Consumer Driven Health Care

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Ideal Medical Savings Accounts For Everyone: Encourage Patient Responsibility!

February 12, 2012

inConsumer Driven Health Care, Information Technology in Healthcare, Medicine: Healthcare System

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Stanley Feld M.D.,FACP,MACE

The third spoke in the future states wheel is Patient Responsibilty for their health and Healthcare dollars.

The Ideal Medical Saving Account would decrease the cost of the Healthcare System because it would dis-intermediate the Healthcare System’s complex and convoluted business model.

The Ideal Medical Savings Account should be an option for all consumers who have all types of insurance coverage. The Ideal Medical Savings Accounts would create competition for patients among physicians. It would create competition among healthcare insurers.

Medicare, Medicaid, corporate self-insurance plans, association healthcare plans, individual healthcare plans and ordinary healthcare insurance plans provided by employers could all offer the Ideal Medical Savings Account.

If MSAs were structured as my Ideal Medical Savings Account is structured the result would be a decrease in the cost of healthcare, a decrease in premium costs and an increase in healthcare quality.

The Ideal MSA must be paid for by pretax dollars as all other healthcare plans are.

If the government, individual or employer puts the first $6,000 of insurance in individual trusts for the consumer the entire healthcare and medical care supply chain would be disrupted by consumers.

An immediate argument is Medicaid patients are not smart enough to determine their own healthcare needs if they were responsible for the first $6000 of healthcare insurance coverage.

This is rubbish. It is condescending to patients on Medicaid. If the government is so worried they should provide education to help these Medicaid consumers make wise healthcare choices using available social media.

The entire goal of the Ideal Medical Savings Account is to provide incentives for consumers to become responsible for their health and healthcare needs rather than be entitled to medical care.

The mechanism for this reversal from a dysfunctional system’s business model to a functional system’s business model is patients’ owning their healthcare dollars and having financial as well as medical incentive to be responsible for their health, maintaining their health, and choosing the most efficient and effective medical care.

Consumers would become Prosumers (Productive consumers) of health care rather than passive consumers of healthcare.

This mechanism has worked in many industries using the Internet as a facilitator.

The Internet can become an extension of the physicians care.

At present there are many web sites offering advice to patients. The defect is they are not an extension of the physician’s care of the patient.

Physicians would be motivated through competition for the patients’ owned healthcare dollars to choose the sites for his patients that would be an extension of their care.

Physicians associations could create web sites for their members. Social networking between physicians and their patients could direct their patients to that site. This would be the meaning of an extension of the physician’s care.

Patient responsibility is the third spoke in my formulation of the future state business model of a functional healthcare system.

It must be remembered that the present state’s business model is dysfunctional. It must be repaired.

The future state must not be encumbered by any of the baggage of the dysfunctional present state business model.

If the future state model is made clear to patients, potential future patients and recovered patients (consumers) they will demand for this future state model.

Using social media consumers can drive the healthcare system to the future state business model.

It turns out everyone is better off and the system is more efficient and costs less for consumers.

The consumers would own the first $6,000. They would be responsible for the management of there healthcare dollars. They would also be responsible for choosing their physician.

I have found that when physicians and patients sign a patient physician contract the treatment results improve. Both physicians and patients have their responsibilities clearly defined.

The patient physician contract motivates patients to be responsible for their own care. Patients responsible for their care is critical to successful clinical outcomes.

If there were a financial incentive attached to this physician patient contract along with a potential bonus the results would be even better.

This was especially true in the treatment of Diabetes Mellitus.

In treating chronic diseases such as Diabetes, physicians must be the teachers, prescribers and coach. Patients must become the professor of their disease. Patients live and care for their disease 24/7.

Financial incentives would motivate patients to take an active role in their medical care.

Obesity is a major problem in America today. Patients and patient education is the only solution to the “The Obesity Epidemic.”

The only way to decrease obesity is by burning more calories than is eaten. Society must encourage exercise, and reducing intake. It turns out society encourages the opposite.

Mayor Bloomberg is doing the right thing in New York City. He uses simple transit Subway advertisements to increase awareness caloric intake. He has required each restaurant to publish calorie counts.

It is a simple educational message that everyone can understand. It is amazing how intelligent people misjudge their caloric intake.

Constant repetition of calorie counts of various foods along with estimates of calories burned can result is a cultural change for the need to burn more than we eat.

Companies such as FitBit are building simple products to help us achieve this goal.

Obesity contributes to the onset of many chronic diseases. The treatment of the complications of chronic disease result in eighty percent of the healthcare dollars spent for direct patient care.

If a consumer abuses his health and ends up spending the initial $6,000 he has no money left to put into his retirement account.

If a patient has a chronic disease and has excellent control of his disease he can avoid the complications of his disease. If the patients take the appropriate medical care avoids hospitalization and the emergency room for the year, the provider of his Ideal Medical Saving Accounts can afford to give that person a bonus for his retirement account.

This would add an additional financial incentive for consumers.

As a society we are smart enough to solve the problem of a dysfunctional healthcare system. The present course is unsustainable.

The future state’s business model with consumers responsible for their healthcare dollars and the patient physician relationship restored can achieve the goal of a sustainable healthcare system.

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

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The Second Spoke Of The Wheel: The Ideal Medical Savings Account

February 8, 2012

inConsumer Driven Health Care, Health Savings Accounts vs Medical Savings Accounts, Healthcare Insurance Industry, Information Technology in Healthcare, Medicine: Healthcare System, Stakeholder Mistrust

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Stanley Feld

"Dear Dr. Feld

If your ideal Medical Savings Account is such a good idea why has it not become more popular?"

The reason is simple. The Ideal Medical Savings Account does not exist as a healthcare insurance option. The healthcare insurance industry has obfuscated the purpose of creating financial incentives for consumers with the offer of Health Savings Accounts.

