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You Are the Product–Privacy Anonymity and Net Neutrality On the Internet - Excellent Stanford University Lecture (Video)

4/23/2011 05:38:00 PM  , ,  

This a a good lecture and answers a lot of questions and covers items even from the TSA and their privacy issues.  Emails at work, all saved due to laws and being imagerecorded and saved. He goes into a little talk about HIPAA for medical students and explains how long data is collected and how long it needs to be saved and the expense of doing so. This is a long video so be sure you have some time to sit down and watch as it’s worth it. 

He discusses the “Like” button if you stay logged in to Facebook.  Facebook has announced they will start selling more data, he states take your phone number and address out and log out when done.  Like buttons are tracking devices.  Google ads too are tracking systems too.  Anything on Facebook chat is not encrypted, so I say don’t use it.  I don’t like instant messages anyway so no problem here.  When you click ok you give programs permissions to use your date and only lawyers really can understand the “I agree” with software licenses.  imageHe explains the profiles that are created and stored by our use of the web. 

He plays a funny video about a Senator Ted Stevens talking about “tubes” on the Internet, tubes?  This was the man in charge of writing laws for the Internet for years…yikes!!! He further says scary as this guy is not from Cisco or any other tech company but had the responsibility, so we have digital illiterates up there maybe opening mouth to insert foot. 

Anonymous reviews are discussed and what little value they have and why many sites want authenticity to get good quality comments. Does Facebook need a “dislike” button he asks?  People are only happy on Facebook he says as people are careful not to offend an he thinks it sucks as it’s not true reality.  What is good too is that he discusses how technology is used for both good and bad.

Stanford Privacy Lecture March 2011

Toward the end Net Neutrality is discussed and what gets through with bandwidth available and throttling down packets you may not want to allow access to.  After listening to this, check out some of the local state lawmakers at the link below and see what gets discussed when we have digital illiteracy with lawmaking, scary as they don’t know what to take a stand on and you see very strange stuff (abortions) from those who are kind of lost and we depend on these folks to be literate with technology but we are not getting it.  

Digital Illiteracy Continues With Lawmakers at State Levels–Insane Laws Proposed And Being Passed-Financial Puppeteers (Video)

Be aware that “some of those people in Washington are complete idiots” and who won’t agree with that statement and that these politics matter.  BD 

March 4, 2011 - Adam Beberg presents several topics related to daily life on the Internet, suitable for a wide and non-technical audience. His work over the last two decades has centered around Distributed Computing, Security, and Education.

YouTube - StanfordUniversity's Channel

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UnitedHealthcare ERISA Class Action Lawsuit Expanded to Include DME and Ambulatory Surgical Center Providers

4/23/2011 10:19:00 AM  , ,  

I think I have heard this complaint locally here in southern California and if reading this correctly, when receiving reimbursements, if there are changes in payments on claims after they have been paid and determined they were overpaid, denied or the payment for whatever reason is being rescinded, the funds are being deducted from future EOBs received.  In other words, and sometimes this takes time for a denial of a claim to take place, if a claim on Jane Doe was originally paid and a couple months later it is determined it was overpaid denied or whatever, that amount of money gets deducted from an EOB that is lets say paid today.  The alleged lawsuit are stated to be non compliant with laws from Employee Retirement Income Security Act of 1974 for private employee benefit plans.

So the payment made on Jane Doe’s claim 3 months ago is being rescinded and deducted on an current EOB for other patients where Jane Doe is not even on the patient list  I can see where this affects the practice management software for the ambulatory doctors in the fact that the EOB is now short paid, and the short pay is not for a patient listed on this EOB for compensation, and thus the adjustments to keep current with all claims could stand to be an accounting nightmare.  Again, correct me if I am not interpreting this correctly but from what I read here this appears to be the issue with the lawsuit filed.  This would be accomplished with algorithms run through accounting software to deduct the amount from EOBs received.  As mentioned the lawsuit also includes the suppliers of durable equipment to be included.  An alternative solution would be to invoice for money rescinded  to the ambulatory doctors and DME suppliers.  The link below has a short blurb on a story from a short while back to where Walmart got into trouble with ERISA laws with a lot of bad press and rightly so for how it played out. 

UnitedHealth Group Sued-Class Action Lawsuit Relative to Purchase of HealthNet in Northeast-Post Auditing With Demands For Providers to Repay Reimbursements

Whether the process is in house or contracted to a 3rd party, auditing medical claims is an algorithmic process when searching for fraud, errors, coding accuracy and so on and from the news coming out currently there seems to be quite a few inquiries into the validity of the algorithms that run to determine if the claim is filed, coded and submitted correctly.  Auditing processes are not new and they are necessary to catch fraud but again we come back to an interpretations when reports are created. 

Back in 2009 such an audit of medical claims was in the news to where a number of dermatology offices throughout California had major issues via such mechanisms.  Within 5 days all offices were no longer receiving compensation for services already provided and the story at the time stated it was the Ingenix algorithms that detected a high amount of claims and again this is from 2009 and I might guess there’s still a lot of fall out ongoing with the offices involved here.

“Ledesma said the decision came from what he called the special investigations unit of Ingenix, a Minneapolis-based company owned by United Health Group that sells information services to many insurance companies. He believes their clinics were singled out because Ingenix noticed a high number of claims.”

Skins game With Dermatology Offices in California – All Insurance Carriers Quit Paying For Treatment Within a 5 Day Period

This is really a big deal with algorithms that check and review claims and all carriers do it to a degree and United has their own in house technology group that sells such services.  Any any rate EOB statements and how they are prepared and compensated in California goes back a number of years to where I had seen capitation statements with what was called “the floating patients” to where some months they would appear and other months they were not on the list and would guess some type of query was run to make the adjustments and I created a spreadsheet process where MDs could compare every month when they requested the statements in an Excel format for easy identification and then they could inquire from there as to why this was occurring.  Again that goes back to when HMOs were started in California  and what I found 12 years ago and is just an example of how complicated it can get. 

