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California Hospital Association Sues HHS With Kathleen Sebelius Named To Block a 10% Cut With Medi-Cal Reimbursements

Governor Brown signed a new law that is retro-active to June 1st, and the federal government approved, so does this mean hospitals and doctors will have to pay back payments they have already received?  I don’t see where this is going to allow greater access at all as many doctors will not see Medi-Cal patients already and this will make it worse.  For Medi-Cal patients who are under an HMO umbrella it’s even worse for compensation rates.  image

The lawsuit also names Toby Douglas the department director in this area for HHS.  This gets stranger all the time as a law is passed and we have hospitals going broke or in the red all over the place.  What will be the future of Medi-Cal?  California is already at the bottom of the barrel when compared to what doctors and hospitals receive in other states from Medicaid.  When the Supreme Court rules on the Healthcare Law, which when it was created we had a different set of economic standards in place, they will need all the help they can get with compiling all the information they need, such as this lawsuit to be among one of the areas to be considered. 

Supreme Court Likely to Rule on Healthcare Law Early Next Year–This Gives The Justices Time to Rent Some Computing Space from the DOE As They Will Need It

With as complicated as things are today, I do wonder if there is really any judge that can truly get all the information together for an accurate ruling here.  BD

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

The trade group for California’s hospitals has sued state and federal officials to block a 10% cut in government reimbursements for healthcare providers who treat low-income patients.

The California Hospital Assn. said in its suit, filed in federal district court in Los Angeles, that cuts to the Medi-Cal insurance program will threaten the ability of many hospitals to continue operating skilled nursing facilities.

Patients, particularly those in rural communities and other medically underserved areas, will likely face delays or gaps in healthcare services, the lawsuit contends.

Other medical providers also have warned that cuts to the program, which is funded by state and federal governments, would deprive low-income patients of access to care. Among those targeted for the cuts are physicians, pharmacists and optometrists.

http://latimesblogs.latimes.com/money_co/2011/11/state-hospital-group-sues-over-cuts-to-medi-cal-program.html?utm_source=dlvr.it&utm_medium=twitter&dlvrit=71041

Wellness Programs Biting Consumers in the Butt As Many Parameters are Either Too Hard to Attain or Difficult to Understand, Thus Many Tune Out-Feel They Are Screwed Anyway With “Discrimination Done by the Algorithm”

Wellness started out to be a good thing, but here we have our old friend the Marketer just wreaking havoc with presentation with employees.  In addition, many wellness programs are owned by insurance companies.  We all know we live in the age of data and analytics and do the various division share data?  Here’s a couple past posts from the Quack in my archives I searched out.  image

UnitedHealth Buys Another Wellness Company – Biometric Monitoring For Data With Employer Contracts

Humana To Purchase Concentra Wellness In Texas Offering Coupons and An Entire Portfolio of Health Programs and Clinics

We don’t know for sure but heck we read tons of these announcements with various companies sharing data so only the algorithms know for sure what is being share and analyzed.  The last line here in this article says some companies limit short term disability for those employees with chronic conditions…yup you are screwed there as how many of us have what is called a “chronic condition” at least half of us as it doesn’t take much anymore with coding etc. to fall into that category.

The algorithms run, pick up that bit of data and bingo, you are limited.  It’s all about those algos running on servers 24/7 that make these decisions. 

Nobody seems to value the consumer time we have today and thinks that we have nothing better to do than learn tons and tons of new software systems but there are some that are working to make it easy to “dumb down” and get your information with games…insults my intelligence and glad I don’t have to “dumb down” in this fashion.

Health Insurer Humana Introduces a New Game Called FamScape–Making It Fun to Get And Maybe Mine Your Data?

Actually I made a post not too long ago about these insurers games…would you see Ben Bernanke “dumb down” to do this?  Of course not but the marketers want to suck you in and keep you bliss and oblivious.  Heck the developers writing this stuff just want to become millionaires and if you were to ask most of them they wouldn’t use their own software as it’s a job and they want to get rich:)  That’s the problem with all of this is that it is always “for those guys over there”…folks at the top can’t stoop to this level but “let’s see who we can market and drag in here":)

Insurer Software Games Continue to “Dumb Down” Consumers–Would You See Bernanke, the President, CEOs and Other Executives Playing an Online Insurance Game–No, Part of the Focus Of Occupy Wall Street Frustrations

Actually I borrowed the phrase “dumb down” from an executive at Homeland Security as he says too that’s what is going on. 

Not every employer is playing this game though, thank goodness but some are and interestingly enough, when it comes to the analytics used by employers wouldn’t you just know it’s another subsidiary of an insurance company there ready to sell them some additional software so we go back in a little different fashion here once again to the “Attack of the Killer Algorithms”. This is all about math and algorithms and the parameters your little body has to meet when stuffed constantly into data tables…my fanny hurts from being stuffed and bit so many times with all these algorithms and their parameters <grin>. 

In the meantime though we also have this “silly” situation with HHS running a Facebook contest…what the heck?  This is what you get today when you have figure heads without any Health IT hands on background, they don’t which end is up ether but can be controlled very easily by those who do and those who do code as they market our government executives and they think they are doing a good thing and later it will come back as chewing on their butts too.  Who sold this bill of goods to HHS?  Next thing we will have an act of Congress to determine what a disaster is…is a riot a disaster?  If so, I would not recommend a Facebook application there by all means, remember the UK?  <grin>. 

