Monthly Archives: June 2013

“Welcome to the Affordable Care Act Call Center, Please Press One for Healthcare, Two for….”

Although tax season has come and gone again in the US, many of us have had the regrettable occasion to call the Internal Revenue Service (IRS) call center to ask a question or confirm a policy or procedure. (and no, this blog is not at all about the recent IRS scandal–I promise). At least in my case, the call center can quickly become an endless loop nightmare of computerized voices and it is very easy to get lost in the depths of the “automated menu” if you are not careful. Often, calls to the IRS call center involve hours of hold times–even my most clever tricks such as pushing “0” at every prompt and claiming ignorance once an actual human being comes on the line doesn’t always help. Large government agencies are often unwieldy and thousands of employees may be located in call centers in vastly different parts of the country–often these employees have very different understandings of policies and procedures and the agency often lacks standardization in response to consumer inquiries. In addition to IRS call centers, there is an IRS website with numerous difficult to understand PDF files of tax rules and regulations (which sometimes appear to be written in some ancient language).

Because of my experience with the IRS (government run) call center and website, I was intrigued while reading the New York Times today when I came across an article describing the Federal government’s plan for developing an “Affordable Care Act” Call center. According to the Times, the call center will be tasked with handling all of the questions and consumer issues that will begin to occur this fall when the health exchange requirement portion of the “Affordable Care Act” goes into effect. The Obama administration apparently realized this past week that most states are completely unprepared for setting up the required “marketplaces” where Americans can buy health insurance that will be required by law starting January 1, 2014. (really, we are unprepared to insure millions of new patients in just a few short months?) The government proudly announced plans to create a website AND a call center where Americans can go and prepare themselves for the October 1st opening of the marketplaces. The call center will be staffed with nearly 9000 operators who will be available 24 hours a day to make sure the every American understands the new health care act and its provisions. (I would love to meet just one of these 9000 as almost no practicing physicians in the US today fully understands the new health care act and its implications). Although this call center will create much needed jobs, it will also increase the costs associated with health care reform as even more government employees will be required to fill these roles. I expect that this call center (as well as the website) will not be the holy grail and fountain of information that our government expects it to be. The new healthcare law is incredibly complicated and is confusing for almost all of us. I am not sure how the average American is going to be able to understand and interpret all of the rules and regulations and make well informed choices as the new healthcare exchange deadlines approach.

There is no doubt that the healthcare system in the US is on life support. Our nation spends more dollars on healthcare per capita than any other industrialized nation on earth. Our costs are high and our outcomes are similar to other industrialized nations where costs are not nearly as astronomical. Obviously changes in our current system need to be made BUT I am certain that the current “Un-Affordable” Care Act is NOT the answer. The legislation is complex and expensive. In addition, moving this legislation forward when the states and other government organizations lack the infrastructure to support it is irresponsible. As a nation, we need to regroup and take from the Affordable Care Act those things that are both good for American citizens and fiscally responsible and leave the waste and political provisions behind. A Call Center and website will NOT make the new Affordable Care Act any more Functional or Affordable–and will not facilitate the establishment of the enormous state by state infrastructure required for its implementation.

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The Power of Social Media in Medicine: Using Facebook to Save Lives

Recently, there has been a great deal in the press surrounding organ transplantation.  Sara Murnhagan, the courageous little girl with end stage cystic fibrosis, captured the nation’s attention as she waited for a life saving lung transplant.  The organ transplantation and procurement system in the US today is not without flaws.  Organs are at a premium and finding the best way to allocate them to matched patients who need them the most is a daunting task.

Today, nearly 120,000 people (men, women and children) are actively waiting for organ transplantations and are listed on the UNOS.  However, only 29,000 organ transplants were performed in 2012.  Obviously the demand far exceeds the supply for suitable organs for patients who need transplantation for survival.  Paradoxically, 90% of Americans say that they support organ donation but only 20% have taken the necessary steps to be a donor.  The rate of registered donors has remained static over the last twenty years while the numbers of those waiting for transplantation has increased 20 fold over the same time period.

