92648

Breath Test May One Day Identify TB and Other Lung Diseases As Strains of Bacteria Have Been Identified With Testing the Breath Exhaled With Lab Mice

This is still work in progress but it can take the diagnosis time imagedown to a few minutes from taking a few days.  So far this has only been done with mice and the next move is to bring this testing to humans.   The great news is that scientists have been able to identify the footprints.  Other scientists have work going in this direction too with cancer and diabetes with a breath test.  This would beat having dogs diagnose, which is as close as we have come so far:)  Volatile organic compounds is what is analyzed in exhaled breath.  BD


Successfully identifying the chemical fingerprints of specific bacteria in the breath could lead to a breathalyser capable of detecting lung diseases such as tuberculosis.

A team from the University of Vermont was able to successfully identify strains of bacteria in the lungs of mice by analysing volatile organic compounds in exhaled breath.

"Traditional methods employed to diagnose bacterial infections of the lung require the collection of a sample that is then used to grow bacteria. The isolated colony of bacteria is then biochemically tested to classify it and to see how resistant it is to antibiotics," said co-author on the study Jane Hill, a microbiologist at the University of Vermont. "This whole process can take days for some of the common bacteria and even weeks for the causative agent for tuberculosis. Breath analysis would reduce the time-to-diagnosis to just minutes."

http://www.wired.co.uk/news/archive/2013-01/11/tuberculosis-breath-test

Uceris, Treatment for Ulcerative Colitis Approved by the FDA

This is a new option for treatment and is a once a day single pill dose.  The drug has less toxicity that other treatments according to one physician and may offer fewer side effects versus using a steroid type treatment.  The drug is to treat mild to moderate ulcerative colitis in adults.  BD

From the website:
UCERIS is an investigational product that is a corticosteroid in a novel oral tablet formulation that uses proprietary imageMMX® colonic delivery technology designed to result in the controlled release and distribution of budesonide throughout the length of the colon. A New Drug Application for UCERIS (budesonide) tablets 9 mg for the induction of remission of mild-to-moderate active ulcerative colitis is under review by the U.S. Food and Drug Administration with a target action date in January 2013. Ulcerative colitis is a form of inflammatory bowel disease that produces ulcerations along the lining of the colon and rectum.



The US Food and Drug Administration (FDA) has approved budesonide extended release tablets (Uceris, Santarus) for the treatment of active mild to moderate ulcerative colitis in adult patients, the manufacturer announced January 16.

The therapy contains the corticosteroid budesonide in an oral formulation that employs the proprietary MMX multimatrix system colonic delivery technology. The approved dosing regimen for the drug, which was developed in collaboration with Cosmo Technologies Limited, is a single 9-mg tablet taken once daily in the morning for up to 8 weeks.



http://www.medscape.com/viewarticle/777917

FDA Approves Botox to Treat Over Active Bladder Where Drugs Have Not Helped or Patients Lack Tolerance for Other Treatments

This appears to be a clearance for addition use as backimage in 2011 the FDA gave approval for use for patients with neurologic conditions.  Treatments can be repeated and at least 12 weeks in between injections is the recommendation.


Allergan Gets FDA Approval for Using Botox To Treat Overactive Bladders


Botox with it’s freezing effect is getting more approval for different uses as it has been approved to treat cervical dystonia and for muscle spams in the wrist and finger areas of the hands.  BD



The U.S. Food and Drug Administration today expanded the approved use of Botox (onabotulinumtoxinA) to treat adults with overactive bladder who cannot use or do not adequately respond to a class of medications known as anticholinergics.

Overactive bladder is a condition in which the bladder squeezes too often or squeezes without warning.

Symptoms include leaking urine (urinary incontinence), feeling the sudden and urgent need to urinate, and frequent urination. image

When Botox is injected into the bladder muscle, it causes the bladder to relax, increasing the bladder’s storage capacity and reducing episodes of urinary incontinence.  Injecting the bladder with Botox is performed using cystoscopy, a procedure that allows a doctor to visualize the interior of the bladder while Botox is being injected.

http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm336101.htm

Foundation Medicine, Makers of Genetic Cancer Tests Gets Unsolicited Email And Then Investment From Bill Gates

Foundation received an unsolicited email from Bill Gates a few months ago and the CEO wasted no time with responding.  It’s a test that allows the ability to see the footprint of the disease.  Over 700 oncologists have used the report.  Foundation provides the information that works for the doctors.  It is a molecular drug company and this helps doctors select the right therapy for each cancer patient. 

Personalized medicine will become the rule and not the exception and it evolves around sequencing and up until this test came along the information came from a test or a series of tests.  In additionimage the FoundationOne test includes genes that the oncologist might already be testing for.  After listening to the video and reading a bit on the website it makes sense as to why Bill Gates searched this one out as the company at the time was really not looking for investors actively.   Bill Gates also paid for one of the tests for a friend who was being treated with chemotherapy to see if a new profile would show up and there was enough in the profile to suggest some alternative treatments, so he was sold.  BD

From the website:

“FoundationOne™ is the first pan-cancer, fully informative genomic profile designed to help you identify potential treatment options for your patients based on a comprehensive assessment of the molecular changes driving the growth of their tumor. FoundationOne is optimized to fit current medical practice. It uses next-generation sequencing to interrogate hundreds of cancer related genes from routine tumor samples. Test results are provided in a simple report that aligns detected mutations with potentially relevant treatment options and clinical trials. Click here to download a technical guide, including the list of genes included in the comprehensive assay.”





So it was a particularly good day for Michael Pellini, CEO of Foundation Medicine Inc., when an unsolicited query from Bill Gates popped up in his inbox last September.

The co-founder of Microsoft Corp. MSFT 0.00% and global-health philanthropist had heard about Foundation's new cancer diagnostic test and wanted more information about the company. The email didn't mention any interest in investing in Foundation, and Dr. Pellini wasn't actually looking for money—the company was poised to announce it had closed on a new round of financing. But Dr. Pellini wasted no time in responding.

The two met for about 45 minutes the following week in Pebble Beach, Calif. The discussion led ultimately to this month's announcement from Cambridge, Mass.-based Foundation that Mr. Gates was among three investors who put up a total of $13.5 million, expanding the full amount the company raised in a Series B financing round to $56 million

Foundation's test analyzes tissue biopsies for alterations in some 280 genes that are suspected of driving growth and proliferation of tumors.  At the end of the conversation, Dr. Pellini recalls, Mr. Gates "leaned back in his chair and said, 'I get this. People will want it.'

http://online.wsj.com/article/SB10001424127887323783704578248033467052500.html

FDA Approves NuPathe Skin Patch to Treat Migraines

It’s not cheap if it is going to be around $59 as the article states that it would be priced around a competitive product that is given by injection. BD 

Below is a little information from the website:   

ZECUITY is not for people with risk factors for heart disease unless a heart exam is done and shows no problem. imageYou have a higher risk for heart disease if you:
 have high blood pressure
 have high cholesterol levels
 smoke
 are overweight
 have diabetes
 have a family history of heart disease
 are a female who has gone through menopause
 are a male over age 40

ZECUITY is not for people with risk factors for heart disease unless a heart exam is done and shows no problem. You have a higher risk for heart disease if you:
 have high blood pressure
 have high cholesterol levels
 smoke
 are overweight
 have diabetes
 have a family history of heart disease
 are a female who has gone through menopause
 are a male over age 40




NuPathe Inc. (PATH), a maker of neurological and psychiatricimage medicines, won U.S. approval to sell the first skin patch to treat migraines.

