Cigna Wants Expatriate Plans Exempt from Medical Loss Ratios-Threatening to Dump 500 Employees in Delaware From Payroll

The contracts and provisions of health insurance just keep getting more complicated and new battle zones keep appearing.  In this case Cigna and other health insurance companies want the expatriate plans to be exempt from the medical loss rations with spending 80% of the premium money on care, as is the requirement for our US domestic policies. 

It’s all about those business intelligence algorithms and maintaining profitability at high levels. When laws and rules are passed, unlike perhaps what the government may do, they get out their high powered software and servers and go to work, figuring out where the parameters of the formulas can be adjusted in order to maintain status quo and this time it appears to be the expatriate policies offered to those over seas.  Does this make sense?  You tell me.  The discussion area here is that expatriate policies are more expensive to administrate and thus they need to be relieved of the US provision of the MLRs.  Using the layoffs of 500 employees in the state of Delaware seems to be new twist added here with again using mathematical formulas and/or reports to show that they don’t feel this is justified. 

“It is a technological arms race in financial markets and the regulators are a bit caught unaware of how quickly the technology has evolved”

Granted by comparison to US policies this may seem to be a small number, but again when using algorithmic formulas and some machine learning technologies these area come up and and alert for a potential risk assessment loss come up and so we have the next move here.  The companies are looking for an permanent policy change.  No wonder things get so complicated but when the risk assessment factors are presented in a format to shows areas for potential improvement, it brings about a need to act on such numbers.  This might also be of interest with noting the Cigna acquisition of Vanbreda International last year to service expatriates, especially with company provided benefit plans so that side of the business needs to generate profits as well and being this acquisition was made in August of 2010, the numbers could now just being scrutinized for the future business model of this subsidiary too. 

CIGNA Acquires Vanbreda International–To Service Expatriate Customers With Health Insurance Outside the US And Employer Benefit Packages–Medical Tourism

Also, the former CEO of Cigna also went to work for a medical tourism company here in California that again would be connected with expatiate services which also occurred in August of last year. 

Former Cigna CEO and Founder Joins Board of Directors With Medical Tourism Company–Accounting and Algorithmic Business Model Expertise Hired

Currently as it stands, the state of Delaware can demand payment from Cigna if they do not keep employees in Delaware and add more jobs.  An economic fix is being discussed for the issue and it will be interesting to see what comes out of this discussion,just one of many that appears today, again based on potential profit losses.  If one is a worker in the Delaware office, well you job could be at stake ant it comes right back around to rules, laws and contracts.  This grows out to where now it is taking an “economic development director” to examine and create a “fix”. 

This is tough when you have such a highly advanced IT infrastructure business like the health insurance business going up against state legislatures, lawmakers, etc. who do not have the same ability to use advanced technologies to predict and fully examine any “unintended consequences’ here and thus those with the data and numbers usually end up on top, as numbers today with substantiated reporting system seem to trump everything else, just look at the financial district on Wall Street for a ton of examples of this methodology if you need to dig a little further.  BD

Health insurance giant Cigna Corp. is using the threat of 500 Delaware layoffs to press a demand that federal policymakers exempt their Claymont-based international insurance business from new rules in last year's federal health care law.

The demand from Cigna, a $21.3 billion Philadelphia-based company, comes just months after Gov. Jack Markell's administration awarded the company $2.4 million in grants to keep those employees in Delaware -- and add to the staff here.

Markell, economic development director Alan Levin, and members of Delaware's congressional delegation are now working on a fix for Cigna and other insurance companies who offer similar "expatriate" health insurance plans.

Cigna and others put on a lobbying effort last year when the National Association of Insurance Commissioners, a group of state insurance regulators, were helping the federal government, Gupte said.

In an October letter to Kathleen Sebelius, secretary of the U.S. Department of Health and Human Services, the NAIC urged Sebelius to exempt expatriate plans from the loss ratio rules.

Cigna threatens Delaware layoffs | The News Journal | delawareonline.com

Technorati Tags: Cigna,expatriates,health insurance,Medical Loss Ratios,MLR,contracts,algorithms,jobs,HHS,patients,doctors

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White House Experiencing Exodus of Tech Advocates and Executives Just Like CIOs in Healthcare and Other Industries–Hard to Deal With Non Digital Literates–Burn Out

I occasionally cover this topic and burn out it is.  Being a CIO today is one of the most thankless jobs around and all are over worked.  We have developing new technologies that appear from right field, from left field and from center field every day.  We are also a society that seems to put more emphasis on our computers entertaining us versus a learning tool, evidenced by all the folks that sit around and play addictive games on Facebook and the likes.  There’s nothing wrong with a little entertainment but if only maybe 15% of that gaming and entertainment time were focused toward a little education we would be miles ahead. 

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

“It’s not uncommon for political appointees to leave after two or three years, especially in the era of BlackBerrys and the 24-hour workday.”

That is a tough task when so much of what is marketed is entertainment and that will keep you stupid for a long time and in actuality we become citizens that are much easier to sway as if you haven’t noticed there have been big leaps in technology this last year and it’s a war and a game and those with the knowledge will win every time.  This is a big job to consolidate IT projects as the way the world works today developers wanting to sell new software just keeping building on other software platforms and program and the price sky rockets without consolidation of technologies to keep things affordable. 

