OT - A intriguing "open lette"r on health care ...

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Ed Pawlowski wrote:

I don't argue there can be some technical improvements; is it apparent that there really is any reduction in the cost to provide the benefits, however?
And, of course, wait until the visit when the inevitable happens that there has been a system malfunction because it _WILL_ occur irregardless of how well the system is implemented. And, just as with paper records, there will be instances of incorrect data entered, the wrong x-rays getting into a patient's file, etc., etc., etc., ... The incident rate may be low, but things will happen.
Again, I don't argue that there are valid reasons to go to electronic records, etc. I just don't buy the argument that there really will be a great reduction in cost associated with doing it. As noted, I'm pretty confident most of the current costs will simply be shifted to alternate expenses in dealing w/ the care and feeding of the records hardware and software systems.
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"dpb" wrote:

Doesn't fit the definition as I was taught in high school civics class.

They haven't been released yet; however, as someone who has required medical service recently, much of the medical industry is in the stone age when it comes to record keeping.
Reminds me of "the book" my parents had at the local grocery store that got settled every other week when Dad got paid.

As the sign says, "Get in, sit down, buckle up, shut up and enjoy the ride".
MRI's are on disc these days, so are X-Rays.
That's a long way from word processing.
My guess is that the medical community is going to create a demand for memory capacity that is going to keep the memory people busy for quite awhile.

And you were never young and stupid?

That's not your decision to make.

Scrooge still lives.
It's almost as if you are jealous that you didn't try to avail yourself of some of these schemes.
I still remember my mother's words, "Never yet saw a U-Haul following a hearse".
Lew
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Lew Hodgett wrote:

I simply echoed back Lew's words. I never heard the phrase before, civics class or no...

> My guess is that the medical community is going to create a demand for > memory capacity that is going to keep the memory people busy for quite > awhile.
You appear to have missed the point that the technology tends to expand what is done but doesn't _necessarily_ bring enhanced productivity.
See earlier response but I simply doubt there really will be any actual _significant_ reduction in costs associated w/ the implementation, operation and upkeep of these automated systems as opposed to the current ones. I've never said there weren't possible benefits, only that it isn't at all clear there really will be cost avoidance that isn't made up by the other overheads that come along w/ the system simply transferring costs from clerical staff to IT staff, etc., as well as the expansion into new areas that is analogous to the creation of the fancy documents instead of a simple typed memo. While wonderful technology and more glittery, will it actually cost less total $$ overall? That is still to be demonstrated as being so.

Not either jealous nor that I wasn't less old, etc., nor that I'm saying what car somebody else should have.
I'm simply pointing out to Lew that his idea that bringing in even more of the uncovered to the system is _NOT_ going to reduce costs; it's simply going to raise demand because there isn't additional revenue in the class to derive and the general incentive is to take rather than give.
That doesn't mean that I have given up hope that by structuring systems such they include incentives for good behavior that one might eventually change some of that culture. I just don't see that as an objective in any of the systems being promoted--in fact, I think it is a specific objective of many to create an even larger dependent-class.
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The rationale behind electronic medical record keeping is not, and never has been, about cost reduction. The entire reason behind it is to reduce errors, improve diagnostics, speed administrative functions and make records more accessible where they are needed. Any cost factors are merely incidental.
I spent several years involved in the medical software industry about 20 years back. Even then all of these same issues were being discussed, although not on the national stage. The goal was to find a way to give better service, not necessarily cheaper service.
-- "We need to make a sacrifice to the gods, find me a young virgin... oh, and bring something to kill"
Tim Douglass
http://www.DouglassClan.com
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Tim Douglass wrote: ...

