CMA Urging Congress to Immediately Pass EMR Meaningful Use Reform-Model Broke-We Need A Law to Stop and Revise Compliance Due to Failure of An Agency to Function In the Real World-Doctors Under the Attack of the Killer Algorithms

<p>There’s been quite a bit about Meaningful Use Stage Three and other items related to Medicare Reporting.  The problem is the model broke and humans can’t keep up with the complexities that the “non data mechanics capable” folks seems to think are attainable.  We have had a tidal wave of technologies hit along with new mobile apps (some of which are completely useless) and we’re back to the same old thing, “we’re not algorithms” as doctors are humans that are there to take care of us when we are ill and not data entry experts.  </p> <p>This is a full on failure of the ONC office to be able on their own to make such changes.  The ONC is currently run by Dr. <img align="right" alt="image" border="0" height="216" src="http://lh3.googleusercontent.com/-qL3qGH735Nc/VdaYarICxuI/AAAAAAABMgk/kcNqZ1K-crc/image%25255B7%25255D.png?imgmax=800" style="border-top: 0px; border-right: 0px; background-image: none; border-bottom: 0px; float: right; padding-top: 0px; padding-left: 0px; border-left: 0px; display: inline; padding-right: 0px" title="image" width="277" />DeSalvo who’s background is clinical and see what happens when you don’t have enough data and code savvy folks on board and in charge?  They don’t get it.  When you look at who’s running HHS, the six degrees of Bob Rubin (former US Treasury secretary and Goldman and Citibank executive) as I call it being Burwell was a former director of his, and Andy Slavitt, a former Goldman Sachs “Algo Man” who don’t have one stick of clinical background, this is what you get, operation-perception.  </p> <p>By the way be sure to advise your Senators to vote no on confirming Andy Slavitt for running CMS as President Obama has nominated him.  In particular he’s one of the big proponents behind all of this reporting.  It’s no big secret if you want to look at reality that United Healthcare and their subsidiaries have been mentoring HHS and CMS models for a number of years.  It all began when Hillary hired Lois Quam from United Healthcare after she was able to get removed from the Department of Justice Lawsuit against United in 2008 where the former CEO left.  Lois Quam while at United was responsible for the PacifiCare take over by United as well as their AARP agreements.  Anyway, read this link below, what did Burwell do to make the news recently…numbers, numbers and more numbers as she too is living what I call the virus of “Stat Rat Fever”, the same thing that hit the VA.  These folks don’t live in the real world.  </p> <h5><a href="http://ducknetweb.blogspot.com/2015/06/cms-chasing-wild-virtual-horses-big.html">CMS Chasing Wild Virtual Horses-A Big Distraction on the Hope of Finding Some “Algo Fairies” By Giving Entrepreneurs Access to Medicare Claims and Other Data…Marketing & Astro Turfing “The Sebelius Syndrome”..</a></h5> <p>Fact of the matter is not only doctors are overwhelmed but so are we as patients.  When you look at the backgrounds again of who’s running healthcare, these Stat Rats don’t have a clue and again without some real technology knowledge, they just assume we as humans can run with new algorithms at the drop of a hat, but we can’t, people don’t work that way.  We’re not algos executing code in a market place.  Most in the Health IT area knew a couple years ago the ONC office of HHS was getting over their heads with complexities and that’s not all their fault but their actions reactions are.  They want to fund their own think tank.  </p> <h5>ONC Awards Contract to Create a Health IT Safety Center “Think Tank” For Who Really Knows What…<img align="right" alt="image" border="0" height="220" src="http://lh3.googleusercontent.com/-8Fm8RiYQOpM/VdaYbm1s4FI/AAAAAAABMgs/47yMIK0noCY/image%25255B8%25255D.png?imgmax=800" style="border-top: 0px; border-right: 0px; background-image: none; border-bottom: 0px; float: right; padding-top: 0px; padding-left: 0px; border-left: 0px; display: inline; padding-right: 0px" title="image" width="334" /></h5> <p>They hired a lawyer from United Healthcare, one of the biggest data sellers out there to advise on privacy.  Does that make sense?  </p> <h5><a href="http://ducknetweb.blogspot.com/2014/10/onc-hires-new-privacy-head-california.html">ONC Hires New Privacy Head, A California Corporate Lawyer From United Healthcare, One of The Biggest Operating Data Selling Companies In the US</a></h5> <p>When people get overwhelmed with “broken models” and have to face a government that can’t see this, and we have to rely on Congress to create a law to put them in line, we have a problem.  If this agency can’t admit there are complexities and that reform and changes need to be made quickly, we’re in trouble.  There’s nothing done for the consumer from this office other than to talk about their “data platforms” and no outreach for the Blue Button to even help seniors so perhaps this division of HHS has seen better days for sure.  </p> <p>As a patient wake up as well to see what’s really going on and again tell your Senator to vote no on confirming Andy Slavitt to head Medicare as the reporting and complexities from a one time Goldman Sachs banker at Medicare will get worse.  He’s the same guy then NY AG Cuomo took down and everyone sued for short paying doctors and patients under the Untied Healthcare subsidiary “Ingenix” which is now renamed to “Optum Insights”.  </p> <p> <hr />With physicians potentially facing large penalties for meaningful use and other Medicare reporting programs, the California Medical Association (CMA) is urging the California members of Congress to cosponsor the American Medical Association's meaningful use (MU) reform legislation, H.R. 3309, “The Further Flexibility in HIT Reporting and Advancing Interoperability Act” (FLEX IT 2 Act) and to immediately move the bill.</p> <p>“Physicians are facing a tsunami of Medicare regulations that threaten the viability of our practices," said CMA President Luther F. Cobb, M.D. "H.R. 3309 would provide some important flexibility and sanity in the meaningful use program while advancing interoperability. Medicare could see a significant decline in physician participation and access to care if these bureaucratic programs are not reformed.”</p> <p>Recently, the Medicare program made a stunning announcement that while 78 percent of physicians are using an electronic health record (EHR) – particularly in California, where physicians have been early adopters – more than 50 percent of eligible physicians will face meaningful use penalties under the EHR Incentive Program in 2015. The Medicare EHR Incentive program was intended to increase physician use of technology to improve care and efficiency. Unfortunately, the program's unrealistic and unnecessary requirements are hindering participation in the program, forcing physicians to purchase expensive EHRs with poor usability that disrupt workflow, interfering with patient care and imposing administrative burdens.</p> <p><a href="http://www.cmanet.org/news/detail/?article=cma-urges-congress-to-immediately-pass-ehr">http://www.cmanet.org/news/detail/?article=cma-urges-congress-to-immediately-pass-ehr</a></p>

