Monday, June 25, 2012

Madonna On Tour Uses “DNA Sterilization Team” to Clean and Disinfect Her Dressing Rooms–Beware of the DNA Snatchers…

I wrote the post back in December of 2010 with the title to bewareimage of the DNA Snatchers of the future and now it looks like the future is here, or at least Madonna is not taking any chances.  Private investigators soon may take on a whole new identify.  As we have all read your DNA can easily be picked up off a glass where you drank some water, a beverage at a bar and so on.

Beware of the DNA Snatchers of the Future

What happens when your DNA gets stolen and used illegally?  We all know what a hassle it is with our personal information but what do you do about something like this?  As sequencing becomes cheaper and folks have time on their hands, who knows what could occur.  There’s black market everything out there today and she’s making sure that she or any part of her doesn’t get cloned in some fashion or another.  This kind of gives a new meaning to the words “material girl” when someone could be seeking DNA:)  BD 




The pop star apparently uses a "DNA Sterilization Team" on her current tour, according to Britain's Daily Mail. The team cleans and disinfects each dressing room Madonna uses on the tour, literally wiping away any trace of the singer.

"We have to take extreme care, like I have never seen for any other artist," said Álvaro Ramos, the promoter handling the Portugal dates on Madonna's tour.

"We cannot even look at the dressing room after it is ready, or even open the door," he says. "We can only enter after her sterilization team has left the room. There will not be any of Madonna's DNA, any hair, or anything. They will clean up everything. In the end it is all to protect her and make her feel comfortable. I do understand it, but it is taken to extremes."

http://www.mercurynews.com/entertainment/ci_20934876/hicks-madonna-using-dna-sterilization-team-tour

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One More Source of Healthcare Expenditures–Hiring “Experts” to Help Hospitals and Providers Document and Code As The System Complexities Grow for Reimbursement Leaving the Clinical Side Behind With Priority At Times With Patient Care

In reading this article, this is what is happening now as folks are calling in the “consultants” who they have to pay to teach the doctors,image nurses and others on staff how to document so claims are paid correctly and promptly.  Who pays for this, the hospitals, so one more expense coming on board for many hospitals that are already financially strapped.  This is kind of a catch 22 item as if they don’t invest they run the gambit of lower compensation and on the other hand they also look to make sure the hospital is not over charging. You wonder sometimes when you read about all these “fines” that hospitals pay for billing errors, is the hospitals no coding right or is it the software and lack of education rolled in there?  Sure there are the obvious cases but each case is it’s own.   You can even buy a shirt that says don’t bother me, I’m coding. 

Some insurance companies, like United Healthcare also created their own clearinghouse subsidiary to audit the bills before they are sent on.  Most providers today do use some type of clearinghouse to check their work for accuracy and with a clearinghouse subsidiary it’s a bigger piece of the pie for overall corporate revenues as this subsidiary servers to generate revenue by subscriptions whereby the hospitals pay for this service, so they could end up with 2 legs of the process here with medical billing with clearinghouse services subsidiaries that check for accuracy before it hits their claims processing.  United has so many subsidiaries anyway though and have recently hired former Minnesota Assistant Attorney General as general counsel as well as hiring the former HHS executive created most of the provisions of the healthcare law.



OptumInsight (A Wholly Owned Subsidiary of United HealthCare Optum Division) Creates Medical Clearinghouse Integrated With Epic Practice Management Software-Subsidiary Watch

US Health Insurance Regulator Leaving to Take a Job at UnitedHealth Care As Vice President of the Optum Division – Moving to the “For Profit Side” With Business Intelligence Algorithm Dollars To Review

 


Meanwhile back at the ranch, HHS Secretary Sebelius is counting on algorithms only while the powerful folks formerly imagein government leave and move over to the “for profit” side and they will have an advantage for sure at United as these folks bring with them knowledge as to how the government operates or doesn’t operate on the other side.  This kind of reminds me of the PBS 4 part documentary to where they spoke with former brokers who made a lot of money and they all admitted they were given the tasks to “find loopholes” so they could make even more money.  Watch this PBS 4 part video series on Wall Street


HHS Secretary Sebelius Still Looking for Tech Breakthroughs To Save the Day

So the long and short of this is more training of doctors and nurses with additional expenditures to create faster claim processing for the hospitals while the bottom line of insurers’ subsidiaries continues to grow.  No wonder medical records are taking on a new reputation as they are now being created for the benefits of compensation rather than clinical care. 

There was an article on the web this week that more doctors are using electronic medical records and liking it less, and this kind of tells the story why as now we have yet one more layer of expertise to use and pay for to make all of this happen, and the payers benefit, not so much the patients for the most part.  BD 



When it comes to patients getting an error-free medical bill, the name of the game for doctors and hospitals is documentation.

That's because if the care isn't recorded and well-documented while it's being provided, insurance companies and federal payers will ask for more information later. Payment for services slows down, and chances for mistakes skyrocket.

That can mean checking that seemingly obvious details are recorded. For instance, each time a nurse starts an IV, she must write it down because there is a charge for the equipment used, Bauschka explained.

That chart -- whether it is electronic or paper -- is also key for the coders, who translate the care documented on the chart into billable codes, said Kathy DeVault, director of professional practice at the national industry organization American Health Information Management Association.

Many health systems and doctors' offices struggle with documentation because of a lack of staff training, DeVault said, adding that "what seems very simple from the outside looking in, is very complex."

http://www.cleveland.com/healthfit/index.ssf/2012/06/many_providers_turn_paperwork.html

Accretive Health Fails to Adequately Respond to Congress And Loses Contract with Second Hospital–A Total of Nine Notebooks Were Stolen or Missing

This keeps getting uglier and when you look at it, it was the business intelligence algorithms that drove all of this as that is the way to profit and make money.  Now there’s nothing wrong with that if you are ethically doing business, but as you read in the news, we are all of sudden finding a entire slew of folks who are not, surprised?  You shouldn’t be as this has been going on a long time but as folks getter smarter about the methodologies that have been used for a number of years, it’s all coming out.  Sure someone can like their business algorithms but if ethics are compromised in the act then what do we have?  Maybe I should ask someone on Wall Street about that while I’m at it.   What started all of this..a stolen notebook that shows their lack of ethics and HIPAA violations. 