The Food and Drug Administration cleared the treatment, called Zecuity, which delivers sumatriptan, the most-prescribed migraine headache medication, through a mild electrical current, Conshohocken, Pennsylvania-based NuPathe said yesterday in a statement.

Anido declined to say how much the patch would cost, though he indicated it would be comparable to the $95 that a similar medication costs as an injection.

http://www.bloomberg.com/news/2013-01-17/nupathe-wins-u-s-fda-approval-for-migraine-skin-patch.html

Costco Becomes a Pharmacy Benefit Manager

What a surprise with Costco and the goal here is to increase foot traffic in the stores and to cater to the businesses located near the Costco stores.  Along with Costco there are independent pharmacies that will work with them with honoring the prices and this could be a benefit for the independent pharmacies too with additional customers as the big chains have taken over a lot of patients due to insurance contracts.  BD  

Independent Pharmacies Not Able to Compete with Big Chains and Fear Going Out of Business–They Don’t Have Same High Levels of Data To Sell to Profit- Attack of the Killer Algorithms Chapter 23


image


The new program offers prescription medicines through Costco's in-warehouse pharmacies or through a network ofimage 64,000 independent pharmacies that have agreed to pre-negotiated prices, according to an article in Costco's membership newsletter, the Costco Connection

The plan will save participants 10-15 percent over other prescription drug plans, according to the newsletter. Nippon Paper Industries USA, a 200-employee company based in Port Angeles, Wash., is among the companies that have signed up.

Costco is "leveraging [its] existing footprint to enter a new market and provide a more comprehensive suite of pharmacy benefits to small and medium-size businesses," said Ross Muken, senior managing director at ISI Group LLC.

Mr. Muken said Costco is looking at employers that are located close to Costco warehouses and is providing a benefit that the members would save money on pharmaceuticals by using the Costco stores.

The benefit for Costco is foot traffic.

If you can contract with employers, the hope is their employees would become Costco members.

http://online.wsj.com/article/SB10001424127887323968304578247982570309620.html

Does the US Government Need a Department of Modeling and Algorithms–Is Data Addiction and Abuse the Next Up and Coming 12 Step Program, Some Classic Posts & Topics Revisited

These are a couple of posts I made 2 and 3 years ago and I’ll be darned if both of them might have a little value today with complexities and everyone looking for the “magical” algorithms as a one shot solution.  I don’t call myself a predictor at all but like to go back and see if any speculation I did comes around. 

Sure algorithms are great and create a lot of neat things in science and otherwise but when you get down to the day to day grind of wanting a one stop solution especially with analytics and business use, it’s just not there.  We hear CEOs putting out press releases and other media that “we can save a trillion dollars” in healthcare which is simply not true.  We can save money but it sounds like someone has meddled in some extreme non linear analytics that has not been verified.  As Charlie Siefe says on models, the average consumer reaction and thoughts are something like this “it has a square root in it, I have read about it several times this week so it must be good”.  CEOs do that too.

Here’s the original post from around 3 years ago when the Madoff case broke and shoot even he was smart enough to hire IT folks to create his “fake” front which later was exposed by his former IT folks.  Harry Markopoulos went nuts over this and for good reason as there’s a lot of smart people but we don’t listen to them. 

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

A Case of “Dirty” Algorithms – 2 Madoff Computer Administrators are Indicted – Illegal Coding and Networking for Big Profits

 

I’ll bring this one up again about the PLOS One study with people fearing math and feeling pain.  Of course I am using a little satire here, but gee based on just my own experience with talking to people, watch them run for the hills when discussing even something very simple.  A few years ago when I was doing some software work for a hospital I had a CEO client that would do that when I walked in with my tablet.  “Oh my gosh she’s in here with that thing again”…you could see the look and now look where we are, everybody does it:)  You can see it’s very easy to get Algo Duped today as this stuff gets very complex.  Algo Duping 101 with a series of videos can be seen here or just watch the 5 videos on the left hand side of this blog.  Let’s start shoving every member of Congress in an MRI and see if this fear exists with the folks we elected:)

“Algo Duping” – PLOS One Journal Publication Explains Why The Fear of Math Plays a Big Role As One Underlying Reason We All Get Duped And Those Who Don’t Fear Math Take All the Money, Gradually, Using “Mathematical Formulas & Algorithms”



Fact is nobody is around checking any math and coding here as there aren’t that many that can or they are around and people don’t use them or want to pay for it.  Just run the code if it makes money.  Last week with Ticketmaster and the inauguration ball, perfect example.  They sold the tickets by mistake ahead of their advertised time of when they were to go on sale.  Did they do anything to make it right..nope.  Those who went to the website early got tickets and their faithful clients who waited for the day of the initial sale were screwed.  Lot of companies doing business this way today and consumers get screwed as they don’t want to go back and mess with their data…hmmm…a place for a Department of Algorithms here? 

Presidential Inaugural Ball–Ticketmaster Algorithms Blow It–Tickets on Sale Before Announced Sales Date– Any Companies, Markets, Etc. Know What They Are Doing Anymore With Models and Algorithms? Attack of the Killer Algorithms Chapter 51


Actually we need a balance between intangibles and tangibles to create jobs here in the US so more of the technology can be used in manufacturing and not just flat out mining and selling data for billions in profits.  That’s why companies don’t expand as it’s much easier to take the easy way out to mine or take data they have in house and sell it.  Wall Street totally exaggerated the value of algorithms like with Facebook and those algorithms bit back with the IPO opening day with Nasdaq and the dollars are still not settled. 

“Devaluate the Algorithm” And “Tax the Data Sellers”–A Cure for Both Healthcare and an Economy Based Heavily on Intangibles–We’ve Lost Our Balance

I’m beginning to feel like I said something that has some value here with accuracy and holding modelers and programmers accountable:)  Here’s a sample post on the complex algorithm at the link below used by Medicare for hospital compensation and even they can’t work with it in house and are fixing the computational algorithms:)

The Complicated Algorithms Used by Medicare to Establish Hospital Compensation

Moving on a bit I do a lot of reading every day and see this software, that app and this website all have the ultimate answers to what ever ails you it seems.  Having written software before I have a bit up on someone who had not and there too are much better programmers out there than me too, but so much I see is repetitive and some has just little or no use and developers if it is a consumer product that  don’t even use their own stuff.  I read not too long ago from a developer that said the same thing I just said here, use your own software if it is a consumer product:) I see data bases related that don’t even belong together, time to make algorithmic bucks is what it is. 



