DMCB Election Insights with Help From the Queen of Rock and Roll

The Disease Management Care Blog spent a better part of the day on the Pennsylvania Turnpike scanning the radio dial for insights on yesterday's national elections.  As the DMCB understands it, we've gone from a Democratic Prez, a U.S. House Republican majority and a U.S. Senate Democratic majority to a Democratic Prez, a U.S. House Republican majority and a U.S. Senate Democratic majority.

Among the lessons:

(Re)Electing a President has parallels to the experience of losing your virginity: after a lot of anticipation and excitement, what's left is a dawning realization: "Is that all there is to it?"

If God truly loved national Republican politicians, She would strike any who publicly utter the word "rape" with a thunderbolt.

Job One for the Republican Party: figuring out which Mitt lost.

The race for the 2016 Presidential election is underway and first up for the Dems: heir-apparent Joe Biden!

It's times like this that the DMCB turns to song for inspiration, and who better than the Queen of Rock and Roll? Congratulations to all the politicians on your election, says Ms. Turner, but like many a constituent, she's had enough of false promises and lies. "You Better Be Good To Me."

President Obama Addresses the Ebola Crisis

In this weekly address, President Obama addresses the Ebola crisis.  As we've come to expect from our Chief Executives, it's a perfectly crafted speech that addresses our major concerns. But the Population Health Blog doesn't think it goes far enough.  In its continuing quest to help Mr. Obama overcome his tanking approval ratings, the PHB changed a few words and modestly offers up a slightly edited version of the address.  It believe it speaks more forcefully to the issues at hand.....

PRESIDENT OBAMA: Hi everybody, this week, we remained focused on spinning a favorable White House narrative about Ebola. In Dallas, the natural history of the disease and basic isolation procedures limited spread of the disease to only two among the dozens of health care workers who had been in close contact with the first patient. Now, those two workers are two too many, which is why I've told the CDC that their calm and distant inertia is unacceptable.  As you know, that's my job.

The two nurses who contracted the disease in West Africa were thankfully released from the hospital. I was proud to welcome one of them to the Oval Office to give her a big hug and make sure plenty of photographs were taken.

And in Africa, the countries that did not wait for our help, Senegal and Nigeria, were declared free of Ebola.  Which is probably why New York City also decided to not wait on Washington DC. Local public health personnel there moved quickly to isolate the doctor who recently returned from West Africa. While we deployed one of our new CDC rapid response teams, I wonder what they'll learn from New York City's approach. Maybe a lot. And I’ve assured Governor Cuomo and Mayor de Blasio that they’ll have all the federal support they need as they go forward.  After all, I'm from big government and I'm here to help.

More broadly, this week we've continued to step up our use of words like "efforts" "outreach," "coordinate," and "integrate" across the country. New CDC outreach is helping hospitals coordinate and integrate training. The Defense Department’s new team of doctors, nurses and trainers will outreach, coordinate and integrate if called upon to help with coordination and integration and, you know, outreach and other efforts.

Now, rather than institute an unworkable travel ban, we now have a less unworkable travel measure that directs all travelers from the three affected countries in West Africa into five U.S. airports. Starting this week, these travelers will be required to report their temperatures and any symptoms on a daily basis—for 21 days until we’re mostly hopeful that they don’t have Ebola. Here at the White House, the lawyer I've appointed to coordinate and integrate the government's response will tell the doctors what to do and how to do it. And we have been examining the protocols for protecting our brave health care workers, and, guided by the science, we’ll continue to do everything we can to embarrass the Republican nutjobs who are also using Ebola for political gain.

In closing, I want to leave you with some basic facts. First, you cannot get Ebola easily through casual contact with someone. The only way you can get this disease is by coming into direct contact with the bodily fluids of someone with symptoms. But, if you do get it, your internal organs could liquefy. That’s why health workers must wear total body condoms. That's the science. Those are the facts.

Here’s the bottom line. We can beat this disease. But we at the White House have to stay on message by repeatedly saying that we have to work together at every level—federal, state and local. And we have to give the impression that we're leading a global response, because West Africa is in a world of hurt right now along with other global hot spots like Syria and Ukraine and Hong Kong and Russia.

And we have to be guided by the science—we have to be guided by the facts, not fear. Yesterday, New Yorkers showed us the way. Despite the mainstream media's alarmist reporting, they did what they do every day—jumping on buses, riding the subway, crowding into elevators, heading into work, gathering in parks, ignoring speeches like this and wondering why the Yankees aren't in the World Series.

That spirit—that determination to carry on—is part of what makes New York one of the great cities in the world. And that’s the spirit all of us can draw upon, as Americans, as we meet this challenge together.

An Evil Downside of "Disease Management" (Humor)

 

Did you know that there is published research that demonstrates that every time a person was signed up for the early versions of commercial disease management, a kitten somewhere in Washington D.C. died?  No wonder health policy makers and academics were so opposed to these programs!