CMA Urging Congress to Immediately Pass EMR Meaningful Use Reform-Model Broke-We Need A Law to Stop and Revise Compliance Due to Failure of An Agency to Function In the Real World-Doctors Under the Attack of the Killer Algorithms

There’s been quite a bit about Meaningful Use Stage Three and other items related to Medicare Reporting.  The problem is the model broke and...

Read more »

CMS Considering Fines for Inaccurate Doctor Listings, Not a Realistic Fix As Complex Doctor Scoring Algorithms Are Found At The Root of the Problem-Enter the Health Insurance Quants…

<p>Stop and think a minute, if this was not such a big issue, don’t you think you would have better directories?  This not only impacts Medicare but all polices anymore as constant changes made with quantitative analytics says “one minute you’re in and next minute you’re out”.  We have been watching this for quite a while now and with connected data the metrics chosen and utilized for such listings get more complex all the time.  As matter of fact, insurers have banked on complexities for profit and perhaps now some of their own methodologies are coming back to<img align="right" alt="image" border="0" height="143" src="http://lh3.googleusercontent.com/-YF2PEOpumYE/Vc9rJKw12uI/AAAAAAABMgE/PmBq9KGnizE/image%25255B6%25255D.png?imgmax=800" style="border-top: 0px; border-right: 0px; background-image: none; border-bottom: 0px; float: right; padding-top: 0px; padding-left: 0px; margin: 0px; border-left: 0px; display: inline; padding-right: 0px" title="image" width="187" /> haunt as they might be so complex that they are having issues in house themselves.  </p> <h5><a href="http://ducknetweb.blogspot.com/2014/10/here-come-dead-doctors-again-located-in.html">Here Come the Dead Doctors Again Located In Flawed Directories–Now It’s From Insurance Companies Who Can’t Produce Semi Accurate Listings And They Pay These People…</a></h5> <p>I wrote a year or so back about insurance companies driving themselves off a cliff with “data lakes” and it’s partly an addition process or what I have called “Stat Rat Fever” with sometimes over working risk factors to where everything almost comes to a stand still if you will, until a human steps in for some of the decision processes.  I sit there and watch some of the same in other processes to where the “I wants” with writing code, queries, etc. can’t match up as there’s money and time involved here.  </p> <h5><a href="http://ducknetweb.blogspot.com/2014/09/health-insurance-business-is-driving.html">Health Insurance Business Is Driving Itself Off a cliff & Doesn’t Know When to Stop With Collecting, Analyzing and Processing Non Relevant Data With Little Or No Impact On Giving Good Care..</a></h5> <p>This is also worth repeating about the design of models and policies with insurers and again it relates to math so it’s really hard to find any healthcare news that tells you what’s going on.  Insurers are using armies of quants, just like the banks have used for years for their business plans, and yes, this is business models in healthcare by the algorithm.  All you have to do is look at the job listings for health insurers and you’ll have tons of listings in your face for quantitative analysts..aka quants.  You can’t wish and hope when you have an coded executed algorithm making decisions.  It’s good to have faith but don’t be stupid and bet on “faith” outdoing an algorithmic process, as it won’t happen.  They do as they are programmed to do, seek out other algorithms and interact with them and so on, just look at the stock market, that’s all that goes on there for big money of course.  Same thing happens with healthcare.  Watch the 4 videos in the footer for a good start on how this works if you like.</p> <h5><a href="http://ducknetweb.blogspot.com/2014/10/data-scientistsquants-in-health.html"><strong>Data Scientists/Quants in the Health Insurance Business–Modeling Beyond the Speed and Capabilities of Humans To Keep Up With The Affordable Care Act–Turning Into A World of Killer Algorithms That We All Hate..</strong></a></h5> <p>With the introduction of quants in areas of healthcare they can get their projections down to how each policy, network, etc. impacts stock price and there’s a bunch of that going on.  I know it’s not really ethical but you can choose the<em> </em><a href="http://ducknetweb.blogspot.com/2014/04/secretary-sebelius-at-hhs-resigns-wrong.html"><em>“Algo Fairy” world, which I call the Sebelius Syndrome</em></a> or reality.  