Medical Quack: 07/01/2014

United Makes More Money Contracting to Fix Vermont State Exchange

Here’s a tale of one more state insurance exchange and the same old insurance company subsidiary cashing in again. I find it hard to believe that there’s nobody else out there that can handle the data issues. Here’s almost another 6 million to fix the system, not to mention 100 people also working in a call center as well as supervising other contractors in the call center.

The system as it stands is that once you are in, there’s no changing anything and that’s one of the main projects here as now it’s all done manually. The state is not sure if it will be ready by November 15h either and we know how that goes, just depends on how long it takes the coders and programmers to fix what’s there. BD

MONTPELIER -- The head of Vermont's health care reform effort says he does not believe one of the basic functions of the state's online health care exchange will be fixed in time for the open enrollment period for insurance this fall.

Thousands of people are unable to fix mistakes or change their coverage online through Vermont Health Connect, and Lawrence Miller, the head of health care reform, says the state needs to put contingencies in place.

The $5.7 million contract asks the contractor to eliminate the backlog by Aug. 1, a deadline Miller said would likely be missed - in part because new people continue to trickle in to the system with a similar error rate to those who signed up for insurance through the exchange last year and earlier this year.

Optum has more than 100 people working in an overflow call center and was instrumental in developing a process to expedite changes that could hinder someone's access to coverage. The contract also charges Optum with reviewing the work of other contractors, such as CGI, Exeter and Maximus, which operates the main call center.

http://www.reformer.com/news/ci_26212057/vermont-health-connect-shakes-up-practices-adds-personnel

Emory Hospital in Georgia Prepares Isolation Unit To Treat Patient With Ebola

Emory hospital in Atlanta is preparing to care for a patient from Western Africa. We don’ t know which patient it will be yet, 2 Americans are infected in Liberia, Nancy Writebol and Dr. Kent Brantly. Ebola is said to not be that contagious in the video but why do so many people get it? CDC has raised travel alerts.

Travel warnings have been issued. In Brooklyn Park, Minnesota caution is also being taken as this is the largest concentration of people from that region in Africa. There is a global call for doctors globally all over the world to come help.

The wife and two children of the doctor left the area in Africa before he was exposed to the virus. BD

“Emory University Hospital has a specially built isolation unit set up in collaboration with the CDC to treat patients who are exposed to certain serious infectious diseases,” the hospital said. “It is physically separate from other patient areas and has unique equipment and infrastructure that provide an extraordinarily high level of clinical isolation. It is one of only four such facilities in the country."

Experts say isolating patients with Ebola is important. The disease is not terribly contagious, but it can spread via bodily fluids and healthcare workers are at special risk. They must wear layers of protective equipment including boots, gloves, a full body suit and face and eye protection.

http://www.nbcnews.com/storyline/ebola-virus-outbreak/special-hospital-unit-readies-ebola-patient-n169951

Baxter Sells It’s Vaccine Business to Pfizer for $635 Million

This is further efforts on the part of Baxter to separate it’s drug other medical products business. Pfizer is also getting a portion of Baxter's facility in Orth, Austria. One vaccine is designed to prevent a type of meningitis and the other is designed to prevent tick-borne encephalitis. BD

Baxter (NYSE:BAX) agreed to offload its commercial vaccines business to pharmaceutical rival Pfizer (NYSE:PFE) for $635 million in cash.

The deal includes Baxter's NeisVac-C meningitis vaccine and the FSME-IMMUN/TicoVac encephalitis vaccine, both of which are already on the market outside of the U.S. Pfizer is also taking over part of an Austrian plant where the vaccines are manufactured, according to a press release.

The divestiture is a small part of Baxter's larger efforts to spin out its pharmaceuticals business into a separate, independent entity. The company announced earlier this year that it would follow in the footsteps of rivals Abbott (NYSE:ABT) and Covidien (NYSE:COV) in separating its drugs business from other medical products.

http://world.einnews.com/article/216514370/1Y-M_yajCzR0h7ET

Congratulations To The US Government - You Have Successfully Created a Complex Healthcare System Built With Little Or No Trust Where Very Few Want Or Know How to Engage With The Current Broken Model..

Well it’s time for a rant and discussion on this topic and to try and take a look at the entire scenario. We read every day about “patient engagement” and sure doctors and patients are still engaging with each other but not using the virtual model that our government seems to believe is what we need. As a matter of fact with the current status quo when it comes to much of the personal apps and devices, due to lack of trust, folks are running for the exits. I have to somewhat laugh or look at some of this with disgust when I see how deluged folks have become with “virtual” values that don’t’ exist in the real world. It’s almost comedy in the fact that when you go to the internet every day there’s several articles that “wearables are exploding” and then take a walk out in the real world and I’m hard pressed to see anyone with a “wearable”. I know that’s marketing and it’s gone on for a long time but now it’s so unbelievable with the news, it’s almost a comedy routine as others see the same thing I do.

The Quiet and Unspoken Consumer Movement to Stay Off the Radar - Contrary To All You Read About Sensors, Apps and Wearables, More Folks Are Running for the Exit Doors…

Basically, I almost have to say we are taking care of out health “in spite” of what the government models put out there and that’s a good thing as we are not giving up, but rather just avoiding the broken model of “virtual values” that the government seems to live in today. We’ve already figured out there’s no experts out there as technology changes things on a daily basis almost so when politicians speak anymore, well it’s only good for a couple of hours maybe at best. I think this is further validated too with the large number of people who work in this environment who are leaving as well, when it gets to the point to where all the processes are to build a fix on virtual values, they can’t do it anymore as it doesn’t work.

Healthcare Policy Experts/Politicians - They Really No Longer Exist and Consumers Are Too Busy Being Chased by Algorithms Anymore to Care About You Anyway…

People don’t work like algorithms and yet we have a government that has a big case of being “Algo Duped” every time you turn around as they just live these “virtual values” and scratch their heads and try to work a new and different virtual value to fix the ones that fail and it just builds on itself. It was interesting to watch the big hospital ratings come out, as not the doctors and people that make hospitals work were tweeting and jiving it up all over the web, but rather the CEOs with a steady precession of 800 pound gorillas beating their chests saying on Twitter and in other social network areas “look at how great we are”. We’re not in that time spot anymore as folks are more concerned about “what hospital is going to be available” for us when we need it, so there you go as well with many hospital executives making a million or more that are out of touch as well.

If you want to look at a really broken model, which may have already read, look at the link below. This hospital is totally lost in virtual values with a model that’s not going to work but rather serves to create more money for the data selling business, it is what it is. It was pretty interesting when I found this post being read by the Senate with a few others as well as seeing Acxiom come of hiding and communicate with me on Twitter and I gave honest responses back to them on flawed data and how it hurts consumers while they make money.

Oh Crap, Now Hospitals Are Now Buying Data From Acxiom - Data Selling Epidemic Continues to Evade on Personal Privacy As “Algo Duped-Stat Rat” People Try to Implement Virtual Models That Won’t Work…

Sure as patients and doctors we get excited with new drugs for treatments or cures, but on the other side when we need them, will they be available to us or will we be “scored” to put some of this out of reach…and the world forum on privacy has addressed this very well with their report on the “Scoring of America” that also talks about the obsessive scoring of consumers that denies access and continue to promote “flawed data” at the same time. Doctors and patients are engaging but in ways the virtual government values can’t or won’t choose to understand as we’re still people helping people. When it comes to privacy issues, and I wrote this a while back, even the most electronically connected doctors if they feel there is a need to help and protect their patients, have the little drawer of paper charts.

Digital Doctors” Little Drawer of Paper Charts” Stands to Grow In Size Due to New HIPAA Laws And Insurer Context, Gov Can’t or Won’t Model?

