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The Promise Of Health Information Technology (HIT) Through Electronic Medical Records (EMR) Is Not Fulfilled

 Stanley
Feld M.D.,FACP,MACE

 In 2005 the
RAND corporation published a
study stating the HIT through EMR can save the
Healthcare System $81 billion dollars a year in a short period of time.

In
2012 HIT and EMR have not come close to fulfilling the RAND study’s prediction.


EMRs
deployed effectively can deliver that promise.

In 2009 the administration’s
stimulus package put aside $19 billion dollars in the first two years and an
extra $50 billion dollars over the next five years to stimulate and subsidize
the adoption of Electronic Medical Records (EMR) to further development of
Health Information Technology (HIT).

The RAND corporation’s 2005 study predicted
a healthcare cost savings of $81 billion dollars a year.

The RAND corporation’s study was
wrong. In the interim healthcare costs have risen $800 billion dollars

 In
our view, the disappointing performance of health IT to date can be largely
attributed
to several factors: sluggish adoption of health IT systems, coupled
with the choice of systems that are neither interoperable nor easy to use; and
the failure of health care providers and institutions to reengineer care
processes to reap the full benefits of health IT.”

Many EMR software development companies have
reaped handsome benefits from the administration’s largess. These software
companies have a strategic defect in common.

These companies are trying to transform the
processes used in the practice of medicine into a process that permits the
government to commoditize the quality of medical care. 

If successful the government believes it
could then “judge quality of care”
and “pay for performance” accordingly.

The goal to ensure success should be aimed at
teaching physicians how to improve the quality of medical care rather than
judging physicians’ care.

The RAND corporation’s new suggestions are
repeating the same mistakes that have failed.

 “We believe that the original promise of
health IT can be met if the systems are redesigned
to address these flaws by
creating more-standardized systems that are easier to use, are truly
interoperable, and afford patients more access to and control over their health
data.

Providers
must do their part by reengineering care processes to take full advantage of
efficiencies offered by health IT, in the context of redesigned payment models
that favor value over volume.”

In the meantime annual health care expenditures in the United
States have grown by $800 billion. 

The new RAND study blamed the underperformance on several
factors,

 “Including: sluggish adoption of HIT systems, along with
balky systems that are hard to use and aren't interoperable; and a failure by
providers and hospitals to adjust care processes to better benefit from
HIT. “

The RAND corporation is looking at the EMR problem
from 30,000 feet. On the ground many private practices and hospital systems had
previously installed information systems that cost them dearly and eroded those
providers’ net revenue.

Money is the main
impediment especially when reimbursement for physicians and hospital systems is
decreasing. Presently, physician groups and hospital systems are struggling to
remain solvent. This is partly from decreased reimbursement and partly from the
cost of ineffective non-functional information systems.

A new capital expenditure
of $65,000 dollars per physicians and $200 to $500 million dollars for hospital
systems is unrealistic even with the government’s partial subsidy. The cost
increases when maintenance fees are added.

 Many hospitals simply do not have the capital
to buy systems that can cost $20 million to $200 million, especially when so
many are struggling to remain solvent. Hospitals also worry about high
maintenance costs, an uncertain payoff on their investment, a lack of staff
with adequate technical expertise and resistance from doctors.

 In 2009 only 1.5 percent of
3000 hospitals had a comprehensive and fully functional electronic medical records
system “ comply with meaningful use criteria.”

The meaning of meaningful
use is all major clinical units in a hospital must perform 24 functions deemed
important by a panel of experts.

The EMR should incorporate
data points. It should include physicians’ and nurses’ notes in data point
format.

The EMR must have the ability
to order laboratory and radiological tests.

It must include clinical
guidelines defining criteria for treating various conditions. It should contain
alerts to avoid dangerous drug interactions and 20 other functions.

It is cookbook medicine all
over again. The goal is to eliminate physician judgment.

On January 1,2013 only 11
percent of the hospitals had even a basic EMR system in at least one major clinical
unit that performed 8 of the 24 functions.

Physicians have been slow to cooperate. Intuitively they
know that a functional EMR might collect data that will be used against them,

The question is will the data improve medical outcomes,
result in less medical complications and less morbidity and mortality? Will it
increase or decrease physicians work hours or increase or decrease physicians’ net
revenue?

“Pamela McNutt, senior vice president/CIO at Dallas-based Methodist
Health System, says HIT advocates were a little naïve early in the
process. 

"There was a bit of over-simplistic thought that if we just purchased
and installed some software that suddenly everyone would start connecting and
talking and it is premature," McNutt says. "Even people who have met
high levels and are ready to meet Meaningful Use Stage 2 still have to work to
get efficiencies."

McNutt
says the whole idea of "efficiencies" in HIT is undefined.

"We
have to talk about what are the efficiencies we are looking for," she
says. 

Accumulating
data to judge performance should not be the goal.  Judging performance does not necessarily increase
efficiency.

The
EMR should improve the physician-patient relationship. It should be for the
patients’ benefit. It should not be for data collection to commoditize medical
care..

The
ideal EMR should be constructed through the eyes of practicing physicians and
not through the eyes of bureaucrats and computer software companies. 

It
should be an EMR that is interoperable and compatible with physicians and
patients needs not the administration’s needs.

The
EMR should be cloud based.

It
should be secure and protect patients’ privacy. 

