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Monday, October 1, 2012

Au revoir, FY 2012. Bonjour FY2013

Five weeks and a day to election day (It's Oct. 1st Eastern time as I write this). We could be in for some huge changes. Or not.


The Conservative Case for Obamacare
September 29, 2012

...The core drivers of the health care act are market principles formulated by conservative economists, designed to correct structural flaws in our health insurance system — principles originally embraced by Republicans as a market alternative to the Clinton plan in the early 1990s. The president’s program extends the current health care system — mostly employer-based coverage, administered by commercial health insurers, with care delivered by fee-for-service doctors and hospitals — by removing the biggest obstacles to that system’s functioning like a competitive marketplace.

Chief among these obstacles are market limitations imposed by the problematic nature of health insurance, which requires that younger, healthier people subsidize older, sicker ones. Because such participation is often expensive and always voluntary, millions have simply opted out, a risky bet emboldened by the 24/7 presence of the heavily subsidized emergency room down the street. The health care law forcibly repatriates these gamblers, along with those who cannot afford to participate in a market that ultimately cross-subsidizes their medical misfortunes anyway, when they get sick and show up in that E.R. And it outlaws discrimination against those who want to participate but cannot because of their medical histories. Put aside the considerable legislative detritus of the act, and its aim is clear: to rationalize a dysfunctional health insurance marketplace.

This explains why the health insurance industry has been quietly supporting the plan all along. It levels the playing field and expands the potential market by tens of millions of new customers...

Read the entire piece (link in the title). "The health care law forcibly repatriates these gamblers..." Love that line. JD rocks. Recall "Free Riders"?


An excellent blog post.
What’s the Business Plan for Serving the Poor?
(From the American Hospital Association’s H&HN Daily, September 25, 2012)

Doing more with less. Doing the most for the least.

Seems like the biggest magic trick ever. It’s invisible, people don’t seem to even notice you’re doing it. You do it every day. And every day it gets harder to pull it off. It’s called “serving the underserved.” Helping the poorest, the least reimbursable, the homeless, the undocumented, often the least educated, least compliant, most addicted. Doing it with fewer resources year over year. Doing it in a climate in which the elderly, the poor, even the children of the poor have increasingly become political and cultural punching bags — with you and your institution caught in the middle.

Despite the reform, the tide of the helpless will continue to grow, and the resources to help them will shrink. How will you manage it? You cannot manage the future of your institution without a good answer to that question.

There is an answer, but it doesn’t lie in cutting back, in spreading the same resources more and more thinly. The answer lies in changing the question from How do I scrape by one more year? to How do I own this? How do we get really good at this? What would it look like if we were to become best in the world at this? How do we “make a living” at this?

The answers are paradoxes, but they are happening now. Let’s talk...

Nice. I heard this while in the car.


The light and smells in places like hospitals can often depress us. And, our favorite room at home keeps us sane. But why? Immunologist Esther Sternberg explains the scientific research revealing how physical spaces create stress and make us sick — and how good design can trigger our "brain’s internal pharmacies" and help heal us.

From the transcript:
Ms. Tippett: Gosh. And so you make this observation in your more recent work that physicians and nurses know that a patient's sudden interest in external things is the first sign that healing has begun. And you ask, do our surroundings in turn have an effect on us? And you're part of these new encounters between neuroscience and other kinds of scientists and architecture and people involved in all kinds of spaces, from how hospitals are designed to civic spaces to contemplative spaces. So there's a drama unfolding. There's a cast of characters and there's this whole new body of knowledge. It's really exciting. And one of the milestones in this story that you've talked about is Roger Ulrich's study called "The View from a Window" study of 1984, which was the beginning of one of these pieces of this new puzzle of what you now call environmental psychology.

Ms. Sternberg: Right. Well, so Roger Ulrich is an environmental psychologist who took advantage of a naturalistic experiment, if you will, where in patients were admitted to a ward for gallbladder surgery. Back in those days, you actually stayed in hospital for a number of days after you had gallbladder surgery. And some of them randomly were assigned to beds with a view of a brick wall and others had a view of a grove of trees. And he simply took the clinical data and measured how much pain medication these patients needed during their recovery, how long they had to stay in hospital, in other words, how quickly they healed, the number of negative nurse's notes where they were complaining or had pain or such, and he controlled for everything: age, sex, you know, med — other medication use, other disease use. And all of these patients were taken care of by the same doctors and nurses. So it was an extraordinarily well-controlled study. And even with all these controls where the single variable that differed between patients was the view out the window, what he found was that the patients with a view of a grove of trees left hospital on average a day sooner, needed less pain medication, and had fewer negative nurse's notes than patients who had a view of a brick wall.