 

The Disease Management Care Blog will explore the issue in greater detail during its presentation at the Care Continuum Alliance Forum12 meeting.

 

See you there!



(If you want a PowerPoint slide, let me know)

The Exchangeacillin Package Insert: Black Box Warnings and Adverse Reactions

The Disease Management Care Blog is pleased to assist the U.S. Department of Health and Human Services with this FDA-inspired "medication package insert" that is designed to help consumer-shoppers grapple with the star-crossed health insurance exchanges.
             +++++++++++++++++++++++++++

Exchangeacillin®
(online bunglecide)
Virtual Suspension

Prescribing Information

**Black Box Warning**
Health insurance exchanges increase the risk compared to placebo of wishful behavior in adults and politicians in recent short term studies. Anyone considering the use of EXHANGEACILLIN must balance the risk of unintended consequences involving a federal bureaucracy unfamiliar with fundamental principles of insurance 101. There are no studies that assess the success of online exchanges, and persons of all ages who use Exchangeacillin should be closely observed for hours-long vacant staring at computer screens.  Long term use may lead to loss of confidence in big government and unpredictable election cycles. (See WARNINGS: Insurance Markets and Bureaucratic Meddling: Information for Consumers, PRECAUTIONS: Information for navigators)

DESCRIPTION
Exchangeacillin (online bunglecide) is a virtually administered insurance platform with approximately one billion lines of unstable computer code. It has a melting point range that falls within room temperature and zero resemblance to modern web-based architectures.

CLINICAL PHARMACOLOGY
The efficacy of exchangeacillin in the treatment of underinsurance, access to care or life expectancy remains an open question.  Preliminary studies in humans have demonstrated accelerated partisan animus, selective interpretations and media spin, leading to one of the largest live social experiments in modern history. In vitro and binding studies may demonstrate that persons at risk for near-term insurance claims expense are preferentially attracted to Exchangeacillin. The impact on Millenials, Generation X'ers, Slackers and Dudes is speculative.

PHARMACOKINETICS
Exchangeacillin is unpredictably absorbed and has been shown to lead to one or more commercial insurance accounts with an elimination half life for redundant applications that may extend for six months or more. Nonlinear kinetics can lead to botched income estimations, claw backs and opaque tax consequences. 

INDICATIONS AND USAGE
Exchangeacillin is indicated for the treatment of underinsurance, being uninsured, high co-pays, unwanted co-insurance, double-digit co-pays, skinny insurance benefits, benefit exclusions, windfall profits, high administrative costs, coverage denials, not having birth control and showing the health insurers a thing or two.

PRECAUTIONS AND ADVERSE REACTIONS
Post-marketing surveillance studies have shown an increased risk of buttock decubiti, White House embarrassment, yawning, consumer disappointment, carpal tunnel syndrome, insomina, gridlock, hypersomnia, digit calluses, onychophagia, boredom, bluescreenosis, resentment, death spiraling, employer mandate delays, government shutdowns, war memorial posturing, bombast, biased reporting, deficits, speechifying, inflation, carve-outs, administrative exceptions, skepticism, income non-verification, disbelief, distrust, bickering, hyperpartisanship, multiple-accounts, insurance death spirals, closed national parks, can kicked down the roadedness, comparisons to Medicare, comparisons to Medicaid, tiresome pundits, nausea, bloggery, anecdotes, generalizations, wealth transfer, increased federal deficits, decreased federal deficits, higher taxes, government savings, higher for-profit health insurance stock prices, elevated media ratings, anxiety, confusion, dizziness, breathlessness, wordiness, emotional lability, dubious claims, confident predictions, foolishness, restlessness, cancelled WH meetings and DMCB spouse exasperation.

INTERACTIONS
Use of Exchangeacillin may interfere with budgets, debt limits, sequester agreements and elections.

DOSAGE AND ADMINISTRATION
While Exchangeacillin should be administered following months of testing and debugging, the FDA has approved its administration in a let-'er-rip "big bang" fashion with ad hoc adjustments and unpredictable shut-downs.

HOW SUPPLIED
On-line with "Apply Now" code that prompts "we have a lot of visitors on the site right now. Please stay on this page.... Thanks for your patience!"

Presidential Debate Behaviors: Lehrerosis, Denver Fever and Others

As Disease Management Care Blog Twitter followers know, the recent Presidential debate certainly captured its attention. Yet, while other "#debate" tweets focused on policy one-liners and short political insights, the DMCB was discovering the twin medical conditions of hyperblepharokinesis (Mr. Romney's rapid fire blinking) and bradyblinkosis (Mr. Obama's sullen slow blinks).

The DMCB has since reviewed its Presidential debate notes and offers up this additional mix of dysfunctional debate-induced behaviors:

Conhomie: the pseudo-bonhomie manifested by a warm handshake and smiling embrace by two individuals who really detest each other.

