In short, Blue Cross is the worst offender in the state in terms of "rescission." What does that mean? It means Blue Cross has been canceling people's insurance policies when they filed claims that appeared too expensive (i.e. not profitable to Blue Cross). Imagine how you would feel if, after a $30,000 trip to the emergency room, Blue Cross told you they were no longer willing to pay as agreed in the contract despite your having paid their exorbitant premiums month after month? I know I'd be pretty angry, assuming I was healthy enough to handle such news.

There are regulatory agencies out there that are supposed to monitor this kind of insurance abuse, but Anthem Blue Cross has managed to get around ponying up to its responsibilities to its paying members. According to this article in the San Francisco Chronicle, "Anthem Blue Cross (of California) has the highest number of alleged illegal rescissions, it may face the least regulatory consequence simply because of its sheer size and its skill in legal intimidation."

"California regulators admitted Thursday that for more than a year they didn't even try to enforce a million-dollar fine against health insurer Anthem Blue Cross because they knew they would be outgunned in court."

It's one thing to pull people's coverage when they need it most. It's another thing to underhandedly duke it out in court with high-priced lawyers just so you can get away with such selfishness. First thing this week, I plan on getting insurance elsewhere. Right now, Kaiser Permanente seems like the best option as they have not practiced rescission since 2006 and, I've heard, either accept you or reject you without the pricing games that Anthem Blue Cross plays by raising your rates for every extra health issue you may have.

SANTA ANA, Calif.—California has sued one of the state's largest hospital operators to stop the company from billing privately insured patients for balances on medical services not paid by the insurer.The practice—known as "balance billing—is becoming increasingly common in California. The Department of Managed Health Care has banned balance billing, but regulations aren't expected to take effect until the fall, at the earliest.

That agency's director, Cindy Ehnes, said Prime Healthcare Services Inc. is "the largest example of this egregious practice we've seen to date, and it must be stopped."

Ehnes' agency filed a lawsuit Friday in Orange County Superior Court against Prime Healthcare. The suit seeks to prohibit the Victorville-based company from billing patients for unpaid medical bills Prime contends insurers owe.

"Consumers who have purchased health coverage in good faith deserve to know that it will cover them in a medical emergency and not result in crushing medical debt," Ehnes told the Los Angeles Times.

Prime acknowledged it has been billing thousands of patients the unpaid portions of their bills. The company contends it can legally do so—and that it wouldn't have to if insurers paid their full portion of medical claims.

Prime has 12 hospitals in Southern California and has acquired all but one of its properties in the past four years.

The Times reported that when Prime takes over a hospital, it often cancels insurance contracts, allowing it to charge higher rates. Insurers contend they had begun sending Prime only partial payments on members' bills.This spring, Kaiser Permanente sued Prime to prohibit the company from billing more than 5,000 of its members for unpaid bills. A temporary injunction prevents Prime from such billing until the case is resolved.

"Is strep throat something that I can just wait out?" I asked my mom.  "I mean, won't it go away eventually?"

She disabused me of this notion, so I went home and called my HMO to see what they had to say.  What they had to say was that I should come in and get a strep test.  Of course the closest after hours center was in Falls Church, about 25 miles away and much closer to where I work than where I live.  I briefly considered scheduling an appointment for this afternoon, but remembered in time that I'm having dinner with a friend and can't be in two places at once.  So I hied myself over to Kaiser Permanente and got my throat culture done at about 7pm.  My appointment time was 7:50, but I was just hoping to get into a room by 8:20...I figured that was reasonable.

It was.  I got into a room at about 8:15, thankful that maybe I'd get home at a reasonable time.  Except the doctor didn't come in until nearly 8:45.  I always thought that ten minutes was long, but this was ridiculous.  I found out that my strep test was negative (yay!), but that I could have mono (boo!).  I told her that I had it two years ago, but she told me that people can get it more than once (boo! hiss!).

So off I went back to the lab where they took out my blood and tested it for I don't know what and mono.  Then I went back to wait for another hour until those came though, only to find that there's nothing wrong with me.  They think.  The mono test won't be ready until tomorrow, but as of last night the mononucleides (sp?) were not elevated at all.  I also don't FEEL like I have mono.  When I had it before, I was SICK and had to take five weeks off from student teaching and went to the ER three times.  I couldn't have alcohol for nearly three months (due to my enlarged liver), but that actually didn't bother me because I didn't feel like drinking or eating anything.

So if I have to have it this time, I wouldn't mind the no appetite thing if I can do without the exhaustion.  *Crosses fingers*

I paid $30 for my copay and $15 for an antibiotic to relieve the swelling of my glands.  So $45+gas.  And I didn't get home until after 11:30, making last night the third in a row that I've gotten less than five hours sleep.  Crap.

From the Technical Track:

Quite a bit of information provided, most of it designed to update the audience on progress the HealthVault team has made since the initial launch last October. There is a lot of repetition in the various technical decks, so if you are going to choose one to download, go with the HealthVault Architecture Overview as it really has all you need to know, with one minor exception.

As for key messages in the technical track, they are as follows:

• Greatly simplifying the sign-in/sign-up process for the consumer (I tested it and it really is a substantial improvement). Also making more general improvements to the UI (user interface).
• Build-out of data types with 20 new ones since launch and 12 more pending. This is quite important for developers of personal health applications (PHAs) that will sit a on top of HealthVault. Still, looking at those data types that they have today, it is hard for me to understand the logic of the choices made. Comes across as somewhat of a free-for-all. Most likely driven by existing partner needs.
• Ability to directly connect to clinical data. This is through their work with such partners as AllScripts, KRIPTIQ, and Eclipsys. Still no Cerner, GE, McKesson and most importantly, Epic, who did not even send a representative. Remember, its Epic's My Chart that powers the Kaiser patient portal My Health Manager that Kaiser and Microsoft will be working on together to link My Health Manager to HealthVault.
• Restatement of basic design principles: Inclusive of standards, Commitment to "Openness" (they have signed on to the Open Specification Promise (OSP)) and CodePlex support (supporting both Java and Ruby).

The most interesting slide in all the technical session slides was the following one (it is not in the Architecture Overview slide deck, but one titled: Platform Adoption) that lays out their overall platform strategy. This gives an extremely clear picture of their thinking and where they are headed.

For example, Consumers are put one target market of six shown, though one may argue that the "Employer" column may share much in common with the Consumer. And what is quite puzzling is: Where are the payers? It oul seem to this analyst that if you are targeting employers, the leap to supporting payers is not that big as employers and payers have very similar needs, particularly when it comes to managing population health and encouraging healthy behaviors.

From the Business Track:

While I found the technical slides to have some real nuggets of information, was quite surprised at the dearth of information found in the business session slides. Most of the information was very simplistic. With all the marketing muscle at Microsoft, I expected something better.

But in and amongst the weeds, I did come across some very interesting information in the presentation entitled: "How We Make Money".

This slide deck begins with a shot of the MSN.com Health & Fitness site, with a HealthVault widget from the American Heart Association embedded on the site demonstrating personalization, how they intend to leverage existing Microsoft properties and sell Web property "real estate" to partners. This theme was extended to the HealthVault search engine.  In this case it looks like Microsoft intends to re-brand HealthVault Search as a subset of the Microsoft existing search engine,  live.com

It appears that Microsoft intends to have HealthVault be subsumed into these existing properties, which see far more traffic then HealthVault does today. I did a quick Alexa analysis comparing first three health-centric websites, HealthVault, RevolutionHealth and WebMD. HealthVault doesn't even show-up in the rankings.

