Tuesday, July 31, 2007

Places to Practice

In a recent article of Medical Economics, they reported some of the best places to practice medicine.

Variables that typically make one location more desirable than another include things such as:
• Low insurance premiums and in an area with a doctor-friendly malpractice environment
• Solid reimbursements
• A good doctor-to-population ratio to help ensure the practice will remain viable
• Close proximity to a hospital providing excellent state-of-the-art care
• A lower-than-average cost of doing business, coupled with an overall lower cost of living.
• Relatively low managed care penetration or, at the least, less market concentration, so that one or two health plans don't call all the shots.
• Typically an area with more traditional family values that usually relate to a better doctor-physician relationship

There are places that meet these stipulations in every area of the country and many within an hour or two of major metropolitan areas.

The Mid-South/South Atlantic
This area is the highest in the nation when it comes to practice revenue. Areas included are:
• Gainesville, GA.
• Waynesville, Clyde, and Hendersonville, NC.
• Huntsville, AL.
• Greenville, SC.
• Martinsville, VA.
• Kingsport, TN.

The Southwest
• The Woodlands, TX.
• Fredericksburg, TX.
• Tyler and Waco, TX.
• Amarillo, Midland, and Lubbock, TX.
• Las Cruces, NM.

The Northeast
• Manchester, NH.
• Portland, ME.
• Scranton/Wilkes-Barre, PA.
• Middletown and Poughkeepsie, NY
• Concord, NH.
• Augusta, ME.

The Midwest
• Lima and Findlay, OH
• Cincinnati.
• Indianapolis.
• Columbus, IN.
• Terre Haute, IN.
• Eau Claire, WI.
• Wichita, KS

The Northwest
• Boise, ID.
• Eugene and Springfield, OR
• Everett and Bellingham, WA.

The West
• Stockton and Modesto, CA.
• Fresno, Visalia, and Bakersfield, CA

As you can see, there are opportunities everywhere.

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Monday, July 30, 2007

Doctors and Drug Companies



Many people question the relationship physicians have with the drug companies. The laws have changed drastically and for the past 5-10 years, there are very few perks provided by drug companies compared to 10-20 years ago.

The New England Journal of Medicine had a recent survey and reported that Cardiologists are more than twice as likely as Family physicians to take payments from drug companies for professional services such as consulting, speaking at professional meetings or enrolling patients in clinical trial.

The study showed that 94 percent of the 3167 physicians questioned, reported some kind of relationship with drug companies; 83 percent accepted food and 78 accepted drug samples whereas only 28 percent performed professional services and accepted monetary reimbursement for the services.

Most family physicians receive advertising in the form of pens and sticky notes and many drug companies provide lunch for the opportunity to sit and give you a “detail” on one or more of their drugs. Most family physicians accept samples for the benefit of their patients who have no insurance and to get patients started on a new drug.

Gone are the days of trips, golf outings, elaborate dinners etc., but the pharmaceutical companies still realize that it is very important to maintain a relationship between their reps and the physicians. The doctor’s pen is still the most important tool used according to the pharmaceutical firms.

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Friday, July 27, 2007

Sneezing




The question arises as to why you cannot keep your eyes open when you sneeze. Various explanations have been given but what is true and what is not?


Some say we close our eyes when we sneeze to keep them from popping out of our heads.
It is very unlikely you will ever sneeze hard enough to cause your eyes to pop out of socket.

Closing the eyes during a sneeze is a reflex similar to the one that occurs when your knee kicks after its hit with a medical hammer, or the way your hand pulls away from something hot when you burn it.


Closing your eyes when you sneeze is a powerful reflex and you can try and force yourself to keep your eyes open, but it is very hard to do.


Another folklore related to sneezing is that we close our eyes closed to keep the stuff we sneeze out from getting in our eyes.


This also is unlikely because the velocity of the sneeze causes the material to travel quite a distance.


The simple explanation is that it is a reflex and typically out of conscious control for the majority of people.


Gesundheit.

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Thursday, July 26, 2007

Driving Competence

In a recent survey by medical economics, the question was asked if doctors should be responsible for judging the patient’s fitness to drive.

The survey results are listed below.



As you can see, two thirds of the physicians responding did not feel it was their place to make this final judgment.

This discussion causes a lot of emotions with older patients. They realize they are declining and driving is sometimes their last independent activity they do. It can be very distressing and cause a lot of family conflict. Physicians are often left to be the “bad guys” and tell the patient.

