I will pull no punches. I like this book for personal reasons. Doctor Donald J. Palmisano is a man after my own heart. He writes with balance. He writes with civility. He writes with utter candor. He uses apt quotes to introduce his 18 chapters, he cites my favorite authors, and his philosophy mirrors mine. As frosting on the cake, he uses humor in the form of colorful cartoons. What's not to like?
I might add, he wrote the book while suffering the personal losses, severe damage of his home, and the destruction of his medical practice from Hurricane Katrina. He adds two chapters on leaders emerging from Katrina.
The son of policeman, Don rose to become a well-known surgeon and then president of the AMA in 2003-2004. He was recognized then and now as one of the most effective presidents the AMA ever had, due in no small part due to his reputation as a brilliant and eloquent speaker, particularly on the need for tort reform.
Today he is president and founder of Intrepid Resources, Inc., a medical risk manager company, that gives advice and counsel on patient safety, risk management, and leadership.
This is not primarily a medical or political book, although he makes his position clear when he says of political candidates, “Ask if the candidates are for a government run micromanaged medial system with rationing or for a system that expands insurance coverage through tax credits, consumer choice, and market enhancements.”
Instead what Doctor Palmisano writes about the enduring verities of leadership – homework, courage, persistence, decisiveness, communication, creativity, and effective interpersonal relationships.
To these, I would add three things:
One -Responsiveness. In my personal relationship with him, he has always responded immediately and helpfully.
Two- Concreteness. In his book in each chapter, he gives concrete examples of heroes and leaders he admires.
Three – Progressiveness. He is a big fan and user of the Internet, and of putting Information Technology to work. He posts regularly at DJPNEWS and www.onleadership. US.
Some 2500 medical leaders read his blog, and he welcomes calls to 504-455-5895 to ask his opinion or his advice. You can purchase his book on amazon.com for $11.01.
Tweet: Donald J. Parlmisano, MD, JD, has written a splendid book, On Leadership, which details leadership qualities.
Sunday, September 4, 2011
Saturday, September 3, 2011
The Paradox of Zero Jobs, Health Care, and Obamacare
A statement that seems contradictory, unbelievable, or absurd but that may be actually true in fact.
Webster’s New World Dictionary definition of Paradox
A zero is a zero in any language.
Anonymous
September 3, 2011 - Today's New York Times front page headline says it all. In bold print, it reads, "ZERO JOB GROWTH LATEST BLEAK SIGN FOR U.S. ECONOMY." President Obama has a problem. After more than 2 ½ years of his presidency, this coming Thursday night, he must explain why his policies generated zero jobs in August, the first time zero job growth has occurred since the Great Depression, and why his jobs program will solve or at least alleviate the problem.
The Paradox
His will not be an easy speech to deliver. He must explain a paradox as it relates to health reform.
Health care is the most prolific job creator in the American economy. According to the U.S. Department of Labor Statistics, despite the overall zero growth in jobs, health care employment rose by 29,700 jobs in August, and the sector has created 205,100 new jobs in the first eight months of 2011, accounting for 22% of the 930,000 non-farm payroll additions in the overall economy in 2011.
Yet health care, which comprises 1/6 to 1/5 of the overall economy, is the sector he proposes to overhaul and perhaps downgrade, partly by paying hospitals and doctors, its principle employers, less, and partly by creating an Independent Payment Advisory Board, with the power to reduce payment to these major employers.
Obamacare as Jobs Killer
President Obama has another, morefundamental problem of even greater magnitude. The nation’s employers regularly list Obamacare as either the number one or two reason they do not hire more employers. They cite uncertainties and increased expenses of meeting and paying for government standards for health plans.
Here Grace Marie Turner of the Galen Institute explains why Obamacare is a jobs killer in a September 2 Op-Ed piece in The New York Post, which I quote in part.
“In the early months of 2010, the economy was starting to show signs of life after the recession. Then Congress passed the president’s health-overhaul law.
Debate over the ObamaCare law’s potential impact on hiring and the economy has been fierce from the start. The president promised it would be a boon to both; then-Speaker Nancy Pelosi said the law would create 400,000 jobs “almost immediately.” Others argued the law would make businesses much less likely to hire new workers.
That debate should now be over.
The Heritage Foundation’s James Sherk recently released a paper comparing the rate of net job growth before and after the passage of ObamaCare in March 2010. The findings show that job creation came to a screeching halt at the time ObamaCare was enacted.