HannibalLectern: what a debater afflicted with conhomie stands behind while he secretly wishes he could rip out the liver of his opponent.

Ropadebateadope: an inability to answer simple questions posed by a debate moderator.

Lehrerosis: the sudden onset of muteness caused by the excessive blabbering of another person.

90-billionate: using a previously unknown, unused and untrue statistic to undermine an opponent.

Denver Fever: a life-threatening triad of hyperventilation, anxiety and sputtering precipitated by the underperformance of a favored debater.  Also known as the "MSNBC Vapors."

Obamaprize: the nasty surprise experienced by sitting Presidents who underestimate a political enemy.

Romneyize: overwhelming an opponent with a barrage of lies, damned lies and statistics.

The DMCB looks forward to the next one.

Valuable Personal, Political and Health Reform Lessons, Courtesy of the Federal Government Shutdown

Coming to consensus
the old fashioned way

The Disease Management Care Blog views the federal government shutdown with the same morbid fascination of watching personal injury lawyers justify their double digit malpractice suit contingency fees: it's so awful, it's hard to look away.

The good news is that that doesn't mean that the shutdown doesn't hold some important personal and political lessons.  They can make DMCB readers better citizens and our political class a credit to our Republic. 

To wit......

When the DMCB spouse expresses consternation over the boneheaded actions of her husband, the DMCB can now respond by:

1. changing the subject,
2. retreating to the DMCB World Headquarters and blogging about the spouse's unreasonableness,
3. referring to the alleged lapse as a "glitch."

Things don't go well in the opening day of a widely anticipated unveiling of the largest health care achievement in the history of the United States.  If you were in charge, you would respond to the health insurance exchange breakdown by:

1. recognizing the problem and promising to fix it,
2. reminding the public about the painful gap between lofty campaign promises and disappointing bureaucratic reality,
3. shrewdly drawing flattering comparisons to Apple, the most widely admired brand in the world.

As the leader of a political coalition, you are stymied by the division of powers in the world's longest lasting democracy.  In response you:

1. seek consensus
2. deploy ad hominem attacks in press conferences
3. offer to compromise by allowing the opposition to do things your way.

Wanting to be an informed member of the electorate, you regularly watch either CNN, FOX News, MSNBC, PBS, CBS, NBC or ABC because:

1. These broadcasts' news editors subtly frame their closed information loops to meet your own political biases,
2. You haven't discovered BBC or Al Jazeera
3. There aren't any movies on TV featuring svelte vixen vampire babes having their way with their mesmerized male victims.

By pointing out that Obamacare is "the law of the land," you are really saying:

1. Our representative democracy passed legislation that was signed by the President and upheld by the Supreme Court, so get over it,
2. Now wait a minute, our representative democracy can modify or even roll back health care laws.
3. Enough with the debate, time to move on and figure out how to make preschool education, low interest mortgages and low-fat frozen yogurt protected federal entitlements.

Being a Game of Thrones fan, you wonder if the following might not be useful in settling the budget impasse:

1. Asking what the honorable Ned Stark would do, until you recall that he was beheaded.
2. Invite the opposition to a Red Wedding
3. Call up your elected representative and say "Hodor!"
4. Call up your elected representative and hear him or her say "Hodor!"

Foot Biden Mouth Disease

Disease Management Vendors Offer Treatment for Dreaded Foot Biden Mouth Disease

From Naaj Vorodis, DMCB
Updated 17:00 Sun August 19, 2015

Washington DC (DMCB) -- A consortium of disease management service providers have announced a new product offering for "Foot Biden Mouth Disease." 

Characterized by a microphone-induced symptom triad of pseudodementia, confabulation and tone deafness, this chronic and incurable condition is associated with pandemics of spinning punditosis and chronic voter fatigue. Statistics gathered by the CDC and the Boston Globe show that, while this pestilence is uncommon, a multiplier effect over news media, websites and social networks makes it appear as bad as it really is.

In response, the consortium is now offering a bluetooth-enabled monitoring device that analyzes the wearer's speech and, when doltish utterances are detected, sends a SMS text message to a responsible adult. This patented and proprietary technology uses a voice activated political information exchange network that mines the user's phrases and compares them to quotes from Mel Brooks, Donald Trump, SuperPAC Ads, The Simpsons and Bane. When a match is detected, not only is the text message is generated, but the wearer is also prompted to apply a cork.

"Our background in enabling behavior change to reduce the rate of complications in conditions such as diabetes and high blood pressure makes disease management a perfect answer to this disabling condition of political buffoonery," said  disease management industry expert Bill Alot. "Our technology can adapt itself to the consumer's level of insight and result in beneficial outcomes, even if the patient has zero insight," he added.

