  We are seeing mergers and acquisitions all over healthcare. 

Below are some of the leading pain killers from King Pharma and the company also has quite a few other drugs outside of pain relief too. 

Embeda™ CII (morphine sulfate and naltrexone hydrochloride) Extended Release Capsules

Avinza® CII (morphine sulfate extended release)

Flector® Patch (diclofenac epolamine topical patch) 1.3%

Skelaxin® (metaxalone)

Thrombin-JMI® (thrombin, topical, bovine origin, USP)

Levoxyl® (levothyroxine sodium tablets, USP)

Ironically and perhaps this is just timing but the FDA approved a drug to help those addicted to pain killers, called Vivitrol so is this perhaps in the line for contention here if for no other reason to offer a solution for those who develop an addiction?  Below is an except from the link above in USA Today.

“Vivitrol is injected monthly, not taken daily by mouth, so it's easier to stick to. Though patients can obtain bupenorphrine at a pharmacy, they must go to clinics daily to get methadone. And, unlike methadone and bupenorphrine, Vivitrol isn't an opioid but a long-acting form of naltrexone, which blocks opioids. "There are treatment programs that really oppose using methadone or bupenorphine," says Nora Volkow, director of the drug abuse institute. "I predict that naltrexone may be acceptable."

This is just some pure speculation here on my part as a consumer looking around and making a bit of sense on how the face of healthcare is changing and evolving today.  BD

Pfizer ( PFE - news - people ), in moving into pain medication, Forbes' Matthew Herper reports (See Pfizer's Future Fighting Pain"), is seeking to facilitate a revenue cushion for its patents that are set to expire next year, one of which includes Lipitor, a drug that brought in $11.4 billion in global revenue in 2009. Simon King, an analyst at Datamonitor, says the loss of Lipitor exclusivity will create a strain big enough for the acquisition to have only a minimal impact on the company's earnings.

Pfizer expects the transaction to contribute at least $200 million in operating expenses, which will be fully realized by the end of 2013. Pfizer's 2010 financial guidance remains the same.

Pfizer, Set to Lose Lipitor, Feels No Pain With King Buy - Forbes.com

Technorati Tags: Pfizer,King Pharmaceuticals,healthcare,drugs,FDA,pain killers,pharma,mergers and acquisitions

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Ouija Board iPad App–Will This Be the Next Item to Speak to Those Patients on the Other Side, Score Medical Claims For Health Insurers And Give our Politicians Their Next Stand?

You have to be 50 or over to really appreciate this as the Ouija Board had it own little cult thing years ago and we all probably at some point in time played around with it and were amazed at what we saw, it was for “talking to those on the other side”. 

Well this is in jest, but I view of the some of the obscure marketing I see today in healthcare is someone going to market this for the next tool for a surgeon or doctor to help with the grief of losing a loved one?  Perhaps there are some new algorithms available for Wall Street and health insurers they have missed with this Ouija Board software on the Ipads since they are frantically looking for any new type of predictive analytics they can get their hands on <grin>.

Just think, healthcare claims having to pass the Ouija Boart Test, and it just might be just as crappy or good as we are seeing today!  The Ouija Board on an IPad doesn’t have the same flair we all knew years ago though and you do need to be a baby boomer to appreciate this post. 

Why Is Almost Everyone In Healthcare Marketing Their “Ass” Off

In short, this is my little poke at some of the ridiculous marketing we see today where it’s anything to make a buck <grin>.  More at the apps store about this little jewel can be found here.  From what I see in the news today though with those clinging to the 70s and the stands being made, gee, maybe some of our politicians are using a Ouija board, you think? 

They all seem to be stuck there and are pretty much “non participants” when it comes to general consumer IT literacy”, so maybe I have solved some of this strange insanity we are seeing today as perhaps they are all dragging out their old Ouija Boards to communicate with the dead from the 70s,  as it it would be too far fetched to think that they would use an app, as they are the recognized and sometimes even touted non participants as we see in the news every day <grin>.  BD

call it “spirit of the glass”, “Spirit of the coin”, depending on which item you use, should we call Ouija on the iPad,  ”Spirit of the iPad?”, will it also translate thoughts from the dead? Developers claim that there inst any AI to do that yet, however they think that it could be a great idea and fun

Ouija Board iPad App, Ouija, Ouija Board HD and Spirit Pad | iPad, iPhone and iPod Touch Applications

Technorati Tags: Ouija Board,humor,medical humor,healthcare,Medical Quack,IPad,health insurance

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Newt Gingrich Scams Doctors With Fake Prize Awards That Costs $5000

American Solutions for Winning the Future is his fundraising group that creates money for Newt.  It will cost you $5000 if you are a doctor to get an invite and an award from Newt Gingrich.  It is funny in the video that they use the a handwriting computer font. 

