Sunday, June 2, 2013

‘Smart’ pillbox can talk to patients, medical centers

According to the American Heart Association, the top problem in treating illness today is getting people to take their medication in the right way. About half of prescription drugs are not taken as prescribed, and in the United States it’s estimated that 10 percent (30 percent in the over-65 group) of all hospital admissions result from noncompliance.
This is a niche that new Israeli technology company Vaica aims to address with a programmable “smart” pillbox that can be filled by hand or preloaded at the pharmacy.
Vaica’s SimpleMed is a cloud-communicating device that can be programmed for seven days a week, at four intervals throughout the day. It sends flashing light and sound reminders when a pill needs to be taken, and if desired can alert primary caregivers or the Vaica call center when a pill is skipped. After a slot has been opened and the contents removed, the pill is registered as taken.
When paired with other Bluetooth-enabled devices such as glucose-, weight- or heart-rate monitors, SimpleMed can help manage healthcare from home, giving people extended levels of independence and an improved quality of life.
“Medication compliance is the center of healthcare management,” says Vaica CEO Gil Margalit.
“All of a patient’s vital signs can now be cross-referenced and compared to their medical records, letting doctors intervene before a patient’s health deteriorates,” he says.
The SmartMed screen can be programmed to deliver customized messages to patients in need of special reminders:  “Take me after a meal” or “with water” can be especially useful for people who might be taking five, 10 or 15 pills a day. The device can also be used as a two-way communication system to alert the call center of a medical emergency.
There are other automated pill dispensers on the market, but none as straightforward to use and as “connected,” asserts Margalit, who notes that the user can choose to have the Vaica call center manage all the details remotely.
Vaica’s platform has been chosen by McGill University in Canada to assure medical compliance in a six-center North American clinical trial on children’s kidney disease..
In one clinical study in Israel, compliance among chronic heart failure patients jumped from about 70 percent to more than 95 percent when SmartMed was introduced, according to Margalit.

Cerner Achievement and Innovation Awards 2013 recognize excellence in adopting health care IT technology in the Middle East

Cerner, a developer of information management systems geared towards health care, recently announced the winners of the Cerner Achievement & Innovation Awards 2013, during a gala awards ceremony at The Address Hotel Marina in Dubai.

Attended by more than 150 of the region's leading health care professionals, the Cerner Achievement & Innovation Awards honored clients that have effectively delivered quality solutions across four different categories.

Abu Dhabi Health Services Company PJSC (SEHA) led the 2013 awardees after it was selected for Achievement & Innovation in Patient Care Delivery, Achievement & Innovation in Patient Care Delivery in Departmental Experience, and Achievement & Innovation in Physician Experience.

SEHA received the Patient Care Delivery award after successfully developing a fully mobile clinic to go to schools, rural areas, national screening and major events in Abu Dhabi.

SEHA was recognized in the Patient Care Delivery in Departmental Experience category after it successfully linked the Cerner Millennium electronic health record to the Health Authority of Abu Dhabi (HAAD) to automate the process of reporting all injuries and poisonings through a stand-alone database.

SEHA received the Physician Experience award when it leveraged the core Cerner Millennium toolset to create a custom reporting system targeted at the Dental services area, allowing the service line to be fully integrated into the main electronic health record.

King Faisal Specialist Hospital & Research Centre in Saudi Arabia was also selected for Achievement & Innovation in Patient Care Delivery, having leveraged Cerner Millennium to automate and reduce the processing time for patient assistance requests from 6 weeks to just 5 to 10 minutes.

The UAE Ministry of Health was selected for Achievement & Innovation in Patient Care Delivery in Nursing Experience after successfully automating the process of producing the 24-Hour Ward Nursing Report using Cerner Millennium.

"Health care services are becoming more efficient and effective as health care institutions are actively taking advantage of state-of-the-art IT technologies. The Cerner Achievement & Innovation Awards clearly demonstrate this ongoing trend by showcasing the tremendous achievements of our clients in leveraging Cerner technology to improve patient care and automating various processes," said Mike Pomerance, vice president and general manager, Cerner Middle East.

"We believe that this initiative will help further improve the quality of health care services by establishing new benchmarks and highlighting the impact of technology in the delivery of basic health care."

The Second Cerner Achievement & Innovation Awards was celebrated during the two-day 2013 Regional User Group (RUG) Conference in Dubai, the annual Cerner event that gathers all of Cerner's clients across the Middle East region.

