Fixing The Healthcare System Cheaply!

This is a story about an ununited America, an America dictated to by those who chose profits over people. It is a story  about how those profiting are destroying our health and health care system It is also a story about how easily this can be rectified as suggested by a very creative lady named Phen who attended at a meetUp for intellectual conversation that I hosted.

The story:  People in America feel alone and in pain because they cannot feel part of something that they are told is their enemy by the news media, America. Media makes us think we live in a terrible country with lots of intolerable problems and dangerous leadership. In reality we are great country with lots of hope. Look around and notice that this is a great county because we are so much different and so much better than other countries whose people are refugees fleeing everywhere they can, like here. Remember people from all over the world still come to our shores for the opportunity of freedom. We’re still the place that everyone dreams of coming to when they are always looking for for a better place to go to; but, this is not to say that it cannot be better. This is the beauty of America, we are free to change it by peaceful process, if we take pride in the American Dream.  To restore America strength means to restore belief in America and the joy our people have in being here. What we need in a leader is someone who can restore our faith for way JFK did.

To do this we need a media that will stop fighting the president and destroying our image of America which is exactly what the Communists have hoped to do.  It’s time to give Americans hope again and a belief that what they working for is a future for their families and God’s dream of peace on Earth through love and respect. It’s time to give people back their pride in America.

Why am I writing this? Because I’m tired of feeling like I must go it alone and like I must make everything work on my own because America is not working for me.  Most Americans feel alone they don’t feel part of a team thanks to the media.  We need to establish the word team again.  Pride, love, happiness, satisfaction, dreams, a desire to work, a desire to achieve all comes from one thing,  believing you’re part of a team that makes a difference.  It’s about Not believing that it is all on your shoulders or hopeless.

How does this connect to healthcare?  The big corporations that are making America sick are using the media to make money by selling people on “fake foods”  that make Americans sick (high carb foods, food with bad fats, foods with fructose).  We all know that the “junk” food advertised night and day over media is killing America.  A few years back the carbohydrate food kings of American “fake food” met and agreed that they were killing Americans and that something had to be done. Then they decided not to do anything as it would affect their profits.  They don’t want to stop peddling their junk that causes, diabetes, strokes, cancer and heart attacks on TV or other media.  So the answer is simple. Ban it!

We banned tobacco advertising and everyone knows why, Cancer.  We can similarly ban ALL food advertising on TV.  Do you really need an add to tell you to buy a carrot or fish? No way, you know food when you see it. You only need an add to sell you on “Captain Crunchies Sugar Coated Fat Balls” for breakfast.

Ban Food Ads! How about saving lives, saving the health care system’s disastrous costs and saving our children’s health. It’s easy, ban all food ads from our media and while we’re at it, ban all drug ads just as they do in many other countries.  Just do it across the board so we treat all of them equally.

What would happen?  People would by foods that they can recognize.  People would buy foods that the hear about by word of mouth.  Quality would count, not brainwashing your kids to scream if they don’t get to Micky Dees 3x a week! While we’re add it tell the supermarket to stop playing the same game and get the candy aisle out of the checkout zone.  We don’t have to charge extra for sugary food.  All that does is help pay some money for the surgery that junk food necessitates.  An ounce of prevention is worth a pound of taxes.  Listen to Phen, ban junk food and drug advertising now!

- This message is brought to you by rational people who don't 
want to see their neighbors lose their legs and arms to diabetes.

 

Advertisements

An Inspiration For Living Lonely Moments In Paradise!

When the plane landed in Fort Lauderdale Florida, the pilot announced “Welcome To fishing-518775_640Paradise!”  I was excited about the pilot’s vision, which seemed at first to be mine; but, concerned about what I was running away from,  what I was losing and how empty it might feel to be without contact with everyone I had known for so long!

I had sold my practice, my home, and nearly everything I owned to move to Florida. I had given up a handful of treasured friendships, a huge number of fun acquaintances and over 12,000 patients, many of whom I knew by name and personal history for nearly 40 years.

I flashed on visions of the forest of friendships I had just willfully been transplanted away from. bamboo-142635_640For moments these thoughts made me imagine images of being a space traveler marooned on a distant, beautiful but alien unpopulated planet, perhaps Mars.