US Federal CIO Vivek Kundra to Review 30 High Risk IT Projects – Federal IT Dashboard Used to Identify Rating Concerns

When working with new technologies and trying to bring in web apps and just things that will make life easier, the resistance is strong and if you don’t read quite a bit today, then you are behind and it will get worse.  As a whole we are just not all on the same road to a better educated country and there are many forces that pull us in every direction and thus the predictions of Intel and many others will come true as being a country left behind with technology as others are not waiting for us.  I think Mr. Kundra got frustrated as we all need a feeling of accomplishment and when you can’t move in that direction, eventually you give up.

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

Dealing with the Congressional arm of our government is especially frustrating just from I read in the news and all cases of foot in mouth due to a lot of digital illiteracy and can these folks really create credible laws?  Scares the daylights out of me and I can be assured when I turn on the news of hearing about more useless abortion debates, sad but I guess that’s about all they think they can control?  Tackle a bigger need I say.  How does one exist and work with a Senate that cuts funding for “cloud” services?  Duh, digital illiteracy at work again.

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…

In addition many in Congress do not understand the value of a good CIO or other tech executive that knows how to configure software system and we have a lot of choices today and when done wrong, a lot of extra money is spent and you don’t get what you wanted.  In what I do, I experience frustrations as well and work hard to work with others as I do comprehend the daily left curve technology sends us and am not bliss by any means and wish more would do so.  Again, as long as we remain a game focused computer user group, we will lose; however big business will continue to gain as they use advanced technologies and as consumers we are taking dull knives to machine gun wars.  Have you not noticed how difficult customer service is any more?  Take note if you have not.  The focus is money and shareholders and not consumers. 

All of this says nothing about the ability of the President and his leadership, as look who he consults with, the tech folks so he’s moving in the right direction.  The Intel CEO has said many times we are falling behind and thus so we see more companies move more money overseas and the last 2 years has seen a huge spike from the big guys like Microsoft and Apple to name two of the many who have moved money outside the US.  When the money moves out of the US, well so the jobs eventually.

President Obama Meeting with Tech Industry Leaders–CEOs and Some of the Smartest CEOs (Algo Men) Who Write Code

So many times the folks that are the “good” IT folks end up looking like the bad guys with trying to push some innovation and that is really sad because they are just trying to help, but in the meantime, the bad guys run a lot behind your back and you have no clue and they take your money and re-arranged the entire financial picture of this country, the power of the algorithms.  Education is the only way to slow this process and to be wise and aware of to use a computer for both learning and entertainment. 

The tech folks that went to work for the White House are giving up, frustrated just like many co CIOs are and we will be less of a power house in the world due to moving on technology in such a slow and illiterate pace while the rest of the world passes us by.  BD

When President Barack Obama took office, he brought with him a pack of technology advocates with impressive résumés and ambitious visions. They wanted to improve the government through the use of Internet tools and iPhone apps and help shape communications policy to expand broadband.

But the core group of techies that launched big initiatives has left the White House over the past six months, raising questions about what will become of the administration’s technology-focused goals.

Tech experts exit White House - Kim Hart and Michelle Quinn - POLITICO.com

Technorati Tags: Technology,CIOs,hospitals,data,healthcare,Health IT,information,think tanks,collaboration,White House,Vivek Kundra,Harvard,burnout

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Good Science, Investments and The Chase for Social Algorithms Has Become a Dangerous Mix-Healthcare and The Creation of Jobs Continue to Suffer

This is a touchy subject and has more to it than I could ever hope to address in this single post, but when you look at the cold hard facts today about the dismal job report, we seem to be chasing the elusive algorithms of data and how to market them and make some fast cash.  They all have their place but with recent moves with technology do we have any type of balance?  I read articles all the time that are well written about how we seem to have lost our backbone for creating wealth and those who write about this concern have some valid points.  What is important and where is all of this going? 

Investing in a software company certainly creates results much faster than investing in biotech and many healthcare related areas as the success or fall is realized much faster and it’s just software without any tangibles attached, so a simpler process if one were to invest; however it seems that we have a huge imbalance here as everyone seems to be jumping over to that side and there’s not enough left on the science and research side for drugs, devices, etc. that we need to either cure or treat our healthcare needs.  We seem to have lost the focus on how tangibles still need enough backers as well.  Sure they are not all gone, but it’s not good with doing a comparison.  Only 1 in a 100 start ups make it, so we have a temporary job increase and as soon as many fall by the wayside, there go those jobs.  Of course there are more start ups that open for business and some find employment there but the entire cycle keeps repeating itself and the newer software start ups require fewer workers, let’s face it. 

Life and Healthcare A Big Batch of Non Balanced Algorithms With Insufficient Intellectual Interpretations–Tax Breaks Maybe For Those Producing Tangibles Vs Formulas

All of the variants have a place and need to exist today but we just appear to be a little off balance as the long term investments are tough and even harder to predict.  Sciences goes bad too and the article below is a sad story on a project at Duke University.  It’s worth reading as it is in fact “sad” and is also one of the reason for investors to steer clear of such long term investments.  The one paragraph below kind of says it all.  When the science was checked on this project it was not accurate.  The marketing and business model though was right in place but it of course fell through too and rightly so.  People lost their lives based on bad science.

“Dr. Baggerly and Dr. Coombes found errors almost immediately. Some seemed careless — moving a row or a column over by one in a giant spreadsheet — while others seemed inexplicable. The Duke team shrugged them off as “clerical errors.”

Regulators in many areas are having difficulties and keeping up with current IT infrastructures is always a challenge.

