March 30, 2011
Merritt Hawkins, a physician recruitment firm, is out with its annual salary survey. Once again, orthopedic surgeons top the list, followed by cardiologists. The top five in salary are
1. Orthopedic surgery: $519,000
2. Cardiology (invasive): $495,000
3. Cardiology (non-invasive): $420,000
4. Gastroenterology: $411,000
5. Anesthesiology: $331,000
You can obtain the report here: http://www.merritthawkins.com/compensation-surveys.aspx
These salaries reflect the hospital marketplace. These physicians can perform many procedures in a day and generate a lot of revenue for the hospital; much more than a pediatrician ($180,000).
At first glance, $519,000 sounds like a lot to pay a physician, but consider what some hospital administrators are making. The Los Angeles Times reported earlier this week that “Three hospital district executives have emerged as among the highest-paid public employees in California.”
The highest paid public employee in California is Palomar Pomerado Hospital District CEO Michael Covert who made $1.2 million in 2009. The second highest paid that year was Nancy Farber, CEO of Washington Township Health Care District in Fremont with $874,000.
The LA Times article is here
March 28, 2011
The New York Times reported yesterday on an interesting new product that could have many used in health care technology. The article, in the Sunday Business section, reported on a new laptop computer with eye-tracking cameras that enables a user to call-up and scroll through different documents simply by moving his eyes.
For the full article http://www.nytimes.com/2011/03/27/business/27novel.html?ref=portablecomputers
As the Times reports, “Just look at a particular location on the screen, and the cursor goes there instantly, ready for you to open a folder or to send an e-mail (at which point you need to use old-fashioned keys).”
The new computers were developed by Tobii Technology of Sweden and Lenovo. The two companies have built 20 prototypes so far.
One computer scientist from Queens University in Ontario, Canada said the new technology could cut in half the time needed for many chores. For example, when people are working on several screens, any of which can be activated with a glance, it could speed up interactions by a factor of two.
Spokesmen for Tobii and Lenovo said the technology wouldn’t be available in stores for at least two years.
March 23, 2011
Self-service kiosks have become ubiquitous in the banking, hotel and airline industries, but you rarely see them in medical facilities. A new article in eWeek says they are gaining popularity and “challenging the traditional roles of administrative clerks, sign-in sheets, payment-collection lines and paperwork in medical offices.”
The article includes a slide show with photos of units from CTS, Phreesia and SoloHealth.
The report notes that check-in kiosks allow patients to enter personal info including names and addresses, answer questions about their medical histories, verify insurance information, schedule appointments, perform signature capture and take payments.
CTS said its Patient Passport Express “achieved 5 million check-ins from 2007 – 10.”
The kiosks come in various shapes and sizes, including traditional stand-up units and a wireless tablet (Phreesia).
I have mixed feelings about kiosks. I have used them many times to check-in at airports, but when I tried to make purchases at Home Depot with a kiosk, I could not get it to work and a clerk had to help me.
March 21, 2011
A new study by the Commonwealth Fund finds that nine out of 10 people surveyed said they want all of their healthcare information made available to all healthcare providers involved in their care.
Karen Davis, president of the Commonwealth Fund, who spoke Monday at the opening session of the American College of Healthcare Executives Congress, said the finding runs contrary to the position of many privacy advocates who argue that patients want to release personal medical information at their discretion to only the providers involved in a specific episode.
For more information about the Fund and its work, see http://www.commonwealthfund.org
I think if you were to survey people about sharing health data with their employer or their insurance company, you would get a different result. Naturally, they want to obtain the best possible medical care and they probably believe that having their data open to providers associated with their care furthers that end. Other surveys have shown people don’t want to share medical information with their health insurer, for fear it will increase their premiums.
In general, I think the public has a poor understanding of how much of their medical information is already available to employers and life/health insurers. There is a lot of data available for those who can find it or pay the proper agencies for it. It roughly follows the model set for financial information. For $25, you can buy a credit report on virtually any adult American that will give you a complete picture of their salary, savings, debts and creditors. There are similar services available for obtaining individual health information, such as the Medical Information Bureau.
March 18, 2011
As part of the ARRA health technology legislation, the feds authorized creation of RECs (regional extension centers), local organizations to help solo practitioners and small med groups select, purchase and install EHRs.
Since spring 2010, more than 50,000 providers have signed up with RECs nationwide, according to the Office of the National Coordinator (ONC) for Health Information Technology. Earlier this year, ONC extended the timelines of RECs’ cooperative agreements, giving them four years over which to attain their goals. Initially RECs had two years of 90/10 federal matching funding. Now that match has been extended to years three and four.
The nation’s largest REC, the California Health Information Partnership and Services Organization (CalHipso), said that more than 3,800 providers have enrolled to date, and seven hospitals have signed up for the rural hospital supplemental funding program.
