According to Dr. Berwick who was recently given a recess appointment by President Obama to head CMS (centers for Medicare and Medicaid), a “pay-for-performance” program will decrease the cost of healthcare. This statement comes from someone who spent most of his career as an academician, not a practicing physician as his pediatric training would suggest.

More troubling is that deviation from guidelines being set will be construed as insurance fraud, thereby making physicians criminals.

So, let’s take a closer look at this. If a doctor evaluates you and decides that a particular medical option would be in your best interest and it is not on the regular guidelines that makes him a criminal? Now it makes him vulnerable to fines and jail time?

More frightening still is that state insurance administrators are establishing guidelines. These people are basing their decision on economics not sound medical options. It was not so long ago that I was told by insurance personnel, “ we are not trained in medicine”. “When we reject treatment reimbursement for a patient being pre-certified, it is not because of the need, it is because we don’t feel that it is something that we should pay for. If you feel that the patient needs a particular treatment and you don’t recommend it, you are totally liable!”

In Massachusetts, Obama’s healthcare model purports to say that doctors who don’t comply with the structure established by state insurance administrators will be publicly discredited and harassed while the patients will be required to pay out of pocket at triple the cost.

This seems that it is not only the physicians who are damned.  It is the public….you and me!

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.

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

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 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?

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?

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?

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?

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 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