Monday, January 19, 2015

Boarded to Death — Why Maintenance of Certification Is Bad for Doctors and Patients — NEJM

Boarded to Death — Why Maintenance of Certification Is Bad for Doctors and Patients — NEJM

Regardless of how the MOC issue is resolved, the recent focus on the ABIM has shed a bright light on how medicine is regulated in the United States. The ABIM is a private, self-appointed certifying organization. Although it has made important contributions to patient care, it has also grown into a $55-million-per-year business, unfettered by competition, selling proprietary, copyrighted products. I believe we would all benefit if other organizations stepped up to compete with the ABIM, offering alternative certification options.

More broadly, many physicians are waking up to the fact that our profession is increasingly controlled by people not directly involved in patient care who have lost contact with the realities of day-to-day clinical practice. Perhaps it's time for practicing physicians to take back the leadership of medicine.

A good start to regaining that leadership might be backing off support for the  Affordable Care Act.  Government's do-gooder effort giving us less care at greater expense.

Beyond a Traditional Payer — CMS's Role in Improving Population Health — NEJM

Beyond a Traditional Payer — CMS's Role in Improving Population Health — NEJM

There are limits to CMS's statutory authority to fund services provided to people other than Medicare or Medicaid beneficiaries, but the agency can leverage its influence beyond the payment of claims. Whereas our approaches for providers focus on enrolled or attributed populations, SIM seeks to affect broader populations


I suppose CMS can leverage but I wonder if those funding limits suggest it shouldn't extend into something its unfunded and therefore ill equipped to influence for the good.

Wednesday, December 31, 2014

Julie Papanek: Healthcare Predictions For 2015

This one's huge. Some excellant insights from Julie Papanek (@JuliePapanek). Someone I've started to follow!
Hospitals become a channel for peer-to-peer lending 
If you understand the flow of payments in healthcare, you can predict the trends. Consumers and employers are purchasing insurance plans with high deductibles. As a result, the first dollar that hospitals earn is now coming from consumers. Actually, the first $17,000 is coming from consumers. With an average income of $55,000, most American consumers simply can’t pay their medical bills. When they don’t pay, it hurts providers financially. What consumers don’t pay shows up as accounts receivable on hospital balance sheets and eventually turns into bad debt. Since many hospitals are financed by debt and their credit worthiness is partially determined by the health of their balance sheet, the problem of getting patients to pay is urgent. This raises the question — how can we find the money to help consumers finance their health care payments? Many consumers are able and willing to pay their medical bills, they just can’t do it all at once. Peer-to-peer lending companies have paved the way for unsecured structure notes, where an individual’s loan can be financed by others. These have shown impressive growth. Peer-to-peer lending is already being used to finance plastic surgery and other cash-pay procedures. Now it could be used for the majority of medical expenses in the U.S.

The Trouble with Putting Care Management in a Box

The Trouble with Putting Care Management in a Box



About the above box (please go read it).

I was struggling once with implementations of clinical pathways and an MD told me the solution, really only solution, was an educated patient.  The patient was the only one who could tell us if he or she was on the pathway so to speak.  Technology and the cell phone over the means now to empower patients.  They're seldom mentioned as participants in these discussions and they're really central to making management work.  The reality is the patient does it and the technology should be built on that foundation.

My Favorite Quotes of 2014

My Favorite Quotes of 2014

Thursday, October 23, 2014

Tuesday, August 26, 2014

Are EHRs Life Savers? Maybe So, According to Preliminary Research

Are EHRs Life Savers? Maybe So, According to Preliminary Research

Clearly a proponent of EHRs, Skinner says that those who criticize the technology for not providing clinicians enough value might not be accurately measuring what the “value” really is. “It may be that a specific clinician hasn’t found much value to him or her, but that doesn’t mean his or her use of the EHR hasn’t proved value to the patient, to the institution as a whole, or to other parts of the institution,” he says.

Skinner notes that the case is easier to make at the organizational level than it is than it is at the individual physician level. “Providers do have a point in that they are being asked to do more and put their hands on a tool they never had to worry about. So there’s no question they have acquired added burdens. But the real question is, ‘Has the institution and its patients gotten sufficient benefit to justify that extra burden?’”

Suppose so but when I'm on the table on what to see the value to me.

Midwest SAS Users Group Conference 2014 in Chicago

I'll be there for the entire conference. Feel free to stop me and say hello. A list of papers to be presented can be found here. SAS Conferences always good opportunities to learn and much of it happens out in the halls between sessions. cya

Monday, June 23, 2014

SAS University Edition

About time SAS did this....

SAS University Edition isn't a watered-down version of our software. You get the most recent releases of the same world-class analytics software used by more than 70,000 business, government and university sites around the world, including 91 of the top 100 companies on the Fortune Global 500® list. That means you'll be using the most up-to-date statistical and quantitative methods whenever and wherever – right on your own PC, Mac or Linux workstation.

Follow the link and download yourself a copy.

From Quants to Data Scientists

A nice blog post by Yves de Montcheuil on the journay from Quant to Scientist.

Steve Miller on Data Distributions

A nice blog post on distributions using R. 
 
....the first priority with a new data set revolves on determining the distribution of values for each of the attributes. Initially, we wish to see frequencies for the responses of each variable. Those give us a general sense of the data, its distribution and its quality. For categorical attributes, we prefer to visualize frequencies sorted from most to least in an unadorned graphic; for numeric attributes that assume many different values, we like histograms – and perhaps even the more sophisticated kernel density plots – to detail the shape of the data.
 
Ought to be some kind of rule that nothing can start until histograms are done.   Count the number of times you see an average referenced during the day with no sense of it's dispersion.  Seems like data analyst malpractice 'cept we're never the ones speaking, and only find ourselves quoted.

Tuesday, November 26, 2013

SAS's ZipCityDistance() function


I knew SAS could do just about anything but I didn't realize there was a function for counting the miles between zipcodes.
 
Below an example taken from a listserv at work,
 
data _null_;
            distance=zipcitydistance('94103', '04401');
            put 'Distance from San Francisco, CA, to Bangor, ME: ' distance 4.' miles';
   run;

Monday, November 25, 2013

Healthcare IT News: Epic to open source code to OHSU

Via Healthcare IT News,

Epic Systems Corp. will build two laboratory installations of its EpicCare electronic health record at Oregon Health & Science University for medical informatics education and research purposes. On the research side, the school will have access to Epic's source code.

This is Epic's first partnership with an academic informatics program and possibly an important turning point for the company. While Epic does release its source code to commercial customers, it historically has conducted research and development almost exclusively on its sprawling campus in Verona, Wis., where all of its employees are based.
"It's a little bit of a change for Epic," said William Hersh, MD, chair of the Department of Medical Informatics and Clinical Epidemiology at OHSU in Portland, Ore. Hersh said it took several years of cajoling to get the vendor to commit to an academic partnership.

 Cajoing indeed....