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Saturday, March 30, 2013

Hello from Walnut Creek

LAS-SFO. I would never fly anyone but Virgin domestically were it possible.
Below, the AirTrain station which takes you straight to BART. Shot that one with my iPhone 4s
Above: The view to the west from the hill overlooking Cheryl's place in Walnut Creek.
Winery tucked in the hills. Paradise.

First, courtesy of Soliant Health.

The Dedicated Doctor


Commentary: The litigation and risk-management concerns meaningful use triggers
March 29, 2013 | James M. Hofert, Partner, Hinshaw & Culbertson LLP and Roy M. Bossen, Partner, Hinshaw & Culbertson LLP and Linnea L Schramm, Associate, Hinshaw & Culbertson LLP and Michael A. Dowell, Partner, Hinshaw & Culbertson LLP

New federal healthcare legislation and implementing regulations seek to exert control over aspects of patient care, from outlining the substantive information that healthcare providers should obtain from their patients to specification of treatment algorithms a physician should consider once a diagnosis is made.

Meaningful use standards require healthcare providers to affirmatively act to identify potential future health risks in patients seen for unrelated health conditions. New regulations also require continued patient follow-up after discharge from care to ensure compliance with care directives. The regulations reflect laudable goals but create significant potential risk for malpractice claims for unwary healthcare providers.

Thus far, great concern has been expressed as it relates to physician and institutional liability if information systems are hacked or if cloud-based products are illegally accessed. CHIME noted that there are significant program issues relating to system interfaces so as to allow communication of EHR between physicians and other institutions. Multiple industry associations have suggested that implementation of Stage 3 be delayed by up to two years to allow for evaluation of the impact of Stages 1 and 2 on the healthcare system.
The emphasis that has been placed on the adoption of information technology in the healthcare field in the last several years, meanwhile, generates potential legal and risk management concerns. As the requirements for acceptable EHR systems evolve, so do relevant common law standards of care. The rapidity with which healthcare institutions must develop and implement EHR systems to meet “meaningful use” criteria presents significant risk for malpractice claims.

Initial transition from paper to electronic record systems can create risk of: implementation errors (software issues); inadequate training issues; incorrect or inconsistent use; and individual mistakes in the creation of the electronic record. The use of both paper and electronic records may create documentation gaps leading to misdiagnosis and inappropriate treatment. Procedures must be developed for confronting problems in the implementation of electronic recordkeeping. Consistent standardized use of developing electronic systems is imperative.

Meaningful use requirements relating to the need to document and treat a patient’s future health risks creates a gray area as to what, if any, responsibility institutions and physicians have in evaluating patients for potential health issues unrelated to the reason for hospital admission and/or treatment. Regulatory requirements relating to coordination of post-hospital care creates obligations to provide services in a reasonable manner, including follow-up where provider/patient communication potentially becomes a significant problem.

The use of electronic communication systems to diagnose and treat patients remotely creates a potential malpractice risk. There is a clear risk of misdiagnosis associated with remote treatment. There is also litigation risk in relation to the failure to properly follow-up...
Reading things like this inevitably takes me "Back Down in the Weeds'."

Individual variation is perceived as normal when occurring in faces and physiques. In physiology and pathology, variation is equally normal and pervasive. Yet, it is often perceived as abnormal, or is not perceived at all. The reason is that medical knowledge about physiology and pathology is usually expressed as rough generalizations about large populations. Knowledge expressed in that form is more easily recalled and processed by the unaided mind than detailed data about unique individual variations. As a result, these more detailed data are less likely to be incorporated in the body of medical knowledge (that is, less likely to be published or otherwise made generally available). Even when thus incorporated in medical knowledge, detailed information about unique individual cases is less likely to be taken into account by practitioners, because their unaided minds cannot quickly comb through the medical literature. In the Addison’s disease case, for example, none of the multiple practitioners who commented on their patient’s deeply pigmented nevi were aware of an article on a Addison’s disease patient in Denmark with nevi of similar appearance (see note 10 above). (It is unknown how frequently Addison’s disease manifests itself with this form of hyperpigmentation, in part because medical records do not reliably record such data, in part because records are not maintained in a structured electronic form accessible to researchers, and in part because Addison’s disease sometimes occurs without ever being diagnosed.)

In short, the unaided mind naturally turns to population-based medical knowledge. Yet that knowledge falls far short of what is needed for the care of unique individuals. The more individualized knowledge that patients need is either unknown or not accessible. This shortfall is most critical at the outset of care. As the case study observes, clinicians usually begin diagnostic investigation by considering first population-based knowledge of what diagnose are “most common.” (Thus the aphorism among physicians—”when you hear hoof beats, think horses, not zebras.”) Yet, this approach is fraught with risk, because it may divert attention from the diagnostic possibilities most applicable to the individual patient. In the case study, for example, Addison’s disease, a rare condition, “did not make the list [of diagnoses to consider] until it was nearly too late to save the child’s life.” Whether a disease is common or rare depends on the context. (Thus the aphorism among physicians might become, in central Africa, “when you hear hoof beats, think zebras, not horses.”). In the general population, Addison’s disease is indeed rare. But in the tiny subpopulation of patients with a combination of findings like fatigue, hypotension, weight loss, abnormal pigmentation, dehydration, nausea, and abdominal pain, Addison’s disease is common (perhaps almost universal). People with this pattern of findings are not identified as a subpopulation in the medical literature and thus do not fit into the usual “evidence-based” mode of analysis.

As applied to individuals, knowledge about large populations is useless, indeed misleading, until other, more individually applicable knowledge is first taken into account. Yet, this other, individualized knowledge is not made readily accessible. Even more disturbing is the health care establishment’s response to this dilemma. Physicians are increasingly expected to apply knowledge derived from large population studies and clinical trials. Referred to as “evidence-based medicine,” a better label for this approach would be “evidence-missed medicine,” because it systematically excludes the individualized knowledge and data essential to patient care. Yet, “so-called evidence-based medicine is rapidly becoming the canon in many hospitals,” Dr. Jerome Groopman observes. “Treatments outside the statistically proven are considered taboo until a sufficient body of data can be collected from clinical trials.”

Evidence-based medicine is rightly intended to prevent physicians from following arbitrary local practices and unsupported personal judgments. But that goal can only be achieved by meticulous accounting for individualized information. Absence of that basic standard of care explains the delayed diagnosis in the Addison’s disease case and much of the health care system’s dysfunction. [Medicine in Denial, pp. 23-25]
Ponder the aggregate ramifications of all the the foregoing. The difficulties attending other fields pale in comparison.