The economy slowly started to recover over the next 15 months; private employers began hiring workers at an average rate of 67,600 per month (net of layoffs). The economy’s high point came with the April 2010 report, when 229,000 jobs were added.
But ObamaCare was signed into law in late March, and the hiring freeze began. In the following months, the economy added an average of just 6,500 jobs per month (net of layoffs) -- less than a tenth the pre-ObamaCare average.
There’s good reason to believe that the health law is a major contributor to the hiring halt.
In a recent US Chamber of Commerce study, 33 percent of business owners cited Obama--Care as either the biggest or second-biggest reason they’re not hiring new workers.
Those findings were backed up by the words of Dennis Lockhart, president of the Federal Reserve Bank of Atlanta, in a speech earlier this summer: “We’ve frequently heard strong comments to the effect of ‘My company won’t hire a single additional worker until we know what health-insurance costs are going to be.’
How does ObamaCare discourage hiring?
First, it adds unknown costs to hiring new workers. Companies already must consider the cost of taxes for Social Security, Medicare, unemployment insurance and workers’ compensation when hiring new staff. combined with health benefits, these costs explain why a $50,000-a-year employee costs a company $62,500 to $70,000 (according to MIT business professor Joseph Hadzima). ObamaCare adds new costs by forcing employers to either provide workers with expensive, government-approved insurance or pay a fine.
The health law also discourages small businesses from becoming mid-size businesses because the mandate to provide insurance kicks in once you reach 50 or more employees. This is profoundly wrongheaded. Small business is the engine for job growth in America, but a recent survey found that 70 percent have no plans to increase hiring in the next year.
As for those companies that already have 50 or more workers, the burden of having to buy expensive government-approved policies (or pay penalties) discourages them from hiring all but essential staff. Indeed, larger companies are doing everything they can to pare back on entry-level jobs and using automation to avoid the added cost of mandatory health insurance for lower-income workers. McDonald’s and CVS drug stores, for example, are replacing some human order-takers and cashiers with electronic systems.
This especially hurts entry-level would-be workers who need jobs so they can get the skills to enter the workforce. Is it any surprise that teen unemployment has now hit 25 percent? The jobs they need are evaporating because of ObamaCare.
The evidence now is clear that ObamaCare is discouraging employers from hiring. The question is how long the president will continue to sacrifice the economy for the sake of his signature legislation.”
President Obama has some explaining to do. He might begin by explaining why employers don’t choose to share the sacrifice or create the jobs he so often calls for.
Closure
I close with two modern variations of old nursery rhymes.
Barack, be nimble
Barack, be quick
Barack, better jump over the mishandlestick
Or,
Humpty Dumpty sat on a wall,
Humpty Dumpty might have a great fall,
All the Democrats’ horses,
And all the Democrats’ men
May be unable to put Humpty Dumpty together again.
But fear not, like Alice in Wonderland, President Obama, given his likability, rhetorical skills, and one billion dollars in campaign funds, will find his way out of the health reform economic rabbit-hole.
Tweet: Obama in an economic rabbitt-hole: health job growth booms while businesses don't hire because of Obamacare.
Webster’s New World Dictionary definition of Paradox
A zero is a zero in any language.
Anonymous
September 3, 2011 - Today's New York Times front page headline says it all. In bold print, it reads, "ZERO JOB GROWTH LATEST BLEAK SIGN FOR U.S. ECONOMY." President Obama has a problem. After more than 2 ½ years of his presidency, this coming Thursday night, he must explain why his policies generated zero jobs in August, the first time zero job growth has occurred since the Great Depression, and why his jobs program will solve or at least alleviate the problem.
The Paradox
His will not be an easy speech to deliver. He must explain a paradox as it relates to health reform.
Health care is the most prolific job creator in the American economy. According to the U.S. Department of Labor Statistics, despite the overall zero growth in jobs, health care employment rose by 29,700 jobs in August, and the sector has created 205,100 new jobs in the first eight months of 2011, accounting for 22% of the 930,000 non-farm payroll additions in the overall economy in 2011.
Yet health care, which comprises 1/6 to 1/5 of the overall economy, is the sector he proposes to overhaul and perhaps downgrade, partly by paying hospitals and doctors, its principle employers, less, and partly by creating an Independent Payment Advisory Board, with the power to reduce payment to these major employers.
