Data interoperability and Workforce Development - S&I frameworks meetings EU-US Conference

Data interoperability and Workforce Development - S&I frameworks meetings

I thought I might follow up this a just a bit on what went on with these meetings. Originally we were going to present some results from our meetings on these topics. However the government shutdown put a crimp in those plans. So we met in both groups with whoever attended to go over case studies and have some dialog on the topic.  The data meeting was pretty small however Dr. Jaffe Ceo of HL7 came in and basically had a roundtable discussion on a variety of topics. We did review our case studies and got some consensus on the topics.

•Scenario 1: Moving From Country to Country & Immunizations

•Scenario 2: Broken Eyeglasses

•Scenario 3: Planned Care

•Scenario 4: Patient has a heart attack and ends up in the ER (or patient is hit by a car)

•Scenario 5: Group of students traveling with someone acting on behalf of, or in the place of, a parent, legal guardian, patient, or subject who needs to obtain medical records for treatment

•Scenario 6: Ran out of/forgot prescription medication while on vacation and need it refilled (for example blood pressure medication)

•Scenario 7: Ambulatory (patient has pre-existing condition such as diabetes that has been out of control and needs to be addressed.

#1 and #2 weren't very popular. There was considerable discussion to combine a few of the other topics together. A moderator from ONC took down the comments and will use them for the next meeting.

Workforce was much better attended and have a large amount of folks from the EU present. What I found fascinating was the big difference between the EU and US where it comes to education and employment.  In the EU what you get your degree in is what you stay in for a career path for the most part. Not always the case here in the US. Also many governmental jobs require masters degrees which also will eliminate younger workers.  Here in the US usually it is experience more than the degree.  The question of how will match job skills and roles to some type of standard was bantered around. ONC talked about the Meaningful use cert .  It appears there was interest on both sides at looking at certification based program. We'll see where this leads.

 

Update on the EU - US Conference Update 10/24/13

Well I have to say I was really happy that I went.  Sometime things just work out on a conference once in a while.  The S&I frameworks groups I was working on did meet and we had some pretty interesting conversations. The irony that only a couple of people attended the. However I got to talk to Charles Jaffe the CEO of HL7 for basically 3 hours one on one as we discussed case studies, C-CDA and a bunch of other topics. It was worth the price of admission for that.  I did meet up with Dr.Fridsma(Chief Science Officer, Office of Science and Technology)  and his team from the ONC during the workforce development meetings.  I learned alot of how healthcare is done in the EU. Their private/public relationships are very different than what we have here in the US. Their rules and regulations are also very different. It's not say we don't have common ground but have a long way to go to understanding how we can find areas of common intersection.

More to follow

3rd EU-US eHealth Business Marketplace and Conference This week

Well I'm attending this conference. I'm part of the EU-US MOU - Call-to Action and Roadmap Work Streams to support EU-US Collaboration. Basically in a nutshell we are trying to find some ways to unify standards to allow for the exchange of healthcare between the two groups.  

Interoperability of Health Records

• Dr. Larry Garber, Medical Director for Informatics, Reliant Medical Group
• Catherine E. Chronaki, Secretary General HL7 International Foundation

 International Workforce Development

• Mary Cleary, Deputy CEO, Irish Computer Society Skills, Ireland

• Stathis Konstantinidis, Research Scientist, Norut – Northern Research Institute, Norway

Are the two areas I've helped a tiny bit on so I'm pretty curious on what is being presented.  