If you read all the studies that come out, the US spends more money and gets worse care and we keep sliding so is it finally time for a wake up call for the government to see they are working a “broken model”? I hope so as if you keep building on the same model it’s only going to keep getting worse. We now have moved from big data to population health and sure there’s some value there with common sense information such as identifying disabled patients as an example and knowing where they live and if they have access to transportation, and sure that’s a good thing. We don’t stop there though after we find that out, we have have to rummage through their MasterCard records and see if they got a new wheel chair last month, or see how many prescriptions were filled to compare this against what the insurance or Medicare claims were submitted. And too, be sure and put the disabled folks on a mailing list to get them to sign up for more credit cards while we are at it and sell their mailing addresses to other marketing firms.

Again, we don’t know when to stop it appears. The latter of what I just mentioned does nothing to promote better care for such a patient. Furthermore is this a patient who will also get hit with the proprietary FICO scoring algorithms too? Let’s get that done too a we have no idea as to what’s in their formula at all, just a bunch of code the proclaims the ability to predict. We are seeing a lot of the predictive models fail today as people take it too far and expect more than what predictive models can actually do. If they were that great, every investor would be rich and there would be no insider trading to worry about.

FICO Medication Adherence Scoring Should Be Banned As It’s Quantitated Justifications for Profit That Hurts US Consumers Using Proprietary Algorithms That Cannot Be Replicated For Accuracy or Audited

I look even at what the White House puts out today with their “email bot” and yes I call it a bot as it’s as impersonal as it can get and uses “junk science” numbers of late and you just look at it and wonder how far “duped in the toilet” are some of these folks that write to us like we are in 1st or 2nd grade and expect that we just believe this stuff? I don’t know about you but when I see such, again it scares me that we have folks duped at the highest levels of government and we can toss Congress in there as well and their own record of actions substantiates that thought too as again they are stuck in virtual value modes as well.

So again, read all the stuff on the web with “patient engagement” you want and the data methodologies and be assured that patients and doctors are still engaging but we are working with a complex system to where companies that are focused on profits only have created a complex system that nobody likes or can work with and it’s only going to get worse until the model gets fixed and perhaps we get some non Algo Duped leaders in place. The VA as I said is just a screamer with a very sad example of folks stuck in virtual mode as people died. We need balance along the line somewhere folks and the Stat Rat mentality is not the total answer but again the duping process for corporations and banks to make money.

Medicare Penalties for Hospitals To Take Effect Later This Year With Patient Safety - Can We Learn From the VA On Not Being “Stat Rats” And Attain The “Desired Virtual Numbers” In The “Real World”? - Medical Quack

Think of it this way if you would, if patients were excited and wanted to engage, would we need all this propaganda discussing it over and over and over and over? I don’t think so. So again look at the models being pushed upon patients and doctors and go create a “real world” model as that might help and certainly add some virtual values where they help us with decision making but put people first. We are not algorithms and nor are we going to function like them either.

Every week I read about how patients are not educated enough in healthcare and this is partly true but what incentive is there to get educated? We all are coming to conclusion that the web is a dangerous place and you have to keep up your defenses to minimize your data exposure so where’s the incentive? It’s your data they want versus helping with your care anymore that’s taking priority. Again I know the value of data and when it helps with decision making and we need some of it for sure today, but we have no balance with being able to say “I have enough data to make a good decision”…and I think this is the thought process that might be entertained soon I hope.

So again, congratulations HHS, White House, Congress, etc. your virtual world values, which I call “The Grays”, that are just are not working and we would invite you to participate at our levels and experience what’s “really” out there and maybe you could find out “people don’t work that way” and get some balance to your perceptions on how all of this is impacting “the real world”.

In addition the White House Privacy Report was also a big let down with a lot of bliss and the inability to talk about data selling and privacy together, it’s like they are off in some kind of fantasy world again not to correlate the two, but we do as consumers as we suffer the consequences of all the flawed data.

White House Privacy Report , “Privacy Bill of Rights”Vague & Complex Verbiage, No Mention of Creating An Index to Identify All data sellers Or The Fact That It’s an Epidemic Leading To Privacy Violations & Flawed Data, Hurting Many Consumers As It Actively Contributes to Inequality

If you want I have my little campaign going to at least create a law to license data sellers in the name of transparency here and provide a look up list of what kind of data they sell and to who, so any little bit helps as I have been working on it already for 2-3 years with this concept. It’s not a virtual value, but rather a “real world value” that can help consumers navigate the insanity of the virtual worlds out there on the web. We have no way of tracking virtually anything used to score us and deny care, money, you name it.

People Don’t Work That Way” A World of Broken Software Models That Don’t Align To the Human Side,Too Much Push At Times With Only A Proof of Concept That Fails in the Real World..

As consumers we have been left with something similar to the Bloomberg Big Gulp failed model and I think that project was important as it shows no matter how much money, influence, etc. that you may have, if it’s a broken model it’s still not going to work and look how much time and money it wasted, so you could look at the current healthcare model as just one huge “Big Gulp” failed model if you will.

In the meantime, doctors and patients will keep using “people”methodologies to support each other as the virtual values keep failing as it’s all we have left and it’s really what matters the most and so if we need to head to the exit doors from time to time to do this, so it is as link above states “people don’t work that way”. Even Google is doing a study as they don’t’ understand how people work either. BD

CVS Caremark Sends Wrong Prescription Information to the Wrong Consumers

The folks affected here know what someone else has on their prescription lists. The reason for the letters going out was to solicit patients to change to a 90 day prescription fill. It was a programming error this time and of course we just live with that of late as complexities in healthcare continue to mount. In other CVS news, I still believe the company is working to buy a huge drug store chain in Brazil as well.

CVS Working To Acquire Brazilian Drug Store Chain DPSP - $4.5 Billion Offered, Refused, Still Working

In California the chain is still facing a large fine as tracking prescription pain killers was an issue with drugs missing from the stores. This is just one more chapter of the Killer Algorithms we all live with today. BD

CVS Drug Stores Could Face $29 Million in Fines For Losing Track of Prescription Pain Killers At California Stores - Don’t Worry About Tobacco So Much And Go Hunt Down That Missing Vicodin..

CVS pharmacy chain sent prescription information for hundreds of customers to the wrong addresses. Now they are concerned for their privacy.

According to a statement Channel 2’s Amy Napier Viteri got from CVS Caremark, the mistake affected around 350 customers.

One woman in Georgia said she got a mailer with someone else's name and a full list of their prescription medications.

The mailing went out to some CVS Caremark customers offering a switch to a 90-day prescription supply. The problem is that hundreds of the mailings went out to the wrong addresses.

http://www.wsbtv.com/news/news/local/customers-concerned-after-cvs-prescription-info-mi/ngqnH/

NueMD Looks to the Future, Sees “Mobile”

NueMD is a valued advertiser at the Medical Quack and are announcing a new upgrade that will stand to simplify the reimbursement process and who doesn’t want that. Below is a message from the CEO of the company. Nice how they are all using Ipads to show how mobility works with their systems. Visit the NueMD website for more information. As a reminder you can always find the link to the NueMD website to the right on the Medical Quack along with my other values advertisers and sponsors. BD

The folks over a NueMD recently announced a major upgrade to their medical software for small practices. This update, dubbed NueMD 4.0, brings a refreshed look and feel and streamlined ease-of-use to their medical billing and EHR software. NueMD’s CEO, Massoud Alibakhsh, said the following about the implications of the release: “NueMD 4.0's new look and feel reflects all the changes and enhancements that have been going on for the last six years.

These enhancements are mainly focused on simplifying complicated reimbursement processes, but at the same time, it sets the stage for our mobile strategy.”

Upcoming mobile enhancements include a mobile EHR for Android and an app designed to help providers communicate with billers while trying to resolve claim denials.

New England Quality Care Alliance, Next Up Duped On Consumer Credit Card Data And Web Information..As The Scoring of America Rolls On..

This kind of funny as the chief medical officer says he’s not real sure about it:) We we know what happened with that Master Card Steroid Marketing Plan, here’s one more that was sold and duped. What they are worried about here is the fact that they need to match up those who can use care management services better, in other words predict. Now if this were something people were breaking the doors down to get it might be a little different. As the article states those who did volunteer on their own before this big “dupe” in predictive analytics takes place were retired people. That’s not good enough and they want more from other age groups so here we go to mine that data, look at those MasterCard Charge transactions and try to predict…well good luck as this is a waste of time. The link below talks about “The Scoring of America” and that’s exactly what this process is set up to do along with “scoring” people here so one more living in The Grays.