Obamacare as Jobs Killer
President Obama has another, morefundamental problem of even greater magnitude. The nation’s employers regularly list Obamacare as either the number one or two reason they do not hire more employers. They cite uncertainties and increased expenses of meeting and paying for government standards for health plans.
Here Grace Marie Turner of the Galen Institute explains why Obamacare is a jobs killer in a September 2 Op-Ed piece in The New York Post, which I quote in part.
“In the early months of 2010, the economy was starting to show signs of life after the recession. Then Congress passed the president’s health-overhaul law.
Debate over the ObamaCare law’s potential impact on hiring and the economy has been fierce from the start. The president promised it would be a boon to both; then-Speaker Nancy Pelosi said the law would create 400,000 jobs “almost immediately.” Others argued the law would make businesses much less likely to hire new workers.
That debate should now be over.
The Heritage Foundation’s James Sherk recently released a paper comparing the rate of net job growth before and after the passage of ObamaCare in March 2010. The findings show that job creation came to a screeching halt at the time ObamaCare was enacted.
The economy slowly started to recover over the next 15 months; private employers began hiring workers at an average rate of 67,600 per month (net of layoffs). The economy’s high point came with the April 2010 report, when 229,000 jobs were added.
But ObamaCare was signed into law in late March, and the hiring freeze began. In the following months, the economy added an average of just 6,500 jobs per month (net of layoffs) -- less than a tenth the pre-ObamaCare average.
There’s good reason to believe that the health law is a major contributor to the hiring halt.
In a recent US Chamber of Commerce study, 33 percent of business owners cited Obama--Care as either the biggest or second-biggest reason they’re not hiring new workers.
Those findings were backed up by the words of Dennis Lockhart, president of the Federal Reserve Bank of Atlanta, in a speech earlier this summer: “We’ve frequently heard strong comments to the effect of ‘My company won’t hire a single additional worker until we know what health-insurance costs are going to be.’
How does ObamaCare discourage hiring?
First, it adds unknown costs to hiring new workers. Companies already must consider the cost of taxes for Social Security, Medicare, unemployment insurance and workers’ compensation when hiring new staff. combined with health benefits, these costs explain why a $50,000-a-year employee costs a company $62,500 to $70,000 (according to MIT business professor Joseph Hadzima). ObamaCare adds new costs by forcing employers to either provide workers with expensive, government-approved insurance or pay a fine.
The health law also discourages small businesses from becoming mid-size businesses because the mandate to provide insurance kicks in once you reach 50 or more employees. This is profoundly wrongheaded. Small business is the engine for job growth in America, but a recent survey found that 70 percent have no plans to increase hiring in the next year.
As for those companies that already have 50 or more workers, the burden of having to buy expensive government-approved policies (or pay penalties) discourages them from hiring all but essential staff. Indeed, larger companies are doing everything they can to pare back on entry-level jobs and using automation to avoid the added cost of mandatory health insurance for lower-income workers. McDonald’s and CVS drug stores, for example, are replacing some human order-takers and cashiers with electronic systems.
This especially hurts entry-level would-be workers who need jobs so they can get the skills to enter the workforce. Is it any surprise that teen unemployment has now hit 25 percent? The jobs they need are evaporating because of ObamaCare.
The evidence now is clear that ObamaCare is discouraging employers from hiring. The question is how long the president will continue to sacrifice the economy for the sake of his signature legislation.”
President Obama has some explaining to do. He might begin by explaining why employers don’t choose to share the sacrifice or create the jobs he so often calls for.
Closure
I close with two modern variations of old nursery rhymes.
Barack, be nimble
Barack, be quick
Barack, better jump over the mishandlestick
Or,
Humpty Dumpty sat on a wall,
Humpty Dumpty might have a great fall,
All the Democrats’ horses,
And all the Democrats’ men
May be unable to put Humpty Dumpty together again.
But fear not, like Alice in Wonderland, President Obama, given his likability, rhetorical skills, and one billion dollars in campaign funds, will find his way out of the health reform economic rabbit-hole.
Tweet: Obama in an economic rabbitt-hole: health job growth booms while businesses don't hire because of Obamacare.
Government Elites at CMS Say Doctors Must Prescribe Electronically
Democrats are mad to define themselves as the party of top-down centralized planning. Moreover, if 15 Washington-based experts really can save a system as vast as Medicare through a process of top-down control, then this will be the only realm of human endeavor where that sort of engineering actually works.
