Wednesday, January 30, 2013

ACO's For All The Wrong Reasons

NOTE:  The original was made private by Atlantic, but see below!!!!!!

This is a serious attempt by the Morristown Medical Center in Morristown, N.J., a member of the Atlantic Health System, to convince doctors to sign on to the Atlantic ACO. Seriously. No kidding.

Hat tip to Fox Business News.


It seems that Atlantic Health has made the video private, for obvious reasons. (I'd be embarrassed too!) So here is the Fox article, quoted in full:

A video leaked to FOX Business mocks how health reform can make more money for doctors and hospitals by preventing patients from being readmitted to hospitals.

The video, made by Morristown Medical Center in Morristown, N.J., a member of the Atlantic Health System, is meant to recruit doctors and medical staffers to join health reform’s new “Accountable Care Organizations,” (ACOs), key to cost savings in the health-reform law.

The video shows doctors barring the doors (See video below article) of the hospital to stop patients from being readmitted for more care, dollar bills exchanging hands between doctors and staffers, as well as workers getting free stuff like laptops.

In the video, a musician sings lyrics to the tune of Waylon Jennings’ “Looking for Love”: “Building an ACO for all the right reasons, an ACO decreasing readmissions.”

The song continues: “Sharing these savings with practices sure seems fair, long as we follow the policies set down by Medicare,” as the video shows money changing hands.

The singer also sings: “Improving care, no more gaps or omissions, what CMS is dreaming of,” as the top executive of the hospital pretends to sleep on the couch. CMS stands for the federal government’s Centers for Medicare & Medicaid Services.

A hospital spokesman tells FOX Business: “The ACO video lyrics came from the ACO Atlantic Health System. I don’t believe the video was meant as a spoof or a mockery by any means. It’s a fun spoof, preventing readmissions as you saw. It’s certainly not meant as a mockery, it’s a video showing the benefits of ACOs. It’s about working together, partnership, taking better care of patients.”

But a staff doctor notes: “The less number of patients re-admitted, or the less exams or tests or referrals, the more government money there is in the pot for the ACO and the more bonuses for the doctors. The less you do as a doctor, the more money the ACO makes. The less risky patients with complications you take on, the more money the ACO makes, because risky patients are going to cost the hospital more money to treat them. That’s why they’re exchanging money in the video. If I order less tests, I get a bonus. If I join, I get free stuff, like free laptops. An ACO pockets more government money by instead making patients manage their illness at home.”

Health reform’s ACOs are meant to curtail soaring health costs from too many doctors ordering too many tests for Medicare patients. But despite the White House’s exhortations that health reform will provide more care, ACOs put the country on a path towards less care, doctors tell FOX Business.

Do you think the video helped or hurt the hospital? Tell us in the Comment section.

ACOs are partnerships of medical providers — doctors, specialists, clinics and hospitals — that operate on a set budget. They get Medicare or Medicaid money from the federal government every year.

Budgets are set according to the health of the population the ACO serves, with payments tied to federal quality standards. Hospitals can earn higher profits and doctors can get bonuses in exchange for meeting federal quality and cost controls, including limiting hospital readmissions. If costs exceed the budget, ACOs share in the losses.

“ACOs reward doctors and medical workers for providing less care to patients,” says a Morristown Medical staffer. ”They reward bad doctors and punish good doctors. If someone dies, it’s more cost effective and cheaper. If someone is readmitted for, say, a wound not healing, the hospital doesn’t get paid by Medicaid or Medicare, it gets fined. Wheeling and dealing is bad care for patients. It is the patient who will get screwed. An ACO is mechanical care, it turns doctors into 9-to-5 shift workers.”

A doctor at the hospital also tells FBN: “Health reform, though, was meant to increase access to health care. Instead, ACOs decrease access to care. It’s totally opposite of what the President wants. ACOs also erode the doctor-patient bond.”

The video surfaces as the federal government recently approved 106 new ACOs. The U.S. Department of Health and Human Services says that as of last July, Medicare ACOs were serving 2.4 million people in 40 states and D.C.

There is cold math behind health reform’s ACOs, now the new face of medicine. At about $550 billion, Medicare is the third largest budget item in the federal government, behind Social Security and defense, and is set to outstrip defense spending in about two years.

But an avalanche of baby boomers retiring, a looming doctor shortage, and hospital bed shortages have given rise to ACOs. Doctors and medical workers warn that baby boomers will increasingly not be treated in hospitals, but in their homes or even over the phone, and not by doctors, but by physician assistants or nurses.

To be sure, many patients would argue that hospitals are vast reservoirs of bacteria and viruses, and would rather avoid them. “But if you get an illness at home after you leave the hospital and really do need more hospital care, an ACO may bargain with you to not re-admit you,” a doctor warns.

Another element of health reform is driving doctors to join ACOs. Central to health reform are “electronic medical records systems, which must be put in place to process Medicare and Medicaid patients,” a doctor explains. “But doctors can’t afford them, so they join an ACO,”

Dr. Jeff Goldsmith PhD, president of Health Futures Inc. and associate professor of Public Health Sciences at the University of Virginia, warned in a 2009 column about a dramatic culture shift in health care. “A rapidly increasing percentage of physicians, particularly primary care physicians, are now hospital employees,” he wrote.

The doctor added: “An entire generation of 80-hour-a-week baby-boomer physicians are retiring and being replaced by younger physicians who want to work 30 hours a week.”

Dr. Goldsmith also warned: “Hospitals will become ‘collections’ of physicians, not communities” with profit and loss statements and management “infrastructure.”

