Utilizing the $1.4 Trillion Information Technology Industry

To Transform the $1.7 Trillion HealthCare Industry

 HPUSA Quarterly, Vol IV, No 1, April 2005

Thank You for Joining the Medical/Professional/Business/InfoTech Gatherings of MedicalTuesdays on the First Tuesday of Each Quarter. We Review the Problems Encountered with the Private and Government Health Plans Here and Abroad and the Ideal HealthPlan for the USA, and by Extension for All Countries.

We will shortly have the enroll and remove features reinstalled on our website and added to this newsletter. We thank you for your patience in the interim. If you were inappropriately referred to us or would like to be removed from this list, please send a email to DelMeyer@HealthPlanUSA.net.

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In This Issue:
1.     Our Purpose: Health Care and MedInfo Tech in the Twenty-First Century
2.     How to Design a Place in Which to Think - Simple Answers are Often Overlooked
3.     Unlimited Thinking Cannot Occur Outside the Laboratory
4.     Thinking Can Occur in Laboratories Outside the Ivory and Glass Towers
5.     Laugh and the World Laughs with You, Snore and You Sleep Alone
6.     Overheard on Capital Hill: Medicare Bankrupting Social Security
7.     Medical Grand Rounds - Physicians at the Forefront of HealthCare
8.     What's New in US Health Care - Physicians and Hospital Cooperation

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1. Our Purpose: Health Care and MedInfo Tech in the Twenty-First Century

History suggests that a sustained period of growth is about to begin for the $1.4 trillion information technology industry. The rewards will not be shared equally. As in the past, they will flow to those enterprises that can turn disruptive shifts to their client’s advantage.

MedInfo Technology is a significant part of the greater IT industry. HPUSA will be a different kind of company utilizing MedInfoTech to provide the most focused patient health care at the lowest cost, reducing the spiraling per capita health care costs for the first time in four decades. It will focus on the prime reason for the existence of our industry, the patient seeking medical care, by bringing the health care provider, the insurance carrier and the financial institutions together on the same internet interface with the patient at the center. This digital interface of all elements of health care also produces an electronic medical record without any government intrusion into our personal medical data or insurance carrier control of our medical care. This innovation will even give patients control over which doctor or health care provider can access their confidential medical information and personal data and exclude all others.

Widespread dissemination of our Personal Health Information (PHI) promulgated by the Health Information Privacy and Accountability Act (HIPAA) gives Medicare, Medicaid,and Health Maintenance Organizations (HMO) the right to copy any confidential file without patient disclosure. Once it's in the Federal Government computers, many of the four million federal employees will have access to our PHI. Since social security medical records are shared with the State Governments, many of the 18 million state workers will have access to our PHI.

Is all this just an unfounded alarmist attitude? Just last month, many of the 400 physicians offices on the street across from my hospital were visited by a Medicare/HMO contracting organization that brought  large xerox machines and spent a half day or more copying as many as forty medical records per office. The notice stated that we should not notify the patients since HIPAA gave them the right to this confidential data.

HPUSA is committed to protecting our patient's Personal Health Information from this intrusion.

 Welcome to an exciting innovative journey into our future.

 But where will all this thinking of a new health care design take place?

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2. How to Design a Place in Which to Think - Simple Answers are Often Overlooked

Duff McDonald reports in a recent issue of WIRED Magazine about the headquarters of the Perimeter Institute for Theoretical Physics in Waterloo, Ontario. The 65,000-square-foot complex of glass with a soaring atrium, multiple fireplaces, a bistro, a squash court, and a 205-seat auditorium for lectures and string quartet performances looks more like a resort than a think tank where some of the smartest people in the world are contemplating the foundations of quantum physics. As the architect puts it, it answers the question, How do you design a place in which to think? http://perimeterinstitute.com/about/researchinteractions.php