Few manpower specialists have noted the cohort effect likely to manifest itself shortly. A continued economic recovery and, more importantly, a recovery in retirement plan and medical real estate asset values will lead as many as 100,000 physicians of all stripes to leave practice in the next few years. We will be replacing a generation of workaholic, 70-hour-a-week baby boom physicians with Gen Y physicians with a revealed preference for 35-hour work weeks. During this same period, we’ll be adding 1.5-1.7 million net new Medicare beneficiaries a year and enfranchising perhaps 25 million newly insured folks through health reform. “Train wreck” is the right descriptor of the emerging primary care supply situation...

Electronic health records. Green’s optimism about the potential productivity improvements from electronic health records might also be misplaced. Despite, or perhaps because of, the pressure from meaningful use to automate office practices, physician offices added 162,000 workers from 2007 to 2011, even with a 10 percent shrinkage of visit volume. Many of these new hires were medical secretaries, physician assistants, and the like.

If there are productivity offsets for practicing physicians from automating medical records, they are hard to detect. Most physicians I’ve talked to about their EMR conversions are spending less time with patients and more time feeding their EMRs coding information and complying with new Medicare documentation requirements.   The result: richer coding and more dollars from fewer patients. Unless documentation requirements are reduced, it is not clear that the EMR will actually make it easier for physicians, or other clinicians for that matter, to see more patients...
Nice article.

April 1, 2013 at 5:45 pm
sara jennings, phd says:

Doctors have become window washers for the HIT vendors, insurance executives, and hospital CEOs. The intrusions and manipulation of medical care to enable the building of their fortunes and greed is despicable. The CPOE and CDS machines make life nasty for doctors and serve no meaningful beneficial purpose, except, perhaps, for a chimp.

More to come...

Tuesday, March 26, 2013

HIT, meet HIX

Robert Laszewski provides a cautionary tale on THCB:
A $910 Million Price Tag For California Exchange: A Dark Omen of Things to Come

So far California has received $910 million in federal grants to launch its new health insurance exchange under the Affordable Care Act (“Obamacare”).

The California exchange, “Covered California,” has so far awarded a $183 million contract to Accenture to build the website, enrollment, and eligibility system and another $174 million to operate the exchange for four years...

For some additional perspective I took a look at what it cost to launch the private insurance marketing site, Esurance. That company sells not only health insurance but also things like homeowners and auto insurance across the country. When I put my zip code into their system along with my age, they offered me 87 different health plans from all the big players in my area. Now granted, the new health insurance exchanges are more complex because they have to interface with Medicaid and the IRS as well as calculate subsidies. But the order of magnitude difference in what it cost to launch esurance compared to the California exchange is pretty big.

Privately funded Esurance began its multi-product national web business in 1998 with an initial $5.5 million round of venture fund investment in 1999 and a second round of $34 million a few months later.

The start-up experience of other major web companies is also instructive. Facebook received $13.7 million to launch in 2005. eBay was founded in 1995 and received its first venture money in 1997––$6.7 million in 1997...

The California Exchange officials also say they need 20,000 part time enrollers to get everybody signed up––paying them $58 for each application. Having that many people out in the market creates quality control issues particularly when these people will be handling personal information like address, birth date, and social security number...
 In that last paragraph: "these people will be handling personal information like address, birth date, and social security number."

Why not just tattoo "defraud me, PLEASE!" on the foreheads of these California HIX officials? What's a Name + Address + DoB + SSN combo worth on the street these days? Hint: upwards of $1,000, by some estimates.

Expect to see an upsurge in "private sector innovation," to be sure.

Pass the popcorn.

Six Months Out Health Plan Execs Say They Doubt Exchanges Will Be Ready

As the Obama administration continues its top secret effort to build federal insurance exchanges in about 34 states while 16 states are doing it on their own, that continues to be the big question.

HHS is using IT consulting firm CGI for much of the work on the exchanges and the federal data hub. CGI has their plate full since they are not only working on the federal exchange but also doing work for the state exchanges in at least Colorado, Vermont, and Hawaii...
And my state, Nevada. They do not particularly inspire confidence.


Changing topics: news of concern on the privacy front:
Mobile location data 'present anonymity risk'
By Jason Palmer, Science and technology reporter, BBC News

Scientists say it is remarkably easy to identify a mobile phone user from just a few pieces of location information.

Whenever a phone is switched on, its connection to the network means its position and movement can be plotted.

This data is given anonymously to third parties, both to drive services for the user and to target advertisements.

But a study in Scientific Reports warns that human mobility patterns are so predictable it is possible to identify a user from only four data points.

The growing ubiquity of mobile phones and smartphone applications has ushered in an era in which tremendous amounts of user data have become available to the companies that operate and distribute them - sometimes released publicly as "anonymised" or aggregated data sets.

These data are of extraordinary value to advertisers and service providers, but also for example to those who plan shopping centres, allocate emergency services, and a new generation of social scientists.

Yet the spread and development of "location services" has outpaced the development of a clear understanding of how location data impact users' privacy and anonymity...
Four data points? The PII re-identifying work of Harvard Professor and ONC HIT Policy Committee member Dr. Latanya Sweeney comes to mind.

In other news...

International Federation of Health Plans
2012 Comparative Price Report
Variation in Medical and Hospital Prices by Country
This year’s survey includes new prescription drug prices in response to increased interest in this area from plans in many countries. We have also added three new non-drug items to our survey: hip prosthesis, knee replacement, and colonoscopy. Prices for each country are submitted by participating federation member plans, and are drawn from different sectors:

• Prices for Canada, New Zealand, Switzerland, and the United Kingdom are from the public sector, with data provided by one health plan in each country.

• Prices for Australia, Chile, the Netherlands, Spain, and South Africa are from the private sector and represent prices paid by one private health plan in each country.

• Prices for France and Argentina are a blend of public and private sector prices with the data provided by one health plan in each country.

• Prices for the United States are calculated from a database with over 100 million paid claims that reflect prices negotiated between thousands of providers and almost a hundred health plans. 

Comparisons across different countries are complicated by differences in sectors, fee schedules, and systems. In addition, for some countries a single plan’s prices are real for that plan but may not be representative of prices paid by other plans in that market. The U.S. numbers are based on an aggregate of over a 100 million paid claims across multiple payers.
I post here just four from the larger deck of slides (pdf). You get the point. The U.S. is clearly the Undisputed Runaway Number One -- in terms of cost.