David Brooks, “Where Wisdom Lives, “ New York Times, June 6, 2011
September 3, 2011 - There’s an unwritten understanding in Washington among the CMS power elite. It says: “We know more than doctors and patients about what is good for them. Wisdom resides here.”
CMS has decided that by January , 2012, doctors must prescribe electronically for bureaucratic clarity and safety of patients – no more scribbling on prescription pads, no more misunderstanding of illegible doctors handwriting, no more confusion about sound-alike drugs.
Besides, as a side benefit, electronic prescribing will give government the opportunity to track what doctors prescribe, and perhaps even control what they prescribe in the future.
Rationale
I understand the rationale behind this elitist thinking. So does David Brooks, technocrats in Washington, Brooks says, “tend to be skeptical that dispersed consumers can get enough information to make smart decisions. Health care is phenomenally complicated. Providers have much more information than consumers. Insurance companies are rapacious and are not in the business of optimizing care.”
The CMS decision therefore is for public power, public good – and public safety. In the process, it is also an example of further government intervention, with accompanying government limitations, into the affairs of doctors and their patients.
Limitations
CMS recognizes these limitations.
• The practice is located in a rural area without high speed Internet access.
• The practice is located in an area without sufficient available pharmacies for electronic prescribing.
• Registration is lagging for participating in the Medicare or Medicaid HER Incentive Program and Certifiable EHR Technology.
• Inability to electronically prescribe to due to local State, or Federal regulations.
• Limited prescribing activity.
• Insufficient opportunities to report the limitations of the measures denominator (whatever that means).
Otherwise
Otherwise Big Gov, and Big Brother, will penalize all of you prescribers by cutting 1% of Medicare payments starting January 1, 2012, 1.5% in 2013, and 2% in 2014.
Do not complain, you 110,000 doctors, nurse practitioners, and others who prescribe and who are estimated will not comply, or 60% to 80% of you who do not currently have EHRs.
Your alternative will be to cease seeing new Medicare or Medicaid patients or to drop out of third party arrangements, or install EHRs.
Remember, electronic prescribing is for your own good and the good of your patients. The handwriting is on the wall and on the fall. You will no longer be able to practice by the seat of your pants, but according to the seat of wisdom from Washington.
Tweet: Commencing January 1, 2012, physicians writing prescriptions will have to do so electronically or suffer a 1% cut in Medicare fees.
David Brooks, “Where Wisdom Lives, “ New York Times, June 6, 2011
September 3, 2011 - There’s an unwritten understanding in Washington among the CMS power elite. It says: “We know more than doctors and patients about what is good for them. Wisdom resides here.”
CMS has decided that by January , 2012, doctors must prescribe electronically for bureaucratic clarity and safety of patients – no more scribbling on prescription pads, no more misunderstanding of illegible doctors handwriting, no more confusion about sound-alike drugs.
Besides, as a side benefit, electronic prescribing will give government the opportunity to track what doctors prescribe, and perhaps even control what they prescribe in the future.
Rationale
I understand the rationale behind this elitist thinking. So does David Brooks, technocrats in Washington, Brooks says, “tend to be skeptical that dispersed consumers can get enough information to make smart decisions. Health care is phenomenally complicated. Providers have much more information than consumers. Insurance companies are rapacious and are not in the business of optimizing care.”
The CMS decision therefore is for public power, public good – and public safety. In the process, it is also an example of further government intervention, with accompanying government limitations, into the affairs of doctors and their patients.
Limitations
CMS recognizes these limitations.
• The practice is located in a rural area without high speed Internet access.
• The practice is located in an area without sufficient available pharmacies for electronic prescribing.
• Registration is lagging for participating in the Medicare or Medicaid HER Incentive Program and Certifiable EHR Technology.
• Inability to electronically prescribe to due to local State, or Federal regulations.
• Limited prescribing activity.
• Insufficient opportunities to report the limitations of the measures denominator (whatever that means).
Otherwise
Otherwise Big Gov, and Big Brother, will penalize all of you prescribers by cutting 1% of Medicare payments starting January 1, 2012, 1.5% in 2013, and 2% in 2014.
Do not complain, you 110,000 doctors, nurse practitioners, and others who prescribe and who are estimated will not comply, or 60% to 80% of you who do not currently have EHRs.
Your alternative will be to cease seeing new Medicare or Medicaid patients or to drop out of third party arrangements, or install EHRs.