The Health Savings Accounts keep premium dollars in the healthcare insurance industry’s control at the end of the year. Consumers are able to use unspent money on healthcare deductible in the future.

The Ideal Medical Saving Account puts the money not spent in a separate tax-free trust for consumers’ retirement. The logic is to reward consumers for good health financially and to encourage consumers to be responsible for their health and healthcare choices.

The goal is not to reward the healthcare insurance company it is to reward consumers. The healthcare insurance industry is controlling the consumer’s money for its own profit.

Despite its faults HSA’s are becoming very popular. It is the fastest growing healthcare insurance product in America.

President Obama wants to eliminate HSAs. His goal is to increase government control over consumers’ healthcare choices. He does not want consumers to control their healthcare dollars. He wants to control consumers.

The healthcare insurance industry’s goal is to maximize its profit. It is not concerned about the consumer’s health. The more consumers in the healthcare system the more premium dollars the healthcare insurance industry controls.

Using the power of lobbying and the influence of lobbyists it has been able to rig the game against the consumer.

"Wendell Potter, former senior executive^[1] at Cigna turned whistle-blower, has written that the insurance industry has worked to kill "any reform that might interfere with insurers' ability to increase profits" by engaging in extensive and well funded, anti-reform campaigns."

"This is nothing new. However, as consumers (patients in all three categories) the Internet and social networking can empower us to have more influence over the politicians than lobbyists."

"After all, we are the people who give them their jobs. Some might say this is a naïve view. However, recent events have shown the effect of People Power and its ability to disrupt the establishment and its lobbyists.

The industry, however, "goes to great lengths to keep its involvement in these campaigns hidden from public view," including the use of "front groups." Indeed, in a 1998 effort to successfully kill the Patient Bill of Rights at that time, “the insurers formed a front group called the Health Benefits Coalition to kill efforts to pass a Patients Bill of Rights.

While it was billed as a broad-based business coalition that was led by the National Federation of Independent Business and included the U.S. Chamber of Commerce, the Health Benefits Coalition in reality got the lion’s share of its funding and guidance from the big insurance companies and their trade associations."

The question is why would the National Federation of Independent Business or the U.S. Chamber of Commerce do this? They either don’t understand the healthcare insurance industry’s motives or they received grant money from the healthcare insurance industry. Both groups are working against the benefit of it own people.

"Like most front groups, the Health Benefits Coalition was set up and run out of one of Washington’s biggest P.R. firms. The P.R. firm provided all the staff work for the Coalition. The tactics worked. Industry allies in Congress made sure the Patients’ Bill of Rights would not become law."^[2]"

Obamacare and the Democratic congress have also yielded to the demands of the healthcare insurance industry. President Obama’s goal is to control all medical decisions for patients to keep healthcare costs down. Most advocates of Obamacare overlook this fact.

President Obama’s individual mandated purchase of healthcare insurance would increase the number healthcare industry’s customers. Its profits would increase.

Medicare and Medicaid are totally dependent on the healthcare insurance industry for administrative services. This results in keeping the healthcare insurance industry in control of healthcare spending. The 2.5% overhead for Medicare and Medicaid continuosly repeated by government officials is completely bogus.

The healthcare insurance industry receives at least 30% of every Medicare and Medicaid dollar spent.

The administrative services costs are supposed to be no more than 15%. However, large sums of administrative costs are applied to direct patient care. Each administrative cost has a profit center attached to it.

These profits center increases the healthcare industry’s profits. In turn the salaries of the executives increase.

The Ideal Medical Savings Account eliminates all these layers of bureaucracy, profits and abuses.

It is a perfect opportunity for “People Power” to demand through social networks that the Ideal Medical Saving Account be added to healthcare insurance choices.

The Ideal Medical Savings Account puts the power back in consumers’ hands.

Neither traditional insurance plans or Medicare or Medicaid provide financial incentives for patient to be responsible for their disease nor their healthcare needs.

Financial incentive for all categories of patients (consumers) can serve to increase adherence to physician’s treatment instructions.

Financial incentives can stimulate consumers to be educated consumers of both healthcare and medical care.

Financial incentives can serve to incentivize patients to become professors of their chronic disease. Self-management can avoid many emergency room visits and hospitalizations.

Instant adjudication of claims can decrease many of the excessive administrative costs.

The Ideal Medical Savings Account is simple and transparent to consumers.

IMSAs revives the patient physician relationship. It drives the government and the healthcare insurance industry to the edge of the medical care transaction. It disrupts the hairball and will instantly disrupt the food chain that is failing under the weight of healthcare costs.

The Ideal Medical Savings Account is a perfect healthcare insurance product if deployed properly. Social networks must be formed to demand its availability in order to permit consumers’ (patients) to drive the healthcare system.

Social networks on other levels can force physicians to be more competitive.

The result would be a reduction in the healthcare system’s cost while eliminating administrative abuse, waste and fraud.

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

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Consumer Driven Healthcare As A Result Of Social Networks

February 5, 2012

inConsumer Driven Health Care, Medicine: Healthcare System

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Stanley Feld M.D.,FACP,MACE

To Reader, You can increase the size of slides to read them by double clicking on the slide.

Social networks can express the feelings and preferences of various groups. They have given people an individual voice. If there is universal agreement on a social network, the social network can change the supply chain of any organization, government policy or even government.

We have seen it this week in the rapid reversal of policy by Nancy Brinker and the board of directors of the Susan Komen Foundation toward the funding of Planned Parenthood of America.

Ms. Brinker and the board were not very transparent for the reasons of its policy change in the first place. The original defunding policy was probably the result of the Foundation’s own funding pressures by pro-life contributors.

The rapid reaction of the Susan Komen Foundation social network, which was so skillfully developed by Ms. Brinker, was the probable reason for the switch back to the original policy.

The new policy was to withdraw funding for Planned Parenthood’s providing mammograms for needing women. The new policy contradicted the mission of the Susan Komen Foundation. The social network reacted and the new policy was rescinded.