This brings me back around to another recent post and it fits perfectly here, as operation perception deception with tossing fines will fix this problem, not going to happen until the models get changed that insurers are currently using.  Being they can see the impact on stock prices, changes for consumers are on the back burner as we all know stock prices and investors come first.  It’s not supposed to be that way, but it is.  <img align="right" alt="image" border="0" height="148" src="http://lh3.googleusercontent.com/-CWeZxtSeUhw/Vc9rJ-y-EOI/AAAAAAABMgM/CmJ3RYT6GpQ/image%25255B3%25255D.png?imgmax=800" style="border-top: 0px; border-right: 0px; background-image: none; border-bottom: 0px; float: right; padding-top: 0px; padding-left: 0px; border-left: 0px; display: inline; padding-right: 0px" title="image" width="249" />Remember Healthcare.Gov and all the changes and coding?  It’s same deal here, models and math needed to make systems work. </p> <h5><a href="http://ducknetweb.blogspot.com/2015/06/operation-perception-deception-into.html">Operation “Perception-Deception” Into Full Swing in the US, With Killer Algorithms, Algo Fairies, Algo Duping, The Grays, and Of Course, Flags As Consumers Confuse Virtual World Values With the Real World…</a></h5> <p>So anyway keep on reading, maybe fines will be levied but don’t look for a real fix any time soon as complexities are here with time and computer code.  Actually too back in <a href="http://ducknetweb.blogspot.com/2009/02/kathleen-sebelius-kansas-governor-for.html">2009 when Sebelius was just nominated</a> I pretty much said such that insurance math models and use of computer code would run her over and she would be duped, no clue on what was waiting.     Here we are today as you know the rest was history with the whacked out perceptions we all have to live through over and over while she was at the helm.  So again, fines..good luck as that can’t push models and code to be written any faster as when you look at this from a business standpoint, insurers would have had it done by now but again stock prices and investor relations top consumer needs and desires here once again.  </p> <p>CMS might want to entertain something else besides fines to govern as this doesn’t work anymore.  Complexities are there and working both for and against you.  Some of the predictive analytics used today need a complete hosing over as well, as we have a lot of “flawed data” and proof of concepts that don’t work the way people do creating a bit of havoc, so when it comes to technology being able to instantly meet the demands we all have today, sometimes it’s just not there.  Enter the world of Secret Scoring of Doctors, this is what impacts the listings.   BD</p> <h5><a href="http://ducknetweb.blogspot.com/2014/08/the-secret-scoring-of-americas.html">“The Secret scoring of America’s Physicians” - Algorithmic Math Models For Insurance Network Contractual Exclusions, Relating to MDs Who See Medicare Advantage Patients..</a></h5> <p> <hr />The CMS plans to more closely monitor <a href="http://www.modernhealthcare.com/section/articles?tagID=5888">Medicare Advantage</a> insurers' provider networks and may fine or otherwise sanction plans that don't accurately show which doctors are available at in-network prices. <br />New provisions related to provider networks and directories were included in the agency's <a href="http://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Downloads/Advance2016.pdf">proposed 2016 rate notice (PDF)</a>, released last Friday. Medicare Advantage payments will drop 0.95% on average, but when accounting for higher risk scores based on coding patterns, health plans on average will receive a <a href="http://www.modernhealthcare.com/article/20150220/NEWS/150229988/cms-pitches-1-1-boost-to-medicare-advantage-payments">1.05% increase</a>.</p> <p>The <a href="http://www.modernhealthcare.com/section/articles?tagID=973">CMS</a> said in the notice that it “has become aware of a range of issues with online provider directories.” Medicare beneficiaries have complained of directories in which providers no longer contract with an Advantage plan, or directories still include in-network doctors who have retired, moved locations or died. Other online provider lists do not indicate if doctors refuse to take new patients.</p> <p><a href="http://www.modernhealthcare.com/article/20150223/NEWS/150229979">http://www.modernhealthcare.com/article/20150223/NEWS/150229979</a></p>