It
should not result in a capital expenditure by physicians or hospital systems.

Provider
would pay by the transaction.

It
should not provide a financial burden to physicians and hospital systems.

It
could be updated and maintained at no cost to providers.

It
would turn an expense into a profit center for the government.

Why can’t the
administration’s healthcare policy makers figure this out?

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

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The Danger of Information Technology and an Electronic Health Record

Stanley Feld M.D.,FACP,MACE

I have mentioned mistrust by physicians of the insurance industry, the government and hospitals. I have also pointed out the invaluable potential of the Ideal EHR in helping physicians increase the quality of care delivered without being penalized by the insurance companies and government. This mistrust is part of the reason for delayed adoption of information technology by physicians.

Steven Petak M.D., J.D.,FACE, FCLM, current AACE(American Association of Clinical Endocrinologists) President wrote an important editorial in First Messenger (the Newsletter for the AACE) illustrating the danger Information Technology presents as a tool against doctors by Blue Cross/Blue Shield of Texas.

BC/BS of Texas data collection resulted in a defective value judgment of Dr. Petak’s quality of care. BC/BS information technology system made that judgment measuring the wrong thing. BC/BS clearly did not understand the use of a specific drug. Dr. Petak is an excellent doctor as are others in his group. Blue Cross/Blue Shield of Texas did not bother to ask Dr. Petak why he did not practice evidence-based medicine while using the drug metformin.

BC/BS of Texas simply awarded Dr. Petak with a gray ribbon (which is bad) for the whole world, his patients, and potential patients who have insurance with BC/BS of Texas, to see. A dark blue ribbon in the Texas Blue Compare program of Texas Blue Cross/Blue Shield stands for excellent. A light blue ribbon is defined as good or average. How would you, as a patient, like to be going to a bad or average doctor? You wouldn’t!

The ribbon classification is available for all the BC/BS of Texas insured patients. It is an attempt at quality transparency for the benefit of their insured members. The coveted dark blue ribbon would indicate to the world that physicians have mastered applying evidence-based medicine and cost efficiency to their patients. Dr. Peak states “ The dreaded gray ribbon would only communicate my shame and wanting to the world. Although a gray ribbon is defined as not being able to provide a measure because of insufficient data for the physician or specialty or their threshold was not met, I knew my hard won reputation for excellence would now be lost”.

What did Dr. Petak do wrong? He failed to meet the evidence-based requirements concerning diabetes care. He did not do enough eye exams, HbA1c, and urine microalbumin assessments. Metformin is used to treat diabetes. Dr. Petak does not treat Diabetes Mellitus and had so informed BC/BS. He did not submit the claim form with a diagnosis of Diabetes Mellitus. He sees many patients with Insulin Resistance Syndrome (Metabolic Syndrome). Metformin is used in the treatment of Metabolic Syndrome by many specialists. Many female patients with Metabolic Syndrome do not ovulate. When the insulin resistance is treated they can ovulate and become pregnant.

Patients can buy metformin for $4 per month at Wal-Mart. If they had a successful ovulatory cycle and became pregnant, the patient has avoided the multiple tests and procedures of in-vitro fertilization. The saving to the patient in stress, anxiety and money is enormous. The savings to the entire cost to the healthcare system is great.

What was BC/BS of Texas’ problem? The problem was a lack of understanding of medical care. They did not evaluate Dr. Petak with accurate or useful information. Their computer system did not search for the diagnosis of Diabetes Mellitus. They assumed he was treating Diabetes Mellitus. They did not ask Dr. Petak why he used metformin. They simply penalized him. They only evaluated him with one of the elements of quality care. They simply used the tests that should be performed at a given interval in treating a diabetic. BC/BS was only interested in showing the world they are a great company protecting their patients from bad doctors. They had no concern for the physicians’ reputation or the physician-patient relationship.

There are other of examples of insurance companies evaluating quality care with the wrong criteria and presenting physicians with report cards that seem meaningless to me. This is part of the reason there seems to be such resistance to the Pay for Performance. It is simply mistrust by the patients of the insurance companies and the government. Both have declared they want to gain our trust. However, they continually act in a way that creates an environment of mistrust.

Bravo, Dr. Petak for publishing this example. The ideal EHR must be set up so it is physician friendly and a physician extender. It should not be a weapon to be used against the physician.

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 Changing The Rules: It Is Just The Beginning

 Stanley Feld M.D.,FACP, MACE

A proposal to cut Medicaid payments to some insurers with excessive reserves stirs concern from healthcare insurers.

Progressive politicians refuse to believe that entitlement programs like Medicaid are not viable. Politicians should be looking at creative ways to structure the Medicaid form of insurance for both physicians and patients.

https://www.politico.com/states/new-york/albany/story/2018/01/22/proposal-to-cut-medicaid-payments-to-some-insurers-with-excessive-reserves-stirs-concern-206875

I have not written a blog lately because both the Democrats and the establishment Republicans in both the house and the senate disillusion me. Neither house or senate members are interested in being creative.

Neither body knows how medicine works.

These politicians have no interest in doing what is best for the people who elected them. They are only interested in maintaining power and extending their power over the people they govern.

The result will be to decrease to quality of care to patients forever.

In the meantime there have been news stories on how different corporate organization and big businesses are trying to take over medicine.

Many readers have noticed that emergency clinics are popping up in every city and town.

