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Is customer satisfaction in healthcare a gateway to corruption?

[preamble] Absolutely correct! Customers aka patients are not always honest on surveys and can be vindictive. Nor can you please everyone. Unfortunately being in business over 25 years, the customer is NOT always right and at times vindictive, deceiving and yes thief’s.
I cannot wait till they begin rating doctors and hospitals – you will lose. Social media with its instant speed of communication right/wrong, true/false will work against you so fast you will not be able to stop it. We existed for quite sometime without surveys and customer satisfaction and the internet – are we really healthier? Will we really save money? and if so how? no one really answers this but the intent is that we the patients are responsible for our health and we will be penalized if we are not healthy![backtopost]

Customer satisfaction is quite the rage these days. Many stores and restaurants, many professional offices, hand out surveys, or ask customers to log onto their survey site on the Internet. As a reward, one may win everything from a free sandwich to an iPad.

I’d be interested to know how customer satisfaction played out in my home. “Kids, now you’ve had a week of school-work. Please fill out the attached survey and give your mom and me an idea how we’re doing. Frankly, if you’re not satisfied, your mom is out as teacher!”

How about politics? That would be interesting, wouldn’t it? I know, we vote. But our current system makes it difficult to remove politicians by vote, and even if it’s possible (and between money and media, it can be a stretch), we’re still stuck with them for two to four years. A “citizen satisfaction survey” would be a lot of fun. Unlike a poll, we could give it some real teeth. ‘Senator, it turns out your constituent surveys are really low. So, we’re cutting your salary by half until you bring it up by making people happier!’

Obviously, that technique has problems too, doesn’t it? Politicians can’t always please, or satisfy, everyone. And to do so would be perilous indeed. In the same way that we don’t drop “enemy satisfaction” surveys along with smart bombs. “Did you feel that the destruction of your compound was done in a professional and timely manner? Would you be willing to be bombed by the same pilot again in the future?”

Customer satisfaction has also been around in medicine for a long while, and seems to gain traction every year. Hospitals, struggling for market share, love patient satisfaction surveys and scores. For better or worse, these things often determine funding, raises, even continuation of contracts in the healthcare world. And negative scores can cause significant reprimands. It has some merit here as well. Physicians, and nurses, can’t go around being incompetent, or unprofessional. It makes for a very bad experience. And when we’re sick, or our family members are suffering, that’s the last thing we want.

However, the science isn’t always so good. For one thing, the sample sizes from which the surveys are drawn are often very small. A friend of mine worked in a hospital where the data might be drawn from one survey for a given month. If you made that one patient mad, then it was going to be a tough time!

Next, as in so many settings, happy people tend not to fill out surveys. If you like a product, you tell your friends. You go back and get another. But if you’re upset? Out comes the pen, and the boxes are checked in frustration or anger.

But lately, some physicians have been asking ‘is this really a good idea?’ A study from the Archives of Internal Medicine, published in February, suggested that physicians with very good scores may have patients who do poorly. It’s only one study, but more will likely follow. And it makes sense.

Patient has illness or injury, and desires specific test or drug. Physician feels drug or test aren’t indicated and does not provide them. Patient complains to administrator who pressures physician. Physician begins to do tests and give drugs (especially narcotics) that aren’t appropriate in order to comply with employer. I suspect this is one reason, though certainly not the only one, for the epidemic of narcotic abuse, addiction and narcotic-related deaths in America today.

I believe we should be attentive to customer service. But we have to be careful. In settings in which a high degree of expertise is necessary to make decisions, or in which grave dangers underlie poor decisions, customer service has to be balanced against knowledge and experience.

And more relevant, we often hear citizens and watch-dog groups rail against corporate interests and inappropriate influences. If a business, particularly a hospital, asks professionals to do the wrong thing in order to secure payment from the “customer,” it sure sounds like inappropriate influence to me. Likewise, the companies that push the surveys are, themselves, businesses with financial interests.

We all want to be satisfied customers. But when satisfaction has the appearance of corruption, or results in danger, maybe a little dissatisfaction would be better, and safer, in the end.