Yeah. But, let the reflexive angry chorus loudly ensue -- clamoring that the U.S. in fact has "the best health care system in the world" (facts and cogent data notwithstanding), and that these internationals are nothing more than a bunch of America-hating Socialists trying to tear us down.

Re-read that Commie Steven Brill, perhaps: "Bitter Pill: Why Medical Bills Are Killing Us."

What do I know? "It's Out Of Your Scope."
NY Times "Room for Debate," March 26th
Re-engineering Health Care

Nice series. See what you think.

apropos of quality in medicine...

Evidence Thresholds
Published by Steven Novella under Homeopathy,Science and Medicine

Defenders of science-based medicine are often confronted with the question (challenge, really) – what would it take to convince you that “my sacred cow treatment” works? The challenge contains a thinly veiled accusation – no amount of evidence would convince you because you are a nasty skeptic.

There is a threshold of evidence that would convince me of just about anything, however. In fact, I have been convinced that many scientific claims are likely to be true – sufficiently convinced to act upon the conclusion that they are true. In medicine this means that I am convinced enough to use them as a basis for medical practice...

Is it time for a meaningful use time out?
March 27, 2013 | Jeff Rowe, Editor, EHRWatch

Nearly 50 percent of HITECH funds have been paid out, and policymakers are gearing up for meaningful use Stage 3. So is it time yell “Stop!” and assess the health IT landscape?

According to one doctor, it is. Describing himself as “a ‘geek’ physician who runs a solo, private practice and the creator of one of the older EMRs,” he claims the enthusiasm for health IT is based on largely unsubstantiated claims.

He makes two main arguments. First, “Many HIT proponents justify their promotion of HIT via analogy. They posit that just as the incorporation of information technology (IT) improved the productivity and efficiencies in many industries, they contend the widespread implementation of HIT will result in many benefits to society at large. While I acknowledge that well designed HIT systems can help physicians/hospitals run their businesses more efficiently, there is no scientific evidence to conclude that this will translate into a reduction in the cost of healthcare.”...
This is a recurrent assertion of late. "No scientific evidence"? Yeah, let's have 20 more years of "analysis paralysis," that'll be much better.

EHR incentive funds often reinvested in IT
March 26, 2013 | Paul Cerrato - Contributing Writer
With no federal rules telling providers how they can spend their meaningful use (MU) incentive checks, practices and hospitals have their options wide open. While many are investing in more technology, that’s only the tip of the proverbial iceberg.

Acacia Internal Medicine Specialists in Phoenix, for example, has used part of its check to invest in a community room to hold wellness classes, and to hire a tai chi teacher. But the prevailing trend is to use the money to fund more IT growth and pay down debt incurred while putting in the software and hardware needed to qualify for MU in the first place.

“Most of our clients are considering the incentive funds paid as an offset for funds they are spending in advance to qualify for meaningful use and to pay for anything additional they will require to meet Stages 2 and 3,” wrote a member of a hospital technology group on LinkedIn in a discussion about how hospitals will use their MU dollars...

A recent analysis reported in Health Affairs came to the conclusion that EHRs are a money-losing proposition for most physicians. Julia Adler-Milstein, PhD, from the University of Michigan in Ann Arbor, and her associates, surveyed 49 community practices and projected that the average doctor “would lose $43,743 over five years; just 27 percent of practices would have achieved a positive return on investment; and only an additional 14 percent of practices would have come out ahead had they received the $44,000 federal meaningful-use incentive.”
My first Nevada MU attesting doc had to sell his practice to a hospital system within about 5 months. He made CNN Business over that unhappy outcome.


Lynn Bennett of sent me a nice email shout-out and heads-up a short while ago.
Today I came across your blog and must say that the informative content of your blog is worth reading. I enjoy your blog, and would love to share our infographic “10 Potentially Devastating Public Health Threats” with you. If you find it relevant, I hope you will consider it for posting at your blog or sharing with your readers through social media channels. Please let me know if you are interested.

Very nice. Wonder how "interexhangeable" Health IT can help here? Some things are already in play, e.g., Rx abuse mitigation via e-Prescribing and HIE, better coordination of care for the difficult Chronics like DM, HTN, obesity, dementia, and sentinel capability for syndromic surveillance, etc.

Can't find out much about this company (if it even is a real "company"). WHOIS search doesn't provide much, and their website doesn't have any "About Us" links. Bit of a yellow flag there. Maybe Lynn can clear that up for me (i.e., that this is not simply some front out there fishing for "public health program students" and getting paid by the sign-up. Stay tuned.

More to come...

Wednesday, March 20, 2013

Figliozzi strikes again


REC Blog Milestone, March 22nd, 7:50 a.m. PST

Thanks, everyone.

Meaningful Use Audits Delay Payment of Some EHR Bonuses
By Sheri Porter

Posted: 3/19/2013, 12:05 p.m. -- Some family physicians who have purchased and implemented an electronic health record (EHR) system and attested to meaningful use of that EHR may be subjected to an audit before they see a bonus check. That's the word from CMS' Office of E-Health Standards and Services.

This most recent round of audits, dubbed "prepayment audits," is in addition to postpayment meaningful use audits that were initiated in the summer of 2012.

According to Elizabeth Holland, director of CMS' Health IT Initiative Group (a department overseen by the e-health standards office), between 5 percent and 10 percent of all eligible professionals attesting for meaningful use will be selected for prepayment audits...

  • As many as 10 percent of physicians and other health care professionals who attested to EHR meaningful use may be selected for a prepayment audit of their application.
  • Physicians who receive an audit letter from Figliozzi & Co. should respond immediately to prevent further delays in payment.
  • Not all physicians waiting for bonus checks are stuck in the audit queue; their payments likely still are being processed by CMS.
HHS had pushed back in this idea, but they ultimately caved to the anti- MU political pressure. Wonder what the quid pro quo was on the Hill over this (if any)? "Leave our Incentive Money alone and we'll agree to your silly additional desk audits"?

There's been some grousing among physicians subjected to the post-payment audits that these Figliozzi cookbook-following auditors are clueless about Health IT and clinical operations (they're an accounting firm, after all).


Clinical Decision-Making Part III
Published by Steven Novella under Science and Medicine

In part I of this series I discussed clinical pathways – how clinicians approach problems and the role of diagnosis in this approach. In part II I discussed the thought processes involved in deciding which diagnostic tests are worth ordering.

In this post I will discuss some of the logical fallacies and heuristics that tend to bias and distort clinical reasoning. Many of these cognitive pitfalls apply to patients as well as clinicians... is a required top-of-the-morning daily stop for me.


