Nanker Posted March 28, 2014 Share Posted March 28, 2014 I think his azz-twerking wiggle room is that in the second speech he's talking about his colleagues in The Senate. In the first he was talking about the liars like the people who HAVE suffered the ill effects of the Abortioncare law, unnamed politicians seeking to gain headlines and score points, and... drumroll please... The Koch Brothers! Hey Hairy Azz Reid - Koch Brothers, Koch Brothers, Koch Brothers, Koch Brothers!!! Sarah Palin! Sarah Palin! Sarah Palin! Sarah Palin! Sarah Palin! Bush! Bush! Bush! Bush! Bush! Bush! Bush! Bush! Chris Cristie, Chris Cristie, Chris Cristie, Chris Cristie, Chris Cristie, Chris Cristie!!! They're in your head Hairy and you can't get them out. Now, go off and buy your granddaughter a nice present. ****. Link to comment Share on other sites More sharing options...
DC Tom Posted March 28, 2014 Share Posted March 28, 2014 One Doctor’s Viral Letter Exposes the Harrowing Reality of Obamacare’s ‘War Against Doctors’ by Emily Hulsey Original Article . I've had to deal with the ICD-10 codes myself. They're insane, and cost-prohibitive. It's increased the time I have to spend filing a claim with MY insurance by a factor of about 4; I can't imagine what a doctor's office would have to go through. Link to comment Share on other sites More sharing options...
B-Man Posted March 28, 2014 Share Posted March 28, 2014 I've had to deal with the ICD-10 codes myself. They're insane, and cost-prohibitive. It's increased the time I have to spend filing a claim with MY insurance by a factor of about 4; I can't imagine what a doctor's office would have to go through. Well I'm sorry to hear that sir. I have to enter the old ICD-9 codes in our EMR (why I ended up with that task I am going to have to re-approach now that we're bigger) and I'm supposed to start learning these new ones soon. . Link to comment Share on other sites More sharing options...
BillsFanM.D. Posted March 29, 2014 Share Posted March 29, 2014 One Doctor’s Viral Letter Exposes the Harrowing Reality of Obamacare’s ‘War Against Doctors’ by Emily Hulsey Original Article "To make matters worse, Washington forces doctors to demonstrate ‘meaningful use’ of EMR or risk not being fully paid for the help we give." Don't lose sight of this little gem in the letter. "Meaningful use" is another layer of nonsense that physicians are now required to document. Apparently, we don't have enough rules about documentation and coding the visit. Now we have to check off that we've done it; set some 'goal' that is already laid out in the note and 'prove' that we are using the EMR in a (cough) meaningful way. This is certain to improve efficiency and patient care. Patients will gladly trade their time with the doc....so the doc can prove that he/she is using the computer the way they are supposed to. You know, the government way. Redundant, slow to respond, irrelevant to most of what is going on/and almost certainly already being done. It provides a free way for the government to mine data that is input by docs. I'm sorry to say I've worked for the federal government in healthcare and the 'clinical reminder' system was much the same. It has little to do with quality of care and moreso to do with acquiring less than pure data to measure 'improvement' standards. If you want to know what's going on in my emr....read it. I'm all about self governance and I didn't go to med school to have a computer tell me what a meaningful interaction/plan with a patient is. I also fail to see how checking a few boxes on a boilerplate emr page provides the fullness of that information anyway. This isn't about arrogance. It's about time. Docs don't have enough time for all this other stuff and the patients suffer as a result. I couldn't agree more with the letter in the article. Link to comment Share on other sites More sharing options...