“It is a technological arms race in financial markets and the regulators are a bit caught unaware of how quickly the technology has evolved”

Back to the point here, when I am sick and need care, do I go take a “Facebook pill”, or get some “Twitter therapy”, or get admitted to a “LinkedIn hospital”?  Sure there’s a bit of satire with that comment and I use and like all the social networks, but again when I see valuations of social algorithms versus human lives today, it doesn’t look so hot by comparison.  I might even venture to say individuals like Bill Gates saw this coming a long time ago and thus we have his foundation dedicated to better care, cures and diseases.  He’s a great thinker and ahead of his time as for years he has testified before Congress with his message that was received but made little impact. Again, look at what he’s doing today for a hint. 

I don’t dispute the fact that everyone should be able to invest and generate a return but again at some point all of this without balance is going to eat us up.  It has been building slow but there’s a shortage of drugs out there right now too and again until this probably grows a little larger, nobody will pay attention.  Drug companies are going where the money is as well and again we hope they have “good science” working for us.

Shortage of Leukemia Drug Cytarabine Serious as Some Hospitals Turn Patients Away And They Will Die Without the Drug

We want productive hospitals and healthcare facilities however without balance you have people that are not being efficient like at UCLA having to find and search out cancer and other life saving treatments. So again none of us ever know when we might be in this situation and all it takes is one diagnosis to see the other side sometimes.  The American Society of Health System Pharmacists have a website with up dated information to reference.  They also note when shortages have been corrected.  FDA has a page too but theirs better and more user friendly.  In the meantime we have tons of new social algorithms with plenty of investors and banks inflating values beyond reasonable and the result is kind of what you see here. 

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

Doctors rely on journals and there have been quite a few stories on false journal publications and the doctors and the patients are the ones on the line relying on this information for authenticity for treatments and when you see bad science and efforts maybe with a higher financial directive, well you get the picture as t what happens and gets diluted. 

You just wonder sometimes with all the data mining that is taking place and the priorities given, if we have embraced the world of the intangibles and forgetting some of the real values of what we need to exist?  This chase will continue until something really hits the wall and in time it will. 

We also have a Congress that I think is oblivious to a lot of this and fails to use technology to create laws that can adequately cover current day technologies too, and we all suffer there, so they are a big part of the process as well as companies today just adjust their business operating algorithms once a law is passed to find a way to shift funds, use new algorithms and so forth.  Just look at insurance companies, they probably do this better than anyone else as they invested a long time ago in IT infrastructures and let’s fact it, they have the data and system in place.  Congress unfortunately didn’t appear to recognize the importance of such tools that could help them. 

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

I do get tired and it’s also depressing covering the status of hospitals in the US today too.  It’s not a good picture and so many are running out of money, going bankrupt and again those are the places we go for care but not enough money around but billions around for social algorithms, so again where’s the balance?  Even when private equity purchases facilities, there’s some shaky financial arrangements there that take place and this is one example that happened in Massachusetts recently.  They were in financial straits and the only way the private equity firm would buy them was if they filed bankruptcy so creditors, doctors groups and so forth were left holding the bag.  There’s a lot of this type of activity going on all around the US today but again are we blind sided watching social algorithms?  This is the side of our society that is in danger today with not having enough financial backing for our immediate needs and it will get worse. 

Quincy Medical Center Files for Bankruptcy Protection And Will be Acquired by Steward Health System

It’s funny how the richest people in the US commit through the giving pledge to give away much of their fortunes but when tax increases are discussed, everything hits the wall, so again, the tech folks at the top giving away fortunes see this, otherwise they wouldn’t do it.  Funds to keep the health system going have to come either from one direction or another or both, donations or tax.  Again I do like all the new technologies and social networks but where’s the balance here?  There is value but someone along the line began a huge skew that keeps feeding itself. 

Until we see a return of the long term investors, accurate science, and again the interest in healthcare it appears that this long term roller coaster of imbalance will be with us for a while and the job market in essence with intangibles carrying the interest of all will not do much so look forward to more of the same in that area.  In the article below one other line kind of says it all too…the financial push is outreaching science and pretty scary.  BD 

“There is already “a mini-gold rush” of companies trying to market tests based on the new techniques, at a time when good science has not caught up with the financial push. “That’s the scariest part of all,” Dr. Ramsey said.

When Juliet Jacobs found out she had lung cancer, she was terrified, but realized that her hope lay in getting the best treatment medicine could offer. So she got a second opinion, then a third. In February of 2010, she ended up at Duke University, where she entered a research study whose promise seemed stunning.

Doctors would assess her tumor cells, looking for gene patterns that would determine which drugs would best attack her particular cancer. She would not waste precious time with ineffective drugs or trial-and-error treatment. The Duke program — considered a breakthrough at the time — was the first fruit of the new genomics, a way of letting a cancer cell’s own genes reveal the cancer’s weaknesses.

But the research at Duke turned out to be wrong. Its gene-based tests proved worthless, and the research behind them was discredited. Ms. Jacobs died a few months after treatment, and her husband and other patients’ relatives are suing Duke.

Dr. Scott Ramsey, director of cancer outcomes research at the Fred Hutchison Cancer Center in Seattle, says there is already “a mini-gold rush” of companies trying to market tests based on the new techniques, at a time when good science has not caught up with the financial push. “That’s the scariest part of all,” Dr. Ramsey said.

First, though, he asked two statisticians at M. D. Anderson, Keith Baggerly and Kevin Coombes, to check the work. Several other doctors approached them with the same request.