Accretive Health Debt Collector Employee Has Laptop Stolen With Non Encrypted Patient Data from 2 Hospitals And Had Access to All the Data Via Revenue Cycling - Patient Information Was Shared With Wall Street Investors – Algorithms For Profit Again?


I wrote a post about 2 years ago on this blog in jest but I think it’s true now that “data addiction and abuse is the up and coming next 12 step program on the horizon”.   We need somewhere to rehab the folks that have this issue and look at the big Oncologist in the OC who did it for years with fraud, he said he couldn’t help himself and he was addicted.  Accretive though goes beyond addiction though and this is all about some marginal pay for performance incentives too.  Nobody is going to collect in fashions they have unless someone is waiving a dollar under their nose.  Maple Grove hospital has now cut them off as well. 

We also have some new information herenot oneimage but nine notebooks were stolen so nine times the potential exposure possibly, depending on what they were carrying around.  The Vice President of the company left a non encrypted laptop with around 24k patients' information on the computer, gee and we wonder why executives are kind of useless today, but you could almost be he preaches to employees NOT to do this:)  This was also Chapter 28 of my Attack of the Killer Algorithm series. 

Accretive Medical Collections and Analytics Cited by Minnesota by Attorney General For Collecting from Patients At Bedside and Worse–Employees on Pay for Performance Too? Killer Algorithms Chapter 28

It looks like they are somewhat ignoring Congress too.  BD



In a letter sent to Accretive Chief Executive Mary Tolan, U.S. Rep. Henry Waxman and U.S. Rep. Diana DeGette said a public statement that the company had provided the U.S. House's Committee on Energy and Commerce was "not an appropriate response" to a request for internal documents.

The congressmen also said Accretive had ignored repeated efforts to reschedule a May 4 meeting between the two sides that the company had earlier canceled.

http://in.reuters.com/article/2012/06/21/idINL3E8HL5FL20120621

Cook Medical Sponsors Clinical Study–New Endovascular Technique With Potential to Reduce A Large Number of Leg Amputations For Patients Suffering from PAD

this is the first study to examine the a new, endovascular approach to treating critical limb ischemia (CLI) – a symptom of peripheral arterial imagedisease (PAD) and if you are not familiar with PAD (peripheral arterial disease) , here’s a couple back links and an interview I did with Cook Medical a while back with Rob Lyles with Cook Medical..  CLU occurs when PAD goes to the worst case and leads to amputation to where 25% of the patients die due to the procedures.  Let’s face it nobody wants to lose a leg.  Back in 2009 I first spoke with Rob Lyles from the peripheral intervention division. 

Cook Medical Interview Discussing PAD Leg Therapies– Rob Lyles, VP Peripheral Intervention Division
image

In addition you can also read up here with the interview I did with Dr. Peter Lawrence at the UCLA Gonda Vascular treatment center to see what they currently do with treating PAD. 


The UCLA Gonda Vascular Center Treats PAD (Peripheral Arterial Disease)-Interview with Dr. Peter Lawrence Chief of Vascular Surgery


Cook has a stent that can be utilized to bring the blood flow back and unlike a heart stent, they have to be rugged, in other words your heart stays in one place, but no so for the legs as they are in constant motion, thus the importance of the stent remaining in place and being secure.  12 locations will participate in the Tibiopedal Access for Crossing Infrainguinal Artery Occlusions study and the Zilver stent was last reported consistent outcomes with treating pad over a 24 month period.  BD


Cook Medical Zilver PTX Drug Eluding Stent Clinical Trial Shows Consistent Outcomes Over 24 Months in Treating PAD


Press Release:

Cook Medical Sponsors First Clinical Study to Examine New Endovascular Technique

 

Study designed to evaluate retrograde tibiopedal vascular access

 

Bloomington, Ind., June, 25, 2012 – Clinical investigators are for the first time examining the retrograde tibiopedal interventional approach, an endovascular technique that has the potential to reduce the rate of leg amputations by as much as 50 percent[1] in patients with critical limb ischemia (CLI), a manifestation of peripheral arterial disease (PAD). Cook Medical, a global pioneer in interventional medical device technologies, is sponsoring the Tibiopedal Access for Crossing Infrainguinal Artery Occlusions study. 

 

With the retrograde tibiopedal approach, a physician gains vascular access at the foot and advances wire guides and catheters up the leg to reach and cross arterial blockages. Individuals1 and single centers[2] have reported initial success with the technique, which is often tried after a traditional antegrade approach fails. This is the first prospective, multicenter study to collect data on this technique.

 

“This endovascular approach developed by leading physicians has the demonstrated potential to address life-limiting and lower-limb-threatening occlusions,” said Rob Lyles, vice president and global leader of Cook’s Peripheral Intervention business unit. “We are committed to enhancing the delivery of quality patient care and look forward to the initial study results in 2013.”

 

An estimated 27 million people in Europe and North America suffer from PAD,[3] which can lead to CLI, a severe obstruction of the arteries that decreases blood flow to the extremities, producing pain and skin ulcers or sores. CLI, which affects up to 300,000 people a year in the U.S.,[4] is the end stage of lower-extremity PAD and poses a significant risk for limb loss. Currently, 25 percent of CLI patients undergo amputation as a primary treatment.4 Within two years of treatment, 25 percent of these patients die and another 30 percent experience additional lower-limb amputation.4 The mortality rate at five years following amputation can be as high as 68 percent.[5]

 

Twelve sites in the United States and Europe will participate in the Tibiopedal Access for Crossing Infrainguinal Artery Occlusions study led by global principal investigator, Craig Walker, M.D., founder, president and medical director of the Cardiovascular Institute of the South in Louisiana. Up to 200 patients with a totally occluded lower-limb artery will be enrolled, and physicians will assess the technical success rates of the new procedure both for gaining vascular access via the foot and for crossing the lesion. Patient follow-up will consist of a telephone interview approximately 30 days after the procedure. J.A. Mustapha, M.D., director of endovascular intervention at Metro Health Hospital, has enrolled and treated the first patients in this study. Drs. Walker and Mustapha are compensated by Cook Medical for educational lectures they present to physicians on the tibiopedal access procedure.