HHS Seems To Be Confused on Social Networks–Facebook for Disaster Support Contest, Give Me a Break Use Twitter Like Everyone Else Does

Somebody around the internet has to make this statement so I guess it’s me with looking at reality and trying to maintain some sanity with all the marketing and misuse of data today.  You have to give people REALISTIC goals and the digital illiterates that work with numbers all day are not capable of doing this, why?  It’s not for them, “it’s for those guys over there” and they never put themselves in someone else's shoes and just drive to make a million.  You can read more of this on my 4 posts about the “Attack of the Killer Algorithms” at the links below, see what you think, as these algos with parameters too high and the digital illiterates that think we can somehow have all the time to do all of this are out of their minds. 

We would love to work with incentives that are created by people and companies that are realistic and not just there to drive consumers nuts just for corporate profits…Occupy Wall Street initiative here and I sure wish some members of the press would educate themselves too and stop the articles about not knowing why they are there.  The series I wrote will answer a lot of questions below and shoot even some of the Occupy folks might want to read too as they may not get it all, but they do know things are not right and are following a lot of gut feelings and expressing their thoughts on “Discrimination by the Algorithms ”.  BD 

Also check out what Wendell Potter has to say too, he worked in the industry for years so if what I have said doesn’t make sense, read what he wrote today…


Killer Algorithms Part 1
Killer Algorithms: Part 2
Killer Algorithms  Part 3

Killer Algorithms Part 4


Maybe you’re not aiming to live to 150 like Chris Traeger, the health nut city manager played by Rob Lowe on NBC’s Parks & Recreation, but if your employer offers a wellness program at work there’s good reason to pay attention. In an attempt to get employees to sign up and live healthier, more employers are imposing financial penalties on employees who say “No thanks.” It’s just another thing to worry about during open enrollment season (usually November) when employees choose workplace benefits for the upcoming calendar year.

The use of wellness penalties by employers more than doubled from 2009 to 2011, rising from 8% to 19% of employers, and is expected to double again by 2012, when 38% of employers expect to have penalties in place, according to Towers Watson’s 2011/2012 Staying@Work Report. Why are employers socking it to employees? They’re desperate for ways to reduce health care costs, and they’ve found that financial incentives go only so far in motivating employees. “When it’s a penalty, it increases changes to people’s behavior,” Wolff says. “People hate to lose more than they like to gain.” (The report is based on a survey of 335 mid- to large-employers in the U.S. and Canada with a total of 7.8 million employees.)

Yet even with incentives participation rates are underwhelming, meaning employees are leaving cash on the table. Average participation in completing health risk assessments is 46% with incentives versus 19% without. Average participation in biometric screenings is 45% with incentives and 25% without. More lucrative incentives are often offered for signing up for disease management programs, but average participation rates are low at just 14% if no incentives are offered, rising to just 16% with incentives.

http://www.forbes.com/sites/ashleaebeling/2011/11/02/employers-ramp-up-wellness-penalties/

Attack of the Killer Algorithms-Occupy Wall Street Part 4 Health Insurance Style - One More App For Folks Who Are Tired of Flawed Algorithms That Require A Ton of Work and Research Time To Create “Perfect” Data Files for Insurers And Others Analytics Processes

I have been wanting to address this for a while and yet we have one more contest to entice consumers to use an application to improve their health.  What is really funny about these contests is that almost none of the folks who write them will ever use it themselves, in other words nobody will eat their own dog food here and developer want to make a few bucks.  We also have the other side with the naïve folks that think apps cure all evils and they don’t.

If we had consumers that were motivated and had information that was not flawed or skewed with marketing maybe this wouldn’t be so bad, but geez, nobody gets this.  When it comes time to create a simple personal health record, which I think is great, nothing wrong there as all to have life saving information and a simple history to help the doctors treating you.  The absolute basics are allergies and medications for starters and then additional information from there is great, like past surgeries, illnesses, etc.  That information is helpful all the way around.

Now here’s where all of this becomes work.  You have services that bring in your medical claims and make that information available and guess what, we have errors and the consumer today should not be responsible to do all the extensive leg work to fix all of this.  This is one big reason why consumers don’t want to mess with it at all.  When you have flawed data in claims going back 20 years or so and you have to fix it that’s a lot of work so insurers can have “perfect” history data files on you. 

The next step is their analytics and there’s some good that comes from some of it as it is not all bad, but when some of the new areas of predictive behavior comes in and you are scored and assessed with an algorithm that is only 60% correct and it is take down to an individual level, we have a problem. This is “flawed data discrimination and it’s happening all over.  We thought we were done with that years ago, right…wrong…same crap just done by the numbers today.  If you want to take numbers and crunch them to run reports, fine as we see those all the time, but again when refined down to a personal level with who knows what type of algorithm, we have problems. I can understand there has to be some filtering but today we have companies with business analytics that have it down to some very specific parameters of which some are needed but some are not needed. 

This is what is happening today and the reasons for the madness and frustration.  We don’t get the “whole truth” and are judged “on the curve” and when you are talking healthcare and money, “that curve is not good enough” for consumers or anyone; however “curves” lead to profit and that’s the issue. Here’s a good example of WellPoint giving you some new web algorithms so you can “fix yourself” and God forbid some of these mistakes get into the MIB as you may be screwed for life if they don’t fix it as all insurers take those records as gospel.  I know a couple of people who cannot get insurance as they can’t get their files corrected at the MIB and their doctors are dead who would normally help them so they are screwed. 

WellPoint Puts More Algorithms Online So You Can Go Fix Yourself and Understand What a Grandfather Is

Take someone looking for a job that doesn’t have their resume that is in the exact format to get through the “job application algorithms”.  If nobody adjusts it to make it through, they end up in the endless circle of resumes that go nowhere.  You still need a human in this process and an algorithm cannot do the entire process.  I’m sure some of the folks in the Occupy Wall Street group have been through this scenario.  A human never gets to see it and the applicant never gets to talk to a human.  You cannot believe all the reports you see today as marketing has come in to spin the numbers.  We are too trusting and still think that math will prove accuracy 100%, it does not.  This is called computer coding and one can write for “accurate” results or “desired” results and the 2 are not always the same. 