I believe these emergency clinics centers are in reality real estate plays waiting for so that big corporations, like Aetna; to buy them out in order to expand their plans to take over medical care.

It feels similar to the proliferation of small banks in the 1980’s. These new small banks’ plan was to grow and be bought out at a premium by larger banks in order to enlarge the sale premium.

When the defective program (Medicaid) is a failure one should learn from that failure. One should not continue to try fixes to the program (Medicaid) when each fix creates greater dysfunction.

One should institute another plan that might work. However, government officials continuously apply an additional patch that leads to more unintentional consequences.

This week New York State governor Andrew Cuomo put another patch on its failed Medicaid system. I predict this patch will lead to more unintended consequences. The result will be to make Medicaid coverage worse for its New York State’s Medicaid recipients.

Governor’s Cuomo’s initial mistake was expanding Medicaid at President Obama’s request. He then compounded the mistake by subsequently allowing illegal immigrants in the state to receive Medicaid coverage.

It is not wise to take a financially failed system and expand it. It is much better to change the system.

Now Governor Andrew Cuomo’s budget is proposing to cut Medicaid payments to certain health insurance companies with excess reserves, a move that is alarming insurers because of its intent and its ambiguity.

“The proposal, part of the $168.2 billion executive budget released last week, says that any Medicaid managed care or long-term care Health Maintenance Organization that has excess reserves across all lines of business would be subject to a prospective cut in Medicaid rates.”

 Why would an insurance company want to participate in these programs?

The immediate unintended consequence is that the insurance company that found a defect in the payment schedule for HMO’s and managed care would leave the Medicaid market.

The second unintended consequence is it would discourage companies from having incentive to make a profit.

“Under current law, all Health Maintenance Organizations are subject to minimum reserve requirements,” said Erin Silk, a spokeswoman for the Department of Health. “This policy will provide the commissioner with the discretion to make rate adjustments to plans holding reserves in excess of the statutory requirements for reasons that cannot be explained or justified.”

The state did not project any savings from this proposal.”

The state cannot run Medicaid without insurance companies being the administrative service providers. It is the same old story. This comes on top of a proposed fourteen percent tax on for-profit insurers as well as the state receiving a cut of the proceeds when a nonprofit insurer converts to a for-profit insurer as a result of the new tax law.

Governor Coumo wants this additional money because he thinks the insurance industry is going to have a windfall from President Trump’s new tax law. He figures the state will collect $640 million dollars more as a result of this move.

“There were 3 million New Yorkers enrolled in these types of plans in 2014, according to a report from the United Hospital Fund.”

The insurance industry gave the usual illogical reason for opposing Cuomo’s proposals.

These insurance companies are there to make money. They are not going to let Coumo out of his commitment. I believe they will walk away from providing administrative services for the states Medicaid insurance coverage.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

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It Is All about How You Look At Things

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Premises Must Be Re-examined

Stanley Feld M.D.,FACP,MACE

A few weeks ago I had a terrific exchange with Steve Brachet M.D. who forwarded my blog to Steve Gregg.

“Stan,

I forwarded your recent blog featuring the five essential steps for HC reform to Stephen Gregg of Portland Oregon.

Steve Gregg is a former senior hospital executive, turned CEO of a managed care plan (successful in WA and OR), developer of alternative healthcare products, developer of patient care informatics, and thought leader in past 10 years on dimensions and confounding variables of health care in all its complexities.

He asked me to send the attached (very brief) piece recently published in the Oregon main media.

I don’t know if he expects a comment or two – but if you care to comment feel free to respond to Steve Gregg directly.

I take it that you are continuing to do your best to ‘right this HC ship’ that seems unlikely to improve on its own – nor with the help of the current Congress.

Steve Barchet M.D.”

I was fascinated with the article Steve Gregg wrote. I agree with many of the points he makes. I am publishing his article with Steve Gregg’s permission. I wrote back and said;

Dear Steve

I welcome your article.

My blog explains the elements needed to Repair the Healthcare System from a physician’s point of view.

As a result of the Internet and improved software, consumers have become king and are driving the consumer consumption market. Amazon and ebay have led the way. Opaque purchasing models have been replaced by price transparent purchasing.

Wal-Mart has been forced to close stores because of online purchasing to remain competitive.

A consumer driven transparent online purchasing model has replaced airline ticket purchasing through travel agencies.

Online banking is transforming banking services. Hardly anyone goes into banks anymore.

There is no reason that shopping for healthcare services cannot transform the healthcare industry with all its opacity.

Consumers must be put in a position to drive the healthcare system and be responsible for their health and healthcare dollars.

Our 2020 business model can transform the dysfunctional healthcare system that can align all the stakeholders’ vested interests by empowering consumers and letting them drive the system.

The result will be a decrease in cost. It will eliminate the entitlement mentality of healthcare consumers and create a competitive mentality for all stakeholders as it has done in the examples above.

All Obamacare is doing is trying to put a patch on a healthcare system whose demise has been accelerated since passage of the Affordable Care Act.

Your articles describe many essential premises that must be reexamined.

However, consumers must be involved and be the responsible party in the healthcare system. They have to be given financial incentive to be involved and responsible.

Thank you for letting me reprint your article.

 

Health Reform…What Next?

Steve Gregg

With the expensive collapse of Oregon’s Health Exchange, a New Year, and approaching changes at the Federal level, it is time to reconsider the formative assumptions driving health care reform.