 

_______________________________________

1  Kavteladze Z. Retrograde recanalization of tibial CTOs. Presented at: TCT 2010; September 21-25, 2010; Washington, DC.

2  Montero-Baker M, Schmidt A, Bräunlich S, et al. Retrograde approach for complex popliteal and tibioperoneal occlusions. J Endovasc Ther. 2008;15(5):594-604.

3 Belch JJ, Topol EJ, Agnelli G, et al. Critical issues in peripheral arterial disease detection and management: a call to action. Arch Intern Med. 2003;163(8):884-892.

4 Norgren L, Hiatt WR, Dormandy JA, et al. Inter-society consensus for the management of peripheral arterial disease (TASC II). Eur J Vasc Endovasc Surg. 2007;33(suppl 1):S1-S75.

5 Reiber GE, Boyko EJ, Smith DG. Lower extremity foot ulcers and amputations in diabetes. In: Harris MI, Cowie CC, Stern MP, et al., eds. Diabetes in America. 2nd ed. Washington, DC: National Institute of Diabetes and Digestive and Kidney Diseases, 1995:409-428.

 

ABOUT COOK MEDICAL

A global pioneer in medical breakthroughs, Cook Medical is committed to creating effective solutions that benefit millions of patients worldwide. Today, we combine medical devices, drugs, biologic grafts and cell therapies across more than 16,000 products serving more than 40 medical specialties. Founded in 1963 by a visionary who put patient needs and ethical business practices first, Cook is a family-owned company that has created more than 10,000 jobs worldwide. For more information, visit www.cookmedical.com.

[1]  Kavteladze Z. Retrograde recanalization of tibial CTOs. Presented at: TCT 2010; September 21-25, 2010; Washington, DC.

[2]  Montero-Baker M, Schmidt A, Bräunlich S, et al. Retrograde approach for complex popliteal and tibioperoneal occlusions. J Endovasc Ther. 2008;15(5):594-604.

[3] Belch JJ, Topol EJ, Agnelli G, et al. Critical issues in peripheral arterial disease detection and management: a call to action. Arch Intern Med. 2003;163(8):884-892.

[4] Norgren L, Hiatt WR, Dormandy JA, et al. Inter-society consensus for the management of peripheral arterial disease (TASC II). Eur J Vasc Endovasc Surg. 2007;33(suppl 1):S1-S75.

[5] Reiber GE, Boyko EJ, Smith DG. Lower extremity foot ulcers and amputations in diabetes. In: Harris MI, Cowie CC, Stern MP, et al., eds. Diabetes in America. 2nd ed. Washington, DC: National Institute of Diabetes and Digestive and Kidney Diseases, 1995:409-428.

Sunday, June 24, 2012

HMOs in Israel Score a Judicial Win Over Formulas Used For Funding–State Has 6 Months To Create New Methodologies to Measure and Project Medical Costs–HMOs Anticipate Greater Funding To Arise

Sometimes it’s interesting to take a look at what’s happening in other countries relative to the rising cost of healthcare and when you read this it’s apparent that this is not only an US problem.  Granted Israel is a much smaller country but the problem are the same, money or lack of.  Just a couple months ago, doctors who work for the state received an order that they needed to punch a time clock.  How would that work in the US…I don’t think it would accomplish much here. 


Israel Judge Issues Court Order For Doctors To Punch A Time Clock


To go a little further here, the country also realizes that allowing private care and selling supplementary insurance contributed to the problem.  The country has 4 HMOs and all are required to join one of the four and there’s always the option to pay for private care.  Some of the same doctors working in the government facilities have referred patients to their private practice or those of other doctors.  The government pays $59% of the cost for the imagecitizens, the lowest compensation percentage for a country with socialized medicine.  If you read further, the doctors are threatened with losing 20% of their pay checks.  The government pays $59% of the cost for the citizens, the lowest compensation percentage for a country with socialized medicine.

Officials In Israel Blame Themselves for Allowing Private Care and the Selling Supplementary Insurance For Degrading Their Public Healthcare System

In addition medical students and state doctors have ongoing protests and strikes to draw attention.  It sounds as if the HMOs could stand to see an influx of funding.  Technology is great but we still need the over all doctor-patient relationship. 
Medical Students and Doctors Protest in Israel Demanding Improvements in the Healthcare System

Two of the largest HMOs filed their complaints 9 years ago questioning the lack of hospitalization not being included. The court will not be creating a formula, but rather told the state and the HMOs to settle it.  Does this sound a bit similar to what we have in the US?  I think so and the cost of healthcare is a global concern for all economies.  BD


 

The High Court of Justice handed down a major decision on health care funding Thursday. It took the state to task for inadequate government funding of the country's health maintenance organizations due to the formula through which it funds hospital stays by the HMOs' patients.

"The right of the citizens of the State of Israel to health [care], as shaped and enshrined in the state health insurance law, is slowly being emptied of content in light of the systematic erosion of the health maintenance organizations' budgets," Justice Salim Joubran stated, ruling on a petition filed by the Clalit and Maccabi HMOs.

The HMOs were challenging the mix of components the government has been using to calculate the cost of medical care. They said it did not accurately reflect the cost of hospitalization and, in the process, was eating away at their budgets.

Justice Joubran, who was joined in the ruling by Supreme Court President Asher Grunis and Justice Hanan Melcer, gave the state six months to come to an agreement on a new method of measuring medical costs. In the process, the state is expected to provide the HMOs with hundreds of millions of shekels in additional funding each year. If adjustments were to apply retroactively, the sums would be in the billions of shekels.

http://www.haaretz.com/business/hmos-to-receive-huge-cash-injection-after-high-court-rules-against-state-1.443423

Attack of the Killer Algorithms–Digest & Links for All Chapters–How Math and Crafty Formulas Today Running on Servers 24/7 Make Life Impacting Decisions About You–Updated 6-24-2012

If you have not caught up with this yet, I started this series by accident as an awareness outreach, I know just like everyone else has out there, but having been a former software writer, hopefully some of this will explain in layman’s terms how some of this works behind the scenes it may offer some answers.  It’s not going to make you happy but it will open your eyes as to how the world of technology functions today with decision making and perhaps give you an idea of where it’s headed too.

