The Computer and the Future of Medical Practice.  Who Owns the Data  and Who Uses It?

Down the road, the IBM supercomputer could become a tool for comparative effectiveness research.

The KHN Blog, April 30, 2012

Given for one instant an intelligence which could comprend all the forces by which nature is animated and the respective  positions of the being which compose it, if morever this intelligence were vast enugh to submit this data to analysis  to it nothing would be uncertain, and the future as the past would be present in its pages.

Pierre Simon de Laplace (1749-1827),  Ouevres, Volume VIII, Theorie Analytique des Probabilities (1812-1820)

April 30, 2012 -  As a rule, I am skeptical about the use of the computer as the be-all and end-all as a principle  means of transforming and improving health care.

That said, based on my personal experience, the computer has a potentially powerful role in health care.  Back in the early days of the Internet,  the late 70s and early 80s, with the help of University of Minnesota physics professor,  I developed a differential diagnosis program called UNIPORT and a program for estimating the state of a person’s health called The Health Quotient .  Using UNIPORT, our clinical laboratory sent out 6 million differential diagnosis reports, with the proper diagnosis listed 80% of the time in the top 5 diagnostic possibilities .   

When a national laboratory bought our laboratory in 1985, the national firm discontinued the two programs, presumably because of expense and potential medical liability claims.

Nevertheless, I saw then and I see now, given a patient’s symptoms,  chief complaints, gender, age,  other demographic data,  lab tests, and medical history, based on clinical algorithms,  one could list a patient’s correct diagnosis, proper treatment, and state of health  more than 90% of the time.

IBM and WellPoint,  using IBM’s supercomputer, Watson, share that belief.   The how-to, what to-do, and when to-do, is being worked upon.  The idea is pretty straightforward – to provide a list of likely diagnoses and  treatments, given the patient’s symptoms and other data.

I have reservations about data-dominated care:  Will the lists be kept forever in government or health plan  databases?  Will the lists be used to judge , to pay for, to reward or as fodder to  punish physician performance?  Will the lists be a basis for telling doctors what tests to do and not to do.  Elizabeth Bingham, WellPoint’s VP for Health IT studies, says her firm is being used to consider what tests to authorize.

There is an Orwellian danger here – that Big Brother knows best.  My main concern is this: Who owns the patient and doctor data?  The government? The health plan? The patient? The doctor?   There is simply no question in my mind that, given enough data, both factual and historically,
 one can precisely predict diagnoses, a patient’s comparative health, and courses of treatment and prevention.  But to whose benefit? And for what purpose?   And is there a possibility of a massive intervention into personal privacy?

Tweet:  IBM and WellPoint, using IBM’s supercomputer, Watson, are working towards providing lists of diagnoses and treatments based on patient  symptoms.

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Two Schools of Health Reform Thought:  Neocon and Neogov

I think, therefore I am.

Rene Descartes (1596-1650)

All jargon of the schools.

Matthew Prior (1664-1721), I Am That I Am, An Ode (1688)

April 30, 2012 – As I wandered down the health reform campaign trail,  I came across two schools of thought.  They were engaged in an “ I am” jam session.

Neocon:  I am American business.  I am a pragmatic capitalist.  Prosperity, happiness, and freedom come only through economic growth.

Neolib:   I am American government.   I am an expert and an idealist.   I am for a more perfect union, which can only come through social justice and fairness.

Neocon: I am a bottom-up person.   Anything truly American percolates up from the bottom of society from the people. I buy and sell.  I consume. I live and let live.  I am free.

Neolib:   I am a top-down person.  Everything truly good in America flows from the top-down for the truly down, from the educated and dedicated to the common good.

Neocon:   I am the center-right, where America has always been and will continue to be.   It is the government’s responsibility to get out of the way.

Neolib:  I am from the center-left,  where America ought to be.  It is the government’s responsibility to cure all the ills of the human condition.

Neocon:  I am the mainstream of everything truly American. I am why people came and continue to  come to America.

Neolib: Nonsense, I am the mainstream.  I speak for American.  That is why our spokespersons are called the mainstream media.