Ten Game Changing Assumptions Shaping Health Reform:

 

  1. The ideologies of the left and right will not sustain a reform solution grounded in compromise and “deal making”.   The endless search for consensus confuses the problem, and is a recipe for failure.

 

  1. The State’s public bureaucracy is too conflicted with its own self interest to impartially govern health reform.

 3.The plethora of proposed actions to reduce demand will not reduce costs. “Supply” being a more important driver of costs than ”Demand”.

  1. Sustainable reform cannot tolerate the variation in provider pricing to patients with differing sources of payment. Perhaps less than 15% of the typical hospital’s patients pay what the hospital bills.

 

  1. It is wrong headed to view reform as a matter of amending the existing system.

 

  1. Financial goals stabilizing health care costs cannot be achieved without prospectively stated and independently measured metrics.

 

  1. Equal access is not a realistic expectation. Universal coverage must be.

 

  1. Genuine Altruism is a deceptive and widely abused value of our non- profit institutions and trade associations.

 

  1. The United States spends twice as much per capita on health care because our health care workers of all stripes (including insurance companies,hospital sytems, government and pharmaceutical companies) s(take out twice as much from the system.

 

  1. The health care structures of other countries, while instructive, are not transferrable to the United States.

 

Bonus:

 The Oregon Healthcare Project rationing experiment was a colossal hoax that channeled billions of new dollars to Oregon’s health care interests. Never measured, never critically evaluated. It was a severe case of the “Emperor Wears No Clothes”.

Conclusion: Think in terms of 2-3 alternative systems reflecting differing ideologies: Liberal / Conservative / Libertarian.

What would this suggest for process?

 

  • Form 3 small task forces assembled around three ideologies: Liberal, Conservative, and Libertarian to articulate assumptions, problem definition, and a broad solution compatible with each ideology.
  • At the end of the process examine what consolidation can occur and if not presume the development of 3 systems available to the free will of people to chose.

 

Liberal: Socially and fiscally liberal

Conservative: Fiscally and socially conservative

Libertarian: Socially liberal / Fiscally conservative

 Note: The prospect of 3 systems capturing U.S. Healthcare, sounds daunting but in reality we have more than that now: Employer, Medicare, Medicaid, TriCare, Municipal, Insured, Self funded etc.

 Alternative List of Assumptions:

 

  1. A sustainable health reform strategy cannot be achieved without the foundation of a well-conceived definition of the problem and formative assumptions.

 

  1. Subsidized or “free” health care is inflationary and will overwhelm administrative protocols for cost reduction.

 

  1. Genuine Altruism is rare and a widely abused cover for proprietary agendas.  Excessive profit is a measure of good management.

 

  1. The community’s health care pathology is infinite and those making a living and profits from health care will seek to capitalize on that.

 

  1. Our health care system in the main is a proprietary endeavor with millions of economic interests seeking to protect or increase revenues. Any initiative that threatens that cash flow will be vigorously resisted.

 

  1. Does the system tilt toward choice and self – determination or equalness, limited choice, and a central authority?

 

  1. “Nearly half of all care delivered produces no medical benefit” is in obvious conflict with a prevailing view of vast health manpower shortages.   Does increasing supply reduce prices and the costs of health care?

 

  1. If the national will demands universal coverage, the utility of competing traditional insurance companies should be called into question.

 

  1. The reformed system must promote individuals seeking care from the “best” provider of care as early as possible in the development of any adverse health care condition.   Forcing patients into an inferior food chain of care is unethical and probably more costly in the end.

 

  1. There is something wrong with a requirement to select a health plan, provider network, and insurance in advance of acquiring a dire condition, and then being locked out of access to the “best” provider.

 


Steve

I do not see consumers playing an active role in your assumptions to Repair the Healthcare System.

Obamacare is wasting money developing an entitlement system that cannot work. The only stakeholder that can develop a healthcare system that can work is a system driven by consumers.

Consumers can force the secondary stakeholders to be competitive and transparent, as they have done in other industries.

It would be cheaper for the government to invest in empowering all consumers using the revolution in information technology and providing financial incentives to all using My Ideal Medical Saving Accounts.

Everyone could be insured as I have described in my article The Ideal Medical Saving Account Is Democratic.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

 All Rights Reserved © 2006 – 2015 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

 

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Making Medicine Function: Five (5) Key Elements From Stanley Feld M.D.,FACP,MACE : Repairing the Healthcare System

Scott Becker of Becker’s Healthcare asked me to write an article on Element needed to Repair The Healthcare System. Becker’s Healthcare is the leading source of cutting-edge business and legal information for healthcare industry leaders.

His portfolio includes five industry-leading trade publications:

  • Becker’s ASC Review
  • Becker’s Infection Control & Clinical Quality
  • Becker’s Spine Review
  • Becker’s Hospital Review
  • Becker’s Dental Review

My article appeared in the latest addition and with permission from Scott Becker. I am reprinting it on my site. Becker’s Healthcare is a valuable information site.

Making Medicine Function: Five (5) Key Elements From Stanley Feld M.D.,FACP,MACE : Repairing the Healthcare System

Patients, physicians, hospital executives, healthcare insurance executive and government all believe the healthcare system is dysfunctional and unsustainable in future years.

All the stakeholders are unhappy with Obamacare.