With more than $120 million endowment, that kind of cash can set a group of physicists free from the distractions that get in the way of scientific progress, like teaching and grading papers. With a management philosophy that rejects the bureaucracy of the big university, you're sending ripples through the fabric of research. Of course, like all efforts to advance physics, Perimeter runs the risk of abject failure. Lee Smolin, the archetypal Perimeter researcher feels that Perimeter is better than the world's greatest physics locales. But sometimes the most challenging scientific problem might be the simplest of ideas. He recalls that the Institute for Advanced Study in Princeton is a great place with a beautiful lunchroom with long tables. But one of their professors observed that for more than 30 years, the particle physicists have been eating at the same table, the astrophysicists at another, and the mathematicians at a third. So to get the scientists to talk to each other, they eliminated long tables. Simple answers of how to think outside of your own box can be overlooked for 30 years! To read the entire story, go to http://www.healthplanusa.net/BlackBerryBrainTrust.htm.

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3. Unlimited Thinking Cannot Occur Outside the Laboratory

The same challenges occur in medicine. Hospital administrators meet with other health-care executives to work on their mutual problems and concerns. Insurance carriers meet with actuaries and MBAs to see how they can define health-care benefits that can predict the unpredictable such as illnesses. Nurses are meeting with nursing administrators about how to improve the care for their patients, while working around the restrictions placed upon them. Physicians are meeting with other physicians in their same specialty about how to advance their cause for the ultimate level in their subspecialty, with little concern for the other team members who maybe engaging in turf battles. Patients, for whom all this activity is directed, are totally out of the loop. In fact, a recent resident of the White House mentioned that patients surely are not informed well enough to make their own health care decisions.

A physician may spend an hour in the initial medical interview and physical examination to learn enough about a patient to understand his or her problem in order to begin appropriate treatment. That the government, insurance carriers and administrators make the patient’s medical decision is so ludicrous if it weren't so tragic. As the planners of the Perimeter Institute for Theoretical Physics understood - innovative thinking cannot occur outside the working laboratory. In Health Care, the laboratory is the patient, with the doctor and nurse at the bedside, who, along with the technical support staff of the twenty or so allied health specialties and administrative staff, bring all their faculties to bear to make an appropriate medical decision for the patient. In our aging population, this is performed in conjunction with the family in order to serve in the best interest of the patient for whom we all toil.

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4.  Thinking Can Occur in Laboratories Outside of the Ivory and Glass Towers

Some of the greatest thinking has occurred in very simple places. William R. Hewlett and David Packard started their business from a research laboratory in a garage, eventually becoming Silicon Valley's first major start-up company. HP also became Silicon Valley's defining partnership and the nation's thirteenth largest business. http://www.hp.com. AriadneCapital, a Global Investment & Advisory Firm, http://www.ariadnecapital.com, developed its international presence and was launched from the CEO's flat in London. MedicalTuesday, an international network of Physicians, Business and HealthCare professionals along with the InfoTech community, http://www.MedicalTuesday.net, was planned and launched from a medical office in Carmichael, California, with more than 20,000 physicians and 3,000 health care professionals on their mailing list.

HPUSA, http://www.HealthPlanUSA.net, is being developed and launched from the health care laboratory of our medical practice in Carmichael also. A small diverse group is gathering every week to evaluate all aspects of health care, with a single focus on the patient's perspective and interface with the insurance carrier, the financial institution and the various health care providers such as hospitals, physicians, nurses and allied health specialties. Just as the origin of MedicalTuesday has a long tradition of professional gatherings on Tuesdays, this dynamic gathering is also occurring every Tuesday evening.

In HealthCare It Doesn't Matter if You're in the Majority

It Only Matters if You Help Patients

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5. Laugh and the World Laughs with You, Snore and You Sleep Alone

March 28 - April 4, 2005 is designated as "Sleep Awareness Week" by the National Sleep Foundation. Dr Jim Murtagh urges all of us to consider the profound impact that sleep disorders have on 40 million Americans. Murtagh, a Pulmonary Specialist who for over the past ten years has become fascinated by the new specialty of Sleep Medicine, is the author of an upcoming novel on huge human problems arising from sleep apnea. http://www.HealthCareCom.net/JM_Profile.htm

Eye-popping studies released by the National Sleep Foundation (NSF) this week shows that sleep disorders contribute to dozens of major diseases. Half of Americans are so sleepy their work, their relationships and happiness are impaired. Sleep disorders have been found to cause more traffic accidents than alcohol. Sleep disorders are usually overlooked, with devastating consequences. Sleep disorders are like the elephant in the middle of the medical living room, ignored, but huge, and not going away anytime soon.