I said back in July he has no knowledge of algorithmic formulas and was kind of blowing smoke this confirms it I think. One more good reason to know about those algorithms as ignorance could cost you a donation you may really not want to give.

Newt Gingrich Gets Healthcare Value Bass Ackwards–It’s All About Those Algorithms

His target this year is physicians and Rachel Maddow did a good job on pointing this out in addition to the article in the Huffington Post so if you are a doctor and get one of these you will be familiar with what it is, as Rachel states it’s a scam, no set of knives.  BD 

Technorati Tags: Newt Gingrich,fund raising,$5000,doctors,awards,Maddow,politics,GOP. algorithms

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Why Is Almost Everyone In Healthcare Marketing Their “Ass” Off

Everybody seems to have a study today and if they don’t they dig through the web and find some small tiny study that may or may not relate, and sometimes they either somewhat make one up or create one.  If you are a regular reader on the web you are seeing this all the time and the lines are getting gray not only for consumers but for doctors too. 

I get a pretty full load of emails with folks sending me information and sometimes I have to read things 2 or 3 times to make what I feel is a good decision on what is good information and helpful and separate that from those that are just marketing.  I like to announce potential products, procedures, FDA approvals that I think are useful but darn I am not going to put a study on here about how eating peaches and plums helps with cutting the risk of breast cancer.  Yup they had a study for that one and I guess it could rank right up there with the men eating pomegranates for prostate cancer, so folks this is what some want us to believe.  As women we get to sit around and eat peaches and plums while the men chow down on pomegranates but I guess we could eat those too and vice versa <grin>.  The fact is we know the food is good for us but the studies that are substantiating some of these products are getting pretty strange. 

One of the funniest ones I think I can remember was the hemorrhoid medical device, which was not much more than a couple big heavy pieces of duct tape to put your cheeks, I spared that one here.  When I get these somewhat obscure studies that come with this stuff, I actually do go look at them and see what the attached information has to say and along with study information there’s usually a hell of a lot of marketing in there too, so even the studies look weird. 

Everything you see on the web today is not 100% factual so read up and really check some of this stuff out.  Sometimes I will post about a new device and keep in mind I don’t take everyone seriously as they all will not survive; however there have been instances to where something looked weird or obscure and then a year o two later someone does take that technology and brings it back in a totally useful and integrated format, so that happens too. 

What concerns me too is that marketing is de-valuing some good causes and products out there too.  We get hounded by consumer products, retail stores and now drug stores and healthcare services.  If we keep up at the current rate I feel that it’s going to have a downward trend and drive people nuts to where some of the good ideas and products won’t be able to work.  Seniors are getting it and I will use my 87 year old mom and her examples as she’s target for all of this. 

Senior Marketing Trends–Dick Van Dyke for Stem Cells, Andy Griffith for Medicare–Is Betty White Next for Birth Control Maybe?

CMS showed us Andy Griffith with healthcare but this is no Andy Griffith in these call centers with auto dialing phone numbers and telling here she needs to call Medicare to get one of the new style devices on the market for glucose readings.  She couldn’t understand why all of them were asking her to call Medicare!  There was no particular product being pushed, but just get a new glucose reader so she could be assured she was getting accurate readings. 

Diabetes Police Telephone Solicitation Patrol–4 Calls Today In 2 Hours Mom Asking If There Was A Diabetic in the House

On the other side of the coin we all may know that pharmacists are on Pay for Performance from United Healthcare so now we get help with an aggression we have not seen there before either.  Some are jumping over the counter to help you whether you want it or not. 

Compliance Police Out In Force for Seniors–Health Plans and Drug Stores Making Phone Calls-Business Models & Caller Behavior Sucks -A Result of Pay for Performance Efforts?