Did another Alexa analysis, this time adding live.com and msn.com (couldn't get a read on the sub-site health.msn.com) and as one would expect, these two properties see lots of eyeballs, which could give far greater exposure to the HealthVault property/brand.

Remains to be seen if that will ultimately be the case, but HealthVault clearly is not getting much traffic today, so it certainly can't hurt. But then again it may have the affect of diluting the HealthVault brand.

But this is where all those partners come in (there are 36 software partners and 9 device partners up and running today). In a somewhat brazen and even arrogant manner, the HealthVault folks are adopting a marketing strategy that they refer to as an "ingredient branding strategy" Think Dolby, Intel Inside, etc. What they are looking to do with the ingredient strategy is have all their partners put the HealthVault label (web tile for websites, logo on device packaging) and let the partners push the HeathVault brand.

This is ludicrous.

In a market as small, immature and nascent as this one, with so many challenges ahead, it is hard to believe that Microsoft is depending so strongly on its partners to take the HealthVault brand to market. Really quite bizarre and something they should rethink.

Tomorrow, will have see the last post on this event and will have highlights from interviews wth several who attended this event.

Lately, I have been feeling more like a philosopher than a producer...or writer for that matter. I have been analyzing my need to thrive instead of just striving. Throughout the majority of my life, I have gained an enormous amount of survival skills that have ensured my preservation. However, I realize that somehow I have been creeping back into the comforts of what is familiar. You know, the scraping of money from your piggy bank between pay checks. The dilemma of what to eat given the price of gas.

And speaking of which, isn't the price of gas enormous! It is outrageous to think that our lawmakers saw this coming and chose not to do anything about it. Who stands to gain in this type of economy?

The rich who have stocks in these oil companies, that's who. I think the smartest people in the bunch right now are those ducking from the financial blows and those riding the waves until something drastic changes.

I am hoping like many that the new President will have a huge impact on these gas prices and the cost of food. Who knew that the poor would be the middle class? Well, my instructors tried to warn us over 10 years ago. With all of this education and technology flipping about, who really listens anyways?

What's the true cost of education, if we choose to remain ignorant? Not sure about the answer to that one. I have yet to payback my student loans. I am in graduate school! LOL! (Pursuing my passion nonetheless).

So back to question in my mind...how do I start to thrive in this economy? Well, for one, after putting out a plethora of resumes, I realized looking for a job, IS a fulltime job! I am very comfortable working for myself. Then, I think, well what does thriving really look like for me?

Well, first of all, I have to make more than just enough. I must ENJOY what I am doing and get paid for it. I love flexibility with time and travel. I truly love writing and expressing my opinion. I am not sure how many corporations want to know what I am truly thinking. LOL!

And then there is the whole quality of life component of the thriving. You know Kaiser Permanente loves to talk about thriving all of the time in their ad campaigns. I used to work under contract as a Project Manager for Kaiser. They were known by insiders and patients nationwide for actually killing people and working their employees to death. Read all about it here: http://www.kaiserthrive.org/. BTW all of this is true.

Marketing is powerful. Deception is lethal, especially in the healthcare industry. So "Kaiser-thriving" (at least the reality of Kaiser Thriving) is NOT what I am interested in.

I am in the process of defining what thriving looks like for me with particular focus on the financial portion because throughout all of my wonderful education, I never learned how to make an abundance of money. The over $100,000 in debt for student loans does not cover a single class in real life money management nor hands-on financial abundance (how to implement in your life so you can pay off your student loans...) wait a minute...that's a great title for a class. "How to Implement Financial Abundance in Your Life So That You Can Pay Off Your Student Loans and Eat and Clothe Yourselves Regularly!"

I am copyrighting as we speak! This is ground breaking! Maybe I can charge per page! As I learn, I can teach! Fabulous! My thriving plan is unfolding in front of my eyes! THIS IS WONDERFUL!!!!

(This is why this section is called "Psycho Babble"- I feel a bit loopy right now! LOL!)

Stay Tuned to this unfolding workof art...or entertainment for that matter. Most people die before paying back their loans.

LOL! And they say that the housing market is the horrible bubble that bursted and disrupted the economy. Wait until these student loans hit the fan...if they haven't already! I wonder if the government is counting on the repayment of that money. DON't HOLD YOUR BREATH UNCLE SAM!!!

FYI: I plan to be in repayment in 2010. SO I will be repaying back my loans with the help of abundant passive income that will overflow from the rafters into my bank accounts.

Pray for me, as you can see, I need help! LOL!

Your Thoughts?

JSC

State officials, hospitals and doctors are locked in a dispute over whether some patients can be charged if they are taken to an emergency room outside of their health care network. For some, that bill can be a couple of hundred dollars, but for others it can reach into the thousands.

The ban proposed by the California Department of Managed Health Care would affect members of HMOs, such as Kaiser Permanente, not members of other kinds of insurance plans. The department only regulates HMOs. Administrators and hospital-based doctors say the state should be targeting insurance companies.

Statewide, thousands of people get pressed for payment by doctors and hospitals, typically after they are taken to an emergency room outside their insurance plan. Doctors and hospitals that think health care plans and insurance companies have shortchanged them on payment for treatment then try to make up the difference by going after patients who already paid their share. It's called balance billing.

Karla and William Gledhill, of Chino Hills, understand the practice well.

The couple got hit with a $53,000 bill from Arrowhead Regional Medical Center in Colton after their insurance company, Anthem Blue Cross, paid about $25,000. Their 16-year-old son, Ryan, was flown to the hospital after a serious dirt bike crash in Lucerne Valley.

Karla Gledhill said she racked up late-payment fees and bill-collection threats as she repeatedly wrote letters and made telephone calls to the hospital and insurance company. Last week, the insurance company agreed to pay the bill.

Gledhill said she thought she would have to hire an attorney, which sometimes is a patient's only recourse, hospital officials say.

The hospital and insurance company said privacy laws prevented them from commenting on the family's claim.

"You don't know anything about balance billing until you're stuck in the middle, trying to hammer out what's right," Gledhill said.

Balance Billing

More than 1.75 million insured Californians who visited emergency rooms in the past two years were asked to pay more, even after their co-payments and deductibles, according to the California Association of Health Plans. The professional organization represents 40 health care plans that cover an estimated 21 million Californians.

The average balance bill was $300, which added up to about $528 million that patients spent in addition to their co-payments and deductibles, the association said. More than half of the patients who were balance billed paid.

"The practice needs to be banned, period," said association spokeswoman Nicole Kasabian Evans. "The patient shouldn't be placed in the middle. That's what the insurance companies and health care providers are doing."

In July 2006, Gov. Schwarzenegger ordered an end to balance billing after he realized many residents were being charged for medical expenses they didn't owe, said Cindy Ehnes, director of the state Managed Health Care Department. But the department couldn't come up with a suitable solution to HMOs and providers, she said. So, the department decided to merely ban the practice.

"We have tried many other approaches to solve this problem," Ehnes said. "We have decided to go back to our first job, which is to protect consumers."

Ehnes said she had hoped lawmakers would have passed legislation regulating balance billing. At least seven states have balance billing laws, including Colorado and Florida. Meanwhile, state Sens. Don Perata, D-Oakland, and Leland Yee, D-San Francisco, have introduced balance billing legislation.