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Criminalizing Society

whats happening to this country is that we take no responsibility for anything. There is no “oops sorry” or an “honest mistake”. What there is is blame, injury and penalization. We are breeding a society of “Deny and Projection” We deny all wrong doing and fault then project the problem onto another.

The government is or has created an atmosphere of fear. Where we are afraid to tell a women she looks beautiful for fear she may sue me for sexual harassment. Fear to get angry lest we “offend” someone. Fear to hold our students to a higher standard lest we “bully” them or god forbid tell them that someone else is smarter. Fear of releasing an employee for fear we discriminated, fear of drinking a 20oz drink for our health insurance may rise, dear of say “god bless you” when someone sneezes – lest we offend, fear of putting up an American flag for lest we hurt someone anti-American feelings, fear of putting up a Christmas three or Menorah – lest we offend those that have no beliefs.

Are we to be like China – or like those in George Orwells “1984” afraid to express ourselves, afraid to offend, afraid not to conform lest we are punished? Perhaps we all should walk in a straight line with our heads down?

There was a StarTrek episode where the people of a planet were indoctrinated to follow the will of Landru – they all walked quietly in the streets and were careful to be nice to each other and tout the greatness of their leader for if they did not, they were stalked by the alien police and brainwashed. Then at nite they would go crazy to release their pent up emotions.

This is not the direction our country or others should be going in.[backtopost]

The criminalization of society continues.

Regular readers know that I strongly disagree with state efforts to criminalize the practice of medicine. See previous posts here, here, and here for a few. Two days ago I posted an article about a doctor who was criminally charged with providing excessive pain medications to patients who died (as I expressed concern about back in 2009). Now federal agents are arresting physicians for providing fraudulent or “unnecessary” care.

This isn’t concerning to anyone?

I have no problem with taking professional action against any medical practitioner who is a danger to the public. Well, I have a little problem. Some of the assertions of “dangerous” activities I have seen made by state licensing boards make me wonder whether the board members should be charged with a crime for incompetency. In one instance, a board was prepared to file a letter of reprimand against a physician because he didn’t order a CT scan on a patient with a headache. The reason? “This patient came to the hospital by AMBULANCE and you didn’t do enough.”  Action taken against license because a patient dialed 911.

I also don’t have a problem filing criminal charges against medical practitioners that break laws. Intentionally engage in fraud? You deserve what’s coming to you. Steal from patients? Go to jail.

However, throwing someone in jail for doing their job – even if they do their jobs poorly – just sends the wrong message and will lead to unintended consequences.

I’m not going to go on a long rant about this, but I wanted to illustrate how more and more professions are coming under a government attack because they allegedly don’t do their jobs appropriately.

Tarl commented about the case of the Italian scientists who were charged with manslaughter and sentenced to six years in jail because they failed to predict an earthquake that killed more than 300 Italian citizens. Prosecutors argued that the scientists offered “incomplete, imprecise and contradictory information” to the Italian citizens. As Tarl noted, scientists from around the world denounced the trial, noting that predicting earthquakes is impossible.
Think about the implications for Italian scientists in the future. Doing everything in their power to avoid a six year prison term in the future, the seismologists will now be encouraged to report to the media that an earthquake may occur and that things may not be safe every time that a truck without a muffler drives past the seismologists’ offices and shakes their equipment. Chicken Little, baby. If someone drops a cup of coffee, the sky must be falling. Run for the hills. In a few years, the population will be so sick of the false alarms that when the real earthquake does hit, they will have ignored the warning anyway.
But by criminalizing an inexact science, the buffoon Italian prosecutors have made Italy a safer place, right?

Then consider the case of attorneys for GlaxoSmithKline who were indicted for making false statements to the FDA when Glaxo was being investigated for promoting Wellbutrin for an off-label use. The in-house counsel hired a national law firm to help Glaxo respond to the FDA’s allegations. A year later, the government came after the attorney for obstruction of justice … for representing her client … alleging that the attorney had assisted Glaxo in furthering a cover-up or a crime. Even documents that are protected from discovery by the attorney-client privilege were forced to be turned over to the government.
How will the threat of criminal charges affect an attorney’s practice of criminal law? Go to jail if you defend your client too zealously? Be concerned about this, people. With the threat of criminal charges looming over attorneys who defend criminal clients, will clients really get the zealous representation to which they are entitled?