I don’t care if people want to crunch numbers with different data bases as you can do that SQL work all day long; however if it doesn't have value and is created to make a buck only, then stuff it and stop writing code to just make a buck.  FICO is one huge example of this and even the layman can see it with using credit score and other non credible data queried with it to sell analytics services to pharma and insurance companies.  I say it’s a far stretch here as if they buy it and query with gosh knows what, you end up with real junk that hurts consumers that the average employee is told to look at the screen and use the data presented to them for their decision making.  If you have not seen the far stretch of what FICO is doing for a buck, read it by all means.  They are really out there on this one and should be admonished and their code should be checked and sources revealed by all means.  A place for that Department of Algorithms….what are they doing to to now with potentially mixing this with revenue cycle business?

FICO Buys CR Software And Gains Access to Revenue Cycle Software Business in Healthcare



FICO Analytics Press Release Marketing Credit Scoring Algorithms to Predict Medication Adherence–Update (Opinion)

So what we have here is analytics used out of context and watch out as this insane analytics to make a buck hurts all of us.  I did a beg detailed post on that as well, again nobody checking any math, models or logic, just the company selling algorithms….Department of Algorithms…the information on the website is set up to “dupe” you  with thinking there’s value here, not.  So even if the model has a square root in it, no value, this is one of those with FICO.  There’s a great video at the link below with big companies on a panel discussing “value” and how to find it.

Big Data/Analytics If Used Out of Context and Without True Values Stand To Be A Huge Discriminatory Practice Against Consumers–More Honest Data Scientists Needed to Formulate Accuracy/Value To Keep Algo Duping For Profit Out of the Game

This is a good podcast radio show and listen to it on how people lie but numbers do not and then watch his video on the left hand side of this blog and what I say here will begin to make more sense. 



“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

Sure we have Big Data and machine learning in the future but again it’s the value of this work that needs to be shown as well as accuracy in computation and not code for just making a buck so be careful when you read some of what is out there today and be aware of Algo Duping for cash.  Here’s a video from Cathy O’neil who worked as a Quant on Wall Street for a Hedge Fund and this was done by PBS Frontline.  She’s far advanced over my background for sure but she explains the same things I have been talking about with fantasy formulas and how models and and algorithms are used against you.

Watch The FRONTLINE Interview: Cathy O'Neil on PBS. See more from FRONTLINE.



Now for a little fun…with all this going on and being promoted for value whether it is there or not, how are we going to deal with some of this…are people addicted?  Sure they are in more ways than one. Good scientific and other good business intelligence algorithms will continue because it makes us smarter but we will have this function of trying to determine what’s a dupe and what’s real…so here’s the next 12 step program for those that think an algorithm is a cure all without the human touch and for those that create the nonsense that clutters the good stuff:)  I made this post back in August of 2010 so ahead of my time maybe?  You tell me. 

Data Addiction and Abuse –The Up and Coming Next 12 Step Program Is On the Horizon–Side Effects Include Lack Of Data Quality, Integrity And Spasmodic Algorithms

We end up with something along this line…and those spasmodic algorithms are causing everyone a bit grief with lack of integrity. 

“In God we trust; all others must bring data”

Nobody has done squat to help engage the consumer so far as they are so wrapped up in analytics, the patient is still left out in the cold and heck we don’t even see any leaders using any technology themselves.  So with these two old posts…was I on track here?  imageIt’s not that I’m so smart it’s just that people who work in the technology field get there before you do as a consumer so sometime we know a thing or two.  Should we work on getting an agency started who can help verify accuracy of some of the stuff tossed our way today and should we begin looking for those that are developing a crippling addiction to cure one algorithm with another?  Again these were topics from 2009 and 2010…and they still seem to have some merit for conversation you think?  BD 

Everybody Wants to be Health Insurance Exchange, Wal-Mart Considering the Idea for Small Companies And Oracle Can Sell You a Software Exchange Platform

Oh boy is the exchange field for health insuranceimage starting to get a little crowded here and now one more potential exchange participant.  We already have quite a few websites that are not exchanges but aggregated information on buying health insurance.  Now Wal-Mart says they are considering it too.  If Wal-Mart wants to do this they can hop on over to Oracle and get the software platform too which is also aligned for states using it as well.  As mentioned though the tax benefits would not be there as they are with using a government exchange should Wal-Mart decide to venture in. 
 

Oracle Announces Insurance Exchange Platform - Purchasing Health Insurance Platform–Available for State Governments



Also back at the end of 2011, WellPoint bought a private health insurance exchange company with their venture capital division.  The Bloom exchange they purchased is primarily focused on  employer provided insurance. 

WellPoint & Partners Buy Bloom Private Health Insurance Exchange From Their Own Venture Capital Company (Sandbox) –Subsidiary Watch


The government exchanges now can have a user’s fee too that can be passed on back to the consumer which was added back in December of 2012.  Also below Blue Cross in California is opting all doctors in unless they send a registered letter asking to be removed and their compensation will be around 30% less than if it was a standard policy bought elsewhere. 

Insurance Exchanges Now to Have a User Fee for Insurers to Pay But It Gets Charged Back to the Consumer


It seems like we are turning hospitals and doctors into technology centers that carry medical licenses! 

Blue Cross in California Automatically Opts Doctors In for Insurance Exchange Participation And Reimbursement Looks To Be Around 30% Less Than They Receive Now For Individual Policies - Employer Provided Insurance Is Not Affected

Just today United said they are going to pick and choose carefully where they participate to make sure it turns a buck and they might also be looking for ways to create some analytics out of their participation too as they are famous for sending  out a lot of reports and self created white papers, you see them all the time. 

United Healthcare States They Will Pick and Choose Health Insurance Exchanges Where They Participate, As They Algorithmically Model Where Profitability Will Exist and Allow for the Creation of Additional Analytics

 

How many exchanges will be there by the end of this year?  Who knows and where will consumers feel most comfortable shopping, who knows.  Granted some are for employer provided policies and there have been other companies smaller than Wal-Mart that have set up their own exchanges.  California just received $674 million for the state exchange and $250 of it will go for marketing…geez…would they have to spend this much if the exchange competition was not so fierce?   Also, families earning up to 93k could get what is called “premium subsidies”.  Don’t ask me what that is as it’s probably not written in stone yet:) 

 

Here’s an exchange, there’s an exchange:)  BD



Now Walmart has even bigger things in mind, according to the Orlando Business Journal. The company is considering a scheme to create a health insurance exchange, in which smaller companies could comparison-shop for employee health benefits, Walmart's vice president of health and wellness, Marcus Osborne, told the newspaper:

The idea is to offer those products through a health insurance exchange -- or as Osborne said, simply a marketplace -- that would leverage Wal-Mart’s buying and marketing power to make the exchanges widely available and used. "It would allow small employers to piggyback Wal-Mart," Osborne said. "We haven’t got it all figured out, but it’s one of the things we’re looking at."