However, ACOs could soon be used for Medicaid, too. The 2010 health-reform bill authorizes a demonstration project that would launch pediatric ACOs within Medicaid and the State Children’s Health Insurance programs. To date, funding is not yet available, sources and reports indicate.

ADDENDUM II: Someone posted a saved copy!!!

Saturday, January 26, 2013


The internet is full of strange and wonderful things. When you think about it, the possibilities are really overwhelming. Here, at your very fingertips, is the sum of all world knowledge; the Library of Alexandria pales in comparison. All you have to do is FIND whatever it is you want.

On occasion, the internet delivers something you didn't know you wanted, but is quite helpful to have.  Case in point:  I was looking through the Pebble Watch website, describing the Kickstarter-funded smartwatch:

And yes, I ordered one, but when it will be delivered I haven't a clue. Some early adopters/Kickstarter supporters are selling theirs on eBay for double or triple the cost. Patience is a virtue, friends.

Without going into detail on the watch function itself, suffice it to say that it is a Bluetooth appendage to a smart phone, either iOS or Android, and it can display various messages from the phone, incoming calls, email, and the like. There are ways for us users to add alerts. For those who can program (which I can't much anymore) there is a developer SDK. But for the rest of us who have a slight knowledge of programming and logic, it seems that Pebble can receive simple alerts and notifications from if this then that ( or from their web-facing RESTful endpoint. The latter seems a little beyond me at the moment, but I'm looking into it. But IFTTT is so easy someone from IT could use it.

Go sign up on and you'll see how it works. Basically, you pick a trigger (the IF This) and a target action (THEN That). For example:

This "recipe" as IFTTT calls it will sniff for the "trigger" of a new Instagram photo uploaded by the certain user and than dumps in in the user's Dropbox. There are 50 some-odd channels of triggers and actions, and a particular channel might include both. For example, (from

The SMS Channel is a native IFTTT channel that provides a set of Triggers and Actions built around sending and receiving Short Message Service (SMS) messages with your SMS enabled cellphone.

The SMS trigger, "Send IFTTT any SMS", fires every time you send any SMS to your IFTTT phone number, and the event "Send me an SMS" will send an SMS to your mobile phone, once it's properly registered.

The Phone Call Channel is a native IFTTT Channel that provides a set of Triggers and Actions built around calls placed to and from your phone.

The action "Call my phone" will call your phone number and say a message. One could, for example, use a calendar trigger to set up an automatic call on a certain date, like a birthday.

This is a very powerful scripting service, and fairly easy to use. I've already set up a recipe to forward blog posts here on Blogspot over to my Doctor Dalai Facebook page. We'll see if it actually works shortly.

The only thing IFTTT lacks is voice command. Perhaps they'll figure out a way to integrate Siri in the next iteration.

Thursday, January 17, 2013

I'm Not Dead Yet...

My usual apologies for not posting anything lately. I've been out of town (Christmas week cruise to Panama, Colombia, Bonaire, Curacao, and Aruba) and I've been sick (really bad URI caught on said cruise), and it's just been a heck of a few weeks at work.

I had great plans to post something interesting today. Nice idea. At 9AM I received a text from my PACS guru: "What happened to your blog?" I went to my front page, and lo and behold..."This blog has been removed." Oy Vey! They got me! I had received no email notices or any sort of warning whatsoever.

Google Webmaster tools told me that the blog had "health issues," "malware" to be exact, but gave me no way to actually investigate what was wrong. To every indication, the blog was gone.

Going on Google's support blog revealed this:

Spam/Terms of Service - Appeal Guidelines - January 2013

Given the fact that automated spam detection is not yet a perfect science, the Blogger Team is happy to investigate any reports of false positive spam reviews, posted here in the forum. That being said, before you request an appeal, it's worth describing a few examples of what Blogger regularly removes, as part of its zero tolerance policy to abusive / inappropriate content:

- Affiliate marketing.
- Content created wth scripts and programs, rather than by hand.
- Content scraped from other sources.
- Copyright Infringement (using photos of people without their permission)
- Content or links referencing GPT, PTC, PTS, 'Make money from home', 'Make money fast', or other referral-based activities.
- Large blogs with multiple, unfocused / unrelated subjects.
- Links to Illegal Downloads / Streaming / Torrents/ Games / Movies
- Links to Password sites/Account Hacks

Just reply here, in this discussion and post the following information

1) Saying that you've read these Guidelines
2) Please be sure to include ALL your deleted BlogSpot Links/URL(s) that have been marked as Spam
3) Also tell us what content you were posting in each of the Blogs

Please note that the Blogger Team may look at other blogs in your account, as part of their review. If you request an appeal, and Blogger discovers other abusive / inappropriate content during the investigation, you risk having all of your content permanently removed. Please consider this when requesting an appeal.

If you want to know why any of this is necessary, read here:
The only thing I could think of was that my account had been hacked, so I immediately changed all passwords, and waited to hear from Google.

The blog came back up this evening. Googles excuse? "It was probably just the Spam Robots being a little wonky this morning...Unfortunately it seems like a bug that Google have now hopefully fixed. Normally the Spam detectors would send out an email, it seems in this case that the emails did not get sent."

I guess one can't expect perfection from a free service, but I can't risk 8 years of my life's work on the whims of Google's Spam Robots. Thus, I've downloaded the entire contents of the blog to my computer, and I've mirrored it on WordPress ( Eventually, I'm going to host it on our PACS servers.

In the meantime, I'll get some more interesting content really, really soon!