Dr. Baggerly and Dr. Coombes found errors almost immediately. Some seemed careless — moving a row or a column over by one in a giant spreadsheet — while others seemed inexplicable. The Duke team shrugged them off as “clerical errors.”

In the end, four gene signature papers were retracted. Duke shut down three trials using the results. Dr. Potti resigned from Duke. He declined to be interviewed for this article. His collaborator and mentor, Dr. Nevins, no longer directs one of Duke’s genomics centers.

How a New Hope in Cancer Fell Apart - NYTimes.com

Technorati Tags: Science,investments,algorithms,social networks,value,intangibles,drugs,devices,hospitals

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Lawsuit Filed Against Quest Diagnostics–Whistle Blower Case Alleging Medicare and Medicaid Over Charges of $1 Billion Or More

Andrew Baker was fired from a company that Quest purchased, Unilab, when he refused to participate in the scam and the case had been sealed since 2005 but recently re-opened.  I remember the acquisition here with Unilab as they were the big lab in southern California.  At the time I was developing my medical records program and it was a pain from the data side until the two different lab codes were finally combined.  It made it hard to run into the chart with 2 of them to work with.

You can read more about the case below but a similar case was just settled with the State of California and it all comes back around to contracted negotiated rates and discounts, nothing new there as this had gone on throughout healthcare all over the place.  BD

Quest Diagnostics Agrees to Settle California Medicaid Suit for $241 Million-Overcharging for Lab Tests

Press Release:

Whistleblowers Continue Fight Against Quest In Appeals Court & Call On U.S. Department of Justice To Intervene

New York, NY (July 5, 2011) -- As the nation’s leaders struggle to address steep health care costs, a Medicare scam is being orchestrated right under their noses and no one is doing anything to stop it, said former medical laboratory executives who have filed a lawsuit against Quest Diagnostics, Inc., accusing the company of overcharging the federal government by over $1 billion.

The individuals suing Quest called on the U.S. Department of Justice to intervene in their lawsuit, which alleges that the scam industry wide among medical labs is costing taxpayers as much as $15 billion in Medicare and Medicaid overcharges.

Since 1996, the federal government has paid more – sometimes as much as 400 to 500 percent more – than private insurers for some Medicare and Medicaid patients’ lab work conducted by Quest, the nation’s largest lab testing company based in Madison, NJ. The lawsuit claims that billions of dollars in lab fees have been siphoned into illegal kickbacks to private insurers, such as Aetna and Cigna, which are among Quest’s largest contract providers.

“Quest and other labs are ripping off taxpayers, yet the federal government has done nothing. Despite our lawsuit, the scam continues and will until the government makes them pay damages,” said Andrew Baker, one of three former executives of Unilab, purchased by Quest in 2003, who brought the lawsuit.

The details of the fraud can be found in Fair Laboratory Practices Associates vs. Quest Diagnostics, Inc., filed in 2005 under seal before the Southern District Court of New York. The federal court recently unsealed an amended complaint that charges Quest with violations of the Federal False Claims Act and the Federal Anti-Kickback Statute. It can be found here.

Baker wonders why the federal government has not joined his lawsuit, especially since just last month Quest settled a remarkably similar California state claim for $241 million in overcharges to the state’s Medicaid program.  In March 2009, California Attorney General Jerry Brown intervened in that case and a settlement soon followed, returning hundreds of millions of dollars to the state’s coffers.  Baker asserts billions are waiting to be returned to the federal government if the U.S. Department of Justice would join the FLPA case.

The California lawsuit alleged Quest overcharged the state by as much as 400 percent for blood, urine and other tests conducted on Medicaid patients. For example, Quest charged the State of California $8.59 for a complete blood test, but billed private insurers only $1.43.

The fraud is simple: Quest pressures private insurers to lean on doctors to send all their lab work to Quest, for patients insured privately and by Medicare and Medicaid. In return, the private insurers benefit from lower and, in many cases, below-cost, lab fees, effectively subsidized by higher fees for the Medicare and Medicaid patients. Insurers threaten to throw doctors out of  their networks if they  refuse to send their tests for Medicare and Medicaid patients to Quest.

While Baker’s lawsuit names only Quest, the FLPA plaintiffs believe the practice of overbilling Medicare and Medicaid has become widespread throughout the industry, resulting in overpayments of as much as $15 billion.  FLPA has appealed a lower court dismissal of their claims based on procedural grounds. The lower court did not rule on the merits of the case. 

The Quest scam could be the largest Medicare fraud committed by one company. In February 1999, the Office of Inspector General for the U.S. Department of Health and Human Services warned against the “pull-through” practice.

###

Technorati Tags: Quest Labs,Medicare,Medicaid,Whistel Blowers,labs,overcharges,fraud,lawsuit whistle blower,health insurance

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Meaningful Use Stage Two Delayed Until 2014 Committee Recommendations Upheld

I think this was the right way to go here being that many still need a lot of IT infrastructure updates and this will serve to give many more time to get through phase one.  With everyone moving as fast as they can and with the high levels of disruption we live with today there has also been some talk about shifting a few other areas of Health IT, such as noted below with ICD-10, and then let’s add on the ACO concept to save money with Medicare. 

There’s so much going on at once and it is challenging today and sometimes have a toll effect on the CIOs due to not only the government’s side of things, but also we have the every day emerging technologies with vendor solutions getting bigger too.  Of course the larger the organization, the tougher the job can be, depending on what technologies are already in place, what needs to be added, updated…and so on.  BD 

Should ICD-10 Implementation Be Delayed With A SnoMed Adoption Focus Come First?