I like technology and how it makes me smarter and more observant but as with everything today, there’s the dark side of how formulas and math are used for profit with some very intelligent and crafty programmers and developers out there and we get fooled.  Everything in here is all public knowledge so there was no digging for any exclusive interviews and so forth, just stuff you can find on the web as well and I’m just connecting some “big dots” to where you may not see this otherwise. 

This blog can be a source of discomfort at times as along with years ago in learning about math, code and formulas, it transitioned me into something very scary indeed, a female that uses logic <grin>. 

So if you have wondered why the Medical Quack is different, there you have it and I have to laugh at myself too as I never intended to become logical and think back quite bit of the days before logic entered the picture and those are some fine memories too.  So there you have it, what’s wrong with this blog…<grin> a female using logic.  I have also been pondering this question since August of 2009….this is a “one duck” think tank <grin>.

 
“Department of Algorithms – Do We Need One of These to Regulate Upcoming Laws?

So without further chat, here’

  

s

  

the Attacks as I see them as it’s all in the math and formulas…Nothing will happen until new code runs through those servers and I feel this is truly the backbone of what started the “Occupy” movement, frustration and nowhere to go for answers as we have leaders in denial that don’t have a clue of how all of this works.   Today I am adding 5 more chapters since the last update. BD


Occupying Wall Street–It’s All About the “Attack of the Killer Algorithms”–The Unfair and Marketing Exploit of Ethics Using Math–This Could be a Subject for Michael Moore to Explore and Document In a Movie

 
“Killer Algorithms: Part 2” Disturbing News for Consumers With Credit Scoring Adding New Data Analytics–Some of the Same Methodologies Used by Insurers With Flawed/Potential Erroneous Data–One More Reason to Continue Occupying Wall Street


 
“Attack of the Killer Algorithms” Part 3–Vatican Doesn’t Like It Either–Occupy Wall Street Belongs in New York As They Don’t Do Code or Algorithms in Washington–Only Find time To Talk Abortions


 
Attack of the Killer Algorithms-Occupy Wall Street Part 4 Health Insurance Style - One More App For Folks Who Are Tired of Flawed Algorithms That Require A Ton of Work and Research Time To Create “Perfect” Data Files for Insurers And Others Analytics Processes

 
“Occupy Algorithms”–”The Attack of the Killer Algorithms Part 5” - Nothing Will Improve Until Audits and Actions Takes Place To Correct Formulas Built for Profit Only by Corporations And We Battle Back With Math

 
Attack of the Killer Algorithms Part 6–Discrimination With Consumer Credit-Same As Health Insurance Wanting Consumers to Reconstruct Records From Many Years Past As Middle Class Turns Into Data Chasers-Days of Taking Risks to Get Ahead Will Be Limited For Most…Occupy Algorithms


 
Flawed Data–Mined by Corporations Online Provides Background Checks Riddled With Errors–Attack of the Killer Algorithms Part 7


 
Consumers Lose More Privacy With New CoreLogic Credit Reporting–”Score” Marketed For Insurers and Employers To Gain Information-California Prohibits Potential Employers – From Using As Jan 1 - Killer Algorithms Part 8


 

Freddie Mac Found to be Betting Against Home Owners Being Able to Refinance - “Attack of the Killer Algorithms” On Consumers Part Nine–Home Mortgage Style


 

Komen Reverses Decision With Planned Parenthood–Hard Lesson on How Business Analytics Are Misunderstood And/Or Abused–Attack of the Killer Algorithms Chapter 10


 

Gamification–You Have Won and Now We Know All About You - It Didn’t Cost One Cent-Insurance Companies Have Games To Find Out More About You Too– “Attack of Killer Algorithms” Chapter 11


 

Colonoscopies–The Bait and Switch on Screenings–If Polyps Are Found You Get A Bill-Some Other Screenings Too–Killer Algorithms Part 12–Medical Billing Codes Style

 

Attack of the Killer Algorithms Part 13–Bank of America Style - Flawed Data With Credit Scoring Agencies–Dead Man Banking And Currently A Consumer Under Attack


 
Insurers to Provide User Friendly Summaries of What’s Covered–Good Luck As Constant Revisions Will Be Required as Business Intelligence Algorithms For Profit Change–Attack of the Killer Algorithms Chapter 14

 

Story of Duke University - The Sad Case of Flawed Data Published in Medical Journals That Was Declared Inaccurate 60 Minutes –Attack of the Killer Algorithms Chapter 15


 

Medicare Low Safety Rankings At Harvard Teaching Hospitals Disputed and Flawed–Attack of the Killer Algorithms Chapter 16


 

Start Licensing and Taxing the Data Sellers of the Internet Making Billions of Profit Dollars Mining “Free Taxpayer Data”–Attack of the Killer Algorithms Chapter 17 - “Occupy Algorithms”– Help Stop Inequality in the US 

 

Pharmacies File Suit Against Texas Human and Health Services Commission - Managed Care Contracts Begin Delegating Reimbursements Too Soon – Attack of the Killer Algorithms Chapter 18


 

AMA Announces Doctors And Patients Can Expect To See the UnitedHealthCare/Ingenix Class Action Settlement Checks In the Mail Soon - Out of Network Short Payments–Attack of the Killer Algorithms Chapter 19


 

Healthcare Blogger Gets Spammed by Hedge Fund Using Internet “Reputation Restore” With Some Really Bad Algos–Attack of the Killer Algorithms Chapter 20


 

Senator Introduces Bill to Prohibit Companies From Using Medical Debt With Assessing Consumer Credit Scores–Attack of the Killer Algorithms Chapter 21 With Flawed Data


 

IBM Watson Going to Work At Citigroup on Wall Street–Congress Didn’t See Big Data As A Tool (Hadoop Framework) When They Had Their Chance…For Consumers The Attack of the Killer Algorithms–Chapter 22


 

Independent Pharmacies Not Able to Compete with Big Chains and Fear Going Out of Business–They Don’t Have Same High Levels of Data To Sell to Profit- Attack of the Killer Algorithms Chapter 23


