Rick Wicklin:The relationship between toothlessness and income

Interesting post on the relationship between toothlessness and income.  Rick ought to throw smoking prevelance into the mix because I expect it will explain more than income would.

And of course the graphs are nice!  

Attribution Identifies Physician-Patient Relationships

Attribution Identifies Physician-Patient Relationships



Something on my mind worth saving.  Attribution not as simple as you'd think.

Join Us At Valence Health’s Value-Based Care Conference

Needless to say, my blogs represent my views and not those of my employers past or present, but below is a plug from my current job about what I think will be a very useful conference.

 Please join us for further 2015, our annual industry conference dedicated to value-based care and reimbursement models. From clinical integration, to shared risk, to provider-sponsored health plans, further 2015 explores the financial, operational and clinical aspects of all types of value-based care and “risk-based” contracting.  Learn more about the expert-led discussions designed for provider-organization executives here: http://go.valencehealth.com/further2015

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.

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

What Hadoop is Not

From the wiki....  probably the most useful one page I've read on Hadoop.

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

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.

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;

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....

Ben Domenech on Affordable Care Act's worst case scenario

Domenech lays it out here.
 
I'd add one further nasty step to the worst case.  People who have lost their insurance and unable to sign up timely on the exhanges, and then faced with a health catastrophe in January would face the cruelist of fates.  Sick, without insurance, and a penalty for not having it.  None of it any fault of their own.
 


 

 

Sunlight Group: Good enough for government work? The contractors building Obamacare

InforWorld writes,
 
The biggest problem with Healthcare.gov seems simple enough: It was built by people who are apparently far more familiar with government cronyism than they are with IT.

That's one of the insights that can be gleaned from the work done by the Sunlight Foundation Reporting Group, a Washington, D.C.-based nonprofit that focuses on government transparency. In a report filed this past week, the group examined why the system broke as horribly as it did: The contracts awarded to those who built it were, by and large, existing government contractors with "deep political pockets."
 
Download the Sunlight Group's report for a list of all the vendors.  Yes, the lobbying and contributions explain some, but the biggest failure I suspect will be lack of imagination.  They did it the same old way.

 

Affordable Care Act's Software Vendors

In case your wondering the trio's "CGI Federal for the website itself,  "Quality Software Systems Inc. (QSSI) for the information "hub" that determines eligibility for programs and provides the data on qualified insurance plans, and "Booz Allen for enrollment and eligibility technical support."
 
Below via Obamacare site hits reset button on passwords as contractors scramble,
 
The result of the headlong rush to October 1 was a system that had never been tested at anything like the load it experienced on its first day of operation (if it was tested with loads at all). Those looking for a reason for the site's horrible performance on its first day had plenty of things to choose from.
First of all, there's the front-end site itself. The first page of the registration process (once you get to it) has 2,099 lines of HTML code, but it also calls 56 JavaScript files and 11 CSS files. That's not exactly optimal for heavy-load pages.
 
Navigating the site once you get past registration is something of a cheese chase through the rat-maze. "It's like a bad, boring video game where you try to grunt and hack your way through to the next step," one site user told Ars.
 
Once you get through all that, it's not clear that it's going to do you any good. Underlying problems in the back-end code—including the data hub built by QSSI—have been causing errors in determining whether individuals are eligible for subsidized plans under the program. In DC, that means health care plan prices won't be available to people registering through DC's portal until November. It may also mean that others who have registered already at the federal and state exchanges may get sticker shock later.
 
A Federal IT Acquistion a heck-of-a-thing to hang one's Political Legacy upon.  Administration will end up seeking a delay and that's what'll be remembered about this shutdown.

Slowdown in Health Care Spending Might Be Short-Lived, Analysts Say - California Healthline

Slowdown in Health Care Spending Might Be Short-Lived, Analysts Say - California Healthline