Seamless Medical Systems Raises $2 Million in Funding

Published 3:00 pm, Friday, May 31, 2013

Practicing Physicians invest in Innovator’s Patient Engagement Platform, SNAP® Practice
Santa Fe, NM (PRWEB) May 31, 2013

Patient engagement leader, Seamless Medical Systems today announced it has closed $2 million in early stage funding.
The financing will support Seamless Medical’s growth strategy in three main areas: integration of their patient engagement platform with leading electronic medical records companies, expanding market penetration and accelerating product innovation and future platform updates.
Seamless Medical investor Dr. Hala Toubbeh said, “Seamless is working to improve patient engagement throughout the entire care continuum, from registration to the exam room and then driving communication between patients and practices outside the office. I see no one else as focused on improving the patient experience like Seamless Medical is with SNAP® Practice.”
The investors to date have all been individuals, with one third of them being practicing physicians, who best understand the value SNAP® brings to improving the patient experience while enhancing practice efficiency.
Seamless Medical’s cloud-based, enterprise platform called SNAP® Practice is a leading technology that replaces the paper forms patients fill out in medical waiting rooms with an iPad. Digital registration is fast and easy with data wirelessly transmitted in real time to the front desk (reducing operations costs and wasteful workflow) and the practice electronic medical record. Patients keep SNAP® Practice after registration is complete and are provided customized health and wellness content from the Mayo Clinic to improve health literacy and compliance.
“We will open another round of funding this summer,” said David Perez, founder and CEO, Seamless Medical Systems. “This will help us expand our market reach in North America this year, as well as releasing SNAP® Practice software updates that include integrations with more EHR systems, forms and health content for additional medical specialties and a Spanish language version.”
About Seamless Medical Systems
Seamless Medical Systems LLC is the creator of the SNAP® Practice Patient Engagement Platform a cloud-based, enterprise solution with 3 components: 1. Digital patient data capture integrated with the EHR. 2. Health education personalized to each patient's demographics and health conditions to improve health literacy and compliance. 3. Communications for the practice to engage the patient outside the clinic to improve care plan adherence and customer loyalty.
For more information, please visit
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Trustees give Medicare a 2-year respite