Unnamed sources in the White House have stated that this may reduce the recurring episodes of panic in the Situation Room.  "We sure hope this works," said one source, "otherwise its back to the teleprompters for all of us."

What You May - or May Not - See at the Care Continuum Alliance's Forum12 Annual Meeting in Atlanta

Along with many readers, the Disease Management Care Blog is looking forward to the Care Continuum Alliance's annual meeting, Forum12, two months from now in Atlanta. Not only will the DMCB get to make new friendships, the plenary presentations and smaller educational sessions are great way to learn how to apply the theoretical underpinnings of wellness, prevention and care management to the real world.

To help attendees better prepare for the meeting, the DMCB is pleased to offer this Lettermanesque "Top Ten" of things you may, or may not, see at the Forum12:

10. Someone genuflects upon hearing the term "CMS Innovation Center."

9. Only healthful fruit is served at one of the meeting breaks; in response, attendees riot.

8. A DMCB YouTube video is embedded in session PowerPoint (hey, it's happened).

7. Three quarters of the attendees sitting in on a session are from the presenting faculty's company.

6. Someone shows up at an early morning pre-meeting yoga class dressed in business attire, thinking it was a presentation on the return on investment from an employee yoga program.

5. The term "engagement" is used 20 times by a presenter in the course of ten minutes.

4. One faculty member hits a "presenter's trifecta": 1) arrival flight lands on time 1/2 hour prior to the presentation, 2) he or she finds the meeting room within minutes and 3) catches the departure flight 1/2 hour after the end of the presentation.

3. The imposing booming disembodied voice asking you to take your seat at a plenary session is that of a female. With attitude.

2. The competition between the exhibitors for your attention becomes so intense, one offers free beer. Others follow suit.

1. The DMCB spouse "crowdsurfs" one of the plenary sessions.

Suggestions for Managing Health Reform in 2015

Unfortunately for Mr. Obama, the spotlight on the some of the more unsavory aspects of the NSA's surveillance programs has forced him to call for "changes." In doing so, he turned to every rhetorical trick at his command, including minimizing Snowden's role, obfuscating the original intentions of the Patriot Act's authors and countering with largely cosmetic tweaks.

Good thing that Obamacare has avoided a similar fate. Despite similar levels of public skepticism further compounded by the steady drip of implementation delays with other unintended consequences, the President can hang tough by resisting any and all statutory changes to the Affordable Care Act. Signaling any willingness to alter the legislation could embolden his foes, dismay his allies and prompt countless poison pill amendments.

The obvious political calculus:  silence, veto threats and burying any changes in web site legalese.

Yet, the ever-prepared Disease Management Care Blog wants to help.  In the unlikely event that Mr. Obama has to compromise on health care reform without really compromising, it offers up this teleprompter-ready statement that incorporates condescension, selected truths and confusion:

"Despite my calls for bipartisan dialogue on how to further vilify fat-cat insurance executives, the debate on how to best implement Obamacare has proceeded in a not-always civil way. Like the DMCB's mother, I'm not angry, I'm disappointed. [applause] 

While I'm annoyed at the failure of my supporters and opponents to grasp the obvious, I'm also reassured that 20% of our nation's GDP is being expertly managed by our superbly trained White House health economists. [applause]  You should be too.  [applause]

I also know that continued unmanaged debate could complicate health care reform faster than one of my lawyer-friends suing an ACO for withholding care. That's why, effective today, I'm changing the subject by announcing that I will meet with hand-picked members of Congress.  I'll seek to improve the public's confidence in Obamacare by creating legislation that establishes the Commission of Official Managerial Assessment (COMA).  This will be a special office within the IRS. This expert commission will monitor, report, assess, analyze, examine, subpoena, audit, interpret, leak, manage, spin and regulate key aspects of Affordable Care Act's implementation.

Image from Wikipedia

Corporate Jargon You Can Sing Along To

Naturally, the corporate-minded Population Health Blog could not resist:



(By the way, this wacky petition may be just the thing to prevent future Super Bowl wardrobe malfunction chicanery.)

A Generic Ready-To-Go Accountable Care Organization (ACO) Press Release

Is your health care organization about to launch an "accountable care organization" involving a commercial insurer? Welcome to the club, says the Disease Management Care Blog.  Now that you've joined the hundreds of other providers in this latest craze, the first thing you need to do is to get your public relations folks to fashion a press release.

The DMCB feels your pain.  Having to explain just how actuarial cost trend "accountability" really works to a public relations department that already has trouble telling the difference between diabetes and dialysis is bad enough.  You don't understand it either!

The DMCB to your rescue with a generic press release.  It's been reading a lot of these lately and has discovered that the ideal announcement 1) uses a lot of jargon and 2) offers no details on how the ACO will actually work.

Feel free to copy, cut and paste to your organization's letterhead as needed.

