The KHIT Blog: You want some cheese with that whine?

Tuesday, April 29, 2014

You want some cheese with that whine?

Continuing with a recent theme (re: my April 25th, April 22nd, and April 15th posts).

Is it time to “damn the mandates” and forget meaningful use?
Jennifer Bresnick, April 29, 2014

Even as the healthcare industry marches dutifully into Stage 2 of Meaningful Use, there are still plenty of physicians that have not yet accepted the requirements put forth by CMS in the EHR Incentive Programs. Dr. Daniel F. Craviotto Jr., an orthopedic surgeon in Santa Barbara, California, took to the Wall Street Journal this week to protest the restrictive chains of EHR adoption, quality penalties, shrinking Medicare reimbursements, and bureaucratic red tape that prevent a physician from focusing on what’s really important: engaging with and treating patients.

“In my 23 years as a practicing physician, I’ve learned that the only thing that matters is the doctor-patient relationship,” Craviotto writes. “I acknowledge that there is a problem with the rising cost of health care, but there is also a problem when the individual physician in the trenches does not have a voice in the debate and is being told what to do and how to do it. When do we say damn the mandates and requirements from bureaucrats who are not in the healing profession? When do we stand up and say we are not going to take it anymore?”

Aaron Carroll has a beaut of a response in The Incidental Economist.

Once more unto the breach...
April 29, 2014 at 10:15 am Aaron Carroll

Austin has been working on his trolling skills. He’s alerted me to another op-ed in the WSJ written by an orthopedic surgeon threatening to walk away from it all.

Look, I’m not suggesting that we limit anyone’s free speech in any way. I’m not suggesting that we shouldn’t hear from unhappy doctors. But I’m going to offer them a bit of (unsolicited) advice. You’re starting to be the docs who cried wolf.

In the interest of providing some media strategy, I’m going to go through this bit by bit. Let’s begin:

In my 23 years as a practicing physician, I’ve learned that the only thing that matters is the doctor-patient relationship. How we interact and treat our patients is the practice of medicine. I acknowledge that there is a problem with the rising cost of health care, but there is also a problem when the individual physician in the trenches does not have a voice in the debate and is being told what to do and how to do it.
OK, right off the bat, you’re claiming that you have no voice in the debate as you are being published in one of the most read op-ed pages in the country. You know who doesn’t have a voice? The 300-plus million people who don’t get to have their thoughts heard in the WSJ...

Ouch. Read the whole thing. An utter smackdown.

Across the country, doctors waste precious time filling in unnecessary electronic-record fields just to satisfy a regulatory measure. I personally spend two hours a day dictating and documenting electronic health records just so I can be paid and not face a government audit. Is that the best use of time for a highly trained surgical specialist?
I’m totally with you here. I think this kind of thing sucks. But do you really think that the average American doesn’t spend a whole lot of time doing things at work that they don’t enjoy? Do you really think lawyers don’t hate billing? Do you really think educators don’t hate teaching to tests and grading essays? Do you really think that small businessmen don’t hate regulations? I think many, if not most Americans, will read this and say, “Wait a minute. You only have to do two hours of crap a day? Lucky ducky!”

Again, read all of it.
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UPDATE

Just in. Relating to the environmental factors of health:

Supreme Court Upholds Air Pollution Regulation

The Supreme Court has given the Environmental Protection Agency an important victory in its effort to reduce power plant pollution that contributes to unhealthy air in neighboring states.

The court's 6-2 decision Tuesday means that a rule adopted by EPA in 2011 to limit emissions from plants in more than two-dozen Midwestern and Southern states can take effect. The pollution drifts into the air above states along the Atlantic Coast and the EPA has struggled to devise a way to control it.

Power companies and several states sued to block the rule from taking effect, and a federal appeals court in Washington agreed with them in 2012.

Justice Ruth Bader Ginsburg wrote the court's majority opinion. Justices Antonin Scalia and Clarence Thomas dissented.

Wow. 6-2. That rarely happens at SCOTUS these days. The smell in the air today is that of climate-denier wingnut hair on fire.

ERRATA

Funny.

COMMONWEALTH FUND INTERACTIVE MAP:
STATES' HEALTH SYSTEM PERFORMANCE

"Interactive." Move your mouse, stylus, or finger around the map for state-by-state data.

DESIGN FLAW

I use the free open source FileZilla FTP upload utility. Very handy. But, twice now I have slipped with my mouse and inadvertently wiped out all of my logins and passwords. Those "clear" items should either be moved elsewhere or backed up with a yes/no "are you sure?" pop-up warning.
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More to come...

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Brave New Health

Commonwell Health Alliance

Another important read (pdf)

I love this kind of stuff. It sustains and humbles me. "As politicians, advertisers, salesmen, and propagandists for various political, economic, moral, religious, psychic, environmental, dietary, and artistic doctrinaire positions know only too well, fallible human minds are easily tricked, by clever verbiage... Common language—or at least, the English language—has an almost universal tendency to disguise epistemological statements by putting them into a grammatical form which suggests to the unwary an ontological statement. A major source of error in current probability theory arises from an unthinking failure to perceive this."

Quotes

"An economist is a person who sees something that works in practice and tries to figure out whether it will work in theory."

- J.D. Kleinke, medical economist
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"The only person who enjoys change is a baby with a wet diaper."

"Every misspent dollar in our health care system is part of somebody's paycheck.