An email blast I sent around the office.

FYI, everyone… just what I need: yet another book to read in my Kindle Cognitive Crack Pipe. The subtitle speaks directly to what must be done in health care ops. I am gonna be all over this stuff.


In my book KAIZEN: The Key to Japan’s Competitive Success (McGraw-Hill, 1986), I ended with the following words:

It is my sincere hope that we will be able to overcome our “primitive” state and that the KAIZEN strategy will eventually find application not only in the business community, but also in all institutions and societies all over the world.

Looking back over the last 25 years since its publication, I am profoundly frustrated with the slow pace at which Kaizen strategy has been embraced by the business community. On the other hand, I am encouraged to note that Kaizen is rapidly gaining momentum in the non-manufacturing institutions like healthcare, services, and government.

I believe that Kaizen is essentially a “human business.” Management must meet the diversified requirements of its employees, customers, stakeholders, suppliers, and its community. In this sense, the healthcare profession can probably best benefit from Kaizen because its central task is people. I am honored to write a foreword to this book by Mark Graban and Joseph Swartz.

Taking this opportunity, I wish to mention a few reminders for successfully embracing the Kaizen strategy.

1. Embracing Kaizen is a long-term journey. It is not a flavor of the month and requires the cultural change, commitment, and self-discipline that needs to be sustained over many decades until they become routine business practices.

2. Top management commitment is the only way to successfully embrace Kaizen, without which nothing else you do will matter.

3. We need to approach our daily business in two phases. One is to maintain the status quo, in which the standard (the best way to do the job) is established and followed. This process is called maintenance and requires dedicated management effort to sustain it, but it is often overlooked or belittled. The second phase is Kaizen, which means to find a better way and revise the current standard. Thus, maintaining and improving the standard becomes the main task of management.

4. My definition of Lean is to employ minimum resources for the maximum benefits. Therefore, Kaizen leads to Lean, and Lean leads to green. Kaizen is the most environmentally friendly approach.

5. Welcome problems. The more problems, the better, because we have more Kaizen opportunities. We only need to establish priorities in dealing with problems. When the problem is correctly identified, the project is halfway successful.

6. One of the best ways to identify problems is to observe the flow of operations. In the medical institutions, there are many types of flows, such as information, physical movement of patients and families, medicines, and supplies. Wherever and whenever the flow is disrupted, there is a Kaizen opportunity.

7. A majority of disruptions of the flow can be easily detected and solved with common sense and do not require sophisticated technologies. 8. Remove the barriers between professionals and laymen. I sincerely hope that you will find your Kaizen journey to be challenging, but most rewarding.

Masaaki Imai, Chairman, Kaizen Institute

Mark; Graban (2012-07-03). Healthcare Kaizen: Engaging Front-Line Staff in Sustainable Continuous Improvements (Kindle Locations 643-644). Taylor & Francis. Kindle Edition.



In healthcare, enormous investments are made in things like buildings, technology, and pharmaceutical development, but little is spent to tap into the creativity of every single healthcare provider and professional. Yes, the new machine or new drug might do wonders, but people like Mark and Joe, the coauthors of this book, are demonstrating there is a much greater opportunity for improvements by enlisting everyone in the healthcare community to identify and solve problems. For example, Baptist Hospital in Pensacola was rated lowest in the state of Florida until they started asking for small improvement ideas from their staff. They became number one in the state and also received, in 2003, the coveted Malcolm Baldrige National Quality Award.

The person doing the job in healthcare, as in any industry, has great knowledge about their work, but they are rarely asked to look around their work area to identify small problems and to implement solutions to those problems. As you go through this book, you will see numerous examples of improvements made by many different people. Each Kaizen might only save a few dollars, but collectively they add up to millions of dollars in savings for an organization, and billions for a state or country. As you will see from this wonderful book, the process is quick to implement and easy to get people involved in. But even more important than the dollars saved are the improvements in communication and coordination that result when everyone is involved in the Kaizen process, leading to fewer errors, improved patient safety, higher quality, and lives saved…

Mark; Graban (2012-07-03). Healthcare Kaizen: Engaging Front-Line Staff in Sustainable Continuous Improvements (Kindle Locations 646-657). Taylor & Francis. Kindle Edition.
From one of my pptx decks several years ago.



By Amy Langfield, TODAY contributor

CVS Caremark has put its employees on notice that they need to reveal their weight or pay a monthly $50 penalty.

“Avoid the $600 annual surcharge,” CVS warns its employees who use the company’s health insurance plan. They’ve been told they are required by May 1 to show up to a doctor for an annual WebMD Wellness Review and submit to tests for blood sugar, blood pressure, cholesterol and body mass and body weight.

“Going forward, you'll be expected not just to know your numbers - but also to take action to manage them,” the CVS policy states.
“There are no penalties based on the results of a wellness screening,” a CVS spokesman told NBCNews via email. “Choosing not to have a screening will result in a $50/month increase.

While many employers have been pushing its workers to get healthier, it’s usually through incentives rather than penalties. “This is about as coercive and blunt as I’ve ever seen,” said Dr. Deborah C. Peel, the founder of Patient Privacy Rights, a nonprofit organization based in Austin, Texas.

“Many employers want to do something for their workers, but very few of them are stupid enough to say give us the information and sign this form and say it’s voluntary,” Peel said.
Smokers working for CVS are also warned: “You must either be tobacco-free by May 1, 2014, or participate in the WebMD tobacco cessation program.” Defiant smokers can avoid penalties if they are healthy enough in other categories specified by the company.

Despite the company’s promises, Peel worries if CVS and WebMD will be able to keep the employee records completely private. Peel said people are already declining to get health treatment for issues ranging from psychiatry to sexual diseases, for fear the information will not be kept private...

Expect to see more of this ongoing. And, you can expect to never again see me in a CVS (I use Walgreens in any event).

UPDATE: I was just surfing through the week's "missed called / messages" stuff on my home phone hard line base unit answering machine.

Well, isn't that interesting? Some industrious CVS Caremark gumshoe dug out my unlisted private home number. Couldn't get any of my old messages to play, so I don't know what this was about. Am I about to be threatened? Or just get some soothing PR flack pitch "clarifying" the "misunderstanding" about the new CVS employee policy. Hmmm...

Call me back, Caremark.



Goes to...