There are drivers of all ages not competent to drive, but there is really no standard on who should make this ultimate determination.

Are there thoughts from readers?

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Wednesday, July 25, 2007

Data Mining



Physicians know all too well that the pharmaceutical reps have data about our prescribing patterns long before they come for a visit. But the state of New Hampshire has been trying to outlaw the data mining of prescription information the drug companies use to provide this information to the reps.

Unfortunately, the federal court struck down a 2006 state law that barred data-miners from using patients’ prescription drug information to directly market pharmaceuticals to physicians.

This ruling in April from U.S. District Judge Paul Barbadoro in Concord, N.H., said the law is a violation of constitutional guarantees of free speech. The suit was filed by two plaintiffs, data-miners Verispan, Yardley, Pa., and IMS Health, Norwalk, Conn.

The process goes like this; prescription data information is sold by drugstores to data-miners, who then refine the data and sell it to drug companies. The drug companies use the data to arm their sales representatives when they “detail” their drugs to doctors.

Many states would like to curb the multibillion-dollar healthcare data-mining industry but this ruling will cause some to reconsider. New Hampshire is planning an appeal.

New Hampshire officials believe the ruling will prove hurtful for residents and physicians and can prove harmful to the doctor patient relationship. They also believe it increases overall healthcare costs.

Some of the arguments centered on the fact that the transfer of prescription data was not speech, and that even if it were, it was not protected, given that there exists a lower standard for commercial speech than private speech.

The appeal is said to be straightforward with the process involving the filing with the District Court which then gets forwarded to the 1st Circuit Court of Appeals in Boston.

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Tuesday, July 24, 2007

CEO Announces Retirement

It is now official that the current CEO of Floyd Memorial is retiring in April of 2008. Many of the readers know that I disagreed with many of his decisions and his management style over the past few years, but this is one decision I believe is well thought out and will help Floyd move forward in a time of great healthcare change.

This blog has been a controversial venue for open discussion on topics that rarely had a forum before. Over the next couple of weeks, there will be a few more topics on healthcare issues but the comments on Floyd will end and the blog will terminate.

I and many of my colleagues will begin working towards a transition from this administration to a new one in a manner that maximizes the chance of success for Floyd Memorial and fosters a better working relationship between physicians and the new administration.

It is time to begin a new era for Floyd Memorial, the staff, and the community. Further public negativity will in no way help create this and now that there is a definitive plan, we can begin building new relationships to enhance the transition.

Our current Board Chairman has worked extremely hard during the year struggling with many issues other than just the financial problems. I pledge to continue supporting him as he assists Floyd in moving forward. This blog has in some ways made his job tougher, but was successful in keeping some important issues in the forefront. His decisive leadership will no longer be hampered by further negativity from here.

As Mr. Hanson winds down his last few months, I truly wish him and his wife a wonderful retirement and hope he can find joy in activities outside of healthcare.

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CEO up to his old tricks


Not surprising to many worker-bees at Floyd, the Administration is reportedly asking for another VP position while they continue to cut other departments and freeze hiring.

The word is circulating fast that the CEO has once again asked to move someone else into a VP position in the midst of a financial crisis.

Anger is probably too kind a word to use for the emotions felt by many directors and middle management as well as the staff in general.

Physicians are really concerned about the potential move and the perception it gives to everyone.

If the financials continue to be bad enough that administration wants to make further cuts in staffing, then there certainly cannot be enough money for another VP.

There is no rational explanation that can be given to make this move even if they want to wait until the first of the year. Is there fear we may lose a good employee if the promotion isn't given or is there another reason?

Rarely is it the right decision to promote someone because of potentially losing them to another institution.

I am confident the Board under its current leadership will see the hypocrisy of this and make the right decision!

On another note, the Board held an emergency unscheduled meeting last night at the office of the Board's attorney. This is extremely unusual and certainly makes you wonder if there is not going to be some significant changes.

We'll wait and see what comes out in the next day or so.

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Monday, July 23, 2007

Does Nurse-to-Patient Ratio Legislation Help Patients?



Floyd has made substantial staffing cuts since January because of the accounting mistake announced at the end of last year. Nursing and all other departments except administration have been working with much fewer personnel and continue to struggle with working harder with less.

Even though the financials appear to be improving in the past 2 months, the Administration is talking about further cuts in order to reach this artificial goal of a certain FTE/adj. occ. bed.