3rdnlng Posted March 29, 2014 Share Posted March 29, 2014 "To make matters worse, Washington forces doctors to demonstrate ‘meaningful use’ of EMR or risk not being fully paid for the help we give." Don't lose sight of this little gem in the letter. "Meaningful use" is another layer of nonsense that physicians are now required to document. Apparently, we don't have enough rules about documentation and coding the visit. Now we have to check off that we've done it; set some 'goal' that is already laid out in the note and 'prove' that we are using the EMR in a (cough) meaningful way. This is certain to improve efficiency and patient care. Patients will gladly trade their time with the doc....so the doc can prove that he/she is using the computer the way they are supposed to. You know, the government way. Redundant, slow to respond, irrelevant to most of what is going on/and almost certainly already being done. It provides a free way for the government to mine data that is input by docs. I'm sorry to say I've worked for the federal government in healthcare and the 'clinical reminder' system was much the same. It has little to do with quality of care and moreso to do with acquiring less than pure data to measure 'improvement' standards. If you want to know what's going on in my emr....read it. I'm all about self governance and I didn't go to med school to have a computer tell me what a meaningful interaction/plan with a patient is. I also fail to see how checking a few boxes on a boilerplate emr page provides the fullness of that information anyway. This isn't about arrogance. It's about time. Docs don't have enough time for all this other stuff and the patients suffer as a result. I couldn't agree more with the letter in the article. Doc, did you work in the VA system? Link to comment Share on other sites More sharing options...
BillsFanM.D. Posted March 29, 2014 Share Posted March 29, 2014 Doc, did you work in the VA system? I did for about five years. I've spent the bulk of my career in private practice. Really enjoyed the time in the VA. I worked with great docs/providers affiliated with a great university. Like most places, I loved 95% of the patients and the other 5% were a challenge. Great stories and great people. I left because of a change in my wife's career and not necessarily because I wanted to. To the point, I had no qualms with the basic functioning of the EMR in the VA. In fact, I got quite proficient in its use. I did, however, object to the component of the 'clinical reminders.' This 'meaningful use' smells of the same ilk. These were templated forms that would be triggered by a time factor, age factor or a nurse intake question etc. They seemed to be quickly moving from a true 'reminder' (which were often overkill anyway) to a clear cut research tool. Again...I, and EVERY other provider I worked with, loathed these things. Way too time consuming; and they were multiplying like rabbits when I left about four years ago. Every time a new one was added, the collective groan could be heard for miles. Link to comment Share on other sites More sharing options...
B-Man Posted March 29, 2014 Share Posted March 29, 2014 ObamaCare’s endless false promises Maryland to dump its ObamaCare exchange :$125 million down the drain. Link to comment Share on other sites More sharing options...
B-Man Posted March 30, 2014 Share Posted March 30, 2014 Even if we accept the phony numbers, Obamacare's not working by Ed Rogers FTA: But, oh, by the way, the most stunning omission from the White House, Sebelius, et. al. is that Obamacare has failed miserably in its original purpose — insuring the uninsured. President Obama and his Democratic allies can claim that 6 million people have gotten insurance, but we still don’t know how many of those are newly insured. Regardless of the number of enrollees, or the number of people who are receiving subsidies, or how many people are able to keep their doctor, the bottom line is that Obamacare’s success should be based on the number of people who have insurance today who were uninsured before Obamacare was passed. Of course, that’s not something the administration will even admit they are tracking. What does that tell you? After all the insurance cancellations, the administration’s insistence that 6 million people now have insurance because of Obamacare is a lot like firing 20 people, hiring 18 of them back and claiming that you have created 18 new jobs. In other words, nobody knows what the net number of people insured is once you have factored in how many people lost their insurance because of Obamacare. But all of this is just the appetizer. The political entrée is how voters will react to the quality of care, access and premiums/co-pays they will encounter in the Obamacare exchanges over the next year. Maybe the Web site works better, and maybe some newly insured individuals have signed up. The real test will be if Obamacare can deliver insurance with a health-care plan that people actually like by November. That’s a lot harder than fixing a Web site or fudging enrollment numbers. From an insurer standpoint, an enrollment mix where only 25 percent are in the golden 18-34 age bracket is not the definition of “success.” And if the enrollees lean toward older, sicker people, premiums are going to go up dramatically for everyone. The premiums will be higher, and the only way insurers can lower prices is to make their networks more and more restricted, limiting access and choice for millions of Americans. That’s not what success looks like. http://www.washingtonpost.com/blogs/post-partisan/wp/2014/03/28/the-insiders-is-obamacare-working/ Link to comment Share on other sites More sharing options...
