Medical students may no longer have the earning potential of the preceding few generations of physician graduates before them. Simply put, the cost of a medical school education may be too high to recoup given the changing landscape of health care. Between decreasing reimbursements, commoditization of physician practices, and increasing overhead, and the cost of debt service, medical students will find themselves struggling to get ahead.
On the medical school side, the costs of providing an education are increasing and schools are finding themselves in budgetary binds with faculty restrictions, layoffs, and salary stabilization.
What's the solution?
If the government wants to dictate to physicians what their reimbursement will be for services provided and simultaneously continually increase the overhead expense of a doctor by regulatory compliance burdens, then the government must subsidize medical school education.
I am all for less big government so the other alternative (which obviously is not happening), would be that government does not dictate fees and reimbursements nor regulatory expense burdens for doctors, natural free market forces do and then in that scenario medical school costs would not be the responsibility of government.
Thursday, February 03, 2011
Tuesday, February 01, 2011
The Reasons to E prescribe
Medicare providers have a few good reasons to start E prescribing. Of all the initiatives relating to health care and technology , the one most likley to get adoption is e-prescribing. It is easier for the office than meeting all the EHR criteria and it makes sense for the patient. The hurdles for EHR adoption for more established older physicians seems less likely and more obtrusive but e-prescribing shouldnt be as intimidating.
Here are a few reasons to do it:
1. Avoidance of 1 percent penalty on claims if providers e-prescribe ten times in 2011.
2. Avoidance of 1.5% penalty on claims if providers e-prescribe at least 25 times in 2011.
Dont forget that to be eligible the physician would need to report the G code, G8553 along with a denominator code such as new and established patient visit codes.
Here are a few reasons to do it:
1. Avoidance of 1 percent penalty on claims if providers e-prescribe ten times in 2011.
2. Avoidance of 1.5% penalty on claims if providers e-prescribe at least 25 times in 2011.
Dont forget that to be eligible the physician would need to report the G code, G8553 along with a denominator code such as new and established patient visit codes.
Monday, January 31, 2011
Potential Impact of Medicare Payment Reductions on Staffing of a Medical Practice
Nice report in January 2011, Dermatology World, that graphically represents the impact of Medicare payment reductions as a function of practice staffing and EHR implementation. In general, a 5-7% cuts in payments to physicians will translate to 20% of doctors reducing staff and 56% freezing staff hiring. And, also, a 5-7% reduction to physician payments will result in 33% of docs delaying EHR implementation and 29% indefinitely postponing.
Bottom line is private practice is small business and as soon as government intervenes with further reductions in payments it results in the unintended consequence of delaying other government initiatives such as EHR implementation and employment. Physicians have taken too big of a hit already and employ significant amounts of the labor burden. You cannot continually increase practice expense burden with regulatory obligations, etc and then at the same time make reductions in income and expect no impact on "initiatives". Docs are too tired and beat up to help here.
Bottom line is private practice is small business and as soon as government intervenes with further reductions in payments it results in the unintended consequence of delaying other government initiatives such as EHR implementation and employment. Physicians have taken too big of a hit already and employ significant amounts of the labor burden. You cannot continually increase practice expense burden with regulatory obligations, etc and then at the same time make reductions in income and expect no impact on "initiatives". Docs are too tired and beat up to help here.
Sunday, January 30, 2011
Medical students, doctors and medical residents are not taught about the Human Resources component of their career
In medical school and in medical residency we, as doctors entering the business world, get no training on HR (Human resources). Doctors are not instructed one iota on how to evaluate, hire, and fire employees. This can be a daunting task and doctors and medical students should be given some expectation of what running a business, ie a private practice is really like. One important aspect of private practice in medicine is knowing when and how to hire staff and when and how to terminate bad staff. There are legal ramifications for both actions. Critical to hiring is defining the role and responsibilities with a job description for each position you fill. (You can find a typical job description for the employees you would need to hire in the book, The Medical Entrepreneur). Having the employees and staff understand their role, responsibilities and job description will help them understand where they need to be focusing their efforts, so they can be more productive. Your staff will appreciate that clarity. Also, whom the employee reports to...such as the office manager in most cases is very important to define from the first day of their job. Also, the job description itself will serve as a benchmark by which you can objectively evaluate their performance. This is particularly important when an employee is not meeting their expected roles and responsibilities. If an employees are not working out, you should understand the process to correct this or if not, to let that employees go as soon as possible.
Wednesday, January 26, 2011
One less administrative headache for practicing medical doctors
Since 2007, another administrative burden loomed large over doctors heads...the "Red Flags Rule". Despite multiple protests from the AMA and other large doctor associations, the legislation persisted as just another threat to increasing administrative burdens for practicing physicians. The FTC delayed enforcement of the "Red Flags Rule" five times since 2007. The rule/bill, which potentially placed compliance cost and administrative burdens on physicians regarding the need for implementing identity theft and notification programs was amended in December to be called the Red Flag Program Clarification Act of 2010, so that health care providers are exempt. It's true, doctors actually caught a break here for the first time since I went into practice almost 20 years ago. I have watched government regulations increase, cost to comply with regulatory demands geometrically increase for practicing physicians, and reimbursement decrease year after year. This little amendment is one small victory for doctors in private practice. Savor it as they dont come often.