A Walmart health insurance exchange for small companies would compete with those set up under President Barack Obama's health care reform law, at least for companies with fewer than 100 workers. The health care law will establish government-run health insurance exchanges in each state for individuals and small employers. (One thing the Obamacare exchanges offer that Walmart can't is tax credits, which are available to some of the smallest businesses.)

New HIPAA Omnibus Rules Certainly Encourage the Use of a Personal Health Record for Patients With Getting Copies of Their Medical Records

I read through a few of the comments here that relate to PHRs and I have been covering the technology since it began.  When you read about the “email” portions of this it’s a slam dunk as to why you really don’t want to rely on standard email systemsimage to do that for you.  It states that once, you as a consumer are advised of the “risk” with using non encrypted technologies to transport information, the monkey is on your back.  There’s 563 pages of the law.  Rules go into effect on March 26th and there's 180 to become compliant. 

The good thing here is a broader coverage for “associates” and when I think of some of those the old Accretive situation comes to mind where a representative was showing a Wall Street investor actual medical records and “their” recommendations for treatment…a big no no which became front page news when they had to report a total of 6 notebooks being stolen.  This is not the way to approach “revenue cycling audits”.  I attended at the end of last year a convention where I asked the million dollar question of how do hospitals work and govern 3rd party entities and it is something everyone works on as you never know when crossing the line to make a buck will happen but we are seeing a lot of that of late in many areas.  If you want more background on this thought process, watch the 5 videos on this blog to your left and see how money takes over.

Accretive Health Debt Collector Employee Has Laptop Stolen With Non Encrypted Patient Data from 2 Hospitals And Had Access to All the Data Via Revenue Cycling - Patient Information Was Shared With Wall Street Investors – Algorithms For Profit Again?

What is also interesting here of late too is that the US CIO, who’s background is with Microsoft is scheduled to testify on January 22nd before the House Oversight and Government Reform Committee on technology and IT systems and how they are purchased and used throughout government.  The digital illiterates at the House won’t get most of this but someone has to make the case for the expense and yes IT services not only in government but everywhere are expensive. 

At least he’s got a better handle on it than Chopra did telling everyone coding could make them rich.  I would even wonder how many members of this House Committee even use a PHR and much less know what one is, as they go back to the dated paradigm of “its for those guys over there”.  You see it in the news every night.

It states that associates and providers are not responsible for educating the consumer about appropriate ways to transmit via encryption so the best thing here is to be an informed patient and be up on it and get yourself a PHR to store your data.  Besides mail servers have issues too, I remember those and just ask anyone who has had to take care of “Exchange’:) 

You can always reference the government page here on HIPAA and keep up to date with the news and find answers to questions.  Anyway as I see it, rather than having long conversations about what is an approved method for patients to get copies of their medical records, get yourself a PHR and be done with it and have a system you know and can rely on.  The full press release can be read here. 

There are a couple other revisions, especially in the areas of security breaches that are of interest to hospitals and the 3rd parties who seem of late to be most of the breaches happening today with HIPAA compliance being almost non existent with the breaches we have read about in the news.

 



One other area of the new rules also substantiates my campaign for licensing and excise data sellers and that has to do with using information for marketing and fundraising…well…how it the heck do we know who’s using our information…answer:  License them and require a federal disclosure page and again get that excise tax in there as companies, banks, and so on make BILLIONS in profits here. 

“The final omnibus rule sets new limits on how information is used and disclosed for marketing and fundraising purposes and prohibits the sale of an individuals’ health information without their permission.”

How do we know who’s using our information for marketing until one of them reaches us…they ignore HIPAA and the dollar takes over. How many HIPAA fines have we had?  That answers the question right there, so don’t depend on the mostly invisible HIPAA police to come to your rescue.  So we have half the job here and without away to enforce it will fail in this area as money seems to be winning all the time.  It’s actually too bad that a more complete comprehensive model was not created here but band aids are better than nothing. 

When we one day get some Hybrid executives in office that understand this perhaps it will get better and they are hard to find but until such time we are stuck with attorneys who like to keep the money rolling in and thus they want to make sure they get paid for every tiny incremental change that is made. 

Excise Taxing the Data Sellers–Nobody’s Supporting the US IT Infrastructure, Especially In Times of Disaster-Companies Have Probably Made Money Off Selling Scraped Data of Those Hurt in the Wake of “Sandy”

And we could have this too…


One More Good Reason to Tax the Data Sellers– Create Additional Funding for the NIH and FDA From Sources That Otherwise Are Too Greedy to Share & Contribute


Anyway, back to PHRs, now that you as a patient can request your records electronically, get one set up, so you can now have one place where you can have access to all your information you collect in one spot.  With a PHR you are set to handle almost any HIPAA compliance method to be used by a hospital, provider and other entities.  If they are not up to the20th century, get a PHR compliant fax number and get your records that way too.  Most importantly they can’t make you as a patient go out and get a new thumb drive (grin) but will have to get into long conversations about alternative methods if you don’t have a PHR.  BD



If a patient wants their data to be placed on an external media drive, like a thumb drive, providers are not mandated to accept the device if their organization has conducted a HIPAA risk analysis and found external drives to be a risk. However, if they reject a patient's thumb drive, they can't require the patient to purchase one the covered entity provides. Instead, they have to find an alternative distribution method, such as email.

The OCR did not define EHRs, but clarified that patients do have access to electronic copies of their health information wherever the data is housed.

Covered entities are not liable for unauthorized access toimage unencrypted emails if patients want to receive their data that way. OCR said in the rule: "We do not expect covered entities to educate individuals about encryption technology and information security. If individuals are notified of the risks, and still prefer unencrypted email, the individual has the right to receive protected health information in that way, and covered entities are not responsible for unauthorized access of protected health information while in transmission to the individual based on the individual's request [or once it's delivered]."

http://searchhealthit.techtarget.com/news/2240176312/Ten-more-grains-of-wisdom-from-the-final-HIPAA-omnibus-rule

Bio Hacking Where Amateurs Get to Tinker, Take Classes and Learn “DIYbio” Labs TED Video

imageGenspace lab in Brooklyn (non profit) was created so novices and beginners could tinker, take classes and she humorously talks about the press and their coverage and she said worked through it, as they thought the lab was going to produce the next Frankenstein, in other words hype it up.   There are more facilities like this opening all over and each have their own flavors on what they work on.  She says there are points to where the amateurs and professionals need to meet as they have access to pathogens.  They follow all laws and regulations and don’t work with pathogens. 