Data Quality Team and Compliance

I'm going to go off and talk a bit on Data Quality Teams and Compliance.  I think there is a constant struggle about who owns the data and who is responsible for it.  Data Quality teams began to get some attention a few years ago in the US and you are starting to see the trend in the EU. Typically the Data Quality team resided under the IT or operations wing and it was put in place to review data going in and out of systems for completeness and accuracy.  It was basically a check to what the day to day operations folks were doing and to catch issues.  I'm going to suggest leveraging these teams if they exist to do compliance reviews.  Who owns the DQT  is always a good question. Being part of IT doesn't really give it independence and I really don't think a compliance team would have a budget for them.  Being part of operations makes sense but there is usually a struggle about cost and value they bring to a organization. Smaller companies I really don't see being able to do this. However with EMR,EHR,Billing and PHA data all going into multiple systems you really need some sort of audit process in place. Also you need to think about HIE's and making sure the data gets and audit before it gets into those systems.  Unique ID trackers are going to be required...  So is your head spinning?  Not only are you going to need legal, clinical and regulatory experience on your team but now also IT?   I see alot of blended roles here and that leads to confusion on independence and oversight. Is your data analysis on loan to you from IT  really trying to make sure IT or Compliance is happy? Who pays the salary and does the review? It's all questions you need to ask.

Compliance and Data - The Emerging Alliance

Compliance and Data - The Emerging Alliance

Last year I mentioned a few times the importance of having compliance involved in data collection and analysis. At the HCCA regional conference in Boston this month this came up as a topic several times. In order to provide evidence of compliance for various state and federal programs you need to provide data evidence.  How would a compliance officer be able to verify with impartiality that the information is correct?  The term data quality compliance analyst came up and I think its worth looking at. Most compliance folks have a clinical or legal background(my background is technical so I must be the extreme minority) and a database is a complete mystery to them.  Frankly I would look  at anything IT gives you with extreme prejudice. IT doesn't look at things from a compliance standpoint and usually regards most regulatory concerns as a burden and not a requirement. Most Health IT organizations have Data Analysts and these skills do bleed over a bit.  However they report to IT and this may be a conflict of interest. You are starting to see the establishment of Data Quality Teams and Data Governance. I would highly suggest talking about establishing these teams or getting involved with them.  You need to talk to your CIO on this.  You will be surprised he probably knows more than you think about this.  IT information security it usually part of the CIO's office and they are getting hit constantly with HIPAA regulations. Talking data compliance and review may spark some serious cross organizational discussions.   

The demise of Performance Reporting with the NCQA Disease Management Accreditation

Well with life some things just fade away. With NCQA's announcement that that it will not be continuing with DM Performance measures in 2014 that will end the certification for the few companies that achieved this.  Well what happen? This program seem to have so much promise and then NCQA began to back off with making DM organization from making it mandatory to not required. It was being cited that it was too hard for companies to implement. However as the changes to supplemental went into effect it became quite clear that these two were related.  If member supplied data wasn't valid for HEDIS then it didn't make sense for DM companies to keep collecting because it wasn't considered reliable.  It's too bad because I don't think any time was spent studying if companies tracking DM measures had better results for their matching HEDIS measures. Once 2015 hits the last DM performance certification will fade into the sunset.

At HCCA New England Conference today!!

Looking forward to the discussions for the day

Medicaid Programs and Compliance - Random thoughts

Medicaid Programs and Compliance - Random thoughts

I've had a few things come across my lap in the past months and read a few articles on some trends.  With the ACA I think it is safe to assume that these populations will grow substantially, this does not mean your job will get any easier. These populations are notorious for medical non-compliance for a variety of reasons(apathy, economic, education, age, disability).  Organizations will find that traditional methods will not work with them as proven over the last 20+ years.  Organizations will try to tap new methods of outreach to get these members to improve their health.  I think you will see a host of new services that have been offered to the commercial populations being offered to medicaid as a way to incentive the members.  This does come with some danger as these programs could be potentially abused and defrauded.  Another area that will constant dangers is communications with the member. Mail just doesn't reach folks the way it used to.  That leaves electronic forms, text, phone and email.   All areas that are potential HIPAA concerns.  Cell numbers and text address changes constantly as plans are dropped and phones retired.  There will be a need for better phone look-up and verification.  I can see bottom feeding lawyers targeting Health Plans over HIPAA with this.  Email has it own problems unless it a free universal provider like Google and Yahoo as people change email fairly regularly. But remember email is that "secure" either. I hope the compliance officer gets cracking on that computer science degree...

