The value or cost of life

Isn’t it amazing that only a short time ago Dr. Kevorkian was vilified for assisted euthanasia.  And yet, now according to lead articles in JAMA and the New England Journal of Medicine, the cost of end-of-life care is being discussed as a potential way to cut waste expenditures in healthcare.  This will be addressed by Berwick who was made head of CMS (centers of Medicare and Medicaid services).

Clinical benefit will be analyzed so that intervention may be denied when there is no expectance of recovery.

Whether or not to pay for life-support or maintain someone who has a degenerating condition may become “ethical” all of a sudden.  The same goes for premature infants or cerebral palsy or just any noncorrective defect in a child.  Where do we draw the line?

The difference between this debate and Dr. Kevorkian is that at least with Dr. K, only those who chose death or the absence of treatment were denied the treatment.  Those who wished to receive treatment, still got it.

It is a matter of maintaining our dignity and our humanity.

Cost of Stem Cell Research to us- If Not Done

Perhaps you have heard that Chief Judge Royce C. Lamberth of Federal District Court of the Washington D.C. has put the brakes on stem cell aid?  Many thought that after President Obama gave the nod in 2009 for stem cell research expansion, that it was a “done- deal”.  Apparently not.

The judge has objected in his temporary injunction that federal policy should return to the “status quo”, though few know what that actually is.  Mr. Lamberth objects to the use of frozen embryos for research.

Scientists are unsure whether the ruling is limited to the use of government funds but that research may continue if funded privately.  Others wonder if the ruling specifies the cessation of research.

With all the controversy surrounding stem cells you may have missed hearing about many of the health benefits or that it currently  has many uses for treating serious diseases. In addition, stem cells may be used for tissue replacement. Tragically, many people die today while waiting for organ or tissue transplants.

Ailments that Stem Cells have been shown to help:

  • Parkinson’s disease
  • Type I diabetes
  • Arthritis
  • Burn victims
  • Cardiovascular diseases
The possibility to reverse disease has been explored with rejuvenating cardiac tissue in those suffering from heart attacks or cardiac damage. Think of replacing brain cells in Parkinson’s disease or senility!
The exciting possibilities are endless!
Yet we may not get to see the benefits.  Stem cells can be derived from other sources like umbilical cord blood.  Let us not forget this.
Also ask yourself, with the thousands of frozen embryos no longer being used, what will actually become of them if they are not being used?  How long will we be responsible for keeping them in limbo?
And by not having the benefits that the stem cells would provide, at what cost will this be?

Is there a Medicare physician around?

How does President Obama plan to save money for Medicare?

According to Richard Foster, the Medicare chief actuary, in the 2010 Medicare Trustees Report, projections for decreases and savings in Medicare spending are totally unrealistic because providers cannot cope financially with the cuts and meet their expenses.

The prices paid by Medicare for health services are very likely to fall increasingly short of the costs of providing these services.”

The President’s savings are derived from overall cuts to Medicare including markedly decreased reimbursements for care to seniors. It also assumes that healthcare zithromax antibiotics online providers will react by becoming more efficient and productive, finding ways to provide the same benefits at a lower cost.

According to Mr. Foster’s projections, by 2019, Medicare reimbursements will actually fall below that of Medicaid payments. Studies have shown that Medicaid patients cannot get proper medical care accessibility in a timely fashion.

Simply put, with the Medicare slashes that the White House proposes regularly, unless seniors are wealthy enough to pay for care, there will just not be any care for them.

Do you have any suggestions on the issue?

Your Online Doctor

A recent survey looked at the question ” What percentage of Adults in the U.S. look for their healthcare information online?”.  This has been an ongoing study with comparisons between years as more people become tech saavy.

Where as 51% of adults searched the web in 2004 and 27% in 1998, a whopping 76% of adults now search the web for health information. Of these adults 86% stated that it was helpful and worthwhile.

Perhaps this will increase further as copays rise and available physician offices become scarce.

Will this be how you will pursue your healthcare?