Ellen is algo a part of the Human Genome project and she describes here participation and he feelings on DNA and she says the study and knowledge outdoes the risk. She gives some good examples of projects, like one who was trying to figure out which dog was pooping in their yard.  DNA bar coding is a technology she discusses about how it’s use leads to all types of information.  She says the secret of the labs are that your are not under the pressure to sell your project to make a lot of money or save mankind, but rather just follow safety guidelines.  We have personal computing so why not personal biotech?  BD 






We have personal computing, why not personal biotech? That’s the question biologist Ellen Jorgensen and her colleagues asked themselves before opening Genspace, a nonprofit DIYbio lab in Brooklyn devoted to citizen science, where amateurs can go and tinker with biotechnology. Far from being a sinister Frankenstein's lab (as some imagined it), Genspace offers a long list of fun, creative and practical uses for DIYbio.

http://www.ted.com/talks/ellen_jorgensen_biohacking_you_can_do_it_too.html?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+TEDTalks_video+%28TEDTalks+Main+%28SD%29+-+Site%29

United Healthcare States They Will Pick and Choose Health Insurance Exchanges Where They Participate, As They Algorithmically Model Where Profitability Will Exist and Allow for the Creation of Additional Analytics

It’s all about money and this pretty much says it all.  When you look and compare health insurance companies there’s not one as big as United with the “huge” daily chain of subsidiaries that keeps growing at a pretty rapid speed.  Most consumers don’t see the entire package here on how health insurance companies operate and make their money, they only look and think about insurance policies, which of course is the first item to look at, but when you dig beyond the first area of business you will find a lot more. 

The CEO states they will participate only in exchanges that are “fair” and the company far outreaches every other insurer out there with the use of analytics and has for years.  You can go back to the AMA lawsuit to where United short paid hospitals and doctors for 15 years and I believe the checks are either or on the way back to doctors or it is soon to happen.  They made money both ways here as they also licensed the analytics data base to other major insurers so you had Blue Cross, Health Net, Cigna and more jump on the same bandwagon and they short paid as well using the United numbers.  This fact in itself makes it very difficult to fully trust some of the reports and studies they create as the CEO had said many times “the shareholders will prosper” and how many of them I wonder are insured by United?  It’s just a question that rambles around in my head and for this reason alone you do have to keep your eyes open as everything analytically may be as it seems.

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

Ingenix Data Base Has Some Long Reaching Legal Tentacles with Aetna, Blue Cross, Blue Shield, Humana


If you don’t understand how health insurance works these days, read up on the web and listen to the quarterly reports and that will give you an idea of all the various entities owned and acquired by the insurers, and again United far ahead of any of the rest of them with a huge focus on analytics and all kinds of other companies.  You can use the words “subsidiary watch” on this blog and find an army of them with all carriers.  You now find United with “retail” stores popping up in the US too.  One executive from the company made a comment recently about what buying insurance can’t be more like a bank with tellers, and United has a bank come to think of it with over a billion on deposit from health savings accounts that allows them to make loans and conduct other types of financial investments with the money.  I posted this back in 2010 and the money on deposit could have grown since then.

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


I don’t know how analysts can theoretically compare United to other insurers if you look at the entire corporation as a whole as they are far more complex and own more entities than the rest.  When you read the latest reports about their profits slipping 1%, let’s not forget the outlay of money spent to buy the biggest managed care companies in Brazil for one example.  The company is making more money “managing” care these days and again this comes back to extreme use of analytics and algorithms modeled for profit. 

United Healthcare Negotiated to Buy 90 Percent of the Largest Managed Care Provider in Brazil, Where Insurers Can Own Hospitals and Physician’s Practices

They also get patents for a lot of their developed technologies and this leaves the door open to of course sell such to many to include other insurers for one.  Next time you take one of their surveys, remember it’s patented and probably available for other companies to license.
 

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

United is busy in the medical records business too…..

They are also in the electronic medical records business with selling CareTracker, which is their own EHR developed years ago as well as owning a couple other subsidiaries that produce electronic medical records for sale to doctors, so the company is very much in the EHR business as well.  CareTracker can connect to their “clearinghouse” company which used to be a division of Ingenix which now falls under the Optum name.  Ingenix and their consulting services have been around for a long time and a big part of their business is selling data for profit.  In addition to CareTracker there’s also Optum Insight, a non-web based EHR system.  Here’s a few examples below on their electronic medical records and HIE businesses. 

Ingenix (Subsidiary of United Health Group) Marketing Care Tracker EHR To Community Health Centers–Subsidiary Watch

Axolotl (A Subsidiary of Ingenix) Creates Reporting and Analytics Solution for Health Information Exchanges–Algorithms for HIE–Business Intelligence -Subsidiary Watch

ClickFreeMD Selling Software EHR, Practice Management Bundled Records Solution–Emphasis on AMA Endorsement And Software “Powered” by Ingenix–Tethered or Untethered

Occasionally they do sell some assets such as this one below which was in the clinical trial business and created their Life Sciences division. 

 

Ingenix (Subsidiary of United Health Group) Sells i3 Clinical Trials And Creates Life Sciences Group-Subsidiary Watch

There’s also the company China Gate they bought a couple of years ago that works to promote Chinese drugs and devices in the US and worldwide. 

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


Also on that note they have yet another consulting company that also consults with drug and device companies here in the US to get them introduced to the FDA and consult on the entire process and you see them regularly at conventions. 

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

For a while it seemed liked almost everything the AMA was offering with electronic records and other software services all began with Ingenix (now Optum) as their initial partner.  I’ve been doing this blog for over 4 years now and posted a lot of those entries.  Then in February of 2012 the AMA sold their Amagine Project to AT&T.  This group continues to market and sell Optum PM and Physician EMR as well as a couple other medical record services.  You just wonder how the data and software trails go, or at least I do on who actually wrote and creates some of the software we see out there so when making a purchase I know who’s making money.  You might be getting marketed and sold a United Healthcare product and not even know it.

AMA Selling Online Physician Portal to AT&T–The Amagine Project, There’s Money in Selling And Aggregating Those Algorithms



Also in the area of medical records United with their Optumsight division is working with Epic Medical records and they went out and created a whole new company that is a clearinghouse (algorithms and analytics) to integrate there being that Epic is installed in so many large hospital systems, not to want to miss a part of the pie here. 

