Saints v. Colts?

Who dat?

Superbowl victory to Saints or Colts: what you say?

What You Say? ‘Cluetrain’ or ‘Cult of Amateur’ Prevails?

OK give it up Tweeple!

Who wins? Cluetrain Manifesto or Cult of the Amateur?

Context here: http://www.youtube.com/watch?v=gxMczrDb1X8

Bundled Payment? Lets Start with the ‘RAPERs’!

Some of the health reform conversation has focused on bundled payment as a ‘bite sized’ basis of implementing change in the ‘whack a mole’ resistent health care borg. In response to a question on a LinkedIn thread entitled ‘Changing the Health Care Payment System: First Step Toward Real Reform?’

Breaking the cycle of health care payments complexity and errors may be one way in which to stem the cost of moving to a consumer oriented health care system, which is one of the popular solutions discussed during the health care reform debate. This concept of consumerism in health care and payments for services may be provocative to many readers of this blog but the facts as they stand currently demonstrate clearly that we have to start reform somewhere and fast. The current legislative efforts have provided little in the way of support for what the American people have expressed they want in the way of a public option so perhaps as an industry we can begin to resolve some of the issues that will be explored in this discussion. It is a fact that when compared to other business sectors such as retail, health care revenue cycle management is difficult at best, fraught with paper and consists of very little standardization. This is clearly an area that is replete with opportunity to drive new business, create jobs, and leverage existing infrastructure investments all while creating better efficiencies and timelier payments for providers.

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The purpose of starting this discussion is not to position the arguments within as the only area of focus for the health care debate just a good start, and all efforts in other areas should continue in tandem. Consider that the health care industry supports bad debt in excess of 60 billion, spends more than $7,000 per person and almost 2.3 trillion dollars by some estimates. Certainly, this would point to an area ready for innovation and change. There will not be a “quick fix” to address these challenges nor is the author suggesting that it is the universal remedy not to mention that many readers will disagree with the points offered in this post. In essence that is the real point of this effort is to start an open, honest dialogue addressing the issues surrounding the payment system in the US Health Care system lest we continue to get more of the same, less individuals insured, spiraling costs and no hope of stemming the tide and effecting change.

…….

I opine below:

Excellent discussion! I will noodle some more after digesting the entire thread, plus comments. Yet, what comes up for me is the ‘C’ word. Underlying health reform whether from the bleeding edge of payment reform, or any other logical portal of entry, i.e., HIT, nothing succeeds absent the ‘cultural’ context to receive and embrace its adoption.

So why not start with ’seeding’ the cultural antecedents to merge (both clinically and financially) all hospital based physicians (HBPs), less affectionately known in the health plan contracting domain as ‘RAPERs’, i.e., Radiology, Anesthesiology, Pathology, Emergency Room docs? This is a logical nexus for bundled payments and rather compelling from the patient’s perspective too.

The notion of bundled payment is potentially sexy. It encourages, if not drives, the consideration of collaboration (& the ostensible alignment of interests) to accept and administer global payment for professional medical services rendered; and theoretically is more efficient and cost effective. Yet, in 2010 there is neither the administrative capacity, nor (outside of IDNs of the Mayo variety) cultural capacity for HBPs to risk experimentation with the financial and clinical collaboration required to co-exist under a bundled payment paradigm. Yet, no where else in medicine is the argument so compelling for such integration, imj.

Clearly, the nature of the exclusive ‘franchise’ often afforded to HBPs in my view augurs in favor of such integration even absent the ‘quid pro quo’ group culture typically required for its successful implementation.

Doctor: Do You Speak ‘Flower’?

Join Dirk Stanley, MD,  @dirkstanley, Steve Daviss, MD, @HITshrink & and Tim Sturgill, MD, @symtym for an exploratory conversation on ‘Doctor: Do You Speak ‘Flower‘? 1/26/10 at 12 Noon EST.

We’ll discuss the history of the idea, current state of the Health Information Technology industry, and this emerging, yet granular quest to bake ‘public utility’ solutions that address well known problems inherent in legacy systems, and potential obstacles to innovation.

For context consider reading ‘The Challenge of Meaningful Use to Joe Sixpack MD: Guest Blog By R. Vaughn, MD’, ‘ Thinking About Flower: A Concept is Born‘ and ‘Speak Flower’.

Join us!

Health Care Web Literacy with HealthTweep & Thought Leader @PhilBaumann

On Tuesday’s broadcast at 9 AM Pacific and 12 Noon Eastern, I will chat with Phil Baumann on our nascent yet rapidly emerging new media, aka ’social’ industry. We will talk about a range of issues from web literacy to content building, promotion, branding and attempts at monetization.

For more information on Phil see his blog here; and Twitter page here. Phil is a witty, generous producer and insightful publisher of social media pieces; a sampling of which can be seen via:  140 Health Care Uses For Twitter, The World’s First Twitter Chat for Nurses: RNchat, and Google Is Watching You: Building Your Reputation on Google.

