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Patient Gets Drunk on Hand Sanitizer in Australian Hospital With Blood Level of 0.271

6/18/2011 11:15:00 PM  ,  

I would say he had quite a buzz going and probably a stomach that didn’t feel too good either.  I don’t that stuff tastes very good and he drank six bottles of the imagesanitizer and 66% alcohol will do it.  I heard stories of how inmates in prisons have ingested it, but this certainly seems to hit the high limit.  What is amazing is that 3 other patients had been nipping the sanitizer too.  The new procedures are to secure it to the wall and not have it available for consumption so easily.  Don’t drink hand sanitizer and drive by all means:)  I read too recently to where there have been cases of drug tests to where hospital staff, just by using the sanitizer correctly have shown traces of alcohol in their system. 

He was there being treated for alcoholism so I say he was in the right place, but lock down the hand sanitizer in the future:)  BD 

SYDNEY (AP) — A man who drank six bottles of alcohol-based hand sanitizer while being treated in an Australian hospital for alcoholism has sparked calls for the anti-bacterial gels to be better secured.Doctors said in a letter published Sunday in the Medical Journal of Australia that they were stunned to discover the man had downed six 375-milliliter (12.7-ounce) bottles of hand sanitizer, giving him a blood-alcohol concentration of 0.271 percent. That's more than five times higher than the 0.05 percent legal limit for driving in Australia.

The 45-year-old had been undergoing treatment for alcohol-related gastritis when he drank the sanitizer. The gel has an ethanol content of 66 percent and is routinely used by medical staff to prevent infection.

Patient gets drunk on sanitizer in Aussie hospital - NewsTimes

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AARP Ready To Throw Grandma Under the Bus? New Statement Today Indicates They Are Now Open for Modification Talks

6/17/2011 09:46:00 PM  , ,  

Modifications are not really a bad thing, just depends on who’s talking and what they are proposing.  Now when it comes to charging those in high income brackets higher contributions, that’s a modification that is fair.  To dump and put it on the open market, that’s more than a modification and not where we want to go.  I think AARP has somewhat become a lame duck lobbyists group in the last few years and focuses more on selling insurance than anything else.  They do spend a lot on mailing as I am at the threshold where they can enroll me and I have not done so. 

Besides I don’t want the coupons that come along with all of this as who knows if they are tracking and selling data too, I wouldn’t be surprised if that were true.  They do work on projects with Walgreens and send fleets of buses out which is a good thing but Walgreens said their business of selling our data is worth $800 million to the retail drug chain by selling our purchase and prescription data, so is Grandma under the Walgreens bus to speak of?  There’s more information on the program at the link below and the video from CBS covers their statement today. 

AARP and Walgreens Sending Out a Fleet of Buses to Offer Free Screenings

Back in 2009 AARP was under Congressional investigations for their health insurance sales tactics and over 60,000 people had cancelled their insurance so this was a big battle going on. At any rate, the video below gives a little history on the situation and even then it was not firm on how they actually stood so this announcement today seems to be more of the same and they talked in circles at that time.  No word on what the “other” group that people changed to, The American Seniors Association is saying about this, no mention, but again maybe they are just there to sell insurance.  The reality here I think is that Senior support for lobbying is pretty weak, sad to say.  BD 

Algorithms, Formulas and Investigations leads to AARP suspending sales of some health plans

Watch CBS News Videos Online

The nation's most powerful senior's group telling the Wall Street Journal it was ready to deal on cutting Social Security benefits. The AARP's policy chief John Rother admitting "some of our members will no doubt be upset."

So upset that within hours the AARP was insisting this was always their position, CBS News correspondent Nancy Cordes reports.

"We can make changes that are modest and we can make changes with a great deal of lead time so we don't need to affect anyone who is currently retired today or near retirement," said said David Certner, AARP's legislative policy director.

AARP sounds alarm: Social Security must change - CBS News

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CMS Announces Anti-Fraud Algorithms Will Begin Auditing Claims on July 1, 2011 Just As Insurance Companies Have Done For Years

6/17/2011 07:06:00 PM  , ,  

This is actually a good thing that should have been done years ago and we will know on July 1st and there after how it will work.  Claims are pretty much electronically scrubbed already by clearinghouses so now this is one more imagetransaction process to audit and look for fraudulent patterns. It will be interesting to see the initial roll out as I am guessing much like any other auditing software that comes into play like this, adjustments to the SQL statements that run the queries looking for patterns may need to be adjusted, so the initial “algos” might be real “tight” or they might be real “loose”

I am guessing the 2nd option of being loose might be the starting point but don’t quote me on that, but it’s the way I would go and then tighten down later after a large amount of claims have passed through the system.  In addition I am guessing with today’s technologies that some “machine learning” will be incorporated here too so those patterns are remembered and adjusted as needed when reporting takes place to watch for efficiencies.  This along with the “Do Not Pay” data base should help out quite a bit.

It’s all about those algorithms and that’s why that word hold center stage at this blog and those who have been reading here for a while are already in tune with what all this means.

Northrup Grumman was the outsourced partner who developed the software auditing system.  Just don’t ask the state of Virginia about them:)  In addition they were also the contractor who created the “meaningful use” data base.  With aerospace being slow contractors are looking and getting contracts to keep more of their own employed and this helps. 

CMS Outsourcing Creation of “Meaningful Use” Database to Northrop Grumman in a $34 Million Contract

In addition, Federal Investigators will have access to such information to analyze and review reporting on such as this will help them do their job a bit better as when equipped with a large number of “potential fraudulent claims” they know where to go looking.

