Seniors punished for Government Spending

David Cutler, an adviser to the President  stated in his analysis that “it costs far more to prolong the lives of the elderly ($145,000 per year gained) than the young ($31,600), and the rate of spending on the oldest Americans has grown the fastest.”

While it would be politically difficult to tell the elderly  that we need to spend less on them, essentially we are- by slashing medicare reimbursement by 21%.  This will place an undue burden on private physicians and healthcare facilities who are trying to make ends meet and still accept Medicare. According to the Center for Studying Health System Change, doctors currently rely on Medicare for 31% of their revenue. Despite all efforts, many of these doctors will be faced with the conflict of dropping Medicare to survive fiscally and abandoning older patients for whom treatment had previously been rendered.

The feared  21.3% reduction in Medicare is slated to take effect June 1 since the House and Senate Democrats failed to pass the legislation to stop it.

The Centers for Medicare and Medicaid Services once again, has instructed its carriers to delay June claim payments  for the first 10 business days of the month so that if the cut is postponed, claims can be reimbursed at the current rate.

The thing is, unless the pay slash is averted, many healthcare providers will not only reject seniors but military families covered by TRICARE as well.

Conflict over Rates due to Deficit Spending Fears

The House Democrats proposed pay cut postponement until  January 1, 2012,with increases in Medicare rates 2.2% for the rest of the year and 1% in 2011. However, Senate approval is needed to become law and they are lax to do so since they now want to curb deficit spending.

Originally the proposal suggested extension until  January 1, 2014.

The next date that Congress will revisit this issue is June 7th.  Hopefully they will come to their senses then.  Healthcare reform can not be successful if physicians must close their offices and seniors can not get care.

This issue is aimed at you!  We will all be affected!

Forced Medicare Acceptance

Two bills have just been put forward regarding Medicare- #2170 in the Senate and #4452 in the House.  Each requires healthcare providers including doctors to accept 110% of Medicare rates for health insurance or risk loss of their license.

Besides Medicare, doctors would be forced to accept all patients from other insurance plans offered by that same insurer.

While the purpose of these proposals is to try to decrease health care costs for small businesses it will fail miserably.

First, the bills do not differentiate between primary care providers  and specialists who tend to increase costs. Both are penalized equally. Nor do these bills require private insurers to pass on savings to employers. The end result is likely to be a net loss of physicians to nearby states and many who join the increasing ranks of physicians who have cash only practices.

Certain questions now arise.  Will physicians who refuse to accept lower rates lose their licenses? What about employees of private health clinics? Will they now have to quit or risk the threat of licensure loss?

Yet again, the savings will not be going to either the patients, physicians or employers of small business. While we continue to feel the squeeze, it is the insurance companies that will glean a windfall.

In a misguided attempt to reform healthcare, will physicians quit practicing in droves and find a different career- one that is rewarding both emotionally and fiscally?  How about making the insurance executives feel the pinch?

If we are to reform the system, let’s do it the right way.  What are your thoughts?

Single Most Important Tool- Part II

Part II: Solutions

Standardized Language

While investigating, examining, and evaluating multiple ontologies and coding languages, software designers and certification agencies have lost sight of the fact that clinicians transfer information in medicalese, for want of a better term. Computer to computer transmission requires transmission protocols for efficient readable transfer of data. Clinician to clinician transmission requires medicalese for efficient transfer of clinical information. Medicalese is a dialect of English and often requires translation by a qualified clinician interpreter for the confused patient and their family.

Medicalese is a logically organized jargon that allows highly specific communication. It is filled with terms like Health Maintenance Organizations, Third Party Payers, Calcium Channel Blockers, Idiopathic Hypertrophic Subaortic Stenosis, Incomplete Left Bundle Branch Block, etc. Medicalese is required for answering the four questions we ask every patient—repeatedly:

  1. Who is going to pay?
  2. Are you allergic to any medicines?
  3. Have you had any previous diagnoses made?
  4. What medications are you taking?