Ms. Tippett
: So interesting, yeah.

Ms. Sternberg: Well, and one of the scientists that we interviewed, Irving Biederman, has a great quote where he says, you know, obviously, looking at a view does something positive to the brain. And his hypothesis is that endorphins are released in that part of the brain that recognizes a beautiful or preferred view. And he said, why else would we pay hundreds of dollars more for a hotel room with a beautiful view?

Ms. Tippett
: Right.

Ms. Sternberg: You know, that really tells you that people are willing to put money out to pay for a view.

Ms. Tippett: Yeah, but we don't think of it in terms of this is good for us. We don't even think it that through that much. We just know that's what we want. So let's talk about some different kinds of experiences that, again, we have and maybe things we kind of know without processing. I mean, so I think most people or certainly many people would agree that being in a place of beautiful nature is somehow nourishing, uplifting. You know, people would use different words. That it feels good and is good for us and we often know that we're restored afterwards. So what do you know — what do we know now about what is happening in us physiologically in those experiences?...
Nice interview. About 51 minutes long.

Brings to mind "God's Hotel," which I reviewed some time back.

Also brings to mind the emerging discipline of "Evidence Based Design."

Yeah, I know...

I downloaded two of Dr. Sternberg's Kindle edition books for study.


Just what I need; something else to keep up with. Ahh.h.h...


Health IT firm’s platform for lets nurses use text messages to manage work flow
September 27, 2012 1:39 pm by Stephanie Baum

As the trend of providers adopting smartphones begins to pick up, a health IT and communication company’s platform for iPhones hopes to reduce medical errors by clinical care team members. The Sarasota, Florida company has raised $6 million in a series B round, according to a Form D document filed with the U.S. Securities and Exchange Commission.

Voalte CEO Robert Campbell told MedCity News the investment raised from strategic corporate investors would help the company scale up to meet demand.

“We set out to address [hospitals'] critical communication needs. Traditionally, hospitals are equipped with antiquated communication systems. Even if hospitals are already using smartphones, getting signals can be a big impediment as many medical devices can create electromagnetic interference.”

The platform relies on the providers Wi-Fi system, so Voalte works with companies to update provider’s Wi-Fi coverage. Its platforms for iPhones and iPads and desk-based computers help members of the clinical care team communicate with each other. The smartphone platform integrates phone calls, alarms and alerts. It shows users which clinical care team members are available...

Interesting. Anything that improves work flow is always of interest to me. This vendor has a nice blog here. I'll certainly look at this more closely.

More to come.


Tomorrow. Last Call.

I should also note that two core "attestation" measures,  -- "Drug-Drug/Allergy Interactions," and "Clinical Decision Support  (CDS)" -- have to be enabled for the entire 90-day period. Same for menu set measure "Enable Drug Formulary Functionality."

This question arose among staff at our weekly REC meeting yesterday, and later during the HITRC Adoption and Implementation CoP "Burning Issues" conference call, wherein they decided to forward the question on to the Meaningful Use CoP. 

We've been so focused here in Vegas on helping getting our high maintenance clinics' numerator/denominator measures up to snuff (along with the onerous and unloved Core 15 "PHI Security Risk Analysis and Mitigation") that some of us (mea culpa inclusive) have failed to remember and emphasize that. I've always asked to see if the functionalities cited were "turned on," but have not verified that they were so for the entire period (and, from system to system, userid date-time stamp audit log information availability may be problematic).

David from our SLC REC staff set us straight on that point. Wyatt from SLC also rightly observed that, absent such a requirement, EPs could enable the functionalities in question on Day 89 and "attest," contravening the intent of the measures (though, why they would choose to do that given the ease of setup escapes me).

Verbatim, from the CMS guidance detail:
Core Set Items
  • Clinical Decision Support: Eligible professionals (EPs) must attest YES to having implemented one clinical decision support rule for the length of the reporting period to meet the measure.
  • Implement drug-drug and drug-allergy interaction checks. The EP has enabled this functionality for the entire EHR reporting period.
Menu Set Item
  • Implement drug formulary checks: The EP has enabled this functionality and has access to at least one internal or external formulary for the entire EHR reporting period.  Exclusion: Any EP who writes fewer than 100 prescriptions during the EHR reporting period.
Being Wrong. It sux.

More to come...

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