This number cannot be calculated with any accuracy and there is no real standard to compare. We have seen this number change so often, no one can give a rational explanation of how it is calculated or what the standard is to compare with. These numbers continue to come from the same department that gave us our financial data for the past 3 years and we have seen the accuracy of that.

Further cuts are a mistake as patient care has already suffered.

Floyd has historically been the premier hospital in southern Indiana and with its heart center; we should be setting the standards and not always playing catch-up.

In an effort to improve patient care at hospitals many states are considering the implementation of nursing ratio laws. These laws would require specific nurse-to-patient ratios be maintained by hospitals at all times.

The specific ratios would differ by hospital departments but would be legislatively mandated. Nursing ratio legislation is currently being considered in the U.S. House, U.S. Senate, Florida, Georgia, Hawaii, Illinois, Iowa, Missouri, New York, Oregon, Pennsylvania, Rhode Island, Vermont, and West Virginia, but so far only California has implemented nursing ratios.

It all began when California’s law was passed in 1999 under Governor Gray Davis. The implementation of ratios began January 1, 2004 and was considered a great success by California nursing groups. The implementation of planned increased standards (lower ratios), scheduled for 2005, was frozen until 2008 by Governor Schwarzenegger as an emergency action due to the predicted high costs to hospitals and severe nursing shortage, but several California courts, however, upheld the legislation and the tougher standards were enforced.

According to the Department of Health Services nursing ratios had an estimated cost of $442 million in 2004, and $652 million for 2005 once stricter standards were in place. The estimate for 2008 and beyond is $956 million annually. An estimated 5,000 additional nurses are required statewide to meet the guidelines; a difficult proposition in the midst of a nationwide nursing shortage.
The California Nurses Association (CNA) claims that ratios have been successful in creating a safer working environment in hospitals. They believe that creating a safer and more pleasant work environment for nurses will attract trained nurses who have left the profession to go back to work.

They also assert that nursing ratios are necessary to protect patient safety and help eliminate the dangers associated with patient overload. There is a strong link between improved nurse-to-patient staffing and lower rates of medical errors and patient deaths.

As with any legislation, it is only as good as the overall plan and implementation. Standards are necessary to help minimize errors and improve patient care, but it comes with a cost. Legislating standards without a plan to fund the additional cost will result in more hospitals failing financially.

Floyd should be the leader in this endeavor of creating workable standards that promote patient care and safety. The nurse to patient ratio in California is 6:1 on Med-Surg units.

Waiting until it is mandated once again puts us in a position of following rather than leading. Is this what we want?? It is what we are getting with the current mindset of our administration.

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Friday, July 20, 2007

To Dust or Not to Dust???



Washing laundry in water that is 140 degrees Fahrenheit or higher kills more dust mites than washing clothes in cooler temperatures, according to a study presented recently at the American Thoracic Society's International Conference in San Francisco.


The study compared allergen levels on cotton sheets after washing them at various temperatures. When the clothing was washed at 140 degrees Fahrenheit or higher, all dust mites were killed, compared with 6.5 percent at lower temperatures (104 degrees). An alternative may be to wash clothing at a lower temperature and then rinse it twice with cold water for three minutes, as this removes more allergens, such as pollen.


A different study has suggested that house dust has its benefits. Melisa Celaya, of the Arizona Respiratory Center in Tucson, and colleagues report that children who live in homes with low levels of endotoxin, a component of dust, were more likely to develop wheezing or eczema by age 3. By contrast, higher amounts of endotoxin seemed to protect the children from wheezing and eczema.


Going forward, "we will be looking at the relationship between endotoxin levels in the home and chemicals (called cytokines) that are produced by certain immune system cells, to see why children exposed to lower levels are developing more allergic symptpms later on," Celaya said in a statement.


As of now, science once again leaves us hanging. Is exposure to dust and dirt harmful or is it beneficial?

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Thursday, July 19, 2007

Your Money


Sometimes it is very difficult to decipher what we hear from our news media and we occasionally hear terms like federal spending, the federal budget, etc, but many may not know the dollar breakdown they are referring to.

As we finished writing those quarterly tax checks in June, many of us wonder where the money really goes. The following may be helpful to illustrate the budget.

Comparing the fiscal year 2008 federal budget with the 1983 and 1968 budgets, you can determine exactly where your tax dollars go now vs. then.