As we drove to our new home using a navigator to guide us along unfamiliar roads,  I thought that I felt for moments like the character in the story “The Martian” must have felt. Had he felt lost, lonely and wondering what tomorrow would be like as I did now? There was a big difference, of course,  from the situation of that of “The Martian” in that we were surrounded by people and a safe environment but what about my soul’s environment?   Like the Martian I had lost all that makes living life meaningful such as the relationships, trust, respect and common history. I had lost what had grown up over many years as a forest of “friendships” with different degrees of nomenclature like casual, personal or family.  More than that I had given up my relationship with my community, my practice of Holistic Eye Care, something I had invented, nurtured and grown into a giant tree.  One so strong that it had survived the financial  storms of 3 major recessions over nearly half a century.

It made me wonder what forces had created such momentum that I had been willing to leave the beautiful creation of a lifetime that had for some reason now become toxic? Something I occasionally viewed as a wasteland of destruction. oradour-sur-glane-1635802_640There was a lot to think about.  There is also no simple answer.  Some have tried such as the book “Who Stole My Cheese?”  But I was not looking for a description of change I was looking for socio-economic forces that had reshaped and redefined my world. Seven months later I think I have found it. I am a sci-fi writer because I am always searching for answers to question such as:  what is it that creates or destroys civilizations?  Why destruction and creation are so intimately intertwined? And finally does it have to be so? My own experience was now helping better define these questions and paint images of possible answers.

I think that the catalyst of the torrentuous socio-economic forces, that I had experienced so recently, might be described as the loss of responsibility and connection between the people that hand-1917895_640make up a civilization.  I thought back on 40 years ago, when I first moved to Brewster in upstate NY, where my office had been.  I recalled a farmer who had walked 3 miles to my office for his eye exam because he said, “It did not warrant starting his truck just to drive 3 miles.”  Times were different then. It was not that he walked so far so casually and so unpressured by time, that was just a description of what had changed since then. That was just a flavor of the essence of the ethos of that era that you could easily taste.  What was so different was that this farmer would soon know me by name as he did hundreds of the other people whose lives he touched every day!  Keep in mind the phrase “whose lives he touched.

40 years ago as I started my practice, I became enamored with the people  I served quite quickly. Apparently they with me too.  Six months after opening my doors to what I expected to be a weekend, part time practice, I was working full time.  I had to give up my other two part time offices. The force that made this change was the large families of  Irish and Italian heritage Americans who were soon to become my extended family.  They got to know me personally, like me and trust me. With that relationship, the whole family had to come see me and eventually most of the town.  We were all in this life together!

What changed 40 years later to make me move and give it all up for a promise of paradise but a loss of family?  In my opinion, the essential force is the loss of connection between people and the loss of responsibility for your actions or inactions.  From the viewpoint of my profession,  we saw the destruction of the doctor patient relationship created by the third party payors.  When people came to me 40 years ago, the service was thorough, affordable and easily paid for in cash.  When I left, the service was more mechanized, far less personal and no longer affordable in cash.  In fact is is the biggest disaster of American health care history.

I believe in the system of free enterprise and capitalism (with some caveats).  It has certainly worked for me for a long time. I believe that the strength of any economy is small business and entrepreneurship. Why?   Because I believe that it is the knowing of your outsource-1345109_640clients and responsibility to your community that keeps you on the straight and narrow path.  The path that for many American’s is defined on Sunday Mornings under the multicolored shafts of light falling through stained glass windows. Take away this connection and it is easy for Chinese factory owners to adulterate milk or put dangerous materials in sheet rock.  It is easy for Monsanto to create toxic herbicide that will likely soon be proven to have caused cancer in millions of people while rationalizing that they are the Horn Of Plenty that feeds civilization.  It is easy for congressmen to take millions of dollars of bribes while the Wall Street rich devour the lifeblood of America’s workers with carnivorous creations called derivatives (otherwise known as gambling).

Where there is no personal responsibility, there is no community. There is nothing to lose but the smell of fresh minted money and what temporary pleasures it might buy.  IBM, in some ways started this revolution and they became named for it.  IBM stood for “I’ve Been Moved” as in from my family, my home and my community for money’s promise.  We were willing to give up what makes life meaningful for the casino of promises that were  never fulfilled.