Tuesday, January 25, 2011
The Medical Entrepreneur book advises Medical Residents how to bill and get paid
Billing and getting paid are two entirely different issues. Billing is the act of electronically submitting a charge to an insurance company for services provided. Getting paid is receiving back what the insurance company contracted rate for you may be for those services. Often times, insurance companies defer, delay, or reject initial claims and as a result the billing process results in an accounts receivable that must be followed closely. The Medical Entrepreneur book really covers this area of importance in your medical practice so you can understand that different types of billing software, insurance company policies and procedures, collection of copays and deductibles and accounting processes you need to have in place to run your medical practice smoothly.
Tuesday, January 18, 2011
At what point should medical students select their specialty?
I changed my mind after two years of residency from one specialty to another. It is difficult for medical students to have a solid basis for long term career specialty selection. Realistically, as medical students, we spend 1-2 months "testing" various specialties. I would say that probably the most influential factor in a medical student's selection for a specialty is the clinical rotation and the attending at that time. If the attending is a mentor and role model that for whatever reason appeals to the student, then that student is more likely to enjoy the rotation and select that career. Good or bad, that is the reality. Do Attending physicians have any idea of the impact they have on shaping a career choice. I remember doing a urology rotation, for example, the surgical attending in the OR was so abusive, that I was compeletly turned off to that as a career choice. Right or wrong, that is how it happens, it is organic and often times subconscious, but it is an interesting variable that often times is overlooked. The career selection process needs to be re-focused and perhaps made a part of the education curricula.
Sunday, January 16, 2011
Medical school debt may be greater than earning potential
Health care "reform" needs to more seriously address the issue of cost of a medical education and plot that against current wages for less lucrative specialties such as pediatrics and family practice. It seems that if every college or medical student calculated their potential earnings and plotted that against the cost of attending four years of undergraduate college and then four years of medical school, they would reconsider their selection as a physician. Here are some rough numbers. The average cost including living expenses for undergraduate schools and medical school is approximately $40,000-$50,000 per year. It is conceivable that all of that is borrowed so that upon graduation, a medical student has over $320,000 in debt. If the doctor wants to pay this off over 10 years, he or she will be paying, approximately $4000 per month or $48,000 per year interest and principal payments. This does not take into consideration the cost of those years in medical school of lost earning potential. This is disastrous for medical students, young doctors and the field of medicine. So, when health care reform begins to start chipping away at a doctor's income, and raising expenses for a doctor to operate their business, politicians need to be aware of the cost burdens on our young doctors. Alternatively, the way things are going, we may have no doctors to take care of our kids and our families.
Saturday, January 15, 2011
Medical Residents and medical students need help preparing for the real world
Are medical students or medical residents given adequate business training prior to entering the work force? Definitely Not. This is a huge deficiency in medical school and medical residency training.
Before any doctor or medical resident enters private practice and signs any contract with a potential medical group or employer, he or she should read The Medical Entrepreneur Pearls, Pitfalls and Practical Business Advice For Doctors. It was written specifically with medical residents, students and doctors in training in mind. There are contributions by health care and corporate attorneys giving advice to medical residents that will end up saving them money and headaches often associated with joining the wrong practice or starting off in practice without the correct licensures. The book gives medical residents and medical students and easy to read, step by step guide on how to be prepared for entering private practice.
Before any doctor or medical resident enters private practice and signs any contract with a potential medical group or employer, he or she should read The Medical Entrepreneur Pearls, Pitfalls and Practical Business Advice For Doctors. It was written specifically with medical residents, students and doctors in training in mind. There are contributions by health care and corporate attorneys giving advice to medical residents that will end up saving them money and headaches often associated with joining the wrong practice or starting off in practice without the correct licensures. The book gives medical residents and medical students and easy to read, step by step guide on how to be prepared for entering private practice.
Friday, January 14, 2011
University of Michigan Study: Medical Residents feel ill prepared to run small businesses
Lead author Linnea S. Hauge of the University of Michigan Medical School says medical residents say they lack instruction and feel ill prepared to run the small businesses doctors in private practice must manage.
The study goes on to show that web based learning may be a reasonable option for medical residents to get some education on business.
This is exactly why the book, The Medical Entrepreneur Pearls, Pitfalls and Practical Business Advice for Doctors was written. Medical students and doctors are not prepared in school or during training for the challenges of private practice and business. The book will help medical students and residents save money and headaches that often accompany the difficulties of private practice.
Private practice can be enjoyable and medical residents can now be prepared. The Medical Entrepreneur book is available at Amazon.com for $19.99 or Kindle for only $9.99.
The study goes on to show that web based learning may be a reasonable option for medical residents to get some education on business.
This is exactly why the book, The Medical Entrepreneur Pearls, Pitfalls and Practical Business Advice for Doctors was written. Medical students and doctors are not prepared in school or during training for the challenges of private practice and business. The book will help medical students and residents save money and headaches that often accompany the difficulties of private practice.
Private practice can be enjoyable and medical residents can now be prepared. The Medical Entrepreneur book is available at Amazon.com for $19.99 or Kindle for only $9.99.
Thursday, April 29, 2010
Hypocrisy of Healthcare reform
The altruistic rhetoric of health care reform is alluring. However, I still cannot understand some of the glaring hypocrisies. If the goal is to reduce the healthcare burden, then why wouldnt tort reform, which has been proven to reduce costs on the system, be aggressively included in this bill? The absence of a bottom line item such as this is a direct reflection of politics. How is anyone to believe motives , positioned as altruistic, to help patients and doctors, when Obama and staff are clearly influenced to not include this issue in the bill. Credibility is lost. You cannot have it both ways. One cannot claim to be motivated by the greater good once you demonstrate politics by excluding tort reform.