WASHINGTON — Medicare’s long-term health is starting to look a little better, the government said Friday, but both Social Security and Medicare are still wobbling toward insolvency within two decades if Congress and the president don’t find a way to shore up the trust funds established to take care of older Americans.
Medicare’s giant fund for inpatient care will be exhausted in 2026, two years later than estimated last year, while Social Security’s projected insolvency in 2033 remains unchanged, the government reported.
An overall slowdown in health care spending is helping Medicare. Spending cuts in President Barack Obama’s health care law are also having a positive impact on the balance sheet, but they may prove politically unsustainable over the long run.
The relatively good news about two programs that provide a foundation of economic security for nearly every American family is a respite, not a free pass. Program trustees urged lawmakers anew to seize a current opportunity and make long-term changes to improve finances. Action now would be far less jarring than having to hit the brakes at the edge of a fiscal cliff.
Politically, however, Friday’s positive report and the absence of a crisis could make legislative action less likely, especially in light of the lack of trust between President Barack Obama and Republicans in Congress. No end is in sight for the partisan standoff over what to do about Social Security and Medicare, two of the government’s costliest programs, and the mammoth budget deficits they help fuel.
Still, fresh warnings were sounded.
“Under current law, both of these vitally important programs are on unsustainable paths,” said economist Robert D. Reischauer, one of two independent public trustees overseeing the annual reports.
The window for action “is in the process of closing even as we speak,” said his counterpart, Charles Blahous III, also a prominent economist.
Social Security provides monthly benefit checks to about 57 million people, including 40 million retirees and their dependents, 11 million disabled workers and dependents and 6 million survivors of deceased workers. Medicare covers nearly 51 million people, mainly retirees but also disabled workers.
If the funds ever become exhausted, the nation’s two biggest benefit programs would collect only enough money to pay partial benefits.
Social Security could cover only about 75 percent of benefits, while Medicare’s fund for hospital and nursing rehabilitation care could pay 87 percent of costs.
With 10,000 baby boomers turning 65 every day, America’s aging population is straining both programs.
While the combined Social Security fund was projected to be depleted in 2033, the trustees warned that the threat to one of its component trust funds that makes payments to workers on disability is much more urgent. They projected that the disability trust fund would deplete its reserves in just three years, in 2016. That date is unchanged from last year’s report.
Blahous said he hoped that would prod lawmakers to act on the broad challenges facing Social Security.
The remaining trustees are senior administration officials, including Treasury Secretary Jacob Lew and Health and Human Services Secretary Kathleen Sebelius. While acknowledging the need for long-term changes to improve program finances, they used the occasion of the annual report to assert that Obama’s policies are working, particularly his health care overhaul.
White House spokesman Josh Earnest saw validation in the reports, too. The Medicare numbers showed Obama’s health overhaul “is having a positive effect on the deficit,” he said, while the Social Security report supports the president’s contention that the retirement program is “not driving our short-term deficit.”
Motivation for both sides to tackle federal spending deficits —always risky because of the pain that could cause voters — has already declined because the improving economy has also pushed projected federal deficits downward. This year’s shortfall is now expected to be $642 billion, down from $1.1 trillion last year.
Obama has proposed significant changes to both benefit programs, in the context of budget talks. Those include a formula change that would pare cost-of-living increases for retirees, and nearly $400 billion in Medicare savings, mainly from cuts to service providers. Congressional Republicans want to do more, particularly on Medicare, by converting the program into a private insurance system.
Social Security is financed by a 6.2 percent tax on the first $113,700 of workers’ wages, paid by both employers and workers. Congress temporarily reduced the tax on workers to 4.2 percent for 2011 and 2012, though the program’s finances were being made whole through increased government borrowing.
The Medicare tax rate is 1.45 percent on all wages, paid by both employees and workers.
Blahous said if Social Security’s shortfall were to be fixed immediately by boosting the payroll tax alone, that rate for workers and employers together would have to be increased from its current 12.4 percent to nearly 15.1 percent. If action were delayed until 2033 — the year of insolvency — the tax would have to rise to 16.5 percent.
If the savings were to come only from reducing benefits and were made immediately, the benefits would have to be cut 16.5 percent for both current and future recipients.
Targeting future beneficiaries alone would mean benefit cuts of nearly 20 percent.
Waiting until 2033 to impose the changes would mean benefit cuts of 23 percent for current and future recipients. If policymakers wanted to limit the cuts to future beneficiaries, even wiping out all of their benefits would not close the shortfall, said Blahous.
“The window of opportunity to deal with Social Security closes well before the early 2030s,” he said.
Not all the news was bleak.
The trustees projected a 2 percent Social Security cost-of-living increase for 2014. And the monthly Medicare Part B premium for outpatient care was projected to remain the same as this year. That’s generally $104.90, although upper-income retirees pay more.
The good news for Medicare may not last. The program’s future costs are difficult to estimate, subject not only to economic fluctuations and the aging society but also to the impact of the latest blockbuster drug or technological breakthrough.
Nonetheless, the trustees said the overall slowdown in health care spending is providing relief for Medicare. It was the main reason for extending the life of the trust fund by two years. The report said there was a particularly sharp drop in spending on nursing home care. Medicare pays for limited nursing home stays while patients recuperate from hospitalization.
Also cited were reductions in payments to popular Medicare Advantage plans, the private insurance alternative within the program. About 1 in 4 Medicare beneficiaries are in such plans, which offer lower out-of-pocket costs usually in exchange for limitations on the choice of hospitals and doctors. The plans had once been overpaid when compared to the cost of care in traditional Medicare, but Obama’s health care law cut back those payments.
Public trustee Reischauer, who specializes in health care economics, said he’s hopeful and cautiously optimistic that the slowdown in health care costs will continue.
HHS Secretary Sebelius said the health care overhaul “has helped put Medicare on a more stable ground without eliminating a single guaranteed benefit.”
But the top Republican on the Senate Finance Committee, Utah Sen. Orrin Hatch, said the report “shouldn’t give anyone comfort” because Medicare’s slower spending reflected the country’s weak economy, even as the program faces rapidly growing numbers of recipients.
“Reforming Medicare and Social Security is a national imperative that policymakers on both sides of the aisle and at the White House must embrace if we are going to protect those programs for our seniors and for future generations, while simultaneously bringing down our sky-high debt,” Hatch said

AARP, the seniors lobby, said it will continue to fight cuts in either program.