World Privacy Forum Report - The Scoring of America: How Secret Consumer Scores Threaten Your Privacy and Your Future - One Big Element that Fuels the Continued Attack of Killer Algorithms & Demise of the Middle Class Creating Profiteering And/Or Denial of Access

Same old stuff, send off to a modeler, who by the way according to the article gets to keep his proprietary formulas and just tell the Alliance which are going to end up in the ER, not take their meds, etc. Wonder if they are going to pull out that ridiculous FICO medication adherence scoring, but no mention of that proprietary scoring formula here.

FICO Medication Adherence Scoring Should Be Banned As It’s Quantitated Justifications for Profit That Hurts US Consumers Using Proprietary Algorithms That Cannot Be Replicated For Accuracy or Audited

I used to work with data and sure you can find patterns that lead to to predict a lot of things but folks are so over sold on this and besides that it pisses people off as there’s no privacy. In fact you read on the web everybody is jumping in when in fact the quiet and unspoken move of the consumers in the real world is to work to stay off the radar.

The Quiet and Unspoken Consumer Movement to Stay Off the Radar - Contrary To All You Read About Sensors, Apps and Wearables, More Folks Are Running for the Exit Doors…

Maybe they should pair up with these duped folks at this hospital here too who got soaked by MasterCard in believing they “just had to have that data” .

Oh Crap, Now Hospitals Are Now Buying Data From Acxiom - Data Selling Epidemic Continues to Evade on Personal Privacy As “Algo Duped-Stat Rat” People Try to Implement Virtual Models That Won’t Work…

I said about 2 years ago that about half of the analytics would a waste of money and you have another one going here so maybe the pilot will give them the answer they are looking for as every proof of concept is NOT a good model. Being the modelers get to keep their formulas, maybe they can peddle it again without having to start from scratch (grin).

“On Being a Data skeptic- Modelers Have A Bigger Responsibility Now Than Ever Before”–A Must Read Essay, Start “Sniffing the Data”…

For more on what goes on with mathematicians, quants, and modelers, check out the Killer Algorithms page to learn when to be a skeptic as sometimes when they are stumped on numbers, they pull one off their head, love to hear Quants say that’s what they do but they do as expectations are so high that they can pull of math miracles too.

Here’s Paul Wilmott, Quant on topic here, we get all kinds of nonsense and it “goes from the sublime to the ridiculous. BD

Michael Cantor, chief medical officer for the New England Quality Care Alliance, has a dilemma. Resources are scarce for care management of patients who the alliance would like to help with their weight, diabetes, or other complex or chronic conditions; and yet it's difficult to predict which patients will be receptive to a care manager.

So he needs to better predict who will use those services, and who will benefit most. That's why the Alliance is piloting a program to marry clinical data with consumer data. The combination, it thinks, might allow for better targeting and prediction.

In the pilot program, the network will send its health data to a modeler, which will pair that information with consumer data, such as credit card and Google usage. The modeler doesn't necessarily have a hypothesis going in, Cantor said.

“They're identifying correlations between the consumer data and healthcare outcomes,” he said.

The modelers won't necessarily give Cantor's group the key predictive attributes; they'll give the network a list. “Here's a list of 100,000 people: who's likely to end up in the ER, who's likely to take their medicines. They're still early on; it's not like there's a definitive model,” he explained.

http://www.modernhealthcare.com/article/20140729/BLOG/307299996?AllowView=VDl3UXk1TytDUDJCa0IvREE0M3hlMFNyaGtVZEErQT0=&utm_source=link-20140729-BLOG-307299996&utm_medium=email&utm_campaign=hits&utm_name=top

Amgen to Lay Off 2900 Employees, Close Two Plants As Profits Are Up 23% 2nd Quarter

This is a restructuring move the article states and it’s not due to lost revenue that’s for sure. The Bothell, Washington operation will be closed impacting 600 jobs in Seattle and 50 at the manufacturing plant and it currently is the largest biotech employer in the area.

Biotech giant Amgen Inc. said it would lay off up to 2,900 employees and close facilities in Washington state and Colorado, as the Thousand Oaks company moved to reign in expenses and focus on new drugs.

Those cuts could amount to nearly 15% of its 20,000 worldwide employees. Amgen said it would use the savings -- as much as $700 million a year -- to support global launches of new products.

Word of the cuts came as the company announced strong second-quarter results that beat Wall Street estimates.

Bradway did not say how many of the job cuts would be at its sprawling Thousand Oaks campus. He said the company intends to focus on "reducing layers of management" as part of the cuts.

Amgen announced the cuts on the same day that it said it posted a 23% increase in second-quarter profit. Revenue was up 11%, the company said.

http://www.latimes.com/business/la-fi-amgen-will-lay-off-up-to-2900-workers-close-plants-in-two-states-20140729-story.html?track=rss&cid=dlvr.it&dlvrit=52116

Big Clinical Data Registries Next? Why Doesn’t Congress Restore the Office of Technology Assessment? More Proof that It’s Needed As This Is Yet One More Complex IT Project That Will Not Contribute Good Care, Just An IT Expenditure With a Lot of Quantitated Justifications Tossed In

I am not against registries at all as they are very useful and 8 years ago I built on in the EMR I wrote so no argument there at all however, a “Big Frigging Data” registry like this? Heck no. This is a flat out burden and big groups like Kaiser Permanente are doing good things with their registries and you don’t need big data here as smaller data works. Kaiser is pretty big data in itself and is a great resource and they have done some great things there. This massive government project as suggested here is just some more Congressional Algo Duping taking place. Best practices are already being established. This is just more IT money to be spent that’s all.

I agree with the AMA on this one as it would be cumbersome, especially since we are still stupefied on exchanging electronic medical records. Damn I wish those folks in Congress would re-establish the Office of Technology Assessment. That agency would be an invaluable tool and if were in Congress I would want it. I just can’t figure that one out as we live in the most complex times ever and they can’t see the forest for the trees. You get folks that are non data mechanic logics wise and they all think building big data bases solves everything (grin). Seriously, look at Richard Cordray, same thing over there, and what a disappointment he is.

Bill To Restore Office of Technology Assessment Was Defeated Again This Year As Congress Chooses to Remain In the Dark With Technology At A Time When Private Industry Is Doing Just the Opposite - “The Grays” Live On…

Even if this type of monstrosity were created, who’s going to have time? The other day, the ONC was looking for doctors to be fellows, well they don’t have time for that either. Regional or Health System registries do a fine job and we don’t need another monster IT project right now and again at least Congressman Waxman can see the light on this one. Just because you can query data and create the data bases doesn’t mean we need every single one created. BD

Draft legislation in the House Energy and Commerce Committee would require the Department of Health and Human Services to publish recommendations for development of clinical data registries to improve patient care.

The bill, introduced by Rep. Pete Olson (R-Tex.), calls for specific recommendations from the HHS Secretary “for a set of standards that, if adopted, would allow for the bidirectional, interoperable exchange of information between the electronic health records of the reporting clinicians and such registries.” The proposed legislation directs HHS to come up with recommendations on how clinical registries, including outcomes-based registries, may be developed and used to evaluate the impact of care models and methods on the management of chronic diseases based on clinical practice guidelines and best practices--such as A1C, blood pressure, and cholesterol levels in the case of diabetes.

How clinical registries can be used to reduce the risk of chronic diseases, such as diabetes, cardiovascular disease, and cancer, is of particular interest, according to the bill. Ostensibly, HHS would recommend how data from such registries may be used to inform physicians and other healthcare professionals regarding clinical practices for the prevention of diseases, as well as the “appropriate methods for the dissemination of clinical practice support tools and other educational resources that may be derived from registry data.”

