A Moral Dilema

Posted in Brenda at 9:11 am by livefood

Part two of the series “Health Care in Crisis” is out…and equalling interesting as the first in the series.

Needless Costs, Needless Deaths

As my wife and I are facing four parents in their 80’s, three of the four with declining health and rising medical costs, you can probably guess that I could comment on the stories in the article. I could. I won’t. I’ll let the article do it’s own talking.

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We’re Drifting A Tad

Posted in Brenda at 10:07 am by livefood

I rather feel like an apology is in order. I know it’s my (our) blog and I (we) can write what we want but the originial intent was to write and share about healthcare IT related topics. I (we) have drifted from that topic many times lately. I feel that the trend will continue. I’ll (we’ll) try to keep as centered as possible, but I must admit that for the past several months, the promise of “as possible” seems to be impossible.

The whole HIT concept seems to have been broken down into EMR (and similar acronyms) and related uses…and “all others.” The “all others” incompasses all of the revenue cycle processes, the business processes and communications outside of the EMR realm. The government has placed so much emphasis on the deadlines for Medicare payment/compliance and the infamous “meaningful use,” that many groups have turned from other business process projects and shifted their assets, if only their concentrations and focus, from just about everything and placed the emphasis on thinking about (and that’s about the extent of what they can do), the EMR/government compliance/reimbursement issues.

We are seeing a significant slow down in business for many companies who are not directly in the EMR software business.

We think this is truly an unintended consquence of the government’s push to change healthcare, but unintended or not, the consequence is real.

Many argue that healthcare is too expensive or unavailable to the average citizen. While that may be true, in many ways a complete EMR driven healthcare system may not address some very real cost challenges.

I have an elderly friend in his mid-80s. He has never complained of poor vision or discomforts in his eyes of any sort. He does wear corrective lens to read and do any upclose work, but his daily life has never been negatively impacted by his vision (to my knowledge). His eye care professional recently performed a catarac proceedure on my friend’s “bad eye.” The surgery was perfect and his vision improved. He vision in that eye is now 70/20! That’s wonderful. It was 80/20.

Now the clinic has scheduled the surgery for the other eye. After that surgery he will need new glasses because of the change in the vision. The clinic will receive about $6000 from the insurance companies for the two surgeries. My friend will pay about $650 including the pharma products. What was gained by this process?

If you ask my friend if he can see better now, he will answer, “I think so.” He’s not sure. If you ask him why he had the surgery, he’s not sure of that either.

Kind of sad really. The government and insurance companies have payed for something that really doesn’t seem to have been necessary or have a meaningful benefit. I really want to think that this is a rare exception to the norm, but my gut tells me this is a common situation.

All the wheeling and dealing in Washington will not be changing the costs of the process I just used in this very true story.

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Good Material for a Quick Read

Posted in Brenda at 10:15 am by livefood

I crtainly can not do better than this article:

Health Care in Crisis: How We Got into This Mess

It’s a quick read and made me want to read the next four in the series.

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Possibilities Can Be Opportunities

Posted in Brenda at 2:44 pm by livefood

A shift in the winds of Washington perhaps? The new term is “insurance reform” and we don’t use that old term “healthcare reform.” Well at least the President didn’t use the older verbiage perferring to spin some new words and further confuse more than a few of us.

We have congress trying to push (or is it punch”) legistlation out the door by the end of the month. We have a deadline of 2013 for hospitals and other providers to have jumped on a bandwagon that is still missing critical definition. Major consultancy groups are concerned that those provider groups may find resources to implement their plans if they wait too long. Here in the office we’re finding that a shift to EMR planning (and all fo the related acronyms) has slowed (or halted) the planning and implementation of other “normal” business practice softwares.

It’s quickly becoming evident that the possibility of a stew is being made without a recipe.

It will take some pretty nimble folks to keep alive during these interesting economic times.

We still feel that the solution for survival and growth in the economic revitalizaion that is sure to come is in improving internal metrics, developing new products and services based on core competencies and putting a little bit of “Just Do It” into the business plan. The timing of the “when” of the economic uptick is a huge debatable, but the “if” is without question.

We continue to talk to candidates and client firms about placing themselves in a position that would be favorable at the economy grows.

This morning a read a resume of a candidate who looked a bit interesting in the top part of the document but as I read over the last 6-8 years to about the time it seemed that a college would have been in the time line nothing progressed. The candidate was essentially doing the same thing now as he was doing right after attending college. I can’t help but think that the lack of finishing the degree was hurting the upward mobility. It’s a good time to invest in completing degrees that might be stymieing the career.