In 1968 the Vietnam War was at its height, and in 1983 the country was in the middle of President Reagan's defense buildup. This gives us some idea of how to compare with today’s budget.

Based on the table above, we can see how the country's priorities have changed over the past 40 years.

We can see that direct payments to individuals are double their budget share than they were in 1968, while the defense spending share of the budget is less than it was at the height of the Vietnam War.

Some of the trends are as follows:

•Defense spending, which accounted for nearly half of the federal budget in 1968, now accounts for a quarter of the 2008 budget.

•Social Security, Medicare, and Medicaid payments, which comprised about 17% of the budget in 1968, now account for more than 40% of the federal budget. In other words, these items as a percentage of the budget have more than doubled in the past 40 years.

•Those line items that made up essentially 0% of the budget in 1968, now account for nearly 7% of the federal budget.

•Interest on debt, as a percentage of the federal budget, has increased by nearly 50% in the past 40 years.

Does this make you feel any better about how your money is being spent?

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Wednesday, July 18, 2007

P4P Pitfalls


Many have heard about Medicare’s plan they will implement very soon. It is called “Pay for Performance” or P4P. They reportedly will be paying more to physicians whose patients meet certain clinical benchmarks. But the whole process is entangled with government bureaucracy and will have many complications.

The typical Medicare patient has several physicians and it is going to be a nightmare trying to determine which physicians are responsible for what.

This is the conclusion from researchers at the Center for Studying Health System Change (HSC) and the Memorial Sloan-Kettering Cancer Center.

They showed that the typical Medicare patient is seen by seven different doctors in at least 4 different practices in any given year. They went on to show that only about 35% of the beneficiaries visits were with the doctor held responsible for the care under the P4P methodology.

Medicare plans to use claims data retroactively to assign responsibility to the providers, but this doesn’t give the provider an opportunity to know in advance which patients he/she should be advising on certain tests and procedures.

How this system will help is up in the air. It will add more hassles and oversight and will create even more cost to an already burdened system. The benefits are questionable. Patients are the ones who should be held responsible for their healthcare.

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Tuesday, July 17, 2007

More from the Top 100 survey

Based on the recent Solucient survey, the nation’s top hospitals deliver higher quality care at lower cost to more and sicker patients.

The study showed they use 35% less contract labor, pay 14% less overtime, pay their people better, and provide $3,000 more in salary and benefits per employee compared with the average hospital.

The study also showed the ratio of registered nurses involved in direct patient care is higher, their case mix and patient volumes are both higher, but they have a lower cost per discharge and a shorter length of stay.

Extrapolating the data showed that if all hospitals were able to duplicate the statistics of the top performers, the U.S. healthcare system would save more than $7.25 billion a year in labor costs which would be an average of almost $2.68 million per hospital.

The data used for the study came from Medicare and analyzed by Solucient. The firm analyzed data looking at metrics such as total paid hours, hours worked per patient day, hours worked and wages paid per adjusted discharge, and wages and benefits per full-time employee and then compared these benchmark numbers with the average performance of the 2,834 hospitals in its database

The surveyors who crunched the numbers said it all starts at the top with the top hospital CEOs thinking about quality and efficiency simultaneously and making it a priority.

Janice Bultema, vice president of human resources at 466-bed University of Wisconsin Hospital and Clinics, Madison said “An employee whose heart is captured is an employee that’s productive.”

Their hospital does regular employee engagement surveys and has its managers address issues directly with the employees they supervise. They focus on how employees feel about their work environment and ask if they understand how their job is tied to the organization’s mission? They want to know if the employees feel that someone’s investing in their development, and if they feel recognized, trusted, involved.

Surveys from our hospital have consistently shown problems in each of these areas.
Top hospitals also were shown to pay top dollar when they are in a competitive environment rather than shooting for the mean which has been the philosophy here at home. Other top performing hospitals pay premiums for jobs and shifts that are an inconvenience to the employee’s lifestyle and they found both nurses and technicians often undertake the off-hours because of the extra money while those who move to a weekday-only schedule take a pay cut.

All of these strategies seem to work, but as stated earlier, this philosophical change has to begin at the top and therein lays the problem.

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Monday, July 16, 2007

Better pay, better performance

Most of us have heard the old adage “You get what you pay for” and based on the most recent Solucient survey, it is especially applicable to the caregivers in healthcare. This was the major takeaway message from an analysis of the annual 100 Top Hospital list from Solucient.