Somehow there has to be a way of connecting people to people and make business, its owners and its workers intimately responsible to the communities of people they serve. We must recognize that each of us holds the lives for our country’s citizens in each others hands. Not because it was so warm and fuzzy to be in the community I helped grow with me 40 years ago (though that is a good enough reason) but because otherwise the landscape of vitamins-2002561_640life becomes so toxic that the best of us will leave.  The vast majority of us do not work for money, we work for personal satisfaction, respect and a feeling of self worth, personal value. The majority of employees leave a job not because of money but because they are not treated with respect, listened to and praised for their achievement.

My experience, is that with the creation of self respect by serving a community of people we know, enough money always follows. You also get to share the wealth around if you don’t live in fear of a lack of money to cover expected personal economic crisis.  America has proven this for over 200 years.  “Too big to fail” is not an option, it is a symptom of the bribery and corruption of our government (mostly our representatives) on all levels that allows for a lack of responsibility.   It is enough to make a person run away from their home and seek a new start almost anywhere else. It is something to write about, for me.

I believe in what Walt Disney said years ago, “It is better to entertain with the hopes of educating, then educating with the hopes of entertaining.”   This is my dream and what I hope to inspire in others I get to form a community with.

Janr Ssor

Why Are U.S. Health Care Costs So High?

todd hixonIN RESPONSE TO TODD HIXON,  FORBES CONTRIBUTOR’S ARTICLE:  Why Are U.S. Health Care Costs So High?

Todd, it is amazing how you can collect numbers to justify nearly anything. I am not saying you did that but I wonder why your numbers add up so poorly from my perspective as a doctor and specialist?  Lets look at it from my perspective.

40 years ago when I started my practice as an eye doctor, I made an income a bit above a PCP but only because my practice offered exceptional services and attracted patients from as far away as Sweden (though not many).  With the advent of “Hillary’s” managed care things changed. Little by little,  year by year my income receded, even though my responsibility grew under the pressure of managed care!  However, the prosperity of insurance companies and the size or their staff grew enormously on the profits sucked out of doctors practices.

health-insurance-profitsNothing has changed!  Doctors incomes have drastically fallen when measured on PROFITABILITY rather than GROSS.  I suspect you used gross income,  which is, in my opinion, smoke and mirrors!  When I started practice (very competitively priced always, despite the excellence of my care) I used a box with a crank handle and IBM triple copy paper to write a receipt.  Believe it or not, I could do this “high tech task”  by myself!

Today, my office and that of all other doctors is filled with staff who WE MUST PAY but who really work for the insurance companies!! One person spends an entire day on the phone fighting for crumbs off the table of fees,  another is a data entry specialist who deals with the intermediate companies that transfer data from our software to the insurance companies (so that they may deny payments as often as possible).

We have Tech Staff, sometimes full time or part time,   who provide IT support so we can run the computer systems that the INSURANCE companies outsourced to our offices at NO FEE (How nice for their profits!).

 

We do and must practice defensive medicine as Liberal Courts pay millions when we are proved to be less than God (never noted that designation in my degree by the way). Thanks to Obama and congress we now have EMR,  which surveys show slow the doctor down about 30% (how efficient!).  EMR is updated regularly and creates havoc so severe that doctors take home records and must work late into the evening to fix the crap that bad code dumps on them. Surely with yearly bureaucratic recommendations and insurance company demands, there will no lack of bugs crashing and confusing our work.  We have ICD 10 (the world standard we are told)  to add to our current very complicated system.  This should “really”  speed up exams by adding levels of frustration the already formidable task of reporting everything we do to our overseers at the insurance companies.

 

Oh, yes this is America and we have freedom of choice!  We can pick another EMR vendor….. not on your life!  We have devoted hundreds of thousands of dollars and thousands of hours of training to use the EMR we purchased.  It is a marriage made in hell but mandated By Congress!   This is just a little of Reality that your numbers are blind to!