Again, this gets very complicated and with all the systems available out there today for revenue cycling and today’s marketing, these ambulatory and DME centers may also be the recipients with even more solicitations promoting more software solutions to solve and address this issue too as these types of algorithmic processes kind of feed themselves and builds needs for more processes to come in a help alleviate such issues and that’s been going on for years and thus they are presented with yet more new software to potentially purchase.  When looking for fraud there can be “false positives” in the algorithmic processes as was noted a couple years ago in the news. 

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

Back in 2009 I stated we might be looking to think about establishing a Department of Algorithms or something along this line to ensure everyone is in check and occurrences as such don’t come up in a blind sided fashion later as payroll and other operating expenses are paid from this compensation and depending on the dollar amount being deducted for claims, this can work a real hardship on medical practices today.  

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

Just a couple days or so ago this was highlighted in an article in the New York imageTimes about how practices are struggling to stay in business.  I am happy to see this get some attention as I have been watching the erosion happen for years.  Occasionally there are cases to where the formulas are questioned and court cases determine the unethical use such as the one below and this goes back to the out of network claims that used the Ingenix data base for around 15 years that Andrew Cuomo challenged and won, and there’s still a bunch more of these types of cases tied up in court systems today.  Here’s one filed last year in California to where the short payments on customary fees were accursedly affecting surgical centers who were not included in the big AMA/United settlement on paying short on out of network charges and thus filed their own class action for their centers. 

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

In the example below HealthNet in 2009 joined in to not use the data base for calculating out of network charges and made a decision to pay the claims at 14% above what the software indicated.  Of course to fight such legal battles is takes a lot of time and money and your small practices does not have either the time or budget to file suit and question the algorithmic processes. 

HealthNet Algorithms – When Do they Prevent Fraud and When Do They Cross the Line and Not Pay Out – Court Case Where the MDs Win

With our current billing system today, yes we need processes to audit claims, but the questions remain on how they are used and where the parameters of the algorithmic queries are set and utilized and thus we have one lawsuit after another and basically this is what it comes down to – those algorithms again.  Sadly what we have today is a lawmaking process that is truly dated and they can’t keep up and need some updated technology (and users thereof) of their own to see in real time what is happening today and venture away to useless discussions on abortions and birthers that fill the news today as the discussions are aimless and do not create any real solutions other than to command big press stories and as a result more lawsuits are filed in order to either get new laws or validate the interpretation of the algorithms.  Last week we were vividly entertained with lack of knowledge with then Colbert report caught a news station that stated “Pap smears” were available at Walgreens and it was funny (I liked it too) but also satirical in showing how little sometimes the public, to even include newscasters understand about what is happening in healthcare today.   

Healthcare Law Is Not Bad; However Algorithmically Changed Business Models Coupled With Mergers and Acquisitions Change the Insurance Governance Frequently

Once more as a suggestion as I have done so many times I’ll mention a book that is good reading that gives some insight here with mathematical formulas and if nothing else it will start you thinking about how things are done today by Charles Seife..  It’s an excellent read and will spur your brain to give some thought to how we make laws, how they are interpreted and how not to be always sucked in by statistics today without some real thought.  Links are in the article clip below to read the legal filings. BD  

“Proofiness–The Dark Side of Mathematical Deception”–Created by Those Algorithms

On April 22, 2011, more healthcare providers, durable medical equipment (DME), ambulatory surgical center (ASC), national and state chiropractic associations, joined and expanded the ERISA class-action against UnitedHealthcare, originally filed on January 24, 2011 by a group of chiropractors, for alleged ERISA violations in its overpayment recoupment and pre-service claim denials in connection with managed care network practice by OptumHealth, a subsidiary of UnitedHealthcare. ERISAclaim.com offers free webinars to examine this ERISA class-action's impact on healthcare industry.

Pomerantz seeks to represent a nationwide class of all health care providers who have been subjected to alleged overpayment demands by UnitedHealth Group to repay previously paid health care benefits for services provided to UnitedHealth Group subscribers, only to have such funds forcibly recouped by the withholding of future payments from unrelated claims in alleged violation of the Employee Retirement Income Security Act of 1974 ("ERISA"), the Federal law governing private employee benefit plans.

Among other things, the Plaintiffs demand judgment in their favor against Defendants to find that United have breached the terms of the plan provisions and have violated federal law ERISA, to stop United from engaging any non-ERISA compliant overpayment recoupment demand and offsetting from any future payments, and to stop OptumHealth from denying pre-service claims and concurrent service claims without compliance with ERISA claim regulation and the plan provisions.

A copy of the initial Class Action Complaint is available at www.erisaclaim.com/UHC_Complaint.pdf

A copy of the First Amended Complaint is available at www.erisaclaim.com/UHC_Complaint2.pdf

For more information on overpayment appeal and other services: www.erisaclaim.com/products.htm

For any questions, please contact Dr. Jin Zhou, president of ERISAclaim.com, at 630-808-7237

UnitedHealthcare Overpayment ERISA Class Action Expanded with DME and ASC Providers for Additional Complaints

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Cook County Shut Down on Good Friday To Save Money-Many Patients Received Automated Calls Confirming Appointments And Showed Up

4/23/2011 12:01:00 AM  ,  

Somebody forgot to check the automated repair system as well as move patient imageappointments.  I think if the appointments had been moved, no automated calls would have gone out.  Pharmacies at hospitals were closed so no prescription refills were given out today.  If you have read the news, then you know how bad off the government is financially in Illinois.  The County has 5 days a year in which they will close all operations to save money.  BD 

Some Cook County health system patients received phone calls confirming appointments set for Friday, only to show up for their visit to find the hospitals closed as part of a money-saving government "shutdown day."

The Cook County Board approved five government shutdown days as part of the budget this year. The idea was to save money without cutting county jobs.

