May 3rd, 2011 by RamonaBatesMD in News, Opinion
Tags: Ethics, Hand Transplantation, Immunosuppression, Medical Ethics, Nerves, Plastic Surgery
No Comments »
There was a lovely news article on the first California hand transplant patient in the LA Times earlier this week: Hand transplant patient speaks (bold emphasis is mine)
Emily Fennell, 26, last month became the first person in California to have the revolutionary surgery. Six weeks and many hours of therapy later, she has no regrets. …..
On March 5, Fennell became the first person to undergo a hand transplant in California and the 13th nationwide to have the revolutionary surgery. . ….
“It’s crazy how good it looks,” she said at her occupational therapy session one morning last week at UCLA, where she spends about eight hours a day working on learning how to move her new hand and fingers. “I knew the match wouldn’t be perfect, but if you didn’t know what happened, you’d think I just had some kind of orthopedic surgery.” ….
Doctors told her that the biggest risk from the surgery comes from the side effects of lifelong use of strong immunosuppressant medications, which can cause high blood pressure, kidney or liver damage, elevated cancer risks and lower resistance to infections. …..
“I decided the benefits were worth those risks,” Fennel said. She has adjusted well to the medications. …. Read more »
*This blog post was originally published at Suture for a Living*
May 3rd, 2011 by Stanley Feld, M.D. in Health Policy, Opinion
Tags: Accountable Care Organizations, ACO, ACOs, Challenges, Concerns, Costs, HMOs, Hospitals, Obamacare, Perils, Quality, Trust
1 Comment »
Thousands of articles have been written about forming ACOs. Millions of dollars have been spent by hospital systems to try to form an ACO. Healthcare policy consultants have discovered a new cash cow.
Hospitals systems are wasting their money. They think the return from owning salaried physicians’ intellectual property will be more than worth the cost.
- Thousands of physicians have been confused by the concept of ACO.
- Many have felt ACOs are an attack on their freedom to practice medicine the best they can.
- Many have rejected the concept because they feel they will have to be salaried by hospital systems.
- Many physicians do not trust President Obama or Dr. Don Berwick.
- The Stage 2 ACO regulations are not easy to understand. They are more ominous than the stage 1 regulations.
The two core stated objectives for ACOs are:
(1) Reducing healthcare costs.
(2) Preserving and improving quality.
The stated objectives are laudable. The government regulations and controls are confusing. Read more »
*This blog post was originally published at Repairing the Healthcare System*
May 2nd, 2011 by DrWes in Opinion, True Stories
Tags: American College of Cardiology, Big Brother, CME, Heart Rhythm Society, Intrusive Technology, Meaningful Use, Medical Conferences, P4P, Privacy, RFID, RFID Tags, Tags
No Comments »
Not everything that counts can be measured.
Not everything that can be measured counts.
-Albert Einstein
Recently, a disturbing trend of monitoring physician quality and accountability has taken another ominous turn: tracking physician’s movements at scientific conferences (so called “tag and release”) using RFID tags imbedded in attendees name badges at national scientific sessions. Having had personal experience with the recent American College of Cardiology meeting, this technology will also be imbedded in the name badges for attendees at the upcoming Heart Rhythm Society meeting to be held in San Francisco in May.
On first blush, it shouldn’t be such a big deal, right? It was all just a great way for companies to obtain, for a fee, the names and institutions of people who visited their display booths and for the conference organizers to track the movements of attendees. (Heck, maybe they can partner with an industry sponsor to pick up our traffic tolls on the way to the conference hall or arrange other exciting activities for us! [Said tongue-in-cheek, of course])
Instead of “opting in” for tracking at scientific meetings, doctors must “opt out” from the use of tracking technology when registering for scientific meetings. At the upcoming Heart Rhythm Society meeting for instance, doctors had to “opt out” from the use of RFID technology tracking by checking a box that says:
Badge scanning technology will be utilized at this event in order to better understand attendee/delegate interests and preferences. The information collected will be used to improve future events to better address your preferences. No personal information is stored in the RFID badge, only an ID number. We encourage all participants to take part in this process to ensure the most accurate data is obtained. You may check this box to opt-out of the RFID data collection.
There’s full disclosure, doctor.
But to me, the default tracking of doctors is disturbing on several levels.
First, tracking was approved by our professional society organizers upon their own members. It is no secret that these societies make a significant portion of their operating revenues from industry sponsors at these meetings. By instituting tracking, the value of their membership’s privacy has taken a back seat to the income generated from tracking revenues. By NOT checking a box, we have implicitly “agreed” to this tracking. (Realize we MUST wear our badge to attend these conferences where we gain our REQUIRED continuing education credits.) Because we have “agreed” in this manner, the tracking data are now legally “discoverable.” At the risk of sounding like a conspiracy theorist, it is not too hard to imagine one’s credentials being called into question in court because a doctor did not demonstrate enough time in CME activities at the scientific sessions to quality for credit or because these data implicate a doctor in a purchasing agreement between a vendor and hospital system simply because a doctor visited a display booth.
