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Archive for the ‘Message from the President’ Category

US Health Care Needs a Major Paradigm Shift from Government-corporate Cartels to Consumer Control

Wednesday, March 21st, 2018

Since the Minnesota Physician-Patient Alliance (MPPA) was founded in 1997 we’ve witnessed a steady and alarming flight of physicians from private, independent medical practices along with increasing government control of the US health care system. Managed care cartels of consolidating hospital-clinic- insurance organizations with all physicians as corporate employees are indeed a dire forecast.

In the meantime, most professional organizations like the MMA and AMA while also losing membership numbers have become advocates of the business interests of large health care organizations. Who supports practicing physicians and their patients today? The stalwart Association of American Physicians and Surgeons (AAPS) remains a beacon of hope for independent medical practices . And now here is a new organization called Practicing Physicians of America

A major paradigm shift from corporate-government control to consumer control is necessary. Americans could have an Amazon-like internet access to the prices of medical services, products, medications, and a variety of health care insurance policies. Yes, a real US health care marketplace will open the door to innovative medical practices and research. But to make this a real possibility for patients and physicians, individuals must take charge of owning and controlling our personal medical information. The technology permitting patients and families to do this already exists, since (almost) all of us have a smart phone or computer able to accommodate, for example, Microsoft’s HealthVault,2817,2473749,00.asp

The following article helps make the case for consumer (patient and family) control of our personal medical records and health care. When we receive (or bargain for) medical care in a clinic or hospital clinical data generated from our case can be easily transferred to our control. Then we’ll have real time medical records portability.

A truly competitive US marketplace for our health care services and insurance requires that we can shop online for health care services and insurance coverage and control the use of our clinical information.

This is the American way.


Why Your Doctor’s Computer Is So Clunky
Washington mandates Electronic Health Records but stands in the way of innovation.

By Marion Mass and Kenneth A. Fisher
March 20, 2018 6:31 p.m. ET 128 COMMENTS

The Trump administration this month announced its own effort to update the Electronic Health Record systems, which disrupt the doctor-patient relationship. The government could do even more good by deregulating EHRs, establishing a free market for user-friendly products. Perhaps Amazon, through its partnership with JP Morgan Chase and Berkshire Hathaway , could eventually do for medicine what it’s done for retail.

EHRs were forced on the health-care community by the 2009 stimulus. Congress has allocated $37 billion so far to help providers upgrade from mostly paper files. Nearly a decade later, the promised efficiencies and savings haven’t materialized.

Instead, EHRs divert doctors’ attention from patients. Physicians often rely on visual cues when taking a patient history, but now what’s visible much of the time is a computer screen. The outdated EHR technology is difficult and time consuming, contributing to doctors’ stress and burnout. The unintuitive interfaces consist of multiple drop-down menus and forms as well as countless boxes to check and pages to navigate. The screen often freezes. It takes seven clicks to order basic antibiotics, 14 clicks to order stronger ones. It’s death by a thousand clicks, and it’s killing the medical profession.

We physicians have the longest training time of any profession, yet we now spend roughly two-thirds of our workday as data-entry clerks, tending to digital paperwork and administrative burdens. A Johns Hopkins study finds that paperwork requirements have significantly reduced the amount of time new doctors spend at patients’ bedsides, limiting their clinical skills. EHRs are also contributing to doctors’ taking early retirement. According to a survey published in Medical Economics, two-thirds of doctors dislike the functionality of their EHRs. Even more say the conversion to EHRs has not been worth it.

Why Your Doctor’s Computer Is So Clunky
The clunky EHR systems distract us from the thinking necessary to make diagnoses. A Harvard-affiliated study found that 147 times in roughly 5,700 cases, EHRs contributed to “adverse events.” Half were serious and one-third fatal. The ECRI Institute, a patient-advocacy group, designated EHR hazards as the No. 1 patient-safety concern for 2014. An example from the front lines: Clonidine, a blood-pressure medication, sometimes gets prescribed instead of Klonopin, a seizure drug, because medical professionals click the wrong box.

EHRs fail to achieve one of their main selling points, interoperability—the ability to share records across providers and systems. Competing systems are generally incompatible with each other. A 2016 KLAS Research report finds only 6% of health-care providers say they can effectively access EHRs between different systems. Thus patient records still must be faxed among providers. It’s like having a computer that can’t connect to the internet.

Why are EHR systems so primitive? Partly because vendors must be certified as compliant by the Department of Health and Human Services, inhibiting better products and insulating existing ones from best-in-tech competitive pressures.

This market protection leads not only to lower quality but also higher prices. EHRs are extraordinarily expensive, with taxpayers, providers and patients footing the bill. For private hospitals, EHR conversion costs anywhere from $40 million to $353 million. Individual physicians spend an average of $32,000 a year on upkeep. All these costs are ultimately passed on to patients.