Neocon:  I am for personal liberty – the right to be what one wants to be, free of government rules and domination. .

Neolib:  I am for personal fraternity and the obligation to follow the rules of a civilized society. Only government can establish those rules.

Neocon:  I am the common folk – the true believers in American freedom.

Neolib:  I am the uncommon educated folk  - scientists, teachers, administrators, government employees, doctors in the public sector, public lawyers, politicians,  staffs of foundations, government experts – all of whom stand up for the disenfranchised. 

Neocon:  I am markets. Markets are imperfect but they are most efficient at creating wealth and distributing it. 

Neolib: I am government. Only government can redistribute wealth fairly and justly. Only government can oversee  markets.

Neocon:  I am free enterprise. It works.  It avoids the welfare state, which slows economic growth and spreads economic misery.

Neolib: I am for the broad public interest. I am the hope and guiding light for the public good.

Tweet:   Two schools of American political thought exist- each right in its own way – the bottom-up center-right and the top-down center-left.

Experts  Versus Behavior of Patients and Physicians:  Opinions, Reality, and Common Sense

Common sense is not so common.

Voltaire (1694-1778),  Dictionaire Philosophique (1694-1778), Common Sense

April 29, 2012 – Call me jaded. Call me cynical.  Call me over-exposed to experts.

But ever since 2005, when I wrote Voices of Health Reform, a book composed of 40 interviews with experts,  I’ve been skeptical of opinions of experts on health reform.

An article in today’s New York Times reinforces my prejudice.  Its headline  reads. “In Hopeful Sign, Health Spending is Flattening: Surprising the Experts.” 

As I read the article and the headline,  I thought:   Maybe there is something to those tired clichés:   An expert is someone from out of town.  An expert knows more and more about less and less. An expert is someone removed from reality.   Say what you will,  health reform experts are usually not someone in the clinical trenches who pays for, receives, or delivers health care.

The experts are confused and vague about why the slowdown is occurring.

·         Karen Davis,  president of the Commonwealth fund,  a liberal think tank,  says, “The tectonic plates may be shifting, “ whatever that means.

·         David Cutler,  Harvard economist and Obama’s chief health reform adviser, who I interviewed for Voices of Health Reform,  chimes in, “The recession just doesn’t account for the numbers we are seeing.” Well, what does.

·         Gail Wilensky,  head of Medicare and Medicaid under   President Bush,  is mystified, “If there’s something going on, we don’t know what it is yet.  The most honest thing to say is:  one, the reduction is use is greater than the recession; two, we don’t understand it yet; and three, you’d be a fool to say we can understand it.”

Let me give the experts a clue:   the low rate of inflation is the common sense of the American people kicking in.    

Because of:

·         the unaffordable costs of care;

·         effective unemployment of 16% or so; 

·         the 35% explosion of high deductible plans,  in which people have to spend their own money and who think twice before parting with their health care dime; 

·         increasing high co-payments of ER care, sometimes $100 or more;

·          proliferating  lower cost options,  such as urgicenters, walk-in clinics,  retail clinics,  and direct-cash options; people watching their dollars and practiciing home care and self-care;

·         I\increasing use of generics and doctor sensitivity of costs,

health spending is coming down.

I was speaking yesterday to the manager of an urgicare center.   I asked her about the center’s patient mix.   

She replied,”  About 25% are uninsured who are paying out of pocket;  about 25% are Medicare and Medicaid’ about 25% are on high deductible plans; and about 25% are on regular health plans.  She added, “ Look the co-pay for the ER is now about $150, so patients are coming to us, or going to their regular doctors.”

I queried, “But what about accountable care organizations.” She responded, “What about them?  There aren’t any around here, and patients have never heard of them.”

I pressed, “”What about the health care law?”  “Nobody, “ she answered, “ every mentions or asks about it.  It is irrelevant to them. All they know is that costs are going up, and employers are dropping some of them from their plans."

Tweet:  Health inflation slowed to 4% in 2009 and 2010. Experts don’t know why, but patients paying health bills and provider delivering icare do.