Remember, electronic prescribing is for your own good and the good of your patients. The handwriting is on the wall and on the fall. You will no longer be able to practice by the seat of your pants, but according to the seat of wisdom from Washington.
Tweet: Commencing January 1, 2012, physicians writing prescriptions will have to do so electronically or suffer a 1% cut in Medicare fees.
Friday, September 2, 2011
The Wonks Are Wrong on Health Reform
Listen to the people. They are telling you what they want.
Anonymous
A person who takes an excessive interest in minor details of political policy: "a policy wonk".
Merriam Dictionary definition of "Wonk"
I’ve heard wonks express the idea a thousand times in a thousand ways.
The idea goes like this:
The system is terrible. It is fragmented. It is inefficient. It is too costly. It relies too much on specialists. Patients with chronic disease see too many over-paid specialists who don’t talk to each other. What we need is more well-paid primary care practitioners. They will provide accessible, continuous, comprehensive, coordinated, connected-electronically, and patient-centered rather than specialist-centered, care.
The Shadow
The problem is between the idea and reality falls a shadow. Patients aren’t listening.
They prefer the choice and freedom of picking their own doctor. In many cases, this doctor is a specialist who treats their specific problem. Patients feel they have enough information to make their own decisions as to what physician to choose. The American public is specialist-oriented. This is why the typical Medicare patient with chronic disease sees 5 or 6 specialists a year, rather than going through a personal primary care doctor who directs their over-all care.
The Problem Comes Home
This problem came home to me yesterday. I accompanied a patient to visit her primary care doctor. When her primary care physician diagnosed late-onset type 2 diabetes, she informed him, “ Please refer me to an endocrinologist who specializes in diabetes.”
He replied, “But I can handle your situation perfectly well. I have all the resources and knowledge needed to manage your illness , including a nutritionist and a team of other providers, to handle your diabetes.”
“No, “ she said, “ I want to see an endocrinologist, inside or outside your system.” She was not concerned about the “fragmentation” of the system.
The Dilemma
Therein lies the dilemma – whether patients chose to be handled by “systems of care,” and funneled through a primary care generalist within the system or to go directly to a specialist of their own choosing.
This is not a trivial matter. It stands in the way of widespread establishment of Primary-Centered Medical Homes (PCMH) and Accountable Care Organizations (ACOs). And it will be a point of dispute between primary care physicians, specialists, and patients. Many patients feel they are perfectly capable of choosing what doctors to go to.
Patients are often unaware of background arguments about primary care doctors working proactively to keep patients healthy, coordinating patient care, achieving measurable better outcomes, and focusing on “whole patient care,” rather than specialists addressing specific illnesses, offering life-style procedural salvations and one-on-one solutions.
In choosing doctors, patients still prefer to think for themselves, rather than having others think for them.
If their decision involves “waste” for the system, so be it. One person’s idea of waste may not be reality-based.
Richard L. Reece, MD, is author of The Health Reform Maze (Greenbranch Publishing), which may be obtained on Amazon.com or directly from publisher at 1-800-933-3711. Doctor Reece blogs at Medinnovationblog. blogspot.com.
Tweet: The Health Care Blog, America’s most widely read wonk review of the current state of health reform, reprinted this blog of mine on Sept.1.
Anonymous
A person who takes an excessive interest in minor details of political policy: "a policy wonk".
Merriam Dictionary definition of "Wonk"
I’ve heard wonks express the idea a thousand times in a thousand ways.
The idea goes like this:
The system is terrible. It is fragmented. It is inefficient. It is too costly. It relies too much on specialists. Patients with chronic disease see too many over-paid specialists who don’t talk to each other. What we need is more well-paid primary care practitioners. They will provide accessible, continuous, comprehensive, coordinated, connected-electronically, and patient-centered rather than specialist-centered, care.
The Shadow
The problem is between the idea and reality falls a shadow. Patients aren’t listening.
They prefer the choice and freedom of picking their own doctor. In many cases, this doctor is a specialist who treats their specific problem. Patients feel they have enough information to make their own decisions as to what physician to choose. The American public is specialist-oriented. This is why the typical Medicare patient with chronic disease sees 5 or 6 specialists a year, rather than going through a personal primary care doctor who directs their over-all care.
The Problem Comes Home
This problem came home to me yesterday. I accompanied a patient to visit her primary care doctor. When her primary care physician diagnosed late-onset type 2 diabetes, she informed him, “ Please refer me to an endocrinologist who specializes in diabetes.”