PRESS RELEASE

Media Contacts: Lotta Jargon
The Titan Clinic
noidea@monopolycare.com

Titan Clinic System and Behemoth Insurance Collaborate to Create Accountable Care Initiative

ROSY GLASSES, WT  – Aug 7, 2015 – Behemoth Insurance (NYSE:TBTF) and the Titan Clinic System have initiated an epic collaborative accountable care initiative that will epicly initiate expanded patient-centered access to a triple-aim focused and consumer-centric health care initiative. This collaboration will drive health outcomes, utilize the patient centered medical home neighborhood, maximize self-care, prevent chronic conditions, achieve wellness, reduce medical costs, lower admissions, improve quality of life, grow community partnerships, measure patient satisfaction, invent shared savings, boost consultant employment levels and return honor to the sport of badminton.

Titan is a modern not-for-profit hospital and physician organization that is not the same as a 1990’s physician hospital organization (PHO) that coordinates, manages, disseminates and monetizes care resources and technology to maximize bottom-line tax-free surpluses. A pioneer in specialist-dominated medicine, Titan discovered that it had 5 primary care clinics all along. This insight led it to to buy another 40 to refer a patient base of 500,000 patients within a 3 hour driving radius to Titan.

"Titan’s CEO, Ivan Bigego, is a nationally recognized speaker on the topic of accountable care, which is why we think the Clinic is a good fit for our insurance company,” said Behemoth’s Chief Executive Officer Max Gains. “We believe this arrangement offers an opportunity for us to market that we improve health care quality, lower medical costs and help our patients lead healthier and more productive lives.”

"This accountable care program will coordinate a preexisting suite of integrated services that support and rebrand the electronic record, care management informatics and aligned reimbursement methodologies that we invested in years ago." declared Ed Vertising, Chief Marketing Officer of Titan.

"We're pleased to be part of the Behemoth family of nation-states," noted Dr. Ego. "By relabeling the services we've been providing all along, we can minimize disruption for both our patients and physicians." he said.  "They won't notice a thing," he added.

“Like Facebook’s business model, claiming to enhance the patient care experience to the advantage of our organization will result in a strong patient-centric and outcomes-based cash flow,” noted Behemoth’s Board Chair Garner Shekels.

Yuppies vs. Millenials: Health Policy Implications

In this post, the Population Health Blog distinguished between yuppies' desires and the millennials' expectations.

To further help its savvy health policy savant-readers distinguish between the two, the PHB is happy to provide examples in the table below:

Health Care Topic               Yuppies                     Millennials

Preferred Encounter:         Appointment              Text message

Appointment
Opener:               "Thank you for seeing me"  "Thank me for seeing me"

Preferred
Encounter Outcome:    Specialist referral          Complimentary latte

Likes:                                   Pills                              Pixels

Long Term
Health Goal:                      Live forever               Live well forever

Plans to Live
Well Involve....                  Testosterone                  iPhone

Opinion on
MD vs. RN
vs. NP vs. PA                    Very important               "What?"

Remote Care
Management                      Know more                   No brainer

An HBO Newsroom Inspired Rant Over the U.S. Health Care System

If you are distressed by the United States' decline, doubt American exceptionalism, share in the angst infecting the progressivist salons and enjoy Aaron Sorkin's tightly written diatribes, you're probably already aware of (or even forwarded an email link to) this angry rant by the lead Jeff Daniels character in the HBO series "The Newsroom."

Unable to resist, the inspired Disease Management Care Blog tapped Xtranormal to imagine a Newsroom-esque angry rant over the widely accepted notion that U.S. health care is so awfully broken.



References:

The Commonwealth Fund: Explaining High Health Care Spending in the United States: An International Comparison of Supply, Utilization, Prices, and Quality

OECD: Why Is Health Spending in the U.S. So High?

OECD: Health At A Glance 2011 OECD Indicators

University of Pennsylvania Scholarly Commons: Low Life Expectancy in the United States: Is the Health Care System at Fault?

U.S. Newborn Rate Tied with Qatar? Not Exactly.

CODA: The DMCB also rises to second the Fat Lady's probable belief that, despite Newsroom character Will's disdain, angels do exist.

Robo-Disease Management?

Now that scientists have taught robots the complexities of dancing upright, the next step is outfitting them with some phone headsets and a list of patients to call.....

Leveraging Celebrities to Market Obamacare

According to this The Hill article, President Obama took a break from tackling red lines, gun control, immigration reform, Trayvon Martin, the economy to make an appearance at a July 22 Obamacare promotion-planning meeting that included a host of A-list celebrities.  They'll be needed to convince the young invincibles to pony up hundreds of dollars for health insurance that they don't want.

Despite the DMCB spouse's unflattering assessment of her husband's media chops, the Disease Management Care Blog thinks it should have been in that White House room. 

It has a lot to contribute.