We invite your participation in the program via call in, chat or Tweetstream’s of @PhilBaumann or @2healthguru; the call in phone number is 347.539.5527.

Ed Bennett on Trends in Social Media for Hospitals & Health Care Organizations

Please join me for a conversation with Ed Bennett!

On the Wednesday, January 13th ‘Trends in Social Media for Hospitals and Health Care Organizations‘ broadcast I am pumped to chat with Ed Bennett of ‘Found In Cache: Social Media resources for health care professionals’ as well as his day job at the University of Maryland Medical System.

I affectionately refer to Ed (rumored to be a die hard Cowboy Junkies aficionado) as the Social Media for Hospitals ‘Oracle’ from Maryland. Ed is a leading voice, documentarian, and visionary change agent in the social media for health care organizations’ space. His tireless commitment to track, update, educate, share and vet emerging health care organizational participation in social media is a major contribution to the granular evolution of the space. Please join me in this conversation with Ed! You can call in with questions or active participation via 347.539.5527, or participate in the chat room;  or as many do, just lurk. All are welcome!

The program airs at 12 noon Eastern time, 9AM. If you can not make it live, it will archive here for rebroadcast or download. I like to subscribe to episodes and listen at my convenience via Google Reader. iTunes of other RSS feed burner.

‘Ground Control to John Goodman’ – A Uwe Reinhardt Appeal

John Goodman of the conservative Dallas based think tank National Center for Policy Analysis (NCPA) issued a “William Wallace-esque’ FREEDOM pitch today on his blog entitled Reforming Health Care the Right Way.

This is a man who previously claimed that there are ‘no uninsured’ (from a health insurance point of view) in America; after all Goodman posits that everyone has access to the ER, so what are you complaining about? (paraphrased).

In his blog post today one day after the historic Senate vote to advance the health care bill, Goodman opines on the ‘right’ and ‘wrong’ way to reform US healthcare.

What I find most insightful is his post is the rebuttal comment proferred by Uwe Reinhardt as to the fantasy world this man, and unfortunately many other ideological predisposed converts, apparently inhabit. The health care industry defies over simplification, yet ’sound byte’ disingenuous over-simplification is the prima facie basis on which the ‘anti-reform crowd has stimulated emotive mis-understanding of the nature of the malady as well as it’s appropriate and quite comprehensive remedies.

Enjoy! And your comments are both encouraged and welcome whether pro or con…

Uwe Reinhardt Says:

December 21st, 2009 at 1:12 pm

I hear Richard Branson of Virgin Air is seriously exploring space travel as a commercially feasible project.

Once he has that done, I shall be able to book a flight to the distant planet on which John Goodman lives.

It is the planet on which all physicians always are purely the agent of their patients and do not have any economic conficts of interest — such as making money on tests they prescribe to anxious patients or from referring patients to imaging centers in which they have a state or to collegues with whom they play gold, and so on. Such conflicts of interest do not crop up on John’s planet, not because government forbinds them (there is no government on that planet), but because such conflicts of interest just don’t exist there somehow. Remember: it’s another planet!

On John’s planet it is also easy to have price competition among physicians, because all ill health on that planet can be cured with just one standard, well defined “unit of health care.” What that is I do not know, but John does, because he lives there. He’s probable consumed some, rationally, I wouold assume.

Contrast that with an earthbound hospital charge master with 20,000 itsems in it or the physician fee schedule with 7,000 items in it. How would one make diffenetials in the elements of those huge vectors understandable to patients?

John took on a new religion on that planet to where he actually immigrated — he once lived on earth. On earth he always boldly talked for decades about “Consumer Directed Health Care,” but neither he nor his entire think tanks (the NCPA) every did a stitch of work to help develop the user-friendly price information that patients as “consumers” would need to make rational choices in health care ex ante.

Once on the new planet, John realized that he sinned on earth and swore to do better there. Of course, on his new planet it’s easy: there is only one type of health care and one price. The redemption was a piece of cake.

All people on John’s planet have the same income — in fact, they all have John’s high income and all also have Ph.D.’s. or M.D.s So the problem with poor people not being able to afford high deductibles and therefore stiffing doctors and hospitals for it does not exist on John’s planet. Nor is there a problem with health illiteracry, because everyone on John’s planet has a Ph.D. or M.D. Every patient on John’s planet knows exactly what he or she needs before going to a doctor and simple shops around for a low price.

For the most part, an individual’s need for health care in a coming year on John’s planet is certain and predictable and thus not really insurable. Only the need for about 20% of all health care is stochastic and hence insurable.

On John’s planet, 50% of any large group of people account for 50% of all health spending — 80% of the people account for 80% of all health spending. Here on earth, 20% of the sickest account for 80% of all health spending, and much of that 80% will also be insured. It will be managed by some insurance clerk coming between doctor and patient.

Oh how I long to go to the planet where John Goodman lives, where life is so easy and so simple. I am so tired of the mess here on our planet. Aren’t we all?

Small wonder that John just up and left Mother Earth for a planet where all his theories actually work.