Medicare Federal Investigators Getting Algorithms to Analyze And Find Fraud-Good Move as Contractors Efforts Are Weak With Risking Loss Of Transaction Revenue

Hopefully too this will cut down the fraudulent claims billed for “dead doctors” along with using the Social Security Death Index.  That is one thing the government does well as the Index is used by all as the #1 source of finding out if we are alive or not.

Dead Doctors and Inaccurate MD Listings On the Web Can Be a Real Hunting Ground of Information to Mine For Crooks Relative to Fraudulent Medical Billing

Now being the geek that I am here I wonder how this is going to work, in other words who’s servers is this going to run on?  Will it be licensed to Medicare contractors (insurance companies) to run or will it be a web based cloud operation they connect with.  I am thinking the last is the solution here but can’t say for sure but it’s the way labs and other auditing software connects today, so hopefully it is kept in house at CMS and does the work and reports back to the Medicare Contractors who have little incentives in this area being that with their work more than one subsidiary of their companies are involved and finding fraud sometimes cuts revenue to another of their divisions. 

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

This is an item that is just now being recognized with all the mergers and acquisitions that have taken place with potential conflicts of interest. CMS really did need their own system as relying on contractors was not going to do much if catching fraud ended up costing revenue from another subsidiary involved in processing claims, and that happens.  A couple months ago Harvard said they were going to do a study on the affect of mergers and acquisitions in healthcare and I said “what took so long” as I have been doing “subsidiary watch” posts here for about 3 years now.  Fraudulent claims pay transaction fees just like the good claims so again no incentive to cut those down and catch the thieves, that is unless it is their own commercial claims and then they are all over that. 

For a good example of “false positives” you can read this post from 2010 with what is now a big legal suit from several dermatologists in San Diego who were shut down via Ingenix (United Healthcare) algorithms. Within 5 days without warning all insurers quit paying them and this is a huge mess and I don’t know the outcome of the case but the link below will tell you how the algorithms affected all their businesses and even closed a few practices as the offices had already rendered all the services and pitted patients against doctors on the money side  This is a story that should not have happened and shows the bad side of lack of communication and could have been handled different.

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

Here’s one more example to where a contracted 3rd party used by Blue Cross was caught with their algorithms that denied care, so again this is big stuff to have the algorithm work properly and find fraud patterns and not use it as 100% grounds for denying claims. 

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

And a few more examples…the point is to know that math is controlling your payment destiny here and be prepared. 

WellPoint Creates Reimbursement Algorithm to Cut Down Hospital Annual Payment Increases and Reward Only Those Who “Score” Well–Analytics on Steroids
SAS® Business Analytics – Algorithms Used by Blue Cross Blue Shield For Business Intelligence, Integration, and Analytics

Being this is a CMS government program though the good news is that you do have a say and can appeal unlike the processes of commercial insurers who deny claims and have to fight tooth and nail to even get a review.  It’s been in the press many times about how these algorithms can lead to false positives and why I think a loose rule to begin with would be the best and adjust the algorithms as more history is built as claims pass through.  All the processes give you a “score” either in your information or in the claim content. 

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

If we could only end up certifying payment algorithmic processes like we do with medical records we would be miles ahead in knowing what to expect, but again with algorithms that can be changed, as well as algorithmic business models in 24-48 hours and rolled out, we are all still at the mercy of what mathematics the insurers use that day. Again I am hoping the appeal process though will NOT model what the insurers are doing, since this is a CMS program.  We can learn a lot from private industry but should stop short and either change or adjust those formulas that don’t work on the government side.  Would that not be a grand day for all to certify insurer payer algorithms so we know what to expect and have them digitally filed for us to reference?  You can bet it’s probably not going to happen though sadly. I have written about that topic before and we still have “Forest Gump” claim processing with insurers in just not knowing what we are going to get. 

HHS Issues Final Rule for Health Insurers To Justify Increases–Need to Certify Insurance Algorithms For Calculation Just Like We Certify Electronic Record Algorithms

So when the new rule goes into effect and claims are audited for potential fraud, let’s hope it rolls in smoothly and doesn’t create a bottleneck with algorithms set too “tight” from the onset.  I will end this post with an article I wrote way back in 2009 and it is still needed today, a Department of Algorithms or something along that line so we can finally have some real transparency.  I was probably once again too far ahead of my time being the former algorithm writer that I am.  BD

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

On the heels of the White House launch of the Campaign to Cut Waste - an administration wide initiative to crack down on waste, fraud and abuse, the Centers for Medicare & Medicaid Services (CMS) announced today that starting July 1, it will begin using innovative predictive modeling technology to fight Medicare fraud. Similar to technology used by credit card companies, predictive modeling helps identify potentially fraudulent Medicare claims on a nationwide basis, and help stop fraudulent claims before they are paid.  This initiative builds on the new anti-fraud tools and resources provided by the Affordable Care Act that are helping move CMS beyond its former “pay & chase” recovery operations to an approach that focuses on preventing fraud and abuse before payment is made. 

“President Obama is committed to hunting down and eliminating waste, fraud and abuse throughout the federal government,” said HHS Secretary Kathleen Sebelius. “Our work to fight Medicare fraud is an important part of the Obama Administration’s effort to root out wasteful spending and change the way government does business.”

“Today’s announcement is bad news for criminals looking to take advantage of our seniors and defraud Medicare,” said CMS Administrator Donald Berwick, M.D. “This new technology will help us better identify and prevent fraud and abuse before it happens and helps to ensure the solvency of the Medicare Trust Fund.”