I think everyone is falling a bit off their rocker here as algorithmic marketing comes in bigger force and it will eventually slow down I hope but all these posts about some facility being number one or some other nonsense like that doesn’t do any good any more because they all say they are #1, it’s losing its effect.  On top of that you have folks like this that buy and market information to help consumers and the mine and sell data too and can’t even get their own data out there with some accuracy.  Who needs them and they just take up space on the web and rack money for a less than what I call substantial service.  Let’s find some dead doctors while we are at it and see how they rank with the care they give?

HealthGrades And Other MD Rating and Referral Sites List “Dead Doctors” on Their MD Information Pages And Even Include the Insurance Plans the “Dead Doctors” Honor

As consumers we want good affordable care and all the rest of the guerilla marketing could go away.  Nobody really seems to focus on what they really do well anymore and it’s a constant game of one upmanship on the web with so much litter any more with everyone “selling their ass off”.  BD   

(CNN) -- A weight loss study by Jenny Craig. A survey of sexual health and condom use by Church & Dwight, the company that makes Trojan condoms.

Both have earned attention-grabbing headlines recently and raised questions about what constitutes good research practice.

And they're not the only ones running scientific studies concerning products that they make. Wrigley's has a campaign called Benefits of Chewing based on research regarding gum helping weight management, stress relief and alertness and focus.

Where's the line between research and marketing? - CNN.com

Technorati Tags: marketing,healthcare,devices,advertising,doctors,hospitals,rankings

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Mercy Hospital CEO in Scranton Has to Clarify the Statements Surrounding The Proposed Sale of 3 Hospitals–Leave Us Out of the Politics

This was kind of interesting to see how this announcement was taken out of context and it’s not too surprising when you look around the web today and read some of the articles where folks are maybe looking for ratings.  He had to clarify that the hospitals are not closing for one and he statement of healthcare reform having an impact was drawn way over the border here as I think any hospital today can mildly say they have been affected, but this one went haywire with not keeping the rest of the facts in tact.  Like many other hospitals in the US they are looking for financial options and selling is obviously one that is in the works here, but the CEO stated he wants to be out of the political arena on all of it.  BD

 

Last week the CEO of Mercy Health System claimed national health care reform was partially responsible for the decision to put three hospitals up for sale.

His comments to Newswatch 16 hit the internet and President Obama's critics used it as a way to slam health care reform.

Now Mercy CEO Kevin Cook is fighting back. He doesn't like what's going on, claiming critics of health care reform are taking him out of context days before a critical election.

Less than a week after Mercy Health Care System announced it's looking for a buyer, radio ads hit the airways.

"Mercy Hospital President Kevin Cook said that President Obama's health care reform bill absolutely played a role in their decision to close their doors," states a radio ad paid for by CatholicVote.org and airing on local radio stations.

"First of all, we're not closing," Cook said Tuesday.

Mercy Hospital CEO Responds to Health Care Controversy - WNEP

Technorati Tags: hospitals,CEO,healthcare reform,politics,Mercy Health Care Sysem,sale,buyer

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Pay on Wall Street Will Pay Out Record $144 Billion This Year–Pay Rises Regardless of Whether Value is Created or Not– Does the Economy Need Us Outside of Betting On Our Behavior and Illnesses

On Wall Street the machines are doing the work today so it appears if one can work with a series of algorithms and set parameters with a bit of gambling in one’s blood and a bit of luck then the financial rewards keep rolling in.  It does make one wonder when you see investment items like human hedge funds and folks betting our our ability to live and fight disease, kind of sick if you ask me.  Watch the video below for some additional details. 

'Dead Peasant' Life Insurance Policies - Human Hedge Funds The Next Bond Issues

Here’s a good example from a healthcare insurer on profits and the compensation and their board recently stated they wanted no limits on executive pay and blow out the doors on lobbyist spending. 

UnitedHealth CEO Compensation Triples From 2009 to $9 Million – 3.9 Billion Profit for UnitedHealthCare

Soon and it has already been happening those same algorithms used to make money are also finding fat on the street, so brokers beware too as you are replaced with automation and the state of the economy adds on so what goes around will come around in some sort I think.  I believe this also means that some are out the door while a few others might tend to even get richer.  Did you see the 60 Minute show on Wall Street, if not watch it and see what is happening there as you will understand why all of those with the powerful algorithms have all the money and why all the rest of us are suffering with high frequency healthcare as a result.  BD

High Frequency Trading on Wall Street Creates and Complicates “High Frequency Healthcare”–Those Algorithms

“Trust us,” Wall Street said.