Researchers are actively engaged in clinical investigations designed to identify better ways to recruit potential organ donors.  In order to improve the availability of organs for those in need we must find a better way to successfully register potential donors and allocate organs.  In particular, certain groups such as minorities and children are poorly represented as registered donors.

Our society today is more connected than ever.  Social media outlets including Twitter, Facebook, and YouTube are easily accessible and widely utilized.  In particular, Facebook is one of the most commonly visited websites in the world–second only to google.  Facebook is often the first stop for those who begin their exploration of the world of social media.  Facebook has become a great place to connect and to share ideas and news.  In addition, Facebook has been a place to inform others of an important cause or event.

Researchers at Johns Hopkins reported on a demonstrated effect of Facebook on organ donor registration rates.  In the report, the rate of increase was nearly 21-fold in one day–this was a day in May 2012 when Facebook allowed users to make their organ donor status public on the site (and also provided easy links to DMV sites so that users could make their status official).  On the first day that the new service was available on Facebook there were over 13,000 new DMV organ donor registrations–as compared to an average day where there are only 600 new registrations in a day.  This enormous bump in organ donor registration demonstrates the power of social media to move people towards action in ways that can benefit others.  Social media outlets such as Facebook are not only a great place to share pictures and reconnect with friends–they can be a new way to effect social change.

In medicine, we have only begun to scratch the surface of the full potential of social media.  It is imperative that physicians begin to interact virtually and engage fully in social media in order to effect change.  As we have seen with the New York Stock Exchange, social media outlet such as twitter can move markets (reference the largest 3 minute drop in the Dow in history when the AP twitter account was hacked).  WE must ALL work together to realize the untapped potential of social media in medicine–it can save lives–improve health–and even provide a large number of new registered organ donors.

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Connectivity, Email and Stress: Finding the Proper Balance for Success

Well, here I am.  Again.  On vacation and connected to the internet.  I must admit, I am addicted.  Twitter, blogging, and email.  I cannot seem to just let it go–not even for a week.  Email, in particular, seems to have taken a dominating role in all of our lives.  Constant hip checks for email downloads to our iphones have become an obsession.  As we speak, I am on a beautiful 4 hour train ride from Edinburgh to London (the same route that Harry Potter and his friends take from Hogwarts, no less).

This week on the website Inc.com, I came across an interesting article that explores the ways in which email is ruining our health.  A group of UK researchers decided to examine the effect of email on a group of workers.  Objective measures such as blood pressure, heart rate and cortisol levels were measured and the workers also kept a log of their work activities during the study period.  Results of the study indicated that a single email was no more stressful than taking a single phone call–however, an inbox full of a large amount of email produced a powerful stress reaction with elevations in cortisol, heart rate and blood pressure.  Interestingly, the study did find that the type of email received had a significant effect on stress.  Email that was received about current activities and contained time relevant information as well as emails that congratulated a “job well done” were not at all stressful.  in contrast, emails that were completely irrelevant and interrupted tasks were incredibly stressful and levels of cortisol, blood pressure and heart rate all spiked.  The lead researcher, Dr Tom Jackson, concluded that the email itself is not the issue–it is how the email is used that causes the problems with increased stress.  We are managing email in the  midst of phone calls, family time, and other in person meetings.  Often, responding to and filtering through email can be a distractor and take us away from more important tasks. Hence–email is stressing us all out.

As I mentioned, I am currently on “holiday” in the United Kingdom with my family.  I have tried very hard not to use email but I have failed miserably.  For me, the act of checking email twice a day has lowered my levels of anxiety about work.  However, when I stumbled upon certain email messages my levels of stress began to spike.  These were often emails that I could  do nothing about until I return to the states.  (As with most folks, feelings of loss of control and the inability to respond also create elevated levels of stress).  Luckily, I have my family with me on our tour through the UK to set me straight–instead of fretting over the emails and how to handle them, I was “convinced” to take a walk to Edinburgh castle and enjoyed a nice day in the sun (It may have been the only sunny day in Scotland this year).  My family and I had a wonderful day together in the castle.