Finally, although not about employment, there is this Wall Street Journal story about how the North Carolina legislature has now made it a Class 2 misdemeanor (.pdf file) for a student to, “with the intent to intimidate or torment a school employee,” do such things as encourage others to post private, personal, or sexual information pertaining to the school employee; post an image of the school employee on the internet; repeatedly engage in e-mail or other transmissions to the school employee; or sign the school employee up for electronic mailing lists.
Take a picture of the teacher in public who is fondling a sixth-grader’s breasts? Even though the teacher is breaking the law and has no expectation of privacy, students may go to jail if they post the picture online or if they encourage others to do so. If the paparazzi hounds the same teacher for doing the same thing … that’s OK … I think.

Anyone every wonder why criminalization isn’t applied to the government officials when they allegedly don’t do their jobs appropriately? I was going to write someone in the North Carolina legislature an e-mail asking them about it, but I didn’t want to be breaking some other inane law they created.

What is happening to this country?

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The Kiss of Death for Meaningful Use Efforts

Basically doctors have more work to do for less payments. I love this paragraph:

Physician documentation at the point of care is another common missing ingredient, he noted. If physicians document their visit after the patient has left the office, they miss on opportunities to view medication alerts in real time and sell the benefits of using a patient portal. “Meaningful use should not be viewed as a checklist, but as part of providing exceptional care.”

Slowing you down and getting paid less – will this really lead to better health care? The emphasis seems to be on me the patient being accountable for my health and government punishing me if i do not comply. Hence me the patient is truly responsible for my health, my followups and my compliance and the doctor and these “care providers” are the guards that will nag me to be compliant and force me to conform. Plus the government is now telling me what kind of and type of care i should have and what they will pay for. I am not comfortable with this nor do i like where its leading …… socialism and rationed healthcare – bad for me, bad for you and bad for the country – watch what happens in less than 24 months .[backtopost]

The kiss of death to an electronic health records meaningful use effort is boiling down the criteria to a checklist of to-do items for physicians.

That’s the word from Jeff Loughlin, project manager at the Massachusetts eHealth Collaborative and executive director of the Regional Extension Center of New Hampshire.

“Physicians hate lists and once you think of meaningful use as a list, you are doomed to failure,” Loughlin said at the MGMA Conference in San Antonio. The program does provide qualification criteria in list format, he acknowledged, but the way to streamline adoption of meaningful use is to describe the criteria not as discrete tasks, but rather as steps that are part of any practice’s given workflow.

Loughlin then proceeded to assign each Stage 2 meaningful use measure to broad workflow categories, beginning with the pre-visit and ending with post-visit follow-up. In between are such steps as registration, intake, visit, and check-out. At each step, various MU measures–such as capturing patient demographics–can be done at check-in. Only a handful of the measures require hands-on work by physicians, he noted, such as reviewing lab results and creating the problem list.

Loughlin warned of several common industry practices that threaten to undermine the purpose of meaningful use to improve patient care. Some practices are merely taking paper-based processes and applying them to the computer. One practice he visited continues to document on paper and just transfers the minimum necessary data into its EHR to qualify.  That approach won’t work in later stages of MU, which put emphasis on sharing data outside the organization and with patients.

Other practices rely too heavily on “out of the box” software, implementing alerts and decision support tools without modifying them for their own practice, Loughlin contended. That can lead to an abundance of needless alerts, which are not only a nuisance but miss the program’s intent of using clinical decision support tools.

Physician documentation at the point of care is another common missing ingredient, he noted. If physicians document their visit after the patient has left the office, they miss on opportunities to view medication alerts in real time and sell the benefits of using a patient portal. “Meaningful use should not be viewed as a checklist, but as part of providing exceptional care.”