Physician Participation in Social Media – What Up?

On Tuesday, December 8th, 2009 I had the pleasure of speaking with Bryan Vartebedian, MD, a pediatric gastroenterologist, active in the social media space via Twitter @Doctor_V, his personal blog 33Charts.com, and periodic contributor to Get Better Health.

We spoke via Blog Talk Radio on his calling to medicine, pediatrics in particular and more recently his attraction to the social media space. Doctor_V has both interesting and witty insights on the medium. Some of his more recent tweets are noteworthy:

When I mention SM to other physicians they just giggle and look confused

LinkedIn may be a good first step for socially retarded physicians

Social media is the fancy awning that hangs from a building; human interaction is the bricks & mortar (a re-tweet)

For more of ‘Doctor_V’s insight, wit and early ‘do’s and don’ts’ for physicians considering a social media presence, listen in to the full interview here.

The ‘Through-put’ Economy of Money Driven Medicine

OK Tweeps in the movie ‘What the Bleep‘ do we know, the line transitioning to the theme of the flick proffers:

it’s time to get wise.

Well the same holds true with respect to the ‘resistance is futile’ health care borg aka ‘the tapeworm medical industrial complex’ economy. Our health care system is at risk of collapse; with 46 million uninsured, 25 million under-insured, primary care physicians bailing on the system daily, health care premiums sky rocketing, while benefits are being reduced and cost shifted from the plan to the employee. No one is happy with this status quo, quite to the contrary of some public opinion polls that tout we have the ‘best health care system’ in the world!

Surely we have the best high tech or ‘rescue care’ medicine that can be found. But when it comes to the ‘value proposition’ the story gets a little more complicated, and requires a bit more than sound-bytes or political grandstanding to get at the truth.

Money Driven Medicine is a primer for such a rational conversation. If we thought the Senate Finance Committee hearings followed by the debate of Chairman’s mark was exhausting, just wait for what’s in store from the special interests, and their ‘Quack-er’ proxies in the Senate during the impending floor debate of the merged bills.

So why not get current and be a part of the solution? Watch Money Driven Medicine and get WISE!

The Names of the Dead

While the political theater slogs towards it’s ‘battle fatigue’ finale in Washington, D.C., and elswhere in the United States of Amnesia, one American, who also happens to be a politician has decided to approach our health care conundrum in the spirit of the Cluetrain Manifesto and from the footprint of the human experience via a story telling process, i.e., the human narrative.

The name is Congressman Alan Grayson, and the site is Names of the Dead (dot) com. While some will immediately look to party affiliation, and standing with respect to the health reform bills before the Congress to position how they’ll ‘receive’ (or discount via an ideological filter) his message, I encourage you to watch some if not all of the videos.

They are personal stories of Americans who died directly as a result of delayed access to medical care. An empirical basis for the claim that lack of health insurance is associated with mortality is provided in the peer reviewed study Health Insurance and Mortality in US Adults.

The publishing of this report is a timely and top of mind topic, since as a male I am one of the 47 million Americans without health insurance, and a boomer in his 50s, who has occasion to think about the 1 in 6 prospects of prostate cancer in my future. Specifically I have pondered, and have avoided to date, submitting to a PSA test. And yesterday via virtual participation in the TEDMED hashtag stream (#tedmed) I came across a prostate CA piece from theVisualMD dot com, which only further affirmed my fear, and stoked a somewhat borderline despair.

Why ‘borderline’ despair? A few illogical and perhaps ‘magical thinking’ reasons come to mind:

• I am avoiding the test since ‘ignorance is bliss, and I am uninsured?’ Ergo, if I or any lab for that matter doesn’t know, then it can’t be confirmed as a pre-existing condition, right?; and
• If I am a positive, then what? I am not insured and can’t afford the treatment. So county here I come? No thanks, I don’t subscribe to the ‘John Goodman theory’ about the mythology of the uninsured in America.

So my choices are to sit with the 1 in 6 odds and continue as I am, pretending not to be concerned. After all, my history is disease free, and as a health care ‘insider’ I avoid interacting with the health care delivery system as a general rule, staying active and eating healthy for the most part.

Yet, I can’t help but think about those stories that Grayson is sharing with America and asking myself, will I be on the list soon?

So while we debate and more accurately obfuscate the nature of the problem we face vis a vis health reform solutions, people die daily. The ‘dead man walking’ queue witnesses some 122 new recruits each and every day.

The health reform imperative is real tweeps. Unfortunately the dividing line all to often seems to be between those who are employed, and have health insurance (aka, the I got mine crowd) and those who do not; many of whom are employed or self employed but none-the-less locked out of the system due to obscene health care costs or opportunistic underwriting and/or retrospective rescission schemes.

So what’s it going to be peeps? As a society, who will we value and install as the ‘anchor’ tenant in medicine? Will it be (generically speaking) a Mayo model, or the status quo, volume incented, quantity driven series of competitive fee-for-service sweat shops, dba ‘McAllen’s’ (generically speaking of course)?