You Are the One Paying for Malpractice Suits

The AMA issued a new report regarding medical malpractice cases. The latest information reveals that 95 claims are filed for every 100 doctors- approximately 1 per doctor.

Even though more than 66% of suits are dismissed, it is obvious that the cost to malpractice premiums will continue to escalate and these statistics encourage healthcare workers to practice defensive medicine in order to protect themselves from legal action.

J. James Rohack, MD, the Past-President of the AMA and practicing cardiologist from Texas states: “This litigious climate hurts patients’ access to physician care at a time when the nation is working to reduce unnecessary healthcare costs. Unfortunately, there are no real surprises in this study for us,” “It reconfirms the need for a solution to our current tort system. If the nation is ever going to control the rise in healthcare costs, we have to eliminate wasteful defensive medicine spending.”

According to a 2006 study in the New England Journal of Medicine (2006; 354:2024-2033), a full quarter of compensated claims had no medical error involved.

So, as I have stressed before, (and as many have confirmed) the real issue is that you cannot effectively lower the cost of healthcare or have healthcare reform, without tort reform.

It seems that legislators are going to have to stand strong against the legal system and their brethren. Take your hands out of your pockets to truly make an impact on the cost of healthcare.

As long as the tort system is not amended, healthcare will be astronomical in cost- a price that is too heavy for most of us.

Wouldn’t you agree?

Docs Accepting Medicare Will be Rare

Kathleen Sebelius, the Secretary of Health and Human Services, states that Medicare funds will extend beyond 2029 assuming that Medicare payment reimbursements to doctors will go forward, Associated Press reports.

Richard Foster, the Medicare Actuary,  warned in the report that the program’s projected savings might not be realistic. The report considers a 23% Medicare payment cut to physicians on Dec.1 and another 6.5 % on January 1 unless the current law is amended.

While these cuts may extend the life of Medicare funding as we know it, the severe reductions will actually accomplish two things, as I have highlighted in a previous blog.  Those physicians that rely on Medicare for payment on services rendered, are scrambling to remove themselves from Medicare participation.  Those that cannot do this, due to the extent of Medicare in their practices, will retire early, sell their practices to the hospital, not accept new Medicare patients, or simply close their doors and walk away.

Hopefully, this was not the intent that the government had in mind for healthcare reform.

Rumors abound that in order to “encourage” the acceptance of Medicare, it will be a contingent to participation in other healthcare plans.

Unlike the perception that many in the public hold, the problem with wanting to maintain the Medicare rates is not greed, but a clawing for financial survival with expenses and liability escalating.

It will become harder to find the physician that accepts Medicare outside of the hospitals and large facilities.

What is your take on the situation?

Kudos to Lazaridis and Research in Motion

At a time where we are constantly hearing about business and the lack of ethics, it is especially refreshing to hear about Mike Lazaridis, the founder of Research in Motion and developer of the Blackberry phone.

Saudi Arabia, the latest in a long list of countries has put pressure on R.I.M. to spy on messages that phone users are leaving.  Rather than cave in to capture additional profits, Mr. Lazaridis made the choice to eliminate a country as purchasers and maintain his principles rather than to cave in to what he believes is wrong in order to capture more money.

Since R.I.M. wouldn’t “play ball”, Saudi Arabia ordered a ban on BlackBerry service, due to failure for the phone to meet its national regulatory requirements.  (so presumably the ability to spy is a requirement).

In his stance with governmental ability to monitor messages from the BlackBerry network, Mr. Lazaridis commented “We’re not going to compromise that”, “That’s what’s made BlackBerry the No. one solution world-wide”. He also stressed that “if you were to ban strong encryption, you would shut down corporations, business, commerce, banking and the internet. “That’s not likely to happen.”

So, kudos to you Mr. Lazaridis and Research in Motion.

The Value of Hiring a H.I.T. man

The article today was submitted by Dereke L.Jones

Confusion reigns due to the many transitions and federally mandated upgrades regarding medical information.