Even more distressing is the notable absence of an aggressive approach to help medical students with their debt burden upon graduation. Too little action with no significant answers for our young and promising future of doctors. How can we expect to attract the talent we need , have them graduate from the best medical schools (that happen to be the most expensive) and then not help them get rid of the debt. If you were a medical student graduating today with over 200k of debt how could you possibly budget to reduce that debt when all future income expectations are in flux . Politicians still refuse to fix the Medicare cost decrease. So, on the one hand, you reduce the payment expectations for these doctors but do not help them with their costs of becoming docs. Medical students are incentivized to attend "cheaper" medical schools at bargains rather than the best schools at premiums. Obama should subsidize 75 % of the cost of a medical school education if he is insistent on lowering the cost of health care.
Two glaring issues whose absence is remarkable: the absence of tort reform and medical school costs subsidization stain the motives and the rhetoric to reflect the real driver behind health care reform.
Even more distressing is the notable absence of an aggressive approach to help medical students with their debt burden upon graduation. Too little action with no significant answers for our young and promising future of doctors. How can we expect to attract the talent we need , have them graduate from the best medical schools (that happen to be the most expensive) and then not help them get rid of the debt. If you were a medical student graduating today with over 200k of debt how could you possibly budget to reduce that debt when all future income expectations are in flux . Politicians still refuse to fix the Medicare cost decrease. So, on the one hand, you reduce the payment expectations for these doctors but do not help them with their costs of becoming docs. Medical students are incentivized to attend "cheaper" medical schools at bargains rather than the best schools at premiums. Obama should subsidize 75 % of the cost of a medical school education if he is insistent on lowering the cost of health care.
Two glaring issues whose absence is remarkable: the absence of tort reform and medical school costs subsidization stain the motives and the rhetoric to reflect the real driver behind health care reform.
Sunday, March 07, 2010
Skinstore.com acquired by Drugstore.com
I am excited about the recent acquisition of the company I started in my house many years ago. Skinstore.com has grown to become a house hold word. It's enduring nature is rewarding.
In 1996, when I first named and started the company, I believed in the need for people to find reputable skin care products and advice on the Internet. I remember writing the business plan and the content for the first pages of the first Skinstore.com website. I knew I was on to something special. I was particularly excited about creating the "education center". In 1997, I created the "education center" on the site. There were not many places for people to learn about skin care issues and then buy their skin care products that addressed those issues. This remains important today. Skinstore.com has helped over a million visitors in the last fourteen years.
Doctors can create a successful business by understanding the needs of their patients. My patients wanted doctor recommended skin care products without having to visit the office every time they wanted a new product. That was the value proposition.
In 1996, when I first named and started the company, I believed in the need for people to find reputable skin care products and advice on the Internet. I remember writing the business plan and the content for the first pages of the first Skinstore.com website. I knew I was on to something special. I was particularly excited about creating the "education center". In 1997, I created the "education center" on the site. There were not many places for people to learn about skin care issues and then buy their skin care products that addressed those issues. This remains important today. Skinstore.com has helped over a million visitors in the last fourteen years.
Doctors can create a successful business by understanding the needs of their patients. My patients wanted doctor recommended skin care products without having to visit the office every time they wanted a new product. That was the value proposition.
I am back
Sorry for the absence. I was busy wrapping up the sale of PassportMD. I am eager to share my experience of being a practicing physician and a medical entrepreneur. It is not easy and it is not for the faint of heart. I will use this blog to share my thoughts, experience and advice for doctors that are interested in becoming entrepreneurs too.
Monday, June 01, 2009
Meaningful use of EHR
The latest stab at "meaningful" use...the lynch pin term that seems to have every EHR vendor white knuckled waiting to see that their EHR provides this so that they can justify it's cost to physicians and promise physician reimbursement via Obama's Stimulus plan is...
"Demonstrates that the provider makes use of, and the patient has access to, clinically relevant electronic information about the patient to improve medication management and coordination of care"
This is the proposed definition by the Markle Foundation.
I would like to see it worded more strongly toward overall physician benefits....
It does focus on medication management but also hints toward the PHR.
As a physician, I would like to see a broader definition..one that includes...
I would propose adding the following for "meaningful" use criteria:
"To be meaningful, Physicians can either document one of the following paremeters: improved office efficiency, improved clinical responsiveness, improved clinical access, improved patient care, improved office administration functionality, improved documentation, improved record retrieval, improved billing, improved reliability and reproducibility of outcomes"
"Demonstrates that the provider makes use of, and the patient has access to, clinically relevant electronic information about the patient to improve medication management and coordination of care"
This is the proposed definition by the Markle Foundation.
I would like to see it worded more strongly toward overall physician benefits....
It does focus on medication management but also hints toward the PHR.
As a physician, I would like to see a broader definition..one that includes...