ATHN Achieves High Attestation
by Zacks Equity Research

Leading vendor of cloud-based services for physician practices - Athenahealth ( ATHN - Analyst Report ) recently revealed that 96% of its concerned providers were successful in meeting the attestation requirements of 2012 Medicare Meaningful Use Stage 1, Year 1. The company’s performance in 2012 leverages on the 85% achieved with regard to 2011 Medicare Meaningful Use Stage 1, Year 1. It is also twice as successful as the industry-wide mean in the low 40% range...

Moving right along...

Dr. Scott Setzer knew when he chose to become a family doctor, he wasn’t going to make the money a specialist would, but that was OK.

He didn’t go into medicine to make money –although, of course, that would be nice.

Mainly he just loved the idea of building relationships with people in a way that could really make a difference in their health and quality of life.

But in his traditional practice, he started seeing the business aspects interfering more and more.

“I found myself spending a disproportionate amount of time on billing and coding, arguing with insurance companies over why I prescribed the drug I did rather than a cheaper one, trying to demonstrate ‘meaningful use’ of electronic patient records in order to receive an incentive,” said Setzer, who said he has watched the nature of primary care change since he began practicing here in 1997.

As Setzer experience first-hand, the business side of doctoring is changing. The number of solo practitioners who are members of the American Academy of Family Physicians fell from 44 percent in 1986 to 18 percent in 2008...
See also
Private practice wanes, physician employment shifts due to MU rules

As the meaningful use rules grow more stringent and Medicare and Medicaid payment reductions loom, many doctors are making the decision to give up their privately owned practice rather than continue dealing with the electronic health record guidelines.

The trend of physicians opting for employment over practice ownership is not necessarily new. Medicare and Medicaid payment reductions that took place over the last couple decades made running the business side of a practice difficult for some doctors. More recently, aspects of health reform and the weak economy made physician employment at hospitals a more secure option for some doctors. But the meaningful use rules, which set the bar high in terms of EHR use for some doctors, are increasingly being seen as the last straw that makes operating a private practice financial untenable.

"Most [private practice owners] flat out do not have the ability to do this," said Travis Singleton, senior vice president at Merritt Hawkins, a Dallas-based physician recruitment firm, referring to the meaningful use requirements. "They're going to have to seek a larger partner; even the ones that want to just can't."...
Robert Smith, M.D., founder of Finger Lakes Family Care in Canandaigua, N.Y., likes his EHR system.

At this point, Smith said his EHR system makes him more efficient in the delivery of care, allowing him to operate with a smaller administrative staff, which limits overhead expenses. But it wasn't always easy. When the practice first started using its EHR system staff took longer to enter patient information, a problem that is commonly reported by recent EHR adopters. Smith said his practice was small at the time, but believes larger practices with more patients would struggle more to overcome the workflow disruption.

While enthusiastic about EHR adoption, Smith is no fan of the meaningful use program. He said the guidelines of the incentive program do little to support the efficiency of his practice. Ultimately it is the technology itself that does that. Nevertheless, he is following the rules, which he described as "silly," and is receiving incentive payments.
"Is the banking industry using paper anymore? Of course not," Smith said. "They're not getting kickbacks from the government. Meaningful use to me is just a silly windfall. It's not persuading me to use an electronic record."...
"Silly windfall"? Dunno. What do you think? Schtimulus Been Berry Gooood to Mr. Bush.

Centers for Medicare & Medicaid Services (CMS) Focuses on Fraud Associated with Increased Use of Electronic Health Records
Thomas S. Crane, Mintz, Levin, Cohn, Ferris, Glovsky and Popeo, P.C.

Acting CMS Administrator, Marilyn Tavenner, recently reaffirmed the agency’s concern that the increased use of electronic health records (“EHRs”) has contributed to increases in fraudulent billing practices by providers. At a March 5th meeting of the Federation of American Hospitals (“FAH”), Tavenner noted an increase in upcoding from physician offices and hospital emergency departments, and expressed concern that the increased use of EHR systems may be the cause. She reiterated that CMS will conduct audits of providers’ billing practices using EHR systems. These “small, targeted audits” will take place in parallel with the meaningful use audit program that started in July 2012 and which is designed to determine whether providers are properly receiving meaningful use incentive payments and complying with program rules. On March 6th, Tavenner also spoke before the Healthcare Information and Management Systems Society Annual Conference and announced a CMS summit in May with providers and EHR vendors to further discuss and address potential upcoding in connection with the use of EHRs...
More of the same, re-reporting on what we've already heard. Yeah, we'll see. A lot of this may be for show, to mollify the Righties on The Hill.

Question: If an REC client EP gets audited and is found to have not actually met all of the MU criteria, would the REC be liable for returning its Milestone 3 money?

So God Made a Quality Manager

LOL. Sounds like my Sweetie. She who has ascended through the myriad Purgatories of the Quality Manager to now Sit, with her pink hard hat at the ready, at The Right Hand of the CEO Father.

Another nice "video"


Very well done. To the point.Great overview. The v/o talent is just a hair too perfect for my taste (diction, pronunciation, cadence), but, better that than Amateur Hour.

More to come...

Sunday, March 17, 2013

Health data flowing "at the speed of trust"

"[I]n 2012, [Dr. Farzard] Mostashari [ONC Director] predicted interoperability and data exchange would be the 'second and more complex challenge,' following meaningful use. The emphasis, he said, will be on containing the costs and reducing the risks and liability of exchanging health data: information 'will flow at the speed of trust.'"

The Internet is a surveillance state
By Bruce Schneier, Special to CNN
updated 11:39 AM EDT, Sat March 16, 2013

...The Internet is a surveillance state. Whether we admit it to ourselves or not, and whether we like it or not, we're being tracked all the time. Google tracks us, both on its pages and on other pages it has access to. Facebook does the same; it even tracks non-Facebook users. Apple tracks us on our iPhones and iPads. One reporter used a tool called Collusion to track who was tracking him; 105 companies tracked his Internet use during one 36-hour period.

Increasingly, what we do on the Internet is being combined with other data about us ... Everything we do now involves computers, and computers produce data as a natural by-product. Everything is now being saved and correlated, and many big-data companies make money by building up intimate profiles of our lives from a variety of sources.

Facebook, for example, correlates your online behavior with your purchasing habits offline. And there's more. There's location data from your cell phone, there's a record of your movements from closed-circuit TVs.

This is ubiquitous surveillance: All of us being watched, all the time, and that data being stored forever. This is what a surveillance state looks like, and it's efficient beyond the wildest dreams of George Orwell...

Maintaining privacy on the Internet is nearly impossible. If you forget even once to enable your protections, or click on the wrong link, or type the wrong thing, and you've permanently attached your name to whatever anonymous service you're using. Monsegur slipped up once, and the FBI got him. If the director of the CIA can't maintain his privacy on the Internet, we've got no hope.