Physicians Alone in Political Wilderness

The present is never tidy, or certain, or reasonable, and those who try to make it so, succeed only in making it implausible..All of it , the prescient and the cockeyed, always arrives in a promiscuous rush, and most men in power, sorting through it, believe what they want to believe, accepting what justifies their policies while taking out insurance, whenever possible, against the possibility that the truth may lie in their wastebaskets.

William Manchester,  The Last Lion: Winston Spencer Churchill, Alone, 1932-1940, Little, Brown, and Company, 1988

April 28, 2012 -  Many, if not most,  physicians are feeling alone and uncertain in the political wilderness,  with Democrats and Republicans unable to decide  about the future of the health system,  whether to cut 27% from Medicare payments to physicians, or  what will happen if the Affordable Care Act is constitutional,  in part or as a whole.

To muddy the waters further,  a leadership vacuum exists among physicians.   Physicians distrust the AMA because it backed Obamacare, even now when Medicare may be in its death throes. Physicians wait to see  if the Supreme Court rules against some or all of the health law’s  provisions, and if the electorate in November ushers the ruling party out.  

Right now, for the next 6 months, the nation’s health system is adrift,  impatiently waiting for reform solutions from a divided political system.  They wonder: how much of the health reform law is destined for the political wastebasket.

Today only 15% to 17% of physicians belong to the AMA, despite its current recruiting drive.  And a corporate transformation of American medicine is underway,  as more physicians become employees of institutions,  and as they pledge their allegiance and owe their careers  to corporate bosses and the missions of those institutions.

Congress, meanwhile, fiddles. It cannot make up its schizophrenic partisan mind what to do about physicians, even though 19 members of Congress are now physicians.  

•  It knows more physicians will bolt from Medicare if the 27% cut in physician pay goes through. 
•  It knows  incoming Medicare recipients,  which are entering the system at the rate of 10,000 to 12,000 a day, will revolt if they cannot find a doctor to care for them. 
• Yet it knows if Congress honestly reimburse physicians or cancels the hated SGR formula,  those acts will add some $300 billion to the national deficit, already as staggering $16 trillion and growing.     
• And yet, if it accepts the Ryan budget, which basically puts Medicare on vouchers and Medicaid on block grants to states,   it will trim funds to federal programs, in effect,  “ending Medicare as we know it,” thereby infuriating and alienating its liberal base.   
•  And yet, if nothing is done, federal programs will go bankrupt.

What to do?  Let the Supreme Court and the electorate decide.  And whatever they decide,  agree the solution resides in some sort of public-private partnership, not in one or the other.  We are a center-right capitalistic nation.   So let us give two cheers, but not three cheers, for capitalism..

Tweet:   American physicians are demoralized and uncertain about their future, as the political system fiddles and dithers about physicians’ fates.

Why Do We Trust Doctors?

The best way to find out if you trust somebody is to trust them.'

Ernest Hemingway (1899-1961)

April 27, 2012 -  The National Journal has released a Special Report.   The Report features a series of  four articles: Restoration Calls – Fixing America’s Crumbling Foundation.  Among these articles is: “Why Do We Trust Doctors?”  It contains results of a Gallup poll, showing trust in doctors is at all-time high of 70% over the last ten years.

 
This is intriguing considering numerous media articles  on physician personal  profiteering  and physician partnerships in technologies such as imaging equipment  for financial gain.  

The article begins, ”We’re cynics about insurance companies and critics of big health companies.  So why do we still believe in physicians?"

Why indeed?  The author of the April 26 piece, Margot –Sanger-Katz, tells the story of 60 year old Mary Morse-Dwelley of Maine who has undergone 22 operations to close an abdominal incision and who has had her gallbladder, uterus, and 2 feet of intestine removed.  She has spent two years in bed.   Despite this long surgical ordeal, she implicitly trusts her surgeon.So does the American public, if you believe Gallup.   