He replied, “But I can handle your situation perfectly well. I have all the resources and knowledge needed to manage your illness , including a nutritionist and a team of other providers, to handle your diabetes.”
“No, “ she said, “ I want to see an endocrinologist, inside or outside your system.” She was not concerned about the “fragmentation” of the system.
The Dilemma
Therein lies the dilemma – whether patients chose to be handled by “systems of care,” and funneled through a primary care generalist within the system or to go directly to a specialist of their own choosing.
This is not a trivial matter. It stands in the way of widespread establishment of Primary-Centered Medical Homes (PCMH) and Accountable Care Organizations (ACOs). And it will be a point of dispute between primary care physicians, specialists, and patients. Many patients feel they are perfectly capable of choosing what doctors to go to.
Patients are often unaware of background arguments about primary care doctors working proactively to keep patients healthy, coordinating patient care, achieving measurable better outcomes, and focusing on “whole patient care,” rather than specialists addressing specific illnesses, offering life-style procedural salvations and one-on-one solutions.
In choosing doctors, patients still prefer to think for themselves, rather than having others think for them.
If their decision involves “waste” for the system, so be it. One person’s idea of waste may not be reality-based.
Richard L. Reece, MD, is author of The Health Reform Maze (Greenbranch Publishing), which may be obtained on Amazon.com or directly from publisher at 1-800-933-3711. Doctor Reece blogs at Medinnovationblog. blogspot.com.
Tweet: The Health Care Blog, America’s most widely read wonk review of the current state of health reform, reprinted this blog of mine on Sept.1.
Republican Governors Association Report on Medicaid
Elections have consequences.
Anonymous
September 2, 2011- An overlooked consequence of the November 2010 elections is that Republican Governors were elected 29 states with similar gains in state legislative bodies. This may make Medicaid as big an issue as Medicare in the upcoming Presidential elections. The health reform law, Republican governors fear, may precipitate bankruptcies in their cash-strapped states.
According to a report just released by the Republican Governor’s Association, Medicaid is the biggest budget buster. Medicaid rolls grew to 65.5 million in 2011 — more than one in five Americans. Medicaid enrollment now exceeds Medicare enrollees by more than 8.1 million based on an average monthly basis.
Here are some facts highlighted in the report.
• When Obamacare provisions take effect in 2014, the Congressional Budget Office (CBO) estimates 25.6 million more Americans will be added to the Medicaid rolls in the next decade, bringing the total Medicaid numbers to 95.1 million.
• A nationwide survey of physicians in June 2010 found 54.5 percent of primary care physicians, 45.6 percent of medical specialists, and 49.3 percent of surgical specialists no longer are accepting Medicaid patients.
• In a 2010 survey of 1,800 emergency room physicians, 71 percent of respondents expect emergency visits to increase, and 47 percent anticipate conditions will worsen for patients.
• Even more utilization of America’s emergency departments by Medicaid enrollees could cost states, hospitals and physicians as much as $35.8 billion over the next decade in unaccounted for expenditures.
The Republican Governors Association propose that the federal government permit states to design and administer their own programs with a yearly lump sum payment provided by the federal government which only would responsible to monitor the programs and establish requirements for service delivery, quality and eligibility standards.
And so the war between cash-strapped states seeking waivers to cut their Medicaid budgets with policy changes for Medicaid from the Centers for Medicare & Medicaid Services (CMS) and patient advocates and physician organizations, who claim the moves restrict access to care, continues to heat up.
The cost of Medicaid will not be lost on the Congressional supercommittee of 12 who are charged with cutting the federal deficit. The incentive for a super committee to look at these principles which include cost-saving solutions is obvious. Under the current shared state-federal formula, the federal government pays a nationwide average of 57 cents on the dollar spent on Medicaid--a program that continues to grow.
The entitlement programs of Medicare and Medicaid are the two single fastest growing drivers of the federal deficit. Medicaid differs from Medicare in that Medicaid recipients do not have the political clout of seniors, who have a more formidable voting clout. That may be about to change as Republican governors exert their political muscle.
The reality that 54.5 percent of primary care physicians, 45.6 percent of medical specialists, and 49.3 percent of surgical specialists are not accepting Medicaid patients has the potential of igniting a political crisis. The U.S, is already short 50,000 doctors, a number expected to grow to 150,000 by 2020. If half of the doctors do not accept Medicaid patients, the situation may be even worse, especially when one factors in the 78 million new baby boomers qualifying for Medicare from 2011 to 2029.