NEW TECHNOLOGY TO HELP FIGHT MEDICARE FRAUD

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Allscripts And Humana Collaborate to Provide Decision Support Software for MDs Along With Financial Assistance and Incentives For Adopting Allscripts EHR System

6/17/2011 12:16:00 AM  ,  

We knew this was coming in time when insurers and medical record companies imagewould get a little closer together.  The insurers are the big benefactors with both electronic records and billing provided to them.  As I read here there looks to be incentives from both companies, Allscripts on the EHR and Humana for rewarding physicians for improved clinical performance. 

It doesn’t say specifically who the selected physicians are and where but I’m sure more may follow later.  This is all about aggregating decision making software services imagethrough the EHR at the time of service and the partner for aggregating patient information data is Availity Health Information with their CareProfile patient record system,  and you can read is that the company is a collaboration from Humana and Blue Cross Blue Shield of Florida.  I’m not sure why they have the quote and recommendation from Newt Gingrich on there but that’s another matter and we know how he likes to raise money.  Availity also offers clearing house services so they make money scrubbing claims for providers as well.   

image

About Availity from the website:

“In 2001, a team of forward-thinking professionals at Blue Cross and Blue Shield of Florida, Inc. and Humana Inc. sought to empower and connect all Florida health care professionals with a smarter, online approach to electronic claims and other daily health plan transactions.

Availity combines dynamic technological innovation with imagean in-depth understanding of the health care industry. Our unique business model is based on the mutual benefits of collaboration and expansion of our network—not fee-based profits. We strongly believe that collaboration is the only way to reduce the rising administrative costs for all participants in the health care system.”

Availity also states they do integrate with other EHR systems outside of Allscripts so here come the data consultants to get everything communicating.  This looks to be another area of technology to where insurers are able to capitalize with additional revenues with the joint effort of both insurers here.  BD 

Humana Inc. (NYSE: HUM), in its continuing commitment to partnering with leading Electronic Health Record (EHR) vendors, has formed an alliance with Allscripts (NASDAQ: MDRX) - a national leader in EHR technology - to provide eligible physician practices with incentives for implementing EHR technology that enables delivery of advanced clinical-decision support at the point of care. The technology provides patient-specific, clinical-quality information to physicians that supports both preventive and chronic-condition management as well as improved care coordination.

Humana will provide financial assistance to selected physicians for adoption of the Allscripts EHR as part of Humana's Medical Home EHR Rewards Program. Physician practices that participate will receive valuable, timely clinical information - electronically - at the point of care, such as a notice of a preventive-care opportunity or information about a patient's medical history that may not appear in a particular doctor's patient chart. Humana will financially reward primary care physicians for improved clinical performance.

Allscripts, Humana partner to deliver clinical-decision support technology for physicians

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Medical ID Theft–Woman Loses Work Opportunities-Medical Records Show She Was an Alcoholic–Now She Can’t Get Medical Records Deleted for Fear of Malpractice Suit

6/16/2011 09:56:00 PM  ,  

This does bring about a good question, what does happen to those records that are created by the fraudulent person.  In this case the other person was also a drug imageaddict and when applying for jobs as a systems analyst the innocent party kept getting turned down for jobs. Medical identify theft has an average cost of 21k per incident. 

Now does she have to have those fraudulent records attached for the rest of her life?  I’m guessing if not, she will have to tell her long tale under each circumstance and I would want them gone as what if they were used, different blood types with other medical information getting mixed up would be my concern as we all know how data can and does get mixed up today.  They should at least be able to archive the records at the hospital along with a full accounting of the fraud from the other patient.  They fear a malpractice suit is the reasoning given to her.  As strange as things are today, probably the other woman who received the care if she’s not serving time will show up and want her copies of her medical records:)  At any rate I feel sorry for this woman and when you watch the video it you can what I mean with having to tell people she’s not an alcoholic or a drug addict.  BD

LOS ANGELES (KABC) -- Identity theft is the fastest-growing crime in America, costing consumers billions of dollars a year. But even worse is medical identity theft because it can possibly cost victims their lives.

Westminster resident Vicki Blair has two college degrees, a professional certification and was a systems analyst for a major aerospace firm for 10 years. But then suddenly, she had trouble finding a job.

"I had interviews, I had no offers. I couldn't figure it out," she said.

Protect yourself against medical ID theft | abc7.com

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Nuance Acquires One More Speech Software Firm - SVOX In Zurich

6/16/2011 04:48:00 PM  ,  

I guess the big question is getting to be, has Nuance missed anybody yet?  I think since I have been covering them at the blog they seem to have quite a group of acquisitions, most of the speech recognition companies.  I had not heard of SVOX and am guessing they are a big player in Europe.  The website shows all types of speech technologies from text to automotive.  Nuance has also been rumored of late to be working with Apple on some new integrated features.  One of their partners listed is “Microsoft Auto”. 

image

Also they do business with Google being the technology partner for Google Translate and dictionary services with speech recognition.  Their mobile technology lists quite a few automobile companies as well such as Audi Nissan, Porsche so it sounds like they have done a ton of development so we can have our talking cars, which is a good thing as that’s less time we have to distract ourselves from driving.  The dollar amount of the purchase was not stated but I agree with Xconomy here in just viewing the website, it’s a big one as there’s a lot going on here.  BD

Some big news in the world of speech software today. Burlington, MA-based Nuance Communications (NASDAQ: NUAN) is acquiring imageZurich-based embedded speech software firm SVOX, Xconomy has learned from a source with knowledge of the deal. The acquisition price wasn’t disclosed, but is said to be in the triple-digit millions of dollars.

The deal seems to make sense for Nuance, which is trying to dominate the fields of speech, imaging, and communications technologies—especially speech.

SVOX, a profitable private company founded in 2000, develops speech interfaces for the automotive, mobile, and consumer electronics industries.