When you get your insurance claim denied, chances are the algorithm did it as it looks at data only, not a human and they run 24/7 on servers all the time.  This is a good place to put the trailer again for Sicko and look again.  The woman in the ambulance example was a great example of an algorithm that denied payment.  As she says when was she supposed to approve it…algorithm doesn’t know but data was lacking…algorithm says claim denied. 

Sick Trailer

There’s another part in the movie to where a woman’s money was rescinded on a claim already paid..why…algorithm says you forgot to include reporting a yeast infection you had several years ago! It’s the algorithms folks.  If their data is not flawed or contains errors, then how come this happens…automated mailings and somehow the envelope stuffer algo had a problem that day.  Things like this happen but if there’s information in your file you have to prove them wrong, even though you entered none of the data they are looking at. 

Rogue Algorithm Strikes Coventry Healthcare in Missouri-EOB Statements Sent to the Wrong Patients-Fried Data or Wrong SQL?

Let’s take a look outside of healthcare for a moment…how about this Quant on Wall Street who for 3 years used flawed software with clients…and knew it…and didn’t fix it…I figured he/she had to be somewhat flagrant for the SEC to make this catch. 

SEC Sues Quant–Undisclosed Error in Trading Algorithm- Miscalculating “Risk”-Healthcare Software Evaluates This Factor Too

Let’s come back around to the MIB who has been collecting information about us for years, before there were computers.  They used to do just that but with modern times and marketing, guess what, they sell too and now records contain more than just healthcare information.

The MIB – Health Insurance Bureau Business Intelligence Mining May Go Beyond Just Healthcare Information

Here’s a screenshot from one of their web pages and guess what the “problem applications” are…it’s us…we are problems in their eyes if we don’t match the exact parameters.  Does this not make you feel real good to know that when you apply for insurance or their services are used for any reason that just going in the door that “we are potential problems”.  It’s pretty disgusting but that’s how the analytics sales folks make their pitch. 

Now I like analytics and how smart it can make us too, but I can also see when they are abused.  Again we have people out there that think a set of algorithms can solve everything for decision making…not. 

Well now that you have been given your claim information with errors possibly, we have other folks now writing software to help you work with it. Are consumers jumping on the bandwagon to learn yet more software to fix errors and get into the confusing pricing of healthcare….nope.  Do I even have any interest myself in doing this…nope…and I deal with and learn a lot of software. Does this grab my attention…nope.  Well I guess I’m like every other consumer out there that says give me some value and this stuff isn’t doing it. 

Let’s go a little further, would you venture to see HHS Secretary Sibelius using such software…I would love to be wrong but I don’t think she would touch it at all as she is very busy like the rest of us and who has time!!  It’s always for “those guys over there” and the software developers just want to make a buck.  Doctors have had this battle longer than we have as consumers with flawed data and all the “rating” web sites and their flawed data.  I jus wrote another chapter on that flawed data today.  When I found my former MD who had been dead for 8 years still listed and taking new patients…Houston we have a problem. 

HealthGrades to Merge with CPM Marketing–Will Their Data and Questionable Algorithms Will Be Improved For Consumers?

Sometimes we struggle to get insurance and boy does it not make us mad to see wasted money with situations like the City of Buffalo who didn’t keep their algorithms going in the right direction and paid out $2 million on deal employees with insurance premiums.  But when it comes back to the consumer…nope you wrong as we have our data and we are right…just because it’s on the computer screen does not make it accurate. 

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

I’m going to pitch my favorite mathematician/professor again from NYU and if you have not heard this radio interview, do it.  He’s right with flawed data and marketing and once you listen up you may not be as gullible next time someone throws numbers and reports in your face, and oh by the way, read his book too if you can.

“Numbers Don’t Lie, But People Do”–Radio Interview from Charles Siefe–Journalists Take Note, He Addresses How Marketing And Bogus Statistics Are Sources of Problems That Mislead the Public & Government

So when it comes to Occupy Wall Street, how do those folks fight this battle?   How do we all fight it?  You can’t see those algorithms, you can’t touch them and most of the time you can’t talk to them so what do you do…it’s frustration at the highest level.  So this is the movement on their part, how do they address this?  They belong on Wall Street as Washington is too digitally illiterate to realize they need greater technologies to make laws and get their data sorted for them.  I have several posts around this blog about the Congressional lack of digital literacy.  Here’s one flaming example… as we just talked about all that flawed data we have in our health information going back years…these two folks think this should all be put out on the web and as taxpayers we should pay millions to have this done?   They think money grows on trees for IT infrastructure project.  Law enforcement should have access but this shows 2 really bad digitally illiterates with these 2 senators. 

Two More Senators Propose More Bills to Publish Medicare Claims Data Without A Hint of Digital Literacy Relative to Cost and Time

So what do you do when you have algorithms at one end and digital illiteracy at the other that can’t make laws!  You go sit on Wall Street where all the code was written that re-arranged the money in this country and the world.  I get a kick out of journalists that don’t get this and I guess there’s some more digital illiteracy or maybe putting the OMG ratings in front of good reporting so they can keep their jobs. 

There has to be some level of forgiveness with the parameters of how the algorithms run, otherwise we have ethics problems and they are everywhere you turn today.  At the Los Angeles CareNow Free Clinic, he summed it up well seeing a woman with advanced breast cancer who did not have insurance and perhaps it could have been caught earlier.  By the way he had to be there as a “consultant” as the California medical board could not get their “algorithms” together to allow doctors from out of state to volunteer. 