CVS/Caremark Sends Letters to Tufts Members Containing Personal Information Like Medical Conditions/Meds Info to Wrong Patients–Attack of the Killer Algorithms Chapter 24


Aetna States Letters Mailed to Thousands of California Customers Were A Mistake–Their Doctors Are Still In Network–”Rogue Algorithms and Flawed Data”–Attack of the Killer Algorithms Chapter 25



Medicare Agrees to Settle Hospital Reimbursement Dispute With 2,200 Hospitals in the US To Receive Approximately $3 Billion–Hospitals Paid Short–Killer Algorithms Chapter 26


 

UnitedHealthCare Sends Letter to Teenager Telling Her She Had Diabetes With No Parent or Doctor Involvement–Only Blood Test Was For Lyme Disease–Analytic Attack of the Killer Algorithms?–Reader Writes



 

Accretive Medical Collections and Analytics Cited by Minnesota by Attorney General For Collecting from Patients At Bedside and Worse–Employees on Pay for Performance Too? Killer Algorithms Chapter 28

 

San Diego Hospitals Having Issues With Anthem Blue Cross Refusing Claims for Psychiatric Emergency Services–Attack of the Killer Algorithms Chapter 29
 


Colbert Talks Accretive Care–Collections in the Hospital ER (Video) Attack of the Killer Algorithms Chapter 30!



Insurers Add 4th Tier to Prescription Pricing–Higher Costs for Patients–Attack of the Killer Algorithms Part 31 As That is What Calculates the Cost


image

Facebook IPO – The Ultimate “Attack of the Killer Algorithms” Chapter 32 - Nobody is Immune In the World of Complicated Computer Code and Formulas Today


Predictive Modeling–Business and Consumer Algorithmic Data Screening Parameters Used With Insurance Underwriting–Same Stuff Wall Street Does - Attack of Killer Algorithms Chapter 33



BATS Stock Exchange IPO Rogue Algos–Attack of the Killer Algorithms Chapter 34–See How Other Killer Algorithms Occur in Every Day Life With Healthcare & Credit



New York Subway Worker, Dubbed as a Hero Has Pension Reduced to $5.00 a Month–Retirement System Error–Attack of the Killer Algorithms Chapter 35




I think there’s a little bit of something in here for everyone and again I do this as an awareness and how we and our government moves forward with this reality, it remains to be seen if we can scoot around the big white elephant in the living room that nobody can see, touch or talk to <grin> but it roars.  Richard Cordray has his work cut out for him and that is an understatement.   

Also because it belongs here and is on the same topic, when you have time listen in here and see how someone with greater intelligence than myself will help explain how this process works too with marketing, media and flawed data as simple math is no longer 100% credible for proving accuracy.  This is a great lecture given at Google’s offices in New York.  It’s hard to tell the difference sometimes between the good stuff and the algorithms created solely for profit as again their crafters are very good and collaborate with media to ensure we have a full diet every day.  BD 

Context is Everything–More About the Dark Arts of Mathematical Deception–Professor Siefe Lecture Given at Google’s New York Office–Big Healthcare Focus



There’s also something here for thought, de-valuate some of these profiteering algorithms so we can balance tangibles and intangibles and not have an economy so out of balance and that promotes the continuation of generating more inequality as that’s the kicker behind the scenes at the root of all of this. 



“Devaluate the Algorithm” And “Tax the Data Sellers”–A Cure for Both Healthcare and an Economy Based Heavily on Intangibles–We’ve Lost Our Balance



NYU Siefe talks at Google

Saturday, June 23, 2012

US Captures The Top Number For the Most Powerful Computer in the World–First Time Since 2009 - IBM Sequoia At the DOE Lab In California

This is a little break away from the normal healthcare blogs but it’s related as these supercomputers are in healthcare.  DOE even rents space imageout for other agencies and I wrote about that a while back.  Too bad our Congress has not figured out that they too could maybe ask the DOE for some super computing space to figure out their data needs when making laws:)  Looks like we booted China out of the #1 spot, at least for now. 

1.7 Billion Super Computer Hours Awarded by the DOE–Biomedical Research Projects Included for Parkinson’s and Cancer


I have mentioned it a few times around here how Congress would benefit and get smarter and bonus points as with intelligence grows, the lobbyists efforts will drop a bit as our lawmakers could tell the difference a little better between marketing information an actual data. 

Use of IBMWatson Technology in Congress Would Allow For Smarter Laws and Decision Processes With Bonus Points For Lowering Over All Impact of Lobbyists

This is kind of an important computer too as it is used the understanding of weapons science as well as vastly improved estimates of uncertainty in predictions of weapons behavior, the nuke-puter that simulates and crunches numbers as a pace surpassing all others.  It has 1.6 petabytes of memory 96 racks and 1.6 million cores…that last number kind of blows me away and this is IBM engineering at work.  BD

image

The twice-a-year list of the Top 500 supercomputers documents the most powerful systems on the planet. Many of these supercomputers are striking not just for their processing power, but for their design and appearance as well. Here’s a look at the top finishers in the latest Top 500 list, which was released Monday, June 18 was announced at the 2011 convention.

The new Top 500 champion is Sequoia, a Blue Gene/Q supercomputer built on IBM Power architecture at the Department of Energy’s Lawrence Livermore National Laboratory in California. The emergence of Sequoia has returned the U.S. to the top spot of the Top500 list for the first time since November 2009. Sequoia consists of 96 racks; 98,304 compute nodes, 1.6 million cores and 1.6 petabytes of memory, and hit an impressive new record of 16.32 Petaflops  on the Linpack benchmark. The National Nuclear Security Administration uses Sequoia to research the safety, security and reliability of the United States’ nuclear deterrent – replacing the need for underground testing. The Blue Gene/Q Sequoia is eight times more powerful than its predecessor BlueGene/L technology.

http://www.datacenterknowledge.com/top-10-supercomputers-illustrated-june-2012/

Statins and Depression

Another quickie from a recent Journal of Clinical Psychiatry article:  Statin Use and Risk of Depression: Data From the Heart and Soul Study.