In today's world, governments and corporations are working together to keep things that way. Governments are happy to use the data corporations collect -- occasionally demanding that they collect more and save it longer -- to spy on us. And corporations are happy to buy data from governments. Together the powerful spy on the powerless, and they're not going to give up their positions of power, despite what the people want.

So, we're done. Welcome to a world where Google knows exactly what sort of porn you all like, and more about your interests than your spouse does. Welcome to a world where your cell phone company knows exactly where you are all the time. Welcome to the end of private conversations, because increasingly your conversations are conducted by e-mail, text, or social networking sites.

And welcome to a world where all of this, and everything else that you do or is done on a computer, is saved, correlated, studied, passed around from company to company without your knowledge or consent; and where the government accesses it at will without a warrant.

Welcome to an Internet without privacy, and we've ended up here with hardly a fight.

Read all of it (link in the title). What, you might ask, does that have to do health "PHI" (Protected Health Information).

Thursday, March 14, 2013
Google Fined for Intercepting Health Data, Other Information

On Tuesday, Google agreed to a multistate settlement acknowledging that it violated individuals' privacy by collecting electronic medical data and other information during its Street View mapping project, the New York Times reports.
Google will pay a $7 million fine as part of the agreement, which settles a case brought against the company by 38 states.
Details of Google's Data Collection
The case stemmed from Google's Street View mapping project, in which the company deployed specially-engineered vehicles to photograph houses and businesses on streets around the world.
The Times reports that during the Street View trips, Google also collected personal data from millions of unencrypted wireless networks (Streitfeld, New York Times, 3/12).
The information was collected between 2008 and March 2010 when a Google Street View vehicle passed by an area where information was being transmitted to or from a Web user inside a house or business (Dolmetsch, Bloomberg, 3/13).
Some of the data collected were:
  • Emails;
  • Electronic health records; and
  • Financial records.
$7 million? That'll teach 'em a lesson.

Right. Google probably spends that much every month on maseusses for their employees.

Insufficiently concerned yet? See
March 14, 2013 · by Edward Champion

Google Glass is a snazzy set of specs that will part the Red Sea if you tap it from the right angle. It aims to fuse smartphones and computers into a hands-free user experience more pleasurable than sex, religion, and world domination combined.

Glass is not yet on the market, but the news of its existence cut a hew through Mountain View with the strident fife of an unpaid piper wooing unsuspecting kids into a dark cave. It inspired Google co-founder Sergey Brin to publicly announce that he felt less male with the thick tools that came before. Some wondered why Brin didn’t just hold hard to his smartphone and slam down shots every Friday night like the rest of America. But when your net worth is $23 billion, different rules apply...

I put forth the modest proposition that Google Glass, conjured and constructed and conceived only in terms of “cool” and propped up by ostensible “journalists” who have never thought to question Mr. Brin’s brilliant PR, could pose more problems to our world than any digital invention we have seen in some time. Contrary to Mr. Brin’s suggestions, his device will not “free” us. It will quite possibly destroy several vital qualities of life we now take for granted, preying upon kind and decent and hardworking people who are still playing pickup from an economic blitzkrieg in which they had no power, little hope, and no control. One would think that a man born in Moscow under Brezhnev would grasp the cruel irony of being directly responsible for an entirely new set of encroachments upon freedom and human possibility. On the other hand, great hills of money often move mountains in other ranges...
It gives Google far more personal information than it needs to know.
According to Google’s privacy policy, this is what Google now collects from you:

  • details of how you used our service, such as your search queries
  • telephony log information like your phone number, calling-party number, forwarding numbers, time and date of calls, duration of calls, SMS routing information and types of calls
  • IP address
  • device event information such as crashes, system activity, hardware settings, browser type, browser language, the date and time of your request and referral URL
  • cookies that may uniquely identify your browser or your Google Account
  • location information
  • device information
  • any personal information you give Google (emphasis added)
Now this is just what Google gets from browsers. And this is the list that arrived just after Google changed its privacy policy in March 2012. The aim was to collect deeper information about its more than 1 billion users. There was, of course, no way to prevent Google from combining the personal data it collected through the many services offered through many devices. Much of this, of course, has been used to recalibrate advertising. But if Google has more data it can mine from you (that is, personal information that you “give” through Glass), and the Google Glass user is constantly recording her life and adding heaps of personal info that advertisers will want to know about, a Google user’s personal dossier will become highly cultivated indeed.

Google has a very poor history of sympathizing with people who don’t want their personal information shared. Forget that these users have very principled reasons for staying anonymous. But as far as Google is concerned, quiet lives don’t contribute to the hard profit line. In December 2009, then Google CEO Eric Schmidt barked to CNBC, “If you have something that you don’t want anyone to know, maybe you shouldn’t be doing it in the first place.” If this remains Google’s philosophy in 2013 (without Schmidt), then will this corporate sentiment apply to Google Glass?

We are dealing with a company that casually collects as much personal information as it can about its users without always informing them. Look no further than this FCC report from last year (PDF), which describes how Google’s Street View vehicles picked up “payload” data — that is, email, text messages, Internet usage history, and other personal information — between May 2007 and May 2010 while performing “location-based services.” Not only did Google collect 200 gigabytes of payload data between January 2008 and April 2010, but Google transferred it all to a data center in Oregon. (This privacy breach case was recently settled for the paltry sum of $7 million.)

So how much payload data will Google Glass collect? And what will the user agree to when signing up for the headset? If data limit isn’t an issue and Google employees are incapable of respecting privacy even on a subconscious level, what brave new metadata will be fed into Google’s data centers?
In December 2009, then Google CEO Eric Schmidt barked to CNBC, “If you have something that you don’t want anyone to know, maybe you shouldn’t be doing it in the first place."

Yeah, like, maybe having to have radiation therapy for prostate cancer, for for having liposuction, or a hip job, hysterectomy, stent, CABG, or just some spinal MRI's to try to determine what the hell is causing your chronic low back pain. Maybe the fact that you take statins, and Ambien, and Zoloft.

The examples you can conjure up are legion, none of them having to do with wanting to hide "bad behavior."

Maybe you should simply stop all that so Eric Schmidt, and his kindred prying, data-trafficking Suits won't be able to find out.

Read the lengthy entirety of the Champion piece. Well worth your time.

I've been probing and reflecting upon the "privacy" issues for quite some time.
...exchanging health data: information "will flow at the speed of trust." 