The focus of this year’s supplement was to examine the connection between high clinical and financial performance and a hospital’s labor costs.

According to the study, hospitals that made the firm’s latest 100 Top list pay their employees an average of $3,000 more in salary and benefits than do hospitals that didn’t make the list.

There was a direct correlation between hospitals that spend more on highly capable caregivers and lower expenditures on contract labor and overtime.

This is a tough lesson for many hospitals such as Floyd whose immediate financial problems prompt Floyd and other hospitals to keep their wallets tight.

But the long term outlook verifies that spending big on talented staffers will actually save hospitals money and produce better patient outcomes.

The next time you are a patient, you might think about asking nurses: “What are they paying you?” in addition to “Is that the right medication?”

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Friday, July 13, 2007

Wierd News

Here are some of the less reported stranger stories from earlier in the yearthe as reported by Chuck Shephard

According to the manager of BJ's Pawn Shop in Gretna, La., a customer came in with his diaper-clad boy of about age 2 in April and handed the kid an AK-47 from the store's shelf, instructed him how to hold it in order to "mow (people) down, kill everybody," and told him that "Daddy's going to buy you this chopper." The manager, incredulous, said he took the gun back and shooed the pair out. [WKMG-TV (Orlando), 4-5-07]

Officials in Apex, N.C., finally confiscated the 80 sheep that David Watts had long been keeping in his home as pets (he slept upstairs, they downstairs), with the final straw coming when some of the sheep wandered into the local cemetery and munched on fresh floral arrangements. The town had apparently tolerated Watts's eccentricity for years because of his pleasantness. Said a next-door neighbor, "(Officials) felt like he was (merely) living an alternative lifestyle." [News & Observer (Raleigh, N.C.), 3-27-07]

South Carolina Highway Patrol officers arrested Howard Fisher, 54, in March and seized 43 pounds of marijuana from his car, after he for some reason was unable to avoid crashing into one of their cruisers, with which they had blocked two lanes of Interstate 95 while investigating accidents. [Orangeburg (S.C.) Times & Democrat-AP, 3-6-07]

In Bridgeport, Conn., in March, Fermin Rodriguez, 21, was charged with assault for stabbing his wife several times (after an argument over her alleged infidelity); police said that following his attack, he apparently handed his knife to the couple's 2-year-old son and said, "Now, you stab Mommy." [Connecticut Post, 3-5-07]

Three men, allegedly carrying $4,000 worth of drugs, were arrested at a toll station on the Triborough Bridge in New York City in March because, between them, they lacked $4.50 to pay the toll. (They had asked an officer if they could mail it in, but a check of the driver's license revealed it had expired, after eight suspensions.) [New York Daily News, 3-20-07]

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Thursday, July 12, 2007

State Board of Accounts

The Indiana State Board of Accounts has acknowledged the recent audit on their website listed here: http://www.state.in.us/sboa/resources/reports/audit/

Although the report is not available online as of now, it can be ordered as described on the site.

It will be interesting to read the whole report as only bits and pieces have been released thus far.

An audit showing $13 million plus in errors needs a thorough explanation and should provide some significant remedies to rectify the underlying problems.

What are the system flaws that allowed this to continue for so many years without being caught sooner? Were there red flags missed or ignored? Who benefited from the mistakes?

All are legitimate questions that need explanations for this County owned, Not-for-profit institution.

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Wednesday, July 11, 2007

New Gang Symbol and Alert



As the Jail doctor for Floyd County this year, we are sent updated concerns about things in the police arena.

The most recent concern is about a mysterious image that has been appearing on the skin and in the writings of a number of criminal organizations. It is called or referred to as the ‘Santisima Muerte’ or ‘Holy Death’ and is an image that is finding popularity among members of gangs and of the Mexican drug cartels.


The images and emblems are shown in the pictures and occur on the skin as well as jewelry etc. Its exact origins are unknown, but there are a number of speculations that the icon comes from a mixture of Aztec heritage, Spanish Catholicism and even African religious culture.

The mythology of Santisima Muerte teaches that the spirit has the power to affect events in the lives of humans and includes events surrounding money, love and justice. Current literature and personal interviews with followers communicate a focus on the spirit’s power to protect criminals from law enforcement.

U.S. law enforcement agencies in Arizona, Florida, Tennessee and Texas have encountered shrines and altars to the saint inside dwellings of narcotics traffickers.