OptumInsight (A Wholly Owned Subsidiary of United HealthCare Optum Division) Creates Medical Clearinghouse Integrated With Epic Practice Management Software-Subsidiary Watch

The company does seem to have an inside advantage that other insurers do not have with the hiring of Steve Larson from HHS who was accredited with writing most of the healthcare law and now he sits over at Optum as vice president..so many in key positions as such have left HHS and we are just lucky someone convinced Todd Parks to go to work there when he did as healthcare is so much about analytics and business intelligence today to where even the medical records systems push payer representation first instead of user interfaces for doctors.  The company also has various incentives in place all throughout healthcare like this one with Walgreens to where pharmacists can make a little pocket change in some areas of the US.  United also has their own internal pharmacy benefit manager too so no battles there like other insurers have with drugs and prescriptions as when you own the place, you direct it. 

UnitedHealthCare To Use Data Mining Algorithms On Claim Data To Look For Those At “Risk” of Developing Diabetes – Walgreens and the YMCA Benefit With Pay for Performance Dollars to Promote and Supply The Tools

Selling data again is also right up there in areas of profit for the company with Ingenix, now Optum with prescription profiling.  You might guess where some of this comes from if you own the pharmacy benefit manager and work with various drug stores across the US as data selling is a huge profitable business today making billions in profits for all kinds of companies and I keep using the Walgreen example of 2010 where they made short of $800 million selling data only. 


 

Also noted on the quarterly report was the revenue anticipated from the new Tri-Care contract which took a few years to settle and United was determined to get one of them through a process of appeals and when that didn’t happen they sued the Department of Defense to get the last unit, the west coast and the current contractor owned by Blue Cross will be going out of business as the loss was not sustainable and United is buying up or contracting with some of the data processing companies that subsidiary owned.

Tri-West Won’t Challenge Tri-Care Military Contract Loss To United Health - Legal Decisions & Contract Awards Allow Machines To Move Money for Profit As Company Will Likely Close Down-Subsidiary Watch

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?

United HealthCare Awards Contract to One Blue Cross/Blue Shield Subsidiary to Process Tri-Care Claims While The Other BlueCross BlueShield Company Lost the Over All Tri-Care Bid To United In the West

Anesthesia management in the hospitals, they are represented here as well with yet another subsidiary.

Ingenix (Subsidiary of UnitedHealthGroup) Buys Picis Hospital Software Analytics Company – Algorithms of Healthcare Continue To Grow

VA Awards Contract to Picis, Subsidiary of Ingenix for Anesthesia Record Keeping Software


The company has also purchased some very large physicians groups in the US and a couple right here in the OC where I live and crying towels were out on this one.

United Healthcare Acquisition of Monarch Healthcare HMO Already Causing Confusion and Access Problems for Blue Shield Patients in Orange County

Now you would have to be living under a rock today not to at least think about the data resources of all of this the the potential they have to run all kinds of analytics and reports and create them for profit, but again remember the company is traded on the open market.  A while back I also pondered this question with the loss or gain of business with one entity and with the use of some analytics, does this tend to outpace what other insurers can do with having the ability to run metrics across all kinds of subsidiaries to look for both sales and profit availabilities?  In other words if business is lost from  one subsidiary is it then absorbed by another and where?  I think that’s a good question to ask. 

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

Recently in the news the Mayo Clinic and United are working together on a data project out of yet another new United subsidiary, Optum Labs to run data comparisons with both clinical and claim data.  The two have worked together before with United having contracts with Mayo for patients covered by employer provided insurance being able to use their facilities, which began back in 2010.  This venture will be crunching data to compare outcomes with money spent.  Researchers will get some benefits here in determining how various treatments work on patients, but Mayo the size they are probably have that going for them already.  Mayo doesn’t have any ownership in the Optum Labs division so there’s one big hint there with how the information will be formulated and used. 

Everyone is looking for those magic formulas that digital illiterate CEOs boast that trillions will be saved, and they don’t get it:)  Sure there are savings but it’s not the illustrious dollars they think as technology moves forward, what you save today will be spent on new technologies and drugs tomorrow.  Sure people may get a little smarter in identifiable areas for treatment, that’s a given but there’s not this big post of gold to be saved.  I have to laugh at reading this over and over in the media.  It’s not the great white hope and will improve efficiencies and help United fine tune their profitability with some of this information too. 

So coming back around it looks like United running the government here to a degree with picking and choosing their exchanges.  It’s too bad that so many of our government entities like HHS, FTC and a few others can’t get their heads around how this game is played with data as it is not always applicable for decision making when numbers are only crunched.  It was kind of embarrassing when HHS accused doctors of “cheating” with billing and even pulled in the Attorney General on the accusation too, with nothing brought to the table and it was a lack of digital mechanical literacy that prompts such “panic” statements.  This was embarrassing and it was more than just me on this blog who said so, the tech folks that see right through it just shake their heads and wonder what the heck is wrong with HHS on this one.  Myself I had to sit back and remember this is the same agency that saw value with a Facebook contest and believes magical algorithms will totally solve hospital re-admissions:)

HHS and DOJ Send Letters to Hospital Trade Associations Warning of Gaming Billing System Via Use of Electronic Medical Records–Hospitals Just Learned How to Bill Better & Hired Consultants–Case of Being Algo Duped With Numbers?


Also it was poor show with HHS taking on Dr. Hamburg at FDA on a drug decision and looked like pulling rank from what I read in the news.  Government has not quite figured out how algorithmically United has their sites on Medicare as they said “we have a good idea on how to handle this and know what’s going on”….

United HealthCare Issues Another Study, This One Telling Government To Aggressively Manage Medical Care For Seniors-An Area Where A Large Chunk of Their Revenue Comes From Today, Managing Care

With this idea of what’s going on, they seemed surprised that the AAFP found they were paying doctors less than Medicare…so do they know what’s going on..probably more than we would guess because they are looking at doctors’ pay as a way of saving money so do they care that doctors in some areas of the US with their contracts get paid less than Medicare and this somewhat fuels the fire that they want to get a bigger slice in some Medicare business as the company is making more money managing care these days than with policies.  Of course you need a policy first to manage that person’s care. 

 

UnitedHealthCare Looks at Doctor’s Pay for Savings, Nothing New There Been Doing It for Years But Keep In Mind We Have the Annual Medicare Cut Fix on the Floor Again with Congress–Timing?

The AAFP Confronts United Healthcare On Reimbursements, Some Are Below Medicare Rates In Parts of the US–Payment Algorithms/Formulas Calculated Deep Within IT Infrastructures Do the Job


What I see out of this venture are some new analytics coming out for sale from United in time with “more data” as that’s what they live for.  It will also stand to fill the pipelines with their studies they put out all the time.  Last time I took exception to the tone they use too on some of them with subliminal messages telling consumers in so many words that their ill health is at the root of the US Economy when it is not, Wall Street and banks did it and you can’t put the squeeze on consumers for this.  There are positive ways to encourage better lifestyles rather than blame shifting and running some of the propaganda they do. 