It took only a week to change the policy back to the old policy.

Social networking caused congress to abandon SOPA and PIPA in two weeks.

Both examples prove the power of the people.

The real question is how do you mobilize the power of the people to fix the healthcare system?

Everybody of all age groups knows the sound bite,“the healthcare system is broken.”

Not many people understand the reasons it is broken. Nor are many people interested in creating the bandwidth to know those reasons until they become sick.

People who are not sick really do not care as long as they perceive they have adequate healthcare insurance coverage.

Many President Obama fans think he is doing a great job reforming the healthcare system because of his use of well-known sound bite that the healthcare system is broken. He has promised to fix it.

He has promised to decrease healthcare costs and provide adequate access to healthcare for all people.

I have shown that President Obama’s healthcare reform act will increase healthcare costs, increase the budget deficit, decrease access to care and ration care.

Even before his healthcare plan is fully implemented it has resulted in an increase in cost of care, decrease access to care and rationed care.

Below is a comment from a neurosurgeon who was returning from a CMS seminar about restriction of access to healthcare.

It is a worthwhile to listen to his comment on new HHS regulations limiting access to care.

https://mail.google.com/mail/ca/?ui=2&ik=5b73a6d1b7&view=audio&msgs=1354467a5b029c30&attid=0.1&zw

A way to mobilize “the people power” is get people 20 to 50 years old to understand what is being done to destroy the healthcare system. Everyone is going to need the healthcare system eventually.

These younger people understand how to develop social networks and get them to have a desired effect.

In order to reduce the cost of healthcare and increase the quality, the system must be converted from a government and healthcare insurance industry driven system to a consumer driven system.

I was “called out” by a reader because I called the new system a consumer driven system. He wants to call it a patient driven system. He defines all consumers as patients.

“ In my opinion, everybody is a patient, and a member of one of three groups: The first group is composed of

"Patients in waiting" (the well, who require periodic screening and health information to stay well, and the worried well, who are coping with issues of some sort for which they have yet to seek professional advice);

The ailing, composed of people who are actually coping with conditions of one sort or another that make them less than well; and

The recovered, those who have regained an adequate measure of good health and functional capabilities after having experienced and recovered from a spell of illness.

What we need to do is to work to make all three publics (to use a marketing term) aware of the fact that regardless of which group they may currently occupy, they are all stakeholders in the mess we currently call the healthcare system.”

This is a great point. It might inspire the “patients in waiting” to get involved now before it is too late.

In my 2020 business plan for the future state, patients are in charge not the government or the healthcare insurance industry.

Patients would own their healthcare dollars. They have incentive to be wise consumers of healthcare and take responsibility for their health and healthcare. They would also have the incentive to make prudent healthcare and medical care choices.

The consequences of this ownership would change the behavior of the government and the healthcare insurance industry.

Both would become facilitators at the edges of the healthcare system and not the gigantic hairball in the middle of the system obstructing the patient physician relationship.

Social networking could force the government to relinquish its quest to control everybody’s choices and access to care.

A consumer driven system would decrease the demands for expensive excessive care by the patients because they have “skin in the game.” The result would be to decrease the cost of healthcare.

These results would occur if all the other spokes of my 2020 business plan on the wheel were accomplished at the same time.

Many of you may remember the hope of a physician in Brooklyn.

“I cannot finish my career in Medicine without finding a way to integrate experienced people with great ideas and insight with young people who know how to create the tools to bring innovative approaches to actually create a functional healthcare system.”

It is my hope also.

Innovative software can be built for the future state that empowers patients in waiting, the ailing patients and the recovered patients (consumers) with the tools to express their needs.

Patients in all three groups can accept and take responsibility for their care.

In order to transform the healthcare system you do not need all the consumers in the country to be in the social network. It simply has to be compelling enough for people to join as the goals get the attention of others.

Consumer (Patient) Driven Healthcare along with the Ideal Medical Savings Account will be the foundation of this transformative healthcare system.

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

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It Is All about How You Look At Things

February 1, 2012

inConsumer Driven Health Care, Information Technology in Healthcare, Medicine: Healthcare System

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Stanley Feld M.D.,FACP,MACE

My son Brad Feld wrote in response to my blog“How Software Innovation Can Cause Creative Transformation Of The Dysfunctional Healthcare System”,

Outstanding blog post dad.

And I think your punchline is completely correct – the healthcare software innovators should focus 100% of their energy on the patient and the physician (their customer). That would quickly transform everything in the healthcare supply chain.

Can you imagine what would happen if the government subsidized Borders and Barnes & Noble? Yup – pretty easy to see that they'd be doing fine and "bookstores would be classified as a public good." What nonsense.”

Healthcare policy makers are trying to reform healthcare using a defective business model.

The business model of 1945 to 1965 was a model that put the patient and physicians in the center of care.

Post Medicare in 1965 the business model changed because lots of government money came into the healthcare system. The secondary stakeholder began to devise ways of taking that money out of the system before and after the money was spent on direct patient care.

The relationships between patients and physicians became distorted. A giant hairball of vested interests by secondary stakeholders came between the patient physician relationships.

Well-intended policy makers tried to fix the system by making revisions and updates to a broken business model.

These revisions only made the healthcare system more expensive and less effective in the care of patients.

The 2011 business model is a jumble. The secondary stakeholders control the healthcare system and interfere with the patient physician relationship.

President Obama’s healthcare reform law is making the healthcare system worse. It is pasting regulations and restrictions on top of a failed business model.

It does not consider a way to get back to the effective business model of 1945-1965 for the 21^st century.

It reminds me of Microsoft and Windows. Microsoft is pasting revisions on top of the DOS operating system of the 1980s rather than revising the operating system.

Obamacare has added complexity to the system. There are many bad ideas such as Accountable Care Organizations and pay for performance rules to name just two. It does not deal with tort reform or patient responsibility for their own care and their own healthcare dollars.