Dr. Oz Says “Enough is Enough” As He Volunteered at the CareNow Free Clinic In Los Angeles “Failure of Basic Morality in the US”

This system of algorithms for care is not working and the Occupy Wall Street folks are right on the money with the healthcare side of this and we all hate it.  We don’t care if insurers are making profits for shareholders and it’s almost time that President Obama pull a “Roosevelt” as in at the end of World War II to where Schering was so corrupt that the US government took over all their US assets.  It’s drastic but where else are we headed with all of this…can someone give me a better answer as we are constantly uncovering inconsistencies with mathematical formulas today and nobody is minding the shop? 

Back in August of 2009 I made a post about needing a US Department of Algorithms to ensure everybody’s math was correct and maybe that time has come.  I have sure had a lot of folks agree on that topic as with the complex sophisticated systems we have today, nobody knows when accuracy leaves off and marketing comes in to sell us a bill of goods. 

If you listen to the President of late, he says the the same thing “its in the math”, so how do the folks at the Occupy movement take a solid stand, other than the fact that as humans we all know something is not right and it’s time to ask questions and get answers on how the math moves all the money around to create the 99% and 1% groups we have today. 

If you want to give consumers something of value with healthcare, get those bar codes out there so we can find recalls with an app and either save a life or prevent illness when recalls occur and stop the insanity of trying to fix all of us with an app that we and the folks who also develop the app are not going to use.

Healthcare Bar Code Posts

Below is an article I wrote where a man died implanted with a device that was not pulled and used in surgery and it failed.  I call this a good app that will have consumer interests and is not one of “its for those guys over there” apps.  Stop with the insanity of apps that have little or no value and save some money.  Parts 1, 2 and 3 of the “Attack” are listed below.  We have folks that don’t listen to consumers when it comes to consumer IT.  If you start with something that has value for consumers other apps will follow and this is the ticket.  BD 

Micro-Cap FDA Recalls Never End

The Robert Wood Johnson Foundation (RWJF) has announced a $100,000 contest for a health IT application that will help consumers use published quality data to choose among physician groups and hospitals in 16 areas around the country.

These 16 communities--ranging in size from rural counties to metropolitan areas to whole states such as Maine, Minnesota, and Wisconsin--have all been involved in RWJF's Aligning Forces for Quality program since 2006. The 10-year, $300 million initiative focuses on improving the quality and reducing the cost of healthcare. An important facet of the program is the public reporting of data on the cost and quality of individual hospitals and medical practices (but not individual physicians)


Occupying Wall Street–It’s All About the “Attack of the Killer Algorithms”–The Unfair and Marketing Exploit of Ethics Using Math–This Could be a Subject for Michael Moore to Explore and Document In a Movie
“Killer Algorithms: Part 2” Disturbing News for Consumers With Credit Scoring Adding New Data Analytics–Some of the Same Methodologies Used by Insurers With Flawed/Potential Erroneous Data–One More Reason to Continue Occupying Wall Street

“Attack of the Killer Algorithms” Part 3–Vatican Doesn’t Like It Either–Occupy Wall Street Belongs in New York As They Don’t Do Code or Algorithms in Washington–Only Find time To Talk Abortions

http://www.informationweek.com/news/healthcare/patient/231902101?cid=InformationWeek-Twitter

Screaming Man Seen in Testicular Ultrasound Dicom Image

This is a wild image and yes you can see the face:)  I hope the man really was not screaming and that all was ok.  The image has been named “the face of testicular pain.  I can imagine this image jumping out as being unique when looking at a number of scans for sure.  BD  

image

http://www.theglobeandmail.com/news/national/doctors-see-screaming-man-in-testicular-ultrasound/article2222541/

United Healthcare Opens Retail “Employer Benefits” Store in Queens New York And Hires Former Minnesota US Assistant Attorney General As General Counsel

One thing I can say for sure with the daisy chain of subsidiaries the company has going today with assorted Health IT and other companies, no wonder they needed an expert in the legal area here. I thought with such a large mixture of different types of companies that they had to have some good anti trust attorneys on staff as this stuff gets very complicated today when you look at potential conflicts of interest and having sufficient competition in various business markets. 

You almost can’t find any entity of healthcare not providing a few pennies to United’s bottom line, even the VA with Picis who was doing business before the acquisition now contributes to the United bottom line.  That is just one example.  The General counsel announcement was made today at the website called “Main Justice”.  They have this big lawsuit against Tri-Care ongoing so I don’t know if this will be in the area of general counsel for him to handle.

Update: UnitedHealthcare Sues Department of Defense Over Tri-Care Contracts–They Said They Would Do This – Is This A Case Of My Algorithms Are Better Than Yours?

One example of diversity is the purchase of HMOs and IPA groups and we had one big acquisition in the OC from United a short while back.  Crying towels were out as all kind of suspect that this may mean lower compensation for MDs but time will tell as things move forward and I would guess this is about 20% of the HMO business in Orange County.  Don’t quote me but that is a guess only as Monarch is huge.

United Healthcare To Buy Huge Chunk of Orange County, California Managed Care Business with the Purchase of Monarch Healthcare–Subsidiary Watch

In addition with so many various entities owned under one conglomerate we now have one division that could cut compensation and then rush in with another division let’s say in the IT area to sell analytics solutions to help them keep what business they have.

Subsidiary Watch-Corporate Conglomerate Insurers Reduce Compensation Contracts Using One Subsidiary Then Market Same MDs With Another Subsidiary in Health IT

For some of those analytics entities they own patents too on the software and when we hear patents well we all think cost today. 