The media eats it up as it create a sense of panic and let’s face it anywhere you strike a bone people start with the “drama queen” antics and it creates an illustrious sense of distraction from what’s really going on in the business world and corporate structure love it to see all distracted so they go about what and how they want to do their business that way with nobody asking questions.  The CEO said it himself a while back:) 

  “Stephen Hemsley, the CEO of UnitedHealth, is not intimidated. "Leading companies take advantage of disruptive change in the marketplace," he told reporters recently. "Our shareholders will prosper."

This being said, it would not surprise me to see United offering their expertise on the design of exchanges, perhaps?  I guess we shall read the news and see if that happens in the near future as they clearly made the point they are only going to participate where it makes money and if the government can’t design it that way I wouldn’t see them at a loss to offer assistance.  They would only stand to get stronger with analytics and closer to getting a share of some Medicare business eventually, it’s the way the models and algorithms work.  I do hope our government executives smarten up as right now I feel at such a loss from what I read in the news.  Who’s running the healthcare system with the data…and insurer or the government?  BD



The leader of the nation's largest health insurer warned Thursday not to assume widespread participation from his company in part of health care overhaul's coverage expansion that unfolds later this year.

UnitedHealth Group Inc. CEO Stephen Hemsley told analysts the insurer's involvement in online exchanges that are expected to help millions buy coverage will depend on whether it's financially viable for the company.

"We will only participate in exchanges that we assess to be fair, commercially sustainable and provide a reasonable return on the capital they will require," he said.

http://finance.yahoo.com/news/insurers-may-prove-choosy-overhaul-213021372.html

“Things Go Better With Coke” Except for Obesity, New Advertising Campaign Coming Soon

Well will we still see Santa Claus who has a few extra pounds at imageChristmas drinking a Coke:)  That’s the first thing that popped into my head and this will be interesting to see how the commercials address obesity.  Myself I don’t think I could drink a regular coke anymore as “diet” has been on my agenda for so many years.  According to the article the commercials are going to show healthy ways to work off the calories you drink which is around 140.  For 140 calories I want something to eat and not really drink

I even watch some of the “healthy” beverages for calories too and don’t over indulge there either if am a little heavy on calorie consumption for the day and stick with my water until I get to start all over the next day.    The article says soft drink sales are decreasing but you couldn’t tell it from the grocery and drug stores I shop in.  Maybe one of these days all soft drinks may be diet where there is no sugary choice.  BD



NEW YORK (AP) - Coca-Cola became one of the world's most powerful brands by equating its soft drinks with happiness. Now it's taking to the airwaves for the first time to address a growing cloud over the industry: obesity.

The Atlanta-based company on Monday will begin airing a two-minute spot during the highest-rated shows on CNN, Fox News and MSNBC in hopes of flexing its marketing muscle in the debate over sodas and their impact on public health. The ad lays out Coca-Cola's record of providing drinks with fewer calories and notes that weight gain is the result of consuming too many calories of any kind - not just soda.

http://www.myfoxdc.com/story/20579357/coca-cola-to-address-obesity-for-first-time-in-ads#ixzz2I0VcFXPe

Are Robots Hurting Job Growth–60 Minutes Report, Robotics in Healthcare Still Need Humans and Will for A Long Time

If you read here often enough, then you have read a couple of my suggestions to bring more jobs back to the US and how to keep more going in to manufacturing as when you watch this video it tells it like it is.  People get recalled back to jobs but not exactly the same job.  Automation has a huge place in healthcare but maybe not the point to where you leave the humans out as it is more of a business of humans working with machines.

My old favorite word that’s been in so many posts here is in this video, “algorithms” and about 4 years ago I started talking about it and in my prior life in logistics, which I left about 15 years ago, there already were automated warehouses with order picking, and of course not to where it is now but robots in warehouses with humans entering the commands were already picking orders, and we used infrared “freight guns” to read manifests and contents of pallets of freight right on the platform.  Big Lots which used to be known as Pic N Save had one of the biggest automated warehouses years ago and again it is much more advanced today. “It’s all done with Algorithms and math”.   

Technology has replaced some jobs but then they move on the the Tugs at El Camino and a drug prescription robots in hospitals.  The conversation goes on to get some opinions at MIT and say the pace is accelerated.  I agree and it will continue.  The video moves on to IBM Watson and computer learning and again if you have read here then you have seen all of this. 



We can forego the Wall Street side of this, as that is where it is really accelerated and errors are coming in because it is moving too fast.  The economy is growing but not doing a lot for the consumer.  One of the only ways is to give manufacturing a bigger swing and that is to balance both intangibles and tangibles as they will need the technology. 

Rethink Robotics Introduces Baxter the Humanoid Robot Out of the Crate and Ready to Work in Factories and Healthcare And Eldercare Apps Could be Next


They even covered “Baxter” the assembly line robot and I covered that one a while back.  If we are going to live with robots and create jobs, we need manufacturing and more of it instead of everyone selling data. 

“Devaluate the Algorithm” And “Tax the Data Sellers”–A Cure for Both Healthcare and an Economy Based Heavily on Intangibles–We’ve Lost Our Balance

Watch Adam the robotic scientist (video below) designing it’s own experiments, again machine learning here.

Adam – The Robot Scientist Designing It’s own Experiments


They even say it in the video, bring the factory back to the US…the incentive to create a balance with intangibles and tangibles…license and tax the data sellers and use to fund the FDA, the NIH and a lot more.  Walgreens in 2010 made short of $800 million selling data so again if you want more jobs make it more attractive for the manufacturing and less attractive to send bots out to mine data and sell it as the latter has not risk and very little government control.  If you want to know more about what Wall Street does with their robotic investing, watch the 5 videos on the left hand side of this blog and come up to the 20th century with “fantasy” fiction in models and algorithms that take your money.

Congress To Investigate the Data Sellers - Need To Create a Law to Tax Them As The Algorithms Used For This Business Generate Billions of Dollars, Partly Why Corporate Profits Are So High - Remove the Medical Device Tax as They Produce Needed Jobs/Tangibles


If you want to see what happens when formulas go rogue with machine learning, and this is happening  a lot more lately, read my story with Google Plus.  We have to be prepared for this as more on the way and you never know when it might hit.  BD


“I’m Sorry Your Google Plus Name Does Not Comply With Google “Names Policies”…Barbara “Duck Algorithm” & Was Using My Real Name All Along…Killer Algorithms Chapter 52

Hospital in Oregon Suing Coordinated Care Organization for Cancelation of Contract as They Assumed When Taking Over Prior Care System

Willamette Valley Community Health is the organization to oversee care for Medicaid Patients in part of Oregon with almost 68,000 patients.  imageBefore this company another company, Marion Polk managed the care for the same group of patients and was the party creating contract.  Willamette replace them and that is where Salem hospital came under their jurisdiction of contracts and providers.  Salem was left out as far as a participating provider at this point and was paid at a lower rate.