While this is one example of something one might do during the economic uncertainties, there are many more. All firms and all individuals should examine the possibilities that might be confronting them. Those possibilities could be fabulous opportunities.

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Some Light Material

Posted in Brenda at 10:42 am by livefood

Every so often I find something that is just plain fun (or funny). So today I share one of those items that I found:

43 weird things said in job interviews

I don’t think people even have to think about making up strange stories about job interviews. It seems as though life certainly is stranger than fiction. Perhaps life is a strange fiction.

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The Moon Walk

Posted in Jim at 2:36 pm by livefood

We owe a lot to the moon landing. More correctly perhaps, we owe a lot to the process that resulted in the moon landing and the discoveries that took place during and after the event. Science rocked our world then and it continues today.


I have to admit that I’m in favor of space exploration. I don’t want to travel in space. To be honest, I don’t like to fly. All right, I don’t like ladders even. While this may be a little TMI, it goes to my point that I support space exploration for reasons other than wanting to fly fast and high.

I love what space folks have brought to me. I love the small and powerful batteries. I love my computers. I really like the miniaturation going on. I love the world view that we can now enjoy. Space brought all this to us.

I can’t really put my arms around what will happened when we target Mars. I think I can dream of a few benefits of aiding other countries to plan and execute space programs. There could be some very big discoveries made when we invite more people to the think tank.

I had the privilege of attending one of the annual guest days at JPL a few years ago. That is a fascinating (and surprisingly small) facility. A year or so prior to the guest day, I was at a banquet where the featured quest was a Project Manager of the first Mars landing…I like the way they think. They are out of the box thinkers. Not what you might expect from a quasi governmental group. They certainly are creative and have to invent much of their technology or technological applications on the fly.

When I look around at the healthcare technology playground and think about how much heathcare and HIT can trace roots to the moon landing project, I am encouraged to think that we might consider continuing the space program so that some 40 and 50 years from now another group of people will be developing new and exciting health initiatives that we can not even conceive, let alone dream of.

Today marks the 40th anniversary of the moon walk. I can remember exactly where I was and what I was doing during the walk. I was at Farragut State Park in Idaho at the 69th National Boy Scout Jamboree. I “saw” the moon walk on a television that was about 12 inches small and projecting the worst, the grainiest, the most black and white picture I can ever remember seeing. Our phones give us better reception and pictures driving down the road than we could get back then.

Thankfully the broadcast was replayed on giant screens during one of our large gatherings in the ampitheater. If you can imagine witnessing that event with some 35,000 other people outdoors on a warm summer evening…it was pretty darn stunning. Of course it didn’t hurt any of us to know that Neil Armstrong is an Eagle Scout.

For most of us, today is just another Monday. It wouldn’t be so bad to just ponder what that moon landing has done for us and what well applied technologies can continue to do for all of us.

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Even The Older Folks Are Connected

Posted in Brenda at 10:03 am by livefood

As reported in July on iheathbeat.org,

“Kaiser surveyed 4,560 Medicare beneficiaries about their:

  • Comfort using computers;
  • Internet habits; and
  • Health status, including chronic conditions and prescriptions.

The survey found that more than 87% of Medicare beneficiaries registered to use Kaiser Permanente’s My Health Manager personal health record are satisfied or very satisfied with the technology.”

I was down at the office of a Church on Friday and listened, once again, to the office manager explain why their web efforts and email efforts have failed, “There aren’t many people in this Church who have email.” They pound the drum more and more and harder and harder so that they can try to be heard over the buzz on the internet all around them.

They don’t get it.

Assumptions can be good and they can be bad, but when assuming connectivity, I think some assumptions can be fairly safe. More people are connected, more people will become connected and more want to be connected in more ways. To think that “There aren’t many people” in this or that segment of the population who are connected to the internet is a bad assumption. The Church has a larger population of medicare eligible folks…and in the heart of Kaiser Kountry. Kaiser could have been surveying the Church.

I as a Kaiser member. I am connected and pretty happy with the what they have done…so far.

Recently I had an MRI on my neck. When I went in for the previously arranged follow-up, there on the screen was the MRI images to review with the Doctor…when I asked about the results of an XRay, he clicked here and there and up pops the images of the hip. It turns out that the neck and the hip have the same challenge. So there I was sitting in facility “D”…with images from facilities, “B and C”…and my primary care physician also had access to the information in location “A.”

Kaiser gets it. Well, at least they are trying.