Successful HCCA Webinar Presentation

Successful HCCA webinar Presentation

I do hope everyone who did attend did enjoy the presentation. I was told we had 37 individuals attend the webinar.  I really hope people were able to take away a few tidbits of info that will help them. I did see some folks from Kaiser and United Healthcare attend. I'll keep chugging away.

Andy

A bit of self promotion....NCQA Accreditation and the role of the compliance professional Webinar August 19th

Topics Covered

• An explanation of what NCQA Accreditation is and what it represents for Health Care organizations
• Why should a compliance professional become involved with the accreditation process
• Organizational pitfalls and misconceptions about NCQA and its programs

 
 
 
http://www.hcca-info.org/Events/EventInfo/sessionaltcd/003_AC081913.aspx

8000 hits on this blog!!

I just want to say thank you for getting to the 8000 hits on my blog mark. My hope is to 10000 by December.  I'll do more posting over the next few weeks.  I'm working as a volunteer camp councilor next week(cub scouts) So I'll have some down time at night.

Thank you all!

Andy

A possible silver lining to the HEDIS changes

Well in any situation you do need to find the silver lining in this case.  I'm going to look at this from the patients point of view.  If there were plans not exactly being honest in their reporting then the fact is people weren't getting better.  The point of these measures was to report if people were closing clinical gaps in their conditions. if they were closing these gaps they would be getting healthier or at least not any worse.  The point of all this is to provide better health care and make people better. Maybe this gets a little lost sometimes with all the different issues that seem to crop up in health care.  What I see changing are organizations turning back to old fashioned health coaching and talking to their members about getting treatments and following up with them. The 20 minute conveyor belt just isn't going to work(not the doctor's fault). The plans and the practices are going to need to work together in outreaching to members after they have left the doctor's office. PCMH is an interesting approach but I think it lacks some teeth in reporting outcomes and outreach post office visit. It's still a good start to seeing changes down the road.  The other winner in this change is really the tax payer surprisingly enough. If plans weren't really supposed to get their bonus payments then HHS isn't going to be paying them extra money. I do recognize the fact however that this may impact plans that were doing nothing wrong.  It's going to be interesting how this all shakes out.

More on the HEDIS Supplemental Changes

I think there will be extra angst as the changes are fully implemented over the next year.  First for measures that have multiple year look backs you will need primary source data in those look back years. That may be difficulty especially if records are stored and not accessible easily.  One area that I think will cause additional pain when plans take on new members.  You will need accurate records to prove that members got required tests and screening from the year that they weren't members of the plan.  Now we all have been dealing with EHR's in some shape or form and this may not be as easy as you think.  What about the pneumonia vaccine you got 4 years ago or the double mastectomy 12 years go. How about doctor tests and results? Hopefully you got your portable records with you. Now as the impacts become more apparent I think some of the rules maybe modified as NCQA gets the feedback rolling in. Personally I don't see any major changes allowing anything but primary source validation.  Because there is state and federal money implications with these scores and there appears to be some indications that there was improper reporting going on NCQA was placed in a pretty difficult position. Either ratchet down the rules or face possible litigation from the OIG is probably what occurred. While NCQA was formed from Health Plans trying to put industry standards and its roots are in health plan promotion I don't think they had much choice in these changes.

HEDIS Supplemental Changes

Sorry I haven't been blogging a while tied up with submission dates and some time off.  I would like to talk about the recent changes to HEDIS supplemental data rules.  Back in April NCQA notified its participants of the changes. In a nutshell unless you have primary source validation for your supplemental data you can't use it. What is primary source?  Basically the hard copy receipts or results of tests and exams.  Without that you can't use the data.  Why did this happen? I suspect there were legal issues with HHS were organizations were playing fast and loose with the rules.  Someone had to have complained and most likely there are open investigations and I suspect you will see OIG cases going to court.  There is a lot of money tied in Medicare STAR ratings and somebody or a few somebodies had to be doing some rather sketchy things.  While the organization that I work for is doing HEDIS Data collection we also were putting this into a disease management registry system, recording calls and had a documented process on what was valid information plus following clinical guidelines for health coaching of patients(our phone staff are RN's).  I suspect there were companies out there just doing cold calling and recording information... With the changes that have occurred we will be out of that line of business.  My guess is there will lowering of scores across the board for Health Plans.  If Plans were using to supplemental data to even boost them half a star its going to hurt. 

