Weight Loss Tips and Articles

On an October Tuesday, Randolph, Mass., family physician Carmel Kelly, MD, was examining an elderly patient who became ill and needed to be transported to the hospital immediately. When emergency technicians arrived, Dr. Kelly handed over a summary of the patient's vitals, her most recent test results and her medical history, all printed out with the click of a button. For the next few hours, Dr. Kelly checked in on the patient, kept track of all tests and received results without leaving her practice.

Had this emergency happened four days earlier, it would have been a completely different scenario.

This seamless coordination of care is what Beth Israel Deaconess Medical Center in Boston had in mind when it made the $20 million decision to subsidize the implementation of electronic health records for its 1,300 affiliated physicians, including Dr. Kelly, who had just gone live four days before the emergency.

"The report [delivered from the EMTs to the emergency physicians] was clear, concise and complete. There were elements that were immediately useful. In that sense, [four days before] I had nothing equivalent," Dr. Kelly said. "That was exciting."

But Beth Israel Deaconess Medical Center is one of the few hospital groups taking advantage of new exceptions to the Stark laws and safe harbors to anti-kickback rules that paved the way for hospitals to help physicians implement health IT. The exceptions are scheduled to expire in 2013.

[...]

The end may be near for the nearly two-year wrangling over the merger of two large nonprofit health plans in Pennsylvania.

With its deadline having passed for the public to submit comments on the proposed Highmark-Independence Blue Cross merger, the Pennsylvania Insurance Commissioner's office says it expects to give, or not give, its blessing by Jan. 27, 2009.

Between now and then, Pennsylvania legislators will have their chance to weigh in one final time, and the commissioner's office will review public and lawmaker comments as it considers the merger, which was first announced on March 28, 2007.

Independence, based in Philadelphia, and Highmark, based in Pittsburgh, want to combine to create a Blues plan with an estimated 8 million members and $23 billion in annual revenue.

The combined company would be the third-largest Blues plan in the country by membership.

The U.S. Justice Dept. has given the merger the go-ahead, leaving final approval to Pennsylvania Insurance Commissioner Joel Ario.

After hosting a series of hearings this summer and receiving hundreds of pages of public comment, the department cut off the official public comment period Oct. 14.

In a note submitted that day, Henry Allen, senior attorney for the American Medical Association's Private Sector Advocacy unit, argued that the merger should be blocked based on the negative impact on potential competition. The letter was written in response to a request from Ario after Allen's testimony on behalf of the AMA at the Philadelphia public hearing.

[...]

As nonprofit health plans holding billions of dollars in surplus ask regulators to help them, some in organized medicine have joined the call for those insurers to at least account for why their reserves need to be so high.

"They've had certain nonprofit tax exemptions, they've been allowed to accumulate money, and we feel some of this money could be put to better use for the public," said Michael Sandler, MD, president of the Michigan State Medical Society.

Michigan is among the states where the debate has been especially heated because health plans have made requests to state government to help them out. While Michigan plans have sought favorable insurance regulations, plans in Pennsylvania have asked for permission to merge and New Jersey plans have sought permission to convert to for-profit status.

Opponents of those proposals, including doctors' organizations, have pointed to these plans' multibillion-dollar reserves as evidence that they aren't working in the public interest and don't need government help.

Goldman Sachs health care industry analyst Matthew Borsch estimates the 30 largest nonprofit Blues have a collective $37.5 billion in reserves, $20.3 billion higher than required by the BlueCross BlueShield Assn. According to state filings compiled by Borsch, those 30 Blues plans more than doubled reserves from $16 billion in 2002 to $36.2 billion in 2007.

"Surplus builds up, in part, because reimbursement to physicians falls," said William Custer, PhD, director of the Center for Health Services Research at Georgia State University. But "if you try to squeeze the insurer too much, they may not be able to stay in business."

[...]

Two days after Hurricane Gustav stormed through Louisiana, Col. Stephen Ulrich, MD, was at a National Guard base in Columbus, Ohio, wearing camouflage and flooded with paperwork. As the state surgeon for the Ohio guard, he got a call-up to review the medical records of 1,500 soldiers who would be helping with relief duties.

Meanwhile, about 55 miles east, the five other physicians in Dr. Ulrich's family practice were trying to conduct business as usual in their Zanesville and New Lexington, Ohio, offices. But first there was some scrambling to make sure Dr. Ulrich's patients were seen.

That wasn't a new challenge for this practice. Dr. Ulrich has been called away twice before -- once for three months, once for six. He served as a flight surgeon in Balad, Iraq, flying with aircraft crews, doing clinical work and flight physicals, and being "just a regular doctor."

Tours of duty can take a toll, not just on doctors going to the war zone but also on those left behind. Both groups must work together to adequately plan for the absence and notify insurers, affiliated hospitals and others.

The emotional stress also extends to both groups. "You listen to the news and just pray he's not in danger. We say a lot of prayers around here when he's gone," said Melody Field, a nurse practitioner for Dr. Ulrich.

This time, Dr. Ulrich spent only a few days in Columbus. As the soldiers left for Louisiana, he was back in his office.

When the National Guard calls a physician to duty in the Middle East, it provides several months' notice to allow for working out a plan for the practice, contacting patients and making arrangements, said Maj. Randall Short, a Guard spokesman.

[...]

You might find your electronic medical record to be an efficient way to store patient data, but is that record legal? If it were subpoenaed, would it help you or hurt you in court?

These kinds of questions are emerging as more physicians go electronic. Federal Rules of Civil Procedure, approved by the U.S. Supreme Court in December 2006, not only make any electronically stored data discoverable in a trial, but also open up physicians to several new liabilities inherent in the detail electronic data provides.

For example, if a nurse records information under your login and password, and that information is incorrect, you could be the one held liable. Or the record's metadata -- the time stamp of who entered what when -- can dispute a doctor's version of events.

While EMRs are touted as a way to make life easier for physicians, health IT and legal professionals say they can make life miserable for a doctor who buys the wrong system, or uses it in the wrong way.

"Where these issues can raise their heads is somewhat unpredictable," said Reed Gelzer, MD, co-founder of Advocates for Documentation Integrity and Compliance, an advocacy and consulting group that educates physicians and health care entities on the legal EMR.

Dr. Gelzer said electronic records can save you when the record-keeping combines with the metadata to provide an accurate picture. But, as some recent cases of snooping hospital employees have proven, EMRs can also detect when someone violates HIPAA. And, just because an EMR creates something that looks like a medical record doesn't mean that document fits the legal definition of a medical record.

[...]