Nuance to Acquire Speech Software Firm SVOX | Xconomy

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Weiner Rehab - Home for the Horny (Humor-Video) From Jimmy Kimmel

6/16/2011 02:07:00 PM    

This is so funny, the Pleasant Valley Home for the Horny.  Where do you send someone with symptoms such as the Congressman:)  BD 

Home for the Horny

You do have to laugh at this as on a serious note, what a waste of time and how many other digital illiterates are working there:)  BD

Rep. Anthony Weiner of New York Admits His Behavior on the Web-Time for All Members of Congress to Increase Their Digital Literacy!

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Vivek Kundra-US CIO To Resign And Take Fellowship at Harvard-Was He OverTaxed And Burnt Out, If So That is Allowed Today As This A True Reality for CIOs All Over the US

6/16/2011 10:42:00 AM  , , ,  

CIO jobs are tough today and with the title above, no disrespect meant at all, but it’s the reality of IT Infrastructure we have today, it can be a brain drain by all means, lot of pressure.  I spent some time talking last year to some high ranking CIOs and wrote about not burning them out.  If you are outside the IT World this could news to you but the pressure and demands for CIOs in tech is huge.  It’s a moving target with a new left hook thrown at your at least once a day if not more often.

CIO Confidence In Meaningful Use Drops-The New Left Curve of Technology That Arrives Daily Contributes-Don’t Burn These Folks Out

I have had a few emails and comments over the last few months that said “thanks” for bringing this to light, no joke here and straight forward, as they mean it and little recognition of this is made outside of the IT world, but it is real.  Public CIOs too are nearing this point as well with the complicated IT infrastructures we deal with.  It’s not easy being in that position with a pretty big digital illiterate crowd that we have today in Congress. 

Institute for Health Technology Transformation Convention–Fall 2010 Convention - Insights From The Medical Quack

I write about that quite a bit here because its true and we have a big conglomeration of “non-participants” in the lawmaker category today and this extends beyond just Congress, take in state legislatures too.  So many still live in the 70s. You can read the link below as see what I have heard from some CIOS and this does not mean they are not qualified to do the job, it’s just that the job and expectations and demands has changed so much that in some areas goals are created by “non participants” in technology that can’t be met, as they don’t get where we are today with the complexities. 

I do a lot of listening.  If I were him I would probably be doing the same thing in heading off to Harvard as at least there are many there who have a lot of wisdom and it could be far less stressful and he will have a better shot at perhaps some of his own personal goals for his career. 

Below is a post from back in 2009 from a CIO who was full of himself and I bring attention to this post as the arrogance here is huge and this is what we hear from big insurer CIOS, kind of funny as he stated people like me make CIOs feel insecure about their jobs, never knew I had that kind of power, was pretty funny and someone just had to rant that day.  He disputed my thoughts on the CIO needing some “tech” knowledge and ripped big time, but aha, look where we are today and turns out I was right back in 2008.  What made the post even funnier was the fact that he tried to remain anonymous and my reports for the blog identified the network he connected with and I knew exactly what company he was from, so it proved that point all the way around.  Again, it’s a post worth reading with a ton of arrogance from 2008 when we were talking about the looming CIO shortages. 

A Major HealthCare CIO Visits and Comments at the Medical Quack – He’s an Executive He Says

Back on track here I think Mr. Kundra has done a good job and he has one of the toughest jobs around as in today’s world not matter what they do, CIOs have a hard time making anyone happy, not because they are not doing their job, but because most do not understand the realm of this position today and frustrations and witch hunts arise where they should not be.  Here’s a good example of what we have to work with on the Hill today, side shows and soap operas that push aside laws and discussions that need to take place, so again for the National CIO a tough place to be and that probably applied for other Executives too.  When budget cuts take place and high level meetings get over shadowed and you have folks like those who are a bit digital illiterate in the Senate cutting funds for cloud computing, well that’s what they did…the levels of digital literacy are shameful and out of focus.  Shoot I think the President feels this too for that matter. 

Digital Illiteracy Still Plagues Law Makers–Severe Focus on Abortion Rights Proves It–Is This Where Our Lawmaking Knowledge Leaves Off or Even Begins? Scary…

IBM Makes 'Watson' Servers Even Smarter With More Cores–We Are Now Graduating to Taking “Dull” Knives to Gun Battles–There’s No Great White Hope for Budgets

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

Do Some Think That Health IT Costs and Systems Grow On Trees-Certainly Starting To Give That Impression of Late

Companies and their executives have tried for years to break through the stymied representatives we have with no luck either, as it always goes back to the 70s.  I have written about this many times and our folks who represent us had a good opportunity to bring in some new technology tools but did they even recognize this could help them do their job better, big flat no. 

So in closing I wish Mr. Kundra the best of luck and appreciate the time that has been given to bring the US up to speed where he could as there was a lot done, but again I understand the human obstacles that could just make that job living hell at times too.  We all need to have feelings of accomplishment and who ever comes next to take the job had their hands full with a lot of high expectations and hopefully some of those will be within goals that are fixated on reality.  BD 

When President Obama appointed Vivek Kundra as the first U.S. CIO, he said, "Vivek Kundra will bring a depth of experience in the technology arena and a commitment to lowering the cost of government operations to this position. As Chief Information Officer, he will play a key role in making sure our government is running in the most secure, open, and efficient way possible."

When he began at the White House, he brought with him the promise of good ideas and a hard-charging style focused on getting things done, necessary qualities to tackle the difficult issues facing Federal IT – an aging infrastructure with rising operating costs, too many major projects failing to deliver, and increasing vulnerability to outside threats. Two and a half years after joining the Administration, Vivek has delivered on that promise.  He has cracked down on wasteful IT spending, saved $3 billion in taxpayer dollars; moved the government to the cloud; strengthened the cybersecurity posture of the nation while making it more open, transparent, and participatory.  His work has been replicated across the world from 16 countries that have deployed the data.gov model to tap into the ingenuity of their people to multiple countries that have deployed the IT dashboard to save money.