The newest attack on us, other than your words,  are ACOs and PCMHs. These wonderful tools,  to reward Insurance Companies,  take all the risk out of their business and dump it squarely aco-scared-doctoron the shoulders of doctors who are now supposed to become  actuaries in addition to everything else!  In essence it is HMO’s revisited using Capitation to cut services to patients.  Okay,  supposedly the “big difference” is that we will share records (another layer of expense doctors will pay that will “obviously reduce costs”  as it comes out of the doctor’s pocket).  Doctors dropped out of  capitation years ago, as fast as they could.  Why?  They were tied in for a year, lost money and had to deny care to make it work.  Now it is ” improved”,  the government mandates that doctors get tied in for 3 years.  I wonder why this is motivational?   I always thought Russian Roulette, with one bullet was dangerous but are you telling me it is safer with 3 bullets?

If  business really want to control health care costs and was made of conservative businessman rather than someone who gets elected from insurance company coffers, as congressmen just might, you might create a new accountable care model that made sense to doctors not insurance companies and the congress they help elect.   For Example:   NO EMR,  No insurance billing by doctors, No corporate payments for insurance. Re-Create the doctor/patient relationship and get big corporations out of the middle!   Instead put responsibility in the place where it creates  Real Accountability at the doctor patient level, the patients hands!   Go back to the 80% insurance payments with 20% copays.  Let companies rate patients fees based on how fat the patients are, how much they smoke…etc!  If the child throws up after eating a box of candy, they will learn prudence.  A big insurance bill because you like to eat chocolate truffles, smoke Havana Cigars, and have two Brandies every evening might deter some.   Accountable Care as designed today, is a JOKE!  It makes the doctor accountable for the OBESE patients, who eat FAKE FOOD, made by mass food processors.  People are SICK!  One Third of all Americans are projected to be diabetic in the next 20 years! When 15 year olds come into my office with arteriosclerosis, and diabetes that their parents never had,  THIS IS THE COST OF HEALTH CARE  as well as the OUTSOURCING OF INSURANCE COMPANY TASKS to doctors offices for free!   Fix Health Care Costs?   ASK DOCTORS AND STOP SHOVING YOUR ARM CHAIR THEORIES DOWN AMERICAS THROAT!

Janr Ssor

 

Accountable Care or The Accountants That Took Out Windows To Improve GM Cars?

OBAMACARE /ACCOUNTABLE CARE:  A doctor with years of success and experience told me that “Accountable Care,” the center piece of ObamaCare, is a name created by congressmen who sit live in palatial royalty while their constituents clamor for crumbs! Is that true? The elderly doctor reminded me that theories of healthcare management are nothing but, dreams and hype to sell at election time!  He reminded me to follow the money trail and notice that it paid off those who elected the congressmen, the insurance accountable-care-organizations-lights-cameras-article-3759companies. It did so by putting all the “financial risk” of the experiment on doctors while guarantying the financial rewards to ‘insurance companies.” It was,  he said,  “like legalized gambling in a Casino that rigged the tables.”   It ruined many nights of my sleep because I knew this man and he had credibilty.

CHANGE AS OF 2014: As of the year 2014, a large percentage of ObamaCare is affecting medical practices of all types. The majority of doctors are no longer writing on paper but using EHR (Electronic Health Records).  Tedious, often slow and unreliable for now, it is quickly becoming the legally required standard.  If a doctor doesn’t  use it they will certainly not get paid easily for insurance claims, if at all!  Is this the dreamed of efficiency that saves us money?  Most doctors surveyed said it made their exams 30% slower. They were clearly less efficient!

RUSHING INTO DATA EXCHANGE, THE NEXT PHASE?:   The imagined economy of ObamaCare is an  exchange of data that prevents the current very real duplication of testing that at times exists in medical care.  Not a bad “idea;”  but,  is it likely to work?   Since I am an eye doctor in addition to being a writer, I chose to look at my profession and get a view from my colleagues eyes.  It was not encouraging, at least at this point in time.  Why? It is simple to explain.

EHRs do not contain the full information of complex testing and technology print outs, they currently contain the summaries. So much data of importance is lacking.  On the other hand,  they are bloated with  miles of garbage produced to satisfy the demands of courts and lawyers rather than patient needs!