Trustees give Medicare a 2-year respite - National News

Coding, Compliance and Sun Tzu Volume 1 - YouTube - Empirical Risk Management

Consumer-driven Healthcare Leads to Reform, Innovation

Even as the U.S. begins implementation of one of the most comprehensive healthcare policies ever passed, Regina Herzlinger, a professor at Harvard Business School and long-time advocate of consumer-driven healthcare, argues that policy cannot fix the broken healthcare system. According to Herzlinger, it will be consumer-focused entrepreneurial innovation that fixes the system -- providing that politicians, providers, insurers, and others with vested interests in the status quo get out of the way.
Speaking at the 2013 Mark McKenna Lecture, which was hosted by the Health Sector Supply Chain Research Consortium, a research group within the W. P. Carey School of Business, Herzlinger said that while the Affordable Care Act has expanded health insurance coverage, in terms of cost, quality, and access, healthcare in the U.S. is still poor. “And that’s not going to change unless we move out of the status quo healthcare system.”
“Innovation,” Herzlinger said, “can help us do that.”
The problem, part 1: Costs are still rising
Of the three issues Herzlinger identified as serious problems with the status quo healthcare system in the U.S., one is cost. The rate of growth of healthcare spending “vastly” outstrips growth in GDP. “We currently spend about 18 percent of GDP on healthcare, and we’re heading for 25 percent.”
More significantly, Herzlinger said, is the fact that labor productivity of healthcare is negative. “That means the more money we pour into healthcare, the less we get out of the system. And that is a very serious economic problem.”
Then there is the issue of huge unfunded Medicare liabilities. In 2009, Medicare unfunded liabilities totaled $89.3 trillion -- meaning that the government has promised almost $90 trillion in Medicare benefits that it has no way to pay for.
The problem of rapidly rising healthcare costs, negative labor productivity, and unfunded Medicare liabilities is compounded by how we pay for healthcare. “The primary payers of healthcare costs are employers,” Herzlinger said. In contrast, she advocates a “consumer-driven” system in which the consumers of healthcare are the ones who pay for it.
“Right now I am oblivious to the cost of care because my employer pays it. If I were to know and be able to control what I pay for healthcare, then I might not want every procedure under the sun. What's missing is real competition, and we won't see it as long as consumers are oblivious to the cost of their healthcare.”
The problem, part 2: Quality is still poor
In addition to the problem of the cost of healthcare is the quality of it. “The quality of healthcare in the U.S. is really unknown,” Herzlinger said. “As consumers of healthcare, we don’t know much about what we’re buying. Quality is reputational -- we go to one hospital or doctor because our neighbor said they were good.”
Even more problematic, Herzlinger said, is that current measures of healthcare quality are based on processes, not outcomes. “Entrepreneurial innovation has a hard time emerging in the science of medicine because we measure quality on whether A, B, and C procedures were done, not on the outcome of those procedures. So if someone thinks X, Y, and Z procedures would yield a better outcome, it’s very hard for them to break in.” In that way, Herzlinger said, “Medicine is notorious for obstructing innovation.”
The problem, part 3: Access is still limited
While the number of insured people in the United States has increased through the expansion of Medicaid, Herzlinger said, “It’s not clear that Medicaid is better than nothing.” Medicaid enrollees, she said, get worse care than patients with commercial insurance or enrollees in Medicare.
“The U.S. public healthcare system provides poor quality care,” Herzlinger said. That’s not a problem limited to America, but in other countries patients have something many Americans don’t: choice. “Brazil has universal coverage, but 45 percent of Brazilians have private insurance. In France and Spain, more than a third of people opt for private insurance over public insurance because they get better access.”
In those countries with national healthcare systems, Herzlinger said, “Public policy still doesn't provide the answer; it doesn't control cost, and it doesn't improve quality.”
Innovating the U.S. system
Controlling cost and improving quality and access, Herzlinger said, requires entrepreneurial innovation to completely overhaul the status quo healthcare system in the U.S. That means changing both the demand for and supply of healthcare, starting, she said, with giving consumers more choice.