However, Rep. Henry Waxman (D-Calif.), ranking member of the committee, noted that the American Medical Association opposes the bill “because they think it’s over-burdensome and may have the opposite effect, making it more difficult to create the registries.” Waxman said he wants to explore AMA opposition in a congressional hearing.

http://www.healthdatamanagement.com/news/Bill-Would-Promote-More-Clinical-Data-Registries-48505-1.html

AAFP Says We’re Not Going To Take It Anymore With Optimization of Provider Networks - Specifically United Healthcare’s Doctor Dumping That Disrupts Continuity of Care

This is not the first time the AAFP confronted United Healthcare as they did back in 2012 when they were getting complaints from doctors across the US that they were getting paid at rates less than Medicare. I hear it all the time in the OC with doctors telling me by use of complex contracts, their net pay is less than Medicare pays. Below is the link from a couple years ago and nothing on that front has changed.

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

In addition this article goes on to state how the AAFP has now joined in the lawsuit filed in Connecticut and that was made possible by a little publicized ruling from the Supreme Court last year that now allows physicians to group to litigate. For years it has been in the contracts that doctors had to sign to be in network that they agreed to allow it to always be one doctor against the corporation should they have a dispute, so how fair was that? Oxford, fought it tooth and nail for years and spent a lot of money I would guess until it landed at the Supreme Court and of course premium money pays for that. The California Medical Association as well as the Texas Medical Association and a few others are also partnered in on this lawsuit.

US Supreme Court Rules Physicians Can Work As A Group To Fight Unfair Business Practices of Health Insurers–Victory Over United Healthcare (Oxford Subsidiary)–Context Once Again With Contracts

The argument presented here is the disruption of patients and doctors interfering with care and we know that happens. Sometimes changes work and sometime they don’t and as people get older, change is harder to do. What’s almost kind of amusing is the link below as we all know about narrow networks now and the fact that United went out and bid a Medicare Advantage contract, won it and then found out through their own doing, they didn’t have any providers in the area the contract covered, already narrowed it down to zero in that area.

Howard County School Board in Maryland Rescinds United Healthcare Contract As Retirees Didn’t Want the Medicare Advantage Plan, No Providers Available..

It’s all done with those little “Algo Men” at United with numbers only so algorithm says, “MD is fired”.

United Healthcare Medicare Advantage Doctor Firing Moves On Into Ohio, New York, And Maybe More? CMS Has Known For Months About the Changes And Is Monitoring….United’s Cost Algorithm Says…You’re Out the Door

The AAFP letter to Tavenner at CMS they wrote, well who knows as we have Andy Slavitt at the number two job at Medicare and we just all pretty much predict he’ll be leading her around by the nose as she had not data mechanics logic so more duping on the way I think. There’s no appeals process for patients who have to find a new doctor and no doctors are getting any real explanation as to why they were cut loose and we know that was an algorithmic process.

How Hard Did United Have to Lobby To Get Someone In The Deputy Administrator Job at CMS? Sebelius Syndrome Lives On With Burwell, In Good Company With Mary Jo White and Richard Cordray To Name A Couple Others…

Burwell has been nothing to write home about either and just seems like she’s one that will follow probably follow orders from Andy Slavitt as well because she’s over her head. If you remember back Andy Slavitt was the President of the United company, Ingenix, which is now renamed Optum when the lawsuit was settled by the AMA for underpaying doctors for 15 years so is that not a great guy to have as the #2 person at Medicare?

In addition we have this guy, Ezekiel Emanuel that hangs around DC with Andy and what dangerous person he is. Emanuel got a lot of attention for wanting to legalize euthanasia and he basically thinks doctors should be more like robots and is just a sick thinking puppy overall that shows little compassion and he just loves all the analytics that United Healthcare produces and thinks they walk on water as well. Nobody I talk to including a former CMS employee can stand the man. And finally the AAFP wants to know if you have been cut loose by United or any other insurance company. BD

“If you have received a letter from an insurance company notifying you that you or your practice is being dumped -- oh, excuse me, “optimized out of network” -- please notify your AAFP chapter. We are in close contact with the chapters on this issue, and it benefits our efforts to organize actions by states and regions.”

Hundreds of family physicians recently have been informed that they are no longer eligible to provide care to patients covered by certain insurance policies. Sadly, most of these physicians were not notified directly by insurers. Instead, patients told the affected physicians that they received a letter stating that their family physician is no longer covered by their insurance plan. These patients and their family physicians were not given any justification why these actions are being taken. They were only given a date on which their relationship would be terminated. These patients are rightfully upset, their family physicians are mad, and the AAFP is taking aggressive action.

To quote the 1980’s rock band Twisted Sister, “We’re not gonna take it.” Last week, the AAFP wrote letters to America’s Health Insurance Plans (AHIP) and United Healthcare notifying them of our concerns and urging them to take a more responsible approach to the formation of their provider networks – especially with respect to primary care physicians.

We also wrote a letter to CMS Administrator Marilyn Tavenner, M.A., expressing concern with actions taken in Tennessee with respect to TennCare, the state’s Medicaid program. TennCare, operated by UnitedHealthcare Community Plan, recently informed hundreds of individuals that they would need to change primary care physicians or face higher out-of-pocket expenses for their health care.

Our recent actions are in addition to the "friend of the court" brief the AAFP joined, along with several other medical societies, in support of two Connecticut medical associations that sued United Healthcare in 2013, challenging its actions to summarily “dump” more than 2,000 physicians from its Medicare Advantage network in the state of Connecticut.

We recognize that insurers have a responsibility to align networks of physicians and hospitals to maintain affordable premiums while ensuring quality and efficiency, but we feel that disruptions to the patient-physician relationship at the primary care level are contrary to both of these goals. Primary care is relatively inexpensive as compared to specialty or hospital care. It also benefits from continuity and trusting relationships. We are baffled by the language used by insurers who say they support patients having a continuous relationship with a primary care physician and then act in a way that make this impossible. In short, we are no longer flattered by insurers’ language that speaks to our policy goals but are demanding action that aligns their public comments with their actions in the health care market place.

http://blogs.aafp.org/cfr/inthetrenches/entry/we_re_not_gonna_take?cmpid=em_21090618_L1

Hospira In Talks With Buying French Company, Danone - Could Be $5 Billion Dollar Tax Inversion

There may be one more on the agenda coming up and nothing is in concrete yet. Hospira is known for being one of the few manufacturers of propofol. BD

Hospira a Midwestern pharmaceutical and medical device maker, is in talks to pay about $5 billion for the medical nutrition business of the French consumer group Danone, a person briefed on the matter said.

The deal, if completed, would allow Hospira to reincorporate overseas in a so-called inversion, lowering its tax rate and freeing its foreign cash.

Hospira, based in Lake Forest, Ill., has a market value of $8.6 billion and makes a range of drugs, pumps and software for the medical industry. The person briefed on the negotiations said they were continuing and could fail. The Financial Times on Sunday reported on the talks.

If completed, Hospira’s deal with Danone could be considered a “spinversion,” in which a foreign company spins off a unit to an American buyer, allowing it to undertake an inversion.

http://dealbook.nytimes.com/2014/07/27/hospira-and-danone-in-talks-on-5-billion-inversion-deal/?partner=socialflow&smid=tw-nytimesbusiness

Protandim And Oxidative Stress Relief At the Medical Quack…

I decided to put on the Medical Quack as I have been taking Protandim now for around 45 days and it is making a difference with how I feel, sleep and with my knees. I’m not an easy sell but what did I have to lose so I tried it and I have taken all kinds of vitamins over the years and I do have to say this is different. The only other supplement I have taken and been impressed with is the enzyme CO Q10, which some doctors now recommend to their patients who take statins.

Below the video from ABC Prime Time that was responsible for really launching the product and it was funny when I saw the video I remembered it. I write enough here about drug approvals, issues etc. so I’m not out to push and sell something I don’t think is worth it. I would not say a word of course without being a test person myself. Watch the video and see what you think. There’s no claim to cure any disease here at all but if you search the web you’ll find people who swear it has done some magical things. Hey if it’s working for them, who am I to say anything different. The product was sold over the counter for a number of years until it went to multi-level marketing.