Rather than pushing the secondary stakeholders to the edges of the healthcare system, Obamacare gives these stakeholders increased control over patients and physicians and destroys the patient physician relationship.

The critical turn is necessary now.

The 2020 business model of Obamacare will increase the velocity of healthcare system collapse. The result will be an increased budget deficit. Healthcare spending can escalate beyond GDP in 40 years.

At this critical turn we must go in a sustainable future state direction. The business plan must be exchanged with a completely new business model. The new business model must be unrestrained by the present business model.

This is where software innovation comes in. Software must be built that redirects the model to a consumer driven healthcare system.

It has been a disaster for the government, healthcare insurance industry and hospital systems to control the healthcare system.

It must be controlled by consumer choice, responsibility and actions with consumers owning their healthcare dollars. Legislation must be written to provide consumers with choice, responsibility, and incentives for compliance.

Consumers are the only ones that can demand this option. Consumers changed the course of SOPA and PIPA. Consumers can change the course of healthcare.

The secondary stakeholders will not give up their power easily. It will only come as a result of the Internet and innovative software that teaches consumers about their power.

Steve Jobs did it with iTunes, iPods, iPhones and iPads. Apple is about to do it with TV. Jeff Bezo did it with Amazon and the publishing industry.

The 2020 business model in the future state must have the following advocates, software developers, healthcare policy wonks, CEO’s of large corporations and small businesses. Most importantly, people 20-50 years old who are ell must start becoming engaged now so they can have a viable healthcare system when they get older. All these groups must think about the future state without present government restrictions. Steve Jobs did it for Apple. It can be done for healthcare.

The components of the future state should be,

The Ideal Medical Savings accounts,
The Ideal Electronic Medical Record,
Patient Responsibility for their care and healthcare dollars,
Patient education as an extension of physicians care
A team approach to chronic disease management with the patient becoming a professor of their disease, the team leader and the physician the coach with his healthcare team assistant coaches,
Tort Reform
Integration of specialty care.

All of these components must be executed at the same time. Consumers must be taught to drive the system.

Skeptics who are try to hold on to power and protect the validity of past policies will fight hard just as the music industry, the publishing industry and the movie industry have.

In the end the skeptics will realize the virtues of Pareto efficency. All the healthcare industry secondary stakeholders will thrive, as the patient physician relationship once again will be revitalized.

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

Please send the blog to a friend

Janelle • February 4, 2012

Along the lines of a consumer driven healthcare system,there is a new web application that is free for families and a low cost for child care providers called MyGrowthCharts.com. Kind Regards.
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Medicine Is A Calling: Not A Business

January 29, 2012

inConsumer Driven Health Care, Health Savings Accounts vs Medical Savings Accounts, Medicine: Healthcare System, Stakeholder Mistrust

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Stanley Feld M.D.,FACP,MACE

I am pleased that I am able to stimulate comments from physicians in various parts of the country. Please keep the comments coming.

Many of these physicians feel trapped by the bureaucracy and medical care policies that are restricting them from developing a real physician patient relationship. The physician patient relationship is precious to the practice of medicine.

The positive physician patient relationship enables an enhanced therapeutic effect.

As stated by a previous physician writer in my last blog,

The patient has a complaint, the physician listens (or not), performs an examination (or not) makes a decision regarding the probable cause of the complaint, writes a prescription (or two, or three), offers some instructions regarding what the patient should be doing to help himself (or herself), says goodbye and asks that the patient return at some future date for reassessment (or not).”

Physicians have been trapped into this behavior as John Goodman pointed out. The patient physician relationship has been destroyed by the dysfunctional healthcare system. Obamacare is accelerating the dysfunction in the healthcare system.

Many tests are done for defensive medicine purposes. In fact the extrapolated cost of defensive medicine is $700 billion dollars a year.

Physicians might even give the patient a shot of something for good measure to prevent a malpractice suit.

The government, hospitals systems, and healthcare insurance industry control the healthcare system.

These secondary stakeholders have made physicians commodities. Physicians are trapped into going through the motions. Medicine is a calling not a business. Physicians have been forced into making it a business.

Physicians are so frustrated with the system that they are joining hospital systems to rid themselves of the bureaucracy and avoid practice responsibility and malpractice suits.

The hope is that it will lead to a “happier life.” Not true.

The privileged hospital employed physicians become the designated spokesperson by the hospital administrator for the staff physicians. They deny there is any anger or frustration toward the government, the hospital system or the healthcare insurance industry.

The rest of the physicians keep their mouth shut and trudge along angry and frustrated.

There is a mountain of pent up anger and frustration toward hospital systems by these physicians.

I received this note from another physician writer,

“Dr. Feld:

When I read your post last week “It’s All About Patients and Physicians”, I thought you were writing to me directly. I have been thinking about this for years. It is not only that software innovation in Medicine lags behind every other industry, but also the focus has not been in the correct area. As with everything else, the medical profession has given control to others.”

This physician is absolutely correct. In a country whose administration and congress is run by lobbyists who are not interested in patients or physicians but are more interested in protecting and furthering their clients’ vested interests the problems will not be solved. Medicine and Surgery do not have adequate representation or resources to make their case to the public.

Perhaps it is because the AMA is too democratic or too civil. The AMA’s customers are physicians. Physicians have deserted the AMA because of lack of representation.

I think the AMA might still have a chance with some bold leadership. After all without patients or physicians you wouldn’t have need for a “healthcare system.”

He goes on,

“Current software tools allow the development of disruptive systems that can put patients and physicians on the same side of the equation, develop networks to allow much better communications, and integrate the future of mobile devices that will transform healthcare. It should be possible to produce change in current relationships.”

It is not only possible it is probable. I need a Posse of consumers to step out and force the secondary stakeholders to not take advantage of them. This must be a consumer driven effort.