Well, as I reported in a prior post, I bought this book on

It's OK. Written from a nursing perspective, which is nice for me, not coming from a clinical background. But, (I'm about a third of the way through, and have skimmed through the backend stuff like the index and Glossary), it's lacking some fundamentals:

How, precisely, can you write a book about "critical thinking" and not define the word "evidence"? The book makes one passing reference to it: "...evidence (facts)..."
That is simply not true. "evidence" properly refers to "facts" -- asserted or indisputable -- that make the truth of a conclusion more likely (or, more rarely, prove it outright). Things that are "true" but nonetheless irrelevant to an issue at hand are not "evidence." That couldn't be more basic.
Beyond that oversight, guess what I'm now getting in my daily emails, repeatedly? Started within a couple of days of my ordering it.

How did they pick me up as a solicitation target (incorrectly, as it were; I'm no candidate for nursing school, either real ones or these bogus online ones)? A big mystery (LOL)., or Google, or Facebook, or someone is trafficking in my book purchases. Some algorithm somewhere is gumshoeing me.

Now, this kind of stuff is banal -- trivial, and an annoyance to me and a waste of their time. As is the snailmail "retirement opportunity" pitches I'm getting now that I've turned 67 and filed for SS (and, which looks like they're selling my info as well).

Where it goes very morally wrong is where it's creepily used behind the scenes to "redline" people for adverse credit, insurance, health care, or employment discrimination (or to do ID theft, which is the lowest of the low). Facebook has quickly become infamous for trying to "monetize" your information. They're by no means the only one.

Again, read Champion's piece.

BTW: Look at my Facebook page, and check my phone number. It's the Facebook Customer Service number. I'd like to claim that I thought that one up, but, no, someone else did. One small way to fight back. Use it.




Creativity in Medicine
How Creative Is Your Doctor?
by Danielle Ofri, New York Times

What are you doing creatively these days?

It’s not a question you hear commonly, and certainly not in a medical journal. But that was the title of a commentary in a recent issue of Academic Medicine. It caught my eye, because medicine is a field with a strong history of creativity, but its daily practice feels less and less so. Health care is being pushed steadily toward standardization, insisting on an algorithmic approach to diagnosis and treatment. Some ramifications of this trend have been beneficial, but many of these algorithms have been mechanized to the point where there is little need for human beings and their intricately personal neural networks.

Part of this stems from the way in which we are taught to think about clinical medicine. Medical school can seem like an ongoing exercise of committing lists to memory, the only creativity being the mnemonics for memorizing branches of the facial nerve or diseases with anion-gap metabolic acidosis. When students present cases, there is a sense of roteness. A patient with chest pain, for example, becomes, “Rule-out M.I. (myocardial infarction). Get an EKG, serial troponin levels, stress test, cardiology consult….”

Some of this roteness, of course, is thoroughness. You need to cover all your bases to ensure you are not missing anything serious. But rote recitation inhibits the ability to think beyond diagnostic straightjackets...

How do we teach creativity in medicine? For one thing, Dr. Kelly suggests, people’s creative sides should be brought to the forefront. She imagines water-cooler conversations and medical conferences that start by asking, “What are you doing creatively lately?” There is likely more creative talent lurking in medical professionals, and in patients, than we suspect. Bringing it forward could have a salutary effect on the medical interactions that follow.

Explicitly focusing on the creative process is the important next step. Many medical schools are beginning to incorporate arts, literature and humanities into the curricula. Critics deride this as fluff, but I think it is crucial in medical education...

If all patients and their diseases presented in exactly the manner of the textbooks, then the algorithms would be sufficient. Computers could surely do our job much more efficiently. Lord knows, they certainly wouldn’t keep misplacing their reading glasses.

But the human condition is far messier — in health and even more so in illness. Complex biology and the many overlays of social, psychological and economic issues make medicine a complicated, and nuanced, affair. The serpentine logic often seems closer to literary metaphor than to the orderly taxonomy of knowledge that we cut our teeth on.

It is our job as clinicians to work with patients to untangle these metaphors. For this, solid medical knowledge is necessary but not nearly sufficient. We need to flex the oddball neurons that connect the disparate corners of our consciousness. They need to be honed in the same manner as muscles at the gym, with ongoing stretches and workouts.

The next time you see your doctor, you might want to ask what he or she is doing creatively these days. (from The New York Times).
I'm as compulsively creative a person as you're likely to find. It just strikes me compellingly at random times, with random outcomes. I found Dr. Ofri's article (link in title) very interesting indeed.

And, how about this:
PHARMA & HEALTHCARE | 3/16/2013 @ 7:16PM |27,915 views
10 Reasons Why We Struggle With Creativity

David DiSalvo

Anyone who says “I don’t have a creative bone in my body” is seriously underestimating their skeleton.  More to the point, they are drastically undervaluing their brain.

My contention in this article is that creativity is an integral part of being human, and to deny its expression is like denying the expression of other crucial human elements that we intuitively realize we’d be miserable without. How about a life without sex, to use one bare-knuckled example? Creativity is no less a part of who and what we are. What follows are 10 reasons why we frequently struggle to get into a creative space, along with suggestions on how to get there.

1. Your brain is always putting out fires.

Cognitive science research tells us that our brains are equipped with sensitive threat-alert systems (of which the amygdala is a significant part), and these systems are older than we are, evolutionarily speaking. In our brains, the limbic system–home of the well-known fight or flight response–is ready to click on with a micro seconds’s notice. That’s a good thing. The problem is that it’s ready to click on with a micro second’s notice. As with many paradoxes within our brains, the good is also the bad depending on context...

2. Chunks of time are hard to come by.

Even when we can outwit our brain’s threat-alert system, it’s still difficult to find what the late, great management philosopher Peter Drucker advised we must find to be effective in any capacity: “chunks of time.”  Spurts of time riddled with interruptions aren’t conducive to creativity because each time our focus is wrecked, we struggle to get back to the point we’d reached in our creative “flow”...

3. The “self-efficacy” problem.
Pioneering psychologist Albert Bandura devoted a large part of his expansive career to figuring out how people can develop a necessary sense of self-efficacy–the outcome when accomplishment yields compounding confidence in one’s abilities. The irony that Bandura uncovered is that we only get there when we’ve experienced enough failure to demonstrate the difficulty of our eventual accomplishment...

Reminds me of a favorite saying: "Good judgment comes from experience, which largely comes from bad judgment."
4. The “governing scenes” problem.