One way to do that is to establish exchanges (just a fancy word, Herzlinger said, for markets). She said that such markets have been transformational for other industries. “As the air travel industry, for example, became more competitive and more consumerized -- as people could go online and choose from among a range of airlines -- the price of travel dropped,” Herzlinger explained.
Health insurance exchanges, Herzlinger said, will offer new types of policies. Those new policies will feature health promotion, high deductible options, medical travel, and bundled care.
“When we stay healthy, our healthcare costs are lower, so why shouldn’t we get paid for it?” Herzlinger asked. So new policies with health promotion features give insured individuals points for eating healthy, working out, and keeping chronic conditions like diabetes under control. “This type of health promotion changes behavior tremendously,” Herzlinger said. “It’s good for the individuals, and it’s good for the system.”
High deductible options, Herzlinger explained, have been shown to keep healthcare costs down, without sacrificing health. “They get the best value for the money.”
Health insurance policies with medical travel options will offer premium reductions to patients who choose to receive elective procedures in lower-cost locations (internationally and within the U.S.).
The most important feature of new health insurance policies, Herzlinger said, will be bundled care for chronic diseases. “Chronic heart failure, for example, has 34 common co-morbidities (co-occurring conditions like kidney disease, diabetes, and depression). The way it is now, that patient has to see 34 different doctors, all with records in systems that don’t talk to each other.”
In contrast, bundled care would provide all chronic heart failure-related care (including care for those related conditions) for a fixed price, within one system. “You could have a lot of competitive organizations focused on providing bundled care, and that would drive down the cost and improve the quality of care.” Herzlinger cited one study which found that if care were bundled, the cost of chronic heart failure care would be 2.5 times lower, and quality would be higher.
The second key to getting out of the status quo healthcare system in the U.S. is changing how healthcare is supplied, Herzlinger said. One supply change, she said, is to provide better-value alternatives, such as retail medical clinics, which offer much lower prices than doctor’s offices and urgent care centers.
Retail medical clinics typically treat patients who don’t have a primary care doctor -- those who are otherwise underserved. And, led by Walgreens, they’re moving into chronic disease management. “That’s a great idea from a public health perspective,” Herzlinger said, “because they’re providing management of self-care in a community setting” -- again, higher-quality care at a lower cost.
America’s global competitiveness is at stake
While Herzlinger had very little good news to share about the current state of healthcare in the U.S., she said that this is an “exciting time” in healthcare “because the system can’t stay the way it is, and there are great opportunities for smart people to make great changes in demand and supply.”
The importance of innovative change in the U.S. healthcare system is hard to overstate, Herzlinger said. It’s an issue of global competitiveness. “We need leaders with the spine to take on the oligopolistic hospitals, intent on maintaining the status quo, which are very dangerous to the U.S. economy. If our leaders don’t, then the U.S. economy doesn’t have much of a future. Healthcare costs will cripple business here.”
Bottom line:
1. The Affordable Care Act has expanded health insurance coverage but in terms of cost, quality, and access, healthcare in the U.S. is still poor.
  • Cost -- Healthcare consumes an increasingly large percentage of our income; the more we put into the system, the less we get out of it; huge unfunded Medicare liabilities will burden future generations; and consumers are insulated from cost because employers (or the government) pay for our healthcare.
  • Quality -- We don’t really know the quality of the medical providers we choose, our choices are largely based on the provider’s reputation; plus, current measures of the quality of healthcare are based on processes, not outcomes (which stifles innovation).
  • Access -- Medicaid enrollees get worse care than patients with commercial insurance or enrollees in Medicare.
2. Innovation in demand will include health insurance exchanges -- markets that will offer new types of policies, featuring health promotion, high deductible options, medical travel, and bundled care to reduce cost and improve quality and access.
3. Innovation in supply will include providing better-value alternatives, such as retail medical clinics, which offer much lower prices than doctor’s offices and urgent care centers.