Our Nation’s First Federal CIO | The White House

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President Obama States “The US Doesn’t Have Enough Engineers (This Category Includes Company Developers)

6/15/2011 09:22:00 PM  , ,  

There’s substance to this as let’s go back to August of 2010, Intel CEO Paul Otellini says the same thing and he said it the year before that and the year before that one.

Intel CEO States the US Faces Decline in Tech Jobs–Announces imagePurchase of German Wireless Chip Company Infineon

The CFO of Intel has said this too.  This is not talking about entrepreneurs but rather company employees as gosh knows we have software freelancers coming out our ears today, but corporate America needs them too or they go elsewhere. 

Intel CFO – US Not Taking High Tech Job Creation Serious Enough – A Reminder That We Are Falling Behind

In 2005, midway through the Bush administration, Microsoft's Bill Gates told a Washington audience that curbs on immigration and guest workers would provide a boost to research institutions in China and India. A year earlier, then-Intel CEO Craig Barrett warned that the U.S. must dramatically improve its education system. “  Bill Gates had said it many times.

Bill Gates speaks at UC Berkeley Global Health, Education and Thoughts on Philanthropy

Bill Gates even gets more specific with lawmakers, what in the world are you doing he asks?  We see the same old stuff with abortions and Weinegate so what a crappy example our lawmakers create at every level and we do have a President trying to address and make a difference, but digital illiteracy is killing us. 

Bill Gates–TED-Talks About States Budgets (Where Are You Getting Those Algorithms) and Educational Needs (Update)(Video)

What’s even worse is we have even fewer females in engineering and this is a good video from Social Networking King Robert Scoble talking about it.  He says there’s plenty of women in tech companies, but not in engineering which includes programming and development.  Let me tell you something here too as I am in complete agreement with his comments on society being ready for “logical” women who code, he says the world is not ready to accept this fact yet in society and I can tell you first hand he is 100% correct.  I never wanted to be logical but once I learned how to code I became that, so this profession changes the way women think, as we get real smart and “logical”.  I am very logical and thus you see my frustrations here with lawmakers who live in the past and sink us down with rhetoric of the 70s and who are completely out of focus so much of the time as “non participants” in technology as they seem to think that all of it is “for those guys over there”.

He also states that there are not enough engineers period in the US.  The gal from Fox adds in and talks about her lack of math interest.  Engineering is like a “think tank” and I can agree with that:)  In short the President is tuned in, while Congress is not. This is probably what we will end up with, a stupid law that will make us all criminals for embedding videos. 

Out of Focus Lawmakers With Digital Illiteracy–Bill To Make It A Criminal Offense for Embedding You Tube Videos and Time And Money Wasted With John Edwards Case

What further scares me is the inability of lawmakers to recognize a tool when they see it.  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

Computerworld - WASHINGTON -- President Barack Obama is making a push to train 10,000 new American engineers a year, primarily with the help of the private sector.

Obama is trying to address the nation's persistently high unemployment level by boosting the number of people with skills in areas where unemployment is relatively low. Engineering fits that bill.

The unemployment rate in 2010 for all engineers was 4.5%. For software engineers it was 4.6%, and for all computing professionals, 5.4%, according to U.S. Labor Department data analyzed by the IEEE-USA.

Obama: 'We don't have enough engineers' - Computerworld

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UnitedHealth Loses Tri-Care Protest Again With Contract Awarded to Humana in the South-Now Protesting Contracts Awarded In Both the South and the Western States

6/15/2011 08:05:00 PM  , ,  

This contracting and bidding situation has been going on since 2009 and yes it’s taking forever, but in the north Healthnet kept their contract and in the south United contested twice and here’s the latest with Humana staying in place.  It’s pretty gutsy when United said that Tri-Care misevaluated the proposals a second time.  According to this article they still have not given up and are reported to be looking at some other methodologies, like maybe pulling some algorithmic reports?   They own enough companies to do all the analytics that one could desire I think and even said they would not stop short of legal action.  The Tri-Care contract for the south includes Alabama, Arkansas, Florida, Georgia, part of Kentucky, Louisiana, Mississippi, Oklahoma, South Carolina, Tennessee and most of Texas.

Humana Keeps Tricare In The South And Back in May of 2010 HealthNet Was Able to Keep the Northeast-Both Companies Filed Appeals

This makes for somewhat of an interesting story as Tri-Care went up for bid and Aetna and United were awarded new contracts; however, Humana and HealthNet filed appeals and both Aetna and United lost the bids and they reverted back to the incumbent insurance carriers.  Back in May of 2010 it was announced that HealthNet would imagestay in place in the north as somehow it was determined that Aetna was considered to have “cheated” with a conflict of interest and now the appeal for Humana has been granted with United Healthcare having to give up their contract too.  Here’s a flashback on HealthNet below. 

Also in the West they won the opportunity to re-open the western states bid for the DOD bid for a $16.9 billion dollar contract for retired military and their families.  Sounds like they want it all.  In April the DOD agreed to re-open the case in the Western states award which was given to TriWest Healthcare Alliance Corporation who was the only other bidder.  They have the big semi 64 foot trailers to move out there for telemedicine it appears and appears they want to get their telemedicine in action.  In the south for other business areas they already have some pharmacists at Walgreens on pay for performance and I’m guessing rolling more patients into this program is a focus as well. 