More on this on the next post

17th Annual Compliance Conference Thoughts

Well now that I have gotten through my 200+ emails since getting back to work all I can say it is really refreshing to be in a place where everybody is in the same boat as you. Whether you do billing, privacy, audit, or anything else we all feel the same pressures and stress.  Having Dan Levinson the US Inspector General for HHS as the keynote speaker there, really reinforced the importance of compliance and another topic, Data Quality.  I don't think he could be any clearer that data quality is going to be extremely important. The push for EMR's is the first step, the next step are HIE's. All medical data is going to be tracked and checked. There are going to be more than a few compliance officers reading books on Data warehouses in the next couple of years.
The other take away I have is reach out to colleagues and ask for help. It's a huge networking event at the conference and to be honest most compliance departments are pretty small staffing wise to have a huge knowledge base. . Reach out and ask questions!!!  The only bad question is the one that is never asked.

ACO discussion with HCCA at the 17th Annual Compliance Conference

Listening to a panel discussion on ACO's
with Shawn DeGroot, Frank Sheeder, Troy Barsky, and Mary Fischer

Interesting Points

• They are run by providers no VC money involved
• Their board has to be made up of 75% of membership
• ACO's are involved in shared savings, shared risks models
• They are judged on performance benchmarks as a measure of success
• ACO's don't totally follow the OIG 7 elements for compliance but have their own structure and a mandatory compliance position that reports to the board.
•  Privacy concerns along with standard federal guidelines are all still present
• Anti-trust concerns with ACO's DOJ and FTC have published papers on this
• ACO's and physicians share money which raises concerns but waivers are available
• Need to focus on quality data
• Potential for false claims based on bad data(IT Data warehouse be aware!!)
• Need to think about Stark and anti-kickback more about co-mingling of money
• Compliance concern needs to be at the table early and often because of the multiple of potential issues.
• ACO  has to service at least 5000 members 
• Litigation's will be a concern with ACO's if they run a foul of regulations
• Serving people vs. financials concerns are a tightrope
• Compliance is a critical part of making an ACO a success
  

Day 3 HCCA National Conference - Personal Reflection

All I can say it is such an uplifting experience to spend time with people in the same field, who go through the same aggravations and give you inspiration to be passionate about what you do.

Day 2 Social Media and Compliance

Social Media and Compliance

Let's just say this was a popular topic for behavioral health organizations

Excellent discussion on issues people have faced and efforts done to avert issues.

Key points

• Social Media is the wild west for compliance
• Organizations struggle to monitor
• Policies are constantly be changed
• National Labor Relations board needs to be checked for social media policies.  It's rulings have directly affected policies and proceedures.
• Social monitoring is now a clear and present issue for compliance
• Training is a big part of averting issues.

Just a great discussion.

Day 2 HCCA National Conference Dan Levinson Speaks

Key Note Speaker
Dan Levinson Inspector General for OIG HHS
Great Speaker Key Points

• Compliance is charting a new course moving into the quality and efficiency fields
• Self Reporting is more important
• EHR's are the road to interoperability 

A lot of networking going on. I'm done to 5 business cards..

Sitting in the program on how to build a compliance program

8 core elements..

More to come

First Session Compliance and Health Care Reform

First Session Compliance and Health Care Reform

Great Session!!!