HMO Vs. Hospital

The ban comes as Kaiser, the state's largest HMO, got a temporary restraining order earlier this month from Los Angeles County Superior Court against Prime Healthcare Services Inc., of Victorville, to stop it from collecting money from thousands of Kaiser patients or reporting them to credit agencies. A hearing is set for Thursday.

"This has been an ongoing dispute for a year or year and a half," said Dr. Ben Chu, president of Kaiser's Southern California region. "... They threatened to trash their credit ratings if they didn't pay."

Earlier this year, Prime Healthcare sued Kaiser, claiming that Kaiser owes $25 million for its patients who were treated at eight of Prime Healthcare's hospitals, including Desert Valley Hospital in Victorville, Chino Valley Medical Center and Montclair Medical Center.

Prime Healthcare attorney Michael Sarrao couldn't be reached for comment.

Prime Healthcare has accused Kaiser of delaying payments by repeatedly demanding patient medical records, claiming that care provided was unnecessary and requiring transfer of members to Kaiser hospitals.

Chu disputed the claims.

"It's not about delaying payment," he said. "It's about substantiating claims."

Calculating Health Cost

Dr. Richard Frankenstein, president of the California Medical Association, said the organization, which represents 35,000 doctors, will fight the state Managed Health Care Department's ban.

"They ought to be regulating the insurance companies, not the doctors, which it does not have the authority to do," he said. "We see this as a $500 million transfer from patients to insurance companies, and the insurance companies aren't paying the bill."

On average, Frankenstein said, insurance companies pay all but about $30 of a doctor's bill.

"If that doctor sees 50 to 60 patients, that $30 does add up," he said.

Some specialists may not work on-call emergencies if insurance companies refuse to pay and they can't bill patients, Frankenstein said.

Frank Arambula, Arrowhead Regional Medical Center's chief financial officer, said the hospital compares its costs to those of other facilities, which are reported to the California Office of Statewide Health Planning and Development. The data are posted on the agency's Web site.

"We set our rates based on market-driven prices," he said. "We think it's a fair assignment and the payer is going to pay those charges."

Conversely, insurance companies rarely show patients and health care providers how they determine what to pay for service, Arambula said.

In a written statement, Anthem Blue Cross spokeswoman Peggy Hinz said the company reimburses out-of-network hospitals for what it considers reasonable and customary costs. It is changing its reimbursement policy to protect members who require emergency care, she wrote.

"It was not the intent of our reimbursement policy to increase out of pocket expenses for our members, who do not have a choice in selecting the place where health care services are performed, such as in the case of an emergency," Hinz wrote.

Anthem Blue Cross bases its reimbursement rates on factors including submitted charges for payment, comparisons of charges for services offered at other hospitals, and service costs that are reported to the state, Hinz wrote.

Fighting the Bill

The Gledhills didn't care whether Arrowhead Regional Medical Center was in their Anthem Blue Cross preferred provider organization network. Their son needed surgery on his pancreas.

"Worst case, we thought we would owe $6,000," said Karla Gledhill, whose husband owns a small Anaheim business.

Anthem Blue Cross first determined the Gledhills owed the hospital $53,273.17 after it paid $25,121.28, according to a claim recap. It paid another $12,606.15 after Karla Gledhill complained to the California Department of Insurance.

The Gledhills still faced a $40,667.12 bill and no explanation of how Anthem Blue Cross determined what it would pay.

"How could I fight a fair fight if I didn't have all the information?" Karla Gledhill asked. "I didn't think Arrowhead's charges were exorbitant for the care my son received."

On May 21, Anthem agreed to pay the rest of Ryan Gledhill's hospital bill after the company "made a one time administrative decision to remit payment," according to the letter the Gledhills received.

The letter did not include further explanation, and Hinz said privacy laws prevented her from offering one.

Reach Lora Hines at 951-368-9444 or lhines@PE.com

As with any such event, we'll be seeing a lot of press releases come out of Microsoft and to a lesser extent, various partners.  The biggest one today is the announcement that Kaiser-Permanente will do a trial with HealthVault.  Microsoft issued a similar press release.

Why this is Important

HealthVault, Google and to a lesser extent (or at least quieter) Dossia, are all looking to create an ecosystem around which other applications and services will be built.

An ecosystem/platform model is a bit of a chicken and egg scenario. First, there is the strategy to get as many developers as possible building applications on a given platform/system. This creates a critical mass of features that will in-turn attract consumers to the ecosystem accelerating growth, presence and ultimately revenue. But before dedicating precious development resources, smaller software companies want to see if the ecosystem provider can deliver customers that may want to use their application(s), subscribing to their service and delivering revenue.  If there are few consumers, what's the point in spending those precious resources?

To date, 3rd party PHAs have gone as much on faith as anything else assuming that Microsoft's HealthVault group (and Google Health) would be successful in attracting consumers. After a pretty poor, at least from the consumer's perspective, launch of HealthVault last October, it was much to that team's credit that they were able to attract so many development partners. In a conversation I had with the HealthVault team a couple of months ago, they stated that they were in discussion with over 100 potential PHA partners and I'm sure that list has only grown. Today, they announced that there are now over 40 PHAs up and running on HealthVault. Then there is also Microsoft's seed funding, Be Well Fund, which was oversubscribed to the point where they actually increased funding by 50% as there were so many good proposals. Microsoft is being very aggressive in developing that ecosystem.

Now it just needs to bring in the consumers, and that's where Kaiser comes in.

Kaiser-Permanente is partnering with Microsoft HealthVault to potentially provide Kaiser's 8.7 million plus members the opportunity to port their Kaiser records to HealthVault. While there may be 8.7 million Kaiser  members, today roughly a third, 3 million, are active users of Kaiser's PHR, but that is still a huge number and arguably the most PHR users under any one umbrella in North America. (Note: Kaiser has done a spectacular job with their tethered PHR, My Health Manager, which is based on the EPIC MyChart patient portal. What really impresses me with the Kaiser PHR is that they continually are measuring and assessing consumer use fine tuning features to best serve both consumers and physicians. They really are setting the standard in the provider space.)

Kaiser will, like Cleveland Clinic did with Google, begin with a trial (beta) enlisting Kaiser's 156,000 employees to opt-in to use HealthVault. It will be interesting to see just how many opt-in as in the Cleveland Clinic-Google beta, only about 16% of those presented with the opportunity opted-in.

The initial trial will run through the summer providing Kaiser an opportunity to test the platform's ability to securely transfer records and populate a HealthVault account. Once the beta program is completed, provided its successful and there is no obvious reason why it won't be, Kaiser will allow its 8.7 million members the opportunity to transfer their records from My Health Manager to HealthVault.

In the conference call today, which oddly enough only had two people asking questions, myself and another, I asked two questions, which were answered by Anna Lisa Silvestre, VP Online Services, Kaiser-Permanente. Note, these are not direct, verbatim responses, but basically the gist of what she communicated.

Ques: Will you be testing the transfer of complete records?

Ans: No, we will test the system by transferring an employee's health summary that will include immunizations, allergies, medications and conditions.  We will use the Continuity of Care Document (CCD) standard to facilitate transfer of these records.

Ques: Will you consider other platforms in the future (this was my roundabout way of asking, is Google in the cards)?

Ans: Yes, we will consider other platforms in the future as this is not exclusive.  Such choices will depend on value that can be ultimately delivered to the end consumer/member.  That being said, we will not partner with every PHR company in the market but will look at a number of factors including security and privacy policies foremost among them.