Two more great psychologists, Silvan S. Tomkins and Gershen Kaufman, devoted much of their careers to figuring out why shame wields so much power in our mental lives.  Tomkins (who is the father of “Affect Theory” and “Script Theory”) coined the term “governing scripts,” and Kaufman built on his work, later coining the term “governing scenes,” which are the mental images of past experience that our brains conjure when we come across a “trigger” for that experience.

The tricky part is that our brains conjure governing scenes automatically–they arise from the unconscious. So when we experience a creative failure, our brains toss out vivid images–not just vague memories, but “scenes”–of past failures...

5. The functionary temptation.

“So, what are you going to do with that?”  Tough question to answer for anyone trying to be creative, because there probably isn’t an answer. What we seem to have a hard time getting our arms around is the fact that there also doesn’t need to be an answer.  What would a world driven by purely functionary concerns look like?  Is that a world you’d want to live in?...

6. Fear of disruption.

Getting into creative flow can disrupt your life. Henry Miller referred to this disruption in Sexus with the pregnant term “primal flux.” It’s a hard fact to handle, but the truth is that creativity isn’t all sweetness and light — it’s a volatile, disruptive force that can shatter presumptions, undermine expectations, and dismantle unquestioned standards...

7. Misunderstanding the “background noise” dimension of creativity.

For some reason we think that to be creative means constantly creating something tangible, but that’s not how creativity works.  Much of the creative process goes on in the background of your conscious mind space and emerges in conscious flurries...

8. Opportunities slip through the cracks.
You know the old story about how writers keep a notebook by their beds in case they have an idea in the middle of the night?  There’s only two things untrue about that story — it’s not just writers who do it (or at least it’s not just writers who should do it) and it’s not just in the middle of the night that a notebook or something to scribble on is invaluable to capture rapidly evaporating thoughts.

9. It’s easier to get numb.

Irony of ironies, the same incredible organ in our heads that allows us to be creative is also perilously prone to brain-numbing distractions. Sure, those can be chemical distractions–drugs, alcohol, etc–but in this case I mean just the regular old “plug-in drugs” like TV (using the term coined by author Marie Winn).  The problem with TV, of course, isn’t TV, it’s the hours upon hours that it draws us in...

10. Limited exposure to the creativity of others.
I’m a firm believer that creative inspiration isn’t all about originality; it’s more about being driven by the creative achievements of others. After reading a great novel, creative energy swirls in the brain like a newly spawned tornado. After watching an incredible movie, mental wormholes open to challenging ideas and possibilities. Same goes for museums and galleries and concerts and even electronics shows. It doesn’t matter where the ideas originate — it matters where they take you...
Indeed. Problematic for today's "productivity treadmill" captive clinical practitioners, no?

Another resource, a favorite book of mine, Steven Pressfield's glorious "The War of Art."

What keeps so many of us from doing what we long to do? Why is there a naysayer within? How can we avoid the roadblocks of any creative endeavor—be it starting up a dream business venture, writing a novel, or painting a masterpiece?

The War of Art identifies the enemy that every one of us must face, outlines a battle plan to conquer this internal foe, then pinpoints just how to achieve the greatest success.

The War of Art emphasizes the resolve needed to recognize and overcome the obstacles of ambition and then effectively shows how to reach the highest level of creative discipline. Think of it as tough love...for yourself.
Excerpt from the excerpts
1. WHAT I DOI get up, take a shower, have breakfast. I read the paper, brush my teeth. If I have phone calls to make, I make them. I've got my coffee now. I put on my lucky work boots and stitch up the lucky laces that my niece Meredith gave me. I head back to my office, crank up the computer. My lucky hooded sweatshirt is draped over the chair, with the lucky charm I got from a gypsy in Saintes-Maries-de-la-Mer for only eight bucks in francs, and my lucky LARGO name tag that came from a dream I once had. I put it on. On my thesaurus is my lucky cannon that my friend Bob Versandi gave me from Morro Castle, Cuba. I point it toward my chair, so it can fire inspiration into me. I say my prayer, which is the Invocation of the Muse from Homer's Odyssey, translation by T.E. Lawrence, Lawrence of Arabia, that my dear mate Paul Rink gave me and which sits near my shelf with the cuff links that belonged to my father and my lucky acorn from the battlefield at Thermopylae. It's about ten-thirty now. I sit down and plunge in. When I start making typos, I know I'm getting tired. That's four hours or so. I've hit the point of diminishing returns. I wrap for the day. Copy whatever I've done to disk and stash the disk in the glove compartment of my truck in case there's a fire and I have to run for it. I power down. It's three, three-thirty. The office is closed. How many pages have I produced? I don't care. Are they any good? I don't even think about it. All that matters is I've put in my time and hit it with all I've got. All that counts is that, for this day, for this session, I have overcome Resistance.


I recall from back when I lived in Knoxville always seeing this billboard while coming up toward the South Knoxville bridge on Chapman Highway, one exuberantly extolling some local restaurant as "The New Dining Tradition."

Fast forward a quarter century.

"The new standard of care"? Via which certifying authorities? Via what empirical outcomes evidence?

This is what you get when you have Gen Y'ers with B.A.'s in Advertising writing ad copy.

You just summarily declare yourself to be a "new standard"?


This Ol' Dawg ain't buyin' it.

Where Will the Clinical Faculty Come From?
James E. Lewis, PhD

Everyone, it seems, agrees that many more physicians are needed over the next 20 to 30 years to respond to more, older Americans, physician retirements and deaths, reduced doctor work hours, and other factors. Both new medical schools and expanded enrollments in existing medical schools are being pursued as ways to increase the physician workforce by 30 percent at minimum. The question is, where is academic medicine going to find the additional faculty to teach more students, and how does that number affect physician workforce calculations and projections? My analysis suggests that question is both critical and lacking attention...
Great post. Large looming problem. Below, from FutureDocs, apropos of medical ed:
What Can the Unmatched Seniors Tell Us?

Yesterday, after the mayhem and jubilation of celebrating a successful match at the Pritzker School of Medicine with our students, I went onto Twitter to follow the #match2013 hashtag to understand what the reactions were.  Most were positive, but one headline caught my attention ‘In Record-Setting ‘Match Day,’ 1,100 Medical Students Don’t Find Residencies.”

It is true this was the largest match because it was “All-in” – programs either were in the match for all their positions (including international medical graduates or IMGs) or they were not.  Obviously, many programs put more positions up for grabs in the Match.  After I reposted this article to Twitter, there were many theories and questions about who these unmatched students were and why...

More to come...