Answers to these four questions are necessary in the care of every patient. In the absence of the answers to these questions, the attending clinician has the entire universe of possible diagnoses and treatments available—along with the entire universe of possible wrong decisions, adverse reactions and additional expense to rectify mistakes that occur. Limiting the diagnostic and therapeutic choices at the outset of the clinical encounter optimizes the decision making process.

The first question, while not obviously a clinical question, addresses limitations to treatment options. The answer dictates which hospital can be used, which specialist can be consulted, which anesthesiologists could be used for a specific operation, which drug is on the formulary and which pharmacy can be used for that particular patient, just to name a few.

The need for the second question is obvious. It limits options for testing as well as therapy and enhances the opportunity for success of proposed therapies.

The answer to the third question builds the context of the milieu in which therapeutic plans are formulated. It focuses attention on particular body systems and known disease mechanisms allowing the attending clinician to refine testing, choose appropriate consultants and more efficiently use the tools at hand for optimal therapeutic decisions. This list also gives the attending clinician the opportunity to add more than medical diagnoses to the context of patient care. Problems such as “illiterate” and “can’t drive a car” give more important contextual data to the attending clinician and allows for more precise and individualized treatment plans.

The answer to the fourth question further delimits treatment options by posing possible drug interactions and offering additional opportunities for more economical choices with change of current medications.

Clinicians spend their important time collecting old information from the patient, because the definitive source of the origin of the diagnosis of an allergy or a disease and the prescriber of a medication are usually not readily available to the treating clinician.

Context in the treatment of patients is everything. This is why so much time is spent taking histories.

An important differentiation to make is the definition between data and information. Data are the unprocessed bits and pieces of the vast numbers, pictures, x-rays, visual clues, auditory hints and tactile suggestions that are processed by every clinician when involved in the care of their patient. Take, for example, an EKG. It is the visual representation of electrical impulses in three dimensions, over time, presented on a piece of paper. It is coded information, presented in a format that requires an “interpreter.” There are computers that “read EKGs”, but are not trustworthy for subtle changes in critical treatment situations. The EKG becomes valuable clinical information only after it is interpreted, processed and documented by the interpreting clinician. Its true value becomes realized only when it is available for rapid access at the point of care by the primary ordering or attending clinician.
When the attending clinician has ready access to the problem/allergy list and medication list, context for the current clinical encounter is provided by the reliable authority of previous attending clinicians. This contextual information affords the current attending physician the opportunity to forgo interrogation the patient and rapidly move to evaluation of the presenting complaint, collection of clinical data and ordering of laboratory testing, while refining the diagnosis and optimizing treatment plans at the point of care. And further, if the attending clinician can readily access the full text of a previous document of clinical activity, then the optimal environment of the congress of attending clinicians at the foot of the patient’s bed comes closer to being realized.

The readily available list of problems and medications becomes the table of contents of the totality of clinical information available for a given patient. It then becomes incumbent upon the attending clinician while creating a new document of the clinical activity, to update and refine the two lists and publish the updated versions, along with the new document of clinical activity, for access by other clinicians at future clinical encounters wherever the point service.

The full power of the Internet information conduit is being realized by posting the full text of the documents of clinical activity at every work site. These documents are indexed by problems, allergies and medications and published into a restricted network that only allows access to credentialed users. This network, available from any Internet connected device, will allow participating clinicians to practice medicine in an environment of optimized clinical information availability and safety. This achievable environment of readily accessible clinical information will revolutionize patient care, reduce unnecessary hospital admissions, stop redundant testing, identify fraud and reduce costs.

This is the kind of reform that clinicians can embrace.



Today’s article is written and brought to you by Dr. Drussia of Medisyn

Part I

The single most important tool in the clinician’s arsenal-access to other attending to other attending clinicians’ clinical information- has been lost in the debate about increased spending, stimulus packages, interoperability, the definition of EHR and the meaning of “meaningful use”.