I think that, in reality, one must find a balance between connectivity and relaxation.  For each person this balance is going to be different and based on individual personality traits.  I enjoy blogging and it is a very relaxing, stress reducing activity for me.  As I have mentioned in a previous blog, writing allows me to process my thoughts and share my feelings.  (Hence this blog is being written over the course of a four hour train ride).  For others, a completely disconnected holiday is the best course.  Whatever it may be, find your own balance.  Understand that email is an important tool for productivity and that it can be abused.  For me, I am learning what types of emails tend to elevate my own cortisol levels and will attempt to avoid these emails on future vacations.  Life work balance is essential to success and longevity–finding your own balance with email and connectivity is a critical component to this process.  With that, I am going to sign off and stare out the window at the beautiful Scottish wind blown sheep.

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How Can We Fix the $2.7 Trillion Dollar Medical Bill????

It is clear that healthcare in the US is more costly than in any other place in the world.  We spend 18% of the gross domestic product on healthcare and our outcomes are no different than those of other industrialized nations who spend less than half that amount.  How did we get here and what are we to do about it?

Recently, an article appeared in the New York Times that explored the increased costs of particular procedures in the US today.  In the Times piece, Elisabeth Rosenthal provides insight into possible reasons for the elevated cost and the ballooning trillion dollar healthcare deficit.  Certainly, insurers, hospital systems, industry and physicians all play a role in the high cost of care in the US.  In general, US healthcare systems tend to test more (and the tests are much more expensive here) and provide heroic care in the late stages of life (and this care may not have a real impact on longevity or quality of life).  Ms Rosenthal uses the colon cancer screening procedure known as colonoscopy as an example of a test that has widely variable cost.  Depending on where you get your test the price tag can vary by thousands of dollars–but in other countries it can cost as little as a few hundred dollars.

How does this happen?  

Ms Rosenthal certainly makes many good points in her article and gives us all pause–industry, hospitals, insurers and physicians all share some responsibility.  However, one important group that she does not mention as a contributor to the  escalating healthcare costs are the trial lawyers and the American Association for Justice (previously known as the  Association of Trial Lawyers of America)–you may can guess why the name change.

First and foremost, I believe the lack of tort reform and the highly litigenous environment that has been allowed to thrive in medicine in the US is a major contributor to escalating cost.  Physicians must often order more tests than necessary in order to avoid frivolous lawsuits and utlimately find themselves practicing “defensive medicine”.  Unfortunately for US citizens, most politicians are attorneys by profession and they tend to “look after their own.”  There has been little activity on tort reform–the trial lawyers are an incredibly powerful lobby.  Medical lawsuits have been allowed to continue unchecked and settlement amounts continue to rise to astronomical levels.  Many lawyers have made fortunes by “chasing ambulances”

Secondly, as physicians begin to see revenue fall and medicare/insurance reimbursement are cut, many turn to free standing surgical centers to increase revenue.  By owning the “facility” and treating the patient there instead of the hospital, the physician group is able to recoup a “facility fee “ that is normally collected by the hospital.  In addition, medicare billing (which often makes no sense whatsoever) will pay higher fees if the procedure is considered “outpatient” or is performed in an ambulatory surgical center.  In addition, academic institutions often are reimbursed at higher rates in order to offset the cost associated with training young doctors.  A more standardized approach to determining payments and reimbursements for procedures and tests must be put in place.  Medicare and CMS reform is essential to this process.  Currently the application of common sense appears to be quite absent from the government regulation and medicare payment determinations.  The system is full of waste and redundancy.  Although an entirely new “coding” system for medicare is due to be launched soon–I am certain that this new process will solve none of our current problems.

Our healthcare system is sick.  Until Washington stops playing politics and calls all parties to the table for talks of compromise, reform and action nothing will change.  The system cannot be fixed by only dealing with one component.  We must strive for tort reform so that physicians can do what is in the best interest of the patient rather than what must be done “in case” they are sued one day.  Politicians must stand up for the American people and stop being swayed by the trial lawyer lobby.  Standardized, equitable and sensible payment systems must be put in place so that the system is not abused by moving procedures from one location to another in order to receive higher payments.  This is a big job.  There is no easy fix.  But we must commit to finding a solution so that the US can continue to claim to have the best healthcare in the world.

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