The image can be male or female in gender, and is depicted in a number of colors including red, black, gold, white and green. The colors represent the specific purpose that the statue is being used for in rituals. For example, a black statue represents protection and aggressive magic while red represents matters pertaining to love.

Offerings given to Santisima Muerte include gifts of flowers, fruit, coins, alcohol and cigarettes and traditional religious artifacts of the Catholic Church such as rosary beads and prayer cards may be found in some of these shrines.

There are no known established sacred texts or orthodox rituals associated with the image, but a traditional church has been established in Mexico with some branches throughout the United States.

Santisima Muerte is also honored by those who are not involved in criminal activity. Some believe she is simply a saint that can identify with the poor, the sick and the oppressed.


Santisima Muerte is but one of a few folk saints that are honored for the protective power over criminal activities. The folk saint ‘Jesus Malverde’ is a ‘robin hood’ of sorts from Sinaola Mexico that was hung for committing crimes in the early 1900s. His image is adorned on jewelry for his ability to protect narcotics traffickers from law enforcement authorities. He is also known as the ‘narco saint.’


The Santisima Muerte subculture appears to growing and a number of incidents surrounding the figure continue to give the spirit’s reputation more credibility as a protector of crime. Murdered victims of the notorious Mexican Gulf Cartel were left at a public shrine to Santisima Muerte in Monterrey Mexico on May 11, 2007. Reports of shrines discovered among drug labs and in the homes of drug dealers continue to grow.

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Tuesday, July 10, 2007

ISMA Warning

Here is a recent memo from the Indiana State Medical Association (ISMA) giving warning to all physicians about the contract language coming from Anthem.

The ISMA has learned five managed care companies submitted bids to care for the state's uninsured population through the newly legislated Healthy Indiana Plan (designated by the General Assembly as the Indiana Check-Up Plan).

Medical offices now are receiving "letters" from Anthem that are, in fact, agreements to provide services under this plan for low-income Hoosiers – even though the state has not yet awarded the contract.

Physician practices already participating with commercial Anthem products likely will be the first to receive these contract letters from Anthem. The language will say "in the event Anthem is selected" and may sound like a letter of intent; however, these documents are actually agreements that will be binding when signed.

The ISMA knows at least three additional companies were interested in providing services under the program. Although not confirmed, Managed Health Services (MHS), MDwise and United Healthcare showed interest in learning about the bidding process.

If you have questions about the Anthem contract, consult with your legal advisor.

Please be advised about this questionably deceitful practice by Anthem and be careful because other insurance companies may follow with similar type of language.

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Monday, July 09, 2007

Verizon's new EHR

The Chairman and Chief Executive Officer of Verizon Communications announced that the company has implemented an electronic personal health-record system for its more than 900,000 active employees, retirees and their families.

They are calling this the Verizon HealthZone PHR. The system works in conjunction with WebMD and will allow individuals to store personalized health information on a password-protected Web site. This information will then be accessible anywhere the internet is available. It will make portability of records more convenient.

The Chairman is hoping that this kind of a simple connection will create more consumer power that may drive changes across the healthcare system.

Critics are claiming it will put personal data at increased risk and may create some increased liability.

What are reader's thoughts about centralizing health data in a manner similar to this?

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Friday, July 06, 2007

Watch where you put your finger


A Huntsville, Alaska man's trip to the gas station became a long and painful one when one of his fingers got stuck in the gas tank's opening as he tried to clear some gunk from around it.

The incident took place on Wednesday afternoon when Dwight Clark was in the parking lot of Medical Arts Pharmacy. There were many helpful people who tried freeing him by spraying WD40 and other tactics, but nothing seemed to work.


According to AP reports, people at the pharmacy finally called the rescue workers for Clark after they failed to help him get free. When they arrived, paramedics first tried spraying a lubricant on the finger, but that didn't work.


Huntsville Fire and Rescue Capt. Nolen Locke and his team tried their best to rescue Clark's finger without cutting the metal because he didn't want them to damage his truck.


When everything else failed, the rescue team eventually had to cut through the quarter-panel and it still took about 25 minutes to get the fuel valve out. Clark was then rushed to Huntsville Hospital where doctors freed his finger.

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Thursday, July 05, 2007

Math 1-0oops-1




The last board meeting was another interesting night with a practice in futility. Many question why so many people are fed up and skeptical about our current situation. This meeting gave a perfect example.

Board packets are usually given out 4-5 days before the meeting. Inside the packets is usually the information that will be discussed in addition to the financial statements. Once again, the packets were lacking some key information that was to be discussed that night.