WASHINGTON, DC – Farzad Mostashari, the national health IT coordinator, said that he agreed with the conclusions of the Health IT Policy Committee for delaying until 2014 the start of stage 2 of meaningful use, essentially signaling to the industry that federal policymakers will follow the advisory group’s recommendation.

He cited the committee’s reasoning that widespread deployment of the next set of electronic health record (EHR) functionality and updating systems in less than six months -- the time between the final rule that details the required measures and the start of stage 2 -- may be “infeasible, and therefore could have a detrimental effect on keeping providers on the meaningful use escalator.”

In its June report, CMS reported that 68,000 eligible physicians and hospitals have registered for the Medicare and Medicaid incentive programs and a total of $273 million have been issued in incentives.

Medicare EHR incentives have been paid to 560 physicians and hospitals. For the Medicaid program, 17 states are open for registration for the incentive program, and Medicaid incentives have been paid to 2,400 physicians and hospitals.

Mostashari backs Stage 2 delay to 2014 | Healthcare IT News

Technorati Tags: Meaningful use,ONC,HealthIT,medical records,incentives,EHR,physicians,hospitals,CMS

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Small Airplane Crashes Into Community Hospital In Northern California

The crash took place after hours and there will be a couple of doctors without offices tomorrow.  Luckily the offices were empty.  Two surgical technicians in surgery left the room and ran out with fire extinguishers to help put out the fire until the fire department arrived.  Thank goodness it was not the surgery areas that were hit.  The account from the one man who saw the faces of the two in the plane is eerie as both died in the accident. 

The hospital area itself was fine with the exception of smoke and the smell of the fire from the crash. One doctor who’s office was affected will be going in as soon as it is safe to secure her patients records.  The hospital is in close proximity of the airport.  BD

UPDATED 9:20 P.M. WATSONVILLE - A four-passenger airplane crashed into Watsonville Community Hospital about 7:30 p.m. Thursday, killing two people, according to Fire Chief Mark Bisbee.

Witness George Benson said he saw the plane take off. The pilot appeared to be trying to clear the fog line.

Benson, a Watsonville pilot, was in the industrial park adjacent to the Watsonville Municipal Airport. He said the single-engine light brown Mooney aircraft was a four-seater.

"He was heading toward the coast and tried to climb," Benson said. "From the time he took off he was going too steep, too slow.

Arnold, whose fiancee is in labor inside the hospital, said the plane came careening sideways across the parking lot about 15 feet above his head.

"I saw two faces and two big sets of eyes," Arnold said of the passengers inside the plane.  Surgical technician Rick Cervantes said he was in surgery and heard the crash. He and his partner ran out with two fire extinguishers and attempted to put out the flames before firefighters arrived.

Airplane nose dives into Watsonville Community Hospital, two people dead - MontereyHerald.com :

Technorati Tags: airplane,crash,hospital,Watsonville,California,surgery,offices,doctors

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Banner Medical Centers in Phoenix Offering Telehealth Monitoring in Intensive Care Unit–iCare System Option

The patient has a choice to be monitored by either a remote doctor while in intensive care or to choose doctors and nurses on premise.  In this example below, the doctor is in Israel and went to school here in the US, so he is familiar with American practices and medical centers and that is a help. 

Banner says the monitoring in the ICU has saved lives and reduces the time of stay in the hospital.  The doctor in Israel has a small office in Tel Aviv that has all of his remote monitoring equipment complete with t-1 high speed data lines.  With the time difference he is covering the night shift here in the states.  He also does some local hospital work so as not to lose his patient in person skills as well.  On an average shift he gets 15-20 calls from nurses and if course he can call a hospital nurse or doctor immediately. 

Banner has a command center set up that connects doctors and hospitals and covers about 450 beds. Doctors in southern California are also joining the system to monitor patients remotely so if you are an MD in California and want to look into this check out Banner Hospitals.  Critical-care specialists, also known as "intensivists," do the monitoring and they can cover more patients than could be done in person.  The iCare service has been around since 2006 so this is not brand new.  BD 

Taylor, 32 and a Phoenix resident, instead went to Banner Estrella Medical Center, where he was diagnosed with a potentially life-threatening diabetic reaction.

At the Phoenix hospital's intensive-care unit, Taylor was treated remotely by a doctor in Tel Aviv, Israel, via a two-way camera installed in the patient's room.

Health-care companies such as Banner have turned increasingly to remote doctors to monitor their patients because of a shortage of critical-care specialists.

Dr. Baruch Goldstein assessed Taylor, monitored his vital signs and regularly communicated with him and his nurses, who provided hands-on care. Taylor received insulin, potassium, magnesium and fluid to treat diabetic acidosis, a condition in which a lack of insulin caused his blood levels to rise. He was out of the hospital's intensive-care unit within 48 hours and returned home that Thursday.

Taylor was satisfied that Goldstein, located half a world away, checked him several times during the day and night, even navigating a scare when Taylor's heart rate slowed in reaction to multiple needle injections. Not only could the doctor see the patient, but the patient could see the doctor.

"This one was a little more instantaneous. I felt he (Goldstein) could respond faster, rather than having to waiting for a doctor to come to your room or call a nurse back."

Banner Health's system is among the nation's largest remote telemedicine systems used for critical care.

Over the past four years, Banner said that patients have spent 26,000 fewer days in critical care and nearly 100,000 fewer days in hospital rooms. Last year, Banner estimates that the remote system saved more than 600 lives by providing more attentive care from critical-care specialists.