The high cost of the transaction of access to clinical information has hobbled the efficient practice of medicine.

Without access to other clinicians’ information, attending clinicians must make diagnostic and therapeutic decisions in a vacuum.  This leads to redundent testing, unnecessary hospital admissions, prolonged hospital admissions, undetected drug abuse, higher costs of administration, undiscovered fraud, spotty quality assurance, measurement of claims data as a substitute for measuring clinical activity and the possibility of not being able to discover best practice activity because it is lost in paper charts in small practices.

The piece that is missing is the clinician to clinician interaction-the extraordinary sharing of clinical acumen and experience that all clinicians experience in medical training when they are surrounded by medical student peers, interns, pharmacists, nurses, ARNPs, therapists, residents and attending physicians who all stood at the foot of the patient’s bed and discussed, refined and pooled clinical information. 

This congress of treating zithromax online sverige professionals represents the optimal way to share clinical information, create an agreed upon list of diagnoses with allergies and formulate an agreed upon treatment plan.  Having access to this common diagnostic and medication list allows all additional clinicians and treatment specialists maximal opportunity for reference, further opportunity for refinement of diagnoses and treatment, avoidance of redundant testing and unnecessarily prolonged admissions and efficient treatment plans without unwanted interrogation of the patient-the usual repository of these two lists at current sites of care. 

The high cost of inaccessible clinical information-lost charts- in closed, after-hours offices, in the assembly area of medical records, waiting for signatures in medical record chart rooms- adds to the immense currently uncounted cots in the healthcare enterprise today.

The power of the Internet information conduit has not been fully realized in the design of the pre-Internet commercial off-the-shelf (COTS) software packages offered by EMR vendors today.  The high cost of the transaction of access to inaccessible clinical information is not a part of the metrics offered by the practice management  and hospital systems.  These are the primary reasons why these currently available COTS have not offered any significant return on investment to the medical practices of busy clinicians.

Stay Tuned for Solutions- Part II


Sex Your Way to Health

I thought these were some interesting and fun facts about sex that I wanted to share with you today from OMG Facts.

Having sex can reduce a fever because of the sweat produced. Sex is also a pain reliever, ten times more effective than Valium: immediately before orgasm, levels of the hormone oxytocin rise by five times, determining a huge release of endorphins. These chemicals calm pain, from a minor headache to arthritis or migraines, and with no secondary effects. Migraines also disappear because the pressure in the brain’s blood vessels is lowered while we have sex. So now we see that actually, a woman’s headache is rather a good reason for having sex, not against it. – OMG Facts.

Health Insurance Price Hikes

The American Medical Association sponsored a study of health insurance premiums and blames the rise on market control by a few, large  insurance companies.

Republicans propose to allow the public to buy insurance coverage across state lines in order to expand competition.  Critics believe that this would foster a loss of state oversight but supporters feel that it would allow price wars in large markets while expanding cheaper options.

Members in Congress have also proposed the repeal of insurance industry exemption from federal antitrust laws thereby preventing companies from fixing prices across the board and blocking competition.

Currently, insurers are able to help establish premiums without fear of retribution regarding price fixing.

This may be changing.  In the near future, companies may be required to justify rate hikes by demonstrating the impact on loss ratios and the percentage of premium revenues spent on medical claims, disease management and patient care as opposed to profits and executive salaries.

These measures are a long time overdue and I applaud the new proposals.  What is your opinion?

Mastectomy Law Change Shows Compassion-Show Yours

Please take a moment to read this (and act on it!)


Written by a surgeon.

I’ll never forget the look in my patients eyes when I had to tell them they had to go home with the drains, new exercises and no breast. I remember begging the doctors to keep these women in the hospital longer, only to hear that they would, but their hands were tied by the insurance companies.