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

Pharmacists at Walgreens in some areas can benefit from pay for performance effort with signing consumers up to the YMCA and perhaps other programs under the partnership.  Perhaps will we be seeing more “retail” locations in other areas soon? 

UnitedHealth, YMCA Expand Diabetes Prevention Program with P4P for Walgreens

At any rate you can read the full details who knows maybe those “cheap” hearing aids will make their way into the stores along with branch locations for their bank for HSA accounts? 

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

In some areas if you sign up for one of the United insurance programs, you basically get a hearing aid for free, which is distributed through yet one of more of their subsidiaries with being a zero co-pay. 

UnitedHealthCare Throws in Free Hearing Aids for Those Who Enroll In AARP Medicare Advantage, HMO & POS Plans in Miami-Dade County From Their New Subsidiary

They are offering an online hearing test which may or may not be the best thing but it’s there. For United customers with Medicare Managed care and drug plans there will be no out of pocket expense and of course when taking a hearing test on line all that is documented and stored so the company can store it and use to tune the device. HiHealthInnovations is a newly formed subsidiary.

United HealthCare Gets In the Medical Device Business–Distributing Cheap Hearing Aides Sold Via Hi HealthInnovations Division –Subsidiary Watch

The hearing aids eventually are designated to show up at WalMart at some point in time to be purchased there as well.  I believe some of the action started here with buying China Gate which works to bring more Chinese drugs and medical devices to the US and world wide and already has a line of communication with the FDA. 

UnitedHealth subsidiary (Ingenix Subsidiary I3) Acquires ChinaGate – Working to Sell Chinese Products Globally

If you are not under their plan the device cost will have a co-pay of $649.  This is interesting as I imagewonder how this works with other insurers as well because every time one is sold outside of the United clients they make money.  They make money all the way around with being a supplier on who ever gets one, plus they have full control of their reimbursement. 

Here’s the division of United that was at AdvaMed this year looking to partner with companies needing to bring a drug or device to market so you can see in just the few short paragraphs here, theoretically  the company could handle everything from initiating a filing with the FDA all the way down to what the doctor gets reimbursed for prescribing…sound like some kind of price controls?  You be the judge. 

United Healthcare (Optum) Owns A Consulting Firm for FDA Drug and Device Approvals, Clinical Trials–CanReg - Subsidiary Watch

So in summary is this why the new General Counsel is there?  It’s just a question to ponder and wonder about with all the diversity happening here and competition with other companies too.  Perhaps soon they will have all of their products in retail stores to cover everything from buying a policy to getting a hearing aid before you walk out the door from the consumer side.  From the business side, how do or will other companies compete?  Will they be buying up small biotechs and device companies next as they already put the new subsidiary in place for hearing aids so what’s next?  BD 

NEW YORK--(EON: Enhanced Online News)--UnitedHealthcare today opened its first comprehensive health benefits store in the nation at 136-02 Roosevelt Ave. in Flushing.

With a focus on serving the Asian-American community, the new UnitedHealthcare Asian Plaza in Queens will provide residents with information and customer service on a variety of UnitedHealthcare benefits programs as well as health and wellness services and free public health education programs.

The 16,000-square-foot consumer-support center gives UnitedHealthcare employer-sponsored, Medicare, Medicaid and individual health plan participants access to customer service professionals who can answer questions in their native language about health care benefits, assist in resolving claims issues, and help with other health insurance-related matters.

Computers and iPads are available for visitors’ use to obtain and print health-related information, and a “health screening kiosk” measures blood pressure, pulse and body mass index (BMI) – all important indicators that help people better understand their health status. UnitedHealthcare also will host an ongoing series of education seminars, which are free to the public. Topics include nutrition and exercise, disease management and financial planning.

In 2009 UnitedHealthcare opened its Alhambra, Calif., storefront to serve as a trusted one-stop shop for culturally and linguistically appropriate health care information and services for Chinese-American Medicare beneficiaries in the community.  Most recently, the company opened a walk-in center for Long Island Medicaid members in Hempstead, N.Y., as well as a temporary pop-up store in Kingston, Tenn., to help eligible individuals select Medicare health care benefits during the annual enrollment period, which ends Dec. 7.

HealthGrades to Merge with CPM Marketing–Will Their Data and Questionable Algorithms Will Be Improved For Consumers?

If you are a regular reader here then you know I look for accuracy with data and gee sometimes you wonder, where is it?  With all data being connected today, it’s easy to blame shift and say “well I’m just using their data” which must be flawed.  That is all over healthcare today, like or not, it is what it is.  It’s not easy updating data and it takes time and costs money.  The latter is more than likely the true focus here on how often information is updated.  Back in May of this year the company said it identified it’s own flaws…more at the link below. 

HealthGrades 'Best Hospital' List Algorithm Needs Work Again - Flawed Data

If you want to dig back you can see where I originally found my former deceased doctor who had been dead for 8 years still listed on their site and the fact that she honored HealthNet.  I know they have fixed some of this since this was a hot topic with accuracy and I even had the AMA interview me about it.  How can that be, dead for 8 years and still listed?  Yup that goes back to updating information.  The New York Times had a similar business and they sold it and got out of it, again it’s a lot of work, time and money to provide real time consumer information that is accurate.  My original post came at a time when HealthGrades was being sold to a private equity firm and being taken off the market for trading so I’m sure I was not real popular with my post:)

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

HealthGrades is not the only one with flawed data as I found a few more, again all using the same sources of flawed data will result in more end user flawed data out there until someone along the line updates it.  You can read the comments at the link below as I had some great doctors look themselves and their medical groups up to see what was out there, we found dead doctors, some listed at hospitals where they had never set foot in and so on. 