Not until it was latched onto by the current administration it wasn't... :) Or, :(, I'm not sure which is more appropriate.
But, I agree, it has merit in some regards but significant cost-savings won't be one of the observed results.
(And I spent 25+ years in a large consulting firm who did many of the early systems for places like NIH, Walter Reed, etc., etc., etc., ... I did other things for the electric utilities but was interested observer and in house to see and hear much that went on on that side of the house.
In general, they _DID_ improve aspects of the operations in some manner and to a greater or lesser degree depending on the scope and how well the specifications were initially laid out, but budgetary reductions??? Not so much.)
--
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Tim Douglass wrote: ...

One wonders how many of these same players (and new ones) are making large contributions to push the current agenda and did so during the campaign...
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Could well be, although few of those players had the kind of size and reach to do any political activism.
Just an odd anecdote relating to electronic medical records. I have a friend whose husband is a GP. He was actually voted state doctor of the year a while back. The clinic he works in recently went to an electronic system and he hates it. A big part of the problem is that he is now expected to enter into the computer (something he is not skilled at) all of the patient notes he previously scribbled on a chart or dictated to a recorder. The result is that he only sees about 2/3 as many patients a day as previously.
OTOH, my personal GP, a younger (OK, still probably in his 50s) doctor in a different clinic went to a computerized system at about the same time. He absolutely loves it. He claims he sees more patients in a day and gives better service. I will attest to the latter because he always sees something now on the computer that prompts him to ask about certain conditions that previously only got brought up if I brought them up. Their billing is still sometimes a bit messed up, but I like that all the lab orders and prescriptions are sent out paperlessly and immediately.
The real point is that the human factor in the doctor's office may have more to do with the effectiveness of any electronic system than all the other factors.
Tim Douglass
http://www.DouglassClan.com
Two Down - Two to Go!
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Funny you mention this as there's currently an active money scandal involving the Ontario government's conversion of medical records to an electronic system. It seems the problem is there's too many government people throwing public money around and too many people without ethics willing to take it.
Anyone else getting the equivalent of a $114,000 bonus on top of a $380,000 salary after just a few months on the job?
http://www.citynews.ca/news/news_35148.aspx
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Tim Douglass wrote:

Well, the particular one(s) w/ which you were associated may not; the former outfit I worked thru is >$2B annual sales and are/were _VERY_ adept at having folks on the inside who knew the current hot-button agenda items of every key player in Congress as well as close contacts in all the pertinent agencies. I've not kept close tabs, but I'm sure they (and all the other of their ilk) haven't been idle. That's not _all_ necessarily bad; it's how things happen, but one shouldn't pretend all of this is happening merely as a goodwill gesture.

My brother is a veterinarian w/ a tie-in to a nationwide group. They went to digital recordkeeping system as well a number of years ago. It had the same effect as the former above--initially it required him to spend several additional hours every evening after closing the doors to transcribe the daily records. Eventually he managed to get adequately-trained technicians who could do most of the transcription but it is still an additional labor cost that he doesn't see made up for in increased productivity or other offsetting cost avoidance.
The system has improved over the years but so have the associated hardware and maintenance costs as the processor power requirements have gone up drastically. As well, it has on occasion become a bottleneck when there have been server/network failures either local or, more often, remote that have kept the system unoperational. Unfortunately in those cases, the business model has move to where they are essentially shutdown if the 'puters are down--that was never the case before.
I think the point about individuals is valid; however, and certainly virtually everyone who is growing up today has far better computer skills than most of the present geezer generation. That combined w/ improving systems themselves probably will make the success rate go up; however, I'm still far more interested in my physician actually knowing some medicine than in him being an expert IT guy and relying on a remote neural net to prod him w/ answers a la the service tech in a far away call center...
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Lew Hodgett wrote: ...

I should point out the "young and stupid" doofus was nearing 40 w/ two teenage kids at the time he pulled this particular stunt...we needn't go into some other bright choices. :(
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krw wrote:

Actually I do think I'd prefer it. Government workers in my field are getting higher pay.

Waiting 30 to 60 minutes for every appointment tells me he makes it a practice to over schedule.

Sure, to refer me to a another doctor it would be worth $15. How much are you willing to pay, say an air conditioning repairman, for a service call who tells you you have to call a another repairman to fix the problem.

