Welcome to the May 2010 issue of the Indidge Advantage newsletter.
No matter what generation you fall into, I'm sure almost everyone is looking forward to summer. Hospitals however are caught in a generational gap which is discussed in the first article.
There is no generational gap where the iPad is concerned. The following article features the rush to purchase one by health care professionals. Should you?
The next article examines (no pun intended) why physicians are not exactly jumping up an down for joy over the health care reform bill.
To lighten up your day, what follows, is some slick (as in oil slick) humor or perhaps it is more appropriate to label this as sick humor with respect to the seriousness of the spill.
The Indidge Advantage is produced by Indidge Systems, a health care software solutions company specializing in Compliance and Risk Management solutions.
by Joe Carlson
As large groups of people under the age of 18 and over 65 tug at each other from across the U.S.' demographic spectrum, hospitals are bound to be caught in an increasingly uncomfortable middle ground that will demand effective leadership, National Public Radio senior correspondent Juan Williams said.
Williams delivered the Malcolm T. MacEachern Memorial Lecture on Tuesday at the American College of Healthcare Executives' annual meeting in Chicago, sounding off on themes of demographic upheaval and the struggle between young and old for influence in the public sphere.
"You are leaders in a much larger sense. You are leaders in our nation," Williams told the crowd of thousands of hospital executives. "And I know you have a lot of anxiety about what has been happening in Washington. ... What you are feeling is but a small aspect of an anxiety that is being felt across our country today."
Just look at the fractious healthcare reform debate, Williams said. The U.S. Census Bureau says that by 2025, 25% of all Americans will be over the age of 65, while another 25% of all Americans today are 18 or younger. Older Americans were the biggest opponents of President Barack Obama's healthcare reform plans, while young Americans are the president's most ardent supporters, Williams said.
"I think what we've got going here is a generational conflict," he said. "In American life now, we have a tug of war. ... In this environment, things can get explosive. You can get, as we saw in the healthcare reform debate, people yelling expletives at each other."
Williams' address followed the awarding of the 2010 Lifetime Service Award to Earl Dresser, who began his healthcare career in 1948 and moved through leadership positions in hospitals in Illinois, Iowa, Minnesota and Wisconsin before retiring in 1986 as the longtime president of Methodist Hospital, St. Louis Park, Minn.
Dresser took to the podium less than two hours after Obama signed the landmark healthcare reform bill, and opened his speech with an observation: "For those of you on the front lines, I know you've encountered many challenges. I think you have many more ahead of you," he said.
by Cheryl Clark
By random and unscientific measure, about one in 10 people in line to buy an iPad at a San Diego Apple Store Saturday were health providers hoping to use it for patient care.
Kevin Kaloha, an intern at nearby UCSD School of Medicine, said he was in line on orders from his Radiology Department chiefs. "They told me to come down here and buy one," he said. "I think they want to test it and try it out to see how we can use it for imaging."
Hal Meltzer, a pediatric neurosurgeon at Rady Children's Hospital, was also eager to test it out in his practice. But he isn't quite ready to bring it into the operating room.
Eventually, he thinks he and other doctors will use it, especially because its toy-like appearance may help explain medical issues to children in a less scary way.
"There's so many possibilities," said the neurosurgeon, who hopes that the device will save trips to the computer monitor to review MRI or CT images. And then there's the hospital, which can use the iPad to communicate with a doctor when his or her patient is in the emergency room.
A key is how the iPad handles EMR or EHR software applications available from Epic, Allscripts or other vendors, many of the physicians said.
Randy Hawkins, a neurologist and chief information officer for Sharp Rees-Stealy Medical Group's 450 doctors, hopes he can use technical "work-arounds" with Citrix or other applications to get the iPad to understand speech.
"I can do that now with my tablet PC, but it's clunky. It's my goal to have a handheld device I can talk to," he said.
Also, Hawkins said, he thinks using an iPad to take notes for patient histories will be faster than turning to his laptop or office-based computer.
Apple's technology isn't quite there for EMR, he says, a fact that he says was "disappointing. It's not yet what we need. I can't use the word ‘slick' and I won't use it until I can." For now, he's buying the device to watch movies.
Maureen Gibbins Paolini, who teaches ethical conduct in research at San Diego State, said the iPad will be useful for patient consent forms and for educating patients about clinical trials. "It encourages interaction," she said.
Theresa Gillete, an X-ray technician at Sharp Memorial's outpatient Pavilion, plans to try it out to look up imaging references. "I'm tired of carrying around a laptop on my back to and from work," she said.
And Greg Steele, an optometrist with a large group practice, thinks the iPad has great promise for certain eye exams. He doesn't know whether his medical group would see it that way, but found hope while standing in line.
"I'm just now seeing the main doctor who's in charge of the medical staff right there in line ahead of us. So maybe there's hope," he said with a laugh.
by Daniel Palestrant, MD
After the debate has ended and the lobbyists have moved on to their next clients, health care will be left the way it started, a physician and a patient sitting in a room trying as best as they can to prolong health and forestall sickness. Fortunately the many victories and losses claimed by both ends of the political spectrum will not change this shared pursuit.