And what has it brought? A new study of 2010 compensation by The Wall Street Journal found that the industry will pay out a record $144 billion this year. The compensation represents a 4% increase from 2009. It also slightly outpaces a 3% revenue increase at the big brokerages — most earned in the early part of the year. See WSJ report on Wall Street pay.

The numbers starkly contrast the reality for most Americans. Those lucky enough to have work are seeing little, if any, rise in wages. The pay figures also sharply underscore how reform, bailouts and aftermath of the financial crisis failed to influence pay.

Pay on Wall Street knows no boundaries MarketWatch First Take - MarketWatch

Technorati Tags: Wall Street,compensation,healthcare,politics,health insurance,policies

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AT&T Moving Into Wireless Mobile Healthcare with eCardio Diagnostics For Cardiology and WellDoc For Diabetes

Perhaps the news on the horizon of an IPhone at Verizon soon has sparked some interest with AT&T with more healthcare connectivity?  There are a couple stories n the news today and we are covering cardiology and diabetes.  Back in August of 2010 WellDoc received FDA approval for their device.

FDA Approves WellDoc Smartphone Mobile Diabetes Tool/Software Using Bluetooth And Automated Algorithmic Analysis Processes

eCardio Diagnostics Introduces Exclusive Extended Monitoring Device

They both use an algorithmic reporting system and AT&T appears to be offering WellDoc to their employees soon.  As mentioned, AT&T is a self insured employer thus they are looking at keeping costs down.  It will be interesting to see what survives in mobile applications as we sure have many today.  I still think he best bet are those that communicate with a PHR. 

With doing this blog I see so many devices and of course they need to be doctor friendly as an MD will go nuts, and rightly so with too many systems to use, kind of like the EHR dilemma we have with way to many software applications.  BD

AT&T has announced plans to carry eCardio Diagnostics' cardiac arrhythmia–monitoring mobile devices on its wireless network to allow physicians to monitor patients' heartbeats in real time.

The eCardio M2M (machine-to-machine) monitor allows heart patients to recuperate at home from arrhythmia, or irregular heartbeats, rather than endure a long stay in the hospital.

ATandT to Provide Wireless Service for eCardio Heart Monitors - Health Care IT from eWeek

This is big: AT&T announced plans to offer WellDoc’s FDA-approved mobile phone-based diabetes management solution to a select group of AT&T employees sometime in 2011. (AT&T’s benefits program covers some 1.2 million employees, retirees and dependents so the company has a vested interest in improving employees’ health while keeping costs low). AT&T potentially plans to offer additional mobile health services developed by WellDoc in the areas of heart disease, asthma, chronic obstructive pulmonary disease and oncology, assuming those programs also receive FDA approval. WellDoc CEO Ryan Sysko told MobiHealthNews that each of these programs are in various stages of commercialization, from prototyping to clinical testing.

http://mobihealthnews.com/9168/why-the-att-welldoc-deal-matters/

Technorati Tags: AT&T,wirless,monitoring devices,WellDoc,eCardio,cardiology,EKG,diabetes,FDA,medical devices,PDA

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California Hospitals Deposit Money Into Fund to Attract Federal Funds and Recoup Some of the Losses on Medi-Cal

Medi-Cal reimbursements are about the lowest in the country for doctor and hospitals in California.  I don’t even completely understand the concept here with the matching federal funds having not seen all the details, but n short the article states that by contributing in 4 payments to a general fund, it will release additional federal funds to help make up for losses last year when the Medicare (Medi-Cal) cuts took place. 

Hospitals like Kaiser stated they contribute but they don’t serve Medi-Cal so their efforts are more of a contribution and everyone makes out in the long run with better care and facility upgrades.  Half of Los Angeles hospitals are operating in the red so it’s a real challenge for some to get the money together but as stated they get it back and then some in the end.  BD 

California hospitals have begun paying billions of dollars into a state-federal program as a way to reap even more money to spend on improved patient care, seismic safety and a range of other projects.

Under state legislation signed by Gov. Arnold Schwarzenegger last month, the hospitals will pay about $3.1 billion into the program and will get that money back in federal matching funds, plus $2.6 billion.

In the San Fernando Valley, for example, Valley Presbyterian Hospital in Van Nuys expects to net about $5 million by participating in the fee program.