Sharon Taylor, who showed up at Stroger to fill a prescription, said she didn't get the message that the pharmacy would be closed Friday

Sixteen county clinics were scheduled to be closed Friday, including pharmacies, labs and hospital-based specialty clinics. Emergency rooms at Stroger, Provident and Oak Forest hospitals are open, as is the urgent care walk-in clinic at the Fantus Health Center.

Cook County 'shutdown' a pain for some hospital patients | WBEZ

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Judge Delays Trial of WellCare Ex General Counsel And States “It’s Complicated” And We Need Time to Chase the Algorithms

4/22/2011 05:29:00 PM  ,  

So what is not complicated today in healthcare when it comes to reimbursement and the pursuit of fraud cases.  With the complicated formulas and the constant change of business models that go faster than laws can keep up, you think we have a slow legal system now, well it’s going to even get slower.  Wellcare ’s issues go back to 2007 to an FBI raid of their offices in Florida for mismanagement of funds and billing.  This is not simple stuff and you need some high powered business intelligence software to get down to the numbers and facts.  Medicare even cut them off a couple years ago.  Back in June of last year we now have a whistle blower adding more information and fuel to the fire. 

Whistleblower Complaint Filed Against WellCare and Memorial Healthcare System Claims the 2 Conspired Together Defrauding Taxpayers With the Hospital Helping Hide the Money

When it gets down to auditing IT systems for conspiracy it’s not easy and it is time consuming as it can get down to the last penny this way.  The company has already agreed to pay $40 million in restitution and forfeit another $40 million to the US government, bingo we have savings generated from catching fraud.  Now let’s multiply this several times across the country and stop denying care for grandma and we would all be a lot happier!  You know I really shouldn’t stop there, it’s more than just grandma today.  This case is complicated as the money stated to have been his in a 3rd company, remember what I say about mergers and acquisitions with companies not being the same as they were just a few years ago, take heed here when you read this.  This is the lawyer here, the general counsel on imagetrial so keep that in mind. 

I have questioned the ability of judges to make decisions based on this fact and evidently this judge knows it with delaying the trial to get all the information together. 

Healthcare Reform Law– Is Any Judge Fully Capable of A Decision on a Law That is Challenged By Constantly Changing Algorithms?

This brings me back to a post form 2009, Do We Need a Department of Algorithms” for all transactional business in healthcare?  Think so.  BD 

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

A FEDERAL JUDGE in Tampa has postponed until at least this fall the trial of Thaddeus Bereday, the ousted general counsel of WellCare Health Plans, Inc., along with four other ex-company execs.
At a status hearing last week, U.S. District Court Judge James Moody, Jr., found the case too complicated to meet the original May 2 trial date.
“A complex and prolonged trial is anticipated,” Moody noted. No new trial date was set.

It's Complicated, Says Judge, as He Delays Trial of WellCare Ex-GC

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Ingen Technologies CEO Steps Down And Begins Serving His Time For Manipulating Company Penny Stock Value

4/22/2011 02:08:00 PM  , ,  

Oh have heard stories this is the news of late, of course we have and the CEO admitted guilt for his role in the company’s penny stock prices.  I think this one was pretty cut and dry as he was selling and working with under cover FBI agents so imagenot a lot questions as far as who, what and where on this case.  He is stated to have made full restitution and has a $4000 fine to pay and a year to serve. 

The violations charged included paying kickbacks to a pension fund fiduciary to induce the fiduciary to misappropriate money from a pension fund in order to buy restricted common stock at inflated prices, in other words someone was paying too much and not the correct use of a pension fund money and the pension fund turned out to be the FBI.  Also part of his sentence which is pretty much standard with such cases is that he can no longer manage a imagepublicly held company and of course offer any penny stock for sale.  Ingen has been around for quite a few years and recently just received a patent for their new SMART Nasal Cannula which allows a patient as well as a clinician to “see” oxygen being delivered.  Their business is focused on reparatory therapy and they are located in southern California.  What was also interesting too on their website was to see PayPal honored for purchases and that’s a good thing as their services put up an encrypted gateway between you and your credit/debit cards.  BD 

Ingen Technologies Inc. CEO Scott Sand departs company, incarcerated and fined for his role in a kickback scheme designed to manipulate the volume and price of his company's stock and in order to encourage stock sales.

Ingen Technologies Inc.'s (OTC:IGNT) former CEO, Scott Sand, is headed to the slammer for his role in a plot involving the illegal manipulation of his company's stock price.

The Yucaipa, Calif.-based medical device manufacturer named Tom Neavitt interim CEO to replace Sand and said current COO Gary Tilden will take over its day-to-day operations.

Ingen CEO put behind bars for penny stock fraud | MassDevice - Medical Device Industry News

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UnitedHealth Pulls Out of Primary Care in the UK and Sells Back Practices to Practice PLC- Shifting Gears to Analytics Focusing on GP Referrals And Help NHS With Saving Money

4/21/2011 11:50:00 PM  ,  

Well I just posted yesterday on the 1st quarter report United issued and guess what more algorithms for profit and this time in the UK so they will get a taste of what risk assessments are all about along with scoring and all the other processes like they run here in the US.  In their conference call, it was noted that OptumInsight (formerly known as Ingenix, the tech solutions area) was the highlight of the entire quarter with business – money in those formulas. 

UnitedHealth Group Reports 1st Quarter Results $25.4 Billion-Profitable Algorithms Contribute To 10% Increase in Revenue

In addition the article below states with their refocus that they can work with the imageNHS to save $20 Billion, so if this occurs with contracts in the UK, care and the way it is rendered will change.   Their CEO is a big supporter of pay for performance and with what he earns based on performance, any idea why that might be true, but it doesn’t seem to shift down to doctors with the same percentage of percentages paid.  So if you are in the UK, they are not gone, just coming back with a new game plan to make money with those algorithms and formulas and who knows how long before the formulas get sold to the NHS?  BD     

United Health CEO Compensation Grew 21 Percent–Pay For Performance/Salary Yielded 4.7 Million of An Almost $11 Million Pay Out

US healthcare giant UnitedHealth has sold off its network of GP surgeries and pulled out of the UK primary care market in order to concentrate on offering GP commissioning support.