Bottom-Line:

Now if I'm a developer at the HealthVault event this week, I sure would be excited hearing this news as it offers the potential for 3 million plus consumers coming on-board by the end of the year.  But is that not the Big Question - if we build it will they come?

In the Cleveland Clinic-Google beta, it appears that the majority of consumers sat back and were not willing (or didn't see enough value) to move their records to Google Health. Sure, it may have been security and privacy issues that held them back but my bet is that it was just indifference.

It remains to be seen just how many of Kaiser's employees and later, members will do likewise, which brings us back to the beginning: Which comes first, the chicken or the egg?  Will these PHSs and their development partners provide enough value (features) to bring in the consumer?  Will developers continue investing in creating enough interesting apps to attract the consumer and hopefully justify their investment?  We are a long ways from finding out the answers to these questions but what is clear is that some very significant players, representing large pools of consumers, Cleveland Clinic, Beth Israel and now Kaiser, are willing to offer consumers the opportunity to take direct control of their records and try these platforms for themselves. That is a start in the right direction.

".. Health Insurance, uses actuarial studies but doesn't actually deliver Insurance."

This article is going to be a look at the transformation of what was an obvious and proven approach to health care and how, lobbyists, financial companies and politicians forced the public discussion in a different direction and convinced many Americans to cheer for a system that steals from them.   While this article is an overview - its focus is on how the discussion changed and why.

There are a few quick terms that need to be clarified:

1. Patient: A patient is someone that is suffering illness and requires, medical counsel, education or medical treatment.  For the purposes of this discussion, there is no illness associated with breast augmentation, lypo-suction, or any of the the other cosmetic procedures delivered through health care professionals.

2. Finance Co.: This is a company that refers to itself as Health Insurance, uses actuarial studies but doesn't acutally deliver Insurance.  What the Finance Co. provides is the equivalent of a pre-paid telephone card - however, they have the right to increase the connection charge - on the fly, with little recourse to the patient.

3.  Medical Professionals:  Doctors, Nurses, Scientists, Medical Admin, Services and Support; including public health services (gov't)

4.  Non-medical Professionals: Massage therapists, teachers, instructors, social service representatives, other public health services (gov't)

5.  Non-Insurance Medical Providers: Kaiser-Permanente is the perfect example. We will refer to it in subsequent installments of this article.

How DId the Discussion Change from Health Care to Health Insurance?

"... drama in the waiting room, eerie reminders of pre-Civil Rights days in the deep South."

Fifteen years ago, there was a National discussion about health care, and 20 years before that, there were similar discussions.  The hiatus was supplied by the Vietnam war, Richard Nixon's struggle with the rules, the warm-up energy crisis and Oliver North's homegrown foreign diplomacy. Scores of other distractions were spawned by America's financial boom, a nice way to describe the national addiction to investing and exponential profits that we'll further refer to as financial crack cocaine.

When the discussions re-started, they included everything from expanding the public health service to providing basic health care for Americans.  Not only basic health care but health education and preventive medicine.  As it is, there is no incentive for delivering preventative medicine in the insurance company dominated health system - yet there are numerous financial incentives for treating more and more illness.  In short, the system, as is, becomes more profitable for investors if the number of sick people rises.  The system by design is flawed.  Consider a private police department whose investors privately hope for higher crime or less public safety in order to increase profits.

Now consider that the cost of detectives is driven by market conditions, and the amount of attention they can dedicate to particular cases is based on the overall profit of those cases, determined by the Financial Co-op.  Public safety, no longer driving the results, the highest profit is realized when more and more cases are opened and crime is elevated, since the crime victim must pay, or pay through a Finance Co., for services.

So as you can see, for the purposes of Part One - we propose that Health Care is essentially the same as Public Safety, Public Water and Sewer, Public Works.  There is only one answer to how the discussion was altered and thereby further dividing classes of American citizens.  The most obvious being Insured and Uninsured.  While many may not see this as a 'Class' distinction - visit  Medical Professional company in your area and observe the drama in the waiting room, eerie reminders of pre-Civil Rights days in the deep South.

Pay Attention to Small Stuff

"... the payment was spread among the entire school population."

For the purposes of this section of the article - we're going to have to stick to practices and not specific people or companies.  While we have some excellent examples of specific people and companies that benefited greatly by redirecting the national discussion, we'll save that for later chapters, with footnotes and research material.

Clearly, the changes were motivated by a new approach to economics.  After being indoctrinated with 'free-market' platitudes, even High School football teams were looking for revenue far beyond what booster clubs and community fund-drives could yield.  So the answer is appetite.  The American appetite for opportunity and great return.

When Junior High schools were selling real-estate to Coke and Pepsi so that they could line the halls with machines selling high fructose corn syrup laden carbonated drinks to children; we were trading public health for corporate finance.  While it paid for the illuminated scoreboard on the football field and much more updated uniforms and equipment, the payment was spread among the entire school population.

While on the surface it seems to be logical, there was a serious breech of both public health and the loco parentis care of our children of which public schools are charged.  But 'the Beat goes on' seemed more enticing than pedantic pleas of health professionals about force-feeding our youth sugary water.  And anyone that doesn't believe that Soda dispensing machines strategically located throughout a public school isn't force-feeding than we beckon a more suitable word.

Courting Independence

"... then you were going to get credit - big and fast."

The financial appetite for return on investment permeated the atmosphere.  IRA's abounded benefiting investors with deferred income tax and lower base taxes by lowering their taxable income.  It was all the talk at the supermarket, at the beauty parlor, at the VFW and at the golf course.  An entire generation of tax planners were armed with Texas Instruments printing calculators in order to show investors, just how many millions they would have at early '80s interest rates of 12%.

These opportunities were not curtailed simply by the sudden drop in interest rates as the stock market began its first surge - because the SEC swung open the doors at the behest of the Reagan Administration to permit individuals to personally direct their retirement money into the risky equity markets.  Penny stocks abounded with the lucre of  Mom's and Pop's, although, much of it evaporated by the late 80's as the equity markets - adjusted.  That's what they call crashes because of uncontrolled financial growth - "adjustments".  On the way up ... they don't call them anything, because no one can hear over the cheering.

Pick a Card - Any Card

".. create a highly lucrative financial turbine of the insurance company."

During this period of time, gasoline rose in price, food rose in price and health care rose in price.  A society stuck for a  ready cash with appetites further whetted by buying stocks and bonds on margin; they started abandoning the sound financial tenets of their roots and willingly accepted credit cards in the simple recruitment terms of the credit card companies.  Buying on credit was easy. It was certainly an analgesic to financial pain -moreover - the new American voracious appetite for  acquiring  more "stuff" wouldn't be derailed because the disposable cash dried up.  Not for a second.  If you could prove that you were stupid enough to load up your retirement portfolio with Penny Stock get rich quick schemes and would be 'market averaging' for the next 100 years in order to get your principle back - then you were going to get credit - big and fast.

The Finance companies were watching and in the game.  They were buying up medical services companies and even hospitals through holding companies and even real estate trusts.  After all, if you are going to expand a business that collects money , shouldn't you also own the companies that you ultimately pay.  In this way you can add the power of the check book while containing costs. Further,  by leveraging the assets of the holding company by selling it off to investors - the Finance Co. in actuality, creates a highly lucrative financial turbine from what appears to be an insurance company.  Ultimately, taking more in than it pays out,  the Finance company maintains high profitability by delivering less health care to the insureds.  In effect, they create a layer that in conclusion, does nothing but convert the massive buying power of an organized group, and convert it into investor profit instead of an actual comprehensive medical plan.  It's very much like the new Electronic Scoreboard and the Soda machines.