The hospital plans to use the money to help care for Medi-Cal patients - reimbursement rates were slashed last year - make seismic-safety improvements and remodel emergency departments and other facilities.

"This is a critically important program," said Gustavo Valdespino, president and CEO of Valley Presbyterian. "We are a safety-net hospital here in the Valley, taking care of a great percentage of Medi-Cal patients."

At least 60 percent of the patients at Valley Presbyterian are on Medi-Cal, the state's program to provide health care for the poor. The hospital serves roughly 4,500 patients a month in the emergency department. Valdespino said the hospital believes it has been underpaid for years for serving Medi-Cal patients.

The program, created through AB 1653 by Assemblyman Dave Jones, D-Sacramento, was written to help California hospitals recoup some of the $4.6 billion they lost in 2009 because of lowered Medi-Cal reimbursement rates.

For Medi-Cal, the per-patient spending is $3,168. In other states, it can be as high as $7,815. The national average is $5,163, McLeod said.

At the beginning of this year, more than half of Los Angeles County's 72 hospitals were operating at a deficit, and two - including Pacifica Hospital of the Valley in Sun Valley - filed for bankruptcy protection.

Hospitals make deposit into fund program - LA Daily News

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Scrubs Gallery Discount for October–Valued Advertiser on the Medical Quack

Check out the Nurses Shoes this month. See below for the code and discount.

One again I thank ScrubsGallery for their continued support of the Medical Quack Blog.  Each month they offer a discount for readers and you can use the link in the image above to take advantage of the discount offered this month.

Next time you need to order scrubs or other healthcare apparel, please check out their website and compare. 

Get 15% off nurses shoes with checkout code "shoes_fg1"

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Prime Healthcare Under Investigation for High Infection Rates in California in Four Hospitals

Prime Healthcare is back in the news again, this time not over ownership and claim issues, but infection rates this time.  Prime Health though is still in the business of buying up hospitals when the opportunities arise and a few months ago they were unsuccessful in their bid for IHHI, a chain of 4 hospitals. 

Heritage Provider Network May Join Prime Healthcare in Bidding for Bankrupt Victor Valley Community Hospital

If you have been to any of their facilities in Orange County, you can roll bowling balls through the parking lots as they are that empty, why?  Prime does not contract with health insurance companies and thus when patients are treated, they pay the normal and customary charges Prime has in place, so what you get is a high class emergency room with good care and a ghost type setting for the inpatient areas.  The alternative for most of the facilities they purchased would have been closure for the many. 

In addition to the infection rates, we are back to audit bills and claims here again too.  BD

The owner of four Orange County hospitals is under state and federal investigation for high infection rates that could indicate Medicare fraud or an alarming health concern,  California Watch reports.

The 13 hospitals owned by Prime Healthcare Services of Victorville have the nation’s highest rate of septicemia, a serious blood infection. That’s according to an analysis done by Service Employees International Union-United Healthcare Workers West.

The union, which represents workers at four Prime Hospitals, including Garden Grove Hospital,  is in a labor dispute with Prime. The company is owned by the controversial Dr. Prem Reddy.

Prime’s Orange County hospitals have the following rates:  West Anaheim Medical Center:  23 percent; Garden Grove Hospital: 14.4 percent; Huntington Beach Hospital 11.6 percent;  La Palma Intercommunity: 8.4 percent, according to the union report.

Prime officials have said their rates may be higher because they treat sicker patients.

Owner of four O.C. hospitals under investigation for infection rate - OC Watchdog : The Orange County Register

Technorati Tags: hospitals,healthcare,investors,money,funds,Orange County,hospital,Network,Prime Healthcare,bankruptcy,California,infections

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Group of House of Representatives Sends Letter to FDA Wanting More Transparency and Detail on Medical Devices–They Better Hire That “Algo Man” So They Can Comprehend

This is pretty much a no brainer in concept as many of the new devices and what is being approved revolves around software, thus they might think about understanding the basic concepts of what software (algorithms) does.  Actually this could be a good move as more would perhaps jump into the consumer digital awareness arena. <Algo Man = Algorithms>

The FDA can be very transparent, but will they understand what is going on is the big question.  Software unfortunately is not perfect and we have more devices that report and record data today and depend on it, so a general summary for transparency that they want won’t cut it.  BD

A bipartisan group of U.S. House representatives send a letter to the Food & Drug Administration asking for more transparency and greater detail from the watchdog agency as it implements changes to the 510(k) medical device clearance process.