When patients are asked why they trust doctors, patients say they see doctors as someone who is trying their best to help them.  They do not see them as agents of government,  insurance companies,  or institutions.  They trust the interpersonal face-to-face relationship and the motives of their doctors.

Doctors are respected for their altruism.   On the other hand , patients may distrust the insurance system which stands as an intermediary between them and the doctor.  They trust the face-to face relationship with the doctor and see him or her as someone trying to fix their problem.

In most cases,  Internet information has helped cement the patient-doctor relationship.  As a consequence of online-information, doctors are more likely to describe the downside of treatment ,  put the odds of success in perspective,  and give more respect to the patient’s choice.  In a sense,  doctors are more likely to team up with the patient .

In this process, doctors have slowly learned a lesson.  A honest appraisal of the situation, based on data and an honest apology should things go wrong goes a long way towards preserving patient-doctor trust. Patients can forgive honest mistakes or unexpected complications but not denials or cover-ups.

Tweet:  Gallup poll indicate trust of the public for physicians has reached a 10 year  high of 70%, higher than trust in government or other institutions or professions.

Doctors Don't Consider Themselves Rich, Survey Says

By Sarah Barr

April 25th, 2012

Preface: Kaiser Health News encourages its readers to pass along its "capsules"  with proper attribution to KHN.   This is an important post because it puts physician incomes and attitudes towards health reform in perspective.

Source: Medscape Physician Compensation Report

Few doctors think of themselves as rich, and only about half think they’re fairly compensated, according to survey results released this week by Medscape.

The annual survey isn’t scientific – and perhaps, not surprising, either — but it offers insights into what nearly 25,000 physicians earn, and how they view that number. In 2011, compensation self-reported by surveyed physicians ranged from an average of $156,000 for pediatricians to $315,000 for radiologists and orthopedic surgeons.

The survey showed that 51 percent of all physicians — and 46 percent of primary care physicians – think they’re compensated fairly.

Only about 11 percent of doctors consider themselves rich, mostly because of their debts and expenses, according to Medscape.

The survey also offers a glimpse at how physicians view coming changes to the health care system, such as efforts to improve quality or offer care through accountable care organizations, which are integrated systems included in the federal health law.

More than half said they expect their incomes to decline because of ACOs (although very few were participating in such a system), and only 25 percent said quality measures and treatment guidelines will improve patient care.

Overall, 54 percent of physicians said they would choose medicine as a career again. Only 41 percent said they would choose the same specialty and 23 percent would choose the same practice setting.

Others groups that survey physicians about their income include the Medical Group Management Association and Merritt Hawkins. A 2011 MGMA report, for instance, which looked at data from 2010, found the median compensation for radiologists was $471,253 and $192,148 for physicians in pediatric/adolescent medicine.

Medscape surveyed 24,216 physicians across 25 specialty areas from Feb. 1-17, 2012 using a third-party online survey collection website.

Tweet:  51% of all physicians think they are compensated fairly; only 11% consider themselves “rich”;   and 54% say they would choose medicine as a career again

Innovation at the Health Care Intersection of Politics, Health Reform, and Medicine

Why not three cheers? On the other hand, why any cheers at all?

Irving Kristol (1920-2009), American Journalist and Columnist, Three Cheers for Capitalism (Basic Books, 2009)

He that will not apply new remedies must expect new evils; for time is the greatest innovator.

Francis Bacon (1561-1626), Essays: On Innovation (1625)

April 25, 2012 -  In two weeks, May 9, to be precise, I will be attending a major meeting of leading national innovators in Washington, D.C.   The nation’s  capitol is where politics, health reform, and medical practices intersect.

That intersection is where I hang out in Medinnovation Blog and in my books.  As I approach the innovation crossing, I find myself asking the $1 trillion questions: From where will the next big health care innovation come?  And will this innovation or combination of innovations solve the country’s health care woes?