Clinical Endocrinologist, Stanley Feld, MD, FACP, MACE, is a physician who believes Obamacare’s business model is seriously flawed. He also believes that Obamacare has accelerated the dysfunction in the healthcare system.

Dr. Feld believes Obamacare has increased the healthcare system’s unsustainability by causing an increase in bureaucracy, a decrease in efficiency and encouraging the gaming of the healthcare system by all stakeholders.

The Obamacare business model must be changed to a consumer driven healthcare business model with the consumer in charge and in the center of the healthcare system, not the government or other secondary stakeholders.

Consumers must be taught and incentivized to use all the 21st century technology tools available including smart phones. The goal must be to improve medical care and treatment outcomes, not improve the measurement of medical process outcomes.

Dr. Feld became interested in the causes of the healthcare system’s dysfunction in 1991 while he was on the steering committee of a nascent medical organization, the American Association of Clinical Endocrinologists (AACE).

He became AACE’s third President and was chairman of the Type 2 Diabetes Guideline committee. He was the chief author of “A System of Intensive Self-Management of Type 2 Diabetes Mellitus.”

In 1991 there was little government and healthcare insurance industry support for the concept of teaching the Type 2 Diabetics how to be the “Professor of Their Disease” even though there was a Type 2 Diabetes epidemic.

The epidemic was the result of lack of understanding by consumers (patients) of how to prevent and treat Type 2 Diabetes Mellitus. Uncontrolled Type 2 Diabetes causes complications that are coronary heart disease, kidney failure, blindness and amputations. Quality of life of is decreased. The complications are costly to the patients and the healthcare system.

America was in the midst of an obesity epidemic. The epidemic continues today. Obesity predisposes consumers to Type 2 Diabetes Mellitus and its subsequent complications.

Dr. Feld said everyones goal for the healthcare system is to have a healthier population at an affordable price. The goal can be accomplished by putting consumers in control of their health and healthcare dollars. Consumers must also be given financial incentives to control their health. No one is focused on the consumer’s responsibility to lower cost in the Obamacare business model.

Dr. Feld believes Obamacare’s business model has too many faults to repair. Each time President Obama alters the business model to fix a fault, the healthcare system becomes more costly, dysfunctional and unsustainable.

Dr. Feld developed a business model that would accomplish the goal of providing a functional and efficient healthcare system at an affordable cost to consumers, employers, healthcare insurance companies and the government.

Dr. Feld’s business model would eliminate most of the government’s inefficiency that absorbs 40% of the healthcare dollars. The inefficiencies must be eliminated or at least significantly decreased.

Here are Dr. Feld’s five key elements necessary to Repair the Healthcare System.

All the key elements listed are explained in detail in Dr. Feld’s blog “Repairing the Healthcare System”. Each link will have a full list of my blog posts on the topic.

  1. The Ideal Medical Savings Accounts (MSAs).

Dr. Feld’s Ideal Medical Savings Account is the insurance model in his business plan.

Medical Saving Accounts are different than Health Savings Accounts. Health Saving Accounts are the fastest growing healthcare insurance plans. Medical Saving Accounts provide consumers with more financial incentive.

The Ideal Medical Saving Account transfers the premium dollars saved by consumers into a tax-free retirement trust that is not restricted to medical care. The financial incentive will cause consumers to be responsible for the control of their health and wisely spend their healthcare dollars.

The Ideal Medical Savings Accounts are democratic. The employer, the individual or the government could fund the Medical Savings Account. The deductible must be high enough to provide enough financial incentive for consumers to be motivated to become responsible for their health and their healthcare dollars. Once the deductible is reached the consumer receives with first dollar coverage for an illness.

If the deductible is not spent the consumer gets it tax-free in their retirement trust.

Ideal Medical Savings Accounts provide consumers the choice of physician. The environment is created where consumers decide on who will provide the best value for their healthcare dollars rather than the government, the healthcare insurance industry or the government.

MSAs would create a Consumer Driven Healthcare System with the benefit of consumers creating competition among the stakeholders in the healthcare system rather than stakeholders deciding for consumers. For greater details go to this link.

  1. The Importance of Tort Reform

Most politicians have ignored the importance of Tort Reform. They have been led to believe that Tort Reform is an insignificant cost to the healthcare system.

Dr. Feld points to study by the Massachusetts Medical Society. Every practicing physician believes the data of this study. The resulting data is an excellent and truthful indicator of the huge cost of over-testing to prevent malpractice claims.

The lack of Tort Reform costs the healthcare system $200 billion to $750 billion dollars a year as a result of over testing by physicians to avoid malpractice suits.

Physicians who order a test usually do not receive the profit built into the test he/she has ordered.

  1. The Importance of Self-Management of Chronic Disease

The unsuccessful management of chronic diseases results in 80% of the cost of care for those diseases. Most important is to prevent the chronic disease from occurring in the first place. Diseases with the highest costs are Diabetes Mellitus, Heart Disease, Hypertension and Cancer. Obesity and consumer’s genetic makeup are responsible for most of these chronic and costly diseases.

Consumers are in control of the development of obesity. They must be responsible for preventing it. However all of our cultural stimulation encourages obesity. Consumers must make a choice. Government can provide public education programs to help consumers make the correct choice. When consumers are educated and are at financial risk for developing obesity, they will become responsible and avoid becoming obese.