Nanker Posted March 30, 2014 Share Posted March 30, 2014 If you like your Doctor, you can change your Senator. If you like your healthcare plan, you can change you Representative. If you like your President, you can change your diaper. Link to comment Share on other sites More sharing options...
boyst Posted March 30, 2014 Share Posted March 30, 2014 (edited) +1 more sorry bastard to sign up for the ObamaCare. It is cheaper, by far, then Cobra. And my new bennies will not kick in for another 90 days. The questions they asked on this site are just awful. ---------- Ok, now that I am actually in the enrollment selection area I have found several really annoying errors and one very big one. When comparing coverages you can view differences. It is a standard column and row layout, but once you remove one of the comparisons to narrow down your search it removes the title of that row and you no longer know for sure what you are comparing for that issue. See, it just says access to doctors and hospitals. prior to removing the 4 i was not interested in it told me what the "yes" was for. Also, at the bottom it still shows the selections and all 10 options on the scrolls, while the top shows the 6 I narrowed down to... Edited March 30, 2014 by jboyst62 Link to comment Share on other sites More sharing options...
boyst Posted March 30, 2014 Share Posted March 30, 2014 (edited) see, this is screen cap, cut and pasted to merge and show beside each other just one of the many silly mistakes. And... now that I go to pay... I click on "Pay for health plan" Edited March 31, 2014 by jboyst62 Link to comment Share on other sites More sharing options...
DC Tom Posted March 30, 2014 Share Posted March 30, 2014 see, this is screen cap, cut and pasted to merge and show beside each other just one of the many silly mistakes. And... now that I go to pay... I click on "Pay for health plan" Erase your email, dumbass. Link to comment Share on other sites More sharing options...
boyst Posted March 31, 2014 Share Posted March 31, 2014 Erase your email, dumbass. I did in the other one, missed it because I have burned my brain up with all of those hard questions. Asking if I was in prison currently, asking if I was in the United States, asking if I am on Medicaid, etc. Link to comment Share on other sites More sharing options...
OCinBuffalo Posted March 31, 2014 Share Posted March 31, 2014 I've spent time in Canada and the UK, and have good friends in both. They've spent time over here, and also have many good American friends. I don't have first hand experience myself, I do. And the above is me, telling you what is actually happening. Your friend's opinions....compared to my terrabytes of empirical data/real world every day experience? Do you really want me to take the rest of this seriously? I will wait to comment on the rest of this...post, until you answer. But, understand: you can take your slight whack now, for posting "what my friend said", or, you can take a serious beating that I see coming...just based on a quick skim of what's below. Up to you. but what they describe lines up with all the "graphs and charts" as being better than our current solution. They call the doctor, set an appointment, usually a week or two out for non emergency appointments. Which, lines up exactly with what I deal with. Never have I heard from actual people who use these systems that they have to bribe doctors in order to get an appointment within six months. Regarding healthcare costs... This is a good read, from Time: http://livingwithmcl.../BitterPill.pdf Also, I should state, that I support a universal *base*, whether that's single payer, or a national healthcare system, either works. But if rich people want to buy super fancy healthcare/insurance, they should be free to do that as well. A universal system of some sort is the best way to make sure the lower and middle classes have access to proper preventative healthcare. It's not necessarily the best for rich people, that much is obvious. Regarding the other rants, I'm not sure where you got all the assumptions about me. But please stop putting opinions into my mouth (or fingers, in this case, heh). Link to comment Share on other sites More sharing options...