United Healthcare Expanding Diabetes Prevention & Predictive Algorithm Program With Walgreens And Pay for Performance Incentives In Atlanta

In addition they recently bought a big IPA in southern California that again I’m guessing they want to roll this all into their current business plans. 

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

The United CEO is the highest paid public company CEO in the US and no wonder he wants everyone else on pay for performance but it’s nowhere near what his P4P is by any means.  Pay for performance is not all that it has cracked up to be either.

Pay For Performance Is Not All That It Has Cracked Up to Be-Time to Rethink As Money Is Not Creating Better Health Outcomes

They will be busy working those algorithms to create analytic justifications it sounds like as the old Ingenix was infamous for doing, now under the Optum umbrella and name.  BD 

A division of UnitedHealth Group lost its protest of a $23.5 billion, five-year contract that was awarded to Humana to provide health insurance to military personnel and their families in the southern U.S.

The Minnetonka, Minn.,-based health insurer which employs thousands of people in Connecticut protested the TRICARE South Region contract given to Louisville, Ky.,-based Humana in late February. The U.S. Government Accountability Office denied the protest by UnitedHealth Military & Veterans Services, LLC.

"The protester argued that TRICARE misevaluated the proposals and made an unreasonable source selection decision," said Ralph O. White, managing associate general counsel for procurement law at the U.S. Government Accountability Office. "The GAO's decision reviewed UnitedHealth's challenges to TRICARE's evaluation and concluded that the agency's assessment of proposals, and selection decision, was reasonable

UnitedHealth Denied In Protest Of $23.5 Billion Federal Contract Awarded To Humana - Connecticut Insurance

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HCA To Pay $1.45 Billion To Take Over Ownership of Seven Hospitals, and 13 Ambulatory Centers In Denver

6/15/2011 06:39:00 PM  ,  

HCA just has their IPO in March of 2011 and with their re-organization efforts here’s one more purchase.  Also what we all remember is Florida governor Scott being forced to resign as the CEO of Columbia/HCA, then the country’s largest hospital chain, while it was being investigated for massive Medicare and Medicaid fraud.  He got off scot free but HCA paid $1.7 billion in fines and settlements with 14 felonies. 

HCA (Hospital Corporation of America) Pulls Off the Largest Private Equity Firm Offering IPO in US History of $3.8 Billion

Health One is the largest health-care system in the Denver area and now they are 100% owned by HCA.  BD 

The Colorado Health Foundation is selling its interest in HCA-HealthONE hospitals, the largest health care provider in the state, for $1.45 billion.

The sale by the nonprofit foundation will balloon its assets into the largest foundation in Colorado. The Colorado Health Foundation has concentrated its grants on expansion of access to health insurance and healthier diets and exercise for state residents.

The foundation will sell its 40 percent interest to its operating partners since 1995, the for-profit national chain Hospital Corporation of America (HCA). The two powers have overseen Colorado institutions including Swedish, Rose, Sky Ridge, P/SL, North Suburban and Medical Center of Aurora hospitals, as well as Spalding rehabilitation, Rocky Mountain Hospital for Children and other major assets.

HCA to take over HealthONE hospitals in $1.45 billion deal - The Denver Post

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Baxter Loses the First Contaminated Heparin Lawsuit–“The Cheap Stuff” As It Was Called In Internal Documents Presented in Court

6/15/2011 06:21:00 PM  ,  

The words, “the cheap stuff” was a term that came from Baxter’s own internal records and I’m assuming it could have been emails or other reports that brought imageabout the term maybe from a marketing area.  You can read the article below where I suggested a couple of years ago to have reports electronically sent from factories to the FDA to indicate certified lot reports.  These would be tamper proof and give raw data on contents.  I would think both side would like this and it would help pinpoint problems immediately.  Of course it’s not 100% proof, but it would certainly help.  Last year B. Braun recalled a number of lots too. 

FDA Heparin Investigation In Conjunction with Chinese Officials Strained and A Lot of Unfinished Business And No Technology Advances to Help the Cause

Also, while we are at it, knock off those “blind” shipments that do not show the real location of origin.  There’s a lot of that going on too, many years in logistics I learned that in a hurry.  BD 

Baxter International has lost the first lawsuit in its ongoing legal battle over the contaminated heparin scandal in 2007 and 2008.
A US court has awarded $625,000 to the estate of Steven Johansen, who died in December 2007 after taking a Baxter heparin product contaminated with over-sulphated chondroitin sulphate (OSCS)

"The active pharmaceutical ingredient in the contaminated heparin received by Mr. Johansen and other Americans was obtained from Baxter/SPL's Chinese supplier, Changzhou SPL (a joint venture with SPL)," said the Nolan Law Group, which represented Mr. Johansen's family, in a statement.
"This crude heparin was referred to in the companies' own internal records as 'the cheap stuff'," it alleges. 

SecuringPharma - Baxter loses first heparin lawsuit

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CMS Lifts Aetna Restrictions on Medicare Part D Enrollment As of July 1, 2011

6/15/2011 04:57:00 PM  ,  

Part D folks will once again be able to enroll with Aetna after a year of punishment from CMS for not properly handling drug benefits and patients had problems with access to Part D drugs.  So once again you will see Aetna marketing  Medicare Advantage and Prescription Drug Plans. 

This could be beneficial in area to where selection of insurers is limited to have one more choice.  6 of one and half a dozen of another.  Earlier this year Aetna pulled out of Colorado for Individual Health Insurance Plans but Part D could be available there, check out Medicare.Gov and see what they have listed. 

Aetna pulls Out of Individual Health Insurance Policies in Colorado as of August of 2012-Risk and Profit Algorithms At Work

Algorithmic business models can sometimes be very confusing as the math determines areas of profitability and some offerings are here today but gone in a few months at times.   BD

Aetna plans to enroll new Medicare beneficiaries by July 1 in response to the lifting of year-old federal sanctions.