The Obama administration may be unable to deliver on its promise of greater access for the uninsured.
Tweet: Medicaid is a fast growing contributor to the states’ debt crisis. It now covers 65.5 million and will grow to 95.5 million in 2014.
.
Thursday, September 1, 2011
Survey on Electronic Health Record Use
September 1, 2011 – Yesterday I received this email.
“We're hosting a survey about the benefits of EMRs on our company blog. I was wondering if you could help me out by spreading the word about it on the Medinnovation blog or by sharing it via social media. You can check out the survey at: http://www.softwareadvice.com/articles/medical/benefits-of-emr-software-survey-1081611/ .
2,400 providers have already been able to attest meaningful use. We're curious of the impact EMR software is having on the quality and delivery of health care. After gathering the results, we'll post the survey findings in a couple of weeks.
Would you be interested in posting a quick note about this survey on the Medinnovation blog?
Thanks,
Michael
____________________________
Michael Koploy
ERP Analyst
Software Advice
714 Congress Avenue Suite 200
Austin, TX 78701
michael@softwareadvice.com
(512) 364-0129”
I told Michael I would be glad to help him out. A great deal of confusion exists on how many doctors and hospitals are using EHRs, how many of these EHRs meet federal standards of “meaningful use,” and what impact EHRs are having on quality.
For example, Sally Pipes in her July 16, 2011 column reported “Just 1026 registered hospitals and physicians out of a possible 56,599 reported using electronic health records and other health information technologies in accord with federal standards, “ and on September 1, David Classen MD and David Bates, MD, advocates of EHR, citing government and HIMMS data, said,”Some recent surveys suggest that nearly half of outpatient practices and in 44% of U.S. hospitals.”(“Finding the Meaning in Meaningful Use,” New England Journal of Medicine, September, 1, 2011. According to an August 3, 2011 report from Robert Tagalicod, the new director of CMS Office of e-Health Standards and Services, 2,383 eligible providers have successfully attested for the Medicare Electronic Health Record (EHR) – or electronic medical record (EMR) – Incentive Program. One hundred hospitals have also attested.
Only one thing is certain, few seem to know if EHRs improve quality. As Bates and Classen put it, “Even though the concept of meaningful use is extremely attractive, it remains to be shown that the standards that are being established will result in improvement of care.”
Perhaps the following survey will help resolve some of the questions about frequency of EHR use, EHRs meeting federal standards, and impact on quality.
Here is a review of the survey. If you wish to fill it out, go to the link provided above provided by Michael Koplov.
Q.1
Before starting, please share the name of the EHR product you currently use
Q.2
Productivity and Financial Benefits
Please rate these on a scale of 1 to 5. 1 means “I highly disagree” or “I have not experienced this benefit.” 5 means “I highly agree” or “I have experienced this benefit.”
1) Reduces paperwork and space requirements
2) Reduces administrative staff and expenses
3) Improves collection rates; reduces claim denials
4)Reduces transcription costs
5)Improves accuracy of coding; eliminates downcoding
6)Eliminates duplicate data entry
7)Improves intra-office communication
8)Easier compliance with regulations
9)Greater legibility of notes
10)Greater accessibility of charts, inside and outside the office
11)Enhances clinical documentation
Q.3
Quality of Care Improvements
Please rate 1 to 5. 1 means “I highly disagree” or “I have not experienced this benefit.” 5 means “I highly agree” or “I have experienced this benefit.”
1)More accurate and up-to-date patient information
2)Improves coordination of treatment by more than one healthcare provider
3)Improves delivery of preventative care
4)Improves clinical decision making
5)Minimizes unnecessary lab tests
6)Fewer medical errors and improved patient safety
7)Fewer medical errors and improved patient safety
8) Increases opportunity to participate in PQRI and similar pay-for-performance initiatives
Q.4
Please share other benefits not listed here. We will use the best comments as quotations in our report.
PS. After reading this blog, Michael Koplov sent me this followup email.
"Dr. Reece,
Thanks for taking the time to add your comments and share our survey. We are collecting the data using the survey management website Poll Daddy, so a link to our article would be necessary for users to easily navigate to the survey. Also, I wanted to create for you some unique content to post on your blog, in addition to your thoughts on EHR software.
Do you think you could replace the content in your post with this unique, HTML formatted content? This content should have a clickable link, making it easier for your readers to navigate to the survey.