(Shostakovich, Festive Overture, Op 96 in an excellent recording from the Nobel Prize awards from 2009.  We played this one in college and it was a lot of fun.)

Long-time readers will know I'm not a huge fan of statins in the water.  That is to say I don't like primary preventative treatment of the general population with a poweful liver, muscle, and brain irritating cholesterol-killing drug without knowing if it is really worth it.  The anti-platelet and anti-inflammatory effects may be worth it for a lucky few (while the unlucky few develop diabetes and muscle damage… seriously, click that link, and then go watch a Crestor commercial)... that said, if you are a middle aged man with a couple of heart attacks or unstable plaque and you eat Ho-Hos and Doritos and smoke two packs a day, hey, take the Zocor.  It may well prevent an earlier death (though even cardiologists will admit this magical effect is not due to lowering cholesterol, but through the aforementioned anti-inflammatory and anti-platelet effects).  Believe it or not, not everyone who comes to my office is excited about giving up her bag-a-day chip habit.  C'est la vie.

I also have bizzare and outlandish views about cholesterol.  I think it might be important to have enough.  And my idea of a "normal" total cholesterol is more along the lines of 220, not "as low as possible."  Though I have no doubts that super-high cholesterol (as in familial hypercholesterolemia) in the present Western food environment comes with a greatly increased risk of heart disease as there is a crapload of oxidized LDL hanging out in the blood.

On the other hand, super low cholesterol is almost always associated with increased risk of death from various causes, including suicide and violence.  Those risks begin to climb below a serum level of 160, and start to really spike around 130.  It's a correlation, not necessarily causative, but given the importance of a nice fluffy supply of fresh free cholesterol in the brain, it is certainly plausible that low cholesterol could be problematic.  For the details, visit my blog article here.  But let's be realistic.  Mr. Smith with advanced diabetes and a history of stroke with a total cholesterol of 330 is unlikely to be plummeted to below 160 by a statin alone (though they might try to get him down there in a heroic effort to make the LDL as low as pharmacologicaly possible as current guidelines reccomend an LDL<70).

Anyway, I have suspicions of statins and the brain, but where the rubber meets the road is the data.  (Or perhaps in the interpretation of the data ;-).  But I do like the Heart and Soul study.  Lots of participants, a long time…though they do use a mere 9-item "Patient Health Questionnaire" (known in the biz as the PHQ-9*) to determine depressive symptoms and not a standardized clinical interview like those careful Germans.

All the participants in Heart and Soul were folks with prior heart disease (that means we are talking about secondary prevention of early death with statins, for which there is a better track record than for primary prevention).  1024 patients (mostly male, as two of the three recruitment sites were VA hospitals) enrolled, 59 died in the first year, but 965 were able to give at least 2 or more annual measures of depressive symptoms to be included in the analysis.  All right, blah blah, analysis, confounders, statistics, etc (you can read the full paper from the first link if you like):

Statin users at baseline (about two thirds of the sample) had a lower rate of depression, but were also less likely to develop new depressive symptoms over the next 6 years.  Non-statin users were more likely to have depression at baseline and develop more depression symptoms later on.   These correlations were preserved by removing a number of confounders (such as "nonadherence" to medication regimen, which occured in 6.1% of the statin users and 12.2% of the non-statin users**)  All told, the odds of developing "depression" (meaning a PHQ score greater than or equal to 10) were 34% less among statin users than non-statin users, and those who were depressed at baseline had a 38%  decreased odds of having depression at a later measured date.  This number is consistent with the only other prospective cohort study done and with 2 large, retrospective case-control studies.

But here's the rub:
To date, however, randomized trials have failed to demonstrate a beneficial effect of statin therapy on psychological well-being.  In 1 randomized trial of 1,230 patients with existing coronary heart disease, those assigned to pravastatin had lower subsequent depression scores (measured by the Global Health Questionnaire) during 4 years of follow-up than those assigned to placebo, but these differences were not statistically significant.  Another trial in individuals with hyperlipidemia but without known coronary artery disease found no improvement of depressive symptoms…during almost 3 years of follow up among patients assigned to simvastatin versus those assigned to placebo.
The authors guess that patients who take statins were "more likely to exhibit healthy other behaviors that would decrease their risk of depression."  They are certainly less likely to admit to nonadherence!  It's also possible that the anti-inflammatory effects of statins could help balance out (my suspicion) pummeling cholesterol metabolism when it comes to mental health states.  The authors think maybe we need larger trials of longer duration to find the beneficial effects…

One more cute quote and then I'm signing off for the day:  "in the previous observational study of patients with coronary heart disease, the beneficial effects of statins on depression appeared to be independent of lipid-lowering effects."

*From time to time I will get a letter from an insurance company.  One of my patients will go to his or her primary care doctor's office and be given the PHQ-9.  A positive score will prompt the insurance company to let me know that my patient might be depressed, and urges me to consider treating that patient.  Insurance premiums well-spent?

**I can't tell from this paper how "nonadherence" was determined.  It says "medical history" was determined by self-report.  I can tell you that both the 6.1% and 12.2% numbers for nonadherence seem incredibly low to me depending upon the definition of "nonadherence," particulary for medicines such as statins or blood pressure medicines that one doesn't notice anything right away if you miss a dose)

Friday, June 22, 2012

Anti-inflammatories and Schizophrenia

Short little post on a paper from a few weeks ago from the Journal of Clinical Psychiatry:  Nonsteroidal Anti-Inflammatory Drugs in Schizophrenia: Ready for Practice or a Good Start?  A Meta-Analysis.

Nothing spectacular here, just some interesting arguments and correlations to add to the literature that major mental illness has an inflammatory pathology, and that searching for anti-inflammatory solutions (and I consider an anti-inflammatory (nutrient-rich, low toxin) diet, proper sleep, proper coping, appropriate exercise and stress reduction as some of these non-prescription solutions to be examined further) is a reasonable course of action, and not woo-ville.

My usual radio haunts have been disappointing recently for brand new music.  But The Heavy came out with a new single this week, and I'm liking it:  What Makes A Good Man.  It sounds really good in the car, but I hope you're not driving right now.

