http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=19464830&as=33379 Most Recent Submissions from RichardReeceMD on Modern Medicine Community Thu, 16 Dec 2010 20:40:54 GMT Thu, 16 Dec 2010 20:40:54 GMT modmedadmin@advanstar.com (ModernMedicine) modmedadmin@advanstar.com (ModernMedicine) KickApps Feed Builder 2010-12-16T20:40:54Z 39 http://community.modernmedicine.com/service/searchEverything.kickAction?as=33379&includeVideo=on&includeAudio=on&includePhoto=on&includeBlog=on&sortType=recent 0 http://community.modernmedicine.com/_Physician-Foundation-Grassroots-Report/blog/3111506/33379.html I would like to bring to your attention a remarkable document. It is a 110 page white paper Health Reform and the Decline of Physician Private Practice. It is a grassroots report conducted on behalf of The Physicians Foundation by Merritt Hawkins, the nation’s largest physician recruiting firm. The Foundation is a nonpartisan, grant-making organization representing independent practicing physicians in state medical societies. Why do I say the document is remarkable? Because it puts health reform in perspective. Amidst all the sound and fury about the health reform law, it tells what’s happening to physicians on the ground and where they are on that ground. Where Doctors Practice The document notes, for example, where doctors actually practice. To hear health reform critics talk, you would think most doctors do their work in large integrated groups or medical centers. Not so. Most of them hang out in solo or small to medium-sized groups. Solo, two physician practices, 32% Group practice, 3-5 doctors, 15% Group practices, 6-10 doctors, 19% Hospital-based, 13% Medical schools/university, 7% Group practice, 51+ doctors , 6% Group/Staff HMO, 4% Community health centers, 3% What’s Happening at the Grassroots The document observes that “informal reform,” socioeconomic trends and pressures on the ground, are just as important, perhaps even more so, than policies being dictated from Washington as embodied in the new health care law. These trends and pressures include: The replacement of traditional independent practice by consolidated entities – hospital-doctor alliances, larger groups, and emerging models, such as accountable care organizations, medical homes, concierge practices, and community health centers. Legal and government pressures fostering and forcing an environment to “comply” with outside authorities and statutes and “improvement” and “compliance” measures. Increased demand for physician services in the face of growing physician shortages, especially of primary care doctors and general surgeons, with no relief in sight because of time required to mint new physicians. The “imperative to care for more patients, to provide higher perceived quality, at less costs, with increased reporting and tracking demands, in an environment of high potential liability and problematic reimbursement," Many physicians regard these imperatives as "mission improbable," or to use a word that runs through the report, as "problematic." The reluctance of Congress to include a “fix” for reasonable doctor Medicare pay, as embodied in the SGR formula, which indicates to physicians that Congress is not on the side of doctors, that health care is too important in the minds of politicians to be left to doctors, and that the viewpoint of doctors in likely to be ignored, further disengaging doctors from the profession and making access to them more difficult. Changes induced by reform, both “informal” and “formal” are inevitable and sometimes necessary, but do not bode well for increased coverage, quality, access, and private independent practice survival, which now and in the future, will be required for a high quality accessible health system. Doctors, conveniently available on the ground and using individual clinical judgment rather than just marching to government mandates, are important, especially when you are sick and need their help. I would like to bring to your attention a remarkable document. It is a 110 page white paper Health Reform and the Decline of Physician Private Practice. It is a grassroots report conducted on behalf of The Physicians Foundation by Merritt Hawkins, the nation’s largest physician recruiting firm. The Foundation is a nonpartisan, grant-making organization representing independent practicing physicians in state medical societies. Why do I say the document is remarkable? Because it puts health reform in perspective. Amidst all the sound and fury about the health reform law, it tells what’s happening to physicians on the ground and where they are on that ground. Where Doctors Practice The document notes, for example, where doctors actually practice. To hear health reform critics talk, you would think most doctors do their work in large integrated groups or medical centers. Not so. Most of them hang out in solo or small to medium-sized groups. Solo, two physician practices, 32% Group practice, 3-5 doctors, 15% Group practices, 6-10 doctors, 19% Hospital-based, 13% Medical schools/university, 7% Group practice, 51+ doctors , 6% Group/Staff HMO, 4% Community health centers, 3% What’s Happening at the Grassroots The document observes that “informal reform,” socioeconomic trends and pressures on the ground, are just as important, perhaps even more so, than policies being dictated from Washington as embodied in the new health care law. These trends and pressures include: The replacement of traditional independent practice by consolidated entities – hospital-doctor alliances, larger groups, and emerging models, such as accountable care organizations, medical homes, concierge practices, and community health centers. Legal and government pressures fostering and forcing an environment to “comply” with outside authorities and statutes and “improvement” and “compliance” measures. Increased demand for physician services in the face of growing physician shortages, especially of primary care doctors and general surgeons, with no relief in sight because of time required to mint new physicians. The “imperative to care for more patients, to provide higher perceived quality, at less costs, with increased reporting and tracking demands, in an environment of high potential liability and problematic reimbursement," Many physicians regard these imperatives as "mission improbable," or to use a word that runs through the report, as "problematic." The reluctance of Congress to include a “fix” for reasonable doctor Medicare pay, as embodied in the SGR formula, which indicates to physicians that Congress is not on the side of doctors, that health care is too important in the minds of politicians to be left to doctors, and that the viewpoint of doctors in likely to be ignored, further disengaging doctors from the profession and making access to them more difficult. Changes induced by reform, both “informal” and “formal” are inevitable and sometimes necessary, but do not bode well for increased coverage, quality, access, and private independent practice survival, which now and in the future, will be required for a high quality accessible health system. Doctors, conveniently available on the ground and using individual clinical judgment rather than just marching to government mandates, are important, especially when you are sick and need their help. Thu, 16 Dec 2010 20:42:35 GMT http://community.modernmedicine.com/_Physician-Foundation-Grassroots-Report/blog/3111506/33379.html RichardReeceMD 2010-12-16T20:40:54Z Health Law & Policy Modern Medicine Community I would like to bring to your attention a remarkable document. It is a 110 page white paper Health Reform and the Decline of Physician Private Practice. It is a grassroots report conducted on behalf of The Physicians Foundation by Merritt Hawkins, the nation’s largest physician recruiting firm. The Foundation is a nonpartisan, grant-making organization representing independent practicing physicians in state medical societies. Why do I say the document is remarkable? Because it puts health reform in perspective. Amidst all the sound and fury about the health reform law, it tells what’s happening to physicians on the ground and where they are on that ground. Where Doctors Practice The document notes, for example, where doctors actually practice. To hear health reform critics talk, you would think most doctors do their work in large integrated groups or medical centers. Not so. Most of them hang out in solo or small to medium-sized groups. Solo, two physician practices, 32% Group practice, 3-5 doctors, 15% Group practices, 6-10 doctors, 19% Hospital-based, 13% Medical schools/university, 7% Group practice, 51+ doctors , 6% Group/Staff HMO, 4% Community health centers, 3% What’s Happening at the Grassroots The document observes that “informal reform,” socioeconomic trends and pressures on the ground, are just as important, perhaps even more so, than policies being dictated from Washington as embodied in the new health care law. These trends and pressures include: The replacement of traditional independent practice by consolidated entities – hospital-doctor alliances, larger groups, and emerging models, such as accountable care organizations, medical homes, concierge practices, and community health centers. Legal and government pressures fostering and forcing an environment to “comply” with outside authorities and statutes and “improvement” and “compliance” measures. Increased demand for physician services in the face of growing physician shortages, especially of primary care doctors and general surgeons, with no relief in sight because of time required to mint new physicians. The “imperative to care for more patients, to provide higher perceived quality, at less costs, with increased reporting and tracking demands, in an environment of high potential liability and problematic reimbursement," Many physicians regard these imperatives as "mission improbable," or to use a word that runs through the report, as "problematic." The reluctance of Congress to include a “fix” for reasonable doctor Medicare pay, as embodied in the SGR formula, which indicates to physicians that Congress is not on the side of doctors, that health care is too important in the minds of politicians to be left to doctors, and that the viewpoint of doctors in likely to be ignored, further disengaging doctors from the profession and making access to them more difficult. Changes induced by reform, both “informal” and “formal” are inevitable and sometimes necessary, but do not bode well for increased coverage, quality, access, and private independent practice survival, which now and in the future, will be required for a high quality accessible health system. Doctors, conveniently available on the ground and using individual clinical judgment rather than just marching to government mandates, are important, especially when you are sick and need their help. health law & policy nonadult false Physician Foundation Grassroots Report text blog health law & policy 885 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=19464830&as=33379 http://media.kickstatic.com/kickapps/images/user/defaultImage_160x120_B.jpg false 0 Health Law & Policy 0 3111506 19464830 Member 0 http://community.modernmedicine.com/_With-Health-Reform-the-Next-Four-Years-are-Critical/blog/2690377/33379.html Because of a series of things (Democrat-adverse November elections, Obama’s plummeting ratings , continued 60% disapproval of Obamacare, disruptions inherent in the health care law, resistance in the states to financial and bureaucratic burdens the new law imposes, price hikes of insurance premiums and mounting skepticism of physicians), the implementation of the Accountable Care Act over the next four years will be no cakewalk. Why four years? In the first place, most of the big reforms--covering 32 million uninsured and getting the health exchanges in place--do not take effect until 2014. Second, multiple disruptions--patients losing their old plans; spikes in costs; and complaints among consumers, physicians, and businesses; and health plans and agents dropping out of the market--will be rampant in the 2010-2014 interval. Here is how CC Jennings and KJ Hayes, principals of Jennings Policy Strategies in Washington D.C., describe the reform landscape:1“In the aftermath of the enactment of the Affordable Care Act, President Barack Obama and his administration are walking a policy tightrope; they must implement meaningful reforms in the transition to a stable insurance market without unduly disrupting existing insurance arrangements by means of excessive increases in premiums or declines in coverage.” I wish the Obama team luck. They will need it. They are dealing with an angry public who are profoundly skeptical about the personal and financial implications of Obamacare. Health plans are hiking premiums to deal with new expenses imposed by the new law, business are negotiating new contracts that shift more costs to consumers. Physicians are up in arms about regulations and other hassles accompanying the new law.In a recent article in the Wall Street Journal (September 1), Hal Scherz, MD, a pediatric urologic surgeon at Georgia Urology and Children's Healthcare of Atlanta, who serves on the faculty of Emory University Medical School and as president and co-founder of Docs4PatientCare, says he and thousands of other doctors are giving patients a letter calling for a repeal of Obamacare.The text of the letter contains this language:"Dear Patient: Section 1311 of the new health care legislation gives the U.S. Secretary of Health and Human Services and her appointees the power to establish care guidelines that your doctor must abide by or face penalties and fines." "In making doctors answerable in the federal bureaucracy, this bill effectively makes them government employees and means that you and your doctor are no longer in charge of your health care decisions. This new law politicizes medicine and in my opinion destroys the sanctity of the doctor-patient relationship that makes the American health care system the best in the world.""Despite countless protests by doctors and overwhelming public opposition—up to 60% of Americans opposed this bill—the current party in control of Congress pushed this bill through with legal bribes and Chicago style threats and is determined now to resist any 'repeal and replace' efforts." "This doctor's office is non-partisan—always has been, always will be. But the fact is that every Republican voted against this bad bill while the Democratic Party leadership and the White House completely dismissed the will of the people in ruthlessly pushing through this legislation.""In the face of voter anger, some Democratic candidates are now trying to make a cosmetic retreat, calling for minor modifications or pretending they are opposed to government-run medicine. Once the election is over, however, they will vote with their party bosses against repealing this bill.""Please remember when you vote this November that, unless the Democratic Party receives a strong negative message about this power grab, our health care system will never be fixed and the doctor-patient relationship will be ruined forever." I am not at all sure what impact this letter will have, but it shows the temper of the times among doctors. Reference1.    Jennings CC and Hayes KJ. Perspective: Walking the tightrope of health insurance reform between 2010 and 2014. N Engl J Med. 2010; 363:897-899. Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Because of a series of things (Democrat-adverse November elections, Obama’s plummeting ratings , continued 60% disapproval of Obamacare, disruptions inherent in the health care law, resistance in the states to financial and bureaucratic burdens the new law imposes, price hikes of insurance premiums and mounting skepticism of physicians), the implementation of the Accountable Care Act over the next four years will be no cakewalk. Why four years? In the first place, most of the big reforms--covering 32 million uninsured and getting the health exchanges in place--do not take effect until 2014. Second, multiple disruptions--patients losing their old plans; spikes in costs; and complaints among consumers, physicians, and businesses; and health plans and agents dropping out of the market--will be rampant in the 2010-2014 interval. Here is how CC Jennings and KJ Hayes, principals of Jennings Policy Strategies in Washington D.C., describe the reform landscape:1“In the aftermath of the enactment of the Affordable Care Act, President Barack Obama and his administration are walking a policy tightrope; they must implement meaningful reforms in the transition to a stable insurance market without unduly disrupting existing insurance arrangements by means of excessive increases in premiums or declines in coverage.” I wish the Obama team luck. They will need it. They are dealing with an angry public who are profoundly skeptical about the personal and financial implications of Obamacare. Health plans are hiking premiums to deal with new expenses imposed by the new law, business are negotiating new contracts that shift more costs to consumers. Physicians are up in arms about regulations and other hassles accompanying the new law.In a recent article in the Wall Street Journal (September 1), Hal Scherz, MD, a pediatric urologic surgeon at Georgia Urology and Children's Healthcare of Atlanta, who serves on the faculty of Emory University Medical School and as president and co-founder of Docs4PatientCare, says he and thousands of other doctors are giving patients a letter calling for a repeal of Obamacare.The text of the letter contains this language:"Dear Patient: Section 1311 of the new health care legislation gives the U.S. Secretary of Health and Human Services and her appointees the power to establish care guidelines that your doctor must abide by or face penalties and fines." "In making doctors answerable in the federal bureaucracy, this bill effectively makes them government employees and means that you and your doctor are no longer in charge of your health care decisions. This new law politicizes medicine and in my opinion destroys the sanctity of the doctor-patient relationship that makes the American health care system the best in the world.""Despite countless protests by doctors and overwhelming public opposition—up to 60% of Americans opposed this bill—the current party in control of Congress pushed this bill through with legal bribes and Chicago style threats and is determined now to resist any 'repeal and replace' efforts." "This doctor's office is non-partisan—always has been, always will be. But the fact is that every Republican voted against this bad bill while the Democratic Party leadership and the White House completely dismissed the will of the people in ruthlessly pushing through this legislation.""In the face of voter anger, some Democratic candidates are now trying to make a cosmetic retreat, calling for minor modifications or pretending they are opposed to government-run medicine. Once the election is over, however, they will vote with their party bosses against repealing this bill.""Please remember when you vote this November that, unless the Democratic Party receives a strong negative message about this power grab, our health care system will never be fixed and the doctor-patient relationship will be ruined forever." I am not at all sure what impact this letter will have, but it shows the temper of the times among doctors. Reference1.    Jennings CC and Hayes KJ. Perspective: Walking the tightrope of health insurance reform between 2010 and 2014. N Engl J Med. 2010; 363:897-899. Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Wed, 29 Sep 2010 20:14:51 GMT http://community.modernmedicine.com/_With-Health-Reform-the-Next-Four-Years-are-Critical/blog/2690377/33379.html RichardReeceMD 2010-09-29T19:41:19Z Managing Your Practice Modern Medicine Community Because of a series of things (Democrat-adverse November elections, Obama’s plummeting ratings , continued 60% disapproval of Obamacare, disruptions inherent in the health care law, resistance in the states to financial and bureaucratic burdens the new law imposes, price hikes of insurance premiums and mounting skepticism of physicians), the implementation of the Accountable Care Act over the next four years will be no cakewalk. Why four years? In the first place, most of the big reforms--covering 32 million uninsured and getting the health exchanges in place--do not take effect until 2014. Second, multiple disruptions--patients losing their old plans; spikes in costs; and complaints among consumers, physicians, and businesses; and health plans and agents dropping out of the market--will be rampant in the 2010-2014 interval. Here is how CC Jennings and KJ Hayes, principals of Jennings Policy Strategies in Washington D.C., describe the reform landscape:1“In the aftermath of the enactment of the Affordable Care Act, President Barack Obama and his administration are walking a policy tightrope; they must implement meaningful reforms in the transition to a stable insurance market without unduly disrupting existing insurance arrangements by means of excessive increases in premiums or declines in coverage.” I wish the Obama team luck. They will need it. They are dealing with an angry public who are profoundly skeptical about the personal and financial implications of Obamacare. Health plans are hiking premiums to deal with new expenses imposed by the new law, business are negotiating new contracts that shift more costs to consumers. Physicians are up in arms about regulations and other hassles accompanying the new law.In a recent article in the Wall Street Journal (September 1), Hal Scherz, MD, a pediatric urologic surgeon at Georgia Urology and Children's Healthcare of Atlanta, who serves on the faculty of Emory University Medical School and as president and co-founder of Docs4PatientCare, says he and thousands of other doctors are giving patients a letter calling for a repeal of Obamacare.The text of the letter contains this language:"Dear Patient: Section 1311 of the new health care legislation gives the U.S. Secretary of Health and Human Services and her appointees the power to establish care guidelines that your doctor must abide by or face penalties and fines." "In making doctors answerable in the federal bureaucracy, this bill effectively makes them government employees and means that you and your doctor are no longer in charge of your health care decisions. This new law politicizes medicine and in my opinion destroys the sanctity of the doctor-patient relationship that makes the American health care system the best in the world.""Despite countless protests by doctors and overwhelming public opposition—up to 60% of Americans opposed this bill—the current party in control of Congress pushed this bill through with legal bribes and Chicago style threats and is determined now to resist any 'repeal and replace' efforts." "This doctor's office is non-partisan—always has been, always will be. But the fact is that every Republican voted against this bad bill while the Democratic Party leadership and the White House completely dismissed the will of the people in ruthlessly pushing through this legislation.""In the face of voter anger, some Democratic candidates are now trying to make a cosmetic retreat, calling for minor modifications or pretending they are opposed to government-run medicine. Once the election is over, however, they will vote with their party bosses against repealing this bill.""Please remember when you vote this November that, unless the Democratic Party receives a strong negative message about this power grab, our health care system will never be fixed and the doctor-patient relationship will be ruined forever." I am not at all sure what impact this letter will have, but it shows the temper of the times among doctors. Reference1.    Jennings CC and Hayes KJ. Perspective: Walking the tightrope of health insurance reform between 2010 and 2014. N Engl J Med. 2010; 363:897-899. Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] health care reform, managing your practice nonadult false With Health Reform, the Next Four Years are Critical text blog health care reform,managing your practice 484 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=19464830&as=33379 http://media.kickstatic.com/kickapps/images/user/defaultImage_160x120_E.jpg false 0 Managing Your Practice 0 2690377 19464830 Member 0 http://community.modernmedicine.com/_Physicians-and-Economic-Uncertainty/blog/2535294/33379.html Physician practices are like small businesses. Physicians dislike uncertainty. They hesitate to invest in new equipment, balk at hiring new staff, and step back from bold innovations. For the economy as a whole, physician uncertainty is not an insignificant problem. Health care is the only expanding economic sector. It consumes 17% of GDP. At its heart, economic expansion is psychological. Uncertainty breeds recession. These are uncertain times. We may be in the throes of a double-dip recession. Unemployment hovers near 10%. All three major stock indices are at yearly lows. Confidence in Obama’s leadership is low as well. Adding to these uncertainties are impacts of Obamacare on physicians and costs of doing business. To bring costs down, the Administration says it will gut Medicare by $585 billion. This will require cutting physician and hospital pay, rationing care, trimming waste and abuse, and rationalizing physician practices through these demonstration projects: Bundling of physician and hospital fees Forming accountable care organizations Paying for performance through comparative data analysis Coordinating care for the elderly, who consume 85% of resources. These four demonstration projects are experimental and therefore uncertain. Then there are the employers themselves. Before ACA, the affordable care act, an acronym and oxymoron wrapped in one package. Starting in 2003, Congress reimbursed the employer for 28% of cost of prescription drugs for retirees. ACA ended that. Instead it taxed the benefit. The change will cost business $14 billion. Under ACA, business will have to cough up another $20 billion or so to cover the cost of covering children of employees up to age 26.The new law will impose fees and excise taxes and coverage of those with pre-existing illnesses on health plans. The plans will pass their increased costs of doing business on to business. All told, in its first year, ACA will raise health insurance costs for business by more than 10%. Add to these uncertainties these certainties. Taxes will be raised to pay for the $13 trillion deficit. This year the deficit accounted for 24% of GDP, a record unsurpassed since World War II. The national debt will reach 62% of gross domestic product by the end of this year, the nonpartisan Congressional Budget Office said recently. The deficit, largely a product of entitlement, may require a VAT tax to cover. Obama has made no secret he will cancel Bush tax cuts when they run out this year. He will hike capital gains taxes. All of this creates more uncertainty. It defies past history. Presidents John Kennedy and Ronald Reagan made permanent tax cuts. The certainty of these cuts “lifted all boats.” At the moment, physicians as business people and employers-at-large have a sinking feeling. Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Physician practices are like small businesses. Physicians dislike uncertainty. They hesitate to invest in new equipment, balk at hiring new staff, and step back from bold innovations. For the economy as a whole, physician uncertainty is not an insignificant problem. Health care is the only expanding economic sector. It consumes 17% of GDP. At its heart, economic expansion is psychological. Uncertainty breeds recession. These are uncertain times. We may be in the throes of a double-dip recession. Unemployment hovers near 10%. All three major stock indices are at yearly lows. Confidence in Obama’s leadership is low as well. Adding to these uncertainties are impacts of Obamacare on physicians and costs of doing business. To bring costs down, the Administration says it will gut Medicare by $585 billion. This will require cutting physician and hospital pay, rationing care, trimming waste and abuse, and rationalizing physician practices through these demonstration projects: Bundling of physician and hospital fees Forming accountable care organizations Paying for performance through comparative data analysis Coordinating care for the elderly, who consume 85% of resources. These four demonstration projects are experimental and therefore uncertain. Then there are the employers themselves. Before ACA, the affordable care act, an acronym and oxymoron wrapped in one package. Starting in 2003, Congress reimbursed the employer for 28% of cost of prescription drugs for retirees. ACA ended that. Instead it taxed the benefit. The change will cost business $14 billion. Under ACA, business will have to cough up another $20 billion or so to cover the cost of covering children of employees up to age 26.The new law will impose fees and excise taxes and coverage of those with pre-existing illnesses on health plans. The plans will pass their increased costs of doing business on to business. All told, in its first year, ACA will raise health insurance costs for business by more than 10%. Add to these uncertainties these certainties. Taxes will be raised to pay for the $13 trillion deficit. This year the deficit accounted for 24% of GDP, a record unsurpassed since World War II. The national debt will reach 62% of gross domestic product by the end of this year, the nonpartisan Congressional Budget Office said recently. The deficit, largely a product of entitlement, may require a VAT tax to cover. Obama has made no secret he will cancel Bush tax cuts when they run out this year. He will hike capital gains taxes. All of this creates more uncertainty. It defies past history. Presidents John Kennedy and Ronald Reagan made permanent tax cuts. The certainty of these cuts “lifted all boats.” At the moment, physicians as business people and employers-at-large have a sinking feeling. Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Fri, 06 Aug 2010 16:47:55 GMT http://community.modernmedicine.com/_Physicians-and-Economic-Uncertainty/blog/2535294/33379.html RichardReeceMD 2010-08-06T16:34:58Z Health Law & Policy Modern Medicine Community Physician practices are like small businesses. Physicians dislike uncertainty. They hesitate to invest in new equipment, balk at hiring new staff, and step back from bold innovations. For the economy as a whole, physician uncertainty is not an insignificant problem. Health care is the only expanding economic sector. It consumes 17% of GDP. At its heart, economic expansion is psychological. Uncertainty breeds recession. These are uncertain times. We may be in the throes of a double-dip recession. Unemployment hovers near 10%. All three major stock indices are at yearly lows. Confidence in Obama’s leadership is low as well. Adding to these uncertainties are impacts of Obamacare on physicians and costs of doing business. To bring costs down, the Administration says it will gut Medicare by $585 billion. This will require cutting physician and hospital pay, rationing care, trimming waste and abuse, and rationalizing physician practices through these demonstration projects: Bundling of physician and hospital fees Forming accountable care organizations Paying for performance through comparative data analysis Coordinating care for the elderly, who consume 85% of resources. These four demonstration projects are experimental and therefore uncertain. Then there are the employers themselves. Before ACA, the affordable care act, an acronym and oxymoron wrapped in one package. Starting in 2003, Congress reimbursed the employer for 28% of cost of prescription drugs for retirees. ACA ended that. Instead it taxed the benefit. The change will cost business $14 billion. Under ACA, business will have to cough up another $20 billion or so to cover the cost of covering children of employees up to age 26.The new law will impose fees and excise taxes and coverage of those with pre-existing illnesses on health plans. The plans will pass their increased costs of doing business on to business. All told, in its first year, ACA will raise health insurance costs for business by more than 10%. Add to these uncertainties these certainties. Taxes will be raised to pay for the $13 trillion deficit. This year the deficit accounted for 24% of GDP, a record unsurpassed since World War II. The national debt will reach 62% of gross domestic product by the end of this year, the nonpartisan Congressional Budget Office said recently. The deficit, largely a product of entitlement, may require a VAT tax to cover. Obama has made no secret he will cancel Bush tax cuts when they run out this year. He will hike capital gains taxes. All of this creates more uncertainty. It defies past history. Presidents John Kennedy and Ronald Reagan made permanent tax cuts. The certainty of these cuts “lifted all boats.” At the moment, physicians as business people and employers-at-large have a sinking feeling. Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] act”, care, health law & policy, mmglobal, reform”, “affordable, “health nonadult false Physicians and Economic Uncertainty text blog act”,care,health law & policy,mmglobal,reform”,“affordable,“health 423 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=19464830&as=33379 http://media.kickstatic.com/kickapps/images/user/defaultImage_160x120_A.jpg false 0 Health Law & Policy 0 2535294 19464830 Member 0 http://community.modernmedicine.com/_Health-Care-Fatigue-and-the-War-Between-the-States/blog/2535291/33379.html “This health care thing is just a vehicle, a vehicle for the debate about what is the role of the federal government and what is the role of the states.” Missouri State Senator, Jim Lembke, a Republican, as quoted in “Missouri Voters To Have Say on Health Law,” New York Times, August 1, 2010 I was recently at a physicians’ meeting about how we could make our opinions known and how we might shape the continuing debate on health reform. One participant in the meeting commented, “Health care fatigue has set in. Will health care even be an issue in the November elections?” I believe it will be. It boils down to the new War Between the States. The states will bear the financial burden of the law, which shifts 20% of costs of 16 million newly insured to Medicaid to the states. The states, unlike the federal government, must balance their budgets. The new law may break their budgetary banks. Lest you forget, the health law was the signature issue that elected Senator Scott Brown in Massachusetts. And it may be in other states as well, for health reform exemplifies and magnifies fears of Big Government taking away personal liberties. Next Tuesday, August 3, Missourians will vote on nullifying the health care law that requires people to pay insurance or pay a penalty. Five other states--Arizona, Georgia, Idaho, Louisiana, and Virginia—have already enacted similar measures, and voters will go to the polls on similar constitutional amendments in Oklahoma and Arizona in November. Elected officials in 22 states have filed lawsuits challenging the individual mandate. The US Supreme Court may have to resolve all these issues. According to Rasmussen, who polls only likely voters, 56% support Repeal and Replacement, but only 48% think voters can do much about it, no matter what the outcome of the November 2 midterm elections. I predict health reform will resurface as a central issue in November. Physicians can play a constructive role in influencing the November election by pointing out its consequences on physicians and patients, positive and negative, of the new law. No other issue can match the magnitude, complexity, universality, and controversial aspects of the new law. Physicians, more than any other group, know firsthand what it entails for patients. So do the states, which must bear the burdens and expenses of its implementation. Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] “This health care thing is just a vehicle, a vehicle for the debate about what is the role of the federal government and what is the role of the states.” Missouri State Senator, Jim Lembke, a Republican, as quoted in “Missouri Voters To Have Say on Health Law,” New York Times, August 1, 2010 I was recently at a physicians’ meeting about how we could make our opinions known and how we might shape the continuing debate on health reform. One participant in the meeting commented, “Health care fatigue has set in. Will health care even be an issue in the November elections?” I believe it will be. It boils down to the new War Between the States. The states will bear the financial burden of the law, which shifts 20% of costs of 16 million newly insured to Medicaid to the states. The states, unlike the federal government, must balance their budgets. The new law may break their budgetary banks. Lest you forget, the health law was the signature issue that elected Senator Scott Brown in Massachusetts. And it may be in other states as well, for health reform exemplifies and magnifies fears of Big Government taking away personal liberties. Next Tuesday, August 3, Missourians will vote on nullifying the health care law that requires people to pay insurance or pay a penalty. Five other states--Arizona, Georgia, Idaho, Louisiana, and Virginia—have already enacted similar measures, and voters will go to the polls on similar constitutional amendments in Oklahoma and Arizona in November. Elected officials in 22 states have filed lawsuits challenging the individual mandate. The US Supreme Court may have to resolve all these issues. According to Rasmussen, who polls only likely voters, 56% support Repeal and Replacement, but only 48% think voters can do much about it, no matter what the outcome of the November 2 midterm elections. I predict health reform will resurface as a central issue in November. Physicians can play a constructive role in influencing the November election by pointing out its consequences on physicians and patients, positive and negative, of the new law. No other issue can match the magnitude, complexity, universality, and controversial aspects of the new law. Physicians, more than any other group, know firsthand what it entails for patients. So do the states, which must bear the burdens and expenses of its implementation. Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Fri, 06 Aug 2010 16:47:24 GMT http://community.modernmedicine.com/_Health-Care-Fatigue-and-the-War-Between-the-States/blog/2535291/33379.html RichardReeceMD 2010-08-06T16:31:32Z Health Law & Policy Modern Medicine Community “This health care thing is just a vehicle, a vehicle for the debate about what is the role of the federal government and what is the role of the states.” Missouri State Senator, Jim Lembke, a Republican, as quoted in “Missouri Voters To Have Say on Health Law,” New York Times, August 1, 2010 I was recently at a physicians’ meeting about how we could make our opinions known and how we might shape the continuing debate on health reform. One participant in the meeting commented, “Health care fatigue has set in. Will health care even be an issue in the November elections?” I believe it will be. It boils down to the new War Between the States. The states will bear the financial burden of the law, which shifts 20% of costs of 16 million newly insured to Medicaid to the states. The states, unlike the federal government, must balance their budgets. The new law may break their budgetary banks. Lest you forget, the health law was the signature issue that elected Senator Scott Brown in Massachusetts. And it may be in other states as well, for health reform exemplifies and magnifies fears of Big Government taking away personal liberties. Next Tuesday, August 3, Missourians will vote on nullifying the health care law that requires people to pay insurance or pay a penalty. Five other states--Arizona, Georgia, Idaho, Louisiana, and Virginia—have already enacted similar measures, and voters will go to the polls on similar constitutional amendments in Oklahoma and Arizona in November. Elected officials in 22 states have filed lawsuits challenging the individual mandate. The US Supreme Court may have to resolve all these issues. According to Rasmussen, who polls only likely voters, 56% support Repeal and Replacement, but only 48% think voters can do much about it, no matter what the outcome of the November 2 midterm elections. I predict health reform will resurface as a central issue in November. Physicians can play a constructive role in influencing the November election by pointing out its consequences on physicians and patients, positive and negative, of the new law. No other issue can match the magnitude, complexity, universality, and controversial aspects of the new law. Physicians, more than any other group, know firsthand what it entails for patients. So do the states, which must bear the burdens and expenses of its implementation. Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] health law & policy, law”, reform”, “health, “healthcare nonadult false Health Care Fatigue and the War Between the States text blog health law & policy,law”,reform”,“health,“healthcare 274 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=19464830&as=33379 http://media.kickstatic.com/kickapps/images/user/defaultImage_160x120_E.jpg false 0 Health Law & Policy 0 2535291 19464830 Member 0 http://community.modernmedicine.com/_Health-Care-and-the-Groundswell/blog/2496299/33379.html Groundswell is a book about the welling up of Internet-based social networking media sites—Facebook, YouTube, Twitter, Flickr, and other sites—as transforming forces in our society. Its authors, Charlene Li and Josh Bernoff, are executives at Forrester Research who conduct surveys to determine how people use technology. Using their extensive database, they discuss the whys, whats, and hows of the impact of the Internet on social and corporate behavior. The book’s purpose is to teach corporate clients how to use the Internet, the blogosphere, and social network sites to market products. They define the groundswell as a powerful social trend in which people use information technologies to get the things they need from each other rather than from traditional institutions like government, corporations, and the medical-industrial complex. They argue the groundswell is an irresistible, completely different way for people to relate and to connect with one another. Three forces propel the groundswell: 1. People, who have always depended on one another to get what they need and to rebel against institutional power 2. Technology, which has changed everything because 73% of people are now online and have broadband connectivity 3. Online Economics, which make it possible to get information virtually free, and which for marketers, makes it possible to influence millions of people through online research and online traffic reports. “The groundswell,” say the authors, “has changed the balance of power. Everybody can put up a site that connects people with people. If it is designed well, people will use it. They’ll tell their friends how to use it. They’ll conduct commerce, or read the news, or start a popular movement, or make loans to one another. Or whatever the site is designed to facilitate.” The groundswell is about power—the power of social connections between people, the power of the buzz, the power of word of mouth, the power of opinion, the power of free information, the power of personal marketing, the power of online advertising, and the power of the Internet to make obsolete and radically reform existing business models. What does this have to do with health care? Plenty. Getting health care information is the number one reason people visit the Internet. People use the Internet to assess from which doctors and which institutions they will get their care, which is why sites like America’s Top Doctors have been so popular. Health care institutions—Mayo, the Cleveland Clinic, and Sloan Kettering—have entire divisions devoted to Internet markets. Certain companies—like Practice Fusion, Inc, an EHR firm—can offer EHRs “free” because online marketers interested in reaching doctors subsidize the EHRs rather than doctors. Medical practices—through physician bloggers and practice websites—can connect personally and in targeted ways to their patient constituencies. Sites, like Carepages.com, can offer support information for patients, families, and friends about almost any given disease or medical situation. Sites like the Healthcare Blog can start movements like Health 2.0 designed to empower consumers. One well-known physician blogger, Kevin Pho, MD, has staked his career and made his name as "the social media's leading physician voice." He lists these previous blogs addressing the impact and the use of the social media on and for physicians: End-of-life blogging benefits and the questions it raises Social media starts the patient dialogue with doctors and nurses Social networking’s impact on patients, doctors, and non-profits Twitter can spread inaccurate medical information Twitter for doctors, a guide for health care professionals Twitter habits of pharmaceutical companies Twitter has problems in the operating room Why doctors should blog with their real name Quit smoking by using Facebook Twitter and Facebook can help conduct group patient visits Doctors using social media to talk to patients, but where's the evidence? I recommend you visit Kevinmd.com and click on one of these blogs to appreciate the power of the groundswell. Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Groundswell is a book about the welling up of Internet-based social networking media sites—Facebook, YouTube, Twitter, Flickr, and other sites—as transforming forces in our society. Its authors, Charlene Li and Josh Bernoff, are executives at Forrester Research who conduct surveys to determine how people use technology. Using their extensive database, they discuss the whys, whats, and hows of the impact of the Internet on social and corporate behavior. The book’s purpose is to teach corporate clients how to use the Internet, the blogosphere, and social network sites to market products. They define the groundswell as a powerful social trend in which people use information technologies to get the things they need from each other rather than from traditional institutions like government, corporations, and the medical-industrial complex. They argue the groundswell is an irresistible, completely different way for people to relate and to connect with one another. Three forces propel the groundswell: 1. People, who have always depended on one another to get what they need and to rebel against institutional power 2. Technology, which has changed everything because 73% of people are now online and have broadband connectivity 3. Online Economics, which make it possible to get information virtually free, and which for marketers, makes it possible to influence millions of people through online research and online traffic reports. “The groundswell,” say the authors, “has changed the balance of power. Everybody can put up a site that connects people with people. If it is designed well, people will use it. They’ll tell their friends how to use it. They’ll conduct commerce, or read the news, or start a popular movement, or make loans to one another. Or whatever the site is designed to facilitate.” The groundswell is about power—the power of social connections between people, the power of the buzz, the power of word of mouth, the power of opinion, the power of free information, the power of personal marketing, the power of online advertising, and the power of the Internet to make obsolete and radically reform existing business models. What does this have to do with health care? Plenty. Getting health care information is the number one reason people visit the Internet. People use the Internet to assess from which doctors and which institutions they will get their care, which is why sites like America’s Top Doctors have been so popular. Health care institutions—Mayo, the Cleveland Clinic, and Sloan Kettering—have entire divisions devoted to Internet markets. Certain companies—like Practice Fusion, Inc, an EHR firm—can offer EHRs “free” because online marketers interested in reaching doctors subsidize the EHRs rather than doctors. Medical practices—through physician bloggers and practice websites—can connect personally and in targeted ways to their patient constituencies. Sites, like Carepages.com, can offer support information for patients, families, and friends about almost any given disease or medical situation. Sites like the Healthcare Blog can start movements like Health 2.0 designed to empower consumers. One well-known physician blogger, Kevin Pho, MD, has staked his career and made his name as "the social media's leading physician voice." He lists these previous blogs addressing the impact and the use of the social media on and for physicians: End-of-life blogging benefits and the questions it raises Social media starts the patient dialogue with doctors and nurses Social networking’s impact on patients, doctors, and non-profits Twitter can spread inaccurate medical information Twitter for doctors, a guide for health care professionals Twitter habits of pharmaceutical companies Twitter has problems in the operating room Why doctors should blog with their real name Quit smoking by using Facebook Twitter and Facebook can help conduct group patient visits Doctors using social media to talk to patients, but where's the evidence? I recommend you visit Kevinmd.com and click on one of these blogs to appreciate the power of the groundswell. Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Mon, 26 Jul 2010 20:00:15 GMT http://community.modernmedicine.com/_Health-Care-and-the-Groundswell/blog/2496299/33379.html RichardReeceMD 2010-07-26T19:21:18Z Managing Your Practice Modern Medicine Community Groundswell is a book about the welling up of Internet-based social networking media sites—Facebook, YouTube, Twitter, Flickr, and other sites—as transforming forces in our society. Its authors, Charlene Li and Josh Bernoff, are executives at Forrester Research who conduct surveys to determine how people use technology. Using their extensive database, they discuss the whys, whats, and hows of the impact of the Internet on social and corporate behavior. The book’s purpose is to teach corporate clients how to use the Internet, the blogosphere, and social network sites to market products. They define the groundswell as a powerful social trend in which people use information technologies to get the things they need from each other rather than from traditional institutions like government, corporations, and the medical-industrial complex. They argue the groundswell is an irresistible, completely different way for people to relate and to connect with one another. Three forces propel the groundswell: 1. People, who have always depended on one another to get what they need and to rebel against institutional power 2. Technology, which has changed everything because 73% of people are now online and have broadband connectivity 3. Online Economics, which make it possible to get information virtually free, and which for marketers, makes it possible to influence millions of people through online research and online traffic reports. “The groundswell,” say the authors, “has changed the balance of power. Everybody can put up a site that connects people with people. If it is designed well, people will use it. They’ll tell their friends how to use it. They’ll conduct commerce, or read the news, or start a popular movement, or make loans to one another. Or whatever the site is designed to facilitate.” The groundswell is about power—the power of social connections between people, the power of the buzz, the power of word of mouth, the power of opinion, the power of free information, the power of personal marketing, the power of online advertising, and the power of the Internet to make obsolete and radically reform existing business models. What does this have to do with health care? Plenty. Getting health care information is the number one reason people visit the Internet. People use the Internet to assess from which doctors and which institutions they will get their care, which is why sites like America’s Top Doctors have been so popular. Health care institutions—Mayo, the Cleveland Clinic, and Sloan Kettering—have entire divisions devoted to Internet markets. Certain companies—like Practice Fusion, Inc, an EHR firm—can offer EHRs “free” because online marketers interested in reaching doctors subsidize the EHRs rather than doctors. Medical practices—through physician bloggers and practice websites—can connect personally and in targeted ways to their patient constituencies. Sites, like Carepages.com, can offer support information for patients, families, and friends about almost any given disease or medical situation. Sites like the Healthcare Blog can start movements like Health 2.0 designed to empower consumers. One well-known physician blogger, Kevin Pho, MD, has staked his career and made his name as "the social media's leading physician voice." He lists these previous blogs addressing the impact and the use of the social media on and for physicians: End-of-life blogging benefits and the questions it raises Social media starts the patient dialogue with doctors and nurses Social networking’s impact on patients, doctors, and non-profits Twitter can spread inaccurate medical information Twitter for doctors, a guide for health care professionals Twitter habits of pharmaceutical companies Twitter has problems in the operating room Why doctors should blog with their real name Quit smoking by using Facebook Twitter and Facebook can help conduct group patient visits Doctors using social media to talk to patients, but where's the evidence? I recommend you visit Kevinmd.com and click on one of these blogs to appreciate the power of the groundswell. Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] care, facebook, information”, internet, managing your practice, media”, twitter, “health, “networking”, “social nonadult false Health Care and the Groundswell text blog care,facebook,information”,internet,managing your practice,media”,twitter,“health,“networking”,“social 357 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=19464830&as=33379 http://media.kickstatic.com/kickapps/images/user/defaultImage_160x120_E.jpg false 1 Managing Your Practice 0 2496299 19464830 Member 0 http://community.modernmedicine.com/_These-Are-the-Things-That-Drive-Up-Costs-And-Cause-Them-to-Vary/blog/2450213/33379.html It has always been a mystery to me why the high costs of care are such a mystery. The answers are right in front of our noses. They are called medical culture, societal culture, human nature, and human uncertainty. These are things no amount of data and no number of algorithms can correct.Take use of imaging. It grows at 15% to 17% each year. In “The Uncritical Use of High-Tech Medical Imaging,” NEJM, July 1, 2010, by radiologist B. J. Hillman and futurist J.C. Goldsmith dissect out these human factors.1. Patients’ desire for more imaging, as advised by friends, the Web, the lay press, and direct-to-consumer advertising.2. The compelling financial interests of physicians, who sometimes benefit from more imaging.3. Physicians’ concern over liability risk, both by physicians who order the tests and those who interpret them.4. The style and content of clinical education, which spills over into medical practice, and which encourages “shotgun,” “no stone unturned diagnostic approaches,These factors are cultural in nature. The authors conclude we will have to change the culture of medical practice as the imaging industry confronts fee reductions and utilization controls. Consider cost variations. These have been usually attributed to provider greed, excessive specialization, technological overuse, underuse of appropriate care, variations in clinical training, but rarely to poverty, dysfunctional socioeconomic condition, and delays in treatment until diseases become prohibitively expensive to treat. Even more rarely do we confront these “scary truth; the science behind medicine is sorely lacking, and often there is no clearly right answer (A.M. Epstein, “Geographic Variation in Medical Spending,” NEJM, July 1, 201 Ponder patient expectations- to be relieved of pain - and the physician mission – to relieve pain. Go no further than hip and knee replacements. These procedures relieve pain, big time, and the public and physicians know it. Here is how the July 2 NYT explains it, “There is nothing like a new hip or knee to put the spring back in your step. Patients receiving joint implants often are able to resume many of the physical activities they love, even those as vigorous as tennis and hiking."No wonder joint replacement is growing in popularity. No wonder U.S. surgeons performed 806,000 hip and knee implants (the joints most commonly replaced), double the number performed a decade earlier and approaching one million this year. To doctors and patients there can never be too much of a good thing, a thing that returns patients to full function and partaking of the good life.Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] It has always been a mystery to me why the high costs of care are such a mystery. The answers are right in front of our noses. They are called medical culture, societal culture, human nature, and human uncertainty. These are things no amount of data and no number of algorithms can correct.Take use of imaging. It grows at 15% to 17% each year. In “The Uncritical Use of High-Tech Medical Imaging,” NEJM, July 1, 2010, by radiologist B. J. Hillman and futurist J.C. Goldsmith dissect out these human factors.1. Patients’ desire for more imaging, as advised by friends, the Web, the lay press, and direct-to-consumer advertising.2. The compelling financial interests of physicians, who sometimes benefit from more imaging.3. Physicians’ concern over liability risk, both by physicians who order the tests and those who interpret them.4. The style and content of clinical education, which spills over into medical practice, and which encourages “shotgun,” “no stone unturned diagnostic approaches,These factors are cultural in nature. The authors conclude we will have to change the culture of medical practice as the imaging industry confronts fee reductions and utilization controls. Consider cost variations. These have been usually attributed to provider greed, excessive specialization, technological overuse, underuse of appropriate care, variations in clinical training, but rarely to poverty, dysfunctional socioeconomic condition, and delays in treatment until diseases become prohibitively expensive to treat. Even more rarely do we confront these “scary truth; the science behind medicine is sorely lacking, and often there is no clearly right answer (A.M. Epstein, “Geographic Variation in Medical Spending,” NEJM, July 1, 201 Ponder patient expectations- to be relieved of pain - and the physician mission – to relieve pain. Go no further than hip and knee replacements. These procedures relieve pain, big time, and the public and physicians know it. Here is how the July 2 NYT explains it, “There is nothing like a new hip or knee to put the spring back in your step. Patients receiving joint implants often are able to resume many of the physical activities they love, even those as vigorous as tennis and hiking."No wonder joint replacement is growing in popularity. No wonder U.S. surgeons performed 806,000 hip and knee implants (the joints most commonly replaced), double the number performed a decade earlier and approaching one million this year. To doctors and patients there can never be too much of a good thing, a thing that returns patients to full function and partaking of the good life.Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Mon, 12 Jul 2010 16:33:47 GMT http://community.modernmedicine.com/_These-Are-the-Things-That-Drive-Up-Costs-And-Cause-Them-to-Vary/blog/2450213/33379.html RichardReeceMD 2010-07-12T16:31:49Z Health Law & Policy Modern Medicine Community It has always been a mystery to me why the high costs of care are such a mystery. The answers are right in front of our noses. They are called medical culture, societal culture, human nature, and human uncertainty. These are things no amount of data and no number of algorithms can correct.Take use of imaging. It grows at 15% to 17% each year. In “The Uncritical Use of High-Tech Medical Imaging,” NEJM, July 1, 2010, by radiologist B. J. Hillman and futurist J.C. Goldsmith dissect out these human factors.1. Patients’ desire for more imaging, as advised by friends, the Web, the lay press, and direct-to-consumer advertising.2. The compelling financial interests of physicians, who sometimes benefit from more imaging.3. Physicians’ concern over liability risk, both by physicians who order the tests and those who interpret them.4. The style and content of clinical education, which spills over into medical practice, and which encourages “shotgun,” “no stone unturned diagnostic approaches,These factors are cultural in nature. The authors conclude we will have to change the culture of medical practice as the imaging industry confronts fee reductions and utilization controls. Consider cost variations. These have been usually attributed to provider greed, excessive specialization, technological overuse, underuse of appropriate care, variations in clinical training, but rarely to poverty, dysfunctional socioeconomic condition, and delays in treatment until diseases become prohibitively expensive to treat. Even more rarely do we confront these “scary truth; the science behind medicine is sorely lacking, and often there is no clearly right answer (A.M. Epstein, “Geographic Variation in Medical Spending,” NEJM, July 1, 201 Ponder patient expectations- to be relieved of pain - and the physician mission – to relieve pain. Go no further than hip and knee replacements. These procedures relieve pain, big time, and the public and physicians know it. Here is how the July 2 NYT explains it, “There is nothing like a new hip or knee to put the spring back in your step. Patients receiving joint implants often are able to resume many of the physical activities they love, even those as vigorous as tennis and hiking."No wonder joint replacement is growing in popularity. No wonder U.S. surgeons performed 806,000 hip and knee implants (the joints most commonly replaced), double the number performed a decade earlier and approaching one million this year. To doctors and patients there can never be too much of a good thing, a thing that returns patients to full function and partaking of the good life.Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] health law & policy, imaging, joint implants, medical costs nonadult false These Are the Things That Drive Up Costs And Cause Them to Vary text blog health law & policy,imaging,joint implants,medical costs 258 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=19464830&as=33379 http://media.kickstatic.com/kickapps/images/user/defaultImage_160x120_E.jpg false 0 Health Law & Policy 0 2450213 19464830 Member 0 http://community.modernmedicine.com/_Diabetes-Obesity-and-Government/blog/2439919/33379.html Obesity and its stepchild, type 2 diabetes, have replaced smoking as the leading health hazards. Yet despite government and public health pleadings to eat less, move more, lose weight, the obesity and diabetes epidemics are on a tear.Here is how the Wall Street Journal Health Blog assesses the situation:“Editors of the Lancet didn’t mince words when they weighed in on the epidemic of type 2 diabetes — they said the fact that the mostly preventable disease has become so prevalent is “a public health humiliation.”“Medicine might be winning the battle of glucose control, but it is losing the war against diabetes,” the authors write."“ ‘Lifestyle interventions’ is another name for efforts to convince people to lose or maintain weight, eat a more healthful diet and get more physical activity. When people do make changes, good things can happen - even a 7% weight loss can produce much as a 58% improvement in the risk of progressing from prediabetes to diabetes.”“It’s not like the diet and exercise message hasn’t been broadcast loud and clear, especially in the United States and other western countries, but public-health entreaties don’t always work. Most adults aren’t supposed to eat more than a teaspoon of salt per day, for example, but a CDC study released yesterday says only 10% of us do that. And other CDC statistics released recently show that in 2009, 29% of Americans were obese. “Hapless GovernmentWhy is government so hapless in persuading people to change for their own good?I suspect the answer lies in complexity of human society and its desire for personal freedom.In his classic The Road to Serfdom (1944), conservative economist Friedrich Hayek wrote that the economy and society are too complicated for centralized government to control and intervene at marketplace or lifestyle levels. That is why the economic stimulus package of February 2009 has failed to raise employment and why the health bill is unlikely to change patients’ lifestyles.Hayek contended political freedom and economic freedom are inextricably linked. In a centrally planned economy, the state infringes on what we do, what we enjoy, and where we live. When the state has the final say on the economy, we need permission of the state to act, speak and write. Economic control becomes political control.The problem with political control is that it attracts people who relish running the lives of others. Further, powerful politicians take care of their friends first and the people second.Americans are suffering from top-down overkill. President Obama has expanded federal control of health care. By doing so, he has left fewer resources for the rest of us to direct through our own decisions. In a a free modern society, we cooperate with others to produce the goods and services we enjoy, all without top-down direction. This holds true in everything that makes life worthwhile —when we sing and when we dance, when we play and when we pray. Leaving us free to join with others as we see fit—in our work and in our play—is the road to true and lasting prosperity.SourcesKatherine Hobson, “ ‘Type 2 Diabetes Epidemic Called a ‘Public Health Humiliation’” Wall Street Journal Health Blog,, June 25, 2010.Russ Roberts, "Friedrich Hayek Is Making a Comeback , “ Wall Street Journal, June 28, 2010. Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Obesity and its stepchild, type 2 diabetes, have replaced smoking as the leading health hazards. Yet despite government and public health pleadings to eat less, move more, lose weight, the obesity and diabetes epidemics are on a tear.Here is how the Wall Street Journal Health Blog assesses the situation:“Editors of the Lancet didn’t mince words when they weighed in on the epidemic of type 2 diabetes — they said the fact that the mostly preventable disease has become so prevalent is “a public health humiliation.”“Medicine might be winning the battle of glucose control, but it is losing the war against diabetes,” the authors write."“ ‘Lifestyle interventions’ is another name for efforts to convince people to lose or maintain weight, eat a more healthful diet and get more physical activity. When people do make changes, good things can happen - even a 7% weight loss can produce much as a 58% improvement in the risk of progressing from prediabetes to diabetes.”“It’s not like the diet and exercise message hasn’t been broadcast loud and clear, especially in the United States and other western countries, but public-health entreaties don’t always work. Most adults aren’t supposed to eat more than a teaspoon of salt per day, for example, but a CDC study released yesterday says only 10% of us do that. And other CDC statistics released recently show that in 2009, 29% of Americans were obese. “Hapless GovernmentWhy is government so hapless in persuading people to change for their own good?I suspect the answer lies in complexity of human society and its desire for personal freedom.In his classic The Road to Serfdom (1944), conservative economist Friedrich Hayek wrote that the economy and society are too complicated for centralized government to control and intervene at marketplace or lifestyle levels. That is why the economic stimulus package of February 2009 has failed to raise employment and why the health bill is unlikely to change patients’ lifestyles.Hayek contended political freedom and economic freedom are inextricably linked. In a centrally planned economy, the state infringes on what we do, what we enjoy, and where we live. When the state has the final say on the economy, we need permission of the state to act, speak and write. Economic control becomes political control.The problem with political control is that it attracts people who relish running the lives of others. Further, powerful politicians take care of their friends first and the people second.Americans are suffering from top-down overkill. President Obama has expanded federal control of health care. By doing so, he has left fewer resources for the rest of us to direct through our own decisions. In a a free modern society, we cooperate with others to produce the goods and services we enjoy, all without top-down direction. This holds true in everything that makes life worthwhile —when we sing and when we dance, when we play and when we pray. Leaving us free to join with others as we see fit—in our work and in our play—is the road to true and lasting prosperity.SourcesKatherine Hobson, “ ‘Type 2 Diabetes Epidemic Called a ‘Public Health Humiliation’” Wall Street Journal Health Blog,, June 25, 2010.Russ Roberts, "Friedrich Hayek Is Making a Comeback , “ Wall Street Journal, June 28, 2010. Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Thu, 08 Jul 2010 17:09:46 GMT http://community.modernmedicine.com/_Diabetes-Obesity-and-Government/blog/2439919/33379.html RichardReeceMD 2010-07-08T17:06:46Z Managing Your Practice Modern Medicine Community Obesity and its stepchild, type 2 diabetes, have replaced smoking as the leading health hazards. Yet despite government and public health pleadings to eat less, move more, lose weight, the obesity and diabetes epidemics are on a tear.Here is how the Wall Street Journal Health Blog assesses the situation:“Editors of the Lancet didn’t mince words when they weighed in on the epidemic of type 2 diabetes — they said the fact that the mostly preventable disease has become so prevalent is “a public health humiliation.”“Medicine might be winning the battle of glucose control, but it is losing the war against diabetes,” the authors write."“ ‘Lifestyle interventions’ is another name for efforts to convince people to lose or maintain weight, eat a more healthful diet and get more physical activity. When people do make changes, good things can happen - even a 7% weight loss can produce much as a 58% improvement in the risk of progressing from prediabetes to diabetes.”“It’s not like the diet and exercise message hasn’t been broadcast loud and clear, especially in the United States and other western countries, but public-health entreaties don’t always work. Most adults aren’t supposed to eat more than a teaspoon of salt per day, for example, but a CDC study released yesterday says only 10% of us do that. And other CDC statistics released recently show that in 2009, 29% of Americans were obese. “Hapless GovernmentWhy is government so hapless in persuading people to change for their own good?I suspect the answer lies in complexity of human society and its desire for personal freedom.In his classic The Road to Serfdom (1944), conservative economist Friedrich Hayek wrote that the economy and society are too complicated for centralized government to control and intervene at marketplace or lifestyle levels. That is why the economic stimulus package of February 2009 has failed to raise employment and why the health bill is unlikely to change patients’ lifestyles.Hayek contended political freedom and economic freedom are inextricably linked. In a centrally planned economy, the state infringes on what we do, what we enjoy, and where we live. When the state has the final say on the economy, we need permission of the state to act, speak and write. Economic control becomes political control.The problem with political control is that it attracts people who relish running the lives of others. Further, powerful politicians take care of their friends first and the people second.Americans are suffering from top-down overkill. President Obama has expanded federal control of health care. By doing so, he has left fewer resources for the rest of us to direct through our own decisions. In a a free modern society, we cooperate with others to produce the goods and services we enjoy, all without top-down direction. This holds true in everything that makes life worthwhile —when we sing and when we dance, when we play and when we pray. Leaving us free to join with others as we see fit—in our work and in our play—is the road to true and lasting prosperity.SourcesKatherine Hobson, “ ‘Type 2 Diabetes Epidemic Called a ‘Public Health Humiliation’” Wall Street Journal Health Blog,, June 25, 2010.Russ Roberts, "Friedrich Hayek Is Making a Comeback , “ Wall Street Journal, June 28, 2010. Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] diabetes, diet, exercise, health epidemic, managing your practice, obesity, smoking nonadult false Diabetes, Obesity, and Government text blog diabetes,diet,exercise,health epidemic,managing your practice,obesity,smoking 309 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=19464830&as=33379 http://media.kickstatic.com/kickapps/images/user/defaultImage_160x120_B.jpg false 0 Managing Your Practice 0 2439919 19464830 Member 0 http://community.modernmedicine.com/_Real-Time-Claims-Adjudication-The-Secret-for-Timely-Payment/blog/2439912/33379.html Here’s how real-time claims adjudication – or instant payment of claims for doctors -works.The doctor has an EHR. A data entry clerk in the office enters the claim data. The claim is submitted through the EHR. And Presto! The doctor is paid.By the time the patient reaches the check-out desk, the doctor has received a payment commitment from the insurer, just as Visa and Mastercard does after a customer swipes a card.Unfortunately, it doesn’t work that way in most doctors’ offices. In the first place, they don’t have an EHR. Secondly, they don’t have a data entry clerk. Thirdly, neither they nor their staff have time to wade through 4500 diagnostic codes and 1500 procedure codes to find just the right codes for appropriate reimbursement. If you’re a generalist, with a high volume of patients with a myriad of conditions, finding the right code can be a nightmare. So the office may take a few days before submitting a claim.The key to instant payment is an EHR, says the Obama administration. Furthermore, install these electronic records, and we will reward you with a 2% bonus for being good boys and girls electronically, and for saving “the system” up to $250 billion to $350 billion in administrative costs. Of course, there are catches. You may save "the system," but it costs doctors. They must meet certain conditions, convert from paper to electronic records, use EHRs only for “meaningful use,” pay high fees for installation and maintenance, disrupt their usual routines and cut back on their productivity by up to 30% over the first year while adapting electronically. Never mind. It's all for government good. Nevertheless, instant processing of claims is an attractive concept. For one thing, all the data is submitted upfront, and insurers do not have to come back for further documentation. Meanwhile, until the documentation is done, doctors will just have to wait to get paid. Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Here’s how real-time claims adjudication – or instant payment of claims for doctors -works.The doctor has an EHR. A data entry clerk in the office enters the claim data. The claim is submitted through the EHR. And Presto! The doctor is paid.By the time the patient reaches the check-out desk, the doctor has received a payment commitment from the insurer, just as Visa and Mastercard does after a customer swipes a card.Unfortunately, it doesn’t work that way in most doctors’ offices. In the first place, they don’t have an EHR. Secondly, they don’t have a data entry clerk. Thirdly, neither they nor their staff have time to wade through 4500 diagnostic codes and 1500 procedure codes to find just the right codes for appropriate reimbursement. If you’re a generalist, with a high volume of patients with a myriad of conditions, finding the right code can be a nightmare. So the office may take a few days before submitting a claim.The key to instant payment is an EHR, says the Obama administration. Furthermore, install these electronic records, and we will reward you with a 2% bonus for being good boys and girls electronically, and for saving “the system” up to $250 billion to $350 billion in administrative costs. Of course, there are catches. You may save "the system," but it costs doctors. They must meet certain conditions, convert from paper to electronic records, use EHRs only for “meaningful use,” pay high fees for installation and maintenance, disrupt their usual routines and cut back on their productivity by up to 30% over the first year while adapting electronically. Never mind. It's all for government good. Nevertheless, instant processing of claims is an attractive concept. For one thing, all the data is submitted upfront, and insurers do not have to come back for further documentation. Meanwhile, until the documentation is done, doctors will just have to wait to get paid. Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Thu, 08 Jul 2010 17:08:33 GMT http://community.modernmedicine.com/_Real-Time-Claims-Adjudication-The-Secret-for-Timely-Payment/blog/2439912/33379.html RichardReeceMD 2010-07-08T17:01:06Z Managing Your Practice Modern Medicine Community Here’s how real-time claims adjudication – or instant payment of claims for doctors -works.The doctor has an EHR. A data entry clerk in the office enters the claim data. The claim is submitted through the EHR. And Presto! The doctor is paid.By the time the patient reaches the check-out desk, the doctor has received a payment commitment from the insurer, just as Visa and Mastercard does after a customer swipes a card.Unfortunately, it doesn’t work that way in most doctors’ offices. In the first place, they don’t have an EHR. Secondly, they don’t have a data entry clerk. Thirdly, neither they nor their staff have time to wade through 4500 diagnostic codes and 1500 procedure codes to find just the right codes for appropriate reimbursement. If you’re a generalist, with a high volume of patients with a myriad of conditions, finding the right code can be a nightmare. So the office may take a few days before submitting a claim.The key to instant payment is an EHR, says the Obama administration. Furthermore, install these electronic records, and we will reward you with a 2% bonus for being good boys and girls electronically, and for saving “the system” up to $250 billion to $350 billion in administrative costs. Of course, there are catches. You may save "the system," but it costs doctors. They must meet certain conditions, convert from paper to electronic records, use EHRs only for “meaningful use,” pay high fees for installation and maintenance, disrupt their usual routines and cut back on their productivity by up to 30% over the first year while adapting electronically. Never mind. It's all for government good. Nevertheless, instant processing of claims is an attractive concept. For one thing, all the data is submitted upfront, and insurers do not have to come back for further documentation. Meanwhile, until the documentation is done, doctors will just have to wait to get paid. Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] billing, coding, ehr, electronic records, managing your practice, reimbursement nonadult false Real-Time Claims Adjudication: The Secret for Timely Payment text blog billing,coding,ehr,electronic records,managing your practice,reimbursement 463 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=19464830&as=33379 http://media.kickstatic.com/kickapps/images/user/defaultImage_160x120_D.jpg false 3 Managing Your Practice 0 2439912 19464830 Member 0 http://community.modernmedicine.com/_Accountable-Care-Organizations-ACOs-The-Whats-Whys-and-Hows/blog/2436365/33379.html An ACO is a local health care organization and a related set of providers (at a minimum, primary care physicians, specialists, and hospitals ) that can be held accountable for cost and quality of care delivered to a defined population.Definition of Accountable Care OrganizationA friend, a patient interested in health reform, asked: “Accountable health organizations are the rage. They’re hot, but what the hell are they?”My short answer was,”ACOs are different ways of herding doctors together to make them behave economically.”He was not satisfied with that. He said, “Be specific.”I replied, specifically, with this physician herd list.• Independent practice associations (IPAs)• Multispecialty groups • Hospital medical staff organizations • Physician hospital organizations• Organized and integrated delivery systems• Virtual extended hospital medical staffsMy friend persisted, “Why herd doctors together?”"That’s easy," I said, “If all the doctors who take care of you – your primary care doctor, specialists, and your hospital – work together financially, you will get better care, and it won’t cost as much.”“Why?” queried my friend.I replied, “To keep Medicare from going bankrupt.”“But how?” said he.I gave him this laundry list.1. By keeping people healthier across care boundaries2. By educating people to their risks and reducing costs to high risk older patients through the use of clinical teams3. By forcing doctors and hospitals to work under a budget and to manage resources4. By paying doctors under different arrangements, e.g. salaries, rather than fee-for-service, which encourages them to do more“That’s not good enough,” he said, “Be more specific.”“OK, I countered, “ I’ll try. “How is this?”1. To bring down Medicare costs, so you will have Medicare in your old age.2. To shift costs and accountability for care away from insurance plans to doctors and hospitals, where actual costs occur.3. To gain the cooperation of doctors and hospitals by having them share in savings produced by ACOs.4. To pay doctors in such a way that they will not treat you in what they regard as their and your best interest but in the best interest of quality and cost to the system.My friend was dubious. He pressed, “But how do ACOs work? Will they save money and raise quality?”I replied, “ I do not know. ACOs have great promise, but obstacles as well.• Doctors treasure their autonomy and do not like to be “bossed”, even by peers.• Doctors are skeptical about being paid and rewarded for not delivering care.• Doctors fear getting stuck with high risk patients with irreversible conditions over which they have little control and for whom they care, may be asked to take a financial bath.• Doctors may regard ACOs as capitated HMOs in drag, a failed cost-savings approach that made everybody miserable.”Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] An ACO is a local health care organization and a related set of providers (at a minimum, primary care physicians, specialists, and hospitals ) that can be held accountable for cost and quality of care delivered to a defined population.Definition of Accountable Care OrganizationA friend, a patient interested in health reform, asked: “Accountable health organizations are the rage. They’re hot, but what the hell are they?”My short answer was,”ACOs are different ways of herding doctors together to make them behave economically.”He was not satisfied with that. He said, “Be specific.”I replied, specifically, with this physician herd list.• Independent practice associations (IPAs)• Multispecialty groups • Hospital medical staff organizations • Physician hospital organizations• Organized and integrated delivery systems• Virtual extended hospital medical staffsMy friend persisted, “Why herd doctors together?”"That’s easy," I said, “If all the doctors who take care of you – your primary care doctor, specialists, and your hospital – work together financially, you will get better care, and it won’t cost as much.”“Why?” queried my friend.I replied, “To keep Medicare from going bankrupt.”“But how?” said he.I gave him this laundry list.1. By keeping people healthier across care boundaries2. By educating people to their risks and reducing costs to high risk older patients through the use of clinical teams3. By forcing doctors and hospitals to work under a budget and to manage resources4. By paying doctors under different arrangements, e.g. salaries, rather than fee-for-service, which encourages them to do more“That’s not good enough,” he said, “Be more specific.”“OK, I countered, “ I’ll try. “How is this?”1. To bring down Medicare costs, so you will have Medicare in your old age.2. To shift costs and accountability for care away from insurance plans to doctors and hospitals, where actual costs occur.3. To gain the cooperation of doctors and hospitals by having them share in savings produced by ACOs.4. To pay doctors in such a way that they will not treat you in what they regard as their and your best interest but in the best interest of quality and cost to the system.My friend was dubious. He pressed, “But how do ACOs work? Will they save money and raise quality?”I replied, “ I do not know. ACOs have great promise, but obstacles as well.• Doctors treasure their autonomy and do not like to be “bossed”, even by peers.• Doctors are skeptical about being paid and rewarded for not delivering care.• Doctors fear getting stuck with high risk patients with irreversible conditions over which they have little control and for whom they care, may be asked to take a financial bath.• Doctors may regard ACOs as capitated HMOs in drag, a failed cost-savings approach that made everybody miserable.”Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Wed, 07 Jul 2010 15:12:57 GMT http://community.modernmedicine.com/_Accountable-Care-Organizations-ACOs-The-Whats-Whys-and-Hows/blog/2436365/33379.html RichardReeceMD 2010-07-07T15:08:54Z Health Law & Policy Modern Medicine Community An ACO is a local health care organization and a related set of providers (at a minimum, primary care physicians, specialists, and hospitals ) that can be held accountable for cost and quality of care delivered to a defined population.Definition of Accountable Care OrganizationA friend, a patient interested in health reform, asked: “Accountable health organizations are the rage. They’re hot, but what the hell are they?”My short answer was,”ACOs are different ways of herding doctors together to make them behave economically.”He was not satisfied with that. He said, “Be specific.”I replied, specifically, with this physician herd list.• Independent practice associations (IPAs)• Multispecialty groups • Hospital medical staff organizations • Physician hospital organizations• Organized and integrated delivery systems• Virtual extended hospital medical staffsMy friend persisted, “Why herd doctors together?”"That’s easy," I said, “If all the doctors who take care of you – your primary care doctor, specialists, and your hospital – work together financially, you will get better care, and it won’t cost as much.”“Why?” queried my friend.I replied, “To keep Medicare from going bankrupt.”“But how?” said he.I gave him this laundry list.1. By keeping people healthier across care boundaries2. By educating people to their risks and reducing costs to high risk older patients through the use of clinical teams3. By forcing doctors and hospitals to work under a budget and to manage resources4. By paying doctors under different arrangements, e.g. salaries, rather than fee-for-service, which encourages them to do more“That’s not good enough,” he said, “Be more specific.”“OK, I countered, “ I’ll try. “How is this?”1. To bring down Medicare costs, so you will have Medicare in your old age.2. To shift costs and accountability for care away from insurance plans to doctors and hospitals, where actual costs occur.3. To gain the cooperation of doctors and hospitals by having them share in savings produced by ACOs.4. To pay doctors in such a way that they will not treat you in what they regard as their and your best interest but in the best interest of quality and cost to the system.My friend was dubious. He pressed, “But how do ACOs work? Will they save money and raise quality?”I replied, “ I do not know. ACOs have great promise, but obstacles as well.• Doctors treasure their autonomy and do not like to be “bossed”, even by peers.• Doctors are skeptical about being paid and rewarded for not delivering care.• Doctors fear getting stuck with high risk patients with irreversible conditions over which they have little control and for whom they care, may be asked to take a financial bath.• Doctors may regard ACOs as capitated HMOs in drag, a failed cost-savings approach that made everybody miserable.”Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] costs, health law & policy, medical practice, medicare nonadult false Accountable Care Organizations (ACOs): The Whats, Whys, and Hows text blog costs,health law & policy,medical practice,medicare 305 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=19464830&as=33379 http://media.kickstatic.com/kickapps/images/user/defaultImage_160x120_E.jpg false 0 Health Law & Policy 0 2436365 19464830 Member 0 http://community.modernmedicine.com/_Newly-Insured-and-New-Medicare-Patients/blog/2436360/33379.html Who will care for this patient population? This question bedevils national policy makers. Not much time remains for answers. Seventy eight million baby boomers start qualifying for Medicare in 2011 at the rate of 13,000 per day. Thirty two million insured by the health reform act will come on board in 2014. Meanwhile.• Primary care physician shortages grow every day. • Only 2% of medical students are entering primary care specialties• Primary care residency programs are capped• It takes 8 to 10 years to produce a newly minted primary care doctor.Community Health Centers (CHCs)What is the answer? Authors from Brown University, Health-AccessRI, and New York Medical Center, say a partial solution may exist in Community Health Centers. (“Health Care Reform and Primary Care – The Growing Importance of the Community Health Center,“NEJM, June 3, 2010).Eight thousand of these centers already exist. The Centers care for 20 million Americans, 5% of the population. The patient load includes 35% on Medicaid, 25% on Medicare, and private plans. The rest are uninsured. Federal FundingThe 2009 Stimulus bill directed $2 billion to CHCs. The recently passed health reform bill poured another $47.6 billion into CHCs. Beginning in 2011, another $300 million will go to support the National Health Services Corp (NHSC)to recruit and place health professionals in care-short areas. According to the authors, “In their new steady state, with 15,000 additional primary care provides in HPSAs, the CHCs may well be entrusted with the primary health care of 40 million Americans – thereby ensuring that most medical disenfranchised Americans receive care.”ChallengesThen the authors go into the “challenges” confronting such a dream.• Funding shortfalls of state Medicaid and CHIP programs • Lack of infrastructure capital • How to pay primary care doctors • Lack of electronic health records and other information technologies• Difficulties in securing specialty referrals because of geographic isolation• Insufficient compensation• Federal red tape• Increases in specialists who prefer not to participate in Medicaid or Medicare sponsored programsIt may be that these challenges can be overcome because of the “key values of the CHC model – a whole person orientation, accessibility, affordability, high quality, and accountability.” And it may be health reform demonstration projects – backed the Commonwealth Fund, Qualis Health, and the MacColl Institute for The Research Institute, will overcome these obstacles. Good intentions may yet trump implementation barriers.Staffing of Community Health CentersBut a key question remains- who will staff these community health centers? Internationally trained physicians who want to live in America? American physicians whose educational debts are guaranteed to be paid? Locum tenens physicians who are adequately compensated? Nurses, nurse practitioners and physician assistants? Above all, who will fund these health centers? Until these questions are answered, the full potential of community health clinics will not be realized. Finally, from whence will physicians spring to provide care, even in more affluent America? In Massachusetts, with its four year old universal coverage plan and with the second highest per capital number of physicians in the U.S., waiting lists to see primary care physicians, cardiologists, and obstetricians are the longest in the land.Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Who will care for this patient population? This question bedevils national policy makers. Not much time remains for answers. Seventy eight million baby boomers start qualifying for Medicare in 2011 at the rate of 13,000 per day. Thirty two million insured by the health reform act will come on board in 2014. Meanwhile.• Primary care physician shortages grow every day. • Only 2% of medical students are entering primary care specialties• Primary care residency programs are capped• It takes 8 to 10 years to produce a newly minted primary care doctor.Community Health Centers (CHCs)What is the answer? Authors from Brown University, Health-AccessRI, and New York Medical Center, say a partial solution may exist in Community Health Centers. (“Health Care Reform and Primary Care – The Growing Importance of the Community Health Center,“NEJM, June 3, 2010).Eight thousand of these centers already exist. The Centers care for 20 million Americans, 5% of the population. The patient load includes 35% on Medicaid, 25% on Medicare, and private plans. The rest are uninsured. Federal FundingThe 2009 Stimulus bill directed $2 billion to CHCs. The recently passed health reform bill poured another $47.6 billion into CHCs. Beginning in 2011, another $300 million will go to support the National Health Services Corp (NHSC)to recruit and place health professionals in care-short areas. According to the authors, “In their new steady state, with 15,000 additional primary care provides in HPSAs, the CHCs may well be entrusted with the primary health care of 40 million Americans – thereby ensuring that most medical disenfranchised Americans receive care.”ChallengesThen the authors go into the “challenges” confronting such a dream.• Funding shortfalls of state Medicaid and CHIP programs • Lack of infrastructure capital • How to pay primary care doctors • Lack of electronic health records and other information technologies• Difficulties in securing specialty referrals because of geographic isolation• Insufficient compensation• Federal red tape• Increases in specialists who prefer not to participate in Medicaid or Medicare sponsored programsIt may be that these challenges can be overcome because of the “key values of the CHC model – a whole person orientation, accessibility, affordability, high quality, and accountability.” And it may be health reform demonstration projects – backed the Commonwealth Fund, Qualis Health, and the MacColl Institute for The Research Institute, will overcome these obstacles. Good intentions may yet trump implementation barriers.Staffing of Community Health CentersBut a key question remains- who will staff these community health centers? Internationally trained physicians who want to live in America? American physicians whose educational debts are guaranteed to be paid? Locum tenens physicians who are adequately compensated? Nurses, nurse practitioners and physician assistants? Above all, who will fund these health centers? Until these questions are answered, the full potential of community health clinics will not be realized. Finally, from whence will physicians spring to provide care, even in more affluent America? In Massachusetts, with its four year old universal coverage plan and with the second highest per capital number of physicians in the U.S., waiting lists to see primary care physicians, cardiologists, and obstetricians are the longest in the land.Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Wed, 07 Jul 2010 15:12:26 GMT http://community.modernmedicine.com/_Newly-Insured-and-New-Medicare-Patients/blog/2436360/33379.html RichardReeceMD 2010-07-07T15:02:10Z Health Law & Policy Modern Medicine Community Who will care for this patient population? This question bedevils national policy makers. Not much time remains for answers. Seventy eight million baby boomers start qualifying for Medicare in 2011 at the rate of 13,000 per day. Thirty two million insured by the health reform act will come on board in 2014. Meanwhile.• Primary care physician shortages grow every day. • Only 2% of medical students are entering primary care specialties• Primary care residency programs are capped• It takes 8 to 10 years to produce a newly minted primary care doctor.Community Health Centers (CHCs)What is the answer? Authors from Brown University, Health-AccessRI, and New York Medical Center, say a partial solution may exist in Community Health Centers. (“Health Care Reform and Primary Care – The Growing Importance of the Community Health Center,“NEJM, June 3, 2010).Eight thousand of these centers already exist. The Centers care for 20 million Americans, 5% of the population. The patient load includes 35% on Medicaid, 25% on Medicare, and private plans. The rest are uninsured. Federal FundingThe 2009 Stimulus bill directed $2 billion to CHCs. The recently passed health reform bill poured another $47.6 billion into CHCs. Beginning in 2011, another $300 million will go to support the National Health Services Corp (NHSC)to recruit and place health professionals in care-short areas. According to the authors, “In their new steady state, with 15,000 additional primary care provides in HPSAs, the CHCs may well be entrusted with the primary health care of 40 million Americans – thereby ensuring that most medical disenfranchised Americans receive care.”ChallengesThen the authors go into the “challenges” confronting such a dream.• Funding shortfalls of state Medicaid and CHIP programs • Lack of infrastructure capital • How to pay primary care doctors • Lack of electronic health records and other information technologies• Difficulties in securing specialty referrals because of geographic isolation• Insufficient compensation• Federal red tape• Increases in specialists who prefer not to participate in Medicaid or Medicare sponsored programsIt may be that these challenges can be overcome because of the “key values of the CHC model – a whole person orientation, accessibility, affordability, high quality, and accountability.” And it may be health reform demonstration projects – backed the Commonwealth Fund, Qualis Health, and the MacColl Institute for The Research Institute, will overcome these obstacles. Good intentions may yet trump implementation barriers.Staffing of Community Health CentersBut a key question remains- who will staff these community health centers? Internationally trained physicians who want to live in America? American physicians whose educational debts are guaranteed to be paid? Locum tenens physicians who are adequately compensated? Nurses, nurse practitioners and physician assistants? Above all, who will fund these health centers? Until these questions are answered, the full potential of community health clinics will not be realized. Finally, from whence will physicians spring to provide care, even in more affluent America? In Massachusetts, with its four year old universal coverage plan and with the second highest per capital number of physicians in the U.S., waiting lists to see primary care physicians, cardiologists, and obstetricians are the longest in the land.Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] chcs, community health centers, health law & policy, medicare, physician shortage nonadult false Newly Insured and New Medicare Patients text blog chcs,community health centers,health law & policy,medicare,physician shortage 265 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=19464830&as=33379 http://media.kickstatic.com/kickapps/images/user/defaultImage_160x120_B.jpg false 0 Health Law & Policy 0 2436360 19464830 Member 0 http://community.modernmedicine.com/_Who-Speaks-for-Americas-650000-Independent-Private-Physicians-Part-II/blog/2432867/33379.html Who,-talks of doctor’s desire for more personal patient relationships and the patient’s distaste for doctor switching , both caused by health plans changing physician networks,-appreciates that most patients do not know doctors are forbidden to enter into private contractual relationships with patents should patients desire treatment outside of Medicare,-contradicts the often-heard liberal message that the U.S. system ranks 37th in the world is based on a deeply flawed 10 year old WHO study that has since been repudiated by WHO itself,-has ever heard of another WHO study ranking U.S. health care number one among other nations in “responsiveness” – more attention to patients, shorter waiting times, more amenities, and greater access to world-class care,-reveals shortcomings of evidence-based care, i.e., care based on statistical data on large populations, which may have little relevance to individual patients,-talks of diagnostic uncertainties, that vast gray zone of vague symptoms of unknown cause, which may require multiple tests and procedures before a diagnosis surfaces.-informs patients that physicians can spend little time with them in order to gain the revenue to pay malpractice fees, staff overhead, rent, and other costs of doing business, -has the courage to say that poor outcomes may rest on what patients do after leaving the doctors, i.e., returning to adverse life styles, not filling prescriptions, resorting to ineffective alternative therapies, rather what the doctor does or recommends in the presence of the patient.-speaks of shortcomings of electronic medical records among doctors – the expense, maintenance costs, lack of return on investment, practice disruptions, 30% dies-installment rate, 25% drops in productivity, mixed records of efficiency and quality improvement, and lack of relevance to solo and small practices.-forewarns government policy wonks that electronic medical records are virtually useless to doctors as communication tools unless physicians are able to enter progress notes using speech-recognition information, or to have access to useful diagnostic support information,-to sum up, informs the outside world of the story of independent practitioners - the backbone of American medicine?Who articulates these things?I would like to say, I do. And I have in my blog, Medinnovation, in my books, and in www.modernmedicine. where I regularly submit blogs and interview national thought leaders. But a more reliable, consistent, and prestigious source is the Physicians Foundation, a nonprofit C01C3 organization that represents all American doctors belonging to state medical societies. These societies are close to the ground and who know what moves them, what discourages them, and what is good and bad for their patients. Visit their website, www.physiciansfoundation.org, and listen to the beat of of the culture of individual physicians, who provide 80% of care for patients in the United States. Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Who,-talks of doctor’s desire for more personal patient relationships and the patient’s distaste for doctor switching , both caused by health plans changing physician networks,-appreciates that most patients do not know doctors are forbidden to enter into private contractual relationships with patents should patients desire treatment outside of Medicare,-contradicts the often-heard liberal message that the U.S. system ranks 37th in the world is based on a deeply flawed 10 year old WHO study that has since been repudiated by WHO itself,-has ever heard of another WHO study ranking U.S. health care number one among other nations in “responsiveness” – more attention to patients, shorter waiting times, more amenities, and greater access to world-class care,-reveals shortcomings of evidence-based care, i.e., care based on statistical data on large populations, which may have little relevance to individual patients,-talks of diagnostic uncertainties, that vast gray zone of vague symptoms of unknown cause, which may require multiple tests and procedures before a diagnosis surfaces.-informs patients that physicians can spend little time with them in order to gain the revenue to pay malpractice fees, staff overhead, rent, and other costs of doing business, -has the courage to say that poor outcomes may rest on what patients do after leaving the doctors, i.e., returning to adverse life styles, not filling prescriptions, resorting to ineffective alternative therapies, rather what the doctor does or recommends in the presence of the patient.-speaks of shortcomings of electronic medical records among doctors – the expense, maintenance costs, lack of return on investment, practice disruptions, 30% dies-installment rate, 25% drops in productivity, mixed records of efficiency and quality improvement, and lack of relevance to solo and small practices.-forewarns government policy wonks that electronic medical records are virtually useless to doctors as communication tools unless physicians are able to enter progress notes using speech-recognition information, or to have access to useful diagnostic support information,-to sum up, informs the outside world of the story of independent practitioners - the backbone of American medicine?Who articulates these things?I would like to say, I do. And I have in my blog, Medinnovation, in my books, and in www.modernmedicine. where I regularly submit blogs and interview national thought leaders. But a more reliable, consistent, and prestigious source is the Physicians Foundation, a nonprofit C01C3 organization that represents all American doctors belonging to state medical societies. These societies are close to the ground and who know what moves them, what discourages them, and what is good and bad for their patients. Visit their website, www.physiciansfoundation.org, and listen to the beat of of the culture of individual physicians, who provide 80% of care for patients in the United States. Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Tue, 06 Jul 2010 15:20:06 GMT http://community.modernmedicine.com/_Who-Speaks-for-Americas-650000-Independent-Private-Physicians-Part-II/blog/2432867/33379.html RichardReeceMD 2010-07-06T15:07:14Z Health Law & Policy Modern Medicine Community Who,-talks of doctor’s desire for more personal patient relationships and the patient’s distaste for doctor switching , both caused by health plans changing physician networks,-appreciates that most patients do not know doctors are forbidden to enter into private contractual relationships with patents should patients desire treatment outside of Medicare,-contradicts the often-heard liberal message that the U.S. system ranks 37th in the world is based on a deeply flawed 10 year old WHO study that has since been repudiated by WHO itself,-has ever heard of another WHO study ranking U.S. health care number one among other nations in “responsiveness” – more attention to patients, shorter waiting times, more amenities, and greater access to world-class care,-reveals shortcomings of evidence-based care, i.e., care based on statistical data on large populations, which may have little relevance to individual patients,-talks of diagnostic uncertainties, that vast gray zone of vague symptoms of unknown cause, which may require multiple tests and procedures before a diagnosis surfaces.-informs patients that physicians can spend little time with them in order to gain the revenue to pay malpractice fees, staff overhead, rent, and other costs of doing business, -has the courage to say that poor outcomes may rest on what patients do after leaving the doctors, i.e., returning to adverse life styles, not filling prescriptions, resorting to ineffective alternative therapies, rather what the doctor does or recommends in the presence of the patient.-speaks of shortcomings of electronic medical records among doctors – the expense, maintenance costs, lack of return on investment, practice disruptions, 30% dies-installment rate, 25% drops in productivity, mixed records of efficiency and quality improvement, and lack of relevance to solo and small practices.