Avvo Physician Rating Service Can’t Get Accurate Information Listed on Doctors - One OC Oncologist Sitting in Jail for Fraud

We have the Social Security Death Index which is a great tool and even it has some flaws with around 30k in there who are still living, but still is a good resource except for those folks who I’m sure would like to be out of there.

Social Security Master Death Index Data Flawed–Over 31,000 Living Found in the Index

We also have errors too made by governments, like the City of Buffalo that didn’t check their record and update them, so again paying out over $2 million in insurance premiums on “dead” employees too? It happened and the insurers may not have been too anxious to find this error either as this was just pure profit, dead people don’t file claims:)

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

Now let’s add a little more insanity here and get the Medicare Claim data that is flawed to the hilt with years of data input and really mess things up?  This is actually a case of digital illiteracy with law makers in not understanding all of this and you know just because it exists does not mean it maybe useful.  Some don’t get this and Dow Jones saw it as an opportunity for some company to take on this massive project to clean it up and make some big bucks on the government’s tab too, so what the heck?  You have to stop and ask the question, “is there value in doing this and secondly, would it be used properly or serve just to confuse and exploit more flawed data”.  Law enforcement needs it by all means and so does HHS to analyze, but to make a case to throw this out to the public is a bit stupid in my opinion. 

Two More Senators Propose More Bills to Publish Medicare Claims Data Without A Hint of Digital Literacy Relative to Cost and Time

Weill CPM dive into getting more accurate data out there with this endeavor?  I imageguess time will tell when we see the changes made.  I just hope this is not yet one more marketing area to “cloud” issues for consumers and doctors.  The answer too is not to have doctors take their valuable time to chase down what others put on the web to correct as well.  Consumers are now getting a taste of this too and we don’t like it and there will be more on a later post on that forefront. 

Actually take this from a higher source than me, NYU professor Siefe who is a mathematician and a journalists.  Numbers don’t lie but people do and he does a very good job in making you think when it comes around to all the stats and reports that are tossed in our faces every day.  One more popular post from the archives at the Quack below:)

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

When you use algorithmic formulas today, guess what, you can make the numbers lie if you want to.  I used to write code, good honest code but there are those who spin it out there too, so be aware as straight math is no long a 100% methodology that can be used anymore to prove accuracy.  Don’t feel bad, the government get sucked in too as we are sometimes just way to trusting as that’s how we have been wired for years, but times are a changing.  The link below has an audio of a radio show that will definitely cue you right in to think about asking questions when your inner sense tells you something is odd.  There’s also a stellar video about how algorithms are shaping our lives, again not to be missed.  

“Numbers Don’t Lie, But People Do”–Radio Interview from Charles Siefe–Journalists Take Note, He Addresses How Marketing And Bogus Statistics Are Sources of Problems That Mislead the Public & Government

So time will tell if we get better data and fewer skewed or marketing algorithms here for better consumer tools I guess.  If you don’t believe it today, ask is my word of advice and do some alternative research.  BD 

HealthGrades has signed a definitive agreement to merge with CPM Marketing Group, a Madison, Wis.-based provider of customer relationship-management services for hospitals.

"Hospitals are under increasing pressure to improve their clinical as well as financial performance," HealthGrades CEO Kerry Hicks said in a news release. "CPM is the relationship management platform hospitals trust to measurably improve the performance of their patient health management and physician alignment initiatives.”
The combined company will retain the HealthGrades name and headquarters in Denver. CPM's products and services will be merged into a business unit with an existing HealthGrades product, the spokeswoman said

http://www.modernhealthcare.com/article/20111102/NEWS/311029957?AllowView=VW8xUmo5Q21TcWJOb1gzb0tNN3RLZ0h0MWg5SVgra3NZRzROR3l0WWRMZmFWZjBERWxiNUtpQzMyWmFxNTM0WUpibW0=#

Meaningful Use EMRs Gilbert and Sullivan Style…”I am the Model User of an EMR That’s Meaningful…”

This is cute…but some real stuff in here to think about too.  We have an EMR model but do we have a doctor mixed in here too, I hope so:)

If you think electronic medical records are getting easier…ask your doctor. The medical records systems themselves are not that difficult but when you add the payables on, the US has a problem like no other country as we are the only ones who tie ICD coding to payments with revenue cycling.  Enjoy the video, nice music and well done.  BD 

Meaningful Use EMR

I am the model user of an EMR that's meaningful
My patient's information is computerized and digital
Each visit note and test result is easily retrievable
With speed and accuracy that is almost inconceivable!
imageIt's shared by every health provider who should need to see it all

And yet it's safely kept behind a well-protected firewall
If somebody should hack into it that would be a federal crime
And if I share my password it's for sure I'll do some prison time

The demographic information I collect may seem absurd
There's date of birth, race, gender, ethnic group and languages preferred.
In short, in matters medical, computerized and digital

I am the model user of an EMR that's meaningful. image
I reconcile each medication, noting every single pill
Except for controlled substances, I electronically refill

I check for interactions for each single drug I may prescribe
And allergies to medications that my patients may describe.
I take blood pressure, weight and height, and calculate their BMI

And check the box that says I told them if it is too low or high.
The system plots a growth chart I don't need to do it manually
I ask each patient's smoking status and update it annually.
I keep a current and updated patient diagnosis listimage
I send reminders to my patients to prevent appointments missed
I'm typing better than my Mom who once worked in a steno pool
I am a model user of an EMR that's meaningful.