The reformed healthcare system could prevent the onset of complications of these chronic diseases. The cost of the complications of chronic disease is 80% of the cost of treating that disease.

These teams must be an extension of their physicians care and responsible to their physician.

  1. The Magic of the Patient/Physician Relationship.

Obamacare tries to quantify patient care. Twenty thousand rules and regulations have been produced so far to measure the care delivered by physicians to patients.

Maybe the measurement criteria for quality care are wrong? Maybe the government is measuring the wrong thing.

There is no quality measurements made about patients’ compliance or adherence. There are no rules to measure the patient/physician relationship.

These would be important measurements for bureaucrats to measure in order to quantitate the effectiveness of care.

If one wanted to commoditize the delivery of quality medical care, consumer responsibility for compliance with their treatment is an important measurement.

The patient/physician relationship is magical. It can result in improved patient compliance and self-management of both acute illness and avoidance of the complications of chronic diseases. The end result is that it can decrease the cost of healthcare by at least 50 percent. The healthcare system would then be affordable.

As the government and healthcare insurance companies try to decrease their cost they have decreased reimbursement and increased regulations and paperwork for physicians

A physicians work product is intelligence, skill and time. Physicians do not have enough time to develop a patient/physician relationship today.

The patient/physician relationship is difficult to measure. It cannot be commoditized into a universal report that a computer program can generate.

  1. The Rule of Information Technology

Physicians are not opposed to information technology. They are against information technology generating data that is being used as a tool to judge their clinical competence and reimbursement by bureaucrats. Many times the “big data” is inaccurate.

Information technology should be used as a tool to extend a physician’s ability to patients. It should be used as a tool to improve physicians’ care.

In order to reduce the cost of medical care and increase the patient’s ability to be a “Professor of Their Disease”, medical care must be delivered by a team approach.

Information technology must be a part the team with the consumer being in the center. Physicians must be the coach; the other members of the team must be physician extenders (assistant coaches).

There are many websites generating both good and bad information. As the manager of the team the physician and his assistant managers should pick the websites for his/her patients to use.

Physicians and his/her healthcare management teams should develop social networks so his/her patients can relate to each other and learn the subtleties of their chronic disease from each other. Physicians and his patient extenders would monitor and correct any false information generated through the social network.

These social networks would be very effective in motivating consumers to be responsible for their care and their healthcare dollars.

These are five elements that would decrease the cost of America’s healthcare system. They would avoid the trap and unintended consequences of a single party payer system.

The real cost curve has not been bent downward. It has been bent upward in the actual cost to taxpayers. The government is not measuring all the costs, including new taxes, as payment for Obamacare.

 

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

 All Rights Reserved © 2006 – 2015 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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I Told You What To Do 8 Years Ago: Part 3

Stanley Feld M.D.,FACP,MACE

I told you about all my ideas necessary to repair the healthcare system 8 years ago. None of the ideas have changed

Politicians and their healthcare policy wonks have not implement or supported any of theses ideas. The adoption of Obamacare has made the healthcare system worse.

“The hardest thing to explain is the glaringly evident, which everybody has decided not to see.”

Any Rand, The Fountainhead

It is a pity that the public votes for people who hold their vested interest and their quest for power above the needs of the people.

It is worse that the traditional media works as a special interest group to support the politicians’ quest for power over the people.

Our government is getting further from the solution to the problems of our healthcare system in order to force consumers to be more dependent on big government and less responsible for themselves.

The end game will be a disaster for Americans, our freedoms and our financial well-being.

My ideas do not support the vested interests of secondary stakeholders. I support consumers’ interest. Many of these secondary stakeholders are abusing the healthcare system. They take advantage of consumers.

The government is one of those secondary stakeholders that cause dysfunction in the healthcare system with its endless regulations.

The government regulations are written to control physicians and patients..

Consumers’ health and their healthcare dollars must be the responsibility of the consumers. A consumer driven healthcare system is the only way to stop the evolving medical care and financial disaster.

This week the progressives in Colorado blew my mind. They want to eliminate Obamacare because it has failed and replace it with a state run single party payer system.

This group has 200,000 signatures to petition that its proposal be put on the 2016 ballot.

In the small print they are proposing a $25 billion dollar tax increase to pay for the proposal.

Obamacare has resulted in increasing the cost and dysfunction of the healthcare care system. The adoption of this single party payer system will make it worse.

I am sure many people in Colorado are unaware of the progressives’ stinking thinking.

However, the petition is the first step in President Obama’s scheme to make thing so bad that the people beg the government to take over the entire healthcare system.

This tactic is right out of Saul Alinsky’s playbook and right up Hillary Clinton’s alley.

Meanwhile, “What Have I Said So Far? Spring 2007 Part 3 is republished below.

Maybe people will start paying attention to what is happening in our healthcare system before it is too late.

For more details on each proposal please click on the links.

“What Have I Said So Far? Spring 2007 Part 3

Stanley Feld M.D.,FACP, MACE

 

The following are additional solutions necessary for the Repair of the Healthcare System

Disease management systems can be developed in primary care physicians’ offices because there are not enough specialists to take care of all the patients with chronic disease.

 Treating chronic diseases this way should lower the complication rate for chronic diseases. The result should be a reduction in the cost of healthcare by at least 45%.