The deal will transfer ownership of UnitedHealth’s GP provider company and all six of its GP practices to The Practice Plc - which already employs 220 GPs at 50 GP practices - with immediate effect.

UnitedHealth now plans to refocus its UK business to concentrate solely on commissioning support, as it seeks to exploit the opportunities presented by the Government’s NHS reforms.

The move signals an end to UnitedHealth’s controversial tenure as a provider of GP services in the UK, with their take-over of practices in Derbyshire, Leicestershire and Camden in north London attracting vehement opposition from anti-privatization campaigners.

Instead, it plans to expand its commissioning support in areas such as data analytics, demand management and medicines management. It is already working with a number of PCTs and GP consortia, including pathfinders in Hounslow who recently signed a deal with the firm to run a major crackdown on GP referrals.

Instead, it plans to expand its commissioning support in areas such as data analytics, demand management and medicines management. It is already working with a number of PCTs and GP consortia, including pathfinders in Hounslow who recently signed a deal with the firm to run a major crackdown on GP referrals.

The company said the move would close the door to any perceived conflicts of interest between the two sides of its business, and said it believed it could play a key role in helping the NHS make £20bn in efficiency savings.

Pulse - UnitedHealth quits primary care and sells off surgeries to The Practice

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FDA Approves New Spider Vein Treatment

4/21/2011 06:20:00 PM  ,  

This is an injection that states it works better than current saline treatments.  Three imagesessions are the norm for most with a 50 to 60 percent improvement.  A very tiny needle is used to inject the chemical into each vein.

The drug is called Asclera and you can read more a the website.  BD

image

DALLAS (KXAS/NBC) - Doctors have said spider veins can be a combo of genetics, pregnancy, using birth control pills, and standing for hours on end, but just in time for summer, the FDA has approved a cure.

"It is hereditary and I got them from both of the times that I had my children, two daughters,'" Marty Arnold said.

Arnold is trying Asclera, a new chemical injectable that destroys the lining of the cells.

Dermatologists like Dr. Ken Aftergut said it's much more advanced than the old saline treatments.

FDA approves new spider vein treatment - KPLC 7 News, Lake Charles, Louisiana

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Scribes Still Continue to Grow in Hospitals–One Doctor Stated He Could See the Trend Expanding To Help Nurses Too

4/21/2011 04:55:00 PM  ,  

Nobody thought that scribes were going to a permanent solution but it looks like they are.  Originally the idea was to help transition doctors over to electronic medical records but the scribes stayed as they show a lot of value for the doctors, especially in the ER where time is short and doctors need to move on to the next patient as quickly as possible.  The scribes doing the job don’t get paid a lot, usually $8 to $12 an hour but they get to follow doctors all over the ER or even other departments and make sure all the notes and data are entered correctly.  Did we build the user input screens universal and easy enough…nope.  If you read the article below Microsoft donated free of charge “A Common User Interface” that anyone could work with and guess what, nobody bit as we don’t' collaborate well in the US. 

Scribes in Healthcare Continue to Grow At Major Hospitals–Proof that Medical Records Systems are Still Not User Friendly Enough And Can Disrupt Physician Time With the Patient

Scribes are not always needed in every system though as if you were to look at a closed system like Kaiser Permanente, they are designed different and with their set up there’s clinic, hospital and payer all together so none of what occurs with independent situations and their doctors too are on salary for the most part, so 2 completely different models, one organized and and one fragmented trying to come together.  We learn a lot from Kaiser as they worked hard at their system to make it work and they have a great Innovation department that works hands on with doctors and nurses too. 

Using Scribes at the Hospital – Some Doctors Really Like This Idea
Common User Interface

I did several posts here at the Medical Quack on how it works and played with the demo myself and of course that would be every doctor’s dream who works at more than one hospital to have the same or similar screens every where you go, right?  Did anyone think or listen to that idea…nope ….we are still stuck on the word “innovation” and can’t move past it to go the next level up to “collaboration”…still happens.  This is the big road block in part of medical record adaptation too is that sometimes the user’s input is not always taken seriously, user meaning the doctors and they get a bad wrap over that so now you can add looking at this situation from another view.  I had one guy tell me he had to learn 5 different hospital medical record systems to get through his internship, hats to off to him for sure!

Needless to say electronic records are here to stay, in what and shape and form along with price is always up for discussion <grin>. 

I need to add another video in here too just for the heck of it.  In 2008 while at HIMMS working to promote Tablet PCs, I loaded up this demo from Microsoft of a prototype of what medical records

EMR Demo
would be like in the future from 2007 as it made for one heck of a demo on a tablet.  I walked around and was showing off the tablet and all the medical record vendors were asking me “who’s system is that”…it was funny and of course I explained it was a demo prototype but everyone wanted to make sure they were not missing something that somebody else had already developed. <grin>  Of course at the same time I was looked at as a bit of a goober too as I had all my notes in One Note and actually used a tablet to take notes and had intelligence files set up before the convention so I could be efficient and cover a lot of ground.  Back in 2008 at HIMMS nobody took the tablets out of their booths and used them for anything else other than to demo an EMR so I was the odd person out ahead of my time.

Back on track, I guess we can wait and see if scribes move in to nursing.  Shoot who knows this blog post might start a movement.   

I can understand why the doctors like them as they have had coding and so much other accounting and software responsibilities added on that were not there a few years ago so something has to give to make sure patients get the time and attention and on the other hand data is entered correctly and timely.  BD

The rise in electronic medical records has given Brittany Fera, a premed student at Temple University, an "awesome" job that she had no idea existed before she saw an ad last year.image

It's not the geeky programming kind of job you might guess.