If a patient has a test that produces many pages of data with images (such as repeat vision fields, which is a tedious and somewhat unreliable test for Glaucoma),  all the pages are almost never stored in EHR records.  Much is stored in the testing machines memory. Furthermore the quality of the  test (as with many tests) may frequently be questioned as the patient may have a bad day,  the technician may have been preoccupied with other issues, and the doctor may have missed something in reading them (they too are human).  If ONE test is the requirement and its detailed pages,  test environment, other related events are not available,  is the currently available “essence” of this whole process all we need to share? Will this create better out comes or more frequent law suits?

There are many other tests used by eye doctors that meet this criteria for failure such as:  OCT (Optical coherence tomography),  HRT (Heidelberg Retina Tomography) all complex imaging tests. Even simpler tests such as: An extended opthalmoscopy,  Biomicroscopy, or Fundus photography! Almost never is the full data store in EHR. As a result, sharing the data between doctors means sharing and duplicating and error becomes highly probable!

ACO AimIn the future as data storage and retrieval becomes more encompassing this significant challenge may be overcome, but for now, rushing into data exchange is only likely to be unreliable and dangerous to doctors and patients!

EXAMPLES FROM A REAL WORLD:  Years ago accountants told GM to take out the operable rear window in their passenger cars and make its opening an “option.” GM mindlessly did this and it cost them a significant bit of their reputation.  Just recently a patient in my office, told me a story of Government Vision and Success!  I was excited to hear this as I felt landing the moon over 40 years ago with no progress of significance since was what I expected of our government.  He told me our congressmen had spent BILLIONS of dollars creating a water treatment plant for NYC.  He told me it would create the best quality water the world had ever seen!  He was enthusiastic about the technology they employed and the excellence his workers had provided in building it.  I was amazed! He then said, “there is one caveat doctor.  After we take this water and make it into the most pristine water the world has ever seen,  it flows out into an open pond on its was to NYC,  where birds shit in it each day.”  Now this is something I can believe comes out of congressmen whose financial liability is nothing like that of private business. They don’t worry about if it works;  but,  they do concern themselves with  who gets paid off!  Does anything work for data exchange?  Sure!  For now if you have the same software in the same facility, yes; with the caveat that you have access to off-line storage in the same machine (that is not on ehr).  So, if you are a hospital or a large medical group, your doctors could exchange some data and get the rest of machines they can access.

What about doctors not in the same group or in a hospital?  Well faxed reports are still viable and work!  When an eye doctor faxes a report to a pcp regarding diabetes or atherosclerosis that information can be incorporated in the PCPs records. This provides better management and better fees as it meets the needs of HEDIS scoring.  It provides better care possibly and in this case the specialist’s input is all the PCP really wants.  Should doctors rush into data exchange software?

Just imagine all the bugs in a doctors EHR software and the I would tell a  doctor, ” ask yourself  two questions:   1) Do you need more bugs and more complexity?   2) If you are in a ACO that will bet its medical outcomes to be enhanced by data exchange, would you tie your financial future into this for 3 years?  Remember capitation?  ACOs are really capitation with not just the very scary dangerous 1 year contracts that doctors dropped like a hot potato years ago  but a much longer 3 year contracts that could do more than burn your fingers!”   The lesson may be:  Don’t rush into anything congress has just blessed or someone is peddling for profit!  Let it prove itself first before you Literally bet your house on it!  We have enough people in bankruptcy in America today!

Janr Ssor.

 

 

 

“Reality Sci-Fi Theater,” A Writer’s Diversion

obamacareReality science fiction (which I have just coined as a name),  is unimagined economic and social forces as devastating as our “Shock And Awe” campaign in Iraq, that are invisible to the naked eye. It is tornado like forces that others see as if they were late fall winds whisking leaves from trees.

As I live outside the box, I see the tornadoes before those inside and so decided to show others the evidence and offer them an opportunity to build and Arc with me and others like me.  So instead of writing Sci-Fi for the last 8 months I have been a  researcher, writer and director,  on stage,  creating  Sci-Fi  Reality Theater performance (one way too real but too sci-fi to be my America.).

As many of you know, I have not posted a lot lately or completed any new sci-fi publication as books.  As some of you know, I am also and eye doctor who has taken a unique challenge in dealing with the impact of ObamaCare on our health care system.