Informative discussion on how the environment is changing.  Compliance needs to take a greater roll in reviewing contracts and BAA's.  Need compliance review of revenue for tax exempt organizations.  Need better control over medical records and their availability.  People need to put better thought into compliance when thinking mergers and acquisitions.  Never want to get into a situation when the acquisition may not be compliant or may be exclusionary with HHS.  Do your due Diligence!!!!

National Health Care Compliance Convention this week in National Harbor Maryland

National Health Care Compliance Convention this week in National Harbor Maryland

I'll be blogging while I'm there!

Fundus Photgraphy Vs, Rentinal Image and other musings

Sorry I've been absent for a while.. things got busy for a bit and I'm wearing some IT hats right now

I ran into something today that made me laugh.  This is total HEDIS nerdy dorkyness but I thought you might enjoy this.   We had one of our health coaches ask about this procedure for the DREE measure(Dilated Retinal Eye exam) and should we allow it to be captured for HEDIS supplemental data in our disease management registry system.  She was asking about a “Ultra wide field retinal image” being used as a DREE.  Now this didn't ring any bells and a quick scan of the HEDIS CPT codes didn't turn anything up.  The clinical staff thought we shouldn't record it because it most likely isn't re-reimbursed by medicare.  Just on a hunch I did a Google search on “Ultra wide field retinal image” and "medicare". Sure enough I found this

http://www.optos.com/Global/documents/P200C_Brochure.pdf

A company called optos sell this optomap utra-widefield retinal imaging product and in their pdf they explain that this prodcut can be billed under CPT code 92250 for reimbursement with medicare.  A quick search in the HEDIS specs for DREE shows CPT code 92250 listed for DREE.

Now what is the description of CPT code?


FUNDUS PHOTOGRAPHY WITH INTERPRETATION AND REPORT.

Gotta love intuitive descriptions ...


I can now say I had some HEDIS FUNDUS today at work.

Enjoy,

Andy

Thank you Matthew Holt

Yesterday Health Dialog had an off site meeting for the company and the guest speaker was Matthew Holt the founder of "The Health Care Blog"

http://thehealthcareblog.com/

Matthew did a great job engaging the participants with a ton of information on trends and thoughts on our current Health Care situation.  His analogy that we are currently a stalled bus sitting on the road is pretty accurate for the US.  I am sorry for my question on defensive medicine.... ;) When half of your family are medical professional and then another group of them are litigation lawyers, what do you expect from a guy who is a compliance dork?  When you said defensive medicine was only a small portion of the problem I will disagree with you because in the next breathe you stated that liability reform should have been included also in the ACA.  I think defensive medicine has a bigger impact than some people want to give it credit for. If 30% of the test and procedures are a waste why do you think they are being done? A good chunk of them is because the doctor is afraid of being sued. But now we have created a culture of being pro-actively "safe"  along with it being a good deal financially for the medical community since they get paid for those additional items.

Saying sorry for a mistake by a doctor may make sense but when you have 1000's of lawyers trolling the internet and TV looking for litigants the system is screwed up. Europe doesn't have this problem since most of their stuff is capped or they have to pay damages if they lose. It's just a piece of the puzzle that needs to get addressed.


Other than my 2 cents I think Matthew did an incredible job talking about where we are headed down the road.


P.S Matthew your red jacket is a true fashion statement.

Some of the new 2013 HEDIS measures may get more interest than previously though unfortunately Part 1

Some of the new 2013 HEDIS measures may get more interest than previously though unfortunately

• Diabetes Screening for People With Schizophrenia or Bipolar Disorder Who Are
  Using Antipsychotic Medications.Diabetes 
• Monitoring for People With Diabetes and Schizophrenia.
• Cardiovascular Monitoring for People With Cardiovascular Disease and
  Schizophrenia.
•  Adherence to Anti-psychotic Medications for Individuals With Schizophrenia.

I think there may be some serious discussion this year with mental health treatment and this may be one of the few areas that will get significant support.