The new record-keeping systems, which are touted as a way to improve efficiency and quality, slow down emergency medicine physicians so much that the doctors are hiring young people like Fera to input data for them. They call this growing group of employees "medical scribes."

The largest scribe company, California-based ScribeAmerica, has 800 employees in 21 states, up from 350 to 400 in 10 states in 2009. Emergency Medicine Scribe Systems (EMSS), another California company, has 600 scribes - 500 more than it had two years ago. PhysAssist Scribes Inc. in Fort Worth, Texas, went from providing 7,500 hours a month of scribe coverage in 2005 to 38,000 last month. All credit electronic records for their growth.

Electronic medical records systems create need for scribes to input data | Philadelphia Inquirer | 04/21/2011

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West Wireless Health Institute Reinventing It’s Mission-Moving Towards Reducing Cost of Care with Technology With Collaboration

4/21/2011 04:02:00 PM  , ,  

The institute has been closely affiliated with Qualcomm in San Diego and now they feel the direction of the institute is better served as working towards better care and saving money through the use of wireless technologies in healthcare.  There have been several resignations from some who came from big corporate conglomerates and with a new direction the marketing section appears to be taking  a back seat to further research and development into how products can be used in the healthcare market.  Back in September of 2010 you can read about their first Innovation Day in DC and see the picture with Aneesh Chopra when he visited the institute. 

West Wireless Center Hosting First Health Care Innovation Day in Washington DC In October–Bring on The Mobile Aggregators

This looks like a move in the right direction as it appears that the “innovation” headlights have turned off as they realize that is present anyway and are focusing on a collaboration of various companies, devices, software and more.  They are working still with many big names such as Medtronic, Cisco and healthcare institutions as well and this looks like a good move to put mHealth on a new productive track instead of loads of software written just because folks can.  Amongst all of this too is to keep in mind we need to not lose track of participator sensing with devices so we don’t create “monsters” that nobody wants to deal with either due to complexity or privacy issues.  BD

Participatory Sensing – Medical Devices Reporting Data for Patient Compliance

When the West Wireless Health Institute named Don Casey as its first CEO last year, the San Diego nonprofit said the former Johnson & Johnson executive was hired to drive development of the institute as “a world-class research organization focused on accelerating wireless health innovations, technology incubation, advocacy and education.”

Today the institute is describing its mission differently. Instead of working to “accelerate wireless health innovations” (as an end in itself), the institute has a more pronounced mission to lower the cost of healthcare. Casey says the difference does not reflect a change in the institute’s core strategy as a catalyst for innovation—but rather a shift in emphasis.

When the West Wireless Health Institute named Don Casey as its first CEO last year, the San Diego nonprofit said the former Johnson & Johnson executive was hired to drive development of the institute as “a world-class research organization focused on accelerating wireless health innovations, technology incubation, advocacy and education.”

Today the institute is describing its mission differently. Instead of working to “accelerate wireless health innovations” (as an end in itself), the institute has a more pronounced mission to lower the cost of healthcare. Casey says the difference does not reflect a change in the institute’s core strategy as a catalyst for innovation—but rather a shift in emphasis.

Casey also confirmed some notable departures, however, including Amir Jafri, who was recruited from Cardinal Health last year to serve as the institute’s chief operating officer, and Mehran Mehregany, who was named as the institute’s executive vice president of engineering and the chief of engineering research.

“Mehran’s passion is pursuing academic and educational training [in wireless technologies],” Casey said. “And as we focused more and more on cost savings, he felt he could better achieve his objectives outside the institute.”

West Wireless Health Institute Distances Itself from Qualcomm, Seeks to Recast its Role | Xconomy

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e-MDs And ZirMed Partner to Offer Complete Revenue Cycle Management Solution

4/21/2011 01:45:00 PM  ,  

e-MDs and ZirMed according to the press release below have already been working together with integrating solutions for physicians and now the imageannouncement is official noting the partnership.  With integrating the two systems there’s a lot less data input from office personnel too.  e-MDs is a valued advertiser at the Medical Quack and I make it a point keep news and events relative to their support as it arrives.  e-MDs is one of the long time vendors in the electronic medical record field, created and maintained by doctors and certified for participation with the government medical records incentives.  Recently in the news they were also selected by the Medical Society of the State of New York.  BD 

e-MDs Selected as EHR Vendor by Medical Society of the State of New York (MSSNY)

Press Release:

LOUISVILLE, KY and AUSTIN, TX – April 8, 2011 – ZirMed, a leading provider of revenue cycle management solutions for healthcare providers today announced a business partnership with e-MDs, a leading provider of electronic health record (EHR) systems.  The business partnership will allow e-MDs clients to benefit from ZirMed’s end-to-end payment management capabilities.  Through the joint solution, e-MDs customers can expect to collect more revenue, more quickly through streamlined workflows, reduced errors, and more complete management of the reimbursement process. image
e-MDs offers a variety of solutions to help increase the quality of care in ambulatory medical practices, while at the same time decreasing the administrative cost of providing that care. 

The company’s EHR/PM is widely recognized as a preferred solution among medical practices due to its intuitive user interface, robust customization capabilities, and workflow centric design.  Physicians using the company’s ONC-ATCB certified solution, qualify for the ARRA Stimulus Package incentives.
e-MDs award-winning EHR makes it easy for small practices, new facilities, established clinics, and even large practices to increase their efficiency. 

ZirMed’s proven services further increase their effectiveness by optimizing client’s revenue cycles, resulting in increased revenue and net profit gains.  ZirMed also helps overcome the ongoing obstacles presented by the continually shifting regulatory landscape, healthcare reimbursement changes, and the emergence of consumer-driven healthcare.
“The combination of solutions offered by e-MDs and ZirMed will immediately have a positive impact for our joint customers,” said Patrick Hall, Executive Vice President of Business Development at e-MDs.  “ZirMed has one of the most robust revenue cycle management solutions available. 

