Thursday, May 19, 2016

Improvement is Not Innovation

LISTEN TO: Arlen Meyers, MD, MBA, President/CEO, SoPE

Innovation is a step further 

"So, the issue is what is innovation? If you ask 100 people, you're going to get 100 different answers. So, here is Arlen's two cents..."First of all there is a difference between an idea, an invention and innovation. An idea is something that pops in your mind - that's the end of it. An invention is an idea reduced to practice. You make a sketch, you build a prototype - you actually start conceptualizing how this thing is going to look/taste/feel, it's reduced to practice. It could be a process or service, it doesn't necessarily have to be a product or goods. But innovation is a step further. Innovation is about creating value and value that someone is willing to pay you for, or exchange something of value which is usually money. So an invention doesn't do you any good unless someone is willing to give you money to use it or buy it. That's what innovation is.

How much is the  changes we are seeing in health care due to innovation?  Much of it is improvement, not innovation  according to Arlen Meyers, M.D., who also founded SO.P.E. (the Society of Physician Entrepeneurs). This boot strapped organization provides some meaningful material for those who want to call themselves entrepeneurs.

As recently as ten years ago  Most physicians were entrepeneurs as the head of their own medical practice. Some were extremely successful following unique models for success in health care and medical practice. Some grew into large multispecialty group with governing bodies.

The founders of many prominent industrial size medical clinics and now health systems were conceived by physicians such as William Mayo, the founders of the Cleveland Clinic, Henry Ford Health Systems, Geisinger Clinic and many others.

What is in MICRA and MIPS ? MU and a lot more - SGR

Such a deal !  Our leaders thought it was a win to eliminate SGR after so many years of waivers.  Actually it was a point of negotiation for those who make these decisions for HHS and CMS as well as Congress.

Without realizing it, our medical organization representatives were naive about the price we would pay to eliminate the SGR. The threat of reductions to reimbursement crept up to over 20%. As a result the agreement or the one sided decision was to substitute MIPS for SGR.

The letters have changed and the bureaucracy increases for those who enjoy paper trails, the hum of computers and the sound of laser printers vomitting reams of paper for analysis only to be shredded at the end of the day, or backed up somewhere in the cloud on a server in a secure site.  These 'cyber-vaults' are visited only by cyber sleuths in t he hope of extracting some vital nugget of information or a giant data stream for the mission of financial gain, or even revenge.

MACRA Webinar Slide deck - 

Friday, May 6, 2016

Mental Health Data Missing from Electronic Health Records

Mental Health Data Missing from Electronic Health Records

The article in HealthLine underscores the issues of developing a total electronic health record. 

Despite federal desires (CMS & HHS )to totally wrap medical records into an electronic format there remain several critical issues important to guarding privacy of patient mental health information. The Federal Definition of an EHR is extends beyond the aspects of recording patient data. They define an EHR with a broad pen including capabilities of meaningful use capturing data for analytic purposes.

By convention, and a long ethical history, providers have always guarded the privacy and protection of patient’s medical records, especially for emotional disorders. The physician has always been the health information collection agent in a fiduciary manner.  If the emotional and behavioral aspects were put into the EHR it would greatly endanger patient’s reputations, employment, and even  discrimination by health plans.  The Affordable Care Act  has markedly reduced the risk of non insurability by law. The other issues have not been addressed.

There is a spectrum of behavioral disorders ranging from severe organic brain disease resulting in schizophrenia and bipolar disorders to mild neurosis and anxiety disorders.  It is a gray playing field and somewhere in the middle it crosses over from ‘medical disorder’ to ‘behavioral disorder" in the reimbursement system. (What's in an ICD code?)

Health Plans discriminate between the two on a reimbursement basis as well. Co-pay for visits to a psychologist are higher than medical visits. In some cases even when an MD psychiatrist is involved the visiit is not treated as a medical visit even if medications are managed by the psychiatrists.

Often the staff at a ‘behavioral clinic’ do not discern the difference and bill improperly.

The federal government is interested in interoperability for purposes of data analytics. The experts who advise congress and HHS are misguided and naive, positing that developing this system will improve the quality of health care.  

Mental health issues should have a higher level of privacy protection. Not every provider should have access to the mental health record of every patient. That is a shot gun approach prone to much collateral damage. Mental health records should only be in the EHR in a higher level of protection with additional access granted only by the patient. The level of emotional dysfunction will be a major determinant in the importance of the information.

In a time when medical care has become patient centered the patient will have the final word on release of potentially harmful behavioral information. It is now established that the patient owns his own data even while it resides in the EHR program. He owns it and no one can take it without the patient's permission. (case precedence ?)

There was a time when public figures could enter a hospital and/or a provider's office and be certain the visit would not be made public. . Politicians, celebrities and other high level people expected this as the normal course of the day.  So too should it extend to all patients with equanimity. Placing this information in the EHR in an unrestricted fashion is not a good thing to consider.

Neither can a metric be applied in this gray zone. Most of it is ‘judgment’  The word that EBMers do not have in their vocabulary.

Unexpected release of protected information either medical or emotional can result in a serious alteration of a patient’s life, and/or employment. Employers like to have this information to determine suitability for employment. Allowing employers or any non medical person not directly involved in the patients health care would be akin to opening Pandora's box.

The Feds are wrong about this, as they have been in most health quality and reimbursement issues. There is no real necessity for inclusion in the EHR the Feds would like it but they are not going to get it unless providers cave in and are once again blackmailed and extorted by another carrot and stick scheme so common to our corrupt system of governing.

Wednesday, May 4, 2016

Dr. Wes: Fearing Exodus: American Board of Medical Specialties Issues Statement on Oklahoma

This important message is networked from the blog of 'Dr. Wes'  Point of information..Dr Wes is a highly regarded cardiologist specializing in cardiac electrophysiology.  A typical highly regarded physician who keeps current without the 'misguided CME mandates of Category I, Category II, etc . Reading journals, internet activity,  consults and discussions lead to far more meaningful education than taking tests. This follows the current trends of 'teaching to the test', a method in elementary school through high school has b een disproven time and time again.

After a long and successful career in Ophthalmology I agree wholeheartedly that personal involvement in patient care and collegial contacts along with small to medium sized regional metings or local specialty medical groups are far more beneficial to practitioners, less financially damaging to practices in terms of time away and fragile financial margins in clinical practice.

The impact of macroeconomics on the microeconomics of providers writing the  check from practice or personal funds is difficult to support.  The IRS deductions are a meaningless endorsement of this ill-conceived extortion by boards of medicine and specialty societies.

All specialty societies should revolt and not provide testing or MOC. The state boards cannot afford to do it, they would disintegrate under the load.  They can barely police the misfits who are licensed to practice medicine.

Do we need this?

The Real Goals

Or is This Better ?

The logic of our doing it to prevent someone else from doing it is a negative incentive and misplaced logic.

Dr. Wes: Fearing Exodus: American Board of Medical Specialties Issues Statement on Oklahoma