-forewarns government policy wonks that electronic medical records are virtually useless to doctors as communication tools unless physicians are able to enter progress notes using speech-recognition information, or to have access to useful diagnostic support information,-to sum up, informs the outside world of the story of independent practitioners - the backbone of American medicine?Who articulates these things?I would like to say, I do. And I have in my blog, Medinnovation, in my books, and in www.modernmedicine. where I regularly submit blogs and interview national thought leaders. But a more reliable, consistent, and prestigious source is the Physicians Foundation, a nonprofit C01C3 organization that represents all American doctors belonging to state medical societies. These societies are close to the ground and who know what moves them, what discourages them, and what is good and bad for their patients. Visit their website, www.physiciansfoundation.org, and listen to the beat of of the culture of individual physicians, who provide 80% of care for patients in the United States. Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] health law & policy, medical practice, physician's foundation nonadult false Who Speaks for America's 650,000 Independent Private Physicians? Part II text blog health law & policy,medical practice,physician's foundation 222 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=19464830&as=33379 http://media.kickstatic.com/kickapps/images/user/defaultImage_160x120_D.jpg false 1 Health Law & Policy 0 2432867 19464830 Member 0 http://community.modernmedicine.com/_Who-Speaks-for-Americas-650000-Independent-Private-Physicians-Part-I/blog/2432865/33379.html Who, -observes that independent physicians care for 80% of America’s patients,-describes the physician culture – its belief system, desire for autonomy, and reliance on clinical judgment,-deplores independent private practice decline, which has shrunk by about 10 % over the last 10 years? (See “The Independent Physician: Going, Going ….” NEJM. February 12, 2010),-explains accelerating departures of private doctors into retirement, non-clinical careers, hospital employment, and new practice models devoid of 3rd party interference.-comments at length on the fast-growing physician movement, locum tenens, traveling physicians for hire.-says that much of American medicine’s costs stem from lack of competition, open-ended comprehensive plans, mandated guaranteed benefits, restrictive regulations, physician malpractice expenses, ensuing defensive medicine practices, and litigious practice environments,- discerns that much of the so-called fraud and abuse occurs in Medicare and Medicaid and is perpetrated by non-physicians using stolen identities, rather than physicians in their practices, -notes that hospital-based medicine, with salaried physicians, as opposed to ambulatory-based medicine conducted by private physicians, drives costs up,-warns the American people about the impending doctor shortages, the coming access crisis, and longer waiting lines for doctor appointments,-highlights polls indicating patients trust their doctors more than government data-wielding bureaucrats, - tells Americans that only 2% of medical students are entering primary care, and that these are the physicians they are expected to visit to sort out problems and to coordinate care,- points out to Americans that many of the new 34 million who may gain insurance will be assigned to Medicaid rolls and that fewer and fewer doctors will accept new Medicaid recipients because of low reimbursements,- explains problems imposed by third parties that erode time spent with patients,- documents that for every hour spent seeing patients, another hour is spent on paperwork and getting permission to perform a test or a procedure?Who articulates these things?I would like to say, I do. And I have in my blog, Medinnovation, in my books, and in www.modernmedicine.com, where I regularly submit blogs and interview national thought leaders. But a more reliable , balanced, and prestigious source is the Physicians Foundation, a nonprofit C01C3 organization that represents all American doctors belonging to state medical societies. These societies are close to the ground. The Foundation and state societies know what moves physicians , what discourages them, what is good and bad for their patients, and how to improve the system. Visit the Physicians Foundation website, www.physiciansfoundation.org, read about its charitable work, listen to the beat of the culture of individual physicians, who provide most of the care for patients in the United States. Part II will appear in my next blog.Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Who, -observes that independent physicians care for 80% of America’s patients,-describes the physician culture – its belief system, desire for autonomy, and reliance on clinical judgment,-deplores independent private practice decline, which has shrunk by about 10 % over the last 10 years? (See “The Independent Physician: Going, Going ….” NEJM. February 12, 2010),-explains accelerating departures of private doctors into retirement, non-clinical careers, hospital employment, and new practice models devoid of 3rd party interference.-comments at length on the fast-growing physician movement, locum tenens, traveling physicians for hire.-says that much of American medicine’s costs stem from lack of competition, open-ended comprehensive plans, mandated guaranteed benefits, restrictive regulations, physician malpractice expenses, ensuing defensive medicine practices, and litigious practice environments,- discerns that much of the so-called fraud and abuse occurs in Medicare and Medicaid and is perpetrated by non-physicians using stolen identities, rather than physicians in their practices, -notes that hospital-based medicine, with salaried physicians, as opposed to ambulatory-based medicine conducted by private physicians, drives costs up,-warns the American people about the impending doctor shortages, the coming access crisis, and longer waiting lines for doctor appointments,-highlights polls indicating patients trust their doctors more than government data-wielding bureaucrats, - tells Americans that only 2% of medical students are entering primary care, and that these are the physicians they are expected to visit to sort out problems and to coordinate care,- points out to Americans that many of the new 34 million who may gain insurance will be assigned to Medicaid rolls and that fewer and fewer doctors will accept new Medicaid recipients because of low reimbursements,- explains problems imposed by third parties that erode time spent with patients,- documents that for every hour spent seeing patients, another hour is spent on paperwork and getting permission to perform a test or a procedure?Who articulates these things?I would like to say, I do. And I have in my blog, Medinnovation, in my books, and in www.modernmedicine.com, where I regularly submit blogs and interview national thought leaders. But a more reliable , balanced, and prestigious source is the Physicians Foundation, a nonprofit C01C3 organization that represents all American doctors belonging to state medical societies. These societies are close to the ground. The Foundation and state societies know what moves physicians , what discourages them, what is good and bad for their patients, and how to improve the system. Visit the Physicians Foundation website, www.physiciansfoundation.org, read about its charitable work, listen to the beat of the culture of individual physicians, who provide most of the care for patients in the United States. Part II will appear in my next blog.Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Tue, 06 Jul 2010 15:19:40 GMT http://community.modernmedicine.com/_Who-Speaks-for-Americas-650000-Independent-Private-Physicians-Part-I/blog/2432865/33379.html RichardReeceMD 2010-07-06T15:02:42Z Health Law & Policy Modern Medicine Community Who, -observes that independent physicians care for 80% of America’s patients,-describes the physician culture – its belief system, desire for autonomy, and reliance on clinical judgment,-deplores independent private practice decline, which has shrunk by about 10 % over the last 10 years? (See “The Independent Physician: Going, Going ….” NEJM. February 12, 2010),-explains accelerating departures of private doctors into retirement, non-clinical careers, hospital employment, and new practice models devoid of 3rd party interference.-comments at length on the fast-growing physician movement, locum tenens, traveling physicians for hire.-says that much of American medicine’s costs stem from lack of competition, open-ended comprehensive plans, mandated guaranteed benefits, restrictive regulations, physician malpractice expenses, ensuing defensive medicine practices, and litigious practice environments,- discerns that much of the so-called fraud and abuse occurs in Medicare and Medicaid and is perpetrated by non-physicians using stolen identities, rather than physicians in their practices, -notes that hospital-based medicine, with salaried physicians, as opposed to ambulatory-based medicine conducted by private physicians, drives costs up,-warns the American people about the impending doctor shortages, the coming access crisis, and longer waiting lines for doctor appointments,-highlights polls indicating patients trust their doctors more than government data-wielding bureaucrats, - tells Americans that only 2% of medical students are entering primary care, and that these are the physicians they are expected to visit to sort out problems and to coordinate care,- points out to Americans that many of the new 34 million who may gain insurance will be assigned to Medicaid rolls and that fewer and fewer doctors will accept new Medicaid recipients because of low reimbursements,- explains problems imposed by third parties that erode time spent with patients,- documents that for every hour spent seeing patients, another hour is spent on paperwork and getting permission to perform a test or a procedure?Who articulates these things?I would like to say, I do. And I have in my blog, Medinnovation, in my books, and in www.modernmedicine.com, where I regularly submit blogs and interview national thought leaders. But a more reliable , balanced, and prestigious source is the Physicians Foundation, a nonprofit C01C3 organization that represents all American doctors belonging to state medical societies. These societies are close to the ground. The Foundation and state societies know what moves physicians , what discourages them, what is good and bad for their patients, and how to improve the system. Visit the Physicians Foundation website, www.physiciansfoundation.org, read about its charitable work, listen to the beat of the culture of individual physicians, who provide most of the care for patients in the United States. Part II will appear in my next blog.Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] foundation”, health law & policy, physicians, practice”, “medical, “physician’s nonadult false Who Speaks for America's 650,000 Independent Private Physicians? Part I text blog foundation”,health law & policy,physicians,practice”,“medical,“physician’s 201 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=19464830&as=33379 http://media.kickstatic.com/kickapps/images/user/defaultImage_160x120_A.jpg false 0 Health Law & Policy 0 2432865 19464830 Member 0 http://community.modernmedicine.com/_Will-Innovation-Save-America-Health-Care/blog/2409878/33379.html For the last three years, I’ve been writing blogs touting health care innovation. I’ve maintained returning to market-based principles, allowing patients spend more of their own money, encouraging more personal responsibility for their health, offering entrepreneurs more capital for health ventures , giving patients more choices, making value-based information more available, encouraging doctors to compete, and innovating across the board hold the answers to a sustainable system. I even wrote a book on the subject, Innovation-Driven Health Care (2007).But to little avail. Clearly, President Obama does not share this world view. Instead he has opted for more government intervention, expansion of the social welfare state, and a more European-type health system to protect all population segments.An article in the New York Times, of all places, sends a warning shot across Obama’s bow.The article “Crisis Imperils Liberal Benefits Long Expected by Europeans,” , opens,“PARIS — Across Western Europe, the “lifestyle superpower,” the assumptions and gains of a lifetime are suddenly in doubt. The deficit crisis that threatens the euro has also undermined the sustainability of the European standard of social welfare, built by left-leaning governments since the end of World War II.“The author reports, among other things, Europe will have to save itself from crushing, unsustainable debts created by rapidly aging and declining populations by doing some of the following: raising its retirement and pension ages, freezing public sector pay, changing inflexible hiring and firing rules, and maybe even changing the slogan of the European Union, “The Europe that protects” through cradle-to-grave social welfare safety-nets. European countries , and the United States, may even have to consider national policies on innovation to stimulate their economies to outgrow the cost of its health care burdens. Writing in today’s The Health Care Blog, “National Health Insurance Isn’t Enough- Six Crucial Steps to Improve Health Care,” Dr. Albert Waxman, CEO and founding partner of Psilos Group, co-headquartered in the Bay Area and New York City, which has funded and developed more than 38 innovative companies dedicated to this vision, including ActiveHealth, AngioScore, Click4Care, Definity Health, ExtendHealth and OmniGuide, has these six suggestions to offer.• Preventing and managing chronic illnesses, such as diabetes and hypertension. These account for 78 percent of all health care expenses in Medicare. Technology can help improve care management to prevent costly procedures and to incentivize consumers to live healthier lifestyles.• Reducing errors in inpatient, ambulatory, and post-acute care. These errors – 19 percent e in medication administration errors at hospital bedsides alone -- are the result of poor information flow and fallible human behavior. Innovative solutions to help care administrators avoid costly and tragic mistakes have begun emerging and have demonstrated positive clinical outcomes.• Addressing and reducing the obesity and diabetes epidemic, which costs an estimated $170 billion annually in the U.S. • Using new medical technologies to enable earlier and better diagnosis and thus earlier intervention to mitigate the impact of high-cost, high-morbidity diseases. Continued innovation around technologies that help identify diseases earlier will have a vital financial and clinical impact.• Fostering the development of medical devices for less invasive and more effective surgical interventions. • Lastly, recognizing and sponsoring entrepreneurs committed to developing solutions for most of the previously mentioned challenges. Venture capitalists must assume a leadership role in spurring the innovation needed to save not just America’s health care economy but its overall economy.Unless we innovate, we may become just another European boiled frog, dying a slow, unrecognized, but certain death from slowly rising debt temperatures engendered by an aging population, lowered birth rates, and social welfare burdens. We have an advantage over Europe because of our public-private mix, our tradition of entrepreneurship, and our birth rates, which exceed those of Europe. Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] For the last three years, I’ve been writing blogs touting health care innovation. I’ve maintained returning to market-based principles, allowing patients spend more of their own money, encouraging more personal responsibility for their health, offering entrepreneurs more capital for health ventures , giving patients more choices, making value-based information more available, encouraging doctors to compete, and innovating across the board hold the answers to a sustainable system. I even wrote a book on the subject, Innovation-Driven Health Care (2007).But to little avail. Clearly, President Obama does not share this world view. Instead he has opted for more government intervention, expansion of the social welfare state, and a more European-type health system to protect all population segments.An article in the New York Times, of all places, sends a warning shot across Obama’s bow.The article “Crisis Imperils Liberal Benefits Long Expected by Europeans,” , opens,“PARIS — Across Western Europe, the “lifestyle superpower,” the assumptions and gains of a lifetime are suddenly in doubt. The deficit crisis that threatens the euro has also undermined the sustainability of the European standard of social welfare, built by left-leaning governments since the end of World War II.“The author reports, among other things, Europe will have to save itself from crushing, unsustainable debts created by rapidly aging and declining populations by doing some of the following: raising its retirement and pension ages, freezing public sector pay, changing inflexible hiring and firing rules, and maybe even changing the slogan of the European Union, “The Europe that protects” through cradle-to-grave social welfare safety-nets. European countries , and the United States, may even have to consider national policies on innovation to stimulate their economies to outgrow the cost of its health care burdens. Writing in today’s The Health Care Blog, “National Health Insurance Isn’t Enough- Six Crucial Steps to Improve Health Care,” Dr. Albert Waxman, CEO and founding partner of Psilos Group, co-headquartered in the Bay Area and New York City, which has funded and developed more than 38 innovative companies dedicated to this vision, including ActiveHealth, AngioScore, Click4Care, Definity Health, ExtendHealth and OmniGuide, has these six suggestions to offer.• Preventing and managing chronic illnesses, such as diabetes and hypertension. These account for 78 percent of all health care expenses in Medicare. Technology can help improve care management to prevent costly procedures and to incentivize consumers to live healthier lifestyles.• Reducing errors in inpatient, ambulatory, and post-acute care. These errors – 19 percent e in medication administration errors at hospital bedsides alone -- are the result of poor information flow and fallible human behavior. Innovative solutions to help care administrators avoid costly and tragic mistakes have begun emerging and have demonstrated positive clinical outcomes.• Addressing and reducing the obesity and diabetes epidemic, which costs an estimated $170 billion annually in the U.S. • Using new medical technologies to enable earlier and better diagnosis and thus earlier intervention to mitigate the impact of high-cost, high-morbidity diseases. Continued innovation around technologies that help identify diseases earlier will have a vital financial and clinical impact.• Fostering the development of medical devices for less invasive and more effective surgical interventions. • Lastly, recognizing and sponsoring entrepreneurs committed to developing solutions for most of the previously mentioned challenges. Venture capitalists must assume a leadership role in spurring the innovation needed to save not just America’s health care economy but its overall economy.Unless we innovate, we may become just another European boiled frog, dying a slow, unrecognized, but certain death from slowly rising debt temperatures engendered by an aging population, lowered birth rates, and social welfare burdens. We have an advantage over Europe because of our public-private mix, our tradition of entrepreneurship, and our birth rates, which exceed those of Europe. Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Thu, 24 Jun 2010 16:25:40 GMT http://community.modernmedicine.com/_Will-Innovation-Save-America-Health-Care/blog/2409878/33379.html RichardReeceMD 2010-06-24T15:25:05Z Health Law & Policy Modern Medicine Community For the last three years, I’ve been writing blogs touting health care innovation. I’ve maintained returning to market-based principles, allowing patients spend more of their own money, encouraging more personal responsibility for their health, offering entrepreneurs more capital for health ventures , giving patients more choices, making value-based information more available, encouraging doctors to compete, and innovating across the board hold the answers to a sustainable system. I even wrote a book on the subject, Innovation-Driven Health Care (2007).But to little avail. Clearly, President Obama does not share this world view. Instead he has opted for more government intervention, expansion of the social welfare state, and a more European-type health system to protect all population segments.An article in the New York Times, of all places, sends a warning shot across Obama’s bow.The article “Crisis Imperils Liberal Benefits Long Expected by Europeans,” , opens,“PARIS — Across Western Europe, the “lifestyle superpower,” the assumptions and gains of a lifetime are suddenly in doubt. The deficit crisis that threatens the euro has also undermined the sustainability of the European standard of social welfare, built by left-leaning governments since the end of World War II.“The author reports, among other things, Europe will have to save itself from crushing, unsustainable debts created by rapidly aging and declining populations by doing some of the following: raising its retirement and pension ages, freezing public sector pay, changing inflexible hiring and firing rules, and maybe even changing the slogan of the European Union, “The Europe that protects” through cradle-to-grave social welfare safety-nets. European countries , and the United States, may even have to consider national policies on innovation to stimulate their economies to outgrow the cost of its health care burdens. Writing in today’s The Health Care Blog, “National Health Insurance Isn’t Enough- Six Crucial Steps to Improve Health Care,” Dr. Albert Waxman, CEO and founding partner of Psilos Group, co-headquartered in the Bay Area and New York City, which has funded and developed more than 38 innovative companies dedicated to this vision, including ActiveHealth, AngioScore, Click4Care, Definity Health, ExtendHealth and OmniGuide, has these six suggestions to offer.• Preventing and managing chronic illnesses, such as diabetes and hypertension. These account for 78 percent of all health care expenses in Medicare. Technology can help improve care management to prevent costly procedures and to incentivize consumers to live healthier lifestyles.• Reducing errors in inpatient, ambulatory, and post-acute care. These errors – 19 percent e in medication administration errors at hospital bedsides alone -- are the result of poor information flow and fallible human behavior. Innovative solutions to help care administrators avoid costly and tragic mistakes have begun emerging and have demonstrated positive clinical outcomes.• Addressing and reducing the obesity and diabetes epidemic, which costs an estimated $170 billion annually in the U.S. • Using new medical technologies to enable earlier and better diagnosis and thus earlier intervention to mitigate the impact of high-cost, high-morbidity diseases. Continued innovation around technologies that help identify diseases earlier will have a vital financial and clinical impact.• Fostering the development of medical devices for less invasive and more effective surgical interventions. • Lastly, recognizing and sponsoring entrepreneurs committed to developing solutions for most of the previously mentioned challenges. Venture capitalists must assume a leadership role in spurring the innovation needed to save not just America’s health care economy but its overall economy.Unless we innovate, we may become just another European boiled frog, dying a slow, unrecognized, but certain death from slowly rising debt temperatures engendered by an aging population, lowered birth rates, and social welfare burdens. We have an advantage over Europe because of our public-private mix, our tradition of entrepreneurship, and our birth rates, which exceed those of Europe. Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] health care innovation, health law & policy, national health insurance nonadult false Will Innovation Save America Health Care? text blog health care innovation,health law & policy,national health insurance 186 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=19464830&as=33379 http://media.kickstatic.com/kickapps/images/user/defaultImage_160x120_C.jpg false 0 Health Law & Policy 0 2409878 19464830 Member 0 http://community.modernmedicine.com/_Medical-Innovations-and-The-Search-for-More-Private-More-Personal-More-Decentralized-Care/blog/2408430/33379.html There is something curious and paradoxical going on out there. It combines high tech, low tech, high touch care innovations. It is a back-to-the-home movement - a yearning to escape from hospitals, specialized clinics, specialists, and those health plans we’ve come to dislike. It seeks high-tech alternatives to high-cost care. It wants high tech tests done at home by patients at home and monitored by doctors. Here is how Steve Lohr, the New York Time’s health care innovation expert describes the high-tech aspects of this transformation,“Mention health care reform and the image that springs to mind is a big government program. But there is another broad transformation in health care underway, a powerful force for decentralized innovation. It is fueled in good part by technology – low-cost computing devices, digital sensors, and the Web.”“The trend promises to shift a lot of diagnosis, monitoring, and treatment of disease from hospital and specialized clinics where treatment is expensive, to primary care physicians and patients themselves – at far less cost.”But there is another leg to this transformation, Lohr did not mention - the search for more private , more personal care. Patients are seeking refuge from the digital revolution, where nothing is hidden and everything is known about their personal habits, illnesses, financial status, and health care shopping patterns. Doctors seek to escape from the expenses and irritation and the prohibitive overheads posed by third party overseers. Patients yearn for a more intimate relationship, eye-to-eye contract with their personal doctor, absent a computer interposed between them, recording every nuance of the encounter. In an April 13, 2010, WSJ Health Blog, Katherine Hobson writes, “Patients already lie to their doctors. And almost half of respondents in a new survey said if there was any hint their health information — even stripped of identifying details like name or date of birth — would be shared with outside organizations, they might be even less forthcoming. ““A study on electronic medical records use by the California HealthCare Foundation, a philanthropic group, found that 15% of the 1,849 adults surveyed said they’d conceal information from a physician if “the doctor had an electronic medical record system” that could share that info with other groups. Another 33% would “consider hiding information.”“Privacy concerns still hover around EMRs, with 68% of survey respondents reporting some degree of worry about what happens to their personal information once it’s stored in a doctor’s computer.”Doctors yearn to break loose from the fetters of third party reimbursement which account for most of their practice’s overheads, now often in the 60% to 70% range and which requires extensive and expensive documentation to justify charges. In an interview I conducted with Donald Copeland MD, a seasoned family physician who has practiced and taught family medicine for decades, he expressed this dissenting opinion on the need for electronic records to document the patient encounter, monitor doctors, and justify fees, in response to a question of mine,“Q. President Obama has recommended the government spend $20 billion over the next five years to make electronic medical records mandatory, and there is an underlying threat to restrict payment only to those doctors with electronic records. What do you think?A: I think it’s ludicrous. You and I know that I know enough about electronic records to know that all EMRs are just a way to keep records. You can teach how to practice primary care or judge how they perform with medical records. How can EMRs transform medicine? EMR advocates say EMRs are a way of teaching or telling us how to practice medicine, but most of the people promoting them have never practiced medicine. “Doctor Copeland’s opinion is not an isolated one. More and more physicians are not accepting Medicare, Medicaid, HMO, and PPO patients, and many are forming concierge or cash-only practices, or letting patients collect the payment from insurers. In a May 23 interview on CBS’s 60 minutes, Marty Cooper, inventor of the cell phone, and the first person to make a cell phone call in 1973, shrugged off the privacy issue by saying, “There is no such thing as privacy anymore.” With wireless technologies, Facebook,Twitter, cellphones, and I-pad, we are being told privacy is no longer the social norm. The age of privacy may be over. But many of us prefer to think that what occurs behind closed doors between a patient and doctor is a private matter. The interchange during the encounter is confidential, and for the doctor’s ears only. And the outside world should not be privy to what goes on there – particularly things that could be used against us.The health system is being transformed as patients and doctors alike seek more personal, private, and decentralized, high tech/high touch relationships. Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] There is something curious and paradoxical going on out there. It combines high tech, low tech, high touch care innovations. It is a back-to-the-home movement - a yearning to escape from hospitals, specialized clinics, specialists, and those health plans we’ve come to dislike. It seeks high-tech alternatives to high-cost care. It wants high tech tests done at home by patients at home and monitored by doctors. Here is how Steve Lohr, the New York Time’s health care innovation expert describes the high-tech aspects of this transformation,“Mention health care reform and the image that springs to mind is a big government program. But there is another broad transformation in health care underway, a powerful force for decentralized innovation. It is fueled in good part by technology – low-cost computing devices, digital sensors, and the Web.”“The trend promises to shift a lot of diagnosis, monitoring, and treatment of disease from hospital and specialized clinics where treatment is expensive, to primary care physicians and patients themselves – at far less cost.”But there is another leg to this transformation, Lohr did not mention - the search for more private , more personal care. Patients are seeking refuge from the digital revolution, where nothing is hidden and everything is known about their personal habits, illnesses, financial status, and health care shopping patterns. Doctors seek to escape from the expenses and irritation and the prohibitive overheads posed by third party overseers. Patients yearn for a more intimate relationship, eye-to-eye contract with their personal doctor, absent a computer interposed between them, recording every nuance of the encounter. In an April 13, 2010, WSJ Health Blog, Katherine Hobson writes, “Patients already lie to their doctors. And almost half of respondents in a new survey said if there was any hint their health information — even stripped of identifying details like name or date of birth — would be shared with outside organizations, they might be even less forthcoming. ““A study on electronic medical records use by the California HealthCare Foundation, a philanthropic group, found that 15% of the 1,849 adults surveyed said they’d conceal information from a physician if “the doctor had an electronic medical record system” that could share that info with other groups. Another 33% would “consider hiding information.”“Privacy concerns still hover around EMRs, with 68% of survey respondents reporting some degree of worry about what happens to their personal information once it’s stored in a doctor’s computer.”Doctors yearn to break loose from the fetters of third party reimbursement which account for most of their practice’s overheads, now often in the 60% to 70% range and which requires extensive and expensive documentation to justify charges. In an interview I conducted with Donald Copeland MD, a seasoned family physician who has practiced and taught family medicine for decades, he expressed this dissenting opinion on the need for electronic records to document the patient encounter, monitor doctors, and justify fees, in response to a question of mine,“Q. President Obama has recommended the government spend $20 billion over the next five years to make electronic medical records mandatory, and there is an underlying threat to restrict payment only to those doctors with electronic records. What do you think?A: I think it’s ludicrous. You and I know that I know enough about electronic records to know that all EMRs are just a way to keep records. You can teach how to practice primary care or judge how they perform with medical records. How can EMRs transform medicine? EMR advocates say EMRs are a way of teaching or telling us how to practice medicine, but most of the people promoting them have never practiced medicine. “Doctor Copeland’s opinion is not an isolated one. More and more physicians are not accepting Medicare, Medicaid, HMO, and PPO patients, and many are forming concierge or cash-only practices, or letting patients collect the payment from insurers. In a May 23 interview on CBS’s 60 minutes, Marty Cooper, inventor of the cell phone, and the first person to make a cell phone call in 1973, shrugged off the privacy issue by saying, “There is no such thing as privacy anymore.” With wireless technologies, Facebook,Twitter, cellphones, and I-pad, we are being told privacy is no longer the social norm. The age of privacy may be over. But many of us prefer to think that what occurs behind closed doors between a patient and doctor is a private matter. The interchange during the encounter is confidential, and for the doctor’s ears only. And the outside world should not be privy to what goes on there – particularly things that could be used against us.The health system is being transformed as patients and doctors alike seek more personal, private, and decentralized, high tech/high touch relationships. Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Wed, 23 Jun 2010 21:17:07 GMT http://community.modernmedicine.com/_Medical-Innovations-and-The-Search-for-More-Private-More-Personal-More-Decentralized-Care/blog/2408430/33379.html RichardReeceMD 2010-06-23T20:23:51Z Modern Medicine Community There is something curious and paradoxical going on out there. It combines high tech, low tech, high touch care innovations. It is a back-to-the-home movement - a yearning to escape from hospitals, specialized clinics, specialists, and those health plans we’ve come to dislike. It seeks high-tech alternatives to high-cost care. It wants high tech tests done at home by patients at home and monitored by doctors. Here is how Steve Lohr, the New York Time’s health care innovation expert describes the high-tech aspects of this transformation,“Mention health care reform and the image that springs to mind is a big government program. But there is another broad transformation in health care underway, a powerful force for decentralized innovation. It is fueled in good part by technology – low-cost computing devices, digital sensors, and the Web.”