The Centers for Medicare & Medicaid Services removed marketing and enrollment restrictions established last April. Aetna has since corrected its deficiencies, the CMS determined after a review of documentation and the conducting of validation exercises, according to a letter sent to Aetna President and Chief Executive Officer Mark T. Bertolini. Small issues remain, but none which should have prevented the reprieve, wrote Brenda J. Tranchida, director of CMS' program compliance and oversight group.

"We have worked very hard to implement improvements to a number of areas that will further support beneficiary access to care, patient safety and compliance with CMS guidelines," Bertolini said in a statement. "Most important, our actions will enhance our ability to support the nearly 1 million Medicare beneficiaries we are privileged to serve today."

Aetna recently announced an agreement to acquire the Medicare supplement and related blocks of in-force business of Genworth Financial Inc. for about $290 million in a deal to expand its presence in the health insurance market for seniors (BestWire, June 13, 2011). The transaction includes the sale of Continental Life Insurance Co. of Brentwood, Tenn., and its American Continental Insurance Co. subsidiary, with Aetna acquiring 100% of Continental Life's stock. It also includes reinsurance agreements to transfer to Aetna the Medicare supplement in-force business sold by certain Genworth life insurance subsidiaries.

Insurance News - CMS Lifts Aetna Sanctions on Medicare Enrollment

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Johnson and Johnson Closing Plant in Ireland 133 Jobs Lost As They Stop Manufacturing Cypher Drug Coated Heart Stents-Looks Like Stent Wars Have Come to A Close As Well

6/15/2011 02:59:00 PM  ,  

If you have followed the news on “stent war legal cases” then you know what I am talking about as J and cashed in very big over the last year or so with the Boston Scientific case for one example so we could be assured of legally patented stents and now they are not going to make them anymore? 

Johnson and Johnson Revenue Increased – Helped Along with “Stent War” Settlementsimage

Go figure, I know just another business decision:)  There were a few smaller cases though where J and J had to pay but the Boston Scientific ruling overshadowed those cases by a mile where J and J benefited.  The company will stop manufacturing of the CYPHER® and CYPHER SELECT® Plus Stents at the end of the year. 

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

The legal battles over the last few years were expensive but I think this was one area that escaped any major recall efforts. 

Will the “Stent Wars” Ever End – We Want to Be Able to Afford them Boston Scientific Files Cross Appeal

Future Plans and Explanation:

“A short while ago, we announced to employees of our Cordis Franchise that we will stop manufacturing CYPHER® and CYPHER SELECT® Plus Sirolimus-Eluting Coronary Stents by the end of 2011 and we will not pursue the development of the NEVO™ Sirolimus-Eluting Coronary Stent in order to better focus on those areas of the Cardiovascular market with the most significant medical needs and the greatest opportunities for growth. 

As many of you know, Cordis introduced the world’s first bare-metal coronary stent in 1994, as well as the world’s first drug-eluting stent (DES), the CYPHER® Sirolimus-eluting Coronary Stent, in 2002.  Since then, the CYPHER® Stent has been chosen by cardiologists worldwide to treat more than three million patients with coronary artery disease.  Coronary stenting truly ranks as one of the great breakthroughs in the history of medical technology. 

A short while ago, we announced to employees of our Cordis Franchise that we will stop manufacturing CYPHER® and CYPHER SELECT® Plus Sirolimus-Eluting Coronary Stents by the end of 2011 and we will not pursue the development of the NEVO™ Sirolimus-Eluting Coronary Stent in order to better focus on those areas of the Cardiovascular market with the most significant medical needs and the greatest opportunities for growth. 

As many of you know, Cordis introduced the world’s first bare-metal coronary stent in 1994, as well as the world’s first drug-eluting stent (DES), the CYPHER® Sirolimus-eluting Coronary Stent, in 2002.  Since then, the CYPHER® Stent has been chosen by cardiologists worldwide to treat more than three million patients with coronary artery disease.  Coronary stenting truly ranks as one of the great breakthroughs in the history of medical technology.”

In addition it was noted with current re-structuring that 900 to 1000 positions will be eliminated as well so now I guess we finally have an end to the ever so expensive stent wars and the cases must be wrapping up and the profit levels might be dipping.  J and J has a whole new group to work with now as they acquired the Synthes Corporation so I think there’s a lot of work involved there coming up as well.  There’s a big privately owned company, Cook Medical who I have interviewed several times on this blog who also produces a line of stents so they may stand to pickup some business as well.  BD

Johnson & Johnson is to close its Cashel manufacturing plant with the loss of 133 jobs, it was confirmed this afternoon.

The decision comes as Cordis Corporation, a Johnson & Johnson company, said it would stop manufacturing its Cypher drug-coated heart stents by the end of the year and end development of a new model.

Cashel plant closure sees 133 jobs lost - The Irish Times - Wed, Jun 15, 2011

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'Silk Road' Security Model Using Encrypted Digital Money Business Model For Selling Illegal Drugs And Collecting Payments, But First Financial Loss of Bitcoin Reported

6/15/2011 09:03:00 AM  , ,  

I learn something new every day and had no idea until recently that the site existed.  Their preferred form of payment according to the article written here is Bitcoin, imagewhich is a peer to peer payment system for lack of a better way to describe how it functions.  Bitcoin has been around for a while and has come under fire from the government for their services they offer as this is a virtual account of money that can be translated to dollars and other currency; however there’s no control over the transactions so I am guessing the one loss today reported is just flat out gone.