I would propose adding the following for "meaningful" use criteria:
"To be meaningful, Physicians can either document one of the following paremeters: improved office efficiency, improved clinical responsiveness, improved clinical access, improved patient care, improved office administration functionality, improved documentation, improved record retrieval, improved billing, improved reliability and reproducibility of outcomes"
Saturday, May 16, 2009
Why doctors arent adopting electronic medical records and how to help them adopt electronic medical records
Okay, so here's the issue...we all know that there needs to be a government incentive to really drive the adoption of electronic medical records but until now (as recent as of today), there have been no real serious solutions. The problem is that the politicians are not really listening to the medical community...the proposed amount by Obama is not close to enough for a doctor to really slow down his practice with interruptions and create a new dependency on an unknown technology and a new dependency on what would be a required new position for any medical practice..ie technology consultant...Doctors by and large really dont have a clue about recurrent licensing fees, hardware, software, third party vendors, broad band, wireless, ethernet, local servers, remote servers, asp models, and more..they just dont have the time to learn all of the issues that accompany the implementation of a successful digital practice...as a result the doctors , understandably are extremely uncomfortable, with turning over the reigns of their practice, the very core of their practice..ie their patient's medical chart..to an unknown entity ie..the emr software vendor..or to the technology consultant or technology independent contractor they have to retain to implement all of the changes that would accompany their shift from the comfort of paper charts to the "promise" of electronic charts...so..bear with me..I will give you my thoughts on how we approach this..but for now...let me lay out what has been proposed by politicians to encourage adoption of emrs (electronic medical records) ..
1. Obama Stimulus plan...docs can get 44,000 over 5 years if they bring in electronic medical records into their practice. This is not nearly enough..granted it is a start but the real costs for a practice..per year per physician is realistically a minimum of 35-40K...so 5 year cost..taking into consideration hardware, additional third party software licensing fees, technology support fees, annual maintanence fees from software vendors, connectivity fees...and this doesnt equate given that productivity in the form of profit per patient visit does not increase for doctor...so this will never happen.
2. MAssachusetts SB 2863 - link medical school loan repayment to health IT competency...this is a good start..but addresses mostly the younger docs , ie those that have the greatest likelihood of adopting emrs anyways...
3. Wisconsin SB 40- tax credit for providers that purchase EMR's...again good start..but at the end of the day..it is pennies back against dollars spent.
4. New York SB 6808- offering incentive payments for porviders who use emr systems... a necessary implementation..and should be national...ie doctors that use emrs in their practice should receive bonus payments.
5. colorado SB 196- reimbursement to encourage services via telemedicine..again..good start but certainly wont jump start physician adoption of emrs.
So...all of these are better than nothing..but not much.
Here are my thoughts...If the government is really serious about having doctors adopt emrs than this is what must happen:
1. Medicare (as the leader for all insurance companies as it relates to setting fees for service) needs to do the following:
Medicare needs to reimburse physicians that have implemented emrs in their practice a separate fee above and beyond the standard fee for service..this code , not unlike a surgical tray code for supplies for a surgeon, or a facility code for an ambulatory care center, must be significant enough for physician to track and record..at least $5 extra per visit.
Medicare needs to pay the physician back for all expenses related to adopting emrs..not just software, but hardware, maintenance , other third party fees, and technology support and maintenance fees, back up and storage fees. It is not enough to say they will get back 44k after 5 years...as this is just not enough to make the change a reality...it is not worth a doctors time to institute this for the equivalent of 8.5 k per year for 5 years...since that number represents less than 2% of most physician's gross..and if you adjust for the expense benefit ...it is really much much less...
So, what does this mean..let me tell you..it means that our government does not have the means to allocate the funds sufficient to implement the change that the President is hoping for and promising...So then what do we do? Well I will tell you...
A great start was removing financial obstacles from private industry and pharma as it related to stark law exceptions. The Stark law technology exception and IT safe harbors to the anti-kickback statute enables hospitals to subsidize as much as 85 % of upfront ongoing costs for EMR software for physicians, so this exception needs to be more broadly applied and specifically more applicable to physician office setting, let the vendors and the hospitals fund this for the government without the concern of anti kickback penalties.
The one big mistake I see happening is tying implementation of healthcare IT to state licensure...that is surely a catastrophe waiting to happen. Stats like Massachusets and Minneosota have started this...but we all know , it will be delayed and eventually repealed..given that you cannot obligate the docs to do this until you have provided the financial means to do it as outlined above...if you force them and they are not ready or do not have the means to do this, or there is no infrastructure set up and tested in advance..then we will probably be visiting many of our old family docs as unlicensed doctors...
The last issue is my bias and for purposes of full disclosure...I founded and am CEO of PassportMD ( http://www.PassportMD.com ) ...a leading personal health record company...so the issue is..at the end of the day..when politicians realize it is not financially feasible to push the doctors to adopt..they will realize what I believe and that is that the easiest way to get adoption (and probably the cheapest as noted after reading my above comments) is to have the consumers push it to the doctors..so in this scenario, the quickest path to get health records digitized is through web based applications like PassportMD and Healthvault , mostly because it is without costing physicians a penny, but must have insurance payors incentivize the consumer/patient/beneficiary to adopt a web based online health record. And then let the consumer brin/push this to the doctor and have the doctor add to this via web access without incurring implementation , technology, hard ware, software and support fees.
http://twitter.com/PassportMD
1. Obama Stimulus plan...docs can get 44,000 over 5 years if they bring in electronic medical records into their practice. This is not nearly enough..granted it is a start but the real costs for a practice..per year per physician is realistically a minimum of 35-40K...so 5 year cost..taking into consideration hardware, additional third party software licensing fees, technology support fees, annual maintanence fees from software vendors, connectivity fees...and this doesnt equate given that productivity in the form of profit per patient visit does not increase for doctor...so this will never happen.
2. MAssachusetts SB 2863 - link medical school loan repayment to health IT competency...this is a good start..but addresses mostly the younger docs , ie those that have the greatest likelihood of adopting emrs anyways...
3. Wisconsin SB 40- tax credit for providers that purchase EMR's...again good start..but at the end of the day..it is pennies back against dollars spent.