Clients can manage the payer reimbursement side of their business,  while accelerating and improving collections on the patient payment side as well.  ZirMed offers our clients the ability to collect more revenue, more quickly, with less effort.”
“Hundreds of clients already experience the benefits of using ZirMed with e-MDs solutions”, said Jerry Merritt, Chief Executive Officer of ZirMed.  “We are very excited to formalize our working relationship with e-MDs.  Doing so will allow us to better serve our existing joint clients, as well as those we will serve together in the months and years to come.  It’s important to offer practices solutions that not only help them survive, but actually thrive in these challenging times. 
With the formal launch of the partnership, all e-MDs clients can now reduce time spent processing claims and can receive payments faster from payers by submitting their claims through ZirMed.
About ZirMed:
ZirMed is a nationally recognized leader in delivering revenue cycle management solutions to healthcare providers, serving more than 100,000 healthcare providers.  ZirMed leverages the power of technology to cure administrative burdens and increase cash flow, enabling providers to not just survive but thrive.  ZirMed solutions include eligibility verification, credit/debit card processing, check processing, claims management, coding compliancy and reimbursement management, electronic remittance advice, patient statements, patient e-commerce solutions, and lock box services.  ZirMed is ranked among Inc. magazine’s 500 fastest growing companies and Healthcare Informatics magazine’s Top 100 companies.  For more information about ZirMed, visit www.zirmed.com.
About e-MDs:
e-MDs is a leading developer of integrated electronic health records and practice management software for physician practices and enterprises.  Founded and actively managed by physicians, the company is an industry leader for usable, connected software that enables physician productivity and clinical excellence.  e-MDs software has received continual top rankings in physician and industry surveys including those conducted by the American Academy of Family Physicians and KLAS.  For more information, please visit www.e-mds.com

ZirMed Partners with e-MDs to Offer Complete Revenue Cycle Management Solution

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UnitedHealth Group Reports 1st Quarter Results $25.4 Billion-Profitable Algorithms Contribute To 10% Increase in Revenue

4/21/2011 12:35:00 PM  ,  

This report may be a little confusing with the recent restructuring and name changes that were announced a few weeks ago as getting used to seeing the new names might confuse all until time moves forward.  The OptumInsight business unit which was formerly known as Ingenix states the following from the press release, which is a long one and you can read here.  Looks like the focus on Health IT where the company made several acquisitions last year. 

UnitedHealth Group Announced Re-Branding of Business Units-Focus on “Optum”–Changes Ingenix Name to OptumInsight

“The OptumInsight contract revenue backlog increased 55 percent year-over-year to $2.8 billion after adjusting for backlog pertaining to the announced divestiture of the i3-branded clinical trial services business, which is estimated to be completed during the second quarter of 2011. Strong demand for solutions that help health system participants improve connectivity, workflow and overall performance continues, further improving visibility on expected full year 2011 revenue growth.”

In addition there were some acquisitions of other types such as IPAs or physicians groups recently. 

OptumHealth (Subsidiary of United Healthcare) Takes Over Memorial IPA in California-Subsidiary Watch

The company also has a bank with over a billion on deposit for health savings accounts and this arm also is used to make loans to healthcare organizations. 

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

With some of the many mathematical formulas they use for payables and other types of algorithms a patent was secured so we know what that means as far as royalties if other companies use them.

QualityMetric/Ingenix (United HealthCare) Receives Patent for Patient Health Survey Algorithms-Subsidiary Watch

The CEO appeared to be compensated with a 21% increase, part of which was pay for performance (maybe this is why he thinks all of healthcare belongs on P4P but we know it doesn't’ work the same as it does for a CEO) the board of United has no interest in limiting any compensation even for how the public views all of this in spite of current economic times.

United Health CEO Compensation Grew 21 Percent–Pay For Performance/Salary Yielded 4.7 Million of An Almost $11 Million Pay Out

One example of algorithmic assessments with contracts can also be disruptive as this example shows below with insulin users and contracts. People with diabetes were notified by UnitedHealthcare that one of the most widely prescribed insulins, NovoLog, is switching from the company's Tier 1 drug list to Tier 3 so we had a bidding war so patients have to change medications based on cost, but by changing contracts with raising the cost of one 250% and supplying the other drug cheaper they make profits, aka contract algorithms here. 

UnitedHealthcare Disrupts Insulin Users So Either Change or Pay More–No Generics Here, Just a Bidding War For A Contract

When you see quarterly reports one after another like this and care not getting any better you have to think about this with lawmakers behind the 8 ball with not keeping up with laws that can regulate and provide fair protections for consumers, this is what corporate America does.  Lawmakers should get some smart algorithms and technology so we are not still taking dull knives to gun battles.  Digital illiteracy is killing us all over the US in lawmaking with not being able to keep up and technology and can be used to fleece as we all saw in 2008.  It is sadly what it is.  BD 

IBM Watson Capabilities Being Pitched to Financial Industry-Congress Must Not Have Felt They Needed This So Further Behind We Fall With Effective Intelligent Lawmaking

MINNEAPOLIS--(BUSINESS WIRE)-- UnitedHealth Group (NYSE:UNH) today reported first quarter results, highlighted by accelerated revenue growth from both its UnitedHealthcare and Optum businesses1. First quarter 2011 net earnings were $1.22 per share. Key performance metrics and costs were in line with or better than Company expectations.

Stephen J. Hemsley, president and chief executive officer of UnitedHealth Group, said, “Demand is increasing for greater connectivity, transparency and sustainable cost structures across the health system, as consumers, payers and care providers call for quality care at affordable prices. UnitedHealth Group is well-positioned for sustained growth as we address these expanding market needs with consistent performance, solid fundamental execution and practical innovation that helps customers achieve their goals.”

The Company updated its full year financial outlook based on first quarter results and business trends, and now forecasts 2011 revenues approaching $101 billion, net earnings in the range of $3.95 to $4.05 per share and cash flows from operations in a range of $5.8 billion to $6.2 billion.