- Brent James, M.D., M.Stat

“We could do healthcare, at markedly higher quality, for everyone in this country, without rationing or denying anybody the care that they need, without having the government dictate how doctors practice or whether hospitals could expand, at half the cost we do it now.”

- Health Care Futurist Joe Flower

Most of the sciences, unlike parts of medical science, are not concerned with the impossible. There is not complementary and alternative physics, or chemistry, or biochemistry, or engineering. These disciplines compare their ideas against reality, and, if the ideas are found wanting, abandoned."

- Mark A. Crislip, MD

"Q: How much alcohol is too much?
A: More than your doctor drinks."

- a physician I once heard speak during a CME presentation

“Just because science doesn’t know everything, doesn’t mean you get to fill in the gaps with whatever fairy tale most appeals to you.”

- Dara O’Briain

'[I]t is one small step from using the computer for "helping" doctors to monitoring them, judging them, dictating to them what to do, and withdrawing payment for computer non-compliance. The use of computer data is a multi-edged sword. It can be used for the "good," facilitating diagnosis and treatment and making it more accurate and up-to-date, and for “evil,” invading privacy, inviting security breechs, and making decisions based on the opinions of remote authorities rather than those present at the patient-doctor encounter.'

- Richard Reece, MD

“[T]here ARE statistics which are non-political. Just because The Washington Post/Fox News reports the temperature is 75 degrees doesn’t mean it’s really snowing and sunscreen is a liberal/conservative plot. Even if you earn a living being ideological.”

- Michael L. Millenson

"It is a generally a fairly convincing argument that people shouldn’t have to be subsidized to undertake a change which is in their best interest.

The reconciliation seems to be that EHR is not supposed to make a doctor’s practice more efficient and higher quality. It is supposed to make the system of care more efficient and higher quality, which is not the same thing. Those of you who took calc recall that maximizing the total of variables is not achieved by maximizing any one variable and this is a perfect example of that.

Those of you have served in combat certainly noticed that too — if everyone works as a team the unit takes fewer casualties. If you try to save your own hide, you might, but at the expense of more casualties overall."

- Al Lewis

"There are two ideas to keep in mind about Bayesian reasoning and how we tend to mess it up. The first is that base rates matter, even in the presence of evidence about the case at hand. This is often not intuitively obvious. The second is that intuitive impressions of the diagnosticity of evidence are often exaggerated."

- Daniel Kahneman, "Thinking, Fast and Slow"

"Physicians apply advanced scientific knowledge, but they must do so without the favorable conditions that experimental scientists create for themselves. Multitasking is forced on physicians, often in chaotic environments and under severe time and resource constraints."

- Lawrence and Lincoln Weed, "Medicine in Denial"

"It’s time to stop the whining about Obama care and acknowledge we already have universal health care. We just pay for it in the stupidest way possible that ensures problems are that much more disastrous and complicated when they’re finally treated."

- Mark Hoofnagle, MD, PhD

"Every act of conscious learning requires the willingness to suffer an injury to one's self-esteem. That is why young children, before they are aware of their own self-importance, learn so easily."

- Thomas Szasz, MD
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"Of course, one reason that process metrics* are so popular is that processes are much easier to define and measure than outcomes."

- The Skeptical Scalpel
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"There is an “illusion of validity” for any random data point, a seductive sense that is colored by what we hope will be true. Mountains of pharmaceutical claims are often made from mere molehills of data."

- Danielle Ofri, MD
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"Joy empowers people. It is a source of energy that enables people to hope and plan and change their lives for the better. Spend some time around someone who is relentlessly negative and how do you feel–drained, right? More and more research shows that joy is not something that just happens to you, like a bolt of lightening out of the blue. Joy is, instead, a habit to cultivate. Negative thinking and despair are the crabgrass of our souls–weeds that take root and spread, sometimes to all areas of life. Joy, in contrast, is a soul’s rose–hardy when cared for, able to put down roots over time and withstand disease and extremes. Like a rose, however, your joy can become blighted from neglect or harsh conditions. We all need to tend to our joy–to prune away the badness, and to know that, even though it may look like a prickly bare root, if you invest time in a joyous outlook, gorgeous things will bloom, even in the harshest conditions."

- Dr. Jan Gurley
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"'Solutions' exist only in mathematics."

- Karen Martin
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"The issue of how to regulate clinical software is, in the long run, indistinguishable from the issue of how to regulate medicine. The only difference is that medicine is practiced in the open, without secrecy, subject to peer review, and under a merit-based state license."

- Adrian Gropper, MD
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"Economist, rope, tree: some assembly required."

- Source unknown

DISCLAIMER:

I write this blog wholly on my own time and my own dime. The views proffered are expressly my own as a concerned and active citizen/taxpayer (in addition to being the result of my substantive experience in the various IT fields), and in no way reflect any policy views of my former employer, notwithstanding that some of the thinking has indeed obviously been spurred by the implications of the work with which I have been doing for them.

FAIR USE POLICY
I cite a ton of news and web sources spanning the breadth of relevant technical and policy domains, sometimes at substantial length. I believe I remain well within the bounds of "Fair Use," as [1] I am not doing any of this for profit, [2] I always provide attribution and links -- which, [3] far from negatively impacting any copyright holders' commercial interests, might actually increase traffic to and interest in their offerings.

Nonetheless, should I post anything of yours regarding which you have any objection, just let me know and I will remove it forthwith.

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Tuesday, April 29, 2014

You want some cheese with that whine?

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