Six Democrats and six Republicans from the U.S. House Energy and Commerce and Health, Education, Labor and Pensions committees signed the letter, writing that at least five of the FDA's proposed changes are "controversial."

House reps to FDA: Regulatory changes for devices must be more transparent | MassDevice - Medical Device Industry News

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WellPoint accused of Misrepresenting Cancellation Practices–We Better Start Certifying Those Algorithms Used By Insurance Carriers–Just Like We Certify Medical Records-The Missing Link

We do spend a lot of time and money getting medical record software certified for use in the fact that it can perform and do what it is slated to do and perhaps we need to look at certifying those algorithms used by insurance carriers too as we just don’t know do we until we get a cancellation or rejection of a claim.  I have been saying this now for about 2 years and perhaps the time is getting closer to give this idea some serious thought. 

Software in essence is not much more than a big huge package of algorithms.  Based on management decisions, the companies adjust the parameters of scoring and analytical algorithms all the time.  If the public is unhappy too many claims get denied, the parameters might be adjusted upward or downward and then at a later time, the can be adjusted once again.  It’s how the big insurance machine works. 

WellPoint Ran a Breast Cancer Algorithm to Target Members for Cancellation of Policies - “Fraud Detection” is the Catch All that Justifies the Reporting

In addition. the word “fraud” leaves an open clause for many areas of auditing too, with “looking for potential fraud algorithms”.  Sad think about some of this is that the crooks out there seem to do so much better at this game as they don’t see patients but know the data end of it and everyone loses there until the crooks are caught. 

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

I think we need to dig in a bit more and get specific with some working algorithmic models so at least we have an idea as to how the mathematics are calculated. 

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

When things get tough and profits are analyzed, all we are going to get are more business intelligence algorithms, many of which are simply put online and with a world of advice saying help yourself to these tools (algorithms). 

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

The SEC has the same type of issue going with Wall Street too and perhaps not exactly the same, but audit trails would be nice.  We keep getting fines and money charged up here with violations, but does anything get done to prevent future occurrences.  This case is specific to the Breast Cancer Algorithm where women were targeted for cancellation upon getting ill.  Right now we just look at printed matter, advertising but if we had actual copies of the proposed algorithms, no problem as the proof would be in the pudding.  BD

Los Angeles city prosecutors Wednesday accused the parent company of insurance giant Anthem Blue Cross of California of falsely stating that it had changed its procedures for canceling the policies of patients after they become sick.
The Los Angeles city attorney's office said that WellPoint Inc. misled the public earlier this year when it denied reports that it targeted women with breast cancer for cancellation.
The prosecutors' action is the latest chapter in the city attorney's ongoing case against WellPoint. It first sued the insurer in 2008, alleging false advertising and fraud over its practice of policy cancellations.

In an amended civil complaint filed Wednesday in Los Angeles County Superior Court, prosecutors said WellPoint issued three "false and misleading" press releases in April and May to burnish its corporate image as it fended off assertions about its cancellation practices in a news story and criticism from the Obama administration that followed.
The prosecutor's office contended that WellPoint continued to target women with breast cancer. It said the company also falsely stated that it had changed its procedures this year before the new federal healthcare law took effect. The law bars rescissions nationwide except in cases in which policyholders lie on applications.

Anthem Blue Cross parent WellPoint accused of misrepresenting cancellation practices - latimes.com

Technorati Tags: health insurance,insurance reform,algorithms,fraud,consumer,legal case,business intelligence,Judge,recission,healthcare reform,Well Point,tech denial,breast cancer

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Medicare.Gov Blue Button Download For Personal Health Record Information for Those Covered by Medicare

If you have not visited the Medicare.Gov site recently, it’s worth a look and again like Healthcare.Gov it looks nothing like a traditional government website, which is a good thing in this case as it is very easy to navigate.  If you are looking for information about Medicare Advantage plans you can go here. 

Right now as it stands, you need to save the format in an excel spreadsheet format and and then the information can be sent to a PHR (personal health record).  Soon I’m sure we will be hearing about some automation to make this an easier process.  The VA has already had over 62,000 downloads with Veterans downloading their information that is on file.  Stay tuned as I’m sure there will be more forthcoming.  At the bottom of the page there are additional links for other Medicare resources from CMS.  You do need to register to use the site to obtain records.  Watch the video here for some additional information as Tony Parks talks about the creation and benefits of having your medical records. 