If Bitcoin grows at an accelerated pace it stands to decentralize currency and is not able to be tracked so in other words it sounds like a “digital” cash business.  I have never used such a service and am just providing awareness information here. Getting back over to “Silk Road”, it has opened up a digital black market for getting drugs on line.  For both programs to work you do need to download software for both programs as it hides your identity basically.  You can watch the video below for additional details.  When you read the comments, it’s somewhat of an insane explanation as to why Silk Road exists by providing a safe environment for those to buy their illicit drugs?  I wonder how long it will exist and according to the ABC report there’s no official word from the DEA about investigating the site. 

I don’t know what or how our Congress could do with an area like this though as far as creating an effective law as it seems this is over the heads of comprehension of most.  Sure they know it exists, but how do you put a stop to the trafficking of illegal and other drugs through this network?  Time for the members of Congress to hire some “real” Algo Men and become digital literate as to what’s happening in the real world of technology.  I have said this many times that our lawmakers need to venture out of the 70s and address real situations and stop focusing on abortions and other such matters.  I think it’s also time to really start thinking about “digital” law formats soon too.  If you are a parent, this is something you might want to be aware of as well as students and children could be using the network to buy drugs.  As you can see below embedding videos is still up for a live discussion with nothing resolved as of yet. 

Out of Focus Lawmakers With Digital Illiteracy–Bill To Make It A Criminal Offense for Embedding You Tube Videos and Time And Money Wasted With John Edwards Case

I don’t know if the site sells other drugs or not that are perhaps counterfeits of real drugs or not but again, this goes to substantiate what I have said about a bar code system for recalls and authenticating real pharmaceuticals.  Shoot we can’t even get technology out there for “legal drugs” that will help us with authenticity and give consumers the information they need. 

Healthcare Bar Code Posts

Counterfeit Drug Factories Outside the US-60 Minutes Reports (Video)-Solution With Bar Codes for Pharma, FDA, DEA, Medical Devices
Counterfeit Alli Warning from the FDA – We Should Be Using Technology for Easier Identification

Again with the first loss reported via Bitcoin, as it does with any transaction process will cause people wake up and take a 2nd look when funds are flat out gone, so it remains to be seen on how the transaction portions of peer to peer business will result as a digital decentralized currency system idea probably is not going to disappear any time soon and who knows what will appear next with new algorithms that can be created.  In a post yesterday, the hackers of the Internet are also making their statement on security and regulations too.

LulzSec Hackers Attack U.S. Senate Website And Creates A Video Threat to Target the Federal Reserve on YouTube

So I guess a future of soap operas and abortion talk is all we are going to be in store for while technology continues to haunt the “non participants” who make our laws.  Sadly it appears that most only saw technology like IBM Watson as a game since it was used on Jeopardy and that’s the sad reality of digital illiteracy with lawmakers today as it seems the hacking and algorithmic formulas just circle around the oblivious and we all suffer. 

IBM Watson Did Get a Chance to Go To Congress-Should be a Permanent Home For Greater Intelligence for Creating Laws

TAMPA - You can get anything on the internet nowadays -- cars, homes, and now, black tar heroin.

It’s called Silk Road, the anonymous marketplace.image

It’s a website boasting thousands of members that was created in February, according to its administrators. On the main page, they proudly and openly sell LSD, marijuana, ecstasy, and most any other drug you can name.

“He is basically the eBay or the Amazon of the drug-trafficking world,” said Capt. Robert Alfonso, head of the narcotics division of the Pinellas County Sheriff’s Office.

Investigator Michael George asked the Silk Road administrator about the addicts that could potentially die because of products sold on the website.

He responded, “I am so sorry if someone you know has been hurt by drugs, but it is my sincere hope that by making drugs available in a safe, secure, and predictable way, that we will eliminate the violence and danger of obtaining and using drugs through traditional methods. We also hope that, by increasing competition for providing drugs in our marketplace, the quality will rise and price will drop, so that addicts can afford the drugs they need and still have money left over to live a normal life, without as much danger of overdose."

“I see that as insanity. It makes absolutely no sense at all. This is what this person will say to justify his behavior, and it’s completely irresponsible,” VanBomel responded.

'Silk Road' website called the Amazon, eBay of heroin, cocaine, drug trafficking

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Newport Beach Doctors and Affiliates Arrested & Accused of Medical Insurance Fraud

6/15/2011 12:19:00 AM  , ,  

There are some second time offenders on this list too.  I read in another account of the arrests that one procedure they billed for only had 2 doctors who were qualified in the entire state of California to administer, so when it comes to catching coding imagefraud, I would think that one would stand out easy enough, if one were not in fact one of the two. 

When you look at the counts, the are big, 883 felony charges for one and 141 for another as an example.  Depending on the outcome, all of these folks could go to jail for life if convicted.  The fraud is a question of a large number of services billed that were never provided.  18 insurance companies as well as the City of Los Angeles were overbilled according the indictment.  BD 

SANTA ANA — Prosecutors on Monday identified a Newport Beach physician and three others as defendants in a grand jury indictment alleging $17 million in workers' compensation insurance fraud.

The Orange County district attorney's office and the California Department of Insurance released a grand jury transcript and a 181-page indictment listing 884 charges against Dr. Sim Carlisle Hoffman, 59, a radiologist from Newport Beach.

Also charged were Dr. Thomas Michael Heric, 74, of Malibu; Louis Umberto Santillan, 44, of Chino Hills; and Beverly Jane Mitchell, 60, of Westlake Village.

They and Hoffman are accused of billing insurance companies for more expensive and unnecessary procedures that were sometimes never performed.

Heric was previously convicted of felony federal fraud in 2008 and had his medical license suspended for 60 days.

Newport Beach doctor accused of medical insurance fraud - Daily Pilot

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