The KHIT Blog: Location®, Location®, Location® -- We ® Family

Thursday, October 23, 2014

Location®, Location®, Location® -- We ® Family

From HL7's latest available Form 990 (pdf, IRS non-profit organization annual information return), publicly available from Guidestar.org. I was simply curious to know more about HL7 as an organization, in light of my recent post on them. Pretty interesting stuff.

HL7 ("Health Level Seven International, Inc") reported $3,601,644 in revenue on this latest information return. They paid a total of $2,197,387, comprised of [1] CEO compensation ($451,873) and, [2] $1,745,514 to their Executive Director's closely-held private for-profit management firm -- 61% of revenue.

The CEO apparently lives in San Diego, where I guess he works from home for about 12 minutes per day. Part of his comp package was that of $95,090 "Bonus and Incentive" pay. Notwithstanding that HL7 reported a loss of $853,810 for the year.

Sweet.

Or, "Suites." 222, 225, and 227 respectively, to be precise. I now can't get Dolly Parton's old "Two Doors Down" out of my head.

The other AMG Principal, Richard Correll, is President and CEO of CHIME. There are two IRS 990's for CHIME, the main organization (pdf), and the "CHIME Foundation" (pdf). Mr. Correll reports working 35 hours per week for CHIME, and 4 hours per week for the Foundation -- apparently pro bono.

CHIME seems to have received $2,915,000 from "related organizations" -- Part VIII, page 9, section 1(d), and Schedule I, Part II, item 1(d).

Uh, that would be the CHIME Foundation. See Part IV, Page 4, line 35b and Part IX, Page 10, line 1(a).

CHIME itself lists $2,560,519 in "Fees for services (non-employee)" on Part IX, Page 10 ("Statement of Functional Expenses"), line 11(a) -- "Management."

Page 6, Section C "Disclosure" line 20 simply notes that the "books and records of the organization are kept by "ASSOCIATION MANAGEMENT GROUP 3300 WASHTENAW AVENUE STE 225 ANN ARBOR, MI"

Part VII, Section B, Page 8 ("Independent Contractors") is blank.

I've been looking at a dozen or so other healthcare space IRS 990's today looking for a bit of context. AAFP of Wisconsin is a cutie, with a Mom & Pop mgmt outsourcing firm sucking up half their gross revenue (Their ED is also a Principal in the mgmt firm).

Here's another. "National Association for Healthcare Quality (NAHQ)."

So, the corporate HQ of NAHQ (and the dozens of other non-profits managed by this firm) is essentially an AMC mail drop?

I know what I'm gonna hear, in harrumphingly indignant (and perhaps quite profane) pushback terms -- "everybody does it, and, it's all legal."

Maybe so.

The "beauty" of this apparent Three Card Monty M.O. is that the "outsourced" ED's don't have to disclose their particular vig component of these "management fees." Privately-Held, Thank You Very Much. We Don't Disclose Confidential Salary Information.

The lowest level individual HL7 dues are $775, btw. $1,400 if you're a provider/organization grossing less than $1m/yr.

Most of these non-profits hold posh conferences in toney locales every year (I went to six last year), run to a significant degree on the free-labor backs of battalions of eager volunteers. The Trustees, Board Members, and Executive Management all swoop in and out VIP, probably all-expenses paid, to gather amiably in roped-off front row seating at the Keynotes before moving on to VIP-only luncheons and receptions.

Q: Re: "context" -- What are the latest data on front-line care doc pay?

2014 data.

CODA

HL7 Board, latest available Annual Report.

Not too many forks in this family tree, 'eh? BTW, RTI (Research Triangle Institute), while nominally a 501(c)(3) (contributions are tax-deductible) is a 3/4 of a billion dollar ("Beltway Bandit?") enterprise that paid its CEO $2.15m according to their latest available 990 (pdf).

IN OTHER NEWS

ONC brain drain hits fever pitch

October 24, 2014 | Tom Sullivan, Editor, Government Health IT

The exodus of top-tier ONC leadership continued late Thursday when Health and Human Services revealed that national coordinator Karen DeSalvo, MD was stepping out of her post — a surprise followed quickly by the news that deputy national coordinator Jacob Reider, MD is leaving as well.

The departures of ONC’s top two executives come as the office is sculpting two critical plans for its future: the 10-year interoperability roadmap and its next Federal Health IT Strategic Plan.

What’s more, DeSalvo and Reider are merely the latest in a string of high-profile ONC employees leaving.

During the last few months, in fact, chief nursing officer Judy Murphy accepted a post with IBM and chief science officer Doug Fridsma, MD resigned to take the helm at the American Medical Informatics Association, while chief privacy officer Joy Pritts and the director of ONC’s consumer eHealth program left without detailing immediate career plans.

The fact that so many executives are leaving ONC raises a number of questions: who will champion the interoperability roadmap and strategic plan? What does all this mean, if anything, for the meaningful use program moving forward? Will HHS Secretary Sylvia Burwell appoint a new permanent national coordinator in the near future and, if so, who?...

OK, EXPEDITED

MORE NEWS: HEALTHCARE TRIAGE

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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
___

"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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Thursday, October 23, 2014

Location®, Location®, Location® -- We ® Family

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