Hospitals turn to telemedicine for remote care of patients - USATODAY.com

Technorati Tags: Banner Hospitals,telehealth,intensive care,hospital,technology,Israel,monitor,opt out,remote monitoring,patient,doctor

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City of Hartford First Major US City to Offer Medical Travel Benefits to Employees With Approximately 6% in Total Budget Savings

When you hire the former CEO of Cigna, perhaps this might be an area of expertise to get coverage and the tourism element started.  The destination here is Puerto Rico which is not totally out of the country being it is a US possession. 

Former Cigna CEO and Founder Joins Board of Directors With Medical Tourism Company–Accounting and Algorithmic Business Model Expertise Hired

Below is a video from their website where a man talks about his experience in going to the Apollo hospital in India for a resurfacing procedure.  I remember when Satori stated out with a video showing a ship and it’s posted around the Medical Quack back around 2008 as it was kind of a teaser/satire if I remember correctly.  You can also find this press release at the City of Hartford’s website. 

Satori World Medical

When you look at their map, Canada is in there too and they have wanted to get into the tourism business as well.

Ontario Hospitals Being Considered for Medical Tourism – If Space is Available

Back in 2009 I attended the World Medical Tourism Conference in Los Angeles and I was a bit of a sponge in soaking up all the information I could get and now just a couple years later I’m seeing some of the companies represented there growing and offering the services which many at the time were just proposals.  You can read the link below for more information as I chatted with companies from Israel, Germany, (the professor who codes, my favorite as we talked medical records too) Turkey, and quite a few from Mexico.  Germany was close to our costs but less and the costs at that time included airfare and travel so I guess they were less when you took out those 2 elements.  I learned a lot that day.  BD

World Medical Tourism Conference 2009 – A Learning Awareness

Press Release:

The City of Hartford selects Satori World Medical as Medical Travel Facilitator

SAN DIEGO/HARTFORD – June 30, 2011 –The City of Hartford, Connecticut has selected through a competitive bidding process Satori World Medical, a global healthcare network and medical travel company, as an additional network option for city employees.  This positions the City of Hartford as the first major city in the United States to offer this innovative medical travel benefit to their employees and dependents.

Satori World Medical will provide City of Hartford employees and their dependents with a full service medical travel program, also known as medical tourism or global healthcare, which can result in 40-80 percent cost savings per procedure. The program offers specialized procedures, such as orthopedic, cardiac, and other major surgeries that can be performed at one of Satori’s network hospitals in Puerto Rico.

“We employ a large Hispanic workforce and having access to some of the best doctors and hospitals in Puerto Rico through Satori’s Global Network may be a very attractive option for their medical care,” said Richard Pokorski, Benefits Administrator for the City of Hartford.  Mr. Pokorski goes on to say that the cost savings will be helpful to the City of Hartford as many municipalities are seeking ways to help balance a shrinking revenue base and higher operating costs. It is estimated that implementing Satori’s medical travel benefit may save the City of Hartford approximately 6% off their total annual medical spend.

“We are very excited to work with such an innovative city and offer access to our high quality, cost-effective network of hospitals,” said Steven Lash, President & CEO, Satori World Medical.  Mr. Lash continues to say “Due to the significant development of quality programs overseas and greater transparency on quality outcomes, coupled with the unrelenting increase in healthcare costs in the U.S. there is now more than ever, a need to provide access to low cost, high quality healthcare.”

Satori World Medical has done extensive due diligence on hospitals and physicians to find the best the world has to offer. Its network features hospitals that meet or exceed U.S. standards of care, are accredited, and monitored regularly by Satori on the quality of care delivered.

For more information on the City of Hartford, visit http://www.hartford.gov/

Satori World Medical provides access to its global network of board-certified doctors and worldwide centers of excellence through a high-quality integrated medical travel program, which is easily added to any health plan, reducing the costs of surgical procedures by an average of 40-80 percent when compared to the same procedures performed in a U.S. hospital. Its business model is specifically designed to deliver high-quality health care services, share the tremendous cost savings with plan sponsors and their employees and to coordinate all medical and travel services for individuals who need care. For more information about Satori World Medical, call +1 (619) 704-2000 or visit at http://www.satoriworldmedical.com.

Technorati Tags: Cigna,Medical Tourism,heatlhcare,Satori,Mexico,CEO,health insurance,algorithm,healthcare reform,James Buncher,board of directors

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Medicare Unveils Plan to Cut Doctor Pay 30% in 2012–Step One of the Annual Plight to Attempt To Solve the Sustainable Growth Formula–Digital Literacy/Tech Needed

This is the first part of the project that will begin rolling up in Congress more than likely as we get closer to the end of the year.  Each year CMS submits their plan by honoring the current SGR that is in place by law, this item that lawmakers have not been able to fix for the last 10 years and this does take an act of Congress.  Instead as you know we get bandaids and not a permanent fix, which has been a good thing instead of cutting doctor compensation with Medicare.  Again, this is the current law on the book that drives CMS to present their case every year and it will keep happening until something permanent is done. 

Dr. Don Berwick, head of CMS states below this cannot happen and has been a long time advocate for a permanent fix, as well as most of us as this comes down the deep drama at the end of the year when the pressure cooker is boiling and it has even exceeded it a couple of times, which is a real mess for billing and claims have to be resubmitted, back tracked for the money that was cut and then when the law goes into place for the extension, the balance of the claims get paid.  This is not an easy process let me tell you as the balance due payments get messed up in “data world” and it creates a lot of work when Congress is late and the time expires.  Smarter lawmaking would be bliss to say the least. 