I'll start breaking these down

Diabetes Screening for People With Schizophrenia or Bipolar Disorder Who Are Using Anti psychotic Medications (SSD)

The percentage of members 18–64 years of age with schizophrenia or bipolar disorder, who were dispensed an antipsychotic medication and had a diabetes screening test during the measurement year

Product lines Medicaid.
Ages 18–64 years as of December 31 of the measurement year.
Continuous enrollment  The measurement year.
Allowable gap No more than one gap in enrollment of up to 45 days during the measurement year. To
determine continuous enrollment for a Medicaid beneficiary for whom enrollment is
verified monthly, the member may not have more than a 1-month gap in coverage (i.e.,
a member whose coverage lapses for 2 months [60 days] is not considered
continuously enrolled).


Anchor date December 31 of the measurement year.

Benefits Medical and pharmacy.

Event/diagnosis
Follow the steps below to identify the eligible population.
Step 1 Identify members with schizophrenia or bipolar disorder as those who met at least one
of the following criteria during the measurement year.

•  At least one acute inpatient claim/encounter (Table SSD-A) with any diagnosis
  of schizophrenia (Table SSD-B) or bipolar disorder (Table SSD-C).
• At least two visits in an outpatient, intensive outpatient, partial hospitalization,
  ED or nonacute inpatient setting (Table SSD-A), on different dates of service,
  with any diagnosis of schizophrenia (Table SSD-B).
•  At least two visits in an outpatient, intensive outpatient, partial hospitalization,
  ED or nonacute inpatient setting (Table SSD-A), on different dates of service,
  with any diagnosis of bipolar disorder (Table SSD-C)

Step 2:
Required exclusions

• Members with diabetes. There are two ways to identify members with diabetes: by
  pharmacy data and by claim/encounter data. The organization must use both
  methods to identify members with diabetes, but a member need only be identified by
  one method to be excluded from the measure. Members may be identified as having
  diabetes during the measurement year or the year prior to the measurement year.
  Pharmacy data. Members who were dispensed insulin or oral hypoglycemics/
  antihyperglycemics during the measurement year or year prior to the measurement
  year on an ambulatory basis (Table CDC-A).
  Claim/encounter data. Members who had two face-to-face encounters in an
  outpatient setting or nonacute inpatient setting, on different dates of service, with a
  diagnosis of diabetes (Table CDC-B), or one face-to-face encounter in an acute
  inpatient or ED setting, during the measurement year or the year prior to the
  measurement year. The organization may count services that occur over both years.
  Refer to Table CDC-C for codes to identify visit type.
•  Members who had no antipsychotic medications (Table SSD-D) dispensed during the
  measurement year.

Administrative Specification

Denominator The eligible population.
Numerator
Diabetes Screening
A glucose test (Table SSD-E) or an HbA1c test (Table CDC-D) performed during the
measurement year, as identified by claim/encounter or automated laboratory data.

I'll be honest this may be a hard measure to get good results for. The Medicaid Population can be tricky when trying to fill gaps. Plus  trying to accurate identify members with correct diagnosis codes for physch disorder could be tough.  Various support service may or may not bill in a way that will be accessible by a plan.

Stealing some thunder from another blog

This from John Lynch's blog(Not the former NH Governor)

http://ourhealthcaresucks.com/health-care/healthcare-cuts-or-sequestration/

 The entire sequestration process – a byproduct of the last debt ceiling debacle in Congress that would make broad cuts in government spending effective on March 1, 2013 (delayed from a January 1, 2013 start as part of the “fiscal cliff” deal) – could be avoided if we’d only tackle our medical misspending that she estimates at 44% of our current healthcare costs. The twin pillars of overhead and overuse are cited as the core causes of this overspending.