Murtagh states that many national major disasters, including the Exxon Valdez and Challenger, can be traced to sleep disorders.  Maybe "Mothers against drunk driving" need to change their focus to "Mothers against drunk and sleepy driving." If any disease shows that no man is an island, sleep disorders surely do. The average sleep-apnea-induced truck disaster kills 4.2 persons. Friends cannot allow friends to drive sleepy.

There are seven simple questions you can ask to assess your risk of a sleep disorder. Take the simple test at http://www.stanford.edu/~dement/epworth.html. To read Dr Murtagh's entire article, go to http://www.healthcarecom.net/JM_Sleep.htm.

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6. Overheard on Capital Hill: Medicare Bankrupting Social Security

Thomas R. Saving, a member of the Board of Trustees of the Social Security and Medicare Trust Funds, says the critics who say President Bush has "manufactured a crisis" so that he can introduce personal accounts into the social security system that is already solvent, and will be so for decades to come, are confecting an alternate reality.

While it is true that Social Security is currently running a surplus, Medicare is running an even bigger deficit. One way to think about this is to realize that Social Security's extra revenues are being used to cover Medicare's shortfalls, and even that is not enough. This year, for the first time in more than two decades, the combined deficit in Social Security and Medicare will require almost 4 percent of federal income-tax revenues. That figure will double in the next five years and double again in the five years after. Ten years from now, the federal government will need one in every seven income-tax dollars to pay benefits, assuming no increase in taxes. By 2020, entitlements for the elderly will consume one in four income-tax dollars. By 2030 they'll consume one of every two. To put that in perspective, in less than 30 years, the federal government will have to cut programs paid for by federal income taxes in half.

There is no saving and no investment. As a result, each generation pays taxes, not to fund its own benefits, but to finance the benefits of the previous generation. When today's workers retire, they will have to depend on future workers' willingness to pay much higher taxes if their benefits are to be paid.

To read the entire editorial, go to http://online.wsj.com/article_print/0,,SB111033492294974307,00.html.

To read a related article by Matt Moore, who estimates that by 2070, almost all federal income tax revenues will be needed to provide full promised Social Security and Medicare benefits, go to http://www.ncpa.org/pub/ba/ba510/.

Should the next generation of workers decide not to pay the current generation of retirees, all benefits could cease instantly. The need to have personal retirement accounts has never been more urgent. Remember, Chile tripled their social security benefits when they privatized social security.

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7. Medical Grand Rounds - Physicians at the Forefront of HealthCare

Medicine is much more complicated than practice guidelines or evidence-based medicine. The hallmark of American Medicine, often overlooked, is the judicious blend of medical advances and clinical judgement. The premier conference for physicians is the Medical Grands (or Surgical, or Pediatric Grand Rounds). This is where the world’s most sterling professors come across the stage every week as the ultimate prestigious faculty to present the latest in every field of Medicine.

Last week, the Chief of Cardiology presented the department’s latest data on doing Mitral Valvuloplasties with a coronary catheter through the coronary sinus. Last year, the Chief of Cardiology presented his data on doing coronary artery bypass grafts (CABG) by a similar route. Doing cardiac repair in the cath laboratory rather than via open heart surgery in the operating room sends reverberations through the surgical faculty and the hospital administration. Although these medical procedures greatly benefit patients, the possibility of losing two high revenue and important surgical procedures will require major adjustments by both surgeons and hospitals.