In announcing the Trump-administration initiative, White House aide Jared Kushner and Seema Verma, administrator of the Centers for Medicare and Medicaid Services, said health-technology companies, insurers, doctors, hospitals and patient groups have been working together for six months on an initiative called MyHealthEData to modernize EHRs and achieve interoperability. But the usual suspects can only do so much. This is a market begging for competition from the likes of Amazon, whose cost-cutting and ease-of-use expertise is well established. Apple has also made a welcome entrance into the market. The administration can help by directing HHS to allow EHR competition.

Doctors and patients deserve cutting-edge technology that would offer such features as wearability, automatic audio and photo uploading to a digital chart, encrypted cloud storage for easy access, and compatibility across platforms in different locations. These features are already available at relatively low prices in consumer products.

Ultimately, EHRs must enhance the doctor-patient relationship, not impede it. Sounds like a task for the Everything Store.

Dr. Mass is a pediatrician. Dr. Fisher is a nephrologist and author of “Understanding Healthcare: A Historical Perspective.” They are, respectively, a co-founder and an advisory board member of Practicing Physicians of America.

Appeared in the March 21, 2018, print edition.

Addressing the Opioid Death Crisis

Thursday, February 1st, 2018

The hospital emergency department (ED) is not the proper setting to do an in depth assessment of a patient’s future needs and provision of ongoing medical or psychiatric or addictions care. This is particularly true for assessing the diagnosis, impact and treatment of chronic pain conditions. And the ED is certainly not the preferred venue for establishing a trusting doctor-patient relationship; at best, it may be a start. But it takes two to tango. And what is the next step? Emergency Medicine in the Age of Managed Care has, for various reasons, become the default “provider” for many too many medical assessments. The ED doc is in the necessary business of triage.

EHRs are no panacea. Calls for alerts and stops on the electronic chart may be OK, but they often lead to CYA (defensive medicine) and patient abandonment. Limiting ER dispensing to ten opioid pills might help, but the real question is what happens to the patient next. Followup? Stigmatizing patients and doctors is not the answer. Crying wolf and putting Prince on a plane? Yes, patients do have rights, I know. But as all parents know, sometimes intervention is necessary.

The Minnesota Prescription Monitoring Program is a valuable tool. Its use should be enthusiastically promoted. In my addictions practice I’d use it as a tool to put data on the table and discuss plans with the patient. PMP registry is a recent requirement for Minnesota medical  licensure. This is good.

Opioid deaths in Minnesota continue to rise.  Obviously this bad situation has both supply and demand dimensions. But physicians and pharmacists are being blamed inordinately. Drug advertising is ubiquitous. And of course pot (both medicinal and recreational) is viewed in the media as a a different matter. We need a lot of education and common sense. And patients and families are key in endorsing (or not) all drug using behaviors.

Two Minnesota experts on effective primary care relationships with patients understand its value for pain management, and also the limited ability of the ED in reversing the current “opioid epidemic.”

Dr. Scott Jensen ( ) and Dr. Wayne Liebhard are two physician authorities on the marginalization of Minnesota primary care, and they authoritatively write about it. They wear both the hat of a primary care physician who espouses professional relationships and alliances with his/her patients and also (in recent years) emergency room physician. Many well trained primary care doctors have become ED doctors due in large part to the lack of administrative support and payment for relationship-based primary care services in Minnesota’s managed care clinic and health insurance systems. Dr. Wayne Liebhard wrote  The Vortex Effect and Elephants in the Examining Room

Below are two articles (perhaps) linking opioid prescriptions (for pain) to Medicaid funding. The argument goes that economically challenged patients on Medicaid have a heightened incentive to sell their prescription opioids on the street. And criminal drug dealers entice them to do so. yet, rich, white suburbanites are dying at high rates. See:


Prescribers allow too many (opioid) pills before individual patients are properly evaluated and treated.  And as a condition of further treatment. The ED is not the best venue to do such evaluations. Funding for addictions treatment is insufficient in Medicaid and other third party pay, almost always program-based rather than patient-centered, programs funded by Medicaid are not properly evaluated and compared for their effectiveness (cost-effectiveness), and demonstrated continuity of relationship-based, patient-centered pain and addiction care with qualified personnel is not currently the key to funding care by third parties.

Pain clinic physicians have been unfairly targeted as opioid enablers.

Opioids will be a political issue in 2018. We should empower patients with money, information, and sound health care choices. I had a lot of Medicaid people who paid cash to see me and get on track reversing opioid dependency. Carfentanyl Law enforcement? Yes. Yes.

Both supply of and demand for opioids must be addressed.