I know people may run away or want to get signed up when they hear this so I decided to put my link up here for those who may like the product and just want to order. I won’t chase you to be a distributor but if you are interested, then you can contact me and it does have a good pay plan. When you go to the site, there’s a place to contact me on this. If you want to order the products, just use the link on the right hand side and you’re off to just order the product.

Protandim has had all kinds of press all over the place from all the major media outlets and you can search YouTube and find more if you like as well. PBS did a nice story on Protandim as well and I’ve embedded it below. Life Advantage even has products for your dog and my dog is not there yet:) I have even ran across some doctors who are selling the product. Here’s another video that you might find interesting about the Protandim Ohio State Heart Study.

Again, I’m not going to say there’s miracle cures here at all, but I can tell you I sleep better, pain in my knees is gone and I have more energy. That’s good enough for me and if there are more benefits to yet show up , that’s also ok with me.

Here’s the link and again it’s always on the right hand side as well. There’s all kinds of additional products for skin care too, but the main product is the the Nrf2 Synergizer, Protandim. The stiffness in my knees seems to be gone and the better sleep is great. BD

United Healthcare Rolls Out Mobile App For Consumers To Address Transparency With Shopping for Medical Treatments, Fine But What About Transparency With Data Selling Which Is Still Non Existent for Consumers, What’s Being “Mined” With this App for Predictive Behavioral Analytics?

Would I used this, nope. More and more we all know there’s a trade off for apps and services and of course I’m sure this is no different as we all know United is the king at gathering data, data and more data about you, so why would this be any different? So it’s collected data from members already so let’s open it up and get some more data. That’s the way these things work anymore and of course they do not have a lock on this as there are other areas you can to go to explore.

If you are not aware, the company subsidiary Med Quest already runs predictive analytics on your prescription refills so if not at the Optum PBM, formerly known as Prescriptive Solutions, they also supply the software that does the same thing for the likes of other PBMSs, such as Express Scripts too. They get it both ways with the software here. We don’t know what they are doing with this type of behavioral “scoring” but we do know they do sell our prescription records to maybe the likes of IMS, a huge data selling medical company that just went public. That parts been going on for years with the data on prescriptions filled, but again what we don’t know is what type of scoring the Optum (or Milliman, another company that does the same) provides. We expect the basics in maybe reviewing current drugs for any type of reaction and that’s ok but the predictive analytics is the dangerous side. A good read here too “The Scoring of America” from the World Privacy Forum and you’ll understand the insanity we have in the US after reading this and the data selling epidemic.

In addition we have most health insurance companies also buying your Master Card records of late and again we don’t we have no clue what other data tables they query this with either. I started calling it “data flipping” as that’s what it is as your data gets queried over and over and over and then “scored”. When you get a “score” there’s a new type of data for sale. I did warn everyone twice last year that Master Card was on this big new campaign to sell all our data and I used their own announcements to let you know.

Mastercard As Well As Other Financial Institutions Using Big Data To Get Into Your “Online Pants” As Many Consumers Seem To Be Accidentally And Inadvertently Leaving Their “Internet Fly” Open

Mastercard Recruiting Software Engineers For New e-Commerce Technology Lab, Maybe More Slicing and Dicing of Our Data To Sell to Insurance Companies for One? Be Wary of Corporate “Algo Dupers” Out There Feeding on “Non Skeptical Consumers”…

You can see how far it went with MasterCard convincing this hospital, and they bought it and got sucked in with buying transaction records with patients. See how this hospital is also combining other records with the MasterCard transactions they are buying so you know if they are doing it insurers have a whale of a game going on here and again so much of it will be “out of context” as the analytics folks put things into format that will save money and you just might be the bad guy here.

Oh Crap, Now Hospitals Are Now Buying Data From Acxiom - Data Selling Epidemic Continues to Evade on Personal Privacy As “Algo Duped-Stat Rat” People Try to Implement Virtual Models That Won’t Work…

Heck Acxiom and LexisNexis will do anything to make a buck and just make our lives miserable. ..

It is interesting when you watch how subsidiaries of insurers too react and do business together as this example from a few years back where Cigna dropped their claims clearinghouse, Emdeon and went with Optum (then Ingenix) so keep that in mind when you see insurers grouping together as well. Here’s another interesting acquisition from a couple years ago too.

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

HHS and CMS have had a long term relationship with United as well and here’s a link from a few years ago as it’s kind of an unspoken from a recent source that told me that every time they get stuck, CMS and HHS have just called up United to do modeling for them. At the link below you can see how much HHS just loved those Ingenix algorithms. By the way Andy Slavitt, the #2 person now at CMS used to be the CEO at Ingenix.

"Reach for the Top" Program Combines Prototype from Ingenix (A Wholly Owned Subsidiary of United Healthcare) for Public/Private Community Health Data on HHS.Gov Site

So again with already buying credit card statements and heck who knows if the insurers share the wealth amongst themselves with our data there and recording our voices at a call center, there’s no way I am going even think about using such an app. Let’s say you look up the cost of a hernia for an example, for a friend not even for you. The way all of this works is that the search is on file and can be set to match with any other type of information as it could be matched with your prescription data, or your voice “scoring” files that are made when you speak to the call centers.

Again we don’t know and thus the reason to get Congress to pass a law for all data sellers and distributors to buy a license so we know who they are and what kind of data they sell and to who. I would not touch this app with a 10 foot pole and will other resources for sure. We are tired as consumers of playing the “click algo game” and when we are sick we just want care as I said below “People don’t work that way”.

“People Don’t Work That Way” A World of Broken Software Models That Don’t Align To the Human Side,Too Much Push At Times With Only A Proof of Concept That Fails in the Real World..

If you like I’m trying to do something here with getting a law passed to license all data sellers as when we need to fix something, we are screwed after we have been “data flipped” a number of times as it might get fixed once here, but over there when I don’t know that my data was sold, I can’t even begin to know where to go. If you read here often enough then you have read 3 years of posts here and there with what I have been working on with this project and without an index on all the data sellers, might as well just “can” privacy as you can see none of it has worked and we need step one to provide an index..aka a license. BD

Insurer UnitedHealthcare has joined the growing list of companies providing mobile apps to price shop for medical treatments.

The Health4Me app, available to members and non-members, provides average prices for more than 520 medical services, the company announced this week. Prices are based on local averages.

"Giving consumers access to important medical cost information is improving transparency and making it easier for people to navigate the health care system," said Yasmine Winkler, UnitedHealthcare's chief product, marketing and innovation officer, in a press release.

The company said that more than 900,000 of its members are using the service. It is available through both the iPhone and Android app stores.

Medical price "transparency" has become a big issue in the industry, and a growing number of insurers and independent groups have scrambled in recent years to offer that service.

http://www.news-press.com/story/life/wellness/2014/07/25/united-healthcare-offers-free-medical-cost-comparison-app/13154869/

Healthgrades Partners With Athena Health To Provide Easier Access to Book Appointments, Like Maybe Doing Better With Sorting Out Some of the “Dead Doctors” Seeing Patients in the After Life?

Well it looks like there’s a new way to determine if some are really dead doctors on Healthgrades, on staff at the hospital stated, and again a way to separate the click bait for ads that Healthgrades has grown to be, along with Vitals, same thing. The amazing thing here is that AthenaHealth funded Vitals as a start up too, it’s in the same boat with being click bait and full of error and really just better off not being around if they don’t fix things. If they want to do just a simple “yellow page” type listing, then fine, but that’s not what you find there. Even the MD who has Ebola, which is very sad thing, still shows on Healthgrades, open for business in Dallas.

If Healthgrades is the #1 Patient Website, we’re all in trouble for sure with the groves and groves of flawed data. I tell doctors to go look themselves up here and there and the are just appalled at the huge errors in their own data. If I were a doctor, why mess with such a mess I would think.