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

So how far to the bell it goes this year remains to be seen on whether or not we get a permanent fix.  To do this though and see all elements Congress is going to need to get some high powered computing so a ton of unintended circumstances will be avoided if they create a permanent fix.  What will it take to grow from denial and realize the power of IT infrastructure and computer learning?  They just don’t get it so until we have “digital literates” representing us, the soap operas go on and we all suffer.  Here’s one very good example of a total waste of time and money on that subject.  This will do little, cost a lot of money and won’t help the consumer.  BD

Digital Illiteracy Is Killing Us With New Bill Wanting MD Medicare Compensation Put Online-No Clue on the Cost, Time and Truckloads of Errors to Audit and Correct

WASHINGTON -- The Centers for Medicare and Medicaid Services has issued its proposed changes to the 2012 Medicare Physician Fee Schedule, including a long anticipated -- and long-feared -- plan to cut Medicare pay to physicians by 30%.

The agency is required to issue the fee schedule based on current payment rules. Using the Sustainable Growth Rate (SGR) formula now in effect, physicians are scheduled for a nearly 30% decrease in reimbursement beginning in 2012. Although similar cuts have been averted almost every year by last-minute Congressional reprieve, CMS cannot assume such a reprieve will occur and must issue its proposed fee schedule as if the payment cut were going to go into effect.

Including the cut, total payments under the fee schedule, if adopted, would be $80 billion in calendar year 2012. That money would be used to reimburse nearly one million providers, including limited license practitioners such as podiatrists, as well as nurse practitioners and physical therapists, in addition to physicians.

CMS will accept comments on the proposed rule until Aug. 30, and plans to issue a final rule by Nov. 1.

Medical News: Medicare Unveils Plan to Cut Doctor Pay by 30% - in Public Health & Policy, Medicare from MedPage Today

Technorati Tags: Medicare,algorithms,media,lawsuit,CMS,Don Berwick,digital illiteracy,technology,SGR

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Study Shows Hospitals Run by Physicians in the US Outperform Those Run By Non Credentialed Managers by 25% Better Quality Care

The study encompasses 300 hospitals in the western US and is focused on performance in areas of cancer, heart surgery and a few other categories, but wait are we not trying to run physician owned hospitals out of business?   This is not a cost study but rather focuses on patient care which we like as patients by all means and might signify a better doctor/patient relationship too.

There’s a lot of anxious individuals waiting to hear more on this study I can bet as if our practice of using non clinical CEOs, which is basically what we have today is not getting the performance desired, then we have been going about this in all wrong ways.  The data being used for the study is from 2009, which is current enough and not ancient history with information relative to how hospitals function today.  The initial percentages numbers are nothing to sneeze at either with 25% being the average with what the study has gathered so far in the area of quality of care.  The information compiled includes both professional and personal backgrounds of both types of each leader.  I would also think the AMA would be all over this study as well.  BD 

The research, to be published in the elite journal Social Science and Medicine, is the first of its kind. Its conclusions run counter to a modern trend across the western world to put generally trained managers -- not those with a medical degree -- at the helm of hospitals. This trend has been questioned, particularly by the Darzi Report, which was commissioned by the U.K. National Health Service, but until now there has been no clear evidence.

Amanda Goodall PhD, the author of the study, and a senior researcher at the Institute for the Study of Labor (IZA) in Bonn, Germany, constructed a detailed database on 300 of the most prominent hospitals in the United States. She then traced the professional background and personal history of each leader. The research focused particularly on hospital performance in the fields of cancer, digestive disorders and heart surgery.

The study shows that hospital quality scores are approximately 25% higher in physician-run hospitals than in the average hospital.

Barry Silbaugh M.D., the CEO of American College of Physician Executives, commented: "We are watching Dr Goodall's research carefully because it seems to finally provide a real evidence-base for physician leadership. This is something we have long supported."

Best U.S. hospitals are run by physicians, study finds

Technorati Tags: study,hospitals,doctors,healthcare,physician owned hospitals,quality,cancer,heart surgery,patients

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US Warns of Potential Breast and Buttock Implants With Terrorists

Well this kind of gives a new meaning to whether or not implants are the way to go if one travels quite a bit as it could mean some additional red tape at the TSA inspection areas.  If a woman terrorist were the subject then it would be breast implants and if it is a male, then we have the buttock implants.  Granted there are not as many men with those and chances are they would be caught easier as it’s something out of the norm. 

One plastic surgeon said it could be done easy enough with today’s technology and then another physician said again this might make women think twice about implants and embrace the fact that small is great.  BD 

The U.S. government has warned domestic and international airlines that terrorists are considering surgically implanting explosives into humans.

This potential threat repeats a worry that emerged more than a year ago, when a British intelligence service described a possible terrorist plan to insert explosives in buttock implants for male bombers and in breast implants for female bombers.

The latest warning is not based on intelligence pointing to a specific plot, but the Associated Press said the U.S. shared its renewed concerns last week with executives at domestic and international carriers.

People traveling to the U.S. from overseas may experience additional screening at airports because of the threat, according to the Transportation Security Administration.

Dr. Christopher Zachary, chairman of the UCI Department of Dermatology, speculated that the reported al-Qaida scheme might change women’s attitudes to breast implants.