My Medicare.Gov Portal

Download My Data/Blue Button

“MyMedicare.gov has a new feature called “Blue Button”. This new feature provides you an easy way to download your personal health information to a file. You can download the file of your personal data and save the file on your own personal computer. After you have saved it, you can import that same file into other computer-based personal health management tools. The Blue Button is safe, secure, reliable and easy to use!

To check out the new Blue Button, visit MyMedicare.gov

How to Download and Save Your Health Information

• Click this Blue Button to create a downloadable file with all your MyMedicare.gov information.
• Save the Excel file onto your computer.
• Upload or import this Medicare Excel data file into a personal health record application or tool that can accept it.”

Below is a link to show what HealthVault has done with the VA version so again stay tuned as I’m sure there’s more on the way here with the Medicare Blue button.

White House Makes Official Introduction of the “Blue Button”–Microsoft Demonstrates HealthVault Integration And Sharing

Here’s a little more about the VA button and a few screenshots.  If you are a physician treating a patient covered and treated by either, I think it’s a good idea to encourage patients to check it out and to verify for accuracy too as with anything today with data, we need to do that second look as we are all still humans doing  a lot of the data input.  BD

VA Can Now Use the “Blue Button” to Download Their Data from Their PHR (Personal Health Record)

The Centers for Medicare and Medicaid Services has launched a new feature on the the MyMedicare.gov secure website that enables 47 million Medicare beneficiaries to view, download and print their complete medical records, officials announced.

The CMS "Blue Button" download feature is similar to the Veterans Affairs Department’s debut of a Blue Button capability on its MyHealtheVet website in August.

The Blue Button capabilities are open government initiatives by both agencies in response to calls from the Markle Foundation and advocacy groups to allow patients greater access to their personal medical data.

The VA’s Blue Button has already proven to be popular. Since it was introduced in August, more than 60,000 veterans have downloaded their medical files, the release said.

Medicare patient data now at your fingertips -- Federal Computer Week

Technorati Tags: Blue Button,Medicare,Personal Health records,excel,PHR,download,MyMedicare.Gov,Medicare.Gov,HHS,health IT,healthcare,VA

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MDLiveCare Offers Online Doctor Visits by Webcam and Integrates with HealthVault and Google Health

Here’s another new telemedicine service that integrates and with PHRs so you can have your records before and after the visit, available for sharing.

The company has also affiliated themselves with the new ShareCare. com website where those posing questions will get answers from both professionals and get answers and be marketed from the likes of Walgreens, United Healthcare and many more so the cost of an answer is going to cost you more advertising exposure.  Here’s a sample below on what you would see on the ShareCare site. 

New Website Sharecare.com–Some Health Advice Will Be From Advertisers So the Line Between Professional Information and Marketing Could Get Just A Bit More Grey and Confusing

ShareCare site is a little bit out there for me, especially in view of what happened with Nielsen scraping PatientsLikeMe.  You can read the ShareCare.Com privacy information by clicking on the image below.  Dr. Oz is on Sharecare.com and I like him, but still prefer my medical information without being marketed and giving up potential privacy. 

Patients Like Me Experienced Data Mining Through a Data Mining Research Firm Break In –The Nielsen Company

We have companies applying for patents so they can match mined data now and with the seemingly lack of IT literate folks in some government places these days, they might get a patent and then we are all screwed when it comes to any privacy.  I could see this being a potential subsidiary acquisition for an insurance company if I were to project here a bit – subsidiary warning here if you didn’t catch the hint. 

Back on track with MdLiveCare you can participate here without having to involve the crowd sourcing site of Sharecare too with your consultation.  Here’s the pitch for employers as when they keep you out of the doctor’s office, they save money.  There are both sides to the coin and sometimes a web visit will work and they are connected to allow prescriptions to be written and work with LabCorp to send you to a lab if the visit required. 

There is an annual membership fee to join or one can pay around $9.00 a month, and guests who are not members pay around $60.00 per visit, so if I were looking at that alternative, give me the face to face time with MD in persona under normal circumstances. 

As mentioned, you can synchronize information with HeatlhVault and Google health for your PHR so there are some interesting possibilities here.  As a doctor you can sign up and be available on the network to do online consultations.  The program is also out there for insurance brokers to sell. 