Consumers can be organized through social networking just as Internet companies, venture capitalists and citizen expressed their voice on the Internet and stopped the two Censorship Acts (SOPA and PIPA) that were being railroaded through congress. The traditional media did not cover these two bills until the organized effort was working.

President Obama backed these bills until it was obvious to all that the anti-censorship effort expressed the will of the American people.

Patients (consumers) need leadership and innovative software to demand that they own their healthcare dollars and healthcare care decisions.

I believe many physicians yearn for the ability to spend more time with their patients. Patients must demand it also and pressure the government to relinquish control over our healthcare system.

This writer/ physician’s note to me expresses this desire. It is an important story about the physician patient relationship’s key role in patient care.

“Let me begin with a story. I take care of an elderly man who lives in Brooklyn and suffered a stroke one year ago. At the time the patient was visiting with his son, who is a Rabbi in Chicago. The patient made an excellent recovery following high-quality rehabilitation at a Chicago hospital.

He is a survivor of the Holocaust who lives with his wife and is generally independent. Although his walking is slow, he is able to walk utilizing a cane to a nearby synagogue for services every morning. As I was interviewing him last week, he mentioned that most of his day is spent at home with very little to do.

He does not have television, and is not that interested in reading newspapers.

After hearing this, I excused myself to go to my office and bring back an iPad to show him. I placed it in front of him, and logged on to a website sponsored by Yeshiva University (yutorah.org).

I showed him that he would have access to literally thousands of lectures by leading rabbis that he could listen to on demand. His eyes widened and he looked at me with amazement. He asked me if that device needed a computer, and whether it would work in his home. He inquired about the cost.

His wife immediately told me that she wanted one (iPad) for him, and that their daughter would be calling me for the information about setting things up.”

Ninety percent of physicians would like to have time to relate to patients this way. The dysfunctional system has forced physicians to act differently.

This patient recovered from his depression. He is thriving with the use of his innovative device (iPad).

He goes on further to say,

I cannot finish my career in Medicine without finding a way to integrate experienced people with great ideas and insight with young people who know how to create the tools to bring innovative approaches to actuality.

I will describe the future state next. Innovative software can be built in the future state that provides patients with the tools to express their needs and for patients to accept responsibility for their care.

Consumer driven healthcare with the ideal medical savings account will be the foundation of this transformative healthcare system.

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

Please send the blog to a friend

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Some Innovative Software Opportunities In Medicine.

January 25, 2012

inChronic Disese Management, Consumer Driven Health Care, Healthcare Insurance Industry, Information Technology in Healthcare, Medicine: Healthcare System

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Stanley Feld M.D.,FACP,MACE

I have pointed out that all the stakeholders are to blame for the dysfunction of the healthcare system.

I have also explained the difference between the healthcare system and the medical care system.

In the past two weeks I have explained that both the medial care system and the healthcare system are ripe for disintermediation with innovative software just as the publishing system was dis-intermediated with amazon.com, the music industry with ITunes and the movie industry with Neflix.

John Goodman has recently written a series of articles on how physicians are trapped by the current healthcare system.

The core problem has developed over the last 40 years. The government and the healthcare insurance industry have created a huge payment hairball between patients and physicians.

ICD and CPT coding has created complications beyond belief for patients and physicians. The ICD 10 is more confusing that ICD 9.

ICD 9 contained 15,000 codes. ICD 10 contains 68000 codes.

Instead of closing the window for fraud and abuse it has opened it further.

The problems with coding can be dis-intermediated by innovative software with its focus on patients and physicians.

A retired physician wrote the following note to me after reading my posts about innovative software and the destruction of the patient-physician relationship. His narrative was in response to the WSJ article “Should Physicians Use Email to Communicate With Patients?”

The writer is a retired physician with 40 years of private practice experience. He has lived through the development of the dysfunction in the healthcare system.

“Stan

This observation has been on my mind for a long time. The health issues in the 4th section of the WSJ today January

23,2011 caused me to put the ideas down on paper.

D”

“In doctors’ offices all across the country, a scenario like this is being played out as I write these comments.

This is an excellent description of the disconnect between the care of patients by physicians. Patients and physicians should have a relationship where patients are at the center of the physicians’ healthcare team. The physicians are coaches. The physicians’ team is the assistant coaches helping physicians treat patients.

“What happens next is where I’d like to spend a little time in this essay.

The written prescription/s may be hand-carried to the pharmacy, the doctor may telephone the prescription/s to the pharmacy, or more commonly these days, the prescriptions may be sent on line or by fax, with the doctor’s assistant doing the sending.

The government is now paying an incentive bonus to the physicians for e-prescriptions. Unfortunately 60% of physicians’ offices cannot afford the software.

This is a place for a fully functional ideal electronic medical record in the cloud.

“Now here is where the situation can get dicey. Up to 20% of all those prescriptions are never picked up by the patient. After an interval, they are returned to stock in the pharmacy. It is unlikely that the doctor will be made aware that this has happened.”

The e-prescription must be a two way street. The physician should be notified electronically by the pharmacy if a patient does not pick up a prescription.

The physician’s office should automatically contact the patient and explain the importance of the medication.

Other results can also happen. The patient picks up some, but not all of the prescriptions because of the cost versus what he/she can afford.

In the fully functioning EMR software can be included to enable the pharmacy to inform the physician.

Or the patient picks up all of the medications ordered. Once at home, the patient may or may not take the medications as prescribed.

The instructions from the doctor may be recalled incompletely or inaccurately.

The healthcare team can electronically reinforce instructions and goals for the medication using the Internet sites picked by the physician.

The physician’s healthcare team must be an extension of the physician’s care.

Freestanding organizations will fail if they are not an extension of physicians’ care.

The CBO recently revealed that President Obama’s pilot studies using freestanding chronic disease management organizations have failed to lower the cost of care.

My fear is that President Obama and his healthcare administrators will conclude that chronic disease management does not lower healthcare costs.