Doctors pretty much hate those sites as they are so riddled with errors with the fact that some are dead, some are retired, the insurance is never accurate, doctors are show being on staff at hospitals where they have never set foot in. In addition when there are revoked licenses and other very public events, it never makes it to either one of these sites. Here’s a great example of a surgeon who worked at the VA and came under fire and 4 years prior he lost his license in New York, never a sanction mentioned. These are just the bottom feeder MD referral businesses on the internet and have been since I found them 4 years ago and had a nice chat with the AMA and nothing has improved and actually the flaws in their data keeps getting worse. Healthgrades merged with a marketing company and that’s all that got better was the marketing.

Top Doctor For Miami VA Healthcare System Lost Medical License in New York, Had Issues With Florida Board of Medicine, But On the Internet He Still Works and Takes New Patients in New York With Plenty of Insurers…

Athenahealth puts out a nice medical records system and I’m sure with the money they put out to fund Vitals it’s a like a sore thumb that just won’t quit and embarrassment to the the rest of what they do and now this even adds a bit more to the fire seeing some work with Healthgrades here to try and make their site a “tiny” bit better. Again to book an appointment the site will have to reference the AthenaHealth data base to see if they are in fact alive or dead. Here’s a couple more blunders and how bad they are from the Quack archives. I exert no energy hardly to even find them, so obvious

Operation Spinal Cap-Former Owner of Orthopedic Hospital Admits He Bribed California State Senator Calderon-Hospital Closed And Sold But Still Listed on Healthgrades

Jacob Reider To Lead the ONC Until New Leader Is Appointed–Visit His Page on Healthgrades Showing He’s Still Open For Business To See Patients, Along With Links to Dead Doctors, Some On Staff At Hospitals They Have Never Set Foot In And More…

Flawed Data With Physician and Hospital Rating Sites- Want To Go See Michael Jackson’s Former Dermatologist? Vitals and Healthgrades Says He’s Still There - Not…Flawed Data & Algorithms Persist…

Nose Doctor on the Run Found Living in a Tent at the End of a Glacier in Italy, Admitted Fraud Still Listed on Some MD Referral Sites

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

This kind of cracks me up here with Healthgrades being in the the Athena “More Disruption Please” program…as there’s been tons of flawed disruption and no fixes for at least 4 years that I have been blogging about Healthgrades and Vitals. When you look at the More Disruption page there’s good companies with good technologies on there as well though and their own funded “Vitals” in in there too.

What happened here was the business plan was a “fail” in the fact that both thought doctors would just come running to those two sites by the groves and it never happened and thus the “cheap” methodology to keep updated information on doctors failed and became more of a joke than anything. It’s the same thing we get as consumers wanting us to fix all the flawed data out there about us on “our” ticket while data gets sold and banks and corporations make billions so Healthgrades and Vitals might be selling some data too as well as maintaining their “click bait” statuses for ad revenue. Below is some information a MD pulled and wait till you see the results… BD

1 that was not a cardiologist at all, 3 with cancelled licenses, and 1 that retired going on 20 years ago, 61% accuracy, with a check of Cardiology zip code 79109.

The other 39% were:

18% More than 50 miles away (credentials of these doctors were not verified, so could have more problems here)

8% License cancelled (one was cancelled as far back as 2001, two were cancelled by the Texas Medical Board)

2.5% Address Wrong

2.5% Retired (in 1998 !!)

2.5% Never licensed in Texas

2.5% Moved

2.5% Not a Cardiologist. (MD runs a weight loss clinic, no education beyond 1 year internship and not boarded in any ABMS specialty)

Denver, CO (July 25, 2014) – Healthgrades, the leading online resource for comprehensive information about physicians and hospitals, today announced that it has partnered with athenahealth (NASDAQ: ATHN) through athenahealth’s More Disruption Please (MDP) program. The new partnership will enable the nearly one million people a day who come to Healthgrades to look for a physician to easily book an appointment with athenahealth’s network of more than 55,000 health care providers.

The offering will bring added efficiencies to physician practices by helping front office staff save time and improve accuracy, drive new appointment requests, and increase awareness among patients. The offering is fully automated, enabling patients to view appointment availability and book appointments from Healthgrades. The information is then directly added into physicians’ schedules on athenahealth’s network.

http://www.healthgrades.com/about/press/healthgrades-partners-with-athenahealth-to-provide-easier-access-to-online-appointment-scheduling

Texas Doctor Working With Ebola Patients in Africa Now Has the Disease Amidst All Precautions and Safeguards-Of Course Still Listed on HealthGrades As Taking New Appointments in Dallas

Not to take away from the seriousness of this story but again don’t rely on Healthgrades or Vitas for any information and expect even a small degree of accuracy these days. The doctor is only 33 years old and this is sad indeed as he’s giving him time and effort to help people with this deadly disease. His family had been living with him there but are now back in the US and I’m sure they may be subject to all types of medical tests if they have not been already.

The doctor has been in Liberia since October of 2013. Between 60 and 90 percent of patients die so we wish the best for sure and he’s being treated. The bad news too is that there are other healthcare workers coming in who are infected as well.

Dr. Brantly has been admitted to a Samaritan’s Purse isolation center at the Eternal Love Winning Africa (ELWA) Hospital in Monrovia for treatment. Ebola is spread through bodily fluids and thus healthcare workers are a big risk with being in constant contact. BD

A Texas doctor working with Ebola patients in Liberia has now tragically contracted the disease, adding to the list of health workers who have been infected with the deadly virus as a result of their work.

Dr. Kent Brantly had worked as a family practice physician in Fort Worth, Texas before traveling to Liberia to work with ebola patients, the Associated Press reports. Brantly went to Liberia as part of his work with Samaritan’s Purse, an evangelical Christian aid organization founded in 1970. Brantly, 33, is a husband and father of two.

Brantly is one of several health workers in Western Africa who have contracted the ebola virus as a result of their work. Dr. Sheik Umar Khan, Sierra Leone’s chief ebola doctor, contracted the disease last week, after giving an interview to Reuters saying how he feared for his life because of his work. Dr. Samuel Brisbane, one of Liberia’s senior ebola doctors at the country’s largest hospital, died Saturday at a treatment center on the outskirt of Monrovia, according to the Associated Press. Brisbane was the first Liberian doctor to die in the outbreak that has killed 129 people in the country, the World Health Organization said, according to the AP.

http://heavy.com/news/2014/07/dr-kent-brantly-texas-doctor-contracts-deadly-ebola-virus-liberia/

Automatic Renewals With Health Insurance Are Too Risky To Take That Chance - Algorithmic Business Models Have Changed Since Initial Enrollment As Well As Price - Would Not Do It Without Full Research as Killer Algorithms Cycle Through Here As Well..

This is a good article and while renewals are meant to be something to make life easier, you can’t say that anymore as what you think you are renewing may cause some financial surprises and here once again the convenience is there, but consumers have to look at the consequences as we are still looking at “Modeling for Inequality with Segmentation”…good video to watch below and it is how it works.

Modeling for Inequality With Segmentation, Insurance Industry Uses Backwards Segmentation As Some Models Stand to Threaten Overall Democracy

Automatic renewals used to be a good thing and in some areas it still could be but not with health insurance as the business model created by insurers is really not user friendly and pretty much for the most part the government got soaked here as they didn’t have the talent at the time the law was created to see beyond this. It’s sad and what we got stuck with today and we all suffer now. Sure more people are insured and of course that’s good thing, but what are they insured with and what are the trap doors we have to work with to be insured is more of the question today. Complexities mean profits for insurers and they know it, so don’t look for any relief there as it’s only going to get worse as new algorithmic business models figure out how to keep big corporate profits rolling.

We still have this complex system of subsidies working out there and again it too is an algorithmic formula that changes so big deal on automatic renewals as you may once again get screwed and and not even realize what happened here, thinking that a renewal would be good thing. Again the government I don’t think didn’t anticipate all of this when writing the ACA and of course as I have said so many times we have that “Sebelius Syndrome” that continues to haunt. I did say in 2009 that she would no match at all to work with insurers as she would be duped and duped again. Pretty much anymore when it comes to the US healthcare model too, not much difference between what United Healthcare puts out in their annual reports and what we see rolling out of CMS to include Andy Slavitt from United Healthcare as the #2 person at CMS, so the duping continues with a White House that is lost living in “The Grays” to where they can’t tell the difference anymore between virtual and real world values.