4. New York SB 6808- offering incentive payments for porviders who use emr systems... a necessary implementation..and should be national...ie doctors that use emrs in their practice should receive bonus payments.
5. colorado SB 196- reimbursement to encourage services via telemedicine..again..good start but certainly wont jump start physician adoption of emrs.
So...all of these are better than nothing..but not much.
Here are my thoughts...If the government is really serious about having doctors adopt emrs than this is what must happen:
1. Medicare (as the leader for all insurance companies as it relates to setting fees for service) needs to do the following:
Medicare needs to reimburse physicians that have implemented emrs in their practice a separate fee above and beyond the standard fee for service..this code , not unlike a surgical tray code for supplies for a surgeon, or a facility code for an ambulatory care center, must be significant enough for physician to track and record..at least $5 extra per visit.
Medicare needs to pay the physician back for all expenses related to adopting emrs..not just software, but hardware, maintenance , other third party fees, and technology support and maintenance fees, back up and storage fees. It is not enough to say they will get back 44k after 5 years...as this is just not enough to make the change a reality...it is not worth a doctors time to institute this for the equivalent of 8.5 k per year for 5 years...since that number represents less than 2% of most physician's gross..and if you adjust for the expense benefit ...it is really much much less...
So, what does this mean..let me tell you..it means that our government does not have the means to allocate the funds sufficient to implement the change that the President is hoping for and promising...So then what do we do? Well I will tell you...
A great start was removing financial obstacles from private industry and pharma as it related to stark law exceptions. The Stark law technology exception and IT safe harbors to the anti-kickback statute enables hospitals to subsidize as much as 85 % of upfront ongoing costs for EMR software for physicians, so this exception needs to be more broadly applied and specifically more applicable to physician office setting, let the vendors and the hospitals fund this for the government without the concern of anti kickback penalties.
The one big mistake I see happening is tying implementation of healthcare IT to state licensure...that is surely a catastrophe waiting to happen. Stats like Massachusets and Minneosota have started this...but we all know , it will be delayed and eventually repealed..given that you cannot obligate the docs to do this until you have provided the financial means to do it as outlined above...if you force them and they are not ready or do not have the means to do this, or there is no infrastructure set up and tested in advance..then we will probably be visiting many of our old family docs as unlicensed doctors...
The last issue is my bias and for purposes of full disclosure...I founded and am CEO of PassportMD ( http://www.PassportMD.com ) ...a leading personal health record company...so the issue is..at the end of the day..when politicians realize it is not financially feasible to push the doctors to adopt..they will realize what I believe and that is that the easiest way to get adoption (and probably the cheapest as noted after reading my above comments) is to have the consumers push it to the doctors..so in this scenario, the quickest path to get health records digitized is through web based applications like PassportMD and Healthvault , mostly because it is without costing physicians a penny, but must have insurance payors incentivize the consumer/patient/beneficiary to adopt a web based online health record. And then let the consumer brin/push this to the doctor and have the doctor add to this via web access without incurring implementation , technology, hard ware, software and support fees.
http://twitter.com/PassportMD
Monday, May 04, 2009
Twitter and Blog for PassportMD
just added my twitter comments to the blog...
Keeping an eye on the real story regarding adoption of EHR based on government incentives...really believe that the stimulus falls short for the doctors...just not enough based on the disruption issue for MD's ...
In the end too costly for the docs and too costly for the government - see the push coming from the patient side...presenting digital data via MIcrosoft Healthvault platform, Google , or PassportMD.
Consumers will need to drive digital adoption by presenting this data to docs...docs will access ASP versions or web based versions of free data...no need to adopt expensive technology disruptive systems.
Keeping an eye on the real story regarding adoption of EHR based on government incentives...really believe that the stimulus falls short for the doctors...just not enough based on the disruption issue for MD's ...
In the end too costly for the docs and too costly for the government - see the push coming from the patient side...presenting digital data via MIcrosoft Healthvault platform, Google , or PassportMD.
Consumers will need to drive digital adoption by presenting this data to docs...docs will access ASP versions or web based versions of free data...no need to adopt expensive technology disruptive systems.
Thursday, February 05, 2009
Barack Obama's latest Comments
Yesterday, President Obama had the following comments after signing a health care bill to help cover an additional 4 million uninsured children..
"And -- and it is just one component of a much broader effort to finally bring our health care system into the 21st century. That's why the economic recovery and reinvestment plan that's now before Congress is so important.
And think about this: If Congress passes this recovery plan, in just one month, we will have done more to modernize our health care system than we've done in the past decade. We'll be on our way to computerizing all of America's medical records, which won't just...
It won't -- won't just eliminate inefficiencies. It won't just save billions of dollars and create tens of thousands of jobs, but it will save lives by reducing deadly medical errors. We'll have made the single largest investment in prevention and wellness in history, attacking problems like smoke and obesity, and helping people live longer, healthier lives."
Although the HHS appointment with Daschle was a small blunder...the train is out of the station on this issue...and with Medicare already involved in a pilot with PassportMD the government has made very clear it's position on personal health records. And that is, we all need them and they will help us get to the point where we all have them.
"And -- and it is just one component of a much broader effort to finally bring our health care system into the 21st century. That's why the economic recovery and reinvestment plan that's now before Congress is so important.
And think about this: If Congress passes this recovery plan, in just one month, we will have done more to modernize our health care system than we've done in the past decade. We'll be on our way to computerizing all of America's medical records, which won't just...