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ObamaCare v. Women Beware of what it takes away

Its called “healthcare rationing” meaning you will not be covered for what you think is needed. A “committee” called Preventive Services Task Force or healthcare rationing group will decide what medical services you need – its socialism at its finest!

This is only the beginning – this will stifle innovation – why would companies development tests and drugs when they are not covered by this committee that only looks at expenses not the people?

Wake up and smell the stink that is being fed to you – its dangerous. We as Americans cannot allow our rights to be taken away. Obama care is socialism. Obama care will not work unless they ration care – do not believe what they tell you.

When this folly ends!![backtopost]
President Obama is campaigning hard on his promise to give women access to free oral contraceptives and surgical sterilization, benefits that are guaranteed under ObamaCare. But women should also know about all of the health services they stand to lose.

ObamaCare empowers a host of new boards and committees to arbitrate over what insurance will pay for, and what remains uncovered. They’ll rule over not just health plans sold inside the ObamaCare exchanges, but even private insurance.

One such board, the US Preventive Services Task Force, will evaluate preventive health services like contraception and decide which benefits must be part of the coverage that insurance plans offer — indeed, which services must be covered in full, with no co-pays.

Sorry, it probably won’t be covered: A hospital women’s imaging coordinator explains the benefits of new 3-D digital mammograms.

Sorry, it probably won’t be covered: A hospital women’s imaging coordinator explains the benefits of new 3-D digital mammograms.

But requiring first-dollar coverage for those services is expensive, so health plans will have to offset those costly mandates by dropping coverage for things that don’t make the board’s grade.

Problem is, what the board deems essential is often out of sync with patient preferences, conventional medical practice and even experts like the Centers for Disease Control — which has clashed with the Preventive Services Task Force over recommendations like screening for HIV and hepatitis C.

What health benefits are likely to be nixed from insurance coverage? Well, look at all of the things that the Task Force doesn’t recommend, and therefore won’t be mandated under ObamaCare.

Dozens of screening tests and treatments that directly benefit women are likely to be dropped from any coverage.

Here’s a sampling of what the Preventive Services Task Force dings: chlamydia screening in most women over 25; cervical-cancer screening in those over 65; breast-cancer screening using digital mammography or MRI instead of the traditional plain film.

Screening for ovarian cancer and the genes that raise a women’s risk of breast cancer also don’t make the cut. Same for clinical breast exams in women older than 40.

Even having a doctor teach women how to do a breast self-exam is unlikely to be covered, since the task force says women are rarely the ones to find their breast cancers.

Americans first became familiar with the Preventive Services Task Force in November 2009, when it made the controversial decision to advocate that women ages 40-49 shouldn’t get routine mammograms. More recently, it rebuffed routine use of tests for detecting the viruses that can cause cervical cancer. And now it’s calling the shots for what benefits must be included and what can be nixed from our plans.

This is what happens when benefits are defined in Washington, rather than by a marketplace of competing plans that cater to patient preferences. This is what happens when you put an insular committee of academics in charge, let them meet in secret and devise their own rules — and insulate them from appeals or lawsuits.

Like other ObamaCare committees, the Preventive Services Task Force convenes in Washington, so it will be cognizant of the political winds. Decisions will inevitably hew as much to politics as to medical need.

That’s how benefits like full coverage for contraception make their way into the mandates, while other important services are left out. The academicians will find a way to make their economic and clinical analyses line up for the politically popular things, because they know their arrangement depends on it.

At its core, ObamaCare is really an exercise of federal power over the regulation of health insurance. The decrees made in Washington will rapidly shape the health plans bought by all Americans, regardless of where we buy our coverage.

As health plans come under tighter regulation of what they must offer, what they can charge for premiums and what they can spend on overhead, insurers will scramble to cut costs by cutting benefits, wherever the feds suggest. Focus groups rather than doctors will start to shape medical benefits.

Women, like all of us under the thumb of ObamaCare, risk losing far more than they’ll gain.