To be continued ......  part Two next week.

Doctors and hospital officials will square off with health insurers Monday in San Diego over a state plan to ban medical providers from billing emergency room patients for charges not covered by insurance companies.

The proposal, by the Department of Managed Health Care, is the agency's third attempt in two years to outlaw so-called balance billing, which turns patients into pawns in payment disputes. The earlier proposals were scrubbed after regulators failed to build consensus among various health care parties.

What remains is a stripped-down version that lacks provisions for an independent dispute-resolution process and a method for calculating fair charges for hospital and doctor services.

The San Diego hearing comes about two weeks after several medical centers owned by Prime Healthcare, including Paradise Valley Hospital in National City, sent thousands of collection letters to Kaiser Permanente members. They demanded payment for outstanding emergency room bills.

Prime's hospitals had sued Kaiser, the state's largest health plan, in February. They contended that Kaiser refused to pay for more than $25 million worth of services after concluding that the conditions of some patients didn't constitute true emergencies.

Kaiser officials said as many as 6,000 of their members received the bills from Prime. A Prime spokeswoman said a relatively small number of bills were sent to patients treated at Paradise Valley, but she didn't know the exact figure.

Cindy Ehnes, director of the managed care agency, said Prime's widespread balance billing “put a face” on a practice that receives little public attention despite being controversial.

A final version of the agency's proposal is expected to be published by fall.

Balance billing surfaces most often when emergency room patients receive care outside of their insurance company's network of contracted providers. State law requires health plans to pay fair amounts for emergency room services, but the exact price is often disputed and insurers wind up paying a lower amount than what they are charged.

Some physicians and hospitals offset the reduced payments by sending bills to patients that cover the difference, an amount that can run from as little as $25 to thousands of dollars.

Balance bills average about $300, according to the California Association of Health Plans, a trade group that lobbies for its 40 members.

The practice can leave patients confused and afraid of being reported to collection agencies if they ignore the bills. While some people lodge complaints with their insurers or state regulators, many pay the charges.

Medical providers who engage in balance billing said the practice is intended to pressure insurers to pay for services in full. They also said it's their most effective alternative to taking health plans to court, an expensive option given the huge legal resources that most health plans have.

The managed care agency's latest proposal will give insurance companies a bigger advantage in payment disputes with out-of-network providers, said Dr. Ted Mazer, past president of the San Diego County Medical Society.

“The department is telling the health plans that they can tell the physicians what their services are worth,” he said.

Instead, Mazer said, the agency should require insurers to pay some portion of disputed bills upfront and use historical data to determine what constitutes appropriate charges.

Supporters of the proposed regulations said a ban on balance billing is long overdue.

“What this does is take the first step: saying it is wrong to have patients in the middle,” said Chris Ohman, president and CEO of the California Association of Health Plans. “The health plan industry is committed to the next step, which is designing a process that will be fair to both plans and providers.”

Insurers, doctors and hospitals must resolve their disagreements without involving patients, said Michael Russo of the nonprofit California Public Interest Research Group in Los Angeles.

“It's ridiculous to hold consumers hostage,” he said. “The patients aren't doing anything wrong.”

I had the pleasure yesterday of presenting at a Web 2.0 Summit sponsored by Kaiser Permanente. Our panel was moderated by Ted Eytan, M.D., who also presented on his blogging experience from the last four years as part of Kaiser's sister (or cousin, or some other relation I don't completely understand) organization, Group Health. He's an interesting guy who also has a passion for LEAN in Health Care, which is the topic of the other blog on which he is a collaborator. I also got to meet and hear Tim Collins from Wells Fargo, whose company has official blogs that include Guided by History, The Student LoanDown and one that supports Stagecoach Island, its virtual world. TIm says Wells Fargo was the first big brand in Second Life, but that they got out just as many others were starting to get in. Now they have a world of their own.

Charlene Li from Forrester Research opened the Summit with an overview of Web 2.0. She's also the co-author of Groundswell, a book I just bought at Audible.com (It's also here on Amazon, and I'll be reviewing it after I listen to it over the next few days). Before her presentation, we got to talk about our experience with audio books, and I recommended some from Patrick Lencioni that I think most people in business would find extremely helpful (and which I have reviewed on this blog): The Five Dysfunctions of a Team and Silos, Politics and Turf Wars. (I thought I had reviewed Death by Meeting, too...but I guess that's on my to-do list.)

I'll have my full review of Groundswell, but meanwhile here are some of the high points and recommendations from Charlene's presentation:

Focus on the relationships, not the technologies. At Forrester, they have developed a four-step process using the acronym POST. You should consider:

• People - for those you want to reach and with whom you want to interact, consider their characteristics and what kinds of social media involvement they have already. Getting seniors into a 3D virtual world may be a mismatch, unless the group you're targeting is retired Microsoft or IBM engineers.
• Objectives - Decide what you want to accomplish
• Strategy - Plan for how relationships with customers will change
• Technology - Decide which social technologies to use

Charlene's blog has a fuller discussion of POST, and I'm sure Groundswell will be even more detailed.

Part of analyzing People is determining where they are on the Ladder of Participation.

Charlene had a lot of other great material in her presentation, but she closed with some Keys to Success:

1. Start with Your Customers.
2. Choose Objectives You Can Measure
3. LIne Up Executive Backing
4. Romance the Naysayers
5. Start Small, but Think Big

I particularly like that last point, because it fits with the SMUG (It's all Free) philosophy. It's possible to start small because the barriers to entry are practically non-existent, but you should plan for success to that you can scale up as necessary.

For example, you can start a blog hosted on Wordpress.com and map to a domain or subdomain of your choosing for $10-$20 (and can extensively customize your look and feel for another $15). Later, if your blog is successful and you decide you want to host it elsewhere to allow more use of Flash and embedded widgets, you can just download and install Wordpress from Wordpress.org and re-map the domain, and you won't lose any of your links. I'll have more on that as I build out the Blogging curriculum.

The new images are "River Flow", "Autumn on the Merced River, Yosemite NP" and "Dogwoods and River, Yosemite NP"

This images can be viewed on the fine art portion of my website.

Under the plan, anyone who agrees to take experimental medicines will be assured of receiving free clinical care as part of the trials. That free care will include routine physical exams as well as visits with medical specialists who can treat any adverse side effects from the experimental drugs the subjects take.  Dental and vision is not included, nor is mental healthcare.     

“This will mean poor people who can’t get health insurance will be able to get care, as long as they don’t mind being ‘guinea pigs,’” said Kaiser Permanente Chief Executive Officer Stefano Medici. “And who doesn’t like free drugs—especially painkillers and anti-depressants?”    

Financial terms of the Eli Lilly-Kaiser partnership were not disclosed.  

Policymakers for years tried to find ways to bring health care costs under control, with many politicians calling for universal coverage.  But those efforts languished even after Kaiser acquired the Department of Health and Human Services from the U.S. government in 2025.

Chelsea Clinton, president of Families USA, an advocacy group fighting for universal health-care coverage, decried Kaiser’s universal-coverage plan as a poorly veiled attempt to make underprivileged citizens unwitting test subjects for drugs that could end up being lethal.  
 
But Eli Lilly CEO P.L. Peddlar insisted that all of the clinical trials will stay within ethical boundaries and will benefit millions of Americans.