Most people would assume the financial reports would have been carefully scrutinized and reviewed prior to being given to the Board especially when you recently had such a huge financial mistake in the tune of $13 plus million dollars.

It is unclear how many college educated people actually see this report before it is given to the Board, but at the very least, the finance department and the CEO should have reviewed it.

Without giving details of the categories these numbers represent, an example of some of the numbers are as follows. Numbers in parentheses are negative or deficits. "Actual" is what actually occured for the month, "Budget" is what was predicted for the month and "% Actual Budget" is the net change.

Actual $208,000
Budget ($154,000)
% Actual Budget -235.1% (this was reported as a negative 235% change)

Actual ($37,000)
Budget ($756,000)
% Actual Budget -32.7% (this was reported as a negative 32.7% change)

I tried explaining to them if you predict a deficit in a certain budget item and you actually show a positive number or less of a loss than was budgeted, the percent change is positive and not negative.

If I predict that next month I will owe 10 dollars but end up making 15 dollars, the change is a positive change, not a negative percentage.

I was still not convinced that some at the meeting really understood the concept, but they did say they would change the formula on the spreadsheet for next month.

And you wonder why so many people still have major concerns about the numbers and their validity!!!

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Wednesday, July 04, 2007

Happy 4th of July





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Tuesday, July 03, 2007

The "Audit Report"



The audit report is official and there is good news and bad news.

The auditors specifiacally stated the hospital and everyone helping on the audit were very cooperative throughout the process. That is the good news.

Now the bad news. The audit did show nearly $2 million dollars in accounting errors in addition to the $11.5 million dollars previously reported.

Nearly two thirds of this was due to uncollectible debts that were placed on the revenue side as collectible. The other nearly one third of this total had to do with bonds not being recorded at fair market value resulting in a reduction of net assets.

The auditors also provided the administration with suggestions and critique on the current accounting practices and needs for improvement.

It is true that these deficits found in the current and previous audit are not cash payments the hospital has to make. That is because the money was already spent.

The problem is that for the past several years, the revenue side of the accounting has been overstated by nearly $13 million dollars. Yes, bonuses were also based on these overstated revenues. Since budgets and what is being spent is based on projected revenue, it means that we already spent nearly $13 million dollars more than we were able to bring in over the past 3-4 years. This is why cuts are being made. We now have to somehow pay for what we already spent plus pay for the ongoing expenses all while having less revenue coming in.

When will the problem end?

***Special thanks to the cartoonist for use of her cartoon. Please visit her site at www.mchumor.com

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Monday, July 02, 2007

Religion and Medicine


As the national debate over religion has been more prevalent, there is more discussion on whether doctors should invoke religion as a means of comforting, understanding, and guiding patients.For many physicians, doing so comes naturally.

In a July 2005 issue of the Journal of General Internal Medicine, a survey showed that 90 percent of the 1144 physicians surveyed attend religious services at least occasionally (compared with 81 percent of the general population), and 55 percent agree with the statement, "My religious beliefs influence how I practice medicine."

Many physicians see religion as one of many things that should be taken into consideration and, occasionally, "prescribed" if it's important to the patient and might affect his or her response to medical recommendations.

I personally ask all new patients about their religious beliefs. I believe it has an impact on their care as some religions forbid transfusions, some have special diets and others guide their beliefs in treatment and healing. I believe it should be asked of every patient as part of a complete history.

Knowing something about a patient's belief system can be helpful in determining social support systems and their acceptance of death.

Many patients and families ask physicians to pray with them or for them as they go through difficult times and it is more common if patients understand their physician’s beliefs.

Holding their hand and offering a silent prayer can be very beneficial to a patient with a religious belief, but it can offend others. This is why it is important to know the patient’s beliefs.

Physician’s initial goal is “to do no harm; and attempt to heal. Healing involves much more than prescribing pills or procedures.

Asking about religion is not proselytizing. It is part of a complete history as it impacts decisions on care.

The physician-patient relationship has to be open to conversation about anything that is relevant to the patient's experience of illness. This includes topics of sex, money, problems with kids, a troubled marriage, conflict at home, work stress or religion. All of these can exacerbate medical problems and coping mechanisms.

The best physician in the world can only prolong life and the statistics are pretty convincing that one out of every one person will die. We should do more to help with the dying aspect and this many times involves religion!

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