“Small is beautiful,” he said, quoting economist Ernst Friedrich Schumacher. “Perhaps this will put some rationality into those who desire the larger bust, for they might be subjected to extra screening in the airport security lines.”

http://inyourface.ocregister.com/2011/07/06/u-s-warns-of-breast-implant-bombs/31311/

Technorati Tags: implants,TSA,bombs,terrorists,intelligence,travel,explosives

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iPhone With Cheap Plastic Lens To Detect Cataract–MIT

The product is being created for the “developing” world which means we will have it here as sometimes in the US we are getting close to using such technologies.  This is not a treatment but a device that can diagnose.  Our phone is going to do just about everything soon.  BD 

iPhone Cataract

Here’s another way the iPhone is revolutionizing medicine — it’s now a cheap, portable tool for detecting cataracts, the leading cause of blindness worldwide.

Researchers at the Massachusetts Institute of Technology have developed Catra, a cheap plastic lens that clips onto the iPhone’s screen. Using a simple vision test, the Catra software creates a map of cloudy areas that may indicate the onset of cataracts.

MIT Researchers Use iPhone To Detect Cataracts | Cult of Mac

Technorati Tags: MIT,cataract,eye,iPhone,cell phone,smartphone,mobile devices,eye test,developing countries

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SoundBite Hearing System Receives FDA Clearance for Hearing Device That Attaches to Your Teeth

A couple years ago I remember when I first posted about the development of the product and it sounded a bit out there but here it is with FDA approval and the sound system will be going on sale this fall in the US. In March of this year the product received the CE Mark of Approval.  There is a piece you wear behind your ear as well and it is small so the part on the teeth communicates with the part behind the ear. 

SoundBite™ Hearing System Gets European CE Mark–Wireless Hearing Aid That Attaches to Your Teeth

In addition to the doctor, this also requires a visit to the dentist as the device is custom made to fit inside your mouth.  For reimbursement the website states that the device is a DME and they seek reimbursement directly from the patient’s insurance company.  The device is programmed via software with a regular PC with the device attached via a cable and settings are stored on the BTE microphone unit..  BD   

SAN MATEO, Calif., July 1, 2011 /PRNewswire/ -- Sonitus Medical, Inc., a medical device company that manufactures the world's first non-surgical and removable hearing device to transmit sound via the teeth, today announced that it has received an additional FDA clearance for its SoundBite Hearing System. The FDA 510(k) clearance for Conductive hearing loss is the second for the SoundBite prosthetic device and marks another significant milestone for the company.

"We are pleased that the uses of the SoundBite system continue to expand," said Amir Abolfathi, CEO of Sonitus Medical. "As we begin the roll out of our product in partnership with Otologists, ENTs, and Audiologists, we remain committed to increasing the number of patients who may benefit from our non-surgical treatment option."

Expanding upon the FDA clearance for the treatment of Single Sided Deafness attained by the company earlier this year, this second indication for use in treating patients with Conductive hearing loss further establishes SoundBite as a non-surgical and cost-effective alternative to bone anchored surgical implants. The SoundBite hearing system will be available starting early this fall through physicians and audiologists in a few select markets in the US (see where at www.soundbitehearing.com/find/), with expansion to additional markets nationwide over the following several months.

Sonitus Medical Receives Second FDA Clearance for SoundBite™ Hearing System -- SAN MATEO, Calif., July 1, 2011 /PRNewswire/ --

Technorati Tags: Sonitus,hearing aides,wireless,teeth,clinical trials,FDA,UHL,SSD,bone conduction,technology,healthcare,European CE mark

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Fitbit Profile Sexual Activity Shows Up In Google Search Results–Default Privacy Settings Allow Search Engines To Post

Ok this sounds a little Facebookish with the default set to place this on the web with having to “uncheck” the box to be private.  Now in addition, how many that are using Fitbit are tracking their sexual activity and does this account for exercise with calories burned?   Last year a guy hacked his Fitbit so he could have his information directly instead of going through the web interface.  Google Health, which is now going away does allow for the information to be input. 

Patients Want their Data–This Guy Hacked a Fitbit to Get it Along With The API Algorithms

Some folks feel different about the automation of collecting and made this comment below.  You can also sleep with a Fitbit on and maybe this is how some of the sexual activity snuck in here?  Also, we have the sales and marketing again with data so what are they selling and to who so thus the hack mentioned above. 

“Manual collection of information means the collector is focusing on the data (whenever collection occurs) and has the opportunity for short reflections, and can keep abreast of the data more easily. We have found that completely automating collection removes these opportunities and can actually hinder individuals in keeping track of and making sense of their data.”

This was a good find over at Tech Crunch and They said it was not Fitbit’s fault totally but I’ll disagree a bit there as we are talking some HIPAA guidelines so cheers to all of those burning their calories and you might want to check with your security settings and while you track exercise with Fitbit, do you really want to sleep with it?  To each their own.  BD 

Yikes. Users of fitness and calorie tracker Fitbit may need to be more careful when creating a profile on the site. The sexual activity of many of the users of the company’s tracker and online platform can be found in Google Search results, meaning that these users’ profiles are public and searchable. You can click here to access these results. The Next Web reported this earlier this morning.

When you create a profile, the default privacy setting allows profiles to be found in search results (Google, Bing, etc). If you don’t unclick this setting, it will obviously make your profile public for anyone to find.

Sexual Activity Tracked By Fitbit Shows Up In Google Search Results

Technorati Tags: Fitbit,PHR,Google Health,medical devices,devices that report data,applications,participatory sensing,algorithms,search engines

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