So there I sat with my patient giving them the instructions they
needed to take care of themselves, knowing full well they didn’t grasp half of what I was saying, because the glazed, hopeless, frightened look spoke louder than the quiet ‘Thank you’ they muttered.

A mastectomy is when a woman’s breast is removed in order to remove cancerous breast cells/tissue. If you know anyone who has had a mastectomy, you may know that there is a lot of discomfort and pain afterwards. Insurance companies are trying to make mastectomies an outpatient procedure. Let’s give women the chance to recover properly in the hospital for 2 days after surgery.

This Mastectomy Bill is in Congress now. It takes 2 seconds to do this and is very important. Please take the time and do it really buy zithromax for chlamydia online quick!
The Breast Cancer Hospitalization Bill is important legislation for
all women.

Please send this to everyone in your address Book. If there was ever a time when our voices and choices should be heard, this is one of those times. If you’re receiving this, it’s because I think you will take the 30 seconds to go to vote on this issue and send it on to others you know who will do the same.

There’s a bill called the Breast Cancer Patient Protection Act which
will require insurance companies to cover a minimum 48-hour hospital stay for patients undergoing a mastectomy. It’s about eliminating the ‘drive-through mastectomy’ where women are forced to go home just a few hours after surgery, against the wishes of their doctor, still groggy from anesthesia and sometimes with drainage tubes still attached.

Lifetime Television has put this bill on their web page with a
petition drive to show your support.. Last year over half the House
signed on. PLEASE! Sign the petition by clicking on the web site
below. You need not give more than your name and zip code number..<>

This takes about 2 seconds. PLEASE PASS THIS ON to your 20 friends.

Let’s Get this Viral!!!

Transparency in Health Insurance

Health and Human Services (HHS) Secretary Kathleen Sebelius called a meeting to discuss escalating premiums with state insurance regulators.

Ms. Sebelius proposes that insurance companies post online explanations of their rate hikes.  She would also like to see spelled out where the premium revenue is meted  out between marketing and administrative expenses in comparison to patient healthcare.  Her request was distributed to CEOs of CIGNA, Aetna and Health Care Service Corp.

The basis for estimates of medical costs for each health insurance company and utilization in addition to the actual number of people receiving premium increases will have to be made public.

Bravo.  This is certainly information that we, the public, should have access to and know.

Why Wait?

There are 200,000 physicians who have implemented electronic medical systems thus far.  Many are in the investigational phase.  The vast majority are still pacing, considering the pros and cons and sitting on the fence.

However, for those of you who are on the fence- it’s time for you to come down.  The sensible question is really not why wait?

Rather the reality is Why You Can’t Wait:

  • The government is currently offering incentives to help defray the cost of your system
  • The government is helping with IT instruction through incentives
  • Both of these incentives will expire within 5 years and will likely not be repeated
  • Your malpractice liability and premiums will start to dramatically rise without a system
  • The government will start reducing your reimbursements for services rendered during each year after 2015 that you do not have an electronic system in place
  • You will be perceived by the public as not being up-to-date and you will lose your patient base as well as your patient referrals (since most referrals will be done online)
Read the handwriting on the wall. The future is here and now.  The future is also inevitable.  Become part of the future or become extinct.
P.S. For those of you in the research phase, there is a resource to help inform you of what is out there and what process implementation and selection will be.  Check out

Interface with me

Why is it that the huge varieties of electronic medical systems for healthcare providers can’t “talk” to each other?  Vendors and IT developers have created systems that are distinct from one another and due to proprietary laws and ownership, can not interface or communicate with each other.

Can you imagine if the person that developed the world wide web would only allow access to a select few or charged for usage?

If you can retrieve your email regardless of your server (safari, netscape, firefox etc) and despite your hardware (IBM PC vs. MAC), why make healthcare systems more complicated than this?  It seems that there will be enough money to go around. (unless you don’t feel that your system is good enough to compete)

Don’t you think that there is an inherent problem here?  What are your views?