All right, some suspicious correlations suggesting the immune system and inflammation may be involved:

1) People with schizophrenia and their close family members have higher risk of autoimmune disorders.
2) Men who have used steroids and NSAIDS (such as naproxen or ibuprofen) have a decreased prevalence of schizophrenia.
3) PET scans of folks with schizophrenia show increased numbers of active microglia in the brains (microglia are immune cells in the central nervous system, activated to fight infection or in autoimmune conditions or inflammation).
4) With brute force hacks of genomes of folks with schizophrenia, one of the gene areas that keeps popping up are markers in the major histocompatibility complex (MHC) region on chromosome 6.  MHC genes code for the markers we put up on our cells to label them as ME so our own immune army doesn't take us out.
5) There are abnormal levels of inflammatory cytokines, immune markers, and autoimmune antibodies in the serum and spinal fluid of folks with schizophrenia.

So something in the immune system is amiss.  Maybe gut-punching inflammation could help the symptoms.  Enter the NSAIDS (non-steroidal anti-inflammatory drugs).  They work by inhibiting the conversion of our old frenemy arachidonic acid (AA, made from the omega 6 linoleic acid, but also available as is from various animal foods) into the class of molecules called prostaglandins.  Prostaglandins help mediate pain, inflammation, and thermal regulation, which is why you might pop an Advil when you have a fever or a muscle ache (or both).

Now, NSAIDS are known to trash the gut and the kidneys if you aren't careful, and various versions may kill you dead with a heart attack (Vioxx) in the long term, and pregnant women and those with ulcers and ulcerative colitis and some others should avoid them…but as I am not currently afflicted with any of the previous conditions I would still take it in lieu of acetaminophen, personally, when I am not toughing it out. Like last Monday, when my children gave me a little virus that toasted me all the way up to 103.3. Personally I'm cool with 102s but the 103s start to make me worry about brain fry-age, particularly in adults.

(An oldie but a goodie:  Neil Finn: She Will Have Her Way   Definitely worth the ad…)

More specifically:  AA + the enzymes COX1 and COX2 make prostaglandins, which mediate pieces of the inflammatory response.  NSAIDS like ibuprofen, naproxen, diclofenac and acetylsalicylic acid (otherwise known as aspirin) will block COX1 and COX2, reducing the ability of the body to make prostaglandins.

So will doing that not only help a fever or an aching muscle, but also the symptoms of schizophrenia?  What does the literature say?

All the randomized controlled trials of antipsychotic medication augmentation with an NSAID were analyzed in this meta-analysis.  (No one official is just using Advil for psychosis.)  In the literature there were 5 (small) RCTs, for a total of 264 patients.  The trials all used celecoxib (a selective COX2 inhibitor) or aspirin, and lasted from 5 weeks to 3 months.  4 of the 5 studies all had similar results, modestly but significantly helpful in both "positive" symptoms such as hearing voices and "negative" symptoms such as social withdrawal.  One study showed the NSAIDs not to be helpful, compared to placebo.   Apparently two other unpublished studies also showed celecoxib to be unhelpful, so we have to be cautious about these findings.

More specifically, with a few of the celecoxib studies, the NSAID didn't appear to be particularly active in the central nervous system, as expression of COX2 wasn't altered in the hippocampus and there were no changes in the cytokine profiles in immune cells called mononuclear cells.  In the aspirin study, however, they were able to detect a treatment effect with differences in cytokine profiles due to the drug.  Since COX1 prostaglandins cause platelet aggregation, inhibiting COX1 leads to the supposed cardioprotective effects (but also the increased risk of ulcers) of the nonselective NSAIDS.  It's a bit irritating that all these studies were done with the selective COX2 inhibitor, celecoxib, but since it was the one on patent, I'm guessing that's why the money was spent there.  It would be interesting to see larger studies done with ibuprofen or aspirin, frankly.

Well!  More wait and see.

Thursday, June 21, 2012

Microsoft Back in the Tablet Business With Their Own “Surface” Units Coming Soon

I do have to say from what I have seen the new Surface Tablets certainly look good and I’ll have to revive and add more to the “Tablet” sectionimage of this blog.  I was one of the very first adopters of a tablet computer and I think that goes back to around 2001.  It’s been a long time and I currently have an Acer Windows Tablet.  The only thing that it lacks is enough battery life to make me happy but you can’t have everything.  I still have this particular tablet as well from Tablet Kiosk and you see it regularly on CSI New York, except they use a black one. 



Sahara Slate Tablet PC i440D From TabletKiosk with Core 2 Duo available to order – Sunlight Display included as a standard feature….
Sahara Tablet PC Graphics and Dictation

 

Way back when I was still writing my medical records program I had it working with tablets too and the tip input bar.  In 2008 I ranimage around HMMS with my tablet and One Note and in those days one was considered a “goober” if you had it in tote as most vendors only showed and used them in the booths:)  Today all that has changed but the article below is still very applicable on using One Note as “intelligence files” and really work a convention and get everything covered that you set out to do.  I did it and had everything I needed and One Note did the queries for my information both before and at the show.  I talked and wrote my notes in One Note.  Everyone kept coming up and asking me what booth others were in as I had that too":)  Just think this is only 4 years later and how far we have come with tablets.  You can see a sample image as to how my rough files looked before I began with all the notes I took. 