“Our trials are very complex and require that we have test subjects who don’t have a lot of education and don’t ask a lot of questions,” Peddlar said. “By having participants who simply smile and take their free drugs as directed, we’ll get new treatments out to the wealthier public much faster.

“And because many of the test subjects we plan to serve are unemployed, any complications or adverse side effects of the experimental drugs should cause little or no disruption in the workforce, since those problems will be caught before any working Americans start taking them.”

Consider these points of comparison:

• The top 10 companies for Blacks average 19 percent Blacks in their work forces, compared with a Top 50 average of 15 percent and a national average of 14 percent, according to the EEOC. There's clearly progress being made. Blacks were 22 percent of new hires for these top 10 companies, compared with 18 percent for the Top 50.
• Blacks were 14 percent of the managers in these top 10 companies, compared with a Top 50 average of 12 percent and a national average of 6.7 percent, according to the EEOC. This ratio is important to note because it illustrates the talent pipeline, that African-American managers received an average of 14 percent of management promotions at these top 10 companies, compared with a Top 50 average of 9 percent.
• Diversity training is extremely important to these companies. Nine of these top 10 have mandatory diversity training for the entire work force, compared with a Top 50 average of 70 percent.
• Fifty percent of these top 10 companies have mandatory employee surveys on diversity, compared with a Top 50 average of 26 percent.

Here's the list and a key factor about why each company was named:

No. 1: Turner Broadcasting System, No. 23 on The 2008 DiversityInc Top 50 Companies for Diversity® list.

Turner reports that 22 percent of its work force and 28 percent of all new hires were Black. The media company spends 25 percent of its advertising budget at media aimed at multicultural people, including Blacks.

No. 2: Darden Restaurants, one of DiversityInc's 25 Noteworthy Companies in 2008.

Chairman and CEO Clarence Otis Jr. is one of five Black CEOs in Fortune 500 companies and also sits on the board of Verizon, No. 1 in the Top 50 this year. One-third of Darden's board of directors was Black, compared with a national average of 8 percent, according to Executive Leadership Council.

No. 3: McDonald's

The fast-food chain spent more than 40 percent of its procurement for Tier I (direct contractors) with minority-owned businesses. Blacks were 20 percent of its work force and 28 percent of its new hires.

No. 4: Wachovia, No. 14 on the Top 50. Also No. 4 on The Top 10 Companies for Recruitment & Retention and on The Top 10 Companies for Executive Women and The Top 10 Companies for LGBT Employees.

Wachovia's dominance in human capital is evident. The bank reported 21 percent of its work force and 31 percent of new hires were Black. Fifteen percent of managers were Black, but 19 percent of management promotions went to Blacks.

No. 5: Bright Horizons Family Solutions, No. 41 on the Top 50.

This company, on the Top 50 for the first time this year, reported that 21 percent of its work force and 23 percent of new hires were Black.

No. 6: Macy's, No. 39 on the Top 50. Also No. 7 on The Top 10 Companies for Recruitment & Retention.

The retailer, very strong on human capital, reported that 20 percent of its work force and 23 percent of new hires were Black.

No. 7: General Motors, No. 44 on the Top 50. Also on The Top 10 Companies for People With Disabilities.

General Motors, which has a strong employee group for Blacks, reported that 13.5 percent of management promotions went to Blacks.

No. 8: Kaiser Permanente, No. 43 on the Top 50. Also on The Top 10 Companies for Executive Women and The Top 10 Companies for People With Disabilities.

The board of directors was 21 percent Black at this healthcare company. Kaiser also has a commitment to its minority-owned suppliers, spending almost 6 percent of its Tier I (direct contractors) procurement budget with minority-owned businesses.

No. 9: Sodexo, No. 12 on the Top 50. Also No. 3 on The Top 10 Companies for Recruitment & Retention and on The Top 10 Companies for Latinos and The Top 10 Companies for People With Disabilities.

This first-rate diversity company, which has very strong employee groups and metrics, reports that 26 percent of its work force and 28 percent of new hires were Black.

No. 10: Cox Communications, No. 6 on the Top 50.

The media company noted that 15 percent of its managers are Black and 16 percent of its management promotions went to Blacks. Of all its women managers, 19 percent were Black and 22 percent of promotions to women managers went to Black women.

SOURCE: Diversity Inc.

long enough to at least dump you on skid row if they get sick of you and your petty little illness. 

There is a commercial on TV now with an old dude...but you don't know he's old at first.  There is a snappy song, (one of those feel good soul songs from the 60's) and a pair of feet wearing snappy shoes, Chuck Taylors with some equally snappy socks.  The feet are happy feet....walking, trolling and dancing and occassionally kicking their heels up in the air with glee.

Then the camera pans up the body and you find out it's an old man and he's really happy cuz he's walking the streets after having been treated by Kaiser Permanente.  First of all; did they JUST treat him...like five minutes ago and then dumped him off on skid row or the MacArthur Park area...the neighborhood eerie-like reminded me of both or at least one of those hoods.  Hmmmm...then the song continues to tell us that he's gonna live forever and ever...(kind of like in Fame...without the performing art school)...

He is smiling and waving and doing acrobatics...now the acrobatics is a bit far...I mean, dude, simmer down...you just left Kaiser permanente; let's not get too nuts and have you go back for more medical care.  By the way; what meds did they give you...??  No one leaves any hospital especially a crappy like like KP and is filled with that much glory and jubilance.

I also must add that it's ironic that Kaiser permanente is bragging about keeping people alive when they are so well known for killing people...letting them sit around, croak and most importantly of all; mistreating and beating up the patients.  Hmmmmmm....good job keeping them alive...I figure that their staff must think; if they can sustain our beatings, lets throw em back on the street...they can endure anything and this fucker ain't dying anytime soon..let's not waste our time on him.  He can fend for himself.  Let's give him some fancy sneakers, put a Richard Simmons pair of shorts and tank top on him and a headband and send him out into the streets to sing the praises of our downtrodden reputation we have for killing old people.   He's old, he's alive...stop your bitching Americans...

The very end of the commercial; this old man who has been bopping about all excited to be alive because Kaiser Permanente didn't kill him (which is a more accurate assessment of the situation...he's happy NOT cuz they kept him alive...but because they did NOT KILL him like they normally do and he actually made it out alive...who cares if you're on skid row...you're alive and out of KP, damn it...sing sing sing...even do some crip walking if you are extra thankful)

I digress...at the end of the commercial...he jumps up in the air...and then comes down and does the splits...the Chinese splits...oy vey!  Then the commercial is done.  WAIT, you mother fuckers...you know if he made it out of KP...he's going back...god knows he suffered from some serious sciatic nerve damage after that manuever...that is not safe for anyone who hasn't stretched properly...let alone an old man who just got out of the hospital...he's going back to KP...hopfully he can get out alive this time; but I doubt it...that will be the last commercial you ever see him in again...

Also slightly curious if this is their new way of making old people pay their hospital bill...Free medicare for everyone...but first you have to wear a monkey suit around skid row and sing and dance and do dangerous acrobatics...If you live through the stunts, rampid gunfire, muggings, and the Chinese splits at the end of the commercial, after jumping 30 feet in the air with your fancy sneakers; then we are square, your bill is null and void.  We do however, still own your soul and those Chuck Taylors we let you borrow for the commercial shoot...please return those by 5pm this evening...

Checo el buzón y veo el asunto de un mensaje: "¡Aguas, panzones porque se pueden volver locos!".