• ·Will it be government  acting alone?  I don’t think so.  Government isn’t good a innovation. It has too many conflicting constituencies to satisfy. It more interested in good intentions rather than results.  It can never shut down a program once launched, for it can always keep running on taxpayer money. Anyway, for the moment at least, it trapped into partisan gridlock,  The Supreme Court and the Election could break the impasse, but there is no promise of that.  
• Will it come from the private sector? Maybe.  The bets now seem to ride on the information technology tiger.  Apple is on a wild upward ride, and 30%  to 50% of physicians are said to own IPads, along with 10-20% of the population at large.  “Instant connectivity” and “total transparency” seem to hold promise of “perfect information,” whatever that is,  but the promise  of  perfect information at one’s fingertips is widely held to the key for unlocking  and unleashing the health innovation beast.
•  Will it spring from the hearts, minds, and actions of denizens of the health care world – health buyers, hospitals, physicians,  other health professionals, and the seemingly endless parade of health care suppliers and companies  that make up the medical industrial complex.  That sector is divided between those who would go it alone without government help and those who depend heavily on government largesse.  Besides, as things now stand,  government pays for roughly 50% of care,  and cares, in one way of another for 110 million of 320 million Americans.   The Centers for Medicare and Medicaid are by far the single biggest payer,  and government still dictates the pace and extent of events.
•  Will  innovation be incremental or sweeping?  Will it emanate from the minds of visionary entrepreneurs, like Steve Jobs, or the bowels of major corporations , like Bell Laboratories, Intel, GE, Google, Microsoft, 3M, IBM, or big health care institutions , like Kaiser, Geisinger , the Cleveland Clinic,  Mayo, or Hopkins?  Will the Election produce a GOP sweep and a market-driven incremental system with shopping across state lines, national tort reform,  tax credits for all, Medicare and Medicaid vouchers, and savings accounts at the workplace for everyone. Or, out of frustration, will be at last opt for single-payer?

I do not know.   I suppose a victor will emerge from the political demolition derby now occurring at the intersection of politics,  health reform, and medicine.  I am riding in the physician-driven car, but other cars may well have more mass, momentum, and money protecting them from destructive impacts.    I suspect in our capitalistic,  conservative society the winning car  will reside in the center right section of the  intersection, with imprints of  both government and private manufacturers.

Tweet:  Innovation may solve  some of our health woes, but innovation alone will not convert adversaries, and time will be the greatest innovator

Obamanation:  Penalizing Hospitals Financially for 30-Day Readmissions: The Downside

1.       The country we live in, can be both good and bad; 2) the country where Obama is president; 3) patently false and outrageous claims about President Barack Obama

 Definitions of Obamanation

April 24, 2012 -  To hear some critics tell it ,  Obamanation  is a play on the word “Abomination ,” which, in turn,  is often a condemnation of Obamacarenation and its unrealistic provisions.  

In the April 12 New England Journal of Medicine,  two sets of authors  (1,2)explain what is wrong with a provision in the Affordable Care Act that penalizes hospitals for “worse than expected” readmissions that occur within 30 days after discharge.  The penalties  are designed to help the government make up for the $17 billion it spends on the nearly 20% of readmissions that occur the 1^st month after discharge.

Unfortunately, as pointed out in the 2 NEJM articles, these readmissions are largely beyond the hospitals’ control and have little to do with hospital quality. 

As authors of one article say,

“ Evidence suggests the primary drivers of variability in 30-day readmissions are the composition of a hospital’s patient population and the resources of the local community – factors that are difficult for hospitals to change.”

Readmissions, in their words, are more about mental illness, poor  social support, and poverty, not  quality of hospital care. Hospital admission rates largely affect institutions care for a poor or minority population with a high burden of mental illness – precisely the populations that Obamacare was designed to protect.

Hospitals with low mortality rates for myocardial infarction,  chronic heart failure, and pneumonia – the three conditions for which penalties will be exacted – have higher readmission rates because they keep the sickest patients alive, and these are the patients likely to be readmitted.   

High readmission rates have little to do with supposed villains – hospital-acquired  infections, premature discharges, and poor communication between patients, hospital personnel , physicians, caregivers, community-based clinicians, and poor planning.  Studies indicate less than 20% of readmissions are “preventable.” Paying these penalties  often distracts and drains funds from hospitals’ other quality and safety-directed efforts.