The challenge is for all elements of the health-care team to work together for the best patient benefit, not only medically, but also including the financial efficiencies. When surgeons devised the laparoscopic cholecystectomy a few years ago, reducing the hospital stay from five days to one day, doctors just assumed this would reduce hospital costs. Thus, they were surprised that the one-day stay cost twice as much as the five-day stay. The biggest surprise is that insurance carriers bought the subterfuge and paid it. Doctors did not find out that their efficiencies did not accrue to the patient until a patient brought in his courtesy statement as a concerned citizen.

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8. What's New in US Health Care - Physicians and Hospital Cooperation

Robert A. McGowan reports in the April 2005 issue of Healthcare Informatics on why Doctors and Hospitals need stronger alignment.

Physicians and hospitals face difficult problems that challenge their relationship. Low reimbursement rates and increased operating costs resulting in lower margins are just the beginning. Emergency departments are overflowing--patients wait hours for care and physicians increasingly refuse to take ER calls or insist on payment if they do. Quality and patient safety issues strain relationships between physicians and between physicians and hospitals. Staff shortages affect the quality of care. Inadequate information systems keep staff waiting for test results. Overworked, underpaid physicians seek new revenue sources by competing with hospital ancillary services and joint-venturing with for-profit enterprises to create niche services and specialty hospitals.

In 2003, a colleague and McGowan completed a study of hospitals and healthcare systems in five New England states (see "Alignment Efforts Revealed" on page 42 of the reference below). Findings indicate that effective, active physician participation in strategic decision making is one of the most critical elements involved in developing positive physician-hospital relationships. It is especially important that physicians have the opportunity to provide proactive leadership in development of strategies for shaping major clinical services. The hospitals reported that certain methods help enhance physician-hospital relationships.
To read the whole article go to http://www.healthcare-informatics.com/issues/2005/04_05/mcgowan.htm.

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URL References for your perusal or study at leisure. You may want to Bookmark these or add to your Favorites. Become knowledgeable about health care matters and political perspectives, and make one hour every Tuesday your MedicalTuesday.

Archives: MedicalTuesday
For MedicalTuesday Archives, see http://www.medicaltuesday.net/index.aspx

Archives: HealthPlanUSA Quarterly Newsletters
HealthPlanUSA Intro  http://www.healthplanusa.net/NewsLetterIntro.htm

Other Articles on Health Care Issues
Medical News Headlines:   http://www.healthplanusa.net/MedicalNews.htm
Single-Payer Initiatives:    http://www.healthcarecom.net/EditorialNov94.html
Single Payer:    http://www.healthplanusa.net/DGSinglePayer.htm
Why are the uninsured, uninsured: http://www.healthplanusa.net/DGUninsured.htm
What’s behind health care costs: http://www.healthplanusa.net/DGRisingHealthCareCosts.htm
Pharmacy costs:    http://www.healthplanusa.net/DGPharmacyCosts.htm
Del Meyer

Del Meyer, MD, CEO & Founder
HealthPlanUSA, LLC
6620 Coyle Ave, Ste 122, Carmichael, CA 95608

 Words of Wisdom

Government is the great fiction, through which everybody endeavors to live at the expense of everybody else.    – Frederic Bastiat, French political economist, (1801-1850) Essays on Political Economy, 1846.

Well done is better than well said. Benjamin Franklin, Poor Richard's Almanac,1737

Health is not valued till sickness comes. - Thomas Fuller, Gnomologia, 1732

 Some Recent Postings

James Murtagh, MD: “Million Dollar Baby” Deserves An Oscar – But The Medical Ethics Debate Has Gone Off The Track at http://www.healthcarecom.net/JM_MillionDollarBabyReview.htm.
National sleep emergency must be confronted at http://www.healthcarecom.net/JM_Sleep.htm.

 This Month in History

Our Theme for This Month in History - April - Is HealthCare.

April is an important month to reflect on our health, health care for our families, and getting enough sleep in order to function.

April showers may bring May flowers, but most Americans are too busy worrying about their taxes to stop and smell the daffodils, tulips, lilies and hyacinths, the most popular blossoms of spring.