“The trend promises to shift a lot of diagnosis, monitoring, and treatment of disease from hospital and specialized clinics where treatment is expensive, to primary care physicians and patients themselves – at far less cost.”But there is another leg to this transformation, Lohr did not mention - the search for more private , more personal care. Patients are seeking refuge from the digital revolution, where nothing is hidden and everything is known about their personal habits, illnesses, financial status, and health care shopping patterns. Doctors seek to escape from the expenses and irritation and the prohibitive overheads posed by third party overseers. Patients yearn for a more intimate relationship, eye-to-eye contract with their personal doctor, absent a computer interposed between them, recording every nuance of the encounter. In an April 13, 2010, WSJ Health Blog, Katherine Hobson writes, “Patients already lie to their doctors. And almost half of respondents in a new survey said if there was any hint their health information — even stripped of identifying details like name or date of birth — would be shared with outside organizations, they might be even less forthcoming. ““A study on electronic medical records use by the California HealthCare Foundation, a philanthropic group, found that 15% of the 1,849 adults surveyed said they’d conceal information from a physician if “the doctor had an electronic medical record system” that could share that info with other groups. Another 33% would “consider hiding information.”“Privacy concerns still hover around EMRs, with 68% of survey respondents reporting some degree of worry about what happens to their personal information once it’s stored in a doctor’s computer.”Doctors yearn to break loose from the fetters of third party reimbursement which account for most of their practice’s overheads, now often in the 60% to 70% range and which requires extensive and expensive documentation to justify charges. In an interview I conducted with Donald Copeland MD, a seasoned family physician who has practiced and taught family medicine for decades, he expressed this dissenting opinion on the need for electronic records to document the patient encounter, monitor doctors, and justify fees, in response to a question of mine,“Q. President Obama has recommended the government spend $20 billion over the next five years to make electronic medical records mandatory, and there is an underlying threat to restrict payment only to those doctors with electronic records. What do you think?A: I think it’s ludicrous. You and I know that I know enough about electronic records to know that all EMRs are just a way to keep records. You can teach how to practice primary care or judge how they perform with medical records. How can EMRs transform medicine? EMR advocates say EMRs are a way of teaching or telling us how to practice medicine, but most of the people promoting them have never practiced medicine. “Doctor Copeland’s opinion is not an isolated one. More and more physicians are not accepting Medicare, Medicaid, HMO, and PPO patients, and many are forming concierge or cash-only practices, or letting patients collect the payment from insurers. In a May 23 interview on CBS’s 60 minutes, Marty Cooper, inventor of the cell phone, and the first person to make a cell phone call in 1973, shrugged off the privacy issue by saying, “There is no such thing as privacy anymore.” With wireless technologies, Facebook,Twitter, cellphones, and I-pad, we are being told privacy is no longer the social norm. The age of privacy may be over. But many of us prefer to think that what occurs behind closed doors between a patient and doctor is a private matter. The interchange during the encounter is confidential, and for the doctor’s ears only. And the outside world should not be privy to what goes on there – particularly things that could be used against us.The health system is being transformed as patients and doctors alike seek more personal, private, and decentralized, high tech/high touch relationships. Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] ehr, emr, personal doctor, privacy, third party insurance nonadult false Medical Innovations and The Search for More Private, More Personal, More Decentralized Care text blog ehr,emr,personal doctor,privacy,third party insurance 248 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=19464830&as=33379 http://media.kickstatic.com/kickapps/images/user/defaultImage_160x120_C.jpg false 0 0 2408430 19464830 Member 0 http://community.modernmedicine.com/_Harvard-Business-Schools-10-Health-Care-Innovations/blog/2406763/33379.html I just ran across the Harvard Business School’s list of 10 innovations written by Gardiner Morse for its Health Care Innovation Insight Center. You can find it on Google under "Ten Innovations That Will Transform Medicine."Here is how I react on a scale of 1 to 10 as someone who has frequently trekked down the health care innovation road.1. CHECK LISTS- Hospitals will require health care providers to follow strict protocols for procedures that benefit from routinization—from preparing a patient for surgery to inserting a central line. I’ll give this a EIGHT, But with this caveat: giving a doctor a checklist for each patient is not the same as giving pilot a checklist when 200 passengers are on board. 2. BEHAVIORAL ECONOMICS - Health care will incorporate insights from behavioral economics–everything from weight loss incentives to using peer pressure to change how doctors work. Barely a SEVEN. Put me down as dubious. Changing ingrained lifestyles and doctors’ practice styles isn’t easy. 3. PATIENT PORTALS - Consumers will use secure web connections to make and check appointments, see lab results, renew prescriptions, and communicate with doctors and nurses. Definitely an EIGHT. We’re getting there as personal computers with broadband access become ubiquitous. 4. PAYMENT INNOVATION - Payment schemes that reward good outcomes and value rather than volume of procedures will become the norm. At best a FOUR. Good patient outcomes are often beyond the reach of doctors. Patients may return to bad habits and often don’t comply with instructions. 5. EVIDENCE-BASED DECISION MAKING - Electronic medical records collect important information for coordinated care, and physicians and nurses are alerted to potential errors and best practices. A mere FIVE. The thesis that EMRs improve care is unproven. EMRS may generate more errors. Medicine is still full of uncertainties without evidence and is still Art as well as Science. Still depends on relationships, not necessarily on”facts,” and the placebo effect is powerful.6. ACCOUNTABLE CARE ORGANIZATIONS – Hospitals and doctors will coordinate care for shared patients in order to keep them well-rather than simply treat them when they’re sick-and share in savings that result from improved quality. A weak FIVE. This assumes doctors will join multispecialty groups and integrated delivery systems, often hospital-based. Reverse may be occurring as patients seek more private personal care, and as doctors form concierge and cash-only practices and shun 3rd party care.7. REGENERATIVE MEDICINE - Stem cell research will lead to treatments for cancer, multiple sclerosis, spinal cord injuries, and other intractable conditions.A hopeful FIVE. I hope this is so, but I have yet to see concrete evidence. Body remains a mysterious “black box.” Mysteries may take years to unravel.8. VIRTUAL VISITS - Health care will be done at a distance with videoconferencing and remote monitoring of blood sugar, blood pressure, heart rate, and other health data. A strong NINE. I agree, as this is happening rather fast as health plans pay for virtual visits and as remote monitoring improves. Problems remain on how to pay for it, how to across care jurisdictions, and how to minimize malpractice tangles. 9. GENETIC MEDICINE - Individual genetic profiles will help doctors to prescribe the most effective treatments, tailored to the patient. A SEVEN. This is becoming routine in evaluating predisposition to breast cancer. And I notice Walgreen put a kit for 42 DNA profiles on market before withdrawing it. We shall see what happens in this political controversy fraught field which smacks of social engineering.10. SURGICAL ROBOTICS -Though ready for prime time technologically, the technology may be ahead of the usefulness. They don’t—yet—necessarily improve outcomes or deliver better value but may offer exciting potential.A pragmatic NINE. We’re already there, as hospitals and specialists seek marketing edge, and 833 hospitals have purchased de Vinci surgical robot. Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] I just ran across the Harvard Business School’s list of 10 innovations written by Gardiner Morse for its Health Care Innovation Insight Center. You can find it on Google under "Ten Innovations That Will Transform Medicine."Here is how I react on a scale of 1 to 10 as someone who has frequently trekked down the health care innovation road.1. CHECK LISTS- Hospitals will require health care providers to follow strict protocols for procedures that benefit from routinization—from preparing a patient for surgery to inserting a central line. I’ll give this a EIGHT, But with this caveat: giving a doctor a checklist for each patient is not the same as giving pilot a checklist when 200 passengers are on board. 2. BEHAVIORAL ECONOMICS - Health care will incorporate insights from behavioral economics–everything from weight loss incentives to using peer pressure to change how doctors work. Barely a SEVEN. Put me down as dubious. Changing ingrained lifestyles and doctors’ practice styles isn’t easy. 3. PATIENT PORTALS - Consumers will use secure web connections to make and check appointments, see lab results, renew prescriptions, and communicate with doctors and nurses. Definitely an EIGHT. We’re getting there as personal computers with broadband access become ubiquitous. 4. PAYMENT INNOVATION - Payment schemes that reward good outcomes and value rather than volume of procedures will become the norm. At best a FOUR. Good patient outcomes are often beyond the reach of doctors. Patients may return to bad habits and often don’t comply with instructions. 5. EVIDENCE-BASED DECISION MAKING - Electronic medical records collect important information for coordinated care, and physicians and nurses are alerted to potential errors and best practices. A mere FIVE. The thesis that EMRs improve care is unproven. EMRS may generate more errors. Medicine is still full of uncertainties without evidence and is still Art as well as Science. Still depends on relationships, not necessarily on”facts,” and the placebo effect is powerful.6. ACCOUNTABLE CARE ORGANIZATIONS – Hospitals and doctors will coordinate care for shared patients in order to keep them well-rather than simply treat them when they’re sick-and share in savings that result from improved quality. A weak FIVE. This assumes doctors will join multispecialty groups and integrated delivery systems, often hospital-based. Reverse may be occurring as patients seek more private personal care, and as doctors form concierge and cash-only practices and shun 3rd party care.7. REGENERATIVE MEDICINE - Stem cell research will lead to treatments for cancer, multiple sclerosis, spinal cord injuries, and other intractable conditions.A hopeful FIVE. I hope this is so, but I have yet to see concrete evidence. Body remains a mysterious “black box.” Mysteries may take years to unravel.8. VIRTUAL VISITS - Health care will be done at a distance with videoconferencing and remote monitoring of blood sugar, blood pressure, heart rate, and other health data. A strong NINE. I agree, as this is happening rather fast as health plans pay for virtual visits and as remote monitoring improves. Problems remain on how to pay for it, how to across care jurisdictions, and how to minimize malpractice tangles. 9. GENETIC MEDICINE - Individual genetic profiles will help doctors to prescribe the most effective treatments, tailored to the patient. A SEVEN. This is becoming routine in evaluating predisposition to breast cancer. And I notice Walgreen put a kit for 42 DNA profiles on market before withdrawing it. We shall see what happens in this political controversy fraught field which smacks of social engineering.10. SURGICAL ROBOTICS -Though ready for prime time technologically, the technology may be ahead of the usefulness. They don’t—yet—necessarily improve outcomes or deliver better value but may offer exciting potential.A pragmatic NINE. We’re already there, as hospitals and specialists seek marketing edge, and 833 hospitals have purchased de Vinci surgical robot. Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Thu, 24 Jun 2010 22:07:09 GMT http://community.modernmedicine.com/_Harvard-Business-Schools-10-Health-Care-Innovations/blog/2406763/33379.html RichardReeceMD 2010-06-22T20:22:17Z Managing Your Practice Modern Medicine Community I just ran across the Harvard Business School’s list of 10 innovations written by Gardiner Morse for its Health Care Innovation Insight Center. You can find it on Google under "Ten Innovations That Will Transform Medicine."Here is how I react on a scale of 1 to 10 as someone who has frequently trekked down the health care innovation road.1. CHECK LISTS- Hospitals will require health care providers to follow strict protocols for procedures that benefit from routinization—from preparing a patient for surgery to inserting a central line. I’ll give this a EIGHT, But with this caveat: giving a doctor a checklist for each patient is not the same as giving pilot a checklist when 200 passengers are on board. 2. BEHAVIORAL ECONOMICS - Health care will incorporate insights from behavioral economics–everything from weight loss incentives to using peer pressure to change how doctors work. Barely a SEVEN. Put me down as dubious. Changing ingrained lifestyles and doctors’ practice styles isn’t easy. 3. PATIENT PORTALS - Consumers will use secure web connections to make and check appointments, see lab results, renew prescriptions, and communicate with doctors and nurses. Definitely an EIGHT. We’re getting there as personal computers with broadband access become ubiquitous. 4. PAYMENT INNOVATION - Payment schemes that reward good outcomes and value rather than volume of procedures will become the norm. At best a FOUR. Good patient outcomes are often beyond the reach of doctors. Patients may return to bad habits and often don’t comply with instructions. 5. EVIDENCE-BASED DECISION MAKING - Electronic medical records collect important information for coordinated care, and physicians and nurses are alerted to potential errors and best practices. A mere FIVE. The thesis that EMRs improve care is unproven. EMRS may generate more errors. Medicine is still full of uncertainties without evidence and is still Art as well as Science. Still depends on relationships, not necessarily on”facts,” and the placebo effect is powerful.6. ACCOUNTABLE CARE ORGANIZATIONS – Hospitals and doctors will coordinate care for shared patients in order to keep them well-rather than simply treat them when they’re sick-and share in savings that result from improved quality. A weak FIVE. This assumes doctors will join multispecialty groups and integrated delivery systems, often hospital-based. Reverse may be occurring as patients seek more private personal care, and as doctors form concierge and cash-only practices and shun 3rd party care.7. REGENERATIVE MEDICINE - Stem cell research will lead to treatments for cancer, multiple sclerosis, spinal cord injuries, and other intractable conditions.A hopeful FIVE. I hope this is so, but I have yet to see concrete evidence. Body remains a mysterious “black box.” Mysteries may take years to unravel.8. VIRTUAL VISITS - Health care will be done at a distance with videoconferencing and remote monitoring of blood sugar, blood pressure, heart rate, and other health data. A strong NINE. I agree, as this is happening rather fast as health plans pay for virtual visits and as remote monitoring improves. Problems remain on how to pay for it, how to across care jurisdictions, and how to minimize malpractice tangles. 9. GENETIC MEDICINE - Individual genetic profiles will help doctors to prescribe the most effective treatments, tailored to the patient. A SEVEN. This is becoming routine in evaluating predisposition to breast cancer. And I notice Walgreen put a kit for 42 DNA profiles on market before withdrawing it. We shall see what happens in this political controversy fraught field which smacks of social engineering.10. SURGICAL ROBOTICS -Though ready for prime time technologically, the technology may be ahead of the usefulness. They don’t—yet—necessarily improve outcomes or deliver better value but may offer exciting potential.A pragmatic NINE. We’re already there, as hospitals and specialists seek marketing edge, and 833 hospitals have purchased de Vinci surgical robot. Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] ehr, emr, healthcare, internet, managing your practice, telemedicine nonadult false Harvard Business School's 10 Health Care Innovations text blog ehr,emr,healthcare,internet,managing your practice,telemedicine 411 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=19464830&as=33379 http://media.kickstatic.com/kickapps/images/user/defaultImage_160x120_C.jpg false 0 Managing Your Practice 0 2406763 19464830 Member 0 http://community.modernmedicine.com/_Is-Practice-Fusions-Free-EHR-for-Real/blog/2405342/33379.html As I was writing blogs on EHRs, I kept pondering these questions: Is Practice Fusion, Inc, a San Francisco-based company offering a “free” EHR to physicians, an example of “disruptive innovation”? After all, its EHR appears to be simpler, more convenient, more affordable, and intuitively easier to use than other EHRs– the criteria usually applied to disruptive innovations. Does it signal a “breakthrough” towards a decentralized technology deployable at the site of care? How can Practice Fusion offer its EHR for “free”? What triggered this “breakthrough”? When all is said and done, I believe this “breakthrough,” if it is that, is not attributable to new EHR software or hardware, but to a new revenue model. Or you might say, it is a “fusion” of all three of these elements.Here is how Ryan Howard, CEO of Practice Fusion, explains this model,‘Our revenue model works in a few different ways. We monetize transactions from our partners. We do some lead generation. So if the doctors are looking for a billing service, for example, we have a billing service that they can use. We do some advertising to the physicians: different health care services, insurance companies, device manufactures and pharmaceuticals as well.”If you think about it, Practice Fusion has adopted and modified the revenue model that has made Google so successful, namely gathering revenues from online advertising and lead generation tied to “free” access by users. It does not require physicians to install new hardware and software, but to off-load what they need in an EHR to the Internet using their existing office computers. The beauty of it is, of course, is that you can use your own computer and somebody else – people and businesses who want access to physicians to sell them products – pays the freight for the EHR.In other words, someone else, not physicians, is paying the bill. According to Howard, “The product is provided to physicians fully subsidized. It’s not a “take now, pay later” or get half of the product now and then pays for the rest of it. Every feature that’s included with the product in any capacity is offered at no cost, so it’s truly free. It’s offered with support, training, and hosting. It’s the only totally free model on the market.”Back to my recent posts for context. • In “Will Innovation Save America’s Health Care?” I wondered out load whether innovations from largely web-based technologies and systems would save us from Europe’s fate- the crushing cost and ensuing debt of unsustainable social welfare programs.• In “EHR‘Inevitability and the Physician Waiting Game,“ I questioned whether EHR systems were ready for prime time, and I implied physicians were right in waiting for useful, affordable, and intuitively and clinical compatible systems.• In “EHRs – Size of Physician Market, Numbers Sold, By Whom, Comprehensiveness of Systems,” I reprinted an article by Chris Thorman of Software Advice, on the scope, players, and nature of the EHR market.In the latter blog, I shared a chart showing EHR vendors and number of physician users. Vendor Physician Users Practices ServedEpic 45,000 AllScripts 40,000 eClinicalWorks 40,000 GE Centricity 35,000 NextGen 35,000 SOAPWare 30,000 Practice Fusion 18,500 Eclipsys 11,000 Sage Health 10,000 .Greenway Medical 6,000 I recently received the following email from Emily Peters, Director of Communications for Practice Fusion, “Hi Dr. Reece, “I’ve been closely following your blog coverage on EHRs about market share, innovation and Practice Fusion.”“We do see some element of the “waiting game” that you described with physicians, but much less than even just six months ago. Practice Fusion now serves about 40,000 users and 2 million patients across the country – making us, not only the fastest growing EMR community, but also one of the largest. “Before that, I had read a podcast interview with Ryan Howard, CEO of Practice Fusion, in which he said, “We just broke 15,000 users.”I have no reason to question or challenge these physician user figures, which bespeak of explosive growth. But I can ask: how could one EHR company grow so fast? Maybe it’s simply a matter of timing, namely, the physician market is primed and ready to get into the EHR game. Maybe it’s the marketing magic of the word “free.” Maybe it’s because Practice Fusion has the only “free” EHR on the market. Maybe it’s word getting around among physician users that this EHR really works. Maybe it’s because the Practice Fusion model profits physician users because it qualifies them as “meaningful users” and therefore qualifies them for federal reimbursement. Maybe it’s because most physicians now have broad band Internet access in their offices and can put this EHR to work in a short time frame without elaborate training and installation preparation. Or maybe Practice Fusion is not what it’s cracked up to be and is too good to be true. There are no perfect systems in the EHR world, all are evolving, and there is always room for skepticism, or as one pessimistic wag with a weakness for puns observed, there is always gloom for improvement.Perhaps readers of this blog will give me insight into what they think of Practice Fusion? Is it for real, or does it have blemishes that I do not see? Please feel free to comment one way or another. Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] As I was writing blogs on EHRs, I kept pondering these questions: Is Practice Fusion, Inc, a San Francisco-based company offering a “free” EHR to physicians, an example of “disruptive innovation”? After all, its EHR appears to be simpler, more convenient, more affordable, and intuitively easier to use than other EHRs– the criteria usually applied to disruptive innovations. Does it signal a “breakthrough” towards a decentralized technology deployable at the site of care? How can Practice Fusion offer its EHR for “free”? What triggered this “breakthrough”? When all is said and done, I believe this “breakthrough,” if it is that, is not attributable to new EHR software or hardware, but to a new revenue model. Or you might say, it is a “fusion” of all three of these elements.Here is how Ryan Howard, CEO of Practice Fusion, explains this model,‘Our revenue model works in a few different ways. We monetize transactions from our partners. We do some lead generation. So if the doctors are looking for a billing service, for example, we have a billing service that they can use. We do some advertising to the physicians: different health care services, insurance companies, device manufactures and pharmaceuticals as well.”If you think about it, Practice Fusion has adopted and modified the revenue model that has made Google so successful, namely gathering revenues from online advertising and lead generation tied to “free” access by users. It does not require physicians to install new hardware and software, but to off-load what they need in an EHR to the Internet using their existing office computers. The beauty of it is, of course, is that you can use your own computer and somebody else – people and businesses who want access to physicians to sell them products – pays the freight for the EHR.In other words, someone else, not physicians, is paying the bill. According to Howard, “The product is provided to physicians fully subsidized. It’s not a “take now, pay later” or get half of the product now and then pays for the rest of it. Every feature that’s included with the product in any capacity is offered at no cost, so it’s truly free. It’s offered with support, training, and hosting. It’s the only totally free model on the market.”Back to my recent posts for context. • In “Will Innovation Save America’s Health Care?” I wondered out load whether innovations from largely web-based technologies and systems would save us from Europe’s fate- the crushing cost and ensuing debt of unsustainable social welfare programs.• In “EHR‘Inevitability and the Physician Waiting Game,“ I questioned whether EHR systems were ready for prime time, and I implied physicians were right in waiting for useful, affordable, and intuitively and clinical compatible systems.• In “EHRs – Size of Physician Market, Numbers Sold, By Whom, Comprehensiveness of Systems,” I reprinted an article by Chris Thorman of Software Advice, on the scope, players, and nature of the EHR market.In the latter blog, I shared a chart showing EHR vendors and number of physician users. Vendor Physician Users Practices ServedEpic 45,000 AllScripts 40,000 eClinicalWorks 40,000 GE Centricity 35,000 NextGen 35,000 SOAPWare 30,000 Practice Fusion 18,500 Eclipsys 11,000 Sage Health 10,000 .Greenway Medical 6,000 I recently received the following email from Emily Peters, Director of Communications for Practice Fusion, “Hi Dr. Reece, “I’ve been closely following your blog coverage on EHRs about market share, innovation and Practice Fusion.”“We do see some element of the “waiting game” that you described with physicians, but much less than even just six months ago. Practice Fusion now serves about 40,000 users and 2 million patients across the country – making us, not only the fastest growing EMR community, but also one of the largest. “Before that, I had read a podcast interview with Ryan Howard, CEO of Practice Fusion, in which he said, “We just broke 15,000 users.”I have no reason to question or challenge these physician user figures, which bespeak of explosive growth. But I can ask: how could one EHR company grow so fast? Maybe it’s simply a matter of timing, namely, the physician market is primed and ready to get into the EHR game. Maybe it’s the marketing magic of the word “free.” Maybe it’s because Practice Fusion has the only “free” EHR on the market. Maybe it’s word getting around among physician users that this EHR really works. Maybe it’s because the Practice Fusion model profits physician users because it qualifies them as “meaningful users” and therefore qualifies them for federal reimbursement. Maybe it’s because most physicians now have broad band Internet access in their offices and can put this EHR to work in a short time frame without elaborate training and installation preparation. Or maybe Practice Fusion is not what it’s cracked up to be and is too good to be true. There are no perfect systems in the EHR world, all are evolving, and there is always room for skepticism, or as one pessimistic wag with a weakness for puns observed, there is always gloom for improvement.Perhaps readers of this blog will give me insight into what they think of Practice Fusion? Is it for real, or does it have blemishes that I do not see? Please feel free to comment one way or another. Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Mon, 21 Jun 2010 22:15:28 GMT http://community.modernmedicine.com/_Is-Practice-Fusions-Free-EHR-for-Real/blog/2405342/33379.html RichardReeceMD 2010-06-21T22:11:25Z Managing Your Practice Modern Medicine Community As I was writing blogs on EHRs, I kept pondering these questions: Is Practice Fusion, Inc, a San Francisco-based company offering a “free” EHR to physicians, an example of “disruptive innovation”? After all, its EHR appears to be simpler, more convenient, more affordable, and intuitively easier to use than other EHRs– the criteria usually applied to disruptive innovations. Does it signal a “breakthrough” towards a decentralized technology deployable at the site of care? How can Practice Fusion offer its EHR for “free”? What triggered this “breakthrough”? When all is said and done, I believe this “breakthrough,” if it is that, is not attributable to new EHR software or hardware, but to a new revenue model. Or you might say, it is a “fusion” of all three of these elements.Here is how Ryan Howard, CEO of Practice Fusion, explains this model,‘Our revenue model works in a few different ways. We monetize transactions from our partners. We do some lead generation. So if the doctors are looking for a billing service, for example, we have a billing service that they can use. We do some advertising to the physicians: different health care services, insurance companies, device manufactures and pharmaceuticals as well.”If you think about it, Practice Fusion has adopted and modified the revenue model that has made Google so successful, namely gathering revenues from online advertising and lead generation tied to “free” access by users. It does not require physicians to install new hardware and software, but to off-load what they need in an EHR to the Internet using their existing office computers. The beauty of it is, of course, is that you can use your own computer and somebody else – people and businesses who want access to physicians to sell them products – pays the freight for the EHR.In other words, someone else, not physicians, is paying the bill. According to Howard, “The product is provided to physicians fully subsidized. It’s not a “take now, pay later” or get half of the product now and then pays for the rest of it. Every feature that’s included with the product in any capacity is offered at no cost, so it’s truly free. It’s offered with support, training, and hosting. It’s the only totally free model on the market.”Back to my recent posts for context. • In “Will Innovation Save America’s Health Care?” I wondered out load whether innovations from largely web-based technologies and systems would save us from Europe’s fate- the crushing cost and ensuing debt of unsustainable social welfare programs.• In “EHR‘Inevitability and the Physician Waiting Game,“ I questioned whether EHR systems were ready for prime time, and I implied physicians were right in waiting for useful, affordable, and intuitively and clinical compatible systems.• In “EHRs – Size of Physician Market, Numbers Sold, By Whom, Comprehensiveness of Systems,” I reprinted an article by Chris Thorman of Software Advice, on the scope, players, and nature of the EHR market.In the latter blog, I shared a chart showing EHR vendors and number of physician users. Vendor Physician Users Practices ServedEpic 45,000 AllScripts 40,000 eClinicalWorks 40,000 GE Centricity 35,000 NextGen 35,000 SOAPWare 30,000 Practice Fusion 18,500 Eclipsys 11,000 Sage Health 10,000 .Greenway Medical 6,000 I recently received the following email from Emily Peters, Director of Communications for Practice Fusion, “Hi Dr. Reece, “I’ve been closely following your blog coverage on EHRs about market share, innovation and Practice Fusion.”“We do see some element of the “waiting game” that you described with physicians, but much less than even just six months ago. Practice Fusion now serves about 40,000 users and 2 million patients across the country – making us, not only the fastest growing EMR community, but also one of the largest. “Before that, I had read a podcast interview with Ryan Howard, CEO of Practice Fusion, in which he said, “We just broke 15,000 users.”I have no reason to question or challenge these physician user figures, which bespeak of explosive growth. But I can ask: how could one EHR company grow so fast? Maybe it’s simply a matter of timing, namely, the physician market is primed and ready to get into the EHR game. Maybe it’s the marketing magic of the word “free.” Maybe it’s because Practice Fusion has the only “free” EHR on the market. Maybe it’s word getting around among physician users that this EHR really works. Maybe it’s because the Practice Fusion model profits physician users because it qualifies them as “meaningful users” and therefore qualifies them for federal reimbursement. Maybe it’s because most physicians now have broad band Internet access in their offices and can put this EHR to work in a short time frame without elaborate training and installation preparation. Or maybe Practice Fusion is not what it’s cracked up to be and is too good to be true. There are no perfect systems in the EHR world, all are evolving, and there is always room for skepticism, or as one pessimistic wag with a weakness for puns observed, there is always gloom for improvement.Perhaps readers of this blog will give me insight into what they think of Practice Fusion? Is it for real, or does it have blemishes that I do not see? Please feel free to comment one way or another. Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] ehr, emr, health it, managing your practice, medical software, mmglobal nonadult false Is Practice Fusion’s “Free” EHR for Real? text blog ehr,emr,health it,managing your practice,medical software,mmglobal 1071 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=19464830&as=33379 http://media.kickstatic.com/kickapps/images/user/defaultImage_160x120_B.jpg false 0 Managing Your Practice 0 2405342 19464830 Member 0 http://community.modernmedicine.com/_EHR-Inevitability-and-the-Physician-Waiting-Game/blog/2402494/33379.html In my last blog,”EHRs – Size of Physician Market, Number Sold, By Whom, and Comprehensiveness of Systems Sold,” I reprinted a report by Software Advice, Inc, on the state of the EHR market “without editorial comment.”I shall make that comment now.Perception of EHR “Inevitability”The perception persists in all quarters that EHR adoption is inevitable. This perception assumes payers, government and private, health consumers, and the public at large will come to expect and demand EHRs as the standard of care and the exemplar of quality. IT technologies and HITECH information technologies, the theory goes, will dominate. The Internet will reign, and we will all dance to its tune. But for now the world of EHRs remains split between the conceptual and impatient “true believers” and the behavioral, more patient “late adopters,” who are dragging their feet and playing the “waiting game.”Among the powerful true believers are• Big Government, specifically the Obama administration, who placed $20 billion in the HITECH basket in its February 2009 stimulus package.• Related government enterprises – The VA, the Department of Defense, Indian Health Services, Community Clinics – all of whom are committed, pledged, and destined to adopt EHRs.• The EHR industry and its 300 vendors, who foresee and thirst for hundreds of thousands of new jobs, new products, new revenues and the makings of an even vaster enterprise.• Integrated delivery systems, like Kaiser, who has already poured $3 billion into adopting system-wide interoperable EHRs.• Large physician organizations and societies – like AAFP, CAP, MGMA, and AMGA – which are committed to EHR adoption by its members.• IT Giants, like Google, GE, Intel, and Microsoft. Microsoft has been in EHR market for three years now, has three products on the market, and is rumored to be anticipating acquisitions of one or more EHR vendors.