Insurance News - UnitedHealth Group Reports First Quarter Results

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California Dept. of Managed Care Asks Blue Shield to Bring in Their Costing Algorithms for Last Round of Premium Increases

4/20/2011 04:59:00 PM  ,  

This is a unique deal here in California with 2 regulatory agencies so the HMO contracts come under the Managed Care Office while other plans that are not HMOs come under the Department of Insurance.  This has been presented to the governor with a proposal to merge these 2.  Just a few days ago the Blue Cross folks were imagegoing to get some big premium increases for private policies where the other policy holders were not so it looks like we might have something similar going on here with Blue Shield. 

Blue Cross Rate Increases Spread Between 2 Regulatory Agencies in California-Consumer Watchdog Calls on Governor to Merge Insurance Commissioner & Managed Care Office As HMO Side Rates Go up 16%

Insurers live and die with the use of both their own internal algorithms and those they contract with 3rd parties such as this case in the northeast last week where stress tests were not being allowed when they should have been. 

Med Solutions and Blue Cross Caught On the Stress Test Denial Algorithm (video)

Back in 2009 I said we need a Department of Algorithms as we go through all the trouble and time to certify the medical record vendors for all their information and interfaces for billing to work correctly, so why do we not certify the formulas the payers use…real good question and it would certainly free some of time up for the judges who so often end up interpreting so many of these cases. 

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

The California agency that oversees HMOs has asked Blue Shield of California to explain rate increases for about 70,000 members covered by individual plans.

The California Department of Managed Health Care said not-for-profit Blue Shield of California raised rates on average by 37.5%. The increase included an 18.8% hike that went into effect in January, and a 15.8% increase effective Oct. 1, 2010, according to the agency.

Calif. Blues asked to explain rate hikes - Healthcare business news, research, information and opinions | Modern Healthcare

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The Greatest Movie Ever Sold” Just Like “The Greatest Healthcare System Ever Sold”- Same Paradigms-Colbert Report (Video)

4/20/2011 02:35:00 PM  , ,  

This is funny but again doing this blog I am marketed from every corner of the earth imagelike most healthcare bloggers and the Colbert Report gets it right and we are headed in this direction with product placement and advertising having to support just about everything out there.  He makes light of sponsor names too, like will students be attending “Red Bull High School” and that makes me wonder if we would see something like the “Viagra Medical Center”  or the “Budweiser Critical Care Clinic”  or maybe the Smirnoff Rehab Center, as we already have sport arenas carrying such sponsored names.  How about this picture of a house, you want that on your house looking like Twitter and Facebook to get a few house payments made?  

We innovate and just throw money around and see what sticks sadly without those who have it giving much though on some of this while research and development for life saving drugs sometimes get shorted and struggles for funds, so what do we really need, life or advertising and if you don’t stop and think about it and raise your digital awareness, guess what you may not be able to tell the difference and get even more confused and suffer even more when trying to find balance.    

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

How ridiculous will we get and how much imagemoney will be sent in these direction versus money invested in drugs for instance that save lives?  You can also watch Morgan Spurlock at the link below at TED this year and with Colbert he does such a fine job making fun of the disruption and sometimes stupidity of those in marketing.  You have market on Wall Street too investing in “intangible algorithms” without a tangible product attached and over inflating value, and when the bubble goes again it will be much worse than 1999 was as all the data is now wall tied together and we will have big snowballs rolling down hill this time, all for the sale of having those algorithms. 

We need technology and I like it, but all the software coming out won’t make it and thus so the jobs it creates is also temporary, keep that in mind too as no wealth get built.   I loved the absolute digital ignorance of Gordon Brown not too long ago when he said seriously on Jon Stewart’s show “I never realized how connected the banks were”,…and there million more like him that still think that way. 

Give Me A Break-Would You Live in a Home That Looks Like This? Innovation Doesn’t Lack in the US But Collaboration Does (TED Video)

When you look at his jacket, will scrubs look like this soon <grin>.  This is great the way he pokes fun at “branding” and “advertising”.  He says “where do we draw the line” and refers to advertisers in schools to make up for budget gaps.  Colbert:  “if we don’t open up advertising to our schools, how will the girls know they have combination skin”…love it…and don’t forget the new commercials about glorifying “arm pits” too where a marketing company completely made up an absurd market for Dove. 

What makes sense anymore with advertising and marketing is the question and well done conversation here as we seeing it everywhere we turn.  Interesting too that he chose Pom Wonderful…remember this…a company right in the middle of the advertising controversy and they are in there sponsoring.  BD 

FTC and FDA Tell Pom Wonderful To Change Their Advertising Claims or Submit for FDA Approval–Another Study Unrelated Claims Peaches and Plums Kill Breast Cancer Cells Too

Marketing and algorithmic formulas will do you in today if you don’t stop and think about what is being presented.  Stephen Colbert invented the word “Proofiness” and there’s a book out that uses that name in the title, good reading and something to make you stop and think about the world around you and perhaps not get sucked in as often and it happens to all of us so good to be aware of the mathematical deception and advertising that explores the dark side, as it does exist in more areas of life than one.  The President knows it as he comments on distraction we deal with all the time when he talks, thus on his last address came the question, “where do we want to be in a few years” and if we continue with digital illiteracy, we’re going to sink and this includes lawmakers too, as they are just digitally illiterate as so many others'; however they are more critical as digital illiterate decisions in lawmaking create unintended consequences where we all suffer without predictive modeling to see what their decisions will create.  BD  

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

Morgan Spurlock pulls the curtain back on product placement and advertising in "The Greatest Movie Ever Sold." (06:08)

Morgan Spurlock - The Colbert Report - 4/13/11 - Video Clip | Comedy Central

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British Beer Created Laced with Viagra and Horny Goat Weed

4/20/2011 11:23:00 AM  , ,  

I would guess to say there’s more Horny Goat weed in here than actual Viagra as there might be some legal issues with Pfizer on that side of the coin and besides horny goat weed is imagean herb and anyone can buy it. The US Trademark office would not give Pfizer the patent on Viagra as they determined it was too close to the same properties of Horney Goat Weed.  There are other studies and information on what companies are doing in the ED area at the link below to include the “rabbit” story from Wake Forest where an organ was grown in a dish and worked. 