The Power of Technology Can Transform Healthcare and Save Lives

Posted: 05/31/2013 9:16 am
Olivia "Bing Bing" Mann was a tiny infant with a complex, but treatable heart disease. From her home in a Chinese orphanage, it appeared virtually impossible for Bing Bing to receive the medical attention that she so urgently needed. But the London-based Swinfen Charitable Trust intervened and - utilizing the latest in telemedicine technology - was able to link baby Bing Bing with Dr. Karen Rheuben, one of the world's foremost experts in pediatric cardiology. From her offices halfway around the world, Dr. Rheuben, the director of the University of Virginia Center for Telehealth, virtually provided local caregivers with guidance on how to treat Bing Bing, who underwent the first in a series of life-saving surgeries. Today, Bing Bing is a thriving, happy three-year-old living a fuller and healthier life with her adoptive family in Pennsylvania.
Bing Bing's story reinforces that, despite the myriad of challenges facing our healthcare system today - including rising healthcare costs and the lack of quality and access to healthcare - there is a tremendous opportunity to use new technology tools to transform the way healthcare is delivered, especially to those most vulnerable - children, women and seniors - in remote or rural areas.

One of the ways we can speed this process is by putting next-generation technologies - like the power of cloud-based telemedicine - into the hands of innovative organizations, like the Swinfen Charitable Trust, who can help address these pressing social challenges.
Swinfen Charitable Trust has an established network of hundreds of renowned physicians around the world. These medical professionals volunteer their time to provide free consultations to healthcare workers in rural or remote parts of the world so these providers may, in turn, treat patients for an unfamiliar illness. And the Swinfen volunteers are able to deliver this expert care from anywhere in the world because of technology: mobile-based telemedicine and a secure, medical-grade cloud for the storing and exchange of patient health information and case referrals. And this is the tip of the technology iceberg.
It is important that companies continue to partner with innovative healthcare nonprofits and programs like these, to help them further expand telemedicine into developing countries where it can give patients like baby Bing Bing a chance to live.
Verizon's partnership with Swinfen Charitable Trust and the University of Virginia Health System allows healthcare workers to send patient information - including photos, X-rays and medical histories - through a secure, Internet-based messaging system to a network of more than 500 specialists across the globe to get more information and direction on care.
Telemedicine has been an effective healthcare resource for the last 25 years in countries with more developed healthcare infrastructure. In the last decade, the use of wireless networks and devices in telemedicine applications has become a critical link in reducing the tremendous disparities in global public healthcare access and delivery. These technologies are innovative in their simplicity and their potential. By utilizing existing networks and the cellular technology that is already in use by millions worldwide, we can deliver quality healthcare that is medically, culturally and socioeconomically relevant to patients. By delivering healthcare and health education via the same device that patients use to communicate with their loved ones and communities, we have the opportunity to improve health outcomes from the ground up by impacting the healthcare delivery system and its ability to scale to meet patient and disease demands.
By using existing wireless and broadband capabilities, we can lay the foundation for the medical experts who can really get this transformative work done. It is all about collaboration that steps outside of the research space into public-private partnerships to identify the most promising healthcare solutions and deliver the most powerful answers. Together, we can uncover new ways to use technology innovations to address society's deepest needs and continue to break through healthcare barriers.
This article is the second in a series covering the topics and initiatives discussed at the Social Innovation Summit, a private, invitation-only forum that explores "What's Next?" in the world of social innovation. For more information on the Social Innovation Summit please visit For real time updates on announcements and attendees follow us on Twitter at @socinnovation.

Parkland Memorial Hospital pays nearly $1.4 million to resolve allegations it submitted improper physical medicine and rehabilitation claims

By U.S. Department of Justice
Jun 2, 2013

DALLAS - Dallas County Hospital District d/b/a Parkland Health and Hospital System (Parkland) settled allegations it violated the civil False Claims Act and Texas Medicaid Fraud Prevention Act, announced U.S. Attorney Sarah R. Saldaña of the Northern District of Texas. The U.S. and Texas contend Parkland caused unallowable and “upcoded” physician consultations and other services to be submitted to Medicare and Texas Medicaid for certain physical medicine and rehabilitation (PMR) related items and services between 2007 and 2011. Parkland fully cooperated with the investigation, and by settling, did not admit any wrong-doing or liability.
When patients are admitted to a hospital, specialists, like PMR physicians, often consult with the attending physician on a variety of issues. At teaching hospitals, faculty physicians may bill for the supervision of residents, if present for the key or critical portions of the services. In both cases such consults, if medically appropriate, are reimbursed by Medicare and Texas Medicaid. The United States and Texas based their investigation on allegations that Parkland submitted or caused the submission of false and fraudulent PMR claims, and false statements in support of such claims, to the Medicare and Texas Medicaid programs between 2007 and 2011 for: (1)consultations that were never requested by a patient’s treating physicians and/or lacked medical necessity; (2) services related to the inappropriate supervision of residents and/or lacked medical necessity; (3) up-codeaninflated evaluation and management services; (4) inpatient rehabilitation stays that did not meet billing requirements; and (5) other unreimbursable costs.
The U.S. and Texas initiated the investigation in response to a March 2010 whistleblower suit brought by Lien Kyri, M.D., a former resident in the PM&R department, UTSW Medical Center at Dallas. Under the False Claims Act and Texas Medicaid Fraud Prevention Act, private individuals may bring actions alleging fraud on behalf of the U.S. and Texas and collect a share of any proceeds recovered by the suit. Dr. Kyri may receive up to 30% of the recovery under the settlement. U.S. Attorney Saldaña praised the efforts of the Office of Inspector General of the U.S. Department of Health and Human Services (OIG) and the Texas Medicaid Fraud Control Unit. U.S. Attorney Saldaña also noted “this settlement demonstrates the Northern District of Texas, and the entire Department, remain committed to investigating allegations of health care fraud, regardless of provider or affiliation.” “Any time false claims are submitted for payment, the nation’s taxpayers and health insurance programs suffer,” said Special Agent in Charge Mike Fields of the OIG’s Dallas Regional Office. “Our agents will continue working to identify providers who manipulate the system to grab precious Medicare and Medicaid dollars to which they are not entitled.”
In addition to paying nearly $1.4 million, Parkland agreed to enter into with the OIG a five-year corporate integrity agreement (CIA) in exchange for release of the agency’s administrative remedies. The CIA requires Parkland to enact and report to the OIG its compliance with billing rules, but also will monitor Parkland to ensure patients receive appropriate care.
The case was handled by Assistant U.S. Attorney Sean McKenna and Assistant Texas Attorney General Paula Juba. The case is captioned United States ex rel. Kyri v. Dallas County Hospital District d/b/a Parkland Health and Hospital System, et al.; Civil Action No. 3:10-cv-0487-D (N.D. Tex.).

