HEALTHY ONLINE

The health care crowd is abuzz with The New York Times revelation that Medicare billing rates seem to have increased by billions of dollars in parallel with increased adoption of EHR technologies for both hospitals and ambulatory services. The culprit for this unexpected increase is the measly E&M code. Evaluation and Management (E&M) is the portion of a medical visit where the doctor listens to your description of the problem, takes a history of previous medical issues, inquires about relatives that suffered from various ailments, asks about social habits and circumstances, lets you describe your symptoms as they affect your various body parts, examines your persona and proceeds with diagnosing and treating the condition that brought you to his/her office or hospital. The more thorough this evaluation and management activity was, and the more complicated your problem is, and the more diagnostic tests are reviewed, and the more counseling the doctor gives you, the more money...

In his dissenting opinion on the health care law, my least favorite Justice, Antonin Scalia, argued that Chief Justice Robert’s opinion stating that the “individual mandate” is simultaneously a tax and not a tax “carries verbal wizardry too far, deep into the forbidden land of the sophists”. Perhaps this is unusual for the legal system in general and the Supreme Court in particular, but in everyday health care conversations verbal wizardry is now the preferred method of communications. However, health care is much more complicated than the law (with deepest apologies to my attorney friends and family), and health care lacks a supreme authoritative source of truth, thus our verbal wizardry cannot be carried out by proclamation alone. Persistence, as they say, is the most important requirement for success, so in health care we are resorting to the tried and true method of repeatedly employing our verbal wizardry in conversation and in writing until it is wizardry no more. But verbal wiza...

A couple of weeks ago I wrote a post about the clueless, but endearing, enthusiasm of technology people as applied to solving the health care problem. A few days ago Dr. Davis Liu published a post on The Health Care Blog describing the vision of Vinod Khosla , the famed venture capital maven, of replacing doctors with machines. It turns out that Mr. Khosla wrote a series of three articles at the beginning of the year in a technology publication describing how his pioneering vision will replace people in industries where either he or his wife are investing capital. Venture capitalists (VCs), although I’m sure they wouldn’t agree with this assessment, are a combination of professional gamblers and loan sharks. The secret to success is pure luck and ruthlessness, and when the combination works and the ball lands on the exact number on the spinning roulette, venture capitalists make lots of money. This is very different than running a business ala Warren Buffet or even Mitt Romney, let...

High Tech people are very enthusiastic people. We are optimistic, confident and creative and if I may be allowed to say so, really, really smart. We start out by saying “Hello World!” not “Hi, I’m Jack or Jane”. We hail the entire Universe and assume it knows who we are, or that it will soon find out, because the sky is not the limit and we are going to change the world, all at once. We don’t wear pocket protectors or duct tape on our spectacles. We wear defiantly baggy clothes; have tattoos and piercings in all the right places, ride motorcycles and listen to the latest music. Actually many of us are former or part-time musicians, or at least dabble in painting, spiritual philosophy and sometimes even a little writing. We don’t make telephones or missiles or coffee makers, but we make your phone smart, your missile guided and your brew master programmable. We solve problems and sometimes we get carried away. Back during the heyday of the Certification Commission for Health Information...

“There were two men in one city: the one rich, and the other poor….. “ (II Samuel 12:1-12) Thus begins the story of King David’s punishment for robbing a simple man of his life and of his one beloved wife. I have had the incredible fortune of being taught the Bible in the City of David, probably a stone throw away from where he perpetrated a sin that haunts his people to this very day. I was taught the Bible not as a divine text, but as a political, historical and philosophical manuscript written by ancient sages, and David’s story was not about the perils of philandering. It was about the disastrous results of social injustice. The story is not a Socialist manifesto. The Bible in its entirety accepts the fact that there are rich men and poor men and David was not admonished for not redistributing his riches equally amongst the poor. The line of decency is crossed when the rich and powerful wantonly decide to take away the poor man’s “one little ewe lamb” , not to love and cherish as t...

Like most home buyers, I toured the house with my family, checking closet space and bathtubs and finally descended into the basement to see if it has any potential. It was a very large and dark basement mostly unfinished, but the scene in front of us was breathtaking. Thousands of glass jars and bottles of every conceivable shape and color, sparkling clean and neatly stacked in groups by size and shape, some in small pyramids, on a myriad of shelves, small tables and wooden crates. There were no labels on any of them and there were no tops. The ex-Marine Sergeant who built the house in the fifties and lived there ever since, must have spent a lot of time cleaning, processing, sorting and arranging glass containers for what seemed like an awful lot of years. Why did he do that? What did he see in those glass mazes he built in his basement? I never found out. We bought the house almost eight years ago, and had a “guy” come by and remove everything that was not nailed to the walls before ...

Dr. Gawande has a new article in the New Yorker suggesting that hospital chains may very well be the solution to our health care problems. Dr. Gawande has a very engaging writing style and in addition to writing for the New Yorker, he writes books and delivers memorable speeches and he is also a surgeon at Brigham and Women’s hospital in Boston. In recent years, Dr. Gawande’s writings have become the cornerstone of health care policy and none more so than his 2009 New Yorker article explaining the inexplicable health care cost explosion and the variability of medical expenditures across the nation. As the New Yorker itself proudly noted , President Obama himself had a most fortuitous epiphany after reading the New Yorker article, and summarily decided that “This is what we’ve got to fix.” In “The Cost Conundrum” Gawande explored the differences in expenditures for Medicare beneficiaries in two Texas towns whose names became synonymous with our health care issues, the expensive McAlle...