Effective chronic disease management of diabetes can lower the complication rate by at least 50%. Decreasing complications can lower the cost of care by 80%

The medications may not be tolerated by the patient, and as a consequence, he/she may elect to discontinue one or more of them, or may elect to take them in some manner other than as directed by the doctor.

The patient may not notify his physician of his difficulty taking the medication.

Social networking between physicians and patients and patients in that physicians practice could solve this problem.

Patients understand that most cognitive physicians are reimbursed for coded procedures. Advice over the telephone or email is not reimbursed. A mechanism for reimbursement must be developed for using social networking.

The medications may prove effective in alleviating the problem that caused the patient to see their physician in the first place, or they may not.

Most of the events described will not be known to the patient’s physician until the patient is next seen in the office, and maybe not even then.

E-mail could have malpractice liability in the current malpractice environment. This is one more reason Tort reform is essential.

In a perfect world, a lot of the issues raised above could be made better by a few simple moves. The pharmacy could make the physician’s office aware that the prescriptions were never picked up.

Someone in the physician’s office could call or email the patient 3-4 days after the visit, and inquire whether the patient is taking the medication,

Reinforcing the physician’s instructions, and inquiring whether the medications are helping the patient, asking if there have been any problems arising from the use of the medication, and passing what is learned back to the physician.

The reinforcement of the instructions can be very helpful, and the awareness of issues relating to the medication can lead to more timely resolution of problems the patient is experiencing.

It has always seemed to this writer that the doctor-patient relationship would be well served if we all started to use what I call “The Doctor Phil Question”, which goes like this: “How’s that working out for you?”

It is all about patients’ responsibility for their healthcare and their healthcare dollar. It is about consumer driven healthcare and the patient physician relationship.

As long as the government and the healthcare insurance industry continues to drive a wedge between the patient and physician the cost of healthcare will continue to rise.

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

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Who Said Consumer Driven Healthcare Cannot Be A Market Force?

January 19, 2012

inConsumer Driven Health Care, Medicine: Healthcare System, Patients Problems

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Stanley Feld M.D.,FACP,MACE

I love Costco. Its prices are great and its selection is abundant. Last week I was dazzled by the display of megavitamins as soon as I walked into the store.

Americans want to be healthy. Few have a death wish but many (60%) are obese. Megavitamins have been touted as the instant route to healthy living. The megavitamin business has grown into a $30 billion dollar a year business.

Megavitamins have been successfully oversold.

There is no evidence that megavitamins are the route to health and healthy living.

“A national survey by the US Food and Drug Administration found that 73% of US adults were found to use dietary supplements in 2002.”

There is little good evidence to support the widespread use of dietary supplements.

The US Preventative Health Services Task Forces reviewed some of the literature on megavitamins and dietary supplements. The group stated there was insufficient evidence for or against the use of multivitamins with folic acid or antioxidants. It also stated that the use of Vitamin A, C or E did not have sufficient evidence for or against its use.

I think these supplements could be helpful if the requisite dosage was known. There is no evidence that these dietary supplements are helpful at the present dosage. There are no scientific studies about which doses would work. There are only testimonials attesting to usefulness.

”Beware of the man with one case.”

A friend of mine worked for thirty years proving the existence of Vitamin D deficiencies in 50% of the elderly population. It took him half that time to convince the medical population that he proved something.

The dosage necessary ended up being 6 times the dosage in multivitamins. Therefore USPHTF conclusions are correct with the present data. However they might have drawn their conclusions from the wrong data.

This is not an unusual occurrence in clinical medicine as I have pointed out previously.

The American Medical Association hedged its bet by stating,

“It recommends supplements specifically for seniors who have generalized decreased food intake.”

Chances are people who are starving or dying from cancer will have a multivitamin and mineral deficiency.

The American Dietetic Association advises,

“low-dose multivitamin and mineral supplements depending on individualized dietary assessment.”

The ADA’s statement is obviously self-serving.

The American Heart Association made the only logical statement in the whole bunch.

“The AHA emphasized healthy eating patterns rather than supplementation with specific nutrients. “

The recommendations against the routine use of supplements are grounded in fairly good evidence if one believes in a methodology used by the Cochrane intervention review.

A Cochrane intervention review of 77 randomized controlled trials with 232,550 participants found no evidence to recommend antioxidant supplementation for primary or secondary prevention of mortality.^[7]^.

There is shabby evidence that cannot be generalized regarding possible harm related to the use of some supplements.

“For example, the Alpha-Tocopherol Beta-Carotene Cancer Prevention Trial demonstrated that beta-carotene supplements increased the risk for lung cancer among male smokers.^[8]^”

At this point there is no good scientific evidence for the use of megavitamins. “People believe what they want to believe.” The placebo phenomenon is extremely important.

The media is the message. Somehow the power of advertising has convinced the public that it is good to take megavitamins.

Costco is trying to take advantage of the hype. Consumers are driving this healthcare choice. The result is a $30 billion dollar a year business. The money is coming directly out of the consumer’s pocket. It is not included in healthcare costs.

Consumers are trying to be responsible for their health on the basis of hype. It is much easier in the mind of most to stay healthy taking a pill than do the heavy lifting required for healthy living.

Why can’t someone create an anti-obesity hype that works as well as the megavitamin hype?

Increases in obesity lead to increased Type 2 Diabetes, hypertension, hyperlipidemia and the resulting Diabetic complications of stroke, heart attack, blindness, amputations, chronic renal disease and cancer.

Many schemes have been devised to decrease the increasing obesity rate. None have worked except eating less and doing more.

With the increasing obesity in children there is an increased incidence of Type 2 Diabetes in kids, teenagers and young adults.

Gastric bypass has become the rage for these young super obese people. To my dismay more and more insurance plans are paying for gastric bypass procedures. Even Medicaid is paying for the procedures.

Is the world going nuts? I guess Medicaid’s logic is if the people become thinner it will decrease the incidence of Diabetes, decrease the complications of Diabetes and therefore decrease the cost of healthcare for these people.