I have led the founding of the NYIPA, a group of doctors forming an Independent Practice Association, IPA.  An IPA could be defined as a  tool that allows doctors to organize as a single groups that provides medical services to buyers.  In my vision it is a tool to help doctors survive the premeditated destruction of all they have worked to achieve,  by the corruption in Washington that has turned America from a Republic into an Oligarchy.  In so doing, I have written miles of text that describes this Reality Sci-Fi Theater as it is being enacted on the streets of our nation.

Here is one of my favorite essays, Peering Over The Professional Precipice,  much of which I stole (with permission) from my colleagues in Ct.

What is the Sci-Fi like reality behind ObamaCare that makes it worth such a diversion from my favorite topic of traditional Sci-Fi?   It is the mass cultural hypnosis that Washington has been able to achieve to get our countrymen to allow a financial give away, much like TARP, to corporations that have underfunded health care and over-funded CEOs.  It is the ability of an Oligarchy to siphon the blood of its civilians while promising weigh loss with no need for dieting.

One of the key features of this charade is EMR  (electronic medical records). Emr is promised as the solution to health care’s inefficiency.  You know what it is as it has replaced your doctor’s attention at all your medical visits over the last few years. It is why you doctor does not know your face when you visit him or her,  but rather a screen full of data that is supposed to be you.  In Sci-Fi EMR will work and in reality it is a give away to insurance companies (who elect the president and congress)  used to turn a doctor’s patient time into free data entry and secretarial services for Insurance companies.

 

The devastating effect of EMR and its accompanying accountable care (ObamaCare)    has inspired my very short story about EMR Terrorism (posted here on a FaceBook group I started),  written for doctors and others,  to help them understand the impact of one missile, EMR, in the Shock and Awe campaign of OmbaCare’s reality show.

Emr Terrorism Book on Smashowrds

For those of you who are curious to read it and don’t love FaceBook here is a link to SmashWords for a free copy of ‘How To Kill Your Doctor For Fun And Profit.”    So you see I have been writing and I did publish a short story.

This short story is just the beginning of a series on how Bill And Hilary’s Great Adventure,  has been recast in the garbs of ObamaCare with the magical pixie dust of EMR to make it seem different.   Make no mistake about it, the tornado you take for a wind, is the rebirth of the failed HMO’s and Capitated health care that died a slow death while destroying the lives of many people back in the ’90s.

So…. this has been my diversion,  Sci-Fi Reality Theater.

Janr Ssor,  (aka Dr Joseph Ross)

 

 

Video

WebMD’s healthy deal with Obamacare: Kind words for law, millions from feds – Washington Times

Two months before enrollment began in the Obamacare exchanges, the administration’s top health care official heaped praise on WebMD for launching an online resource to help Americans navigate the complex law.

PHOTOS: Eye-popping excuses in American political scandals
The consumer health care site had the occasional nice thing to say about Obamacare, too. In one article, it predicted doctors might pick up more patients and crowed in an article titled “7 Surprising Things About the Affordable Care Act” that many consumers already had received insurance refunds under the law.

But what neither Health and Human Services Secretary Kathleen Sebelius nor WebMD mentioned at the time was that the company, which millions of Americans regularly read for health news, also stood to earn millions of dollars from a federal contract to teach doctors about Obamacare.

The contract documents, reviewed by The Washington Times, reward WebMD handsomely. For instance, the fee schedule offers dozens of products, including:

• As much as $126,826 for a single 5,000-word review article on scientific advances in a clinical topic.

• Up to $68,916 for a four-minute video from an opinion specialist.

• More than $140,000 for an eight-question online quiz.

Read more here….. http://www.washingtontimes.com/news/2013/nov/12/webmds-healthy-deal-with-obamacare-millions-of-dol/?page=all

Graves opposes efforts to exempt Congress from Obamacare

Washington, D.C. – U.S. Rep. Tom Graves (R-GA-14) issued the following

Graves opposes efforts to exempt Congress from Obamacare

statement after Politico reported that members of Congress are seeking to exempt themselves and congressional staff from Obama…

via Graves opposes efforts to exempt Congress from Obamacare.

 

It amazes me that Congress can pass a bill that they say is good for America but exempt themselves because it is not good enough for them. This is what helped send Marie Antoinette to the Guillotine.  Hmmmm……… makes me think.