Thank you very much for your help with this.
Best,
Michael
----
“We're hosting a survey about the benefits of EMRs on our company blog. I was wondering if you could help me out by spreading the word about it on the Medinnovation blog or by sharing it via social media. You can check out the survey at: http://www.softwareadvice.com/articles/medical/benefits-of-emr-software-survey-1081611/ .
2,400 providers have already been able to attest meaningful use. We're curious of the impact EMR software is having on the quality and delivery of health care. After gathering the results, we'll post the survey findings in a couple of weeks.
Would you be interested in posting a quick note about this survey on the Medinnovation blog?
Thanks,
Michael
____________________________
Michael Koploy
ERP Analyst
Software Advice
714 Congress Avenue Suite 200
Austin, TX 78701
michael@softwareadvice.com
(512) 364-0129”
I told Michael I would be glad to help him out. A great deal of confusion exists on how many doctors and hospitals are using EHRs, how many of these EHRs meet federal standards of “meaningful use,” and what impact EHRs are having on quality.
For example, Sally Pipes in her July 16, 2011 column reported “Just 1026 registered hospitals and physicians out of a possible 56,599 reported using electronic health records and other health information technologies in accord with federal standards, “ and on September 1, David Classen MD and David Bates, MD, advocates of EHR, citing government and HIMMS data, said,”Some recent surveys suggest that nearly half of outpatient practices and in 44% of U.S. hospitals.”(“Finding the Meaning in Meaningful Use,” New England Journal of Medicine, September, 1, 2011. According to an August 3, 2011 report from Robert Tagalicod, the new director of CMS Office of e-Health Standards and Services, 2,383 eligible providers have successfully attested for the Medicare Electronic Health Record (EHR) – or electronic medical record (EMR) – Incentive Program. One hundred hospitals have also attested.
Only one thing is certain, few seem to know if EHRs improve quality. As Bates and Classen put it, “Even though the concept of meaningful use is extremely attractive, it remains to be shown that the standards that are being established will result in improvement of care.”
Perhaps the following survey will help resolve some of the questions about frequency of EHR use, EHRs meeting federal standards, and impact on quality.
Here is a review of the survey. If you wish to fill it out, go to the link provided above provided by Michael Koplov.
Q.1
Before starting, please share the name of the EHR product you currently use
Q.2
Productivity and Financial Benefits
Please rate these on a scale of 1 to 5. 1 means “I highly disagree” or “I have not experienced this benefit.” 5 means “I highly agree” or “I have experienced this benefit.”
1) Reduces paperwork and space requirements
2) Reduces administrative staff and expenses
3) Improves collection rates; reduces claim denials
4)Reduces transcription costs
5)Improves accuracy of coding; eliminates downcoding
6)Eliminates duplicate data entry
7)Improves intra-office communication
8)Easier compliance with regulations
9)Greater legibility of notes
10)Greater accessibility of charts, inside and outside the office
11)Enhances clinical documentation
Q.3
Quality of Care Improvements
Please rate 1 to 5. 1 means “I highly disagree” or “I have not experienced this benefit.” 5 means “I highly agree” or “I have experienced this benefit.”
1)More accurate and up-to-date patient information
2)Improves coordination of treatment by more than one healthcare provider
3)Improves delivery of preventative care
4)Improves clinical decision making
5)Minimizes unnecessary lab tests
6)Fewer medical errors and improved patient safety
7)Fewer medical errors and improved patient safety
8) Increases opportunity to participate in PQRI and similar pay-for-performance initiatives
Q.4
Please share other benefits not listed here. We will use the best comments as quotations in our report.
PS. After reading this blog, Michael Koplov sent me this followup email.
"Dr. Reece,
Thanks for taking the time to add your comments and share our survey. We are collecting the data using the survey management website Poll Daddy, so a link to our article would be necessary for users to easily navigate to the survey. Also, I wanted to create for you some unique content to post on your blog, in addition to your thoughts on EHR software.
Do you think you could replace the content in your post with this unique, HTML formatted content? This content should have a clickable link, making it easier for your readers to navigate to the survey.
Thank you very much for your help with this.
Best,
Michael
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Software Advice is hosting a survey on the benefits of electronic health records (EHR) software. If you have successfully implemented are in the process of implementing a system please, please help them out by following this link to take the PollDaddy survey: Benefits of Electronic Medical Records (EMR) Software | 2011 Physician Survey.
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