Most RECs negotiate group contracts with vendors. In theory, the RECs are conducting due diligence on vendors and presenting providers in their service area with a list of finalist candidates. The idea is to significantly speed the vendor selection process as physicians adopt EHRs on a fast-track.
For example, in Georgia, the local REC selected eClinicalWorks, e-MDs, Greenway Medical Technologies, Medical Informatics Engineering and NextGen Healthcare Information Systems.
Smaller EHR vendors complain that REC officials (some of whom come from vendor companies) turn to vendors they have worked with in the past or fall prey to aggressive salespeople from large companies. As a result, smaller EHR vendors often don’t get to compete for the final “approved” list of some RECs.
On the other hand, with 300+ EHR vendors, a selection process that included every conceivable vendor could take years.
March 13, 2011
The federal HIT incentive funds are being used by providers to purchase first-time EHRs and to replace existing ones, according to a new KLAS survey.
KLAS surveyed some 400 provider organizations that were buying an ambulatory EHR system. Of this group, 35% were replacing an existing system. According to KLAS executives, some of these replacement buyers owned “ancient technology,” while others were ditching practically brand-new systems.
The company’s report notes that providers traditionally are reluctant to retire their EHR or practice management systems, even when vendors are no longer supporting them. The KLAS report calls the new, widespread technology replacement a “purge” due to the availability of the current EHR incentive program.
Remember the “cash for clunkers” program in 2009? That cost $3 billion and resulted in some 700,000 new car purchases.
Perhaps we should call the HIT incentive program “cash for EHR clunkers.”
March 8, 2011
Should every patient being admitted to the hospital undergo whole-genome sequencing (having his entire DNA code analyzed)?
We are a step closer to that with a new program underway at the Medical College of Wisconsin. Researchers at the college are making the DNA analysis a standard part of diagnostic testing for children with rare inherited disorders not easily diagnosed by traditional methods.
The story is reported in the MIT Technology Review, http://www.technologyreview.com/biomedicine/35068/?nlid=4212&a=f
The Wisconsin researchers point out that children with rare diseases often go through a series of tests, each of which search one or a few genes for the mutation causing the disease. Thus, an initial whole-genome sequencing can actually cost payers less. At least one insurance company has agreed to pay for the new DNA code analysis.
The time it takes to analyze a genome, a factor in cost, has dropped from a few months to a few weeks. Researchers say they expect to analyze about 20 genomes this year and 100 next year.
What about the ethical question of whether scientists should reveal genetic mutations that don’t underlie the disease at hand but might put the patient at particular risk for other disorders later in life? Currently, the Wisconsin team specifically asks families what they want to know from the genome sequence. They can change their minds at any time.
This is an amazing development and is certainly good news for families of children with these rare diseases. It also explains why pharmaceutical companies have been investing so heavily in genetic research and development.
March 6, 2011
The online news outlet Politico had a brief story on Friday reporting that Senate Democrats have given up on confirming Don Berwick as CMS administrator in the wake of a letter from 42 Republican senators opposing the nomination.
The full story is here http://www.politico.com/news/stories/0311/50698.html
Apparently, Dr. Berwick’s big mistake was haven spoken favorably about Britain’s National Health System in speeches several years ago. He said a word nobody likes to use in the U.S., “rationing.”
Dr. Berwick’s nomination had been supported by the American Medical Association. Prior to being named head of CMS (in a recess appointment) by President Obama, he served as Clinical Professor of Pediatrics and Health Care Policy in the Department of Pediatrics at the Harvard Medical School and Professor of Health Policy and Management at the Harvard School of Public Health.
President Obama will have to find someone else to nominate, someone who is more politically savvy and will say all the right things about our amazing U.S. health care system, which manages to be the most expensive in the world yet ranks below every European country when it comes to infant mortality and other public health statistics.
March 1, 2011
Surescripts and AAFP will launch new nationwide service for clinical information exchange. The new service, Physicians Direct, will enable physicians to message each other securely online using SMTP (basic email protocol). They will be able to attach referrals, care summaries, discharge summaries, lab results, and other data pertinent to patient care.
This is the largest independent HIE (health information exchange) endeavor announced to date. The announcement, made just two days before HIMSS, did not get the media attention it deserved.
AAFP’s 75,000 members will be able to use Surescripts for electronic prescribing free of charge, however, they will have to pay $15 monthly each to use the Physicians Direct service. That charge will cover unlimited use of the service.
Non AAFP physicians will be able to subscribe to the service for a separate fee. A number of EHR vendors including Amazing Charts, e-MDs and SOAPware, have announced that they will link their EHR systems to the Surescripts network and participate in the program.
For more information see the FierceHealthIT article: http://www.fiercehealthit.com/story/surescripts-aafp-launch-secure-clinical-messaging-service-doctors/2011-02-15