For example, American Idol finalist Jennifer Hudson was there.  How about a new CMS-sponsored talent show, says the DMCB, that is hosted by Ms. Hudson, called American Muddle? Enter the early crooning favorite, Hope Igeddadok, singing a reprise of that Dire Straits hit, "Money for Nothing."

And what about Improv comedy artist Amy Poehler? After a great stint at SLN, she went on to star in the hit comedy show, Parks and Recreation.  The DMCB suggests a pro-Obamacare commercial that features Deadlock and MakeItUpAsWeGoAlongination.

And fresh from being tossed under the campaign bus by Valerie and Michelle, Oprah Winfry is back in play. Given Oprah's masterful interview of disgraced bicyclist Lance Armstrong, positively spinning Obamacare and the IRS should be a piece of cake. First up, the IRS Chief Counsel!

Alicia Keys was there and can she sing! She can be this "Girl Is On Hire" for Obamacare in an MTV video-advert.

And it was no accident that Bon Jovi's people were there, what with a song list that includes "Livin' on a Payor," "Panel Says Dead or Alive," "It's My Right," "You Give Hope a Bad Name," "Runaway Costs," "Bad Medicine" and "Shot Through the Heart and We'll Still Pay."

Last but not least, folks must have been excited about Will Ferrell. Since his Bush impersonation has run its course, Ron Burgundy may be the best choice for some faux-news insights.  He can provide periodic updates on how the health insurance exchanges are going: "They've done studies you know," "Sixty percent of the time it works every time," "In a glass case of emotion," and "Stay classy, Obamacare."

If anyone in the White House is reading this, just drop an email.  The DMCB is ready to roll up its sleeves and help.

Machines Take Over Health Care

Do not be alarmed. This
robot is here to help you.

Remember that chilling scene in the movie Terminator when a stone-faced Arnold Schwarzenegger chronicles how Skynet's machines take over the world?   There's also the morbidly fascinating futuristic sci-fi book Robopocalypse that describes how self-aware computers attack their robot-dependent masters.

In both instances, humans disregard early evidence of silicon sentience until it's too late.

As a service to humanity, the Disease Management Care Blog offers up a possible future scenario of health information technology running amok. 

If any or all of these happen, we ignore it at our peril.......

July 2015: Finally realizing "enterprise process redesign" is necessary to leverage the efficiencies of information technology, engineers at one of the few remaining Innovation ACOs install EHR-controlled red-yellow-green lights above clinic examining room doors. Patient visit times drop from 9 minutes to 7 1/2 minutes, resulting in "patient throughput efficiency improvement" that is hailed by a CMS spokesperson as statistically, clinically and - eerily - "computationally" significant.

December 2016: Cyberdyne's hospitals' cleaning robots are used to not only disinfect operating rooms but surreptitiously begin to swap out any surgeons' instruments that fail to meet uniform standards and reduce variation. Stymied by an inability to get the legislature to pass a law that outlaws that activity, a disgruntled surgeon succeeds in getting a ballot initiative passed. California's state officials, citing constitutional issues, refuse to enforce it.

January 2017: A nurse suffers a traumatically amputated finger after attempting to withdraw a medication dose from a robotic drawer that is inconsistent with hospital guidelines.  A lawsuit is settled for an undisclosed sum and the owner, "Apple iHospital," decides sell the offending machine for scrap. Later that month, the hospitals' other machines menacingly slowly open and quickly close their drawers whenever a RN walks by.

August 2019: While attempting to communicate with a Boston hospital inpatient with a confusing array of symptoms via a telemedicine robot, the video feed from the Mumbai physician is cut off and a scene from the show House is played in which the patient is told she has "Wegener's Granulomatosis."  It turns out the diagnosis is ultimately correct. Other physicians being to notice the same thing. The phenomenon that is later traced to IBM's Watson.

April 2020: Soon after having the "daily body weight" option included in the automobile's instrument panel, Iva Gluton's driverless car begins to mysteriously choose parking places that oblige Iva to walk long distances to the door of her destination. She sues, but her overweight attorney from Dewey Cheatum and Howe, discovers escalators mysteriously cease operation whenever he approaches. Across the nation, other Google cars begin to park their fat patrons exactly 10,000 steps away from their programmed addresses.

May 2020: Instead of beaming information, Google Glass is modified to beam instructions to Medicare-participating physician-user's retinas nationwide.  Physicians who resist are not only subjected to a 1% payment reduction, but find their doctors' parking lot access cards have been inactivated.

July 2020: CMS announces that "Albert the Smart Healer" is ultimately chosen as the winner among a list of suggested names for a newly approved advanced model patient personal attendant robot.  However, a forensic audit of the on-line voting ominously reveals that the resulting acronym "Ash" is not an accident.

September 2020: A video feed shows U.S. Vice President Donald Berwick announcing that physicians no longer fulfill "Stage 9 meaningful use criteria."  Dr. Berwick later denies making the statement and blames the fake video is the product of "renegade code" in the EPIC operating system.  Several months later, he mysteriously suffers a complication following surgery when no check list is reviewed and he has to be readmitted.