Medicine looks to industries for inspiration

 Connected coverage — selected articles on trends, challenges and controversies in the changing world of medicine.

Posted April 22, 2013
When physicians, hospitals and health systems encounter systemic problems that might lead to inefficient or substandard patient care, they don't always look within to find solutions. In some cases, the ways that nonmedical industries have changed their practices to boost quality, safety or efficiency can provide valuable examples that doctors and other health professionals can adapt to their own situations.
American Medical News has shed light on several instances in which the medical system has borrowed expertise and best practices developed by experts in other occupations that at first glance might appear to be completely unrelated. It might come as a surprise that the lessons learned by professionals overseeing car assembly lines, racing vehicle pit lanes and airplane cockpits can be used to improve medical care. Although they are not perfect analogies, champions of the approaches say the evidence is clear that adapting these solutions thoughtfully can save time, money and lives.

Cardiac treatment improves after taking page from Toyota playbook

The use of “lean management” principles, which focus on boosting productivity through reducing variation and waste, helped make the Toyota Motor Corp. the world's largest automobile manufacturer. New research shows that the principles also are working for hospital interventional cardiac care units, where lean management has entailed standardized admission order sets, immediate alerts for cardiac catheterization teams and regular monitoring of clinical procedures.

Doctors use Formula One pit crews as safety model

Racing pit crews help their drivers shave valuable seconds off their times through precision and near-perfect synchronization, with the overarching goal of keeping everyone at the track safe in the process. Following the crews' example, U.S. and British hospitals use similar elements of team leadership, situational awareness and data checklists to cut down on the rates of potentially harmful errors when handing off surgery patients to recovery settings.

Patient safety: What can medicine learn from aviation?

Many believe aviation safety principles such as adherence to checklists, crew resource management and anonymous incident reporting hold great potential for adaptation to the field of medicine — and in some ways they already have been adapted. But some experts caution that patients are not airplanes, and attempting to copy aviation's example without applying those skills to a particular process of medical care will not necessarily yield the results that everyone wants.

ACA data “dashboard” will track chronic conditions

The Centers for Medicare & Medicaid Services on March 28 announced that it was employing a new data tool to advance the health system reform goals of helping Medicare beneficiaries with multiple chronic conditions.
CMS said the new “dashboard” would make it easy for physicians and others in the health system to find current information on where these types of conditions take place, what services these beneficiaries need, and what Medicare spends on them. In 2011, the program spent about 93% of its funding, or $276 billion, on beneficiaries with two or more chronic health issues.
The dashboard is part of a larger initiative, begun in 2009, by the Dept. of Health and Human Services to improve the health of people with multiple chronic conditions.
The majority of Medicare beneficiaries have chronic diseases such as diabetes and heart disease, “and that number will rise with an aging population,” said Marilyn Tavenner, CMS acting administrator. “The Affordable Care Act addresses these health problems by making people with Medicare eligible for recommended preventive care without Part B deductibles or co-payments. The health care law also promotes better health care coordination and management of chronic conditions through analysis of current data.”

Will patients trade human imperfection for computerized perfection?

The Atlantic this week published a provocative article entitled “The Robot Will See You Now.”  Using the supercomputer Watson as a starting point, the author explored the mind-bending possibilities of e-care.  In this near future, so many aspects of medicine will be captured by automated technology that the magazine asked if “your doctor is becoming obsolete?”
The IT version of health includes continuous medical monitoring (i.e. your watch will check all vital functions), robotic surgery without human supervision, lifelong personal database with genetic code core and intensive preventive care modeled for each person’s need; all supervised by artificial intelligence with access to a complete file of medical research and findings.  The e-doctor will never forget, never get tired, never get confused, never take a day off and will give 24/7 medical care at any location, anywhere in the world, for a fraction of the cost. Perfect care, everywhere, at every moment, for a pittance.
While the transformation for doctors seems clear, a shift from being at the core of medicine to being what the article described as “super-quality-control officers,” what intrigues me is not how doctors will change (retire); the real question is how patients will adapt to this new healthcare world?  Particularly when experiencing extreme or life threatening illness, will patients accept that family, friends and a pumped up iPad are enough?
150 years ago doctors had little actual healing to offer, so what they gave was themselves at the bedside.  In our romantic memory of that time, patients expected professional compassion, gentle wisdom and personal support.  With the medical revolution of the past century, doctors now have a great deal more true care to offer.  However, that focus on science has resulted in patients expecting professional distance, fragmented communication and, no matter what passion a physician may hold in his heart, a lack of effective compassion at the bedside.
This next step in health evolution may completely remove the human provider from care and thus a vital question must be whether patients fighting extreme illness will trade human imperfection for computerized perfection?
It seems bizarre to consider a world where a patient dying of cancer, on hospice, would receive care supervised by machine.  But, once we trusted our hard won dollars to a person called a banker, thought the self-checkout-line at the market was insulting, actually shopped at stores, traveled in airplanes flown by men, bought or sold stock certificates representing value, could read a map and predicted the weather by the color of the sunset, not by satellites flying far above the sky. Once, the couple I saw get engaged on bended knee by the fire, spent the rest of the night dreaming and staring into each other’s eyes, not texting on smart phones.
Perhaps the privacy, freedom and quality promised by the e-hospice-doc, means its organic ancestor is doomed as the dinosaur.  Patients will get perfect care at home with the one’s they love, and avoid physician office waits and emergency room indignities, comforted by computer screen reassurance and synthetic GPS-like voice.  But, on that day, when that first patient dies with dignity, gently and quietly supervised by monitor’s glow, I will wonder whether doctors are the only thing that has become extinct.
James C. Salwitz is an oncologist who blogs at Sunrise Rounds.