TH3 Posted March 31, 2014 Share Posted March 31, 2014 Still waiting for OC's data that shows other industrialized countries costs are the same as USA due to shadow costs Link to comment Share on other sites More sharing options...
OCinBuffalo Posted March 31, 2014 Share Posted March 31, 2014 (edited) Second - got ANY reports etc that show these "shadow costs" that other countries have? Hey Rookie? Protip: every thread on this board has a search function. I've already covered your question in this thread. This is the first and last time I will do this for you. Here: http://forums.twobil...20#entry3043525 Thesis here: http://www.nyu.edu/p...lessons.html#IV Turn your attention to doing a page search(Ctrl-F on most browsers) on "illegal side payments", and? As in Canada or Germany, there is no "extra-billing": neither physicians nor hospitals may bill their patients more than the authorized fee; but illegal side-payments are common and condoned. and there you are. Smack dab in the middle of a paper, whose Foreward is quite frankly absurd, given its content. But, what else should we expect from something in which KPMG is involved? So there it is, and enough of your whining. You're lucky I'm not here every day(because, you know, I'm in hospitals/LTC/Rehab places, actually doing the stuff you can only talk about). If I were, you'd have more homework that your meager intellect could probably handle. "To make matters worse, Washington forces doctors to demonstrate ‘meaningful use’ of EMR or risk not being fully paid for the help we give." Don't lose sight of this little gem in the letter. "Meaningful use" is another layer of nonsense that physicians are now required to document. Apparently, we don't have enough rules about documentation and coding the visit. Now we have to check off that we've done it; set some 'goal' that is already laid out in the note and 'prove' that we are using the EMR in a (cough) meaningful way. This is certain to improve efficiency and patient care. Patients will gladly trade their time with the doc....so the doc can prove that he/she is using the computer the way they are supposed to. You know, the government way. Redundant, slow to respond, irrelevant to most of what is going on/and almost certainly already being done. It provides a free way for the government to mine data that is input by docs. I'm sorry to say I've worked for the federal government in healthcare and the 'clinical reminder' system was much the same. It has little to do with quality of care and moreso to do with acquiring less than pure data to measure 'improvement' standards. If you want to know what's going on in my emr....read it. I'm all about self governance and I didn't go to med school to have a computer tell me what a meaningful interaction/plan with a patient is. I also fail to see how checking a few boxes on a boilerplate emr page provides the fullness of that information anyway. This isn't about arrogance. It's about time. Docs don't have enough time for all this other stuff and the patients suffer as a result. I couldn't agree more with the letter in the article. I've said meaningful use a lot of times on this site, and only now, as I fully expected, do the doctors here finally start getting it? THIS is why I say "I should be Obamacare's biggest fan!". Because? You'll see. If you want some posters to cry about a long post, I will explain. Otherwise? You'll see. Edited March 31, 2014 by OCinBuffalo Link to comment Share on other sites More sharing options...
B-Man Posted March 31, 2014 Share Posted March 31, 2014 HealthCare.gov Down on Final Enrollment Day http://www.youtube.com/watch?v=Hm6YSCHec-o Just as happened when HealthCare.gov launched on October 1, users are encountering problems with the website for the federal health-care exchange on the final enrollment day. CNN’s John King noted that he ran into error messages about half the time he tried to log on this morning. “The system isn’t available at the moment,” a message on a number of the site’s web pages read Monday morning. “We’re currently performing maintenance. Please try again later.” The site began functioning properly around 8 a.m. An administration official told the Hill that the error messages were a result of extending the off-hours, nighttime maintenance window beyond its regularly scheduled time. Link to comment Share on other sites More sharing options...
DC Tom Posted March 31, 2014 Share Posted March 31, 2014 The site began functioning properly around 8 a.m. An administration official told the Hill that the error messages were a result of extending the off-hours, nighttime maintenance window beyond its regularly scheduled time. Idiots. Link to comment Share on other sites More sharing options...