Lo abro y dice: "Una organización de salud revela que, de acuerdo a un estudio que hizo, los mayores de 40 y que están panzones están en peligro de sufrir demencia cuando cumplan 70".

El texto continúa diciendo que Kaiser Permanente realizó un estudio cuyos resultados evidencian que hay una relación directa entre la circunferencia de la cintura y el riesgo de demencia.

Según Rachel Whitmer, la autora de la investigación, el estudio de la obesidad abdominal en una persona de mediana edad puede ser un indicador de disfunción metabólica que, por ende, conduce a un riesgo alto de demencia.

El estudio fue dado a conocer por la revista Neurology. En el mismo, la Dra. Whitmer dijo que "el nivel de adiposidad abdominal en adultos de edad avanzada tenía una vinculación con la atrofia cerebral".

La muestra examinada fue de 6 mil 583 personas de entre 40 y 45 años.

Conozco al menos dos que ya les dio...

Looks like it.

This is what a study of Kaiser Permanente patients found:

Middle-aged people with excess visceral fat - usually apparent in the thick waist or pot belly of an apple-shaped body - are nearly three times more likely to suffer from dementia in their 70s and 80s than people with little to no belly fat.

Are you an apple or pear?

People with pear-shaped bodies tend to carry most of their weight below the waist, in the hips, buttocks and thighs.

People with apple-shaped bodies carry their weight around the belly –that big lump on top of your stomach that makes it hard to see your shoes, much less tie them.

People with apple shapes are at greater risk of having too much visceral fat surrounding internal organs deep in the abdominal cavity. That even applies to thin people with a small pot belly.

Rachel Whitmer, PhD, a research scientist at Kaiser's Division of Research, said they don't yet understand why visceral fat is particularly dangerous, but the fat is metabolically active and doctors think it may release toxins associated with atherosclerosis, or plaque build-up in the brain that shows up in people with Alzheimer's disease.

The good news is that you can lose this fat by doing the usual stuff.

Eat less and exercise more. It’s probably worth it to keep your wits about you when you’re older.

The study was published today in Neurology, the journal of the American Academy of Neurology.

You can read more in today’s San Francisco Chronicle.

And if you’re looking for an excuse to avoid losing that beer belly, here’s an article on the BBC News web site that argues it could be caused by the genes you inherited. Blame your grandpa.

Speaking of keeping your wits, you can test them out on these puzzle games at our web site: Braingamessoftware.com.

Recycling medical devices labeled for single use is legal as long as certain Food and Drug Administration guidelines are followed. But the practice, which involves shipping devices to reprocessing facilities to be cleaned, sterilized and tested for reuse, has raised concerns about safety. Medical device makers say their single-use products are just that, and pose a higher risk of failure and harm when recycled. Reprocessing companies, hospital associations and environmental groups counter that the devices they reprocess are as safe as new thanks to modern sterilization methods, cost 40% to 60% less, and can eliminate thousands of tons of waste from landfills.

In January, after reviewing eight years of FDA data, the Government Accountability Office weighed in with a report concluding there is no evidence that reprocessed single-use devices create an elevated health risk for patients. About 100 devices -- just 2% of all devices labeled for single use -- are now reprocessed.

But while the GAO report tilts the debate strongly in favor of reprocessing and opens the door to more widespread use, device makers are sticking to their guns. They are lobbying in several states for legislation that would require health-care providers to obtain "informed consent" from a patient before using a reprocessed device during a procedure. Utah already has approved liability protections for original equipment makers, and other state bills include measures that would free original manufacturers from liability if a reprocessed device fails and causes injury or death.

Device makers maintain that their products labeled for single use aren't designed to hold up to harsh sterilization chemicals and processes. Even when the devices are sterilized, blood, tissue or other bodily fluids on porous surfaces and in tiny crevices could allow transmission of viral and bacterial infections, they say. In general, "single-use devices present an increased safety risk to patients because they are designed for optimal performance and safety in a single patient," says Tara Federici, vice president of technology and regulatory affairs at AdvaMed, a trade group that represents leading device makers.

For example, heart stabilizers, the devices used to position a beating heart during surgery, have hollow tubes and other parts that device manufacturers say could harbor blood and tissue and become weakened during reprocessing in ways that might not be evident during inspection. A study by the University of Minnesota of stabilizers made by Medtronic Inc. found that while new devices showed little or no manufacturing debris, a majority of reprocessed devices had corroded parts and traces of human hair and protein, bringing into question the effectiveness of the reprocessing efforts.

Last year, the FDA began requiring that reprocessed heart stabilizers undergo more rigorous premarket clearance reviews, and a Medtronic spokesman says the company plans to repeat the tests to see if the more stringent requirements improve performance. Until then, he says, the company stands by its position that the devices can't safely be reprocessed.

The Association of Medical Device Reprocessors, a trade group whose members reprocess the majority of devices, counters that it recycles only products made from rigid, hard metals or durable polymers and plastics that can safely be reused between two and five times, depending on the device. The group has petitioned the FDA to require new heart stabilizers to undergo the same premarket review as reprocessed ones, because the device itself is high-risk. Since 2001, the group notes, there have been 73 adverse events reported to the FDA involving devices used to stabilize the heart, including incidents in which pieces have broken off and fallen into the chest cavity.

Dan Vukelich, president of the group, says reprocessed devices can be safer in some cases because each must be inspected before reuse, while original manufacturers test new devices only in batches. He also contends that device makers label many products as single-use merely to be able to sell more new devices to hospitals and thwart competition -- a contention that medical device makers dismiss.

About $31.5 billion of single-use medical devices are sold annually in U.S. hospitals and surgery centers, of which around $150 million are recycled, according to Ascent Healthcare Solutions, a leading reprocessing company. John Grotting, Ascent's chief executive, estimates that about $3.6 billion of single-use devices are safe for reprocessing, which could save the health-care industry about $1.8 billion a year. Ascent hospital customers eliminated about 1,684 tons of waste from their local landfills last year, a 31% increase over 2006, by using reprocessed devices, Ascent says.

Mr. Grotting says reprocessed devices are as safe as new ones. Of 65 events reported to the FDA from October 2003 to July 2006 involving or suspected to involve reprocessed devices, the device was just one of several possible causes of harm, and the adverse events were of the same type reported for new, nonreprocessed devices, the FDA found.

Manufacturers began labeling more products as single use starting in the 1980s, partly in response to concern about the spread of infectious diseases like AIDS. Single-use items such as tongue depressors, bandages, adhesive tape, urinary catheters and breathing tubes are discarded after one use. FDA-approved reprocessing, with sterilization methods that would result in only a one-in-a-million chance of a contaminant surviving the process, is very different from cases such as a recent outbreak of hepatitis C in Nevada traced to the reuse of unreprocessed syringes.

But hospital administrators and other experts say many products such as saw blades that were historically designated as reusable now carry single-use labels, with no obvious difference in the product.

"Single-use labeling is a real scam for a lot of devices, and by not using reprocessed devices where possible it is wasteful and not environmentally responsive, since these items have to be disposed of as biomedical waste," says Kenneth Kizer, a consultant and former undersecretary for health at the U.S. Department of Veterans Affairs. "The reuse of medical devices that are labeled for single-use only is a well-established and safe practice regulated by the FDA and utilized by most of the top-ranked hospitals in the country."