While I don't agree with everything said in the blog it provides some excellent reading and discussion on what is going and what can be done.  One topic touched on was defensive medicine.  It's something that I don't think was addressed with the ACA.  Doctors order far more tests and procedures not because its needed but because if they don't do it they could be sued for malpractice if something goes wrong.  We really need to focus on quality not quantity and get lawyers out of the equation. Some of the accepted performance measures being used do touch on these. For example AAB Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis or URI Treatment of Children with Upper Respiratory Infection. Between unneeded tests and prescriptions plus frivolous lawsuits we are hiking up our costs and wasting money.  Even though I'm a compliance professional having these rules in place keep me gainfully employed we do need to realize that the system is broken and needs to be fixed






John does know what he is talking about

John Lynch has several decades of diverse healthcare experience informing a unique perspective that can help you and your family navigate our turbulent – and dangerous – healthcare system.

These range from consumer advocacy and hospital management to regional planning and developing innovative service delivery models, including:

• Founded and served as Chairman, President and CEO of a company that developed a network of mobile MRI clinics (Medical Diagnostics, Inc., or MDI) that he took public as the only profitable mobile MRI company in the country; MDI was twice ranked among Business Week’s top ten “Best Small Businesses” in America;

• Former independent consultant for hospital planning and program development projects; developed an early methodology for projecting patient need for an emerging diagnostic technology (MRI) recognized by the American Hospital Association;

• Served on the Boards of a hospital and consumer advocacy group for the medically uninsured, as well as the Hospital Trustee Committee of his state hospital association;

• Served on Boards of health centers, Harvard-affiliated mental health center, & statewide drug rehabilitation program;

• Managed the emergency room, outpatient, and community-based programs of a large teaching hospital; &

• Served as Planning Director for a regional health planning agency & reviewed dozens of hospital expansion plans.

Interesting view on US Health Care

I was reading over this blog that I follow
http://diseasemanagementcareblog.blogspot.com/
it's Posted by Jaan Sidorov

Jaan's takeaways was this based on the research that was presented in his blog.

DMCB takeaways:

If other developed nations are role models for the U.S., large clinic systems are not necessarily the way to go.

There may be an inverse correlation between patients' ability to pay for care and access to specialist care.

The U.S. is in the middle of the pack when it comes to EHR use.

Nurse-led care manage is not uncommon overseas and a 43% rate in the U.S. is higher than generally realized.

Timely transmittal of emergency room and hospital discharge information seems to be a problem everywhere.


I find it interesting because we are at a crossroads where we look to fundamentally change how we do healthcare  in the US.  The ACA is beginning to get implemented at a much higher rate in 2013.  The results to be honest have been less than impressive.  The goal was to make health better and cheaper not created endless bureaucracy,  Jaan's last 2 points I find really interesting. In many countries your provider is a nurse and not a doctor. Sometimes it's because there isn't a doctor available or because the system in place has you go through a "triage" before you get to see a physician.  In the US we prefer to see the "doctor" becuase that's the expectation. Working in a healthcare system setting, there are times I'd rather see a nurse who has 20 years under her belt than a resident just out of school.. It's something that we might need to consider more.  Plus its more cost effective and it give the Dr's time to work with patients rather than squeeze them in for 17 minute visits.

The other point is the exchange of info with the ER and discharge.  We frankly we stink at this and the issue is really on both the Dr. and the patient.  Most times you get out of the ER and the attending gives you the paperwork and it good bye. They usually don't follow up with the primary.  Unless they happen to work in the same hospital. On the flip side the patient needs to show an iota of common sense and let his primary know what happen.  Now if this person doesn't have coverage or a primary that's another whole issue.  I think this trend is changing with the ER. Now what needs to happen is the patient needs to show some personal responsibility and get penalized when they don't.  Because if they don't we all have to pay in the long run.

I'm not a big fan of the ACA  just because it was to huge and was way too partisan.  Though I agree with it in the spirit that the system is broken and needs to be fixed.  I really hope 2013 the Senate gets its act together and allows some bills to be voted on that could fix a few things on this act. Though based on Harry Reid's track record I won't hold my breathe.  On the other hand the house should stop wasting its time on trying repeal and focus on fixing the act incrementally with the areas that have the biggest flaws. You'll get more support that way.

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