At each encounter's end I print an after visit summary
I'm tracking 14 core objective measurements of quality
Plus 5 of 10 more menu set objectives chosen just for me
Will this improve the care I give or is it just frivolity? image
It does not matter, 'cause my data pretty soon will be online

And patients who can see it will be judging me in no short time
Deciding if I am a doctor who provides them decent care
Based only on the numbers that the CMS report puts there.
It's been 5 years since I have looked a patient straight into the eyesimage
Without my finger on the keys or else a laptop on my thighs
Though I have carpel tunnel syndrome, trigger thumb and shoulder pull,
I am a model user of an EMR that's meaningful.

http://www.youtube.com/watch?v=tIOxpaOtoMI

Patients in 2 Detroit Nursing Homes Found Infested with Maggots

This is just flat out disgusting and no excuses for these two patients as it seems it was laziness or perhaps staff neglect for whatever reason, busy, short of people, and so on.

Maggots just don’t appear over night either.  When you watch the videos, both places look very nice on the outside.  The reports were both done within the last year or so.  You can click on the images to watch the videos at the news site.  Sometimes maggots are used to help clean wounds but that was not the case here with either of these patients.  BD 

image

Here’s the other patient….

image

Both nursing homes stated they both now operating legally again and the state has now approved their current operating conditions again.  BD 

http://www.clickondetroit.com/video/29656397/index.html

Father’s Death from Inline Staph Infection Inspires Son To Innovate and Create A FDA Approved Medical Device Without a Need for A Sterile Field To Catheterize a Heart

This is quite the story both from the sad portion of his father surviving heart surgery imagebut then only to die from an inline staph infection.  You can watch the video on the Reavill system and see how it works.  When it comes to inspiration and saving someone else from the same fate as his father, you know we have passion here.

With Sepsis being the 10th leading cause of death, and inline infections being a potential cause of death, I hope the product gets a try by some community or other hospital system soon.   BD 

ReavillMED CV

His 59-year-old father survived heart surgery in 1994 only to die of an ensuing staph infection. The infection came from a central line catheter that was inserted into his dad’s heart through a large vein in his neck.

“He languished for 22 days,” Reavill said.

Central lines are used to administer medications and get diagnostic readings in patients. Now Reavill has invented a device that he says could have prevented his dad’s infection and thousands of others by stopping germs from entering the body during placement of a central line.

The invention, called the ReavillMED CV, won an international innovation award last month at the Health Pitch Battlefield competition sponsored by OmniCompete in London.

In announcing the winner, OmniCompete judges said, Reavill “developed a simple way to catheterize the heart without the need for creating a sterile field.”

Instead of manually feeding the catheter into a vein, his device has a syringe that pushes the catheter into the blood, he said. There, circulation floats it to the heart in about 30 seconds.

The irony is not lost on Reavill: He couldn’t pass his fluid dynamics class in college, but his innovation relies on fluid dynamics to deliver the catheter to the heart.

Reavill said his device is less prone to infection or complications and is easier to use.

Reavill secured FDA approval in December and hired a former colleague to help him market the new device. He sold portions of his company to stay solvent during the past few years and depleted his own savings.

A few hospitals are studying Reavill’s product. All he needs is one hospital to use it and others will follow, he said.

http://heraldnews.suntimes.com/news/8521465-418/dads-death-leads-to-medical-innovation.html

Man Tries to Remove His Pacemaker Himself - Ends Up Dead in the Process

This is not a good idea by all means and the way the article is written it’s hard to tell if it was the incision he made or if the pacemaker caused the pain in his chest and imagehis desire to try to remove it.  Another article I read said he may have had a history of mental issues so who knows at this point as to why he tried to remove it, but pacemaker removal is not a do it yourself chore.  It will be interesting to hear the autopsy on how his death occurred as he was alive and passed away in the ambulance ride.  BD 

A Chicago man has died after authorities say he cut his chest to try to remove his pacemaker.
The Cook County medical examiner says 47-year-old Channing Askew died Monday night at a Chicago hospital. The Chicago Tribune reports ( http://trib.in/sflxJM ) that a doctor told police that Askew apparently had tried to remove his pacemaker himself. Police say paramedics were called to a group home where Askew lived when he complained of chest pain.

Police say Askew complained to paramedics about chest pains. Askew fell unconscious in the ambulance. Paramedics trying to revive him removed Askew's shirt and found a puncture wound on the upper left side of his chest.

http://www.chicagotribune.com/news/chi-ap-il-selfpacemakerremo,0,972968.story

Exparel Post Surgery Non Opioid Injection Pain Drug Gets Approval From FDA

I can only think back to when I had my surgeries about how nice pain relief like this would have been instead of taking pills, as it could have reduced the amount I had toimage take for a few days afterwards as I felt they made me goofy and out of touch. 

Exparel is a liposome injection of bupivacaine indicated for single-dose infiltration into the surgical site to produce postsurgical analgesia.  Certainly there could be a need for oral pain pills but this seems to cut down the amount if I am reading this correctly.  BD 

PARSIPPANY, N.J. - Pacira Pharmaceuticals Inc. said Monday that the Food and Drug Administration approved its drug Exparel, which is intended to treat pain following surgery.

The company said it plans to start marketing the drug to hospitals in January, focusing at first on abdominal soft tissue surgeries. Exparel is a long-acting drug that is designed to treat pain for up to three days after surgery. It does not contain opioids. Pacira said it has hired 63 sales representatives, and they will ultimately market the drug for use after abdominal surgeries, plastic surgeries like breast augmentations and abdominoplasties, and balloon-pump replacements.

http://www.cnbc.com/id/45108809

A Virtual Nurse for Hospital Discharge–Elizabeth With a Very Familiar Xtranormal Type Voice…

This voice sounds very familiar…like those videos we see on the web that have some humor usually:) 

This is not humor (voice sounds like Xtranormal) here but instead of dealing with a human it looks like there’s a new automated choice on the horizon.  Click on the image for the link to watch. People actually liked this better than a human and I might go on to say is that part of the reason for this is that you can do it in your own time.  To have 2 humans available at the same time today to converse and handle information is getting to be more of a challenge every day.  BD 

image

Researchers at Northeastern University have developed a virtual nurse and exercise coach that are surprisingly likable and effective—even if they're not quite as affable as the medical hologram on Star Trek. In fact, patients who interacted with a virtual nurse named Elizabeth said they preferred the computer simulation to an actual doctor or nurse because they didn't feel rushed or talked down to.