When is the last time your doctor prescribed an experimental drug. I believe mine only prescribes the FDA approved ones. I never mentioned 100%, just effective.

The doctor is free to run any test he wants. I think he'd pick the one that would provide the most conclusive results the first time rather than paying for three or four slightly less expensive tests that he suspects has little chance of revealing the problem.

That could very well be. That's probably the reason my wife's family got a $3000 hospital bill for services rendered to her mother where the date of the services performed were three months after her burial. Neither are right.

Why, my wife has been more than satisfied with her oncologist who has treated her twice in the past.
Forget hospice care.
I agree.
Nice plan you have going there.
Thank you!

I guess so.
--
Jack Novak
Buffalo, NY - USA
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"Nova" wrote:

Having been involved with hospice twice in the last 18 months, they do, or at least for me, did a great job.
Lew
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So *you* are the guy who liked Nixon's wage and price controls.

"Every"? You've gone through his records and checked every patient?

That was the "administrative cost". You allowed the doctor nothing for the doctor. If you didn't need his time, effort, and knowledge why pay the "administrative costs" and just see the specialist.

You're changing the subject now. Most drugs are not effective for everyone and some have adverse reactions to them. Is that the doctor's fault?

No, he would pick "none", because there is a high probability that any individual test will come up negative. If he knew what the diagnosis was, why run the test at all?

Now you're changing the subject to fraud, so you do know your argument is asinine.

You are a sick puppy.

At least you admit to your failings.
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So it would lso be Ok if the government regulated your pay?

So you go in to see the doctor and he ushers you out at the end of 15 minutes, finished with you or not, so that he can get to the next patient. Your Ok with that?

I can see that.

I see your point but you may be perscribed a potent dosage of, "what ever", that may be more harmful in the long run but does cure your symptoms.

I would be more willing to pay for those tests, I don't want the doctor to hold back on tests because he is going to have to pay for them himself. You really don't want him guessing which "one" test should provide the information needed.

I think getting rid of the strangle hold the insurance company has would take care of the over priced 10 cent items.

I think pay up front for the services rendered but if you have to go back the visits should be at no charge.

Is your doctor responsible for you not taking medication exactly as perscribed, or not going to therapy, or some other part of your body crapping out because of the illness you had?
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My wife has had two serious hospitalizations. The billed rate was $110,000 for the first and $60,000 for the second. The hospital accepted $60,000 for the first and $28,000 for the second from the insurance company as payment in full. The first cost us $800 out of pocket and the second $100.
The insurance company paid rates negotiated with the hospitals. And this is part of the problem. Uninsured people, the ones who can least afford it, pay the highest rates. I'm no socialist, but that just ain't fair.
Incidentally, that is another good reason to maintain even a high-deductible health insurance policy. You will get the negotiated rate even if you pay most of it yourself.
-- Doug
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Maybe, maybe not. Some low income and no income people have those bills and pay nothing. The rest of us pay for them.
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Douglas Johnson wrote:

Fair? What's UN-fair about a willing buyer and a willing seller?
If you bought a $110,000 product or service from me every couple of days, I'd probably be willing to cut you a 45% discount, too.
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is "damaged" should get all his losses (including reasonable lawyers' fees) reimbursed. The "loser" should pay all lawyers fees, and indeed punitive "rewards" should go to the state.
The Walmart thing is possibly just cases going after deep pockets, IMNSHO that is not to be permitted. However, someone or some organization should have been punished for the "thing" that happened to the person(s) trampled to death during the Black Friday opening of a store in Valley Stream Long Island. It does not seem logical that providing insufficient security should go unpunished. Plus the mob there should have been punished somehow. Just my opinion.
--
Best regards
Han
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Han wrote:

So now the state treats lawsuits as a source of revenue and does everything it can to encourage them.
Can you say "unintended consequences"?

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J. Clarke wrote:

Ooh! Good point!
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