Thursday, July 3, 2014

Hospital CEOs--Not Doctors--among Medicine's top earners

NYT finds healthcare exec pay eclipses salaries of surgeons and general physicians
 By 


Healthcare and insurance executives' base pay outstrips physician salaries, according to an analysis for The New York Times by Compdata Surveys. 

Wednesday, July 2, 2014

Veterans Administration Debacle.....New or a Chronic Problem

No one should be pleased with the recent publcity regarding the VA hospital situation.

VA officials, Democrats work to offset scandal damage


As Department of Veterans Affairs (VA) hospitals work toward solutions to delayed care, vulnerable Democrats want to mitigate damage from the revelations surrounding the scandal.
The VA administration has taken several steps to fix departmental problems, So far, various agencies conducted several reviews and investigations, including a report from the VA's independent office of inspector general, an internal audit and a broad review of the VA network pointing to a "corrosive culture" in which management retaliated against whistleblowers, 
In addition, the VA banned executive bonuses and made several leadership changes; VA head Eric Shinseki resigned in June, and President Barack Obama this week nominated former Proctor & Gamble CEO Bob McDonald to replace him. In the meantime, interim VA Secretary Sloan Gibson reached out to more than 100,000 wait listed veterans to schedule appointments and discuss their healthcare needs, according to the Washington Post. Furthermore, the VA removed seeing patients within 14 days of appointment requests as a goal, a target White House advisor Rob Nabors called said was unrealistic, overly vague and had potentially "incentivized inappropriate actions."
The director of Richard L. Roudebush Veterans Affairs Medical Center in Indianapolis is touting the results of steps the facility took to fix problems, telling visiting members of Congress that patient wait times are down two-thirds,according to the Indianapolis Star. Director Tom Mattice said the 229-bed facility reduced average wait times from 42 days to less than two weeks.

Obama to name former Proctor Gamble CEO as new VA head

Bob McDonald tapped to replace Shinseki as Secretary of Veterans Affairs



The choice of a successor to Gen Sinsheki is a bit out of the 'box' Typically the head of the VA is chosen from a list of military generals with a large amount of experience in military and government organization. Although Bob McDonald graduated from West Point and had a relatively brief career in the military, his most recent success was as head of Proctor and Gamble. His position at P&G (80 billion dollar business) gives him a strong consumer oriented approach to a product.
The VA administrative organization is heavy with ex-military personnel who have a direct path to civil service positions when they retire from their military activity. Their strength may be in organizational and hierarchal decision making, but lacks a patient oriented attitude unless they were in a health care related positon in the military.
The rigidity of the VA does not readily adapt to patient needs, and the prevailng attitude is to squeeze the patient into the system, instead of designing a system to fit the patient.
The change in leadership in this direction indicates that a 'patient centric' approach will mimic the change in other areas of health care.


Monday, June 30, 2014

Revolutionary Hologram Guided Surgery is a Heartbeat Away

It sounds like something out of a sci-fi thriller, but an Israeli holographic imaging system for the operating room is poised to revolutionize surgery in the near future.

Though only in the clinical beta prototype stage, the world’s first 3D holographic display and interaction system for medical applications was already featured on the TV show Grey’s Anatomy and has been tested successfully by surgeons at Israel’s Schneider Children’s Medical Center in Petach Tikva.
This proprietary digital technology from RealView Imaging in Yokneam projects hyper-realistic, dynamic 3D holographic images of body structures “floating in the air” without the need for special glasses or a conventional screen.
The physician can literally touch and interact precisely with the projected three-dimensional volumes, providing an unprecedented tool for planning, performing and evaluating minimally invasive surgical procedures.
As reported in the Israeli Times

Sunday, June 29, 2014

Doctors4 Patient Care Direct Payment Models

In this article Hal Scherz MD discusses direct payment models, the VA Crisis and other related items such as America's Web Radio,(available as a mobile app on iTunes) The Doctor's Lounge, and Doctors 4 Patient Care.