 

Measurement of quality should be all of the above. However, the key measurement of quality is the medical outcome as it relates to the financial outcome. If you prevent a $50,000 complication utilizing $1,000 of treatment you have a leveraged financial outcome as well as an excellent medical outcome.

The main question is, “was the complication of the chronic disease avoided?” We are misguided when we start believing that measuring the percentage of our patients we measure cholesterol on, or the percentage of patients on whom we do colonoscopies or bone densities is a measure of quality of care.

It is simply one element of quality medical care and it should not be rewarded as the Pay 4 Performance advocates are suggesting. This thinking makes us vulnerable to another false hope of reducing complications of chronic diseases.

 

  • Increasing obesity in our population is a huge health risk.The government should declare war on obesity. It should strive to eliminate the many stimuli we are exposed to. It should institute a gigantic public media campaign to explain the health risks and the stimuli in society to overeat.

    The most important need is to put the patient in charge of his disease management. The patient must be responsible for his care and in control of his health care dollar. We do not need more schemes destined to fail such as;

the California and Massachusetts mandates. We do not need the Pay 4 Performance scheme that will distort the healthcare system even further.

We need some common sense infused into the development of a healthcare system that is driven by the patients and not the facilitator stakeholder for the purpose of the facilitator stakeholders’ bottom line.

If patients do not want to take care of themselves they will suffer medically and financially.


These are some of the solutions I have proposed. We need the political will and leadership to institute and execute these solutions.

Responsibility for follow up care and compliance must be the patient. The physicians are the teachers educating patients to be experts in their disease self- management.

In the present system the penalty to the patient is bad health. The new system should have a clear message of good health and financial reward. It is much cheaper for all the stakeholders in the long run.

The patient has to;
• Be responsible for the purchase of care.
• Have ready access to care.
• Be responsible for the appropriate adherence to care and medication regime given by the physicians.
• Be rewarded for excellent lifestyle changes and avoidance of complications of disease.

If this is accomplished, and it can be with appropriate leadership and the demand by the consumer, we can repair the healthcare system.”

It is almost past time to start listening and demanding a “consumer driven healthcare system.”

Consumers have Patient Power and do not even know it.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

 All Rights Reserved © 2006 – 2015 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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I Told You What To Do 8 Years Ago

Stanley Feld M.D.,FACP,MACE

I started my blog Repairing The Healthcare System in 2006. I methodically described the defects in the Healthcare System.

I provided healthcare alternatives in policy and regulations to both Democrats and Republicans to Repair the Healthcare System.

No one listened to me.

In 2007 the healthcare system was unaffordable and unmanageable.

Republicans had some weak ideas and no inclusive business model for the future.

The election of President Obama and the partisan passage of Obamacare have accelerated our healthcare system’s demise.

I believe President Obama’s goal is to destroy the healthcare system. He wants it replaced with a single party payer system (2003). Consumers of healthcare know the government cannot manage healthcare.

American cannot sustain Obamacare financially. Consumers cannot be sustained medically with Obamacare or after the collapse of Obamacare with a government run single party payer system.

The obvious proof is the dysfunction and failure of the VA Healthcare System, Medicaid and Medicare.

All these healthcare systems are government run single party payer systems. All are unsustainable.

As I was archiving my blogs I ran across four blogs I wrote in 2007 outlining the problems and what should be done about them.

The government has made none of the repairs I have suggested. Obamacare has made the situation worse. I will present all four parts of “What Have I Said So Far? Spring 2007” consecutively as written.

What Have I Said So Far? Spring 2007 Part 1

Stanley Feld M.D.,FACP,MACE

April 01, 2007 in Medicine: Healthcare System

 In August 2006 I summarized my blog to that point. I outlined some important solutions necessary to Repair the Healthcare System.

Since then I have covered many of the solutions to the key questions I raised. Not one of these questions has been addressed effectively by our leadership or people in control of making policy.

One must ask: Do they really want to solve the problems in healthcare delivery in this country or are they focused on preserving their own vested interest to the exclusion of a breakthrough that might benefit not only their vested interests but the vested interest of all the stakeholders.

The questions were:

  • How do we reduce the cost of medical care? • How do we provide affordable insurance for the 45 million people uninsured?
    • How to we provide affordable medical care coverage so that all the patients can have access to medical care?
    • How do we align all stakeholder incentives?
    • How do we construct a system so that all the stakeholders make a reasonable return on investment?
    • How do we close the holes in the system to eliminate abuse by stakeholders?
    • How do we restore trust between stakeholders?
    • How do we restore trust between the patient and physician?
    • How do we stop secondary facilitator stakeholders from continuously destroying the patient physician relationship?

In reality, developing solutions to these questions are in themselves business opportunities for facilitator stakeholders that can help Repair the Healthcare System.

However, neither the insurance industry, hospital systems, nor the government see the long term advantage and economic opportunity.

In a comment to my blog Shel Isreal said “

98% of the people think it is broken and the other 2% work for the insurance industry.

The insurance industry has the money and the power.”

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2007/01/the_ideal_elect.html.

However, we have demonstrated the abuse and misuse of the power of information technology by the insurance industry. The misuse and abuse has lead to further dysfunction in the healthcare system and mistrust by the hospitals and physicians.

The insurance industry and the government have used information technology to penalize both physicians and patients using the wrong data to draw their conclusions.

Insurance companies do not have the information technology resources to measure the correct parameters to measure quality care.