It won't -- won't just eliminate inefficiencies. It won't just save billions of dollars and create tens of thousands of jobs, but it will save lives by reducing deadly medical errors. We'll have made the single largest investment in prevention and wellness in history, attacking problems like smoke and obesity, and helping people live longer, healthier lives."
Although the HHS appointment with Daschle was a small blunder...the train is out of the station on this issue...and with Medicare already involved in a pilot with PassportMD the government has made very clear it's position on personal health records. And that is, we all need them and they will help us get to the point where we all have them.
Sunday, January 18, 2009
Personal Health Records going from step child to favorite son
Having lived in this space for several years, I can tell you that the PHR world has gone from sleepy "cottage" , "mom and pop" industry to the hottest sector in healthcare IT.
Why?
Several reasons...EMR's were the "favorite son" of every investment firm, government legislator and healthcare IT..the great promise of EMR's were highly tauted as the savior of the medical industry...for the last 20 years...everyone was betting on the EMR's to transition US healthcare from caveman record keeping to real world real time interoperable pie in the sky exchange...but the fireworks turned to a small fizzle...when the realism of pushing entrenched doctors, already squeezed by health insurers and liability issues and government regulations, to purchase expensive technology systems for their practice died. Why would a doctor spend another 25,000 a year per provider to interrupt his practice when he has watched his income go down, his hours go up, and regulatory burdens suck the pleasure out of practicing medicine? Well, the answer is..they wouldnt...would you?
So, after 20 years of promise..the industry went through major consolidation with very few little guys left...and at the end of the day...only 20% of docs in the best case scenario have picked up the cost of EMR's...
So, the wise men on the hill realized that the goal of healthcare IT transformation will not be through waiting for docs to adopt EMRs...The answer is PHRs or Personal Health Record Systems...neglected for years until lightening strikes last year...and standards for Personal health record systems int he form of CCR/CCD are adopted. That was the critical happenstance. As soon as the standards were adopted by the AMA, AAFP, the CCHIT mandated that all backend EMR systems accept the standard for certification and everyone soon realized that the way to drive the electronic healthcare revolution is through this piece...give it to the consumer...make it interoperable..if the consumer takes his record with him wherever he goes..or said differently if his record goes with him...then the record will be the piece that drives the adoption of the EMR. And I think the Medicare Pilot program is a testament to this, the government is ready to push this...So, the PHR goes through all the different disparate systems and the patient (rather than the physician) drives the adoption...I believe that is what is going to happen. The patient will be incentivized to adopt the phr via health insurance cost incentives..less costly premiums or covering the expense of the cost of PHR for the individual insured. (Recent study from Partners Healthcare in Boston shows health insurers save over $20 billion per year after giving phrs' to people). The last incentive will come from government and health insurers that push doctors to update the phr and read the phr through the CCD/CCR standard.
So, when we read in the NY Times, “Health information technology will succeed only if privacy is protected,” said Frank C. Torres, director of consumer affairs at Microsoft. “For the president-elect to achieve his vision, he has to protect privacy.”
Mr. Torres is correct except the privacy part is a given...just as bread is necessary for a sandwich...but what lies between the 2 pieces of bread is what really distinguishes the sandwich..and in my opinion the absolute , without question, necessity for health information technology to succeed and for Obama to reach his goals...the only answer and the only critical part is the incentive that must be provided to the doctor to participate and the patient to participate...without the incentive , it fails..I believe Obama knows this or they should read this..so they understand that they must properly incentivize the active participants or we will wait another 20 years ...
The good news is...the incentives are coming...(and I see EMR systems merging with PHR's as all ASP systems that dont cost anything for the doctor to use-will discuss in future blogs)
Why?
Several reasons...EMR's were the "favorite son" of every investment firm, government legislator and healthcare IT..the great promise of EMR's were highly tauted as the savior of the medical industry...for the last 20 years...everyone was betting on the EMR's to transition US healthcare from caveman record keeping to real world real time interoperable pie in the sky exchange...but the fireworks turned to a small fizzle...when the realism of pushing entrenched doctors, already squeezed by health insurers and liability issues and government regulations, to purchase expensive technology systems for their practice died. Why would a doctor spend another 25,000 a year per provider to interrupt his practice when he has watched his income go down, his hours go up, and regulatory burdens suck the pleasure out of practicing medicine? Well, the answer is..they wouldnt...would you?
So, after 20 years of promise..the industry went through major consolidation with very few little guys left...and at the end of the day...only 20% of docs in the best case scenario have picked up the cost of EMR's...
So, the wise men on the hill realized that the goal of healthcare IT transformation will not be through waiting for docs to adopt EMRs...The answer is PHRs or Personal Health Record Systems...neglected for years until lightening strikes last year...and standards for Personal health record systems int he form of CCR/CCD are adopted. That was the critical happenstance. As soon as the standards were adopted by the AMA, AAFP, the CCHIT mandated that all backend EMR systems accept the standard for certification and everyone soon realized that the way to drive the electronic healthcare revolution is through this piece...give it to the consumer...make it interoperable..if the consumer takes his record with him wherever he goes..or said differently if his record goes with him...then the record will be the piece that drives the adoption of the EMR. And I think the Medicare Pilot program is a testament to this, the government is ready to push this...So, the PHR goes through all the different disparate systems and the patient (rather than the physician) drives the adoption...I believe that is what is going to happen. The patient will be incentivized to adopt the phr via health insurance cost incentives..less costly premiums or covering the expense of the cost of PHR for the individual insured. (Recent study from Partners Healthcare in Boston shows health insurers save over $20 billion per year after giving phrs' to people). The last incentive will come from government and health insurers that push doctors to update the phr and read the phr through the CCD/CCR standard.