To me it is like painting over rust. The rust will bleed through and the money for the paint will be spent already.

Americans do not get any help from society norms. We are flooded by manufactured foods with tons of calories and tons of salt. Mayor Bloomberg passed an educational law that fast food stores must publish calorie counts on foods.

This is helpful is the calorie count is accurate and people pay attention.

Home cooking served in small portions is essential. The fat, calories and salt can be controlled. There is no need to have a home cooked meal anymore.

All you have to do is go to Costco or Sam’s and buy any precooked meal you want. Dinner is a 3 to 10 minute microwave pop away. Why would any busy person bother to prepare a home cooked meal? The harmful consequences prepared meals are in the distant future.

If you have dinner at a restaurant an average meal contains more calories than the average person burns in a day. My wife and I have been sharing for years.

Consumers want to be responsible but it is very difficult in the cultural milieu of our society.

Ken Cooper M.D. created an exercise craze in the 1970’s. It has lasted until the present. He did not figure out how to get people to sustain their exercise program. He also did not figure out how to get people to decrease their intake in our sea of manufactured food and pre-cooked food.

The incidence of obesity is growing.

Most consumers are not stupid. They seek to be responsible in the easiest way possible.

Someone will come along and initiate a legitimate health craze.

The Ideal medical savings account (by providing financial incentives along with intense public education through appropriate advertising) can be as successful as the Dietary Supplement industry.

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

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Thanks for finally talking about >Repairing the Healthcare System: Who Said Consumer Driven Healthcare Cannot Be A Market Force?
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It Is All About Patients and Physicians

January 8, 2012

inConsumer Driven Health Care, Information Technology in Healthcare, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust

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Stanley Feld M.D.,FACP, MACE

Society is in the midst of an electronic revolution. Innovations in hardware and software have created greater shifts in our economy than the assembly line, mass transportation and electricity. We ain’t seen nothing yet.

The potential for economic growth as of result of this revolution is unimaginable.

Current business models have crumbled and have been replaced by software driven companies. Software driven companies are cheaper to run and have created innovative and easy to use products and services for consumers.

Marc Andreessen, founder of Netscape, has a tremendous handle on this revolutionary change. So does my son, Brad, and his good friend Fred Wilson.

Marc Andreessen wrote an excellent article in the WSJ on August 20th, 2011 entitled, ” Why Software Is Eating The World.”

“More and more major businesses and industries are being run on software and delivered as online services.”

Almost all industries have been affected. The hardware and software revolution have overturned many industry’s business models.

Brad Feld wrote a perceptive blog today defining some of the changes to be expected in the near future. He also warned of incumbent and political abuses to the technological advances that are being made by entrepreneurs.

Even the freedom of the Internet is being threatened by a congress that does not understand its potential and is driven by vested interests, not the preservation of freedom, creativity and innovation.

My hope is Congress will be unsuccessful in restricting these freedoms. There will be many more industries that will be disrupted by innovative software in the coming decade.

“Over two billion people now use the broadband Internet, up from perhaps 50 million a decade ago.”

Marc Andreessen expects, “at least five billion people worldwide own smartphones, giving every individual with such a phone instant access to the full power of the Internet, every moment of every day.

Amazon.com is a dramatic example of a company that has used innovative software to transform an industry. Twelve years ago Borders was the king of stick and brick booksellers. Borders had an effective software book distribution system for its increasing number of bookstores.

Amazon, with software that distributed books directly to the customers ate Borders’ lunch. Borders thought on-line book sales was non strategic. “People like to touch books before they buy them.”

How wrong can one be? Using the same software Amazon now sells everything at a lower price than most retail stores and on-line companies. Its software decreases overhead and in turn consumer prices.

Consumers are not stupid. They want the best product at the lowest price. Amazon produced and consumers responded.

Big box stick and brick retail stores that took over the local mom and pop businesses will fail unless they became hybrids.

The old business model bankrupted Borders.

Amazon didn’t stop there. Its Kindle digitized books and delivered them instantly at half the price to consumers with a greater margin for Amazon.

This demonstrates the genius of innovation. The creative uses of innovative software are staring us in the face daily. Most industries have a Blind Spot.

The existence of those people who want to touch the pages of books is fading fast. Jeff Bezo saw this Blind Spot.

Netflix copied Amazon with DVD movies. It destroyed Blockbuster. Netflix then switched from physically delivering DVDs by mail to both delivering DVDs and on-line downloads.

It would have worked if they put the consumer first. Netflix infuriated consumers with its pricing. It almost immolated itself. I do not think Netflix will recover unless consumers perceive that they are first.

Amazon, using a more sensible model, is going to take over the on-line movie business. Blockbuster, now owned by Dish network, doesn’t have a clue about the needs of consumers.

Dish, Direct TV and Cable are trying to adjust to the rapid pace of software innovation. I do not think they can because they are bogged down in bureaucracy.

They are simply not entrepreneurial.

This brings us to Apple, Steve Jobs and the entrepreneurial spirit. Steve Jobs turned the music industry on its ear with ITunes, the smart phone industry on its ear with the IPhone and the computer industry on its ear with the IPad and the Mac Book Air.

His method was to use innovative software that made the appliance work for the consumer. He does not make the consumer suffer as Microsoft does with constant software freezes.

He kept his eye on the consumers. He put the consumer first. It served his vested interest well.

Before is died he made a statement in which he said he finally figured out television.

Google is a close second to Apple but Google is hampered by a growing bureaucracy.

“The great incumbent software companies like Oracle and Microsoft are increasingly threatened with irrelevance by new software offerings like Salesforce.com and Android (especially in a world where Google now owns a major handset maker).”

I could mention many more companies that have served as disinter mediators of incumbent businesses by software innovation. These innovations have resulted in vast improvements in value to consumers, decreased costs and economic growth.