Oh, well, as Samuel Johnson,  the 17^th century dictionary-maker and social critic, observed, “The road to hell is paved with good intentions.”

Tweet: The Affordable Care Act, aka Obamacare, is destined to fail if it hopes to recoup the loss of $17 billion spent on hospital readmissions.

References

1.Robert Berenson, et al,”Medicare’s Readmission-Reduction Program – A Positive Alternative,” NEJM,  April 12, 2012.

2.  Karen  Joynt, et al, ”Thirty-Day Readmissions – Truth and Consequences, “  NEJM, April 12, 2012.

 

A Day without Computer

We live in a technological world in which we are always communicating.  And yet we have sacrificed conversation for mere connection.

Sherry Turkle, psychologist, professor at M.I.T. and  author of Alone Together: Why We Expect More from Technology and Less from Each Other, in New York Times,  “The Flight from Conversation,” April 22, 2012

Studs Turkel (1912 - 2008  ),  Chicago Journalist and Radio Host, Talking to Myself, A Memoir of My Times, 1992

April 23, 2012 – What shall I do today?   My computer is down.  I just ripped it loose from its moorings.  I am taking  it to Staples for “diagnostics” to see why the damned thing doesn’t work. 

I’m  thinking of those practicing doctors.  What would they do without computers, IPads, or electricity ?   

Close their offices?  No, that wouldn’t do no patients, no income, no purpose. They would have to listen to patients, talk to them, examine them,  read their body languages.   They would have to write to what they see, hear, feel, and observe.   They couldn’t dictate. They couldn't click. They would have to write down their observations  with pen or pencil. 

 

They might  have to do what I’m doing now – talking to myself or others , unconnected to the rest of the world.  I would have no posts to write,  no tweets to tweet.  no texts to text, no calls to make, no IPad to click.

Between patients, they would   have to do what I’m doing now, alone by themselves.  Sitting, thinking and using their  noodles  without outside connections.  Woe is me. Woe is them.  Talking  to ourselves, or to patients.   We may find out what’s on our mind or what’s on their minds or what their gestures or their bodies reveal.

Tweet:  Think about it. What would you do if your computer went down, the electricity went out, and your IPad went incommunicado..

Are EHR Government Bribes, Bonuses, and Subsidies for Real?

I tell everybody very plainly I take bribes, but what kind of bribes?

Nicolia Gogel (1809-1882), Russian writer and critic of government bureaucracy, The Inspector-General (1836)

The American Republic will endure until the day Congress discovers it can bribe the public with its own money.

Alexis de Tocqueville (1805-1859), Democracy in America, (1840)

April 22, 2012- “Bribe” isn’t a bad word.  “Bribe” has many beneficent-sounding synonyms – bonus, favor, inducement,  subsidy, and incentive.   When government applies the word to EHRs, “bribe” is transmogrified into “incentives” for “meaningful use, ” of course.  “Incentives,” as every bureaucrat and capitalist knows, are a good thing. 

What government wants from EHR incentives is a nation-wide, interoperative, coordinated  computer system – with EHRs in every hospital and every doctor’s office.  

 These incentives resonate with government bureaucrats and EHR entrepreneurs, who have gathered together at the $27 billion EHR feeding trough.

Government has made a good start towards its goal of a national system.  CMS has just announced it has so far contributed $4.5 billion of taxpayer money to hospitals and doctors for installing EHRs that qualify for cash payments for meeting “meaningful use” criteria..

These EHRs are the basis for vast computer systems that will:

·         --speak and communicate with one another

·         --allow government to track health use and expenditures

·       ---  improve care though comparative outcomes

·        --- achieve “transparency “ in government health care dealings

·         --separate “good” hospitals and doctors from their “bad” counterparts, “good” being those who scrupulously follow CMS rules, regulations, and mandates

·         --reward hospitals and doctors who are “good” providers, to the tune of some $43,000 for Medicare and $52,000 for each doctors and several million dollars for hospitals who qualify by installing EHRs qualifying for “meaningful use.”