If you want to learn more about the impact and power of algorithmic formulas like this and in the financial world, visit the Killer Algorithm page and take in some videos that explain how math models work and how all of this is planned out and keep inequality going as accelerated speeds today via “The Scoring of America”. Secret scoring and algorithmic formulas keep big corporations in the money while our side keeps dwindling. BD

For the 8 million people who persevered through all the software trapdoors in the new health insurance exchanges and managed to sign up for coverage in 2014, their policies will probably automatically renew come November when open enrollment begins.

Seems like good news after all the headaches consumers endured after the program’s launch last year. Except that renewing the same policy may not be the best choice. Many may end up paying far more than they need to and with policies that don’t best fit their individual circumstances.

http://www.kaiserhealthnews.org/Stories/2014/July/25/Pitfalls-Emerge-in-Health-Insurance-Renewals.aspx

Johns Hopkins $190 Million Settlement Complex But Will Be Paid By Insurance Created by A Pool of Hospitals In the Northeast Years Ago To Pool Risk

Between the pooled risk insurance company and a second company formed a long time ago in Bermuda, this is where the payment settlements will come from. As many as 10,000 patients may be splitting the money so when you break it down that’s not as large as it seems with the big dollar amount but still a good good chunk of change for sure.

If you need a quick refresher this case was all about a gynecologist secretly taping patients with Dr. Nikita Levy, who committed suicide in February 2013 after being caught with hundreds of pelvis pictures. This was pretty sleazy as the doctor wore a pen camera around his neck to get his pictures.

Women joining the suit must describe how much time they spent with Levy, whether a nurse was present, and any sexual, verbal or physical abuse. The doctor had over ten computer hard drives of pictures. BD

When Johns Hopkins Hospital agreed this week to a $190 million settlement with thousands of patients who were secretly photographed during gynecological exams, it put a number of prominent East Coast medical institutions on the hook.

Hopkins joined with hospitals and schools affiliated with Yale, Cornell and Columbia universities and the University of Rochester years ago to create a pair of insurance companies to save money and pool risk, but they now face one of the largest claim settlements of its kind.

Hopkins has said little about the settlement with patients of Dr. Nikita Levy, who worked in a Hopkins clinic in East Baltimore, and how it will be paid, aside from saying it would be covered by insurance and the hospital's quality of care wouldn't be affected.

The details of the insurance arrangements are complex, and the specifics of the settlement have not been disclosed. But MCIC Vermont and Medical Centre Insurance Company Ltd., based in Bermuda, likely will be responsible for about $25 million, according to documents filed with Vermont regulators. Both companies are owned by the medical centers.

The remainder would be paid by additional coverage the insurance companies purchased from commercial insurers to pay claims in excess of the cap on the medical centers' self-insurance pool, documents show.

The settlement amount is more than all the claims in each of the past five years paid by the two companies, which cover 16 hospitals, 12,000 physicians and 50,000 total employees. The payout comes close to the $200 million cap the commercial insurers agreed to pay for a claim, according to the documents.

When Hopkins and the other institutions formed the insurance company in 1996 in Vermont, where many medical centers have chosen to locate their malpractice insurance companies because of the tax benefits, hospital leadership might have had few domestic options because such coverage was becoming difficult if not impossible to acquire, Provost said.

The Bermuda company was formed years earlier and provided insurance to the members from a country that the insurance industry saw as having fewer regulatory and tax burdens. The offshore company still offers the medical centers most of their basic coverage — the Vermont company is expected to pay about $100,000 of the Levy settlement, while the Bermuda company would pay about $25 million.

http://www.baltimoresun.com/health/bs-hs-hopkins-settlement-20140726,0,153034.story

Former Hospital Owner in Texas Convicted of Medicare Billing Fraud And Faking Documentation for EMR Stimulus Funds of $18 Million..

At one time he had 6 hospitals, 4 closed and 2 are struggling with financial issues under new ownership. The news stated he was allowed to operate this way for years before it was finally addressed. There were a couple billing coders that were asked and told to change the codes and they refused so they found a way to work around them. One coder was fired 3 weeks after she refused to dummy up the billing codes.

In addition his former administrator also faces charges on falsifying documents to obtain $18 million in stimulus funds for converting to electronic medical records and EMRs were never done.

Dr. Mahmood’s defense was that he “suggested” changing the codes but any smart biller that has done this for years will catch on to what’s happening in a hurry. It would be pretty easy to see the stimulus money fraud as if you walk in and there’s no EMRs in use anywhere, well that would tell the story. BD

According to information presented in court, Mahmood, a general practitioner, owned and operated several hospitals in the state of Texas, including Cozby Germany Hospital in Grand Saline, Renaissance Terrell Hospital in Terrell, Central Texas Hospital in Cameron, Community General Hospital in Dilley, and Lake Whitney Medical Center in Whitney. From January 2010 to April 2013, Mahmood and others carried out a scheme to defraud Medicare and Medicaid through the submission of false and fraudulent claims.

Mahmood and others added, changed, deleted, and incorrectly sequenced diagnostic codes in a way that did not reflect the actual diagnoses and conditions of the patients. They submitted false and fraudulent claims to Medicare and Medicaid based on the added, changed, deleted, and incorrectly sequenced diagnostic codes. Mahmood and others also unlawfully used Medicare beneficiaries’ names and Medicare numbers in order to commit health care fraud. Mahmood was indicted by a federal grand jury on April 11, 2013.

http://www.ketknbc.com/news/crimewatch/etx-hospital-owner-convicted-of-health-care-fraud

Doctor Shoots Armed Patient in Philadelphia Hospital - Saves Lives But Case Worker Shot By Patient Died

A doctor came to the rescue here after the mentally ill patient had already shot his case worker and I don’t see a problem with that as the patient was headed for doctor Silverman next. The doctor didn’t kill the patient but wounded him pretty bad. The case worker died from being shot by the patient. It was a shock that the psychiatrist was armed but after the fact here there’s not a lot to say as there would have been more dead people.

This is not a discussion about pro guns either for goodness sakes as the news will make it appear to be as the police try to figure out why the doctor broke the rules and had the gun. I might guess there had been some event in the past that caused him to have a gun as we are talking the psychiatric area here. I think it would be pretty stupid other than to maybe issue a reprimand to say much more to the doctor being the events we have here. BD

ATLANTA — A mental-health caseworker is dead and a doctor and his patient wounded after a bizarre gunfight at a gun-free-zoned hospital in Yeadon, Pa., near Philadelphia, Thursday. As police prepare murder charges against the wounded patient, focus is shifting to the gun-toting psychiatrist who stopped the mayhem, likely saving other lives.

Prosecutors say Dr. Lee Silverman opened fire on Richard Plotts, after Mr. Plotts shot his caseworker and barged his way toward Dr. Silverman’s office desk after gaining access to Mercy Fitzgerald Hospital. Silverman crouched down behind his desk and fetched his gun, which he then fired at Mr. Plotts, wounding him several times before he was subdued.

According to media reports, Plotts had a history of personal problems, including drug abuse, and his arrest records show run-ins with police over weapons violations and suicide attempts. “You could see he needed help,” one neighbor told the Philadelphia Daily News. If Plotts survives his injuries, prosecutors plan to charge him with first-degree murder.

http://www.csmonitor.com/USA/2014/0725/Doctor-shoots-armed-patient-in-Philly-hospital-A-gun-rights-case-is-born

Zoeticx Clarity Server - Middleware HIE Will Save Millions Maybe Billions With HIE And Has 3-6 Year ONC Compatible Time Line, Works Using APIs, Web Apps Where Nobody Has to Swap Out Their EHR…

You have may have already read about the big CommonWell project with the consortium of big EMR players and what they are working on I’m sure is right along this line as well with using APIs and a cloud platform to connect any type of electronic medical record system. Again they have more involved of course as far as putting together as they have existing business client out there and do can’t upset their apple cart and rightly so as I would do the same in their positions. Internally as an example too with Kaiser Permanente, they have done some work internally to develop their own Clarity Server configurations that aligns with their Epic Medical Records System, so using a Clarity server as a tool is not brand new out of the box by any means and here with Zoeticx it’s doing a job being “middleware”.