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VA drowning in benefits backlog despite expensive paperless system

[preamble]Again our government fails at it.Please tell me again why its thought O-crapa care will work?
Despite spending $491 million on a paperless Veterans Benefits Management System, the Department of Veterans Affairs has only installed the system–which has processed a meager 800 claims–in four offices, Gerald Manar, deputy director of the National Veterans Service for the Veterans of Foreign Wars, told the House Veterans’ Affairs Committee on Tuesday, according to Nextgov.

The VA’s only hope for digging out from a massive backlog of benefits claims was “to get out of the paper world and into the digital world,” lawmakers were told in January. So far, it’s been slow going.

The number of number of backlogged claims stands at 913,690, with about 66 percent (575,773) taking more than 125 days to process–more than three times the number two years ago, according to Nextgov. The VA’s goal has been to process disability claims within 125 days–and with 98 percent accuracy–by 2015.

The new claims process was described as being similar to online tax-preparation software that guides users through with an interview-style interface. Nationwide rollout of the new system was scheduled to begin this summer and continue into next year. Some lags in calling up files, however, have raised concerns about those efforts.

To go fully paperless, the VA would need 4,000 more workers to scan its billions of pages of paper benefit claims, William Bosanko, a top executive at the National Archives and Records Administration, told the House committee. NARA has performed sophisticated scanning operations for the department at five sites for the past two years under contracts valued at $9.7 million, but has suggested the VA turn the work over to a private contractor, according to a second Nextgov article.

With nearly 230,000 disability claims related to Agent Orange now finalized, processing should speed up, VA officials said. But there are plenty of skeptics, according to a Stars and Stripes report.

Meanwhile, the VA’s own employees have called out the agency for its inefficiency. Ahead of the hearing, claims workers at the VA regional office in Columbia, S.C., planned to planned to protest all the bureaucracy and lack of accountability in the claims process, according to the New York Times.

Delays seem to be a way of life within the VA. A patient scheduling system has been blamed in part for falsified data showing that 95 percent of patients who sought mental health care in 2011 received an appointment within two weeks. In actuality, the wait averaged 50 days for 94,000 patients.

And only five of 55 VA medical clinics approved by Congress since 1998 have been completed. Three out of the four VA hospitals under construction in Orlando, Las Vegas, New Orleans and Denver are more than a year behind schedule.

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Medical Errors Cost 1 Trillion Dollars

I guess doctors are really bad at what they do!

A study in the Journal of Health Care Finance from Wolters Kluwer finds medical errors in the U.S. may cost up to $1 trillion per year.

That figure includes measuring the cost of lost human potential and contributions, making the overall cost from errors considerably higher than shown in previous research. Study authors used Quality-Adjusted Life Years (QALY) to get a more  complete accounting of the economic affect when a person dies from a preventable medical error. They took calculations on measures from multiple previous reports, including the 1998 benchmark figure from the Institute of Medicine of 98,000 deaths caused annually from medical errors.

“Then they estimated an average of 10 years of life lost for each of the 98,000,” according to an explanation. “For an infant, the number of years is probably much higher than for an adult in his or her 60s or 70s. A range of $75,000 to $100,000 per year was applied–standard values for a year of life that account for lost earnings and other contributions. Based on that, there is a loss of $73.5 billion to $98 billion in QALYs. However, an article in last year’s Health Affairs says preventable deaths due to medical errors are 10 times higher than the IOM estimate. If that is the case, the economic impact is a loss of $735 billion to $980 billion–nearly $1 trillion–in human potential.”

When calculations include patients who suffer a medical error but survive, the economic cost could be much greater than $1 trillion, according to the study.

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Florida Passes Plan For Racially-Based Academic Goals

Lowering standards of performance means we lower our own expectations and we lower the students efforts. Its just bad – I don’t care your color, economic condition or race – if we demand excellency, we will get excellence and build up the self esteem of our students.

This feeling in our country that everyone has to win, competition is bad and that no one is better than anyone else – is wrong.

There are Winners – There are Losers
Some are Born Great – Some Achieve Greatness
Cream Rises To The Top
Not Everyone Wins
Competition is good
Some are meant to sweep floors and some are meant to tell others to sweep floors – its what makes the world go round – we need Indians and chiefs

Lowering test scores for minorities is demeaning, insulting, unconstitutional, unfair, unhealthy and disgraceful for them and for society as a whole.