Gary M Posted March 31, 2014 Share Posted March 31, 2014 The site began functioning properly around 8 a.m. An administration official told the Hill that the error messages were a result of extending the off-hours, nighttime maintenance window beyond its regularly scheduled time. It's not like anyone that needs this stuff have a job to go to or anything!! Link to comment Share on other sites More sharing options...
OCinBuffalo Posted March 31, 2014 Share Posted March 31, 2014 (edited) Oh and B-man and DC_Tom here is something about ICD-* that you might hate/like. It's long, and I don't care if you don't read it. It's just something I wrote out while listening to a dopey call today. I've had to deal with the ICD-10 codes myself. They're insane, and cost-prohibitive. It's increased the time I have to spend filing a claim with MY insurance by a factor of about 4; I can't imagine what a doctor's office would have to go through. Well I'm sorry to hear that sir. I have to enter the old ICD-9 codes in our EMR (why I ended up with that task I am going to have to re-approach now that we're bigger) and I'm supposed to start learning these new ones soon.. The problem with ICD-* is actually quite simple. Origin of the problem: Mumps. Mumps was widely spread(like manure) in health care, and remains widely spread to this day. Mumps has informed the thinking of practically every health care person(and yeah, most don't know it). Mumps is a hierarchical database, a B-tree, etc. Hierarchical approaches are crap. Largely because they don't allow for multi-node properties, and, nothing can be transitive. Hence, if I want to describe a pizza in ICD-9, I have: 1. Pizza 1.1 Dough 1.2 Cheese 1.2.1 Mozarella 1.2.2 Ricotta 1.3 Pepperoni This is great if you are moron, and work at a pizza place that buys everything from SYSCO, has 2 employees, and is a cash business. The real, not "it's 1979 and Mumps is the best!", world needs to look at pizza in more than a "what do i do first" way. It may look at pizza in terms of "toppings", but, it could also look at pizza in terms of "things I buy from company X". ( I use 2 different doughs, one from company X, one from company Y, and also 3 different cheeses from 3 different suppliers, etc.). But instead of being able to attach that info, I have to make a subnode, just like I did to show different kinds of cheeses. The effect of the problem: if you notice above the way I've laid out my data means I only get the, moronic, "what do I do first" look. ICD-* dopiness is that in order to add the classifications, or properties that I need in order to supply the other looks, the answer always is: add a new code. This is an inifinitely stupid thing for health care, as the classification of different diseases NEVER breaks down in a single, uniform manner, however, the premise of a hierarchical data structure requires that. We need to be able to look at diseases in more than 1 way. In one case, because one disease/condition can cause another. The only way to represent the exact same disease, one "free standing", one caused by another? 2 different ICD-* codes. Clearly that is patently ridiculous. It's the same damn disease. Ask yourself: do we treat that disease differently? You say "sometimes"? Yeah, and what is the solution there? More ICD-* codes! Most importantly, we need to be able to look at diseases in terms of "WTF are we going to do about it, given that there may/not be other diseases present", and ICD-* fails miserably in terms of functional thought/care/whatever. There are a lot more examples, but, I say again: ICD-* is what happens when you let the unqualified do my job. The only reason ICD is the way it is? Mumps thinking, left over from the late 70s early 80s, and there's really no reason to keep it around. NOTE: This is not an endorsement for doing this in a relational model either, so sorry Tom, your 3rd normal form, MS_Access experience is useless here as well. Diseases do not lend themselves SQL structure, and nobody wants to put up with doing the joins/many to many tables required to make that happen either. This is probably part of the excuse as to why ICD is still in the horrible state that it is. Solution to the problem: Look at HL7. THEY have got something going on...finally. They think in terms of objects/properties. ICD could easily be fixed if they used HL7's approach. However, HL7 also has many design flaws. We have a better design for all of it. But, we have to do other stuff first. Meaningful use is our first exploit.... Edited March 31, 2014 by OCinBuffalo Link to comment Share on other sites More sharing options...
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