Not too long ago there was some kind of an update on Forbes I think it was with the journalists previewing a little bit of what their efforts were as Commonwell and I remember reading it was something to the effect of “they put something in the software to enable all EHRs to communicate”. Well that may be just the very same direction at what we have here with Zoeticx. Here’s a couple prior posts I created not too long ago when the product was introduced.

Zoeticx Patient Clarity Server -HIE For Next Generation of Healthcare Applications -Agnostic To Current EMR Deployments, Works With Any Electronic Medical Records System From the Cloud With A Common User Interface

Another Answer To Interoperability With Medical Records - Middleware From Zoeticx With Common User Interface, I Knew That Idea Would Not Die:)

For years there’s been discussion on using APIs in healthcare, and time has arrived but again it’s new technology and Zoeticx has been in the works for a couple years now to give you a timeline on development time and for that matter look how long CommonWell has been working at it too. I read this article at Politico and about fell off my chair though. First off it really makes a case for Congress to restore the Office of Technology Assessment as if they had that research available they wouldn’t be having this conversation about EHRs communicating. I have been screaming about this for 3 years when we live in such complex times, you would think Congress would put this in place to help them so they could be productive and understand the fast evolving technologies we have.

Bill To Restore Office of Technology Assessment Was Defeated Again This Year As Congress Chooses to Remain In the Dark With Technology At A Time When Private Industry Is Doing Just the Opposite - “The Grays” Live On…

From Politico article…

“The Appropriations Committee asked for a “detailed report” on the extent of information blocking, including an estimate on the number of vendors or eligible hospitals or providers who block information, and how to combat it. It also demanded the Health IT Policy Committee submit a report on the barriers to interoperability.

An ONC representative would not comment. The agency is in charge of managing the EHR incentive program that CMS has funded with about $25 billion in incentive payments since 2011.”

It’s kind of what I call a very goofy and political battle going on out there with many EHRs building this perceptual nightmare for the general public to stamp out smaller medical record vendors. I’ve seen a bunch of those articles out there even to the point to where someone blogged and and just really went off the wall about “those bad interoperable EHRs”. There’s very few “bad” EMRs out there if you will as companies work hard at their programming and nobody wants to lose market share by all means. I found it rather humorous actually, but I look at things differently anyway than someone who’s never written code and consumer should listen to folks like as we tell you what’s going on and it might be boring and not as interesting as a news article, I can agree with that. The video below shows an example on how a nurse at the hospital would communicate on an Ipad with a doctor who is not at the hospital, just one example of a consultation demo.

From a recent press release:

“The API resides within Zoeticx’s powerful Patient-Clarity server, utilizing Zoeticx Gateway technology designed specifically to seamlessly read and write to any EMR system. The server drives the collaborative “smart” hub for Zoeticx’s own suite of Care applications--CareIntelligence, CareSynergy, CareHistory and CareCompliance, developed with the Patient-Clarity server.

“We recently introduced a Healthcare Open Architecture to bring long awaited EMR connectivity to medical professionals. Now Zoeticx has opened its API so EMR developers worldwide can build apps once and deploy them anywhere, helping the medical industry bridge the gap between medical data and improved patient care,” said Thanh Tran, Co-Founder and CEO of Zoeticx. “We look forward to working with third-parties and making it easy for world class apps to be launched for the betterment of medical patients across the globe.”

Application developers can develop on any platform and license the PC server from Zoeticx.These products are engineered using the latest mobile, cloud, and SOA technology.”

Of course Zoeticx likes to partner with EMR vendors by all means as everyone wins here. Again I mention that somewhat political battle and the perceptions being painted right now on and EMR witch hunt if you will that seems counter productive to me, but that’s how marketing works out there today in political battles. Again Congress would be ahead of the game at times if they had that Office of Technology Assessment as they could digest and report items like this so they don’t get snowed. We have had enough of that with the “Sebelius Syndrome” at HHS since 2009 and even though she’s gone, there’s a lot of other folks, i.e. even the SEC that has that syndrome.

This next video might be a little boring to the average reader but for those in Health IT it will be interesting for sure. This shows some configurations and some simulated information on how the “alert” system functions with Zoeticx and screenshots of role users here and how it works. The great thing here I forgot to mention is that you have the same “common user interface” at all sides. There’s also noting to stop an app being built to where this information could be shared with a patient.

Security is built in with using the Symantec Sealed Program. A while back Nuance gave Zoeticx an App of the month award as well. SureScripts has an open API as well – so does eClinicalWorks and it might not be too quick to build a solution like Zoeticx because it is not in their interest to solve the problem for their competitors? That’s just a guess on my part and then again we circle back around to the Commonwell Health Alliance as mentioned above who’s working on their solution too as you can can bet it’s using APIs as for the last couple of years there have been endless articles asking “when is healthcare going to begin using APIs”. It has not been that simple in healthcare as other industries as there’s been a lot of work on standards, and I mean a lot not to mention time and money.

The developer/CEO here spent a great deal of his life in the past at Borland (which if you have been around for while in IT you know that name) and BEA software building infrastructure solutions. With Zoeticx Red Hat is a strategic partner as well as other established relationships with tools such as New Relic which is used by companies such as the Wall Street Journal, Microsoft, NBC and more.

Anyway with reading that somewhat “nonsense” article in Politco I thought maybe it was time for another post here. It’s really interesting too as I have sent folks like so far on the other posts I have written to get some feed back and “nobody seems to understand this and then yet the next day I see an article asking “why is healthcare not using APIs”…very interesting and of course tells you that we have a disconnect here with what can be done today and just the fact that Health IT is becoming pretty complex out there. Next up though with news, it’s going to be the consumer that needs more education (sorry had to include this satire as I see that out there all the time and Sebelius was so infamous for those talks herself when she is right up at the top of the list herself:)

I’m not picking on the journalists from Politico, but rather the lack of knowledge and an agency that can help Congress with this battle so they don’t get snowed. We have enough Algo Duping out there today for sure with perceptions that are just flat out wrong and it’s hard to understand this side of the world for the consumer too, so why I create pages like the Killer Algorithms with videos at layman level to shed some light on some of this too. Heck for that matter in addition to restoring the Office of Technology Assessment, Congress and their staff as well as the White House could spend some time over there too, it’s only there to help so why not let it rip and share some wealth of knowledge?

So in closing here, check it out and let’s move interoperability off the war zone here and perhaps look at what an open infrastructure has to offer as this could easily work at the VA and DOD as well with each facility having a Clarity Server from Zoeticx and how long have we been waiting for that one? Sometimes too though in the case of the VA and DOD, they may have spent money and I’m sure they have burial ground of sandbox software they have tested, but in this case waiting for the technology such as Zoeticx might be the best thing that has come along. No matter what the decide to do with bidding and upgrading systems, Zoeticx has no problem with legacy systems and could sit on top of VistA today as well as the DOD ALTHA system. ALTHA and VA systems are not as bad what the news tells you, they work and with any software system, they need updates, so be careful on what you read.

The White House even has a version of the DOD ALTHA as their medical records system. So rather than fighting this battle at the EMR level it makes sense to me to stop wasting time here and move forward by all means. Now we have both Democrats and Republicans on this and this should be music to their ears if you will and again if they had that Office of Technology Assessment to help them too, well we might even be seeing this article in Politico as they would be miles ahead, and be doing the work and support that we want them to as consumers.

There’s nothing but a bunch of wasted time going to come out of a battle on non inter operative medical records systems at this point and time to move forward and quit wasting time. Zoeticx was initially funded with a grant from the NIH. Would it not be nice to start putting affordable solutions in place, and maybe get Congress to reinstate that Office of Technology Assessment at the same time:) BD