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Affordability and Availability Are Different Issues

Posted in Jim at 8:46 am by livefood

Not necessarily HIT, but I jumping out of my chair about this.

The big news earlier this week was the announcement yesterday of the House version of the healthcare reform bill. Of course it includes the infamous “government issue” of a national plan. The Congressional Budget Office unfortunately says that only some 11 or 12 million people will be covered by the plan. That’s only 25% of the estimated number of uninsured and only 5% of the population (or so..and in round figures). The GPO also estimates that the plan will be a whopping 10% less than similar private plans.

Take my premiums for example then apply that estimated 10% savings…is $495 a month affordable?

The average wage earner in the USA earns less than $30K. A young (early 30s) friend of mine told me yesterday that she thought that people should only spend about 5% of their salary in healthcare coverage. That would mean a premium of less than $125 per individual.

But my question continues to be, what is affordable? That same family of four with the single wage earner would be paying in excess of 10% of the wages by the time taxes and housing is taken from the wage. Where does affordability enter into the equation?

There is a huge difference between the concepts of availability and affordability. Most Americans have access to healthcare plans but can’t afford them. Making more healthcare available without the affordability component doesn’t solve many issues. Without defining “affordability” first and designing programs to fit that definition, the government is just offering more healthcare, something that is already there…and not addressing the costs.

I see this as being similar to the infamous “Bridge to Nowhere” in Alaska. Congress is compelled to make us feel good as they jump on the healthcare reform bandwagon. They want to build the program regardless of the destination. I really think they should define the destination in real American Dollars and for real American expectations.

The other question that Congress might like to ask, or perhaps they could have Jay Leno ask the question in one of his popular “Jay Walking” experiences is, “Hey Joe the Plumber (yes I know he was a temporary Republican icon, but he was the first name I coule think of), what would be a reasonable and affordable healthcare premium for you?” Don’t ask that question and you won’t have the answer which is critical to affordabiltiy of the program design.

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The $800K Bargain

Posted in Jim at 9:26 am by livefood

I picked this up on HIStalk. It’s a blog about what is happening in Healthcare across the nation. The owner/author is not fond of high priced “C Level” folks. It shows a bit in this piece.

“Hospitals in New York State have readmission rates that are much worse than average. The local hospital association (trade group) blames poverty, but didn’t offer an explanation of why Harlem Hospital Center excels and IT-loaded and $3 million CEO-led Montefiore Medical Center lagged.(I noticed while snooping around Montefiore’s federal records that even its chairman of dentistry makes $1.7 million a year, which seems absurd).”

Our local hospital is paying the new CEO about $800K. It’s a rather big controversy locally, but apparently the Hospital Director see the wage as a bargain in the current climate.

On a few blogs there was some banter about lowering healthcare costs by forcing pharma to bring product to market faster and for the Feds to allow it…and to develop procedures faster or let the Drs. perform more procedures that are currently deemed in the USA but performed in Europe and Asia.

These ideas might work IF the liablilty for the deaths and “other” issues could be taken care of. I would hate to be the firm that brought something new to the market quickly and then something went wrong and the law suit folks came to town (or went to town). Heck in today’s litigeous society, the drug or proceedure won’t even have to do any physical harm…frivilous is easy to get around…just the discomfort of how your friends and neighbors might look at you could create grounds to suit a pharma company or a unfortunate Doctor. Tort has to be addressed.

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22,000 In The Door but How Many Out?

Posted in Jim at 3:20 pm by livefood

I have been seeing a few more reminders that Walmart is going to add on something like 22, 000 new jobs during this next year. That’s really good news. I know, they might not pay the best in the World, but when you are wanting to work, any money is better than no money at the end of the week. I’m pretty sure that the work done on the floor of a normal Walmat wouldn’t appeal to someone graduating with an MBA, but like I said, any paycheck at the end fo the week is better than no paycheck at the end of the week.

I think we’ll see more of the 22,000 new job story as time moves along. Walmart is refocusing their IT departmental functions and moving the work to India. The contract for the out sourceing is millions of dollars in scope…probably offsetting the money gained through the 22,000 retail jobs. Walmart wouldn’t use the 22,000 new job claim to shelter them from the negative PR of sending the higher paying positons off shore would they?

The labor in India is 75% less per hour than the equivalent labor here in the USA. I can’t fault them for their business decision. I just hope they don’t hide from the decision and mask it with the 22,000 lower paying positions, although I think we can all agree that 22,000 new positions is a good thing and any job is better than no job (most of the time).

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