Viagra Patent Rejected By US Trademark Office – Not Much Different Than Horny Goat Weed

This is a great and funny story here and was a hoot to post but along with all of this great news, let’s not forget the shortage of cancer drugs we have out there and some who may not live if they can’t get their drugs.  I mention this to bring back focus of where we need to be and bring about some thoughts of priorities that seem to escape us when stories like this one surface.  BD 

Drug Shortages Continue–UCLA Spends 2 Hours A Day Checking on Cancer Drug Availability–ASHP Website Lists All Current Shortages

Forget the little blue pill. A British company has brewed the first beer laced with Viagra.

The new brew is called Royal Virility Performance, and has been specially created to mark the upcoming Royal Wedding.

Downing just three bottles is equivalent to taking one pill of Viagra, which enhances men's sexual performance.

A string of British brewers have already created special edition royal wedding beers, including Adnams Royal Wedding Ale and Castle Rock Brewery's “Kiss Me Kate.”

Last month, Pfizer started selling a chewable version of Viagra in Mexico to cater to the more than 6 million Mexican men who suffer from impotence.

New British Beer Is Laced With Viagra - FoxNews.com

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Johnson and Johnson CEO Pay-Thanks Bill for The Recent Efforts to Make the Richest Man in Switzerland Richer-Big Pay For That Effort..Any Consumer Efforts Alive?

4/20/2011 10:25:00 AM  , ,  

In case you missed it, the latest talks are about the biggest acquisition in healthcare history with being able to purchase another big device company, so I guess when you have issues internally with your own companies, go buy another company?  If you have read the news of late, that’s what you see, nothing on better handling of recalls or regaining consumer confidence.  The purchase of Smith and Nephew with their 30 year knee replacement has them looking elsewhere, so they said “no thanks”. 

Johnson and Johnson Talks With Synthes–Both Companies Have Serious Product Recall History With No Solutions in Sight With Rebuilding Consumer Confidence

Sure there are efforts being made and some imposed by the FDA too, so let’s not lose sight of those facts.  At a time when so many of their products have been recalled with no plan of action to help consumers, all we get to hear is the news about the company getting bigger? 

Johnson and Johnson Consumer Health Division United Barred From Resuming Operations in Until Quality Standards are Met-Consent Decree Agreement With FDA

Sure I understand that mergers and acquisitions are on the move today, but can we walk and chew gum and not lose focus of the consumer side?  We also realize the importance of having legally patented stents in our bodies if we need them and the expense required for all the legal battles so as consumers we teeter on whether or not we will be able to afford them.  I just see so much spent on stent wars and not enough on rebuilding consumer products.  image

Where’s Some of the Focus for Johnson and Johnson Revenue Cycles – “Legally Patented Stent Wars”?

How about making it easier for consumers to find all your recalled products?

image

image

So again, if this acquisition were to take place, how about the Synthes legal cases that have been filed?  Who would settle those?  Also, can you begin treating pallets outside and give us as consumers a little relief there to cut back on the “stinky” drug recalls?

Johnson and Johnson Recalls Stinky Topamax Drug Used for Epilepsy-The Cold Weather Stench That Stole Topamax

Is this the way to regain consumer confidence, buy it somewhere else?  I don’t know but from what I read in the news today this substantiation for compensation looks pretty weak.  I think even the employees are getting a snow job based on the latest update so employees can tell others about the big growth plans….again anything on this agenda for boosting and regaining consumer confidence?   I’m happy that “the ability to focus” is mentioned though, as that’s a big one. 

“A few weeks ago, I met with our senior leaders from around the world during our annual Leadership & Growth meeting.  We had candid discussions about the state of our business, our strategic plan, Our Credo, and the many ways we serve our patients. 

I’m pleased to report that, as an outcome of this meeting, the Executive Committee has identified several commitments that will be initiated this year to improve our ability to focus on growth. Priorities were also identified for each of our business segments, and you’ll hear more about them within your businesses.

One common commitment across our businesses is our focus on developing people.  The Executive Committee is committed to building new leadership capabilities by providing top talent with greater opportunities to rotate across functions and geographies.  We will advance leaders who have demonstrated excellent results, a strong growth orientation, a commitment to Our Credo, and the ability to develop others.”

I recognized and read about new drugs and other good developments too but the consumer commitments are killing the view with the lack of attention on this side and those divisions are somewhat on their own “auto pilot” courses, which I don’t think as a lot to do with the day to day actions of a CEO, but the recalls and serious issues with the FDA do! 

When are you going to start making a difference in the lives of the consumers Johnson and Johnson touches every day…how about the rest of us?  What is a five-year plan for corporate citizenship?  Does this mean closer relationships with the banks and credit agencies and what about “modeling behaviors” for all, does this affect the CEO too?  I’m just asking out of curiosity.

If the acquisition goes through is this yet one more area to be evaluated for compensation if the richest man in Switzerland gets richer?  I have no problem with companies making a profit but when it seems a bit lopsided and is blasted all over the news everyday about dysfunctional areas that need to be addresses, the compensation and pats on the back just don’t seem justified.  BD

Johnson & Johnson (JNJ) reiterated Tuesday that shareholders should approve the company's compensation plans for Chief Executive William Weldon, and it defended its ability to tie the CEO's pay to J&J's performance.

The company's comments, included in a filing Tuesday with the Securities and Exchange Commission, follows a report last week by an influential advisory firm that recommended a vote against ratifying compensation for J&J's executive officers and said shareholders should be "concerned" about Weldon's pay.

J&J Defends CEO Pay, Urges Support In Vote On Compensation - FoxBusiness.com

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