Why hasn’t healthcare in the U.S. been the beneficiary of this software revolution?

The reasons are clear to me having practiced Clinical Endocrinology for 30 years.

Healthcare is an industry with a gigantic Blind Spot. There is a good reason for healthcare’s Blind Spot.

Software developers in the medical space do not know who their customers are. Their customers are patients and physicians and the patient/physician relationship. The customer is not the government, the healthcare insurance industry or hospitals.

Once this is understood the software revolution in medicine will begin.

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

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Dave Chase • January 8, 2012

Stanley – I couldn’t agree more. This is the reason why the kernel of my startups architecture is opening a rich communication channel between physician and the individual (most of us don’t think of ourselves as “patients”). I was fortunate to have founded Microsoft’s health business many moons ago and play a role in the shift from mainframe to client-server based systems. However, this shift is not only a big architectural shift but the fundamental healthcare delivery model must shift as well. The biggest driver, for better or worse, is the shift that is happening from the “do more, bill more” reimbursement model to one that is focused on value and outcomes.
I can’t think of a more exciting time to be in the field. There is a wave of disruptive innovation that isn’t fully recognized right now — Gibson’s quote (“the future is here…it’s just unevenly distributed”) is apropos. One great example is Direct Primary Care — see http://www.delicious.com/chasedave/DPCArticles for more. There’s more where that came from.
Great to see experienced MDs blogging like this, btw!
Stanley Feld M.D.,FACP,MACE • January 28, 2012

Great comments everyone.
Thanks
Stanley Feld M.D.,FACP,MACE
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Hospital Systems Are Creating Local Monopolies.

December 4, 2011

inConsumer Driven Health Care, Stakeholder Mistrust

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Stanley Feld M.D.,FACP,MACE

The primary stakeholders in the healthcare system are patients and physicians. Without patients or physicians there would not be a healthcare system.

Patients should be the drivers of the healthcare system. They are not. The primary drivers are the government and the healthcare insurance companies.

Hospital systems play the next largest role in driving up the costs of the healthcare system. Large hospital systems are constantly playing a game of chicken with the government and the healthcare care insurance industry.

Somehow, large hospital systems have been able to stay under the radar. They have been able to avoid the responsibility of the rising costs of healthcare.

Large hospital systems and large hospital chains know that insurers need them to service their network of patients. The healthcare insurance companies know that the hospital systems can hold them hostage to increased reimbursement.

When a large hospital system demands an increase in reimbursement the healthcare insurance industry simply increases premiums.

An example is the increasing premiums and costs that resulted from Romneycare in Massachusetts. Romneycare’s structure is one large driver of rising costs in Massachusetts.

Hospitals in Boston were extremely competitive before 1990.

The race in the late1980’s was to build the best hospital/physician network in town. The goal was to attract patients, overwhelm the competitors and get the best reimbursement from insurers.

In 1993 the model changed from a competitive model to a monopolistic model.

The merger between two eminent Harvard-affiliated hospitals, Massachusetts General Hospital and Brigham and Women’s Hospital developed a hospital system (Partners) that would control the marketplace.

The two most prestigious hospitals in the state forced the healthcare insurance industry to increase their reimbursement for providing care. Meanwhile, the Tufts hospital system offered a lower reimbursement rate but patients wanted to go to Partners.

Partners HealthCare created a monopoly. It could deny access to the patients of any insurer who dared not accept whatever Partners wanted to charge.

What patient would want to be on an insurance plan that didn’t have access to the two most prestigious hospitals in Boston?

“Partners’ secret agreement in 2000 with Blue Cross Blue Shield of Massachusetts, in which Blue Cross would give Partners more money, in exchange for Partners’ promise that they would demand the same rate increases from everyone else. The growth rate of individual insurance premiums in the state doubled.”

Many executives at Blue Cross/ Blue Shield wanted to fight Partners’ demands. However discretion was the better part of valor.

An executive of Blue Cross/Blue Shield said,

“We are a successful business up against a hospital system that save people’s lives. It’s not a fair fight…”

Many hospitals are merging throughout the country to take advantage of this market leverage and increase reimbursement from the healthcare insurer.

Hospital systems are frantically trying to buy primary care physicians’ private practices to enjoy this leverage. The statistics claim that from 30% to 70% of practices have been bought by hospital systems.

The fiction is that medical schools are producing a different breed of physicians. The fiction is all the present day physicians want is a salary. I do not think this is true.

The barrier of entry to opening a private practice is cost. Physicians completing medical school have already incurred large debt.

The problem with being employed by hospital systems is the hospital system controls the overhead expenses. These expenses are inflated. Many salaried physicians do not realize the unfair overhead expenses because the expenses are opaque.

It takes a while for physicians in the system to figure out that they are not getting their fair share of the reimbursement for their productivity. At that point physicians start fighting with the hospital system. Some physicians quit en mass and open their own practice.

Partners’ physicians figured it out. Partners is still intact but the physicians are now getting their fair share.

Physicians are starting to realize they have leverage over their hospital employee and that they must have control of their overhead.

The Department of Justice is opening an investigation of hospital systems engaged in anticompetitive behavior. It is also challenging mergers in various parts of the country. Hospital systems have offered the defense that mergers will lead to “more efficient and cost-effective care.”

“But the long history of hospital mergers shows no evidence that consolidation leads to either. Indeed, according to FTC lawyer Matthew J. Reilly, the merged Toledo hospitals immediately went to work jacking up rates:”

“Soon after the acquisition was consummated,” Mr. Reilly said, “ProMedica approached certain health plans to obtain higher reimbursement rates.”

“The higher rates, he said, are typically passed on to consumers in the form of higher premiums, co-payments and other costs.”

Businesses act in the pursuit of their vested interests. Government sets the rules and businesses seek to take advantage of those rules.

Somehow, secondary stakeholders must be controlled. It will take a consumer driven healthcare system to control it.

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

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