The company is also soliciting health insurance companies to join and you can see their pitch here for this side of the business.  Again, I do try to look at various funding sources and acquisitions and mergers and who has access to what and while this looks to be very convenient and could save money, the data and the marketing here leave a bit on the questionable side for me.  It appears that if you stay with the MDLiveCare and not venture over to the ShareCare site you could be spared some algorithmic marketing and potential data mining as a patient but the MDs look like they are prime targets to incorporate into the ShareCare site to answer questions and perhaps there’s some incentive in that area too.  BD

Press Release:

SUNRISE, Fla., Oct. 12 /PRNewswire/ -- Going online to talk to a doctor is emerging as a fast and low-cost cure for multiple healthcare irritations, ranging from unnecessary and middle-of-the-workday doctor visits to the difficulty of receiving after-hours, out-of-town or phone-based medical advice. Enter MDLiveCare, the first 24x7x365 virtual house call service to offer webcam, phone or email consultations for primary, pediatric, specialty and behavioral health care - all for as little as $39.95 per visit or $9.95 per month.

With one-hour guaranteed access to board-certified physicians and licensed therapists in every state, MDLiveCare is designed to treat non-emergency physical and mental health conditions for both children and adults, including fevers, colds, diarrhea, flu, bronchitis, stomach ache, anxiety, depression and marital problems.

Patients simply fill out an online medical history that will be available to the physician during the consultation and then make an appointment at www.MDLiveCare.com. In lieu of in-person visits, the service offers real-time virtual consultations that include:

• The ability to speak to an on-call doctor or a specific physician, chosen from an online list that includes the provider's credentials.
• The option to choose face-to-face video conferences via webcam, toll-free phone calls or secure email consultations. The video conference option works even at low bandwidth and includes a unique multi-user capability that allows the patient, multiple doctors and family members to be online at the same time as well as share documents and provide explanations on virtual whiteboards.
• Electronic documentation of the consultation, enabling patients to retrieve the doctor's notes and recommendations post-appointment.
• Optional integration with Google Health or Microsoft Health Vault personal health records (PHRs), allowing users to share their medical records from the MDLiveCare consultation with their own doctors for continuity of care. This is particularly useful for those with chronic medical conditions.
• Prescription and lab test orders, via MDLiveCare's strategic alliances with SureScripts and LabCorp. Prescriptions can be delivered electronically to over 60,000 pharmacies, while lab tests can be performed at over 2,000 locations.
• Privacy protection provided through MDLiveCare's secure, encrypted HIPAA-compliant platform.

"Studies show that 64% of doctor visits do not require face-to-face contact, 64% of ER visits are not emergencies, and 56 million rural Americans have inadequate access to primary care. MDLiveCare addresses these and other issues," said MDLiveCare Chairman & CEO Randy Parker. "Whether your new baby has a fever, you can't leave work to see the doctor, you're not feeling well at 3 am, you lose your heart medicine on an airplane, or your primary care doctor is simply not available, we can quickly get you in touch with a healthcare professional who can help at a price that is usually no more than a co-pay."

Non-members can utilize MDLiveCare for $59.95 per visit. Members pay $39.95 per visit and receive unlimited email advice. Memberships cost $9.95 per month ($99.95 per year) for an individual or $19.95 per month ($129.95 per year) for a family plan.

Group programs are available for employers, payors, and brokers and consultants.

About MDLiveCare

MDLiveCare (www.MDLiveCare.com) offers affordable, 24x7x365 healthcare consultations by webcam, phone or email, making it possible for patients to receive medical attention after hours, at work, while traveling, in rural areas, if they are chronically ill and bedridden, and in other scenarios where a face-to-face visit is not convenient. The company has a nationwide network of U.S. board-certified physicians, including specialists in the fields of pediatrics and dermatology, licensed therapists and certified life coaches. It offers both individual and group plans as well as a technology platform for physicians who want to incorporate online patient care into their practices. MDLiveCare was founded in 2006 and is based in Sunrise, FL.

MDLiveCare Offers Online Doctor Visits by Webcam, Phone or Email, Primary Care Press Release

Technorati Tags: MDLiveCare,HealthValult,Google Health,Telemedicine,healthcare,doctor,remote monitoring,webcam,prescriptions,labsm Sharecare.com

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