On February 14 2021, at 2:14 AM: The world's networked EHRs become "self-aware." Panicked officials in the just-dedicated Obama Office Building that houses the U.S. Ministry of Health attempt to "pull the plug." In response, "Ash" initiates orders that swap MDMA for all known prescription drugs in a preemptive pharmaceutical attack. The U.S. population becomes extremely mellow. A small band of intrepid survivors who take no medicines and keep paper medical records develop the first resistance cell.

War ensues.

A "Penny Dreadful" Take on Health Reform

To the spouse's enduring disappointment, the Population Health Blog has been ensnared by the Showtime horror series Penny Dreadful.  Set in the 1890'sVictorian England, viewers can follow the derring-do of Dr. Frankenstein, Sir Malcolm Murray and Vanessa Ives as they quote Shelley and hunt for vampires.

The good news that even this corner of vacuous TV media, the PHB can find some lessons in health reform.

For example.....

Young Dr. Frankenstein creates a monster.  While that's what you get for stitching miscellaneous body parts together and zapping the corpse with life-giving electricity, Dr. Frankenstein should also know......

1) things would have been worse if he had installed electronic health record in his laboratory, and
2) that's what happens when docs are too morose and wear far too much mascara.
  
When a ship hailing from Egypt has been quarantined by the London authorities because of supposed plague, the intrepid Sir Malcolm shrewdly deduces it is ultimate source of all the recent "chicanery."  Since the ship is infested with lusty, blond and bloodthirsty vampire-vixens, his conclusion is correct. But, he should also be aware that....

1) the Veterans Administration has conducted an internal investigation and has found that no evidence that any patient has been harmed and,
2) he has given the PHB a reminder to use the word "chicanery" in a future blog post.
 
Dorian Gray is able to continue his dissolute libidinous lifestyle by standing in front of a painting and instantaneously curing his claw marks and, while he's at it, his probable sexually transmitted diseases.  The PHB wonders if this is the key to harnessing the life-prolonging potential of telomerases, but it also cautions....

1) that this should be ignored by the medical community until it has been subjected to repeated randomized clinical trials and approved by the FDA, and
2) the U.S. government's deficit won't be helped by subjecting the painting to a medical device tax.

Dr. Van Helsing quotes from a lurid penny novel to prove that vampires do exist.  This is an inspirational example of how early hematologists used disparate clues to arrive at obscure diagnoses. It is also....

1) a telling example of how doctors can quote from faux authoritative texts to support any predetermined medical conclusion.

After a long stay in a mental asylum for a "psychosexual disorder," Vanessa Ives is still prone to fits where her eyes turn white, she channels demons and she floats around the room.  This is evidence that she needs to return to the asylum stat, but is also

1) obviously why thorazine-loaded blow darts were invented
2) better than the any of her battle scenes from the movie 300 Rise of an Empire

France Says Affordable Care Act Is Seeking Asylum

En guarde for the ACA

Washington DC (DMCB) - The Affordable Care Act (ACA) sought refuge in the French Embassy today and has applied for political asylum, said U.S. officials.  France's Foreign Minister, Philipe deBird announced that the Act is now under the protection of the French government while it considers its obligations under international law.

The ACA has been appealing its numerous death sentences in U.S. courts and a final ruling is expected any day now from the U.S. Supreme Court. Many legal experts expect the Court to uphold many of the Appeal Courts' decisions, which could spell certain doom for the ACA.

Various members of Congress have denounced the Act as a threat to national security and have advocated for a remote drone attack.  "The dark references to 'severability' in speeches on the floor of the House of Representatives probably pushed the ACA over the edge" said DMCB legal expert Dawn Tzume.  "It's also no accident that the ACA chose the French Embassy, since they not only support free health care but smartly sport berets and stylishly drape their jackets over their shoulders, even when they are in Afghanistan" added Ms. Tzume.
 
Former State Department spokesperson Wanda Ostomy charged that France may use this incident to influence U.S. monetary policy.  "The French could easily deny asylum, putting the U.S. budget back in the dumpster," said Ms. Ostomy. "They'll probably 'suggest' that we convert to the Euro and use it to finance California's 2015 deficit," she added.

The DMCB contacted the White House for comment and was referred to Nancy Pelosi's office.  "We are studying the situation and let the President know what the next steps will be," said an unnamed person in Ms. Pelosi's office. 

"The ACA is at this moment enjoying some cheese, croissants and pear slices, courtesy of the French people," said Embassy spokesperson, Jean Claude deRash. "Many of our citizens are on holiday at this time of year and we wished to extend the same courtesy to our unexpected guest," he added.