 
HIMMS 2008 Summary - Getting organized is the trick

The little Acer Arconia does ok for what I need now but it’s not a digitizer and I do miss that with having the option to be touch or a full digitizer on the unit, and my TabletKiosk model does both and I can switch back and forth.  If you have not caught a video of the new Surface Tablet you can view it below.  I’m one of the founding members of the Los Angeles Windows Mobile Group (Pocket PC) which has undergone a few other name changes tooimage and I remember the one night back in Santa Monica at our meeting at Microsoft where we all got to see one of the first tablets previewed even before they were released and a special employee from Microsoft arrived to give us the unannounced prior presentation. I just wrote to a Microsoft Tablet MVP who made a video of it to see if he could dig it out for nostalgia purposes:)  The video quality is not what we have today but seeing this from 2001 would be fun to look back at.   I’ve mobile before it was cool to be mobile and Pocket PCs were not phones yet:)

I did the mini UMPC round of tablets as well and this is one of my clients, a doctor a few years back using the small imagetablet to enter data in his medical records program in 2007.  At any rate I hope before too long that I am able to get my hands on one of the Surface units and really check it out.  Little humor, this is far cry from a Mike Arrington Crunch Pad for those that remember:)  It’s been a while so time for a little friendly reminder of the project. For your absolute utter enjoyment here’s a picture of a couple of tablets running my antiquated VB6 medical records system, although it was hot at the time and your screens could be any color you wanted:) If that picture did anything for you, there’s more at this link of some screenshots of the antiquated coder/blogger at work.  Boy the formatting was tough to get right for the little tablet. 
What Does an Antiquated EMR (Electronic Record System) Look Like


The bigger unit with the Intel processor looks like the real imagework horse and of course I will be interested to see what battery life is like as for years it seem as if you want more power you get less battery and even the IPAD with it’s wonderful engineering only does one program at a time and that’s how the battery can last so long.  They really did a good job on that design, however let’s see what Surface can do and for sure it stands to be a huge tool for the enterprise and healthcare world with medical records.  Tablets have come such a long way since that first little Acer I had years ago.  BD 



Surface Tablet Video


http://www.youtube.com/watch?v=dpzu3HM2CIo&feature=player_embedded

Recalls Have Gone to the Toilet, Really As Flushmate Recalls Exploding Toilets

You don’t really get to take your toilet back but can get a repair imagekit to fix it so it won’t blow up on you.  Over 300 tank explosions I guess made the case for the fix. 
You can call Flushmate at (800) 303-5123 weekdays between 8 a.m. and 4:30 p.m. Eastern TIme or by visit their recall site.  BD




Flushmate
is recalling its Flushmate III Pressure-Assist Flushing System after it received 304 reports of toilets “bursting,” causing property damage and 14 “impact or laceration injuries.”

The system is used in more than 2.3 million toilets in the U.S. and is sold at Home Depot and Lowe’s. It is also sold to toilet manufacturers that include American Standard, Crane, Eljer, Gerber, Kohler, Mansfield and St. Thomas.

http://abcnews.go.com/blogs/business/2012/06/flushmate-recalls-2-3-million-bursting-toilets/

Larry Ellison The Full and Uncut Interview At the All Things Digital Conference–The Good Stuff - How Larry Thinks and and Works – “Men Who Know Code”

I posted the highlights version of the interview which basicallyimage covered what was going on with Mr. Ellison and Oracle but when you hear the entire interview you get a real glimpse of how he thinks and works and we haven’t heard a lot of that as this goes beyond the media coverage you normally hear.  I like how he discusses the “cloud” technology and he’s right, it has been around forever and the opinion on how it became the buzzword we live by today is interesting. 

Hardware is software he states and the complicated process is the software and he’s the “product guy” at Oracle.  Oracle is not a consumer business but they sell to consumer oriented companies, like Apple.  He’s been around for a long time and knows the players and their technologies.  It’s humorous to hear him talk about SAP and how they admitted to stealing patented technology.  “You want me to give HP advice”…classic and you have to hear the history he gives here.  You can read about his NIH award from last year. 

Larry Ellison Announced As Distinguished Medical Informatics Awardee for His Contributions to Health IT and the Ellison Foundation From the Friends of the National Library of Medicine (NIH)

He’s also part of the “Giving Pledge” along with Bill Gates, Warren Buffet and others. 

The Giving Pledge Call for Philanthropy Continues to Grow–40 Billionaires Committed


He’s fascinated with technology and it shows how he tests limits.  If you read the news in the last couple days, he has is own island now in imageHawaii too.  He has no limits:)  When asked about his image that is projected in the media, he’s extremely funny and candid.  He’s definitely one of a kind and has the left brain in gear and then some as he knows code as well as marketing and his company.  It took 6 to 7 years to re-write all the Oracle applications for the cloud, so keep this in check when you think about how we function today and the amount of coding and development it takes to move to the cloud with applications.   I said a while back when the President had his meetings with the brilliant men of code, he was there to learn, “aka men who write code”. 

President Obama Meeting with Tech Industry Leaders–CEOs and Some of the Smartest CEOs (Algo Men) Who Write Code



He discusses “Workday” and and how Salesforce and many others use “Oracle” and how “Workday” doesn’t use one.  He knows his engineering and infrastructure. In the question and answer session he is asked about what he is doing for healthcare and he talks about the Ellison Medical Foundation (and jokes about how long it took him to come up with that name) and how they are focused on  “diseases related to aging” “for obvious reasons he states”..funny.  The do both primary and applied research in this area with about a billion to support it.  They are also simulating molecular computational control and building chemical simulators so they can design and test drugs.

Oracle is bringing back manufacturing to the US as well and he also brings up the shortage of engineers in America.  He said we need engineers who are trained in the US to stay in the US and not leaveimage.  He says it is madness that someone gets their PHD from Stanford and then get a note to “get out”.  We don’t have enough “trained engineers” in the US and finishes up the interview by saying “it’s insane” what we do.  I agree.  Great interview and nice insight into what makes “Larry” tick..he’s one of most valuable “hybrid” personalities and individuals walking the earth today and he has logic, marketing, engineering and humor all wrapped into one. 



I can hardly wait to see and hear what he does with his new island too:)  BD  



Perhaps more than any other tech figure in Silicon Valley, Larry Ellison — now also trying to become the proud owner of Hawaii’s Lanai — is, for lack of a better word, the man.

It’s a bit about endurance (he’s been at it since 1978, when he founded Oracle), a bit about success (the database giant still remains a very powerful force in the industry), a bit about spoiling for a fight (Hewlett-Packard, SAP, any small cloud company that irks him) and a lot about style (America’s Cup sailing, his gazillionaire Ironman persona and, for goodness sake, he is planning on buying an entire Hawaiian island, presumably for a lair). Ellison has the kind of long-term and powerful perspective that is rare in the app-happy Web 2.0 era of small ideas and too-big valuations.

http://allthingsd.com/20120621/larry-ellison-tells-it-like-it-is-the-full-d10-interview-video/?mod=tweet