Given the fact that Medicare/Medicaid is the biggest  health payer by far of them all,  reaching these goals has the ring of inevitability.   

 Furthermore,  the government strategy seems to be working.  And why not?  Hospital executives and practicing doctors are smart people.   They will willingly accept the cash government is handing out and are not about to bite the hand that feeds them.

At least, that’s why I conclude from this article by Joseph Conn in the April 20 issue of Modern Healthcare,  and I quote.

“Nearly  $4.5 billion in federal incentives to implement electronic health-record systems has been paid out thus far, with program enrollments and payments still increasing in the first quarter of 2012.”

“There are now more than a quarter of a million (225,765) actively enrolled participants in the Medicare and Medicaid EHR incentive programs created under the American Recovery and Reinvestment Act of f2009, according to CMS.  Hospitals can receive payment under both the Medicare and Medicaid programs, and most do, but physicians and  other professionals can participate in one program or the other.”

“There have been 2, 667 payments made to hospitals under the Medicare and Medicaid technology programs, or both, totaling $3.1 billion.”

“Meanwhile, 222, 282 eligible professionals have enrolled, and 73,945 have been paid.  Medicare payme ts to 44,014 eligible professionals have totaled $792 million, while various state Medicaid programs hve paid 29,931 eligible professionals $628 million.”

“Active registrations by hospitals increased by 406, or 13%, in the first quarter of this year to 3, 483 participating hospitals.”

“Registrations for eligible professionals rose to 49,319,  29%, during the quarter to 222, 282.  Medicaid program enrollments of eligible professionals jumped nearly 51%."

“The average Medicare payment payment to hospitals l receiving Medicare and Medicad  payments has been $1.78 million.”

Are EHR incentives for meaningful use for real?  You bet they are.

Tweet:  CMS has paid $4.5 billion for hospitals and physicians who install EHRs.  CMS still has $22.5 billion in the till for more installations.

Wisdom of People: The Key to Reducing Health Costs

No one in the world, as far as I know, has ever lost money by underestimating the intelligence of the great masses of plain people.

H. L. Mencken (1880-1956),  Social Critic known at the Sage of Baltimore

Why the Many Are Smarter Than the Few and How Collective Wisdom Shapes Business, Economies, Societies, and Nations.

James Surowiecke (born 1967), American journalist, in  subtitle to The Wisdom of Crowds, Doubleday (2004)

April 21, 2012 -  I harbor this belief.  It defies conventional political wisdom.  I believe the great masses of people – be they employers, employees, those in the streets, and in their houses – are wiser than politicians and even doctors when it comes to their health.

People know what is good and bad for their health.  People know good care from bad care.  People know a good medical deal from a bad medical deal.  People know that what people do outside doctors’ offices, where they spend 99.99% of their time, is more important to their health than what happens inside those offices.  People know,  as my doctor told me, “It is not what I can do for you, but what you can do for yourself.” The exception, of course, is when you are sick. That’s where doctor skills and knowledge come into play.

People  instinctively know these elemental  things. So do employers. That ‘s  why people-driven care, aka consumer-driven care, is taking off in the workplace. A Towers Watson and National Business Group survey indicates 59% of companies with over 1000 employees are now  offering health savings accounts with high deductibles, or equivalent plans, to employees,  either as stand-alone plans or as a choice between HSAs and PPOs.

Savings accounts jumped 35% in 2011.  People are wise. Employers are wise .   Both know these accounts save 15% in health costs, and premiums are lower, sometimes 30%- 50%  lower.  People know when it comes to spending their own money, they make wiser more prudent choices.  People know the money they spend on these new account plans is tax-free.   They know this tax-free money rolls over into the next year and serves as retirement money. They know out-of-pocket responsibility leads to wiser and more careful spending of health dollars. And they know what they pay for and  do,  for and to themselves,  is the single most critical factor contributing  to their physical and economic  well-being.

Tweet:  Employers offering health-savings accounts with high deductibles,  and their various equivalents, increased by 35% in 2011.