Dr. Kizer testified last year at a congressional hearing that the VA could save up to $30 million in 2008 by using reprocessed medical devices. The VA, with 153 hospitals, has had a longstanding policy against the use of reprocessed devices on the grounds that it can't determine if they are safe, noting that manufacturers didn't design them to be used more than once and don't provide instructions on cleaning and sterilizing the devices. A spokesman says the VA reviews the policy from time to time but has no plans to change it at present.

The FDA has stepped up its oversight of reprocessing, including more plant inspections, after new legislation in 2002 began requiring devices to be labeled if they are reprocessed. The FDA says it is working on a new strategy for monitoring and communicating information about reprocessed devices, and conducting research on "acceptable" single-use device-cleaning criteria.

AMDR, the reprocessing group, is fighting efforts to require that patients go through formal informed-consent processes. Mr. Vukelich says informed consent is meant for experimental treatments and clinical trials, and not for devices that are legally marketed and approved by the FDA. For patients, however, it may be reassuring to ask physicians whether a reprocessed single-use device will be used during an invasive procedure and what steps have been taken to ensure it carries no additional risk

Oakland, Calif.-based health-care giant Kaiser Permanente started working with Ascent to reprocess single-use devices more than a decade ago, and sharply increased its use of reprocessed devices in 2006. Dean Edwards, vice president and chief procurement officer, says Kaiser shaved about $3.5 million from its device costs in 2007, and eliminated about 45.7 tons of medical waste.

At Catholic Healthcare West, the nation's eighth-largest hospital system, a wide range of medical devices labeled as "single use" are reprocessed each year. Last year, the San Francisco-based concern figures it reduced waste volume by 41 tons and saved $1.8 million.

"The safe use of these reprocessed devices helps us conserve resources so we can be more cost-effective in delivering care" says Sister Susan Vickers, vice president of community health. "And we are diverting significant amounts of medical waste, which definitely benefits our planet."

I don't want to get rid of him. I also don't want to get evicted. So...yeah. I asked if my friend would adopt him, but she said no, so I've turned to freecycle. I really, really don't want to take him to the shelter. There is not a "no kill" shelter around here at all. No cat rescue groups, either.

Its a sad day today.

We are getting ready to go to DD9's oncology appointment. DD11 is going to stay home. I don't relish driving to Fontana, but Kaiser is better than the other health plan, so off we go.

Dr. Preston Maring, of Kaiser Permanente gave the keynote address on Monday. Maring started the farmers market at the Kaiser Permanente Medical Center in Oakland for the benefit of employees and visitors to the center where he is associate physician-in-chief. Kaiser Permanente facilities now have 30 farmers markets in six states.

A regular farmers market shopper for years, Maring promotes local markets from his belief that “what people eat makes all the difference in the world” to their health. Conversely, he said, “the effects of bad diet go way, way downstream in the health care system.”

The markets provide outlets for local growers and according to surveys of employees who shop the markets have increased fresh produce in their diets. Seventy-one percent said they have increased their use of fresh fruits and vegetables since the opening of the markets at their workplace. Sixty-three percent also said the availability has led them to experiment with at least “a few more kinds of fruits and vegetables”.

Kaiser Permanente is also working to change the image of “hospital food”. The company worked with Community Alliance with Family Farmers to analyze their food system. The results showed that while 10% of their purchases were for fresh produce, there had been no regard for local purchasing or seasonal freshness. “Kaiser Permanente was buying its food out of season and shipping it from all over the place,” Maring said.

Maring credits CAFF and Growers Collaborative with enabling Kaiser Permanente to turn that situation around. Under the CAFF umbrella, Growers Collaborative works to assist small farmers in supplying produce in sufficient amounts to serve institutional buyers. In 2006 Growers Collaborative provided 25 tons of fresh food to Kaiser Permanente. In 2007 that amount grew to 60 tons.

And patients have noticed the difference in food quality, Maring said, “When they get that little fresh peach on their tray… it brings back memories of their childhood.”

The association of Growers Collaborative and Kaiser Permanente has also helped open the door to other institutional users. Berkeley City Schools, UC Berkeley, UC Davis, and Stanford have all started using local produce supplied through Growers Collaborative.

Maring plans to further encourage the local supply line by expanding the use of local produce into the company’s employee and visitor cafeterias. For employees who don’t have time to shop the markets themselves, plans are being made for a CSA-type service to bring a selection of “the best of the market” to subscribers for a single price.

Maring believes that local growers selling to local eaters provide both an economic and a health benefit, and encouraged growers at the conference to continue their efforts. “What you grow is the fundamental, bottom line, most important factor for the health of our communities,” said Maring.

Dr. Maring also enjoys cooking at home and publishes Dr. Maring’s Farmers’ Market and Recipe Update. Find it on the web at www.KP.org/farmersmarketrecipes

Thanks again to farmer Bill, here are more interesting reports available from the conference ....

CSA report from SFC.doc 23K View as HTML Open as a Google document Download

BusTourHoopHouse.doc 26K View as HTML Open as a Google document Download

From a CDC document:

Morgellons is an unexplained and debilitating condition that has emerged as a public health concern. Recently, the Centers for Disease Control and Prevention (CDC) has received an increased number of inquiries from the public, health care providers, public health officials, Congress, and the media regarding this condition. Persons who suffer from this condition report a range of coetaneous symptoms including crawling, biting and stinging sensations; granules, threads or black speck-like materials on or beneath the skin; and/or skin lesions (e.g., rashes or sores) and some sufferers also report systemic manifestations such as fatigue, mental confusion, short term memory loss, joint pain, and changes in vision. Moreover, some who suffer from this condition appear to have substantial morbidity and social dysfunction, which can include decreased work productivity or job loss, total disability, familial estrangement, divorce, loss of child custody, home abandonment, and suicidal ideation.

As of February 2007, approximately 10,000 families had registered with the Morgellon’s Research Foundation (MRF) and felt they or a family member met criteria for Morgellons as defined by the MRF. Of the U.S. families in the MRF registry, 24% reside in California with geographic clustering in the San Francisco metropolitan area.

The etiology of this condition is unknown, and the medical community has insufficient information to determine whether persons who identify themselves as having this condition have a common cause for their symptoms or share common risk factors. An epidemiologic investigation is needed to better characterize the clinical and epidemiologic features of this condition; to generate hypotheses about factors that may cause or contribute to sufferers’ symptoms; and to estimate the prevalence of the condition in the population; and to provide information to guide public health recommendations. A contractor is needed who can provide timely services to assist the CDC in the investigation of this emerging public health problem. [CDCP document]

]]> http://riversideliving.wordpress.com/?p=110 Wed, 13 Feb 2008 23:43:33 +0000 riversideliving http://riversideliving.wordpress.com/?p=110 Ugh I have a nasty laceration with 9 staples on the top of my foot.  I went to Kaiser's urgent care and they hooked me up quick.  Of course, I was bleeding A LOT and nearly fainting while waiting in line.  Everyone was nice, including a concerned couple who gave up their seat for me and a nice lady who wheeled my sorry ass outside to the curb.

I'm supposed to not walk at all for 3 days and then use crutches for a bit after that.  I think I'm going to develop a drinking habit (ha, as if I don't have one already) and watch my neighbors out my upstairs bedroom window a la "Rear Window" and "Disturbia".  Oh snap, I can't climb my stairs.  I guess the drinking habit will have to suffice.

Thanks Kaiser staff.  Many <3s.

New meme? Link to official Semi-Pro site. Link to Kaiser Permanente.