Palm Beach, Fla. (CBS TAMPA) – The Florida State Board of Education passed a plan that sets goals for students in math and reading based upon their race.

On Tuesday, the board passed a revised strategic plan that says that by 2018, it wants 90 percent of Asian students, 88 percent of white students, 81 percent of Hispanics and 74 percent of black students to be reading at or above grade level. For math, the goals are 92 percent of Asian kids to be proficient, whites at 86 percent, Hispanics at 80 percent and blacks at 74 percent. It also measures by other groupings, such as poverty and disabilities, reported the Palm Beach Post.

The plan has infuriated many community activists in Palm Beach County and across the state.

“To expect less from one demographic and more from another is just a little off-base,” Juan Lopez, magnet coordinator at John F. Kennedy Middle School in Riviera Beach, told the Palm Beach Post.

JFK Middle has a black student population of about 88 percent.

 “Our kids, although they come from different socioeconomic backgrounds, they still have the ability to learn,” Lopez said. “To dumb down the expectations for one group, that seems a little unfair.”

Others in the community agreed with Lopez’s assessment. But the Florida Department of Education said the goals recognize that not every group is starting from the same point and are meant to be ambitious but realistic.

As an example, the percentage of white students scoring at or above grade level (as measured by whether they scored a 3 or higher on the reading FCAT) was 69 percent in 2011-2012, according to the state. For black students, it was 38 percent, and for Hispanics, it was 53 percent.

In addition, State Board of Education Chairwoman Kathleen Shanahan said that setting goals for different subgroups was needed to comply with terms of a waiver that Florida and 32 other states have from some provisions of the federal No Child Left Behind Act. These waivers were used to make the states independent from some federal regulations.

“We have set a very high goal for all students to reach in Florida,” Shanahan said.

But Palm Beach County School Board vice-chairwoman Debra Robinson isn’t buying the rationale.

“I’m somewhere between complete and utter disgust and anger and disappointment with humanity,” Robinson told the Post. She said she has been receiving complaints from upset black and Hispanic parents since the state board took its action this week.

Robinson called the state board’s actions essentially “proclaiming racism” and said she wants Palm Beach County to continue to educate every child with the same expectations, regardless of race.

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Now they come for marriage! Us Government claims marriage between man/women is unconstitutional

A direct attach on the Catholic Church and its teachings. Marriage between a man and women is unconstitutional!
I guess our supreme justices will find a way o make this part of the constitution- maybe call it a tax?

Marriage can be recognized by a state, an organization, a religious authority, a tribal group, a local community or peers. It is often viewed as a contract. Civil marriage is the legal concept of marriage as a governmental institution irrespective of religious affiliation, in accordance with marriage laws of the jurisdiction. Forced marriages are illegal in some jurisdictions.[3]

Such a union is often formalized via a wedding ceremony. In terms of legal recognition, most sovereign states and other jurisdictions limit marriage to two persons of opposite sex or gender in the gender binary, and some of these allow polygynous marriage. Since 2000, several countries and some other jurisdictions have legalized same-sex marriage. In some cultures, marriage is recommended or compulsory before pursuing any sexual activity.

Since the beginning of time marriage was between a man and a women – now its illegal! I have no issues with same sex marriages – people that live/love together should be recognized by the government and allowed all the legal rights as man/women marriages have.

What I do not like is a MINORITY group (3.4%) changing my religious and legal values and demanding i conform to their way.

When this follow ends!
Where is my religious organizations now that we are under direct and clear assault. 1 in 5 in our country do not believe in god or religion – and we wonder why for so many of the issues of today?

Open your eyes  – stop the trend now!

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Older People Eating Carbs Have More Problems – So Was Said On Radio Today

Quick post – today on the radio, a new “study” said old people who eat carbs are more prone to health problems. HMMM – meaning, when obama care comes into effect, if you are old and eat carbs, you will have to pay more and/or not be taken care of because you eat wrong and are costing to much money.


Its not a stretch – its realty. Its happening.