I do not see an attempt on their part to correct this deficiency. I only see a movement to make the healthcare system worse with a Pay for Performance (P4P) reimbursement system that is not well thought out. .

It is essential that the solutions I have proposed be coordinated and introduced simultaneously as a single plan rather than introducing elements of the solution separately.

Unfortunately, the government with the pressures of its present political vested interest influences finds it difficult to present the components of repair as a single plan.

The solutions will have to be driven by the consumer (the patient) and not the government. The patients have the power to drive the solutions because they are the users of the healthcare system. If they were the purchases of healthcare, some clever entrepreneur could provide the option for a compelling insurance product that could reward the patient for being responsible for their own care and well being.

The insurance produce could be built to fix the healthcare system.

All that is needed is for the government to write sensible regulations, enforce them and get out of the way.”

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

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The Shovel Ready EMR Project?

Stanley Feld M.D.,FACP,MACE

  The Health Information Technology for Economic and Clinical Health (HITECH) Act passed in 2009 directed 5 % of the $800 billion dollar economic stimulus package towards digitizing medical records.

This was considered one of President Obama’s shovel ready projects. This project has lots of problems and was much less than shovel ready.

It was George W. Bush, not Obama, who started the project to digitize medical records. EMRs make sense if they are directed toward improving patient care.

President Obama funded the project with his shovel ready economic stimulus package in 2009. Physicians dislike the project. Patients find little value in the project.

It is estimated that in five years 50 times more health information will be generated and digitized than today. Diagnoses, treatments, DNA, medical images and vital signs already are being analyzed and stored.

One large problem is Americans don’t own their own healthcare information.

In its present form patients find little useful information in the EMRs. Many of the EMRs do not fit the Obama administration’s criteria of meaningful use EMRs. Medical practices will experience a penalty this year.

Government punishment hardly ever works. Government providing for innovative opportunities works.

The government and the insurance industry own the information.

The big data is derived from meaningful use EMRs. The government is only interested in evaluating the quality of physicians’ care. The government would like to decide on the reimbursement of that care.

The EMR has not added value to patient care because physicians have to spend too much time concentrating on filling in required documentation. Much of the information is worthless because they cut and paste template reports that are required documentation for the government to judge. The medical record is cluttered with information that is not useful.

The cost is physicians do not have time to relate to patients.

Michael F. Raab, M.D.Sanibel, Fla writes in the WSJ

 “I recently received 147 pages of EMR which took me 30 minutes to review. I only found three lines that added new information.”

HIPAA (Health Insurance Portability and Accountability Act) requires hospitals, physicians, labs, pharmacies and other “covered entities” as well as the health plans and their “business associates” (for example, an information-technology vendor) to protect how your data. This rule applies only to paper record. It does not apply to digital records.

Most EMRs aren’t covered by HIPAA at all, and providers and vendors can do whatever they want with your information.”

Digital records are vulnerable to hackers. Health records were stolen from nearly 80 million Anthem health-plan members. The façade of privacy has been exposed.

Electronic medical records companies, and hospitals and health systems that own physician practices own the patients’ digitized healthcare records.

These entities have withheld health information from patients in order to gain an edge over competitors. It becomes difficult for patients to switch to other healthcare plans or providers without their records.

Patients are entitled to their records but they must get past vendor delays.

There is great financial value of patients’ data beyond competitive advantages to these providers. The value is in marketing research for specific demographics. The revenue comes from using health information for drug research, targeted marketing and other efforts.

Many big data companies are investing heavily to own a piece of the multi-billion-dollar monetization of health information.

 “These companies know that whoever controls health information will dominate the health-care marketplace and its vast profit pool.”

Congress has been slow to fix these problems. It needs to update health-information policy and privacy rules.

These are the four most important rules that Dr.David Brailer (the former national health information technology coordinator in the Department of Health and Human Services (2004-06)has outlined.

"1. Individuals should have unqualified ownership of their health information. Every person should be able to access his information whenever he wants, without blocking or delay.

1a. Health information should automatically follow patients wherever they get treated, unless they don’t want that to happen.

1b. Patients should be able to control which people and organizations are allowed to see their information, and whether those organizations can retain that information.

2. Individuals should be able to designate an intermediary to manage their information on their behalf. Many people would not want to handle their health information, so an “infomediary” could assist them and ensure that their information is used to advance their health status.

2a. Intermediaries could be a spouse, a hospital, a health plan, a pharmacy or even a tech company like Google, SalesForce or Yahoo.

 3. Standards for security protection should be raised so that information is protected wherever it flows.

3a. A secure medical Internet—encrypted data lines that are walled off from hackers and other threats—is needed to protect the perpetual movement of information among hospitals, physicians and other legitimate data holders.

4. Every “covered entity” that touches health data, including every app, should follow the same rules."

Congress must act now!

The goal of the EMR was to have computers that could talk to each other for instant availability of patients’ medical information to enhance care and decrease retesting.

The availability of the $30 billion dollar Obama stimulus and the lack of consumer control has led to an evolving inefficient bureaucracy and rules and regulations that have created pain for the two most important stakeholders, patients and physicians.

The EMR project was not shovel ready as President Obama promised. It has turned out to be a waste of money. Instead of improving patient care it is hurting patient care.

An effective healthcare system would provide consumers with ownership of their healthcare data, their healthcare dollars and a desire to be responsible for their health.

 The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

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