So then why has reform that promises to get millions more in a discourse with their doctors been so polarizing? Making sure more Americans have health insurance can only be a major victory, right? Too bad the medical establishment is not celebrating. In fact, the mood in those exams rooms is downright morose.
In tens of thousands of exam rooms all over the country physicians are struggling to make sense of the 2,000-plus pages of the reform bill. A recently released poll of more than 2,000 physicians, conducted by Athenahealth and Sermo, is alarming. The poll, part of a broader Physician Sentiment Index, indicates that 79% of physicians are less optimistic about medicine since the passage of health care reform. Fifty-three percent indicate they will consider opting out of insurance plans with passage of the bill. Worst of all, 66% indicate that they will consider opting out of all government-run programs. The same reform bill that will provide "care for all" may drive away more physician caregivers than attract previously uninsured patients. What a predicament that would be.
Many may find the data from the poll puzzling. How could physicians be so pessimistic about a bill that clearly has so many positives? For one, the bill addresses none of the issues most consistently ranked by physicians as the most critical for lowering costs and improving access. Tort reform, streamlining billing and payment, and fixing the flawed government formula for calculating physician reimbursement are given little, if any, serious attention.
What physicians knew then and certainly know now is that instead of fixing these issues, the government will be forced to take the path of least resistance to save money (that is to say the path with the least special interest resistance). That means reducing physician reimbursement, just as the country is counting on even more physicians to be available.
Physicians knew the health care bill had a "gotcha" buried deep inside. The only way it could be called "budget-neutral" was to implement significant reductions in physician payments. So just as we are hoping more physicians become available to treat the influx of 31 million more patients, the government is implementing a massive reduction in physician reimbursement (a 21% reduction in physician reimbursement went into effect April 1 after several years of no adjustments for inflation, meaning physician reimbursement has been declining for several years already).
In a moment of complete legislative hypocrisy, the proponents were touting one health care bill that included cost estimates that assumed a massive reduction in payments while another bill moved its way through Congress that would reverse those cuts (the bill reversing the cuts was ultimately defeated, meaning the cuts did go into effect). At some point, basic supply and demand will kick in, and there will be insufficient physician resources for treating patients.
But what of the much-touted American Medical Association's support for the bill? The AMA, which counts less than 10% of its $300 million dollars in revenue from physician membership dues (the rest comes from a government sanctioned monopoly whereby the AMA sells the billing codes upon which the entire health care system relies) had little choice but to endorse the bill, lest the government retract its exclusive license on billing codes. Again physicians know what the public does not: Less than 15% of practicing physicians are AMA members, so any AMA support is more a reflection of the AMA's financial interests than what physicians in this country truly want. This is a situation that proved opportunistic to proponents of the bill but could prove painful for America's health care system.
Indeed this might be a pyrrhic victory. Health care without active physician participation is no health care at all. Many physicians are investing in electronic health records and billing technologies that alleviate some of the huge administrative brunt that threatens the independent medical office and enables them to fare better in the uneven fight with insurers. These technologies do hold great promise in ensuring these projections remain just that, projections, and not reality.
But still, as the Athenahealth-Sermo poll shows, many physicians are ultimately faced with the choice of opting out of government insurance programs or going out of business. A significant number of physicians are realizing they cannot stay in business--let alone remain independent--if they continue to accept artificially low government reimbursement rates.
Many states are recognizing this impending crisis, and rather than addressing the causes of medical inflation are resorting to an "easy," short-sighted fix: Make participation in state and federal insurance programs a condition of medical licensure. Far from a theoretical proposition, Massachusetts' health care system is so over budget that the state legislature is considering a bill that would mandate physician participation, in effect making physicians state employees.
Can anyone say socialized medicine?
Join us Wednesday, June 9th, 2010, from 11:00 AM - 12:30 PM PDT for a free educational webinar. Just click on the register button below or if this does not fit your schedule , send Tom Reid an email at tom.reid@indidge.com or call him now at (480) 829-0479 Ext. 138 to arrange a web demo that better fits your schedule.
Is that slick humor or sick humor?
"This oil spill in the Gulf is affecting everybody. In fact, when I went to lunch this weekend and ordered the sea bass, they asked if I wanted it regular or unleaded." -David Letterman
"British Petroleum said today that if this spill gets worse, they may soon have to start drilling for water." -Jay Leno
"Dick Cheney's pals at Halliburton ... say they're going to do the underwater cement job to plug the hole. I thought, wait a minute, this is a mistake. Underwater cement? You call the mafia. Am I right?" -David Letterman
"The oil company said it was the rig company's fault. The rig company said it was Halliburton. And somehow, each time they passed the blame, Goldman Sachs made a hundred million dollars." -Bill Maher