Doctors have seen this sort of activity before when “only” our license and demographic information was sold by the American Medical Association (AMA). The AMA currently “licenses” physician state medical license numbers and demographic information to health care information organizations (HIOs), HIOs then collect and compile this information with prescribing data that contains the doctors’ license numbers (no names, mind you) and then sell the lists to pharmaceutical companies. The AMA tells its members it does “not collect, license, sell or have access to physician prescribing data” and this is true. But the AMA facilitates an intermediary’s ability to pair doctors’ license information to a their prescribing habits via a third party. One can only speculate how out prescribing and practice profiles are being developed by other similar health information companies with the use of our RFID tracking data.
Behind all of this is a bigger issue: doctors are frustrated by the increasing intrusion into our day-to-day practice of medicine to measure things. Take, as one example, our “quality performance measures” that have done little to facilitate patients office visits, but rather add burdonsome documentation requirements in the interest of government payments. A number of hospital administrators have confided in me that it costs more to collect this data than they make in government payments. In fact, whether these programs are ultimately are found to be cost-effective or improve the quality of care has been brought into question in our literature. Yet we continue to collect these measures and expand them. We are now dispatching legions of people to collect and compile data to “prove” that Electronic Medical Records are used in a “meaningful” way. But an honest appraisal of this policy discloses the reality: these measures permit health care systems to collect another $40,000 per doctor from the government because they are using computers, not because it improves patients’ care in any “meaningful” way. As proof of the overburdensome nature of all this data collection for the physician, doctors (or their health care systems) are increasingly employing “scribes” to relieve them of the data-entry burdens in the name of “efficiency.” How much, exactly, do these scribes cost our health care system? Few dare to ask the question since no one wants to deny themselves of that juicy $40,000 pot of gold being paid per doctor.
Adding insult to injury, all doctors will soon be required to disclose if we receive anything over $100 from industry representatives. Like the public, most of us recognize the pernicious nature of industry influence upon our profession. Yet we now find we are being used. Should our professional organizations be any less forthright with their industry dealings and the use of our demographic data at national scientific sessions? How much is at stake?
Finally, we see more and more onerous licensure requirements and fees paid to the same tag-and-release operatives at considerable cost to ourselves. We now spend thousands of dollars to remain “credentialed.” We wonder how much the RFID “return on investment” to industry sponsors adds to our annual membership fees. Could it reduces them? Who knows? Maybe, like other IT models, we should insist our membership fees be waived if we agree to being RFID tagged and released because most of us realize someone’s making money on this deal.
In summary, doctors increasingly find the imperative to guard the privacy of our patients without regard to our own personal and professional privacy with the very same patients disturbing. Everything about doctors is being measured these days and it’s taking its toll on patient care. We are frustrated with the governmental bureaucratic standards that threaten our time with patients. But time with patients does not pay bills. Meeting data-collection milestones do. Our government and employers have lost sight of the main issue here: improving and expanding our contact with (and the ability to do good for) our patients.
But as long as there is money to be made with our personal information, it is clear that there will be those that will try to capitalize upon it, whether we realize it or not. Only by demanding constant accountability and transparency from the collectors of this information be they government bureaucrats or our professional society appointees, can we hope to maintain any modicum of professionalism in our tenuous doctor-patient relationships of the future.
*This blog post was originally published at Dr. Wes*
May 2nd, 2011 by Glenn Laffel, M.D., Ph.D. in Health Policy, Opinion
Tags: Alzheimer's Disease, Commentary, Dementia, Diagnosis, Early Detection, Ethics, Geriatrics, Guidelines, Internal Medicine, Neurology, Providers, Stages
1 Comment »
For the first time in 30 years, an expert panel has updated guidelines for the diagnosis of Alzheimer’s disease. The long overdue facelift should favorably impact care for millions and accelerate badly needed research on the disease.
The guidelines were produced by representatives from the National Institute on Aging and the Alzheimer’s Association. They portray Alzheimer’s for the first time as a three-stage disease. In addition to ‘Stage 3,’—the full-blown clinical syndrome that had been described in earlier versions of the guidelines—the new guidelines describe an earlier ‘Stage 2,’ of mild cognitive impairment due to Alzheimer’s, and a ‘Stage 1, or preclinical’ phase of the disease. The latter can only be detected with biochemical marker tests and brain scans.The guidelines legitimize years’ worth of observations by the family members of Alzheimer’s patients, who recognize in retrospect that Grandpa had a slowly progressive cognitive disorder long before he was diagnosed. The guidelines also reflect progress on the research front, where it has now been established that the disease begins years before patients become symptomatic.
Alzheimer’s patients and their families, and the teetering US health system that supports them, would have been better served by the publication of these guidelines 2-3 years ago. Read more »
*This blog post was originally published at Pizaazz*
May 1st, 2011 by Berci in News, Opinion
Tags: Blogs, Facebook, Health 2.0, Physicians, Should Physicians Participate In Social Media, Social Media, Twitter
No Comments »
Healthcare IT News recently asked its readers about their thoughts on doctors using social media.
The interesting part here is when 13% of participants think that doctors should not be using social media at all. I wonder why they ignore social media that much. Maybe because they have never heard about the limitations, dangers and potential tools to fight these dangers. Maybe we should talk more about these issues.
*This blog post was originally published at ScienceRoll*