• Young IT savvy physicians, reared on computers and inspired by YouTube, Facebook and Twitter and now I-Pad, who take EHRs as a given and who migrate to groups, hospitals, and other physician employers with existing EHR platforms. • Organizations like Health 2.0, a consortium of consumer-oriented health IT companies and vendors, who see EHRs and Personal Health Records as transformers of the health care landscape.The Waiting GameThese are powerful and formidable agents and forces for change but practicing doctors continue to exhibit caution and to play the waiting game. Despite a 6- to 8-year push by government IT aficionados, industry, and Internet gurus, only 1.5% of hospitals and 6% of doctors have “fully functional” EHRs. A full-fledged “interoperable” system remains a pipe-dream, albeit one that continues to evolve and promises to burst into full flower sometime soon.Reasons to resist change are legend – high installation costs, training and maintenance expenses, drops in clinical productivity, disruption of practice patterns, altered doctor-patient relationships, and little or no return in investment. Understated, but tangible nevertheless, is the feeling that EHRs violate or compromise doctors and patient privacy and confidentiality or will be misused to the detriment of both. To doctors, these are real, and sometimes profound, reinforced by the recession, and calls for cautionary waiting. Waiting for further developments, most doctors believe, at least those on the mean practice streets, is safer than plunging into the maelstrom.Hospitals, meanwhile, are experiencing lower admission rates, declining revenues, and difficulties accessing capital. Doctors too are having trouble acquiring capital for recruiting new physicians, meeting operating expenses, and dealing with demands for more information infrastructure. It should be no surprise, then, that the AMA and the AHA are saying forced digitization demands are “too much, too soon” and are pushing back against too fast and too much EHR adoption.We are in a period of watchful waiting for further developments.• Waiting to see if EHR costs will come down with competition.• Waiting to see which EHR companies will survive.• Waiting to see if new “free” EHR business models, such as Practice Fusion, Inc, where advertisers, not doctors, pay for installation and maintenance, are for real.• Waiting to see if payers, government and private, will demand EHR adoption for participation.• Waiting to see if hospitals will offer more financial and technical support for EHRs. .• Waiting to see if EHRs are as good as promised in reducing errors and improving care – as good in concrete practice as in the abstract theory.• Waiting so to see if EHRs become more user friendly and functional in clinical use.• Waiting to see if benefits to insurers and patients outweigh the headaches to doctors.• Waiting to see if physician transitions and adjustments to new business models – HSAs with high deductibles, cash-only models, concierge practices, hospital employment – offer escapes from having to climb the EHR learning curve.And so, the EHR waiting game and merry-go round continues. How fast forward it goes, when and where it stops, grinds to halt, or plunges over the cliff to a new nirvana no one knows.A New Yorker cartoon captures the dilemma of waiting for EHR inevitability. A group of cavemen are keeping count by making vertical slashes in groups of five on the wall and counting with their fingers. The caveman leader explains to a visitor at the mouth of the cave,” It will take longer than we thought to go digital.”Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] In my last blog,”EHRs – Size of Physician Market, Number Sold, By Whom, and Comprehensiveness of Systems Sold,” I reprinted a report by Software Advice, Inc, on the state of the EHR market “without editorial comment.”I shall make that comment now.Perception of EHR “Inevitability”The perception persists in all quarters that EHR adoption is inevitable. This perception assumes payers, government and private, health consumers, and the public at large will come to expect and demand EHRs as the standard of care and the exemplar of quality. IT technologies and HITECH information technologies, the theory goes, will dominate. The Internet will reign, and we will all dance to its tune. But for now the world of EHRs remains split between the conceptual and impatient “true believers” and the behavioral, more patient “late adopters,” who are dragging their feet and playing the “waiting game.”Among the powerful true believers are• Big Government, specifically the Obama administration, who placed $20 billion in the HITECH basket in its February 2009 stimulus package.• Related government enterprises – The VA, the Department of Defense, Indian Health Services, Community Clinics – all of whom are committed, pledged, and destined to adopt EHRs.• The EHR industry and its 300 vendors, who foresee and thirst for hundreds of thousands of new jobs, new products, new revenues and the makings of an even vaster enterprise.• Integrated delivery systems, like Kaiser, who has already poured $3 billion into adopting system-wide interoperable EHRs.• Large physician organizations and societies – like AAFP, CAP, MGMA, and AMGA – which are committed to EHR adoption by its members.• IT Giants, like Google, GE, Intel, and Microsoft. Microsoft has been in EHR market for three years now, has three products on the market, and is rumored to be anticipating acquisitions of one or more EHR vendors.• Young IT savvy physicians, reared on computers and inspired by YouTube, Facebook and Twitter and now I-Pad, who take EHRs as a given and who migrate to groups, hospitals, and other physician employers with existing EHR platforms. • Organizations like Health 2.0, a consortium of consumer-oriented health IT companies and vendors, who see EHRs and Personal Health Records as transformers of the health care landscape.The Waiting GameThese are powerful and formidable agents and forces for change but practicing doctors continue to exhibit caution and to play the waiting game. Despite a 6- to 8-year push by government IT aficionados, industry, and Internet gurus, only 1.5% of hospitals and 6% of doctors have “fully functional” EHRs. A full-fledged “interoperable” system remains a pipe-dream, albeit one that continues to evolve and promises to burst into full flower sometime soon.Reasons to resist change are legend – high installation costs, training and maintenance expenses, drops in clinical productivity, disruption of practice patterns, altered doctor-patient relationships, and little or no return in investment. Understated, but tangible nevertheless, is the feeling that EHRs violate or compromise doctors and patient privacy and confidentiality or will be misused to the detriment of both. To doctors, these are real, and sometimes profound, reinforced by the recession, and calls for cautionary waiting. Waiting for further developments, most doctors believe, at least those on the mean practice streets, is safer than plunging into the maelstrom.Hospitals, meanwhile, are experiencing lower admission rates, declining revenues, and difficulties accessing capital. Doctors too are having trouble acquiring capital for recruiting new physicians, meeting operating expenses, and dealing with demands for more information infrastructure. It should be no surprise, then, that the AMA and the AHA are saying forced digitization demands are “too much, too soon” and are pushing back against too fast and too much EHR adoption.We are in a period of watchful waiting for further developments.• Waiting to see if EHR costs will come down with competition.• Waiting to see which EHR companies will survive.• Waiting to see if new “free” EHR business models, such as Practice Fusion, Inc, where advertisers, not doctors, pay for installation and maintenance, are for real.• Waiting to see if payers, government and private, will demand EHR adoption for participation.• Waiting to see if hospitals will offer more financial and technical support for EHRs. .• Waiting to see if EHRs are as good as promised in reducing errors and improving care – as good in concrete practice as in the abstract theory.• Waiting so to see if EHRs become more user friendly and functional in clinical use.• Waiting to see if benefits to insurers and patients outweigh the headaches to doctors.• Waiting to see if physician transitions and adjustments to new business models – HSAs with high deductibles, cash-only models, concierge practices, hospital employment – offer escapes from having to climb the EHR learning curve.And so, the EHR waiting game and merry-go round continues. How fast forward it goes, when and where it stops, grinds to halt, or plunges over the cliff to a new nirvana no one knows.A New Yorker cartoon captures the dilemma of waiting for EHR inevitability. A group of cavemen are keeping count by making vertical slashes in groups of five on the wall and counting with their fingers. The caveman leader explains to a visitor at the mouth of the cave,” It will take longer than we thought to go digital.”Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Fri, 18 Jun 2010 14:49:48 GMT http://community.modernmedicine.com/_EHR-Inevitability-and-the-Physician-Waiting-Game/blog/2402494/33379.html RichardReeceMD 2010-06-18T14:46:19Z Managing Your Practice Modern Medicine Community In my last blog,”EHRs – Size of Physician Market, Number Sold, By Whom, and Comprehensiveness of Systems Sold,” I reprinted a report by Software Advice, Inc, on the state of the EHR market “without editorial comment.”I shall make that comment now.Perception of EHR “Inevitability”The perception persists in all quarters that EHR adoption is inevitable. This perception assumes payers, government and private, health consumers, and the public at large will come to expect and demand EHRs as the standard of care and the exemplar of quality. IT technologies and HITECH information technologies, the theory goes, will dominate. The Internet will reign, and we will all dance to its tune. But for now the world of EHRs remains split between the conceptual and impatient “true believers” and the behavioral, more patient “late adopters,” who are dragging their feet and playing the “waiting game.”Among the powerful true believers are• Big Government, specifically the Obama administration, who placed $20 billion in the HITECH basket in its February 2009 stimulus package.• Related government enterprises – The VA, the Department of Defense, Indian Health Services, Community Clinics – all of whom are committed, pledged, and destined to adopt EHRs.• The EHR industry and its 300 vendors, who foresee and thirst for hundreds of thousands of new jobs, new products, new revenues and the makings of an even vaster enterprise.• Integrated delivery systems, like Kaiser, who has already poured $3 billion into adopting system-wide interoperable EHRs.• Large physician organizations and societies – like AAFP, CAP, MGMA, and AMGA – which are committed to EHR adoption by its members.• IT Giants, like Google, GE, Intel, and Microsoft. Microsoft has been in EHR market for three years now, has three products on the market, and is rumored to be anticipating acquisitions of one or more EHR vendors.• Young IT savvy physicians, reared on computers and inspired by YouTube, Facebook and Twitter and now I-Pad, who take EHRs as a given and who migrate to groups, hospitals, and other physician employers with existing EHR platforms. • Organizations like Health 2.0, a consortium of consumer-oriented health IT companies and vendors, who see EHRs and Personal Health Records as transformers of the health care landscape.The Waiting GameThese are powerful and formidable agents and forces for change but practicing doctors continue to exhibit caution and to play the waiting game. Despite a 6- to 8-year push by government IT aficionados, industry, and Internet gurus, only 1.5% of hospitals and 6% of doctors have “fully functional” EHRs. A full-fledged “interoperable” system remains a pipe-dream, albeit one that continues to evolve and promises to burst into full flower sometime soon.Reasons to resist change are legend – high installation costs, training and maintenance expenses, drops in clinical productivity, disruption of practice patterns, altered doctor-patient relationships, and little or no return in investment. Understated, but tangible nevertheless, is the feeling that EHRs violate or compromise doctors and patient privacy and confidentiality or will be misused to the detriment of both. To doctors, these are real, and sometimes profound, reinforced by the recession, and calls for cautionary waiting. Waiting for further developments, most doctors believe, at least those on the mean practice streets, is safer than plunging into the maelstrom.Hospitals, meanwhile, are experiencing lower admission rates, declining revenues, and difficulties accessing capital. Doctors too are having trouble acquiring capital for recruiting new physicians, meeting operating expenses, and dealing with demands for more information infrastructure. It should be no surprise, then, that the AMA and the AHA are saying forced digitization demands are “too much, too soon” and are pushing back against too fast and too much EHR adoption.We are in a period of watchful waiting for further developments.• Waiting to see if EHR costs will come down with competition.• Waiting to see which EHR companies will survive.• Waiting to see if new “free” EHR business models, such as Practice Fusion, Inc, where advertisers, not doctors, pay for installation and maintenance, are for real.• Waiting to see if payers, government and private, will demand EHR adoption for participation.• Waiting to see if hospitals will offer more financial and technical support for EHRs. .• Waiting to see if EHRs are as good as promised in reducing errors and improving care – as good in concrete practice as in the abstract theory.• Waiting so to see if EHRs become more user friendly and functional in clinical use.• Waiting to see if benefits to insurers and patients outweigh the headaches to doctors.• Waiting to see if physician transitions and adjustments to new business models – HSAs with high deductibles, cash-only models, concierge practices, hospital employment – offer escapes from having to climb the EHR learning curve.And so, the EHR waiting game and merry-go round continues. How fast forward it goes, when and where it stops, grinds to halt, or plunges over the cliff to a new nirvana no one knows.A New Yorker cartoon captures the dilemma of waiting for EHR inevitability. A group of cavemen are keeping count by making vertical slashes in groups of five on the wall and counting with their fingers. The caveman leader explains to a visitor at the mouth of the cave,” It will take longer than we thought to go digital.”Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] ehr, electronic health records, emr, health it, managing your practice, mmglobal, software nonadult false EHR Inevitability and the Physician Waiting Game text blog ehr,electronic health records,emr,health it,managing your practice,mmglobal,software 234 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=19464830&as=33379 http://media.kickstatic.com/kickapps/images/user/defaultImage_160x120_C.jpg false 0 Managing Your Practice 0 2402494 19464830 Member 0 http://community.modernmedicine.com/_EHRs-Size-of-Physician-Market-Number-Sold-By-Whom-Comprehensiveness-of-Systems-Sold/blog/2401289/33379.html I recently received the following email from Chris Thorman, Senior Marketing Manager for Software Advice in Austin, Texas (chris@softwareadvice.com). I pass it along to you without editorial comment.EHR Software Market Share AnalysisCalculating market share for the electronic health record (EHR) market is no easy task. There are over 300 software vendors, many market segments (consider: size of practice served, specialties services, inpatient/outpatient) and very “fuzzy” sources of data.Nevertheless, the team at Software Advice set out to see what numbers we could pull together. We limited our analysis to the outpatient EHR software market. Moreover, we decided to measure market share based on the number of physicians users, rather than vendor revenue or other metrics. We tried to keep it simple. It’s not.Number of Doctors Using EHR SoftwareFirst, let’s define the total size of the market we are analyzing. Of the approximately 788,000 physicians in the United States, 65% of them work in an outpatient facility or physician’s practice, according to the Bureau of Labor & Statistics. That’s 512,000 possible physicians who are in the outpatient EHR software market.According to a recent study of office-based physicians released by the Center for Disease Control and Prevention (CDC), 44% of those of 512,000 office-based doctors had adopted either a partial, basic, or fully functional EHR system. That’s 225,000 outpatient doctors using an EHR to some extent. Here’s how EHR adoption breaks down among the total number (512,000) of outpatient physicians in the United States:Outpatient EHR Adoption , 2009• No EHR adoption, 56%• Basic EHR adoption, 21%• Partial EHR adoption, 17%• Fully functional EHR adoption, 6%The CDC defines “partial” EHR systems as those not exclusively used for billing. “Basic” systems include the following functionalities: patient demographic information, patient problem lists, clinical notes, orders for prescriptions, and viewing laboratory and imaging results.Systems defined by the CDC as “fully functional” include all functionalities of a basic system plus these functionalities: medical history and follow-up, orders for tests, prescription and test orders sent electronically, warnings of drug interactions or contraindications, highlighting of out-of-range test levels, electronic images returned, and reminders for guideline-based interventions.Outpatient EHR Market ShareSo, what EHR software are the 225,000 physicians using? Based on number of physician users, here’s how the market breaks down:Outpatient EHR software market share by vendor, 2010• Epic, 17%• AllScripts, 15%• eClinicalWorks, 15%• NextGen, 13%• SOAPware, 12%• GE Centricity, 10%• Other Vendors, 10%• Practice Fusion, 7%Software Advice’s analysis showed that a handful of vendors – Allscripts, Epic, eClinicalWorks NextGen, and GE Centricity – own more than three-quarters of the ambulatory EHR software market. This is a similar trend that other EHR market reports and analysis have noted.Here is the data Software Advice was able to gather on the top EHR vendors, based on volume of physician users:Vendor Physician Users Practices ServedEpic 45,000 N.A.Allscripts 40,000 N.A.eClinicalWorks 40,000 6,500GE Centricity 35,000 2,500NextGen 35,000 2,000SOAPWare 30,000 8,000Practice Fusion 18,500 10,000Eclipsys 11,000 N.A.Sage Health 10,000 N.A.Greenway Medical 6,000 1,400Clarifications, Disclaimers, Footnotes, Contradictions, etc.As mentioned in the introduction, the EHR software market has many “fuzzy” sources of data. In fact, when all of the physician users are calculated in the table above, the number of physicians using EHRs in the United States is more than 40,000 over what the CDC reported. Clearly, we need to dig into these numbers a bit more.In most cases, the information was gathered directly from the EHR software vendors. For those vendors that weren’t able to be contacted, publicly reported information was used. In some cases, exact numbers of physicians and practices were available. In some cases, approximations were used by Software Advice and the software vendors (In the case of a discrepancy, please contact us).Here are a few questions that came up during the research process whose answers would help refine our market share numbers:• Sage Health. How many of Sage Health’s users are using their Intergy EHR product in conjunction with their practice management software versus those using just Sage’s practice management software, in particular, Medical Manager? • Allscripts. How many of Allscripts users are still using Misys practice management systems? Like Sage, they have a huge practice management installed base, but not all of those customers are using their advanced EHR systems. • Epic and NextGen. How many of their users are exclusively outpatient customers? Both of these EHR vendors are meaningful players in the inpatient EHR market. We need to exclude those physicians from our analysis. • GE Centricity. General Electric didn’t distinguish between physician (MD) users and mid-level providers in their count of users. This would be a helpful distinction to have in this analysis. • Practice Fusion. Being a free EHR system, it would be important to see how many of Practice Fusion’s EHR users are actively using their software, instead of just kicking the tires on a cool new web-based EHR and “freemium” business model. Feedback (We Need Your Help)Software Advice knows many of you are just as, if not more, intimately plugged into the EHR software market than we are. That’s why we’d like your feedback to help figure out these numbers.Which vendors’ numbers are higher? Lower? Who are the up and coming players that will earn significant market share in the coming years? Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] I recently received the following email from Chris Thorman, Senior Marketing Manager for Software Advice in Austin, Texas (chris@softwareadvice.com). I pass it along to you without editorial comment.EHR Software Market Share AnalysisCalculating market share for the electronic health record (EHR) market is no easy task. There are over 300 software vendors, many market segments (consider: size of practice served, specialties services, inpatient/outpatient) and very “fuzzy” sources of data.Nevertheless, the team at Software Advice set out to see what numbers we could pull together. We limited our analysis to the outpatient EHR software market. Moreover, we decided to measure market share based on the number of physicians users, rather than vendor revenue or other metrics. We tried to keep it simple. It’s not.Number of Doctors Using EHR SoftwareFirst, let’s define the total size of the market we are analyzing. Of the approximately 788,000 physicians in the United States, 65% of them work in an outpatient facility or physician’s practice, according to the Bureau of Labor & Statistics. That’s 512,000 possible physicians who are in the outpatient EHR software market.According to a recent study of office-based physicians released by the Center for Disease Control and Prevention (CDC), 44% of those of 512,000 office-based doctors had adopted either a partial, basic, or fully functional EHR system. That’s 225,000 outpatient doctors using an EHR to some extent. Here’s how EHR adoption breaks down among the total number (512,000) of outpatient physicians in the United States:Outpatient EHR Adoption , 2009• No EHR adoption, 56%• Basic EHR adoption, 21%• Partial EHR adoption, 17%• Fully functional EHR adoption, 6%The CDC defines “partial” EHR systems as those not exclusively used for billing. “Basic” systems include the following functionalities: patient demographic information, patient problem lists, clinical notes, orders for prescriptions, and viewing laboratory and imaging results.Systems defined by the CDC as “fully functional” include all functionalities of a basic system plus these functionalities: medical history and follow-up, orders for tests, prescription and test orders sent electronically, warnings of drug interactions or contraindications, highlighting of out-of-range test levels, electronic images returned, and reminders for guideline-based interventions.Outpatient EHR Market ShareSo, what EHR software are the 225,000 physicians using? Based on number of physician users, here’s how the market breaks down:Outpatient EHR software market share by vendor, 2010• Epic, 17%• AllScripts, 15%• eClinicalWorks, 15%• NextGen, 13%• SOAPware, 12%• GE Centricity, 10%• Other Vendors, 10%• Practice Fusion, 7%Software Advice’s analysis showed that a handful of vendors – Allscripts, Epic, eClinicalWorks NextGen, and GE Centricity – own more than three-quarters of the ambulatory EHR software market. This is a similar trend that other EHR market reports and analysis have noted.Here is the data Software Advice was able to gather on the top EHR vendors, based on volume of physician users:Vendor Physician Users Practices ServedEpic 45,000 N.A.Allscripts 40,000 N.A.eClinicalWorks 40,000 6,500GE Centricity 35,000 2,500NextGen 35,000 2,000SOAPWare 30,000 8,000Practice Fusion 18,500 10,000Eclipsys 11,000 N.A.Sage Health 10,000 N.A.Greenway Medical 6,000 1,400Clarifications, Disclaimers, Footnotes, Contradictions, etc.As mentioned in the introduction, the EHR software market has many “fuzzy” sources of data. In fact, when all of the physician users are calculated in the table above, the number of physicians using EHRs in the United States is more than 40,000 over what the CDC reported. Clearly, we need to dig into these numbers a bit more.In most cases, the information was gathered directly from the EHR software vendors. For those vendors that weren’t able to be contacted, publicly reported information was used. In some cases, exact numbers of physicians and practices were available. In some cases, approximations were used by Software Advice and the software vendors (In the case of a discrepancy, please contact us).Here are a few questions that came up during the research process whose answers would help refine our market share numbers:• Sage Health. How many of Sage Health’s users are using their Intergy EHR product in conjunction with their practice management software versus those using just Sage’s practice management software, in particular, Medical Manager? • Allscripts. How many of Allscripts users are still using Misys practice management systems? Like Sage, they have a huge practice management installed base, but not all of those customers are using their advanced EHR systems. • Epic and NextGen. How many of their users are exclusively outpatient customers? Both of these EHR vendors are meaningful players in the inpatient EHR market. We need to exclude those physicians from our analysis. • GE Centricity. General Electric didn’t distinguish between physician (MD) users and mid-level providers in their count of users. This would be a helpful distinction to have in this analysis. • Practice Fusion. Being a free EHR system, it would be important to see how many of Practice Fusion’s EHR users are actively using their software, instead of just kicking the tires on a cool new web-based EHR and “freemium” business model. Feedback (We Need Your Help)Software Advice knows many of you are just as, if not more, intimately plugged into the EHR software market than we are. That’s why we’d like your feedback to help figure out these numbers.Which vendors’ numbers are higher? Lower? Who are the up and coming players that will earn significant market share in the coming years? Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Thu, 17 Jun 2010 16:53:53 GMT http://community.modernmedicine.com/_EHRs-Size-of-Physician-Market-Number-Sold-By-Whom-Comprehensiveness-of-Systems-Sold/blog/2401289/33379.html RichardReeceMD 2010-06-17T16:22:50Z Managing Your Practice Modern Medicine Community I recently received the following email from Chris Thorman, Senior Marketing Manager for Software Advice in Austin, Texas (chris@softwareadvice.com). I pass it along to you without editorial comment.EHR Software Market Share AnalysisCalculating market share for the electronic health record (EHR) market is no easy task. There are over 300 software vendors, many market segments (consider: size of practice served, specialties services, inpatient/outpatient) and very “fuzzy” sources of data.Nevertheless, the team at Software Advice set out to see what numbers we could pull together. We limited our analysis to the outpatient EHR software market. Moreover, we decided to measure market share based on the number of physicians users, rather than vendor revenue or other metrics. We tried to keep it simple. It’s not.Number of Doctors Using EHR SoftwareFirst, let’s define the total size of the market we are analyzing. Of the approximately 788,000 physicians in the United States, 65% of them work in an outpatient facility or physician’s practice, according to the Bureau of Labor & Statistics. That’s 512,000 possible physicians who are in the outpatient EHR software market.According to a recent study of office-based physicians released by the Center for Disease Control and Prevention (CDC), 44% of those of 512,000 office-based doctors had adopted either a partial, basic, or fully functional EHR system. That’s 225,000 outpatient doctors using an EHR to some extent. Here’s how EHR adoption breaks down among the total number (512,000) of outpatient physicians in the United States:Outpatient EHR Adoption , 2009• No EHR adoption, 56%• Basic EHR adoption, 21%• Partial EHR adoption, 17%• Fully functional EHR adoption, 6%The CDC defines “partial” EHR systems as those not exclusively used for billing. “Basic” systems include the following functionalities: patient demographic information, patient problem lists, clinical notes, orders for prescriptions, and viewing laboratory and imaging results.Systems defined by the CDC as “fully functional” include all functionalities of a basic system plus these functionalities: medical history and follow-up, orders for tests, prescription and test orders sent electronically, warnings of drug interactions or contraindications, highlighting of out-of-range test levels, electronic images returned, and reminders for guideline-based interventions.Outpatient EHR Market ShareSo, what EHR software are the 225,000 physicians using? Based on number of physician users, here’s how the market breaks down:Outpatient EHR software market share by vendor, 2010• Epic, 17%• AllScripts, 15%• eClinicalWorks, 15%• NextGen, 13%• SOAPware, 12%• GE Centricity, 10%• Other Vendors, 10%• Practice Fusion, 7%Software Advice’s analysis showed that a handful of vendors – Allscripts, Epic, eClinicalWorks NextGen, and GE Centricity – own more than three-quarters of the ambulatory EHR software market. This is a similar trend that other EHR market reports and analysis have noted.Here is the data Software Advice was able to gather on the top EHR vendors, based on volume of physician users:Vendor Physician Users Practices ServedEpic 45,000 N.A.Allscripts 40,000 N.A.eClinicalWorks 40,000 6,500GE Centricity 35,000 2,500NextGen 35,000 2,000SOAPWare 30,000 8,000Practice Fusion 18,500 10,000Eclipsys 11,000 N.A.Sage Health 10,000 N.A.Greenway Medical 6,000 1,400Clarifications, Disclaimers, Footnotes, Contradictions, etc.As mentioned in the introduction, the EHR software market has many “fuzzy” sources of data. In fact, when all of the physician users are calculated in the table above, the number of physicians using EHRs in the United States is more than 40,000 over what the CDC reported. Clearly, we need to dig into these numbers a bit more.In most cases, the information was gathered directly from the EHR software vendors. For those vendors that weren’t able to be contacted, publicly reported information was used. In some cases, exact numbers of physicians and practices were available. In some cases, approximations were used by Software Advice and the software vendors (In the case of a discrepancy, please contact us).Here are a few questions that came up during the research process whose answers would help refine our market share numbers:• Sage Health. How many of Sage Health’s users are using their Intergy EHR product in conjunction with their practice management software versus those using just Sage’s practice management software, in particular, Medical Manager? • Allscripts. How many of Allscripts users are still using Misys practice management systems? Like Sage, they have a huge practice management installed base, but not all of those customers are using their advanced EHR systems. • Epic and NextGen. How many of their users are exclusively outpatient customers? Both of these EHR vendors are meaningful players in the inpatient EHR market. We need to exclude those physicians from our analysis. • GE Centricity. General Electric didn’t distinguish between physician (MD) users and mid-level providers in their count of users. This would be a helpful distinction to have in this analysis. • Practice Fusion. Being a free EHR system, it would be important to see how many of Practice Fusion’s EHR users are actively using their software, instead of just kicking the tires on a cool new web-based EHR and “freemium” business model. Feedback (We Need Your Help)Software Advice knows many of you are just as, if not more, intimately plugged into the EHR software market than we are. That’s why we’d like your feedback to help figure out these numbers.Which vendors’ numbers are higher? Lower? Who are the up and coming players that will earn significant market share in the coming years? Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] ehr, emr, health it, managing your practice, mmglobal, software nonadult false EHRs – Size of Physician Market, Number Sold, By Whom, Comprehensiveness of Systems Sold text blog ehr,emr,health it,managing your practice,mmglobal,software 273 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=19464830&as=33379 http://media.kickstatic.com/kickapps/images/user/defaultImage_160x120_B.jpg false 1 Managing Your Practice 0 2401289 19464830 Member 0 http://community.modernmedicine.com/_Military-Medicine-In-Remembrance-of-Military-Doctors/blog/2386778/33379.html "Things come from civilian medicine, and then we take it into the cauldron of the war and focus it, test it and evaluate it, and then use it many, many, many more times than the civilians have. And then whatever spits out in the end is better.” — Army Col. John Holcomb, MD, commander of the U.S. Army Institute of Surgical Research, 2007On this Memorial Day, it is time to remember, celebrate, and commemorate military doctors.We sometimes forget military doctors have served in every American war since 1775.We sometimes forget lessons learned and innovations developed by military doctors carry over to civilian life in operating rooms, trauma, and rehabilitation centers across the land.We sometimes forget doctors in the Spanish-American war learned mosquitoes cause yellow fever, in World War I that transfusions saved lives, in World War II that penicillin and sulfa drugs were indispensable for treating infections, in Korea and Vietnam that prompt helicopter evacuations reduced death tolls, and in Iraq and Afghanistan that hemorrhage can be stopped on the spot by new types of bandages and drugs.We sometimes forget that military medicine in times of war is very intense because of new treatment methods, recognition that time passed before treatment is the enemy of life. For the military physicians, there’s no wasted moments, no wasted movements; military treatment is very, very focused.We sometimes forget we have a medical school, the Uniformed Services University in Bethesda, devoted to educating and training doctors for military duty in peace and war.We sometimes forget that 80% of our civilian doctors spent part of their education and training in Veterans Hospitals affiliated with teaching centers.We sometimes forget our military hospitals–Walter Reed in Washington, over 190 Veterans Affairs hospitals comprising the largest hospital system in the world, and military clinics strewn all across the U.S. and over the world. Sometimes these hospitals even exist in the sky, during flights from Iraq to Germany.We sometimes forget that the famed comedy series MASH (Mobile Army Surgical Hospitals) was based on a book MASH: A Novel About Three Army Doctors, was written by an Army surgeon, Richard Hooker, MD. With death and chaos of war, sometimes comes humor. But risk also comes, especially in wars without front lines. Doctors, nurses, and other medical personnel in Balad in northern Iraq are ordered to carry firearms.We sometimes forget that the managerial and leaderships experiences gained in the military carry over into civilian life. In the armed services, doctors learn to organize, to treat populations of patients, to train paraprofessionals, to function and work as teams, and to improvise and innovate.So let us not forget on this day our heroes–military doctors.Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] "Things come from civilian medicine, and then we take it into the cauldron of the war and focus it, test it and evaluate it, and then use it many, many, many more times than the civilians have. And then whatever spits out in the end is better.” — Army Col. John Holcomb, MD, commander of the U.S. Army Institute of Surgical Research, 2007On this Memorial Day, it is time to remember, celebrate, and commemorate military doctors.We sometimes forget military doctors have served in every American war since 1775.We sometimes forget lessons learned and innovations developed by military doctors carry over to civilian life in operating rooms, trauma, and rehabilitation centers across the land.We sometimes forget doctors in the Spanish-American war learned mosquitoes cause yellow fever, in World War I that transfusions saved lives, in World War II that penicillin and sulfa drugs were indispensable for treating infections, in Korea and Vietnam that prompt helicopter evacuations reduced death tolls, and in Iraq and Afghanistan that hemorrhage can be stopped on the spot by new types of bandages and drugs.We sometimes forget that military medicine in times of war is very intense because of new treatment methods, recognition that time passed before treatment is the enemy of life. For the military physicians, there’s no wasted moments, no wasted movements; military treatment is very, very focused.We sometimes forget we have a medical school, the Uniformed Services University in Bethesda, devoted to educating and training doctors for military duty in peace and war.We sometimes forget that 80% of our civilian doctors spent part of their education and training in Veterans Hospitals affiliated with teaching centers.We sometimes forget our military hospitals–Walter Reed in Washington, over 190 Veterans Affairs hospitals comprising the largest hospital system in the world, and military clinics strewn all across the U.S. and over the world. Sometimes these hospitals even exist in the sky, during flights from Iraq to Germany.We sometimes forget that the famed comedy series MASH (Mobile Army Surgical Hospitals) was based on a book MASH: A Novel About Three Army Doctors, was written by an Army surgeon, Richard Hooker, MD. With death and chaos of war, sometimes comes humor. But risk also comes, especially in wars without front lines. Doctors, nurses, and other medical personnel in Balad in northern Iraq are ordered to carry firearms.We sometimes forget that the managerial and leaderships experiences gained in the military carry over into civilian life. In the armed services, doctors learn to organize, to treat populations of patients, to train paraprofessionals, to function and work as teams, and to improvise and innovate.So let us not forget on this day our heroes–military doctors.Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Wed, 09 Jun 2010 19:44:20 GMT http://community.modernmedicine.com/_Military-Medicine-In-Remembrance-of-Military-Doctors/blog/2386778/33379.html RichardReeceMD 2010-06-09T19:39:15Z Primary Care Modern Medicine Community "Things come from civilian medicine, and then we take it into the cauldron of the war and focus it, test it and evaluate it, and then use it many, many, many more times than the civilians have. And then whatever spits out in the end is better.” — Army Col. John Holcomb, MD, commander of the U.S. Army Institute of Surgical Research, 2007On this Memorial Day, it is time to remember, celebrate, and commemorate military doctors.We sometimes forget military doctors have served in every American war since 1775.We sometimes forget lessons learned and innovations developed by military doctors carry over to civilian life in operating rooms, trauma, and rehabilitation centers across the land.We sometimes forget doctors in the Spanish-American war learned mosquitoes cause yellow fever, in World War I that transfusions saved lives, in World War II that penicillin and sulfa drugs were indispensable for treating infections, in Korea and Vietnam that prompt helicopter evacuations reduced death tolls, and in Iraq and Afghanistan that hemorrhage can be stopped on the spot by new types of bandages and drugs.We sometimes forget that military medicine in times of war is very intense because of new treatment methods, recognition that time passed before treatment is the enemy of life. For the military physicians, there’s no wasted moments, no wasted movements; military treatment is very, very focused.We sometimes forget we have a medical school, the Uniformed Services University in Bethesda, devoted to educating and training doctors for military duty in peace and war.We sometimes forget that 80% of our civilian doctors spent part of their education and training in Veterans Hospitals affiliated with teaching centers.We sometimes forget our military hospitals–Walter Reed in Washington, over 190 Veterans Affairs hospitals comprising the largest hospital system in the world, and military clinics strewn all across the U.S. and over the world. Sometimes these hospitals even exist in the sky, during flights from Iraq to Germany.We sometimes forget that the famed comedy series MASH (Mobile Army Surgical Hospitals) was based on a book MASH: A Novel About Three Army Doctors, was written by an Army surgeon, Richard Hooker, MD. With death and chaos of war, sometimes comes humor. But risk also comes, especially in wars without front lines. Doctors, nurses, and other medical personnel in Balad in northern Iraq are ordered to carry firearms.We sometimes forget that the managerial and leaderships experiences gained in the military carry over into civilian life. In the armed services, doctors learn to organize, to treat populations of patients, to train paraprofessionals, to function and work as teams, and to improvise and innovate.So let us not forget on this day our heroes–military doctors.Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] affairs”, mmglobal, physicians”, primary care, reed”, services, university”, “military, “uniformed, “veterans, “walter nonadult false Military Medicine - In Remembrance of Military Doctors text blog affairs”,mmglobal,physicians”,primary care,reed”,services,university”,“military,“uniformed,“veterans,“walter 221 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=19464830&as=33379 http://media.kickstatic.com/kickapps/images/user/defaultImage_160x120_B.jpg false 0 Primary Care 0 2386778 19464830 Member 0 http://community.modernmedicine.com/_Memorial-Day-Washington-Report-on-Sustainable-Growth-Rate-Fix-for-Doctors/blog/2386749/33379.html The Physicians Foundation regularly features “The Washington Report.” Lee Stillwell, Founder of the Stillwell Group, a public affairs consulting group in the nation’s capitol, writes it. Stillwell has worked for a Western Republican, an Eastern Democrat, and the AMA Advocacy Group. In his report, he gives Physician Foundation members a candid look inside Beltway politics.In his Memorial Day report, Stillwell focused on the continuing saga of the Sustainable Growth Rate (SGR) formula. Congress uses this formula as the basis for paying physicians for Medicare services.For the last 10 years, Congress has been unwilling and unable to fix the SGR to pay doctors at rates which they can sustain their practices in order to continue to see existing and new Medicare patients. Congress, in short, seems incapable of delivering on its promises to provide physician access to Medicare patients or even to deliver on its pay-go promises. The reasons for Congressional fiddling, dithering, and stalling are political and economic.According to Stillwell, “First, take a look at the fiscal impact at the years of delay in fixing the SGR. The Congressional Business Office (CBO) estimate indicates the price tag for a “doc fix” now is $275 billion through 2010, assuming it is a freeze. That is a 33 percent increases from last year’s legislative projections of $207 billion. Now, if you were to include cost-based raises fo this period in the 0.7 percent to 1.8 percent, the costs climb to $329.9 billion. . If you gave physicians a modest two percent raise, the costs climb to $374.2 billion!”Congress, if you’ll recall, promised Obamacare would cost under $1 trillion over the next 10 years – a number the OMB just shattered by estimating it would cost an extra $115 billion to implement. Add over $300 billion to that, and you blast the $1 trillion figure to smithereens. Stillwell observes, “The estimates, quite frankly, drive the nail in the coffin, killing efforts for a long-term fix. A Congress and Administration that has spent and spent now refuses to offset these mounting costs under the pay-go promises.”Stillwell goes on, “Whether another 30-day extension, or a longer temporary fix, will be adopted when Congress returns from next week’s Memorial weekend recess, SGR fatigue will grow among physicians, tired and weary with this political consequences.”What would the political consequences if Congress fails to rescind the 21.3% SGR cut scheduled for June 1? It won’t happen, of course, Congress will kick the fix further down the road. But if it did not executive a temporary fix, Stillwell says, “An informal AMA survey found that 68 percent of physicians would either stop taking new Medicare patients or stop seeing Medicare patients altogether if the 21.3 percent were to take effect.”An American Osteopathic survey indicated 37 percent would not accept new Medicare patients, 32 percent said they might, and 30 percent said they would.With 78 million baby boomers coming on board the Medicare train in 2011 at the rate of 13,000 each day, doctors not accepting new Medicare patients would put Congress in a pretty political pickle, with a good chance of incumbent members drowning in the electoral pickle barrel. A physician access crisis will be upon us, and it will dwarf the growing current discontent over Obamacare. The latest Rasmussen poll indicates 64 percent disapprove of the health care bill, versus 32 percent who approve. This is the first time disapproval has exceeded 60 percent. The information contained in this blog does not necessarily reflect the views or position of the Physicians Foundation or its Board members or of Lee Stillwell in the Washington Report or of the Stillwell group.Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] The Physicians Foundation regularly features “The Washington Report.” Lee Stillwell, Founder of the Stillwell Group, a public affairs consulting group in the nation’s capitol, writes it. Stillwell has worked for a Western Republican, an Eastern Democrat, and the AMA Advocacy Group. In his report, he gives Physician Foundation members a candid look inside Beltway politics.In his Memorial Day report, Stillwell focused on the continuing saga of the Sustainable Growth Rate (SGR) formula. Congress uses this formula as the basis for paying physicians for Medicare services.For the last 10 years, Congress has been unwilling and unable to fix the SGR to pay doctors at rates which they can sustain their practices in order to continue to see existing and new Medicare patients. Congress, in short, seems incapable of delivering on its promises to provide physician access to Medicare patients or even to deliver on its pay-go promises. The reasons for Congressional fiddling, dithering, and stalling are political and economic.According to Stillwell, “First, take a look at the fiscal impact at the years of delay in fixing the SGR. The Congressional Business Office (CBO) estimate indicates the price tag for a “doc fix” now is $275 billion through 2010, assuming it is a freeze. That is a 33 percent increases from last year’s legislative projections of $207 billion. Now, if you were to include cost-based raises fo this period in the 0.7 percent to 1.8 percent, the costs climb to $329.9 billion. . If you gave physicians a modest two percent raise, the costs climb to $374.2 billion!”Congress, if you’ll recall, promised Obamacare would cost under $1 trillion over the next 10 years – a number the OMB just shattered by estimating it would cost an extra $115 billion to implement. Add over $300 billion to that, and you blast the $1 trillion figure to smithereens. Stillwell observes, “The estimates, quite frankly, drive the nail in the coffin, killing efforts for a long-term fix. A Congress and Administration that has spent and spent now refuses to offset these mounting costs under the pay-go promises.”Stillwell goes on, “Whether another 30-day extension, or a longer temporary fix, will be adopted when Congress returns from next week’s Memorial weekend recess, SGR fatigue will grow among physicians, tired and weary with this political consequences.”What would the political consequences if Congress fails to rescind the 21.3% SGR cut scheduled for June 1? It won’t happen, of course, Congress will kick the fix further down the road. But if it did not executive a temporary fix, Stillwell says, “An informal AMA survey found that 68 percent of physicians would either stop taking new Medicare patients or stop seeing Medicare patients altogether if the 21.3 percent were to take effect.”An American Osteopathic survey indicated 37 percent would not accept new Medicare patients, 32 percent said they might, and 30 percent said they would.With 78 million baby boomers coming on board the Medicare train in 2011 at the rate of 13,000 each day, doctors not accepting new Medicare patients would put Congress in a pretty political pickle, with a good chance of incumbent members drowning in the electoral pickle barrel. A physician access crisis will be upon us, and it will dwarf the growing current discontent over Obamacare. The latest Rasmussen poll indicates 64 percent disapprove of the health care bill, versus 32 percent who approve. This is the first time disapproval has exceeded 60 percent. The information contained in this blog does not necessarily reflect the views or position of the Physicians Foundation or its Board members or of Lee Stillwell in the Washington Report or of the Stillwell group.Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Wed, 09 Jun 2010 19:42:33 GMT http://community.modernmedicine.com/_Memorial-Day-Washington-Report-on-Sustainable-Growth-Rate-Fix-for-Doctors/blog/2386749/33379.html RichardReeceMD 2010-06-09T19:00:18Z Health Law & Policy Modern Medicine Community The Physicians Foundation regularly features “The Washington Report.” Lee Stillwell, Founder of the Stillwell Group, a public affairs consulting group in the nation’s capitol, writes it. Stillwell has worked for a Western Republican, an Eastern Democrat, and the AMA Advocacy Group. In his report, he gives Physician Foundation members a candid look inside Beltway politics.In his Memorial Day report, Stillwell focused on the continuing saga of the Sustainable Growth Rate (SGR) formula. Congress uses this formula as the basis for paying physicians for Medicare services.For the last 10 years, Congress has been unwilling and unable to fix the SGR to pay doctors at rates which they can sustain their practices in order to continue to see existing and new Medicare patients. Congress, in short, seems incapable of delivering on its promises to provide physician access to Medicare patients or even to deliver on its pay-go promises. The reasons for Congressional fiddling, dithering, and stalling are political and economic.According to Stillwell, “First, take a look at the fiscal impact at the years of delay in fixing the SGR. The Congressional Business Office (CBO) estimate indicates the price tag for a “doc fix” now is $275 billion through 2010, assuming it is a freeze. That is a 33 percent increases from last year’s legislative projections of $207 billion. Now, if you were to include cost-based raises fo this period in the 0.7 percent to 1.8 percent, the costs climb to $329.9 billion. . If you gave physicians a modest two percent raise, the costs climb to $374.2 billion!”Congress, if you’ll recall, promised Obamacare would cost under $1 trillion over the next 10 years – a number the OMB just shattered by estimating it would cost an extra $115 billion to implement. Add over $300 billion to that, and you blast the $1 trillion figure to smithereens. Stillwell observes, “The estimates, quite frankly, drive the nail in the coffin, killing efforts for a long-term fix. A Congress and Administration that has spent and spent now refuses to offset these mounting costs under the pay-go promises.”Stillwell goes on, “Whether another 30-day extension, or a longer temporary fix, will be adopted when Congress returns from next week’s Memorial weekend recess, SGR fatigue will grow among physicians, tired and weary with this political consequences.”What would the political consequences if Congress fails to rescind the 21.3% SGR cut scheduled for June 1? It won’t happen, of course, Congress will kick the fix further down the road. But if it did not executive a temporary fix, Stillwell says, “An informal AMA survey found that 68 percent of physicians would either stop taking new Medicare patients or stop seeing Medicare patients altogether if the 21.3 percent were to take effect.”An American Osteopathic survey indicated 37 percent would not accept new Medicare patients, 32 percent said they might, and 30 percent said they would.With 78 million baby boomers coming on board the Medicare train in 2011 at the rate of 13,000 each day, doctors not accepting new Medicare patients would put Congress in a pretty political pickle, with a good chance of incumbent members drowning in the electoral pickle barrel. A physician access crisis will be upon us, and it will dwarf the growing current discontent over Obamacare. The latest Rasmussen poll indicates 64 percent disapprove of the health care bill, versus 32 percent who approve. This is the first time disapproval has exceeded 60 percent. The information contained in this blog does not necessarily reflect the views or position of the Physicians Foundation or its Board members or of Lee Stillwell in the Washington Report or of the Stillwell group.Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] foundation”, growth, health law & policy, medicare, mmglobal, rate”, sgr, “physicians, “sustainable nonadult false Memorial Day Washington Report on Sustainable Growth Rate Fix for Doctors text blog foundation”,growth,health law & policy,medicare,mmglobal,rate”,sgr,“physicians,“sustainable 207 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=19464830&as=33379 http://media.kickstatic.com/kickapps/images/user/defaultImage_160x120_C.jpg false 0 Health Law & Policy 0 2386749 19464830 Member 0 http://community.modernmedicine.com/_Unnatural-Human-Communication-The-Main-Trouble-with-EMRs/blog/2335469/33379.html To hear the electronic online crowd tell it, electronic medical records (EMRs) are the Holy Grail for improving and rationalizing the healthcare system. At one stroke (and with multiple key strokes), EHRs will Reduce medical errors Narrow disparities in care delivery Engage patients in their own care Spark coordination of care Give access to doctors to best practice information Enhance communication across the health care spectrum Besides, EMRs will replace and overcome dreadful paper records, which are Space-occupying Irretrievable For physician-eyes only Private, personal, and secure Individualistic Fragmenting the system EMRs are, in short, a way to bring order out of chaos and to reduce the world to a series of electronic bullet-points, around which everything can be organized, everything is logical, everything can be encapsulated, and everything can be presented and understood as a kind of PowerPoint presentation. The main trouble with all of this is that EMRs and PowerPoint presentations cannot capture all the subtleties, permutations, and combinations of human interactions and reduce these exchanges into data bytes and bullet points. As observed in today’s New York Times, “We Have Met the Enemy and He is PowerPoint, “ PowerPoint presentations are akin to “hypnotizing chickens,” ie, they look good, feel good, and mesmerize viewers, but lack the subtleties and nuances of humankind. Still, the chickens are crossing the communications road and seem to be in command of the road. In The Health Care Blog, Robert Rowley, MD, chief medical officer of Practice Fusion, Inc, writes in “Challenges in EMR Adoption by Doctors’ Offices,” that his company’s “free” EMR system--which allows small practices to install an EMR, quickly, with minimal training at no cost to the practice except having a computer with broadband access to the Internet--may be a starter for overcoming physician barriers to EMR adoption. These barriers include direct and indirect costs of installation and maintenance, diversion and distraction from seeing patients, and drops in productivity and income. Dr Rowley should know; His practice has been paperless since 2004. And he may be right. The world is moving on Internet time at Internet speed, the paper world of newspapers and book publishing is going paperless, and we paper-bound creatures are groping for new paperless business models to survive. Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] To hear the electronic online crowd tell it, electronic medical records (EMRs) are the Holy Grail for improving and rationalizing the healthcare system. At one stroke (and with multiple key strokes), EHRs will Reduce medical errors Narrow disparities in care delivery Engage patients in their own care Spark coordination of care Give access to doctors to best practice information Enhance communication across the health care spectrum Besides, EMRs will replace and overcome dreadful paper records, which are Space-occupying Irretrievable For physician-eyes only Private, personal, and secure Individualistic Fragmenting the system EMRs are, in short, a way to bring order out of chaos and to reduce the world to a series of electronic bullet-points, around which everything can be organized, everything is logical, everything can be encapsulated, and everything can be presented and understood as a kind of PowerPoint presentation. The main trouble with all of this is that EMRs and PowerPoint presentations cannot capture all the subtleties, permutations, and combinations of human interactions and reduce these exchanges into data bytes and bullet points. As observed in today’s New York Times, “We Have Met the Enemy and He is PowerPoint, “ PowerPoint presentations are akin to “hypnotizing chickens,” ie, they look good, feel good, and mesmerize viewers, but lack the subtleties and nuances of humankind. Still, the chickens are crossing the communications road and seem to be in command of the road. In The Health Care Blog, Robert Rowley, MD, chief medical officer of Practice Fusion, Inc, writes in “Challenges in EMR Adoption by Doctors’ Offices,” that his company’s “free” EMR system--which allows small practices to install an EMR, quickly, with minimal training at no cost to the practice except having a computer with broadband access to the Internet--may be a starter for overcoming physician barriers to EMR adoption. These barriers include direct and indirect costs of installation and maintenance, diversion and distraction from seeing patients, and drops in productivity and income. Dr Rowley should know; His practice has been paperless since 2004. And he may be right. The world is moving on Internet time at Internet speed, the paper world of newspapers and book publishing is going paperless, and we paper-bound creatures are groping for new paperless business models to survive. Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Thu, 13 May 2010 00:34:29 GMT http://community.modernmedicine.com/_Unnatural-Human-Communication-The-Main-Trouble-with-EMRs/blog/2335469/33379.html RichardReeceMD 2010-05-13T00:30:29Z Managing Your Practice Modern Medicine Community To hear the electronic online crowd tell it, electronic medical records (EMRs) are the Holy Grail for improving and rationalizing the healthcare system. At one stroke (and with multiple key strokes), EHRs will Reduce medical errors Narrow disparities in care delivery Engage patients in their own care Spark coordination of care Give access to doctors to best practice information Enhance communication across the health care spectrum Besides, EMRs will replace and overcome dreadful paper records, which are Space-occupying Irretrievable For physician-eyes only Private, personal, and secure Individualistic Fragmenting the system EMRs are, in short, a way to bring order out of chaos and to reduce the world to a series of electronic bullet-points, around which everything can be organized, everything is logical, everything can be encapsulated, and everything can be presented and understood as a kind of PowerPoint presentation. The main trouble with all of this is that EMRs and PowerPoint presentations cannot capture all the subtleties, permutations, and combinations of human interactions and reduce these exchanges into data bytes and bullet points. As observed in today’s New York Times, “We Have Met the Enemy and He is PowerPoint, “ PowerPoint presentations are akin to “hypnotizing chickens,” ie, they look good, feel good, and mesmerize viewers, but lack the subtleties and nuances of humankind. Still, the chickens are crossing the communications road and seem to be in command of the road. In The Health Care Blog, Robert Rowley, MD, chief medical officer of Practice Fusion, Inc, writes in “Challenges in EMR Adoption by Doctors’ Offices,” that his company’s “free” EMR system--which allows small practices to install an EMR, quickly, with minimal training at no cost to the practice except having a computer with broadband access to the Internet--may be a starter for overcoming physician barriers to EMR adoption. These barriers include direct and indirect costs of installation and maintenance, diversion and distraction from seeing patients, and drops in productivity and income. Dr Rowley should know; His practice has been paperless since 2004. And he may be right. The world is moving on Internet time at Internet speed, the paper world of newspapers and book publishing is going paperless, and we paper-bound creatures are groping for new paperless business models to survive. Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] business operations, ehrs, emrs, managing your practice, medical errors, paperless office nonadult false Unnatural Human Communication, The Main Trouble with EMRs text blog business operations,ehrs,emrs,managing your practice,medical errors,paperless office 365 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=19464830&as=33379 http://media.kickstatic.com/kickapps/images/user/defaultImage_160x120_E.jpg false 2 Managing Your Practice 0 2335469 19464830 Member 0 http://community.modernmedicine.com/_Medical-Licensure-Conditional-on-Seeing-34-Million-Government-Subsidized-Patients/blog/2335455/33379.html From Daniel Palestrant, MD, founder and CEO of Sermo.com, a social networking company with 115.000 physician members headquartered in Cambridge, Mass, comes this word. The Massachusetts legislature is considering making accepting government-subsidized patients a condition for medical licensure ("(More) Madness in Massachusetts," The Health Care Blog, April 22, 2010). Palestrant's fear is that the Massachusetts Madness will spread to the rest of the nation. Palestrant puts it this way: “Lately I have been watching with complete horror the events playing out in my home state of Massachusetts. A bill currently under review by the state legislature will make participation in the state and federal Medicare/Medicaid programs a condition of medical licensure, effectively making physicians employees of the state.” “This is particularly alarming because Massachusetts is essentially a leading indicator of what will happen in the rest of the country. Several years ago the state passed a series of laws mandating health coverage. Like the recently passed national health reform bill, the Massachusetts law did not address any of the well-known causes of runaway costs, including tort reform, drug costs, or insurance regulation.” Can Massachusetts Impose This Mandate on Doctors? Is it constitutional? After all, America is a democracy. Like other citizens, physicians have individual rights. Will the Massachusetts government risk imposing its power over the rights of private physicians and the will of the people? A recent joint survey of 1000 physician across the United States by Athenahealth, another Massachusetts health firm, and Sermo indicates 59% of physicians thought the quality of care after Obamacare would deteriorate over the next five years while 54% said further government intervention would not improve care. Then there is the election of Senator Scott Brown in Massachusetts. Exit polls indicate his opposition to Obamacare sealed his victory. As it turned out, of course, Brown’s opposition to Obama’s health plan was not enough to ward off the Obama health plan passage. Furthermore, an average of national polls (Quinnipiac, Associated Press. Rasmussen Reports, GWU/Battleground, FOX News, CBS News, USA Today/Gallup, Washington Post, Bloomberg, and CNN/Opinion Research) reveals that 52.8% oppose the Obama Health Care Plan while 40.0% favor the plan. Will the percentage of those against the plan increase when the public sees cost increases (Robert Pear, "Health Care Cost Increase is Projected for New Law," New York Times, April 23, 2010). Palestrant is not optimistic about physicians’ prospects for independence. “We will no doubt see the same sequence of events play out across the country as the current versions of healthcare reform are implemented. The net effect of these laws is that it will make it close to impossible for physicians to stay in private practice. Patient access to physicians will suffer as more and more physicians retire and/or move to different states." These events raise a fundamental question. Does government, at either the state or federal level, possess the power to impose its laws over the will of physicians or the American people? Not a Trivial Question This is not a trivial question. It strikes at the core of the American democratic experiment – balancing the power of a collectivist government against the will of scattered individuals and ordinary people. Mandating doctors to accept patients in government programs represents a struggle for power over the control of health care resources. No one knows how this struggle will play out over the next 10 years, but the midterm elections in November 2010 may indicate how the struggle will go and in what direction the country is headed. Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] From Daniel Palestrant, MD, founder and CEO of Sermo.com, a social networking company with 115.000 physician members headquartered in Cambridge, Mass, comes this word. The Massachusetts legislature is considering making accepting government-subsidized patients a condition for medical licensure ("(More) Madness in Massachusetts," The Health Care Blog, April 22, 2010). Palestrant's fear is that the Massachusetts Madness will spread to the rest of the nation. Palestrant puts it this way: “Lately I have been watching with complete horror the events playing out in my home state of Massachusetts. A bill currently under review by the state legislature will make participation in the state and federal Medicare/Medicaid programs a condition of medical licensure, effectively making physicians employees of the state.” “This is particularly alarming because Massachusetts is essentially a leading indicator of what will happen in the rest of the country. Several years ago the state passed a series of laws mandating health coverage. Like the recently passed national health reform bill, the Massachusetts law did not address any of the well-known causes of runaway costs, including tort reform, drug costs, or insurance regulation.” Can Massachusetts Impose This Mandate on Doctors? Is it constitutional? After all, America is a democracy. Like other citizens, physicians have individual rights. Will the Massachusetts government risk imposing its power over the rights of private physicians and the will of the people? A recent joint survey of 1000 physician across the United States by Athenahealth, another Massachusetts health firm, and Sermo indicates 59% of physicians thought the quality of care after Obamacare would deteriorate over the next five years while 54% said further government intervention would not improve care. Then there is the election of Senator Scott Brown in Massachusetts. Exit polls indicate his opposition to Obamacare sealed his victory. As it turned out, of course, Brown’s opposition to Obama’s health plan was not enough to ward off the Obama health plan passage. Furthermore, an average of national polls (Quinnipiac, Associated Press. Rasmussen Reports, GWU/Battleground, FOX News, CBS News, USA Today/Gallup, Washington Post, Bloomberg, and CNN/Opinion Research) reveals that 52.8% oppose the Obama Health Care Plan while 40.0% favor the plan. Will the percentage of those against the plan increase when the public sees cost increases (Robert Pear, "Health Care Cost Increase is Projected for New Law," New York Times, April 23, 2010). Palestrant is not optimistic about physicians’ prospects for independence. “We will no doubt see the same sequence of events play out across the country as the current versions of healthcare reform are implemented. The net effect of these laws is that it will make it close to impossible for physicians to stay in private practice. Patient access to physicians will suffer as more and more physicians retire and/or move to different states." These events raise a fundamental question. Does government, at either the state or federal level, possess the power to impose its laws over the will of physicians or the American people? Not a Trivial Question This is not a trivial question. It strikes at the core of the American democratic experiment – balancing the power of a collectivist government against the will of scattered individuals and ordinary people. Mandating doctors to accept patients in government programs represents a struggle for power over the control of health care resources. No one knows how this struggle will play out over the next 10 years, but the midterm elections in November 2010 may indicate how the struggle will go and in what direction the country is headed. Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Wed, 12 May 2010 16:36:13 GMT http://community.modernmedicine.com/_Medical-Licensure-Conditional-on-Seeing-34-Million-Government-Subsidized-Patients/blog/2335455/33379.html RichardReeceMD 2010-05-12T16:17:03Z Health Law & Policy Modern Medicine Community From Daniel Palestrant, MD, founder and CEO of Sermo.com, a social networking company with 115.000 physician members headquartered in Cambridge, Mass, comes this word. The Massachusetts legislature is considering making accepting government-subsidized patients a condition for medical licensure ("(More) Madness in Massachusetts," The Health Care Blog, April 22, 2010). Palestrant's fear is that the Massachusetts Madness will spread to the rest of the nation. Palestrant puts it this way: “Lately I have been watching with complete horror the events playing out in my home state of Massachusetts. A bill currently under review by the state legislature will make participation in the state and federal Medicare/Medicaid programs a condition of medical licensure, effectively making physicians employees of the state.” “This is particularly alarming because Massachusetts is essentially a leading indicator of what will happen in the rest of the country. Several years ago the state passed a series of laws mandating health coverage. Like the recently passed national health reform bill, the Massachusetts law did not address any of the well-known causes of runaway costs, including tort reform, drug costs, or insurance regulation.” Can Massachusetts Impose This Mandate on Doctors? Is it constitutional? After all, America is a democracy. Like other citizens, physicians have individual rights. Will the Massachusetts government risk imposing its power over the rights of private physicians and the will of the people? A recent joint survey of 1000 physician across the United States by Athenahealth, another Massachusetts health firm, and Sermo indicates 59% of physicians thought the quality of care after Obamacare would deteriorate over the next five years while 54% said further government intervention would not improve care. Then there is the election of Senator Scott Brown in Massachusetts. Exit polls indicate his opposition to Obamacare sealed his victory. As it turned out, of course, Brown’s opposition to Obama’s health plan was not enough to ward off the Obama health plan passage. Furthermore, an average of national polls (Quinnipiac, Associated Press. Rasmussen Reports, GWU/Battleground, FOX News, CBS News, USA Today/Gallup, Washington Post, Bloomberg, and CNN/Opinion Research) reveals that 52.8% oppose the Obama Health Care Plan while 40.0% favor the plan. Will the percentage of those against the plan increase when the public sees cost increases (Robert Pear, "Health Care Cost Increase is Projected for New Law," New York Times, April 23, 2010). Palestrant is not optimistic about physicians’ prospects for independence. “We will no doubt see the same sequence of events play out across the country as the current versions of healthcare reform are implemented. The net effect of these laws is that it will make it close to impossible for physicians to stay in private practice. Patient access to physicians will suffer as more and more physicians retire and/or move to different states." These events raise a fundamental question. Does government, at either the state or federal level, possess the power to impose its laws over the will of physicians or the American people? Not a Trivial Question This is not a trivial question. It strikes at the core of the American democratic experiment – balancing the power of a collectivist government against the will of scattered individuals and ordinary people. Mandating doctors to accept patients in government programs represents a struggle for power over the control of health care resources. No one knows how this struggle will play out over the next 10 years, but the midterm elections in November 2010 may indicate how the struggle will go and in what direction the country is headed. Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] health law & policy, healthcare reform, medicaid, medical licensure, medicare, mmglobal nonadult false Medical Licensure Conditional on Seeing 34 Million Government-Subsidized Patients text blog health law & policy,healthcare reform,medicaid,medical licensure,medicare,mmglobal 281 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=19464830&as=33379 http://media.kickstatic.com/kickapps/images/user/defaultImage_160x120_E.jpg false 0 Health Law & Policy 0 2335455 19464830 Member 0 http://community.modernmedicine.com/_Women-in-Medicine-One-Womans-Lifestyle-Practice/blog/2335453/33379.html Elizabeth Chase, better known as Betsy, is a close and enduring college friend of my son, Spencer. She is a solid, pragmatic, hard-working obstetrician-gynecologist, with two sons and an architect husband, who spends his time caring for their children and their house in Dover, New Hampshire. She represents many of changes that occur when women become full-time physicians. The purpose of this interview is to give insight into trials, tribulations, and joys of being a woman physician in a transformed healthcare system. Q: Dr. Chase, when did you graduate from medical school, and how old are you? A: I graduated from Tufts University School of Medicine in 1992. I am 46 years old, and I have practiced for 12 years. Q: Has your career lived up to your expectations? Has anything surprised you? A: From the standpoint of the joys of being part of patients’ lives, listening to their stories, and the pleasure of doing surgery, it has lived up to my expectations. Q: And what have been your disappointments? A: The hardest part in my early years of practice in Pennsylvania was a combination of things—the shock of low reimbursements paying me half of what I expected to make, the negative malpractice environment, and inadequate amount of time I had to spend with patients to make up the difference. I just could not justify spending so little time with patients. I left Pennsylvania partly for personal and partly for professional reasons. I was part of an exodus of doctors from Pennsylvania. I recall a full-page ad in the Philadelphia Inquirer, listing all the doctors who had fled Pennsylvania. I moved to Dover, New Hampshire. Q: Give us some context of the community you’re in, the hospital you use, and your practice setting. A: I practice in a community hospital with a level 2 nursery. We have about 900 births per year. Dover has 50,000 people, and its primary industries include the headquarters of Liberty Mutual insurance company and we have some high tech firms. The hospital employs a lot of people. We have a private practice, five doctors, and all women. Q: You’re part of the gender revolution. A: Yes, but Tufts was one of the first medical schools to accept women, and my class had 50% women. And OB/GYN at this point is something like 80/20 women/men entering the profession. Q: That changes medical practice dynamics. Women require pregnancy leaves, spend more time with family, are more likely to be employees, retire earlier, and sometimes women doctors are working and the husbands are not. How many women in your practice have “house husbands? A: All four of us, including myself, have a “house husband.” It gets a little hectic, but we manage very well. We’re on call every fourth night, but we make our call easier by working with midwives. About half of our on-call time is back-up call, with the midwives taking primary call. Q: Describe to me the hospital-physician practice environment. As you know, hospitals are hiring more and more primary care doctors these days and even specialists. How large is your hospital? A: We have 155 beds and 10 operating room suites. All primary care practices are “owned.” There are no independent generalists working out of our hospital. We have a fully staffed hospitalist program. And all primary care practices participate in the hospitalist program. We have 13 hospitalists on staff at this point. We have 24-hour ICU coverage by hospital-employed doctors. None of the surgical practices or subspecialty practices is owned. There appear to be some collaborative agreements with plastic surgeons. Hospitals like to own the physicians because they can control them. We are not owned, but the hospital has often suggested to us the only solution to any financial problem we might have is to be owned. We feel much more comfortable with owning ourselves. We prefer the independence we have. We’re making it financially. We’re 5 women, and 4 of us have kids. All our midwives have children. We call ourselves a lifestyle practice, and we try to blend being mothers with a sustainable way of being a doctor. We give ourselves 6 weeks of vacation a year and we give ourselves 2 weeks of CME. We do not believe in working 24 hours a day, 365 days a year. Our salaries are not as high as the national average, but we are happy this way. We look after each other, and we collaborate and cooperate with the town’s other OB/GYN practice. I’ve learned how to deal with adversity, and not make it kill me. I like medicine too much to stop. We truly love our patients and try to develop positive relationships with them. Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Elizabeth Chase, better known as Betsy, is a close and enduring college friend of my son, Spencer. She is a solid, pragmatic, hard-working obstetrician-gynecologist, with two sons and an architect husband, who spends his time caring for their children and their house in Dover, New Hampshire. She represents many of changes that occur when women become full-time physicians. The purpose of this interview is to give insight into trials, tribulations, and joys of being a woman physician in a transformed healthcare system. Q: Dr. Chase, when did you graduate from medical school, and how old are you? A: I graduated from Tufts University School of Medicine in 1992. I am 46 years old, and I have practiced for 12 years. Q: Has your career lived up to your expectations? Has anything surprised you? A: From the standpoint of the joys of being part of patients’ lives, listening to their stories, and the pleasure of doing surgery, it has lived up to my expectations. Q: And what have been your disappointments? A: The hardest part in my early years of practice in Pennsylvania was a combination of things—the shock of low reimbursements paying me half of what I expected to make, the negative malpractice environment, and inadequate amount of time I had to spend with patients to make up the difference. I just could not justify spending so little time with patients. I left Pennsylvania partly for personal and partly for professional reasons. I was part of an exodus of doctors from Pennsylvania. I recall a full-page ad in the Philadelphia Inquirer, listing all the doctors who had fled Pennsylvania. I moved to Dover, New Hampshire. Q: Give us some context of the community you’re in, the hospital you use, and your practice setting. A: I practice in a community hospital with a level 2 nursery. We have about 900 births per year. Dover has 50,000 people, and its primary industries include the headquarters of Liberty Mutual insurance company and we have some high tech firms. The hospital employs a lot of people. We have a private practice, five doctors, and all women. Q: You’re part of the gender revolution. A: Yes, but Tufts was one of the first medical schools to accept women, and my class had 50% women. And OB/GYN at this point is something like 80/20 women/men entering the profession. Q: That changes medical practice dynamics. Women require pregnancy leaves, spend more time with family, are more likely to be employees, retire earlier, and sometimes women doctors are working and the husbands are not. How many women in your practice have “house husbands? A: All four of us, including myself, have a “house husband.” It gets a little hectic, but we manage very well. We’re on call every fourth night, but we make our call easier by working with midwives. About half of our on-call time is back-up call, with the midwives taking primary call. Q: Describe to me the hospital-physician practice environment. As you know, hospitals are hiring more and more primary care doctors these days and even specialists. How large is your hospital? A: We have 155 beds and 10 operating room suites. All primary care practices are “owned.” There are no independent generalists working out of our hospital. We have a fully staffed hospitalist program. And all primary care practices participate in the hospitalist program. We have 13 hospitalists on staff at this point. We have 24-hour ICU coverage by hospital-employed doctors. None of the surgical practices or subspecialty practices is owned. There appear to be some collaborative agreements with plastic surgeons. Hospitals like to own the physicians because they can control them. We are not owned, but the hospital has often suggested to us the only solution to any financial problem we might have is to be owned. We feel much more comfortable with owning ourselves. We prefer the independence we have. We’re making it financially. We’re 5 women, and 4 of us have kids. All our midwives have children. We call ourselves a lifestyle practice, and we try to blend being mothers with a sustainable way of being a doctor. We give ourselves 6 weeks of vacation a year and we give ourselves 2 weeks of CME. We do not believe in working 24 hours a day, 365 days a year. Our salaries are not as high as the national average, but we are happy this way. We look after each other, and we collaborate and cooperate with the town’s other OB/GYN practice. I’ve learned how to deal with adversity, and not make it kill me. I like medicine too much to stop. We truly love our patients and try to develop positive relationships with them. Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Wed, 12 May 2010 16:35:34 GMT http://community.modernmedicine.com/_Women-in-Medicine-One-Womans-Lifestyle-Practice/blog/2335453/33379.html RichardReeceMD 2010-05-12T16:13:45Z OB GYN & Women’s Health Modern Medicine Community Elizabeth Chase, better known as Betsy, is a close and enduring college friend of my son, Spencer. She is a solid, pragmatic, hard-working obstetrician-gynecologist, with two sons and an architect husband, who spends his time caring for their children and their house in Dover, New Hampshire. She represents many of changes that occur when women become full-time physicians. The purpose of this interview is to give insight into trials, tribulations, and joys of being a woman physician in a transformed healthcare system. Q: Dr. Chase, when did you graduate from medical school, and how old are you? A: I graduated from Tufts University School of Medicine in 1992. I am 46 years old, and I have practiced for 12 years. Q: Has your career lived up to your expectations? Has anything surprised you? A: From the standpoint of the joys of being part of patients’ lives, listening to their stories, and the pleasure of doing surgery, it has lived up to my expectations. Q: And what have been your disappointments? A: The hardest part in my early years of practice in Pennsylvania was a combination of things—the shock of low reimbursements paying me half of what I expected to make, the negative malpractice environment, and inadequate amount of time I had to spend with patients to make up the difference. I just could not justify spending so little time with patients. I left Pennsylvania partly for personal and partly for professional reasons. I was part of an exodus of doctors from Pennsylvania. I recall a full-page ad in the Philadelphia Inquirer, listing all the doctors who had fled Pennsylvania. I moved to Dover, New Hampshire. Q: Give us some context of the community you’re in, the hospital you use, and your practice setting. A: I practice in a community hospital with a level 2 nursery. We have about 900 births per year. Dover has 50,000 people, and its primary industries include the headquarters of Liberty Mutual insurance company and we have some high tech firms. The hospital employs a lot of people. We have a private practice, five doctors, and all women. Q: You’re part of the gender revolution. A: Yes, but Tufts was one of the first medical schools to accept women, and my class had 50% women. And OB/GYN at this point is something like 80/20 women/men entering the profession. Q: That changes medical practice dynamics. Women require pregnancy leaves, spend more time with family, are more likely to be employees, retire earlier, and sometimes women doctors are working and the husbands are not. How many women in your practice have “house husbands? A: All four of us, including myself, have a “house husband.” It gets a little hectic, but we manage very well. We’re on call every fourth night, but we make our call easier by working with midwives. About half of our on-call time is back-up call, with the midwives taking primary call. Q: Describe to me the hospital-physician practice environment. As you know, hospitals are hiring more and more primary care doctors these days and even specialists. How large is your hospital? A: We have 155 beds and 10 operating room suites. All primary care practices are “owned.” There are no independent generalists working out of our hospital. We have a fully staffed hospitalist program. And all primary care practices participate in the hospitalist program. We have 13 hospitalists on staff at this point. We have 24-hour ICU coverage by hospital-employed doctors. None of the surgical practices or subspecialty practices is owned. There appear to be some collaborative agreements with plastic surgeons. Hospitals like to own the physicians because they can control them. We are not owned, but the hospital has often suggested to us the only solution to any financial problem we might have is to be owned. We feel much more comfortable with owning ourselves. We prefer the independence we have. We’re making it financially. We’re 5 women, and 4 of us have kids. All our midwives have children. We call ourselves a lifestyle practice, and we try to blend being mothers with a sustainable way of being a doctor. We give ourselves 6 weeks of vacation a year and we give ourselves 2 weeks of CME. We do not believe in working 24 hours a day, 365 days a year. Our salaries are not as high as the national average, but we are happy this way. We look after each other, and we collaborate and cooperate with the town’s other OB/GYN practice. I’ve learned how to deal with adversity, and not make it kill me. I like medicine too much to stop. We truly love our patients and try to develop positive relationships with them. Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] gyn & women’s health, hospital employment, malpractice, midwives, ob, women physicians nonadult false Women in Medicine: One Woman’s Lifestyle Practice text blog gyn & women’s health,hospital employment,malpractice,midwives,ob,women physicians 320 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=19464830&as=33379 http://media.kickstatic.com/kickapps/images/user/defaultImage_160x120_A.jpg false 0 OB/GYN & Women’s Health 0 2335453 19464830 Member 0 http://community.modernmedicine.com/_Reeling-Writhing-Rithmetic-and-Health-Reform/blog/2311524/33379.html "Reeling, and Writhing, of course, to begin with," the Mock Turtle replied, "and the different branches of Arithmetic – Ambition, Distraction, Uglification, and Derision." — Lewis Carroll, 1832-1898, Alice’s Adventures in Wonderland Lewis Carroll was a mathematician in real life. Maybe the time has come for us to think like mathematicians and to do the math on health reform. For examples, the nonpartisan Congressional Business Office, says, The budget shortfall this year will be $1.5 trillion—a post-World War II record at 10.3 % of the national economy Obama’s proposed budget will grow to more than $9.7 trillion for the next decade to 90% of the economy By 2030, health care will add $3 trillion or so to the debt. Medicare is scheduled for bankruptcy by 2016, or sooner, if the economy does not pull itself out of its present ditch. Furthermore Furthermore is an appropriate word to use in explaining these projections. We know further that 78 million more baby boomers will start qualifying for Medicare in 2011 at the rate of 13,000 a day. These further numbers add more fodder to the national debate about unsustainable national debt, passing this debt onto our grandchildren, and overgrowth of a “socialistic” government. Furthermore, we know these numbers lead to all sorts of political arithmetic—ambitious politicians saying we need more or less government, distracting us with budgetary gimmicks, uglifying their arguments by accusing the other side of inflammatory extremism, and using derision to demean opponents. No More Furthermore We cannot continue on this furthermore course. We must look at the math and make fundamental decisions to reverse the numbers—such as moving the entry age of Medicare from 65 to 67 or even 70; acknowledging the reality that most Americans will soon live to 80 or beyond; means testing Medicare so that affluent elders pay more; allowing private contracting between patients and doctors so that patients of means can access care outside of Medicare; giving more leeway to health saving accounts with catastrophic caps so consumers can use their own money to decide what care they want and can afford; and recognizing that “free” government entitlement programs have always and will always exceed government projections. Otherwise, we will continue reeling, writhing, and defying the rules of ‘rithmetic. Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] "Reeling, and Writhing, of course, to begin with," the Mock Turtle replied, "and the different branches of Arithmetic – Ambition, Distraction, Uglification, and Derision." — Lewis Carroll, 1832-1898, Alice’s Adventures in Wonderland Lewis Carroll was a mathematician in real life. Maybe the time has come for us to think like mathematicians and to do the math on health reform. For examples, the nonpartisan Congressional Business Office, says, The budget shortfall this year will be $1.5 trillion—a post-World War II record at 10.3 % of the national economy Obama’s proposed budget will grow to more than $9.7 trillion for the next decade to 90% of the economy By 2030, health care will add $3 trillion or so to the debt. Medicare is scheduled for bankruptcy by 2016, or sooner, if the economy does not pull itself out of its present ditch. Furthermore Furthermore is an appropriate word to use in explaining these projections. We know further that 78 million more baby boomers will start qualifying for Medicare in 2011 at the rate of 13,000 a day. These further numbers add more fodder to the national debate about unsustainable national debt, passing this debt onto our grandchildren, and overgrowth of a “socialistic” government. Furthermore, we know these numbers lead to all sorts of political arithmetic—ambitious politicians saying we need more or less government, distracting us with budgetary gimmicks, uglifying their arguments by accusing the other side of inflammatory extremism, and using derision to demean opponents. No More Furthermore We cannot continue on this furthermore course. We must look at the math and make fundamental decisions to reverse the numbers—such as moving the entry age of Medicare from 65 to 67 or even 70; acknowledging the reality that most Americans will soon live to 80 or beyond; means testing Medicare so that affluent elders pay more; allowing private contracting between patients and doctors so that patients of means can access care outside of Medicare; giving more leeway to health saving accounts with catastrophic caps so consumers can use their own money to decide what care they want and can afford; and recognizing that “free” government entitlement programs have always and will always exceed government projections. Otherwise, we will continue reeling, writhing, and defying the rules of ‘rithmetic. Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Fri, 23 Apr 2010 20:12:48 GMT http://community.modernmedicine.com/_Reeling-Writhing-Rithmetic-and-Health-Reform/blog/2311524/33379.html RichardReeceMD 2010-04-23T19:49:46Z Health Law & Policy Modern Medicine Community "Reeling, and Writhing, of course, to begin with," the Mock Turtle replied, "and the different branches of Arithmetic – Ambition, Distraction, Uglification, and Derision." — Lewis Carroll, 1832-1898, Alice’s Adventures in Wonderland Lewis Carroll was a mathematician in real life. Maybe the time has come for us to think like mathematicians and to do the math on health reform. For examples, the nonpartisan Congressional Business Office, says, The budget shortfall this year will be $1.5 trillion—a post-World War II record at 10.3 % of the national economy Obama’s proposed budget will grow to more than $9.7 trillion for the next decade to 90% of the economy By 2030, health care will add $3 trillion or so to the debt. Medicare is scheduled for bankruptcy by 2016, or sooner, if the economy does not pull itself out of its present ditch. Furthermore Furthermore is an appropriate word to use in explaining these projections. We know further that 78 million more baby boomers will start qualifying for Medicare in 2011 at the rate of 13,000 a day. These further numbers add more fodder to the national debate about unsustainable national debt, passing this debt onto our grandchildren, and overgrowth of a “socialistic” government. Furthermore, we know these numbers lead to all sorts of political arithmetic—ambitious politicians saying we need more or less government, distracting us with budgetary gimmicks, uglifying their arguments by accusing the other side of inflammatory extremism, and using derision to demean opponents. No More Furthermore We cannot continue on this furthermore course. We must look at the math and make fundamental decisions to reverse the numbers—such as moving the entry age of Medicare from 65 to 67 or even 70; acknowledging the reality that most Americans will soon live to 80 or beyond; means testing Medicare so that affluent elders pay more; allowing private contracting between patients and doctors so that patients of means can access care outside of Medicare; giving more leeway to health saving accounts with catastrophic caps so consumers can use their own money to decide what care they want and can afford; and recognizing that “free” government entitlement programs have always and will always exceed government projections. Otherwise, we will continue reeling, writhing, and defying the rules of ‘rithmetic. Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] budget deficit, federal budget, health law & policy, healthcare reform, mmglobal nonadult false Reeling, Writhing, ‘Rithmetic, and Health Reform text blog budget deficit,federal budget,health law & policy,healthcare reform,mmglobal 126 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=19464830&as=33379 http://media.kickstatic.com/kickapps/images/user/defaultImage_160x120_C.jpg false 0 Health Law & Policy 0 2311524 19464830 Member 0 http://community.modernmedicine.com/_Practice-Fusion-Inc-An-Innovative-Web-Based-EHR/blog/2311499/33379.html When the government passed its $787 billion stimulus in February 2009, it included $20 billion for health information technology and up to $44,000 for each doctor adopting certified EHRs with “meaningful use.”This government act set off a chain of innovations for EHR companies and physicians. There's nothing mysterious about successful medical innovation - it is about attracting venture riches, filling niches, adding sons of niches, anticipating physician bitches, and satisfying government hitches. Practice Fusion, Inc, a San Francisco-based EHR startup, had all of these ingredients when it was founded in 2005. It attracted venture riches, ie, funding from Band of Angels and Felicis ventures. It filled niches: (1) Primary care doctors and specialists seeking easy-to-use, easy-to-install, free, certified systems to capitalize on the $44,000 federal largess; (2) multiple practice management features its management team was familiar with; (3) the appeal of the Internet, which allows doctors to off-load all their needs to the Internet using nothing but personal computers and broadband access without installing hardware and software in the office. It is free, Web-based, and no-risk. It added sons-of-niches: Those multiple other features such as new speech recognition programs--Dragon Naturally Speaking, MacSpeed Dictating, scanning paper documents, e-prescribing programs, and Personal Health Record programs. It anticipated physician bitches: Complaints such expenses of installing, training, difficulty of data entry, and loss of productivity. It satisfied hitches: Government reimbursement, such as those hard to understand conditions such as what EHRs qualified for “certification” and what constituted “meaningful use,” is handled. And if that were not enough, it could be installed quickly, required no lengthy training or instruction, could be up and running in 5 minutes, and it had a business model, similar to Google’s Adsense, that allowed it to be “free” for clinicians. The business model is based on advertisements from insurers, suppliers, and drug companies when certain keywords appeared during Practice Fusion use. Small wonder, then, that Practice Fusion has grown rapidly and now has 30,000 users. Here is how Ron Howard, CEO of Practice Fusion explains its acceptance. “Practice Fusion is an electronic health record, which is provided to physicians at no cost for licensing, hosting, support, and training of the application. Right now we’re the fastest growing physician practice community in the country.” “Every feature that’s included with the product in any capacity is offered at no cost, so it’s truly free. It’s offered with support, training, and hosting. It’s the only totally free model on the market.” “ Practice Fusion competes with most major systems in the marketplace. It’s fully featured. It has everything from front-office scheduling to patient management to full-charting templating, prescription writing, lab management, the entire gamut of services. From a major competitor standpoint, we compete with them relatively well, especially over the next few months where we’ll be extending our products to include Quest Lab integration and e-prescribing.” “Within our product we have a vast template library. We are servicing over 25 specialties today. Templates are created by everyone from our Chief Medical Office to our Physician Advisory Board to our end users. It’s one of the things that’s unique about the product. The product is not only free and web-based, but we have a process called Live in Five. If you go to our website and register, you can actually start using the products within five minutes.” Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] When the government passed its $787 billion stimulus in February 2009, it included $20 billion for health information technology and up to $44,000 for each doctor adopting certified EHRs with “meaningful use.”This government act set off a chain of innovations for EHR companies and physicians. There's nothing mysterious about successful medical innovation - it is about attracting venture riches, filling niches, adding sons of niches, anticipating physician bitches, and satisfying government hitches. Practice Fusion, Inc, a San Francisco-based EHR startup, had all of these ingredients when it was founded in 2005. It attracted venture riches, ie, funding from Band of Angels and Felicis ventures. It filled niches: (1) Primary care doctors and specialists seeking easy-to-use, easy-to-install, free, certified systems to capitalize on the $44,000 federal largess; (2) multiple practice management features its management team was familiar with; (3) the appeal of the Internet, which allows doctors to off-load all their needs to the Internet using nothing but personal computers and broadband access without installing hardware and software in the office. It is free, Web-based, and no-risk. It added sons-of-niches: Those multiple other features such as new speech recognition programs--Dragon Naturally Speaking, MacSpeed Dictating, scanning paper documents, e-prescribing programs, and Personal Health Record programs. It anticipated physician bitches: Complaints such expenses of installing, training, difficulty of data entry, and loss of productivity. It satisfied hitches: Government reimbursement, such as those hard to understand conditions such as what EHRs qualified for “certification” and what constituted “meaningful use,” is handled. And if that were not enough, it could be installed quickly, required no lengthy training or instruction, could be up and running in 5 minutes, and it had a business model, similar to Google’s Adsense, that allowed it to be “free” for clinicians. The business model is based on advertisements from insurers, suppliers, and drug companies when certain keywords appeared during Practice Fusion use. Small wonder, then, that Practice Fusion has grown rapidly and now has 30,000 users. Here is how Ron Howard, CEO of Practice Fusion explains its acceptance. “Practice Fusion is an electronic health record, which is provided to physicians at no cost for licensing, hosting, support, and training of the application. Right now we’re the fastest growing physician practice community in the country.” “Every feature that’s included with the product in any capacity is offered at no cost, so it’s truly free. It’s offered with support, training, and hosting. It’s the only totally free model on the market.” “ Practice Fusion competes with most major systems in the marketplace. It’s fully featured. It has everything from front-office scheduling to patient management to full-charting templating, prescription writing, lab management, the entire gamut of services. From a major competitor standpoint, we compete with them relatively well, especially over the next few months where we’ll be extending our products to include Quest Lab integration and e-prescribing.” “Within our product we have a vast template library. We are servicing over 25 specialties today. Templates are created by everyone from our Chief Medical Office to our Physician Advisory Board to our end users. It’s one of the things that’s unique about the product. The product is not only free and web-based, but we have a process called Live in Five. If you go to our website and register, you can actually start using the products within five minutes.” Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Fri, 23 Apr 2010 20:13:27 GMT http://community.modernmedicine.com/_Practice-Fusion-Inc-An-Innovative-Web-Based-EHR/blog/2311499/33379.html RichardReeceMD 2010-04-23T19:26:10Z Managing Your Practice Modern Medicine Community When the government passed its $787 billion stimulus in February 2009, it included $20 billion for health information technology and up to $44,000 for each doctor adopting certified EHRs with “meaningful use.”This government act set off a chain of innovations for EHR companies and physicians. There's nothing mysterious about successful medical innovation - it is about attracting venture riches, filling niches, adding sons of niches, anticipating physician bitches, and satisfying government hitches. Practice Fusion, Inc, a San Francisco-based EHR startup, had all of these ingredients when it was founded in 2005. It attracted venture riches, ie, funding from Band of Angels and Felicis ventures. It filled niches: (1) Primary care doctors and specialists seeking easy-to-use, easy-to-install, free, certified systems to capitalize on the $44,000 federal largess; (2) multiple practice management features its management team was familiar with; (3) the appeal of the Internet, which allows doctors to off-load all their needs to the Internet using nothing but personal computers and broadband access without installing hardware and software in the office. It is free, Web-based, and no-risk. It added sons-of-niches: Those multiple other features such as new speech recognition programs--Dragon Naturally Speaking, MacSpeed Dictating, scanning paper documents, e-prescribing programs, and Personal Health Record programs. It anticipated physician bitches: Complaints such expenses of installing, training, difficulty of data entry, and loss of productivity. It satisfied hitches: Government reimbursement, such as those hard to understand conditions such as what EHRs qualified for “certification” and what constituted “meaningful use,” is handled. And if that were not enough, it could be installed quickly, required no lengthy training or instruction, could be up and running in 5 minutes, and it had a business model, similar to Google’s Adsense, that allowed it to be “free” for clinicians. The business model is based on advertisements from insurers, suppliers, and drug companies when certain keywords appeared during Practice Fusion use. Small wonder, then, that Practice Fusion has grown rapidly and now has 30,000 users. Here is how Ron Howard, CEO of Practice Fusion explains its acceptance. “Practice Fusion is an electronic health record, which is provided to physicians at no cost for licensing, hosting, support, and training of the application. Right now we’re the fastest growing physician practice community in the country.” “Every feature that’s included with the product in any capacity is offered at no cost, so it’s truly free. It’s offered with support, training, and hosting. It’s the only totally free model on the market.” “ Practice Fusion competes with most major systems in the marketplace. It’s fully featured. It has everything from front-office scheduling to patient management to full-charting templating, prescription writing, lab management, the entire gamut of services. From a major competitor standpoint, we compete with them relatively well, especially over the next few months where we’ll be extending our products to include Quest Lab integration and e-prescribing.” “Within our product we have a vast template library. We are servicing over 25 specialties today. Templates are created by everyone from our Chief Medical Office to our Physician Advisory Board to our end users. It’s one of the things that’s unique about the product. The product is not only free and web-based, but we have a process called Live in Five. If you go to our website and register, you can actually start using the products within five minutes.” Richard L. Reece, MD, graduate of Duke Medical School, is a pathologist (which he defines as a doctor who knows everything but it may be too late), editor-in-chief of Physician Practice Options, and author of Voices of Health Reform (2005), Innovation-Driven Health Care (2007), Obama, Doctors, and Health Reform (2009), and over 1200 blogs on www.medinnovationblog.blogspot.com. He invites you to visit and comment on his blogs. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] business model, certified, cloud computing, e-prescribing, ehrs, electronic health records, innovation, internet, managing your practice, meaningful use, practice fusion, speech recognition nonadult false Practice Fusion, Inc--An Innovative Web-Based EHR text blog business model,certified,cloud computing,e-prescribing,ehrs,electronic health records,innovation,internet,managing your practice,meaningful use,practice fusion,speech recognition 298 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=19464830&as=33379 http://media.kickstatic.com/kickapps/images/user/defaultImage_160x120_E.jpg false 1 Managing Your Practice 0 2311499 19464830 Member 0