Doctors 4 patient care continues to be a strong force for physician opinion for freedom, and for eliminating much of the bureaucracy and governmental regulation preventing effective medical decisioins.




Tuesday, June 24, 2014

The Feds are Enforcing Privacy Rules With Stiff Fines for violating HIPAA Regulatons

Groups hit with record $4.8M HIPAA fine



And finally, not all data breaches are electronic:

This breach involved records from a hospital emergency department that should have been shredded ending up in a dumpster in front of the hospital. "It was a windy day. Security forgot to put a lid on the dumpster. The records are down the street," Hinkley recounted. Ultimately, school children nearby ended up collecting the records and returned them to the hospital. "The security guard said, 'not my job,'" said Hinkley. "How could someone seeing papers (flying about) not think, 'Gee, is that something I should think about?'"
 
The incident could well serve as the poster child for inadequate employee training, added Hinkley. The key is to "have it be owned by everybody from the first person the patient sees to the last one they see and everybody that touches their data in between."

EHRs and other digital storage or HIT network has been delayed, despite HIPAA regulations. Implementation may be delayed due to a multitiude of mandated changes in health reform. Institutions are hard pressed to comply due to financial limitation meeting all their responsibilities. 


DISRUPTIVE MEN IN HEALTH CARE

The second category of Disruptive Men is those who disrupt conventional wisdom creating catalytic innovation. These individuals or groups innovate and create 'sea changes' in medical  practice and administration.

Many changes are initially perceived as 'disruptive' rather than as a catalytic innovation. This applies to adopting electronic health records, changes in reimbursement from volume based payment  to quality of outcome. This group includes administrators as well as physicians.  Progress may be seen as creating inefficiency initially. Diffusion of innovation as described by Everett Rogers, a professor of communication studies, popularized the theory in his book Diffusion of Innovations; the book was first published in 1962, and is now in its fifth edition (2003).[1]  

Adopter categoryDefinition
InnovatorsInnovators are the first individuals to adopt an innovation. Innovators are willing to take risks, have the highest social class, have great financial liquidity, are very social and have closest contact to scientific sources and interaction with other innovators. Risk tolerance has them adopting technologies which may ultimately fail. Financial resources help absorb these failures. (Rogers 1962 5th ed, p. 282)
Early adoptersThis is the second fastest category of individuals who adopt an innovation. These individuals have the highest degree of opinion leadership among the other adopter categories. Early adopters have a higher social status, have more financial liquidity, advanced education, and are more socially forward than late adopters. More discrete in adoption choices than innovators. Realize judicious choice of adoption will help them maintain central communication position (Rogers 1962 5th ed, p. 283).
Early MajorityIndividuals in this category adopt an innovation after a varying degree of time. This time of adoption is significantly longer than the innovators and early adopters. Early Majority tend to be slower in the adoption process, have above average social status, contact with early adopters, and seldom hold positions of opinion leadership in a system (Rogers 1962 5th ed, p. 283)
Late MajorityIndividuals in this category will adopt an innovation after the average member of the society. These individuals approach an innovation with a high degree of skepticism and after the majority of society has adopted the innovation. Late Majority are typically skeptical about an innovation, have below average social status, very little financial liquidity, in contact with others in late majority and early majority, very little opinion leadership.
LaggardsIndividuals in this category are the last to adopt an innovation. Unlike some of the previous categories, individuals in this category show little to no opinion leadership. These individuals typically have an aversion to change-agents. Laggards typically tend to be focused on "traditions", likely to have lowest social status, lowest financial liquidity, be oldest of all other adopters, in contact with only family and close friends.
LeapfroggersThe phenomenon when resistors upgrade they will often need to skip several generations in order to reach the most recent technologies.