How Are Visual Illusions Used In Medicine And Arts And What Was Their Role In History?

01 Jun 2013 

A conference at the University of Leicester will explore the medical, psychological, historical and religious uses of visual illusions

Experts from around the world are set to gather in Leicester to discuss how optical illusions have played an important part in medicine and art through the centuries.

A University of Leicester conference will assess visual illusions throughout history in light of recent findings which show that visual illusions can alter brain function and pain.

Visual Illusions - past, present and future use will be held at the University's Bennett Building on Friday, 7 June.

This conference will bring experts from around the world together to examine the medical, psychological, historical and religious use of visual illusions, and their influence on the arts and society.

Examples to be considered at the conference include:
  • Mirror therapy - where a mirror is used to help treat people with phantom limb pain. This occurs when patients feel pain in a limb after it has been amputated - and helps to ease the pain in their "phantom" limb. It also helps in other pain conditions and in stroke to improve movement
  • Rubber hand illusion - in which a dummy hand and a patient's own hand are stroked in the same way simultaneously, which can lead the person to feel that the dummy hand is their own
  • Hallucination and illusion theories in the 19th century - a period which gave rise to secular, psychical and spiritual theories about illusions that influenced the development of modern psychological and psychotherapeutic theories, and what the brain does when we look at art and architecture
The event has been organised by Professor Steven King, Acting Pro-Vice-Chancellor and Head of the College of Arts, Humanities and Law and Director of the Centre for Medical Humanities and Annegret Hagenberg, Research Fellow of the Centre.

The day will feature talks from academics from around the world - with keynote lectures from Dr Melita Giummarra, of Monash University, Australia, Professor Eric Altschuler, of New Jersey Medical School, USA and Dr Nick Holmes of the University of Reading.

It will also feature demonstrations of the illusions - which guests will be able to participate in.

There will be performances by the IMCO improvisational dance company, and the event will also feature an exhibition of artwork around the topic of visual illusions.

Annegret Hagenberg, Research Fellow of the Centre for Medical Humanities, said: "This conference aims to achieve a more complete understanding of Visual Illusions in the Arts and Science, and to point the way forward to research in this field.

"It brings together distinguished researchers in the fields from three different continents who are involved with Visual Illusions in Neuroscience, Psychology, History, Arts, Sociology and the Medical Humanities themselves, creating a network for progress in research and clinical application for the benefit of the public and people suffering from pain or motor impairment.

"We will hear, for example, how during the 19th century many theories about illusions emerged and influenced modern psychology and psychiatry as well as literature and the arts and how modern neuroscience was applied by Old Masters of Art.

"More recently, with the discovery of mirror therapy by Professor V.S. Ramachandran and the further use of mirrors to regain function in stroke by Professor Eric Altschuler who is a key speaker at our conference, the new understanding of the brain was accelerated: the brain is not hard-wired but very flexible and can be influenced with sometimes very simple tricks.

"This has opened new areas for research that are fascinating - such as the rubber hand illusion and transferring sensations to another person through the use of visual illusions. Dr Melita Giummarra and Dr Nick Holmes are expert researchers in this field and are both key speakers at the conference.

"Other speakers will tell us how the use of a simple mirror can have a huge effect in rehabilitation and modern technology takes this further into virtual reality and 3D set-ups to reduce pain and regain function.

"This conference will increase our understanding by looking at the topic from all these different areas. It is hoped that new insights will arise to benefit all: researchers, clinicians, and the interested public."

It will be held at the Bennett Building, University of Leicester, on Friday, 7 June. Bookings are taken up to 1 June here

Source: University of Leicester
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