From the switch to 5010 transaction standards in preparation for ICD-10-CM/PCS to the adoption of EMR, the value of HIT expertise must soon be realized. When considering the many changes that will take place the anxiety of some healthcare organizations may face are very understandable.

In the HIM community there is excitement because HIT experts are aware of the many benefits and opportunities that will arise for healthcare facilities as a result of these technological advancements.

The ICD-10-CM is a more concise adaptation of modern medicine and a more specific billing platform. The restructuring of the disease and procedural categories will lead to increased billing and coding efficiency, thus leading to better reimbursement. ICD-10-CM along with the adoption of electronic medical records will provide increased clinical workflows and even revenue.

EMR adoption is slowly on the rise but there is still seems to be a real sense of future shock amongst physicians who are not prepared to adapt to new technologies. An increasingly competitive EMR market makes the margin for implementation error extremely wide. Increased roles of HIT men (and women) are vital in targeting the best system to fit the needs of its users and the available HITECH funds to purchase these systems.

There are many factors to consider when choosing an EMR so a professional should be on hand to assess clinical and administrative needs before selecting. It is extremely important to match your healthcare facility to the appropriate software.

For instance there are two very similar but different approaches to software delivery, SAAS (software as a service) and the more common ASP (application service provider). Often these terms are used interchangeably and they should not be. It’s easy to misunderstand the differences between the two because the differences are few but notable. The most apparent difference is the large upfront cost of the SAAS model to the more cost effective pay per month method of licensed ASP applications. ASP is on premise single tenant software, while SAAS offers a common set of licensed applications to multiple users from a secure internet data center. The data center eases the burden of software customization while IT support must be on site to customize and upgrade locally hosted ASP software. Usability of both are virtually the same once implemented and this is perhaps the reason some consider them equal.

During these times of transition HIT men & (women) will be helpful identifying the various subtle but not so subtle differences in EMR software.

About Dereke L. Jones:

He is an HIT specialist with an insatiable drive to help sketch the roadmap to a healthier nation by means of advanced Medical Information and offers EMR consulting services as well as standards compliance training to physician practices. Dtreljones@yahoo.com

Hybrid EMR Systems Help Transition Docs

The following article is submitted by guest writer Dereke Jones,  specializing in Information Technology and Services.  He is a former Program Coordinator at Ohio Services Unlimited

Lots of physicians work in a hybrid (paper & emr) environment as they transition to electronic records. After patient discharge that paper record is usually scanned into an electronic document capture system. The record is then made available electronically after quantitative and qualitative analysis have been performed. The action taken  with paper records after that point may differ according to the retention standards of the facility.

Features of an SAAS (Software as a service) allow electronic medical record transition in which users may begin with the system in no time. This is because implementations are internet-based and applications are deployed directly from the saas data center.

Through saas implementations EMR transitions are fairly quick and painless. Now, transitions through an ASP (Application service provider) are slow due to borrowed commercial software from other providers. This may be the difference between the paper trails and the seamless transition and immediate EMR functionality.

There is no difference in usability between saas and asp models once they are implemented, but implementation itself is not the same. Saas is known to be the less time consuming method and I am not saying that asp models can not be implemented quickly because it is possible with the correct IT support. Generally asp being installed anywhere near as fast as saas applications are simply not the case and yes implementation for both is big operations. Getting appropriate data to doctors and combining treatment and workflow are some of the core functions of the EMR itself and these things should be possible without paper once EMR is up and running. Although paper records may no longer be necessary, some physicians may keep them in use until they are completely comfortable with their new system.

Saas is known to be the less time consuming method and I am not saying that asp models can not be implemented quickly because it is possible with the correct IT support. Generally asp being installed anywhere near as fast as saas applications are simply not the case and yes implementation for both is big operations. Getting appropriate data to doctors and combining treatment and workflow are some of the core functions of the EMR itself and these things should be possible without paper once EMR is up and running. Although paper records may no longer be necessary, some physicians may keep them in use until they are completely comfortable with their new system.