So, when we read in the NY Times, “Health information technology will succeed only if privacy is protected,” said Frank C. Torres, director of consumer affairs at Microsoft. “For the president-elect to achieve his vision, he has to protect privacy.”
Mr. Torres is correct except the privacy part is a given...just as bread is necessary for a sandwich...but what lies between the 2 pieces of bread is what really distinguishes the sandwich..and in my opinion the absolute , without question, necessity for health information technology to succeed and for Obama to reach his goals...the only answer and the only critical part is the incentive that must be provided to the doctor to participate and the patient to participate...without the incentive , it fails..I believe Obama knows this or they should read this..so they understand that they must properly incentivize the active participants or we will wait another 20 years ...
The good news is...the incentives are coming...(and I see EMR systems merging with PHR's as all ASP systems that dont cost anything for the doctor to use-will discuss in future blogs)
Thursday, November 13, 2008
Medicare Selects PassportMD for PHR PIlot
MEDICARE NEWS
From: CMS Office of Media Affairs
November 12, 2008
MEDICARE SELECTS FOUR COMPANIES WHERE BENEFICIARIES CAN
CHOOSE TO MAINTAIN THEIR OWN PERSONAL HEALTH RECORDS
The Centers for Medicare & Medicaid Services (CMS) today announced the selection of four personal health record (PHR) companies to participate in the new Medicare PHR Choice Pilot in Arizona and Utah.
This pilot program will, beginning in early 2009, offer beneficiaries with Original Medicare the opportunity to choose one of the selected PHR companies to maintain their health record information electronically.
The four selected companies are Google Health, HealthTrio, NoMoreClipboard.com, and PassportMD. These choices offer beneficiaries a range of product choices from ones that are free to ones that have “concierge” service as well as a diverse set of connections to health care providers, pharmacies, and other sources of health information.
“This pilot is a major step forward for Medicare. It will provide information and tools that will empower consumers to manage their health better,” said HHS Secretary Mike Leavitt. “Importantly, the pilot provides beneficiaries with a choice of products to meet their individual needs.”
PHRs are tools that can help consumers manage their health and health care services. A PHR is a record of health information that is under the control of the consumer or patient. Sometimes it only contains data entered by the individual or his or her provider, but it can also include information from a health plan – as is the case in this pilot, where Medicare will provide health information from its claims database.
A PHR, which is controlled by the consumer, is different than an electronic health record (EHR), which is owned by and under the control of the physician. A PHR may only contain data entered by the consumer or his or her health care provider.
Through this pilot beneficiaries who select one of the participating PHR vendors can add other personal health information if they choose. Medicare will also transfer up to two years of the beneficiary’s claims data into the individual’s PHR, if the beneficiary requests it.
Depending on the specific product, beneficiaries may be able to authorize links to other personal electronic information such as pharmacy data.
PHRs also may offer links to tools that help consumers manage their health such as wellness programs for tracking diet and exercise, information about drugs and medical devices, health education information, and applications to detect potential medication interactions. Beneficiaries can elect to allow family members, health care providers, or whomever they choose to have access to their PHR. This can allow caregivers to help manage loved ones health or be critical to a physician caring for you in an emergency.
Each company has privacy and security standards to protect the information transmitted and stored in their PHR records. More information on the specific security and privacy policies of each of the participating companies can be found on their websites.
CMS’ contractor, Noridian Administrative Services (NAS), led the intensely competitive selection process.
“At Medicare, we strive to find innovative ways to better serve our beneficiaries,” said CMS Acting Administrator Kerry Weems. “We encourage beneficiaries to consider whether a PHR is right for them. We plan to evaluate beneficiaries’ satisfaction, issues or concerns about PHRs, and whether PHRs seem to improve the health and associated costs for caring for beneficiaries as part of this pilot.”
More information about the selected companies may be found at these web links:
https://www.google.com/health
http://www.healthtrio.com/phr.html
https://www.passportmd.com/
From: CMS Office of Media Affairs
November 12, 2008
MEDICARE SELECTS FOUR COMPANIES WHERE BENEFICIARIES CAN
CHOOSE TO MAINTAIN THEIR OWN PERSONAL HEALTH RECORDS
The Centers for Medicare & Medicaid Services (CMS) today announced the selection of four personal health record (PHR) companies to participate in the new Medicare PHR Choice Pilot in Arizona and Utah.
This pilot program will, beginning in early 2009, offer beneficiaries with Original Medicare the opportunity to choose one of the selected PHR companies to maintain their health record information electronically.
The four selected companies are Google Health, HealthTrio, NoMoreClipboard.com, and PassportMD. These choices offer beneficiaries a range of product choices from ones that are free to ones that have “concierge” service as well as a diverse set of connections to health care providers, pharmacies, and other sources of health information.
“This pilot is a major step forward for Medicare. It will provide information and tools that will empower consumers to manage their health better,” said HHS Secretary Mike Leavitt. “Importantly, the pilot provides beneficiaries with a choice of products to meet their individual needs.”
PHRs are tools that can help consumers manage their health and health care services. A PHR is a record of health information that is under the control of the consumer or patient. Sometimes it only contains data entered by the individual or his or her provider, but it can also include information from a health plan – as is the case in this pilot, where Medicare will provide health information from its claims database.