CMS Considering Fines for Inaccurate Doctor Listings, Not a Realistic Fix As Complex Doctor Scoring Algorithms Are Found At The Root of the Problem-Enter the Health Insurance Quants…

Stop and think a minute, if this was not such a big issue, don’t you think you would have better directories?  This not only impacts Medicar...

Read more »

CVS To Remove Viagra From Covered Drug Formulary, ED Folks Will Have to Switch to Cialis For Bathtub Sex, Cheaper Now

<p>Several other drugs will be removed as well effective January 1st.  Viagra of course is a big name drug that we have all known for years, so now it’s the battle of the ED drugs.  There’s also a lawsuit filed in California with CVS overcharging consumer for drugs as well.  $135 is the cost for 90-day supply of a generic version of Fosamax for osteoporosis, but if you pay cash it’ $12 and you become an Outlier.  This is interesting as <img align="right" alt="image" border="0" height="90" src="http://lh3.googleusercontent.com/-qBfrEZaPWuE/VcgytrhGXyI/AAAAAAABMfo/v3vpvARFJYk/image%25255B2%25255D.png?imgmax=800" style="border-top: 0px; border-right: 0px; background-image: none; border-bottom: 0px; float: right; padding-top: 0px; padding-left: 0px; margin: 0px; border-left: 0px; display: inline; padding-right: 0px" title="image" width="187" />I had that recent conversation with a pharmacist on the predictive medication adherence program that’s now rating you on a secret scoring system and you can’t get that score at all.  </p> <p>You default to one star of non or little compliance if they can’t find enough data to prove that you can be compliant.  It’s a good read and also look at this angle as well, it’s more costly to be covered by a drug plan as you have all the data processing and selling that goes with it, versus a much smaller amount with paying cash.  CVS has to cover their costs for supplying all the data they mine on you is pretty much what I figure is going on here.  They have to distribute all this data to your insurance company and also send such data to their own CVS data base for further behavioral analytics, so be the winner and pay cash and never mind that you are now an Outlier.  Read the link below and your jaw will drop when you see what’s going on with the data game.  Drug companies love to blame consumers when drug sales are down or lost.</p> <h5><a href="http://ducknetweb.blogspot.com/2015/07/patients-who-pay-cash-when-filling.html">Patients Who Pay “Cash” When Filling Prescriptions Are Now Called “Outliers, Pharmacists Required to Fix Outliers as They Show Up As Non Medication Adherence Compliant With 5 Star Systems Full of Flawed Data…</a></h5> <p>A total of 26 drugs are on the list to be removed and the full listing can be <a href="https://www.express-scripts.com/art/pdf/Preferred_Drug_List_Exclusions2016.pdf">found here.</a>  BD </p> <p> <hr />For example, those customers who take Pfizer's Viagra, a well-known medication for erectile dysfunction, can still find the drug on CVS shelves, but the company will no longer help with the cost. However, customers will still be able to receive coverage for Eli Lilly & Co.'s Cialis, which the company deemed a cheaper, yet adequate alternative.</p> <p>Other drugs removed from CVS/Caremark's formulary include:</p> <ul> <li><strong>Abilify</strong> (antipsychotic) </li> <li><strong>Amitiza</strong> (irritable bowel disease) </li> <li><strong>Cymbalta</strong> (depression) </li> <li><strong>Fosrenol</strong> (kidney disease) </li> <li><strong>Diovan </strong>(high blood pressure)</li> </ul> <a href="http://www.usatoday.com/story/news/health/2015/08/06/cvs-drops-viagra/31227269/">http://www.usatoday.com/story/news/health/2015/08/06/cvs-drops-viagra/31227269/</a>

CVS To Remove Viagra From Covered Drug Formulary, ED Folks Will Have to Switch to Cialis For Bathtub Sex, Cheaper Now

Several other drugs will be removed as well effective January 1st.  Viagra of course is a big name drug that we have all known for years, so...

Read more »