As the diffusion process progresses and the innovation gains popularity, observers and adopters often credit the 'disruptors' as creative individuals. The conventional wisdom of doing more to increase productivity is replaced by thoughtful analysis of the tasks at hand.  Also as the diffusion occurs improvements occur in the original idea which make it more acceptable and useful.  The disruptive process if fine tuned by early disrupters, making it also more acceptable to current process.

How experts explain technology adoption cycle

The accepted premise is that every new technology goes through the following phases:
  1. Hype: Search for next big thing leads to Hype around any new technology.
  2. Struggle: Adoption of these Bleeding Edge technologies depended on the Visionaries who had the vision, energy and money to make it work.
  3. Success: Mainstream adoption required convincing the Pragmatists who needed success stories and support system around the technology.













Not all innovation is accepted or gains popularity. 

Monday, June 23, 2014

Real Health Care Reform Should be Affordable

The average Floridian pays way too much for health care. Roughly, 18 percent of your income goes towards your health care, on average. Now research from Harvard shows that health care spending will grow faster than the economy for at least the next 20 years.


The Affordable Care Act was supposed to prevent this, but it cannot. Rather than reform health care, the law merely expanded health insurance, a costly system that leaves patients behind and is largely responsible for spiraling costs.

What Geometry Can Teach Us


 Insurance Plan Reimbursement                                      Patient--Provider Payments    


Think back to your eighth-grade geometry class. You probably learned that the shortest path between two points is a straight line. You can apply this same logic to spending, where the cheapest option involves only two parties. In health care, the two parties that matter are you and your health care provider (your doctor, the pharmacy, etc.). You spend the least money when you pay them directly. onsider how health insurance works. Your money exchanges hands multiple times before it reaches the provider. It first goes to a third party (either the insurance company or the government, such as in Medicare and Medicaid). From there, those entities negotiate compensation schedules with providers and facilities. Both of these steps add bureaucratic and administrative costs to health care’s price tag. And although insurers attempt to lock in reasonable prices on your behalf, they often come up short.Why? Because they’re not spending their money: They’re spending yours. They thus have less of a financial incentive to get the best deal. Businesses and bureaucrats are no different from you and me; if you give them someone else’s money, they’re more likely to spend it foolishly.
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Now consider how health insurance works. Your money exchanges hands multiple times before it reaches the provider. It first goes to a third party (either the insurance company or the government, such as in Medicare and Medicaid). From there, those entities negotiate compensation schedules with providers and facilities. Both of these steps add bureaucratic and administrative costs to health care’s price tag. And although insurers attempt to lock in reasonable prices on your behalf, they often come up short.
Why? Because they’re not spending their money: They’re spending yours. They thus have less of a financial incentive to get the best deal. Businesses and bureaucrats are no different from you and me; if you give them someone else’s money, they’re more likely to spend it foolishly.
The same problem affects you once you have health insurance. After you pay your premiums, insurance gives you the illusion that you’re spending someone else’s money. The health insurance trap thus comes full circle, both insurers and consumers make it more expensive.
This raises the question: If not “Obamacare,” what else? Reformers should start by giving consumers the freedom to make their own health care choices. We need to return health insurance to the role of taking care of unpredictable, catastrophic health care expenses, and leave the great majority of everyday health care decisions in the hands of consumers.

We know this works. In the fields of cosmetic surgery,  lasik eye surgery , alternative medicine, and dentistry, the absence, or minimal presence, of government regulation or health insurance has driven prices down, and quality and service up. This has occured due to these procedures being elective, and requirement for out of pocket payment  by the patient.
Doctors can also refuse to take health insurance. More doctors and hospitals are choosing this path. One of my patients did this and saved $17,000 on a single procedure.
Lawmakers should encourage this kind of patient-focused innovation. Instead, they gave us “Obamacare,” which wraps health care in red tape and forces everyone to purchase health insurance. Real reform shouldn’t leave us with a higher bill.
Dr. Jeffrey Singer practices general surgery in Phoenix and is an adjunct scholar at the Cato Institute.