A PHR, which is controlled by the consumer, is different than an electronic health record (EHR), which is owned by and under the control of the physician. A PHR may only contain data entered by the consumer or his or her health care provider.
Through this pilot beneficiaries who select one of the participating PHR vendors can add other personal health information if they choose. Medicare will also transfer up to two years of the beneficiary’s claims data into the individual’s PHR, if the beneficiary requests it.
Depending on the specific product, beneficiaries may be able to authorize links to other personal electronic information such as pharmacy data.
PHRs also may offer links to tools that help consumers manage their health such as wellness programs for tracking diet and exercise, information about drugs and medical devices, health education information, and applications to detect potential medication interactions. Beneficiaries can elect to allow family members, health care providers, or whomever they choose to have access to their PHR. This can allow caregivers to help manage loved ones health or be critical to a physician caring for you in an emergency.
Each company has privacy and security standards to protect the information transmitted and stored in their PHR records. More information on the specific security and privacy policies of each of the participating companies can be found on their websites.
CMS’ contractor, Noridian Administrative Services (NAS), led the intensely competitive selection process.
“At Medicare, we strive to find innovative ways to better serve our beneficiaries,” said CMS Acting Administrator Kerry Weems. “We encourage beneficiaries to consider whether a PHR is right for them. We plan to evaluate beneficiaries’ satisfaction, issues or concerns about PHRs, and whether PHRs seem to improve the health and associated costs for caring for beneficiaries as part of this pilot.”
More information about the selected companies may be found at these web links:
https://www.google.com/health
http://www.healthtrio.com/phr.html
https://www.passportmd.com/
Sunday, October 19, 2008
Joan Lunden Joins PassportMD Announces ConcierCare Service
DELRAY BEACH, Fla., Oct. 14, 2008 – PassportMD, the award-winning provider in online health record and wellness services, announced today that television personality Joan Lunden has signed a multi-year partnership with the company. The announcement comes as PassportMD launches its innovative concierge service, ConcierCare™. Ms. Lunden, a mother of seven children, will educate busy moms across America about PassportMD’s concierge service, which helps users create an online health record for family members by collecting records, digitizing images, and assisting with other health and wellness tools.
As the primary caregiver of an aging mother and best-selling health and wellness author, Ms. Lunden understands the challenges that moms in the “sandwich” generation face as they manage the health and wellness of their children and parents.
“My brother took care of our mother’s health care information,” said Ms. Lunden. “When he passed away, I had to recreate her last 10 years of doctor visits and prescriptions. It was overwhelming. PassportMD’s ConcierCare is an invaluable tool for all moms.”
Ms. Lunden will not only help to create awareness of the importance of maintaining a Personal Health Record (PHR), but she will also be involved in future product development and is an active member of PassportMD’s advisory board.
Two New Services: ConcierCare and Doctor Access
ConcierCare is the first concierge service of its kind. With one simple phone call, users are able to have a dedicated concierge collect medical records of each person the account designates, including the user’s children and parents. Health records are obtained in a HIPAA-compliant manner using encrypted channels after users provide a secure, electronic signature. Collection and population of the PHR takes approximately two weeks.
“People understand the value of having their health records accessible and organized, but find the task of collecting and uploading them incredibly daunting,” said Steven M. Hacker, MD, Founder & CEO of PassportMD, Inc. “Our ConcierCare service removes this burden and makes the process simple.”
Another important feature of the PassportMD concierge service is the Doctor Access program, which not only makes communicating with physicians easier than ever, but also has the potential to reduce medical errors. Doctor Access is invaluable before physicians make treatment decisions concerning their patient’s health. A click of the mouse allows users to invite their doctors to share and review their medical records, including diagnostic quality images.
“Creating an easy way for consumers to invite authorized doctors to view selected health information is the challenge of most PHR companies,” said Dr. Hacker. “PassportMD solves this problem.”
As the primary caregiver of an aging mother and best-selling health and wellness author, Ms. Lunden understands the challenges that moms in the “sandwich” generation face as they manage the health and wellness of their children and parents.
“My brother took care of our mother’s health care information,” said Ms. Lunden. “When he passed away, I had to recreate her last 10 years of doctor visits and prescriptions. It was overwhelming. PassportMD’s ConcierCare is an invaluable tool for all moms.”
Ms. Lunden will not only help to create awareness of the importance of maintaining a Personal Health Record (PHR), but she will also be involved in future product development and is an active member of PassportMD’s advisory board.
Two New Services: ConcierCare and Doctor Access
ConcierCare is the first concierge service of its kind. With one simple phone call, users are able to have a dedicated concierge collect medical records of each person the account designates, including the user’s children and parents. Health records are obtained in a HIPAA-compliant manner using encrypted channels after users provide a secure, electronic signature. Collection and population of the PHR takes approximately two weeks.
“People understand the value of having their health records accessible and organized, but find the task of collecting and uploading them incredibly daunting,” said Steven M. Hacker, MD, Founder & CEO of PassportMD, Inc. “Our ConcierCare service removes this burden and makes the process simple.”
Another important feature of the PassportMD concierge service is the Doctor Access program, which not only makes communicating with physicians easier than ever, but also has the potential to reduce medical errors. Doctor Access is invaluable before physicians make treatment decisions concerning their patient’s health. A click of the mouse allows users to invite their doctors to share and review their medical records, including diagnostic quality images.
“Creating an easy way for consumers to invite authorized doctors to view selected health information is the challenge of most PHR companies,” said Dr. Hacker. “PassportMD solves this problem.”
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