The hospital states they do have a contract and can’t just be dropped.  The compensation would go to around 55% and that’s a lot of money to be lost for any hospital.  The hospital has already done a report stating that they have been underpaid by over $18 million from Medicaid.  Supposedly all contracts were cut of with Willamette except for one, and well if you read, that’s the way it seems to be done.  In the OC I watched it as United Healthcare bought IPA, new contracts and they are never for more money.  In this last year, the hospital barely broke even.  I keep reporting more and more stories as such as big business, keeps cutting the hospitals in pay and they are the 3rd party management companies.  Its is obvious that we need a larger spread of medical expenses and a Single Pay plan would do that.  BD



Gov. John Kitzhaber’s plan for improved health care for Medicaid patients promised better coordination, better outcomes and fewer costs. But launching the new collaborative system has come with a dispute over who gets paid how much.

Salem Hospital has filed a lawsuit against the local coordinated-care organization, consequences from which could mean less revenue for the hospital.

Salem Hospital has filed a lawsuit against the local coordinated-care organization, consequences from which could mean less revenue for the hospital.

Willamette Valley Community Health is the local coordinated-care organization formed to deliver care to Medicaid patients in the Mid-Valley. Coordinated-care organizations, or CCOs, are a key part of Oregon’s overhaul of the Oregon Health Plan and include a network of providers expected to deliver more comprehensive mental, physical and dental care for thousands of low-income

At the heart of the dispute is compensation — how much WVCH would pay Salem Hospital for its services to enrollees. Hospitals that contract with a managed care organization receive a reimbursement rate that is 68 percent of the Medicare reimbursement rate.

In fiscal year 2012, Salem Hospital barely broke even, reporting an operating margin of 0.8 percent.

http://www.statesmanjournal.com/article/20130112/NEWS/301090121/Salem-Hospital-sues-area-coordinated-care-organization?nclick_check=1

Nantucket Cottage Hospital–Helps 81 Hospitals in Massachusetts Reap Additional Reimbursement Due to Medicare Rule Stating Doctors & Staff Must Be Paid the Same as a Rural Hospital…Killer Algorithms Part 53

Normally rural hospitals are not like this one as it became a “rural “ hospital on a very rich affluent island, only 19 beds, which usually not the imagea case with hospitals outside the city areas.  What this has done is hurt hospitals in other states and they are not happy and who wouldn’t be.   It became a rural hospital when it was bought by Partners Healthcare, the group that always seems to be making money and charging more at many of their facilities so one may wonder was there any influence here with making the hospital a “rural” hospital?  When the pay system changed the money went up. 

What is also interesting is to hear Dr. Donald Berwick’s comments too on how any hospital would “game” it if it is there in front of you and he’s right.

“The entire way the payment system is now calculated has become so complex and so susceptible to gaming and manipulation that you’d play the game yourself if you were running a hospital, to make sure your reimbursements continue to go up,” said Dr. Donald Berwick, President Obama’s former administrator of the Centers for Medicare and Medicaid Services and a health policy lecturer at Harvard Medical School. “It’s a zero sum game. What Massachusetts gets comes from everybody else.”

These are “business models” and rules…more complex by the moment..and Texas, New York, Michigan, Florida, and Illinois are the biggest losers, tens of millions of dollars each year under the current system are lost under this rule.  California hospitals benefitted in some areas too but it was because of one hospital as there are many here.  Now on the other side with losing the money it’s enough to push some of the hospitals in the state over the edge to operate and in the red or be very close to it, so here we go again with one of my frequent topics here, “flawed data”.  For a few years not too I have been called the doctor and hospital ratings sites very flawed come to think of it.  Doing this blog I keep seeing being shifted one way and then the next all the time and smaller dollar amounts that people spend hours and and is it worth it?

Physician Rating Sites Are Seeing Fewer Reviews These Days–Flawed Data Catching Up Along With Loss of Value As Consumers and Doctors Lose Interest?

Back on topic here for Congress to get anywhere with this I’m going back to one of my old posts as you can see the math is bad and they need to model. We have the technology today to do a better job and I realize it will never be perfect but we can avoid many unintended circumstances for sure.  IBM Watson would be grand for Congressional research but they couldn’t see it as we don’t have quite enough digital literacy there to recognize a tool but Citibank did and no doubt they will get more of our money with using it.  It would really be a huge tool for both the House and Senate as all could use speech recognition to ask questions and everybody would start with the same number.  It will be interesting to see where the changes are made here.  BD


IBM Watson Going to Work At Citigroup on Wall Street–Congress Didn’t See Big Data As A Tool (Hadoop Framework) When They Had Their Chance…For Consumers The Attack of the Killer Algorithms–Chapter 22


WASHINGTON — Nestled on an island 30 miles out to sea, Nantucket Cottage Hospital is the only rural hospital in Massachusetts, as defined by the federal government. Its weathered cedar shingles and widow’s walk evoke the bygone era of its founding a century ago, when the hospital consisted of just three tiny cottages.

But the 19-bed hospital on the tony island, where the number of residents balloons from 10,000 to 50,000 each summer and the median home price hovers north of $1 million, has become a national symbol of inequity and political machinations in the way the federal government reimburses hospitals for treating Medicare patients.

Under an arcane hospital payment system, Nantucket Cottage’s rural designation has allowed the state’s 81 other hospitals to collectively reap between a $256.6 million and $367 million annual bonus for the last two years — at the expense of other states. An Institute of Medicine report released in July referred politely to the bonanza as the “Nantucket effect.”

http://bostonglobe.com/news/nation/2013/01/13/states-planning-legislative-fight-for-massachusetts-medicare-windfall/HV4WGdUCSOISoTxIcbwSUL/story.html

Dr. Oz Visits Piers Morgan for a Brief Physical And Talks BMI and Blood Pressure

Dr. Oz is making the rounds to make sure out late night show hosts are in good shape.  The conversation about the belt isimage funny and so true.  After hearing his numbers Piers has invited Dr. Oz to come back in 6 weeks after asking Dr. Oz how long it would take to make some progress, so looks like we will get a revisit…perhaps it’s all the stress from the recent talk on his stand on guns that’s running up his blood pressure and they mention that too.  Well at least the late night shows are in two cities so not too far for Dr. Oz to make TV “host” calls.  Just a couple days ago we had Jimmy Kimmel with Dr. Oz and you can read and view that post here. 


Actually this is great way to bring about awareness and in humorous way and does so much more than those bogus reports about how fat people are wrecking the economy.  This makes sense to educate this way as all those folks doings reports are about half off their rockers anyway with their “risk and cost” numbers.  If it wasn’t this battle with healthcare it would be others.  Good show and realistic too, again by comparison to those horrible reports where nobody can really predict as what you save today gets zapped by something else tomorrow be it a drug, a procedure, an insurance parameter change, and more, and that too has been in the news of late too.  BD 

http://www.youtube.com/watch?v=3n8YSEUDOZg&feature=player_embedded