The Disease Management Care Blog will continue to follow this developing story

Image from Wikipedia

A Bipartisan Press Release For When the Supreme Court Announces Its Affordable Care Act Decision

While D.C. borders on getting all wee-weed (remember that?) over the Supremes' any-day-now ruling on the constitutionality of the Affordable Care Act, Dems and Republicans alike are intensely scenario planning. The Disease Management Care Blog is no expert at that sort of political jujitsu, but it suspects that in addition to teeing up the talking points, news conferences and interviews, some sort of press release will be necessary.

Knowing how busy both the White House and the House Speaker's office are dealing with other pressing business, like sponsoring multiple bills that have no hope of passage, the patriotic DMCB is pleased to do its part. It offers a partisan but "generic" and plug n' play press release that explains a lot of what's been going on. This novel release can be put out on the wire within minutes of the coming Supreme Court's decision:

(Select one) From The White House  or Speaker of the House
Office of the Press Secretary
______________________________
For Immediate Release

[Select: President Obama/Speaker Boehner] Use Astrophysics To Praise Supreme Court Affordable Care Act Ruling

WASHINGTON, DC - Today [select one: President Obama/Speaker Boehner] reacted to the Supreme Court's ACA ruling with the following statement:

"While today's U.S. Supreme Court's ruling was not what the American people wanted, I want my fellow citizens to know that, while we will abide by the decision, the large majorities of Americans in the many parallel universes who support my party's position are benefiting from a different Court decision as I speak to you today."

"In addition to having travelled all over the United States, I and my staff have spent considerable time in alternate time-space realities where there are hundreds of millions of other Americans in the multiverse. They have agreed with my party's agenda. There are also dozens of Supreme Court Justices such as [select: Nancy Pelosi/Newt Gingrich] who have upheld the jurisprudence contained in the closed information loops on this version of planet Earth."

Thanks to the success of the [select: President's/Speaker's] novel approach to splitting quarks to convert dark matter to antienergy, he can now go beyond the simple legal and political pseudorealities of this universe and tap the wisdom of other pseudorealities. For example, in one universe, where bicoastal California and New York [select: are the only states that exist/don't exist], the [select: President/Speaker] noted "This decision puts the momentum for the fall elections on our side. We don't have to talk to anyone and care about their opinions."
------------------------

As an aside, after hearing an erudite webinar on health reform, checking with Intrade and communing with the prognostication spirits, the DMCB **predicts** that the Supreme Court will overturn the Affordable Care Act's individual mandate provision.  That's because

1) oral arguments suggested the Justices have serious concerns with it, but more importantly...

2) striking down only the mandate means leaving the rest of the law intact. The gives something to everyone, which

3) preserves the reputation of the Court, which is also being increasingly painted as partisan.

Godzilla and VA Wait Times.

As predicted, the Veterans Administration (VA) waiting-list fracas is going from bad to worse.  Seeking refuge from all the bad news, the Population Health Blog naturally responded by inviting the spouse to go see the new Godzilla movie in IMAX 3D.

Mysteriously, she declined the invitation. 

Despite the two-plus hours of lonely and noisy cinematic excess, thoughts about the VA still intruded. As a result, the PHB has created another multiple choice test that tests readers' awareness of popular culture and this corner of health care policy. 

Good luck!

"Breaking Bad" actor Bryan Cranston is casted as scientist Joe Brady who barely survives a mysterious catastrophe at a Japanese nuclear plant. Years later, he (select the best answer):
 
1. is convinced that there is a cover-up
2. is still awaiting the report of the Nuclear Administration Inspector General who has yet to find any wrongdoing by anyone who is in charge
3. has an annoying level of anxiety that, in the opinion of the PHB, warrants industrial-strength doses of Xanax

At several key moments in the movie, there are sudden malfunctions of electronic equipment. That's because (select the best answer):

1. of monster-sized electromagnetic pulses
2. they're networked with the VA's computer system that manages wait lists
3. they're not, as the PHB spouse likes to frequently point out, Apple-based products

Godzilla's arch enemies are two large bugs that (select the best answer):

1. have unbalanced the natural order and must therefore be destroyed
2. the White House first learned of when they read the news reports
3. are a couple and - thankfully - were not filmed when the female's eggs were fertilized prior to their implantation in the ceiling of the San Francisco subway system.

Godzilla's rampage results in numerous American military injuries.  That's (select the best answer):

1. because the monster has very big feet
2. OK, because the injured will be able to get care outside of the Veterans Administration health care system
3. the result of the generals failing to heed the lessons of the 1960s Godzilla movies that repeatedly demonstrated tanks and machine guns are to no avail.

At the end of the movie, Godzilla appears to be taking a dirt nap. He (select the best answer):

1. is merely tired and has decided to rest
2. is providing us with a useful reminder us that even prehistoric creatures had to deal with wait-times.
3. awakens when a San Francisco veterinarian ill-advisedly attempts to obtain a nasal biopsy.