A recent clinical trial of the technology found that Elizabeth also appears to have a beneficial effect on care. A month after discharge, people who interacted with the virtual nurse were more likely to know their diagnosis and to make a follow-up appointment with their primary-care doctor. The results of the study are currently under review for publication.

http://www.technologyreview.com/video/?vid=753&ref=rss

Liposuction Patients Donate Fat to Stem Cell Research at UCLA

This is a good idea, donate the fat for research, why not, as otherwise it’s just disposed of.  The fat is anonymous when donated, in other words there’s nothing that ties a donor to any type of recognition.  BD 

Dr. David Stoker is offering Los Angeles liposuction patients the opportunity to be a part of a ground-breaking research opportunity imagethrough the University of California, Los Angeles (UCLA). Women and men who have liposuction can choose to donate their excess fat to UCLA's stem cell research center, and help scientists develop a range of treatments for conditions such as diabetes and cancer.

"This is an excellent opportunity for women and men to reuse their fat to benefit medical research," notes Dr. Stoker. "Typically, when patients have liposuction, excess fat is disposed of as medical waste. Now, scientists from UCLA can use this fat to advance their stem cell research. After a patient has surgery, our services will anonymously donate the excess fat. Patients can benefit with the knowledge that they can both enhance their physical appearance and potentially help others lead healthy and active lives.

http://www.prweb.com/releases/2011/10/prweb8916203.htm

Dr. Oz Says “Enough is Enough” As He Volunteered at the CareNow Free Clinic In Los Angeles “Failure of Basic Morality in the US”

The CareNow Free Clinic got off to a rocky start but it looks like Dr. Oz had to be here as a consultant as California did not get the provisions implemented to allow doctors to travel over state lines to volunteer here.  The Medical Board messed up and had over a year to get this set up.  At any rate Dr. Oz was there and he wrote about his experiences with a couple of patients. 

“After more than 6,600 people overwhelmed volunteers at a free mobile health clinic in Los Angeles last year, California legislators passed a law making imageit easier for out-of-state medical personnel to assist with future events.
But just over a week before the massive clinic returns, the state has failed to adopt regulations needed for the additional volunteers to participate. As a result, only medical personnel licensed in California will be able to treat patients and some people could be turned away. It also means Mehmet Oz of "The Dr. Oz Show" won't be able to see patients at the clinic as planned, though he can serve as a consultant.”

Dr. Oz and the Uninsured Lose Again–Free Clinic Coming Next Week to Los Angeles–State Board Has Had Since September of 2010 To Implement Law To Allow Doctors To Cross State Borders to California to Volunteer-Failed

Dr. Oz concludes his comments making a couple good points, dignity and the chance to be healthy are vanishing in the US and it’s time to do something about it.  He also states his lack of confidence and disappointment in the politics and how it’s killing people like the woman he counseled with late stage breast cancer who had lost her job and had not been able to see a doctor for a couple of years.  What if this had been caught sooner? 

The insurance industry and the ability to cover and pay gets worse every day and I report it here on the Quack and do have to agree, time for single payor system as enough is enough.  BD 

The smell was unmistakable. I recognized it immediately – a fungating infection. It’s what happens when a cancer breaks through the skin and the puss oozes out and aerosolizes, producing an unsurprisingly foul odor. This is what late-stage cancer looks like if left unchecked, like many cancers were 100 years ago and still are today in the developing world. But I encountered this case this month, and Yvonne, the woman who sat crying before me, lives in Los Angeles. She lost her job two years ago, and when her insurance expired, she was too ashamed to seek help for a mass she felt in her right breast. Now the tumor had replaced her entire breast and blasted through the skin. Being cared for now — so late in her illness — was surely not what she would have wanted; and just as surely, it could have been avoided. How did we let this happen in America?

I was volunteering at the CareNow Free Clinic in the Los Angeles Sports Arena, where more than 700 doctors, nurses and health professionals had turned out to serve the local community. CareNow is a nonprofit founded to bring medical care to underserved communities, and the Los Angeles event was organized by Don Manelli, the indefatigable president of the group. He was aware of what we would see that day, as was I, having volunteered at similar clinics in Little Rock, Ark., and Moorsville, N.C. We also conducted our own clinic for The Dr. Oz Show in Houston in 2009 and saw more than 1,800 patients in one day. But simply having been down this road before does not mean you’re ever fully prepared for it.

It’s this tide of disease and despair that CareNow exists to fix. The group was informally established by a team of first responders who’d learned the art of swooping in to help after hurricanes, earthquakes, wildfires and tsunamis. In May 2009, they held the largest free clinic ever, also in Los Angeles, and a breathtaking 8,000 people showed up. After that, CareNow was formally founded, with the goal of providing care when there is no natural disaster. And on an otherwise unremarkable Friday afternoon in the fall, I was a small part of that effort, gently offering what encouragement I could to a weeping Yvonne.

But we’re not perfecting the law; we’re fighting over it. Politicians dither and people die. Lawyers argue the merits of this or that technical point, and more blameless Americans grow sick and slip away. This isn’t just a failure of politics and policy; it’s a failure of basic morality.

http://ideas.time.com/2011/10/31/enough-is-enough/